NYC Class this Weekend!

This Sunday, September 29th, I’ll be in NYC teaching what I hope will be a really interesting class on the analysis of point functions.

Here’s the problem… Most acupuncturists are taught acupuncture points through memorization of point actions without engaging with an in-depth understanding of why points do what they do. To remedy this, our class will provide an understanding of acupuncture points by combining Tung's acupuncture concepts and classical Chinese Medicine principles based on texts such as the Neijing and Nanjing. We will explore key acupuncture points and indications to establish a framework for analysis, allowing participants to move beyond mere memorization. Additionally, we will begin a discussion of strategic point combination and how this enhances treatment. This class will be an excellent introduction to Tung’s principles using points all acupuncturists already use on a daily basis, and it will also be useful for practitioners already familiar with Tung’s points.

Join us if you can. Click on the photo to go to registration information. Seats are limited and running out fast!

Happy Mid-Autumn Moon Festival 中秋節快樂

Today, Tuesday September 16th, is the Mid-Autumn Moon Festival, a festival held on the 15th day of the 8th lunar month each year. It is celebrated all throughout Asia, including in China, Japan, Korea, and Vietnam. The Mid-Autumn Moon always falls on a day of the full moon, and originated as a harvest festival that has been celebrated as far back as the Shang Dynasty (1600-1046 BCE).

As a harvest festival it is a time of family gathering, thanksgiving and prayer. One of the favorite foods of the holiday is mooncakes. These are tasty round pastries usually filled with sweet pastes made from lotus seeds or dates. Sometimes they also contain other things such as seeds, nuts, or salted egg yolks.  The round shape of the cakes mimics the shape of the full moon, and the round shape also symbolizes completeness, fullness, and therefore, family harmony and reunion.

Aside from these associations with mooncakes, they also are connected to an interesting political story. During the Yuan Dynasty (1271–1368 CE), when Mongol rulers controlled China, Chinese revolutionaries, led by Zhu Yuanzhang (who later founded the Ming Dynasty), used mooncakes to secretly plan their uprising. According to legend, they hid messages inside mooncakes instructing people to rebel on the night of the Mid-Autumn Festival. This clever strategy helped coordinate a successful revolt against the Mongols, making mooncakes a symbol of unity and resistance in Chinese history.

I'd like to wish everyone a happy Mid-Autumn Moon festival and express my gratitude for being part of your extended family!

Point Functions and Indications

Did you know that traditionally, Lung 5 did not clear Lung Heat? Ok, ok…. To be fair, it did clear Lung Heat, but the association of Lung 5 with a specific function, or any acupuncture point for that matter, is something modern. 

What I am talking about here is the difference between a point function or action (功效) and a list of indications (主治). While in modern textbooks each point is described in terms of actions and indications, this was not the case historically. For example, in Deadman, Lung 5 is said to: clear heat from the Lung and descend rebellious Qi, regulate the water passages, activate the channel, and relax the sinews. Indications on the other hand are specific disease or sign/symptoms. For Lung 5 these would include cough, coughing phlegm, dyspnea, nosebleed, pain in the arm and shoulder, etc… The list is long. However, while these are present in modern textbooks, traditionally only the indications would have been listed, not actions. I’m actually old enough to have gone to school before books like Deadman’s Manual of Acupuncture. We just had Chinese Acupuncture and Moxibustion (affectionately known as CAM). And, in CAM, there are NO actions – only indications. In this sense, CAM is much closer to how pretty much all books were written historically. Points are given a location, needling or other treatment recommendations, and then a list of indications.

Point actions were, as Deadman points out, mostly something developed after World War II. Now, this did not happen of course ex nihilo. Point actions were deduced by looking at larger themes hinted at by point indications. Moreover, point categories were historically given actions. For example, Ying-Spring points were said to treat body heat. That’s a point action. Yet, in the 20th century all points were eventually described in text books as having actions. This is why Deadman and Al-Khafaji in their Manual of Acupuncture (1998) say, “In general, it can be said that the ascribing of actions to acupuncture points is a modern (i.e. 20th century) practice, and one that draws from the Chinese herbal medicine tradition.” As they point out, this was partly done to help integrate acupuncture with the practice of herbal medicine, the dominant form of Chinese medicine in China both at that time, and today.

To be clear, I’m not implying that I think actions are a bad idea. I think for beginning students they are a good summary that can help with ease of understanding when points can be used. But… (there’s always a but) in my opinion they sometimes over simplify points. For example, when we look at Lung 5, other traditional indications include diarrhea, abdominal distension, and vomiting. Lung 5 also has knee pain and lumbar pain on the list! These indications are not as easily understood through the lens of point actions. To do so would need some significant extrapolations and mental gymnastics. Yet, by looking at indications and deeply analyzing them we can see much larger ranges of what points treat beyond the actions that while useful for beginners, can be limiting for the more experienced clinician. Deeper analysis of indications also elucidates the myriad connections in the body between the five phases, different organs, channels, and tissue systems.

 Over the last few years this topic has been of particular interest to me, and has been useful for both my understanding of Tung points as well as regular (i.e., conventional) points. If anyone is interested in exploring this topic with me, my next two classes will be devoted to analyzing point indications for conventional acupuncture points.  

September 20-22 I will be teaching for 3 days in Dublin, and during that class we will cover single point analysis as well as point combination. And again, unlike most of my lectures, the topic will not be Tung points but rather conventional acupuncture points. People interested in this class (there’s still room left) can contact the course organizer in Dublin for more information and registration.  

After that on Sunday, September 29, ASNY is sponsoring my class in Manhattan where we will do a shorter analysis of conventional acupuncture points. Both of these are excellent opportunities to deepen understanding of the full range of both how and why points do what they do.

Below please find an excellent video that our friend Lorraine Wilcox did on the topic of point functions and indications. I hope to see some of you either in Ireland or NYC!

