Download Common Gut Problems

Core of Self
Common Gut Problems
GIT Two
The Gastrointestinal Tract &
the Core of Self
2
CNS/
Brain
ANS
ANS
Immune
Enteric
Nervous System
Afferent and
Efferent
Endocrine
Oesophagus
Liver
Pancreas
Gallbladder
Stomach
Small Intestine
Large Intestine
Appendix
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Rectum
2/02/15
MIND OF THE GUT;
THE EFFERENT & AFFERENT NERVOUS
SYSTEMS, THE VAGAL SYSTEM & THE
MICROBIOME
3
Brains
4
—  In mammals there exist two brains of almost equal importance to
the individual. One is the cranial brain, the instrument of volitions,
of mental progress and physical protection. The other is the
abdominal brain, the instrument of vascular and visceral function.
It is the automatic, vegetative, the subconscious brain of physical
existence. In the cranial brain resides the consciousness of right
and wrong. Here is the seat of all progress, mental and moral . . .
—  However, in the abdomen there exists a brain of wonderful power
maintaining eternal, restless vigilance over its viscera. It presides
over organic life. It dominates the rhythmical function of
viscera. . . . The abdominal brain is a receiver, a reorganiser, an
emitter of nerve forces. It has the power of a brain. It is a reflex
centre in health and disease. . . . (Robinson, 1907, pp. 123-126).
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•  For Robinson, the abdominal brain
is centred in the solar plexus (Fig.
1). The abdominal brain is the
primary control center of an
extensive peripheral nervous
system containing a number of
"little brains." Anatomically, this
peripheral system is roughly
equivalent to the autonomic
nervous system.
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5
2/02/15
Gut-Brain Trade-off
6
More effective nutrient gathering
Higher Diet
Quality
Cooking reduces bulk
and creates greater
nutritional assimilation
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Increased Energy
Availability
Smaller Gut
Larger
Brain
Increased efficiency:
5% used in assimilation
2/02/15
Gut-Brain Axis
7
—  Communications along the brain-gut axis (GBA) involve
neural pathways as well as immune and endocrine
mechanisms. The two branches of the autonomic nervous
system are integrated anatomically and functionally with
visceral sensory pathways, and are responsible for the
homeostatic regulation of gut function.
—  The autonomic nervous system is also a major mediator of
the visceral response to central influences such as
psychological stress and other central factors.
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Mind in the Belly
8
—  We speak of gut reactions and the truth of the ‘instinctive’
response; this ‘feeling response’ is directly related to our
enteric (ENS) and vagal (VNS) nervous systems and, the
ancient and primordial response to attack and danger.
—  Our gut feeling is an important component in the personal
self, to knowing one self.
—  The ENS is of special interest because it is the only
substantial grouping of neurons outside the central nervous
system that form circuits capable of autonomous reflex
activity.
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Microbiota-Brain-Nervous System
Interactions
9
—  The gut–brain axis (GBA) is a bi-
directional communication system
through which the brain modulates
gastrointestinal function and
through which gut function is
monitored by the brain.
—  Neural, endocrine and
immunological mechanisms underlie
gut–brain interactions (Bienenstock
& Collins, 2010).
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Bowel and Behaviour
10
—  The enteric microbiota interacts with the host to form
essential relationships that govern homeostasis. Despite the
unique enteric bacterial fingerprint of each individual,
there appears to be a certain balance that confers health
benefits.
—  A decrease in the desirable gastrointestinal bacteria will
lead to deterioration in gastrointestinal, neuroendocrine or
immune relationships and ultimately disease.
—  Specific modulation of the enteric microbiota may be a
useful strategy for stress-related disorders and for
modulating the co-morbid aspects of GI disorders such as
IBS and IBD (2011, doi:10.1111/j.1365-2982.2010.01664.x).
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Bowel and Behaviour
11
—  Collins et al., (2012) have described the recent advances in
the understanding of how the intestinal microbiota
communicates with the brain via the gut-brain axis (GBA)
to influence brain development and behaviour.
—  They also reviewed how this extended communication
system might influence a broad spectrum of diseases,
including irritable bowel syndrome, psychiatric disorders
and demyelinating conditions such as multiple sclerosis
(doi: 10.1038/nrmicro2876).
—  Microbial-based therapeutic strategies to aid in the
treatment of mood disorders was studied by Forsythe &
Kunze (2013, doi: 10.1007/s00018-012-1028-z).
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GBA
12
—  The GBA has been implicated in primary psychiatric and in
functional and inflammatory gastrointestinal (GI) diseases.
Psychiatric co-morbidity occurs in up to 60% of these GI
disorders (Whitehead et al, 2002).
—  The brain is aware of the introduction of pathogenic
microbes into the gastrointestinal tract. This results in
brain stem nuclei becoming activated and, in some
instances, associated with the development of anxiety-like
behaviour (Lyte et al, 2006).
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GBA
13
—  The ENS is an extensive network of neurons widely
dispersed throughout the gut that coordinate to regulate
gastrointestinal events such as peristalsis, blood flow,
secretion, and absorption (Costa and Brookes, 1994). The
ENS can influence the CNS both through nerve reflexes and
the pro­duction of neuropeptides.
—  It is estimated that 80% of vagal fibres are visceral afferents
(Davenport, 1978). Recent work has also shown a vast
overlap of neuropeptide activity in the gut and the brain
(Pert et al., 1985). The ENS is an active area in physiologic
research with more than 1000 articles on MEDLINE since
1985.
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ENS
14
—  The Enteric Nervous System (ENS) is present in all
vertebrates, has these functions: to regulate the normal
activity of the digestive system and prepare it for whatever
its future may hold: our "Gut Reaction”, which is the
feedback loop to the CNS.
—  Many of its structures and chemicals parallel those of the
CNS. It has sensory and motor neurons, information
processing circuits, and the glial cells. It uses the major
neurotransmitters: dopamine, serotonin, acetylcholine,
nitric oxide and norepinephrine. It even has
benzodiazepines, chemicals of the family of psychoactive
drugs that includes Valium and Xanax.
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ENS
15
—  When the brain signals danger, it activates mast cells in the
lining of the small intestine and/or colon to release
histamine and other chemicals.
—  These chemicals trigger an inflammatory response inside
the GIT, attracting immune cells from the bloodstream into
the area and the body is ready for trauma. But when this
inflammatory response gets out of control one may develop
IBS, IBD, reflux, ulcers, 'leaky gut' and even cancer.
—  Cytokines can and do pass through the BBB and induce
‘anxiety-like’ feelings
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ENS
16
•  The enteric nervous system (ENS) exerts a
profound influence on all digestive
processes, namely motility, ion transport
associated with secretion and absorption,
and gastrointestinal blood flow.
•  Some of this control emanates
from connections between the
digestive system and central nervous
system, but the digestive system is
endowed with its own, local nervous
system (Bowen 2006).
•  The ENS is capable of autonomous
functions such as the coordination of
reflexes (Dorland's n.d.).
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Vagus nerves
Preganglionic sympathetic
Postganglionic sympathetic
Preganglionic parasympathetic
Postganglionic parasympathetic
Intrinsic enteric neurons
Afferents
Sympathetic chain
T1
T2
T3
T4
T5
T6
T7
T8
T9
T10
T11
T12
L1
L2
S2
S3
S4
Vagus nerves
Splanchnic
nerves
Celiac or superior
mesenteric ganglia
Celiac ganglion
Mesenteric nerves
following blood
vessels
Superior
mesenteric
ganglion
Inferior
mesenteric
ganglion
Mesentery
Pelvic nerves
Serosa
Longitudinal muscle
Myenteric plexus
Circular muscle
Submucous plexus
Muscularis mucosae
Mucosa
2/02/15
ENS
17
—  Evidence is accumulating to suggest that gut microbes
(microbiota) may be involved in neural development and
function, both peripherally in the enteric nervous system
and centrally in the brain. There is an increasing and
intense current interest in the role that gut bacteria play in
maintaining the health of the host.
—  There are rapidly coalescing clusters of evidence which
point to the possibility that variations in the composition of
gut microbes may be associated with changes in the normal
functioning of the nervous system (Forsythe et al, 2010).
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Peristalsis
18
—  Peristalsis is a manifestation of two major reflexes within the
enteric nervous system that are stimulated by a bolus of
foodstuff in the lumen. Mechanical distension and perhaps
mucosal irritation stimulate afferent enteric neurons. These
sensory neurons synapse with two sets of cholinergic
interneurons, which lead to two distinct effects:
—  One group of interneurons activates excitatory motor neurons
above the bolus - these neurons, which contain acetylcholine
and substance P, stimulate contraction of smooth muscle
above the bolus.
—  Another group of interneurons activates inhibitory motor
neurons that stimulate relaxation of smooth muscle below the
bolus. These inhibitor neurons appear to use nitric oxide,
vasoactive intestinal peptide and ATP as neurotransmitters.
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Afferent & Efferent
19
—  The gastrointestinal tract is in two way communication
with the CNS. Afferent neurons convey information about
the state of the gastrointestinal tract. Some of this reaches
consciousness, including pain and discomfort from the gut
and the conscious feelings of hunger and satiety, which are
integrated perceptions derived from the gastrointestinal
tract and other signals (blood glucose, for example).
—  Other afferent signals, concerning, for example, the
nutrient load in the small intestine, or the acidity of the
stomach, do not normally reach consciousness. In turn, the
CNS provides signals to control the intestine, which are, in
most cases, relayed through the ENS.
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ENS
20
—  The ENS is an extensive network of neurons widely
dispersed throughout the gut that coordinate to regulate
gastrointestinal events such as peristalsis, blood flow,
secretion, and absorption (Costa and Brookes, 1994). The
ENS can influence the CNS both through nerve reflexes and
the pro­duction of neuropeptides.
—  It is estimated that 80% of vagal fibres are visceral afferents
(Davenport, 1978). Recent work has also shown a vast
overlap of neuropeptide activity in the gut and the brain
(Pert et al., 1985). The ENS is an active area in physiologic
research with more than 600 articles on MEDLINE since
1985.
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Vagal Nervous System
21
—  Stimuli that are interpreted by the brain as extreme or
threatening, regardless of their modality, elicit an
immediate stereotypic response characterised by enhanced
cognition, affective immobility, vigilance, autonomic
arousal and a global catabolic state.
—  The brain differentially activates a subset of vagal and
sacral parasympathetic efferents that mediate the gut
responses to stress (Habib et al. 2001).
—  The vagal nerve also activates heart rate, respiration,
epigastric motility and expression.
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Vagal Nervous System
22
—  The VNS affects heart rate, digestion,
Vagus Nerve (X): Schema
respiration rate, salivation,
perspiration, and diameter of the pupils,
micturition, and sexual arousal.
—  Whereas most of its actions are
involuntary, some, such as
breathing, work in tandem with the
conscious mind.
Posterior nucleus of vagus
nerve (parasympathetic
and visceral afferent)
Glossopharyngeal nerve (IX)
Solitary tract nucleus (visceral
afferents including taste)
Meningeal branch of vagus nerve
Auricular branch of vagus nerve
Spinal tract and spinal
nucleus of trigeminal nerve
(somatic afferent)
Auditory (pharyngotympanic, Eustachian) tube
Levator veli
palatini muscle
Nucleus ambiguus
(motor to pharyngeal
and laryngeal muscles)
Salpingopharyngeus
muscle
Cranial root of
accessory nerve*
(see next plate)
Palatoglossus muscle
Vagus nerve (X)
Palatopharyngeus
muscle
Jugular foramen
Superior pharyngeal
constrictor muscle
Superior ganglion of vagus nerve
Inferior ganglion of vagus nerve
Stylopharyngeus muscle
Middle pharyngeal constrictor muscle
Inferior pharyngeal constrictor muscle
Cricothyroid muscle
Trachea
Esophagus
Right subclavian artery
Right recurrent laryngeal nerve
Heart
Hepatic branch of anterior
vagal trunk (in lesser omentum)
Celiac branches from anterior
and posterior vagal trunks
to celiac plexus
Pharyngeal branch of vagus nerve (motor to muscles of
palate and pharynx; sensory to lower pharynx)
Communicating branch of vagus nerve to
carotid branch of glossopharyngeal nerve
Pharyngeal plexus
Superior laryngeal nerve:
Internal branch (sensory and parasympathetic)
External branch (motor to cricothyroid muscle)
Superior cervical cardiac branch of vagus nerve
Inferior cervical cardiac branch of vagus nerve
Thoracic cardiac branch of vagus nerve
Left recurrent laryngeal nerve (motor to muscles of larynx
except cricothyroid; sensory and parasympathetic to
larynx below vocal folds; parasympathetic, efferent, and
afferent to upper esophagus and trachea)
Celiac and superior mesenteric
ganglia and celiac plexus
Pulmonary plexus
Cardiac plexus
Hepatic plexus
Esophageal plexus
Gallbladder
and bile ducts
Anterior vagal trunk
Liver
Gastric branches of anterior vagal trunk
(branches from posterior trunk behind stomach)
Pyloric branch
from hepatic plexus
Vagal fibers (parasympathetic motor,
secretomotor, and afferent fibers) accompany
superior mesenteric artery and its branches
usually as far as left colic (splenic) flexure
Pancreas
Duodenum
Small intestine
Ascending colon
Efferent fibers
Cecum
Afferent fibers
Appendix
Parasympathetic fibers
© Elsevier, Inc. - Netterimages.com
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Vagus
23
—  The vagus nerve, also known as the tenth cranial nerve. In Latin,
'vagus' means 'wandering', and the nerve was so named due to its
meandering and multi-branched route through the body; it
originates at the brain stem and travels through the chest where
it spreads out in multiple directions to innervate organs in the
neck, thorax and abdomen, effectively connecting your brain to
your lungs, digestive tract and, most notably, your heart.
—  The vagus assists the adrenal glands during 'fight or flight'
situations by stimulating the release of epinephrine in the brain.
It is the vagus nerve which activates the PNS to calm the body
after the perceived danger has passed, slowing the heart rate so
that normal bodily functions, such as digestion, can resume.
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Vagal Nervous System
24
—  It traditionally has been divided by subsystems, the
parasympathetic nervous system and sympathetic nervous
system and more recently the vagus and enteric systems.
—  Porges (1995) has shown clear evidence that the third, more
modern branch of the ANS; the vagus nerve is a survival
value specific to more sophisticated animals especially
primates. “Social Nervous System” is the proposed term for
this third branch of the ANS
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Vagal Tone
25
—  Vagal tone is proposed as a novel index of stress
vulnerability and reactivity with applications in all branches
of medicine and measurement of cardiac vagal tone is a
method to assess on an individual basis both the stress
response and the vulnerability to stress (Porges 1992).
—  Cardiac vagal tone is proposed as a novel index of stress
and stress vulnerability in mammals (Porges 1995).
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Vagal Tone
26
—  Vagal tone (VT), an index of autonomic flexibility, is linked
to social and psychological well-being. The association
between VT and well-being reflects an "upward spiral" in
which autonomic flexibility, represented by VT, facilitates
capitalising on social and emotional opportunities and the
resulting opportunistic gains, in turn, lead to higher VT.
—  Adults who possessed higher initial levels of VT increased
in connectedness and positive emotions more rapidly than
others. Furthermore, increases in connectedness and
positive emotions predicted increases in VT, independent of
initial VT level (Kok & Fredrickson, 2010).
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Vagal Tone
27
—  Psychophysiology emphasises a continuity between neuro-
physiological and psychological processing. Psychophysiologists assume that the nervous system provides the
functional units for the bidirectional transduction of
psychological and physiological processes.
—  Thus, from a psychophysiological perspective, it is possible
to link psychological processes with neuro-physiological
processes and brain structures (Porges 1995).
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Vagal Tone
28
—  The mammalian vagus is neuroanatomically linked to the
cranial nerves that regulate social engagement via facial
expression and vocalization.
—  As the autonomic nervous system changed through the
process of evolution, so did the interplay between the
autonomic nervous system and the other physiological
systems that respond to stress, including the cortex, the
HPA axis, the neuropeptides of oxytocin and vasopressin,
and the immune system (Porges 2001).
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Sensory
System:
Afferent
Others Impact on us
Parasympathetic
Regulatory
Functions:
“Vagal Brake”
Heart
Cardiac Regulation, Heart Rate &
Blood Pressure
Lungs
Respiratory Regulation
Middle Ear
Isolating Human Voices
Pharynx & Larynx
Speaking & Swallowing
Oesophagus, Stomach & Intestines
Feelings of Hunger & Satiation; Craving
Swallowing & Digestion
Motility/Peristalsis
Kidney, Gallbladder, Pancreas, Liver
From: Cozolino 2006
29
Motor
System:
Efferent
Impact on Others
Vagal Tone
Higher Vagal Tone
Lower Vagal Tone
—  Self Regulation
—  Irritability
—  Self Soothing
—  Behavioural Problems
—  Control of Emotions (not
—  Emotional Dysregulation
suppression)
—  Reliable Autonomic Response
—  Suppression of Heart Rate
—  Enhanced Attention
—  Positive Social response
—  Increased Behavioural
Engagement
—  Consistent Caretaking/ Secure
Attachment
30
—  Distractibility
—  Hyper-reactivity to
Environmental & Visceral
Stimuli
—  Withdrawal
—  Poor Impulse Control
—  Insecure Attachment
From: Cozolino 2006
2/02/15
Polyvagal Theory & Social Nervous System
31
—  The mammalian vagus is neuroanatomically linked to the
cranial nerves that regulate social engagement via facial
expression and vocalisation. The Polyvagal Theory provides
neurobiological explanations for two dimensions of intimacy:
courting and the establishment of enduring pair-bonds.
—  The establishment of enduring pair-bonds is dependent upon
a co-opting of the visceral vagus from an immobilisation
system associated with fear and avoidance to an
immobilisation system associated with safety and trust.
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Polyvagal Theory & Social Nervous System
32
—  The theory proposes that the phylogenetic development of the
mammalian vagus is paralleled by a specialised
communication, via oxytocin and vasopressin, between the
hypothalamus and the medullary source nuclei of the visceral
vagus.
—  The third stage, unique to mammals, is characterised by a
myelinated vagus that can rapidly regulate cardiac output to
foster engagement and disengagement with the environment
(Porges 1998).
—  The fear of intimacy, fear of bonding = IBS
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“Insult”
Social Nervous
System
Behavioural/Psychological
Outcomes
Social
Communication
& Regulation
Hyper-arousal
Hyper-vigilance
Hypertension
Gut Problems
Anxiety Disorders
Mobilisation
Hypotension
Vasovagal Syncope
Fibromyalgia
Immobilisation
Avoidant Social
Withdrawal
Affect Limitations
Self-Medication
From: Porges 2003
33
Dissociative States
Suicide Risk
Cardiac Vagal Tone
34
—  Infants with higher baseline cardiac vagal tone were rated
in the laboratory as showing fewer negative behaviours and
were less disrupted by the experimental procedure.
—  Infants who were able to decrease cardiac vagal tone during
the laboratory assessment were rated on maternal report
temperament scales as having longer attention spans, and
being more easily soothed (Huffman et al, 1998).
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Vagal Tone
35
—  There have been a growing number of reports
demonstrating disordered autonomic function in subgroups
of functional bowel patients (Jorgensen et al, 1993). While a
number of different methods were used to assess
autonomic function, they generally point to decreased vagal
(parasympathetic) outflow or increased sympathetic
activity in conditions usually associated with slow or
decreased gastrointestinal motility.
—  Under certain conditions, altered autonomic balance
(including low vagal tone and increased sympathetic
activity) may also alter visceral perception (Kamath et al,
1993).
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Vagal Tone & Acupuncture
36
—  Acupuncture-induced balance of the autonomic nervous
system activities is one of its key mechanisms. 1) regulating
cardiac sympathetic-beta-adrenergic receptor activity and
myocardial intracellular GTP-binding protein (Gs)adenylylcyclase (AC)-cyclic adenosine monophosphate
(cAMP)-protein kinase (PKA) signalling, and 2) balancing
cardiac sympathetic and vagal nerve activities (
http://www.ncbi.nlm.nih.gov/pubmed/24684118).
—  Acupuncture may be effective in patients with functional
gastrointestinal (GI) disorders because of its effects on GI
motility and visceral pain (2013, doi: 10.1016/
B978-0-12-411545-3.00014-6).
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Vagal Tone & Acupuncture
37
—  An analysis by da Silva & Dorsher (2014) demonstrated
marked correspondences of the indications for those lateral
head and neck acupoints to the clinical effects (beneficial
and adverse) documented for the VNS device in the medical
literature.
—  This clinical correspondence, in conjunction with the
anatomic proximity of the acupoints to the vagus nerve in
the lateral neck, strongly suggests that vagus nerve (and
hence the autonomic nervous system) stimulation is
fundamental in producing the clinical effects of the
acupoints (doi: 10.1089/acm.2012.1022).
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Vagal Tone & Acupuncture
38
—  The effect of auricular acupuncture (AA) applied to the
"Shenmen" and "Point Zero" points on the postoperative
heart rate variability (HRV) was studied by Arai et al.,
(2013, doi: 10.1155/2013/945063).
—  AA kept the low frequency (LF)/high frequency (HF) ratio
at lower levels and HF at higher levels during postoperative
period in the patients who had undergone hemicolectomy.
—  They concluded AA is a diagnostic and treatment system
based on normalising the body's dysfunction, and has been
applied for pain relief, relaxation. These techniques would
modulate the autonomic nerve system
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Vagal Tone & Acupuncture
39
—  Acupuncture manipulation significantly decreased low
frequency components (LF) of both HR variability (HRV)
and systolic blood pressure (SBP).
—  Changes in HF (index of parasympathetic activity) and total
power (overall activity of the autonomic nervous system) of
HRV were positively correlated.
—  ANS changes induced by manipulation inducing specific
acupuncture sensations might be mediated through the
central nervous system, especially through the forebrain as
shown in EEG changes, and are beneficial to relieve chronic
pain by inhibiting sympathetic nervous activity (Auton
Neurosci. 2007 May 30;133-2).
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2/02/15
Darwinian Perspective
40
—  Ethanol and caffeine are two of the oldest human drugs.
Their pervasive integration into the modern human diet
may reflect behavioural attempts to correct maladaptation
induced by evolutionary displacement of the autonomic
system.
—  Caffeine effectively exploits a pre-existing association
between adrenergic activity and cognitive readiness.
Ethanol may have emerged as a dietary means to buffer the
maladaptive chronic sympathetic activation and fear
response associated with stressful lifestyles and the social
phobias associated with the dissolution of kin networks
(Med Hypotheses. 2007;68(1):31-6).
