Treating for Stealth Viral Infections

with Japanese Acupuncture and Herbal Therapy:

Butch Levy, MD, LAc

Complex chronic diseases have reached epidemic proportions. The clinical offices of many primary care providers are filled with chronically ill patients struggling with exhaustion, cognitive impairment, sleep disorders, and recurring pain. These illnesses tend to be unresponsive to emergency interventions, surgery, or intensive pharmaceutical treatment, and frequently all our skills and experience still fall short in improving those patients’ health and quality of life. In my own practice, a significant number of these conditions are associated with opportunistic viral infections that have gone undiagnosed or have resurfaced.

These covert but potentially aggressive infections include viruses such as flavivirus (West Nile), hepatitis B (HBV) and C (HCV), human papilloma virus (HPV), and many of the herpes viruses, such as cytomegalovirus (CMV), Epstein-Barr virus (EBV), herpes simplex (HV-1 and HV-2), and varicella zoster virus. The majority of these infections are considered incurable, although the symptoms are often controllable. Pathogens that are also well-recognized as oncoviruses with the potential to be causative agents in specific cancers include CMV, EBV, HBV, HCV, HH8 (Kaposi’s sarcoma-associated herpesvirus), and HPV.

When patients come in symptoms that suggest these types of infections, I apply Chinese or Japanese medicine in tandem with Western diagnostic tools to broaden the perspective treatments available. Based on the encouraging results I see, I would propose the value of integrative treatment, bridging East and West, for these types of viral infections.

Diagnostic Concepts

In Western Medicine, immunologists recognize that certain infectious pathogens are able to cloak their identity and remain present in the body. The patient may be relatively symptom free, or not, and possess what appears to represent adequate immune function. Yet under the right conditions, they can be subject to reappearance of these hidden pathogens. What is even more concerning is our inability to detect inner cellular changes that alter normal homeostatic pathways and potentially create malignant transformation. Just as the recognition that cellular messaging from unfavorable diet and lifestyle can produce inflammation and oxidative stress, these pathogens can create similar issues, but are often unrecognized as the cause of biochemical alterations in the etiology of chronic disease.

Chinese medicine recognized millennia ago that patients could suffer from covert afflictions or “evils,” stealth pathogens that would remain in the body. The Chinese system was able to delineate measureable changes in the pulse and in diagnostic areas on the abdomen that alerted the practitioner to the presence of sequestered infection. These diagnostic tools could also be used to detect the progression of illness to deeper levels in the body. For example, one might diagnose EBV and associated symptoms of chronic fatigue, but at what level of illness does it exist? As will be shown, the Chinese approach encompasses greater recognition of progression of disease to deeper levels, suggesting the potential of greater cell injury and with that more serious illness.

The classic herbal text, the Shanghan Lun (Treatise On Cold Damage Disorders) by the medical sage Zhang Zhong-Jing, dating from 220 AD, was a manual on the diagnosis and treatment of externally contracted diseases, which today would suggest infections. The text systematically described the invasion of pathogens as they entered the body and the course disease could take unless interrupted, as well as signs, symptoms, and patterns of illness that would emerge as illness spread deeper.

The genius of this treatise was its specific recommendations for both treating ongoing disease and protocol to force the pathogen toward a depth of reduced aggressive potential. Using symptom configurations, abdominal palpation, and pulse patterns, the practitioner was able to discern the level of illness and in concert with the patient’s energetic strength, compose an individualized treatment plan. This would include acupuncture and herbal formulas composed of a combination of herbs in an exact formulation, designed to match the pattern of presentation in real time.

Applying these strategies in current practice, ongoing treatment requires that with each visit, the exam is repeated and based on changes in response to therapy, the acupuncture and herbs are adjusted accordingly to match the patient’s alteration in the pattern of illness, in a chess match of extraordinary proportions. These protocol, developed two millennia ago in Chinese medicine, are still utilized and found to be effective.

