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Naturopathic Medicine and the Qi Dynamic:  Insights into the Treatment

of Leaky Gut Syndrome by

 

 

TCM Concepts

 

A number of TCM practitioners over the years have noted the similarity

between the naturopathic diagnosis of leaky gut syndrome and the

Chinese understanding of spleen dysfunction and what is called the qi

dynamic.  TCM has a long history of considering new ideas based on new

information or changing times, so it is not surprising that the modern

Chinese have considered the role of intestinal dysbiosis in

spleen/stomach pathology in TCM.  Bob Flaws has pointed this out in his

most recent contribution on this topic. 1  I think is interesting and

useful to understand these latest developments in naturopathy in their

historical context.

 

While some scientific approaches to TCM attempt to reduce TCM to

already understood concepts of physiology, I will pursue a different

path.  Heiner Fruehauf, chairman of the Classical

Department at the National College of Naturopathic Medicine in

Portland, Oregon, was one of my teachers.  His favorite 20th century

author on TCM was Zhang Xi Chun.  Zhang is remembered as an early

proponent of the school of chinese-western medicine integration. 2  

However, Zhang Xi Chun used TCM concepts to expand his understanding of

physiology and restore a holistic, dynamic quality to this modern

science, rather than try to reduce TCM to science.  He was the first to

attempt to describe western drugs in TCM terms, something that has been

attempted more recently by others, such as Z’ev Rosenberg 3, chairman

of the department of Chinese Herbal Medicine at the Pacific College of

Oriental Medicine.  In the same vein, we will consider some of the

naturopathic and scientific approaches to illness in such TCM terms.  

Let's start with some TCM terminology.

 

In TCM terms, the qi dynamic refers to the four movements of ascent,

descent, exit and entry.  For clinical purposes, it is basically the

up-down flow of qi in all living creatures.  The ascent of qi can be

compared to the assimilation and distribution of pure essence and the

descent to the removal of turbid matter for excretion. Even the

simplest plants and microorganisms must still ingest part of their

environment, transform it into pure and turbid components, incorporate

the pure and excrete the turbid.  This simple process which is describe

both in the nei jing and also any college physiology textbook, is the

most basic attribute of life. Thus, the emphasis on proper diet and

cleansing has been part of many healing traditions, including shamanic,

ayurvedic, essene, native American, Egyptian, Greek, Arabic and modern

naturopathic, as well.  Of course, all of TCM may essentially be broken

down into these two categories, with therapies focused either on

removing excess (cleansing) or building up deficiencies (nutrition). 

The real attraction of TCM, in fact, may be the sophistication with

which it has developed these two  basic approaches.  The long written

and scholarly tradition of China allowed a refinement of a method used

worldwide in ancient times.  This refinement was not possible in other

parts of the planet for various historical reasons, but the basic

method remains the same.

 

At the core of this refinement is the notion of the qi dynamic. 

Because TCM is based on a dynamic concept called qi, it is not enough

to say that waste is excreted and nutrients are assimilated, the

direction of this dynamic force is considered vitally important, as

well.  The turbid is discharged downwards, which is quite intuitively

sensible, as the major wastes of our bodies move in that direction. 

That the pure should ascend is perhaps less apparent, but is actually

physiologically sensible as well.  The essences of food must be

ascended to mix with air in the lung to form the pure blood that is

pumped through the body by the heart.  This is remarkably similar to

modern physiology's description of blood formation.  Also the pure

clear essences must rise to brighten the spirit, as well.  Likewise, 

modern physiologists talk about glucose and oxygen requirements for

proper brain function.

 

The key TCM organ networks that regulate the qi dynamic are the stomach

and spleen.  The spleen moves qi up and the stomach moves qi down. 

Thus, the spleen governs the assimilation of the pure and the stomach

the excretion of the turbid.  Spleen diseases involve failure and

weakness of organs due to poor assimilation, while stomach disease is

the beginning place for toxic internal heat to brew due to turbid

accumulation.  The liver provides the actual upward force via its

smooth distribution of kidney yang qi and the lungs aid descent with

their continuous bellows like action drawing air qi down into the

body.  But the spleen and stomach remain central to this process.  The

kidneys and the yang organs continue the process of separation of pure

and turbid, finally discharging the turbid through the bladder.

 

Impairment of the qi dynamic often leads to dampheat, a TCM

pathomechanism that is present in most serious chronic illness to one

degree or another.  This is relevant to this discussion, because

dampheat is very similar to several naturopathic ideas, such as the

generic term toxin or the more specific liver toxicity or bowel

toxemia.  In addition to being associated with acute infectious

diseases in TCM, dampheat is also thought to arise from a polluted

internal environment.  It settles in the lower part of the body and

causes disruption in blood circulation and emotional stability.  Both

the location of dampheat in the colon and its widespread impact on

general health reveals certain similarities with the concept of

intestinal dysbiosis, which we shall explore below.

