On Seasonal Influences in North America vs. China

Here's a quick post about attempting to treat with the seasons that way classical Chinese physicians believed we must.

As you may know, in addition to helping build Meridian Acupuncture & Herbal Medicine, I am also working towards my Doctorate of Acupuncture and Oriental Medicine at Pacific College of Oriental Medicine in San Diego, CA. In a course on the foundational Chinese medical text Huang Di Nei Jing Su Wen (Yellow Emperor's Inner Cannon: Basic Questions), we were asked to formulate questions for the most well-known and respected western translator of classical Chinese medical texts. Dr. Paul Unschuld is a Sinologist and medical historian who has spent his career analyzing and contextualizing the written sources of Chinese medicine. My question for him and his response follow:

Colby: With the emphasis on seasonal influences in Chinese medicine, how does a practitioner adjust to the differing manifestations of seasonal change in different parts of the country? As a practitioner trained in San Diego and practicing in Kentucky, my experience of the seasons and their influence of patients' Qi is very different. China, as much as the US, has diverse climates spread over a large territory, so this is not a problem unique to North American practitioners.

Dr. Unschuld: A question very difficult to respond to as it touches on one of the most essential problems associated with a transfer of Chinese medical concepts not only from one culture sphere to another, but also from geographic and natural environment to another. China itself is almost exactly as large as the USA. However, to its West, where the winds and the weather come from, China has the huge landmass of the Eurasian continent. This is different from the US, and also from Western Europe. With the Eurasian landmass to its West, the climate in the region where Chinese medicine was conceptualized was much more predictable than in Western Europe or North America. The fact is, the begin of a new season is much more “on time” in China than at the Western End of Eurasia. Hence Chinese naturalists two millennia ago may have been convinced to see a regularity which they felt could be expressed in terms of Yin-Yang and Five-Phases, and also in the doctrine of the Five-Periods and Six-Qi. To think this over and to argue in favor of or against a meaningful transfer of these ideas to North America – that is a homework yet to be done. Chinese medicine may be researched on the basis of modern biomedical parameters. It may also be researched in its own terms: Take the data offered in the Suwen, and see how they apply to human existence in North America. Very little has been done in this respect so far. Maybe the insights documented in the Suwen should just be seen as alerting today’s readers to the fact that climate-qi has a bearing on our health, and to acknowledge, as does the Suwen, that people living in the North, South, West, East or Middle live in different natural environments with numerous consequences. All this needs to be discussed. The Suwen is simply a stimulus from antiquity that is thought provoking even today. Subsequent generations in China have more or less faithfully further developed the ideas expressed in the Suwen. To believe that one could draw on these thoughts and stimuli without adapting them to the time and environment we live in may be insufficient.

Just like western medicine, it's an ever-changing science, despite its roots in antiquity. Enjoy your Thanksgiving!

Happy Thanksgiving

Turkey, ham, stuffing, yams, mashed potatoes, green bean casserole, cranberry sauce, pumpkin pie, wine, beer, coffee; yeah, I'm going to stuff my face this Turkey Day! It's tradition to pile your plate high and eat way beyond satiation. There are multiple levels of "full" on Thanksgiving, and I want to introduce an herbal formula designed to help us from feeling sick from overeating.

Zhu Dan Xi, a 15th century Chinese physician and herbal master who believed that overindulgence in food, drink, and other worldly pleasures was the major source of illness, created the most popular herbal formula for the treatment of what we call "Food Stagnation."



Food Stagnation is exactly what it sounds like and generally encompasses that "Oh, God, I ate too much and feel sick" sensation. That could be anything from abdominal distention and bloating, pain, acid regurgitation, belching, nausea, vomiting, and diarrhea. The main formula we use to treat this, especially when it's caused by overconsumption of meats, greasy foods, and alcohol, is Bao He Wan or "Preserve Harmon Pill."

The main ingredient of Bao He Wan is hawthorne berry. It's primary functions in this formula are transforming accumulated food stagnation by awakening the Spleen, unbinding the Stomach, promoting food intake, and assisting digestion. We know from modern western research on hawthorne berries, called Shan Zha in Chinese, that is has the ability to lower blood pressure and cholesterol levels, so there is multi-leveled benefit to this herb. 

In China, Shan Zha is often eaten as a dessert after meals. You can find the berries candied on a stick in most food markets.

