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Autism as Bai He Bing (百合病): A Chinese Medicine Perspective

Several months ago, I posted an article entitled, Autism as Shao Yang Disorder: A Chinese Medicine Perspectivein which I laid out a novel clinical approach to treating autism spectrum disorder (ASD) as a Shào Yáng (少阳) patternThat post inspired a fair bit of correspondence from other practitioners, so I thought it would be appropriate to follow-up with another classical disease (病) that might also be relevant to the treatment of ASD.

Autism Awareness ribbon

Before I begin, I’d like to clarify—as I always do with potentially “triggering” subjects—that I am NOT suggesting that Chinese medicine cures autism. I have witnessed both the lure of the “autism cure” that leads parents of autistic children/adults into a false sense of hope, and the subsequent disappointment when these therapies fail to meet expectations. In this article, I am offering a clinical theory rooted in the classics, and one that I hope will benefit your treatment of ASD. When treating autism with Chinese medicine, the goal should be the reduction of detrimental behaviors, the management of anxiety, and an increase in the quality of life for both the patients and their families. Ideally, Chinese medicine practitioners should try to work in tandem with the MD or specialist who handles the patient’s care from a biomedical perspective.


In early winter, I accepted a position teaching the Jīn Guì Yào Lüè (金匮要略)—a classic work on medical formulas from the second century CE—in the doctoral program at the Pacific College of Oriental Medicine. As I was preparing for a recent class, I was reminded of an obscure illness from that text called bǎihé bìng (百合病). Scholars have argued about the translation of bǎihé bìng, which either relates to Lilii Bulbus (the primary herb used to treat the disease), or a description of the syndrome (“Hundred Union Disease”). For the sake of brevity, I will avoid these semantic issues and leave the term untranslated.

Zhang Zhong-jing (Author of the Shang Han Lun and Jin Gui Yao Lue)

Here is the description of bǎihé bìng from the Jīn Guì Yào Lüè:

The classic says: bǎihé bìng, [the] hundred vessels [share] one ancestor, [so] all of them can cause disease. [The patient] desires food, but cannot eat; they are often quiet, and they desire to lie down, but cannot; they desire to walk, but are incapable of doing so; perhaps they desire food and drink at one time, but then the smell of food is offensive; they look like that are cold but without being cold, they look like they are hot without being hot; they have a bitter taste in the mouth; they have red urination; and no medicine can cure them. Even if the medicine causes intense vomiting, there is no benefit. They look like they are possessed by spirits or mischievous sprites, but the physical form seems harmonious; the pulse is faint and rapid. (Chapter 3, line 1)

As I began to contemplate this passage, my mind couldn’t help but zone in on the phrase, “they are often quiet.” Other (more experienced) translators have rendered this symptom as “frequent taciturnity” (Wiseman and Wilms, p. 69). The other statement that struck me was: “They look like they are possessed by spirits or mischievous sprites, but the physical form seems harmonious.” Having worked with individuals on both ends of the autism spectrum, I began to wonder if some forms of autism might be a type of bǎihé bìng. Interestingly, “bitter taste in the mouth” is a hallmark symptom of the Shào Yáng (少阳) stage disorders I described in the previous article on ASD, and “taciturnity” may manifest in certain Shào Yáng (少阳) stage disorders as well (Mitchell, Ye, & Wiseman, p. 410).

The treatment for bǎihé bìng is quite simple, and involves a decoction of only two herbs: the aforementioned bǎihé (Lilii Bulbus) and shēng dìhuáng (Rehmanniae Radix). Unfortunately, the original formula calls for the juice of shēng dìhuáng to be used, which is all but impossible to obtain. As such, my advice on dosages would be to follow the dosage ratio used in the research study below, or begin with the 2:1 ratio of shēng dìhuáng (生地黄) and bǎihé (百合) used in Bai He Gu Jin Tang and modify the dosages accordingly—up to 24g of bǎihé may be used (Bensky & Barolett, p. 161). Since the formula only involves two herbs, finding the proper dosage is crucial and may take several attempts, so it would be wise to inform the patient (or their family) ahead of time.