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G.I. Disorders
Weakens
Liver Qi
Stagnation
Stomach &
Spleen
Qi Xu
Encourages
Blood Xu
Stress
Generates
Heat
Blood
Stasis
Yin Xu
Generates
Damp
Phlegm
Damp
Diet
Antibiotics
Damp Heat
41
2/02/15
The Gut and its Function
42
—  The average adult human is, in essence, a 10-meter-long
tube. The inner lining of this tube—the gut—absorbs
nutrients and defends against would-be pathogens, yet the
number of microorganisms it accepts and even embraces is
higher than the number of cells making up our entire body.
—  Its tissues are wreathed in sensory cells and awash in
hormones relaying information back and forth. What goes
on within the gut is still largely mysterious, and in this issue
we explore some of its most interesting secrets (Simpson et
al, 2005).
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2/02/15
Gut & Immunity
43
—  Eighty percent of the human immune system resides in the
gastrointestinal tract. Alongside it are the trillions of
symbiotic bacteria, fungi and other single-celled organisms
that make up our guts’ microbiomes.
—  Normally everyone wins: The microorganisms benefit from
a home and a steady food supply; we enjoy the essential
assistance they provide in various metabolic and digestive
functions.
—  Our microbiomes also help calibrate our immune systems,
so our bodies recognise which co-inhabitants should be
there and which should not (Scientific American, Oct 8
2014).
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2/02/15
Gut & Immunity
44
—  The gut represents a unique dilemma for the immune
system. It has the largest surface of the body harbouring
numerous species of microorganisms. T helper and
cytotoxic T cells obtain their antigen experience in the gut
associated lymphatics after migration from the thymus.
—  Evidence suggests a CD8 positive T cell that directly
migrates to the intestinal epithelium increasing the role of
the thymus in shaping intestinal immunity (2005 doi:
10.1136/gut.2005.087288)
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2/02/15
Gut & Immunity
45
—  The thymus is the major primary immune tissue for the
production of functional T lymphocytes in vertebrates.
However, its evolutionary origin is unknown. It has recently
been shown that the generation of local T cells also occurs
in gut-associated lymphoid tissues (GALT). This suggests
that the thymus and GALT have similar functions and that
they might be evolutionarily related.
—  The thymus may have evolved from mucosa-associated
lymphoid tissues (MALT) (Matsunaga T & Rahman, 2001)
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2/02/15
Gut & Stress
46
—  Certain exteroceptive stressful life events have been
associated with the onset or symptom exacerbation in some
of the most common chronic disorders of the digestive
system, including functional gastrointestinal disorders
(FGD), inflammatory bowel disease (IBD), gastrooesophageal reflux disease (GORD), and peptic ulcer
disease (PUD).
—  Early life stress in the form of abuse plays a major role in
the susceptibility of individuals to develop functional as
well as IBD later in life (Mayer, 2000).
[email protected]
2/02/15
Gut & Stress
47
—  IBS is characterised by an over-activation of the HPA axis
and a proinflammatory cytokine increase (Dinan et al,
2000).
—  Low HPA axis and locus ceruleus–norepinephrine (LC/NE)
activity, fatigue, depressive symptomatology, hyperalgesia
and increased immune/inflammatory responses to stimuli
are pathophysiologic effects of the dysregulation of the
stress response, which may result in vulnerability to several
disease entities, such as anxiety or depression and chronic
inflammatory processes including GI function (Tsigos &
Chrousos 2002).
[email protected]
2/02/15
Gut & Stress
48
—  Levels of stress, gynaecological events, bowel, and
psychological symptoms in Chinese women of reproductive
age who experienced both diarrhoea-predominant irritable
bowel syndrome (D-IBS) and premenstrual syndrome were
studied.
—  The results revealed that compared to D-IBS patients, the
patients in the overlapping syndromes group had increased
stress and gynaecological events and more severe bowel
and psychological symptoms. Overlapping syndromes were
associated with repeated episodes of longer duration and
delayed recovery (2014, doi: 10.1097/SGA.
0000000000000067).
[email protected]
2/02/15
FGID
49
—  The clinical definition of FGID corresponds
to how these patients present, it has
proved difficult to apply in the search for
the pathophysiological factor(s) potentially involved in
these conditions.
—  While much remains to be done in that regard, it is
increasingly accepted that these conditions are
multifactorial, and that the symptoms experienced by two
individual patients, although somewhat similar, may in fact
result from a number of different aetiologies (Tougas G Gut
2000;47:iv78-iv80).
[email protected]
2/02/15
FGID
50
—  In recent years, we have undergone a substantial shift in our
conceptual definitions of what constitutes functional bowel
disorders and IBS. In general, we now view these conditions
as a group of disorders or clinical entities characterised by
the presence of, to a varying degree, chronic pain, discomfort,
and disordered gastrointestinal function. functional disorders
must to some extent involve the brain as well as the gut.
—  Secondly, if visceral factors such as an infectious event in the
gut affect the cortical response to visceral stimuli, and if
conversely, psychological events can alter the function of the
gut, gut-brain and brain-gut communication must be one of
the important modulators involved
[email protected]
2/02/15
FGID
51
—  Functional gastrointestinal disorders (FGIDs) can affect
any part of the gastrointestinal (GI) tract, including the
oesophagus, stomach and intestines. They are disorders of
function, not structural or biochemical abnormalities. As a
result, x-rays, blood tests and endoscopies can show
essentially normal results.
—  FGIDs are also not psychiatric disorders, although stress
and psychological difficulties can make FGID symptoms
worse.
[email protected]
2/02/15
Three Primary Features of FGID
52
—  Motility is the muscular activity of the GI tract. Normal
peristalsis is an orderly sequence of muscular contractions
from the top to the bottom. In FGIDs, the motility is
abnormal - there can be muscular spasms that can cause
pain, and the contractions can be very rapid (fast motility is
diarrhoea) or very slow (slow motility is constipation).
—  Sensation is how the nerves of the GI tract respond to
stimuli (for example, digesting a meal). In FGIDs, the
nerves are sometimes so sensitive that even normal
contractions can bring on pain or discomfort.
[email protected]
2/02/15
Three Primary Features of FGID
53
—  Brain-gut dysfunction relates to the disharmony in the
way the brain and GI system communicate. With FGIDs,
the regulatory conduit between the brain and gut function
may be impaired and this can lead to increased pain and
bowel difficulties which can be worsened by stress.
—  There is evidence that a brain to gut pathway may account
for GI symptoms in some FGIDs, but other evidence points
to the gut being the primary driver of symptoms via the gut
to brain connections through cytokines.
[email protected]
2/02/15
Biopsychosocial Model of FGID
54
—  The biopsychosocial model of
FGID supports the concept that
early life events, such as genetic
and environmental factors, play
an important role in increasing
susceptibility to gut
dysfunction, including the
development of visceral
hypersensitivity.
[email protected]
2/02/15
FGID
55
—  Koloski et al., (2012) found a FGID diagnosis at baseline to
be significantly associated with higher levels of anxiety and
depression.
—  FGIDs in the community are chronic and while there is a
waxing and waning of symptoms they do not usually
disappear on their own. Second, in the FGIDs, including
IBS and functional dyspepsia, the hypothesis that early
identification and treatment of psychological distress in
patients presenting with abdominal pain like symptoms will
help prevent the subsequent development of persistent
FGIDs.
[email protected]
2/02/15
Brain-Gut Axis
56
—  There is a bidirectional relation between the central
nervous system and the digestive tract. Numerous data
argue for a dysfunction of the brain-gut axis in the
pathophysiology of irritable bowel syndrome (IBS).
—  Visceral hypersensitivity is peripheral and/or central in
origin and may be the consequence of digestive
inflammation or an anomaly of the nociceptive message
treatment at the spinal and/or supraspinal level.
—  Stress is involved in the genesis and maintenance of IBS.
Disturbances of the autonomic nervous system are
observed in IBS as a consequence of brain-gut axis
dysfunction.
[email protected]
2/02/15
GORD etc.
57
—  Altered autonomic function may be involved in
gastrointestinal conditions, such as gastro-oesophageal
reflux disease and neuropathic upper gastrointestinal
motility disorders (Ogilive et al., 1985). More interestingly,
such vagal abnormalities have also been identified in
patients with functional gut disorders, including functional
dyspepsia and colonic inertia(Haug et al., 1994)
—  Aggarwal et al (1994) have shown convincingly that a
subgroup of patients with IBS also showed various
autonomic abnormalities.
—  Patients with increased sympathetic activity and low vagal
tone tended to have constipation, whereas diarrhoea prone
patients primarily showed increased parasympathetic
activity. Depression/anxiety
[email protected]
2/02/15
FGID
58
—  The dietary carbohydrate fructose can be incompletely
absorbed in the small intestine and is sometimes associated
with gastrointestinal symptoms that include motility
disturbances and abdominal pain. Fructose malabsorption
has been well documented in variable but similar
proportions of healthy and populations with functional
gastrointestinal disorders.
—  Restricting dietary fructose intake and other poorly
absorbed short-chain carbohydrates and polyols remains an
efficacious approach for managing FGIDs
[email protected]
2/02/15
FGID
59
—  It is increasingly perceived that gut host–microbial
interactions are important elements in the pathogenesis of
functional gastrointestinal disorders (FGID). The most
convincing evidence to date is the finding that functional
dyspepsia and irritable bowel syndrome (IBS) may develop
in predisposed individuals following a bout of infectious
gastroenteritis.
—  The current working hypothesis is that abnormal
microbiota activate mucosal innate immune responses
which increase epithelial permeability, activate nociceptive
sensory pathways and dysregulate the enteric nervous
system.
[email protected]
2/02/15
IBS
60
—  Irritable Bowel Syndrome (IBS) is the most common
digestive complaint, suffered by one in seven adults. It can
occur at any age, but most likely between the ages of 20-60,
with women being more susceptible than men.
—  Sufferers report feeling pain in the belly, bloating and wind;
and bouts of either diarrhoea or constipation or they may
alternate (classified as IBS-D, IBS-C or IBS-A, respectively).
—  As a functional gastrointestinal disorder (FGID), IBS has no
known organic cause, a diagnosis of IBS is usually made by
exclusion; when nothing else can be found.
[email protected]
2/02/15
Habba Syndrome or IBS
61
—  Sometimes patients are diagnosed with IBS. This can be a
“catch all” or “wastebasket” diagnosis. When patients are
tagged with an IBS diagnosis, they can be dissatisfied and
continue to change physicians in hopes of getting relief.
—  Habba Syndrome can cause chronic diarrhoea or three or
more bowel movements per day for at least three months.
The diarrhoea is mostly after meals.
—  The Habba Syndrome is a dysfunction of the gall bladder.
There is inappropriate bile in the gastrointestinal tract. It
can cause painful stools which are watery and without
blood. Most of the patients have normal gallbladder
ultrasounds.
[email protected]
2/02/15
Habba Syndrome- Bile Acid Sequestrants
62
—  Studies have shown that the
resin gum guggul, can
decrease elevated lipid
levels. The stereoisomers Eand Z-guggulsterone have
been identified as the active
agents in this resin. Recent
studies have shown that
these compounds are
antagonist ligands for the
bile acid receptor farnesoid
X receptor (FXR)
[email protected]
Zlim Trim
—  Citrus Aurantium
Synephrine
(standardised)
—  Hydroxycitric acid (HCA)
Garcinia
—  0.5-2% E & Z
Gugglesterones (Guggul)
—  forskohlii extract,
standardised to contain
'185 forskolin'
—  L-Tyrosine
2/02/15
IBS
63
—  Several conditions may present themselves as IBS,
including coeliac disease, fructose malabsorption, mild
infections, parasitic infections like giardiasis, several
inflammatory bowel diseases, bile acid malabsorption,
functional chronic constipation, small intestinal bacterial
overgrowth, and chronic functional abdominal pain.
—  The most common theory for IBS is that it is a disorder of
the interaction between the brain and the gastrointestinal
tract, although another common theory is that for at least
some individuals with IBS there are abnormalities in the
gut flora which results in inflammation and altered bowel
function.
[email protected]
2/02/15
Serotonin (5-HT) & IBS
64
—  Serotonin is an important gastrointestinal signalling
molecule. It is a paracrine messenger utilised by
enterochromaffin (EC) cells, which function as sensory
transducers. Serotonin activates intrinsic and extrinsic
primary afferent neurons to, respectively, initiate peristaltic
and secretory reflexes and to transmit information to the
central nervous system.
—  Serotonergic signalling abnormalities have been putatively
implicated in the pathogenesis of functional bowel diseases
(Gershon & Tack, 2007).
[email protected]
2/02/15
Serotonin (5-HT) & IBS
65
—  Serotonin exerts its effects via neurocrine, paracrine, and
endocrine pathways. Recent studies have demonstrated
that serotonin, acting primarily through 5-HT3 and 5-HT4
receptors, is intricately involved in initiating the peristaltic
reflex and facilitating intraluminal secretions.
—  GI motor activity and sensory dysfunction in patients with
IBS may be a result of alterations in serotonin levels or
associated 5-HT receptors.
—  Serotonin agonists (for constipation IBS) and antagonists
(for diarrhoeal IBS) may offer new treatments that
normalise GI motor and sensory functions in patients with
disorders of GI function.
[email protected]
2/02/15
Da Jian Zhong Tang
66
—  Pericarpium Zanthoxyli
Bungeani (hua jiao)
—  Rhizoma Zingiberis
Officinalis (gan jiang)
—  Radix Ginseng (ren shen)
—  Saccharum Granorum (yi
tang)
[email protected]
—  Daikenchuto (Da-Jian-
Zhong-Tang) dosedependently improved
delayed gastrointestinal
transit by acting as a 5-HT
antagonist (Tokit et al.,
2007)
2/02/15
Suan Zao Ren Tang
67
—  Semen Zizyphi Spinosae
(suan zao ren)
—  Radix Ligustici Wallichii
(chuan xiong)
—  Sclerotium Poriae Cocos
(fu ling)
—  Rhizoma Anemarrhenae
Asphodeloidis (zhi mu)
—  Radix Glycyrrhizae
Uralensis (gan cao)
[email protected]
—  One ingredient of
suanzaorentang, zizyphi
spinosi semen, exhibits
binding affinity for
serotonin (5hydroxytryptamine, 5-HT)
receptors, 5-HT(1A) and
5-HT(2), and for GABA
receptors (Yi et al., 2007).
2/02/15
Ban Xia Hou Pu
68
—  Rhizoma Pinelliae
Ternatae (ban xia)
—  Cortex Magnoliae
Officinalis (hou po)
—  Sclerotium Poriae Cocos
(fu ling)
—  Rhizoma Zingiberis
Officinalis (sheng jiang)
—  Folium Perillae
Frutescentis (zi su ye)
[email protected]
—  Magnolia bark (PMB) &
Poria (PPO) were the two
principal components of
polysaccharides elevating
5-HT levels. BanxiaHoupu decoction
attenuated abnormalities
in the serotonergic and
dopaminergic system
functions (Yi et al., 2009)
2/02/15
IBS
69
—  RASCIBLY for Gut Harmony is a 20-herb Chinese
medicinal formula that offers beneficial effects in patients
with IBS. Studies showed that this brilliant product, a
combination of 20 key botanicals, potently inhibited proinflammatory cytokines, macrophage marker nitric oxide
synthase and decreased pro-inflammatory cytokine
secretion from JAWS II dendritic cells.
—  RASCIBLY also blocked the drop in transepithelial electric
resistance and significantly suppressed the up-regulation of
key inflammatory cytokines in inflamed colon.
[email protected]
2/02/15
Panaxea RASCIBLY
—  Angelicae Dahuricae Radix (Bai
— 
— 
— 
— 
— 
— 
— 
— 
— 
— 
Zhi)
Artemisiae Scopariae Herba
(Yin Chen)
Atractylodis Macrocephalae
Rhizoma (Bai Zhu)
Aucklandiae Radix (Mu Xiang)
Bupleuri Radix (Chai hu)
Citri Reticulatae Pericarpium
(Chen Pi)
Codonopsis Radix (Dang Shen)
Coicis Semen (Yi Yi Ren)
Coptidis Rhizoma (Huang
Lian)
Fraxini Cortex (Qin Pi)
Glycyrrhizae Radix et Rhizoma
(Zhi Gan Cao)
[email protected]
70
—  Magnoliae Officinalis Cortex
— 
— 
— 
— 
— 
— 
— 
— 
(Hou Po)
Paeoniae Alba Radix (Bai
Shao)
Plantaginis Semen (Che Qian
Zi)
Phellodendri Amurensis
Cortex (Guan Huang Bo)
Pogostemonis Herba (Guang
Huo Xiang)
Poria (Fu Ling)
Saposhnikoviae Radix (Fang
Feng)
Schisandrea Chinensis
Fructus (Wu Wei Zi)
Rhizoma Zingiberis
Praeparatum (Pao Jiang)
2/02/15
SIBO
71
SMALL INTESTINE BACTERIAL OVERGROWTH
[email protected]
2/02/15
SIBO not IBS
72
—  Here are the top 6 symptoms of SIBO:
1. 
2. 
3. 
4. 
5. 
6. 
Abdominal bloating and distension
Constipation
Diarrhoea
Abdominal pain or discomfort
Acid reflux or heartburn
Excessive gas or belching
[email protected]
2/02/15
Here are six signs you might have SIBO
73
1. 
2. 
3. 
4. 
5. 
6. 
You notice that fibre worsens your constipation.
You notice an improvement in IBS symptoms when
taking antibiotics.
You feel more gas and bloating when you take probiotics
that contain pre-biotics.
You are coeliac or gluten intolerant and do not have 100%
resolution of symptoms on a gluten-free diet.
You develop chronic symptoms of gas, bloating,
constipation or diarrhoea after taking pain medications,
like opiates.
Your blood work shows chronically low iron
[email protected]
2/02/15
SIBO
74
—  The small intestine contains less than 10,000 bacteria per
millilitre of fluid when compared with the large intestine at
least 1,000,000,000 bacteria per millilitre of fluid and the
types of bacteria normally present in the SI are different
from those in the LI.
—  SIBO is not caused by a single type of bacteria, but is an
overgrowth of the various types of bacteria that should
normally be found in the LI or a local SI overgrowth.
—  SIBO may significantly interfere with digestion of food and
absorption of nutrients, primarily by damaging the mucosal
lining the small bowel. Additionally, this damage to the
small bowel mucosa can lead to leaky gut
[email protected]
2/02/15
SIBO
75
—  Patients with underlying SIBO have significant delays in
small bowel transit time (SBTT) as compared with those
without.
—  The association between prolonged SBTT and positive
lactulose breath testing (LBT) may be useful in identifying
those patients with SIBO diagnosed by LBT and potentially
target therapeutic option. Small bowel transit specifically
predisposes to the development of SIBO (J Clin
Gastroenterol. 2014 Oct 14).
—  Low ileocaecal junction pressures (IJP) is significantly
associated with SIBO (2014, doi: 10.1007/
s10620-014-3166-7).
[email protected]
2/02/15
Risk factors for SIBO
76
—  Low stomach acid
—  Irritable bowel syndrome
—  Long-standing Coeliac disease
—  Crohn’s disease
—  Prior bowel surgery
—  Diabetes mellitus (type I and type II)
—  Multiple courses of antibiotics
—  Organ system dysfunction, such as liver cirrhosis, chronic
pancreatitis, or renal failure
[email protected]
2/02/15
SIBO
77
—  The number of people with SIBO in the general population
remains unknown. Some studies suggest that between 6 to
15% of healthy, asymptomatic people have SIBO, while up
to 80% of people with irritable bowel syndrome (IBS) have
SIBO (Gastroenterol Hepatol 2007).
—  Antibiotics are often used to treat SIBO. However, studies
show that despite treatment with antibiotics, recurrence
develops in almost half of all patients within one year.
—  Herbal therapies are at least as effective as rifaximin for
resolution of SIBO. Herbals also appear to be as effective as
triple antibiotic therapy for SIBO rescue therapy
(Global Advances. May 2014, Vol.3, No 3).
[email protected]
2/02/15
SIBO
78
Extrinsic factors that alter the gut microbiome and may
influence the development of small intestine bacterial
overgrowth:
—  FODMAPs (fructose, lactose, galactans, fructans, sugar
alcohols)
—  Proton pump inhibitors
—  Anti-motility agents
—  Fibre
—  Prebiotics
—  Probiotics
—  Antibiotics
[email protected]
2/02/15
How do we treat SIBO?
79
1. Diet options
—  Paleo diet or autoimmune paleo diet
— 
Low FODMAP diet (http://www.taste.com.au/news+features/
articles/2752/low+fodmaps+diet)
— 
GAPS Diet (http://www.gapsdiet.com/
INTRODUCTION_DIET.html)
Avoid all alcohol
Use caution with probiotics/prebiotics
Use caution with fermented foods as they can increase
histamine
[email protected]
2/02/15
How do we treat SIBO?
80
2. Antimicrobial herbs
—  Berberine
—  Epi-Gastro Formula
¡ 
Increases pepsin and enhances protein absorption
Increases gastric emptying time
—  Emodin
—  AntiBioBotanical
—  Scutellaria baicalensis extract baicalein (Kim et al., 2009)
—  Genistein
—  Phellodendron chinensis (huang bai)
[email protected]
2/02/15
Panaxea Emodin
81
—  Emodin can enhance the function of small intestinal
peristalsis of mice by mechanisms of promoting secretion of
motilin, lowering the content of somatostatin and
inhibiting Na+-K+-ATPase activity of small intestinal
mucosa.
—  Emodin increased the content of motilin, while reduced the
content of somatostatin in the small intestine significantly
(World J Gastroenterol. 2005 May 28;11:20).
—  Emodin can inhibit the apoptosis of intestinal mucosa cells
and up-regulate the serum leptin content to protect the
intestinal barrier function and prevent the translocation of
bacteria and endotoxin (2009, doi: 10.3736/
jcim20091215).
[email protected]
2/02/15
FODMAPs
82
—  FODMAPs is an acronym that stands for Fermentable
Oligo-, Di- and Mono-saccharides, and Polyols. This term
was coined by a group of researchers who theorise that
foods that contain these forms of carbohydrates exacerbate
the symptoms of some digestive disorders, such as irritable
bowel syndrome (IBS) and inflammatory bowel disease
(IBD).
—  These substances are poorly absorbed by the small intestine
and thus it is theorised that they may contribute to
digestive difficulties in some people due to the processes of
fermentation and/or osmosis.
[email protected]
2/02/15
Panaxea Genistein
83
—  Genistein at low doses (0.1 mg/kg) had mild anti-
inflammatory effects in ileitis (Crohn's ileitis is a type of
Crohn's disease affecting the ileum). Therapeutic benefit
included a reduction in nitric oxide production, granulocyte
infiltration and improved mucosal architecture. Genistein,
at low doses, also appeared to attenuate
immunohistochemical staining for inducible nitric oxide
synthase (iNOS) and nitrotyrosine (1998, doi:
10.3181/00379727-217-44244).
