Difficult Disease and the Application and Understanding of Gu Syndrome Treatment

Paul L. Reller L.Ac. / Last Updated: August 03, 2017

Difficult and Chronic Disease may be related to the ancient Chinese categories of Gu Zheng, or syndromes of broad pathogenic and parasitic antigens

The term Gu in ancient Chinese Daoist medicine was applied to the phenomena of microbial parasitic disease that was widely disseminated in the body and produced a variety of syndromes, with manifestations ranging from a chronic mild fatigue to a serious and life-threatening set of symptoms. In modern times, Traditional Chinese Medicine (TCM) has not focused on this complex category of disease, but a renewed interest in ancient medical theories and treatment protocols has stimulated some interesting research and application of the astute medical theories and treatments of the Daoist (Taoist) physicians in ancient China. Since infectious parasitic diseases have once again risen to a status of prominent threat worldwide, with Tuberculosis being the disease with the most deaths attributed per year now overtaking another infectious parasitic disease, Malaria, and a rising incidence of infectious parasitic diseases related to helminths, spirochetes, arthropod-borne viruses, and zoonotic bacteria, even the American public is becoming aware of this rising health threat. In fact, many difficult diseases may be attributed to pathogenic parasitic antigens, or Gu, and the subject of late effects of infectious and parasitic diseases, such as the Post-Lyme's Disease syndromes, Chronic Fatigue Syndromes, etc. are now eliciting much attention and research focus. TCM may have much to offer in the form of adjunct or even primary therapies in this realm of difficult diseases, and a revisiting of the theories and treatment protocols of the Gu Zheng, or syndromes of pathogenic parasitic disease, may be very helpful in the treatment of often systemic and difficult to treat chronic and acute diseases.

The success of the introduction of an herbal remedy to malaria, Artemesia Qinghao, and especially the main active chemical, artemisinin, has resulted a dramatic decrease in the incidence and mortality of this difficult disease, which in the recent past was the number one cause of death worldwide from a single disease. Reports in 2015 show that between 2000 and 2013, that deaths from malaria worldwide decreased between 30-64 percent, depending on the source of the statistics. The World Bank reported that global incidence decreased from 233 million in 2000 to 198 million in 2013, but that deaths attributed to malaria dropped from 985,000 per year to 584,000 in that time period. This is amazing, and can be attributed to a tremendous effort by such organizations at the Clinton Global Initiative, or the Clinton Foundation, providing a wealth of interest in funding effective programs, but the advent of effective medications did not occur until the World Health Organization adopted artemisinin and its derivatives as the main medicinal to treat malaria, despite an enormous campaign for years by the pharmaceutical industry to stop this designation of an herbal medicine as such an important cure.

Malaria is a term for a number of parasitic diseases that are generally spread by mosquitoes. The main parasitic microbe causing malaria is a protozoa protist called Plasmodium falciparum, spread by the female of the species Anopheles mosquito. This more deadly form of malaria is seen in sub-Sahara Africa predominantly, and less deadly species of Plasmodium predominate in other countries. The use of the herb Qing hao to treat malaria was well documented in 1596 in China, but the herb itself has been used for over 2000 years, and research during the 1970s in China, after the success of treating malaria with the herb during and after the Southeast Asia Conflict and the aftermath in the 1960s, led to an eventual Lasker Award in 2011 for Dr. Tu Youyou and colleagues in China for their research concerning artemisinin. This was followed, finally in 2015 after much resistance, by the Nobel Prize for Medicine. To this day, the pharmaceutical industry continues to fight the use of artemisinin despite its apparent enormous success, with a documented cure rate for malaria of 94 percent! Mistruths concerning supposed artemisinin resistance developing in Africa, which has occurred to some extent concerning the compound medicines with synthesized derivatives of artemisinin, are widely publicized, and despite the herb Artemesia qinghao being a weed that can be easily cultivated cheaply, the industry now makes artemesinin by expensive means with genetically modified bacteria and yeasts, instead of just growing a weed. For this type of deadly parasitic disease, though, Chinese herbal medicine has made tremendous advances in disease treatment, and other herbal contributors, such an quinine, Tamiflu, Colchicine, Vincristine, etc. are largely ignored as well, despite their obvious contributions to modern medicine.

In the case of malaria, the course of the parasitic syndrome is complex. The various species of Plasmodium parasite may only survive in the female mosquito, and when a bite occurs, the spores of the parasite infect liver cells, and are cleared within 30 minutes by the host immune responses. Unfortunately, the spores of the protists differentiate in the liver cells and undergo asexual multiplicaton, eventually emerging from the liver cells into the bloodstream and infecting red blood cells, where they again replicate. The disease in Africa has apparently produced an inherited resistance to this process linked to sickle cell anemia. The spores may differentiate into schizonts, gametocytes, or microgametes. Nature has created a complex and bizarre set of biological transmutations that perpetuate this disease, and the host organisms have created an evolving set of complex immune responses to keep it in check. For this reason, malaria has persisted as a very difficult disease. The malarial Plasmodium falciparum has been studied and found to interact with the human cells and mitochondria for as long as the present species of human has existed, and obviously, a holistic approach to disease intervention is sensible, utilizing whatever resources have evolved in Nature, yet we are fighting this approach. When species of parasites are known to have infected human worldwide for thousands if not millions of years, the focus should be on host defenses, which are evolved with the infection.

