Recently I conducted an interview with Heiner Fruehauf, Ph.D., one of our great classical scholars. He and I have done quite a few interviews to date. It was on the topic of “ascending and descending” in herbal medicine. In the past we have spoken at length on Lyme disease, aconite prescribing, the Fire Spirit method, Gu syndrome and other topics. These past interviews are all easily found online. In this blog post I want to expand on ascending and descending as it applies to chronic Lyme disease patients.
I have a personal test I conduct when a new patient comes and expresses a fear she might have chronic Lyme disease. I don’t doubt the symptoms, but I recognize that not every patient with strange symptoms is likely to have Lyme disease. There are other possibilities. My test is not definitive by any means—in the terms of my old career in mathematics, it is a necessary but not sufficient test.
What is it that I do? I check out the neck tension and ROM as well as in the upper back. If it feels reasonably free of tension, I am immediately dubious that they have chronic Lyme. Why is this? A key feature of Gu syndrome (chronic Lyme disease is a modern instance of the ancient Chinese concept of Gu) is the feeling of being “hollowed out.” This is expressed as a mental-emotional feeling by the patients, but we find this hollowness in a real physical way in the lower jiao. The tissue there will be lacking tone relative to the rest of the abdomen.
When the ming men weakens, it can no longer anchor the heat that should be held there, and this heat will follow its nature and float upwards. For a time the containment function of Earth might stop this heat in the middle jiao with resulting digestive symptoms showing. Over time however the middle jiao will eventually weaken, and the heat will continue to float upwards. Here in the upper jiao it will manifest as palpitations and anxiety, perhaps shortness of breath. If it then goes just a little farther up, and it for sure will continue upwards if this is true chronic Lyme, then we find incredible muscle tension and pain in the neck and upper back. Normal ROM is lost. I have found this in ALL cases of chronic Lyme. I hope it goes without saying—but I will spell it out for the sake of clarity—what I mean by claiming this is necessary but not sufficient, i.e., patients can obviously have horrible neck and upper back problems without any Lyme involvement—perhaps someone has had multiple motor vehicle accidents—but every Lyme patient I have seen, and there have been many, has tragically painful and tense necks and upper backs.
This in fact was my motivation for suggesting the topic of ascending and descending to Heiner. I wanted to get his thoughts on the matter. I knew he had studied with Wu Sheng’an, a genuine master who trained outside the TCM college system in China, and I knew this doctor focused strongly on regulating the up and down movement of qi in his formulas. Curiously Wu works frequently through the Lung organ-network to drive the qi, not through the Liver with something like chai hu. He has a four-herb combo that he uses frequently to get the qi to descend and to drive healthy qi movement throughout the whole body: she gan, jie geng, xing ren, jiang can (Called she jie xing chong tang). These typically are used in equal parts; three of these herbs will descend, and one for balance is ascending.
What I want to reflect on here is how this connects to a complaint often leveled against Japanese Meridian Therapy and its extremely gentle and superficial needling. Since the Lung rules the surface of the body, it is often commented that Japanese Meridian Therapy’s superficial needling is really only directed to the Lung organ-network. I am not personally convinced of the argument, but even if we accept it, here we have a top-notch Chinese practitioner working the same concept in herbal medicine—using the Lung in its role as “Commander of the Qi” to promote a healthy qi dynamic in the whole body.
I have trained in quite a few acupuncture styles but currently practice quite gently compared to what I suspect the norm is nationally. I have found this gentle approach particularly appropriate for chronic Lyme patients. Their nervous systems are so over stimulated by the disease process, and they are so fatigued that it makes no sense to me to do deep, strong insertions. In my role as a clinic supervisor I have had the chance to hear from many of these patients when someone else they went to gave them that sort of strong treatment. It is never a good story. Always these patients are only further exhausted by this sort of strongly stimulating needling. For them, less is more. I encourage those of you treating chronic Lyme patients regularly to experiment with gentler, more superficial needling.
Back to the herbs—I have had about two years now to investigate this Wu Sheng’an idea of treating through the Lung in my formulas for chronic Lyme patients, and I can say now in a provisional way that I think it adds a crucial piece that was missing. An important point to remember when studying with Heiner is that ideas are applied flexibly. What I mean here by mentioning this is that, for example, in a given case it might not seem appropriate to give she gan, an herb that clears heat strongly, and in those cases he might just substitute zi su ye or zi su zi instead. Perilla is one of the most helpful herbs in treating Gu syndrome. In another case it might make sense to use di long instead of jiang can. Those sorts of substitutions can be made.
I hope I have provoked some thought with this blog post. Best wishes all around.
Bob Quinn
Post note: Please remember that Blue Poppy’s Mentha and Perilla formula was the very first formula on the market designed for Gu syndrome. If you are not comfortable, prescribing an individually tailored formula, then this is a good way to go with these patients.