In this blog article, we would like to talk a more about autoimmune conditions and discuss some common illnesses such as lupus, rheumatoid arthritis (RA), multiple sclerosis (MS), and diabetes. These might be common problems that your patient present with either as standalone or in combination with other diseases.
As previously established, the immune system in biomedicine includes a range of tissues and cells that collaboratively defend our body from foreign pathogen invasion. But suddenly, in the case of autoimmune disorders, healthy tissues and structures are attacked by their own cells. As you know, certain auto-immune diseases are very common today and most of them affect connective tissues. Connective tissue is what it says it is, its function is to connect. Depending on what tissue is involved and what function is impaired or modulated, the condition is given a different name. What’s also interesting is that Women are often more affected by autoimmune conditions than males except in the case of Multiple Sclerosis. Could the female physiology somehow present more opportunity for an auto-immune condition to develop?
In TCM, according to the framework you work in (a preference for Zang Fu, 5-elements, Shang Han Lun, etc), there is either organs, meridians or network levels or energy layers that defend our internal environment from disruption caused by external factors. Regrettably, contemporary TCM is not familiar with the concept of auto-immune conditions. However, TCM does recognise bi-syndrome (Rheumatoid arthritis) or Xiaoke (Diabetes). Other fitting models that we could apply to gain a better understanding of auto-immune conditions could be the invasion of external pathogens such as wind, heat, cold, damp and perhaps the concept of latent pathogen. But there are limitations to those analogies, and it comes back to how we view our patients in their completeness.
In 2019, 6% of the European population was diagnosed with a type of autoimmune disease. There are four different types of lupus: Systemic Lupus Erythematosus (SLE) is the most common type, other types are called Cutaneous Lupus Erythematosus (CLE) and there are two uncommon types called neonatal lupus or drug-induced lupus. It is possible that around 5 million people worldwide suffer from a form of lupus. Rheumatoid Arthritis (RA) may affect as much as 1% of the population. This condition can affect children up to the age of 17 years of age. Nearly three million people suffer from Multiple Sclerosis (MS) worldwide and patients are predominantly male. Diabetes affected 537 million individuals in 2021 which represents a massive 6.7% of the world population.
Every autoimmune disorder affects the body in a different way. Some have strong genetic factors; others are slightly likely to be family related. As factors or disruptions of symptoms that will results in auto-immune conditions need to align, the onset can be later in life. If an auto-immune conditions is diagnosed during childhood, it could mean that it is a more aggressive form and there could also be a stronger genetic component.
Many such conditions have no identifiable causes, are chronic in nature and often difficult to treat. Symptoms may disappear for some time but the potential for them to return or being triggered and hence reoccurrence can be high. Knowing this, every time a new patient comes in with an auto-immune disorder, I feel slightly nervous. The patients usually have been to several (other) health professionals, they know themselves (and their bodies) well and they have studied and researched their condition. But each time, I start talking to these patients, charting their journey, and noticing their symptoms, I remember Hippocrates and one of his famous quotes: We must treat the patient and not the disease. And immediately I feel a lot more confident that TCM may be able to offer something to these patients.
How To Treat Patients With Auto-Immune Diseases
Research in China today is focused on targeting the connective tissue that is primarily affected by the auto-immune condition and identify herbal compounds that might be able to interfere with the malfunctioning by correcting it. This approach might not be what we consider the TCM pattern differentiation, nor it is establishing root cause or branch treatment for our patients. So, for me personally when I look at treating a patient with herbs, I will ask myself a range questions:
- Could the condition arise in the first place because there is a weakness? Could this be deficiency of Qi, Blood, Essence and would this lead to an easier invasion and establishment of latent pathogens which then disrupt the functions of Qi, Blood, Zang, meridians or individual layers?
- Is there an overarching genetic weakness which we often associate with the kidney and the essence?
- And may this situation in combination with diet and lifestyle choices attract autoimmune conditions? Is it necessary to treat the digestive function first?
- Consequently, if we tonify (Kidney yin or yang) will there be an overall improvement for the patient? And can this improvement help their bodies to combat and correct the malfunctioning?
- If I clear the latent pathogen first, or harmonise the layers, will the proper functioning be automatically re-established?
