Thursday, January 22, 2015

The Amazing Power of Cordyceps

Cordyceps is one of the most potent and interesting herbs in the entire Materia Medica. It has also recently become one of the most prolific herbs, in a sense, appearing in the vitamin and supplement sections of health food stores, as energy bar products in sporting goods stores, and featured in the wild on the BBC nature documentary Planet Earth. Its moniker of "killer fungus" has earned it a place in the annals of pop culture, inspiring zombies stories, the single most awarded video game of all time, and memorable episodes of The X-Files and Fringe. (I'll wait while you run and watch those.) 

Cordyceps is, indeed, a parasitic fungus, and it doesn't take a whole lot of searching to find some truly terrifying images of it online. Fortunately, it generally infects insects, spiders, and other small critters. The species used in Chinese herbal medicine is Cordyceps sinensis, which grows from specific caterpillars in southwest China, particularly Tibet. In Chinese, it is called dong chong xia cao
(冬虫夏草), which means "winter insect, summer herb." According to the Materia Medica, the fungus infects the larva of moths as they hibernate in the Tibetan mountains in late autumn. As the spore infiltrate the circulatory system and nervous system, the larva is compelled to climb to a higher place. Through the winter, the fungus proliferates, killing the caterpillar and causing the outer shell to harden. As spring or early summer approaches, a stroma develops and emerges from the larva, eventually growing to be much longer than the original body. At this time the fungus and the body are harvested.

Photo credit: TeaLeafNation

This entire process makes dong chong xia cao a potent yang tonic, yet it is still endowed with yin nourishing properties, making it a very harmonious herb. The environment plays a significant role in this, as well. The Tibetan plateau is quite literally the top of the world; its extreme elevation and high mountain peaks make the region very yang in nature. The lack of moisture and good quality soil, however, make vegetation sparse. Other species of cordyceps in other parts of the world frequently infest plants or less robust insects. The Tibetan variety is forced to focus on the hardy Hepialidae armoricanus, which, after developing in such a harsh climate, instills the fungus with its yin nature. In Rectification of the Meaning of Materia Medica, "it responds to the [deep, hidden] yang qi generated at the arrival of winter, crawling deep into piled snow, by nature fearless of the cold... because when the yang is generated, the yin grows." Other types, which are often the species tapped for supplements and energy bars, lack this. The feng shui of area truly allows the cordyceps to grow to the best of their ability and develop the most therapeutically useful properties. Geo-sourcing,  harvesting a herb specifically from its native habitat to optimize it's naturally-endowed quality and potency, is incredible important for Chinese medicinals and doubly so for dong chong xia cao. While it's difficult and often dangerous to collect cordyceps on the slopes of the Himalayas, substituting the species of spore and host or creating lab-grown fungi fundamentally changes the essence of the herb.

The functions of dong chong xia cao are twofold. It is used to augment the essence and tonify the Kidney yang, allowing it to treat weakness and pain in the low back and legs, as well as impotence and other reproductive symptoms associated with yang deficiency. In combination with qi tonics, this herbs can be used to treat debility from weakened protective qi. Its other major function is to reinforce the Kidney-Lung conduit by which clear qi is inhaled by the Lungs and grasped deeply by the Kidneys. Dong chong xia cao tonifies the Kidney yang while also nourishing the Lung yin in a uniquely harmonious way due to its composition. Most yang-strengthening medicinals are slightly damaging to the yin, yet cordyceps is very safe and beneficial to both aspects.

Cordyceps cooking in ceramic ginseng pot

Augmenting the Lung and Kidney in this way treats asthma and respiratory disease very efficiently. Moreover, strengthening the Lung's ability to bring in more clear qi allows for greater oxygenation of the blood. Much like the formula for athletic endurance I've discussed before strengthens and protects the muscles, tendons, and ligaments, cordyceps helps the body reach peak performance by increasing oxygen saturation levels, allowing the muscles to fire more quickly and effectively. Athletes love this, but even more exciting is seeing this herb transform asthmatics into athletes. Currently, research on cordyceps is also showing promising results in the treatment of chronic lung and kidney diseases, altitude-related illnesses, and certain types of leukemia and renal and liver cancers. I definitely encourage anyone who is interested in the modern applications and studies of cordyceps to stop by PubMed and do a quick search. 

Because dong chong xia cao is so well-balanced as a yin and yang nourishing herb, many in China consume it regularly as part of a practice called "nourishing life" or yang sheng (养生). Yang sheng focuses on preventative action and healthy living to avoid the need to treat illness. That will be the subject of my next blog!



Tuesday, December 23, 2014

Toxins In, Toxins Out - Acupuncture and Detox

Lemon juice, cayenne pepper, ice water, dandelion leaves, laxatives, enemas, and pills - does that really sound like the best menu for a healthy, high-functioning body?

Detox diets and cleanses are a hugely popular right now, and New Year's resolutions to get in shape often involve swift and direct action to mitigate the holiday season's less-than-healthy festivities. January will no doubt see a lot of us turning to the internet to find the best way to recover from overindulgence in eggnog and honey-baked ham, but throughout the year I'm asked if there's such a thing as "acupuncture for detox."

This answer, of course, is yes! But maybe not the way most people expect.