In 2011, the Centers for Disease Control and Prevention (CDC) released the findings of a 31-year study that suggested that parasitic infection may be being spread unknowingly via the U.S. donated blood supply. A tick-borne parasitic infection of Babesia microti, itself a relatively rare parasite that is protozoal (Piroplasma), occurred in clinical settings year round in states where the tick-borne parasites are not found between the years 2000 and 2009, prompting CDC researchers to investigate. This research found that nearly 80 percent of the known cases of Babesia infection caused by blood transfusions between the tracking years of 1979 to 2009 occurred between 2000 and 2009. CDC researchers stated: "Babesia microti has become the most frequently reported transfusion-transmitted parasite in the United States." There are currently no diagnostic tests approved by the U.S. Food and Drug Administration that can detect this infection before people donate blood, and more than 100 Babesia species/genotypes have been found. Acute Babesia infections produce signs and symptoms of anemia, fatigue, fever and chill, and may proceed in vulnerable patients to organ failure and death. Symptoms vary widely in individuals, though, and are often mild and not brought to the attention of medical doctors, and thus the potential for chronic disease affecting many patients in the United States from blood transfusion is a real threat, and may go undiagnosed, or misdiagnosed, when symptoms flare. This study highlights the possible threat of undiagnosed parasitic disease in many forms as a more widespread problem than anticipated. The relatively small number of cases of this particular tick-borne parasite in the past does not diminish the potential unseen threat of parasitic disease in many forms that could be affecting the public and undiagnosed, or misdiagnosed as a variety of difficult and chronic diseases. In 2015, the antimalarial herbal chemical artemisinin, and other chemicals in the Chinese herb Artemesia annua, or Qing hao, were tested as a potential treatment for infection by Babesia gibsoni by the National Research Center for Protozoan Diseases at Obihiro University in Hokkadio, Japan. These researchers noted that both artemisinin and artemether from the herb could inhibit the growth of Babesia gibsoni in vitro. These herbal chemicals worked well, and had a synergistic effect, but with less effect against atovaquone-resistant Babesia gibsoni (PMID: 25523292). The use of a simple alcohol extract of the herb Qing hao could thus have tremendous potential for patients receiving a blood transfusion in the United States to protect against a potential transfusion-acquired infection. Of course this will not be recommeded in standard medicine, despite its low cost and complete safety.

These zoonotic pathogenic parasitic diseases may be infectious or not, concerning human transmission, and perhaps even involve parasitic antigens that are more complex in nature than the typical parasite. Parasitic antigens are proving adaptable in the human body and the environment, with both drug-resistant strains of microbial antigens evolving, and elusive adaptation to the body's immune responses as well. An antigen is defined as any substance or molecule which is capable of inducing specific immune responses and reacting with the products of that immune response under appropriate conditions. Antigens can be toxins, bacteria, altered normal proteins that are attacked by the body's immuned defenses (autoantigens), viral RNA expressions, or molecules produced from helminths, protozoa (e.g. giardias), or other microbial parasites. Today, this category of difficult disease may encompass Acquired Immune Deficiency Syndromes (AIDS), as well as many autoimmune and virally mediated Chronic Fatigue Syndromes (CFS/ME). Since recent research has indicated that the genetic components related to many cancers are about 90 percent related to microbial DNA and RNA, perhaps many cancers could be considered in this category of parasitic disease, or Gu Syndrome, as well. The theories and research revealing the superantigen responses are also potentially linked to this fascinating syndrome that was well thought out by ancient Chinese Daoist physicians. A number of medical scholars have found that the treatment protocols for Gu syndromes are applicable today to treat these various difficult diseases.

Now, the common response to the notion that obscure theories in ancient Chinese Daoist medicine may be highly applicable and effective in treating diseases that elude successful treatment with modern medicine has been ridicule. When looking at the term Gu in English-Chinese dictionaries, we find little reference to the term that is applicable to medical terminology today. Even in TCM literature, we find a confusing set of terms. In the Chinese languages, a particular word sound may refer to a large number of words, and the word Gu has many potential meanings. The word Gu, as used in the terms referring to types of difficult diseases and toxins in TCM, is not a modern term in the Chinese language, as it is represented with a complex pictogram, or character, in ancient Chinese language. Hence, the definition of the term is somewhat elusive. Many mistakes are made when interpreting ancient Chinese characters, as both Chinese and non-Chinese have jumped to conclusions in interpreting ancient characters and the combinations of these characters. An expert in the United States, Victor H. Mair, Professor of Chinese Language at the University of Pennsylvania, received his Ph.D. from Harvard University, and states: "There is probably no subject on earth concerning which more misinformation is purveyed and more misunderstanding circulated than Chinese characters or sinograms." The science of the Chinese language is a difficult discipline.

The character for gu that is used to describe the difficult diseases and toxins (gu zhang and gu du) in English translation TCM texts is now defined in simple English/Chinese dictionaries as a 'legendary venomous insect', or parasite, that poisons and 'bewitches'. This translation of a word character no longer in the modern language has been also used by translators of ancient Chinese medical texts. Of course, the diseases under the term Gu zhang or "parasitic spreading", and Gu du or "parasitic toxin", encompass a wide variety of systemic disorders and symptoms, and are not seriously thought to be attributed to a 'legendary venomous insect'. The dictionary translaters, of course, had little knowledge of ancient medicine when producing this translation of the now unused word related to the character Gu. One might stick to this dictionary definition if the intent was to to ridicule ancient Chinese Taoist medicine as superstition, which many deluded modern medical authorities have tried to do in the West, but a serious study of ancient Traditional Chinese Medicine (TCM) shows that these Taoist physicians were not superstitious simpletons, but rather astute scientists, and their medical theories based on profound fact and realization. The famous physician Sun Si Miao would not believe that the acute and chronic diseases he described under the term Gu Zheng all came from the eating of, or bite of, a mythical insect. Anyone reading the texts that this famous doctor wrote could not really believe this. For this reason, the simple definition for this gu character in an English/Chinese dictionary should not be taken literally when taking a serious look at ancient Chinese Taoist medicine and Gu Zheng, or pathogenic parasitic syndromes of disease. Of course, reference to a mythical or legendary insect as an illustrative metaphor for parasitic disease could have been used to illustrate the concept, which would have been consistent with the oral explanations for difficult phenomena at that time in history.

When looking at the history of the category of Gu syndromes in ancient Chinese medicine we must take a logical approach to the application to these concepts and treatment protocols for parasitic diseases. Obviously, this was a subject that was treated seriously in ancient Chinese medicine. The surviving versions of the Shen Nong Ben Cao Jing have many references to Gu Du, Gu Zhang, and Gui Zhu, implying that this was a large and serious consideration for chronic diseases. Of course, we don't take this obscure history seriously without some modern objective support. Research with the herbs recommended to treat these Gu syndromes (Gu Zheng) has produced this objective modern support for the application of these herbs for difficult parasitic diseases. Hopefully, this article will help the practitioners of professional herbal medicine to better understand how this is unfolding.

