Chinese Herbal Therapy
By Henry Ehrlich
As described by NCCIH (the National Center for Complementary and Integrative Health–a branch of the NIH) traditional Chinese medicine combines many different approaches, including “acupuncture, moxibustion (burning an herb above the skin to apply heat to acupuncture points), Chinese herbal medicine, tui na (Chinese therapeutic massage), dietary therapy, and tai chi and qi gong (practices that combine specific movements or postures, coordinated breathing, and mental focus).” There is a many centuries old record of efficacy. It has been widely adopted in the United States as the result of growing discontent with the state of allopathic (or mainstream) medicine, particularly for the treatment of chronic disease including allergies. In fact, I once heard a Chinese official say that Western medicine should be referred to as traditional Western medicine because of its shortcomings.
As a lifelong reader of the New York Times, my first acquaintance with traditional Chinese medicine (TCM) came on July 26, 1971, when thecolumnist James Reston wrote about his emergency appendectomy while covering Henry Kissinger’s visit to China. The diagnosis and surgery were accomplished by a combination of Chinese and Western medicine; however, his considerable postoperative pain was relieved by acupuncture.
Reading it again 41 years later, I was impressed by how vibrant TCM was both as an academic and a practical field back then. My own association with TCM was confined to the jars of dried vegetables on shelves in Chinatown stores.
NCCIH cites estimates that in 1997 that some 10,000 practitioners served more than 1 million patients each year. The 2007 National Health Interview Survey (NHIS), which included a comprehensive survey on the use of complementary health approaches by Americans, estimates that 3.1 million U.S. adults had used acupuncture in the previous year, and that acupuncturist visits tripled between 1997 and 2007.
The first recorded accounts of TCM date to the Qin and Han Dynasties—3rd century BCE-3rd century CE) but the formulas and practices are probably much older. TCM has its own system of anatomy and disease. It focuses on multiple organ systems in analyzing the presentation of symptoms, and treatments.
TCM literature emphasizes the linking of theoretical principles, treatment strategies, medical formulas, and medical substances—including herbs, flowers, barks, and parts of animals. What they all have in common is potent organic compounds that serve an evolutionary purpose such as protection against natural threats to the organism. These can be harnessed on behalf of human patients.
While the philosophical underpinnings of this system are complex and beyond my immediate power to explain, there are some accessible shortcuts. TCM distinguishes between treating the root and treating the branch.
Acute disorders are “branch” problems. When someone is vomiting or bleeding the symptoms must be stanched.
Chronic disorders are “root” disorders. That is, the symptoms are the result of something deeper and systemic.
Sometimes both root and branch must be addressed either in combination or sequentially. This construct is particularly pertinent for allergic disease. For example, with asthma, there are both acute and chronic problems. Asthma attacks can be controlled with “rescue” inhaled albuterol, but unless the underlying inflammation is addressed through use of steroids or other “controller” medication, it will return.
The age of integrative medicine—i.e. combining Chinese and Western medicine—began during the Qing Dynasty (1644-1906) when there were many fevers. This was the period when contact with Europe picked up and later America. White Tiger Decoction was used for fever and it had the wonder drug aspirin as well as herbs. Chinese doctors learned how to use injections and IVs. Today, Western science helps us understand how the medicines work and how to make them better.
In the 20th century both TCM and Western medicine were taught in China. Now doctors are trained in both. The Chinese government has recognized TCM as a unique resource and is subsidizing its study and practice with emphasis on understanding its mechanisms and improving efficacy using Western science.
Dr. Xiu-Min Li’s Fight Against Allergies
The food allergy treatment developed by Dr. Xiu-Min Li is part of a comprehensive treatment of the whole “atopic march” –the progression of allergic disease from eczema, to some combination of environmental allergies, asthma, and food allergies. Rather than “desensitizing” the immune system by giving increasing amounts of an allergen to a point where the body can tolerate it, the herbal therapy seeks to “re-educate” the immune system to the point where it is no longer reactive and the range of skin, airway, and gastric symptoms no longer occur.
Dr. Li was trained in both traditional Chinese medicine [TCM] and Western medicine in Henan, China. She did further clinical work in Beijing before coming to Stanford University, Johns Hopkins, and finally the Jaffe Food Allergy Institute at Mount Sinai in New York to conduct research.
Her treatments are derived from Chinese herbal medicines that have been used for breathing disorders, burns, and intestinal parasites. They are administered through a combination of ingested teas, tablets, and capsules, and topical formulations including baths, creams, and pastes. There are three principal reasons for this.
- Large quantities of ingestible medicines are hard to take, which makes following the doctor’s orders difficult.
- Also with oral medication, there are limits to how much of the active ingredients can be absorbed, and the skin is also very good at absorbing them.
- Even with diseases that seem to affect a single organ, such as the lungs, the skin, or the digestive tract, TCM theory and practice recognize that more than one organ system are usually involved, which can best be treated using a variety of medications delivered through multiple points of entry.
A further difference between TCM and Western standard of care specifically regarding food allergies is that TCM regards them as both an immune system disease and a digestive disease, unlike mainstream allergists who treat just the immune system. Allergens contain strong proteins that are normally broken down by enzymes and acids so that they can eventually be taken into the blood through the large intestine. However, in food allergic people they survive intact and when they enter the blood they are recognized by the immune system for their similarity to natural enemies such as parasites, at which point the body attacks them.
