Hidden pathogens and emerging viral activity are pressing concerns for modern medicine. AIDS, chronic fatigue syndrome, and viral threats such as Ebola and increasingly virulent strains of influenza are accenting this concern. Modern genetic engineers are in the process of discovering the mechanism of a "guest" pathogen that may have slipped by the body's defenses relatively unnoticed and set up long-term residence. The possibility of this guest pilfering valuable resources to a degree that chronic weakness and eventual death can result is now being acknowledged.
Oriental medical theory has worked with this idea for centuries. By understanding this ancient medical model and applying it to our modern considerations, we may find much valuable information and significant solutions. Mechanisms may already exist in Oriental medical thought to assist in the dispersal of these here-to-fore unnoticed guests that are parasites in the most literal sense.
The purpose of this paper is to provide an outline of Oriental herbal and medical techniques from traditional literature and to urge a meeting of west and east toward finding ways to give Homo Sapiens an increased advantage in the encounter with the viral world. Further research is called for to determine the full effect of these ancient ideas on modern medicine. It is my contention that there is a place for the cooperation of the two seemingly disparate technologies of Western and Eastern medical thought in relation to hidden pathogens and emerging viral problems.
Hidden Pathogens in Modern Medical Research
A current trend in modern medicine regarding recalcitrant and difficult to treat diseases is the idea of hidden or latent pathogens. A sickness will invade the body at a time of vulnerability and then evolve into a state of relative peace with its host. As a result, usual attempts by the body's immune system to disperse the disease are largely absent. The general effect is a long-term, low-grade infection that reduces the viability of the living organism. There are recent indications that chronic diseases such as hypertension, clinical depression, chronic fatigue syndrome, and others may be infectious in origin and involve hidden pathogens.
This is not a new concept according to Richard Krause of the National Institutes of Health. "Earlier in this century there was a popular notion that hidden infections were the cause of all sorts of ailments, from headaches to arthritis. Indeed, for a time it became popular to remove the large bowel to relieve the body of its putrid eluvium. And teeth were extracted and tonsils removed in an effort to eliminate any possible focus of infection." (1)
The focus in Western, mainstream medicine has currently intensified the search for the location of the pathogen, the ability to identify it, and the discovery of its long-term effect on the organism. As genetic scientists and virologists are now able to "find traces of viral particles in bits of tissue taken from chronically ill individuals, an understanding develops of how viruses engage in a kind of mutiny of the very organisms they depend upon for survival and of how the occult presence of an alien bit of genetic material can have lifelong, chronic effects." (2)
Michael B. A. Oldstone, head of molecular immunology at the Scripps Clinic, La Jolla, California writes, "This insidious mode of viral activity may underlie many human illnesses, such as certain kinds of growth retardation, diabetes, neuropsychiatric disorders, autoimmune disease, and heart disease, (all of which) have not (previously) been suspected to have an infectious cause." (3) Dr. Oldstone offers an intriguing theory on viral-caused, chronic disease described in detail in A Dancing Matrix, Robin Marantz Henig's excellent book on emerging viruses. "Every cell has certain jobs it must perform in order to survive. The cell's basic jobs are to make more of its own DNA, to produce certain proteins to maintain its integrity, and to manufacture enzymes for cellular metabolism. But every cell also has some functions that are, in a way, luxuries, not really essential to the cell's survival but part of the way that the cell contributes to the optimal performance of the organism as a whole." (2)
Henig goes on to describe those functions that are luxuries to the cell and anything but luxuries to the organism. If a pancreatic cell involved in the production of insulin, for example, is compromised in its luxury function, it can easily become life threatening to the organism as a whole. Here the hidden virus becomes meaningful as an entity. For various reasons a pathogen enters the body without being detected. It may enter at a very young age before the immune system fully develops, during a time of acute illness, or when stress is greater than normal. The pathogen then affects the cell enough to compromise its luxury function to the point that overall health is diminished, often with long-term, even deadly, results.