—  SIBO might be a cause cause ileitis, particularly in women
[email protected]
2/02/15
SIBO or IBD
84
—  SIBO represents a frequently ignored complication in
Crohn’s Disease (CD), often mimicking an acute flare. The
symptoms of SIBO can be difficult to differentiate from
those caused by the underlying disease. People with
Crohn’s disease have a predisposition to SIBO mostly due
to altered motility from structures, fistulas or surgery.
—  Several studies found that SIBO was present in 23 to 34%
Crohn’s patients tested.
[email protected]
2/02/15
Leaky Gut
85
—  While SIBO usually manifests with local GI symptoms, a
leaky gut will manifest with complaints that affect the
immune system throughout the body. Keep in mind that it
is not uncommon to have both SIBO and leaky gut
simultaneously.
—  And very often, if you have SIBO for a long period of time,
you will develop a leaky gut. About half of the patients
diagnosed with SIBO will also have leaky gut. Most of the
time if SIBO is treated, leaky gut will heal itself
[email protected]
2/02/15
Panaxea Gut Clear
86
—  Uncaria rhynchophylla
—  Coix lacryma-jobi (yi ren)
(gou teng)
—  Flos Chrysanthemi Indici
(ye ju hua)
—  Citrus aurantium (zhi ke)
—  Trichosanthes kirilowii
(tian hua fen)
—  Angelica Dahurica (bai
zhi)
—  Agastache rugosa (huo
xiang)
—  Tribuli terretris (bai ji li)
[email protected]
—  Mentha haplocalyx (bo
he)
—  Hordeum vulgare (Mai
Ya)
—  Magnolia Flower (hou po
hua)
—  Atractylodes lancea (cang
zhu)
2/02/15
Gut Clear
Continued
87
—  Pueraria lobata (ge gen)
—  Coptis chinensis (huang
lian)
—  Aucklandia lappa (mu
xiang)
—  Grapefruit Seed (pu tao zi)
—  Asafoetida (Ferula
Foetida) Gum Resin (60
to 75 percent concentrate)
(a wei)
[email protected]
Indications
—  Irritable bowel syndrome
(IBS)
—  Gut dysbiosis
—  Small intestine bacterial
overgrowth (SIBO)
—  Diarrhoea / Constipation
—  Low IgA response
2/02/15
IBD
88
CROHN'S DISEASE & ULCERATIVE COLITIS
[email protected]
2/02/15
IBD
89
—  Cramping
—  Irregular bowel habits, passage of mucus without blood or pus
—  Weight loss
—  Fever, sweats
—  Malaise, fatigue
—  Arthralgias
—  Growth retardation and delayed or failed sexual maturation in
children
—  Extra-intestinal manifestations (10-20%): Arthritis, uveitis, or
liver disease
—  Grossly bloody stools, occasionally with tenesmus: Typical of UC,
less common in CD
—  Perianal disease (eg, fistulas, abscesses): Fifty percent of patients
with CD
[email protected]
2/02/15
IBD
90
—  Inflammatory bowel disease (IBD) is an idiopathic disease
caused by a dysregulated immune response to host
intestinal microflora.
—  Inflammatory bowel disease (IBD) is not a single condition.
It is the term for a group of disorders that cause prolonged
inflammation of the digestive tract and the two most
common types are ulcerative colitis and Crohn’s disease.
—  There is no single cause although many suspect heredity,
immune disregulation, stress, smoking and alcohol, gender
and age, and geographical location as urban areas and
industrialised countries have a higher risk. (no dirt to eat)
[email protected]
2/02/15
IBD
91
—  We could be "poisoning the world with our McDonalds’ and
fatty fried foods," says Balfour Sartor, MD, chief medical
advisor for the Crohn’s & Colitis Foundation of America.
"We’re purifying water, embarking on sanitation, and
dramatically changing the environment. Any one or a
combination of these factors could be affecting this.”
—  Crohn's disease was more common in subjects whose first
houses had a hot-water tap (odds ratio 5·0, 95% Cl 1·4–
17·3) and separate bathroom (3·3, 1·3–8·3) (1994, DOI:
10.1016/S0140-6736(94)91841-4).
[email protected]
2/02/15
IBD
92
—  Literature suggests that the hygiene hypothesis and its
association with decreased microbial exposure in childhood
probably plays an important role in the development of
IBD. The most promising factors that may potentially be
associated with development of IBD include H pylori
exposure, helminths, breastfeeding and sibship.
—  Improved hygiene is believed to result in a limited exposure
to micro-organisms. Such exposure is thought to be
necessary in programming the immune system of the gut
and mitigating its future inflammatory responses, perhaps
even resulting in CD when the immune system is
challenged (Am J Gastroenterol. 2006 May;101,5).
[email protected]
2/02/15
IBD & Stress
93
—  Stress-exposed subjects demonstrated increased risk of
clinical episodes of disease when compared with unexposed
subjects (RR = 2.6, 95% CI: 1.3–4.9). Elevated effect
measures were highest for the domain of health-related stress
(RR = 3.8, 95% CI: 1.5–9.9).
—  In the multiple regression analysis, major stress events
remained the most significant indicator of disease activity in
the presence of the co-variables considered (1991, DOI:
10.1080/08964289.1991.9937553.
—  There is consistent evidence for a contribution of
psychological factors to IBD disease course, especially stress
in UC and depressive symptoms in CD (2008, DOI
http://dx.doi.org/10.2174/156652408784533832.
[email protected]
2/02/15
IBD & Vagus Nerve
94
—  The Inflammatory Reflex (IR) describes an interaction
between the vagus nerve and peripheral macrophages,
which result in attenuation of proinflammatory cytokine
release in response to systemic exposure to bacterial
endotoxin.
—  The vagus nerve plays a counter-inflammatory role in acute
colitis via a macrophage-dependent mechanism. The
identification of a counter-inflammatory neural pathway
opens new therapeutic avenues for treating acute
exacerbations of inflammatory bowel disease (Ghia et al,
2006).
[email protected]
2/02/15
NSAIDs & IBD
95
—  Aspirin and other nonsteroidal anti-inflammatory drugs
(NSAIDs) are known to disrupt the intestinal epithelial
barrier. This disruption may alter the interaction between
gut microbes and immune cells and, secondarily, may raise
risk for inflammatory bowel disease.
—  NSAIDS is associated with a small increase for the
incidence of ulcerative colitis (Ann Intern Med. 2012
http://www.annals.org/content/156/5/350.full)
[email protected]
2/02/15
Vitamin D
96
—  In epidemiological studies serum levels below 30 nM of 25-
OHD3, the precursor of the active vitamin D metabolite
1,25-(OH)2D3, were consistently associated with incidence
of colorectal cancer. The active vitamin D metabolite
possesses antimitotic, pro-differentiating and proapoptotic
capacity in vivo and in vitro.
—  VDR-mediated signaling antagonising TNF-α and IL-6
receptor-activated pro-inflammatory and proliferative
intracellular pathways, may prevent development of IBD
and colitis-associated colorectal cancer (2011, DOI:
10.1016/j.mce.2011.07.022).
[email protected]
2/02/15
IBD
97
—  The commensal intestinal microbiota drive the
inflammation associated with Crohn's disease. However,
bacteria such as bifidobacteria appear to be
immunoregulatory.
—  In healthy subjects the intestinal microbiota are influenced
by prebiotic carbohydrates such as fructo-oligosaccharides
(FOS). Preliminary data suggest that FOS increase faecal
bifidobacteria, induce immunoregulatory dendritic cell
(DC) responses and reduced proportions of interleukin
(IL)-6 to reduce disease activity in patients with Crohn's
disease (Benjamin et al, 2011).
[email protected]
2/02/15
IBD
98
—  Stools from 109 patients with inflammatory bowel disease
(13.4%) contained C. difficile or its toxin, an incidence
similar to the stools of 99 control patients with diarrhoea
(11.9%), but significantly higher than the stools of 77
control patients with a normal bowel habit (1.4%)
(Greenfield et al, 1983).
—  C difficile colitis has doubled in North America over the
past 5 years and recent reports have demonstrated an
increase in incidence and severity of these infections in
patients with inflammatory bowel disease (IBD; Crohn's
disease, ulcerative colitis) (Issa et al, 2008).
[email protected]
2/02/15
C. difficile
99
—  The annual rate of disease has risen more than 20-fold due
to use of proton-pump inhibitors (PPIs). In a case-control
analysis, older age, prior hospitalisation, and antibiotic use
all correlated strongly with increased risk for Clostridium
Difficile-Associated Diseases/Diarrhoea (CDAD).
—  Gastric-acid suppression has been associated with an
increased risk for bacterial enteric infections such as
salmonellosis, and several studies now suggest that it also
heightens risk for CDAD (Hookman P & Barkin, 2006).
[email protected]
2/02/15
C. difficile
100
—  There are new data on the aetiology of and potential risk
factors for Clostridium difficile infection (CDI);
controversial issues include specific antimicrobial agents,
gastric acid suppressants, potential animal and food
sources of C. difficile, and the effect of the use of alcoholbased hand hygiene agents (Freeman et al, 2010).
—  The epidemiology of CDI has changed dramatically during
this millennium.
[email protected]
2/02/15
C. Difficile Infection
101
—  In humans the disease pseudomembranous colitis, caused
by Clostridium difficile, is almost always a consequence of
antibiotic treatment. In humans it has been shown that
administering faecal enemas derived from a healthy human
adult can reverse C. difficile infection (CDI).
—  In chickens it has long been known that dosing newly
hatched chicks per Os with faecal suspension from adult
hens can prevent the establishment of salmonellae in the
gut.
[email protected]
2/02/15
C. Difficile Infection
102
—  Faecal transplantation through colonoscopy seems to be an
effective treatment for recurrent CDI and also for recurrent
CDI caused by the virulent C. difficile 027 strain.
—  During the first 12 weeks after faecal transplantation,
symptoms resolved in all patients who did not have strain
027 C. difficile infections. Of 36 patients with 027 C.
difficile infection, 32 (89%) had a favourable response
(2012. http://dx.doi.org/10.1053/j.gastro.2011.11.037)
[email protected]
2/02/15
Autism & C. Difficile
103
—  Novel findings associated with alterations in nicotinic acid
metabolism within autistic individuals showing increased
urinary excretion of N-methyl-2-pyridone-5-carboxamide,
N-methyl nicotinic acid, and N-methyl nicotinamide
indicate a perturbation in the tryptophan−nicotinic acid
metabolic pathway. These biochemical changes are
consistent with some of the known abnormalities of gut
microbiota found in autistic individuals.
—  Children with autism are producing toxins that might
interfere with brain development. One of the compounds
identified in the gut is C. Difficile (Yap et al 2010),
[email protected]
2/02/15
Blastocystis hominis
104
—  Case reports and series have suggested a
pathogenic role of B. hominis in causing
intestinal inflammation. Also some studies have suggested
that inflammatory bowel disease (IBD) and irritable bowel
syndrome (IBS) are associated with B. hominis infection
(Ustün & Turgay, 2006).
—  Blastocystis is a very peculiar organism in that it especially
likes grains. Many people with Blastocystis may have grain
allergies or difficulties tolerating grains.
[email protected]
2/02/15
Reduced Firmicutes in CD
105
—  The role of the intestinal microbial community (microbiota)
in the onset and chronicity of Crohn's disease (CD) is
strongly suspected, mainly represented by the phyla
Bacteroidetes and Firmicutes.
—  Among the Firmicutes, 43 distinct ribotypes were identified
in the healthy microbiota, compared with only 13 in CD.
The reduced complexity of the bacterial phylum Firmicutes
is a signature of the faecal microbiota in patients with CD
(Manichanh et al, 2006).
[email protected]
2/02/15
IBD
106
—  Despite extensive research, the exact cause of Crohn’s
disease remains unknown. People with Crohn’s have
various mutations (NOD2, ATG16L1, IL-23, IL12B, STAT3
and NKX2-3) in their genes that healthy people don’t have.
Expression of the altered genes affects how bacteria interact
with the intestinal surface and how our immune system
interacts with these adherent bacteria.
—  One thing is clear – People with Crohn’s have an altered
microbiome, suffering a 50% decrease in the diversity of gut
microbes including the loss of bacterial species Bacteriodes,
Eubacterium and Lactobacillus
[email protected]
2/02/15
IBD
107
—  The composition of the intestinal microflora has been
proposed as an important factor in the development of
inflammatory bowel diseases (IBD). Antibiotics have the
potential to alter the composition of the intestinal
microflora.
—  There is a strong association between antibiotic use and CD
in childhood.
[email protected]
2/02/15
Panaxea Gut Bug
108
—  Sophorae Flavescentis (Ku
—  Sclerotium Poriae (Fu
Shen Gen)
—  Corneum Gigeriae Galli
(Ji Nei Jin)
—  Sargento Doxae (Hong
Ten)
—  Stemonae (Zhi Bai Bu)
—  Arecae Catechu (Bing
Lang)
—  Quisqualis (Shi Jun Zi)
—  Glycyrrhizae (Gan Cao)
Ling)
—  Pericarpium Citri
Reticulatae (Chen Pi)
—  Dioscorea Bulbiferous
Huang Yao Zi)
—  Testa Dolichoris (Bian
Dou)
—  Atractylodis
Macrocephalae (Bai Zhu)
—  Saussureae Lappae (Mu
Xiang)
[email protected]
2/02/15
Panaxea UC
109
—  Scutellaria baicalensis
Purges Toxic Heat and
(contains extract berberine
regulates Damp
(BE)
—  Ulcerative Colitis
—  Glycyrrhiza uralensis (contains —  Crohn’s Disease
extract glycyrrhizin (GL)
—  Gastrointestinal
—  Pinellia Tuber (ban xia)
Inflammatory Disorders
—  Scutellaria Root (huang qin)
—  Inflammatory Bowel
—  Panax Ginseng, red (ren shen)
Disease
standardised ginsenosides
—  Zizyphus jujuba (da zao)
—  Glycyrrhiza uralensis (zhe gan
cao)
—  Coptis japonica (huang lian)
[email protected]
2/02/15
IBD
110
—  Higher scores of neuroticism, depression, inhibition, and
emotional instability, are typical for many patients with
chronic diseases and nonspecific for chronic
gastroenterological disorders. Patients with chronic
gastrointestinal disorders have impaired health-related
quality.
—  Psychological treatment in IBD achieved lower demands for
health care rather than a reduction of anxiety or
depression. Psychotherapy with chronic gastrointestinal
disorders could lead to improve the course of the disease,
changing psychological factors such as depression and
dysfunctional coping and improving the patient's quality of
life.
[email protected]
2/02/15
IBD & Depression
111
—  Psychological factors such as a depressive mood associated
with anxiety and impaired QOL may exert a negative
influence on the course of IBD.
—  Therefore, assessment and management of psychological
distress should be included in clinical treatment of patients
with IBD. Depression was found in 28% of patients, and
59% experienced at least one relapse during the 18 months
of follow-up (Mittermaier et al, 2004).
[email protected]
2/02/15
IBD & Depression
112
—  Depression may coexist with Crohn’s disease more often
than would be expected by chance. Clinical and
experimental evidence indicates that intestinal
inflammatory conditions can be exacerbated by depression.
The tonic counter-inflammatory influence mediated by the
vagus nerve in experimental colitis provides a potential link
between behaviour and gut inflammation.
—  Depressive-like behaviours in mice increased susceptibility
to intestinal inflammation by interfering with the tonic
vagal inhibition of pro-inflammatory macrophages and
produced a vulnerability to colitis by a mechanism
involving parasympathetic transmission (Ghia et al, 2008).
[email protected]
2/02/15
Treatments
113
—  IBD
Panaxea UC regulates intestinal hormones somatostatin,
motilin, and gastrin. Down-regulates pro-inflammatory
cytokine levels in the colon, including TNF, IFN-γ,
Keratinocyte chemoattractant (KC), and IL-17 and increases
regulatory cytokine IL-10. Suppresses inflammatory bowel
disease (IBD) and significantly reduces colonic damage.
¡  Panaxea Curcumin is an adjunct to treatment protocols for
IBS, Crohn’s disease, Ulcerative colitis, Diabetes, Alzheimer's,
RA & Cancer.
¡  Panaxea ICC reduces various inflammatory mediators,
including interleukin-6 (IL-6), IL-1 beta, TNF-alpha,
prostaglandin E2 and leukotrienes.
¡ 
[email protected]
2/02/15
Panaxea UC
114
—  Scutellaria baicalensis
—  Panax Ginseng, red
(contains extract
berberine (BE)
—  Glycyrrhiza uralensis
(contains extract
glycyrrhizin (GL)
—  Pinellia Tuber (Bàn Xià)
—  Scutellaria Root (Huáng
Qín)
(Hong Rén Shēn)
standardised
ginsenosides
—  Zizyphus jujuba (Dà Zǎo)
—  Glycyrrhiza uralensis
(Zhì Gān Cǎo)
—  Coptis japonica (Huáng
Lián)
[email protected]
2/02/15
IBD
115
—  Using IBD as a model of inflammation, we explore the
principal complementary and alternative medicine
treatments that show promise in this regard, namely,
resveratrol, green tea, curcumin, boswellia, fish oil, vitamin
D, and probiotics (Clarke JO & Mullin, 2008).
—  These compounds have the ability to modulate the immune
system and disrupt the proinflammatory cascade through a
variety of mechanisms, including antioxidant effects,
alterations in cell signalling (in particular the nuclear factor
(NF)-κB pathway), cytokines, proinflammatory mediators,
and disruption of bacterial flora.
[email protected]
2/02/15
Panaxea Puerarin
116
—  Oxidative stress is believed to be a key factor in the pathogenesis
and perpetuation of the mucosal damage in IBD. In addition,
neutrophils and monocytes in patients with active IBD have been
shown to produce higher concentrations of oxygen-derived free
radicals than those in controls.
—  Malondialdehyde (MDA), Glutathione (GSH) levels in the gut
mucosa and histological analysis were measured in tissue
samples.
—  Compared with model control group, puerarin group showed
significantly lower mucosal MDA and higher mucosal GSH levels
after 2 and 8 hr. Puerarin can maintains GSH levels and reduced
lipid peroxidation and partly by decreasing Caspase-3 expression
(Liu & Chen, 2009)
[email protected]
2/02/15
Puerarin
117
—  Contemporary pharmacological research has demonstrated
that puerarin, the most important phytoestrogen extracted
from Pueraria lobata, has protecting functions on the
cardiovascular system, nervous system, osteoporosis, liver
injury, and inflammation in vivo and in vitro. Most of these
research studies focused on inhibiting oxidative stress and
apoptosis through regulating various bio-activators and
signal pathways (2014, doi: 10.1016/
S1875-5364(14)60064-9).
—  Mucosal iNOS gene expression decreased significantly in
puerarin high-treated group (Liu & Chen, 2005)
[email protected]
2/02/15
IEC Apoptosis
118
—  Intestinal epithelial cells derive from stem cells at the base
of the crypt and migrate along the crypt-lumen axis. Their
life is terminated as they reach the luminal surface where
they detach and are shed.
—  Intestinal epithelial cells show evidence of apoptosis in the
region of shedding, and cell death is thought to resemble a
form of apoptosis called detachment-induced cell death, or
anoikis (Grossmann et al, 1998).
—  They have a lifespan of about 4 weeks (Histology. n.d.)
[email protected]
2/02/15
IEC Apoptosis
119
—  Intestinal epithelial cell (IEC) apoptosis contributes to the
development of ulcerative colitis (UC), an inflammatory
bowel disease (IBD) that affects the colon and rectum.
—  Therapies that target the inflammatory cytokine TNF have
been found to inhibit IEC apoptosis in patients with IBD,
although the mechanism of IEC apoptosis remains unclear
(Qiu et al, 2011).
[email protected]
2/02/15
Advanced Mucosal Healing
120
—  Advanced mucosal healing (MH) is a complex phenomenon
viewed as a succession of steps necessary to restore tissue
structure and function. These steps include epithelial cell
migration and proliferation, cell differentiation, restoration
of epithelial barrier functions, and modulation of cell
apoptosis.
—  Data suggest that supplementation with specific amino
acids including arginine, glutamine, glutamate, threonine,
methionine, serine, proline, and the amino acid-derived
compounds, polyamines can favourably influence MH.
[email protected]
2/02/15
Advanced Mucosal Healing
121
—  Short-chain fatty acids, which are produced by the
microbiota from undigested polysaccharides and proteinderived amino acids, also exert beneficial effects on the
process of intestinal MH in experimental models as well as
endogenous prostaglandin synthesis.
—  Among micronutrients, several vitamin and mineral
deficiencies with different frequencies have been observed
in patients with inflammatory bowel diseases and
supplementation with some of them (vitamin A, vitamin
D3, vitamin C, and zinc) are presumed to favour MH
(Inflamm Bowel Dis. 2014 Sep 9).
[email protected]
2/02/15
Colo-Rectal Cancer
122
[email protected]
2/02/15
Panaxea Artesunate (oral & IM)
123
—  Artesunate significantly inhibited both the invasiveness and
anchorage independence of colon cancer SW620 cells in a
dose-dependent manner. The protein level of intercellular
adhesion molecule 1 (ICAM-1) was down-regulated as
relative to the control group.
—  Artesunate could potentially inhibit invasion of the colon
carcinoma cell line SW620 by down-regulating ICAM-1
expression (Fan, Zhang, Yao & Li, 2008).
—  MDR: Artesunate acts via p53-dependent and- independent
pathways in isogenic p53+/+ p21WAF1/CIP1+/+, p53-/p21WAF1/CIP1+/+, and p53+/+ p21WAF1/CIP1-/- colon
carcinoma cells (Efferth et al., 2003).
[email protected]
2/02/15
Panaxea Ai Di Injection
124
—  There are significant differences in clinical benefit response
and KPS score with Ai Di Injection (ADI). In addition,
adverse gastrointestinal reactions and the incidence of
leukopenia were lower than that of the control group.
—  Aidi injection, combined with FOLFOX4, is associated with
reduced toxicity of chemotherapy, enhanced clinical benefit
response, and improved quality of life in patients with
advanced colorectal cancer (Xu, Huang, Li, Li, & Tang,
2011).
[email protected]
2/02/15
Ai Di Injection (ADI)
125
—  Mylabris phalerata (ban
mao)
—  Panax ginseng (ren shen)
—  Astragalus
membranaceus (huang
qi).
—  50-100ml once daily: 10 days as
a course of treatment. Single
application: 15 days as a cycle,
with 3 days interval., 2 cycles as
a course of treatment.
[email protected]
—  When combined with
radiotherapy or
chemotherapy: treatment
is synchronised to
radiotherapy or
chemotherapy.
Application before or after
the surgery: 10 days as a
course of treatment.
2/02/15
Panaxea CRC
126
—  Herba Hedyotiolis Diffusae
— 
— 
— 
— 
— 
— 
—  CRC combined with
chemotherapy significantly
(Bai Hua She She Cao)
increased 1- and 3-year survival
Flos Lonicerae Japonicae
rate. The combined therapy
(Jin Yin Hua)
significantly slowed colorectal
Radix Scutellariae
cancer progression and improved
Baicalensis (Huang Qin)
quality of life.
