The Five Taxations 五勞 - Part III

Here's the repost of part three of the Five Taxations that I published awhile ago…

Ok, so it’s been awhile since my last installment of the Five Taxations (the last one was back in April of this year if anyone would like to go back to read it again). To remind everyone, the Five Taxations (五勞) are a list of 5 damages caused by overuse or overexertion, and they are found in the Xuan Ming Wu Qi (Wide Promulgation of the Five Qi, Su Wen 23). The first was taxation that involved the Heart, and the second the Lung. Today we move on to the next one.

The third of the Five Taxations reads, “sitting for a long time damages the flesh” (久坐傷肉). Wang Bing then tells us in his commentary that this is taxation of the Spleen. The connection between Spleen and Flesh is clear – both are correlates of the Earth Phase. The question then is why sitting for a prolonged period of time damages the both of these structures?

In Chinese medicine it is said that the Spleen is the Zang-viscera that governs yùn huà – movement and transformation (運化). Yùn can be translated as transportation, and thus many TCM students today memorize that the Spleen governs ‘transportation and transformation.’ However, what we gain in alliteration we lose in some of the other meanings of the word. The term yùn is the same as in yùn dòng (運動). This term means motion or movement, and it also means exercise, athletics or sports. Many of our patients in the modern west work white-collar jobs, and tend to sit for long periods of time during the day. Also, as time goes on, fewer and fewer people make the effort to engage in any meaningful physical activity or exercise for leisure. As our body moves less, the movement and transformation of Qi and Blood in the body is damaged. This is one way that prolonged sitting directly damages the Spleen. The link between exercise and digestion is recognized in colloquial Chinese with sayings such as “fàn hòu bǎi bù zǒu, huó dào jiǔ shí jiǔ” (飯後百步走，活到九十九) – walk a hundred steps after each meal and you will live a very long life (literally, to 99 years).

We can also arrive at Spleen and Flesh damage from the other direction. There are many patients we see who complain of feeling fatigued, and have a sensation of easily fatigable and weak limbs. Getting out of a chair is difficult, and they may also complain of aching in the joints. This sort of patient is often diagnosed with having dampness of the Spleen, perhaps due to improper diet, or other long-term habits that damage the Spleen and Stomach. As the Spleen and Stomach are damaged, impaired movement and transformation leads to the accumulation of damp and then phlegm. Thus the Zhi Zhen Yao Da Lun (SW74) says, “All damp, swelling and fullness, without exception they are associated with the Spleen” (諸濕腫滿皆屬於脾). This type of patient sits for a prolonged period of time because their body feels uncomfortable to move, so the inclination to sit is a symptom of Spleen damage. The difficulty here is that the lack of movement, which was originally from the Spleen, further contributes to damaging movement and transformation, worsening the Spleen injury more. It is a vicious cycle. This is why the Zang Qi Fa Shi Lun (SW22) says, “In the case of a Spleen disease, the body is heavy; muscles and flesh tend to be limp. The feel cannot be contracted for walking.” (脾病者，身重善肌肉痿，足不收) 

The patient with damaged Flesh and Spleen can actually have two things happen – they can either become obese, or they can become emaciated. Lack of movement by itself can cause obesity. Lack of movement and obesity together can lead to all sorts of chronic diseases, such as hypertension or diabetes. That said, damage to Spleen and Flesh can also mean the person loses weight, for example in elderly patients with sarcopenia, the degenerative loss of muscle mass and quality. For both of these patients exercise as a therapeutic intervention is invaluable. Even moving a little, has tremendous benefit. The better option however is the ideal that the superior physician treats disease before it arises. Maintaining a regular exercise regimen throughout life can help prevent both obesity and emaciation. Why? Because it ensures the health of both the Spleen and the Flesh.

The first and some of the most important therapies for these patients is diet and movement (I prefer the term movement because patients find the word exercise scary or daunting). After that we can consider other treatments. In Tung’s acupuncture we can first consider points such as Si Hua Shang 77.08, a point that is the same as Zu San Li ST-36. In Tung’s own writing he said this point supplements the Qi. It is also specifically indicated in conventional acupuncture for weakness or heaviness of the limbs, and specifically the Five Taxations that we are discussing in this blog post series. If there is poor digestion, poor appetite, or abdominal comfort including diarrhea, this point is commonly combined with Men Jin 66.05. Lastly, a great Tung style point combination is a Dao Ma group called the Zu Wei San Zhen (足胃三針) – the Leg Stomach Three Needles. This is the combination of Zu San Li ST-36, Shang Ju Xu ST-37, and Xia Ju Xu ST-39. This combination is indicated for dizziness, agitation, tinnitus, enteritis, stomach pain, diarrhea, constipation, dysentery, soreness and pain of the knee and shin, lack of strength in the lower extremities. In the Taiwanese literature it is recommended for elderly patients to regulate the Zang Fu, supplement the Yuan and turn back the Jing, and to strengthen the lower extremities.

That was an interesting statement – to supplement the Yuan. Let’s also remember that weakness of the Spleen can eventually damage the Original Qi (元氣). Since the Spleen is the Latter Heaven source of Qi and Blood, if that is damaged it eventually taxes the Early Heaven Qi and Blood, in other words, the Original Qi rooted in the Kidney. This is the reason that the next Tung point combination that I recommend for the third of the Five Taxations is the use of the Lower Three Emperors (下三皇), namely Tian Huang 77.17, Di Huang 77.19 and Ren Huang 77.21. These points are located along the Spleen channel overlapping Yin Ling Quan SP-9 and San Yin Jiao SP-6. However, in Tung’s acupuncture they are one of the main Dao Ma groups for the Kidney. Notice also that it is one of the most commonly used Dao Ma groups for conditions such as diabetes, one of the complications of Spleen and Flesh taxation that we mentioned above. 

The point groups listed above have a general regulatory effect on the Spleen and the Kidney, but what about the eventual other problems such as obesity from phlegm or damp accumulation, or weakening of the muscles. We can talk for hours on the subject actually, but a here is a quick set of suggestions for us to start chewing on. For accumulation of phlegm, in Tung’s acupuncture we would consider the Three Weights Three Needles (三重三針; i.e., Yi Zhong 77.05, Er Zhong 77.06, and San Zhong 77.07), or a point like Feng Long ST-40. For wasting of the Flesh we can consider points that lie along the Yang Ming channels, such as Jian Zhong 44.06 (for example, weakness of the lower extremities can be treated by combining Jian Zhong 44.06 and Si Hua Shang 77.08).

As you can see this discussion can go quite deep, and it illustrates the depth of insight that our early ancestors had in the clinic. What they saw then, we still see now, and Chinese medicine continues to be an excellent treatment for what would seem to be the ongoing human condition.

The Five Taxations 五勞 - Part II

This is the second repost of a series I did awhile ago… Enjoy!

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 for which he mentioned moxibustion, 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.

Cold Dew 寒露 Seasonal Node

Today, Thursday, October 8th is the beginning of the Cold Dew (Han Lu 寒露) Seasonal Node, the first 15-day segment after Autumn Equinox. Here in the Northeastern United States fall is definitely underway. The leaves are slowly starting to change color and the evening temperatures are steadily dropping. However, one of the weather characteristics of Cold Dew is a significant difference between day and night temperatures. For example, today the high in northern New Jersey will be close to 70 degrees, while tonight the temperature is going to drop to the 40s. That’s about a 30 degree temperature difference! This time of year people have a hard time dressing appropriately for the temperature because what we feel in the morning is not the same as what we feel in the afternoon. The best solution is layering so that one can adapt to the changing thermometer as the day progresses. This is especially important for the elderly, or for other people who, because of either constitution or illness, have diminished toleration for extremes of temperature.

Because temperature continues to drop one of the recommendations for Cold Dew is to avoid overconsumption of cold foods, including for example raw vegetables, iced beverages, or foods eaten right out of the refrigerator. Overconsumption of cold foods, especially in patients with weak Spleen/Stomachs, easily leads to abdominal discomfort or diarrhea. These people should drink warm beverages including for example ginger tea (adding honey to protect against Autumn dryness). They can also regularly apply moxibustion to Zu San Li ST-36.

One of my favorite things this time of year is apples! All sorts of varieties are now commonly available. According to Chinese medicine apples are sweet and sour and have a slightly cold nature. Therefore, regular consumption helps generate fluids, stop thirst, and moisten the Lungs. Since dryness is the seasonal characteristic of Autumn, these functions make apples great for this time of year. However, since apples are cold, as mentioned above, overconsumption of raw apples can lead to digestive upset for some people. Moderation is always the key. 

Like apples, other foods that are slightly moistening or sour can be eaten during Cold Dew, but also like apples they should be eaten in moderation. Moistening and yin nourishing foods include Chinese red dates (da zao 大棗), walnuts, chestnuts, yams, peanuts, Chinese white wood ear mushrooms, and lily bulbs. Slightly sour foods include hawthorn, lemons, grapes, pomelos, grapefruits, star fruits, and other similar fruits.

Here is a traditional recipe for Cold Dew…

Cold Dew Congee 寒露粥

Ingredients:

• 100g Rice

• 30g Lily bulb 百合

• 20g Lotus seeds 蓮子

• 4-6 dried red dates 紅棗

• 10g Gingko nuts 銀杏

• 8-10 cups water

Directions:

1. Put all ingredients into a large pot, bring to rapid boil on high flame

2. As soon as boiling, reduce to medium and simmer for 40 minutes to 1 hour, until rice starts to break up and become oatmeal-like

3. Add sugar, or honey to taste

This recipe moistens the lungs, stops cough, clears the heart, quiets the shen. Being a congee it is also warming and supplementing for the middle jiao.

Additional Nourishing Life 養生 Practices for Cold Dew

Since I practice a lot of acupuncture (and I like doing it), I’m predisposed to liking Nourishing Life practices that work directly with the channels or acupuncture points. So, I’d like to offer some other ideas we can apply during this seasonal node.

