Herbal Medicine
Breathing Exercises for Insomnia
Everyone has their achilles’ heel—even the most successful or effective clinicians—and one of mine, as I’ve discussed before, is insomnia. On the bright side, mine is not constitutional—I never struggled with sleep as a child or adolescent. Unfortunately, this means by around 30 years old I had created it myself, whether through stress or unhealthy lifestyle, surely with a dash of genetic predisposition. My family tends to be more manic and wiry than sluggish or lethargic, the former of which lends itself to an overactive “yang,” or sympathetic nervous system.
There are many disease patterns that might explain insomnia, but the top 3 are as follows:
- Blood deficiency: These people tend to be interrupted and/or have trouble staying asleep more than they do falling asleep. If they wake up and feel hot this might be the “blood deficient yang ming syndrome,” which requires heat-clearing in addition to blood nourishing.
- Ben Tun Syndrome: These people tend to have more trouble falling asleep, are subject to ruminating thoughts, anxiety, and heart palpitations. If there are no ruminating thoughts, and they’re just inexplicably lying there awake, good news: This might be the aforementioned “Yang Ming heat” stirring, more than sort of any anxiety condition.
- Food stagnation: These often wake in the middle of the night with stomach discomfort, reflux, or phlegm in the sinuses. They tend to benefit greatly from intermittent fasting, where they either skip dinner or eat it very early, around 5 or 6pm. They
In the past Chinese Medicine has intermittently helped with my own sleep issues, although there have been times where neither me nor my own herbalist/teacher have been able to crack the code. Much like a lawyer who represents themselves in court, it is challenging to write your own formula or treat one’s self. With acupuncture, beyond treating the overall pattern, I like to use points on the head, around the prefrontal cortex and pineal gland to modulate the neurological component of the issue.
I’ve used products like melatonin or Doc Parsley also with intermittent success, but obviously one should not be reliant on such supplements in perpetuity, especially since it is impossible to prescribe them holistically, tailored to the patient. They are symptom-managers, admittedly helpful during crises and less aggressive than pharmaceuticals, but still not ideal.
Beyond internal medicine, the best tools to maximize sleep are the obvious sleep hygiene and the breath. Melatonin secretion begins at 9pm and peaks at 10, so this is the best time to get in bed. If you can’t get to bed by 10, the earlier the better. Of course, sleep in a dark, relatively cool room, and spend the last two hours before bed with as little electronic (and digestive) stimulation as possible. If your sleep is interrupted use your breath to try and relax. This works for me about 80% of the time:
The 4-7-8 breath is one I learned from my wife, Dr. Jillian Cohen, and she learned it from Dr. Weill’s fellowship for Integrative Medicine.
Whenever that doesn’t work for me, I move on to this Kundalini yogic breath, defined by its silent mantra, which simply means saying it silently to yourself.
Finally, if that doesn’t work, I bring out the heavy artillery, which is to say God. You don’t have to be religious to believe in a higher power, and I imagine anyone who’s laid awake in bed struggling for several hours is willing to invoke whatever might be available to resolve the crisis. Using another silent mantra and breathing only through the nose I inhale: “I am God,” then exhale: “God is love.” This works almost all of the time, I think calming my central nervous system with the reassurance that no matter how poorly I sleep, no matter how difficult tomorrow is, I am ultimately connected to the source and none of this shit really matters. Hope that helps!
Balancing the Bitter Cold with Chinese Medicine
Welcome to the “Bitter Cold.” Holidays are over, New Year’s has passed, viral plagues have not, and single digit temperatures have arrived. Although we do not hibernate, nor could we, even if the more introverted of us might prefer to, in theory we should do so at this time. Instead, how can we compensate for the nature of the present climate?
In Chinese Medicine herbal formulas that contain bitter and cold ingredients, such as coptis root, phellodendron, or gardenia fruit, generally harmonize their harsh properties with more acrid, warm ingredients, such as ginger, dry-fried ginger, tangerine peel, or pinelliae root. This enables the bitter, cold herbs to purge systemically damp/hot inflammation without compromising the integrity of the stomach qi, or microbiome. This is holistic medicine.
