Acupuncture for Hot Flushes in Menopause

158px-Ase_o_fuku_onna2Problems at the time of or prior to menopause are often seen in the acupuncture clinic, come in for a consultation to see if treatment can help you.

A study by The Journal of Alternative and Complementary Medicine concludes that, “Acupuncture is an integrated system that includes therapeutic techniques such as diet therapy and Tuina self-massage can be used to treat hot flushes and selected symptoms in postmenopausal women.”

http://www.ncbi.nlm.nih.gov/pubmed/24827469

The results showed that “Treatment with acupuncture significantly reduced the occurrence of hot flushes and sudden sweating (p<.001). Other symptoms (sleep disorders, tightness in the chest, irritability, bone pain, feeling depressed) significantly improved.”

Fibromyalgia and Traditional Chinese Medicine

Traditional Chinese Medicine (TCM) considers every individual to be unique and therefore any illness they have will be unique to them. This is particularly noticeable in fibromyalgia as patients often have differing signs & symptoms and varying levels of impairment.

I see patients with signs & symptoms of widespread musculoskeletal pain and tenderness, sleep disturbance, anxiety and low mood, etc. that have been diagnosed by their GP or consultant with fibromyalgia. It occurs to me that many of these patients also have signs similar to chronic fatigue syndrome (CFS); in fact I wonder if sometimes fatigue and sleep disturbance are a precursor to fibromyalgia.

TCM considers one cause of fibromyalgia and to some extent CFS to be due to a previous and unresolved invasion of external pathogenic factors; in a Western sense these might be seen as bacterial or viral infections. Particularly problematic are reoccurring infections often over many years that never seem to fully clear and are perhaps treated inappropriately with long courses of antibiotics or steroids. Other important factors that may cause or contribute to fibromyalgia are emotional stress, irregular diet and excessive physical work.

TCM views fibromyalgia as both deficient and excess in nature. Underlying deficiencies such as Blood, Yin and Yang deficiency ultimately lead to excess conditions such as Dampness and Qi & Blood stasis. It is the deficiencies that tend to feed the condition and cause the fatigue, and the excesses that tend to cause the pain.

TCM Treatment of Fibromyalgia

In my clinical experience I have found cupping therapy to be a good treatment for fibromyalgia. Although many patients find physical treatment painful and in some cases even find the touch of their clothes painful, they actually find cupping pleasant and helpful. My observations are supported by a 20111 study that concluded cupping to be beneficial in the treatment of fibromyalgia by reducing pain and the number of tender areas.

Subject to an in depth consultation and TCM pattern diagnosis I usually find a threefold treatment plan offers the best results:

Acupuncture and moxibustion to address the underlying deficiencies and to calm the mind of anxiety and low mood.

Dietary changes based on TCM food energetics to further address deficiencies and resolve Dampness.

Cupping therapy to move stagnation, ease pain and reduce symptoms.

Depending on the patient, their particular issues and their TCM diagnosis treatment is often weekly for some time and then monthly to maintain improvement. Due to the nature of fibromyalgia some patients find that they come for treatment only when they feel they need it.

Cupping Therapy

Fire cupping for fibromyalgiaCupping is an established and ancient treatment skill still very popular around the world today. I favour fire cupping using glass cups. Just before the cup is placed on the skin a flame is held momentarily in the cup to cause a slight vacuum. Once on the skin the cup remains in place due to the vacuum and can be left in one place (static cupping) or slid about (sliding cupping). Cupping has a strong therapeutic effect on the treatment area and the underling tissues and organs.

Studies

In 20111 the centre for evidence based Chinese medicine at Beijing University concluded in a study of 30 fibromyalgia patients that cupping therapy was associated with a reduction in symptoms for both pain ratings and number of tender points.

A 20052 clinical trial from the Mayo Clinic concluded that acupuncture lessened fibromyalgia pain, fatigue and anxiety.

The 20033 World Health Organisation (WHO) report on the efficacy of acupuncture concluded that acupuncture has a therapeutic effect on Fibromyalgia.

References:

1Cao H, Hu H, Colagiuri B, Liu J. Medicinal cupping therapy in 30 patients with fibromyalgia: a case series observation. Forsch Komplementmed 2011; 18: 122- 126.

2Martin, D. Mayo Clinic Proceedings, June 2006; vol 81: pp 749-757.

3WHO (2002): Review and Analysis of Reports of Controlled Clinical Trials

Healthy Eating

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kohlrabi vegetableIntroduction

The following is general advice for healthy eating; it is based on empirical evidence gained over thousands of years through the practice of Chinese medicine and my own clinical observations. This advice holds true for many people however in some circumstances you may need to follow different dietary advice, so please seek a proper *pattern diagnosis.

Diet has a fundamental and profound effect on our physical and emotional wellbeing and I believe that even moderate changes in the way we eat, drink and think about our food plays a significant and important role in our wellness and treatment of disease. The correct diet based on your pattern diagnosis will often enhance the effectiveness of other treatments such as acupuncture and lead to improved health.

Brief Dietary Advice

In general in the UK we tend to eat too much dairy and cold raw food such as salads and sandwiches, we also have a diet high in sugar from hidden sources such as juice drinks, breakfast cereals, processed foods and high glycaemic carbohydrates. Most of us would benefit from more variety in our diet and reducing our portion sizes.

The following rules would be healthy for most of us, particularly when the patterns of ‘Spleen Qi Deficiency’ or ‘Dampness’ are indicated by signs and symptom like a propensity to worry or over-think, a tendency to low moods, tiredness, loose stools, a feeling of bloating after eating, a feeling of weak limbs, a tendency to obesity or even being overly thin.

