by Shawn Kirby L.Ac.

In case you hadn’t noticed, “cleansing” is one of the biggest fads in alternative health care right now. My spam filter at work collects literally hundreds of emails a day advertising various products and procedures. (This trend has gotten so out of hand that a woman recently found that someone had hijacked her dead mother’s facebook account as a vehicle to advertise a colon cleanse.) Walk into any health food store and you’ll typically find an entire aisle of products ranging from concentrated extracts of Cascara Sagrada, to gallon jugs of Aloe Vera, to 5 pound tubs of psyllium husk mixed with Senna lining the shelves. The mind boggles in the face of this veritable arsenal of nuclear bombs designed to “cleanse” the body and “restore health and wellbeing.” Advertisements for high colonics pepper the bulletin boards as you leave the store, and while most of them still seem to be done out of the back of some guy’s garage, many trendy spas and even acupuncture clinics now offer this service. Supply seems to be meeting demand, and people are trying “cleansing” in record numbers. I can’t tell you how many times I’ve had a patient come into my office and ask me what I thought about them “doing a cleanse.” The question becomes, is all this “cleansing” beneficial, necessary, or even safe?

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A Brief History of Super Colon Blow (the other Big Bang)

There are many ideas and theories behind “cleansing” and the need to “detoxify” the body, and while some of them are fairly new-fangled, many of them go all the way back to ancient Egypt. The oldest and most common among these ideas is the notion that disease can result when stool lays in the colon for long periods of time and putrefies. The technical term for this is “auto-intoxication,” an idea that reached a high point in its popularity in the late 1800’s. The most vocal proponent of this theory was Dr. Ilya Ilyich Mechnikov, a Russian whose ideas also indirectly helped to pioneer the use of pro-biotics.1

Alas, science, reason and common sense prevailed, and the theory of auto-intoxication became defunct by 1919.2 By this point, however, the craze had already caught fire and while it was no longer a treatment used by the mainstream medical community, “cleansing” found new and more ardent supporters in the world of alternative healthcare. Over the following decades, pseudo-science and chicanery allowed the theory to develop into more and more gruesome and outlandish forms, finally reaching its zenith with “mucoid plaque.”

Mucoid plaque holds a place in the urban legend hall of fame second only to “el Chupa Cabra.” There are several books available, and countless sites on the internet, that feature full color photographs of the most ghastly stool samples imaginable – black, tar-like and rubbery and formed in the shape of the intestinal wall akin to an obscene molding of Jell-O. These horrors are purportedly to be found rotting in the guts of anyone not strictly adhering to whatever dietary guidelines are recommended by the book or website displaying the photos. I’ve even heard stories (‘round the camp fire, mind you) that John Wayne supposedly had 50 pounds of black tar-like filth rotting in his gut from all the steak he had eaten over the years that was discovered during his autopsy.

But is mucoid plaque real? In a moment of unprecedented bad taste, Katie Couric recently displayed her innards to millions of Americans when she aired her colonoscopy on the morning news program. Shocked into wakefulness by this gruesome display before they had their morning coffee, or worse, in mid spoonful of cornflakes, the viewing public was greeted to mile after seeming mile of pink, clean and healthy intestine without a speck of plaque in sight. So, Katie must have done a lot of coffee enemas in her day, right? Or at least been a strict vegan for most of her life? Hardly. The fact is, after hundreds of physicians have done countless operations, autopsies and biopsies on innumerable patients from all walks of life, not a single speck of mucoid plaque has ever been found. It is a scientific fact that, barring abnormality, 99% of the population completely clears their bowels in three days or less.

In the end, mucoid plaque is not hard to explain. Take a liberal dose of pysillium husk, add a dash of cascara sagrada or other purgative herb of your choice to add color, and mix with water. Leave this mess overnight in a bundt cake mold, and you too will have a nice sample of rubbery “mucoid plaque” that you can take pictures of and display with pride on your facebook page. (And just think – if you do it this way, you can avoid the enema entirely!)

The Dangers of Cleansing

While most doctors view cleansing as mere quackery, most don’t believe it to be of any harm either and consequently ignore the practice. Unfortunately, this attitude has allowed many of the dangers of cleansing to go unnoticed and underreported.

The most common side effects of cleansing are, of course, the obvious risk of injury to the delicate anal and rectal tissue. It goes without saying, but I’ll say it anyway, that just because these practices are labeled “natural” does not mean that there is anything even remotely natural or healthy about repeatedly shoving a rubber hose up your rear end. The improper or extensive use of enema apparatus can produce tearing and scarring as well as hemorrhoid-like symptoms and even severe infections and fissures that can require extensive rounds of antibiotics to clear out.

Less commonly discussed, but much more insidious, is the use of cleansing as a quick way to lose weight. People are more and more commonly turning to “cleanses” as a way to fit into their little black dress before a Christmas party, or to get back into “bikini shape” before spring. While this may seem innocent enough, from a Chinese medical standpoint this is a good way to damage the spleen, the yuan qi and, consequently, the person’s immunity resulting in someone more susceptible to illness. (Maybe you’ve heard, but apparently there’s a really nasty flu bug going around this year.)