 

 

 

Historical Development of Naturopathy

 

Modern Naturopathic medicine began at the end of 19th century, largely

as a medicalized amalgamation of several popular health trends of the

era.  These included nature cure, fasting, hydrotherapy, colonics,

exercise, diet emphasizing raw foods and vegetarianism.  Many religious

zealots were involved with these lay movements, but the profession of

Naturopathy has been a serious one for a hundred years.  Over this

century, Naturopathy survived and absorbed the dying professions of

homeopathy and eclectic herbalism, as well.  Now, naturopaths always

used herbs and homeopathics, but they tended to use these methods

within their core philosophy, which was distinctly different from the

eclectics and the classical homeopaths.  Naturopathy has always been

focused on removing toxins from the body, the idea being that when the

system was purged of filth, it would function properly.  As you might

surmise, they got it only half right from our perspective.

 

While naturopaths certainly were early advocates of the need for proper

nutrition to build healthy tissues, early proponents like Jethro Kloss,

Arnold Ehret and Henry Lindlahr, M.D. felt that the vital essences of

raw vegetarian foods would be fully absorbed in a system that was

totally clean.  Thus, the foods they chose for therapy tended to

strongly emphasize removal of excess.  Raw vegetables stimulate bowel

movements and urination.  At the turn of the century, when many nature

cure patients were farmers, vigorous cleansing may have produced some

miracle cures.  Zhang Zi He, a medieval Chinese proponent of the idea

that all disease is evil toxin, which must be purged, would have agreed

with this approach.  However, in TCM history, Zhang's methods proved

too harsh to be used in more sedentary types (like modern office

workers). So Zhu Dan Xi modified Zhang's method to be more balanced. 

Thus, purgation is still used in TCM when appropriate.  As naturopathy

moved into the modern age, it also evolved a more sophisticated

approach for several reasons.

 

The absorption of eclecticism and homeopathy before WWII certainly

shaped modern naturopathy.  Eclecticism and homeopathy both relied on

precise methods of regulating what is called the vital force. 

Naturopathy also embraced this concept, but had largely focused on

removing the obstacles to the vital force, largely through vigorous

cleansing methods.  So naturopaths now began to incorporate subtler

methods of regulating the vital force into their practices.  At the

same time, there was an explosion of research on nutrition occurring in

Europe and America.  While nutrition has recently become of interest to

medical doctors, this not because there was no information available

earlier.  Naturopaths made early use of this information in their

practices throughout this century.  So after refining their theories

for about sixty years now, they have arrived at a methodology that

meshes very nicely with the Chinese concept of the qi dynamic.

 

The jumping off point for the most sophisticated naturopathic theories

about disease causation are rooted in two important naturopathic

concerns, namely bowel toxemia and assimilation of nutrients.  The

concept of bowel toxemia was largely promoted by a doctor named John

Tilden in the thirties.  Tilden postulated that improper diet led to

stagnation of food in the colon, which then putrefied and formed

toxins.  He associated heavy rich food like meat with this toxemia,

however he was not necessarily a raw foods advocate.  He often

recommended lightly cooked vegetables and broths as his regimen.  It is

now well known that low fiber, high fat diets alter the environment of

the colon in a way that promotes the formation of carcinogens and other

" toxins " . 4If these wastes are not removed from the body, they can

indeed wreak havoc on the cardiovascular, immune and neuroendocrine

systems, so they very likely play a role in the pathogenesis of diverse

illnesses.

 

Naturopathic physicians oriented towards Nature Cure long emphasized

the use of raw foods and juices to ensure assimilation of all available

nutrients nature provided.  Their raw food advocacy also stressed the

importance of enzymes in living foods which are destroyed by cooking. 

Knowing that raw foods contain large amounts of enzymes, like all

living tissues, and knowing that such enzymes were largely destroyed by

cooking, they postulated that eating large amounts of raw food would

keep enzyme levels high in the body.  These enzymes would then spare

the body of the need to produce its own enzymes, thus conserving the

vital force for other activities, like immunity and free radical

scavenging.  There is no actual evidence that the enzymes in most

common foodstuffs actually enter the bloodstream and impact one's

health in any dramatic fashion.

 

It is also highly questionable whether raw foods can actually be

considered the " natural diet " of homo sapiens, anyway.  It is likely

that modern human beings have always had the use of fire, having

inherited it from an earlier species called homo erectus.  Evidence of

the use of fire to cook food is thought to predate humanity by perhaps

as much as one million years.  The use of fire to cook gives a well

known survival advantage in the form of being able to consume otherwise

inedible starchy roots during times of food shortages.  Over the course

of a million years, it is likely that those who thrived on cooked food

were selected over those who depended upon raw foods.  Also, nature is

geared towards reproduction, not longevity.  The same diet that confers

youthful reproductive vigor may not be appropriate later in life.

