Spring is the season of the Wood element and is characterized by reawakening and outward expansion. It is associated with the Liver and Gallbladder energetic systems, which when balanced are known for Qi that flows smoothly, initiative and good decision-making. Physical associations manifest in the eyes, tendons, ligaments and sinews which are nourished and maintained by the Liver. Just as the expansiveness of Spring can be seen in nature, emotional and physical energies associated with the Liver can be directed outward. Just like a sprout beginning to rise, energy is still fragile and can easily be damaged. Outbursts or projections of excess energy can best be put to good use with activities or projects that can utilize it.
Climactically Spring is associated with wind. The wind which can carry other pathogens also tends to aggravate the wood element. In the body it can cause allergies, itchy skin and pain patterns that tend to move from place to place. Symptoms may present as fever, slight aversion to wind or cold, cough, or mild thirst with burning pain in local areas. Sensitive people should enjoy windy outdoor time in minimal doses.
Injuries may present as:
- Wind: marked by a decrease in range of motion and pain that changes location.
- Heat: local inflammation and/or redness in the joints or extremities, and may be aggravated by heat.
- Damp: fixed and intense pain with a feeling of heaviness, numb skin and muscles that wet conditions may aggravate.
Movement in the Spring
To prevent injuries and improve performance in the Spring, consider the following:
Warm up properly utilizing dynamic stabilization exercises to ensure that postural muscles are activated prior to regular training.
As a stand-alone program or as an adjunct to another endeavor or sport, take advantage of strength training with slower to moderate speed movements. Strength guidelines state using 70%-85% of your estimated 1 repetition maximum, at a moderate to high volume (up to 25 sets when your main activity is weight training), with up to 60 seconds rest between sets. Incorporate this into your program for about four to six weeks to allow ligamentous tissues, which have a poor circulatory system, time to adapt. The nervous system and muscles characteristically adapt more quickly, which is part of the strength continuum but does not take all tissues into consideration. Transitioning into ballistic movements too soon, especially after a lay off due to injury or from sedentary life will predispose a person to further injury. Beginners should spend more of their workout doing stability exercises with a strength component.
As part of a post workout cool down, emphasize static flexibility to bring the body back into a more parasympathetic (normal) state. This will allow tendons to relax and circulation of metabolites in the muscles to move more smoothly.
Proper maintenance such as Tui Na, bodywork, acupuncture and meditative movements assist in recovery from exercise and injuries and boost the immune system.
Spring Time Nutrition
Food that assists in balancing the nature of the Liver and Wood element should nourish, soothe and keep the Liver clean, tonify the Spleen, nourish Yin, & strengthen Yang. Enjoy plenty of young plants, fresh greens, sprouts, and yellow to red veggies nutrient-dense and low in calories. These include tomatoes, loquat, beets, mint, onion, green beans, broccoli, chives and leeks. Flavor meals sparingly with vinaigrettes and pickled foods.
Keep high-calorie, refined, greasy or fried foods, sugars and alcohol that overtax the Liver and Gallbladder to a minimum.
Fasting will over tax the Liver and create more disharmonies in the body. A better way to cleanse the Liver is via sound nutrition, herbs that support Liver function and simply sweating from exercise.
Ju Hua (chrysanthemum) congee: 100g white rice, 50g chrysanthemum.
Soak chrysanthemum separately for 30 minutes. Then combine with rice over heat for 5 minutes. Soothes the Liver and brightens the eyes.
An Chun (‘animal ginseng,’ quail) dish: 100g quail, asparagus 100g, mushrooms 5g, cucumbers 15g, egg whites.
Slice quail and mix with egg whites then sauté. Add asparagus, cucumber & mushrooms later. Sea salt to taste. Nourishes and soothes Liver.
Spring Herbal Considerations
This year has brought much change in the world and continuous perceptions of disharmony which sound nutrition and lifestyle may not relieve quickly. Strong emotions may affect digestion, causing stomach butterflies or bloating, acid regurgitation diarrhea and/or stomach pain. A Chinese formula that has made its way into Western use is called Xiao Yao San or “Free and Easy Wanderer”. This formula profoundly soothes the Liver, thereby reducing the effects of stress on the body and helps prevent digestive symptoms. For those with enteric brains, this is quite a find. (For a thorough diagnosis, consult a Licensed Acupuncturist (L.Ac.)
