Advanced Herbal Approaches for Gastro-Intestinal Lyme Disease Treatment
GU ADVANCED HERBAL STUDIES:
Treatment of Gastro-Intestinal Lyme Disease
Hillary Thing, LAc., Cert. Herbalist (NCCAOM)
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Gastroparesis
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SIBO (small intestine bacterial overgrowth)
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Syndromes appearing as Crohn’s disease or colitis
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Abdominal pain
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Cramping
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Vomiting and nausea
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Diarrhea
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Constipation (Bell’s Palsy of the gut)
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Heartburn / GERD
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Blood in the stool
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Borreliosis
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Bartonella
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Mycoplasma
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H pylori
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Babesia
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Yeast
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Parasites
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Common location of biofilm
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Potential exposure to tick or other insect bites;
Atypical presentation;
Recent medical history includes additional unusual and non-
GI related symptoms such as fever, joint pain or neurological
symptoms;
Current GI disorder is accompanied by neurological or other
unusual symptoms.
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Direct infection of the gut;
Damage resulting from antibiotic or other pharmaceutical
treatment;
Immune system changes caused by the pathogenic factors
that lead to the development of food allergies;
Infection of the nervous system that infuses the organs of
the GI tract;
Consuming food that feeds the inflammation and
congestion.
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Unresolved PF (pestilential qi) can lead to serious
inflammatory disease even in previously healthy person
Chronic condition with unresolved pathogenic factors
weakens qi and lingers in the body for a long time.
In order to heal, need to know how to restore qi and
blood.
All of us could benefit from post-natal qi tonification to
maintain the integrity of our health.
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Can lead to overstimulation and taxation of the immune system, GI
system, and liver;
In some cases body may become dependent on routine
supplementation e.g. CoQ10 and diminishes own production;
Overtonification of qi -> increases heat -> increases dampness as a
response -> sluggish energy
If supplement the system that’s already weak, how to ensure
absorption takes place; otherwise, expensive urine. (with poor
results).
If take s/t, should be s/t the body is lacking + seek to correct the
mechanism to produce it.
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Earth School / Bu Tu Pai
–> poor digestion is the root of all disease (Li Dong
Yuan, 1180-1252 AD)
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Basis for post-natal qi & blood
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Intestine Stomach specialty / Chang wei ke
-> dev. During Southern Song D.
(1279 AD); the 2 were developing concurrently and co-existed in China.
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Chang Wei Ke model of good digestion:
1.
Stimulate the appetite (open the stomach)
2.
Descend Stomach Qi (harmonize stomach with Spleen)
3.
Stimulation of Stomach Fire (or clear excess)
4.
Ripening & rotting, transformation & transportaion
5.
Descension of Large Intestine & Urinary Bladder
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1.
Food enters the Stomach; the Stomach rots & ripens
and allows formation of gu qi (food qi);
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Under the auspices of the Spleen, gu qi ascends and
mixes w/ qi from the exterior; Da (great / air) qi
combines in chest;
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Synergy / union of 2 is chest / Zong qi -> produces
zheng qi / True = post-natal qi is final product.
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Problems in this process occur when:
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Food is not properly descending
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Not enough good gathering / movement (diaphragmatic function)
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Quality of Da (air) Qi or Gu (food) qi is poor
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Lack of sufficient bowel emptying
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Liver invading Spleen – emotions override what you really need
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Imbalanced food intake – too much or not the right “flavor” for your body
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Excess or deficient Stomach fire (hyper or hypo-acidity and enzyme activity) /
infection
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Damp-heat in liver-gallbladder or intestines (infection, inflammation &
congestion)
ALL COMPLICATIONS MUST BE ADDRESSED BEFORE / IN ORDER FOR TONIFICATION
TO OCCUR!!
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1.
Open the Stomach (appetite)
2.
Descend Stomach Qi
3.
Harmonize Stomach with Spleen
4.
Clear excess Stomach Fire
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Strengthen Spleen’s Production of Gu Qi
1.
Dissolve Food Stagnation
2.
Transform Fluid Stagnation
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Regulate Qi Stagnation & Stasis
4.
Enhance Absorption of Da (Big) Qi
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Open the Diaphragm
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Tonify Spleen’s Transformative & Transportive capacity
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Support elimination via the bowels
1.
resolve damp-heat
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Purging
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Promote peristalsis
4.
Replenish bowel fluids
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Treats poor appetite; creates optimum environment for ingestion;
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Stimulates appetite before meals; assists in digestion if taken after;
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Prevents food stagnation.
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Single herbs (for modification of other formula): all are warming, spicy
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Amomi villosum (cardamom) / sha ren – strengthens Spleen by getting rid of damp;
harmonizes Spleen w/ Stomach
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Myristica (nutmeg) / rou dou kou – Opens Stomach by emptying LI; stops diarrhea due to
yang def., regulates LI; tx abdominal pain, ST ache, analgesic; moves qi, relieves stagnation
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Amomi cardamom (white cardamom) / bai dou kou – Opens Stomach by relaxing
diaphragm, bringing more air into Lungs; tx rebellious qi in Lungs, STomach
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Spicy, warming dilates and opens – too much may produce ST fire, promote
appetite too much (use small amounts of these herbs)
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Cook short time (5–10 min.).
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Representative Formula: Fat Baby Pill / Pang Er Wan
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Tx poor appetite, malnourishment; parasites; leaky gut; good for children
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Opens Stomach, descends Stomach Qi, harmonizes Spleen and Stomach, treats excess
Stomach Fire
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Need to strengthen the Spleen before attempting tonifcation, and get rid of damp-heat.
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Ingredients:
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Dry-fried Massa Fermentata / chao shen qu
300 g
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Coptis / huang lian
300 g
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Nutmeg / rou dou kou
150 g
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Quisqualis / shi jun zi
150 g.
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Barley sprout / mai ya
150 g
(sub xiang fu)
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Areca nut / bing lang
120 g
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Sausurrea / mu xiang
60 g
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Powder; take on empty stomach (before food)
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Hunger but then fills quickly b/c Stomach Qi is not descending fully
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Loss of appetite, nausea, belching (esp. after little intake of food);
regulates intestinal pain
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Basic herbs:
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Immature Citrus Aurantium / zhi shi – breaks up stagnant qi, reduces
accumulation; transforms phlegm
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Pinellia / ban xia – dries damp, transforms phlegm, descends rebellious ST qi;
dissipates ndoules & clumps
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Magnolia bark / hou po – dry damp, transform phlegm, direct qi down,
dissolve distention
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Imperata / bai mao gen - sweet, cold - clears ST fire and LU heat; cools heat in
blood; tx painful urination (UTI)
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Use as addition to modify other formulas as needed.