 

Recently, modern research on antioxidants has revealed the importance

of heat stable flavonoid molecules in dark vegetables that become much

more accessible and concentrated through cooking (such as lycopene). 

These components are now generally thought to be as important, if not

moreso, than heat-labile factors like vitamin C.  While it remains

arguable as to whether anyone would ever benefit from a mostly raw

foods diet, this fact certainly cannot be deduced from the existing

anthropological evidence.  It is, of course, also noteworthy in this

respect that major healing traditions like Ayurveda and TCM make the

use of cooked foods central to their healing regimens.  Enzymes derived

from food thus do not seem to play a major role in either of these

traditional dietetic systems.  Despite these flimsy foundations,

continued research into the obvious potential therapeutic role of

enzymes has yielded important clinical insights.

 

 

Modern Naturopathic Medicine

 

The current naturopathic approach still relies on the concept of bowel

toxemia and enzymes, but the discussion has been recast in light of

recent scientific findings.  Bowel toxemia has largely been replaced

with the terms leaky gut syndrome and intestinal dysbiosis.  Dr. Jeremy

Appleton, ND, says, " the intestinal mucosa is a selective barrier that

admits nutrients, but excludes unwanted ... materials " . 5  This is

clearly a modern description of the separation of the pure from the

turbid, as described in TCM.  The term " leaky gut syndrome "

specifically refers to an impairment in the integrity of this barrier. 

So leaky gut syndrome is, by extension of this logic, an impairment in

the separation of pure and turbid, thus a failure of the qi dynamic in

TCM terms.

 

Intestinal dysbiosis refers to the alteration in the normal flora and

fauna of the colon.  This may lead to overgrowth of pathogenic

organisms, such as candida.  Intestinal dysbiosis is caused by turbid

matter stagnating in the colon and overuse of antibiotics.  This is

interesting for several reasons.  First, as mentioned above, external

dampheat is often caused by bacteria or other pathogenic

microorganisms.  Examples include dysentery, urinary infections, food

poisoning, etc.  However, the internal generation of dampheat may also

be related to pathogenic microorganisms that normally live inside of us

(like candida).  And in TCM, it has long been postulated that the

overuse of certain herbs damages the GI tract, contributing to chronic

dampheat.  Those herbs are now understood to be powerful antimicrobials

in their own right, like coptis, scute and phellodendron (e.g.

therefore analogous to antibiotics).   Thus, the TCM  idea of

internally generated dampheat appears to overlap conceptually with

intestinal dysbiosis.  

 

So we can already see that leaky gut syndrome can be understood in

terms of two TCM concepts introduced above.  One is the stagnation of

the turbid waste and the other is dampheat.  We now turn to the ascent

of the pure and the role of enzymes.  In recent years, a new form of

enzyme has become prominent in the practices of sophisticated

naturopaths.  These enzymes are produced from friendly bacteria and

have the amazing property of being stable in the entire pH range of the

human digestive tract.  They are not destroyed by stomach acid and

remain active in the colon.  Similar stable enzymes are produced in the

fermentation that produces the Chinese herb, shen qu (AKA massa

medicata, fermented leaven), a herb commonly used in chronic spleen

illness in TCM.  These enzymes serve a variety of therapeutic

purposes.  Large doses are antiinflammatory.  Some evidence suggests

anticancer activity, as well.  But what they do in normal doses is

promote the transformation of food into its finest essences.  Thus,

nutrients are absorbed and turbidity is not produced from food.

 

Because the enzymes are active down to the rectum, they continue to

promote transformation along the way, thus breaking down old stagnant

food and normalizing the colonic environment.  TCM puts an identical

emphasis on the need to transform stagnant " dampheat " in the colon. 

However, the whole story also involves direct repair of the intestinal

mucosa.  The enzymes prevent further damage, but they do not restore

the integrity of the intestinal villi.  The restoration of the villi is

what we would call in TCM a tonic effect.  In all longterm chronic

cases, there is some aspect of deficiency or sinking qi present. So

this aspect of treatment is more geared towards what we might associate

with promoting ascent of spleen qi.  The term seems particularly

appropriate because we are actually preventing something from leaking

or sinking downwards.  Naturopaths indicate antioxidants as playing a

key role in this aspect of treating leaky gut syndrome.  According to

Dr. Appleton, " reducing oxidative stress [in the gut] can help break

the vicious cycle that makes other conditions worse. "

 

Dr. Appleton goes on to recommend antioxidants like gingko, quercitin

and N-acetyl-csyteine. 6  However, herbs such as bupleurum, ginseng and

astragalus all have significant antioxidant activity and all three are

used to lift the spleen qi.  So, by using our TCM approach to qi

dynamic imbalance, we may gain insight into another aspect of leaky gut

syndrome.  Again, hopefully we have not reduced treating the qi dynamic

to enzymes and antioxidants, but rather demonstrated that the TCM

approach implicitly includes actions supported by recent scientific

enquiry.  Now, it is not real meaningful to me that bupleurum is an

antioxidant.  That doesn’t change my use of bupleurum.  What is more

important to me is to the concept of bupleurum ascending spleen qi and

how this concept and others may be used to expand modern physiology.

