Saturday, January 26, 2013


Magnesium stearate is a widely used excipient in drugs and herbal remedies.  It has been used for many years without any safety concern. However, I have been investigating how magnesium stearate is made and I have come to the conclusion that it is better to avoid it.  As a result, the Three Treasures and Women’s Treasure remedies are now made without magnesium stearate and the only excipients used in their manufacture are potato starch and cellulose.

Magnesium stearate, also called octadecanoic acid, is a white powder which becomes solid at room temperature. It has the chemical formula Mg(C18H35O2)2. It is a magnesium salt of stearic acid.  It is a salt containing two equivalents of stearate (the anion of stearic acid) and one magnesium cation (Mg2+).

Magnesium stearate is widely used as a diluent in the manufacture of medical tablets, capsules and powders. The substance has lubricating properties, preventing ingredients from sticking to manufacturing equipment during the compression of powders into solid tablets; magnesium stearate is the most commonly used lubricant for tablets and it is widely used in the manufacture of herbal remedies and other supplement.  Magnesium stearate is also used to bind sugar in hard candies like mints, and is a common ingredient in baby formulas.

Manufacture of Magnesium Stearate
Magnesium stearate is usually manufactured from vegetable oils.  Stearates can be produced by hydrogenation although some supplement manufacturers claim that they use magnesium stearate derived from non-hydrogenated, non-GM palm oil.

The commonly-used sources of magnesium stearate are palm oil and cottonseed oil after hydrogenation. Hydrogenated oils are a common source of magnesium stearate in tablets. Hydrogenation creates a hydrogenated partially saturated fat.

Hydrogenation - to treat with hydrogen - is a chemical reaction between molecular hydrogen (H2) and another compound or element, usually in the presence of a catalyst. The process is commonly employed to reduce or saturate organic compounds. Hydrogenation typically constitutes the addition of pairs of hydrogen atoms to a molecule, generally an alkene. Hydrogenation of unsaturated fats produces saturated fats and, in some cases, trans fats.

Production of hydrogenated fats increased steadily until the 1960s, as processed vegetable fats replaced animal fats in the US and other western countries. At first, the argument was a financial one due to lower costs; advocates also said that the unsaturated trans fats of margarine were healthier than the saturated fats of butter. This view has now been completely reversed.

Trans fat is the common name for unsaturated fat with trans-isomer (E-isomer) fatty acid(s). Because the term refers to the configuration of a double carbon-carbon bond, trans fats are sometimes monounsaturated or polyunsaturated, but never saturated. Trans fats do exist in nature but also occur during the processing of polyunsaturated fatty acids in food production.

The consumption of trans fats increases the risk of coronary heart disease by raising levels of LDL cholesterol (so-called "bad cholesterol") and lowering levels of HDL cholesterol (so-called "good cholesterol"). There is an ongoing debate about a possible differentiation between trans fats of natural origin and trans fats of vegetable origin but so far no scientific consensus has been found.

The National Academy of Sciences (NAS) advises the United States and Canadian governments on nutritional science for use in public policy and product labeling programs. Their 2002 "Dietary Reference Intakes for Energy, Carbohydrate, Fiber, Fat, Fatty Acids, Cholesterol, Protein, and Amino Acids" contains their findings and recommendations regarding consumption of trans fat.

The NAS reached the conclusion that "trans fatty acids [whether of animal or plant origin] are not essential and provide no known benefit to human health". They also concluded that, while both saturated and trans fats increase levels of LDL cholesterol (so-called bad cholesterol), trans fats also lower levels of HDL cholesterol (good cholesterol); thus increasing the risk of coronary heart disease. Because of these facts and concerns, the NAS has concluded there is no safe level of trans fat consumption.

In 1979, the FDA's Subcommittee on GRAS (generally recognized as safe) Substances (SCOGS) reported, "There is no evidence in the available information on ... magnesium stearate ... that demonstrates, or suggests reasonable grounds to suspect, a hazard to the public when they are used at levels that are now current and in the manner now practiced, or which might reasonably be expected in the future."

However, some research has shown that stearic acid suppresses T cells—the natural killer cells—which are a key component of the immune system. According to that study, stearic acid causes the collapse of cell membrane integrity—an effect that was found to be time- and dose-dependent—which, ultimately, can destroy cell function.


Another issue that has been raised in relation to magnesium stearate is the fact that the stearate is commonly sourced from hydrogenated forms of cottonseed oil. This crop is oftentimes genetically engineered, but even when it is not, cottonseed oil tends to have high levels of pesticide residues.

Other contamination can also occur during the manufacturing process of the magnesium stearate. According to a December 2011 report by the World Health Organization (WHO), several batches of magnesium stearate by a particular manufacturer were found to contain various levels of harmful contaminants such as calcium hydroxide, Bisphenol-A and Irganox 1010.

During the March 2010 session of the Codex Committee on Food Additives (CCFA), it was recommended that "magnesium salts of fatty acids" (ie magnesium stearate) be deleted from the Codex, as it has no known use in food. The following year, at the March 2011 CCFA session, the International Alliance of Dietary Supplement Associations (IADSA) submitted a request to reinstate magnesium stearate as a food additive. It was subsequently reinstated under INS number 470(iii).


