lyme-tick

Integrative Medicine for Lyme Disease

lyme-tickLyme disease is often thought of as a modern-day hidden epidemic. Patients can present with Lyme-disease symptoms years after being bitten by a disease-carrying tick (Ixodes Pacificus). Common presenting symptoms include chronic fatigue, myalgias, migrating arthalgias, and what is best described as brain fog.

For several years, I have been treating chronic-disease patients who are looking for a more accurate diagnosis and treatment. Each patient presents a unique challenge to my medical knowledge bank. What has been particularly helpful in treating these patients is using a combination of medical paradigms and remedies specific to their presenting symptoms. I have learned from two different kinds of teachers: There are the doctors who are specialists in treating Lyme disease with  modern medicine and there are the doctors steeped deeply into the Classics of Asian medicine. Learning from each of these medical paradigms has suggested to me, a middle path which integrates the best of both medical approaches. I am grateful to these doctors for the work they have done for some of the most difficult conditions in modern medicine and equally grateful to them for sharing their knowledge with me.

Biomedical perspectives

Biomedical treatment-protocols to treat Lyme disease span from the use of long-term multi-spectrum antibiotics to the more conservative approach of wait and watch.  Some physicians are adamantly against any treatment if the patient doesn’t present with acute symptoms, a bulls eye rash, or show positive acute lab markers.  However, delayed treatment in someone who has early signs of infection often leads to worse symptoms and contributes to a more chronic disease condition.

I have worked with several patients where neither of us understood initially if their symptoms were related to Lyme disease. In those cases, I suggest an approach that may alleviate symptoms without targeting Lyme disease, or suggest a milder Lyme treatment and look for worsening symptoms.

 East Asian Medicine Perspective

In East Asian Medicine the pathology associated with chronic illness is viewed as a continuous accumulation of pathogens with a weakening of core essential qi or life force. Left untreated, the progressive stagnation of qi and blood stasis result in interior coldness and a progressive decline of the life-sustaining kidney qi.

According to the Basic Questions in the classical text Huang di Nei jing, “if the body is attacked by cold in the winter, the person will suffer from a warm disease in the spring”. (1) Classical-text scholars have interpreted this to include any pathogenic factor that is contracted at sometime in the past, with or without presenting symptoms, and that lies dormant for an in determinate period of time prior to its active expression. (2)

The classical medicine description of Gu syndrome, translated as “Possession Syndrome”, implies an ever-present underlying pathogen. Inherent in Gu syndrome’s hidden nature is an insidious impact on multiple organ systems. Gu is described as two substances being like oil mixed with flour. They can never be separated on blended together. In Western medical terms, this might describe a slime-like matrix that adheres to cells and organ structures. The resilience of this matrix interferes with healthy communicating networks within the cells of the body. If the original pathogenic factor is not resolved, accumulations of phlegm, qi, and blood stagnation will continue to harbor the unresolved pathogen. This vicious circle perpetuates trapped dampness and heat.
Gu syndrome can be more easily described in Biomedicine as Biofilms.

Biofilms

There is growing evidence that the resilience of complex syndromes like Lyme disease are due to the presence of resistant bio-films.  Bio-films are complex communities of microorganisms encased in a matrix of secreted extracellular substances. (3) These microorganisms self- produce adhesive protective layers and attach themselves to cell surfaces.

Acute infections are generated by free-floating bacteria which makes them more accessible by targeted prescribed antibiotics.  However, chronic infections form bacterial communities that have more sophisticated survival mechanisms. They have an ability to encapsulate themselves and protect themselves  from an attack by the immune system. This advanced method of self-preservation interferes with conventional treatment regimens. In order to effectively eradicate a persistent and well-armed pathogen, multiple protocols and at times, multiple antibiotics, are often prescribed.

According to the National Institute of Health, 65 percent of all persistent microbial infections are caused by bio-films.(4) Common chronic bacterial conditions associated with bio-films include dental plaque, resistant urinary-tract and ear infections and long term catheter infections.  Cholera and antibiotic-resistant staphylococcus infections and tuberculosis are examples of life-threatening diseases associated with bio-films.

