gu sindrome

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an in-depth interview with heiner fruehauf

GU syndromein the autumn of 2008 heiner fruehauf, ph.d., l.ac., sat down with two of his students,erin moreland, l.ac., and bob quinn, daom, l.ac., to discuss the ner points of gu syndrometreatment. this discussion is best understood as a follow-up to and elaboration of the

ideas presented in heiner’s earlier article on gu syndrome published in the 1998 mayissue of The Journal of Chinese Medicine.

Quinn: Heiner, rst of all thanks for making time for the interview. We want to discuss clinical treatmentstrategies for Gu syndrome, but before we get into the specics, for the sake of the people who did not read yourarticle in The Journal of Chinese Medicine on Gu syndrome, could you quickly go over what Gu syndrome is andhow you got started on the research?

Heiner Fruehauf: Certainly. The phenomenon of Gu syndrome is for me a prime example of the clinical powerthat classical Chinese medicine carries, in a eld where we have thrown out so much and where the recordhas been truncated for the sake of standardization. My own discovery of Gu syndrome came when there wasa certain number of cases that I was not making sufcient progress with clinically, particularly with people Ibelieved had parasites. I nally took literally a two-week time out and just immersed myself in ancient texts.From my reading of the modern literature there were very few cases with chronic parasites recorded—sure, therewere some cases of acute amoebic dysentery, but I felt that in a country like China it shouldn’t be any differentfrom Nepal or India, where I knew that parasites have been a part of the clinical landscape for hundreds of

years. When I looked at the classical textual record, it was a different story. I found chronic parasitism reectedin a huge area of classical Chinese medicine that was called Gu zheng, or Gu syndrome, which essentially means“Possession Syndrome”. Gu is a character that is very old, perhaps one of the oldest characters in the Chinesetextual record altogether, since it is a hexagram in the Yijing. It is literally the image of three worms in a vessel.This to me is one of those strokes of brilliance that you nd in the symbolism of the ancient Chinese—thatthey recognized 3000 years ago that chronic parasitism can cause psychotic or psychological symptoms. Because


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gu syndrome: an in-depth interview with heiner fruehauf

classicalchinesemedicine.org © 2009 Heiner Fruehauf, Ph.D. 3classicalpearls.org

University, where a very valuable project called theContemplative Studies Initiative is spearheaded bymy friend and colleague Prof. Harold Roth. He is arespected scholar of Daoist religion and cosmologicaltexts. In a nutshell, he has been ceaselessly workingto debunk the 19th century perspective of theimperialist explorer who goes to Egypt, China, Japanor other places to research exotic cultures and theirmedicines, assuming the aloof perspective of “lookat how quaint these tribal barbarians are, and howarchaic and unsophisticated their knowledge is.” AsHal Roth has shown, this basic attitude still runs deepin contemporary academic circles. If, as a reputableacademic, you set out to actually practice one of thesemethods, it would be the death of your professional

career in most cases. The science of Chinese medicineclearly shows that ancient medical wisdom can bemore than a fascinating study subject, by offeringclinical approaches that still work in a very palpablemanner today. Fittingly, the academic engagementwith our eld is split in half. On one side, we havethe sinologists working with the primary literature toilluminate the record, but most of these people wouldnever want to be caught dead promoting the actualuse of these healing methods; and on the other sidewe have practitioners who work hands-on with themedicine but know very little about its history. Welive in the 21st century, and it is anachronistic for usto believe in the clinical power of Chinese medicineon the one hand, but root ourselves in the work ofscholars who still promote a 19th century imperialistmindset on the other. With the ContemplativeStudies Initiative, which encourages scholars toactually practice the disciplines they study, we havea good example of a unied approach in the eldsof religion and anthropology, so why not embracethis open-minded method in Chinese medicine? Ivery much believe that it behooves practitioners ofChinese medicine to embrace foundational conceptsthat have always been a part of our science. Theproblem, really, are not the demons, but the properunderstanding what a “demon” is. No need to betriggered into some kind of panic that we are goingback to a medicine that was practiced in 500 BC.

