Author: Rowan Everard

Hormonal transition and Chinese medicine

 

This week I want to turn to a topic that is rarely discussed in any medical forum, eastern or western: hormonal transition. Hormonal transition can really refer to several experiences: puberty, menopause, andropause, and health-related hormonal shifts are all normal processes that bodies go through. Puberty for transgender people is also normal; it just happens to be medically-assisted.

There are many myths and misunderstandings about this process, and Chinese medicine can help us to see our way through them and towards a more comprehensive view.

Before we dive in, a general disclaimer: hormonal transition is a process that some, but not all, transgender people go through. Efforts to withhold access to hormonal transition over the last hundred-ish years have created very bizarre gate-keeping systems around who can access this kind of care, and although this is changing there continue to be people in the world who want to hormonally transition but have not yet been able to. Being on hormones does not make someone “more” trans or more “real”; it is simply a decision that some trans people make, in consultation with their healthcare practitioners.

Almost every body contains some mixture of estrogen and testosterone.

These hormones are responsible for a wide range of processes throughout the body, but they are best know for their roles in secondary-sex characteristics such as hair texture and pattern, body composition, skin texture and muscle mass. They both move in cycles, although the testosterone cycle is not accompanied by blood, so it tends to fly under the radar.

Yin and Yang are not concepts that map perfectly onto estrogen and testosterone, but they have a history of being framed that way. Though there can be conceptual problems with a 1:1 comparison, there is some utility to using them. To do so well, though, we have to keep a few things in mind.

First, yin is not “bad” and yang is not “good”.

Yin processes are generally cooler, slower, and more physical, while yang processes are hotter, faster and more about energy. Both are equally required for life to occur. Similarly, estrogen and testosterone exist within relationship to one another in healthy human bodies, and though the mix is different from person to person, it is that relationship that creates physiological balance.

Second, yin is not “weaker” than yang, and estrogen is not “weaker” than testosterone.

There is a strong desire to map sexist notions onto these concepts and molecules, and while I understand where that comes from, it’s misleading at best. Yin is required for life; without rest and darkness we would die. Estrogen is an extraordinarily powerful hormone that influences just as many physiological processes around the body as testosterone, including libido. Estrogens have powerful regulatory effect on bone density, metabolism and protein synthesis that people don’t often know about, because these functions are often thought of as being “masculine”.

All of these misconceptions feed into the way that people understand medical hormonal transition, even for medical providers.

This is a topic too big for this essay, but it suffices to say that people who transition to estrogen-dominance are often saddled with the dumb sexist tropes that already get hung around estrogen, yin, and femininity in general. There is more medical scrutiny, more concern (trolling), and sometimes even more monitoring. Folks who transition to testosterone dominance get the shiny things that sexism awards to men, but also sometimes experience a weird form of medical negligence that assumes that men don’t need care and that minimal monitoring is fine.

It is important to frame hormonal transition correctly: it’s puberty.

Puberty is a normal process that people go through, some earlier in life and some later. Like pregnancy, itis not an illness or a disease process, but it is wise to have a medical provider around when it’s happening. Like any puberty process, it involves a massive shift in the chemical soup of the body, in myriad ways. Appetite changes, sex drive changes in both its level and quality, and the appearance of the body also shifts. What can complicate this process for trans people who did not have access to care as young people is that one hormonal process has to be shut off, and another has to begin, simultaneously.

For people who are transitioning to testosterone dominance, this means that they are going through menopause (declining estrogen levels) and masculine puberty at the same time. For those who are transitioning to estrogen dominance, there is a simultaneous andropause (decline of testosterone) and feminine puberty.

These two processes can be a bit taxing for any body on their own, and together they can sometimes be challenging.

This is where Chinese medicine comes in. Our medicine is all about the balance of yin and yang in the body, and these hormonal shifts are just another manifestation of that process. When we treat any kind of symptom, it is within the context of thinking “is this a yin symptom or a yang symptom?”. We treat menopausal symptoms quite often, usually seen as Kidney Yin deficiency and Liver blood deficiency, and similar symptoms can appear with testosterone supplementation. Andropause can cause coldness, lethargy and sadness, which we usually see as Kidney or Spleen yang deficiency, and we sometimes see similar patterns in people who are supplementing estrogen.

None of these symptoms are terrible, and they usually disappear over time, but we can get them to resolve much more quickly by treating them.

