Pulse Diagnosis, Parasites and Herbs

PARASITES

Chong

This article was sponored by Qualiherb in 1989.

The increase of world travel brings the problem of parasites to more affluent nations, it is no longer a subject of poverty stricken areas and third world countries. With the increase of disease patterns involving immune system breakdown, the involvement of parasitosis should be included in the differential diagnosis of all immunosuppressive conditions.

In 1978 the national statistic for parasite infection in the U.S. was 13.3%. In southern states it tends to be increased, such as in Texas where it was 26%.

Studies done in Houston Texas with pediatric patients showed a 49.5% positive stool sample rate. This came from a general cross-section of race, age, sex, ethnic group, income bracket, and household size. The single most common factor in each case was travel.

Infections are frequently difficult to diagnose as symptoms are often vague and mimic other disease patterns. There are a few labs capable of "esoteric" stool tests, and these can often provide more accurate information than a standard ovum and parasite at the local hospital lab. the average lab. The problem is compounded by the fact that many times infection is not revealed in the stool sample.

In leu of a positive stool sample, a cluster of symptoms unresponsive to normal treatment should be suspect. Altered bowel habits are the most common symptoms, and they can include watery loose stool, or constipation. Also observe for the following:

*rectal itching and burning *respiratory symptoms with hepatomegaly particularly at night

*excessive appetite *hepatobilliary symptoms

*food allergies *depression

*improvement of symptoms after eating *foul intestinal gas

*epigastric pain and heartburn *loss of weight

*swelling around the umbilicus *breast swelling and tenderness unrelated to the menstrual cycle

Symptoms: Onset can include itchy erythematous or petechial rash. Acute findings can include fever, malaise, urticaria,diarrhea,cough,eosinophilia,hepatomegaly, splenomegaly, usually becoming asymptomatic within 3-8 weeks.

Signs: Visual: white patches in the buccal mucos and grey lines in the sclera, Pulse: without root in both middle positions, a Jue Yin diagnosis in Shang Han Lun will have a very deep and weak or thready pulse.

Chronic findings occur 6 months to several years after infection as the lesions slowly develop, with subsequent slow progression over 5-15 years or longer. Symptoms can include diarrhea, dysentary, and abdominal pain in the initial stage progessing to anorexia, intestinal polyps, portal hypertension, hepatic insufficiency, peculiar urogenital symptoms.

TCM as western practitioners learn it, generally recognizes worm infestation as an aspect of the Jue Yin stage of the Shang Han Lun (the end stage of febrile disease progressions). Current world trends however, indicate a need to include a model for determining parasitic infection that is distinct from febrile disease progressions. Observation of vague symptom pictures that tend to be unresponsive to basic therapies are a place to start.

One approach to the differentiation of formulas is accomplished by the presenting temperature condition of the patient. Antiparasitic herbs can be added to the formulas for treating hot, cold, or moderate conditions. If the patient is Qi or Blood deficient it should be addressed as well with a corresponding formula adjustment, or by adding to the treatment regimen.

Phyto-therapeutics can be much more gentle than synthetic drug therapy and are therefore preferred in weak patients. The gentler action of herbs take a longer period of time to produce results so allow two months for therapeutic results. Botanicals also remain efficacious for a longer period of time than drug therapies. There are minimal side-effects with botanical treatment and with well balanced formulas the digestive system is improved.

To accomplish a balance within the formulas, we must consider that stronger parasiticides may stress the digestive function, this tendency may be addressed with Massa Fermentata (Shen Chu) and Fructus Craetegi (Shan Zha). These two herbs may also be included when there are any signs of digestive disturbance. Further support for abdominal pain may be provided with Aurantii Immaturis (Chih Shih) and Angelica Sinensis (Dang Gui). If necessary, purgative herbs such as Rhizoma Rhei (Da Huang) may be added to assist elimination of intestinal worms and the eggs. For biliary obstruction, one may add Artemisia Capillaris (Ching Hao) to one of the rhubarb combination variants. The use of ascariacides is greatly enhanced by constitutional treatment and the use of tonic support for weak conditions. Due to the common manifestation of qi stagnation in patients with parasitic infection, it is helpful to support with carminative therapies as well. Eating pumpkin seeds regularly during worm detox can assist the process greatly. And Bulbus Alli (Garlic) has strong antiparasitic functions along with its myriad of other benefits.