Whenever someone tells me they would like to detox, I always ask what sorts of toxins are in their body and how they got there. Part of me expects an exciting Jack Bauer-esque story of intense radiation exposure while diffusing a dirty bomb in the basement of the KFC Yum! Center or contracting an experimental retro-virus in the process of saving the mayor from terrorists, but that's almost never what patients report to me. Usually, it's something along the lines of, "Well, I've kind of been eating a lot of junk lately and/or drinking too much, so I feel like I need to get that out of my system." Yeah, that's a bit of a different story... and luckily an easier fix!

I came across a great article earlier in the month about the non-benefits of popular detox diets and products that made a couple good points. Firstly, there is a distinction between detoxing drugs from your system, especially with regard to addiction, and cleaning out your colon. Secondly, the body is built to filter and remove waste constantly by way of the kidneys, liver, skin, lungs, and intestines, obviously. Basically, you're pretty much pooping all the bad out. Toxins generally don't accumulate in the body because of it's ability to self-cleanse, and indeed I would argue that "toxin" is not really the appropriate word for junk food in the body, unhealthy as it may be. Again, drugs and heavy metal exposure are a slightly different situation, but generally people are not turning to the Master Cleanse for that. The takeaway is really that "detox" sounds like something that would be really beneficial, but "the word [is] being hijacked by entrepreneurs, quacks, and charlatans to sell a bogus treatment" that's really not necessary. 

The Acupuncture Side of Things

In the context of acupuncture, there are generally two very broad diametrical treatment strategies that we employ in any given treatment: 1) supplement and nourish that which is deficient, or 2) drain and sedate that which is excessive. In the ancient Chinese medical texts, there is a lot of dramatic language about how dangerous it is to do the wrong thing at the wrong time. You wouldn't want to add more to a system that is already overly replete, and you definitely wouldn't want to further deplete someone who is already weak. Detox products, recipes, and diets are almost always draining in nature because the goal is the remove something from the body.

The problem lies in the fact that the average detox-seeking patient would most often be diagnosed according to Chinese medicine as having a deficiency condition. The feelings of general un-wellness, which can include fatigue, malaise, sleep problems, body aches, bloating, indigestion, irregular bowel movements, foggy-headedness, and emotional turmoil usually have less to do with poison coursing through your body and more to do with deficiency of the Qi and Blood or a weak Spleen. Stress and overtaxation deplete the Qi and Blood, and poor diet weakens the Spleen over time. Now add a detox protocol that involves precipitating frequent bowel movements with cold, Spleen-damaging ingredients, and it will usually make things much worse. At the very least, it perpetuates the underlying conditions of deficiency which make a person feel the need for another cleanse down the road.

The Spleen, in many ways, is the detox organ of Chinese medicine. Its function is to "separate the clear and the turbid" from the food we ingest, utilizing the nutrients to create Qi, Blood, and the other vital substances that nourish the body and sending waste to the Large Intestine to be expelled. If the food we eat is comprised of more turbid than clear, such as junk food, then the Spleen has to go back to work on transforming and removing waste after it has managed to extract all available nutrients. When the diet is poor, this process gets backed up, and dampness starts to accumulate in the body. Still, this is closer to amassing water weight and fat than harboring actual toxins. The way to treat this is at its source. Acupuncture can be used to strengthen the Spleen, making it more efficient at its job of transformation. There are acupuncture points that are described as being able to powerfully augment the Spleen Qi and awaken and revitalize splenic transformation. Acupuncture can also facilitate a bowel movement in a much safer and less draining way than purgatives and laxatives.

Equally important is what we are putting into our bodies. The best way to "cleanse" the body is with a "clean" diet. There doesn't have to be a dramatic intervention to shock the body into turning over a new leaf. As I mentioned, the body is always working at filtering out the bad. Yesterday's Big Mac is already pretty much out of your system, so why not make today the first day of eating better? Giving your Spleen a break by eating food which is easier to break down and more nutrient rich will be better for the system in the long run. The hallmark of a Chinese therapeutic diet is balance. An easy way to achieve this is with colorful natural foods. If all the colors are represented in a daily or weekly menu, all of the elements the body needs should be met. Since cold and raw foods are harder on the Spleen, these types of foods should ideally be avoided, but balancing them with warm teas and soups helps to mitigate their draining effects. Dairy and processed foods are just going to bog down the Spleen, so they are best avoided.

Eating Healthy Is All Well and Good, But What About Actually Detoxing Off Of Drugs?

Okay, so not everyone who is interested in detoxing wants to do so because of a Dr. Oz fad diet. Sometimes, such as in cases of drug and alcohol addiction, there is a legitimate need for medical intervention. Acupuncture is really good at addressing this, as well. Detoxing from addictive substances is a process made difficult in no small part by cravings and withdrawal symptoms. These are commonly addressed by auricular acupuncture in a treatment plan called the NADA Protocol. Developed by the National Acupuncture Detoxification Association, this protocol has been used successfully to treat addiction in court-mandated drug rehabilitation programs across the country. Ear acupuncture is a bit of a different system than the meridian based tradition of classical Chinese medicine. It's a relatively modern style which interfaces directly with the central nervous system; the NADA protocol uses points to invoke the organs of detoxification - Liver, Kidney, Lung - while also balancing the sympathetic and parasympathetic nervous systems to reduce withdrawal symptoms.

