A Case Example of Tung’s points with Classical Acupuncture

When I teach Tung’s points a question that frequently comes up is the integration of Tung’s points with classical acupuncture points. One of the more extreme examples of this that I’ve heard on more than one occasion is that if someone combines Tung’s points with conventional points, or Tung’s point with local points, then it would somehow negate the treatment rendering it useless to the patient. Not only does this make no sense to me (Tung himself was aware of the conventional channel points, and used them in his clinic), it shows that whatever teacher said this had a profound misunderstanding of acupuncture as a therapeutic intervention.

As a beginning student of any system it is important to stick as closely as possible to the original methodology in order to fully understand how a system works. But the eventual goal is the flexible application of numerous theories at the same time. Here is a clinical case example from my own practice that I saw this week. It illustrates the combination of Tung points with time based point selection. Time based point selection is one way of looking at it is a method of treating disease first by putting a patient’s body back in resonance with the movement of Yin-Yang and the Five Phases in nature.

The patient is an early middle-aged woman with menstrual irregularities and compromised fertility. She has not had a menstrual cycle in some time now. I initially diagnosed her with an insufficiency of the Chong vessel as one of her primary patterns. Today her pulses, as is typical, were overall thin and weak. However, her left guan position was particularly weak while the right guan position was wiry and slightly strong in the superficial level and weak at the deep level. This shows an overall insufficiency of the Wood phase, and in the Earth phase the Stomach channel is slightly replete while the Spleen channel is vacuous. The patient is also very stressed out with a lack of sense of proper direction in her current situation (which confirms the vacuity of Wood phase).

The point selection was Xia Xi GB-43, Ren Huang 77.21 (i.e., San Yin Jiao SP-6), and Fu Ke 11.24. Xia Xi was chosen because the patient presented at 7:30am (actual time; 8:30am for daylight savings time, which is not real/solar time) on a Ren 壬 stem day; this is the open point in the Zi Wu Liu Zhu 子午流注 (Na Jia Fa 納甲法) point selection method. On top of that Xia Xi is the Ying and Water point on the channel, making it the supplementing point of the Leg Shaoyang Gallbladder. Supplementing Yang Wood helps drain Yang Earth (Stomach channel) since Wood and Earth are in a control cycle relationship. Lastly, Xia Xi, on the foot, images the lower abdomen.

Adding in Ren Huang (i.e., San Yin Jiao) strengthens the Kidney as well as the Spleen and Liver. Likewise, Ren Huang images the lower abdomen and can be used to regulate the menses. Once Xia Xi and Ren Huang were inserted the pulses normalized, i.e., the wiry quality in the left guan evened out and overall the pulses were more even at the middle depth in all positions. At the end Fu Ke was added as a general regulator of the Chong and the uterus. Thus, this case illustrates a typical therapeutic approach to a common case using both Tung lineage and classical acupuncture points.

Minor Heat 小暑 Seasonal Node

Friday, July 7, is the beginning of the next seasonal node – Minor Heat (Xiao Shu 小暑). This important time period marks a major transition in the movement of Qi in the natural world. Summer Solstice (Xia Zhi 夏至) began the transition from Yang-expansion to Yin-contraction in the environment. Therefore, Minor Heat is the first seasonal node in the Yin time of the year. That said, it is still hot out! Even the name of this seasonal node acknowledges this. Although we are transitioning into the Yin time of the year, weather change happens slowly. Think of it like a train barreling ahead at high speed. Once the conductor decides to stop the train and put it in reverse, she first puts on the breaks. Even though the breaks are applied, it takes several hundred feet before the train actually stops. Only then will it very slowly start moving in reverse. The movement of the seasons is just like this. Once we have flipped the switch from Yang to Yin, the weather still continues to warm for some time before the very slow movement in the opposite direction begins.

The most important “to do” during this time is to nourish the Heart by maintaining an optimistic outlook. Why is this? June and July are the months associated with the Fire phase. Also, if we overlay the 12 time periods of the day with the 12 months of the year (i.e., the 12 two-hour periods of the day that each correspond to one of the primary channels), June is the time of the Heart channel and July the Small Intestine channel. Both are Fire phase channels. Since this is the Fires Phase time of year, it is the time of the Heart Zang. We nourish the Heart by keeping a calm mind and being optimistic. Pessimism or other negative emotional states can lead to patterns such as Liver stagnation, which in turn can transform into heat and harass the Heart.

During this seasonal node, the first 5-day period is known as Wen Feng Zhi (溫風至), - Sultry Winds Arrive. This certainly describes what is happening in the weather right now, especially in the Northeastern United States! The weather has been hot, and very humid. Therefore, we need to be careful about environmental dampness damaging the body. As clinicians we should instruct patients who are prone to damp patterns on how to eat, dress, etc… In this light the main “to avoid” this time period is undue exposure to cold and excessive consumption of cold items (both cold temperature and cold thermal nature). While it may seem logical to be in cold places in cold weather, there is certainly a problem in the west with using air conditioners to cool rooms to temperatures lower than we’d feel comfortable with in winter! Recently in our clinic we’ve seen quite a few patients with summer colds from frequently going between very hot and very cold environments. Furthermore, the overconsumption of cold (and especially cold and sweet) food and drink damages the Spleen leading to more damp accumulation. Instead, we should drink beverages that are cooling, as well as either bitter (to drain), or acrid (to move). This will cool the body without developing damp stagnation. Examples include chrysanthemum and mint, or even green teas. In China summer is the season to drink green teas such as the famous Dragon Well – Long Jing Cha 龍井茶.

Diet (and a little Moxibustion) for Minor Heat

As we mentioned above, during Minor Heat there is still significant dampness and heat in the environment. Therefore, we should consume foods that are cooling and either bitter or acrid. For example, this is the time of year to consume in-season fresh greens. In addition to chrysanthemum and mint we can also consume lotus leaf tea; lotus is a plant with a summerheat cooling nature that is also slightly bitter to drain heat and dampness. Advise patients to sip fluids throughout the day so they don’t dehydrate rather than drinking copious amounts of iced beverages all at once that may exacerbate damp conditions. If patients have damaged fluids, they can consume cooling and moist vegetables (such as cucumber) or fruits (such as watermelon).

One traditional recipe for this time of year is congee made from Yi Yi Ren (pearl barley) and adzuki beans. This basic combination is mild and neutral in temperature, and both the Yi Yi Ren and adzuki beans drain dampness. Yi Yi Ren strengthens the Spleen and adzuki beans clear heat as well.

In contrast however, this time of year is also a time when warming therapies are traditionally used. This is a method of treating winter disease in the summer. Starting in the Qing Dynasty (1644 – 1912) there has been a method of treating long standing cold disease by employing a type of moxibustion on the three hottest days of summer. These days are called the San Fu Tian, and the method of treatment San Fu Moxibustion, or San Fu Jiu.

San Fu Moxibustion was originally used to treat chronic respiratory problems such as asthma, although in modern times it has been expanded to other conditions. The basic theory of San Fu treatment combines the effective use of hot herbs applied to acupuncture points on the body during the hottest (i.e., most Yang) days of Summer. Doing so very aggressively expels cold that may linger in the body. Obviously however, this treatment is designed for patients who are vacuous and cold, and should not be performed on patients that in general have primarily hot conditions.

The actual treatment days are chosen based on Chinese astrology. The first of the San Fu days is the third geng (Yang metal) day after Summer Solstice in the Chinese calendar. The second day is 10 days after the first, and the third day is the first geng day after the Beginning of Autumn (which falls at the beginning of August). Usually there are three days in this method of day selection, but occasionally there is a fourth that can be used. This year the San Fu days are July 12, July 27, August 1, and August 11. The first of these days falls during Minor Heat. Around noon on these days (noon is a Yang time) a special paste is applied to acupuncture points on the upper back that all warm the Yang qi and expel cold. While recipes for this paste vary, they include very hot herbs such as mustard seed (bai jie zi), asarum (xi xin) and ginger juice.  People interested in learning more about San Fu Moxibustion should read Lorraine Wilcox’s book on moxibusion - Moxibustion: A Modern Clinical Handbook. You may also click here for more information on San Fu written by one of my former students, Dr. Heidi Lovie.

Now, back to food… In Korea there is a traditional custom of eating ginseng and chicken soup on these same San Fu days, and this dietary remedy can be done by anyone at home as general health prevention and maintenance. Ginseng and chicken soup has a very nourishing and supplementing function, and eating it on the San Fu days can help build internal Yang qi to prevent disease in the colder seasons that follow. This is very useful for patients who generally have weak qi, especially of the Spleen or Lung. Again, patients who are very hot by nature should avoid eating this soup in the summer.

Here is a basic Korean soup recipe:

Korean Ginseng and Chicken Soup - Samgyetang

Ingredients:

• 1 small chicken (Cornish game hen)
• ¼ cup glutinous rice
• 1 – 2 small fresh ginseng roots (ren shen 人參)
• Several Chinese dried red dates (hong zao 紅棗)
• Several peeled garlic cloves

Directions:

1. Soak rice in a small amount of water for 1 hour
2. Clean and rinse chicken and then stuff the cavity with the rice, ginseng, red dates and garlic. Place in pot and cover with water.
3. Bring pot to a rapid boil and then continue boiling over high heat for about 20 minutes, skimming off the foam as necessary. Replenish water that has boiled off and then continue to simmer for another 40 minutes until chicken is falling apart or can easily be pulled apart.
4. Garnish with freshly chopped scallions, salt and pepper to taste.

