Minor Cold 小寒 Seasonal Node

It certainly has been a crazy week and I have to admit I don’t have the mental energy to post new material for the current seasonal node. I think most of us reading this blog are alarmed by the actions of the most extreme demagogue in American history, and the person who is the biggest threat to the American democratic system and even world peace that we’ve seen in decades. Scenes from this week have shaken the world and I hope we can eventually claw ourselves back to something we can be proud to leave our children.

So, instead of a new seasonal node blog post, I’ll just repost last year’s. Everyone please stay safe (especially those of you who are health care providers), and let’s hope for the best in the coming weeks…

After Winter Solstice there are only two more Seasonal Nodes in the Chinese calendar before the Chinese Solar New Year and the beginning of Spring - Minor Cold (小寒) and Major Cold (大寒). As is clear from the names, temperature is an important part of understanding the last two seasonal nodes of the traditional Chinese calendar. Today as I woke up before coming into my clinic we had a dusting of snow. Even though the temperatures are not frigid, it is definitely cold! What is more important is that now is the time of year when the potential for sustained cold is very real as, even though we are moving into Spring, January and February are usually the coldest months of the year.

This year Minor Cold (小寒) starts today, January 6th [n.b., in 2021 the date was January 5th]. In 2020 this is one day after the Earth being in perihelion, the exact day when the planet is closest to the Sun. Perihelion happens each year about 2 weeks after the Winter Solstice, however the warmth of the season is determined by angle of sunlight, not proximity to the Sun, which is why even though we are close, it is still cold.

The three shorter breakdowns of Minor Cold, the material manifestations, are Geese Head North (Yan Bei Xiang 雁北向), Magpies Begin to Build Nests (Que Shi Chao 鵲始巢), and Ring Necked Pheasants Begin to Crow (Zhi Shi Gou 雉始雊). In Chinese there is a saying that goes “Xiao han da han, leng cheng bing tuan” 小寒大寒冷成冰團 – “Minor Cold and Major Cold, coldness is here and ice abounds.” The previous seasonal node was Winter Solstice, the time of the year when Yang qi is born again in the natural world. However, despite the growth of yang this month continues to become colder and colder. Why does cold continue to worsen even though we are moving to the Yang phase of the year?

Think of the movement of temperature as being driven by the fluctuations of yin and yang in the natural world. Even though the “switch” has been flipped from yin to yang, it takes time for the climate to catch up. Imagine driving a car at 75 miles per hour (I apologize to you all who use the metric system – I’m metric impaired). If you want to stop and go in reverse, first you have to hit the brakes. However, if you hit the brakes really hard, that car is going to continue skidding forward for quite a distance before you can start moving in the opposite direction. Thus, even though the brakes have been put on the Yin movement of the year, before we can really move towards the Yang we continue “skidding” colder and colder for awhile, before Spring truly warms up the Earth.

The health maintenance guideline for this season is similar to Winter Solstice. Specifically, during Minor Cold we should focus on (1) Nourishing the Kidney (Yang Shen 養腎), and (2) Safeguarding the Spleen and Stomach (Baohu Pi Wei 保護脾胃). Winter is the time for all the Qi to be stored away internally – my Neijing students will remember this discussion from Su Wen Chapter 2. Since Kidney is the root of storage, and the root of Earlier Heaven (先天) Qi, we nourish the Kidney to nourish the body’s ability to store Qi away (i.e., the movement of Winter – 藏). While Kidney is the Earlier Heaven root, the Spleen and Stomach are the Later Heaven (後天). So, protecting the Later Heaven helps to ensure that Earlier Heaven is not excessively tapped into. This is especially important for our patients with conditions of vacuity (especially either Kidney or Middle Jiao vacuity), or patients with cold conditions (for example patients with chronic arthritic conditions – Bi syndrome from Wind, Cold and Damp).

Continue having patients get to bed early. Also encourage warming therapies such as moxibustion, especially on points like Zu San Li ST-36, Guan Yuan Ren-4, Qi Hai Ren-6, and Huo Fu Hai 33.07. Patients who have long term Bi syndrome can do daily acupressure on Feng Fu Du-16. This is a special technique from the famous Chinese acupuncturist He Puren.

In addition to the acupressure mentioned above, consider using the Leg Nine Miles Dao Ma Group (足九里) from Tung’s system. This is one of the best groups to use for Bi syndromes when multiple areas of the body are affected, or when we’re not quite sure where to start with a patient. The three points in this group are Middle Nine Miles, Upper Nine Miles, and Lower Nine Miles (88.25, 26, 27), with the middle point overlapping Feng Shi GB-31. Patients can be taught to do Paida (拍打) in this area as a daily health maintenance regimen.

Dietary guidelines for Minor Cold are similar to Winter Solstice. Since we want to protect the Middle Jiao in particular, the first basic guideline is to eat foods that are easy to digest and take foods at regular intervals. Since most of us are coming out of holidays with lots of eating going on, it’s also a good idea to cut back on intake of meats and other heavier foods.

Patients with overall yang vacuity should consume yang warming foods such as lamb, venison, alcohol (in small quantities), and warming spices like cinnamon. Meats can be taken in moderation, but moderation is important. Traditional Chinese lists would add dog meat to the “should” list, but I have to admit that’s way out of my cultural comfort zone! These same patients should avoid cold foods such as duck, rabbit, chrysanthemum, mint, milk or yoghurts. Patients who are prone to cold damp conditions (such as arthritic patients) should do the same as already mentioned and especially avoid cold-damp producing foods such as oranges and orange juice, tropical fruits, and the overconsumption of refined sugars.

Instead of a traditional dietary recipe for this node I’ll offer readers a medicated wine. This formula is specifically for the treatment of Bi syndromes due to cold in the channels, and can be taken by patients over the age of 40 for the prevention of joint problems as well. The recipe is actually given to us by Tung in his original text from 1973. While he was an amazing acupuncturist, like all doctors in China, he was familiar with a number of Chinese medicine therapies (including the basic use of herbal medicines).