Pathogenic parasitic diseases in modern classification

The term parasite summons an image of an insect or worm, but the term, even in modern language is much broader. A parasite is any organism that lives on or in an organism of another species, known as the host organism. Now, the human organism is host to many types of symbiotic and non-symbiotic species of organisms. In fact, bacterial cells outnumber human cells by about 40 to 1 in the typical human body, and one of our most important cellular components, mitochondria, is thought to originally be a parasite. Of course, these abundant parasites are not usually pathogenic, or disease-producing. The possibilities of even symbiotic parasitic microbes becoming pathogenic when there is a dysfunction or imbalance of the complex immune responses is real, though. Recent genetic research has mapped the entire human genome and is fully exploring the DNA and RNA in our bodies. This research has turned up some surprising facts. In cancer research, up to 90 percent of the DNA and RNA expression that is linked to cancer mechanisms is traced to microbial DNA or RNA in our bodies. Some prominent cancer researchers point to the fact that we could consider ourselves more as a microbial colony than a human. Perhaps we could even be considered a parasite to this complex microbial colony, as far-fetched as this sounds. Thus, the term parasite in relation to human disease becomes a complex subject, and the category of treatment in Traditional Chinese Medicine (TCM) related to parasitic origins of disease also becomes complex. The ancient term Gu thus may refer to parasites that are pathogenic, not to all parasites.

When looking at the International Classification of Diseases (ICD) set up by the World Health Organization (WHO), which is used by all physicians in the United States, we see, even in the ICD-9 version, a wide variety of diseases under this classification of parasitic diseases (001-139). This list includes intestinal diseases such as Salmonella, Shigellosis, Amoebiasis, protozoal intestinal diseases (Giardiasis, Trichomoniasis et al), viral intestinal diseases related to parasitic organisms (rotavirus enteritis), and ill-defined intestinal diseases such as colitis enteritis. The list also includes a variety of Tuberculosis disease manifestations, zoonotic bacterial diseases (Brucellosis, Anthrax, Listeriosis), other bacterial diseases (Mycobacteria diseases such as "Walking pneumonia", Diptheria, Streptococcal sore throat, Tetanus), HIV, Poliomyelitis and other non-arthropod-borne viral diseases of the central nervous system (meningitis due to enterovirus, slow virus infection of the CNS, Creutzfeld-Jakob disease, commonly called "Mad cow"), viral diseases accompanied by exanthem (widespread rash) (Chickenpox, postvaricella encephalitis or myelitis, Herpes zoster (shingles), herpes simplex, measles), arthropod-borne viral diseases (Yellow fever, Dengue fever, Tick-borne viral encephalitis, West Nile), Rickettsiosis and other arthropod-borne diseases (Malaria, Lyme disease), Syphilis and other venereal diseases (Reiters disease, chlamydia, gonorrhoea, gonococcal conjunctivitis), Spirochete diseases, Mycoses (tinea, histoplasmosis), Helminthiases (intestinal parasites), other parasitic diseases (scabies, lice, sarcoidosis), and late effects of parasitic diseases (Tuberculosis late effects, Polio late effects, Post-Lyme's disease syndromes).

Some of these infectious and parasitic diseases are commonly linked to autoimmune disorders, such as strep throat and chickenpox, where past infections have been linked to Multiple Sclerosis and a host of autoimmune disorders. Even simple parasitic diseases, such as the protozoal infections that we once thought to only occur when travelers drank untreated water in the wild, but now is found to be prevalent even in the urban populations of developed countries due to the large amounts of protozoas such as Giardia entering the drinking water from large industrial animal farms and feedlots, are now a health threat. The spread of once rare diseases in the United States such as Lyme's disease and West Nile, and a rising incidence of herpes zoster, are posing a significant challenge to the medical system. The possibility of late effects of these parasitic diseases causing elusive to diagnose and difficult to treat chronic syndromes is becoming ever more prominent as more and more patients seek treatment of sometimes debilitating chronic syndromes of disease that have no apparent immediate cause. Complementary and Integrative Medicine and Traditional Chinese Medicine (CIM/TCM) present a wealth of potential treatments in this realm of difficult and chronic diseases.

Of course, with a classification of disease as diverse as this, specific herbs should not be seen as a miracle cure for desperate patients. Application of Gu Syndrome treatment protocols to infectious parasitic diseases will require not only a professional herbalist, or TCM physician, but a knowledgeable one, and one willing to explore and study both the knowledge from the past as well as the current research to apply specific herbs and formulas to specific cases of parasitic disease. The use of differential signs and symptoms to guide therapy, which is a fundamental part of the TCM diagnostic process, will be very important to this treatment protocol. The ability to adjust the treatment protocol as the signs and symptoms change will also be vitally important, as these parasitic diseases may adapt to the individual immune responses, and this too is a fundamental part of the training in TCM. For medical doctors untrained in TCM specialty, and for the untrained patient, depending on advertised products to treat these difficult diseases is not sensible. Referral to a competent TCM physician, or Licensed Acpuncturist and herbalist (L.Ac.) that is experienced and knowledgeable, will be the key to successful use of this herbal medicine as an adjunct therapy.

As Traditional Chinese Medicine (TCM) becomes finally more accepted and integrated into standard medical practice, medical doctors are finally suggesting that perhaps the patients should seek out a knowledgeable TCM physician, or Licensed Acupuncturist, to help treat these problems. Since the longer the pathogenic parasitic disease has lingered in the body usually implies that the ridding of the disease and its late effects may be prolonged, early treatment for suspected pathogenic parasitic diseases, or Gu Zheng, is sensible. Patients and doctors must be aware, though, that these diseases vary widely in severity and presentation, and there is no simple formula to gauge the course of therapy, which could be short or very long. The adaptability of the pathogenic parasitic disease in the body also means that the treatment protocol must often by assessed and altered as the body responds to adaptations by the parasitic organisms or molecules and substances that have been produced by these parasitic organisms and viruses. In cases of more severe symptoms, treatment to adress these symptoms may by the first focus, followed by treatments to rid the parasite and support the immune responses. This treatment course may be thus prolonged and require persistence.