Herbs and isolated active components in the research laboratory have shown either anti-inflammatory or immune-regulating functions. But how can such models (in animals or the petri-dish) be applied to a person with a complex condition? As a TCM practitioner, how can we not feel like a traitor by choosing a single herb over a formula when considering that herbal substances were broken into chemical compounds. We look at the whole, not broken-down factors or components, we are gardeners not mechanics. Looking after a garden has to do with establishing conditions that benefit the entire garden whereas mechanics might look at an individual part that needs repairing or replacing. I feel more like a gardener than a mechanic but sometimes I also have strong desire to help my patients feeling better quickly, so I might make a compromise (and choose a herb in my formula that has been researched and the lab and proven to be an effective immune-regulator).
RA could have existed for a long as bi-syndromes because the Neijing Suwen indicated that wind, cold or dampness may cause painful obstruction. A bi-syndrome is painful obstruction caused by external invasion. Here is compilation of a complete compilation of painful obstruction formulas. We are lucky if we can establish that our patient suffers from a bi-syndrome because many formulas have been recognised to handle it.
Lingdan Pian, Zhen Wu Tang and Sheng Ling Bai Zhu San for SLE
Those formulas were used in clinical trials in China as adjunct to steroid therapies. They were given for at least three months. Not all herbal ingredients were disclosed for Lingdan Pian but the main substances are Qing Hao (Artemisiae Annuae Herba), Mu Dan Pi (Moutan Cortex), Qin Jiao (Gentianae Macrophyllae Radix), Gui Ban (Testudinis Plastrum), Shui Niu Jiao (Bubali Cornu), Sheng Di Huang (Rehmanniae Radix), Gan Cao (Glycyrrhizae Radix) and Xuan Shen (Scrophulariae Radix). It doesn’t appear that pattern differentiation was applied, and consequently, the same formula was administered to everyone. Zhen Wu Tang (Fu Zi –Aconiti Lateralis Praeparata Radix, Bai Zhu – Atractylodis Macrocephalae Rhizoma, Fu Ling –Poriae, Bai Shao – Paeoniae Albae Radix, and Sheng Jiang – Zingiberis Recens Rhizoma) was used in another trial.
These patients were also taking prescription medication at the same time as the herbs. In another group, a modified version for Sheng Ling Bai Zhu San was administered. In this case, the modifications were based on pattern differentiation for each patient. These are just a few ideas on how SLE was treated in two Chinese hospitals. I don’t seem to meet many patients with these afflictions but if I do meet them, they are predominantly female. We also know that if they are taking steroids, that these medications will cause their own group of signs or symptoms which should be considered when prescribing herbs for these individuals.
Flaccidity Syndrome: Wei Zheng
We can find some references to MS in the ancient texts, and it’s referred to as muscular weakening. The Neijing Suwen attributes an entire chapter to this syndrome. Further elaboration can be found in the book: Advanced Textbook for Traditional Chinese Medicine and Pharmacology. Here, Wei Zheng is described as disorder affecting the five organ systems. And three of the five Wei are particularly interesting in relation to the manifestation of MS.
The first one is the weakness associated with heat of the heart, empty blood vessels and consequently malnutrition of the muscles which causes weakening of the lower limbs. The second one refers to pathogenic heat and dampness affecting the spleen and causing impairment of stomach yin and lastly, severe exhaustion of the yin with deficient fire impacting the flaccidity of the lower limb muscles and spine. The Neijing Suwen accentuates the lack of nourishment of channels and muscles as cause of the weaknesses. This is great because we can work with this in clinic! So here come some formula suggestions: Hu Qian Wan, a later formula derived from this is called Wei Zheng Fang, Shi Quan Da Bu Tang, San Miao Wan, Dao Tan Tang or Dang Gui four combination which is Si Wu Tang plus Hong Hua (Carthami Flos), Tao Ren (Persicae Semen) and E Zhu (Curcumae Rhizoma).
Xiaoke – Diabetes, A Worldwide Pandemic?
