The long, frustrating road to healing chronic disease
“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.
I am going to quote a passage from one of the world’s oldest medical texts1, a work that has guided the practice of Chinese Medicine for over two thousand years.
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:
The Lung organ network & resonance with the breath of autumn
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.
WW Podcast episode 13 – Eric & Amanda talk about non-judgment in holistic healthcare
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.
You can access the episode here.
Should you come to your acupuncture appointment when you’ve got a cold?
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!
Treating the common cold with Chinese herbal medicine, or on when not to reach for Yinqiao san
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!
Looking at the effects of testosterone through the lens of classical Chinese medicine
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
Chinese medicine for ankle sprains and other exercise-induced injuries
As spring begins to creep up on us, people flock 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?
Well, first-off, you can come see me to get some care.
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!
An introduction to acupuncture for acute pain
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.
Have you ever tried acupuncture just after an injury or accident? If so – what was the result?
The Effects of Compression: Binding, Chinese Medicine, and You
It’s a dilemma that trans-masculine people know all too well: the need to reduce the painful experience of dysphoria on the one hand, and concerns about longterm health on the other. At first, the decision is easy; we strap down our breast tissue somehow some way, whether with ace bangs, commercially-made binders or compression shirts. The internal alarm bell that goes off when we look into the mirror or down at ourselves quiets, and we finally get some relief. All seems well for weeks, maybe months.
Unavoidably though, a new problem arises: pain.
Where the pain resides exactly depends on the person and the binding method, but it will arise. Compression of our rib case, and the soft tissues beneath, can lead to a wide variety of problems. Rib pain, shortness of breath, dizziness, and even scary chest pain can all becomes staples of daily life during binding.
Let’s examine how to think about this situation using the tools & science of Chinese Medicine. In this way of thinking, the trunk of the body is divided into three compartments, or Jiao. The upper Jiao contains the lungs, heart and pericardium. The middle houses in the liver, gallbladder, stomach and spleen, while the lower is the home of the kidney, bladder and both intestines. The final organ, the Sanjiao or Triple Burner, is a network of water passages that connects all three for the purposes of transport and communication.
In addition to the organs, we also have meridians or Chanels associated with each organs, as well as larger channels that connect all twelve.
The most-often-used metaphor for this system is a watershed that runs through the deepest parts of our bodies, which then consolidates and emerges into broad rivers between the muscles and fascia, finally concluding as small streams at our surface. What a nice metaphor – and it has broad utility. This network, according to Chinese medical theory, carries information, regulates water metabolism, and ensures that homeostasis (the balance inside our body that enables health) is maintained by subtly responding to all of the weird things that happen us throughout our lives.
Given this system’s intricate levels of communication through different kinds of tissues, imagine what might happen if we took the entire thing in the upper and middle Jiao, and squeezed. Not just once, but constantly, every day, during every waking hour and sometimes sleeping hours as well. One can imagine that all sorts of processes could be negatively impacted!
Here are a few of the potential consequences, on this view:
Blood flow: blood is hugely important process that our bodies use to transport nutrients, gasses and yang (life force) from place to place, and its functions are especially associated with the heart, pericardium and liver. If blood flow is impeded, these organs can become either too full of blood (stagnation) or have their blood supply be subtly reduced (deficiency).
Symptoms can include chest pain, pain in the ribs and abdomen, anxiety and depression.
Water metabolism: The spleen, lung and kidney are all important organs that ensure the proper flow of moisture around the body. The kidney is said to seam water up into the upper Jiao, the spleen to transform and transport it from food and drink into the other organs, and the lung to accumulate moisture and then rain it back down to the rest of the body. If the lung becomes physically compressed, moisture can accumulate and build up as phlegm.
Over time, the heat of the body can cook this immobilized phlegm into a hot goo that results in chronic congestion, hot chest pain, cough and anxiety.
Qi transformation: the work of the organs is done around the body by their associated channels, through a process called Qi Hua or Qi transformation. To give one example; the stomach channel carries the hot and drying Qi of the stomach organ up the front of the body to assist with digestion, heat distribution and immune functions.
Cutting down the size of its pathway through the chest can impede its flow, resulting in stomach organ issues like reflux, nausea or vomiting. It can also have implications for our immune systems.
