MAPPING A KILLER PATHWAY

繪製殺手通路

Doctors typically specialize in parts, rather than the whole picture. During medical school, we choose our specializations in certain body parts, going on to become cardiologists, gastroenterologists, neurologists, psychiatrists, and so on. And the same is true for most research funding and advocacy agencies—the American Heart Association, the American Cancer Society, the American Psychiatric Association, and others—which are also built around particular disease processes or parts of the body, rather than the living person who in every moment integrates the parts into a lived whole. This is how chronic inflammation, the underlying cause of the world’s most common and fatal illnesses, managed to fly under the radar for so long. But zoom out and you can finally see the map: chronic inflammation is a superhighway that runs straight to the most deadly diseases out there. Yet how often has your doctor helped you reduce inflammation in your body or even brought it up?

醫生通常專注於部分，而不是整體。在醫學院期間，我們選擇身體某些部位的專業，繼續成為心臟病專家、胃腸病學家、神經學家、精神病學家等。大多數研究資助和倡導機構（美國心臟協會、美國癌症協會、美國精神病學協會等）也是如此，它們也是圍繞特定的疾病過程或身體部位建立的，而不是每時每刻將這些部分整合到一個活生生的整體中的活人。這就是慢性炎症（世界上最常見和最致命疾病的根本原因）如何能夠在雷達下飛行這麼長時間的原因。但縮小範圍，您終於可以看到地圖：慢性炎症是一條直通最致命疾病的高速公路。然而，您的醫生多久幫助您減少體內的炎症，甚至提出它？

The so-called lifestyle illnesses—cancer, heart disease, stroke, lung disease, and diabetes—are the top causes of death and disability in the United States, and they account for 75 percent of all health-care spending. Two-thirds of all deaths in the United States are caused by these five diseases alone, and for the most part, these statistics repeat themselves across other developed countries. Worldwide, 27 percent of deaths in 2015 were caused by heart disease and stroke, and deaths from diabetes were up approximately 60 percent compared to 2000. Death due to dementia more than doubled from 2000 to 2015.² And then there’s depression, announced by the World Health Organization (WHO) in 2017 as the leading cause of ill health and disability worldwide. More than three hundred million people in the world are now living with depression, according to WHO estimates, and this represents an increase of more than 18 percent between 2005 and 2015. People who are depressed have less robust immune systems and are vulnerable to more illness in general and to poorer recoveries.³

所謂的生活方式疾病——癌症、心臟病、中風、肺病和糖尿病——是美國死亡和殘疾的首要原因，它們佔所有醫療保健支出的 75%。美國三分之二的死亡病例僅由這五種疾病引起，而且在大多數情況下，這些統計數據在其他發達國家也會重複出現。2015年，全球27%的死亡是由心臟病和中風引起的，與2000年相比，糖尿病死亡人數增加了約60%。從2000年到2015年，失智造成的死亡人數增加了一倍多。²然後是抑鬱症，世界衛生組織 （WHO） 於 2017 年宣佈抑鬱症是全球健康情況不佳和殘疾的主要原因。據世衛組織估計，世界上現在有超過3億人患有抑鬱症，這意味著2005年至2015年期間增加了18%以上。抑鬱症患者的免疫系統不太強大，通常更容易患上更多的疾病，恢復能力較差。³

All across the globe, it’s lifestyle illnesses and depression that are ruining health and vitality. They’re painful, they’re expensive, and their rates are increasing. Clearly, we need to be doing something differently. Outside of the handful of individuals who experience spontaneous healings, most of us who end up with one of these illnesses don’t end up recovering. Sometimes we learn to live with them, manage them, medicate them successfully. Mostly, though, we lose function and quality of life, and far too often end up dying early.

在全球範圍內，生活方式疾病和抑鬱症正在破壞健康和活力。它們很痛苦，很昂貴，而且費率還在增加。顯然，我們需要做一些不同的事情。除了少數經歷自發癒合的人之外，我們大多數人最終患上這些疾病之一最終都不會康復。有時我們學會了與它們共存、管理它們、成功地給它們用藥。然而，大多數情況下，我們會失去功能和生活品質，而且往往會過早死亡。

The statistics are staggering. If this level of mortality were being caused by a type of disease we could medicate away with one of our “silver bullets,” we surely would have already declared war on these illnesses and essentially wiped them out long ago, the way we did with smallpox, polio, and tuberculosis. But the tricky thing about lifestyle illnesses—why they get to stick around and become more prevalent and aggressive, killing more of us each year—is that in many cases, they stem from fundamental ways that we, as a culture and society, operate on a daily basis: what we eat, where we live, how we eat and live, what we think about, how we feel. They have their roots in our values systems and how we define success and happiness. This isn’t something you can just medicate away.

統計數據令人震驚。如果這種死亡率是由一種我們可以用「靈丹妙藥」來治療的疾病引起的，那麼我們肯定早就向這些疾病宣戰了，基本上早就消滅了它們，就像我們對天花、脊髓灰質炎和肺結核所做的那樣。但是，關於生活方式疾病的棘手之處——為什麼它們會持續存在並變得更加普遍和具有侵略性，每年殺死我們更多的人——在於，在許多情況下，它們源於我們作為一個文化和社會每天運作的基本方式：我們吃什麼，我們住在哪裡，我們如何吃和住， 我們的想法，我們的感受。它們植根於我們的價值觀體系以及我們如何定義成功和幸福。這不是你可以隨便吃掉的東西。

With inflammation-based lifestyle illnesses, we’ve made incredible breakthroughs in surgery, medications, and technology to mitigate or treat these illnesses when their symptoms flare up in the most painful and immediately life-threatening ways. We can insert cardiac stents when the blood vessels aren’t allowing enough blood through; we can bring down blood sugar when a person is in diabetic ketoacidosis and sliding into a coma. We can brilliantly manage all manner of other crises. But to truly prevent and heal illness—to place a guardrail at the top of the cliff rather than just line up the ambulances at the bottom—we need to change a whole lot more than that. Chronic inflammation comes from how we think, how we feel, how we live.

對於基於炎症的生活方式疾病，我們在手術、藥物和技術方面取得了令人難以置信的突破，以減輕或治療這些疾病，當它們的癥狀以最痛苦和立即危及生命的方式發作時。當血管不允許足夠的血液通過時，我們可以插入心臟支架;當一個人處於糖尿病酮症酸中毒並陷入昏迷時，我們可以降低血糖。我們可以出色地管理各種其他危機。但是，要真正預防和治癒疾病——在懸崖頂部放置護欄，而不僅僅是在底部排列救護車——我們需要做出的改變遠不止於此。慢性炎症來自我們的思維方式、感受方式和生活方式。

Inflammation itself isn’t inherently evil. In fact, acute inflammation is an essential, lifesaving function. This intense, laser-focused process is what creates the redness and swelling when you get cut or infected. These are the visible signs of what happens when a wide variety of highly specialized cells are sent to the scene so that efficient cleanup, clotting, and repair occurs. Without acute inflammation, you’d die, overrun by harmful bacteria and invaders, unable to heal.

炎症本身並不是天生的邪惡。事實上，急性炎症是一項必不可少的救命功能。這種強烈的、以鐳射為中心的過程是當您被割傷或感染時產生發紅和腫脹的原因。這些是當各種高度專業化的細胞被送到現場以進行有效清理、凝血和修復時所發生情況的可見跡象。如果沒有急性炎症，你會死去，被有害細菌和入侵者侵佔，無法癒合。

Acute inflammation typically resolves within hours or, at most, three days.⁴ The problem occurs when an inflammatory response persists beyond the normal physiological function and results in tissue destruction.⁵ This is when inflammation gets turned on and then never turned back off. When it becomes chronic, inflammation can settle in, becoming a constant state, a kind of erosion depleting the immune system and wearing down the body’s systems and cells. This unceasing wear and tear creates conditions in the body that are ripe for disease to take root and grow.

急性炎症通常在數小時或最多三天內消退。⁴當炎症反應持續超出正常生理功能並導致組織破壞時，就會出現問題。⁵這是炎症被打開然後再也沒有關閉的時候。當它變成慢性時，炎症會穩定下來，成為一種持續狀態，這是一種消耗免疫系統並消耗身體系統和細胞的侵蝕。這種不斷的磨損在體內創造了條件，使疾病生根發芽。

Here’s an example. In the previous chapter on diet, we talked about sugar, its addictive qualities, and its potential link to cancer and infection. It’s also a runway to chronic inflammation. Imagine for a moment what sugar looks like when it enters your bloodstream. At the microscopic level, it’s clear crystal, covered on all sides by sharp edges. When you consistently consume sugar and it filters into your bloodstream, those geometric particles flood through your veins, bouncing off the walls as they go, tearing little micro-cuts into the endothelium of your arteries and capillary walls. The endothelium is the one-cell-thick lining of the interior surface of all your blood vessels, and damage to the endothelium is the earliest discernible precursor to atherosclerosis (the buildup of substances on the artery walls) and cardiovascular disease.⁶

下面是一個示例。在上一章關於飲食的章節中，我們談到了糖、它的成癮性以及它與癌症和感染的潛在聯繫。它也是通往慢性炎症的跑道。想像一下，當糖進入您的血液時，它會是什麼樣子。在微觀層面上，它是透明的晶體，四面都覆蓋著鋒利的邊緣。當你持續攝入糖並過濾到你的血液中時，那些幾何顆粒會湧入你的血管，在它們移動時從細胞壁上反彈，在你的動脈內皮和毛細血管壁上撕開小小的微切口。內皮是所有血管內表面的單細胞厚襯里，內皮損傷是動脈粥樣硬化（動脈壁上物質堆積）和心血管疾病最早可辨別的前兆。⁶

As we’ve seen, your immune system deploys repair cells that rush in to fix the cuts. So far, so good! This is exactly how your immune system should be functioning, right? Sure, but if your arteries are constantly undergoing damage and repair efforts, over time, they will become stiffer, thicker, and less flexible like scar tissue does on the outside of your body. Plaque is more likely to build up on those repair sites, narrowing your arteries and veins and making it more difficult for blood and all the nutrients it carries to move through the body. When your diet includes a lot of sugar or refined carbohydrates (many of which are hidden in the Western diet), the glucose load may be much less intense in the moment, but it’s still causing damage over time. For most people, glucose is a slowly dripping faucet, allowed to run for decades, leading to constant damage and scarring. And it’s not just sugar and refined carbohydrates—some of the chemical additives in our food create the same type of inflammation and the same damage-and-repair cycle.

