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Abstract: This article discusses the CM energetic properties of antibiotics, how to deal with them from a completely CM point of view, including acupuncture point selections and herbal prescriptions and modifications.

Keywords: Antibiotics, penicillin, acidophillus, probiotics, energetic description
How to deal with antibiotics from an entirely Chinese Medical point of view? What points, herbs, foods and rationale to use when dealing with patients on antibiotics? How to support these patients before, during and after antibiotics treatment.

How to deal with these modern medicines? There is already a lot of writing that elaborately critiques the prescription of these drugs. However, the aim of this article is to provide practical insights into the energetics of antibiotics to actively support the patient’s health with that knowledge.

As one of the very few therapeutical systems, Chinese Medicine has its own conceptual language. Using this language any practitioner can succinctly describe a patient’s current situation. Applying the si zhen (i.e. any form of macroscopic diagnosis) one can determine the patient’s status at that moment. Chinese Medicine developed into a primarily descriptive method, therefore as long as 1. a rudimentary description of ‘health’ is available, and 2. the energetic effects of the therapy are known. Chinese Medicine can be applied to any situation. It is entirely irrelevant if the patient, deals with a well-known or ‘new’ disease, if the patient is human or animal or what herbs, pills, tools, surgical operations or therapies are applied. As long as the effects of these modalities are coded in the same conceptual language as the situation of the patient.

Imagine the following, given that Penicillin had been discovered in the China of yore. How likely would it be that it would NOT have been used? Obviously, a medicinal as effective as Penicillin would have been annexed into the existing Materia Medica’s immediately. In fact, I think it highly likely that its medicinal properties would have been described and the substance used without delay. After noticing the clear side effects associated with use, other substances would have been used to harmonize the unwanted effects. Additionally, new herbal formulas would develop to further enhance its therapeutical properties. I find it very important for the professional
development of Chinese Medicine to describe these energetic properties. In this article I present a formalized description for peer review.

Please note that this article focuses on a GENERAL energetic description of antibiotics (covering most Beta-lactam, Tetracyclin and Macrolide class antibiotics. It does NOT describe Interferons or steroidal anti-inflammatory drugs. These are sometimes called antibiotics, but adhere to completely different modes of action.

Antibiotics, since the 1940’s the drug-class of choice for the smothering of bacterial infections. It has saved millions of lives and has reduced suffering for many patients. Was the original penicillium a naturally growing fungus, nowadays new types are neatly synthesized in sanitized laboratories [7][4].

A lot has changed since the discovery of Penicillium’s medical significance in 1928. Research has given new insights into the workings of antibiotics. Despite this biomedical research, the properties of antibiotics have roughly remained the same, with all their positive and negative effects [4]. Although there are many different types of antibiotics, here a general description is presented which helps understand both the effects and side-effects.

Antibiotics – a general description

Title: Antibiotics
Also known as: Penicillin, Amoxycillin, Doxycyclin, Clarythromycin, etc.
Western Materia Medica Category: Systemic anti-inflammatory agents
Type: Natural or synthetic compound
Chinese Materia Medica Category: Downward draining substances
Zang fu orientation: Stomach, Spleen Lung, Large Intestine
Properties: Cold, bitter, toxic

Actions:
– Drains fire and du (Toxicity) downward, clears heat from the organs and promotes defecation
– Drains phlegm, promotes breathing and alleviates pain
– Calms the shen

Cautions & Contraindications: Due to its toxicity and depleting nature, use only for short periods of time.

Toxicity: Antibiotics are toxic. LD50 indications are different per antibiotic and per route of administration, usually between 8 and 30 mg/kg (oral)[4][5]. Use with great caution in pregnancy.

Contraindications: Wei qi xu, spleen yang xu or kidney yang xu due to the extreme cold.
Kidney yin xu or liver xue xu due to toxins building internally.

