Monday, December 5, 2011

Chinese winter -- the Water element

This is a late post, but I hope you'll excuse me -- between the flood, the visit from my in-laws for Thanksgiving and the additional writing associated with teaching a weekly class on the meridians and point location, I haven't been able to keep up with my blog. Plus, if I wasn't a modern American acupuncturist I'd be in semi-hibernation by now, so I'm climatically sluggish, too.

Chinese winter began November 7th this year. Although late summer and fall have some ambiguity, calendar-wise, winter, spring and summer tend to be more straightforward -- here in Central PA, winter usually begins when all the leaves are off the trees. Winter is associated with the kidneys and bladder. Its element is water, but it might be more accurate to describe it as ice. The emotion is fear, and the spirit of Water is the will. This might seem counter-intuitive, but if you are afraid of the bear and run, that is a manifestation of the will to survive. On another hand, hibernation in the winter time is a supreme triumph of the will to survive ("I'll starve if I don't slow down my metabolism") over fear ("Sure hope no bigger animal finds me and eats me in my sleep").

Cold is the pathogen associated with the Water element, and although science denies any connection between the weather and illness, most of us have had the experience of getting sick or hurt after being too cold. The beginning of winter is an excellent time to do a change of season treatment, to preemptively ward off the coming cold. Such a treatment will include many Kidney points, many of which will be heated with moxa to inject yang qi into the body in order to counteract the season's cold. If you want to do everything you can to avoid winter-time colds, flues and blues, try a winter tune-up.

The water element is associated with the jing, or essence, which controls the deepest aspects of existence -- sexual reproduction, formation of the skeleton and bones -- and is also the metabolic powerhouse that rules all other physical functions. The jing is said to be essentially finite -- what you're born with is all you get, and when it runs out your life is over. There is some dispute about this, and many taoist practices are all about preserving, restoring or extending your jing, but in any event, the jing is very precious, and not to be used up frivolously or casually. Overwork, extreme trauma or shock, and too much sex are some of the main things said to contribute to the decline of your jing. The jing also deals with hereditary illnesses, conditions or tendencies. Although jing-related issues are deep and profound, they are frequently the sorts of things for which people seek acupuncture treatment. From infertility, to migraines like your mom's, or back pain like your dad's, western medicine sometimes either doesn't recognize the dynamic or over-attacks it with expensive and intrusive procedures. That's when an American is most likely to seek an alternative, like acupuncture.

The water element is also associated with sorcery, with the solitary and secretive practitioner. Most of us American acupuncturists end up being viewed this way -- acupuncture is so alien to most westerners that the only way many people can understand it is as a type of magic. Although I don't feel the least bit like a magician, I understand that people see me as an unusual and alien healthcare practitioner. This is part of the reason that I wear all black for my work uniform -- black or blue is the color associated with the Water element, and is also the color associated with magic in western societies. The other reason I wear all black, of course, is because I love Johnny Cash. "Til things are brighter, I'm the man in black." Presumptuous, perhaps, but so is being a modern American practitioner of ancient Chinese medicine.

Monday, October 3, 2011

The Metal element

The Metal element is associated with the Lungs and Large Intestine. Autumn is its season, its color is white and its emotion is grief. Metal's sound is crying, and its musical note is "shang," like the sound of a gong. Metal's positive attribute is organization, but this can be over-done and then you become anal retentive. If you are constipated, the Chinese say you need to “order your qi.” Following these bowel dynamics back to Metal’s emotion, some people are sloppy with their grief, crying all over everyone and making people want to avoid them, while others repress and withhold their grief, acting out in crazy ways or making themselves physically ill. There's no getting around grief in this life, but we can wallow in it or try foolishly to avoid it and make its sting that much worse.

Grief comes into every life, and we all need to have some degree of organization to get through our days. The trick is to know yourself – to know what you need, when and how much. I've always been fairly good at organizing things and have never had any issues with constipation. However, I’ve always had a problem with processing grief, and have had many lung problems. I have tended to try to tough it out, then utterly collapse at some inopportune moment, with the wrong person or in an inappropriate situation. What can I say – I was born in Texas, and cowboys aren’t supposed to cry. As I’ve gotten older and seen how much withheld grief has hurt me, my loved ones and my patients, I’ve tried to anticipate my weakness, but it’s not easy. On one hand, I am much more sentimental about children, animals, athletes, injured veterans and dead loved ones, ready to tear up at a special memory of my late brother or, for that matter, a well-crafted cellphone commercial. But when recently faced with immediate, real grief -- news of the life-threatening illness of an old and dear friend -- I didn’t do so well. I am ashamed to say that I acted stoic for a few days until I arranged to drink too much and totally ruin my wife’s Friday evening tv-watching with my blubbering.

I also generally have a hard time with the autumn -- I am always impatient and discouraged with myself, feeling like the grasshopper in the fable of the Grasshopper and the Ants. I am moody and grumpy, and want to make up for all the lost time swimming and picnicking in the summer by getting ready for winter, dammit! When I first realized this tendency in myself, my darling wife helped me figure out a strategy so I wouldn't be so blue (and grumpy) in the fall. First of all, I'd try really hard to avoid injuring myself on Labor Day weekend, trying to squeeze one last bit of summer joy in before the autumnal curtain came down. Second, I'd paint my toenails (usually metal flake sky blue) so that every time I put my shoes on for the next month, I'd see my toenails and remember the last days of summer with a smile. I haven't painted my toenails for the last couple of years, thinking I was doing better, but maybe I was fooling myself. “Doctor, heal thyself” sometimes means, “Doctor, keep on trying to heal thyself.” Sigh.

As I described in my last seasonal post, there is some confusion about how to deal with the Earth element, and therefore some variability about when the Metal season begins. According to the Chinese Almanac, Metal season began on August 7th this year, but that totally left out the Earth season, late summer. However, here in Central PA, where we have such a clear late summer, I would say that Autumn began this year around September 9th, after the recent flooding, or it may have just begun with the cool snap at the beginning of October. The storms that came with Tropical Storm Lee were tropical in nature, as were the recent heavy rains we were experiencing, but we’ve also had some bona fide cold snaps. I don’t think this blurring of the seasons is such a bad thing – even though the weather was (Earth element) humid and sweaty at the beginning of August, many of my patients were already very impatient to begin (Metal element) organizing their garages and basements for winter, and I also saw a spate of respiratory issues and grief-related conditions at that time. Writing this blog has been very useful for helping me to observe such correspondences between the seasons and my patients' behaviors and ailments.

