Leaky gut syndrome

LEAKY GUT SYNDROME A Modern Epidemic Problem Jake Paul Fratkin, OMD
Leaky Gut Syndrome (LGS) is a major cause of disease and dysfunction in modern society, and in my
practice accounts for at least 50% of chronic complaints, as confirmed by laboratory tests. In
discussing LGS, I want to first describe the situation in terms of western physiology, and at the end of
the article I will discuss aspects of LGS that are unique to Traditional Chinese Medicine.
In LGS, the epithelium on the villi of the small intestine becomes inflamed and irritated, which allows
metabolic and microbial toxins of the small intestines to flood into the blood stream. This event
compromisese lymphatic system, and the immune response including the endocrine
system. It is often the primary cause of the following common conditions: asthma, food allergies,
chronic sinusitis, eczema,ritable bowel, fungal disorders, fibromyalgia, and
inflammatory joint disorders including rheumatoid arthritis. It also contributes to PMS, uterine
fibroid, and breastGut Syndrome is often the real basis for chronic fatigue syndrome
and pediatLeaky Gut Syndrome is reaching epidemic proportions within the population. As a disease entity, it has
not been discussed in classical or modern TCM literature. In fact, taking a strictly classical Chinese
medicine approach to LGS is often ineffective or only partially effective, because the disease is not
addressed in all of its complexity.
TCM has never addressed the issue because it is a modern phenomenon. Historically, the only way
bowel toxins entered the blood stream was through trauma, for example by sword or spear. This
quickly led to septicemia that might be treatable, or more probably, ended in death. Outside of trauma,
the body maintained a wonderfully effective selective barrier in the small intestine, one that allowed
nutrients to enter, but kept out metabolic wastes and microbial toxins rampant in the intestines.
What modern event allowed such a break-down? Primarily it ha, secondarily non-
steroidal antiinflammatory drugs (NSAIDs). The first antibiotic, penicillin, did not enter mainstream
health care until 1939. Since the 50s and 60s, antibiotic use has been frantically prescribed for every
infection and inflammation, particularly pediat, bronchitis, and sore throat. It is sadly
ironic that most of these infections are viral in nature, and not only are the antibiotics damaging, but
they are ultimately unnecessary. Antibiotics should be considered a hospitalization level medicine,
when bacteria have entered the blood, bone, or organ.
NSAIDs are commonly taken for various nclude ibuprofen (Motrin, Advil). They are quite
damaging to the small intestine mucosa lining.

Antibiotics destroy beneficial bacteria.
Antibiotics create their damage in two ways. The first is by destroying beneficial bacteria. The small
intestine and large intestine host over five hundred different kinds of beneficial bacteria. These
bacteria perform hundreds of functions required for healthy metabolism and immune response.
Through enzyme secretions, bacteria transform metabolic and microbial wastes before they are
discharged by the body. These wastes include cellular debris, hormones, chemical wastes, bile, pus
accumulations, viral toxins, bacterial toxins, etc.
For example, the body creates bile not only as a lubricant to flush wastes out of the liver, but also, by
its cold and bitter nature, to detoxify many of the poisons accumulating in the liver. Bile however is
extremely caustic to large intestine epithelium. When bile enters the small intestine via the common
, beneficial bacteria break the bile salts down into a less caustic compound, making it non-
dangerous by the time it reaches the large intestine. When you take antibiotics you destroy these
bacteria and the bile salts freely enter and damage the large intestine. I believe this contributes
significantly to the high inciociety.
Beneficial bacteria also break down hormone secretions that are discharged from the liver to the small
intestine. If you lack the bacteria to break down and the intestinal permeability has been
altered, the patient is now reabsorbing estrogens in their original state. The body will deposit these in
estrogen sensitive areas such as the breast, uterus, or ovaries, contributing, if not causing, fibroids and
tumors. The same scenario is responsible for premenstrual syndrome as well.
Antibiotics Promote the Growth of Fungus.

