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Feeling withdrawn, closed off, and depressed in the winter is normal and natural because the body is so heavily influenced by the environment and weather around it.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.   

  

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!

Diabetes Mellitus Treatment in TCM

25.8 million people in the United States, 8.3% of the total population, have diabetes. It's one of the most prevalent chronic diseases in the country, and it's also one of the most preventable causes for heart disease, high blood pressure, blindness, kidney disease, neuropathy, and amputations. We spent $245 billion on diabetes patients last year with most of that going directly towards treatment. Traditional Chinese Medicine offers an effective and much cheaper alternative to managing diabetes.


Diabetes in Chinese Medicine

Traditionally, diabetes is characterized as xiao ke, wasting and thirsting disorder, but because of the most common symptoms experienced, it is often called duo shi, profuse eating, duo yin, profusing drinking, and duo niao, profuse urination. Diabetes, like most conditions we treat, can stem from several possible causes, according to Chinese medicine. These include congenital essence deficiency, aging, unregulated eating and drinking, and internal damage by the seven affects (meaning lifestyle and emotional factors).

In juvenile-onset diabetes, the cause is attributed to an insufficiency of the essence naturally endowed to newborns from their parents during fertilization. Whenever there is a congenital deficiency of jing, the most primary essence which we store in the Kidney, the child has an inherent tendency towards disease. This can be anything from developmental delays to scoliosis to diabetes (type 1). The nature of the disorders that manifest depend on the quality of jing from the parents, and many, though not all, can be overcome with early treatment.

Adults who develop diabetes later in life typically have a pattern of long-standing heat in the Stomach coupled with Spleen deficiency. The heat may come from over-eating hot, spicy, greasy,

fatty, rich foods or alcohol or from depressive heat of the Liver affecting the Stomach; this causes a large appetite and rapid hungering after meals. The Spleen deficiency may be due to over-eating
sugars and sweets or fatty, rich food, as well. It could also be from over thinking, too little exercise, or over taxation of the body. Spleen deficiency allows for the accumulation of dampness in the body causing obesity. Long-standing Spleen deficiency also accounts for the emaciation and muscular atrophy later in the progression of the disease. Enduring heat eventually damages and consumes the yin fluids of the Stomach and Lung causing thirst. If Lung yin deficiency reaches the Kidney and is complicated by yin deficiency from aging, Kidney yin deficiency may develop. Spleen qi deficiency may develop into Kidney yang deficiency over time. Dual vacuity of Kidney yin and yang can lead to urinary problems and impotence. Chronic deficiency with damp accumulation gives rise to Blood stagnation and a lack of nourishment of organs and tissues, accounting for the neuropathy of the muscles and optic nerves.

Treatment

Treatment of diabetes, particularly type 2, will focus on strengthening the Spleen and Kidney and regulating and transforming dampness. These are the most common aspects of the disease pattern we see clinically, but variations may include: Lung and Stomach heat accumulation with damage to fluids, exuberant Stomach heat, dual deficiency of qi and yin, Kidney yin deficiency, Spleen-Stomach qi deficiency, damp heat obstructing the center, and Spleen-Kidney yang deficiency. Liver qi stagnation and Blood stasis often accompany the main pattern.

Acupuncture and moxibustion are very efficient at bolstering Spleen function, but due to the chronic nature of the disease, most patients choose herbal medicine as a more cost-effective treatment for diabetes. Taking an herbal formula also addresses the condition daily rather than intermittently as with acupuncture. A daily regiment of herbal medicinals helps to treat the condition from the inside on a molecular level and helps to manage blood sugar levels.

Our most commonly used formula for the treatment of diabetes is called Jiang Xue Yuan Jian. It contains Huang Qi, Shu Di Huang, Xuan Shen, Tu Si Zi, Cang Zhu, Nu Zhen Zi, Fu Ling, Zhu Ling, Huang Jing, and Shan Yao. The synergistic effect of the ingredients work to fortify the Spleen, nourish the Kidney, regulate body fluids and transform damp accumulation, quell fire, and redirect heat to warm the yang. It's a good balance of augmentation, dissipation, and harmonization. Patients are able to report normalized blood sugar levels, increased energy, and, in many cases, weight loss and better weight management (though the most significant results are seen in patients willing to make dietary and lifestyle changes).

Lastly, acupuncture and herbs are amazingly effective at healing diabetic ulcerated wounds. In addition to managing the diabetes, there are acupuncture and herbal techniques for healing and regenerating flesh. Getting an open sore to close, finally, and preventing a gangrenous infection can be the difference between a patient continuing to walk or losing a foot. Seems like an easy choice!

