STOMACH-YIN DEFICIENCY

STOMACH-YIN DEFICIENCY

Aetiology
The Stomach is a Yang organ but it frequently suffers from Yin deficiency.  Indeed, I would say that Stomach-Yin deficiency is very common in the patients we see.  The cause of Stomach-Yin deficiency is irregular eating habits.  That includes eating late at night, eating in a hurry, eating while working, eating standing up, etc. all very common habits in the patients we see. 

Another less common cause of Stomach-Yin deficiency is eating too drying foods.  The Stomach likes warm but moist foods such as soups, porridge or rice congee.  “Drying” foods includes broiled or baked foods which would include bread. Broiling and baking makes foods dry and causes dryness when eaten in excess.  That dryness can eventually lead to Stomach-Yin deficiency.  Interestingly, there is very little broiling and baking in Chinese cooking and even bread is steamed (man tou) rather than baked.

Diagnosis
How do we know there is Stomach-Yin deficiency?  Primarily from lack of coating on the tongue. The normal tongue coating derives from the Stomach rotting and ripening and it indicates a normal functioning of the Stomach.  When Stomach-Yin is deficient, there is no coating on the tongue.

However, there are some intermediate stages before reaching a full-blown Stomach-Yin deficiency and no coating on the tongue.  The very beginning of Stomach-Yin deficiency will manifest with a coating without root. A coating without root looks likes it is resting on the tongue rather than growing out of the tongue body the same way grass grows out of the soil.

The next stage of Stomach-Yin deficiency is manifested with a tongue that lacks a coating in patches, wherever the patches may be: they may not necessarily be in the Stomach area in the centre of the tongue. 

The tongues below all lack a coating in patches.

Please note that when the tongue lacks a coating but has a normal colour, it indicates Stomach-Yin deficiency without Empty Heat: it is only when the tongue lacks a coating and it is red, that it indicates Empty Heat deriving from Stomach-Yin deficiency.

The tongue below is a good example of a tongue that lacks a coating but is not red.

 The two tongues below are without coating and red, therefore indicating Stomach-Yin deficiency and Empty Heat. The tongue on the right indicates an extreme degree of Empty Heat.

 Another sign of Stomach-Yin deficiency is a Stomach crack (or cracks) on the tongue.  However, Stomach cracks may indicate a constitutional tendency to Stomach-Yin deficiency rather than the actual pathology.  In any case, when I see such cracks I nourish Stomach-Yin.



The tongues below show Stomach cracks.

Treatment
The treatment depends a lot on the tongue: if there is coating but it is either rootless or
in patches, I use Shen Ling Bai Zhu San Ginseng-Poria-Atractylodes Powder.

If the coating is missing entirely, I use Sha Shen Mai Dong Tang
Glehnia-Ophiopogon Decoction.

With acupuncture, the points to nourish Stomach-Yin are very simple: Ren-12 Zhongwan, ST-36 Zusanli and SP-6 Sanyinjiao.

Obviously treatment must include also a change in eating habits.

THE TREATMENT OF MALE PROBLEMS IN CHINESE MEDICINE

While Chinese medicine has a rich tradition in the diagnosis and treatment of gynaecological problems, fewer ancient or modern texts are dedicated to the diagnosis and treatment of men’s problems.  For example, Chinese medicine refers to the “Uterus” in all its classic texts, but no mention is ever made of the prostate. The Du Mai, Ren Mai and Chong Mai are said to arise in the Lower Burner and flow through the uterus: but where do they flow through in men?  The classics do not say.

The present article will discuss the physiology of men’s sexual organs, some aspects of pathology and the treatment of the following conditions:

•    Erectile dysfunction
•    Premature ejaculation
•    Low sperm count
 
Before discussing the treatment of specific conditions, we should look at the channels that affect men’s genital system and how the penis, testis, seminal vesicles and prostate fit in Chinese Medicine.
     
Chapter 65 of the “Spiritual Axis” says: “The Ren and Chong Mai originate from the Lower Dan Tian [literally “Bao”].”1  The actual term used by the “Spiritual Axis” is “Bao” which is often translated as “uterus”.  However, while the term “Zi Bao” refers to the Uterus, the word “Bao” indicates a structure that is common to both men and women: in women, it is the Uterus, in men, it is the “Room of Sperm”.  Both these structures reside in the lower Dan Tian and store Jing and, as the Extraordinary Vessels originate from here, they are closely connected to Jing. 

The “Golden Mirror of Medicine” (Yi Zong Jin Jian, 1742) says: “The Du Mai arises within the lower abdomen, externally in the abdomen, internally in the ‘Bao’ . . . also called Dan Tian in both men and women: in women it is the uterus, in men it is the Room of Sperm.”2

This classic text therefore states clearly that Bao is a structure common to men and women, in the former corresponding to the “Room of Sperm” (or “Room of Jing”) and the latter to the Uterus.  The “Room of Sperm” is in the lower abdomen but we know that the sperm is made in the testicles, seminal vesicles and prostate.  I think it is therefore legitimate to assume that the prostate is a structure that is equivalent to the uterus in women and that therefore the Du Mai, Ren Mai and Chong Mai flow through the prostate.

     
CHANNELS INFLUENCING MEN’S GENITALIA
The genitals are related primarily to the Liver and Kidney channels and to the Ren, Chong and Du Mai.  The Liver Luo channel, loops around the genitalia. While the influence of the Ren Mai on the genitalia is obvious, that of the Du Mai Vessel is often overlooked. 

The “Su Wen” (Chapter 60) describes an anterior branch of the Du Mai Vessel that flows to the external genitalia both in men and women, and to the pubic bone and from here ascends up the abdomen on the same trajectory as the Ren Mai.

The branch of the Du Mai going to the penis in men and vagina in women has clinical significance because it means we can use the Du Mai (rather than the Ren Mai) for genital problems in both men and women. We would want to do that when there is a pronounced Kidney-Yang deficiency.

The pathways of the channels flowing through the genitalia are as follows:

    •A branch of the Du Mai flows down to the genitalia.
    •The Kidney Main, Luo and Muscle channels flow through the genitalia.
    •The Liver Main, Luo, Divergent and Muscle channels wrap around the genitalia.
  
MALE PATHOLOGY
I would like to discuss two pathological conditions of the male genital aasystem i.e. Phlegm and  stasis of Jing.

Male genital manifestations of Phlegm
•    Prostatic hypertrophy
•    Peyronie’s disease
•    Priapism
•    Erectile dysfunction
•    Sweaty genitals
   
Male genital manifestations of stasis of Jing
Although it may seem strange to talk of “stasis” of Jing, it does occur in men and it is basically men’s equivalent of Stasis of Blood in the Uterus in women.

The clinical manifestations of stasis of Jing are:

stabbing pain lumbar region
pain in perineum
hypogastric pain
pain in testis and/or penis
erectile dysfunction
premature ejaculation
priapism
prostatic hypertrophy
premature greying of hair
itching or pain pubic region
abnormal sperm
Peyronie’s disease
Purple tongue
Choppy or Firm pulse
 
THE ROLE OF THE HEART IN THE MALE GENITAL SYSTEM
The menstrual and sexual function in women and the sexual function in men rely on the coordination and harmony between Kidneys and Heart. The Water of the Kidneys and the Fire of the Heart need to nourish each other. While the Kidney-Jing is the origin of sperm in men and menstrual blood/ova in women, the Heart plays an important role in erection and sexual arousal.

In particular, in men, the Heart plays a crucial role in erection, orgasm and ejaculation. Just as the discharge of blood at menstruation and the release of the eggs at ovulation depend on the descending of Heart-Qi, erection and ejaculation also depend on the descending of Heart-Qi. To perform these functions, Heart-Qi descends to communicate with Kidney-Qi.

Kidney-Water needs to ascend towards the Heart and Heart-Fire (the physiological Emperor Fire) needs to descend towards the Kidneys: the coordination between the descending of Heart-Fire and ascending of Kidney-Water ensures a normal menstruation and ovulation in women and normal sexual function in both men and women.

The ascending of the Kidneys and descending of the Heart in the menstrual and sexual sphere is also ensured by the communication between the Du Mai and the Ren Mai: in fact, both these extraordinary vessels originate from the space between the Kidneys, both flow through the Uterus (in men through the prostate) and both flow through the heart.

The Du Mai and Ren Mai form like a closed circuit and may be looked upon as one channel, one Yang, the other Yin. The Du Mai represents the Kidney-Yang and the Ren Mai the Kidney-Yin in the fluctuation of Yin and Yang during the menstrual cycle: the proper communication between Heart and Kidneys and between the Du and Ren Mai ensures a normal menstruation/ovulation and normal sexual function in both men and women.

With regard to sexual function, during sexual excitation the Minister Fire within the Kidneys is aroused and flows up towards the Pericardium and Heart: for this reason the person becomes flushed in the face (the complexion is a manifestation of the Heart) and the heart rate increases during sexual excitation. With orgasm and ejaculation, there is a downward movement of Qi which releases the accumulated Minister Fire downwards: in order for this to occur normally the downward movement of Heart-Qi is crucial.

        A normal sexual desire, arousal, erection and orgasm therefore relies on three main factors:
   
•    The ascending of Kidney-Water and descending of Heart-Fire
•    The communication between Kidneys and Heart
•    The connection between Du and Ren Mai.
   
 If the Minister Fire within the Kidneys is deficient there will be a decreased libido in both men and women and an inability to reach an orgasm in women and impotence in men. If Heart-Qi and Heart-Blood are deficient or not descending to communicate with the Kidneys, there may be impotence or premature ejaculation in men and inability to reach an orgasm in women even in the presence of sexual arousal.

 The “Discussion on Blood” written in 1884 by Tang Zong Hai says: “Fire is Yang and generates Blood which is Yin. On the other hand, Blood nourishes Fire and makes sure that Fire does not flare up, whilst Blood moistens the lower Burner. It is stored in the Liver, it fills the Sea of Blood and the Chong, Ren and Dai Mai, and it warms and nourishes the whole body . . . When Blood moistens the Lower Burner and the Sea of Blood, and Heart-Fire follows it down to the umbilicus, then Blood is flourishing and Fire does not flare excessively, so that men are free of disease and women are fertile.”

From this passage it is apparent that the Heart-Qi and Heart-Blood need to flow downwards to the Lower Burner to interact with Blood and Jing.
   