As I was preparing my lecture on bǎihé bìng for the students, I came across two additional pieces of information that support my theory. The first is from a book entitled, Understanding the Jin Gui Yao Lue, which states that: “this formula can be used in the treatment of a variety of neurological and mental disorders” (Sung, p. 74). The second was a recent study entitled, “Involvement of the Cerebral Monoamine Neurotransmitters System in Antidepressant-Like Effects of a Chinese Herbal Decoction, Baihe Dihuang Tang, in Mice Model” that was published in the journal Evidence-based Complementary and Alternative Medicine (Chen, et. al., 2012). This study concluded that “[Bai He Di Huang Tang] possess antidepressant-like effects…mediated, at least partially, via the central monoaminergic neurotransmitter system” (Chen, et. al., 2012). Since anti-depressant medications are often used in the treatment of ASD, this finding is significant. In fact, Temple Grandin, a professor at Colorado State University on the high functioning end of the autism spectrum, notes that: “My anxiety and panic attacks were 90% eliminated with a low dose of antidepressants” (TempleGrandin.com).

Taken as a whole, this modern research, and the description of bǎihé bìng from the Jīn Guì Yào Lüè, suggest that some forms of ASD may respond to treatment with Bai He Di Huang Tang—particularly in those patients who present with a faint and rapid pulse.


References

Chen, et. al. (2012) “Involvement of the Cerebral Monoamine Neurotransmitters System in Antidepressant-Like Effects of a Chinese Herbal Decoction, Baihe Dihuang Tang, in Mice ModelEvidence-based Complementary and Alternative Medicine.

“Frequently Asked Questions” (TempleGrandin.com)

Craig Mitchell, Feng Ye, and Nigel Wiseman, (1999). Shang Han Lun.

Sung Yuk-ming, (2010). Understanding the Jin Gui Yao Lue.

Nigel Wiseman and Sabine Wilms, (2000).  Jin Gui Yao Lue.




© Dr. Phil Garrison and Ancient Chinese Medical Theory, 2015. Unauthorized use and/or duplication of this material without express and written permission from this blog’s author and/or owner is strictly prohibited. Excerpts and links may be used, provided that full and clear credit is given to Dr. Phil Garrison and Ancient Chinese Medical Theory with appropriate and specific direction to the original content.

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Autism as a Shao Yang Disorder: A Chinese Medicine Perspective

Before, during, and after receiving my master’s degree in Chinese medicine, I worked with the special needs community. For a good portion of that 10 year period, I was an aide for young adults with Autism Spectrum Disorder (ASD). The experiences I had during that time were profound and life-changing. It is with great humility, and with the deepest respect for the autistic individuals with whom I came into contact, that I offer this post.

Before I begin, I’d like to clarify—as I always do with potentially “triggering” subjects—that I am NOT suggesting that Chinese medicine cures autism. I have witnessed both the lure of the “autism cure” that leads parents of autistic children/adults into a false sense of hope, and the subsequent disappointment when these therapies fail to meet expectations. In this article, I am offering a clinical theory rooted in the classics, and one that I hope will benefit your treatment of ASD. When treating autism with Chinese medicine, the goal should be the reduction of detrimental behaviors, the management of anxiety, and an increase in the quality of life for both the patients and their families. Ideally, Chinese medicine practitioners should try to work in tandem with the MD or specialist who handles the patient’s care from a biomedical perspective.

 

Autism: A Brief Synopsis
Information about autism can be gleaned from a variety of internet sources, so I’m only going to give a very brief synopsis here. Autism Spectrum Disorder (ASD) is: “a range of complex neurodevelopment disorders, characterized by social impairments, communication difficulties, and restricted, repetitive, and stereotyped patterns of behavior” (NINDS). As suggested by the moniker, autism exists on a spectrum, with a wide range of presentations. The majority of individuals I worked with were non-verbal, but on the other end of the spectrum, you have someone like Temple Grandin, who teaches at Colorado State University and writes best-selling books. Grandin describes autism as “a behavioral profile,” as opposed to a precise diagnosis (TempleGrandin.com).

Current Chinese Medicine Thinking
The perspective I will put forth in this article is novel—novel in the sense that I have yet to see a similar theory presented in an English-language Chinese medicine journal, lecture, or blog. As I mentioned before, autistic individuals occupy a wide spectrum, and each person is unique. As such, the range of symptoms and diagnoses (from a Chinese medicine point of view), varies from person to person. I am not offering a definitive Chinese medicine diagnosis for ASD, I am merely offering a diagnostic alternative to the standard TCM thinking, for practitioners who may not be satisfied with the typical ways of approaching autism in the clinic.