In addition to the NADA protocol, body acupuncture is still done based on a diagnosis. There is still generally a pattern of deficiency that needs to be addressed as drugs and medications delete the body of vital substances and throw the organ systems off balance. This goes for non-habit-forming long-term prescription drugs, too, as well as chemotherapy.  All of that passes through the kidneys and liver, and many damage the stomach and other digestive organs. Part of the "acupuncture detox" treatment may involve support for these organs so that they are better able to handle the metabolism and excretion of medications. When these prescriptions are necessary, especially over the long term, it becomes even more vitally important to have a clean diet. Otherwise, the body is getting a double dose of weird crap to filter and transform! 

Personally, I'd rather eat a balance of steamed and roasted vegetables, high-quality organic meat, and limited amounts of dairy than have a colonic - I don't care how nice the spa is.

Photo credit:

Saturday, May 10, 2014

Athletic Endurance through Herbal Medicine

I wrote an article last fall about supporting athletes during training to help prevent and recover from injuries. I discussed the Chinese medicine view of tendomuscular health and the role the Liver and Kidneys play in bone strength and keeping the muscles and tendons nourished and lubricated.

 (You can read that here)

Recently, I decided to do a couple of mud run races this summer, starting with the 10-12 mile Tough Mudder race next month. If you're not familiar with the Tough Mudder, it's an obstacle course designed by British Special Forces that includes things like 12-foot walls to scale and 1/2-mile mud crawls under barbed wire and electrified fencing, all along a 10-mile off-road raceway.

In order to train for this, I've started doing some trail running in addition to the circuit training I had started a few months ago. Running the rough and uneven trails of Cherokee Park will help me get used to the type of running required in the event, and the circuit training exercises simulate some of the movements needed to tackle many of the course's obstacles. All of this is pretty hard on the knees, and I'm also pretty susceptible to lateral shin splints. Luckily, taking Chinese herbs are making these a non-issue!

This is a formula that be taken by someone making the jump from cough potato to gym member or a veteran marathoner. It focuses on nourishing and lubricating the muscles to increase strength, endurance, and flexibility while minimizing pain, soreness, and recovery time. Most importantly, it's designed to help prevent injuries.

Because it reduces inflammation, protects the knees, and treats shin splints, this formula is ideal for runners, football players, basketball players, soccer players, and triathletes of all levels from novice to professional.    

  • Huang Qi - Astragalus Root - tonifies the Qi, especially the Lung Qi and the Protective Qi, meaning it increases energy, improves breathing, and strengthens the immune system 
  • Ren Shen - Ginseng Root - strongly tonifies the Qi and generates fluids, providing an energy boost, as well as lubrication to the body 
  • Dang Gui - Chinese Angelica Root - nourishes the Blood and increases circulation
  • Bai Shao - White Peony Root - nourishes the Blood, calms and nourishes the Liver, which governs the tendons, stops muscle spasms
  • Sha Shen - Glehnia Root - generates body fluids, guides the action of the herbs to the Stomach Meridian (Tibialis Anterior muscle) to treat lateral shin splints
  • Mai Men Dong - Ophiopogon Tuber - moistens the Lungs to improve breathing, generates body fluids, guides the action of the herbs to the Stomach Meridian (Tibialis Anterior muscle) to treat lateral shin splints.
  • Gou Qi Zi - Goji Berry - nourishes the Liver Blood to nourish muscles
  • Sheng Di Huang - Rehmannia Root - nourishes the Blood while clearing heat to reduce inflammation
  • Niu Xi - Achyranthes Root - invigorates Blood in the legs, used to reduce pain and inflammation in the knees
  • Chuan Xiong - Szechuan Lovage Root - invigorates Blood to reduce pain
  • Chuan Lian Zi - Toosendan Fruit - smoothes out Liver Qi to reduce pain
  • Ji Xue Teng - Spatholobus Vine - invigorates Blood to reduce pain and inflammation, stretches and relaxes the tendons
  • Mu Gua - Chaenomeles Fruit - relaxes the tendons and muscles, unblocks the channels, increases flexibility, and reduces pain
  • Hong Jing Tian - Rhodiola Root - tonifies the Qi, together with Huang Qi improves respiratory function, reduces pain and inflammation 
  • Zhu Ru - Bamboo Shavings - this can be added to the formula to guide the actions of the herbs to the Gallbladder Meridian, which runs through the IT band 

These herbs are, of course, compounded and cooked into a tea in order to extract all the medicinal properties out of the raw, whole plant parts for maximum potency. Cooking them together allows for the properties of all of the herbs to combine synergistically - something that is not achievable when using pills and powders. Tinctures are okay, but their limited potency makes them ideal for children. Raw decoctions are the way to go!

I take this formula steadily whenever I kick my butt into gear and work out consistently, and it always saves my knees and gives me the boost to keep going. I would definitely recommend using this formula during training regiments or sports seasons. It's completely natural and safe to consume regularly, and with an herbal consultation and diagnosis, it can easily be modified to address more specific muscle groups or other complaints.  

Thursday, March 27, 2014

Rapid Fire Q&A

I wanted to take an opportunity to share my opinion on some hot button topics that are brought up a lot during treatment sessions or from inquiring patients. These frequently asked questions may get different responses from different acupuncturists or other types of practitioners, so you should know that the answers in this blog all represent my own opinion. Also, I tried as best as I could to resist the urge to answer all questions with, "Just take herbs."

What are your thoughts on probiotics? 

Generally, probiotics are used to improve digestive function by introducing healthy microorganisms into the gut, but this is something that should be achieved by adjusting the diet. Why is digestion a problem in the first place? Usually cleaning up digestion starts with cleaning up the diet. If there's a more significant pathology at work, then I'd rather turn to an herbal formula tailored to the specific diagnosis rather than a general probiotic treatment. Probiotics can be useful after taking antibiotics, but I still feel it's best to reintroduce flora to the gut through the diet.

