by Bob Flaws, Dipl. Ac. & C.H., FNAAOM

Introduction

Many Western patients seeking treatment from either alternative-minded Western MDs or from chiropractors and naturopaths are told that their many otherwise undiagnosable complaints are due to either intestinal dysbiosis, leaky gut syndrome, or candidiasis. Whenever I hear that a patient has been previously given one of these Western diagnoses, I can rest pretty assured that their Chinese pattern discrimination will be some combination of spleen qi vacuity, liver depression, and damp and/or depressive heat with another two or three patterns thrown in for good measure. Therefore, most Western sufferers of these conditions can be categorized as manifesting yin fire conditions, and Li Dong-yuan's theories about and protocols for yin fire are often the best ones for treating these patients.

Intestinal dysbiosis

In previous essays, I have outlined the main ideas concerning yin fire and its treatment. Here let me explain a little about these Western diseases and their Chinese disease causes and mechanisms. Intestinal dysbiosis means that the mixture of the fauna and flora in the intestines is not a healthy, correct one. Our intestines are home to a number of microorganisms, including various types of protozoa, bacteria, and fungi. Many of these commensal microorganisms provide important services to the body's ecology. When these populations of protozoa, bacteria, and fungi are in their proper numbers and relationships, they tend to inhibit and control one another, keeping the mix from becoming lop-sided and pathological. If one or another of these populations explodes, it may throw off this balance, resulting in one or more diseases.

The causes of intestinal dysbiosis

What factors may cause such a loss of balance of the protozoa, bacteria, and fungi in the intestines? Certainly one of the first and foremost causes in modern days is the use of Western medical antibiotics. Antibiotics as a class of medicines kill bacteria. Often antibiotics kill bacteria in the body indiscriminately, eliminating all the healthy bacteria as well as any pathological bacteria. Since "good" bacteria in the intestines help to keep populations of yeast and fungi in the guts in their proper numbers, if one wipes out all these healthy bacteria, yeast and fungi populations may soar.

Yeast and fungi populations may also soar due to exposure to certain types of hormones. This helps explain why these populations typically increase during the luteal phase of women's menstrual cycle and also during pregnancy when progesterone levels are up. However, hormone therapies, including the use of corticosteroids, may also stimulate the proliferation of yeast and fungi in the body.

Further, faulty diet may also contribute to over-growths of yeast and fungi. If you want to grow yeast and fungi in a bucket of water, what do you do? You add sugar. Therefore, diets high in sugars and sweets tend to feed yeast and fungi in the body to an unnatural and unhealthy extent. Human beings are now eating unprecedented amounts of sugars and sweets which were unavail-able to the majority of people only 150 years ago.

According to Chinese medical theory, antibiotics are bitter and cold and can easily damage the spleen if used in too large doses or for extended periods of time. Sweet is the flavor corresponding to earth and which enters the spleen. In very small, naturally occurring amounts, the sweet flavor fortifies the spleen and supplements the qi. However, due to its correspondance with earth (which is damp in nature), the sweet flavor also engenders dampness. When too much sweet is eaten, instead of fortifying the spleen, it damages the spleen and engenders evil dampness. If either antibiotics or overeating sugars and sweets damages the spleen and dampness is engendered, this dampness will obstruct and hinder the free flow of yang qi. The yang qi will become depressed and this depressed qi may transform into evil heat. If this depressive heat mutually binds with this dampness, it then gives rise to internally engendered damp heat.

Estrogen is a yin essence supplement. If taken in excessive amounts for the individual patient's pattern, estrogen can cause pathological accumu-lations of dampness and even phlegm (i.e., con-gealed dampness). Progesterone is a yang essence supplement. Being yang, progesterone adds yang qi to the system and yang is inherently warm. Thus progesterone in some patients may stir min-isterial fire and quicken the transformation of evil dampness into damp heat or simple qi stagnation into depressive heat. Corticosteriods, such as Prednisone, are warm, exterior-resolvers which transform essence into yang qi which is then upborne and out-thrust. Although out-thrusting is one way of clearing internal heat, because they are yang, corticosteroids may also quicken or make more likely the transformation of dampness into damp heat, especially in those where strong use of exterior-resolving damages yin fluids and leads to yin vacuity with yang hyperactivity.