Bon appétit!

Golden Needle Pointing South 金針指南

It’s a warm and lazy summer weekend here so I thought I’d just write a little of my own thoughts and experiences. So there won’t be anything very specifically clinical here. One of the things on my mind lately is the incredible depth of thought and experience of our ancestors. Highlighting this for me was the convergence of two experiences, one from my students, and one from my own personal studies.

Over the last few weeks as we’ve been studying more clinical applications of Five Phase theory in my Nan Jing class, I’ve been hearing from students that they are astounded at the complexity of thinking doctors from 2000 years ago had. One thing the Nan Jing teaches us is that there is more to Five Phase theory than just the rote memorization of basic correspondences. Unfortunately in most modern AOM programs, this is all that we teach of the Five Phases. More complicated theories such as the Ten Celestial Stems and Twelve Earthly Branches are never even mentioned. When we start taking a look at advanced clinical applications of the Five Phases, we see how they can be used in an incredible rich and flexible system of diagnosing and treating the body. And doctors from two millennia ago took the time and had the sensitivity to discover all these complicated body relationships.

Then came yesterday… Fridays and Saturdays are my time to visit my own Shifu to continue my Neigong and Taiji training. Over the last two years or so we have spent most of our time working Taiji, but these last few weeks we returned to some Neigong exercises. Yesterday he taught me a new posture that I had read about but not yet practiced, an exercise called “Golden Needling Pointing South” (金針指南). This posture is a type of Wai Dan Gong (External Dan); the difference between the Nei Dan Gong and Wai Dan Gong being a focus on working internal Qi circulation (for the Nei Dan), or working body relationships with external Qi (for the Wai Dan). Exercising the Golden Needle Point South starts with facing an appropriate direction based on Twelve Heavenly Stems theory, and then holding a standing post position for about 10 minutes. Then, we slowly turn, paying attention to the sensation of facing different geographical directions. The practice is supposed to sensitize us to the Qi of the different directions so that eventually one’s own body becomes sensitive like a compass.

That just blew me away…

I don’t know if this is really possible for me, but I’m almost certain that in ancient times it was possible. As my own acupuncture students have been seeing, in years past people had a lot more time to sit and think. Or, if they were Neidan practitioners, sit and meditate, exercise, or just feel with their own bodies. They didn’t have Netflix, Facebook, or blogs to steal time from practice. As I get older I’m finding that simply taking time to practice is becoming more and more important to me, and more and more meaningful.

On top of that, recently I listened to an NPR story about a group of people without any terms for relative direction; in other words, this group had no words for right or left, or front or back. All they had were absolute direction terms. That means when giving directions they’d always say something like, “go straight ahead, and turn East at the corner,” rather than saying turn left or right. Or they might say something like, “hey watch out! There’s a bee flying on your North near your head,” instead of saying there’s a bee behind you. They pay attention to where they are, no matter where it is, to always know what direction they are facing in absolute geographical terms. Wikipedia mentions some of these groups of people under their Relative Direction article (click here to read).

There are still some mammals that have enough of a magnetic sensitivity that they can use it for orientation and navigation (click here to read some more). So, why not humans in modern times? Whether or not I can actually learn to do this, just the process makes me take time, in a quiet and relaxed manner, to just feel and learn sensitivity to the world around me. In the end that alone is not a bad thing.

I’m going outside to practice more, and I recommend you all do the same. If anyone is in the New Jersey area and wants to come learn Qigong in my classes, please click here to read more.

Summer Solstice 夏至 Seasonal Node

Over the last two weeks or so I’ve been up early. Really early. By 5 or 5:30am I’m awake, long before I have to be. In New Jersey we’ve finally been getting much warmer weather, and the sun has been bright in the sky. I’m sure I’ve been getting up because we are now in the most expansive Yang time of the year. Today, June 21, starts the next seasonal node, the Summer Solstice (Xia Zhi 夏至). Summer Solstice is a very important seasonal node in that it marks the apex of Yang in the natural world as well as the rebirth of Yin. It is the longest day of 2017; starting tomorrow the days will get shorter and shorter culminating eventually with the longest night on the Winter Solstice. In terms of the time of day, Summer Solstice corresponds to high noon, and is the time of the Heart channel. In Yijing (I Ching) symbolism, this time period is represented by hexagram 44, which is made up of Qian-Heaven trigram (3 solid yang lines) over Xun-Wind trigram (1 broken yin line under 2 solid yang lines). Thus, the complete hexagram is 5 solid yang lines over one broken yin line at the bottom – yin is being birthed once again. One of the translations for the name of Hexagram 44 is “The Queen,” also showing that this time of year begins the transition towards returning inward to the hidden, the yin, the Blood, and the Dark Mother that is referred to in the first chapter of the Dao De Jing.

When we break down Summer Solstice into the smaller 5 day periods of time, it includes the time periods know as Deer Shed Antlers (Lu Jiao Jie 鹿角解), Cicadas Begin Singing (Tiao Shi Ming 蜩始鳴), and Pinellia Grows (Ban Xia Sheng 半夏生). In the United States deer actually shed antlers earlier in the year. However, in New Jersey, this is cicada time. Three years around this time we were in the middle of a 17-year cicada invasion, and in some parts of the state they were literally as loud as trains! No wonder cicada shells (chan tui 蟬蛻) are good for conditions such as loss of voice. Notice also that this time is when Ban Xia is growing, the king of drying damp and getting rid of phlegm turbidity (a Yang herb to treat a Yin pathology). Likewise, in China this is the time of year to harvest Aconite (fu zi 附子) to enhance its Yang nature.

In some parts of China people perform simple ritual activities designed to protect against the Yin that is about to start growing. This Yin can be seen as an increase in various disease carrying insects (such as mosquitos) that bring epidemic disease. To ward off Yin in the form of insects and disease, Chinese traditionally hang aromatic (i.e., Yang) herbs around the house, such as Acorus (Shi Chang Pu) or Mugwort (Ai Ye). Other aromatic herbs such as Angelica (Bai Zhi) and Atractolodes (Bai Zhu) are made into medicines and incense.

Practically speaking, although this is a time of transition to Yin, this is still a hot and damp season. The first thing that is recommended during this time of year is to clear summerheat and drain dampness. For example, during this time it is common to see various skin problems due to external contraction of summerheat damp. It is also common to see other symptoms of summerheat strike such as malaise, fatigue, low-grade fever or heat effusion, low-grade headache, nausea, etc… There are several ways we can help ourselves as well as our patients when they present with summerheat damp symptoms. First, is to regulate diet, which we will discuss more below. We can also counsel basic lifestyle recommendations, such as dressing appropriately to the weather (such as wearing light clothes made of natural materials that breathe well), staying in shade in the midday when temperatures are highest, and drinking plenty of light and clear fluids. This is especially important for our older patients, since as we age we lose the normal ability to adapt to more extremes in temperature. Furthermore, seniors are more likely to be on prescription medications or may have chronic medical problems that inhibit perspiration or make extremes of temperature less tolerable. Some medications also increase sensitivity to sun raising risk of sunburns (examples include tetracyclines, quinolones such as Cipro, Celebrex, and some chemotherapeutic agents).

In terms of therapy, Dr. Zhong Yong Xiang of Taiwan suggests bleeding the jing well points on all the fingers for more severe cases of summerheat strike. This bloodletting method is described in my book Pricking the Vessels. We can also consider performing gua sha on the back to help move stagnant summerheat damp in the exterior muscle layer.

The next recommended “to do” during Summer Solstice is Shui Hao Zi Wu Jiao 睡好子午交. This means sleep well during both the Zi and Wu hours. Certainly, sleeping well is something we should be doing all year long. Zi and Wu refer to the time periods of midday and midnight, with Zi being the 11pm – 1am hour, and Wu being the 11am – 1pm hour (to be adjusted for standard time in locations that observe daylight savings time). In general it is important to get into bed before the Zi hour. Remember, the Zi hour is the time of transition from Yin to Yang, representative of the Winter Solstice. After this time period our bodies are already in a state of Yang expansion, the movement contrary to good sleep. Getting to bed and sleeping through this hour ensures that we really rest, that we really go into the state of storage that replenishes our vital substances.

The Wu hour is also a time of transition, and like the Summer Solstice, represents the change from Yang to Yin. The traditional recommendation is to take a short nap during this time to harmonize the body with this movement of Yang to Yin. That said, the recommendation is just a short nap of maybe only 30 minutes time (this is just the beginning of Yin after all). After that, don’t linger. Get up and back to normal activity.

Diet for Summer Solstice

As already mentioned, Summer Solstice is the time of transition from Yang to Yin in the natural world. That said, Summer Solstice is still a time of damp and heat in many places. Therefore, the basic strategy of clearing heat and draining dampness can help guide us in our diet strategy. It is important to keep in mind that during summer over-sweating and prolonged exposure to heat can deplete the Qi and fluids of the body. So, once we are clear of heat and damp, if there is vacuity we can focus on supplementation. However, since this is a hot time of year, cool supplementation is best.

In summary we can generalize this is the time to eat foods that clear heat (especially summerheat), drain dampness, nourish the Qi and boost fluids. Examples include cucumber, winter melon, luffa, tomato, honeydew melon, star fruit, peach, plumb, and mung beans. This is also a good time to eat bitter melon (ku gua 苦瓜). When I lived in Okinawa as a graduate student, bitter melon was a basic staple of food since Okinawa is a very hot and damp climate. Here is a recipe for a very traditional Okinawan dish called Goya Champuru (‘goya’ is the Okinawan word for bitter melon and ‘champuru’ means something mixed together). This dish gently clears heat and drains damp, but also boosts Qi and yin-blood.