  • Avoid or reduce bananas, oranges and non-organic yoghurts
  • Avoid or reduce dairy food, particularly cheese, ice cream and cows’ milk (goats’ milk is a good alternative)
  • Eat in moderation, chew well and stop eating just before you feel you are full
  • Substantially reduce sugar intake including reducing or stopping fruit juice and cordials, and processed carbohydrates such as white pasta and white bread
  • Favour warm cooked foods, i.e. whole wheat rolled oats porridge made with water for breakfast (some fruit or raisins may be added for extra sweetness) instead of cold cereal, sugar and cows’ milk
  • Enjoy your water at room temperature or slightly cool (not cold from the fridge) and sip it throughout the day rather than gulping it down in large quantities
  • Avoid drinking too much while eating
  • Enjoy a variety of good quality organic green tea (preferably not supermarket tea bags), Jasmin tea in moderation is particularly good for warming the Spleen and resolving Dampness
  • Avoid drinks containing Aspartame and other artificial or alternative sweeteners
  • Avoid eating too near to bed time; allow about 4 hours before your last meal and bed
  • Eat in a relaxed way, not rushed while working or worrying
  • Savour and enjoy your food

Further Reading

I can recommend in no particular order three excellent books on diet and Chinese medicine which give the reader a good understanding of basic *patterns of disharmony and how to put into practice a healthy diet:

  1. Recipes for Self-healing, Daverick Leggett, Meridian Press, ISBN: 0952464020
  2. Helping Ourselves A Guide To Traditional Chinese Food Energetics, Daverick Leggett, Meridian Press, ISBN:0952464004
  3. The Tao of Healthy Eating: Dietary Wisdom According to Traditional Chinese Medicine, 2nd edition, Bob Flaws, Blue Poppy Press, ISBN: 0936185929

Starting on Page 4 of this document is an extract from the 1st edition of Bob Flaws’ book that offers a very good explanation of how Chinese medicine considers the digestive process. Reading and understanding these processes will greatly enhance your understanding of the importance of diet and the TCM function of the Spleen and Stomach.

Another excellent source of information, particularly for pregnant women or women undergoing fertility treatments is at Debra Betts’ site http://acupuncture.rhizome.net.nz under the ‘Dietary Therapy’ section.

The Five Flavours and Energetic Nature

Chines medicine categorises food by its energetic effects rather than its calorific value. Some foods are warming and nourishing while others are cooling and eliminating; some foods strengthen Qi while others nourish Blood, Yin or Yang. Cold foods such as milk and bananas are problematic for people with Yang Deficiency or Dampness, but (in moderation) are beneficial for people who are Yin Deficient. So depending on your state of health, effectiveness of your digestive system and your constitution you should favour eating nourishing healthy foods that are right for your individual body type and *pattern diagnosis.

Chinese medicine groups all foods by the five flavours, Salty, Sour, Bitter, Sweet, Pungent and their energetic nature, Hot, Warm, Natural, Cool, Cold:

Salty Flavour e.g. Kelp, Seaweed, Soya Sauce, Leek

Salty relates to the water element and the Kidneys. Salty moistens and purifies, softening the hardening of muscles and glands. It regulates the body’s water balance, promotes digestion and improves mental concentration. In small amounts it nourishes the quality of the Blood but too much salty flavour can cause Blood to stagnate and stress the Heart.

Sour Flavour e.g. Grapefruit, Olives, Lemon, Raspberry

Sour relates to the wood element and the Liver. Sour stimulates contraction and absorption and controls conditions involving loss of body fluids such as haemorrhage, diarrhoea and sweating. It counters the effects of fatty foods, checks stagnation and benefits digestive absorption. It stimulates the gall-bladder and pancreas and despite its acid nature usually lowers the acidity of the intestines. Sour flavours support the Spleen’s function of containment and give tone to the tissues. It invigorates Blood and eliminates stagnation, but as with most things only when taken in moderation, too much can cause tightness and over-retention of moisture.

Bitter Flavour e.g. Rye, Chicory, Thyme, Rhubarb, Dandelion Leaf

Bitter relates to the fire element and the Heart. Bitter travels downward through the body draining and drying. It stimulates digestion and improves appetite, and draws out Heat and Dampness. Bitter flavours reduce excess and therefore should be restricted in cases of Cold or Deficiency. Bitter acts on the Heart but also benefits the Lung. Too much bitter flavour can deplete qi and moisture.

Sweet Flavour e.g. Pumpkin, Rice, Beef, Potatoes, Dairy, Apples

Sweet relates to the earth element and the Spleen. Sweet is the most common flavour and to some extent it is found in all foods; it harmonises all the other flavours and is central to our diet. Sweet treats deficiency and is tonifying and strengthening, gently stimulating the circulation of Qi and Blood. Sweet is moistening and benefits dryness, however in excess (common in our modern society) it leads to Dampness, Phlegm and Heat. Refined sugars, sweetening chemicals and foods processed to produce sweetness should be avoided as they can engender pathogens and weaken Blood.

Pungent flavour e.g. Onion, Cayenne Pepper, Ginger, Garlic, Peppermint

Pungent relates to the metal element and the Lung. Pungent disperses stagnation and promotes the circulation of Qi and Blood. It stimulates digestion and helps breakdown phlegm. Hot pungents such as horseradish and chilli are extreme and will eventually cool the body due to sweating. Warm pungents such as cloves and nutmeg have a longer lasting effect helping to warm Cold conditions. Cool pungents such as echinacea and mint can be used in cases of Heat. Dampness and Stagnation often arise due to an underling deficiency and although pungents can help resolve Dampness and move Stagnation an excess of pungents can exhaust Qi and Blood, so pungents frequently need to be supported by a tonifying diet.

Energetic Nature

The flavour of foods remains unchanged during cooking, for instance a potato is considered Sweet and in moderation Tonifies Qi and Blood. However, we can change the Nature of the food through its preparation and most of us would benefit from Boiled, Stir-Fried or Stewed foods as these are unlikely to be too cooling or warming. Cold foods should be avoided where there is a Cold diagnosis such as Yang deficiency or Spleen Qi Deficiency, and Warm foods should be moderated where there is excess heat such as might be seen in eczema or heartburn. In general those with digestive problems should favour Neutral preparation.

Preparation from coldest to hottest effects food as follows:

Raw Cooling
Steamed Cooling/Neutral
Boiled Neutral
Stir-Fried Mildly Warming
Stewed Warming
Baked More Warming
Deep-Fried Heating
Barbecued More Heating
Grilled More Heating
Roasted Most Heating

For most of us a balanced diet should include regular use of all Flavours in moderation, with the Sweet Flavour taking the central position. Particular Flavours can be increased, decreased or avoided based on our individual needs or our *pattern diagnosis. We can include more Warming foods for those with Cold conditions, and more Cooling foods for those with Heat conditions. People with weak digestive processes should avoid Raw foods as these are the most difficult to digest and may lead to deficiency of Qi and Blood and the engendering of Dampness.