In more advanced cases however, a whole new generation of “health-nuts” are using the techniques of cleansing as a way to enable their bulimia nervosa. Cleansing allows these young women (and men) the opportunity to by-pass many of the tell-tale signs that classic bulimic behavior, namely vomiting, leave behind. When you “cleanse” instead of vomit, you avoid the tooth decay, G.E.R.D and throat irritation commonly found in bulimic patients, making diagnosis more difficult for a physician or parent. What’s more, since these practices are considered “natural,” many parents openly endorse them, enabling their children to wreak untold damage to both their body and their psyche. I’ve personally witnessed several young women turn to cleansing as a way to drop weight quickly. Some have gone so far as to do week long water fasts accompanied by daily enemas (the enemas purportedly lower the “detox symptoms” brought on by fasting) as a way to drop over forty pounds in one week. This was done before proms, dances and even sporting events. The parents, viewing this behavior through the lens of “natural health,” stood aside and did nothing except applaud their daughter’s efforts.

Cleansing and Chinese Medicine

The idea that rotting stool is the hidden factor behind the ills of mankind doesn’t really seem to have surfaced in Chinese medicine. While its true that Zhang Zi-he, the Jin-Yuan master who promoted the “attacking school” of thought, advocated using purgatives to clear pathogenic heat from the body, his theories are not widely held in modern Chinese medicine. Few, if any, doctors in the modern era can be said to truly follow the attacking school of thought. While there are certainly powerful purgatives and formulas that will have a profound laxative effect within our traditional formulary, most of these formulas are only used in cases of severe illness – Da Cheng Qi Tang for example. However, while it is true that there are a few formulas that clear yang ming heat in the Shang Han Lun, there are many more formulas in that text that treat complications resulting from improper use of purgation method, clearly indicating that purgation is not to be performed indiscriminately.

Constipation in the average patient is most often due to vacuity. Our popular formula Free the Flow treats a pattern discrimination of qi, blood, yin and yang vacuity with qi stagnation and blood stasis complicated by internal heat. The formula itself is based on Bu Zhong Yi Qi Tang and the majority of the herbs are supplementing – not a nuke in sight. (I should mention at this point that many in the alternative health care field define “constipation” as the absence of a bowel movement the size of your forearm in the past six hours. This is ridiculous and can put patients who think that they need to achieve this level of bowel competence under a level of stress that can be, ironically, quite constipating. The medical definition of true constipation is when stool has not been passed in 72 hours.)

Traditional Ayurveda, the Indian equivalent to TCM, does use purgation technique in their practice of Pancha Karma. However, the whole procedure takes a month of total rest, while the patient is essentially hospitalized and put under the care of trained traditional physicians. Patients receive oil massage, steam baths and other preparatory treatments long before any purgation techniques are used. When purgation is finally performed, it can take either the form of an enema, an herbal purgative or an emetic depending on the patient’s presenting Dosha. The entire practice is undertaken with great care, caution and reverence, with special meditation and spiritual practices accompanying the procedure. The harsh and heroic measures that define western cleansing are utterly absent in this practice.

Finally, it must be said, that when these types of treatments are used in a traditional medicine, such as TCM or Ayurveda, they are only done according to the needs of a specific patient, under specific circumstances, at a specific moment in time. The idea of a panacea, a one-size-fits-all treatment, is utterly lacking in TCM just as it is in all forms of legitimate medicine, alternative or otherwise.

An Alternative Cleanse

So what do I tell my patients when they ask me what I think about them “doing a cleanse?” If they’re at risk for bulimia nervosa, I refer them to their doctor and speak with their parent or guardian as appropriate according to my scope of practice and associated laws. If they are looking to lose weight, I tell them to go take a walk and lay off junk food. If they tell me that they feel “toxic,” burdened by the polluted environment and the stress of their lives, first I tell them this story.

Over a decade ago, a small lake near the U.S. and Canadian border became so polluted that it would no longer support life. A team of scientists was called in and a detailed analysis was undertaken. In the end, the consensus was that it would take at least one hundred years for the lake to recover. The pollutants that had caused the problem were diverted away from the lake and the area was declared an ecological disaster area. As such it was left completely alone without any attempt to clean up the pollutants, which was the only course of action that seemed reasonable under the circumstances.

Once people left well enough alone and stopped poisoning it, the lake fully recovered to a state of pristine ecological health in less than five years, nourished by nothing more than the tender mercies of the Tao.

Then I give them the following “cleanse.” It is simple and takes one month.

Step 1. Unplug your TV. Television is, without question, the most toxic thing I know of. The TV is to stay off for the full month, no exceptions. This step will also free up more than enough spare time to adhere to steps 2 and 3.

Step 2. Do something for your spiritual life every day for one month, no exceptions. This can be Buddhist meditation, praying the rosary, or taking a walk in nature – whatever is appropriate to your patient.

Step 3. Cook at least one meal a day, preferably all three if you can, from scratch for one month. Scratch means scratch – no Hamburger Helper.

After one month of this, your patient should feel as fresh and clean as a spring morning – and not an enema bag in sight.

1. http://nobelprize.org/nobel_prizes/medicine/laureates/1908/mechnikov-bio.html
2. Sullivan-Fowler M (July 1995). "Doubtful theories, drastic therapies: autointoxication and faddism in the late nineteenth and early twentieth centuries". J Hist Med Allied Sci 50 (3): 364–90. doi:10.1093/jhmas/50.3.364. PMID 7665877