Modus operandi:
Antibiotics are very substantial, cold and bitter in nature. Their heat-draining and phlegm drying properties close the exterior and drain fire and du (toxicity) downward. Antibiotics are very substantial and cloying which greatly taxes the Spleen in its yun hua function. Used to purge heat and drain downward, used for longer periods of time it depletes Spleen qi resulting in fatigue, abdominal distention and chronic diarrhea. Its toxic nature causes the Stomach qi to rebel upward,
resulting in vomiting, nausea and sometimes diarrhea. Their use depletes the qi of the Lung and and Spleen. Long-term use builds up toxins internally, drying the Kidney yin and Liver xue eventually resulting in inflammation of organ tissue.

Comparisons:
Antibiotics are similar to Da Huang (Radix et Rhizoma Rhei) in terms of their cold and bitterness and the ability to purge Fire and du (Toxicity) downward. Most notably however is the similarity in closing the surface, which traps an exterior pathogen on the inside. Left untreated, this pathogen can ‘smolder’ on the inside and consume zheng qi, often with sub-clinical symptoms [3]. Antibiotics are similar to several of the cold herbs in calming the shen when it is irritated due to heat or fire.

Examples are Zhi Mu (Rhizoma Anemarrhenae Asphodeloidis) and Huang Lian (Rhizoma Coptidis). Antibiotics are similar to Sheng Di Huang (Radix Rehmanniae Glutinosae), not in their nourishing abilities, but in their cloying nature.

This cloying effect in part hinders the downward flow of Stomach qi and it taxes the yun hua function of the Spleen, thus giving rise to symptoms of middle jiao deficiency, comparable to excessive consumption of Di Huang. Most evident of these is a hua mai, slippery pulse, that may remain evident up to several weeks after treatment with antibiotics.

Treatment effects:
Antibiotics are highly effective in acute conditions. Long-term use however shows many unwanted effects.

In terms of the nei jing tu, the internal landscape, antibiotics use is like flooding the empire in a cold mist. The mist hinders both xie qi, the foreign soldiers, and the zheng qi, native forces, thus stopping the battle and alleviating the symptoms. The antibiotic mist extinguishes small fires but in its stead, leaves a layer of thick moisture. After treatment is stopped, the mist settles and the farmers work to remove the moist layer that covers the lands.

This analogy describes how antibiotics influence the ENTIRE organism, not only xie qi. Furthermore it shows that the mist also causes a strain on the system that lasts longer than the period of the inflammation itself.

It is easy to understand that this moist layer that covers the land hinders the creation and transportation of new farmers and especially soldiers. Additionally, if the xie qi is not completely destroyed but ‘covered’ by the mist, it may remain undetected while slowly growing and consuming the produce of the empire.

Chronic overuse of antibiotics results in an increasingly thick layer of moisture on the lands, that poisons the produce and eventually kills the inhabitants. In this state of disarray, a renewed uprising of the foreign army can occur with detrimental results.

Antibiotics-use, as is true with most cold substances, is contra-indicated in Stomach and Spleen deficient patterns, overuse quickly creates diarrhea and tiredness and inhibits the Spleen in its functions of transforming gu qi. Secondarily, since the Spleen stores dampness in the Lung, this prevents the Lung in its generative, purgative and defensive tasks. Long term and repeated treatment depletes the yang of the entire system and eventually toxins build up internally. Toxins both in and of themselves are damaging to the system. Secondarily, toxins and other forms of excessive heat can trigger a hidden or ‘antibiotically smothered’ pathogen. A current example is an old tuberculosis, reemerging during corticosteroid treatment.

Commentary:
Many physicians prescribe antibiotics liberally when a bacterium is (presumed to be) the cause of an inflammation. Antibiotics often close the exterior too quickly, thus preventing the wei qi from dealing correctly with the evil hot or cold pathogen. A trapped pathogen often ‘smolders’ on the inside and is the cause of many post-inflammation symptoms, in some leading to serious illness. With regard to ‘smoldering’, It is important to state that anyone treated with antibiotics for a strong
pathogen, may have a ‘hidden evil’ in their system without clear symptoms.

Of course, antibiotics may be the only and best choice to treat an inflammation in some instances. CM has a unique role in supporting the treatment, preventing side-effects and supporting the patient’s well-being. This is remarkably easy when sticking to the conceptual methodology underlying CM.

