After a lot of research and discernment, we have made significant updates to our cancellation and no-show policy, and as of February 1, 2021, we will be making a concerted effort to enforce it. This marks a big change for us because, while we've always had a cancellation policy, we've frankly struggled to know when and how to enforce it. After a lot of discernment and research, we feel ready to move forward.
Because change is hard, and we're all amid a whirlwind of change in other ways, we wanted to lay out the reasons behind the change in hopes it will ease the transition. If, after reading this, you still have questions or concerns – please don't hesitate to reach out to us.
The basics of the new policy
- AS ALWAYS – We ask for notification of your intent to cancel or reschedule 24 hours or more before your appointment. If you cancel/reschedule within 24 hours, that's a late cancellation. If you just don't show up, that's a no-show.
- Always always call to cancel as soon as you can if you believe you are sick with a viral illness. Particularly during this era of the pandemic's ongoing spread, we want to give a wide latitude to cancellation due to illness. You will not be charged even if this is within 24 hours of your appointment.
- Likewise, if a close contact has been diagnosed with COVID-19, please call to cancel as soon as you can, and you will not be charged if this is within the 24 hour cancellation window.
- You will be charged $50 for violations of our late cancellation policy. There are additional penalties for repeated violations.
- You can read all the details on our cancellation policy page.
The purpose of the cancellation policy
We have a cancellation and no-show policy in place because we have limited resources, and want to use them to best help the community. When a person cancels late, it is often impossible to fill the slot they vacated. This creates a chain reaction of lost opportunities that have real impacts on real people's lives. Our intent is NOT to make others' lives more difficult or to create a punitive environment. Our concerns about finding the right balance are why we've taken a while to craft our approach.
When there is an appointment on the books, our practitioners and staff are here, ready to serve you. The
clinic has been prepared for your arrival and the flow of practitioners through rooms and other resources is determined. Usually, your practitioner will have done some preliminary research appropriate for the upcoming appointment, and their understanding of how their day will unfold includes your appointment.
Repeated interruptions here cause a lack of easy flow through the day and week, as practitioners scramble to figure out what to do with a new window of time. Further, of course, the practitioner loses income when the appointment fee is not paid. Like anybody, practitioners need reliable income to live. The stress of frequent income loss impacts practitioners the same way it would impact anyone.
Our primary purpose in enforcing our policy is to ensure that practitioner time, skill and energy is respected.
Respecting other patients' needs
In Clatsop county, as in many rural counties, healthcare resources are limited. This, combined with the high skill level of our practitioners and our robust in-house insurance billing, means that our practitioners are very busy. In the case of our massage therapists, they are often booked months out. It's unfortunate, but there's just not enough supply to meet the demand.
When a person late cancels or doesn't show up, that potential appointment is lost. For some patients, massage is critical to their regular functioning, and it's hard for them to not be able to get in regularly. By not showing up for an appointment, a late canceller misuses a limited resource that could have been used by someone else. Nobody wants that!
The precariousness of small business
The last year has been hard on everyone. Small businesses like ours have been hit on multiple levels, and the fun isn't over yet. We've been very lucky to have ongoing growth and support from our patients as well as grant and loan funding from several sources – keeping us afloat during a rough time. But the expenses and challenges of operating under these circumstances are real, and every little loss takes us closer to having to reduce services or even close.
Recovering some money when a person cancels isn't going to restore that appointment lost, but it will help to ensure that the practitioner gets some of what they would have made and that the clinic can continue to pay its bills. And, hopefully, the accountability structure the fee creates will just help motivate all of us to pay a bit closer attention to our calendars and communications.
We'll be monitoring how the policy works, listening to your feedback, and adjusting as needed. Thanks for your ongoing support and your help in keeping our doors open and our practitioners happy.
As an accompaniment to the movement studio's focus on the breath this month, we'll be offering articles looking at the themes surrounding the breath and the lungs through the lenses of our other practitioners, modalities and various perspectives. Enjoy!
In Chinese Medicine each anatomical organ is associated with an entire energetic channel network that runs through the body. Additionally, each organ network serves as a symbol that has resonance with the natural world. It resonates with a particular season, direction, color, emotion, sound – there are many symbols the Chinese have associated with the organs over the years. If you want to dig in a bit deeper, you can read this brief article on Eric Grey's website, Chinese Medicine Central, about the classical Chinese concept of organ systems.
Understanding our physical organs through symbol offers us the opportunity to relate to our body in a more accessible way than the mere anatomical functions that we are familiar with through textbooks.
