Gu syndrome

I have been fortunate to receive training in the treatment of a unique disease concept discussed in classical Chinese medicine called Gu syndrome. The word in Chinese is 蠱, which in the most ancient scripts of Chinese language, looked like the image here, and is a picture of a container with worms in it (image courtesy of classicalchinesemedicine.org). The image relates to the original understanding of Gu syndrome, which involved the creation of an extremely poisonous insect by putting a variety of venomous insects and other creatures in a pot and letting them fight amongst themselves until there is one creature standing. That creature is considered to be the “Gu worm” and was, perhaps, actually used historically in certain rituals or procedures.

Of course, this isn't exactly what we're talking about when we talk about Gu Syndrome. The truth is that Chinese language, and particularly the language around ancient Chinese medicine, is symbolic. The symbols often have some literal truth to them, but are meant to point in the direction of a concept or set of concepts, and understood more broadly than the words might suggest. Instead, the term refers to a disorder in which there is often some type of parasitic involvement (present or past) but above all includes chronic, recalcitrant and challenging symptom sets that confound treatment.

I learned about Gu from Heiner directly, both during my primary medical school training at NUNM and in extra-curricular capacities. Because of this training, I was fortunate to attract a lot of Gu syndrome cases early in my career which helped to refine what I had learned. Now, because COVID-19 has many Gu-like properties, I'm prescribing these treatments more than ever, and connecting with other providers who do this work, increasing my skill and knowledge with this vexing disorder so I can assist you.

Please read the following information to learn more about how I work with Gu Syndrome in my practice. If you're interested in exploring Gu Syndrome treatment, get in touch! 

NOTE : I do not work with patients outside of Oregon. I do limited consultation work with practitioners who are treating patients that fit the Gu Syndrome profile. If you are a patient who is interested in this treatment, but are not accessible to Astoria, Oregon, you might consider discussing this option with your practitioner.


What is Gu Syndrome?

Gu syndrome is a term used to refer to recalcitrant and debilitating disease that involves multiple challenging symptoms and resists standard forms of treatment, both conventional and alternative. It often begins with a parasite, virus or bacteria that overwhelms the digestive and immune systems and eventually results in neurological and/or mental-emotional complications. These diseases often have an auto-immune component, and frequently patients cycle through multiple doctors and treatment types before finding any relief.

Gu syndrome is very commonly discussed with regards to chronic Lyme disease and similar tick or mosquito borne diseases that have a chronic syndrome associated with them. Most of the literature you will see about Gu syndrome will discuss these types of disorders, or more obvious parasitic diseases such as infection with tapeworms or pinworms. But, truthfully, a majority of my Gu Syndrome patients are not aware of any such infection. It is not required in order to have a diagnosis of Gu, or to treat the problem with Gu Syndrome type treatments.

Gu syndrome is a classical concept, not typically discussed in standard TCM practice. However, Heiner Fruehauf became interested in the concept during his research, and has brought a robust understanding to our profession through his scholarship. If you are interested in learning more technical information, please see the following articles by Heiner, or as interviews with Heiner.

What symptoms are typical of Gu Syndrome?

There are no “typical” symptoms, because Gu can impact every system in the body in diverse ways. However, the following symptoms, derived from my clinical experience, are common in a majority of cases, with a single patient having multiple or all of the following in various degrees of severity.

  • Digestive upset including chronic diarrhea, constipation or back-and-forth between the two, and nearly always involving some type of dietary sensitivities.
  • Neurological symptoms including twitching, buzzing, numbness, tingling anywhere on the body. Patients also report strange pains or “flashes” in multiple locations around the body.
  • Extremely low energy and dysregulated sleep that doesn't respond to other treatment.
  • Profound and unrelenting emotional distress, including feelings of being “poisoned,” “possessed,” or a sense of real hopelessness about health.
  • Brain fog, dizziness and low grade headaches with no obvious cause.
  • Immune insufficiency with frequent colds and flus, lymph node swelling or just a constant low-level sore throat.
  • Flare ups of previously dormant disorders such as herpes and mono.

When should a diagnosis of Gu Syndrome be considered?

There are unfortunately no blood tests for Gu Syndrome! It also doesn't have obvious pulse, abdominal or other signs that Chinese medicine practitioners commonly utilize in making a diagnosis. Instead, it is diagnosed based on symptom presentation and the response of the patient to treatment.

I rarely start out a treatment relationship with Gu Syndrome treatment, unless a patient comes to me from a practitioner who was already treating them using that perspective. Even with a Lyme diagnosis or obvious parasitic involvement, I will try to use standard classical formulas first. I do this because not all parasitic diseases are Gu Syndrome, and often a problem that seems like it could be Gu can be resolved using simpler, cheaper formulas.

I start thinking about Gu Syndrome chiefly when the treatment direction we're trying with standard formulas is not working. I'm even more likely to consider this diagnosis when a patient has frequent negative reactions to classical formulas. This is particularly true if the patient reacts very strongly to nourishing formulas, or to any product containing “tonic” herbs like Ashwaganda or Panax ginseng.

How is it treated?

Chinese herbs are the most important tool in working on Gu Syndrome. Heiner Fruehauf has created a series of encapsulated herbal products specifically for use with Gu, and we will typically start out with one of these remedies with new Gu patients. The formulas are complex, including warming and cooling herbs, tonic and clearing herbs, and while the majority of the formulas are the same Chinese herbs we use in most formulas, there are some specialized anti-parasitic herbs that Heiner has researched, sourced and included in these powerful remedies.

Because I studied closely with Heiner, I do also make custom Gu herbal formulas when the primary remedies aren't working, or aren't right for the situation. Sometimes patients will take multiple formulas at a time, including both standard classical formulas and the specialized Gu remedies. Each persons' regimen is customized based on what I learn during appointments.

Acupuncture is an excellent companion to herbal treatment. Acupuncture can be particularly useful in relieving the pain, anxiety, depression and low energy often associated with this disorder. Moxibustion is a common addition to the acupuncture treatments of Gu patients.

How long does treatment take?

This is the tough part. Treating Gu Sydrome is like “separating oil from flour” as Heiner frequently says. It takes time, it requires great care, and sometimes it just doesn't work. My most successful patients are more than 90% compliant with treatment and home care suggestions, and generally have to take the formulas consistently for 2-4 years for treatment to be “complete.” Ending the therapy too early can result in a resurgence of symptoms, and is not recommended.

That said, if the symptoms are relatively new, or if the patient is quite robust otherwise (strong energy, no real health problems prior to Gu) treatment can be shorter. Further, patients often have lots of improvement in symptoms within weeks or months of starting treatment.

What can I do at home to help Gu Syndrome?

While Chinese herbs are the best way to treat and eventually eradicate the disorder, there are many things you can do to help yourself during treatment.

  • Eating a generally anti-inflammatory and very low sugar/carb diet
  • Avoiding leftovers, nearly expired food, or consuming anything else that may have bacterial growth
  • Drinking plenty (80 ounces or more) of fresh, preferably spring, water daily
  • Doing gentle movement like qigong, taiji or walking, rather than heavy aerobic or weight training workouts
  • Spending plenty of time outdoors, preferably in reasonably intact ecosystems, especially forests
  • Limiting your exposure to intentionally scary media and keeping news and social media to an absolute minimum
  • Limiting alcohol and recreational drugs
  • Spending time in salt water, including a tub with epsom salts, or doing hottub or sauna time frequently