Cold Dew is the segment of the year just after Autumn Equinox. It is a part of the time of year represented by the Xu (戌) Earthly Branch, and the phase Yin Soil as the transition period at the end of Autumn heading towards Winter. This is the time associated with the Arm Jueyin Pericardium channel as well as the fifth cervical vertebra.

One of the problems we come up against during Cold Dew is the decreasing temperatures, and especially the increasing gap between day and evening temperatures. Since cold is associated with the Water phase, even though Cold Dew is the Pericardium channel time, the Water phase channels (the Bladder and Kidney) are susceptible to problems. In particular, exposure to cold in the evening can cause stagnation in the Qi and Blood circulation of the upper back, leading to stiffness and tightness or pain. Legs can also be affected, likewise experiencing stiffness or pain. So, with all that in mind, here are some easy Nourishing Life practices for Cold Dew:

1. Rubbing the Bottom of the Feet: The bottom of the foot is home to the first point on the Kidney Channel, Yong Quan (湧泉穴). Yong Quan is located just behind the ball of the foot and sometimes it is known as the “Great Medicine” (大藥) at the bottom of the feet. Once or twice a day rub the bottom of the foot over the area of Yong Quan 100 times. This warms and stimulates the Kidney channel, and can be used to treat forgetfulness, insomnia, low back pain, and internal cold.

2. Soaking the Feet: Soaking the feet in the evening is another excellent way to warm the channels of the feet and legs, and it is a second method of working with Yong Quan. One of my common recommendations for Cold Dew is soaking specifically with Epsom salts. To do this, dissolve Epsom salts in hot water and soak feet each evening for 10-15 minutes. Like the previous method of rubbing the bottom of the feet, soaking warms and stimulates the Kidney channel, and can be used to treat forgetfulness, insomnia, and low back pain. For added therapeutic effect, Chinese herbal formulas can be added to foot soaks based on an individual’s pattern differentiation. For example, patients with Qi vacuity can soak with herbs such as Dang Shen, Huang Qi or Bai Zhu. Patients with Kidney vacuity low back pain or the like can soak with Du Zhong, Xu Duan, and Sang Ji Sheng.

3. Acupressure at Wei Zhong: Weather change and exposure to cold, as mentioned, can create stiffness in the back or legs. One of the master points for increasing Qi and blood circulation in the back and legs is Wei Zhong (委中穴), located at the back of the knees. While seated, press deeply into the point on both sides simultaneously, until a slightly sore or numb sensation is felt and hold for a few seconds. Release pressure (one press and release equals one stimulation). Stimulate 25-50 times in a sitting. Optionally, medicated liniment or medicated oils that warm the channels, expel cold, and move the Qi and blood can be used while pressing the point.

4. Fire Cupping the Upper Back: The last traditional recommendation I’ll offer for Cold Dew is the use of fire cups on the upper back. Fire cupping (火罐) can warm and expel cold, resolve the exterior, and course Qi and quicken blood in the channels. When done on the upper back it relieves stiffness in the muscles as well as prevents colds. However, after cupping, be sure not to leave the area exposed. Common points to cup include Jian Yu (肩髃穴), Jian Jing (肩井穴), and Tian Zong (天宗穴). Another area to cup is the back of the neck, as the fifth cervical vertebra is associated with Cold Dew. Just as with the previous recommendation, cupping can be done after the application of a medicated liniment or oil.

Stay warm, stay healthy, wear your masks, and eat lots of apples!

The Five Taxations 五勞 - Part I

This is a repost from awhile ago. I’ve made some small edits, so please enjoy! - Henry

It’s a beautiful autumn days here in northern New Jersey and I thought I’d spend some time writing about a topic from the Nei Jing. 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 Nei Jing 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 consolidate 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 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,’ and ‘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).

Autumnal Equinox 秋分 Seasonal Node

An essential characteristic of Chinese medicine is that following and adapting to the seasons is a vital part of how we stay healthy. The Liu Jie Zang Xiang Lun (Treatise on the Visceral Manifestations and the Six Terms of the Year, Su Wen Chapter 6) says, “those who do not know how the breakdown of the year contributes to health, how the qi abounds and becomes debilitated, and thus how vacuity and repletion arise – they cannot serve as a practitioner.” (不知年之所加，氣之盛衰，虛實之所起，不可以為工矣。) Clearly the ancients thought seasonal harmonization was important. Since we’ve been involved in a global pandemic for most of 2020, anything we can do to protect out heath is a treasure. And as medical providers we should also impress this on our patients.

Today is one of the most important markers of seasonal shift in the year – the Autumn Equinox. The last week or so here where I am located in New Jersey has really felt like Autumn. Last night late in the evening I practiced Taijiquan outside while the thermometer read 46 degrees F (8 degrees C). True to the season, leaves are also starting to drop from trees and the days are getting noticeably shorter.

The Autumnal Equinox is the day midway between the solstices. Being the midway point, the equinoxes are times of even balance between Yin and Yang. Furthermore, today September 22nd begins the next 2-week long seasonal node, also called Autumn Equinox. In the Chinese calendar we are in the eighth lunar month and thus the time related to the Kidney channel. The smaller 5-day segments of this seasonal node are called Thunder Begins to Retract its Sound (Lei Shi Shou Sheng 雷始收聲), Hibernating Insects Reinforce their Shelters (Zhi Chong Pei Hu 蟄蟲培戶), and Water Begins to Dry Up (Shui Shi He 水始涸). The names of these 5-day segments of time all point to a similar phenomenon – this is the time of year when the Yin-contracting movement of nature is in full gear in preparation for Winter’s slumber. 

During this time of year the Nei Jing suggests that we “nourish the Yin” (春夏養陽，秋冬養陰) by conforming with the Yin-contracting nature of Autumn. In practical terms one meaning is that we should start getting more sleep. As the days grow shorter so should there be less activity in our daily lives. Thus, the Nei Jing says that we can still wake at the cock’s crowing, but we should be in bed earlier.

During this seasonal node one traditional recommendation is to guard the Lungs, and in particular the Lung Yin. Autumn is the season associated with the Metal Phase and therefore the Lung. Furthermore, Autumn is associated with environmental dryness so protecting the Yin fluids of the Lung is important. Some of the foods that protect the Lung Yin are milk, peaches, pears, apples, soymilk, glutinous rice, sesame seeds, and honey. Those who are adventurous can cook rice congee using white wood ear mushrooms.

Another method for helping the Lungs is acupressure at Chi Ze LU-5 (尺澤穴). This point regulates Lung function and treats conditions such as cough, wheezing, asthma, the common cold and seasonal allergies. It is also the Water point on the Lung channel meaning that it is appropriate for both the season (Autumn relates to the Lung) and the Lunar Month (the eighth Lunar Month relates to the Kidney channel, which is the Water phase).

In addition to environmental dryness, this time of year sees temperatures dropping. Therefore, while we focus on protecting the Lung we should also be cautious about cold exposure. People who are cold and fatigued in general should focus on warming and supplementing the body during equinox. Wearing adequate clothing is an important part of this strategy. Additionally, certain warming and supplementing Chinese herbs can be consumed as functional foods. For example, one traditional recipe for the Autumn Equinox Seasonal Node is Angelica and Codonopsis Lamb Soup. To make this, take 1lb organic lamb meat and cook in an appropriate amount of water with 10g Chinese Angelica (Dang Gui 當歸), 10g Codonopsis (Dang Shen 黨參), 30g Angelica Dahurica (Huang Qi 黃耆), 10g fresh ginger, and salt and pepper to taste. Other in season vegetables can also be added as desired. This recipe warms the Kidneys, supplements the Yang, quickens Blood and moves Qi.

A great tea for general use appropriate to this time of year is Chrysanthemum with Honey (菊花蜂蜜茶). To make, take about 1 tablespoon of dried chrysanthemum (the kind sold as a Chinese herb). Steep in boiled water for 3-5 min and then stir in some honey to taste. This tea can treat seasonal allergies such as dry, itchy eyes or headache. This recipe nourishes the Liver, brightens the eyes, moistens the Lung and awakens the brain.

As the weather gets colder and we move to the darker days, it is the time to start preventive moxa treatment for the Winter. This is especially important for patients who are cold and vacuous. Starting some weekly moxa at Zu San Li ST-36 (足三里穴) will go a long way to keeping vitality strong the in months to come. An alternate is to apply moxa to Huo Fu Hai 33.07 (火腑海) on a regular basis.

Qigong and the Seasons

When people think of Qigong practice, or Taiji practice for that matter, there is the image of Chinese practitioners up very early in the morning in parks going through their routines. Early morning is a traditional time for practice, but not the only best time. Generally speaking, practices such as Qigong are best practiced at four possible times of day: 5-7am, 11am-1pm, 5-7pm, and 11pm-1am (all adjusted for Daylight Savings Time). 

Why these times?

These four times of the day are like the four cardinal directions. The hours around high noon and midnight both respectively are the most Yang and Yin times of the day. The 5-7 hours (either am or pm) are then the midpoints of the day when the movement of Yin and Yang is most balanced. Practicing during these times allows us to ride the movement of Yin and Yang to make our Qigong practice all the more effective.

These times are also representative of different times of the year. Noon corresponds to the Summer Solstice, Midnight corresponds to the Winter Solstice, 5-7am corresponds to the Vernal Equinox, and 5-7pm corresponds to the Autumnal Equinox. As the name suggests, the Equinoxes are the most balanced times of the year in terms of Yin and Yang. As such, on these days practicing Qigong with the effort of creating internal balance is very appropriate. In the system of Qigong I practice one of the fundamental exercises is the collecting the Qi patterns (採氣功; see video below). Around the Equinox we can all practice equal numbers of repetitions for all three of these exercises to balance the body overall. 

So, I hope everyone is having a very peaceful and balanced Equinox! If you are local and would like to join us for Qigong practice, click here for more information.

White Dew 白露 Seasonal Node

Earlier this week on Monday September 7th, the White Dew (Bai Lu 白露) Seasonal Node began. We are now well into Autumn in the Chinese calendar, and the midpoint of Autumn, the equinox, is only about 2 weeks away. Autumn is one of the two Yin seasons (along with Winter), and in Five Phase theory it is associated with the Metal, the Lungs, and the direction West. The name White Dew is a direct reference to Five Phase association of Autumn, as white is the Metal Phase’s color.