Looking at the ancient character for Gu , we cansee that the ancient Chinese suspected that a goodnumber of psychotic (“possession”) episodes arecaused by parasites (“demons”)—a very scientic wayof looking at the body, indeed. We lose out clinicallyif we get scared off by the term “demon” or “ghost”in a way that triggers the paranoia inherent in ourown “religion”—which is scientic materialismin the West, or Marxist materialism in the People’sRepublic of China. When I use the term scienticmaterialism here, I mean not true science in the senseof open-minded inquiry, but rather a sort of knee-jerk dogmatism.

To answer your question more directly, I would say

this: I’m a scholar, which means that I’m trying tounderstand Chinese medicine as a science in its ownright. I’m very much against making things up, orprojecting my own desires for the future path of thismedicine. In the context of Gu Syndrome, it is simplya fact that the classical record of Chinese medicine hasbeen extremely truncated for ideological reasons, andpart of that was done for the purpose of education. Ifyou were trying to educate illiterate peasants in a two-week workshop conducted in rural China during the1950s, complicated concepts and regimen didn’t seempractical at the time. Another point to be made is thatthe reemergence of Gu syndrome, and me writingabout it, and the interest it has stirred—both for andagainst—is evidence of the maturing of the eld. Inthe beginning when people didn’t know much aboutChinese medicine, a concept like this would have notevoked any kind of reaction. Now we have peoplein the eld who read Chinese, who actively immersethemselves in Chinese culture, and bring with them anew level of maturity. We have sixty accredited schoolsin the country, we have doctoral programs now—theeld itself is clearly maturing, and with that comes

a greater depth and complexity. As time passes, wewill be confronted with more pieces of informationthat we have never heard of before. In my view, itis good for our eld to have an increase in the scopeand containment of what our profession can stomach.The “archeological discovery” of Gu syndrome is


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thus timely in every sense of the word—it has comeat a time when we can actually do something withthat discovery, because there is both the intellectualcapacity and clinical experience needed to processthe information. There are now lots of practitionerswho immediately recognize the value of Gu therapy,because everybody has cases where little headway ismade with the regular TCM approach.

Q: And Gu is mentioned in various classical texts?

HF: Gu syndrome has not just been mentionedin a single classic, but every notable book by everymaster in the past generally featured a chapter on Gu syndrome, because it was such a major part of what

a Chinese doctor practicing anywhere between 500BC and the 1940’s was facing. We should add herethat Gu is not an anthropological phenomenon, abizarre disease in the swamps of ancient China thatdoes not exist anymore. Quite the contrary–due tothe decreased immunity in modern people, becauseof the way we eat and the way we move our bodies,and the way many of us were given antibiotics askids, the average modern city dweller is actuallymuch more susceptible to parasitic organisms thanChinese villagers in the past. The clinical concept ofGu , therefore, is actually more useful now than it’sbeen in the past. According to my own experience,it is a most prominent disease. In my own clinic, forinstance, about a quarter of patients are treated forthe chronic inammatory syndrome that I believethe ancient Chinese called Gu syndrome—whetherit is travelers’ diseases like malaria and Denguefever, or whether it is chronic recognized virusessuch as AIDS or herpes. When the associatedanxiety and depression and physical symptomsthat come with Gu are brought into the calculus,you have covered a good many patients. And wecan’t leave out the complicated digestive disordersassociated with chronic blastocystis hominis, giardiaor other protozoan organisms. It is perfectly safeand reasonable to treat all these patients using theGu approach outlined in my article, particularly ifyou fail to make headway with other methods. In

other words: If you encounter a patient with bizarresymptoms that puzzle the doctors and don’t t TCMregular categories, go with Gu syndrome.

Q: Would you say that you would always nd at leasta history of parasitic infection, even if the patientcurrently tests negative for parasites on biomedicaltests?

HF: At the bottom of Gu syndrome, and we see thisin the symbol as I described earlier, is always a kindof pathogen. A worm is more easily discovered, butvery often it is the small things that are most potentand remain hidden in the dark. Remember that theChinese called this a yin (dark/hidden) pathogen.