However, it must be said that there are many voices in defence of magnesium stearate.  They affirm that stearic acid is unique among all saturated fatty acids because it does not raise LDL cholesterol levels. They say that 10% - 12% of cocoa is fatty acids of stearic acid, one of the richest sources of stearic acid in the food supply.  They say it is easy to get 5 grams of stearic acid (5,000 mg) by eating a bar of chocolate. By comparison, a dietary supplement capsule product typically contains between 1% - 2% stearic acid or 10 mg - 20 mg of stearic acid per capsule. 


Legislation and regulation
In Canada, Health Canada has required that food labels list the amount of trans fat in the nutrition facts section for most foods. Products with less than 0.2 grams of trans fat per serving may be labeled as free of trans fats.  In June 2007, the federal government announced its intention to regulate trans fats to the June 2006 standard unless the food industry voluntarily complied with these limits within two years.  Effective September 30, 2009, British Columbia became the first province in Canada to mandate the June 2006 recommendation in provincially regulated food services establishments.

United Kingdom
In January 2007, the British Retail Consortium announced that major UK retailers intended to cease adding trans fatty acids to their own products by the end of 2007.  On 13 December 2007, the Food Standards Agency issued news releases stating that voluntary measures to reduce trans fats in food had already resulted in safe levels of consumer intake.  Rejecting an outright ban, the Health Secretary Andrew Lansley launched on 15 March 2012 a voluntary pledge to remove artificial trans fats by the end of the year.

On July 11, 2003, the Food and Drug Administration (FDA) issued a regulation requiring manufacturers to list trans fat on the Nutrition Facts panel of foods and some dietary supplements. The new labeling rule became mandatory across the board, even for companies that petitioned for extensions, on January 1, 2008. However, unlike in many other countries, trans fat levels of less than 0.5 grams per serving can be listed as 0 grams trans fat on the food label.

The state of California and some US cities are acting to reduce consumption of trans fats. In May 2005, Tiburon, California, became the first American city wherein all restaurants voluntarily cook with trans fat-free oils.

The following countries have implemented a total ban on trans fats: Austria, Denmark, Iceland, Sweden, Switzerland.

Three Treasures, Women’s Treasure and Little Treasures tablets
Given the doubts about the safety of magnesium stearate, itself a partially hydrogenated oil,  the Three Treasures and Women’s Treasure remedies are now made without magnesium stearate and the only excipients used in their manufacture are potato starch and cellulose.  The Little Treasures granules are also free of magnesium stearate.

Friday, January 11, 2013


Autoimmune diseases comprise a large number of diseases (more than 200) which are very different from one another.  The most common ones that we will see in the clinic are:

-          Multiple sclerosis
-          Systemic lupus erithematosus (SLE)
-          Rheumatoid arthritis
-          Sjogren’s Syndrome
-          Hashimoto Thyroiditis
-          Graves’ Disease
-          Crohn’s Disease

      Chinese medicine does not have a single explanation of the autoimmune pathology as obviously ancient Chinese medicine could not have such a view of the immune system.  One can of course use a Chinese identification of patterns for each of these diseases and treat them successfully, but that does not really explain the autoimmune pathology or whether there is a common thread in the treatment of these diseases.  For example, we can treat Hashimoto Thyroiditis successfully without any reference to it being an autoimmune disease. However, is there a single, underlying pathology in all autoimmune diseases and a common thread in the their treatment? 

      From a Chinese medicine perspective, it is clear to me that we need to treat each autoimmune disease individually according to its pathology, aetiology, patterns irrespective of the fact that is an autoimmune disease. However, should we go a step further? Is there an underlying common treatment to all autoimmune diseases?  The present article will endeavour to answer these questions. 

An autoimmune disorder is a condition that occurs when the immune system mistakenly attacks and destroys healthy body tissue perceiving it to be “non-self”. There are more than 80 different types of autoimmune disorders.

  Normally the immune system’s white blood cells help protect the body from antigens such as bacteria, viruses, toxins, cancer cells, and blood or tissues from another person or species. The immune system produces antibodies that destroy these harmful substances.

In patients with an autoimmune disorder, the immune system perceives the body’s own tissues as antigens and attacks them. The result is an immune response that destroys normal body tissues. This response is a hypersensitivity reaction similar to the response in allergic conditions.  In allergies, the immune system reacts to an outside substance that it normally would ignore. With autoimmune disorders, the immune system reacts to normal body tissues that it would normally ignore.

What causes the immune system to no longer tell the difference between healthy body tissues and antigens is unknown. One theory is that some microorganisms (such as bacteria or viruses) or drugs may trigger some of these changes, especially in people who have genes that make them more likely to get autoimmune disorders.  The possibility that microorganisms might trigger the pathology of auto-immunity is interesting because I believe that Latent Heat is often at the root of autoimmune diseases. Moreover, in my view, immunizations have a lot to do with the development of Latent Heat.  

An autoimmune disorder may result in:
- The destruction of one or more types of body tissue
- Abnormal growth of an organ
- Changes in organ function
- An autoimmune disorder may affect one or more organ or tissue types.

Organs and tissues commonly affected by autoimmune disorders include:
- Blood vessels
- Connective tissues
- Endocrine glands such as the thyroid or pancreas
- Joints
- Muscles
- Red blood cells
- Skin
  A person may have more than one autoimmune disorder at the same time.