                                                       ERECTILE DYSFUNCTION
FACTORS AFFECTING ERECTION
•    Du Mai – Kidney-Yang – Minister Fire – Fire of Ming Men
•    Blood – Heart-Blood
•    Chong Mai in four ways:
        - Sea of Blood
        - Post-Natal Qi (at ST-30 Qichong)
        - Pre-Natal Qi (at Ren-1 Huiyin, KI-13 Qixue and Ren-4 Guanyuan)
        - Influences penis through Zong muscles
•    Liver channel (Main, Luo, Muscle and Divergent) wraps around penis
•    Pathogenic factors such as Dampness, Blood stasis, stasis of Jing.
 
KIDNEY-YANG DEFICIENCY
Impotence, lower backache, dizziness, tinnitus, frequent-pale urination, nocturia, feeling cold, cold lower back and knees, Pale tongue, Deep-Weak pulse.

Gui Lu Bu Shen Tang
 Lu Jiao Jiao, Gui Ban Jiao, Gou Qi Zi, Rou Cong Rong, Huang Qi, Shu Di Huang, Yin Yang Huo, Yi Zhi Ren, Ba Ji Tian.

Acupuncture: SI-3 on the left with BL-62 on the right (Du Mai), BL-23, Du-20, Ren-6, Ren-4, Ren-3, KI-3.

 
KIDNEY-YIN DEFICIENCY
Impotence, lower backache, dizziness, tinnitus, scanty-dark urine, night-sweating, insomnia, tongue without coating, Floating-Empty pulse.

Di Long Tang
Di Long, Shan Yao, Shan Zhu Yu, Tu Si Zi, Tian Men Dong, Gou Qi Zi, Gui Ban Jiao, Shu Di Huang, Mu Li, Mu Dan Pi.

Acupuncture: SI-3 on the left with BL-62 on the right (Du Mai), BL-23, Du-20, Ren-6, Ren-4, Ren-3, KI-3, LU-7 with KI-6 (Ren Mai).


 
DAMP-HEAT IN LOWER BURNER
Impotence, difficult-painful urination, turbid urine, itching of genitals, urethral discharge, tongue with sticky-yellow coating with red spots on root, Slippery pulse.

Bi Xie Fen Qing Yin
Zhi Bo Di Huang Wan

Acupuncture: SP-4 on the left with P-6 on the right (Chong Mai), LIV-5, SP-9, SP-6, Ren-2, Ren-3, LIV-1, LIV-3.

    
DAMP-HEAT IN LIVER CHANNEL
Impotence, difficult-painful urination, rash external genitalia, irritability, tongue with red sides and sticky-yellow coating and red spots on the root, Wiry pulse.

Qing Gan Li Shi Tang
Huang Bo, Huang Qin, Qu Mai, Bian Xu, Hua Shi, Zhi Zi, Che Qian Zi, Mu Tong, Chai Hu, Yin Chen Hao, She Chuang Zi, Wang Bu Liu Xing, Jin Qian Cao.

Acupuncture: SP-4 on the left with P-6 on the right (Chong Mai), LIV-5, SP-9, SP-6, Ren-2, Ren-3, LIV-1, LIV-3.

 
LIVER-BLOOD DEFICIENCY
Impotence, dizziness, blurred vision, depressed mood, insomnia, Pale tongue, Choppy pulse.

Shao Yao Gan Cao Tang Jia Wei
Bai Shao, Zhi Gan Cao, Dang Gui, Shu Di Huang, Huang Jing, Shan Zhu Yu, Wu Wei Zi, Gou Qi Zi.

Acupuncture: LU-7 on the left with KI-6 on the right (Ren Mai), BL-23, Ren-4,  LIV-8, Ren-3, ST-36, SP-6.

   
HEART AND GALL-BLADDER QI DEFICIENCY
Impotence, premature ejaculation, depressed mood, timidity, sighing, insomnia, palpitations, easily startled, Pale tongue, Weak pulse.

Da Bu Yuan Jian
Shu Di Huang, Shan Zhu Yu, Shan Yao, Gou Qi Zi, Du Zhong, Dang Shen, Gan Cao, Dang Gui.

Acupuncture: SI-3 on the left with BL-62 on the right (Du Mai), HE-7, GB-40, Ren-4, Du-20, ST-36, SP-6,.

   
HEART-BLOOD DEFICIENCY
Impotence, palpitations, dizziness, depressed mood, insomnia, Pale tongue, Choppy pulse.

Gui Pi Tang 

Acupuncture: SI-3 on the left with BL-62 on the right (Du Mai), HE-7, HE-5, Du-24, Ren-15, Ren-4, Ren-3, BL-15, SP-6.


   
STASIS OF JING AND PHLEGMImpotence, pain in the testis and perineum, hypogastric pain, premature greying of hair, abnormal sperm (motility, shape, etc.), oppression of the chest, urethral discharge, Purple tongue, Firm-Slippery pulse.

Huo Xue Tong Jing TangDang Gui, He Shou Wu, Yi Mu Cao, Ji Xue Teng, Chuan Niu Xi, Gou Qi Zi, Xue Jie, Ban Xia, Dan Nan Xing, Gua Lou.

Acupuncture: SP-4 on the left with P-6 on the right (Chong Mai), Ren-3, LIV-5, SP-10, BL-34, ST-40, SP-9.
   
                                                   PREMATURE EJACULATION
HEART AND KIDNEYS NOT COMMUNICATING (Heart- and Kidney-Yin Xu)
Premature ejaculation, 5-palm heat, dizziness, tinnitus, night-sweating, palpitations, lower backache, depressed mood.

Zhi Bai Di Huang Wan plus Jin Suo Gu Jing Wan

Acupuncture: SI-3 on the left and BL-62 on the right (Du Mai), HE-7, KI-7, Ren-15, Du-20, BL-23, BL-32, Ren-4.

   
HEART AND KIDNEYS NOT COMMUNICATING (Heart- and Kidney-Qi Xu)
Premature ejaculation, dizziness, tinnitus, palpitations, lower backache, depressed mood, pale face.

Gui Pi Tang  plus Jin Suo Gu Jing Wan

Acupuncture: SI-3 on the left and BL-62 on the right (Du Mai), HE-7, KI-7, Ren-15, Du-20, BL-23, BL-32, Ren-4.

   
                                                      LOW SPERM COUNT
KIDNEY-YANG DEFICIENCY
Low sperm count, dizziness, tinnitus, lower backache, cold back and knees, frequent-pale urination, etc. Pale tongue, Weak-Deep pulse.

Wu Zi Heng Zhong Wan Variation
Gou Qi Zi, Tu Si Zi, Wu Wei Zi, Fu Pen Zi, Che Qian Zi, Sang Shen Zi (Fructus Mori albi), Fu Zi, Jiu Cai Zi (Semen Allii tuberosi), Lu Ba Zi (Semen Trigonellae Foeni-graeci), She Chuang Zi, Dang Gui, Xu Duan, Dang Shen, Ba Ji Tian, Lu Jiao Jiao

Acupuncture: SI-3 on the left and BL-62 on the right (Du Mai), BL-23, Ren-4, KI-13, KI-12, BL-32.

   
KIDNEY-YIN DEFICIENCY
Low sperm count, dizziness, tinnitus, feeling of heat in the evening, night sweating, backache,  tongue without coating, Floating-Empty pulse.

Ye He Sheng Jing Tang
Mu Dan Pi, Di Gu Pi, Chi Shao, Bai Shao, Shan Zhu Yu, Lian Qiao, Xia Ku Cao, Chai Hu, Zhu Ye, Fu Ling, Sheng Di Huang, Xuan Shen, Mai Men Dong, Zhe Bei Mu, Dan Shen, Gou Qi Zi, Yin Yang Huo, Mu Li.

Acupuncture:  LU-7 on the left and KI-6 on the right (Ren Mai), Ren-4, Ren-7, KI-13, KI-12, BL-23.

 
LIVER-QI STAGNATION WITH KIDNEY DEFICIENCY
Low sperm count, lower backache, dizziness, tinnitus, night-sweating, irritability, abdominal distension. Tongue without coating, Pulse Weak and slightly Wiry on the left.

Zhi Bai Di Huang Wan Variation
Shu Di, Gou Qi Zi, Tu Si Zi, Shan Zhu Yu, Lu Jiao Jiao, Shan Yao, Fu Ling, Huang Bo, Zhi Mu, Suan Zao Ren, Chai Hu, Huai Niu Xi.

Acupuncture: LU-7 on the left and KI-6 on the right (Ren Mai), Ren-4, KI-13, KI-12, BL-23, LIV-3.


   
DAMP-HEAT IN THE GENITAL SYSTEM
Low sperm count, low motility, difficult urination, turbid urine, dark urine, painful urination, tongue with sticky-yellow coating and red spots on the root, Slippery pulse.

Long Dan Xie Gan Tang

Acupuncture: LU-7 on the left and KI-6 on the right (Ren Mai), Ren-9, ST-28, KI-12, Ren-3, Ren-5, BL-22, SP-9.
 
QI STAGNATION AND BLOOD STASIS
Low sperm count, poor motility, distension and discomfort of testis, pain in perineum, hypogastric pain, prostatic hypertrophy, Purple tongue.

Ge Xia Zhu Yu Tang 

Acupuncture: SP-4 on the left and P-6 on the right (Chong Mai), LIV-3, SP-10, BL-17, KI-14, ST-30.

   
                                                       LOW SPERM  MOTILITYKIDNEY-YANG DEFICIENCY
Low sperm motility, pale face, dizziness, backache, pale-frequent urination, etc.

Zuo Gui Wan Variation
Shu Di, Shan Yao, Gou Qi Zi, Tu Si Zi, Nu Zhen Zi, Han Lian Cao, Wu Wei Zi, Sang Ji Sheng, Lu Jiao Jiao, Yin Yang Huo, Suo Yang, Ba Ji Tian, Sha Ren, Gan Cao.

Acupuncture: SI-3 on the left and BL-62 on the right (Du Mai), BL-23, Ren-4, KI-13, KI-12, BL-32.

   
KIDNEY-YIN DEFICIENCY WITH EMPTY HEAT
Low sperm motility, backache, dizziness, tinnitus, night-sweating, 5-palm heat, malar flush, nocturnal emissions with dreams, Red tongue without coating, Floating-Empty and Rapid pulse.

Er Xian TangXian Mao, Yin Yang Huo, Ba Ji Tian, Dang Gui, Zhi Mu, Huang Bo.