Extract From Bob Flaws’ Book

Printed below is an extract [sic] from Bob Flaws’ book ‘The Tao of Healthy Eating: Dietary Wisdom According to Traditional Chinese Medicine , 1st edition’. The 2nd edition of his book includes additional material and rewrites such as, not one, but several healthy eating pyramids for different dietary styles, new discussions of the modern Western diet, trans-fats, corn syrup, pesticides, and chemical additives, recipes for specific pattern discriminations and a concise history of Chinese dietary therapy.

“The Process of Digestion

In Chinese, the digestive system is called the xiao hua xi tong. The words xi tong simply mean system but the words xiao and hua are more pregnant with meaning. Xiao means to disperse and hua means to transform. In Chinese medicine, digestion equals the dispersion of pure substances to be retained and impure substances to be excreted after these have undergone transformation. Therefore, the digestive tract is called the xiao hua dao or pathway of dispersion and transformation. In TCM we mostly describe the process of digestion in terms of the functions of the Chinese stomach and spleen. Once one understands the functions of the stomach-spleen according to TCM theory, Chinese dietary theory becomes very clear and logical.

Three Burners

The stomach and spleen are a yin yang pair. The stomach is one of the six hollow bowels and is relatively yang. The spleen is one of the five solid organs and is relatively yin. The stomach’s function is to receive food and liquids and to ”rotten and ripen” these. In Chinese medicine, the stomach is likened to a pot on a fire. As mentioned in the previous chapter, all physiological transformations in Chinese medicine are warm transformations. The body is seen as three alchemical retorts. These are called jiao or burners. There is an upper burner containing the heart and lungs, a middle burner containing the stomach and spleen, and a lower burner containing the kidneys, intestines, liver, and reproductive organs.

The Stomach as a Pot

The stomach is the pot of the middle burner and the spleen is both the fire under this pot and the distillation mechanism to which this pot is attached. Just as a mash rottens and ripens in a pot, so foods and liquids rotten and ripen within the stomach. In Chinese medical terms, this means that, as foods and liquids rotten and ripen, the pure and impure parts of these foods and liquids are separated or come apart. It is then the spleen’s function to distill or drive off upwards the purest parts of foods and liquids, sending the pure part of foods up to the lungs and the pure part of liquids up to the heart. The pure part of foods or the five flavors become the basis for the creation of qi or vital energy within the lungs. The pure part of liquids becomes the basis for the creation of blood within the heart. The sending up of the pure part of the foods and liquids by the spleen is called ascension of the clear.

The stomach then sends down the impure part of foods to be further transformed by the large intestine and the impure parts of liquids to be further transformed by the small intestine. In Chinese medicine, the large intestine’s function is to reabsorb the pure part of the impure foods or solids. This becomes the postnatal or latter heaven fuel for kidney yang or the life fire. The small intestine’s function is to reabsorb the pure part of the impure parts of liquids. This is transformed into the body’s thick liquids, such as cerebrospinal and intra-articular fluids, and nourishes postnatally kidney yin. The large intestine conducts the impure of the impure solids down and out of the body as feces. The small intestine conducts the impure of the impure liquids to the bladder from whence they are excreted as urine. This sending down of the impure part of foods and liquids initiated by the stomach is called the descention of the turbid.

Therefore, in Chinese medicine, digestion is spoken of as the separation of the clear (qing) and turbid (zhuo) This separation is dependent upon the qi hua or energy transformation of the middle burner or stomach/spleen and upon the spleen qi’s ability to transport or yun foods and fluids. Hence, Chinese spleen function is summed up in the two words yun (transportation) and hua (transformation). Yun hua is the older, more traditional form of the modern term xiao hua.

The analogy of the cooking pot is very important. It is said in Chinese that the stomach fears or has an aversion to dryness. In other words, stomach function is dependent upon the creating of a mash or soup in its cauldron or pot. It is also said in Chinese that the spleen fears dampness. Since spleen function is likened to a fire under a pot distilling the essence from the mash held in the stomach, it is easy to understand that too much water or dampness can douse or injure that fire.

Using this analogy, it is simple and crucial to understand that the digestive process, according to Chinese medicine, consists of first creating a 100°F soup in the stomach, remembering that body temperature is 98.6°F. Whatever facilitates the creation of such a 100° soup in the stomach benefits digestion and whatever impedes or impairs the creation of a 100° soup in the stomach impedes or impairs digestion. This is basically true even from a Western medical perspective. Most of the insights and principles of Chinese dietary theory and therapy are logical extensions of this commonsense and irrefutable truth.

The Implications of this Process

Cooked vs. Raw Foods

First of all, TCM suggests that most people, most of the time, should eat mostly cooked food. Cooking is predigestion on the outside of the body to make food more easily digestible on the inside. By cooking foods in a pot on the outside of the body, one can initiate and facilitate the stomach’s rottening and ripening in its pot on the inside of the body. Cold and raw foods require that much more energy to transform them into warm soup within the pot of the stomach. Since it takes energy or qi to create this warmth and transformation, the net profit from this transformation is less. Whereas, if one eats cooked foods at room temperature at least or warm at best, less spleen qi is spent in the process of digestion. This means that the net profit of digestion, i.e., qi or energy, is greater.

The idea that eating cooked food is more nutritious than raw food flies in the face of much modern Western nutritional belief. Because enzymes and vitamins are destroyed by cooking, many people think it is healthier to eat mostly raw, uncooked foods. This makes seeming sense only as long as one confuses gross income with net profit. When laboratory scientists measure the relative amounts of cooked and raw foods, they are not taking into account these nutrients’ post-digestive absorption.

Let’s say that a raw carrot has 100 units of a certain vitamin or nutrient and that a cooked carrot of the same size has only 80 units of that same nutrient. At first glance, it appears that eating the raw carrot is healthier since one would, theoretically, get more of that nutrient that way. However, no one absorbs 100% of any available nutrient in a given food. Because the vitamins and enzymes of a carrot are largely locked in hard to digest cellulose packets, when one eats this raw carrot, they may actually only absorb 50% of the available nutrient. The rest is excreted in the feces. But when one eats the cooked carrot, because the cooking has already begun the breakdown of the cellulose walls, one may absorb 65% of the available nutrient. In this case, even though the cooked carrot had less of this nutrient to begin with, net absorption is greater. The body’s economy runs on net, not gross. It is as simple as that. Of course, we are talking about light cooking, and not reducing everything to an overcooked, lifeless mush.