Integrative Diagnosis, East and West

In my practice, patients frequently come having already been given a diagnosis by their medical doctor. Typically that information can be a starting point for my own investigation, providing the access point to information based on fundamental Western concepts. I then add another perspective using the Chinese model, conducting two simultaneous but separate examinations, one from each paradigm. This allows for the creation of different perspectives on the same information. Seen from the vantage point of Chinese medicine, I view their condition as a pattern of imbalance, rather than as a fixed diagnosis of disease. Allowing a synergism of both paradigms often provides more than just the sum of two viewpoints, and creates opportunities for therapies that are inclusive of each other rather than exclusive.

The goal then is to view the illness dynamically, recognizing that the patient is continually changing, and is done an injustice by having the label of a disease name placed on them. Certainly it provides an image of signs and symptoms but fails to delineate where they are on the continuum of disease or its severity. Is it just beginning, or full on? Is it winding down or revving up? Labels also imply that everyone is the same, and therefore treatment is the same. As is often expressed in Chinese medicine, “There can be the same treatment for different diseases, and different treatments for the same disease.”

Immunity.

The recognition of immune hyperactivity has revolutionized treatment in fields such as rheumatology. One example is the treatment of collagen vascular diseases. The advancement of pharmaceutical research, in response to this understanding, has created therapies to “shut down” immune over activity and limit system damage by reducing inflammation. Yet at the opposite polarity, the understanding of an underachieving or vulnerable immune system has generated limited current agreement as to its causes and more importantly resulted in few effective treatment approaches. Situations of immune dysfunction focus primarily on immune compromised patients with a heightened risk of severe, often overwhelming infection. Otherwise the idea that patients may have some form of immune dysfunction, while acknowledged, offers little therapeutic help to those affected.

Terrain.

One corollary, which seems relatively underappreciated in allopathic Western medicine, is a focus on the underlying energetic strength of the patient in combating disease. It is not just the illness that determines outcome, but also the inner terrain in which the illness occurs. The Chinese medicine perspective posits that the vital force within, the Qi, determines our energetic strength and functional capacity to respond to threats and changes with the body. The strength of this energy is the essential aspect of our protection and defense against infection. It is recognized that the origin of Qi is the genetic merging of our parents. The Qi can be revitalized from our foods and is inhaled in every breath. It is transformative in the production of fluids and blood, it provides containment, and it is the source of growth and development, as well as physiologic activity and metabolism. Ultimately, the terrain determines outcome, and Chinese medicine can directly influence the Qi for its support.

Homeostasis

Maintaining global equilibrium.

Eastern medicine reflects a perspective that health can be maintained in a way that offers vibrancy, harmony, and quality to our daily lives. An essential paradigm suggests that each person’s health or lack thereof is related to imbalance in the body’s global equilibrium. Certainly disease can occur, but the goal is to shift the balance back toward health and recovery whenever possible. This certainly doesn’t imply that all we need is balance, and everything will be right. On the contrary, disease often will require Western care, but together a blend of both paradigms can support necessary treatments with a shift toward recovery.

Intervening before disease begins.

Eastern medicine also developed concepts that recognized the essential need for preventive medicine. If you were to become ill, available urgent care was really not an option, so staying healthy was a necessity. In the ruling court, the physician was only paid if the Emperor remained healthy. Any illness meant a forfeiture of pay. Pursuing that concept of a desire to treat before disease begins is a viable complementary approach to existing Western health practices. This paradigm focuses the practitioner on prevention, rather than just early intervention, and provides tools and protocol to restore homeostasis at a much earlier stage.

A Systems Perspective

The individual organs represented in the Chinese model are not considered isolated independent systems, as often expressed in Western medicine, but part of a whole, unified and absolutely interdependent. The focus of health requires an interaction of the entire network as a system rather than correcting the dysfunction of a single organ. Consequently the strategy in treatment is to support the interplay within and among the organ systems, with system balance as the fundamental objective, a coordinated effort between mutually dependent structures. Disease disrupts the ebb and flow of the entire organism, as if a sports team were trying to perform with one or two players who are not functioning up to par. When that occurs, the performance of the entire team is impacted.