Acupuncture: LU-7 on the left and KI-6 on the right (Ren Mai), Ren-4, KI-12, HE-6, KI-3, Ren-7.

AN IMPORTANT ARTICLE BY CHRIS DHAENENS ON ARISTOLOCHIA

ARISTOLOCHIA: THE MALIGNANT LIE AND THE BENIGN TRUTH
Chris Dhaenens
Journal of the Register of Chinese Herbal Medicine (UK), Spring 2013, Vol. 10, no. 1.

This article was commissioned in response to a recent piece in the Lancet (Daniel Kell, Justin Stebbing. ‘Aristolochia: the malignant truth’) published under ‘Quackery’ rubric, in www.thelancet.com/oncology/Vol 14 January 2013 which revisits the aristolochia story. The trigger for this revisitation was a completely unrelated case of acute liver failure in a patient poisoned by arsenic oxide, contained in a remedy that she had been taking (the nature of the remedy is not specified). Arsenic, the authors note, is a "well known poison that has been linked to the death of several historical figures, including George III. Although we cannot discount the potential medicinal properties of many natural and alternative therapies...this case serves to highlight the potential dangers associated with the use of unlicensed or underevaluated products or their use without strict medical supervision. What better example of this than the traditional Chinese medicine aristolochia?"
Editor 

A black cat, in a dark room, is hard to find. Especially when it is not there…(Kung Fu Tzu)The story of Aristolochia and its toxicity has cast a twenty year long shadow over Traditional Chinese
Herbal Medicine (TCHM) and Complementary and Alternative Medicine alike. Although new cases
have not occurred in the past decade, the same evidence and incidence is being recycled year
after year in scientific papers, invariably referring to these cases to highlight the dangers of (herbal)
quack-medicine. Under the heading ‘Quackery’ and the title ‘Aristolochia: the malignant truth’, The
Lancet deemed it necessary to freshen up our memory once more in its January issue.  For different reasons, all highlighted further on, writing about Aristolochia is an extremely delicate matter, technically as well as ethically. Therefore, let it be clear in advance that nobody in his right
mind disputes the ban on Aristolochia species.

However, the Lancet article is one more sad example of how this case is abused for other agendas: highlighting the dangers of unlicensed medicines, the alleged absence of testing and quality control and the inevitable connection to quackery. It is simply revolting how the authors connect a case of arsenic poisoning and, bloody hell... the death of King George III, to the case of Aristolochia. The saying goes that for a man with only a hammer, everything begins to look like a nail…. It is remarkable that the virulent attacks on traditional herbal medicine are systematically reduced to the problem of Aristolochia, in an unprecedented stream of scientific echolalia, without providing new information or even mentioning the existence of alternative and more nuanced hypotheses.

The Belgian case: not a quack or herbalist to be seen
First of all one should be aware that the Aristolochia stigma on TCHM, goes back to the major ‘clear-cut’ case in Belgium, a drama that took place exclusively in the medical prescription and pharmaceutical dispensing circuit. No quack nor even a herbalist on the horizon! It beggars belief that the sceptic establishment points its guns so disproportionally to herbal medicine at a time juncture when all aspects of safety-efficacy evaluation for regular medicine are under scrutiny.

In Belgium, 2000 deaths per year are officially attributed to licensed medicine (overdosages not
included). A list of over 1600 licensed products considered ineffective is circulating in EU. On a
regular basis phase ‘1-3 clinically tested medicinals’ are withdrawn from the market because of severe side-effects and deaths. Can the authors present a similar negative curriculum for botanical food supplements and medicinals? Moreover, recent research points out that in one third of scientific
papers, results and data are ‘massaged’ under the urge to publish, and more and more cases of
scientific fraud are being revealed. Likewise, the selective combination of truths, half-truths,
concealment and conjecture that characterizes the Aristolochia hypothesis leads one to suspect that
plenty of anomalous information was diligently transformed into accomplished fact. To such an
extent that one would sigh: ‘Where’s Edzard Ernst when you really need him?’…. because this case
cries out for a meta-analysis.

The poverty of the EU model
Meanwhile in the ‘usual suspects’ discourse that we are so familiar with, clearly reference is made to
Aristolochia to legitimize the stringent safety and quality guidance as required under the THMPD.
However, this EU directive involves a registration model that wrings traditional phytotherapy into an
unworkable straitjacket since it fails dramatically to reconcile statutory regulation with efficient
Quality Safety-control. The EU model seems to solve all problems that have never existed, and
leaves the few real problems unsolved. It is symptomatic for the poor understanding of traditional processing by the regulatory authorities, and shows how little lessons have been drawn from
the Aristolochia tragedy: traditional ingredients should not be used frivolously outside their
traditional context and preparation form, which are quite specific.

Aristolochia: vital to distinguish intrinsic toxicity and the wider context of its use
Since all potential safety issues associated with herbal remedies seem to epitomize in the case of
Aristolochia, it may be worthwhile to distinguish the real, intrinsic toxicity from the circumstantially
caused damage. Coming back to the Belgian case, some facts that were poorly highlighted in the
scientific papers.

The Aristolochia case involved an adulteration of species due to poor identity control by the
responsible supervising pharmacists! Aristololochia fang ji (Guang Fang Ji) was used instead of Stephania tetrandra (Han Fang Ji).

Both the original herb and the adulterant are only remotely indicated for the intended diuretic action and both herbs were traditionally prescribed as ingredients of a classical formula or a multi-herbal tailored prescription, not as single ingredient.

The herbs were prescribed by medical doctors devoid of any experience with TCHM. All
recommendations regarding dosage, processing, length of administration and traditional contraindications were systematically ignored.

The herbal ingredients were added to a cocktail, consisting of dexfenfluramines, diethylpropion,
diamox, meprobamate, a.o. All of these licensed medicinals were withdrawn from the market in the years to follow because of severe side effects. Two of those turned out to cause cardiac  alvulopathies and peritoneal and pulmonary fibrosis similar to the pattern encountered in the majority of the victims.

It is commonly accepted that the common denominator in all cases of interstitial fibrosis as
established in the victims, was Aristolochia. This is basically correct, but of little use, since
thousands of women visiting this slimming clinic, were administered Aristolochia but did not
develop such pathology. Far more interesting is the fact that all victims but one, issued from one
surgery where, in a 4 month stretch, high dosages of serotonin enhancers were injected.
Not a single victim issued from the 4 surgeries where the same criminal cocktail was administered for 2 years. The epidemiological data of this unsavoury case were never published in full. The combination of high dosages of administered serotonin with the dexfenfluramine which prevents the re-uptake of serotonin by blocking the 5-HT receptors turned the poor women into ticking time-bombs calling for more tranquillizers (meprobramate) and high amounts of diuretics. Several expert nephrologists pointed to serotonin as the principal causative agent of the rapidly progressing interstitial fibrosis, but their voices went unheard in the subsequent hysterical aristophobia. [1]

It is very well possible that Aristolochic Acid is partly responsible for this fibrotic syndrome, but
only in a secondary phase of the evolving pathology since the kidney lesions rather point to serotonin. Unlike what the papers say, the toxicity of the Aristolochia plant is well known from pharmacopoeae all over the world and comparable to colchicine. Pathology is acute and reversible, unlike the chronic, degenerative and irreversible renal failure syndrome encountered in the victims. In Hippocratic medicine Aristolochia is considered a powerful amphoteric drug (ie a drug with opposite characteristics). In this context amphoteric means that it has the ability to act as an acid and as base. As such it may have played a part in the pathology, given the fact that, while trying to restore the acid/base balance on the level of the extra-cellular matrix (in obese people already tending to grave
acidosis!), it may have contributed to turn the extra-cellular matrix more alkaline, thus further
polarising a pre-existing disbalance and accelerating the fibrotic process.

Again, under such extreme conditions the role of Aristolochia is to be considered secondary, but it was the wrong ingredient at the wrong place and the wrong time. As such, it proved the ideal scapegoat for the scientific community to reduce the incredible complexity of this pathology to Aristolochia uniquely, but also the ideal escape route for irresponsible doctors and negligent pharmacists only driven by  unscrupulous pursuit of profit.

The bottom line is that the epidemiological data hardly implicate Aristolochia in the kidney
pathology. At a very conservative estimate at least 15000 people were exposed to Aristolochia
between 1989 and 1993. Herbalists prescribed tailored combinations with Aristolochia for the
treatment of fistula with amazing results. All in ‘tempore non suspecto’… It is remarkable that
only a relatively small number of people, concentrated in one place, developed the fibrotic syndrome. In 2001 the Belgian Ministry of Health conducted a large-scale inquiry, inviting everyone to whom Aristolochia/Stephania had been administered, for a free kidney screening. Between 5000 and 8000 people reacted. (Yes, there is a traceability system in Belgium.) Not even one new case nor suspicious mortality has been reported.

How about the alleged carcinogenity of Aristolochia? The carcinogenic properties of AA have only been established in rodents and are due to anaerobic bacterial nitroreduction in the forestomach of rats , a mechanism that cannot be extrapolated to humans. If the mechanism would apply, we talk about exorbitant dosages to which no human being has ever been exposed.

The urothelial carcinoma affecting some of the Belgian victims in the slipstream of the renal
pathology, was immediately attributed to AA. Subsequently, AA-DNA adducts were discovered
in their renal biopsies by a research team Heidelberg. [2] The results turned out to be qualitatively and quantitatively impossible but were slavishly swallowed by the scientific community, despite multi-leveled incongruities with previous results. One of the co-operators at the time, Professor A. Pfohl-Leszkowicz, could not reconcile to the outcome of the assay and conducted her own research in which she put forward the hypothesis of ochratoxine as the source of BEN, the Balkan Endemic
Nephropathy, also attributed to Aristolochia. The ochratoxine hypothesis gained momentum when
she was able to re-examine original biopsy samples from the Belgian victims. She identified the adducts as ochratoxine-adducts, and at the same time highlighted the major flaws and anomalies in the AA-hypothesis.[3][4][5]

Despite the absence of sound contra-arguments, her conclusions are mainly hushed up among
toxicologists. The reason? The big food concerns stick to the AA-hypothesis since the costs for QS
control on their cereals would increase exponentially if the OTA-hypothesis were proved right. Interestingly, in the early nineties, a Belgian expert group, advisory to the Department of Health, came to a similar conclusion, but at that time one could not let the truth interfere with a good story…

It is little known that on the basis of the argumentation above and after hearing experts from both sides two Courts of Law final verdicts (Belgium and France) confirmed the absence of any proven causal link between the pathologies and the herbal ingredients!

