Radical Acceptance

"At this very moment, can you or your circumstances be otherwise? When you understand that this present moment is all there is, you have no choice but to come to a radical acceptance that is none other than true peace and composure."

"To me, total responsibility means that everything -- literally every single phenomenon inside and outside of my being -- is wholly a projection of myself."

--Eido Shimano Roshi

Healthy Nutrition

Proper nutrition is one of the most important things that we can do to ensure good health. In Chinese medicine, we say that the Spleen-Pancreas (hereinafter Spleen) is responsible for the transformation and transportation of food and fluids. It is the Spleen’s job to break down and assimilate – it pulls out the vitamins, mineral, nutrients – the essence – of our food and drink and uses it to make energy and blood. It is the Spleen’s role to supply the rest of the body with energy and nutrients. The Spleen is able to perform these functions only when healthy and adequately supplied by yang/fire (metabolic force) from the Kidneys.

The Kidneys store our essence. They can be seen as our savings account; all our energy and reserves are stored there. If we tax our bodies (and/or our minds) through immoderate living we are debiting our savings without ever replenishing. Eventually our reserves will run out, just like a car will eventually breakdown if we don’t supply it with fuel and oil.

So, what are the things that deplete the Spleen and Kidneys? From a nutritional standpoint, the following will damage the digestive system: sweet sugary foods, greasy or fatty foods, too much dairy, cold or raw foods, overeating, overdrinking, undereating and underdrinking. Overeating refers to eating more than that which makes you about 70% full. It also refers to eating when you are not hungry. Undereating refers to not eating enough nutrients and quality of food (not just calories, as calories can be empty) to sustain your body’s energy requirements and not eating when you are hungry. Sweet sugary foods refers to refined sugars or any food or drink which has a large percentage of sugar. This obviously includes candies, chocolates, cookies and the like. It also includes fruit juices whose nutritional value is overshadowed by the tremendous sugar content (30+ grams of sugar per 8 oz. serving). Whole fruits are not prohibited, and are in fact recommended that one eat 2 servings per day.

Cold has two meanings. One is physical temperature. Our body’s natural environment is 98+ degrees and when we consume food or drink which is chilled or frozen it puts our digestive organs into shock. Cold has the nature of contracting and constricting and prevents proper circulation in the digestive system. Our Spleen must expend its yang/fire (metabolic force) to bring the food/drink to body temperature prior to assimilating it. It then must expend more energy to assimilate and extract the essence. This depletes the Spleen twofold and over time will damage and weaken the digestive fire. The second meaning refers to abundance of raw foods. Raw foods, despite physical temperature, are considered cold in that they require Spleen yang to work extra hard to break them down. This depletes metabolic fire and over time weakens the system. If one's diet is high in raw foods, it is recommended that digestive aids be used. Such aids include warming aromatic herbs like ginger, onion, cardamom, fennel, garlic, cloves, cinnamon, mashing foods to release it's juices, fermenting, chewing thoroughly to initiate salivary enzymes. This is why sushi is always served with plenty of ginger, daikon and wasabe. (See prior posts on the benefits of "raw" milk, i.e., unpasteurized).

Excessive dairy (pasteurized/homogenized) also taxes the digestive system and creates what we call in Chinese medicine “dampness.” Dampness has many meanings, but for our purposes we can think of it as excessive mucus which lines the digestive tract. Vitamins, minerals, etc. are extracted through the gut linings into the blood for transport to the rest of the body. When dampness exists, it prevents this absorption and the body is unable to benefit from the food. Thus, one can eat a great meal and receive absolutely no benefit if they are damp. Dampness comes because the Spleen is the main organ which transforms fluids. If the Spleen becomes weak for any reason, it will be unable to perform its functions and fluids stagnate and dampness forms. Signs and symptoms of dampness include: gas, bloating, abdominal distention, thirst without any desire to drink, nausea and vomiting, heaviness in the body, limbs and head, poor memory, sluggishness, lethargy to name a few.

So how do we prevent dampness and keep our digestive system strong? One should eat a diet high in lightly cooked/steamed vegetables and liberally use warm and easy to digest foods spiced with herbs to aid digestion. One should avoid excesses in the food categories listed above (damp cold raw sweet dairy fried greasy foods). One must be careful not to overeat and not eat when not hungry and make sure that he/she receives sufficient nutrients and quality of food.

A key factor to optimal digestive health is regularity in eating. The digestive system craves regularity and routine. The digestive organs prepare for food. Their energies gear up to receive the food and break it down. If one eats breakfast at 6 am one day, 7 am the next, 8 am the following, the Spleen and Stomach don’t know when to prepare for the meal. What winds up happening is that they gear up at the wrong time (which depletes their energies) and need to receive and assimilate food when they are not ready (which further depletes energy). Food winds up being poorly digested, starts to ferment, putrefy and form toxins.

In addition, we say that one should eat like a prince at breakfast, a merchant at lunch and a pauper at dinner. Every two hours a different organ system’s energy is most abundant. For the Spleen and Stomach that is between 7:00 am and 11:00 am, with the Stomach being between 7 and 9, and the Spleen between 9 and 11. Thus, our digestive system is most able to handle food between 7 and 9 am and the Spleen is most able to work on that food and extract and assimilate between 9 and 11 am. The opposite 12 hour period of time (between 7pm and 11pm) those organs have the least amount of energy. Thus, it is unwise to eat large amounts in the evening. Your meal will sit in your Stomach and not be properly broken down.

One should also incorporate each of the five flavors into meals. Acrid (spicy, pungent), bitter, salty, sour and sweet (from grains, vegetable and carbohydrates, not refined sugars) should be used to harmonize the internal organs. Each flavor is associated with a different pair of organs and helps to stimulate that organ when used appropriately.

Emotions also affect our digestive energies; they affect the ascent and descent of digestive Qi and can prevent the separation of the pure and turbid resulting in food stagnation and dampness. Some general guidelines include: Don’t eat when upset; Don’t eat with people you don’t like; Be mindful when eating: concentrate on your food; concentrate on chewing and enjoying the food; Do not be distracted while eating, thinking about other things, reading, working, on the run, in a hurry, etc. Overthinking and worry weaken Spleen and Stomach energies and fear and depression weaken Kidney fire.

Also important is the way that one combines food within each meal. Improper food combining can result in poor digestion and stagnant food which ferments, putrifies and causes the production of toxins. Proteins require an acid environment to be properly digested and carbohydrates require an alkaline environment. Combining the foods in the same meal prevents proper digestion. Equally important is the proper chewing of food. Saliva contains alkaline enzymes which begin to break down carbohydrates in one’s mouth. The Spleen thrives on an alkaline environment, so thorough chewing allows the enzymes to alkalize one’s food, taking the burden off of the Spleen.

Applying these guidelines to one’s nutrition will yield profound health changes. The understanding that everything that we eat and/or drink has an impact on our health should help guide us to take more time and consideration regarding our food choices.

For a list of hundreds of foods and their Chinese medicine properties, click Eastern Nutrition -- Foods and Their Properties.

The Path

I just saw this on another site, and really enjoyed it.

Lung Cancer

OAT CELL LUNG CANCER

History: Patient is a 60 year old female with a chief complaint of oat cell Lung cancer. The cancer was diagnosed approximately 1 year prior to our initial visit. Over the course of the year, patient has undergone 30 treatments of chemotherapy (CPT-11 and Cisplatin), as well as 30 treatments of radiation therapy. Patient was strongly discouraged by her doctor from seeking acupuncture and/or herbal medicine therapy during her treatments. At the time of our visit, patient’s western treatments had been stopped for approximately 2 months due to a decline in her white blood cell counts (approximately 2.0). At her last oncologist appointment (1 week ago), x-ray and CT scans revealed that the cancer was still present. Due to this finding, patient turned to Chinese medicine for help.

Current Health Status: Patient presented extremely fatigued. She has been housebound for approximately 1 year during the course of her chemo and radiation. During chemo she experienced cold sweats. She suffers from insomnia (trouble falling and staying asleep) and requires medication to have a restful night sleep. She has poor appetite, abdominal pain, gas, belching, bad breath and nausea and vomiting. She has alternating constipation and diarrhea. She went through menopause at 43 years old without experiencing any symptoms. She has tinnitus, dry mouth and throat and canker sores from the chemotherapy. She suffers from anxiety and depression, high blood pressure and dizziness.

