Author: Rowan Everard

Estrogen use and its side effects from an East Asian medicine perspective

Estrogen is a complex hormone with myriad effects on many systems throughout the body. Over centuries of medical research characterized by sexism, it has been cast as a hormone that governs cycles solely in the bodies of cisgender women, and also as a chemical that is “less strong” than testosterone. These beliefs are not accurate appraisals of human physiology, however. Estrogen has diverse effects throughout all kinds of bodies, many of which are vital to the health and wellbeing of everyone.

It is true that estrogen creates feminine secondary sex characteristics, IE breast growth, pubic and armpit hair growth, and hip widening. Estrogen regulates menstruation in people with uteruses, along with progesterone. It regulates breast milk production in people who are nursing babies. It is also vital to the clotting process, which is initiated when a person is injured and bleeding, as well as to the cycle bone formation , repair and growth. Estrogen strengthens the lining of vaginal and uterine walls, and also the walls of people’s urethras.

I want to stress the universal nature of estrogen’s power because, in the context of hormonal transition, pernicious narratives about estrogen’s “weakness” play a particularly intense role in the framing of transition as a medical process.

The mythology goes like this: the effects of estrogen are “easy to erase”, which the effects of testosterone are more “resilient”. These ideas happen to neatly dovetail with prevailing sexist notions that femininity is “weak” and masculinity is “strong”, and the projection of these ideas onto the biochemical processes that people feel correlate with gender expression is pretty transparent, and leaves a lot to be desired on a scientific level. For example, the fact that beard growth is difficult and painful to reverse through electrolysis is often put forward as proof of testosterone’s superior “staying power”, but no one ever raises the fact that the widened hips brought about by estrogenic puberty are impossible to erase.

All of this is to say that, when considering how to think about the effects and side effects of estrogen in Chinese Medicine, there is a lot that needs to be unpacked before we can ever begin.

There is a parallel retrograde school of thought within some corners of Chinese Medical thinking, wherein testosterone is yang and therefore “good” and estrogen is yin and “bad”. Men are more yang, and therefore virile and stalwart, while women are more yin, and must be protected because they are fragile and retiring. Similar sexist imperatives have been at work in China over the last many hundreds of years as in the west, and it shows. This view, however, is also a willful misrepresentation of science, within our medical framework, and must be similarly challenged.

Yin and yang can be seen as concepts of duality. In the world of philosophy and metaphysics, they are often positioned as light and dark, good and evil, sun and moon, etc. This is all well and good, and the philosophical roots of Chinese Medical theory should be kept in mind, but we need to also remember that there is no good and evil in human physiology. The human body is a finely balanced organism that constantly keeps all factors within a tight range of homeostasis to avoid death. We can characterize disease as evil, perhaps, but parts of human physiology not so much.

A more defensible definition of yin, in physiological terms, is that which is physical, and also fluid.

Yin builds the bones, the blood, and regulates the spaces in the body where new human beings are grown. Yin produces the fluids in the body that moisten and protect, while yang causes things to move and expand. The complementary nature of two becomes clear when framed in this light. A person with only yang in their body would soon dry up and become a fiery, desiccated husk. Similarly, a person who was solely yin would overflow and spill out into the world with no perceptible boundary, much like the “Blob” of the 1950’s horror movie. Of course neither of these extremes exist in nature, but we can see the symptoms of imbalance in this light.

Here are some potential side effects of too-high estrogen levels: fatigue, depression, loss of sex drive, weight gain, abdominal pain, cold hands and feet, breast tenderness, insomnia, and anxiety. For the most part, they fall mainly into the Chinese Medical categories of yin accumulation and blood stagnation. We must remember that too much yin also inherently means too little yang, because they are relational concepts. So if a person is producing more fluids or blood than their body can move properly, they will settle around the body and cause problems. The body will work harder to move them, and if it still cannot summon the yang needed to do so, heat will be produced in the effort, which leads to heat symptoms like insomnia and anxiety.

