In this blog article, we will cover the basic structure of the immune system according to biomedicine and TCM and talk about potential treatment strategies for common conditions that our patients present with common colds and allergic rhinitis (hay fever). We also want to talk about some formulas used in a randomised clinical trial in Germany and address the importance of constitutional formulas.
Immune System Comparison
|Organs, tissue, cells, and other structures
The bone marrow
They thymus gland
The entire lymphatic system
The lymph nodes found in different locations of the body: the neck, armpits, groin, around the gut, and between the lungs (their primary function is to drain lymph fluid from nearby organs or areas of the body)
The mucous membranes (like the ones inside of the mouth)
|Jin Gui Yao Lue: “If the Spleen qi is strong during all four seasons, the body will not be attacked by evil qi.”
Su Wen (Plain Questions) “If zheng qi remains strong, xie qi cannot invade the body. Zheng qi must be weak when invasion of xie qi takes place.”
The TCM immune system is made up of a combination of different forms of qi. So, there isn’t just one simple word describing immunity or the immune system. The strength of immunity is based on individual parts and the state of zheng qi in general.
Zheng qi consists of yuan qi, zhong qi, yin qi, wei qi and qi of all the zang fu organs.
This means, that we can identify the exact part of the immune system requiring attention (treatment). And herbs can be tailored to address those parts.
Immunity according to biomedicine is the quality or state of being immune. It signifies the condition of being able to resist a particular disease through preventing the development of a pathogenic microorganism or by counteracting the effects of its products. According to biomedicine, immunity defends us from foreign invasion.
It’s not different in TCM, the immune system is our system of defense. It protects us from external influences that disrupt our harmonious (balanced and healthy) internal environment. But what’s different to the biomedical framework is that we consider many different parts of the body responsible for the optimal function for such protection. For this, we need to consider TCM frameworks, such as the Zang Fu (Kidney, Spleen and Lung), or the formation of qi or if you are into Han era medicine, then it would be the six conformations (Shaoyang, Taiyang, Yangming as well as Taiyin, Shaoyin and Jueyin) and it’s best never to compare the way TCM immunity works to actual existing organs (and truly existing structures) as our biomedical colleagues do. It’s best to remain pure and treat according to our own TCM models.
How Is Immunity Considered in TCM?
Immunity according to TCM is strongly depending on the state of at least one, but more likely, several systems. Consequently, our perception is broader and in TCM, we don’t seem to be bothered with the existence of single viruses, bacteria, or other pathogenic influence. However, we consider the effects and impacts of those external pathogens. Our treatment strategies typically involve assisting the body in its defensive actions more so than attacking the individual pathogen. This doesn’t mean that we reject emerging research on pharmacological actions of herbs, but to me it means that we honour our TCM approaches. Without any doubt, there will be some of you practicing in a more integrated manner and kudos to those, navigating the difficult task of combining two fundamentally different systems.
To help us understand how we can support the body optimally to respond in a case of invasion, we consider signs and symptoms, history, pulse, tongue, abdominal and channel palpation. The sound of our patient’s voices, the expectorants and we also check on how all other elements are working? Has the foreign invasion caused havoc with the digestion? Is the temperature regulation damaged, are they mentally/emotionally impacted, are the fluids congested? Is the muscle layer involved? Many different frameworks offer different diagnostic approaches and ways to come to a clinical diagnosis and a treatment strategy. Even with a simple cold, we consider the whole state of the individual.
This provides us with great advantage to other medical systems and allows us to customise the treatment specifically. And as with other conditions, we treat what we see. We regulate the exterior, we drain, we transform, we supplement, and we harmonise and so forth.
Common Conditions: Cold and Hay Fever
With conditions such as the common cold or hay fever in adults, we need to firstly establish their presenting pattern and then decide if we are going to treat the root or the branch (manifestation) or both. As individual practitioners, we all see different things in our patients. So, don’t be surprised if you feel that you want to treat the runny nose first and your colleague opts to address the urgent urination. But let’s assume in this case, we have discussed with the patient that it would be beneficial to address the root – for example, this particular patient has a has a week earth element (spleen and stomach) and we are just focusing on replenishing, then a strategy could be to regulate digestion. So, it could be formulas such as Li Zhong Wan, Ban Xia Xie Xin Tang, Bu Zhong Yi Tang etc.
If we are only treating the symptoms of the current invasion first, then looking at exterior releasing formulas such as one of the many (Yang layer) Taiyang, Shaoyang or Yangming formulas of the Shang Han Lun. Those formulas (if the correct one is chosen) are incredibly effective and even basic structures such as Gui Zhi Tang, Ma Huang Tang, Xiao Chai Hu Tang or Chai Hu Gui Zhi Gan Jiang Tang create outstanding results.