The energetics of antibiotics

This part deals with several practical issues surrounding the treatment of patients on antibiotics.
Treatment options: Before, during and after

Supporting the antibiotic treatment of an active inflammation. Note: formulas and point-selection provided here are suggestions, it may be very relevant to change these according to your patient’s situation.

Although this article focuses on combining treatment modalities with regard to active bacterial inflammation, the ultimate goal and last point of this article is to support the patient’s individual constitution and prevent recurrence and support.health.

However, this article ultimately shows that within the logical equation of Chinese Medicine we can effectively support antibiotics treatments and circumvent unwanted effects as long as we stick to the energetic description of the patient and the medicinals he uses.

Before antibiotic treatment

Considering the energetic properties of antibiotics, the treatment principle is simple:
Tonify the the center qi – supports the zheng qi for the coming battle and subsequent cleanup actions It is understood here that this period lasts no longer than a few days or even hours. The suggestions provided here however are highly practical. The patient can use the below mentioned substances during the entire treatment period.

Probiotics: Lactobacillus Acidophillus
As soon as your patient contacts you, advise them to start probiotic treatment (unless there are circumstances which make this unwise, such as bacterial overgrowth in the stomach, etc). Probiotics are readily available and generally cheap. Acidophillus cultures, somewhat sweet, salty and warm in nature are excellent in protecting Stomach qi and the Spleen’s yun hua function.

Fresh ginger
Widely available and cheap, Sheng Jiang (Rhizoma Zingiberis Officinalis) is advised. Simply make a tea from several slices. Drink during the day for the entire period that antibioitics have been prescribed. Discontinue if redness or itching in the flanks present and be cautious if the patient has a primary yin vacuity condition. Acrid and warming, Sheng Jiang (Rhizoma Zingiberis Officinalis) is ideal for protecting the Stomach and Spleen against the extreme cold of antibiotics, harmonizing the middle jiao and preventing nausea and stomach upset. Additionally, Sheng Jiang (Rhizoma Zingiberis Officinalis) gently harmonizes the effects of drugs and has good detoxifying properties to support phlegm-drying herbs (such as Ban Xia (Rhizoma Pinelliae Ternatae)).

Acupuncture point combinations should follow the same principle.
Tonify the center qi – Zhongwan REN-12, Guanyuan REN-4, Zusanli ST-36, Sanyinjiao SP-6
If the patient easily experiences diarrhea or other gastrointestinal complaints, also use Shangjuxu ST-37. If the patient has concurrent dampness, also use Fenglong ST-40.

During antibiotic treatment

One of the most interesting points about antibiotics is their ability to close the surface. Although this alleviates symptoms spectacularly it not always solves the problem. As stated above, this same problem occurs with Huang Qin (Radix Scutellariae Baicalensis). To counter this, a surface releasing effect mus be established to prevent ‘smoldering of evil heat on the inside’.

Having established this, the principles of treatment are clear:
– Clear heat or fire – the inflammation
– Release the exterior – prevent ‘smoldering’
– Protect the Stomach and support the Spleen

Xiao Chai Hu Tang (Minor Bupleurum Decoction) and its associated modifications are highly suitable for these tasks. Herbalists will recognize the ever-present combination of Chai Hu (Radix Bupleuri) and Huang Qin (Radix Scutellariae Baicalensis) in all of the ‘Chai Hu’-formulas. This combination exists for the exact reasons described above. Chai Hu’s imperial presence is required here to release the exterior and push out evil heat. Without Chai Hu (Radix Bupleuri), this formula’s ability to clear heat would be vastly different. It would then have the ability to dry phlegm, drain heat from the upper jiao, stop sweating and promote the downward direction of Stomach qi.