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Often presents as disruption of Stomach’s descension affecting Spleen’s ascension with
pent-up sensations in the chest and throat (e.g. plum pit qi, nausea / vomiting,
bloating, reflux, flatulence) – sx above and below the umbilicus;
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focal distention with qi stagnation (chest tightness, throat obstruction
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May be accompanied with hot or cold signs or both (heat above, cold below) b/c qi
movement is stuck / ST fire consumes qi
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Basic Herbs:
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fresh ginger / sheng jiang – release exterior wind-cold, warms middle, detoxifying; tx cough, n/v
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perilla leaf / zi su ye – release exterior wind-cold, moves qi and expands chest; food poisoning
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Pinellia / ban xia - dries damp, transforms phlegm, descends rebellious ST qi; dissipates ndoules &
clumps
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2 Representative Formulas:
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Ban Xia Hou Po Tang / Pinellia & Magnolia Bark Decoction
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Ban Xia Xie Xin Tang / Pinellia Drain the Heart Decocotion
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Ingredients:
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Fresh ginger / sheng jiang
15 g
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Pinellia / ban xia
9 g
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Magnolia bark / hou po
9 g
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Hoelen / fu ling
12 g
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Perilla leaf / zi su ye
6 g
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Tx Stomach heat / fire damaging Spleen qi; heat is rising and infecting
the heart.
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Disharmony in both upper and lower GI (e.g. nausea / vomiting +
diarrhea); sudden turmoil disorder
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Tx infectious diseases, e.g. GI flu
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No tonification but corrects the qi dynamics.
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Ingredients:
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Pinellia / ban xia
9 g
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Dried ginger / gan jiang
9 g
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Scutellaria / huang qin
9 g
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Coptis / huang lian
3 g
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Ginseng / ren shen
9 g
(sub out)
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Jujube / da zao
12 pc.
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Honey fried licorice / zhi gan cao
9 g
(sub gan cao)
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More rebellious stomach qi sx;
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More heat / inflammation / infection
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Excess heat can impair proper “rotting and ripening” of the Stomach -> can’t
build post-natal qi. Damages the Spleen, Stomach fluids, and blood.
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May involve infectious pathogenic factors
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Presents as bad breath, GERD, gum swelling / bleeding (blood), toothache (jing),
excess hunger (mucous membranes where jing qi is = blood, jing levels)
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Basic Herbs:
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Coptis / huang lian - bitter, cold – ST fire affecting Heart (spirit disturbance); antimicrobial
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Imperata / bai mao gen – sweet, cold - Descends rebellious ST qi; clears ST fire and LU heat;
cools heat in blood; tx painful urination
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Eryobotrya / pi pa ye – bitter, cold, LU, ST – Descends ST and LU qi; harmonizes stomach;
expels phlegm
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Phragmites / lu gen – ST, LU; sweet, cold – Promotes urination, generates fluids; clears heat +
tx Stomach yin def
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Gypsum / shi gao – mineral to cool down exuberant fire in Lungs, Stomach; spicy, sweet, cold
so doesn’t damage yang qi
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Representative Formula: Qing Wei San / Clear the Stomach Powder
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Ingredients:
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Coptis / huang lian
1.8 g
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Cimicifuga / sheng ma
3 g
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Moutan / mu dan pi
1.5 g
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Raw rehmannia / sheng di
.9 g
(sub out)
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Angelica sinensis / dang gui
.9 g
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Sub out raw rehmannia for other clear stomach fire herb; use bai mao
gen if lots of blood level symptoms; if sx of toxic heat, use gypsum;
fluid deficiency -> lu gen; abscesses, sores on tongue/mouth – pi pa
ye
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Works with ascension of Spleen qi and SP’s transformation and
transportation of gu qi, jin-ye body fluids, and red substance that
eventually becomes xue-blood (at the Heart).
1.
Dissolve food stagnation
2.
Transform fluid stagnation
3.
Regulate Qi Stagnation & Stasis
4.
Enhance absorption of Da – Big Qi
5.
Open the diaphragm
6.
Tonify Spleen’s transforming & transporting capacity
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Manifests as epigastric and abdominal distention, reflux, pain, and
weighted feeling on the chest; nausea, vomiting, loss of appetite b/c food is
not digesting;
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inability to “ripen” will increase “rotting” which produces bad breath,
dampness, stomach turbidity, thick tongue coating b/c food hasn’t reached
maturity it doesn’t fully transform.
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Can lead to qi stagnation with belching and flatulence (and eventually
heat); likewise, qi stagnation can lead to food stagnation.
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Basic herbs:
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Shan zha (meat)
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Amomi tsao-ko / cao guo (meat)
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Rice & barley sprouts / gu ya & mai ya (complex carbs / starch)
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Massa fermentata / shen qu (alcohol, simple sugars)
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Curcuma zedoaria / e zhu & sparganium / san lung (for sugar clumping the blood ->
blood stasis)
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Representative formula: Preserve Harmony Pill / Bao He Wan
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Created by Zhu Dan Xi
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Tx Stomach fire -> Spleen qi deficiency with damp accumulation / phlegm stasis -> taxation on
kidney; helps patient’s digestion get better so system can strengthen
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Ingredients:
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Crataegus / shan zha
180 g
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Massa fermentata / shen qu
60 g
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Raphani (radish seed) / lai fu zi
30 g
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Pinellia / ban xia
90 g
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Mature citrus peel / chen pi
30 g
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Hoelen / fu ling
90 g
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Forsythia / lian qiao
30 g
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If Kidney yang deficient symptoms (cold!!), + gan jiang / dried ginger
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If food stagnation the result of insufficient stomach fire with Spleen yang qi def -> add more
ascending, warming spicy herbs
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Treats overweight, damp digestion contributing to blood stasis, high cholesterol, phlegm stasis,
pre-diabetic condition.