Past Medical History: seasonal allergies (sinus congestion), high blood pressure

Family Health History: both parents had heart disease, father had diabetes (type II)
Husband died of Lung cancer 10 years ago

Medications: atenolol, hydrochorazide, paxil, atavan, ambien

Allergic History: seasonal allergies

Physical Exam:
a. Tongue: body: pinkish purple, dry, thin, scalloped, puffy in Lung
coat: dry yellow burnt
veins: slightly dark
b. Facial complexion: pale withered
c. Body shape and posture: overweight; flaccid muscle tone
d. Shen: depressed and anxious
e. Listening and Smelling: raspy hoarse voice, labored breathing
f. Palpation:
i. Pulse:
Right – thin weak faint forceless
Left – imperceptible
ii. Abdomen/Channels: n/a

Diagnosis: This is a situation of multiple system profound organ deficiencies with significant stagnation and toxic heat. With the immediacy that this case presented, treatments were geared towards attacking the Lungs while simultaneously nourishing the immune system and constitution to enable the patient to fight off the cancer. Severely weakened by a year of chemo and radiation which left the patient debilitated, nourishment was a prime concern.

First Treatment: September 25
Acupuncture: LU 7, KI 6, KI 7, LU 8
Herbs: Ren Shen 12g Ling Zhi 12g
(raw ½ bag per day) Bai Zhu 15g Sha Ren 6g
Ban Xia 6g Mai Men Dong 12g
Tian Men Dong 12g Jin Yin Hua 20g
Pu Gong Ying 20g Bai Hua She She Cao 20g
Pi Pa Ye 9g Ba Yue Zha 12g
Sheng Di Huang 12g Huang Lian 6g
Jiao Gu Lan 9g Fu Ling 9g
Dan Shen 6g


Second Treatment: October 2
Notes: White blood cells doubled since first treatment. Chest x-ray shows status quo, no mets. Tumor is in lymph.
Right pulse was deep thin and vacuous; left pulse extremely faint and thin
Acupuncture: R LU 7, L KI 6, L LU 5, R LU 11, bilateral LV 8, ST 36, SP 9
Ear: Lower Lung
Notes: During treatment patient felt strong aching and sharp sensation deep inside chest/lungs
Herbs: Continue on same prescription

Third Treatment: October 9
Notes: Patient had x-ray yesterday. Tumor/cancer is GONE. No signs of cancer.
Right pulse is fuller, left pulse has more force
Acupuncture: R LU 7, L KI 6, L LU 5, LI 11, bilateral SP 9, ST 25, ST 37
Herbs: Continue on same prescription plus add Jie Geng 6g

Indigestion

Patient Last Name: S Patient First Name: J
Treatment Date and Time: . May 12, 2001
Sex and Age: Male 48 Profession: Artist

1. Chief Complaint: Indigestion and Stomach Pain for 15 years

2. Medical History:
Present Illness: The patient has suffered from indigestion and stomach pain for 15 years (beginning around the same time as his divorce). He is frequently hungry and feels good initially after eating, but begins to experience discomfort beginning an hour and ½ after meals. He experiences indigestion, which he initially described as a burning chest and epigastric pain that was most pronounced at Ren 12 and followed upward along the Ren channel behind his sternum and radiated down his shoulder and the posterior aspect of his left arm to about Ht 2 level. Now, the burning quality has subsided and the pain is milder and achy. The pain is worse with pressure and feels better after belching. He also experiences frequent acid regurgitation with a bitter taste (especially in the morning), bad breath and often has gas and abdominal distension. The patient feels that his digestion is slow – a condition that seems to be exacerbated by medication (Prilosec) for H. pylori, which he has had before. The patient also has chronic tightness in his chest, which is worse with stress. He has discovered that the tightness is somewhat relieved when he relaxes and makes an effort to “open” the area. His cardiologist has ruled out any new cardiac problems although the patient suffered a mild MI in December ’98 and becomes very nervous about any symptoms that may indicate heart problems.
Until recently, the patient suffered from irregular bowel movements, alternating between constipation with bleeding and diarrhea accompanied by a burning sensation, but these symptoms have resolved. He also used to experience frequent anxiety attacks, particularly around large crowds in the subway, which he described as severe anxiety with tightness in his chest and palpitations. During those attacks he had to “talk himself down” and said that his self-consciousness was sometimes the only thing that kept him from “breaking down”. However, since beginning treatment, he has only had one or two attacks and feels less anxious in general.

3. Current Health Status:
Appetite: frequently hungry; craves sweets and salty foods
Urine: more normal (used to be frequent, scanty and yellow)
Stool: well-formed, 1X/day *see above
Temp: tends to be warm
Sweat: no unusual sweating reported *clammy skin/limbs
Thirst: not particularly thirst; prefers cold
Energy: ok; worse when his stomach is bothering him
Sleep: no difficulty falling asleep; profuse vivid dreaming; anxiety dreams
Emotions: appears sad/resigned, easily anxious *see above; feels he’s “a wreck” right now
Head/Eyes/Ears: floaters
Other: some low back soreness and tightness in his right shoulder. Dry skin and a dry red rash over Ren 17 (no pain/itching)

4. Past Medical History: MI in December ’98; Dx: GERD, High Blood Pressure (watching)
5. Medications: antacids, garlic tablets, Prilosec
6. Allergic History: none noted
7. Physical Exam:
a. Tongue:
body: pale red with a red tip and a deep crack to the tip; puffy, scalloped; there is a faint ulcer on the right side around the lung area.
coat: thin slightly yellowish
b. Facial complexion: pale, sallow
c. Body shape and posture: withered; sunken chest
d. Shen: dull
e. Listening and Smelling: nothing noted
f. Palpation: very sunken at Ren 14, tender @ Ren 17, over the epigastric area, SP4
i. Pulse: 80bpm, weak
Right: thready, wiry
Left: soft (especially in the guan)


INITIAL DX: Stomach Heat with an underlying Heart and Spleen Deficiency

Stomach Heat Heart (blood) deficiency Spleen (Qi) Deficiency
Foul breath
Bitter taste
Acid regurgitation
Belching
Burning sensation (epigastrum)
Red tongue
Rapid pulse
Constipation w/burning Vivid dreams
Anxiety attacks
Sad appearance
Pale Complexion
Floaters
Thready pulse Abdominal pain/distension
Gas & Bloating
Slow digestion
Loose stools/diarrhea
Scalloped, puffy tongue
sallow complexion
deficient pulse


This patient’s symptoms began in the midst of his divorce 15 years ago. Constrained emotions from traumatic events can easily cause disruption of the Qi dynamic and blood flow in the middle jiao. When emotions are constrained, the Liver cannot move Qi smoothly and the Heart cannot propel blood properly creating an excess condition. Excess in the Liver can cause it to overact on the Spleen and Stomach by pathologically overloading the normal flow in the control cycle.. Over time, this has impeded movement in the Middle Jiao, eventually generating heat. The spleen, which is also taxed by excessive thinking and melancholy, was no longer able to properly process food and liquid, causing gas and bloating with loose stools. The digestive system became sluggish and the Stomach was forced to work harder to process the excess in the middle jiao. Obstruction of the Spleen and Stomach from stagnation led to a pathological intermingling of clear and turbid, which inhibited the normal physiological function and generated heat and dampness, creating alternating constipation and diarrhea. Excess in the Stomach caused Stomach Qi to rebel upward, causing foul breath, belching, acid regurgitation and a burning sensation in his epigastrum, particular at Ren 12, the Front Mu of the Stomach. Some of this dampness and heat has poured down and become lodged in the patient’s Lower Burner causing irregular bowel movement with a burning sensation.
This condition was exacerbated by the patient’s “heartbreak”. Emotional sadness has taxed the patient’s Heart Qi. Since the Heart, as the Fire organ, is the Mother of the Spleen, the Earth organ, it failed to properly nourish the Spleen. The Spleen failed to generate blood and was unable to generate Heart blood in turn. Without sufficient blood to house the shen, the patient experienced many vivid dreams and often suffered from acute anxiety as his shen was not rooted. There was not sufficient blood to nourish his face and eyes and the patient has floaters and pale complexion.
The patient’s rapid pulse reflects the heat constrained in his body. It is a thready and forceless pulse because the patient over time is developing a blood deficiency and heat has also burned up yin fluids causing the vessels to become thin and deficient. His red tongue also demonstrates that there is heat in his body and the deep central crack indicates that the heat is damaging fluids. The tongue body is scalloped and puffy due to Spleen qi deficiency failing to properly transport and transform fluids.

Initially, I made efforts to clear the heat and nourish the Heart and Spleen. The heat signs resolved first (urination became less yellow, pulse slowed and tongue became less red) and then signs of rebellious stomach qi became much milder. The patient no longer complains of bad breath and has far fewer episodes of acid regurgitation. He now has well-formed bowel movements 1X/day. His anxiety attacks have virtually stopped.

