It can sneak up on a person, a silent betrayal from within. A bone breaks when it shouldn’t or wouldn’t have a few years ago. Unless Osteoporosis is diagnosed with a bone density scan, the first sign is a fracture and pain. Vertebrae, forearm, rib or hip are the most common areas to break. Our bones are in a constant state of change. Far from being set in stone, they are a metabolically active tissue. Osteoblasts form new bone cells and osteoclasts breakdown the old cells. Healthy bones are a balance between these two activities. Speaking of balance. Calcium homeostasis is dependent on well-functioning kidneys help to maintain.(1) This regulates calcium flow to and from the bones. Inadequate blood calcium will result in calcium being pulled from the bones to maintain the blood calcium level. Too much breakdown and not enough formation will cause the natural spaces inside to bones to increase, to become more porous. Osteoporosis is from the Greek meaning "porous bones”. Bone loss is driven by the interaction of Vitamin D and calcium. With a sufficient store of D, Calcium is absorbed in the small intestine. If digestion is compromised Calcium will not be absorbed. Likewise, Magnesium absorption will be limited. When Magnesium is low bone formation is low too.(2) The connection between the gastrointestinal tract and osteoporosis is shown in a 2010 study. It concludes: “Control of inflammatory disease activity and nutritional support play a key role, among the other risk factors for osteoporosis.”(3)
Risk factors for osteoporosis include being: small, thin, well-aged, female, menopausal, inactive, smoking, undernourished. Some medications predispose bones to become porous, they are steroids and/or antiepileptics.
When we turn to Traditional Chinese Medicine there is a reflection of what we know through biomedicine. The Kidneys are the rulers of the bones. Kidney Qi is the main Qi of the body and it is further divided into Kidney Yin and Kidney Yang. Kidney Yin being the material, cool and calm partner to active, hot Yang energy. Also included in the Kidney world is Kidney Jing or Essence. It controls birth, puberty, menopause, and death. Good stuff to hang onto, when it’s used up life is over. It is the material basis for Kidney Yin and Yang. Jing is what is used when blood is deficient. Since Jing is difficult to replenish it is best to keep digestion optimal so blood is healthy. The patterns of osteoporosis in TCM will be based on Kidney Qi either directly or indirectly through digestion.(4)
Liu Wei Di Huang Wan
Liu Wei Di Huang Wan. Six Flavor Teapills. Six Flavor Rehmannia. These are all names for the same classic Chinese herbal formula. Qian Yi ( 1032-1113 A.D.) created this formula for pediatric use a thousand years ago. Modern practitioners find uses for Liu Wei Di Huang Wan well beyond the original intent. Qian Yi would be amused to know it is very popular in China to support aging in the over 50 set. Liu Wei Di Huang Wan is a good choice for osteoporosis with signs of Kidney Yin and Jing deficiency. These symptoms include hot flashes, night sweats, insomnia, sore knees and lower back.(5) In a well-designed study using 48 rats, researchers found Lui Wei Di Huang Wan to be very promising in the treatment of osteoporosis. The formula significantly improved bone mineral density, bone mineral content, and blood antioxidant enzymes activities. It also increased bone strength and prevented the deterioration of microarchitecture of the bone.(6)
Caution: Weak digestion
Usage: Use Liu Wei Di Huang Wan according to product recommendation unless directed otherwise by your health care practitioner. Combine with Bao He Wan is you have weak digestion or experience loose stools or loss of appetite. Do not use it if you are taking cold medicines.
Er Xian Tang
Two Immortal Decoction
This formula is appropriate when there is osteoporosis accompanied by a post-menopausal pattern of both Kidney Yin and Yang Deficiency. The Kidney Yin symptoms include hot flashes, sweating, nervousness, insomnia, irritability, and palpitations. The Kidney Yang symptoms include fatigue, lassitude, depression and frequent urination.(5) Er Xian Tang is an effective formula for osteoporosis because one of the stars the of formula is Yin Yang Hao. It has other (more fun) names too, Horny Goat Weed, barrenwort, bishop's hat, fairy wings. Scientifically called Epicedium there are some 60 species. Yin Yang Hao can refer to grandiflorum, sagitatum, and brevicornum. Using phytoestrogen flavonoids derived from Epimedium brevicornum, researcher studied bone loss in one hundred postmenopausal women. This was a 2 year, randomized, double-blind, placebo-controlled clinical trial. Results showed that the Epimedium phytoestrogen flavonoids rebalanced bone turnover in favor of formation. Unlike other phytoestrogens, it did this without detectable thickening of the uterine lining. This means that the phytoestrogen from Epimedium is specific to bones and does not bind to other estrogen receptor sites. Epimedium is an MVP for bone health.(7)
Serving size: According to product of choice or instructions from your health care practitioner.
