LYME DISEASE: Treatment with Chinese Herbs

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LYME DISEASE: Treatment with Chinese Herbs

_http://www.itmonline.org/arts/lyme.htm_

(http://www.itmonline.org/arts/lyme.htm)

by Subhuti Dharmananda, Ph.D., Director, Institute for Traditional

Medicine, Portland, Oregon

Lyme disease is the result of a spirochetal infection (Boerrelia

burgdorferi) transmitted to humans by deer ticks (mainly Ixodes scapularis,

though a

relative, I. pacificus is the carrier in the Western U.S.). The infection

sometimes results in a serious disease pattern, most often characterized by

progressively worsening arthralgia, though a central nervous system

disorder or even a heart disorder may arise (1, 2, 3, 10). The disease is named

for the town (Old Lyme, Connecticut) where, in 1975, a number of children

presenting symptoms similar to juvenile rheumatoid arthritis were eventually

found to have acquired this Boerrelia infection.

The occurrence of Lyme disease is regional, being dependent on:

1. the distribution of the ticks that carry the bacteria (prevalent

in forested areas in temperate climates, such as northern U.S. and northern

Europe);

2. the presence of this particular bacteria in the ticks. The

bacteria is carried by animals, particularly mice and deer, that are bitten by

the

tick; in the endemic area, only about 15-30% of ticks are infected; and

3. exposure of the human population to the ticks, which generally

requires living in or venturing into areas where the ticks can be directly

encountered.

Contact with a tick does not necessarily mean the disease will be

experienced. In fact, it is estimated that only 1-3% of tick bites result in

Lyme

disease. While the region where infection is a somewhat likely possibility

is expanding, the primary distribution still remains limited. As of 1995, it

was reported that Boerrelia infections in the U.S. occurred mainly in 8

states of the northeastern U.S. and one Midwest state (Wisconsin).

Retrospective studies indicate that there were probably a few cases of this

disease

many decades earlier, with cases appearing in Massachusetts and Wisconsin in

the 1960s, and in northern Europe as early as the 1920s. There is some

evidence to suggest cases of this or a very similar disease in Germany-a

country that was heavily forested and full of deer-in the 1880s. The reason for

the sudden epidemic of the disease during the past 25 years has been the

change in land use and lifestyle that occurred, such as new growth of forests

in abandoned farm land and movement of city dwellers into the forested

countryside, either for recreation or for a new place to live. For those who

are at risk for acquiring the infection, a vaccine against Boerrelia

burgdorferi has been approved by the FDA and is now readily available.

There is no reference to Lyme disease in the Chinese literature and there

may be none for some time, as most of China's forests have been eliminated.

There are other spirochetal infections that have been addressed by Chinese

physicians and by Chinese researchers conducting clinical trials or

laboratory tests of infection-inhibiting properties. The relevant organism most

often studied in China is Leptospira, which causes the disease called

leptospirosis. This organism is carried by a wide range of animals, and is not

uncommon in animals raised for food. In China, it has long been common

practice for each family to keep animals, such as pigs and chickens, in and

around

their homes, so exposure has been possible for a large portion of the

population. The bacterium can enter the body through the skin, usually from

contact with animal urine. A small outbreak occurred at Fort Bragg in the U.S.

in 1942, and the disease was nicknamed Fort Bragg Fever. Its cause was

traced to swimming in ponds and streams that had been contaminated by

livestock urine. Fewer than 200 cases occur in the U.S. each year, mostly in

the

warm southeastern states.

TRADITIONAL AND MODERN VIEWS OF LEPTOSPIROSIS AND ITS TREATMENT

The Leptospira infection causes fever and chills, headache, and muscle

ache (especially in the shoulders). These symptoms match the Shang Han disease

described in the ancient text Shang Han Lun. In fact, the initial course

of leptospirosis follows a pattern, over a period of several days, that is

somewhat like that described in the ancient text. In the advanced stage,

leptospirosis can cause liver disease (with jaundice) or a severe form of

meningitis; the symptoms of some cases of advanced Shang Han disease are

similar. According to proponents of the general application of the Shang Han

Lun

as a guide to treatment of disease, the formulas recommended in that text

could be used for modern diseases with similar symptom presentation.

