In no other time in history has remote connection been such a vital part of every aspect of our lives. Work, school, and even our social interactions with loved ones are dependent on accessing our world with heads down for extended periods of time to connect with each other through technology. It is no surprise, then, that we have been seeing an increase of patients at Watershed Wellness seeking relief from neck pain. We're also seeing all the symptoms often accompanying neck pain such as headaches, tingling, numbness, and the referral of these symptoms down the arm and upper back.
Fortunately, biomedical research is begining to demonstrate the effectiveness of acupuncture treatment for neck pain. In one of the largest studies to date, an analysis of 29 studies involving close to 18,000 participants showed that acupuncture relieved pain by about 50%. The research, published in 2018 in The Arizona Pain And Addiction Curriculum Faculty Guide, conclusively demonstrates that acupuncture treatment of neck pain is an effective, non-invasive and affordable approach to reducing neck pain without the use of opioids, especially over the long-term (1).
Acupuncture treatment for neck pain will vary for each individual, because the differential diagnosis of patterns of imbalance based on Chinese Medicine theory varies for each person.
For example, Cervical Spondylosis is a type of degenerative disease wherein the cartilage lining the vertebrae on each side of the disk wears away over time, resulting in less room for the nerves attached to the spinal cord to pass between the vertebrae. The acupuncture treatment of chronic neck pain for this type of condition would be to tonify deficiencies in the body to support the body in restoring strength in bones and tissues in addition to moving qi and blood to relieve pain. There are many such chronic conditions that cause neck pain that can be effectively treated with acupuncture. However, some people are surprised to learn that acupuncture is also an excellent choice for acute causes of neck pain.
Acute causes of neck pain include car accident, sports injury, neck sprain from a poor sleeping position, or any number of traumas. All of these can cause sudden and debilitating pain in the neck that can be aided by acupuncture treatment. Acupuncture theory focuses on the creation of qi and blood stagnation in channels and tissues after these acute events. Needles are used, often employing special techniques, to reestablish the normal flow of circulation, thus allowing the body to resolve the blockage fairly quickly – alleviating the pain. The duration and frequency of treatments varies based on the condition and the healing ability of the individual. While acute cases of muscle strain may resolve in a few sessions with frequent visits, chronic conditions may take longer as resolution of the underlying deficiencies will be necessary for continued relief.
Research continues to examine the benefits of non-invasive procedures for managing acute and chronic pain conditions, including the acupuncture treatment of neck pain.
As explained in the Harvard Women’s Health Watch, “researchers determined that up to twelve 50-minute acupuncture treatments over several months were more effective for relieving chronic neck pain than customary treatment with pain relievers and physical therapy” (2). Depending on the chronic or acute cause of the neck pain in addition to the precise location of pain, the acupuncture treatment itself will be unique to each person. In the acupuncture treatment of neck pain, needles might be gently inserted directly into the neck, shoulders, and upper back, but do not be surprised if points on the hands and ankles are used.
These are often referred to as “distal points.” Acupuncturists view the body as having a “highway” system in which 12 meridian channels can be accessed from specific points along the channel to elicit a healing response in different areas of the body. These distal points for treatment of neck pain are considered to be especially useful for acute disorders, and are also suitable for more chronic ones. Our classical texts, many reaching back thousands of years, help us think about the channel system and the unusual nature of these distal points.
For instance, the Huang Di Nei Jing (The Yellow Emperor's Classic of Internal Medicine) says,
“The three yins of the arm go from the organs to the hands. The three yangs of the arm go from the hands to the head. The three yangs of the legs go from the head to the feet. The three yins of the legs go from the feet to the abdomen.”
Biomedical research as well as the classical texts of Chinese medicine all indicate how acupuncture can contribute to the treatment of neck pain.
Call Watershed Wellness today to schedule an acupuncture appointment to see what this modality can do for you.
(1) Villarroel, Lisa., Mardian, Aram. “The Arizona Pain and Addiction Curriculum Faculty Guide.” ARIZONA DEPARTMENT OF HEALTH SERVICES September 1, 2018. Accessed June 20, 2020. azdhs.gov/audiences/clinicians/arizona-pain-addiction-curriculum
(2) “Is It Time to Give Acupuncture a Try for Pain Relief?” Harvard Women’s Health Watch, vol. 23, no. 6, Feb. 2016, p. 3. EBSCOhost, search.ebscohost.com/login.aspx?direct=true&db=c8h&AN=112372422&site=ehost-live.