Beginning of Autumn 立秋 Seasonal Node

By all accounts it has been an incredibly hot and humid summer here in the Northeastern United States. After some intense rain yesterday though, we have what will probably be a short break in the heat (but not humidity). I’m not sure what the rest of August will bring, but we’re enjoying the cooler air for the time being. a very hot July, it’s nice to have August be a bit more seasonable. 

Even if it doesn’t last the rest of the month, this year again the slight cooling is on time as today, Wednesday August 7th, is beginning of Autumn (and the seasonal node of that same name) in the traditional calendar. Although in the modern western world August is a summer month, the Chinese calendar is concerned with the relative balance of Yin and Yang in the natural environment over temperature as a marker of the seasons; this 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. Therefore, even though August weather can still be hot we are in the time of growing Yin and contraction in the natural environment.

In the Lü Shi Chun Qiu (The Spring and Autumn Annals of Lü Bowei; 呂氏春秋), the classic text of Chinese philosophy from the 3rd century BCE, it is said that the Emperor Shao Hao (少昊), and his son Ru Shou (蓐收) are the sovereigns associated with the three months of Autumn. This obscure statement sheds tremendous light on the essence of Autumn, and eventually allows us to understand how to stay healthy this season. 

According to some legends (since they do vary), Shao Hao was one of the Five Emperors (五帝) of ancient China. His mother was a weaver goddess who fell in love with the planet Venus, and the result of that union was Shao Hao. Together with his son Ru Shou, Shao Hao settled on Chang Liu Mountain where they ruled over the Western Heavens and controlled the setting of the sun. Remember, the west is associated with the Metal phase, and therefore Autumn. Certainly, Autumn is the time of year that corresponds to sunset during the day, and in Chinese astrology Venus is the planet of the Metal phase, and thus too corresponds with Autumn. Even the son’s name, Ru Shou, has the word “shou” (收) within – the word meaning “to harvest” or “to collect,” an attribute of Autumn. The Neijing says that when we move and behave in a way that allows us to resonate with Autumn, we are in the state of Nourishing the movement of Harvest (養收).

In early Autumn (August is the first month of the season) we experience the ongoing but very gradual shift to shorter days and, eventually, cooler temperatures. In other words, we are shifting more and more to the Yin phase of the year. Yet, August in particular can still be damp and humid. It is also the time of tropical storms which bring moisture and wind – an external event. In Chinese medicine, weakness in the Spleen and Stomach leads to damp accumulation – an internal event. In early Autumn we therefore should avoid dampness externally and simultaneously strengthen the digestive organs internally. 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. According to the noted moxibustion scholar Lorraine Wilcox, the time around the beginning of Autumn is also a special time for applying prophylactic moxibustion in an effort to strengthen the body for the cold season to come. 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.

As August continues and into September as the weather does become cooler, we need to be cautious of sudden returns of very hot and humid weather, a common weather pattern here in New Jersey. In Chinese this is called “The Old Tiger of Autumn” (Qiu Lao Hu 秋老虎). 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!

Ghost Month 2024!

Yes, it’s that time of year once again! Today is the day in the traditional calendar that that Yama 閻王, the King of Hell, opens the gates of the hell realms, allowing the spirits of the deceased to wander the earth – basically a one-month vacation for ghosts. This is Ghost Month, the 7th month of the Chinese lunar calendar.

This supernatural sojourn lasts until the end of the lunar month (the 8th lunar month starts on September 3rd), when the gates of Hell are once again closed. The culmination of the month is the 15th lunar day (this year on August 18th), 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. Since I personally usually practice outside in the evening, during Ghost month I skip Qigong and practice martial arts such as Baguazhang instead. Martial arts are traditionally used to ward off mischievous spirits, which is why martial arts demonstrations often accompany displays such as Lion Dancing that are used to consecrate businesses, or exorcize negativity in a building or other location.

Whether or not we believe that this month is the time of ghosts, what this custom perhaps does is remind us of how the natural balance of Yin and Yang is shifting in a very real way this time of year. Not long ago we came to the beginning of Autumn in the East Asian calendar. Even though days are still hot in August, it is true that we are in the early part of the Yin portion of the year. After the Summer Solstice the days start to slowly get shorter. By August here in northern New Jersey plant growth is mostly over. Even the grass is growing more slowly than before. In the environment we are seeing a significant increase in dampness and humidity – and water is a Yin substance. Thus, one of the main pathological environmental factors our patients now complain of is dampness, or summerheat-dampness (a combination of pathogenic Yin and Yang together).

When I look at customs like the ghost month, I see other interesting health recommendations, such as the prohibition against activities outside in the evenings. Ghosts or not, there are so many mosquitoes and insects outside that there’s no way I can practice slow moving exercises like Qigong outside! These types of insects, as vectors for disease, can cause serious problems in people who might be more vulnerable – such as the elderly, the young, or the sick.

Other health recommendations this time of year also focus on counteracting the growing Yin. In some parts of China around the time of Summer Solstice there is the custom of hanging herbs such as Ai Ye and Shi Chang Pu above doors. Both Ai Ye and Shi Chang Pu are aromatic, and the aromatic nature is Yang that can disperse Yin influences as well as ward off insects.  Some people will also put powdered Xiong Huang (realgar) at the bottoms of doors to keep bugs out of the house (realgar is a very toxic medicinal).

In terms of internal herbal medicine, this is the time of year when a lot of patients benefit from formulas such as Huo Xiang Zheng Qi Tang. This formula contains aromatic and Qi moving medicinals such as Huo Xiang, Hou Po, Chen Pi and Bai Zhi to transform damp. It also includes medicinals that likewise strengthen the Spleen so as to allow for normal movement and transformation (the Yang functions of the Spleen). This idea of expelling the Yin and supporting the Yang is the same principle underlying the use of San Fu moxa (see previous blog posts).

So, please be careful out there and avoid the Yin, ghosts or not. But, just to be sure, I for one will be burning some joss paper outside later today to appease some ghosts!

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; r. 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.