This is why soups and stews are so nourishing. These are the foods we feed infants and those who are recuperating from illness. The more a food is like 100° soup, the easier it is for the body to digest and absorb its nutrients. The stomach-spleen expend less qi and, therefore, the net gain in qi is greater. This is also why chewing food thoroughly before swallowing is so important. The more one chews, the more the food is macerated and mixed with liquids, in other words, the more it begins to look like soup or a stew.

Cold Food & Liquids

As a corollary of this, if we drink or eat chilled, cold, or frozen foods or drink iced liquids with our meals, we are only impeding the warm transformation of digestion. Cold obviously negates heat. And water puts out fire. This does not mean that such food and liquids are never digested, but it does mean that often they are not digested well. In Chinese medicine, if the stomach-spleen fail to adequately transport and transform foods and liquids, a sludge tends to accumulate just as it might in an incompletely combusting automobile engine. This sludge is called stagnant food and dampness in Chinese medicine.

Dampness & Phlegm

If the solid portions of food are jam-packed into the stomach or their digestion is impaired by cold and chilled foods and liquids or if too many hard to digest foods are eaten, stagnant food may accumulate in the stomach. The stomach tries all the harder to burn these off and becomes like a car stuck in overdrive. It becomes hotter in an attempt to burn off the accumulation. This often results in the stomach becoming chronically overheated. This, in turn, causes the stomach to register hunger which, in Chinese medicine, is a sensation of the stomach’s heat. This hunger then results in eating more and more and a vicious loop is created. Overeating begets stagnant food which begets stomach heat which reinforces overeating. Further, persistent stomach heat may eventually waste stomach yin or fluids causing a chronic thirst and preference for cold drinks and chilled foods.

If the liquid portions of food and drink jam the transporting and transforming functions of the spleen, what is called the qi ji or qi mechanism in Chinese, these may accumulate as dampness. This plethora of water inhibits the spleen qi’s warm transforming function in the same way that water inhibits or douses fire. Over time, this accumulated dampness may mix with stagnant food and congeal into phlegm which further gunks up the entire system and retards the flow of qi and blood throughout the body.

Different people’s digestion burns hotter than others’ Those with a robust constitution and strong ming men or fire of life tend to have a strong digestion. These people can often eat more in general and more chilled, frozen, hard to digest foods without seeming problems. Likewise, everyone’s metabolism runs at different temperatures throughout the year. During the summer when it is hot outside, we generally can eat cooler foods and should drink more liquids.

However, even then, we should remember that everything that goes down our gullet must be turned into 100° soup before it can be digested and assimilated.

Post-digestive Temperature

In Chinese medicine, there is an important distinction made between the cold physical temperature of a food or drink and a food or drink’s post-digestive temperature. Post-digestive temperature refers to a particular food or drink’s net effect on the body’s thermostat. Some foods, even when cooked, are physiologically cool and tend to lower the body’s temperature either systemically or in a certain organ or part. In Chinese medicine, every food is categorized as either cold, cool, level (i.e., balanced or neutral), warm, or hot. Most foods are cool, level, or warm and, in general, we should mostly eat level and warm foods since our body itself is warm. Life is warm. During the winter or in colder climes, it is important to eat warmer foods, but during the summer we can and should eat cooler foods. However, this mostly refers to the post-digestive temperature of a food.

If one eats ice cream in the summer, the body at first is cooled by the ingestion of such a frozen food. However, its response is to increase the heat of digestion in order to deal with this cold insult. Inversely, it is a common custom in tropical countries to eat hot foods since the body is provoked then to sweat as an attempt to cool itself down. In China, mung bean soup and tofu are eaten in the summer because both these foods tend to cool a person down post-digestively. If we are going to eat cold and frozen foods and drink iced, chilled liquids, it is best that these be taken between meals when they will not impede and retard the digestion of other foods.

Many Westerners are shocked to think that cold and frozen foods are inherently unhealthy since they have become such an ubiquitous part of our contemporary diet. However, chilled, cold, and frozen foods and liquids are a relatively recent phenomenon. They are dependent upon refrigeration in the marketplace, refrigeration during transportation, and refrigeration in the home. Such mass access to refrigeration is largely a post World War II occurrence. That means that, in temperate zones, people have only had widespread access to such foods and drinks for less than 50 years. 50 years is not even a blink on the human evolutionary scale.

Dampening Foods

Not only do foods have an inherent post-digestive temperature but different foods also tend to generate more or less body fluids. Therefore, in Chinese medicine, all foods can be described according to how damp they are, meaning dampening to the human system. Because the human body is damp, most foods are somewhat damp. We need a certain amount of dampness to stay alive. Dampness in food is yin in that dampness nourishes substance which is mostly wet and gushy. However, some foods are excessively dampening, and, since it is the spleen which avers dampness, excessively damp foods tend to interfere with digestion.

According to Chinese five phase theory, dampness is associated with earth. Fertile earth is damp. The flavor of earth according to Chinese five phase correspondence theory is sweet. The sweet flavor is inherently damp and also is nutritive. In Chinese medical terms, the sweet flavor supplements the qi and blood. Qi is energy or vital force and blood in this case stands for all body fluids. Therefore, the sweeter a food or liquid is, the more damp it tends to be.

When one looks at a Chinese medical description of various foods, one is struck by the fact that almost all foods are somewhat sweet and also supplement qi and blood. On reflection, this is obvious. We eat to replenish our qi and blood. Therefore it is no wonder most foods are somewhat sweet. All grains, most vegetables, and most meats eaten by humans are sweet no matter what other of the five flavors they may also be. This sweetness in the overwhelming majority of foods humans regularly eat becomes evident the more one chews a food.

A modicum of sweetness supplements the body’s qi and blood. It is this flavor which gathers in the spleen and provides the spleen with its qi. However, excessive sweetness has just the opposite effect on the spleen. Instead of energizing the spleen, it overwhelms and weakens it. This is based on the Chinese idea that yang when extreme transforms into yin and vice versa. When the spleen becomes weak, it craves sweetness since that is the flavor which strengthens it when consumed in moderate amounts. However, if this craving is indulged in with concentrated sweets, such as sugar, this only further weakens the spleen and harms digestion. Thus, another pathological loop is forged in many people.