Ingredients:

• Huang Qi 1 30g

• Wu Jia Pi 30g

• Placenta (powdered) 1.5g

• Ge Jie 1 piece

• Chuan Niu Xi 9g

Place all the herbs in an appropriate amount of grain alcohol (e.g., vodka), and let soak for about 1 month. Then, so consume about 1 shot per day or as otherwise needed. For patients with ongoing, active Bi syndrome pain, I suggest combining with external liniments (跌打酒). We did a class through eLotus in August 2019 on Tung’s acupuncture and external herbs for injury management (click here for more information on that class).

I hope everyone had a great New Year. Stay warm!

Henry

Winter Solstice 冬至 Seasonal Node

Last year as I wrote my blog post for Winter Solstice I couldn’t have imagined what the year would bring, and I’m sure I’m not alone in that sentiment. Solstice is the original Winter holiday, that which is the basis for why other holidays – Christmas, Julian Calendar New Year, Hanukah, Saturnalia – are celebrated this time of year. Solstice is the promise of new life and life renewing itself. It is post tenebras lux. It is the literal as well as metaphorical return of light. After this year, with worsening pandemic and threats of the unthinkable martial law in the United States, this turning towards hope and life is even more meaningful.

In 2020 the astronomical Winter Solstice arrives at 5:02am (Eastern Standard Time) on Monday December 21, and this same day starts the Winter Solstice Seasonal Node. This is the moment when the elliptical orbit of the sun reaches the point where, because of the tilt of the planet, the sun’s rays hit the Tropic of Capricorn at 90 degrees. This angling of the planet towards the sun means the least hours of daylight for the northern hemisphere out of any day of the year, and in the most northern latitudes there is 24 hours of darkness. However, after today the Earth’s path around the sun changes such that the tilted northern hemisphere will gradually be hit more directly by the sun’s rays, slowly making the days longer and the warmer. Appropriately, in the Chinese almanac, this year Monday the 21st is an “Open” day, meaning it is auspicious for most activities.

The Chinese term for Winter Solstice (dong zhi 冬至) literally means the “extreme of Winter” (the most Yin season), and symbolically this node is represented by Hexagram 24, which is comprised of one Yang line at the bottom of 5 Yin lines. Hexagram 24’s name is Return – Fu (復). What is returning? The Yang and the light are returning. One of the basic laws of Yin-Yang theory is that of mutual transformation. When something reaches an extreme, then it naturally reverts to the opposite. Now is when Yin has reached its extreme thereby giving birth to Yang. The smaller segments, the Material Manifestations, for this node are Earthworms Congeal (Qiu Yin Jie 蚯蚓結), Moose Deer Shed Their Horns (Mi Jiao Jie 麋角解), and Aquifers Stir (Shui Quan Dong 水泉動).

During Winter Solstice we should consider the Chinese folk saying, “Dong zhi yang sheng you da dao, xia bing dong zhi shi miao zhao” (冬至養生有大道，夏病冬治是妙招) – “Nourishing life at Winter Solstice is a great Dao, treating summer’s disease in winter is very clever!” (Yes… It rhymes better in Chinese…) What can we do then to stay healthy during this time period? The first basic recommendation is “Zao shui, wan qi” (早睡晚起) – go to bed early and sleep late. Winter is the time of year that is most yin, and ideally we should sort of be hibernating, both physically and mentally. Finding more time for rest and reflection puts us into harmony with the Yin of Winter.  That said, too much sleep is also not great. Sleep (which is Yin) when excessive damages the Yang, which is why the Su Wen says excessive sleep (literally, lying down) injures the Qi (久臥傷氣). The recommendation I typically give patients is that 7-8 hours of sleep is plenty for the average healthy person.

The second recommendation is “Chi xu yun dong” (持續運動) – persist in moving. Even though Winter is the time of yin quietude, as mentioned above the Winter Solstice marks the birth of yang.  Because movement is Yang it is important for us to “persist in moving” during this time of year. Appropriate exercises include gentle movement such as Taiji, Qigong or Yoga. 

To stay healthy this time of year there are also some things to avoid. Since this time of year has an abundance of Yin influences (i.e., the cold and dark) and a lack of Yang, the first admonition is to guard against weakening the Yang Qi. As Winter Solstice is the time of Yang Qi’s birth in the natural world, it is important to be sure that there is adequate Yang Qi in the body. For patients with Qi Vacuity cold it is especially important to avoid excess cold exposure. This is a time period where those patients can apply moxibustion at home on points such as Qi Hai REN-6, Guan Yuan REN-4, or Zu San Li ST3-6. Alternately, they can do moxibustion on Tung’s point Huo Fu Hai 33.07. Another traditional recommendation for this time of year is to try exposing oneself to sunlight as much as possible. If possible, traditional medicine recommends allowing the back to be exposed to the sun, and this can be done inside a warm room with large windows. Why the back? In Chinese medicine the back is seen as Yang while the anterior of the body Yin. Warming the back is a way to warm and strengthen the Tai Yang (greater Yang) channel, and in general the Yang of the entire body.

The second thing to be cautious of during Winter Solstice is excessive “bedroom activity.” Since Winter is the time of storage, a traditional recommendation for the season is to guard our sexual vitality. Jing essence is the stored and most precious form of Yang Qi, and is stirred during sex. Hence Chinese medicine suggests guarding against excessive sexual activity in Winter. However, we should be careful to not read this only literally. More broadly, sexual activity is a metaphor for expending our essence on all levels. This is why in many cultures around the world this time of the year is the time of reflection and planning for the next year to come. It is a time to step back and move inwards rather than to expend our vitality outwards.

