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LEAKY
GUT SYNDROME: A
Modern Epidemic
By Jake Paul Fratkin, OMD, L. Ac.
Part
1: The Problem
Leaky Gut Syndrome (LGS) is a major cause of disease and dysfunction in
modern society, and in my practice accounts for at least 50% of chronic
complaints, as confirmed by laboratory tests. In discussing LGS, I want to first
describe the situation in terms of western physiology, and at the end of the
article I will discuss aspects of LGS that are unique to Traditional Chinese
Medicine.
In LGS, the epithelium on the villi of the
small intestine becomes inflamed and irritated, which allows metabolic and
microbial toxins of the small intestines to flood into the blood stream. This
event compromises the liver, the lymphatic system, and the immune response
including the endocrine system. It is often the primary cause of the following
common conditions: asthma, food allergies, chronic sinusitis, eczema, urticaria,
migraine, irritable bowel, fungal disorders, fibromyalgia, and inflammatory
joint disorders including rheumatoid arthritis. It also contributes to PMS,
uterine fibroid, and breast fibroid. LGS is often the real basis for chronic
fatigue syndrome and pediatric immune deficiencies.
LGS is reaching epidemic proportions within
the population. As a disease entity, it has not been discussed in classical or
modern TCM literature. In fact, taking a strictly classical Chinese medicine
approach to LGS is often ineffective or only partially effective, because the
disease is not addressed in all of its complexity.
TCM has never addressed the issue because it
is a modern phenomenon. Historically, the only way bowel toxins entered the
blood stream was through trauma, for example by sword or spear. This quickly led
to septicemia that might be treatable, or more probably, ended in death. Outside
of trauma, the body maintained a wonderfully effective selective barrier in the
small intestine, one that allowed nutrients to enter, but kept out metabolic
wastes and microbial toxins rampant in the intestines.
What modern event allowed such a breakdown?
Primarily it has been antibiotics, secondarily non-steroidal anti-inflammatory
drugs (NSAIDs). The first antibiotic, penicillin, did not enter mainstream
health care until 1939. Since the 50s and 60s, antibiotic use has been
frantically prescribed for every infection and inflammation, particularly
pediatric ear infection, bronchitis, and sore throat. It is sadly ironic that
most of these infections are viral in nature, and not only are the antibiotics
damaging, but they are ultimately unnecessary. Antibiotics should be considered
a hospitalization level medicine, when bacteria have entered the blood, bone, or
organ.
NSAIDs are commonly taken for various pains,
and include ibuprofen (Motrin, Advil). They are quite damaging to the small
intestine mucosa lining. Antibiotics destroy beneficial
bacteria
Antibiotics create their damage in two ways. The first is by destroying
beneficial bacteria. The small intestine and large intestine host over five
hundred different kinds of beneficial bacteria. These bacteria perform hundreds
of functions required for healthy metabolism and immune response. Through enzyme
secretions, bacteria transform metabolic and microbial wastes before the body
discharges them. These wastes include cellular debris, hormones, chemical
wastes, bile, pus accumulations, viral toxins, bacterial toxins, etc.
For example, the body creates bile not only
as a lubricant to flush wastes out of the liver, but also, by its cold and
bitter nature, to detoxify many of the poisons accumulating in the liver. Bile
however is extremely caustic to large intestine epithelium. When bile enters the
small intestine via the common bile duct, beneficial bacteria break the bile
salts down into a less caustic compound, making it non-dangerous by the time it
reaches the large intestine. When you take antibiotics you destroy these
bacteria and the bile salts freely enter and damage the large intestine. I
believe this contributes significantly to the high incidence of colon cancer
plaguing today’s society.
Beneficial bacteria also break down hormone
secretions that are discharged from the liver to the small intestine. If you
lack the bacteria to break down estrogen and the intestinal permeability has
been altered, the patient is now reabsorbing estrogens in their original state.
The body will deposit these in estrogen sensitive areas such as the breast,
uterus, or ovaries, contributing, if not causing, fibroids and tumors. The same
scenario is responsible for premenstrual syndrome as well. Antibiotics Promote the Growth
of Fungus
The second way antibiotics damage the intestines is by fostering the
growth of Candida Albicans and other pathogenic fungi and yeast. This event,
more than any other, precipitates LGS. In a healthy situation the small
intestine epithelium maintains tight cell junctions, which contributes to the
physical barrier involved in intestinal absorption. In addition to the physical
barrier, there is an important chemical barrier within the mucus that contains
immune agents, which neutralize any toxin that comes in contact.