All of the issues that can arise from binding can be treated through acupuncture, herbs, bodywork, and targeted exercise, but their cause is the practice itself. I want to be careful here not to engage in victim-blaming. Many healthcare providers think about this issue and say “yes, my patients should certainly stop binding if it’s causing so many problems!” But that ignores the entire reason that we do it in the first place. Dysphoria is a very real health problem with severe mental health implications.
Binding is often a life-saving act of harm reduction that allows us to life our lives without the constant mental anguish that dysphoria creates.
Surveys of people who bind find that the vast majority of people are doing it while they await the ability to access a surgical solution. Until very recently, top surgery was not covered by insurance and was only available to those who could pay out of pocket. This has begun to change in some states, but remains the case for most people. Therefore we should remember that binding is a self-preserving response to a societally-imposed scarcity of medically-necessary healthcare.
While we engage in the activism needed to change this, here are some harm reduction strategies to consider:
- Stretch it out: engage in stretching poses that open the chest and ribs, for at least five minutes a day
- Build strength: strengthening the muscles of the back and chest may help hold the body of your ribcage in place and protect them from the longterm effects of compression
- Move your body: qi and blood move when we do, and exercise of any kind helps prevent stagnation. Depending on how you bind, running may not be a great plan, but walking is wonderful for both our bodies and our moods.
- Get some acupuncture: we can reduce stagnation and pain by unblocking channels and moving qi and blood in targeted ways
- Take some herbs: chest stagnation and digestive issue in particular respond well to Chinese herbals formulas
- Listen to your body: only you can know what is right for you in terms of when to bind, how to move, and how to balance all of the considerations in your life.
Above all, be gentle with yourself as you navigate the complexities of trans experience. If you want support in your journey, schedule an appointment and let's see how we can work together.
How to Prepare for Top Surgery Like a Pro (with a little help from Chinese medicine)
Top surgery, like so much of trans healthcare, is a subject about which much information in desired, but little is available from trusted sources. Every surgeon has their own particular instructions on how to prepare and heal, and most of them do not have good websites. I personally don’t know how anyone transitioned before the advent of YouTube (I guess talking to other people in real life?), but random people in the internet may or may not be good sources of knowledge about a complex medical procedure.
To help solve this problem, I want to offer some basic information about how Chinese Medicine thinks about surgery in general, and top surgery in particular, and then outline some basic steps that you or a loved one can take to have the best possible experience.
First of all, what do we really mean by the term top surgery? This is really an umbrella term for a few different procedures that reconstruct a person’s chest to have a flat appearance, if that person has grown breast tissue that they do not want. Most people who undergo such procedures are trans-masculine and non-binary people. Broadly speaking, there are two categories of surgeries: the kind that use long incisions to remove tissue and re-size nipples, and those that use only a small incision near the nipples. The first kind is used for most people who have a B cup or larger, which the second is reserved for those who have a small amount of tissue to remove. While the procedures involving only liposuction and a small incision are less invasive that those where more tissue is cut away, they both require recovery time and can be hard on the body.
A key thing to know about surgery is that the body does not really differentiate between a surgical procedure and a stab wound.
A surgical cut is much cleaner than the average wound, and is closed with staples or sutures to increase the speed and comfort of the body’s repair cycle, but it stills goes through all of the regular stages of the healing process.
In Chinese Medicine, all wound healing has three basic stages:
- First stage wounds and injuries are characterized by heat, severe pain, and swelling. This stage can last anywhere from a few hours to several days, depending on the severity of the wound. In this stage, we want to help the body clear away the damaged tissue, which we consider a form of toxicity, and dispel the heat of the inflammation. We use cooling, fluid moving and blood moving herbs, either internally or topically, to help this stage resolve as quickly as possible.
- The second stage begins when the heat in the injury subsides. There is still Qi and blood stagnation in this stage, as the body continues to mobilize resources into the area, and this congestion can cause stiffness and pain. This stage is where the incisions begin to consolidate into the beginning of scars, and we want to keep Qi and blood moving so that all incisions heal quickly and with minimal pain.
- Third stage healing is the cleanup phase, where all incisions have fully closed and scarred, but there can be lingering pain and stiffness, and sometimes numbing or other odd sensations. A fresh wound is vulnerable to the environment, particularly to dampness and cold, because the skin is open and Qi and blood are not not circulating normally in the area. If dampness or cold become lodged in the tissue, chronic pain and stiffness can result. Is this stage we focus more on using herbs that warm tissue and expel cold and dampness, as well as moving Qi and blood.