Let's breakdown the actions of the other herbs in the formula. In addition to Shan Zha, the is also Shen Qu (Massa Medicata Fermentata), which assists the main ingredient in reducing the stagnant accumulation of alcohol and food. It directs Qi downward to transform phlegm, warms to Stomach to transform thin mucus, and strengthens the Spleen to alleviate diarrhea and distention. Lai Fu Zi (Radish Seed) excels at reducing the accumulation of phlegm from stagnant grains and at facilitating the flow of Qi. These three herbs in combination can thus treat food stagnation caused by overindulgence in food and drink of all types. Zhi Ban Xia (Pinellia Rhizome) and Chen Pi (Aged Citrus Peel) promote the movement of Qi and transform stagnation; they are really good at harmonizing the Stomach to stop nausea and vomiting. Fu Ling (Poria) strengthens the Spleen and leeches out dampness, helping to stop diarrhea. The last herb Lian Qiao (Forsythia Fruit) is generally considered a heat-clearing medicinal, and it is included her to address the potential build-up of heat from constraint that often accompanies accumulation. It's dispersing and penetrating action further reinforce the functions of the formula.

As an added bonus, because this formula treats the same symptoms due to accumulation from drinking alcohol, it makes for a good hangover remedy! Have a happy Thanksgiving!

Acupuncture vs. Dry-Needling

We have a lot of patients tell us that acupuncture has been a successful form of pain relief for them in the past and that they are very excited to have discovered our new Meridian clinic. However, many times patients tell us after the treatment that it was quite unlike their previous experiences with acupuncture: "This was much less painful." "I can really tell a difference already." "Your explanation of the problem really makes sense." "The physical therapist put the needles in different places."

Wait - you got acupuncture from a physical therapist? "Actually, he called it dry needling, and it was so painful, I was hesitant to come get acupuncture again." Well, that's never a good sign. Let's take a look at this.

What is Dry Needling?

Dry needling is a technique developed in the late 1970s by a physician who noticed that injections into painful muscles relieved pain irrespective of the analgesic used. With this in mind, he started using empty hypodermic needles from syringes to poke areas of knotted muscle tissue, or trigger points. Needling these trigger points causes a local "twitch" response: the muscle will involuntarily contract or "jump" due to reflexive signals sent from the spinal cord. This is believed to allow the muscle to relax and thus relieve pain, although the insertion of the needle and the local twitch response can themselves be quite painful. 

Dry needling is presently performed by physical therapists and chiropractors, depending on state laws. Many have gotten smarter over the years, realizing that patients generally don't like syringes inserted into their muscles, so they've started using the same solid, filiform needles that we acupuncturists use. 

What's the Difference between Dry Needling and Acupuncture?

Essentially, practitioners using dry needling are performing rudimentary acupuncture. The technique of needling directly into an area that is painful upon palpation is outlined in the earliest foundational text about Chinese medicine and acupuncture, the Huang Di Nei Jing (黄帝内经), written around the 4th century BCE. Acupuncture has been further refined over the centuries to high levels of sophistication; dry needling represents, at best, the crudest and most elementary form of acupuncture techniques and, at worst, non-acupuncturists attempting to rebrand an ancient medical technique for modern insurance billing purposes.

Here are some of the advantages of acupuncture over dry needling:

1) Dry needling aims for trigger points and knotted muscle fibers whereas acupuncture employs and is based on the meridian system. As discussed in previous blog entries (here and here), the meridian system maps out the flow of Qi throughout the body - to the various organ systems and body tissues. We are able to relieve pain by stimulating points along specific meridians, and often the site of the needling is far away from the painful area. Dry needling does not take into account this fundamental aspect of Chinese medicine.

2) Dry needling treats symptoms while acupuncture address underlying causes of pain. Pain in your shoulder can stem from an issue in your elbow or a problem near your spine. Essentially, Qi stagnation in a meridian can cause pain anywhere along that meridian, so it's not always useful to needle the site of the pain. Furthermore, what is causing the stagnation of Qi? Is there heat in the meridian? Cold? Blood stagnation, as well? Are you frequently straining muscles because they are not properly nourished by Blood and Yin? Is emotional constraint preventing the Qi from flowing properly? Dry needling isn't going to be able to treat Yin deficiency or Liver Qi constraint, nor can it be used as preventative medicine. That's why the effects of acupuncture tend to be stronger and longer-lasting. 

