Ecology in Chinese Medicine - Part Two
Natures Ecological Strategies
Several years ago, a patient startled me by saying, “I never thought that I’d think of asthma as a friend. Now it really is. I was on heavy medication and frequently had to go the emergency room. It was out of control. Now I do carry an inhaler, but ‘if seems to bother me, I know it is because I’m getting out of control-overdoing it, not eating right or resting, not clearing an argument with family or co-workers. It truly reminds me.”
Symptoms are often much more complicated and do not always become friendly, but this incident highlights two important aspects of acupuncture treatment. The first is that symptoms are generally ways in which your body tries to stop you from creating greater levels of stress and illness. They can be signs from, or protection for, vital organs. Painful joints may prevent an elderly person from straining the circulatory system, for instance. Secondly, acupuncture increases awareness and heightens your ability to have symptoms function more effectively as friends and protectors. It helps you to understand your body’s messages more clearly, and, when possible, to act to stop things from getting worse. And thirdly, there will always be pain and suffering. However, by understanding the role of symptoms, we can learn how to make them more useful in our lives and relieve the pain when the symptom has led to the root.
Ecology in the sense that we are using the concept here in Chinese medicine involves the use of symptoms to lead us to the deepest etiological roots as already described and to nature’s strategies for resolving the pathological consequences.
We must also consider the consequences of ignoring ecology and focus on eliminating rather than learning from symptoms. If we examine the examples described below we find that if we ignore the symptom’s message regarding aetiology and intervention, we will be treating the wrong condition.
b. Specific Strategies
Over the years I have had a number of patients present with episodic depression who did not respond to anti-depressant or psychotherapy [usually the cognitive type]. On inquiry some were also found to experience a wide variety of accompanying symptoms including flu-like symptoms, blurred vision, nausea, constipation, headache and others. All treated themselves successfully by resting, often sleeping, for several days.
A Chinese medical examination revealed people who found no balance between being able to advance [Liver Yang] and retreat [Liver Yin] (see end note 1). They fell into the group of people described as `Type A’ whose personality has been linked to coronary occlusion. Furthermore they all were found with an underlying moderate Qi deficiency often from birth, usually a combination of mild to moderate Kidney Essence deficiency and Heart Qi-Blood deficiency from stress and shock in-utero. All responded well to nourishing formulas and one required thyroid supplementation.
These people differ from the severe deficiencies who never manage sufficient energy to be Type A, unable to advance to that degree and who tend to experience life-long illness that forces them to lead a more moderate life-style in order to survive. They also differ in outcome from the Type A person who is strong enough to persevere through warning signs of impending disaster without the warning signs experienced by our more deficient depressed collapsed patient described above and never retreat. They die suddenly either from coronary occlusion or from stroke, though cancer seems to increasingly be a consequence.
Our responsibility is to inform our patients of their limitations, of their current capacity to function, and how they are going beyond the tolerance of their `terrain’ (see end note 2) . We need to teach them early signs of collapse and depression and constructive methods of retreat [meditation, biofeedback, tai chi, hobbies, naps, etc.] from work beyond their energy.
Unexpectedly, all of the people to whom I have delivered this message have been grateful and did not experience this as a threat to their ego that I had anticipated. All felt liberated and some, men included, cried in relief, free of the guilt that they could not live up to the expectations they had internalized of their family and society. They were liberated.
Collapse in the form of depression is nature’s way of retreating and resting, of imposing a `governor’ on an unsupportable expenditure of energy in the service of restoration and survival.
b. Ignoring Ecology
For example, those patients presenting with intermittent depression and withdrawal who are unable to retreat and rest when their qi is depleted are usually treated with anti-depressants when what they really need is to adjust their lifestyle to spare their limited terrain until the latter can be enhanced.
Most importantly, the result of using anti-depressants for such people deprives them of a true solution of their condition and will perhaps further inhibit their ability to retreat, rest and recover and drive them into more serious disease from which their periodic collapse is protecting them against.
Furthermore, there are many side effects from anti-depressants including weight gain or loss, intense restlessness, panic and anxiety, fatigue, sexual dysfunction, gastro-intestinal bleeding, nose bleeds and bruising. Some, the Atypical Anti-depressants are associated with heart attacks.