 

Supporting Athletes and Performers

As Holistic healthcare practitioners, we place great importance on investing in the health of the community.  It is in this spirit that Meridian will be sponsoring local athletes and performers, using Chinese medicine to support their training and artistic pursuits.

During the spring and summer seasons, we sponsored local athlete Luke. We diagnosed and treated Luke with acupuncture and Chinese herbal medicine to aid him as he competed in numerous marathons, triathlons, and, most recently, his second Ironman competition in Louisville. Luke didn't have specific complaints but wanted to care for his body during his intense training. We focused on boosting energy and endurance, strengthening immunity, and promoting joint health. This helped him to avoid tendon and ligament injuries, recover from workouts faster, and stave off adrenal fatigue over the many months of training and conditioning. We'll get in to specifics below, as we are taking a similar approach with our new athlete, but you can read about Luke's experience and journey in his blog http://lukeapowell.blogspot.com/.


For the fall and winter seasons, we will be working with a local young performer. Jessica is a 22 year old ballerina and teacher with the Louisville Ballet Company. Anyone who's ever done any formal dancing or Pure Barre workouts knows how intense the training regiment for ballet is. It requires high levels of strength, agility, and flexibility, and the body must be in prime condition. She came to Meridian presenting with calf pain and cramping, muscle fatigue, and plantar fasciitis. Doctors weren't able to offer any relief, and the only thing that reduced the pain was taking breaks from dancing - that's not an option!

Her pain was deep within the calf and extended down from the back of knee to the Achilles tendon attachment. Upon palpation, her Kidney and Spleen Meridians were tight, and her Kidney Meridian also had palpable nodulations. The Liver Meridian was thin and warm to the touch, while the Stomach Meridian was tight and warm. Her pulses were thin with the middle positions absent. We diagnosed her as having Liver Yin deficiency and Blood deficiency giving rise to heat.

The fluids that lubricate joint spaces and nourish our body tissues are derived from the body's Yin fluids and Blood, which are manufactured by the Spleen from the food we intake and further differentiated and managed by the Liver and Kidneys. The Liver governs the tendons and sinews, so when it becomes deficient and dry, it cannot properly nourish these tissues, and the body is vulnerable to muscle and ligament injuries. The lack of lubrication and moistening also causes a build up of heat in the Meridians, which can manifest as pain, inflammation, and, eventually, atrophy. Proper support of the Liver and Kidneys (and to a lesser extent, the Spleen) is required to treat and prevent tendomuscular injuries in athletes, particularly since the intense physicality of their activities burns through Yin and Blood much more quickly than the average individual.

We treated our triathlete and dancer in similar fashion with a combination of acupuncture and Chinese herbs. The acupuncture is used to invigorate the Meridians to move out any stagnation lodged in the tissues which may be causing pain. This could be viewed as helping the body process metabolic waste in the muscles, such as lactic acid. Promoting free flow of Qi and Blood also serves to bring fresh nourishment into the tissues. Acupuncture points are also included to bolster the production in Yin and Blood in the Liver, Kidney, and Spleen. Often, a specific point of the Gall Bladder Meridian (which is the Liver Meridian's Yin-Yang pair) is used to strengthen and support the tendons and muscles; one of the names for this point is Jin Hui (筋會), meaning "sinew convergence."

Herbally, we often look to a classical formula which nourishes the Liver and Kidney Yin: Yi Guan Jian. The formula includes Gou Qi Zi to soften the Liver and nourish the Kidney; Dang Gui to nourish and invigorate Blood; Sheng Di Huang to enrich fluids, nourish the Liver, and clear deficiency heat; Mai Men Dong and Sha Shen to moisten and engender Yin; and Chuan Lian Zi, which disperses constrained Liver qi, thereby indirectly reducing pain, and works to counteract the cloying tendencies of the other ingredients. From there we usually modify the formula to increase its focus on joint and muscle health. Herbs which relax, stretch, and nourish the tendons may be added, such as Mu Gua, Shen Jin Cao, and Hong Jing Tian. Huai Niu Xi is added for its action of invigorating Blood, particular in the legs, and Zhu Ru may be used to guide the actions of the formula to the Gall Bladder Meridian, which traverses and penetrates the iliotibial band (IT band).  Lu Xian Cao invigorates Blood and relaxes sinews, and because it enters the Kidney Meridian, which begins on the sole of the foot, it is an effective addition for treating plantar fasciitis.

This is a very effective strategy for repairing or protecting against sports injuries. We would recommend a similar treatment plan for any athlete or dancer, but this is also a great way to stay healthy while doing a workout regime, practicing yoga (particularly hot yoga!), hiking, or another other physical activity.  