Transgender people have been informed, either explicitly or implicitly, that our healthcare is a burden  and that we should just be grateful for whatever we get, regardless of quality. The time for accepting this message is rapidly coming to an end. People can transition without any help with side effects, and we have been doing so for decades, but we don’t need to. We can have an even better and more fulfilling experience of transition with a little bit of extra help from a medicine whose entire raison d’etre is balancing yin and yang.

I’ve helped many people through this process already, and I’m excited to work with you. Please get in touch if you have questions – otherwise you can just get on my schedule.

The LGBTQ community, health outcomes & the importance of relationships in healthcare

In this moment, in this world, being a queer and/or trans person can feel really hard and scary. It can be hard to prioritize your health and well-being in a world that seems hell-bent on making your life terrible. I’ve written before about the utility that Chinese medicine has in treating anxiety, depression and chronic pain, which disproportionately effect the LGBTQ community, and today I want to talk about something a little more subtle: early detection of possible health issues.

Statistically-speaking, queer and trans people are less likely to have a serious illness or condition diagnosed early-on. (1) This results in poor treatment outcomes, especially for potentially life-threatening conditions like diabetes and cancer. The reasons for this trend are multifaceted; many queer and trans people are low-income and cannot afford preventative care, many LGBTQ people fear (often correctly) that they will be subject to harassment or cruelty in medical contexts, and healthcare providers are not always trained in how to appropriately do screening tests for bodies like ours.

There is also just the human level of things, where a provider who feels discomfort with a patient because of their perceived sex/gender/orientation will be more likely to forget questions, or will feel shy or awkward about having the conversations that need to be had. (2)

To give an easy example, let’s think about a conversation about breast/chest discomfort.

A patient who has pain in this area may feel hesitant to share this information with a provider who they do not trust, especially if they think it will result in an examination that will make them feel vulnerable or ashamed. A provider who is not comfortable with LGBTQ patients may hear the patient say “I’ve been having pain in my left breast/chest” and note it down without asking any follow-up questions, because they don’t know how to navigate the patient’s discomfort – or their own.

The solutions to this problem are easy to imagine; physicians should develop solid rapport with patients, be educated about their experiences, work through any emotional baggage that they as providers might have about certain types of patients, and pay careful attention to the patient’s comfort in the interaction. All take time, though. Often the most well-meaning and educated western medicine providers are expected to see each patient for 15-20 minutes. This can create serious problems with detailed conversation and questioning.

Luckily in the world of natural medicine, we are able to spend 40 minutes to an hour with each patient.

This means that we can get to know patients and develop trusting relationships with them over time, such that the above conversation would be more likely to happen and go smoothly. We also have specific diagnostic tools in Chinese medicine that help us to detect issues before a patient mentions them. With the patient in the above example, a practitioner might feel the patient’s pulse and notice a choppy or tense quality in the left distal pulse position (associated with the upper torso) and inquire whether the patient was having any discomfort there.

This could create an opportunity for the patient to say “oh yes, I forgot about that, but in fact I have been”. Many early warning signs of illness are subtle enough that patients genuinely forget to mention them, so having several diagnostic systems that go beyond asking questions is quite helpful. A practitioner might also look at that patient’s tongue and find discoloration or a change in texture in the part of the tongue associated with the left side of the chest, and this would have a similar diagnostic meaning, and lead to similar sorts of questions.

All of these factors, combined with a provider who has genuine competency with queer and trans people and their healthcare needs, can create a patient experience where the vital details of a patient’s symptoms are not overlooked. Working in concert with other kinds of providers, Chinese medicine practitioners can help to provide the trusting relationships that make good healthcare possible for everyone.

Resources cited

(1) http://www.familyequality.org/_asset/bg19d2/Top-Health-Issues-for-LGBT-Populations-Information–Resource-Kit.pdf

(2) http://www.sciencedirect.com/science/article/pii/S0277953613001019

Trapped underwater – kidney yang deficiency, cold & chronic pain

 

In the last installment of this series of articles, let us to turn to the all-important kidney yang. If you’ve missed them, you may want to check out some earlier articles in this series, such as this one about terror and the Chinese medicine heart, or this one about the liver and depression.

As we discussed last time, the kidney yin in Chinese Medicine controls water metabolism, bone and hair health, and is responsible for nourishing the organs with cooling fluid. The Kidney yang, as you may imagine, has to do with warming processes. Specifically the kidney yang is the root of all warmth in the entire body, and all motive force ultimately flows from it.