The second way antibiotics damage the intestines is by fostering the growth of Candida Albicans and
other pathogenic fungi and yeast. This event, more than any other, precipitates Leaky Gut Syndrome.
In a healthy situation the small intestine epithelium maintains tight cell junctions, which contributes
to the physical barrier involved in intestinal absorption. In addition to the physical barrier, there is an
important chemical barrier within the mucus that contains immune agents which neutralize any toxin
that comes in contact.
Candida exudes an aldehyde secretion which causes small intestine epithelial cells to shrink. This
allows intestinal toxins to infiltrate through the epithelium and into the blood. The secondary barrier -
immune agents in the epithelial mucus -remain the sole agent for neutralization. Eventually, the
immune system becomes exhausted rising to this challenge.
Many people have an erroneous belief that the Candida itself enters the blood stream, allowing it to be
deposited elsewhere, such as the brain. Unless the immune response is completely depleted, as in
AIDS, Candida is quickly destroyed in the blood. The real damage done by Candida is to the intestinal
epithelial barrier, allowing the absorption of serious toxic agents and chemicals, which then enter the
blood and affect numerous organs, including the brain.

Food Allergies: The Complicating Factor.
When the integrity of the intestinal barrier has been compromised, intestinal toxins are not the only
pathogens to be absorbed. The barrier, in a healthy state, selectively allows digested nutrients to enter
the small intestine when all is ready. With leaky gut, nutrients can be absorbed before they are fully
digested. The body’s immune response, through specific antigen-antibody markers, will tag some of
these foods as foreign irritants. Every time that particular food touches the epithelia, an inflammatory
immune response is mounted which further damages the epithelial lining. What started as a Candida
irritation with shrinking of the cells has now been complicated with active inflammation every time a
particular food is eaten. Food allergies are a common secondary problem to Candida, and if present,
will maintain the leaky gut continuously, even if the Candida is eradicated.
The most common food allergies are dairy, eggs, gluten grains (wheat, oats, rye), corn, beans
(especially soy), and nuts. There are seldom real allergies to meat, rice, millet, vegetables, or fruit,
although an allergy to garlic is not uncommon. We have to distinguish a real allergy - that which causes
a histamine inflammatory reaction at the site of the SI epithelia - from sensitivity, which may cause
uncomfortable symptoms, but seldom is damaging. Sensitivities are usually due to low stomach acid or
pancreatic enzyme secretion, that is, poor digestion.
In the healing of the intestinal lining, exposure to a significant allergy can sabotage the treatment. For
example, one may be very good at restricting wheat, dairy and eggs, but then compromises the
treatment by taking garlic tablets.

The Role of the Liver and Lymphatic System.
The metabolic and microbial toxins that enter the bloodstream during leaky gut end up in the liver,
which has the job of detoxifying and discharging the poisons. Under normal conditions, the liver is
taxed just by processing the daily metabolic wastes created by cell and organ activity. Imagine the
further load created by dumping serious intestinal toxins on a regular basis. There is a point when the
liver becomes saturated; it cannot further detoxify the poisons, and they are returned to the blood
circulation. The blood has sophisticated mechanisms for preserving chemical homeostasis, and will
diffuse as much of the toxic chemicals and physical debris into the interstitial fluids as is possible.
From here the lymphatic system will attempt to collect and neutralize the toxins, but unable to send
the toxins to the liver, the body essentially becomes toxic. Microbes grow and develop, hence there can
be chronic lymphatic swelling, especially in children. Over a period of time, toxins will be forced into
distal connective tissue around muscles and joints, causing fibromyalgia, or into the cells, which can
precipitate genetic mutation and ultimately cancer.

Stress to the Immune and Endocrine Systems.
The immune system is stressed in three major ways. First is at the site of the intestinal mucosa. As
toxins and food antigens brush up against the mucosa, the immune system mobilizes to neutralize the
toxins. Normally, much of this work would have been done by beneficial bacteria, which have been
destroyed by antibiotics. For toxins that make it to the mucosa, the body will tag them with a chemical
secretory IgA (SIgA), which attracts macrophages and other white blood cells to consume the toxins. It
is not long before this immune response is overwhelmed and depleted. This can be measured directly
with a stool or saliva test for the intestinal SIgA level.