It must be said that these are symptoms of internal imbalance, not inevitable effects.

Often lowering estrogen dose, adding progesterone, or supplementing very small doses of testosterone will resolve them. However this is not always possible, as some of these effects are the result of an internal imbalance that preceded hormone therapy, and is being worsened by it. This imbalance would need to be treated either way, and the effects of hormone supplementation are simply revealing it.

Chinese medicine has been used for thousands of years to regulate hormones, particularly estrogen.

The use of acupuncture and herbal medicines for key hormonal experiences like pregnancy, menopause and andropause far predates the practice of hormone prescribing. The two together can be even more powerful, as the blunt power of the hormones can be directed more precisely by the subtlety of acupuncture and herbs.

One excellent formula to consider is the formula “Wen Jing Tang” or “flow-warming decoction”. It pairs herbs that warm and transform fluids, such as ginger and pinellia, with herbs that supplement and move blood like Angelica and Chinese lovage root. The picture of this formula is a person who is quite depressed, with cold and hands and feet, nausea, abdominal pain, menstrual irregularity and/or infertility. Menstruation is not a required feature however, but an expression of blood stagnation and cold in the lower abdomen, which cause the other symptoms as well. Along with warming and clearing acupuncture techniques, this formula will resolve the above symptoms within a few weeks.

Estrogen, like all things in the human body, is powerful and vital in the correct balance. Any person with a hormonal imbalance can experience unpleasant effects as a result, and Chinese Medicine can be an important tool in righting the ship. As medical providers, acupuncturists and Chinese herbalists are bound by the same medical ethics as any other profession: to see our patients and their suffering clearly, and treat accordingly.

This article describes some possible ways that estrogen imbalance could look or feel, but there are many possibilities. If you want to start feeling better now, come on in for a new patient visit!

Here are some articles that I used in researching this piece:

  • Bienfield, Harriet , and Efram Korngold . “Menopause, Hormones and Chinese Medicine.” Acupuncture.Com – Menopause, Hormones and Chinese Medicine – February 2009, www.acupuncture.com/newsletters/m_feb09/menopause%20chinese%20medicine.htm. Accessed 26 Sept. 2017.
  • Blakeway, Jill, Ms LAc. Addressing Estrogen Dominance in Perimenopausal Women Using TCM.” Pacific College, 14 Sept. 2016, www.pacificcollege.edu/news/blog/2016/01/14/addressing-estrogen-dominance-perimenopausal-women-using-tcm. Accessed 26 Sept. 2017.
  • Bradford, Alina. “What Is Estrogen?” LiveScience, Purch, 2 May 2017, www.livescience.com/38324-what-is-estrogen.html. Accessed 26 Sept. 2017.
  • Weizenbaum, Sharon. “Wen Jing Tang according to Huang Huang” http://www.pdxacustudio.com/wp-content/uploads/2015/10/Wen-Jing-Tang-.pdf. Accessed 26 Sep. 2017.

Looking at the effects of testosterone through the lens of classical Chinese medicine

testosterone chinese medicineHormone supplementation can be a very helpful tool for some transgender people to live full and authentic lives. There is also a great deal of fear-mongering about the side effects of hormones, usually from non-transgender doctors. While more long-range study is needed, a large-scale recent long-term trial found no elevated risk for mortality, either broadly or specifically, for transgender people taking hormones. (1)

Care providers who try to scare trans people away from hormones are not standing on firm evidence in doing so.

That being said, the lack of mortal danger does not mean that there are never annoying or difficult side effects from hormones. Any medication, taken over a long period, can cause some unwanted experiences to occur. In the next two articles in this series, I’m going to break down some of the most common side effects of testosterone and estrogen supplementation, and explain how Chinese Medicine can help resolve them.

