Acupuncture
Sprained Ankle Remedy: The Follow-Up
I want to begin this week’s newsletter by clarifying and/or elaborating on the previous. This is just part of the reason I appreciate and enjoy replies and feedback. The latter as it serves keep in touch with old friends—the former as it gives me the opportunity to improve my communication in educating people about Chinese Medicine.
Several people responded to my miraculous sprained ankle healing story with inquiries to whether they could or should use the same topical for their own chronic pain; which told me I fell a bit short in my explanation.
The external application I used for my acute injury, San Huang San, contains herbs that are very blood-invigorating, which can be good for most forms of pain, but also very COLD, which is only advisable in the very first stage of an acute injury. Past that interim, San Huang San would most likely do more harm than good (just like ice), as in contrast to allopathic medicine we offer no one-size-fits-all remedy for a particular symptom, i.e. Pain/Inflammation.
The same principle applies to internal medicine, as people have come into the clinic asking for “the herb for weight loss,” or “the herb for high blood pressure.” There is no such thing, and if an acupuncturist ever tells you or prescribes otherwise, run. From our perspective, either of these pathologies can be a result of different dysfunctions in different organ systems within each person. While in one case we may have to strengthen the lungs’ circulatory function and remove fluid retention from the urogenital microbiome, in another we might have to remove fluid from the gastrointestinal microbiome and sedate pulmonary function. Very different diagnoses and prescriptions.
For chronic pain the best things people can do, in my opinion, are yoga, qi gong, or pilates. Without a daily, or at minimum weekly routine, I can’t imagine how it is humanly possible to live without pain or discomfort. Topically, what I am presently using in the clinic and seeing best results with is a more warming analgesic liniment, nicknamed “Evil Bone Water”—bottles available upon request at my office.
As the weather in the northeast has suddenly shifted from very warm to cold and pouring rain it is common for people to be more vulnerable to viruses or exacerbations of musculoskeletal pain. The warm weather opens our pores and dilates our blood vessels, and we wake up the next morning and must go outside into the cold rain, which has greater opportunity to “enter” and exacerbate pre-exiting “dampness” at the neuromuscular or immunological layers.
This is why during this time of year it is especially important to dress relatively warm (I can’t tell you how many girls I’ve seen in cutoff belly shirts and guys I’ve seen outside jogging topless, both of which just begging for pathological dampness!), avoid raw foods, and eat ginger, garlic, and onions. This past weekend of torrential downpour we made a chicken soup cooked in chicken bone broth, with the typical accoutrement, chopped celery, carrots, potato, onion, garlic, and ginger, with quinoa cooked separately so as to add to the many leftover portions to come. Rice or noodles are a fine substitution here, but as we consume plenty of both in our home, I like to occasionally honor the western nutritional perspective as well.
I hope everyone is now a bit clearer on what San Huang San is, why it worked so well for me, but likely would not for you presently. However, there are other options for chronic pain, such as the now widely renowned in my world, “Evil Bone Water,” as well as the always advisable diet and exercise. Wishing everyone a pain and virus free week, in spite of this proverbial cold, wet rag that temporarily surrounds us.
Healing my Acute Ankle Sprain Overnight!
Every once in a while I am reminded, by way of my own personal suffering, of the incredible power of our medicine when we “nail it,” usually thanks to the healing hands of others, but sometimes even by “representing myself in court.”
Thursday mornings are generally the most challenging at home. I have to leave a bit earlier to get to the school downtown and teach, which means I have to prepare breakfast and the baby’s things a bit faster, and often times endure her expressions of raging heartbreak when I must break out of the house shortly after she wakes up. Last week was one such morning.
