Treatment of Irritable Bowel Syndrome with Chinese Herbs from: Huang Suiping, Department of Internal Medicine, Provincial Hospital of Guangdong, Journal of Traditional Chinese Medicine 31 (3) 1990. translated and edited by Dr. Fu Kezhi (Harbin)
Thirty patients suffering from irritable bowel syndrome were treated with:
Tiao Gan Fang (Liver Harmonizing Formula)
Bupleurum Peony Chih-ko Saussurea Atractylodes Siler Ilex Oiubiying) [Note: juibiying is not available in the West but can be substituted by another species of Ilex, such as maodongqing.--S.D.] Formula modifications:
Spleen Oi deficiency: add astragalus and codonopsis Dampness: add coptis
The formula is made in the form of pills, 6 grams taken each time, three times daily (total 18 grams per day). Decoctions were used in a few patients if substantial modifications were deemed necessary. The proportions of herbs used in the pills or decoctions was said to be "an appropriate amount."
The patients were diagnosed by traditional methods to reveal that all thirty cases were of the Liver Qi stagnation type nine cases were complicated by Spleen deficiency. All patients complained of diarrhea and accompanying abdominal pain.
A study was performed in the blind cross-over method. Placebo pills having an appearance very similar to the Tiao Gan Fang Pill were administered to half the patients while the remaining half took the Tiao Gan Fang Pill. After three weeks of daily administration, there was a two week interruption of treatment, and then the pills were switched so that those receiving the placebo now obtained the active formula and vice versa.
During the period of administration of Tiao Gan Fang Pill, 28,patients showed improvements in the bowel responses and fecal conditions whereas duong the placebo period only 9 patients had improvements. Other symptoms, such as abdominal pain, mucus in the feces, gurgling of the intestines, and insomnia were similarly alleviated in about 92% of the patients while taking the active pills and such improvements occurred in only about 30% of the patients while taking the placebo.
definition: A chronic inflammatory, ulcerative disease of the large bowel, recognized mostly by bloody diarrhea.
etiology: The disease is seen in both sexes equally, though whites and Jews are more often affected. Peak occurrence is from 15-35 years old, although any age is susceptible. Many factors may be involved in the development of ulcerative colitis: food sensitivities, poor stress management, genetics, infectious, and immunologic abnormalities have been implicated. The disease typically begins in the sigmoid colon and/or rectum, and then usually progresses proximally until the entire colon is affected. In ulcerative colitis, only the colonic mucosa is involved, and the lesions are uniform and continuous with no areas of normal tissue interspersed between the diseased mucosa.signs and symptoms: onset may be insidious or dangerously acute
Signs and symptoms
increased urgency to defecate: up to 10-20 times/day bloody, watery and mucous bowel movements: may just consist of blood and pus abdominal cramping: may also have severe tenesmus in severe acute attacks: sudden, extreme diarrhea fever peritonitis toxic colitis if the disease is limited to the rectosigmoidal area, then the stools may be normal or dry (there can be constipation), but rectal mucous high in WBCs and RBCs accompanies defecation, or occurs between bowel movements
systemic and extracolonic symptoms include: fever malaise anorexia weight loss dehydration arthritis skin changes liver disease posterior uveitis, etc. decreased growth and development, failure to thrive (in children)
lab findings:
Relevant Labs:
a) Gastric acid analysis
b) Comprehensive Stool Analysis
c) 24 hour urine for androgens
sigmoidoscopy
hypoalbuminemia
increased ESR and CRP
iron deficiency anemia (may be profound)
leukocytosis and eosinophilia, or monocytosis
may see B12 or folate deficiency
CEA may be increased
decreased electrolytes from dehydration and diarrhea
mild liver enzyme changes, especially alk. phos. elevation
may see false (+) RF
The disease is recurrent: most patients experience another attack within a year of their first attack. However, there may also be long times of remission when symptoms, if present, are mild and benign. Approximately 85% of patients have mild to moderate disease that can be easily managed without hospital care. In about 10-15% of patients, the disease presents much more seriously, particularly in the elderly, and the prognosis is very unfavorable.
Complications include hemorrhage toxic colitis (causing ileus, peritonitis and toxic megacolon) small rectovaginal fistulae colon cancer (in patients having the entire colon affected and in patients afflicted with the disease for > 10 years) and biliary dysplasia and cancer.
Conventional treatment consists of dietary counseling ("normal diet but without raw fruits and vegetable roughage": Merck) no milk if the patient is sensitive to it drugs (particularly sulfasalazine, hydrocortisone suppositories or injection) and surgery (eventually performed on a third of UC patients).
Differentiation (rule out)
regional enteritis irritable bowel syndrome malabsorption syndromes infectious gastroenteritis parasitic infections
ULCERATIVE COLITIS STUDIES
Ulcerative colitis is a chronic inflammatory disease of the intestines. It appears to be a stress reaction, much like gastric ulcer, but may also involve chronic infection, allergy responses, and genetic predisposition. In Chinese medical terms, most ulcerative colitis is classified as Spleen deficiency type, since the symptoms of diarrhea and spontaneous bleeding that occur in these individuals correspond well to that type of syndrome.
In the Journal of Traditional Chinese Medicine, 1985, a report from the Shang Hai College of Traditional Chinese Medicine presented the following formula for treatment of mild to moderate ulcerative colitis: Codonopsis Atractylodes Hoelen Ginger Saussurea Citrus Fraxinus Sanguisorba
This is a simplified version of Ginseng and Astragalus Combination (Bu Zhong Yi Qi Tang) with fraxinus for relieving inflammation of the intestines and sanguisorba to inhibit intestinal bleeding. It was claimed to be highly effective. For more severe cases of the disease, the decoction was given orally and another mixture, made with a decoction of gall (wabeizi) and portulacca (machixian), plus the powder of indigo (qingdai) and san qi, was given as an enema. This combination treatment was reported to be effective in 2/3 of the severe cases treated. The use of herb enemas for treatment of intestinal diseases is a common practice in China.
