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Migraines & Headaches

The Physiology of Wildfire Smoke (in NYC)


While the sepia tones and brush aromas from this week’s Canadian wildfires’ spillover to the northeast might have looked great in a photograph, or smelled enticing in 1% of its dosage (if seated by a campfire with marshmallows), on the ground in real life it was daunting, and for many systemically disruptive. Personally, I was outdoors plenty, both on my commute and on my break at Union Square farmer’s market, albeit with a mask on, and thankfully did not experience symptoms.

Chinese Medicine nicknamed the lungs “the delicate organ,” which really they are not—in fact quite the opposite—however what is meant by this is their being most and primarily vulnerable to external pathogens. Toxic fumes are an external pathogen. They dry the sinuses and respiratory microbiome, which can bring with it symptoms such as chest oppression, frontal (or maybe temporal) headaches, and of course, dryness. Or as my wife and I learned, if you are a 2-year-old trapped indoors as a result, rabid, recurring cases of cabin fever.

The formula everyone needed at least one day of at home this week was “Xiao Chai Hu Tang,” or “Minor Buplureum (root) Decoction.” It includes buplureum root to clear heat from the upper body by increasing circulation downwards; pinellia root to dissolve accumulation in the chest and sinuses; scutellaria root to clear heat specifically from the lungs; ginseng to generate healthy fluids in the stomach to protect it from the bitter nature of the other herbs; ginger to warm the stomach for a similar reason; and finally licorice and red dates to generate healthy fluids in the stomach, chest, and central nervous system.

It’s no wonder this is one of the most commonly prescribed herbal formulas in Chinese Medicine. Nevertheless, it should almost always be modified according to the individual; especially those with low energy, low appetites, and/or aversions to cold weather. Typically, these were the body types I saw most impacted by the air pollution this week. Frontal headaches, dryness in the throat, and chest oppression, as a result of the external toxicity exacerbating their pre-existing internal toxicities as a result of metabolic dysharmony. Not to worry, as my father always said. There’s hope.

If any symptoms are lingering and you are not presently coming for acupuncture or taking herbs I would recommend any or all of the following:

  • Hot mint tea, maybe with honey, to open the chest, cool, and lubricate the sinuses
  • Asian pears, or fresh pear juice, also to lubricate the lungs and sinuses.
  • Rice congee with chopped up pears, red dates, some honey and cinnamon—YUM—to generate healthy fluids in the respiratory and gastrointestinal microbiomes.
  • Gentle exercise, such as qi gong, yoga, or deep breathing. NOT… outdoor running, for the love of God.
  • If nothing else, just stay hydrated, preferably with room temperature or hot water. Cold drinks constrict blood vessels, which obviously then traps local inflammation.

These are great treatments to treat only the branch of the problem, as its root cause is of course Republicans.

Can It Be All Stress?


“It’s just stress,” is a diagnostic platitude commonly heard by patients when relaying either to friends or their doctor about some odd or non-immediately fatal symptom that lacks any conventional, empirical treatment.

It would be an over-simplification to label this stock response as wholly or always dismissive—in my opinion it is more often a result of the listeners’ lack of knowledge of physiological nuances, disease spectrums, and of course the entire internal paradigm of Chinese Medicine.

The mind is en vogue in the past generation, so much so that people jump at the opportunity to sound mentally acute even while being mentally lazy in its default citation as a scapegoat for everything, the way fat was in the 20th century or sugar is now. It makes them feel aware of the more mysterious, all while maintaining an orthodox adherence to conventional medicine’s present understanding of things. I picture people picturing themselves as if sipping a small cup of whiskey wearing Coke bottle glasses and a bowtie in their reply: “It’s (probably just stress),” then putting their cup back down and nodding their head as if they’d just cured HIV.

While no one could dispute that stress is an important variable in the etiology of most illnesses, it is also just that: One important variable. So why when we have curious symptoms that conventional medicine has no explanation or treatment for do they never say: “It’s just diet?” “It’s just your sleep hygiene?” Or: “It’s just your exercise routine that needs refinement or reduction, or simply needs to exist?”