According to the Su Wen, the movement of Autumn is the movement of harvest (收). All of nature is now in the stage of slowly winding down; for example it was only in the last few days I’ve been noticing that the mornings are not quite as bright when I’m waking up, and the sun is noticeably setting earlier. The names of the three smaller material manifestations of White Dew reflect harvesting of food for the Winter to come, and the return of birds in their migratory patterns: Hongyan lai 鴻雁來 (Swan Geese Pass Through), Xuanniao gui 玄鳥歸 (Swallows Go Back), Qunniao yangxiu 群鳥養羞 (Flocks of Birds Stockpile Morsels).

Even though we are in Autumn (a Yin time of year) it is clear that Yin and Yang are engaged in a closely intertwined dance. During White Dew, the days can still be quite warm and somewhat humid. However, evenings are starting to dip in temperature. Therefore, one of the traditional prohibitions this time of year is wearing clothes that are too light or too exposing of the body. During the early morning hours or in the evening be sure to wear clothing that affords protection against the gradually cooling temperatures (last weekend I wore a light fleece going over to our early Sunday morning Qigong class). In some places the weather continues to be fairly warm and thus slightly out of sync with this Seasonal Node. In those places guard against rapid temperature fluctuations as they may trigger colds or other upper respiratory problems.

Another caution this time of year is overconsumption of cold foods. Eating cold foods burdens the Spleen and Stomach, and this is more so during the Yin and colder times of the year when the body is trying to consolidate its Yang warmth. Thus in Chinese it is said, “bai lu shen bu lu, zhao liang yi xie du (白露身不露，著涼易瀉肚) – during White Dew be sure not to overexpose the body as cold can easily lead to diarrhea.

The conceptual idea to start focusing on during White Dew is Nourishing the Yin (養陰). Now, this doesn’t mean that we should all go out and start taking Yin nourishing herbs such as Di Huang! To understand this we need to think deeply about the real meaning of Yin and Yang beyond basic correspondences. The Su Wen tells us that the sage nourishes Yang in the Spring and Summer and nourishes Yin in the Autumn and Winter (所以聖人春夏養陽，秋冬養陰). Here, Yin means the movement of contraction/harvest (收) going towards storage (藏). These are the very defining concepts of the Autumn and Winter seasons. This time of year we should all start slowing down, going to bed just a little earlier, and taking stock of our lives (i.e., literally moving our minds inward in self-reflection).

In more concrete medical terms, some of the most common problems our patients will see this time of year are seasonal allergies and rhinitis. Here in New Jersey I’ve seen a significant rise in allergy complaints in the last few weeks. Patients can be taught simple home remedies such as using a Neti pot to keep sinus passages clear and open. Alternately, they can do a steam inhalation with eucalyptus oil. Since Autumn is the season of dryness, if patients suffer from very dry nasal passageways, they can rub a small amount of coconut oil inside their nose on a daily basis. I predict one of the challenges clinicians will see in the next few months is the confusing of common cold symptoms with COVID infection symptoms. Since many overlap, we will all need to continue to be vigilant in whatever infection control measures we are taking professionally and personally.

When choosing treatment points we can focus on those that have a Lung association. In Tung’s acupuncture, some useful points include Mu (木穴; 11.17), and the Dao Ma combination of Chong Zi (重子穴; 22.01) and Chong Xian (重仙穴; 22.02). In both September and October, Mu is one of my most frequently used points. It has the association of Lung Channel in Tung’s Five Phase system, and it lies on the palmar surface of the index finger (thus placing it on the Hand Yangming – also a Metal channel). It treats a wide range of conditions of the upper burner related to Wind patterns such as the common cold, seasonal allergies, and sinus congestion. Patients can also be taught to massage these points as needed. For a more detailed discussion of these points please refer to the Practical Atlas of Tung’s Acupuncture (click here to find out where it can be purchased).

Aside from Tung’s acupuncture, this is the time of year to start doing preventive moxibustion on Zu San Lu (ST-36), or other treatment of the Stomach channel. Chinese medicine has a variety of ways to match time and channels or organs. According to the Zun Sheng Ba Jian, the second month of Autumn corresponds to the Stomach channel, which is why the seasonal node exercise for White Dew is associated with it, and treats lips turned dark in color, swelling in the neck, retching, mental disorders, and flushing of the face (all Stomach channel symptoms). Finally, since Soil-Earth is the mother of Metal, treatment or supplementation of the Stomach channel has a beneficial and supplementing effect on the Lung.

Diet for White Dew

During White Dew the foods we eat should gently moisten dryness and protect the Lungs. While the days are still hot we can eat mildly hear clearing foods but again being cautious about eating very cold (or chilled) foods. In order to help build Yin in the body we also can increase mildly sour foods. White Dew is still a season of fresh fruits that fit these guidelines perfectly, such as peaches (although we are really at the tail end of peach season in New Jersey), apples and pears. Other foods to eat include watery vegetables such as zucchini. For those near Asian groceries, White Dew is the time to eat nagaimo (shan yao 山藥 in Chinese) and fresh lily bulbs (百合). 

Rice congees are a perfect fit for White Dew in that they are gently moistening and, taken warm, supportive of the Spleen and Stomach. One of the traditional White Dew congees is Lily Bulb and Pear Congee. To make this take one large Asian pear and slice into bite sized pieces (the peel can be left on). Then take one fresh edible lily bulb and separate out the corms. Cook the pear and lily bulb in a medium sized pot of water and rice (with a rice to water ratio of about 1 to 6). Simmer until the rice starts falling apart and the mixture becomes like watery oatmeal. Finish by adding a small amount of local honey to taste.

To read more about general health tips for Autumn please click here.

White Dew Seasonal Node Daoyin (Qigong) Exercise

Japanese Psychology Online Training

For those interested in ways of working with the mind and emotions our friends at the ToDo Institute are running a three day online program in Japanese Psychology (this is the organization where I did my certification in Japanese psychology). This program is most always done as a residential one, but because of the pandemic they have reworked their training to include this online component. For more information click on the photo below or email Linda Anderson Krech (linda@todoinstitute.org). Personally, I have found the ToDo Institute programs personally and professionally transformative, and a lot of their material forms the basis for the elective on Emotional and Spiritual Healing that I teach at PCOM.

End of Heat 處暑 Seasonal Node

This last week in the US Northeast we finally had a break from the recent hot weather. According to the National Oceanic and Atmospheric Administration this past July was the hottest on record for the northern hemisphere, with arctic sea ice at an all-time low. While still warm out, things around here are slowly starting to cool a little. Sleeping in the evening with the windows open now requires a blanket (I don’t think I used a blanket for most of the month prior!). We are also really starting to see a difference in the day and night temperatures. Just a few weeks ago there wasn’t much change between day and night, but now at night the thermometer is dropping about 20 degrees. Next weekend the evening forecasts are calling for temperatures in the 50s!

While we will certainly have warmer days yet to come, the gradual cooling temperatures this time of year are indicative of the seasonal node that starts tomorrow on August 22nd – Chu Shu 處暑, ‘End of Heat’.

Autumn is the time of year when Yin grows. All things are moving towards the hibernation phase and many plants are being readied for harvest. This is why in the Neijing, the movement of Autumn is described as 收 – receiving, taking in, putting away, gathering in. The names of the smaller 5-day periods of this seasonal node are quite interesting and illustrative of this idea. The first is called Ying Nai Ji Niao 鷹乃祭鳥, Hawks Start to Sacrifice Birds. This time of year starts the slow march towards the death phase of nature, and many plants and animals with short life spans won’t make it to next Spring. The image of hawks harvesting or killing smaller birds then fits perfectly with this image. The next two 5-day time periods are Tian Di Shi Su 天地始肅, Heaven and Earth Become Austere, and He Nai Deng 禾乃登, Rice Plants Are Harvested and Presented as Offering. Just as this is the time of year for bringing things to harvest, it is also the time for us to start becoming quieter and more introspective, for us to take stock of what, out of the myriad things in our lives, is really important (i.e., we become austere like heaven and earth).

In more tangible respects there are things to keep in mind to maintain health this time of year. The first traditional recommendation for Chu Shu is Ben Franklin’s favorite – ‘early to bed, early to rise’ (zao shui zao qi 早睡早起). When Yin predominates in the natural environment we can mimic that in our own body by getting more sleep. In the summer it is permissible to stay up later and still wake up early because in the Yang time of year less sleep is just fine. However, now that Autumn (a Yin season) is upon us, we need to get a little more rest. My general recommendation to patients is to get into bed a bit earlier, preferably before 11pm or midnight. Here’s a little quiz for other Chinese medicine providers – why is it important to get to bed before this hour? (Hint – it isn’t because of the Liver hour just afterwards) 

The weather pattern associated with Autumn is dryness and thus another caution during Autumn is not becoming too dry. One way we do this is through diet; now is the time to focus on shao xin, zeng suan 少辛增酸 – ‘less spicy, more sour’. Spicy flavors have a mild drying quality as well as a sweat promoting quality, both of which dry the body. To the contrary, sour foods are gently moistening and hold in sweat. Increasing the amount of foods such as vinegar, pickled vegetables, and fruits such as plums is appropriate to the season. Other moistening foods include milk, soymilk, and fruit juices (especially apple or pear). This recommendation should be taken less seriously for those with very damp constitutions or presentations, and can also be moderated when the outside weather is particularly damp.

One traditional recipe for this season is Pear and White Wood Ear Soup. This dish is just simply delicious, and it is effective for supplementing the Lungs, nourishing fluids, and moistening dryness (without being so cloying as to create dampness).

