A number of TCM practitioners over the years have noted the similarity between the naturopathic diagnosis of leaky gut syndrome and the Chinese understanding of spleen dysfunction and what is called the qi dynamic. TCM has a long history of considering new ideas based on new information or changing times, so it is not surprising that the modern Chinese have considered the role of intestinal dysbiosis in spleen/stomach pathology in TCM. Bob Flaws has pointed this out in his most recent contribution on this topic.1 I think is interesting and useful to understand these latest developments in naturopathy in their historical context.
While some scientific approaches to TCM attempt to reduce TCM to already understood concepts of physiology, I will pursue a different path. Heiner Fruehauf, chairman of the Classical Chinese Medicine Department at the National College of Naturopathic Medicine in Portland, Oregon, was one of my teachers. His favorite 20th century author on TCM was Zhang Xi Chun. Zhang is remembered as an early proponent of the school of chinese-western medicine integration.2 However, Zhang Xi Chun used TCM concepts to expand his understanding of physiology and restore a holistic, dynamic quality to this modern science, rather than try to reduce TCM to science. He was the first to attempt to describe western drugs in TCM terms, something that has been attempted more recently by others, such as Z’ev Rosenberg3, chairman of the department of Chinese Herbal Medicine at the Pacific College of Oriental Medicine. In the same vein, we will consider some of the naturopathic and scientific approaches to illness in such TCM terms. Let’s start with some TCM terminology.
In TCM terms, the qi dynamic refers to the four movements of ascent, descent, exit and entry. For clinical purposes, it is basically the up-down flow of qi in all living creatures. The ascent of qi can be compared to the assimilation and distribution of pure essence and the descent to the removal of turbid matter for excretion. Even the simplest plants and microorganisms must still ingest part of their environment, transform it into pure and turbid components, incorporate the pure and excrete the turbid. This simple process which is describe both in the nei jing and also any college physiology textbook, is the most basic attribute of life. Thus, the emphasis on proper diet and cleansing has been part of many healing traditions, including shamanic, ayurvedic, essene, native American, Egyptian, Greek, Arabic and modern naturopathic, as well. Of course, all of TCM may essentially be broken down into these two categories, with therapies focused either on removing excess (cleansing) or building up deficiencies (nutrition). The real attraction of TCM, in fact, may be the sophistication with which it has developed these two basic approaches. The long written and scholarly tradition of China allowed a refinement of a method used worldwide in ancient times. This refinement was not possible in other parts of the planet for various historical reasons, but the basic method remains the same.
At the core of this refinement is the notion of the qi dynamic. Because TCM is based on a dynamic concept called qi, it is not enough to say that waste is excreted and nutrients are assimilated, the direction of this dynamic force is considered vitally important, as well. The turbid is discharged downwards, which is quite intuitively sensible, as the major wastes of our bodies move in that direction. That the pure should ascend is perhaps less apparent, but is actually physiologically sensible as well. The essences of food must be ascended to mix with air in the lung to form the pure blood that is pumped through the body by the heart. This is remarkably similar to modern physiology’s description of blood formation. Also the pure clear essences must rise to brighten the spirit, as well. Likewise, modern physiologists talk about glucose and oxygen requirements for proper brain function.
The key TCM organ networks that regulate the qi dynamic are the stomach and spleen. The spleen moves qi up and the stomach moves qi down. Thus, the spleen governs the assimilation of the pure and the stomach the excretion of the turbid. Spleen diseases involve failure and weakness of organs due to poor assimilation, while stomach disease is the beginning place for toxic internal heat to brew due to turbid accumulation. The liver provides the actual upward force via its smooth distribution of kidney yang qi and the lungs aid descent with their continuous bellows like action drawing air qi down into the body. But the spleen and stomach remain central to this process. The kidneys and the yang organs continue the process of separation of pure and turbid, finally discharging the turbid through the bladder.