In the Jiangxi Zongyiyao, 1985, there was a report on the treatment of chronic colitis using the following formula in decoction:
Pinellia Coptis , Scute Ginger Ginseng Licorice , Jujube, Pueraria , Smilax , Oldenlandia , Dandelion
The first seven ingredients represent the basic Pinellia Combination, traditionally used in the treatment of persistent or severe diarrhea. Pueraria is often used in cases where diarrhea is accompanied by intestinal irritation. Smilax, oldenlandia, and dandelion are toxin-relieving herbs that may inhibit infection and inflamation. Twelve of fifteen patients were reported cured by this method, using a one to four month treatment time. An ulcerative condition was not mentioend in this report, but in such cases, the addition of hemostatic herbs would undoubtably be recommended. Sanguisorba is one of the most frequently mentioned for that application.
In the journal Chinese Traditional and Herbal Drugs, 1989, a formula in tablet form was used for ulcerative and chronic colitis. The ingredients included:
Astragalus Codonopsis Atractylodes Licorice Ginger Saussurea Tang-kuei Peony Corydalis Catechu Mume
This is basically the Ginseng and Astragalus Combination with peony, corydalis, and catechu added to regulate the blood, and mume added to astringe the intestines (peony is also astringent). About 2/3 of patients were cured in 40 to 60 days. More than 260 patients were involved in the research work.
In the Journal of Traditional Chinese Medicine, 1986, a ra study of chronic colitis began with the division of patients into four categories, all of them involving Stomach/Spleen deficiency: Stomach/Spleen Deficiency Complicated Deficiency Complicated Qi and Yin Deficiency Type by Cold by Damp Heat Deficiency
Astragalus Astragalus Astragalus Astragalus Lotus seed Lotus seed Lotus seed Lotus seed Codonopsis Codonopsis Bupleurum Atractylodes Atractylodes Citrus Chih-shih Tang-kuei Citrus Saussurea Peony Rehmannia Saussurea Aconite Coptis Ophiopogon Peony Ginger Pulsatilla Melia Bupleurum Cimicifuga Artemesia Cimicifuga Cimicifuga Pulsatilla Sanguisorba Pulsatilla Pulsatilla Licorice Artemesia Licorice Oldenlandia Sanguisorba Oldenlandia Rubia
Citrus, saussurea, and codonopsis are deleted in cases of heat syndrome (either damp heat or Yin deficient dry heat). Astragalus and lotus seed are common to all formulas, used to strengthen the Spleen and inhibit diarrhea. Oldenlandia and pulsatilla are the primary anti-toxin herbs relied upon. The formulas were modified by additions for certain specific symptoms as follows:
incontinence of feces: schizandra, kaolin (red clay) and pomegranite mucus in the feces: pinellia, atractylodes (red), and allium blood stasis syndrome: peony and corydalis bleeding: use the patent formula Yunnan Pai Yao
For severe cases, a retention enema with hemostatic herb mixtures was used. It was claimed that 84% of patients had notable improvements using this treatment for three months.
These formulas can be made from individual powdered herb extracts, or by a modification of the base formulas such as Ginseng and Astragalus Combination or Pinellia Combination. One could also apply a formula such as Ginseng 18 or Lotus 9 along with a second formula such as Imperata 10 (for bleeding) or Picrorrhiza 11 (for diarrhea). Note that the treatment times recommended are usually several months and that 20-30% of patients have little response to the treatments.
Chinese Herbal Formulas
The following are for refference only as the correct formula will have to be selected and modified for the individual.
Yun Nan Bai Yao (patent): to control bleeding. (Zhu, p. 243) (Pseudoginseng)
Fu Lung Kan (Huang Tu Tang) Huai Jiao Wan (patent): Spleen Yang Xu (Deficiency) with Spleen Unable to Govern the Xue (Blood): chronic GI Bleeding. (Fu Lung Kan: Hsu, 1980, p. 420 Yeung, p. 129 Bensky and Barolet, p. 343 Huai Jiao Wan: Zhu, p. 185) Atractylodes and Setaria C.: Spleen Qi Xu (Deficiency): chronic enteritis and persistent diarrhea in patients of weak conformation (Hsu, 1980, p. 461) Holine, Tang Gui, Ginseng, White Peony, Red Attractalodes, Ligusticum, Cinnamon Twig Anemone C. (Bai Tou Weng Tang) Huai Hua San Chuan Xin Lian Kang Yan Pian (patent): Large Intestine Damp-Heat: diarrhea with blood and pus (more blood than pus)(Anemone C.: Hsu, 1980, p. 187 Yeung, p. 39 Bensky and Barolet, p. 99 Huai Hua: Yeung, p. 119 Bensky and Barolet, p. 339 Chuan Xin: Zhu, p. 189) Peony C. (Shao Yao Tang): Large Intestine Damp-Heat: diarrhea with equal amounts of blood and pus, tenesmus (Hsu, 1980, p. 428 Yeung, p. 196 Dharmananda, 1986, p. 295 Bensky and Barolet, p.194) Ginseng and Atractylodes F. (Shen Ling Bai Zhu San): Spleen Qi Xu (Deficiency) with Spleen Distressed by Dampness: loose stools or diarrhea, reduced appetite, weak extremities, weight loss, pallid complexion.(Ginseng and Atractylodes F.: Hsu, 1980, p. 260 Yeung, p. 201 Bensky and Barolet, p. 239) Bupleurum S (patent): Spleen Distressed by Dampness (Dharmananda, 1990, p. 40) Vitality C. (Zhen Wu Tang): Kidney and Spleen Yang Xu (Deficiency): weak patient, especially colitis patient on corticosteroids (Hsu, 1980, p. 278 Yeung, p. 287 Bensky and Barolet, p. 197) Si Shen Wan Ren Shen Yang Rong Wan (patent): Kidney Yang Xu (Deficiency): early morning diarrhea (Si Shen Wan: Yeung, p. 218 Bensky and Barolet, p. 359 Ren Shen Yang Rong Wan: Zhu, p. 268) Tong Xie Yao Fang Bupleurum 12 (patent) Xiao Yao Wan (Bupleurum Sedative Pills)(patent): Liver Invading Spleen: abdominal pain, borborygmus, pain is not better after diarrhea (Tong Xie Yao Fang: Yeung, p. 237 Bensky and Barolet, p. 149 Bupleurum 12:Dharmananda, 1990, p. 39 Xiao Yao: Zhu, p. 227) Bamboo and Ginseng C. Cyperus 18 (patent): Liver Qi Stagnation: Digestive distress especially related to emotions (Bamboo and Ginseng: Hsu, 1980, p. 90 Dharmananda, 1986, p. 247 Cyperus 18: Dharmananda, 1990, p. 45)