Lyme disease is a good example; the spirochetalpathogen is very elusive and so small that it is hardto discover with modern methods of diagnosis. I havea lot of patients where their case history makes thema shoe-in—they’ve been to Nepal, or India, or LatinAmerica; they had amoebic dysentery; they tookFlagyl and since that time their health has never beengood. That kind of case is as clear as it can get, but thereare lots of people who never left the country, and theycan’t remember any kind of initial infection, but all ofa sudden they’ve become chronically fatigued or havebeen diagnosed with bromyalgia. Their doctors putthem on Prozac because they don’t know what elseto do, when actually they’ve likely picked up someparasite in a restaurant or had a tick bite that theynever knew about. This category of parasites includesthe widest possible range, including viruses such asherpes or the Coxsackie virus, chronic systemic yeast,and so on.

Q: One curious thing in your original article whenyou talk about the treatment strategy is to seefamiliar herbs used in unfamiliar ways. I’m thinkingparticularly of the exterior releasing, highly aromaticherbs often. Can you talk about the nuts and bolts alittle bit of what a Gu formula looks like? I think yougo through six or seven categories of herbs that youhave teased out in your studies.


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HF: What makes a Gu prescription so different froma regular TCM formula is that the regular TCMapproach is tied to an either-or, black-and-whiterecognition of the eight parameters. Is it internal orexternal, is it hot or is it cold? The Gu approach isan extreme intermingling of approaches that youwould nd contradictory in the strategies we learnedin school. First and foremost is the combination ofexternal herbs—herbsthat are generallylearned in the contextof a surface-resolvingcategory—with herbsthat are entirely usedfor the interior, entering

either the blood layeror the qi layer. Thechoice of internal herbsmakes sense, because these people have been ill fora long time and thus need to be treated internally.Very often, however, they report that their mainsymptom is a u-like feeling all the time. They havean aversion to wind, they feel like they’ve had a 24/7u for years. Therefore, the simultaneous use of windherbs makes sense as well. The rst and perhaps mostimportant category of the Gu approach, and I thinkthis is brilliantly devised, is what has been called“release the surface with herbs that kill the snakes.”This rst category primarily includes the three herbsbaizhi , zisu, and bohe, but in an extended sense canalso include jinyinhua, lianqiao, chaihu, and gaoben.In a Gu formula you usually have 2-3 herbs from thiscategory, otherwise it wouldn’t qualify as a true Gu formula. All the other categories are internal categories thatfor the most part are tonic. The ancient Chineserecognized that this kind of patient presents with a

general exhaustion of yang and qi and blood, becausethe process of chronic inammation takes its tollon these reserves. At the same time the creators ofGu remedies knew that traditional tonics, ginseng especially, can also tonify the pathogen behind theinammation. In all of these categories, we therefore

nd a careful selection of herbs that are tonic andanti-parasitic at the same time. It truly is a brilliantand meticulous approach. The rst of these internal categories is qi tonication,and the two lead herbs here are gancao, which mustalways be raw gancao, not zhi gancao, otherwise itsanti-toxin-resolving, anti-parasite properties will not

be there; and secondly huangqi , which in thetraditional record hasbeen described not onlyas a surface-fortifyingherb but also as anherb for furuncles and

carbuncles. It denitelyhas some anti-toxinproperties along with

its qi-lifting properties. Another herb that I like toinclude in this category is wujiapi , which is particularlyuseful for a type of Gu that I call “Brain Gu”. BrainGu is a sort of nervous system inammation. MostLyme disease patients are diagnosed with Brain Gu in my clinic. Wujiapi is particularly useful when themain symptom is body pain. The next category are herbs that exhibit blood tonicand anti-parasitic properties. The main materialsin this category are danggui and chuanxiong, and onoccasion baishao may be used. As you mentionedalready in your question, one of the ways theseanti-parasitic herbs work is that most of them arearomatic; they are basically fumigants. Constantherbal fumigation makes the system uninhabitablefor any kind of pathogen. We can look at most ofthese herbs as a sort of internal incense. Incense istraditionally used for spiritual cultivation, to keep thehermit cave-dweller safe from mosquitoes and otherpathogens that disturb the meditative process, andalso to open the so-called orice of the heart. Thatis where the mental disturbance comes from in thesepeople—the orice of the heart is obscured, and thesefragrant substances can help to open it up.