Even more interesting is a class of virus called Retroviridae or simply retrovirus. It functions in reverse from most viral activity. Beginning with a strand of viral RNA and creating a viral DNA is opposite from the action usually seen. This enables the virus to splice its own genetic makeup directly into the cell's DNA. The result is that the retrovirus looks more like the cell's normal genetics than other viruses. Since the invasion is not detected in the usual way, the body's normal defense mechanisms are effectively sidestepped. The function of the cell is compromised while the immune system does not note this as a problem.
HIV, generally thought to cause AIDS, is the best-known virus of this type. Among the cells in which this retrovirus lives as a guest are the so-called Helper T-cells and certain macrophages, both major players in immune response. Over time, immune functioning is affected so that the host organism is unable to mount a defense to the simplest of infections and, as the T-cell function is further diminished, will eventually die. (4-6)
Hidden Pathogens in Oriental Medicine
English words that are commonly used to describe the equivalent Oriental medical concepts are inherently distorted by the translation. These terms are attempting to capture the essence of thoughts that may have no real words in English that come close to describing them. It may even be that there is also no Chinese character that can accurately convey the intended meaning. A complete understanding of these ideas is a long, major study. As an example of the difficulty involved, in the discussion below the term "Heat" is used. Though this may seem at first glance a commonplace term, even approximating it from within the context of Oriental medicine and diagnosis is complex. There are many types of pathological Heat and Fire. The term could mean fire toxin (huo du) or possibly fire pathogen (huo xie). To further complicate matters, there also can be the transformation of the five emotions into fire (wu zhi guo ji) or an uncontrolled overflow of emotion that produces a diseased Heat. It is precisely this depth of meaning inherent in the Oriental medical terms and the fact that they spring forth from a completely different view of the human system that make them potentially valuable in the study and treatment of difficult diseases. To place emphasis on the differences in the meaning inherent in what at first glance is an ordinary term, certain words like Heat, or Kidney are capitalized throughout the body of this paper.
Oriental medicine has been dealing with the concept of hidden pathogens for many centuries, calling them deep-lying qi resulting in febrile diseases (fu qi wen bing) or latent pathogen (fu xie). This relates to a situation in which the pathogenic and the correct temporarily maintain a state of equilibrium and so do not manifest obvious symptoms. As a person's correct qi becomes diminished the pathogenic qi accordingly grows and symptoms develop. The movement of this sort of illness is from the internal to the external as opposed to the normal invasion from the outer to more internal aspects of the body. (7) It is my experience with this type of pathogenic invasion that often, relatively little importance should be given to the exact nature and action of the pathogenic factor. Instead, the focus should be on the level where the pathogen resides as a guest in the body and the pathogenic climate created by the invasion. This view gives more attention to the informational exchanges and relationships between the various systems and sub-systems which make up this complex being called the self. As a result, this view becomes more valuable in treating recalcitrant and chronic disease. Instead of focusing on the direct mechanism of the immune system or the genetic makeup of the invading factor in a reductionist, mechanistic way, Oriental medicine, in this case, focuses on the energetic or functional outcome of these activities on the organism itself. This perspective is not sidestepping the "cause" of the illness as it may first appear, but is identifying the pathogenic environment created by the invasion, or the relationship between the pathogenic influence and the host. I believe this approach may be very valuable as related to epidemic type pathogens and emerging viral activity.