The second stressor happens in the liver and lymphatic system which, also overwhelmed, puts
demands on the immune system. The third stressor is a consequence: as the immune response
diminishes, more microbes (viruses, bacteria, and fungi) multiply, allowing for a chronic state of
infection. What might be tagged as a viral infection, such as Epstein-Barr virus for Chronic Fatigue
Syndrome, is actually an opportunistic infection taking advantage of a weakened immune system .
The most important organ in the production of immune agents seems to be the adrenal gland, and
Leaky Gut Syndrome slowly diminishes adrenal function. In the early and middle stages, there is
actually an adrenal excess, as measured by excess cortisol output. Eventually, cortisol levels drop, and
one now has exhaustion.

The Role of the Digestive Tract.
Candida flourishes when the terrain in the intestines favors it. Just killing Candida is usually not
successful, because the chemistry and vitality of the terrain has not been normalized, and Candida
returns. Antibiotics are the original cause of the change on the terrain. By killing acid forming bacteria
(Lactobacillus bacteria produce lactic acid, for example), the environment becomes alkaline, which
promotes Candida. Antibiotics and chronic illness reduce stomach acid production, contributing to the
alkalinity, and also allowing poor digestive absorption. In fact, many people with LGS are
malnourished, no matter how healthy the food is that they eat.
The terrain of the small intestine requires proper pH and electromagnetic resonance. The idea that
lactobacillus supplementation is all that is required after antibiotics is somewhat delusional; in fact
most of the lactobacillus from supplementation does not survive in the intestine, due to poor terrain.

Organizing the Therapy.
Leaky Gut Syndrome has various components, all of which need to be evaluated and addressed. First,
ongoing irritants to the small intestine mucosal lining (fungus, food allergies, and NSAIDs) need to be
identified and neutralized. Second, nutrients and herbs are required to promote healing of the
epithelial lining. Third, and perhaps the key link, the liver needs to be regulated. Fourth, the
lymphatics and interstitial fluids need to be detoxified. Fifth, the immune and endocrine systems need
to be regulated and supported. And sixth, the stomach and pancreas needs to be regulated, if
The therapy takes between four and eight months. Patients need to be vigilant about their diet in
avoiding food allergies and minimizing the growth of Candida.

Understanding Leaky Gut Syndrome in Terms of TCM.
Antibiotics introduce a very cold environment into the digestive system. It depletes spleen yang and
disrupts spleen-stomach harmony. This impairs digestion and absorption of food and fluids, and more
important, depletes the Qi necessary to maintain the integrity of the small intestine. The small
intestine is controlled by the spleen. The spleen’s function of absorption and distribution of Qi and
fluid happens in the small intestine, and the function of the SI is controlled by the Stomach and Spleen
channels (not the Small Intestine channel). So, the initial damage to the integrity of the small intestine
is due to damage of the spleen function.
We can understand the small intestines discharging toxins to the liver in terms of spleen insulting
liver, that is, a reverse control within the wu xing (five phase) cycle. The liver will become excess,
causing a stagnation of Qi and blood. Its ability to store and distribute the blood (which includes the
ability to cleanse the blood) becomes impaired. This is the main excess in an array of other deficiencies
(spleen, kidney), and as such, becomes the pivotal key-link that needs to be addressed first. Zang-Fu
therapy usually requires that the excess be addressed at the beginning.
When the spleen becomes depleted, the kidney will become excess, according to wu xing theory.
Initially, the body responds with a kidney yang excess, to try to reinforce the yang that has been
depleted in the spleen. This will manifest as stress, anxiety, and poor sleep. (It is directly measurable
as an elevated adrenal cortisol level.) Over a period of time, kidney yang will begin to become depleted,
leading to fatigue. Over a longer period of time, both kidney yang and yin will be come depleted,
leading to a depletion of the yuan-jing reserves, resulting in true exhaustion.