Minor Heat 小暑 Seasonal Node

It turns out that this June was the hottest on record yet, and that means that 2024 may be one of the hottest overall years. The change in climate is palpable in almost all parts of the world, yet unfortunately there are still climate change deniers putting everyone at greater risk.

In terms of seasonal shift in the northern hemisphere, we are entering the hottest time of the year and just a few days ago on July 6th we started the Minor Heat (Xiao Shu 小暑). This 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 nascent 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 smaller segments of the seasons for this Node are Warm Winds Arrive (温風至), First Lotuses Blossom (蓮始開), and Hawks Learn to Fly (鷹乃学習).  These three are the traditional Japanese version of the mini-seasons. The Chinese version is slightly different, with the second being called Crickets Take Up Residence in Walls (蟋蟀居壁).  Personally, I’d rather have lotuses rather than crickets invading my house!

The most important “to do” recommendation during this time is to nourish the Heart by maintaining an optimistic outlook – something I’m personally trying to do despite what I mentioned in the introduction above. 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. 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 (we are doing some of these in our online practice sessions).

As mentioned above, the first 5-day period of Minor Heat is known as Wen Feng Zhi (溫風至), - Warm 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 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! 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

Because now is the time of significant dampness and heat, in general we should consume foods that are cooling and either bitter or acrid (which can drain damp). 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.

This time of year it is also a great idea to start preparing herbal formulas that will be used in the colder weather. One of my next blog posts will discuss making a medicated wine for the cold seasons to come.

Book Review: Exercise Prescription in Sui China (581 – 618 CE)

I’ve been behind on books I’ve been wanting to review, so I figured that I’d kick things off again with a review of my newest acquisition, and then I’ll work backwards to some other East Asian medical texts and then some more books on martial arts. So, enjoy this review, and hang on for more to come soon!

Exercise Prescription in Sui China (581 – 618 CE)

By, Dolly Yang and Mugen Chiang

Purple Cloud Press, 2024

I initially became interested in East Asian medicine through my own practice first of martial arts, and then later my introduction to and subsequent engagement with body centered practices such as Qigong. To me, these played a big part of my own views and practice of East Asian medicine. In my own training at the New England School of Acupuncture we did have an all too short class on Qigong, but while there I was surrounded by other people for whom internal martial arts and Qigong were essential to their own version of East Asian medicine, such as my friend and mentor Rene Navarro. Yet, as I started teaching East Asian medicine outside of the New England area, it became clear to me how very limited most acupuncturists’ exposure to movement therapies was. For example, for several years I taught a combined Qigong / Taiji course at the Pacific College of Health and Science in New York, and there, students got a single 28 hours long class as their only real exposure to these arts during the almost 4 years of their master’s degree!

As a result of all this, one of my personal interests is improving the teaching of Qigong and related arts, and encourage their use by licensed East Asian medicine professionals. My fantasy would be eventually to have a school of East Asian medicine here in the United States have movement therapies such as Qigong and Taiji be a focused course of study, like a university major. It will come as no surprise then that I was extremely pleased when I found out that this book, Exercise Prescription in Sui China, was slated for publication by Purple Cloud Press.

Exercise Prescription is an outgrowth of Dolly Yang’s PhD dissertation completed under Vivienne Lo at University College London. The text is based on the Zhu Bing Yuan Hou Lun 諸病源後輪 – the Treatise on the Origins and Symptoms of Medical Disorders (hereafter “Treatise”), a very influential medical text compiled during the 7th century at the behest of Emperor Yang Di. What the Treatise did was categorize and explain diseases that were known at the time, giving treatment options for physicians encountering said disorders. However, the most important thing for our discussion was the systematic inclusion of Dao Yin as a treatment modality for an incredibly wide range of diseases.

To put this in better context we should remember that by the Sui period there was no such thing as Taijiquan (Tai Chi), and the term Qigong is essentially a neologism that would not be used for over 1000 years still. Dao Yin is a term that describes a wide range of movement, breathing and visualization practices, and many of these would make their way into the modern category of Qigong. Also, prior to the Treatise, most texts on Dao Yin presented them as aspects of Yang Sheng, i.e., disease prevention and health maintenance. What is so revolutionary about the Treatise, is that it basically moves Dao Yin out of the realm of prevention and elevates it to a remedial therapy that can be prescribed based on a specific patient’s complaints. As such, it is THE granddaddy of all books on what we today would call Medical Qigong, or Clinical Qigong.

What Dr. Yang does in Exercise Prescription is significant and I think will be monumental to the reestablishment of Qigong-like practices to their once major role within East Asian medicine. In this book Yang starts with introductory material that describes and defines Dao Yin, and then analyzes various practices associated with Dao Yin such as postures, movements, breathing patterns, self-massage, and visualization. She also gives a brief overview and background of the Treatise, which will help situate the material historically.

After the introductory material, and in the main sections of the book, Dr. Yang translates all of the Dao Yin sections, disease by disease, that are given in the Treatise. Thus, we are given Dao Yin prescriptions for the treatment of a wide range of disorders from musculoskeletal problems, to disorders of the internal Zang and Fu, to diseases of the sensory orifices, and to just about everything in between. The material is copious, with the current book coming in at about 500 pages in length!

One problem with the original Treatise though is that there were no diagrams, and sometimes it is difficult to discern exactly what a movement pattern is from the written word alone. To overcome this, Exercise Prescription includes illustrations by the very talented Mugen Chiang. Thus, the original text is brought more to life by the visual interpretations created by the partnership between Yang and Chiang.

I do think that this book will become a defining text in English on the prescription of Dao Yin and Qigong, and is destined to be a very important work. This is definitely my kind of book, and honestly to me it is one of the most exciting publications I’ve seen in recent years. For anyone interested in East Asian medicine it is a must have, and my hope is that it will contribute to bringing this aspect of medicine back to the prominent place it once historically had in East Asian medicine.

My last suggestion is that purchasing the book directly from the publisher (here) puts more money in the hands of the authors. While it is listed on Amazon, please let’s all support small independent publishers by shopping directly with them. For information on my own classes on Clinical Qigong for licensed East Asian medicine providers please go here.

