ALS: A Chinese Medicine Perspective

With the recent attention given to the ALS Icebucket Challenge, I thought it would be beneficial to consider Amyotrophic Lateral Sclerosis from a Chinese medicine perspective.

Ah…the ALS Icebucket Challenge: it’s got everyone from Justin Bieber to George W. Bush dumping buckets of ice-water on their heads; it’s got California environmentalists annoyed because people are wasting water in a drought; and it’s got your—or at least my—Facebook friends divided over whether this awareness-raising publicity stunt is “played out,” “narcissistic,” or “really important.” Before I begin my analysis of ALS from a Chinese medicine perspective, allow me to state the following:

• I am not suggesting that Chinese medicine cures ALS.
• I am not suggesting that you should ignore your doctor’s advice or stop conventional treatment if you have ALS.
•  The following is a theoretical discussion based on a synthesis of ancient Chinese medical literature and modern biomedical research. It is not based on clinical experience with ALS.

 

What is ALS?
According to the ALS Association, Amyotrophic Lateral Sclerosis, or “Lou Gehrig’s Disease,” is “a progressive neurodegenerative disorder that affects nerve cells in the brain and the spinal cord” (ALSA.org). As these nerves die, those who suffer from the disease gradually lose muscle control, until complete paralysis—and ultimately, death—results.

ALS as Atrophy Syndrome
The Chinese character, wěi 萎, meaning “atrophy” or “wilting,” is composed of two parts. The upper part, cǎo 艹, means “grass” or “plant,” while the lower part, wěi 委, means “to fall” or “to hang down” (Scheussler, 512). As I have mentioned in previous posts, I am not a Chinese language specialist, but the concept of a wilting plant seems an accurate and poetic description of the physical atrophy commonly seen in patients with neurodegenerative disorders like ALS.

Atrophy syndrome was first mentioned in chapter 44 of the Huáng Dì Nèi Jīng Sù Wèn, one of the foundational texts of Chinese medicine. What follows is a complex discussion about the various manifestations of atrophy, which requires a rather advanced knowledge of Chinese medical theory to understand. The clinical result of this discussion is that atrophy syndrome is primarily related to dysfunctions involving the yáng míng 阳明, the chōng mài 冲脉, the dài mài 带脉, and the dū mài 督脉: several of the channels that traverse the body. Elsewhere in the same chapter, the yáng míng 阳明 is described as the sea of the internal organs, and the chōng mài 冲脉 is described as the sea of the acupuncture channels (Huáng Dì Nèi Jīng Sù Wèn Chapter 44). According to another classical text of roughly the same time period, the dài mài 带脉 encircles the body at the waist, while the dū mài 督脉 travels up the inside of the spinal column before entering the brain (Nán Jīng Chapter 28).

Chapter 44 of the Huáng Dì Nèi Jīng Sù Wèn gives a very specific acupuncture treatment protocol for atrophy syndrome: the use of spring (yíng 潆) points and transport (shū 輸) points on the affected channels. Modern research suggests that the channels are closely related to interstitial connective tissue planes and that acupuncture points occur at the junctions thereof (Langevin & Yandow, 2002; Ahn, 2010). According to researchers, this interstitial connective tissue “constitutes a continuous network enveloping all limb muscles, bones, and tendons, extending into connective tissue planes of pelvic and shoulder girdles, abdominal and chest walls, neck, and head” (Langevin & Yandow, 2002). This potential link between acupuncture and the connective tissue makes it an ideal adjunct therapy in cases of ALS.

Shun-fa Jiao, a modern Chinese practitioner who has extensively studied the relationship between acupuncture and neurology, states that “[The term] ‘joint junctions,’ [mentioned in chapter 1 of the Huáng Dì Nèi Jīng Líng Shū] refers to the places where the neurofilaments of the anterior lateral sulcus and posterior spinal cord cross to form anterior and posterior roots, and then cross again to form a spinal nerve. After several of these crossovers, they become the nerves that travel throughout the body” (Jiao, p. 57-58). If Jiao’s hypothesis is correct, it would provide even stronger support to the potential benefits of acupuncture in the treatment of ALS.