The combined depletion of kidney and spleen, with depletion of the yuan-jing reserves, significantly
depletes the ying Qi flowing through the channels. Wei Qi, being the active radiating yang aspect of the
ying Qi, is also depleted, diminishing an effective response to pathogenic factors. The whole stomach
and intestinal tract is still considered the outside of the body, and as such, depends on wei Qi to keep
pathogenic factors from entering. As the wei Qi is reduced, pathogenic toxins are free to enter the body
and further sap its reserves of energy.
Successful rehabilitation requires that the ying and wei be restored to normal levels, through
regulation of the spleen and kidney. This tonification of the wei Qi will help regenerate tissue on the
surface of the small intestine. Again, it is required that the blockage and congestion at the liver be
allowed to open up again, or, in terms of TCM, dredged.
Underlying the susceptibility to Leaky Gut Syndrome is the probability that the Qi is deficient to start
with. This goes back to a modern lifestyle of poor eating habits and poor food choices which injures the
spleen, and the various stresses of modern life (lifestyle, chemicals, electromagnetic) that depletes
kidney Qi. Within the acupuncture network, this contributes to a weakened dantian, or hara. The small
intestine lies over and around the dantian. This is one of the most important energy centers in the
body, the place where food is converted to Qi and blood. When the dantian becomes weakened, it
creates a terrain that allows LGS to take place. And it indicates that a successful adjunct to therapy
would include dantian Qi gong.
People worry about many sorts of environmental toxins: vaccinations, dental amalgams, pesticides,
herbicides, food additives, chlorine, etc. It is true that all of these are stressors on the body, and
contribute to an overall decline in health. The worst threat, however, is an ongoing toxic intrusion
from the cesspool that exists in our intestines. The body has a marvelous mechanism, a selective
intestinal permeability, that allows digested nutrients in while keeping toxins meant for excretion out.
Throughout history, in general, this barrier has maintained its integrity. During the last fifty years, due
to the intrusive irritation of antibiotics and NSAIDs, the average person’s health has been significantly
challenged and weakened.
Jake Paul Fratkin, OMD
In Part 1 of this article, we discussed the causes of Leaky Gut Syndrome. To review, repeated use of
antibiotics create dysbiosis in the small and large intestines, allowing the proliferation of pathogenic
fungi while reducing or eliminating over 500 species of beneficial bacteria. These beneficial bacteria
are required for digestion and absorption of food and nutrients, and neutralization of toxic waste
products. Candida albicans, a toxic fungus, produces a caustic aldehyde which irritates the epithelium
of the small intestine, allowing absorption of microbial and metabolic toxins. These toxins overwhelm
the liver, allowing toxic accumulations in the lymphatic fluids and deposits into the connective tissue,
causing symptoms of fatigue, fibromyalgia, headache, poor concentration, and certain skin conditions,
including eczema and urticaria. I believe that Leaky Gut accounts for 50% of chronic illness in the
modern clinical practice.
The complicating factor in Leaky Gut Syndrome is that of acquired food allergies. As the intestinal
mucosa is irritated by Candida, foods are absorbed before they are completely digested. The body can
tag these as foreign by using specific antibodies. When those foods are eaten there is an inflammatory
response at the intestinal epithelia, which keeps Leaky Gut going. If Candida is effectively eradicated
but the food allergy problem is not addressed, the various illnesses will continue.