Climate and physiological change affect the natural tendency of the Liver to spread and grow. By nourishing and maintaining the Wood element, the outward momentum of Spring will segue nicely into the warmer months of Summer.
Read about the coming Summer
Irritable Bowel Syndrome (IBS), also known as spastic colitis, is the most frequent gastrointestinal (GI) disorder and accounts of 30 -50% of all referrals to gastroenterologists. In 10-20% of European and American populations it starts in late teens to early twenties occurring more often in women.
IBS is not classified as a disease, but as a syndrome. It is considered a functional GI disorder characterized by a variable combination of chronic and recurrent intestinal symptoms that are not explained by structural or biochemical abnormalities.
Symptoms may occur alone or in combination: abdominal pain or discomfort with altered bowel function; abnormal frequency of bowel movements (BM); typically diarrhea, constipation or both; flatulence, bloating, loss of appetite, nausea, increased mucous production, painful BMs. Cramping, intermittent, lower abdominal pain does not usually occur at night nor interfere with sleep and most symptoms are commonly relieved by defecation.
Additional non-bowel symptoms may include heartburn, chest pain, headaches, fatigue, muscle pain, urologic dysfunction and gynecological symptoms, and often coincide with chronic fatigue syndrome. There is a Mind-Gut interaction where anxiety and/or depression frequently accompany IBS symptoms in varying degrees.
The cause of IBS is not clear. It is felt to be a “dysregulation” of intestinal motor and sensory functions of central nervous system (CNS) origin – thus the psychogenic component. The gut produces 95% of serotonin in the body. If the gut is not functioning optimally this affects mood, thought processes and clarity of mind. There is strong evidence for disruption of balance between non-pathogenic flora and the immune system, while GI infections treated by antibiotics result in a higher chance of acquiring IBS.
Diagnosis follows the Rome III Criteria, which includes abdominal pain for at least three days per month for three months and is characterized by two out of the three following symptoms: pain relieved with a BM; change in frequency of BM; and change in the consistency of BM.
Other causes should be ruled out such as lactose intolerance, drug-induced diarrhea, parasites, food sensitivity (may depend on combination) and food allergies.
Medications include the possible use of tricyclic antidepressants and symptomatic treatment for spasms, constipation and diarrhea. Antibiotics are often improperly prescribed because diarrhea is confused with infection. This leads to other gut problems such as poor gut flora.
Lifestyle: Eliminate offending foods such as common allergens: wheat, dairy, corn and soy. Avoid gas-producing and diarrhea-producing foods: beans, fermentable carbs, sweeteners, hydrogenated fats, brussel sprouts, cabbage, cauliflower, raw onions, grapes, plums, raisins, coffee, garlic, red wine and beer. Increase dietary fiber from non-wheat plant sources for constipation and foods that promote healthy flora in the gut such as beet fiber.
TRADITIONAL CHINESE MEDICINE (TCM) cannot be simplified without losing its essence. It seeks to find and understand the cause. TCM’s advantage in treating functional disease is holism and emphasis on various exterior functional activities of the human body.
TCM can’t live without the Spleen (SP); biomedicine does not consider its importance. In TCM the SP and Stomach (ST) energetic systems are paired. Together they receive food, assimilate it and send it to the rest of the organs and the body to be further processed. The SP ascends energetically while the ST descends. SP dysfunction may result in diarrhea, while ST dysfunction may result in nausea or vomiting.
The Small Intestine (SI) separates pure substances from the un-pure. It has the ability to absorb and distribute nutrients. There are few specific SI syndromes and SI qi deficiency can result in chronic diarrhea. Most SI diseases are referred to as SP problems. The Large Intestine (LI) has the ability to eliminate waste and its dysfunction is constipation.
Causes of IBS in TCM include: irregular diet; emotional stress leading to qi stagnation and affecting the SP and ST; SP deficiency causing anxiety, depression and sleep disturbances; Qi, Blood, Yin or Yang deficiency after chronic disease or after delivery; or overuse of laxatives or purging supplements.
