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. 
  



    

Holiday Newsletter

Below you will find our Holiday Newsletter. In this issue we'll touch on the following exciting topics:

• Winter hot stone massage with our wonderful massage therapist, Misha Davied 
• The medicinal properties of meats and poultry
• A case study on the treatment of childhood asthma
• The holiday recipe: a delicious lamb dish - perfect for holiday parties!

Be sure to scroll down to read the newsletter!