Pear and White Wood Ear Soup 雪梨銀耳湯

Ingredients: 

• 1 large Asian pear 雪梨

• 2 dried white wood ear mushrooms 銀耳

• 1 small fresh edible lily bulb 百合

• About ½ cup white or rock sugar

 Cooking Instructions:

1. Soak wood ear for about 30 minutes, until softened

2. Rip wood ears into bite sized pieces, peel and cut pear into medium bite sized chunks, and separate out lily bulb into individual corms

3. In a pot, put about 6 cups of water together with all ingredients; bring to boil and simmer for 30minutes to 2 hours on a very low heat

For those who like wood ears crisper, go for the shorter simmer time. For those who like things softer and more gelatinous, cook longer. My suggestion is to take small tastes along the way. This soup can be served warm or chilled (depending on preference and outside temperature).

The last recommendation I’ll offer is for those patients who continue to experience symptoms of damp, heat, or the combination thereof in the form of summerheat. A traditional channel based recommendation for Chu Shu is regular acupressure on Cheng Shan BL-57. This point helps expel damp and clear heat, and treats many symptoms of lingering summerheat such as headache, body aches, heavy limbs, or diarrhea. Notice that this area of the leg is one of thick flesh, and remember that the seventh chapter of the Ling Shu describes a needling method based on the five tissues and their relationships to the five viscera. One of the passages from that chapter reads: 

四曰合谷刺，合谷刺者，左右雞足，針於分肉之間，以取肌痺，此脾之應也

The fourth is called united valleys piercing. United valleys piercing is to pierce left then right from the same hole, like a chicken's foot. Pierce to the division between the flesh. This treats flesh block (bi). It is in resonance with the Spleen.

Here we see that needling into fleshy areas of the body treats problems of the flesh as well as treats problems of the Spleen. As dampness is the disease evil of the Soil/Earth phase (and thus the Spleen), this needling technique also has resonance with its treatment. For example, over the last few weeks, patients in my office have been complaining of aching and heaviness in the joints, especially of the knees, hips and in general lower extremities. This is because dampness, as a Yin disease evil, commonly moves down in the body. One of the points I’ve been using over and over again to work with this is Jian Zhong 44.06. The point, located on the shoulder, is in a fleshy area of the body just like Cheng Shan BL-57 is. Likewise, it treats damp accumulation of the joints and extremities. Other points in the shoulder area, such as Bei Mian 44.07, are specifically indicated for digestive problems such as abdominal distension, vomiting or enteritis (which I’ve also been seeing a lot of). This is because, like Jian Zhong 44.06 and Cheng Shan BL-57, Bei Mian is in an area of thick flesh and thus treats problems of the Spleen. This time of year as we are still experiencing summerheat and dampness, these types of points can be frequently used. Pairing these points with formulas such as Huo Xiang Zheng Qi San is particularly effective!

Beginning of Autumn 立秋 is here...

It’s hard to believe I’m writing this, but today, August 7th, is the beginning of Autumn in the traditional calendar. We’ve also been dealing with the pandemic now for coming on 6 months, and other people have been at it even longer in different parts of the world. This is the first summer I think that I’ve been hoping time would just pass faster, although I think we’re all going to have to continue dealing with pandemic concerns for the foreseeable future at this point.

Although in the western world Autumn is a summer month, the Chinese calendar is concerned with the relative balance of Yin and Yang in the natural environment, which is closely tied to day length. Summer Solstice in June was the longest day of the year. By now the days are getting gradually shorter, and we are only 6 weeks away from the Autumnal Equinox, a day of balanced light and dark. Even though August weather can still be hot we are in the time of Yin and contraction in the natural environment.

As a symbol of the growing Yin time of the year, the seventh lunar month (i.e., August), is the Ghost month in Chinese lore  (ghosts being Yin entities). This year the seventh lunar month will start in about a week and a half on August 19th, and in the traditional Daoist calendar this is the day that Yama, the King of Hell, opens the gates of hell to allow all the spirits of the deceased to wander the earth – basically a one-month vacation for ghosts. This happens until the gates are once again closed at the end of the lunar month. The culmination of the month is the 15th lunar day (this year September 2nd), which is known as Zhong Yuan Jie (中元節).

Throughout this month there are many taboos that Chinese culture observes. These include not allowing the elderly, the very young or generally physically weak people to do various activities outside at night. This is the time of day when ghosts are most active! Qigong should also not be practiced outside late at night during this time. Whether or not we believe that this month is the time of ghosts, what this custom perhaps does is serve as a reminder of how the natural balance of Yin and Yang is shifting in a very real way this time of year. 

Now back to the Seasonal Node… While the weather is beginning to shift to Yin, August can still be damp and humid. It is also the time of tropical storms which bring moisture and wind. Right now here in New Jersey hundreds of thousands of homes are still without power in the wake of the storm earlier this week. In Chinese medicine, weakness in the Spleen and Stomach leads to damp accumulation. In early Autumn we therefore should avoid dampness and simultaneously strengthen the digestive organs. One way to accomplish this is to eat light and clear foods, increase the amount of seasonal vegetables, and eat a little less meat. Vegetables can be consumed lightly steamed or stir-fried, or in the case of light salad greens, raw. In general avoid overly hot, spicy foods. Congees are appropriate to help strengthen the digestive organs and one traditional congee recipe for this seasonal node is Euryale Seed and Discorea Congee (Qian Shi Shan Yao Zhou 芡實山藥粥).

Euryale Seed and Discorea Congee (Qian Shi Shan Yao Zhou) 芡實山藥粥

 Ingredients:

• 1 cup rice (use glutinous rice if available)

• 200g Euryale seed (Qian Shi )

• 200g Discorea (Shan Yao )

• 200 g sugar

 Instructions:

1. Grind rice, Euryale seed, and Discorea to a powder. Mix the three together with sugar and blend well so evenly mixed

2. In a pan, add 50 – 100g of blended powder to cold water, enough to make a thick soupy consistency

3. Put over medium flame and warm for several minutes, stirring occasionally

4. Enjoy in the morning on an empty stomach (consume warm)

This congee strengthens the Spleen, stops diarrhea. However it is contraindicated for patients with diarrhea due to infections, or with damp heat type diarrhea.

In addition to dietary recommendations we can perform acupressure on supplementing points such as Zu San Li (ST-36). If patients tend to cold and vacuous patterns of the Spleen and Stomach, gentle direct thread moxa at Zu San Li is also applicable. Those familiar with Tung’s acupuncture can needle the Zu San Tong (足三通) Dao Ma group, consisting of Tong Guan 88.01, Tong Shan 88.02 and Tong Tian 88.03. These points are the main Dao Ma group for Heart, but really they function like Pericardium channel points, which is why they are indicated for Spleen and Stomach problems. Furthermore in terms of Five Phase theory, supplementing Heart will strengthen Spleen because of the engendering cycle relationship between Fire and Soil-Earth.

Autumn is the season associated with the Lungs, and thus even though we should avoid very spicy foods, mildly acrid foods are good this time of year for Lung function. These foods include ginger, scallion, leek, and black pepper. Mildly sweet and slightly sour fruits also help moisten and benefit the Lungs, including the now in-season stone fruits (i.e., plums and peaches). This recommendation however should be based on individual patient characteristics. For example, if patients have Spleen vacuity with dampness they should avoid overly sour foods.

In August we need to be cautious of sudden return of very hot and humid weather, the very weather pattern happening this week in New Jersey. In Chinese this is called “The Old Tiger of Autumn” (Qiu Lao Hu 秋老虎), and is similar to what in the west we would call an Indian Summer. When the old tiger rears its head again Summerheat pathogens are a risk – symptoms of this include headache, dizziness, nausea or vomiting, poor appetite, stuffy chest, heavy or fatigued limbs, and possibly diarrhea. If intense hot and damp weather returns, focus the diet on foods that are cooling and moistening. Foods to consider adding on a daily basis include all sorts of sprouts (e.g., mung bean or alfalfa), cucumbers, muskmelon, winter melon, tomato, and loofah. Mung beans are very cooling, and in hot weather they can be made into a sweet dessert soup. For more serious conditions consider giving patients formulas such as Huo Xiang Zheng Qi San.

Here’s a formula from the Zun Sheng Ba Jian (遵生八箋) – the Eight Treatises on Following the Principles of Life. Written by a scholar by the name of Gao Lian at the end of the Ming Dynasty (1368-1644), the text is an almost encyclopedic collection of all manner of Nourishing Life (養生) recipes, techniques, theories, etc… One of the formulas specifically for Autumn is called Conserve the Spleen Pill (攝脾丸). It treats damage to the Spleen that happens during the Autumn months that leads to abdominal distension and diarrhea. The ingredients listed are Mu Xiang, He Zi, Hou Po (ginger fried), Wu Bei Zi (slightly toasted), and Bai Zhu (earth fried). These ingredients would be ground to a powder and made into pills the size of a Tung Tree seed, and 10 pills would be a daily dose. 

I hope everyone is having a great end of Summer and start of Autumn, and is continuing to wear masks and be safe!

Great Heat 大暑 Seasonal Node

We are in the hottest time of the year according to the traditional Chinese calendar – the San Fu 三伏 period. Right now here in the US Northeast, we are having very hot and very humid weather. Lately, the daily highs have been in the 90s and with the humidity it feels even hotter. Appropriately, today, Wednesday July 22, is the beginning of the last node of Summer in the Chinese calendar – Great Heat (Da Shu 大暑).

In some parts of the world this part of the summer can also be one of the dampest times of year.  As we’ve discussed before, each of the 24 seasonal nodes (jie qi 節氣) can be further broken down into 3 five-day periods of time, known as the 72 Material Manifestations (wu hou 物候). The 3 periods within Great Heat are Decaying Grass Transforms into Fireflies (fucao hua wei ying 腐草化為螢), The Earth Lies Wet Beneath Sweltering Heat (tu run ru shu 土潤溽暑), and Heavy Rains Fall Intermittently (da yu shi ying 大雨時行). In these rather poetic names we see the images of plant life coming to an end of growth (in particular, delicate plants such as grasses, or, in my garden, lettuces), and we also see references to the combination of both dampness and heat in nature.