Symptoms of an autoimmune disease vary enormously based on the disease and location of the abnormal immune response. Symptoms that often occur with autoimmune diseases include:
General ill-feeling (malaise)
From a Chinese perspective these three symptoms could be symptoms of Yin Fire or Latent Heat.
Before discussing the possible interpretation of autoimmune diseases from the Chinese perspective, I would like to discuss the Chinese medicine correspondent of the immune system or, to put it differently, what parts of Chinese Vital Substances and functions influence the immune system.

Wei Qi
Ying Qi
Kidney (Yin and Yang)
Bone marrow
Yuan Qi
Stomach and Spleen

It would be easy to identify the function of the immune system as a Yang function (protection, immune cells constantly moving and hunting for antigens) but it would be wrong. The whole humoral part of the immune system relies on Blood and Yin.

Wei Qi
It is a very common misconception to attribute the immune response to Wei Qi which is natural since it is indeed the “protective” or “defensive” Qi that protects from exterior pathogenic factors. The following is the Chinese ideogram for "Wei".

The inside part is phonetic (wei) while the two outer parts together are xing, i.e. to move.  Separately, they are the left and the right footprint and some say they suggest two guards patrolling back to back, hence Wei Qi being defensive Qi


Left foot print

Right foot print

     These two parts together form the character xing  which means "to move" (and it also the character for "Element" as in the "5 Elements".  The modern, simplified character for "wei" 卫 does not mean anything.

  Chapter 18 of the Ling Shu says: “Ying Qi comes from the Middle Burner; Wei Qi comes from the Lower Burner.” This may come as a surprise to some as we are used to think of the Wei Qi being associated with the Lungs and therefore the Upper Burner, which it is. However, it is said that the Wei Qi comes from the Lower Burner because it is associated with Kidney-Yang.  Of course, it is also true that the Wei Qi is diffused in the Upper Burner by the Lungs, but its origin is in the Lower Burner. 

  Zhang Yuan Su (ca. 1151-1234) in the Yi Yuan  “Origin of Medicine” says very clearly that the Wei Qi comes from the Lower Burner and the context can leave no doubt because he lists the three Burners, from Upper to Middle to Lower and therefore the third one (for the Wei Qi) could not but be the Lower Burner.

  He says: “Zong Qi accumulates in the Upper Burner; Ying Qi comes out in the Middle Burner; Wei Qi comes out in the Lower Burner. Ying Qi follows the Zong Qi in the channels [mai]; the Wei Qi cannot follow the Zong Qi and cannot enter the channels. It therefore stays outside the channels, penetrating the space between the skin and muscles in the head, eyes, hands and feet.”

     He also says: “Ying Qi is clear, Wei Qi turbid; Ying moves in the channels, Wei moves outside the channels. The Upper Burner is like a mist; the Middle Burner like a cauldron; the Lower Burner like a ditch.  Wei Qi depends on the Yang part of the Yin of the Lower Burner, it rises to the other two Burners [because it is Yang], but it comes from the Lower Burner.”

  Ying Qi is Yin, Wei Qi is Yang. We are used to think of Ying Qi as the one corresponding to food, nutrition and that is why it is called “Nutritive Qi”. However,  Wei Qi is also related to food and nutrition. In fact the Su Wen says: “Wei Qi is the rough [han] Qi of water and grains.” The Su Wen uses the word “fierce, ferocious” [han 悍] that I translate as “rough”.

The Ying Qi is also connected to “water and grains”: “Ying Qi is the essence [jing Qi] of water and grains which enters the channels [mai].”

  Although stemming from the Lower Burner, Wei Qi influences the Upper Burner, the Lungs, the Exterior, the Cou Li space, the pores and sweating.

Wu Qian  says in the The Golden Mirror of Medicine (Yi Zong Jin Jian 1746): “Both Ying and Wei Qi derive from Gu Qi. The clear part of Qi forms Ying Qi, the turbid part forms Wei Qi. The Qi of Wei Qi is “rough”[“fierce”, “ferocious”]; the Blood of Ying Qi is an essence. In terms of location, we talk of Qi and Blood; in terms of movement, they are Wei and Ying. Ying Qi moves in the vessels [mai] and is Yin; Wei Qi moves outside the vessels and is Yang. The movement of Ying and Wei relies on the Pre-Natal Qi of the Kidneys.”

     He also says: “There are three Qi in the body: the Wei Qi exits in the Upper Burner and the Ying Qi in the Middle Burner: these are two Qi. These two Qi coalesce in Heart and Lungs to form the Zong Qi.  Ying Qi is in the vessels and is close to Blood: Wei Qi is outside the vessels and is close to fluids. As Ying Qi is close to Blood, it is affected by Blood stasis: as Wei Qi is close to fluids, it is affected by fluid retention.  To treat Blood, one must move and transform Ying Qi; to treat fluids, one must warm and move Wei Qi.”

  Please note that the statement here that the Wei Qi exits in the Upper Burner is not in contradiction with the earlier one (Zhang Yuan Su) that stated that the Wei Qi comes from the Lower Burner.  Wei Qi originates from the Lower Burner but it exits in the Upper Burner where it is controlled by the diffusing of Lung-Qi.

