AI and lurking heat

[Guest guest]

Over the years a number of people have raised the question of whether autoimmune

dz and lurking heat are related in any way. The idea has often been proposed on

flimsy grounds which is then vigorously dismissed as lacking any precedent in

the literature on one hand and no evidence of cure through this method on the

other. As I read the Wen bing xue more closely, I think we should reconsider

this idea again. I find Liu an easier read, but the contents are basically the

same as the wen bing xue tr. by Sieffert. Liu adds cases and commentary, which

are helpful to me.

 

While I doubt that anyone ever developed a skin rash (exteriorization of lurking

heat) and was subsequently permanently cured of an AI dz, there is certainly

other evidence to the link the ideas. Consider spring-warmth again. One is

kidney essence xu by birth or lifestyle (in WM, the potential to get an AI dz is

definitely genetic). Then one gets a cold invasion. In my opinion, wind-cold

invasions are more common in adults than wind heat. If one uses cold-bitter

herbs or antibiotics at this point, the pathogen could become trapped. I

include yin qiao san in this misuse. In WM, the genetic potential is unleashed

by contact with a common virus. I wonder if the rise in AI dz parallels the

rise in antibiotic use because one causes the other. Another theory of AI dz

attributes antibiotic use to intestinal dysbiosis and spleen qi damage, thereby

playing out as a systemic candida, food allergy, yin fire scenario.

Spring-warmth seems apt as it is a cold pathogen that would be more likely to be

trapped by misuse of cold herbs.

 

If you look at the later stage patterns associated with spring warmth, you see

excess patterns that involve rashes as in lupus and stirring of internal wind as

in MS, especially when either appears in a young person. But I think it is the

pattern of liver wind due to yin vacuity that really resembles some of the more

advanced neurological presentations of illnesses like MS and ALS (Liu, pg. 295).

However I typically find an anomaly in such cases that has cuased me to

emphasize the treatment of dampheat and yin fire. That is the fairly ubiquitous

presence of a sticky, dirty or yellow tongue coat in most such patients. Is it

possible that dampheat is a key factor in a complex that may also include

lurking spring-warmth. Damp-heat may account for the characteristic joint pain

in may AI dz.

 

As for the relationship between wen bing dampheat theory and Zhu-li medicine

emphasizing yin fire, beginning on pg 411 Liu explains the progression of

damp-warmth. He says it can go to dry heat and yin damage if heat predominates

and injury to qi and yang if damp predominates or qi is already weak. If yin,

blood and ying qi are damaged, one uses formulas for those patterns, with

consideration for residual dampheat. Several other patterns can arise. One is

a bloody stool pattern as in chrohn's or ulcerative colitis, the former always

an AI dz, the latter sometimes (TCM:chronic dysentary). Another is spleen

weakness with DH remnant, treated with light uplifting herbs like huo xiang, pei

lan, but not tonics. And finally a yang xu edema treated with none other than

zhen wu tang.

 

From this perspective, exterior dampheat is the root that then can injur the

spleen qi and yang, burn up the yin, even stagnate the qi dynamic, all

pathomechanisms involved in the development of yin fire. If we assume some

association between microorganisms, then microorganisms become a primary cause

of illness. A person with constitutional yin vacuity could easily develop

serious problems relatively early in life from a combination of dampheat and

lurking spring-warmth. Liu associates exterior dampheat with food, either wrong

food, contaminated food or indiscretions over a long period of time. One really

does have to wonder how many low grade pathogens one gets exposed to just eating

in restaraunts. Then consider the excessive use of antibiotics and weakened

immunity and one could easily explain an epidemic of low grade infections where

neither the pathogen nor the body can get the upper hand (thus remissions and

excaerbations of AI illness due to a variety of factors that affect zheng and

xie qi). Of course, a weak spleen does allow DH to linger in the first place, so

which is chicken, which is egg?

 

My hunch would be the pathomechanisms of complex diseases can be explained in

part by yin fire, in part by damp-warmth and spring-warmth. I think they all

logically dovetail together. In addressing dampheat, I have found strategies

from the wen bing xue to be helpful. While I have found long term treatment

with the yin fire method to be a sound strategy, I have much need for aggressive

treatments directed at pathogenic factors in the initial stages. For damp-heat

bi joint pain, xuan bi tang is great for dealing with the flaring of the

dampheat, but it does not eliminate the illness.

