In past articles, I have discussed approaches to healing the gut and resolving long standing food sensitivity issues. Now I would like to discuss a basic foundational approach to addressing and clinically managing complex issues related to gastric challenges coupled with food sensitivities/allergies.
It is extremely common for TCM clinicians to have patients presenting with apparent food allergies, most notably gluten and dairy, and these cases can be very complex and difficult to treat. It very easy for clinicians to become overwhelmed with these complex presentations and it requires a thorough and integrated approach for effective clinical results and symptom resolution.
The 4R Approach
The "4R" approach is a basic foundational system which TCM practitioners can build upon to achieve more comprehensive results and one which can be seamlessly integrated within a standard TCM differential diagnostic rubric. The "4R" approach consists of the following four steps: Remove, Replace, Reinoculate, and Repair.
This basic approach can guide clinicians and patients alike and provide an effective road map to gastric system integrity. The "Remove" phase is the most basic starting point where clinicians must assist patients in completely removing substances which have been identified as food sensitivities/allergies. Patients must understand that elimination must be complete in order for healing to occur. "Remove" also means targeting issues such as parasites, intestinal dysbiosis (pathogenic bacteria), and fungal issues in the intestinal tract. This may involve administration of herbs/supplements which clear Damp Heat in concert with medicinals which target toxic heat as well. If this approach of "Remove" is not addressed other clinical therapies will offer minimal benefit.
The "Replace" step is the main area in which the digestive capacity targeted and strengthened. Here the gastrointestinal secretions must be addressed and issues such as HCL deficiency, pancreatic enzyme deficiency and bile secretion must be considered. Without the appropriate digestion of food, nutrients will not be absorbed or be able to contribute to the healing of the integrity of the intestinal lumen. This is also an area in which acupuncture can play an important role emphasizing points which influence the Spleen and Stomach meridians. TCM formulas which boost the Spleen Qi/ Yang, harmonize the Spleen/Liver, Course the Liver Qi and depress the Stomach Qi are very important in this step as well. These formulas can easily be used in concert with digestive enzymes and herbal bitters and can resolve underlying physiological mechanism which enzymes do not target.
The "Reinoculate" step refers to important action of establishing a healthy microfloral balance in the intestinal tract via the reintroduction of "good" bacteria. This can be done with the use of cultured / fermented foods and / or the use of probiotics in powder or enteric-coated forms. TCM formulas which target the Spleen can also be an aid in this area and used in concert with fermented foods/probiotics to re-establish a healthy intestinal milieu. This is a huge area of discussion and this short article will not discuss this area in-depth however clinicians should be encouraged to educate themselves on this step and also explore the area of "prebiotics" and their role in assisting probiotics to re-implant and reinoculate in the small and large intestines.
The final step of "Repair" is the approach whereby important nutrients are used to heal and repair the integrity of the brush border of the small intestine and includes the use of substances such as: colostrums, vitamins C, E, and A, Zinc, Glutamine, Gamma Oryzanol, Turmeric, Bromelain, and Boswellia. Patients must continue on the low irritant diet throughout this step to assure support the growth and repair of the intestinal lining.
It is crucial that clinician emphasize to patients that symptom improvement is not a signal to reintroduce "red flag" foods. If the irritant foods are reintroduced, the gut lining will be unable to repair and heal. This is also an area in which acupuncture and TCM medicinals can play a contributory role and accelerate the healing process.
It is important to remember that TCM clinicians can use this "4R" approach as a topographic guide however they must always include TCM pattern differentiation in the appropriate manner to assure that the patient is receiving a thorough individualized therapeutic protocol.
Acupuncturists and TCM herbalist can easily work in concert with allopathic and naturopathic physicians by assisting in each step with appropriately administered acupuncture and medicinal protocols. Please refer to my last articles for more in-depth discussion of targeting food sensitivities/allergies and healing the integrity of the gastrointestinal tract at www.acupuncturetoday.com.
