Autoimmune Disorders and Chinese Medicine
Patients suffering with arthritis and other autoimmune diseases may seek out acupuncture treatment when standard anti-inflammatory medications cease to be effective, or must be discontinued due to side effects. While needling can bring immediate relief from pain and stiffness, complete and long lasting remission of symptoms can be difficult to achieve with acupuncture alone. Traditional Chinese herbal formulas prescribed on the basis of syndrome differentiation can also provide symptomatic benefits, but often fail to obtain lasting results.
Our clinical experience points to a three part process where infection and/or exposure to environmental toxins trigger hyperactivation of the immune system, followed by chronic inflammation and tissue destruction. In our experience both Western and Chinese medicine inadequately address the issue of sub-clinical infection and toxic chemical exposures as a root cause of autoimmune disease. Chinese herbal formulas prescribed on this basis may provide excellent and rapid clinical responses, with long periods of complete remission of symptoms.
Rheumatoid arthritis occurs in about 1% of the population, with three times as many females as males affected. Rheumatoid factor (RF), an auto-antibody to streptococcal IgG immunoglobulin, is present in about 75% of cases. High titers of RF are associated with more severe disease, and a poor prognosis. Acute onset occurs in 20% of patients, with the usual course being slow progression with occasional flare ups. Standard therapy includes exercise, non-steroidal anti-inflammatory drugs, and in severe cases, steroids and chemotherapeutic agents that suppress immune function.
Traditional Chinese Medicine defines arthritis as a condition due to "wind-damp", which can be complicated by "heat" and "cold". We consider "wind" to be a roughly equivalent term for infectious processes due to bacteria and/or viruses. "Damp" indicates both the response to climatic changes and the swelling that accompanies the inflammatory process. Chinese herbal medicines with strong anti-inflammatory effects are generally in the therapeutic category known as "expelling wind-damp". Antiviral and antibacterial herbs are classified as "clearing wind-cold", "clearing wind-heat", and "clearing heat and toxins". By combining these classes of herbs, we can both eliminate the infection at the roots of the disorder, as well as control inflammation.
The first step in diagnosis of autoimmune disease is to locate the source of infection causing hyper-immune responses. The most common sites of chronic bacterial infection triggering joint inflammation are the lymph nodes, lungs, digestive tract, oral cavity, and spleen. Residual effects of past illness as a hidden pathogenic factor are common causes for autoimmune disease, including tonsillitis, ear infections, and pneumonia. Minor symptoms suggestive of low level infection such as night sweats, palpitations, and insomnia may be the only indicator of remaining lung pathology.
The second step is to neutralize the antibody formation and assist the clearance of circulating immune complexes with blood tonics and wind-damp herbs. Antibodies may be formed against the bacteria itself, or the toxins excreted by the bacteria. In lupus, antinuclear antibodies may trigger inflammation in multiple organ systems, and in rheumatoid arthritis, antibodies are cross reactive with bone, cartilage, tendon, and connective tissues.
The third step is to address the inflammatory process. The modern literature on Chinese herbal pharmacology confirms the regulatory effects of wind-damp herbs on many aspects of immune function, including the interleukins, interferons, and tumor necrosis factor (TNF). Wu Jia Pi (Cortex Acanthopanacis), Jiang Huang (Rhizoma Curcumae Longae), and Tu Fu Ling (Rhizoma Smilacis Glabrae) are three examples of herbs that reduce TNF-alpha. Blood tonics like Dang Gui (Radix Angelicae Sinensis) and blood movers like Chuan Xiong (Rhizoma Chuanxiong) inhibit the effects of bacterial endotoxins, which trigger the immune response.
In addition to infectious organisms, environmental toxins can also induce autoimmunity. Occupational silica exposure is associated with scleroderma (SSc), rheumatoid arthritis (RA), systemic lupus erythematosus (SLE), glomerulonephritis (GN) and small vessel vasculitis (SVV). Exposure to cleaning products, formaldehyde, solvents, synthetic adhesives, and vinyl chloride has been linked to systemic sclerosis. Scleroderma is associated with exposure to paint thinners, paint removers, perchloroethylene, and trichloroethylene. Mercury can induce autoimmune kidney disease and SLE. Chronic exposure to low levels of chromium and other chemicals in tap water can increase SLE incidence. Cadmium, lead, and mercury all stimulate proliferation of T- and B-cells, increasing immune responses and production of IgG1.
