A discussion of many diverse topics within the realm of Alternative Medicine and Healthy Living, some of which include: Acupuncture, Chinese Herbal Medicine, Eastern Nutrition, Pulse Diagnosis, Psychology and Bodymind Medicine, Aromatherapy, Philosophy, Spirituality, Buddhism, Meditation and Family.
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Today an initial patient visit highlighted the integration of Contemporary Chinese Pulse Diagnosis, Contemporary Oriental Medicine, Classical Chinese medicine and Classical pulse diagnosis.
The patient, a 66 year old female artist (retired mostly due to jealousy of her now deceased husband and fear), complains of severe left hip pain and osteoarthritis. The pain began 5 years ago after her husband's death, a long drawn out illness of Alzheimer's and complications, in which the patient was the primary caregiver. She is a former yoga instructor (not in many years) and is troubled that she can no longer move her body freely. She is overly controlled by her aggressive daughter, as she was by her first husband (divorced, then re-married) and her sister in childhood. Her pain is on the left Gall Bladder channel around GB 29-30. Pain is localized, but is also felt around the knee cap and lateral shin, mostly Stomach channel. In addition, she has lost muscle tone in her left thigh. The hip pain is worsened upon walking and putting pressure on the leg during a full stride. Balance and posture have been affected.
Patient experiences anxiety and some panic, and fear since the death of her husband. When stressed, she experiences occipital tension and loss of smell and appetite with some nausea and occasional vomiting.
Childhood history: corrective procedure for being tongue-tied; polio age 13 (miracle cure by local healer); sled accident and back injury age 15.
A few relevant findings on the pulse:
HT qi deficiency (changing intensity (3-3+), Interrupted pulse, Changing Intensity (2) over Uniform Impressions)
HT blood deficiency (increase rate on exertion 28)
Yin-Jing-Essence deficiency (Ropy)
LR qi stagnation (Tense Robust Pounding (3+ to 4))
LR blood stagnation (Choppy, engorged distally (2+) and ulnar engorgement)
GB qi and blood stagnation (Choppy Inflated)
SP deficiency/connective tissue weakness (Squirmy entire right side, especially middle)(see comments for description of Squirmy)
ST qi stagnation with heat (Tense Robust Pounding (3+ to 4))
2. CCM pulse:
HT not expressing its Shen
LU not diffusing wei qi to the surface
BL/KI sinew meridian activity
BL/KI divergent meridian activity
ST luo vessel heat/stagnation
LR blood stagnation
Analysis and Integration:
Seeing the connections between these two pulse systems and diagnoses and how they each relate and explain the patient's symptoms and findings are interesting.
Arthritis in COM has much to do with the HT and its ability to control the circulation and dissemination of blood to the distal regions of the body. It is very common to see HT qi deficiency on the pulse with arthritis. HT blood deficiency is another very common characteristic. I have written on this in the past in my journal article with Chinese Medicine Times. You can find that article here.
Arthritis in CCM is often the result of bi obstruction syndrome resulting from an invasion of wind-cold-dampness. Often the initial location affects the tai yang system. There are different interpretations on progression, the Su Wen detailing a longer history towards the formation of the bi syndrome (penetration from the head, to the throat, chest, abdomen, sacrum, Kidneys, triple burner mechanism to the Bladder shu points). The Divergent meridians are another theory on progression wherein the bodymind is unable to resist a pathogenic external invasion allowing for the yuan qi to come to the assistance of wei qi and translocate the pathogen to the interior (typically at the level of the joints). Resources are diverted to allow for this latency and over time are depleted resulting in more chronic degenerative conditions. Initially, the resource that is used up is yin-jing fluids at the level of the BL/KI. When taxed, the jing converts to blood at the second confluence (GB/LR), then to thin fluids-jin (ST/SP), then to thick fluids-ye (SI/HT), etc. So, looking at the BL/KI divergent meridian problem with degeneration, we are seeing a yin-jing-essence condition. This is also reflected in the Ropy pulse (CCPD).
So we can see the connection with the HT deficiency, Ropy pulse and the BL/KI divergent meridian activity. They reflect lack of resources and degeneration of structure.
