Guest guest Posted September 25, 2004 Report Share Posted September 25, 2004 Heiner Fruehauf has written and lectured at length for the past few years about his take on Gu syndrome. Gu syndrome is the result of some sort of evil infestation. This may include worms, protozoa, bacteria and viruses from the modern perspective. In ancient times. gu syndrome was associated with demonic possession, because of the bizarre mental symptoms patients often exhibit. Because of this textual emphasis on demons, the modern communists were pretty quick to jettison this pattern when they standardized TCM. However, the frequent mention of GU in classical texts and the claims of cure for stubborn chronic ailments caught the eye of Fruehauf. Fruehauf practices in Portland, Oregon and has seen a lot of knotty cases over the years. We mentioned Dr. Fruehauf earlier in the lesson on the six stage theory. Fruehauf was trained inthe classical method of zhang zhong jing and relies heavily on these ancient formulae in his practice. Fruehauf also likes Li dong yuan’s dynamic method of regulating the stomach and spleen, so he has always focused on the qi mechanism in his teaching and practice. However, certain patients with chronic digestive and mental complaints were not getting well using standard methods. Noting that many of these patients had presently or previously tested positive for various parasites led Dr. Fruehauf on a peculiar journey through the archive of Chinese medicine. In the process, he unearthed another piece of the puzzle of how to treat chronic illness through regulation of the qi mechanism. It is important to begin with the understanding that gu syndrome is not an acute parasite invasion. It often begins that way, but according to Fruehauf, gu is the “state of extreme stagnation and mental and physical decay ... [caused] by parasites that combine their toxic potential to gradually putrefy the patient’s body and mind.”34 Other characteristics of Gu reinforce its association with mysterious chronic illnesses. Gu causes noticeable problems long after an initial infection was apparently resolved. Patients often experience diverse unusual groups of symptoms. Digestive symptoms can be severe and painful, with aberration of appetites and cravings. Symptoms of hot, cold, photophobia and fibromyalgia/arthralgia are common. Depression, anger, anxiety, insomnia are a few of many mental aberrations. Patients may feel possesed or even have seizures. So food allergy, candida, multiple chemical sensitivity, fibromyalgia and other common diagnoses may all be related to gu syndrome in some cases. According to Fruehauf, Gu only occurs in a weakened individual, so the therapeutic approach relies on strategies that supplement deficiency as well as expel gu toxins. Longterm gu patients cannot handle the very hot or very cold herbs often used to treat parasites. They are thus prescribed rather unusual formulae that kill parasites directly in some cases, but focus more on calming the mind, as well as supplementing and moving both the qi and the blood. The herbs selected in these various categories are specific for their anti-gu nature. Not just any herbs will do. The key to anti-gu therapy is the use of large dosages of surface relieving herbs. According to Fruehauf, large dosages of surface relieving herbs like bo he and zi su ye have a penetrating effect on the system. They illuminate the dark places where gu toxins lodge and allow the other herbs in the formula to reach to every crevice of the body.35 Bob Flaws has noticed that the formulae suggested for gu syndrome bear a striking resemblance to Li dong yuan’s methodology for yin fire discussed above.36 Remember, Li was famous for his explicit use of surface relieving herbs to ascend the spleen qi. While zhang zhong jing was the first to actually do this, Li was the first to write about this methodology at length. So both approaches use surface relieving herbs, tonics and heat clearing agents simultaneously to treat a problem rooted in the digestive system. However, there are distinct differences, as well. According to Fruehauf, Gu specialists used much larger doses of surface relievers than spleen/stomach specialists because their intent was penetration of the darkest recesses where gu may have lodged, rather than merely uplifting the qi. Fruehauf has also stated that certain tonics are also prohibited in Gu, particularly ginseng, one of Li’s favorites. Ginseng is said to worsen