The 21st century practitioner of Chinese medicine must include these factors when taking a case history. Air travel, recent home remodeling or repainting, occupational chemical exposures, house cleaning products, vaccinations, and dental history are all risk factors for autoimmune disease and multiple chemical sensitivity. A common example is a patient with recurrent sinusitis and bronchitis that is triggered by the use of Clorox bleach as a bathroom cleaner. Many sensitive patients will be subject to constant respiratory tract infections due to the damaging effects of chlorine gas on the lungs and immune system.
By taking a complete history, and noting the subtle signs of chronic infection, we can assemble an herbal prescription that addresses the totality of the pathogenic and environmental factors that trigger autoimmune disease. The non-toxic nature of Chinese herbal medicines and their beneficial effects on reducing the inflammatory process and assisting the clearance of pathogens allows for long-term, effective treatment with minimum side-effects. Integrated pharmaceutical and herbal treatment can optimize the patient response and limit drug toxicities as well.
Case Study
Mr. A developed pemphigus, an autoimmune disorder characterized by blisters, vesicles, and bullae of the skin and mucous membranes. The onset of the symptoms followed immediately after two days exposure to solvents in the form of lacquer-based paints. The medical literature associates the disease process with exposure to pesticides, chemicals, metal vapors, and ultraviolet light.1,2,3,4,5 Traditional Chinese Medicine classifies pemphigus as a syndrome where Heart fire and Spleen damp generate Kidney and Spleen deficiency with damp turbidity and toxins. Externally, wind-heat toxins obstruct the skin and flesh.
According to our clinical experience, exposure to environmental toxins via inhalation damages Lung yin, giving rise to Heart fire. When Lung yin is injured, Kidney yin also suffers, allowing Heart fire to generate inflammatory lesions. Immune responses in pemphigus include excessive activity of interferon gamma, interleukins5,6,8,10 and tumor necrosis factor (TNF)-alpha.6,7,8,9,10
Dan Shen (Radix et Rhizoma Salviae Miltiorrhizae) and Ku Shen (Radix Sophorae Flavescentis) reduce interferon gamma; Jiang Huang (Rhizoma Curcumae Longae) reduces interleukin6,8 and TNF-alpha. Tu Fu Ling (Rhizoma Smilacis Glabrae) and Fen Bi Xie (Rhizoma Dioscoreae Hypoglaucae) inhibit interleukin 1-beta and TNF-alpha. Yin tonics, Tian Men Dong (Radix Asparagi), Nu Zhen Zi (Fructus Ligustri Lucidi) and Bai Shao (Radix Paeoniae Alba), protect against the damaging effects of formaldehyde, a common airborne environmental toxin.11 Other solvent and petrochemical exposures including jet fuel, paints, and cleaning solutions can be addressed with yin tonics that benefit the Lungs, and immunosuppressive herbs that reduce the inflammatory response.
Bai Zhu (Rhizoma Atractylodis Macrocephalae), Yi Yi Ren (Semen Coicis), Fu Ling (Poria), and Shu Di Huang (Cooked Rehmannia) can reduce the damp toxins and inhibit TNF-alpha, assisting the resorption of fluids and down-regulating inflammation. Bai Zhu (Rhizoma Atractylodis Macrocephalae) and Shu Di Huang (Cooked Rehmannia) also help with the clearance of circulating immune complexes which can accumulate in target tissues causing damage. The prescription Shen Qi Zhi Mu Tang Jia Jian includes many of these components, and can be modified to address the immunological origin of the disease.12
About the Author
Dr. Van Benschoten is a graduate of the California Acupuncture College of Los Angeles, with over 30 years of clinical, research, and teaching experience in acupuncture, Chinese herbal medicine, and medical Qi Gong. He is the author of more than fifty papers on acupoint diagnostic methods, chronic fatigue syndrome, AIDS, autoimmune disease, breast cancer, mercury toxicity, and indoor mold exposure. His clinical practice focuses on multidrug resistant infections, immune dysfunction, and environmental illness.