Typically the initial invasion of the pathogen produces a quality of Heat or fire pathogen (huo xie) or, more usually, damp heat (shi re). This hot climate, and any succeeding climactic changes, is produced by the invasive pathogenic factor and the body's attempt to fight the invasion. The body, in its attempt to protect, often is the cause of damage to a much greater extent than the injury from the pathogenic invasion itself. This effect is rather obvious in relation to the influenza virus (a member of the Orthomyxoviridae family) that only directly attacks the respiratory tract. It doesn't infect the muscles or intestines. It is the body's immune response that "causes" the myriads of additional symptoms, such as intestinal uneasiness and muscle aching, we normally associate with the flu. (8-10) As a further example, Chronic Fatigue Syndrome is thought to be the result of the fatiguing brought about by the body's overzealous attempt to fight the virus involved causing the immune system and the organism to become chronically fatigued. (8, 11) Even more significantly, the virus often causes no damage while the immune response can be lethal. One example is the Borna virus in rats. It appears the inflammation that causes the fatal brain damage of the Borna virus comes from the body's defense system as opposed to any direct action of the virus. (12)
The Oriental medical focus on the body's disease climate becomes particularly powerful in those cases where there is little or no immune response to observe when looking in a mechanistic manner. However, if observed from the perspective of a relationship of systems and their interactions, more may be seen. The respective functional oscillations of an organic sub-system would be lower in amplitude and the on-going, dynamic relationship with the vicious invasive energy would change. This would eventually become a deficiency condition resulting from the organism functioning less efficiently over time, or a xu (vacuous or hollow) condition that would be readily diagnosable and be described in relation to specific body/mind functions. Oriental medicine is classically much more interested in the functional side of disease than in the symptomatic effects except as they act as a pointer or indicator. The diagnostic techniques used by this system of medicine detect these functional changes within the framework of their own medical terminology and therefore can identify shifts that result from the various stages of the hidden pathogen process that may otherwise go undetected.
Nourishing the "Correct" with Emphasis on the Kidney to Promote the Expulsion of the Pathogen
One qing dynasty scholar and physician is widely quoted within the Oriental medical tradition in relation to this idea. His name is Liu Bao-yi. For example, one protocol described and made popular by Dr. Liu is the concept of dispersing Hidden Evils by nourishing the zheng qi (correct or righteous qi) with emphasis on the Kidneys. (13) Two items in this general statement come to mind immediately:
Nourishing the Correct
At the core of treatment is strengthening and nourishing the body's natural strength and sense of self as it relates to the microbial world (surrounding vicious or pathogenic qi). One of the strongest aspects of Oriental medicine relates to its medical focus on the innate strength and root of the body and its functioning, and the ability to nourish or support this activity. Much attention is given to filling a xu function based on the idea that the healthy body can be more effective fighting disease than even well-directed outside intervention. Indeed, it could be argued that chronic illness by definition is the effect of a diminished body function or functions over a long period.
It seems that few resources in modern virology are being utilized in this direction. Much more attention is placed on the process of infection and the genetics involved, and, accordingly, to the mechanistic genetic level activities that will alter this process. Interventionist techniques are used that allow the genetic engineer/physician to alter the invasive process directly. (14) Liu Bao-yi is advocating filling the vacuous (xu) condition on the assumption that a major factor in the successful invasion of the pathogen in the first place was a relative weakness or exhaustion. This weakness could be related to stress, trauma, increased exposure to environmental toxins, acute disease, or combinations of these and other factors.
The strategy of nourishing the correct has at least two aspects: 1) Maintaining a strong root early in the life of an individual to preclude any invasion of pathogenic influences. This is preventative medicine at the highest level. 2) Strengthen the functional root after the fact. This is based on the idea that if correct qi is strengthened and then maintained, deep-lying qi illness will not arise. A weakness of zheng qi is required in order for symptoms to develop (see above) and for disease to be expelled more easily. In fact this theory holds that out thrusting would be impossible if this nourishing does not occur (see references below to postnatal jing).
Emphasize the "Kidney" Function
Liu Bao-yi also recommends emphasis on the level of the Kidneys (shen), perhaps in both the nourishing process and a dispersing one. Again, the Kidney spoken of here is decidedly not the organ kidney as thought of in Western anatomy and physiology. Important to this topic is that Kidney is used here as a functional term.