We know that ancient TCM scholars were aware of diabetes because it was also mentioned in the Huangdi Neijing particularity in relation to the ingestion of rich in fatty or sweet food. Consequently, diabetes was a condition that afflicted affluent citizens. Today, two commonly used formulas in China or Japan come from the Jin Gui Yao Lue (Essential prescriptions from the golden cabinet) and are called Ba Wei Di Huang Tang (also called Jing Gui Shen Qi Wan) or Bai Hu Jia Ren Shen Tang. Later formulas were Mai Men Dong Yin Zi or Fang Feng Tong Sheng San. Research on Chinese herbal hypoglycaemic agents have yielded results individual herbs such as:
- Ze Xie (Alismatis Rhizoma)
- Zhi Mu (Anemarrhenae Rhizoma)
- Huang Qi (Astragali Radix)
- Bai Zhu (Atractylodis Macrocephalae Rhizoma)
- Cang Zhu (Atractylodis Rhizoma)
- Shan Yao (Dioscoreae Oppositae Rhizoma)
- Ren Shen (Ginseng Radix Et Rhizoma)
- He Shou Wu (Polygoni Multiflori Praeparatum Radix)
- Fu Ling (Poriae)
- Di Gu Pi (Lycii Cortex)
- Gou Qi Zi (Lycii Fructus)
- Jie Geng (Platycodonis Radix)
- Huang Jing (Polygonati Rhizoma)
- Ge Gen (Puerariae Lobatae Radix)
- Sheng Di Huang (Rehmanniae Radix)
- Dan Shen (Salviae Miltiorrhizae Radix)
- Xuan Xhen (Scrophulariae Radix)
- Tian Hua Fen (Trichosanthis Radix)
- Yu Zhu (Polygonati Odorati Rhizoma)
The evolution of diabetes is considered in stages, and you may take this into consideration when assessing a patient:
- Yin Deficiency
- Yin Deficiency produces internal heat
- Impairment of both qi and yin
- Impairment of qi, yin, and yang
- Failure of qi, yin, and yang
There is also a note of caution when treating a diabetes patient with herbs who might also take medication. The concerns are that blood sugar may be lowered too quickly and consequently, herbs might have to be introduced gradually and their blood sugar must be measured continuously. Once the herbs contribute to lowering blood sugar, medication may be reduced. It’s best to be guided or collaborate with the treating medical practitioner. This is a very possible scenario and, in my opinion, works as well as dietary changes work extremely well for patients.
Each condition requires a slightly different approach to management, and it might largely depend on each individual patient. Some patients are relying on both prescription medication and Chinese herbs. In this case, the additional complexity is that we are not sure what signs or symptoms are brought on by the medication. Others require to work with us because they want to seize taking prescription medication and only rely on Chinese herbs. I usually work with patients and their other health professionals, particularly their medical doctors when determining a treatment strategy. Those strategies are long-term and certainly require a dietary approach as well. In the case of auto-immune disease I sometimes go beyond what TCM offers with diet therapy and for example consider diets that are low in antihistamines. Having said that, I am not a trained nutritionist, but you can find basic compilations of food that combat histamine overloads.
Other areas that I tend to work is that they take measures to avoid stress and anxiety. If they sleep badly (for whatever reasons), then that’s an aspect of consideration as well as other basics such as reducing alcohol or sugars and make sure that they have a moderate exercise routine in place too. These are really all basic factors and if nothing else, we can help with that, always!
Most importantly, I tend to treat what I see and support the patient in what they feel most comfortable with. If you remember the beginning of this article, patients are often well informed of their condition, and they also tend to know a lot of what they can or can’t do. Auto-immune diseases despite of being complex and notoriously difficult to treat, TCM is a great system to look beyond small parts of our bodies that need repair and consider the big picture.
- Definition & Facts for Celiac Disease
- What is Lupus?
- PubMed NCBI
- RA Facts: What are the Latest Statistics on Rheumatoid Arthritis?
- What is Multiple Sclerosis (MS)?
- Autoimmune Diseases and the Potential Role of Chinese Herbal Medicine
- Treatment of Systemic Lupus Erythematosis (SLE) With Chinese Herbs
- Chinese Herbal Treatment for Multiple Sclerosis and Other Flaccidity Syndromes, Including Myasthenia Gravis and Amyotrophic Lateral Sclerosis
- Treatment of Diabetes With Chinese Herbs and Acupuncture