Self-care can be “holistic” as well. Ie. If we eat a cold salad or ice cream it should be had with or followed by hot ginger or cinnamon tea (No, it doesn’t help to have ginger or cinnamon flavored ice cream). Conversely, if we eat an especially rich or spicy meal, and/or have alcohol we might accompany it with a few cucumbers or radishes—or follow it with peppermint or barley tea the next day (still hot, as cold beverages can never benefit the gut from our perspective). If we exercise or work out hard on a particular day we should get to bed early that night, in order to properly recover the body fluids used in the workout. If we slept awful the night before we should take it easy. Nap if possible. If we slept and feel wonderful we should exercise and strive for progress. It is said that we should view each day as a lifetime in itself, and try our best to balance it accordingly.
From a climactic perspective, we might counterbalance the bitter cold weather with similar choices. As the low temperatures and more difficult commutes exhaust our cellular energy, which is what engenders our immunological energy, all forms of conservation are advisable: Less exercise, less sex, less work (if possible), and earlier bedtimes as often as possible. All of these, with the exception of less exercise for the “New Year, New Me” crowd, are relatively intuitive in January.
As goes the outdoor environment, it is most advisable to eat like Eastern Europeans for now. Think beef or lamb stews, chicken soups, even sausages and pork chops, all of which paired with roasted or steamed vegetables. Vegetables might be sauteed with ginger, garlic, onions, any warming spices to recover from the bitter cold that surrounds us. Duck is actually considered to have a “cooling” effect on the body, although I am inclined to think that a duck confit roasted with onions and garlic and served with red wine should amply warm the body. While 11pm is the advisable bedtime for summer, 10pm is ideal for winter. Beer and other cold beverages should be minimized, as should raw fruit and all forms of sugar. For my apple-loving daughter, I roast them at 350 or 375 for 10-20 minutes with a sprinkle of cinnamon and a drizzle of maple syrup. For myself I would also add clove powder, but it is too spicy for her.
For my purposes, many of you will notice me doing a lot more moxibustion on the body at this time of year. Whether on the belly, along the spine, or at point, “Stomach 36,” just below the knee, no hands-on modality is more effective at regenerating healthy fluids and moving the blood than “moxa.” My opinion is that acupuncturists who do not use moxa at all are likely doing their patients and the entire medicine a disservice, as at its inception Chinese Medicine was not called “Chinese Medicine,” but “Zhen Jiu,” or “Acupuncture and Moxibustion.” Our classical texts dictate: “Use acupuncture to treat ‘yang patterns,’ moxibustion to treat ‘yin patterns’.” My understanding of this is that acupuncture excels at clearing heat and releasing stagnation, but the mugwort is necessary to dissolve unhealthy fluids and regenerate healthy ones.
What are We Actually Craving, in Our Cravings?
Why do many women crave chocolate or dairy more while on their menses? Why do men generally crave beer more than women? Why do some people crave sweets more at night, or wake up in the morning feeling everything from ravenous to having no appetite at all? And how do these tendencies influence future tendencies within our bodies?
Western medicine has no clue—“some people are just like that,” they shrug, or my personal favorite: “That’s normal (as you get older).” Without an intricate understanding of the paradigm of internal (Chinese) medicine, unique preferences and/or habits can be difficult to explain, hence impossible to change.
“I just have a sweet tooth,” people say, which is an expression. What if your will power was not entirely psychological, but partially a result of the state of your internal organs, making it much harder for you to resist temptation than others?
Dryness is an epidemic. It stands to reason in a society that over-prioritizes the yang, masculine energy. While yin is represented by rest, stoppage, sleep, coolness and moisture, yang is work, working out, going out, staying out late, everything out; burning it at all ends, not to mention excessive caffeinated diuretics and overly seasoned or spicy foods.
In Chinese Medical terms stress “depletes the healthy body fluids,” as do NSAIDS, most meds, skipping breakfast, poor sleep, overwork, over-working out, or excessive masturbation. Unfortunately, these are not fluids that can be supplemented through hydration. While it’s great to hydrate, from our perspective this loss is of metabolic/organ fluids that can be restored only through proper rest, herbal medicine, and diet, namely eggs and red meat.