Impairment of the qi dynamic often leads to dampheat, a TCM pathomechanism that is present in most serious chronic illness to one degree or another. This is relevant to this discussion, because dampheat is very similar to several naturopathic ideas, such as the generic term toxin or the more specific liver toxicity or bowel toxemia. In addition to being associated with acute infectious diseases in TCM, dampheat is also thought to arise from a polluted internal environment. It settles in the lower part of the body and causes disruption in blood circulation and emotional stability. Both the location of dampheat in the colon and its widespread impact on general health reveals certain similarities with the concept of intestinal dysbiosis, which we shall explore below.
Historical Development of Naturopathy
Modern Naturopathic medicine began at the end of 19th century, largely as a medicalized amalgamation of several popular health trends of the era. These included nature cure, fasting, hydrotherapy, colonics, exercise, diet emphasizing raw foods and vegetarianism. Many religious zealots were involved with these lay movements, but the profession of Naturopathy has been a serious one for a hundred years. Over this century, Naturopathy survived and absorbed the dying professions of homeopathy and eclectic herbalism, as well. Now, naturopaths always used herbs and homeopathics, but they tended to use these methods within their core philosophy, which was distinctly different from the eclectics and the classical homeopaths. Naturopathy has always been focused on removing toxins from the body, the idea being that when the system was purged of filth, it would function properly. As you might surmise, they got it only half right from our perspective.
While naturopaths certainly were early advocates of the need for proper nutrition to build healthy tissues, early proponents like Jethro Kloss, Arnold Ehret and Henry Lindlahr, M.D. felt that the vital essences of raw vegetarian foods would be fully absorbed in a system that was totally clean. Thus, the foods they chose for therapy tended to strongly emphasize removal of excess. Raw vegetables stimulate bowel movements and urination. At the turn of the century, when many nature cure patients were farmers, vigorous cleansing may have produced some miracle cures. Zhang Zi He, a medieval Chinese proponent of the idea that all disease is evil toxin, which must be purged, would have agreed with this approach. However, in TCM history, Zhang’s methods proved too harsh to be used in more sedentary types (like modern office workers). So Zhu Dan Xi modified Zhang’s method to be more balanced. Thus, purgation is still used in TCM when appropriate. As naturopathy moved into the modern age, it also evolved a more sophisticated approach for several reasons.
The absorption of eclecticism and homeopathy before WWII certainly shaped modern naturopathy. Eclecticism and homeopathy both relied on precise methods of regulating what is called the vital force. Naturopathy also embraced this concept, but had largely focused on removing the obstacles to the vital force, largely through vigorous cleansing methods. So naturopaths now began to incorporate subtler methods of regulating the vital force into their practices. At the same time, there was an explosion of research on nutrition occurring in Europe and America. While nutrition has recently become of interest to medical doctors, this not because there was no information available earlier. Naturopaths made early use of this information in their practices throughout this century. So after refining their theories for about sixty years now, they have arrived at a methodology that meshes very nicely with the Chinese concept of the qi dynamic.
The jumping off point for the most sophisticated naturopathic theories about disease causation are rooted in two important naturopathic concerns, namely bowel toxemia and assimilation of nutrients. The concept of bowel toxemia was largely promoted by a doctor named John Tilden in the thirties. Tilden postulated that improper diet led to stagnation of food in the colon, which then putrefied and formed toxins. He associated heavy rich food like meat with this toxemia, however he was not necessarily a raw foods advocate. He often recommended lightly cooked vegetables and broths as his regimen. It is now well known that low fiber, high fat diets alter the environment of the colon in a way that promotes the formation of carcinogens and other “toxins”.4 If these wastes are not removed from the body, they can indeed wreak havoc on the cardiovascular, immune and neuroendocrine systems, so they very likely play a role in the pathogenesis of diverse illnesses.