ALS and the Sea of Marrow

“The brain is the sea of marrow…when the Sea of Marrow is insufficient, it results in revolving of the brain, noises in the ear, weakness of the legs, dizziness with spots, and the eyes without vision” –Huáng Dì Nèi Jīng Líng Shū, Chapter 33 (Wu, p. 133).

In Chinese medicine, the Sea of Marrow (suǐ hǎi 髓 海) is a rather curious term. According to Shun-fa Jiao, whose work with acupuncture and neurology was mentioned above, “Marrow (suǐ 髓) illustrates the changes the channels undergo after they enter the spinal canal” (Jiao, p. 68). Based on this description, and the one given in Chapter 33 of the Huáng Dì Nèi Jīng Líng Shū, a biomedical definition of the Sea of Marrow would likely encompass the brain, the spinal cord, and the cerebrospinal fluid. From this perspective, it should be obvious that the Sea of Marrow plays a large role in neurodegererative diseases like ALS. Clinically, there are two points specific to the Sea of Marrow: Du-16 and Du-20. These two points are both on the dū mài 督脉, which was mentioned above as one of the channels typically affected in atrophy syndromes.

Bridging Two Worlds: Integrating Acupuncture and Biomedical Treatment
As of now, there is no cure for ALS. The only therapy that exists is a pharmaceutical drug called Riluzole. Unfortunately, Riluzole only extends the patient’s lifespan by 2-3 months, and it often causes undesirable side effects like nausea and fatigue (Skidmore, 2007). Without an effective biomedical cure, acupuncture and Chinese medicine must be considered as potential adjunct therapies to manage the symptoms of ALS and to reduce the side effects of Riluzole.

In a recent study, researchers found that integrative therapies, including acupuncture and Chinese medicine, improved subjective symptoms in patients. These patients reported feeling more comfortable, slightly happier, and more energetic; some patients reported more restful sleep and improved appetite as well (Pan, 2013). This study suggests that acupuncture and Chinese medicine have the potential to play a supportive role in conventional ALS treatment, both to improve overall quality of life and to reduce the side effects of Riluzole treatment.

In another study, patients were treated with the following acupuncture points: Spleen-3, Lung-9, Heart-8, and Lung-10 (Lee & Kim, 2013). Do you recall the earlier statement from the Nèi Jīng that one should treat the spring (yíng 潆) and transport (shū 輸) points in cases of atrophy? Spleen-3 and Lung-9 are transport (shū 輸) points, and Heart-8 and Lung-10 are spring (yíng 潆) points! In addition to performing acupuncture, Spleen-3 and Lung-9 were connected to electrical stimulation for 15 minutes at a frequency of 100Hz (Lee & Kim, 2013). The researchers found that this point protocol had a significant influence on SpO2—or oxygen saturation levels—leading them to conclude that acupuncture treatment could positively influence inspiration (Lee & Kim, 2013). Inspiration (aka inhalation), is an active process facilitated by muscular contraction, primarily of the diaphragm and intercostal muscles (Tamarkin, 2011). This finding is particularly noteworthy, since the progressive neuromuscular degeneration of ALS ultimately leads to the failure of the respiratory system.

Other studies suggest that electrical stimulation performed on Stomach-36 elicits anti-inflammatory effects in animal models of ALS (Yang, 2010; Jiang, 2011). Inflammation commonly accompanies the neuronal death that occurs in ALS patients, and many researchers are currently seeking ways to reduce the inflammation that is associated with the disease (ALSA.org/research). If acupuncture can potentially reduce inflammation in ALS patients, why not incorporate this safe and effective therapy into an integrative treatment strategy?