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Manifests as abdominal fullness and drum-like distention; heaviness
and pitting edema; may affect Spleen’s production of blood -> anemia
/ blood deficiency signs
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Basic herbs: both are acrid, bitter, aromatic, warm, enter SP, ST
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Black atractulodes / cang zhu – bitter, clears damp in lower-jiao; strengthens
Spleen; helps transform damp in the 4 limbs (swelling)
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Magnolia bark / hou po – tx food stagnation leading to phlegm; food stag due
to damp, refined sugar
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The combination transforms fluid stagnation, damp turbidity and
phlegm.
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Manifests as generalized focal (pi) distention, fullness and pain in epigastric
ad abdominal region w/ occasional spasm (wind), flatulence, belching,
bloating; constipation and/or very frequent bowel movement
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Unresolved qi stagnation -> food stagnation, heat
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Also leads to qi stasis -> abdominal masses
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Often due to emotional or eating rapidly; important for tx of eating
disorders due to emotional issues.
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Basic herbs:
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Xiang fu / cyperus - Liver
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Chen pi / Mature citrus peel – Lung, Stomach
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Zhi shi / Immature citrus Aurantium - Stomach
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Mu xiang / Sausurrea – Stomach & Intestines
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Lai fu zi / Raphani (radish seed) - Spleen, Stomach
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Representative formula: Saussurrea & Areca Nut Pill / Mu Xiang Bing Lang
Wan
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Regulates qi for digestion, moves downward via purging
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Ingredients:
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Sausurrea / mu xiang
30 g
•
Areca nut / bing lang
30 g
•
Mature citrus peel / chen pi
30 g
•
Immature citrus peel / qing pi
30 g
(or zhi shi)
•
Coptis / huang lian
30 g
•
Curcumae zeodaria / e zhu
30 g
•
Rhubarb / da huang
90 g
•
Phellodendron / huang bai
90 g
•
Pharbitidis / qian niu zi
120 g
(or mang xiao)
•
Dry fried cyperus / chao xiang fu
120 g
•
May add 30 g san leng / sparganium
•
Gentler non-purging option – Cyperus & Amomi Villosum to Calm the Stomach
Powder / Xiang Sha Ping Wei San
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Increase respiratory capacity, strengthen resistance to environmental pollutants, increase
ability to expel EPI
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Stabilizes strength and moves qi through the Lungs
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Treats concurrent weak digestion + poor energy / immunity; weakness/SOB on exertion;
lack of stamina
•
+ Some weakness / stagnation of lungs
•
Basic herbs:
•
Tangerine peel / ju pi – bitter, warm; gathering so enhances absorption of da qi
•
Mature citrus peel / chen pi -
•
Diospyros (persimmon top) / shi di – LU, ST, bitter, astringent; stops vomiting, belching; relaxes
diaphragm, opens Lung capacity
•
Caryophylli (clove) / ding xiang – SP, ST, KI; spicy, warm; tx yang deficiency, warms the middle; tx
rebellious qi, enhances opening the diaphragm
•
Withania somnifera / Ashwaganda
•
Rhodiola
•
Astragalus / huang qi
•
Representative formula: Clove & Persimmon Calyx Decoction
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Enhances Da Qi, promotes respiration, descends rebellious Stomach
qi and anchors qi in Kidneys
•
Ingredients:
•
Clove / ding xiang
6 g
•
Persimmon / shi di
6-9 g
•
Ginseng / ren shen
3-6 g (sub out)
•
Fresh ginger / sheng jiang
6-9 g
•
Substitute rhodiola, astragalus and/or ashwaganda for ren shen
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An open diaphragm is important for the movement of pathogens out
through portals – sense organs, skin, urine, etc. either up and out or down
and out; Spleen can’t get qi to the lungs due to constriction of the
diaphragm; if liver not tight but lung is, use citrus peels for diaphragmatic
constriction due to phlegm
•
Qi stagnation due to diaphragmatic constriction can result in phlegm or
heat stagnation, or emotional disturbance (e.g. irritability)
•
If can’t get Da Qi produced -> Qi Deficiency
•
Basic herbs:
•
Bupleurum / chai hu – fave of Li Dong Yuan – LV / GB; sl. Acrid, dispersing, bitter,
ascends the yang qi, regulates Liver, treats shao yang conditions, cooling (upward fx);
best for yang emotions (anger, anxiety)
•
Cyperus / xiang fu – Nourish Yin School – acrid, sl. Bitter, sweet, sl. Warm, regulates
menses and emotions, tx diaphragmatic constriction from Liver qi stagnation (opens
up or down) – best for yin emotions (fear, depression, sadness)
•
Saussurea / mu xiang – Purgative School – acrid, bitter, warm; regulates Spleen,
Stomach & Intestinal Qi; relaxes liver (downward fx)
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Have to address Gu Qi / Da Qi paradigm or won’t benefit by tonification of
post-natal qi;
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Done properly, tonification won’t add to Lung or Stomach heat and will be
well-absorbed and digested
•
Basic herbs: warming!
•
Shan yao / dioscorea
•
White atractylodes / bai zhu
•
Licorice / gan cao
•
Astragalus / huang qi
•
Representative formulas:
•
Saussurrea & Amomi Villosum to Nourish Stomach Decoction / Xiang Sha Yang Wei
Tang
•
Tonify the Center to Benefit the Qi Decoction / Bu Zhong Yi Qi Tang
•
Preserve the Original Decoction / Bao Yuan Tang
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Ingredients:
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White atractylodes / bai zhu
3 g
•
Ginseng / ren shen
1.5 g
•
Black atractylodes / cang zhu
2.4 g
•
Hoelen /fu ling
2.4 g
•
Magnolia bark / hou po
2.4 g
•
Fresh ginger / sheng jiang
3 g
•
Mature citrus peel / chen pi
2.4 g
•
Cyperus / xiang fu
2.4 g
•
Amomi villosum / sha ren
2.4 g
•
Amomi cardamom / bai dou kou
2.1 g
•
Sausurrea / mu xiang
1.5 g
•
Jujube / da zao
1.5 g
•
Honey-fried licorice / zhi gan cao
1.5 g
•
Cold-damp diet (vegan), cold-damp condition;
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**Addresses all concerns of Chong Wei Ke
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Developed by Li Dong Yuan
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Ingredients:
•
Astragalus / huang qi
3 g
•
Ginseng / ren shen
.9 g
•
White atractylodes / bai zhu
.9 g
•
Honey-fried licorice / zhi gan cao
1. 5g
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Angelica sinensis / dang gui
6 g
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Mature citrus peel / chen pi
.9 g
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Cimicifuga / sheng ma
.9 g
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Bupleurum / chai hu
.9 g
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Builds both qi and blood, enhances da qi absorption, opens diaphragm.