3) Dry needling is only used for orthopedic complaints, generally muscle pain. Acupuncture is awesome for pain, but of course it also treats conditions which would fall into the category of internal medicine such as digestive problems, high blood pressure, infertility, anxiety, flu, and on and on. 

4) Dry needling tries to excite the muscles into twitching, which can be uncomfortable or painful. Acupuncture is generally painless and very relaxing.

5) The level and quality of training is very different. PTs and chiropractors can perform dry needling with as few as 23 hours of training. This is basically a course or workshop in an adjunctive therapy very unlike the main techniques of these professions. The acupuncturists at Meridian Acupuncture undertook a 4-year Master's program in acupuncture and oriental medicine, learning many different needling techniques. More importantly, we have gained a full understanding of traditional Chinese medicine theory, allowing us to practice acupuncture needling within the context in which it was created, develop a diagnosis and treatment plan, and incorporate herbal medicine when appropriate.  

How Does this Affect the Medicine?

That's a tough question to answer. On the one hand, I personally don't agree with the principles and treatment philosophy behind dry needling. Compared to acupuncture, which has grown out of an established system rooted in 5000 years of tradition, dry needling just doesn't have as much to offer. The effects aren't as strong or long-lasting, and the root cause of the problem isn't even considered. Worse yet, the minimal training required for dry needling practice leaves me wondering if it isn't potentially dangerous to perform on a large patient base. Every patient who has told me about their dry needling experience always had a lot of criticism of the treatment, whether in regards to how painful it was, how limited the effectiveness was, or how uncomfortable they were with the practitioner.

On the other hand, surely there must be patients who get some, temporary pain relief, otherwise therapists would not be out there attempting to perform this type of acupuncture.  Presumably, then, some might leave thinking they've had good results with real, Chinese medicine-based acupuncture. This could make them more open to visiting an actual licensed acupuncturist for future problems. Dry needling practitioners can then potentially become unwitting ambassadors for Chinese medicine. My hope is that patients who receive dry needling and aren't completely turned off by it will then want to take the next step and consult the Chinese medicine experts.    

Back to School: Stay Healthy with Herbal Medicine (Part 3)

I figured it was finally time to post the long-awaited part 3 of our discussions on herbal formulas to help keep you healthy this fall and winter season.

Today, we'll be looking at Yin Qiao San, also called Honeysuckle and Forsythia Powder. This is a formula we need use when a patient develops fever and slight chills, headache, thirst, cough, and sore throat. In fact, Yin Qiao San is typically one of the first formulas considered when a patient complains of sore throat. 

This formula is used for what we call a Wind-Heat attack. The pathogen will typically enter the nose and mouth and directly damage the Qi of the Lungs. It also constrains the diffusion of protective Qi in the skin and muscle layer. That constraint of the protective Yang Qi causes fever, and if the pathogen remains on the exterior, it will also block and prevent sweating. If the dissemination of Lung Qi is blocked, a could will develop. When heat damages the body's fluids, there will be thirst. Since the throat is "the door to the Lungs," heat from constraint will cause itchy and sore throat; if the heat remains it will transform into "heat toxin," causing pain and inflammation.

Here's a quick breakdown of the ingredients:

Jin Yin Hua (Honeysuckle Flower) and Lian Qiao (Forsythia Fruit) are the chief ingredients and they release the exterior, clear heat from the Lungs, and resolve toxicity. Jie Geng (Platycodon Root) and Niu Bang Zi (Arctium Seed) spread the Lung Qi and benefit the throat. Bo He (Mint), Dan Dou Chi (Prepared Soybean), and Jing Jie (Schizonopeta Bud) aid the chief herbs in releasing exterior heat. Dan Zhu Ye (Lophatherum Leaves), Lu Gen (Reed), and Gan Cao (Licorice Root) generate fluids and alleviate thirst. Gan Cao and Jie Geng are also an effective combination for treating sore throat.

According to Chinese Herbal Medicine: Formulas and Strategies: with the appropriate presentation, the formula may be used to treat a wide variety of throat and lung disorders, primarily involving acute respiratory tract infections like the common cold, influenza, bronchitis, pneumonia, and tonsilitis, but also measles, mumps, meningitis, and encephalitis B.