gu and is often used as a diagnostic indicator thereof (i.e. if a very depleted patient becomes violently ill upon taking ginseng, you should consider gu syndrome).37 In any event, there are distinct relationships between certain aspects of gu treatment and regulation of the qi mechanism. First, the very nature of gu is to disrupt the qi mechanism. The traditional description of gu is that of oil mixing with flour.39 Basically, the toxin has seeped into and bound up with the tissues of the body. This can only happen when the body becomes incapable of separating pure and turbid. In the weakened patient, food-borne parasites that are not fully expelled remain in the central and lower burners brewing and putrefying. Thus, the pure is now unable to ascend , the most profound sign of this being the mental aberrations. The turbid fails to be descended and excreted properly. The accumulation of turbidity and toxicity further aggravate the GI and mental symptoms. Meanwhile, the body is unable to replenish it’s postnatal jing from food and the kidneys are thus drained of their essences. We often see our old friend dampheat associated with gu, especially if no strong cooling treatments have yet been applied. It is common to treat chronic parasites with strong cooling antimicrobials like berberine, flagyl, nystatin, capryllic acid, etc.40 While these substances may have some role in gu therapy, according to Fruehauf, they do not address the deep penetration of the toxin outside the GI tract nor do they restore the qi mechanism in any way. Treating dampheat makes sense at this stage, but standard dampheat treatments will not work on gu patients. So while herbs like lonicera, forsythia, sophora and artemisia qing hao are used to clear dampheat toxin, they must be combined with the penetrating herbs like zi su ye. So like most of our other approaches, dampheat and the qi mechanism are at the core of this pathology and the therapeutic approach described in ancient texts implicitly recognizes this in formula design. Fruehauf discusses two basic gu patterns. The first is more of the dampheat pattern we have been discussing so far. The recommended formula is called su he tang and was originally recorded in Zhi Gu Xin Fang (New Methods for Gu Treatment, Lu Shunde, Qing Dynasty). Since this formula also includes cooling moistening herbs and mild yin tonics like sheng di, xuan shen, huang jing and bai he, it is as much of an homage to zhu dan xi as li dong yuan, perhaps. Remember, it was zhu who focused on the enduring damage to yin fluids that was caused by dampheat, which itself arose due to qi mechanism disruption. There seems to be something counterintuitive about choosing such herbs in a bloated digestive condition, yet Fruehauf puts great emphasis on herbs like sheng di, xuan shen, huang jing and bai he in this condition, as well as qi lifting tonics like huang qi. Bob Flaws has pointed out that zhu dan xi actually wrote about gu in his seminal Ge Zhi Yu Lun.41 The chapter in question is titled " Drum Distension " (chinese: gu zhang). While the gu that means drum is a different character than the gu that means " worm " , the worm-gu is often substituted for the drum-gu in the term gu zhang. This is because drum distension is often related to gu poison. Drum distension is a severe form of abdominal pain. According to Wiseman in his Practical Dictionary of TCM, drum distension is almost always related to liver spleen disharmony. It is often caused by alcoholism, as well as gu poison. According to both Flaws and Fruehauf,42 Zhu appears to state that drum distension is essentially synonymous with gu-worm distension. However, Zhu's indicated formulae focus on supplementing deficiency, rather than attacking gu poison directly. While there is definitely similarity between Zhu's herb selection and that of Fruehauf, the absence of penetrating wind medicinals and anti gu toxin clearing herbs is notable. Like Fruehauf, Zhu makes the point that gu is a severe deficiency condition and treats accordingly. Yet the absence of herbs that directly attack worms leads me to believe that Zhu was using the term gu-worm in a more general sense of poison penetrating the system, yet not involving parasites. Zhu also uses Ginseng, which Fruehauf has declared a prohibited herb in gu syndrome, a point Flaws disputes.43 Nevertheless, Zhu's explanation of the gu pathomechanism and formula selection is instructive for us. He puts considerable emphasis