Medical Mysteries…really ?

Just because you can’t fly an airplane into space, doesn’t mean you can’t get there. You need another vehicle, and you need a different technology to get you to it.

It never ceases to astonish me when I pull up my homepage in the morning and see the latest “Medical Mystery” pop up on the news page. The latest one that peaked my interest was “Sleeping Beauty Syndrome”.Generally, when I see the word “Syndrome” I’m tipped off that these guys really have no idea what’s going on with this patient, but just recognize a cluster of symptoms that they’ve seen in someone else in the past. That cluster of abnormal and unexplained findings generally has no treatment, because there is no understood mechanism that caused the symptoms to appear. So what happens then? Doctors give it a name, and seem to be more on top of things because they can say, “oh yes, we’ve seen that before, this is what it’s called”. This particular syndrome is medically referred to as “Kleine-Levin Syndrome”.

More information on "Sleeping Beauty Syndrome"

This syndrome is characterized by bouts of extreme recurrent sleepiness and fatigue, lethargy and sometimes depression and listlessness that can last from a few days to a few weeks in some cases. This can happen to the extent that a patient, while experiencing one of their “sleep spells”, can be asleep for 2 weeks at a time, and only wake long enough to eat and use the restroom or shower, all the while remaining in an intense “fog” or daze.

This is the initial news clip I saw on Yahoo! news that got me interested in finding out more:

15 year old girl with Kleine-Levin talks about her Syndrome

So now the next question would naturally be- “Western Medicine admittedly has no answer for this girl- but does Chinese Medicine?”

Of course we do. Let’s explore that. Now, I can’t be terribly specific, because  most Western diagnoses are often umbrella terms that can encompass many different underlying imbalances from the Chinese Medicine perspective. With out actually talking to this patient and finding out specific details about symptoms, it will be difficult to come up with a complete explanation of the disorder’s mechanism and treatment, but I can generalize based on the information I’ve gathered. To fully diagnose and treat her I would need the answers to questions such as:

• Her emotional state and patterns during and outside of her “sleeping spells”
• Details regarding the initial “cold” she caught at the onset of her “Sleeping Beauty Syndrome” including the types of medications she was taking to treat that “cold”
• Does she dream?
• Can she sleep regularly and easily when she is not caught up in a sleeping bout
• how is her energy through the day when she is not in a sleeping bout
• are her hands and feet warm or cold
• I would need to feel her pulse to get information about the state of her internal organs and the internal environment
• I would need to see her tongue, which would also show me certain qualities to give me clues as to her bodies internal imbalances
• How is her digestion? Regular Bowel movements?
• Is she thirsty? What temperature water does she prefer?
• What does her diet consist of?
• How is her appetite? Any cravings?
• are there any particular times during the day or night that she finds herself repeatedly waking up or falling asleep? This gives me more insight into what organ systems may be affected.
• What color is her urine- clear, light, dark yellow?
• I would need information about her menstrual cycle- when did it begin? Is it regular? Is it painful? Are their a lot of blood clots? Do the “sleeping spells” or fatigue seem to be associated with her cycle?

There are probably some more things that would come up as I spoke to her, but that’s where I would start.

My initial thought upon seeing this video was, “Oh! I know I know! Ma Huang Fu Zi Xi Xin Tang!” ::dusts off hands with a satisfied grin:: Done.

Of course it’s not that simple, but I do think Ma Huang Fu Zi Xi Xin Tang would be the best place to start. My inclination is to assume that, because she stated that back in 2008 she had caught a bad cold and the overwhelming sleepiness began and really never stopped, that this syndrome is directly related to that “cold”.

When we look at the human body in terms of what the Shang Han Lun teaches us we know that there are 6 different layers, so to speak, that pathogens can exist in. Each of these layers will show a different set of symptoms when it is negatively affected by the presence of a pathogen, causing an imbalance. Think of it as an onion- each layer gets peeled away to reveal the next, deeper, layer. They are kind of like barriers too- each layer is trying to prevent the pathogen from being able to pass to layer underneath it. These pathogens can be any number of things, but right now I’m talking most specifically about bacteria and/or virus, and the chain reaction that their presence in the body can set off. Even when the bacteria is killed- say with antibiotics, or a virus becomes latent, the effects of its presence can be felt long after its activity. Like dropping a pebble into a pond- the pebble will immediately sink to the bottom, becoming one of many, no longer moving or affecting anything. Its disruption of the water’s stillness as the pebble splashed and sank, however, will continue spreading ripple after ripple, layer after layer, to the entire span of the lake.