From a TCM perspective, there are many potential etiologies for Autism Spectrum Disorder. When I did a basic Google search for “Autism and Chinese Medicine, ” or “Autism and Acupuncture,” many of the same diagnoses popped up. The most popular etiology seems to be “Phlegm Misting the Mind.” That diagnosis may sound unusual—I’m sure the Quackwatch guy would have a field-day with it—but it basically means “clouded thinking” or “blunted affect.” There are two types of “phlegm” in Chinese medicine, “substantial” and “non-substantial” phlegm. A diagnosis of Phlegm Misting the Mind refers to the latter type. In other words, we don’t think there is literally phlegm in the brain! Treatment for this diagnosis primarily focuses on clearing phlegm and supplementing the Spleen, a TCM “organ” that creates phlegm when imbalanced. Again, for those who don’t know Chinese medicine theory, the “Spleen” referred to here is a holographic metaphor for a specific series of structures and processes in the body. [Note: I am using “holographic” in the same way that Michael Talbot uses the term in The Holographic Universe.]

Treatments for autism that I found on PubMed included: scalp acupuncture, tongue acupuncture, and electro-acupuncture. Some practitioners like to treat the Heart, others like to treat the Kidney. A more research-based “integrative medicine” approach suggests treating autism as an inflammatory process using a specific Chinese herbal formula (Lee & Kong, 2012). As you can see, there are a lot of treatment options!

The one option that is curiously absent, however, is the possibility of treating ASD from a six-stage perspective (popularized by Zhang Zhong-jing in the Shang Han Za Bing Lun). It is my belief that many manifestations of ASD are disorders of the Shào Yáng (少阳).

The Shào Yáng and Autism
According to the Huang Di Nei Jing (Su Wen Chapter 6), the foundational classic of Chinese medicine:

“In the division and unity of the three yang [vessels], the major yang (Tai Yang) is the opening; the yang brilliance (Yang Ming) is the door leaf; the minor yang (Shào Yáng) is the pivot” (Unschuld, p. 131).

Thus, the Shào Yáng regulates opening and closing, and disorders of the Shào Yáng are often described as “half exterior half interior” (Mitchell, Ye, & Wiseman, p. 407). What is important about this idea? The modern classical scholar, Li-hong Liu, has this to say about the Shào Yáng:

“There are three organs which are most prone to opening and closing. The mouth opens and closes for Yang (talking) and for Yin (receiving and chewing food). The throat opens and closes for Yang (breathing) and for Yin (swallowing food, drinks and saliva). The eyes open and close for Yang (to catch daylight and vision) and for Yin (to allow Yin storage and tears). If the pivot or the hinge is obstructed, the opening and closing will suffer…The action needed is to harmonize” (Seidman, p. 8-9).

Zhang Zhong-jing (aka Zhang Ji) 150-219 CE

Liu based this statement on his understanding of the Shang Han Lun, an important medical text written several centuries after the Huang Di Nei Jing. According to the Shang Han Lun, bitter taste in the mouth, dry throat, dizzy vision, and red eyes are general symptoms of Shào Yáng disorder (Mitchell, Ye, & Wiseman, 1999). Thus, Liu describes the mouth, the throat, and the eyes as “most prone to opening and closing” (Seidman, p. 8).

The concept of the eyes opening and closing is particularly relevant to ASD. According to the available information, as well as my own experience, one of the chief signs of autism is an inability to maintain eye contact (AutismSpeaks.org). Using Liu’s description as a starting point, failure to maintain eye contact could be considered a yin-yang imbalance of the eyes: when they open and close, there is either too much qi coming in (hypersensitive individuals) or too little qi coming in (hyposensitive individuals). If the term qi is too esoteric, consider replacing it with either “stimulus” or “information,” which are two types of qi.

The mouth, according to Liu, “opens and closes for Yang (talking).” As mentioned above, many of the individuals I worked with were almost completely non-verbal, and communication difficulties often plague higher functioning autistics as well (Stevenson, et. al., 2013). The Shang Han Lun lists “taciturnity” or reluctance to speak as another potential symptom of Shào Yáng disorders (Mitchell, Ye, & Wiseman, p. 410). This symptom is caused by “depressed Liver-Galbladder qi,” causing the “Heart qi to become constrained, which in turn affects the Heart’s function of governing the spirit” (Mitchell, Ye, & Wiseman, p. 413).

