Transdisciplinary Approaches to Patient Care: Lymph and Ground Substance

William Morris, PhD

(Matrix Regulation, Pulse Diagnosis, Lymph Function, Endocrine Function, and Chinese Medicine)

Transdisciplinarity can be distinguished from interdisciplinarity which is information systems that travel between disciplines. Whereas multidisciplinarity is a grouping of disciplines in an effort towards a common purpose, transdisciplinarity is information systems that move between, across and beyond all disciplines. Transdisciplinarity aims to realize that which disciplines share and to connect to that which lies beyond them. In comparison with interdisciplinarity and multidisciplinarity, transdisciplinarity is multireferential and multidimensional. It creates the possibility of the emergence of new data and new interactions from the encounter between disciplines. This in turn allows for a potentially new vision of nature and reality. (Nicolescu, 2002)

Collaboration between Eastern and Western medicine occurs in many strata from the socio-political environment of the public policy makers to various forms of institutional involvement to the efforts between practitioners. In addition to these sociological collaborations, synthesis can occur between Eastern and Western epistemologies in terms of clinical practices. This paper examines a transdisciplinary approach to pulse diagnosis at the clinical level through a synthesis of Eastern and Western medical thinking. To accomplish the synthesis there will be an exploration of the relationship between immunology, fluid metabolism, lymph drainage, endocrine function, and Chinese medicine with attention to pulse diagnosis.

Pulse Diagnosis and the Interstices

Both Western and Eastern medical thought may be elucidated by the pulse diagnostic methods of Chinese medicine. Pulse qualities that suggest collection of fluid in the interstices such as the ‘cotton’ pulse of the Shen-Hammer system suggest impeded flow of protective qi which, in turn, suggests poor local perfusion resulting in the production of interstitial fluid accumulation and diminished lymph return. Table 1 correlates Chinese and Western concepts and common pulse diagnostic findings.

Table 1: Pulse diagnostic findings common to Chinese and Western medicine

Western Concepts related to the phenomena Chinese concepts related to the condition Pulse finding

 

Lymph

Protein

Thyroid

Exercise

Immune

Spleen Depletion

Kidney Yang Depletion

Heart Qi and Yang Depletion

 

Cotton pulse

Weak pulse

Deep pulse

Floating pulse

Slow pulse

Changing qualities

Changing rate at rest

Arrhythmias

 

The following is an explanation of each of the pulses and the ways in which they can contribute to interstitial fluid accumulation and correspondingly poor lymph return. These phenomena are considered by the author to be synonymous with the Chinese medicine pathogen ‘damp.’

Cotton Pulse

The cotton pulse is conflated with the soft pulse by some practitioners. However the soft pulse is described as the sensation of a thread floating on water while the cotton pulse is a “spongy, amorphous, formless resistence that is without structure and wave form.” (Hammer, 2001, pp237) The pathophysiological findings are similar: dampness, or interstitial fluid accumulation.

Weak Pulse

The weak pulse lacks force and is very soft, deep, and thin. It can only be felt in the deep level. This can be indicative of low cardiac output and a likely low circulating blood volume resulting in poor perfusion and interstitial fluid accumulation known as ‘damp.’

Deep Pulse

The deep pulse is found only at the organ depth. It can be compounded by deficiency patterns which can also suggest poor perfusion and accumulation of interstitial fluid.

 

Floating Pulse

The floating pulse occurs when there is a depletion of qi or when there is an external pathogen. When due to deficiencies, yin and yang lose intimate contact. The warming and moving functions of qi allow for local metabolic functions to become impaired with a corresponding collection of damp.

Slow Pulse

The slow pulse may often be associated with poor circulation and local perfusion, resulting in the accumulation of interstitial fluids. A chief exception is in the case of highly efficient cardiac ejection fraction as with an athlete.

Changing Qualities (Hammer, 2001)

When the pulse changes qualities, there are two primary reasons. First is that the physiology and structure of the vascular system cannot express all the processes that are occurring in complex patterns of disharmony at once, so they happen over time. The other is that the qi is deficient and cannot maintain the shape of the vessels over time so that they change. In the latter situation, the qi is deficient such that damp easily accumulates.