正如我們所看到的，您的免疫系統會部署修復細胞，這些細胞會衝進來修復傷口。目前為止，一切都好！這正是您的免疫系統應該如何運作的，對吧？當然可以，但如果您的動脈不斷受到損傷和修復，隨著時間的推移，它們會變得更硬、更厚、更不柔韌，就像身體外部的疤痕組織一樣。斑塊更有可能在這些修復部位積聚，使您的動脈和靜脈變窄，並使血液及其攜帶的所有營養物質更難在體內流動。當您的飲食包含大量糖或精製碳水化合物（其中許多隱藏在西方飲食中）時，葡萄糖負荷在當下可能會弱得多，但隨著時間的推移，它仍然會造成損害。對於大多數人來說，葡萄糖是一個緩慢滴落的水龍頭，可以運行數十年，導致持續的損傷和疤痕。不僅僅是糖和精製碳水化合物——我們食物中的一些化學添加劑會產生相同類型的炎症和相同的損傷和修復週期。

But it’s more than just our diets that affect inflammation; as we saw with Eileen, the way you relate to stress can also trigger chronic inflammation. Cortisol and norepinephrine, the cocktail of hormones that your brain releases into your bloodstream in response to stress, can have the same effect over long periods of time.⁷ Whether it comes from a dietary cause like sugar or other toxins, or from your body’s stress response, inflammation is like an unnoticed brush fire, where the low flames spread through plants and grasses—never igniting into a full blaze but smoldering along the ground, causing damage to the landscape. This is your body when chronic inflammation is present. And all it takes is one spark to turn smolders into the full-blown flames of illness.

但影響炎症的不僅僅是我們的飲食;正如我們在 Eileen 身上看到的那樣，您與壓力的關係也會引發慢性炎症。皮質醇和去甲腎上腺素是大腦在壓力下釋放到血液中的激素混合物，可以在很長一段時間內產生相同的效果。⁷無論是來自糖或其他毒素等飲食原因，還是來自身體的壓力反應，炎症就像一場不被注意的灌木叢火，低火在植物和草中蔓延——從未點燃成熊熊大火，而是沿著地面悶燒，對景觀造成破壞。當存在慢性炎症時，這就是您的身體。而只需要一個火花，就可以將悶燒變成疾病的全面火焰。

There are a hundred ways to push the On button for chronic inflammation. What’s a lot harder is figuring out how to deactivate it once it is established in the body. But cases of spontaneous remission are showing us that some remarkable individuals—whether by accident, intuition, or trial and error—are finding that Off button and pressing it, taking out illness at its source. It’s similar to getting rid of weeds in your yard; you can’t just keep cutting them down with a mower. You have to dig up the roots.

有一百種方法可以為慢性炎症按下 On 按鈕。更難的是弄清楚一旦它在體內建立起來，如何使其失活。但是，自發緩解的案例告訴我們，一些了不起的人——無論是偶然的、直覺的還是反覆試驗的——正在找到那個關閉按鈕並按下它，從源頭上消除疾病。這類似於清除院子裡的雜草;你不能只是用割草機一直砍伐它們。你必須挖出根。

UNDOING A LIFE SENTENCE

撤銷無期徒刑

In the photo, Juniper Stein is the picture of health. She’s in her midthirties but could be ten years younger. Sitting on a swing set in their backyard in Rancho Santa Fe, California, she holds her toddler son on her lap, arms wrapped around the smiling boy, next to her husband and daughter. Lit from behind by the dropping sun, she seems to glow with contentment and vitality. The photographer caught her mid-laugh, and her smile is wide and genuine.

照片中，Juniper Stein 是健康的圖片。她三十多歲了，但可能年輕了十歲。她坐在加利福尼亞州蘭喬聖達菲（Rancho Santa Fe）自家後院的秋千上，把蹣跚學步的兒子抱在腿上，雙臂摟著這個微笑的男孩，旁邊是她的丈夫和女兒。在落日的照耀下，她似乎散發著滿足和活力的光芒。攝影師捕捉到了她的笑聲，她的笑容燦爛而真誠。

This photo, from 1989, should not exist. At least not in the way that it does, showing a strong, healthy, vibrant woman with two children. But here it is, in front of me, paper-clipped to the inside of a manila folder that contains records on Juniper’s case. I unclip the photo to look closer, amazed once again at how improbable—almost impossible—this scene is.

這張 1989 年的照片應該不存在。至少不是這樣，展示了一個堅強、健康、充滿活力的女人和兩個孩子。但在這裡，在我面前，用回形針夾在一個馬尼拉資料夾的裡面，裡面有關於杜松案的記錄。我解開照片，仔細觀察，再次驚訝於這個場景是多麼不可能——幾乎是不可能的。

Seven years before it was taken, Juniper was diagnosed with a devastating, progressive, and incurable autoimmune disease that should have taken everything from her: her health, her ability to move without a wheelchair, the family she’d envisioned. Before that, her life had been like a book, the pages turning neatly and evenly: grow up, be a good student, go to college, get married, have a career. She sailed through it all. But then, the page turned, and horrifyingly, the next chapter was called “Illness.” Except Juniper then tore the chapter out and rewrote the narrative.

在服用避孕藥的七年前，Juniper 被診斷出患有一種毀滅性的、進行性的、無法治癒的自身免疫性疾病，這種疾病本應該奪走她的一切：她的健康、她在沒有輪椅的情況下移動的能力、她所設想的家庭。在此之前，她的生活就像一本書，書頁整齊而均勻地翻動著：長大、做個好學生、上大學、結婚、有事業。她順利度過了這一切。但隨後，翻開了這一頁，可怕的是，下一章被稱為“疾病”。但杜松隨後撕掉了這一章並重寫了敘述。

She grew up in Brooklyn and Long Island in the 1950s and ’60s, in the postwar boom where all-American houses popped up in grids all over the country. Her family was stable and loving; she grew up with two parents and two brothers. In the evenings, they ate dinner together—the typical American fare of the era. Meat, starch, canned vegetable. She studied a lot, excelled academically.

她在 1950 年代和 60 年代在布魯克林和長島長大，當時正值戰後繁榮時期，全美式房屋在全國各地的網格中湧現。她的家庭穩定而充滿愛;她與兩個父母和兩個兄弟一起長大。晚上，他們一起吃晚飯——這是那個時代典型的美國美食。肉類、澱粉、蔬菜罐頭。她學習了很多，學業成績優異。

“There was no trauma, no drama,” she says of her childhood. “It was a very normal childhood, very traditional.”

“沒有創傷，沒有戲劇性，”她談到自己的童年時說。“那是一個非常正常的童年，非常傳統。”

There wasn’t any particular attention to health; it wasn’t something they discussed or pursued. It wasn’t on anybody’s radar. If you got sick, you went to the doctor and walked out with a scribbled script for an antibiotic or cough syrup with codeine. And Juniper wasn’t athletic; she was more the studious type. She didn’t do sports and didn’t have much awareness of her body. Her body wasn’t something she noticed at all—unless something went wrong with it, and usually, nothing did. It was just the vehicle that got her around, the house for her mind, which was her real self. She didn’t really think about it.

對健康沒有任何特別的關注;這不是他們討論或追求的事情。它不在任何人的雷達上。如果你生病了，你會去看醫生，然後帶著一份潦草的抗生素或含可待因的止咳糖漿的劇本走出去。而且杜松不擅長運動;她更像是好學的類型。她不做運動，對自己的身體也沒有太多的瞭解。她的身體根本不是她注意到的東西-除非它出了什麼問題，而且通常什麼都沒有。這隻是讓她四處走動的載體，她心靈的房子，這就是她真正的自我。她真的沒想過。

She went upstate for college, to Syracuse University, an urban campus plopped in the middle of a tree-filled city that curled around murky Onondaga Lake. A lot of people played sports or attended games every weekend, but more often than not, Juniper stayed in and studied. She majored in accounting, nailed her grades. She met another accounting major—a dark-haired guy named Lee with an easy smile, who was just as ambitious as she was. In quick succession, they graduated, got married, moved to Philadelphia. Lee jumped feetfirst into law school; Juniper started a job as a certified public accountant. As a CPA, she sat at a desk all day, poring over financial statements, preparing tax documents, wrangling numbers into spreadsheets. Sometimes she’d go for a walk, strolling along the leafy city blocks of their neighborhood.

她去了上州的雪城大學（Syracuse University），這是一個城市校園，坐落在一個綠樹成蔭的城市中央，蜿蜒在陰暗的奧農達加湖（Onondaga Lake）周圍。很多人每個週末都參加體育運動或參加比賽，但更多時候，Juniper 會留下來學習。她主修會計，取得了優異的成績。她遇到了另一個會計專業的人——一個名叫 Lee 的黑髮小夥子，笑容隨和，和她一樣雄心勃勃。很快，他們畢業、結婚、搬到了費城。Lee 一躍進入法學院;Juniper 開始了一份註冊會計師的工作。作為一名註冊會計師，她整天坐在辦公桌前，仔細研究財務報表，準備稅務檔，將數位整理成電子表格。有時她會去散步，沿著他們家附近綠樹成蔭的城市街區漫步。

Not long after that, her back started bothering her. Sitting at her desk as she always did, it started to feel tight and achy in the lower back, down by her hips. She’d shift forward in her chair, or get up to get a cup of tea, try to walk it off. Occasionally, there’d be a very sharp stab that made her gasp—like something had struck a nerve—low down in the back of her pelvis. But then it would be gone.