Herba Solani Nigri (Long
—  It had positive effects in immunoKui)
regulation.
Caulis Sargentodoxae (Hong —  CRC as an adjunctive therapy also
Teng)
had significant advantages in
reducing the adverse effects of
Fructus Sophorae Japonicae
chemotherapy (Zhong et al.,
Immaturus (Huai Jiao)
2012).
Radix Sanguisorbae
Officinalis (Di Yu)
[email protected]
2/02/15
Probiotics
127
[email protected]
2/02/15
Caesarean & Gut Health
128
—  Children born by caesarean are 26% much more likely to be
admitted to hospital with gastrointestinal disease or 12%
more likely for chest infections than those born vaginally.
—  These babies miss out on picking up important gut bacteria
when passing through the vagina.
—  626,700 births were tracked in NSW, Australia from
2001-2008 as reported in the journal Archives of Diseases
in Childhood (Roberts et al, 2012)
[email protected]
2/02/15
Probiotics in Pregnancy
129
—  Neonates of mothers who received a probiotic had higher
cord blood (CB) IFN-γ levels, and a higher proportion had
detectable blood IFN-γ levels, compared with the placebo
group.
—  This suggests that supplementation with probiotics in
pregnancy has the potential to positively influence foetal
immune parameters as well as immunomodulatory factors
in breast milk (Prescott SL, et al. 2008)
[email protected]
2/02/15
Alimentary
System
Plants
Soil
Plants
Genetics
Faeces
Age
Environment
Stress
Diet
Antibiotics
Chemicals
NSAIDS
Intestinal Flora
Eubiosis
Health
Mammals
Dysbiosis
Un-health
Disease
The intestinal flora influence the immune system and
regulate the body's ability to cleanse itself of waste
products i.e. detoxification. A harmonised and balanced
flora will contribute to a better absorption of nutrients,
such as minerals, trace elements, vitamins and amino
acids.
© DR.D.Weber 2012
130
2/02/15
Panaxea ProB)Plus
131
—  Astragalus Polysaccharide
(APS)
—  Germinated barley
foodstuff (GBF)
Probiotic Blend
—  Lactobacillus plantarum
—  Lactobacillus rhamnosus
—  Lactobacillus paracasei
—  Lactobacillus salivarius
—  Bifidobacterium infantis
—  Bifidobacterium bifidum
[email protected]
—  Maintains and stabilises
gut microflora.
—  Increases microflora after
antibiotic therapy.
—  Modulates systemic
immunity and intestinal
microbiota.
—  Reduces colonic mucosal
inflammation.
2/02/15
ProB)Plus
132
—  Symptoms associated with intestinal flora imbalance such
as: diarrhoea, constipation, bloating and flatulence.
—  Colonic mucosal inflammation.
—  Irritable Bowel Syndrome
—  Inflammatory Bowel Disease
—  Acute diarrhoea
—  Antibiotic-induced diarrhoea
[email protected]
2/02/15
ProB)Plus
133
—  Based on findings by Aiba et al (1998), L. salivarius was
found to be a potentially effective probiotic against H.
pylori.
—  L. plantarum produces antimicrobial substances. These
antimicrobial substances have shown significant effect on
Gram-positive and Gram-negative bacteria (Kleerebezem et
al, 1995).
—  Intestinal colonisation by TNFαinhibitory L. paracasei
reduced intestinal inflammation in H. hepaticus-challenged
IL-10-deficient mice and had a direct modulation of
mucosal inflammatory responses (Peña et al, 2005).
[email protected]
2/02/15
ProB)Plus
134
—  There is an important role of bacteria in the bidirectional
communication of the gut–brain axis and certain organisms
prove to be useful therapeutic adjuncts in stress-related
disorders such as anxiety and depression.
—  L. rhamnosus reduced GABAAα2 mRNA expression in the
prefrontal cortex and amygdala, but increased GABAAα2 in
the hippocampus. Importantly, L. rhamnosus reduced
stress-induced corticosterone and anxiety, and depressionrelated behaviour via the vagus nerve (Bravo et al, 2011).
[email protected]
2/02/15
ProB)Plus
135
—  Astragalus polysaccharide had promoting growth action to
probiotics (Liu et al, 2005) and all the tonic traditional
Chinese medicines have a certain modulation in dysbacteria
(Shi et al, 2005).
—  Chinese herbal medicines may replace the using of
antibiotic to play an important role on intestinal
microecology balance (Li et al, 2003).
—  Probiotics and Astragalus polysaccharides (APS) can
modulate systemic immunity and intestinal microbiota.
Results showed that probiotics combined with APS
administration displayed synergistic modulation effects on
immunity and intestinal microbiota (Li et al, 2008).
[email protected]
2/02/15
ProB)Plus
136
—  Germinated barley foodstuff (GBF) reduces colonic
mucosal inflammation.
—  GBF effectively prevents colitis-related dysplasia and
inflammatory change in chronic and subacute colitis
models by modulating the intestinal environment as a
prebiotic. This prebiotic might contribute to the prevention
of mucosal damage including colorectal cancers (Komiyama
et al, 2011).
—  GBF significantly elevated faecal acetic acid and n-butyric
acid levels. GBF tended to increase the number of
eubacteria and that of bifidobacteria (Araki et al, 2000).
[email protected]
2/02/15
Stomach Disorders
137
GASTRO-OESOPHAGEAL-REFLUX DISORDER
GASTRIC ULCER, GASTRIC BLEEDING,
GASTRITIS, GASTRIC CANCER, OESOPHAGEAL
ADENOCARCINOMA
[email protected]
2/02/15
GORD
138
—  Gastro-oesophageal reflux disease is a chronic symptom of
mucosal damage caused by stomach acid coming up from
the stomach into the oesophagus. GORD is usually caused
by changes in the barrier between the stomach and the
oesophagus, including abnormal relaxation of the lower
oesophageal sphincter, which normally holds the top of the
stomach closed or impaired expulsion of gastric reflux from
the oesophagus.
—  GORD is more common in the Western world than in Asia,
and the low rate of incidence relative to prevalence reflects
its chronicity.
[email protected]
2/02/15
GORD
139
The most-common symptoms of GORD are:
—  Heartburn and regurgitation
Less-common symptoms include:
—  Pain with swallowing/sore throat (odynophagia)
—  Increased salivation (also known as water brash)
—  Nausea
—  Chest and upper back pain
—  Dry cough
Factors that have been linked with GORD, but not conclusively:
—  Obstructive sleep apnea
—  Gallstones, which can impede the flow of bile into the
Duodenum, which can affect the ability to neutralise gastric acid
[email protected]
2/02/15
Causes of GORD
140
—  Being overweight but not high fat food consumption is
implicated as causes of reflux disease.
—  Other factors associated with reflux disease hospitalisation
included age, low recreational activity, and history of
doctor-diagnosed arthritis.
—  In practice the treatment of GORD is oriented toward the
individual patient's symptoms, and includes offering
reasonable advice on how to adapt to personal dietary
intolerance and lifestyle factors.
[email protected]
2/02/15
PPI
141
—  A recent study determined that proton pump inhibitors
(PPIs), drugs used to treat chronic acid reflux, cause the
constriction of blood vessels. The finding raises concern
that long term use of PPI drugs such as omeprazole and
lansoprazole will lead to high blood pressure and a
weakened heart.
—  PPIs suppressed the enzyme DDAH, dimethylarginine
dimethylaminohydrolase. That caused an increase in the
blood levels of ADMA (asymmetric dimethylarginine), an
important chemical messenger. They found ADMA in turn
suppressed the production of another chemical messenger,
nitric oxide (NO).
[email protected]
2/02/15
PPI
142
—  In 2009 a staggering 113.4 million prescriptions for proton
pump inhibitors (PPIs) are filled, making this class of
drugs, at $13.9 billion in sales, the third highest seller in the
United States.
—  It should come as no surprise that PPIs have been shown to
be overprescribed; between 53% and 69% of PPI
prescriptions are for inappropriate indications (Arch Intern
Med. 2010;170(9):747-748).
—  It has been proposed that long-term acid suppression in the
presence of H. pylori infection accelerates the development
of atrophic gastritis, which may lead to gastric cancer
(www.gesa.org.au/members_guidelines/helicobacter/
index.htm).
[email protected]
2/02/15
PPI
143
—  Most of patients with GORD have a sleep disorder.
Melatonin has an inhibitory action on gastric acid secretion
and seems to control the lower oesophageal sphincter.
—  Proton pump inhibitors (PPIs) are a group of drugs whose
main action is a pronounced and long-lasting reduction of
gastric acid production. They are the most potent inhibitors
of acid secretion available today. Omeprazole (one of the
PPIs) and melatonin have similarities in their chemical
structures (2010 doi: 10.4292/wjgpt.v1.i5.102)
[email protected]
2/02/15
Melatonin
144
—  Excess alcohol consumption and stress are suggested to be
key elements in the development of gastrointestinal
disorders (Konturek et al. 2011). Dysfunction of the small
intestinal barrier function with increased permeability is a
common clinical observation in patients with inflammatory
bowel syndrome (IBS) and alcoholic liver disease
(Sommansson et al. 2013).
—  Therapeutic administration of melatonin has shown to be
beneficial, and clinical studies have demonstrated
attenuated abdominal pain in IBS (Song et al. 2005).
[email protected]
2/02/15
Melatonin
145
—  Melatonin is a circulating hormone released from cells in
the pineal gland and from enterochromaffin cells in the
gastrointestinal tract. The hormone is a close derivative of
serotonin, and circulating levels are high at night and low
during the day. Hence, the classical function of melatonin is
as a regulator of circadian and seasonal rhythms.
—  Besides this, melatonin has been demonstrated to have
multiple other functions. It affects the cardiovascular
system and immune system and is involved in regulation of
body fat mass, insulin secretion and metabolism of glucose
and lipids (2014, DOI: 10.1111/apha.12364).
[email protected]
2/02/15
Melatonin
146
—  The work by Sommansson et al. (2014) for the first time
establishes beneficial effects of oral application of
melatonin on tissue damage in the small intestine.
—  Melatonin is a cheap and non-toxic molecule that has great
potential to have beneficial effects on public health, not
only on gastrointestinal disorders but also metabolic
diseases (Song et al. 2005, Mulder et al. 2009,
Nduhirabandi et al. 2012).
[email protected]
2/02/15
PPI & SIBO
147
—  Small intestinal bacterial overgrowth (SIBO) occurs due to
alteration of the microbiota within the upper
gastrointestinal tract. Proton pump inhibitor (PPI) therapy
has been suggested as a risk factor for SIBO.
—  PPIs exacerbate NSAID-induced intestinal damage at least
in part because of significant shifts in enteric microbial
populations. Prevention or reversal of this dysbiosis may be
a viable option for reducing the incidence and severity of
NSAID enteropathy.
[email protected]
2/02/15
GORD/Reflux
148
—  Panaxea Core)Ease
¡  CORE)EASE
is based on a classical formula sometimes
referred to as CALM THE STOMACH POWDER. It has
the advantage over the classical formula in including a
group of isolates. This combined with herbs facilitates
faster and more effective clinical outcomes.
¡  CORE)EASE is an antiinflammatory & carminative and
has powerful effects on two systems: Gastro-Intestinal
and Gynaecological.
CORE)EASE acts on the whole digestive system,
removing obstruction and stagnation by elimination via
the intestines.
[email protected]
2/02/15
GORD/Reflux
149
—  Panaxea ZJP (Ethanol extraction only)
¡  Huang Lian (coptis rhizome)
85.7%
¡  Wu Zhu Yu (evodia fruit)
14.3%
¡  The anti-inflammatory properties of ethanol extract from ZJP might
be the results from the inhibition of iNOS, COX-2, IL-6, IL-1β, and
TNF-α expression through preventing the nuclear translocation of the
NF-κB p50 and p65 subunits in RAW 264.7 cells. In addition, these
results provided evidence to understand the therapeutic effects of ZJP
on gastritis, gastric ulcer, and other inflammatory diseases in clinic.
Stomach ‘Cold’
¡  Ethanol extract from ZJP produced antidepressant-like effect and the
possible mechanism, at least in part, is via the central monoaminergic
neurotransmitter system and 5-HT plays a major role
[email protected]
2/02/15
H. pylori
150
—  H. pylori is one of humanity’s old friends and companions:
the bacteria has been in human stomachs for at least
50,000 years, and probably longer. Roughly fifty percent of
all humans carry it (Science. 2003 Mar 7;299:5612).
—  Interestingly, the percentage of infected people has been
decreasing since the 1950s, with richer countries having
much lower rates than the rest of the world. In the US, less
than 25 percent of adults and only about 5 percent of all
school children are infected.
[email protected]
2/02/15
H. pylori
151
—  Every infected person harbour their own individual H.
pylori strain, but strains can undergo genetic alteration in
vivo, driven by an elevated mutation rate and frequent
intraspecific recombination. This genetic variability, which
affects both housekeeping and virulence genes, has long
been thought to contribute to host adaptation (2007, doi:
10.1038/nrmicro1658).
—  Most strains possess factors that subtly modulate the host
environment, increasing the risk of peptic ulceration,
gastric adenocarcinoma, and possibly other diseases (2009,
doi:10.1172/JCI38605).
[email protected]
2/02/15
H. pylori
152
—  In spite of being a highly prevalent bacterium in the gastric
mucosa, only 15 % of carriers develop overt disease.
Bacterial pathogenesis is believed to arise from an
interaction of strain-specific immunity-mediating
capabilities and the host susceptibility.
—  In a healthy host, the H. pylori strains that are
asymptomatically tolerated are those with the ability to
invade the mucous layer as well as those that inhibit the
ability of epithelial cells to secrete defensin and
chemoattractants (Wendelsdorf et al. Immunology
Conference 2011).
[email protected]
2/02/15
H. pylori
153
—  Since the 1950s, the number of patients with allergies,
asthma or autoimmune diseases has sky-rocketed. Children
without Helicobacter in their stomachs are more likely to
suffer from skin allergies or hay fever.
—  The bacteria also seem to provide a certain protection
against coeliac conditions, also wheat FODMAPs
intolerance. The bacteria might even manipulate our
appetite: the New York based doctor Martin Blaser assumes
a connection between its eradication and the growing
obesity problem worldwide.
[email protected]
2/02/15
Chronic Atrophic Gastritis
154
—  When severe inflammation of gastric membrane destroys
gastric mucosal epithelial cells, gastric glandular cells are
destroyed and eventually replaced by intestinal-type
epithelial cells with high cell proliferative rate and fibrosis.
—  Then chronic atrophic gastritis with intestinal metaplasia
and dysplasia, an important causative factor for gastric
cancer, occurs.
—  Intestinal metaplasia disturbs the cell proliferation and
apoptosis in normal gastric mucosa and increases incidence
of gastric cancer which is the second most common cause of
cancer deaths worldwide.
[email protected]
2/02/15
Chronic Atrophic Gastritis
155
—  53 Chinese medicinal herbs and prescriptions were
investigated for chronic atrophic gastritis (CAG), Panax
notogenseng and Magnolia officinalis were discovered to be
sensitive, Prunus mume and Corydalis Yanhusuo were
moderate sensitive, and Coptis chinensis and Rheum
palmatum highly sensitive to HP.
—  Decoction of Clearing up the Heat and Relieving the Blood
Stasis (CHRBS) was used to treat 70 CAG patients with
Stomach Heat Syndrome. The effective rate of gastroscopic
examination was 85.7% (Zhang et al, 1995)
[email protected]
2/02/15
Zhu Yu Tang (CHRBS)
156
—  Semen Persicae (Tao Ren)
—  Poria (Fu Ling)
—  Flos Carthami (Hong Hua)
—  Caulis Spatholobi (Ji Xue
—  Rhizoma Sparganii
— 
— 
— 
— 
— 
(San Leng)
Rhizoma Curcumae (EZhu)
Rhizoma Chuanxiong
(Chuan Xiong)
Radix Salviae Miltiorrhizae
(Dan Shen
Radix Angelicae Sinensis
(Dang Gui)
Radix Paeoniae Alba (Bai
Shao)
[email protected]
— 
— 
— 
— 
— 
Teng)
Sanguis Draconis (Xue Jie)
Ramulus Cinnamomi (Gui
Zhi)
Ramulus Mori
(Sang Zhi)
Rhizoma Cimicifugae
(Sheng Ma)
Flos Caryophylli
(Ding Xiang)
2/02/15
Zhu Yu Tang (CHRBS)
157
—  Rhizoma et Radix
— 
— 
— 
— 
— 
Notopterygii (Qiang Huo)
Rhizoma Cyperi (Xiang Fu)
Rhizoma Alpiniae
Officinarum (Gao Liang
Jiang)
Radix Gentianae
Macrophyllae (Qin Jiao)
Rhizoma Corydalis (Yan
Hu Suo)
Cortex Moutan (Mu Dan
Pi)
[email protected]
—  Radix Cyathulae (Chuan
— 
— 
— 
— 
Niu Xi)
Semen Nelumbinis (Lian
Zi)
Fructus Jujube (Da Zao)
Radix Glycyrrhizae (Gan
Cao)
Fructus Liquidamberis (Lu
Lu Tong)
2/02/15
Weiqi Decoction
—  Radix Angelicae Sinensis
(dang gui) 20g —  Radix Astragali (huang qi)
25g
—  Radix Codonopsis (dang
shen) 20g
—  Rhizoma Curcumae Ezhu
25g
—  Fructus Aurantii (zhi qiao)
25g
—  Fructus Akebiae (ba yue
zha) 25g
—  Herba Taraxaci (pu gong
ying) 50g
[email protected]
158
—  Inhibits AGS cell
proliferation through G2/
M arrest due to downregulation of cyclin B1
protein expression, and
promotes apoptosis by
caspase-3 and
mitochondria-dependent
pathways (Chin J Integr
Med 2014 Jun;20,6)
2/02/15
Panaxea Epi-Gastro Enzyme Formula
159
—  Radix Linderae (wu yao)
—  Hypochlorhydia
—  Flos Lonicera (jin yin hua)
—  SIBO
—  Endothelium Corneum
Gigeriae Galli (ji nei jin)
—  Alpha-Amylase
—  Tryptin Protease
—  Lipase
—  Bromelain
—  Papain
—  Pepsin
—  Cellulase
[email protected]
—  Gastric Ulcer
—  Poor protein absorption
—  Pepsin deficiency
—  Slow gastric emptying time
2/02/15
Insulin Resistance
160
—  Extragastric or extraintestinal manifestations of
Helicobacter pylori has been linked with insulin resistance
(IR). The metabolic syndrome consists of several known
factors which include IR, abnormal fat metabolism,
hypertension, abdominal obesity, proinflammatory and
prothrombotic state.
—  H. pylori infection and metabolic syndrome both show
increase in prevalence with age, and since IR is a key factor
in the pathogenesis of metabolic syndrome, research of a
possible correlation between H. pylori infection and IR has
intensified in the last decade (doi: 10.3748/
wjg.v20.i16.4607).
—  Research has demonstrated a direct link between H. pylori
infection and IR
[email protected]
2/02/15
H. Pylori infection
Chronic
Inflammation
Psychophysical
Factors
Gastric
Hormones
Leptin
Ghrelin
Gastrin
Somatostatin
Inflammatory
Cytokines
IL-1β, TNF, CRP
Insulin Resistance
Insulin Secretion
T2DM
[email protected]
161
2/02/15
H. pylori
162
—  Helicobacter pylori (H. pylori) has been conclusively
related to several gastro-duodenal diseases. The possible
role of the bacterium in the development of extragastric
manifestations has been investigated.
—  Controversial findings of H. pylori seroprevalence have
been obtained in patients with bronchial asthma, lung
cancer, pulmonary tuberculosis, sarcoidosis, cystic fibrosis,
chronic bronchitis and bronchiectasis.
—  In the past few years, a variety of extradigestive disorders,
including cardiovascular, skin, rheumatic and liver
diseases, have been associated with H. pylori infection.
[email protected]
2/02/15
H. pylori
163
—  Heimesaat et al., (2014) investigated microbiota changes
along the entire GI tract after infection with H. pylori.
Comprehensive cultural analyses revealed that severe
gastric diseases such as atrophic pangastritis and
precancerous transformations were accompanied by
elevated luminal loads of E. coli and enterococci in the
caecum.
—  This leads to distinct shifts of the microbiota composition
in the distal uninflamed GI tract. Hence, H. pylori induced
immunopathogenesis of the stomach, including
hypochlorhydria and hypergastrinaemia, might trigger
large intestinal microbiota changes.
[email protected]
2/02/15
H. pylori
164
—  The role of Helicobacter pylori (HP) in some digestive
diseases (gastritis, ulcer, gastric cancer, MALT lymphoma)
is well known. It has also involved in respiratory disorders
(chronic obstructive pulmonary disease, bronchiectasis,
lung cancer, pulmonary tuberculosis, bronchial asthma);
vascular disorders (ischaemic heart disease, stroke, primary
Raynaud phenomena, primary headache); autoimmune
disorders (Sjogren syndrome, Henoch-Schonlein purpura,
autoimmune thrombocytopenia, autoimmune thyroiditis,
Parkinson's disease, idiopathic chronic urticaria, rosacea,
alopecia areata); other disorders (iron deficiency anaemia,
growth retardations, liver cirrhosis).
[email protected]
2/02/15
Panaxea Helico)X
165
—  Coptis Chinensis Rhizoma
— 
— 
— 
— 
— 
— 
(Huang Lian )
Rheum Palmatum Rhizoma
(Da Huang)
Heydyotidis Diffusa Herba
(Bai Hua She She )
Radix Pseudoginseng (San
Qi )
Salvia Miltiorrhiza Radix
(Dan Shen )
Magnolia Officinalis Cortex
(Hou Po)
Pueraria Lobata Radix (Ge
Gen)
[email protected]
—  Chicken Gizzard (Ji Nie Jin )
—  Paeoniae Lactiflorae Radix (Bai
— 
— 
— 
— 
— 
Shao)
Prunus Mume Fructus (Wu
Mei )
Codonopsis Pilosula, Radix
(Dang Shen )
Astragalus Membranaceus
Radix (Huang Qi )
Cinnamom Cassia Ramulus
(Gui Zh)
Olibanum Gummi (Boswelia
Carterii) (Ru Xiang )_(fried w/
vinegar)
2/02/15
Panaxea Pure)arin
166
—  Puerarin significantly attenuates gastric mucosal damage
induced by water-immersion stress, inhibits gastric
motility, specially decreases the index of gastric motility
and percentage of gastric contraction time and numbers of
violent contraction. The gastric mucosal blood flow and NO
level in gastric mucosal were enhanced.
