The connective tissues are fabric-like substances that form a matrix that wraps and fills all the spaces in the body, even extending into the innermost parts of cells. All the major bodily systems--the circulatory system, the nervous system, the digestive tract, the musculoskeletal system, and each individual organ--are surrounded and supported by the connective tissue. With the exception of cartilage, all the connective tissues are highly vascular. Collagen is a fibrous, insoluble protein in connective tissue. It represents about 30% of the total body protein. The diseases that affect this tissue are collectively known as connective tissue disease (CTD), or sometimes collagen vascular diseases. These include systemic lupus erythematosus (SLE), scleroderma, rheumatoid arthritis, and combinations of these three diseases, called mixed connective tissue diseases or MCTD's. They share many characteristics, so the herbal treatments discussed here can be used for all these problems.
Rheumatoid arthritis is characterized by fatigue, weakness, and gradually intensifying joint pain. The pain usually begins in the small joints, eventually affecting all the joints in the body. It is an extremely painful and disfiguring condition.
Lupus (SLE) is an inflammatory CTD that occurs predominantly in young women--90% of all cases are diagnosed in this portion of the population. Although it can develop slowly over time, lupus often starts with a fever or acute infection. Most patients complain of arthritis-like pain, swelling, and skin inflammation, and there is often a characteristic butterfly-shaped reddening on the cheeks. Lupus can spread to the brain, kidneys, lymph glands, lungs and other tissues. There is a strong suspicion that part of the cause involves hormonal abnormality. For example, there is a higher incidence of the disease in women taking synthetic estrogen supplements (Sanchez-Guerrero et al 1995). Patients should avoid prolonged sun exposure as it often exacerbates the disease.
Scleroderma is a CTD disease characterized by progressive thickening and stiffening of the skin, followed by atrophy and changes in pigmentation. It can progress to the internal organs, eventually leading to death.
Treatment of CTD's
The high level of inflammation and tissue destruction that occurs with CTD's points clearly to a weakness in the body’s detoxification systems and resultant accumulations in the tissues that precipate immune attack. Alteration in blood chemistry parameters indicates a need for immune and general tonification, as well as additional support of the digestive system. The seriousness of these diseases often necessitates concomitant use of strong Western anti-inflammatories such as prednisone when a patient is in crisis. The swelling and pain dictate a need to remove dampness and blockage.
To understand the connective tissue you must realize that it is elastic. Moreover, it is not found just in our fibrous well-known "gristle." Connective tissue proteins are also found within cells in the contractile filaments, stiff tubes and connecting trabeculae, and some even surrounds the genetic material (Oschman 1986). Just as the discovery of the virus erased the supposed dividing line between "life" and "non-life,” scientists are now moving away from the traditional rigid view of the body as a collection of separate cell units with distinctly different functions. As they delve deeper into the physical tissue, it is possible to find the same or similar patterns, tissue types and functions repeating themselves at all levels.
It is essential to seek professional help in serious or advanced cases. Nutritional experts emphasize the need to check for food allergies. Many patients benefit from dietary elimination of cow's milk products, wheat, oats, barley, rye, and grains containing the proteins gluten and gliadin. As in most inflammatory diseases, fish and flaxseed oils are often used to treat CTDs. Long-term use of borage oil has also been shown to benefit rheumatoid arthritis patients (Zurrier, 1996). The combination of boths oils together has been reported effective by numerous practitioners (reported in Bland, 2000).
According to Jonathan Wright, MD, author of the Nutrition & Healing Newsletter, digestive weakness is very common. He says, "I can't remember the last time I saw someone with lupus who had a normal stomach test; usually there is no stomach acid and pepsin at all, or very little. Replacement hydrochloric acid and pepsin capsules are almost always necessary" (Wright 1999).
Hollywood news media reports in 1999 claimed that actor James Coburn recovered from a severe case of RA using a nutritional supplement called MSM. MSM is an easily assimilated food source of nutritional sulfur that helps strengthen connective tissue. MSM has captured interest among the nutritional science community because of its ability to strengthen and maintain joints and collagen structures. It is also a scavenger for free radicals and foreign proteins. Patients usually use 1,500 mg of MSM twice a day. Initial onset of action is typically three to six weeks, with maximum benefits seen at three months. I have used it with moderate success. It sometimes works very well, and sometimes does not work at all.