Summer Solstice 夏至

This week we arrive at one of the major cardinal points in the transition of the year – the Summer Solstice for the northern hemisphere. The astronomical solstice is tonight, June 20th, at 4:50pm EDT.  At that exact moment, the North Pole will at its maximum tilt (about 23.5 degrees) toward the Sun, resulting in the longest day and shortest night of the 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 June 21st. 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) In Japan the names for the 72 Material Manifestations (七十二物候) differ slightly. The names of these three mini seasons for the Japanese are Prunella Dries (乃東枯), Irises Bloom (菖蒲華), and Pinellia Grows (半夏生 - this one is the same as the Chinese calendar). 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 when Aconite (Fu Zi 附子) is harvested 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, damp and hot weather will most likely be with us for the foreseeable future. Thus, 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).

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 by one hour in locations that observe daylight savings time). In general it is important to get into bed before the Zi hour (which is midnight during Daylight Saving time). 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

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 distension 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 go here.

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

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

On the Dan Tian 丹田 (Repost)

This is a post that I originally wrote back in summer 2022.

Recently one of our new online Qigong class students posed a question about the Dan Tian. At the end of most all of our postures we do a maneuver called ‘collecting in the qi’ (my loose translation of 收功), in which, while moving the hands down in front of us and sinking, we visualize everything in the body returning down to the Dan Tian (丹田), the space in the abdomen between the navel and Ming Men (命門). As I frequently point out in class, our’s is the Neigong (i.e., Qigong) in the lineage/tradition of Hu Yaozhen (胡耀真), one of my great-grand teachers, and a key feature of this tradition is the almost constant focus on Dan Tian.

The Dan Tian, from a colorized version of the Diagram of the Inner Landscape 內經圖 found at the White Cloud Temple 白雲觀 in Beijing.

A common English translation for Dan Tian is the ‘elixir field.’ The word ‘tian’ (田) just means field. The word ‘dan’ (丹) is a bit more complicated. One meaning of the word is cinnabar, a scarlet-red mineral form of mercury sulfide (HgS) that is a common ore source used for refining pure liquid mercury. Since Daoists used mercury as one metaphor in their descriptions of the meditative processes used for transcendence or immortality (and in some unfortunately cases experimented with ingesting actual mercury while seeing the same), the term ‘dan’ became associated with the process of spiritual transformation. ‘Dan’ and the compound term ‘Dan Tian’ thus becomes a synecdoche - a stand in for the entire process of cultivation. It is the symbolic elixir that, when taken, confers a higher state. Hence, the translation of Dan Tian as ‘elixir field’ – the place that is used to create the elixir of immortality and transcendence.

In the body, the Dan Tian is conceived of as a physical location, although the physicality of Dan Tian is a topic of debate. For our purposes however, we will take it as a physical location. Properly speaking, there are three Dan Tian in the body: an upper (上丹田), middle (中丹田), and lower (下丹田). There are some slight variations on the locations of these three structures depending on the source. Most agree that the upper Dan Tian is located in the head. The middle Dan Tian is sometimes associated with the area of the chest, that location that in Chinese medicine is referred to as the Sea of Qi 氣之海 (not to be confused with the acupuncture point of the same name), or the Tan Zhong 壇中.  In Hu Yaozhen’s lineage, we located the middle Dan Tian not in the chest, but rather in the abdomen between the navel and Ming Men. Hu Yaozhen then places the lower Dan Tian at the base of the abdomen in the pelvic cavity, just above Hui Yin 會陰 – the perineum. While a large number of modern Qigong texts situate the middle Dan Tian in the chest, it is interesting to note that in some older texts it is located in the abdomen as Hu teaches. For example in the Yuji Qiqian (雲笈七籤), an anthology of the Daoist Canon written circa 1029, the middle Dan Tian is associated with the middle jiao, the abdomen, and the area ‘below the heart’ (心下).

Regardless of the variations, somewhere in the area of the abdomen seems to be the most important of the Dan Tian used in various schools of meditation, Qigong, martial arts, etc… But why is this? Why is it so important?

A large (about 4 inches from top to bottom) piece of Cinnabar ore 硃砂 in my private collection.

For Chinese medicine practitioners this is an interesting question. If we look at the earliest of Chinese medicine cannons, we can’t find the term ‘Dan Tian.’ For example, the only chapter of the Huangdi Neijing that mentions it is the Treatise on the Origin of Disease (本病論). Unfortunately, this is one of the two apocryphal chapters of the Su Wen. While it may have been in circulation for over 1000 years by now, it is most likely not original to the Han Dynasty version of the text and was not a chapter Wang Bing would have seen or worked with in writing his highly important and definitive edition of the Neijing. That said, the abdomen is an important location. Most of the Zang Fu are located there. Furthermore, highly important vessels originate in the abdomen. For example, according to the Treatise on Bone Hollows (SW60 骨空論), the Chong, Ren and Du all originate from a location in the abdomen. These are extremely important vessels, with the Ren and Du respectively being tied to the core Yin and Yang of the body. For example in the Song Dynasty text Xi Shang Fu Tan (席上腐談) the Ren and Du are called the Seas of Yin and Yang (陰陽之海). The Chong is associated with all the channels, and in the Treatise on the Seas (LS33 海倫) the Chong is said to be the Sea of the 12 Channels (衝脈者，為十二經之海) – i.e., all the channels. Clearly, even though the Dan Tian is not mentioned by name, the abdomen is tied to basically all the important structures of the body.