When people say their nervesare fried, it is really the yinof the Lung that has beencompromised. When this

happens people become jittery.


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The next category is yin tonics, which I ndparticularly important for people suffering fromthe “Brain Gu” type of syndrome. I look at yintonics, particularly the yin of the Lung, as a kindof protective sheathing around the nerves. Whenpeople say their nerves are fried, it is really the yinof the Lung that has been compromised. When thishappens people become jittery. The leading herb hereis baihe, which has been brilliantly discussed as ananti-parasitic, anti-anxiety, and anti-depressive agentby Zhang Zhongjing in his JinGui yaolüe , where hehad a whole chapter devoted to Baihe Bing, or “LilyDisease”. Lily Disease is essentially a type of mentalimbalance caused by a yin deciency of the Lung,and the treatment was basically to prescribe baihe,

sometimes in combination with other yin tonic herbs.Next in this category is huangjing , a Daoist herb oftenused by hermits in the countryside in southern andsouthwest China to ward off parasites and to calmthe nervous system. The third one in this category,also a Lung yin tonic and anti-parasitic, is beishashen.Another one is heshouwu, a common tonic that hasalso anti-parasitic properties. The only caveat with heshouwu is that in its unprocessed state—which iswhat we want to use—it has mild laxative properties.Therefore, you want to use it only for people who areconstipated; you can choose huangjing instead forpeople who are more on the diarrhea side. In the next category are herbs that are primaryanti-parasitics and have been recognized as such inthe traditional materia medica. There is kushen and shechuangzi for parasites in the intestinal and urinarytracts. Other herbs in this category are qinghao,excellent for parasitic afictions in either the digestivetract or the nervous system. This is why qinghao hasbecome so famous as an herb for malaria, which is atypical brain Gu afiction. Xuanshen and tufuling areparticularly good for brain Gu and anti-spirochetaleffect; xuduan is anti-spirochetal; baitouweng isprimarily just for the digestive type of Gu ; shichangpu is excellent for both types of Gu syndrome, digestiveand brain. It is not only anti-parasitic, but also anherb that’s particularly famous for opening up the

orice to the brain and the Heart. This opening andawakening effect is so important in the treatment ofGu .

Q: Heiner, you have just mentioned two types ofGu patients, a Brain Gu patient and a DigestiveGu patient. Can you take a moment to clearlydifferentiate them by discussing common symptoms?

HF: Yes, the two big Gu types: Brain Gu andDigestive Gu . People who have chronic digestivesystem symptoms are referred to as digestive Gu .In the mildest case this will be bloating, gas, strangebowel movements like alternating diarrhea andconstipation, or strangely shaped bowel movements.

Along with these symptoms one will usually ndchronic lethargy. A certain amount of brain fogginessor psychological symptoms like bad dreams can gowith Digestive Gu as well.

Brain Gu syndrome is basically caused by chronicviruses that target the nervous system (suchas coxsackie, herpes, and in some cases HIV),or spirochetes (especially Lyme disease and itscoinfections), or other exotic pathogens causingchronic forms of meningitis, malaria, leptospirosis,etc. A lot of patients in this category are diagnosed withbromyalgia these days. There may be symptoms ofbody pain, anxiety, depression, headaches, eye aches,visual hallucinations, strange sensations that there issomething stuck in their head, etc. Very often thesepeople have been put on Prozac or some other kindof anti-depressant, which often doesn’t work. Theymight exhibit some digestive symptoms as well, andvery often Brain Gu and Digestive Gu go together.The approach is similar in many ways, but there arecertain herbs that are more specic to spirochetes andviruses, and some herbs that are more specic forworms and protozoan parasites.

Q: In your experience do musculoskeletal issuestypically accompany Brain Gu?


