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Journal of Chinese Medicine Gu Syndrome 57 10

Journal of Chinese Medicine Gu Syndrome 57 10

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Published by Mise En Abyme
Chinese Medicine
Chinese Medicine

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10
 JOURNAL OF CHINESE MEDICINE NUMBER 57 MAY 1998
DRIVING
 
OUT
 
DEMONS
 
AND
 
SNAKES
A
 
FORGOTTENCLINICAL
 
APPROACHTO
 
CHRONIC
 
PARASITISM
by Heiner Fruehauf
A
s the field of Oriental medicine matures in amodern environment, we are beginning to be-come aware of the enormous dimensions that thisfield encompasses. While ten years ago the Western publicstill thought of Oriental medicine as a synonym for acupunc-ture, most practitioners have now broadened their under-standing of the term to something that includes acupuncture,moxibustion, herbs, dietetics and qigong exercises. Althoughother clinical approaches that once shaped the face of Chinesemedicine, such as Daoist psychotherapy or the application of herbs to acupuncture points, remain forgotten, there is goodreason to believe that in time they will be unearthed and putto use in a modern clinical context.This presentation is an attempt to participate in the proc-ess of 'medical archaeology' by exploring one of the sub-merged areas of Oriental medicine, namely the complexand variegated clinical approach to the diagnosis and treat-ment of Gu syndrome (
 gu zheng
). A review of the mod-ern research literature showsthat this topic has remainedvirtually unexplored in bothChina and the West
1
. Al-though there are too manyclassical references to en-tirely ignore the phenom-enon of Gu syndrome, mainland Chinese scholars gener-ally dismiss it as an “ancient, feudalist and superstitious” belief in demons and exorcist practices that has little or novalue in modern clinical practice. However, a close exami-nation of the original texts illuminates the mysterious con-cept of Gu syndrome as a valid clinical approach that maypotentially provide an answer to the many invisible ‘de-mons’ that plague patients in a modem age, namely sys-temic funguses, parasites, viruses and other hidden patho-gens.
Cultural and Medical Concepts of Gu
Historically, the term Gu was first introduced as a metaphorfor stagnancy, debauchery, degeneration and hidden evil.The words
 gudao
(the way of Gu) and
wugu
(shamanic Gupractice) are mentioned in one of China’s earliest historicalrecords as a reference to black magic used to kill or confuseothers, “Shamanic Gu practice entails the administration of poison to people, causing them to forget who they are”
2
.The
Book of Records
(Shiji), moreover reports that in 91 BCEa Gu incident resulted in the annihilation of tens of thousandsof people. The unsuspecting victims were reportedly killed by the black magic practice of putting spell-cast woodenpuppets into the ground close to them
3
. In this context, theterm ‘Gu’ describes a situation where the attackers were inthe dark, while the victims did not know what washappening to them. It was this original meaning - a type of yin (hidden) evil that is doing harm to people’s mental andphysical well being - that became the trademark of allother Gu phenomena inChinese cultural history,including the medical conceptdiscussed in this essay.It is the mother matrix of Chinese civilisation, the
Yijing
(Book of Change), that pro-vides the earliest clues for an understanding of the medicalconnotations that were originally associated with the termGu. Hexagram eighteen is entitled Gu, here most oftentranslated as 'Degeneration'. It is formed by the trigram
xun
(wind) below and the trigram
 geng
(mountain) above.Classical commentators have remarked that this particularhexagram describes an energetic situation where a feeblewind cannot penetrate the dense area at the mountain’s base, creating a place that does not receive air and thus becomes decayed and rotten. According to the movement
GU SYNDROME
 A close examination of the original texts illuminatesthe mysterious concept of Gu syndrome as a validclinical approach that may potentially provide ananswer to the many invisible ‘demons’ that plaguepatients in a modem age, namely systemic funguses,parasites, viruses and other hidden pathogens.
 