The results of intestinal dysbiosis

If yeast and fungi remain in the intestinal tract, they cause only digestive complaints, such as bloating and gas after meals, diarrhea, nausea and vomiting, and intestinal pain. However, when yeast multiply unchecked, they may branch out by sending hyphae or tentacles through the walls of the intestines. New fungi then bud from these hyphae and reproduce within the body itself. When these yeast and fungi, which are now on the inside of the body, die, they break down into foreign protein molecules which the body recog-nizes as "not me." Hence the body mounts an immune response against these foreign molecules. This immune response may be experienced as an allergic response. Further, because these fungi have breached the intestinal lining with their tentacles, other large molecules which would not enter the "inside" of the body may pass through. These other large, undigested food molecules may also provoke allergic reactions. This is what is meant by leaky gut syndrome.

If a constant succession of allergic reactions continue day in and day out, over time two things will happen. One, the immune system will lose its perspective of what to attack and what not to attack. It "pops off" at the drop of the hat so to speak, reacting to stimuli as threats to the body which most people do not. Eventually, if the immune system loses all sense of what it should and shouldn't do, it may start to attack our own tissues and organs. Then we label the patient as suffering from this or that autoimmune disease depending upon what tissues the body is attack-ing. If the body's immune system is attacking the thyroid gland, then the patient may suffer from autoimmune or Hashimoto's thyroiditis. If the body's immune system attacks the ovaries, causing autoimmune ovaritis, then the patient may suffer from endometriosis. Secondly, because of overwork, the immune system may become fatigued and not very effective at fighting the pathogens it normally should. So patients with this scenario may also easily be invaded by viruses and other disease-causing pathogens most of us routinely and successfully ward off.

Diet & polysystemic chronic candidiasis

Since this scenario may lead to a wide range of tissues and organs being affected, some Western clinicians have referred to this as polysystemic chronic candidiasis (PSCC), but whatever we call it, in Chinese medicine, we are talking about Li Dong-yuan's concept of yin fire. All the foods which typically negatively affect this condition are those that Chinese medicine says either damage the spleen, engender dampness, aggravate heat, or impede the free flow of qi. For instance, we have seen above that sugars and sweets damage the spleen and engender dampness. Likewise, foods which are high in wei or flavor (a technical concept in Chinese medicine) tend to be hard to digest and have a high proportion of turbidity to clear qi. If clear and turbid are not thoroughly separated and turbidity eliminated from the body, then turbidity may also lead to evil dampness. Foods high in wei which tend to be dampening include milk, cheese, and dairy products in general as well as yeasted, steamed, or boiled wheat flour products. According to Li, "sodden wheat foods damage the spleen." Alcohol and oil are both damp and hot. They engender dampness but may also create evil heat or damp heat. The sour flavor enters the liver and is astringing. Astringing implies inhibiting the free flow of the qi. Thus sour flavored foods, such as vinegar, may damage the liver's coursing and discharge and cause or aggravate liver depression qi stagnation, ultimately transforming into depressive heat. Add sweet and sour together, as in orange juice or tomato sauce and we have a perfect recipe for damp heat.

Hence Chinese dietary therapy agrees with all the foods that Western clinicians say to avoid if one suffers from intestinal dysbiosis, leaky gut syndrome, or candidiasis. Again, these are all foods which damage the spleen and engender dampness, engender or aggravate heat, or impede the free flow of qi. A logical extension of this is that one must complement Chinese medicinal therapy for yin fire conditions with correct dietary therapy. If one does not adhere to the clear bland (qing dan) diet of Chinese dietary therapy and avoid those foods which are known to aggravate candidiasis, then no combination or no amount of Chinese herbs will ever get a really satisfactory result. I have achieved many very startling clinical results with very strict anti-candida, hypoallergenic, clear bland diets even without any Chinese medicinals.

