If one looks at the pattern discrimination of various allergies and autoimmune diseases in modern Chinese medical texts, one will see several patterns listed under each disease category. Then, under each pattern, there are generalized signs and symptoms, tongue signs, and pulse signs. Under that come the treatment principles for that particular pattern. And finally, there is a suggested Chinese medicinal formula based on the treatment principles. Therefore, such textbooks make it seem that the clinician's job is to determine which of the listed patterns their patient exhibits and then give them the treatment described under that pattern.

The problem with this very clear-cut methodology is that patients with allergies and autoimmune diseases rarely exhibit a single pattern. Rather, real-life patients with these kinds of chronic diseases typically exhibit three, four, five, or six patterns simultaneously. This means that no single formula under any one pattern is going to be categorically correct.

For instance, many Chinese medical beginners' textbooks give the patterns under allergic rhinitis as wind cold external invasion pattern, lung qi vacuity pattern, spleen qi vacuity pattern, kidney yang vacuity pattern, and phlegm dampness pattern. However, first of all, we must distinguish between the acute allergic episode and the underlying bodily constitution or terrain, what Chinese doctors refer to as the "habitual bodily" condition. During an acute allergic rhinitis attack, the attack itself is provoked by an unseen airborne pathogen, i.e., wind, and the signs and symptoms most typically involve clear, white or "cold" phlegm. Therefore, the acute episode is described as a wind cold external invasion pattern. But this does not account for why one person has been invaded when another exposed to the same external evils has not.

If one is invaded by external evils, it means that the person's defensive qi has not been strong enough to secure the exterior and densely pack the interstices. The defensive qi is manufactured by the spleen qi and sent up to the upper burner for distribution to the exterior by the lungs. Hence, we can say that everyone suffering from allergic rhinitis has a de facto defensive qi vacuity. In clinical terms, this means a lung-spleen qi vacuity. All the medicinals used to supplement the defensive qi primarily supplement the lung qi by fortifying the spleen and boosting the qi. Therefore, it is not that some allergic rhinitis sufferers have a lung qi vacuity, while others exhibit a spleen qi vacuity.

The spleen is in charge of moving and transforming water liquids. If the spleen is vacuous and weak, then it may fail to move and transform water within the body. If this gathers and accumulates, water may transform into dampness. If this dampness endures, it may congeal into phlegm. Thus it is said, "The spleen is the root of phlegm engenderment, while the lungs are [only] the place where phlegm is stored." Therefore, everyone with allergic rhinitis does have phlegm dampness, not just lung-spleen qi vacuity.

The spleen is the latter heaven or postnatal root, while the kidneys are the former heaven or prenatal root. The postnatal and prenatal support and assist one another. When we are young, our kidneys and spleen are both immature, meaning vacuous and weak. Our spleen matures first at around six or seven years of age. It is because the spleen matures and now engenders a superabundance of qi and blood postnatally that acquired essence can bolster the kidneys and hence the kidneys can mature and become exuberant at adolescence. Likewise, it is the spleen which first become weak due to aging, and then only secondarily do the kidneys become vacuous and weak after that. Therefore, in clinical practice, one rarely encounters a pure kidney yang vacuity. In almost all cases, what one actually sees is a spleen qi-kidney yang vacuity. Since the lungs, spleen, and kidneys are the three viscera which transform and engender the qi and which move and transform water in the body, when one of these malfunctions, typically at least one other does as well. Therefore, what one really sees as the underlying terrain of allergic rhinitis sufferers is either a lung-spleen qi vacuity with phlegm dampness or a lung-spleen qi vacuity and kidney yang vacuity with phlegm dampness. Then invasion of external wind cold evils is superimposed on this habitual bodily constitution.