Clinical Protocols and Beyond
In this paragraph, I’d like to take a brief moment to address the acupuncturists who might be reading this article. Hopefully, the discussion presented here has already inspired you to consider how you might treat this disease in your clinic. If not, consider incorporating the information from classic texts and modern research into a comprehensive clinical protocol. At minimum, use Lung-9, Spleen-3, Heart-8, Lung-10, Du-16, Du-20, and Stomach-36. Of course, this protocol is extremely basic, and must be modified according to the patient’s presentation (including tongue and pulse). Consider using other points on the yáng míng 阳明 and dū mài 督脉 based on the patient’s specific symptoms.

A word of caution: while we can learn much from an integrative approach, we must always seek to explain biomedical terms and diagnoses with Chinese medicine terminology—not the other way around!

Herbal Approaches
While much of this article has focused on acupuncture protocols for the treatment of ALS, I’d like to take a brief moment to mention some potential herbal therapies. Of course, before undertaking any course of herbs, consult your doctor or primary healthcare professional.

Based on the symptoms of muscular atrophy, fatigue, and respiratory failure, a comprehensive Chinese medicine approach to ALS treatment would likely involve herbs that boost the qì of the Lung and Spleen. According to Chinese medical theory, the Spleen rules the muscles (Huáng Dì Nèi Jīng Sù Wèn Chapter 5). Note: the term Spleen (脾 pí) refers to a holographic representation of biological and physiological processes, not only to the organ itself. The respiratory issues that occur as the result of ALS suggest that Lung qì deficiency also plays a role in the etiology of the disease. Chinese herbal medicine works best when the formula is tailored to meet the specific needs of the patient, but here are a few potential starting points:

Four Gentlemen Decoction: the most basic formula to fortify the Spleen qì.

Li Zhong Wan: slightly warmer than Four Gentlemen; also used to fortify the Spleen qì.

Shi Chuan Da Bu Wan: fortifies both the qì and blood; includes Huang Qi (Astragalus root) to support the Lung and Rou Gui (Cinnamomi Cortex) to support the Kidney.

Cordyceps: fortifies the Lung and Kidney; helps maintain respiratory health.

Sheng Jiang, Zi Su Ye, Ban Xia, Da Zao, and Gan Cao: a simple formula to ease the nausea that may accompany Riluzole treatment.

Closing Thoughts
Obviously, acupuncture and Chinese medicine have the potential to play an important role as an adjunct therapy to biomedical treatment for patients suffering from ALS. The conventional biomedical treatment for this disease extends life by up to three months, but may produce undesirable side effects like nausea and fatigue. Why not pursue an integrative approach, so that the patient can be as comfortable as possible throughout the duration of the disease?

 

References

ALSA.org

ALSA.org/research

Ahn, et. al., (2010)

Huáng Dì Nèi Jīng 黄帝内经

Jiang, et. al., (2011)

Sun-fa Jiao, (2012) Nine Needles and Twelve Yuan-Source Points

Langevin & Yandow, (2002)

Lee & Kim, (2013)

Pan, et. al. (2013)

Axel Schuessler, ABC Etymological Dictionary of Old Chinese

Linda Skidmore, (2007) Mosby’s Drug Guide for Nurses, 7^th edition

Dawn Tamarkin, (2011)

Paul Unschuld, (1986) Nan-Ching: The Classic of Difficult Issues

Jing-nuan Wu (1993) Ling Shu: Or the Spiritual Pivot

Yang, et. al. (2010)

© Dr. Phil Garrison and Dr. Phil’s Chinese Medicine Blog, 2014. Unauthorized use and/or duplication of this material without express and written permission from this blog’s author and/or owner is strictly prohibited. Excerpts and links may be used, provided that full and clear credit is given to Dr. Phil Garrison and Dr. Phil’s Chinese Medicine Blog with appropriate and specific direction to the original content.

The Crisis of American TCM

As the first cohort of students I taught embarks upon the final year of their master’s program, I wanted to offer them some words of encouragement. In thinking about what to say, I began to recognize a potential problem that not only affects them, but all current students, teachers, and practitioners of Chinese and East Asian medicine in the United States.