Differentiation follows the basic presentations such as diarrhea-predominant IBS, constipation-predominant IBS with abdominal pain and flatulence, abdominal pain-predominant and alternating between diarrhea and constipation. Subcategories go into further detail and include but are not limited to:
- Excess presenting with abdominal distension and/or pain, red face, scanty and/or red urine, dry smelly mouth; may occur in heavier kids with less BMs due to lack of exercise.
- Deficiency in older patients and weaker constitutions with diminished Yin essence from over-consumption of spicy food and irregular toilet habits. There may be weakness, no power to pass stool, might not be dry, may even be soft; sweaty, pale complexion, shortness of breath and/or fatigue. This is also common in women after giving birth due to blood loss.
- Cold, in chronic conditions and older patients. Stools may not be dry, but difficult to pass or the patient may have no power to pass stool and present with a sallow or pale complexion, cold in the four limbs and lower abdomen and an aversion to cold with clear urine.
Acupuncture and Herbs seek to alleviate symptoms, address the cause and restore balance to the entire person by being highly modifiable based on patient presentation. Some acupuncture points are near areas of discomfort while others are found on distal aspects of the body. Herbs are a way to safely treat the body internally.
Nutritional considerations follow an energetic standpoint that is synonymous with the TCM diagnosis. Foods are recommended that nourish and balance the body without aggravating the gut.
Both Western and Eastern medicine agree it is necessary to address the whole body to alleviate the IBS presentation. After being diagnosed it is imperative that consistent lifestyle changes are made to maintain and prevent reoccurrence of symptoms.
With the multitude of seasonal allergens to choose from, it’s no wonder that allergies tend to be a large topic of conversation.
Air born allergens include seasonal pollens such as cedar trees, grass, and weeds. As an added bonus year round allergens such as molds, vehicle exhaust, dust mites, pet dander, and insect parts can be added to the list.
Seasonal allergies can cause a great deal of discomfort with non-native plants and trees, temperature changes, and winds carrying pollen.
As far back as the 2nd century BC, Oriental medicine (OM) techniques such as acupuncture, herbs, and dietary recommendations have been used to provide relief from the environment and create balance in the body. Today we know that acupuncture can modulate levels of cytokines and anti-inflammatory mediators as well as regulate the immune system’s overall response when too weak or overly active.
In conventional medicine, allergies are an increased response to an antigen or substances that can enter the body and stimulate it to create antibodies called IgE which bind to allergens. Mast cells then release histamine which cause symptoms (heat, pain, swelling, redness, itchiness, etc).
It is important to note that air born allergens are a localized immune system (wei qi) blockage that tends to cause symptoms in the head such as itchy, watery eyes, sneezing, runny nose, post nasal drip, headaches, ear congestion, throat irritation and/or occasional body fatigue. While the common cold (gan mao) tends to include most of the head symptoms but will also carry on to body aches, chills, fever, and for some digestive disturbances.
On top of these already uncomfortable symptoms, underlying factors can also contribute to this immune system burden (e.g. food sensitivities, chemical additives to foods, tobacco smoke, chemicals in the home or workplace, medications, or even hormonal fluctuations).
If left untreated or ignored, air born allergies can progress to more serious conditions such as:
- Allergic rhinitis is the body’s immune system over-responding to non-infectious particles in the air. Symptoms include the development of sinusitis, eustachian tube dysfunction, chronic otitis media, and anosmia (inability to smell).
- Sinusitis, which is inflammation or swelling of the sinuses, typically happens after having allergic rhinitis. This happens when sinuses become blocked and fill with mucous that can harbor bacteria, viruses, or mold causing an infection.
- Both rhinitis and sinusitis can lead to less productivity at work and more doctor visits.
- Some people may exhibit increased allergy sensitivities. For example, people who have fibromyalgia are more aware and some pregnant women in their second trimester may experience increased allergic symptoms and hypersensitivity to their environment and medications.
Allopathic medications can help in acute conditions, but tends to mask symptoms and come with a slew of side effects. Many patients turn to antihistamine relief at the first sign of allergies and are quickly prescribed antibiotics for nasal rhinitis.
Antihistamines are designed to treat allergies and relieve respiratory symptoms by blocking the effects of histamine, which is a not a natural process, as they affect ALL mucous membranes and can dry them out. Common antihistamines, such as Benadryl, tend to dry up body fluids (jin ye).