In Chinese medicine, although one organ may be symptomatic, creating signs of imbalance, therapy requires recognition all of the members of the team and how each might be affecting the others in a potentially supportive or detrimental way. The system is represented with metaphors that relate to the interaction of a large family dynamic. However, the body is not viewed as a chaotic system, but one of great refinement.

Symptoms may be reflected in the function of one organ system, but the cause could be originating from other organ imbalances. The understanding is that the disease is not necessarily a single-organ phenomenon, but could be the downstream or upstream response to an imbalance in another system. In my experience, this phenomenon is surprisingly common. By way of example, core kidney energy in Chinese medicine affects kidney function and the urogenital system, but it is also responsible for the function of the prostate, for reproductive energy, the spine, the lower extremities, and the brain. It is nurtured by the lung and controls the heart while supporting the liver. If the kidney is viewed as a fulcrum point in this model, it may be that weakness or excess in other organ systems are affecting the kidney. Unless they are treated, the kidney will continue to show signs of deterioration, which impacts the other organs.

The implication being that each organ is interconnected to the others, and an imbalance or disease in one is reflected in the function of all to some degree. This creates a whole-person concept of health and illness. People were not considered to have isolated tissue organ complaints. Rather it is essential to evaluate the signaling and interaction among organ systems that would reestablish balance.

Diagnostic Tools

While Chinese and Japanese practitioners originally studied the same texts, their applications and adaptations are culturally distinct. In the Chinese model, clinical information is derived from talking to the patient, observing them, looking at the tongue, and taking the pulse. The Chinese practitioner utilizes both herbs and acupuncture, with herbs being the primary focus. The Japanese system, which I have adopted in my practice, developed in two directions. Acupuncture is a tradition usually practiced as a distinct discipline, to the exclusion of herbal treatment. In the early 17th century the Shogun decided that blind people should never be without a profession and were therefore trained as acupuncturists. Even today in Japan, a large percentage of acupuncturists are sightless. Obviously facial and tongue observations were not available. Consequently, Japanese acupuncturists have developed astute palpatory skills.

Pulse diagnosis.

Probably the most distinct and unique of the fundamental exams in Chinese medicine relates to the pulse system of diagnosis. In contemporary Chinese medicine, taking the pulse involves feeling the radial artery at the wrist. By “listening” with the fingers, one is able to gain information from the flow of fluid through the artery. Pressing with the first three fingers can offer information sensed by each finger individually or by all three as a single unit.

The intention of pulse diagnosis is to first assess three fundamentals: 1) Reflection of depth of disease: is the pulse superficial or deep? 2) The second fundamental: is the pulse weak or strong reflecting the patient’s energy? 3) Is the pulse rapid or slow, indicating that the overall system is warm and inflamed, or cold, sluggish, and slow to respond?

At that point, the diagnosis moves into a deeper, more subjective interpretation of the pulse, termed the pulse quality. These qualities are described in the literature as tight (like a guitar string), choppy (reflecting changes in the rhythmic cycle of the pulse from beat to beat), slippery (visualize a rolling pearl in a basin), or hollow (suggesting that when the pulse is pressed, no energy can be detected inside, like pushing on a scallion). There are more than two dozen variations in the waveform of the wrist pulse, reflecting variations in the frequency and amplitude of blood flow as a means of diagnosing body imbalance and dysfunction. Pulse diagnosis can be seen as the ability of the musician to recognize notes and chords, and the melody that their combinations can produce. The practitioner’s listening skills may be seen as a reflection of their interpretation of the unique song of life being displayed by their patient.

Abdominal exam.