The clinician is best served by utilizing laboratory tests to confirm and gauge various aspects of Leaky Gut including Candida levels, digestive function, food allergies, etc. Many of the tests are expensive and one needs to be prudent in what tests are absolutely required. If testing is out of the question due to cost restrictions, certain assumptions and advice may be given to the patient. If there is a history of antibiotics (two episodes within a lifetime is enough to set up Leaky Gut Syndrome; yearly doses of antibiotics will guarantee it), assume there is Candida. You will need to give anti-Candida medicines and advise a special diet. Diet therapy alone will not eradicate high levels of Candida, but certain foods will sabotage successful therapy: sugars, yeasts, refined white flour products (bread, pasta, pastry), vinegar, fermented products including miso, canned fruit juice, and dried fruit. Fresh fruit may or may not be a problem, depending on the severity. Secondly, assume there are food allergies. If any food allergy is allowed to persist, the intestinal wall will remain inflamed and toxic absorption will continue. Without testing, the best you can do is avoid completely the common allergenic foods: dairy (milk, cheese, cottage cheese, yogurt, ice cream,
butter), gluten grains (wheat, rye, oats, spelt, barley); eggs; corn (including popcorn, corn syrup, corn
oil); and beans (especially soy, lentil and kidney; soy includes tofu, miso, and tamari). Other foods that
commonly test as allergenic are almonds, peanuts, and garlic. The most common of the allergenic
foods are dairy, gluten grains, and eggs. Be careful of these ingredients in packaged foods or foods
prepared in restaurants.
A non-allergenic diet can be obtained by eating meat, chicken, fish, vegetables, potatoes, rice, millet,
and fruits. Many patients feel that certain foods are allergenic because of reactive symptoms. We have
to distinguish sensitivity from allergy. A food that might cause sensitivity, like tomatoes or oranges,
causes discomfort because of an imbalance of digestive acids and enzymes. Real allergies cause
damage to the intestinal lining by initiating an inflammatory reaction, and ironically, are usually
without any perceived reaction.
Diet is perhaps the hardest path for patients to follow, but this is what determines who gets better and
who doesn’t. Your management and encouragement here is essential to a real success. Patients need to
understand that allergenic foods keep the intestines inflamed, allowing toxins to continuously enter
the body.
Useful Laboratory Tests.
Most of the pertinent tests require a stool sample, and kits can be provided directly by the practitioner
to the patient. Food allergy tests require a serum sample, which is performed by a registered
phlebotomist or lab, who gives the spun serum back to the patient to mail.
As far as useful tests, I think it is essential to assess the level of Candida infestation. Low levels do not
require aggressive anti-Candida treatment, whereas high levels do. The blood antibody test for
Candida is not very useful as it tends to show only in the severely immuno-suppressed, such as AIDS
patients. The better Candida tests use a stool sample, and I would recommend either Great Smokies
(Asheville) or Diagnos-Techs (Seattle).
Leaky gut can also be caused or aggravated by pathogenic bacteria and protozoans, especially those
acquired in the tropics, particularly India and southeast Asia. Both Great Smokies (using the CPx1)
and Diagnos-Techs (using the CH panel) and do a good job here.
The next test I often order is the Chymotrypsin level. This is a digestive enzyme produced by the
pancreas, and is a good global indicator for pancreatic function. Many symptoms that look like Leaky
Gut may actually be stomach-pancreas deficiency, without Candida or intestinal permeability damage.
Chymotrypsin deficiency indicates relative spleen Qi deficiency. By measuring the Candida and
Chymotrypsin levels first, one can infer or rule out Leaky Gut. If both tests are normal, it is an unlikely
diagnosis. If they are abnormal, I usually go on to recommend food allergy testing.
There are other tests that are useful. ACHY (anti-chymotrypsin factor) is measured in the stool and is a
direct marker for small intestine inflammation; it often indicates food allergies. However, in a chronic
case where the immune system has plummeted, the ACHY can look normal. This means that the
immune system is too depleted to mount an adequate defense at the site of the mucosal membrane.
Secretory IgA (SIgA) is a direct marker of the patient’s immune system at the site of mucosal lining of
the small intestine, also measured by stool. I have reduced the usage of this test, because all patients
with Leaky Gut syndrome seem to have a severely low level; I have come to assume that it will be low.
However, as far as educating the patient and getting compliance, this is a good test for the patient to
Great Smokies provides an intestinal permeability test. The patient drinks a liquid containing two
measurable sugars, followed by the collection of urine for 24 hours. It accurately shows the degree of
Leaky Gut. Again, it is helpful for patient education and compliance, as well as making your case with
medical doctors.