Other medication side effects include drowsiness, epistaxis (nose bleeds), and nasal dryness in addition to normal allergy symptoms. Steroids (oral, topical, inhaled) can reduce inflammation but foster overgrowth of yeast. Prolonged or inappropriate use of antibiotics can lead to immune deficiencies, digestive disturbances, and chronic fatigue.
The cause (pathogenic factors) of allergies is a relative idea. OM pays considerable attention to the symptoms of pathogenic factors (allergens), which are related to body constitution and lifestyle factors.
Food sensitivities or allergies, blood sugar fluctuations and stress can tax the kidneys (adrenals) and create a cortisol imbalance. This depletion leads to inflammation in the body which may manifest as pain, tightness, fatigue, and water retention leading to poor digestion and lowered immunity.
Compromised digestion and immunity invite our external environment and seasonal allergens to easily allow for viral and bacterial infections to take hold.
Seasonal symptoms can be predictable:
- Fall – ragweed whose symptoms are characterized as Wind Dryness
- Winter – cedar, cedar fever is clearly Wind Heat
- Year round allergies have a Wind component
- Mold is considered Wind Dampness
Acupuncture Treatments help to moderate the body’s response to allergens and help create a healthy immune response. Although an appropriate diagnosis of a person’s presenting pattern is important, there are specific allergy points located in the ears and important points on the hand, feet, head & face. In addition to needles cupping, moxibustion and herbs play a strong role in improving the way you feel.
Herbal Treatments, which are easily modifiable, also support the immune response and continue to help as a daily therapy to compliment acupuncture treatments.
A common Chinese formula, Jade Wind Screen Yu Ping Feng San, is helpful for year round allergy sufferers who tend to have a weakened immune response, characteristically tend to catch cold easily and are sick longer than normal. It can be administered two months before specific seasons as well as during.
For more acute allergies non-sedating antihistamine formulas such as Nose Inflammation Formula Bi Yan Pian, Magnolia Flower Powder Xin Yi San and Pe Me Kan Wan are very helpful. When made into a tea the steam can be inhaled from the cup to get an immediate effect before drinking
- If you are aware of a seasonal allergy don’t wait until symptoms occur to start receiving acupuncture and herbal treatments. Starting treatments at least two months prior will prepare and support the immune system for the season to come.
- Check daily pollen counts before leaving your home.
- Whenever possible exercise *indoors in moderate temperatures, esp. in the afternoon when pollen counts are highest. Also avoid haze and smog, weather changes and exhaust fumes from vehicles.
- All mucosal membranes are affected by eating foods that create an immune response. Avoid phlegm producing foods (dairy, wheat and soy which are also common food allergens)
- Reduce processed sugars – sugar decreases immune function and increases inflammation.
- Reduce your internal load: In your home and work spaces use non-toxic, low residue paint and household cleaners. When looking for body products buy aluminum free, low in chemical and perfume additives.
- Moderate emotional factors – crying, yelling and distress – all cause increases in cortisol, which in excess decreases immune function.
- An additional, a natural approach is a nasal saline lavage. It has minor decongestant benefits and improves mucociliary function in both allergic and non-allergic rhinitis. To avoid contamination from faucets, try distilled water.
*Note: mold spores are found indoors too.
If you’re an athlete, you might know what it’s like to suffer from pain, stiffness, swelling and injury. The causes of most of these obstacles to training can include trauma, inadequate warm-up and cool-down, improper form, overtraining, irregular diet and weather – which is often over-looked.
To alleviate the problem, common treatments such as excess application of ice and cold therapies are used, medications with side-effects are taken and injuries are sometimes ignored in hopes that they will go away. These approaches can all mask deeper imbalance, further exacerbating the original problem.
Acupuncture and Oriental medicine create a competitive edge that is safe, time-tested, natural and drug- free.
Benefits that athletes and weekend warriors gain from acupuncture and Oriental medicine treatments include injury prevention and recovery, decreased pain, improved mental state and clarity of mind, improved flexibility and ROM, faster recovery time, decreased inflammation and overall enhanced performance.
Oriental Medicine takes the entire person into consideration. Not only is the local area of discomfort examined but the whole body, mind and spirit are also addressed. Questions will be asked about sleep patterns, diet, allergies, focus and digestive health to provide a more accurate picture of how to treat you.