However, it would trap the evil heat on the inside, similar to antibiotics, defeating the purpose of this formula. Without minister Huang Qin (Radix Scutellariae Baicalensis), this formula’s ability to clear Heat would be reduced, as well as its ability to drain downward. Also, Huang Qin (Radix Scutellariae Baicalensis) protects the yin, which is necessary because of Ban Xia’s (Rhizoma Pinelliae Ternatae) drying and Chai Hu’s (Radix Bupleuri) yang raising -thus yin depleting- natures.
Although it is essentially possible to remove Huang Qin (Radix Scutellariae Baicalensis) from the formula, and let antibiotics perform its tasks of draining heat, It is advisable to keep it in because of its yin-protecting effects. On the other hand, the amount of Chai Hu (Radix Bupleuri) can be doubled to support clearing the surface ‘through’ the presence of both Huang Qin (Radix Scutellariae Baicalensis) and antibiotics.
– Xiao Chai Hu Tang (Minor Bupleurum Decoction) [2] – Radix Bupleuri (Chai Hu) 24g
– Radix Scutellariae (Huang Qin) 9g
– Rhizoma Pinelliae Ternatae (Ban Xia) 24g
– Rhizoma Zingiberis Officinalis Recens (Sheng Jiang) 9g
– Radix Ginseng (Ren Shen) 9g
– Honey-fried Radix Glycyrrhizae Uralensis (Zhi Gan Cao) 9g
– Fructus Zizyphi Jujubae (Da Zao) 12 pcs

Alternatively, if there is a situation of severe deficiency, it is advisable to use a formula that is stronger in tonifying the qi. Ren Shen Bai Du San is then applicable. Even though it is contraindicated for use in situations with heat, as long as the inflammatory heat is countered by antibiotics, this formula can be used. Interestingly, classically too it was modified with a doubling of Chai Hu (Radix Bupleuri) and the addition of Huang Qin (Radix Scutellariae Baicalensis), which is also highly relevant in this case, since this supports the treatment of a condition with heat.
– Ren Shen Bai Du San (Ginseng Powder to Overcome Pathogenic Influences) [2] – Radix et Rhizoma Notopterygii (Qiang Huo) 30g
– Radix Angelicae Pubescentis (Du Huo) 30g
– Radix Ligustici Chuanxiong (Chuan Xiong) 30g
– Radix Bupleuri (Chai Hu) 30g
– Radix Platycodi Grandiflori (Jie Geng) 30g
– Fructus Citri seu Ponciri (Zhi Ke) 30g
– Radix Peucedani (Qian Hu) 30g
– Radix Ginseng (Ren Shen) 30g
– Sclerotium Poriae Cocos (Fu Ling) 30g
– Radix Glycyrrhizae Uralensis (Gan Cao) 15g

Acupuncture following the same treatment principles
– Clear heat – Chuchi LI-11, Dazhui DU-14, Lingtai DU-10
– Release the exterior – Zhongfu LU-1, Lieque LU-7, Hegu LI-4
– Protect the stomach and support the Spleen – Zhongwan REN-12, Zusanli ST-36, Sanyinjiao SP-6
Add points as required by the situation.

After antibiotics treatment

If the inflammatory symptoms have been countered and the ‘mist has settled’, it is relevant to clean up and harmonize the patient. This ends, by definition, in treatment of the ben and should support the patients constitution.

Treatment principle:
– Transform cold phlegm
– Move the qi and drain dampness

If the zheng qi is sufficient, strong formulas can be used such as: Qing Qi Hua Tan Wan (Clear the Qi and Transform Phlegm Pill), Er Chen Tang (Two-Cured Decoction) or Bai Tou Wen Tang (Pulsatilla Decoction). All are excellent in transforming and removing phlegm and dampness out of the various nooks and crannies of the patient’s system.

Er Chen Tang (Two-Cured Decoction) is the most relevant of these formulas. From it, most of the other formulas have been derived. This simple formula is centered around Ban Xia (Rhizoma Pinelliae Ternatae) and Chen Pi (Pericarpium Citri Reticulatae). These warm and moving herbs are excellently suited to deal with the cold, cloying nature of antibiotics. With the ministers Fu Ling (Sclerotium Poriae Cocos Botanical) and Zhi Gan Cao (Honey-fried Radix Glycyrrhizae Uralensis)
the Spleen and Stomach are well protected, especially if the patient also drinks fresh ginger tea.