While the Nanjing (Classic of Difficulties) does not specifically mention the Dan Tian either, it does get a little closer in identifying the Kidneys and the Moving Qi between the Kidneys (i.e., the Ming Men) as being core aspects of our vitality. The idea of Ming Men the way we conceive of it today is absent from the Neijing, unless of course you are a creative reader in the way that Zhao Xianke was (there’s a good Chinese medicine inside reference for you!). This Moving Qi between the Kidneys, in addition to being associated with the Ming Men, have also been associated with the Dan Tian by some physicians. For example, the 66th Difficulty says that, “the Qi moving below the navel and between the Kidneys are a human’s life. They are the origin and root of the twelve channels, and thus are called source” (臍下腎間動氣者，人之生命也，十二經之根本也，故名曰原). Yang Xuancao, a commentator writing in the 7-8th c. CE said of this line that, “the Qi moving below the navel and between the Kidneys are the Dan Tian. The Dan Tian is a human’s origin and root” (臍下腎間動氣者，丹田也。丹田者，人之根本也). Yang continues with a beautiful description of the Dan Tian that is too long to quote in its entirety here, but, for example, he says that the Dan Tian is yellow in the center, green-blue on the left, white on the right, red on top, and black on the bottom. This of course is just metaphorical language that says the Dan Tian in the abdomen is connected to all of the Five Phases, and thus all the organs and all the channels.

It may very well be that this sort of medical theory that we see in the Nanjing, and not in the Neijing, arose because of the influence of people such as the inner alchemists and Daoists – an example of cultivational literature influencing medicine (we see many other examples of the opposite of course). Some of the more conservative medical commentators (i.e., the Neijing purists) have pointed this out as a criticism, and an example of adding theory to medicine that has no legitimate right being there. I’ll let my medical providing readers decide for themselves if they find these ideas relevant to their clinical practices.

Hua Tuo’s Chart of Neigong from the writings of Hu Yaozhen (who was probably the actual author of the chart). Notice the upper Dan Tian in the head, and the lower Dan Tian just above the perineum. The middle Dan Tian is located in the space level with the navel, although here called the ‘Entrance Hall’ - a Buddhist term.

Aside from our discussion of medicine, the Dan Tian is described extensively in the literature of internal alchemy and other aspects of Daoism (which in turn become some of the important sources from which Neigong/Qigong concepts of Dan Tian spring). For example, the Direct Pointers to the Great Elixir (大丹直指 DZ 244), a Quanzhen text attributed to the Daoist master Qiu Chuji (1148-1227 CE), discusses Dan Tian as a part of the process of cultivating transcendence. It says that the navel at the center of the body is the Central Palace (中宮), which it also identifies as an alternate name for the Dan Tian (但臍在人身之中，名曰中宮、命府、混沌、神室、黃庭、丹田). The Direct Pointers goes on to say that the Dan Tian stores essence and marrow, and connects the hundred channels and nourishes the entire body (此處包藏精髓，貫通百脈，滋養一身).

In Hu Yaozhen’s teaching, the meditative process of bringing attention down to the abdomen is called the Three Senses Return to the One (三性歸一). In reality the number three here is a symbol for all of the senses, not just literally three of them. By bringing the meditative focus to the interior we can induce a still calmness. I am not qualified to talk about this from a real internal alchemy or Daoist perspective, but certainly this inward focus can have a profound effect on centering the mind and pulling us back into a state of centered focus. In other words, it helps to tame the monkey mind that is our norm. Even in the clinic I will often ask patients undergoing acupuncture to simply bring their focus down to their abdomen and breathe deeply. In terms of Tung’s acupuncture this is another example of how we apply the Moving Qi (動氣) needling method that is a part of achieving De Qi (得氣 – for more on what De Qi really is please see my class on classical treatment strategies expressed in Tung’s acupuncture). But I digress…

Aside from inducing calm centeredness, the cultivation of Dan Tian, from both the alchemical and medical perspectives presented above, must also have a beneficial health effect on pretty much all the channels and organs. If the Dan Tian is connected to everything and nourishes the entire body, it means that a robust Dan Tian leads to robust health.

Hu Yaozhen may very well have focused heavily on the Dan Tian because one of his main teachers was a Daoist master and practitioner of inner alchemy by the name of Peng Tingjun (彭庭隽), and Peng in turn was a disciple of a Daoist hermit by the name of Huo Chengguang (霍成光). It is from Peng that most of Hu’s Neigong came down to us. To be honest, I think the better question is why don’t all schools of Neigong/Qigong focus more on the Dan Tian? It would seem natural to me that it be a major part of most every posture in one way or another.

I hope my short musings help stimulate more thought, as they have for me just sitting down, collecting my thoughts, and putting them to paper (or screen as the case may be). Whether you, the person reading this, are a physician, Qigong practitioner, or just someone interested in East Asian medicine or cultures, I hope thinking about the role of Dan Tian deepens your own practice.

Duan Wu Festival 端午節

The Duan Wu 端午 Festival, also known as the Dragon Boat Festival, is a traditional Chinese holiday celebrated on the fifth day of the fifth lunar month which this year falls on today, Monday, June 10th. With a history that dates back over 2,000 years, this festival holds great significance in Chinese culture.

At its core, the Duan Wu Festival commemorates the life and death of Qu Yuan, a renowned poet and statesman during the Warring States period. Qu Yuan was deeply devoted to his country and expressed his frustrations through his poetry. However, when his counsel was ignored and his state fell into turmoil, he was overcome with despair. In 278 BCE, he drowned himself as a final act of protest against the corruption and injustice rampant at that time.

Dragon Boat in Okinawa

Duan Wu's rituals and customs are partially rooted in the belief that Qu Yuan's spirit could be protected and honored. One of the most obvious customs during the Duan Wu Festival is dragon boat racing. These races involve teams of paddlers rowing in long, narrow boats decorated like dragons, a very Yang and auspicious creature. The act of racing dragon boats on rivers is not only fun to watch but also a way of warding off evil Yin and preventing bad luck, much in the same way that Lion dancing does.

Mugwort 艾草

Another Duan Wu custom is the consumption of zongzi, sticky rice dumplings wrapped in bamboo leaves. Legend has it that when Qu Yuan drowned himself, villagers threw rice balls into the river to prevent fish from devouring his body. To this day, people eat zongzi as a way of paying homage to Qu Yuan and as a symbol of warding off evil spirits and disease during the hot summer months. Aside from this practice, during Duan Wu people frequently hang aromatic herbs on the outside of their houses, such as Mugwort 艾草 or garlic. These Yang substances also serve to ward off Yin negativity and disease (such as dampness related conditions, or conditions caused by insects such as mosquitos).