The Lancet article concludes as follows: "…when comparing conventional therapies with unlicensed
or under-eveluated herbal products, the old Irish anecdote : ‘better the devil you know than the devil
you don’t’, might be more appropriate…"  This quote illustrates the condescending arrogance that , by
combining selective information and model-based biases, finishes off herbal medicine. And, while
talking about the devil you know…What to think about the huge slimming scandal in France where a
big pharmaceuthical company is standing trial for causing the death of at least 500 people and serious valvulopathic complications in over 30000 patients. The licensed medicine Isomeride (Mediator) was registered as an anti-diabetic but promoted and prescribed exclusively as an appetite depressant. Incidentally, Isomeride is a molecule that comes close to the dexfenfluramine discussed above, in fact it is a chemical disguise for it and it shares its destructive properties. As early as 1992 and as a result of the ‘Chinese Herb drama’, the Belgian authorities were alerted about its implication in the valvulopathies and the fibrotic syndrome. However, the inconvenient truth was kept in the dark for years while the Belgian researchers were pasting together the Aristolochia hypothesis, the more convenient scapegoat. Had there been an objective assessment and nuanced communication the French drama could have been avoided and the health of tens of thousands of people would not have been jeopardized. No herbs involved this time. ‘Unlicensed and underevaluated’: did we read correctly ?

Again, this is absolutely not a plea for lifting the ban on Aristolochia. But as long as the truth
remains in exile, and the ‘open ends’ in every hypothesis remain, it would be helpful to stop the
vitriolic attacks on herbal medicine, especially in cases where the tradition is abused by criminals
who disguise molecules like sibutramine, sildenafil and others as herbal remedies. It has been 20
years chewing on the same story and really, there’s no more juice in it.

References
[1] De Broe. On a nephrotoxic and carcinogenic slimming regimen: American Journal of Kidney Diseases. Vol 33 no. 6, 1999, pp 1171-1173.

[2] Bieler C., Stibirova M., Wiessler M., Cosyns J-P, van Ypersele de Strihou C., Schmeisser H. 32P-post labelling analysis of DNA adducts formed by aristolochic acid in tissues from patients with Chinese herbs nephropathy. Carcinogenesis. 1997 May;18(5):1063-7.

[3] Pfohl-Leszkowicz A. Ochratoxin A and Aristolochic Acid Involvement in Neuropathies and Associated Urothelial Tract Tumours. Arh Hig Rada Toksikol 2009;60:465-483.

[4] Mantle PG, Faucet-Marquis V, Manderville RA, Squillaci B, Pfohl-Leszkowicz A. Structures of Covalent Adducts between DNA and Ochratoxin A: A New Factor in Debate about Genotoxicity and Human Risk Chem. Res. Toxicol. 2010, 23, 89–98 89.

[5] Expertise Médicale. Considerations critiques, Note Définitive, Conclusions Générales, par Dr. D. De Keukeleire, Dr. A. De Vriese, Dr. J. Halewyck de Heussch, Dr. N. Lameire et Dr. P. Wettendorff (unpublished).

About the Author: Chris Dhaenens is a herbalist and acupuncturist. He trained at the European
University of TCM, Antwerp, and at the International Acupuncture Training Center, Beijing.
He is president of O.P.P.A.S, a professional association of herbal companies represented in the
Belgian regulatory commission on plants and plant preparations, and also president of the European
Benefyt Foundation, a professional association striving for an appropriate legal framework for
Traditional Herbal Medicine in the EU.

THE TREATMENT OF ALLERGIC RHINITIS ("HAY FEVER")

The main clinical manifestations of allergic rhinitis (“hay fever”) are nasal congestion, a watery nasal discharge and sneezing.  In a few cases it affects the eyes and the conjunctiva may become red and itchy.  In 20% of cases there is also asthma in conjunction with the rhinitis. 

Allergic rhinitis is due to an antigen-antibody reaction in the nasal mucosa.  If the antigens responsible are only pollen particles then it causes seasonal allergic rhinitis (hay fever).  If the antigens are dust, house-dust mites’ faecal matter, fungal spores and animal dander, it causes perennial allergic rhinitis.

Allergic rhinitis develops as a result of the interaction between the inhaled allergen and adjacent molecules of IgE antibodies.  These adhere to the surface of the mast cells which line the nasal epithelium with the first exposure to the offending allergen.  After the first exposure, the mast cells are “primed”, i.e. high levels of IgE antibodies adhere to their surface.  With subsequent exposure to allergens, the IgE antibodies provoke an "explosion" in the mast cells with the massive release of histamine.  Histamine itself causes an increase in permeability of the epithelium allowing allergens to reach IgE-primed mast cells.  Sneezing results from overstimulation of the afferent nerve endings and starts within minutes of the allergens entering the nose.  This is followed by a greatly increased nasal secretion and eventually nasal blockage about 15-20 minutes after contact with the allergen.

The Western treatment of allergic rhinitis relies mostly on the use of antihistamine agents.  These work by preventing histamine from reaching its site of action, i.e. the H1 receptors and hence they are called H1-receptor blockers.  Side-effects include sedation, dizziness, fatigue, insomnia, nervousness, and gastro-intestinal disturbances.  Failure to respond to antihistamines is due to the fact that inflammatory chemicals other than histamine are released in allergic states.

All modern Chinese books equate allergic rhinitis to Bi Yuan but this disease corresponds more to sinusitis  than to allergic rhinitis.  There is, in fact, an ancient Chinese disease entity called Bi Qiu  (鼻 鼽) which actually corresponds more closely to allergic rhinitis.  Bi Qiu means “Stuffy Nose” and it is characterized by a profuse, thin, clear nasal discharge, stuffed nose and sneezing.  Another Chinese disease category which may correspond to allergic rhinitis is called Qiu Ti (鼽 嚏) which may be translated as “Stuffy Nose and Sneezing”.

The only exception among modern Chinese doctors is the book “New General Outline of Chinese Medicine” by the Guangzhou Army Health Department which attributes the pathology of allergic rhinitis to a Kidney deficiency and a deficiency of the Du Mai (as I do).  The book also says specifically: “The Kidneys control sneezing. The Du Mai flows to the upper lip. Sneezing, stuffed nose, runny nose with a watery, clear nasal discharge is due to a deficiency of the Kidneys and of the Du Mai. Itchy nose is due to Wind."

Bi Qiu (“Stuffy Nose”) is characterized by itchy nose, sneezing, profuse, white-watery nasal discharge, and stuffy nose.  On examination, the nasal mucosa is swollen but not inflamed.

Allergic rhinitis vs sinusitis
Please note that it is important to understand the difference between these two conditions as they are frequently confused.  The term “allergy” or “allergic” is frequently used to describe the symptoms of sinusitis by both patients and practitioners.  Sinusitis is not an allergic disease: it is an inflammation of the tissue lining the sinuses due to an infection. Normally, sinuses are filled with air, but when sinuses become blocked and filled with fluid, germs (bacteria, viruses, and fungi) can grow and cause an infection.  By contrast, in allergic rhinitis, there is inflammation but no infection.

In sinusitis, the nasal discharge is thick and yellow and there is no sneezing; in allergic rhinitis, it is profuse, white and watery and there is sneezing.

Pathology of allergic rhinitis
In my experience, allergic rhinitis is characterized by Wind in the same way as in an external invasion of Wind (common cold). The allergens could be seen as a form of “Wind”.  Wind obstructs the nose and it impairs the diffusing and descending of Lung-Qi: this causes sneezing and a congested nasal mucosa.  This is the Biao [Manifestation] of this condition. 

The Ben [Root] is a deficiency of the Kidneys and of the Du Mai.  It is the Kidney deficiency that, on the one hand, allows Wind to enter the nose and, on the other, it is the cause of the allergic constitution.  In allergic rhinitis, the Kidneys are involved not only in the Root of the disease, but also in the Manifestation through the Du Mai.  

The Du Mai emerges from between the Kidneys and flows up the spine to the top of the head and then down to the nose and lips.  It is therefore the channel connection between the Kidneys and the nose.  For this reason the Kidneys are responsible not only for breathing, due to their function of grasping Qi, but also sneezing.  Sneezing itself is also directly linked to the Kidneys and not necessarily due only to Wind.  Chapter 23 of the “Simple Questions” says: “The Kidneys control sneezing.”  Chapter 64 of the “Simple Questions” discusses the consequences of inserting a needle into an organ and, for the kidneys, it says: “If we pierce the kidneys, this will cause sneezing and death will ensue within 6 days.”

Thus the hyper-reactivity of the immune response of allergic rhinitis is due to a deficiency of the Kidneys and of the Du Mai.  With regard to the role of the Du Mai in allergic rhinitis, it is interesting that many of the herbs which Li Shi Zhen connected with this vessel are expelling-Wind herbs which act on the nose.  These herbs are Fang Feng Radix Saposhnikoviae, Cang Er Zi Fructus Xanthii, Jing Jie Herba Schizonepetae, Qiang Huo Rhizoma seu Radix Notopterygii, Xi Xin Herba Asari and Gao Ben Rhizoma Ligustici.   

The symptoms and signs of allergic rhinitis are those of Wind-Cold as the nasal discharge is always white and watery.  This indicates a deficiency of Wei Qi which is spread by the Lungs but has its root in the Kidneys.  Thus, although some books do refer to a Kidney deficiency as the Root of allergic rhinitis, the Kidneys are responsible not only for the Root of this disease, but also for the Manifestation through their direct connection with the Wei Qi and sneezing and with the Du Mai (which flows through the nose).

There are two types of allergic rhinitis: perennial or seasonal.  Perennial allergic rhinitis is due to allergy to house-dust mites, cats dogs, horses, etc and the patient suffers from it all year round.  Seasonal allergic rhinitis (“hay fever”) is due to allergy to pollen and it occurs only during the pollen season.  The timing of its occurrence varies as it depends on which particular grasses the patient is allergic to. 

Treatment of seasonal allergic rhinitis (“hay fever”)
The treatment of seasonal allergic rhinitis depends on the season.  During the allergic season (usually Spring), we must treat the Manifestation (Biao), i.e. expel Wind. 