As Jillian scrambled to get ready upstairs and I to prepare to leave downstairs, Peyton found herself in a “Daddy mode,” wanting me and only me, as my wife attempted to dress and brush teeth in hyper-speed so as to not leave our very mobile, curious toddler alone downstairs. Finally, it was 7:55, my hard out. I picked up the baby, carried her upstairs in hysterics, kissed her, set her down in front of my flustered wife, scrambled down the steps, and WHAM! Rolled my left ankle inward and exclaimed in pain in lieu of shouting “I love you,” on my way out.
I’d gotten lucky. On my walk to the train I realized the sprain or strain, or whatever had just happened must have been mild, as I felt only a mild twinge of pain at the ankle. I figured this should be a quick fix while watching TV later that evening.
But over the course of the day, I observed the pain grow gradually worse, and it wasn’t because I was standing or pounding on it excessively. To the contrary, supervising student clinic shifts is mostly sedentary and physically undemanding. By the end of the shift I was truly limping, to the point that it was difficult to get down the subway steps. By the time I got off the subway it was difficult to drag myself through the tunnel at Penn Station, requiring manual use of a wall to support my limp. And by the time I got off New Jersey Transit a half hour later I was in pain even at rest and could not apply any pressure to the foot whatsoever. In all of my youthful years skateboarding and playing soccer this was easily the worst sprain I’d ever had. I hopped down the stairs one step at a time and needed a ride home from the station.
As most of you know, I am a big believer that painkillers of any form should be relegated for pain—not discomfort—as my opinion is the laissez faire way in which they are ingested likely contributes over time to malabsorption in the gut, which is a primary etiology for many diseases. However, they do have their place, and this was one of them. With both sides of my ankle now throbbing, even while elevated on the couch, I ate some soup and took the max dosage of ibuprofen. From there the pain subsided and I returned to Chinese Medicine.
San Huang San is an empirical treatment for the first stage of such injuries. Nicknamed “herbal ice,” it reduces inflammation even more powerfully, but instead of constricting local blood circulation it enhances it, and I desperately wish all professional athletes knew about this ancient cure. I hopped into the kitchen, cracked an egg into a bowl, removed the yolk, and poured the herbal powder in with the white part to make a poultice. Stirring, stirring, stirring furiously, while my ankle pounded, pounded, pounded furiously with pain, I was determined to get back to the couch and begin this healing process as soon as possible.
Step 1: Bleed the “jing wells.” Jing well points are the first on each meridian, which means ends of the fingers and toes. It’s not always the most pleasurable experience, but pricking these points with a lancet to drain stagnated blood along the channel of physical trauma is a great way to begin the anti-inflammatory process by making space for new blood to come in. It’s a bit psychologically challenging to do on one’s self, but I managed, on the ends of both the big and fourth toes.
Next I used a spoon to apply my brown pasty, egg-white-based poultice to the entire ankle and wrapped it all up with bandages from our medicine cabinet. When the ibuprofen kicked in, I was no longer in pain at rest, but still was unable to put any weight whatsoever on the foot. That night I chose to sleep on the couch downstairs, as opposed to thunderously hopping up the steps and surely waking the baby.
Before bed I did acupuncture: Two points along the posterior tibial nerve pathway that innervates the medial malleolus (inner ankle), and two points along the peroneal longus and brevis respectively, which innervate the lateral malleolus (outer ankle). 15 minutes on each side, a protocol I was about to great practice in performing in the week to come.
I canceled my entire workday on Friday (sorry everyone), just praying that things would be manageable by Monday. When I woke up the next morning I was not in pain at rest, which meant I could put the Advil away for now. Before choosing to hop to the bathroom I thought I’d give a very light limp a try. I braced myself by my arm up against the living room wall and put the gentlest pressure I could muster onto the floor. No real pain. “Heyyy, that’s at least some improvement!” I took another step, this time cautiously applying even more pressure, and again noticed zero to minimal pain.