 

I am not sure one can eliminate the illness and that might be an inappropriate

criteria for gauging the effectiveness of treatment of applicability of the

theory. Chip Chace has written that a lurking pathogen is more of a syndrome

than a pathogen, per se. And that it may be recurrent for that reason. When you

consider this in the context of spring-warmth, it becomes clearer to me. If

spring-warmth demands kidney vacuity as prerequisite, then the person who tends

to spring-wamrth by birth will always tend to be invaded by evils that are not

fully dispelled or at least leave some permanent damage. As Liu quotes from the

wen yi lun, if xie qi is not strong enough to fight against zheng qi, it just

lurks and does not make trouble for the body. It lurks in the qi level. And

the heat develops from constraint of the cold pathogen (see more on this below).

 

As I read Liu, it appears he is saying that if the zheng qi is strong, the

pathogen will remain more superficial and move deep if the zheng qi is weak. As

I have noted, this is the opposite of what Liu writes for warm pathogens in

general and thus I have come to wonder if the distinction is that spring-warmth

starts as a cold pathogen and qi stagnation leading to heat is a key part of the

pathomechanism. BTW, I have left lurking summerheat out of this discussion as

it appears to be a different animal. Whileit may be involved in many diseases,

even chronic ones, in some parts of the world, its acuity and seasonality are

considered key diagnsotic points, while Liu poijnts out that spring-warmth can

actually surface all year round, even without a secondary exterior invasion.

 

Several things come to mind as a result of all of this. In some cases, the

lurking pathogen can be expelled. At least some autoimmune processes seem

self-limited, which suggests the body can overcome it. Perhaps in these cases,

herbs can increase the chance of this. In others, the pathogen can be held at

bay, but inbron constitutional weakness (such as the yin vacuity of

spring-wamrth) might make it impossible to ever fully expel the pathogen, so the

lurking evil complex is lifelong. But herbs can keep it from getting worse and

partially or repeatedly expel it. Subhuti pointed out long ago that aggressive

prevention and treatment of viral infections and exterior invasions should be a

key to preventing the onset and worsening of AI dz. All such patients should

have any wind invasions and/or flareups of internal heat treated immediately and

aggressively. In spring-warmth patients, a secondary wind-cold invasion can

immediately transform to heat and will then cause the lurking complex to

manifest.

 

With some of the discrepancies in theory, it is hard to know whether it makes

sense to to supplement or drain or fast in the remission stage. However there

is at least one more clue in Liu (and no doubt many more elsewhere in chinese).

In this case, it comes from the wind-warmth section, but the advice given seems

to be of a genral nature. On pg. 229, when discussing why dan shen is in qing

ying tang, Liu quotes Zhao shao qin, " Once it becomes stagnant, qi is unable to

battle with the warm heat pathogen, which then remains in the ying. Any method

that can restore qi circulation, especially when combined with clearing heat

from the nutritive level and enriching yin, should be helpful in moving the warm

heat pathogen to the qi level [from where it can be expelled] " . That would seem

to say that the best approach to dealing with an internal pathogen is moving qi

and as Liu says, also moving, blood, food and phlegm. In other words,

dispersing pathogenic factors directly may be an ideal approach to helping the

body recover from some seemingly chronic vacuity illnesses.

 

The wen bing theorists were certainly in line with zhu dan xi vis a vis dampheat

and yin xu. They tended to the spleen mainly with fragrant and bland herbs.

And while they liked blood and yin tonics, they seemed to largely shy away from

qi and yang tonics. Many of the classical patterns involve severe fevers which

would do great damage to the yin and blood. The people were also largely

malnourished. In modern times, most people do not develop high fevers during

any illness due to antipyretic use (aspirin, tylenol). This may be another

factor that leads to easily trapped pathogens. Fever could clear a cold

pathogen in many cases if you let it manifest, right? But the lack of fever may

change something else as well, the degree of yin damage. Also, with our diets

overabundant with yin nourishing substances like protein and fat and carbs and

lack of vital yang substances like enzymes and vitamins and co-factors, we are

likely to have significant damp and phlegm as a foundation.

 

This is a clear example of the vital necessity of adapting strategies to

circumstances. I have a new transfer student who began her internship

elsehwere. And in that other place she was fairly well indoctrinated by a kanpo

afficionado who had taught her that classical formulas were sacrosanct and

should not be adjusted in any way from the source text. I find this japanese

idea ironic as it is so not chinese. Chinese SHL px do indeed modify their rx

and all I have studies with make a point of noting this. CM is rooted in the yi

jing, the classic of changes, change being the only constant. This is the heart

of chinese philosophy, IMO and thus to declare anything as unchangeable is what

seems anthema to me. In the case of wen bing formulas, if one were to just

uncritically apply such formulas, your patients will end up with yang vacuity

and phlegm.