This post summarizes a fascinating article by Naoki Umeda entitled, Gut flora (the second brain) connects Eastern and Western medicine: intestinal hyperpermeability or Qi deficiency can affect brain, mind, and whole body. His article explains the Leaky Gut Chinese medicine connection and how Traditional Chinese medicine (TCM) should play a primary role in treating this condition.
Gut Microbe Imbalance
Gut microbe imbalance and intestinal hyperpermeability (a.k.a. Leaky Gut) damage the endothelial function of blood vessels leading to organ dysfunction. Traditional Chinese Medicine (TCM) doctors have consistently recognized the importance of the digestive system and that Qi deficiency triggers mental and physical symptoms. DNA sequencing shows how intestinal dysbiosis relates to obesity, metabolic syndrome, brain disorders, autoimmune diseases, and mood disorders (Brain-Mind-Gut axis).
In addition, artificial intelligence (AI) “deep learning” technology may ease the worldwide medical-economical crisis. Practitioners in China will soon use AI-assisted TCM-style history-taking computers and portable wrist pulse diagnostic devices. In the new era of preventive medicine, gut microbiota research, precision medicine with genome analysis, AI technology, and ancient TCM wisdom will combine, making it possible to detect and treat pre-clinical diseases before real diseases occur.
Gut Health Background
Two thousand years ago, Hippocrates (the “Father of modern medicine”) and Traditional Chinese Medicine doctors probably envisioned similar notions. Gut microbiota imbalance (dysbiosis) is the root cause of disease:
- All disease begins in the gut. (Hippocrates)
- You are what you eat. (Anthelme Brillat-Savarin, 1826)
- You have a second brain in your gut. (modern scientists’ quote)
- I have a gut feeling. (common expression)
Traditional Chinese Medicine (TCM) doctors have recognized this connection for thousands of years. For example, the acupoint CV4, located 2 inches below the umbilicus, is one of the most essential points to generate Qi (vital energy) to nourish the body (internal organs, brain, heart, skin, muscle, and mind). In addition, diet and herbal therapy are vital to human lives.
Similarly, in 1674, Leeuwenhoek, a Dutch scientist, first found bacteria in the stool. In 1928, Fleming, a Scottish physician, discovered penicillin, and the progress of modern medicine has accelerated ever since. And while antibiotics have saved millions of lives from infectious diseases, overuse has triggered antibiotic-resistant and encapsulated bacterial strains.
Genome Sequencing
Genome sequencing has found that every person has about 100 trillion microbiota (“gut flora”), compared to about 60 trillion normal cells. In addition, there are 3.3 million microbial genes, outnumbering human genes by 150:1. No wonder scientists speak of a second brain in the gut and a “Brain-Mind-Gut axis.” For instance, short-chain fatty acids (SCFA), produced in the colon when bacteria ferment fibers, are beneficial in preventing diseases like colon cancer, liver cancer, obesity, and diabetes. SCFA also sends signals to the brain to suppress appetite and modulate the immune system.
Leaky Gut Chinese Medicine Connection
Undoubtedly, gut microbiota imbalance (dysbiosis) is strongly related to the TCM concept of Qi deficiency. Dysbiosis triggers intestinal hyperpermeability (leaky gut), similar to Qi deficiency. Dysfunction in the gut could spread systemically, affecting the body and mind—systemic inflammation, immune imbalance, and multiorgan dysfunction. Leaky gut is a common term describing intestinal hyper-permeability. Dysbiosis is the process of pathogenic bacteria and toxins passing through the intestinal wall into the bloodstream (“leaking” from the intestine), spreading to the whole body, and triggering inflammation in multiple organs.
A natural intestinal mucosal barrier allows for bidirectional interaction between microorganisms and normal cells. Typically, this “cross-talk” regulates molecular trafficking, and the intestine acquires tolerance or immunity to “outsiders.” However, when this barrier is damaged (loss of tight junction between mucosal enterocytes), toxins start passing through the barrier, creating intestinal hyper-permeability. This begins a chain reaction leading to systemic inflammation, immune imbalance, and oxidative stress.
Understanding Qi Deficiency
According to TCM theory, Qi deficiency similarly triggers multiorgan dysfunction to intestinal hyper-permeability. If we can treat pre-clinical diseases by caring for the gut, we could prevent many modern autoimmune disorders. “The Yellow Emperor’s Classic of Internal Medicine” states, “Great physicians do not treat disease. Instead, they treat pre-clinical disease.” Another classical TCM textbook “Qian Jin Fang,” says, “Top-level physicians heal the whole country, mid-level physicians treat people, while low-level physicians treat diseases only.” Top-level physicians can save the country by treating “pre-clinical disease.”