In my 20 years as a patient of Chinese Medicine, that walk from the couch to the bathroom was one of the most awe-inspiring, amazed experiences I’d ever had. With every step I applied more pressure and with every step I felt more gratitude and disbelief. I knew the reputation of San Huang San powder. I’ve used it on patients as well as on myself before, but I’d never seen it work at this speed with this degree of efficacy. My ankle was 80-90% better literally overnight. I almost thought twice about calling my patients to reschedule the afternoon, but with the help of a more level head from my better half I thought better of it and took the day to rest. Instead, and to satiate my Type A workaholism I purchased an online webinar by one of my mentors and spent the day studying. I am now one week removed from the sprain and feel 100% better.
Most people are aware of Chinese Medicine’s efficacy at treating chronic pain and injuries, but don’t realize that many such protocols, powders, formulas, and treatments were created and developed to treat injured soldiers in the ancient times of China’s warring states. Instead of the western RICE method, which even its creator, Dr. Gabe Mirkin, has conceded as wrong, please don’t hesitate to reach out the next time you sprain an ankle, break a bone, or tear a ligament. Like the smartphone saying, “There’s an app for that,” in Chinese Medicine we might echo, “There’s a treatment for that.”
The Importance of Bland, Sour, & Bitter Foods
There are three flavors that are resoundingly unrepresented in the typical, daily, western diet, whose void is arguably part of the cause of our leading all first world nations in major disease. Sour foods, bitter, and bland foods all induce important healing mechanisms in the body that can only be fully understood through Chinese herbal medicine.
Sour foods have an astringent effect, which makes it very curious why so many Americans drink lemon water or tea when they have a cold or virus, which we want to do anything but astringe. From our perspective foods like lemon, pickles, (apple cider) vinegar, and sauerkraut might be great for improving immune function to prevent contracting colds, but once we are sick, acrid foods such as cinnamon, ginger, and garlic are more advisable.
Sour foods help to conserve (by astringing) the body’s cellular energy and healthy fluids. If we are completely burnt out, or experiencing symptoms such as muscle cramps, or getting a second wind late at night that prevents a healthy bedtime, these might all be requests from our body for more astringing of resources. Personally, I enjoy lemon water, or sprinkling it on kale, broccoli, and/or asparagus. Tomatoes are great this time of year and sauerkraut is especially balancing with spicy foods. Since the spice will naturally bring fluids up and out, we can use the kraut to counteract this effect and keep nutrients inside. Of course, sauerkraut is generally taken raw, so it is important to eat in conjunction with cooked foods or hot tea to fully digest.
The bitter flavor must be hands down the most unpopular in America, and the reason I figure it to be healthy is because my 2-year-old hates it more than anything—while obviously preferring sweet to anything. In Chinese medicine the bitter flavor clears heat (or inflammation) from the body, which is especially important for the next two months of the year. Scutellariae root clears heat from the lungs, Coptis root from the microbiome, and phellodendron from the urogenital microbiome.
These make up the “three yellows,” and if I’ve ever put them in your herbal formula you’ve likely complained to me the following week. Instead, regular consumption of unsweetened green and/or dandelion tea, most leafy greens, and cabbage can help to mature your palette all while reducing the kind of systemic inflammation that tends to rise eventually into the chest or central nervous system later in life. If you must have sweets after dinner, do so with either hot dandelion or barley tea to counter their effect.
The bland flavor is the toughest for me, because like most people with “damp heat” internal body types, I love spices and flavors, and especially love cooking vegetables in a way that is delicious and not so boring. But while there is a time and place for culinary creativity and indulgence, plain steamed vegetables were a staple in the diets of most human beings for centuries prior, which happened to be centuries of much fewer diseases. Sure, people weren’t living as long, but chronic illness in 40-year-olds was much rarer than it is today.
Poria mushroom is one of our most commonly used bland herbs for draining dampness from the gastrointestinal and urogenital microbiomes. Its bland flavor helps to modulate urinary function and reduce pathogenic fluid retention, and by doing so it has the additionally desirable side effect of calming our minds and spirit. How does this work? By reducing the proverbial internal traffic jams of unwanted fluids, our healthy fluids can then more easily circulate up to and from the central nervous system without diversion or congestion. If spicy foods ramp us up, it should be pretty deductive that bland will calm us, and who couldn’t use more calm?