Parasite differentiation can be classified according to six levels of host-parasite relationships:

1. Strong Wei Qi- no invasion.

2. Symbiosis- invasion with mutual benefit.

3. Commensalism- invasion without symptoms.

4. Sterilizing Immunity- developed resistance to reinfection.

5. Concomitant Immunity- invasion with symptoms and immune reaction with some resistance to reinfection.

6. Ineffective immunity- no resistance with ineffective immune response.

It is important to recognize that parasites can be asymptomatic in up to 50% of the infected populous. Lab tests often provide a false negative, although an elevated eosinophil 4+ along with elevated IgE is a strong confirmation.

1. Schistosoma ( bilharziasis )

Location: Found in many tropical and subtropical areas of the world such as the Mideast, Africa, South America, the Caribbean, and Asia.

Chronic findings may occur 6 months to several years after infection as the lesions slowly develop, with subsequent slow progression over 5-15 years or longer. Symptoms can include diarrhea, dysentery, and abdominal pain in the initial stage progressing to anorexia, intestinal polyps, portal hypertension features, hepatic insufficiency, urogenital infection, bladder polyps and or tumors; severe disease of the lung,liver, nervous system or genitals is rare.

2. Clonorchis sinensis ( liver fluke )

Location: Endemic to areas such as Europe, Southeast Asia, and India. Symptoms: Often asymptomatic with few parasites.

Acute symptoms follow the entry of the worms into the biliary tract presenting with the following; malaise, lowgrade fever, epigastric pain, tender liver, hepatomegaly, high white blood cell count, and eosinophilia. The acute phase is difficult to diagnose since ova frequently don't appear in the stool until 3-4 weeks after the initial symptoms appear.

Chronic symptoms can include weakness, anorexia, epigastric pain, diarrhea, lowgrade fever, progressive hepatomegaly, intermittent right upper quadrant pain, and hepatic tenderness.

Vector: Infection results from eating raw or under cooked fish. Pickling, drying, and smoking may not be sufficient to eliminate the fluke.

3. Paragonimus westermani ( lung fluke )

Location: West Africa, Asia, China, Japan, the Pacific Islands, as well as Central and South America.

Symptoms: Heavier infections include dyspnea, signs of bronchitis, bronchiectasis, weight loss, malaise, and weakness.

Chronic infections include low grade fever, hemoptysis, pleuritic chest pain, and dry cough progressing to cough with blood-flecked viscous sputum.

Vector: Crustaceans such as crabs or crayfish eaten raw or pickled. They can also infect a container or be transmitted by unwashed hands.

4. Fasciola hepatica ( sheep liver fluke )

Location: Sheep raising countries where raw salads are eaten.

Symptoms: Acute infestation reveals an enlarged and tender liver, high fever, eosinophilia, and epigastric or right upper quadrant pain. There may also be headache, anorexia, and allergic symptoms such as urticaria or myalgia.

Chronic infestation tends to be relatively symptom free, although there can be degrees of RUQ sensitivity, vomiting, diarrhea, or hepatomegaly.

Vector: Infection usually results from ingestion of aquatic vegetables such as watercress. Washing is not effective, although cooking is. Water should also be boiled.

5. Fasciolopsis buski ( large intestine fluke )

Location: A common parasite of humans and pigs in Southeast Asia, China, and India.

Symptoms: After several months of incubation, GI symptoms begin to appear. These symptoms include anorexia, nausea, diarrhea that can alternate with constipation, upper abdominal pain, and in light infection there can be no symptoms revealed.

Vector: Snails transport the flukes to water plants particularly water chestnuts, bamboo shoots, or caltrops. Infection is a result of eating the uncooked plants.

Fluke Treatment Formulas

1.Damp Heat: Capillaris Combination

2.Liver Qi stagnation with Spleen Qi Shu: Bupleurum & Tankuei Combination (Shao Yao San)

3.Damp Stagnation: Hoelin 5 Combination (Wu Ling San)

4.Liver & Kidney Yin Shu: Six Rehmannia (Liu Wei Di Huang Wan) and its derivatives

5.Interior heat with stagnation: Major Bupleurum Combination (Da Chai Hu Tang)

Tapeworm ( cestodes )

1. Beef tapeworm- Taenia saginata

2. Fish tapeworm- Dyphllobothrium latum

3. Pork tapeworm- Taenia solum

Location: Worldwide, there are actually 6 forms of tapeworm commonly found throughout the world. These include rat, dog, and humans as well as the above listed. The fish and pork tapeworms find more limited distribution than the others.