Goya Champuru ゴーヤーチャンプルー (Serves 4)

Ingredients:

• 2 bitter melon (about 400 g)
• 1 block of firm tofu (300 g)
• 2 eggs
• cooking oil
• salt
• soy sauce

Directions:

1. Cut bitter melons in halves lengthwise. Remove the seeds and fibers with a spoon. Slice thinly and sprinkle with salt to soften them. When soft, rinse with water, then squeeze out the extra water.
2. Wrap tofu in a cloth or paper towel, place a light weight (a plate will do fine) on top, and leave for at least 2 hours to press out excess water.
3. Heat 2 tablespoons of cooking oil in a wok, crumble the tofu into fairly large pieces, fry well while adding salt to taste, then remove and set aside on a plate.
4. Add 1 tablespoon of cooking oil to the wok, then stir fry the bitter melon slices. The longer you fry it and the thinner it is sliced, the less bitter it will be.
5. Return the tofu to the wok and stir fry with the melon. Beat eggs and add to wok. Mix everything together well until eggs cook, and salt to taste.
6. At the last moment, pour a small amount of soy sauce around the edge of the frying pan for extra taste. Mix all ingredients quickly and remove from heat immediately.

Another simple traditional dish for this time of year is Millet and Red Date Congee. For this recipe take about ½ cup of millet and 5 dried Chinese red dates (紅棗) and place in a pot of 6-8 cups of water (use 6 cups for a more creamy congee, or use 8 for more watery). Bring to a boil and then reduce flame to simmer for 45 minutes or longer, until the millet has broken down and the resulting congee is creamy. Remove from heat and add a small amount of brown sugar to taste.

Millet is said to moisten the Yin and nourish the blood, and the red dates are also blood and Qi nourishing. Too much sweating depletes the body fluids and can eventually damage the Qi and blood. Even though this is a warm dish, it can replenish the body after outdoor activity in hot weather that induces significant sweating.

To read a more comprehensive article on staying healthy in Summer click here.

I hope everyone is having a great summer and staying healthy!

Henry

Video for Basic Qigong

I've just posted a video describing the descending the Qi and washing the organs Qigong exercise that we do prior to other postures. My hope is to do more videos first on the Qigong exercises for the 12 channels (that go with the Pai Da regimens), and then some other basic videos. Enjoy this short video!

Upcoming Online Class and Happy Fathers' Day

We're only a few weeks away from my Pro D class on Tung's acupuncture for gynecological conditions. In that class I'll do a review of core theory essential to the system, and then we go through some of the most important Tung lineage points for various gynecological conditions.

On another note, I'd like to wish everyone out there a very happy Fathers' Day! I'll write again later this week as we're only a few days away from the Summer Solstice. It's hard to believe that Yang is about to turn the corner back to Yin, and the days will be getting shorter soon.

Click here for more information on the Pro D class or to register. 

Beginning of Summer 立夏 Seasonal Node

The days are slowly getting longer, and my tree peonies are in full bloom. This post is coming out a bit late since almost 2 weeks ago, on May 5, the Beginning of Summer (Li Xia 立夏) arrived. Perhaps I’m writing this so late because around here the last few weeks were unseasonably cold. However, this week there was a dramatic shift to warmer weather appropriate to the current season. The days are really are much longer and brighter, and at this point in time, in only about 1 ½ months the days will start getting shorter again. Right now the Yang of the natural world is close to its fullest, and correspondingly the hexagram that represents this time of year is Qian Gua (乾卦) – six solid-Yang lines.

Summer is associated with the Fire phase, although the 4th month belongs to the Spleen (the 4th month in the Chinese calendar is May, since February is the first month). This is interesting as in ancient times the Heart was associated with the Earth phase as well as the Fire phase. For example, in the Shuo Wen Jie Zi, the Han Dynasty dictionary that gives the etymology of ancient characters, the definition of Heart is 人心土藏 – “human Heart, the Earth zang-viscera.” The Spleen channel also has a direct connection to the Heart Zang. Many of you who practice Tung’s acupuncture will notice that the main Heart Dao Ma group is located in the space between the Spleen and Stomach Channels; this Dao Ma group is the Zu San Tong consisting of Tong Guan 88.01, Tong Shan 88.02 and Tong Tian 88.03. In Tung’s acupuncture all of the major Heart points have some relationship with Pericardium channel, the original Heart channel from the Neijing (e.g., the Source point of Heart in the Ling Shu is Da Ling PC-7, not Shen Men HT-7). One needling technique we can use during this time of year with otherwise healthy patients is to incorporate Pericardium channel points (such as Nei Guan PC-6) or the Zu San Tong Dao Ma group into point prescriptions. These points help the body harmonize with the movement of the season right now.

To remind everyone, each of the 24 Seasonal Nodes has a traditional set of health guidelines where we should focus on certain things and avoid others. For Beginning of Summer the traditional things we focus on are preserving a good mood, nourishing the Heart, and thereby entering stillness (保持良好情緒，養心入靜). The things to avoid are allowing Heart fire to become too exuberant and intemperance in food and drink (心火過旺，飲食沒有節制).

As we just mentioned, the Heart is the fire organ. This means that occasionally it is prone to excess heat, signs of which include insomnia, irritability, dry and hard stool, red eyes, and thirst for cold beverages. One way to avoid excess Heart Fire is to dress appropriately for the warmer weather as it starts to come. Avoid strenuous work in direct midday sun, instead taking advantage of the slightly cooler temperatures in the early morning or later afternoon. Be sure to consume plenty of clear fluids such as water or herbal teas. Mint tea and chrysanthemum tea are both gently cooling to the body, and additionally they help with allergies that are so prevalent right now in northern New Jersey.

Another way to avoid problems of Heart Fire is to maintain a good mood. One of the best prescriptions for stress relief is moderate exercise. Take advantage of the improving weather and go for a short walk in the cool early morning hours. Also consider taking a few moments throughout the day to simply take some quiet deep breaths. Those who are local to New Jersey can consider joining our Qigong and Taiji classes.

With the new seasonal node come new dietary suggestions. One of the first, as already mentioned, is to avoid intemperance in food and drink. Overeating, especially of very heavy, sweet or greasy foods, places a burden on the Spleen. Overeating these foods, and overconsumption in general, also create internal heat that can worsen Heart Fire.

In terms of traditional flavors, this time of year we should focus on eating slightly more sour, a little more bitter, and light or gently cooling foods. Eating sour foods helps build fluids and blood so as to nourish the Heart, and bitter can drain fire. As the heat in the environment increases it is understandably appropriate to eat more light fresh vegetables and other foods that will gently cool the body. Specific foods to consider this Seasonal Node include bananas, peaches, plums, umeboshi (Japanese salted plums), asparagus, cucumber and corn. Since this time of year is associated with Fire and Heart, red foods are also good to incorporate – think of strawberries, tomatoes and hawthorn berries.

It is appropriate to increase slightly intake of water or herbal teas. Patients who tend towards excess heat can drink chrysanthemum tea. Even though the beginning of Summer means more heat, some patients still may be cold and deficient internally. Since Summer sees increased environmental dampness, these people can drink a very light ginger tea or fennel seed tea, sweetened with a little local honey. Allergy sufferers (right now in New Jersey we are in the middle of a pollen tsunami) can take mint tea with some local honey, as local honey is used as a traditional allergy remedy.

Two traditional Beginning of Summer recipes are Celery Congee 芹菜粥 and Suan Zao Ren Congee 酸棗仁粥. For Celery Congee take several stalks of celery, remove the leaves, clean and cut into small pieces. Take an appropriate amount of white rice and cook in water to make a porridge (i.e., congee), and then add celery for the last 10-15 minutes of cooking. Add salt and pepper to taste. This recipe clears heat and extinguishes fire, reduces blood pressure, and eliminates vexation. However, it should be avoided by those with Spleen-Stomach vacuity cold patterns. Celery Congee can be taken daily in the morning as a warm breakfast. This recipe originally comes from the Ben Cao Gang Mu.

For the second recipe, Suan Zao Ren Congee, use about 50g of Suan Zao Ren 酸棗仁 to about 100g of white rice. Add an appropriate amount of water and boil until you have congee. At the end, add a small amount of sugar or honey to taste. This recipe can be taken as an evening snack as it can treat Heart vacuity and vexation to help sleep.

I hope you are all enjoying the gradually improving weather. Happy Summer!

Qian Gua - Seasonal Hexagram for Beginning of Summer

Grain Rain Gu Yu 穀雨 Seasonal Node

Last Thursday, April 20, 2017, was the beginning of the Grain Rain (Gu Yu 穀雨) seasonal node. Grain Rain is actually the last seasonal node of Spring, as early May marks the beginning of Summer in the Chinese calendar. Considering today was a slightly chilly Spring day here in New Jersey, it feels odd writing that Summer will begin in just 2 weeks. However, in the traditional Chinese calendar seasons are tied more to the changes of day length than actual temperature. Believe it or not, in only about 2 months from now the days start getting shorter again – so even though it’s still chilly outside get out and enjoy the sunshine!