In terms of diet, this is the time of the year to eat more foods that help supplement the Kidney and Spleen, such as rice congees, lamb, beef, shan yao (nagaimo), and winter squash. It is also appropriate to eat a small amount of mildly acrid foods such as fresh ginger, scallions and black pepper (to help keep things moving and to birth yang). Try to avoid cold foods in general, or foods that are difficult to digest such as greasy, raw, or very spicy foods. This is especially so for those patients who tend towards Spleen and qi vacuity patterns.

Here’s a traditional recipe for Winter Solstice:

Longan and Lamb Soup 龍眼羊肉湯

Ingredients:

• 1 lb. Lamb (deboned and cut into chunks)

• Dried longan fruit (龍眼肉) 15g

• Fresh ginger (peeled and sliced) about 20g

• Scallions (chopped)

• Salt

• Cooking wine

 Cooking Instructions:

1. Put lamb in a pot with 3 cups water, bring to a boil and simmer for just about 2 minutes; strain out lamb and discard water to remove the fat

2. Place lamb back into pot with enough water to completely cover the meat (6-8 cups), the sliced ginger and scallions, dried longan, and a small amount of cooking wine

3. Bring to a rapid boil on high flame, then reduce flame to a low simmer and cook for about 2 hours; remove from heat and add salt to taste

This recipe warms the interior and builds Qi and blood, and nourished the Heart to quiet the Spirit.

In the north of China there is a long tradition of eating dumplings around Winter Solstice. In Japan, where dong zhi is pronounced tōji (とうじ), a common tradition is to take baths in water scented with Yuzu citrus. One of the foods of choice in Japan is kabocha, where it is commonly stewed together with adzuki beans to create a dish called itokoni (いとこ煮). The red color, as a symbol of Yang, is thought to ward off evil and confer good luck.

The Gallbladder and Winter Solstice 

Yes, the Gallbladder channel has a lot to do with Winter Solstice, yet in my experience even many Chinese medicine practitioners are slow to make this connection. In Chinese medicine there are 12 main channels in the body, each linked with an internal organ. These 12 channels are also associated with the 12 watches (時辰), the 12 two-hours time periods that make up the day in the traditional Chinese method of counting time. Since there are 12 months in the year, the 12 watches of the day correspond each to one of the months. The Gallbladder channel is associated with the time 11pm – 1am, the Zi (子) hour. This time of day, because it is a Water phase earthly branch, is the time that goes with the second month of Winter, the month of the Winter Solstice.  

This helps us see the Gallbladder channel in a new and interesting light. One of the things I mention when I teach is that we, as Chinese medicine practitioners, eventually need to deepen our understanding of Chinese medicine beyond the very basic things we memorize in our initial training. I think our inability to do this is what leads some to eventually adopt all sorts of supplementary ideas (let’s all do muscle testing, tuning forks, or use a pendulum to decide what herbs are good for a patient, as examples) that have nothing to do with Chinese medicine. For me, Chinese medicine is deep enough and rich enough of a medical system in its own right that not even 5 lifetimes would be enough to really study all of it!

So, back to the Gallbladder… In school we all memorize a Five Phase association with each of the organs and channels, but this is just the beginning of understanding the complexity of these theories (special thanks to Heiner Fruehauf for opening my eyes to looking at the channels in this layered way). To start then, we know that the Gallbladder is a Wood Phase channel. But that’s only step one!

As I just mentioned above, the Gallbladder is associated with the Zi Hour (11pm-1am), the time also associated with the second month of Winter and the Winter Solstice. This time of day is a Water time of day (not a Wood time of day). Thus, the Gallbladder channel, while primarily Wood in nature, also has a Water association. This helps us understand why the Jing Mai chapter of the Ling Shu (LS10) says that the Gallbladder channel governs disorders of bones, and why the Gallbladder is one of the Six Extraordinary Fu, and a Fu that stores clear essence (清精之腑).  

In addition to the Water and Wood associations, Gallbladder is also a Fire organ. Why? The Gallbladder is the Shao Yang. Each of the six channel families is associated with one of the Five Phases, and the Shao Yang specifically has a Fire association. The Shao Yang is also one of the pivot channels (the Yang pivot channel), meaning it is also symbolic of the Winter Solstice – the time of year where all of nature pivots towards Yang.  

Now, the theory is interesting but in the end if it has no practical application to medicine for us it is of no use. The Gallbladder association with Wood, Water and Fire though actually clarifies why some points on this channel actually do what they do. Let’s take Tung’s Nine Miles Dao Ma Group. The main point of the group, Middle Nine Miles (88.25 Zhong Jiu Li 中九里) overlaps Feng Shi GB-31. In Tung’s acupuncture one of the things this point treats commonly is pain (in multiple parts of the body). The Wood phase partly deals with the smooth movement of Qi and Blood in the body, and the Shao Yang as the pivot has the same function. The Gallbladder channel having a Water (and a bone) association then helps us understand why Middle Nine Miles is indicated for bone spurs (i.e., a type of stagnation at the level of bones).

Lastly, “lack of strength in the nerves” (神經衰弱) is an important indication for Middle Nine Miles. This term is actually a psychological symptom, often translated as the now out-dated term neurasthenia. Neurasthenia included a wide range of presentations such as insomnia, fatigue, depression and a wide range of anxiety based disorders. As we said above, the Gallbladder as the Shao Yang has a Fire association. Furthermore, we know that the Shao Yang communicates with the Shao Yin (Heart), the other pivot channel. The close connection with the Fire and Heart illustrates the use of this point in treating Shen-spirit disorders. This is why in my clinic the stressed-and-tired Winter Solstice treatment is the combination of Middle Nine Miles with the Lower Three Emperors (77.17/18, 19, 21), one of the main point groups for the Kidney.

Obviously there’s a lot more exploration we can do for any channel – looking at the other channel connections, names of points, etc… One of my resolutions for the coming year (and I encourage everyone else to do the same) is to try as hard as possible to look more and more deeply at Chinese medicine so we can better understand the system and how to use it in the clinic.