From a Chinese medicine perspective, it is essential that we learn to live in harmony with the seasons. There is, of course, no monolithic “Chinese medicine perspective” but all lineages and even more modern interpretations of Chinese medicine theory discuss the health benefits of seasonal awareness.
The recent movement around local and seasonal foods is a nod to the importance of this timeless principle. People are recognizing that living in accordance with their immediate spatial and temporal environment is not just for hippies (although, for them too). Food tastes better, is more healthful, is less expensive and somehow just FEELS better when it is eaten at the right time for the place that one is in.
But the Chinese philosophy on living in balance with seasonal energy goes farther than food choices. In fact, most of what I have found in the Classical texts of Chinese medicine has nothing to do with food.
1. Physical/mental/spiritual activity levels and types
The guidelines regarding activity go into every realm of life, just as the seasonal energy touches us everywhere – all the time. In the Neijing one of the first practical recommendations concerning seasonal living involves activity.
“During this season [spring] it is advisable to retire early. Arise early also and go walking in order to absorb the fresh, invigorating energy” (From Maoshing Ni's translation)
2. Social activity levels
This is perhaps simply an outgrowth of #1 – but I think it is easy to overlook. We naturally gather together in the summer – although in the United States, some of our most “together” holidays are in the winter. Just as we should limit excessive physical activity in the winter, so should we ramp down our social activity.
3. The color, smell and feeling of the surrounding environment
Paying close attention to the seasonal changes is important in resonating with their energy. All of our senses should be engaged in the study of our environment. It makes sense to similarly alter our internal environment to some degree. Letting your decorations follow the ebb and flow of nature will help you to become closely in tune with seasonal energy. Of course, you will want to keep balance as well – so surrounding yourself with emblems of Metal during the Fall is not necessarily the best way to go, but there are simple, effective and gentle ways to remind yourself of the seasonal energy even when you must be inside.
All of this and much more is included in the kind of lifestyle counseling that naturally grows out of Chinese medicine theory on the energy of the seasons. We’ll be discussing more specifics about each season on the blog in articles to come.
Do you have a favorite season? Which one and why?
“Am I ever going to feel better?”
If you’ve struggled with a long-term illness, you may have asked yourself this question.
Maybe you’ve suffered with chronic pain, or a challenging digestive disorder, or a recurrent skin problem or some other ailment for so long, you’ve forgotten what it feels like to be well. To be ‘normal.' Maybe somebody has told you your condition is permanent. Perhaps you’ve been given a diagnosis and told it will be with you for life. Maybe you’ve even stopped asking yourself the question if you can be well again.
There is a lot I could say about Chinese Medicine’s perspective on chronic illness. I could tell stories of miraculous cures I’ve heard from my teachers and mentors, or discuss my own successes as an acupuncturist and herbalist in treating complex diseases.
I could even talk about my own experiences as a patient, suffering from disorders that were never supposed to get better, but which did with regular treatment. But I’m not going to do any of that here.
Instead, I would like to let the tradition of this medicine speak for itself.
Here is what it says on the subject of chronic illness:
“Now, when any of the five major organ systems has an illness, it’s as if one was pierced by a thorn, or soiled by dirt, as if there were a knot, or something closed. A thorn may have pierced one for long, and yet it can be pulled out. A stain may have existed for long, ad yet it can be cleansed. A knot may have been tied for long, and yet it can be untied. A closure may have lasted for long, and yet it can be opened. If someone says an illness with a long duration cannot be removed, then that is an erroneous statement.
“Now, those who are experts in the use of acupuncture needles, when they remove an illness, that is as if they pulled out a thorn, as if they cleansed a stain, as if they untied a knot, as if they opened a closure. The illness may have lasted for long, and still it can be brought to an end. Those who state that it cannot be cured, they simply have not acquired the necessary skill.” 2
If you’re feeling hopeless about your health problems, I want you to take a minute and read those paragraphs again. Really let them sink in.
If you are suffering from a chronic illness, I want you to save that passage, and take it out and read it whenever you feel like things will never get better. Health is a journey, and sometimes, it is a long and winding one. The terrain can be rough. It may seem you are moving backwards. There may be moments when you feel lost. But progress is always possible.
As a practitioner of Chinese Medicine, I am here to walk that journey with you, every step of the way. I am completely committed to restoring your well-being, and I invite you to commit to the possibility of your own recovery yourself.
1 This text is called the Ling Shu (靈樞). It’s the second half of a medical treatise called the Huang Di Nei Jing (黃帝內經 ), or the Yellow Emperor’s Classic of Internal Medicine.
