Arthritis
What do Gout, Varicose Veins, & Neuropathy Have in Common?
What do neuropathy, gout, and varicose veins have in common? In western medicine not much, aside from being awful inconveniences, ranging from sources of extreme pain to discomfort and/or a significant cosmetic preoccupation.
For neuropathy you go to the neurologist, for gout to the rheumatologist, and for varicose veins you might see your primary care, who will likely refer you to a vein specialist. The neurologist may or may not inquire about venous circulation, and it is very unlikely the rheumatologist will ask about numbness or tingling in your feet.
But from a Chinese medical perspective, all of these conditions fall under the heading of impaired circulation in the lower extremities, caused by either weakness, inflammation, or both, leading to a misdistribution of bodily fluids, which exacerbates the former, which exacerbates the latter, and so on.
They are different in specifics only as a result of individual genetic proclivities—in fundamental mechanism they are the same. Someone with a colder bodily constitution—prone more to hypothyroid or hypotension, will be more susceptible to varicosities, whereas people with warmer body types—prone more to hyperthyroid or hypertension, will be more susceptible to gouty arthritis. The former are well advised to eat plenty of lamb and red meat, while the latter might consider being mostly vegetarian.
Neuropathies can go either way in the way of temperature, as they are more telling of issues with fluid metabolism. We find that neuropathy patients are either unusually thirsty, unusually not thirsty, or they urinate excessively or not enough. In either case, their body is clearly weakened to some degree, and it is imperative they get to sleep by 11pm, so nerves can properly regenerate.
While inadequate urination obviously leads to fluid retention which can clog neurological pathways and impair circulation, excessive urination can dry vessels of their healthy synovial fluids, causing us to feel parts of our body we previously took for granted as being unaware of.
Holistic medicine should modulate the organ function that is causing the improper excretion of fluids in addition to treating local blockages causing pain or discomfort. Easier said than done of course, as such conditions generally took many years to form, plus might be aggravated by present challenges, such as diet, stress, or medications being used to treat other conditions. However, through a course of treatment of acupuncture, herbal medicines, and dietary modifications, one should see improvement over a proper course of treatment, 120 days.
Please be discerning in your choice of clinician. If you see someone—whether east or west—who is failing to assess or treat beyond the immediate site of pain or discomfort, I would highly recommend getting a second opinion.
Spring Wind!
Did anyone else notice how many times in the past week the weather said something like 52 but felt more like 32? Spring wind! In the lunar calendar we are already well into spring, the season the ancient Chinese correlated with pathologies of “wind.” What does that mean?
“Wind pathologies,” in Classical Chinese, basically refers to anything that moves within the body. Think joint pains or almost any pains, also neurological tics, from Restless Leg to Parkinson’s disease, finally many dermatological conditions that traverse different body parts and seem to constantly change in shape or surface area covered. Where does it come from?
The pathology of autumn is dryness, hence all the foliage drying up and sinus issues it commonly brings. Following is the bitter cold of winter, which consolidates said climate of dryness, constricts our blood vessels, thereby offering fewer pathways for lubrication, whether to our skin, orifices, or otherwise.
Dryness, in Chinese medicine, whether manifesting as a lack of blood, lack of healthy blood, mucosal metabolic fluids, or parasympathetic neurotransmitters, can give rise to physiological symptoms that might be metaphorically described as “wind.”
Another cause can be literal wind, as it gusts down the avenues and seemingly even turns corners to blow hats off our heads and make 52 degrees feel like 32. This causes a local constrictive response in the head, which contains our autonomic nervous system, which manages a great part of vital organ function. Am I suggesting the entire body is connected and that which accosts the head can in turn accost our entire physiology? Yes. Ask anyone who’s suffered a concussion. What can we do?
Wear a scarf. Wear a hat or a hood. Wear a hood over your hat. Wear a mask beneath the hat beneath the hood above your scarf. You don’t have to be sick or paranoid to wear a mask in the cold and/or windy months of the northeast. You can simply be protecting your many cranial nerves that traverse the face and have far-reaching physiological implications. Modern fashion is such that there are many stylish options for these accessories. With all we have already working against us—modern stress, western diet, the simple biology of aging—doesn’t it make sense to do the simple, little things to prevent or prolong the scale from tipping into Parkinson’s?
As for “wind prevention” by way of treating the root, which is to say nourishing blood and vital fluids, I have mostly the same old boring, science-based advice: Animal protein, eggs, cooked vegetables, small portions of rice or pasta, meditation, and going to sleep before 11pm. As for accessible, food-grade Chinese medicine, tea made from red dates, licorice, and/or pearl barley can also be helpful. For the spring we also recommend more sour foods, kraut, lemon, and/or vinegar with the intention of “astringing” as many of our good fluids as possible.
Lastly, happy Mercury Retrograde, an admittedly somewhat ironic salutation to those who “observe.” Remember to expect delays in transit and traffic and problems in technology and communication. Double check who you’re sending that text or email to. Accept that things will go wrong. Try to breathe. Ask people to clarify before shouting back at them. Breathe again.
(photo from a fun shoot back in 2007, one year pre-Chinese medical school!)
The Nuance of Positive Thought
As many of you know, I suffer from congenital gout disease, inherited from my father, surely exacerbated by growing up on an American diet, in addition to my own part of culpability in adolescent self-destruction. Thankfully, it is under control with an Eastern diet and medicine, a victory I take great pride in.