CURRENT DX: Yin Wei Disharmony

Upon palpation, this patient is tender at Ren 17, Spleen 21 and Spleen 4, as well as his entire subcostal and epigastric area. This is strongly associated with a Yin-Wei Chong Mai Extraordinary Vessel pattern. Looking over his signs and symptoms, I noticed that the rest of his presentation also indicated imbalances associated with Yin Wei disharmony.
The Yin Wei Channel dominates the interior, particularly the Qi and Yin of the Heart, Lung, Spleen and Stomach. Disorders and symptoms of those orders, such as chest, epigastric and abdominal pain, cardiac problems, fullness and distension, borborygmus, diarrhea and lumbar pain can all be treated with Yin Wei points.
This channel is also responsible for balancing the emotions. When the yin channel is disturbed, there may be mental instability, uneasiness, low self esteem, lack of will power and discouragement. Yin Wei points can be used to lift the spirit and balance the emotions.



TP: Clear Heat and Regulate the Stomach; Tonify Heart blood and Spleen Qi
Harmonize the Yin Wei channel

Acupuncture Points:
Ren 12 Front Mu of the Stomach - Influential point of Fu organs; Harmonizes Stomach & Downbears counterflow; Fortifies Spleen & Disinhibits Damp
ST 25 Front Mu of the LI - Courses & Regulates the Large Intestine; Supports Earth and Transforms Damp
LJ empowering stability during transitions.
ST 44 Ying Spring/Water - Promotes Free Downbearing of Stomach Qi; Harmonize Intestines and Transform Stagnation
Ren 17 Front Mu of the Pericardium/Influential Point of Qi - Regulates Qi and Downbears Counterflow; Loosens the Chest and Disinhibits Diaphragm
LJ reunion point where PC and Lu meet; grounds the essential child-like nature of the heart
PC 6 (L) Luo/Confluent of Yin Wei - Clears Heat & Eliminates Vexation; Loosens Chest & Rectifies Qi; Downbears Counterflow & Stops Vomiting; Harmonizes ST & Relieves Pain; Regulates HT Qi & Blood; Calms Mind; Regulates JueYin:.
LJ Regulates inner and outer aspects of illumination governed by the heart & fires of ming men.
SP 4 (R) Luo/Confluent of Chong - Supports the Spleen & Stomach and Rectifies Qi
LU 7 (R) Confluent of the Ren/Command of Head & Neck/ Luo to LI -
GM Has a releasing effect on emotions (esp. sadness, worry, grief) constraining Po in the chest.
Ki 6 (L) Confluent of Yin Qiao - Frees channels; Drains Fire & Courses Qi; Clears Spirit Disposition
Ear Seeds: Shen Men, Stomach

The point prescription was designed to clear heat, regulate and open the Middle Jiao, tonify the Spleen and calm the spirit. Ren12 and St 25 work together as both local points and front mu points of both the Stomach and Large Intestine to promote movement and downbearing, allowing heat and stagnation to move out of the body. Ren 17 assists in promoting downbearing and can also loosen the chest. As the Front mu of the Pericardium and the influential point of Qi, it can also tonify the heart and spleen. PC6 and Sp4 are the confluent points of the Yin Wei (chest/interior) and Chong (blood) and aid in downbearing stomach qi as well as tonifying the Spleen and calming the spirit. Lu 7 is the luo to the Large Intestine and also works with Ki 6 6 to open the Ren channel, where this patient reports having a burning sensation. St 44 is particularly good point for clearing heat and downbearing stomach qi and has a function to harmonize the intestines.

Other Prescriptions: SP4, PC6, Ki 9 (xi cleft of Yin Wei), Du20 Ear: Shen Men, Sympathetic
Lv 3, PC 6, Ht7, Ren 17, Sp 6, St 36

Initial Herbs:

Sheng Di Huang Clear Heat & Cool Blood; Nourish Yin; Cools Upward Blazing of Heart Fire
Dan Shen Invigorates Blood; Clears Heat & Soothes Irritability
Dang Gui Tonify/Invigorate Blood; Moistens Intestines; w/Dan shen tonifies blood & nourishes Ht w/o stagnation
Fu Ling Strengthens Spleen, Drains Damp, Transforms Phlegm, Quiets Heart & Calms Spirit
Mai Men Dong Tonifies Heart & Stomach Yin, Clears Heat, Soothes Irritability; Moistens Intestines
Wu Wei Zi Quiets Spirit and Protects Heart Qi; Binds Ki Essence; Stops Diarrhea
Suan Zao Ren Nourishes Heart Yin and Liver Blood, Quiets Spirit
Bai Zhu Tonifies Spleen Qi; Dries Damp; Stabilizes Exterior
Mu Xiang Moves Qi, Relieves Pain, Strengthens Spleen, Regulates Stagnant Qi In Intestines
Xiang Fu Moves Liver Qi
Hai Piao Xiao Binds Essence, Resolves Damp, Stops Diarrhea; Stops Bleeding; *Rebalances Stomach Acid
Huang Lian Clears heat & Dries Damp; Clears Heart & Stomach Fire; Stops bleeding (Guides to Heart)
Mu Li Settles/calms the spirit; absorbs acidity, alleviates pain, binds essence, benefits yin and anchors yang

A variation on Tian Wan Bu Xing Dan, which tonifies yin and blood of the heart and kidneys, and Gui Pi Tang, which nourishes Spleen Qi and Heart Blood. Huang Lian and Hai Piao Xiao was added to clear some of this patient’s excess stomach heat and help control stomach acids that contribute to nausea and acid regurgitation. Mu Li controls stomach acid and settles the spirit.

Current Formula:
Dang Shen 9 Bai Ji Li 9
Bai Zhu 12 Shi Chang Pu 6
Fu Ling 12 Fo Shou 12
Suan Zao Ren 6 Zhi Ke 9
Huang Qi 9 Ye Jiao Teng 9

10. TCM Patterns of “Upset Stomach”
• Spleen-Stomach Disharmony – characterized by glomus, continuous pain in the stomach duct exacerbated by hunger, abdominal distension and poor transformation of food, belching, hiccup, and in severe cases, vomitting. Other signs are a pale, scalloped tongue and thin, white fur, and a forceless, sunken, fine or sunken/moderate pulse.
• Spleen-Stomach Yang Vacuity – characterized by reduced food intake, vomiting, diarrhea, cold limbs, fatigue, withered-yellow facial complexion, dizziness, pale tongue, soft enlarged tongue, thick turbid tongue fur and a large, vacuous pulse.
• Spleen-Stomach Damp Heat – characterized by glomus and oppression in the stomach duct, torpid intake, nausea, sloppy stool, yellow urine and heavy, cumbersome limbs. The tongue is red with yellow, slimy fur and the pulse is soggy.
• Spleen Qi Vacuity – a condition arising when irregular eating or anxiety, thought and taxation fatigue damage the spleen and stomach.
• Spleen-Kidney Yang Vacuity – characterized by enduring diarrhea, early morning diarrhea, or clear-food diarrhea, drum distension and lower abdominal cold pain. Other chief signs are a bright, white puffy face and swollen limbs, a pale, enlarged tongue with white, glossy fur and a sunken, fine, slow and weak pulse.
• Spleen Vacuity with Food Damage – characterized with bloating after eating and by sloppy stool containing untransformed food. In general there is no abdominal pain and the tongue fur may be completely normal.
• Splenic Movement and Transformation Failure – In mild cases, abdominal distension, torpid intake, rumbling intestines, diarrhea and other signs of poor digestion are observed.
• Stomach Qi Ascending Counterflow – characterized by nausea, vomiting, belching or hiccough.
• Stomach Reflux – characterized by distension and fullness after eating, vomiting in the evening food ingested in the morning or vomiting in the morning food that was ingested the previous evening.
• Stomach Vacuity Cold – characterized by stomach pain, vomiting and vacuity cold signs
• Stomach Repletion Cold – characterized by acute cold pain in the stomach duct relieved by vomiting, physical cold and cold limbs.
• Stomach Heat – characterized by bitter taste in the mouth, dry mouth, bad breath, rapid hungering, red tongue with yellow fur and a rapid, slippery pulse.
• Liver-Gallbladder Damp Heat – chief signs include alternating fever and chills, bitter taste in the mouth, ribside pain, jaundice, abdominal pain/distension, nausea, vomiting and loss of appetite. Stools tend to be dry if heat is pronounce and sloppy if dampness is more pronounced. The tongue fur is yellow and slimy and the pulse is rapid and stringlike.
• Liver Qi Invading the Spleen – characterized by headache, irritability, bitter taste in the mouth, chest oppression, glomus and fullness after eating, sloppy diarrhea and a moderate, stringlike pulse. It differs from Invasion of the Stomach by a predominance of spleen signs such as diarrhea and distension.
• Liver Qi Invading the Stomach - characterized by stomach duct pain, vomiting of sour fluids, torpid intake, abdominal distension, diarrhea. There will also be liver signs such as dizziness, ribside pain, irritability and a stringlike pulse.
• Liver-Stomach Disharmony – characterized by distending ribside pain, belching, glomus, fullness, torpid intake, acid regurgitation and clamoring stomach.
• Large Intestinal Vacuity Cold – usually associated with Spleen-Kidney Yang vacuity, and is characterized by thin diarrhea, reduced food intake, cold limbs, aching lumbus, thin tongue fur and a fine, sunken pulse.
• Large Intestinal DampHeat – a disease pattern generally characterized by abdominal pain and diarrhea with ungratifying defecation and foul-smelling stool.
• Food Accumulation – pathology attributable to spleen-stomach movement and transformation failure. It is characterized by fullness and oppression, in the chest and stomach duct, in some cases with hardness or glomus, abdominal pain that dislikes pressure, hard stool, loss of appetite, foul belching and acid regurgitation.
• Food Damage – pathology due to voracious overeating or spleen-stomach vacuity. It is characterized by aversion to food, nausea and vomiting, belching, foul-smelling vomit, acid regurgitation, painful bloating, diarrhea or constipation, foul-smelling stool and flatus. The tongue fur is usually slimy or thick or yellow.
• Damp Obstructing the Middle Burner – characterized by abdominal distension, loss of appetite, sticky mouth, thirst with desire for warm drinks, short voidings of reddish urine and slimy white tongue fur.

