马克.海曼（MARK HYMAN）
- 克利夫兰功能医学中心主任，美国功能医学研究院院长；
I am often asked if there is a way to deal with autoimmune disease-the most common chronic disease-the most common question being〝is there any way to deal with this without taking powerful anti-inflammatory drugs that often have serious side effects?〞
Autoimmune diseases are a huge problem in this country. As a whole, autoimmune diseases affect over 80 million Americans and five percent of the population in Western country.They include type1 diabetes, lupus, rheumatoid arthritis,multiple sclerosis,colitis, Crohn's disease, and dozens of others, but they all have one thing in common: The body attacks itself.经常有人问到我有没有解决自体免疫性疾病的办法，这是一种很常见的慢性疾病，逾八千万美国人，在西方国家甚至高达5%的人群饱受自体免疫性疾病的困扰。常见自体免疫性疾病包括I型糖尿病、红斑狼疮、风湿性关节炎、多发性硬化、结肠炎、克罗恩病等等，它们都具有一个共同特点∶机体对自身的攻击。Autoimmune diseases,rheumatoid arthritis or RA often include challenging symptoms such as pain swelling fatigue, and disability.
At their root, a central biochemical process connect these seemingly disparate Diseases:A runaway immune response, called systemic inflammation, inevitably results in your body attacking its own tissues.Your immune system's job is to defend you against invaders or foreign microbes, toxins or abnormal cell like cancer a foreign food proteins (allergens).Imagine your immune system as an army that must clearly distinguish friend from foe.Autoimmunity occurs when your immune system gets confused and your own tissue gets caught in the crossfire. Your body is designed to fight off harmful things like infections, toxins, allergens,or a stress response. Some times and for reasons not fully known, that immune army directs its hostile attack on your joints, brain, skin, and sometimes your whole body.Conventional medicine accepts this problem, but stops there, without LOOKNG for what might be causing the body to be out of balance and attacking itself.Instead, conventional medicine invents pharmaceutical drugs to inhibit, block or anti-something, and fails to answer one simple question: Why is the body out of balance to begin with? and how do we help it regain the proper balance?风湿性关节炎或类风湿性关节炎等自体免疫性疾病通常表现为**挑战性的症状，如疼痛、肿胀、疲乏甚至残疾。从根源来进，一个中心的生化过程把这些看似不同的疾病连接在一起，失控的免疫反应，全身系统的炎症，不可避免的导致机体对自身组织的攻击。我们免疫系统的任务就是保护身体免受外来者，如微生物、毒素或异常细胞（癌细胞）、食物蛋白（过敏源）的入侵，想象一下我们的免疫系统就是军队，它必须明确区分朋友和敌人。当我们的免疫系统变得混乱，自体组织开始被攻击时，自体免疫启动。身体本来的设定是为了对抗有害物质如感染、毒素、过敏或压力反应，有时却在不明原因下，免疫大军开始攻击关节、大脑、皮肤甚至整个机体。传统医学接受这个观点，但就此止步，并不深究到底是什么引起了身体的失衡和自我攻击。然而，传统医学通过药物来抑制、阻断或者对抗，却不能回答一个简单问题：那为什么身体会出现失衡?我们应该怎样恢复平衡?lsabel, a cute 10-year-old girl from Teas who loved riding horses,walked into my office several years ago with one of the most severe cases of autoimmune disease I had ever seen.Her face and joints were swollen and her immune system was attacking her entire body including her muscles,skin, joints, blood vessels, liver,and white and red blood cells.Isabel couldn't squeeze her hand or make a fist.The tips of her fingers and toes were Perpetually cold from Raynaud's disease. She had been suffering from rashes that burned and irritated her skin for years. She felt tired and miserable and was losing her hair.Isabel was an elephantine doses of intravenous steroids every three weeks just to keep her alive, and she was taking prednisone, aspirin, acid blockers,and methotrexate, a chemotherapy drug used to shut down the immune system daily.
