While attending herbology classes in acupuncture school, I recall being presented with scenarios that seemed far-fetched. One example of this is the diagnosis of "running piglet syndrome," in which the patient experiences a sensation moving from the pubis to the sternum as if a small animal were running over the abdomen.
Another area which seemed to be far from my scope of concern was herbs to treat parasites. It seemed to me a waste of time to cover such subjects such as roundworms and liver flukes. However, early in 1991, I was presented with a puzzling case. A female in her late twenties came to me with a complaint of alternating constipation and diarrhea. After an apparently successful treatment she returned a week or so later with urinary retention and discomfort upon voiding. This I also treated with apparent success only to receive the report of a relapse of the first condition. I repeated the bowel treatment (again successfully) only to receive the report of the return of the dysuria and retention. At this point I felt that I needed a more thorough history than I had previously taken since the patient was a visitor from Europe and perhaps something significant had ocurred to her outside of the US. The thorough history revealed an accidental plunge into the Nile river in Egypt. She had fallen into the water and drank some of it. She had to be revived and upon her return to Europe she had been treated with prednisone for schistosomiasis.
With the necessary information I was able to complete her treatments with no more relapses. That very unusual case aside I assumed parasite infestation to be a scenario for Africa or Asia and not close to home. That is until I watched a few travel and cooking shows on television. As I watched chefs competing and critics commenting I had some reason for concern. The trend in gourmet dining towards searing meats and fish, cooking the protein on the outside while leaving the inside very rare or partially raw can lead to the ingestion of vectors as well as parasite eggs and larvae.
Among the innovative dishes I have seen on the travels of hosts in search of exotic fare are: raw sea squirt, seared barracuda with crispy skin and raw flesh, raw dried shark, raw sun dried beef, snails and octopus grilled until smoke-flavored and eaten still raw, langoustine with raw body and grilled head as well as a variety of molluscs and crustaceans pickled in ceviche.
The shows featuring gourmet cuisine and competing chefs insist on meat other than pork being served rare and frequently feature both fish and meat seared, with the inside very rare. On these shows traditional forms of raw proteins such as crudo, carpaccio, ceviche and tartare are also frequently featured.
Among the traditional raw fish dishes on the global menu are: broodjeharing from the Netherlands, lutefisk and rakfisk from Scandinavia, kinilaw from the Philippines, Japanese kusuya as well as sushi and sashimi, Korean hongeohoe, Italian crudo, Latin American ceviche, and Icelandic hakare. Raw meat fare includes: African kibbeh nayyeh, goredgored, and kitfo, German mett, Italian carpaccio, Korean yuk hoe and a variety of tartares. Undercooked or raw fish is a source of anisaskis, a roundworm, which lives in the stomach causing stomach pain and nausea. Thorough cooking or freezing fresh fish below -14 degrees F for 48 hours can ensure safety. The larvae of the parasite is eaten by small crustaceans and squid. These are the food of fish which are eaten by humans. Snails are hosts to shistosomes or blood flukes. Raw crustaceans such as crabs, and crayfish can host lung flukes while fasciolopsis or intestinal flukes results from ingestion of the inermediate host, snails, or undercooked i.e. raw salmon and carp.
Also ocurring in freshwater fish are tapeworms in humans reaching nine meters. These infest freshwater food fish through tiny crustaceans, which ingest the tapeworm larvae and are eaten by small fish. These are consumed by carp for example. Found in undercooked "gefilte fish" and frequently in Scandinavia as the result of improperly prepared "lutefisk." Beef and pork tapeworms are found in the muscle tissue of cows and pigs. Beef in the form of carpaccio and steak tartare in Europe, Ethiopian gored-gored and kitfo, or Arabic kibbeh nayyeh can contain tapeworm larvae. Cooking for five minutes at 133 degrees F (56 degrees C) is all that is necessary to kill taenia saginata. Pork that is undercooked or in the form of tartare such as German "mett" can contain larval or encysted tapeworms.
Herbs that expel parasites are of two types: poisonous and edible. Poisonous herbs are used topically or in reduced quantities (li) orally. Edible herbs are combined to utilize their gentle, but effective specific actions. Herbs, which are toxic must be used with extreme caution. When used internally they are generally compounded in minute quantities less than 200mg. For further safety they are diluted with flour and honey and made into pills. Topical applications are ususally in the form of washes and poultices. Caution must be taken with poultices to prevent overexposure of the skin (or lesion) to the toxic material. If left unattended, even garlic can cause excessive irritation.