The Kidneys store the essence (jing). As described by Ted Kaptchuk, popular author and scholar of Oriental medical theory, the jing rules "...birth, development, and maturation. Although it is undifferentiated material, it is the substance that gives organic life its specific character. It contains the possibility of birth, maturation, decay, and death." (15) What is being called jing here has two sources: prenatal jing and postnatal jing. Prenatal jing "is inherited from the parents. In fact, the fusion of this prenatal jing occurs at conception. Each person's prenatal jing is unique and will determine his or her particular growth pattern." Postnatal jing "is derived from the purified parts of ingested food. The postnatal jing constantly adds vitality to the prenatal jing. Together they comprise what may be called the overall jing of the body." (16)
Two things come to mind in relation to these passages. First, the Kidney level and the jing or essence it stores has a striking similarity to the gene model in modern Western medical understanding. Genes could, in some cases, be described generally using the same words as one would use to describe jing. For example, as quoted above "it is the substance that gives organic life its specific character. It contains the possibility of birth, maturation, decay, and death." Since, as we stated above, much of the work of Liu Bao-yi is related to the location of the pathogenic factor as opposed to its cause, it could be interpreted that he is speaking of the level of genetic functioning using his own medical model and descriptive terms. Dr. Liu is recommending a filling or consolidating of the level of the Kidneys as a first step in dispersing old, hidden evils. This seems to be a reasonable and logical, strategy. A healthy genetic mechanism is more capable of maintaining its own integrity as a system.
Secondly, the description of mixing prenatal jing and postnatal jing would imply that what was called the overall jing (the total integrity of the body's genetic makeup) can be nourished and strengthened by attention to "the purified parts of ingested food" or physical and non-physical nourishment. "The postnatal jing constantly adds vitality to the prenatal jing." (16) This would go against the generally accepted idea that genetic traits are carved in stone and can be changed very little. At least in regard to the basic integrity and strength of the genetic system, Oriental medical philosophy would give us some hope that it can be reinforced with the proper techniques. This protocol speaks of two aspects: 1) the basic strength of the organism is the best cure for disease and that 2) this organic strength can be maintained and even rebuilt to levels of higher integrity.
Mobilize the Yang Within the Yin
Dr. Liu focussed on promoting the yin to expel Heat and directly based this idea on Xu Dan-xi's Watering Yin School. This school's basic principle is to nourish the yin to combat accumulated Heat and Damp Heat. This yin vacuity is thought of as an inherent condition, and as both a physical and a spiritual phenomenon. (17) Liu advocates an additional medical principle which can be linked to the School of Life's Gate of the Song Dynasty. This axiom is stated, "Although one must assist the yin, if one does not mobilize the yang within the yin, the pathogen will move more deeply and not emerge." (13) This again seems to concur with the discoveries of modern virology. Retroviruses, for instance, instill a stagnation or lack of movement to certain aspects of the body's functioning. The normal immune responses do not act on the pathogen in a timely manner. To effectively deal with this problem requires a functional increase in activity or the force of movement (yang) in relation to the body's defense mechanism (wei qi) on a particular pathogenic invasion. Clinical success in this regard has been achieved by nourishing the "energy of grains" or stomach qi (wei qi) . This principle is clearly communicated in the oldest Chinese classics including the Nei Ching and Nan Ching and developed more fully in the Treatise on the Stomach and Spleen (Pi Wei Lun). (18) The Stomach and Spleen are considered the functional center of the human organism, and all disease is considered to be rooted in a weakness of the Earth or Stomach/Spleen qi. The in-depth consideration of this Oriental medical technology is quite large in scope and is the subject of another work in progress. Nourishing the root of the human system may make an essential contribution in our current war with emerging febrile diseases.
Lead Surface-Dispersing Medicinals to the Kidneys to Disperse Deep-lying/Latent qi
This brings us to another of Dr. Liu's basic strategies related to deep-lying qi. Chinese herbal medicine effectively uses lead herbs to take other herbs places they do not usually enter. The strategy is to assist normally surface-dispersing (and often cooling) elements to the Kidney (genetic?) level where they can have an out thrusting effect on the deep-lying evils.