不久之後，她的背部開始困擾她。像往常一樣坐在她的書桌前，下背部開始感到緊繃和疼痛，一直到她的臀部。她會在椅子上向前移動，或者起身喝杯茶，試著走開。偶爾，會有一陣非常尖銳的刺擊，讓她喘息——就像有什麼東西擊中了神經一樣——在她的骨盆後部。但那樣它就會消失。

At first, it wasn’t that bad, and it came and went. It was more irritating than debilitating, and for a long time, she ignored it. She was only twenty-four, and this sort of thing seemed like an older person’s problem. She went to the doctor, unsure if anything was really wrong and feeling a little silly. But the doctors didn’t have any real ideas about what it might be and didn’t seem too interested in trying to find out. One insisted it was psychosomatic. Another suggested that her legs were different lengths. Eventually, she stopped asking doctors and decided to just live with it. She was young. It would go away. It was probably a passing affliction—just one of those things.

起初，情況並沒有那麼糟糕，而且來來去去。這比使人虛弱更令人惱火，而且在很長一段時間里，她都忽視了它。她才二十四歲，這種事情似乎是老年人的問題。她去看醫生，不確定是不是真的有什麼問題，感覺有點傻。但醫生們對它可能是什麼沒有任何真正的想法，而且似乎對試圖找出答案不太感興趣。其中一人堅稱這是心身疾病。另一個人認為她的腿長不一。最終，她不再問醫生，決定忍受它。她還年輕。它會消失的。這可能是一種短暫的痛苦——只是其中之一。

Besides, there wasn’t a lot of time to think about it. Juniper’s and Lee’s young careers were really starting to take off. Lee had graduated from law school, and Juniper landed a new accounting job at an international holding company with investments all around the world. When the opportunity came to take a job with even more responsibility at one of their subsidiaries in California, she jumped at the chance. At twenty-four, she became tax director, responsible for half a billion dollars’ worth of revenue. She was good at what she did, and they knew it. It was an enormous amount of responsibility for a person so young, but she felt ready.

此外，沒有太多時間考慮它。Juniper 和 Lee 的年輕職業生涯真正開始騰飛。Lee 從法學院畢業后，Juniper 在一家投資遍及全球的國際控股公司找到了一份新的會計工作。當有機會在他們位於加利福尼亞的一家子公司找到一份責任更大的工作時，她抓住了這個機會。24 歲時，她成為稅務總監，負責價值五億美元的收入。她擅長她所做的事情，他們也知道這一點。對於一個這麼年輕的人來說，這是一個巨大的責任，但她覺得自己已經準備好了。

She and Lee moved across the country to San Francisco, which was vibrant, gritty, and beautiful, with the fog rolling in across the bay. Mostly, they worked. Wanting to start his own business, Lee joined an office in LA, a business management company that served clients in the entertainment industry. He commuted back and forth between LA and San Francisco. Juniper put in long hours, wanting to prove herself at her new job. It was a whirlwind time, exciting but exhausting.

她和李搬到了全國各地的三藩市，那裡充滿活力、堅韌不拔、美麗，霧氣在海灣上翻滾。大多數情況下，他們都起作用了。為了創業，Lee 加入了洛杉磯的一家辦事處，這是一家為娛樂行業客戶提供服務的商業管理公司。他在洛杉磯和舊金山之間來回通勤。Juniper 投入了大量時間，想在她的新工作中證明自己。那是一段旋風般的時光，令人興奮但又令人筋疲力盡。

Juniper’s career accelerated. But then so did her illness.

Juniper 的職業生涯加速發展。但後來她的病也隨之而來。

The pain she’d had in her back, and the sharp pinching deep in her pelvis that had come and gone back in Philadelphia, flared up again. But this time, it didn’t go away. It just started to get worse and worse.

她背部的疼痛，以及在費城來來去去的骨盆深處的尖銳擠壓，再次爆發。但這一次，它並沒有消失。情況開始變得越來越糟。

When she woke up in the morning, she was so stiff it was hard to move. She started getting up early enough that she could run a hot bath before work, ease herself into it, and lie there long enough for her joints to soften, for the ache to subside so she could get dressed, eat breakfast, and get in the car. Sitting in the car was getting harder, though—a bump in the road could send a lightning bolt of pain through her. It came from inside her pelvis, below her tailbone, and shot through her body, liquid hot and nauseating. At night, if she rolled over in her sleep, she would wake up screaming. A sneeze that caught her off guard could leave her shaking with pain.

當她早上醒來時，她非常僵硬，很難動彈。她開始起得足夠早，這樣她就可以在上班前洗個熱水澡，讓自己放鬆下來，然後躺在那裡足夠長的時間讓她的關節軟化，讓疼痛消退，這樣她就可以穿衣服、吃早餐和上車了。不過，坐在車裡越來越難——路上的顛簸可能會讓她感到一陣閃電般的痛苦。它從她的骨盆內部，尾骨下方射出，射穿她的身體，液體滾燙而令人作嘔。晚上，如果她在睡夢中翻身，她會尖叫著醒來。一個讓她措手不及的噴嚏可能會讓她痛苦地發抖。

At work, she sat at her desk from 9:00 a.m. to 6:00 p.m. and sometimes later. Mostly, she was able to hide her rapidly worsening illness from her coworkers, but it was getting more difficult.

在工作中，她從上午 9：00 到下午 6：00 坐在辦公桌前，有時甚至更晚。大多數情況下，她能夠向同事隱瞞自己迅速惡化的病情，但事情變得越來越困難。

“Whenever I got up from my desk,” she says, “I had to kind of organize my body. Remember how to move to get it all going again. The first few steps were always awkward and stiff, but once I started moving it would get better.”

“每當我從辦公桌上站起來時，”她說，“我都必須整理一下自己的身體。記住如何移動以重新開始。最初的幾步總是很笨拙和僵硬，但一旦我開始移動，情況就會變得更好。

She walked hanging on to walls and learned to arrange her body carefully in a desk chair, in just the right position to avoid breathtaking pain. Lifting herself up from her desk became excruciating. What had started as an annoyance had taken over her life. Now, most of her waking hours revolved around how to get through, avoid, or manage the thought-shattering pain she lived with. She went to doctor after doctor, specialist after specialist. Okay, she’d say to herself. Which type of doctor haven’t I seen yet? And then she’d move on to the next specialist, crossing them off the list.

她靠著牆壁走路，學會了小心翼翼地把身體放在桌椅上，以恰到好處的位置避免了驚人的痛苦。從桌子上站起來變得非常痛苦。一開始的煩惱已經佔據了她的生活。現在，她醒著的大部分時間都圍繞著如何度過、避免或管理她所經歷的令人心碎的痛苦。她去看了一個又一個醫生，一個又一個專家。好吧，她會對自己說。我還沒有見過哪種類型的醫生？然後她會轉到下一位專家，將他們從名單上劃掉。

Finally, she hit a wall. The pain was overwhelming. Her doctor began to worry that she had bone cancer. He ordered a bone scan. On the day of the scan, Juniper put on a hospital gown, and a nurse injected a minute amount of radioactive substance into her veins. She got on the exam table, the cool paper crackling, and lay very still, hoping that this time, finally, the high-tech scanning camera that the nurse was positioning above her body would yield some answers.

最後，她碰壁了。痛苦是壓倒性的。她的醫生開始擔心她患有骨癌。他要求進行骨掃描。掃描當天，杜松穿上了病號服，一名護士向她的靜脈注射了微量的放射性物質。她爬上檢查台，冰涼的紙張噼啪作響，一動不動地躺著，希望這一次，終於，護士放在她身體上方的高科技掃描攝像頭能給出一些答案。

In a bone scan, the radioactive substance that’s gone into your veins disperses through your body. It becomes attracted to areas where the body is actively repairing itself from some type of damage. In a healthy person, there may be small spots here and there where this is happening, but that’s considered normal and doesn’t indicate any kind of problem. But in the case of bone cancer, for example, the damage done as tumor cells grow and replicate will be much larger, along with the body’s attempt to repair. The radioactive substance will rush to the repair sites, lighting up the tumors like a string of Christmas lights.

在骨掃描中，進入靜脈的放射性物質會分散到全身。它被身體正在積極修復某種類型損傷的區域所吸引。在一個健康的人中，發生這種情況的地方可能會到處都是小點，但這被認為是正常的，並不表示有任何問題。但以骨癌為例，腫瘤細胞生長和複製時造成的損害會大得多，同時身體的修復嘗試也會大得多。放射性物質會衝向修復部位，像一串聖誕燈一樣照亮腫瘤。

Juniper didn’t have any tumors—her bones were dark and healthy, clear of repair attempts. Except for one spot.

杜松沒有任何腫瘤——她的骨骼黝黑而健康，沒有嘗試修復。除了一個地方。

Her sacroiliac area—the pelvis, coccyx, and lower spine—were bright under the scanner’s sweep. She didn’t have cancer, but Juniper’s body was, for some reason, frantically attempting to repair something there. But why? Her doctor referred her to a rheumatologist, a specialist in autoimmune disorders, who would be able to look into what was going on. Something was very, very wrong.

她的骶髂區域——骨盆、尾骨和下脊柱——在掃描儀的掃掠下很亮。她沒有患癌症，但出於某種原因，Juniper 的身體正在瘋狂地試圖修復那裡的某個東西。但是為什麼？她的醫生將她推薦給一位風濕病學家，一位自身免疫性疾病專家，他將能夠調查發生了什麼。有些事情非常非常不對勁。

Dr. Rodney Bluestone was based in LA and was one of the top rheumatologists in the state. Juniper and Lee flew down from San Francisco together for the appointment. Dr. Bluestone had a pretty good idea of what she had even before he had her lie on the examining table and bent and unbent her joints, before he ordered the MRI—radio imaging that would illuminate the damage already done. To him, the diagnosis was unmistakable; he’d seen it many times before. Ankylosing spondylitis (AS), a devastating form of arthritis that, as it progressed, would fuse the bones and joints of Juniper’s pelvis before working its way up her spine.

