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Ebola and Traditional Chinese Medicine: Nothing New Under the Sun?

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While I don’t think it is appropriate for any herbalist or alternative practitioner to claim to be an expert in treating such an obviously dangerous disease as Ebola, it might be of interest to know that there is a historical precedent for treating hemorrhagic diseases such as Ebola in the history of traditional Chinese medicine. In the 14th century, Wang Lu (Wang An-Dao, 1332-1391) wrote that some infectious diseases could be caused directly by "Heat." "Heat" in the traditional sense did not refer to atmospheric temperature but represented the acknowledgement of contagious infectious diseases with a specific set of symptoms.  About a hundred years later, the physician Wang Ji (Wang Shi-Shan, 1463-1539) proposed that such diseases could be contracted directly. Finally it was as recent as the Qing dynasty (1644-1911) that the Warm disease theory was codified and diagnostic and treatment protocols were set forth, obviously based on the experience of numerous Chinese physicians successfully treating these conditions.

To back up a bit, we need to understand that the germ theory of disease which refers to the presence of small microorganisms such as bacteria, viruses, protists (such as protozoa), fungi or prions, confirmed by microscopes strong enough to detect them, could only be inferred. This was true both in China as well as the West where the germ theory was first proposed in the mid-16th century. This gained widespread credence with further discoveries during the 17th century.

In the early history of China infectious diseases caused by Heat were only hinted at in ancient texts such as the Yellow Emperor, long before the distinction between diseases caused by the energetic concepts of Cold and Heat was made. Similar to the Western traditional medicine encompassing ancient Greco-Roman and Arabic medicine, the etiology of diseases first compiled in the 2nd century attributed the major factors of diseases to be the individual’s constitution, environmental factors including and especially climate and seasonal conditions, bad diet, overwork and emotional imbalance.

These were broadly divided in Chinese medicine into two main categories:

  1. Internal damage caused by constitution, diet, work, stress or emotions.
  2. External diseases caused by atmospheric environmental factors such as wind, cold, summer heat, dampness, dryness, or fire.

This led to the creation of one of the first and arguably the most important clinical manual of Chinese medicine called the Shang Han Lun (Discussion of diseases caused by Cold damage) by Zhang Zhong-Jing in the early 3rd century. This text outlines six stages of disease and 108 formulas considered by many to be the core to the practice of TCM. As a result of wandering Chinese Buddhist monks visiting Japan soon afterward, this same group of formulas was adopted and form the basis of traditional Japanese Chinese Medicine known in Japan as Kanpo.

Many of these formulas happen to have considerable anti-pathogenic properties; they treat infectious diseases directly or work to stimulate the body’s innate ability to fight pathogens. Many of these types of Cold Damage diseases are self-limiting, meaning that given a supportive health regime, the formulas listed in the Shang Han Lun were and still are effective in preventing, lessening the severity and duration of symptoms.

The theory of Warm diseases developed in the 17th century is based on the recognition of especially virulent infectious diseases, most of which are viral. These diseases are so life threatening that the repertoire of formulas described in the Shang Han Lun are barely if at all effective.  

Warm disease theory describes four basic levels of disease progression especially relevant for the treatment of infectious diseases caused by Heat:

  1. Protective level: the body’s innate defenses (immune system or Wei Qi) are weakened and a pathogen is able to penetrate. At this level there is fever, slight aversion to cold, chills (forming a bridge between the early classification of diseases caused by Cold), slight thirst, red-tipped tongue with a thin, white coat and a floating and rapid pulse.
  2. Qi level: At this level, the pathogen (virus) penetrates. The fever is stronger, there is profuse sweating, thirst for cold drinks, yellow coated tongue, and a flooding and slippery pulse.
  3. Nutritive (Ying) level: The Yin (body fluids) are depleted and this causes a disturbance of the spirit (Heart). Here the fever is especially worse at night, there is restlessness, occasional delirium or muddled consciousness and a deep red tongue.
  4. Blood (Xue) level: The virus penetrates deeply and affects the blood. Symptoms of high fever, muddled consciousness, coma, various kinds of bleeding and a very deep red tongue.

What distinguishes the category of Warm Diseases are:

  • Symptoms appear very quickly
  • Heat signs and symptoms predominate
  • The hot nature of pathogens affect and injure the fluids (Yin) and Blood.

One might further add to this that diseases caused by Heat are contagious, seasonal, endemic and epidemic meaning that they can be transmitted to others.

It is most obvious that influenza caused by virus would be included in the category of warm diseases. While it is not always easy to distinguish between the common cold (caused by the rhinovirus) and influenza, the differentiation between the two rests in the degree of heat or feverishness which is higher with a Warm Disease influenza virus. Most importantly, with diseases caused by Heat, the degree of heat or inflammation results in a sore throat.

These categories of Warm disease are especially represented in the first two levels and is treated by one of the most popular over the counter TCM formulas called Yin Chiao powder (Honeysuckle and Forsythia Combination).

While all four stages can be critical for some people who are severely weakened and die from influenza, the most life-threatening stages of disesaes caused by Heat are the 3rd and 4th stages. I recommend that only the most experienced herbalists treat 3rd and 4th stage Heat diseases, and also refer to conventional Western medical treatment.