Candida exudes an aldehyde secretion, which
causes small intestine epithelial cells to shrink. This allows intestinal toxins
to infiltrate through the epithelium and into the blood. The secondary barrier -
immune agents in the epithelial mucus - remains the sole agent for
neutralization. Eventually, the immune system becomes exhausted rising to this
challenge.
Many people have an erroneous belief that
the Candida itself enters the blood stream, allowing it to be deposited
elsewhere, such as the brain. Unless the immune response is completely depleted,
as in AIDS, Candida is quickly destroyed in the blood. The real damage done by
Candida is to the intestinal epithelial barrier, allowing the absorption of
serious toxic agents and chemicals, which then enter the blood and affect
numerous organs, including the brain. Food Allergies: The
Complicating Factor
When the integrity of the intestinal barrier has been compromised,
intestinal toxins are not the only pathogens to be absorbed. The barrier, in a
healthy state, selectively allows digested nutrients to enter the small
intestine when all is ready. With LGS, nutrients can be absorbed before they are
fully digested. The body’s immune response, through specific antigen-antibody
markers, will tag some of these foods as foreign irritants. Every time that
particular food touches the epithelia, an inflammatory immune response is
mounted which further damages the epithelial lining. What started as a Candida
irritation, with shrinking of the cells, has now been complicated with active
inflammation every time a particular food is eaten. Food allergies are a common
secondary problem to Candida, and if present, will maintain the leaky gut
continuously, even if the Candida is eradicated.
The most common food allergies are dairy,
eggs, gluten grains (wheat, oats, rye), corn, beans (especially soy), and nuts.
There are seldom-real allergies to meat, rice, millet, vegetables, or fruit,
although an allergy to garlic is not uncommon. We have to distinguish a real
allergy - that which causes a histamine inflammatory reaction at the site of the
small intestine epithelia - from sensitivity, which may cause uncomfortable
symptoms, but seldom is damaging. Sensitivities are usually due to low stomach
acid or pancreatic enzyme secretion, that is, poor digestion.
In the healing of the intestinal lining,
exposure to a significant allergy can sabotage the treatment. For example, one
may be very good at restricting wheat, dairy and eggs, but then compromises the
treatment by taking garlic tablets. The Role of the Liver and
Lymphatic System The
metabolic and microbial toxins that enter the bloodstream during LGS end up in
the liver, which has the job of detoxifying and discharging the poisons. Under
normal conditions, the liver is taxed just by processing the daily metabolic
wastes created by cell and organ activity. Imagine the further load created by
dumping serious intestinal toxins on a regular basis. There is a point when the
liver becomes saturated; it cannot further detoxify the poisons, and they are
returned to the blood circulation. The blood has sophisticated mechanisms for
preserving chemical homeostasis, and will diffuse as much of the toxic chemicals
and physical debris into the interstitial fluids as is possible. From here, the
lymphatic system will attempt to collect and neutralize the toxins, but unable
to send the toxins to the liver, the body essentially becomes toxic. Microbes
grow and develop; hence, there can be chronic lymphatic swelling, especially in
children. Over a period of time, toxins will be forced into distal connective
tissue around muscles and joints, causing fibromyalgia, or into the cells, which
can precipitate genetic mutation and ultimately cancer. Stress to the Immune and
Endocrine Systems
The immune system is stressed in three major ways. First is at the site
of the intestinal mucosa. As toxins and food antigens brush up against the
mucosa, the immune system mobilizes to neutralize the toxins. Normally, much of
this work would have been done by beneficial bacteria, which have been destroyed
by antibiotics. For toxins that make it to the mucosa, the body will tag them
with a chemical secretory IgA (SIgA), which attracts macrophages and other white
blood cells to consume the toxins. It is not long before this immune response is
overwhelmed and depleted. This can be measured directly with a stool or saliva
test for the intestinal SIgA level.
The second stressor happens in the liver and
lymphatic system – which is also overwhelmed - puts demands on the immune
system. The third stressor is a consequence: as the immune response diminishes,
more microbes (viruses, bacteria, and fungi) multiply, allowing for a
chronic state of infection. What might be tagged as a viral infection, such as
Epstein-Barr virus for Chronic Fatigue Syndrome, is actually an opportunistic
infection taking advantage of a weakened immune system.