Rodney Bluestone 博士常駐洛杉磯，是該州頂級風濕病學家之一。Juniper 和 Lee 一起從舊金山飛來赴約。Bluestone 醫生甚至在他讓她躺在檢查臺上並彎曲和松開她的關節之前就已經對她的情況瞭若指掌，然後他才下令進行 MRI 檢查——無線電成像可以照亮已經造成的損害。對他來說，診斷是明確的;他以前見過很多次。強直性脊柱炎 （AS） 是一種毀滅性的關節炎，隨著病情的發展，杜松骨盆的骨骼和關節會融合在一起，然後向上蔓延到她的脊柱。

Given this diagnosis, Dr. Bluestone told Juniper to expect that she would get stiffer and stiffer and lose more and more of her mobility. Her spine would calcify and curve inward. Her sacroiliac joints would turn into one solid piece of calcified bone. The nickname for ankylosing spondylitis is “bamboo spine,” because that’s what your spinal column looks like when the disease is finished with you. Instead of a delicately interlocking series of bones that bend and flex with your body, it becomes a single piece of bone, the spaces between the vertebrae filled in thickly, as though spackled. On x-rays, it looks exactly like a thick, smoothly knobbed stalk of bamboo.

鑒於這一診斷，Bluestone 醫生告訴 Juniper，預計她會變得越來越僵硬，並且會失去越來越多的活動能力。她的脊柱會鈣化並向內彎曲。她的骶髂關節會變成一塊堅實的鈣化骨頭。強直性脊柱炎的昵稱是“竹脊柱”，因為這就是疾病結束後脊柱的樣子。它不是一系列微妙地互鎖的骨頭，隨著你的身體彎曲和彎曲，而是變成了一塊骨頭，椎骨之間的空隙被厚厚地填滿，就像被填滿了一樣。在 X 光片上，它看起來就像一根粗壯、光滑的竹竿。

Juniper and Lee sat across from the doctor’s expansive desk, stricken, trying to understand what this meant. Dr. Bluestone recommended some medications that might slow the progress of the disease, but he warned them: this was incurable. As time passed, it would only get worse.

Juniper和Lee坐在醫生寬大的桌子對面，愣住了，試圖理解這意味著什麼。Bluestone 博士推薦了一些可能會減緩疾病進展的藥物，但他警告他們：這是無法治癒的。隨著時間的推移，情況只會變得更糟。

“If you are planning on having children,” said Dr. Bluestone, “you’d better do it now.”

“如果你打算生孩子，”Bluestone 醫生說，“你最好現在就做。

WHEN YOUR IMMUNE SYSTEM IS YOUR OWN WORST ENEMY

當您的免疫系統是您自己最大的敵人時

As with the sugar example we saw earlier, something had triggered Juniper’s body to repair damage. Except in this case, unlike the image of the sugar molecule scratching the inside of your veins, we don’t yet know exactly why her body turned against itself. In most of the one hundred or so autoimmune diseases that have been identified, the exact trigger remains frustratingly out of sight. We suspect that autoimmune illnesses can be activated by everything from a genetic code you’ve been carrying with you all your life, to an environmental toxin, a tick bite, a pregnancy, a food allergy, or another co-occurring illness that somehow trips the switch. But doctors are rarely, if ever, able to identify the specific cause.

與我們之前看到的糖例子一樣，有什麼東西觸發了 Juniper 的身體來修復損傷。除了這種情況，與糖分子劃傷你血管內部的圖像不同，我們還不知道她的身體為什麼會反抗自己。在已確定的 100 多種自身免疫性疾病中，大多數疾病的確切觸發因素仍然令人沮喪地看不到。我們懷疑自身免疫性疾病可以被各種事物啟動，從您一生隨身攜帶的遺傳密碼，到環境毒素、蜱蟲叮咬、懷孕、食物過敏或其他以某種方式觸發開關的併發疾病。但醫生很少（如果有的話）能夠確定具體原因。

Whatever the cause, something had convinced Juniper’s immune system that an enemy combatant was present, and in response, it sent out armies of repair cells to her sacroiliac area, where they swarmed the bones, trying to fix what did not need to be fixed. In the process, they had begun to lay out the matrix for new bone. The entire area was inflamed, full of “defend and repair” cells that were doing anything but.

不管是什麼原因，有什麼東西讓杜松的免疫系統相信有敵方戰鬥人員在場，作為回應，它派出了修復室大軍到她的骶髂關節區域，在那裡他們蜂擁而至，試圖修復不需要修復的東西。在這個過程中，他們已經開始為新骨骼佈局矩陣。整個區域都發炎了，到處都是“防禦和修復”的細胞，它們什麼都沒做。

By the time she was diagnosed, Juniper’s body had spent years locked in a vicious cycle of inflammation fueled by desperate attempts to repair what wasn’t broken. Her pelvis was already irrevocably damaged—thick striations, like scar tissue, wrapped around her pelvis where her immune cells were inadvertently creating new bone. She had AS bilaterally—on both sides of the pelvis. Once her pelvis had been ossified with bony matter, her confused immune system reaction would move up the sacroiliac joint and into the spine. Most people with AS end up with a frozen curvature of the spine and often have difficulty breathing as the ribs stiffen. There were medications available that might cool down the fire of the inflammation in her pelvic area, but they wouldn’t be able to quench it or even really slow it down significantly. There is no cure for AS, only ways to buy just a little more time.

當她被診斷出時，Juniper 的身體已經陷入了炎症的惡性循環中數年，而絕望地試圖修復未破損的部位則助長了炎症的惡性循環。她的骨盆已經受到了不可挽回的損傷——厚厚的條紋，就像疤痕組織一樣，纏繞在她的骨盆周圍，她的免疫細胞無意中在那裡創造了新的骨骼。她的雙側 AS 在骨盆的兩側。一旦她的骨盆被骨質骨化，她混亂的免疫系統反應就會沿著骶髂關節向上移動並進入脊柱。大多數 AS 患者最終會出現脊柱凍結彎曲，並且隨著肋骨僵硬，呼吸經常困難。有一些藥物可能會冷卻她骨盆區域的炎症之火，但它們無法撲滅它，甚至無法真正顯著減慢它。AS 無法治癒，只有多買一點時間的方法。

The most frustrating thing about a disease like this is that doctors could tell Juniper what her immune system’s cells were doing—harming her by trying to help—but not why they were doing it. What had triggered her immune system’s armies to fan out and attack what it was sworn to protect? How had such an essential, intelligent body system gotten so off track?

像這樣的疾病最令人沮喪的是，醫生可以告訴 Juniper 她的免疫系統細胞在做什麼——試圖幫助來傷害她——但不知道他們為什麼要這樣做。是什麼觸發了她的免疫系統大軍展開並攻擊它發誓要保護的東西？這樣一個重要的智慧身體系統怎麼會如此偏離軌道呢？

Autoimmune diseases and inflammation are inextricably linked. According to the American Autoimmune Related Diseases Association, there are over a hundred known autoimmune disorders,⁸ and as a group, they are all categorized as “inflammatory” illnesses—causing a repeating cycle of inflammation in the body or brain. Chronic inflammation can often pave the way for an autoimmune disease, which then intensifies in the body. The illness breathes heat into the smoldering coals of inflammation, and this ground fire continues to spread through the body, preventing health from taking seed.

自身免疫性疾病和炎症有著千絲萬縷的聯繫。根據美國自身免疫相關疾病協會的數據，已知的自身免疫性疾病有一百多種⁸，作為一個群體，它們都被歸類為“炎症性”疾病——導致身體或大腦炎症的重複迴圈。慢性炎症通常會為自身免疫性疾病鋪平道路，然後在體內加劇。疾病將熱量吸入炎症的陰燃煤中，這種地火繼續在體內蔓延，阻止健康播種。

This happens not just with autoimmune disease. Juniper’s situation repeats itself in doctors’ offices every day, with almost every category of illness you can think of. Widespread inflammation in the body and brain precedes the onset of all the most deadly diseases. In multiple studies, inflammatory markers in the bloodstream increase before the onset of illnesses. C-reactive protein, or CRP, is a sensitive biological marker for inflammation. It’s produced in the liver in response to inflammation in the body, and researchers have discovered that CRP is consistently high just before the onset of many types of diseases, from hypertension⁹ and heart disease¹⁰ to diabetes (both type 1 and type 2), autoimmune disorders, and even many types of cancer.¹¹ In all these cases, CRP was elevated before other markers of disease, such as blood glucose levels or blood pressure, were noted. Some studies have also shown that other inflammatory markers may be increased prior to disease onset, even when CRP isn’t. In other words, inflammation appears as the original root cause across diverse illnesses.

這不僅發生在自身免疫性疾病中。杜松的情況每天都在醫生辦公室重演，幾乎有你能想到的所有類別的疾病。身體和大腦中的廣泛炎症在所有最致命的疾病發作之前就存在。在多項研究中，血液中的炎症標誌物在疾病發作前增加。C 反應蛋白 （CRP） 是炎症的敏感生物標誌物。它是在肝臟中對體內炎症的反應而產生的，研究人員發現，在許多類型的疾病發作之前，CRP 一直很高，從高血壓⁹和心臟病¹⁰到糖尿病（1 型和 2 型）、自身免疫性疾病，甚至許多類型的癌症。¹¹在所有這些病例中，CRP 在注意到其他疾病標誌物（例如血糖水準或血壓）之前就升高了。一些研究還表明，其他炎症標誌物可能在疾病發作前增加，即使CRP沒有。換句話說，炎症似乎是各種疾病的原始根本原因。

A test for C-reactive protein that comes back high unfortunately won’t tell you what’s causing the inflammation—only that it’s there. But it can still be an immeasurably useful tool. It’s one canary in the coal mine that says, “Conditions are right for disease.”