 

For example, if bupleurum raises spleen qi and raising spleen qi helps

with leaky gut syndrome, then it follows we could utilize the concept

of spleen qi sinking to guide us in our future explorations of the

western physiological and herbal literature. While the antioxidant

quality of bupleurum that seems to be of importance here, what else is

going on?  Bupleurum cannot be reduced to an antioxidant.  What else is

it about bupleurum that contributes to this action and are there

perhaps similar herbs and substances in the Naturopathic pharmacopeia

that have been overlooked regarding their usefulness in leaky gut

syndrome?  Besides the well known bupleurum, a number of other more

obscure herbs are also used to regulate the qi dynamic in TCM.  Of note

is that many of these herbs are carminatives and/or used typically to

treat acute superficial ailments.  Of similar significance is the

historical importance of many similarly acting western herbs, despite

their relative disuse in modern times.  For instance, carminatives like

oregano and caraway are used merely to relieve digestive symptoms or

just to flavor food, however such herbs are thought to uplift or spread

the qi in TCM terms.  So their effects my actually help get at the root

of the problem, rather just relieve suffering.    Also, once revered

herbs like yarrow, verbena and eupatorium, now generally relegated to

the treament of colds and flus, perhaps deserve renewed consideration

for their possible role in treating leaky gut syndrome and complex

chronic illnesses.

 

 

 

Endnotes

 

 

1.  Flaws, Bob, Intestinal dysbiosis, Leaky gut syndrome, Candidiasis

and Yin Fire / Blue Poppy.com/articles.htm

2.  Fruehauf, Heiner, The Five Organ Networks of /

Portland, OR: Institute for Traditional Medicine   1998, pg. 82

3.  Rosenberg, Z'ev, A Chinese Look  at Western Pharmaceuticals

/Acupuncture.com

4.  Appleton

5.  Ibid

6.  Ibid

 

 

Bibliography

 

 

Appleton, Jeremy, " Leaky Gut Syndrome " , Advancing the Standard

2:1/Gresham, OR:  Tyler Encapsulations   2/99

 

Clavey, Steven, Fluid Physiology and Pathology in TCM / New York, NY:

Churchill Livingstone   1995

 

Flaws, Bob, Allergies, Autoimmune diseases and Yin fire /Blue

Poppy.com/articles.htm

 

Flaws, Bob, Intestinal dysbiosis, Leaky gut syndrome, Candidiasis and

Yin Fire / Blue Poppy.com/articles.htm

 

Flaws, Bob, Gu Parasites & Yin Fire Theory /Blue Poppy.com/articles.htm

 

Flaws, Bob, Chinese Articles and Essays Advocating the use of Li dong

Yuan's Ideas in Modern Clinical Practice /Blue Poppy.com/articles.htm

 

Flaws, Bob, Li Dong-Yuan's theory of Yin Fire & Difficult to Treat,

Knotty Diseases /Blue Poppy.com/articles.htm

 

Flaws, Bob, Zhu dan-xi on Gu Conditions /Blue Poppy.com/articles.htm

 

Fruehauf, Heiner, The Five Organ Networks of /

Portland, OR: Institute for Traditional Medicine   1998

 

Fruehauf, Heiner, Classnotes and Private Correspondence,1992 - present

 

Fruehauf, Heiner, " Gu Syndrome:  A Forgotten Clinical Approach to

Chronic Parasitism " , Journal of #57 London, England

1997

 

Rosenberg, Z'ev, A Chinese Look  at Western Pharmaceuticals

/Acupuncture.com

 

Wiseman, Nigel; Ellis, Andy; Zmiewksi, Paul, Brookline, Fundamentals of

/MA:  Paradigm 1985

 

Yang Shou Zhong, The Heart and Essence of Dan Xi's Methods of

Treatment:  A translation of the Dan Xi Zhi Fa Xin Yao / Boulder, CO: 

Blue Poppy Press   1993

 

Yang Shou Zhong, Extra Treatises Based on Investigation and Inquiry:  A

Translation of Zhu Dan Xi's Ge Zhi Yu Lun / Boulder, CO:  Blue Poppy

Press   1993

 

Yang Shou Zhong, Li Jian Yong, Li Dong Yuan's Treatise on the Stomach

and Spleen:  ATranslation of the Pi Wei Lun / Boulder, CO:  Blue Poppy

Press   1993

 

 

 

 

 

 

 

 

 

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