What about vitamin supplements?

It's the same with vitamins. If you're eating right, there isn't a need to super-dose vitamins. You should be getting all of the proper nutrients from your diet. The argument I run up against is that the typical American diet does not provide enough of the nutrients we need. That's an excuse as much of a reason. Vitamins may not be the same as pharmaceutical medications, but in many cases they still represent looking for answers in a pill rather than in lifestyle adjustments. Vitamins are best absorbed in their natural forms, hence why so much is wasted and excreted from the body in the form of neon green urine when taking supplements. 

How do you feel about coffee? 

I hate coffee. I think it's gross. 99% of people I know have a love affair with coffee that I will never understand. Medically speaking, I kind of feel that same way. Sure, every now and then you see some study that says coffee prevents or treats such and such disease. Ok, fine; but that's extracts from the coffee plant, not anything mixed up at Starbucks, mind you! My thoughts on coffee, from a TCM point of view (and I will say that there are acupuncturists who will disagree with me here), is that it taxes the Kidneys. I really believe that the energy and buzz that comes with drinking coffee is, in fact, Qi activated and released from the Kidneys. Coffee acts as the catalyst for burning your own fuel rather than being the source of that quit boost. Essentially, you're robbing Peter to pay Paul, and eventually you get caught - that's why there's the crash a few hours later, and that's why over time people tend to feel greater levels of fatigue. You're slowing spending Kidney Qi that normally would be stored and preserved for more fun things, like baby-makin'. 

What are your thoughts on cannabis? 

Overall, I'm not a fan. Cannabis has a similar effect on the Kidneys as coffee does. Cannabis also has an effect on the aspect of the spirit controlled by the Kidney, the Zhi ("will" or "willpower"). This is why frequent users tend to lack motivation... Also, I think it's fairly obvious that smoking is bad. Cannabis may not have every chemical that cigarettes do, but inhaling smoke adds pathological heat to the Lungs and weakens the Lung Qi. I do have cancer patients who believe it's an important part of the puzzle for managing some of their symptoms, and I generally don't argue with them. If you're looking to use it to manage pain, however, I'll probably steer you towards a more effective and specific herbal treatment.     

What about St. John's Wort / Echinacea / Milk Thistle / Rhodiola / etc.?

Most of the herbs that are popularly known or you read about on the internet come out of a western/European herbal tradition and are generally different from the Chinese herbs we use (though there are some that overlap). Typically, these herbs are misused, according to their Chinese medicinal properties, which is understandable because most (western) "herbalists" are not really trained, and fewer will have any formal education in the subject. That's why you don't see many apothecaries around, and most of these people work at Whole Foods, etc. The approach to western herbology tends to be symptom management with blanket treatments, i.e. "this is good for headaches" and "this is good for sleep." That's crap. Diagnosis is so, so important! Long story short, we generally use other herbs that achieve the same goals but are much more effective because they correspond to a diagnosis that encompasses all symptoms stemming from a root cause. Oh, I do like echinacea, though! And rhodiola is actually a Chinese herb - you just gotta use it right!

Juice cleanses?
No. Just, no.

Which is best for me: yoga, tai ji, qi gong, or the gym?

Yoga is great for most people - it's just important to choose the right kind for your body type and constitution. I admittedly don't know much about the different types of yoga, but based on my clinical experience, I recommend that patients with Blood and Yin Fluid deficiencies avoid "hot yoga," as the loss of body fluid worsens those conditions. It's also important to be supervised; I see a lot of people who injure themselves trying to do yoga from a video. Tai Ji and Qi Gong I think are universally beneficial. They are considered yang sheng - nourishing life practices that when mastered lead to immortality. It's a great meditative practice, actually, because it engages mind and body, just as yoga does. Again, better to be instructed and supervised. The gym is great, so long as you're not overdoing it. It's important to do rigorous exercise as part of your routine. Getting the heart pumping and the sweat flowing is a good thing. Again, supervised and not to the point of damaging body fluids, which can in turn lead to musculoskeletal injury. I use an herbal formula for anyone starting a new workout regiment or who is routinely sore after working out. You can read about it here: Supporting Athletes and Performers
How do you feel about cholesterol and blood pressure numbers and cut off values? 

These are generally used to decide "objectively" whether or not someone needs to be medicated. Again, medication tends to subvert the willingness to make lifestyle adjustments. As far as the numbers themselves, so long as someone is not at high risk for heart failure or stroke in the immediate future, I'm not too concerned with them as long as they're actively engaged with lifestyle adjustments. That can includes diet and exercise, as well as acupuncture and herbs, at least for my patients. There really is a lot to say about the numbers, particularly in that they don't accurately represent the needs of every person's body, but I will say this: they are useful in that they are an objective way to show an MD that Chinese medicine is benefiting the body.

What's the difference between an acupuncturist and doctors and chiropractors who claim to do acupuncture?

Training. MDs, chiropractors, and physical therapists do not have the 4-year education in acupuncture technique, which includes safe needling angle and depth for several hundred acupuncture points, nor do they have but perhaps the most rudimentary understanding of Chinese medicine diagnostics. MDs can legally needle someone with their license and can get acupuncture certificates through weekend workshops for MDs. How can you choose an acupuncture point without knowing the cause of the disease? They do many things well. I don't want an acupuncturist to remove my appendix, but I certainly wouldn't seek a physician to give me acupuncture to help me recover from surgery, either.