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HF: Yes, musculoskeletal issues are typical signsof Brain Gu . Digestive bloating, pain, and alteredbowel movements are the primary signs of DigestiveGu . But both of them will have a certain degree ofmental symptoms, therefore the “demonic possession”label—the Digestive Gu less, and the Brain Gu more.

Q: What if there is anactual worm?

HF: There is a wholecategory of anthelminticherbs that specicallyhave an anti-wormeffect, including shijunzi,

binglang , and guanzhong.Guanzhong , by the way,is also an excellent herb for chronic viruses, muchbetter than the over-used banlangen . For me, it’seffect is very much like qinghao, without the moreobvious shaoyang afnity of qinghao. The differenceof worm afiction is that worms will often be expelledrather quickly, while spirochetes, viruses, protozoanparasites and microplasma need to be treated for along time. This brings up a key difference betweenthe Western and traditional Chinese approachesworking with parasites. It says clearly in the classicaltexts that the nature of Gu syndrome can be comparedto oil seeping into our. This is much different from apearl falling into our—with a pearl you can just taketweezers and remove it, which is the idea behind theWestern antibiotic approach. You blast somebody fora week with those, and theoretically the pathogen is allgone. Similarly, the regular TCM approach is whereyou prescribe strong heat clearing herbs for amoebicdysentery and expect that it is all cleared up in oneweek. Gu is not like that. It is the oil that has gotteninto the our, and now has virtually become one withthe our, and is thus hard to get back out. Even inthe best case scenario this is a long process—the Gu manuals speak of a minimum of six months and amaximum of three to ve years. This is denitely myown experience, as well. In sum, the only way you canget rid of this problem is by avoiding the customary

herbal approach of blasting the system with stronganti-parasitic herbs that are not tonic to the systemand are hard to digest. Those will generally make thepatient feel good for a week, but then s/he will notbe able to stomach them afterwards. The brillianceof the Gu approach, once again, is that every singleherb in the prescription is anti-pathogenic and tonic

at the same time, and thussuitable for long-termtreatment. Rememberthat this kind of patientwill always need long-term treatment.

Moving forward to the

next category: the ancientChinese apparentlyrealized what we only know now, via the scienceof modern parasitology—parasites have the innateability to camouage and shield themselves with acertain kind of armor that is often called a biolm.Traditional heat-clearing and anti-toxin herbs arenot able to get rid of many of these parasites becausethey cannot penetrate the biolm. It is therefore veryimportant to include this category of blood movingherbs, containing yujin, sanleng, ezhu, muxiang, zelan and chenpi. These are all herbs that have a directeffect on the symptom of bloating, but that also haveingredients in them that are able to crack that ancientbarrier. Together with these fragrant and bloodmoving substances, the other anti-parasitic and anti-toxin herbs can then change the cozy environment ofthe parasite, and over time convince it to evacuate.

The last category features herbs that are both stronglyaromatic and anti-parasitic. The main herb here isclove, dingxiang. Other herbs in this category includepurple single-clove garlic, and hezi, and huajiao ,which all have additional anti-parasitic propertiesthat are different from the detoxifying ones that wediscussed before. Most likely, they have an effect oncertain egg or larva stages of parasites that the otherones can’t touch.

[Gu] is the oil that has gotteninto the our, and now has

virtually become one with the our, and is thus hard to get

back out.


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Altogether, we have ve or six different herbalcategories that are working together in a highlyintegrated fashion, making them suitable for long-term use and clinically very effective. Even thoughthe treatment will take a long time, patients usuallyfeel a positive difference within six to twelve weeksafter the treatment has begun, sometimes even rightaway.

Q: Can we talk about dosage?

HF: In the Chinese record, Gu syndrome oftenreferred to severe and life-threatening infectiousdisease, such as schistosomiasis. Patients weretherefore often prescribed formulas that included

150 to 300 grams of crude herbs in decoction perday. Nowadays, whether you end up using your owncrude herbs or granules, or Thunder and LightningPearls—which are patent formulas I’ve createdfor the purpose of helping practitioners treat Gu patients—the daily amounts can be considerably lessthan that, such as 50-120g of crude herbs, or 10-25gof herbal granules, or the capsule equivalent thereof.