   

Preventing Breast Cancer the Chinese Medicine Way

Breast cancer prevention was bought to the forefront of the news last week with Angelina Jolie's announcement of her decision to undergo preemptive surgery to minimize her risk of developing breast cancer. As I understand it, her choice was heavily influenced by her being a carrier of the BRCA1 genetic mutation, an inherited genetic condition that inhibits DNA replication and ultimately increases cancer risk notably. Obviously seeking a surgical solution before the disease manifests is a deeply personal choice, and many are asking themselves whether they would make the same decision. While the National Cancer Institute estimates that 1 in 8 women will be diagnosed with breast cancer in her lifetime, the prevalence of the BRCA1 mutation is only about 1 in 400-800. This means that for most women considering cancer prevention, BRCA1 will not be a factor, and preemptive surgery would be a rather extreme option. So what alternatives does Chinese medicine offer for breast cancer prevention?

Breast Cancer and Chinese Medicine

When we consider cancer in Chinese medicine, we characterize tumors as an accumulation of stagnant Qi and Blood, and usually phlegm and dampness, that has become very dense. This long-standing mass of static Blood builds up heat over time due to the lack of free flow - so much heat that it damages the surrounding tissue. We call this toxic heat or heat toxicity. This is typically allowed to happen against a backdrop of inherent Qi deficiency, meaning the immune function is too weak to break up these clumps of toxic heat and Blood, ie. cancer cells.

The breasts are governed by the Liver, with the Liver Meridian passing directly through the breast tissue. As you may know, the Liver is the organ responsible for ensuring free flow of Qi and Blood through the Meridians, and so dysfunction of the Liver leads to Qi stagnation. The Liver meridian itself is particularly susceptible to stagnation - that is why women experience breast tenderness or develop (temporary) breast lumps during their premenstrual period.

Prevention

Like everything else in Chinese medicine, cancer prevention is all about protecting the Qi. The most important thing is to maintain strong "upright" Qi. Having a strong immune system allows the body to constantly clean up pre-cancerous cells before they can get a foothold. A balanced diet is key; obviously you should avoid or limit processed foods, but be careful about making your diet too limiting, as well. A good rule of thumb is to eat a good variety of things to ensure that all of the 5 elements are represented by your food intake - the easiest way to do this is to enjoy very colorful meals (this means lots of different fruits and vegetables!).

It's also very important to limit stress and negative emotions. This seems like obvious advice that's not always easy to follow, but Chinese medicine places a lot of emphasis on emotional factors as causes of disease. Stress, frustration, anger, unfulfilled desire, and constrained bottled-up emotions all stagnate the Qi because they are emotions associated with the Liver. Experiencing these emotions in excess is very taxing to the Liver, so it's best not to repress them. For some people this means adopting a meditative practice, whether that's guided breathing or something more like Tai Ji or Qi Gong; for others it's physical exercise.

Moving the Qi is very important, as well. Exercise is a great way to move the Qi as the physical activity literally jostles the Qi loose and helps it move through the Meridians. Of course regular acupuncture and herbal treatments can supplement that, but it's very important to remain physically active. And walking doesn't count! I'm talking about something aerobic that gets the heart beating and the sweat flowing.



Lastly, be nice to your Liver. Try to avoid things that add heat to the Liver and the body. That means limit alcohol intake and avoid smoking. Because the Liver organ is associated with the Wood element, it is also related to the sour flavor. Citrus is great for Liver health, and even squeezing lemon juice into your water helps soothe the Liver. Mint, dandelion, kale, spinach, and beets are all great, too.

Later in the week I'll talk a bit about herbs that are used to move Qi and Blood in the breasts, as well as dissipate masses in the breast tissue. I'll also discuss how we care for patients who actually have breast cancer.  


 

Chinese Sports Medicine: Anatomy of a Compound Tibial Fracture

Chinese Sports Medicine: Anatomy of a Compound Tibial Fracture

Today I want to discuss how Chinese medicine can greatly improve the recovery from a compound tibial fracture. If anyone saw the Louisville vs. Duke basketball game last night, you know exactly what kind of sports injury this is. While it's rare to see it occur during a basketball game, it's not uncommon for football and soccer players to break the tibia.

Whereas with a soft tissue injury we can begin acupuncture treatments immediately, a fractured bone needs to be set by an MD before we can go to work. Compound fractures involve the broken bone protruding from the skin and are thus a more serious injury that require surgery.