The health maintenance guidelines for Great Heat are to focus on clearing heat, boosting qi, and treating winter diseases ahead of time (冬病夏治).  Clearing heat seems to be intuitive – too much heat in the body needs to be removed to keep us in balance. But why should we also boost the qi? The Yin Yang Ying Xiang Da Lun (Su Wen Chapter 5) says, “the qi of strong fire weakens” (壯火之氣衰), “strong fire feeds on qi” (壯火食氣), and “a strong fire disperses qi” (壯火散氣). The reason we need to boost qi this time of year is because too much heat in the environment drains and weakens the qi internally. Likewise, excessive sweating damages both the qi and the fluids. One potential general maintenance herbal formula this time of year is Sheng Mai San, the combination of Ren Shen, Mai Men Dong and Wu Wei Zi. When giving this formula during Great Heat, my suggestion to use either plain Chinese white ginseng, or American ginseng, as Korean red ginseng will be too hot. Sheng Mai San in small doses builds qi, clears heat, and nourishes the fluids with herbs that are not so cloying that they would worsen internal dampness.

As already mentioned, now is the San Fu period. This time of year there is a tradition of applying mustard plasters to acupuncture points on the back, a practice known as San Fu moxibustion. While called a type of moxibustion, the heat source for this treatment is not burning mugwort, but the heat derived from the mustard (and other herbs) plasters that are placed on the skin (click here to read more about San Fu moxa). 

In addition to San Fu moxa , this time of year we can start applying regular moxibustion as well The Bian Que Heart Classic (扁鵲心書) suggests that every year at the transition between summer and fall we should apply moxa to Guan Yuan REN-4. As part of the recommendation the text suggests the application of 300 cones every 3 years for people over the age of 30, every 2 years for people over the age of 50, and yearly once age 60 is reached.  While 300 seems like a lot of cones, we don’t have to do them all in one sitting. Break up application of moxa into smaller amounts of cones and proceed daily for several weeks; in other words we are looking for a total of 300 over time, not 300 all at once. Other points to consider for moxibustion include Zu San Li ST-36, Shen Que REN-8 and Qi Hai REN-6.

The caution for Great Heat is to be on guard against damp-heat and its ability to damage the Spleen-Stomach and hamper appetite and digestion.  One way to do this is through diet, which we discuss below. Another traditional recommendation to accomplish this during the current seasonal node is herbal foot bathing.  One effective Great Heat footbath recipe includes Pu Gong Ying 30g, Su Mu 30g, Gou Teng 25g, Fu Ling 25g, Bai Fan 15g, Fang Feng 15g, Han Fang Ji 15g.  Boil these herbs in about ½ gallon of water for 20-30 minutes. Then, cool until able to be used as a warm soak, and soak feet for about 30-40 minutes. These herbs are also effective for treating athlete’s foot, a common problem of this time of year, and a very obvious manifestation of excess damp-heat. For this condition use the same soak frequently, at least twice daily, with 3 days (of twice daily) being one course of treatment.

For practitioners of Tung’s (Dong’s) acupuncture, we can apply these same principles in general maintenance or preventive treatments. In point prescriptions consider adding points that have a general qi supplementing function such as Ling Gu 22.05 and Si Hua Shang 77.08. We also can choose points that generally clear heat such as Zhong Kui or the Wu Ling and Shuang Feng points along the back. In my bloodletting book I also detail another Taiwanese method of treating excessive summerheat by bleeding. Click here for more information on the book. For patients who tend towards being deficient, after bloodletting in the clinic, administer one dose of Liu Wei Di Huang Wan in tablet form (this was Master Tung’s practice in his own practice).

Diet for Great Heat

Along with the guidelines described above, during Great Heat we should simultaneously clear heat and drain damp, while boosting the qi and protecting the Spleen and Stomach. Avoid overly spicy foods and foods which are overly heating. This is the time of year to eat in-season vegetables, especially those that clear heat and nourish fluids such as cucumber, raw tomato, and bitter melon. Gentle heat clearing herbs can be added to the diet such as mint and Huo Xiang (agastache), and this is the seasonal node when Huo Xiang congee is traditionally consumed.  In China people drink winter melon juice during Great Heat. I honestly don’t find this too appealing so I suggest in the west we substitute winter melon juice with watermelon juice!

One fun recipe for Great Heat is stir fried lotus root…

Stir Fried Lotus Root 

Ingredients:

• 1 lotus root (about ½ lb)

• 1” piece of ginger, chopped

• 1 cup roughly chopped scallion

• 2 cloves garlic, peeled and chopped

• 1 tablespoon sesame seeds

• white vinegar

• cooking oil (sesame)

• soy sauce or tamari

Instructions:

1. Peel lotus root and cut into slices about ¼ inch thick, submerge in water with a small amount of white vinegar to prevent discoloration

2. Heat some cooking oil in a large frying pan, add ginger and garlic and cook until fragrant

3. Drain lotus root and place the slices in pan in a single layer; cook until they start to change color and become slightly translucent and then turn over and cook a few minutes longer

4. Add in sesame seeds, a splash of soy sauce or tamari, and the scallions and fry a short while longer until the scallions start to wilt

5. Remove from heat and enjoy

This recipe stops thirst, expels heat, and clears heat to engender fluids. Furthermore, it also supplements the center and nourishes the shen-spirit.

I hope everyone is staying cool and dry!

Minor Heat 小暑 Seasonal Node

This weekend was the Independence Day holiday in the United States (which we all celebrated hopefully with good social distancing and no major group events). Yesterday I was outside in the sun a bit too long, and today I’m a bit redder than I should be! This year the heat of Summer is definitely here now and it is right on time, as today July 6th, starts the next seasonal node of 2020 - Minor Heat (Xiao Shu 小暑).

The Minor Heat seasonal node marks an important change 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. However, although we are transitioning into the Yin time of the year, it is still hot and getting hotter. 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. Since this is the Fire 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. We can also nourish the Heart and regulate the Fire phases by doing some specific Qigong exercises. Over the last few weeks in our weekly Qigong classes on Thursday morning we have been doing exercises for the four Fire channels in the body. While these exercises are not yet posted, you can see other basic Qigong exercises on my Youtube channel by clicking here.

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! This time of year 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 green teas, or chrysanthemum and mint herbal teas. In China summer is the season to drink green teas such as the famous Dragon Well – Long Jing Cha 龍井茶.

Diet for Minor Heat

As we mentioned above, during Minor Heat there is 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.

Preparing for the Seasons to Come – A Medicated Liquor

One of the maxims in Chinese medicine is that it is usually best to treat disease before it arises, and part of that is being well prepared ahead of time. The second chapter of the Su Wen says, “Thus, the Sages did not treat disease that were already manifest, they treated disease that had yet to arise. They did not treat what was already in a state of disorder, they treated before disorder arose” (是故聖人不治已病，治未病，不治已亂，治未亂). It goes on to explain that doing this was akin to digging a well after one is thirsty, or forging weapons after war has already broken out. Both are too late to do as much good as possible.

In this spirit we can use this time of year to start preparing formulas to use in a few months, once the weather becomes cold again. A very traditional format of herbal formulas that is particularly suited to the colder weather is medicated wines (also called medicated liquors since they are made with distilled spirits, not actual wines). Ethyl alcohol is warm, acrid and sweet. This combination means that it can warm and course the Qi and Blood, as well as supplement at the same time. When herbal formulas are prepared in alcohol (i.e., ethanol) the functions of the ingredients are amplified in this therapeutic direction.

One very useful formula that we can start preparing now for use in colder weather is Song Ling Tai Ping Chun Jiu (松齡太平春酒), a formula I will simply translate into English as Great Harmony Eternal Spring Wine. Here are the ingredients…

Great Harmony Eternal Spring Wine 

Ingredients:

• Shu Di Huang 250g

• Dang Gui 125g

• Hong Hua 15g

• Gou Qi Zi 125g

• Fo Shou 15g

• Gui Yan Rou (i.e., Long Yan Rou) 250g

• Song Ren (pine nuts) 125g

• Fu Shen 50g

• Chen Pi 25g

Directions:

• Choose as best quality possible for each of the above medicinals. Place in a clean wide-mouthed jar with about 2.5 liters of vodka, or another distilled spirit of similar alcohol content. Allow the medicinals to soak for at least a month (although up to three months is preferable). Periodically the mixture be stirred with a clean spoon, or simply shaken a little to agitate the liquid. Once ready, take one or two shots per day as a dosage (spread out if two). 

This formula was a favorite of the Emperor Qianlong (1711 – 1799; reigned 1735 – 1796), one of China’s most important Emperors and one of the longest reigning monarchs in world history. The formula, crafted by Imperial physicians, was one of the Emperor’s longevity tonics. While we find a few variations on the formula today, in general the major ingredients and thus therapeutic thrust of the formula is the same. Overall the formula strengthens the Spleen, benefits the Qi, and nourishes and quickens the Blood. It is contraindicated for patients with significant internal heat patterns, and for those who normally cannot consume alcohol.

The very interesting name of the formula is deserving of a short discussion. The first word Song (松) means a pine tree, and the second word Ling (齡) means years of age. At first glance this is an odd combination of words – age of a pine tree. Put together it is a reference though to long life. The pine, as an evergreen, is a symbol of enduring life and youth, which is why pine nuts are seen as a longevity food. These two words are also reminiscent of the Chinese phrase Song He Yan Ling (松鶴延齡) – “live as long as the pines and cranes.” Both of these are powerful symbols of longevity in Chinese culture. Finally, going back even to the works of Confucius, in the Analects there is a passage that says, “The Master said, "When the year becomes cold, then we know how the pine and the cypress are the last to lose their leaves” (子曰：歲寒，然後知松柏之後彫也). Thus, in old age (when the year becomes cold) it will be apparent who maintains youthful vigor. We know from history that Emperor Qianlong certainly did!

I hope everyone is staying cool and dry, and that we are all thinking of how we can start preparing for the colder months a little ways off in the future.

The Way of Peng Zu

Here's a quote for the day. This is from the Yin Shu (引書), the "Book of Pulling." It is the earliest known book we have so far on Daoyin (i.e., early versions of Qigong) dated to c. 186 BCE. It was unearthed at Zhangjiashan in the early 1980s. This is the first line of the text, and those of you who've studied the Neijing will recognize this as a variation on a very important line(s) in that text.