“Pre-clinical disease” occurs when patients have troublesome symptoms, but their labwork is clean. Such is the case with the modern diseases of irritable bowel syndrome (IBS), chronic fatigue, migraines, and fibromyalgia. Qi deficiency, dysbiosis, intestinal hyper-permeability, and pre-clinical diseases are all related. There is no doubt that practitioners could apply natural interventions like TCM as a first step in preventing the onset of these diseases.
Intestinal Hyperpermeability
Unfortunately, modern-world exposure has predisposed most of us to intestinal hyperpermeability. These factors include delivery by Caesarean section, formula instead of breast milk, frequent antibiotics use, stress, non-steroidal anti-inflammatory drugs (NSAIDs), high-fat and high-calorie diets, genetically modified foods, chemical, and processed foods, preservatives, trauma, infections (virus, bacteria, mold, or parasites), and heavy metal toxicity.
When a patient presents with chronic symptoms involving three or more organs (i.e., fatigue, bloating, frequent colds), Qi deficiency should be strongly suspected. Once diagnostic tests have ruled out severe conditions (like cancer, liver/ kidney disease, hypothyroidism, inflammatory bowel diseases, or brain diseases), the TCM diagnosis and treatment of Qi deficiency is appropriate. Other common symptoms of Qi deficiency include insomnia, constipation, diarrhea, abdominal pain, cold hands and feet, migraines, tension headaches, sinus congestion, dry skin, hair loss, and chemical sensitivities.
Spleen Qi, Kidney Qi, and Leaky Gut
It is essential to distinguish between two different forms of Qi when treating intestinal permeability. Spleen Qi is related to food, while Kidney Qi is related to telomeres. A telomere is a region of repetitive DNA sequences at the end of a chromosome. They protect chromosomes from becoming frayed or tangled. Kidney Qi deficiency typically causes stronger symptoms than Spleen Qi deficiency.
Each person has unique DNA, resulting in specific microbiota (“microbial fingerprints”) and requiring each person’s TCM diagnosis and treatment to be unique. While TCM has five different Qi energies, two of them, Spleen and Kidney Qi, are especially relevant to intestinal function. Spleen Qi derives from food-related nutrients absorbed by the digestive system. Therefore, harmful foods trigger microbial dysbiosis, impairing Spleen Qi production. Spleen Qi is also called “acquired Qi,” which people create after they are born from the food they eat.
Kidney Qi is Inherited
Kidney Qi is called “inherited Qi,” which individuals inherit from their parents. Kidney Qi is most abundant at birth but decreases with aging. Kidney Qi is directly related to genetic makeup (telomeres). Their most significant length is at birth, but becomes shorter through aging (15,000 at birth, but reduced to 8,000 at age 35). When telomeres become shorter, the chromosome becomes unstable, disrupting cell division and increasing health risks, impairing organ function, and leading to premature death.
To understand the relationship between Spleen and Kidney Qi, imagine a hybrid-powered motor vehicle that combines gasoline and rechargeable batteries. They correspond to Spleen and Kidney Qi, respectively. Gasoline is fueled repetitively (Spleen Qi increases by eating beneficial foods), but the battery (Kidney Qi) wears down over time, eventually losing its charging ability.
Qi Deficiency Symptoms
However, microbial dysbiosis damages Spleen Qi’s ability to “refuel,” triggering symptoms like fatigue, insomnia, bloating, loose stools, constipation, cold hands and feet, headaches, dizziness, and dry skin. Over time, a weakened Spleen Qi taxes the Kidneys (electric power), leading to more significant dysfunction.
Kidney damage generates more long-lasting and complicated symptoms like chronic fatigue syndrome, migraines, depression, hair loss, frequent infections, food intolerance, small intestinal bacterial overgrowth (SIBO), fibromyalgia, chemical sensitivity, and postural orthodontic tachycardia syndrome (POTS). Spleen and Kidney deficiency are the roots of most autoimmune diseases.
Understanding Qi Stagnation
In addition, the Qi deficiency associated with autoimmune conditions often leads to Qi stagnation, which is the improper flow of Qi energy in the body. Autoimmune diseases involve inflammation from the body attacking itself. Western medicine calls them “rheumatic” conditions. In Greek, “rheuma” means “flow.” Stagnating flow (Qi stagnation) is a unique diagnosis in TCM. To sustain good health, Qi must always flow smoothly throughout the body. However, when the amount of Qi decreases (Qi deficiency), the flow becomes disrupted, causing conditions like rheumatoid arthritis, menstrual irregularity, hemorrhoids, joint pain, and Hashimoto’s thyroiditis.
The Role of Artificial Intelligence
Since the gut microbiota “second brain” is a highly complicated system, artificial intelligence (AI) will be used more frequently in the future for microbiota research, stool tests, and gut flora treatments. In China, practitioners are starting to use AI-assisted, TCM-style history-taking computers and portable wrist pulse diagnostic devices at several “minute clinics.” Some TCM experts say these devices can predict and obtain an 80% accurate diagnosis. They obtain the remaining 20% by adding physical exams such as pulse diagnosis, tongue examination, and face expression reading.