An example of a herbal formula using toxic herbs is Hua Chong Wan, the "dissolve parasites pill." Ku lian gen pi and he shi are toxic and active against round worms and tapeworms. Bing lang is not toxic. It kills tapeworms and flukes and expels them. These three are deputies and are used in the same dosage as the extremely toxic chief herb Qian dan (minium). This is modified by ming fan, which counteracts diarrhea due to the toxic ingredients and expelling properties of bing lang. Equal parts - 1500g of each deputy and the chief, with one fourth of that for the assistant. Envoys of honey and flour dilute the formula and pills of 9g are taken for short periods to prevent poisoning. A modification of this formula excludes qian dan and ming fan and substitutes shi jun zi and wu yi and is preferred for weak patients such as children, pregnant women, and the elderly.
One example of edible herbs in a formula for parasites is a modification of Wu Mei Wan (black plum pills). This combination consists of tonify middle qi herbs as assistants and two edible herbs, which kill parasites. Three fourths of the four gentlemen formula: ren shen, bai zhu and fu ling are assistants, while chuan jiao and wu mei used in identical doses are chief herbs.
Another set of edible herbs used to modify Wu Mei Wan can be used in combination with wu mei itself. These are shi jun zi, bing lang, and fei zi. Additionally , ku lian gen pi can be included. Although it is classified as toxic, it can be used in doses as high as two liang. Shi jun zi kills roundworms, while fei zi kills tapeworms and roundworms as does bing lang. Wu mei expels roundworms especially from the biliary duct. In this combination the chief herbs are bing lang and fei zi with shi jun zi and wu mei as deputies and ku lian gen pi as assistant. It should be noted that although not mentioned as a modifying herb in the above , shi liu pi (pomegranate husk) is effective in eliminating both tapeworms and roundworms and is used in combination with shi jun zi and bing lang.
My treatment for shistosomiasis was based on food herbs. The most active substance I used was bing lang 1 liang (30g). Being effective against flukes, betel nut not only kills the parasites, but also expels them, which eliminates the need for additional downward draining herbs such as da huang or fan xie ye. The deputy was nan gua zi (pumpkin seed)which has a specific effect on shistosomes inhibiting the development of the larvae. These seeds are used raw, crushed in a mortar to prepare for decoction.
I used 2 liang (60g) in the decoction along with 15g of purple skinned garlic which is able to assist the actions of both the bing lang and nan gua zi. I gave my patient one package of herbs per day for 10 days, the entire formula decocted in three cups of water. After reducing the liquid to one cup, the patient took one half of the decoction after lunch and the remaining half after dinner. I used the maximum recommended dosages because the herbs were mostly foodstuffs and safety wasn't a factor of concern.
After the 10-day course my patient had developed a moderate case of diarrhea with tenesmus. The feeling of unfinished defecation with pressure around the anus was caused by the bing lang's function of expelling the parasites. Any further continuation of this formula would probably result in rectal prolapse.
Having ascertained that the parasite symptom profile had normalized I replaced the first formula with Bu Zhong Yi Qi Tang. The dual function of strengthening the middle burner and uplifting the viscerae was amplified by the addition of zhe ke(3g) and increasing the huang qi to 30g. As adjunctive therapy I suggested that the patient take a snack of pumpkin seeds panfried with fresh garlic two to three times a day as the appetite would dictate for the next two weeks.
The same protocol was effective years later when I was confronted with a giardia case for which no traditional treatments were available for reference. The giardia case was the result of a camping trip in the Sierras of California while the schistosomiasis was contracted from the Nile river in Egypt. Not exactly your everyday locations or circumstances. But if care isn't taken to assure that the tartare or sushi is safe or if while traveling the kibbeh nayyeh, mett, or broodjeharing is a temptation, then a familiarity with the signs, symptoms and treatments for parasites may prove to be useful.
Gordon Cohen, LAc has been practicing acupuncture in the S.F.Bay area for 20 years. His TCM nutrition courses are approved by the NCCAOM and the California acupuncture board for distance continuing education (pda and ceu) and are available at www.gordonrcohen.com and www.barefootdoctorskitchen.com.