不幸的是，C 反應蛋白的檢測結果很高，並不能告訴你是什麼導致了炎症——只告訴你它就在那裡。但它仍然是一個非常有用的工具。煤礦里的一隻金絲雀說，「條件適合疾病。

As Eileen’s case from earlier in the chapter may suggest, the link between chronic stress and inflammation cannot be ignored, especially when it comes to cases of spontaneous healing. Stories like hers repeat themselves over and over in medicine, every day. Up to 80 percent of visits to primary care doctors are stress related,¹² yet most doctors are trained to focus exclusively on disease symptoms and medication management. Multiple studies have demonstrated that half of all outpatient visits, in fact, have no identifiable physiological basis. Chronic stress dramatically increases a person’s risk for developing coronary heart disease (CHD) as well as a wide range of other illnesses, and there’s strong evidence that a single emotional event can trigger a CHD episode.¹³ Though the exact biological mechanisms are still being delineated,¹⁴ the road that runs from stress to inflammation to disease is a well-traveled one. And people who recover from “incurable” illness seem to find an off-ramp to exit that highway, turn around, and start driving the other direction.

正如本章前面的 Eileen 案例所暗示的那樣，慢性壓力和炎症之間的聯繫不容忽視，尤其是在自發癒合的情況下。像她這樣的故事每天都在醫學界一遍又一遍地重複。高達 80% 的初級保健醫生就診與壓力有關，¹² 但大多數醫生接受過專門關注疾病癥狀和藥物管理的培訓。多項研究表明，事實上，一半的門診就診沒有可識別的生理基礎。慢性壓力會大大增加一個人患冠心病 （CHD） 以及各種其他疾病的風險，並且有強有力的證據表明，單一的情緒事件可以引發 CHD 發作。¹³儘管確切的生物學機制仍在描述中，¹⁴ 從壓力到炎症再到疾病的道路是一條人跡罕至的道路。而那些從“不治之症”中康復的人似乎找到了一個出口匝道，離開那條高速公路，掉頭，然後開始向另一個方向行駛。

We’re beginning to see that unmanaged chronic stress wears your immune system down over time, the same way constant, unrelenting waves wear down a rocky bluff. Anxious thoughts and feelings, the constant drip of stress hormones into your bloodstream—these internal inflammation triggers are just as powerful, if not more so, than a food you’re allergic to or a dangerous toxin in your environment. In numerous studies, the majority of people (80 percent) who developed autoimmune diseases like Juniper’s reported “uncommon emotional stress” just before the onset of their first symptoms.¹⁵

我們開始看到，隨著時間的推移，不受控制的慢性壓力會消耗您的免疫系統，就像持續、無情的海浪會磨損岩石懸崖一樣。焦慮的想法和感受，壓力荷爾蒙不斷滴入血液——這些內部炎症觸發因素與您過敏的食物或環境中的危險毒素一樣強大，甚至更強大。在大量研究中，大多數患有像 Juniper 這樣的自身免疫性疾病的人 （80%） 報告說，在他們第一次出現癥狀之前，他們就報告了“不常見的情緒壓力”。¹⁵

Just like inflammation itself, stress hormones are not inherently bad. In fact, they are necessary for health and survival. While your body produces a bouquet of hormones, neurotransmitters, and neuropeptides in response to stress, which work together in a complex chemical reaction, the main stress hormone is cortisol. It’s a major part of the human fight-or-flight response, which rapidly recalibrates your body’s many functions—blood flow, oxygen, digestion, and so on—to allow you to outfight or outrun a threat. Like acute inflammation, a rush of cortisol in our bloodstreams is meant to be a brief, occasional occurrence—our bodies are not built to be in fight or flight all the time. So when we become locked in a state of chronic fight or flight, which is for many of us the reality of living in the modern world, we expose our bodies to a chemical environment that it wasn’t built to handle.

就像炎症本身一樣，壓力荷爾蒙本身並不是壞的。事實上，它們是健康和生存所必需的。雖然您的身體會在壓力下產生一束激素、神經遞質和神經肽，它們在複雜的化學反應中協同工作，但主要的壓力荷爾蒙是皮質醇。這是人類戰鬥或逃跑反應的主要部分，它會迅速重新校準您身體的許多功能——血流、氧氣、消化等——讓您能夠戰勝或逃脫威脅。就像急性炎症一樣，我們血液中皮質醇的激增意味著短暫、偶爾發生——我們的身體並不是為了一直處於戰鬥或逃跑狀態而生的。因此，當我們陷入一種長期的戰鬥或逃跑狀態時，這對我們中的許多人來說是生活在現代世界中的現實，我們的身體會暴露在一個化學環境中，而這種環境並不是為了處理而生的。

At healthy doses, cortisol is actually great for us. It helps regulate our blood sugar and even acts to reduce inflammation in the body. The problem comes when cortisol is rigidly flowing through our veins most hours of every day, rather than flexibly, when needed. Our tissues become acclimated to this new, constantly high level of cortisol, and its ability to regulate the inflammatory response wears off. The cells of the immune system become desensitized to cortisol’s regulatory effect¹⁶—it’s like pushing the Mute button; they can’t hear the instructions anymore. They become confused, disorganized, overactive, and, as in Juniper’s case, attack the body’s own healthy tissues.

在健康劑量下，皮質醇實際上對我們很有好處。它有助於調節我們的血糖，甚至還可以減少體內的炎症。當皮質醇在每天的大部分時間里都僵硬地流經我們的血管時，問題就來了，而不是在需要時靈活地流淌。我們的組織適應了這種新的、持續高水準的皮質醇，它調節炎症反應的能力也逐漸消失。免疫系統的細胞對皮質醇的調節作用變得不敏感¹⁶——這就像按下靜音按鈕;他們再也聽不到指令了。他們變得困惑、雜亂無章、過度活躍，並且像 Juniper 的情況一樣，攻擊身體自身的健康組織。

One particularly startling study even found that chronic stress can alter the very genes of your immune cells—the original coding that determines a cell’s function and behavior. Chronic stress disrupts and rewrites that code like a malware virus wiping a hard drive and replacing it with destructive programming. Researchers evaluated the effect of stress on immune system cells first in mice and then in humans, and the effects were the same; after a prolonged exposure to stressful conditions, the stressed group had four times as many immune system cells circulating in their bloodstreams as the control group. And in that larger swarm of immune system cells, a dramatically higher proportion were “pro-inflammatory”—their gene expression had been altered by the long exposure to stress to cause inflammation.¹⁷ Basically, what this means is that these cells had been reprogrammed to cause inflammation. And without a way to wipe that malware and reboot, they would continue to race through the body with that mission.

一項特別令人震驚的研究甚至發現，慢性壓力可以改變免疫細胞的基因——決定細胞功能和行為的原始編碼。慢性壓力會破壞和重寫這些代碼，就像惡意軟體病毒擦除硬碟驅動器並用破壞性程式設計取而代之。研究人員首先評估了壓力對小鼠免疫系統細胞的影響，然後是人類，效果是相同的;在長時間暴露於壓力條件下后，壓力組在血液中迴圈的免疫系統細胞數量是對照組的四倍。在更大的免疫系統細胞群中，“促炎”的比例要高得多——它們的基因表達因長期暴露在壓力下而發生改變，從而引起炎症。¹⁷基本上，這意味著這些細胞已被重新程式設計以引起炎症。如果無法擦除該惡意軟體並重新啟動，他們將繼續在體內奔跑以執行該任務。

Your immune system is your most powerful tool in the fight against illness, but like any powerful tool, it has to function correctly so that it’s making repairs, instead of doing more damage. No matter what kind of illness you’re dealing with, tackling inflammation so your immune system can do its job is key to opening up more avenues to healing. But figuring out what puts out the fire of chronic inflammation in your individual situation, or for your loved one, can initially feel challenging. It may seem that everything can be fuel for this fire, another scrap of kindling tossed on—what you eat, what toxins or pollutants you’re exposed to, what you think about, what you feel. So how do we stop feeding this fire, and where do we find the supply of cool water to put it out for good?

你的免疫系統是你對抗疾病的最強大工具，但就像任何強大的工具一樣，它必須正確運作，以便進行修復，而不是造成更大的損害。無論您正在應對哪種疾病，解決炎症問題以便您的免疫系統能夠發揮作用是開闢更多治癒途徑的關鍵。但是，弄清楚是什麼在您的個人情況下或為您所愛的人撲滅了慢性炎症的火焰，最初可能會感到具有挑戰性。似乎一切都可以成為這把火的燃料，是另一點火種——你吃什麼，你接觸到什麼毒素或污染物，你想什麼，你感受什麼。那麼，我們如何停止餵養這把火，我們在哪裡找到冷卻水的供應來永久撲滅它呢？

To begin, we need to start opening lines of communication with our bodies. Those who recover from incurable illness often try a lot of different things before they home in on the specific lifestyle changes that start to help them feel better. We saw this in the previous chapter with diet: while it works for some people (like Tom Wood) to launch right into a new way of eating and then stick with it, most people (like Claire Haser) needed a period of trial and error to figure out what modes of eating really worked to help them feel better, more energetic, more joyful. There is no one “anti-inflammation” prescription you can follow, though you can begin with some common tactics that help most people knock down inflammation and reclaim immune function.

首先，我們需要開始打開與我們的身體的溝通管道。那些從不治之症中康復的人通常會嘗試很多不同的事情，然後再開始改變特定的生活方式，開始幫助他們感覺更好。我們在上一章的飲食中看到了這一點：雖然有些人（如 Tom Wood）可以直接開始一種新的飲食方式並堅持下去，但大多數人（如 Claire Haser）需要一段時間的反覆試驗才能弄清楚哪些飲食模式真正有效幫助他們感覺更好。 更有活力，更快樂。沒有一個 「抗炎 」的處方可以遵循，但你可以從一些常見的策略開始，幫助大多數人擊退炎症並恢復免疫功能。

It’s a good idea to start with the basics: move toward a more nutrient-dense diet (nutrient-dense diets are, in general, inherently more anti-inflammatory) and get rid of processed foods and sugar, which can kick-start the inflammatory response. And start to look for your personal stress triggers. They aren’t always what you think. When do you start to feel stressed or anxious? What are the major points of friction in your day when you feel overextended, worn down, overwhelmed? Sometimes these may have obvious fixes once you become aware of them—adjusting a routine, asking a partner for more support in a particular area, or even letting go of responsibilities that are simply too much for you during this era of your life. Other times, you may have to engage in a larger life overhaul to eliminate unnecessary stressors and prioritize health. Juniper, and many others who recovered from incurable illness, ended up making radical changes to how they lived their lives that may have helped reboot their immune systems into a more anti-inflammatory mode.