Going back to dampness, the sweet flavor engenders dampness and the sweeter a food is the more dampening it is. According to Chinese medicine, this tendency is worsened when the sweet flavor is combined with sour. Therefore, Chinese medicine identifies a number of especially dampening foods. These include such sweet and sour foods as citrus fruits and juices and tomatoes, such concentrated sweets as sugar, molasses, and honey, and such highly nutritious foods as wheat, dairy products, nuts, oils, and fats.

Highly nutritious foods are those which have more wei than qi. All foods are a combination of qi and wei. In this context, qi means the light, airy, aromatic and yang part of a food. Whereas, wei, literally meaning taste, refers to a food’s heavier, more substantial, more nourishing, yin aspects. Highly nutritious foods, such a dairy products, meats, nuts, eggs, oils, and fats are strongly capable of supplementing the body’s yin fluids and substances. However, in excess, they generate a superabundance of body fluids which become pathologic dampness. Although to some this may appear a paradox, it has to do with healthy yin in excess becoming evil or pathological yin or dampness, phlegm, and turbidity.

It is also easy to see that certain combinations are even worse than their individual constituents. Ice cream is a dietary disaster. It is too sweet, too creamy, and too cold. Ice cream is a very, very dampening food. Pizza is a combination of tomato sauce, cheese, and wheat. All of these foods tend to be dampening and this effect is made even worse if greasy additions, such as pepperoni and sausage, are added. Tomato sauce bears a few more words. It is the condensed nutritive substances of a number of tomatoes. Therefore it can be especially dampening.

In the same way, drinking fruit juices can be very dampening. Fruit and vegetable juices are another relatively modern addition to the human diet. Prior to the advent of refrigeration as discussed above, juices would turn into wine or vinegar within days. Therefore, when they were available in traditional societies, they were an infrequent treat. Now we have access to tropical fruits and juices thanks to refrigeration and interstate and intercontinental transportation. However, we should bear in mind that we would not eat 4-6 oranges in a single sitting nor every day. When we drink a glass of orange juice, tomato juice, apple juice, or carrot juice, that is exactly what we are doing. We are drinking the nutritive essence of not one but a number of fruits or vegetables. This over-nutrition typically results in the formation of pathogenic dampness and phlegm.

Meats, because they are so nutritious, or supplement qi and blood so much, also tend to be damp in the same way. The fatter and richer a meat is, the more it tends to generate dampness within the body. Amongst the common domestic mammalian meats, pork is the dampest with beef coming in second. Therefore, it is important not to eat too much meat and especially not greasy, fatty meats. Most people do fine on two ounces of meat 3-4 times per week.

On the other hand, eating only poultry and fish is not such a good idea either. Everything in this world has its good and bad points. Poultry and fish tend to be less dampening and phlegmatic, it is true, but chicken, turkey, and shellfish tend to be hot. If one eats only these meats, they run the risk of becoming overheated. I have seen this happen in clinical practice. From a Western scientific point of view, we can also say that eating too much fish may result in mercury accumulation and toxicity and overeating commercial chicken may result in too much estrogen and exposure to salmonella food-poisoning. Chinese medicine sees human beings as omnivores and suggests that a person should eat widely and diversely on the food chain.

The Basic Healthy Diet

Therefore, to sum up the traditional wisdom of Chinese dietary theory, humans should mostly eat vegetables and grains with small amounts of everything else. We should mostly eat cooked and warm food which is not too sweet, not too greasy or oily, and not too damp. In addition, we should eat moderately and chew well. It is healthful to drink a teacup of warm water or a warm beverage with meals. This facilitates the formation of that 100° soup. But it is unhealthy to drink or eat chilled, cold, and frozen drinks and foods with meals.

In general, I would emphasize that most Americans do not eat enough vegetables. It is easy to load up on breads, grains, and cereals but not as easy to eat plenty of freshly cooked vegetables. Grains, like meat and dairy products, are highly nutritious but heavy and relatively more difficult to digest. If overeaten they can cause accumulation of dampness and phlegm. In Asia, Daoists and Buddhists interested in longevity emphasized vegetables over grains and even modern Chinese books on geriatrics counsel that more vegetables should be eaten.

Amongst the grains, rice holds an especially healthy place. Because it promotes diuresis, it tends to leech off excessive dampness. Other grains, in comparison, tend to produce dampness as a by-product of their being so nutritious. This ability of rice to help eliminate dampness through diuresis becomes more important the more other dampening foods one eats.

Flavors & Spices

As said at the beginning of this chapter, the purest part of foods are the five flavors. These are sweet, salty, bitter, pungent, and sour. Chinese medicine also recognizes a sixth flavor called bland. Each of the five flavors corresponds to one of the five phases and, therefore, tends to accumulate and have an inordinate effect on one of the five major organs of Chinese medicine. Just as overeating sweet injures the spleen, overeating salt injures the kidney, overeating sour injures the liver, and overeating spicy foods injures the lungs. I know of no one who overeats bitter food. A little bitter flavor is good for the heart and stomach. In general, although most food is sweet, one should eat a modicum of all the other flavors. Overeating any one flavor will tend to cause an imbalance in the organs and tissues associated with that flavor according to five phase correspondence.

Most spices are pungent or acrid and warm to hot. These spices aid digestion when eaten in moderate amounts. As discussed above, the digestive process is like an alchemical distillation. The middle burner fire of the stomach-spleen cooks and distills foods and liquids driving off their purest parts. To have good digestion means to have a healthy digestive fire. Moderate use of acrid, warm spices aids digestion by strengthening the middle burner fire.

That is why traditional cultures found the use of pepper, cardamom, cinnamon, ginger, nutmeg, mace, and cloves so salutary. These spices contain a high proportion of qi to wei and so help yang qi transform and distill yin substance, dampness, and fluids. On the other hand, when eaten to excess, such spices can cause overheating of the stomach and drying out of stomach fluids, and remember, the stomach does not like to be dry. Therefore, a moderate use of such spices is good for the spleen but their overuse is bad for the stomach and lungs.

A Return to a More Traditional Diet

What this all adds up to is a diet very similar to the Pritikin diet or Macrobiotics. Both these dietary regimes suggest that the bulk of one’s diet be composed of complex carbohydrates and vegetables and that one get plenty of fiber and less animal proteins, refined sugars, oils, and fats. This is very much the traditional diet of all people living in temperate climates the world round. This is also very much like what our great grandparents ate.