Therefore, patients with yin fire scenarios need to understand the importance of proper diet and be willing to stick to such a diet for at least three months. After even only two weeks of such a clear bland diet, most candidiasis/leaky gut patients will experience improvement in their conditions across the board. After three months, their condition should be greatly improved. However, the patient should also understand that, if they revert to their previous diet, their symptoms will probably quickly come back. For more lasting results, patients need to stick with the clear bland diet for 6-9 months or even a year. And even then, lapses from this diet should only be occasional exceptions and not the daily rule. For more information on the clear bland diet of Chinese medicine, readers may see my The Tao of Healthy Eating published by Blue Poppy Press.

Herxheimer reactions

In general, professional Chinese medicine seeks to cure without any side effects, and mostly we do not try to provoke nor do we expect what homeopaths refer to as "healing crises." However, when patients suffer from candidiasis/yin fire scenarios, their first few doses of medicine may provoke what is called a Herxheimer or die-off reaction. According to Western medicine, the medicinals may cause a massive die-off of yeast and fungi throughout the body. As these die, their decomposing bodies cause a type of toxicity within the body. The body may not be able to excrete and expel all these toxins as quickly as the patient would like. In that case, the patient may feel sick due to this back-up of yeast and fungi breakdown products.

If seeming side effects to Chinese medicinals for yin fire conditions are actually a Herxheimer reaction, these medicinals should not be suspended, but rather they should be continued, possibly increased, and maybe also modified by the addition of other medicinals. If such seeming side effects are a die-off reaction, then there will be the following symptoms: The patient will feel fluey, achy in the joints, possibility even a little feverish. They will feel nauseous and may even vomit. Likewise, they may experience diarrhea. There is also often a headache. Various of the patient's other symptoms may suddenly flare up or get worse. However, if this is truly a Herxheimer reaction, it will only last 12-36 hours, and after it subsides, the patient and their practitioner should see that all of the patient's other signs and symptoms also recede along with the symptoms of the Herxheimer reaction. If vomiting, diarrhea, nausae, fever, or bodily aches and pains continue for more than 36 hours, then this is probably not a Herxheimer reaction, the medicinals have been improperly prescribed for the patient's pattern, and they should be suspended or modified.

Other things one can do during a Herxheimer reaction in order to speed its passing is to use every means available to rid these die-off toxins from the body. This means that one may add an intestinal purgative to the patient's regime, such as Magnesium Citrate from the drugstore or Radix Et Rhizoma Rhei (Da Huang) and Mirabilitum (Mang Xiao) from the Chinese aopthecary. They may also do an enema. They should drink more water in order to increase urinary excretion and take a hot bath or sauna to provoke sweating. If one takes a hot bath, one may put Epsom Salts in the bath water.

Some Chinese doctors from China who do not know about Herxheimer reactions have been scared off from giving Western patients Chinese herbs. They knew their formulas were correct based on their patient's pattern, but the patient had seemingly unexplainable nausea, vomiting, and diarrhea. This has led some native Chinese doctors now working in the West to say that Westerners cannot take Chinese herbal medicine. This is a great mistake. It is true that, up till now and due to differences in diet and medical care, Chinese patients have tended to suffer less from complicated yin fire conditions that Westerners. Therefore, many Chinese doctors from China do not have much clinical experience in dealing with these kinds of conditions. Because these kinds of conditions are so prevalent in exactly the patient population which makes the greatest use of acu-puncture and Chinese medical practitioners in the West, Western practitioners need to be well-versed in this topic. The following functional translation of a recent Chinese medical journal article on intestinal dysbiosis and Chinese medi-cine helps explain some of these concepts further.

Chinese literature on intestinal dysbiosis

(From "The Treatment of Intestinal Dysbiosis Diarrhea with Yu Ping Feng San [Jade Windscreen Powder] Combined with Si Ni San [Four Counterflows Powder]" by Zheng Jian-hong & Lin Zhi-rong, Xin Zhong Yi [New Chinese Medicine], #5, 1998, p. 30-31)

Following the use of heavy [doses] of antibiotics, some patients develop intestinal dysbiosis whose symptoms become increasingly numerous. This condition easily relapses and may continue for five years. The authors of this clinical audit have treated 22 cases of this disease with a combination of Yu Ping Feng San and Si Ni San with relatively good therapeutics effects as described below.

