Now, let us examine how the story of the small intestine in Donguibogam translates into modern medicine. Representative examples of a breakdown in the separation of clear and turbid in the small intestine are celiac disease and gluten intolerance, which we are discussing today. Celiac disease is an autoimmune disease where our body’s immune system reacts excessively to gluten—a specific protein found in wheat, barley, and rye—thereby damaging the small intestinal mucosa.
Consider this: inside our small intestine, tiny projections called villi sprout densely. These villus projections act like tiny toothbrush bristles, vastly increasing the surface area for absorbing nutrients from food. However, in patients with celiac disease, consuming gluten causes these villus structures to become flattened, atrophied, and damaged due to an inflammatory reaction. When the villus structures are damaged, nutrients cannot be absorbed properly, which corresponds exactly to the phenomenon described in Donguibogam as clear qi failing to be absorbed and leaking away.
Consequently, patients with celiac disease can experience not only chronic diarrhea, abdominal pain, and dyspepsia, but in severe cases also weight loss, anemia from iron malabsorption, osteoporosis from calcium malabsorption, chronic fatigue, skin rash, and even depressive feelings or neurological symptoms. This all happens because poor nutrient absorption in the small intestine affects the entire body. Many people complain of feeling constantly dizzy and weak due to anemia, and very often this originates from problems in the small intestine. Furthermore, because it is an autoimmune disease, it commonly coexists with other autoimmune conditions such as thyroid disease or type 1 diabetes mellitus.
Celiac disease has a strong genetic component and is particularly likely to develop in people carrying the HLA-DQ2 or HLA-DQ8 genotypes. Diagnosis is initially evaluated through a blood test for anti-tissue transglutaminase IgA and anti-endomysial antibody, followed by a small bowel biopsy for definitive diagnosis. To date, strictly maintaining a lifelong gluten-free diet is the only treatment. Beyond simply avoiding wheat flour, it is a demanding process of identifying and eliminating every food where gluten is hidden. Yet this very effort is the path to restoring the damaged small intestine and regaining bodily balance.
If you do not have celiac disease but still experience similar symptoms after eating gluten, you might consider non-celiac gluten sensitivity. This refers to cases where there is no intestinal damage from an autoimmune response, yet one experiences discomfort such as abdominal pain, diarrhea, and fatigue due to the body’s sensitive reaction to gluten. While modern medicine reveals even microscopic changes and the immune response of the small intestine, looking into the fundamental principles shows that it does not deviate from the broad framework of small intestine dysfunction that Donguibogam already addressed.