Questions have been raised about the use of these medications to avoid dealing with the personal internal issues that are painful to confront yet necessary to psychological growth and change. There is a saying that the most valuable jewel in God’s crown is pain and that pain is what God gives to those he/she loves the most.
I have had several patients, all young women, who presented with a complaint of procrastination. The most recent one, age twenty-two was nearing the end of college and despite putting off studying in favour of going to parties, she was about to graduate with the goal of becoming a social worker and supported herself as a waitress. As she expressed it: “If I need to write a paper I put it off- go to a movie, choose fun over school responsibilities and am easily distracted with great resistance to do what I `should’ do.
She feels that “I cannot let anyone down. I have too many commitments to others as well as myself and feel that I am the caretaker of the entire family-perhaps why I am drawn to social work. I always sought approval-especially as a child.” She is the youngest of five siblings, two brothers, two sisters’ two of whom are step-siblings. Her mother died of melanoma age 37 when she was four years old and she has little memory of her mother. Her father remarried: She loved her step-mother but less so at first bossy step-sister. Her father drank heavily at night and parents argued and recently divorced after her step-mother who was very angry, had an affair and also began to drink but stopped since divorce. She was relieved when they divorced. She attributes her sense of duty and deep self-reproach about her procrastination to “having been raised in a fundamentalist religion full of `shoulds’ and great deal of guilt, which was very narrowly focused and not worldly”.
On review of symptoms and with her original complaints she said little about her energy except that it was better at night and difficult to sustain focus. Throughout our original interview she maintained a cheerful optimistic demeanour. However, her pulse revealed a gradual progression from what was to a varying degree of deficiency to complete collapse. It was as if she could attempt but not sustain function. This was confirmed during our second interview when mention of her collapsed pulse changed her entire demeanour from the cheery young girl to complete deflation, responding with “I am always tired, all I want to do all the time is take a nap”.
There is much more to discuss here than space permits including the obvious rebellion against unrealistic expectations of family and religion.
However, more importantly from the evidence, nature is protecting this young woman from total exhaustion and collapse by reducing the amount of energy expended on academic work through `procrastination’ and instead steering her to energy enhancing `fun’. She does not have sufficient Qi [a True Qi- Qi Wild condition] to sustain long periods of heavy mental focus in addition to support herself financially and the energy expended supporting her family. She is obviously intelligent enough to complete college without extensive academic focus.
There is evidence of a significant insult at conception when father’s alcoholism, especially at night, and her mother’s melanoma [from which she died in five years] could be factors that led to damage to the early embryo and an underlying Kidney Yang-Essence deficiency.
b. Ecology Ignored
Were she not spared this additional expenditure of energy and depreciation of terrain through procrastination and rebellion, we can only guess at where physiology would collapse and pathology ensue, though her history, pulse and tongue point to her Lungs as the likely organ with evidence of a Lung retained stagnant damp heat pathogen. She came with a prolonged upper respiratory infection.
3. Physical and Emotional Withdrawal
Especially during the past fifteen years, younger patients are more and more deficient. A seven year- old girl was brought to me by her mother with the following problems: she was skinny with no appetite [except hot soup], cold, low body weight, anaemic, bowel movements like a rock, always tired with a need to lie down, frequent upper respiratory infections, withdrawn from adults with obvious fear but not children and she was one or two school grades behind. Mother had anorexia during pregnancy and has ongoing hypertension. The child was induced two to three weeks early due to no growth in-utero and weighed four pounds. She appeared very thin, with little emotional expression [flat affect] and obvious fear of adult strangers.
Nature has adjusted to an extreme deficiency of Qi from birth by limiting all the activities that would drain her Qi and lead to serious disease. It seemed clear to me that, though we employed herbs in the form of Shih Quan Da Bu Wan [Ginseng and Dang Qui Ten Combination] cooked with chicken to make a therapeutic soup that she enjoyed-even craved] and other strategies, my principal strategy was advice to the parents to respect her need to frequently retreat [massive qi deficiency and need to regenerate], to eat soups that are easy to digest [to spare her Spleen] and with a little spice to warm her Kidney Yang and circulate Heart qi. Reduced stress in terms of not pushing academic achievement would spare more qi for growth.