Testosterone, as we’ve discussed in the past, is primarily a hot and yang substance. What this means in practice is that it makes this growth, move faster, and makes people feel warmer. What it can also mean is that it can cause some people to get too hot, and develop unpleasant symptoms as a result. In Chinese Medical thinking, the yin of the body, or the cooling and moistening substances, need to be able to balance out the yang.

Over time if the yin is taxed by something, whether it’s a stressful life event or something we are consuming, the heat can overwhelm the system.

Some signs that this may be happening include; night sweats, anxiety, heart palpitations, changes in hunger, hot flashes, acne and pain in the legs. These are mostly symptoms that are associated with puberty or menopause, and there is a very good reason for that: people who are taking testosterone are inducing puberty and menopause, concurrently. This is not a bad thing; it’s just a life process.

But it can be a lot for the body to deal with.

In addition to heat, sometimes testosterone can lead to reduced blood flow in the lower abdomen, or what we call “blood stagnation” in Chinese Medicine. Blood stagnation can manifest as frank tissue changes, like polyps or tumors, but most often it shows up as pain from impaired microcirculation.

This can result from muscular changes in the pelvis bowl (particularly that pesky psoas muscle), the cessation of menses, or from the surgical removal of reproductive organs. Some trans people who take testosterone find that they develop mysterious wandering pain in the lower abdomen after several years on testosterone.

The fact that some people experience these unpleasant effects can feed back into the medical world’s desire to pathologize transgender people and say that taking hormones is just bad and dangerous.

This is rarely said, of course, for most other medications. Very few people say “metformin can cause balance testosterone acupuncturediarrhea in some people, so no one should ever take it”, because it is seen as a life-saving drug. Hormones are also life-saving, and deserve the same medical care and respect as therapies. The correct way to think about this situation is not to say that testosterone is bad, but rather that we need to help the body integrate the changes from hormone supplementation in a more efficient way.

Acupuncture and Chinese herbs to do this, along with dietary changes in some cases.

The body is intelligent, and can learn how to self-regulate under new conditions. We can help it to vent excess heat, supplement yin, move blood, and adapt. Acne can be treated, night sweats disappear, hunger cues return to normal, and the body changes in a normal and healthy way. Instead of yelling at people about the “dangers” of the medications they take, we can work with people and make their experience be the smoothest it can possibly be.

Note: Not all people will have unpleasant side effects from testosterone, and not all side effects will look like what is described above. Each person in unique, both in their constitution and in their life experiences and circumstances.

If you are taking hormones and experiencing any difficulties, feel free to schedule an appointment with me so we can talk through what classical Chinese medicine might be able to do for you.

(1) Largest Study to Date: Transgender Hormone Treatment Safe. Kathleen Louden. July 02, 2017 http://www.medscape.com/viewarticle/827713

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.

Chronic pelvic pain, East Asian medicine & the LGBTQ+ community

The lower abdomen is sometimes referred to, in kinesthetic medicines of various kinds, as “the basement of the body”. It’s where issues that we can’t deal with at the moment, whether emotional or physical, get put so that can work on them later. Hopefully.

This dynamic can be illustrated in a few ways: sexual assault survivors have a heightened risk for pelvic inflammatory disorder (3), inflammatory bowel disease (a complex issue for another article), and menstrual pain (2). Increased pelvic pain, urinary tract infections (UTIs) and back pain have been documented in women who are survivors of domestic violence (1).

More broadly, the Adverse Childhood Experiences study has found that adults with childhood traumas are many times more likely than baseline populations to experience a wide variety medical problems, including all-cause mortality (4). The pelvic bowl is not the only place where traumatic events show up as physical symptoms later on, but it is one of the main things that manual medicine providers see clinically.

This literature can feel pretty scary for survivors of any kind of traumatic event, so I want to be super clear about something: risk factors are not guarantees of future illness.

It is not the case that 100% of survivors go on to have serious medical problems beyond the effects of aging. It is also the case that risk factors, and their early symptoms, are often quite treatable, which I’ll discuss further down the page.