春產，夏長，秋收，冬藏，此彭祖之道也

Spring births, summer flourishes, autumn harvests and winter stores. This is the Way (i.e., Dao) of Peng Zu.

For those who aren’t familiar with Peng Zu, he was a mythical figure in classical Chinese philosophy who lived several centuries. In the Neijing (those of you who've studied the Neijing will recognize this as a variation on a very important line(s) in that text) we see this from Ling Shu Chapter 44:

春生, 夏長, 秋收, 冬藏, 是氣之常也, 人亦應之

Spring engenders, summer flourishes, autumn harvests and winter stores. This is the constant of Qi and humans also resonate [with this movement].

Clearly these lines are related, and this was a common and essential concept in medicine during the Han period. Being included in the Yin Shu also means that it was essential to cultivation practices, which is why it is the Dao of Peng Zu (i.e., the Way of cultivating health and longevity). Here we see the movement of the Five Phases at their most essential, and all aspects of medicine and cultivation must be based on this.

So, when you next practice Qigong, pick up an acupuncture needle, or write an herbal formula, think of this idea and evaluate if you are working in this grand cycle of life.

Summer Solstice 夏至 Seasonal Node

In just a few hours we (and this is a big collective ‘we’ as it includes the entire northern hemisphere) will reach the astronomical Summer Solstice. At exactly 5:44pm on June 20th (Eastern Daylight Time) the North Pole will be at its maximum tilt (about 23.5 degrees) toward the Sun, resulting in the longest day and shortest night of the calendar year. This means that tomorrow the days will slowly start getting shorter, heralding the cosmic transformation from Yang to Yin that has just been triggered.

In addition to being one very important moment in time, the Summer Solstice (Xia Zhi 夏至) is also the name of the seasonal node that starts tomorrow, Sunday June 21. This node marks the apex of Yang in the natural world as well as the rebirth of Yin that will eventually culminate with the longest night on the Winter Solstice in December. In relationship to the times of day, Summer Solstice corresponds to high noon, the Wu (午) hour, and is the time of the Heart channel. When we break down Summer Solstice into the smaller five-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). Notice 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 Yijing (I Ching) symbolism, this time period is represented by hexagram 44, 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.

Practically speaking, although this is a time of transition to Yin, this is still a hot and damp season. This coming week in New Jersey promises to be hot and wet. The first health recommendation for Summer Solstice is to focus on clearing summerheat and draining dampness. For example, various skin problems due to external contraction of summerheat damp are commonly seen now. 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 upper back to help move stagnant summerheat damp out of 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’s a formula from the Zun Sheng Ba Jian (遵生八箋) – the Eight Treatises on Following the Principles of Life. Written by a scholar by the name of Gao Lian at the end of the Ming Dynasty (1368-1644), the text is an almost encyclopedic collection of all manner of Nourishing Life (養生) recipes, techniques, theories, etc… This is a seasonal formula for summer from this text.

Cardamom Powder 豆蔻散

Ingredients:

• Cao Dou Kou 草豆蔻 120g (toast until yellow together with 120g of fresh ginger, then remove the peel for use)

• Mai Ya 麥芽 300g (dry fry until yellow)

• Shen Qu 神曲 120g (dry fry until yellow)

• Zhi Gan Cao 炙甘草 120g

• Pao Jiang 炮薑 30g

Instructions: 

• Grind all ingredients to a fine powder. Take a small amount daily with water or tea. During summer as heat and dampness increases, occasionally this will negatively affect people’s digestive function and appetite. This formula opens the Stomach, increases appetite, treats abdominal distention and is particularly useful if weather is cooler or damper than usual. 

I hope everyone is staying cool and dry. For those who would like to read more about Summer seasonal recommendations in general, please click here.

I also have a more comprehensive course on acupuncture and the seasons, including how to use diet, acupuncture (including Tung’s acupuncture) and other lifestyle recommendations to harmonize with all the seasonal nodes. For more information on that class, click here. 

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

Bearded Grain 芒種 Seasonal Node

These last few months have been different for just about all of us. The global pandemic we find ourselves in have challenged us in terms of health, finances, societal stability, and in more ways we won’t understand for years to come. My practice was closed for several weeks before we reopened slowly with better infection control measures in place. At this point I’ve also treated a number of COVID patients through telemedicine. I can only imagine Zhang Zhong Jing sitting on Zoom with his patients, also trying to treat as many people as possible for the epidemic diseases that ravaged his world.

Most of you have also noticed I’ve been silent on my blog. I’ve spent a lot more time lately reading, and engaging in my own Neigong and Taiji practice, things that have been real anchors for me in a world spinning out of control. Now, as things here slowly start returning to normal, I’m going to try to get my regular blogging going again. As I went through the past few years I realized it’s been almost 5 years since I managed to get a blog up during this seasonal node. So, to start us off again, here’s Bearded Grain… 

Yesterday, Friday, June 5th, was the beginning of the Bearded Grain (Mang Zhong 芒種) seasonal node, the ninth of the year. Bearded Grain is the last node just before Summer Solstice, the most expansive and Yang time of the year. The name, ‘Bearded Grain,’ is a reference to crops. The word Mang (芒) refers to the maturing crops, especially the winter wheat, which is harvested about this time of year. The word Zhong (種) is a reference then to the new rice crops that are planted at this time. This gives us the image of one thing coming to maturity (as in the growing Yang of the season) so that it can eventually perish (i.e., be harvested), allowing a new crop to be started. The image of transfer and renewal is characteristic of the transition period of the solstice that fast approaches. 

The three smaller 5-day material manifestations of this node are Tanglang sheng 螳螂生 (Praying Mantises Are Born), Ju shi ming 鵙始鳴(Shrikes Begin to Sing), Fanshe wusheng 反舌無聲 (Mocking Birds Cease to Vocalize). The first two are dramatically illustrative of the current node. Praying mantises are notorious for females killing males just after mating. And shrikes are about the creepiest birds I know! These birds are know for catching their prey (usually large insects or small mammals such as rodents), and then impaling them on some natural spike-like plant for them to come back later and consume after the creature has died. Both images are images of the death bringers. Eventually solstice is the time of Yin’s rebirth – days will get shorter again. It is the reminder that all life cycles back towards quiescence, towards winter, towards death, towards Yin.

 But we must get back to more practical concerns… During this time of year there are several things traditionally recommended for healthy living. The first is taking a siesta – in other words an afternoon nap (in Chinese, Wu Shui 午睡). During this time of year damp and heat evils in the environment start to predominate. In Chinese medicine the Spleen is susceptible to dampness, the disease evil associated with the Soil-Earth phase. The Spleen governs the flesh and the four limbs. Damp evils encumber the flesh of the four limbs making them feel heavy and weary, leading our body feeling fatigued and without strength. Napping is a way to recuperate vitality, especially when done during the most Yang/hot time of day. Napping traditionally allowed people a rest from the summer heat and dampness, and offered a way to support the Latter Heaven (hou tian 後天) of the Spleen.

The second recommendation is to regularly clear toxins. Toxins in this case refers to both heat toxins and water toxins, since, again, this is a time of increasing dampness and heat in the environment. In much of Asia, this is the rainy season. Likewise, here in New Jersey, last week we saw rain and this week we will see more. During this time period it’s important for us all to be sure we stay cool and dry inside. Be cautious of overexposure to the heat, especially during the middle part of the day. Patients who are prone to internal damp conditions should reduce salt or other similar dietary intake that can lead to accumulation of fluids and swelling.

Our next admonition is both a “to do” and a “to avoid.” Mang Zhong is the time of the year to really keep our environment sanitary to avoid molds, as warm, humid, and rainy weather is the perfect combination for toxic molds to start growing. Keep houses clean and dry, and quickly patch up any areas of water leaks that may lead to mold growth. Natural products such as Tea Tree Oil and even plain white vinegar are effective anti-mold cleaning agents and people should be encouraged to make use of them! This is important for just about all our patients, but especially so for people with various environmental sensitivities, breathing difficulties, or damp patterns.

In terms of acupuncture, since this is a time of heat and dampness that can affect digestive function, think of supporting with middle with Tung’s points such as Ling Gu 22.05, Si Hua Shang 77.08, and Men Jin 66.05 (these three together make an excellent point combination). For lack of appetite consider Kai Pi (開脾穴), and if the patient presents with summerheat manifesting as loose stool or diarrhea needle Shou Wu Jin 33.08 and Shou Qian Jin 33.09. As it is summer, based on the recommendation of the Nan Jing, Ying-Spring points are appropriate to clear heat in whatever channel is appropriate.

Diet for Bearded Grain

As already mentioned, the Bearded Grain seasonal node is characterized by dampness and summer’s heat, and this is especially so in parts of the world where this month is rainy season. In general, this time of year one should avoid eating too many sour foods, instead focusing on bitter flavors. For example, in China there is one type of famous tea called Qing Shan Lü Shui 青山綠水 – “Clear Mountain Green Water.” This wonderful tea from the Sichuan region is not an actual tea plant and has no caffeine.  Rather, it is the first flush of an herb called Ku Ding Cha 苦丁茶, “bitter spike tea.” The taste of the young plant is very mildly bitter at the beginning with a faint sweet aftertaste. It is the perfect damp draining and mildly cooling herb for this summer that replenishes Qi as well with a mildly sweet nature. The other side of this is that mild sour flavors are good for people who are dehydrated or who live in climates that are too dry this time of year. A simple refreshing and rehydrating drink is water with just a little lemon juice squeezed in.

Since this a hotter time of year, during the warmest days in have patients focus on mildly heat clearing and bland foods. Also eat foods that expel summerheat and nourish fluids to stop thirst. These foods include melons and fruits, leafy greens, rice, beans, and bean products (such as tofu). The foods that should be minimized in the diet include greasy foods and meats. This is the time eat more vegetarian for sure. Patients who are slightly cold or Qi deficient can eat more mildly warming fruits such as cherries, lychees, longans, coconut milk, and apricots. Patients with warm patterns can focus more on cooling fruits such as watermelon, bananas, pears, tomatoes, persimmons, and cucumbers. Balanced temperature fruits for just about everyone are pineapples, grapes, apples, peach, coconut flesh, oranges, and ginkgo nut. 