This approach based on nature’s own strategy to conserve and nurture her massively deficient qi succeeded over a period of three years to a high level of academic achievement, higher energy levels, greatly increased sociability and affect and greatly diminished fear.
b. Ecology Ignored
Coming from a family of high achievers this young girl could and would not succumb to her parent’s ambitions and be pushed beyond her inherent severe deficits. Her mother, who began to study Chinese medicine, began to recognize that her daughter was simply conserving what little Yang she was endowed, and then at great expense to her own energy, protected her.
With the support of her teachers, this mother’s acknowledgement of her daughter’s innate failure to develop and her protection from pressure to excel gave the little girl the room to gather her resources and grow on the outside help she received. Were her refusal to eat `normal’ foods, frequent withdrawals from both physical and mental activities experienced and treated as stubbornness and punished rather than respected as natures protection, she would have died young or lived a lifetime of endless malaise and illness.
We have already discussed diarrhoea above under `Symptoms as a guide to Intervention’ stating that diarrhoea is one of nature’s strategies to eliminate excess toxic heat from the body. The preferred route for the body to eliminate toxins is downward through the bowels and urine. Some small quantity is eliminated through the Lungs during expiration. It was my practice with excess people to use controlled diarrhoea as a safe way to eliminate toxic heat.
One interesting illustration of this attempt to move heat down is a patient whose feet would become so hot that they could not sleep unless they put them in ice. In all ways this person exuded excess heat including hypertension [`heat in the blood’] (see end note 3) and finding another exit for the heat through the bowels was the only potential solution that this patient rejected.
2. Ignoring Ecology
The toxic heat that is not eliminated through the bowels and urine is intolerable to the body and must be eliminated elsewhere or stored in a `neutral’ part of the body where it is not destructive to vital organs and a threat to life.
Excess toxic heat is sent to the Liver to eliminate through the Gallbladder. Failing that the toxic heat goes into the blood that the Liver stores and circulates through the body to the skin where an attempt will be made to eliminate in the form of perspiration and failing that in the form of skin rashes.
Failing to eliminate it completely through the skin, the divergent channels take the toxic heat to joints, muscles, tendons, ligaments and fascia where it creates an inflammatory condition that leads to other complications that are classified as arthritis and myo-facial fibromyalgia [inflammation the nerve endings].
Heat that remains in the blood will eventually lead to elevated blood pressure and to all of the cardiovascular sequellae including atherosclerosis, stroke and coronary artery disease. The patient with the hot feet mentioned above and who refused the loose stool solution suffered increasing hypertension requiring more medication and one mini-stroke [`wind in the channels’].
5. Thickening Toenails- [“unsightly”]
Many toenails exhibit a thickening for which there are now powerful internal and local medications. However, from a Chinese medical perspective the thickness, attributed to a fungus, has a direct correlation to a systemic phlegm condition in the body. Phlegm is toxic and the body needs to eliminate it, usually in the form of mucous in the stool. If this strategy is not sufficient to eliminate it the body continues to attempt to move it down, and similarly to the excess heat discussed above, the phlegm appears on the toe nails where it makes a perfect culture medium for fungus which prefers the dark humid conditions of shoes and socks that usually perspire.
The fungus on toenails informs me of a systemic phlegm condition, impelling me to consider how the patient is creating that internal environment, what lifestyle habits need to change and what therapeutic action is required to deal with the phlegm rather than medication to eliminate fungus. In classical Chinese medical terms, the fungus is the branch and the phlegm and its cause, the root.
2. Ignoring Ecology
Without understanding that the toenail fungus indicates that a systemic phlegm condition exists which we can prevent through lifestyle changes, the condition will continue to grow internally with extensive damage to arteries [atherosclerosis] to lungs [bronchitis and asthma], neoplasms throughout the body, phlegm misting the orifices of the Heart causing mental and emotional problems, Heart valve problems with growths on the valve leafs and vaginal candida issues for women among other sequellae, including divergence to joints and a highly resistant damp arthritis.