—  Puerarin exerts a significant protective effect on waterimmersion stress-induced gastric mucosal damage by
relaxing the vessels, increasing NO level in gastric mucosal,
increasing regional gastric mucosal blood flow and
inhibiting gastric motility (Wang et al, 2006).
[email protected]
2/02/15
Peptic Ulcer
167
—  A clinical study involving 30 cases of peptic ulcer, the
patients took 12 sea buckthorn oil capsules daily for one
month. A curing rate of 76.6 % and a total effective rate of
96.7 % were reported.
—  Sea buckthorn oil was also used as an adjuvant treatment of
116 peptic ulcer patients, 71 with duodenal ulcer and 45
with gastric ulcer (AGROFood Industry Hi-Tech, 2003 Vol.
53, No.3). Oral application of sea buckthorn oil relieved
pain and accelerated the repair process of gastric and
duodenal epithelial tissue and mucosa.
[email protected]
2/02/15
SSRIs, Alcohol & Gastric Bleeding
168
—  SSRI users had a 50% increased risk for upper gastrointestinal
bleeding (UGIB) compared with nonusers. Both antiplatelet drugs
and nonsteroidal anti-inflammatory drugs (NSAIDs) increased the
risk for a bleeding episode; the concomitant use of both with SSRIs
resulted in a nine-fold elevated risk for UGIB (2014,
http://dx.doi.org/10.1016/j.cgh.2014.06.021).
—  Ethanol has experimentally been shown to be "ulcerogenic,"
independent of gastric intraluminal pH. Ethanol remains
ulcerogenic despite anti-secretory doses of H2-receptor
antagonists. Low-dose alcohol stimulates acid secretion, an effect
possibly mediated by histamine or gastrin. High-dose alcohol
reduces intraluminal acid by damaging mucosa. Ethanol is capable
of increasing gastric mucosal permeability (Emerg Med Clin North
Am, 1990).
[email protected]
2/02/15
SSRIs & Gastric Bleeding
169
—  SSRI users had a 50% increased risk for upper
gastrointestinal bleeding (UGIB) compared with nonusers.
—  Both antiplatelet drugs and nonsteroidal anti-inflammatory
drugs (NSAIDs) increased the risk for a bleeding episode;
the concomitant use of both with SSRIs resulted in a ninefold elevated risk for UGIB (2014, http://dx.doi.org/
10.1016/j.cgh.2014.06.021).
[email protected]
2/02/15
Gastric Bleeding
170
—  Banxia-baizhu-tianma-tang (BCT) protects the gastric
mucosa against ethanol-induced gastric injury by
increasing the antioxidant status. Shin et al., (2013) suggest
that BCT could be developed as an effective drug for the
treatment of gastric injury caused by alcohol intake.
—  BCT reduced ethanol-induced haemorrhage, hyperaemia,
and loss of epithelial cell in the gastric mucosa. BCT
reduced the increased lipid peroxidation associated with
ethanol-induced acute gastric lesions, and increased the
mucosal GSH content and the activities of antioxidant
enzymes (2013, doi: 10.1186/1472-6882-13-170).
[email protected]
2/02/15
Ban Xia Bai Zhu Tian Ma Tang
171
—  Pinelliae Tuber (ban xia)
—  Gastrodiae Rhizoma (tian
—  Citri Unshius Pericarpium
ma)
—  Ginseng Radix (ren shen)
—  Astragali Radix (huang qi)
—  Alismatis Rhizoma (ze xie)
—  Zingiberis Rhizoma
(sheng jiang & gan jiang)
—  Phellodendri Cortex
(huang lian)
(wen zhou migan)
—  Hordei Fructus
Germinatus (mai ya)
—  Atractylodis Rhizoma
Macrocephalae (bai zhu)
—  Massa Medicata
Fermentata (shen qu)
—  Poria Sclerotium (fu ling)
—  Atractylodis lancea (cang
zhu)
[email protected]
2/02/15
Panaxea Emodin
172
—  Several studies done in China demonstrate the protective
effect of Radix et Rhizoma Rhei (da huang) and its
component Emodin on gastric bleeding.
—  Three groups, namely, Rheum officinale Baill, Rheum
palmatum L, and Rheum tanguticum Maxim were studied.
—  The time taken for the stool occult blood changing from
positive into negative was 57.1, 53.4, and 56 hours
respectively. This shows that they are efficient in curing the
upper digestive tract bleeding (Zhong Xi Yi Jie He Za Zhi.
1983 Jul;3(4):251-2; Zhong Xi Yi Jie He Za Zhi. 1988 Jun;
8(6):344-6, 324-5,Zhong Xi Yi Jie He Za Zhi. 1990 Mar;
10(3):150-1, 131-2).
[email protected]
2/02/15
Thyroid & Stomach
173
—  In rats dietary iodides are able to defend brain cells from
lipid peroxidation (Katamine et al, 1985). In normal thyroid
hormonogenesis, iodide in giving its electron to oxygen
reduces H2O2 by peroxidase activity. The remaining iodine
readily iodinates the tyrosine and so neutralises its own
high oxidant power.
—  The stomach and the thyroid share iodide concentrating
ability and many morphological and functional similarities
such as cell polarity and apical microvilli, similar organspecific antigens and associated autoimmune diseases
(Roitt et al, 1988).
[email protected]
2/02/15
Thyroid & Gut
174
—  The thyroid gland is, embryogenetically and
phylogenetically, derived from the primitive gut, and we
may consider the thyroid cells as primitive gastroenteric
cells, which, during evolution, migrated and specialised in
the uptake of iodide and in the storage and elaboration of
iodine compounds (Venturi & Venturi, 1999).
[email protected]
2/02/15
Panaxea Thyrocaps
175
—  Supplies L-Tyrosine for thyroxine production
—  Increases thyroxine production
—  Increases T4 to T3 conversion
—  Increases thermogenesis
—  Increases mitochondrial activity
—  Relieves symptoms of hypothyroidism such as fatigue,
depression, weight gain and dry skin
[email protected]
2/02/15
Thyrocaps
176
—  L-Tyrosine
—  Coleus forskohlii
(contains extract 20% of
Forskolin)
—  Cordyceps (contains
extracts 0.15% adenosine
& 5% mannitol)
—  Guggul (guggulipid
extract standardized to
10% guggulsterones,
containing 0.5-2% E- and
Z-guggulsterones)
[email protected]
—  Forskolin may increase
thyroid through the
activation of the betanaphthylamidase enzyme
which functions to raise
cyclic adenosine
monophosphate (cAMP)
levels. This in turn
stimulates the release of
thyroid hormone (TSH)
2/02/15
Gastric Cancer
177
—  A combination of chemotherapy with oral administration of
YWKL Formula significantly increased the survival of stage
IV gastric cancer patients. Orally administration with
YWKLF had anti-tumour cell activity.
—  Li et al., (2008) observed that sera from rabbits
administered with YWKLF induced the apoptosis of
MGC-803 cells by causing the loss of mitochondrial
membrane potential, increasing the expression of Fas
protein and Bax mRNA, as well as down-regulating Fas-L
mRNA.
[email protected]
2/02/15
YWKL (Gastric Cancer) Formula
178
—  Codonopsis pilosula
(Dang Shen)
—  Astragalus
membranaceous (Huang
Qi)
—  Paeonia alba (Bai Shao)
—  Dioscorea opposita (Shan
Yao)
—  Cyperus rotundus (Xiang
Fu)
—  Citrus reticulata (Chen
Pi)
[email protected]
—  Activates major apoptotic
pathways
2/02/15
Gastric Cancer
179
—  Treating advanced stomach cancer, with the combination of
Kangai injection and chemotherapy, may decrease the
adverse effects of chemotherapy on patients′ cellular immune
functions and other side effects, and thereby, improve the
quality of life of patients (Wu & Yang, 2007).
—  Expressions of Tenascin-C are down-regulated when gastric
cancer MGC-803 cells were treated with Shenqi Fuzheng
injection at high concentration, therefore the invasiveness of
gastric tumours may be reduced (Ma et al., 2013).
[email protected]
2/02/15
Shen Qi Fu Zheng
180
—  Codonopsis pilosula
(dang shen)
—  Astragalus
membranaceus (huang
qi)
[email protected]
—  Shenqi-Fuzheng injection
plus chemotherapy can
improve cellular immune
function, tolerance of
chemotherapy, and
reduce toxicity in patients
with advanced gastric
cancer (Yin & Jiang,
2013).
2/02/15
Gastric Cancer
181
—  The control group was treated by chemotherapy and the
treatment group by chemotherapy and Yiqi Bushen Oral
Liquid. The relapse and metastatic rate of the treatment
group was remarkably lower than that of the control group.
The Karnofsky score, peripheral blood and immune
function were all remarkably improved in comparison with
the control group.
—  Yiqi Bushen oral liquid, combined with chemotherapy, has
an effective function in down-regulating stomach
metastasis after surgery, increasing chemo-sensitivity,
decreasing adverse reactions, improving quality of life, and
improving immune function of patients (Liu et al., 2008).
[email protected]
2/02/15
Panaxea Yiqi Bushen Liquid
182
—  Astragali Radix (huang
—  Scutellariae barbatae
qi)
—  Poria (fu ling)
—  Ligustri lucidi Fructus
(nu zhen zi)
—  Lycii Fructus (gou qi zi)
—  Sclerotium Polypori
Umbellati (zhu ling)
—  Curcumae Rhizoma Ezhu
(e zhu)
Herba (ban zhi lian)
—  Actinidiae Chinensis
Radix (teng li gen)
—  Coicis Semen (yi ren)
—  Caulis Aristolochiae
Manshuriensis (ba yue
zha)
—  Jujubae Fructus (da zao)
—  Glycyrrhizae Radix
preparata (zhi gan cao)
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2/02/15
Oesophageal Adenocarcinoma (OA)
183
—  Participants who took 1 or more multivitamin pills/day had
a significantly decreased risk of tetraploidy and OA
compared to those not taking multivitamins. Significant
inverse associations were also observed between risk of OA
and supplemental vitamin and vitamin E.
—  In this cohort study, use of multivitamins and single
antioxidant supplements was associated with a significantly
reduced risk of OA and markers of neoplastic progression
among individuals with Barrett's oesophagus (Dong et al.,
2008).
[email protected]
2/02/15
Oesophageal Adenocarcinoma
(Syndrome differentiation)
184
—  For obstruction of Phlegm and qi: Xuan Fu Dai Zhe Tang
combining Li Ge Hua Tan Wan (Lin Zongguang)
—  For obstruction of stagnant Blood and Phlegm: Qi Ge San
combining Tao Hong Yin and Li Ge Hua Tan Wan
—  For Fluid injury and stagnant Blood accumulation: Sha
Shen Mai Dong Tang combining Tong You Tang (Lin Zg,
2004).
[email protected]
2/02/15
Oesophageal Adenocarcinoma
185
For the middle and advanced stage, in combination with
chemotherapy or radiotherapy
—  Shen Zhu Fu Zheng Tang: huang qi, dang shen, bai zhu, fu
ling, dan shen, chuan xiong, di long, xi xue teng, gan cao
(Fu Js, 2008)
For the advanced stage, which is not suitable for surgery,
chemotherapy, or radiotherapy
—  Fu Zheng Xiao Ai Tang: dang shen, dang gui, sheng di, shi
hu, tian hua fen, san qi, wei ling xian, jiang can, ban xia, fu
ling, chai hu, bai zhu, gan cao (Liu & Zhang, 2008)
[email protected]
2/02/15
Oesophageal Adenocarcinoma
(Treatment according to different principles)
186
Methods of clearing ‘Phlegm’ and removing ‘Stagnant Blood’
for the middle and advanced stage
—  Formula: zhi ban xiao, zhi nan xing, qing meng shi, lu feng
fang, dan shen, yi yi ren, chuan xiong, fu ling (Gao & Shen,
2007)
For the advanced stage, as the main treatment
—  Ding Xiang Tou Ge Tang: ding xiang, sha ren, sheng huang
qi, bai hua she she cao, xia ku cao, zhi ban xia, zhi nan xing,
sheng wa leng zi, ji xing zi, qiang lang chong, zhi shou gong,
wei ling xian, shi da chuan, lu feng fang, quan xie, wu gong
(Xu & Zhong, 2006).
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2/02/15
Pancreatitis
187
PANCREATIC ENZYMES (ESPECIALLY
TRYPSIN) THAT DIGEST FOOD ARE
ACTIVATED IN THE PANCREAS INSTEAD OF
THE DUODENUM
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2/02/15
Panaxea Berberine
188
—  Berberine attenuates intestinal barrier dysfunction and
ameliorates intestinal mucosal barrier damage and
membrane permeability associated with severe acute
pancreatitis (SAP).
—  Although berberine exerted minimal effects on tight
junction proteins in the ilea of SAP rats, it was observed to
significantly inhibit SAP-induced MLC phosphorylation
(2014, doi: 10.3892/mmr.2014.1996).
—  Berberine showed preferential selectivity toward pancreatic
cancer cells compared to normal ones (2010, DOI: 10.1055/
s-0030-1249931).
[email protected]
2/02/15
Panaxea Emodin
189
—  Serum levels of amylase, tumour necrosis factor-alpha
(TNF-α), angiotensin II (AngII), maleic dialdehyde (MDA),
glutamic pyruvic transaminase (ALT), glutamic oxaloacetic
transaminase (AST) and C-reactive protein (CRP),
intestinal secretory IgA (SIgA), pancreatic and hepatic
myeloperoxidase (MPO) activity as well as plasma levels of
D-lactate and endotoxin were measured.
—  Emodin-assisted early enteral nutrition (EAEEN) could
significantly ameliorate these parameters and prevent
pancreas and liver from serious damage (2007, doi:
10.1155/2007/29638).
[email protected]
2/02/15
Emodin
190
—  Emodin and somatostatin analogs can be used the
management of acute pancreatitis, which might be ascribed
to the upregulation of TGFβ1 and EGF gene expression,
which subsequently increases DNA synthesis and protein
content and thus accelerates pancreatic repair and
regeneration (Pancreas. 2002 Aug;25(2):154-60).
—  Emodin enhances cytokine TGFβ1 gene expression,
regulates cell growth and differentiation, stimulates the
formation of extracellular matrix components, increasing
DNA synthesis and protein content, to take part in
pancreatic repairing and remodeling (http://
www.ncbi.nlm.nih.gov/pubmed/12577439).
[email protected]
2/02/15
Gardenia jasminoides
191
—  Gardenia jasminoides (zhi zi) remarkably reduced the
serum amylase and myeloperoxidase levels of both serum
and pancreatic tissue as well as the level of TNF-alpha and
IL-6 as well as reducing injury by oxygen-free radicals, NO
and endotoxins (Chin J Integr Tradit West Med 1996;
16:355-7).
—  Gardenia can lower vasopermeability and inflammation,
improve pancreatic haemodynamics, protect the function of
the cellular membrane and alveolar subcellular organelles,
strengthen the defence mechanism and inhibit the release
of pancreatic enzymes and biotic active factors (J
Hepatopancreatobiliary Surg 2003; 15:156-7).
[email protected]
2/02/15
Salvia miltiorrhiza
192
—  Salvia miltiorrhiza (dan shen) can alleviate pathological
changes in the pancreas due to its inhibitory effect on initial
neutrophilic granulocyte and endotheliocyte adhesion by
decreasing IL-1, IL-6 and TNF-α levels in the blood,
pancreatic enzyme production and phospholipase A
activation (Chin J Pract Chin Modern Med 2004;
4:1969-71).
—  A significant difference in the incidence of complications,
frequency of surgery and average hospital stay has been
reported by Zhang et al. between the salvia miltiorrhizatreated group and the control group (J Jiangsu University
(Med Edition) 2004; 14:406-9).
[email protected]
2/02/15
Panaxea Silibinin
193
—  Silibinin effectively inhibited the pancreatic carcinoma
AsPC-1, BxPC-3 and Panc-1 cells’ proliferation and caused
apoptosis. Silibinin induced a decrease in S phase and cell
cycle arrest in G1 phase in AsPC-1 cells, but had no obvious
changes in BxPC-3 and Panc-1 cell cycle (2011, doi:
10.3390/ijms12084861).
—  Silibinin may protect pancreatic exocrine cells (Cell Mol
Life Sci. 1997;53: 917–920).
—  Silibinin is thought to be an antioxidant, a cell membrane
stabiliser, a general "hepatoprotectant", and a compound
that helps to conserve intracellular glutathione levels and
encourage cellular growth and regeneration.
[email protected]
2/02/15
Pancreatitis
194
—  Acanthopanax (wu jia pi) led to apparently a higher serum NO
level and superoxide dismutase activity in the treated group in
relation to the severe acute pancreatitis group, and a notable
decline in serum amylase as well as a decreased pathological
state of the pancreas (Zhang, JOP. J Pancreas 2007).
—  Baicalin has a protective effect on multiple organs of a severe
acute pancreatitis rat model similar to that of octreotide (ibid)
—  Panax Notoginoside has been found to downgrade the serum
amylase level in severe acute pancreatitis and the positive
incidence of germiculture for the pancreas, liver, spleen, lung
and mesenteric lymph nodes; it protects the intestinal mucosal
barrier, inhibits enteric bacterial translocation and lessens
pathological injury (Chin J Bases Clin Gen Surg 2004)
[email protected]
2/02/15
Panaxea CelProtect
195
—  Radix Pueraria lobata (Ge
— 
— 
— 
— 
— 
Gen) contains Daidzein
Semen Sojae Praeparatum
(Dan Dou Chi) contains
Glycitein
Sojae Praeparatum (Dan Dou
Chi) contains Genistein
Radix Scutellariae Baicalensis
(Huang Qin) contains
Baicalein
Radix Scutellariae Baicalensis
(Huang Qin) contains Baicalin
Fructus Gardeniae
Jasminoidis (zhi zi) contains
Jasminoidin
[email protected]
—  Anti-inflammatory
—  Enhances immunologic
functions
—  Inhibits angiogenesis
—  Anti-tumoural
2/02/15
Microbiome
196
GUT/MICROBIOME CO-EVOLUTION
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2/02/15
Evolution of Microbiome
197
—  Ley et al., (2006, DOI: 10.1016/j.cell.2006.02.017) argue
that the microbial diversity of the human gut is the result of
coevolution between microbial communities and their
hosts. They suggest that the peculiar structure of microbial
diversity in the human gut resulted from natural selection
operating at two levels.
—  Host level, “top-down” selection on the community favours
stable societies with a high degree of functional
redundancy. An opposing “bottom-up” force is selection
pressure driving microbial cells to become functionally
specialised
[email protected]
2/02/15
Microbial Diversity
198
—  Ley et al., suggest the idea that
microbial community structure
should be considered as a factor
that can influence predisposition
to specific diseases in certain host
contexts.
—  We need to monitor human
“microevolution” during this
period of profound social,
economic, and ecological change,
and, hopefully, help us forecast
changes in our disease
susceptibility.
[email protected]
2/02/15
Evolution of Microbiome
199
—  Humans are ecosystems containing trillions of
microorganisms, but the evolutionary history of this
microbiome is obscured by a lack of knowledge about
microbiomes of African apes.
—  Moeller et al., (2014 doi: 10.1073/pnas.1419136111)
sequenced the gut communities of hundreds of
chimpanzees, bonobos, and gorillas and developed a
phylogenetic approach to reconstruct how present-day
human microbiomes have diverged from those of ancestral
populations.
—  Human microbiomes have lost ancestral microbial diversity
while becoming specialised for animal-based diets
[email protected]
2/02/15
Evolution of Microbiome
200
—  In the distinct habitats of the gut, environmental filtering
and competitive exclusion between microbes are the driving
factors shaping microbial diversity.
—  Specialists have smaller genomes than generalists, and
microbes with environmental reservoirs have large
accessory genomes. A shift toward a Neolithic diet
increased loads of simple carbohydrates and selected for
their increased breakdown and absorption in the small
intestine.
—  Humans who outcompeted microbes for the new substrates
obtained more energy from their diets (2011, doi: 10.1146/
annurev-micro-090110-102830)
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2/02/15
Evolution
201
—  If one looks at the gut microbiome as a major, if not
dominant, component of the DNA of a host animal, then
changes in the gut microbiome can quite naturally lead to
new adaptations and speciation just like changes in nuclear
genes.
—  Dr. Seth Bordenstein adheres to this view and suggests that
the gut microbiome must be considered a major portion of
the genetics of an animal, in combination with the nuclear
genome and organelles – what is now called a hologenome.
—  The changes in the gut microbiome can promote the
evolution of one species, the microbiome into two species;
the micro-biomes and the host.
[email protected]
2/02/15
Microbiome
202
—  Individual human health is determined by a complex
interplay between genes, environment, diet, lifestyle, and
symbiotic gut microbial activity. Here, we demonstrate a
new "nutrimetabonomic" approach in which
spectroscopically generated metabolic phenotypes are
correlated with behavioural/psychological dietary
preferences.
—  Data suggest that specific dietary preferences can influence
basal metabolic state and gut microbiome activity that in
turn may have long-term health consequences to the host (J
Proteome Res. 2007 Nov;6:11).
[email protected]
2/02/15
Diet & Microbiota
203
—  Diet is a major force that shapes the composition and
activity of the gut microbiota. This is evident from
alterations in gut microbiota composition after weaning or
drastic dietary changes. Owing to the complexity of the
microbiota, interactions of intestinal bacteria with the host
are difficult to study (2013, doi: 10.3920/BM2012.0029).
—  As diet appears to play a predominant role in shaping the
microbiota and promoting obesity-associated dysbiosis,
parallel initiatives are required to elucidate dietary patterns
and diet components (e.g., prebiotics, probiotics) that
promote healthy gut microbiota (2013, doi: 10.1016/j.mam.
2012.11.001).
[email protected]
2/02/15
Microbiome & Obesity
204
—  Microbes in the gastrointestinal tract are under selective
pressure to manipulate host eating behaviour to increase
their fitness, sometimes at the expense of host fitness.
Microbes may do this through two potential strategies: (i)
generating cravings for foods that they specialise on or
foods that suppress their competitors, or (ii) inducing
dysphoria until we eat foods that enhance their fitness
(2014, DOI: 10.1002/bies.201400071).
—  Conventional wisdom often blames unhealthy eating on a
lack of willpower. However, binge eating is not just a matter
of mental control (Int J Eat Disord. 1995 Jul;18:1) food
cravings are unlike other cravings.
[email protected]
2/02/15
Microbiome & Obesity
205
—  Obesity-related disorders derive from a combination of
genetic susceptibility and environmental factors. Recent
evidence supports the role of gut microbiota in the
pathogenesis of obesity, type 2 diabetes mellitus, and
insulin resistance by increasing energy harvest from diet
and by inducing chronic, low-grade inflammation.
—  Several studies describe characteristic differences between
composition and activity of gut microbiota of lean
individuals and those with obesity (2012, doi: 10.1016/j.gtc.