Happy Solstice!

Great Snow 大雪 Seasonal Node

The Great Snow seasonal node starts today, December 7th. While we don’t have snow right now here in New Jersey, I think the best way we should look at the names of this and the last seasonal node is figuratively. Certainly, in some places by now there is snow, but most of the snowiest weather in the Northeast US will most likely come later in the season. Right now what we do have is a dramatic turn towards much colder weather, and because of that we are in the time of year with the potential for real snow. Tonight in New Jersey the temperatures are going to dip into the 20s (that is below 0 Celsius), meaning our outdoor Taiji classes will be cold! In my opinion, this is the best way we can think of the nodes’ names – the potential for snow as a symbol for the seasonal change we are experiencing right now.

Great Snow is the last Seasonal Node before Winter Solstice, representing the final stage of the most Yin time of year and symbolized by the hexagram Kun 坤, composed entirely of Yin (broken) lines. The two weeks of Great Snow are the longest nights of the year, culminating with the Solstice after which days will slowly be getting longer again. The Material Manifestations for Great Snow are Spangled Drongos Cease to Sing (He Dan Bu Ming 鶡旦不鳴), Tigers Begin to Mate (Hu Shi Jiao 虎始交), and Water Irises Grow (Li Ting Sheng 荔挺生).

The main way to guard health in this period is to focus on warm supplementation, while at the same time avoiding exposure to cold. Thus the Neijing tells us during Winter it is appropriate to “avoid the cold and seek warmth” (去寒就溫).  Along these lines people can continue practices such as preventive moxibustion on points like Qi Hai REN-6, Guan Yuan REN-4 and Zu San Li ST-36. Another guideline from the Huang Di Nei Jing for the Winter is to “Nourish Yin” (秋冬養陰). While this may seem counterintuitive for the cold time of year, the meaning of ‘Yin’ in this passage refers to the body’s ability to store, and thereby regenerate, its vitality. Yin means being able to be in a state of quite, rest and solitude. Therefore, during this Seasonal Node try to get more sleep, attempting to get into bed earlier. Sleep is one of the best Chinese medical prescriptions for supplementing the Qi and strengthening the Kidney!

In terms of Tung’s acupuncture, Nourishing Yin (in other words, nourishing consolidation and containment) means we should focus on Zones 7 and 8 on the legs. The point groups that will focus on Kidneys, the organ of the season, are the Lower Three Emperors (Xia San Huang 下三皇), and the Penetrate Kidney Three Needles (Shen Tong San Zhen 腎通三針). These points are easily and quite effectively combined with the moxibustion suggestions above. Over the next several blog posts my goal is to start giving more specific recommendations about Tung’s points and treatment strategies for each of the nodes.

Aside from acupuncture and moxibustion, medicated wines have a long tradition of use in Chinese medicine. They are a cost effective way to take a small dose of expensive or hard to find herbs, and alcohol itself is a preservative to stretch the shelf life of medicinal products. Since alcohol is warm, acrid and sweet by nature, it has the ability to warm and expel cold, and supplement the Qi and Blood while also circulating them. Thus, medicated wines are appropriate for Winter. One traditional medicated wine that is prepared during Great Snow is Gecko Wine (Ge Jie Jiu 蛤蚧酒). To prepare, soak one pair of Gecko (ge jie 蛤蚧) obtained from a Chinese pharmacy in 1000ml of grain alcohol of at least 80 proof (vodka is a good choice). Let sit for at least 1 month, and then take 1 small shot glass per day in the evening. Gecko has a Yang warming and Kidney supplementing effect. Along the lines now of incorporating more Tung points in these posts, here’s a quiz for readers… What Tung point closely mimics the herb Ge Jie? We’ll talk about this in an upcoming post!

In addition to medicated wines this is the time of year to eat warming, and especially Kidney supplementing, foods. Although many people think of Chinese herbs as the main way to supplement Kidneys, in Chinese there is a saying, “medicinal supplementation cannot be as good as supplementing with food” (cao bu bu ru shi bu 藥補不如食補). Foods appropriate for Great Snow include lamb, beef, chicken, venison, shrimp, and mussels. In addition to these animal products, foods to emphasize this Seasonal Node are walnuts, almonds, or other nuts, and warming spices such as ginger and cinnamon. Since this time of year can be cold and dry it is appropriate to cook soups or stews as they are both warming and moistening. Sipping warm water throughout the day is also an excellent recommendation for people who feel dry (i.e., our patients with Blood or Yin vacuity). Now is the time of year to continue using root vegetables such as yams or turnips that traditionally could be kept in cold storage for Winter consumption.

While warming foods are good for the season, the pitfall is overconsumption creating too much heat and stagnation in the digestive system. As such, if possible this time of year we should consume some foods that help gently clear heat, open the Stomach, and descend yang (to consolidate it).  In that vein, one traditional vegetarian recipe for Great Snow is Garlic Chrysanthemum Greens.

Garlic Chrysanthemum Greens (蒜泥茼蒿)

Ingredients:

• Edible chrysanthemum greens (Tong Hao 茼蒿) ½ lb.

• 1 small garlic bulb

• Sesame oil

• Salt and pepper to taste

Directions:

1. Rinse chrysanthemum greens and chop into 1 inch pieces

2. Peel, crush then chop garlic

3. Bring a pot of salted water to boil, then blanch chrysanthemum greens by immersing in water for about 3 minutes; then drain

4. Mix greens with chopped garlic, and a small amount of salt, peper and sesame oil to taste; serve slightly warm or room temperature

This recipe loosens the center, rectifies Qi, disperses accumulated food and opens the Stomach. 

Stay warm and happy Winter!

