Welcome to Chinese Medicine Bristol's official blog! Here, Acupuncture and TCM pracitioner Sandra Arbelaez will share information about Acupuncture and Chinese Herbal Medicine, how they work, and the latest research and developments related to TCM. You will also find knowledge and ideas on how to enjoy a full, healthy life that she has picked up over the course of 15 years of exploring the world of natural health

Tuesday 21 August 2012

Conscious breathing: living beyond survival

The human body cannot survive long without air
Air is essential for life, it is in fact the only thing that we need at every moment in order to stay alive. The human brain becomes oxygen-starved after just a few minutes without air, after which the rest of the body dies. Despite this, the intake of air – breathing-, and the quality of this air, are totally taken for granted by most of us.

Although the actual exchange of gasses between the body and the environment pertains to the respiratory system and to some extent to the skin, breathing is an action performed by every single cell in the body. At a superficial level, there is a seemingly simple exchange of gasses, we take in air and retain its oxygen and expel carbon dioxide and other gasses our body cannot use. At a deeper level, this action has the essential function of providing every cell in the body with oxygen. Oxygen is the fuel mitochondria need to turn nutrients into the energy needed for proper functioning of all cells, and for the elimination of waste products - such as carbon dioxide - which could otherwise interfere with cell activity.

Just as at the cellular level respiration is related to energy production and elimination, at a systemic level dysfunction in breathing mechanisms or insufficient intake of oxygen are bound to affect energy production and are likely to lead to an accumulation of toxic or waste products. Thus, if we fail to breathe properly or the quality of our air is poor, we may encounter problems of increased toxicity and dysfunction in energy production at every level. This may be a contributory factor to the host of “syndromes” -  collections of symptoms - of unknown cause or cure which plague modern societies.

TCM views:

"Air Qi" is one of the basic ingredients for health
Although mitochondria and cellular respiration were not understood in ancient times when TCM theory was developed, the concept of “Air Qi” (Kong Qi) - the basic nourishment we extract from air - as necessary for the integrity of the body appears in the ancient texts. In fact, Kong Qi is seen as essential for life as a basic ingredient in the production of the Qi that fuels the functioning of all organs of the body and that provides protection from disease. When Kong Qi mixes with Gu Qi (the nourishment extracted from food) they combine to become Zong Qi or Chest Qi, the energy behind the functioning of the Lung and Heart and by extension of the Respiratory and Circulatory systems. Catalysed by Yuan Qi (the essential energy from the Kidneys) Zong Qi then becomes Zhen Qi or "True Qi" which will provide fuel to all tissues of the body, to all organs and systems,  and will also provide protection from disease.

Coming directly from the air, Kong Qi is most closely related to the Lungs. How much nourishment or Kong Qi we receive, will depend not only on the quality of the air but also on the ability of the Lungs to absorb and process this nourishment. This is very much like the digestive process where the nourishment extracted from our food depends not only on the quality and nutritional value of what we consume but on our ability to extract and metabolise its goodness. This is in Chinese Medicine the realm of the Spleen. The health of our Lungs and our Spleen are thus the most basic constituents of the health and integrity of our whole body and mind as these organs provide the basis for optimum functioning of all organs.

Just as in the West we have grown used to being “under-nourished” by virtue of consuming foods that are high in toxicity but which contain little in the way of nutrition, we have also become habitually under-oxygenated not only because of air pollution but because we have forgotten how to breathe.

Making an effort to breathe:

Breathing can be affected by our life-style and environment
You may wonder here, how come since breathing is mostly an involuntary action, do I say we don’t breathe properly? Although breathing is controlled by the autonomic nervous system and mostly occurs involuntarily, it is a function over which we can also exert voluntary control. Breathing is thus linked directly with the conscious mind and its “automatic” functioning is designed to keep us alive but we need conscious effort to go beyond the surviving into the optimum health level. Banking on the involuntary process of breathing for our “air nourishment” may provide us with enough Kong Qi to subsist but not necessarily with enough to enjoy full health.

