Traditional Chinese Medicine in Geriatrics, Evidences, and the Guideline

*Koh Iwasaski*

## **Abstract**

The average life span of Japanese is 90 years. So that Japan is an unprecedented super-aging society. However, healthy life span is 10 years shorter than life span. Many spend an average of 10 years in frailty. People become frail, and reached to "geriatric syndrome."

**Keywords:** traditional chinese medicine, elderly, dementia, aspiration pneumonia, constipation

### **1. Geriatric syndrome**

Geriatric syndromes include many symptoms caused by aging, such as dementia, depression, delirium, incontinence, vertigo, falls, spontaneous bone fractures, failure to thrive, and neglect and abuse. Geriatric syndromes are associated with reduced life expectancy. To be considered a geriatric syndrome, these conditions must interfere with a person's daily life.

In ancient China, people considered this phenomenon as Qi (気) deficiency in Kidney organ (shen xu, 腎虚). Qi is energy and signaling using energy. Kidney in traditional Chinese medicine (TCM) is very different from Kidney in Western medicine. TCM kidney is somewhat base of life. Human inherits essence of life (jing, 精) from his/her parents and keeps it all his/her life. When jing runs out, people die. TCM kidney is the box keeping jing. When people become old, the jing in TCM kidney decreases, and the function of whole body goes down. This is the reason of aging and geriatric syndrome. These thoughts were written in the famous ancient medical text book Huan di nei jing (黄帝内経), written in BC 2nd ~ 1st century. That is to say, TCM had geriatric medicine in 2000 years ago. How can we keep jing in TCM kidney? People seeked the ways, from unexpected to some herbal drugs, training methods.

Here, we introduce some evidences of TCM for geriatric syndrome and clinical practice guideline from Japan Geriatrics Society. How can we treat geriatric syndrome using traditional Chinese Medicine?

### **2. Dementia**

In China, dementia is called as chidai (痴呆). Zhang Jing yue (張景岳) developed this term in his text book Jing yue guan Su (景岳全書), in12th century. But Zhang Jing yue considered chidai as acquired symptoms. He thought that unstable emotion induced chidai. In Qing (清) era, 19th century, Wang Qing Ren (王清任)

**Figure 1.**

*Change of MMSE(lt) and ADAScog of 2 groups, donepezil plus KUT combination (*○*) vs. donepezil only (*△*). Combination group showed significant improvement to single donepezil group. Colored areas in the brain reveal areas in which significant blood flow increases in the combination group.*

considered that chidai was caused by brain atrophy. Wang Qing Ren is the first man who described dementia in a scientific manner.

We demonstrated that a combinatorial use of donepezil plus Jia wei weng dan tang (加味温胆湯), was more beneficial than donepezil alone in both cognition and brain perfusion (**Figure 1**) in demented people. Although cholinergic-related adverse effects might be expected, such events did not occur in the combination group. Therefore, despite a small sample size and a short observation period study, donepezil and Jia wei weng dan tang may work synergistically in a safe fashion to enhance an availability of acetylcholine [1].

Same time, we showed that bawei dihuan wang (八味地黄丸、BDW) could improve the cognitive function of Alzheimer disease patient. **Figure 2** shows that BDW improves Mini Mental Score Examination about 2.5 in the treatment period [2]. BDW was described in the ancient text book Jin kui Yao lue (金匱要略) written by Zhan Zhong jing (張仲景) in 2nd century. He wrote that this recipe delayed aging, i.e., effective for Qi (気) deficiency in Kidney organ (shen xu, 腎虚). Therefore, it is used for geriatric syndrome and frailty of aged people. It contains Rehmaniae Radix, Corni Fructus, Dioscoreae Rhizoma, Alismatis Rhizoma, Hoelen, Moutan Cortes, Cinnamomi Cortes and Aconi tuber.