Since we are dealing with a living pathogen that hasthe ability to adapt, I recommend a regular changein the details of the prescription. It is best to changea Gu prescription regimen, at least somewhat, everysix weeks. The classical record already points thisout, by warning about the ability of Gu pathogens toadapt, and suggesting to always stay a step ahead bymaking changes to your herbal approach. Changingthe formula means that you leave the six categoriesintact—those categories never change, they are inevery Gu formula—but of the two or three herbs in aparticular category you always rotate at least one outand put a new one from the same category in. In thisway, the general arrow of the therapeutic approachnever changes, but you change the herbs within it.Your knowledge of plant qualities should of courseplay a role in the selection of what gets rotated inand what gets rotated out. In the rst category, forinstance, you have a choice between the more cooling jinyinhua (lonicera) lianqiao (forsythia) approach, and

the more warming baizhi (angelica) and zisu (perilla)approach. Q: When you use your own products, the Thunderand Lightning Pearls, how do you dose them?

HF: Lightning Pearls is the standard formula forBrain Gu , and Thunder Pearls is the main formulafor Digestive Gu . During the rst 6 weeks oftreatment for Brain Gu , I generally recommend to useLightning Pearls at a dose of 3-6 capsules 2-3 times aday—amounting to a minimum of 6 capsules and amaximum of 18 capsules a day. Then I generally havepatients take a week-long break from the LightningPearls, during which time Thunder Pearls are used as

an alternating remedy in similar amounts. After that,it is back to the Lightning Pearls, or a combinationof Lightning Pearls and one of the formulas inthe aconite remedy series that help with staminarebuilding and the relief of specic symptoms.

The herbs in our capsules are 10:1 extracts, meaningit takes ten grams of dried raw herb material to makejust one gram of our extracts. One capsule contains0.5g of herbal extract, which is equivalent to 1gof granules or 5g of crude herbs. So they are quiteconcentrated. If you open one capsule and taste ityou will see how effectively the factory preserves thearomatic plant constituents.

Q: Can practitioners give your formula and a granuleformula of their own on top of that?

HF: Yes, of course. We do that in our clinic all thetime, prescribing 6 capsules of Thunder or LightningPearls in the morning, and 6-10g of a custom-madegranular formula in the afternoon. But the customformula still needs to follow the principles of Gu

prescribing, and be changed every six weeks or so.Q: Any particular challenges to prescribing for theseGu patients that we have not already addressed in ourquestions?


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HF: Often these type of patients have many symptomsbecause they tend to be allergic. Both the Brain Gu type as well as the Digestive Gu type can exhibit manyauto-immune symptoms, including food allergies,and often react extremely sensitively to stimuli intheir environment. It is important, therefore, thatyou work your way up to the target amount slowly.These patients canreact poorly to herbs,even if it is the rightformula, if you doseinitially too high. It isbetter to start on thelow end and work yourway up to the medium

or high range.

Also, I nd it veryimportant to mentionthat while chronicinammatory patients seem to manifest a lot of heatsymptoms, seem very inamed, seem over-reactive,have damp tongue coatings—even yellowish tonguecoatings—underneath all that surface heat they tend tobe yang decient. You can verify this best in the pulse.The more inamed someone is, the more energy islost over time. So, depending on their degree of yangdeciency, you have to give them serious yang tonicssuch as Sini Tang along with the Gu herbs, either rightaway in very cold patients, or after six months whenthe body is asking to switch to recharge mode in mostpatients. This is the only effective way to containand gradually repair the trauma in their immunesystem. Fuzi (aconite) is not used here to achievean enhanced damp drying effect, but to implementthe master approach I learned from the Fire SpiritSchool (huoshen pai) of Sichuan herbalism. In theteachings of the 19th century physician Zheng Qin’anand the Lu family lineage, Sini Tang is considered tobe the main way of containing an overactive immunesystem, where the body’s yang energy is hovering atthe surface rather than being properly stored in thebattery of the Kidney. In this situation, you need to

pair the Lightning or Thunder Pearl approach withthe likes of Vitality Pearls, a formula that containsSini Tang and Fuzi Lizhong Tang in a balanced formappropriate for sensitive Gu patients.