Small Snow 小雪 Seasonal Node

I’ve been saying the same thing for a few months now – it feels like Groundhog Day with the pandemic still ongoing and now worsening again. Yet, even though I keep expecting to see Punxsutawney Phil each morning as I’m walking to the clinic, I can’t believe we’ve been at this now for 9 months. Time is simultaneously standing still and racing ahead at a fast pace.

Here in the United States this upcoming week is the Thanksgiving Day holiday, meaning the end of 2020 is very close at hand. So, before we talk about the next seasonal node let me first express, in the spirit of this week’s holiday, my gratitude for all of you reading this blog who form a community of medicine that I think continues each day to make a tremendous difference in people’s lives. In my opinion the world today is in a state of sickness, although perhaps this has been the case for a long time with only now the symptoms being painfully evident. My wish this Thanksgiving week is that we all continue to try to heal the world. It is a tall order, but I think this is our task. And the task is healing on a physical level, emotional level, social level, and political level. The immenseness of this job reminds me of this quote from The Analects of Master Kong:

曾子曰：士不可以不弘毅，任重而道遠。仁以為己任，不亦重乎？死而後已，不亦遠乎？

Zeng Zi said, “a scholar-official must be determined and strong as his burden is heavy and the path long. Benevolence [towards all people] is the burden he considers as his to sustain – is it not heavy? Only with death does this burden end – is that not long?” 

Even though we haven’t seen any snow yet in the Northeastern US, today, Sunday November 22nd, starts the Small Snow (xiao xue 小雪) seasonal node. Today was a particularly grey day highlighting the general lack of light corresponding to the diminishing Yang in the natural world. This week the temperatures are fairly average with most days forecast to be in the 50s. The three smaller segments of Small Snow allude to the gradual unfolding of the new, Yin, Winter season – Rainbows Stay Hidden Out of Sight (虹藏不見), Heaven Qi Ascends While Earth Qi Descends (天氣上騰，地氣下降), and All is Blocked Up and Has Completed Winter (閉塞而成冬).

Guidelines for Small Snow are similar to previous seasonal nodes. The thing to focus on to ensure health this segment of Winter is to nourish the Kidneys and protect the Yang Qi. During winter we need to get a little more sleep, getting into bed a little earlier and ideally sleeping past sunrise. The Neijing tells us to, “not disturb the yang - go to bed early and rise late. You must wait for the shining of the sun (無擾乎陽，早臥晚起，必待日光).” Since at a fundamental level Kidney represents the Water phase, it is just a symbol in the body for the movement of Winter – quiescence and storage. Being a little more quiet, a little more rested, and a little more inward-directed puts us in resonance with the Qi of Winter.

The main environmental Qi for the time period from Small Snow to Small Cold (just after New Year) is Cold. Cold easily harms the Kidneys, and thus nourishing Kidney and protecting the Yang (against Cold) are more or less two sides of the same coin. Trying to stay warm is one way to protect the Yang. Be sure to dress appropriately for the temperature, and avoid unnecessary exposure to cold. Moxabustion can be continued on points such as Guan Yuan REN-4 or Qi Hai REN-6. If appropriate, some patients can take small regular doses of herbs like Jin Gui Shen Qi Wan as a pill. Also remember to continue wearing masks while in public. This will help slow the spread of COVID and it really does make the face warmer!

As the weather gets colder another pitfall is stagnation of Qi and Blood. As a result many of my patients in the last few weeks have been complaining of an increase in pain and stiffness. One of the best formulas for moving Qi and Blood is to increase movement (which is why in some systems of acupuncture, such as Tung’s, we combine movement with needling). Encourage patients to engage in some regular movement activity or exercise. If the weather allows, walking outside is great, or if the weather is bad then doing some easy exercise inside is a good substitute.

Diet should also be modified to match the Small Snow node. A very simple recommendation is to take a small amount of fresh ginger every morning just before breakfast, or alternately start the morning with a light ginger tea. Ginger warms and protects the Yang, and circulates Qi and Blood internally, thus satisfying the basic recommendations previously mentioned.

The other basic idea to follow for diet is to avoid foods that create internal heat rising, and incorporate foods that are gently heat clearing and Qi descending. This may sounds a bit contradictory, but the ancient Chinese realized this time of year people are prone to eating more meat. Before refrigeration this time of year there would be less access to fresh fruits and vegetables. If people consume more meat than usual over the next few weeks (think Thanksgiving with lots of turkey and heavy desserts), they may be prone to internal heat from diet. The way to counteract this is consuming just a little heat clearing and Qi descending foods. One traditional food for Small Snow that does this is daikon (Asian radish). Small amounts of bitter greens, or more salty foods are also appropriate.

Here is a traditional recipe for Small Snow:

Lamb and Daikon Soup 羊肉白蘿蔔湯

Ingredients:

• Lamb ½ lb. (boneless)

• Daikon ½ lb.

• ¼ large onion

• Ginger, cilantro, salt and pepper

Directions:

1. Blanch lamb, drain away water and then cut lamb into cubes

2. Place blanched lamb back into pot, add ginger and sliced onion. Cover with an appropriate amount of water and bring to a boil Simmer for around another hour.

3. Cut daikon into cubes and add to pot, cook for another 10 minutes until daikon are translucent

4. Remove from heat, garnish with fresh cilantro and add salt/pepper to taste

This recipe warms the stomach, supplements Qi, protects the Yang and restores vigor to a weak body.

I hope everyone reading this will have a great Thanksgiving (including for those outside the United States). Even though we all may be itching to socialize more with family and friends, let’s all keep the holidays small and end the pandemic as soon as possible. Stay warm, stay safe, and wear your masks!

Beginning of Winter 立冬 Seasonal Node

If you asked me on Monday of this week I would have said that I can feel Winter coming on strongly. However, today as I write this post we have a reprieve in the colder weather. It really is a beautiful and sunny day, and close to a record high for northern New Jersey with the temperature now around 70 degrees. Despite the warmer day though, today is the beginning of Winter.