How do you know if an acupuncturist is legit?

Acupuncturists must be licensed, though in the state of Kentucky we are called "Certified Acupuncturist" though the state's medical licensure. In order to become licensed, we have to complete a 4-year Master's degree program at an accredited school. Definitely look for these credentials. Beware of so-called "medical acupuncturists," MDs advertising acupuncture, for the reasons stated above. Also watch out for acupuncturists claiming to be doctors of Chinese medicine. Some states call their acupuncturists doctors in their licensure - New Mexico comes to mind - but their training is only at the Masters level. There does exists a doctorate degree in Chinese medicine called a DAOM (Doctor of Acupuncture and Oriental Medicine), which requires advanced training and clinical work, as well as completing and defending a research dissertation. There are only around 50 DAOMs in the country currently, but I am happy to say I will be one of them in the next couple of months!

What about acupuncturists who don't use herbs?

I think there are some situations which require herbs, plain and simple. I can appreciate that there are some practitioners who specialize in sports medicine and think they don't need to use herbs for that (I guess...), and I can appreciate that herbal pharmacies aren't feasible for everyone's private practice. On the other hand, I had classmates who would often say they wouldn't use herbs in private practice because developing that expertise is too difficult. Being an herbalist improves your diagnostic abilities and your acupuncture skills, in my opinion.  

What do you think of community acupuncture?

Really, it's a case of you get what you pay for. It's discount acupuncture at a discount rate. Sure the treatment may only cost $20, but you're only getting $20 worth of acupuncture, and when you don't see results, you've wasted that $20. Community acupuncture is usually done in an open setting with patients sitting together in chairs. Treatment times are short, so there's not enough time for a thorough intake and diagnosis, and because it's done in a much more public setting, there are privacy issues. Also, since there are other people around, and the treatments are done in a sitting position, not all points of the indicated points can be used. There are no herbs. Really, this model is for students to maximize patient exposure, essentially to practice and experiment on patients before going into private practice or working at hospitals. You wouldn't want to see a fledgling doctor or dentist who's bouncing around from person to person in an open room trying to figure out how to be a good practitioner. The advantage of seeing an acupuncturist is that one-on-one time followed by time to lie in peace and relax. I did work in a community clinic at a homeless shelter the semester before I became in intern while at school, and it is definitely a great way to bring the medicine to underserved populations, but that was certainly the most hectic place I've ever seen to treat patients.

What are some books you'd recommend to new patients?

For generally TCM info, I like Between Heaven and Earth: A Guide to Chinese Medicine. It has a lot of good info that's easy to understand. It's what I read before starting acupuncture school. There's a section in there about figuring out what element you are, if that's your thing. The Web That Has No Weaver: Understanding Chinese Medicine is good, too, but it's a little dry. For dietary information, I'd go with The Tao of Nutrition, Healing with Whole Foods, and Ancient Wisdom, Modern Kitchen. The last one was written by two of our amazing teachers who teacher the eastern nutrition classes and advanced herbology classes.  

Who do you like in the game tomorrow?


Friday, February 28, 2014

Get Results - Not Pain Control - For Your Ovarian Cysts

I recently asked a patient of mine who had great success in her treatment of a very large and painful ovarian cyst to write about her experience with Chinese medicine for the blog. She is a young healthcare professional who is intimately familiar with western medicine, yet passionately pursues, and even conducts, research on alternative therapies and natural healing. That she has come to value the effectiveness and wide-reaching application of Chinese medicine makes me think that perhaps we are doing a thing or two right! Here is what she has to say:

Ovarian cysts are a problem that most women face; however, mine were abnormal. Most ovarian cysts are fluid filled. Mine were not. My main symptom was pain that radiated down my right side. I had frequent urination, abdominal distention, and an increase in right-sided pain after exercise and coitis. I went to my Gyno numerous times for suggestions on how to decrease the size my ovarian cyst. The suggestions I received were solely focused on pain management with pharmaceutical medication. I could not get any alternative suggestions; therefore, I was forced to take matters into my own hands and conduct research. After conducting research and trying various remedies, one remedy presented drastic results. To have a 7cm cyst go down to a 3cm cyst in the matter of a few weeks was a miracle. Since the change in size of my ovarian cyst, I have been continuously taking Chinese herbs per suggested in order to prevent further formation of ovarian cysts. I am happy to state that my ovarian cyst has ceased. The Chinese herbs were effective and less costly than the frequent visits to the Gyno and pharmacy. I strongly suggest considering an alternative that works with your body rather than against it.

Ovarian cysts vary in their presentation. Some are large and painful, as she describes, while others may be small and go unnoticed. Some women regularly get cysts that come and go with changes in their cycle and are more of a nuisance than anything. Cysts may even occur on the uterine wall or inside the fallopian tube, affecting fertility. Size, location, frequency, and pain are all clues as to how to approach treatment, yet there are some commonalities among different types of cysts according to Chinese medicine. 