TCM expert Bob Flaws wrote a very interesting piece on a Mainland China TCM treatment for SLE. He reported that most of his patients had wind, damp, and heat blockages, liver energy blockage, kidney Yin and/or digestive energy (Spleen Qi) weakness, and sometimes blood stasis (Flaws 1999). He used complex formulas that would require formulation by a professional TCM practitioner according to signs and symptoms. I would agree, and my clinical experience confirms that these problems require complex and long-term guidance under a professional. Any suggestions I make here (and elsewhere, for that matter) should not be seen as panaceas.
TAM doctors suggest using anti-inflammatory herbs, along with laxative, diuretic and digestive herbs, for six months or longer. Effective anti-inflammatory herbs include triphala, guggul gum, and guduchi stem. Interestingly, they also use plasters that contain sulphur— MSM cream would perhaps be the modern equivalent. One unique medicine that may be of benefit is narayana taila, a complex medicated oil also used to treat osteoarthritis.
Antibiotic treatment with minocycline has been shown effective in rheumatoid arthritis, lending credence to the idea that there may be an unknown infectious component to CTD's (Kawanaka N et al. 1998). In fact allopathic doctors are increasingly using two antibiotics, sulfasalazine and minocycline, that have been shown effective in treating rheumatoid arthritis. I have seen Dr. David Jezyk, a holistic MD, put rheumatoid arthritis patients into temporary remission using these medicines. This method seems to only work in a percentage of patients, perhaps about 1/3. This treatment can serve as a good beginning for a holistic program. Along similar lines, and as a result of my own experiences in developing protocols for MS (another autoimmune disease), I have concluded that immune system tonification is an important component of treatment. I often use herbs like ginseng root and astragalus root.
Dietary counseling is essential. I often find that the diet for heat and dampness is the best choice. The exercises of T'ai Chi and Yoga, combined with “breathwork” such as Qi gong and Pranayama, work to restore energy and elasticity directly to this tissue and are therefore fundamental to the treatment of CTD's.
I treat CTD patients by first helping them to understand the importance of strict dietary control as outlined above. I think it is important for patients to accept the fact that CTD's do not respond to "quick fix" methods. I then formulate at least two long-term herbal combinations, choosing herbs primarily from the following lists, emphasizing different herbs depending on the patient's signs and symptoms. My choices are highly individualized.
Herbs for treating CTDs
• To strengthen the body's own anti-oxidant status and liver removal of toxins, choose from amla fruit, dandelion root, milk thistle seed, wheat sprouts, and white peony root.
• I often use two or three grams of concentrated wheat sprouts for a minimum of six weeks early in the therapy.
• To directly remove inflammation and swelling, make a combination of herbs that reduce heat or heat and dampness such as ashwaghanda root, boswellia gum, honeysuckle flower, licorice root, raw rehmannia root, rhubarb root, willow bark, guduchi stem, and turmeric root (concentrated to be high in curcumin)
• Essential fatty acids are critical to use
• To modulate the immune system and reduce autoimmune attack, use either (a) low-dose prednisone (b) moducare or (c) isocort. This part of the protocol is critical, not as an end in itself, but to buy time for the cleansing and dietary therapies to work.
• For digestive support and to help the body eliminate protein or sticky deposits, use high doses of digestive enzymes These should be used along with guduchi stem or kaishore guggul.
• To remove dampness and swelling, choose from black atractylodes, coix, dandelion leaf, and phellodendron bark.
• To strengthen the connective tissue itself, choose from herbs and nutrients like glucosamine sulfate, gotu kola leaf, bamboo sap (Bambusa species), flavonoid-rich fruits, multi-mineral combinations, hawthorn, stoneroot and MSM. In scleroderma cases, MSM is also useful topically, as a cream.
Combinations of these herbs must be used in moderate to high doses for a long period of time, and chosen and adjusted according to patient response. Although we have not succeeded in completely reversing CTD's, many of our patients have experienced slowed progress and a noticeable reduction in symptoms. We have put some patients into remission, but it is too early to know if these will last. Not enough time has passed. You can add breathing and stretching exercises to the regimen once the patient has progressed enough to do them comfortably. This usually occurs a few months into treatment. Moderation is the key.