Known throughout history to mothers and physicians, a mild temperature is evidence that a person is capable of mobilizing wei qi [with metabolic heat] to resist external pathogenic factors, and is to be endured and watched.
b. Ignoring Ecology
Efforts to eliminate mild `fevers’ diminishes the body’s innate ability to defend itself, and leaves it open to the more serious consequences of the invasion of external pathogenic factors.
7. Menorrhagia and Nose Bleeds
Bleeding is one way the body eliminates excess toxic heat. In women, excessive vaginal bleeding can be attributed to many causes some of which are ecological, that is, an attempt by the body to rid itself of unwanted pathological factors. The most common is excess heat. In men the most common forms of bleeding are `nose-bleeds’.
The symptom should alert us to this possible condition so that we may address this underlying issue and stop the reason for the bleeding. The source of heat in a person and in that person’s life is where we are directed.
b. Ignoring Ecology
Excess heat over time will cause blood to coagulate which in the female lower burner often takes the form of uterine fibroids. Procedures commonly practiced to remove fibroids include surgery, and one which I heard recently involving injecting a small bead into an artery that feeds fibroids cutting off the blood supply and leading to necrosis of the fibroid.
Neither addresses the underlying issue, the excess heat that led to this blood stagnation and tumour that the body will continue unabated to attempt to excrete or neutralize. I recently heard of one patient who developed severe dermatological problems following a hysterectomy, another attempt to express the excess heat after that had led to the fibroids.
Nor do these procedures address the other common aetiology of blood stagnation in the lower burner, Heart and Circulation deficiency that is unable to overcome gravity. Gravity, and the forces required to surmount it, has been a challenge to human physiology since man first stood erect and is one of the most overlooked influences on pathology in the lower body.
`Nose-bleeds’ are nature’s safety valve in men with excess toxic heat in the blood and elevated blood pressure, at risk of a stroke. As a child with my grandfather and as a medical intern I became aware of this relationship between `nose-bleeds’ and stroke and how suppression of the bleeding [cauterizing the plexus of vessels in the lower part of the nose] seemed to increase the incidence of stroke.
8. Hot Flashes and Sweats
Persisting in the textbooks is the idea that hot flashes and sweats are a Yin deficient condition. This puzzled me since the same books recommended a formula, Er Xian Tang [Two Immortals] whose individual herbs are:, Yin Yan Huo [Epimedium (9-15 gm)]; Xian Mao [Curciligo (9-15gm)]; Dang Gui [Angelica,(6-9gm)]; Huang Bai [Phellodendron (6-9gm)]; Zhi Mu [Anemarrhena (6-9gm)].
Two of the herbs, Yin Yang Huo and Xian Mao are primarily for Yang deficiency and expelling wind-cold-damp. Regarding Yin deficiency, with Yin Yang Huo there is a disparity between The Materia Medica [3rd Edition] which says that “This herb should not be taken as decoction over a long period of time, as it can injure the yin” (see end note 4) and Formulas and Strategies (see end note 5) where it says “Herba Epimedii also tonifies Yin and Yang”. While in Formulas and Strategies it says “Cortex Phellodendri nourishes Kidney yin and drain fire from deficiency”, in The Materia Medica, quoting the Materia Medica of Combinations it equivocates about the Yin nourishing issue and finally says about both Huang Bai and Zhi Mu “ mistakenly used, as the water becomes dried [by their bitterness], the fire will blaze even higher, and contrary to one’s intention, yang will become separated from yin and fly away. This is irremediable.”
In my opinion, hot flashes are Yang leaving due to a separation of Yin and Yang that, according to the formula Two Immortals, is as much or even more a deficiency of Yang than Yin. A severe deficiency of either will cause this separation and, as the Materia Medica of Combinations poetically expresses it, Yang will “fly away. The hot sweat is Yin trying to follow the Yang and natures attempt to heal the separation of Yin and Yang. The reason this occurs more at night is because the sun’s energy during the day compensates for the inner Yang deficiency and also inhibits the Yang escaping.
b. Ignoring Ecological Strategy
If the body does not excrete Yang, it will rise in the body causing conditions varying from headache to stroke, depending upon the degree of the person’s excess heat condition and other factors such as the ability to safely emit the excess through other avenues [bowels].