2 This is a paraphrased version of Paul Unschuld’s translation of the Ling Shu. The original text in Classical Chinese is:
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!
Hormone supplementation can be a very helpful tool for some transgender people to live full and authentic lives. There is also a great deal of fear-mongering about the side effects of hormones, usually from non-transgender doctors. While more long-range study is needed, a large-scale recent long-term trial found no elevated risk for mortality, either broadly or specifically, for transgender people taking hormones. (1)
Care providers who try to scare trans people away from hormones are not standing on firm evidence in doing so.
That being said, the lack of mortal danger does not mean that there are never annoying or difficult side effects from hormones. Any medication, taken over a long period, can cause some unwanted experiences to occur. In the next two articles in this series, I’m going to break down some of the most common side effects of testosterone and estrogen supplementation, and explain how Chinese Medicine can help resolve them.
Testosterone, as we’ve discussed in the past, is primarily a hot and yang substance. What this means in practice is that it makes this growth, move faster, and makes people feel warmer. What it can also mean is that it can cause some people to get too hot, and develop unpleasant symptoms as a result. In Chinese Medical thinking, the yin of the body, or the cooling and moistening substances, need to be able to balance out the yang.
Over time if the yin is taxed by something, whether it’s a stressful life event or something we are consuming, the heat can overwhelm the system.
Some signs that this may be happening include; night sweats, anxiety, heart palpitations, changes in hunger, hot flashes, acne and pain in the legs. These are mostly symptoms that are associated with puberty or menopause, and there is a very good reason for that: people who are taking testosterone are inducing puberty and menopause, concurrently. This is not a bad thing; it’s just a life process.
But it can be a lot for the body to deal with.
In addition to heat, sometimes testosterone can lead to reduced blood flow in the lower abdomen, or what we call “blood stagnation” in Chinese Medicine. Blood stagnation can manifest as frank tissue changes, like polyps or tumors, but most often it shows up as pain from impaired microcirculation.
This can result from muscular changes in the pelvis bowl (particularly that pesky psoas muscle), the cessation of menses, or from the surgical removal of reproductive organs. Some trans people who take testosterone find that they develop mysterious wandering pain in the lower abdomen after several years on testosterone.
The fact that some people experience these unpleasant effects can feed back into the medical world’s desire to pathologize transgender people and say that taking hormones is just bad and dangerous.
This is rarely said, of course, for most other medications. Very few people say “metformin can cause diarrhea in some people, so no one should ever take it”, because it is seen as a life-saving drug. Hormones are also life-saving, and deserve the same medical care and respect as therapies. The correct way to think about this situation is not to say that testosterone is bad, but rather that we need to help the body integrate the changes from hormone supplementation in a more efficient way.
Acupuncture and Chinese herbs to do this, along with dietary changes in some cases.
The body is intelligent, and can learn how to self-regulate under new conditions. We can help it to vent excess heat, supplement yin, move blood, and adapt. Acne can be treated, night sweats disappear, hunger cues return to normal, and the body changes in a normal and healthy way. Instead of yelling at people about the “dangers” of the medications they take, we can work with people and make their experience be the smoothest it can possibly be.
Note: Not all people will have unpleasant side effects from testosterone, and not all side effects will look like what is described above. Each person in unique, both in their constitution and in their life experiences and circumstances.
If you are taking hormones and experiencing any difficulties, feel free to schedule an appointment with me so we can talk through what classical Chinese medicine might be able to do for you.
(1) Largest Study to Date: Transgender Hormone Treatment Safe. Kathleen Louden. July 02, 2017 http://www.medscape.com/viewarticle/827713
As spring comes into full bloom with the approach of May, people are flocking outside to run, jump, play… and get injured. Such is life! So now is the perfect time to discuss the most common varieties of common exercise-induced injuries: the sprain and its sibling the strain. When you pull a muscle or roll your ankle, it’s likely that you have sprained or strained something.
The broad definition of this painful condition is that you have stretched or torn a ligament (sprain) or a muscle or tendon (strain) without the joint popping out and becoming dislocated. Any time that something pulls or pushes on tissue with more force than it can resist, a sprain or strain is likely to occur.
Once a force is exerted on tissue and something tears, Qi and blood rush in to clear away the damaged tissues and bring nutrients in for the process of repair.
As this process gets under way, the area swells and will often become red, hot and painful. If the injury is severe enough, the joint may become too tender and swollen to bear weight or to use. Over a few days or weeks, the intensity of the repair process will decline, and so the swelling and pain will subside gradually until all is well again. This is the ideal circumstance, in which very little intervention from the outside is needed.
Unfortunately, this happy progression is not always what occurs.
One reason sprains and strains in the limbs are more often discussed is that the tendons and ligaments in our limbs don’t have excellent blood flow through them (fancy medical words: they are not well-vascularized). This means that the process of inflammation and repair has less resources to work with, a bit like the difference between a car crash in a city center and one in a remote area. The ambulance will get there as fast as it can in both cases, but it might be a while if you are far out in the wilderness.
The other tricky variable to consider in how quickly an injury will heal is the underlying physiology if the individual person. Here is a very zoomed-out overview of the organ systems that could be involved in healing a musculoskeletal injury from a Chinese medicine perspective:
- Liver feeds blood to the tendons and ligaments
- Spleen feed nutrients to muscles
- Lung ensures that Qi is circulated to the whole body
- Gallbladder moves fluid in the joint spaces
- Heart is in charge of moving and controlling blood in the whole body
- Sanjiao (Triple Burner) moves fluid in every space between organs and body cavities
- Kidney builds and maintains the bones
You can see that many organ systems are involved in the repair of injuries!
But which organs are impacted and to what degree is often best explained as an outgrowth of your constitutional tendencies. If you have digestive issues that your spleen is already dealing with, then its ability to repair your muscles will be compromised.
If you have liver Qi stagnation from a stressful job, the liver will have a harder time getting blood to the tendons or ligaments to repair them. When people are blood-deficient the liver doesn’t have much to work with in the first place.
“This is why treatment for an injury in Chinese Medicine is so individually tailored; it’s often a matter of treating underlying problems that are preventing the healing process from perfectly unfolding.”
What can you do the next time you roll your ankle or throw out your back?
Acupuncture, Chinese herbs, and especially topical herbs are very important for healing injuries quickly and completely. In addition, here are some home remedies based on prior imbalances that you can try out yourself:
- For Liver Qi stagnation (depression, stuck anger, frequent sighing, discomfort in the ribs): journaling, nature walks, talk therapy, exercise
- For blood deficiency (frequent waking from sleep, anxiety, abnormal-for-you pale complexion, forgetfulness) eating organ meats, leafy green veggies, possibly iron and b vitamin supplementation
- For Spleen Qi deficiency (fatigue, loose stools, feeling tired after meals, poor appetite) simple foods (grains, sweet potatoes, congee), regular meals (as in at a similar time every day), medicinal vinegars before meals (check out your local Asian market for delicious drinking vinegars), eating meals while focused on the food rather than in front of a screen or in the car.
- For Sanjiao stagnation (swollen lymph nodes, frequent itching of the skin, swollen and red areas in the neck and ears, chronic illness such as Lyme): proper hydration, gently detoxifying foods like citrus, fresh herbs, and burdock root
- For Kidney Qi or Yang deficiency (deep exhaustion, low back ache, chronic pain made worse by cold, frequent urination at night): rest, meditation, foods from the sea, quiet spaces, warm compresses
Have fun, take care, and drop us a line if you take a spill!
One day as a medical intern during my schooling, a faculty member came in for a treatment for acute pain. He had just rolled his ankle outward, which is the harder and more painful way, and it was swollen almost to the same size as his knee. He wanted to know if I knew how to do acupuncture for acute pain, because he was leaving for a vacation the next day, and wanted relief! I said yes, and did what I considered to be a fairly simple acupuncture treatment to drain heat (inflammation) and move blood. We also applied a poultice of Chinese herbs guided by the same principles.
I've seen countless successes with acupuncture for acute pain since that time as an intern. Classical Chinese medicine, as I have written before, is designed to treat the most common maladies that people experience. However, because of the relatively recent introduction of Chinese medicine to the American system, combined with some structural problems in our healthcare system itself, means that people rarely consider an acupuncturist when they are injured. The way that injuries are approached from a Chinese medicine context is quite different from how they are approached in biomedicine (also called Western medicine).
Biomedicine, let's be clear, is responsible for incredible recoveries – seeming miracles in many cases. For treatment of trauma, and enacting life saving measures in the face of poor prognosis, biomedicine is incredible. However, some have found that full treatment of those injuries to a pain free state, or overall treatment of chronic pain, seems not to be as well developed in this system. Could this be because the approach to acute injuries in biomedicine comes from work in extreme circumstances, such as battlefield medicine & high performance sports contexts?
