Adverse Reactions, Pharmaceutical Resistance, and Chinese Herbal Medicine by M.M. Van Benschoten, OMD

Case 1 Statins

Ms. A is a 76 yr old female diabetic with previous Lipitor use for over 10 years. Six months after changing to Crestor she develops severe calf pain. She discontinues the Crestor 1 year later with no change in calf pain, balance disorder, memory loss, left arm pain, and loss of motivation for business.

Statins are documented to cause mitochondrial damage to skeletal muscles and the central nervous system.

TCM diagnosis - statin induced damage to blood and jing with blockage of channels and collaterals

Prescription - cistanche (rou cong yong), corydalis (yan hu suo), cyathula (chuan niu xi), dipsacus (xu duan), homalomena (qian nian jian), milletia (ji xue teng), rehmannia cooked (shu di huang), polygonum multiflorum (he shou wu), lindera (wu yao), pueraria (ge gen), cuscuta (tu su zi), tribulus (bai ji li)

Cistanche, corydalis, cyathula, dipsacus, homalomena, and milletia relieve pain, muscle spasms, and protect the nervous system. Rehmannia, polygonum multiflorum, lindera, and pueraria stimulate nerve growth factors and improve memory. Cuscuta and tribulus protect mitochondria and elevate testosterone.

Case 2 Colchicine and Kineret

Mr. B is a 62 year old male with familial mediterranean fever, an inherited disorder of neutrophil function. After thirty years of complete control of febrile episodes using oral Colchicine, he is currently uncontrolled after changing to generic colchicine and Kineret, an injectable Interleukin 1 inhibitor. Changing back to the imported colchinine at a dose of 5 mg per day has no effect. Daily fever and chills, chest pain, abdominal pain, and diarrhea are the primary symptoms. A positive TB blood test with negative chest X ray results in a 6 month course of isoniazid prescribed by his MD. The history suggests possible mold and mycobacteria exposure from old carpeting and a contaminated shower head.

TCM diagnosis - yin deficiency heat with qi and blood stasis

Prescription - anemarrhena (zhi mu), artemisia annua (qing hao), salvia (dan shen), moutan (mu dan pi), paeony red (chi shao), atractylodes macrocephala (bai zhu), cardamon (sha ren), mastic (ru xiang), poria (fu ling), cyperus (xiang fu), phellodendron (huang bai), forsythia (lian qiao)

Anemarrhena, artemisia annua, salvia, and moutan are antipyretic. Cardamon, mastic, and poria decrease Interleukin 1 beta and have analgesic and antiulcer effects. Cyperus relieves smooth muscle spasm in the intestines. Atractylodes decreases IL-6 and TNF alpha, both proinflammatory cytokines related to fever. Paeony red is analgesic and reduces C reactive protein and prostaglandin F2 alpha. Phellodendron and forsythia are antifungal and antituberculosis.

References

J Diabetes. 2013 Jun;5(2):207-15. doi: 10.1111/1753-0407.12013.
Association of statin use with peripheral neuropathy in the U.S. population 40
years of age or older. Tierney EF, Thurman DJ, Beckles GL, Cadwell BL.
Diabetes Translation, Centers for Disease Control and Prevention, Atlanta, GA 30341, USA. ext5@cdc.gov [1]
The prevalence of peripheral neuropathy was significantly higher among those who used statins compared with those who did not (23.5% vs 13.5%, respectively; P < 0.01).

Am J Cardiovasc Drugs. 2008;8(6):373-418. doi: 10.2165/0129784-200808060-00004.
Statin adverse effects : a review of the literature and evidence for a
mitochondrial mechanism. Golomb BA, Evans MA. Department of Medicine, University of California, San Diego, California 92093-0995, USA. bgolomb@ucsd.edu [2]
Converging evidence supports a mitochondrial foundation for muscle AEs associated with statins, and both theoretical and empirical considerations suggest that mitochondrial dysfunction may also underlie many nonmuscle statin AEs. Evidence from RCTs and studies of other designs indicates existence of additional statin-associated AEs, such as cognitive loss, neuropathy, pancreatic and hepatic dysfunction, and sexual dysfunction.

FEMS Immunol Med Microbiol. 2008 Apr;52(3):370-8. Epub 2008 Feb 22.
Heightened endotoxin susceptibility of monocytes and neutrophils during familial Mediterranean fever. Davtyan TK, Harutyunyan VA, Hakobyan GS, Avetisyan SA. Armenicum Research Centre, CJSC Armenicum, Yerevan, Republic of Armenia. tigdav@excite.com [3]

Familial Mediterranean fever (FMF) is a relapsing autoinflammatory disorder, caused by various mutations in the MEFV gene, which encodes a protein called pyrin, expressed in neutrophils and activated monocytes. Induction of monocyte endotoxin tolerance is observed in FMF patients during attack, whereas monocytes from patients in the attack-free period failed to induce lipopolysaccharide tolerance and exhibited heightened sensitivity to bacterial endotoxin. In this study, we demonstrated that impaired lipopolysaccharide tolerance induction in attack-free FMF patients correlates with both increased lipopolysaccharide-induced proinflammatory cytokine synthesis polarization and a different time-course pattern of lipopolysaccharide-induced changes on monocytic surface expression of CD14 and CD11b coreceptors.

Proc Natl Acad Sci U S A. 2009 Sep 22;106(38):16393-9. Epub 2009 Sep 14.
Opportunistic pathogens enriched in showerhead biofilms.
Feazel LM, Baumgartner LK, Peterson KL, Frank DN, Harris JK, Pace NR.
Department of Molecular, Cellular and Developmental Biology, University of
Colorado, Boulder, CO 80309-0347, USA.
To determine the composition of showerhead biofilms and waters, we analyzed rRNA
gene sequences from 45 showerhead sites around the United States. We find that
variable and complex, but specific, microbial assemblages occur inside showerheads. Particularly striking was the finding that sequences representative of non-tuberculous mycobacteria (NTM) and other opportunistic human pathogens are enriched to high levels in many showerhead biofilms, >100-fold above background
water contents.