on the qi mechanism and dampheat, as we would now expect. In his own words, " The seven affects damage the internal, the six environmental excesses invade from outside, food and drink are had without restraint, and chamber taxation causes vacuity. [Any of these causes may] damage spleen earth yin [and consequently,] the office of transportation and conveyance may fail to carry out its duty. Although the stomach [still] receives grains, [the spleen] cannot transport or transform them. As a result, yang keeps on upbearing itself and yin keeps on downbearing itself, resulting in the disadvantageous divorce between heaven and earth. When this happens, clearness and turbidity are confused together and the tunnels are congested and held up. Qi transforms into the turbid, and blood becomes stagnated with depressive heat [being generated]. When heat remains for long, qi transforms into dampness. Dampness and heat mutually engender, thus giving rise to distention and fullness. This is what the classic calls drum distention because, though hard and full, the abdomen is empty with nothing inside, [thus] resembling a drum. The disease is persistent, firmly fixed, and difficult to cure. It is also called gu. Because it is as if [one were] invaded and being eaten by worms, therefore, [this kind of distention] is called gu. " 44 Fruehauf also presents a cold gu syndrome and his chosen formula, jia jian su he tang, is very similar to variations of li dong yuan’s famous bu zhong yi qi tang (minus the ginseng, of course). Unlike zhu’s variation, Fruehauf’s does not use cooling herbs, but actually warming and qi moving herbs at this stage, so he is obviously describing a more classic cold condition in this case, rather than a yin fire syndrome.45 In clinic, one may actually prescribe something more between the hot and cold type gu formula. The net result would probably look a lot like the formulae recommended by both Zhu dan xi and li dong yuan for this type of condition (i.e. chronic illness rooted in vacuity with concomitant heat and stasis). What this reinforces is that there are multiple causes of qi mechanism disharmony and treatment varies accordingly. In some cases, similar strategies may be used for diverse etiology, so it is always vital to evaluate the case carefully. Gu syndrome is a difficult diagnosis to make properly. In ancient times, it was largely a diagnosis of exclusion, determined by failure of other therapies. In modern times, the presence of parasites in a stool culture are highly indicative of gu, however the absence of these pathogens does not rule out gu. In some cases, the pathogen is gone and only the poison remains. It is not surprising that gu syndrome is treated with methods that seem to borrow from the methods of Li Dong Yuan and Zhu Dan xi. After all, the gu specialists culminated their theories in the late qing dynasty. They were no doubt familiar with the works of these great masters, who lived many centuries before and were both well known in qing times. In addition to treating enduring yin damage with cooling herbs, gu formulae also address dampheat without overuse of harsh bitter cooling herbs. So, as well as using herbs like lian qiao and jin yin hua instead of ones like huang lian and huang bai, the inclusion of chai hu and sheng ma as additional standard ingredients surely also represent the influence of Li Dong Yuan. The formulae are notable for their inclusion of qi movers, but the absence of herbs that either purge the bowels or disinhibit urination. Thus, a sophisticated variation on the treatment of yin fire emerges, as Flaws has suggested. 34. Fruehauf, Heiner, “Gu Syndrome: A Forgotten Clinical Approach to Chronic Parasitism”, Journal of #57, pg. 11 35. Ibid, pp. 13-14 36. Flaws, Bob, Gu Parasites & Yin Fire Theory 37. Fruehauf, Heiner, “Gu Syndrome: A Forgotten Clinical Approach to Chronic Parasitism”, Journal of #57, pg. 13 38. Bob Flaws, Personal Correspondence, 9/24/99 39. Fruehauf, Heiner, “Gu Syndrome: A Forgotten Clinical Approach to Chronic Parasitism”, Journal of #57, pg. 13 40. Ibid, pg. 15 41. Flaws, Bob, Zhu dan-xi on Gu Conditions 42. Fruehauf, personal correspondence, 10/21/99 43. Bob Flaws, Personal Correspondence, 9/24/99 44. Flaws, Bob, Zhu dan-xi on Gu Conditions 45. Fruehauf, Heiner, “Gu Syndrome: A Forgotten Clinical Approach to Chronic Parasitism”, Journal of #57, pg. 16 Chinese Herbs FAX: Quote Link to comment Share on other sites More sharing options...