A renewed interest in the subject of Gu Zheng, or pathogenic parasitic diseases and syndromes, by both TCM and standard physicians and researchers

Pathogenic parasitic diseases and syndromes have a long history in China and in the specialty now called Traditional Chinese Medicine (TCM) in the West. As the modern TCM practitioner studies this subject of parasitic disease the tendency is to not give it much weight in the importance of diseases of clinical presentation in the United States. Without looking deeper at this category of parasitic disease and treatment protocol we naturally assume that it is referring to acquiring a parasitic worm or insect, and consequently, even most TCM physicians have paid little attention to this section of the medical literature related to Gu Zheng in countries where common parasitic worms and insects are no longer a threat. Upon closer scrutiny, though, a number of scholars have found that the theories and applications in this category of parasitic diseases applies to a number of difficult diseases today, most related to a parasitic microbe, not a visible worm or insect. Various key herbs in this category have been researched and found to be effective in treatment of a wide variety of diseases that encompass many systems, and interactions of systems in the body. Indeed, the now famous herbal anti-parasitic chemical artemisinin has been found to be a potent treatment for a number of types of cancer, as well as difficult and chronic neurological diseases.

The best example of the application of Chinese herbs to modern difficult disease that is pathogenic and parasitic thus is the herb Artemisia annua Qinghao, whose main reknown is that it is the first herbal extract (artemisin) to be recommended as the primary medicine for a major disease, malaria, by the World Health Organization (WHO). Studies in 2000 in Nebobongo, Congo (Mueller MS et al), found that this Chinese herb could be successfully cultivated in Africa, and that even the hybrid produced to grow in this African climate contained sufficient artemesinin to clear malaria in 92 percent of patients with a simple herbal decoction or alcohol extract. With the occurrence of drug-resistant strains of malaria, Artemesia annua became an inexpensive and safe alternative to pharmaceuticals. Of course, the pharmaceutical industry fought this treatment guideline fiercely, but in the meantime, the main pharmaceuticals used in the treatment of malaria, quinone variants, or chloroquines, were researched for off-label uses to find alternated ways for profit. The success of Artemisia Qinghao in treating malaria, for which it was used successfully since at least 340 AD in China, as documented by Ge Hong in his book Zhou Hou Bei Ji Fang (a Handbook of Prescriptions for Emergencies), prompted much research into the chemistry of this herbal medicine, which found that chemicals in Qinghao had also demonstrated potent anti-cancer properties. The effects of antimalarial drugs have shed some public light onto the potential of this anti-malarial herb to treat various difficult diseases, and the potential of this herbal anti-malarial as an anti-cancer agent may have prompted research into the use of antimalarial drugs to treat cancer. In the end, this is all for the good of the public. For countries stricken with malarial deaths, the fast rise of drug-resistant strains of the mosquito-borne parasite has resulted in a strong support for Qing hao to be utilized in standard malarial treatment. While the pharmaceutical industry has produced and distorted much clinical research to try to stop the use of this life-saving Chinese herb, the efficacy and life-saving effects of this harmless herb and its extracted chemicals have benefited many patients worldwide. Recent research has found that not only the herbal constituent artemisinin, but also other chemicals evolved in this plant, have anti-malarial, anti-tumor, and other beneficial effects, and probably work synergistically in the human organism. Study of more of the herbs listed in ancient medical texts for Gu Syndrome should be explored, perhaps saving many more millions of lives. This sensible course has not been embarked upon only because of massive resistance and propaganda employed by the profitable medical industry.

An article in the New York Times Science section of January 17, 2012, entitled For Intrigue, Malaria Drug Gets the Prize, by Donald G. McNeil Jr., reveals that the Nobel committee was considering awarding the Nobel Prize for Medicine to a scientist or scientists responsible for the elucidation and promotion of the herbal extract artemisin from the ancient Chinese herb Qing hao, or Artemisia qinghao, which has saved millions of lives in the treatment of malaria with no side effects. The article outlines the alarm and objection in the standard scientific medical community over this potential selection. Already, the 2010 Lasker Award (the American Nobel) for clinical medical research was given to the former chief of the Materia Medica (herbal medicine institute) in Beijing, Dr. Tu Youyou, for Project 523, a large mandated collaboration of hundreds of researchers and physicians in China started in 1967 to find the most effective cure for malaria, mandated by Chairman Mao Zedong of the Communist Party, a great supporter of Traditional Chinese Medicine. Dr. Tu was credited for isolating the active herbal chemical artemesin and elucidating how this chemical effectively treats parasitic infection, such as malaria, by the unique action of this sesquiterpene lactone with a peroxide bridge, which allows the clearing terpenoid to target cells that are trying to rid themselves of a microbial parasite by a strong antioxidant clearance utilizing hydrogen peroxide. Dr. Tu and her team also discovered that this active chemical was largely lost in traditional water decoction, and needed to be extracted in an alcohol medium. Now, this finding, and the widespread production and use of artemesin occurred in 1970, yet in 2012, 42 years later, the scientific community is finally acknowledging this herbal accomplishment, and the importance of utilizing the wealth of knowledge from Complementary Medicine and the rich history of TCM. Artemesin is not a synthetic drug, yet this New York Times article refers to it as a drug, providing a continuing misinformation to support the pharmaceutical industry and stop acknowledgement of the validity of Chinese Herbal Medicine and TCM. Artemisin, a chemical in the herb Artemesia annua, or Qing hao, was duplicated in the laboratory to a synthetic drug, artemisinin, and the widespread use of the chemical was not initiated until this unneccessary step had been taken. The New York Times article also fails to report why this scientific acknowledgement, and the worldwide utilization of this superior antiparasitic and antimalarial medicine, was so long delayed. Research confirming the efficacy of artemisin and Qing hao, showing that it was superior in trials to the best pharmaceutical drug mefloquine, was conducted by Dr. Keith Arnold in 1979. Research scientists at Walter Reed Hospital found that this species of artemesia grew worldwide and could be easily cultivated shortly thereafter. The World Health Organization wanted to acknowledge this important herbal medicine at this time, yet dramatic opposition from the pharmaceutical industry delayed this endorsement until 2000! The WHO had to finally agree to accept a medicine that combined artemisinin with the problematic mefloquine, which has alarming side effects, including CNS changes that may cause paranoia and nightmares, and was implicated in a number of cases of American Special Forces soldiers killing family members after receiving the drug and returning from Afghanistan. Today, more than 150 million doses are distributed at low cost each year to patients, and many more simple decoctions and tinctures are made locally, reducing the worldwide mortality from Malaria dramatically.