Why when one person experiences incredible stress does it show up as digestive issues, while for another it does as insomnia, and another as hives all over their skin? “People are different,” idiots might shrug and say, which isn’t untrue, but is an egregious oversimplification. People are different, which means if we each consumed diets and partook in exercises suitable to our own individual constitutions, we’d likely be able to ward off the ill effects of short or even medium-term life stressors.

If stress causes you low back or neck pain we know there is “dampness trapped on the exterior layer of the body.” If stress causes stomach issues we know there are already stomach issues, since most or many people can endure stress without such symptoms. If stress causes headaches or migraines then there was likely already some dysregulation of cerebrovascular flow in particular neurological pathways

In this way stress can be invaluably informative, by tipping our internal scale and showing us where we are weak, where in our bodies we are retaining pathogenic fluids, so we can properly treat, instead of dismissing it. Because odd, inexplicable symptoms are never nothing. They are not “all in our minds” or insignificant. Instead, from a Chinese Medical perspective, sadly they are potential coming attractions—foreshadows of diagnoses to come.

I apologize if this sounds dark or ominous. My intention is the opposite, to offer optimism and agency to those of us who have been repeatedly implied to that we must resolve all of our internal turmoil in order to be free of a particular problem. While I am all for a daily practice of meditation, prayer, community, and anything else that reduces stress, we should be able to also rely on medical providers to step in with something more to offer during periods where our practice of psycho-emotional work and discipline just is not enough.

Smart Discipline for Smart Phones

Most blessings in life bring particular challenges, often in the form of implicitly required discipline—other times in the form of added responsibility and/or reliance from others. Think fame, wealth, or parenting. Most of us are familiar with the inverse Buddhist principle, that every challenge brings particular blessings, in the form of greater wisdom or opportunity for growth. Think… parenting again? I beg your pardon for my present tunnel vision.

Smart phones, technology, and even social media, in my opinion, have been enormous blessings in many ways. We no longer need to write down geographic directions or suffer the inconvenience and frustration of getting lost on unknown roads. We no longer need to get into unnecessary arguments with loved ones over “what year that album came out,” since every such debate can be easily and definitively resolved within seconds. As for social media, I’ve personally used it to reconnect and mend old friendships, as well as to further my Chinese Medical studies in groups online.

On the other hand, most of us are familiar with the troubles caused by modern technology, whether directly or indirectly, neurologically, psychologically, and/or socially. First, from a Chinese Medical perspective, staring at a screen for the better part of everyday depletes the body’s blood and healthy body fluids. From a neurological perspective, we know that frequently checking any device is a form of constant, miniature gratification, and that our brain’s neurotransmitters do not operate as well under constant stimulation. Not to mention the potential psychological and intellectual drawbacks of viewing the world largely through this particular filter, as opposed to good old-fashioned, interactive reality.

I’ve observed my own relative addiction to social media in the past, never spending much time scrolling, growing easily bored, nevertheless checking the apps quite often through each day. On my commute, on any elevator, upon waking up, even while watching sports on TV (I mean, how sad is it that it has become normalized to multi-task technological distractions? We are truly in the future); obviously it doesn’t sit well with my goals for self-discipline.

In many cases complete abstinence is a form of non-discipline and/or an emotionally induced over-compensatory response to a pathology. Moderation is often not only more logical, but more difficult. To that end, for some time now I’ve made it a point to turn off email notifications only on weekends, which doesn’t mean I don’t check my email at all, but my brain gets spared a couple of days of unnecessary constant dings.

Second, I make it a point while watching TV in the evenings, to not keep my phone within arms’ reach, but instead on the other side of the room with the ringer turned on. My rule is not orthodox, in that I might still occasionally bring it over to read or search something, but once finished I return it to its “station,” instead of mindlessly using it as another distraction.

I almost never text while walking (down the street), which I think is as irresponsible to our own neurology as drinking and driving is to the safety of others. With obvious exceptions, I try to keep my text and email responses to three times out of each day. My opinion and observation is, if you reply to everyone/everything as it comes in you’ll slowly lose your mind.