Back Pain

Patient Last Name: WA99 Patient First Name: J
Treatment Date and Time: September 23, 1999
Sex and Age: Female, 21

1. Chief Complaint: Back Pain from MVA since May 1999

2. Medical History:

a. Present Illness: Patient complains of back pain with initial onset 1997 from MVA. She was treated successfully with acupuncture and herbal medicine over a 1 ½ year period. Three months later (May 1999), she suffered another trauma to her back in a MVA. Patient experiences pain on palpation from GB 21 down the first line of the UB channel to her sacrum bilaterally. She also experiences headache pain from GB 21 up to GB 13, 14, 15. Her pain is aggravated with forward, backward and lateral flexion and extension, damp weather, prolonged standing or sitting. Her pain is chronic, mostly dull but can be sharp and localized. Pain is alleviated with medication (Vicadan), heat, and stretching. O’Donahue’s was positive in all directions. Generally, pain without movement is 3/10, worsening at the end of the day to 7/10. She was diagnosed by M.D. as whiplashed; MRI and X-rays were negative.

b. Current Health Status:
Skin: constant itching over entire body, dry skin, especially on chest
Head: headache post MVA from GB 21 to GB 13, 14, 15
Eyes: occasional floaters
Ears: progressive loss of hearing
Respiratory: chronic smokers cough, phlegm difficult to expectorate, bronchitis history
CV: cold hands and feet, occasional dizziness
GI: nausea, better with food, history of constipation and diarrhea
Sleep: difficulty falling asleep, 5-10 hrs per night, awakes tired
Urine: frequent (every 1-2 hrs), but drinks often
Stool: 1-2x/day, occasionally loose, history of undigested food in stool
Temp: cold extremities, heat in body 98.7 degrees
App: good, eats frequently
Sweat: history of night sweats
Thirst: very thirsty, drinks often
Emotions: history of depression; suicidal tendencies after finding out she had genital warts
BP: 106/70

c. Other: Patient smokes cigarettes @ 1 pack/day; also smokes marijuana @ 1 joint every 2-3 hrs. to relieve pain and nausea

d. Past Medical History: MVA 1997, treated successfully with acupuncture and herbal medicine over 1 ½ year period. Three months later (May 1999), subsequent MVA.

3. Family Health History: N/A

4. Medications: oral contraceptives, Vicodan, Soma

5. Allergic History: N/A

6. Personal History: asthma, bronchitis, Stomach/intestinal disorders, allergies, UTI

7. OB/GYN: menarche @ 15 yrs, LMP 9/15/99, 28 day cycle, 4 day flow, dark red at onset, thick blood, clotting, PMS depression, abdominal and breast distention

8. Physical Exam:
a. Tongue: body: pink red, thin, pierced
coat: turbid white sticky in rear
veins: dark and distended
b. Facial complexion: ok
c. Body shape and posture: Patient's shape and posture appears healthy
d. Shen: present
e. Other: movement before after
i. Neck forward flexion 6 4
ii. Neck extension 8 (↓ ROM) 6 (↑ROM)
iii. Neck L lateral flexion 5 4 (↑ROM)
iv. Neck R lateral flexion 8 5
v. Back extension unable 8 (↑ROM)
vi. Back extention (passive) 8 -------
vii. Back L lateral flexion 7 2
viii. Back R lateral flexion 7 2
f. Listening and Smelling: no unusual odors, breathing or vocal changes were observed
g. Palpation:
i. Pulse
Level: middle
Speed: 72
Rhythm: regular
Strength: chi bilaterally was deep and vacuous, LV vacuous
Shape/Quality: tight

ii. Abdomen/Channels: Extra Channel Hara Diagnosis revealed a Ren Mai-Yin Qiao and Yang Wei-Dai Mai disharmony. Also pressure pain down UB line (relieved after treatment)

9. Differential Diagnosis:
a. TCM: Qi and Blood stagnation from trauma (underlying yin/blood ↓)
b. Japanese: Ren-Yang Wei Disharmony

A. Qi and Blood Stagnation Yin and Blood deficiency
Back pain which can be sharp itching
And localized esp. during movement dry skin
Thick menstrual blood w/ clotting floaters
depression Loss of hearing
abdominal and breast distention Cough w/ diff to expectorate phlegm
dark and distended SLV Dizziness
tight pulse Difficulty falling asleep
Deficiency heat
Night sweats
Thirst
tremors

B. Pathology: The root of patient’s pathology is a yin and blood deficiency. This deficiency can develop from years of chronic abuse of cigarettes and marijuana coupled with her history of chronic LU infections and emotional depression. The itching and dry skin result from the lack of yin and blood nourishing the skin. The floaters and progressive loss of hearing from yin and blood not rising to nourish the eyes and ears. A further progression of this lack of nourishment rising is patient’s dizziness. Due to the long-term nature of patient’s abuse of alcohol, cigarettes and marijuana despite her young age, her yin and blood have been depleted enough to result in tremors from wind arising from deficiency. Yin deficiency leads to a relative excess of yang and causes deficiency heat, night sweats and thirst, as well as difficulty falling asleep due to yin’s inability to house the yang at night.

With this yin and blood deficiency at the root, patient suffered severe trauma to her back and neck from a series of motor vehicle accidents over a short period of time. This trauma caused qi and blood stagnation manifesting as back pain which can be sharp and localized especially during movement. This stagnation interrupted the qi and blood dynamic in the body causing a menstrual period characterized by thick dark blood with clotting, PMS, depression and breast distention. It is further evidenced by her dark and distended sublingual veins. This stagnation has remained over a long period of time partly due to her yin and blood deficiency. With such a deficit of yin and blood, coursing qi and blood becomes difficult due to the danger of creating more deficiency. With a greater degree of deficiency, there is less blood to course, and deficiency can easily lead to excess, i.e., stagnation. Furthermore, the trauma has caused damage to the tissues, sinews, muscles, ligaments, etc. In order to fully heal these tissues, blood and yin fluids are needed to nourish them. The lack of blood and yin fluids makes this process difficult and further leads to the degeneration of these tissues creating a devastating cycle with an inability to resolve her disharmony.

