by Z'ev Rosenberg, L.Ac.

Kan Herbal Crossroads: November 2005

There has been an alarming increase in recent years of autoimmune diseases, ranging from allergies to serious disorders, such as multiple sclerosis and scleroderma. About 75 percent of autoimmune diseases occur in women, most frequently during the childbearing years. According to biomedicine, hormones are thought to play a role; some autoimmune illnesses occur more frequently after menopause, others suddenly improve during pregnancy, with flare-ups occurring after delivery, while still others will get worse during pregnancy. Autoimmune diseases may have a genetic component, but mysteriously, they can occur in families as different illnesses. For example, a mother may have lupus erythematosus, her daughter diabetes and her grandmother, rheumatoid arthritis. Research is shedding light on genetic as well as hormonal and environmental risk factors that contribute to the causes of these diseases.

Individually, autoimmune diseases are not very common, with the exception of thyroid disease, diabetes, and systemic lupus erythematosus (SLE). Taken as a whole, they represent the fourth-largest cause of disability among women in the United States. If we also consider other conditions, such as environmental allergies and Chrohn's Disease, an even larger number of people are affected. Chinese medicine can be very helpful in the long-term management of patients with autoimmune diseases. Many autoimmune diseases were recognized over the long history of Chinese medicine, and several seminal texts developed treatment strategies for such patients. The source texts that may be useful today for treating such diseases include the Shang Han Lun, the Nan Jing, Pi Wei Lun/Treatise on the Spleen and Stomach, and the body of literature known as Wen Bing Xue or 'Study of Warm Disease'.

According to the "Golden Mirror of Medicine" a Qing dynasty text1, women's diseases differ from men in terms of menstrual disorders, vaginal discharge, fertility and child-bearing, pregnancy, post-partum, breast and uterine diseases. In the Nei Jing Su Wen, chapter 1, women's life cycles are defined as seven year cycles of development (menses is said to begin around fourteen years of age), whereas male life cycles are eight year cycles. We may find clues here, as to why women tend to develop autoimmune diseases more than men. The complexity of the female body, and more frequent fluctuations based on cycles of blood, qi, and yin, may contribute to the development of autoimmune disease.

Formulas to help regulate the menstrual cycle and maintain the health of female patients include Women's Chamber, Women's Journey, Women's Rhythm as well as Giovanni Maciocia's Women's Treasure which includes 27 formulas addressing women's reproductive issues.

External versus internal cause of diseases

Chinese medicine classifies diseases in two broad categories: 1) Wai gan/external contractions caused by exterior evils such as wind, cold, damp, heat, summer heat, and dryness and 2) Nei shang/internal damage caused by emotional excesses and taxation from poor diet, lack of rest, overwork and immoderate sexual activity. The Shang Han Lun and Wen Bing Xue have developed diagnostic and treatment strategies for external contractions, whereas such texts as the Pi Wei Lun/Treatise on the Spleen and Stomach and the Jin Gui Yao Lue/Prescriptions From the Golden Cabinet focus on internal damage disorders.

The Treatise on the Spleen and Stomach has a pivotal statement on which we can focus on, in trying to understand autoimmune disease from a Chinese medical perspective: "Ministerial fire is the fire of the pericardium developing from the lower burner. It is a foe to the original qi. (This yin) fire and the original qi are irreconcilable to each other. When one is victorious, the other must be the loser."2

My explanation of this theory is as follows: the ministerial fire, also known as lifegate fire (ming men huo), is the fire of the lower burner that according to the Nan Jing resides between the two kidneys. Normally, it is like a pilot light, a level flame that maintains the metabolic heat of the organism. If too low, kidney yang vacuity or dual spleen/kidney yang vacuity may develop, leading to cold and sore lower back and legs, clear copious urination, and diarrhea with undigested food particles (clear food diarrhea). If the ministerial fire is stirred, it rises up, damaging the spleen and stomach and disturbing the heart. The ministerial fire is stimulated by overexertion, overwork, alcohol, smoking, recreational drugs such as cocaine, prescription drugs such as prednisone, excessive sexual activity, loud music, violent movies, and late-night partying. This excessive stirring of ministerial fire eventually consumes the original qi, which is composed of da qi/air qi from the lungs, combined with food qi from the spleen and jing/essence from the kidneys to support the organism. When the original qi becomes debilitated, and the spleen and stomach are weakened, the clear and the turbid are not properly separated. The clear qi circulates and supports the defense qi, which cannot properly protect the body's exterior, therefore it 'collapses' inwards. The defense qi is yang in nature, therefore warm, and this heat collects internally to produce what Li Dongyuan calls 'yin huo' or yin fire, heat that arises from inside the body. This is an evil, debilitating heat that slowly wastes qi, blood and fluids over time. In addition, the harmonious interaction of the wei/defense and ying/construction is lost, leaving the exterior unstable and exposed to attack by external evils.