The Japanese have developed and refined the art of abdominal palpation. This approach involves palpation of the hara or central abdominal area, the solar plexus, as a way of accessing information from the body’s energy source and spiritual center. The Japanese style of herbal practice is called kampo, and the abdominal examination used to determine the herbal formula is called fukushin. The goal is to palpate the abdomen and correlate it with specific symptoms that form a distinct pattern, called a shoh, and that shoh or pattern directs therapy by indicating a specific herbal formula.

Palpation.

Touch is an effective way to evaluate the body, to identify the tone of the muscles and tendons and tightness or tension in various areas of the body. Palpation also makes it possible to assess temperature changes from the upper to the lower areas of the body.

Facial diagnosis.

Color in different areas of the face can indicate organ imbalance. One might observe, for example, a yellow tint reflecting spleen weakness or a blackish facial hue indicating kidney deficiency. Lines in the face may point to emotion, to the emotional personality of the patient, and suggest the involvement of a particular organ system. Facial contours (round, oval, square, or trapezoid) reflect a patient’s personality type and can enhance the style of communication they need in order to understand their issues.

Tongue diagnosis.

Another useful addition in the Chinese model of care comes from tongue diagnosis. Each area of the tongue represents a different organ system, and the color of that area and the contours of the tongue provide clues to pathology in the body. A “geographic tongue” implies intense inflammation. Correct treatment can alleviate the problem, and this will be

reflected in the tongue, which will slowly begin to return to normal.

Diagnostic use of acupuncture points.

Each organ manifests in the outer extremities as well as in the acupuncture meridians. The meridians provide a means of assessing the flow of energy in the body and whether there might be an obstruction or a blockage in energy.

Treatment Concepts

The Chinese, faced with numerous epidemics over the millennia, have devised evaluation and treatment approaches outlined in classic texts on herbal therapies and acupuncture. Variations based on their methodologies have led to adaptations that are currently useful in the treatment of stealth viral infections.

References are made in the Wen Bing text (Warm Disease Theory) state that a cold in the late fall or winter can return to cause illness in the spring. Even hundreds of years ago it was recognized that an infection could incubate for a period of time and then resurface, causing a new illness. The point was not that a cold could later recur. The concern was that illness had significant potential to return as a deeper level of disease. Treatment for initial infection required a greater emphasis on the prevention of subsequent illness that might go deeper. Consequently, aggressive treatment of acute infection was encouraged. Certainly thousands of years ago, a cold that became pneumonia, a cut that became a cellulitis, or a GI infection that worsened more likely than not could prove fatal.

Integrative Interventions

When damage to the overall system is eminent, the options left to interrupt the disease and prevent further deterioration are limited. The strongest and fastest means available is often Western drug therapy, which may be the only available option if organ function has weakened and declined to a level that is life threatening. The idea of repair and recovery, at this point, becomes a secondary goal to survival.

From my own observations, Western therapies designed for complex chronic diseases are extremely useful. By affecting a particular metabolic pathway, the downstream production of biochemical molecules will be influenced in a way that changes cellular response, ultimately reducing the symptoms that reflect an imbalance. However, treatment seldom resolves or eliminates the disease.

Although chronic tissue damage may be slowed or stopped, Western medicine has no strategy for repairing or restoring function to the damage that has ensued. Even when the disease process has been inhibited, without the continuation of medication, a return and progression of the disease is a strong possibility. In the situations we encounter with stealth infections, despite a clear diagnosis, the tenacity of the infection often proves difficult, given the level of entrenchment. Chinese medicine encompasses thousands of years of confirmation that the herbal treatments are effective for the patterns they are designed to treat. Please understand that we are not treating a “disease state,” but a constellation of symptoms in a patient with a specific energy level. These treatments, when deftly applied, can be hugely successful for the problem.