One can look at the muscle pain that the patient experiences from a sinew meridian perspective as well. Pain with movement, particularly extension, relates to the tai yang sinew meridian of the leg. (Pain elicited by rotation would suggest shao yang (if seated shaoyin), pain with weight bearing, yang ming, etc.) When flaccidity is present with weakness it implicates a more chronic picture in which the pathogen has affected the yin internal pair, here the Kidneys. So yang and yin sinew meridians are involved in this case.
So, putting it together we see the location of the pain as relating to the GB channel at the hip (qi and blood stagnation on the pulse) and knee cap (yang ming) and lateral leg (GB and ST channels) with the nature of that pain being related to the tai yang leg sinew meridian (BL: BL sinew meridian pulse) and leg shao yin (due to it's chronicity). The chronic nature is demonstrated by the lack of muscle tone and weakness, a yin deficiency according to CCM creating lack of fluid volume and resources to nourish the muscles/connective tissue, etc. This is further evidenced by the Squirmy pulse (CCPD) reflecting the connective tissue weakness and SP involvement. The ST heat shows up from a luo vessel perspective from internal factors (lifestyle, diet, emotions). The ST luo vessel psychological make-up from a CCM pespective is a retreat from stimulation, weak lower limbs (can’t move to the places to provide you with the experiences you want); feeling of emptiness, no enthusiasm or animation. The 2nd trajectory of the ST luo vessel goes to the KI channel and deals with fear even to the point where the legs can paralyze (ie loss of tone). This is emptiness of the ST luo. The patient does show some of the major themes, especially of the second trajectory. Fear has been a major issue for her since her second husband died 5 years ago. This is the exact time frame that her pain started as well. The heat from the ST also contributes to the yin deficiency and lack of nourishment of the earth element which controls the 4 limbs and the connective tissue. This exacerbates the sinew meridian lack of tone. After all, wei qi has its origin not just in Du mai/Kidney yang, but also via ST yin (the pure nourishes the sensory orifices and the turbid the sinews and skin).
Emotionally, the anxiety and panic can be explained in COM as an imbalance of the HT and KI. Being tongue-tied at birth suggests HT as well.
The symptoms of occipital tension and loss of smell with stress and accompanied nausea/vomting can be seen as BL sinew meridian symptoms (occiput and nasal area) involvement with the LR/GB internal organ imbalances of qi and blood stagnation with rebellious qi into the vulnerable earth organs.
The polio can be seen potentially as the first major challenge to yuan qi weakening the taiyang and shaoyin conformations.
And of course, the initial trauma to the patient's back setting the stage for where the chronic degeneration would manifest.
What is significant in tying these systems of diagnostics together is the richness of the information that they provide. The depth at which one can understand a patient's complaints and experience of suffering only enhances one's options therapeutically. Understanding all of this from multiple paradigms also allows for increased treatment options and modalities and more specific as well as varied interventions. Using CCM, one's options in treatment are extended to the use of not just the primary meridians, but also the sinews, divergents and luo vessels. Each of these secondary channels has a greater affinity towards a specific level of imbalance and allows for a more targeted approach. Of course, this is not an in depth discussion of either system of CM, either in general or as it pertains to this case...
acupuncture in new jersey
Wednesday 11th of November 2009 09:16:55 PM | Comments
The lecture I did last week on Chinese medicine, and in particular, on my upcoming book is now available at the following link.
Please let me know your thoughts.
Best of health,
Saturday 17th of January 2009 10:00:40 AM | Comments
Check out this small article here.
Saturday 12th of July 2008 10:29:05 AM | Comments
My most recent article with my colleague and good friend Brandt Stickley has just been published with the Chinese Medicine Times relating to the Heart in Chinese medicine. You can access it here.
Tuesday 18th of March 2008 07:12:28 PM | Comments
What would you make of a drug that aims to deal with traumas and shocks by reducing or eliminating one's memory of the traumatic event? Would forgetting the trauma negate the negative impact of it on the body and emotions?
Recently, I learned of a growing use of the beta blocker propranolol. In certain dosages it is being used to impair one's memory shortly after a trauma in order to negate the effects of trauma on one's emotions. At the end of this post are a few links to articles addressing this usage.