11
 JOURNAL OF CHINESE MEDICINE NUMBER 57 MAY 1998
oriented philosophy of the
Yijing
that laid the foundation of all Daoist sciences, including Chinese medicine, movementmeans life and health, stagnation means death and disease.In the broad cultural context of the
Yijing
, Gu thus marks astate of extreme stagnation where corruption and decayhave already manifested and can no longer be ignored.Whether this occurs in society as a whole or in the micro-cosm of the human body, the oracle advises that onlydrastic (albeit thoughtful) action can turn this serious situ-ation around. Gu, in short, is the ancient Chinese symbol forextreme pathological yin - the dark side of life, the worstnightmare of any human being. It represents darkness,rottenness, slithering vermin, poisonous snakes, betrayal, black magic, backstabbing murder and in medical terms,progressive organ decay accompanied by torturous painand insanity.The Chinese pictogram for Gu yields similar information.Brilliantly exemplifying the multidimensional quality of the symbolist mode of expression, the character Gu cap-tures both the concept of decay as well as its most pertinentcultural and medical manifestations. Since the beginning of Chinese writing approximately 3,500 years ago, it has por-trayed either two or three worms squirming in a vessel. Inthe words of a traditional commentator “Gu is if a cookingvessel remains unused for a long time and worms start togrow in it”
4
.This symbol also reflects a bizarre yet widespread practiceof ‘black alchemy’. Many traditional medical texts defineGu as the verminous manifestation of evil that appearswhen a wide variety of toxic worms and insects are lockedinto a vessel, where they naturally become each others prey.After a period ranging from three to twelve months, onlyone snake-like worm remains, which is said to contain thevicious and toxic potential of all the others. The ‘seed’ of the‘Gu worm’ (
 gu chong
), in a procedure of which the technicaldetails remain unclear but which nevertheless can be clas-sified as an early example of biological warfare, was thenused to poison other people. The victim of these uncannymachinations appeared to die from a chronic disease andGu poisoning was thus regarded as a popular way to killwithout exposing the attacker - a scenario similar to Napo-leon’s ‘sickbed’ death induced by small but regular doses of arsenic, the true nature of which came to light only after theadvent of hair analysis.As in other occult practices, the details of the productionand application of Gu poison were kept secret by thecommunities that commanded them. Although primarilydesigned to empower their guileful masters by appropriat-ing the victims’ wealth and source energy on both a materialand a magical dimension, some practitioners apparentlyused it to further their political goals. Zhang Jiao for in-stance, the Daoist wizard and co-architect of the YellowTurban uprising that toppled the powerful Han dynasty1800 years ago, is said to have been “a master of Gu, thehighly destructive and disorienting effects of which haveoften been confused with magic”
5
.Reminiscent of homeopathic reasoning, the ground-upGu worm was also renowned as one of the most effectiveremedies against Gu poisoning. So widespread was theproduction of Gu and anti-Gu substances that entire re-gions in Southern China became known as commercial Gucentres, similar to villages that base their livelihood on thecultivation of herbs. A host of textual references indicates,moreover, that the Gu phenomenon was deeply entrenchedin the habitual texture of Chinese everyday life. Ancienttravellers routinely carried rhino horn powder, said tomake contaminated food foam, or other ‘anti-evil’ sub-stances such as musk, realgar and garlic. The repercussionsof Gu hysteria finally reached a state of intensity that causedthe government to intervene. In 598 CE, according to theofficial dynastic annals, an imperial decree was issued thatexplicitly forbade the manufacture of Gu worms
6
. Althoughthe widespread application of this misguided alchemicalpractice has since disappeared, it reportedly survives untilthe present day among the mountain tribes of SouthwestChina
7
.In medical texts, the character Gu most often describes asituation where the vessel of the human body is filled withthriving parasite populations that eventually bring about astate of extreme stagnation and mental and physical decay.China’s earliest dictionary, the
Shuowen Jiezi
(An Explana-tion of Symbolic Lines and Complex Pictograms), definedGu as a state of “abdominal worm infestation” 2000 yearsago
8
. It is important however, to point out that traditionaltexts always use the term Gu syndrome (
 gu zheng
) in con-trast to worm syndrome (
chong zheng
). Whether initiated byman-made Gu poisoning or by natural infection, a parasiticsituation labelled as Gu syndrome traditionally warrantsthe presence of particularly vicious parasites, or a superin-fection of many different kinds of parasites that combinetheir toxic potential to gradually putrefy the patient’s bodyand mind. From a modern perspective this definition of Gu
 Hexagram 18: Gu/Degeneration Ancient pictograms for Gu: worms in a pot
 