Grain Rain is the 6th step of the 24 seasonal nodes thus corresponding roughly to the 3rd watch of the day (7-9am). Furthermore it is the time of transition from Spring to Summer correlating to the Earth phase (the Earth phase is the transition between seasons). Thus, Gu Yu is the time of year associated with the Stomach channel. The general movement of Spring is the movement of Liver-Wood, but the Earth phase is also in charge of movement and transformation. Because of this, during Grain Rain we need to ensure that Qi and Blood are moving smoothly. Watch for signs of Qi stagnation in yourself and in your patients. This is why one of the basic recommendations for this time of year is performing regular self-massage to ensure smooth circulation of Qi and Blood in the body.

One of the easiest points to massage for the average person is the collection of points known as the Shi Xuan 十宣穴. These points are located one at the tip of every finger and every toe. The word “Shi” means 10 – there is a point on each finger and toe adding up to 10 total. The word “Xuan” means to spread or diffuse. Since all the channels of the body connect to the fingers and toes, these points together spread or move all the Qi in all the channels of the body, and can be massaged as a general way to prevent and treat stagnation in the channels. To massage simply squeeze and rub the tip of each finger and toe in succession. Repeat throughout the day, but preferably at least once each morning and once each evening.

As the weather does get a bit sunnier and warmer it is important to increase outside activity – consider walking or gardening. However, since Spring is a time of temperature ups and downs, be careful to dress appropriately as dictated by each day. This is the tail end of the cold season, so pay attention to preventing colds, and seek treatment as soon as any cold or allergy symptoms start. Grain Rain is a time when Lung Heat is thought to be a potential problem (over the last week or two many allergy sufferers have been manifesting with Lung Heat signs and symptoms). Consider needling (if you’re an acupuncturist) or massaging (if a patient) Da Zhui DU-14 this seasonal node. Other points include needling or massaging Tung points Chong Zi 22.01 and Chong Xian 22.02.

Getting back to the idea of stagnation, it is vital that during Grain Rain we prevent stagnation in the Stomach (since this is the time of Stomach channel). To this end, the traditional thing to avoid this time of year is overeating or overdrinking. Similarly, this is the time of year to avoid oily and greasy foods. Other foods to avoid are very cooling fruits (such as a lot of citrus).

Start eating lighter and easier to digest items and in-season vegetables such as asparagus. Other foods to emphasize should help boost Qi and Blood, and gently strengthen the Spleen and Stomach (since the Yang of the Spleen/Stomach is still fragile now, especially since Liver-Wood can over-control Earth) – rice or rice congee, Bian Dou, yams, nagaimo (Shan Yao in Chinese), peanuts, and cherries (a slightly warming fruit). If you didn’t know, this is also egg season. Yes… Eggs have a season! Most chickens naturally lay eggs only when day length is about 10 hours or more (commercially grown eggs are available because farmers trick chickens with strong artificial lighting year round). One of my favorite early spring recipes is steamed asparagus with scrambled eggs – delicious and light, and good for you too!

Here’s a traditional Chinese recipe for Grain Rain – Tofu and Spinach Soup

Tofu and Spinach Soup 菠菜豆腐湯

Ingredients:

• One small bunch spinach
• One block fresh organic tofu (about 4-5 oz.)
• 5 cups chicken or vegetable broth
• Salt
• Toasted sesame oil

Directions

1. Wash spinach thoroughly and remove thick stems
2. Drain tofu and cut into small cubes
3. Place tofu and spinach in the broth, bring to a boil and simmer just until spinach is cooked through and tofu absorbs the flavor of the broth
4. Add some salt and toasted sesame oil to taste, and serve; optionally can add some chopped scallions as garnish

This recipe boosts the blood, nourishes yin, and at the same time is easy to digest and strengthens the Spleen and Stomach. As an alternative a raw egg can be stirred in at the end to make a type of egg drop soup with spinach and tofu.

I hope everyone is enjoying the Spring!

Henry

Updated Course Schedule

I've just recently updated the course schedule to include my first online class with ProD Seminars. Please click here to go to the course offering page. Most of my other courses this year are as part of DAOM programs, but I will be in Colorado for an in person class this October. I'm working on getting some other live classes up for the fall, so stay tuned!

And speaking of the DAOM programs (someone had asked me about the programs I teach in), here are the 3 places I teach. I teach most at OCOM where in addition to Tung's acupuncture I teach clinical case writing, and sometimes Neijing. So, for those looking for advanced training these are the places I'd suggest (right now I can't recommend any of the first professional DACM programs):

Oregon College of Oriental Medicine DAOM Program (focusing on geriatric medicine and women's health)

American College of Traditional Chinese Medicine DAOM Program (focusing on pain management and women's health)

Academy of Chinese Culture and Health Sciences DAOM Program (focusing on classical Chinese medicine)

The Five Taxations 五勞 Part II

Awhile ago I started writing about the Five Taxations (五勞), a list of 5 damages caused by overuse or overexertion found in the Xuan Ming Wu Qi (Wide Promulgation of the Five Qi, Su Wen 23). The first was taxation of the Blood, so today I’ll continue with a short discussion of the second taxation.

After the discussion of blood, the Su Wen tells us that “lying down for a long time damages the Qi” (久臥傷氣). This is taxation that, according to Wang Bing, is associated with the Lung.

The Jing Mai Bie Lun (SW21) says, “The Lung invites the hundred vessels to have audience with it” (肺朝百脈). The Lung is the canopy that covers all the other viscera and bowels, and it is the Lung that orders the Qi movement in the body, which is why the Ling Lan Mi Dian Lun (SW8) says that order and moderation originate with the Lung (治節出焉). Remember, the Latter Heaven production of Qi starts with Spleen and Lung, but it is the Lung that orders the Qi, separating it into Ying and Wei, and then distributes it through all the channels and vessels.

When the Neijing says lying down for long periods of time, it means we are physically inactive. Physical movement moves the Qi, one of the main reasons why in Tung’s acupuncture we frequently combine physical movement with needle stimulation at the same time. When we don’t move enough, over time that alone will create stagnation in the Qi, and eventually this stagnation of Qi will go back to damage the Lung. Thus the Zhi Zhen Yao Da Lun (SW74) says, “All Qi oppression and stagnation, without exception they are associated with the Lung” (諸氣膹鬱，皆屬於肺). Damaged Lung and stagnation of Qi leads to vacuity taxation of the Qi.

One of the reasons exercises like Qigong are so effective is that they combine physical movement with regulated breathing, and therefore my first recommendation for damage to the Qi is Qigong, Taiji or other exercises that combine breathing with movement. In our weekly Qigong classes one of the first exercises we practice are forms that grasp and draw in the Qi of nature (採氣功). In my own body I know that if I am fatigued and my pulse is deep and weak, after Qigong practice not only do I feel refreshed, but my pulse will become stronger and more even throughout all the pulse positions.

In terms of Tung’s acupuncture, one of the best points for the second of the Five Taxations is Huo Fu Hai 33.07. This point is located near Shou San Li LI-10, and it functions to expel wind and depurate the Lungs. In addition it supplements the Qi (and Blood) mainly through the Lung and Kidney Zang – everyone’s homework is to think about why that is the case. In Tung’s original book this point was the only one that he mentioned moxibustion for, and he said that moxa here enhances longevity. In my own clinic I typically apply direct rice-grain sized moxa to this point, and have patients use a tiger warmer to apply moxa at home. Aside from Huo Fu Hai, consider other points like Zheng Hui 1010.01, and the Zu Si Ma Dao Ma group (88.17, 18, 19), the main Dao Ma combination for the Lung Zang.

Next time we move on to sitting for too long. Until then, get outside and enjoy the spring.

Clear and Bright 清明 Seasonal Node

Tuesday April 4th was the beginning of the Clear and Bright (Qing Ming 清明) seasonal node. Clear and Bright is the node just after the Vernal Equinox and the next step in the progression of Spring. This seasonal node is also a traditional holiday in much of Asia – the Qing Ming Festival. In Okinawa, where I lived as a graduate student, the day is called Shimi in the local Hogen (indigenous Okinawan language). Qing Ming Festival is a time for Asians to visit graves and pay respect to the ancestors. Thus it is a time to remember the past while at the same time starting the New Year and the new Spring.

The last few weeks in New Jersey have seen dramatic ups and downs in temperatures, and even later this week the thermometer is expected to deep to just above freezing in the overnight hours. Not surprisingly then, the first “to do” during Clear and Bright is to protect being warm (bao nuan 保暖).  Spring is the time of growing Yang, and we don’t want to do anything that damages that internal warming Qi. The second chapter of the Su Wen admonishes us that if we don’t take care in Spring, then cold disease will arise in the Summer that follows. Since during the next few weeks typically temperatures will continue to fluctuate up and down, be sure to tell patients to dress appropriately for the day, and not to think that just because it’s supposed to be Spring, that every day will be warm enough for light clothing.

The second “to do” during Clear and Bright is be active in outdoor activities or exercise. With the continued growth of Yang in the natural world, it is important to increase our physical activity. Again, the second chapter of the Su Wen tells us that in Spring we should be sure to “move around throughout the courtyard with leisurely strides” (廣步於庭). The Wood phase and the Liver are responsible for the normal smooth circulation of Qi in the body, and similarly during Spring we should be sure to keep our bodies moving. Of course, exercise doesn’t have to be intense to be effective. Suggest to patients that just getting outside to do light yard work or gardening is a great idea. Practicing Taiji or Qigong outside is also appropriate. For those who are local to northern New Jersey and are interested in starting a traditional Qigong or Taiji practice, please check out our weekly classes (click here for more information).