I discussed how the injury is considered damage to the Meridians, as well as the local tissue and bone, in the last blog: Anatomy of an Ankle Sprain (http://meridianlouisville.blogspot.com/2013/03/chinese-sports-medicine-anatomy-of.html). There is severe stagnation of Qi and Blood, impeding free flow, so there is pain and inhibited ability to heal the damage. The same principles apply here, though with a broken bone the treatment is altered slightly. With a compound tibial fracture, the Foot Yang Ming Meridian will be especially traumatized. The Yang Ming channels are said to be the most exuberantly full (of Qi and Blood) of all the Meridians. Imagine how abundant the Yang Ming of an athlete is! On the one hand, the nature of the injury is considered very serious because that Meridian is involved, but on the other hand, acupuncture can significantly hasten recovery time since this channel, when properly repaired and utilized, can bring a lot of much-needed nourishment to the injured area.

Treatment:

Normally with an orthopedic/sports injury, we would needle at the site of the trauma to break up static Blood that is clumping in the area; however, broken bones are usually set with casts, and so we are only able to needle distal to the injured area. Fortunately, the Meridian system connects the body so thoroughly that invigorating one part of a Meridian increases circulation in the whole Meridian. Assuming the broken leg is casted from below the knee down to the foot, we are able to use points on the thigh and near the toes. If the whole leg is covered, we are able to work with the affected Meridians on the opposite leg or paired Meridians on the arms. Also, in addition to the points we use that are aimed at conditions specifically affecting the lower extremities, treatments would include points indicated for bone conditions. These are points that have been shown to increase osteoblastogenesis, meaning increasing the rate at which new bone cells are created. The Kidney governs the bone, according to Chinese medicine, so strengthening the Kidney Qi also increases osteoblastic activity to help bones grow and heal quicker.

Herbal Treatment:

Taking an herbal formula becomes much more important with a bone injury due to the severity of the injury and the likelihood that the immediate area of trauma will be inaccessible and immobilized. The treatment principles remain the same as with acupuncture: Invigorate Qi and Blood in the affected Meridians to alleviate pain and restore proper flow, promote healing of the damaged tissues, and specifically mend bone. It is vitally important to understand the timeline of recovery - immediately after surgery you cannot invigorate Blood! The focus should first be on healing the blood vessels and recovering from surgery, holding off on the Blood-moving herbs and using herbs that generate flesh, instead (San Qi, Dang Gui, Rou Gui). Once swelling goes down, you can proceed.

As always, the specific formula will need to be custom-tailored to the individual and their injury, but the base formula will be geared towards strongly promoting circulation. Qi-strengthening and Blood-nourishing herbs are usually added to address the blood loss during injury and surgery, and warming herbs may be added if Cold has entered the Meridians, either from immediate icing of the injury or during surgery, since Cold is another cause of stagnation (see the last blog!). Finally, herbs that tonify the Kidney Yang are added to promote bone growth. These herbs can also be taken to treat and prevent stress fractures by strengthening bone.

Here are a few herbs that specifically strengthen and mend bone:

Du Zhong (Eucommiae Cortex):
- Tonifes the Liver and Kidney, strengthens the sinews and bones
-Aides in the smooth flow of Qi and Blood: used to promote circulation, especially in those with weakness of the sinews and bones

Gou Ji (Cibotii Rhizoma):
- Tonifes the Liver and Kidney, strengthens the sinews and bones
- Expels Wind-Cold-Dampness to relieve painful obstruction

Xu Duan (Dipsaci Radix):
- Tonifes the Liver and Kidney, strengthens the sinews and bones: especially good for tonifying without causing stagnation
- Promotes the movement of blood, alleviates pain, and reconnects the sinews and bones: often used for trauma, and especially good for pain and swelling in the limbs from trauma.

Gu Sui Bu (Drynariae Rhizoma):
- Tonifes the Liver and Kidney, strengthens the sinews and bones
- Promotes mending of the sinews and bones: for traumatic injuries such as falls, fractures, contusions, and sprains. Especially good for ligamentous injuries and fractures

Chinese medicine is amazing for treating sports injuries! If there is a specific condition you'd like to learn about, let us know, and we'll blog about how we treat it!

Chinese Sports Medicine: Anatomy of an Ankle Sprain

Chinese Sports Medicine: Anatomy of an Ankle Sprain

One of the most common sports injuries is a sprained ankle, and 75-80% of the time, it's a lateral sprain. This means the tendons and ligaments that stabilize the ankle joint and are located on the lateral side of the foot become stretched too far and tear. This usually happens when the foot is inverted (when someone “rolls” their foot to the outside), and the most common ligament to be torn is the anterior talofibular ligament. Usually there's pain, swelling, and often bruising.