In the future, AI should be used more both in TCM (diagnosis and treatment) and stool microbiota tests, as this will make it easier for doctors to find “pre-clinical diseases” before they become “real diseases.” In addition, AI can help doctors spend more quality time with patients and prevent provider burnout. The overarching goal is to bring back the humanity of medicine since the medical provider-patient relationship is a founding principle of health care.
Chinese Herbal Medicine
Chinese herbal formulas typically combine five to ten herbs to create one TCM herbal remedy. The blending creates a “synergetic effect” (e.g., 1+1+1 becomes 10 or 20), but Western medicine practitioners have found its mechanism very difficult to understand. There has been a big wall between TCM and Western medicine for many years, and unfortunately, it still exists at this present time. However, AI may remove the wall by making TCM’s theory of synergetic blending of multiple herbs understandable to Western doctors.
In addition, AI can change the TCM diagnosis and treatment process to include numeric information which is understandable to everyone. It has always been challenging for Western practitioners to understand TCM from a scientific point of view. However, genome analysis technology (such as DNA sequencing) and microbiota research have enabled us to understand the strong relationship between TCM and modern medicine.
It’s Time for Whole-Person Care
Patients increasingly demand whole-person care, mind-body connection, patient-centeredness, cost-conscience treatment, and personalized plans from their healthcare providers. In addition, many countries face a healthcare financial crisis that will only worsen. Integrating ancient wisdom, modern science, and AI is one of the best solutions for addressing this issue. Moreover, AI’s deep learning technology will significantly accelerate the “connecting the dots” process in TCM and modern science.
For example, If a patient is diagnosed with rheumatoid arthritis, modern medicine’s guideline-based therapy, such as methotrexate, should be considered first. On the other hand, if a patient’s medical issue is migraine only, serotonin 5-hydroxytryptamine (5-HT) receptor agonists (“Triptans”) or some TCM herbal remedies which contain Evodia (“Wu zhu yu” in Chinese) might be most effective. However, in today’s modern society, an increasing number of people present to clinics with “pre-clinical disease,” associated with multiple symptoms but without a definitive diagnosis.
Better Care, Better Outcomes
For instance, many patients struggle with chronic headaches, fatigue, depressive mood, and eczema at the same time. These patients are often transferred from one specialist to another, never getting the needed treatment. We should first consider interventions to address the “root causes,” often related to gut microbiota imbalance and Qi deficiency. The treatment should be “tailor-made” since everyone has a different level of stress, various symptoms, different DNA, and different microbiota (so-called “microbial fingerprints”).
Leaky Gut Conclusion
This article is just a rough sketch of the Brain-Mind-Gut connection. More scientific research is needed for TCM to be utilized and well-accepted in the new era of medicine. Several TCM herbs have been assessed scientifically (for instance, Ginseng for energy, Astragalus for the immune system, and Licorice for digestion) with promising results. However, rather than evaluating each herb separately, we should move to the next phase to elucidate the real essence of the synergetic effects of multiherbal TCM remedies with possible help from AI. AI-assisted TCM research combined with genome-analysis precision medicine will become the best pathway for the future of preventive medicine.
Next Steps
At Raleigh Acupuncture, we specialize in the treatment of complex autoimmune conditions. TCM and acupuncture enable us to treat the root issues underlying many of these diseases. While we do not use AI in our diagnostic assessment, we have a 2,000-year history of assessing imbalances in the body, enabling us to identify imbalances like Spleen and Kidney Qi deficiency. In addition to acupuncture, we have a complete Chinese herbal medicine pharmacy, so we can prescribe herbs to supplement our acupuncture treatments.
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Reference
Umeda N., Gut flora “the second brain” connects Eastern and Western medicine: intestinal hyperpermeability or Qi deficiency can affect the brain, mind, and whole body. Longhua Chin Med 2019;2:6. doi: 10.21037/lcm.2019.04.01
Naoki Umeda, Department of Wellness and Preventive Medicine, Center for Integrative and Lifestyle Medicine, Cleveland Clinic, Cleveland, OH, USA Correspondence to: Naoki Umeda, Clinical Assistant Professor of Medicine, Cleveland Clinic Lerner College of Medicine; Department of Wellness and Preventive Medicine, Center for Integrative and Lifestyle Medicine, Cleveland Clinic, 1950 Richmond Road, Lyndhurst, Ohio, USA. Email: umedan@ccf.org.
Focus Keyphrase: Leaky Gut Chinese Medicine Connection
Photo by Marcus Aurelius: https://www.pexels.com/photo/woman-sitting-on-a-yoga-mat-while-smiling-6787215/