The final test that is important is a good food allergy panel. The skin prick test for allergens only shows
IgE levels, the immediate reactions. Most food allergies are delayed reactions, and require testing of
the IgG levels through blood serum. This is a new test, about seven years old, and very few medical
doctors know of it except those using natural approaches.
Currently, four labs offer a combined IgE/IgG test that I know of. (See the listing at the end of the
article). For years I have successfully used the General Food Panel from National Biotech in Seattle,
which returned the results within ten days. They have recently been acquired by Great Smokies, who
now offer a comprehensive panel.
The advantage of a lab food allergy test is that they appear accurate based on dramatic improvements
in the clinical picture. Further, seeing a paper print out of one’s allergies is quite reinforcing to the
patient. There are practitioners who do machine or muscle testing of food allergies, and this is quick
and inexpensive. However, they do not seem to distinguish true allergens from sensitivities.
In any event, I recommend that you call the laboratories to obtain their excellent practitioner
educational materials and study them carefully. They have many useful tests that can aid your clinical
practice, including hormone profiles from saliva samples.
Treatment of Leaky Gut Syndrome is complex and multi-layered. Most acupuncturists are
overwhelmed by the multiple patterns that coexist in a Leaky Gut case. They don’t know where to
begin or how to organize signs and symptoms. First of all, identification and elimination of Candida
and food allergens is essential to any real success, and can coexist with any of the zang fu patterns. The
next overall approach is to prioritize which zang fu to begin working with: liver, spleen, kidney, or
heart. They may all be involved, but if you treat all simultaneously, the patient will suffer from a
confused and inefficient approach. In the absence of true disturbed shen presentation, it is usually best
to start herbal therapies with liver, then spleen, and finally, kidney.
Treating Candida can be a big challenge. Funguses are survivors and they are very hard to get rid of.
Their job is to suck the life out of decaying tissue, so a fundamental imbalance in the vitality and
chemistry of the small intestines is often the root cause. Addressing proper pH and restoring vitality
via herbs and dan tian Qi gong, are useful. When the Candida levels are +4 or +5 (on a scale of 1 to 5),
it may be necessary to use western prescription medicine, specifically Nystatin. When combined with
an anti-Candida diet, Nystatin is usually effective but needs to be taken for four months. The
recommended protocol is 500,000 unit tablets, slowly working up to 1 to 2 tablets, 3 x day. Other
western medicines, such as Nizoral, Diflucan, an Sporex, are effective but can be toxic to the liver.
Without western medicine, it can take up to nine months or longer to eradicate +4 Candida with
natural medicines.
For levels of +3 or below, many natural products will work. The key is to change any anti-fungal
product every month, to avoid tolerance and adaptation. Herbally, Huang Lian Jie Du Pian seems to
do the trick. I also recommend Fratkin's Intestinal Fungus Formula, a formula designed by myself and
available from Golden Flower Chinese Herbs
Naturopathic products that work include those made with grapefruit seed extract, oregano oil,
undecylenate acid, and berberine herbs. Again, talk to the reps of the various companies (listed at the
end of the article) for ideas. For children there are a number of homeopathic nosode products that are
quite effective from Professional Health Products (PHP), NutriWest, and others.
Most patients will require supplementation with beneficial bacteria to restore probiosis, the healthy
bacterial terrain of the small and large intestine. Supplements combining various strains of
lactobacillus are helpful, although quality really can vary depending on the manufacturer. Most should
be refrigerated, and taken without food. New evidence points to Lactobacillus Sporogenes as being
particularly effective, and a children’s chewable exists. Contact Marcopharma for information.
Liver Patterns. In Leaky Gut, the intestines have been dumping unnatural amounts of microbial or
metabolic toxins into the blood, which quickly end up in the liver. This causes stagnation of Qi and
blood leading to heat with a reduced ability to clear toxins. It is ultimately the cause of fibromyalgia,
because the toxins that the liver cannot neutralized are returned to the blood, then the lymph, and
finally the connective tissue.