Beyond the history and the customs associated with the festival, Duan Wu carries an inner meaning. This is the time of mid-summer as we discussed in the previous post on Summer Solstice from yesterday. It is the time when Yang has come to its apex and Yin starts the slow progress towards becoming the dominant movement in nature. Thus, it is an opportunity for cleansing and purification so that while we can embrace the movement of Yin, we can also avoid the negative aspects of that phasic movement. In the clinic this means watching our patients for patterns such as damp turbidity, especially in the digestive system. As the weather becomes more and more hot and humid this will be a commonly seen problem. We can treat this by supporting the Spleen and Stomach with acupuncture and gentle moxibustion, or by the consumption of slightly warm aromatic herbs when appropriate. An example of a seasonal formula along these lines is the Cardamom Powder in the Summer Solstice blog post that we posted last year.

Enjoy the day, hang some garlic, and eat some zongzi if you can. Happy Duan Wu, Dragon Boat Festival!

Bearded Grain 芒種 Seasonal Node

June is here, the weather is warm, and this week is humid and wet in New Jersey! It feels like just yesterday I was writing about winter, and then the Lunar New Year. Time flies by quickly, and no matter what we do seasons change.

The change of seasons is a good reminder that all things change over time. Most of you in the East Asian Medicine world know that the Oregon College of Oriental Medicine, one of my alma maters, is closing down this summer after over 40 years of providing in my opinion some of the highest quality education in our field. One positive aspect of me writing about seasonal fluctuations is the reminder that change is the constant of everything. For example, while many of us mourn the loss of summer as we move into autumn, it is important to keep in mind that change is natural, and that patterns eventually are cyclical. As I taught my final class for OCOM last weekend, I was hit by an overwhelming sense of sadness. But, none of us are here forever, and none of our institutions are eternal. One summer turns into autumn, and then the cycle goes on forever with every subsequent summer being slightly different. East Asian Medicine is larger than any one of us, or any one school. So, while this chapter is ending, East Asian Medicine will continue on as it has for several thousand years. We just have to see what the new season brings us.

But I digress… Back to the seasons.

Yesterday, June 5th, was the beginning of Bearded Grain, the ninth seasonal node of the year (and today, June 6th, is the new moon and start of the fifth lunar month). Bearded Grain is also the last node just before Summer Solstice, the most expansive and Yang time of the year. The name, ‘Bearded Grain,’ is a reference to crops. The word Mang (芒) refers to the maturing crops, especially the winter wheat, which is harvested about this time of year, and the word Zhong (種) is a reference to the new rice crops that are planted at this time. This gives us the image of one thing coming to maturity (as in the growing Yang of the season) so that it can eventually perish (i.e., be harvested), allowing a new crop to be started. The image of transfer and renewal is characteristic of the transition period of the solstice that fast approaches.

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

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

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

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

Remember, much of our treatment goes way beyond the time we spend putting in needles or writing formulas. Basic concepts of public health and hygiene are some of the most important things we can help teach our patients.

Diet for Bearded Grain

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

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

Recipe for Bearded Grain – Licorice and Mung Bean Congee

(Gan Cao Lü Dou Zhou 甘草綠豆粥)

Ingredients:

• Rice 150g

• Mung Beans (lü dou 綠豆) – 50g

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

• Rock sugar to taste

Directions: 

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

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

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

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

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

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

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

The Five Taxations 五勞 - Part V

And… The the last of the Five Taxations repost!

The word taxation (勞) as a medical term refers to some sort of physical exertion, or fatigue resulting therefrom. It also can describe some sort of significant wear and tear on the body. Previously I had blogged about a list of Five Taxations from the Xuan Ming Wu Qi (Wide Promulgation of the Five Qi, Su Wen 23).  This is the last installation on the Five Taxations and it is long overdue. For those who are new subscribers or who missed the last posts, the first was taxation that involved the Heart, the second the Lung, the third the Spleen, and the fourth the Kidney. As is typical with the Neijing the five track along the Five Phases and thus the Five Viscera.

The last of the Five Taxations goes with the Sinews and the Liver. The source chapter says, “to walk for a long time damages the sinews” (久行傷筋). Wang Bing points out here that this then relates to the Liver. Like the previous taxation, there is little other explanation with my Translation and Explanation of the Neijing Suwen adding: 过度的行走，可以伤筋 (“excessive walking can injure the sinews”).

Now, I think most of us would consider walking a great form of exercise that just about anyone can do, and this is true. It has lower impact on joints than running, and it is easy and convenient. Medically though, we do know that overdoing anything is a problem. Remember, that the word in Chinese for ‘Chinese Medicine’ is Zhong Yi 中醫. The first part of that word, Zhong (中), stands for China (Zhong Guo 中國). However, Zhong literally means center, or middle. Thus, Chinese medicine is literally medicine of staying in the center. One of the core fundamental teachings of Chinese medicine, as illustrated by all five of the taxations, is that balance, in other words staying in the center, is health. Lack of balance is disease. This is why the Ping Ren Qi Xiang Lun (Su Wen Chapter 18) says that “a balanced person has no disease” (平人者不病也). Even with walking, overdoing it can be problematic. Endurance walking in particular is known to possibly cause dehydration, blisters on the feet, and, just as this taxation suggests, muscular pulls, strains, or other injuries.

At this moment I’ll remind everyone that the word Sinew in Chinese medicine is not the same as tendon in western medicine. The Chinese word sinew (筋) can refer to tendons and ligaments, but is also refers to the contractile strength of skeletal muscle. This is why in the middle of that character we see the character for physical strength (力).