Maybe if I was more anal in my practice -- a numerologist or astrologer, perhaps -- I would be more concerned with the precise astronomical moment when the seasons shift, but I’m not. I feel my way through all of these Chinese principles more than I religiously observe them. Maybe this Metal season I can transfer some of that organizational ease into my grief-processing and quit being so (ineffectually) rigid in how I try to deal with the grief life brings to me. My wife is worried I'll die of a respiratory disease some day, and she's got some reason to fear such an outcome. From poor processing of grief, to infantile pneumonia, to being the child of cigarette smokers, to being a young adult smoker who held a variety of jobs that used toxic and volatile compounds and wore little or no respiratory protection, I have certainly been rougher on my lungs than my other organs.

However, I have also come the furthest in my life with my lungs. My entry to the world of healing came via breath-centered exercise therapy -- yoga and, especially, Gyrotonics. Using my breath to make myself stronger, quicker, more flexible and more in tune with my body and spirit was one thing, but I really came into my own when I began working with others to help them understand how to expand their use of breath. Therefore the background photo for this post. Yes, as an inexperienced blogger I am limited to the photographic options that offers to me, but the more I think about it, the more pleased I am with the dumbbells. Obviously they are metal; the photographic highlights make them look very white; and they refer to exercise, which got me started on a breath-centered and more balanced life. Done with mindful breathing, exercise can make one less prone to constipation and depression. Being in tune with ones breath can make one less likely to kill oneself with poor judgment and self-destructive habits, less prone to poor grief management and less likely to ruin someone's Friday evening tv-viewing. In other words, my darling wife might say, less likely to be a dumbbell.

Tuesday, July 26, 2011

Late Summer -- the Earth element and the Chinese Almanac

Late Summer is the fifth season on the Chinese calendar, and it is associated with the Earth element. The Earth element has to do with existence right here and now on this earthly plane. In the Late Summer, when the air is warm and humid and when the local harvest is just beginning, we are immersed in the sights, sounds, smells, tastes and thoughts of plenty, but we also worry about the colder, leaner times to come. Late Summer is a pivot in the calendar, from the active yang energy of Spring and Summer to the subdued yin energy of Autumn and Winter.

The Earth element is associated with the stomach and spleen (most Westerners believe the Chinese spleen actually refers to the pancreas), the two primary organs of digestion. Earth's climate is damp, its color is yellow, its flavor is sweet, its sound is singing and its spirit and emotion are both Thought. This may seem strange, as either a spirit or an emotion, but when you consider that on one hand thought can be obsession and on another it can be thoughtfulness or sympathy, it makes more sense. The Earth element, being concerned with earthly existence, also deals with boundary issues -- making sure that you are fulfilling your potential without spilling over into other people's territory or being distracted by earthly delights ("Guilty, your honor! Please have mercy.").

Given that Late Summer is such an important transition time, it is curiously difficult to locate on the calendar. This is due to two things, one philosophical and the other practical, if frustrating. The philosophical issue has to do with two different ways of understanding the Earth season within the five elemental view of the calendar. One way sees the Earth as having its own season, Late Summer, which marks the transition from yang energy to yin energy within the year. The other point of view sees the Earth season as the transition period between each of the other four seasons -- so you'd have four 18-day Earth transition periods per year, one between each season. In practice, an acupuncturist uses both models as they fit the particular situation, but as theory it's pretty messy. However, here in Central PA we have such a clear Late Summer that I always observe it as a distinct season, separate from the Summer and Autumn. Since we can have damp, humid weather any time in the summer, I mark the beginning of Late Summer by the appearance of the first locally grown sweet corn. That should be any day now. In addition, usually the Chinese start their seasons on a new or full moon. Since there is a new moon coming on Sunday, July 31, I figure that Late Summer begins this year on July 31, 2011.

However, the definitive authority, the Chinese Almanac, does not back me up, and in fact says that Autumn begins this year on August 7th. This is the second, practical (and frustrating) reason for the difficulty in knowing the date for Late Summer. The Chinese Almanac is available on paper or online, and is the absolute authority on matters ranging from Chinese fortune telling to what day of the Chinese year it is (July 31, 2011 is the Chinese Lunar Date 7/2/4708). There are various formulas for figuring these things out, but mostly anyone interested in the Chinese point of view simply consults the Almanac, and its word is law. I use, and encourage you to check it out. As you'll see, the Chinese Almanac doesn't currently recognize Late Summer as a distinct season, so it doesn't list a date for the beginning of Late Summer. My guess is that this reflects a general trend in modern China to streamline and "make more reasonable" Chinese traditional medicine and philosophy. Both philosophical points of view regarding the Earth season have solid historical backgrounds, but as I noted, it's messy to have two competing points of view. Especially when you're trying to write a simple reference guide like an almanac.

In spite of the Chinese Almanac's silence on the topic of Late Summer, though, it is a really good time to treat certain conditions, and it would be a shame to miss the opportunity just because of a disagreement about scheduling. If you are having problems with digestion, boundaries, concentration or obsessive thinking, now is a good time to come for an acupuncture treatment. Addictions are pretty much a combination of appetite and poor boundaries, so they would be usefully treated in this season. Furthermore, if you are dreading the coming Autumn and Winter ("I said I'm guilty!"), now is a good time to work on smoothing out the transition. Warm weather and plenty will leave and cold weather and need will take their place whether we want them to or not -- the Earth keeps on a-turning. We can, however, work on our responses to the realities, harsh and sweet, of life on this mortal coil.

Saturday, May 14, 2011

But enough about me

Okay, it's official. I got MRIs of my cervical and thoracic spine done and have ruptured discs in each section. I'd also bet money I've got one or more ruptured discs in my lumbar spine, but couldn't afford the additional scan.

Along these lines (affordability), I have to give a major thumbs-up to CP Advanced Imaging, 155 Canal St., New York, NY. They did my two MRIs (including report and copy on CD ROM) for 1/5 (one fifth) the price I was quoted by my local imaging services corporation. CP's facility and service were first-rate (including a manager who told me, correctly, "That was a bad decision" when I told her how I was injured), and a radiologist who read my scans and faxed me his report within 18 hours (on a Saturday morning, yet).