In the meantime, whether consciously or not, we are all craving the ultimate yin. Think breastfeeding: An opportunity to stop everything, be comforted and nuzzled by some soft, fatty, support structure, nourished by its sweet, thick, delicious juice. Since few of us have that opportunity, we opt instead for ice cream or cheese, boba tea, or some delectable hazy IPA—anything thick, sweet, and nurturing in lieu of the adult version of nursing, which might be an early bedtime after a relaxing day. Imagine that. Do we deserve such a thing?
“Nighttime belongs to the blood,” is an expression in Classical Medicine that refers to our healthy body fluids being in charge of evening operations, whereas cellular energy and sympathetic manage the day hours. When a symptom, such as sweet cravings, is worse at night, it further confirms fluid deficiency as part of its etiology. What many women are craving during their cycle, is frankly, more blood. Most don’t have the opportunity to necessarily get more rest, eat more red meat or go to sleep earlier (though if you do, you should!). Instead, they reach for sweets and/or dairy to temporarily satiate the desire to supplement yin. Unfortunately, in doing so this creates more dampness in the microbiome, which makes it harder for the organs to then convert future foods into healthy nutrients, which causes more cravings, and so on. Healthier options for sticky, yin-nourishing substances might be nut butters, smoothies, non-dairy yogurts, or baked apples with some honey.
“Yin-nourishing herbs” are damp. I always think of the foxglove root, one of the most herbs in our pharmacopeia, which looks, but does NOT at all taste like a chocolate brownie. It is rare to meet a patient, man or woman, who does not need some amount of foxglove to supplement lost fluids; although it is even more rare to meet someone whose gut is ready for it. Foxglove is thick and heavy, like boba tea or breastmilk, so if someone has weak digestion, loose stools, acid reflux, etc. it is probably not ideal for them. It is important in our “moments of weakness” to access at least enough will power to reach for healthier alternatives enough of the time, so as to protect our gut health—so that one day our herbalist will give us the green light to truly nourish our yin organ fluids with brilliant substances like foxglove.
3 Tips for Winter Self-Care
With the shorter days and longer, colder nights of winter upon us, it is in our best interest to follow nature to best support well-being. Of course, to some degree it is relatively impossible for most of us to alter most things about our lifestyle based on the seasons. Modern society does not follow, nor concern itself with the Tao. The Tao does not make money nor promise love, and even if it could we are not learned enough in it to follow with much accuracy. Nevertheless, we can still do what we can when we can, make minor modifications, certain mindful choices whenever possible, as I would be remiss to not share.
- Stay warm… but not too warm! While Chinese Medicine is all about warmth, encouraging vasodilation over constriction, if you live in a climate that has the four seasons it does not benefit your “wei qi” (immune system) to never experience the conditions and elements at all. This does not mean go out wearing belly t-shirts, short sleeves, or no socks at the first weather report above 40 degrees. On the contrary, hats and scarves are highly recommended, as is not being overly sedentary or sheltered. A sheltered existence, whether literally or figuratively, creates a weaker shell. For our purposes we might think of our immune system as our shell. Even if just for a commute or walk around the neighborhood, it is important to get outside on most days, bundle up, and not fall too victim to the privilege of modern climate control.
- Sleep earlier. While the recommended bedtime in Summer is 11pm, in Winter it is 10pm. This doesn’t mean get into bed at 10pm, watch a movie until 12, and fall asleep around 12:20. It means to be unconscious at 10:00. For those of us this presents a challenge for, the earlier you can do the better. There is a biomedical belief that for healthy sleep habits, consistency of bedtimes is most important. If one goes to sleep at 1am a few nights out of the week, one should do so every night. From a Chinese Medical perspective, this is a bit like recommending if you eat pizza once a week you should do so daily, so that it is never able to shock your microbiome. Instead, we recommend making the healthiest possible choice as often as possible. Also, don’t eat pizza every week. I love pizza too, but let’s be honest. It’s fast food.