Qinghao is just one herb in the class of herbs from various categories in the Materia Medica of Traditional Chinese Medicine that were recommended for the complex treatments of Gu (parasitic toxin) syndromes in ancient China. Other herbs and mineral medicines mentioned in the ancient Shen Nong Ben Cao Jing, or the Emperor Shen Nong's Herbal Foundation Classic Text, included Realgar (Xiong huang), Feldspar (Chang shi), Azuritum (Fu qing), Hematitum (Dai zhe shi), Alkali (Lu xian), Sal (Da Yan), Cimicifugae (Sheng ma), Gentianae scabrae (Long dan cao), Indigonis seed (Lan shi), Eupatorii root (Lan cao), Caesalpinieae sepiariea seed (Yun shi), Cynanchi caudati (Bai tu huo), Gastroidae (Chi jian, or the herbal parts of the Tian ma root), Ligustici (Mi wu, or the herbal parts of the Chuan xiong root), Asteris Tatarci (Zi wan), Daphne genkwa (Yuan hua), Cirsii japonici (Da ji), Gelsemii elegantis (Gou wen), Forsythia (Lian qiao), Galarhoei Eblactealati (Long du), Podophylle versipellis (Gui jiu), Phytolaccae acinosae (Shang lu), Metaplexis stauntoni (Nu qing), Cynanchi paniculati (Shi xia chang qing, or Xu chang qing), Polypori umbellati (Zhu ling), Suberalatum euonymi alatae (Wei mao, or Gui jian), Crotonis tiglii seed (Ba dou), Gleditschiae chinensis fruit (Zao jia), and Benincasae hispidae (Gan gua zi). This text represented Chinese herbal medicine predating 300 BC, and is found to be accurate in modern research. Of course, some of these minerals and herbs are seldom used today, and some have some toxicity, and adverse clearing effects, although they were used successfully across the world for centuries. It is highly recommended that almost all of these herbs be prescribed by professional herbalists rather than experimented with by untrained medical doctors and patients themselves. We also see that many of the nontoxic herbs in this list are still widely used in Chinese herbal formulas, including those that are traditionally prescribed for parasitic infections, which now are used more broadly to treat a wide variety of chronic diseases and gastrointestinal complaints.

The modern Chinese Materia Medica contains a number of anti-parasitic herbs that may have application to the Gu syndromes, but this application is no longer part of the standard Materia Medica, and only the mention of anti-parasitic qualities of the herbs is mentioned, not the treatment of Gu syndromes. Modern scholars have a renewed interest in recent years into the application of these anti-parasitic herbs, though. Heiner Fruehauf Ph.D. L.Ac., founding professor of the School of Classical Chinese Medicine at the National College of Natural Medicine in Portland, Oregon, suggest that a long list of herbs from the Chinese Materia Medica may be applicable to Gu syndromes, or chronic inflammatory diseases. This list includes Flos Lonicerae japonica (Jin yin hua), Forsythia fruit (Lian qiao), Perilla frutescentis (Zi su ye), Cimicifugae rhizome (Sheng ma), Flos Chrysanthemi morifolii (Ju hua), Astragalus root (Huang qi), Canthopanacis (Wu jia pi), Ligustici rhizome (Chuan xiong), Ligustici folium (Mi wu), Polygonatii rhizome (Huang jing), Glehniae littoralis (Bei sha shen), Sparganii rhizome (San Leng), Curcumae zedoariae (E zhu), Curcumae tuber (Yu jin), Auklandiae lappae (Mu xiang), Lycopi lucidi (Ze lan), Aged garlic (Da suan), Caryophylli flos (Ding xiang), Zanthoxyli bengeani pericarpium (Hua jiao), Terminalieae chebulae fruit (He zi), Artemisia apicaeae or annua (Qing hao), Acori graminei (Shi chang pu), Cnidii monnieri fruit (She chuang zi), Sclerotium omphalieae lapidescens (Lei wan), Arecae catechu seed (Bing lang), Sophorae flavescentis (Ku shen), Flos immaturus Lonicerae japonicae (Huai hua), Pulsatillae chinensis (Bai tou weng), Dolichoaris lablab seed (Bai bian dou), Lignum euonymi suberalati (Gui jian yu), Torreyae grandis fruit (Fei shi), Quisqualis fruit (Shi jun zi), Smilacis galbrae (Tu fu ling), Dipsaci root (Xu duan), Scrophulariae ningpoensis (Xuan shen), and Indigo maturalis (Qing dai). We see a considerable overlap with the ancient Shen Nong Ben Cao Jing. Of course, the individual herbs may require some more study and documentation for clinical application to specific chronic diseases related to potential parasitic inflammatory diseases. We also see, though, that these herbs are commonly included in many common Chinese herbal formulas in TCM practice, and thus could be providing prevention and early treatment for many subclinical parasitic infections. The medical specialty of TCM gets no acknowledgement for this, and is largely unappreciated.