What we know of propranolol is that it is a beta blocker which blocks the action of the sympathetic nervous system, decreases the heart rate, the amount of oxygen required by the heart and the force of contraction. It is used to treat angina, migraines, tremors, tachycardia. Side effects include: abdominal cramps, constipation, diarrhea, fatigue, insomnia, nausea, depression, fever, light-headedness, depression, numbness, tingling, cold extremities, sore throat, shortness of breath, wheezing, low blood pressure, and of course, memory loss. It can aggravate symptoms of heart failure and cause dangerously slow heart rates.
The issue of how traumas and shocks affect us physiologically and emotionally has been detailed by Dr. Leon Hammer. (For more information on Dr. Hammer and Contemporary Chinese Pulse Diagnosis, explore the links "Dr. Leon Hammer" and "Dragon Rises Seminars.") Pathognomonic of a shock/trauma that is significant enough to affect the heart, and hence, the circulation is a rough vibration over the pulse. Typically, the initial result of such a shock/trauma will also be to elevate the heart rate. The pulse, especially in the heart position and at the Qi depth can also become tight, reflecting the consumption of Yin from the heart, and the tension in the nervous system respectively. If the shock is great enough, or occurs at an early age (i.e., in utero or during birth, infancy or early life) prior to the maturation of the organ systems, the kidney yang (akin to adrenals) will become depleted. As the kidneys govern the stages of development, growth and developmental delays/insults can become evident.
The effect of trauma on the heart as evidenced by the rough vibrations, elevated rate, tightness in the heart and nervous systems, predisposes one to a wide range of anxieties, emotional instabilities, post-traumatic stress disorders, sleep disturbances, and circulatory disorders which can affect one on a systemic level. Herbal formulas such as Yunnan Bai Yao and modifications of Sheng Mai San taken together can treat and correct the signs on the pulse, and as such, the emotional and physical ramifications of shock and trauma. Adding herbs to boost kidney yang/adrenals is common where that has been affected as a result of significant trauma or early life shocks.
One of the reasons that traumas affect us emotionally is due to the effect of the shock on the heart and circulation. In Chinese medicine we say that the spirit resides in the heart blood, and an abundance of blood and the smooth flow of the blood is crucial to providing a stable home for the spirit. By correcting the impact of shock on the circulation and the heart with herbs and acupuncture, one can also settle the spirit and make traumas less "traumatic." Stabilizing the mind and nervous system, correcting the circulation and strengthening the heart and kidneys negates the harmful impact of the trauma.
The heart, according the Chinese medicine also has a strong connection to the memory. As the mind and spirit are controlled by the heart, and the spirit resides in the blood, our memories are stored in our blood. Keeping our blood circulating and our heart peaceful allows for a healthy perspective on our emotions and memories, painful and pleasureable ones alike.
So knowing all this, can such a drug reduce the signs of trauma/shock on the heart (rough vibration, tight pulse, rapid rate)? Can it bolster the kidney/adrenals? How exactly does it affect memory?
While I imagine I will see patients who have taken this drug to suppress traumas in the near future, for now I can only speculate. Patients on beta blockers typically have unnaturally slow heart rates. When we are talking about trauma patients, they typically have rapid rates resulting from the shock to the heart. Thus, at first glance, this seems to be beneficial. Unfortunately, understanding the energetic mechanisms behind these rate differences suggests otherwise. The reason for elevation of heart rate in the trauma patient is the quick depletion of heart yin, the anchoring, organizing substance of the heart itself. Propranolol doesn't work by nourishing heart yin, more by depleting heart qi. Reducing the amount of oxygen/energy available for the heart deprives it of its qi and weakens it rather quickly and significantly over time. Without a treatment that nourishes the heart yin, one will be predisposed to all sorts of anxieties and emotional lability.
In addition, symptoms such as fatigue, numbness, tingling, cold extremities are side effects of this medication suggesting the heart is not circulating the blood adequately. Understanding that trauma effects the circulation and part of the protocol for undoing its effects is to enhance/invigorate circulation, propranolol would most likely exacerbate the rough vibrations and circulatory stagnation. From this perspective, propanolol would be detrimental to the trauma patient.