Acupuncture
With acupuncture, I would use these points: BL-12 Fengmen, BL-13 Feishu, LU-7 Lieque, L.I.-20 Yingxiang, Bitong, Du-23 Shangxing, G.B.-20 Fengchi, Yintang.  Reducing or even method.  Cupping is applicable on BL-12 and BL-13. 
    During the pollen season, the patient must be treated frequently, i.e. at least once a week or more frequently.

Herbal treatment
Prescriptions that can be used include:
Xiao Qing Long Tang Small Green Dragon Decoction
Cang Er Zi San Xanthium Powder
Ma Huang Tang Ephedra Decoction



1.  Guangzhou Army Health Department 1974 A New General Outline of Chinese Medicine, (Xin Bian Zhong Yi Xue Gai Yao), People’s Health Publishing House, Beijing, p. 676.
2. 1979 The Yellow Emperor’s Classic of Internal Medicine-Simple Questions (Huang Di Nei Jing Su Wen), People’s Health Publishing House, Beijing, p. 150. First published c. 100 BC.
3.  Ibid., p. 355.
4. Wang Luo Zhen 1985 A Compilation of the Study of the Eight Extraordinary Vessels (Qi Jing Ba Mai Kao Jiao Zhu), Shanghai Science Publishing House, Shanghai, p. 89.  The Study of the Eight Extraordinary Vessels was written by Li Shi Zhen and first published in 1578.
5. Another interesting connection between the Kidneys and rhinitis could be observed in the use by some Chinese doctors of injection of cortisone in the point BL-12 Fengmen with far fewer side-effects than in a systemic administration of cortisone.  If we view cortisone as a kind of "Kidney tonic", it would make sense to inject it in the point BL-12 which expels Wind and spreads Wei-Qi in the Exterior.

THE HEART CHANNEL FUNCTIONS PART - 2

Backache
I often use points of the Heart channel for lower backache, particularly in men. The reason is the same as that given for the use of these points for men's sexual problems: the Heart is like an "Upper Kidney" and it therefore naturally influences the lower back. I find that the point HE-7 Shenmen is the best for this function because, besides its indirect action on the Kidney channel (and therefore the lower back), it also has a general anti-spastic effect, thus relaxing the muscles. I usually combine this point with the opening points of the Du Mai (only if the pain stems from the spine area).

An example of a combination in a man would be SI-3 Houxi on the left, BL-62 Shenmai on the right, HE-7 Shenmen on the right and KI 4 Dazhong on the left. If the pain is unilateral, I use KI-4 Dazhong on the side of the pain and HE-7 Shenmen on the opposite side.

Nausea, Vomiting
Although nausea and vomiting are always related to Stomach-Qi ascending instead of descending, Heart-Qi also has (or should have) a descending movement. The "Explanation of Acupuncture Points" says: "When Heart-Qi rebels upwards there is belching or vomiting: this means that Heart-Qi is full; tonifying the Water point [HE-3 Shaohai] will make Qi descend". The same also specifically recommends it for nausea and vomiting. The same text also recommends HE-5 Tongli for vomiting of bitter fluids and HE-7 Shenmen for vomiting of blood. The "Great Dictionary of Chinese Acupuncture" mentions also HE-6 Yinxi for vomiting of blood and HE-1 Jiquan for dry vomiting.

Furthermore, the Heart channel is closely related to the epigastrium; in fact, in the old times, the distinction between Heart pain and Epigastric pain was somewhat blurred. Incidentally, this is borne out by modern medicine too when symptoms of incipient cardiac infarction may often resemble indigestion.

Thus, if Heart-Qi ascends rather than descend, nausea and vomiting may ensue (which incidentally may also occur in the prodromal stage of a heart infarction). This is probably the reason why P-6 Neiguan (acting on the Heart) is such an important point for nausea and vomiting. From the Heart channel, HE-5 Tongli is the best point, and also Ren-15 Jiuwei or Ren-14 Juque both of which act on the Heart.

Calm Nerves in Asthma
Points of the Heart channel can be used to treat acute attacks of asthma. This is probably due to their anti-spastic action and they presumably relax the bronchial muscles and therefore relieve broncho constriction. Thus, in this case, Heart point are not used to "calm the Mind" but to relax the bronchial muscles.

The main point used is HE-7 Shenmen, usually in combination with Du-24 Shenting and Ren-15 Jiuwei (which relaxes the chest and acts on the Heart). The "Explanation of Acupuncture Points" recommends HE-7 Shenmen for rebellious Qi and Heart-Fire causing breathlessness. Heart points also help asthma because they help to restore the descending of Qi in the chest. The "Great Compendium of Acupuncture" recommends HE-7 Shenmen, SP-9 Yinlingquan, BL-60 Kunlun and GB-41 Zulinqi for breathlessness.

Tremors
Heart points can be used to alleviate tremors in Parkinson's disease. They have an effect on tremors for two reasons: first, through the anti spastic effect mentioned above; secondly, because Heart points will nourish Yin in the arm and will help to alleviate tremors of the arm (since Wind, especially in old people, derives from Yin deficiency). The main points are HE-7 Shenmen, HE-6 Yinxi and HE-5 Tongli. The "Great Dictionary of Chinese Acupuncture" recommends the point HE-3 Shaohai for contracture of the hand and numbness of the arm.

When treating the tremor of Parkinson, I would advise in any case not using too many Yang points on the arm as Yang corresponds to movement. Thus, I would balance the Yang points with some from Yin channels and especially those from the Heart channel.

Interestingly, the extra point for tremors called Xiaochanxue (Stopping Tremor Point) is located on the Heart channel (1.5. cun below HE-3 Shaohai).

Knees
The best point is HE-5 Tongli. The Su Wen mentions a combination for swollen and painful knee: SI-2 Qiangu, HE-8 Shaofu, KI-2 Rangu and BL-66 Tonggu. The Heart points affect the knee firstly because of the relationship with the Kidney channel and secondly, because Heart points can be used to clear Heat and cool Blood in general. I have tried this combination many times and it works. In my experience, it is best when the knee is inflamed and swollen.

Eye
Both the Heart main and Luo channels flow to the eye and Heart points can therefore be used for eye problems, especially from inflammation. The best point is HE-5 Tongli. In fact the "Explanation of Acupuncture Points" recommends HE-5 Tongli for painful and red eye (from Heart-Fire) and HE-7 Shenmen for yellow and painful eye.

Urinary Problems
The Heart channel points can be used for urinary problems due to its connection with the Bladder channel through the Small Intestine channel. In fact, the Heart is exteriorly-interiorly connected to the Small Intestine and this, in turn, has an Above-Below connection with the Bladder channel within the Tai Yang channels. The Heart channel is particularly used for Lin urinary problems from Heart-Heat transmitting to the Small Intestine and Bladder, and the main point is HE-8 Shaofu, in combination with SI-2 Qiangu, BL-66 Tonggu. Sometimes Heart-Fire combines with Liver-Fire to cause urinary problems and the main points are HE-8 Shaofu and LIV-2 Xingjian. The "Explanation of Acupuncture Points" recommends HE-8 Shaofu (with reducing method) for urinary problems.

THE EXTERIOR, INTERIOR AND PIVOT OF CHANNELS

Chapter 6 of the Su Wen introduces the concept of channels “opening onto the exterior” (or being the “opening”), closing onto the interior (or “being the door leaf”) and being the pivot (or hinge).

In this chapter the order for the Yang channels is as follows:
Tai Yang opens
Yang Ming closes
Shao Yang is the pivot
 
The order for the Yin channels is:
Tai Yin opens
Jue Yin closes
Shao Yin is the pivot

With regard to the Yin channels I personally see the Jue Yin as the pivot (I call it “hinge”) and the Shao Yin as opening onto the interior (or “closing”).  There are various reasons for this.

 Firstly, if we read chapter 6 of the Su Wen in full and we look at the context of the exterior/interior/hinge quote, we will see that things are not quite as they seem. It sounds like this chapter is talking more about Zangfu organs than channels and more about the trunk and abdomen than arm or leg channels.

Secondly, the very same chapter also says:  “The vessel behind Tai Yin is Shao Yin. The vessel in front of Shao Yin is Jue Yin.” Therefore, Tai Yin is in front of Shao Yin and Jue Yin is in front of Shao Yin: this means that Jue Yin is in the middle between Tai Yin (the ‘front”) and Shao Yin (the “back”).  That sounds very much like the Jue Yin is in between the Tai Yin and the Shao Yin, i.e. it is the “hinge”.  Moreover, when it talks about the Yang, chapter 6 says: “The vessel outside the Jue Yin is the Shao Yang.”  As the Shao Yang is the hinge of the Yang, it being “outside the Jue Yin” would imply that the Jue Yin must be a hinge too.Of course the Shao Yang (Triple Burner and Gall-Bladder) have a Yin-Yang connection with the Jue Yin (Pericardium and Liver) and that is why this chapter says that the Shao Yang is "outside" the Jue Yin.

Thirdly, the book “Great Treatise of Chinese Acupuncture” (Zhong Guo Zhen Jiu Da Quan) by Wang Xue Tai uses similar terminology when it refers to “front”, “middle” and “back” of channels, which I would translate as “lateral”, “middle” and “medial”.  This book confirms that the Jue Yin is in the "middle".

This is reflected all over the body in the situation of the channels (with the exception of the lower leg). For example, if we look at the chest, we have the Spleen channel (Tai Yin) outside (lateral), the Kidney channel (Shao Yin) inside (medial) and the Liver channel (Jue Yin) in between.  The same in the abdomen.  This is even clearer in the arm where we have the Lung channel (Tai Yin) on the lateral side, the Pericardium channel (Jue Yin) in the middle and the Heart channel (Shao Yin) on the medial side.  Only the lower leg represents an exception as the Liver channel (Jue Yin) is on the lateral side initially but it crosses over in the middle of the lower leg.                        
 
The order of arrangement of the 6 Stages in the Shang Han Lun also points to the Jue Yin being the hinge.  In fact, this is the order:

Tai Yang
Yang Ming
Shao Yang
Tai Yin
Shao Yin
Jue Yin

Thus, if Shao Yang is the hinge of the Yang channels, then the Jue Yin must also be of the Yin channels because it occupies a corresponding place in the Yin as that of the Yang.
 