The ears may also be affected in cases of Shào Yáng disorders (Mitchell, Ye, & Wiseman, p. 408). Implementing the same logic that Liu uses in his discussion of the eyes, we can say that the ears have an opening and closing function as well (hearing/listening). In modern terms, the brain is constantly filtering—choosing which sounds to focus on or to ignore; in Chinese medicine terms, we could describe this process as the ears’ ability to open and close. Auditory processing is affected in ASD (Porges, et. al., 2014): when the ears are too open (incapable of filtering/isolating sound), this condition causes hypersensitivity to sound; when the ears are too closed (no sound getting through), this condition causes hyposensitivity to sound.

The Autism Awareness Ribbon

Conclusion
Based on my interactions with autistic adults and children, I feel that Shào Yáng disorder is an accurate representation of many presentations that I’ve seen. I’ve heard several high-functioning autistic adults describe the world as “overstimulating” from a visual and auditory point of view. Several of the individuals I worked with wore either sunglasses or sound-blocking headphones to compensate for the sensorial overload created by the world around them. According to the DSM-V, one of the diagnostic criteria for ASD is, “Hyper- or hypo- reactivity to sensory input or unusual interests in sensory aspects of the environment” (AutismSpeaks.org). In other words, the pivot isn’t working, so the sensorial “door” (to use the Nei Jing analogy) is constantly open (hypersensitivity) or closed (hyposensitivity). Based on the descriptions from autistic individuals, on Li-hong Liu’s analysis of the Shang Han Lun, on modern research, and on my own experience, I believe that ASD can be approached clinically as a Shào Yáng disorder.

In my own practice, I have used Xiao Chai Hu Tang for the withdrawn and non-aggressive manifestations of autism, and Chai Hu Long Gu Mu Li Wan for the hyperactive and aggressive manifestations of autism. Both of these formulas originate from the Shào Yáng section of the Shang Han Lun. Of course, no Chinese medicine theory would be complete without a pulse: the Shào Yáng pulse is either “stringlike and fine,” or simply “stringlike” (Mitchell, Ye, and Wiseman, p. 409).

Finally, the Shang Han Lun specifically states that in Shào Yáng disorder, “only one sign [means that] this is [the pattern], they do not all have to be present” (Mitchell, Ye, & Wiseman, p. 420). I mention this line for its clinical relevance: you may not be able to discern whether a non-verbal autistic patient has certain symptoms (bitter taste, fullness under the ribs, dry throat, dizzy vision). If there are sensory processing issues, taciturnity, and a stringlike pulse, you can be confident using the Shào Yáng formulas to treat—if you are so inclined!

References:
“Autism Fact Sheet” (NINDS.nih.gov)

“DSM-V Diagnostic Criteria” (AutismSpeaks.org)

“Frequently Asked Questions” (TempleGrandin.com)

David Lee & Xuejun Kong, (2012). “Potential Treatment of Autism with Traditional Chinese Medicine“. North American Journal of Medicine and Science, Vol. 5(3): 189-192.

Craig Mitchell, Feng Ye, and Nigel Wiseman, (1999). Shang Han Lun.

SW Porges, et. al. (2014). “Reducing Auditory Hypersensitivities in Autistic Spectrum Disorder“. Frontiers in Pediatrics.

Yaron Seidman. Three Yin and Three Yang: Clarifying Zhang Zhongjing’s Diagnostic Approach.

Ryan Stevenson, et. al. (2014). “Multisensory Temporal Integration in Autism Spectrum Disorders“. The Journal of Neuroscience, vol. 34(3): 691-697.

Paul Unschuld, (2011). Huang Di Nei Jing Su Wen.


© Dr. Phil Garrison and Ancient Chinese Medical Theory, 2014. Unauthorized use and/or duplication of this material without express and written permission from this blog’s author and/or owner is strictly prohibited. Excerpts and links may be used, provided that full and clear credit is given to Dr. Phil Garrison and Ancient Chinese Medical Theory with appropriate and specific direction to the original content.

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