- More (red) meat), less raw food. I know it feels like Chinese Medicine doctors are always trying to get people to eat more red meat and less raw food, but that really is not the case. The summer is a time for both raw foods and red meat in moderation. There can be more days of veganism or pescatarianism in Summer, as excessive beef is too warm for most bodies on hot days. By contrast, Winter is the coldest, most yin time of year. It is the time to protect our bodies’ “yang qi,” or metabolic fire, as we observe in so many other animals as a time to store fat (you can begin your South Beach diet in April). The oppressive cold of yin requires balance in the form of yang-warming ingredients—think steak cooked with garlic, onions, or ginger. If you cannot consume red meat it is advisable to accentuate the warming spices. Please note, this does not mean hot sauce or red pepper, which is a bit to healthy spices what coffee is to much needed rest. It will give a temporary surge of warmth, but in the long run will dry out the healthy stomach fluids, which will make it more difficult to absorb nutrients and generate natural yang inside the body. Spicy food is not “yang,” any more than yelling or shouting is “strong.”
For my part what I can offer for the next few months is more moxibustion, heat lamps, and heated tables when indicated. Burning the mugwort herb on acupuncture points generates healthy warmth and organ fluids in a way that no other modality can, in my opinion. In biomedical terms, it reduces cartilage damage from inflammation by modulating the NF-κB signaling pathway. It also drops pain via the suppression of Cox-2, which is an inductible enzyme that is highly expressed with pain. Recall, one of the oldest Chinese Medicine maxims: Where there is pain there is stagnation. Where there is stagnation there is cold. This is why my office smells like an incense store in winter.
Cinnamon (Donuts?!) for Common Cold
Last week my daughter was sick—it feels almost bi-weekly since starting pre-school, which I understand is relatively par for the course. Sometimes my wife and I both catch it, other times only one of us does, and occasionally we both sort of manage to fight off an apparently diluted version of it for a few days. Fortunately, this time around was the latter.
There is a saying in the west: No cure for the common cold, implying of course that we can take over the counter meds to manage symptoms but there is no actual medication to resolve the virus itself—the best we can do is rest, take care, and let it run its course. This is false. As is the case almost anytime biomedicine claims no cure exists, what it really means is that they have nothing to offer it. Whereas every Chinese Medical text ever written describes countless different viral patterns and presentations and their corresponding prescriptions, complete with the dosage modifications as indicated.
One of the most common herbal formulas given is called Gui Zhi Tang (gway-jer-tong), which contains simply cinnamon branch, paoniae root, ginger, red dates, and licorice. It is often indicated when there is congestion and/or headaches, chills, mild body aches, and mild sweating. If there is no sweating at all and severe body aches, we are more likely to use an ephedra-based formula, as gui zhi tang would be incorrect here.
Cinnamon branch warms the interior of the body and brings healthy fluids and the immunological cellular energy contained within them to the surface of the body. Ginger complements this function, whereas the licorice, dates, and paoniae counterbalance it, regenerating healthy metabolic fluids, preventing the cinnamon and ginger from creating excessive internal dryness and thereby prolonging imperfect health. It’s quite brilliant. Paeoniae has the additional benefit of entering the body’s muscle layer to reduce aches. This is often applicable to chronic pain as well.
Classically it is recommended to drink the formula then immediately eat a bowl of congee rice porridge, get under the covers, and induce a mild sweat to fully and finally resolve the cold. Personally, I have done this in the past with great success. If congee’s not your thing, a bowl of ramen or pho can work just as well—just please no smoothies, yogurt, or salads while sick!
My wife, daughter, and I went to one of the local farms last week, gathering pumpkins and apples for the season, and although refined sugar is a rarity at home, I was compelled to grab some apple cider cinnamon donuts as a seasonal staple. When Peyton came down with her cold I hid some Chinese herbs inside one of the donuts, and almost instinctively she took it over to the couch, sat down, and got under a blanket to indulge.
Surely, the donut did more harm than good, but that doesn’t mean it didn’t do any good at all. In conjunction with the herbs, I spent whatever time I could rubbing and tapping her upper back, over her lungs, a similar premise to using gua sha or cupping techniques at the same location for when people come into the office sick. Some of these techniques might have to be dusted off, as 2023 marks the first in the past few years that people with colds are welcome back, preferably with a mask of course.
As we enter cold and flu season, I hope folks will consider Chinese Medicine, as opposed to taking over the counter symptom suppressants that push the pathogen deeper into the body and potentially create the more notorious pattern, the “unresolved exterior pathogen.” This can be seen in everything from autoimmune to migraines or skin conditions, and often demands the cinnamon branch ingredient as well, though within much more complex formulas, taken over much longer periods of time, and never within a donut.