I’ve written before (link to previous article) about the higher instances of untreated illness among queer and trans populations, and here is a place where we should return to those findings. Not all queer and trans people have experienced severe trauma over the course of our lives, but many have. This has obvious implications for the baseline risk factors that we have in the world, but it can also combine with societal risk factors to create a pretty toxic sludge of comorbidity (the medical term for multiple medical risk factors or illnesses occurring at once).

For example, imagine a cisgender gay man who is also a sexual assault survivor, and who is experiencing unexplained testicular pain.

If his medical provider is uncomfortable with queer patients, that person may not inquire deeply enough about said pain, or may be unwilling to properly examine the patient. In such case, a possible tumor might not be discovered until it has progressed into something much more difficult to treat. Because we are dealing with complex human beings, the many possible permutations of these phenomena are pretty much endless.

In East Asian medicine, we also have some extra tools available to us in terms of early treatment.

Basically, from this perspective, most problems begin as stagnation of Qi (the body’s life force), and if Qi stagnation goes on for too long then blood begins to stagnate. In the case of pelvic pain, let’s say that a 25-year-old bisexual trans man presents with wandering and intermittent pain in his lower abdomen. The pain began shortly after he experienced a car accident, and has been getting worse every since then. In this case, the emotional shock to the heart from the accident has lead to Qi stagnation in the liver channel, which is closely linked with the heart and passes through the pelvic bowl.

If left untreated, such a patient could develop more overt disease symptoms, such as uterine fibroids or polyps. When a symptom manifests with a physical tissue change, and is accompanied by a fixed pain rather than a wandering one, then something has progressed into the realm of blood stagnation. Both Qi and blood stagnation are treatable, but Qi stagnation resolves more quickly and is far less frightening and painful for the patient. If this can be treated at the stage of pain that no one can pin down, this is ideal.

Needless to say, having a safe provider to see about this pain is one of the biggest factors in whether or not this patient would be able to access care for it.

Assuming that he did, treatment in the early stages for such a case would involve acupuncture techniques to reestablish proper flow of Qi in the liver channel, as well as other channel in the lower abdomen, and also to restore the Qi of the heart. This would generally have the knock-on effect of also resolving any anxiety, depression or sleep issues that may be lingering from the car accident. If treatment were to occur in the blood stagnation stage, then the above steps would be taken, along with needling techniques and herbs to break up stagnant blood and help the body to reestablish the appropriate flow and rhythm of blood in the lower abdomen.

In either case, this patient being aware of his own bodily and emotional experience is the most important factor in accessing any kind of care.

The best way that we can care for ourselves is to understand how our lives effect us. East Asian medicine can be an important tool for anyone who wants to recover from a traumatic event, treat an early-stage illness, or finally address a problem that has been bothering them for a long time.

Works Cited

(1) Campbell J, Jones AS, Dienemann J, Kub J, Schollenberger J, O’Campo P, Gielen AC, Wynne C. Intimate Partner Violence and Physical Health Consequences. Arch Intern Med. 2002;162(10):1157–1163. doi:10.1001/archinte.162.10.1157

(2) Jacqueline M. Golding. Sexual-Assault History and Long-Term Physical Health Problems. Current Directions in Psychological Science Vol 8, Issue 6, pp. 191 – 194. First published date: June-24-2016

(3) Latthe Pallavi, Mignini Luciano, Gray Richard, Hills Robert, Khan Khalid. Factors predisposing women to chronic pelvic pain: systematic review BMJ 2006; 332 :749

(4) Vincent J Felitti, Robert F Anda, Dale Nordenberg, David F Williamson, Alison M Spitz, Valerie Edwards, Mary P Koss, James S Marks, Relationship of Childhood Abuse and Household Dysfunction to Many of the Leading Causes of Death in Adults, American Journal of Preventive Medicine, Volume 14, Issue 4, 1998, Pages 245-258, ISSN 0749-3797, http://dx.doi.org/10.1016/S0749-3797(98)00017-8.

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.