Accordingly, early stage of spirochetal infection, such as Lyme disease and

Fort

Bragg fever, might be treated by the same formulas used in the Shang Han Lun

(see: A modern view of the Shang Han Lun).

Modern understanding of these infectious diseases may help reflect on the

development of Chinese concepts of disease causation and treatment. Shang

Han disease occurred most frequently in winter, the time of year when

animals were brought into the house, thereby increasing opportunity for

exposure

to pathogens; thus, exposure of people to cold may not have been the reason

that some diseases were observed to occur during the cold season.

Similarly, the summer heat syndrome, which often produces digestive system

disturbances, may not be the direct result of exposures of humans to the damp,

hot

climate, but exposure to pathogens that grow in that climate and infect the

food and water supplies (see the articles: The six qi and six yin and Pill

Curing and Huoxiang Zhengqi Pian).

The book Modern Study and Application of Materia Medica (4) provides

information about herbs reputed to inhibit Leptospira based on laboratory

testing (herb extract applied to cultured bacteria causing them to die) and, in

some cases, clinical evaluation (herbs administered to infected patients

resulting in clearance of symptoms). The following list of

leptospira-inhibiting herbs was culled from the Chinese medical literature:

Isatis leaf

Smilax Isatis root Gardenia Andrographis Hu-chang Coptis

Chien-li-kuang Scute Verbena Phellodendron Sanguisorba Forsythia

Ching-hao

Most of these herbs treat a condition described as damp-heat; many of the

herbs have broad-spectrum antibiotic and antiviral properties. The book

Thousand Formulas and Thousand Herbs of Traditional (5), no

doubt relying on the same source material, listed the first nine ingredients

of the above list as inhibitors of Leptospira; this text also presents

five traditional formulas suggested for treating leptospirosis, divided by

syndrome:

* Exogenous pathogen invading the qi phase (this corresponds to the

initial disease symptoms, which may include a flu-like pattern): Yin Qiao

San (Lonicera and Forsythia Formula).

* Summer heat and damp heat misting the three burners (for treatment

of skin manifestations of the disease, such as rashes): Sanshi San (Three

Stone Powder, made with calamine, gypsum, and red kaolin; this is applied

topically).

* Acute jaundice (this is the manifestation of leptospirosis as

liver disease): Ermiao San (Red Atractylodes and Phellodendron Powder; this is

a general formula for damp-heat).

* Summer heat injuring the lung: Xin Jia Xiangru Yin (Modification

of Elsholtzia Combination; the base formula contains elscholtzia, dolichos,

and magnolia bark; a common addition is coptis).

* Heat invading the pericardium with liver wind moving internally

(this is the manifestation of leptospirosis as meningitis): Zhengan Xifeng

Tang plus Angong Niuhuang Wan (Decoction to Subdue Internal Wind plus Pill of

Ox Gallstone to Pacify the Palace).

All of the recommended formulas treat a heat syndrome, and include herbs

that alleviate damp-heat, though they include few herbs from the list of

those that have thus far been shown to inhibit the subject organism in

laboratory and clinical tests. The herbal therapies may alleviate symptoms

without

curing the spirochetal infection, while it is the cure of the disease,

defined by freedom from the bacteria, that is the goal of most Western

patients and their physicians.

CLINICAL EVALUATIONS

There was considerable clinical research into treatment of leptospirosis

in China during the early 1970s (9). It was reported that tablets prepared

from equal amounts of the extracts of scute, lonicera, and forsythia,

administered three times daily in large amounts were useful for treating mild

and

moderate cases of the disease. Andrographis extract, in the form of an

injection or tablets of the crude extract or of the isolated lactones, was

reported to effectively treat leptospirosis. In one evaluation, 31 of 35 cases

were said to be cured by the andrographis lactones (mainly diterpene

lactones, which are also found in the anticancer herb rabdosia).

More recently, Deng Shifa reported on efforts at prevention and treatment

of leptospirosis (6, 7). He administered a decoction prepared from fresh,

rather than dried, herbs, using ching-hao, houttuynia, eclipta, imperata,

mentha, lonicera stem, humulus (lucao), and rhubarb. This formula only

includes one herb, ching-hao, from the list of individual herbs above. The

drink

was consumed 4-6 times per day (that is, at intervals of 2-4 hours), and it

was reported that recovery from symptoms occurred, on average, in about 11

days. The results obtained with the Chinese herbs were similar to those

obtained with penicillin, based on cure rate, which was 97%. The same herb

formula, with rhubarb deleted, was said to help prevent leptospirosis.