Clinical Practice and Laboratory Science
Dr. Li is “a full-time scientist and a part-time healer.” Her laboratories research the chemistry and biology of allergic disease and treatment using both animal and human models. The clinical practice consists of individualized treatment employing herbal medicines classified as supplements under terms of the National Center for Complementary and Alternative Medicine, a branch of the National Institutes of Health, along with acupuncture and acupressure in some cases. Patient progress is closely studied and the data collected permits the labs to continually refine the medicines. All research is conducted meticulously to support the eventual goal of allergy treatment by mainstream doctors and through integrative medical practice. By identifying active compounds through such techniques as high performance liquid chromatography (HPLC) fingerprinting, the team of scientists are hoping to standardize the herb-based medicines, and reduce daily dosages to accelerate therapy.
Balancing the Immune System
The goal of therapy is to re-balance the immune system to make it less allergic while increasing resistance to bacterial and viral infection. The immune system is broadly separated into two parts—innate immunity and acquired immunity. Innate immunity is the part that goes into action to fight routine infections. Acquired immunity is the part that creates antibodies to recognize those bugs if you encounter them a second time and get rid of them before they make you sick. Innate immunity is associated with one type of T Helper cells called Th1. Acquired immunity is associated with Th2 cells. In a normal immune system, Th2 immunity is a tiny fraction of Th1, but in allergic people Th2 is proportionately much greater creating antibodies to things that normally aren’t a problem—proteins in allergens, such as pollens and foods. When the Th1 function is too strong, autoimmunity can result. That is the immune system can attack the body’s own tissue.
The capacity to rebalance the overall immune system is one of the most intriguing things about TCM. Two lines of research it has spawned are notable. One is for Crohn’s/Irritable Bowel Disease. The herbal formula for food allergies suppressed secretion of an inflammatory substance called tumor necrosis factor alpha, which is elevated in Crohn’s. Subsequent research revealed other improvements in the peripheral blood. Another intriguing study shows promise for avoiding tissue rejection after organ transplants.
Complex Cases Welcome
For the time being, TCM therapy is demanding and costly. An initial in-person consultation with Dr. Xiu-Min Li is required along with blood work-up to ensure there is no disease that might be affected by the herbal treatment. Baseline measurements of allergic antibodies are also required. Monthly or bi-monthly phone consultations and annual office visits are part of treatment as well as follow-up blood work.
TCM is most appropriate for cases where there are active challenges to quality of life that can’t be effectively managed through standard treatment, usually involving more than one allergic disease. Food allergies can be managed by avoiding allergens and competent emergency care. They can also be treated at least in part by oral immunotherapy. But food allergies accompanied by eczema that resists topical steroids and/or asthma that also resists treatment using inhaled steroids may make a patient a better candidate for treatment with TCM.
As a standalone treatment for food allergies TCM has its weaknesses. Because it is conducted while avoiding the allergen, it is difficult to measure progress. Current blood tests and skin tests don’t reveal the current state of reactivity. When treated along with poor quality-of-life diseases like asthma and eczema, progress in those conditions can indicate progress with the food allergies. In addition, many patients who have always been vulnerable to colds and other infections also report improvement in general health. This may be an indication that the overall immune system is being rebalanced. In addition, some TCM patients have shown progress for eosinophilic esophagitis, for which there are no treatments beyond use of steroids and/or avoidance. Other immune diseases such as mast cell activation syndrome and Crohn’s are also being treated.
What Lies Ahead?
In her clinical practice, the “part-time healer” Dr. Li is working towards her vision of integrative medicine by collaborating with both mainstream doctors and TCM practitioners. The mainstream doctors are “co-seeing” patients with Dr. Li and learning the basics of her methods without having to study the tenets of TCM. The acupuncturists/herbalists are studying the pathology of allergic disease as understood by the specialty of allergy and immunology. Together they should begin to use these treatments.
In the laboratory Dr. Li’s team continues to experiment with ways of making the medicines more concentrated to reduce dosages and treatment time.
There are also plans for more clinical trials of the medicines themselves and in combination with other treatments, such as immunotherapy and Xolair (omalizumab) an anti-IgE drug. Additionally, there are plans to create a food allergy vaccine using a bacillus spore and a non-toxic form of cholera toxin (CTB) as adjuvants.
Another critical element of Dr. Li’s research is the pursuit of “practice-based” research, which can be conducted without the cost and rigid protocols of classic placebo-controlled trials. This format is being pursued to study “tolerance in a test tube” — biomarkers for patient progress during treatment without continual use of food challenges. All practice-based research is being conducted with the sanction of institutional review boards and with rigorous data collection that can eventually be used to make the case for full FDA trials.
Beyond the laboratory there is an active effort to promote collaborations with researchers around the world. Dr. Li observes that one of the impediments to progress is that there just aren’t enough researchers in the field to do all the work that could be done. She says, “We know that these medicines work. They key is to show how they work and how to make them better.”
(Henry Ehrlich is the editor of asthmaallergieschildren.com, co-author of Asthma Allergies Children a parent’s guide, author of Food Allergies: Traditional Chinese Medicine, Western Science, and the Search for a Cure, and co-author with Dr. Xiu-Min Li of Traditional Chinese Medicine, Western Science, and the Fight Against Allergic Disease.)