Recipe for Bearded Grain – Licorice and Mung Bean Congee

(Gan Cao Lü Dou Zhou 甘草綠豆粥)

Ingredients:

• Rice 150g

• Mung Beans (lü dou 綠豆) – 50g

• Chinese licorice root (gan cao 甘草) – 50g

• Rock sugar to taste

 Instructions:

1. Rinse the rice and mung beans, wrap gan cao in teabag to make removing easier (optional)

2. Place gan cao in about 1750 ml (about 7 cups) of water, bring to a boil and simmer until water is a yellow color

3. Add in mung beans, bring to boil again and then simmer on low for about 40 minutes until beans soften

4. Add in rice and continue cooking for about 30 minutes until the rice starts to beak apart and mixture is the consistency of congee

5. Remove from heat, add in rock sugar to taste (optional) 

This recipe aromatically opens the Stomach, strengthens the Spleen and transforms damp, and clears heat and disinhibits damp. It should be used with caution in patients with Spleen and Stomach vacuity cold, or patients with chronic diarrhea. The source text for this recipe was the Ming Dynasty encyclopedic work, the Pu Ji Fang (Prescriptions for Universal Relief). 

My best wishes for everyone’s health. Stay cool and dry!

Classes move online due to COVID

This spring I was scheduled to teach a number of classes in Germany and other locations. Obviously, due to the COVID pandemic, I am not traveling outside of about a 1 mile radius from my home! Luckily for all of us, this new world we have found ourselves in has opened up more online communication opportunities. As I mentioned before, through the magic of Zoom, I’m now teaching some Qigong classes online.

The two days of courses scheduled for this weekend in Frankfurt have also been moved to an online format, opening up attendance opportunities to those outside of Germany. This Saturday we will be doing a deep dive into the theory of Tung’s pain management, and then Sunday we will look at the Five Shu points, an essential topic in classical acupuncture that is downplayed in modern TCM needling. For those interested please consider joining us. Below is the link for more information

Click here for more information on this weekend’s classes.

I’ll leave you all with a great photo from downtown Madison, NJ, my home and the location of my clinic. This is the bust of President Madison for whom the town is named. Even he is taking extra precautions these days!

Lead with the Body & Online Qigong Classes

Many of you have probably noticed I’ve been silent in the last month or so. It has been quite an unprecedented time (at least in most of our lifetimes) here, and I assume the case is the same where most of my readers are located. I’ve been busy with treating the patients that I can, including doing distance consults for some with COVID. And, in addition to treating respiratory conditions I’ve been treating a lot of general stress and anxiety.

I’m sure most all of us have been dealing with the same fear, uncertainty, etc… In times like these some of the basic teaching of Japanese psychology (which I was trained in at the ToDo Institute) are of tremendous help. In particular, Morita Therapy is a very practical way of managing both ourselves, and our patients. Here are some basic concepts for us to chew on.

Accept Reality – One of the core aspects of Morita Therapy is arugamama – acceptance. Before we can get a handle on our circumstances we need to accept the reality of what is happening. This doesn’t mean blind acceptance to our fate, but rather understanding where we are, and what we can and can’t do about it. Once we know where we are we can see where we can move.

Feelings and Thoughts are Uncontrollable – Part of acceptance is understanding what is and what isn’t controllable. A basic idea of Japanese psychology is that our feelings and thoughts are uncontrollable. Feelings are a natural part of being a human (welcome to the club!) and arise as a result of what is happening to us at any moment. They also arise based on our own conditioning to circumstances and events. I’ll give you an example right now… Don’t think of a duck. Just stop. Stop thinking of a duck. Like most people reading this, right now you’re thinking of a duck and will for at least the next few minutes! Once we accept the reality that feelings are uncontrollable we can focus our energy on what is controllable, including our actions and responses to events.

Lead with the Body – Even if I am feeling anxious, or sad, or fearful, I can still make my body get up and do something. Years ago when I was in my teens I made my first trip to Europe. My grandmother (who to this day worries about everything) was so upset while I was away she ended up painting the second floor of her house. She couldn’t control her feelings, her thoughts, or her anxiety, but she could move her body, and in doing so, she felt a little better. Even if you have a “shelter in place” order and can’t get out of the house, I strongly suggest moving your body in some way. It’ll be good for both your body, and your mind. In an effort to keep myself moving more, and keep my community moving more I’ve started teaching online Qigong classes. If you’d like to be on my mailing list for the online classes shoot me an email and I’ll add you to the list.

I hope everyone is doing as well as they can, and I’m going to get back to more blogging soon. If you’d like more information on Japanese psychology please visit the ToDo Institute website here, and if you’re looking for a great non-profit to support they are one of my favorites.

Beginning of Spring 立春 Seasonal Node

Friday afternoon I was visiting with my Shifu, Wang Fengming. When I got to the house his wife (one of the legendary Feng Zhiqiang’s daughters) asked me if I had enough red dates at home. This is the time to consume red dates (紅棗) she said, because this week was the start of Spring in the Chinese calendar. Red dates nourish Liver blood, and since the Spring is the season of Wood, it is time to nourish the Liver.

While westerners are accustomed to placing the beginning of Spring in March, the Chinese calendar marks time more by relative daylight. As the days are now getting longer, we are in the time of everything waking from Winter’s slumber. The darkest and longest nights are now 6 weeks behind us, and in only another 6 weeks we will be at the Equinox – half way to when the days will get shorter again. 

The Chinese use both a lunar and a solar calendar to mark time, and because of this there are two dates that are considered the beginning of Spring. One is called Li Chun (立春) – the “Beginning of Spring,” which is one of the twenty four seasonal nodes. The solar beginning of Spring happens every year February 4th or 5th, and this year it started last Tuesday (February 4th). The other beginning of Spring is the lunar, also known as Chun Jie (春節), the Spring Festival. This day is the Chinese Lunar New Year, and it falls on the second new moon following the Winter Solstice (with the rare possibility of it falling on the third new moon in some years with an intercalary month). The Lunar New Year is one of the most important traditional holidays in China, and is a time for people to visit with family and friends (we discussed this in our last blog post).  The lunar festivals traditionally last about 2 weeks until the full moon, which happened just yesterday on Saturday.

This time of year the Yang influences are growing in the natural world. As mentioned already, 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. Even with cooler weather lingering this week the days are getting longer. Where I am in northern New Jersey there is dramatically increased songbird activity in the mornings.  This increased activity in the natural world is 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 all 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 frequently comb the hair (or head if there is no hair). 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, and 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 are living and contain Qi, which bone and wood do not. This is such a simple exercise that anyone can be taught to do it.

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 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 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. Tung recommended eating beef stewed with garlic for the treatment of Liver Vacuity (Tung, 1973). While he didn’t mention it specifically for Beginning of Spring, we can say that this recipe is perfect for the warming and strengthening of the Liver Yang that is now appropriate.

 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. In the clinic we can mimic this basic formula with points such as Mu Yan 11.20 or Gan Men 33.11.

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)

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. 

I wish everyone a very happy, health, and prosperous Year of the Metal Rat. Happy New Year, and Happy Spring!

Happy Lunar New Year! 新年快樂！

Today is the beginning of the new Chinese lunar year. We are now ushering in a Geng Zi (庚子) year, which really more properly starts with the next Seasonal Node – Beginning of Spring (there is both a lunar and solar new year in the Chinese calendar). Geng is the seventh Heavenly Stem associated with Yang Metal, and Zi is the first of the Early Branches. The Zi branch is Yang Water associated with the Rat zodiac. Thus this coming year is the Yang Metal Rat year!

The lunar new year always starts on a new moon, so to start the new year off I thought I’d take a break from seasonal nodes and talk a little today about lunar cycles and acupuncture. This semester I’m also back to teaching a course on the philosophical and historical foundations of Chinese medicine, and at every class we’ve had so far I’ve told them it all comes back to Yin-Yang and Five Phases. Lunar acupuncture, like everything else we discuss, illustrates this principle.

Clearly ancient physicians thought that knowledge of the changes in the natural world were an essential foundation to practicing medicine. This is why in Su Wen Chapter 9 it says, “He who does not know what a year contributes [to human health], how the qi abound and weaken, and why repletion or vacuity arise, they cannot serve as a practitioner [of medicine]” (不知年之所加，氣之盛衰，虛實之所起，不可以為工矣). In this sentence the word year refers to the cyclical fluctuations of time based on movement of the heavenly bodies such as the sun, moon and stars. In our Seasonal Node posts we talk a lot about the longer term changes in time and weather, but we don’t talk as much about the shorter cycles such as the moon.

Su Wen Chapter 26 (Ba Zheng Shen Ming Lun) gives us a discussion of what is sometimes called Taiyin Needle Methods (太陰針法). Taiyin, Greatest Yin, means the moon. This chapter says, “at the time of the beginning crescent moon, blood and Qi originate as jing-essence, and the guard qi begins to move” (月始生，則血氣始精，衛氣始行). The commentary to this line by Yang Shang Shan says that at the new moon Qi and Blood are in the stage of being created again. This, like the Winter Solstice, is the birth of Yang. But since during the new moon the cycle is at its most Yin (where Yang is reborn), it is a time of cold and insufficiency.

The moon is a symbol of Yin, and in the body Yin can refer to the actual physical substance of our being. Thus, in the same chapter of the Su Wen it says, “when the disk of the moon is full, blood and Qi are replete; the muscles and the flesh are firm” (月郭滿，則血氣實，肌肉堅).  Based on these quotes we find this treatment recommendation: 

“As the moon starts to wax, do not drain. At full moon, do not supplement. When the disk of the moon is empty, do not treat.” 月生無寫，月滿無補，月郭空無治

During the Yin time, the new moon, it is therefore appropriate to supplement and not drain. Moxa at Zu San Li (ST-36) is appropriate as regular preventive treatment on the day of the new moon. In the clinic I am less likely to apply bloodletting therapy on a new moon, unless the patient is clearly replete and hot. On the other end of the spectrum during the full moon bloodletting is often more effective and also safer to apply in patients with mixed patterns where pure repletion may not be the presentation.

