Author: Rowan Everard

Lost in the woods: Chinese medicine, depression, and the liver

chinese medicine depression portland

I’ve briefly discussed depression in past articles, specifically that depression that can arise from a closed heart wherein a person loses the ability to feel joy. Today I want to turn to a more common kind of depression: stagnation of liver qi.

In Chinese medicine, as in western medicine, the liver has an extraordinary number of functions.

Paramount among these is the smooth circulation qi and blood in the entire body, in a cyclical and rhythmic way. The liver also “stores” the blood, which is a function closely linked with hormonal cycles in both women and men, and with the circulation of blood in the lower abdomen.

Emotionally, when we are in balance our liver helps us to strategize and plan our way around obstacles.

The liver is deeply connected to the sympathetic or “fight or flight” nervous system, and it takes charge when we need a dose of healthy fear or anger to get ourselves out of dangerous situations. Our ability to manifest healthy anger, to set boundaries or reestablish them when they are violated, is a liver function.

As with anything tasked with so many jobs, the liver tends to be the bottleneck in our bodies where things get stuck.

Liver issues are the most common presentation in any Chinese medicine clinic. Because the liver is managing the flow of qi and blood in the entire body, any problem with either substances anywhere will cause extra stress on it. This is true for physical illness and injury, but more often applies to any kind of emotional stress.

If your life is putting you in positions where you feel frustrated, anxious or unsafe in a chronic way, this will eventually wear down the liver organ and channel’s ability to smooth things out. When the liver gets overwhelmed, quite a wide variety of symptoms can manifest.

The liver channel begins on the foot and runs up the inner leg, over the belly and then winds around the ribs before diving into the chest. When qi and blood stop moving smoothly, or stagnate, people will often experience a painful stuck sensation in the ribs. This is often diagnosed as costochondritis, or inflammation of the rib junctions. The rib junctions are indeed inflamed, because they are no longer receiving what they need from the channel that runs through them.

In general the liver supplies all of the tendons and sinews in the body with blood, so stiffness and pain around the joints often occurs with liver pathology. Cold hands and feet, even to the point of turning white or black, can be a symptoms of liver channel problems if the organ is unable to send the blood all the way out to the ends of the limbs. Cramping in the intestines is also common, because the rhythmic flow of the healthy liver keeps GI tract in time.

In terms of a person’s inner world, the liver’s function of healthy anger can turn inward to create frustration and even rage that is self-directed.

This kind of reversed anger congeals, over time, into a toxic and volatile kind of depression. People stuck in the wilderness of liver pathology often lose the ability to see their way out of the situation that are causing them pain, because the liver’s ability to persevere and plan an escape has been impaired. They are often morose and argumentative; the kind of depressed person who will argue with anyone who tries to cheer them up, almost as if they don’t want to stop feeling sad.

It must be said here that Chinese medical pathology in the liver does not always correlate with frank biomedical liver disease.

Chaihu 柴胡 Bupleurum chinensis plant – the main ingredient in Xiao chaihu tang

Liver qi stagnation is the beginning of a long process of possible decline, during which the biomedical liver might become subtly less efficient in its function. If left unchecked for years, this can manifest in the physical body as frank liver disease, but our aim is to treat it before things progress that far.

In Chinese medicine, most treatments are fairly straightforward in their logic. If something is blocked, unblock it. If it’s empty, fill it with something. For the liver, if it has become stagnant, we get it moving again and smooth it out. One easy way to accomplish this goal is to needle the liver channel, and channels connected to it. As the flow of qi is corrected, mostly people feel significant relief from their symptoms.

Another strategy for smoothing the liver qi is to prescribe herbal remedies that balance the liver with other organs, a technique we call “harmonizing” the liver. One common Chinese herbal formula that accomplishes this goal is Xiao chaihu tang 小柴胡湯, which unblocks the flow of qi in the Liver while simultaneously building the qi of the Earth organs, Spleen and Stomach.

Liver issues can range from mild and transient to chronic and longterm.

A traffic jam will cause mild to moderate liver qi stagnation in everyone. An emotionally abusive boss can cause severe liver qi stagnation that can lead to pelvic pain, menstrual irregularity and chronic depression. Whatever the presentation, the good news is that healing is always possible.

This article is not intended to help you diagnose yourself or your friends, but simply to shed light on how Chinese medicine understands and treats emotional distress. Your particular depression or rib pain may or may not fit this Chinese medical pattern, which is why finding a qualified practitioner who can diagnose and treat your condition is important. If you’ve enjoyed my articles, why not get on my schedule to get yourself on a path to healthier Liver qi!

Treating closure of the Heart – Herbal formula Zhishi xiebai guizhi tang

In the previous two installments of this series we discussed the emotional and physical consequences of not having enough yin or yang in the heart and surrounding organs, particularly with reference to important Chinese medicine concepts and Chinese herbal formulas. You can read the first article here, and the second one here.

Today we’ll take a look at a slightly different cause of anxiety and depression: what happens when the heart is energetically closed.

A healthy heart is permeable. It opens to give and receive love and connection, and closes to protect itself from harm. This is mostly an energetic and psychological process, but the physical heart’s pumping mirrors it. The heart must beat even, pumping blood in and out in a rhythmic and equal way, in order to move blood to every part of the body.

When our hearts are healthy we able to reach for what nourishes us, and shrink away from that which does not serve our highest good. Life is full of both kinds of experiences, and if we are agile and responsive then our movement is similarly rhythmic; bringing close and letting go.

A wounded heart, however, can slip too far into either extreme.

heart opening depression chinese medicineIf too much injury is sustained, either in the moment or over time, the heart can lose its ability to open and reach out. It can forget how to receive care or how to feel tenderness. When this pattern becomes deeply entrenched, it can develop into a specific diagnosis that we call “heart closed”.

A closed energetic heart does have symptoms, both emotionally and physically. The up side of closing off one’s heart is that the risk of pain from loss is reduced. But pain of separation cannot be mended with anything other than connection, and this pain can become an overwhelming depressive state called anhedonic depression, or the inability to feel joy.

Transient moments of happiness may be possible, but transcendent joy remains out of reach. Anxiety can also result from this pattern, particularly the sort of low-level “I’m not sure what is wrong” anxiety, and this is usually also the result of lack of connection.

Such a person will often struggles to form or maintain close relationships, and will spend time alone reflexively.

The physical symptoms of such a situation are mostly local. People often experience tightness in the chest, a feeling that they cannot fully expand the chest, and even a visible sunken-ness over the heart. This is not generally frank chest pain per se, but certainly chest discomfort. This occurs because the heart is not fully able to circulate qi and blood to the surrounding organs and tissues.

This condition is not bad enough to cause overt disease, at least not in the short term, but it does cause the effected organs to perform below their full potential. The area above the heart is often tender to palpation in such cases.

The treatment for such cases is, as you may imagine, to open the heart. With acupuncture we would needle over the chest, and in the channels that pass through the chest, to do this and also nourish and move blood of the chest.

The herbal formula we might prescribe to this sort of patient is called Zhishi Xiebai Guizhi Tang (pronounced jir shir shea bi guay jir taang), or unripe bitter orange, Chinese chive and cinnamon twig formula. This formula contains several aromatic herbs that open the “orifices” of the body, meaning the sense organs, and thereby restore consciousness. It also has a great deal of cinnamon, which restores heart function and moves blood.

The transformation that can arise from this treatment is profound.

People find that they are able to connect with their inner feelings, and thereby connect to other people, in ways that they had almost forgotten were possible. Their depression improves dramatically, and they often feel like they are turning a corner in their lives. Also, their chest tightness goes away! Bonus!

This is a pattern that responds readily to correct treatment, but does not generally resolve on its own. It is obviously also very helpful to combine treatment with Chinese medicine with other therapies from qualified mental health professionals. If you resonated with this article, and want to see how Chinese medicine might help you in your quest to find balance – feel free to get on my schedule!

This article is not intended to help you diagnose yourself or your friends, but simply to shed light on how Chinese medicine understands and treats emotional distress. Your particular depression or chest tightness may or may not fit this Chinese medical pattern, which is why finding a qualified practitioner who can diagnose and treat your condition is important.

Guizhi jia gui tang : Terror and the Heart in Chinese medicine

Last week we discussed how chronic anxiety can deplete the yin of the organs in the chest (heart, pericardium, lung) and cause various heat symptoms. In this article we’ll explore the opposite phenomenon: how terror can deplete the yang of the heart.

Yang is the motive force in the body. Yang is the force of warmth, growth, expansion and speed. The yang of the heart is what propels its contraction, keeps its rhythm stable, and helps it to adjust in real time to the changing circumstances of our movement and our emotions. The heart also contains a part of our souls, the part reflected in the eyes that we call Shen in Chinese medicine.

A healthy heart is a warm and open place, free of clutter or debris.

Terror, however, can injure the yang of the heart. While chronic anxiety is a hot process that occurs over time, fright is a cold process that is sudden and intense. Terror is said to “scatter the qi”, causing the person to have an out-of-body-experience, which can involve seeing the incident from above or from another vantage point and to feel numb.

In Chinese medicine, the animal representing Heart is Horse

A car accident, an assault of some kind, or even very bad news can cause terror, and this cold insult to the heart is very physiologically intense. In people who are otherwise robust and healthy, the shock will dissipate and the heart will heal itself in time.

However, in the very young, the very old, or people who are already compromised by illness or stress, the injury to the yang of the heart can become its own lasting problem.

What might the symptoms of this picture be like? Chinese medicine is often very literal. Yang is hot, and therefore an injury to yang causes cold. People who have a heart yang deficiency will often experience a feeling of cold in or around their heart. This can be the very strange sensation of having transient heart palpitations that feel cold, or having the chest directly over the heart be cold to the teach.

The feeling of cold can often radiate behind the heart and into the back, between the shoulder blades. Sleep issues are common, as with all anxiety patterns. The predominant feeling that such a person will have is intense fear. This is both the terror left over from the original event and also a more existential fear: the fear of imminent death. We can survive without many of our organs, but our hearts must be functioning in order for us to remain living.

Therefore, when the heart in injured, our bodies send the strongest possible signals that something is very wrong.

A heart yang injury does not necessarily mean that someone will die immediately. Left untreated, though, it can lead to more physical symptoms as time goes on. The yang of the heart maintains rhythm and contraction, and issues with it can lead to deterioration of those functions.

Frank heart attacks can occur, heart rhythm problems beyond occasional palpitations can arise, and other organs like the lungs can become drained as they lend their qi to assist the heart. This can lead to tendency towards bronchitis or pneumonia, and even in very dire cases to chronic obstructive pulmonary disease (COPD).

Luckily, none of these down-stream illnesses need to happen.

Injuries to the yang of the heart can be readily treated with herbal medicine and acupuncture. The first herbal formula we would consider in this kind of case would be Guizhi Jia Gui tang, or cinnamon combination plus extra cinnamon. This formula is the same as Guizhi Tang (cinnamon combination), a famous cold and flu formula, but the amount of cinnamon is doubled, changing the focus to the heart.

Cinnamon is a blood tonic, heart yang tonic, and mild blood mover, among other things.

Guizhi / 桂枝 / Cinnamon twig

It is an excellent herb for many kinds of heart conditions, and when combined with peony, ginger, dates and licorice, this formula helps improve digestive function so that the body can produce more blood to send to the heart, and to warm the heart. While the patient takes this formula, we would also apply acupuncture to points that drive out cold, warm the heart, and open the chest. Because this is usually an acute pattern, these kinds of symptoms tend to resolve fairly quickly once treatment begins.

This article is not intended to help you diagnose yourself or your friends, but simply to shed light on how Chinese medicine understands and treats emotional distress. Your particular fear or heart palpitations may or may not fit this Chinese medical pattern, which is why finding a qualified practitioner who can diagnose and treat your condition is important.

If these ideas resonate and you would like to see how Chinese medicine treatment could help you with your symptoms of anxiety – press the orange button below this article to be taken to the convenient online scheduler.

I look forward to learning more about you & helping you find greater balance – and less discomfort – in your life.

Sheng Mai San: Chinese Medicine and Chronic Anxiety

If you have ever suffered from anxiety, you know that your anxiety is not the same as other peoples’.

There are many common experiences that folks with anxiety have, such as feelings of worry and fear, and possibly increased heart rate. However, there are also real differences in people’s manifestations of anxiety. Some people get palpitations while others get sweaty palms or nausea. In Chinese medicine we acknowledge many types of anxiety, each with their own particular causes and treatments. In this short article I will describe one of these specific anxiety types: chest yin deficiency.

Yin deficiency is a Chinese medical diagnosis that describes a tissue state and an energetic state.

Every part of our body has an ideal temperature and moisture level, and our body’s ability to self-chinese medicine yin deficiency anxiety dry cracked earthregulate relies on having enough warming, cooling, moistening and drying energies available. Over time, however, stressful life events and/or illness can deplete these energies. Yin is a term that describes all of the energies and substances in the body that are cooling and moistening. Tears are yin, mucus membranes are yin, and many aspects of the blood are yin. If we endure a hot process of some kind, say a fever, the yin substances in our body are taxed and eventually damaged in the fever goes on for too long.

Anxiety is generally a hot process, which depletes Yin over time.

It can be caused by a single event that leaves a lasting imprint on someone, like a car accident, or by an ongoing situation such as a stressful job. Anxiety can effect different organs, depending on the person’s constitution and their health status. When it effects all of the organs in the chest (the heart, pericardium and lungs) and burns up their yin, then chest yin deficiency in the result.

What might this look like for an actual person? Oftentimes people with this pattern have heart palpitations that came and go with stress, their chest often feels hot subjectively, they have a dry cough and/or sore throat that are mild but lingering, and they have intense anxiety that they feel emanating from their chest. They also generally will experience sleep issues, such as inability to fall asleep and/or frequent waking. This state can be temporary and resolve on its own over time, but it can also become chronic and require direct treatment.

One useful way to think about diagnostic patterns in Chinese medicine is to use herbal formulas as representations.

This enables practitioners to talk about complex presentations in short-hand, rather than describing all of the patient’s symptoms or diagnoses individually. The formula that represents chest Yin deficiency is called Sheng Mai San (pronounced Shung My Sahn). This herbal formula contains Ginseng, Ophiopogon Tuber (a relative of Asparagus), and Schisandra berry. The name Sheng Mai San translates roughly as “generate the pulse powder”, so named because people with chest yin deficiency tends to have rapid but weak or thin pulses. Sheng Mai San moistens and nourishes the Yin and blood of the chest organs, helping to calm anxiety and relieve the other various symptoms described above.

chinese herbs anxiety yin deficiency
(Not Shengmai san :))

Herbal treatment is almost always paired with acupuncture in Chinese medicine.

We can stimulate the channels of the associated organs (in this case the Lung, heart and pericardium channels) to clear heat, nourish Yin and blood, and settle the mind. The length of treatment depends on how long the person has been experiencing symptoms, but generally within a few months most symptoms will completely resolve.

This article is not intended to help you diagnose yourself or your friends, but simply to shed light on how Chinese medicine understands and treats emotional distress. Your particular anxiety may or may not fit this Chinese medical pattern, which is why finding a qualified practitioner who can diagnose and treat your condition is important.

If these ideas resonate and you would like to see how Chinese medicine treatment could help you with your symptoms of anxiety – press the orange button below this article to be taken to the convenient online scheduler. I look forward to learning more about you & helping you find greater balance – and less discomfort – in your life.

Healing trauma, community cohesion, and Chinese medicine

watershed wellness rowan everard lgbt health community trans

Modern research on the effects of systemic violence tells us that people who are exposed to many emotionally difficult/traumatic experiences tend to develop a predictable set of health problems. These can range from increased risk of heart disease and diabetes to chronic pain, anxiety, depression and even schizophrenia. In the never-ending debate about nature vs nurture, it is becoming increasingly clear that people’s life experience has a strong impact on their health.

This is important on an individual level, of course

If you are a person who is suffering from post-traumatic stress disorder and your daily life requires you to navigate highly stressful interactions due to racism or sexism, your path toward recovery from PTSD is going to be more challenging than it otherwise would. Collectively, though, it is easy to see how this dynamic would create barriers in a community’s ability to advocate for itself effectively and improve its circumstances.

Organizing anything in a community, whether a bingo night or a get-out-the-vote effort, requires a high tolerance for stress and interpersonal conflict. This reality can become a damaging cycle for earnest activists who want to bring people together, but find that their health suffers whenever they reach into the forge to create something. People burn out and get sick, others step into the fire, and then the same thing occurs.

This cycle itself becomes a barrier to collective liberation, as people’s individual symptoms become a block toward creating and maintaining community cohesion.

If you are unable to leave your house then you can’t show up for other people as easily. If you are always having to self-medicate to get through the day then the difficult work of conflict resolution becomes even harder. People fall through the cracks, lose touch with their friends and families, and their brilliance and light become inwardly-focused out of necessity. There is no need to victim-blame here, as everyone’s decisions make personal sense, but collectively the presence of containers where people can enjoy and rely on one another can become quite challenging to maintain under such conditions.

Watching this dynamic play out, both in my life and in the lives of those around me, is part of what lead me to choose a career in Chinese medicine. I began my journey as a patient seeking help for my asthma, which improved dramatically, but I stayed for help with my anxiety and depression. As I walked the path of treatment I noticed my tolerance for difficult situations, and my ability to re-center myself after volatile emotional experiences, growing. I became more effective, as well as happier and more balanced.

It occurred to me that this medicine could be incredibly helpful for my queer and trans community, where people often struggle to access any kind of care, much less affirming medicine that improves their lives in the measurable ways that I had seen my own improve.

A medicine that is tailored to every individual, and which can treat myriad emotional and physical problems without drugs, can be an incredible asset to people who have historically been all but barred from recieving medical care. Moreover, I believe strongly that individual health translates to collective health in a ways that mirrors the process of illness and burnout described above. As we heal ourselves we are more able to see another, hold complexity, and stay in connection with people even under stressful circumstances.

We become conduits for work that needs doing, both internally and externally.

One of my favorite teachers at NUNM often says “illness is oppression”. This seemingly-simple statement encapsulates everything that it took me three paragraphs to say so far in this article. It is a profound way to understand the connection between personal health and collective wellbeing. The corollary to this is that healing is liberation. This, in essence, is my treatment philosophy, and what I am excited to share with every patient I have the privilege of working with.