The Rise of the Disempowered Healer
Chinese medicine in America is stuck: the growing number of acupuncturists and practitioners of East Asian medicine has created a new economic market for postgraduate certification programs. Subsequently, we have begun to create a culture of secrecy and certification that is ultimately detrimental to our field. The most recent generation of practitioners is particularly susceptible—we don’t have the experience of our colleagues who have been practicing for 20+ years, so we often compensate for this perceived deficiency with workshops, seminars, and certifications. Let me take a moment to clarify my terms: I am not talking about CEUs required for licensure, I am talking about the myriad of certificated programs that do not adhere to the academic standards of other disciplines, and thusly confer unaccredited titles. We are continually being enticed by teachers who promise to unlock the secrets of Chinese medicine, as revealed to them through arcane lineages that were originally transmitted from the favorite pupil of the Yellow Emperor (or some such thing). In many cases, this leads to complacency: instead of educating ourselves, we rely on others to do it for us. We accept the myth of “secret knowledge.” Simply put, we voluntarily disempower ourselves. In so doing, we gain certifications and techniques, but not true knowledge of the medicine. As a practitioner who graduated within the last 10 years, and as a former teacher, I have witnessed my colleagues—and myself—succumb to this Faustian bargain.

In addition to holding MTCM and DAOM degrees from accredited institutions, I also have several unaccredited certifications, but out of respect for other practitioners and students of the medicine, I no longer list any of these certificated titles on my website or other marketing materials. Let me be clear: I am not suggesting that these certificates have no value—they represent hours of training and study in their respective subjects—they just don’t hold any weight with the greater academic community. When I joined the faculty at Five Branches University, I was not permitted to list any unaccredited certifications in my bio, and though I no longer teach there, I have chosen to follow the standard set by that institution (my master’s-level alma matter). It’s one thing to be proud of one’s accomplishments, but I believe it sends the wrong message about our field to current students, the biomedical community, and the general public when we list certifications obtained through non-accredited sources alongside legitimate degrees and credentials. We should be proud of our master’s degrees, doctoral degrees, and licenses. They are well deserved!

How did this happen?
Many of us are drawn to Chinese medicine because of the mysterious and mystical ideas it seems to hold, only to be frustrated as we wait in vain for the part about dragons and ancient sages who have unlocked the mysteries of the universe. In my experience, few teachers ask students to think critically, and students are often discouraged from doing so, both in the classroom and in the clinic. Seeking the magic within the medicine, students begin to look outside their schools for the “secret knowledge” that isn’t taught anymore. Many of us have entertained romantic notions of stumbling upon an old man with a white beard walking the Chinese countryside, or meditating on the subtleties of nature in a subterranean cave. Unfortunately, while a few of us may attain this fantasy, most won’t. As a community, we need to reject the fallacy of “secret knowledge” that is found somewhere outside of ourselves—a notion that is inherently disempowering. Instead, we must hold ourselves to a higher level of academic rigor and integrity. Only then will we see that there is no veil between ourselves and true understanding of this timeless medicine.

Pedagogy and the Failure of the TCM Educational Model
The first American schools of TCM inherited a model of education from China that did not truly meet the needs of American students. While we have largely adapted the clinical practice of Chinese medicine to meet the needs of the American patient population, we have not—for all intents and purposes—adapted our teaching model to meet the needs of the American student. As part of my doctoral research on pedagogy and ancient chinese medical literature, I referenced Bloom’s taxonomy of educational objectives when composing a curriculum for the Huáng Dì Nèi Jīng. Put simply, Bloom’s taxonomy is a method of grouping learning outcomes in the classroom: ranging from lower-order to higher-order cognitive processes (Bloom, 1956). Unfortunately, many teachers at American TCM and OM schools are basing their learning objectives on lower-order processes, like “remembering” or “understanding.”