Q: I know your ideas on aconite differ from what iscommonly taught in TCM schools, or also in Japanese

Kampo, for that matter.Can you go into thata bit even though it isa bit off topic of Gu syndrome? As youhave just explained itnecessarily comes intothe picture with certain

Gu patients.

HF: Aconite was oncecalled the “King ofthe 100 Herbs” for its

superior effect in the treatment of severe and chronicdiseases. Nowadays, we are all hesitant to use it,because its results are often unreliable and sometimesallergenic in nature. This is not because of the toxicityof aconite itself, but because of improper processingshortcuts in the herb industry since the 1960s, oftenusing chemicals such as bleach to detoxify thisherb. It is sad to know how far modern processingtechniques have departed from the traditional scienceof herb preparation in this case. That is why I havebeen eager to be in touch with local peasants in theonly area in China where genuine medicinal-gradeaconite comes from. I am very interested in restoringtraditional processing techniques and to restore thefull clinical power and safety of this herb. I am happyto announce here that we now have fuzi powderedextracts that people can purchase and use in theirgranule dispensaries. These can be ordered fromClassical Pearls as an 8:1 extract where there is nostarch carrier at all. We also have a 5:1 powderedextract that matches the strength of granules. Thatone has a small amount of starch carrier derived fromthe herb shanyao.

...Sini Tang is considered tobe the main way of containingan overactive immune system,where the body’s yang energy is

hovering at the surface ratherthan being properly stored inthe battery of the Kidney.


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Q: Exactly what sets this aconite apart from othermaterials available today?

HF: Aconite should be planted at the winter solsticeand harvested at the summer solstice, so that it isgrowing only during the time of year when yangis in its ascendancy. This is the case with our fuzi.Traditionally, the best fuzi comes only from one smallarea in Sichuan province. This is where we growand process it in accordance with the labor-intensivemethods prescribed in traditional paozhi manuals.

Q: And is this top-of-the-line aconite in any of yourClassical Pearls formulas?

HF: This aconite has gone into all of our aconiteremedies, six of them so far. All of them are inspiredby the Fire Spirit School’s approach of treating apatient’s constitutional core. For the specic purposeof addressing the yang deciency needs of Gu patients,I’ve also produced a remedy called Vitality Pearls.Other aconite remedies can be used as well, such asPeace Pearls for pronounced symptoms of anxiety/ insomnia, or Guanyin Pearls for menopause, but itwas the Vitality Pearls that were specically designedfor the second and third stage of Gu treatment. Forespecially yang decient patients, they can evenbe used during the rst stage of Gu therapy, whengenerally only Thunder and Lightning Pearls areprescribed. For the average Gu patient you may haveto wait some time before the Vitality Pearls would beappropriate. However, remember that no matter howmuch heat a person exhibits initially when they cometo your clinic, they will eventually need this type ofSini Tang-based treatment. I should clarify: WhenI say Sini Tang I also mean to include other aconiteformulas like Fuzi Lizhong Tang and Qianyang Dan .Vitality Pearls is based on Fuzi Lizhong Tang .

Q: What is the focus when you have taken a personthrough a few years of this Gu treatment and thechronic parasites are no longer a problem? Whatneeds to happen then?

HF: When there are no more signs of inammatorypathogens and the person has no more wind symptoms,and they are just burned out from the ordeal, thenit is time to exclusively switch to the Vitality Pearlapproach, or some other aconite remedy that containssoothing and partially anti-parasitic herbs like baihe.We would do this typically for another year or two.

Q: I know you use a type of testing with anelectrodermal device to see if herbs are appropriatefor patients. Can you talk about that a bit?