I feel that the first zang fu organ needing regulation in Leaky Gut is the liver, requiring formulas that
move Qi, invigorate blood, and clear heat. Try to determine if liver stagnation is affecting either the
stomach or the menses. If it is affecting the stomach with symptoms of food stasis, bloating, costal
distension, or poor digestion, use Chai Hu Shu Gan Tang, Xiao Chai Hu Tang, or the patent medicine
Shu Gan Wan. If the pattern is causing gynecological symptoms including PMS, dysmenorrhea or
menstrual irregularity, use Jia Wei Xiao Yao San. Patent medicines or American made Chinese herbal
products are quite adequate here.
If the pattern indicates heat toxins in the liver, with symptoms of fatigue, lymphatic swelling, and low
grade fever, it is helpful to add herbs or formulas that clear heat toxins. The patent medicine Chuan
Xin Lian contains Andrographis Chuan Xin Lian, Taraxacum Pu Gong Ying, and Isatis Ban Lan Gen. It
is quite effective in targeting the liver and lymphatics.
There are other naturopathic products that help clear liver congestion. Every company has their
favorites, and you can read their literature or talk with their reps. My personal favorites include the
following: Hepar Comp or Hepeel; Core Level Liver or Core Level Detox; Detoxifying Factors;
The spleen is responsible for repairing the intestinal lining of the small intestine, and prolonged Leaky
Gut easily depletes spleen Qi. This can be noticed with traditional TCM signs and symptoms, or by the
Chymotrypsin enzyme test. If spleen deficiency and liver stagnation coexist, choose a formula that
addresses both, such as Chai Hu Shu Gan Tang, Ginseng Stomachic Pills (Zi Sheng Wan) or Shu Gan
Wan. In such cases, there will often be food stagnation. If all signs of excess are gone with signs of a
weak or small pulse, tonifying the spleen is required. You can use Si Jun Zi Tang, Xiang Sha Liu Jun Zi
Tang or Shen Ling Bai Zhu Tang.
Naturopathic approaches often include hydrochloric acid (HCL) and pancreatic enzyme support. HCL-
pepsin capsules are good, taking one to two capsules with each meal. It will not rehabilitate the
pancreas like Chinese herbs, but it can promote efficient digestion while the spleen-pancreas is
Critical to the success of a leaky gut case is repair of the intestinal mucosa. If one can stop the irritating
factors, namely fungus, protozoa, food allergies, and non-steroidal anti-inflammatories like ibuprofen,
the intestinal lining will heal by itself, although slowly. Use of the spleen Qi tonics mentioned above
will help to repair the lining, as will certain naturopathic products including ginkgo, slippery elm, aloe
vera, bioflavonoids such as quercetin, essential fatty acids, antioxidants, and the amino acid glutamine.
As for Chinese herbs to repair intestinal inflammation, I use Fratkin's Pulsatilla Intestinal Formula,
designed by myself and available from Golden Flower Chinese Herbs.
Prolonged or chronic Leaky Gut Syndrome invariably causes kidney deficiency, and kidney tonification
is often given after excess patterns have been addressed. Kidney is responsible for the endocrine
system and, along with Spleen, for the immune system. When the body needs reserves, it uses kidney
energy, stored in the Eight Extraordinary Channel network. In western physiology this includes
adrenal function. As adrenal energy is depleted, other endocrine glands also become depleted,
especially thyroid and pituitary, causing a myriad of symptoms. The naturopathic approach is to
provide glandular support of adrenal or thyroid, which often has a positive therapeutic effect.