Pathomechanisms:

From a Chinese medicine prospective, not only has the patient damaged the local tissue during the injury, but he has also damaged one or more Meridians that cross the area. Just as when a blood vessel is damaged, circulation is impeded when a Meridian is damage. Qi and Blood cannot flow through the area properly and becomes stagnant. When there is a blockage and no where else for Qi and Blood to flow, it will travel outside the Meridians and blood vessels where it moves chaotically before stopping and clumping. Since Qi is not moving, there is pain. Naturally, damage to the tissue causes Blood to move outside the vessels, as well, and there is bruising. The lack of free flow also causes a build up of heat, thus there is inflammation.

Treatment:

To treat an ankle sprain, we will use acupuncture both at the sight of the injury and away from the trauma. Needling into the area of the injury breaks up the static Blood that is clumping in the area while needling distal to the injury along the affected Meridians draws Qi and Blood away from the area. Additionally, points that have specific actions of invigorating circulation in the lower body or lower extremities may be used. Both needling techniques aim to promote greater circulation and free up the flow of Qi and Blood. This immediately reduces the pain level as the cause of the pain is the congestion in the area. This also works to continue to relief pain as circulation improves over time. Once normal circulating is restored, Qi and Blood can properly move to and through the area to nourish and repair the damaged tissue and Meridians.

Adjunctive Treatments:

Ice is a popular treatment for sports injuries, particularly immediately after the trauma. It is used mostly to prevent or reduce swelling, but swelling is actually a normal and helpful part of the healing process. Swelling is a rush of healthy blood cells to the area to began the repair process. Ice will impede that process. In fact, according to Chinese medicine, cold constricts the flow of Qi and Blood. Compare the flow in the Meridians to water flowing in a stream; in the winter, the stream will freeze and stop flowing. Ice will cause cold to penetrate directly into the site of the injury, often lingering long after the ice is removed. Its constricting and stagnating influence complicates the injury, and treatment will required warming techniques in addition to standard invigorating and circulation-improving treatments.

Bird's Nest: The Ancient Chinese Beauty Secret

On a recent trip to Los Angeles Chinatown, Robert and Karen purchased Yan Wo (燕窝), one of the most exotic and precious herbal medicinals in the Chinese Materia Medica. Yan Wo, also called "bird's nest," is a very strong tonic and such a pervasive part of Chinese culture that the Beijing National Stadium was built to look like it.

The nests are made from the nutrient-rich saliva of swiftlets, which build their nests on high ocean cliffs. The difficulty of harvesting the nests and the amazing restorative properties of the enzymes in the saliva make Yan Wo quite expensive - it is sometimes referred to as "the caviar of the East."

(Isn't Russia in the East...?)

Why do the Chinese pay top-dollar for birds nest? Well, traditional claims and modern research show that it increases vitality, aids digestion, restores sex drive, strengthens immunity, prevents stroke, attacks cancer cells, restores respiratory function, sbenefit pregnant mothers, facilitates normal body function, and repairs damaged tissues.  That's a pretty impressive list, but Yan Wo is most popularly used for its uncanny ability to revitalize and repair the cells and tissues of the face. Wealthy Chinese women (and men) drink soup made from birds next to retain and restore their youthful appearance, firming and brightening the skin.

From a strictly Chinese medicine prospective, Yan Wo is characteristically sweet in flavor, which is typical of Qi and Blood tonifying medicinals; it's also warm in flavor, which allows it to rise up and promote circulate in the head and face. It enters the Lung, Spleen, Kidney, and Stomach Meridians. The first three are the organs primarily associated with vitality as they are the systems which store Essence and generate Qi. The Stomach meridian is also called the Foot Yang Ming Meridian, and it is the Yang Ming Meridians which are more abundant in Qi and Blood. The Stomach Meridian in particular starts just below the eye and descends around the mouth and jawline before plunging down the neck, so it's pathway makes it an ideal channel to tonify in order to restore facial vitality.

Cooking the bird's nest is an all-day process. There are numerous recipes, and at Meridian we add Gou Qi Zi (Goji Berries) and Long Yan Rou (Longan Fruit) to strengthen it's restorative function. Both Gou Qi Zi and Long Yan Rou are typically included in formulas we give to our Facial Rejuvenation clients due to their ability to restore facial cells and tissues. The bird's nest, however, really represents our most powerful herbal tool for Facial Rejuvenation. An order of our Yan Wo soup will run you $80.00, and it's generally taken all at one time once a week.