eating principles: _ elimination/rotation diet, rotation diet, rotation diet expanded _ correct nutrient deficiencies _ provide adequate calories _ be careful with food combinations: especially avoid starch, sugar, protein combinations (i.e. cheesecake). Avoid eating too many types of foods at one time. Stick to one type of starch per meal. Eat more steamed vegetables than raw ones. See General Guidelines for Eating _ short (3-5 day) fasts are recommended as are an alkaline juice fast (see Fasting in materia medica) _ high complex carbohydrate, high fiber diet _ all foods must be eaten slowly, chewed and salivated well eat in a calm atmosphere, do not read or watch television while eating
sample diet: _ acute phase (1-3 weeks) _ breakfast: whole brown rice cereal (cook 3-4 tbsp. rice flour with 2 cups water, stirring constantly over heat), 2 tsp. olive or corn oil _ morning snack: raw grated apple or applesauce or baked apples (sour or semi-sour only) _ lunch: vegetable soup from celery, parsley, zucchini, squash, pumpkin, carrot, potatoes (blended and strained), steamed carrots and squash, rice or millet or barley or potato, 2 tsp. olive or corn oil _ afternoon snack: same as morning _ dinner: same as lunch
_ as improvement occurs: _ breakfast: oatmeal 3x/week add soft boiled egg during one meal 3x/week _ snacks: add almonds (raw and blanched) with apples _ lunch and dinner: if no intolerance to dairy, add yogurt (preferably goat), green beans, waxed beans, lettuce, cucumber, green onion, parsley, celery, garlic, lentils, peaches, apricots, watermelon, grapefruit, grapes, ripe bananas, goat whey
_ food supplements: liquid chlorophyll, alfalfa tabs, chlorella, calming herb teas
_ after stabilization: _ Vegetarian Sample Diet _ cruciferous vegetables to be eaten only with carminatives (fennel, caraway, cumin, anise, dill)
therapeutic foods:
_ foods that calm the Shen (Spirit), harmonize the Stomach and Spleen, potato broth, carrots cooked, okra, parsnips-steamed and mashed, squash, pumpkin, figs and flax seed tea, steamed zucchini and squash, papaya, grated raw apple, applesauce, ripe peaches without skin, banana (not in Cold conditions), rice porridge (Shefi) _ miso soup, slippery elm gruel, psyllium seed powder, flaxseed powder (Marz) _ foods high in the omega-3 and omega-6 fatty acids: vegetable, nut, seed oils, cold water fish, evening primrose oil, black currant oil, flaxseed oil (Marz)
for flare ups Rice (mush), bannana, mild teas, water For maintenance High Fiber, Low fat
(the following are not recommended for a cold damp spleen defficient type person because Juices are inherently sweet, dampenning, and cooling) fresh juices: _ carrot (Walker, p. 132) _ carrot and spinach (Walker, p. 132) _ carrot, celery, parsley, and spinach (Walker, p. 132) _ celery (Shefi) _ apple (Shefi) _ carrot and sour apple(Shefi) _ papaya (Shefi) _ coconut milk and carrot (Jensen, p. 50)
foods contraindicated: _ artichoke, grapeskins and seeds, roughage, raw foods, cold foods
avoid: _ food intolerances wheat, corn and dairy, carrageenan-containing foods _ avoid peanuts, meat, sugar and sweet food, refined and processed foods, corn, soybeans, most legumes, coffee, caffeine, oranges, alcohol, hot sauces, spicy foods, fried foods, fatty foods, rich foods, salty foods
The following are only meant as a refference as each person would need to tailor their supplements)
_ Glutamine (for permeability issues) _ Vitamin A 50,000-75,000 I.U. q.d.(fish oil)w/food _ Zinc picolinate 30 mg q.d. _ Magnesium _ folic acid 20-30 mg q.d., esp. if on sulfasalazine, see below folate supplementation associated with a reduced risk of colon cancer (Gastroenterol, 1988 19 (5 part 2) A252 (abstract) Lashner, et al., 1989 49: 127-131) _ omega-3 fatty acids 2-3 g t.i.d. _ Vitamine A, 1000,000 IU/day initially, then taper _ PABA, 2g, 4 times per day _ Vitamin E 800 I.U. q.d. _ Vitamin B12 IM _ Vitamin C (buferred) 1 g q.d. (use milk-free product) _ lactobacillus acidophilus (Marz) _ liquid chlorophyll _ alfalfa tabs _ Chlorella (more cleansing) _ Quercetin 500-1000 mg q.d. 15 minutes before meals _ Digestive enzymes w/ meal (Pancreatin, 1,400 mg,2-3 tablets tid after meals if defficient _ Hydrochloric Acid, 40-70 grains per meal if hypochlorydric _ Antioxidant--Grape seed oil _DHEA (men) predenalone (wowmen)
_ drug interaction: _ prednisone/prednisolone: - causes Sodium retention - causes reduced activation of Vitamin D (Travato, 1991 44:1651-1658 Tuttle, 1982 126: 1161-1162) 1,25(OH)2D3 can be measured to determine if supplementation necessary, with low levels can use calcitriol - causes increased urinary excretion of Zinc, Vitamin K and Vitamin C (Buist, 1984 4 (3):114) _ folic acid and sulfasalazine (Azulfidine): causes decreased absorption of folic acid (Longstretch and Green, 1983 143: 902-904)
Candida overgrowth occurs when the immune system is debilitated, and perhaps also when the immune functions affecting certain tissues (e.g. mucous membrane surfaces) are blocked by abnormal blood circulation or by fluid accumulation. While the ultimate solution to the problem of candida overgrowth is to recover full immune functions, an immediate treatment is to directly inhibit candida. This latter function is often accomplished with antifungal drugs, but it appears that the yeast quickly become resistant to most drug therapies.
In China, candida is treated with herbal combinations. The syndrome is related to a dampness disorder, caused either by cold affecting the stomach and spleen (as occurs, for example, with chronic use of either antibiotic drugs or cold bitter herbs with antiseptic properties), or by damp-heat accumulation (which may arise, for example, from dietary components or from transformation of cold dampness to heat as the fluid remains stagnant over time).