For the TCM practitioner utilizing these herbs to treat Gu Zheng the clinical applications must be applied with care and caution on an individual basis, and due to the adaptability of these pathogenic parasitic diseases, persistence and altering of the herbal formulas must be accomplished in relation to the changing symptoms and signs of the patient. Many patients with chronic disease may be debilitated and have weakened constitutions that overreact to purging herbs, and various tonics are almost always combined with these moving and clearing herbs to provided a reasonable treatment outcome and decrease adverse effects of treatment, especially with patients that have a weakened gastrointestinal system, anemia, or wasting or consumptive aspect to the disease. Some prominent TCM physicians that specialized in difficult diseases, such as Misha Cohen of the non-profit and publicly supported Quan Yin Healing Arts Center in San Francisco, have created some formulas for HIV patients and other various chronic disease applications, that have been studied in clinical human trials and found to be successful. You will see many of the herbs listed above in these formulas, some of which are available from Health Concerns. Others have also created formulas based on the study of difficult and pathogenic parasitic diseases, and Heiner Fruehauf of Portland, Oregon, mentioned above also has a line of formulas in pill form that may be utilized in practice. Of course, to achieve the best effects in the treatment of pathogenic parasitic diseases and syndromes the use of raw herbal decoctions combined with fresh herb tinctures is most applicable to the needs to individually vary and tailor the herbal treatment protocol over time. Unfortunately, the unwillingness of patients to decoct and drink these raw herbal decoctions is a problem, and the maintaining of the raw herbal pharmacy in private practice has declined. In China, professional raw herbal pharmacies decoct the individual prescriptions quickly in machines and provide the patients with bags of decocted fluid to drink. We are still waiting for this practice to become viable in the United States. Public support, as well as government support, would help in this regard.

Characteristics of the Gu syndromes in ancient Chinese texts, especially Gu zhang and Gu du, or parasitic spreading and toxin

Gu Du is a term used in ancient TCM medical texts (Traditional Chinese Medicine) to describe the pathogenic parasitic toxins that may cause disease. Gu Zhang is both a term used to describe pathogenic parasitic spreading throughout the body, and also a term applied to liver ascites, and drum distention of the abdomen (tympanites) from diseased dysfunction of the liver or spleen. Since the Chinese characters for the Gu and Zhang used in the Gu Zheng (parasitic syndromes) are no longer used in modern Chinese, the term guzhang, or abdominal drum distention, in modern use, has presented a language confusion. The characters used in guzhang in ancient texts are no longer in common use as well, but the term has survived to denote abdominal distention with ascites or other disease mechanism in modern texts. The origins of these Gu syndromes is thus unclear in modern times, but nevertheless we may make some assumptions. The character for zhang in this word literally means expansion or swelling, and can be applied to simple bloating after a meal, or to expansion or spreading related to aspects of heat and cold (e.g. inflammation or deficient function). Since pathogenic parasitic diseases often do have symptoms of abdominal bloat, or swelling of the chest or abdomen, this does present much confusion when trying to understand the ancient texts and pathological descriptions, with the term applied to symptoms as well as parasitic diseases. While this subject of Gu Syndromes and toxicity is still unclear in modern TCM, we may make some assumptions related to the past uses of these terms. The term Du is a general term for toxin. Gudu is not a modern term. To confuse American TCM physicians and students even more, the term Gu Zheng is still commonly used in teaching, but with different characters, signifying "steaming bone syndrome", which is a related syndrome of deep pathogenic fever or deficiency heat related to the bone marrow, or immune stem cells and various red blood cells, for instance platelets. Terms such as "steaming bone" are perhaps bad translations of ancient Daoist terms, but this one refers to deep persistent low grade fever related to immune dysfunction. These terms should not be confused with each other, even though they share the same Pinyin words. We can clearly see the relationship between these various Gu Syndromes and toxicities and the variety of parasitic diseases, though. The mistake in analysis of TCM historical terminology is to think that these generalized terms refer to a specific diagnosis, as in modern medicine we do like to arrive at a very specific diagnosis in all cases, even when the disease does not present a clearly specific condition. Terms such as Gu Zheng in Daoist medical texts refers to a broad classification of diagnosis, not a specific narrow disease.

In ancient classic texts of Traditional Chinese Medicine (TCM), such as the Shen Nong Ben Cao Jing (or what has survived as versions of this early text), the Qian Jin Yi Fang of Sun Si Miao, and works related to Tao Hongjing, the ancient characters and terms for Gu Zheng, Gu Du, and Gu Zhang still appear. Translations imply that these Gu syndromes and toxins are infectious, parasitic, and altering of the central nervous system ('bewitching' is a loose translation by Western translators, unfortunately). Eight characteristics of the Gu disease are patterned: stagnation, difficulty, lingering, psychological, tremors, swellings, bi pain (painful obstruction of nerve or blood circulation), and arthralgia. We see how these may be applied to Lyme Disease or any number o parasitic disease presentations. The Gu zheng, or pathological parasitic disease or syndrome, may involve Gu du, or toxins related to parasitic infection, and these toxins may manifest as psychological illness, autoimmune disorder, and unclear etiologies of disease mechanisms. These endotoxins and exotoxins of microbial parasites are well studied today. Even modern testing in diagnostic workup will often not test for these parasitic-related toxins, though, leaving the patient with no explanation for their symptoms. The term Gui Zhu is also used in relation to pathological parasitic diseases in these ancient texts, and the common translation of Gui zhu is "demonic influence", but we may take this with a grain of salt when looking at it from a biomedical perspective, and assume that this is another form of Western translation with a Eurocentric bias. Characterizing ancient Daoist physicians as crazy shamans that only believed in voodoo and witchcraft appears to be a popular historical sport, or neurosis. There is no great talk of 'demons' in the TCM medical literature. The term Gui may mean ghost, spirit, or psyche, and the term Zhu used in this word is often translated as influx, but may literally mean pour into, or refer to diarrhea, or to water accumulation, or swelling and bloating. As stated, the subject of Chinese language characters and meanings is difficult and prone to mistaken assumptions. This language was written always in context in early Chinese civilization, and the reader was aware of the contextual usage, whereas in modern interpretations we are left with guesswork and assumptions. The physicians that used these terms no longer are living and cannot supply the context. We might assume, though, that the term Gui Zhu refers to the manifestations of either strange behavior, psychological symptoms, and/or swelling, diarrhea, or quick spreading. Once again, these presentations are representative of the symptoms experienced in many cases of difficult disease which could be attributed to parasitic overgrowth, and often these presentations are dismissed in modern medicine as being attributed to anxiety and stress, a "hypochondria", or somatic disorder. Such attitudes toward difficult chronic disease presentations are very frustrating for many patients.

