What follows is an exposition of Flagyl (Metronidazole) according to Chinese medicine, and an analysis for treating its side effects, namely digestive discomfort and liver toxicity. This is relevant to transgender health care in that long-term medication use–for instance, of Spirolactone to suppress androgens–may be associated with some degree of liver toxicity. Because Flagyl is incredibly hepatotoxic, any treatment of its side effects, especially those to the liver may be useful in palliative treatment of patients on hormone-replacement therapy (HRT) for gender transition.
Metronidazole (MNZ), or Flagyl as it is commonly known, is a nitroimidazole antibiotic and anti-parasite medication, in this case used to treat amebiasis, such as E. histolytica. It works by inhibiting nucleic acid synthesis in the DNA of microbial cells.
Common side effects include nausea, diarrhea, abdominal pain, headache, and dizziness. High doses and long-term treatment are associated with leucopenia, neutropenia, and central nervous system toxicity. It is listed by the US National Toxicology Program as a reasonably anticipated human carcinogen, and by the WHO International Agency for Research on Cancer as a possible carcinogen.
From the perspective of Chinese medicine, Flagyl is very cold in nature and bitter, like other antibiotics and antimicrobial herbs. As such, taking it in large doses over a short period of time to treat parasites can be thought of as excess cold invading the middle jiao, particularly the ST. Likewise, the SP prefers to be warm, and its qi will be damaged by a course of Flagyl. The SP is the source of post-natal essence and is responsible for generating blood. If this function is damaged, there is less blood available which will aggravate the LV. The LV organ is very testy, and as such requires a dynamic balance of blood/yin, and movement/yang. Any disruption in this balance will lead to stagnation. In relation to Flagyl, deficient SP qi due to the invasion of excess cold could lead to less generation of LV blood and resultant qi stagnation. In a way, the LV then is both depleted and agitated simultaneously.
Hence, in the herbal formula from the previous post, several herbs that have an affinity for the LV are combined to restore and maintain this yin-yang balance, namely Yin Chen (Herba Artemisiae Scorpariae), Bai Shao (Radix Paeoniae Alba), and Gou Qi Zi (Frustuc Lycii). This may provide the basis for a general LV-protective protocol for countering the adverse effects of medication use.
Yin Chen has demonstrated hepatoprotective effects, in that studies have shown that herbal formulas in which it is the chief herb effectively reduce liver enzyme (ALT, AST) serum levels (1). Furthermore, Yin Chen has shown success in treating patients with acute infectious hepatitis, reducing fever, jaundice, and overall liver size (2). The herb also has antihyperlipidemic qualities, and has been shown to lower plasma cholesterols and beta-lipoproteins in rabbits (3). Though not listed in traditional herbal books as a function, these features can be thought of as cleaning the LV.
Bai Shao in Chinese medical theory is said to nourish the LV blood and preserve yin, calm LV yang, and smooth/soften the LV. These functions and by extension this herb are relevant to all potential LV disfunction, whether excess of deficiency. In the case of a course of Flagyl, it can soften and smooth the LV and likewise tonify any aspects of the LV that are deficient. A thorough intake including tongue and pulse readings will determine the necessary quantities of Bai Shao and its relevant combinations with other herbs.
In pharmacological terms, Bai Shao as been used to treat dysenteric disorders with rectal tenesmus. In other words, its qualities can treat any residual symptoms from intestinal amebiasis such as occasional urgent diarrhea (4). It is also an anti-inflammatory and antibiotic, with inhibitory actions against Bacillus dysenteriae, E. Coli, Salmonella typhi, and others (5).
The final LV related herb in the formula is Gou Qi Zi, which nourishes LV yin. This herb has been shown to be immunostimulatory, and is associated with an increase in non-specific immunity such as phagocytic activity of macrophages and the total number of T cells (6).
The synergistic combination of these herbs may form the basis of a LV balancing and hepatoprotective addition to formulas for patients undergoing HRT and other long-term medication use. Proportions and dosage as always are determined by the patient’s condition and the practitioner’s diagnosis on that day.
- Guo Wai Yi Xue Zong Yi Zhong Yao Fen, Monograph of Chinese Herbology from Foreign Medicine, 1986; 8(5):22.
- Fu Jian Zhong Yi Yao, Fujian Chinese Medicine and Herbology, 1959; 7:42.
- Zhong Yao Yao Li Yu Ying Yong, Pharmacology and Applications of Chinese Herbs,1990; 15(6): 52.
- Xin Zhong Yi, New Chinese Medicine, 1989; 21(3): 51.
- Zhong Yao Zhi, Chinese Herbology Journal, 1993: 183
- Zhong Cao Yao, Chinese Herbal Medicine, 19(7):25.