The body does an excellent job of rebuilding itself after being damaged, and our goal with natural medicine is to help modulate the body’s actions and make them as efficient as possible. The third stage of healing need not become chronic, so long as the first two stages are managed well. However, if there are complications then chronic symptoms can arise.
A variety of issues can arise as a result of even uncomplicated surgeries.
First, scarring. Sometimes people’s scars are larger or most noticeable than they would like. This can occur from moving the arms too much during the first few weeks after surgery, and sometimes can just happen even if utmost care is being taken. Life happens. Keloids can also occur, and may be more likely to form in those with darker skin. A keloid is a hard growth of scar tissue that is raised, hard, and smooth. It is not dangerous or malignant, but it can be more noticeable than non-keloid scar tissue. Most scaring is considered an issue of blood stasis in Chinese Medicine.
Second, restricted movement. If scars do not heal well, movements involving raising the arms or turning to the side can become more difficult because of the pulling effect. Qi and blood stagnation in the channels that were cut into is usually also involved.
Third, numbness/loss of sensation: some surgical methods involve cutting the nerve stalk that connects the nipples to the rest of the nerve structure of the chest. This causes of loss of sensation, and can also lead to numbers or tingling in other parts of the chest in some cases. This is often due to dampness or wind that has sneaked into the area, and become a third-stage problem. And fourth, pain. Pain from surgical wounds can persist beyond full healing. This is generally, but not always, seen along with some numbness or loss of sensation.
Acupuncture and Chinese herbs can treat all of these issues, even years later. A combination of herbs, acupuncture, gentle movement and appropriate dietary adjustments can continue the healing process in gentle, but effective ways. However, the goal of this article is to help you reduce the chances of any of those things from happening in the first place! With that goal in mind, here are some steps that you can take to prepare your body for surgery and recover well.
- Take good care of yourself in general. Eat nourishing foods, get plenty of sleep, and exercise in ways that feel good to you. The better you feel before surgery, the better you will feel afterwards.
- Take some herbs. Much of the difficulty in healing from surgery comes from the blood loss inherent in the process. Taking herbs that help build blood prior to the procedure gives the body the most resources possible to do the job.
- Treat any underlying health concerns. If you have digestive problems, breathing issues, chronic pain, or anything else that is really bothering you, surgery is going to add stress. Most people get a date far in advance, so plan ahead and access as much care as you can beforehand.
- Supplement strategically. Vitamin C, Zinc and Selenium are all involved in the process of synthesizing collagen, which is the main building block of new tissue in our bodies. They are cheap individual supplements to buy, and you can take them in the weeks leading up to the procedure, and then start again a few days after.
- Take some herbs, again. Faster and less painful healing is a huge win. We like to prescribe Wangbuliuxing Tang (Vaccaria Seed formula) 2 weeks before and 2 weeks after surgery. This is an
herbal formula traditionally used to treat cuts from knives. It speeds things up by moving blood and fluid, and treats pain quite well.
- Get some acupuncture. Acupuncture treats pain, reduces swelling, decreases scarring, and helps people recover emotionally from the difficult experience of a medical procedure.
- Follow the instructions of your surgeon. When they say not to lift heavy things, please listen. Ditto for raising your arms. Try to set up your living area so that everything is at waist height, and ask for help if you can’t reach something. Your future self will thank you.
Lastly, I want to say a bit about the emotional experience of top surgery.
As I said earlier in this article, our bodies don’t really know the difference between an on-purpose surgery and a stabbing. This is also pretty true of our minds/psyche/spirit. Mentally, we may be excited about one and fearful of the other, but a sharp metal object is piercing our skin either way. This is important to understand, not only to frame the steps of healing, but also to put into context the feelings that can arise after going under the knife. People are generally quite happy to be in a body that feels more aligned with their felt sense of themselves, but there can also be powerful feelings of helplessness, fear and even anger that arise after waking up covered in bandages and in pain.
Bearing this in mind, it helps to do everything that you can to create a cozy and loving environment for yourself or your loved one to settle into once they leave the surgery center or hospital. Comforting foods, movies, careful snuggles and pet friends can all help people return from the experience more quickly and fully. Give yourself space to feel whatever you feel, and know that the scary stuff will pass.
Much thanks to Hamilton Rotte, who provided the bulk of the information about the three stages of injury healing. More information about his work can be found by clicking this link.