Naturopathic physicians oriented towards Nature Cure long emphasized the use of raw foods and juices to ensure assimilation of all available nutrients nature provided. Their raw food advocacy also stressed the importance of enzymes in living foods which are destroyed by cooking. Knowing that raw foods contain large amounts of enzymes, like all living tissues, and knowing that such enzymes were largely destroyed by cooking, they postulated that eating large amounts of raw food would keep enzyme levels high in the body. These enzymes would then spare the body of the need to produce its own enzymes, thus conserving the vital force for other activities, like immunity and free radical scavenging. There is no actual evidence that the enzymes in most common foodstuffs actually enter the bloodstream and impact one’s health in any dramatic fashion.
It is also highly questionable whether raw foods can actually be considered the “natural diet” of homo sapiens, anyway. It is likely that modern human beings have always had the use of fire, having inherited it from an earlier species called homo erectus. Evidence of the use of fire to cook food is thought to predate humanity by perhaps as much as one million years. The use of fire to cook gives a well known survival advantage in the form of being able to consume otherwise inedible starchy roots during times of food shortages. Over the course of a million years, it is likely that those who thrived on cooked food were selected over those who depended upon raw foods. Also, nature is geared towards reproduction, not longevity. The same diet that confers youthful reproductive vigor may not be appropriate later in life.
Recently, modern research on antioxidants has revealed the importance of heat stable flavonoid molecules in dark vegetables that become much more accessible and concentrated through cooking (such as lycopene). These components are now generally thought to be as important, if not moreso, than heat-labile factors like vitamin C. While it remains arguable as to whether anyone would ever benefit from a mostly raw foods diet, this fact certainly cannot be deduced from the existing anthropological evidence. It is, of course, also noteworthy in this respect that major healing traditions like Ayurveda and TCM make the use of cooked foods central to their healing regimens. Enzymes derived from food thus do not seem to play a major role in either of these traditional dietetic systems. Despite these flimsy foundations, continued research into the obvious potential therapeutic role of enzymes has yielded important clinical insights.
Modern Naturopathic Medicine
The current naturopathic approach still relies on the concept of bowel toxemia and enzymes, but the discussion has been recast in light of recent scientific findings. Bowel toxemia has largely been replaced with the terms leaky gut syndrome and intestinal dysbiosis. Dr. Jeremy Appleton, ND, says, “the intestinal mucosa is a selective barrier that admits nutrients, but excludes unwanted … materials”.5 This is clearly a modern description of the separation of the pure from the turbid, as described in TCM. The term “leaky gut syndrome” specifically refers to an impairment in the integrity of this barrier. So leaky gut syndrome is, by extension of this logic, an impairment in the separation of pure and turbid, thus a failure of the qi dynamic in TCM terms.
Intestinal dysbiosis refers to the alteration in the normal flora and fauna of the colon. This may lead to overgrowth of pathogenic organisms, such as candida. Intestinal dysbiosis is caused by turbid matter stagnating in the colon and overuse of antibiotics. This is interesting for several reasons. First, as mentioned above, external dampheat is often caused by bacteria or other pathogenic microorganisms. Examples include dysentery, urinary infections, food poisoning, etc. However, the internal generation of dampheat may also be related to pathogenic microorganisms that normally live inside of us (like candida). And in TCM, it has long been postulated that the overuse of certain herbs damages the GI tract, contributing to chronic dampheat. Those herbs are now understood to be powerful antimicrobials in their own right, like coptis, scute and phellodendron (e.g. therefore analogous to antibiotics). Thus, the TCM idea of internally generated dampheat appears to overlap conceptually with intestinal dysbiosis.
So we can already see that leaky gut syndrome can be understood in terms of two TCM concepts introduced above. One is the stagnation of the turbid waste and the other is dampheat. We now turn to the ascent of the pure and the role of enzymes. In recent years, a new form of enzyme has become prominent in the practices of sophisticated naturopaths. These enzymes are produced from friendly bacteria and have the amazing property of being stable in the entire pH range of the human digestive tract. They are not destroyed by stomach acid and remain active in the colon. Similar stable enzymes are produced in the fermentation that produces the Chinese herb, shen qu (AKA massa medicata, fermented leaven), a herb commonly used in chronic spleen illness in TCM. These enzymes serve a variety of therapeutic purposes. Large doses are antiinflammatory. Some evidence suggests anticancer activity, as well. But what they do in normal doses is promote the transformation of food into its finest essences. Thus, nutrients are absorbed and turbidity is not produced from food.