Phellodendron is often a key herb in the treatment of candida because it has antiseptic properties (including ability to inhibit candida), it dries dampness (astringent), and it clears deficiency heat. In the case of cold syndrome, it is combined with cinnamon bark, which is very warming, also has astringent effects (because of tannins in the bark) and is antiseptic (because of the essential oils). For example, Willow Blossom Powder (Liu Hua San) is comprised of phellodendron (15 g), cinnamon bark (3 g), indigo (qingdai, 9 g), and borneal (0.5 g) the ingredients ground to fine powder and taken orally. For oral thrush, some powder can also be applied topically, and for intestinal candidiasis, the formula can be used in the form of an enema. [note when using the powder as an internal medicine, as opposed to applying it topically, one can substitute 9 grams cardamon for the borneol (the latter is the main active component of cardamon).]
For systemic effects, the formula can be modified to treat spleen dampness by adding red and white atractylodes, cardamon, hoelen, coix, and dolichos. For kidney and spleen yang deficiency, add aconite, ginseng, dry ginger, and evodia. In a study of the effects of the formula in 13 cases, all were cured, and the average treatment time was just five days.
An active component of phellodendron is berberine, and this may inhibit candida. Coptis also contains this component and is often combined with phellodendron or used in place of it to treat candidiasis. For example, a modern version of Pinellia Combination, made with pinellia (10 g), scute (10 g), coptis (8 g), dry ginger (8 g), codonopsis (8 g), and licorice (4 g), was given to more than 20 patients with thrush and a cure was obtained within five days.
Other astringent herbs are also found to be effective. For example, four cases of candida that arose after prolonged administration of antibiotics and corticosteroids were given a decoction of 18 grams mume per day, plus tablets of acacia gum (axianyao) 1 gram each time, three times, for a total of 3 grams. This treatment led to negative stool culture for candida after a few days. Mume is extremely sour, so that the decoction would be hard for most people to take therefore, it could be used in the form of a granule (dried decoction), about 3-6 grams of the extract per day.
The main active component in acacia is catechin (a common tannin found in tree wood and leaves) and quercetin (one of the most common flavonoids). Catechin is similar to an ingredient of mume called epicatechol. Astringents, such as tannins, are often used topically to treat infections and by enema to treat diarrhea and intestinal inflammation.
In a recent review of herbs that inhibit candida in laboratory testing (Modern Study and Application of Materia Medica), the following herbs are mentioned: phellodendron, scute, sophora subprostrata, melia fruit, and pseudostelaria (tu jing pi this is the golden larch bark). In an earlier source (Pharmacology and Applications of Chinese Materia Medica), the following herbs are mentioned: phellodendron, plantago leaf, pulsatilla, capillaris, cnidium fruit, houttuynia,- and anemarrhena (these herbs are included in a formula called Phellostatin produced by Health Concerns). It was also mentioned in this reference that seven cases of oral candidiasis that did not respond to nystatin, trichomycin, or amphotericin were effectively treated with Bupleurum and Rehmannia Combination this formula includes phellodendron, coptis, and scute. There are many other herbs and formulas reported to inhibit yeast and fungi, either by topical application (e.g. polygonatum extract), or oral ingestion (e.g. rehmannia).
Houttuynia is rich in quercetin and related flavonoids. It is possible that this is an active component against candida. Tannins, such as catechin, are condensed flavonoids. The role of flavonoids in tannins in plants is believed to be, in part, as a protector against fungi and other organisms. Oral thrush was successfully treated in children in China by topical application of a powder that included rhubarb (a rich source of catechin) and phellodendron.
A compound that can be isolated from many plants, caprylic acid, has been prescribed by naturopathic practitioners for treatment of candida. This acid is found in capillaris. It has been reported that caprylic acid can produce side- effects, such as lower energy, which can be countered by consuming coenzyme Q10.
A combination of phellodendron, capillaris, scute, and mume, could be utilized as an antiseptic for yeasts in the form of extract granules. If these are taken with Quercenol (high in quercetin) and Cartaequin (which contains coenzyme Q10, and crataegus, which has effects similar to mume), the effects may be prompt. These herbs and supplements are all suitable for patients with weak constitution as long as the underlying or constitutional condition is being treated at the same time (e.g. by warming the spleen otherwise, modify the base formula accordingly with herbs such as cinnamon bark, codonopsis, dry ginger, licorice, atractylodes, etc.).
In cases of candida affecting the throat, the addition of gardenia may prove helpful as an adjunctive herb. Gardenia is highly recommended by Kanpo doctors for irritable conditions of the esophagus, throat, and mouth. It is given for esophageal constriction, esophageal cancer, pharyngitis, laryngitis, and salivary calculus. However, gardenia can cause diarrhea if used in large quantities.
Applicability
Rather than the physician diagnosing "candida" as a cause of the patients symptoms, many patients will arrive convinced that internal candida is responsible for a wide variety of physical and psychologic symptoms that have long been undiagnosed or ignored by conventional physicians. The "candida situation" is a complicated one. The alternative health care community often commits the same error as the patient, convinced that candida is responsible for a variety of unrelated symptoms and furthering the patient's anxieties about 'infestation.' The nutritional supplement industry produces a vast variety of products to 'cleanse' the body of every last yeast bud and 'balance' the remaining microflora. During a recent visit to a health food store, there were far more products devoted to candida than, say, to cholesterol control. On the other hand, the mainstream medical community is largely unconvinced of the existence of the syndrome at all and mainly express nervousness about excessive use of antifungal agents. Like most dichotomies, the "truth" is not really known, and probably lies somewhere in between. A good place to begin is with the book that started it all. Dr. William Crook, a family physician, wrote "The Yeast Connection" after having observed a similarity of symptoms in women with recurrent vaginal yeast infections and a variety of subjective complaints. He posited that due to a variety of factors such as diet, stress, use of antibiotics, hormonal imbalances, an intestinal overgrowth of candida could occur. The symptoms that followed could be classified into several groups:
1.Vulvovaginal candidasis from repeated re-seeding
2. Gastrointestinal symptoms such as bloating, gas, and frequent indigestion
3. Systemic complaints from absorption of the breakdown products of candida through a damaged intestinal mucosa 4. An immune complex syndrome as the absorbed products create antibodies which circulate and produce areas of local inflammation 5. Food allergies as the incompletely digested food products are absorbed through a damaged and hyperpermeable intestinal lining ('leaky gut syndrome') 6. Food cravings as part of the food allergies
It is very important to understand that what all the books on the subject describe is an immune complex condition and not the candidemia associated with a profoundly compromised immune system like AIDS or during chemotherapy. Much of the alternative literature on the candida syndrome will use words like 'invasion' and comment how 'distant organs, beyond the gastrointestinal system' are 'invaded.' Having joint pains due to an immune complex reaction is, of course, a whole lot different from having candida proliferating in the bursar sac but most of the patients, already anxious, do not understand the nature of an immune complex disease and genuinely picture their bodies looking something like a ripe piece of blue cheese. To my mind, the main failures of the book are: 1. Attributing the vast number of fairly common symptoms all to a single cause. 2. Inducing an unnecessary anxiety in readers, most of whom, upon taking the test at the end of the book, will arrive at a self diagnosis of candida. 3. Conveying to both patients and alternative practitioners that the only reliable way to arrive at a diagnosis is through this subjective questionnaire that tests, though helpful (see list below) are unreliable. 4. Treatment with prolonged use of antifungal agents and a diet so rigid that patients are convinced a single cookie will produce massive immediate overgrowth and exacerbation of symptoms. The 'natural' treatments (like caprylic acid, berberine or gentian) are probably a whole lot safer than antifungal agents but necessitate complex dosing schedules for inordinate lengths of time and seem of 'medium' efficacy.