從基礎開始是個好主意：轉向營養更豐富的飲食（一般來說，營養豐富的飲食本質上更具抗炎作用）並擺脫加工食品和糖，這些可以引發炎症反應。並開始尋找您個人的壓力觸發因素。他們並不總是你想像的那樣。您什麼時候開始感到壓力或焦慮？當你感到過度勞累、疲憊不堪、不知所措時，你一天中的主要摩擦點是什麼？有時，一旦你意識到它們，這些可能會有明顯的解決辦法——調整日常生活，在特定領域尋求伴侶的更多支援，甚至放棄在你生命中的這個時期對你來說太過分的責任。其他時候，您可能不得不進行更大規模的生活改革，以消除不必要的壓力源並優先考慮健康。Juniper 和許多其他從不治之症中康復的人最終對他們的生活方式進行了根本性的改變，這可能有助於將他們的免疫系統重新啟動到更具抗炎性的模式。

REFOCUSING THE IMMUNE SYSTEM

重新聚焦免疫系統

Juniper and Lee took Dr. Bluestone’s advice. Fueled by the fear that they would lose their chance to ever have a family, they started trying for a baby.

Juniper 和 Lee 接受了 Bluestone 博士的建議。由於擔心自己會失去擁有家庭的機會，他們開始嘗試生孩子。

By that point, it had taken more than two years from the time Juniper’s back pain finally drove her to the first doctor to get an actual diagnosis. And in that time, her illness had worsened rapidly, leaving her hobbling along the halls of her workplace, gripping the walls, moving slowly and deliberately through a maze of pain. But the only time she allowed herself the use of a wheelchair was when she had to quickly move long distances through an airport. She refused to buy one for regular use. Somehow, she knew that if she got into one, she wouldn’t get out; she knew that she would start to think of herself as “sick.”

到那時，從 Juniper 的背痛最終驅使她去看第一位醫生進行實際診斷，已經過去了兩年多的時間。在那段時間里，她的病情迅速惡化，讓她蹣跚地走在工作場所的走廊上，緊緊抓住牆壁，緩慢而刻意地穿過痛苦的迷宮。但她唯一允許自己使用輪椅的時候是她不得不在機場快速長途移動的時候。她拒絕購買經常使用的。不知何故，她知道如果她陷入困境，她就不會出去;她知道她會開始認為自己是 「病的」。

It wasn’t that she was in denial; she understood that she was sick. But she refused to reconcile herself to a lifetime of illness, limitations, and pain.

這並不是說她否認;她明白自己生病了。但她拒絕接受一生的疾病、限制和痛苦。

“I accepted the diagnosis,” she says now. “But not the prognosis.”

“我接受了診斷，”她現在說。“但不是預後。”

The first thing she did after the diagnosis was fill the prescription Dr. Bluestone gave her for Naproxen, a nonsteroidal anti-inflammatory that would get her symptoms under control. She didn’t want to take it for very long; she was aware of the side effects and worried that treating the symptoms of AS with medication would simply allow the disease to continue to wreak havoc on her bones under the numbing veil of medicine. But she felt that a medication like Naproxen offered urgent relief to her suffering and could buy her some time while figuring out the next steps. Only a few days after she started taking it, the pain began to recede. She realized it had been like a thick wave, engulfing her.

診斷後，她做的第一件事就是按照Bluestone醫生給她的萘普生處方配藥，這是一種非甾體抗炎藥，可以控制她的癥狀。她不想忍受太久;她知道這些副作用，並擔心用藥物治療 AS 的癥狀只會讓疾病在藥物麻木的面紗下繼續對她的骨骼造成嚴重破壞。但她覺得像羋普生這樣的藥物可以緊急緩解她的痛苦，並且可以為她爭取一些時間，同時弄清楚下一步。在她開始服用后僅幾天，疼痛就開始消退。她意識到它就像一股洶湧的海浪，吞沒了她。

“The medication helped me catch my breath,” she says, “and it was calming, to know that it was there as an option.”

“藥物説明我喘口氣，”她說，“知道它是一種選擇，這讓我很平靜。

Dr. Bluestone had also given her a printout with suggestions for exercises that might help with the pain. She took one look at them and thought, These are for an eighty-year-old woman. She decided to try another approach.

Bluestone 醫生還給了她一份列印件，上面有可能有助於緩解疼痛的運動建議。她看了一眼，心想，這些是給一位八十歲的老婦人的。她決定嘗試另一種方法。

She’d never been a very body-conscious or athletic person, but the feeling of disconnection from her body—the numb, muffled feeling of taking medication and realizing that she was missing important messages—drove her to a yoga class for the first time in her life. She knew that yoga was, in part, about stretching and flexibility. If she could push her body into those poses, perhaps she could slow down what was happening to her joints. Wouldn’t it be harder for the AS to fuse the small interlocking bones of her spine, she reasoned, if she was constantly moving and stretching them?

她從來都不是一個非常注重身體或運動的人，但與身體脫節的感覺——服藥和意識到自己錯過了重要資訊的麻木、悶悶不樂的感覺——驅使她有生以來第一次去上瑜伽課。她知道瑜伽在一定程度上是關於伸展和柔韌性的。如果她能把自己的身體推到這些姿勢上，也許她可以減慢她關節發生的事情。她想，如果 AS 不斷移動和伸展它們，那麼 AS 不是更難融合她脊柱的小環環相扣的骨頭嗎？

After the first yoga class, she was in more pain than she’d ever experienced. It hurt to stand, to sit, to move—the pain was like fire licking up her back, a heat that made her dizzy and nauseous. But she decided to go back the next day. Yoga wasn’t in the list of exercises the doctor had handed her; she just had a gut feeling that it was the right thing to do. She could picture the new yoga poses—which she performed clumsily, shakily—breaking up the calcifications on her bones, freeing her skeleton from their vise grip. Moving slowly and painfully into a new pose in class the next day, she visualized what she hoped would happen: the thick calcifications shattering like plaster and falling away, leaving her joints smooth, the bones sliding past one another like they were supposed to.

第一節瑜伽課後，她的痛苦比以往任何時候都嚴重。站著、坐著、移動都很痛——疼痛就像火舔舐著她的背，這種熱度讓她頭暈目眩。但她決定第二天回去。瑜伽不在醫生交給她的練習清單上;她只是有一種直覺，覺得這是正確的做法。她可以想像新的瑜伽姿勢——她笨拙、顫抖地表演——打破了她骨骼上的鈣化，讓她的骨骼擺脫了老虎鉗的抓握。第二天，她在課堂上緩慢而痛苦地換上了新姿勢，想像著她希望發生的事情：厚厚的鈣化物像石膏一樣碎裂並脫落，留下她的關節光滑，骨頭像應該的那樣相互滑動。

Juniper understood that the Naproxen she was taking wasn’t going to cure her, though privately she wondered why—Naproxen was an anti-inflammatory, and AS was an inflammatory disease. Why wouldn’t the medication quell the raging inflammation in her body?

Juniper 明白她正在服用的羋普生不會治癒她，儘管她私下裡想知道為什麼——萘普生是一種抗炎藥，而 AS 是一種炎症性疾病。為什麼藥物不能平息她體內肆虐的炎症呢？

The answer is that no anti-inflammatory medication that’s been developed so far can make a significant dent on chronic, systemic inflammation in the body and brain. Naproxen attempts to reduce one pathway of inflammation in a body that has multiple pathways. It’s like putting a Road Closed sign up when there are five other roads that run to the same location.

答案是，迄今為止開發的抗炎葯都不能對身體和大腦的慢性全身性炎症產生重大影響。萘普生試圖減少具有多個通路的體內的一個炎症通路。這就像當有其他五條道路通往同一位置時放置 Road Closed 標誌。

After about a month, Juniper felt that the medication was muffling the communication between herself and her body. She stopped taking it. But the medicine had given her a leg up; it had provided her a ladder out of the fog of constant pain, one that helped her remember what life was like when she felt better.

大約一個月後，Juniper 覺得藥物抑制了她自己和身體之間的交流。她停止服用了。但藥物給了她一個説明;它為她提供了一個走出持續痛苦迷霧的梯子，一個説明她記住當她感覺好些時的生活是什麼樣的。

From there, Juniper threw herself into her daily yoga practice. Classes were hard, and she had to push through the same veil of pain every time. The effort was Sisyphean; it felt like climbing a mountain, and then starting over the next day back at the bottom. But slowly, gradually, she began to notice a difference. One day it felt easier—like she’d started partway up the mountain this time. The next day, she was a few more steps up the path. Progress was slow, but it was progress.

從那時起，Juniper 全身心地投入到她的日常瑜伽練習中。課程很辛苦，她每次都不得不穿過同樣的痛苦面紗。這種努力是西西弗斯式的;感覺就像爬山，然後第二天從山腳下重新開始。但慢慢地，漸漸地，她開始注意到一個不同。有一天感覺輕鬆了——就像這次她開始爬山的一半一樣。第二天，她又沿著小路走了幾步。進展很慢，但就是進步。

She felt her range of motion increasing, too—she began to be able to go farther into the poses. Outside of class, she walked and moved more easily. She stopped waking up screaming in pain. The electric pain that had strummed through her pelvis began to dull and fade. She started to walk through the house without hanging on to the walls.

她感覺到自己的活動範圍也增加了——她開始能夠更深入地擺姿勢。在課外，她走路和移動都更容易了。她不再痛苦地尖叫醒來。在她骨盆中彈奏的電擊疼痛開始減弱和消退。她開始在房子裡走來走去，沒有抓住牆壁。

And then, the good news: Juniper was pregnant.