Anyway, I know more now than I did yesterday, and I know a lot more now than I did 10 months ago. Hopefully I will learn enough to get out of my mess and be able to help others get out of their messes.

Don't forget: CP Advanced Imaging, 155 Canal Street, New York City. Especially if you're an un-insured 50 year-old who makes bad decisions...

Thursday, May 5, 2011

Summertime -- the Fire element

The first day of summer on the Chinese calendar this year is May 5. Summer is associated with the fire element, and represents the obvious height of yang qi in the seasons -- wood starting to grow is the beginning of yang movement, but the burning of wood is the absolute pinnacle of yang qi. Fire is about as yang as nature gets -- hot, moving, insubstantial, but very real and very powerful.

The emotion associated with the fire element is joy -- its negative attribute is anxiety. The organs associated with the fire element are the heart and small intestine, and uniquely among the five elements it has two "accessory" organs, the pericardium and the triple heater. As usual, the yang organ, or bowel, is seen to have fewer and less profound energetic properties than the yin organ. The small intestine is said to separate the pure from the impure, both in terms of nutrients in the gut and discrimination between different possibilities. The heart completes the process of making blood (which is begun by the spleen), and in one of the most mystical mechanisms of basic Chinese physiology, that blood fuels the heart to pump the blood around the body -- sort of like a perpetual motion machine. The spirit associated with the heart is the Shen, which is concerned with your destiny, fate or karma. The heart is called the Emperor, and traditionally wasn't treated directly, because you don't tell the Emperor what to do. In addition, how can anyone else know what your karma is or how to treat it?

In modern Chinese medicine the heart is treated directly at times, but I share the classical deference toward other people's hearts. I am more likely to explain the concept and pass along my observations about their specific heart status (deficient qi or blood, stagnant blood or phlegm obstruction, or possibly not being on their true path in life) than to actually treat the heart. I am also more likely to send someone to their doctor (or the emergency room) for heart issues than for any other category of imbalance I detect. Several of my patients had no symptoms, but on my direction saw their doctors and needed immediate heart surgery. Those patients are pretty much the reason that I first came to believe that Chinese pulse reading is a valid diagnostic technique.

The color of the fire element is red, its flavor is bitter (scorched) and fire foods are especially pit fruits and lettuces. Lettuce grows in a loose but convoluted and ascending way, like flames, and pit fruits grow around an essential core or heart (and tend to be red). Ironically, these fire foods tend to be cooling energetically, as is the bitter flavor associated with the fire element. Too much joy is as dangerous as too much grief or fear in the Chinese way of thinking.

The days are long in the summer, and summertime is a good time to stay up late and seek joy. However, it's also a time to avoid too much heat, to rest in the heat of high noon and beware of burning out. Spiritual paths begin in the summer for eager young graduates striking out open-hearted on their own for the first time, but they also end for burned-out grandfathers and grandmothers, slumping over their lawnmowers and gardens, their hearts worn out.

Each season has its pleasures; each season has its dangers. Navigating each season as gracefully as possible is the challenge and the reward of life.

Wednesday, April 27, 2011

Pain, part 1

I didn't set out to become an expert in pain, but that's pretty much the way my life has gone. I think this is a fairly common thread among American acupuncturists -- the first two people I knew who became acupuncturists did so after breaking their necks in car crashes -- acupuncture was the only thing that helped them with their pain, so they followed through by becoming acupuncturists.

I've had chronic knee pain from soccer injuries since I was 13 years old. That's 37 years of chronic pain, and I thought I understood it pretty well. My knee pain led me to exercise therapy based on breath work and then to acupuncture. However, I've been having new experiences in the last decade which have blown my old ideas of pain out of the water.

First was the tectonic heave into fatherhood, which brought the simultaneous establishment of a huge increase in expectations of my ability to provide long-term protection, financial support and emotional stability with an ironically huge reduction in my invulnerability to emotional pain. This was efficiently followed by the emotional pain associated with losing my closest family members to death. Next was the disappointed exhaustion of losing 2 political races. And now, most recently, is mysterious, chronic, diffuse and severe physical pain. Bad pain all over, every day, with no clear origin. Pain which intensifies as I sleep, by the way, so that from 3:00 a.m. until waking most days I am tossing, turning and groaning. On one hand it catches me by surprise: "It really does happen!" The thing some of my patients have told me about over the years now has a first name as well as a last name. On another hand, it makes me kind of nervous: "Gee, what new kind of pain will I experience next?"

There's a whole other round of concern, as well. One problem with body/mind/spirit medicine is that it can seem like every health issue is the sufferer's fault: "Well, that's what happens when you don't process grief." This is where the sensitivity, maturity and humanity of the practitioner come into play. Yes, there is truth to "that's what happens when you don't process grief," but a humane, mature and sensitive person will understand that grief happens in life, sometimes unendurable grief. It is a cruel and unhelpful person who simply offers a generic observation, and it is a more useful one who tries to help you with your specific process. Even less helpful is the person who says "That's your karma." Maybe it is and maybe it isn't, but it certainly is useless, offensive and entirely presumptuous advice.

When you are in the middle of extended, severe pain, though, to some extent you do have a choice to make -- will you succumb to the pain and try everything in your power to retreat from it? Or will you try to learn from the pain and try everything in your power to work through it, even if you must do so over and over again, day after day? These are very personal questions and no one on the outside has any right to make any judgment or determination about the pain sufferer's answer. The answer may change, too, from day to day or week to week, and none has the right to judge those changes, either.

For now, my decision has been to try to understand my pain as well as I can, seek such assurance as I can that the pain doesn't herald some lethal condition, and seek the assistance of those whose opinions I value to help me with understanding the pain or (please God!) relieving it.

Pain, part 2

I was born to be a writer, and then there was some training involved. Daddy was an English professor and Mama was a newspaper editor. I always loved to read and write, but the thought of doing it for a job made me depressed, so I pursued dance, exercise therapy and acupuncture instead. I have to confess, I've always had a morbid fantasy that I will some day suffer an accident that leaves me physically disabled, leaving me no choice but to pursue writing. Little did I imagine that pain might be that disability.