12
 JOURNAL OF CHINESE MEDICINE NUMBER 57 MAY 1998
syndrome points to aggressive helminthic, protozoan, fun-gal, spirochete or viral afflictions that have become sys-temic in an immune-compromised patient. In ancient China,schistosomiasis and chronic entamoeba infections may have been the most common manifestations of Gu syndrome.
Physical and Mental Signs of Gu Syndrome
Traditional medical sources present varying accounts of theaetiology and pathogenesis of Gu syndrome, but they allagree on the devastating nature of the disorder, “Gu rankssecond only to the viciousness of wild beasts when it comesto harmful natural influences; although Gu unfolds itsharmful nature only long after the initial encounter, it killspeople just the same”
9
.Here are some of the clinical characteristics that arefrequently highlighted in the traditional Gu literature: i. Gupathogens are malicious and have life-threatening conse-quences; ii. Gu pathogens primarily enter the body throughfood; iii. Gu pathogens represent a type of toxin (
 gu du
). Thismakes reference to their virulent epidemic quality, but alsoto the only recently corroborated fact that the metabolic by-products of parasitic organisms have a toxic affect on the body. Starting with the 7th century medical handbook,
Zhubing Yuanhou Lun
(A Discussion of the Origins andSymptomatology of All Disease), classical texts have statedearly on that “Gu can transform itself into harmful toxins”
10
;iv. Gu pathogens are most likely to thrive in already defi-cient organisms, and once established further harm the body’s source qi; v. Gu pathogens operate in the dark. It isoften unclear when and how the pathogen was contracted,making an accurate diagnosis extremely difficult. Due tothe multiplicity of potential symptoms moreover, mostdoctors appear confused by Gu pathologies. Chinese mas-ter physicians have continuously pointed out that Gu-induced chronic diarrhoea, ascites, wasting syndrome,mental symptoms, etc. must be diagnosed and treatedcompletely differently from the general occurrence of thesedisorders. “The coarse doctor treats the Gu type of diar-rhoea just like regular diarrhoea,” the Ming Dynasty ency-clopaedia
Puji Fang
(Common Aid Formulas) emphasises,“and this is completely wrong”
11
.Some of the typical Gu symptoms cited in the literaturerefer to the familiar picture of acute protozoan infection,such as abdominal cramping and pain, vomiting, and theexcretion of bloody stools. Others paint the infinitely morecomplex and variegated picture of systemic superinfection by chronic parasites, funguses and viruses. “There arethousands of Gu toxins, all of which may potentially causedifferent symptoms” the authoritative 6th century encyclo-paedia
Beiji Qianjin Yaofang
(Thousand Ducat Formulas)explains, “some of them will cause bloody stools, whileothers initiate the desire to lay in a dark room; others may bring about bouts of irregular emotions, such as depressionthat alternates with periods of sudden happiness; othersagain cause the extremities to feel heavy and ache all over;and then there are myriads of other symptoms that we donot have the space here to list in their entirety”
12
.Although it is one of the defining trademarks of Gusyndrome as well as my own clinical experience that chronicparasitism may involve virtually any symptom in virtuallyany combination, for diagnostic purposes the indicationsmost consistently quoted in traditional texts can besynopsised in the following way.
Digestive symptoms
Chronic diarrhoea, loose stools or alternating diarrhoeaand constipation; explosive bowel movements; abdominal bloating or ascites; abdominal cramping and/or pain; nau-sea; intestinal bleeding and/or pus; poor appetite or raven-ous appetite, peculiar food cravings.
Neuromuscular symptoms
Muscle soreness, muscle heaviness, muscle weakness; wan-dering body pains; physical heat sensations; cold nightsweats; aversion to bright light.
 Mental symptoms
Depression, frequent suicidal thoughts; flaring anger, fits of rage; unpredictable onset of strong yet volatile emotions;inner restlessness, insomnia; general sense of muddlednessand confusion, chaotic thought patterns; visual and/orauditory hallucinations; epileptic seizures; sensation of “feeling possessed.”
Constitutional signs
Progressing state of mental and physical exhaustion, indi-cations of source qi damage; dark circles underneath theeyes; mystery symptoms that evade clear diagnosis; historyof acute protozoan infection; history of travel to tropicalregions; floating and big pulse or congested (choppy) pulse;stagnation in sublingual veins; rooted damp tongue coat-ing; red tongue tip or red ‘parasite dots’* on top of thetongue.Among this wide range of signs and symptoms, it is thedistinct presence of mental symptoms that (usually in com- bination with digestive problems) is the most consistentlyquoted element of Gu Syndrome. The
Chunqiu Zuozhuan
(Spring and Autumn Annals), one of the earliest extantChinese texts, relates the story of an erotomanic marquiswho acted “as if suffering from Gu disease” when comingclose to the female quarters of his estate, and concludes that“Gu is a disease which catapults a person’s mind and willpower into a state of chaos”
13
. A later commentator pointsout that the Chinese character for worm or parasite isactually an integral building block in the pictogram
 feng
*Parasite dots (chong ban) are little red dots that generally cluster onthe front third of the tongue (shining through a greasy tongue coating),sometimes extending to the middle. They are often said to be indicativeof worms and other parasites (especially when observed in children).They are a sign of “localised heat” amidst the dampness, an energeticenvironment that, while different from damp-heat, is typical for mostparasitic disorders.

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