The wonderful thing here is that nothing in these recommendations should surprise us as long as we keep Yin and Yang in mind. So, today go do some moxa on Zu San Li, eat vegetarian (for the new year), and try to take it easy a bit. Happy New Year, and happy Spring. I’ll blog again shortly at the solar start of Spring that will be happening in less than two weeks. For those who want to learn more about Chinese medicine and acupuncture’s relationship to time and the seasons can see my online class on the topic (click here).

Major Cold 大寒 Seasonal Node

Today, Monday January 20th, is the start of the Major Cold (da han 大寒) Seasonal Node. This year in northern New Jersey it is a little different from last. Last year as Major Cold arrived we were having overnight highs of about 8 degrees (-13 degrees Celsius). This year is slightly warmer. Last week we had much more temperate weather, but this week we are getting more typical January temperatures, and there’s even a little snow on the ground reminding us that it is Winter outside.

The days are slowly getting longer, and this morning as I left early to teach my Qigong class birds were singing more than they were even just a few weeks ago. The bird songs were a reminder to me that Major Cold is the last node of the traditional Chinese year, and we are now only days away from the Lunar New Year, and about two weeks away from the solar New Year and the Beginning of Spring seasonal node.

The three material manifestations of Major Cold are Hens Begin to Breed (Ji Shi Ru 雞始乳), Birds of Prey Act Fierce and Swift (Zhi Niao Li Ji 鷙鳥厲疾), and Rivers and Lakes are Frozen Within (Shui Ze Fu Jian 水澤腹堅). Notice here imagery of the impending Spring. In Five Phase theory the domestic animal associated with Spring is the chicken, and during Major Cold hens are getting ready to become pregnant with baby chicks that will hatch in Spring. Thus, even though the weather outside is still very cold, Yang is definitely on its way back as the gradually lengthening of the days attests to.

As the name suggests, the Major Cold Seasonal Node is the time of the year when the main environmental factor we contend with is cold. The first thing that Chinese medicine recommends for this time is to eat clear and easily digested foods (qing dan shi wu 清淡食物). Why is this? The Spleen and Stomach are the roots of Latter Heaven Qi. During the end of Winter even though the time of the year is still predominantly Yin, the Yang qi is being birthed. Eating clear and easily digested foods allows the Spleen and Stomach to move and transform appropriately, and to build Latter Heaven Qi. If foods are too heavy, such as overly greasy or sweet foods, then the ability of the Spleen and Stomach to move and transform is impaired. Easy to digest foods ensures that we continue to build Latter Heaven Yang Qi to get ready for the upcoming spring.

In addition to cold, the other main environmental pattern seen during Major Cold is dryness. Even with wet snow on the ground this morning, lately my patients have been complaining of dry skin on an almost daily basis. Much of the environmental water is bound up in snow or ice, making the air dry. Knowing this, the second recommendation this time of year is to stay warm but also be sure to not be too dry. Staying warm is obviously important in this time of greatest cold. But since certain organs are harmed by excessive dryness, such as the Lungs, we need to be vigilant there. For example, for those with forced hot air heating systems, it may be prudent to run a humidifier periodically. Sipping warm liquids such as herbal teas throughout the day can also keep our internal environment appropriately moist.

With patients who are cold, or have Spleen or Kidney vacuity patterns, continue to warm and supplement. Moxibustion, especially at points like Zu San Li ST-36, Qi Hai REN-6 or Guan Yuan REN-4 is still appropriate. Acupuncturists can include Tung’s point San Cha San 三叉三穴 frequently in point prescriptions. This point has the ability to warm yang and supplement the Kidney. Furthermore, since it pierces through Ye Men SJ-2, “Fluids Gate,” it benefits fluids, particularly of the upper orifices.

As already mentioned, during Major Cold we should emphasize consuming easily digested foods that protect internal warmth and strengthen the middle. Foods that satisfy this requirement include, for example, rice, glutinous rice (in moderation), yams (including nagaimo), peanuts, clear soups like chicken soup, and cooked vegetables. In general avoid raw vegetables, cooling fruits, very greasy meats, and very sweet deserts. When cooking make frequent use of fresh ginger, and other mildly warming spices like nutmeg.

In addition to protecting the Spleen with food, during Major Cold it is also important to consume foods that guard against dryness, and in particular Lung dryness. To this end traditional recommendations for food include consuming white wood ear mushrooms (Yin Er 銀耳) and pears, especially Asian pears.  A great traditional tea for Major Cold is Goji Berry and Red Date Tea (枸杞大棗茶). To prepare, take about 1 teaspoon Goji Berries (Gou Qi Zi) and 3 small red dates and place in a large mug. Cover with boiling hot water and let steep at least 5 minutes. After drinking about ½ the mug, refill once or twice more with boiling hot water. This tea supplements and moistens the Kidney and Liver, nourishes blood and supplements the Spleen.

Another good recipe for Major Cold comes directly from Tung’s writing. In his 1973 book on Tung’s Acupuncture he includes a chapter on dietary therapy. While not specifically listed for Major Cold, one of the recipes he gives is for pork kidney steamed with ginger strips. This easy dish treats kidney vacuity with dryness, manifesting for example with dry mouth.

As I’ve mentioned in some previous posts, since I do so much acupuncture in my clinical practice and I teach Qigong regularly, I really like channel based Yang Sheng practices in addition to lifestyle and diet that we usually discuss. One traditional recommendation for Major Cold is foot soaking and acupressure to support some of the goals we’ve already described above. The time of day associated with Major Cold is the Chou 丑 hour (1-3am). While I don’t recommend staying up too late, this practice can be done before bed, as close to that time as possible while still getting to sleep at a reasonable hour. Start by soaking feet in hot/warm water for 10-15 minutes, and Epsom salts can also be added to the water if desired. After that follow the soaking with acupressure on Yong Quan KD-1, Tai Bai SP-3 and Tai Yuan LU-9. This helps warm and strengthen the Kidney channel, and supplement the Spleen and Lung channels thus corresponding to some of the basic recommendations discussed above.

The last recommendation I’ll offer is gentle massage of the lower back. We all know that the low back is the abode of the Kidney, and gentle stimulation of the low back can thus relax and warm the Kidney. Furthermore, Major Cold is specifically associated with the 3rd lumbar vertebra. There are 24 total vertebrae corresponding one to each of the seasonal nodes, and this association is well known in esoteric Daoist circles. In the White Cloud temple in Beijing there is a diagram of the body carved in stone on the side of one of the walls that maps out the associations of the vertebrae with the nodes. So, in light of that correspondence, one great Yang Sheng practice for Major Cold is to sit quietly, starting with vigorously rubbing the palms together to get them as warm as possible. Then, place the hands on the low back in the area of L-3 feeling the warmth of the hands penetrating the back. After that rub the back to warm the area, or gently tap the low back.

I hope everyone is staying warm, and I’ll be back blogging next when Spring arrives!

Stone plaque at the White Cloud Temple (Beijing) showing the inner view of the body. The spine shows each vertebra as being related to the 24 Seasonal Nodes.

Close up of the same plaque showing the lower spine.

Cold Season Blue Garlic 臘八蒜

Anyone reading this blog knows that seasonal foods are a big thing in China. Actually, seasonal foods are a big thing in all cultures except for the modern west where we can have anything we want at any time of year. Today I thought I’d talk about a simple and delicious traditional side dish.

Drinking tea with Master Wang, our regular pre- and post- training ritual.

Most Fridays I visit with my Taiji Shifu 師父, Wang Fengming, and we train together. Last week after training I stayed for dinner and had my first experience with cold season blue garlic that was made by my Shimu 師母, Mrs. Feng (she is one of Grandmaster Feng Zhiqiang’s daughters).

I had never seen this food before, but it is commonly made in the north of China during the cold season. It is a type of pickled garlic that actually turns bluish (see the photo below), and in Chinese is known as Laba Garlic (là bā suàn 臘八蒜). Laba is a traditional holiday on the 8th day of the 12th lunar month, celebrating the date of the Buddha’s enlightenment. Being in the 12th lunar month it usually falls around the Minor or Major Cold Seasonal Nodes, in other words, one of the most Yin times of the year.

As a food, garlic is quite warming. Its flavor is acrid and sweet, representing the dual functions of being able to move and supplement Qi. It has a Spleen and Stomach strengthening and warming effect, and it moves stagnation to aid the digestive process. The time we are in now is a transition between Winter and Spring (which starts in less than a month from now), and the transition times are associated with the Soil/Earth phase – thus the Spleen and Stomach. However, the weather is clearly still cold, with the exception of the unseasonal warmer temperatures predicted in New Jersey this weekend. Our general dietary strategy this time of year therefore should be to warm and protect the Spleen and Stomach. We can also do this with acupuncture, moxibustion, or herbs as I’ve described in other posts recently.

Raw garlic is too harsh for most people to want to eat. Cold Season Garlic is a type of pickled food that becomes mild enough to be eaten as a side dish, often traditionally with dumplings. The vinegar used to make it can also be eaten on dumplings, or just about anything else that uses vinegar.

Finished Cold Season Garlic with some of its pickling vinegar.

To make, start by taking a desired amount of garlic, and separate and peel to cloves. Place in a clean jar and simply cover the garlic with good quality aged Chinese vinegar (some recipes add sugar, but it is unnecessary). Let sit either at room temperature or in a refrigerator for at least 3 days, although longer storage in the garlic is fine. Within several days the garlic will start turning blue-green, and after that it can be eaten at any time. And the flavor is fantastic! Use as a side dish to dumplings, meats, any type of vegetable, or with morning congee.

I’ll be blogging about the Major Cold Seasonal node sometime soon. And for those wanting to escape the cold for a bit, consider joining me for our upcoming classes in Sydney (click here for more information).