Cohort description:

All the patients in this study had been treated with a long course of antibiotics and none had previously had any history of abnormal diarrhea. Of these 22 patients with intestinal dysbiosis, 12 were men and 10 were women. They ranged in age from 20-63 years old, with a median age of 46. Four cases were between 20-30, six cases were 31-40, eight cases were 41-50, and four cases were 51 years old or above.

Treatment method:

The basic medicinals used were: Radix Astragali Membranacei (Huang Qi) and Semen Coicis Lachryma-jobi (Yi Yi Ren), 24g @, Rhizoma Atractylodis Macrocephalae (Bai Zhu), Radix Albus Paeoniae Lactiflorae (Bai Shao), and Sclerotium Poriae Cococs (Fu Ling), 18g @, Radix Ledebouriellae Divaricatae (Fang Feng), Fructus Immaturus Citri Aurantii (Zhi Shi), and Rhizoma Coptidis Chinensis (Huang Lian), 9g @, Radix Bupleuri (Chai Hu), 12g, and Radix Glycyrrhizae (Gan Cao), 6g.

If abdominal pain was severe, 17g of Cortex Magnoliae Officinalis (Hou Po) and 9g of Fructus Amomi (Sha Ren) were added. If tenesmus was marked, 6g of Radix Auklandiae Lappae (Mu Xiang) and 12g of Semen Arecae Catechu (Bing Lang) were added. If vacuity cold was pronounced, 18g of Radix Codonopsitis Pilosulae (Dang Shen) and 9g of dry Rhizoma Zingiberis (Gan Jiang) were added. If there was food stagnation, 15g of Fructus Germinatus Hordei Vulgaris (Mai Ya) and Fructus Crataegi (Shan Zha) were added. If damp heat was heavy, 15g of Herba Patriniae Heterophyllae Cum Radice (Bai Jiang Cao) and 12g of Radix Pulsatillae Sinensis (Bai Tou Weng) were added. If there was simultaneous nausea and vomiting, 12g of Rhizoma Pinelliae Ternatae (Ban Xia) and Herba Agastachis Seu Pogostemi (Huo Xiang) were added.

One ji was administered per day, decocted in water two times, and given warm in two divided doses on an empty stomach. Seven days equalled one course of treatment.

Treatment outcomes:

Complete cure was defined as disappearance of the symptoms of diarrhea with 1-2 bowel movements per day and formed stools. All bodily symptoms and other laboratory tests returned to normal. Marked effect was defined as 2-3 bowel movements per day with the stools gradually taking shape or loose stools but only one time per day. At least one other bodily symptom or laboratory test result had not yet returned to normal. A change for the better was defined as some improvement in the disease symptoms, the bodily condition, and laboratory tests. No effect meant that, after one course of treatment, there was no improvement or [the condition] had gotten worse.

Based on the above criteria, 15 out of 22 patients were judged cured, five got a marked effect, and two got no result. Thus the total amelioration rate was 90.91%.

Representative case history:

The patient was a 20 year old male who was first examined on Mar. 17, 1997. Due to a a number of broken bones in his thighs and neck, he had already gone for surgery three times and, therefore, he had had to undergo long and heavy doses of antibiotics. One week prior, he had developed diarrhea with abdominal pain and a low-grade fever. Each day he had watery stools 10 or more times. His WBC count was 11 x 109/L. N was 0.82. HGB was 70g/L. There were an abnormally high number of white blood cells in his stools. Therefore, his Western medical diagnosis was intestinal dysbiosis diarrhea. Three days previously he had stopped using antibiotics and had tried taking ready-made medicines, such as Huang Lian Su (Coptis Simple). However, the diarrhea had not improved. Therefore, he came to a Chinese doctor for examination.

At the examination, it was seen that his temperature was 37.8°C. His facial complexion was sallow yellow. He passed stools more than 10 times per day. These stools were watery. These were accompanied by a small amount of plaque-like mucusy material. Each time he ate or drank water, he would have abdominal pain. There was intestinal tenesmus and a yellow-colored water seeped and leaked from his anal gate. No matter what the patient ate, he felt vexed, agitated, and disquieted. He was fatigued and lacked strength. His urination was short and scanty and its color was faintly yellow. His tongue was pale and had the marks of his teeth on its edges. Its fur was thin and yellow. His pulse was fine and weak.