The kidney stores various kinds of life essence; qualities that we would think of as genetic are associated with the kidney, as well as the essence in evolved in reproduction and sexual health. Urinary health and the ability to control urination properly are governed by the kidney system. Lastly, but most importantly, there is an area between the two kidneys, known as the gate of life, where our most fundamental life essence is stored. This is the kind of essence that you are born with, and when it is gone, your life ends.

As far as our emotional lives are concerned, the kidney yang gives us the will to create and bring new things into being.

This is particularly true of things that take a long time. It also responsible for our faith in ourselves and our eventual success, despite setbacks or adverse circumstances. As the kidney yin allows us to rest in the knowledge that we are part of something greater, the yang is our belief that we are something greater. A certain kind of hope therefore emerges from the kidney yang; the even if we are not where we want to be now, we can get there with enough hard work.

The physical symptoms of damaged kidney yang are usually associated with aging, but that is not the only way that damage can occur.

Any intense ordeal can potentially injure the kidney yang, especially if that ordeal involves exposure to cold. Generally such an ordeal will either be life-threatening (I’m thinking of a patient who nearly died of frostbite after a snowmobile accident) or sustained over a very long period of time (imprisonment for example). Symptoms can include; sore and weak back and knees, cold feelings around the body, aversion to cold, weak lower limbs, edema, fatigue, clear copious urine, poor appetite, loose stools, various sexual health issues, and fertility problems.

Many kinds of chronic pain are associated with kidney yang damage, as well as chronic fatigue-type conditions.

Emotionally, symptoms are similarly long-term. The kind of depression that results from impaired kidney yang tends to be many years in the making, and often begins in childhood. The feeling of this depression is like being trapped under water, and people often report feeling cold, lethargic, and unable to imagine feeling any other way. Damaged kidney yang can interfere with a person’s ability to manifest their will, both in visualizing future outcomes that they desire, and in acting upon it.

Above all, there is a certain type of hopelessness that develops out of this pattern, and that hopelessness seeps into the person’s entire life.

Treating these issues is not a quick process. The hopelessness itself needs to be addressed, because otherwise it becomes a block to treatment. This is one place where seeing a talk therapist is often required in conjunction with Chinese Medicine, if the person’s belief in themselves has become too damaged to participate in treatment fully.

However, once treatment develops enough momentum symptoms begin to resolve.

Warming and supplementing yang is the way to go for these patients, and herbs and needling techniques that move stagnant water are often indicated as well. One excellent formula for this condition in Shen Qi Wan (pronounced shen chii wahn), which has been prescribed as a tonic for the aging, among other things, for thousands of years.

Thank you for reading this article, and perhaps the entire series. My intention in writing these posts has been to demystify Chinese medicine, and allow people to see themselves or their loved ones in these patterns.

I’ve included treatment strategies because I want to make it clear that all manner of disease can be treated, even those which other kinds of medicine have written off as too strange or intractable to resolve. Our bodies all want to return to better health, and when given the correct stimulus they will almost always do so.

If you have seen yourself in any of these articles, or you just want to come chat, feel free to come see me any time.

The kidney yin, mysteries & panic in the face of the unknown

In previous posts I’ve discussed organs from four of the five elements in Chinese Medicine; The heart (fire), the lung (metal), the liver (wood) and the spleen (earth). In the final articles in this series I want to conclude by the discussing the water organ, the kidney.

Our kidneys in western medicine are vital in filtering out waste products in our bodies, balancing the electrolytes in our systems, producing active vitamin D, and sending hormonal signals throughout our internal ecosystems that regulate blood pressure and blood cell production.

Many of the Chinese Medicine functions of the kidney have clear overlap with the biomedical functions.

Our kidneys are deeply involved in water metabolism (along with the lung), which is the process in which fluid is absorbed into the body, transported to the places where it is needed, and excreted if we don’t need it anymore. They are also involved in the health of our bones and hair, in our urinary health, and in the basic vitality of our bodies throughout the aging process.

As in previous articles, I want to focus on first the yin, and then the yang of the kidney.

Being the water organ, many of its functions connected to moistening and cooling. The water element is paired in a yin/yang relationship with the fire element, and thus the kidney and heart have a special bond. If the embers of fire in the heart are not balanced by the glacial streams of the kidney, fire symptoms can begin to overtake the body.