Guest guest Posted September 30, 2004 Report Share Posted September 30, 2004 > > > Saturday, September 25, 2004 8:49 AM > cha > gu essay reformated > > > > Heiner Fruehauf has written and lectured at length for the past few > years about his take on Gu syndrome. Gu syndrome is the result of some > sort of evil infestation. This may include worms, protozoa, bacteria > and viruses from the modern perspective. In ancient times. gu syndrome > was associated with demonic possession, because of the bizarre mental > symptoms patients often exhibit. Because of this textual emphasis on > demons, the modern communists were pretty quick to jettison this > pattern when they standardized TCM. [Jason] Didn't this happen way before TCM? -Jason Quote Link to comment Share on other sites More sharing options...
Guest guest Posted September 30, 2004 Report Share Posted September 30, 2004 Modern CM did not/has not jettisoned the concept of gu worms. You'll find a definition of gu worms in most, if not all, Chinese language CM dictionaries, including Wiseman and Feng Ye's English language dictionary which is based on standard Chinese language sources. There are two main divisions of worms: 1) visible and 2) invisible. In modern CM, gu worms are defined as invisible worms. In standard professional CM, gu worms are associated with the core disease mechanisms of spleen vacuity, damp heat, and liver depression qi stagnation. By at least Zhu Dan-xi, gu worms had been reframed into a totally naturalistic concept by mainstream literate Chinese doctors. According to Zhu, gu worms are associated with " great spleen vacuity, " damp accumulation, and qi stagnation. In contemporary CM, Zhu's dampness has become damp heat. Bob Quote Link to comment Share on other sites More sharing options...
Guest guest Posted September 30, 2004 Report Share Posted September 30, 2004 > > Bob Flaws [pemachophel2001] > Thursday, September 30, 2004 8:58 AM > > Re: gu essay reformated > > Modern CM did not/has not jettisoned the concept of gu worms. [Jason] If this is response to my post, I was referring to the idea of gu worms being associated with demonic possession. - You'll > find a definition of gu worms in most, if not all, Chinese language CM > dictionaries, including Wiseman and Feng Ye's English language > dictionary which is based on standard Chinese language sources. There > are two main divisions of worms: 1) visible and 2) invisible. In > modern CM, gu worms are defined as invisible worms. In standard > professional CM, gu worms are associated with the core disease > mechanisms of spleen vacuity, damp heat, and liver depression qi > stagnation. > > By at least Zhu Dan-xi, gu worms had been reframed into a totally > naturalistic concept by mainstream literate Chinese doctors. According > to Zhu, gu worms are associated with " great spleen vacuity, " damp > accumulation, and qi stagnation. In contemporary CM, Zhu's dampness > has become damp heat. > > Bob > > > > > Chinese Herbal Medicine offers various professional services, including > board approved continuing education classes, an annual conference and a > free discussion forum in Chinese Herbal Medicine. > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted October 10, 2004 Report Share Posted October 10, 2004 Will MacLean's patent (his words Bob!) herb book, he has a chart in the glossary on the heat - Qi stagnation - Spleen Xu triad called the Primary Pathological Pyramid, with formulas for the various areas of the triangle. Interesting read! Geoff , " Bob Flaws " <pemachophel2001> wrote: > are two main divisions of worms: 1) visible and 2) invisible. In > modern CM, gu worms are defined as invisible worms. In standard > professional CM, gu worms are associated with the core disease > mechanisms of spleen vacuity, damp heat, and liver depression qi > stagnation. > > By at least Zhu Dan-xi, gu worms had been reframed into a totally > naturalistic concept by mainstream literate Chinese doctors. According > to Zhu, gu worms are associated with " great spleen vacuity, " damp > accumulation, and qi stagnation. In contemporary CM, Zhu's dampness > has become damp heat. > > Bob Quote Link to comment Share on other sites More sharing options...
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