One idea to incorporate this all into a meal is steamed or boiled broccoli (dress with olive oil if you like), sauteed leafy greens with garlic, salt, and pepper, any tofu or animal protein prepared to taste, and a glass of lemon water, and/or sauerkraut on the side; followed by a hot cup of dandelion or barley tea, with honey if you must.
Arthritis: What is the Cause & Cure?
I can’t tell you how many times patients have either inquired to me about a cure for arthritis or informed me that there is no cure, that the cause is objectively unknown, and of course I must laugh to myself at the obtusity of the latter in the context of our dynamic.
First I want to reiterate, I am not one of those (alternative) medicine clinicians who believes biomedicine has no place, nor that my own paradigm of medicine can cure all. If someone has a brain tumor or stage 3 liver cancer they need a biomedical doctor—not me (though they’re best advised to utilize someone like me for complementary support).
I am, on the other hand, absolutely one of those alternative medicine clinicians who believes that biomedicine’s understanding of the human body is limited to structural and literal objectivities, wholly in neglect of its intangible dynamics of physiological substances. This is what Chinese Medicine is almost entirely predicated on, and more relevant to arthritis.
Synovial fluid surrounds our joints. Healthy body fluids surround everything, in perfect illustration of our microcosmic embodiment of the world we exist in. When fluid circulation is impaired it coagulates, like a traffic jam in the body, and equally frustrating to our global agendas. First fluids stick and accumulate, then to the point that they obstruct the thinner, healthy fluids from doing their job of lubricating the joint, creating the ironic illusion of dryness. We hear cracking and feel dry, and label arthritis as a “dry condition,” when in fact it is the opposite. Stress and fatigue, along with sugar, alcohol, dairy, gluten, raw/cold foods and drinks, all induce fluid accumulation, so is it any wonder how arthritis is rampant in the modern world?
Arthritis is very personal to me, as it was the first condition I attempted and failed at treating in my father, as an acupuncture student many years ago. Dad was a great dad, but his diet was poor, stress was high, and he drank daily for a very long time; not to mention that he had a son and student as his practitioner. I think we peaked at temporary relief of symptoms each week.
Conversely, I take great pride in my own management of the gout disease that I inherited from Dad. I was diagnosed with the men of our family’s condition at the premature age of 25, and after suffering several painful attacks many doctors told me that I should live on Allopurinol, or whatsoever was the drug being presently recommended. Instead, I went on to learn Chinese Medicine. I all but completely abstained from refined sugar (exceptions for holidays, birthdays, and Paris) and obviously follow a very Eastern diet. My stress and fatigue inevitably wax and wane, as goes life. I know gout is something I’ll always have to be mindful of, but the fact that I’m now 45 and have never lived on medications or with annual attacks is a feather in my cap.
Without dietary modifications arthritis cannot be cured, in my opinion. That doesn’t mean one has to be completely abstinent from all of the aforementioned usual suspects. Just that the diet should be highly impressive 90% of the time.
Without internal herbal medicine arthritis cannot be cured, in my opinion. Acupuncture is fantastic, but it is rarely powerful enough to break down fluid accumulations or deposits, or adequately restore metabolic function the way herbs can. As always, with herbs there is no one size fits all prescription, no “herbal allopurinol,” nor even one prescription that one would take throughout a course of treatment. As the body changes, the formula changes and adapts to the patient’s evolving presentation.
While organ function is being restored through internal medicine, acupuncture can be invaluable to pain relief and improving local circulation. Committed patients must come for regular treatments for 3-6 months and modify their diets. In the first month acupuncture and moxibustion should be used twice a week. In subsequent months, once a week, and eventually every other week is fine so long as we are consistent and accurate with herbal formulas.