Visual representation of Bloom’s taxonomy

Let me illustrate this concept using yīn-yáng theory as an example: a teacher outlines the basic concept of yīn-yáng theory, along with some general associations (yīn=dark, yáng=light; yīn=water, yáng=fire). The lowest-order cognitive process is simply “remembering,” so students are only asked to repeat back the previously mentioned yīn-yáng associations on a test or when questioned in class. The next level up is “understanding,” so students are asked a question like, “What is yīn-yáng theory?” and they are expected to answer something along the lines of, “An ancient Chinese theory about the dynamic polarity of opposites,” and then give a few examples. These lower-order processes are important at the beginning stages of any subject, but they must evolve throughout the semester (and the program) as the students’ understanding of the subject matter deepens.

Ideally, someone who is teaching at the foundational level should begin with lower-order objectives, and as the semester progresses, gradually incorporate higher-order objectives into their lesson plans. Using the same example of yīn-yáng theory, higher-order questions would sound something like, “Analyze how yīn and yáng affect your life,” “Compare yīn-yáng theory with Five Phase theory,” or “Some Chinese scholars believe the full moon is maximum yīn, while others believe it is maximum yáng: what do you think, and why?” How many teachers, even in the final year of a four-year master’s program, ask students to employ these higher-order cognitive processes in the classroom? Not many, in my experience. Even in the final year, most learning objectives seem to be geared toward the memorization of disease patterns and the rote repetition of point and/or herbal prescriptions. The model employed in many American master’s programs is utilitarian in this regard: these programs doggedly prepare students to take State and/or National Board exams, which are largely based on lower-order cognitive processes (specifically recall of information). Unfortunately, this also means that many master’s students graduate without ever really thinking critically about Chinese medicine and the theories thereof. These graduates then go on to teach, and the cycle repeats…and the cylce repeats…a d  t e  c c e  r p a s…until the knowledge is obscured and thus appears secret.

So What?
The lack of higher-order learning objectives in most TCM and OM classrooms does two things: it creates a surface understanding of the practice and theory of the medicine, and it drives students toward external sources of information. In my case, it did the latter. I wasn’t getting the answers or understanding I sought, so I spent most of my free time reading books about the medical classics, ancient Chinese philosophy, or the history of Chinese medicine. By graduation, I had read more than 50 books on these subjects—none of which were required reading! Most of my colleagues thought I was crazy for reading this much in addition to the required texts, but I enjoyed finding answers to my lingering questions. Other colleagues attempted to rectify their academic frustration by becoming involved in outside classes and school-sanctioned electives, or by obtaining certification in some other modality related to Chinese or East Asian medicine. As mentioned above, I took this approach, too. I mention it merely to underscore a point: teachers should give more to their students, and students should expect more of their teachers.

Students should be encouraged to find answers to the questions that intrigue them, and teachers at American schools of East Asian medicine should foster this curiosity in both the classroom and the clinic. Schools need to prepare students for the boards, but also need to challenge them to do more than repeat and regurgitate TCM banalities like, “The Liver is associated with the color green.” American students are hungry for knowledge, and no matter how many times the administration or their teachers tell them: “Just focus on passing the boards for now, and then you can study the things that interest you,” they are going to seek it out!  Furthermore, the students at American TCM and OM schools are being yoked with a crushing amount of student-loan debt, so they should not be forced to look outside of their schools to find the knowledge they are seeking; consequently, the teachers at these schools should not be satisfied with relying on lower-order learning objectives in the classroom or in the clinic.  We—as a community—need to up our game, or we will never be taken seriously by the greater world of academia.

Integration of Knowledge from Other Disciplines
Most American TCM schools do an admirable job of teaching students how to interface with MDs and other biomedical professionals. Unfortunately, Chinese medicine is a complex discipline and—to accurately articulate its theoretical underpinnings—an understanding of the history, philosophy, and culture of China is required. As teachers, we need to incorporate knowledge from these other disciplines into our classrooms, so that our students can dialogue intelligently with academics in these other fields as well. We also need to do a better job of citing our sources. As a scholar of the Huáng Dì Nèi Jīng, I find it incredibly frustrating when I see a post or an article by a member of our community that says, “According the Nèi Jīng…” without specifically citing from which of the 162 potential chapters the statement originated!