Despite these mega-doses of medication, she still wasn't getting any better,and her lab tests were still abnormal.Her doctors wanted to add another powerful immune suppressing drug (a TNF alpha blocker) to the regimen of medication. She was already taking.This drug increases the risk of cancer and death from overwhelming infection, because it prevents the immune system from fighting infections normally.The inflammation slows down, thus the autoimmune symptoms may abate, but at a cost Increased risk for cancer and infection.Disturbed by these possibilities and disgusted with conventional approaches that weren't working, her parents brought her to see me.
Two months after I first saw babel, when I discovered and then treated the underlying causes of her inflammation-after，as she says she＂stopped eating gluten，dairy，and sugar and took some supplements＂-she was symptom free.In less than a year,she was completely healthy,her blood tests were normal, and she was off all her medication.伊莎贝尔是一个可爱的10岁小女孩，来自德克萨斯州，热爱骑马，几年前来到我的诊所，是我所见过最为严重的自体免疫性疾病案例之一，她的面部和关节水肿，免疫系统攻击了她整个身体，包括肌肉、皮肤、关节、血管、肝脏和血细胞。伊莎贝尔甚至不能握紧她的手，攥成拳头，雷诺氏病导致手指和脚趾永远失去知觉，长年累月受皮疹的困扰，她感到厌倦、绝望，开始脱发。伊莎贝尔每三周就需要注射大剂量的类固醇来维持生命，同时每天服用强的松、阿司匹林、抑酸剂和甲氨蝶呤（一种化疗药物）来抑制免疫系统。尽管用了如此巨大剂量的药物，但她并没有丝毫好转，实验室指标依旧不正常。医生准备增加另一种强效的免疫抑制剂，但这种药物会增加癌症和死亡的风险，使机体不能正常对抗感染，可能导致大面积感染而致死。炎症虽然被降下来了，自体免疫性疾病的症状有所减轻，但需要付出的代价却是∶感染和癌症的风险大大增加!由于担心传统疗法以上副作用及疗效不确定，她父母最终带她来到我的诊所。距离我**次给伊莎贝尔看病后两个月，也就是我寻找炎症根源并治疗一段时间后--通过停止食用麸质、奶制品和糖，并补充一些营养素，她的症状消失了。不到一年的时间，她已经完全恢复了健康，血液检测指标正常，不需要再服用任何药物了。A Functional Medicine Perspective to Autoimmune Disease，功能医学角度看自体免疫性疾病Isabel's story is a perfect example of the power of Functional Medicine, which provides a map to find the root cause of inflammation, which underlines autoimmune disease.Functional Medicine asks why that inflammation exists When we identify the underlying sources,we can heal the body. Those causes include stress, hidden infections, food allergies or sensitivities, toxic exposure, genetic predisposition, nutrient deficiencies, and leaky gut.伊莎贝尔的故事是功能医学疗效好的一个典型案例，提供寻找炎症根源的路径-自体免疫性疾病形成的基础。功能医学寻求为什么炎症会存在，当我门确定潜在的根源，就可以治愈身体。这些原因包括压力、隐性感染、食物过敏或敏感、毒素曝露、遗传易感性、营养不足和肠漏。In fact, there are just five root causes of all diseases:事实上，只有五个问题是导致所有这些疾病的根源∶ Allergens，过敏
Microbes or imbalance of the bugs in your gut，微生物或肠道菌群失衡
Toxins，毒素
Poor diet，饮食不佳
Stress，压力
All of these can trigger symptoms and create thousands of diseases, including autoimmune diseases.If you want to cool off inflammation in the body, you must find the source. Physicians are mostly taught to diagnose disease by symptoms, NOT by their underlying cause.Functional Medicine approaches diagnosing and treating disease differently.It focuses on causes not symptoms, one that is based on an understanding of the dynamic way our genes interact with environment, one that goes beyond simply treating diseases based on the label.Functional Medicine teaches practitioners to understand the body as a system to seek the causes of illness to understand the body's basic functional systems, where they go awry, and how to restore balance; to understand the interconnections between symptoms and organs rather than segregate diseases into specialties.This approach provides a fundamentally different way of seeking medical problems,one that allows us to decipher the origins of illness and identify the disturbances in biology that lead to symptoms. And that leads me back to isabel's story.