Click here to view a complete list of courses by Matt Van Benschoten.
References
1Valikhani M, Kavusi S, Chams-Davatchi C, Daneshpazhooh M, Barzegari M, Ghiasi M, Abedini R. Pemphigus and associated environmental factors: a case-control study. Pemphigus Researh Center, Razi Hospital, Tehran University of Medical Sciences, Tehran, Iran. Clin Exp Dermatol. 2007 May 32(3):256-60. Epub 2007 Mar 13.
2Wohl Y, Brenner S. Pemphigus in IsraelAn epidemiologic analysis of cases in search of risk factors. Department of Dermatology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel. Isr Med Assoc J. 2003 Jun;5(6):410-2.
3Brenner S, Tur E, Shapiro J, Ruocco V, D'Avino M, Ruocco E, Tsankov N, Vassileva S, Drenovska K, Brezoev P, Barnadas MA, Gonzalez MJ, Anhalt G, Nousari H, Ramos-e-Silva M, Pinto KT, Miranda MF.
Pemphigus vulgaris: environmental factors. Occupational, behavioral, medical, and qualitative food frequency questionnaire. Department of Dermatology, Tel Aviv Elias Sourasky Medical Center and Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel. derma@tasmc.health.gov.il. Int J Dermatol. 2001 Sep;40(9):562-9.
4Haustein UF. Pemphigus vulgaris in association with silicosis. University of Leipzig, Department of Dermatology, Liebigstr. 21, D-04103 Leipzig,Germany. ufh@medizin.uni-leipzig.de. Eur J Dermatol. 2000 Dec;10(8):614-6.
5Haustein UF. Pemphigus vulgaris in association with silicosis. University of Leipzig, Department of Dermatology, Liebigstr. 21, D-04103 Leipzig,Germany. ufh@medizin.uni-leipzig.de. Eur J Dermatol. 2000 Dec;10(8):614-6.
6Goldberg I, Shirazi I, Brenner S. In vitro interferon-gamma release test in patients with drug-induced pemphigus. Department of Dermatology, Tel Aviv Sourasky Medical Center, and Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv, Israel. Isr Med Assoc J. 2008 Jun;10(6):424-7.
7Narbutt J, Lukamowicz J, Bogaczewicz J, Sysa-Jedrzejowska A, Torzecka JD, Lesiak A. Serum concentration of interleukin-6 is increased both in active and remission stages of pemphigus vulgaris. Department of Dermatology, Medical University of Lodz, 94-017 Lodz, Poland. joanna.narbutt@onet.pl. Mediators Inflamm. 2008;2008:875394.
8Keskin DB, Stern JN, Fridkis-Hareli M, Razzaque Ahmed A. Cytokine profiles in pemphigus vulgaris patients treated with intravenous immunoglobulins as compared to conventional immunosuppressive therapy. Department of Cancer Immunology and AIDS, Dana Farber Cancer Institute, 44 Binney Street, Boston, MA, USA. Cytokine. 2008 Mar;41(3):315-21.
9Kraigher O, Wohl Y, Gat A, Brenner S. A mixed immunoblistering disorder exhibiting features of bullous pemphigoid and pemphigus foliaceus associated with Spirulina algae intake. Department of Dermatology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel. Int J Dermatol. 2008 Jan;47(1):61-3.
10Nakashima H, Fujimoto M, Asashima N, Watanabe R, Kuwano Y, Yazawa N, Maruyama N, Okochi H, Kumanogoh A, Tamaki K. Serum chemokine profile in patients with bullous pemphigoid. Department of Dermatology, Kanazawa University Graduate School of Medical Science, 13-1 Takaramachi, Kanazawa, Ishikawa, Japan. Br J Dermatol. 2007 Mar;156(3):454-9
11Nwafor PA, Okwuasaba FK. Anti-nociceptive and anti-inflammatory effects of methanolic extract of Asparagus pubescens root in rodents. Department of Pharmacology, College of Medical Sciences, University of Maiduguri, PMB 1069, Maiduguri, Nigeria. nwaforp@unimaid.edu.ng. J Ethnopharmacol. 2003 Feb;84(2-3):125-9.
12Dermatology in Traditional Chinese Medicine pg 355, Xu Yihou, Donica Publishing 2004