Symptoms: Usually asymptomatic, tapeworms can cause vague GI symptoms such as diarrhea, abdominal pain, nausea, and anorexia as well as fatigue, hunger, and dizzyness.

Vector: People contract tapeworms from meats that are improperly cooked. Dogs, cats, and rodents can also be involved in the transmission of tapeworms.

ROUNDWORMS ( NEMATODES )

1. Roundworm (ascarius lumbricoides)

Location: Cosmopolitan distribution, particularly areas where human feces are used as fertilizer.

Symptoms: Pulmonary phase- cough, dyspnea, allergic findings ( urticaria, asthma, eosinophilia ) Intestinal phase- abdominal discomfort, occasional vomiting, abdominal discomfort.

2. Hookworm (trichuris trichiura) (necatur americanus) (ancylostoma duodenale)

Location: Tropical and subtropical affecting a quarter of the world population.

Symptoms: Early picture-Dermatitis with a pruritic, erythematous papulovesicular lesion at the site of the larval invasion. Pulmonary symptoms include episodic coughing, asthma, fever, eosinophilia, and blood tinged sputum.

Later picture-Intestinal symptoms include diarrhea, anorexia, and abdominal discomfort. Anemia with fatigue, pallor, deformed nails, dyspnea on exertion, palpitations, peripheral edema, and heart failure.

3. Threadworm (strongyloides stercoralis)

Location: Tropical, subtropical, and some temperate areas such as in the US.

Symptoms: Pruritic dermatitis at the site of larval penetration, epigastric pain, nausea, diarrhea, cough, rales, eosinophilia.

5. Pinworm (enterobius vermicularis)

Location: Worldwide, pinworms are one of the most common causes of helminthic infection.

Symptoms: Nocturnal perianal and vulval itching, insomnia, restlessness, irritability, and vague GI symptoms.

6. Trichinosis (trichinella spiralis)

Location: Wherever pork is eaten.

Symptoms: Diarrhea, cramps, malaise, muscle pain and tenderness, fever, facial edema, and conjunctivitis.

5. Pinworm (enterobius vermicularis)

Location: Worldwide, pinworms are one of the most common causes of helminthic infection.

Symptoms: Nocturnal perianal and vulval itching, insomnia, restlessness, irritability, vague GI symptoms,

6. Trichinosis (trichenella spiralis)

Location: Wherever pork is eaten.

Symptoms: Diarrhea, cramps, malaise, muscle pain and tenderness, fever, facial edema, and conjuncivitis.

7. Whipworm (trichuriasis)

Location: Throughout the world, particularly tropic and subtropic.

Symptoms: Symptoms: Usually silent; heavy infection can include diarrhea, lower abdominal cramps, flatulence, tenesmus, rectal prolapse, and bloody stool.

Single Herb Qualities

1. Sm Areca (Bing Lang) has a high rate of effectiveness for paralyzing tapeworms (70%) average. It is also good for fasciolopsiasis, ascariasis, trichuriasis, oxyuriasis, and ancylostomiasis. There is also some effect with giardia.

Dosage 9-90 gr.

Cautions: 1. Can cause stomach spasm, nausea, and vomiting.

2. Use in cool water to reduce side effects.

3. Soak areca in water for 3-5 hours before cooking, or use a

powder concentrate.

2. Omphalia (Lei Wan) has proteolytic enzymes that act as taenicidal agents, it works best for fasciolopsiasis, ascariasis, trichuriasis, oxyuriasis, and ancylostomiasis.

Dosage 20-60 gr powder.

Cautions: Due to the enzymatic action, omphalia should not be cooked so as to retain the taenicidal action.

3. Melia Brk (Chuan Lian Zi) is 70%-87% effective in the treatment of roundworms and has about an 80% effectiveness in defertilizing the worms eggs. The primary substances responsible are tannins, and natural resin.

Dosage: 2-6 gr. daily.

Cautions: With large doses there can be facial flushing and sleepiness.