然後，好消息是：Juniper 懷孕了。

As the months went by, she felt even better. For most of the pregnancy, she didn’t have inflammation or pain; it temporarily faded away as the pregnancy progressed. It turns out that the hormones of pregnancy can have a positive impact on some autoimmune diseases, causing a remission of symptoms or even slowing down the progression of the illness.¹⁸

幾個月過去了，她感覺好多了。在懷孕的大部分時間里，她沒有炎症或疼痛;隨著懷孕的進展，它暫時消失了。事實證明，懷孕的荷爾蒙可以對某些自身免疫性疾病產生積極影響，導致癥狀緩解，甚至減緩疾病的進展。¹⁸

At twenty-eight weeks, Juniper went into premature labor and was put on bed rest, where she remained for the next month. She took a leave of absence from her busy, demanding job. She left her desk set up—picture frames propped up by the computer, cardigan draped over the back of her chair. But as it turned out, she never went back. When her pregnancy was full term, the doctors released her from the bed-rest restriction, and she started walking the hills of San Francisco, trying to urge her body into labor. She walked those hills for two weeks until her daughter, Serena, was born, a perfectly healthy baby, in February of 1982.

在 28 周時，杜松早產，臥床休息，她在那裡呆了一個月。她從繁忙、要求高的工作中請了假。她把書桌佈置好了——電腦支撐著相框，開衫披在椅背上。但事實證明，她再也沒有回去過。當她懷孕足月時，醫生讓她擺脫了臥床限制，她開始在三藩市的山上行走，試圖催促她的身體分娩。她在那些山上走了兩個星期，直到 1982 年 2 月她的女兒 Serena 出生，她是一個非常健康的嬰兒。

In the weeks after the birth, as the pregnancy hormones faded, the pain began to return. Sitting in the glider in her daughter’s room, breastfeeding her new baby, she felt those excruciating electric sparks starting up again deep in her pelvis. She realized that she couldn’t do it all—she couldn’t work full-time, take care of an infant, and devote the kind of time to her yoga practice that her healing required. She quit her job, and in a leap of faith, she and Lee relocated to LA and started their own business management firm, Stein & Stein. It was a lot of work and stress, but at least now she controlled her schedule and could prioritize the yoga practice that she was certain was the key to treating her AS.

在分娩后的幾周內，隨著妊娠激素的消退，疼痛開始回歸。坐在女兒房間的滑翔機上，給她的新生兒餵奶時，她感覺到那些令人痛苦的電火花在她的骨盆深處再次升起。她意識到她不能做所有事情——她不能全職工作，照顧嬰兒，也不能把她康復所需的那種時間花在她的瑜伽練習上。她辭掉了工作，憑著信念的飛躍，她和李搬到了洛杉磯，開始了他們自己的商業管理公司，Stein & Stein。這是大量的工作和壓力，但至少現在她可以控制自己的日程安排，並且可以優先考慮她確信是治療 AS 的關鍵的瑜伽練習。

Encouraged by the progress she’d made so far and searching for ways to accelerate her healing, Juniper began to look for ways to deepen her yoga practice. Like many who recover from incurable illnesses, one of the first things she began to change was what she ate. She didn’t follow any particular diet or meal plan; she simply started noticing that certain foods made her feel better, stronger, lighter, and more energetic in yoga class, and others made her feel heavy and sluggish. She found herself rapidly shifting to a plant-based diet.

杜松受到她迄今為止取得的進步的鼓舞，並尋找加速康復的方法，她開始尋找加深瑜伽練習的方法。像許多從不治之症中康復的人一樣，她開始改變的第一件事就是她吃的東西。她沒有遵循任何特定的飲食或膳食計劃;她只是開始注意到某些食物讓她在瑜伽課上感覺更好、更強壯、更輕鬆、更有活力，而另一些食物則讓她感到沉重和遲鈍。她發現自己很快就轉向了植物性飲食。

She pursued Rolfing—a type of bodywork that’s like massage, but deeper. Its goal is to rework and reorganize the connective tissues of the body—the fascia and ligaments that bind joints together. She tried a couple of different Rolfers but didn’t feel a good connection with them, and the trial sessions with them didn’t seem to help much. Their technique was fine, but they didn’t seem to have any real intuition about the body and what an individual might need that was different from their next client. Then she found Mark, an experienced practitioner who’d studied directly with Ida Rolf, the founder of the practice. There was something different about him. She felt a connection with him, trusted him. He had the intuition she was looking for. He told her that his approach was to visualize in his mind what he wanted to accomplish in the fascia, then use his hands, knuckles, and elbows to melt away adhesions and open up blocked stagnant areas. Juniper felt that his mental and physical energy was able to clear what she calls her “stuck spots,” allowing healing to happen on multiple levels.

她追求 Rolfing——一種類似於按摩但更深入的身體鍛煉。其目標是重新設計和重組身體的結締組織——將關節連接在一起的筋膜和韌帶。她嘗試了幾種不同的 Rolfer，但感覺與它們的聯繫並不好，而且與它們的試用似乎沒有多大説明。他們的技術很好，但他們似乎對身體和個人可能需要什麼沒有任何真正的直覺，這與他們的下一個客戶不同。然後她找到了 Mark，他是一位經驗豐富的從業者，曾直接師從該診所的創始人 Ida Rolf。他有一些不同之處。她覺得自己與他有聯繫，信任他。他有她一直在尋找的直覺。他告訴她，他的方法是在腦海中想像他想在筋膜中完成什麼，然後用他的手、指關節和肘部融化粘連並打開阻塞的停滯區域。Juniper 覺得他的精神和體力能夠清除她所說的“卡住的地方”，讓癒合在多個層面上發生。

After Rolfing sessions with Mark, Juniper was able to go even deeper in her yoga—holding poses longer, lengthening farther into the stretches. She’d started with hot yoga, reasoning that the heat would help warm up her joints and ligaments and allow for a greater range of motion. Hot baths had always helped her loosen up her stiff and painful skeleton; it made sense that hot yoga would do the same. But the hot yoga she was practicing was limited to a repetition of twenty-six poses, and once Juniper mastered them, she began to want more. She felt that to continue to keep the aggressive autoimmune illness at bay, she needed to be progressing in her practice and not remain static.

在與 Mark 進行 Rolfing 課程後，Juniper 能夠在她的瑜伽中更深入地保持姿勢——保持姿勢的時間更長，伸展得更遠。她從熱瑜伽開始，認為熱瑜伽有助於溫暖她的關節和韌帶，並允許更大的運動範圍。熱水浴總是幫助她放鬆僵硬和痛苦的骨骼;Hot Yoga 也會這樣做是有道理的。但她練習的熱瑜伽僅限於重複 26 個姿勢，一旦 Juniper 掌握了它們，她就開始想要更多。她認為，要繼續阻止侵襲性自身免疫性疾病，她需要在實踐中取得進步，而不是停滯不前。

Over the years that followed, she worked her way through various styles of yoga, adjusting her practice to suit the shifting needs of her body and to keep her healing on course. She found that the deeper she went into the Rolfing, the more effective the yoga was, and the less pain she felt—not only in sessions but anytime: lifting one of her children, sitting at her desk, going for a walk. And she discovered that microdosing with cannabis took the edge off the Rolfing sessions, which could be quite painful, and allowed Mark to get even deeper into her soft tissues and ligaments. The pain relief from the microdosing, the Rolfing, and the yoga—she was learning to use them together to transform her body and also her immune system, making it an inhospitable place for an inflammatory autoimmune disease. But there was still more to do to shut down the illness entirely.

在接下來的幾年裡，她努力學習各種風格的瑜伽，調整她的練習以適應她身體不斷變化的需求並保持她的康復進度。她發現，她越深入 Rolfing，瑜伽就越有效，她感受到的痛苦就越少——不僅在課程中，而且在任何時候：抱起她的一個孩子，坐在她的書桌前，出去散步。她發現，大麻的微劑量可以減輕 Rolfing 療程的邊緣，這可能會非常痛苦，並讓 Mark 能夠更深入地瞭解她的軟組織和韌帶。微劑量、Rolfing 和瑜伽緩解疼痛——她正在學習將它們一起使用來改變她的身體和她的免疫系統，使其成為炎症性自身免疫性疾病的不適宜之地。但要完全關閉這種疾病，還有更多工作要做。

Running Stein & Stein with Lee was better, when it came to flexible hours, than her previous position heading up the taxes of the largest trucking company in the world. Owning her own company was certainly a weight on her shoulders, but she liked having a sense of control and agency—being her own boss, in charge of her own time. Still, the job took its toll. They managed finances for a lot of Hollywood types who expected them to be available 24-7. And their business was young. “We were the new kids on the block,” Juniper says. To compete with established outfits in the area, they had to work twice as hard and be twice as accommodating.

在靈活的工作時間方面，與她之前擔任世界上最大的卡車運輸公司稅務主管的職位相比，與Lee一起經營Stein&Stein要好。擁有自己的公司當然是她肩上的重擔，但她喜歡有一種控制感和能動性——成為自己的老闆，掌控自己的時間。儘管如此，這份工作還是付出了代價。他們為許多好萊塢類型管理財務，他們希望他們能 24/7 全天候可用。而且他們的生意還很年輕。“我們是這個街區的新孩子，”Juniper 說。為了與該地區的老牌公司競爭，他們必須加倍努力工作，並加倍適應。

“We’d wake up at 2:00 a.m. to the phone ringing,” Juniper says. “It would be a call from some rock star we represented, saying, ‘I just got really mad at my wife and threw a Tiffany lamp across the room. Is it insured?’”