If we look at the 12 channels during the day (LU-LI-ST-SP, etc.)  we get:

Ext            Int                 Int                Ext          Hinge        Hinge   

Tai Yin    Yang Ming    Shao Yin    Tai Yang    Jue Yin    Shao Yang
LU           LI                 HE               SI               P             TB       
SP            ST                KI                BL            LIV          GB

If we bear in mind the Yin-Yang connections among channels, the Triple Burner (Shao Yang) is connected to the Pericardium (Jue Yin) and the Gall-Bladder (Shao Yang) to the Liver (Jue Yin). Therefore, if the Shao Yang is the hinge of the Yang (as it clearly is), then the Jue Yin must be the hinge of the Yin. The diagrams below illustrate this concept.

 The two diagrams below show the position of the channels in arms and legs as indicated above. The diagram below shows clearly how, if we related the concept of opening/closing/hinge to channel topography, the Jue Yin must be the hinge. Notice how the Heart and Kidney channels are both medial, both "inside", both the "most interior" (and therefore not pivot or hinge) of the Yin channels.

Clinical significance
What is the clinical significance of all this? In my opinion, the clinical significance is more relevant for the Yang than for the Yin channels.  If we look at the Yang channels, it is very obvious why the Tai Yang "opens onto the Exterior". Its channels are lateral, on the outside and cover the very Yang area of back of the neck and back. Not by chance, the first stage of the Shan Han Lun is the Tai Yang stage and not by chance this stage is marked by occipital stiffness (Tai Yang area).

That the Shao Yang is the hinge between Tai Yang and Yang Ming is also clear from the Shang Han Lun.  The Shao Yang Syndrome is characterized by the alternation of feeling cold and feeling hot.  This is due to the fact that the pathogenic factor is trapped between the Tai Yang (exterior) and the Yang Ming (interior): when it floats toward the Tai Yang, the patient feels cold; when it goes to the Yang Ming, the patient feels hot.

In my view, however, the most important clinical significance of the concept of "hinge" is in the field of mental-emotional problems. This is a view according to my experience and not according to Chinese texts.

I see the role of "hinge" of the Shao Yang and Jue Yin as a metaphor of their involvement in relationships, in our relating to others. All four of the Shao Yang and Jue Yin channels play a role in relating but especially so the Jue Yin, i.e. Pericardium and Liver.  The Liver even more so because it houses the Hun which provides the Shen with the "movement" necessary to relate.

THE HEART CHANNEL: MORE THAN THE SHEN

The Heart houses the Shen and its most important clinical use is for mental emotional problems. This article will explore the clinical use of the Heart channel for uses other than for mental-emotional problems. The uses of the Heart channel for problems other than Shen problems discussed are listed below:

Itching
Sexual function in men
Connection with Uterus in women
Backache in men
Nausea, vomiting
Calm asthma
Tremors
Knee
Eyes
Urinary

Itching
Points of the Heart channel have a marked effect in stopping pruritus (itching). The two main points for this are HE-7 Shenmen and HE-8 Shaofu, the latter being stronger. Using Heart points for itching is the equivalent of using herbs that calm the Mind and nourish the Heart (such as Ye Jiao Teng Caulis Polygoni multiflori or Bai Zi Ren Semen Biotae orientalis) which also stop itching.
 
Stopping itching is extremely important in eczema and is the first treatment strategy one should adopt because, as this disease causes intense itching, the scratching resulting from it perpetuates the disease by causing excoriation of the skin and possible infections.

Sexual Function in Men
The Heart channel is related to the Kidney channel within the Shao Yin channels. It is also indirectly related to the Kidneys through the Du Mai and Ren Mai, both of which flow through the Heart and originate from the space between the Kidneys. Both the Du and Ren Mai have a profound influence on sexuality and the sexual function including sexual desire, sexual arousal, erection, maintenance of erection and ejaculation. Furthermore, the Chong Mai also starts from the space between the Kidneys and goes to the Heart and, in addition, it controls the zong muscles in the abdomen which many interpret as being the penis.

Thus, especially in men's sexuality, we can consider the Heart as an "Upper Kidney", influencing many of the sexual functions. If we accept this, it is easy to see how mental-emotional stress affecting the Heart has a profound influence on the sexual function in men.

There is yet another important connection between men's sexual function and the Heart via the Minister Fire of the Ming Men. The Minister Fire is a special type of Fire that can actually generate Water: thus, the Fire and Water within the Kidneys are inseparable and interdependent. The Minister Fire warms and nourishes the Room of Sperm: when it is deficient, the Room of Sperm is cold and this may cause impotence or lack of libido; when it is excessive, it flares upwards affecting the Heart and Pericardium.

The Room of Sperm, located in the Dan Tian is also called Bao, a term that applies to both men and women and that is therefore often erroneously translated as "Uterus" (Zi Bao is the Uterus). In women, the Uterus corresponds to the Lower Field of Elixir (Dan Tian) which in men houses the "Room of Sperm". The "Golden Mirror of Medicine" (Yi Zong Jin Jian, 1742) says: "The Du Mai arises within the lower abdomen, externally in the abdomen, internally in the Bao...also called Dan Tian in both men and women: in women it is the Uterus, in men it is the Room of Sperm".

This passage clearly shows that Bao is a structure common to both men and women being the Uterus in women and the "Room of Sperm" in men. The extraordinary vessels arise from this area. We can therefore consider the Pericardium (Xin Bao) and Room of Sperm (Jing Shi) (also called Bao) as two centres of sexuality, one in the Upper Burner, the other in the Lower Burner: it is the coordination of these two centres that controls sexuality and specifically in men, libido, erection, orgasm and ejaculation.

These two centres, the Heart and Pericardium above and the Minister Fire of the Kidneys below, regulate the ascending and descending of Fire and Water and mutually nourish each other.

Thus, in men we can use the Heart channel points to treat sexual dysfunctions such as impotence or premature ejaculation which are often due to Heart-Qi not descending to the Lower Burner to communicate and link with the Kidneys. That is why, in most cases, all the common animal Kidney-Yang tonics such as deer antler, dog's penis, seal penis or sea-horse seldom have much effect.

The main points for this function are HE 7 Shenmen and HE-3 Shaohai. I often combine the point HE-7 Shenmen with the opening points of the Du Mai. An example of a point combination for a man complaining of impotence or premature ejaculation against a background of mental-emotional problems would be SI-3 Houxi on the left, BL-62 Shenmai on the right, HE-7 Shenmen on the right and LIV-3 Taichong on the left if the pulse is Wiry, or KI-3 Taixi if there is also a Kidney deficiency and the pulse is Weak and Fine.

Connection with Uterus
The Heart is closely connected with the Uterus through the Uterus Vessel (Bao Mai) and this explains the profound influence of mental-emotional problems affecting the Heart on the Uterus. The Uterus is related to the Kidneys via a channel called the Uterus Channel (Bao Luo). The "Simple Questions" in chapter 47 says: "The Uterus Channel extends to the Kidneys".

The Uterus is physiologically related also to the Heart via a channel called Uterus Vessel (Bao Mai). The "Simple Questions" in chapter 33 says: "The Uterus Vessel pertains to the Heart and extends to the Uterus" and "When the period does not come it means the Uterus Vessel is obstructed".

Hence normal menstruation and fertility depend on the state of the Kidney-Jing and Heart-Blood. If Heart-Blood is deficient, Heart-Qi does not descend to the Uterus. If the Kidney-Jing is deficient, menstruation does not occur. A deficiency in either Heart or Kidneys can therefore cause infertility or amenorrhoea.

There is also another important connection and that is via Blood: the Heart governs Blood and the Uterus stores Blood. Although the overwhelming majority of gynaecologists will emphasize the role of Liver-Blood in relation to the Uterus, some put the accent on Heart-Blood. Thus, when they want to nourish Blood in gynaecological problems, these gynaecologists would nourish Heart-Blood with points such as HE-7 Shenmen and BL-15 Xinshu.

Moreover, the famous Qing dynasty's gynaecologist Fu Qing Zhu said that the Tian Gui (i.e. menstrual Blood and ova) derives from the Kidney-Jing but with the assistance of Heart-Yang which must flow down to communicate with the Kidney-Jing. Thus, tonifying the Heart, will necessarily help Kidney-Jing to produce menstrual Blood. This is probably the reason why Gui Pi Tang, which nourishes Heart Blood, is such an important formula in gynaecological problems.

Dr Yao Shi An mentions several patterns of the Heart which affect the gynaecological functions.
Women are prone to stagnation of Qi, this often turns into Fire which affects the Heart; Fire harasses downwards and disturbs the Ren and Chong Mai, the Sea of Blood becomes reckless and this may result in Heavy Periods or Flooding and Trickling. The "Ji Yin Gang Mu" says: "Fire burns the Heart, Blood becomes reckless and causes bleeding downwards".

Sadness over a long period of time may cause Heart-Yin deficiency, the Mind has no residence, this causes Heart-Yang to float and may cause menorrhagia. The "Simple Questions" says in chapter 44: "Sadness leads to severance of the Uterus Channel: when this is severed Yang Qi is agitated in the Interior and the Heart causes menorrhagia".

When Heart-Qi rebels upwards, it impairs the descending of Lung-Qi; Qi cannot descend and communicate with the Uterus Vessel and amenorrhoea results. The "Simple Questions" says in the chapter Ping Re Bing Lun: "If the periods do not come it means the Uterus Vessel is shut...Qi rises to harass the Lungs, Heart-Qi does not descend and the periods do not come".

Overwork weakens Heart-Yin which leads to Empty Heat: this may also cause amenorrhoea. The "Secret Record of the Orchid Room" (Lan Shi Mi Cang) says: "Mental strain and stress weaken the Heart, Heart-Fire rises and the periods do not come".

When there is Fire in the Heart channel, it rises to harass the Heart and the mouth and below it may cause excessive vaginal discharge. Chen Zi Ming says: "Vaginal sores in women are due to mental restlessness and chaotic Heart and weak Stomach-Qi resulting in stagnation of Qi and Blood". The "Simple Questions" in the chapter Zhi Zhen Yao Da Lun says: "Pain, itching and sores are due to the Heart".

Pensiveness and worry agitate the Heart, the Emperor Fire moves and fails to communicate with the Kidneys, Water and Fire do not communicate and infertility may result. Wang Yu Tai says: "Pensiveness and worry may make it difficult for a woman to conceive, the Heart houses the Mind. pensiveness makes the Heart turn towards the outside, the Emperor Fire cannot descend, Above and Below do not communicate, Water and Fire do not communicate and infertility may result".