Seven Forests Eucommia 18 Jian Gu Pian
Eucommia 18 is a warming formula targets osteoporosis accompanied by Yang deficiency. It also contains herbs to warm and enhance the digestion. Indications include sore knees and lower back, aversion to cold, fatigue, urine incontinence, decreased libido, edema, and sterility. It’s a big formula, eighteen herbs, hence the name. Here are the herbs one or two of their actions:(8)
Du Zhong ( Cortex Eucommiae ) Tonifies Yang and helps the low back. Ba Ji Tian ( Radix Morindae Officinalis ) Tonifies Yang. Xu Duan ( Radix Dipsaci ) Tonifies Yang and Bones without stagnation. Rou Cong Rong ( Herba Cistanches ) Tonifies Yang and helps constipation. Gu Sui Bu ( Rhizoma Drynariae ) Tonifies Yang and Bones. Niu Xi ( Radix Achyranthis Bidentatae ) Pain and knees. Shu Di Huang ( Radix Rehmanniae Preparata ) Blood, Kidney Yin, and Jing. Shan Zhu Yu ( Fructus Corni ) Supports Kidney Yin and Yang. Yin Yang Huo ( Herba Epimedii ) Tonifies Yang helps libido. Lu Lu Tong ( Fructus Liquidamberis ) Moves Blood helps with pain. Gou Qi Zi ( Fructus Lycii ) Tonifies Kidney Yin, Yang, and Blood. Shan Yao ( Rhizoma Dioscoreae ) Tonifies Kidney Yin, Jing and helps digestion. Ren Shen ( Radix Ginseng ) Tonifies Qi and helps digestion. Nu Zhen Zi ( Fructus Ligustri Lucidi ) Tonifies Liver and Kidney Yin. Dang Gui ( Radix Angelicae Sinensis ) Tonifies and moves Blood and helps with pain. Bai Zhu ( Rhizoma Atractylodis Macrocephalae ) Tonifies Qi and helps digestion. Huang Qi ( Radix Astragali ) Tonifies Qi and Blood and helps digestion. Fu Ling ( Sclerotium Poriae Cocos ) Helps digestion and calms nerves.
This formula strongly tonifies Yang with six herbs from that category straight out of the gate. Channels entered are mainly Kidney, remember Kidney rules the bones, followed by Liver for the sinews. Although it is not present in the greatest amount, the star of the show is Yin Yang Huo ( Herba Epimedii ) also called Epimedium, which you read about in Er Xian Tang. In Eucommia 18 Jian Gu Pian Yin Yang Huo is served up in combination with other herbs which create enhanced herbal actions. Pairing Yin Yang Huo with Shan Yao results in enhanced functions of the latter. Six other herbs in this formula work with Yin Yang Huo help overcome inflammation of the spinal cord and weakness of the lower extremities or lower body. A study published in 2012 sought to identify which herbs in the Chinese Materia Medica were most helpful for treating osteoporosis. Of the 12 top herbs, five are in Eucommia 18 Jian Gu Pian Rou: Cong Rong, Du-Zhong, Niu Xi, Gu Sui Bu, and, of course, Yin Yang Huo.(9)
Serving Size: 2-3 tablets, three times per day.
Osteoherbal
This very warming formula from Dr. Fung is based on 60 years of clinical experience. It may be taken long term. It is the right one for the frail elderly who has already broken a bone or two. The patient would be cold and tired. This formula will perk them up and strengthen the bones. The strategy of this formula is worthy of three-dimensional chess. Let’s unpack it. Here are the 12 ingredients in OsteoHerbal plus basic actions.(8)
Lu Jiao ( Cornu Cervi ) Tonifies Yang, Bones and Spine. Gui Ban (Plastrum Testudinis ) Tonifies Yin, Blood, and Bones. Dang Gui (Radix Angelicae Sinensis ) Tonifies and moves Blood and helps with pain. Shu Di Huang ( Radix Rehmanniae Preparata ) Blood, Kidney Yin, and Jing. Chuang Xiong ( Rhizoma Ligustici Chuanxiong ) Moves the Blood Special for headaches. Ji Xue Tang ( Caulis Spatholobi ) Tonifies Blood and moves Blood and channel Qi. Zou Ma Tai ( Giantleaf Ardisia Rhizome ) Strengthens bones and helps with pain. Gui Zhi ( Ramulus Cinnamomi ) Unblocks theYang and goes to the shoulders. Mu Gua ( Fructus Chaenomelis ) Helps with pain and digestion. Wu Zhu Yu ( Fructus Evodiae ) Warming and helps digestion. Dang Shen ( Radix Codonopsis ) Tonifies Qi, Blood and digestion. Gan Cao ( Radix Glycyrrhizae ) Tonifies Blood and Qi and harmonizes.
Overall it is a warming and moving formula. Some herbs have the ability to target specific body areas. OsteoHerbal covers the head, extremities, shoulders, spine, lower back, and legs. Many of the herbs are being tapped for more than one of their actions. Of the 12 herbs, there are 3 which tonify Kidney Yin or Yang or both. 2 herbs tonify Kidney Essence. To support the Kidney Essence through the Blood, there are 5 herbs nourishing that fluid. There are 6 which address pain. There are 3 which strengthen the bones and sinews. And finally, there is one herb to harmonize them all, Gan Cao, licorice root.
Serving Size: 3 count, three times a day, between meals.
If there is osteoporosis and no obvious Kidney deficiency, it is reasonable to optimize digestion. The body simply is not getting the building blocks for the biochemical reactions to initiate and form bones.