This pattern was categorized as spleen vacuity qi fall with damp obstruction transforming into heat. Treatment was, [therefore,] in order to fortify the spleen and boost the qi, rectify the qi and transform dampness, assisted by clearing heat. The prescription [read]: Radix Astragali Membranacei (Huang Qi) and Semen Coicis Lachryma-jobi (Yi Yi Ren), 24g @, Radix Albus Paeoniae Lactiflorae (Bai Shao), Radix Codonopsitis Pilosulae (Dang Shen), and Sclerotium Poriae Cocos (Fu Ling), 18g @, Fructus Immaturus Citri Aurantii (Zhi Shi), 9g, Rhizoma Coptidis Chinensis (Huang Lian), Radix Auklandiae Lappae (Mu Xiang), and Radix Glycyrrhizae (Gan Cao), 6g @, and Semen Arecae Catechu (Bing Lang), 12g.

After three ji, [the patient] was re-examined. His body temperature was normal. He was defecating 5-6 times per day. [The stools] were yellow in color and sticky in consistency. His abdominal pain and tenesmus were markedly decreased. There was already no seeping and leakage of stools, and his essence spirit had improved. [Food] intake had increased, but his tongue and pulse were the same as above. White blood cells in the stools had significantly decreased. [Therefore,] Auklandia and Areca were removed from the above formula and 15g of Fructus Germinatus Hordei Vulgaris (Mai Ya) and Endothelium Corneum Gigeriae Galli (Ji Nei Jin) were added. After [another] three ji, there was no abdominal pain or tenesmus. He was defecating two times per day with mushy stools. His essence spirit and stomach intake were improved. [Hence,] another three ji of the above formula were continued and his stools became normal, while his essence spirit and stomach intake were quite good. He was suggested to continue taking stomach-fortifying, dampness-transforming Chinese medicinals in order to secure the treatment effect. On follow-up after half a year, there had been no relapse.

Chinese authors' discussion:

This disease is due to long-term heavy use of antibiotics causing loss of balance of the intestinal fauna and flora. Clinically, this is mainly evidenced by diarrhea and abdominal pain. Chinese medicine disease diagnosis categorizes this as diarrhea (xie xie). Its root is spleen vacuity qi fall. Its disease mechanisms [include] dampness obstructing the qi [which causes] stagnation. If this endures, it transforms into heat, and clear and turbid are not divided. Therefore, the root is vacuous, while the branch is replete. Cold and heat are mixed together and the disease is by nature recurrent.

Treatment should, [in this case,] support the righteous and dispel evils. Taking into account changes in the disease's nature and discriminating clearly between cold and heat, vacuity and repletion, one must cleverly support the righteous while not retaining evils and dispel evils without damaging the righteous. Yu Ping Feng San boosts the qi and secures and astringes. It also commands the intestinal tract's opening and closing. Si Ni San plus Ledebouriella courses and out-thrusts, dries dampness, divides [clear from turbid], and rectifies the middle burner. Coix and Poria are added to the above to fortify the spleen, divide [clear from turbid], and disinhibit urination. Taken as a whole, this combined formula fortifies the spleen and dispels dampness, dispels evils and quiets the righteous, thus curing the disease.

This disease easily relapses. The main causes of such recurrences are spleen vacuity and damp obstruction. Therefore, after achieving a [clinical] cure, one should continue fortifying the spleen and transforming dampness in order to preventively treat and stop recurrent outbreaks.

Bob's discussion:

As the reader can see, the formula used in the above protocol follows all of Li Dong-yuan's principles for treating yin fire conditions. There are spleen-fortifying qi supplements, liver-coursing qi-rectifiers, and bitter, cold heat-clearing medicinals. In addition, other medicinals from other categories can be added depending on whatever other disease mechanisms are at work. This is the kind of complex formula which I find is required to treat the vast majority of my patients with chronic problems.