After conception Blood is deviated to the nourishment of the foetus, Fire easily rises, this disturbs the Heart and causes mental restlessness. The "Discussion of Gynaecology" (Nu Ke Jing Lun) says: "When the Heart is affected by Blood Heat, Heart-Qi is not clear and this causes mental restlessness".


Worry agitates the Heart and causes a difficult birth. The "Gynaecology of the Bamboo Grove" (Zhu Lin Nu Ke) says: "When the Heart is affected by worry and pensiveness, Qi and Blood stagnate or flow in the wrong direction, in many cases this cases a difficult birth".

The book "Explanation of Acupuncture Points" recommends tonifying HE-8 Shaofu for prolapse of the vagina or vaginal pain and itching. The "Great Dictionary of Chinese Acupuncture" mentions HE-5 Tongli for heavy periods or Flooding and Trickling, especially in combination with LIV-2 Xingjian and SP-6 Sanyinjiao (Great Compendium of Acupuncture, 1601).

AUTOIMMUNE DISEASES - PART 2

Obviously there is no theory of “autoimmune” diseases in Chinese medicine. However, by analyzing the nature of autoimmunity and of the Chinese correspondent of the immune system (which I shall call “defence system”) , we can formulate certain theories.

In my opinion, autoimmunity implies seven aspects from a Chinese perspective which set it apart from other immunity problems (such as allergy or infection):

1) The origin of the derangement of the defence system is deeper than in other diseases;
2) The onset of the pathogenic factor in autoimmune diseases is more insidious (the Chinese word would often be “lurking”)
3) The defence system’s derangement is rooted more in its Yin aspect (Jing, Marrow, Kidneys).
4) A Kidney deficiency is at the root of autoimmunity
5) Autoimmune diseases have a very complex pathology
6) We should not equate inflammation with Heat
7) The aetiology of autoimmune diseases is different than ordinary Chinese aetiology

Before looking at these seven aspects, I would like to summarize the possible types of  pathology of the immune system and their Chinese interpretation.  My premise is that the 6 Stages and 4 Levels can be seen as patterns of disharmony of the immune system.   

Before proceeding, I should define  “Zheng Qi”.  “Zheng” can be translated as “correct” or “upright”.  I translate “Zheng Qi” as “Upright Qi”.  Note the ethical, apart from medical, implication of the term: it is a Qi that is not only healthy but “correct”, “upright”.  The term “zheng” reveals a Confucian influence on Chinese medicine.  “Upright” or “correct” implies the application of the Confucian quality  “Yi”, i.e. the appropriateness of conduct, doing what is “appropriate” in every situation (of course appropriate according to Confucian ethics). Thus, Zheng Qi is not only what is appropriate from a medical point of view but also from an ethical one.

In practical terms, “ Zheng Qi” is a general term for all types of Qi that play a role in the defence from pathogenic factors and therefore the immune response.  It is not a specific type of Qi (as Gu Qi is, for example), but a collective term to indicate all types of Qi that play a role in the immune response. The terms “Zheng Qi” is often used in opposition to “Xie Qi”, i.e.  pathogenic factor (literally “evil Qi”).

Types of immune system pathology and Chinese equivalent in the 6 Stages and 4 Levels
The following is an interpretation of dysfunctions of the immune system from the perspective of the 6 Stages and of the 4 Levels.

Invasion of exterior pathogenic factor at the Exterior level
Firstly, there is an acute bacterial or viral infection which is of course a very big part of Chinese medicine: it is the invasion of an exterior pathogenic factor that causes acute symptoms.  These are described in the 6 Stages of the Shang Han Lun or the 4 Levels of Ye Tian Shi of the Wen Bing School.  In both systems, it is the beginning stage, i.e. the Tai Yang Stage in the 6 Stages or the Wei Level in the 4 Levels.  By definition, the acute symptoms of this stage (especially fever) indicate that the Zheng Qi is reacting against the pathogenic factor: this is a good thing. The Zheng Qi is reacting against the pathogenic factor or, from a biomedical perspective, the immune system is fighting the virus (or bacteria): this is a normal, healthy reaction.  Our aim is ideally to expel the pathogenic factor at the Exterior stage; if this is not possible, we should definitely expel it (or “clear” it or “drain” it) at the Qi Level.

Exterior pathogenic factor penetrating into the Interior
If the exterior pathogenic factor penetrates into the Interior, it changes into Heat and, at this stage, it is Interior Heat: this is either the Yang Ming stage of the 6 Stages or one of the Qi Level patterns. At this stage, the fever is higher and this is still good as it indicates that the Zheng Qi (or the immune system) is reacting against the pathogenic factor (or infection in a Western sense).  These two stages (the Exterior one and the Interior-Heat one) are “normal” developments in the pathology of an invasion of a pathogenic factor.   

Yin stage as an immune deficiency 
Another pathology of the immune system is an immune deficiency as that seen in HIV. From a Chinese perspective, this is a serious and total deficiency of the Zheng Qi in all its aspects.  I would add to this also the immune deficiency that leads to cancer. In the Chinese theory of cancer (which focuses on solid tumours) all cancers are due to an accumulation of Qi and Blood: this accumulation cannot occur without an underlying deficiency of Zheng Qi. If Zheng Qi is healthy and circulates well, Qi and Blood cannot accumulate and stagnate and cancer cannot develop.  This is borne out by Western biomedicine as we know that cancers cells are formed all the time in healthy individuals and that they are neutralized by the immune system every day.
    From a Chinese perspective, I assimilate this to the three Yin stages of the 6 Stages or the Ying and Blood Levels of the 4 Levels. I am not saying that these describe the pathological changes of cancer but that they can be seen as a paradigm of the pathology of cancer in the context of the immune system.

Relative immune deficiency
There is a new type of immune deficiency that is now recognized as the root of Chronic Fatigue
Syndrome (CFS). In CFS, the patient’s immune system is reacting but not enough: this leads to the chronicity of this disease that can go on for years without the patient getting better or worse. This has only been recognized as a pathology of the immune system recently.  Previously it was thought that either the immune system is working and the patient will get better or it is not, as is the case in HIV.  From a Chinese perspective, in CFS the patient does not improve because there is a simultaneous deficiency of Zheng Qi and a pathogenic factor that is usually Dampness.
    With reference to the 6 Stages and 4 Levels, CFS often presents with the Shao Yang pattern of the 6 Stages or the Gall-Bladder Heat pattern of the 4 Levels (which is almost the same as the Shao Yang pattern).  The patient is not getting better and the course of the disease is chronic because the pathogenic factor is “stuck” in the Shao Yang energetic layer and it “bounces’ between the Yang Ming stage (causing feeling of heat) and the Tao Yang stage (causing feeling of cold), hence the alternation of feeling hot and feeling cold.

Hyper-reactivity of the immune system (allergy)
In allergy, the immune system is hyper-reactive, i.e. it reacts against allergens that a normal immune system would not react against. This is seen in allergic asthma, allergic rhinitis and atopic eczema.
    Leaving eczema aside, the allergic hyper-reaction can be assimilated to the Tai Yang stage (of the 6 Stages) or the Wei level (of the 4 Levels).  This is very clear in the case of allergic rhinitis where the symptoms mimic those of an invasion of Wind (sneezing, runny nose, headache).  Thus we could argue that the Tai Yang stage and the Wei Level describe not only the symptoms of an acute invasion of Wind but also those of respiratory allergy.
    The following Table summarizes the types of immune system dysfunction with the last one, autoimmunity, discussed below.

Immune reaction	Disease	6 Stages/4 Levels
Acute viral infection, exterior invasion of Wind	Acute influenza	Tai Yang/Wei Level
Good reaction by immune system after external attack	Acute disease (e.g. bronchitis)	Yang Ming/Qi Level
Not reacting	HIV, cancer	Tai Yin-Jue Yin-Shao Yin/Ying and Blood Level
Reacting, but not enough	Chronic Fatigue Syndrome	Shao Yang Stage/GB-Heat Qi Level
Hyper-reactivity, allergy	Allergic asthma, allergic rhinitis, atopic eczema	Tai Yang Stage/Wei Level
Autoimmunity		Latent Heat/Yin Fire

AUTO-IMMUNITY
Finally, autoimmunity is another possible pathology of the immune system in Western medicine. 
Let us look at seven aspects of autoimmunity from a Chinese perspective more in detail.  As we know, in autoimmune diseases, there is a total breakdown in that the body’s immune system fails to recognize the body as ‘self” (as the normal immune system does) and attacks it as if it were a foreign body.

1) The origin of the derangement of the defence system is deeper than in other diseases
Autoimmune diseases stem from a derangement of the immune system but none of them starts with symptoms of an exterior invasion. The onset cannot be clearly defined and the pathology is complex. Thus, the “Zheng Qi” that reacts against an external pathogenic factor is different than the “Zheng Qi” that leads to an autoimmune disease. The former is a healthy Qi that fights pathogenic factors; the latter is a dysfunctional type of Qi that attacks the body itself.

2)  The onset of the pathogenic factor in autoimmune diseases is more insidious
The onset of autoimmune diseases is never like an external invasion, it is insidious and the Chinese word used is often “lurking”.  The Chinese term for Latent Heat (which is often the pathology of autoimmune diseases)  is “fu” which means “hidden”.  As we shall see, this is often due to the development of  Latent Heat or Yin Fire.  Its “insidious” character implies that the root is often difficult to see and that the treatment will be more difficult.  For example, in an external invasion of Wind, the nature of the pathogenic factor is very clear and the treatment relatively easy.  By contrast, in an autoimmune disease, the pathogenic factor is less visible and one that gives often rise to contradicting Hot and Cold symptoms.

3) The defence system’s derangement is rooted more in its Yin aspect
As we have seen, there are very many components of the immune system in Chinese medicine, some Yang, some Yin.  Wei Qi is a Yang type of Qi and so are Yuan Qi and Ming Men; Jing and Marrow are Yin types of Qi.
    The derangement of the defence system seen in autoimmune diseases is due more to the Yin than the Yang components, i.e. Jing and Marrow.