So, if you are combining the root with the branch treatment, perhaps choose the external formula and combine in with the herbs to strengthen digestion. A common cold formula could be to use Gui Zhi Tang (if there is sweating) and add digestive herbs to re-establish the descending of the stomach qi and/or dry the spleen off excessive dampness to increase absorption. If the digestive system is failing, it needs to be addressed as a priority. Otherwise, the administration of herbs is in vain because they can’t be properly assimilated.
For a hay fever presentation which is seasonal, Xiao Chai Hu Tang with modifications to address the weakness in the earth element is a great start. Xiao Chai Hu Tang not only harmonises the Shaoyang, but it also addresses potential problems of the middle or the Taiyin.
A study using acupuncture and Chinese herbal medicine (CHM) concluded in 2004 that the use of those modalities is beneficial for patients suffering from Allergic Rhinitis or Hay fever. The approach they took was to have a basic treatment routine and then add herbs and acupuncture points according to additional or constitutional patterns, they added both herbs and acupuncture to make the treatment more relevant to the individual.
The Basic Formula Administered in Raw Herbs Was:
- Jing Jie (Schizonepetae Herba) – 5 g
- Ju Hua (Chrysanthemi Flos) – 10 g
- Jue Ming Zi (Cassiae Semen) – 10 g
- Che Qian Zi (Plantaginis Semen) – 12 g
- Bai Ji Li (Tribuli Fructus) – 10 g
This would probably not be a formula that we would think of firsthand. In fact, it looks like it has been combined by combining individual herbs rather than using the synergies of an classical herbal formula. Nevertheless, this formula was used in combination with one of the following patterns:
- Wind-heat in the lungs: Bo He (Menthae Herba) 4 g, Sang Ye (Mori Folium) 10 g, Fu Ping (Spirodelae Herba) 5 g, Bai Shao (Yao) (Paenia Albae Radix) 10 g.
- Liver-heat and fire: Lian Qiao (Forsythiae Fructus) 3 g, Zhi Zi (Gardeniae Fructus) 6 g, Chi Shao (Yao) (Paeoniae rubra, Radix), 6 g, Sheng Di Huang (Rehmanniae Radix) 10 g.
- Lung Yin depletion: Mai (Men) Dong (Ophiopogonis Radix) 10 g, Bei Sha Shen (Glehniae Radix) 10 g.
- Cold in the lung: Xi Xin (Asari Herbs) 3 g, Bai Zhi (Angelica dahurica Radix) 6 g.
- Spleen Qi depletion: Huang Qi (Astragali Radix) 12 g, Fu Ling (Poria) 10 g, Dang Shen (Codonopsitis Radix) 18 g, Bai Zhu (Atractylodis macrocephalae Rhizoma) 6 g, Gan Cao (Glycyrrhizae Radix) 3 g.
And as previously mentioned, this approach was successful in assisting patients with allergic rhinitis in a randomised controlled trial (RCT) which are notoriously hard to design for whole systems such as Chinese medicine because RCTs call for controlled conditions and generally don’t accommodate for customisations of the prescribed herbs. This is a conversation to have on another occasion, for now, it’s important to understand how effective a combination of acupuncture and Chinese herbs for the treatment of hay fever is.
Constitutional Treatment Approach To Follow Up the Acute Stage
So, once the exterior is stabilised (no more temperature regulation problems such as sweating) and digestion is working well – if necessary, with dietary adjustment, we would then look at constitutional formula. So, this could be a kidney or heart-kidney formula.
Many patients suffer from an abundance of stress and/or anxiety, sleep badly or excessively worry about this or the other. In such cases, and in between of acute phases of hay fever or common colds, the imbalance of fire and water could be addressed. There must be enough fire to regulate the water and enough water to control the fire.
Most patients do well with minerals to help them with these issues and allow them a restful sleep. One of the most prescribed formulas for kidney yin deficiency is Liu Wei Di Huang Tang. It was originally designed for childhood diseases in 1119 CE but today, many patients fit the pattern of Kidney Yin deficiency. With the addition of Long Gu (Draconis Os) and Mu Li (Ostreae Usta Concha) formula is an excellent base to address any deep seating fire-water imbalance and to support a patient with a constitutional approach. This is only one example to demonstrate a follow up and support patients beyond the acute phase of hay fever or allergic rhinitis. It shows that whole systems such as TCM do well with ongoing treatment in the absence of obvious signs and symptoms. It’s worthwhile to plan the treatment beforehand as well as educate your patient on expected outcomes.
- Acupuncture and Chinese herbal medicine in the treatment of patients with seasonal allergic rhinitis: a randomized-controlled clinical trial, B. Brinkhaus et al. 2004
- Acupuncture Today– May, 2008, Vol. 09, Issue 05 Nei Wei Qi Represents Immune System in TCM, Part 1 BY YU CHEN, LAC