4. Quisqualis (Shi Jun Zi) has a sweet taste making it suitable for use with children, it can be used by itself, or with Sm. Areca. The main ingredient, potassium quisqualate has a 70% effectiveness quotient for roundworms.

Dosage: For ascariasis use 1 gr daily for each year of age for 1-3 days. Dosage should not exceed 12gr for children and 15 gr for adults. For intestinal trichomonas use 1.5 gr per year of age.

Cautions: When used alone it can cause hiccups, and with large dosage there can be vertigo and or vomiting.

5. Torreya (Fei Zi) is primarily used for intestinal parasites such as roundworms, hookworms, pinworms, and tapeworms. It is more effective than tetrachloroethylene for tapeworms and hookworms.

Dosage: 3-10 gr daily.

6. Ulmas (Wu Yi) is used for round worms and tapeworms, it is less effective when used by itself.

Dosage: 3-9 gr.

7. Pulsatilla (Bai Tou Weng) is used primarily for amoebic dysentery.

Dosage: 3-12 gr.

Cautions: Contraindicated in chronic dysentery like disorders with spleen-stomach damage.

8. Artemesia qinghao (Qinghao) is traditionally used as an antimalarial clinically it is being found useful for other protozoal infections such as giardia.

Dosage: 6-9 gr.

9. Blechnum (Guan Chong) contains filicic acid, filicin, and albaspidin as the active ingredients for treating tapeworms and hookworms.

Dosage: 5-12 gr.

10.Zanthoxyli (Shan Jiao) is added frequently to increase the effect of Mume, it is said that the pungent flavor of Zanthoxyli extends the half-life of herbs within the system. It is also used for roundworms.

Dosage: 2.5-6 gr.

Parasitic Formulas

1. Quisqualis & Areca Sd. Combination (Shi Jun Zi Bing Lang Tang)

Quisqualis (Shi Jun Zi) 3.0 Areca Sd. (Bing Lang) 1.5

Used primarily for round worms, this formula has a 70% effectiveness rate.

2. Melia & Areca Combination (Dan Dau Fei Chong Tang)

Sm. Melia (Chuan Lian Zi) 5.0 Sm. Areca Bing Lang) 5.0 Fr. Aurantii (Zhi Ke) 3.0

Quisqualis (Shi Jun Zi) 3.0 Saussurea (Mu Xiang) 2.0

This is primarily a roundworm formula.

3. Pen Fei Chui Zhau Tang

Sm. Torreya (Fei Zi) 4.0 Polygonum avicularis (Bian Xu) 3.0 Sm. Areca (Bing Lang) 4.0 Sophora (Ku Shen) 3.0

This is used primarily for roundworms and tapeworms, primarily intestinal parasites.

4. Ulmus Combination

Ulmus (Wu Yi) 6.0 Torreya (Fei Zi) 3.0 Areca (Bing Lang) 9.0

Coptis (Huang Lian) 2.5 Saussurea (Mu Xiang) 1.5

This formula is primarily used as follow up support to a stronger primary anthelminthic therapy, it is not as effective as the sole treatment. It is particularly effective for pain due to roundworms.

5. Areca & Mume Combination (Pin Wu Ho Chi Tang)

Areca (Bing Lang) 9.0 Mume (Wu Mei) 3.0 Licorice (Gan Cao) 1.0

Used to treat fasciolopsis (large intestine fluke), it is given in single 4-8g dosages daily.

Cautions: 1. May Cause stomach pain, vomit, or diarrhea.

2. Take in cool solution to reduce side effect.

3. Soak Areca in water for 3-5 hours before cooking to increase effectiveness, or use powdered concentrate.

6. Blechnum Formula (Guan Chong Tang)

Blechnum (Guan Chong) 3.0 Fo. Perilla (Zi Su Ye) 5.0 Melia (Chuan Lian Zi) 5.0

Schizonepetae (Jing Jie) 5.0

Used for hookworms.

7. Ginseng & Zanthoxylum (Ren Shen Shan Jiao Tang)

Ginseng (Ren Shen) 1.5 Atractylodes alba (Bai Zhu) 5.0 Poria cocos (Fu Ling) 6.0 Mume (Wu Mei) 2.0 Zanthoxylum (Shan Jiao) 1.5 Ginger (Gan Jiang) 1.5

Used for ascariasis when there is a deficient cold condition in the stomach.

