Treating Chronic Inflammatory Diseases with Chinese Herbs: “Gu Syndrome” in Modern Clinical Practice

by Heiner Fruehauf

“Gu” was once a prominent term in ancient medical texts, but the word has virtually disappeared from modern textbook descriptions of Chinese medicine. I came across this concept nearly twenty years ago when I began researching the traditional treatment of parasitism in Chinese herbalism. In my research, I found that the character Gu most often describes a situation of entrenched parasitism that eventually brings about a state of extreme stagnation, as well as mental and physical decay. Generally, the label Gu represents a syndrome that warrants the presence of particularly vicious parasites, or a super-infection of many different parasites that have combined their toxic potential to gradually putrefy the patient's body and mind. From a modern perspective, this definition of Gu syndrome points to aggressive helminthic, protozoan, fungal, spirochetal, or viral afflictions that have become systemic in an immune compromised patient.

In modern times, the Gu approach can be utilized for many different degenerative chronic infections, such as those caused by HIV and Lyme disease. In addition, this approach is useful in other difficult chronic conditions such as fibromyalgia, chronic fatigue syndrome and GI disorders like IBS. The herbal principles that underlie the treatment of Gu syndrome are indispensable tools in the treatment of chronic disease. I have come to associate Gu with not only chronic parasitism, but also the broader category of “Chronic Inflammatory Disease”.

This article outlines the clinical signs and symptoms associated with the typical Gu or “Chronic Inflammatory” patient. In addition, it synthesizes the primary treatment principles that have traditionally been used in the treatment of this disorder. A materia medica of anti-parasitic substances, which includes my own experience treating chronic inflammatory syndromes, can be found at the end of the article.

Gu syndrome can manifest in a myriad of ways. Some of the clinical characteristics frequently highlighted in the traditional Gu literature are: 1) Gu pathogens are malicious and have life-threatening consequences. 2) Gu pathogens represent a type of toxin (gudu). This refers to their virulent epidemic quality, but also to the only recently corroborated fact that the metabolic byproducts of parasitic organisms have toxic effects on the body. 3) Gu pathogens are most likely to thrive in already deficient organisms, and once established, further harm the body's source qi. 4) Gu pathogens operate in the dark. It is often unclear when and how the pathogen was contracted, making an accurate diagnosis extremely difficult. Due to the multiplicity of potential symptoms, moreover, most doctors appear confused by Gu pathologies. Chinese master physicians have continuously pointed out that Gu induced chronic diarrhea, ascites, wasting syndrome, mental symptoms, etc., must be diagnosed and treated completely differently from the general occurrences of these disorders. "The coarse doctor treats the Gu type of diarrhea just like regular diarrhea," the Ming Dynasty encyclopedia Puji Fang (Common Aid Formulas) emphasizes, "and this is completely wrong."[i]

Although it is one of the defining trademarks of Gu syndrome that it may involve virtually any symptom, for diagnostic purposes, the indications most consistently quoted in traditional texts can be summarized in the following way:

  • Digestive symptoms: chronic diarrhea, loose stool, or alternating diarrhea/constipation; explosive bowel movements; abdominal bloating or ascites; abdominal cramping and/or pain; nausea; intestinal bleeding and/or puss; poor appetite or ravenous appetite, peculiar food cravings.
  • Neuromuscular symptoms: muscle soreness, muscle heaviness, muscle weakness; wandering body pains; physical heat sensations; cold night sweats; 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 muddled-ness and confusion, chaotic thought patterns; visual and/or auditory hallucinations; epileptic seizures; sensation of "feeling possessed".
  • Constitutional signs: progressing state of mental and physical exhaustion, indications of source qi damage; dark circle underneath the eyes; mystery symptoms that evade clear diagnosis; history of acute protozoan infection; history of travel to tropical regions; floating and big pulse, or congested pulse; stagnation in sublingual veins; rooted damp tongue coating; red tongue tip or red "parasite dots" on top of tongue.

Herbal Treatment

The purpose of this article is to create awareness of the concept of Gu and to transmit an herbal system of treatment that has historic depth and sophistication, but is at the same time modular and simple enough that it can be comprehended and executed in clinical practice. What makes a Gu prescription so different from a regular TCM formula is that the regular TCM approach is tied to an either-or, black-and-white recognition of the eight parameters: internal or external, hot or cold, etc. The Gu approach, in contrast, represents an intermingling of approaches that is quite different from traditional TCM strategies.

Traditional Gu formulas stand out by combining diaphoretic herbs with herbs that are used for internal problems. The choice of internal herbs is not hard to understand, because this type of patient is chronically ill and thus needs to be treated internally. In addition, however, afflicted individuals often report that their main symptom is a constant flu-like feeling and an aversion to wind. The primary herbal category for the Gu approach has thus been called “release the surface with herbs that kill the snakes” (shashe fabiao). Most Gu formulas tend to feature 2-3 herbs from this category.

The remaining categories consist of internal herbs that are, for the most part, tonic in nature. Ancient Chinese physicians recognized that this kind of patient presents with a general exhaustion of yangqi, and blood, due to the chronic nature of the disease. At the same time, the creators of Gu remedies knew that traditional tonics, ginseng especially, would also tonify the pathogen. In all of these categories, we therefore find a careful selection of herbs that are tonic and anti-parasitic at the same time. One of the ways these anti-parasitic herbs work is through their aromatic quality; they are basically fumigants. Constant herbal “fumigation” makes the system uninhabitable for any kind of pathogen. These tonics include blood tonics, qi tonics, yang tonics, and yin tonics.

An additional category deals with what has recently been termed “biofilm”: an aggregate of microorganisms that adhere to an internal body surface, using a self-produced matrix that is most difficult to break up and remove from the body. These herbs are aromatic qi/blood movers. In the next category are herbs that are primarily anti-parasitic and have been recognized as such in the traditional materia medica. The final, and perhaps most important, category of herbs is composed of herbs that tonify and support the storage of the yang. This category is integral to supporting the patient’s constitution and engendering a return to health.

In general, chronic inflammatory patients that belong to the category of Gu syndrome need to be treated for a period of 1.5 to 5 years. Since this class of disorders involves living pathogens that have the ability to adapt, I recommend a regular change in the details of the prescription. It is best to make modifications to a Gu prescription regimen every six weeks. Frequent alteration of remedies is a traditional component of Gu treatment. I recommend doing this by leaving the herb categories intact, but rotate at least one herb in each category. In this way, the general arrow of the therapeutic approach never changes, yet the formula is different enough each time to stay ahead of the microorganism’s attempts to adapt. Your knowledge of individual herb qualities should play a role in the selection of what gets rotated in and what gets rotated out. The more precise the use of these herbs, the fewer chances there are for adverse reactions in your patients. This is particularly important with chronic inflammatory syndrome patients because they tend to be incredibly sensitive. For this reason, it is best to begin with a lower dose and gradually work up to the desired amount.

After almost two decades of working with chronically inflamed patients, I have synthesized the classical Gu approach into the Classical Pearls line of herbal patents, which can be used for patients suffering from “Digestive Gu” (chronic parasitic gut infections) and “Brain Gu” (chronic nervous system inflammation). See the following table for details of the Black “Gu” Label (Thunder Pearls, Lightning Pearls, Dragon Pearls) and other Classical Pearl remedies that were designed for this class of difficult and recalcitrant diseases.

In depth information concerning the history and treatment of Gu syndrome is available at Information about the Classical Pearls line of products can be found at