I have been thinking of my pain as an internal bed of nails. Like the beds of nails used by fakirs, I hope that it will lead me to new understandings and new insight that I can use to help myself and my patients, but maybe I’m just a deluded masochist. I am willing to endure this pain fairly cheerfully in hopes of such an outcome, but at 4:00 a.m., when I roll over and am pierced for the third time by those internal nails, it's hard to be cheerful. I've only had this pain for 6 months -- in a year I may be begging for Oxycontin. You never know, and I hope I won't be judged for it, however things go.

There's this additional thing with chronic pain: it seems like the pain channels become burned in, as in “screen burn-in” on a monitor. It feels like our nervous systems, like LCD screens, undergo physical changes because of repeated and prolonged energetic transmissions across certain of our circuits. You don't become scarred by the internal bed of nails but rather get sores from it that are constantly inflamed and re-inflamed. In other words, we chronic pain sufferers may hyper-develop the physical channels associated with the pain response itself, ironically amplifying our sensitivity along those same damn channels.

Has anyone else noted that irony seems to be a by-product of pain?

So. Whaddaya do about pain?

Get ahead of it. This is a pretty standard idea with wide agreement among different practitioners. If you were my sister, I'd say, "Acupuncture, Advil, hot bath, massage, hypnotherapy -- whatever works. And try to stay ahead of it -- falling behind and getting back ahead is a lot more stressful than getting ahead and staying ahead." In addition to acupuncture, yoga and diet, I recently started using aspirin, myself. A temporary measure, but it helps me get by while I search out a more profound and permanent treatment.

Be open-minded. Hoo, boy, this is tough. Whatever direction your mind doesn't go? It may need to go there in dealing with your pain. Try to be patient.

Breathe. We could go into a LOT more detail about this, but if you can start a breath and finish a breath, the pain hasn't killed you yet. This is a starting place, and when all you can see is an undifferentiated sea of pain stretching in every direction, a starting place can be a kind of anchor.

Pain, part 3

A lot of eloquent, heartfelt and authoritative words have been written about pain, from every age and every culture on the planet. It takes real chutzpa to think I might be able to add anything to the extensive literature on pain. So let me start this section by telling a blond joke.

A blond went to his doctor and said, "Dr. G., you gotta help me! I've got pain all over my body! I don't know what's causing it and nothing makes it better! I can't sleep from the pain and from worrying about the pain! I'm at my wit's end! You gotta help me!"

Dr. G. knew his patient pretty well, and after sitting down and crossing his arms and legs he said, "Show me."

The blond lifted his trembling right hand to his forehead and touched it with his finger. Immediately, tears sprang to his eyes and he began to whimper. The doctor said, "Again." The blond repeated the same process, this time touching his left shoulder. Again the tears and whimpering, this time with a groan thrown in for good measure.

"One more time," said the doctor. The blond gingerly touched his knee with his finger and almost crumpled to the floor, weeping and gasping, his face white.

The doctor stood up, closed the blond's file and started out of the examination room. "It's very simple, Trey," he said as he walked out the door. "You broke your finger."

Funny but cruel, like most good humor. However, there's a lot of truth to the blond's predicament. We each have different tolerances for pain, as we have different tolerances for everything. When our tolerance is exceeded, things start to pour in and in the flood of sensation you can lose your bearings. I referred earlier to the "screen burn-in" phenomena of chronic pain, and when that pain is diffuse and of unknown origin, the "burn-in" can seem to permeate everything. Every perception becomes filtered through the burned-in lens of pain. Even if it IS only a broken finger, when all your perceptions come in through that avenue, as far as you can tell you have pain everywhere. And for a variety of reasons, it can be hard to develop new avenues of perception, especially when you are under siege by pain.

I have been clinically depressed before, and am familiar with its spiritual and psychological alienation, disorientation and isolation, but this physical pain response is something different. Although it is curious and provocative that anti-depressants are frequently prescribed for sufferers of chronic pain and seem to help somewhat... Still, clinical depression is associated with a lack or deficit (of connection, love, concern, energy, motivation), while the disorientation of chronic diffuse physical pain is due to an excess of sensation -- it's not just white noise, it's white noise amplified until you can't hear or see or feel anything else. Chronic physical pain tends to paralyze you, while depression makes you inert. In other words, chronic pain is an unbearably oppressive yang state, while depression is an unbearably passive yin state.

Yang, being active, has many faces and many personalities, while yin, being passive, is her own unmoving, cold-blooded self. Yin pain (depression) is itself, obviously and inevitably. Yang pain is every pain, and so is difficult to pin down. Do I have a Lyme flare, multiple spinal injuries or a combination of specific exacerbations to existing chronic injuries and dysfunctions? It feels like my right radial biceps tendon is ruptured, my left sacroiliac joint received a serious injury and my thoracic vertebra are all messed up. It also feels like I have polymyalgia rheumatica, or maybe fibromyalgia. My chronically painful knees haven't been anywhere close to right since last July. It feels like I have an aggressive crystalline blood stagnation borne of blood deficiency and exhaustion -- systemic gout, more or less. My hands hurt all the time, but especially in the morning -- I can hardly open jars, turn my car key or hold an acupuncture needle. All in the last 6 months. What I'm saying is: whatever it is, it's more pains than I can process. Maybe it's everything, or maybe it's four or five things and I can't tell the difference.

Fortunately, I am human. I can stop and consider my situation.

I can breathe.

I can get feedback from other people I trust.

Maybe I’ll learn something from my pain and maybe I won’t, but I'll deal with my pain and see you in the morning.

I mean, what else is a blond to do?

Pain, part 4

Hallelujah! I have relief from some of my pain! But more than that, I have had my first definitive, clear vision of the sources of my pain -- the curtain of oppressive yang sensation has been pulled aside so I can see what is bothering me, SO I KNOW WHAT TO DO!

The agent (or angel) of this revelation is my old friend Frania Zins, PT and Feldenkrais practitioner extraordinaire. I took a hellacious fall last summer while hurriedly building a rabbit hutch for my five-year old's birthday bunnies. I was lucky I didn't die, honestly, and the lesson is clear: no matter how big a hurry you're in, go get a ladder instead of standing on top of something dangerously inappropriate (a sliding board, in my case)! I knew I was badly hurt right away, and craved Frania's experienced, knowledgeable hands right away, too. But she's in New York, I'm in Central PA, I had a practice to run, kids to raise, an election to lose, yadda yadda yadda. Besides, I did what I could and my immediate pain went away after about 6 weeks. It wasn't for another month or so that I started awaking in pain. And I certainly had Lyme disease, gout and other real reasons to worry about some other, systemic origin for my comprehensive pain pattern.