In addition to the literal reading, we can try to understand this taxation in a deeper way. Sinews and Liver go with the Wood phase, the architype of Spring. Spring is the beginning of movement, the movement of rebirth, and thus ultimately a Yang season. While the taxation of sitting too long (i.e., lack of movement) damages the Spleen, we can also see that lack of movement damages the Liver and sinews as the symbolic representation of the muscles and connective tissue. Too much movement is also problematic. In that case, too much Yang-movement damages the physical manifestation (Yin) of the Wood-Liver (Yang).

Looking at this taxation in the other direction is also possible. As the Yang declines with the aging process, people are less inclined to move. In the 54th chapter of the Ling Shu the ageing process actually starts with a decline in Liver. And in the very first chapter of the Su Wen tells us that, “as the Qi in the Liver weakens, the sinews no longer can move” (肝氣衰，筋不能動).

So, how do we work with this taxation clinically? The first thing is to counsel patients to be active, but not to be so active as to constantly injure themselves. If your clinic is like mine, this is a constant issue really. How many times do we have a patient come in with shoulder, neck or back pain (or any other type of musculo-skeletal injury) that is a direct result of some overdone exercise? After we treat them and they feel better, often the first thing they do is go right back to the offending exercise and reinjure themselves. Like Chinese medicine at its fundamental level, we need to tell patients to seek balance in movement and rest, activity and stillness. Some patients need to exercise more, but some actually need to exercise less. A lot need to vary exercise so as not to constantly stress the same body areas.

For weakness of the sinews in general manifesting as weakness in moving the limbs, pain in the joints, and intolerance to exercise, I recommend Tung’s points the Lower Three Emperors (下三皇). This is an important Dao Ma combination on the lower leg that has a strong regulatory effect on the Kidney. Why do we use the Kidney here? Because strengthening the Kidney-Water benefits the Liver-Wood, conforming with the Nanjing strategy of “in vacuity supplement the mother” (虛者補其母). We can combined the Emperors with Yang Ling Quan (GB-34), the meeting point (會穴) of the sinews.  Specific locations of weakness can be addressed individually with other points in addition to this general method of strengthening the Liver (via the Kidney) and benefitting the sinews.

I hope everyone has enjoyed this short series of essays, and that they show what sort of great knowledge is embedded in our classical texts!

The Five Taxations 五勞 - Part IV

Here’s repost part four!

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!

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The Five Taxations 五勞 - Part III

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

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.

Beginning of Summer 立夏 Seasonal Node

Tree Peony 牡丹花 in New Jersey (stone lion in background)

The last week or so have seen some really nice weather here in New Jersey. Even better, we’re starting to get some awesome tree peony blooms! Everything in nature seems to be practically exploding and growing at lighting speed, and this is appropriate since today, Sunday May 5th, is the beginning of Summer in the traditional Chinese calendar, and thus the start of the Beginning of Summer (立夏 lì xià) seasonal node. By now the days are getting significantly longer, and at this point in time, even though it’s a horrible thought, in only about 6 weeks the days will start getting shorter again. Right now the Yang of the natural world is close to its fullest, and correspondingly the hexagram that represents this time of year is Qian Gua (乾卦) – six solid-Yang lines.

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

One thing to keep in mind is that the weather in early May can still on occasion be chilly and wet. Summer is the time of rising Yang in the natural world, but it is still early enough in the season that it can slowed by the back and forth of temperatures and lingering dampness. The second chapter of the Su Wen says that when we don’t follow the guidelines of Spring then there is change to cold in the season that follows. Zhang Zhicong interprets this as the development of cold diseases (i.e., cold patterns). This is also the case though when the weather doesn’t behave – not just we humans not behaving. The continued cold and damp (both Yin evils) effectively restrict the Yang movement in our bodies. Thus, clinically this time of year we can see more joint pain, general aching, fatigue, digestive weakness, and diarrhea. For these patients consider doing moxa on points such as Zu San Li ST-36, or needling points such as Zhong Jiu Li 88.25 for general joint pain. Encourage patients to dress adequately for the weather on days where cold lingers.

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

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

Another way to avoid problems of Heart Fire is closely tied in with traditional meditation and body cultivation practices (such as Neidan, or in modern terms, Qigong). Early medical texts such as the Ma Wang Dui manuscripts taught the importance of sinking the Qi down to the lower part of the body, a place in cultivation literature known as the Dan Tian (丹田; Tanden たんでん in Japanese). This idea later became vitally important in meditation schools such as those of Internal Alchemy, and then was inherited by modern Qigong practitioners. The flaring up of fire is seen to be an extremely harmful problem, and one of the main ways to counteract this is by focusing on the space in the abdomen – the Dan Tian.  This can be done during standing meditations, such as standing post (站樁), or in seated meditations (坐禪). Doing these types of practices regularly is perhaps one of the best ways to deal with the upflaring of Heart Fire. For those in New Jersey or New York, we discuss these techniques frequently in our weekly Neigong/Qigong and Taijiquan classes (and we do the same in our online pandemic Qigong classes, which are still ongoing). 

Diet for Beginning of Summer 

With the new seasonal node come new dietary suggestions. One of the first is to avoid intemperance in food and drink. Overeating, especially of very heavy, sweet or greasy foods, places a burden on the Spleen. Overeating these foods, and overconsumption in general, also create internal heat that can worsen Heart Fire. If patients experience digestive upset, as a temporary measure we can needle points such as Ling Gu 22.05, Si Hua Shang 77.08 and Men Jin 66.05. If there is Heart Fire bleed the ear apex.