Beginning to explore these connections within our own body can open new ways of relating to both our internal and external environment, and also be an aid in our personal healing journey. These symbol associations are based upon an intricate science developed from the wisdom of ancient Chinese civilizations who closely recorded the interaction between the human body and the seasons/cycles of planet earth and the cosmos. Just as plants go through cyclical changes each year, so do we as humans.
Learning to live in harmony with these changes are key to our health, happiness and longevity.
We can understand this concept by examining the Lung organ network. The Lungs are a symbol of harmony as seen in the ever present rhythm of our breath. The Lungs have the ability to bring in what the body needs (oxygen) and discard what no longer serves (carbon dioxide), constantly maintaining balance. The Lungs are an important organ network in the Fall and Winter as they are related to our immune system. They have a close connection to our skin and serve as a barrier for keeping harmful pathogens outside of the body.
The Lungs are also connected with the metal element, which has a downward direction, resonant with the season of fall.
During fall the energy above ground is moving down and in, preparing to enter deep within the earth for wintertime hibernation and the eventual springtime regeneration. An example of this can be seen by observing a tree in the fall, who drops its leaves down to the ground. The leaves then decompose into the soil and after a long winter, provide nourishment for the roots of the tree and new green springtime growth.
By bringing awareness to what is happening in nature, we are able to understand how our body and being can best be in alignment during particular times of the year. Thus the fall is a good time for letting go of what we do not want to carry with us into hibernation and beyond. Energetically we begin to conserve our resources, drawing the outward yang energy inside to our core, lighting our internal fire that will keep us warm and inspired throughout the dark of winter.
Developing a qigong or movement practice as well as a breathing practice during this time can greatly benefit our health.
In the early spring the tiny seed requires robust energy in order to burst through the thin frost covering the earth. We too as humans rely upon the adequate energy reserve that we intentionally stored and carefully guarded within. When the springtime comes we will be strong and fit for bringing our new creations and dreams fully to life once again.
One final thought is that the Lungs are particularly sensitive to grief.
Grief can arise due to many of life's ups and downs, including: loss of loved ones, loss of parts of self and longing for a reality other than what is. Grief is a natural part of the human experience and shall be honored as such. Just as the tree may grieve the loss of it's leaves as they fall to the ground, the human too may grieve the loss of whatever was. But both the tree and the human are constantly reminded that the future holds the steady rhythm of the untold mystery of regrowth.
Interested in learning more?
We have a weekly Qigong class instructed by Hilly Shue, LAc that incorporates theory from Chinese Medicine in a gentle and informative way. This gentle movement class is accessible to everyone. Questions? Reach out!
Interested in what Qigong looks like? Check out this short demo by Hilly.
In this episode, I sat down with Amanda to talk about judgment, and non-judgment, in the holistic healthcare environment.
In particular, we examine some of the things that commonly hold people back from getting care due to worries about judgment around:
- Body image, such as body hair, body odor or weight gain
- Social factors, such as identification as gay or trans, or having low income and so being unable to wear “fancy” clothes
- Political and intellectual factors, such as having a very conservative viewpoint when you believe your practitioner to be quite liberal
It's just a quick 20 minutes, and we hope it will provoke questions – check out the form on the main podcast page to share your thoughts.
Occasionally a patient won’t be able to come to an appointment for one reason or another, because life is complicated. However, there is one kind of cancellation that I find really strange: a patient cancels their appointment because they are sick.
Now, obviously, if someone is too sick to leave their house, then this is completely reasonable. But the prevalence of this phenomenon makes me think that I have neglected to educate my patients about how effective our medicine is at treating acute illness.
So here, dear reader, is the scoop on Chinese Medicine and common bugs.
Chinese Medicine, like all medicine, grew out of daily necessity. Over thousands of years, practitioners have learned to treat the maladies that their communities and families have suffered from. This certainly includes chronic and terminal conditions, like arthritis and cancer, but the most common afflictions that affect us are illness and injury.
While we think of illness in the modern industrialized world as mostly uncomfortable and annoying, epidemic illness was the leading cause of death in much of the ancient world. The flu virus continues to kill thousands of people a year in the US alone, even with our modern medical systems in place. Imagine the destruction it would have wrought without these systems.
Ancient physicians, then, were spending most of their time treating and curing epidemic illnesses.
In fact the vast majority of the herbal texts that have been passed down to us through the ages concern the stages that exogenous (coming from outside the body) illness pass through in the human body, and how to treat every presentation at every stage. Treating an illness early is always best, but we can’t control when a patient will come to see us, so we have intricate systems for treatment regardless of the timeline.
We also understand, based on these systems, that every person’s presentation is different, and requires a different approach.
