While I was in the OCOM DAOM program I had the good fortune to observe many hours in the Hai Shan Clinic of Heiner Fruehauf, Ph.D., a noted classical scholar and sinologist. After I finished my DAOM degree I went to work in his clinic for a number of years. It was there in the Hai Shan Clinic that my still ongoing adventure/mission with treating chronic Lyme disease began.
Chronic Lyme is just one instance of what was called Gu syndrome in ancient times. Heiner’s first article on Gu syndrome, published in the late 1990s in The Journal of Chinese Medicine was a watershed moment for Chinese medicine in the West. It struck a chord that resonated with many practitioners who had, like Heiner, been struggling to help patients with strange constellations of symptoms. Gu translates as “demon possession”; when you work with chronic Lyme patients, you hear again and again statements like, “I feel possessed,” or “I don’t feel like myself”—all this from people who have not read Heiner’s work and who know nothing of Gu Syndrome. Obviously he touched on an important phenomenon that was being missed by the modern TCM system and textbooks. Paul Unschuld’s Medicine in China, required reading at many TCM colleges, does contain mention of Gu Syndrome, but from reading it one would not suspect that the ancient Gu literature was in any way relevant to modern medicine and its challenges.
A few years after his article came out Bob Flaws and Honora Wolfe decided to start Blue Poppy Herbs. One of the first formulas they made was called Modified Perilla and Mentha. This was Bob’s modification of Su He Tang, a formula mentioned in Heiner’s article. This Blue Poppy formula became the first formula designed to treat Gu Syndrome in the West. I remember at the time talking to Honora about it (at the time I was working for the company that manufactured the formula for Blue Poppy, and they were my customers). She related to me that they were getting the strangest reports from Blue Poppy customers about Modified Perilla and Mentha; it was helping patients with a totally odd array of conditions. This bizarre collection of conditions is a classic Gu syndrome presentation. One Chinese doctor I studied a bit with said: “If it is strange, it is either phlegm, blood stasis, or Gu.”
In the last ten years I have treated many patients with chronic Lyme disease and have come to appreciate what a challenge it is to work with this population. I have some thoughts on treatment that I would like to share here. I won’t repeat points made in Heiner’s article, since it is easily found online and should be considered essential reading if you want to treat chronic Lyme disease patients. Those interested can also find online in various places interviews I have conducted with Heiner on this and related topics.
First, an important clarification: Acute Lyme disease may in most cases be easily cured with appropriate antibiotics, but that is not the case with chronic cases. A quick turnaround is unlikely, if not impossible. Patients have to be counseled to look for steady improvement over time. Slowly the chronic fatigue and pain and brain fog can lift, but it requires patience. This means regular treatment, weekly if possible. At Heiner’s Hai Shan Clinic we would tell chronic Lyme patients that they could well be coming for three or more years.
Second, the treatments must be gentle in nature. Lyme patients are in a state of inflammation and are completely exhausted from it. Strong stimulation is just not a good idea. So if you are thinking in the way of “It’s a serious disease, so I have to give a strong treatment”, you will only make a bad situation worse. Japanese Meridian Therapy shows its strength in these situations, but if you do not know how to practice that system, then you still need to soften your normal way of working. Use very thin needles, preferably 42 or 44 gauge, and only insert superficially and for a short time. Use direct moxa in your treatment to rebuild the strength—but not too much of it either. Use half-rice-grain moxa on points like TB 4, ST 36, CV 12, CV 6, LI 11, and relevant back shu points. Slowly strength will return. Teach them to do moxa at home, daily if possible, on a few of these points. You can sell them stick-on moxa products if they will not commit to learning to use loose moxa.
Third, before you start treatment allow the patient all the time she needs to tell her story. With my other patients I get them up on the table fairly directly, but I have learned with chronic Lyme cases that this idea is counterproductive. They REALLY need a chance to tell their whole story. They might well ramble, but it is an important piece of the treatment that you listen to them closely.
Fourth, keep your herb doses initially low and move them up when you can see that the formula is well tolerated. Chronic Lyme patients are typically highly sensitive, so that high doses of herbs are hard to take without side effects. And change the formula every 6 weeks or so. If you are writing custom formulas, play close attention to Heiner’s instructions in his article. He lays out key herb categories that must be included in a Gu formula. Perhaps in a future blog we can go into this herbal method more closely.
Fifth, another point to make on the herbal medicine side of things is that chronic Lyme patients can for a time be treated by classic formulas that are not at all Gu formulas as Heiner describes them—so do not throw out your existing herb knowledge. As an example of this, I have given Chai hu jia long gu mu li tang to chronic Lyme patients when I felt that the focus had to be on getting their emotional state more grounded, and it has worked wonderfully well, almost magically so, in some cases. So, the point is that even though a patient might have Gu syndrome, it does not mean that every single formula you give them has to follow the system Heiner lays out in his article. But when you stray for a time from this type of Gu formula, you will eventually have to return to the herbs that are best suited for Gu syndrome.
Sixth, consider incorporating a little gentle bodywork into your treatments. It might be cranial-sacral therapy, or Feldenkrais, or Sotai, or Trager, or some other work, but it has to be gentle. All chronic Lyme patients have very tight upper backs and necks. In another blog post I will go into the pathomechanism behind this, but for now I ask you to just accept that this is the case. The bodywork can be focused on delivering some measure of relief from this chronic tension. Don’t try to alleviate all of it though; it would be a mistake to even try. Just get things to soften a little bit more in every treatment. Slowly, slowly they will get the relief they seek.
Lastly, no matter how good a practitioner you are, chronic Lyme patients are going to be hard on your ego, because you will not always succeed. There is no way around it. Lyme is such a complex condition that it is simply impossible to hit a homerun with every patient and every treatment. Be content with the two steps forward, one step back degree of progress.
You will likely learn the hard way that it is easy to over treat these patients. For their sake though try to learn this lesson as quickly as possible. Take the long view and slowly build them back up, treatment by treatment. Use your best knowledge of enlightened lifestyle to make sure they are doing what they can at home to support the work you do in your clinic. Many Lyme-literate MDs for instance insist their chronic Lyme patients eat as if they were diabetic, i.e., avoid simple carbohydrates completely, maximize cooked vegetable intake, minimize fruit intake, eat moderate amounts of quality protein, and keep the diet organic if possible. A simple qigong routine can be taught as well as meditation. All these elements of a healthy lifestyle contribute significantly to the recovery of health and vitality. Counseling is also in many cases necessary. Gu Syndrome has a major impact on the emotional state, such that most Lyme patients suffer from anxiety. Finding the right psychologist or counselor can be a blessed support.
I have much more to say about Lyme, but for now, let’s leave it to another time. I hope this post helps to stimulate some thoughts in those of you with chronic Lyme patients.
Until then, best wishes
Bob Quinn