Lily Disease and Chinese Herbal Treatment

William Eugene Martin III, Bing Yang

New England School of Acupuncture

MCPHS University

Keywords:  Lily Disease, Bai He Syndrome, Chinese herbal medicine

Abstract: Lily Disease, known as Bai He Syndrome in Traditional Chinese Medicine (TCM), is a complex condition characterized by mental depression, anxiety, and various physical symptoms such as abnormal appetite and behavior, bitter taste in the mouth, and slightly rapid pulse. Named after the herb Bai He (Lily Bulb), which is central to its treatment, Lily Disease primarily affects the Heart and Lung Yin.  The condition often arises from emotional disturbances or febrile diseases that damage the Heart and Lung Yin, leading to emotional and psychological issues. TCM approaches the treatment of Lily Disease by nourishing the Heart and Lung Yin, pacifying Heart-Fire, and addressing the underlying emotional and physical imbalances. This paper explores the clinical manifestations, etiology, and therapeutic strategies for Lily Disease.

Introduction

Lily Disease or Bai He Syndrome, is a rare, potentially deadly and complex TCM medical condition that has garnered attention in the clinical community for its unique presentation and the challenges it presents in diagnosis and treatment. Lily disease gets its name from the TCM formula that is used to treat it, Bai He Gu Jin Tang, which contains Bai He, lily bulb. A common misconception about Lily Disease is that it is the same diagnosis as Lily Fox syndrome. Although these two diagnoses are often used together, they are separate things. Fox disease, or Fox Bewitching syndrome, contains the differential diagnosis factor of genital-anus-throat complex heat, which resembles Bechet’s Triad closely. Fox Bewitching syndrome is treated with Gan Cao Xie Xin Tang, not Bai He Gu Jin Tang (Kang, X. (1893)). 

The term “syndrome” in Lily Syndrome, refers to a group of symptoms and signs that occur together, typically pointing to a particular disease or condition. Lily Syndrome is particularly elusive, and while there has been significant progress in understanding its origins by reviewing the classics of Chinese medicine, much remains unknown about its precise causes and the best ways to manage it. 

Symptoms and Diagnosis

Lily Syndrome presents a unique array of symptoms that can affect various systems within the body. The most reported symptoms include:

• Neurological and Psychological Symptoms: These often involve cognitive delays, difficulty with coordination, and sometimes, seizures. Some individuals with Lily Syndrome also experience tremors or involuntary muscle movements. Patients with Lily Syndrome will also present with the classic symptoms of being hungry but not eating, being thirsty but not drinking, and being tired but not sleeping and temperature dysregulation ranging between very hot and very cold. Historically, patients may also be aware of supernatural beings and suffer from delusions and hallucinations. This is an imbalance of not just the physiological aspects of the organs, but also their spiritual effects, affecting the Hun, Shen, Po, Zhi and Yi. This can easily be misdiagnosed for the classical Zang Zao syndrome, treated by using the herbal formula Gan Mai Da Zao Tang, which would lead to deleterious effects by tonifying the already damaged organs and their spirits instead of expelling the pathogenic factor of heat smoldering yin. 
• Dermatological Manifestations: Patients frequently exhibit skin abnormalities, which may include discoloration, unusual lesions, or fragile skin that bruises easily. These skin-related features are one of the hallmark signs of the syndrome. Patients may also have scarlet rashes that appear over the trunk and abdomen. The dermatological dysfunction in Lily Syndrome is directly correlated to the Lung yin and qi being injured, and failing to descend and diffuse, as well as regulate the Cou li space and keep the Wei level open and free. 
• Autoimmune Features: One of the defining aspects of Lily Syndrome is its link to autoimmune responses. Individuals may have elevated levels of certain antibodies, indicating an abnormal immune system response. This can lead to symptoms resembling autoimmune diseases, such as joint pain or inflammation. This also may be a cause of pathological phlegm accumulating in the joint and channels.  This autoimmune presentation is linked to the triple warmer, as some scholars believe it to be part of the endocrine system, which would include the Triple Warmers paired Shaoyang organ Gallbladder. 
• Chinese Medical Symptoms and Signs:  Patients with Lily Syndrome will present with a thin-rapid pulse, red –peeled tongue with significant redness in the Upper Burner portion of the tongue around the Heart and Lung region. Patients may also have bitterness in their mouth. Patients Shen reflection of the eyes may be cloudy or not consolidated as well. 
  
  

Diagnosis of Lily Syndrome remains a challenge. Because it encompasses multiple organ systems and shares features with other, more common conditions, a differential diagnosis is often necessary. A TCM physician trained in western medicine may use genetic testing, a detailed patient history, and symptomatology to rule out other potential causes. Diagnostic imaging, such as MRIs or CT scans, may be used to assess any neurological damage or abnormalities in the brain, such as cancer, bleeding or trauma. Chinese medical diagnostic procedures such as pulse taking, tongue diagnosis, channel palpation and abdominal palpation are used to fine-tune the diagnosis and ensure a solid diagnosis before treatment begins. 

Etiology and Pathophysiology

The etiology of Lily Syndrome is hard to pinpoint. We know that the classics indicate that Lily Syndrome is a manifestation of Lung and Heart Yin deficiency that is caused by heat. This heat can become pathological either internally or externally, and begins to grow in the Upper Burner, where the Heart and Lungs are located. This heat grows to the point where it consumes heart and lung yin, creating a yin deficiency (Shang B, 2020). 