Acupuncture

Current interpretation of why acupuncture works is still intelligently theoretical. There is the idea that using needles influences the matrix (fascia and connective tissue), to change the electrical potential within. This then influences local neuro-vascular communication creating a physiological reverberation on a more global scale. Another remarkable aspect of acupuncture occurs in the setting of the Extraordinary Meridians. A useful metaphor from ancient times refers to the establishment of dikes and irrigation canals to control water during times of flood or drought. The Extraordinary Meridians are used to provide a similar concept. They act as reservoirs that are able to move energy away from areas of excess or bring needed energy to depleted areas.

Using the acupuncture points individually allows for symptom modification, while the Extraordinary points can help up regulate or down regulate systems to better balance the whole. For example a patient with a lurking pathogen causing digestive level issues can be treated with local points for bloating or diarrhea, while the digestive system can be helped by balancing the organs. In addition, if the liver energy, by emotionally overacting, has played a role in the digestive problem, the same approach to that organ can be overlapped as well.

Herbal Therapies

The Chinese concept of herbal treatment consists of the integration of symptoms, pulse, and tongue diagnosis to arrive at an assessment and treatment with herbal formulas and acupuncture. These formulas are a combination of plant, mineral, and animal substances designed to treat systematic problems as well as organ imbalances.

Many contemporary herbal formulas prescribed are derived from texts that originated two thousand years ago. The Shanghan Lun and the companion text, the Jin Gui Yao Lue (Essential Prescriptions from the Golden Cabinet), provide the framework for interpreting specific symptoms and describe specific herbal formulas for successful treatment. To understand, integrate, and balance the entire person is different than treating symptoms alone. Rather the herbal formulas are based on a construct of illness applied to interpret the depth of disease. The Chinese perspective on infection is also multidimensional. If you understand the path inward that disease can take, then the objective is to reverse that direction and push the infection outward to remove it from the body, whenever possible. This is dynamic movement however, as the disease can penetrate deeper, causing more severe symptoms or can actually be encouraged in a more superficial direction resulting in the lessening of symptoms. The text also provides valuable information concerning correcting iatrogenic practitioner-induced errors.

The intent of this article is to provide practitioners with a brief overview of the Japanese and Chinese approaches to assessment and treatment for opportunistic stealth viruses, which the Chinese aptly term lurking pathogens—a common, but often unrecognized cause of complex, chronic disease. I view this approach as an important aspect of integrative patient care for certain chronic disorders. Eastern medicine offers additional perspectives to the practitioner for treatment and can be seamlessly integrated with naturopathic therapy, functional medicine, and Western care. An experienced practitioner of Chinese medicine can aid in shifting the balance of recovery for the patient. Inclusive integrative treatment strategies promote the higher concept that utilizing the best of all models of care can only benefit our patients in restoring health.

Butch Levy, MD, Lac

Butch Levy is an integrative practitioner, board certified in Family Medicine and NCCAOM certified in acupuncture. Dr. Levy has been in private practice for 37 years, including care from obstetrics and pediatrics to geriatrics and hospice care. In the late 1980’s Dr. Levy attended acupuncture school, completing many of the classes, but also apprenticed with and was mentored by Miki Shima to complete his requirements for certification. Dr. Levy’s training in Eastern medicine is in the Japanese style of herbal diagnosis using abdominal patterns, fukushin, and his acupuncture style is distinctly toward the Extra Vessel and Divergent Channels. Dr. Levy’s current practice integrates allopathic care with Chinese medicine and functional nutritional medicine, bridging east and west with comprehensive, practical approaches to illness. He sees a wide variety of patients, and his focus of interest is toward complex chronic disease, including supportive care for cancer and autoimmunity.

Integrated Medical Care

Dr. Butch Levy
8966 W Bowles Ave., Unit L
Littleton, CO 80123

303 972 2727

303 972 8652 fax

Editorial

Nancy Faass, MSW, MPH, is a writer and editor in San Francisco who has worked on more than 40 books for publishers that include Elsevier, Harper, New Harbinger, and others. Director of the Writers’ Group, she also provides articles, white papers, and writing for the Web and can be reached at info@HealthWritersGroup.com.