Like other masses that can form in body, from lipomas to cancerous tumors, fluid-filled or solid cysts are a manifestation of phlegm and Blood stasis in the body. When there is dampness in the body that is not properly transformed and moved out of the tissues, it can begin to coalesce and condense in the phlegm. Over time, the phlegm becomes thicker until it starts to solidify into a nodule. The same can occur with stagnant Blood; as Blood sits unmoving inside or outside of a vessel, it congeals over time and forms a mass. When the vessels and tissues are blocked by dampness or phlegm, Blood flow is further impeded, so phlegm and Blood consolidation often occur together. Cysts and other masses tend to be some combination of the two, and the ratio of phlegm to Blood in the composition dictates the emphasis of the treatment. Transforming phlegm and invigorating Blood to break up stasis are always key strategies, however. 

Because the root cause of phlegm nodulation is dampness, and because dampness occurs as a byproduct of weak splenic function, acupuncture and herbal treatments must include tonification of the Spleen. The Spleen is also the organ that is responsible for transforming pathogenic turbidity in the body - dampness and phlegm - so it must be bolstered in order to do this properly. The other issue is lack of free flow in the body of Qi and Blood, so they must be invigorated, as well. 

For this case, elements of Xiao Yao San are used as a base formula. It includes Bai Zhu and Fu Ling to fortify the Spleen and Chai Hu and Dang Gui to move Qi and Blood. From there, there formula is modified to target and shrink the cysts. Chuan Xiong, Tao Ren, and Lu Lu Tong are added to increase the Blood invigorating action of the formula.  Chen Pi and Ban Xia are used to transform phlegm. Hai Zao and Kun Bu, which are two species of seaweed, are also used to transform phlegm strongly, but their salty taste also means they are especially useful for softening hardnesses. Ju He, the tangerine seed, regulates Qi and breaks up masses. Xiang Fu and Mu Dan Pi are also used to regulate Qi and Blood and break up stasis. 

This, of course, is not the only combination of medicinals to treat cysts. Depending on the nature of the mass, more powerful Blood movers may be indicated. Since the mass is obstructing free flow, the build up of heat from stagnation may need to dealt with. Malignant tumors are destructive because the mass emanates toxic heat. On the other end of the spectrum, cysts that come and go may be managed with a formula that simply focuses on Qi regulation. Once the symptoms are properly diagnoses, herbal medicinals are highly effective.

Tuesday, December 3, 2013

Treating Seasonal Affective Disorder in Chinese Medicine

The Seasonal Part of Seasonal Affective Disorder

Seasonal Affective Disorder (SAD) is a type of depression triggered by external cues related to the changing seasons, particularly associated with the decrease in the length of the day during winter. While there may be a bit of stigma attached to the word "depression," Chinese medicine actually expects everyone to experience this, to some degree, during the winter months. The quintessential foundational text of Chinese medicine, the Su Wen, states:

The three months of winter are called the period of closing and storing. Water freezes and the Earth cracks open. One should not disturb one’s Yang. People should retire early at night and rise late in the morning and they should wait for the rising of the sun. They should suppress and conceal their wishes, as though they had no internal purpose, as though they had been fulfilled. People should try to escape the cold and they should seek warmth, they should not perspire on the skin, they should let themselves be deprived of breath of the cold.

There's a natural process of, for lack of a better term, hibernation that we go through in the winter, both physiologically and socially. Obviously it's colder, grayer, and darker in the winter, and we're pretty much done tending the crops for the year, so we tend to hold up in our homes near the fire and wait out the winter like hermits, so to speak. Sure, we still go out but much less than during the warmer months. The exception might be holiday gatherings, but these are traditionally done in the home, as well. Similarly, the Qi resides deeper in the body during the winter. It stays closer to the organs to warm them and encourage storage of vital substances, so there's much less outward expression of the Qi. The inherent characteristics of the winter season naturally work to subdue the emotions. 

Feeling withdrawn, closed off, and depressed in the winter is normal and natural because the body is so heavily influenced by the environment and weather around it. However, these feelings should be mild to moderate and last only temporarily - otherwise, there's a little more going on than a natural physiological phenomenon. Since the Qi is already deeper, slower, more subdued, there is a greater potential for a pathological process to occur and for feelings of depression to increase beyond the typical winter blues.   

Depression from Depressed Qi

In the 18th century Za Bing Yuan Liu Xi Zhu (Wonderous Latern Peering into the Origin & Development of Miscellaneous Diseases), it says, "All depression can be classified as liver disease." The meaning here is that, although, like any condition diagnosed with Chinese medicine, there are a myriad causes, depression almost always has a component of Liver Qi stagnation (which is often referred to as "Liver depression" or "depressed Liver Qi"). Now, the thing with Liver Qi stagnation is that it has become such a commonplace diagnosis among acupuncturists that there's almost a gut reaction (for me and many of my colleagues, at least) to want to state that one cannot simply blame everything on Liver Qi stagnation. Something to keep in mind, however, is that the Liver, as the Wood element, is responsible for managing the orderly reaching (branching out) of Qi, as well as its coursing and discharge. The Liver keeps the Qi moving - through all the channels and vessels - so when that process is impeded or impaired, all systems and meridians are at risk for Qi stagnation. Many patients with depression present with stagnation of Qi in the Lung system, for example, but rather than being due to Lung deficiency and an inability to push the Qi with the Lungs, the stagnation comes from a loss of the Liver's ability to make Qi course throughout the entirety of the body, and so the Lungs become affected.