Environmental factors may also contribute to the onset of the syndrome. These could include viral infections, exposure to certain toxins, or other environmental stressors that trigger the creation of pathogenic heat, which further rises and injures the lung and heart yin. Lifestyle also plays a role, as factors such as excess sex, not enough sex, poor diet, poor mindset, mental health issues, life stressors and trauma/shock can all cause excess heat in the body. 

Treatment and Management

The treatment strategy for Lily Syndrome is to clear heat, calm and stabilize the Shen and nourish the lung and heart yin. This is done by using the classical Chinese herbal formula Bai He Gu Jin Tang, or ‘’Lily Bulb Decoction to Preserve the Metal’’. The word ‘’Metal’’ of the English translation refers to the element associated with the lung, which is Metal. The ingredients to the formula BHGJT are listed below. 

Bai He, Sheng Di Huang, Shu Di Huang, Mai Men Dong, Xuan Shen, Chuan Bei Mu, Jie Geng, Dang Gui, Bai Shao, Gan Cao 

 For more severe heat signs, Zhi Mu and Yu Xing Cao may be added. And, for more intense tidal fever Bie Jia and Bai Wei may be added. For depletion of fluids, common in yin deficiency, Tian Huan Fen may be added to generate fluid, as well as Lu Gen. Lastly, for severe sore throat Niu Bang Zi, Jin Yin Hua and Ban Lan Gen may be added. 

This formula is traditionally taken as a decoction 1-3 times daily, depending on severity. The action of this formula is beautiful, in that it moistens the lung yin, heart yin, stops cough, clears heat and phlegm, and re-calibrates the Lung and Heart actions. The Bai Shao in the formula works to move liver qi and blood and acts as a Jueyin/Shaoyang harmonizer to ensure the smooth flow of qi is restored, to carry the proper and health yin to the lung and heart. 

Other treatment approaches based on clinical features and presentation are listed below.

1. Neurological Treatment: Cognitive and motor symptoms are often treated with herbs aimed at improving brain function and reducing seizures or tremors, which is a manifestation of wind or chaotic yang in the body.  Anticonvulsant/Wind -Expelling type herbs such as Quan Xie, Chuan Tui, Wu Gong, Long Gu and Mu Li, may be prescribed to control seizures, while physical modalities such as Tuina and cupping can assist with motor coordination issues.
2. Dermatological Treatment: For skin-related symptoms, herbs such as Bo He, Fang Feng, Tian Hua Fen, Ju Hua, Shi Gao can be used to generate flesh and bolster the exterior, while venting out pathogens. Herbs such as Fu Ling, Bai Zhu and Zhu Ling may be used in Damp-heat situations to drain the dampness internally. 
3. Autoimmune Management: Herbs such as Huang Qi, Ling Zhi, Da Zao and Dong Chong Xia Cao work well to regulate the immune system by bolstering the Wei qi, stabilizing the exterior, and on a western medical note scavenging for free radicals, increasing white cells, and tonifying the immune system. 

In addition to herbal treatments, lifestyle changes, and supportive therapies are essential. Patients are often encouraged to maintain a healthy diet, engage in physical therapy, and seek mental health support to address any psychological challenges related to the syndrome.

Lily Syndrome is a rare, ancient and not commonly seen condition that acupuncturists and Chinese herbalists may run into and should be well prepared to encounter. This condition, if real Lily Syndrome, can be deadly and have severe long-term effects on physical, emotional and psychological health. Therefore, it is pertinent to recognize the common signs and symptoms, pathology, etiology and recommended treatment for this condition, to better serve our patients. 

References

Kang, X. (1893). The Cult of the Fox. New York: Columbia University Press.

Shang B, Zhang H, Lu Y, Zhou X, Wang Y, Ma M, Ma K. Insights from the Perspective of Traditional Chinese Medicine to Elucidate Association of Lily Disease and Yin Deficiency and Internal Heat of Depression. Evid Based Complement Alternat Med. 2020 Nov 25;2020:8899079. doi: 10.1155/2020/8899079. PMID: 33299463; PMCID: PMC7710406.Insights from the Perspective of Traditional Chinese Medicine to Elucidate Association of Lily Disease and Yin Deficiency and Internal Heat of Depression – PMC

Chen, J. K., Chen, T. T., & Crampton, L. (2012). Chinese Medical Herbology and Pharmacology. Art of Medicine Press, Inc.

Herb formulas. Bai He Gu Jin Tang – 百合固金湯 – Lily Bulb Decoction to Preserve the Metal – Lily Combination – Chinese Herbs – American Dragon – Dr Joel Penner OMD, LAc. (n.d.). https://www.americandragon.com/Herb%20Formulas%20copy/BaiHeGuJinTang.html

Budi, Nirmala Khairunnisa (2023) “REPRESENTATION OF HULI JING (FEMALE FOX SPIRIT) IN CHINESE LITERARY TEXTS,” International Review of Humanities Studies: Vol. 7: No. 1, Article 20. Available at: https://scholarhub.ui.ac.id/irhs/vol7/iss1/20

Authors Biography- 

William Martin is a final-year Acupuncture and Chinese herbal medicine student at New England School of Acupuncture. He went on to study medical lab science and immunology at the University of Nevada, Reno, and Health Sciences at Southern Maine Community College. 

Bing Yang is a licensed acupuncturist and herbalist in Massachusetts. She received her Bachelor’s and Master’s degrees in Acupuncture and Chinese Medicine from Beijing University of Chinese Medicine in the 1990s and her Doctoral degree from Massachusetts College of Pharmacy and Health Sciences (MCPHS). Currently, she is the associate professor and Director of Chinese Herbal Programs of New England School of Acupuncture, MCPHS, and also maintains a private practice in Boston.