Besides sounding strikingly similar to using viral carriers to the genetic workings of diseased cells being researched today (14), this idea makes use of a potentially valuable technology indigenous to Oriental medicine: Herbs used in proper synthesis will bring about effects more complete and harmonious than the effects of a single herb alone. It has been clinically observed in my practice and in those of many others that relief of the aforementioned climates of disease through balanced herbal formulas has a profound effect on difficult diseases. The use of surface cooling herbs based on various time-tested combinations appears superior for long-term sinus and bronchial infections, for example, than either antihistamines or a protracted antibiotic series. If these combinations can potentially affect the human organism in ways not duplicated by Western pharmaceuticals, as indicated by clinical observation and empirical evidence, it is possible that this synergistic herbal effect may be useful at the Kidney/genetic level as well. Based on the possible value of this approach, more definitive double-blind laboratory study may be indicated here.
Herbal Combinations Related to Hidden Pathogens
Several herbal combinations are stressed in Liu Bao-yi's writings and notes. Many of the principles described in this paper are related to the formulae he mentions. This section briefly and generally discusses some of the combinations thought to be of value in dispersing hidden pathogens. Many of these formulae have been shown clinically to have positive benefit.
Radix Angelicae Sinensis (tang kuei/dang gui) is often combined with Radix Paeoniae Lactiflorae (peony/bai shao) to nourish the Blood (xue). These two herbs are often combined with more traditional yang herbs to work with inherent stagnation. As noted above, while nourishing yin, aspects of yang should be promoted in the treatment and removal of fu qi or fu xie. There are two general ways to promote movement clinically. One is to push it forcefully (yang), while the other is to allow movement to occur naturally by softening and removing obstructions (yin). Since Liu is promoting yin in general to cool and disperse accumulated Heat pathogen, utilizing a "yang within yin" approach to support yang would suit his herbal style. The combination of the herbs above tend to promote this latter type of movement.
Semen Soja Preparatum (soja/dou chi) was used to open the pathways of the tai yang (Bladder and Small Intestine) and enter the Kidneys. Indications are for latent pathogens in the shao yin (Heart and Kidney). This herbal principle utilizes the relationship between the more internal energetics of the body, commonly anglicized as organ or viscera (wu zang or liu zang) and external bowels (liu fu). These entities have also been called functional orbs to indicate that they are functional, as opposed to physical in nature. (19) As the pathogen resides at an internal level, opening these pathways provides a way to move from the hidden state and be dispersed naturally.
Along these lines, Liu also often combined Herba Menthae (mentha/bo he) and Radix Rehmanniae Glutinosae (rehmannia/sheng di) with the dou chi to nourish the yin and promote the expulsion of pathogens. The sheng di huang has several actions. It is a standard herbal to deal with warm febrile diseases in which Heat has entered the nutritive (constructive) level and also strongly nourishes the yin, again in accord with Liu?s basic strategic approach. Also, the sheng di is effective in leading the cooling and Heat dispelling herbs to the Kidney level. Most likely the mentha is chosen for its ability to disperse Wind Heat. I have found that Scutellariae Baicalensis (scute/huang qin) can be combined with these herbs and will increase the general efficacy, especially when dealing with more chronic/Damp Heat pathogens internally. This seems to follow Liu Bao-yi's primary prescription for expelling latent pathogens (Huang qin Tang) (13) which includes huang qin, along with bai shao, Radix Glycyrrhizae Uralensis (licorice/gan cao), and Fructus Zizyphi Jujube (jujube/da zao). I have found that da zao is a highly capable member in this herbal family for its effect in nourishing the Spleen in accord with Li Dong-yuan?s strategy of warming to chase Damp Heat (18) and nourishing the nutritive or construction (ying) qi while simultaneously calming the Spirit (shen). (20) This conception as set forth in the Pi Wei Lun is of major importance in dealing with recalcitrant and chronic illness and may be a useful principle in treating hidden pathogens.
The following history utilizes Oriental herbal techniques to disperse hidden pathogens. The primary techniques used in this example involve leading dispersing and cooling herbs to a more internal region where Heat resides while nourishing a xu or vacuous condition.