9. External Pathogenic Factors [EPA] including Allergies
If the Wei Qi is strong EPA and allergens will be repelled without symptoms. If the Wei Qi is deficient a second round of defence comes into play that involve symptoms including running nose, tearing eyes to exude the invader from nasal passages. Bronchioles and bronchi contract to prevent the invader reaching Lung alveoli causing asthma-like symptoms. We already mentioned elevated temperature.
The vast thrust of both Western medicine and recently, regrettably, Chinese medicine is to eliminate the symptom, the very mechanism that is preventing the invasion of dangerous factors that could cause much more severe disease. I am for recognizing the vital function of these symptoms in the service of defence and alleviating them only in the context of reinforcing the Wei qi whose deficiency requires their presence.
b. Ignoring Ecology
Already mentioned is that suppressing the symptoms that nature has provided as second lines of defence against EPA when Wei qi is deficient is counterproductive, and leads to pulmonary diseases, bronchitis and pneumonia, that are difficult to treat and are debilitating.
Using the largest organ in the body, the skin, perspiration is the medium by which the body eliminates whatever its homeostatic mechanisms deem a danger to health. Control of sweating, the environmental barrier, is exercised by the Wei qi. If the Wei qi is deficient the sweating can be excessive, putting the body in danger of dehydration.
b. Ignoring Ecology
Measures that inhibit sweating in the interest of decorum, body odour, endanger the organism by preventing the elimination of toxic material that will otherwise be retained and as a retained pathogen wreak havoc in the vital organs or in the areas where they might be diverted [Divergent Channels], such as joints.
If we suppress perspiration rather than inquire, we can lose enormous amounts of information that could lead us to important knowledge of our solid-hollow organs and the general nature of our body condition [terrain]. For example, if the perspiration occurs, spontaneously with little or no exertion we surmise significant qi-yang deficiency, especially of the Heart. If the sweat is hot we surmise an internal excess heat condition and if cold more of an internal cold, Yang deficient condition. If it is oily we suspect a very serious, even terminal Heart Yang deficiency. If it occurs at night and stops when awakened the condition is more serious that if the sweating continues after awakening.
Suppressing the perspiration would obviate this critical diagnostic information and drive the pathogen even deeper and later more inaccessible and ultimately dangerous to vital organs and function.
Signs and Ecology
Signs, the pulse, tongue, colour, abdominal palpation etc., as well as symptoms, communicate the ways terrain is interacting with stress. While they do not per-se tell us as specifically as symptoms how nature attempts to resolve the distress, the implication of aetiology is there in the signs.
The Pulse (see end note 6)
Each pulse quality is a sign of the organism's attempt to restore equilibrium, or of its failure to do so. For example, a Rapid Rate is often a sign that Heart qi is deficient and that it must work harder to meet its physiological mission. The left distal position will be Feeble rather than Tight, a sign of Heart Yin deficiency, or Robust Pounding with excess heat in the Heart.
Reduced Pounding, Reduced Substance and Diffuse qualities can be a sign of an organism attempting to compensate for working beyond its `energy’. And an Empty pulse is a sign that the compensatory restorative measures are failing. Our attention is drawn to searching for the reason, either in the underlying deficiency [terrain] of that organ or in the life-style that is causing it to work beyond its ability.
Floating qualities are associated with acute disharmonies. The Floating quality is a sign of an attempt to eliminate heat or cold that is invading from the exterior. This quality is a sign of the body’s attempt to restore equilibrium. It is an indication for the practitioner to assist this process by enhancing Wei qi rather than suppressing it by eliminating the accompanying symptoms of running nose, sneezing, sweating, light temperature, wheezing and cough, all of which are back up manoeuvres to eliminate a pathogen.
The Flooding Excess quality is a sign that the body is attempting to eliminate accumulating heat in an organ, for example, acutely as with fulminating hepatitis, cystitis, ileitis, or chronically as with the chronic forms of these diseases.