以上这些问题可以引起成干上万种疾病及各种症状，其中就包括自体免疫性疾病。如果你想缓解身体炎症，必须找到炎症的根源。医生们大都被教育通过症状来确诊疾病，而非更深一层的寻找根本原因。功能医学在诊断和治疗疾病与传统医学不同-专注于病因而非症状，深入了解基因与环境的动态相互作用，并不只是根据症状来治疗疾病。功能医学教育医生把机体当初一个系统的整体来找寻疾病的根源，了解机体的基础功能系统，哪那里出现问题，如何恢复平衡，理清症状与器官之间的相互连接，而非把疾病归为某一个专科。这就为我们找寻医疗问题提供了一条完全不同的思路，通过明确疾病的根源和明确引起的症状的功能失衡。我们再回到伊莎贝尔的故事。From Conventional illness to Functional Health，从传统疾病到功能健康For lsabel, the only response physicians had to her life-threatening illness was to shut down her immune system, leaving her at risk for cancer, infection, osteoporosis, muscle wasting and psychiatric illness. But there was another way.I simply asked the question "WHY?" I didn't focus on WHAT the name of her disease was, but WHY she was inflamed, WHERE this inflammation originated from, and HOW we could locate the causes and restore balance to her overactive immune system that was attacking her own body?The immune system usually responds to some insult such as an allergen, a microbe, or a toxin, and then runs out of control. Finding and removing that trigger is essential.In a review in the New England Journal of Medicine,researchers acknowledged that 'even in a genetically predisposed person some trigger, an environmental exposure,or change in the internal environment-is usually required for autoimmunity.When l initially talked to lsabel I discovered many potential triggers for her inflammation.She was being exposed to a toxic mold, Stachybotrys, in her house. Her mother worked in limestone pits exposing her to excessive amounts of fluoride while pregnant babel had a her immunizations before1999 when thimerosal was removed from vaccines.She also had a thimerosal-containing flu shot every year.Thimerosal contains mercury, a known immune toxin. This problem became compounded by her diet,which inchuded large amounts of tuna and sushi she loved and ate regularly (and which exposed her to even more mercury),and loads of dairy and sugar.In the year before she got sick, she also had many courses of antibiotics.
Mold,mercury,antibiotics, sugar,gluten, and dairy all become potential immune irritants.lsabel's lab tests were frightening. Her muscle enzymes and liver function tests showed severe damage.She had many autoimmune antibodies(anti-nuclear antibodies, rheumatoid factor,anti-SSA anti-DNA anti-RNP,lupus anticoagulant),a sign that the level at which the body was attacking itself were extremely elevated.Other markers of inflammation were extremely high as well. Her white blood count and red blood cell count were low. Her vitamin D was also low. She had elevated levels of antibodies to gluten which is a common cause of autoimmune disease and trigger significant intestinal inflammation.And her mercury level was extremely high in her urine after a provocation test(the only