When we do not "make the effort" to breathe correctly, our breathing can easily be negatively affected by the following:
- Too much exercise: Although moderate exercise can enhance breathing capacity, too much or exercise that is too demanding can in fact have a detrimental effect on breathing. It is a well-researched fact that athletes are more likely to develop lung problems than the general population (1).
- Lack of exercise: While moderate exercise encourages deeper inhalation and strengthens the Lungs and Heart, doing no exercise at all will not only result in bad posture which in itself affects the way we breathe, but also results in shallow breathing and subsequently poor oxygenation in all the cells of the body.
- Air pollution: As a natural reaction, we do not inhale deeply when the air around us is laden with fumes, bad smells, or dirt. These may be characteristics of the air in some of our modern cities which have the consequence of inhibiting our breathing and damaging our health.
- Emotions: Sadness, fear, anger, stress, anxiety, etc., make us breathe shallowly and prevent us from oxygenating fully. As emotions affect our breathing in many different ways, leaving our breathing “unattended” will allow them to control our oxygen intake and affect the whole of our health.
- Poor nutrition: Poor nutrition affects respiratory health in more than one way. When we do not get all the nutrients we need, cell reproduction and the functioning of all body organs are compromised. In addition to this, when we overwhelm the body with foods which have little nutritional value but are high in fats or chemical additives that the body does not know how to use, a build-up of these chemicals may affect mucous membranes throughout the body and result in inflammatory processes even in the respiratory system (2).  
A lack of balance in the diet and excessive intake of certain foods such as milk derivatives and wheat-based products can also result in excessive production of mucus which can end up blocking the air passages. I have seen countless cases of people who have a moderately balanced diet but consume large amounts of bread, pasta, milk, cream, and cheese, and as a result spend their lives gasping for breath as the amount of mucus in their air passages impedes proper breathing, More often than not, stopping wheat and dairy products completely results in clear air passages and an improvement in respiratory symptoms.


Conscious breathing:

Our breathing is affected by many things without us even realising and, as a result, most of us are not getting enough oxygenation, which in both Western and Chinese Medicine terms can only compromise our health. Because of this, breathing awareness or conscious breathing should be a part of our everyday life. Practising even just a few minutes of conscious breathing on a daily basis will not only remind your body of how to breathe properly but will also provide every cell of your body with more oxygen.

This is a very easy exercise which can have powerful effects on the breathing:

Sitting up on a comfortable position, make sure you feel your weight being supported by your sit-bones and, if you are sitting on a chair, that some of the weight is felt on the soles of your feet which should be placed flat on the ground. Place your hands comfortably on your knees. Take 3 or 4 deep breaths and become aware of areas of tension, trying to let go of this tension as you breathe out. After this, feeling more relaxed and comfortable you can perform this conscious breathing, try to do it for a minimum of 3 minutes: 
Inhale really slowly through your nose, first expanding your abdomen allowing it to fill with air, then expanding your chest to its maximum capacity without straining yourself. Stop for a few seconds. Exhale slowly through the nose gradually allowing your chest to come back to its normal position and emptying your abdomen by contracting it gently. Stop for a few seconds. Repeat as many times as it feels comfortable without feeling strain or discomfort. When you have finished, take a few normal breaths before you continue with your day.

Practising this exercise regularly can improve your Lung health and contribute to increase your energy levels, enhance your metabolism, and provide you with an amazing tool to achieve emotional stability. Deep breathing not only aids the oxygenation of every cell but returns us to the present moment where all the frustrations and resentments from the past do not exist, and where all the anxiety and fear about the future are irrelevant. Conscious breathing can provide you with a window into yourself; this is why observing your breath is one of the most basic meditation techniques. Deep breathing not only makes us aware of what our mind is doing but it gives us access into deeper levels of our being


Taking it further

Although just practising the above exercise will benefit your health, there are other things that you can do to literally “clear the way” for health-giving air and oxygen to reach the deepest levels of our body. These include:

- Exercise:  Moderate exercise such as walking, non-competitive cycling, and gentle swimming can enhance breathing capacity and circulation resulting in a more efficient respiratory system and increased circulation that will improve oxygenation of all the cells in your body.
- Diet: As mentioned above, foods laden with chemical additives and fats can contribute to inflammation in the respiratory tract and have a detrimental effect on Lung function. Avoiding these foods is essential for good respiratory health. In addition, wheat and dairy products which tend to have a strong presence in the UK diet, need to be either minimised or cut out completely at least for a period of time as they make the body produce excess mucus and can contribute to blocking the respiratory tract. If we eat these foods in excess on a daily basis, we give no chance to the body to process them correctly and end up with and accumulation of mucus that can result in serious illness.
Following a balanced diet following TCM principles can instead encourage good digestive and respiratory health.  

Breathing clean air regularly can benefit our whole health
- Breathing clean air: For those us who live in bustling cities full of fumes and other pollutants, it is important to have access to clean air if not daily at least on a regular basis. At home, house plants -apparently some more than others (3) - can do some of this work for us; as does keeping at least one room in your house smoke and dust free. Negative ions are also useful to clean the air of air-born particles that can cause allergies and blockage of the airways (4). Air purifiers or ionisers may be useful for those who live too close to big roads or in airless buildings. Most of all, making sure that you get out of the city regularly and breathe in deeply some pure air is the best way to ensure cleansing and energising breathing. Practising conscious breathing in the open air enhances its benefits and will also make you feel more in tune with nature and with yourself. 