Based on its known symptomology of high fever, body aches, vomiting, dehydration and internal and/or external bleeding describing a severe form of hemorrhagic fever, Ebola would be a fourth Level Warm Disease.

While Western medical doctors are clamoring to find effective prevention and treatment protocols for Ebola it may be worth studying the two primary TCM formulas and in particular a single unique ingredient indicated for these stages of Heat disease (including Ebola, meningitis, encephalitis, septicemia, boils, acute leukemia, and hepatic coma).

The first is Qing Ying Tang [Decoction to disperse Pathogenic Heat from the Ying (Blood-Nutrient) System]. The second is Buffalo Horn and Rehmannia Decoction.

Both of these include Bubali cornu (water buffalo or bull horn) at a dose of 30 grams daily with the other herbs in the respective formulas.

Buffalo horn contains a number of therapeutically active biochemical constituents including keratin, glutamic acid, aspartic acid, and the amino acids cystine, leucine and arginine. In addition it contains a number of trace elements including sodium, magnesium, potassium, iron and zinc. TCM describes it as being salty in flavor and having a cold energy. It enters the Heart, Liver and Stomach meridians. It is antipyretic and antitoxic or Heat-clearing. It clears Heat from the Blood which stops bleeding symptoms associated with fever. It is useful for fever, convulsions caused by febrile diseases and can also be applied topically to treat skin eruptions caused by febrile diseases.

Cow horn, but especially bull horn, clears infectious Heat, high fever, removes viral or bacterial toxins, calms the mind and relieves convulsions.  A 2010 study published in the American Journal of Chinese Medicine confirmed and reported that Bubali Cornu had antipyretic activity in rats and lowering temperature.

Hemorrhagic fever occurs when fever is so severe that it results in bleeding. This can be externally from rashes on the body or internally with vomiting of blood, bleeding in the intestinal tract, nose bleed and blood in the stools and urine.

It is the added complication of incessant sweating, vomiting and diarrhea that results in the severe depletion of Yin (fluids). Around-the-clock intravenous hydration has proven to be one of the most effective medical treatment for Ebola patients.

To replenish and guard against this depletion of fluids, other herbs that should be considered when treating hemorrhagic fever are strongly moistening herbs such as unprepared Rehmannia glutinosa, Ophiopogon root and Scrophularia root. These are effective for lubricating, and nourishing both Blood and Yin. Bamboo shavings clear Heat and are very effective for stopping vomiting, cooling Blood Heat and stopping bleeding including nosebleed and vomiting of blood.  Chinese red sage (dan shen) moves and cools blood, and calms the mind. The antiviral heat clearing combination of coptis root, lonicera flower and forsythia buds are effective antiviral and antibacterial agents. Together with 15 to 30 grams of water buffalo horn, the combination of all of these herbs are found in Qing Ying Tang.

Another formula, Water Buffalo (or bull horn) and Rehmannia Combination, combines 15-30 grams of buffalo horn, 20-30 grams of unprepared Rehmannia, 1-15 grams of red peony root and 9-12 grams of moutan peony root. This formula is indicated if the symptoms of bleeding and blood stagnation (with broken blood vessels under the skin) are more pronounced.

I hope I never have to treat hemorrhagic fevers. However, one must always be prepared and certainly in the present fear-ridden crisis it is somewhat reassuring to know that even with the threat of this Ebola outbreak it is not a new disease. While Western medicine scrambles to find a vaccine and possible effective drugs, there is a tradition dating back to 17th century in China for its treatment.

 

References

5 comments

  • Comment Link Bethany Bechtel Saturday, 06 December 2014 23:12 posted by Bethany Bechtel

    Thank you for writing this! I have been thinking alot about Ebola as an extreme example of a heat pathogen. I hope there is some way Ebola patients could get access to these formulas. Have you contacted the Medicins san frontiers?

  • Comment Link Holly Hutton Sunday, 12 October 2014 21:53 posted by Holly Hutton

    I have been waiting for someone to address TCM and write exactly the article that you just did. Many thanks.

  • Comment Link Melissa Sylvan Sunday, 12 October 2014 01:33 posted by Melissa Sylvan

    How do you feel about the use of Moutan Peony and Arnebia, in addition to those herbs you mentioned, for cooling the Blood in this type of case.

  • Comment Link Leanne Saturday, 11 October 2014 04:52 posted by Leanne

    Very interesting article,but the part about the buffalo horn is schocking how many TCM's uses animal parts?! I am from South Africa and its terrifying what is happening to the Rhino! Such an ancient medicine cant be that out of allignment surely there is another way...

  • Comment Link Philip Goshorn Thursday, 09 October 2014 22:06 posted by Philip Goshorn

    Hi Michael,
    Thanks for your article on Ebolia and Hemoragic fevers.
    I do belive that there is validity in the formularys for the various stages. I belive that these formularies with western RX can be used to form an effective Rx schedule.
    The biggest issue there will be is the costs of Rx for larger populations of patients, and the infructure, supplies and machines.
    I look foward to your next news letter

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