Nothing about propranolol makes it suitable to treat the kidney yang/adrenals should they be impacted from severe trauma or early life events.
Then, what to make of the memory loss of a traumatic event. Is this beneficial? If we understand the premise that the memory is part of our connection to our spirit (which circulates in the blood), it would seem that the memory loss effect of propranolol serves as a disconnect with our spirit. Where enhancing circulation and pacifying the spirit help to make our spirit whole and contented, weakening the heart, negatively impacting circulation and creating additional stagnation of Qi and blood would almost "lock" the trauma away in areas of stagnant blood creating suppression and repression of these emotions.
To heal is to make one whole and a good therapy should be designed to promote healing and wholeness. Disconnecting ourselves from our memories and, hence, our spirit serves to further our imbalances and should, in my opinion, be counseled against.
Wednesday 18th of April 2007 09:37:39 AM | Comments
Is exercise good for one’s health? Before you answer that question, ask yourself how you define health. Do you really have an understanding of health or do you, like western medicine, define it simply as the absence of disease. Looking at athletes or compulsive exercisers from the standpoint of bloodwork, MRIs or CT scans one finds no disease, but does that prove health.
By no means do I intend to state that athletes or the countless millions of exercisers out there are sick and unhealthy, but I encourage the reader to expand one’s definition of health and to question the current dogma regarding proper exercise and the effects that aerobic exercise have on one’s heart, circulation and overall well-being.
In Chinese medicine we define health as the balance of yin and yang and the smooth flow of qi and blood. With this barometer in mind, we can evaluate changes and deviations from the definition of health, especially as it relates to the health of the heart, and concomitantly, the circulation and rest of the organism.
The heart is deemed equivalent to the emperor. With its paramount function of circulating blood throughout the body, it effects every nook and cranny of the organism and every organ, tissue, cell relies on the heart for nourishment. Should any part be deprived of this nourishment, it will eventually succumb. Weakness or instability in the heart will effect every part of the body, just as disturbance or imbalance in the emperor will cause chaos in the rest of the empire.
With the exercise craze that has overtaken our country, many are pushing their bodies past the limits, and are, in fact, doing more harm than good. Exercise needs to be done in accordance with one’s constitutional strengths and weaknesses in mind. For some without the constitution of an olympic athlete, trying to engage in strenuous exercise and training regimes will only leave them weakened and depleted. Eventually, if they do not heed the warning signs, illness will result.
Some of the earliest warning signs are fatigue, poor recuperation, sleep disturbances (difficulty falling or staying asleep, waking not rested), emotional lability, anxieties, depressions, achiness or wandering arthritic-like pains.
One of the most troubling signs of the over-exerciser is the slowing of one’s heart rate. While I know conventional medicine considers that to be a sign of a healthy efficient heart, in Chinese medicine, we understand the opposite. See the charts below for the healthy ranges of one’s heart rate according to one’s age.
Birth to 4 years 84-90/min
50+ years 66-72/min
In embryo 150-160/min
Upon birth 130-140/min
First year 115-130/min
Second year 100-115/min
Third year 90-100/min
Age 4-7 85-90/min
Age 8-14 80-85/min
Old age 60-75/min
Hammer, Leon, Chinese Pulse Diagnosis, A Contemporary Approach, Eastland Press, 2001, p. 152.
What is obvious from this chart is that from our earliest age (in utero) our heart rate is the fastest. Upon birth, it is significantly slower and continues to slow as we age until death. Heart rate is actually a good barometer of the health of one’s heart. As we age, our heart rate gets slower and slower until we die. With heavy exercise beyond one’s innate capabilities, we accelerate the process of aging our heart and move closer and closer to death.
Another very common sign of the over-exerciser is the Ropy pulse. The Ropy pulse is defined by its distinctness from the surrounding tissues. It feels as if it can be plucked right out of the wrist. It signifies hardening of the arteries. The process as it relates to over-exercising is defined very succinctly by Dr. Leon Hammer is his book cited above.
Wednesday 18th of April 2007 09:44:23 AM | Comments