4) A deficiency of the Kidneys is at the root of autoimmunity
A deficiency of the Kidneys is, in my opinion, nearly always at the root of autoimmune diseases. Please note that this is not necessarily a Kidney-Yin deficiency: it can be a Kidney deficiency in all its possible manifestations, i.e. Kidney-Yin, Kidney-Yang, Kidney-Jing. One reason is that a Kidney deficiency is usually the root of the development of Latent Heat which is often the pathology underlying autoimmune diseases.  Latent Heat is formed when a pathogenic factor invades the body without causing acute symptoms: the absence of acute symptoms indicates that, when the pathogenic factor invaded the body, the Zheng Qi did not react, there was no healthy immune system response.  As we shall see later, this is due to a Kidney deficiency.
    Some modern Chinese doctors see the pathology of autoimmune diseases as Yin deficiency and Empty Heat.  I cannot agree with this view and personally think that the pathology of autoimmune disease is more complicated than that. Very many patients with autoimmune diseases suffer from a Yang deficiency (clearly shown by a pale tongue).

5) Autoimmune diseases have a very complex pathology
Autoimmune diseases have a very complex pathology and confusing and contradictory symptoms and signs.  We should expect this and consider it the norm rather than the exception. This is because there is an underlying Kidney deficiency which may be Kidney-Yang deficiency which would cause Cold symptoms but, at the same time, there may be Heat symptoms due to Heat or Damp-Heat. Rheumatoid arthritis is a good example of this as the joints are hot to the touch and possibly red and yet, if there is Yang deficiency, the tongue is pale, the skin pale and the patient often feels cold.
    Another example is that of Hashimoto’s thyroiditis which is characterized by hypothyroidism in which the most common pattern is Spleen- and Kidney-Yang deficiency; however, there are cases of it with Yin deficiency.  In rheumatoid arthritis there is inflammation of the joints which may be red and swollen and yet very often the tongue is pale. Sjøgren’s syndrome’s symptoms are clearly those of Yin deficiency but often the tongue does not show it.
    Moreover, in very many autoimmune diseases there are multiple pathogenic factors such as Dampness, Phlegm, Qi stagnation, Blood stasis, Toxic Heat. 

6) We should not equate inflammation to Heat
In all autoimmune diseases there is inflammation which plays a big role in the pathology of these diseases.  Inflammation is discussed more at length below.  It is very important not to equate the Western biomedical concept of inflammation with the Chinese concept of Heat. It is perfectly possible to have inflammation in the presence of Cold and Yang deficiency. Indeed that is what often happens in Hashimoto’s thyroiditis and rheumatoid arthritis just to mention two.
    Also, if we look at the list of anti-inflammatory Chinese herbs, we can see that they are found in many different categories and not only in that of Clearing Heat: indeed, there are anti-inflammatory herbs in the Tonifying Yang or Expelling Cold categories.
A list of the anti-inflammatory Chinese herbs was given in the previous post on autoimmune diseases of 11th of January 2013.

7) Aetiology of autoimmune diseases
It is important to grasp the aetiology of autoimmune disease because it gives us an indication as to their treatment. Chinese books always mention invasion of external pathogenic factors, emotional stress, irregular diet, etc.  These do play a role but they are more triggering than causative factors.  It is true that, for example, Dampness can be an aetiological factor in MS but millions of people are invaded by Dampness and only very few will get MS, so there must be other factors at play. These factors may be toxicants, tobacco, alcohol, infectious agents and radiation.
    Again, the aetiology of autoimmune disease is deeper, more subtle, more insidious, more complex and one that must take into account modern factors.

Genetic aetiology of autoimmune diseases
In answer to the above question as to why millions of people are invaded by Dampness but only a few get MS, the answer is that there must be a strong genetic component, or what might be called “Pre-Heaven” in Chinese medicine. Therefore we must acknowledge that and remember that in the treatment, i.e. we must treat the Kidneys and Kidney-Jing.

Immunizations as aetiological factor in autoimmune diseases
In my opinion, immunizations play an important role in the aetiology of autoimmune diseases.  This is impossible to prove but my opinion and experience strongly direct me to this.  Briefly, I believe that most immunizations may create Latent Heat and this is, I believe, the pathology of may cases of autoimmune diseases (not all).  From a 4-Level perspective, when we immunize (a child or adult with influenza vaccine for example), it is as if we injected a pathogenic factor (the vaccine, whether attenuated or live) at the Blood Level directly, bypassing the other three Levels, and, crucially, especially the Wei Level. Although immunizations are supposed to stimulate the immune system to produce antibodies, the by-passing of three Levels, plays havoc with the immune system. This leads to the formation of Latent Heat which may be the cause of very many syndromes, one of them being autoimmune diseases.

Hygiene theory in autoimmune diseases
Some now think that autoimmune diseases may be caused by lack of exposure to bacteria in childhood. This is because modern children live in much more hygienic conditions than in the past. In the past, they were exposed to more bacteria and this had the effect of actually strengthening the immune system. Nowadays, children are not exposed to so many bacteria so that the immune system becomes “delicate” and starts reacting to itself (in the case of autoimmune diseases). For this reason, this theory is called the “hygiene theory”.  This is still only a theory but I think there is a lot of truth in it.  Previously, the hygiene theory explained the increasing incidence of allergic diseases but it is now thought that it also applies to autoimmune diseases.  Although very different pathologies, there is a similarity between the two in that the immune system reacts to substances it should not react to: allergens in the case of allergic diseases, the body’s own cells in the case of autoimmune diseases.    

INFLAMMATION
As inflammation is a feature of autoimmune diseases, we should discuss inflammation in biomedicine and its interpretation in Chinese medicine. Inflammation is the normal response of the organism to pathogens or irritants. Inflammation is often the consequence of infection but we should not confuse the two. When we are invaded by Wind (a virus in Western medicine) we develop a fever and an acute inflammation, i.e. we have an infection and a subsequent inflammation.

Inflammation is part of the complex biological response of vascular tissues to harmful stimuli, such as pathogens, damaged cells, or irritants.  The classical signs of acute inflammation are pain, heat, redness, swelling, and loss of function.  Inflammation is a protective attempt by the organism to remove the injurious stimuli and to initiate the healing process. Inflammation is not a synonym for infection, even in cases where inflammation is caused by infection. Although infection is caused by a microorganism, inflammation is one of the responses of the organism to the pathogen.
       
Inflammation may become chronic and play an important negative role in many diseases.  In such cases, inflammation does not play a positive role such as that played by acute inflammation in response to a pathogen.  For example, allergic asthma is an allergic disease in which an excessive number of IgE on the mast cells in the bronchi react to allergens leading to an “explosion” of the mast cells with the release of chemical mediators that cause inflammation.  These perpetuate broncho-constriction,  airway hypersensitivity and thickening of the airway wall, inflammation becomes chronic and the patient “has chronic asthma”.

Chronic inflammation can lead to a host of diseases.  Chronic inflammation is now known to be involved in cardiovascular diseases, cancer, diabetes, obesity, arthritis, neurological diseases, pulmonary diseases and autoimmune diseases.  We now know that most of these diseases are caused by dysregulation of inflammatory pathways, leading to chronic inflammation.  Interestingly, the aetiological factors of inflammation are stress, toxicants, tobacco, alcohol, infectious agents and radiation.  I would add to these immunizations (that count as infectious agents).  This list shows how modern aetiological factors are different from those of ancient Chinese medicine.

Extensive research has indicated that pro-inflammatory genes are regulated by transcription factors. Transcription factors act as drivers to control gene expression and to regulate signalling pathways.  Dysregulation of these transcription factors induces chronic inflammation and chronic disease.

Many plant active ingredients have been shown to regulate transcription factors and inhibit inflammation. The following is a list of these ingredients from Chinese herbs.

Butein from Jiang Xiang Lignum Dalbergiae odoriferae (move Blood)
Cardamonin from Cao Dou Kou Semen Alpiniae katsumadai (resolve Dampness, move Qi).
Berberine from Huang Lian  Rhizoma Coptis (clear Heat and Damp-Heat)
Evodiamine from Whu Zhu Yu Fructus Evodia rutaecarpae (expel Cold)
Boswellic acid from Ru Xiang Resina Boswelliae carterii (move Blood)
Emodin from Hu Zhang Rhizoma Polygoni cuspidati (move Blood) and Da Huang Radix et Rhizoma  Rhei 
Curcumin from Jiang Huang Rhizoma Curcumae longae (move Qi, move Blood).

Inflammation can be classified as either acute or chronic. Acute inflammation is the initial response of the body to harmful stimuli and is achieved by the increased movement of plasma and leukocytes (especially granulocytes) from the blood into the injured tissues. A cascade of biochemical events propagates and matures the inflammatory response, involving the local vascular system, the immune system, and various cells within the injured tissue.

Chronic inflammation, leads to a progressive shift in the type of cells present at the site of inflammation and is characterized by simultaneous destruction and healing of the tissue from the inflammatory process.

An allergic reaction, known as type 1 hypersensitivity, is the result of an inappropriate immune response triggering inflammation.  A common example is allergic rhinitis which is caused by a hypersensitive response by skin mast cells to allergens.  Pre-sensitised mast cells respond by degranulating, releasing vasoactive chemicals such as histamine.  These chemicals propagate an excessive inflammatory response characterised by blood vessel dilation, production of pro-inflammatory molecules, cytokine release, and recruitment of leukocytes.

Other hypersensitivity reactions of type 2 (hemolytic anemia, myasthenia gravis, pernicious anemia) and type 3 (SLE, rheumatoid arthritis, autoimmune glomerulonephritis) are mediated by antibody reactions and they also induce inflammation by attracting leukocytes which damage surrounding tissue.

Inflammation plays a role also in cancer. Inflammation orchestrates the microenvironment around tumours, contributing to proliferation, survival and migration. Cancer cells use selectins, chemokines and their receptors for invasion, migration and metastasis.

Inflammation and autoimmune diseases
The part of the immune system that fights pathogens is the acquired immune system.  It “remembers” foreign antigens, or proteins, so that it can fight them if they come back. It employs  lymphocytes.
    The body also has an innate immune system that is more primitive. It employs other types of white blood cells such as granulocytes and monocytes to destroy harmful substances.  In autoinflammatory diseases, this innate immune system causes inflammation for unknown reasons. It reacts, even though it has never encountered autoantibodies or antigens in the body.  This is interesting as, in my opinion, the innate immune system might be reacting against the pathogens of immunizations.
    Autoinflammatory disorders are characterized by intense episodes of inflammation that result in such symptoms as fever, rash, or joint swelling.  These diseases also carry the risk of amyloidosis, a potentially fatal build up of a blood protein in vital organs.