2012.08.009).
[email protected]
2/02/15
Microbiome & Obesity
206
—  A large cohort study (n = 64,580) in the US found an
increased risk of obesity in children aged 2–5 years who had
been exposed repeatedly to broad-spectrum antibiotics in
their first 24 months (four or more episodes) (rate ratio [RR]
1.11, 95% confidence interval [CI] 1.02 to 1.21) (JAMA Pediatr
2014;168:1063–9).
—  A review of antibiotic use in infants and delayed health effects
found the use of antibiotics resulted in a change in gut
microbiota (BJOG 2006;113:758–65).
—  In a study of 14 infants' gastrointestinal microbial
communities over the first year of life, use of antibiotics was
associated with a sudden change in the density or
composition of the microbiota (PLoS Biol 2007;5:e177).
[email protected]
2/02/15
Immune System & Gut Microbiome
207
—  Rich and balanced bacterial communities seem to be
perceived as "self" and induce a quick maturation of the
immune system and gut responses (induction of regulatory
T cells and IgA), while a poor and unbalanced bacterial
community is apparently perceived as "non-self" and
induces responses aimed at eliminating it (T cells with
inflammatory properties and IgG or IgE responses (2014;
doi: 10.1016/j.immuni.2014.05.016).
—  New insights from DNA sequence-based analyses of gut
microbial communities and a renewed interest in mucosal
immunology suggest that the microbiome represents an
important environmental factor that can influence
autoimmune disease manifestation.
[email protected]
2/02/15
Microbiome & Immunity
208
—  Evidence suggests that when our resident biota are out of
balance, they contribute to numerous diseases, including
diabetes, rheumatoid arthritis, autism and multiple
sclerosis (MS) by inciting rogue immune activity that can
spread throughout the body and brain.
—  A single-celled organism called methanobrevibacteriaceae
that activates the immune system is enriched in the
gastrointestinal tracts of MS patients whereas bacteria that
suppress immune activity are depleted. Preliminary
findings indicate that in MS, gut microbiome composition
is significantly altered, with enrichment for microbiota
known to be associated with gastrointestinal infectious
processes (Tremlett H, et al., 2014).
[email protected]
2/02/15
Microbiome & Immunity
209
—  Several studies have shown that gut bacteria have a role in
diabetes. As healthy infants approach the toddler stage,
their microbiomes become healthier and more stable,
whereas, children who are destined for autoimmunity
develop a microbiome that is less diverse and stable. Hence,
the autoimmune microbiome for T1D may be distinctly
different from that found in healthy children.
—  Bacteria that negatively correlated with the autoimmune
state may prove to be useful in the prevention of
autoimmunity development in high-risk children (The
ISME Journal 2011 doi:10.1038/ismej.2010.92).
[email protected]
2/02/15
Microbiome & RA
210
—  A newly published study found that the onset of rheumatoid
arthritis (RA) could be partly mediated by specific intestinal
bacteria. Scher et al., (2013) found that patients with newly
diagnosed rheumatoid arthritis had more of a species of
bacteria called Prevotella copri in their guts compared to
healthy individuals or patients with chronic, treated RA.
—  The presence of Prevotella copri as strongly correlated with
disease in new-onset untreated rheumatoid arthritis
(NORA) patients. Increases in Prevotella abundance
correlated with a reduction in Bacteroides and a loss of
reportedly beneficial microbes in NORA subjects (doi:
10.7554/eLife.01202).
© DR.D.Weber 2012
2/02/15
Microbiome & RA
211
—  The production of cross reactive antibodies is strikingly
increased in the gut of many RA patients. Their food related
problems might reflect an adverse additive effect of
multiple modest hypersensitivity reactions mediated, for
instance, by immune complexes promoting autoimmune
reactions in the joints (2006,doi:10.1136/gut.
2005.076901).
—  New insights from DNA sequence-based analyses of gut
microbial communities and a renewed interest in mucosal
immunology suggest that the microbiome represents an
important environmental factor that can influence
autoimmune disease manifestation such as RA (2011, doi:
10.1038/nrrheum.2011.121.
[email protected]
2/02/15
Periodontal Disease & RA
212
—  New-onset rheumatoid arthritis (NORA) patients exhibit a
high prevalence of periodontal disease (PD) at disease
onset, despite their young age and paucity of smoking
history. The subgingival microbiota of NORA patients is
similar to chronic RA (CRA).
—  Prevotella and Leptotrichia species are the only
characteristic taxa in the NORA group irrespective of PD
status. The role of A. geminatus and Prevotella/
Leptotrichia species in this process merits further study
(2012, doi: 10.1002/art.34539).
[email protected]
2/02/15
[email protected]
213
2/02/15
The extrinsic sensory innervation of the gastrointestinal tract
is the conduit through which the gut and the central nervous
system communicate. The hindbrain receives information
directly from the bowel via the vagus nerve, while
information from spinal afferents arrives in the central
nervous system through the dorsal root ganglia.
[email protected]
214
2/02/15
Dysbiosis
215
LEAKY, CREAKY AND THE PERMEABLE GUT
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2/02/15
Dysbiosis
216
—  Craven et al., (2012) sought to examine the dynamics of the
relationship between inflammation, the ileal microbiome,
and host genetics in murine models of ileitis.
—  Acute ileitis induces dysbiosis and proliferation of
mucosally invasive E. coli, (Adherent-invasive Escherichia
coli (AIEC) irrespective of trigger and genotype.
—  The identification of CCR2 chemokine (C-C motif) as a
target for therapeutic intervention, and discovery that host
genotype and therapeutic blockade of inflammation impact
the threshold and extent of ileal dysbiosis are of high
relevance to developing effective therapies for Crohn’s
Disease (doi:10.1371/journal.pone.0041594).
[email protected]
2/02/15
Dysbiosis
—  The relationship between
217
Normal Flora
Dysbiosis
the
human host and her army of microbes is described by the
Greek word, symbiosis, which means "living together".
When symbiosis benefits both parties, it is called
mutualism. When symbiosis becomes harmful, it is called
dysbiosis.
—  The first line of protection against dysbiosis and intestinal
toxicity is strict control of intestinal permeability, the
ability of the gut to allow some substances to pass through
its walls while denying access to others.
© DR.D.Weber 2012
2/02/15
[email protected]
218
2/02/15
Gut Permeability
219
—  Increased epithelial permeability may be important in the
development of chronic gut T cell–mediated inflammation.
CD4 T cells activated by gut antigens in Peyer's patches
migrate to the lamina propria (LP).
—  In healthy individuals, these cells die by apoptosis.
Increased epithelial permeability may allow sufficient
antigen to enter the LP to trigger T cell activation, breaking
tolerance mediated by immunosuppressive cytokines and
perhaps T regulatory cells. Pro-inflammatory cytokines then
further increase epithelial permeability, setting up a vicious
cycle of chronic inflammation (MacDonald & Monteleone,
2005).
© DR.D.Weber 2012
2/02/15
Cholecystokinin
Gall Bladder contraction
Gastrointestinal Motility
Pancreatic Exocrine Secretion
Secretin
Pancreatic Exocrine Secretion
GIP
Incretin Activity
Motilin
Gastrointestinal Motility
Ghrelin
Hunger
Growth Hormone Release
Gastrin
Acid Secretion
Insulin & Glucagon
Glucose Homeostasis
Pancreatic Polypeptide
Gastric Motility
Satiation
Amylin
Glucose Homeostasis
Gastric Motility
GLP-1
Incretin Activity
Satiation
GLP-2
Gastrointestinal Motility
and Growth
Oxyntomodulin
Satiation
Acid Secretion
PYY
Satiation
Enteric Endocrine System
Gut Feeling
© DR.D.Weber 2012
220
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EES
221
—  The second of the two systems that control digestive
function is the endocrine system, which regulates function
by secreting hormones.
—  The gastrointestinal tract is the largest endocrine organ in
the body and the endocrine cells within it are referred to
collectively as the enteric endocrine system.
—  The secretion of hormones is in response to fairly specific
stimuli and they stop secreting when those stimuli are no
longer present. In most cases these endocrine cells respond
to changes in the environment within the lumen of the
digestive tube.
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2/02/15
Paracrine Molecules
222
—  PM can affect energy balance and impact obesity and other
diseases of the organs mentioned before (autism,
depression, allergy, diabetes, inflammatory bowel disease,
and so on).
—  These molecules will also affect host biology, possibly at the
interface between microbial populations and the gutassociated immune system. It is known that the microbiota
exerts important effects on the maturation of the
mammalian immune system, so the small molecules in the
intestine could be used to modulate these relationships in
controlled ways.
[email protected]
2/02/15
MAJOR ACTIVITY
STIMULI FOR RELEASE
Stimulates gastric acid secretion
proliferation of gastric epithelium
Presence of peptides and amino
acids in lumen
Cholecystokinin
Stimulates secretion of Pancreatic
enzymes and emptying of the GB
Presence of fatty acids and amino
acids in Small Intestine
Secretin
Stimulates secretion of water and
bicarbonate from Pancreas and bile
ducts
Acidic pH in lumen of SI
Ghrelin
Strong stimulant for appetite and
feeding; potent stimulator of hGH
Secretion peaks prior to feeding and
diminishes with gastric filling
Motilin
Involved in stimulating general
patterns of motility in Stomach and
SI
Secretion is associated with fasting
Gastric Inhibitory Polypeptide
Inhibits gastric secretion and
motility and potentiates release of
insulin in response to blood glucose
concentration
Presence of fat and glucose in SI
HORMONE
Gastrin
[email protected]
223
2/02/15
HCA
224
—  The pH in the fundus can be on the order of 1–2. With this
low pH, pepsinogen, secreted by chief cells is converted to
pepsin. Pepsin breaks down protein-containing foods in the
fundus into peptides and amino acids, and calcium and
vitamin B12 are released. These food components arrive in
the antrum, where they induce the production of the
hormone gastrin. Gastrin travels via the blood to the fundus
to increase hydrochloric acid secretion.
—  Gastrin also enhances closure of the pylorus and
oesophageal sphincter. Local histamine secretion sensitises
parietal cells to the effects of activation the vagus nerve and
of gastrin.
[email protected]
2/02/15
HCA
225
—  Hydrochloric acid constitutes the majority of gastric acid,
the human digestive fluid. In a complex process and at a
large energetic burden, it is secreted by parietal cells.
—  Finally, the stomach secretes intrinsic factor, which is
required for vitamin B12 absorption in the intestine.
Vitamin B12 is a large molecule, and requires intrinsic
factor to protect it from destruction by the stomach.
[email protected]
2/02/15
H. Pylori
226
—  From approximately age 35 most
people begin to secrete less stomach
acid and by their 50's, it is estimated that over 50% have
low stomach acid. People with a history of HP infection
and/or who have long-term use of protein pump inhibitor
(PPI) medications are likely to have hypochlorhydria.
—  In Western countries the prevalence of HP infections
roughly matches age (i.e., 20% at age 20, 30% at age 30,
80% at age 80 etc).
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2/02/15
Neuropeptide Transmitters
227
—  In humans, eradicating H. pylori affects the regulation of
two hormones produced in the stomach and involved in
energy balance, ghrelin and leptin.
—  And as H. pylori has disappeared from people's stomachs,
there has been an increase in gastroesophageal reflux, and
its attendant problems such as Barrett's oesophagus and
oesophageal cancer (Blaser, 2011).
[email protected]
2/02/15
Ghrelin
228
—  Mice exposed to chronic social
defeat stress (CSDS), increased
both conditioned place
preference (CPP) and intake of
high-fat diet. The stress-induced food-reward behaviour
was dependent on signalling by the peptide hormone
ghrelin.
—  Engagement of these neurons (dopaminergic) by ghrelin
induces a series of changes that minimises what would
otherwise be worsened depression-like behaviours (Chuang
et al, 2011)
[email protected]
2/02/15
Ghrelin and Motilin
229
—  Ghrelin and motilin are the only two mammalian hormones
known to decrease in the postprandial period. Ghrelin and
motilin participate in initiating the migrating motor
complex in the stomach, and stimulate gastrointestinal
motility, accelerate gastric emptying, and induce "gastric
hunger".
—  In addition to modulating the release of growth hormone
and gut motility, ghrelin plays a crucial role in the secretion
and protection of the stomach and colon (Curr Pharm Des.
2012;18,31).
[email protected]
2/02/15
Motilin, Gastrin, and Somatostatin
230
—  A single oral administration of Ninjin-to, at a dose of 6.0 g,
caused significant increases in plasma motilin levels at 40
to 90 min and somatostatin levels at 20 to 90 min,
compared with a placebo treated group.
—  These results suggest that pharmacological effects of
Ninjin-to on gastrointestinal functions closely relate to
changes of motilin, gastrin, and somatostatinimmunoreactive substance levels in human plasma (2001,
http://dx.doi.org/10.1248/bpb.24.194).
—  Radix Ginseng (3.0 g), Glycyrrhizae Radix (3.0 g),
Atractylodis Rhizoma (3.0 g), Rhizoma Zingiberis (3.0 g)
[email protected]
2/02/15
Transmitters
231
—  The effects of four classical TCM formulas for mediating the
spleen and stomach on cerebral neuropeptide transmitters.
—  Buzhongyiqi Decoction could markedly reduce the level of
Vasoactive intestinal peptide (VIP) and raise the level of
Neuropeptide Y (NPY) in the cerebral cortex, Dachengqi
Decoction could decrease the levels of somatostatin (SS)
and substance P (SP) in the cerebral cortex and the level of
VIP in the hippocampus, Guipi Decoction could increase
the level of SS in the cerebral cortex, and Wendan
Decoction could lower the level of VIP in the hippocampus
(He et al, 2003).
[email protected]
2/02/15
Transmitters
232
—  VIP and dorsal vasopressin affect timing of daily biological
rhythms in mammals (SCN) (Stopa et al, 1984) and are
seen to control mood disorders like anxiety and as well as
peristalsis (Freund, 2003).
—  A correlation between NPY and cortisol was found in
suicidal patients with depression. Cortisol was high and
corticotrophin releasing hormone (CRH) and neuropeptide
Y (NPY) appeared to be low (Westrin et al, 1999)
[email protected]
2/02/15
Transmitters
233
—  The substance P receptor (neurokinin-1 receptor) has been
implicated in stress responses and anxiety traits and
neurokinin-1 receptor antagonism may have antidepressant
and anxiolytic effects. This suggests that the function and/
or expression of neurokinin-1 receptor might be affected in
subjects with mood disorders including unipolar depression
(Burnet & Harrison, 2000).
—  SP has been supposed to be involved in the aetiopathology
of affective disorders (Lieb et al, 2002).
[email protected]
2/02/15
Transmitters
234
—  A single oral administration of Sho-hange-ka-bukuryo-to
[SHKBT], comprised of Pinelliae Tuber, Zingiberis
Rhizoma and Hoelen caused significant increases in plasma
somatostatin-, CGRP- and substance P-immunoreactive
substance (IS) levels. Transient elevation of gastrin-IS
levels in the placebo group was inhibited by the
administration of SHKBT, but the medicine showed no
effects on plasma motilin- or VIP-IS levels.
—  These results might indicate that the pharmacological
action of SHKBT is closely related to changes in gastrin-,
somatostatin-, CGRP- and substance P-IS levels in human
plasma (Biol Pharm Bull. 2004 Oct;27(10):1674-8.).
[email protected]
2/02/15
Shu Wei Decoction
235
—  A reduction of the Cajal Interstitial Cells (ICC) expression
in the gastric antrum is a pathophysiological basis for
functional dyspepsia of liver Qi stagnation and spleen
deficiency (LQSD); and a reduced expression of serum
Substance P (SP) and motilin might be the neurobiological
basis.
—  Shuwei Decoction can significantly promote drinking,
eating, ICC and MTL expression, serum SP secretion and
gastric emptying in FD rats with LQSD. This study revealed
possible mechanisms of SWD on LQSD type functional
dyspepsia (Wang et al., Journ Acu and Herbs, 2014).
[email protected]
2/02/15
Shu Wei Decoction
236
—  Pericarpium Citri
—  Bulbus Lilii (bai he)
Reticulatae Viride (Qing
Pi) or
—  Fructus Immaturus Citri
Aurantii (Zhi Shi)
—  Roasted Atractylodes
tuber (chao bai zhu)
—  Pinellia tuber (ban xia)
—  Radix Coptis (huang
lian)
—  Radix Lindera (wu yao)
[email protected]
—  Semen Areca (bing lang)
—  Radix Salvia miltiorrhiza
(dan shen)
—  Radix Codonopsis
pilosula (dang shen)
2/02/15
Pattern Discrimination
237
—  Those with depressed liver and insufficient spleen were
given SWD plus Bupleurum root and Cyperus tuber, those
with water retention due to hypo-function of spleen were
given SWD plus Poria and magnolia bark ; those with
deficiency of stomach-Yin were given SWD minus with
Pinellia, plus Dendrobium and Adenophora root ; those
with insufficiency of spleen-Yang were given SWD with the
dosage of Coptis reduced but plus Astragalus and dried
ginger ; those with retention of food were given SWD plus
charred medicate leaven and stir-baked Semen Rephani;
those with blood stasis were given SWD plus Corydalis
yanhusuo and Typha Angustifolia.
[email protected]
2/02/15
Pattern Discrimination
238
—  The genotype–phenotype distinction is drawn in genetics.
"Genotype" is an organism's full hereditary information.
"Phenotype" is an organism's actual observed properties,
such as morphology, development, or behaviour. This
distinction is fundamental in the study of inheritance of
traits and their evolution. Chinese medicine looks at
phenotype.
—  Polymorphism is described as morphs of the phenotype.
The term is also used somewhat differently by molecular
biologists to describe certain point mutations in the
genotype, such as Single Nucleotide Polymorphism (SNP)
[email protected]
2/02/15
Pattern Discrimination
239
—  Omics informally refers to a field of study in biology ending
in omics, such as genomics, proteomics or metabolomics.
The related suffix Ome is used to address the objects of
study of such fields, such as the genome, proteome or
metabolome respectively.
—  Omics aims at the collective characterisation and
quantification of pools of biological molecules that translate
into the structure, function, and dynamics of an organism
or organisms.
—  Omics-based medicine and systems pathology will realise a
new personalised and predictive medicine (2010, http://
dx.doi.org/10.3414/ME9307)
[email protected]
2/02/15
Gastrointestinal Peptides
240
—  The mechanism of spleen deficiency (SD) was studied by
the relationship of gastro-intestinal peptides level and ileal
electro-mechanical activity of SD rats and cold restrained
rats.
—  Spleen deficiency (SD) model was established by feeding
Houpou:Zhishi: Dahuang in the ratio of 3:3:2, 3 ml/time,
for 42 days. (2) The cold restrain stress model: Animals
were restrained on grille and placed in a cool water at 18
degrees for 3 h. (3) Substance P (SP) and vasoactive
intestinal peptide (VIP) levels in all layers of initial part of
ileum and blood in rats were measured.
[email protected]
2/02/15
Gastrointestinal Peptides
241
—  Changes of Substance P (SP) and vasoactive intestinal
peptide (VIP) levels levels in initial part of ileum and blood of
SD rats and cool stress rats may be closely related to the
gastrointestinal motility disorders presented in SD and cool
stress rats. the Chinese herbs (Jia Wei Si Jun Zi Tang)
currently used have partially therapeutic effect.
—  SP and VIP partly distributed in the mucosa of gastric
antrum, the mucosa of the jejunum, ileum. In the intestine,
VIP markedly stimulates intestinal secretion of electrolytes
and hence of water. Its other actions include relaxation of
intestinal smooth muscle; sphincters; dilation of peripheral
blood vessels; and inhibition of gastric acid secretion (World
J Gastroenterol 2003 Mar 15;9(3):553-556).
[email protected]
2/02/15
Bowel Motility
242
—  Daikenchuto stimulates gastrointestinal motility though a
neural reflex involving presynaptic cholinergic and 5-HT3
receptors. Daikenchuto improves postoperative bowel
motility and postoperative ileus. Furthermore, it is reported
to cause an increase in gastrointestinal hormones (motilin,
vasoactive intestinal peptide, and calcitonin gene-related
peptide) and intestinal blood flow.
—  Rikkunshito, a traditional Japanese medicine consisting of
eight herbs, is thought to stimulate gastrointestinal motility
and ghrelin secretion (2010, doi: 10.1007/
s00595-010-4388-8).
[email protected]
2/02/15
Bowel Motility
243
—  Rikkunshito increased the plasma acylated ghrelin level in
healthy volunteers and normal mice. Additionally, this
change was maintained for at least 4 weeks after the end of
administration. In mice, Rikkunshito increased the ghrelin
mRNA expression level in the stomach (2010, doi: 10.1007/
s00535-009-0166-z).
—  Rikkunshito improves upper gastrointestinal symptoms in
patients with functional dyspepsia (FD), accompanied by
an increase in the levels of ghrelin (2012, doi: 10.5754/
hge11246) and anorectic conditions including cisplatininduced dyspepsia (Curr Pharm Des. 2012;18,31).
[email protected]
2/02/15
Formulas
244
Daikenchuto
Rikkunshi-to
—  5.0 g processed Zingiberis
—  Rhizoma Atractylodes Lancea
(pao jiang)
—  3.0 g ginseng (ren shen)
—  2.0 g Semen Zanthoxyli
(jiao mu)
(cang zhu)
—  Panax Ginseng (ren shen)
—  Rhizoma Pinellia (ban xia)
—  Sclerotium Poria (fu ling)
—  Fructus Jujubae (da zao)
—  Citrus Unshiu (wu he ju)
—  Glycyrrhiza (gan cao)
—  Zingiberis (sheng jiang)
[email protected]
2/02/15
Big
245
[email protected]
2/02/15
Obesity
246
—  Obesity is not just a matter of balancing energy in with
energy out, it is a great deal more complex. The prevalence of
obesity has been rising steadily over the last several decades
and is currently at unprecedented levels: more than 68% of
US adults are considered overweight, and 35% are obese
(JAMA 303:235–241, 2010).
—  Data indicates that segments of individuals in the highest
weight categories (i.e., BMI > 40 kg/m2) have increased
proportionately more than those in lower BMI categories
(BMI < 35 kg/m2) (2012, DOI:10.1007/s00261-012-9862-x).
[email protected]
2/02/15
Obesity
247
—  Body weight is regulated by the hypothalamus, and there
have been many recent advances in understanding of energy
balance that might help understand why some individuals
develop obesity, and lead to new treatments.
—  Both genetic and environmental factors contribute to the
development of obesity. The recent identification of a single
gene defects that cause severe early onset obesity, such as
deficiency of the hormone leptin (2001, DOI: 10.1002/pdi.