“我們會在淩晨 2：00 醒來，電話響起，”Juniper 說。“那會是我們代理的某個搖滾明星打來的電話，說，'我剛剛對我的妻子真的很生氣，把一盞蒂芙尼燈扔到了房間的另一頭。有保險嗎？

Eventually, she realized that to truly heal, she needed to reorganize her life. Juniper and Lee sold the business and moved to San Diego to focus more on her well-being and the kids. Lee became president of a real estate development company by the waterfront in San Diego, while Juniper committed herself to putting her healing first, even in the midst of raising—by that point—three children. She wasn’t immune to the kind of guilt most mothers feel, putting themselves before their children, but she carved out the hours, every single day, for yoga. She told her kids, “I need to go to class so I can be a good mommy.”

最終，她意識到要真正治癒，她需要重新安排自己的生活。Juniper 和 Lee 賣掉了生意，搬到了聖地牙哥，以更多地關注她的福祉和孩子。Lee 成為聖地牙哥海濱一家房地產開發公司的總裁，而 Juniper 則致力於將自己的康復放在首位，即使在那時撫養三個孩子時也是如此。她也不能免於大多數母親的那種內疚感，把自己放在孩子之前，但她每天都抽出時間做瑜伽。她告訴孩子們，“我需要去上課，這樣我才能成為一個好媽媽。

Looking back now, she isn’t exactly sure when the pain stopped completely. She started having more good days than bad. Then, the bad days got fewer and further between. One day, it dawned on her that she felt good, that she had no pain, that it had been a long time since she’d noticed it.

現在回想起來，她不太確定疼痛是什麼時候完全停止的。她開始過得好日子多於壞日子。然後，糟糕的日子越來越少。有一天，她突然意識到自己感覺很好，沒有疼痛，已經很久沒有注意到了。

She didn’t need a new diagnosis from Dr. Bluestone to know that she was better; she could feel it. But she wanted confirmation. Back in the very same office where she’d received a diagnosis that should have been a life sentence, she lay on the exam table while Dr. Bluestone lifted one of her legs to test her flexibility. He began to gently press it backward toward her body, checking her face every couple of inches, expecting her to wince in pain. “Are you okay?” he asked, pressing her leg back farther. Juniper nodded. “Are you okay now? How about now?” Juniper’s leg folded smoothly back toward her torso, and the look on Dr. Bluestone’s began to shift to one of shock and amazement.

她不需要Bluestone 醫生的新診斷就知道她好多了;她能感覺到。但她想要得到證實。回到她被診斷出本應被判無期徒刑的同一間辦公室，她躺在檢查臺上，而Bluestone醫生抬起她的一條腿來測試她的柔韌性。他開始輕輕地將它向後按向她的身體，每隔幾英寸檢查一次她的臉，預計她會因痛苦而畏縮。“你還好嗎？” 他問道，把她的腿往後壓得更遠。杜松點點頭。“你現在還好嗎？現在怎麼樣？Juniper的腿平穩地向後摺疊到她的軀幹上，Bluestone博士的表情開始轉變為震驚和驚訝。

Juniper describes finding the path into what was right for her body as a long process of trial and error. “Looking back and talking it through, it might seem like a straight line,” she says. “But there were a lot of wrong turns.” Some of the tactics she tried, she says now, turned out to be dead ends. But when she hit on something that made her feel better, she steered toward it. She course-corrected over and over as she received information from her body. She changed how she ate, exercised, worked, and structured her days. She fundamentally changed her life to change her body and health.

Juniper 將找到適合她身體的道路描述為一個漫長的試錯過程。回頭看，這似乎是一條直線，“她說。“但有很多錯誤的轉彎。”她說，她現在嘗試的一些策略被證明是死胡同。但是當她遇到讓她感覺更好的事情時，她就會轉向它。當她從自己的身體接收到資訊時，她一遍又一遍地糾正路線。她改變了自己的飲食、鍛煉、工作和安排日子的方式。她從根本上改變了自己的生活，改變了自己的身體和健康。

Nobody told her to do any of it. The yoga, the Rolfing, the microdosing, the sweeping diet changes, the reorganization of her life to relieve stress and prioritize her health. She came to it all on her own, through trial and error, intuition, and developing a deeper connection with and awareness of her own body. Juniper integrated an array of healing tactics that now, more than thirty years later, are largely backed up by the latest science. Cannabis, for example, has not only gained widespread recognition as an effective and safe form of pain relief but also as an anti-inflammatory. Some researchers now suspect that imbalances in the microbiome may actually be at the root of autoimmune diseases like rheumatoid arthritis¹⁹—and that restoring a thriving, balanced microbiome in the gut and body can roll back inflammation-based diseases. There may even be a link between the health of the microbiome and cancer—a connection we’ll explore in more depth later. And yoga—along with its closely related cousins, meditation and mindfulness—has emerged as an undeniably beneficial tool in fighting chronic illness, even when exceptional performers like Juniper, who go very deeply into their practice, are washed out in the means and averages of the typical double-blind study.

沒有人告訴她做任何事情。瑜伽、Rolfing、微量給葯、徹底的飲食改變、重組她的生活以緩解壓力並優先考慮她的健康。她通過反覆試驗、直覺以及與自己身體建立更深層次的聯繫和意識，自己來到了這一切。Juniper 整合了一系列治癒策略，這些策略在 30 多年後的今天，在很大程度上得到了最新科學的支援。例如，大麻不僅作為一種有效和安全的止痛方式獲得了廣泛認可，而且還是一種抗炎藥。一些研究人員現在懷疑，微生物組的失衡實際上可能是類風濕性關節炎¹⁹等自身免疫性疾病的根源，而恢復腸道和身體中繁榮、平衡的微生物組可以逆轉基於炎症的疾病。微生物組的健康情況與癌症之間甚至可能存在聯繫——我們稍後將更深入地探討這種聯繫。而瑜伽——連同它密切相關的表親——冥想和正念——已經成為一種不可否認的對抗慢性病的有益工具，即使像 Juniper 這樣非常深入練習的傑出表演者在典型的雙盲研究的手段和平均值中被沖昏了頭腦。

For Juniper, yoga was the north star that kept her on course, but that doesn’t mean it has to be yoga for everyone. Yoga, for Juniper, was not only a way to keep her ligaments soft and limber but perhaps, more important, a way to achieve inner equilibrium—to transition into an anti-inflammatory lifestyle and turn off the constant drip, drip, drip of the stress hormone cortisol that damages her body’s ability to regulate inflammation.

對於 Juniper 來說，瑜伽是讓她走上正軌的北極星，但這並不意味著每個人都必須學習瑜伽。對 Juniper 來說，瑜伽不僅是一種保持韌帶柔軟和靈活的方式，而且也許更重要的是，它是一種實現內部平衡的方式——過渡到一種抗炎的生活方式，並關閉不斷滴、滴、滴的壓力荷爾蒙皮質醇，這些皮質醇會損害她身體調節炎症的能力。

An anti-inflammatory lifestyle is ultimately based on changing your relationship with your body. That means being very intentional about what you’re putting into it and how you’re exercising it. It means, to the extent you can, moving your body every day. Depending on what level of health challenge you’re facing, that might mean just going for a walk or doing some gentle stretches if you can. Studies found that even just twenty minutes of moderate exercise is enough to bring down inflammation in the body.²⁰ And if, like Juniper, you find something that your body and health really responds to, lean into it. Make room in your daily routine for it. Rearrange things to the extent you can to prioritize your body and your health.

抗炎生活方式最終是基於改變您與身體的關係。這意味著要非常有意識地考慮你投入什麼以及如何使用它。這意味著，在你能做到的範圍內，每天活動你的身體。根據您面臨的健康挑戰程度，這可能意味著如果可以的話，只需散步或做一些溫和的伸展運動。研究發現，即使只是 20 分鐘的適度運動也足以減輕體內的炎症。²⁰如果您像 Juniper 一樣，發現您的身體和健康真正能做出反應，那就去做吧。在你的日常生活中為它騰出空間。盡可能重新安排事情，優先考慮您的身體和健康。

And a big part of changing your relationship with your body is going to be revisiting the stress piece. In the next chapter, we’ll look more closely at the human stress response, its potential role in disease, and the power of shifting out of a state of chronic stress and inflammation and into healing mode.

改變你與身體的關係的很大一部分將是重新審視壓力。在下一章中，我們將更仔細地研究人類的壓力反應、它在疾病中的潛在作用，以及從慢性壓力和炎症狀態轉變為治癒模式的力量。

Juniper keeps a letter from Dr. Bluestone in her medical files now, a landmark of impossible recovery. He confirms both his original diagnosis and his assessment that her AS is in indefinite remission. And not only that, he observes that she has not only halted the progress of the disease but rolled back many of its damaging effects. Her joints have more range of motion than they did at her diagnosis; her white blood cell count (an indicator of autoimmune disease) has gone back to normal. In attempting to describe what happened to her, he finally concludes that she has achieved “a unique form of remission.”

Juniper 現在在她的醫療檔案中保留了 Bluestone 醫生的一封信，這是不可能恢復的里程碑。他確認了他最初的診斷和評估，即她的 AS 處於無限期緩解期。不僅如此，他還觀察到她不僅阻止了疾病的發展，還減少了許多破壞性影響。她的關節活動範圍比她診斷時更大;她的白細胞計數（自身免疫性疾病的指標）已恢復正常。在試圖描述發生在她身上的事情時，他最終得出結論，她已經實現了“一種獨特的緩解”。

Thirty years later, Juniper laughs just thinking about it. “I guess I’m still in ‘a unique form of remission,’” she says.

30 年後，Juniper 光是想想就笑了。我想我仍然處於'一種獨特的緩解形式'，“她說。

Now sixty-four, Juniper has been disease-free for three decades. There is no trace of AS left in her system. However, her pelvic bones still bear the mark of the disease. A scan will still show the old scars—a reminder etched into her bones that an incurable illness existed, which is now gone.

現年 64 歲的 Juniper 已經三十年沒有生病了。她的系統中沒有留下任何 AS 的痕跡。然而，她的骨盆骨上仍然帶有這種疾病的印記。掃描仍然會顯示舊的疤痕——刻在她骨頭上的提醒，一種無法治癒的疾病存在，現在已經消失了。