So starting with the most surface layer of the body and working our way to the deepest we have

• Tai Yang (surface)
• Yang Ming
• Shao Yang
• Tai Yin
• Shao Yin
• Jue Yin (deepest)

Now, when you catch a “cold”, what’s actually happening, in terms of Chinese Medicine, is that Tai Yang layer is being invaded by a foreign pathogen and its energy flow is disrupted. Your body will begin to try to use it’s energy to push this pathogen (bacteria, virus, whatever) out via the most superficial mechanism possible- sweating. If Tai Yang layer can clear its self of this pathogen on its own because your body had strong  enough energy to begin with, then all is well, you will get over the cold and go on with your life.

Unfortunately, in a world of antibiotics and super-bugs, coupled with the “go, go,go, we can sleep when we’re dead” mentality, it is rare that a person is strong enough to circumvent the need for some sort of assistance in expelling this pathogen. Even if the symptoms of the cold eventually go away on their own, often times the bug has just moved deeper to the next layer, and the symptoms begin to change as it disrupts the natural flow of the Yang Ming or Shao Yang and so on. Even if the patient treated her cold with antibiotics, the condition could have done lasting damage- Dr. Ni has always said that the properties of these drugs are very cold, and from a Chinese Medicine perspective, antibiotics injure the Heart Yang.

One possibility, which I am assuming to be the case with our Sleeping Beauty patient here, is that the Tai Yang pathogen actually bypassed the other layers and was transmitted directly into the Shao Yin, which can happen with a person who has weak Zheng Qi. This basically means the energy (qi) that circulates at the surface of their body, and in the interior of their body, is insufficient to protect pathogens from moving deeper and affecting vital organs.  This energy can be weak due to prolonged illness, medication, aging, lifestyle, or a congenital disposition. At any rate, when the Zheng Qi is weak, Shao Yin can be affected directly as a result of a Tai Yang external invasion, because these two “levels” have a direct interior/exterior relation.

Tai Yang is comprised of the Small Intestine and Bladder, which are directly related to the organs of the Shao Yin-the Heart and Kidneys.

[I know this is confusing if you have never been exposed to this information before… I’m trying to do my best to make this relatable to everyone regardless of their knowledge of Chinese Medicine I hope I am somewhat succeeding.]

A disorder of Shao Yin transmitted directly from Tai Yang means that there is probably still a disruption of the Tai Yang that needs to be corrected.  Using herbs to promote sweating to help to release the exterior and expel any remaining pathogen may still be the best way to do that. Now, though, because we also have a disorder in Shao Yin level, we have to address that too. Once the Shao Yin level is impaired you will end up with an accumulation of cold, stagnant fluid. Basically once there is an imbalance between these levels you’ll find that heat stops being transmitted to the ministerial fire (or the temperature of the small intestine) from the heart. This causes yang to fail to get to all of the abdominal organs, and eventually cold fluid stagnates as movement and heat stop, the cold fluid gets into circulation and gets back to the heart, which further impairs/cools heart and pericardium yang- and the Shen starts to diminish.

If you read back to my previous blog entry, “Here’s To Your Health” you can find a more detailed explanation of the function of the heart and kidneys in the eyes of Chinese Medicine. This basically explains how the heart’s energy is needed to warm the kidneys, and create the energy they need to metabolize fluid. If the heart’s yang is weakened, the kidney’s energy will be weakened and cold fluid will be retained in the vessels. This causes typical symptoms of feeling sleepy all day, as the burden of the cold fluid on the body gives the sensation of feeling “heavy”. A desire to lay and sleep, often curled up, because the natural tendency of cold is contraction, as opposed to the expansion of heat. Other symptoms would be cold hands and feet. Dislike of cold temperatures. The mental and emotional symptoms associated with all of this are due largely to a diminished Shen (mind/spirit)- as the heart and pericardium lose their vital heat, the Shen (which is rooted here) is effected.