Between the winter holidays I am as guilty as many of pushing the over-indulgence envelope (relative to my own standards), and one night last week, as our toddler was giving us a hell of an evening in resistance to sleep, I experienced some pain in the distal inter-phalangeal joint of my big right toe (always the culprit, interestingly located on acupuncture’s meridian that corresponds with the pancreas!). It was the perfect storm of parenthood physiology: The body needs twice as much rest and self-care, and is allotted half (if you’re lucky). Needless to say, I was worried, as we all are when our Achilles heels rear their heads, that this would “turn into something.”
Because of said toddler insubordination, the subversive from within, plus an early workday the next morning, my wife and I had already conceded a good night’s sleep. Instead, just to unwind, we put on our latest favorite show, I soaked my feet in hot epsom salt water for 20 minutes, during which I needled points on my left hand to treat my right foot (a particular style and technique many of you have suffered through at my hands, no pun intended).
The next morning I woke up tired, only moments before my daughter did, insisting, requesting, yelling, and crying, offering me no moment of reprieve or transition into consciousness (it truly never ends) as I got everything ready for the day. I was tired. My head had that subtle pounding to it that heads have after going down too close to midnight and/or waking too early. I felt irritable and frustrated. BUT… my toe was pain-free!
When we are exhausted or irritable about something or someone, it can be challenging to focus on the positive—look at the bright side instead of the hole in the donut. I spent the day reminding myself, each time I got annoyed or felt resentful, of my right foot, my big toe, how much worse that could have gone, what it could have meant for the week to come, and how big of a disaster I avoided. Not to mention that my daughter did have pre-school the next day and the weather was nice! There have been instances in the past where my joint pain worsened, school was out, I was on full-time Dad-duty, and the weather was awful. All considered, I was very lucky. Sure, I was tired and the day wouldn’t feel or probably go as I’d planned or hoped, but I repeatedly made an effort to return my focus to that toe, and all the things that had gone right.
Patient sometimes come in and apologize for telling me everything that’s still wrong when overall they’re doing much better and so many things are positive, and I remind them that my office is the place to focus on the negative. Apprise me of every imperfection as it aids in the diagnostic process in our aim for physiological optimization. In the remaining 23 hours of every day though, try to focus on that healed part of you that was previously headed in a drastically different direction. I understand it’s not always that easy—the negative is not always as simple or temporary as a bad night’s sleep, a mild headache, or argument. For such instances I extend my sympathy and support.
Tom Brady & Nightshade Vegetables
If he isn’t universally considered the greatest football player of all time, he’s at least objectively the most successful. Supposedly, one of Tom Brady’s secrets to success was an extremely strict diet, which was about 80% plant-based, organic, paleolithic, with abstinence from sugar, alcohol, soy, condiments, frozen foods, gluten, and nightshade vegetables.
Nightshade vegetables include white potatoes, tomatoes, eggplants, and bell peppers, and although all of these contain nutrients, they also contain a compound called solanine, a natural pesticide that can be toxic in high concentrations. People with irritable bowel, autoimmune, and/or arthritic conditions can be more vulnerable to solanine’s adverse effects—in Chinese medical terms, it creates dampness, or inflammation in the gut, which gets sent “outwards” to our joints. As someone who has battled gout disease off and on for twenty years, I’ve recently decided to experiment with nightshade abstinence. When it comes to self-experimentation, I generally recommend and adhere to the rule of the life cycle of a red blood cell, which is 120 days, or about four months, so I’ll let you know how things are when I reach the finish line.
Potatoes are an easy workaround, since sweet potatoes are safe, not to mention healthier overall, and delicious. I’ll miss French fries, but I’m an adult, and let’s be honest, they’re probably one of the worst things we can possibly eat. Eggplant and peppers are generally easy to avoid, but tomatoes will be tough. I love sauce and meatballs, not to mention a good caprese salad as we approach the season, however I do not love any of these things as much as I do my internal organs. Potential workarounds in said Italian realm are sauceless meatballs (+olive oil), pesto sauces, or garlic and oil primaveras, the latter of which sans peppers of course.
In playing with diet, I’ve found the same benefit I once did when imposing creative restrictions on myself as a comedian many years ago. For example, at one point I chose to not do or write any jokes about race anymore, simply because they’d become so ubiquitous and hacky on the circuit. I got so bored of hearing them that I couldn’t bring myself to perpetuate the problem, no matter how unique I thought a particular idea of mine was. By “censoring” myself in this way I think I became a superior writer, forced to think harder and write more imaginatively. Similarly, when we omit certain foods from our diet, we might be forced to broaden our horizons (just use Google!), expand our minds and at-home menus, and probably discover new foods that we love, and more importantly love us in return.
If you suffer from any chronic joint pain, autoimmune, or intestinal condition I would invite you to join in my self-experiment and see how your body feels. You/we don’t have to commit to forever. Just four months to intelligently reassess. If you prefer to wait until after tomato season you can enjoy throughout the summer, begin after Labor Day, and resume nightshade indulgences again for the winter holidays. As humans go, it seems the second most common time of year to clean up our acts after New Year’s is the end of summer, in the wake of vacations, ballgames, beers, and barbeques.
None of us can become Tom Brady on the football field, but it would be nice if our internal organs and systems could be as close as possible to the Tom Brady’s of our bodies. As we weaken with age, I believe the most logical antidote is strength in discipline, in hopes of maximizing physical freedom through restrictions or subtraction. Less is more, as they say, a fine maxim to default to under the spell of American food.
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.”