Changing Rate at Rest (Hammer, 2001) and Arrhythmias

When the pulse rate changes at rest, this can be due to sinus node inefficiencies and cardiac conductivity inefficiencies. It can also occur due to rapidly changing humoral influences with respect to the psycho-neuro-endocrinological loop – this usually occurs concomitantly with labile emotional tonus. Under these circumstances, the local perfusion is impacted and damp can accumulate. The same is true for the arrhythmias.

Lymph as a Portal to Integral Medicine

It has been argued that the lymph return system has features common to the flow of the protective qi. (Kendall, 2002) If a patient presents with a ‘cotton’ pulse, (Hammer, 2001) then there is an accumulation of interstitial fluid occurring that is consistent with poor lymph return. Hammer describes this as a ‘sad’ pulse wherein people live lives of quiet desperation; however, this may not be the only reason for such a pulse. Other causes may include spleen qi or yang depletion leading to damp accumulation; other causes include impaired cardiac function or kidney yang depletion. From a Western perspective, this scenario can be induced through sedentary behaviors or reduced metabolism related to an impaired pancreatic function or hypothyroidism. (Gretz et al., 2000)

Before 1983, editions of Guyton’s Physiology (Guyton, 1982) describe lymph function in substantial detail, yet later editions of the book have much of the lymph conversation deleted. This was to the author’s chagrin since he continues to consider lymph a critical piece of a normal physiological state. There are specialists who call themselves ‘lymphologists.’ This specialty refers to tissues states such as ‘dry’ or ‘wet.’ When the state of the cell and interstitial spaces is ‘dry,’ it tends to be richly oxygenated and nourished resulting in healthier and pain-free with longer living, while the patient in the ‘wet’ state tends to have fatigue, malaise, and patterns related to spleen qi depletion.  These concepts are also directly applicable to cell wall tone and function. The strategy is to bring tissue and cellular integrity back to a ‘dry’ state in order to achieve health and longevity. In Chinese medical concepts, we are boosting qi and draining damp through the use of medicinals such as bai zhu (Rhizoma Atractylodes alba) or fu ling (Poria cocos). Other treatments strategies may be helpful such as harmonizing the protective and nutritive qi with gui zhi (Ramulua Cinnamomi) and bai shao (Rhizoma Zingiberis), and supplementing yang or supplementing, harmonizing and moving blood, Blood supplementation occurs with improved protein intake and correspondingly, the blood proteins are increased. The hydrophilic nature of the protein in the blood stream attracts the fluids back into the vessels. These proteins such as albumin can also enhance the movement of fluids through tissues and across cell membranes. There is a net improvement the osmolarity of the tissues due to the increase of protein mass within the circulating serum.

The issues of poor lymph return are rooted in lifestyle, especially exercise. However, depression and worry can overwork the spleen and cause dampness to accumulate as the pure yang qi of the spleen is depressed. If this state of affairs continues, the yang of the kidney and heart (shao yin) axis can be affected as the disease progresses towards a chronic debilitative and poorly compensated state.

The ability of cells to communicate with each other through electrical conductivity and energy movement within and between the cells is moderated through the ‘sodium-potassium pump’ which is the most important part of the mineral electrolyte conduction system since it is the only one that is ubiquitous.  The inner cellular mineral electrolyte mix becomes more potassium dominant closer to the nucleus, whereas it is sodium dominant near the cell membrane. The cell membrane is where the sodium-potassium pumping mechanism resides. If the inner-cellular fluid matrix becomes loaded with sodium, the highly structured fluid state within the cell breaks down and degenerative disease, especially cancer, sets in. This is due to impaired nucleus communication with the other parts of the cell as the intracellular matrix is less conductive. (Pischinger, 1991; Tso et al., 1986)

Perfusion through tissues with oxygen requires a functional sodium/potassium pump and this requires that the tissue spaces be in a ‘dry’ state For the ‘dry’ state to occur there must be adequate perfusion with nutrient supply and adequate waste removal. Under these circumstances, lymph congestion can lead to inflammatory compound buildup. (Gretz et al., 2000) This is another route to a toxic physiological environment wherein many chronic a diffuse functional disorders may occur. This set of problems is addressed by using medicinals that are ‘aromatic’ and ‘dry damp’ such as those medicinals that contain the term ‘xiang’ or fragrance in the name like mu xiang (Radix Sausurrea) or tan xiang (Lignum Santali albi), These are combined with medicinals that clear heat toxins such as lian qiao (Fructus Forsythia) and jin yin hua (Flos Lonicera). Perfusion and effective regulation of the intracellular matrix also requires activities that improve circulation and move energy include qi gung, breathing exercises, moderate cardiovascular exercise, (Convertino, 1991) and clean drinking water. Moderate stair-step type exercise induces deep breathing and the muscle movement helps propel lymph through the body and back to the thoracic duct and then back through the subclavian vein into the blood system. (Albert et al., 2004)