Numerous web sources on Kleine-Levin Syndrome include these symptoms as well:

1. confusion and disorientation
2. lack of energy
3. apathy (lack of emotion)
4. hypersexuality (mostly in males), depression and/or mental agitation uncommunicative, even when awake
5. hypersensitivity to sound and light
6. excessive eating
7. episodes can be triggered by menses in females

I want to explain each of these in relation to my take on this syndrome.

1. Confusion and disorientation:
   • The kidney function is impaired, they are burdened with an onslaught of cold fluid that they are unable to process. The kidneys control mental function- memory, comprehension, focus, mental clarity.
2. Lack of energy:
   • Again, the cold water acts as a burden to the body and fluid retained in the vessels makes the body feel heavy and lethargic. Adequate amounts of good quality blood is not circulating to the vital organs. Kidneys also play an important role in energy level, if kidneys are weak, your energy will be low.
3. Apathy and lack of emotion:
   • The heart is the center of all emotional processes in the body. According to Chinese Medicine all organs have an emotion attached to them, and this is true of the heart as well, but it is also has the additional task of processing all of the emotions. When the heart is blocked by a stagnation of cold fluid, it is unable to process these emotions effectively, leading to disconnect and apathy. Again, the Shen losing its root and becoming weakened.
4. Hypersexuality,Mental agitation,Depression, Uncommunicative even when awake
   • As written by Dr. Heiner Fruehauf in his essay “All Disease Comes From the Heart”  which points out that according to Wang Fengyi’s “System of Five Element Associations”, the heart (fire element) corresponds to the positive qualities of “understanding and connection”. On the other hand, the heart also corresponds to the negative association of “inappropriate sexual behavior”.Weakness of the kidneys often plays a role in sexual dysfunction, though it is generally has more to do with impotence or lack of libido, not the hypersexuality. It is possible though, due to the dual nature of this “syndrome” that during “sleeping spells” the patient experiences hypersexuality and the opposite outside of these spells. I would have to ask.
5. Hypersensitivity to sound and light
   • The hearing is controlled by the kidneys, and so are the pupils. A healthy pupil reaction (constricting in bright light, dilating in dim light) is indicative of good Kidney Yang. On the other hand when the pupil is unable to have to energy to constrict in bright light, it takes in an overwhelming amount, causing discomfort. This tells me there is a weakness of Kidney Yang, or function/heat. 
6. Excessive eating
   • Most patients don’t seem to express hunger, but are simply driven to eat. I’ve seen this to a certain degree with people who have an impaired nutritional absorption in the past. It can be something as simple as your body’s natural way of telling you that it is lacking nutrients.  The patient misinterprets this signal by being driven to overeat. Of course the cold fluid retained in the body is going to impair the spleen function, which helps to create blood and qi from the food you eat. If your spleen isn’t able to do those things because it lacks the yang it needs, this a likely cycle to see. 
7. Episodes can be triggered by menses in females
   • Because the spleen is unable to create blood from nutrients the body become blood deficient. This exacerbates the problem of proper blood circulation and cold in the system. When more blood is lost during menstruation, the patient is further depleted and feels more fatigued and an episode is triggered.
   • Because the Shen is rooted in the blood of the heart, mental distress is a common symptom in blood deficient patients.

I would start with Ma Huang Fu Zi Xi Xin tang or some variation of it, of course depending on specifics and see how she responded. Hopefully it would be by having a larger volume of urine as some of the cold fluid was eliminated and by feeling more well rested upon awakening. After seeing a shortened frequency, duration and severity of these “sleeping spells”I would continue using this as a base formula until her pulse and other symptoms indicated that we had cleared the Shao Yin stage. This might manifest as the original pathogen working its way back to the Tai Yang, giving her the symptoms of that original cold or flu that she had a few years ago. I would give her the appropriate herbs to  expel it from Tai Yang, most likely via inducing sweating. Then once all of that was cleared I would focus on strengthening the underlying weaknesses she may have had in the beginning that allowed a simple cold to wreak such havoc on her system. This would  include herbs to strengthen the heart and kidney yang, of course, in addition to whatever other deficiencies she may present with- that’s a hard thing to guess at this point. 

I suppose this is all I really have to say on the topic. If anyone has any feedback, please comment. I’m curious what other Chinese Medicine minds think.