The beginning of Winter (i.e., the beginning of the new seasons) is also the Beginning of Winter (立冬) seasonal node. While in the modern American calendar we think of Winter Solstice as the start of Winter, in Asia the seasons are calculated by the balance of Yin and Yang in the natural environment as evidenced by the relative balance of day and night. Since Winter Solstice is the darkest time of year, it is the apex of Yin, and hence mid-winter. Therefore, the early part of November is the beginning of Winter, the time of year moving into the darkest and most Yin.

Chapter 2 of the Huang Di Nei Jing says Winter is the time of “closing and storage” (閉藏). It is the season of hibernation and represents the death phase. However, this should not be construed as a bad thing. We need to enter the phase of ultimate silence and stillness, in other words the death phase, so that Yang (and Yang is life) can be reborn again. The organ associated with the Winter is the Kidney, and the phase is Water. Keeping this in mind will help us understand the basic health recommendations of this seasonal node.

The three Material Manifestations that make up the Beginning of Winter Seasonal Node are Water Begins to Freeze (Shui Shi Bing 水始冰), Earth Begins to Harden (Di Shi Dong 地始凍), and Pheasants Dive into the Watery Abyss to Become Giant Clams (Zhi Ru Da Shui Wei Shen 雉入大水為蜃). All three contain striking Yin images, specifically images of water, of earth, and of moving deep to a hidden and quiet place. In general the main environmental manifestation of Winter is cold, and Chinese medicine teaches that cold creates hardness and stagnation. Thus, as expressed in these names, both water and the soil of Earth become hard and impenetrable.

The first suggestion for this seasonal node is to nourish and protect the Yang, or warmth of the body (養陽護陽). This is especially true for seniors, since as we age the body become less tolerant of temperature extremes. Be sure to dress appropriately for the cooler temperatures. Likewise, foods should be cooked or warmed when eating. This is not the time for copious amounts of raw vegetables, juices, or chilled foods and beverages. Soups and stews are winter foods! While in some seasons eating too many warming foods can trigger internal heat, this is less so in Winter. Why? For one, Winter is cold. Eating warming foods is necessary to counteract the exterior temperatures as they drop. Second, the natural Qi movement in Winter is inward and downward. As already mentioned, this is the time of “closing and storage.” Eating more warming foods in the Winter allows the body to secure and store that warm vitality, thereby strengthening the body for the seasons to come afterwards. Thus, eating more warming foods in Winter has fewer side effects than doing so in other seasons.

Another recommendation for Beginning of Winter is the consumption of tonics. These are Chinese herbal formulas, often in pill form, that have an overall strengthening effect on the body. The specific tonic should be determined based on individual need, but in general formulas such as Jin Gui Shen Qi Wan can be taken in small but regular doses.

Since Winter is the season of the Kidney, the third recommendation for Beginning of Winter is to safeguard the Kidney and the Jing-essence. According to Chinese medicine there are three things that really deplete the Kidney and the Jing: (1) excessive sex, (2) staying up late and getting too little sleep, and (3) losing one’s temper. Excessive sex is certainly something that varies greatly from person to person. The question to ask patients is does sexual activity leave one feeling refreshed, or tired and worn out. If the latter, then it may be excessive. Staying up late goes directly against the movement of Winter, which is the movement of hibernation; Su Wen chapter 2 tells us that in Winter we need to get to bed a little earlier and sleep a little later, waiting until well after sunrise to get out of bed (早臥晚起，必待日光). Lastly, losing temper or having a generally angry disposition harms the Kidney. In the 39th chapter of the Su Wen it says that anger causes the Qi to rise (怒則氣上). Since the movement of Kidney is a movement of downward storage, anger forcing the Qi to rise depletes Kidney (i.e., it is the opposite movement of Kidney) and impairs the storage of Qi that is the natural and essential movement of Winter.

Over the last week or so here in northern New Jersey we’ve been seeing a lot of simple colds in addition to the rise in COVID infections. Allergies are still plaguing some as well. Winter is the time of year for these conditions, and in Chinese medicine this means that the exterior layers of the body, namely the Taiyang channel, is being challenged. A great basic acupressure to teach patients to help both expel and protect against wind evils is stimulation of Feng Chi GB-20. Massaging this point on a daily basis can help ward off colds and relax stiffness of the next and back that is a main characteristic of Taiyang patterns. If there is concurrent nasal congestion, they can also include acupressure on Ying Xiang LI-20. For this, have them hold Feng Chi on one side of the head while simultaneously pressing into Ying Xiang on the other (for example, their right hand presses right Feng Chi, while the left hand presses left Ying Xiang). Hold until there is a sensation of clearing in the sinuses, and then switch sides.

Diet for Beginning of Winter 

The basic idea for Beginning of Winter diet is to focus on foods that are nourishing and supplementing agents. In general then we want to focus on foods that are warming and nourishing, usually meaning more animal products. We can incorporate foods that are slightly oilier, while still consuming in season fruits and vegetables while they last (we are in the very tail end of apple season here in New Jersey). Foods to incorporate more regularly include lamb, beef, chicken, sparrow, soybeans, sesame, wood ear mushrooms, peanuts, sweet potato, and persimmon (fresh or dried). Warming spices to use include ginger or cinnamon. And patients who are dry or have Yin insufficiency can take either cow or goat milk 

However, China is a land of multiple culinary traditions and thus seasonal eating recommendations vary from place to place. In the north of China people eat dumplings (jiao zi 餃子), especially those made of lamb and scallion (we’ll discuss a dumpling legend below). In the west of China where it is particularly cold people commonly eat more beef and lamb often in hot pots. In the areas of the high plateaus and mountains the weather is very dry and as such more fruits and vegetables that are still in season are consumed. In the south of China, where it is still relatively more warm even though it is Winter, duck, chicken and various types of fish are traditionally eaten now (i.e., foods that are supplementing but not overly warming).