As mentioned in the Treatise on the Spleen and Stomach (pg. 86), "consequently, there is no yang qi to sustain the constructive and defensive. As they are unable to withstand wind and cold, cold and heat are generated. All this is due to insufficient qi of the spleen and stomach. However, although they look quite the same, this differs essentially from the pattern of external contraction of wind and cold." In other words, the body may generate symptoms that look like an external wind/cold attack, but is actually an internal condition caused by vacuity of the spleen and stomach. Rather than relying on prescriptions to release the exterior, we need to supplement the spleen and stomach as a core treatment strategy in treating some cases of seasonal allergies, rhinitis, sinusitis and repetitive events of the common cold.

This may seem to be a complex theoretical explanation for autoimmune disease, but it does show that Chinese medicine has developed an elegant explanation for the autoimmune process. The Treatise on the Spleen and Stomach, translated into English in 2004 by Bob Flaws, also has in-depth descriptions of disease processes that resemble such 'modern' conditions as multiple sclerosis and other neurological disorders such as ALS and Parkinson's Disease.

The core of this approach involves healing the spleen and stomach, specifically the function of separating the clear and turbid, restoring the normal ascending function of the spleen and descending function of the stomach and intestines. It also involves eating a proper diet, called the qing/dan or 'clear-bland' diet, based on natural foods with no artificial additives or excessive condiments or flavors, and regulating lifestyle and emotions to emphasize peace and equanimity in one's life.

Kan Herb Company has several prescriptions developed by Li Dongyuan in the Treatise on the Spleen and Stomach. Kan Herbal's Arouse Vigor, developed by Ted Kaptchuk, is a faithful version of Bu zhong yi qi tang/Supplement the Middle and Augment the Qi Decoction, perhaps Dr. Li's most famous prescription for sinking of the spleen qi.3 The Alembic Herbals line, which I developed, has two more variations of Dr. Li formulas, Huang qi ren shen tang/Ginseng and Astragalus Decoction, sold as Rejuvenate and Regulate, useful for liver qi depression, instability of defense qi with spleen qi vacuity, along with Qing shu yi qi tang/Clear Summer heat and Augment the Qi Decoction, or Qing Shu formula, which is used for conditions involving liver qi depression and spleen qi vacuity with damp heat. The Chinese Modular Solutions line, developed by Efrem Korngold and Harriet Beinfield, has a version of Sheng mai san/Restore the Pulse Powder known as Move Mountains. Prosperous Farmer and Six Gentlemen both address Spleen Qi vacuity and Damp accumulation.

Long term management of autoimmune disorders

"In this world there are two times. There is mechanical time and there is body time. The first is as rigid and metallic as a massive pendulum of iron that swings back and forth, back and forth, back and forth. The second squirms and wriggles like a bluefish in a bay. The first is unyielding, predetermined. The second makes up its mind as it goes along," Alan Lightman, "Einstein's Dreams", pg. 23.

In the second part of this article, I will discuss Nan Jing strategies for long-term management of autoimmune disorders. It is essential to be able to project treatment and prognosis for conditions that may require extended treatment, so as to not lose our bearings in the protracted course of these disorders.

The Nan Jing or "Difficult Classic", is in essence a meditation on the relationship of human beings to the phenomenon of time, specifically 'body time'. Several chapters or 'difficulties' in the Nan Jing are about the relationship of the breath to the pulse, and systematic correspondences between color, sound, odor and palpable sensations. These phenomena are the external manifestations of channel and visceral relationships that not only give us a real-time picture of various illnesses, but also their origin and possible course of development.

The ideal pulse, or movement in the vessels, is perfectly balanced, smooth, pliable and flexible, with an even, moderate rhythm. Beginning from this measurement, variations in speed, quality (rough, fine, soggy), depth, and position (inch, bar and cubit lengthwise, heaven, human and earth depth-wise) show us deviation from this ideal equilibrium. The more complex the disease pattern, the more complex the pulse will be. As in any mathematical computation, we begin from the simplicity of yin and yang qualities into complexity, which are simply variations of yin and yang multiplied by the number of disease factors present. We then determine treatment by synthesizing information from the pulse along with other sensory data, and the results of our questioning the patient.

All variations from the norm are called xie qi or evil qi in Chinese medicine. Zheng qi or correct (right) qi is that which maintains normal health and visceral function of the body. Through the pulse and other diagnoses we try to calibrate the degree, speed, and direction of evil qi versus the ability of correct qi to resist it. Evil qi can include visiting evils, such as wind, cold, damp, heat, summer heat, or dryness, epidemic evils such as damp-warmth and warm toxin disease, or internal evils caused by excessive emotions damaging the viscera and bowels. To support correct qi, we use supplementation or harmonization methods. A harmonizing formula such as Minor Bupleurum dispels xie, evil qi while supporting Zheng, correct qi.