Initial treatments utilize distal points on the body or head. Follow up treatments may include local needling such as Dr. Lu Ding Huo’s oblique needling sports medicine techniques. Many effective acupuncture points have a strong correlation to trigger points and motor end points.
Chinese herbs, Tui na (Chinese medical massage) and corrective exercise may be prescribed as an adjunct to acupuncture. Herbs are used to continue healing at home between treatments. Tui na reinforces the acupuncture treatment and assists in breaking up fascial adhesions. Corrective exercises are given to restore proprioception, normal movement and balance in the affected area.
As seen in the 2010 Olympics all athletes can benefit from acupuncture; this includes cyclists, runners, swimmers, volleyball players, bodybuilders, wake boarders, martial artists, dancers, golfers, yogis, and even moms who keep up with their kids and desk jockeys.
Part two of a two part series
Traditional Chinese Medicine explains in its own manner the theories and pathologies of endometriosis. Endometriosis does not have a common name in TCM, rather its signs and symptoms are a combination of disease categories within Chinese medicine, but it may be referred to as Neiyi or internal lump. This ‘lump’ may be caused by unremoved dead cells or xue (blood) that has stagnated and caused pain. In Eastern and Western medicine blood nourishes the body, removes dead cells, and should not get stuck anywhere.
Endometriosis is characterized by qi yu (stagnation of energy), and yu xue (blood stasis) or congealed blood manifesting as dysmenorrhea and abdominal masses. Most symptoms such as dysmenorrhea, bowel problems, and lumbago are worse during menses. Focal bleeding from endometrial implants may be called extravasation of blood caused by blood stasis/stagnation. Pain caused by inflammatory cytokines in the peritoneal cavity are considered to be heat in the lower jiao. Irritation or direct infiltration of nerves in the pelvic floor, as in pelvic distortion, are considered qi stagnation or blood stasis in the lower jiao. (1) Overall presentations may be referred to as rebellious qi (energy)/blood with hidden re (heat) in the li (interior) and xue yu (blood stagnation) or stasis. Some Eastern and Western practitioners say that unresolved cases of dysmenorrhea may be endometriosis. (5)
TCM Diagnosis and Treatment
Endometriosis has no specific category in TCMand diagnosis is based on the symptoms that a patient currently presents. Diagnosis is arrived at and confirmed via directed questions, palpation, and tongue diagnosis. The information gathered is utilized to create an appropriate treatment plan.
Treatments in TCM will depend on individual cases. They include the use of acupuncture and herbal medicines. When herbs are administered they are introduced via decoctions, which are stronger and can be pao zhi (enhanced) via different cooking methods. Later patients are switched to powders, or pills for easier administration. With the growing evidence that Chinese herbs have anti-inflammatory and pain alleviating properties more patients and related health care providers are more open to utilizing their benefits.
InTCM patients present differently and have overlapping presentations according to external factors or environment, stage of disease, constitution and lifestyle. Here are some of the many possible causes of endometriosis and herbal treatments appropriate to each condition.
- Surgery, blood stagnation and stasis
- Seven Emotions: anger, mania, pensiveness, grief and sadness, fear and fright
- Cold Uterus
Indirect transplantation of endometrial cells can occur with c-sections, or other pelvic surgeries. This relates to qi stagnation and blood stasis with internal heat due to internal trauma. Over time this may evolve into a kidney deficiency. This condition is treated by moving qi and blood, resolving stagnation and transforming stasis, clearing heat and cooling blood.
Stressors, and the seven emotions they manifest, are contributing factors to the development of endometriosis.
- Anger is manifestation of the Liver and related to the Wood element.
- Mania is a manifestation of the Heart and related to the Fire element.
- Pensiveness is a manifestation of the Spleen and related to the Earth element.
- Grief and sadness are manifestations of the Lung and related to the Metal element.
- Fear and fright are manifestations of the Kidney and related to the Water element.
In anger stagnant liver qi transforms into fire (huo) and becomes rebellious by rising upwards. Blood follows the qi, since qi is the commander of blood, resulting in qi stagnation and blood stasis transforming into heat. Symptoms may manifest as ovulation pain, delayed ovulation, irregular periods, with irritability and anger, restlessness, a red face, bitter taste in mouth, headaches and distending pain in the hypochondria. The tongue is red and pulse is rapid and wiry.