One of the Nourishing Life exercises that is appropriate to Clear and Bright is pressing and rotating Shen Que REN-8 (i.e., the navel). Shen Que is obviously an important point on the body as the abdomen is the location of many important internal organs. Likewise, it is the area where some of the most important channels in the body originate – the Ren, the Du and the Chong. In Chinese these three extraordinary vessels are said to be “one origin and three branches.” For this exercise first rub hands together vigorously to warm them. Then place the warmed hands over the navel and slowly, with moderate pressure, rotate 50 times in a circle one direction, then 50 times in the other direction. Shen Que rotation helps warm the center and expel cold and is especially appropriate for patients who are cold and depleted, and for patients with clear nasal discharge such as seasonal allergies. Think of doing moxibusion at Shen Que for patients who are particularly or chronically depleted.

The flip side of this is to be cautious of patients with uprising Liver yang patterns, or patterns of internal wind; Clear and Bright is the time to guard against hypertension in patients who are prone to this condition. These patients should be counseled to get some more exercise, as this is an effective adjunct therapy for hypertension.

The “avoids” for Clear and Bright are mainly related to diet. First, Chinese medicine recommends that patients avoid very acrid and spicy foods. While somewhat acrid foods and herbs are appropriate to Spring (such as leeks or scallions), overly spicy foods may potentially either stir internal Yang or dissipate internal Qi. The second type of food to avoid is very sour or greasy foods. Both sour and greasy foods create stagnation, and thus inhibit the normal coursing of Qi. Since Spring is the time of Wood-Liver, it is important to keep Qi moving internally.

In general the diet for Clear and Bright should reflect the name of the seasonal node. Light and clear foods that neither block the Qi mechanism nor overly stimulate it are appropriate. Gentle movement and easy to digest should be the focus. As more vegetables become available, patients should increase consumption of fresh produce. Traditionally this is the time for greens such as spinach and mustard greens. In the west certainly April is the season for fresh asparagus. All these greens are beneficial to the Liver.

Patients who are somewhat Qi deficient, or patients with seasonal allergies can try making Jade Screen Chicken at home.

Jade Screen Chicken – Yu Ping Ji 玉屏雞

Ingredients:

• 1 whole chicken (about 2 lbs.)
• Huang Qi 黃耆 60g
• Bai Zhu 白術 20g
• Fang Feng 防風 20g
• Salt and pepper to taste

Directions

1. Rinse and clean chicken
2. Take herbs and stuff inside, close chicken to retain herbs inside the cavity
3. Place chicken in a slow cooker and cover with water, allow chicken to cook until done

This can take a long time to cook in a slow cooker, but I think it will yield the best results. I suggest this be set up overnight and put on the low temperature setting. By lunch the next day it should be done as cooking can take 8 hours or more. Other vegetables can be added to this soup as desired. Patients can both consume the meat as well as drink the resulting broth. Season with salt and pepper to taste. The recipe helps nourish Qi, secure the exterior and expel cold.

Here’s a second traditional recipe for Qing Ming, this one taken from the Qian Jin Yao Fang – Almond Kernel and Walnut Soup.

Almond Kernel and Walnut Soup – Xing Ren He Tao Tang 杏仁核桃湯

Ingredients:

• Almond kernel (Xing Ren 杏仁) 25g
• Walnuts (raw) 25g
• Fresh ginger root 10g
• Honey

Directions

1. Peel and slice the ginger root and then crush the almond kernel and walnuts into very small pieces
2. Place the ginger, almond kernels, and walnuts into a pot with several cups of water
3. Bring to a rapid boil, then reduce to a medium heat and simmer for about 10 minutes
4. Add honey to taste; drink twice per day, once in the morning and once in the evening

This recipe strengthens the Kidney and moistens the Lung to help stop coughing making it also good for seasonal allergies that happen around now.

Happy Spring everyone!

Vernal Equinox 春分 Seasonal Node

This year the Vernal Equinox fell on this past Monday, March 20th. In the western calendar we celebrate this as the beginning of Spring. In Persia this day was traditionally revered as the beginning of the year (called Nowruz), and Rosicrucian mystics count Vernal Equinox as the new year as well. However, in the Chinese calendar the Vernal Equinox is the midpoint of Spring. Why? Because we are now at the balance point of Yin and Yang. If the height of Yang is the longest day (Summer Solstice), and the height of Yin is the longest night (Winter Solstice), then the midpoints and points of balance are the Equinoxes. Even though we’ve had some significant ups in downs in temperature, the days are slowly warming, and all around plants are starting to bud.

The three 5-day periods in this seasonal node are Swallows Arrive (xuanniao zhi 玄鳥至), Thunder Starts Resounding (lei nai fasheng 雷乃發聲), and Beginning of Lightning (shi dian 始電). In Yijing (I Ching) theory the Thunder Trigram (Zhen Gua 震掛) is a Wood trigram, linking thunder and lightning, yang activities of the heavens, with Spring. Zhen Gua is composed of one solid yang line on the bottom, with 2 yin (broken) lines above. This is the image of yang emerging from underneath, continuing to grow up and out. Spring is exactly that time of year – the time when Yang of the natural world is slowly starting to push itself up and out of the Yin of Winter.

The main thing to focus on during this 15-day period is “Nourishing the Liver” (yang gan 養肝). One of the ways we nourish the Liver is to ensure normal Liver function. For example, this is the time of year to really ensure our patients' Qi is freely coursing (one of the main functions of Liver is to ensure normal coursing of Qi). Patients who tend to Liver stagnation can be encouraged to perform regular acupressure on the Four Gates 四關 (i.e., He Gu LI-4 and Tai Chong LR-3).

The second “to do” during this time is to “both Clear and Supplement.” This means that when the Liver is hot or hyperactive, clear and sedate. When it is vacuous (e.g., has Blood vacuity), then supplement. Since any pattern of disharmony in Liver will impair some of its major functions, when we see Liver patterns during this seasonal node they must be treated.

As mentioned already, the Vernal Equinox is the time of balanced yin and yang. It is appropriate at this time to also have balanced mind states. Thus, one of the “avoids” during the Vernal Equinox is extremes of the Seven Affects. Chapter two of the Su Wen says that Spring is the time to not be angry. We should try to relax, and not allow our emotions to run too far in any direction. The second thing to avoid during this seasonal node is overdoing “bedroom activity.” Since sex stirs the yang to mobilize jing-essence, to keep an overall balance in health we need to seek a balance in sex. As this time of year is a time of balance, too much sex may deplete the yin-jing. That said, no sex at all can lead to stagnation in the circulation of Qi and blood.

Diet for the Vernal equinox should mimic the balance that is present in nature at this time. In general, the continued use of mildly acrid foods such as ginger and scallions help ensures normal coursing of Liver qi. This is especially useful for patients with Liver depression patterns. Patients who tend more towards vacuity patterns, especially Liver blood insufficiency, can increase consumption of sour foods such as pickles or vinegar.

A simple tea most patients can consume during this time is rose bud tea. This tea is made by steeping Mei Gui Hua 玫瑰花 in hot water. Mei Gui Hua is warm and sweet and is found in the Qi regulating chapter of the Materia Medica. It courses Liver as well as gently quickens the blood. It is especially useful for our female patients who have menstrual irregularities due to Liver stagnation. In the Baijiquan 八極拳 system of Chinese marital arts, Mei Gui Hua tea is used as a general Qi and Blood moving tea for injury.

One traditional dish for Vernal Equinox is Stir Fried Pig Kidney with Eucommia (杜仲豬花). Here’s the recipe:

Ingredients

• Organic pig kidney ¾ to 1 lb
• Eucommia bark (Du Zhong 杜仲) 6-9g
• 1 scallion, 1 piece of ginger (about the size of your thumb or a little larger), 1-2 cloves of garlic
• Cooking oil, salt, soy sauce

Cooking Directions

1. Cook Du Zhong in about 1 cup of water by bringing to a boil and then simmering until only about ½ cup of liquid is left
2. Cut kidneys into thin slices and then score one side of each slice; peel and slice the ginger, slice the garlic, and slice the scallion
3. In a pan, add a small amount of cooling oil, and start by cooking the garlic and ginger just until fragrant and / or the garlic is transparent. Add in the kidney slices and cook for several minutes. Then add a small amount of salt and soy sauce.
4. Add in the Du Zhong liquid, and cook down in the pan with the kidney. Add scallions. Cook until kidneys are thoroughly cooked through.
5. Optionally can add Gou Qi Zi (i.e., Goji berries) at end as well before liquid has cooked down, cooking until slightly plump.

This recipe supplements the Kidney, boosts essence, and nourishes the Liver blood. It is good for lower back pain, knee pain, declining visual acuity, or other symptoms of Liver and Kidney vacuity.

For a vegetarian recipe associated with the season please click here to see last year’s post on the Vernal Equinox.

Happy Equinox!!!

Soy Consumption and Cancer - New Research on the Safety of Soy in Breast Cancer

For many years a lingering controversy has plagued many breast cancer patients and survivors – the question of to eat, or not to eat soy products. This question arose because soy is a source of isoflavones, compounds that are sometimes called phytoestrogens since they bind to estrogen receptor sites on cells in the body. As many breast cancers are estrogen related, the fear was that consumption of these compounds in soy products would at best prevent certain cancer therapies from working, and at worse actually be a contributing factor in the development of breast cancer.