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If Spleen qi deficient, ability to absorb not strong -> sip throughout day
rather than take large amount at once.
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Developed by Li Dong Yuan
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Ingredients:
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Astragalus / huang qi
6-9 g
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Ginseng / ren shen
6-9 g
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Cinnamon bark / rou gui
1.5 – 2.1 g
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Honey-fried licorice / zhi gan cao
3 g
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Builds Zong-Gathering Qi; brings Kidney yang to middle jiao (MM fire
to support Spleen qi)
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Skeleton (teaching) formula when 4 herbs only; add to address
complications
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Resolve damp-heat in the bowels
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Purging the bowels
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Promote peristalsis
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Replenish yin fluids (cannabis seed, magnesium, vitamin c, oils)
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Basic Herbs:
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Capillaris / yin chen hao
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Coptis / huang lian
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Scutellaria / huang qin
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Representative Formula: White Peony Decoction / Shao Yao Tang
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White peony / bai shao
30 g
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Angelica sinensis / dang gui
15 g
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Coptis / huang lian
15 g
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Scutellaria / huang qin
15 g
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Rhubarb / da huang
9 g
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Cinnamon inner bark / rou gui
7.5 g
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Areca nut / bing lang
6 g
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Sausurrea / mu xiang
6 g
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Licorice / gan cao
6 g
•
Constipation / diarrhea; emotional disturbance (established HT/KI communication);
diaphragmatic constriction; immune deficiency
•
See also Mu Xiang Bing Lang Wan (more focus on SP/ST dynamic, parasites,
fermentation)
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Basic Herbs:
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Rhubarb / da huang
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Mirabilitum / mang xiao
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Cannabis seed / huo ma ren
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Representative Formulas:
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Hemp Seed Pill / Ma Zi Ren Wan
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Cannabis Seed / huo ma ren
600 g
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Rhubarb / da huang
300 g
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Prunus armenica / xing ren
150 g
•
White peony / bai shao
150 g
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Immature citrus aurantium / zhi shi
150 g
•
Magnolia bark / hou po
150 g
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Need yin and blood to help flush out PF’s
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Dry stool; severely constipated
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Powder into pills w/ honey and take 9 g / 1-2x / day
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Basic Herbs:
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Immature Citrus aurantium / zhi shi
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Mature Citrus aurantium / zhi ke
•
Cistanche / rou cong rong
•
Senna
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Cascara sagrada
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Is this strategy included in the formula? Does the patient need this, and if so, in what
proportion?
Open the Stomach (address appetite)
Descend Stomach Qi
Harmonize Stomach with Spleen
Clear excess Stomach Fire
Strengthen Spleen’s Production of Gu Qi
Dissolve Food Stagnation
Transform Fluid Stagnation
Regulate Qi Stagnation & Stasis
Enhance Absorption of Da (Big) Qi
Open the Diaphragm
Tonify Spleen’s Transformative & Transportive capacity
Support elimination via the bowels -> purging / peristalisis / nourish fluids
resolve damp-heat / address specific microbial infections
Break up biofilm
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E
S
1.
Gastrointestinal Lyme, by Dr. Martin Friedman.
https://www.lymedisease.org/TheLymeTimes-
V42/files/assets/common/downloads/page0022.pdf
2.
Neurologic Lyme Disease Presenting As Abdominal Pain in 71-year-old
Patient. Daniel Cameron, MD.
http://danielcameronmd.com/neurologic-
lyme-disease-presenting-as-abdominal-pain-in-71-year-old-patient/
3.
The Spectrum of Gastrointestinal Manifestation in Lyme Disease. Fried,
Martin; Abel, M; et al. Journal of Pediatric Gastroenterology &
Nutrition:
October 1999 - Volume 29 - Issue 4 - p 495
4.
Schefte DF, Nordentoft T. Intestinal Pseudoobstruction Caused by Chronic
Lyme Neuroborreliosis. A Case Report.
J Neurogastroenterol Motil
.
2015;21(3):440–442. doi:10.5056/jnm14118
5.
Yuen, Jeffrey. Personal notes from lectures 2000-2005.
Unveil the symptoms, stealth pathogenic gut infections, differentiation from typical GI diseases, causes of GI disorders, and post-natal Qi tonification in addressing Gastrointestinal Lyme Disease using advanced herbal studies. Learn to differentiate infectious GI diseases, identify potential causes, and restore vital energy for holistic healing.
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GU ADVANCED HERBAL STUDIES: Treatment of Gastro-Intestinal Lyme Disease Hillary Thing, LAc., Cert. Herbalist (NCCAOM)
Symptoms of Gastrointestinal Lyme Disease Symptoms of Gastrointestinal Lyme Disease Gastroparesis SIBO (small intestine bacterial overgrowth) Syndromes appearing as Crohn s disease or colitis Abdominal pain Cramping Vomiting and nausea Diarrhea Constipation (Bell s Palsy of the gut) Heartburn / GERD Blood in the stool
Known stealth pathogenic gut infections Known stealth pathogenic gut infections Borreliosis Bartonella Mycoplasma H pylori Babesia Yeast Parasites Common location of biofilm
Differentiation from typical / non Differentiation from typical / non- -infectious GI disease disease infectious GI Potential exposure to tick or other insect bites; Atypical presentation; Recent medical history includes additional unusual and non- GI related symptoms such as fever, joint pain or neurological symptoms; Current GI disorder is accompanied by neurological or other unusual symptoms.
Causes of Gu Causes of Gu- -GI dis GI dis- -ease ease Direct infection of the gut; Damage resulting from antibiotic or other pharmaceutical treatment; Immune system changes caused by the pathogenic factors that lead to the development of food allergies; Infection of the nervous system that infuses the organs of the GI tract; Consuming food that feeds the inflammation and congestion.
School of Post School of Post- -Natal Qi Natal Qi Tonification Tonification Unresolved PF (pestilential qi) can lead to serious inflammatory disease even in previously healthy person Chronic condition with unresolved pathogenic factors weakens qi and lingers in the body for a long time. In order to heal, need to know how to restore qi and blood. All of us could benefit from post-natal qi tonification to maintain the integrity of our health.
Critique re. excess Critique re. excess tonification supplementaton supplementaton tonification / / Can lead to overstimulation and taxation of the immune system, GI system, and liver; In some cases body may become dependent on routine supplementation e.g. CoQ10 and diminishes own production; Overtonification of qi -> increases heat -> increases dampness as a response -> sluggish energy If supplement the system that s already weak, how to ensure absorption takes place; otherwise, expensive urine. (with poor results). If take s/t, should be s/t the body is lacking + seek to correct the mechanism to produce it.
2 main schools of though re. digestion in CM: 2 main schools of though re. digestion in CM: Earth School / Bu Tu Pai > poor digestion is the root of all disease (Li Dong Yuan, 1180-1252 AD) Basis for post-natal qi & blood Intestine Stomach specialty / Chang wei ke -> dev. During Southern Song D. (1279 AD); the 2 were developing concurrently and co-existed in China. Chang Wei Ke model of good digestion: 1. Stimulate the appetite (open the stomach) 2. Descend Stomach Qi (harmonize stomach with Spleen) 3. Stimulation of Stomach Fire (or clear excess) 4. Ripening & rotting, transformation & transportaion 5. Descension of Large Intestine & Urinary Bladder
Creating Functional Digestion for post Creating Functional Digestion for post- -natal qi production: Chong Wei production: Chong Wei Ke natal qi Ke (Gastroenterology) (Gastroenterology) 1. Food enters the Stomach; the Stomach rots & ripens and allows formation of gu qi (food qi); 2. Under the auspices of the Spleen, gu qi ascends and mixes w/ qi from the exterior; Da (great / air) qi combines in chest; 3. Synergy / union of 2 is chest / Zong qi -> produces zheng qi / True = post-natal qi is final product.
Creating Functional Digestion for post Creating Functional Digestion for post- -natal qi production: Chong Wei production: Chong Wei Ke natal qi Ke (Gastroenterology) (Gastroenterology) Problems in this process occur when: Food is not properly descending Not enough good gathering / movement (diaphragmatic function) Quality of Da (air) Qi or Gu (food) qi is poor Lack of sufficient bowel emptying Liver invading Spleen emotions override what you really need Imbalanced food intake too much or not the right flavor for your body Excess or deficient Stomach fire (hyper or hypo-acidity and enzyme activity) / infection Damp-heat in liver-gallbladder or intestines (infection, inflammation & congestion) ALL COMPLICATIONS MUST BE ADDRESSED BEFORE / IN ORDER FOR TONIFICATION TO OCCUR!!
Treatment Principles for Treatment Principles for Creating Functional Digestion Creating Functional Digestion 1. 2. 3. 4. 5. Open the Stomach (appetite) Descend Stomach Qi Harmonize Stomach with Spleen Clear excess Stomach Fire Strengthen Spleen s Production of Gu Qi 1. Dissolve Food Stagnation 2. Transform Fluid Stagnation 3. Regulate Qi Stagnation & Stasis 4. Enhance Absorption of Da (Big) Qi 5. Open the Diaphragm 6. Tonify Spleen s Transformative & Transportive capacity Support elimination via the bowels 1. resolve damp-heat 2. Purging 3. Promote peristalsis 4. Replenish bowel fluids 6.
Step 1: Open the Stomach (Kai Wei) Step 1: Open the Stomach (Kai Wei) Treats poor appetite; creates optimum environment for ingestion; Stimulates appetite before meals; assists in digestion if taken after; Prevents food stagnation. Single herbs (for modification of other formula): all are warming, spicy Amomi villosum (cardamom) / sha ren strengthens Spleen by getting rid of damp; harmonizes Spleen w/ Stomach Myristica (nutmeg) / rou dou kou Opens Stomach by emptying LI; stops diarrhea due to yang def., regulates LI; tx abdominal pain, ST ache, analgesic; moves qi, relieves stagnation Amomi cardamom (white cardamom) / bai dou kou Opens Stomach by relaxing diaphragm, bringing more air into Lungs; tx rebellious qi in Lungs, STomach Spicy, warming dilates and opens too much may produce ST fire, promote appetite too much (use small amounts of these herbs) Cook short time (5 10 min.). Representative Formula: Fat Baby Pill / Pang Er Wan
Step 1: Open the Stomach (Kai Wei) Step 1: Open the Stomach (Kai Wei) Representative Formula: Fat Baby Pill / Pang Representative Formula: Fat Baby Pill / Pang Er Er Wan Wan Tx poor appetite, malnourishment; parasites; leaky gut; good for children Opens Stomach, descends Stomach Qi, harmonizes Spleen and Stomach, treats excess Stomach Fire Need to strengthen the Spleen before attempting tonifcation, and get rid of damp-heat. Ingredients: Dry-fried Massa Fermentata / chao shen qu Coptis / huang lian 300 g Nutmeg / rou dou kou 150 g Quisqualis / shi jun zi 150 g. Barley sprout / mai ya 150 g (sub xiang fu) Areca nut / bing lang 120 g Sausurrea / mu xiang 60 g Powder; take on empty stomach (before food) 300 g
Step 2: Descend Stomach Qi Step 2: Descend Stomach Qi Hunger but then fills quickly b/c Stomach Qi is not descending fully Loss of appetite, nausea, belching (esp. after little intake of food); regulates intestinal pain Basic herbs: Immature Citrus Aurantium / zhi shi breaks up stagnant qi, reduces accumulation; transforms phlegm Pinellia / ban xia dries damp, transforms phlegm, descends rebellious ST qi; dissipates ndoules & clumps Magnolia bark / hou po dry damp, transform phlegm, direct qi down, dissolve distention Imperata / bai mao gen - sweet, cold - clears ST fire and LU heat; cools heat in blood; tx painful urination (UTI) Use as addition to modify other formulas as needed.
Step 3: Harmonize the Stomach & Spleen Step 3: Harmonize the Stomach & Spleen Often presents as disruption of Stomach s descension affecting Spleen s ascension with pent-up sensations in the chest and throat (e.g. plum pit qi, nausea / vomiting, bloating, reflux, flatulence) sx above and below the umbilicus; focal distention with qi stagnation (chest tightness, throat obstruction May be accompanied with hot or cold signs or both (heat above, cold below) b/c qi movement is stuck / ST fire consumes qi Basic Herbs: fresh ginger / sheng jiang release exterior wind-cold, warms middle, detoxifying; tx cough, n/v perilla leaf / zi su ye release exterior wind-cold, moves qi and expands chest; food poisoning Pinellia / ban xia - dries damp, transforms phlegm, descends rebellious ST qi; dissipates ndoules & clumps 2 Representative Formulas: Ban Xia Hou Po Tang / Pinellia & Magnolia Bark Decoction Ban Xia Xie Xin Tang / Pinellia Drain the Heart Decocotion
Ban Xia Ban Xia Hou Decoction Decoction Hou Po Tang / Po Tang / Pinellia Pinellia & Magnolia Bark & Magnolia Bark Ingredients: Fresh ginger / sheng jiang Pinellia / ban xia Magnolia bark / hou po Hoelen / fu ling Perilla leaf / zi su ye Tx Stomach heat / fire damaging Spleen qi; heat is rising and infecting the heart. Disharmony in both upper and lower GI (e.g. nausea / vomiting + diarrhea); sudden turmoil disorder Tx infectious diseases, e.g. GI flu No tonification but corrects the qi dynamics. 15 g 9 g 9 g 12 g 6 g
Ban Xia Ban Xia Xie (Epigastrium) Decoction (Epigastrium) Decoction Xie Xin Tang / Xin Tang / Pinellia Pinellia Drain the Heart Drain the Heart Ingredients: Pinellia / ban xia Dried ginger / gan jiang Scutellaria / huang qin Coptis / huang lian Ginseng / ren shen Jujube / da zao Honey fried licorice / zhi gan cao More rebellious stomach qi sx; More heat / inflammation / infection 9 g 9 g 9 g 3 g 9 g 12 pc. (sub out) 9 g (sub gan cao)
Step 4: Clear Stomach Fire Step 4: Clear Stomach Fire Excess heat can impair proper rotting and ripening of the Stomach -> can t build post-natal qi. Damages the Spleen, Stomach fluids, and blood. May involve infectious pathogenic factors Presents as bad breath, GERD, gum swelling / bleeding (blood), toothache (jing), excess hunger (mucous membranes where jing qi is = blood, jing levels) Basic Herbs: Coptis / huang lian - bitter, cold ST fire affecting Heart (spirit disturbance); antimicrobial Imperata / bai mao gen sweet, cold - Descends rebellious ST qi; clears ST fire and LU heat; cools heat in blood; tx painful urination Eryobotrya / pi pa ye bitter, cold, LU, ST Descends ST and LU qi; harmonizes stomach; expels phlegm Phragmites / lu gen ST, LU; sweet, cold Promotes urination, generates fluids; clears heat + tx Stomach yin def Gypsum / shi gao mineral to cool down exuberant fire in Lungs, Stomach; spicy, sweet, cold so doesn t damage yang qi Representative Formula: Qing Wei San / Clear the Stomach Powder
Step 4: Clear Stomach Fire Step 4: Clear Stomach Fire Rep. Formula: Qing Wei San / Clear the Stomach Powder Rep. Formula: Qing Wei San / Clear the Stomach Powder Ingredients: Coptis / huang lian Cimicifuga / sheng ma Moutan / mu dan pi Raw rehmannia / sheng di Angelica sinensis / dang gui Sub out raw rehmannia for other clear stomach fire herb; use bai mao gen if lots of blood level symptoms; if sx of toxic heat, use gypsum; fluid deficiency -> lu gen; abscesses, sores on tongue/mouth pi pa ye 1.8 g 3 g 1.5 g .9 g .9 g (sub out)
Step 5: Strengthen Spleens Processing of Gu Qi Step 5: Strengthen Spleen s Processing of Gu Qi Works with ascension of Spleen qi and SP s transformation and transportation of gu qi, jin-ye body fluids, and red substance that eventually becomes xue-blood (at the Heart). 1. Dissolve food stagnation 2. Transform fluid stagnation 3. Regulate Qi Stagnation & Stasis 4. Enhance absorption of Da Big Qi 5. Open the diaphragm 6. Tonify Spleen s transforming & transporting capacity
Step 5: Strengthening Spleens Processing of Gu Qi, Step 5: Strengthening Spleen s Processing of Gu Qi, Part 1 Part 1 - -> Dissolving Food Stagnation > Dissolving Food Stagnation Manifests as epigastric and abdominal distention, reflux, pain, and weighted feeling on the chest; nausea, vomiting, loss of appetite b/c food is not digesting; inability to ripen will increase rotting which produces bad breath, dampness, stomach turbidity, thick tongue coating b/c food hasn t reached maturity it doesn t fully transform. Can lead to qi stagnation with belching and flatulence (and eventually heat); likewise, qi stagnation can lead to food stagnation. Basic herbs: Shan zha (meat) Amomi tsao-ko / cao guo (meat) Rice & barley sprouts / gu ya & mai ya (complex carbs / starch) Massa fermentata / shen qu (alcohol, simple sugars) Curcuma zedoaria / e zhu & sparganium / san lung (for sugar clumping the blood -> blood stasis) Representative formula: Preserve Harmony Pill / Bao He Wan
Step 5: Strengthening Spleen, Part 1 Step 5: Strengthening Spleen, Part 1 - -> Dissolving Food Stagnation Food Stagnation Rep. Formula: Bao He Wan / Preserve Harmony Pill Rep. Formula: Bao He Wan / Preserve Harmony Pill Created by Zhu Dan Xi Tx Stomach fire -> Spleen qi deficiency with damp accumulation / phlegm stasis -> taxation on kidney; helps patient s digestion get better so system can strengthen Ingredients: Crataegus / shan zha 180 g Massa fermentata / shen qu 60 g Raphani (radish seed) / lai fu zi 30 g Pinellia / ban xia Mature citrus peel / chen pi 30 g Hoelen / fu ling Forsythia / lian qiao 30 g If Kidney yang deficient symptoms (cold!!), + gan jiang / dried ginger If food stagnation the result of insufficient stomach fire with Spleen yang qi def -> add more ascending, warming spicy herbs Treats overweight, damp digestion contributing to blood stasis, high cholesterol, phlegm stasis, pre-diabetic condition. > Dissolving 90 g 90 g
Step 5: Strengthening Spleens Processing of Gu Qi, Step 5: Strengthening Spleen s Processing of Gu Qi, Part 2 Part 2 - -> Transform Fluid Stagnation > Transform Fluid Stagnation Manifests as abdominal fullness and drum-like distention; heaviness and pitting edema; may affect Spleen s production of blood -> anemia / blood deficiency signs Basic herbs: both are acrid, bitter, aromatic, warm, enter SP, ST Black atractulodes / cang zhu bitter, clears damp in lower-jiao; strengthens Spleen; helps transform damp in the 4 limbs (swelling) Magnolia bark / hou po tx food stagnation leading to phlegm; food stag due to damp, refined sugar The combination transforms fluid stagnation, damp turbidity and phlegm.
Step 5: Strengthening Spleens Processing of Gu Qi, Step 5: Strengthening Spleen s Processing of Gu Qi, Part 3 Part 3 - -> Regulate Qi Stagnation & Stasis > Regulate Qi Stagnation & Stasis Manifests as generalized focal (pi) distention, fullness and pain in epigastric ad abdominal region w/ occasional spasm (wind), flatulence, belching, bloating; constipation and/or very frequent bowel movement Unresolved qi stagnation -> food stagnation, heat Also leads to qi stasis -> abdominal masses Often due to emotional or eating rapidly; important for tx of eating disorders due to emotional issues. Basic herbs: Xiang fu / cyperus - Liver Chen pi / Mature citrus peel Lung, Stomach Zhi shi / Immature citrus Aurantium - Stomach Mu xiang / Sausurrea Stomach & Intestines Lai fu zi / Raphani (radish seed) - Spleen, Stomach Representative formula: Saussurrea & Areca Nut Pill / Mu Xiang Bing Lang Wan
Step 5: Strengthening Spleen, Part 3 Step 5: Strengthening Spleen, Part 3 - -> Regulate Qi Stagnation & Stasis Stagnation & Stasis Rep. Formula: Rep. Formula: Sausurrea Sausurrea & Areca Nut Pill / Mu Xiang Bing & Areca Nut Pill / Mu Xiang Bing Lang Wan Lang Wan Regulates qi for digestion, moves downward via purging Ingredients: Sausurrea / mu xiang Areca nut / bing lang Mature citrus peel / chen pi 30 g Immature citrus peel / qing pi Coptis / huang lian 30 g Curcumae zeodaria / e zhu Rhubarb / da huang Phellodendron / huang bai Pharbitidis / qian niu zi Dry fried cyperus / chao xiang fu May add 30 g san leng / sparganium Gentler non-purging option Cyperus & Amomi Villosum to Calm the Stomach Powder / Xiang Sha Ping Wei San > Regulate Qi 30 g 30 g 30 g (or zhi shi) 30 g 90 g 90 g 120 g 120 g (or mang xiao)
Step 5: Strengthening Spleens Processing of Gu Qi, Step 5: Strengthening Spleen s Processing of Gu Qi, Part 4 Part 4 - -> Enhance Absorption of Da (Big) Qi > Enhance Absorption of Da (Big) Qi Increase respiratory capacity, strengthen resistance to environmental pollutants, increase ability to expel EPI Stabilizes strength and moves qi through the Lungs Treats concurrent weak digestion + poor energy / immunity; weakness/SOB on exertion; lack of stamina + Some weakness / stagnation of lungs Basic herbs: Tangerine peel / ju pi bitter, warm; gathering so enhances absorption of da qi Mature citrus peel / chen pi - Diospyros (persimmon top) / shi di LU, ST, bitter, astringent; stops vomiting, belching; relaxes diaphragm, opens Lung capacity Caryophylli (clove) / ding xiang SP, ST, KI; spicy, warm; tx yang deficiency, warms the middle; tx rebellious qi, enhances opening the diaphragm Withania somnifera / Ashwaganda Rhodiola Astragalus / huang qi Representative formula: Clove & Persimmon Calyx Decoction
Step 5: Strengthening Spleens Processing of Gu Qi, Part 4 Step 5: Strengthening Spleen s Processing of Gu Qi, Part 4 - -> > Enhance Absorption of Da (Big) Qi Enhance Absorption of Da (Big) Qi Rep. Formula: Clove & Persimmon Calyx Decoction / Ding Rep. Formula: Clove & Persimmon Calyx Decoction / Ding Xiang Shi Di Tang Xiang Shi Di Tang Enhances Da Qi, promotes respiration, descends rebellious Stomach qi and anchors qi in Kidneys Ingredients: Clove / ding xiang 6 g Persimmon / shi di 6-9 g Ginseng / ren shen 3-6 g (sub out) Fresh ginger / sheng jiang 6-9 g Substitute rhodiola, astragalus and/or ashwaganda for ren shen
Step 5: Strengthening Spleens Processing of Gu Qi, Step 5: Strengthening Spleen s Processing of Gu Qi, Part 5 Part 5 - -> Open the Diaphragm > Open the Diaphragm An open diaphragm is important for the movement of pathogens out through portals sense organs, skin, urine, etc. either up and out or down and out; Spleen can t get qi to the lungs due to constriction of the diaphragm; if liver not tight but lung is, use citrus peels for diaphragmatic constriction due to phlegm Qi stagnation due to diaphragmatic constriction can result in phlegm or heat stagnation, or emotional disturbance (e.g. irritability) If can t get Da Qi produced -> Qi Deficiency Basic herbs: Bupleurum / chai hu fave of Li Dong Yuan LV / GB; sl. Acrid, dispersing, bitter, ascends the yang qi, regulates Liver, treats shao yang conditions, cooling (upward fx); best for yang emotions (anger, anxiety) Cyperus / xiang fu Nourish Yin School acrid, sl. Bitter, sweet, sl. Warm, regulates menses and emotions, tx diaphragmatic constriction from Liver qi stagnation (opens up or down) best for yin emotions (fear, depression, sadness) Saussurea / mu xiang Purgative School acrid, bitter, warm; regulates Spleen, Stomach & Intestinal Qi; relaxes liver (downward fx)
Step 5: Strengthening Spleens Processing of Gu Qi, Step 5: Strengthening Spleen s Processing of Gu Qi, Part 6 Part 6 - -> Tonify Spleen s Transformative & > Tonify Spleen s Transformative & Transportive Transportive Capacity Capacity Have to address Gu Qi / Da Qi paradigm or won t benefit by tonification of post-natal qi; Done properly, tonification won t add to Lung or Stomach heat and will be well-absorbed and digested Basic herbs: warming! Shan yao / dioscorea White atractylodes / bai zhu Licorice / gan cao Astragalus / huang qi Representative formulas: Saussurrea & Amomi Villosum to Nourish Stomach Decoction / Xiang Sha Yang Wei Tang Tonify the Center to Benefit the Qi Decoction / Bu Zhong Yi Qi Tang Preserve the Original Decoction / Bao Yuan Tang