In the ancient medical texts, the Gu Zheng, or pathogenic parasitic syndrome, often caused symptoms of mental and emotional derangement, palpitations, fear and clouded thought (Gui reference). The general treatment consideration for Gu Du was to treat these toxins with toxic materials when possible, but to include in the formulas herbs that decreased the toxicity of the decoction, and supported the frailty of the system. The theories of treating toxins with medicinal toxins, or like treatment, was popular in Europe as well, even in recent centuries. Formula considerations in ancient Chinese medicine always tempered the use of toxic herbs and minerals with pretreatment of the material, proper dosage limitations, and support herbs in formulary to make this work with few manifestations of the toxicity from the treatment. Nevertheless, each patient responded differently, and the astute herbal practitioner adjusted the treatment accordingly, and did not persist with harmful toxicities in the individual cases. Of course, the term toxicity is applied both to highly toxic materials as well as herbs with a very mild toxicity, and does not imply that all of these herbal medicines are harmful. Today, the use of toxic herbal preparations is rare. The use of herbs and minerals with mild toxicity has been a common and controlled aspect of medicine for many centuries, and is a safe and developed practice in the hands of professional herbalists even today, though. Modern drugs often have toxicities themselves, and the FDA system was created to address the threat of drug toxicities in pharmaceuticals, measuring risk versus benefit. There is very little discussion today of pharmaceutical toxicities, though, and we have taken this subject perhaps too lightly. Most of the herbs mentioned in TCM literature to treat these Gu Syndromes listed in this article have no toxicty.

In some texts, the Gu Zhang is described in ancient texts as a turning of normal chemistry in the body to a pathological state in a similar way that "worms added to wine will turn it to vinegar". The symptoms of jaundice, asthenia, fatigue, whole body pain, excess mucus congestion, excess salivation, cloudy or dark urine, dysuria, dribbling urine, stool mixed with blood or pus, dry mouth and lips, fullness to the chest and/or sides, deep pain in the abdomen as if nibbled by insects, indigestion with fermenting food, diarrhea, excess gas, and parasitic pathogens invading the organs, with organ dysfunction and possibly death, were all mentioned as possible symptoms of Gu Zhang in ancient medical texts. Manifestations as lung disease were also mentioned, and could be equated to lymphangiomyomatosis or other somewhat rare and poorly understood lung pathologies today, which are often equated to the spread of uterine fibroid tissues, or leiomyomas, to bronchioles, perivascular spaces, alviolar septa, and lymphatics. This cancerous spreading could be considered a type of parasitic disease as well. This Gu Zhang may manifest only when cysts or bullae are formed, chylous pleural effusion occurs, or idiopathic pneumothorax occurs. Of course, this could be related to cases of lung cancers as well. The five deficiencies (signs) are often mentioned in relation to these syndromes, which are: thready pulse (def Heart Qi), skin chill (def Lung Qi), lack of strength or mobility (def Liver Qi), incontinence of bowels or urine (def Kidney Qi), or inability to eat or drink (def Spleen Qi). Of course, the classic TCM texts state that these 5 deficiencies must always be addressed immediately in therapy to stop a deteriorating condition, and this broad classification once again just points the TCM physician to areas of focus in visceral sytems, and does not suggest specific treatment. In this sense, we see that alleviating alarming symptoms and signs is a priority, and then proceeding to try to clear the specific parasitic cause is recommeded. These TCM Daoist terms sought to group a wide variety of disease presentations under broad terminology, to facilitate diagnosis and coordinate the effort of the physicians. The responsibility of the treating physician is to narrow the particular case to specifics, and utilize a wealth of knowledge in herbal medicine to treat each individual case uniquely, and to integrate with standard care.

Today, modern medicine seeks to define each case to a neat and narrow diagnostic box in order to proceed to a one-size-fits-all pharmaceutical treatment, or other treatment type. In traditional medicine, the physicians sought a less defined diagnostic grouping in terminology but a very individualized treatment, utilizing a broad array of options. These two approaches are completely different, and this does present a challenge in integrating Complementary Medicine and TCM with modern allopathic medicine. If the patients and physicians are made aware of this difference in approaches, this integration could be successful.

Information Resources and Links to Studies

While the full range of scientific studies on the herbs mentioned above for the treatment of pathological parasitic infection and allied syndromes is not able to be listed here, below are some examples of the wealth of scientific study that can be found concerning the applications of these herbs to such diseases. One can also go to the article entitled Parasitic Disease on this website to access many more links to studies.

