As I write this, we are deep into autumn and winter is coming. It’s the time of year when many of us start to think more about how well our immune system is functioning. We hope to be able to avoid more severe courses of the seasonal viruses that will inevitably circulate during the winter months. This year, of course, we not only have colds and influenza to worry about. We continue to be preoccupied with COVID-19, which appears to be surging around the world with the coming of winter to the northern hemisphere. Those of us in the Western United States may wonder, additionally, whether persistent exposure to wildfire smoke (or avoidance of outdoor activity due to smoky air) over the past two months, during this year’s unprecedented fire season, may have impacted our abilities to deal with infections this winter.
In this late autumn context, in the midst of a pandemic, with flu season up on us, I thought it could be useful to talk about immunity.
In March 2020, as the pandemic arrived in North America, Dr. Weizenbaum and her colleagues were learning about the treatment of COVID-19 in China & beginning to treat COVID patients on the East Coast, using classical Chinese herbal medicine prescriptions. At that time, Dr. Weizenbaum gave a lecture on her interpretation of the Chinese medicine perspective on immunity and the immune system, drawing particularly on the classical Chinese Medicine text, the Discussion of Cold-Induced Disorders, or Shang Han Lun, attributed to the Eastern Han Dynasty physician Zhang Zhong-jing (150-219 CE.)
This lecture was much more theoretical than practical, and did not go into specific herbs and therapies. I found interesting Dr. Weizenbaum's effort to "open the narrative" on immunity, distinguishing between an us-vs-them perspective & a more holistic, integrated view of host and environment.
Opening the “Standard Narrative” on Immunity:
Dr. Weizenbuam begins her lecture by stating that there is a standard narrative on immunity that informs our approach to infectious disease in the modern, western world. It is characterized by a dualistic and militaristic quality, an "us vs them" perspective. It is basically:
There are bad things out there. They can “get in” and “GET ME.”
The way to stay healthy is to strengthen my defenses and keep the bad things OUT.
If they get in, I need to ATTACK them, kill them, and/or get them out.
My “immune system” keeps things out and helps my body FIGHT BAD THINGS OFF.
Dr. Weizenbaum acknowledges the value of this narrative for some purposes. In the context of the pandemic, the narrative of “there are bad things out there that can get inside of me” forces us to social distance, which in turn slows the spread of the virus and saves lives.
At the same time, Dr. Weizenbaum states that this narrative of immunity can have some negative outcomes. She seeks to open our understanding of immunity to different narratives.
There is No “One-Size-Fits-All” Approach,
Everyone Needs to be Treated as an Individual:
Dr. Weizenbaum acknowledges that the idea that “there are bad things out there that can get inside of us” created an atmosphere of fear at the onset of the pandemic. Some of us sought protective herbs. Various one-size-fits-all preventive herbal or medicinal formulations got pedaled around the internet. There were recommendations for herbal formulas consisting of cold, bitter “antiviral” herbs; and others for warm, dispersing “protective” herbs. Dr. Weizenbaum points out that herbal prescribing needs to be more nuanced, based on a complex understanding of the natures and qualities of herbs, as well as the synergistic qualities of herbal formulations. It also needs to be based on an understanding of each individual’s specific need as determined by a differential diagnosis of symptom patterns and constitution. If a patient is already cold, they should not take cold, bitter herbs. This could make them worse. If a patient is symptomatic, they should probably not take warming, tonifying herbs. Simplistic one-size-fits-all herbal preventive measures, though attractive in the face of a scary viral pandemic, could be dangerous for certain individuals.
The Immune System is Not Just One Thing:
Dr. Weizenbaum continues her lecture by broadening our perspective on the immune system. Asking, “How, then, do I help my immune system?”, she notes:
The “immune system” is none other than the sum-total of the functions of my whole body. Immunity is based on the collective functioning of all body systems: circulatory, digestive, respiratory, nervous, etc.
If this is true, I should observe: How does my body function? How is my body not functioning optimally?
Often one can observe a weak link or two in how our body is functioning. This weak link, she states, is the area that needs strengthening, or optimizing, as we seek to improve our immunity.
For example, if every time I eat, I get bloated, and food moves through my body really slowly, perhaps this inhibits my body’s ability to create healthy cells. So, digestion and assimilation of nutrients is the area that needs attention as I seek to boost my immunity.
Various Historical Approaches to Infectious Disease in Chinese Medicine:
Next in her lecture, Dr. Weizenbaum briefly surveys some of the approaches to infectious disease in various historical periods of the Chinese medicine traditions. You can find a brief summary of these here, in one of my blog posts from earlier this year.
Dr. Weizenbaum concludes that some of these approaches are still dominated by the narrative of “bad things out there.” For example, she states, the 18th century “Wen Bing” or “Warm Disease” theory, which arose in China in response to the introduction of western viral infections like measles & mumps, is basically restatement of the idea that there are “bad” viral pathogens out there that can get inside of me. In the Wen Bing school of thought, we look at a patient’s symptoms to reveal the “nature of the pathogen.” I.e., if the patient’s tongue has a yellow-greasy coating, then the pathogen must be warm and damp. But what exactly does this mean, that the pathogen is warm-damp? Is there really a pathogen inside of us spreading heat and dampness? What exactly is that pathogen doing in our body? Modern-day practice of Traditional Chinese Medicine continues to follow this pathogen-focused approach: i.e. we have to find, identify and attack the pathogen, using herbs that counter the nature of that pathogen. With the increased influence of western biomedical theory, modern practitioners of TCM seek to add herbs shown to have “antiviral” properties to our armory for treatment and prevention of viral infection.
