Note: This disease is very difficult to treat, and my clinical results have not been satisfactory to me. I am presenting this information in the hopes that it may contribute to the discussion, and I invite anyone who has more information to contact me (click on Clinic tab on left navigation bar) Anyone trying to use natural medicines with RP must have a qualified practitioner to work with.
Note 2: This article was written in 1999, and suggests both Vitamin A and Omega-3 fatty acids. Note that recent research has validated this approach.
Retinitis pigmentosa (RP) is a slow, progressive deterioration of the retina that results in diminished vision as it progresses. It is often hereditary. The rods that govern peripheral vision are first affected, and peripheral vision gradually deteriorates as time passes and the condition worsens. Night vision also worsens. The pigment degenerates in a way that can be seen by ophthalmologists, until gradually the optic nerve disc changes appearance, and finally central vision is affected. Cataracts may also develop.
Another contributing factor seems to be excessive production of cortisol in response to extreme stress. Immunologist Alfred Sapse, MD, announced in March 1988 that not only does elevated cortisol contribute to this disease, but treating people with anti-cortisol drugs improves the condition. Dr Sapse believes that there are two separate components to this disease, one hereditary, and the other autoimmune, related to stress and cortisol levels. He also points out that failure notice connections between cortisol and chronic disease is due to the fact that cortisol levels often swing dramatically due to 24 hour circadian rhythms (Sapse, 1997).
Research seems to indicate that patients with this disease have numerous nutritional and metabolic abnormalities, including often hidden thyroid issues. Microscopic examination shows major problems in 1) the daily renewal and shedding of the photoreceptor outer segments, 2) light energy transmission, and 3) vitamin A metabolism. There is also the presence of deposits in the retinal pigment epithelium (van Soest et al., 1999). Though not deficient in the amino acid taurine, RP patients appear to have faulty cellular uptake of it (Head, 1999). Both the red blood cells and sperm of RP patients are deficient in the important fatty acid DHA (Simonelli et al., 1996, Connor et al., 1997). The cause of this is the inability to biosynthesize DHA even if dietary levels are adequate, so it must be given directly (Hoffman et al., 1995). The problems with DHA and vitamin A metabolism no doubt extend to several other nutrients. The cellular antioxidant methionine is a major source of both taurine and cysteine, and can be supplied directly by taking wheat sprouts. Large doses of Vitamin A (up to 30,000 iu per day) can help hereditary retinitis pigmentosa.
Given this backdrop, there are three ways to deal with this: directly add the needed nutrients, add precursors to drive cellular uptake, and stimulate general metabolic energy through a variety of mechanisms. I hypothesize that all three need to be done simultaneously to maximally overcome the metabolic barriers, and with the third component herbal medicine has much to offer.
To summarize, elevated stress levels weaken general energy, and combined with genetic metabolic weakness cause a gradual atrophy of the retina. From a TCM perspective this is definitely a deficiency condition (Yin, Yang, Essence, Liver blood etc.). There is also blood congestion. Therefore, in addition to the specific nutrients mentioned, we would want to write a formula that calms stress, strengthens the Qi, nourishes the blood, Yin and Essence, and strongly breaks down blood congestion to get fresh blood into the atrophied tissue. We also want to repair tissue as much as possible.
This requires a complex formulation, choosing herbs from each of the following groups:
• To strengthen the Qi, use white atractylodes, astragalus root, huang jing rhizome (Polygonatum sibiricum) and ginseng root.
• To break down blood congestion, choose from persica seed (tao ren or Prunus persica), salvia root, red peony root, tien chi root, ginkgo leaf, prickly ash bark, and zedoary root (E zhu or Curcuma zedoaria).
• To nourish the tissue, choose from dang gui root, shou wu root, elderberry, triphala or amla fruit, blueberry or bilberry, white peony root, eclipta, lycium fruit, cuscuta seed (tu si zi or C. chinensis), wheat sprouts and gotu kola.
If there is more Yin deficiency, add cooked and raw rehmannia root. If there is more Yang deficiency, add deer antler or astragalus seed (sha yuan ji li or A. complanatus). If there are signs of tension or Liver Qi restriction, add bupleurum root and ashwaghanda root.
Taurine, Co Q10, Vitamin A + D, mixed carotenoids, L-carnitine, DHA, Vitamin E. Dr Abel and I have developed a specialized herbal formula falled iHeal with herbs that help with blood vessel congestion and oxygen delivery to the retina, and this formula goes well with these nutrients.
Clinical Research Highlights
• 54 patients (106 eyes) with hereditary RP were treated for three months with TCM herbal therapies. Computer-averaged oscillatory potentials (OPs) of electroretinograms (ERG) were recorded to measure changes in the physiological functioning of the retina. The results showed that cone activity could be moderately improved even in advanced patients, while rod potentials could be improved only in patients with less advanced retinal degeneration (Wu, 1995).
• A follow-up study confirmed earlier results, and found that "TCM treatment could also enhance the bioactivity of nerve network and therefore have a definite significance in retarding the progression of disease and keeping the central vision" (Wu and Tang, 1996).