If you consider this possibility, it does make sense, because people dealing with extreme circumstances tend to innovate and create useful technologies. Many pioneering approaches have come out of battlefield medicine, such as ready-made tourniquets and quick-clot. There is a dark side here, though: both sports and battlefield situations have different aims than regular civilian life. They both require people to be ready to exert themselves again as quickly as possible. This is not the same thing as healing an injury as fully as possible.
In fact, sometimes healing as quickly as possible can impede fullest recovery over the longer term
A simple illustration of this can be seen in the RICE protocol. RICE stands for rest, ice, compression and elevation. It has long been the standard approach to sprains and strains, and it comes from sports medicine. Icing an injury certainly does cause the swelling to go down. It allows someone to put weight on the joint again sooner, and get back on the field.
After the first day or two however, as the intense heat of swelling recedes, it begins to introduce cold in the site. Cold tends to slow biological activity, and can kill cells. From a perspective in Chinese medicine theory, cold injuries Yang, Qi and blood. In my clinical experience, and that of my teachers, this can lead to instability in the joint as it heals, and increased scar tissue. In extreme cases, it can an acute injury and creates a chronic one. Using acupuncture for acute pain – before it becomes a chronic condition – may be part of the answer!
How do acupuncturists look at acute injuries differently?
We’ll return to sprains in later posts, but for now let’s examine how Chinese medicine theory relates to acute injuries. There are various types of acute injuries, of course: breaks, cuts, punctures, dislocations, crush injuries, and endless variations and combinations of those types. From a CM perspective, what all of these types of injury share is that they cause Qi and blood stagnation. Wait – blood stagnation? You may wonder “how can a bleeding cut or similar be blood STAGNATION?” There's a lot to say about that, but let's summarize by saying that we define blood stagnation as any situation where blood is not flowing properly inside of the vessels. Being outside of the vessel, and pooling between layers of tissue, qualifies.
This becomes more clear if you imagine the process of wound healing with clotting, scabbing over and then scarring. Qi stagnation happens anytime that the body’s abilities to communicate is compromised, even at a cellular level. As cells are destroyed by an injury, dead zones of communication are created.
Stages of injury in Chinese medical theory
Acupuncturists treating acute pain recognize three stages that all acute injuries move through.
- Stage 1: The site of the injury becomes hot and swollen, and dead tissue builds up, which was think of as heat toxins. The body sends Qi and blood to the site to repair the damage.
- Stage 2: Some of the acute heat swelling recedes, and stagnation of Qi and blood due to tissue damage begins to create pockets of cold
- Stage 3: All acute heat and swelling are gone and only stagnation remains, largely as scar tissue, which leaves the area vulnerable to wind and cold becoming trapped.
Our acupuncture for acute pain treatment strategies flow naturally and rationally from these stages of healing.
- Stage 1: We drain heat toxins, stop bleeding and move Qi and blood
- Stage 2: Some draining and moving and some warming methods are used
- Stage 3: Warming and nourishing methods used, some moving Qi and blood but more gently
When treated properly with the above methods, injuries tend to resolve more completely. We accompany the patient through all of the stages of healing, giving them support every step of the way. This leads to a much more stable joint/limb/body cavity, with less scarring and often less pain. Simply put : acupuncture for acute pain helps avoid needing treatment for chronic pain down the road. While acupuncturists absolutely can, and do, treat old injuries – preventing them is much more satisfying.
What you can do on your own for acute injuries
You can always come see me if you get hurt, I specialize in acupuncture for acute pain! But, sometimes treatment isn't feasible – or not feasible soon enough! In that case, here are some take-home strategies for self-treatment!
- Sanhuang San (pronounced Sahn Hwahng Sahn): known as herbal ice, this external herbal formula clears heat and moves Qi and blood, thus reducing swelling and pain. It works with the body to improve circulation, rather than shutting it down. You can mix the powdered herb with any ointment and apply thickly to the site of the injury, like icing on a cake. Do not use on open wounds! You can find the powder here, among other places.
- Warm/cool hydrotherapy: you can improve circulation in and out of the area by alternating warm and cool soaks or washcloths. Shoot for 10 minutes of one and 10 minutes of the other, for no more than an hour at a time. This will help flush toxins out of the area and then assist the body in bringing the circulation back.
- Don’t ice after the first two days! Really, please don’t. Use warm/cool hydrotherapy instead – protect that yang qi!
- Massage out bruises. Be gentle, of course, but from a Chinese medicine theory perspective, bruises are stagnant blood that needs to be broken up – moved. A little goes a long way here!
Use your injured body part gently and stretch. Circulation of Qi and blood is vital to the healing process, and needs to be balanced with rest. Listen to your body as you learn your limits during your healing process.