Blood coagulopathy and Blood stasis

Both Biomedicine and Oriental medicine recognize the importance of blood micro circulation to maintain dynamic homeostasis. In Biomedicine, blood clotting or coagulopathy is recognized only after an occurrence of a medical event such as cerebral thrombosis or myocardial infarction.  Frequently, in these cases, blood-thinning medications are prescribed. These medications are commonly associated with adverse side effects and are of limited therapeutic benefit, after a thrombo embolic damage has already occurred.
More evidence has shown abnormal blood coagulation is commonly associated with chronic diseases such as Lyme disease, fibromyalgia, and chronic viral and fatigue syndromes. Blood tests can measure predictable markers pointing to blood coagulation. In a cohort study of 54 patients with Chronic Fatigue Syndrome, 92 percent of the patients showed demonstrable blood coagulopathy or low-level activation of coagulation. (5)

In Oriental medicine signs of coagulopathy is recognized as blood stasis and is a detectable sign before blood laboratory markers might show abnormalities. One of the most notable signs is if the radial pulse feels choppy or may also feel deep or hard as though the blood flow is impeded. The tongue may appear dull or dark with shades of purple and sublingual vein congestion. The abdomen is usually noted as feeling tight or moderately tender especially in the peri navel area and lower quadrants. (6)

Laboratory tests to detect blood coagulopathy include blood viscosity markers as well as signs of erythrocyte and platelet aggregation and adhesion factors. High levels of these markers may increase the risk of thrombogenesis and  the risk of microvascular and cardiovascular diseases.

Immune-system pathologies have also been shown to coexist with blood coagulopathy. (7) Understanding this interrelationship begins with the understanding that impaired blood circulation interferes with oxygen transport and immune-signaling. When the body lacks essential communication within its immune pathways, inflammatory cytokines are stimulated. (8) A perpetual cycle of immune dysregulation, inflammatory cytokine production, and coagulopathy inhibits effective treatment response.

Treatment of Lyme disease

I have found that no two Lyme disease patients are alike. Each one presents a unique mixture of complaints affecting multiple organ systems. Each patient has their own associated impression of how they expect to feel as ideal health. Discussing their impressions of ideal health often leads to a clearer understanding of the symptoms patients report.

There are four main treatment principles I follow to address chronic pathogens such as Lyme disease.

1. Eliminate the pathogen – The offending pathogen has to be eliminated or there is continuous defensive posturing from the immune system that interferes with improving the immune response.
Biomedicine initially recommends antibiotics such as doxycycline which also has anti-inflammatory effects. Combination anti microbials often include macrolides or quinolones along with anti-parasitic medications such as Flagyl. The presence of co-infections also frequently calls for anti-malarial medications like Rifampin or Mepron.

Often these antibiotic regimens are prescribed in cycles of three months before re-evaluating or retesting for improvements.

Chinese herbal approaches to treat chronic pathogens address multiple symptoms concurrently. Often aromatic herbs are combined with clear heat and toxin herbs. Not only do aromatic herbs ameliorate the cooling effect of the clear heat herbs but they also penetrate into deeper body layers, assisting in healing.  Herb combinations such Huang qin or Lian qiao may be combined with Zi su ye or Bai zhi, depending on where symptoms predominate.

Formulas such as Su He Tang (Perilla and Mentha Decoction) (9) or Wu Hua Tang (10) combine herbs which clear toxins along with exterior herbs that attempt to push pathogens upward and outward.

2. Open the pathways – Healing can’t occur without efforts to further penetrate biofilms or slime matrices.

Biomedicine is in its infancy to detect early signs of blood coagulopathy. Sophisticated tests are available (though these are rarely recommended by conventional doctors) that measure clotting factors and genetically related abnormalities.

Chinese medicine has recognized the pathogenicity of blood stasis for centuries. Extensive modern research has studied the impact of herbal therapies on the coagulation pathways.
The most notable traditional Chinese remedy is the commonly-used cool temperature herb, Dan Shen (Salvia miltiorrhizae). Besides its traditional properties to invigorate the blood and calm the spirit, Dan Shen has also been found by researchers to have active pharmokinectic tanshinones that have an inhibitory effect on several coagulation factors in the plasma. (11) Dan Shen is often recommended for cardiovascular conditions and stands out for its potential impact to treat biofilms. Further research has shown studied herbs have more pharmacokinetic effects of reducing platelet aggregation and dilating coronary and peripheral vessels. (12)

Chuan xiong (Ligusticum wallichii) and Dang gui (Angelica sinensis) are warmer herbs included that also invigorate or vitalize the blood.

3. Detoxify the body – Although detoxification is not a separate treatment strategy in traditional East Asian medicine, toxicity and heat is considered as part of a whole body systems approach and treatment.

In Biomedicine, detoxification is focused on the liver, gallbladder and intestines. This can include screening for intestinal bacteria overgrowth or parasite infestation. There can be chronic underlying conditions that impact and slow down the immune response as well as mask symptoms of Lyme disease.