In addition, because the clear qi is not being upborne and dampness and phlegm are hindering and obstructing the free flow of qi, most allergic rhinitis patients also exhibit signs and symptoms of liver depression qi stagnation even though no Chinese textbook lists this as one of the patterns of this disease. Yet I have never seen an allergic rhinitis patient who did not have at least some signs and symptoms of liver depression. If nasal obstruction has endured for a long time, cold evils may have transformed into heat. Because qi moves the blood and if the qi stops, the blood stops, enduring nasal congestion may also have resulted in blood stasis. So besides, lung-spleen qi vacuity, phlegm dampness, and liver depression with possible kidney yang vacuity, there may also be transformative heat, damp heat, and/or blood stasis. And as soon as our patients exhibit a combination of spleen vacuity, liver depression, and some kind of evil heat, we have crossed into the territory of yin fire.

In fact, most sufferers of allergies, including atopic dermatitis, allergic asthma, and so-called food allergies, including allergic colitis, exhibit yin fire patterns with spleen qi vacuity, liver depression, and some kind of heat, usually depressive and/or damp heat. Likewise, most autoimmune sufferers also exhibit the same or similar combination of core patterns. Remember, autoimmune diseases are simply an allergy against onself. Such autoimmune diseases include rheumatoid arthritis (RA), dermatomyositis/polymyositis, systemic lupus erythmatosus (SLE), multiple sclerosis (MS), scleroderma, myasthenia gravis, Sjogren's syndrome, Crohn's disease, Hashimoto's thyroiditis (a type of hypothyroidism), and endometriosis (due to autoimmune ovaritis). Most patients with autoimmune diseases do not exhibit a single textbook pattern but rather a cluster of patterns perhaps best described by Li Dong-yuan's yin fire theory. Further, most patients with chronic fatigue immune deficiency syndrome (CFIDS) and fibromyalgia also exhibit yin fire patterns. In other words, most patients with these conditions exhibit some combination of spleen qi vacuity, liver depression, and evil heat plus some other patterns as well.

Take for instance rheumatoid arthritis. The overwhelming majority of patients with rheumatoid arthritis complain of fatigue. Fatigue is the single most obvious and important symptom of a qi vacuity, and the spleen is the latter heaven root of qi engenderment and transformation. Therefore, most patients with rheumatoid arthritis have a spleen qi vacuity. Now, anyone who is chronically ill is going to have liver depression qi stagnation even if that liver depression did not originally cause their disease. After all, if one is diseased, one ipso facto cannot fulfill all one's desires. Either one cannot do what one wants, eat what one wants, look as one wants, or cannot get away from one's pain as one wants. Such unfulfilled desires are the main cause of liver depression. Therefore, everyone who is chronically ill does have liver depression.

The joint pain of rheumatoid arthritis is categorized as bi or impediment in Chinese medicine. Either it can be wind cold damp impediment or wind damp heat impediment. One or the other of these is typically superimposed on a basis of spleen qi vacuity and liver depression. In rheumatoid arthritis in the West, wind damp heat impediment is very common. If the spleen qi is vacuous and weak, then the spleen may not be engendering and transforming blood sufficiently. Therefore, there may be a concomitant liver blood-kidney yin vacuity. Or kidney yin vacuity may be due to enduring heat damaging and consuming yin fluids. It is also possible that enduring disease or aging may result in spleen qi vacuity evolving into kidney yang vacuity, in which case there is still spleen qi vacuity but now there are also some signs and symptoms of kidney yang vacuity as well. If the qi is vacuous and the liver is depressed, the qi may not have either the power or the free flow to move blood and water liquids. In that case, there may be the complications of blood stasis and/or phlegm nodulation.

RA, dermatomyositis, polymyositis, Crohn's arthritis, fibromylagia, and SLE are all types of impediment conditions due to complicated yin fire scenarios. MS is a wilting condition (wei zheng) due to the same basic disease mechanisms minus the impediment patterns. Most autoimmune sufferers have a history of one or more allergies. They often have histories of antibiotic use, which has damaged the spleen. In China today, a popular topic for Chinese medical journal articles is post-antibiotic spleen qi vacuity or intestinal dysbiosis due to spleen qi vacuity in turn due to antibiotics. In such cases, the spleen qi has been damaged and this results in dampness, while dampness transforms into damp heat. We have discussed some of the most important causes of spleen qi vacuity in a previous essay. In the West, these have to include faulty diet, too much thinking, too much worry and anxiety, not enough exercise, and too much work, and usually there are some or all of these in significant amounts in allergy and autoimmune patients.

