By Dr. Sydney Malawer, DAIM L.Ac.
Autoimmune disease has become a wide-spread epidemic in the United States affecting 50 million Americans - twice as many as heart disease (25 million) and four times as many as cancer (12 million). It takes Americans an average of 4.6 years and consultations with five different physicians to receive a diagnosis of an autoimmune condition, and the medical intervention options are limited to symptom suppression or management through immunosuppressants, biologics, or in extreme cases chemotherapy. Many of those with autoimmune conditions seek relief through alternative or integrative medicine such as functional medicine, nutritional therapy, East-Asian medicine, naturopathic medicine, among others. East-Asian Medicine has proven to be a very effective modality in the treatment and management of autoimmune conditions through it's individuality and subjective-based approach to diagnosis and treatment. This means that no two people with rheumatoid arthritis will be treated the same - their treatments are individualized to the pathomechanism of qi, blood, and body fluids that are causing the RA symptoms for each individual.
According to thought leaders in the field such as Bob Flaws and Giovanni Maciocia, most autoimmune conditions stem from a pathology called "yin fire", a disharmony of ministerial fire due to deficiency stemming from pathomechanical qi movement from the Spleen and Stomach. This concept was first introduced to East-Asian Medicine by Li Dong Yuan in the 1200s through his famous work called the Pi Wei Lun (Treatise on Spleen and Stomach). In this work he discusses how when the Spleen and Stomach are compromised, the entire system is becomes imbalanced and therefore vital substances such as qi, blood, and body fluids are not properly created nor distributed around the body. Because of this the system starts to heat up in the areas where these vital substances are stuck and unable to move - think of when the oil runs out in your car and the engine overheats. This causes chronic inflammation which is the crux of autoimmune disease since inflammation is an immune response that is triggered when the body is trying to correct an imbalance and return to homeostasis. Chronic inflammation occurs when the body cannot return to homeostasis but is constantly trying to anyway, and in turn healthy tissue suffers which is what we have labeled an autoimmune response. This is the modern interpretation of what Li Dong Yuan described as "yin fire" back in the 1200s.
So how can East-Asian medicine help in these circumstances? By determining which manifestation of yin fire is occurring and treating it appropriately. In a June 2021 article in the Journal of Chinese Medicine Shaun Ramsden breaks down four manifestations of yin fire that are in line with what Will Maclean teaches in his CEU courses on chronic inflammation. They are summarized below. If you are a pracitioner working with chronic inflammation I HIGHLY recommend reading Ramsden's article and taking Will Maclean's CEU courses.
Latent Pathogen (Unresolved Infection)
This pattern is common in those whose symptoms started after a serious infection such as pneumonia or after acquiring a chronic, low-grade infection such as Lyme's disease, Epstein Barr Virus, or SIBO (Small Intestinal Bacterial Overgrowth). In this case the body is either stuck in the pattern of fighting an infection even when a pathogen isn't present or constantly using inflammation to fight a pathogen that does exist. In EAM terms, this pattern is due to a cold pathogen that is stuck in the shaoyin level, so along with heat symptoms such as sore throat, red face, and irritability there will be marked cold symptoms such as cold hands and feet and diarrhea. The appropriate treatment for this pattern is to move the pathogen out of the shaoyin level and anchor the fire causing inflammation back to the Kidneys. You can do this through acupuncture and moxibustion to move out the cold pathogen and anchor ministerial fire as well as herbal formulas comprised of warm-natured, acrid herbs to dispel the cold pathogen and correct the flow of qi.
Qi Deficiency (Suboptimal Digestion)
This pattern is commonly seen in those with a nutrient-poor diet, chronic digestive issues such as IBS, or syndromes where fatigue is common such as hypothyroidism (Hasmitoto's or otherwise) and depression. The link between diet and chronic inflammation has been proven in conventional and functional medicine, so this pattern is the view of the pathodynamics from an East-Asian medicine perspective. Here the qi dynamic of the Spleen and Stomach is compromised, leading to a sinking of qing qi into the shaoyin Kidney which stirs up ministerial fire causing symptoms such as shortness of breath, chest pressure, and fatigue with irritability. The appropriate treatment for this pattern is to raise qing qi by supporting the Spleen and Stomach while only gently clearing heat in conjunction with supporting the Spleen and Stomach if the heat is markedly intense. This can be done with acupuncture and moxibustion focused on nourishing the Spleen and raising the qing qi to untrap the the rogue ministerial fire. Herbally this is done with formulas that are comprised of qi and blood nourishing herbs with acrid herbs used as guides to raise the qi up, such as Bu Zhong Yi Qi Tang.
Heart-Kidney Miscommunication (Hormonal Imbalance)
This pattern is seen a lot in perimenopause and in those whose symptoms began around menarche and tend to occur with the menstrual cycle. There could be a measurable hormonal component such as high FSH or low E2, both of which signal menopause in conventional medicine. In EAM this shows up as classic Kidney yin defiency with floating yang. Common symptoms are irritability, insomnia, tinnitus, night sweats, thirst (especially at night), and/or scanty urination. The appropriate treatment for this pattern is to nourish Kidney yin and anchor yang. Treatment will differ depending the the degree of heat and inflammation that is present, although acupuncture should focus on rooting yang and nourishing yin of the Kidney, Lung, and Liver. The quintessential formula is Liu Wei Di Huang Wan, and Shaun Ramsden comments that adding sour herbs such as wu wei zi has improved clinical effectiveness - although the formula should be adjusted depending on the level of heat present.
Qi Stagnation (Stress-Induced Inflammation)
This pattern is seen mostly in those whose symptoms worsen with stress and get better on vacation. This is all too common in those with autonomic nervous system imbalances where sympathetic dominance is present. In EAM this is considered a form of shaoyang stagnation fire, where the pivot of yang qi between interior and exterior is compromised causing "back up" fire in the Kidneys. Possible symptoms are burning feet, yellow urination, insomnia, irritability, psychoemotional upset, and/or digestive issues such as diarrhea, constipation, bloating, and/or abdominal distention. The appropriate treatment method is to move qi and restore the shaoyang pivot. Through acupuncture and moxibustion the focus would be on releasing stagnation in the shaoyang and paired jueyin channels, and herbally the focus is on moving qi in the shaoyang with the appropriate level of chai hu in accordance with the level of stagnation. According to Shaun Ramsden the most appropriate formulas to start with are (Dan Zhi) Xiao Yao San, Xiao Chai Hu Tang, or Si Ni San.
This is a small preview of how East-Asian medicine approaches autoimmune disease and chronic inflammatory conditions. To learn more about my approach to autoimmunity, visit the Internal Medicine page. If you have questions about how East-Asian medicine can help you, reach out to me by scheduling a call here.