One person’s cold may start in their chest as a hot and dry cough, while another’s manifests as profuse clear runny nose and a mild fever. Treating these two presentations differently results in a faster recovery in each case. By carefully observing your specific symptoms, we can craft an acupuncture treatment and an herbal formula that will be tailored to your exact experiences and completely resolve all of them.
We also know that proper treatment of acute problems prevents chronic ones.
This is a key concept to understand. A lingering cough from a simple cold can become a long term problem as the lungs’ ability to regulate themselves becomes more and more compromised. Such a process can predispose a person to chronic bouts of bronchitis, asthma attacks, or lung infections.
By completely treating the issue the first time, we never have to deal with any of those problems down the line. For those who already have a chronic health condition, this is doubly true. Autoimmune disease, chronic pain and depression all sap our body’s immune systems and create increased openings for acute illness to become chronic.
With this in mind, my advice is to seek out care when you first feel sick.
That woozy feeling in your head, the tickle in your throat, and the snot you woke up with this morning are telling you that you are already mounting an immune response to something. This is our opening to set you up for the shortest and least painful illness possible, and maybe even a complete avoidance of further symptoms.
And don’t worry about getting me sick; this is my job!
My Chinese herbal lineage focuses on deep understanding of the most venerated text of Chinese herbal medicine, the Shanghan za bing lun.
The first, and most well known, part of this text (often referred to simply as the Shanghan lun) contains information about treating diseases that are caused by factors outside the body. In particular, the vast majority of the formulas in the text treat the common cold, other viral respiratory infections & the secondary infections and complications that come from them. So, you could say that I spend a lot of time thinking about the topic of colds & flus!
Different types of colds?
Chinese medicine (CM) discusses various types of colds – which we call “external invasions,” to differentiate them from diseases caused by food, drink & strongly disordered emotional states. The symptoms of the external invasion, and the method for treating those symptoms, varies based on the character of each type of cold. In the simplest way of looking at it in CM, there are colds that are more “hot type” (with higher fever, yellower phlegm) versus those that are more “cold type” (with lower fever, runnier nose).
But further differentiations exist, based on the origin of the pathogen, the health status of the person invaded, and so on. The Shanghan lun differentiates the varieties of symptoms of exterior invasion into six stages, called Conformations. The conformations are a complex theoretical construct, so we can only sketch the outlines here. If you're interested in getting a bit more information, you might want to read about it on my website for students and practitioners of CM.
The conformations relate to the way a cold develops, and also helps us to see the difference between “regular colds” and more virulent & severe epidemic type invasions. The conformations themselves include physical structures, various bodily functions, acupuncture channels and other diverse parts of the human body. In other words, each conformation is not a single structure, but a mixture several structures and functions.
In a way, each conformation is like a landscape – and as a cold travels through each of the six landscapes, the way it manifests, and the way we treat it, changes.
I list and briefly describe the conformations below in order from the most superficial / exterior layer of the body all the way into the Jueyin which is the deepest level, the most interior to the body. As disease travels through the conformations, it changes character. The more exterior layers (yang layers) look more like typical cold & flu symptoms, and so it is from the chapters describing these disorders that most of my formulas come from when I treat this type of disorder.
- Taiyang – Taiyang contains the Bladder and Small Intestine channels & organ networks, as well as aspects of our immunity, our water metabolism and more. This is the most surface layer, and when struck, the typical symptoms of a mild cold are the result. Runny nose, mild congestion, an often lower grade fever, body aches, frontal headaches and low energy can all be the result. We treat this stage of cold by forcing the pathogen out & strengthening the surface to prevent reinvasion.
- Yangming – Yangming contains the Large Intestine and Stomach channels & organ networks, and thus has a lot to do with digestion, but dysfunction here can also impact mental state (anxiety, mania) and temperature regulation, among other things. We are proceeding more deeply into the body here, and if a cold or flu reaches here, the symptoms tend to be more severe. Very high fevers, even leading to bleeding, severe headaches, sinus trouble including congestion, and certain types of hot lung conditions can all be the result. We treat this stage by cooling down the body and allowing the body to release as much built up matter and energy as possible.
- Shaoyang – Shaoyang contains of the Gallbladder and mysterious Triple Burner channels & organ networks. The impacts of this conformation can be VERY diverse as befits the layer of the body that is getting so much closer to the interior (yin). As cold or flu symptoms, Shaoyang symptoms tend to be back and forth (fever AND chills), less acute and can also hang on for much longer. People who are repeatedly getting sick within one season, but never really having a fever or serious acute symptoms are often trapped in the Shaoyang stage. This can be harder to treat, and we do so by helping to “harmonize” the yin and yang aspects of this stage.