Finally, I’ve taken to abstinence from social media on Friday through Monday every week. This ensures that I look at it less than half the days in the week, but on those days I don’t restrict myself from popping on as much as is organic (although since self-implementing this restriction I genuinely think the urge or idea to check them comes up less frequently). There have been many times in these days that I note the proverbial light go off in my mind—“time to check Facebook”—reminiscent of when I once quit smoking—and much like my once nicotine victory I simply ignore the light until it perpetually pops up less and less. My wife’s taken a different approach, by requesting her phone limit the amount of time spent on certain apps in each day. You can do this under Settings – Screen Time – App Limits. Either approach makes sense.

I think smart phones and social media are or can be very positive things, but much like automobiles and animal protein, they should be used mindfully, cautiously, with the understanding that just as in medicine, anything that has the power to help also has the power to harm.


The “Unresolved Exterior Pathogen”

I think one of my favorite concepts in Chinese Medicine is that of the “unresolved exterior pathogen.” What does it mean? When we catch a cold, whether bacterial or viral, most cases should be vented, sweated out, while we rest as much as possible and consume warm foods, such as the classic chicken soup to support our “wei qi,” or immunological cellular energy.

Obviously most modern people do not do this. We take over-the-counter cough suppressants, congestion suppressants, anti-pyretics, and every other suppressant to make us feel as comfortable as possible until the cold resolves… or at least appears to.

This is a totally understandable mistake. First of all, most people don’t know that Chinese Medicine can treat the common cold (along with nearly everything else under the sun), and even if they did herbalists and herbal medicine are not readily available to most.

From a Chinese Medical perspective when a cold is suppressed it gets pushed deeper into the body, from the “wei qi” or immunological layer, to the organs and metabolic layer. Anyone have digestive issues since having Covid-19? This is an “unresolved exterior.”

More common symptoms of unresolved pathogens include rheumatological, dermatological, or orthopedic; autoimmune joint pain being the most self-explanatory, which makes orthopedics not far behind it. Lingering “dampness,” residual plaques or mucus from an exterior pathogen go latent, and if we’re lucky enough that they don’t create the kind of molecular mimicry to over-activate our immune system they may lodge into our muscles, tendons, and ligaments. While neck and back pain during a common cold are well-known, pay more attention to such symptoms that linger in their wake. It usually indicates fluids that should have been sweated out are trapped wherever we happen to be orthopedically most vulnerable.

Thankfully, we’ve gotten to a point where few people are any longer terrified or paralyzed by Covid-19. Most of us are more or less going about our lives taking varying precautions—this doesn’t mean we cannot at the same time respect our opponent.

After I had Covid I continued to consult and get treated by mentors for at least one month after symptoms resolved, with the obvious intention of prevention and full resolution, not just from a biomedical standpoint, but from a more neurotic, perfectionist Chinese Medical assessment. I wanted to ensure that my tongue looked like my tongue again—also that we took steps to avoid any of my own constitutional proclivities from rearing their heads as a result of any unresolved inflammation.

While going through Chinese Medical school it was fascinating to think that my eczema and ski conditions that I’d had all my life may have been a result of an improperly treated cold I had as a baby. Or to view my low back or knee pain as not something relegated exclusively to the orthopedic surface and/or old athletic injuries, but connected to my systemic inflammation. I beg your pardon for my broken record tendency in refutal of one my greatest pet peeves:

“Holistic” does not mean everything alternative, “New Agey,” nor related to spa treatments, nor gentle or weaker than biomedicine. It means analyzing all symptoms and systems as interconnected and the incredibly more challenging task of treating accordingly.



My Own Covid Story

When my wife texted me two Friday nights ago that she’d had a persistent cough throughout the day, juxtaposed to the emoji for concern and/or terror, I was unperturbed. Over the course of the now close to three years into this pandemic, we’d both seen this play enacted by one another many times over. A cough, a headache, a tickle in the throat or oddly stubborn congestion, and like any typical urban, Jewish medical professionals we immediately grasped for one of our many rapid Covid tests in the closet, crossed our fingers, and hoped for the best; and were always rewarded as such—that was up until last week.