8. Picrorrhiza & Mume Combination

Picrorrhiza (Hu Huang Lian) 3.0 Omphalia (Lei Wan) 9.0

Phellodendron (Huang Bai) 2.4 Mume (Wu Mei) 2 seeds

Zanthoxylum (Shan Jiao) 10 pieces Areca Sm. (Bing Lang) 2seeds

Used for heat in the liver and stomach with pain , anorexia, and vomiting of worms. The salient features being a redness to the face, fever, a fast pulse, dry mouth, and possibly disturbed heart function.

9. Mume Combination

Mume (Wu Mei) 3.0 Asarum (Xi Xin) 3.0 Aconite (Fu Zi) 3.0

Cinnamon (Gui Zhi) 3.0 Phellodendron (Huang Bai) 3.0 Ginseng (Ren Shen) 3.0

Angelica sisnensis (Dang Gui) 2.0 Zanthoxylum (Chuan Jiao) 5.0 Ginger (Gan Jiang) 5.0 Coptis (Huang Lian) 7.0

Used for a moderate temperature manifestation including chills and fever. Formulas 7,8,and 9 above can be used based on differentiation by hot, cold, and moderate temperature conditions. For stronger anthelmintic function, add the appropriate formula from above to the program.

10.Cnidium & Stemona Combination (Zhi Yang Ding)

Fr. Cnidium (She Chuan Zi) 5.0 Rx Stemona (Bai Bu) 5.0

Soak in alcohol and apply thin paste externally.

Used for crabs, lice, and itching associated with infestation.

11.Indigo Combination (Qing Dai San)

Indicum (Qing Dai) 2.0 Phellodendron (Huang Bai) 2.0

Gypsum (Shi Gao) 4.0 Talcum (Hua Shi) 4.0

Mix with water into a thin paste and apply externally.

Used for dermatitis due to schistosomiasis, or hookworm invasion. It is also used for chemical allergin dermatitis.

PROTOZOAL

INFECTIONS

1.Amebiasis

Location: Worldwide, particularly tropical zones.

Symptoms: Mild to moderate amoebic colitis has mucous without blood, and acute amoebic colitis has mucous with blood, fever and colic. Hepatic involvement is revealed by hepatomegaly, tenderness, and fever.

2.Giardiasis

Location: Worldwide, particularly in subset groups such as travellers, campers, male homosexuals, and people with impaired immune states.

Symptoms: Usually silent, there can be sulphur smelling flatus, acute or chronic diarrhea, with bulky, greasy, frothy stool, lassitude, upper abdominal swelling, malabsorption syndrome, and or discomfort. Vector: Humans and contaminated water supplies.

3.Toxoplasmosis

Location: Worldwide

Symptoms: Can be asymptomatic, or present with mild to acute febrile conditions similar to mononucleosis; arthralgia, stiff neck, sore throat, rash, lymphadenopathy, and or confusion. With immunocompromised individuals, such as those with hematologic or other cancers, AIDS, or people on immunosuppressive therapies, encephalitis is the most common progression although pneumonitis, myocarditis, and other systemic inflammatory conditions can occur. Congenital infections are the most likely to develop retinochoroiditis, it seldomly develops in adults or older children.

Vector: Cats, it is also found in other animals and birds.

Protozoal Therapies

Metronadazol (Flagyl) is the primary choice for amoebiasis and can have side effects that include GI distress, tachycardia, hypotension, muscular weakness or dermatosis. Quinicrine is another drug of choice for giardia and can cause severe GI distress or toxin related psychosis.

A lowtoxic alternative includes the use of Artemisia Qinghao. This botanical has been used as an antimalarial for centuries and as of late many practitioners are getting good clinical results using Qinghao for giardiasis. Application for toxoplasmosis is also worthy of experimental consideration. Qinghao has been shown to have an ingredient called Artemissin which has the ability to cross the blood brain barrier, this makes Chinghao a possible option for amoebic meningitis. Qinghao also contains a sequiterpine lactone which has a peroxide like function. This sesquiterpine lactone is thought to have its primary interaction with the parasites membrane structure. The lactone has also been observed to alter the endoplasmic reticulum and cause swelling of its mitochondria. This altering affect on infrastructures of the cell is thought to expose the parasite to the host immune response mechanism.