Biomedicine can also evaluate the liver’s functional pathways. Functional tests can measure detoxification systems and help track the efficiency of toxin-clearing processes like methylation and  glucuronidation that support normal liver function.

Detoxification also includes implementing an anti-inflammatory diet, reducing exposure to further internal and external toxins, and supplementation with supportive nutrients.

4. Regulate the immune system – The immune system is complex. The more it is compromised, the harder it is to regain its balance.

In Lyme disease, there are blood markers that can be tracked to monitor the immune-system. CD57 counts track a lymphocyte subtype. C3a and C4a markers track a biochemical complement cascade that potentiates antibody efforts to clear pathogens from an organism. These markers are only guides and do not replace the clinical analyses necessary for following and treating a patient.

Chinese  medicine looks to herbs such as Huang qi (Astralagus  membranasecus) and Ren shen (Panax ginseng), which have a long history of enhancing the immune system.  Clinical trials using these herbs have shown marked improvements in patients with immune deficiency. The consistent use of these types of herbs can be of immense benefit in treating patients with chronic illness. Herb choices vary since they are based on an individuals constitution and may be changed during the course of treatment.

Acupuncture

Treatment for chronic pathogens calls for more than one acupuncture protocolPresenting symptoms and signs may change as the condition changes. Clearing channels from the exterior toward the interior allows the pathogen to move upward and outward toward the surface. Shallow needling and moxibustion enhance the gradual release of pathogens towards the exterior. Acupuncture can be applied to help alleviate symptoms but is also used to provide a continuous support for the organ systems to enhance immunity and protect it from further damage.

Conclusion

A chronic illness like Lyme disease can be as hard to diagnosis as it is to treat. In my practice, I use an Integrative Medicine approach to address the complexities encountered in treating these sometimes-resistant conditions. I will often treat the patient initially with acupuncture and herbs while waiting for the results of diagnostic tests. After a more specific diagnosis antibiotic therapies might be prescribed as well as supportive therapies including diet, nutritional supplements, and specified referrals. Herbs and Acupuncture provide help not only to treat the condition but also to support and strengthen the patient while they are undergoing other methods of treatment.

While it is true that there are some areas where modern medical science remains in a deep sleep it is also true that there are biomedical insights and protocols that can be used to modernize the ancient principles of East Asian Medicine. These biomedical frameworks and tools can allow for deeper understandings of medical conditions without demanding that ancient medical wisdom be abandoned. By accepting a blend of medical paradigms and exercising a tolerance for both traditions, a better medicine can emerge that is integrative and complementary at the same time. Ultimately this is the goal for more successful patient care.

This article in its original form was published in

California Journal of Oriental Medicine Vol.2 No.2 Fall/Winter 2009

References:

1.     Huang Di Nei Jing Su Wen Jiao Shi – (Annotated Huang Di’s Inner Classic: Elementary Questions), People’s Health and Hygiene Press, Beijing, 1980:p46

2.     Chace, Charles, Lurking Pathogens, Three Modern Approaches. www.charleschace.com.

3.    Olmstead, S. (2009) Gastrointestinal Detoxification. Technical summary by Klaire Labs a division of ProThera,Inc.

4.    Lewis, K. (2001). Riddle of biofilm resistanceAntimicrobial agents and chemotherapy, 45(4), 999-1007

5     Dahlén GH, Ekstedt B: The importance of the relation between lipoprotein(a) and lipids for development of atherosclerosis and vascular disease. J Intern Med, 250 (3): 265–7.

6.   Matsumoto, K. (2007). Clinical Strategies. Kiiko Matsumoto International

7.   Caplice NM, Panetta C, Peterson, et al. (2001). “Lipoprotein (a) binds and inactivates tissue factor pathway inhibitor: a novel link between lipoproteins and thrombosis”. Blood 98 (10): 2980–7
8.   Schreiner PJ, Morrisett JD, Sharrett AR, et al. (1993). “Lipoprotein(a) as a risk factor for preclinical atherosclerosis“. Arterioscler. Thromb. 13 (6): 826–33. 

9.   Heiner Freuhauf, Gu Syndrome, www.classicalchinesemedicine.org

10. Steven Alpern, Lightening the Load to Disengage from Disease. www.ccmforhealing.com

11. Huang, Kee Chang. 1999 The Pharmacology of Chinese Herbs. CRC Press LLC

12. G. Neeb. Blood Stasis. New York, NY: Churchill Livingston; 2007

Labels: Chronic IllnessLyme Disease