My wife continued to test negative for her first 24 hours, even as symptoms were worsening: Headache, body aches, fatigue, all to the severity that she figured if not covid it must have been the flu. Regardless of the biomedical disease label, her Chinese medical pattern was her Chinese medical pattern, so I dutifully drove to the pharmacy in Chinatown to get her what I hoped was the perfect formula. By the 48th hour she tested positive, just at around the same time she’d begin her herbs and self-quarantine. We only hoped it wasn’t too late for the baby and me.


I felt fine for another two days, playing Super-Dad, cooking all meals plus Chinese herbs, caring for the baby, and leaving meals on the floor outside of the dreaded infected room. Unfortunately, once woken in the night, our 15-month-old refuses to return to sleep without the comforts only Mom can provide. They ended up spending the night together and within another 48 hours I had a tickle in my throat so subtle that three years ago, or even three days ago I would have thought nothing of it. A mild cough that could have just as easily been the kind of mild seasonal allergy symptom exhibited by those of us lucky enough to not much suffer with seasonal allergies. Hoping against hope that maybe it was psychosomatic or even a stretch of a coincidence, but within six hours I was writhing on my bed with a 100.4 fever (not terrible), plus a cough and rather heated oppression in the chest. Still testing negative, but immediately emailed one of my mentors for a virtual consultation the following morning.


My first twelve hours were rather awful: One of the worst occipital headaches I’d ever experienced, low back pain that was reminiscent of after my Covid vaccine, and a queasy lack of appetite that is as foreign to my own constitution as it is to most common colds. Covid’s unique strength is in the sticky nature of the spike protein, “damp” as we’d coin it in Chinese medicine, obviously evidenced in its well-known cerebrovascular and gastrointestinal complications, as well as brain fog, which can all be explained by either modern psychoneuroimmunology and/or good old fashioned, Chinese medicine. The muscle aches, for example, are the excess body fluids on the surface fighting the pathogen but temporarily losing, as is apparent by the lack of sweat I was still experiencing.


My brother was my angel, kind enough to use his free time to run to Chinatown for me, pick up the formula written by my mentor, and drop it off at my building, so that I wouldn’t lose a day. Covid is the kind of disease that evolves rapidly, entering the body at one “organ level” but quickly traversing to the next if not immediately and appropriately addressed. My brother understands just enough about Chinese medicine to know this logic, so I needn’t explain to him the urgency, in spite of well knowing mine was not an “urgent” case by biomedical standards.


By this time my wife was 80% better, the baby practically asymptomatic aside from some odd eating and sleeping habits. I felt much better by my 24-hour mark, though my “pattern” did shift, as the headache and muscle aches had abated and I was left with a burning sore throat. I called my mentor for another consultation, as we had to change the formula, this time with an intention of clearing heat from the lungs. Once that was clear I was finally left with a low-grade brain fog for a few days, which was resolved with formula #3, a return to more aromatic herbs to dry the leftover fluid retention in the gut. No, I did not request my brother make any more trips to Chinatown, as I felt up to driving in myself, requesting they bring my bag of herbs outside to exchange safely on the sidewalk.


All told, it was approximately a one-week process for myself, probably a bit shorter for my wife, and a lot shorter for the baby, and I thought it all too appropriate to not share, doing what I do for a living, and this all having fallen the week before Thanksgiving.


We have much to be grateful for through this experience, first and foremost of course being our health and full recovery. While I realize the majority of the western world has been “over this” for quite some time, and the present variant is supposedly mild, I suspect the latter hypothesis to be applicable mostly to those who are on their second or third times around. For our household this was our first—we were naïve enough to believe we might even evade it—and although we managed, it was no fun going through it with a 1-year-old. Though we made it through, and to this end my primary gratitude goes to Kamwo Pharmacy, of course my brother, and Chinese medicine in general; while the western world continues to box acupuncture in as some nifty new age modality to treat muscle pains, at its inception it is the most thoughtful form of internal medicine, and all of its classical literature is more or less wholly dedicated to illnesses like coronavirus. I hope should any of you contract it in the future you’ll allow me to help first.



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