Still, after starting to write about my situation (and after listening to my wife, Amy, in more and more exasperation tell me for five months to go get myself some help!), I made arrangements to meet Frania for a Feldenkrais/acupuncture swap. One of the things that is amazing about Frania is that her hands can make your body understand directly what is happening to it, and as soon as I felt them on my lumbar, thoracic and cervical spine, I knew, "Oh, damn. That's hurt bad." See, after the initial six weeks of lower back pain from landing on my left butt cheek, I never perceived my back as hurting -- I perceived the pain as starting at my hips and shoulders and radiating outward from there -- this was part of the incomplete, flawed perception that my sea of pain obscured. But it was clear from Frania's hands that, Lyme disease or no, I definitely had hurt my spine pretty badly in three different regions.

I would be lying if I said I leapt up off her table, right as rain, but I did get up slowly, with my hands and shoulders hurting a lot, knowing a lot more about my situation than I did when I laid down. Furthermore, Frania gave me one simple anatomical/kinesthetic concept to fool with, and one week later, while lying in bed on a Saturday morning, something big let loose in my deep right hip (piriformis, maybe?), a place where I had never had any particularly intense pain, and by the next day my legs and lower back worked again and were essentially pain-free. I mean, pain-free for an out-of-shape 50 year-old with chronic knee problems.

Now don't get me wrong -- I am not going to play soccer or perform ballet again, and the absence of that lower body pain brought my upper body pain into much sharper relief -- but I can get up out of a chair now and walk, I can roll over in bed, and I can clearly feel the pain in my neck and upper back that is tied to the pain in my shoulders and hands. I still awake at 3:00 a.m. most days in pain, but since it is only half of me that hurts, I can re-position myself more easily, or hell, get up and take some more aspirin if I need to. The thought of getting out of bed and walking to and from the bathroom is no longer the scary ordeal it was a few weeks ago. That's the most important thing -- my pain level is back within my thresholds, so I am no longer held in thrall by it.

Yes, Amy and everybody else, I am going back to see Frania again next weekend, and I am really looking forward to making some headway against my upper body pain. And if I had health insurance I probably would have gotten an orthopedic or neurological consult that would have revealed my ruptured discs or fractured vertebra 9 months ago. But I would have missed this opportunity to experience and understand a new, debilitating and terrifying pain, the sort of pain that so many of my patients endure.

By the way, I will probably follow through with getting a neurological examination, with MRI and all, but I would bet $100 that it will show ruptured discs in my lumbar and cervical spine, fracture or ligamentous damage in my thoracic spine and a fully torn supraspinatus muscle in my right shoulder. More damage accumulated in this animated carcass to go along with all the other injuries, illnesses and iatrogenic mishandling. I will probably have to be careful about lifting for the rest of my life, and my head- and handstand days are probably over. But that leaves a lot I can still do, and even if my neck, shoulder and hand pain don't get any better than they currently are, I am not paralyzed by pain as I was. Hallelujah!

Tuesday, April 26, 2011

Another analogy, for chronic health issues

What I have striven to do as an acupuncturist is to help people with chronic problems find the end of a piece of energetic string that they can follow out of their maze. Sometimes you pick up and drop many ends of string before you find one that leads somewhere. Sometimes the string leads you in a bad direction and you have to retreat. And sometimes it's just a big ball of knots and you have no choice but to sit there, picking and picking at the knots to try to get the line to run free.

For awhile now I have used the image of an old-fashioned fishing reel to describe the process of dealing with a chronic health issue. Some people talk about an onion, and describe how you have to peel away layers to get at what's underneath, but I find that a detestable metaphor -- onions are nothing BUT layers! The implication is that there is nothing to life BUT pathology, and when you get under the layers which are currently tormenting you there will be new layers beneath for you to peel. Ugh. I'd step in front of a truck if I believed that.

I prefer the fishing reel image because when it gets a backlash (a big tangle of knotted fishing line which keeps the reel from working correctly) you have no choice but to untangle the knot on the surface, then the next knot you come to, then the next knot until the line runs free. At that point you can reel in the line and resume fishing. Yes, it also works to just cut the whole mess of tangled line out of the reel and fish from there, but you can only do that a couple times before you run out of line entirely and have to quit fishing. "Fishing" standing in for "living" in this metaphor, I plainly think it is worthwhile to try the patient knot-picking approach for some time before resorting to surgery. It's also a good idea to work on your cast ("cast" being synonymous with "lifestyle"), but when you've got a big ol' backlash staring at you it's not the time to lecture about casting technique.

When there is an auto-immune, latent or hyper-sensitive component to the chronic health issue, I add to the backlash image a layer of glue (dampness, in Chinese pathological terms). The glue is made up of painkillers, steroids, antibiotics, alcohol, sugar, fat and other substances we use to comfort ourselves, but which are all suppressive, in Chinese energetic terms. The glue holds the knots in place, allowing you to reel up whatever line you have on top of the backlash and continue fishing, but your cast is greatly limited and you're going to be in big trouble if you catch a big one and need to let out some line. Furthermore, as you fish you are constantly losing a little line here and there, tying on lures and whatnot, and it's only a matter of time before you work your way down to the level of the original problem. When you finally get down to untangling the backlash, you will find that the glue has cemented the knots in place and has spread to deeper and more superficial layers of the line, expanding the boundaries of the original backlash in a very discouraging way.

I think this is a pretty good analogy, but now that I have spent 6 months considering chronic, diffuse pain from the inside, I would add another factor to the puzzle: it can happen that you don't know which way to turn the reel's handle. This means that until you find a productive end of line to pull on and then watch to see which way the handle turns in response, you don't know, literally, which way to turn. Your choice is to either thrash about in a panic, almost certainly making the knots worse, or to wait calmly until you get a clue, which can look like denial, indecision or self-destruction from the outside and which feels like paralysis from the inside.

This is where the assistance of an experienced, sensitive and trusted practitioner comes into play. Their distance provides some context for pointing out to you the way to turn. In this situation, the practitioner is not just helping you find an end of string -- he or she is throwing you a lifeline.