Another spirochete, Treponema, gives rise to two diseases, syphilis (from

T. pallidum) and yaws (from T. pertenue). Since these diseases are easily

controlled by modern antibiotic therapy, there is little mention of herbal

remedies in the literature. Smilax (tufuling), an herb for damp-heat that is

included in the list of anti-leptospira herbs, is still prominently

mentioned for this application (4, 8). In Western herbal practice, a species of

Smilax, known popularly as sarsaparilla, was used for treatment of syphilis.

This repeated reference to the herb in clinical use supports the idea that

smilax may have a reliable inhibitory effect for spirochetal infections.

Treponemes have been isolated from the blood of patients with Lyme disease,

suggesting that the ticks may harbor both types of spirochetes.

TCM ANALYSIS OF LYME DISEASE

The traditional Chinese medicine (TCM) analysis of a new disease, such as

Lyme disease, depends on the disease manifestations and the analysis of

other diseases that have some characteristics in common with it. The salient

features are these:

1. the tick introduces the pathogen into the blood stream directly;

2. the infection typically yields a blotchy red rash, often in a

" bull's eye " pattern of red skin coloration and swelling, about 3-20 days after

the tick bite;

3. there may be flu-like symptoms, including fever, headache, sore

throat, nausea, fatigue, swollen glands, stiff neck, aching muscles; and

4. if unresolved there may be recurrences of fever and, usually after

several months, arthralgia, usually in the knees, with swelling and hot

feeling.

It is estimated that 25-50% of those infected do not get the rash or

flu-like symptoms, and that about half of those who experience the rash go on

to

experience arthralgia. The disease may be interpreted in TCM terms most

simply as a heat pathogen entering the blood, which can reside as a **hidden

toxin** in some individuals, manifesting disease symptoms later, after some

factor activates it.

As an example of traditional prescribing that might be appropriate to Lyme

disease, a formula recommended for a heat toxin entering the blood and

producing eruption of macules (11) is Lonicera and Gypsum Combination

(Liangxue Baidu Tang; Cool Blood and Defeat Toxin Decoction). It contains

forsythia, gardenia, scute, and coptis, which are included in the list of

anti-leptispirosa herbs, along with gypsum, talc, lonicera, anemarrhena,

carthamus,

moutan, raw rehmannia, scrophularia, and imperata (the original formula also

included horns of antelope and rhino).

TREATMENT OPTIONS IN THE WEST

Medical studies suggest that if the Boerrelia infection can be treated soon

after it occurs with antibiotics, there is strong likelihood of it being

eliminated quickly and completely. The current medical treatment for Lyme

disease is a course of therapy using doxycycline, amoxicillin, penicillin, or

erythromycin. These are taken orally except in severe cases in which they

may be administered intravenously instead. Many of those who become

infected spontaneously recover within days or months even without antibiotics

(no

doubt, the bacteria eventually succumbs to the immune system). For those

who have the infection for months prior to treatment without improvement,

antibiotics may need to be administered for several months before the

infection finally resolves, and some cases may entirely escape cure with this

therapy due to the characteristics of the bacteria (ability to avoid the immune

system by antigenic changes on its surface and ability to avoid antibiotic

inhibition by infiltrating areas of the body, such as the joints, that have

lower levels of exposure to the drug).

The absence of direct clinical evaluation of Chinese herbs in relation to

Lyme disease means that there is some difficulty recommending that this

method be used in lieu of the currently accepted course of antibiotics. Some

individuals may wish to attempt to increase the chances of success with

antibiotics or even shorten the duration of treatment with antibiotics by

combining a Chinese herbal treatment, and a few individuals may wish to try

using Chinese herbs alone, saving the antibiotic therapy as a back-up. One

would apply herbs that are reputed to inhibit other spirochetes (since these

should have an excellent chance of inhibiting this one), as well as any herbs

that might treat the specific symptoms or the patient's constitution.