One hundred years ago, most people only ate meat once or twice a week. Mostly they ate grains and vegetables. Because they did not have refrigeration, they ate mostly what was in season and what could be stored in root cellars and through pickling, salting, and drying. One hundred years ago, sugar was too expensive for most people to afford more than a tiny bit per year. Likewise, oils and fats were relatively precious commodities and were not eaten in large            quantities. Those oils which were available were pressed from flax, hemp, sesame seeds, or were derived from fish oil, lard, and butter. They were not the heavily hydrogenated tropical oils which are so frequently used in commercial food preparation today.

It was also a well-known fact of life 100 years ago that rich people who ate too well and exercised too little were more prone to chronic health problems than those who lived a more spartan and rigorous life. If one looks at the cartoons of the 18th and 19th centuries, one frequently sees the overweight nobleman with the enlarged and gouty toe. Likewise, the Chinese medical classics contain numerous stories of doctors treating rich patients by getting them to do some physical work and to eat simpler, less rich food. Gerontologists today have noted the fact that those ethnic groups who tend to produce a large proportion of centenarians, such as the Georgians, the Hunzakuts, and certain peoples in the Peruvian Andes, all eat a low animal protein, low fat, high fiber diet.

The Modern Western Diet

The modern Western diet which we take so much for granted is mostly a product of post World War II advances in technology and transportation. Until after World War II, mass refrigeration and interstate transportation did not allow for everyone to buy a half gallon of fresh orange juice anytime of the year at an affordable price nor to keep a half gallon of ice cream (or now frozen yogurt) in their home freezer. In addition, special interest advertising has fostered erroneous ideas about the healthfulness of many of these ”new” foods. We have been so bombarded by tv commercials extolling the healthful benefits of orange juice that we seldom remember that these are partisan propaganda bought and paid for by commercial growers who depend upon the sale of their product to turn a profit.

The modern Western diet is a relatively recent aberration in the history of human diet. It is an experiment which has largely run its course as more and more people as well as governmental agencies come to the conclusion that so much of what we take for granted these days as a normal diet is really not healthy. Just as we are now realizing as a society that smoking is bad for the health, likewise we are also now coming to realize that too much sugar, fats, oils, and animal protein are also not good for the health nor conducive to longevity.

Pesticides, Preservatives, & Chemicals

Traditional Chinese Medicine has, in the past, not said anything about pesticides, preservatives, and chemical additives because these things were not known until relatively recently. However, poisoning is a TCM cause of disease listed in the bu nei bu wai yin category of neither internal nor external etiologies. All the evidence suggests that eating food which is contaminated by pesticides, preservatives, and chemical dyes and additives is also not good for long term health and well being. Therefore, it is advisable to eat food which is as free from these as possible. That means organic produce and grains and organically grown meat. These are becoming increasingly more common and available.

Wrecked Foods

Since Chinese medicine says that the qi comes from the purest of the pure part of foods, the xiang or flavor/aroma, Chinese dietary theory also suggests that food should be freshly made and eaten within 24 hours. As food becomes stale, it loses its aroma and its ability to supplement qi is directly proportional to this aroma. Food which is stale is called wrecked food in Chinese. The implication is that, although the substance is still there, the xiang, aroma, or qi is gone.

Such wrecked foods tend to be more dampening and phlegmatic.

If one follows the above Chinese dietary guidelines, one will eat nutritiously and well. One will be supplemented by their food and not unduly harmed by it. Such a moderate, commonsense diet is one of the four foundations of good health. This diet is more or less appropriate to everyone living in a temperate climate. Patients suffering from specific diseases may require various individualized modifications of the above outlined regime. However, because whether in sickness or health the process of digestion is essentially the same, this is the healthy diet for the majority of people. In the following chapter, we will discuss specific modifications for the most common groups of imbalance described by TCM. Yet even these modifications are based on this same commonsense approach to food and eating.

Treatment should primarily be based on pattern discrimination”

*Pattern Diagnosis

Patterns of disharmony (also called pattern diagnosis and pattern discrimination) are the diagnosis that traditional Chinese medicine practitioners give to the disharmonies that lead to disease; it is these patterns that are treated to return your body and mind to a proper and healthy balance. After your initial consultation and throughout your treatments I will discuss with you your particular pattern diagnoses. Bear in mind that these patterns can change as your condition changes or if you contract new conditions, such as a common cold or stiff neck. There are dozens of pattern disharmonies and some more common examples are Spleen Qi Deficiency, Liver Qi Stagnation, Liver Blood Deficiency, Kidney Yang Deficiency, Kidney Yin Deficiency, Lung Qi Deficiency, Damp, Heat, Cold and Wind.

Traditional Acupuncture and Male Fertility

This short article originally appeared in the summer 2014 edition of Nurture magazine.

needlingAs a traditional acupuncturist I treat infertility based on traditional Chinese medicine (TCM) theories, treatments are either standalone or tailored to complement assisted reproduction techniques such as IVF. Statistics suggest that between 35-50% of infertility is due to male pathologies and the NHS suggests that in 25% of all cases the exact cause is unknown.

From a Western biomedical viewpoint it is thought that acupuncture stimulates the nervous system, influencing the production of hormones and neurotransmitters, thus activating the body’s self-regulating homeostatic systems encouraging your natural healing abilities. An increasing weight of evidence from Western scientific research is demonstrating the effectiveness of acupuncture for treating a wide variety of conditions.

Traditional acupuncture takes a holistic approach and regards illness or dysfunction as a sign that the body is out of balance. This holistic understanding that we are all individuals and that the exact pattern and degree of our imbalances are ultimately unique to us is one of the key strengths of TCM. My skill as an acupuncturist lies in identifying the precise nature of the underlying imbalances and selecting the most effective treatment plan.

Male fertility is influenced by many factors including genetics, environment, age, injury and physical or emotional stresses. I usually see men in the clinic after they have been tested and found to have a low sperm count, reduced motility or sperm with abnormal shape and size.

From a TCM perspective fertility problems typically fall under the influence of the Kidney. The Kidney is an approximate translation of the Chinese 腎 shèn and describes a conceptual framework affecting particular functions within the human body; the Kidney is often referred to as the ‘Root of Life’.