277). A TOTAL deficiency in or resistance to the protein
leptin causes severe obesity (Science 269, 546−549 1995;
Nature 377, 530−532 1995)
[email protected]
2/02/15
Obesity
248
—  Massive obesity with marked increase in body weight was
observed after about 10 weeks when norepinephrine (NE)
was infused chronically into the unilateral ventromedial
(VMH), lateral or paraventricular hypothalamic nucleus, but
not into other hypothalamic loci.
—  Plasma insulin level went up markedly at the early stage of
NE infusion and remained high during the infusion period,
but plasma glucose did not change appreciably. Similar, but
less pronounced effects were observed with epinephrine
infusion into the VMH (Brain Res. 1986 Mar 26;369:1-2).
[email protected]
2/02/15
Obesity
249
—  The control of body weight and composition depends on an
axis with three interrelated and self-controlled components:
(1) food intake; (2) nutrient turnover and thermogenesis; (3)
body fat stores. Complex feedback mechanisms underlie all
these components. The major factors involved in obesity
seem to be dietary and physical activity habits.
—  These factors are affected by susceptibility genes that in turn
may influence energy expenditure, fuel metabolism, muscle
fibre function and appetite or food preferences (2000,
doi.org/10.1017/S0029665100000380).
[email protected]
2/02/15
Microbiome & Obesity
250
—  Exposure to broad-spectrum antibiotics in children
younger than age 2 years was associated with elevated
obesity risk between ages 2 and 5 years. Obesity is also been
associated with risk factors such as sleep duration and
screen time.
—  By age 24 months, 69% of children had received at least one
systemic antibiotic course (average 2.3 courses); narrowspectrum antibiotics 62%; (penicillin or amoxicillin) and
broad-spectrum antibiotics, 41%.
—  The microbiome may be adversely influenced by broadspectrum antibiotics (2014, doi.org/10.1001/
jamapediatrics.2014.1539)
[email protected]
2/02/15
Panaxea Xlim
251
—  Fructus Corni (shan zhu
—  Attenuates weight gain
yu)
—  Rhizoma Dioscorea
(shan yao)
—  Fructus Aurantii (zhi shi)
—  Radix Platycodonis (jie
geng)
80% Ethanol Extraction
(90% total weight)
—  Platycodin D (10%)
—  Regulates Adipogenesis
[email protected]
through AMPK
5' AMP-activated protein
kinase or AMPK or 5'
adenosine
monophosphate-activated
protein kinase is an
enzyme that plays a role in
cellular energy
homeostasis.
2/02/15
Panaxea Blueberrin
252
—  Blueberrin extracted
from blueberry leaf
—  Metabolic Syndrome
—  Hyperlipidaemia
—  High blood glucose —  Diabetes
[email protected]
2/02/15
Blueberin
253
—  Blueberin reduced fasting plasma glucose from
143+/-5,2mg/L to 104+/-5,7 mg/L (p<0,001), whereas
there was no statistically significant changes in the Placebo
group from 138+/-4,8 mg/L to 126+/-5,1mg/L (p>0,05).
The reduction of fasting glucose was correlated with the
reduction of serum CRP in the Blueberin group.
—  Furthermore, the Blueberin also significantly reduced the
levels of plasma enzymes ALT, AST and GGT, indicating
that, in addition to anti-diabetes effects, Blueberin also
possess pharmacologically relevant anti-inflammatory
properties (Georgian Med News. 2006 Dec; 141).
[email protected]
2/02/15
Obesity
254
—  The prevalence of obesity and related disorders such as
metabolic syndrome has vastly increased throughout the
world.
—  Recent insights have generated an entirely new perspective
suggesting that our microbiota might be involved in the
development of these disorders. Studies have demonstrated
that obesity and metabolic syndrome may be associated with
profound microbiotal changes (Tilg & Kaser, 2011).
[email protected]
2/02/15
Obesity & Microbiota
255
—  Alcock et al., (2014) reviewed several potential mechanisms
for microbial control over eating behaviour including
microbial influence on reward and satiety pathways,
production of toxins that alter mood, changes to receptors
including taste receptors, and hijacking of the vagus nerve,
the neural axis between the gut and the brain
(DOI: 10.1002/bies.201400071).
—  Altered gut microbiota composition and impaired gut
barrier function together with interrelated mesenteric
adipose tissue inflammation, result in increased release of
pro-inflammatory cytokines, bacteria-derived factors, and
lipids into the portal circulation, promoting the
development of insulin resistance (Physiology (Bethesda).
2014 Sep;29:5).
[email protected]
2/02/15
Obesity & Microbiota
256
—  Acquired tastes may be due to the acquisition of microbes
that benefit from those foods. The review by Alcock et al.,
(2014) suggests that one way to change eating behaviour is
by intervening in our microbiota.
—  It is encouraging that the microbiota can be changed by
many interventions, hence facilitating translation to the
clinic and public health efforts. Microbiota community
structure changes drastically within 24 hours of changing
diet (Science 2011 334: 105–8; Science 2013 334: 105–8).
Faecal transplants have shown efficacy in treating a variety
of diseases (BioEssays 2013 35: 508–12).
[email protected]
2/02/15
Obesity & Microbiota
257
—  Obesity results in a pronounced
shift in the relative abundance of
the two dominant divisions in the
mouse gut. Is the increased ratio of
Firmicutes/Bacteroidetes in the
obese (ob/ob) gut microbiota a
cause of, or a compensatory
obesity?
[email protected]
response to,
2/02/15
Microbiota & SCFAs
258
—  Microbiota regulates host
metabolic functions. The
microbiota controls host
physiology at multiple levels.
—  Microbial metabolic products
such as SCFAs bind to GPCRs on intestinal epithelial cells
to control energy balance, partly via the gut-derived
hormone Pyy, and also to control the inflammatory
responsiveness of the host, which in turn regulates appetite,
weight gain, and insulin sensitivity through unknown
mechanisms (Tilg & Kaser, 2011).
[email protected]
2/02/15
Weight Gain
259
—  In a small number of studies, investigators have observed
that some patients gain weight after eradication of
Helicobacter pylori.
—  Prevalence rates of overweight and obesity were inversely
correlated with the prevalence of H. pylori in the same
populations (r = −0.43; P<0.01 and r = −0.29; P<0.05).
The inverse correlation remained after adjusting for GDP
per capita (2014, http://dx.doi.org/10.1111/apt.12790).
—  Thus, the gradual decrease of the H. pylori colonisation that
has been observed in recent decades (or factors associated
with decrease of) could be causally related to the obesity
endemic observed in the Western world.
[email protected]
2/02/15
Insulin Resistance
260
—  Insulin resistance is often associated with obesity and is a
major risk factor for development of type 2 diabetes as well
as cardiovascular and hepatic diseases. Insulin resistance
may also increase the incidence or the aggressiveness of
some cancers. Insulin resistance occurs owing to defects in
insulin signalling in target tissues of this hormone.
—  Inflammatory cytokines activate several signalling
pathways that impinge on the insulin signalling pathway
and (2014, doi: 10.1051/jbio/2014014).
[email protected]
2/02/15
Inflammation & Obesity
261
—  Increasing evidence suggests a tight
coupling of metabolic and immune
systems. This cross-talk mediated by
neuroendocrine peptides as well as
numerous cytokines and chemokines
is believed to be responsible for integrating energy balance
to immune function.
—  The discrepancy between the environment, in which hunger
and the immune system evolved in prehistoric times, is
vastly different from the calorie-rich “obesogenic”
environment in the modern world (2008, doi: 10.1189/jlb.
0108028).
[email protected]
2/02/15
Inflammation & Obesity
262
—  Obesity may be a low-grade systemic inflammatory disease.
Overweight and obese children and adults have elevated
serum levels of C-reactive protein, interleukin-6, tumor
necrosis factor-alpha, and leptin, which are known markers
of inflammation.
—  The complex interaction between several neurotransmitters
such as dopamine, serotonin, neuropeptide Y, leptin,
acetylcholine, melanin-concentrating hormone, ghrelin,
nitric oxide, and cytokines and insulin and insulin receptors
in the brain ultimately determines and regulates food
intake (Nutrition. 2001 Nov-Dec;17:11-12).
[email protected]
2/02/15
Obesity & Breast Feeding
263
—  Breast-feeding of more than 12 mo is associated with
decreased incidence of obesity. Breast milk is a rich source
of long-chain polyunsaturated fatty acids (LCPUFAs) and
brain is especially rich in these fatty acids. LCPUFAs inhibit
the production of proinflammatory cytokines and enhance
the number of insulin receptors in various tissues and the
actions of insulin and several neurotransmitters.
—  This results in an imbalance in the structure, function, and
feedback loops among various neurotransmitters and their
receptors, which ultimately leads to a decrease in the
number of dopamine and insulin receptors in the brain
(ibid).
[email protected]
2/02/15
Berberine
264
—  Berberine has been shown to have a significant beneficial
effect on type 2 diabetes, and may be as effective, or more
so, than metformin. Berberine acts through several
mechanisms, including mimicking insulin; improving
insulin action by activating AMPK; reducing insulin
resistance through protein kinase C-dependent upregulation of insulin receptor expression; inducing
glycolysis; and on incretins by promoting GLP-1 secretion
and modulating its release, and by inhibiting DPP-4 (Lee et
al., 2006; Chen et al., 2010).
[email protected]
2/02/15
Berberine
265
—  Recent evidence suggests that the gut microbiota
composition is associated with obesity and type 2 diabetes,
which are closely associated with a low-grade inflammatory
state. The protective effect against diabetes of gut
microbiota modulation with probiotics or antibiotics has
been confirmed in recent observations.
—  Berberine has significant antimicrobial activity against
several microbes through inhibiting the assembly function
of FtsZ and halting the bacteria cell division (2011, DOI:
10.12659/MSM.881842).
—  Gut microbiota modulation may be one mechanism of the
antidiabetic effect of berberine
[email protected]
2/02/15
Obesity, Stress & Inflammation
266
—  Circulating IL-6 stimulates the hypothalamic–pituitary–
adrenal (HPA) axis, activation of which is associated with
central obesity, hypertension and insulin resistance
(Yudkin et al, 2000).
—  A study by Nishitani & Sakakibara (2005) suggests that
obese male Japanese workers tend to be in a stressful state
from high job demands and low job latitudes in the
workplace. Such stressful conditions may affect eating
behaviours to eat much and contribute to obesity.
[email protected]
2/02/15
Obesity, Stress & Inflammation
267
—  Environmental, perinatal and genetic factors induce
neuroendocrine perturbations followed by abdominal
obesity with its associated co-morbidities.
—  The activation of the HPA axis and the sympathetic nervous
system have been utilised as objective measurements of
stress reactions and elevated cortisol, particularly when
combined with secondary inhibition of sex steroids and
growth hormone secretions, which causes accumulation of
fat in visceral adipose tissues as well as metabolic
abnormalities (Björntorp , 2001).
[email protected]
2/02/15
Herbs that suppress cellular inflammatory
responses
268
Microglia/microphage:
—  Andrographolide (Chan et al, 2010), Paeonol / Cortex
Moutan (Hsieh et al, 2006) Wogonin / Scutellaria
baicalensis (Kim et al, 2001), Sophora japonica (Lao et al,
2005), Angelica sinensis (Lin et al, 2008), Panax
Notoginseng (Son et al, 2009), Apocynin / Picrorhiza
kurroa (Hur et al, 2010)
Astrocytes
—  Zizyphus jujube (Yoo et al, 2010)
[email protected]
2/02/15
Herbs that suppress cellular inflammatory
responses
269
Adhesion Molecules
—  Selectins: Polydatin / Resveratrol analogue (Cheng et al,
2008)
—  Integrins: Polydatin (Cheng et al, 2008)
—  Inter-Cellular Adhesion Molecule 1 (ICAM-1): Ferulic acid /
açaí palm (Euterpe oleracea) (Cheng et al, 2006), polydatin
(Cheng et al, 2008), Panax Notoginseng saponins (He et al,
2005), apocynin (Genovese et al 2011), Paeoniflorin /
Paeonia radix (Tang et al, 2010)
[email protected]
2/02/15
Herbs and Suppressed Inflammatory Response
270
—  Low-grade chronic inflammation in overweight subjects is
thought to play an important role in disease development.
—  Dietary products; resveratrol, green tea extract, atocopherol, vitamin C, Omega-3, polyunsaturated fatty
acids, and tomato extract, selected for their evidence-based
antiinflammatory properties, were combined and given as
supplements to healthy overweight men with mildly
elevated plasma C-reactive protein concentrations in a RCT
crossover study with treatment periods of 5 wk (2010, doi:
10.3945/ajcn.2009.28822).
[email protected]
2/02/15
Parasites
271
UNWANTED GUESTS?
[email protected]
2/02/15
Gastrointestinal Parasites
272
—  Intestinal parasites include protozoans (organisms having
only one cell) and parasitic worms (helminths). Of these,
protozoans, including cryptosporidium, microsporidia, and
isospora.
—  Each of these parasites can infect the digestive tract, and
sometimes two or more can cause infection at the same
time.
[email protected]
2/02/15
Gastrointestinal Parasites
273
—  Blastocystis hominis is a microscopic parasite sometimes
found in the stools of healthy people as well as in the stools
of those who have diarrhoea, abdominal pain or other
gastrointestinal problems.
—  Researchers don't yet fully understand the role that
blastocystis plays, if any, in causing an infection. Certain
subtypes of blastocystis may be more likely to cause
symptomatic infection, or may pose a risk only when
combined with other types of infection. In some cases,
blastocystis simply resides in the digestive tract without
causing harm.
[email protected]
2/02/15
Gastrointestinal Parasites
274
—  International travel and getting traveller’s diarrhoea
—  A history of food poisoning and digestion has not been the
same since.
—  Trouble falling asleep, or waking multiple times during the
night.
—  Skin irritations or unexplained rashes, hives, rosacea or
eczema.
—  Grinding of teeth (bruxism) in sleep.
—  Pain or aching in muscles or joints.
—  Fatigue, exhaustion, depression, or frequent feelings of
apathy.
—  Never feeling satisfied or full after meals.
—  Iron-deficiency anaemia.
[email protected]
2/02/15
Gastrointestinal Parasites
275
—  Blastocystis hominis
—  Gastrointestinal
—  Enterobius vermicularis
parasites
—  Amoebic dysentery
—  Amoebic/bacterial
parasites
—  Bacillary dysentery
—  Giardia lamblia
—  Ancylostoma duodenale
—  Necator americanus
—  Entamoeba histolytica
[email protected]
2/02/15
Panaxea Gut Bug
276
—  Sophorae Flavescentis (Ku
—  Sclerotium Poriae (Fu
Shen Gen)
—  Corneum Gigeriae Galli
(Ji Nei Jin)
—  Sargento Doxae (Hong
Ten)
—  Stemonae (Zhi Bai Bu)
—  Arecae Catechu (Bing
Lang)
—  Quisqualis (Shi Jun Zi)
—  Glycyrrhizae (Gan Cao)
Ling)
—  Pericarpium Citri
Reticulatae (Chen Pi)
—  Dioscorea Bulbifera
(Huang Yao Zi)
—  Testa Dolichoris (Bian
Dou)
—  Atractylodis
Macrocephalae (Bai Zhu)
—  Saussureae Lappae (Mu
Xiang)
[email protected]
2/02/15
Nausea
—  Motion sickness or
— 
— 
— 
— 
— 
— 
— 
— 
— 
seasickness
Early stages of pregnancy
Medication-induced
vomiting
Intense pain
Emotional stress (such as
fear)
Gallbladder disease
Food poisoning
Infections ("stomach bug”)
Overeating
Ulcers
[email protected]
277
—  A reaction to certain smells
— 
— 
— 
— 
— 
— 
— 
or odours
Heart attack
Concussion or brain injury
Brain tumour
Some forms of cancer
Bulimia or other
psychological illnesses
Gastroparesis or slow
stomach emptying (a
condition often seen in
people with diabetes)
Ingestion of toxins or
excessive amounts of alcohol
2/02/15
Panaxea Qi-Inversion
278
—  Pericarpium Citri Reticulatae (Chen Pi)
—  Ginger Fried Caulis Bambusae in Taenia (Zhu Ru)
—  Rhizoma Zingiberis Recens (Sheng Jiang)
—  Radix Ginseng (Ren Shen)
—  Rhizoma Pinelliae (Ban Xia)
—  Herba Agastache (Huo Xiang)
—  Magnolia Flower (Hou Po Hua)
—  Fructus Amomi (Sha Ren)
[email protected]
2/02/15
Candida Albicans Overgrowth
279
—  Chronic diarrhoea, constipation, bloating and flatulence
—  Lethargy and fatigue
—  Reduced or hyperactive immune function: Autoimmune
disease such as Hashimoto’s thyroiditis, Rheumatoid
arthritis, Ulcerative colitis, Lupus, Psoriasis, Scleroderma
or Multiple sclerosis
—  Skin eruptions
—  Skin and nail fungal infections (such as athlete’s foot or
toenail fungus) —  Vaginal infections, urinary tract infections, rectal itching or
vaginal itching
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2/02/15
Candida Albicans Overgrowth
280
—  Candida albicans is normally a harmless yeast present in
the gastrointestinal tract and vaginas of warm-blooded
animals.
—  Hormonal imbalances, antibiotics and oral contraceptives,
excessive consumption of sugar and simple carbohydrates,
food allergies and sensitivities, stress, or exposure to
environmental toxicants can all lower immune defences
and contribute to Candida's transformation from a benign,
round yeast into a filament-shaped fungus with long
hyphae or "roots" that penetrate intestinal cells in search of
food.
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2/02/15
Candidiasis
281
—  Candida expels waste products into the circulatory system,
depressing immunity and leading to numerous ailments
that may fall within the syndrome called the Candida
Related Complex or Candidiasis.
—  Candida albicans also can be spread by direct contact
during intercourse and through intravenous feedings,
dialysis and surgery.
[email protected]
2/02/15
Candidiasis
282
—  In traditional Chinese medicine, more than 300 herbs have
been discovered to have "pesticidal" activities, and some of
these have been used as antifungal agents in clinical
practice for many years.
—  These include cortex moutan, cortex pseudolaricis, rhizoma
alpiniae officinarum, rhizoma coptidis, clove and
cinnamon, anemarrhena cortex phellodendri, ramulus
cinnamomi, and Chinese gall.
—  The effective anti-Candida principals were identified to be
berberine, palmatine, allincin, pseudolaric acid A and B,
magnolol, honokiol, and galangin (2011, doi:
10.1177/0022034511399286)
[email protected]
2/02/15
Candida Albicans Overgrowth
283
—  Check blood levels for IgG, IgA, and IgM candida anti-
bodies. These can be checked through most any lab. High
levels indicate an overgrowth of candida.
—  Comprehensive stool test rather than the standard stool
test.
—  Urinary test detects a waste product of Candida yeast
overgrowth known as D-Arabinitol.
[email protected]
2/02/15
Panaxea Cand)EX
284
—  Biotin
—  Phellodendron amurense
—  Calcium undecylenate
—  Pau d'arco (Tabebuia
avellanedae) bark extract
—  Enlyse enzyme blend
(protease, lipase,
serrapeptase,
hemicellulase, amylase and
chitosanase)
— 
— 
— 
— 
— 
[email protected]
(contains extract berberine
sulfate)
Polygonum cuspidatum
(contains extract transresveratrol)
jin qian cao - lysimachiae,
herba
huo xiang - agastache,
herba
bai tou weng - pulsatillae,
radix
ren dong teng - lonicerae,
caulis
2/02/15
Lectins
285
—  Lectins are a class of protein molecules capable of using
these sugar moieties to bind to the surface of cells. Lectins
provide the way for one molecule to stick to another
molecule without any immunity involved.
—  Lectins play a wide role in health, but their ability to
influence the inflammatory process indicates they are
involved in inflammatory bowel disease, rheumatoid
arthritis and even weight gain. Lectins’ potential
involvement in many aspects of our health caused DJ
Freed, MD to state, “Lectins are causes in search of
diseases.”
[email protected]
2/02/15
Lectins
286
—  There is an abundance of literature from the most
prestigious journals that lectins initiate allergic reactions in
the gut causing the release of IL-4, and histamine from
human basophils producing noticeable allergic symptoms.
Wheat germ agglutinin (WGA) has been shown to interfere
with protein digestion and increase gut permeability.
—  Dietary lectins, by their chemical reactivity with cell surface
receptors on the intestinal epithelium, are metabolic signals
for the gut and are capable of modulating immune and
hormone functions.
[email protected]
2/02/15
Lectins
287
—  After ingestion, most dietary lectins bind to the absorptive
microvilli of the small intestine. From there lectins may
gain access into the blood and lymph system through a
process called endocytosis which carries the intact lectin
across the microvilli membranes as a vesicle. Then, the
lectins may enter the liver, pancreas and systemic
circulation.
—  It is estimated that about 5 per-cent of ingested lectins
enter the body systemically, where, lectin binding occurs on
other tissues such as nervous and connective tissue and the
bladder, which are very sensitive to the agglutinating effects
of lectins.
[email protected]
2/02/15
Panaxea Lectin Control
288
—  N-Acetyl Glucosamine
—  Enhance immunity
—  Bladderwrack (contains
—  Relieve GI disorders
extract Fucoidan)
—  D-Mannose
—  Mucin
—  Sodium Alginate
—  Pepsin
—  Fight allergies
—  Supports liver function
—  Inhibit blood clotting
—  Fights against free radicals
—  Lowers cholesterol levels
—  Decreases high blood
pressure
—  Stabilises blood sugar level
[email protected]
2/02/15
Appendix & Abdominal
Obstruction
289
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2/02/15
Appendix
290
—  The appendix or caecal appendix is a blind-ended tube
connected to the cecum, from which it develops
embryologically. The cecum is a pouch-like structure of the
colon, located at the junction of the small intestine and the
large intestine.
—  While the true function of the appendix is unknown, it is
speculated to play a role in mucosal immunity or to act as a
storage site for intestinal flora to repopulate the colon if
needed
[email protected]
2/02/15
Spleen qi Xu
291
—  The regulation of intestinal flora for spleen deficiency was
determined by colonic content and stool specimens
containing Enterobacteriaceae, Enterococcus,
Bifidobacteria, bacteroides, Lactobacillus.
—  After one course of treatment with Shenlingbaizhu, the
quantities commensal bacteria returned to normal,
intestine wall skin layer thickness and cup form cell
quantity increased, intestinal mucous membrane increased
in a fine arranged order, and mitochondria function
improved notably (Yang et al, 2009).
[email protected]
2/02/15
Shen Ling Bai Zhu
292
—  Panax ginseng (ren shen)
—  Dolichos lablab (bai bian
—  Atractylodes
dou)
—  Coix lacryma-jobi (yi yi
ren)
—  Amomum villosum (sha
ren)
—  Platycodon grandiflorum
(jie geng)
—  Nelumbo nucifera (lian zi
xin)
macrocephala (bai zhu)
—  Poria cocos (fu ling)
—  Glycyrrhiza uralensis (gan
cao)
—  Dioscorea opposita (shan
yao)
[email protected]
2/02/15
Appendix & Immunity
293
—  Gut-associated lymphoid tissues are responsible for the
generation of IgA-secreting cells. Appendectomised mice
show delayed accumulation of IgA(+) cells in the large
intestine, but not the small intestine, after colonization.