The early stages of chronic disease are almost entirely due to interference with normal function that we call stagnation and which frequently goes unobserved clinically. The Tense quality is most common at this stage. Attempts to resolve stagnation lead to the appearance of heat necessary to overcome stagnation with qualities such as increased Tense [`string-bow’] and a mild degree of Robust Pounding in an attempt to eliminate the heat. If that attempt fails, toxic heat accumulates and the Robust Pounding increases proportionately.
If it cannot do this through the normal channels, the intestines, urine, skin and expired gases [lungs], some of the heat enters the blood so that we have Blood Heat. This can progress to Blood Thick and Hollow Full-Overflowing qualities, signs of increasing heat in the blood and the pulse may become Rapid.
If attempts to eliminate the heat are not successful the body must provide fluid [yin] to balance the heat. This gradually depletes the Yin and especially Kidney Yin which is the principal source. The qualities change to Tight and Wiry and the pulse may be a little Rapid. At the blood depth the Slippery quality will appear as a sign of turbulence. Later, as the heat inflames (see end note 7) the walls of the vessels a Rough Vibration will appear at the blood depth. When heat accumulates blood begins to stagnate and we will have the Choppy qualities, especially in dependant areas such as the pelvis.
Over time this attempt to overcome stagnation and eliminate heat depletes qi as well as Yin. We move to a Diminished or Yielding Qi Depth and then Spreading qualities, a Flooding Deficient Wave, then Deep and Feeble-Absent qualities. The final step in the process of qi depletion are the qualities associated with the separation of Yin and Yang such as the Empty qualities [Empty, Scattered etc.] and Changing Qualities as well as those associated with damaged parenchyma such as Rough Vibration, Unstable and Non-Homogeneous. Blood deficiency usually accompanies qi deficiency so that the pulse might also become Thin. While in women a Thin quality is common [menstruation], In men the Thin quality is considered a serious sign.
From these few examples we see that the pulse qualities inform us how nature is attempting to deal with stresses that is afflicting function, Robust Pounding to eliminate excess heat, Heat in the Blood telling that the body is unable to eliminate it through normal channels and is diverting to holding patterns.
Furthermore, the pulse is informing all of this often before the onset of symptoms and provides us with the most sophisticated early warning system, a working preventive medicine, ecological in the best sense.
Ecology of the Individual
Ecology is a branch of biology concerned with the relations between organisms and their environment. The human being is an organism and his environment are his genes, the lifestyle of his parents from conception to adulthood, the exigencies of that passage involving others and finally himself and the inner being that evolves. It is part of our ecological task to discover and make those connections for our patients, to encourage their awareness of who they are and how their various environments were involved. Simple questions such as why do you eat to assuage emotional pain, why eat so rapidly or irregularly and sacrifice yourself to ambition, can lead to the most profound insights, to the root of their pain and fear. These connections are the ecology of the individual.
Among those called to heal, including myself, the strongest impulse is to relieve suffering, to alleviate the symptom, the messenger. I am presenting this paper to remind practitioners that the messenger, the symptom, can direct us to the stress-terrain interplays of lifestyle and constitutional viability, to the individual, and as importantly instruct how nature heals, from which we can learn valuable interventions.
From conception, an inherent intelligence ceaselessly engages and adapts our innate terrain to life’s stresses, shocks and trauma. We can only learn from this intelligence and rarely improve on it if we recognize and respond quickly to its messages. Respect the symptom, respect your nature; don’t kill the messenger.
1. Hammer, Leon I. M.D. :Dragon Rises Red Bird Flies, Chapter Nine; Eastland Press, 2005
2. Hammer, Leon I. M.D.; Terrain, Stress, Root-Vulnerability; 2009 Unpublished
3. Hammer, Leon I. M.D.: Inflammation in Atherosclerosis; Medical Acupuncture, Vol. #15, No 2, 2003
4. Chinese Herbal Medicine, Materia Medica; Eastland Press, 2004, P. 776
5. Chinese Herbal Medicine; Formulas and Strategies; Eastland Press 1990, p. 262, 139
6. Hammer, Leon I. M.D; Chinese Pulse Diagnosis; A Contemporary Approach; Eastland Press, 2001, 2005
7. Hammer, Leon I. M.D.: Inflammation in Atherosclerosis; Medical Acupuncture, Vol. #15, No 2, 2003