Wei Qi and Lungs
Wei Qi goes to the Upper Burner and the Lungs “diffuses” it like an aerosol spray to the Upper Burner, the skin and the Cou Li space.  Although we stress a lot the descending of Lung-Qi, the diffusing of Lung-Qi [xuan 宣] has an ascending movement.

Acupuncture: LU-7 Lieque, L.I.-4 Hegu, BL-12 Fengmen.

Wei Qi and Exterior
The “Exterior” is the space of the body that is outside the Zangfu and also outside the Main channels.  It is the space where the Luo channels are. The Luo channels are the channels through which external pathogenic factors penetrate the body and the Wei Qi flows in the Luo channels performing its function of protection from external pathogenic factors.

Acupuncture: LU-7 Lieque, L.I.-4 Hegu, BL-13 Feishu.

Wei Qi and Cou Li Space
The term Cou Li is difficult to translate. Cou means “cavity” while Li means “texture” as in the texture or grain of wood. Although Cou refers to any cavity of the body, some large, some small, the term Cou Li is usually used (although not strictly correct) to indicate the space between the skin and muscles.

  This is not literally and anatomically the space between skin and muscles but it must be interpreted energetically as a superficial space of the body, actually, apart from the skin itself, the most superficial.  This is the space where the smaller and more superficial Luo channels flow [sun mai and fu mai].

     The Cou Li 腠 理  space is the space between skin and muscles. The Luo channels are more superficial than the Main channels and they run in all directions, horizontally rather than vertically. Amongst other spaces, they fill the Cou Li space, i.e. the space between skin and muscles.

Acupuncture: LU-7 Lieque, L.I.-4 Hegu, BL-13 Feishu.

Wei Qi, pores and sweating
The Wei Qi influences the pores on the skin and therefore sweating. Sweat is in the Cou Li space. Th is space is regulated by the balance of Ying and Wei in it.  When these are regulated, sweating is normal, i.e. normal sweating on exercise or when it is hot.

  The Cou Li space may be “too tight” which means the pores are closed and the person does not sweat on exercise or when it is hot. It also means that if this person gets an invasion of Wind, they will not sweat and one must use Ma Huang Tang Ephedra Decoction.

The Cou Li space may also be “too relaxed” in which case the pores are open and the person sweats spontaneously. It also means that if they get an invasion of Wind, there will be slight sweating, which is actually due to a deficiency of Ying Qi in the Cou Li space; one uses Gui Zhi Tang Ramulus Cinnamomi Decoction to regulate Ying and Wei in the Cou Li space.

Acupuncture: LU-7 Lieque, L.I.-4 Hegu, BL-13 Feishu.

Ying Qi
Ying Qi, the “nutritive” Qi is inseparable from Wei Qi. Although the two are always contrasted with each other, they are actually closely connected.  The Wei Qi could not exist without Ying Qi.
The Ying Qi is called “Nutritive” because it comes from “water and grains”: “Ying Qi is the essence [jing Qi] of water and grains which enters the channels [mai].”  However, Wei Qi also derives from water and grains except that its Qi is more “coarse”: “Wei Qi is the rough [han] Qi of water and grains.”
Ying Qi also keeps the Cou Li space “consolidated”; if the Cou Li space is not "consolidated" it is prone to invasions of Wind. If the Ying Qi is weak in this space, there is slight sweating during an invasion of Wind.

Acupuncture: ST-36 Zusanli, Ren-12 Zhongwan, BL-20 Pishu, BL-21 Weishu.

The Su Wen relates resistance to disease to Blood in many passages. “When the Qi of Blood is not harmonized, 100 diseases can arise.”  Blood influences resistance to disease also due to its relationship with Ying Qi.
The point BL-11 Dashu is the point of the Upper Sea of Blood of the Chong Mai. I use it with direct moxa, also to stimulate resistance to disease and to external pathogenic factors.

Acupuncture: BL-11 Dashu, BL-17 Geshu (with direct moxa), Ren-4 Guanyuan, KI-3 Taixi, SP-6 Sanyinjiao, ST-36 Zusanli.

The Kidneys play a big role in the immune system and resistance to disease.  First of all, Kidney-Yang is the root of the Wei Qi which stems from the Lower Burner. Resistance to disease from a Chinese perspective depends on Qi and Qi is movement and movement is Yang. Kidney-Yang is the root of the Yang of the whole body.

  If we think of the B cells, T cells, macrophages, neutrophils etc, and how they move in the blood stream and the cells we get an idea of the need for Yang, i.e. movement (although the medium where it all happens is blood which is Yin). If we consider that the B cells produce highly specific antibodies at a rate of as many as 2000 molecules per second for four to five days, we get a very good idea of why it is a Yang process.
  The Kidneys play a role in the immune system also due to Yuan Qi and bone marrow which will be discussed separately.

Acupuncture: BL-23 Shenshu, Ren-4 Guanyuan.

Bone Marrow
Bone marrow depends on the Kidneys, more Yin than Yang. Jing is the organic foundation for the production of Marrow.  “Marrow” (sui 髓) does not correspond to bone marrow of Western Medicine.  “Marrow” in Chinese Medicine is a substance which is the common matrix of bones, bone marrow, brain and spinal cord.