 More photos of our bird's nest soup, as well as traditional Chinese preparation methods of Yan Wo, can be found on our Facebook page: https://www.facebook.com/media/set/?set=a.429515153800552.1073741826.211970382221698&type=3

Digestive Health and Joint Pain

There's a lot of discussion nowadays about the way certain foods affect our bodies. An especially hot topic is the idea of wheat and gluten sensitivity. It is believed by some that eating foods that contain gluten can trigger an allergic or autoimmune response in the body causing an inflammatory process to occur. As much of our diet includes gluten, this inflammatory process is more or less ongoing, and it can affect the gut or body joints or both. It's unclear if this sensitivity affects only some people or if it affects all of us, just to varying degrees.

Many of my colleagues, classmates, and teachers place greater emphasis on this than I do. I like to think my reluctance to frame the discussion in this context stems more from my preference to view health and wellness through the lens of Traditional Chinese Medicine than from my love of fried chicken...

So What Does Chinese Medicine Say?

Any machine will create heat while running, and when a machine is not running properly or efficiently, it will create more heat. The Spleen and Stomach, the body's chief digestive organs in Chinese medicine, are no different. There's a normal amount of physiological heat produced in the Spleen during digestion which is safely radiated up and out of the body by the Stomach. When the Spleen and Stomach are weak and digestion is poor, however, that heat is not properly funneled outward and instead retrocedes back into the Stomach. As that heat builds up in the Stomach, which is a Yang organ, it starts to spread to the other Yang organs - most commonly the Large Intestine because together the Stomach and Large Intestine are a paired system called the Yang Ming organs. 

When there is heat in the Yang Ming organs, there is a wide range of symptoms and conditions that one can experience: indigestion, vomiting, belching, heartburn, acid regurgitation, peptic ulcers, IBS, Crohn's disease, celiac disease, and on and on. What's more is that this heat can spread to the Yang Ming meridians, as well, causing pain and inflammation along those pathways. 

 

As you can see, the Yang Ming meridians (Large Intestine in the upper body and Stomach in the lower body) cross every major joint. That knee pain, hip pain, ankle pain, shoulder pain, or elbow pain that feels like arthritis is probably caused or worsened by heat built up in your digestive tract and spreading to these channels. Chinese medicine doesn't really point the finger at gluten for causing this type of inflammation in the gut; there's no single culprit. Spleen-unfriendly (or dampness-engendering) foods can include greasy and fried foods, heavy, creamy foods, milk and milk products, sugars, and, of course, processed foods. Even overconsumption of cold and raw foods is said to damage the Spleen. 

The important thing to remember is a balanced diet is the best diet according to Chinese medicine. A good rule of thumb is to have all of the elements represented either in a dish or in a meal by using foods of every color. If your health situation demands that you're limiting your diet in some way - not eating meat, for example - make sure you're balancing your foods to fill that nutritional gap. Keep in mind that the gap created by removing milkshakes from your diet is relatively small :)

 

Why diet is so important in Chinese medicine

The food we eat is the fuel in the tank. You can run your car on high octane gasoline and drive for hundreds of thousands of miles, or you can run it on moonshine and quickly blow up your engine.

In Chinese medicine, we look to the Spleen as the driving force behind digestion. Its job is to transform the food we eat into vital body substances: Qi, Blood, Body Fluids, Yin, and Yang. The classical texts describe the Spleen's role as "separating the clear from the turbid." So consider what you put in your body and where it fits on the clear-turbid spectrum.

Whole foods, particularly fresh produce and meats, are great. Things with lists of ingredients typically are listing things your Spleen has to work through to get to the Qi of the food, that is, lots of turbid to separate out. These can be sugars, additives, preservatives, chemicals, or even excess dairy or certain grain products. Long-term consumption of these foods means the Spleen is chronically overtaxed, busy separating clear and turbid all the time, and this leads to Spleen Qi deficiency. A weak Spleen is less efficient at it's job, so what ends up happening is that the turbid that gets separated out, instead of being transformed and transported out of the body as waste, becomes dampness that lingers and stagnates in the body. Translation: we get fat.

Obviously this isn't revolutionary information, but it's always helpful to think about things in different ways!

Chew on that!

Our New Herb Room!

I wanted to take a minute to show off our latest renovation of the clinic. It's still a work in progress, but it definitely looks great! We can display our herbs much more clearly now, and there's much more working space.

We always envisioned having a stove in the herb room in order to practice paozhi. Paozhi refers to preparation and processing techniques used to alter the medicinal properties of herbs. This may involve means such as roasting, dry frying, wine frying, honey frying, earth frying, vinegar frying, baking, or broiling an herb. It's a traditional way of enhancing an herb's characteristics or mitigating harsh properties. For example, cooking an herb in wine increases its ability to promote circulation, as the alcohol takes the herbal constituents to the blood level. Alternatively, ban xia (pinellia) is an herb commonly used to treat phlegm congestion. It is considered "toxic" in its raw form - toxic in the sense that it would probably causes a stomachache. To make this herb safe for consumption and remove irritants, ban xia is soaked in water and fried with ginger. It's important to point out that herbs which require this type of paozhi are never sold before they are prepared, so it is not up to acupuncturists to alter the herb - it's already been made safe. On our herb lists, you will always see zhi ban xia or jiang ban xia ("prepared" pinellia or "ginger-fried" pinellia).

