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.
If food is medicine then creating each meal should be a bit like writing your own herbal formula. Whenever possible, it should be as agreeable as possible with our unique physiology, though this is admittedly challenging when cooking for a family where everyone has different body types. Nevertheless, one part of each meal should complement the other parts, either through synergistic benefit or offsetting its potentially detrimental qualities.
As a longstanding, traditional example, any time we get Thai or Mexican food, it is served with cucumber or radishes, respectively, which are there to mitigate the side effects of the spice.
Most foods are good, but almost all of them have “side effects.” Red meat nourishes the body’s blood, yin, and qi, but if it were an herb it would be a bit warm and damp. Too much red meat and/or red meat that is not harmonized by the remainder of the meal can create damp heat, or inflammation in the stomach and intestines. Then again too little red meat can cause a deficiency of blood, yin, and qi. Ideally red meat (and pork) would be consumed alongside steamed vegetables, then followed by hot green tea, either after the meal or the following morning (green tea at other times and/or for vegetarians is thought to have a bit too cooling, or vasoconstrictive effect on the microbiome—for them black teas are preferable).
Carbohydrates are settling for both the stomach and the mind—probably why they give us such immediately pleasure—but they are obviously stickier foods, “damper” foods, which are more difficult to digest. For this reason whenever possible, it is best to eat them warm and cooked, and alongside more acrid spices in the meal, such as basil, rosemary, ginger, garlic, or onion. While I am Jewish and from New York, and love a great tuna on a bagel, there is a remarkable difference in the physiological response to cold tuna on bread versus cooked pasta with garlic and oil, maybe vegetables and cannelini beans. Yum!
Salads. Oh boy, do westerners love salad. Frankly, if you tend to any digestive problems whatsoever, raw foods should be avoided as much as possible, but if you must:
Consume salad more in summer—less in winter—and always alongside some cooked protein and/or ginger tea. The acridity of the ginger should help to warm the stomach to digest the raw foods. The protein should provide warmth, plus some much needed calories, or “qi and yin.”
Cooked vegetables, allergies notwithstanding, are probably the only perfect food that wholly lack side effects, which is probably why they are also the one food that nearly every paradigm of medicine agrees upon. If you don’t consume cooked vegetables daily you are on a dangerous path, in my opinion. They are nearly always harmless and beneficial… yet still ultimately inadequate, as we can only imagine the metabolic fatigue and inevitable illnesses to come were someone to consume exclusively vegetables.
Food is a gentle medicinal. It will neither heal nor destroy us quickly on its own, however it will always do one or the other over time. I’ve seen firsthand, in myself, loved ones, and patients eradicate chronic symptoms by pursuing a more Eastern diet, though it took many months—in my case years! People should not get discouraged by eating well for a particular interim and not feeling dramatically better. Instead, pay attention to whether you feel worse (always a possibility), meanwhile recognizing that without internal medicine, diet alone may take a long time to cure disease. It is up to us to continue to better understand the nature of each food, so that we can wisely design the perfect “herbal formula” three times a day until the end of time.
Pictured above is an imperfect, but still great meal: Breaded chicken cutlet, sauteed spinach, and roasted acorn squash with roasted apples, cinnamon, and maple syrup. What is “imperfect” about it? First, fruit should be consumed at least 15 minutes apart from other foods so as to avoid creating its notoriously mucus-like congestion in the microbiome. Also, “natural” or not, let’s be honest: maple syrup is sugar; and chicken is healthier without breadcrumbs. On the other hand, breadcrumbs make up a very small amount of the meal, the apples are at least cooked, hence easier to digest, and the leafy greens with garlic should help to optimally process the meat and sugars.
Patients often ask me what they should eat for breakfast. Most Americans are conditioned to either skip breakfast, have something simple and unhealthy like a bagel or toast, or something “healthy” like yogurt or smoothies. While the latter might check off as such within the context of a scientific laboratory, obviously Eastern Medicines hold that uncooked foods are more difficult to digest, thereby ultimately providing us with less nutrients, in spite of having maybe started with more on the grocery shelf.
While going through Chinese Medical school my own microbiome was a minor disaster, and one of my teachers who was treating me at the time requested I eat sweet potatoes (with my eggs) for breakfast.
“You want me to eat Thanksgiving for breakfast?” I asked. He laughed and asked if I’d ever had eggs with hash browns or french fries. Of course I had, countless times.
He rhetorically asked me what the difference was —if I chopped sweet potatoes in the same way as hash browns, even adding onions to my liking. For years to follow sweet potatoes became my daily breakfast. And many of my health issues gradually improved during that time.
I became perpetually more educated in health and self-care, also about food itself. I learned that sweet potatoes are not in season for the majority of the year, which means during those periods they are, a) not as much what my body needs, and b) likely lacking in their maximum nutrients. From yams it was an easy transition to exploring other vegetables as side dishes with breakfast, which I realized was a good way to get in some daily recommended portions of greens from the start.
For many years now my breakfast has been eggs with a cooked, in-season vegetable, and would struggle to imagine starting the day any other way. In the Winter we eat a variety of root vegetables—whether roasted potatoes, carrots, radishes, or turnips—in Summer it’s more leafy greens. As for the ongoing, raging egg debate, now reignited by many functional medicine docs, all I can say is I’ve eaten eggs every single day for decades. I don’t doubt some peoples’ allergies to them, in which case they should surely avoid until that allergy is rectified. For the rest of us eggs provide invaluable nutrients in a very light, easily metabolized way. In Chinese Medicine they are said to nourish the blood, so much so that the yolk is even an ingredient in the herbal formula, “Huang Lian E Jiao Tang,” which is used to clear inflammatory heat that exists as a result of healthy systemic fluid deficiency. This “blood” benefit is probably why eggs are so highly recommended by many holistic fertility doctors.
EGGS AND “ZUCCH” (as my daughter calls it)
- Pre-heat oven to 375
- Slice squash however you like it, leave all of the slices on the cutting board, and lightly sprinkle them with salt. Let them rest for about 10 minutes (or longer) so that their excess water gets sweated out, then pat them dry.
- Add to pan with olive oil, sprinkle with salt, pepper, and whatever seasonings you like.
- Cook for 15-20 minutes, turning them over once in the middle to roast both sides
- Once almost finished cook your eggs to your liking.
- Drizzle a nice olive oil on top of them once plated
In contrast to the requisite ruling out of red flags by most nurses in conventional medical settings, the reason Chinese Medical practitioners ask about almost every system in your body is because we are diagnosing based on complete patterns—not just symptoms.
For example, if someone comes in for acid reflux, we cannot know their prescriptions until we know how often they urinate or poop, what each one is like, whether they experience headaches or dizziness, which part of the head they get their headaches in, how is their appetite, how thirsty they are during the day versus in the evening, etc. etc. This is because we are one of the only true forms of holistic medicine.
So, what is normal?
A normal amount of urination is approximately 6 times a day (yes, this includes waking at night). Much less than that and you are likely either retaining, or not drinking enough water in the first place. More than 6 indicates either a weakness in the urogenital microbiome, or excessive inflammation in the urogenital microbiome, which over time can lead to local weakness by putting strain on it. The remainder of the intake questions will determine which of the two is the case.
People should sweat, but not excessively so. Chinese Medicine is critical of HIIT or marathon training, hot yoga, and sauna therapy in most cases. While these might all feel great in the short-term and/or be proven to offer certain isolated benefits in the short-term, we believe they ultimately deplete the body’s healthy metabolic fluids. On the other hand, never sweating (exercising) at all is obviously just as harmful.
While some people barely break a sweat even when they exercise, others are drenched by the time they finish their morning commute, especially triggered by certain climates or seasons. The former can either indicate body fluid depletion or a malfunction of the immunological “qi.” The latter can either indicate inflammation, fluid retention, or also a malfunction of the immunological “qi.” This is where diagnoses and prescriptions get tricky.
Many western doctors have now begun to recognize the health benefits of the Chinese herb, astragalus, which on one hand is great. On the other hand, their recognition by way of empirical studies poses the challenge of having no comprehension of Chinese Medicine. If you give astragalus to the former example of a “cold-body person” with a simple immunological malfunction they will feel amazing and sing your praises. If you give it to someone with both immunological malfunction AND fluid deficiency it will do almost nothing. Worse, if you give it to a “hot-body person” with inflammation and fluid retention they will feel much worse.