What causes Liver Qi stagnation? The most common causes are emotional factors: anger, frustration, stress, even depression. Yes, depression can cause the condition in the body that causes depression! That's why treatment is so important to break the cycle! Other causes include Blood deficiency, poor diet, too little exercise, and aging. With regard to depression, Bob Flaws emphasizes unfulfilled desires. He says in The Treatment of Western Psychiatric Disease with Chinese Medicine:

"All desire is the subjective experience of a movement of Qi towards something we want or away from something we don't want. When such desires remain unfulfilled, this inhibits the Liver's Qi mechanism. The Liver's Qi mechanism is responsible for coursing and discharge. This means the spreading and extension of the Qi. If the Liver's Qi mechanism becomes depressed, then the Qi becomes stagnant."

Pattern Discrimination 

When a patient indicates that they want to address symptoms of depression, it is important to find out what depression means to them. We have a general sense of what depression is, at least in our own mind or own experience, and therefore an expectation that everyone else conceives of it that same way, but really each of us experiences depression in a different way. The specific symptoms (and even feelings) that accompany depression give us idea of what the mechanism of imbalance is. Many times, signs and symptoms that patients don't associate with their condition actually offer important clues, as well.   

Here are some of the main patterns of depression we look for as described by Bob Flaws:

  • Liver Qi Stagnation will present with irritability, a tendency to sigh, taciturnity, solitariness, PMS, chest oppression and rib-side pain, lower abdominal distention and pain, diminished appetite, possible delayed menses which are painful and with darker blood. The tongue will be normal or slightly dark with a white coat, and the pulse will be wiry.

  • Liver Fire is a pattern which occurs with prolonged or intense Liver Qi stagnation; where there is non-movement of Qi, heat builds up. It is the nature of fire to flare upward, so in addition to signs of Liver Qi stagnation, patients will also experience anger instead of just irritability, bitter taste in the mouth, possible acid regurgitation. The tongue will be red and have a yellow coat, and the pulse will be wiry and rapid. Often there will be headache, tinnitus, red eyes, dry mouth, dry stool and constipation, and outbursts of anger marked by shouting, cursing, and potentially violence. 

  • Phlegm Obstruction can occur when Liver Qi stagnation affects splenic function. Symptoms include "plum pit qi," a subjective feeling of something lodged in the throat that can neither be swallowed or expelled, classically described as feeling like a piece of roasted meat; oppression in the chest, possible rib-side pain. The tongue will have a slimy, white coat, and the pulse will be slippery or wiry and slippery.

  •  Heart Qi and Blood Deficiency means the Heart is not properly nourished, and so the spirit becomes restless or depressed. Patients will experience mental-emotional abstraction, restlessness, sorrow and anxiety, and a tendency towards crying. The tongue will be pale with thin, white coating, and the pulse will be thin and wiry.

  • Deficiency of Heart and Spleen presents with excessive thinking with a tendency to worry, heart palpitations (which, when discussed in Chinese medicine, mean a subjective feeling or awareness of your heart beating within you chest), difficulty sleeping, impaired memory, lack of concentration or focus, lassitude of spirit, diminished interest in eating and drinking, and possibly weakness in the arms and legs. The tongue will be pale and possibly swollen, and the pulse will be thin and weak.

  • Spleen and Kidney Yang Deficiency, according to Bob Flaws, doesn't usually present in its pure form with regard to depression may complicate patterns of Liver depression. It causes emotional listlessness and depression, a predilection to lie down, lack of desire for movement, fright and fear, heart palpitations, sleep loss, a somber facial complexion, decreased or absent libido, sexual dysfunction, low back soreness, and cold feet. The tongue will be swollen and pale with possible teeth marks on the sides, and the pulse will be thin and deep.

  • Kidney Yin Deficiency with Heat presents with anxiety and depression, vexation and agitation, vertigo and dizziness, heart palpitations, insomnia, profuse dreaming, heat in the palms and soles of the feet, easy angering, low back soreness, menstrual irregularities, possible sexual dysfunction, aversion to people, and dry mouth and throat. The tongue will be dry and red with a scanty coat, and pulse will be thin and rapid. 

Clinically, each of these patterns can and usually do present in combination with other patterns. As mentioned above, Liver Qi stagnation is almost always a factor, and phlegm and deficiency conditions are common as well. One of the most commonly used herbal formulas for mild depression, irritability, or stress (among many other possible uses) is generally considered to be THE formula for Liver Qi stagnation, but it actually functions as equal parts Qi-mover, Blood-nourisher, and Spleen-fortifier.

Treatment Strategies

The acupuncture and herbal treatments employed generally focus on coursing or invigorating Liver Qi but also on transforming phlegm and dampness or nourishing the Heart, Spleen, or Kidneys, depending on the pattern. Taking an herbal formula in particular, as always, is a great way to continue treating the condition on your own time. 

Another great way to work on depression is exercise. Any intense physical activity that gets the heart rate up is perfect. That physical movement of the body moves the Qi - it literally jostles it loose and forces it to flow. Many people run or go to the gym as a form of stress relief, and this is precisely why it works so well. If you're not physically fit enough for Iron Man-level workouts, start slow and work your way up gradually. Tai Ji and yoga are great ways to move the Qi that are easily accessible at all levels of physical fitness. Even starting with a brisk walk around the neighborhood can be very helpful. Take advantage of sunny days during the winter. Sunlight exposure increase serotonin production and is believed to be a key factor in Seasonal Affective Disorder. Also, don't underestimate the power of fresh air! Motivation can definitely become an issue, so use acupuncture to help get over that initial hurdle!