  1. A partial list of common human parasites that are pathogenic is listed in wikipedia: http://en.wikipedia.org/wiki/List_of_parasites_of_humans
  2. In response to studies that have shown that the huge array of parasites and species of parasites may have made it difficult to screen all donated blood for all of these parasites, and thus passed on many systemic low-grade parasitic infections through this route is now a concern. In 2015, a study in the Czech Republic of 2473 ticks collected betwen 2011 and 2014 showed that 5 species of overlooked parasites were found in a significan percentage of the questing ticks, perhaps spreading these parasitic diseases unknown to the individuals, as most cases may be mild in symptoms or asymptomatic in a healthy host:http://www.ncbi.nlm.nih.gov/pubmed/26482948
  3. Research into the Chinese herb Artemisia annua, or Qinghao, used to treat Gu syndromes in ancient Chinese medicine, reveal proof of the herbal chemicals to not only treat the parasitic disease malaria, but cancers as well: http://cancerx.wordpress.com/2011/02/04/antimalarial-artesunates-potential-against-cancer/
  4. Malaria is acknowledged as a parasitic disease even in modern disease classification, and many of the symptoms of this Gu syndrome, Gu zhang, or parasitic expansion, are the same as those described in ancient Chinese medical texts for Gu syndromes:http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001646/
  5. The reknowned Sloan-Kettering Cancer Center in the U.S. provides research data for the Chinese herb Artemisia annua, or Qinghao, showing that the chemicals in this herb are effective for treating a variety of microbial parasitic diseases, as well as cancers: http://www.mskcc.org/mskcc/html/69126.cfm
  6. In 2000, researchers in Africa showed that Qinghao, or Artemisia annua, could be cultivated in Africa as a hybrid and still retain its potency and cure acute malaria in 92 percent of patients studied with a simple and inexpensive herbal decoction: http://www.ncbi.nlm.nih.gov/pubmed/11091003
  7. In 2004, a randomized clinical trial comparing a simple tea preparation of Artemisia annua with the anti-malarial drug quinine (also derived from an herbal bark originally), showed that the simple tea preparation of the herb had an effective cure rate of 74 percent compared to 91 percent for quinine. Of course, professional herbal extracts of the herb would be even more reliable, and combinations of herbs, as in Chinese herbal formulary, even more effective. Recrudescence rates, or a return of malarial symptoms, were higher with the simple tea preparation of Artemisia annua compared to the pharmaceutical quinine, but the herbal treatment was discontinued for each patient after just 7 days. These studies were supposed to show the WHO that Artemisia annua should not be recommended over drugs despite the rise in drug-resistant strains of malaria. The WHO did not reverse its guidelines, but did capitulate to a recommendation that Artemisia annua be combined in a professional medicine with standard anti-malarials: http://www.ncbi.nlm.nih.gov/pubmed/15109558
  8. In 2008, researchers at the Leiden University Institute of Biology, in Leiden, Netherlands, wrote that the main drug used as an anti-malarial, chloroquinone, was now ineffective due to drug resistance of the parasite, and that resistance to other antimalarials was increasing rapidly. Scientific study of artemesinins and other chemicals extracted from Artemisia annua showed a high degree of effectiveness in treating what had become the disease the caused the most deaths in the world. The research was also turning up many surprising possibilities for the use of Artemisia annua Qinghao extracts for various parasitic diseases: http://www.ncbi.nlm.nih.gov/pubmed/18977424
  9. The herb Hua jiao, or zanthoxyllum, was reviewed in 1991 by the Shanghai Medical University Department of Pharmacognosy for its species-related herbal chemicals used in modern medicine: http://www.ncbi.nlm.nih.gov/pubmed/1823995
  10. The herb Hua jiao, or zanthoxyllum, was studied in 2006 at Kochi University Department of Hematology and Respiratory Medicine, and it was found that the water extract of this herb possesses potent anti-tumor activity against a wide variety of cancer cells, including those from lung, breast, prostate, and leukemia: http://www.ncbi.nlm.nih.gov/pubmed/16685399
  11. The herb E zhu, or curcuma zedoaria (turmeric), has been well studied and much support for its medical use supplied worldwide. Here, the College of Medicine and Medical Sciences at Taif University in Saudia Arabia, in 2009, showed that this herb had significant effects against the parasitic infection with schistosomiasis, and showed that the herb acted to regulate inflammatory cytokines, adhesion molecules, and enzymes linked to inflammation: http://www.ncbi.nlm.nih.gov/pubmed/19249123
  12. A related herb, Curcuma longa, or Jiang Huang, is a tonic herb in the curcuma family, which is also mentioned above and studied for its cytotoxic and anti-inflammatory properties as well as its use in adjunct cancer therapies - here studied in 2011 by the University of Mainz in Germany, the University of Heidelberg, and the German Cancer Research Center : http://www.ncbi.nlm.nih.gov/pubmed/21865023
  13. Further study in 2011 at the Department of Parasitology at the University of Texas MD Anderson Cancer Center, found that Curcuma longa showed multiple pathways of suppressing the difficult to treat biliary cancer : http://www.ncbi.nlm.nih.gov/pubmed/21325634
  14. Study at the Institute of Parasitology in Moscow, in 2003, found that herbal chemicals successfully stimulated an effective immune response against parasitic helminth infection, both prior to infection, and following infection, in animal studies. Furthermore, the herbal chemicals studied supported the host homeostasis to decrease damage. The helminth studied, Trichinella spiralis and pseudospiralis, damaged the host small intenstine, liver, and muscles. : http://www.ncbi.nlm.nih.gov/pubmed/16889026
  15. Study at the Department of Veterinary Parasitology in 2003, at Seoul National University, in South Korea, showed that 3 common anti-parasitic Chinese herbs, Sophora flavescens (Ku shen), Sinomenium acutum (Han fang ji), and Pulsatilla koreana (Bai tou weng), produced herbal extracts that provide anti-protozoal activity against Toxoplasma gondii and Neospora caninum. Alcohol extracts of these herbs proved to have a dose-dependent toxicity to these problematic parasitic microbial diseases of up to 98.6 percent effectiveness: http://www.ncbi.nlm.nih.gov/pubmed/14519322
  16. Study in 2013 at Chungbuk National University College of Pharmacy, in Cheonjiu, South Korea, found that the Chinese herb Lonicerae flos (Jin yin hua) exerted specific anti-inflammatory activity against LPS-induced sepsis, or lipopolysaccharides from low-grade bacterial infections, mediated in part through the inhibition of IRAK-4, or interleukin-1 (IL-1) receptor-associated kinase 4, a pro-inflammatory immune messenger that is linked to many chronic diseases: http://www.ncbi.nlm.nih.gov/pubmed/24269819
  17. Study in 2013 at the Chinese Academy of Medical Sciences, Beijing, China, found that the traditional trio of herbal extracts from Loniceriae Flos Japonica (Jin yin hua), Fructus Forsythiae (Lian qiao) and Scutellariae root (Huang lian), called Shuang Huang Lian formula, is effective against liposaccharide-induced (LPS-induced) inflammatory diseases (often difficult and chronic), and inhibits TNF-alpha, IL-1beta, Il-6, via ERK1/2 and p38-mediated pathways, exerting significant anti-inflammatory and anti-oxidant effects against chronic disease induced by parasitic microbial lipopolysaccharides: http://www.ncbi.nlm.nih.gov/pubmed/24192210
  18. Study in 2013 at Nanjing University of Chinese Medicine, Nanjing, China, showed that the traditional herbal combination of Flos lonicerae (Jin yin hua) and Fructus Forsythia (Lian qiao), found in the popular formula Yin Qiao San, provided significant benefit for preventing chronic low-grade viral infection in the gut when combined with chitosan, a chemical in inoki mushrooms now used to promote weight loss (LeanTain), increasing the intestinal permeability and effectiveness: http://www.ncbi.nlm.nih.gov/pubmed/23675483