10. Treatment Plan: Course qi and blood and relieve pain; harmonize Ren-Yang Wei

11. Prescription:
a. Acupuncture:
i. Root Step 1: SJ 5, KI 6 (retain 2 min, check abdomen; if + add
GB 41, LU 7 (hook IP cords, retain 10 min)
ii. Root Step 2: R UB 22, R UB 19, L UB23, L UB 13 (retain 5 min)
iii. Branch: thread down UB first line bliaterally
iv. Tuina on upper and lower back
v. Stretching

b. Acupuncture Analysis:
SJ 5: confluent of yang wei mai
KI 6: confluent of yin qiao mai
GB 41: confluent of dai mai
LU 7: confluent of ren mai

c. Herbs: Meridian Passage

d. Herbal Analysis:
This formula is a combination of Shen Tong Zhu Yu Tang and Mo Yao Xiang Sheng Dan. It is for congealed blood in the meridians, joints, low back and limbs. It consists of:
Hong Hua: invigorates blood
Niu Xi: invig blood, nourishes LV and KI
Qin Jiao: expels wind damp, softens tendons, guide to meridians
Qiang Huo: wind damp, focus on KI and UB
Chuan Xiong: invig blood, expels wind
Dang Gui: invig and tonifies blood
Xiang Fu: moves qi along with the blood
Gan Cao: harmonizes, focuses to meridians
Mo Yao: invig blood, promotes healing
Zi Ran Tang: invig blood, enters LV and KI
Gu Sui Bu: tonifies KI, heals bones and tendons
Bai Shao: tonifies blood, smoothes LV qi, important for pain and spasms
Ru Xiang: invig blood, relaxes muscles, stabilizes pain

Impotence

Patient Last Name: Dv00 Patient First Name: A
Treatment Date and Time: 5/13/00
Sex and Age: Male, 29

1. Chief Complaint: impotence
2. Medical History:
Present Illness: the onset of patient’s illness was approximately one year ago. He was in the Peace Corps, and would spend his summers in West Africa. While there, he was dating a West African woman whom he would see each summer. In his last summer, he told the woman that they shouldn’t continue their relationship and she became very upset. That night at dinner, the patient thought his food tasted funny. After completion of the meal, he felt a cold, numbing sensation from his lower abdomen to the tip of his penis. He described the sensation as if Ben Gay had been rubbed there and the heat wore off leaving it cold and numb. He has had this ever since, and has been unable to achieve an erection or any sensation. He later learned that his ex-girlfriend had gone to see a West African witch doctor who had cast a spell on him and had treated his food with some herbs. After seeing western doctors to no avail, patient went to see an herbalist who misdiagnosed the impotence as a kidney yang deficiency. Patient was prescribed herbal formulas to tonify his yang, and as a result, has experienced such great heat signs that his hair began to fall out and his upper body is laden with heat and dryness.

b. Current Health Status:
Temp: hot
Sweat: none (unable to sweat)
Thirst: for cold liquids
Urine/Urogenital: 2 x/day, moderate amount, clear to yellow in color. Testosterone and prostate normal
Energy: low
Sleep: difficulty falling asleep; gets too hot to sleep; restlessness; vivid strange dreams
Emotions: worry, anxiety, frustration regarding impotence; has lost passion for life; difficulty experiencing joy; difficulty socializing
Head: dry heat sensations; headache 3-4 x/week behind eyes
Ears: ringing; bright red color
Eyes: dry, scratchy, burning
Skin: face and hands very hot and dry
Digestion: gas and bloating
Stool: diarrhea 3-4 x/week; loose with undigested food

c. Past Medical History: none noted


3. Family Health History:
None noted

4. Medications: n/a

5. Allergic History: n/a

6. Physical Exam:
a. Tongue: body: red, scallops, center cracks, red tip
coat: dry, thin white, scanty
veins: dark and distended
b. Facial complexion: slightly red, with bluish hue around eyes and mouth
c. Body shape and posture: tall thin
d. Shen: diminished, lacking vitality
e. Listening and Smelling: groaning voice
f. Palpation:
i. Pulse: 88 bpm
Right – wiry
Left – wiry

ii. Abdomen/Channels: none done; feet very cold

9. Diagnosis: yin vacuity

10. Correspondence of Signs & Symptoms: heat sensations; inability to sweat; thirst for cold; scanty urine; restlessness; inability to sleep; anxiety; tinnitus; dry, scratchy, burning eyes; red tongue, especially tip; scanty tongue coat; rapid pulse


11. Treatment:
a. Points: SP 4
KI 3, 6
LV 8
REN 4
LV 5
b. Herbs: Tian Wang Bu Xin Dan

6/1/00
Changes: dry heat around chest and nose (worse at night and late afternoon). Temperature still hot; hair still falling out, but not as much, oil returning. Emotions affected by hair; feels tired and old, but a little happier this week about hair. Slight sweat this week – needed deodorant for first time. Headache frontal dry heat
Points: Ki 1, 7, 10
LV 8
UB 23, 43
Du 14
Herbs: alternate Tian Wang Bu Xin Dan and Zhi Bai Di Huang Wan

6/8/00
Changes: difficulty sleeping; missing spark – no more desire or zest for life; head really hot and dry
Points: KI 7, 24
HT 3
PC 8
Du 20
Herbs: Gui Zhi Jia Long Gu Mu Li Tang


6/15/00
Changes: after formula noticed warmth and slight sensation in genitals; more oil in hair; energy better. Boiled last two bags together and drank entirety in one hour.
Points: UB 18, 23, 44
KI 2, 7
LV 8
PC 7
Herbs: Gui Zhi Jia Long Gu Mu Li Tang + Sheng Di, Shi Gao and Zhi Mu (with large doses: 90g of Long Gu and Mu Li; 30g of Shi Gao and Zhi Mu; and 24g of rest)

6/22/00
Changes: felt great; majority of heat symptoms gone. Prior to treatment he rated his heat on a scale of 1-10, at 12/10; at this treatment he rated it a 5/10. Also, more warmth in genitals and progressively more sensation.
Points: HT 3, 8
LV 2, 8
SP 2, 9
KI 2, 10
Herbs: same (using Long Chi instead of Long Gu)

Pathology: Patient’s pathology appears to be a combination of spiritual and iatrogenic causes. The onset of patient’s inability to achieve sensation in his genitals directly followed a meal in which his food was tainted with herbs (and possibly witch craft). The focus of these herbs (and witch craft) was to specifically affect patient’s genitalia, making him unable to be intimate with another woman, the result of a vengeful action perpetrated by an ex-girlfriend. While it is not clear what herbs (or spells) were used, it is clear that the result was to leave the patient impotent with a numbing cold sensation. This cold sensation, however, should not be confused with a Kidney yang vacuity – the cold is limited to this area, had an immediate onset, and there is an absence of any other yang vacuity signs. Unfortunately, the first herbalist that patient visited made this mistake and prescribed yang tonics. These yang tonics caused immense heat signs in the patient, resulting in the symptoms listed above. Thus, patient’s presentation is a mixture of demonic possession, herbal toxicity, and iatrogenic causes. His pattern currently presents as a yin vacuity with a separation of yin and yang. Patient’s signs and symptoms reflect floating yang; all of his heat signs are on the upper half of his body. His lower body is cold, with lack of sensation. The herbal and demonic causes of his condition caused an imbalance of yin and yang; a separation at his root or dan tian. The Kidney yang formulas that he was prescribed furthered this imbalance by warming his unanchored yang and scorching his yin. Physically, this imbalance is manifested by the extreme heat signs in the upper half of his body and the coolness in the lower half. Psychospiritually, the herbal toxicity, witch craft, and betrayal from an intimate relation has resulted in patient’s difficulty experiencing joy and loss of passion in life. Patient’s Heart and Kidneys, the central axis of spiritual stability, have lost communication. This has caused the patient to become separated from his destiny. With this loss of communication between fire and water, other elements become affected. For instance, along the sheng cycle from water to fire exists wood. The wood element is responsible for mediating the flow of qi between the water/jing and fire/shen. When the jing and shen are not in contact, the flow of qi becomes disordered. Here, patient has some qi stagnation which has resulted from this disharmony. It is reflected in his frustration, wiry pulse, and dark and distended sublingual veins. On the other side of the sheng cycle between fire and water exists earth and metal. These elements, too, have been affected. The fire in the upper jiao has affected the yin of the metal element reflected in patient’s low energy, hot skin, inability to sweat, heat around chest and nose, etc. The disharmony has also affected the earth and yang of the metal elements resulting in thirst for cold liquids, frontal headaches, gas and bloating, loose stools with undigested food, and scalloped tongue with center cracks.


12. TCM Patterns of Impotence (Therapeutics of Chinese Medicine, by Yan Wu)

PATTENS
DEBILITATION OF LIFE GATE FIRE

KI yang defic

80% Complete or partial impotence, frequent spontaneous seminal discharge, dizziness and vertigo, tinnitus, pale complexion, cold limbs, listlessness, weak aching lower back and legs, frequent urination
T: pale w/ white coat
P: deep thready Ren 4, 2, KI 11
Du 4
UB 23
KI 3
Du 20
UB 31-34 [Ba Liao]

For vacuity of HT/SP add UB 15, HT 7, SP 6 Wu Zi Yan Zong Wan

Zan Yu Dan Also for female infertility
DOWNPOUR OF DAMP HEAT INTO L.J. Flaccidity of penis w/ inability to achieve or sustain erection, accom by premature ejac in most cases; also, sweatiness in scrotum, heavy aching lower limbs, thirst or bitter taste, dark burning urine
T: yellow slimy coat
P: slippery rapid Ren 3
Du 4
SP 6, 9
ST 36
LV 5


If KI yin also, add KI 3 Long Dan Xie Gan Tang





If KI yin also, Zhi Bai Di Huang Wan

Amenorrhea

History:
S is a 32 year old actress and writer with a 16 year history of secondary amenorrhea. She stopped menstruating at 16, when she was also suffering from anorexia nervosa. Over the past two years, she has experienced what she believed to be two menstrual periods. Both took place during visits to Italy – a place she associates with safety and comfort. She also reported eating meat and cheese during these trips, which she does not normally consume. The first period, which took place in July ’98, consisted of four days of spotting (no other details were charted). In late January ’99, she reported having one day of spotting with dark brown blood. During a recent visit to her gynecologist, the doctor explained that her hypothalamus is not functioning properly and she has been taking estrogen and progesterone for the past 4 months to regulate her hormones. Since beginning hormone therapy, the patient has been experiencing strong maternal feelings and a desire to have children, as well as an increased interest in sex.