Decreased colonic IgA(+) cells correlate with altered faecal
microbiota composition.
—  The caecal patch is a major site for generation of IgAsecreting cells that migrate to the large intestine (doi:
10.1038/ncomms4704).
[email protected]
2/02/15
Appendectomy
294
—  Appendectomy might be a risk factor for recurrence of
Clostridium difficile infection (Im et al., 2011). Researchers
identified 396 patients with C. difficile infection, of whom
244 had undergone abdominal computed tomography (CT)
scans, allowing determination of appendectomy.
—  In multivariate analysis, appendectomy was independently
associated with an increased risk for recurrent C. difficile
infection, as was age >60. The recurrence rate was 18% in
patients with an appendix versus 45% in those without.
[email protected]
2/02/15
Acute Abdominal Obstruction
295
—  The cessation of peristalsis in either the small or large
bowel leads to obstruction. This may me due to adhesions
or incarceration of a hernial sac. Also impacted faeces,
strictures due inflammatory diseases/infections, gallstones,
haematomas amongst others.
—  Vomiting, ‘crampy’ pain and distension are common
symptoms.
—  TCM diagnosis is Internal, Full and Hot; Stagnation of qi
and Blood Stasis and in the elderly, emptiness of righteous
qi.
[email protected]
2/02/15
Stage 1: Ileus, increased upper
intestinal motility, accumulation
Of qi & Fluid. Distension of
Intestine
Qi Congestion
in Intestines
Qi Congestion
becomes Blood
Stasis
Stage 2: Upper abdominal distension,
Mucosa, vilii and microvessels
compressed & obstructed. Cell death
Accumulation &
Congestion of Blood
Changes into Heat
damage to the
Blood and mucosa
Stage 3: Intestinal vasoconstriction,
necrosis, and perforation. Fluid,
bacterial translocation and peritonitis.
Septic shock
Necrosis
© DR.D.Weber 2012
296
2/02/15
Formulas
297
Emptiness of
Righteous qi
Blood Stasis
—  Angelicae Sinensis (dang
—  Pruni Persicae (tao ren)
gui)
—  Pruni Persicae (tao ren)
—  Viridis Citri Reticulatae
(qing pi)
—  Linderae Strychnifolii (wu
yao)
—  Rubrus Paeoniae
[email protected]
Lactiflorae (chi shao)
—  Carthami Tinctorii (hong
hua)
—  Angelicae Sinensis (dang
gui)
—  MagnoliaeOfficinalis (hou
po)
—  Rhei (da huang)
2/02/15
Formulas
298
Heat Accumulation
Damp & Heat
—  Magnoliae Officinalis (hou
—  Euphorbiae Kansui (gan sui)
po)
—  Raphani Sativa (lai fu zi)
—  Pruni Persicae (tao ren)
—  Rubrus Paeoniae
Lactiflorae (chi shao)
—  Rhei (da huang)
—  Mirabilitum (mang xiao)
—  Pruni Persicae (tao ren)
Note: Oral and enema
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—  Rubrus Paeoniae Lactiflorae
— 
— 
— 
— 
(chi shao)
Achyranthis Bidentatae (niu
xi)
Magnoliae Officinalis (hou
po)
Rhei (da huang)
Auklandiae (mu xiang)
(From: Marcus, Blue Poppy Press 1991)
2/02/15
Formulas for Appendicitis
299
Qi Stagnation, Blood Stasis
Qi Stagnation, Blood Stasis &
Heat
—  Sargentodoxae (hong
—  Sargentodoxae (hong
teng)
—  Violae Yedoensis (zi
huang di ding)
—  MeliaeToosendanis
(chuan lian zi)
teng)
—  Berberis Sargentianae or
brachypoda (san ke zhen)
—  Rhei (da huang)
—  Mirabilitum (mang xiao)
[email protected]
(From: Marcus, 1991)
2/02/15
Coeliac Disease
300
AND GLUTEN SENSITIVITY
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2/02/15
Coeliac Disease
301
—  Coeliac disease is a digestive disorder that damages the
small intestine and interferes with the absorption of
nutrients from food. It is the prototype of an immune
mediated response dominated by the activation of the
adaptive immune system and in particular of CD4+ HLA
class II restricted T cells.
—  Patients with this condition have an intolerance to the
protein in gluten which damages their intestinal lining and
makes it difficult to absorb nutrients.
—  Coeliac disease is four times more common now than it was
in the 1950's and People who have CD appear to have a
higher rate of Crohn's disease than the general population.
[email protected]
2/02/15
Coeliac Disease
302
—  Individuals with CD are at significantly increased risk for
developing thyroid disorders, including hypothyroidism,
hyperthyroidism and thyroiditis (Journal of Clinical
Endocrinology and Metabolism, 2008). As many as three to
four percent of patients who have osteoporosis have the
bone disease as a consequence of having CD, which makes
them unable to absorb normal amounts of calcium and
Vitamin D.
—  Frequent rotavirus infections predicted a higher risk of CD
autoimmunity. The rate ratio for CD autoimmunity was
1.94 for one rotavirus infection and 3.76 for two or more
rotavirus infections compared with zero rotavirus infections
(American Journal of Gastroenterology, 2006).
[email protected]
2/02/15
Coeliac Patients are at greater risk for:
303
—  Anaemia
—  Non-Hodgkin lymphoma
—  Addison's Disease
(doi: 10.1111/j.
1365-2036.2011.04972.x)
—  Lupus
—  Sjogren's syndrome
—  Scleroderma
—  Crohn's Disease
—  Thyroid Disease
—  Fibromyalgia
—  Chronic active hepatitis
—  Alopecia Areata
—  Graves Disease
—  Diabetes
—  Myasthenia gravis
[email protected]
2/02/15
Non-Coeliac Gluten Sensitivity
304
—  Non-coeliac gluten sensitivity, is characterised by
gastrointestinal or extra-intestinal symptoms that respond
to gluten withdrawal without evidence of underlying coeliac
disease. Its symptoms overlap considerably with those of
irritable bowel syndrome and the number of individuals
embracing a gluten-free diet is rapidly growing.
—  Its pathogenesis remains obscure but may be related to
non-gliadin molecules in grains that stimulate the innate
immune system of the intestine (Ned Tijdschr Geneeskd.
2013;157(21):A6168).
[email protected]
2/02/15
Non-Coeliac Gluten Sensitivity
305
—  No underlying cause for gluten intolerance has yet been
discovered. Moreover, there are a host of triggers for
gastrointestinal distress. Generally, non-coeliac gluten
sensitivity is assumed to be the culprit when coeliac disease
is ruled out.
—  Symptoms display significant overlap with the irritable
bowel syndrome. Many important factors regarding this
relatively novel condition remain to be elucidated; no
discriminative markers to support a diagnosis of gluten
sensitivity have been identified yet and its pathogenesis
remains obscure (Biesiekierski et al., 2013).
[email protected]
2/02/15
Non-Coeliac Gluten Sensitivity
306
—  Gibson (2013) found that each treatment diet, whether it
included gluten or not, prompted subjects to report a
worsening of gastrointestinal symptoms to similar degrees.
Reported pain, bloating, nausea, and gas all increased over
the baseline low-FODMAP diet. Even in the second
experiment, when the placebo diet was identical to the
baseline diet, subjects reported a worsening of symptoms.
—  Gluten wasn't the culprit; the cause was likely
psychological. Participants expected the diets to make them
sick, and so they did. FODMAPS are a far more likely cause
of the gastrointestinal problems attributed to gluten
intolerance (doi: 10.1007/s11882-013-0386-4).
[email protected]
2/02/15
Non-Coeliac Gluten Sensitivity
307
—  A double-blinded, randomised, placebo-controlled
rechallenge trial was recently reported in patients in whom
coeliac disease had been excluded by either normal
duodenal histology on a gluten containing diet. Participants
were randomly assigned to receive either 16 g/day
carbohydrate-free gluten or placebo for six weeks.
—  Change between baseline and final weeks were greater for
patients receiving gluten in overall symptom severity
compared with those receiving placebo. and were worse
with gluten within one week for pain, bloating, satisfaction
with stool consistency, and tiredness (2011, doi: 10.1111/j.
1440-1746.2011.06653.x.).
[email protected]
2/02/15
Gut Inflammation
308
—  IgA-class anti-reticulin or anti-gliadin antibody-positive
patients with normal small-bowel mucosal morphology
frequently have immunohistochemical markers of coeliac
disease latency. Together with our follow-up data this
implies that they may be gluten-sensitive (Scand J
Gastroenterol. 1998 Sep;33:9).
—  Gliadin antibody (AGA)-positivity is often persistent. Overt
coeliac disease is seldom found behind persistent AGApositivity, but this characteristic is associated with mucosal
inflammation and gastrointestinal symptoms at least in
Human Leukocyte Antigen (HLA)-positive individuals
(2011, doi: 10.1016/j.dld.2011.04.025).
[email protected]
2/02/15
Colonic Pouches
309
DIVERTICULOSIS, DIVERTICULA AND
DIVERTICULITIS
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2/02/15
Diverticula & Diverticulitis
310
—  This is a problem of the large bowel which is very common
in the over 50’s. Symptoms include pain and discomfort
usually in the lower belly on the left hand side. It can cause
loose stools, ‘crampy’ pain, change in your normal bowel
habit and sometimes even bleeding.
[email protected]
2/02/15
Si Mo Decoction
311
—  Simo Decoction (SMD), a traditional Chinese medicine, has
been used to improve gastrointestinal dysmotility in clinical
practice for a long history in China. SMD dose-dependently
evoked hypercontractility of antral circular strips, and the
maximal contractile effect of circular smooth muscle
induced by SMD was significantly higher than that induced
by acetylcholine (10(-3)M).
—  SMD promotes contractions of antral circular strips in rats
mainly via activation of muscarinic M3 receptor, but partly
via activation of muscarinic M2 receptor, Ca(2+) channel
and nicotinic receptor, inhibition of adrenergic receptor
and releasing of NO (2012, doi: 10.1016/j.jep.2012.09.008).
[email protected]
2/02/15
Si Mo Decoction
312
—  Fructus aurantii (zhi shi)
—  Radix aucklandiae (mu
xiang)
—  Semen Arecae (bing
lang)
—  Radix Linderae (wu yao)
[email protected]
—  Si Mo Decoction and
Clostridium butyricum
were given to infants to
treat neonatal asphyxia
after feeding. SMD
promoted
gastrointestinal
maturation, improved
feeding tolerance and
reduced vomiting (Zhou
W-J, 2012).
2/02/15
Panaxea Cool Blue
313
—  Cyperus rotundus (xiang
—  Corydalis turtuchanivnovii
— 
— 
— 
— 
— 
— 
— 
fu)
Citrus reticulata (chen pi)
Citrus aurantium (zhi ke)
Amomum villosum (sha
ren)
Alpinia katsumadai (cao
kou)
Magnolia officinalis (hou
po)
Aquilaria agallocha (chen
xiang)
[email protected]
— 
— 
— 
— 
— 
(yan hu suo)
Melia azederach (chuan
lian zi)
Aucklandia (mu xiang)
Paeonia lactiflora (bai
shao)
Bupleurum chinensis (chai
hu)
Poria cocos (fu ling)
Silybum marianum - 80%
Silymarin
2/02/15
Cool Blue
314
—  The results showed that Shugan Pill could enhance pain
threshold and markedly inhibit gastric ulcer, created by
reserpine and absolute ethyl alcohol. It significantly inhibit
the secretion of gastric acid and pepsin and promote the
secretion of gastric mucus, markedly delay gastric emptying
in normal mice and when gastric emptying and small
intestinal propulsion was stimulated by neostigmine.
—  These effects might be the pharmacological mechanisms of
Shugan Pill on gastric pain (Zhong Cheng Yao. 2004; 26(2):
124-128).
[email protected]
2/02/15
Bai Tou Weng Decoction
315
—  Radix Pulsatillae Chinensis
(bai tou weng)
—  Cortex Phellodendri (huang
bai)
—  Rhizoma Coptidis Recens
(huang lian)
—  Cortex Fraxini (qin pi)
Additions:
—  Rhizoma Curcumae E Zhu
—  Radix et Rhizoma Rhei (da
huang)
—  Pericarpium Citrus
aurantium (zhi shi)
[email protected]
—  Clears ‘Heat and Toxicity’
‘Cools Blood’, and stops
diarrhoea. Antibacterial,
and aids with diverticulitis
2/02/15
Diverticulitis
316
—  11 heat-clearing Chinese herbs including Scutellaria
baicalensis (huang qin), Coptis chinensis (huang Lian), Flos
Lonicerae (jin yin hua), Forsythia suspensa (lian qiao),
Isatidis Folium (da qin ye), Radix Isatidis (ban lan gen),
Viola yedoensis (zi hua di din), Pulsatilla Radix (bai tou
wen), Andrographis paniculata (chuan xin lian),
Houttuynia cordata (yu xing cao), and Patrinia Herba (bai
jian cao) have anti-inflammatory and antimicrobial effects.
—  Their ability to affect multiple target signalling pathways
and their potential mechanisms of action contributing to
their anti-inflammatory and antimicrobial activity may be
related to their action of removing ‘Heat and counteracting
Toxicity’. (2014,doi: 10.4103/2225-4110.126635).
[email protected]
2/02/15
Cholecystitis
317
GALL BLADDER DISORDER
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2/02/15
Cholecystitis
318
—  Cholecystitis is inflammation of the gallbladder, which
occurs most commonly due to obstruction of the cystic duct
with gallstones (cholelithiasis). Blockage of the cystic duct
with gallstones causes accumulation of bile in the
gallbladder and increased pressure within the gallbladder.
—  Concentrated bile, pressure, and sometimes bacterial
infection irritate and damage the gallbladder wall, causing
inflammation and swelling of the gallbladder.
—  Females are twice as likely to develop cholecystitis as males.
Uncomplicated cholecystitis has an excellent prognosis;
however, more than 25% of patients require surgery or
develop complications
[email protected]
2/02/15
Cholecystitis
319
—  For symptomatic cholecystitis, antibiotics and
antispasmodic treatment are conventional therapy while
cholecystectomy or laparoscopic cholecystectomy are also
appropriate modalities of treatment (Cochrane Database
Syst Rev. 2006 Oct 18;(4):CD005440). However gallstone
disease of this type may recur within several months.
Gallstones may also recur in the biliary tract after
cholecystectomy
—  Traditional Chinese medicines (TCM) has a long history of
use for treating cholecystitis and has developed an
integrated system of medical examination and treatment.
[email protected]
2/02/15
Cholecystitis
320
—  Cholecystitis is considered by TCM to be caused mainly by
unrestrained food and drink, exogenous heat and moisture,
chronic illness and/or injury (China Press of Traditional
Chinese Medicine; 2003. pp. 270–302).
—  Patients with gallstone always have Gan-qi stagnation that
affects the functions of Pi-Wei, or even the passage among
the triple energisers. Most patients in this study showed
signs of Gan-qi stagnation.
—  Shitong Mixture No. 1 was formulated for dissolving Gan-qi
stagnancy, normalising the function of gallbladder and
removing stones, expelling stagnation and relieving pain,
and enlivening the Pi and regulating Wei (Chin J Integr
Med 2007 Mar;13:1)
[email protected]
2/02/15
Cholecystectomy
321
—  The symptoms of digestive disturbance would present
themselves in patients after laparoscopic cholecystectomy
(LC), such as abdominal dissention, poor appetite, belches,
nausea and vomiting, corpulent tongue (teeth-imprinted
tongue), white sticky tongue after LC, and belong to
syndrome of qi-deficiency with dampness stagnation in
TCM.
—  For this reason, modified Liujunzi Decoction is chosen for
drying up dampness to help digestion, regulating qi and the
middle energizer to promote blood circulation (ibid).
[email protected]
2/02/15
Shitong Mixture No. 1
322
—  Radix Bupleuri (chai hu)
—  Fructus Aurantii (zhi shi)
12g
—  Herba Lysimachiae (jin
qian cao) 30g
—  Radix Aucklandiae (mu
xiang) 18g
—  Radix Curcumae (e zhu)
12g
—  Rhizoma Cyperi (xiang fu)
12g
—  Fructus Hordei
germinatus (mai ya) 30g
12g
—  Rhizoma Atractylodis
macrocephalae (bai zhu)
30g
—  Pericarpium Citri
reticulatae (chen pi) 20g
—  Endothelium Corneum
Gigeriae galli (ji nei jin)
20g
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Liujunzi Variation Decoction
323
—  Radix Codonopsis pilosulae
—  Fructus Citri sarcodactylis
— 
— 
— 
— 
— 
— 
— 
(dang shen) 15g
Rhizoma Atractylodis
macrocephalae (bai zhu)
15g
Poria (fu ling) 20 g
Rhizoma Dioscoreae (shan
yao) 20g
Radix Glycyrrhizae (gan
cao) 3g
Pericarpium Citri
reticulatae (chen pi) 15g
Rhizoma Corydalis (yan hu
suo) 15g
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— 
— 
— 
— 
— 
(fo shou)10g
Rhizoma Pinelliae (ban xia)
6g
Fructus Crataegi (shan zha)
20g
Radix Salviae miltiorrhizae
(dan shen) 30g
Radix Aucklandiae (mu
xiang) 15g
Radix Bupleuri (chai hu)
15g
Fructus Amomi (sha ren)
6g
2/02/15
Meta-System or yin/yang:
Organism and its Relationships
System:
Kidney, Liver, Heart
Blood, qi etc. i.e.
Psycho-Neuro-ImmunoEndocrine-Somatic (Organ)
Chronic Degenerative
Diseases:
Cancer, CVD, etc.
Premature Ageing
Dementia, Weak Libido,
Obesity, etc.
Sub-System / Element:
Kidney yang / HP Axis
Disease Manifestation: i.e. Loss of Integrity of System
HPA Axis Dysregulation / Relationships
Kidney yang Xu / Hypothalamic Disorder
A "meta-system" is a system about other systems, such as describing, generalising,
modelling, or analysing the other system(s).
A system is a set of interacting or interdependent components forming an integrated
whole and is a set of elements and relationships, which are different from
relationships of the set or its elements to other elements or sets.
© DR.D.Weber 2012
324
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Brain/Gut Diseases; The Future
325
—  Conventional medical treatment for neurologic disorders
such as epilepsy, migraine, and autism focuses on the brain,
however some individuals respond poorly or not at all to
regular medicine. Evidence is accumulating in the medical
literature that the enteric nervous system (ENS)-that part of
the nervous system associated with the alimentary canal-also
plays a role in these disorders.
—  Neurologic diseases with systemic features (particularly with
significant GI symptoms) may be approached from a
complementary medicine model that recognises the role of
the abdominal nervous system with regard to aetiology and
treatment (THE JOURNAL OF ALTERNATIVE AND COMPLEMENTARY MEDICINE.
Volume 5, Number 6, 1999).
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2/02/15
Cancer References
326
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Dong LM, Kristal AR, Peters U, Schenk JM, et al. Dietary supplement use and risk of neoplastic progression in
esophageal adenocarcinoma: a prospective study. Nutr Cancer. 2008;60(1):39-48. doi: 10.1080/01635580701586762.
Efferth T, Sauerbrey A, Steinbach D, et al. Analysis of single nucleotide polymorphism C3435T of the multidrug
resistance gene MDR1 in acute lymphoblastic leukemia. Int J Oncol. 2003 Aug;23(2):509-17.
Fan Y, Zhang S, Yao & Li. 2008 CHINESE JOURNAL OF PATHOPHYSIOLOGY Year 2006, Issue 4, Page 748-751
Fu Js. Treating 40 cases of esophageal cancer of middle and late stage with Shen Zhu Fu Zheng Fang in combination
with radiotherapy and chemotherapy. Zhong Guo Zhong Yi Yao Xian Dan Yuan Cheng Jiao Yu. 2008, 6(10): 1212)
Gao Jl, Shen Zh. Treating 30 cases of esophageal cancer of middle and late stage with the method of clearing phlegm
and removing stagnant Blood. Zhe Jiang Zhong Yi Yao Da Xue Xue Bao. 2007, 31(2): 176-177 )
Li J, Sun GZ, Lin HS, et al. Int Immunopharmacol. 2008 Sep;8(9):1196-206. doi: 10.1016/j.intimp.2008.04.007.
Lin Zg. Answering clinic questions: how to treat esophageal cancer according to syndrome differentiation. Zhong Yi Za
Zhi. 2004, 41(12): 755)
Liu Jh, Zhang Z. Treating 25 cases of esophageal cancer of advanced stage with self-formulated Fu Zheng Xiao Ai Tang.
Si Chuan Zhong Yi. 2008, 26(1): 82)
Ma JW, Song YC, Zhang Y, et al. (2013). Effects of Shenqi Fuzheng injection on the invasiveness of cells and expression
of Tenascin-C in human gastric cancer MGC- 803 cells. Journal of Modern Oncology, 21(2), 263-266.
Liu YX, Jiang SH, Kuang TH, Yao YW, Yang JW, Wang YQ. (2008). Clinical Observation on 28 Cases of the Metabasis
of Stomach Cancer after Operation Treated by Yiqi Bushen Oral Liquid: and Chemotherapy. Zhong Yi Za Zhi, 49(2):
128-130.
2012, Pages 240–252
[email protected]
2/02/15
Cancer References
327
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Wu L, & Yang Y. (2007). A clinical study of treating advanced gastric cancer with the combination of Kangai injection
and chemotherapy. Proceeding of Clinical Medicine, 18(7), 1671-8631.
Xu HX, Huang XE, Li Y, Li CG, Tang JH. A clinical study on safety and efficacy of Aidi injection combined with
chemotherapy. Asian Pac J Cancer Prev. 2011;12(9):2233-6.
Xu Lx, Zhong Jh. Treating 80 cases of esophageal cancer with Ding Xiang Tou Ge Tang. Ji Lin Zhong Yi Yao. 2006,
26(12): 36-37)
Yin LL, & Jiang CY. (2013). Observation on the influence of Shenqi-Fuzheng injection on T-lymphocyte subsets, NKcell
and the leukocyte of the patients with advanced gastric cancer. International Journal of Traditional Chinese Medicine,
35(1), 22-24.
Zhong LLD, Chen H-Y, Cho WCS, et al. The efficacy of Chinese herbal medicine as an adjunctive therapy for colorectal
cancer: A systematic review and meta-analysis. Complementary Therapies in Medicine. Volume 20, Issue 4, August
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2/02/15
Thank You
328
Q
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Q
2/02/15