One of my drawbacks as a practitioner is perhaps too much deference to my patients. Some of it has to do with maintaining clear boundaries and avoiding fostering dependence, some has to do with avoiding making a reputation for myself as someone who just wants you to come back for another treatment, and some has to do with sincere philosophical belief -- who the hell am I to tell anyone else how to live? But some of my stand-off-ishness may have to do with a kind of cowardice -- the kind of cowardice that allowed me as a young man to enter into romantic liaisons with a disclaimer that I wouldn't commit to the relationship. It took me far too long to realize the shamefulness of that trick -- I pretty much had to be on the receiving end before I understood the dishonesty, cruelty and sophistry of such words. Although I started in a decent place, not wanting to manipulate anyone, I proceeded in a cowardly and dishonest fashion, denying involvement or entanglement in spite of the evidence provided by tangled limbs and complicated schedules.

Now, having been on the receiving end of a lifeline thrown by my honest, loving and brave friend Frania, I am beginning to realize an additional layer of responsibility and commitment I owe to my patients. No, I can't help everyone, and no, I don't want to have certain types of reputation, but I am more self-serving, less brave and less generous than I care to admit when I hold myself aloof. Having caught this lifeline and felt the relief, hope and restored confidence that had been so drowned by my sea of pain, I realize now how little my concerns about professional boundaries matter. I wouldn't have minded if my butt was bared in public, would have paid all the money I have and would have endured any kind of lecture (and believe me -- Frania can lecture!) in return for that lifeline.

It is a small but terrifying step to go from standing at a patient's side, helping them look for the end of a piece of string, to going out on a limb, looking them full in the face and giving it your best shot, throwing with all your heart in hopes that they will be able to catch hold and start to pull themselves out of their torrent of pain or dysfunction. It is a step that I will be taking from now on, and it is a huge part of what I have been able to learn from my ordeal.

If I intend to keep writing I'm going to have to find another disability to blame, or maybe scrap that whole morbid need for an excuse to write and simply write because I can. And because my writing may act as a lifeline for someone who reads it and needs it.

Tuesday, March 15, 2011

An Analogy for the Mechanism of Acupuncture

In the Spring of 2009 a patient asked me how I thought acupuncture worked in scientific terms. I’ve heard this question many times in ten years of practice and don’t have an answer, but told her I thought it had something to do with the undifferentiated nerve fibers that occur throughout the sub-dermal level of our bodies. These fibers were found in the 1990’s by scientists looking for something else, and are remarkable because they don't have a connection to the central nervous system. Those researchers thought that perhaps the fibers were involved in the pain response, but didn’t really know their purpose. I have always wondered if these undifferentiated nerve fibers might be associated with proprioception, but in any event I have reasoned that whatever else an acupuncture needle does, it penetrates this layer of nerve fibers when it is inserted into the body.

In casting about for a way to describe this that might make sense to my patient, a computer network specialist, I suddenly had an idea and said, “Maybe these undifferentiated nerve fibers work like a wireless computer network. Maybe what has been previously described as a mystical ‘aura’ or ‘subtle energy’ is actually like an internal wireless communication system between these fibers and the central nervous system.”

And I was pretty pleased with my metaphor.

However, my patient took it a step further the next day. She told me that in thinking about what I had said, it occurred to her that many wireless networks she had worked with periodically needed to be hard-wired to the server. After adding new hardware or software, you had to re-sync the wireless and the wired systems by briefly connecting them with a wire and re-booting. Maybe, she suggested, the acupuncture needle fulfills the role of the wire acting to re-sync the wireless system with the server.

Well, I have to give it to her. Exchanging physical, mental and spiritual trauma for the computer system’s hard and software trauma, I think this makes more sense than any other scientific explanation I have heard for describing the mechanism of acupuncture. The more I've tested it the more I have liked the analogy, but I have no idea how to turn it into a hypothesis capable of being tested. Still, it comes closer than other scientific ideas I have heard for describing at least part of the range of mechanisms I have witnessed in ten years of practicing and 20 years of receiving acupuncture.

Tuesday, March 8, 2011

The Pulse

Feeling the pulse is the strangest part of what I do. Utterly subjective impressions of 27 possible qualities at 12 more or less specific points on the radial artery are one of the primary sources of diagnostic information. As a student, of course, you're terrified you won't ever be able to feel it, and I could only feel thump-thump-thump for about a year. Finally one night I could feel qualities in the pulse. My wife and I had gotten into bed and turned out the lights before I remembered that I needed to feel a 12th pulse for the next day's homework assignment. I reached out under the covers and held her wrist. I was relaxed and she was at a point in her menstrual cycle when her pulse was more active than usual. Clear as day there in the dark, her heart pulse was thin! Liver was soft, Kidney was..soft, too!

That was a cool moment, but come on. Really. How can you justify making diagnoses of mental, physical or spiritual illness by feeling the pulse on each wrist at three points on the radial artery?

I can't. And so once I could feel it I kind of ignored it. I'd feel the pulse and write a note, but I gave it very little attention in diagnosing the people I was treating. But after a couple of years I noticed that people with healthy heart pulses did okay. That is, I worked with a number of people who had real physical issues and very weak pulses at all of the other pulse positions, but were robust at the heart position. All such people tended to have fairly positive outcomes. On the other hand, I noticed some people had all decent pulses except for a weak heart pulse and they tended to not do as well as expected. The shen is called the Emperor or Empress, and is the spirit associated with the heart. The shen has to do with your fate, destiny or karma. Knowing you are on the right track, whatever it looks like on the outside and however it affects others, is a sign of heart health. Knowing you are on the right track, even if you have significant health issues, seems to give you better health. And being unsure of your path, even in the absence of physical or mental issues, seems to have a depressing impact on your health.

After proving to my satisfaction that there was this correlation between the heart pulse and the status of my patient's spirit, I started to pay more attention to all the pulses and to see how the qualities I felt did or did not help with accurately diagnosing conditions. By this point, ten years along, I feel pretty confident that what I feel at my patients' radial arteries is real and really does indicate something pretty much like what the Chinese tell us it does.

However, I still have no idea why.

Friday, March 4, 2011

The Gout

One of the challenges of being an American acupuncturist is that some conditions have uniquely modern characteristics -- for instance, exposure to exotic environmental toxins. However, toxins are toxins, and Chinese medicine has many approaches available for dealing with different sorts of toxic conditions. You may have to adjust techniques as new toxins show up, but the underlying principles are spelled out in the Chinese classics of medicine.