The patient is simultaneously dealing with several emotional issues associated with repeated childhood sexual abuse and other physical and mental abuse. She reports experiencing a great deal of fear and anxiety as she becomes more social and receives more attention from men. She has also expressed some anxiety about getting her period and becoming a “whole woman”, although more recently she claims that she is ready. Furthermore, the patient has a fear of losing control that manifests itself primarily in her dietary habits. For the past several years she has belonged to a 12-step program for overeaters (“Gray Sheet”), which has put her on a very restricted diet. As part of this program she weighs and measures everything she eats. The patient fears that without these parameters, she might lose control. Recently, she has been attempting to take small steps outside these parameters by eating some of the foods that she craves that are not “on her list” (eg. soybeans, oatmeal), but this can cause acute anxiety.

Current Health Status:
Digestion: Gas and bloating after eating; trouble digesting food – some nausea/gagging
Appetite: ok; craves “mushy” food. Her diet consists largely of soymilk, wheat germ and green salads. Her dietary program permits 4oz of protein per meal (usually as tofu).
Urine: 6x/day; yellow color due to vitamins
Stool: 2x/day; well-formed
Temp: dislikes cold/dry weather
Sweat: not remarkable
Thirst: not particularly; drinks soymilk and several cups of coffee daily
Energy: good, but needs coffee to get motivated; *appears frazzled and manic.
Sleep: generally good; has been having nightmares that she wakes from gasping for air and sometimes screaming; dreams with common themes of empowerment and water.
Emotions: Anxiety related to boundary issues (people getting close, trusting); tends to dissociate and can become “spaced out”. The patient is has been fearful and manic and is inclined to worry obsessively.
Head/Eyes/Ears: Migraines (1-2x/month); throbbing, lateral headaches; better w/caffeine
Menses: amenorrhea (see above)

Past Medical History:
1969 – born jaundiced; blood transfusion after poisoning
1996 – broken ankle (steel plate inserted)
1997 – fainting/dehydration
1998 – steel plate removed
2000 – broken nose due to a fall (fainting)
Herpes (oral)
Frequent colds, nightsweats, dizziness, fainting, palpitations
Brittle bones – due to her eating disorder, the patient has osteopenia.

Family Health History:
None noted

Medications:
estrogen, progesterone

Allergic History:
n/a

Physical Exam:
a. Tongue:body: pale red, puffy, scalloped; concave in lung area
coat: thin white, becoming thicker & yellow towards root veins: normal
b. Facial complexion: yellow complexion, particularly around mouth
c. Body shape and posture: thin/slightly underdeveloped upper body; yellow hands
d. Shen: manic and animated
e. Listening and Smelling: no unusual sounds or smells observed
f. Palpation:
i. Pulse: 56 BPM
Right – slippery and forceful
Left – slippery, less forceful

ii. Abdomen/Channels: tender @ Sp 21, Ren 12, subcostal areas, Sp 4, 6, 9 & Pc 6

Diagnosis: Heart and Kidney failing to communicate; Kidney Essence Deficiency

Kidney Essence Deficiency Heart & Kidney Not Communicating
Amenorrhea for 16 years
Brittle/Broken Bones
Anorexia Thin, underdeveloped upper body
Manic behavior; restlessness
Nightsweats
Palpitations
Profuse dreaming (water themes)
Waking from nightmares gasping for air
Fear and Anxiety
history of sexual abuse




Discussion:
This patient’s pathology is rooted in emotional/physical trauma. As the victim of childhood sexual abuse, this patient suffered significant trauma at an early age, which has compromised the interaction of Heart and Kidney. Because of this, the patient’s insight is no longer rooted in her inherent nature. Without root, she cannot direct her efforts towards her own fulfillment and is constantly seeking answers and finding influences outside her own instincts.

The patient’s will (zhi) focuses externally on trying to control her body and her eating habits. She struggles on a regular basis with what she craves or is instinctually drawn to, choosing instead to direct her will towards adhering to strict dietary regimen that was designed to address an eating disorder that she believes she has. She exercises control by weighing and measuring all of her food, literally depleting her innate potential of jing to satisfy habitual desires of the mind. Over time, her prior anorexia and present diet, which consists primarily of cold and raw foods in very limited quantities, has deprived her of the gu qi/food qi she requires to produce post-heaven qi. Without sufficient gu qi produced by the Spleen, her body tapped into its reserves, using yuan qi or essence from the Kidneys. Deficient Kidney essence has led to brittle bones and the patient is prone to fractures. Her overall constitution has been compromised and she has muscle atrophy and weakness in her upper body. Deficient Spleen qi hinders the Spleen’s functions of properly transforming and transporting food and water, and dampness has accumulated in the patient’s middle jiao, producing gas, bloating and nausea after meals . And since the middle jiao serves as a pivot between the upper and lower jiao, the relationship between the heart and kidney is further compromised. The patient’s slippery pulse is indicative of the excess damp that is accumulating. Her puffy and scalloped tongue body also points to the inability of Spleen to properly nourish muscles and send water downward through the water passageways.

The Chong is the “Sea of Blood” and is strongly related to gynecological and reproductive function. This channel relies on blood produced by the Heart and Spleen and essence from the Kidneys in order to warm and nourish the womb. Overthinking, emotional trauma and lack of nutrients have damaged both Heart and Spleen Qi, preventing them from producing blood. Without sufficient blood and essence, the Chong can no longer nourish the womb and promote reproductive function and the patient cannot get her period.

Heart fire normally descends to warm the kidneys as Kidney water rises to meet with the heart, maintaining a balance of water and fire. When heart fire no longer descends to meet the kidneys, fire flares upward to cause mania and restlessness and frequently manifests as fever blisters around the patient’s mouth. Without its connection to the kidneys, the Heart spirit (shen) wanders and the patient experiences profuse dreams. Frequent dreams of water may be evidence of the heart shen (fire) seeking its link to the kidney (water). The patient wakes from nightmares gasping for air since the Kidneys are also responsible for grasping the Qi. Furthermore, the heart governs intimacy. Without the connection between heart and kidney, the patient appears to long for intimacy in every interaction while simultaneously mistrusting and fearing truly intimate relationships. The kidneys, which are strongly associated with sexuality and reproductive functions, no longer have the guidance of the heart and the patient is threatened by her sexuality. She becomes easily “disconnected” when social interactions overwhelm her.


Treatment Plan:
Secure Kidney Essence; Tonify Heart & Kidney Yin

Prescription:
a. Acupuncture:
Sp 4 Confluent of the Chong - Harmonizes the Chong, Regulates Menses, Rectifies the Qi Dynamic, Supplements the Spleen & Stomach
Pc 6 Confluent of the YinWei –Eliminates Vexation; Calms the Mind; Regulates Heart Qi and blood
Lu 8 Jing River (Metal/horary)
Ki 7 Jing River (Metal/mother) – Tonifies the Kidneys and resolves damp; Tonifies Yin
Du 20 Intersects Yang Channels & Ren – Clears the Spirit & Returns inversion; Tonifies Yang; Calms the Spirit; Raises Yang Qi and brings Clear Qi to the head; Strengthens Ascending Fx of the Spleen
Ren 4 Front Mu of SI; Intersects with SP/LV/KI; Banks the Kidneys & Secures the Root; Supplements Qi and Returns Yang; Warms and Regulates the Blood Chamber and Palace of Essence; Eliminates Cold in the Genitals; Nourishes Blood and Yin; Roots the Ethereal Soul.
Ht 5 Luo – Quiets the Spirit and Regulates Heart Qi; Clears Heart Fire (through urine/UB)

b. Acupuncture Analysis:
This formula focuses primarily on tonifying the Kidneys, calming the heart and restoring blood and yin in the Chong to bring about menstruation. Sp 4 and Pc 6 are used together to open the Chong and have particular functions to regulate the patient’s menses and calm her restless spirit. These points will also tonify her Spleen and redirect rebellious qi, enabling her to digest food better to produce qi and blood. Lu 8, the mother (metal) point on the Kidney’s mother channel, is used with Ki 7, the mother (metal) point on the Kidney channel, to tonify the Kidneys . In addition to tonifying kidney yin, Ki 7 has a special function to regulate waterways and prevent damp accumulation, which is useful since this patient is having digestive difficulties that tend to encourage dampness. Du 20 works with both Pc 6 and Ht 5 towards calming her spirit to address her mania and alleviate her “spaced out” feeling. These points can also help with her dream disturbed sleep. Once the qi has been distributed and tonified, Ren 4 is used to bring her back to center, tonifying her Kidneys, securing essence and supplementing blood in her reproductive organs and warming and calming this patient.