The problem is that this idea was just a theory not based on much actual evidence. It also didn’t take into account that phytoestrogens are found in many foods that were never included in the list of things to avoid for breast cancer patients. A short sampling of other foods containing phytoestrogens includes sesame seeds, oats, barley, lentils, apples, carrots, beer, and even coffee (and the list goes on after that).

Over the last few years however, the evidence has been coming in that not only does soy consumption not contribute to cancer, but, in many patients it actually can prevent recurrence of breast cancer in breast cancer survivors. In earlier studies of Asian women, a group of people who consume much higher amounts of soy than women in the United States, soy intake was seen to actually have a protective effect against cancer (in other words, it helped prevent breast cancer, not make it more likely).

Earlier this month another large-scale study (looking at over 6000 women) was published in the journal of the American Cancer Society. This paper looked at an ethnically diverse group of women with breast cancer based in the United States, and evaluated the effect of their soy intake. According to the authors of the study, “In this large, ethnically diverse cohort of women with breast cancer living in North America, a higher dietary intake of isoflavone [soy] was associated with reduced all-cause mortality.” In other words, consumption of soy products in some groups reduced risk of dying from breast cancer. Furthermore, the study found that no group of breast cancer patients, including those with estrogen based cancers, had any negative effect from consuming soy. To read the original article please click here (the abstract is free to read although the full article requires a subscription).

At this point we can clearly say that based on scientific evidence breast cancer patients can safely consume soy products. It is important to note though that this recommendation is made about actual food, not dietary supplements. We would also recommend trying to only consume high quality soy in the form of organic soybeans, tofu, tempeh, etc…  We do not recommend consuming highly processed and artificially colored or flavored soy products made for example to mimic other foods (like soy hotdogs and the like). Enjoy eating real food, and enjoy staying healthy as a result. Remember that other aspects of a healthy lifestyle, including getting adequate rest and exercise, reduce risk and recurrence of cancer as well.

Xiao Yao San Tea - A dietary recipe

In my clinic today I sent out a newsletter in honor of International Women's Day. In the newsletter I had a brief discussion of perhaps one of the more common Chinese herbal formulas used by women - Xiao Yao San. Something that I find interesting is the use of main flavor structure of an herbal formula translated into a dietary recipe so as to approximate some of the function of the formula in food. One of the challenges I think we all face is that some patients are resistant to using herbal formulas, and this can be for a variety of reasons. Some object to the taste, some to the cost, some have concerns about herb-drug interaction. When we approach patients with dietary "formulas" however there is less resistance. They usually taste good, and contain mild enough ingredients that the worry of herb-drug interaction is mitigated.

So, let's consider Xiao Yao San as an example. The main Dui Yao pair in the formula that courses liver and relieves depression is Chai Hua and Bai Shao. This pair is the combination of cool and mildly acrid (Chai Hu) with sour (Bai Shao). Acrid courses Qi, sour constrains to help nourish blood. Since the Liver is a Yang viscus (as the wood phase) it has a tendency to overheating when constrained, so cool is also appropriate. Thus, this particular combination is effective at treating Liver Depression (肝鬱). Added to this basic pairing is the sweet supplementing of Bai Zhu (which is enhanced by Gan Cao). This is the trip of main flavors in Xiao Yao San.

Now, how can we approach this as dietary therapy? One recipe I give patients that approximates Xiao Yao San is mint tea with lemon. Like Chai Hu, mint is cooling and slightly acrid (and by the way it is in Xiao Yao San as well). Lemon is sour. If we also want to add in something slightly warm and sweet that supplements the Spleen as Bai Zhu does, then patients can add in honey to taste. Thus, we have a simple and pleasant tasting tea that is essentially a milder version of Xiao Yao San. Consider this basic dietary tea recipe when treating patients with this formula pattern.

Awakening of Insects 驚蟄 Seasonal Node

“Awakening of Insects” (jing zhe 驚蟄) is the third seasonal node of the year, and it started Sunday, March 5th. This is the next segment of Spring, and as the name suggests it is the time when we start seeing the very initial stirring of life in the world outside. Here in New Jersey the crocuses are just starting to push out of the ground in spite of the lingering cold, and the peony buds are doing the same. The three 5-day periods in this seasonal node are Peach Trees Begin to Blossom (tao shi hua 桃始華), Orioles Sing (canggeng ming 倉庚鳴), and Hawks Transform into Cuckcoos (ying hua weijiu 鷹化爲鳩).

The first “to do” for this period of time is to guard and protect the Yang qi. Even though we are in Spring, this early part of the season can be cold as we have seen this past weekend here. Continue to dress appropriately. As Yang qi continues to grow in the natural environment, this is also the time to start doing slightly more gentle exercise. This recommendation conforms to what the Neijing says in the second chapter of the Su Wen, the The Great Treatise on Regulating the Spirit with the Four Seasons (Si Qi Tiao Shen Da Lun). There Qi Bo recommends that during Spring we should “upon waking take a walk in the courtyard, loosen the hair and relax the body, thus focusing the will on life.” Movement, especially in the morning, is a Yang activity. The Neijing recommends that “in Spring and Summer nourish Yang, and in Autumn and Winter nourish Yin (春夏養陽，秋冬養陰).”

The “to avoid” during Awakening of Insects is undo stress and strain. As Chinese medicine practitioners we all know the mental pattern associated with Wood phase, and thus Spring, is anger. Patients who are prone to Liver depression or Liver repletion patterns should be monitored during this time period to be sure qi is circulating smoothly. This is the time of year where formulas in the Chai Hu family are appropriate for many people. For patients prone to resentment and anger, contemplative practices such as Japanese Naikan are appropriate.

Diet for this time of year can help protect the Yang qi as well. I recommend that people in general eat warming foods such as leeks, chives, and scallions. Likewise, it is appropriate to drink a little alcohol, provided the patient does not have specific sensitivities, morbidities, or medications that require abstinence. All of these substances are warm and acrid, and thus course and warm the qi. I also suggest that everyone consume slightly more white noodles. In general, wheat husk (bran) is cooling, while the endosperm (inner white portion) is warming. White noodles, especially in soups, have the function of warming and supplementing the qi.

One traditional dish for Awakening of Insects is clear fried amaranth. Amaranth is called Xian Cai 莧菜 in Chinese, and in Chinese groceries it comes commonly in long bunches of beautiful dark green and purple leaves. Sometimes it is sold as “Chinese spinach.” Amaranth’s taste is mild. The basic preparation of the vegetable for this dish is to rinse clean (it often has a lot of grit), and then quick fry in an appropriate amount of cooking oil. Garlic or ginger can also be included for taste, and a small amount of salt and fresh ground pepper can be added at the end of cooking. In Chinese medical terms this dish clears heat and resolves toxins, disperses swelling and stops pain. People with spleen vacuity cold should be cautious with this recipe, unless a good amount of ginger is used in the cooking to counterbalance the cooling of the amaranth. If the weather is very cold still, I recommend that everyone use ginger or garlic in preparing the dish.

The last recommendation I’ll offer for Awakening of Insects is the traditional Chinese practice of Pai Da – stimulating acupuncture points and channels by patting. As mentioned above, Spring is the time to increase movement. Liver (the organ of Spring) ensures the free coursing of Qi and Blood in the body. Thus, any exercise or practice that opens and circulates the channels of the body will have a beneficial effect on the Liver. One basic Pai Da technique is to use the hands held in loose fists to pat acupuncture points on the upper limbs. Start by patting the shoulders – the area of Jian Jing GB-21. Alternate right and left while patting. Then, continue with patting the sides of the elbows at Qu Chi LI-11. Finish with tapping the He Gu LI-4 area. Practice this daily as you are able to circulate Qi in the arms, and thereby helping Qi circulation in the entire body.

Next installment we reach the Vernal Equinox!

Rain Water 雨水 Seasonal Node

Today, Saturday February 18, is the beginning of the second seasonal node of the new-year and the new Spring – 雨水 Yu Shui, “Rain Water.” During Rain Water the expansion of Yang in the natural environment continues. In addition to the 24 Seasonal Nodes that we have been mentioning, each of the 24 periods can be further broken down into 3 five-day periods (making up the 72 Material Manifestations of the year). The 3 periods of Rain Water are “Otters Sacrifice Fish” (ta ji yu 獺祭魚), “Swan Geese Appear” (hong yan lai 鴻雁來), and “Vegetation Sprouts” (caomu mengdong 草木萌動). The swan goose is a rare large goose native to northern China. While we don’t have them here in the US, we do have other species of geese, and here in NJ we beginning to see geese flying north again heralding the warmer Spring weather to come.

One of the statements in Chinese related to Rain Water says, “Yu shui lai lin shi qi zhong, dang xin pi wei shou shang hai” 雨水來臨濕氣重，當心脾胃受傷害 – “as Rain Water arrives damp qi is heavy, be careful not to damage the Spleen and Stomach.” When walking around outside, I’m struck by the shift in the feeling. As I write this essay, today we are having warmer enough temperatures that snow is melting. The ground and air are both moist with the release of water that was trapped in frozen form and there is now significantly more dampness outside in nature. This time last year a small part of my Grandmother’s driveway practically washed away in torrential rain! The dryness of winter is fast going.

This brings us to some of the basic “to do” recommendations for Rain Water. First is to supplement the Kidney and strengthen the Spleen. We do this because the weather is still chilly and can tax the Kidney as the viscera of cold and Winter. We need to protect the Spleen because of the increased dampness. The Spleen is also the viscera associated with seasonal transition, and even though we are in Spring we are in a period of weather transition.