It doesn't take long to put (1) through (5) together and get the following scenario: a young woman with vague complaints reads the book, takes the questionnaire, and 'knows' she has candida. She begins the extremely rigid diet and goes to the health food store where the clerk prescribes a variety of herbs and cleansers. Feeling no better, she goes to a mainstream physician who pronounces her fears unnecessary and the book 'hogwash.' She searches for another physician and perhaps finds one who knows something about the syndrome. He orders some tests (let us say stool and vaginal cultures and serum antibodies) which come back negative. But the literature has told her the tests are unreliable and the diagnosis is based on the questionnaire. Finally she locates a physician who treats candida based on subjective complaints, receives a prescription for nystatin, diflucan, or sporonox and she feels better. With no way to clinically monitor her subjective response, recurrences of symptoms trigger the 'candida anxiety' and another go-round of antifungal agents. I describe all this only to prepare you for the patient who will burst into tears when you explain there is simply no evidence of candida in her body. These are not necessarily tears of relief. She has been carrying the myth of candida infestation, aided and abetted by books, health food store clerks and well-meaning but inexperienced alternative practitioners, hoping that this single diagnosis would 'explain everything.' The other frequent scenario is the patient who calls, 'knowing' her diagnosis (same sources) and visits solely for you to write the anti-fungal prescription.
Therefore, along with the impressive array of vague symptoms, the patient often is depressed and anxious (from being chronically symptomatic, and her situation undiagnosed and untreated). The situation is not helped by the conventional medical community which, after many years of hearing about the candida syndrome still seems to think that the patients believe they have candidemia and try to reassure these neurotic individuals they'd be in intensiw care units if this were the case.
To make matters worse, the alternative medical community has made candida a virtual growth industry (pun intended). A medical diagnosis, made by non-medical individuals, based on highly subjective and common complaints, will invariably lead to overdiagnosis.
The logical fallacy of:
The patient has fatigue Candida causes fatigue The patient has candida
or
The patient has fatigue and a vaginal yeast infection Candida causes fatigue The patient definitely has candida
sums up the diagnostic processes of individuals without medical training entering into an area beyond their skills.In summary: 1. The diagnosis of candida is often made on highly subjective complaints which could be the basis of hundreds of other conditions. Because of a barrage of educational materials from supplement companies reaching the alternative practitioner (the diagnosis is especially popular among chiropractors and a group called "Certified Clinical Nutritionists") which focus on candida, there is a tendency to fixate on this diagnosis, adding fuel to the fire of the patient's fears. Just as the cardiologist might perceive all of a patient's symptoms as referable to an ailing heart, the alternative community too often attnbutes candida to everything.
2.In an attempt to sell their products, both nutritional supplement manufacturers and several clinical laboratories offer "diagnostic aids" which predominantly yield a diagnosis of candida, treatable (of course) with the company's products. One patient described it well to me, referring to a nutritionist who gave her the "standard candida script." This was a well-rehearsed monologue, a dozen supplements, and a diet program so complicated she thought she might as well live with the candida (which, as is frequently the case, she did not seem to have at all).
The standards for making an actual diagnosis among alternative practitioners vary widely and are inconsistent. Since the Medical Practice Act forbids unlicensed practitioners from making any kind of diagnosis in the first place, I once wondered why they so fixated on this until I appreciated the treatment lay in the only areas open to them: diet and nutritional/herbal supplements. I remarked earlier the diet is rigid and the dosing schedule of the natural supplements very complex. I have heard from the patients themselves how when tests demonstrate continued candida infestation, the practitioner basically places the blame on the noncompliant patient. If I sound a bit testy about all this, it's because of the frequent encounters I've had with despondent young women, feeling crummy and hundreds of dollars poorer because a candida diagnosis was 'ascertained' by such questionable methods as reflexology, applied kinesiology, iridology, or a single stool culture demonstrating presence of yeast.
History The patient usually presents with most of the following:
. Fatigue, depression, malaise, gastrointestinal symptoms of bloating, food intolerances, constipation, diarrhea · Headaches, difficulty with concentration · Arthralgias, myalgias · If female, recurrent monilial vaginitis and PMS, especially with oral contraceptives There is frequently a history of: protracted antibiotic use, prednisone use, high sugar/ junk food diet
Diagnostics · Two separate stool samples for candida should both show overgrowth . Vaginal culture - IgG, IgM, and IgA antibodies by ELISA. IgM elevation appears early if all three are elevated, this pattern is most diagnostic if IgG is elevated, but not IgM, this suggests a previous infection. · Food allergy testing may show an unexpectedly large number of positive results reflecting intestinal hyperpermeability
I have personally found the various candida questionnaires to vague to be helpful and remind me of the way a magician forces a card on a member of his audience which he then 'mysteriously' draws out of a hat. Chiropractors or Certified Clinical Nutritionists reading this may feel I miss a lot of candida but as an internist, one needs some basis of a diagnosis beyond a subjective one before starting treatment. Having a document to show a patient when she gets well is also very helpful.
The most common Traditional Chinese Medicine pattern differentiation is that of Liver Qi Stagnation overacting on the stomach with subsequent Stagnation of Food, Dampmess, and Phlegm (the latter developement) in the Middle and Upper "Jiao" or compartments, as they are referred to. The Liver here is a broader network of related functions in the body, rather than just the anatomical Liver. However, an intolerance to oily foods also suggests gallbladder insufficiency, but probably a spasmed spincter in kind with the spasms of the esophagus. The Liver is said to rule the free flow of Qi throughout the body. This relates most closely to the Sympathetic Nervous System. The symptoms of Liver Stagnation mainly include smooth muscle disorders. This relates to the stomach, intestines, uterus, and Arterial system to name a few. See Liver Network, for a full write up.
You can think of the Sympathetic Nervous System as a Yang function and the Parasympathetic as a Yin function. The Ancient Chinese didn't know about these two opposing and interacting systems, but they knew the manifestations of their relative imbalance. Today, we live in a culture that is high stress, highly adrenalized. This again is Sympathetic Nervous System (SNS) activity. The problem is, whereas the adrenal (fight or flight) pattern was originally a protective mechanism for when a 15 foot animal was considering us for dinner, it is now rampantly out of control. It kicks in even with the thought a a perceived danger, fear, threat, deadline, or other disdained experience. The result is a chronically out of balance Automatic nervous system, especially the SNS, which by nature shuts down the Parasympathetic function (Vegetative Nervous System) which is control of all the more subtle, "yin" functions such as sleep, immune function, digestion, reproduction (although arousal itself is more yang), menstruation, calcium levels, production of enzymes, etc. This then leads to the many "chronic" "degenerative" syndromes including autoimmune, allergies, digestive, etc..From the TCM viewpoint, we must regulate the stagnant Liver Qi, promote the Spleen, and resolve the phlegm. Since the pattern is more of a hot syndrome, bordering on a fire condition, we must also pay heed to using cooling agents. I am including some perspectives on Achalasia including the psychophysiology , and some other recommended therapies including Homeopathic remedies and accupuncture..
Psychophysiology
The inability to speak up for one's self swallowing anger stifled creativity refusal to change. The throat is an avenue of expression and channel of creativity. (Hay, 1984, p. 186)
Swallowing is a form of integration, of ingestion, of incorporation. There are many occasions when we have to swallow unwelcome pieces of information, and bad news makes us 'swallow hard'. We drink liquor because there is something else in our lives that we cannot or will not swallow. (Dethlefsen, p. 130)
related to anger stifled creativity refusal to change. The throat is an avenue of expression and channel of creativity. (Hay, 1984, p. 186)
affirmation:
It's OK to make noise. I express myself freely and joyously. I speak up for myself with ease. I open my heart and sing the joys of love. I express my creativity. I am willing to change. (Hay, 1984, p. 186)
psychotherapy:
In cases of stomach disorders and digestive complaints, ask some related questions:
What is it that I am unable or unwilling to swallow? Let go of? Speak of? Is something eating me up inside? What am I feeling so sour about? How am I handling my feelings? How am I coping with my aggression? To what extent am I avoiding conflicts? Am I longing for the conflict-free time of childhood when I was secure, loved, and cared for? (Dethlefsen, p. 134)
process paradigm: (experientially oriented) What is the symptom preventing me from doing? What is the symptom making me do? (see process interview: digestive system)
Chinese psychophysiology:
Stomach Wei is the Sea of Nourishment and origin of all fluids transforms and digests food so that the Spleen can separate the distilled food essences with the Spleen, is the root of post-natal Qi and as Earth, relates to the ability to assimilate, stabilize, and feel balanced and centered. Healthy expressions are fairness, openness, and nurturance. Weakness, dysfunction, and illness are associated with worry, anxiety, and overthinking. Worry will cause Stagnation of Qi in the Stomach and will manifest as a niggling, burning pain, belching, and nausea. Anger, frustration, and resentment affect the Stomach indirectly through Liver Qi Stagnation which invades the Stomach. (Maciocia, p. 267) Stomach Shi (Excess) signs include nightmares acne skin eruptions excess stomach acid (Seem, p. 28) heat in the abdominal area overactive digestive system causing hunger and thirst dark yellow urine gluttony halitosis swollen gums red dry lips pains and cramps in legs.
Liver Gan is the residence of the Hun (Ethereal Soul) it relates to decisiveness, control, and the principle of emergence maintains smooth flow of Qi and Xue (Blood) controls the muscles, especially their contractility and reflects emotional harmony and movement. Healthy expressions are kindness, spontaneity, and ease of movement. Liver Qi Stagnation reflects and accentuates emotional constraint as the Liver's function of facilitating smooth flow in the body is constricted. Stagnation is associated with frustration, irritability, tension, and feeling stuck. With time this pattern tends to produce a gloomy emotional state of constant resentment, repressed anger or depression, along with tightness in the chest, frequent sighing, abdominal tension or distension, and/or a feeling of a lump in the throat with difficulty in swallowing. (Maciocia, p. 216)
Homeopathy
Bryonia: spasm of muscle causes choking pain in esophagus as if contracted in lower part pressure in esophagus from overloaded stomach < motion sickness Hyoscyamus: cannot swallow liquids constriction muscles of tongue and throat are paralyzed food taken through mouth comes up through the nose sight or sound of water produces spasmodic constriction of esophagus Mercurius corrosivus: burning pain in esophagus < external pressure spasms of esophagus on attempting to swallow even a drop of liquid vomiting of whitish, slimy, tenacious masses Nitric acid: confusion of muscular action of throat causes food to stop in throat with choking sticking in throat like a splinter on swallowing Stramonium: cannot swallow due to spasm choking on attempting to swallow, hydrophobia Strychninum: burning along with spasm of esophagus dry, contracted throat feeling of lump in throat Acupuncture points
palpate and consider: PC-6 (+): pacifies the Shen regulates the Qi opens the chest harmonizes and spreads the Qi in the Upper and Middle Warmers releases and expands the diaphragm relieves Liver Qi Stagnation harmonizes the Stomach descends Rebellious Qi to resolve nausea, reduce eructations, and stop vomiting/neasea/dysphagia opens the Yin Wei Mai (Yin Linking Vessel) to distribute Qi to the Stomach, chest and Heart Pericardium Luo Connecting point Master point of the Yin Wei Mai (Yin Linking Vessel) Couple point of the Chong Mai (Penetrating Vessel) LI-4 (-): moves and descends Qi in throat regulates Qi and Xue (Blood) relaxes Stomach spasms relaxes pylorus and regulates peristalsis Large Intestine Yuan Source point Lu-7 (=): opens and regulates the Ren Mai (Conception Vessel) benefits the throat treats Shi (Excess) patterns resolves Phlegm and clarifies Mucus tonifies Yang Ming (Stomach and Large Intestine) Lung Luo Connecting point Master point of the Ren Mai (Conception Vessel) Lu-9 (+): opens Qi in chest cools and clears Heat in the Lung, Liver and throat clears and descends the Upper Warmer and Lung Qi Lung Yuan Source, Earth and Tonification point CV-17 (ind. with ginger): calms emotions regulates and smooths Qi circulation in the Upper Warmer descends Rebellious Lung Qi in the chest expands the chest and soothes the diaphragm elevates Spleen Qi suppresses Stomach Qi transforms Phlegm suppresses nausea Mu Alarm point of the Upper Warmer Hui Reunion point of the Qi CV-16 (ind. with ginger): relaxes the chest and facilitates the flow of Qi descends Rebellious Qi harmonizes the Middle Warmer CV-12 (+): regulates the Stomach Qi increases peristalsis of the Stomach opens the pylorus and increases muscle tension in the stomach so lower portion descends (Finkelstein, p. 88) transforms and suppresses Rebellious Qi(neasea,vomiting,acid reflux) clears Stomach Fire and Heat strengthens Middle Warmer to allow Qi to descend Mu Alarm point of the Stomach and Middle Warmer St-36 (-): harmonizes digestion regulates the Stomach and strengthens the Spleen regulates Ying (Constructive) Qi spreads Liver Qi tonifies Qi and Xue (Blood) stops vomiting descends Rebellious Qi(neasea,vomiting,acid reflux) governs and directs all descending energies in the body Stomach He Sea Lower Uniting and Earth point Sea of Nourishment point St-44 (-): harmonizes the Stomach cools Heat and drains Dampness from the Stomach and Intestines regulates Rebellious Qi stops pain, esp. abdominal pain with fever Stomach Water point
illustrative combinations: LI-4, CV-22 and CV-17: increase peristalsis of esophagus (Finkelstein, p. 93) Bl-38 and CV-17 Sp-6 and Bl-17 Kd-21, Bl-45 and PC-8 GB-20, Bl-18, CV-22, LI-11 and Sp-5 for esophageal spasm (Mann, p. 103)
Chinese Herbal Medicine Pinellia and Gardenia C.: Esophageal stenosis/polyps, esophageal cancer (Hsu, 1980, p. 555) Pinellia and Magnolia C. (Ban Xia Hou Po Tang) Cyperus 18 (patent): Liver Qi Stagnation: sensation of lump in throat (Pinellia and Magnolia C.: Hsu, 1980, p. 395 Yeung, p. 42 Dharmananda, 1986, p. 226 Bensky and Barolet, p. 291 Cyperus 18: Dharmananda, 1990, p. 45) Gardenia and Soja C. (Zhi Zi Dou Chi Tang): Mild Stomach Fire Blazing: stifling sensation in chest, insomnia with tossing and turning in bed (Hsu, 1980, p. 162 Dharmananda, 1986, p. 284 Bensky and Barolet, p. 73) Gardenia, Licorice and Soja C. (Zhi Zi Gan Cao Chi Tang): More severe Stomach Fire Blazing: shortness of breath, stifling sensation in chest, insomnia (Hsu, 1980, p. 161 Dharmananda, 1986, p. 284 Bensky and Barolet, p. 74)
eating principles: eat small, low fat meals frequently throughout day, increase foods rich in Vitamin A eat slowly and relax while eating chew food thoroughly high fiber diet
specific remedies: 1-2 drops peppermint essential oil in 1/2 cup warm water 15 minutes before each meal (Shefi)
avoid: meat, alcohol, hot sauces, spicy foods, fried foods, fatty foods, rich foods, salty foods, coffee, caffeine, chocolate, sweet foods and sugar tomato, milk, nicotine (Marz)
Many of the common conditions treated in a primary care practice have a component of food sensitivity. A very quick at-home test to determine if food sensitivities are a factor in your specific condition is as follows: 1. Understand that the commonest food sensitivities are to A. dairy products B. egg products C.citrus fruits D. wheat products E. bananas F. kidney, lima and string beans G.chemicals used in food processing H. any food you may either crave excessively or eat more than three times a week
2. To do a simple test for food sensitivities, eliminate all the foods containing those ingredients for one month. This will require some careful shopping and eating quite number of grains with which you may be unfamiliar but is worth the effort if you find yourself feeling well for the first time in years.
3. At the end of a month, if your condition is exactly the same as before the diet, then food sensitivities are not an issue and you can resume your previous eating habits.
4. On the other hand, if you're feeling better, then rechallenge yourself with each food group, adding back the foods at the rate of one group per week. If the symptoms return during a particular week, then you're likely sensitive to foods from that group.
5. Once you've found foods that e-create your symptoms, eliminate them completely for 4-6 months. At the end of that time, you can probably return to eating the offending foods providing you eat them less often than before, usually no more than twice weekly, spaced apart by at least three days.
6. If you are sensitive to foods from several groups, don't eat foods from more than one of these groups on the same day.
NOTE: any of the recommendations below in which the phrase "eliminate food sensitivities" is used, refers to using the program as outlined above.
1. Sugar
Avoid all foods containing added sugar (e.g. cakes, candies, ice cream, sodas, certain cereals, jello, ketchup, etc.) Sugar natural to food such as sugar in a fruit may be eaten-raw unfiltered honey, unsulphured black strap molasses, pure Vermont syrup, rice syrup and "date sugar" may be used as acceptable sweeteners, but should be used in moderation..
2. Alcohol Avoid all alcoholic beverages including liquor, beer and wine. Try naturally sparkling spring water with a twist of lemon or lime as your social drink.
3. Caffeine Avoid coffee, tea, cola and chocolate It is advisable to also avoid decaffeinated coffee such as Sanka or Brim as chemicals are used in the decaffeination process. There is a swiss water process decaffeinated coffee which is permissible Folger's is one. Herb teas and health food store "coffee substitutes" such as Pero or Postum are acceptable.