c. Herbs: Tian Wang Bu Xin Dan + Bai Zhu, Xiang Fu, Yi Mu Cao

Herbal Analysis:
The patient’s formula, a moderated version of Tian Wang Bu Xin Dan, is intended to tonify yin and blood of the Heart and Kidneys to soothe the patient’s anxiety and provide nourishment to the Chong to promote menstruation. The formula also addresses and underlying Spleen Qi vacuity and prevents dampness and stagnation with moving and mildly draining herbs.

Tian Wang Bu Xin Dan is a formula designed to tonify Heart and Kidney Yin and reestablish the relationship between the two organs. It’s chief herb, Sheng Di Huang, nourishes both blood and Kidney yin, enabling Kidney (water) to control the heart fire that disturbs the patient’s spirit. Zhu Sha aids in anchoring the spirit, along with Bai Zi Ren and Yuan Zhi, which help soothe the patient and prevent her manic tendencies, palpitations and nightmares. Mai Men Dong, Tian Men Dong and Xuan Shen help to tonify yin and clear deficient heat while Suan Zao Ren and Wu Wei Zi prevent leakage of Heart Qi and work with the yin tonifiers to prevent night sweats and help the patient sleep more soundly. Dan Shen and Dang Gui work together to nourish and move blood to promote menstruation. Ren Shen and Fu Ling also nourish and protect heart qi, but can also tonify Yuan Qi and strengthen the spleen, providing her with both pre-natal and post-natal qi. Fu Ling can also drain some of the dampness that has accumulated due to her spleen deficiency.

Bai Zhu has been added to further tonify Spleen Qi and address dampness. Xiang Fu and Yi Mu Cao work together to move both Qi and blood, particularly in the lower jiao and uterus, to bring about her period.


Subsequent Visits
S reports feeling good following treatment and feeling very “grounded”. She has gradually gained self-confidence and begun to trust her own instincts. She has stopped measuring her food and is attempting to develop healthy eating habits for herself, although she still has a great deal of fear and struggles with a tendency to binge under stress. She began gaining weight as soon as she began to make dietary changes (she was initially slightly underweight), and recently gained significant weight very rapidly due to erratic eating during an exceptionally stressful period. The patient’s complexion is significantly less jaundiced and she is generally less fragmented, although still prone to very manic behavior, particularly when issues related to her childhood abuse surface.

2/22 The patient is experiencing increasing sexual awareness with slightly less anxiety. Feeling empowered
Points: LU 7, KI 6, UB 44,52,47,20, DU 20, KI 1

3/11 Patient has anxiety about weight and body image; lots of creative and sexual energy
Points: DU 20, KI 1 & 7, HT 7, Ren 4 & 6, ST 30

3/21 Patient is scattered and unfocused, reporting breast tenderness for the first time ever with slight spotting. She continues to expand her diet with some anxiety. Patient’s complexion is becoming significantly less yellow and sallow.
Points: SP 4, PC 6, HT 3, KI 7, 6 (open pt), ST 30, GB 41 (ashi), Yin Tang
Ear: Endocrine, Liver

3/25 Period began on Thursday. Flow was initially dark brown and continuous, eventually turning bright red. This is the longest period she has had with a continuous flow. Reports knee aching/pain which extends down to her ankle.
Points: HT 7, KI 7, Zi Gong Xue, LV 8, GB 34, 40, 41, Yin Tang

3/28 Finished period (4 day flow). The patient returned to Gray Sheet for a few days; binged after an argument with her mother regarding critical comments about her weight. Feeling colder; reports some dizziness
Points: DU 20, UB 43, 44, 20, 52, 62 (open pt), SP 6

4/1 Binging issues; abuse issues surfacing. Patient wants to stop taking prozac
Points: HT 1, SP 21, SP 6, KI 7 & 22, Ren 6, SJ 4, Yin Tang

4/7 Increasing self-confidence – spoke out at a Gray Sheet meeting; stopped binging; frontal HA
Points: DU 4, KI 7, DU 20, UB 15,44, 23, 52, 20
Herbs: Modified Tian Wang Bu Xin Dan and Gui Pi Tang
(Sheng Di Huang, Dan Shen, Dang Gui, Ren Shen, Fu Ling, Yuan Zhi, Suan Zao Ren, Long Yan Rou, Mu Xiang, Da Zao, Bai Zhu, Shan Yao, He Huan Hua, Mei Gui Hua)

5/4 The patient gained significant weight over the break, particularly in her lower body, and has been having difficulty with controlling binging urges as more of her abuse issues surface.
Points: UB 44 & 52, DU 4, UB 20 & 21, SP 4

5/12 Period began 5/10, preceded by cramping, irritability and breast tenderness. Brown with clots at onset, turning pink and then red-red; light bleeding, but continuous flow; frontal HA.
Points: HT 3, KI 6, 7, UB 67, Yin Tang
Ear Seeds: Mouth, Stomach, Exciting Pt.

6/4 Peroid began 6/4

* Patient has received her period every month, regularly, since.


TCM Patterns of Amenorrhea
• Liver & Kidney Vacuity – absence of initial menstruation by 18 years old, or late menstruation where the menstrual discharge gradually decreases to the point where menstruation no longer occurs; accompanying symptoms include weak physical condition, low backache, leg weakness, dizziness and vertigo.
• Depletion of Yin & Blood Dryness: gradual decrease in menstrual discharge until menstruation no longer occurs, vexing heat in the five hearts, flushed cheeks, dry mouth and throat, night sweats, steaming bone with a red tongue with little coating and a rapid, thready pulse.
• Qi and Blood Vacuity: gradual lengthening of menstrual cycle, light menstrual discharge of pale color and thin consistency, with the menses eventually ceasing. The patient will have a pale tongue with thin white coat and a weak, thready pulse.
• Qi Stagnation and Blood Stasis: cessation of menstruation, psychological depression, irritability, distension and fullness in the chest and costal region, lower abdominal distension with pain that is aggravated by external pressure. The pulse is deep, wiry and rough and the tongue will be dark purple
• Obstruction by Phlegm Dampness: cessation of menstruation, obesity, fullness and oppression in the chest and costal regions, nausea and vomiting, excessive phlegm, tiredness, fatigue, excessive white vaginal discharge, edema of the face and feet.

Non TCM Pattern
• Heart & Kidney Not Communicating: nightsweats, mouth sores, red tongue with little coating, irritability, restlessness and insomnia the prevents the patient from not getting enough sleep

Case studies

As many people reading these blog posts are not practitioners of Chinese medicine and aren't familiar with the concepts thereof, I thought I'd post a series of case studies to give more of a flavor of the medicine and how I approach diagnosis and treatment.

Many of the case studies I have written, however, are from when I was an intern in medical school, and thus, was just prior to my introduction to Dr. Leon Hammer and Contemporary Chinese Pulse Diagnosis. Nevertheless, many of the concepts I explain are relevant to the work I do today and represents my path within this medicine. I will try to also prepare a few recent cases to demonstrate the depth of the information one can access with pulse diagnosis and Chinese medicine, and how that information can profoundly impact treatment.

As always, I welcome comments (knowing that many of these cases are from the infancy of my career and with a less sophisticated understanding of Chinese medicine).

Spring is here (almost)

Tonight spring has arrived, and as such we are transitioning from the dormancy of winter (water - Kidneys) into a time marking the renewal of life (wood - Liver). Technically, we are not fully there yet, as the 3 week period of time between seasons is mediated by the earth - Spleen/Stomach. The earth phase helps to assure stability in the midst of such dramatic climactic change. And what does it need to buffer?

The springtime (and Liver) are associated with wind. Not just that which we feel on our bodies, or see evidence of moving the trees. Wind is essentially change. Quick change. Change that the body needs to adapt to, or otherwise fall prey to imbalance and sickness. Wind is said to bring in the "hundreds of diseases." It carries in the common cold with all its variations. Should we be unable to defend against it, we get sick. Internal wind makes us dizzy. Without the stability internally, we cannot adapt to the rapid change and we lose our grounding. We become unsteady, uncertain, unable to find our center.

