Lingering pathogen syndrome in Traditional Chinese Medicine

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By Melissa Carr, BSc, DrTCM

In my practice. I’ve had patients come to me with ongoing symptoms from an illness they experienced years prior. In Traditional Chinese Medicine (TCM), this syndrome is termed “Gu zheng,” and though it directly translates as “possession syndrome,” a better translation now is “lingering pathogen syndrome.”

There are several examples of lingering pathogens, including Lyme disease, malaria, candidiasis, human papillomavirus (HPV), shingles, herpes, and human immunodeficiency virus (HIV), but there are many more that don’t have names, leaving patients with unexplained symptoms and undiagnosed diseases that leave them exhausted and frustrated. Some of these lingering pathogens can trigger autoimmune and chronic inflammatory diseases like rheumatoid arthritis, Crohn’s disease, Sjogren’s syndrome, lupus, and Hashimoto’s thyroiditis. Gu syndrome may be at the root of many problems we see in clinic today.

More recently, amid the novel coronavirus (COVID-19) pandemic, there are a growing number of “long COVID-19” patients struggling with fatigue, shortness of breath, body aches, headaches, difficulty concentrating, and problems sleeping. They may have recovered from the initial infection and no longer have detectable virus in their bodies, but months later, they still don’t feel better.

There are two main types of Gu syndrome, digestive Gu and brain Gu. Pronounced “goo,” this syndrome seems aptly named, as it can be difficult to remove. Digestive Gu symptoms include bloating, gas, constipation, diarrhea, and digestive malaise, causing the patient to feel like their digestive system is “gunked up.” It might be diagnosed as leaky gut syndrome, candida overgrowth, intestinal parasites, irritable bowel syndrome, or an inflammatory bowel disease. Brain Gu can cause foggy-headedness, problems with focus and concentration, poor memory, mood disorders, chronic pain, and hypersensitivity.

This isn’t to say that everyone with these diseases or symptoms has Gu syndrome, but it is worth investigating, particularly if they’ve already tried usual therapies and changes in diet and lifestyle without success. The challenge is that because the range of pathogens is so massively diverse, there is no definitive diagnostic tool that can consistently test for Gu syndrome, so assessment and treatment plans are largely made based on the symptoms and detailed current and past medical history.

For some patients, there may be no specific, distinctive incident, but it may have been precipitated by a lowering of the body’s immune defenses. While acute infection, a bug or animal bite, food poisoning, or travel to another country may be to blame, stress, exposure to pollutants or other toxins, poor sleep, and overuse of antibiotics can all weaken the initial immune response.

Since there is such an array of potential pathogens and related symptoms, the treatments also vary. Fortunately, TCM uses combinations of herbs, chosen to best suit the individual, and there are some general principles to follow when addressing Gu syndrome.

There are many antiviral, antibacterial, antifungal, and antiparasitic herbs that help kill pathogens and drive them out of the body. Most of these herbs are classified in TCM’s materia medica under the various categories that clear Heat, addressing symptoms associated with inflammation, abnormal sweating, red rashes, restlessness, irritability, dryness or irritation of respiratory or digestive tracts, and low-level or afternoon fever. Herbs like lian qiao, jin yin huan, chai hu, sheng ma, zi su ye, huo xiang, bai dou kou, and bai zhi are used for this purpose. Qing hao (sweet wormwood), for example, has been found to be as effective as quinine in treating malaria, and it is categorized in TCM under “herbs that clear Heat from Deficiency.”

At the same time, we often need to tonify Qi and Blood, as people with Gu syndrome usually have a weakened immune system as a starting point for the allowance of the pathogen to remain, even if the immune system later overreacts with autoimmune attacks. It’s important to make sure to choose herbs that don’t also strengthen the pathogen. Dang gui, chuan xiong, san qi, huang qi, gan cao, and bai shao are examples of herbs here. Additionally, the patient may need herbs to calm the nervous system, promote urinary flow and bowel elimination, promote Lung function, and break up the pathogen’s biofilm.

According to Qing Dynasty Daoist healer, Master Ranxi, “Gu toxins that have entered the core of a person’s being can be compared to oil seeping into flour—it is everywhere and cannot be separated out.”

This shows how challenging it can be to treat, but with careful assessment, appropriate treatment that is modified regularly to prevent the pathogen from adapting to the therapy, and persistence, these are treatable conditions.

Case Study

Will is a 36-year-old male who, while visiting family, came to see me with idiopathic joint pain in early 2021. He had been diagnosed with inflammatory arthritis, and treated with oral steroids and cortisone injections, but hadn’t found relief.

The pain had started in his ankle in April 2020, but then hip pain began in November after a prolonged urinary tract infection, and hand pain began after cycling in cold, damp weather. Before the onset, he was training for a triathlon and was in excellent shape. By the end of 2020 he was barely able to walk a few blocks without extreme pain. He said his hands felt stiff, and he had occasional shooting pains in his hands and feet. His bloodwork, ultrasound, CT scans, and x-rays showed only some mild peroneal tendon sheath tenosynovitis. He was also extremely fatigued, had restless sleep, and was feeling anxious.

I asked if he had been sick around the time this all started. Interestingly, in April, Will had had a bit of a cough, and a couple of weeks later the ankle pain started. He said he suspected that he had had COVID-19 because one of his roommates, who works in a hospital, had tested positive for antibodies in May, and though she hadn’t felt sick, had lost her sense of taste and smell in April.

Will was only able to receive a couple of acupuncture sessions because he needed to return to the United Kingdom for work, but I was able to prescribe a modified Chai Hu Gui Zhi Tang to address the lingering pathogen component and Zhu Feng Tou Gu Wan to address his joint pain. I also advised that he take proteolytic enzymes like bromelain, trypsin, and serrapeptidase on an empty stomach for their anti-inflammatory and immunomodulatory effects.

As chronic inflammation and autoimmune conditions are more common, healthcare practitioners need to consider whether lingering pathogens are at the root, especially as we are now likely to see more long COVID-19 patients. TCM offers a long-standing treatment approach, with both acupuncture and herbs to provide both relief of symptoms and resolve of the cause.

References

Carfi, A., Bernabei, R., Landi, F. (2020) Persistent Symptoms in Patients After Acute COVID-19. Journal of the American Medicine Association. Retrieved from: https://pubmed.ncbi.nlm.nih.gov/32644129/

McIntosh HM, Olliaro P. (2000). Artemisinin derivatives for treating severe malaria. Cochrane Database Systemic Review. Retrieved from: https://pubmed.ncbi.nlm.nih.gov/10796551/

McIntosh HM, Olliaro P. Artemisinin derivatives for treating uncomplicated malaria. Cochrane Database Systemic Review. Retrieved from: https://pubmed.ncbi.nlm.nih.gov/10796519/

Parisi, S., Borrelli, R. (2020) Viral Arthritis and COVID-19. The Lancet Rheumatology. Retrieved from: https://www.thelancet.com/journals/lanrhe/article/PIIS2665-9913(20)30348-9/fulltext

Ramani, S. Samet, J. (2021) Musculoskeletal involvement of COVID-19: review of imaging. Skeletal Radiology. Retrieved from: https://link.springer.com/epdf/10.1007/s00256-021-03734-7