A greater challenge may lie in dealing with conditions that especially affect individuals from certain geographic or ethnic populations. Sickle cell anemia and thalassemia spring to mind as conditions that are known to disproportionately affect certain populations, but other conditions also seem to affect specific populations. Multiple sclerosis, for instance, seems to be strongly associated with people of western European descent, especially those who live in northern latitudes.

And then there's The Gout. In central Pennsylvania there's lots of gout -- it is usually capitalized and is always preceded by the honorific, The. The Gout traditionally had an almost comic association, because it was typically overweight, red-faced, self-indulgent people who got it, and when they were suffering an attack, their suffering was operatic. Nowadays there seems to be a new class of gout sufferer, though -- although uric acid levels may be high, they aren't necessarily high enough to meet the threshold for classic gout. Maybe we are more sensitive, or maybe some genetic change has occurred, but none of the gout sufferers I have known are particularly red-faced or overweight, although indulgence in gout-triggering food and drink must be confessed.

As far as I can tell, though, gout doesn't really exist in Asia. This may be because the foods which are said to be the irritating factor in gout -- beer, wine, chocolate, coffee, smoked meats and organ meats, as well as foods rich in purines (beans, oily fish, nightshades) -- aren't as widely consumed in the East as they are in the West. Or it may have something to do with differences in genetic make-up. The Gout is said to have a pretty strong hereditary component, and if there is limited intermarriage between geographically separated groups, it's easy to see how different groups might inherit different conditions. As we move around and intermarry more these "ethnic" conditions will become more universal, but for now, gout hardly seems to exist in the East and there is practically nothing in the Chinese medical literature about how to treat it. Since it is a very painful and somewhat mysterious condition, it is something that an American acupuncturist can expect to see in his or her patients.

I certainly saw quite a few gout sufferers in my early years of practice, and it was pretty clear that I wasn't able to do a damn thing for them and their gout. Believe me, all healthcare practitioners keep internal score of what they are pretty effective at dealing with and what they are not very effective at dealing with. They don't usually advertise their score, but they know what it is. And I knew that I was getting my butt kicked by The Gout.

Then I got it. Both my brothers had it, and being native Texans, beans, beer and barbeque were like mother's milk to us. Although, by the luck of the draw, it was a coffee binge that put me over the top and brought on my first bout of The Gout. There was no mistaking it -- it was like the comic book version of The Gout, or The Gout for Dummies. I awoke out of a dead sleep at 1:30 in the morning in a feverish sweat, my right big toe joint (bunion) consumed with a throbbing, hammering and unbearable pain. I don't remember how I got through that first night, but by daylight I had begun to try to think of a way to treat myself with acupuncture. And really, feeling such an intense, specific pain, it was pretty clear what had to be done.

Throbbing, fixed and intense pain is, in Chinese terms, blood stagnation. The easiest, most direct way to move stagnant blood is by bleeding. So I had to get a thick needle and stab myself right in one of the most exquisite pains I had ever felt until I drew a few drops of blood. From a remove it sounds pretty bad, but as any sufferer of The Gout will tell you, at the height of an attack you are ready to use coyote medicine -- that is, if we were more flexible and had sharper teeth, a fair number of us would just chew the toe off and be done with it. I had the flexibility but not the teeth, and I also wanted to come up with a modality that I could use on my patients. So I got a short, stiff needle, screwed up my nerve and went: stab,stab,stab,stab,stab,stab,stab!!!

Boy, did it hurt. But also, almost immediately after a few drops of very dark blood (confirming the stagnant blood diagnosis) appeared, I felt the fever break and the throbbing begin to ebb away. It took several days for the attack to resolve -- my toe remained tender for weeks after that first attack, and I remain vulnerable to subsequent attacks (I've had three or four in four years). I have become skittish about the offending food and liquor groups, but see it more as a difficult balancing act than as a lifelong responsibility to deny myself some of the things that, for me, define pleasure. Those TV commercials for The Gout medicine that show a shlub carrying a beaker of green fluid are very evocative for me, but more as a metaphor for keeping your balance (and grace) while carrying around a fragile and unsightly burden than as a metaphor for the need to adjust your chemistry.

Which brings us to a big difference between the way that western and eastern medicine understand, and treat, The Gout. Western allopathic medicine describes gout as a build up of uric acid in the blood which precipitates into the joints, especially the proximal big toe joint, via an incompletely understood pathway. Uric acid is typically excreted in the urine, and so gout is associated with the kidneys and bladder. However, in Chinese terms the meridian which is almost always affected, at the medial side of the big toe, is the spleen meridian. How can one reconcile the western, scientific explanation of a uric acid condition with the Chinese concept of the spleen meridian?

Although there is not perfect translation of even basic physiological functions between western and eastern understandings of the internal organs, it is widely assumed that the Chinese concept of the spleen primarily encompasses the functions of the western pancreas. The Chinese spleen, like the western pancreas, is the primary organ of digestion, but unlike the pancreas, the spleen also has a primary role to play in the formation of blood. Furthermore, as one of the organs associated with the earth element, the spleen is said to be involved with boundaries. The spleen is also said to dislike dampness.

Working backwards: relief being provided by bleeding at the spleen meridian (spleen 1 - 4 area) indicates blood stagnation associated with the spleen; the spleen is responsible for beginning the process of making blood, dislikes dampness and is associated with boundaries; over-indulgence in damp or yin-intensive foods (beer, wine, beans, shellfish, organ meat) contribute to gout. So what western medicine describes as uric acid crystals which are formed through some dysfunction of the kidneys and/or bladder, Chinese medicine would describe as a damp blood accumulation associated with a weak or over-taxed spleen. Among other things, this provides some possible explanation for a long-known but little-understood fact about The Gout -- cherries and cherry juice seem to be helpful for preventing gout flare-ups. In Chinese medicine, pit fruits (especially cherries), growing in the Summer, the fire element season, and being red, the fire element color, are especially good for the function of the heart, the internal organ associated with the fire element. I previously said that the spleen initiates the process of creating blood, but the second stage, which finalizes the process, occurs in the heart. Furthermore, under certain circumstances the heart has the ability to vaporize phlegm, a particularly sticky and dense form of dampness. Perhaps cherry juice increases the heart's ability to vaporize phlegm before it stagnates in the blood. By the way, the heart meridian flows from the armpit to the little finger. Sometimes if gout is not resolved at the big toe, it next affects the little finger, lateral wrist and sometimes the elbow.