Speaking of the Nèi Jīng: how many students are graduating from their program without even a cursory understanding of this foundational text? How many students know basic Five Phase theory, but have never heard of Zuo Yan, who popularized it (Wang, p. 6)? How many of our colleagues create articles, blog posts, and websites that make statements about acupuncture or East Asian medicine without citing their sources? And how many of us rely on the statement, “According to my teacher…”? That phrase is fine when we are repeating personal insights a teacher has shared with us based on their clinical experience, but it is not acceptable when making specific claims about the medicine. If a teacher makes a statement that is anything but experiential, they should be able to cite a source. That is the accepted standard in all academic disciplines: why should we be any different?

The Remedy
Fortunately, there are literally hundreds of journal articles and books available in English encompassing topics as esoteric as the Magic Square and Nine-star Feng Shui. I know they exist: I read and incorporated many of them into my DAOM research. It’s simultaneously humbling and inspiring to see all the questions that university professors and academics have answered already! And on the flip-side, for those who long for a more modern approach to Chinese medicine, there are scientific articles on biophotons, Bonghan ducts, and fMRI imaging of the brain during acupuncture treatment.

Few teachers or practitioners have time to read these articles, however, because they are working to pay off student loans, and need downtime between managing their practices and attending to worldly responsibilities. This scenario is precisely why I started Dr. Phil’s Chinese Medicine Blog. In the coming weeks and months, I am pledging my free time to the advancement of our field through the dissemination of accurate and reputable information. Whether you want to know more about the translation of Chinese medical terms into English, or are interested in the latest research on acupuncture and PTSD, I’m going to share it with you or tell you where to look. Whether you are a teacher, a student, or a member of the general public who is interested in Chinese medicine, I hope you will find something inspiring, and go in your own direction with whatever you are passionate about. You don’t need an arcane lineage or a certificate to be a great practitioner. You need to believe in yourself. You need to believe in the medicine. Teachers need to believe in their students. Practitioners need to believe in their patients. You hold the secret of Chinese medicine: find your own Dao.

References
Aihe Wang, Cosmology and Political Culture in Early China

Benjamin Bloom, Taxonomy and Educational Objectives Book 1: Cognitive Domain

Bloom’s Taxonomy

Bloom’s Taxonomy Action Verbs

© Dr. Phil Garrison and Dr. Phil’s Chinese Medicine Blog, 2014. Unauthorized use and/or duplication of this material without express and written permission from this blog’s author and/or owner is strictly prohibited. Excerpts and links may be used, provided that full and clear credit is given to Dr. Phil Garrison and Dr. Phil’s Chinese Medicine Blog with appropriate and specific direction to the original content.

Ebola: Reflections from a Chinese Herbalist

With all the recent news about the Ebola virus, I thought it would be interesting to consider the disease from the perspective of Chinese medicine. **The ideas presented here are purely theoretical, and should not be taken as a substitute for medical care. If you think you have the Ebola virus, see your doctor or go to the nearest emergency room.**

The Ebola Virus

The following is a list of symptoms gathered from the World Health Organization, Centers for Disease Control, Mayo Clinic, and National Institutes of Health:

EARLY STAGE SYMPTOMS

Fever

Headache

Muscle/Joint Pain

Sore Throat

Chills

Weakness

LATER STAGE SYMPTOMS

Vomiting

Diarrhea

Rash

Chest Pain

Internal/External Bleeding

ANALYSIS

Based on the signs and symptoms, Ebola would likely be diagnosed as 温病 wēn bìng (warm disease) in Chinese medicine. Wēn bìng is a term that was first mentioned in Sù Wèn Chapter 31 of the 黄帝内经 Huáng Dì Nèi Jīng (Yellow Emperor’s Inner Classic), the foundational text of Chinese medicine.  Despite this early reference, it wasn’t until the Qing dynasty that the theory developed into a comprehensive doctrine.  In short, 温病 wēn bìng refers to infectious febrile diseases with rapid onset and progression. The Ebola virus’ progression of symptoms lines up well with the “four-levels” progression put forth by Ye Tian-Shi in his 温热论 Wēn Rè Lùn (Discussion of Warm Heat) (Liu, 19; Maciocia, 721; Wiseman & Ye, 659).  According to this theory, 温病 wēn bìng moves from the exterior 卫 wèi (protective/defensive) level to the 气 qì level to the 营 yíng (constructive) level to the 血 xuè (blood) level (Maciocia, 723; Wiseman & Ye, 659).  As the pathogen penetrates deeper into the body, the signs and symptoms usually become more severe.