  The Ling Shu says in chapter 36: “The five flavours and fluids amalgamate to form Fat: this irrigates the cavities inside the bones, it tonifies the Brain and the Marrow and flows to the thighs”.

          This statement is interesting in its reference to a form of “fat” formed by food and drink which goes to form bone-marrow and the spinal cord and brain.  Therefore the bone-marrow, spinal cord and brain (all manifestations of “Marrow”) are a dense, material type of Qi which the Ling Shu calls “Fat”.  Another interesting aspect of the above statement is the reference to the Marrow flowing to the thighs: therefore the ancient Chinese seem to have grasped the fact that long bones contain bone-marrow.

The Marrow is also the basis for the formation of bone marrow which nourishes the bones. Thus the Kidneys also govern the bone marrow and bones.  The “Simple Questions” in chapter 17 says: “The bones are the Fu [organ] of the Marrow”.2

The Kidneys store Jing which produces marrow: this, in turn, generates bone marrow which contributes to making Blood. A doctor of the Qing dynasty, Zhang Lu, in his book Medical Transmission of the Zhang Family (1695), says: ‘If Qi is not exhausted, it returns essences to the Kidneys to be transformed into Jing; if Jing is not depleted, it returns to the Liver to be transformed into Blood.’3

It seems remarkable that the Chinese account of the blood-forming function of bone marrow, so similar to that given by Western physiology, was formulated during the Qing dynasty before the introduction of Western medicine into China. Lin Pei Qin, a doctor of the Qing dynasty, formulated the theory that ‘Liver and Kidneys have the same source’ and that Blood is transformed from Kidney Jing.

The connection between bone marrow and Blood is a primordial understanding of the role of bone marrow in the immune system since both B cells and T cells derive from bone marrow.

Acupuncture: BL-11 Dashu, G.B.-39 Xuanzhong, BL-17 Geshu, BL-23 Shenshu.

Yuan Qi
The Yuan Qi emerges from between the Kidneys. Chapter 66 of the Nan Jing is one of the earliest descriptions of the Yuan Qi.  It says: “The Yuan Qi is the Motive Force [Dong Qi] situated between the two kidneys, it is life-giving and it is the root of the 12 channels.”4

Yuan Qi can be seen as the dynamic motive force that arouses and moves the functional activity of all the organs. It does so because, like Jing, it is the foundation of vitality and stamina. As a form of Qi, it circulates all over the body, in the channels. It could be said to be the link between Jing, which is more fluid-like and related to slow, long-term cycles and changes, and the day-to-day Qi, which is Qi-like and is related to short-term cycles and changes.

Yuan Qi also facilitates the transformation of Gu Qi into Blood in the Heart. This is another way in which the Kidneys participate in the production of Blood.

Chapter 8 of the Nan Jing: "Sometimes the Cun Kou is normal and yet the patient dies.  Why is that? The pulses of the 12 channels all originate from the Yuan Qi. This Yuan Qi is the root of the 12 channels, it is the Motive Force (Dong Qi 动 气) between the Kidneys, the root of the 5 Zang and 6 Fu and of the 12 channels, the gate of breathing and the origin of the Triple Burner.  It is the spirit that guards against pathogenic factors (or evil influences). Such Qi is the root of humankind; if the root is cut stalks and leaves wither. When the Cun Kou is normal but the patient dies, it means that the Yuan Qi has been cut off internally."

This chapter establishes some very important principles.  First, it talks about the Yuan Qi 原 气: this is essentially the meaning of the expression “Sheng Qi Zhi Yuan” which can be translated as the “Origin of Life’s Qi” or “Origin that generates Qi”.  It says that Yuan Qi is between the Kidneys (like the Ming Men) and that it is the root of the 12 channels, the Triple Burner and the 5 Zang and 6 Fu.

This chapter also establishes the idea that the Yuan Qi (and therefore the Kidneys) is the root of the 5 Zang and 6 Fu, of the 12 channels and of the Triple Burner.

Secondly, this passage establishes the principle that the Yuan Qi (and therefore the Kidneys) play a role in the resistance to pathogenic factors.  Interestingly, it calls the Yuan Qi the Shen that protect from pathogenic factors (or evils).

This is of huge clinical significance because it means that our resistance to pathogenic factors depends not only on the Wei Qi and therefore Lungs but also on the Kidneys and the Yuan Qi (and also Jing due to the extraordinary vessels). In any case, Wei Qi stems from the Lower Burner.

This is of clinical significance not only in resistance to pathogenic factors but also in the pathology of allergic asthma and allergic rhinitis, the root of which is also in the Kidneys, the Jing and the Yuan Qi.

As we shall see, a deficiency of the Kidneys also plays a role in the formation of Latent Heat and a deficiency of Yuan Qi plays a role in the formation of Yin Fire which are often at the base of auto-immune disorders.

Chapter 66 of the Nan Jing also discusses the Yuan Qi: “Below the umbilicus and between the kidneys there is a Throbbing Qi [Dong Qi 动 气] which constitutes a person’s life [sheng ming 生 命].  This [Throbbing Qi] is the root of the 12 channels, also called Yuan Qi [原 气].  The Triple Burner is the envoy of the Yuan Qi [or it allows the Yuan Qi to separate into its different functions]. It is responsible for the passage of the three types of Qi in the 5 Zang and 6 Fu.