The earth phase helps to buffer the extreme change/wind between the seasons. Moving from dormancy to life requires stability and centeredness. Being careful of what we eat and our digestion during this time is warranted. Starting to move away from winter-fare towards foods that are more alive. Green. Green is the color of spring/wood/Liver.

Something I wrote for a magazine a few years ago on springtime:
In Chinese medicine, every phase (pair of organ systems) has an associated color and energetic seasonal influence. The wood phase (Liver and Gall Bladder systems) is associated with the springtime and the color green. The spring is a time of rebirth or regeneration. It is a time when the reserves protected during the winter are utilized and activated. The growth of the spring gives us hope and directs us towards the future. As such it provides us with a vision and a purpose; it directs us upwards and onwards to grow in the direction of our goals. There is an active, forceful quality to the spring energy. This forcefulness and strength is not hard or rigid, however; it is flexible to accommodate the uncertainty of life.

The color of the wood element and the springtime is green and/or blue-green. It reflects the blooming of flowers, trees and grass. Diagnostically, one can use color to determine the nature of one’s imbalance. For instance, often the color green will manifest most prominently around the lateral aspect of the eyes, between the eyes or around the mouth when an imbalance in the Liver or Gall Bladder is present.

The climate of the spring is windy -- it can bring about rapid and powerful changes. If one’s body is unable to adjust to such change, imbalance can result causing allergies, the common cold, dizziness, skin disorders and other “wind diseases.”

The sound associated with the wood element is "shouting" or "lack of shout." The shout is attributed to the forceful quality of the spring season and the emotion of anger. "Lack of shout" manifests when the wood element is weakened resulting in a person who feels resigned or defeated or unable to express oneself.

The odor of the wood element is rancid. It is the smell of oil or fat that has spoiled. It may also be associated with the bile and oil of the liver.

The emotion of wood is anger. This anger is typically sudden and forceful. When this emotion is not expressed or when the element is weakened, it may manifest as frustration, passive-aggressive behavior, or an abnormal lack of anger. When one’s Liver and Gall Bladder is out of balance, he/she can be overcontrolling and aggressive. This person may be excessively ordered, planning for every contingency, or completely unable to make or execute plans and decisions.

WOOD ELEMENT ORGANS AND THEIR FUNCTIONS

Liver. The functions ascribed to the Liver are: (1) maintaining the smooth flow Qi-energy; (2) storing and detoxifying the blood; (3) controlling the sinews and tendons; (4) influencing the eyes; (5) influencing the nails; (6) controlling the ethereal soul; (7) internally and externally related to the Gall Bladder; (8) responsible for planning and vision of the future.

Gall Bladder. In Chinese medicine, the Gall Bladder (1) stores and secretes bile; (2) is responsible for decision-making, and judgment; (3) assists the Liver in coursing the Qi.

COMMON SYMPTOMS OF THE LIVER AND GALL BLADDER

Physical: hypochondriac pain, red burning eyes, vertex and migraine headaches, hernia pain, stuffiness in chest, feeling something is caught in throat, menstrual cramps and clotting, one-sided symptoms, nail disorders, insomnia, stiff muscles, poor coordination, sciatica (side of leg), lateral ankle or foot pain, dizziness, hypertension.

Emotional/Spiritual: timidity, poor self-esteem, depression, impatience, irritability, intolerance, angry, frustrated and aggressive.

Nurture v. Nature (cont'd)

Recently I was watching a great documentary on multiples in the womb. It highlighted the numerous stages of gestation and the interactions between the brother and sister fetuses while in utero. One of the very intriguing things brought to light was how often one fetus would dominate the other, in terms of obtaining the better position and space and utilizing a higher share of the nutrition. But what is striking is that these behaviors translate once out of the womb. That same sibling who was the aggressor, who took more food and blood, who pushed and shoved to occupy the prime positioning in the womb, would also be more aggressive towards the sibling, more confrontational and bullying, and demanding more attention from parents and caretakers. The reserved sibling would oblige, retreat easily, and overall tend towards more of an introverted personality.

With this information out in the western scientific world, it's not clear to me why so many often disregard the extent to which early life events and traumas can impact one's personality and physiology, emotional and physical well-being. On my website I have a case study on migraines and cluster headaches. In it, the patient had suffered many years before severe head trauma. All the doctors that she consulted for treatment (of which there were many, and some of which were top neurologists) all discounted these traumas as being sufficiently in the past to have no impact on her current situation. Dealing with this trauma with acupuncture and herbs led to rapid relief and cure of her symptoms.

By no means do I intend to negate the effects of genetics and "nature." Clearly, it has a profound impact on us all. But, I think it incumbent on all of us to critically examine our habits, lifestyle, nutrition, significant events in our lives, etc. to see how they have affected us in the past, and more importantly, how they continue to effect us in the present and will affect us in the future.

Nurture v. Nature

This debate has been going on forever. I don't have an answer! But I was recently thinking it very convenient to blame so much of our health problems on genetics. Cancer genes, family histories of heart disease, cholesterol, diabetes, obesity, etc. It seems as if every week we hear of another medical revelation/breakthrough: recently I saw a story on the genetic link between anorexia and twins. (It can't be that they were raised in the same family with similar experiences and trained food habits and attitudes towards food, nourishment and their bodies.) If only we can blame every medical problem we face or are to face in the future on genetics, we can have a vaccine or pharmaceutical to treat everyone and everything. No more responsibility for how we treat our bodies, minds or spirits. No more thought to how we treat the environment. Eat and drink whatever you want and take your few dozen pills daily. It's what the doctor ordered!

The Life of Buddha

A really nice video

An Inconvenient Truth

I can't believe I haven't seen this movie before tonight. I strongly encourage everyone to watch it and to do what they can to implement lifestyle changes to save our planet. This is truly shocking and profound information.

Check out the trailer here:

Dang Gui, Estrogen, Cancer Protection

For years the debate has raged as to whether herbs with estrogenic properties contribute to the formation of cancer and thus should be avoided by those with cancer, those with family histories, or other risk factors. Finally, a study has come out to dispel the fears of estrogenic herbs, and backing millenia-long history of prescribing herbs based on diagnostic need.

Check out this link for more and be sure to click on the "Free Download" to see the actual study.

Living in Accord with Nature (Part II)

My recent trip to Costa Rica reminds me of my post from January regarding living in accord with nature. I am always struck by how well I feel in Manuel Antonio. The minute I get there, until I return back to the states, my energy levels are high, spirit is soaring with an overall feeling of well-being. Perhaps it is how seemless one's experience is with the multitude of living creatures and flora/fauna all around. Things are alive in the jungle, and that life is palpable. A little video of the wildlife is below.

Cloned Animal Products Soon to be on Grocery Shelves

I came across this interesting alert and thought you might be interested. It's from the Organic Consumers Association:

CITIZEN COMMENTS NEEDED
FDA APPROVES FOOD FROM CLONED ANIMALS
Despite a September survey found that 64% of Americans are repulsed by the idea of eating food from cloned animals, the FDA announced this week that milk, eggs and meat from cloned animals will soon be allowed on the market. Ignoring a number of disturbing studies suggesting potential human health hazards, Stephen F. Sundlof, director of the FDA Center for Veterinary Medicine said "that meat and milk from cattle, swine and goat clones is as safe to eat as the food we eat every day." Consumer, food safety, and animal welfare groups have condemned the announcement, pointing out that animal cloning is inherently unpredictable and hazardous, and that the practice of cloning has led to a high number of cruel and painful deformities in the experimental animals' offspring. Recognizing that requiring labels on cloned food would lead to a massive boycott by consumers, FDA bowed to industry lobbyists by stating that there likely will be no required labeling of food products containing ingredients from cloned animals. The FDA's controversial proposed regulations in the Federal Register will now be followed by a three month public comment period. The OCA is calling on health and humane-minded consumers across the nation to stop this outrageous and hazardous regulation from coming into force as federal law.
Take action here: http://www.organicconsumers.org/rd/clones.htm


Take action now at http://www.democracyinaction.org/oca/campaign.jsp?campaign_KEY=6433&t=

Culture Shock

Vacations are a good opportunity for introspection; they help to give you perspective, a chance to critically examine one's current life and lifestyle with those of people's in other locations/countries, and ultimately the life that one wishes for oneself. It's always very inspiring, and I wonder why I don't take more.

I caught a bug in Costa Rica!

All it took was an hour private lesson, and I must admit, I am hooked. Kowabunga!

Video: