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 blogspot.com 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.

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
http://www.chinesefortunecalendar.com/FarmerCal.htm, 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.

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...

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.

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?