The “three Qi” mentioned here are the Yuan Qi, Ying Qi and Wei Qi of Lower, Middle and Upper Burner respectively. Yuan Qi is part of a triad of types of Qi, all which play a role in resistance to disease in the three Burners: Yuan Qi in the Lower, Ying Qi in the Middle and Wei Qi in the Upper Burner.

Acupuncture: Ren-4 Guanyuan, BL-23 Shenshu, Du-4 Mingmen.

We are used to think of Jing as the precious Essence that we inherit from the parents, that determines our constitution and that resides in the Lower Dan Tian.  When described like that, the Jing sounds like an inert essence but, in reality, Jing circulates in the channels and plays an important role in resistance to disease.

It circulates in the channels through the extraordinary vessels. The influence of the Extraordinary Vessels on the space between skin and muscles implies their important role in protection from pathogenic factors.  As the Extraordinary Vessels circulate the Kidney-Jing, this means that Jing plays a role in many physiological functions and, in particular, in the protection against external pathogenic factors.

A deficiency of Jing plays a role in the formation of Latent Heat and, in my opinion, in the aetiology of allergic diseases such as allergic asthma, allergic rhinitis and atopic eczema and of auto-immune disorders.  Indeed, it is in my opinion the aetiology of atopy itself.

The "Study of the Eight Extraordinary Vessels" by Li Shi Zhen says: "...when the Qi of the channels overflows, it flows into the extraordinary vessels where it is turned into irrigation, warming the organs internally and irrigating the space between skin and muscles externally."
The Qi of the Extraordinary Vessels “irrigates” the space between the skin and muscles where Defensive Qi circulates to prevent invasion of pathogenic factors.

Because all the Extraordinary Vessels derive directly or indirectly from the Kidneys, they play an important role in the defence against exterior pathogenic factors.

- Du Mai: SI-3 Houxi with BL-62 Shenmai, BL-23 Shenshu, Du-4 Mingmen, Du-14 Dazhui.
- Ren Mai: LU-7 Lieque with KI-6 Zhaohai, Ren-4 Guanyuan.

Stomach and Spleen
Finally, the Stomach and Spleen also play a role in the resistance to disease.  This is quite obvious since they are the origin of nutrition and of Gu Qi which is the basis for both Ying and Wei Qi.
     The Stomach and Spleen play a particularly important role in the immune system of children. Dr Shen used to say that there are only two aetiological factors in children: external Wind and nutrition (Stomach and Spleen).  He then added that, the younger the child, the more there is only one aetiological factor and that is the Stomach and Spleen because they determine resistance to external pathogenic factors.

Acupuncture: Ren-12 Zhongwan, ST-36 Zusanli, BL-20 Pishu, BL-21 Weishu.

The 6 Stages were developed by Zhang Zhong Jing in his book "A Discussion of Diseases from Cold Injury" (Shang Han Lun, ca. AD 220) while the 4 Levels were developed much later by Ye Tian Shi in his book "A Discussion of Warm Diseases" (Wen Bing Lun, 1742).

     The patterns of both of these theories describe the progression of fevers from external invasions of Wind. Although these two theories are often contrasted to each other, they have many points in common as illustrated in the diagram below.  The patterns in this diagram are colour-coded to show the connections between the patterns of the 6 Stages with those of the 4 Levels. In particular, there is a strong connection between the Yang Ming Stage and the Qi Level and many of the prescriptions used by Ye Tian Shi for the Qi Level are the same as those for the Yang Ming Stage in the Shang Han Lun.


     I have been thinking about these ancient patterns and it occurred to me that they could be seen as a picture of the immune system and this idea is illustrated in the diagram below.  For example, if we fall ill with a fever of external origin (we can think of influenza, for example) and, after the initial stage, we develop a higher fever, it indicates that the body is reacting and fighting the pathogenic factor: this is a good state of the immune system and it corresponds to the Qi Level of the 4 Levels or the Yang Ming stage of the 6 Stages.

     Allergy, such as in allergic asthma and allergic rhinitis, represents a hyper-activity of the immune system that is reacting to allergens to which it should not: this could be represented by the Wei Level pattern in the 4 Levels or the Tai Yang Stage in the 6 Stages.

     In chronic fatigue syndrome, the immune system is reacting to a viral infection, but not enough, so that the disease has a chronic course: this corresponds to the Gall-Bladder-Heat pattern of the 4 Levels or the Shao Yang Stage of the 6 Stages.

     If our immune system is greatly debilitated, it may succumb to cancer and this corresponds to the Blood Level of the 4 Levels or the three Yin Stages of the 6 Stages.

     In autoimmune diseases, the immune system has a deep dysfunction that leads it to attack the cells of the body, mistaking them for "other": this often (but not always) corresponds to Latent Heat.

In my view, the presence of an auto-immune dysfunction of the immune system indicates an aetiological factor that is at a deep energetic level and that is different from normal exterior pathogenic factors. It indicates a more insidious form of pathogenic factor. The immune dysfunction also indicates a pathology of the Yin aspects of the immune system, i.e. Blood, bone marrow, Kidneys.

However, auto-immune diseases are so many and so disparate that it is impossible to prescribe a blanket treatment method for them.  For example, the pathology of Hashimoto’s thyroiditis and MS are so different that they really have very little in common.

