Autoimmune Disease Treatment with TCM: Rheumatoid Arthritis & Ulcerative ColitisAdina Stanescu, R.TCMP November 1, 2009
Traditional Chinese Medicine (TCM) can offer much help to sufferers of autoimmune diseases, yet this fact remains largely unknown to many patients and their doctors.
As a TCM practitioner with specialized training in the field of autoimmunity, I am often frustrated by the difficulty of getting this knowledge across to those who need it, at least of doing so via the more “official” channels of hospital-based patient support groups, national associations, fundraising and advocacy groups, and their respective online portals.
Many of these organizations are either funded by drug companies that have a vested interest in monopolizing treatment options, or are under tight control of medical specialists who need to approve any speaker that offers to introduce an alternative treatment. The usual response is that the alternative treatment is “unproven,” and therefore not admissible for discussion. Patients, often frightened by their severe symptoms and told by their world-renowned specialists that there is no other option, are understandably leery to trust another therapy. There are also online forum posts of those who have strongly benefited from TCM treatment, but are met with skepticism or disinterest from other readers who invariably say, “Surely my doctor would know about this, if it worked so well…” Or, your doctor may suffer from the arrogance, ignorance and lack of imagination that seems to infect many in the medical profession, like a truly incurable disease.
Yet in China, Taiwan, Japan, Korea and Singapore, in everyday medical settings, Chinese herbal treatment is standard for many of the autoimmune diseases. Its effectiveness can range from significant improvement in symptoms – all the way to induction of such long-term remission that it may as well be called a cure. When we consider the fact that the pharmaceuticals used to manage autoimmune diseases have severe and profound side effects if used long-term, it is imperative to disseminate other effective treatment options such as Traditional Chinese Medicine (TCM).
Still, I should state categorically that the steroids, immune suppressants and chemotherapy drugs of modern medicine can be absolute lifesavers to someone who is in the throes of a severe autoimmune flare-up and they should never be refused dogmatically – severe, untreated autoimmune disease can damage the body as profoundly as any drug.
However, herbal medicine, when customized and properly prescribed by a qualified herbalist, can often bring about equally dramatic improvement in symptoms – without the side effects – and with the long-term goal of correcting the imbalances that produced the autoimmune dysfunction in the first place.
TCM treatment is generally in two stages: the acute stage, when strong anti-inflammatory herbs are used to deal with the pain, discomfort and dramatic symptoms; and the remission stage, where symptoms have temporarily subsided and we have a huge opportunity to use herbal tonics and adaptogens to modulate the immune system, strengthen organ function and nourish the blood.
Let’s look at the specific treatment of four common conditions to illustrate how this works in practice:
The symptoms of Rheumatoid Arthritis (RA), with its relapsing and remitting cycles, as well as its propensity to cause joint deformity, were described quite accurately in ancient TCM texts. One of the most famous formulas used to treat it (“Cinnamon Twig, Poria and Anemarrhena Decoction”) was conceived in 220 AD, and is still doing a fine job today.
At that time in history, China was still very much an agrarian society. Constant exposure to the elements and their effects on the joints meant that Chinese medicine had to develop effective treatments for the different types of arthritis. Indeed, invasion of wind, cold and damp from the environment is still thought to be a cause of such conditions. No doubt that in the case of RA, such factors interact with stress, genetics or viral infection to trigger the autoimmune component of the condition.
TCM works very well for RA because it asks a lot of questions about the exact presentation of the affected individual. For instance, there are four general categories of symptoms:
1) Cold Type: With this type, joints feel very stiff, worse with cold, and pain is fixed and severe. This is treated with warm circulatory herbs such as cinnamon, ephedra and ginger, which scatter the cold that has lodged in the joints and bring fresh, warm blood to the area.
2) Damp Type: Here, there is dull pain and pronounced swelling of the affected joints, as well as generalized ache and heaviness of the whole body. Herbs such as job’s tears and poria mushroom are essential to drain away this excess fluid, which obstructs joint movement and sustains the inflammation.
3) Hot Type: With this type, it is often part of an acute flare where the joints turn red, are warm to the touch and swollen. There may be systemic symptoms such as generalized fever and malaise. Strong anti-inflammatories such as lonicera stem, red peony root and large leaf gentian root are important. Large leaf Gentian (Qin Jiao), has been found to have anti-inflammatory effects comparable to prednisone, but without the steroid’s bone-thinning and kidney-damaging side effects.
4) Stagnant Blood Type: Here, nodules and joint deformity begin to develop. Pain is worse at night and with rest, and the tongue is purplish. This is usually a very chronic stage that sets in once RA has been around for many years. It requires strongly blood moving herbs such as peach pit, frankincense and myrrh.
There is no single, magic bullet treatment for RA. Each case is different, and presents at a different stage in the progression of the disease. Additionally, each individual’s genetic inheritance, environment, lifestyle, stress and constitutional type can interact to result in many possible presentations. By paying close attention to such details, TCM is able to target the symptoms exactly. Furthermore, to make the treatment even more specific, we use herbs and formulas that act on certain parts of the body.
Du Huo Ji Sheng Tang, for instance, is a very famous formula that is largely used for the joints of the lower body – the low back and sacrum, the hips, knees and feet – for chronic presentations with stiffness, cold and depleted vitality.
WHEN CAN IMPROVEMENT BE EXPECTED?