Overeating impairs circulation through the mesenteric tract and subsequently the whole body. Undigested foods builds up metabolic toxins that can be absorbed into the blood stream causing the capillaries to dilate and flood the interstitial spaces with excess fluids and blood proteins, which tends to congest the lymph system. This process will cause an accumulation of peptides within the blood stream and can be felt as a widening of the vessel and blood stream as one lifts the fingers from the organ depth through the blood depth, and a subsequent narrowing of the vessel as one lifts further to the qi depth. Hammer calls this pulse ‘blood unclear.’

Toxic influences due to improper diet, environmental factors, drugs, and chemicals have the effect of dilating blood capillaries and flooding the tissues with excess fluids and blood proteins that cause histamine reactions as well as a series of inflammatory cascades involving kinins. This leads to chronic health problems and degenerative conditions. The pulse that indicates that this process gets even wider when lifting through the blood depth. It is wider than the ‘blood unclear’ pulse and is called ‘blood heat.’ This situation tends to respond well when mu dan pi (Cortex Mutan radicis) is added to the formula.

Emotional stability is an important part of the equation, so much so that the primary pulse of this condition–the ‘cotton’ pulse–is also called the ‘sad pulse’ by Hammer.  Emotional stresses can cause a spillage of blood proteins and excess fluids into the interstitial spaces.  Here aromatic open orifice herbs are helpful in respect to opening the mind. It is important to cultivate non-attachment and a moderate response to life events for those who tend to overreact. This is easier said than done, and meditation is a key to cultivating a moderated response to difficult life situations.

Summary and Closure

Diffuse complex and clinical scenarios often involve several systems and the multifactorial events of life. The functional disorders that result from this set of circumstances often occur subclinically. However, Chinese medicine has a great deal to offer for this range of maladies. Impaired fluid metabolism, endocrinological concerns, and poor lymph return are often present with the ‘cotton’ pulse that demonstrates a stagnation of ‘wei qi’ or interstitial fluid and lymph. When this occurs, it is important to explore thyroid function. Here we are considering the fluid metabolism lymph return and the impact of thyroid function on metabolic capacity to supply nutrients. When the lymph and metabolic function are slower than necessary, then the extra cellular and interstitial matrices are congested with fluid and toxins. This scenario predisposes a significant range of complex clinical scenarios that are both replete and delete, hot and cold, but in this case the cold is due to the metabolic insufficiency of thyroid deficiency or–yang depletion.

In closing, the malaise and fatigued state of the walking wounded are often bound with clinical scenarios involving hypothyroidism, depression, and a ‘wet’ cellular state. These conditions have clear diagnoses in Chinese medicine when they remain undiagnosed due to the subclinical nature of the disorders from a Western medical perspective. There are tremendous advantages with respect to the TCM approach to these concerns. Lastly – the crossover in terms of the related pathophysiology for these conditions makes for fertile ground as a model of integration at the biological level.

References

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Convertino, V. (1991). Blood volume: Its adaptation to endurance training. Med Sci Sports Exerc., 23(12), 1338-1348.

Gretz, J. E., Norbury, C. C., Anderson, A. O., Proudfoot, A. E. I., & Shaw, S. (2000). Lymph-borne chemokines and other low molecular weight molecules reach high endothelial venules via specialized conduits while a functional barrier limits access to the lymphocyte microenvironments in lymph node cortex. J. Exp. Med., 192(10), 1425-1440.

Guyton, A. C. (1982). Human physiology and mechanisms of disease (3rd ed.). Philadelphia: Saunders.

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Pischinger, A. (1991). Matrix and matrix regulation, basis for a holistic theory in medicine. Brussels: Haug International.

Tso, P., Barrowman, J. A., & Granger, D. N. (1986). Importance of interstitial matrix hydration in intestinal chylomicron transport. Am J Physiol Gastrointest Liver Physiol, 250(4), G497-500.