The only thing they might have in common is the aetiology.  In many, but not all, auto-immune diseases the aetiology is Latent Heat. This is the case especially when there are symptoms of Heat, with lassitude and possibly fever, they have something in common in their pathology.  In other cases of autoimmune diseases, the main pathology may also be Yin Fire. Also, if we know we are dealing with an auto-immune disease, it gives us an important pointer from the point of view of prognosis.

However, there is an interesting common feature of some auto-immune diseases and that is the pulse. I have noticed this especially in MS, RA, Hashimoto's thyroiditis and Crohn’s disease.  The pulse is of the Leather [ge 革] quality, i.e. it is superficial and “stretched” like a drum but empty at the deep level: it feels hard on the outside but empty inside, like a drum.  The Leather pulse indicates severe deficiency of Blood, Essence or Yin. It also indicates Qi floating upwards because it is not rooted by Blood. This would indicate that the root of these autoimmune diseases is a Kidney deficiency.

- No Chinese theory obviously.

- All diseases are very different and must be treated according to their specific pathology and patterns (e.g. 
   MS and Hashimoto’s thyroiditis have nothing in common from Chinese perspective).

- Being auto-immune affects ease (or difficulty) of treatment and prognosis. They are more difficult to treat.

- Compare hyperthyroidism and Graves' Disease: latter has more severe symptoms and will be more
   difficult to treat.

- In late stages of auto-immune diseases, there seems to be a common pulse, i.e. the Leather pulse which is
   superficial but empty at the deep level. The surface is kind of “broad” and feels kind of stretched like a
   drum. This indicates a severe Kidney deficiency.

- Must grasp aetiology, pathology and patterns of the disease ignoring its auto-immune nature. For _example, Sjogren’s Syndrome, Hashimoto thyroiditis, Crohn’s Disease, MS and RA have very little or _nothing in common in terms of pathology.
______Sjogren’s Syndrome: Yin Xu of Stomach and Liver
______Hashimoto's Thyroiditis: Phlegm, Spleen-Qi Xu, Kidney-Yang Xu
______Crohn’s Disease: Damp-Heat in Intestines
______MS: Dampness, Stomach-Spleen Xu, Liver-Kidneys Xu
______RA: Damp-Heat in joints

- Must treat the Kidneys which are the root of the auto-immune process.  This can be Kidney-Yang,
   Kidney-Yin, Jing, Yuan Qi, Minister Fire.

- Must treat inflammation with at least one or two anti-inflammatory herbs.

- Check if there is Latent Heat or Yin Fire and treat them accordingly.

Ba Ji Tian Radix Morindae officinalis
Bai Shao Radix Paeoniae alba
Bai Zhi Radix Angelicae dahuricae
Can Er Zi Fructus Xanthii
Cao Wu  Radix Aconiti Kusnezoffi
Chai Hu Radix Bupleuri
Chi Shao Radix Paeonia rubra
Chuan Xin Lian Herba Andrographis
Da Huang Radix et Rhizoma Rhei
Da Qing Ye Folium Isatidis
Dan Shen Radix Salviae miltiorrhizae
Dang Gui Radix Angelicae sinensis
Dang Shen Radix Codonopsis
Di Yu Radix Sanguisorbae
Du Huo Radix Angelicae pubescentis
Du Zhong Cortex Eucommiae
Fang Feng Radix Saposhnikoviae
Fu Zi Radix Aconiti Lateralis preparata
Hong Hua Flos Carthami
Hei Zhi Ma Semen Sesami nigri
Hu Zhang Rhizoma Polygoni cuspidati
Huai Hua Flos Sophorae
Huang Lian Rhizoma Coptidis
Huang Qi Radix Astragali
Huang Qin Radix Scutellariae
Jiang Huang Rhizoma Curcumae longae
Jie Geng Radix Platycodonis
Jin Qian Cao Herba Lysimachiae
Jin Yin Hua Flos Lonicerae
Jing Jie Herba Schizonepetae
Ku Shen Radix Sophorae flavescentis
Kuan Dong Hua Flos Farfarae
Lei Gong Teng Radix Tripterygii wilfordii
Lian Qiao Fructus Forsythiae
Lu Hui Aloe
Lu Lu Tong Fructus Liquindambaris
Man Jing Zi Fructus Viticis
Mao Dong Qing Radix Ilicis pubescentis
Mu Dan Pi Cortex Moutan
Nu Zhen Zi Fructus Ligustri lucidis
Pi Pa Ye Folium Eriobotryae
Qiang Huo Rhizoma et Radix Notopterygii
Qin Jiao Radix Gentianae macrophyllae
Qin Pi Cortex Fraxini
San Qi  Radix Notoginseng
Shan Dou Gen Radix Sophorae tonkinensis
Sheng Ma Radix Cimicifugae
Tao Ren Semen Persicae
Tian Ma Rhizoma Gastrodiae
Wu Jia Pi Cortex Acanthopanacis
Xi Xian Cao Herba Siegesbeckiae
Xi Xin Herba Asari
Xia Ku Cao Spica Prunella
Xian Mao Rhizoma Curculiginis
Xiang Fu  Rhizoma Cyperi
Xiao Ji  Herba  Cirisii
Xu Chang Qing Radix Cynanchi Paniculati
Xue Jie Sanguis Draconis
Xue Yu Tan  Crinis Carbonisatus
Xun Gu Feng Herba  Aristolochiae Mollissimae
Ye Ju Hua Flos Chysanthemi Indici
Yin Yang Huo Herba Epimedii
Yu Xing Cao  Herba Houttuyniae
Ze Xie Rhizoma Alismatis
Zhi Zi Fructus Gardeniae
Zi Cao Gen Radix Lithospermi