Along these lines the basic “avoid” during Rain Water is “don’t rush to put away winter clothes.” The northeast US is starting to warm up. But, we are early enough in the year that we may see more cold, and the increased dampness in the environment makes the temperature feel a little chillier than it actually is. So, the recommendation to not rush to put away winter clothes is spot on. Even though we are enjoying warmer temperatures this weekend, and even though in the Chinese calendar we have passed the beginning of Spring, be cautious to protect yourself against the cold. Stay warm, and remember to use moxabustion as necessary on yourself and on your patients.

The second “to do” for Rain Water is eat congee! Honestly, is there a season when congee is bad? For those not in the know, congee is a type of rice porridge or soup (depending on how thickly you prepare it). And why eat congee now? Because it dovetails with the other recommendations for Rain Water. First, congee is warming and supplements the Spleen. Furthermore, congee is mildly damp draining so it protects the body against the increase in dampness in the environment. Congee is incredibly easy to make, and in China it is a common breakfast or brunch food. People of all levels of health can benefit from being taught to make and eat congee.

The base recipe for congee is to add 1 part rice to 6 to 10 parts water. For example, we can cook ½ cup rice in 5 cups of water. This is cooked until the rice basically starts falling apart so that the resulting product is creamy white. Depending on the type of rice you use, this can take anywhere form 45 minutes to 2 hours of cooking. What I do at home and what I recommend to patients is that they put all the ingredients into a slow cooker overnight on low heat, and by morning perfect congee is done. Or, if you are local to the NY metropolitan area you can join me for a bowl of congee at Big Wong's in NYC Chinatown - I'm there getting congee most Tuesdays when I'm in the city to teach at PCOM.

Into this base congee just about any ingredient can be added. Herbs, vegetables, meats, other spices – its all possible. For patients with weak Spleens and damp accumulation, a basic congee starts with rice as described above. After that, add in several slices of fresh ginger, a handful of Yi Yi Ren 薏苡仁, and several Dang Shen 黨蔘 roots. Season with soy sauce to taste when finished. This basic Spleen-strengthening and damp-percolating dish can be eaten daily for breakfast.

During Rain Water, since it is a time period of early spring, we also need to stay warm and guard against Wind. Here is a basic tea recipe associated with Rain Water. Its function is to warm and resolve the exterior, strengthen the Spleen, and guard against Wind.

Five Sprits Tea (Wu Shen Tang 五神湯)

Ingredients:

• Jing Jie 荊芥 9g
• Zi Su Ye 紫蘇葉 9g
• Sheng Jiang (i.e., fresh ginger root) 生薑 9g
• Tea leaf (green or oolong) 6g
• Brown sugar 30g

Directions:

1. Place the herbs in a pot with 3 cups of cold water. Let soak for several minutes.
2. Bring water and herbs to a rapid boil over a high flame. Then, reduce and simmer for 10 minutes uncovered.
3. Strain out herbs and add in the tea leaf, letting the tea steep in the hot liquid for several minutes.
4. Strain out the tea. Stir in brown sugar and drink warm throughout the day. Molasses or honey can be substituted for brown sugar (use to taste, and the addition of sweetener is optional).

Generally speaking, for patients with more pronounced Spleen weakness, use Oolong tea as the base. For patients who tend more towards heat, then use green tea. Also, to make life easier, the first three ingredients can be purchased as a granule concentrate, and then just stirred into brewed tea. Here’s another recipe, this time a soup…

Job’s Tear and Lily Pork Soup (Yi Mi Bai He Shou Rou Tang) 薏米百合瘦肉湯

Ingredients:

• ½ lb. lean pork
• 1 large carrot
• 1 oz. Job’s Tear barley 薏苡仁
• 1 oz. Lily Bulb herb 百合
• ¼ cup (or a little more) of corn (or about ½ ear fresh corn)
• Ginger
• Salt

Directions:

1. Rinse Job’s Tear and Lily Bulb; place in a pan with about 4 cups of water and bring to a boil, then simmer for about 30 minutes on low heat
2. While cooking, prepare other ingredients by cutting up carrot and pork into bite-sized chunks; remove corn from cob if using fresh corn; peel and slice ginger (an appropriate amount to taste)
3. Add carrot, pork and ginger to the soup (add a little more water if necessary); simmer on very low heat for about 2 hours; add salt to taste

This recipe removes phlegm, strengthens the Lungs, expels dampness and opens the Spleen. Moreover, this is a light soup that won’t create internal dampness or damage the digestive function. It is also not overly warming.

Happy February!

Daoyin for Rain Water 雨水

Here is the Daoyin exercise diagram for the Rain Water Seasonal Node. We practice these Daoyin exercises every Sunday morning during our weekly Qigong class. These Daoyin exercises are attributed to Chen Xiyi, the founder of the Taiji Stick and Ruler Qigong we also practice during class.

Dai Mai 帶脈 Case and Tung's Acupuncture

The last two weeks in the Nanjing (難經) class that I teach in NYC we spent time going over classical references to the Eight Extraordinary Vessels. Also, this last month or so we have been practicing Dai Mai (帶脈) exercises in the Daoist Neigong / Qigong class that I teach regularly here in New Jersey. Inspired by both, I’ve been reading some Extraordinary Vessel books out of China, so I thought I’d discuss a Dai Mai case study here and include some musings about Tung acupuncture treatments related to treating that vessel.

This Dai Mai case comes from Qi Jing Ba Mai Yu Zhen Jiu Lin Chuang 奇经八脉与针灸临床 by Mei Jianhan and Yang Yuhua (Beijing: People’s Medical Publishing House, Beijing). This case is of a 38 years old male worker by the name of Zhang suffering from Kidney Fixity (腎著). Kidney Fixity is described in the Jin Gui Yao Lue, and is a condition where Kidney vacuity leads to cold damp being “fixed” on the interior, usually leading to pain and heaviness in the lower back. In the Jin Gui the treatment given is Gan Cao Gan Jiang Fu Ling Bai Zhu Tang. In this case of course the treatment given is acupuncture.

Zhang’s main complaint was low back pain of 2-3 years duration. He reported a sensation of cold and severe heaviness in the lumbus, with difficulty turning side to side. Pain was worse at night. He had frequent urination and sloppy stool. There was some edema in the lower extremities. The pulse was deep and slow, and the tongue coating was grayish. The disease started when he would sweat during manual labor. After, while resting, the cold sweat on his body penetrated internally to the muscle layer leading to cold-damp Bi impediment. His Wei-defense was impaired allowing invasion of cold evils, thereby depleting the Qi. This led to a weakening of the Dai Mai. The treatment principle was to warm the cold, expel damp, diffuse impediment and stop pain.

The points treated were Wei Dao GB-28, Dai Mai GB-26, Ming Men DU-4 and Wei Zhong BL-40. All points were treated with even supplementing and draining technique, then warming needle moxa was done on all points except Wei Zhong. During the second examination, the pain had diminished and the original prescription was repeated, except that time bleeding Wei Zhong. Similar treatments continued and within 10 treatments he was mostly better.

I really like this type of Extraordinary Vessel approach that does not need to include the so-called master/couple points so common in modern practice (I tend not to use them in my own treatments that often). Chewing on this idea, I’ve seen many patients with similar complaints that could be diagnosed as Kidney Fixity with impairment of the Dai Mai. A typical Tung acupuncture protocol would be to needle Dao Ma groups such as the Shen Tong San Zhen (腎通三針; i.e., Tong Shen 88.09, Tong Wei 88.10 and Tong Bei 88.11), with bleeding of the Posterior Thigh Zone (大腿股後區; pp. 114-115 of my bloodletting book). Interestingly, bleeding this area of the leg is a classical treatment for the Dai Mai…

In the Ci Yao Tong (Piercing Lower Back Pain, SW41) there is a description of low back pain related to the Transverse Network Vessel (衡絡之脈). According to Zhang Zhicong, this vessel is actually a description of the Dai Mai. When afflicted, usually due to injury from improper lifting, the appropriate treatment is to bleed the spider nevi on a horizontal line on the posterior thigh proximal to Wei Zhong. In many cases of chronic low back pain this is precisely the area, in addition to those at Wei Zhong, where I observe dark veins.

This Tung protocol replicates the same treatment strategy as the Dai Mai case study above. The Shen Tong San Zhen points, especially Tong Bei 88.11, secure the kidney, bank the origin, warm the channels, and scatter cold. Bleeding the Posterior Thigh Zone is a specific treatment for the Dai Mai. Together these points strengthen the Kidney, warm cold, and expel evil that has penetrated into the Dai Mai. I do believe that there are other Tung points and protocols that regulate the Eight Extraordinary Vessels and perhaps in future points I’ll discuss this idea more.

The Five Taxations 五勞 Part I

It’s a snow day here in northern New Jersey so I thought I’d spend some time writing about a topic from the Neijing. In the last week or so I’ve been reading for myself the Xuan Ming Wu Qi (Wide Promulgation of the Five Qi, Su Wen 23). One of the concepts at the end of the chapter is “Five Taxations” (五勞), a list of 5 damages caused by overuse or overexertion. Like the rest of the chapter, the Five Taxations closely track Five Phase theory, although a deeper look at these five simple lines makes us ponder interesting theory and complex interrelationships in the body.

The first of the Five Taxations reads, “To observe over a long time harms the blood” (久視傷血). Here the character for observe (shì 視) means to look at, or to watch. It also means vision. In classical Daoist literature it is part of the compound term Nèi Shì (內視) – “Inward Vision,” the practice of internal visualization of body gods or viscera as a meditative practice. What do we use to observe something, or to look at something? The sense organ that looks is the eyes. In Five Phase theory the eyes are the orifice of the Liver and Wood Phase.