Why should I use herbal medicine?

By the same token, you could ask, why are the practitioners at Meridian so crazy about herbs? Well, our college placed a lot of emphasis on herbology, both so that we'd become proficient herbalists and in order to make us understand the important role herbal medicine has played and continues to play in the development of Chinese medicine theory overall. Perhaps more importantly, each of us have seen the powerful effects and profound benefits of herbal medicine in our school clinic, as well as here at Meridian.

Here are the main benefits as I see them:

1) Taking an herbal formula extends the effect of your acupuncture treatment. You're only in my treatment room for an hour a week (and usually less often than that), but if you're taking herbs regularly, there's something acting on your body every day. It also allows us to space out visits once your condition is stabilized with acupuncture, so instead of coming in weekly, it can be semi-weekly or monthly, and herbs are used to fill in the gaps. This helps us keep patient costs down over time. 

2) With herbs, we can address multiple health concerns at once. If you have tennis elbow or back pain, we can treat those things with acupuncture which improving your mood or digestion with herbal medicine. Additionally, and what we're typically looking to do with herbs, we can treat the pain locally with acupuncture to offer some relief and write an herbal formula designed to address the underlying cause of the pain or what's going on in your body that's preventing you from healing faster.

3) There are actually some things that herbal medicine treats more effectively than acupuncture. Don't get me wrong; both are great and able to address just about anything on their own. But many Chinese medicine physicians believe that if your body is lacking a vital substance - qi, blood, body fluids, yin, yang - herbs are better at replenishing them. Acupuncture works to help the organs responsible for generating vital substances become stronger and more efficient, whereas herbal medicinals actually are substantial, so they add things to the body. Just like foods, they are full of nutrients, and they are full of qi!

4) There are some formulas that target very specific conditions for immediate relief. Acupuncture has similar unique uses as well, but it's worth noting that there are specific herbs that, when added to a formula, can treat things such as high cholesterol, night blindness, athlete's foot, kidney stones, goiter, and non-healing wounds, to name a few.

5) Taking an herbal formula is a great means of introducing Chinese medicine into your lifestyle in a real way. Chinese medicine is as much about living well as it is curing disease; drinking an herbal decoction is a gateway, a powerful yet simple first step towards other "nourishing life" practices that make up your daily routine and lead to health and happiness. Pretty soon you'll be striving to become a wise, contemplative qigong master. 

About the Blogger:

Colby is the blogger. He likes to stand in the herb room and blog about herbs. Unfortunately he favors writing too much over editing, and for that he apologizes...

   

Bi Syndrome (or as Robert's dad calls it, the Wen-Ding-Dang)

Chronic pain is one of the most commonly treated conditions in our clinic. A National Health Interview Survey from 2007 found that about a quarter of adults in the United States experience some type of chronic pain, and in that year, about 3.1 million of them turned to acupuncture for relief. We notice that these chronic pain patients typically experience worse or more frequent pain in the colder winter months. I'll try to explain why that's the case. Let's discuss Bi Syndrome.


Bi Syndrome ( 痹证 bi zheng), also called "impediment syndrome" or "painful obstruction," is a Chinese Disease indicated by pain, particularly of the joints, and sometimes numbness. This is typically arthritis and arthralgia, lumbar disc disease, sciatica, gout, and pain from old injuries. The nature and location of the pain vary depending on the level of penetration of the pathogenic influences and whether cold or heat is also involved. The pain is caused by obstruction of the meridians - remember from an earlier blog post, we said, "If there is free flow, then there is no pain; if there is pain, then there is no free flow" (Tong zhi bu tong; bu tong zhi tong) - and with Bi Syndrome, the obstruction is caused by wind and dampness (and more often than not, cold, as well). Most acupuncturists will automatically think of wind-cold-damp obstruction when they hear Bi Syndrome because it most commonly presents as a combination of those three evils. 

When talking about the cause of Bi Syndrome, there is always this idea of pathogenic qi penetrating the body, at least to some degree, and entering the joint spaces (via the meridians that cross those joints). Wind, in Chinese medicine, is often thought to be the mechanism or vehicle by which pathogens enter the body. This is true for Bi Syndrome as well as infectious diseases - think of a virus that's "airborne." You can also think of wind as a representation of the weather, with cold and damp being characteristics of the atmosphere with regard to temperature and barometric pressure. How often did your grandmother predict rain or fog using her achy bones? That subtle yet noticeable change in the air is wind-dampness.