4. Tobacco Avoid cigarettes, cigars, pipes, etc. Try to avoid inhaling other people's smoke, as much as possible.
5. White Flour Products Avoid white bread, white pasta products and also white rice. Whole grain flour products and brown rice may be used instead.
6. Hydrogenated Fats Avoid hydrogenated fats which are oils which have been made hard by the addition of hydrogen atoms (e.g., margarine, Crisco, mayonnaise, and processed peanut butter). Old fashioned peanut butter may be used. Saturated fats (e.g., butter, animal fats) are allowed in moderation. Unsaturated cold pressed vegetable oils (e.g., safflower, sesame, canola sunflower, virgin olive oil) may be used. Avoid frying in vegetable oil broth may be used.
7. Chemicals added to food: Labels must be read. In some cases, labels do not reflect the chemicals in the food. Avoid artificial preservatives: (e.g., BHA, BHT, MSG, nitrites, nitrates, sodium ben- zoates, etc.) commonly found in bread, crackers, cereals. All processed cured meatssuch as bologna, salami, frankfurters, corned beef and pastrami, should be avoided because of the addition of chemicals. Avoid artificial coloring: commonly found in frankfurters, soda, certain candy, maraschino cherries, juice drinks, etc. Avoid artificial flavoring: commonly found in certain ice creams, frozen pies and candy. Avoid artificial sweeteners: Sweet 'n' Low, all diet sodas, any diabetic foods, other processed low calorie foods.
8. Fluoride Avoid fluorinated water and all tap water. Use bottled spring water, distilled or filtered water. Avoid fluorinated toothpaste (toothpaste without fluoride and containing natural ingredients may be purchased at most health food stores, such as Auromere and Homeodent). 9. Aluminum cookware and Teflon cookware Avoid aluminum and Teflon cookware as aluminum tends to accumulate in the body and fluoride may be released from Teflon. Stainless steel, Pyrex, enamel, Corning and iron cookware may be used instead. Occasionally, persons who have been addicted to ingredients on this list experience "withdrawal symptoms". Please don't be alarmed if you should experience unusual fatigue, headaches, or cravings during the first three to four days of abstinence. If symptoms are severe, consider weaning yourself gradually. Soon your body will begin to regulate and you should then experience a new sense of health and well being.
10. Non-prescription Drugs Avoid marijuana, cocaine, hallucinogens (like LSD) and generally all "recreational drugs."
11. Prescription Drugs are necessary for medical management. However, the paradox is that although the drug "treats" the problem at mechanistic level, it more often exasterbates the root cause of the diharmony.
LABORATORY TESTING FOR GASTROINTESTINAL PROBLEMS
FOOD SESITIVITIES
It May be possible that symptoms of irritable/spastic colon are precipitated by food sensitivities. Questions to ask:
* Do certain foods seem to trigger symptoms? * Is there a family history of dairy or other food intolerance? * Do you feel worse, rather than better, after eating? If so, this is suggestive of food sensitivities. (this is Stagnation of the food, or Sleen Qi defficiency by TCM)
Diagnostic tests helpful in dealing with food sensitivities:
* 96 Food Allergy Panel (serum test for IgG4) * Comprehensive Stool Digestive Analysis * Lactose Intolerance test * Small Bowel Bacterial Overgrowth by breath test
The following is a simple way to diagnosis food sensitivities (while waiting for test results or in lieu of)
1. There is a product called "Ulta Clear". This is a hypoallergenic protein powder which comes with a patient information booklet that outlines a seven day elimination program. Start on this for the one week period.
2. If food sensitivities are an issue, you will feel better within this first week. If so, then procede with an allergy elimination diet. (by TCM, this is gennerally a diet that is matched with the treatment principle for your condition, i.e. avoiding warming foods for a "heat" "inflamatory" condition)
3.If test results show a large nmber of offending foods, then I suspect a "leaky gut syndrone" or "intestinal hyper-pereability"
INTESTINAL HYPERPERMEABILITY "LEAKY GUT SYNDRONE"
Intestinal hyper-permeability is a damage to the lining if the intestine in which incompletely digested foods are inappropriately and prematurely absorbed into into the prtal system (Liver blood) and ultimately determined by the immune system to be antigenic (a antigen). There appear to be six main causes of intestinal hyperpermeability, the correction of which often alleviates the food hypersensitivity situation.
1. Maldigestion (hypochlorydria/enzyme deficiencies, i.e. Spleen Defficiency by TCM) 2. Inflamatory bowel disease (Crohn's/ulcerative colitis, i.e. heat stagnation by TCM) 3. Use of alcohol or non-steroidal anti-inflammatory drugs. 4. Intestinal parasites. 5. Poor nutritional status (Qi and Blood defficiency by TCM) 6. The offending foods themselves. (may have inherrent toxicity/contamination/or wrong energetics, ie too cold/hot)
At this point, two additonal tests are helpful.
1. Comprehensive Stool Digestive Analysis. ($300) In this test, the patient collects two stool specimens, one with a Fleet's Phospho-Soda purge, the other without, and sends specimens by Air Express to one of several labs. The test result will determine if food is being appropriately digested and absorbed, and if there are pathogenic bacteria/parasites present.
2. Intestinal Permeability Testing. This can be preformed in either of two ways:
B. A blood specimen is obtained for antibodies to a variety of intestinal bacteria which should not be present unless there is permeability. ($200)
LIVER DETOXIFICATION CAPACITY ($85.00, saliva and Urine)
Liver detoxification capacity. When there is intestinal hyperpermeability, one can envision the liver being deluged with an unusually large amount of agents it must detoxify. These toxins challenge the body's own antioxidanr system. Two tests can reflect the functional status of the system.
1. Liver detoxification capacity (available through many labs). A simple test measuring the liver's ability to clear caffeine after a standrdized challenge. A very slow response suggests liver disease (e.g. chronic hepatitis) wheras an overly fast response suggests a pathologic detoxifier with a production of an inordinate amount of free radicals.
2. A simultaneous test of the antioxidant defense system (usually) measures serim glutathione will determine if excessive toxic exposure exsists. ( $127.00 for both Liver detox and oxidative test)
Also a Anti-oxidant profile can be done which measures these levels. ($100)
All the above tests are done by Great Smokies Laboratories, 800-522-4762
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