In particular, more women than men suffer from autoimmune diseases and the incidence of such autoimmune diseases increases in the mid-30s and through the 40s and 50s. This is no accident and also has to do with the same set of disease mechanisms we have been discussing under the title yin fire. Women lose blood every month. Therefore, they are more prone to spleen vacuity than men, since it is the spleen, which carries the brunt of blood production. Even if a woman does not lose too much blood each month, the fact that during the second half of her menstrual cycle two things happen which account for the cyclic worsening of both spleen qi vacuity and liver depression. If a woman is marginally blood vacuous, when the blood is sent down to accumulate in her uterus during the premenstruum, there may not be enough left over to emolliate and harmonize her liver. Thus her liver becomes depressed and her qi becomes stagnant. Since this also means that the liver is replete, a replete liver may invade the spleen, making it vacuous and weak. All this helps explain why women are more at risk for autoimmune diseases than men. It also explains PMS and why PMS worsens in the mid-30s and 40s.

The Nei Jing says that the spleen becomes weak due to aging in the mid-30s in women. Thus it is common for the incidence of autoimmune diseases, read yin fire scenarios, to increase after 35 or so. By the 40s, spleen qi vacuity is beginning to affect kidney yang. The yang of the kidneys is also necessary for the liver to do its job of coursing and discharge. Liver function is not just dependent on blood for its nourishment. It also requires kidney yang to "warm and steam" the liver. If kidney yang becomes weak due to aging as a consequence of the spleen qi no longer bolstering and assisting it the way it once had, then this will also aggravate any tendency towards liver depression qi stagnation.

Thus round and round it goes. But it is Li Dong-yuan's theory of yin fire, which helps one cut through this cycle of one disease mechanism engendering another. When one suffers from an allergic or autoimmune disease, during times of relative remission, one needs to treat all the disease mechanisms associated with the "habitual bodily" or underlying condition all at one go. Then, during acute exacerbations, one needs to treat the underlying "habitual bodily" condition plus any other patterns superimposed upon that basis.

In other words, during acute allergic rhinitis episodes, one usually needs to supplement the lung and spleen qi (really the same thing), possibly also supplement kidney yang, rectify the qi and downbear counterflow, transform phlegm and eliminate dampness, and dispel wind and disinhibit the portals (of the nose), while securing the exterior. If damp phlegm has transformed into damp heat and phlegm, then one might also have to clear heat.

In the case of RA, during remission, one typically has to supplement the spleen qi, possibly supplement liver blood and kidney yin, possibly also supplement kidney yang, course the liver and rectify the qi, possibly clear depressive, damp, or vacuity heat, possibly quicken the blood and dispel stasis and/or transform phlegm and scatter nodulation. During acute attacks, one must do all of this plus dispel either wind, cold, dampness or wind, damp, heat, free the flow of impediment, and stop pain. In SLE, there basically is always wind damp heat impediment, and not wind cold dampness.

Likewise, in the case of MS, one usually has to supplement the same viscera as in RA, course the liver and rectify the qi, and possibly quicken the blood and dispel stasis. If there is damp heat, one must also clear heat and eliminate dampness, even though this is not damp heat impediment, per se. Usually in MS, there is also some element of either blood vacuity or yin dryness somewhere in the body even if there is spleen vacuity with dampness transforming into damp heat.

Because most allergy and autoimmune disease sufferers do not manifest the single, simple, discreet patterns that are described in beginners' textbooks, they require more complex formulas than the simple classical formulas which for the bulk of commonly available Chinese "patent medicines." Because these are chronic conditions that require long-term, protracted treatment, administering medicinals in pill form makes such long-term treatment easier, and, hence patient compliance is greater. Therefore, I believe many Western patients with chronic allergic conditions and autoimmune diseases will benefit from Blue Poppy Formulas based on Li Dong-yuan's yin fire theories. These are the types of formulas which I prescribe to all my patients with these sorts of diseases, and this is what I have seen work best in Western patients with these "difficult to treat, knotty diseases."