Once herbal treatment is initiated, improvement can be seen fairly quickly. For instance, a study published in the Chinese Journal of Integrated Traditional and Western Medicine 1985; 5(5): 284-285, followed the progress of 310 patients who were given a Chinese herbal formula. After 10 days, 70% reported significant pain reduction. At the end of one month, blood work values indicative of RA, such as erythrocyte sedimentation rate and rheumatoid factor, were normal in half the patients. This is an exceptionally fast result for a condition that normally requires the big guns of pharmaceutical medicine to bring under control. As treatment for RA would continue for several months, and in many cases for up to two years, even recalcitrant cases can expect similar improvements. In my practice, I expect to see pain relief within the first two weeks, and if this does not happen, I need to rethink the herbal combination.
When the pain symptoms are drastically reduced and the blood work is improved, the herbal formula changes to include herbs that nourish and repair the tendons and joints. These tissues have a poor blood supply at the best of times, and may have sustained damage as a result of the inflammation. Unlike Western medicine, TCM has many herbs in its arsenal, which can lubricate the joints by nourishing the fluids that cushion the joint articulations. This allows for pain-free movement and long-term integrity of the joint capsule.
When one has suffered pain for a long time, it is likely that the “Righteous Qi” – the body’s resources, blood, stamina and vitality – are also depleted. Anemia and fatigue are common symptoms in RA, and they can be well treated with strong tonics such as Astragalus, Angelica and Rhemannia glutinosa root. This last herb, rich in the iridoid complex of bio-chemicals, can also reduce liver inflammation and prevent osteoporosis.
CAN TCM BE COMBINED WITH WESTERN DRUGS?
Yes. Occasionally, if patients have suffered greatly with this condition, they are initially afraid to discontinue their Western medication because it has provided relief. However, these medications are often chemotherapeutic agents such as Methotrexate or immune suppressants such as Remicade which can damage the liver, decrease resistance to infection, and increase cancer risk. In this case, TCM can initially provide supportive treatment for the blood, joints and organs, so that once the patient is confident to begin a more active herbal treatment, their body is in a better position to withstand the gradual withdrawal of Western medicines.
Ulcerative colitis is an inflammatory bowel disease of autoimmune origin, with symptoms so severe they may ruin a person’s quality of life. Frequent diarrhea with bleeding, pain, urgency and mucus are the main symptoms. Colonoscopies show ulcerations in the large bowel, especially the rectum. Some cases are so severe that patients may have upwards of 10 to 15 bowel movements a day.
The autoimmune attack may be triggered by an infection or by severe stress. Surveys have shown that up to 80% of patients with autoimmune disease report an unusually stressful life event preceding diagnosis. As well, studies show that traumatic events in childhood can predispose to autoimmune disease development in adulthood. I believe the stress connection is particularly applicable to the gastrointestinal autoimmune diseases, such as Ulcerative Colitis and Crohn’s disease, through what is now called the “abdominal brain.” Chinese medicine has long used herbal formulas that specifically address digestive disease as a consequence of stress.
Inflammatory bowel disease treatment is very sophisticated in Chinese medicine, and I can say without hesitation that it is the best treatment available for Ulcerative Colitis. With herbs, we can bring about profound improvement in a very short time, with bowel movements decreasing by half within a couple of weeks, and more after that, and bleeding stopping altogether during that time.
The reason for this success is, as always, that TCM pays very close attention to the exact symptom presentation, and matches this as precisely as possible with the herbal formula. For example, is the diarrhea foul smelling and burning, or not at all? The answer will dictate what herbs are included. Is there mucus or not, is the mucus profuse or only a little, is pain a central feature or not, and is the disease recent or long-standing? Is the tongue coating yellow or white? The answers will point to the exact herbs that are needed. Formulas such as Pulsatilla Decoction are often chosen and modified individually for the very acute and “hot” stages of active disease.
Further, herbal medicines for UC are specially prepared by carbonizing, toasting or processing with ginger in order to increase their hemostatic (stopping bleeding) or anti-diarrhea effect, as well as to increase their ability to absorb and eliminate toxins from the bowels.
Once the symptoms are dramatically reduced, the herbal formula changes to one that strengthens the digestive organs and regulates the immune response. Herbs such as Ginseng and Astragalus are important here, although if used incorrectly or prematurely while the disease is still too active, they can make things worse. Self treatment is never indicated. This approach can produce a very long-lasting remission, and even – although frowned upon to say so – very often a cure.
Crohn’s differs from UC in that it can affect the GI tract anywhere from mouth to anus, whereas colitis only attacks the large bowel. They otherwise may share very similar symptoms, and consequently the TCM treatment protocols are very similar. In mild to moderate cases, the results are as wonderful as those of UC, but more severe cases require considerable patience. Whereas in UC we may see a dramatic improvement within two weeks, severe Crohn’s may need up to six weeks to demonstrate improvement.
Any serious natural therapy for autoimmune diseases should show some improvement within eight weeks at most. Several criteria need to be satisfied: practitioner training and experience; sufficiently high dosage of herbal medicine to be effective; and clear timelines for improvement.
But the most important element, in my opinion, is that a good therapy will always feature a high degree of customized treatment, well matched to the patient. A medical doctor who treats all cases with steroids (and a naturopath who treats all cases with essential fatty acids and probiotics) are not applying an individualized, specific treatment, and so are likely to fail. In Chinese medicine, this is called “trying to play the violin with the tuning pegs glued into place…”
•Complementary and Alternative Medicine http://archpedi.ama-assn.org/cgi/collection/complementary_and_alternative_medicine
•Dermatologic Disorders http://archpedi.ama-assn.org/cgi/collection/derm_disorders
•Connective Tissue Diseases http://archpedi.ama-assn.org/cgi/collection/connective_tissue_diseases
•Renal Diseases http://archpedi.ama-assn.org/cgi/collection/renal_dis