Er Chen Tang (Two-Cured Decoction) thus tonifies the middle, transforms the ‘antibiotic mist’ and drains dampness downward. This not only removes the antibiotic leftovers, but also removes the dampness that was created by the original battle between xie qi and zheng qi. Er Chen Tang (Two-Cured Decoction)
– Rhizoma Pinelliae Ternatae (Ban Xia) 15g
– Pericarpium Citri Erythrocarpae (Ju Hong) 15g
– Sclerotium Poriae Cocos (Fu Ling) 9g
– Honey-fried Radix Glycyrrhizae Uralensis (Zhi Gan Cao) 4.5g
– Ju Hong (Rubra Epicarpii Citri Erythrocarpae) is usually substituted by Chen Pi (Pericarpium Citri Reticulatae). [1][2][3]

Er Chen Tang (Two-Cured Decoction) can be modified by adding more tonifying herbs such as Bai Zhu (Rhizoma Atractylodis Macrocephalae) and Ren Shen (Radix Ginseng), Maciocia notices that Tai Zi Shen (Radix Pseudostellariae Heterophyllae) has ideal qualities to support the Stomach and Spleen during and after antibiotic treatment [6]. Heat clearing herbs such as Huang Qin (Radix Scutellariae Baicalensis), Huang Lian (Rhizoma Coptidis) or Huang Bai (Cortex Phellodendri) can
be added depending on the presentation. Please note: Er Chen Tang (Two-Cured Decoction) is warm and drying, patients with underlying yin vacuity patterns require additional herbs such as Sheng Di Huang (Radix Rehmanniae Glutinosae), Gou Qi Zi (Fructus Lycii) and Zhi Mu (Rhizoma Anemarrhenae Asphodeloidis).

If the zheng qi is deficient it may be relevant to combine the above with tonifying formulas such as Liu Jun Zi Tang (Six Gentlemen Decoction) or Shen Ling Bai Zhu San (Ginseng, Poria, and Atractylodes Macrocephala Powder) in case of more qi deficiency. Use Shi Wei Wen Dan Tang (Eleven-Ingredient Decoction to Warm the Gallbladder) instead of Qing Qi Hua Tan Tang ((Clear the Qi and Transform Phlegm Pill) to better support the qi and xue.

Acupuncture treatment following the same principle is quite short:

Transform phlegm and move dampness – Sanyinjiao SP-6 (moxa), Taibai SP-3, Fenglong ST-40 (moxa), Zhongfu LU-1 and Chize LU-5
Add points to support constitution.
Harmonize and maintain health.

Eventually, after the pulse has normalized, harmonize the patient with formulas that support their constitution to prevent recurrence of the pathological situation. The end advice is of course: Meditation, Yoga, Taiji, Qigong, a regular lifestyle and imperially healthy foods.

About the author: Edgar Vossen is a licenced Acupuncturist, Herbalist and Tui Na Massage
Therapist maintaining a practice in Zwolle, The Netherlands and publishes mainly on the energetic descriptions of non-CM medicinals.

For any comments or questions, please contact the author at Vossen@EdgarVossen.com

Bibliography
[1] Bensky, D. & Gamble, A., [1992]. Chinese Herbal Medicine Materia Medica. 3rd edition. Eastland Press
[2] Bensky, D. & Barolet, R., [1990]. Chinese Herbal Medicine Formulas & Strategies, Eastland Press
[3] Chen, J.K. & Chen, T.T., [2001]. Chinese Medical Herbology and Pharmacology, Art of Medicine Press, Inc.
[4] Vossten, G.J., [2003]. Thesis: The East West Dialogue – Describing and using energetic descriptions of western medications
[5] Gascoigne, S., [2003]. Prescribed Drug Guide, Jigme Press
[6] Maciocia, G., [1997]. The Practice of Chinese Medicine, Churchill Livingstone, Ch.25
[7] Wikipedia, [2007]. Antibiotics

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