Lastly, in addition to maintaining a healthy and balanced diet, there are certain foods which help to move the Liver Qi. Artichokes, beets, cilantro, cucumber, lotus root, parsley, turnip, grape, grapefruit, hawthorn berry, lemon, lime, and fennel are all good at moving the Qi. Avoid spicy, oily, and fried foods as they aggravate the Liver and encourage phlegm production. 

Other foods to use are those which are considered fiery in nature and offer a good balance to the water season of winter.

From a Daoist 5-element perspective, fire is associated with the Heart which expresses joy as it's emotional. Cultivating the Qi of fire during the winter season helps to bring joy and alleviate seasonal depression. Eat foods that grow in the winter like asparagus and cabbages. Broccoli and cauliflower are also good. Red cabbage and brussels sprouts are particularly good because their leaves grow inward which reinforces their fire and Heart Qi-boosting properties. Consider roasting your meats and vegetables to further endow them with a fiery nature, and you'll cruise right through winter.   

Saturday, October 19, 2013

Will taking herbs affect my meds?

With the vast majority of our patients on an herbal formula, we're asked this question quite frequently. It's a legitimate concern considering how many prescription medications the average person takes daily. The truth is that yes, herbs may influence how meds interact with your body, but the reality is herbs will probably affect your meds about as much as your lunch will. The real question should be: "Is it safe to take herbs while on prescription medications?"

A Quick Look at How Drug-Herb Interaction is Studied 

When looking at drug-herb interaction, researchers tend to focus more on the drug side of things; this is because drugs are very specific lab-made synthetic compounds, whereas herbs are complex organisms (for the most part). Drugs are essentially a chemical equation with every action accounted for in their structures. Herbs are latticework of organic structures which have naturally evolved, so, frankly, it's too difficult to isolate specific properties to study.

With that in mind, the basic approach is to take any given drug and ask whether or not it's properties allow it to be safely combined with other things including herbs, supplements, foods, and other drugs. The main way of deciding this is looking at the drug's therapeutic index - the window in which a drug works both safely and effectively. If a drug has a wide therapeutic index, there's less of a concern that other things in the body can render it ineffective or dangerous. If a drug has a narrow therapeutic index, there is very little difference between a safe dosage and a toxic dosage, so there is a greater concern about interfering with its actions.

Prescribing Chinese Herbs Safely

There are several steps we take to make sure that it is safe for our patients to take an herbal formula whether they are taking prescription medications or not:

1) Extensive study and training of Chinese herbal medicine. We spend 4 years learning the herbs inside and out. We are trained to identify the herbs by sight, smell, and taste, must know their actions on the body and what parts of the body they act on, what symptoms and conditions they treat, how to combine them into formula, how to prepare and cook them, and all possible contraindications. As acupuncturists, we are often compared to doctors, but when it comes to herbal knowledge, we are more like pharmacists.

2) Detailed diagnosis. With any system of medicine, treatment is only safe and effective when you nail the diagnosis. This is the most emphasized aspect of Chinese medicine, and herbs are only ever prescribed in accordance with a Chinese medicine pattern diagnosis.

3) Dosing low. This is something we do at Meridian as an extra precaution. Because people are generally not used to drinking teas made from twigs and barks, and because people are used to supplements working very subtly over time, we always start with the lowest effective dosage and increase it as needed. This is how herbal medicine is practiced in Japan, as well. Like the Japanese, Americans seem to have more delicate systems than the Chinese. In China, patients regularly leave the hospital with their raw herbs for the week in dosages that fit in garbage bags. What we give patients as a weekly dose, Chinese herbalists prescribe and package for daily consumption. Keep in mind that this is in conjunction with pharmaceutical medications, as well!

Each one of these is one day's dose.

4) Constant monitoring. We prefer to prescribe herbs one week at a time and have patients report back to us before refilling their formulas. This allows us to make adjustments in ingredients and dosages based on changes in symptomology. This allows helps us determine when herbs are no longer needed. Most patients are on herbs temporarily, though it may be long-term. This is in stark contrast to drugs which many patients are on indefinitely.

5) Caution with herbs with similar actions as drugs. On one hand, a formula that supports and enhances the action of meds can be very useful. In fact, many patients, in consultation with their physicians, are able to reduce or come off their meds while taking herbs. It serves as a natural way to ween off of pharmaceuticals. Again, those decisions are made by patients and their doctors rather than us. On the other hand, increasing the action of specific drugs can be non-therapautic. For example, if someone is on blood thinners, we are careful about using herbs which also invigorate the Blood from a TCM perspective. While even that is usually safe, we always operate with an abundance of caution.

6) Avoiding harsh herbs in conjunction with hardcore drugs. This goes back to the idea of therapeutic index. Most of the drugs that have a narrow therapeutic index are very serious meds like lithium and certain type of chemotherapy drugs. It is very rare that these patients also present with a condition that would required our harsher herbs (things like aconite or scorpion, which in large enough dosages can be slightly toxic). We are extremely cautious when these things show up on the med lists, and sometimes the safest and most appropriate course is to forego herbs altogether.

Following these principles, we have never had a problem with bad reactions from herbal formulas. At this point we've prescribed formulas to thousands of patients, most of whom have been on some form of prescription drugs. Even when advising patients that they might get a bit of an upset stomach the first day (since roots and sticks aren't normally in their diet), fewer than 1% ever report experiencing that.

So, are herbs safe to take with prescription drugs? Yes, it can absolutely be done safely, and no patient for which it is not safe will receive herbs!