1/7/92 Sarah, professional woman, 32 years old. She is suffering from constant fatigue and malaise. Sarah has received a medical diagnosis of environmental sensitivities and chronic fatigue syndrome. Chronic adult acne disorder was present. A long term antibiotic series had little effect on this condition. Sarah believes that the fatigue condition was started or at least exacerbated by environmental poisoning after beginning to work in a toxic environment. Fatigue is accompanied by itchy watering eyes, shortness of breath, and some feelings of nausea during acute episodes. Symptoms were exacerbated during her menstrual cycle.
Comments: Long-term hidden pathogens were suspected with a suppression and weakness of Spleen and Stomach qi contributing. This condition appeared to pre-date Sarah's suspected environmental poisoning, though the mentioned incident could have weakened the zheng qi enough to bring forth the fu qi. Pulse diagnosis and other signs pointed to a vacuity of the Spleen and Stomach being unable to engender Lungs with a hidden deep-lying Heat evil as central to Sarah's disease pattern (bian zheng). Sheng di with the addition of some companion herbs was utilized to lead the cooling and dispersive herbs to deep levels and to nourish yin. Chai wu was also utilized as a wind agent to, in the terminology of Li Dong-yuan, "upbear and perfuse yang qi." (25) The ingredients of liu jun zi tang (Six Gentlemen Decoction) were combined with some variation to support the Stomach and Spleen. As discussed above, a level of stagnation is apparent in fu qi or fu xie illness and it is the experience of the author that the addition of sha ren and mu xiang act as assistant ingredients which move qi and remove intruding qi and, as a result, generally improve the effect.
The initial formula: Radix Bupleuri (chai hu) 7g; Radix Scutellariae Baicalensis (huang qin) 5g; Rhizoma Pinelliae Ternatae (ban xia) 5g; Rhizoma Zingiberis Officinalis Recens (sheng chang) 3g; Radix Ginseng (ren shen) 8g; Honey-fried Radix Glycyrrhizae Uralensis (zhi gan cao) 3g; Fructus Zizyphi Jujubae (da zao) 3g; Radix Rehmanniae Glutinosae (sheng di) 3g; Fructus Corni Officinalis (shan zhu yu) 1.5g; Radix Dioscoreae Oppositae (shan yao) 1.5g; Sclerotium Poriae Cocos (fu ling) 3g; Cortex Moutan Radicis (mu dan pi) 1.5g; Rhizoma Alismatis Orientalis (ze xie) 1.5g; Rhizoma Atractylodis Macrophalae (bai zhu) 2g; Pericarpium Citri Reticulatae (chen pi) 1g; Fructus Amomi (sha ren) 2g; Radix Aucklandiae Lappae (mu xiang) 2g.
Over the next several months improvement was gradual but constant. Energy increased to normal levels and her sensitivity to various toxins were greatly reduced. On 2/27/92 Fructus Lycii (gou qi zi) and White Flos Chrysanthemi Morifolii (bai ju hua) were added to the formula. Both herbals being sweet and cold allow them to reinforce the dispersive effect of fu qi and address the symptoms of eye sensitivity. The general effect of the formula was improved with this addition. As her healing process continued, the ban xia was removed and huang qin reduced. Other adjustments to the formula were made as diagnostic signs called for them. In general, Wind herbs and cooling herbs were reduced over time and Kidney-supporting herbs were increased slightly as needed. Sarah has since moved to the Western slope of Colorado with no major allergic episodes. She was last seen for follow-up 9/1/95.
This paper summarizes information being gathered in Western virological and immunological research, significant questions related to their inquiries, and, finally, relationships between these questions, diseases, and protocols that are extant in Oriental medicine for many hundreds of years. Technologies derived from Chinese medical theory will hopefully prove to be quite useful in answering key health questions facing us at this time. It is my hope that this brief discussion may act as a stimulus for other medical professionals to explore this area of health care.
Thanks to Charles Chace for sharing his personal notes on Damp Heat and Epidemics as well as his translations of the articles Liu Bao Yi's Experience in the Discrimination and Treatment of Latent Qi Warm Illness and An Introductory Discussion of the Theory of Deep-Lying Qi from the original Chinese medical journals.
Copyright 1995 by Donn Hayes