A person with compromised kidney yin can begin to have burning urination, hot flashes, night sweats, and even dry cough as water metabolism disfunction begins to effect the lungs.

With regards to our emotions, kidney yin is the root of our ability to calm down in times of extreme stress.

Because kidney yin deficiency so quickly effects the heart, it is rarely seen on its own in the wild. This is why some of its symptoms so strongly overlap. When panic overtakes the heart and it begins to burn too brightly, the yin of the kidney cools it. If we are completely healthy, when we feel the the universe is a place that is too fast, too dangerous or too unknowable for us to be in relationship with, the vast and endless waters of the kidney remind us that we are part of a universe, and that the universe it a part of us.

When we step out into the ocean can we feel this deep connection, as the awe of our smallness both frightens and reassures us.

The kidney is about giving ourselves over to that which is mysterious and unknowable in our relationship with the world. Ultimately, that ability to surrender to things bigger and more ancient than us is what allows us to live our lives even with the knowledge that our deaths are inevitable.

A person with truly damaged kidney yin will often have a deep and abiding sense of panic about their eventual death that refuses to be soothed, and frequent and extreme panic attacks are a common feature of this presentation.

Treating kidney yin deficiency is similar to other kinds of yin deficiency; where there is excess fire it must be drained.

Where things are too dry, they must be moistened. Needling techniques and herbal remedies are used to achieve this effect. One excellent herbal formula for this presentation is Huanglian Ejiao Tang (pronounced hwang leeahn uh jeow tahng).

As mentioned above, this almost invariably involves treating the heart as well.

Working with this pattern tends to involve a crisis of faith or meaning in the person’s life that also comes to a resolution through the course of treatment. If you feel that this kind of support could be helpful in resolving the mental and emotional difficulties you’re struggling with – I’m available for appointments and take most insurance. 

Earth yin deficiency in Chinese medicine – When you want it ALL

 

Last week we discussed the lack of motivation and depression that can result from not having enough yang in the Spleen. The rest of the articles in this series are also available including the first one about chronic anxiety, the second one about terror, the third one about closure of the heart, the fourth one about depression, and the fifth, about anger and rage.

Let’s turn our attention to a new possibility. What if there was not enough yin present in the spleen’s paired organ, the stomach?

First we should explain a core concept of Chinese medicine: paired organs. Because yin and yang are always relational concepts, that is they only exist in comparison to each other, the organs of each element are conceived of as yin and yang pairs. The Chinese elements are earth, metal, water, wood and fire. The stomach and spleen are the earth organs, meaning in part that they are the organs who deal most directly with physical matter.

The spleen is the yin part of this pair, and its functions are about fluid transport and secondary digestion (enzymes rather than acid). The stomach is the yang earth organ, and its functions are about burning things up with acid and physically mashing them up.

Understanding the yin and yang nature of an organ helps us to predict what kinds of things will go wrong with it. The spleen is yin already, and so its pathologies tend to involve too much yin; coldness, dampness, and too much stillness.

The stomach, as a yang organ, tends toward too much yang: burning sensations, dryness and manic activity.

More specifically, stomach yin deficiency generally has the following symptoms: heartburn, constipation, too much appetite, great thirst, and fever, and in extreme cases hemorrhagic (bleeding) fevers.

Emotionally, the stomach provides our appetite for life. It helps us visualize what we want, and move towards it. It reminds us that our physical bodies have needs, including hunger and thirst, and that those needs are important. On a fundamental level the stomach provides desire. Desire makes life worth living by reminding us that there is always something else in the world that we want to see, do, or have.

In a healthy person this bottomless desire is balanced by the knowledge that we can’t have everything that we want.

Even for someone with unlimited financial resources none of us can live forever, or have every experience in the world. We can only be one person having our own experiences. The yin of the earth element (the spleen) keeps us attuned to our limits, but also our need for rest and appreciation of what we already have.

Someone with a stomach yin deficiency is unable to keep these practicalities in mind.

Such a person has a strong tendency towards obsession, either with a sort of object (for example collecting antiques or model trains), an experience (seeing a certain movie every day), or a person (an ex, a potential partner, a friend, etc). It is not difficult to imagine how this could become a problem.

Our ability to tell ourselves “no”, even when we want something, is a key part of a being a healthy adult human being.

In a person whose yin has been damaged, that brake cable has been compromised. In its most extreme manifestation this can result in someone losing touch with consensus reality and moving into a space that might look like a manic episode or a psychotic break. There is the potential for violence in such a case if the person perceives that their path toward getting what they want is being blocked.

A patient in that level of an extreme state will not usually present themselves in the Chinese Medicine clinic.

For very understandable reasons, an ER visit or a trip to a psych ward are usually the path that such a person takes. However, someone who is on this trajectory but not yet at that level of extremity may come in, and at that point they can be treated. One common presentation that can look like this is a person with bipolar disorder who is on the upswing of a manic cycle. This state can also result from an intense fever or another illness that depletes the yin of the stomach, and leaves the person in a strange-feeling physical and emotional state.

Treatment is similar in either case: the excessive heat that this process generates needs to be cleared, and then the yin of the body needs to be restored.

Yin-nourishing herbs such as Maimendong (asparagus tuber) and Baihe (white lily bulb) can be given along with heat clearing herbs like Dahuang (rhubarb) and Huanglian (coptis rhizome). Acupuncture can be applied with a similar treatment strategy, and very quickly reduces the patient’s agitation and heat symptoms. The best part about treating this at its early stages is that we can head this process off at the pass and help the patient avoid potentially-disastrous life events in the future.

This article is an attempt to educate you about some of the ways that Chinese medicine looks at the treatment of mental and emotional distress – but it is not intended to help you diagnose you or your friends. If you’re interested in seeing if acupuncture and Chinese herbs can help you with your depression, anxiety, anger, or other uncomfortable emotional states – jump on my schedule and let’s talk!

Earth Yang deficiency in Chinese medicine – Too tired to care

 

To read the previous articles in this series : the first on chronic anxiety, the second addressing terror and the Chinese medicine heart, the third looking at  severe closure of the heart, the fourth concerning depression and the Chinese medicine liver and the most recent about Chinese medicine and rage or anger.

I’ve gone five entire articles without mentioning digestive health so far. Five! For writing about natural medicinethis is unheard of.

The day has come though, as our digestive health is in fact the foundation of our overall health. The entire Internet can tell you what to eat, and what not to eat, with varying degrees of accuracy. However my focus here will be on the intersection of gut health and emotions.

In particular I want discuss the humble and lovable spleen.

The spleen in Chinese medicine is related to the western medicine spleen, but is also distinct from it. The first thing to know is that, when we say spleen, we really mean “spleen-pancreas”. This is clear in classical texts, but was not carried over into English translations. The spleen in western medicine is basically a giant lymph node, while in Chinese medicine it forms a functional pair with the pancreas, and this pair helps us properly digest our food, transport broken down nutrients and water around the body, and direct waste products down and towards the eliminatory organs.

How did the pancreas get lopped off the end in translation?

Originally many translations of Chinese medical texts were done by French medical missionaries, and their system of translation was sometimes not entirely accurate. Though this mistake has been recognized for many years, it is a fact of life that the term “spleen-pancreas” simply does not role off the tongue, and thus western practitioners continue to shorthand this important organ simply as the spleen.

As is true for all organs in East Asian medicine, the spleen has a yin and a yang aspect.

The yin is cooling and moistening, while the yang is warming and drying. It is the yang of the spleen that warms our food and exerts enough force on it that is can transported around the body as useful food essence. One very literal part of this process is the digestive enzymes of the pancreas, but there are emotional aspects as well. The yang of the spleen digests and integrates the outside world; experiences, relationships and emotions. It also maintains our physical boundary and sense of our body.

The spleen builds the muscles of our body and maintains their strength, and thus it is responsible for a certain kind of confidence in our own stability. It allows us to support others by having the energy to do so and the knowledge of where we end and where the other begins. Understanding the boundary of our body is key in relationships, because without boundaries all intimacy can feel dangerous and blurry, and threaten our sense of self.

A person with a struggling spleen yang will often have cold digestive issues.

These can include diarrhea; tiredness after eating, generalized body pain, brain fog, low energy, cold abdomen, nausea, and low appetite. They will also have a few key emotions difficulties as well; poor sense of boundaries around care are especially common. Either they will care for others at the expense of themselves, or they will feel that they cannot afford to spend the energy and risk the loss of self in doing so, and they instead avoid extending themselves on behalf of others entirely. This can come off as either intense neediness or cold aloofness, both of which are opposing sides of the same spectrum of troubles.

Anxiety and depression are common in these individuals, and the specific kind of each are characterized by exhaustion. This person has the sort of depression where they cannot get out of bed, and an anxiety that prevents them from leaving their house or doing much of anything. While it may appear that they are uncaring, what is more true is that they don’t have the energy to care.

This person needs warming, both physically and emotionally.

A Chinese medicine practitioner would use warming needling techniques and would burn Moxa (dried Chinese Mugwort) over points on the spleen and stomach channels, as well as prescribe warming and dampness-draining herbs. A favorite formula of mine in these case is Fuzi Lizhong Tang (pronounced Fu Tsuh Lee Johng Tahng), which is traditionally indicated for digestive pain and diarrhea, with cold hands and feet and lethargy.

As the cold and dampness resolve, and the person’s body recovers, their spirits generally return to normal as well.

This article is not intending to diagnose or help you treat any illness. Whether your digestive difficulties or emotional issues are exactly the same as the ones described above or not, it can be very helpful to seek care from a trained professional. I have appointments available at convenient times and I’d be happy to talk with you about your digestive, emotional or other health concerns.

No chill left – the treatment of anger and rage with Chinese medicine

In the previous article in this series, I discussed the depression that can arise when the Qi of the liver stops flowing properly. You may also want to read the first and second articles in this series – exploring various aspects of the treatment of emotional difficulties with Chinese medicine.

In this week’s installment I want to examine the other extreme of liver Qi stagnation: rage.

Depression is often described as anger turned inward. Anger directed outward is a more straight-forward problem for others to see, but also a differently-stigmatized problem. Clearly there is a long history and present difficulty that those suffering from depression face in reaching out for care, because depression has often been papered over and ignored as a problem.

Intense and lasting anger is much more visible, but is often attributed to a character failing on the part of the sufferer.

It is important to note that anger is not, in itself, pathological. Its healthy purpose in our lives is to let us know when our boundaries have been crossed, and to help us reassert them. Healthy anger comes up, does its work, and then recedes out of view. But anger that has no clear target, or which is the product of a bodily process that has gone awry, can fester.

This festering anger grows beneath the surface, until it becomes a rage that pops out at the slightest provocation.

Let’s turn to a Chinese medicine view of this process. The healthy liver gives us the quality of perseverance in the face of obstacles, self-protection and planning. It distributes Qi and blood throughout the body in a regular, rhythmic way. If a physical blockage occurs anywhere in the body, either in the channels that circulate Qi (often called meridians through an odd bit of French translation) or in the blood vessels, then the liver has to work harder to do this job.

Over time, this hard work depletes the Yin, or cooling and calming essence, of the liver.

In this frazzled state, the Yang, or hot and enlivening essence, begins to take over. Imagine a car whose gas pedal is being pressed continually down, but with the transmission in neutral, and this is the sort of situation being described. Things get hotter and dryer, until something gives.

That something, in the case of a human, is their ability to be a calm and reasonable person in times of stress.

Rage is one expression of a hot and erratic process in the body, both there are other telltale signs that appear in the pattern.

If someone truly has this deep, Yin-deficient heat running rampant in their body they will also have burning urination, red eyes, intense headaches, and sometimes itching rashes that come and go. These are all expressions of the same dynamic: the Yin of the liver can no longer contain its Yang, and it begins to erupt out of the body in harmful ways.

This level of extreme is not seen often in the world. Most people in this state burn off the Yang of the liver and revert to an exhausted kind of depression.

This back and forth cycle can occur many times, depleting the Yin and Yang of the liver into deeper and deeper illness over time. If this person does come in for treatment while the intense upswing of this cycle is occurring though, treatment is quite straightforward. The heat needs to be drained off in the short-term, which will resolve most of the symptoms quickly.

Longdancao – 龍膽草 – one of the primary herbs for treating liver fire in some CM traditions

In Chinese medicine, we would use strong heat-disbursing needling techniques to accomplish this, as well as formulas like Long Dan Xie Gan Tang (pronounced long dahn shay gahn tahng) that clear heat and restore yin. The most important thing to understand in this sort of case is the cyclical nature of the symptoms, and the need to address both the Yin and the Yang of the organs involved to achieve a full recovery.

Whether you reach these extremes of the expression of emotional pathology or not, you may find it helpful to talk to a Chinese medicine practitioner about how herbs and acupuncture can help you find greater balance and peace.

I’m available for scheduling online or by phone – feel free to reach out any time!

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.