When mania occurs it causes heat in the Heart and it can directly become blood heat. The Heart and the Liver are related via blood. The Heart governs blood, while the Liver stores it. If there is Heart fire causing blood heat, this may cause blood heat in the Liver. Hot blood can extravasate and rebel upwards facilitating ectopic implantation of endometrial tissue. (1) Accompanying symptoms may present as anxiety, insomnia, palpitations and irregular ovulation.
Pensiveness, over-thinking, constant worry, and anxiety can weaken the Spleen. When the Spleen is weak, the Liver’s opportunistic nature will attack. This interrupts the production of post-heaven qi (from food) and blood. As a result the qi may rebel upwards, carrying just enough blood with it to facilitate ectopic implantation of blood. Over time, this will transform into heat. A decreased qi production results in an inherent hypo-immune state.
The Spleen produces blood which is stored in the Liver and Liver blood is transformed into Kidney essence. If Kidney essence is constantly undernourished, then the Kidneys will become weak and unable to support the Spleen and the Kidney’s function of creating yuan (source) qi, allowing ectopic endometrial tissue to thrive without resistance. (1)
In grief and sadness weak lungs will cause weak Kidneys, while weak Kidney function will cause insufficiency of Spleen qi. Spleen qi deficiency will create a hypo-immune response and blood deficiency. Blood deficiency creates blood stasis which will transform into heat and a weakened immune function allows the deposition of ectopic endometrial tissue in the body.
Fright can scatter qi and fear causes it to descend. These shifts in energy may contribute to dysmenorrhea, delayed periods, infertility, frequent urination, or back ache.
The origin of this pattern is a history of exposure to cold – either cold temperatures or the habitual consumption of cold foods – especially during menstruation. Cold uterus may present abdominal tenderness, pressure and pain before or during periods, a preference for warmth, an aversion to cold, blood clots with periods, pain relieved after the periods; pale complexion; nausea or vomiting with severe menstrual pain; a pale, purplish tongue with spots and a white coating; and a wiry, tight pulse.
Acupuncture and Herbal Medicine
Acupuncture is an important part of treatment protocol for endometriosis and its presentation. Symptoms are varied and there are no empirical points, rather there are acupuncture points and point combinations unique to the individual case. (6) All presentations of endometriosis have commonly overlapping symptoms and all herbal formulas are modifiable based on patient presentations.
By learning about the Eastern causes of endometriosis such as stress management, diet, and lifestyle, changes could be made to prevent and manage this and similar conditions. Flaws references the following guidelines from Han Bai-ling’s Gynecology (5) :
- Avoid fear, anger and excessive emotions.
- Avoid fatigue just prior to and during menstruation.
- Do not dwell on negative thoughts.
- Avoid cold and raw foods prior to or during periods.
- Avoid sex during periods.
- Avoid strong vigorous movement or exercise during menstruation.
- Eat and drink moderately, avoid spicy foods, maintain regular waking and sleep hours and be happy.
Additionally, diet should include an intake of green vegetables and fruit and a reduction of red meats and processed meats.
- Berkley, M. (April 2010) Endometriosis: Diagnosis and Treatment Options. AAAOM, Bernalillo, NM.
- Chek, P. (2005) Abdominal Wall Function and Organ Health. Video series. SD, CA.
- Chen, J. and Chen, T. (2009) Chinese Herbal Formulas and Applications. City of Industry, CA: Art of Medicine Press, Inc.
- Endo-Online The Voice of the Endometriosis Association http://www.endometriosisassn.org/endo.html
- Flaws, B. (1989) Endometriosis, Infertility and Traditional Chinese Medicine A Laywoman’s Guide. 1st Ed. Boulder, CO: Blue Poppy Press.
- Lyttleton. J. (2007) The Treatment of Infertility with Chinese Medicine. Pro Seminars. Sydney, Australia.
- Maciocia. G. (1998) Obstetrics & Gynecology in Chinese Medicine. Churchill Livingston. 258-259.
- Porth, C. (2005) Pathophysiology 7th Ed. PA: Lippincott Williams & Wilkins.
- Werner, Ruth. (2005) A Massage Therapist’s guide to Pathology 3rd Ed. Lippincott Williams & Wilkins.