But how does it get inside your body? As I mentioned before, the wind-dampness penetrates into the interior tissues of the body and lodges in meridians associated with major joints. It enters through the couli or "interstices" of the body - the open spaces. On the surface of the body, these are your pores, and at a deeper level, these are the spaces between body tissues. In a healthy person, these interstices are closed, and the body is protected from invasion by external pathogens. When the qi is weak, however, the opening and closing of the pores is not properly regulated, and wind-dampness can get it. This is usually at or near the site of a weakened joint, as well. 

From Treatment Decisions Categorized According to Pattern by 19th century writer Lin Pei-Qin:

All [cases of] painful obstruction ... intrinsically [develop] from a primary deficiency of protective and nutritive qi. If the pores and interstices are not firm, wind-cold avails itself of [this] deficiency to assault the interior. The normal qi [then] becomes blocked by the pathogens and is unable to disseminate or move. As it lodges and stagnates, the qi and blood congeal and stagnate, which, over time, causes painful obstruction. 

If you consider back pain caused by disc degeneration or knee pain due to worn cartilage, there is or has been over a long period of time a deficiency situation at the local area. The lubricating and nourishing fluids that keep our joints working well are comprised of blood and yin fluid, so a deficiency of either allows these tissues to become malnourished and susceptible increased and premature wearing out. This deficiency also allows wind-dampness to enter and fill that space, obstructing proper circulation and further nourishment. When you sustain a trauma to an area, say a blow to the shoulder during your football days, you disrupt the qi at the site of the injury. The severity of the injury, ie the force of the blow, determines how deep that disruption goes. The mechanics of opening and closing of the couli and flow of qi, blood, and yin through the meridians at the area are all potentially disrupted. So whether it's a case of getting old and wearing out your joints or just one bad fall, car wreck, tackle, etc., that joint becomes vulnerable to invasion of wind-dampness and thus pain caused by Bi Syndrome.  

The herbal forumlas we used to treat these conditions have as their chief ingredients herbs that expel wind-dampness from the meridians, such as du huo, qiang huo, fang feng, or qin jiao. Depending on pattern, they are combined with assisting herbs from three other groups of herbs. The first group of herbs are blood-invigorating herbs such as chuan xiong, rou gui/gui zhi, niu xi, or dang gui. They are used because, as pointed out in the Convenient Reader of Established Formulas, "To treat wind, first treat the blood; when the blood moves, the wind will be extinguished." The second group of herbs are herbs that tonify the qi and nourish the blood, such as ren shen, huang qi, gan cao, dang gui, shao yao, or shu di huang. They work to support the body as well as mediate the drying and dispersing actions of the chief herbs. The third group includes herbs that tonify the Liver and augment the Kidneys such as du zhong, sang ji sheng, and niu xi. The Kidneys govern the bones, while the Liver governs the sinews. Where painful obstruction penetrates to the bones and sinews, usually in more chronic patterns that involve weakness of the lower back and knees, it is therefore essential to tonify the Liver blood and Kidney qi. 

In my clinical experience, I have found that emphasizing the treatment of blood stasis is paramount in treating Bi Syndrome. Of course, this is far from a new concept. Qing dynasty physicians already emphasized the role of blood stasis in the treatment of chronic pain. Wang Qing-Ren, contemporary of Lin Pei-Qin (quoted above), was a big proponent of this strategy and launched a full-scale attack on older treatment techniques in an essay entitled "Painful Obstruction Patterns are Characterized by Static Blood." Included in his seminal Corrections of Errors Among Physicians, his discussion declares: "Generally, [when] one drives out wind-cold or eliminates damp-heat, it becomes even more difficult to invigorate the already congealing blood." The herbs that expel wind and dry dampness also dry up blood and slow qi, so it's important to promote movement (and nourishment) at the same time. 

On a more practical level, trauma causes blood stasis! When you slip on the ice and bruise your tailbone, that bruise is literally static blood. The micro-tears in your rotator cuff that slowly form scar tissue are causing blood stasis, as that's what a scar is in Chinese medicine. Some bruises heal, and others only appear to fade from the surface - that's why that whiplash from a car wreck in 1995 still gives you trouble. Furthermore, maybe patients come to us after surgery (or surgeries), and the scarring created during the procedure, which in itself is a type of trauma to the local tissue, leads to more blood stasis, complicating the condition and creating more painful obstruction.