Kidney deficiency is commonly seen in male infertility and may include or lead to other pathologies such as Blood and Qi stagnation (Qi in this context means the flow of bodily functions or energies). I typically aim treatment at balancing and strengthening the Kidney and smoothing or invigoration the flow of Blood and Qi.

The Kidney thrives under moderation and a healthy lifestyle, difficult for many of us in these modern times. Stress relieving activities such as qigong, yoga and meditation are helpful as are refraining from long term excessive exercise, excessive physical work and excessive sexual activity. Long term consumption of cold and raw foods, living with chronic illness and just getting older all deplete the Kidney.

A diet high in fruit and vegetables, warm cooked foods and if possible organic foods is preferable. Reducing alcohol and caffeine, stopping smoking and reducing exposure to toxins and pollutants can all be helpful. Men should also ensure their testes are kept relatively cool by not using a laptop on the lap and avoiding tight underwear.

In my experience male and female fertility can often be directly improved through the use of traditional acupuncture and indirectly improved by relieving stress and anxiety and improving ones general sense of wellness.

Sources and further reading:

http://www.acupuncture.org.uk/a-to-z-of-conditions/a-to-z-of-conditions/male-infertility.html

http://acupuncture.rhizome.net.nz/infertility-men.aspx

Liang, L. (2004) Acupuncture & IVF Increase IVF Success By 40—60%, Boulder: Blue Poppy Press.

Lyttleton, J. (2004) Treatment of infertility with Chinese Medicine, Philadelphia, Churchill Livingstone.

http://www.nhs.uk/conditions/Infertility/pages/causes.aspx

Ni, D., and Herko, D. (2008) The Tao of Fertility: A Healing Chinese Medicine Program to Prepare Body, Mind, and Spirit for New Life, New York:  HarperCollins.

http://www.resolve.org/diagnosis-management/infertility-diagnosis/male-factor.html

http://www.webmd.com/infertility-and-reproduction/news/20050803/acupuncture-may-improve-sperm-quality

Knee Pain

Knee pain is a condition I regularly see in the clinic and acupuncture is often very effective in reducing the pain and swelling.

Where appropriate I have always advocated deep needling at acupuncture points Knee-Eyes (the two dimples below the knee cap); so it was interesting to see that recently published research from the Shanghai Journal of Acupuncture and Moxibustion concluded that deep needling at Knee-Eyes had a quicker analgesic effect and better overall effect on knee osteoarthritis than conventional acupuncture.

Knee Acupuncture
Acupuncture points shown are ST-34, SP-10, Heding, ST-35 and XIyan (Knee Eyes), GB-34 and ST-36.

I often use the points shown in the this picture to treat knee pain of all types, not just osteoarthritic pain. I also add distal points to treat the underling condition of the person being treated. Results are usually good with a lessening in the pain and often an increase in the range of movement. Swelling when present is also treated to relieve pressure on the joint and further reduce pain.

The following is an abstract from “Clinical Observations on Deep Needling of Points Dubi and Medial Xiyan [Knee-Eyes*] for the Treatment of Knee Osteoarthritis”.

“Objective To investigate the clinical efficacy of deep needling of points Dubi(ST35) and medial Xiyan(Ex-LE5) in treating knee osteoarthritis. Method Forty patients were allocated, in order of visits, to two groups, 20 cases each. Th e treatment group received deep needling of and electroacupuncture at points Dubi and medial Xiyan and conventional acupuncture at points Heding(Ex-LE2), Yanglingquan(GB34) and Zusanli(ST36). The control group received electroacupuncture at points Dubi and medial Xiyan and conventional acupuncture at the above other points. Both groups were treated three times a week, two weeks as a course. Knee joint function was assessed using the Lysholm Knee Scoring Scale before and after treatment. Result There were no statistically significant pre-treatment differences in various indices between the two groups(P>0.05), indicating comparability. Various index scores increased in different degrees in both groups after treatment compared with before. There were statistically significant pre-/post-treatment differences in the three(pain, flaccid leg and climbing stairs) index scores in the treatment group(P<0.05) and significant post-treatment differences in two indices flaccid leg and knee pain compared with the control group(P<0.05). Conclusion Deep needling of bilateral points Dubi and Medial Xiyan has a quicker analgesic effect on knee osteoarthritis and its effect is better than that of conventional acupuncture.”

References:

Liu, N. “Clinical Observations on Deep Needling of Points Dubi and Medial Xiyan for the Treatment of Knee Osteoarthritis.” Shanghai Journal of Acupuncture and Moxibustion (2013): 857-858.

*Nomenclature varies in translation and from school to school but the points described as Dubi and Medial Xiyan are the points collectively known as Knee-Eyes.

Spleen Pathologies and Diet

Are you a worrier, over-thinker, prone to low moods, tired with loose stools, prone to bloating after eating, have a feeling of weak limbs, a tendency to obesity or even overly thin? These signs & symptoms point towards the diagnosis of a Spleen pathology in traditional Chinese medicine and you may be wise to avoid diary and even bananas! To find out more book a free consultation, it may change your life.

I was prompted to write this post in response to a blog by Ian Claxton suggesting that diary is bad for us, see his blog here.

In general I agree with Ian’s comments. Dairy is often a contributory factor in illnesses that I see at the acupuncture clinic. In many cases I believe patients would be healthier for giving up diary. However for a few ‘deficient’ people the nourishing qualities of milk can be beneficial but only in untreated or organic full fat milk or better still organic goats milk, but like all things it is only healthy in moderation and unfortunately highly processed diary is everywhere and difficult to avoid.

Preparing for Treatment

Normally you will have received (in person, via email or downloaded) a patient questionnaire to complete at your leisure and bring to your initial consultation. During your consultation I will consider this questionnaire and ask further questions and carry out any relevant examinations.

I will explain clearly the consultation, diagnosis and treatment plan. If there is anything you are unclear about or concerned about please tell me. Your understanding of your illness and its treatment is an important aspect your recovery. There are many traditional Chinese medicine treatment methods at my disposal* and if you are uncomfortable with a particular method I can usually offer a suitable therapeutic alternative.

When preparing for treatment please wear loose clothing with legs and sleeves that are easy to roll-up out of the way. You need to be prepared to remove items of clothing as required, but be assured that I am always mindful of your modesty and comfort.