Rep Formula #1: Rep Formula #1: Saussurrea Stomach Decoction / Xiang Sha Yang Wei Tang Stomach Decoction / Xiang Sha Yang Wei Tang Ingredients: White atractylodes / bai zhu Ginseng / ren shen Black atractylodes / cang zhu Hoelen /fu ling Magnolia bark / hou po Fresh ginger / sheng jiang Mature citrus peel / chen pi Cyperus / xiang fu Amomi villosum / sha ren Amomi cardamom / bai dou kou 2.1 g Sausurrea / mu xiang Jujube / da zao Honey-fried licorice / zhi gan cao Cold-damp diet (vegan), cold-damp condition; **Addresses all concerns of Chong Wei Ke Saussurrea & & Amomi Amomi Villosum Villosumto Nourish the to Nourish the 3 g 1.5 g 2.4 g 2.4 g 2.4 g 3 g 2.4 g 2.4 g 2.4 g 1.5 g 1.5 g 1.5 g
Rep Formula #2: Tonify the Center to Benefit the Qi Decoction / Rep Formula #2: Tonify the Center to Benefit the Qi Decoction / Bu Zhong Yi Qi Tang Bu Zhong Yi Qi Tang Developed by Li Dong Yuan Ingredients: Astragalus / huang qi Ginseng / ren shen White atractylodes / bai zhu Honey-fried licorice / zhi gan cao 1. 5g Angelica sinensis / dang gui Mature citrus peel / chen pi Cimicifuga / sheng ma Bupleurum / chai hu Builds both qi and blood, enhances da qi absorption, opens diaphragm. If Spleen qi deficient, ability to absorb not strong -> sip throughout day rather than take large amount at once. 3 g .9 g .9 g 6 g .9 g .9 g .9 g
Rep Formula #3: Preserve the Original Decoction / Bao Yuan Rep Formula #3: Preserve the Original Decoction / Bao Yuan Tang Tang Developed by Li Dong Yuan Ingredients: Astragalus / huang qi Ginseng / ren shen Cinnamon bark / rou gui Honey-fried licorice / zhi gan cao Builds Zong-Gathering Qi; brings Kidney yang to middle jiao (MM fire to support Spleen qi) Skeleton (teaching) formula when 4 herbs only; add to address complications 6-9 g 6-9 g 1.5 2.1 g 3 g
Step 6: Support Elimination via the Bowels Step 6: Support Elimination via the Bowels Resolve damp-heat in the bowels Purging the bowels Promote peristalsis Replenish yin fluids (cannabis seed, magnesium, vitamin c, oils)
Step 6: Support Elimination Step 6: Support Elimination - -> Resolve Damp in the Bowels in the Bowels Basic Herbs: Capillaris / yin chen hao Coptis / huang lian Scutellaria / huang qin Representative Formula: White Peony Decoction / Shao Yao Tang White peony / bai shao Angelica sinensis / dang gui Coptis / huang lian Scutellaria / huang qin Rhubarb / da huang Cinnamon inner bark / rou gui Areca nut / bing lang Sausurrea / mu xiang Licorice / gan cao Constipation / diarrhea; emotional disturbance (established HT/KI communication); diaphragmatic constriction; immune deficiency See also Mu Xiang Bing Lang Wan (more focus on SP/ST dynamic, parasites, fermentation) > Resolve Damp- -Heat Heat 30 g 15 g 15 g 15 g 9 g 7.5 g 6 g 6 g 6 g
Step 6: Support Elimination Step 6: Support Elimination - -> Purging > Purging Basic Herbs: Rhubarb / da huang Mirabilitum / mang xiao Cannabis seed / huo ma ren Representative Formulas: Hemp Seed Pill / Ma Zi Ren Wan Cannabis Seed / huo ma ren Rhubarb / da huang Prunus armenica / xing ren White peony / bai shao Immature citrus aurantium / zhi shi Magnolia bark / hou po Need yin and blood to help flush out PF s Dry stool; severely constipated Powder into pills w/ honey and take 9 g / 1-2x / day 600 g 300 g 150 g 150 g 150 g 150 g
Step 6: Support Elimination Step 6: Support Elimination - -> Promote Peristalsis > Promote Peristalsis Basic Herbs: Immature Citrus aurantium / zhi shi Mature Citrus aurantium / zhi ke Cistanche / rou cong rong Senna Cascara sagrada
GI GU Formula Checklist GI GU Formula Checklist Is this strategy included in the formula? Does the patient need this, and if so, in what proportion? Open the Stomach (address appetite) Descend Stomach Qi Harmonize Stomach with Spleen Clear excess Stomach Fire Strengthen Spleen s Production of Gu Qi Dissolve Food Stagnation Transform Fluid Stagnation Regulate Qi Stagnation & Stasis Enhance Absorption of Da (Big) Qi Open the Diaphragm Tonify Spleen s Transformative & Transportive capacity Support elimination via the bowels -> purging / peristalisis / nourish fluids resolve damp-heat / address specific microbial infections Break up biofilm
REFERENCES REFERENCES 1. Gastrointestinal Lyme, by Dr. Martin Friedman. https://www.lymedisease.org/TheLymeTimes- V42/files/assets/common/downloads/page0022.pdf 2. Neurologic Lyme Disease Presenting As Abdominal Pain in 71-year-old Patient. Daniel Cameron, MD. http://danielcameronmd.com/neurologic- lyme-disease-presenting-as-abdominal-pain-in-71-year-old-patient/ 3. The Spectrum of Gastrointestinal Manifestation in Lyme Disease. Fried, Martin; Abel, M; et al. Journal of Pediatric Gastroenterology & Nutrition: October 1999 - Volume 29 - Issue 4 - p 495 4. Schefte DF, Nordentoft T. Intestinal Pseudoobstruction Caused by Chronic Lyme Neuroborreliosis. A Case Report. J Neurogastroenterol Motil. 2015;21(3):440 442. doi:10.5056/jnm14118 5. Yuen, Jeffrey. Personal notes from lectures 2000-2005.