One simple traditional recipe for Beginning of Winter is Ginseng Congee. To make this simply put 1 cup of rice in with about 8-10 cups water (increase or decrease based on how watery you like your congee), and 9-12g of high quality sliced and dried ginseng root. Bring to a boil and then simmer for at least 40 minutes, or until the rice starts to break up to make a porridge like soup.  Another idea that is easy to implement is adding Gou Qi Zi (Goji berries; 枸杞子) to a favorite chicken soup recipe. Doing so focuses the recipe on building the blood, and strengthening the Liver and Kidney.

Zhang Zhong Jing and the legend of dumplings…

Did you know that one of our most famous historical doctors, Zhang Zhong Jing, was not only a master of herbal medicine but also a culinary innovator? According to popular Chinese legend, Zhang was the inventor of the dumpling – jiao zi (餃子). Zhang held a mid-level government position in Changsha. The year he retired from political life he did so around the Beginning of Winter seasonal node. On his travels back to his hometown he came across many people who had suffered frostbite, and as a result had lost parts of their ears. This touched Zhang deeply as he felt sorrow for the suffering of those poor folk. 

Once home he found his hometown suffering from an infectious epidemic. The people were starving from lack of food, and also suffering from frostbite. To remedy this he had his assistants set up a large pot on a public square to cook up a remedy. The formula he decided on was a combination of mutton with a number of very warm cold expelling herbs known as Qu Han Jiao Er Tang (去寒嬌耳湯) – Delicate Ears Expelling the Cold Decoction. After cooking the meat was chopped up and wrapped in small wheat flour skins in the shape of ears, and then cooked more and served to the people together with some of the soup. And thus the dumpling was born, as well as the tradition of eating them around the Beginning of Winter!

I hope you are all enjoying the darker time of year. And remember… In just only about 6 weeks the days will start to get longer again!

The Five Taxations 五勞 - Part IV

When I originally started the Five Taxations series at this point a long time ago, I never got to finishing all five, only getting to the third installment. So, now it’s time for part four! For those who are new subscribers or who missed the last posts, the Five Taxations (五勞) are a list of five damages caused by overuse or overexertion that 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, and the thirst the Spleen. As is typical with the Neijing the five track along the Five Phases and thus the Five Viscera. 

The fourth of the taxations reads, “standing for a long time damages the bones” (久立傷骨), and according to Wang Bing this is taxation that affects the Kidneys. We have little other commentary in modern versions of the Neijing aside from this. For example, my copy of a Translation and Explanation of the Neijing Suwen by the Shanghai Scientific and Technical Publishers simply adds this comment: 过度的站立，可以伤骨 (“being on one’s feet too much can injure the bones”). Not really much of an explanation – just a translation into modern Chinese with not much else to offer readers. This leaves us to ponder this short but interesting line.

Medically we know that standing, especially for longer periods of time, puts increased pressure on the spine and lower extremities (in particular the knees). If people are overweight, this is even more of a potential problem. Prolonged standing thus can cause muscular tension and strain, wear on joints from joint compression, low back pain, foot pain and inflammation, and a host of other issues (click here or here to read more).

But, in terms of Chinese medicine, we need to think more deeply about the symbolic meaning that may be present in the original line from the Su Wen. When I read this line, I first am reminded of the phrase “spring engenders, summer flourishes, autumn harvest and winter stores” (春生，夏長，秋收，冬藏). This association of the four seasons with a specific movement is recorded in several locations in the Neijing, and the idea likely comes out of even earlier literature. For example, in the Yin Shu (引書; Book of Pulling), one of the earliest texts we have from the Dao Yin 導引 traditions, it says, “in spring generate, in summer flourish, in autumn harvest and in winter store – this is the Way of Peng Zu” (春產，夏長，秋收，冬藏，此彭祖之道也). Perhaps sometime soon I can write a blog post about Peng Zu and the deeper meaning in this line! But the important point for now is that these lines are almost identical. This association of the seasons, and thus the five phases, were shared by numerous authors in the formative period of our medicine.

For winter then, we have to ask ourselves what is the meaning of “store.” Storage means a time of quietude, and a time of moving inwards. In the symbolism of the Twelve Branches, the utmost of storage is Zi 子. This branch represents the time of midnight, and in the course of the year represents the 12th solar month and the time of the Winter Solstice, in Chinese literally the zenith of Winter (冬至). The definition of “store” from the Shuo Wen Jie Zi is “to hide or to conceal” (藏：匿也). Hiding or concealing something is the image of hibernation, or the image of a person going into the most private part of their house – their bedroom. The movement of Winter and storage in my opinion is sleep, as this is the closest humans get to hibernation. For example, in Tung’s acupuncture we place heavy emphasis on having patients move while getting acupuncture. However, when I have patients that have Kidney vacuity patterns I often find letting them sleep while getting acupunctured is best. Why? Because sleeping is the actual movement of Winter, and therefore the Kidney. If we want to help those patients rebuild Kidney, we need to let them sleep and help them rebuild normal sleeping patterns.

Even though prolonged standing is a type of stillness, it is not the same stillness that sleeping or hibernating are. Prolonged standing without any movement can create significant stiffness. This idea reminds me of another important quote, this time from the eighth chapter of the Su Wen. “The Kidneys are the official functioning as operator with force” (腎者，作強之官). This word force (qiáng 強) deserves special attention. On one hand it represents the healthy state of the Kidney and the bones. The bony structure is that which gives the body the scaffolding that holds it up. The spine, as a symbol and extension of the Kidney and bone, needs to be strong and upright, which is why the first point on the Du Mai is called “long and strong” (長強穴). On the other hand, however, this same word represents the diseased state of the Kidney and the bones. An alternate pronunciation of the character 強 is jiàng, and when read this way means stiff or unyielding. This is exactly the diseased state of the Kidney! Cold is the evil associated with Water and thus Kidney, and cold is nothing more than the symbol for a pathological state of being still, stuck and unmoving.