Quiet Digestion
Based on centuries-old Bao He Wan or “Preserve Harmony Pill”, Quiet Digestion is a modern formula. Quiet Digestion covers the basic digestive complaints. These are bloating, nausea, vomiting, and diarrhea. Taking Quiet Digestion for two weeks can help fine-tune the digestion. This results in improved absorption of herbal formulas and food nutrients. This is a good choice if the osteoporotic patient tends to have loose stools. Quiet Digestion is also useful for a hangover, food poisoning, hiccups, poor appetite, erratic stools, motion sickness, and morning sickness.
Serving size: 2 tablets between meals; or 1 to 2 tablets before and/or after meals to help food absorb. In acute conditions take every two hours. If constipation results, reduce serving size.
Triphala
Triphala is an Ayurvedic formula made of three fruits. Amala (Emblica Officinalis), Harada (Terminalia chebula) and Bibhitaki (Terminalia bellirica). Amla and Bihitaki are rejuvenators and laxatives from Ayurvedic herbalism. Harada, called the Tibetan “king of medicine, is originally from Iranian herbal traditions. Traditionally it is used as a digestive cleanser and for spiritual advancement. The combination of those three fruits creates a formula which is tridoshic, or benefits all three doshas. A dosha is the patterning diagnostic system used in Ayurvedic medicine. Triphala has everyone covered. It has been used for over a thousand years as a digestive, bowel cleanser, and rejuvenator as well as for osteoporosis. It is very beneficial in maintaining colon health, which in Ayurvedic medicine plays a vital part in nourishing the bones. One of the active constituents of Triphala is gallic acid. This has been shown to increase bone formation and decrease the breakdown.(10) Recall that there is a relationship between poor gastrointestinal health and osteoporosis. In a rat study using induced colitis, Triphala helped all the rats. The researchers concluded Triphala had a considerable and reliable effect in reducing colitis. They attributed this to its antioxidant activity and flavonoid content.(11) Triphala is a good choice if the osteoporotic patient tends towards constipation, IBS or colitis.
Usage: take according to product recommendation or that of your health care provider.
Disclaimer Use herbs wisely. If you have questions or special considerations, work with your practitioner. If symptoms worsen or you have concerns, contact a knowledgeable practitioner. These statements have not been evaluated by the Food and Drug Administration. These products are not intended to diagnose, treat, cure or prevent any disease.
References
1 Un Sil Jeon, M.D, Kidney and Calcium Homeostasis, Electrolyte Blood Press, 2008 Dec; 6(2): 68–76.
2 Sara Castiglioni,1 Alessandra Cazzaniga,1 Walter Albisetti,2 and Jeanette A. M. Maier, Magnesium and Osteoporosis: Current State of Knowledge and Future Research Directions, Nutrients, 2013 Aug; 5(8): 3022–3033.
3 Seymour Katz, MD, FACP, MACG,Stuart Weinerman, MD, FACP, Osteoporosis and Gastrointestinal Disease , Gastroenterol Hepatol (N Y), 2010 Aug; 6(8): 506–517.
4.Maciocia, G, The Foundations of Chinese Medicine, Churchill Livingstone, 1989
5 Bensky, Scheid, Ellis, Barolet Formulas and Strategies. Portable 2nd edition. Eastland Press Inc. 2015
6 Hui Sun, Li - jing Li, Ai - hua Zhang, Ning Zhang, Wen - jun Sun, Xi-jun Wang, Liuwei Dihuang Wan, A Traditional Chinese Medicinal Formula, Protects Against Osteoporosis, Pharmaceutica Analytica Acta, 2013
7 Ge Zhang, Ling Qin, Yinyu Shi, Epimedium‐Derived Phytoestrogen Flavonoids Exert Beneficial Effect on Preventing Bone Loss in Late Postmenopausal Women: A 24‐Month Randomized, Double‐Blind and Placebo‐Controlled Trial, Journal of Bone and Mineral Research, 04/09/2007
8 Bensky, Gamble, Chinese Herbal Medicine Materia Medica, Revised edition, Eastland Press, 1993
9 Zhi-qian Wang, Jin-long Li, Yue-li Sun, Min Yao, Jie Gao, Zhu Yang, Qi Shi, Xue-jun Cui, and Yong-jun Wang , Chinese Herbal Medicine for Osteoporosis: A Systematic Review of Randomized Controlled Trails, Evidence-Based Complementary and Alternative Medicine, Volume 2013, Article ID 356260, 11 pages
10 Shashi Chauhan, Aditi Sharma, Navneet Kumar Upadhyay, Gajender Singh, Uma Ranjan Lal, Rohit Goyal, In-vitro osteoblast proliferation and in-vivo anti-osteoporotic activity of Bombax ceiba with quantification of Lupeol, gallic acid and β-sitosterol by HPTLC and HPLC BMC Complementary and Alternative Medicine (2018) 18:233
11 Rayudu V., Raju AB, Effect of Triphala on dextran sulfate sodium-induced colitis in rats, Ayurveda, 2014 Jul-Sep;35(3):333-8