The Seven Forests herb formula tablet Isatis 6 provides isatis leaf,

hu-chang, and andrographis from the list of herbs given above, and the Seven

Forests formula Forsythia 18 provides forsythia, gardenia, scute,

phellodendron, and coptis, which are also on that list. Together, these

formulas may

provide the bacterial inhibition that is sought from Chinese herbs in a

convenient form of administration (suggested dosage would be 3-5 tablets of

each

formula, three times daily). As with treatment of any infection, the

intended application is a high dosage for a few days or weeks. Since the

formulas fall into the category of clearing heat, persons with symptoms and

signs

indicating a constitutional cold syndrome would probably do better to have

a personalized formula made (e.g., extract granules), combining the desired

anti-bacterial ingredients (which have a cold nature) with herbs for

addressing the constitutional imbalance.

The single herb ching-hao may be of interest in treating this disease.

This is an herb for damp-heat that is one of the most effective herbal agents

for treating malaria, another parasitic disease (though a very different

pathogen) introduced directly into the blood stream by an insect (mosquito).

It was included in the formula recommended by Deng Shifa for treatment and

prevention of leptospirosis. Aside from being listed as an anti-spirochete

based on laboratory evaluation, this herb also helps regulate the immune

system in cases of autoimmune disorders. For example, it is found useful in

treating the autoimmune attack against connective tissue (mainly skin and

joints) in patients with lupus (9). The arthralgia experienced by persons

with advanced Lyme disease may involve some autoimmune component (at this time,

it is unclear whether persistence of the bacteria is solely responsible

for persisting symptoms or if there is an induced autoimmune process that

contributes to the symptoms).

Further, if the symptoms of arthralgia have already developed, then herbs

traditionally used for that purpose would also be administered (selection

of ingredients would depend on symptom presentation and constitutional

factors). Lonicera stem, included in the treatment for leptospirosis described

by Deng Shifen, may be of interest, as it is used like lonicera flower as an

anti-toxin agent, but is considered a specific treatment for arthralgia.

Based on the analysis that has been presented here, for patients willing

to take a decoction or dried decoction, the following is proposed as a base

formula that may be modified, if deemed necessary, for individual needs:

Anti-Spirochete Mixture

(equal parts)

Smilax

Ching-hao

Forsythia

Hu-chang

Andrographis

Lonicera stem

When using a decoction, the dosage of individual herbs should be 12-15

grams for a one day dose. Using dried decoctions, a daily dosage of 15-18

grams of the mixture would be appropriate. Three times per day dosing is a

usual recommendation for the treatment of infections.

REFERENCES

1. Biddle W, A Field Guide to the Germs, 1995 Henry Holt and Co.,

Inc., New York.

2. Karlen A, Man and Microbes, 1995 G.P. Putnam's Sons, New York.

3. Lane K (executive editor), Merck Manual of Medical Information,

Merck & Co., Inc., West Point, PA.

4. Dong Zhi Lin and Yu Shu Fang, Modern Study and Application of

Materia Medica, 1990 China Ocean Press, Beijing.

5. Huang Bingshan and Wang Yuxia, Thousand Formulas and Thousand

Herbs of Traditional , vol. 1, 1993 Heilongjiang Education

Press, Harbin.

6. Deng Shifa, Preliminary study on the prevention and treatment of

leptospirosis with traditional Chinese medicine, Lianing Journal of

Traditional 1985; 9(5): 15-17.

7. Deng Shifa and Sheng Rixin, Treatment of leptospirosis with Qixian

Drink, Zhejiang Journal of Traditional 1991; 26(7):

293-294.

8. Hong-Yen Hsu, et al., Oriental Materia Medica: A Concise Guide,

1986 Oriental Healing Arts Institute, Long Beach, CA.

9. Hson-Mou Chang and Paul Pui-Hay But (eds.), Pharmacology and

Applications of Chinese Materia Medica, (2 vols.), 1986 World Scientific,

Singapore.

10. Robbins SL, Cotran RS, and Kumar V, Pathologic Basis of Disease,

Third Edition, 1984 W.B. Saunders Company, Philadelphia, PA.

11. Hsu HY and Wang SY, The Theory of Feverish Diseases and Its

Clinical Applications, 1985 Oriental Healing Arts Institute, Long Beach, CA.