To attack evil qi, we use sweating, precipitation/purging, vomiting, urination, dispersing and warming. In addition, we may use dietetics, lifestyle modifications, behavioral therapies or meditation and prayer to help strengthen correct qi and eliminate evils.

Every disease has to be differentiated by pattern and stage, using the pulse and symptom picture to determine the degree of repletion or vacuity, interior or exterior, heat or cold, location in qi, blood or fluids. We can also determine the stage of the illness using the liu jing bian zheng/six channel pattern differentiation from the Shang Han Lun, or the si fen bian zheng/four aspects pattern differentiation of Warm Disease Theory. These systems, or 'immunological maps', determine the location, direction of movement and speed of the evil qi through the channel system, and determine the strength of the correct qi and its ability to resist the evil qi. Warm disease theory also talks about latent evils, that have 'incubated' deep inside the body from season to season or even over a several year period.

Once we have determined the location, strength, duration and direction of the autoimmune disorder, we need to develop long-term treatment strategies in order to 'change the direction' of the disease. In other words, we need to direct the disease outwards, away from the yin interior, and towards the yang exterior to prevent the disease from lodging itself in the blood, fluids and/or yin viscera. According to Chinese medicine, diseases have 'exit routes' through the yang channels and their associated bowels, and most treatment strategies are designed to take advantage of these exit routes, as diseases cannot directly exit from the yin viscera, blood or fluids. Many patients with autoimmune diseases also have weakened, damaged or exhausted jing/essence, which can take years of treatment to reverse. Emotional traumas such as death of a loved one, divorce, loss of job, or sudden change in climate or residence can also tax the essence and correct qi, and can contribute to the development of a chronic disease.

For those patients who have a long history of an autoimmune disease, it is very important to take a detailed history, as such diseases as lupus and rheumatoid arthritis often go through several stages of aggravation and remission, with different symptom patterns manifesting at each stage. The experienced practitioner will not rely just on one method of pattern differentiation, but will use what is appropriate, whether it is spleen-stomach theory, five phases, six channel, four aspect, or some combination thereof. The effects of previous or concurrent treatments, must also be factored in. Many autoimmune diseases are treated with powerful drugs such as steroids, antibiotics, anti-inflammatories or chemotherapy drugs, and this can alter the symptom picture somewhat or weaken the correct qi and essence. One then alters treatment accordingly, being cautious about potential drug-herb interactions, and then primarily supporting the correct qi. For example, a patient with later-stage nephrotic syndrome or chronic nephritis may be taking toxic medications to control proteinuria or high creatinine counts, with many side effects or complications. In such cases, the safest course is to use such herbs as dong chong xia cao/cordyceps sinensis which supplements and protects the kidneys against further damage.

MycoHerb formulas that address the delicate balance required when treating autoimmune diseases include Myco-Forte, Fu Zheng Support, Reishi Forte, and Reishi. These formulas invigorate the defensive wei qi while simultaneously eliminating auto-toxicity.

Chronic diseases transform according to natural cycles, such as seasonal changes. They transform, aggravate, worsen or move towards remission. When the correct qi is strengthened, it can keep the disease in check, leading to a more optimum level of functionality and stability. It is possible to help our patients with autoimmune diseases return to a healthier, normal life with Chinese medicine, but we need to be very detailed and observant in our diagnosis and treatment strategies. In this short article, I have tried to give the general outline of those strategies, but the details will need to be filled in with deeper study and practice, practice, practice. I strongly recommend all new practitioners to find a mentor with long-term experience in treating these disorders. The reward of effective Chinese medical treatment is to create a better quality of life for our patients, and increased recognition of the efficacy and safety of Chinese Medicine.

References

1. The gynecology section of the "Golden Mirror of Medicine" will soon be published by Paradigm Publications as "Heart Approach to Gynecology: Essentials in Verse," translated by Shen Yu.

2. "Treatise on the Spleen and Stomach", Li Dong-yuan, translated by Bob Flaws, Blue Poppy Press, Boulder, Co. 2004, pg. 82.

3. Sinking of the spleen qi/pi xia xian: "insufficiency of spleen qi in which its uplift is diminished and manifests in sinking effects such as prolapse of the anus, prolapse of the uterus, enduring diarrhea, or depressed fontanel in infants," Practical Dictionary of Chinese Medicine, Wiseman/Feng, Paradigm Publications, Taos, N.M., pg. 55.