way to assess total body burden of metals). Normal is less than three. Hers was 33.At the first visit, I simply put Isabel on an anti inflammatory elimination diet to remove possible trigger of inflammation from food allergens. She stopped eating sugar, dairy, and gluten from wheat)I gave her a multivitamin, vitamins D,B2, and B9(folate); fish oil; and evening primrose oil of which are anti-inflammatory.I also gave her nystatin (an non-absorbed anti-fungal) to treat suspected yeast overgrowth due to the multiple courses of antibiotics. I gave her N-acetyl cysteine (NAC) to support her liver, and told her parents to take her off of the aid blocker, the calcium channel blocker that she used for her Raynaud's, and the intravenous steroids she had been taking.Two months later,at her second visit, Isabel reported the rash was totally gone. She had no joint pain and her hair was growing back. Her autoimmune markers had dramatically improved.Her muscle enzymes,liver function,and level of inflammation were all normal. I added probiotics to support healthy digestive function and reduce gut inflammation. I also started her on DMSA (a chelating agent) to help bind the mercury from her tissues and cell and help her excrete it. To help her get off the prednisone, I gave her herbs to support her adrenal gland function.Seven months later, he tests were normal, including her white blood count. Her mercury came down from 33 to 16.After 11 months, her mercury was down to 11 and her gut inflammation was gone. She was off all her medications and feeling happy, normal, and was able to ride and show her horse again.Isabel's experience is not rare, and I take a similar approach (though not always as comprehensive) with autoimmune disease. Considering these and other amazing results,wouldn't you say Functional Medicine should be expanded and made available to more patients? Shouldn't we see more case studies and success stories like lsabels?面对危及伊莎贝尔生命的疾病，医生能做的只有关闭她的免疫系统，让她不得不陷入癌症、感染、骨质疏松、肌肉萎缩、精神疾病的巨大风险。现在，有了另外一种治疗方式。
我只是问这样一个简单的问题"为什么"，并不关注疾病的名称，但"为什么"她发炎了，炎症的来源到底是"哪里"，我们应该"如何"找到病因并使她过度活跃攻击自身的免疫系统恢复平衡?免疫系统一般被一些外来物质触发而最终失控，如过敏源、微生物、毒素等，找到并清除"触发器"是至关重要的。发表在新英格兰医学杂志上的研究发现，即使在基因为易感的条件下，仍然需要环境毒素的曝露或内部环境的改变触发自身免疫。当我最初与伊莎贝尔交谈时，我就发现许多潜在的炎症触发因素。她曾经曝露于有毒霉菌（葡萄穗霉属）的房间里，她的母亲在怀孕时曾在石灰岩区工作，并接触大量氟化物。伊莎贝尔接种了各类疫苗（直到1999年硫汞才从疫苗中去除），并且一年两次注射流感疫苗。硫汞中含有汞，是一种已知的免疫毒素。她的饮食方式更为加剧了这种毒素在身体的累积，大量金枪鱼和寿司（含有大量汞），奶制品，糖。在她生病的前一年，还服用了大量的抗生素。霉菌、汞、抗生素、糖、麸质、奶制品等都成为了潜在的免疫刺激物。伊莎贝尔的实验室指标也是很惊人的，她的肌酶和肝功能检查显示严重受损，体内有大量自身免疫抗体（核抗体、 类风湿因子、anti-SSA、anti-DNA、anti-RNP、狼疮抗体），说明身体自我攻击的程度非常高。其他的炎症指标也是非常高的，白细胞计数和红细胞计数很低，维生素D水平很低，麸质抗体水平很高，这是一种最常见的引起自体免疫病和触发严重肠道发炎的因素。尿液激发试验发现体内汞的水平非常之高，正常应该是在3以下，她的检查结果是33。**次就诊时，我告诉伊莎贝尔要通过限制饮食来祛除一些引起炎症的过敏源，她停止食用糖、奶、麸质（小麦），服用综合维生素、维生素 D、B12、叶酸、鱼油、月见草油等抗炎营养素。同时服用 Nystatin（制霉菌素），这是一种不会被肠道吸收的抗霉菌药物，因为她服用较多抗生素，体内霉菌可能超标。另外，服用N-乙酰半胱氨酸来支持肝脏。停用之前治疗雷诺氏病的抑酸剂、钙离子阻滞剂和类固醇。两个月后她第二次来复诊时，伊莎贝尔的皮疹已经基本痊愈，关节痛消失了，头发也开始重新长出来。自体免疫指标奇迹般的改善，肌酶、肝功能炎症指标都基本恢复了正常。我开始给她服用益生菌来支持健康消化功能和降低炎症，使用DMSA 促使她体内结合在细胞和组织里的毒素汞分离并排除体外，通过支持肾上腺功能的草药来摆脱强的松。七个月以后，她的检测结果一切正常，包括白细胞计数。体内汞的水平也从33降到了16。11个月以后，汞的水平降到了11，肠道炎症消失。