Now we can see that prolonged standing, a stiff sort of stillness, can damage the bones and the Kidney. Taken together with the previous taxation related to the flesh and the Spleen it is a powerful reminder that we must balance rest and activity, but maintain flexibility at the same time. For example, in my lineage of Taijiquan standing post (站樁) is an important practice. In standing post exercises we adopt a specific standing posture and hold it as a type of standing meditation for a period of time. In my own practice I’ll typically stand in that one position for 20-30 minutes without moving. But, standing by itself is never enough. That practice must be balanced by some sort of moving practice. Just as Yin and Yang are intimately linked, so too must be movement and stillness. 

For this blog post I’m not going to offer any specific acupuncture points or protocols. My best suggestion is that we encourage patients to engage in a movement practice that simultaneously encourages flexibility and relaxation, such as Qigong, Taijiquan, Baguazhang, or anything else similar. And then I’ll offer everyone my secret formula for strengthening the Kidneys – go to sleep!

Hoarfrost Descends 霜降 Seasonal Node

Last week Friday, October 23rd was the start of the Hoarfrost Descends (Shuang Jiang 霜降) seasonal node. This is the last segment of Autumn as the next seasonal node is the beginning of Winter. The days are clearly getting shorter and darker. Next weekend we go off Daylight Savings Time, and when that happens the sun will be setting much earlier. Although last week we had some warmer days, in general it’s getting colder. Here in New Jersey today the high was only in the 50s, with evening temperatures are dipping into the 40s.

The shorter 5-day segments of Hoarfrost Descends are Chai nai ji shou 犲乃祭獸 (Dholes Start to Sacrifice Beasts), Caomu huangluo 草木黃落 (Vegetation Withers and Defoliates), and Zhechong xianfu 蟄蟲咸附 (Hibernating Insects Stop Up Their Burrows). A dhole is a type of wild dog native to many parts of Asia, and the image of them sacrificing beasts is an image of the harvesting of food. Autumn is harvest time, which is why the Neijing says in many chapters that Spring Engenders, Summer Flourishes, Autumn Harvest, and Winter Stores (春生，夏長，秋收，冬藏). Interestingly, in Chinese astrology, the dog is associated with the Earthly Branch Xu (戌), which goes with the 9th lunar month (i.e., October in the solar calendar). The other two segments of Hoarfrost Descends offer additional images of the closing down and increasing Yin of the season.

The ancient text Yue Jin Qi Shi Er Hou Ji Jie says, “the Qi is solemn during Hoarfrost Descends. It is when the Yin starts to condense.” Since we are moving into the Yin and colder part of the year, the first traditional recommendation for Hoarfrost Descends is to protect against the cold and preserve internal warmth. Be sure to dress appropriately for the weather on any given day. When eating, keeping the Spleen and Stomach warm helps warm the entire body. Traditional Chinese foods for Autumn include lamb and rabbit, and this is the time to eat more stews and soups. Spices such as ginger and cinnamon can also warm the body. Hoarfrost Descends is a traditional time to take tonics. Therefore, this time of year most people can take small doses of Spleen and Stomach tonics such as the Four Gentlemen (Si Jun Zi Tang), or other similar formulas. Generally speaking, for asymptomatic people, taking tonics in pill form at a lower but consistent dose is beneficial.

While it is important to keep the Spleen and Stomach warm, since Autumn is the Metal and therefore Lung season, supplementing the Lungs and preventing upper respiratory tract infections is a key seasonal strategy, especially this year with the ongoing COVID pandemic. One of the traditional teas for late Autumn is called Jin Qi Hua Cha (金芪花茶). To make this tea take 5g Huang Qi and 3g Jin Yin Hua and simmer in 1 cup of boiling water for 5-10 minutes. When finished, remove the herbs and let cool to just below boiling. Add 3g of good quality Jasmine Tea and let steep for only about 2 minutes. Strain and enjoy! Alternately, this can be made with granular concentrates that approximate the same dosage of raw herbs. Jin Qi Hua Cha gently clears heat and drains fire, but at the same time it supplements and rectifies the Qi, and harmonizes the center. 

In addition to herbal teas or other formulas we can continue thinking of what acupuncture points or protocols would be appropriate for this time of year. Since Autumn is still the Metal time associated with the Lungs, for generally healthy patients we can needle the Zu Si Ma (Leg Four Horses 足駟馬) Dao Ma group. This is the main group of points in Tung’s acupuncture for the Lungs. It also can treat chronic sinus congestion or nasal dryness associated with seasonal allergies. For other allergy patients (a common complaint still) consider adding in point such as San Jian LI-3 or Mu (木穴11.07). 

One traditional recipe for Hoarfrost Descends is Angelica and Ginger Lamb Stew.

Angelica and Ginger Lamb Stew (Dang Gui Sheng Jiang Dun Yang Rou 當歸生薑燉羊肉).

Ingredients:

• 1lb. Boneless lamb meat, cut into cubes

• 6-8 cups water or chicken broth

• 20g Chinese Angelica (Dang Gui 當歸)

• 15g Fresh ginger root (peeled and sliced)

• Cooking oil (peanut oil is traditional)

• Black pepper

Directions:

1. Coat a thick metal pot with some cooking oil and heat over medium flame. Place cubed lamb meat in the pot and brown.

2. Add water (or broth), angelica and ginger. Bring to a boil and then reduce to a medium simmer (other vegetables can be added as desired).

3. Cover part way with a lid and simmer for about 90 minutes. Add black pepper and salt to taste.

4. Remove Angelica before eating (or just eat around it!). Ginger can be eaten.

This fantastic stew warms the yang and scatters cold, moves Qi and quickens the Blood.

Stay warm and dry, and don’t forget to wear your mask!

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!