Yet, Wang Bing in his commentary says that the first taxation of observing for a long time is the taxation that damages the Heart viscera…

In the Neijing the Heart viscera is associated with the tongue, or sometimes the ears (for example in the Jin Gui Zhen Yan Lun, SW4). The Liver is associated with the eyes, and the Liver also stores blood. Yet, the Yin Yang Ying Xiang Da Lun (SW5) tells us that the Heart generates the blood (心生血). It would seem that Liver and Heart both have a close relationship with blood. So what is the relationship between Liver and Heart?

In terms of Five Phase theory, Wood-Liver is the mother of Fire-Heart. When one of the phases is vacuous the treatment strategy is to supplement the mother (from Nanjing 69: 虛者補其母). Use of the eyes is overtaxing to the Liver and can damage the Liver’s ability to store blood. When the Liver is vacuous it fails to generate Fire-Heart, and leads to vacuity of the Heart. This is even more so when people do the common overuse of looking at screens in the evening before bed, which we clearly know upsets sleep. When sleep is disturbed and we fail to go adequately into the storage phase of the daily cycle, the Yin-blood (rooted both in the Liver and the Heart) cannot be secured or generated. Eventually then both Liver and Heart are harmed.

In Tung’s acupuncture the main Dao Ma group for Liver vacuity and for chronic eye problems is the Upper Three Yellows (Shang San Huang, 上三黃). This point group also has an ability to supplement and nourish the blood. It shouldn’t be a surprise then that in Tung’s original writing he said that the points in this group are associated with the Liver, Kidney and Heart channels. In many ways they mimic the channel connections of San Yin Jiao SP-6, the meeting of the leg Taiyin, Jueyin and Shaoyin. Kidney-Water is the mother of Liver-Wood, and the viscera that stores the Jing-essence, a substance essential to the material production of blood. Liver stores blood, and Heart generates blood. Acupuncture treatment for vacuity detriment of the blood then can include points like the Upper Three Yellows, or the application of moxa at points such as San Yin Jiao SP-6.

But perhaps there is another deeper meaning of, “To observe over a long time harms the blood.” Other definitions for observe (shì 視) are to treat as, to take to be. Also, to look for but not see. When we ‘look but cannot see’ or cannot find, this in many ways describes yearning or desire. Or when we ‘treat as’ or ‘take to be,’ this can be a description of attachment. Both Daoism and Buddhism warn about this subtle form of suffering. The Shang Gu Tian Zhen Lun (SW1) says that, “quiet peacefulness, absolute emptiness, the true Qi follows these states” (恬惔虛无，真氣從之). Zhang Zhicong explains that ‘emptiness’ in this passage means not being confused by items and desires. The same chapter tells us that constant desires damage the Heart. Thus, observing for a long time, or in other words, looking for and desiring for a long time, clearly damages the blood (the material basis of the Shen-Spirit) and by extension the Heart.

What about treating this? Certainly some acupuncture can calm and nourish the Heart. In Tung’s acupuncture we have points such as Zhen Jing 1010.03 (鎮靜穴) or Huo Ying 66.03 (火硬穴), or Dao Ma groups such as the Leg Three Penetrations (Zu San Tong, 足三通). However, the first chapter of the Su Wen tells us the main treatment for this type of Heart detriment when is says, “When essence and spirit are guarded internally, where could a disease come from?” (精神內守，病安從來) Essence is Kidney and Yin, Spirit is Heart and Yang. This line is a reference to contemplative or meditative practices such as Neigong, Zuo Chan, or Japanese practices such as Naikan, practices that all function to revert attention of Heart-mind to the interior rather than to the exterior world around us. While acupuncture and Chinese herbal medicines can be good adjuncts for damage to Heart, the best treatments are those taken from the schools of meditation, or in modern times practices that would for example fall under the heading of Qigong. This is why in Chinese it is said, “Disease of the heart has never been treated with medicine” (心病從來無藥醫), or “Diseases of the heart must be treated in the heart [i.e., not with acupuncture, herbs or drugs]” (心病還用心藥醫).

Note: Neijing translations are from the Unschuld and Tessnow translation (University of California Press, 2011).

Beginning of Spring 立春 Seasonal Node

Friday, February 3 is the Beginning of Spring (Li Chun 立春) for 2017 and thus the beginning of the new solar year! The Lunar New Year (known as Chun Jie 春節 in Chinese) already happened on January 28. The Beginning of Spring means that the Yang influences are growing in the natural world. By this date we are only about 6 weeks away from the Vernal Equinox (Chun Fen 春分), one of the times of year where the Yang and Yin are balanced and we have more equal day and night. But even now, with some cooler weather lingering the days are getting longer and in northern New Jersey where I am, in the morning I am hearing some songbirds starting to return. The increased activity in the natural world are also reflected in the names of the shorter 5 day segments (the 72 Material Manifestations of the year) that make up Beginning of Spring – Dong Feng Jie Dong 東風解凍 (The East Wind Liberates From Icy Shackles), Zhe Chong Shi Zhen 蟄蟲始振 (Hibernating Insects Begin to Stir), and Yu Shang Bing 魚上冰 (Fish Rise Up to the Ice).

Beginning of Spring is the time of year for new beginnings. It is also time to continue growing the ever-expanding Yang in our bodies so as to mimic the expanding Yang in the natural world. One of the basic health exercise recommendations for Beginning of Spring is to comb the hair (or head if there is no hair) frequently. In Chinese, this is called Shu Fa 梳法, or “combing therapy.” Combing therapy has been around since at least the Sui dynasty, and is found in both Yang Sheng texts as well as Tuina manuals.

To apply Combing Therapy comb the hair (or scalp) daily, 100 times each sitting. This can be done either in the morning upon waking or in the evening before bed. The traditional recommendation is to use a comb of either bone or wood. That said, simply combing with the fingers is even more effective since the fingers actually contain Qi (which bone and wood do not). This is such a simple exercise, that patients can be taught to do this as well.

Combing has several functions. By stimulating the head we are stimulating the top of the body, meaning the most Yang area of the body. Since Spring is a time of Yang growth and expansion, stimulating the Yang area of the body is appropriate. Gently working the surface of the body also stimulates Wei Qi movement in the head and channels of the head. This in turn helps expel wind, and avoiding wind is one of the basic “avoids” for the Beginning of Spring. Furthermore, the scalp is a microsystem of the entire body, so stimulating the channels on the scalp actually mobilizes Qi and Blood in the entire body.

Spring is the time associated with the Wood phase and the Liver, and the Liver is a Yang viscera (with Heart being the other Yang viscera). A traditional saying for Beginning of Spring is “Li chun yang gan shun tian shi, qu chu ji bing bao jian kang” – “At the beginning of Spring nourishing the Liver means to following the timing of Heaven, expel and rid yourself of disease and protect your health.” Diet recommendations at the Beginning of Spring then are designed to help and nourish Liver.

As a general rule this is the time to consume foods that help maintain normal Liver function, especially the Yang of Liver. Since the Liver governs free coursing, eating mildly acrid and warm foods will accentuate and support this function. For example, appropriate foods this time of year include scallions, leeks, chives, cilantro, and garlic.  Here is another phrase for this time of year: “Duo chi jiu cai chao rou si, yang hu gan yang zhu sheng fa” – “Eat a lot of leeks and pork to nourish and protect the Liver yang and develop the nature of birth.”  In the Huang Di Nei Jing the Spring is associated with the term sheng 生 or “birth.” This is the same sheng as in, for example, Sheng Jiang 生薑 – fresh (or living) ginger. Here is a very simple recipe utilizes leeks to warm and move the Liver yang. Take 100g of leeks and 50g of very thin pork strips. Shred the leeks and then stir-fry with the pork in cooking oil, adding soy sauce, salt and pepper to taste. This recipe nourishes the Liver and protects the Yang.

Patients with chronic Liver fire should take care this seasonal node as Yang is on the rise everywhere. A traditional Beginning of Spring drink for these patients is Yin Chen Da Zao Tang. For this drink take 20g of Yin Chen Hao and 30g of Da Zao. Place in a pot with about 2 ½ cups water. Bring to a rapid boil then reduce and simmer for 30 minutes. Separate into 2 doses and drink in the morning and evening. This formula benefits qi, generates fluids, and protects the Liver.

One more traditional dish for Beginning of Spring is Pork Bone Red Date Soup. Yes, even before bone broth became the latest health trend here in the US, it was considered an important food for health the world around. This dish can be taken daily; it builds blood, warms the interior without being too warming or drying, and can be taken both to prevent and treat colds.

Pork Bone Red Date Soup 豬骨紅棗湯

Ingredients:

• Pork bone, about 3 lbs
• Chinese dried red dates (Hong Zao, or Da Zao), about 6 pieces
• Ginger
• 1 Large scallion white
• Salt

Instructions:

1. Place washed pork bones into a slow cooker and add enough water to cover bones (about 2 quarts)
2. Cut ginger and scallion into large pieces, place in slow cooker with bones; add dates as well to slow cooker
3. Cook on low for 8 hours or more (the prep can be done in the evening and left to cook overnight); add salt to taste
4. Drink broth daily

Other vegetables or ingredients can be added to this soup as desired. To read more about general Spring health care please click here. Happy Spring!