Finally, it is normal to be thirsty, for 6-9 cups of water per day. A lack of thirst tells us there is fluid retention in the microbiome, signaling to the brain that it’s got plenty of liquid down here—no need to hydrate! This is dangerous, and better to fake it ‘til you make it in acquiring thirst. On the other pole are those who are ravenously or insatiably thirsty, which informs us of inflammatory heat in either their respiratory microbiome, gastrointestinal microbiome, or both, drying out their fluids. As always, the most complicated patterns are those who are generally unthirsty followed by sudden bouts of desperate thirst. This is a combination pattern that requires more thought, trial, and error.
I hope this was interesting and informative. One of western medicine’s shortcomings is its reliance on tests and labs to determine whether we are healthy or normal. While these are undeniably valuable, they tell only part of the story, which is why so many diseases get caught too late. Chinese Medicine is more brilliant in its neurotic recognition of pathologies in any abnormality, any imbalance, as something to rectify before it spirals into disease.
Well, if Covid and seasonal allergies had a lovechild its name would apparently be the upper respiratory pathogens of Winter, 2023. I experienced both personally and professionally, not only the severity of these viruses’ symptoms, but maybe even more troubling was how stubborn they were to resolve. Coughs that would linger for weeks on end, allergies turned to sinus infections, and one friend had the shingles virus transform into a vicious cough, which in my humble opinion occurred because he didn’t properly treat the former with Chinese Medicine.
I am grateful we seem to be passing simultaneously, likely not coincidentally, out of this post-pandemic ripple effect along with the cold weather. Besides dilating the blood vessels of our respiratory microbiomes, thereby giving pathogens wider exit pathways, the warm air should eventually aid in transforming latent mucus and boosting our metabolic energies enough to in turn boost our immunological energies, or “wei qi.”
I plead ignorance, in the past few years more than ever, to most current events, trends on social media, philosophical platitudes, and pop culture; and I often question whether that makes me an “ignorant person”—especially since we will all eventually die still relatively ignorant about most things and peoples. Besides my family, I devote most of my time and mental energy to Chinese Medicine. Whatever is left over at the end of each day are mere scraps, an hour or two at most, and I choose to shut my mind off with friends and/or sports. Maybe in another chapter of my life I’ll read more articles and keep up with external themes and events.
Before blowing my own nose about 50 times a day one week back in January, my lungs exacerbated by the need to rid themselves of phlegm, I had never heard of “the man cold.” Apparently, amongst the infinite social media cliches is one that guys are overly dramatic or whiney about their common colds, obviously underscoring “girl power,” which is a great thing, but also the idea that men are weak(er), which might not be great, or accurate.
Recall the first wave of Covid, we were quickly informed that men, along with the elderly and obese, were most susceptible to severe infections. Why? Well, from a Chinese Medical perspective men have more heat and/or yang qi in the body’s upper region. On one hand it is why we are fortunate enough to have generally more energy. It is consistent with our generally superior upper body strength; though it is also why the inflammatory cytokine response is more intense in the context of upper respiratory viruses.
If you require this be translated in conventional medical terms—and most westerners do—as a result of our increased testosterone and androgens, men possess higher numbers of T cells and Natural Killer cells than women, whereas women have greater B cells, neutrophils and phagocytic activity, which makes them more adept at clearing viruses, as well as the toxins from vaccines. Women also have a greater susceptibility to dysregulation of innate lymphoid cells, which makes them generally more prone to autoimmune disease. (source: https://www.nature.com/articles/nri.2016.90.pdf)
Returning to the brilliant simplicity of Chinese Medical jargon: It is the heat from our body’s (masculine) yang qi that provides ample metabolic strength to regulate our lymphoid cells and avoid autoimmune disease. It is that same heat, left uncontrolled, that creates a more inflammatory cytokine storm in the lungs and makes clearing external pathogens more stubborn. It’s not because your husband is being a little bitch.