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

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

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

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

And one last recipe for Beginning of Summer…

Pickled Cold Lotus Root

Ingredients:

• 1 lb. lotus root

• 3 cups rice vinegar (or white vinegar)

• ½ cup sugar

• ½ tsp salt

• 1 small red chili pepper 

Directions:

1. Peel lotus root and then slice into VERY thin slices; soak for a few minutes in a bowl of cold water with a little white vinegar to keep from discoloring

2. Slice red chili pepper in to very thin slices, or julienne; if whole pepper is not available then substitute with red pepper flakes if desired

3. Combine vinegar, sugar and salt in a small saucepan, bring to a simmer for just one minute, and stir to be sure salt and sugar have completely dissolved

4. Bring another pot of water to boil and parboil lotus root for several minutes; then drain in colander and cool with cold running water

5. Put cool lotus root and sliced chili pepper in a clean bowl and cover with the vinegar solution; cover and then refrigerate at least overnight or up to a few days before eating; to eat, remove from liquid and serve chilled

This recipe nourishes yin, clears heat, supplements vacuity and awakens the Spleen. It is good for those with poor digestion as well as those with dryness symptoms.

Some final reminders… You can follow us on Instagram for more seasonal and plant photos, and we continue to offer free online Taiji Silk Reeling and Qigong classes to professional Chinese medicine practitioners every Monday and Friday afternoon. If you want to join in, please email me.

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

The Five Taxations 五勞 - Part I

This is a repost from a few years ago. Please enjoy again!

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).

Grain Rain 穀雨 Seasonal Node

This year the weather in northern New Jersey has been slightly cooler than usual, but honestly to me this is refreshing knowing that the real heat and humidity of summer are just around the corner. We are coming upon the transition times between Spring and Summer, but I’m happy to have Spring a bit longer.

Hoopoe

This blog post is actually coming out late by almost a week, as last Friday, April 19th, we started the Grain Rain (Gu Yu 穀雨) seasonal node. The name of this seasonal node refers to precipitation that feeds the grains and other plants readying them for harvest, allowing them to grow to their fullest. While this week hasn’t had much rain here, the last few weeks where I am have seem some decent rainfall. The three smaller segments of the node are Ping shi sheng 萍始生 (Duckweed Begins to Grow), Mingjiu fu qi yu 鳴鳩拂其羽 (Cockoos Flutter Their Wings), and Daisheng jiang yu sang 戴勝降于 (Hoopoes Land on Mulberry Trees) – all images of early plant growth or increased bird activity.

Grain Rain is actually the last seasonal node of Spring since early May marks the beginning of Summer in the Chinese calendar. In only about 2 months the days start getting shorter again – so get out and enjoy the sunshine! Grain Rain is also the 6th step of the 24 seasonal nodes thus corresponding roughly to the Chen (辰) watch of the day (7-9am). It is the time of transition from Spring to Summer correlating to the Soil (i.e., Earth) phase; the Soil phase represents the transition between seasons. Thus, Gu Yu is the time of year associated with the Stomach channel. The general movement of Spring is the movement of Liver-Wood, but the Soil phase is also in charge of movement and transformation. Because of this, during Grain Rain we need to ensure that Qi and Blood are moving smoothly. Watch for signs of Qi stagnation in yourself and in your patients. This is why a good basic recommendation for this time of year is performing regular self-massage to ensure smooth circulation of Qi and Blood in the body.

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

As the weather does get a bit sunnier and warmer it is good to increase outside activity – consider walking or gardening. However, since Spring is a time of temperature ups and downs, be careful to dress appropriately as dictated by each day. This is also allergy season, for which I suggest using Tung’s Mu (木穴; 11.17) point. Located on the palmar surface of the proximal digit of the first finger, this point is also call the common cold point of the hand (手感冒穴). Also because of the ups and downs we’re still seeing quite a bit of upper respiratory infections around here (including COVID since it isn’t completely gone). Be sure to wash hands, and mask when feeling sick or around patients presenting with upper respiratory tract infection symptoms.

Getting back to the idea of stagnation, it is vital that during Grain Rain we prevent stagnation in the Stomach (since this is the time of Stomach channel). With acupuncture treatment this means making frequent use of Men Jin (門金穴; 66.05), the Tung point overlapping the Shu-stream point of the Stomach channel. It is also important to avoid overeating or overdrinking, and the overconsumption of oily and greasy foods.

During Grain Rain start eating lighter and easier to digest items and in-season vegetables such as asparagus. There are also a host of other early blooming plants that are just fantastic seasonal food. In Japan, this is the time for bamboo shoots. Known as Takenoko (竹の子) in Japanese, they are sweet and slightly bitter. Their temperature is cold and they enter the Lung, Stomach and Large Intestine. Thus, they can nourish fluids to treat dryness of the Lungs or intestines.

There are also plenty of lesser known seasonal foods local to the western world. In the Northeastern United States we are at the tail end of fiddlehead season. Fiddleheads are curled fern fronds that have a wonderful fresh flavor similar to asparagus. In Japan and China, bracken (Japanese: こごみ; Chinese: 蕨菜), another type of fern, are also eaten as local fiddleheads there. We cooked some last night in pesto with scallops and they were fantastic! Another seasonal food I’ve recently discovered is magnolia blossoms - the beautiful petals can be quick pickled (we are going to do this tonight). I’ll report back on their flavor later but I’ve heard they are gingery, meaning slightly acrid. Last are ramps, a tasty cousin of the leek, onion and garlic plants. Ramps are native to the Appalachian Mountains, north into Canada, west into Missouri and Minnesota and south to North Carolina and Tennessee. As an Allium, ramps are slightly warming, acrid and sweet – meaning they’re perfect for moving Qi in the Stomach and Liver.

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

I hope everyone is staying healthy and having a great Spring.

A Natural Approach to Mental Wellness

Our friends at the ToDo Institute are gearing up to start their next online course – A Natural Approach to Mental Wellness. For 30 days during this experiential program, participants will explore some of the basic concepts and practices from Japanese Psychology, including coexisting with our internal experience, working with our attention, living with purpose, developing acceptance and practicing self-reflection.  Every day they will receive a practice exercise to work with that is informed by the principles of Japanese Psychology and that will help explore and understand the nature of this work. Taught by my teacher, Gregg Krech, this is an excellent chance to engage with non-Western approaches to mental wellness. My students and friends can participate at a 20% discount with the code “mccann.” Class starts this week on April 19th!

Click on the photo below to go to course description and registration.

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