     As one can see, this list is so extensive that practically every formula we use will have some anti-inflammatory herb in it.  I believe it is very important to use some anti-inflammatory herbs in the treatment of autoimmune diseases. I especially use Mu Dan Pi Cortex Moutan.  It is worth also noting that the anti-inflammatory herbs are found in many different categories of herbs, not just those that clear Heat: thus having an anti-inflammatory effect does not necessarily involve clearing Heat from the Chinese perspective.  Indeed, it is very interesting (and somewhat surprising) that even Fu Zi and Cao Wu (extremely hot herbs) are anti-inflammatory.
The following is an online article from Harvard University about the effect of  the Chinese herb Chang Shan Radix Dichroae febrifugae on autoimmune diseases.
     For roughly 2,000 years, Chinese herbalists have treated malaria using a root extract, commonly known as Tu Chang Shan, from a type of hydrangea that grows in Tibet and Nepal. More recent studies suggest that halofuginone, a compound derived from this extract’s bioactive ingredient, could be used to treat many autoimmune disorders as well. Now, researchers from the Harvard School of Dental Medicine have discovered the molecular secrets behind this herbal extract’s power.

It turns out that halofuginone (HF) triggers a stress-response pathway that blocks the development of a harmful class of immune cells, called Th17 cells, which have been implicated in many autoimmune disorders.
“HF prevents the autoimmune response without dampening immunity altogether,” said Malcolm Whitman, a professor of developmental biology at Harvard School of Dental Medicine and senior author on the new study. “This compound could inspire novel therapeutic approaches to a variety of autoimmune disorders.”

  "This study is an exciting example of how solving the molecular mechanism of traditional herbal medicine can lead both to new insights into physiological regulation and to novel approaches to the treatment of disease,” said Tracy Keller, an instructor in Whitman’s lab and the first author on the paper.

This study, which involved an interdisciplinary team of researchers at Harvard-affiliated Massachusetts General Hospital and elsewhere, will be published online Feb. 12 in Nature Chemical Biology.
Prior research had shown that HF reduced scarring in tissue, scleroderma (a tightening of the skin), multiple sclerosis, scar formation, and even cancer progression. “We thought HF must work on a signaling pathway that had many downstream effects,” said Keller.

In 2009, Keller and colleagues reported that HF protects against harmful Th17 immune cells without affecting other beneficial immune cells. Recognized only since 2006, Th17 cells are “bad actors,” implicated in many autoimmune diseases such as inflammatory bowel disease, rheumatoid arthritis, multiple sclerosis, and psoriasis.

The researchers found that minute doses of HF reduced multiple sclerosis in a mouse model. As such, it was one of a new arsenal of drugs that selectively inhibits autoimmune pathology without suppressing the immune system globally.  Further analysis showed that HF was somehow turning on genes involved in a newly discovered pathway called the amino acid response pathway, or AAR.

Scientists have only recently appreciated the role of the nutrient sensing-AAR pathway in immune regulation and metabolic signaling. There is also evidence that it extends life span and delays age-related inflammatory diseases in animal studies on caloric restriction.

AAR lets cells know when they need to preserve resources. For example, when a cell senses a limited supply of amino acids for building proteins, AAR will block signals that promote inflammation because inflamed tissues require lots of protein.

“Think about how during a power outage we conserve what little juice we have left on our devices, foregoing chats in favor of emergency calls,” said Whitman. “Cells use similar logic.”For the current study, the researchers investigated how HF activates the AAR pathway, looking at the most basic process that cells use to translate a gene’s DNA code into the amino acid chain that makes up a protein.

The researchers were able to home in on a single amino acid, called proline, and discovered that HF targeted and inhibited a particular enzyme (tRNA synthetase EPRS) responsible for incorporating proline into proteins that normally contain it. When this occurred, the AAR response kicked in and produced the therapeutic effects of HF treatment.

Providing supplemental proline reversed the effects of HF on Th17 cell differentiation, while adding back other amino acids did not, establishing the specificity of HF for proline incorporation. Added proline also reversed other therapeutic effects of HF, inhibiting its effectiveness against the malaria parasite as well as certain cellular processes linked to tissue scarring. Again, supplementation with other amino acids had no such effect. Such mounting evidence clearly demonstrated that HF acts specifically to restrict proline.

The researchers think that HF treatment mimics cellular proline deprivation, which activates the AAR response and subsequently impacts immune regulation. Researchers do not yet fully understand the role that amino acid limitation plays in disease response or why restricting proline inhibits Th17 cell production.
Nevertheless, “[the] AAR pathway is clearly an interesting drug target, and halofuginone, in addition to its potential therapeutic uses, is a powerful tool for studying the AAR pathway,” said Whitman.

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