There is my best explanation for the causes and cure for arthritis.
Mercury Retrograde: The Covid Edition
But isn’t it just like Mercury Retrograde to bring with it a wave of coronavirus to add to its usual technology issues, transportation delays, and miscommunications? I am no astrology expert, though it is a science that I enjoy and observe accuracy in, and question when it is mindlessly dismissed, since the absence of belief obviously requires just as much blind faith as belief.
As we presently reside in what is arguably 2023’s first Covid wave, we’ve concurrently embarked upon the “pre-shadow” of Mercury’s retrograde. This means the planet has just begun to circulate in its reverse direction, which can impact Earth and its inhabitants in the aforementioned ways. This will last until mid-September, and recommendations are as follows:
- Plan for delays, not just logistically, but emotionally. Trains will be even worse and slower than usual, and you will be late for appointments. Life will go on. Try to breathe and/or text-vent to a loved one to keep your cool. It’s not fair, but it always happens—especially on the MTA or New Jersey Transit.
- Plan for technology problems: Lack of service on your phone, web sites not loading, calls dropping, documents getting accidentally erased, etc. This can be infuriating, but is generally not as bad if we expect and accept it as a matter-of-fact byproduct of the temporary cosmic energy we find ourselves in.
- Plan for communication problems. Someone you love will probably say something triggering in the next 6 weeks, and/or you will erroneously hear or misunderstand them. Clarify before you react, try to take a deep breath, remember when we are, and either respond calmly or pick up the dialogue in October (if you can wait that long).
- Be careful. This must be the new dad in me talking, but be sure to look both ways when crossing the street, drive a bit more carefully, and take care around glasses and hot surfaces. Personally, I find myself to be way clumsier during these times, once having knocked down an entire shelf of wine glasses in a restaurant I was working at in Beverly Hills. Not my finest moment.
- Finally, now more than ever, take care of yourself. I also find myself more prone to illness and injury during Mercury retrogrades, and as this one has bestowed upon us what is arguably the year’s first coronavirus, it is that much more important. Eat warm breakfasts, warm everything, steamed vegetables, hydrate, exercise in moderation, and go to sleep between 10-11pm. Stress management indicated as always.
The first stage of Covid is generally treated with an individualized version of the formula: “Huo Xiang Zheng Qi San,” which interestingly targets fluid retention in the gastrointestinal microbiome. This is generally advisable only on the very first day. Once the virus is in the throat or chest we’re almost invariably looking at one of the most famous formulas in all of Chinese Medicine, “Xiao Chai Hu Tang,” still modified to the unique patient, but with the intention of opening the chest and lungs, downbearing qi, and reducing heat and/or fever symptoms. Past this stage things become more interesting. Per usual, there is no one size fits all formula, but instead many ways we can prescribe based on constantly evolving symptoms and tongue appearance. Time is of the essence with this crafty, clever virus, so if you should contract it please contact me as soon as possible for a virtual consultation. Spare no expense. You don’t want long Covid.
I am not an “anti-vaxxer,” but based on my clinical observations in the past few years I can understand why some people would be wary of certain vaccines. I cannot, however, fathom why we cannot as a society adopt masks as a standard practice during waves in crowded spaces. While most people do fine with Covid, it is a gross over-simplification to say: “it’s just like the flu.” The flu almost never had summertime waves (Covid has had one every year), and almost never caused so many long-term neurological and cardiovascular diseases. I agree that we cannot live in fear—nor should we live in denial.
For the next month try to not snap at the pedestrians or cars that cut you off in public. Try and accept that that web site just won’t load when you want it to, that you’re going to be late, and things just will not get done according to schedule. Mercury’s retrograde might be viewed as Buddha’s messenger, to teach us unattachment, acceptance, and patience, in the face of a lifetime of the opposite conditionings. I’m speaking here to myself as much as anyone else.