However, in early stages of Leaky Gut, adrenal supplementation is contraindicated. This is because
from a TCM point of view, the kidney yin depletes first, and later kidney yang. Adrenal glandulars
basically tonify kidney yang. It is preferable to intervene early with supplementation of kidney yin
through formulas like Liu Wei Di Huang Wan or Zhi Bai Di Huang Wan. This is determined through
pattern differentiation. Later on, kidney yang tonics may be needed, such as Jin Kui Shen Qi Wan or
You Gui Wan. In individuals with depleted kidney Qi, stronger tonics are needed. I have found that
placenta (Zi He Che ) is quite useful, as is Siberian ginseng (Wu Jia Shen), royal jelly (Feng Wang
Jiang), Cordyceps (Dong Chong Xia Cao), and deer horn (Lu Rong).
Occasionally, there are some useful naturopathic products for adrenal deficiency due to kidney yin
deficiency. In these cases, from a western physiological point of view, cortisol levels are elevated as
confirmed by saliva tests. These products would include Core Level Auto Para and DSF Formula
(NutriWest). When cortisol levels are depleted, supplementation with adrenal products is beneficial.
Heart and Shen Patterns.
It is not uncommon to find disturbed shen patterns as the predominant presentation, marked by
insomnia or restless sleep, anxiety, easily frightened, or palpitations. These are the cases that are often
treated with Prozac or other antianxiety or antidepressive medications. Chinese herbal medicine is
quite effective here. The formulas that I use most often are the following: Tian Wang Bu Xin Dan, An
Mian Pian, and Bai Zi Yang Xin Wan. Occasionally Chai Hu Mu Li Long Gu Tang is appropriate.
In Chinese acupuncture, regulation of Liver and Spleen is often the predominant protocol, and using
points such as Liv 3, St 36, and Ren 12 is helpful as a foundation formula. In Japanese Meridian
Therapy, liver deficiency is the most common presentation, with treatment at Liv 8 and Ren 12 being
effective. Ion pumping cords for the Chong Mai (PC 6-SP 4) is often indicated, or at Ren Mai (Lu 7- Ki
6). Supportive moxibustion at Sp 3, St 36, and St 27 is potent for healing an irritated intestinal lining. I
would recommend acupuncture treatments once or twice a week, especially for the first two months of
If the patient can stay on an allergy free diet, recovery is possible within four or five months using the
types of therapy indicated above. However, some patients may need up to nine months of treatment for complete recovery if they have depleted their energy reserves. All sources of stress must be addressed and minimized, including emotional, lifestyle, work, and climate exposure. What I have proposed here focuses on the physical stress of massive toxic overload from the intestines. Leaky Gut Syndrome at its heart is auto-toxicity. The need is to rehabilitate the selective barrier of the small intestinal wall, detoxify the body, and restore liver, spleen and kidney functions. For a more thorough background see: DIGESTIVE WELLNESS, Elizabeth Lipski, Keats Publishing, Inc., 1996 DETOXIFICATION & HEALING; Sidney MacDonald Baker, Keats Publishing, Inc., 1997 THE FOUR PILLARS, Leo Galland. GREAT SMOKIES DIAGNOSTIC LAB: Physician Information JAKE PAUL FRATKIN, OMD, R.Ac. has been in practice since 1978, treating acute and chronic problems in children and adults. He is the author of Chinese Herbal Patent Formulas, and the editor of the recently released Practical Therapeutics of Traditional Chinese Medicine, By Wu and Fischer, Paradigm Press. He practices in Boulder, Colorado, where he combines Chinese herbal medicine, Japanese meridian balancing acupuncture, and nutritional medicine.

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Atc alphabetical.pdf

Alphabetical Listing of ATC drugs & codes. Introduction This file is an alphabetical listing of ATC codes as supplied to us in November 1999. It is supplied free as a service to those who care about good medicine use by mSupply support. To get an overview of the ATC system, use the “ATC categories.pdf” document also alvailable fromwww.msupply.org.nzThanks to the WHO collaborating ce


Preliminary introduction to Infringement The rights conferred by a registered trade mark are set out in Article 5 of the TM Directive. Article 5 provides as follows: 1. The registered trade mark shall confer on the proprietor exclusive rights therein. The proprietor shall be entitled to prevent all third parties not having his consent from using in the course of trade: (a) any sign which is

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