The disease typically begins with fever—or a combination of fever and chills—and headache, suggesting that the disease is on the exterior 卫 wèi level.  Sore throat is also common when the 卫 wèi level is affected.  According to Chinese medicine, fever (or fever with chills) is caused by the struggle between the pathogen and the 卫气 wèi qì (protective/defensive qì).  The headache is a result of the pathogen attacking the upper portion of the body and disrupting the free flow of qì (Maciocia, 726).  Similarly, the body aches are caused by the pathogen obstructing the muscle layer.

At this initial stage, the formula of choice would likely be Yin Qiao San (Honeysuckle and Forsythia powder), with modifications depending on presentation (including tongue and pulse).  At this stage, one should add Huang Qin (Baical Skullcap root) if the disease is obstructing the Lung and causing shortness of breath or expectoration of yellow sputum, and/or Tian Hua Fen (Tricosanthis root) if there is pronounced thirst.

As the disease progresses to the 气 qì level, the chills (if there were any) will likely abate, and the fever may become more pronounced. At this stage, stronger heat clearing medicinals will be necessary.  A strong heat clearing formula like Bai Hu Tang (White Tiger Decoction) would be most appropriate at this stage.  One should also consider modifying the formula depending on presentation (including tongue and pulse).  Herbs like Zhi Zi (Gardenia fruit) and Huang Qin (Baical Skullcap root) should be added to the formula to support its heat clearing properties.  In cases of strong thirst, Tian Hua Fen (Tricosanthis root) should be added as well.

At any point during these two stages, if a macular papular rash should develop, add herbs like Zi Hua Di Ding (Violet leaf and flower), Da Qing Ye (Isatis leaf), and/or Sheng Di Huang (raw Rehmannia root).

Macular Papular rash

 

 

If there is vomiting/nausea, add Ban Xia (Pinellia ternata) and Sheng Jiang (fresh ginger root).  In cases of diarrhea, consider adding Mu Xiang (Aucklandia root), Yi Yi Ren (Coix semen), and/or Gan Jiang (dried ginger root).

The final stages of Ebola often cause vomiting of blood or some other type of bleeding disorder.  In these cases, the disease has entered the blood level and the blood should be cooled.  Herbs like Sheng Di Huang (raw Rehmannia root), Mu Dan Pi (Moutan cortex), and Zhi Zi (Gardenia fruit) should be utilized at this stage, in addition to other herbs related to the presentation (including tongue and pulse).

 

References:

Huáng Dì Nèi Jīng 黄帝内经

Warm Pathogen Diseases by Guohui Liu

Chinese Medical Herbology and Pharmacology by John & Tina Chen

Formulas and Strategies by Dan Bensky and Randall Barolet

A Practical Dictionary of Chinese Medicine by Nigel Wiseman and Feng Ye

Foundations of Chinese Medicine by Giovanni Maciocia

National Institutes of Health www.nih.gov

Centers for Disease Control www.cdc.gov

World Health Organization www.who.int

Mayo Clinic www.mayoclinic.org

© Dr. Phil Garrison and Dr. Phil’s Chinese Medicine Blog, 2014. Unauthorized use and/or duplication of this material without express and written permission from this blog’s author and/or owner is strictly prohibited. Excerpts and links may be used, provided that full and clear credit is given to Dr. Phil Garrison and Dr. Phil’s Chinese Medicine Blog with appropriate and specific direction to the original content.