Because the enzymes are active down to the rectum, they continue to promote transformation along the way, thus breaking down old stagnant food and normalizing the colonic environment. TCM puts an identical emphasis on the need to transform stagnant “dampheat” in the colon. However, the whole story also involves direct repair of the intestinal mucosa. The enzymes prevent further damage, but they do not restore the integrity of the intestinal villi. The restoration of the villi is what we would call in TCM a tonic effect. In all longterm chronic cases, there is some aspect of deficiency or sinking qi present. So this aspect of treatment is more geared towards what we might associate with promoting ascent of spleen qi. The term seems particularly appropriate because we are actually preventing something from leaking or sinking downwards. Naturopaths indicate antioxidants as playing a key role in this aspect of treating leaky gut syndrome. According to Dr. Appleton, “reducing oxidative stress [in the gut] can help break the vicious cycle that makes other conditions worse.”
Dr. Appleton goes on to recommend antioxidants like gingko, quercitin and N-acetyl-csyteine.6 However, herbs such as bupleurum, ginseng and astragalus all have significant antioxidant activity and all three are used to lift the spleen qi. So, by using our TCM approach to qi dynamic imbalance, we may gain insight into another aspect of leaky gut syndrome. Again, hopefully we have not reduced treating the qi dynamic to enzymes and antioxidants, but rather demonstrated that the TCM approach implicitly includes actions supported by recent scientific enquiry. Now, it is not real meaningful to me that bupleurum is an antioxidant. That doesn’t change my use of bupleurum. What is more important to me is to the concept of bupleurum ascending spleen qi and how this concept and others may be used to expand modern physiology.
For example, if bupleurum raises spleen qi and raising spleen qi helps with leaky gut syndrome, then it follows we could utilize the concept of spleen qi sinking to guide us in our future explorations of the western physiological and herbal literature. While the antioxidant quality of bupleurum that seems to be of importance here, what else is going on? Bupleurum cannot be reduced to an antioxidant. What else is it about bupleurum that contributes to this action and are there perhaps similar herbs and substances in the Naturopathic pharmacopeia that have been overlooked regarding their usefulness in leaky gut syndrome? Besides the well known bupleurum, a number of other more obscure herbs are also used to regulate the qi dynamic in TCM. Of note is that many of these herbs are carminatives and/or used typically to treat acute superficial ailments. Of similar significance is the historical importance of many similarly acting western herbs, despite their relative disuse in modern times. For instance, carminatives like oregano and caraway are used merely to relieve digestive symptoms or just to flavor food, however such herbs are thought to uplift or spread the qi in TCM terms. So their effects my actually help get at the root of the problem, rather just relieve suffering. Also, once revered herbs like yarrow, verbena and eupatorium, now generally relegated to the treament of colds and flus, perhaps deserve renewed consideration for their possible role in treating leaky gut syndrome and complex chronic illnesses.
1. Flaws, Bob,Intestinal dysbiosis, Leaky gut syndrome, Candidiasis and Yin Fire/ Blue Poppy.com/articles.htm
2. Fruehauf, Heiner, The Five Organ Networks of Chinese Medicine/ Portland, OR: Institute for Traditional Medicine 1998, pg. 82
3. Rosenberg, Z’ev, A Chinese Look at Western Pharmaceuticals/Acupuncture.com
Appleton, Jeremy, “Leaky Gut Syndrome”, Advancing the Standard 2:1/Gresham, OR: Tyler Encapsulations 2/99
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Yang Shou Zhong, Li Jian Yong, Li Dong Yuan’s Treatise on the Stomach and Spleen: ATranslation of the Pi Wei Lun/ Boulder, CO: Blue Poppy Press 1993