To gain the best from treatment please enjoy a light meal beforehand and refrain from any strenuous activities for a few hours. No alcohol should be taken before or after treatment.

*Acupuncture is not always used, particularly if you are needle-phobic or have a condition or medication that is not suited to acupuncture. Other Traditional Chinese Medicine treatment methods I frequently use are acupressure, massage, moxibustion (heat treatment) and cupping therapy.

Tui Na (tuina) Massage

Chinese Tuina Hand massage
Tuina Hand Massage

Tui Na (tuina) massage is traditional Chinese therapeutic massage that has been practiced for thousands of years, evidence suggests it was used as far back as the Shang Dynasty of China, 1700 B.C.E.

Tuina is a therapeutic tool that can also be used for simple and effective relaxation and stress relief in the form of a neck, shoulder and back massage. It is excellent for treating musculoskeletal disorders and with the acupuncturist’s skilled knowledge of points and channels it can be used to treat a wide range of pathologies including stress related disorders, digestive, respiratory and reproductive problems.

Subject to a health consultation, contraindications and a pattern diagnosis* tuina and acupressure when administered by a skilled and caring practitioner is suitable for infants, children, adults and the elderly. I often combine treatments to gain the maximum benefits,  so a typical session may include acupuncture and or cupping combined with local tuina massage.

*Patterns of disharmony: Also called pattern diagnosis and pattern discrimination are the diagnosis that traditional Chinese medicine practitioners give to the disharmonies that lead to disease; it is these patterns that are treated to return your body and mind to a proper and healthy balance. After your initial consultation and throughout your treatments I will discuss with you your particular pattern diagnoses, bear in mind that these patterns can change as your condition changes or if you contract new conditions, such as a common cold or stiff neck. There are dozens of pattern disharmonies and some more common examples are Spleen Qi Deficiency, Liver Qi Stagnation, Dampness, Heat, Coldness, Liver Blood Deficiency, Kidney Yang Deficiency, Kidney Yin Deficiency and Lung Qi Deficiency.

Women’s Problems

Women’s Problems

Traditional Chinese Medicine (TCM) acupuncture is very good for alleviating the underlying causes and signs & symptoms of many women’s problems such as period pains, erratic periods, heavy periods, long periods, short periods, PMS, endometriosis, polycystic ovary syndrome (PCOS), menopausal changes, anxiety and infertility.

I treat holistically, after all it is unlikely that one woman’s circumstances and signs & symptoms are exactly the same as another’s, they may be similar but there will be distinct differences, recognising this patient individuality is one of the distinctive strengths of TCM diagnosis and treatment.

No matter what the Western disease label, in Chinese medicine diagnosis we simply look at all the signs and symptoms, menstrual history, use of medications, contraceptives, general health and lifestyle of the patient. If offered I will also consider Western medicine evidence such as endocrine tests, bloods and scans. Treatment will be directed at alleviating the signs & symptoms (pain, bleeding, hot flashes, etc.) and treating the underlying disharmonies and imbalances such as blood deficiency, blood stasis and stress. Treatment may vary depending on where in her cycle the patient is and where I think we will get the best results. For instance when PMT plays a significant role then mid cycle treatment may be appropriate and where there is severe pain then treatments shortly before the period are suggested.

By Austin ©2014 Austin Austin www.austinaustin.co.uk

Sciatica – Lumbosacral Pain

I often treat patients who attend clinic with pain in the lumber, buttock and leg, commonly described as sciatica.

Sciatica is usually described by the patient as a stabbing or burning pain that radiates from the buttock down the back or side of the leg occasionally reaching the foot (generally following the path of the sciatic nerve). Typically it affects only one side and is aggravated by driving, walking, bending and coughing. The pain can vary in intensity and affect more or less areas of the leg at different times of the day. The pain can be severe, debilitating and very draining.

Western medicine breaks sciatica down into primary and secondary types. Primary sciatica is due to an infection affecting the sciatic nerve directly. Secondary sciatica is caused by adjacent structures causing pressure or displacement of the sciatic nerve, such as a prolapsed lumber disk, infection in the tissues about the sacrum, coccyx or pelvis, or muscular dysfunction. In clinic I find that a condition called piriformis syndrome, where the piriformis muscle in the buttock excerpts pressure on the sciatic nerve, is often the cause of sciatic pain.

It appears to me that the Western medicine treatment of sciatica  is often vague and comes down to taking pain killers and waiting for it to spontaneously resolve; unfortunately by the time I see a patient the pain has often been present for a long time and or the problem resolves briefly but returns frequently. Fortunately though traditional Chinese medicine (TCM) takes a more practical approach and is often an extremely effective treatment.

TCM classifies the signs and symptoms associated with sciatic pain as Bi Syndrome (pronounced ‘bee syndrome’), a particular diagnosis referring to a painful condition. The cause of this bi syndrome is most often considered to be due to stagnation of qi and blood in the Gall Bladder and or Bladder meridians that closely follow the pain route, see images below.

Bladder Channel

Gall Bladder Channel

This stagnation of qi and blood may be caused by various aetiologies but some common examples are:

  • Prolonged trauma or strain generally characterised by stabbing or piercing pain and a history of trauma. I have noticed that a poor driving position or excessive driving over many years can be a cause and trigger of sciatica
  • Invasion of Wind-Cold-Damp generally characterised by a radiating heaviness with the pain worse in cold damp weather or a cold damp environment, and better for a warm dry environment
  • Kidney Deficiency generally characterised by frequent recurrence of the sciatica. It is often aggravated by exertion, alleviated by rest and accompanied by a weak sore back and knees, tiredness and a feeling of cold in the affected area

Experience shows that TCM treatments are frequently effective in treating the underlying patterns causing qi and blood stasis and relieving the pain of sciatica. Treatment may consist of acupuncture, cupping, moxibustion, massage, or often a combination of these therapies. Usually the patient responds quickly with relatively few treatments, although further treatments may be recommended to treat the underling disorders to help prevent recurrence.

To prevent sudden relapse the patient should not let the affected area get cold and should slowly build up exercise and stretching. Where there is an underlying pattern involving Damp then it may also be advisable for the patient to modify their diet to avoid foods cold and dampening in nature.

By Austin ©2014 Austin Austin www.austinaustin.co.uk