The most important organ in the production
of immune agents seems to be the adrenal gland, and LGS slowly diminishes
adrenal function. In the early and middle stages, there is actually adrenal
excess, as measured by excess cortisol output. Eventually, cortisol levels drop,
and one now has exhaustion. The Role of the Digestive
Tract
Candida flourishes when the terrain in the intestines favors it. Just
killing Candida is usually not successful, because the chemistry and vitality of
the terrain has not been normalized, and Candida returns. Antibiotics are the
original cause of the change on the terrain. By killing acid forming bacteria
(Lactobacillus bacteria produce lactic acid, for example), the environment
becomes alkaline, which promotes Candida. Antibiotics and chronic illness reduce
stomach acid production, contributing to the alkalinity, and allowing poor
digestive absorption. In fact, many people with LGS are malnourished, no matter
how healthy the food is that they eat.
The terrain of the small intestine requires
proper pH and electromagnetic resonance. The idea that lactobacillus
supplementation is all that is required after antibiotics is somewhat
delusional; in fact most of the lactobacillus from supplementation does not
survive in the intestine, due to poor terrain. Organizing the Therapy
LGS has various components, all of which need to be evaluated and
addressed. First, ongoing irritants to the small intestine mucosal lining
(fungus, food allergies, and NSAIDs) need to be identified and neutralized.
Second, nutrients and herbs are required to promote healing of the epithelial
lining. Third, and perhaps the key link, the liver needs to be regulated.
Fourth, the lymphatics and interstitial fluids need to be detoxified. Fifth, the
immune and endocrine systems need to be regulated and supported. And sixth, the
stomach and pancreas need to be regulated, if necessary.
The therapy takes between four and eight
months. Patients need to be vigilant about their diet in avoiding food allergies
and minimizing the growth of Candida. Understanding Leaky Gut
Syndrome in Terms of TCM
Antibiotics introduce a very cold environment into the digestive system.
It depletes spleen yang and disrupts spleen-stomach harmony. This impairs
digestion and absorption of food and
fluids, and more important, depletes the qi necessary to maintain the
integrity of the small intestine. The spleen controls the small intestine. The
spleen’s function of absorption and distribution of qi and fluid
happens in the small intestine, and the function of the small intestine is
controlled by the stomach and spleen channels (not the small intestine channel).
Therefore, the initial damage to the integrity of the small intestine is due to
damage of the spleen function.
We can understand the small intestines
discharging toxins to the liver in terms of spleen insulting liver, that is, a
reverse control within the wu xing (five phase) cycle. The liver will
become excess, causing a stagnation of qi and blood. Its ability to store
and distribute the blood (which includes the ability to cleanse the blood)
becomes impaired. This is the main excess in an array of other deficiencies
(spleen, kidney), and as such, becomes the pivotal key-link that needs to be
addressed first. Zang-Fu therapy usually requires that the excess be
addressed at the beginning.
When the spleen becomes depleted, the kidney
will become excess, according to wu xing theory. Initially, the body
responds with a kidney yang excess, to try to reinforce the yang that
has been depleted in the spleen. This will manifest as stress, anxiety, and poor
sleep. (It is directly measurable as an elevated adrenal cortisol level.) Over a
period of time, kidney yang will begin to become depleted, leading to
fatigue. Over a longer period of time, both kidney yang and yin will
be come depleted, leading to a depletion of the yuan-jing reserves,
resulting in true exhaustion.
The combined depletion of kidney and spleen,
with depletion of the yuan-jing reserves, significantly depletes the ying
qi flowing through the channels. Wei qi, being the active radiating yang
aspect of the ying qi, is also depleted, diminishing an effective
response to pathogenic factors. The whole stomach and intestinal tract is still
considered the outside of the body, and as such, depends on wei qi to
keep pathogenic factors from entering. As the wei qi is reduced,
pathogenic toxins are free to enter the body and further sap its reserves of
energy.
Successful rehabilitation requires that the ying
and wei be restored to normal levels, through regulation of the
spleen and kidney. This tonification of the wei qi will help regenerate
tissue on the surface of the small intestine. Again, it is required that the
blockage and congestion at the liver be allowed to open up again, or, in terms
of TCM, dredged.
Underlying the susceptibility to LGS is the
probability that the qi is deficient to start with. This goes back to a
modern lifestyle of poor eating habits and poor food choices, which injures the
spleen, and the various stresses of modern life (lifestyle, chemicals,
electromagnetic) that depletes kidney qi. Within the acupuncture network,
this contributes to a weakened dantian, or hara. The small
intestine lies over and around the dantian. This is one of the most
important energy centers in the body, the place where food is converted to qi
and blood. When the dantian becomes weakened, it creates a terrain
that allows LGS to take place. And it indicates that a successful adjunct to
therapy would include dantian qi gong. Conclusion
People worry about many sorts of environmental toxins: vaccinations,
dental amalgams, pesticides, herbicides, food additives, chlorine, etc. It is
true that all of these are stressors on the body, and contribute to an overall
decline in health. The worst threat, however, is an ongoing toxic intrusion from
the cesspool that exists in our intestines. The body has a marvelous mechanism;
a selective intestinal permeability that allows digested nutrients in while
keeping toxins meant for excretion out. Throughout history, in general, this
barrier has maintained its integrity. During the last fifty years, due to the
intrusive irritation of antibiotics and NSAIDs, the average person’s health
has been significantly challenged and weakened. Part
2: DIAGNOSIS AND TREATMENT
In Part 1 of this article, we discussed the causes of LGS. To review,
repeated use of antibiotics create dysbiosis in the small and large intestines,
allowing the proliferation of pathogenic fungi while reducing or eliminating
over 500 species of beneficial bacteria. These beneficial bacteria are required
for digestion and absorption of food and nutrients, and neutralization of toxic
waste products. Candida albicans, a toxic fungus, produces a caustic aldehyde,
which irritates the epithelium of the small intestine, allowing absorption of
microbial and metabolic toxins. These toxins overwhelm the liver, allowing toxic
accumulations in the lymphatic fluids and deposits into the connective tissue,
causing symptoms of fatigue, fibromyalgia, headache, poor concentration, and
certain skin conditions, including eczema and urticaria. I believe that LGS
accounts for 50% of chronic illness in the modern clinical practice.
The complicating factor in LGS is that of
acquired food allergies. As the intestinal mucosa is irritated by Candida, foods
are absorbed before they are completely digested. The body can tag these as
foreign by using specific antibodies. When those foods are eaten, there is an
inflammatory response at the intestinal epithelia, which keeps LGS going. If
Candida is effectively eradicated but the food allergy problem is not addressed,
the various illnesses will continue. Dietary Restrictions
The clinician is best served by utilizing laboratory tests to confirm and
gauge various aspects of LGS including Candida levels, digestive function, food
allergies, etc. Many of the tests are expensive and one needs to be prudent in
what tests are absolutely required.
If testing is out of the question due to
cost restrictions, certain assumptions and advice may be given to the patient.
If there is a history of antibiotics (two episodes within a lifetime is enough
to set up LGS; yearly doses of antibiotics will guarantee it), assume there is
Candida. You will need to give anti-Candida medicines and advise a special diet.
Diet therapy alone will not eradicate high levels of Candida, but certain foods
will sabotage successful therapy: sugars, yeasts, refined white flour products
(bread, pasta, pastry), vinegar, fermented products including miso, canned fruit
juice, and dried fruit. Fresh fruit may or may not be a problem, depending on
the severity.
Secondly, assume there are food allergies.
If any food allergy is allowed to persist, the intestinal wall will remain
inflamed and toxic absorption will continue. Without testing, the best you can
do is completely avoiding the common allergenic foods: dairy (milk, cheese,
cottage cheese, yogurt, ice cream, butter), gluten grains (wheat, rye, oats,
spelt, barley); eggs; corn (including popcorn, corn syrup, corn oil); and beans
(especially soy, lentil and kidney; soy includes tofu, miso, and tamari). Other
foods that commonly test as allergenic are almonds, peanuts, and garlic. The
most common of the allergenic foods are dairy, gluten grains, and eggs. Be
careful of these ingredients in packaged foods or foods prepared in restaurants.
A non-allergenic diet can be obtained by
eating meat, chicken, fish, vegetables, potatoes, rice, millet, and fruits. Many
patients feel that certain foods are allergenic because of reactive symptoms. We
have to distinguish sensitivity from allergy. A food that might cause
sensitivity, like tomatoes or oranges, causes discomfort because of an imbalance
of digestive acids and enzymes. Real allergies cause damage to the intestinal
lining by initiating an inflammatory reaction, and ironically, are usually
without any perceived reaction.
Diet is perhaps the hardest path for
patients to follow, but this is what determines who gets better and who
doesn’t. Your management and encouragement here is essential to a real
success. Patients need to understand that allergenic foods keep the intestines
inflamed, allowing toxins to continuously enter the body. Useful Laboratory Tests
Most of the pertinent tests require a stool sample, and kits can be
provided directly by the practitioner to the patient. Food allergy tests require
a serum sample, which is performed by a registered lab or phlebotomist who gives
the spun serum back to the patient to mail.
As far as useful tests, I think it is
essential to assess the level of Candida infestation. Low levels do not require
aggressive anti-Candida treatment, whereas high levels do. The blood antibody
test for Candida is not very useful, as it tends to show only in the severely
immuno-suppressed, such as AIDS patients. The better Candida tests use a stool
sample, and I would recommend either Great Smokies (Asheville) or Diagnos-Techs
(Seattle).
LGS can also be caused or aggravated by
pathogenic bacteria and protozoa’s, especially those acquired in the tropics,
particularly India and Southeast Asia. Both Great Smokies (using the CPx1) and
Diagnos-Techs (using the CH panel) do a good job here.
The next test I often order is the
Chymotrypsin level. This is a digestive enzyme produced by the pancreas, and is
a good global indicator for pancreatic function. Many symptoms that look like
LGS may actually be stomach-pancreas deficiency, without Candida or intestinal
permeability damage. Chymotrypsin deficiency indicates relative spleen qi deficiency.
By measuring the Candida and Chymotrypsin levels first, one can infer or rule
out LGS. If both tests are normal, it is an unlikely diagnosis. If they are
abnormal, I usually go on to recommend food allergy testing.
There are other tests that are useful. ACHY
(anti-chymotrypsin factor) is measured in the stool and is a direct marker for
small intestine inflammation; it often indicates food allergies. However, in a
chronic case where the immune system has plummeted, the ACHY can look normal.
This means that the immune system is too depleted to mount an adequate defense
at the site of the mucosal membrane.
Secretory IgA (SIgA) is a direct marker of
the patient’s immune system at the site of mucosal lining of the small
intestine, also measured by stool. I have reduced the usage of this test,
because all patients with LGS seem to have a severely low level; I have come to
assume that it will be low. However, as far as educating the patient and getting
compliance, this is a good test for the patient to see.
Great Smokies provides an intestinal
permeability test. The patient drinks a liquid containing two measurable sugars,
followed by the collection of urine for 24 hours. It accurately shows the degree
of LGS. Again, it is helpful for patient education and compliance, as well as
making your case with medical doctors.
The final test that is important is a good
food allergy panel. The skin prick test for allergens only shows IgE levels, the
immediate reactions. Most food allergies are delayed reactions, and require
testing of the IgG levels through blood serum. This is a new test, about seven
years old, and very few medical doctors know of it except those using natural
approaches.
Currently, four labs offer a combined IgE/IgG
test that I know of. (See the listing at the end of the article). For years, I
have successfully used the General Food Panel from National Biotech in Seattle,
which returned the results within ten days. They have recently been acquired by
Great Smokies, who now offer a comprehensive panel.
The advantage of a lab food-allergy test is
that they appear accurate based on dramatic improvements in the clinical
picture. Further, seeing a paper print out of one’s allergies is quite
reinforcing to the patient. There are practitioners who do machine or muscle
testing of food allergies, and this is quick and inexpensive. However, they do
not seem to distinguish true allergens from sensitivities.
In any event, I recommend that you call the
laboratories to obtain their excellent practitioner educational materials and
study them carefully. They have many useful tests that can aid your clinical
practice, including hormone profiles from saliva samples. Treatment
Treatment of LGS is complex and multi-layered. Most acupuncturists are
overwhelmed by the multiple patterns that coexist in a LGS case. They do not
know where to begin or how to organize signs and symptoms. First of all,
identification and elimination of Candida and food allergens is essential to any
real success, and can coexist with any of the zang fu patterns. The next
overall approach is to prioritize which zang fu to begin working with:
liver, spleen, kidney, or heart. They may all be involved, but if you treat all
simultaneously, the patient will suffer from a confused and inefficient
approach. In the absence of true disturbed shen presentation, it is
usually best to start herbal therapies with liver, then spleen, and finally,
kidney. Candida
Treating Candida can be a big challenge. Funguses are survivors and they
are very hard to get rid of. Their job is to suck the life out of decaying
tissue, so a fundamental imbalance in the vitality and chemistry of the small
intestines is often the root cause. Addressing proper pH and restoring vitality
via herbs and dantian qi gong are useful. When the Candida levels are +4
or +5 (on a scale of 1 to 5), it may be necessary to use western prescription
medicine, specifically Nystatin. When combined with an anti-Candida diet,
Nystatin is usually effective but needs to be taken for four months. The
recommended protocol is 500,000 unit tablets, slowly working up to 1 to 2
tablets, 3x day. Other western medicines, such as Nizoral, Diflucan, and Sporex,
are effective but can be toxic to the liver. Without western medicine, it can
take up to nine months or longer to eradicate +4 Candida with natural medicines.
For levels of +3 or below, many natural
products will work. The key is to change any anti-fungal product every month, to
avoid tolerance and adaptation. In terms of Chinese herbs, Huang Lian Jie Du
Pian seems to do the trick. I can also recommend my own formula: FRATKIN’S
CANDIDA FORMULA Atractylodes
Bai Zhu
6 % Codonopsis
Dang Shen
9 Pinellia
Ban Xia
9 Coptis
Huang Lian
9 Phellodendron
Huang Bai
9 Houttuynia
Yu Xing Cao
9 Isatis
Ban Lan Gen
6 Cinnamomum
Rou Gui
6 Amomum
Sha Ren
4 Coix
Yi Yi Ren
6 Artemisia
Yin Chen Hao
6 Poria
Fu Ling
9 Melia
Chuan Lian Zi
6 Mume
Wu Mei
6
Naturopathic products that work include those made with grapefruit seed
extract, oregano oil, undecylenate acid, and berberine herbs. Again, talk to the
reps of the various companies (listed at the end of the article) for ideas. For
children, there are a number of homeopathic nosode products that are quite
effective from Professional Health Products (PHP), NutriWest, and others.
Most patients will require supplementation
with beneficial bacteria to restore probiosis, the healthy bacterial terrain of
the small and large intestine. Supplements combining various strains of
lactobacillus are helpful, although quality really can vary depending on the
manufacturer. Most should be refrigerated, and taken without food. New evidence
points to Lactobacillus Sporogenes as being particularly effective, and a
children’s chewable exists. Contact Marcopharma for information. Liver Patterns
In
LGS, the intestines have been dumping unnatural amounts of microbial or
metabolic toxins into the blood, which quickly end up in the liver. This causes
stagnation of qi and blood leading to heat with a reduced ability to
clear toxins. It is ultimately the cause of fibromyalgia, because the toxins
that the liver cannot neutralize are returned to the blood, then the lymph, and
finally the connective tissue.
I feel that the first zang fu organ
needing regulation in LGS is the liver, requiring formulas that move qi,
invigorate blood, and clear heat. Try to determine if liver stagnation is
affecting either the stomach or the menses. If it is affecting the stomach with
symptoms of food stasis, bloating, costal distension, or poor digestion, use Chai
Hu Shu Gan Tang, Xiao Chai Hu Tang, or the patent medicine Shu Gan
Wan. If the pattern is causing gynecological symptoms including PMS,
dysmenorrhea or menstrual irregularity, use Jia Wei Xiao Yao San. Patent
medicines or American made Chinese herbal products are quite adequate here.
If the pattern indicates heat toxins in the
liver, with symptoms of fatigue, lymphatic swelling, and low grade fever, it is
helpful to add herbs or formulas that clear heat toxins. The patent medicine Chuan
Xin Lian contains Andrographis Chuan Xin Lian, Taraxacum Pu Gong
Ying, and Isatis Ban Lan Gen. It is quite effective in targeting the
liver and lymphatics.
There are other naturopathic products that
help clear liver congestion. Every company has their favorites, and you can read
their literature or talk with their reps. My personal favorites include the
following: Hepar Comp or Hepeel (Heel-BHI); Core Level liver or Core Level Detox
(NutriWest); Detoxifying Factors (Tyler); Hepatica (MarcoPharma). Spleen Patterns
The
spleen is responsible for repairing the intestinal lining of the small
intestine, and prolonged LGS easily depletes spleen qi. This can be
noticed with traditional TCM signs and symptoms, or by the Chymotrypsin enzyme
test. If spleen deficiency and liver stagnation coexist, choose a formula that
addresses both, such as Chai Hu Shu Gan Tang, Ginseng Stomachic Pills (Zi
Sheng Wan) or Shu Gan Wan. In such cases, there will often be food
stagnation. If all signs of excess are gone with signs of a weak or small pulse,
tonifying the spleen is required. You can use Si Jun Zi Tang, Xiang Sha Liu
Jun Zi Tang or Shen Ling Bai Zhu Tang.
Naturopathic approaches often include
hydrochloric acid (HCL) and pancreatic enzyme support. HCL-pepsin capsules are
good, taking one to two capsules with each meal. It will not rehabilitate the
pancreas like Chinese herbs, but it can promote efficient digestion while the
spleen-pancreas is recovering.
Critical to the success of an LGS case is
repair of the intestinal mucosa. If one can stop the irritating factors, namely
fungus, protozoa, food allergies, and NSAID’s like ibuprofen, the intestinal
lining will heal by itself, although slowly. Use of the spleen qi tonics
mentioned above will help to repair the lining, as will certain naturopathic
products including ginkgo, slippery elm, aloe vera, bioflavonoids such as
quercetin, essential fatty acids, antioxidants, and the amino acid glutamine.
As for Chinese herbs to repair intestinal
inflammation, I have used the following formula: FRATKIN’S
INTESTINAL INFLAMMATION FORMULA Astragalus
Huang Qi
12 % Dioscorea
Shan Yao
9 Ginseng
Ren Shen
9 Paeonia
Chi Shao
9 Glycerrhiza
Gan Cao
5 Cimicifuga
Sheng Ma
6 Coptis
Huang Lian
9 Pulsatilla
Bai Tou Weng
9 Benincasa
Dong Gua Ren
9 Cyperus
Xiang Fu
9 Sanguisorba
Di Yu
9 Lotus
Lian Zi
5 Kidney patterns
Prolonged
or chronic LGS invariably causes kidney deficiency, and kidney tonification is
often given after excess patterns have been addressed. Kidney is responsible for
the endocrine system and, along with spleen, for the immune system. When the
body needs reserves, it uses kidney energy, stored in the Eight Extraordinary
Channel network. In western physiology, this includes adrenal function. As
adrenal energy is depleted, other endocrine glands also become depleted,
especially thyroid and pituitary, causing a myriad of symptoms. The naturopathic
approach is to provide glandular support of adrenal or thyroid, which often has
a positive therapeutic effect. However, in early stages of LGS, adrenal
supplementation is contraindicated. This is because from a TCM point of view,
the kidney yin depletes first, and later kidney yang. Adrenal
glandulars basically tonify kidney yang. It is preferable to intervene
early with supplementation of kidney yin through formulas like Liu Wei
Di Huang Wan or Zhi Bai Di Huang Wan. This is determined through
pattern differentiation. Later on, kidney yang tonics may be needed, such
as Jin Kui Shen Qi Wan or You Gui Wan. In individuals with
depleted kidney qi, stronger tonics are needed. I have found that
placenta (Zi He Che) is quite useful, as is Siberian ginseng (Wu Jia
Shen), royal jelly (Feng Wang Jiang), Cordyceps (Dong Chong Xia Cao),
and deer horn (Lu Rong).
Occasionally, there are some useful
naturopathic products for adrenal deficiency due to kidney yin deficiency.
In these cases, from a western physiological point of view, cortisol levels are
elevated as confirmed by saliva tests. These products would include Core Level
Auto Para and DSF Formula (NutriWest). When cortisol levels are depleted,
supplementation with adrenal products is beneficial. Heart and Shen Patterns
It is not uncommon to find disturbed shen patterns as the
predominant presentation, marked by insomnia or restless sleep, anxiety, easily
frightened, or palpitations. These are the cases that are often treated with
Prozac or other anti-anxiety or anti-depressive medications. Chinese herbal
medicine is quite effective here. The formulas that I use most often are the
following: Tian Wang Bu Xin Dan, An Mian Pian, and Bai Zi Yang
Xin Wan. Occasionally Chai Hu Mu Li Long Gu Tang is appropriate. Acupuncture Protocols
In Chinese acupuncture, regulation of liver and spleen is often the
predominant protocol, and using points such as Liv 3, St 36, and Ren 12 is
helpful as a foundation formula. In Japanese Meridian Therapy, liver deficiency
is the most common presentation, with treatment at Liv 8 and Ren 12 being
effective. Ion pumping cords for the Chong Mai (PC 6-Sp 4), is often
indicated, or at Ren Mai (Lu 7- Ki 6). Supportive moxibustion at Sp 3, St
36, and St 27 is potent for healing an irritated intestinal lining. I would
recommend acupuncture treatments once or twice a week, especially for the first
two months of treatment. Prognosis
If the patient can stay on an allergy free diet, recovery is possible
within four or five months using the types of therapy indicated above. However,
some patients may need up to nine months of treatment for complete recovery if
they have depleted their energy reserves. All sources of stress must be
addressed and minimized, including emotional, lifestyle, work, and climate
exposure. What I have proposed here focuses on the physical stress of massive
toxic overload from the intestines. LGS at its heart is auto-toxicity. The need
is to rehabilitate the selective barrier of the small intestinal wall, detoxify
the body, and restore liver, spleen and kidney functions. SOURCES
FOR MEDICINES: 1) CHINESE HERBAL (PATENT)
MEDICINES: MAYWAY (800) 262-9929 NUHERB (800) 233-4307 GOLDEN FLOWER (800) 729-8509 HEALTH CONCERNS (800) 233-9355 HERBAL TIMES (800) 233-4307 JADE PHARMACY (800) 827-4372 K’AN HERB COMPANY (800)
543-5233 KPC (SOUTH MOUNTAIN) (800)
572-8188 MINTANG FORMULAS (800)
888-9998 PLUM FLOWER (800) 262-9929 QUALIHERB (800) 533-5907 SEVEN FORESTS (800) 544-7504 SUN TEN FORMULAS (800)
333-4372 MCZAND HERBAL, INC. (800) 800-0405 2) NATUROPATHIC PRODUCTS: AMERICA’S BIO-PLUS (800)
498-6640 ALLERGY RESEARCH GROUP (800)
545-9960 BIOTICS-DSD, INC. (800)
232-3183 ECLECTIC INSTITUTE, INC. (800)
332-4372 EMERSON ECOLOGICS (800)
654-4432 HEEL-BHI (800) 621-7644 INTERPLEXUS (800) 875-0511 METAGENICS WEST, INC. (800)
321-6382 MARCO PHARMA INT., INC. (800)
999-3001 NATREN (800) 992-3323 NUTR. ENZYME SUPPORT SYS.
(800) 637-7893 NUTRI-WEST (800) 443-3333 PERQUE (703) 758-0689 PROBIOLOGIC (800) 678-8218 PHYTOTHERAPY RESEARCH (800) 274-3727 RAINBOW LIGHT (800) 227-0555 STANDARD PROCESS WEST (800)
321-9807 THORNE RESEARCH, INC. (800)
228-1966 TYLER ENCAPSULATIONS (800)
869-9705 UAS LABS (800) 422-3371 3) LABORATORIES: GREAT SMOKIES DIAG. LAB (800)
522-4762 DIAGNOS-TECHS, INC (800)
818-3787 SERAIMMUNE PHYSICIANS LAB
(800) 533-5472 MERIDIAN VALLEY LABS (800) 234-6825 For a more thorough
background see: DIGESTIVE WELLNESS, Elizabeth
Lipski, Keats Publishing, Inc., 1996 DETOXIFICATION & HEALING;
Sidney MacDonald Baker, Keats Publishing, Inc., 1997 THE FOUR PILLARS, Leo Galland GREAT SMOKIES DIAGNOSTIC LAB: Physician Information JAKE PAUL FRATKIN, OMD, L.Ac.,
has
been in practice since 1978, treating acute and chronic problems in children and
adults. He is the author of Chinese Herbal Patent Formulas, and the
editor of the recently released Practical Therapeutics of Traditional Chinese
Medicine, By Wu and Fischer, Paradigm Press. He practices in Boulder,
Colorado, where he combines Chinese herbal medicine, Japanese meridian balancing
acupuncture, and nutritional medicine. Originally published for the Great Smokies Diagnostic Lab website. Also published in: THE POINTS: A JOURNAL OF NEW MEXICO ACUPUNCTURE ASSOCIATION and CALIFORNIA JOURNAL OF ORIENTAL MEDICINE | ||||
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