HF: Due to the sensitivity that these patients veryoften have, I encourage practitioners to test every herb

in every category for Gu patients before prescribingthem, whether it is with muscle testing, electrodermalscreening, or another diagnostic modality thatdirectly registers patient responses. The more specicyou can be about which one of these herbs is the rightone right now, the better. The process of choosingwhich herb in a category is needed can be quiteunpredictable at times. I nd that the more precisethe use of these herbs, the fewer chances there are foradverse reactions in your patients.

Q: One last thing to touch on. These patients oftenare difcult to work with because of the verysymptoms you’ve described. Any tips about how towork with people when you’re going to have to seethem for maybe three years. By the time they getto you they’ve suffered quite a bit already and theywant understandably a quick turnaround. Have youdeveloped any insights on how to best prepare themfor a longer-term treatment?

HF: You denitely need to educate this type of patientby getting them mentally prepared. Whether they’vebeen in it for a long time already or whether they’rejust getting started with this treatment, they aregoing to need treatment for a while. And again, thatmeans six months minimum for the person who justcame back from Nicaragua and contracted dysenteryfor example, treated it with Flagyl, and now three


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months later discovers that the symptoms are comingback—fatigue and strange bowel movements andso on. That would be the 22-year-old Peace Corpsparticipant who started out with a strong constitutionbefore his ordeal—he is going to be in it for sixmonths. Whereas somebody in their 50’s who looksdecient to you on all levels and has contracted manydifferent viruses in their lifetime, followed by this lastjourney to Nepal, or this last tick bite that was thehair that broke the camel’s back—this person is in itfor the three to ve year course.

Hopefully, there are two things that will happen. First,there is the prospect of achieving some immediatesymptom relief, which will gain you more of the

patient’s trust. Secondly, just the fact that you seemto know what it is that they’re suffering from will bea tremendous relief to this kind of patient, who hasbeen handed from practitioner to practitioner, and inthe worst-case scenario has been declared mentally illby the western medicine community. This person willfeel tremendous relief that you know what’s going onwith them, that you can contain their suffering, thatthey have something to point to that tells them thatthis is not their fault and they’re not imagining it, butthat this is a real phenomenon.

Q: Isn’t it possible the patient hits a plateau at somepoint in the treatment and starts to lose faith in thisstrategy?

HF: As for clinical progress, there are two differentkinds of scenario. One is when the patient gets betterright away and is grateful, but even this patientwill reach a place where they feel they’ve reached aplateau. They may have recovered enough to go backto work, but then they burn out like everybody elseand wonder why nothing is working anymore. Atthis point you need to remind them that the reasonthey’re back to work in the rst place is because thetreatment has been working, and that they need torest more rather than immediately using the newlygained energy to work excessively.

The more difcult scenario is when there are noobvious signs of progress—this usually happens withpatients who take steroids, or benzodiazepines, orantibiotics, or other strong acting natural productssimultaneously. This may have to do with theautoimmune aspect triggered by this disease. Inpeople with Brain Gu and chronic skin diseases, forexample, everything is chronically inamed. In thesecases the body often produces strong autoimmunereactions. These cannot be soothed quickly, and itwill take some time to see marked improvements.In these cases you should talk to the patient aboutsome of your previous (and eventually successful)case histories, and emphasize the Gu concept of “oilseeping into our,” which means that you are dealing

with something that’s become part of the body andcan’t be so easily removed. It is important to checklifestyle habits for this type of patient, so that they’renot maintaining poor food habits in particular. Ifthey keep eating a lot of carbohydrates and sweetsthat make the body acidic, you’ll never get rid of themilieu that hidden pathogens like. Containment,listening and empathy are all very important for thistype of patient.

Q: Heiner, thank you for your time. I hope thisinterview will help those you who read it to developa better understanding of how to proceed in thetreatment of Gu cases.

HF: You’re welcome.

NOTES:

The Journal of Chinese Medicine article “Driving OutDemons and Snakes: Gu Syndrome, A ForgottenClinical Approach to Chronic Parasitism” byHeiner Fruehauf published in May of 1998 can beviewed from the Clinical Information section atclassicalchinesemedicine.org

To learn more about the Classical Pearls formula series, please visit classicalpearls.org.

© 2009 Heiner Fruehauf, Ph.D.

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