Ultimately, having surveyed these historical Chinese medical schools and trends, Dr. Weizenbaum chooses to be guided by the older classical Shang Han Lun (or Cold-Induced Disorder) laid out in the writings of the Eastern Han Dynasty Physician Zhang Zhong-Jing (150-219 CE,) which she feels is more compatible with an expanded understanding of the human immune system. Again, see my previous blog post for more information on these various historical streams in the Chinese medicine approach to infectious disease.
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| Eastern Han Dynasty Physician Zhang Zhong-Jing |
“This is a Narrative About the World and Life:” A Different Narrative on Immunity
In her understanding of Shang Han Lun theory of diagnosis and herbal treatment, Dr. Weizenbaum sees an understanding of immunity that is wider than the dualistic, militaristic “bad things out there that I need to protect myself against” narrative.
The narrative she seeks to embrace, in her approach to health, healing and immunity, is about the world and life. It involves an understanding that:
The nature of life is one of interconnection;
Health is about being in a workable relationship with life;
Healing is about coming into this workable relationship with life.
The fact is that the novel coronavirus (COVID-19) has become a part of our world. Part of “boosting our immunity” to this virus might be our body making a shift so that we can eventually live with the virus without it causing us problems. Illness or infection with the virus might be perceived as a process of our body shifting, so that we can now live with the virus as part of our world.
Dr. Weizenbaum states that, with this shift in perspective, the question changes from “how do I keep the virus out of me?” (although this is also important at this stage!) to “When I do get sick, how can I help my body process this, so it doesn't hurt me so much? How can I improve my chances of coming through the illness well, and to become able to live with the virus being part of my world?”
Dr. Weizenbaum states that Chinese medicine, and Chinese herbs, have a lot to offer in terms of helping our bodies shift into a workable relationship with the new virus.
What Is COVID-19 then? And how does it relate to our Immune System?
Dr. Weizenbaum states that COVID-19 is something new in our world that we are being forced to come into relationship with. And our immune system, in this narrative, is the sum of all our body functions that help us learn to come into relationship with the outside world. It is our immune system that enables us to learn to live in harmony with the world outside our bodies, which now includes the COVID-19 virus. This view is in contrast to the dualistic, militaristic idea of our immune system “fighting off the virus.”
How Do the Symptoms of COVID-19 Guide Us?
Dr. Weizenbaum tells us that our symptoms, when we contract an illness, tell us two things:
The specific ways in which our specific body is having a hard time coming into relationship with this illness, and
What demands this new illness is making is making on our individual body as we come into relationship with it. (i.e. we can consider what particular demands this particular virus is making on certain systems of our individual bodies, based on where dysfunction shows up as we encounter the virus.)
As A Healer…
As healers, then, our goal is to help the patient’s body come into relationship with this new virus. (The same can be said for any of us caring for ourselves as we encounter a new challenge.) Our process of diagnosis is to observe where the body is having a hard time in terms of physiological functions (rather than considering the specific nature of the pathogen.) Our treatment is to provide measures to help the body process this new challenge better, and to not let it kill us/the patient.
Seeing the Body as a Circle
Having established a foundational framework that our bodies are part of an interconnected network of life in the world, Dr. Weizenbaum further describes how our bodies relate to and interact with the world. Our bodies, she states, function as a circle. We are constantly taking in life and nature, and giving back to nature. In this way, we live with nature. We are nature.
We take in life/nature in a vertical downward motion, according to natural rhythms, through breath, digestion, our pores, our senses and our hearts. We give back to nature not only through our breath, our pores, our excrement, but also through our actions, our relationships, our creations, our lives.
If we try to keep something out (as in “keep out the virus,”) we are stopping a natural, cyclical process.
So, we are constantly taking in and giving back, in a cyclical manner. We are in a permeable relationship with life. The ability to do this well is the mark of a healthy immune system.
Problems (illness) occur when:
Our body doesn’t process something well, or
Something is being demanded of our body that is beyond our body’s ability to process.
By extension, COVID-19 makes a person very ill or, tragically, kills a person when:
- The person’s body can’t process the virus in some way, and
- The person’s body does not get the help it needs to process the illness.
At least in the early stages of the pandemic, western medicine was mostly at a loss in terms of what to offer to help a patient's body process the virus before it became severe or life-threatening. Some interventions might include a humidifier, or over-the-counter medications like robitussin or mucinex. Chinese herbs are another supportive intervention.
COVID-19, Dr. Weizenbaum states, is coming into our world with very particular demands on our bodies. Her application of herbs is to help the body shift in a way to allow the novel virus to move through without hurting us so much. Diagnosis is identifying where in the cyclical process of taking in nature and giving back our bodies need help. The signs and symptoms an individual experiences in the course of a COVID infections give us the answer: where exactly in this cycle does the body need help to process.
I will not go deeply into Shang Han Lun theory here, because that's a more lengthy & complicated discussion. Suffice it to say, Shang Han Lun theory illustrates six places in this this circular cycle where obstruction, insufficiency or dysfunction can occur. (For example, is there a blockage in our body's ability to vent a pathogen at early onset? Is there a blockage in the descension of food and oxygen? Do we lack ability store vital energy? Is our ability to tranform what comes in into vital energy? Etx.) Signs and symptoms are very specifically described in the Shang Han Lun text, which guide diagnosis of these dysfunctions. Herbal formulas aid physiological function by addressing these specific areas of dysfunction.
In conclusion, I thought that this holistic perspective on immunity provides a nice counterpoint to our dominant narrative on host vs pathogen. I see these contending narratives play out in various medical approaches. On one extreme, western medicine devotes itself to understanding the nature of the infectious pathogen and its impact on our bodies in minute biochemical detail, and thereby learning how to fight and kill it. Holistic medicine, by contrast, tends to be more interested in cultivating the host's immune physiology. May the two systems work together, and perhaps the holistic view perspective might help us live in the world with less fear, and more peace and gentleness.