- Taiyin, Shaoyin & Jueyin – The Shanghan lun text I have been discussing goes into detail about the treatment of deeper layers of the body as they are impacted by the consequences of external invasions. However, because these look less like what we call “cold” or “flu,” I'll not discuss them here. The same goes for the next two layers..
I hope to talk more about the conformations and how understanding them can help you respond better to cold-season illnesses. But, for now, with that general idea explained – a word on customization of cold treatment.
Different types of people, different treatments – right?
So, there are different types of colds to begin with, but there are also different types of people having those colds! One of the most important things about Chinese medicine as a distinct profession in healthcare is how we focus on the customization of treatment to the uniqueness of the individual patient. If a person is very weak, with a thin and deep pulse, not having much of a fever and the cold lingers for weeks, we will treat them much differently than a person who comes in with a big fever, big pulse and very rapidly moving illness. Doesn’t that just make sense?
You may have a different herbal formula than your partner with a similar cold!
That's the outcome of true customization of treatment. But, of course, sometimes I find myself prescribing very similar formulas to a large group of people. While customization is important, it’s also true that many people react similarly to particular colds traveling through their town. And there are some types of treatment or supplementation that help most people feel better. This is why we see standardized over-the-counter remedies on the shelves in the first place – they are a convenient way to help large groups of people. So, as a practitioner, or for you as a member of the public, we have to find the best way to balance customization and convenience.
Over-the-counter remedies and Chinese herbal medicine – the case of Yin Qiao (or Yin Chiao)
For many of my patients, the first Chinese herbal formula they ever took was in the form of several small tablets called Yin Qiao San – said to be great for the common cold. Many people swear by the remedy and keep it on hand just in case. In fact, there are some Chinese medicine practitioners who ask their patients to keep it on hand for just this reason. This formula was formally written down in a book published in 1798 devoted to exploring “Warm diseases,” so those types of illnesses that are either caused by warming factors, or expresses itself through heat type symptoms, or both.
It contains cooling, lightweight herbs like honeysuckle flower and forsythia seed pod.
This formula is appropriate for people who have hotter cold symptoms such as : fever, burning sore throat and a tendency to a more rapid pulse & yellowing tongue coat (especially as the cold progresses). In the basic CM way of looking at things, a warm or hot pathogen creates these symptoms. Warm and hot pathogens are traditionally more likely to be encountered in warm climates. If a cold came from a more cold type pathogen – such as those typical in my home in Oregon – then this formula would most likely NOT be appropriate. Further, when the cold goes into the interior, causing a phlegmy cough or profuse nasal discharge, this formula wouldn’t be appropriate regardless of the nature of the exterior invasion.
In other words, Yin Qiao San can indeed be effective – for certain types of colds and not others.
What are the potential consequences of using a formula that isn’t appropriate for the type of cold or other disorder you’re experiencing? Fortunately, Chinese herbal medicine is powerful – but also very gentle. Yin Qiao San is quite cooling, but it is also relatively easy on the body and the dose typically taken is too small to do much damage. So while there are Chinese herbs that can cause serious complications if you take them when they are not indicated for your condition, this particular example is not one of those.
That said, if you need warming treatment and take cooling herbs instead, there are undoubtedly consequences for the yang of the body. Long term, a person who inappropriately takes Yin Qiao San may find lowered surface immunity or mild digestive problems. That the consequences may not be severe in this case, though, doesn't mean we shouldn't attend to always taking the right herbal formula for our situation.
How do you avoid taking the “wrong Chinese herbal formula?”
Does the highly customized nature of Chinese herbal medicine mean that there can be no on-hand remedies a patient could self prescribe? Of course not. There are general treatment strategies that assist nearly anyone who is experiencing the symptoms of a cold or flu. For instance: increasing fruits and vegetables, decreasing sugar and strenuous physical activity and staying warm and hydrated will help virtually anyone have a better time with a cold or the flu.
But, if you would like to take a more active role to treat future colds and flus, or you have developed complications from one – like a chronic painful cough – seeking out treatment from a licensed Chinese medicine practitioner may well be part of an answer. If you come in for a visit, I will use CM diagnostic techniques, including a wide ranging discussion with you, to help determine the best treatment for an existing cold – or the prevention of one in the future. While I would be unlikely to prescribe Yin Qiao San, it being outside of my lineage and climate, I could certainly recommend a group of herbal formulas to have on hand for potential situations that would be appropriate for your constitution.
This is just a brief overview of the issues involved in treating colds and flus with Chinese herbal medicine. Questions? Get in touch – maybe I’ll write a future article about your question!