So both western and eastern medicine see The Gout as an accumulation. Western medicine looks at the internal, chemical processes, comes up with an explanation for gout's mechanism and creates chemicals to counteract that mechanism. Even though it is my western eyes looking through an eastern lens, Chinese concepts lead to an observation of the typical external sites and character of the pain, ties those observations to phenomena observed to be associated with the condition (purines bad; cherries good) and comes up with a different explanation and a different approach to treatment. Both treatment approaches (allopurinal and colchicine in the West; bleeding the site of the pain in the East) are effective.

How to make sense of both?

Wednesday, March 2, 2011


One of the things that I appreciate more and more about Chinese medicine is the wisdom of its observations of the seasons. Especially the season we are currently in, Spring. On the Chinese lunar calendar, Spring began this year on February 3rd, even though the vernal equinox isn't until March 20. The beginning of Spring varies each year on the Chinese calendar, but it is always earlier than solar Spring, some time in early February or even late January.

Why do I think this is wise? Well, Spring is associated with the wood element, and a tree can either be an inspiring and graceful example of life's resilience, beauty and tenacity or it can be a big damn nuisance if it's growing through your sidewalk. The emotion associated with Spring is anger/impatience/frustration, but it has a positive aspect too -- drive/focus/determination. All seasons on the Chinese calendar and their associated elements have this duality, but it is particularly easy to see in the Spring. Almost every year, there is a spell of "unseasonably mild" weather sometime in late January or early February. When it is over and cold weather returns, people are suddenly fed up with Winter. They get crabby and bent out of shape, and call it cabin fever. The organ associated with Spring is the liver, whose nickname is "the free and easy wanderer." The liver tends to get clogged up with the over-eating (and drinking) and reduced physical activity of the Winter season. The combination of this physical clogging with cabin fever psychology leads inexorably, year after year, to people feeling angry, impatient and frustrated sometime around now. If you're lucky, or know what to expect, you'll bend this potentially destructive energy to a project of some kind which requires a little drive, focus and determination. This time of year is especially well-suited to cleaning up your act and getting a fresh start, whether that involves going on a fast or cleaning and re-organizing your home, office or shop.

The other thing I appreciate about Spring starting in early February is that usually in this part of the world (central Pennsylvania), the first day of spring is the first day that the tips of the daffodils and other early Spring flowers first poke through the earth. It will be weeks or months before they bloom, but even if snow covers the ground, underneath the snow there are these stirrings of new life. And trees, even though they will be without leaves for a couple more months, have begun sending sap from their roots up toward the canopy. Making syrup is a great springtime activity -- it gets you out of the house, gets your sap flowing, and requires a little drive, focus and determination to see it though, from dozens of gallons of watery sap to a gallon or two of sweet syrup.

Sprouts and things that grow upward, like asparagus, are especially good to eat in this season, and springtime eating rituals (dandelions, maple syrup and shad around here) persist long after we have access to almost any food at any time from the local supermarket. The ancestral memory persists of creeping out when there's still snow on the ground to find something, ANYTHING, green to eat, or fresh meat after a long weary winter of eating dried, salted, preserved or buried food. Or starving.

Even in our modern, sealed-off world we still are connected to the earth, which starts awakening right around the time ancient Chinese observations say it does.

The color associated with the wood element is green, of course, and I chose the bamboo photograph in the background of this blog to indicate the season. The photo will change at each season. The next season, Summer, is due to start on May 5th this year.



I have just seen that "the official quarterly professional publication of the American Association of Acupuncture and Oriental Medicine (AAAOM)" is called The American Acupuncturist.

The AAAOM is a fine organization that I have belonged to and support, but I want to make clear that my blog has absolutely no connection to the AAAOM or any of its publications.

Thank you.

Welcome to An American Acupuncturist


Trey Casimir L.Ac. here. I was born in Texas, raised in Pennsylvania and received my acupuncture training in New York City. I have been licensed for 10 years and have been in private practice for that entire time. I have spoken and written about acupuncture and Chinese medicine many times in the last ten years, but have been seeking a broader audience and an expanded format. Therefore this blog.

I intend to write posts on basic concepts of Chinese medicine, to describe interesting case histories and to respond to questions you may have, about either general or specific topics. Most of all, I hope to begin a dialogue with patients, other acupuncturists and other healthcare practitioners about what it means to be a modern, science-loving practitioner of an ancient, decidedly non-scientific form of healing. How are Chinese medical principles universal, and how are they rooted in a particular time and place that may not always be easy to translate to other times and other places?

I have had many excellent teachers over the past 30 years and would like to acknowledge them, both to pay my respects and to give you some idea of my background and training. I have to start with my friend Elisa King. Although she is a dancer, dance teacher and choreographer rather than a healer, her influence started me trusting non-literal, non-linear reality. She also browbeat me into going to White Cloud Studio, which is where my training as a healer began in earnest. Juliu Horvath and Hilary Cartwright were the co-owners of the studio, and each of them taught me priceless lessons about yoga, healing and life. I was extremely lucky to get into the Swedish Institute's short-lived Acupuncture program as a member of their second class. The academic dean at the time was Sheila George, M.D., L.Ac., but the program's main teacher and driving force was Jeffrey Yuen. Jeffrey is known in the Chinese medical community as a once in a lifetime teacher with an encyclopedic knowledge of classical Chinese medical schools of thought, and I was extremely fortunate to be able to study with him. My other teachers were no slouches, either, and I would especially like to mention Francesca Biryukov, Edith Lee, Urayoana Trinidad, Sheila Mason and John Katomski as people whose words still ring in my ears. Finally, although she wasn't one of my formal teachers, Frania Zins, P.T. and Feldenkrais practitioner, taught me a tremendous amount during the 7 years I worked for and with her. I am humbled and grateful to say that several of these amazing people continue to advise, inform and enlighten me to this day.

My next two posts will be out in the next few days. The first will deal with a basic concept of Chinese medicine -- the seasons, specifically the current season, Spring. The second post will deal with a case history (my own) that illustrates an example of translating universal Chinese principles in order to treat a condition of a different culture (and possibly a different gene pool).

Thank you for your interest!

Please send me some questions!

Take good care!