伊莎贝尔摆脱了所有药物，感受到像普通人一样的快乐，重新开始骑马了。伊莎贝尔的案例并非罕见，我采取的只是自体免疫性疾病相似的疗法，但考虑到这些惊人的效果，我门是否应该广为宣传功能医学并使更多的病人受益呢?10 Steps to Reverse Autoimmune Disease，逆转自体免疫性疾病的十条策略Functional Medicine removes the bad stuff, but it also replenishes with good stuff What are the ingredients for great health? They include fresh food, light, air, water, movement,love,sleep,connection balanced hormones, meaning, love, and purpose.If you have an autoimmune disease,I encourage you to work with a Funcional Medicine practitioner.These are among the strategies I take to reverse RA and other autoimmune diseases功能医学祛除有害健康的因素，并用有益健康的因素替代，什么是有益因素呢，包括新鲜食物、光线、空气、水、运动、爱好、睡眠、沟通、荷尔蒙平衡、意义、爱情和目标。如果你患有自体免疫性疾病，我建议你寻求一位功能医学医生。- Get tested fa hidden infections. Work with you doctor to check for hidden infections like yeast,viruses,bacteria,and Lyme or other tick borne illnesses.查出潜在感染，如霉菌、病毒、细菌、螺旋体或其他虱传播疾病。
- Try The Blood Sugar Solution 10-Day Detox Diet. My plan is designed to eliminate most food allergens and reduce inflammatory foods.尝试 10 日血糖调节饮食，计划旨在消除食物过敏并减少致炎食物的摄入.
- Get tested far celiac disease. This is a blood test any doctor can do.做乳糜泻检测。
- Get checked for heavy metal toxicity. Mercury and other metals can cause autoimmunity.检测体内重金属是否超标。汞和其他重金属都可导致自体免疫性疾病。
- Fix your gut Leaky gut and other gut tissues such as over growth of bad bugs( yeast, bacteria, and parasites) fuel the flames of inflammation, exacerbating autoimmune diseases. Functional Medicine practitioners can test your stool and employ the 5R program (remove, replace, re- inoculate, repair and renew))修复肠道。肠漏症和其他肠道问题:坏菌、霉菌、寄生虫过度生长等都会引发肠道炎症，加重自体免疫性疾病。可通过粪便检测肠道并使用 5R疗法进行治疗。
- Use anti-inflammatory nutrients. Great anti-inflammatory nutrients that help calm your immune system include fish oil, vitamin C,vitamin D,and probiotics. You can find them a on my online stare.应用抗炎营养补充剂。优质的抗炎营养素可以平复免疫系统，如鱼油、维生素C、维生素D、益生菌等。
- Try anti-inflammatory herbs. Curcumin, Boswela extract,ginger, etc can work well often use Zyflamend also known as inflamasyn with my patients.应用抗炎草药，姜黄、乳香属萃取物、姜等。我经常使用 Zyflamend.
- Exercise regularly. Regular, consistent exercise is a natural anti-inflammatory. Click here to find a simple, effective plan no matter what your fitness level is.坚持规律的运动是非常好的抗炎机制。
- Practice deep relaxation. Stress worsens the immune response.Relaxation for you might include yoga, deep breathing biofeedback,or massage. You might also try my UItraCalm CD.练习深度放松。压力会加重免疫反应，可以采取瑜伽、深呼吸、生物反馈或按摩等方式放松。
- Get 8 hours' sleep every right. You can get 19 of my top sleep tips here.保证每晚至少8小时睡眠。
Even though autoimmune diseases now affect over 80 million people, conventional Strategies like powerful immune-suppressing medication fail to address the underling cause. That's like taking a lot of aspirin while you are standing on a tack.The treatment is not to take more aspirin or a strong immune suppressant,it is to remove the tack.即使目前有超八干万人群（美国）受到自体免疫性疾病的困扰，传统医学的治疗方法如强效免疫抑制依旧不能解决深层的原因，这就像是你站在一个大头钉上服用止痛药，并没有什么用。真正的治疗不应是服用更多的止痛药或强效免疫抑制剂，而是要找到并移除大头钉!
何 健，功能医学专家顾问
国际知名功能医学专家，Wake Forest University 博士，梅奥诊所博士后，Genova Diagnostics实验室原主任，《中华健康管理学杂志》编委及“功能医学专栏”主持人。