"Nourishment" comes in different forms. Although there is much talk of nutrition and diet, breathing and proper oxygenation are often overlooked and taken for granted. As Air Qi (Kong Qi) and Food Qi (Gu Qi) are the basic ingredients to the functioning of the whole body, acquiring good eating and breathing habits is key to maintaining our health. We are not just we eat but also what we breathe!



(1) This article by Abbie Thomas discusses several studies that have found athletes to be more susceptible to lung disease (Accessed online 13/8/12) http://www.abc.net.au/science/articles/2000/09/06/171793.htm

(2) This study by doctor Lisa Wood shows the link between lack of proper nutrition and the consumption of junk foods with inflammation in the respiratory tract (Accessed online 20/8/12) 


(3) A suggested list of the house plants that produce more oxygen to help us keep healthy air at home (Accessed online 20/8/12) http://www.secrets-of-longevity-in-humans.com/oxygen-producing-plants.html

(4) This article from the Penn State University College of Engineering explains how negative Ions can clean the air (Accessed online 20/8/12) http://www.engr.psu.edu/iec/abe/control/neg_ion.asp

Tuesday 7 August 2012

What's in a headache? A TCM view

Chronic headaches can be disabling
Most of us have experienced a headache at one time or another during our adult life. Nevertheless, it may be hard to believe that many people suffer from headaches during childhood and teenage years; and that some very unlucky individuals experience recurrent headaches or migraines that can even occur on a daily basis. According to the World Health Organisation, over 80% of adult females and two-thirds of adult males in developed countries suffer from tension headaches, while up to one adult in 20 experiences headaches on a daily or almost daily basis (1). Not only that, but migraine headaches -the most studied type of chronic headache- is one of the top 20 causes of years lived in disability. All in all, headaches can be a disabling symptom that can substantially diminish the quality of life of sufferers and affect their relationships and work productivity.

Conventional medicine classifies headaches into two main types: Primary and Secondary. Primary headaches are those that occur independent of any other condition, while secondary headaches may occur as a result of injury, infection, circulatory disorders, conditions that affect the brain, toxins, alcohol and drugs, or medication. The most common primary headaches are tension-type headaches which often occur as a result of stress, bad posture or life-style, migraines which are severe headaches usually accompanied by nausea and light sensitivity, and cluster headaches which are very severe headaches that come in bouts of weeks of months and tend to affect one side of the head and the back of one eye. Common secondary headaches include those caused by trauma to the head, medication overuse, and pain-killer overuse. The twisted reality experienced by sufferers of chronic headaches is that they may not only have primary headaches but also develop secondary headaches as a result of regular intake of pain killers (2).

Conventional treatments for chronic headaches are limited to different types of pain killers and anti-inflammatory drugs, vasodilators (drugs that make the blood vessels dilate), and nerve blocks for the occipital nerve in the case of very severe recurrent headaches. Besides the risk of side effects from long-term daily intake of these drugs, sometimes even the strongest painkillers will not make a difference when the headache is severe while vasodilators and anti-inflammatory drugs only work for some people but not others. Similarly, nerve blocks only seem to work for certain types of severe headaches. As a result, many people experience disabling symptoms that not only include the headaches themselves but tiredness induced by chronic pain, stress from not being able to perform normal activities or work, digestive problems from medication over-load, and many more. 

 Traditional Chinese Medicine (TCM) views:

TCM diagnosis is not limited to the symptoms
“Different treatments, same disease” is a commonly quoted TCM statement. Headache is a good example of this as different individuals presenting chronic headaches may receive completely different TCM treatment approaches. The reason for this is that in TCM many factors are taken into account before defining a person’s diagnosis and subsequent treatment. Energy levels, quality of sleep, the functioning of different organ systems, and emotional issues - just to name a few - are invariably part of the case history and will serve to inform each individual diagnosis. At the centre of this we will find the specific characteristics of the headache such as the quality of the pain, the patterns such as time of day and factors triggering or worsening attacks, and the specific site of the headaches as well as the quality of the pulses and the tongue. 

There are two basic mechanisms that can trigger headaches: excess and deficiency. Generally speaking, excess is reflected by fullness, blockage, and strong acute symptoms; while deficiency is reflected by emptiness and moderate symptoms that may nevertheless be more constant and debilitating. Deficiency is basically a condition of emptiness and under-functioning of the body, in turn Excess conditions consist of accumulation and blockage usually due to toxicity and products that the body cannot either metabolise or excrete. Both excess and deficiency can be caused by lack of moderation in diet and life-style, exposure to extreme climatic conditions, toxicity, and a general lack of balance between rest and activity. In many cases, excess symptoms (“full” and severe) can be caused by long-term deficiency; and vice-versa. This makes the diagnostic skill of the practitioner essential to provide long-term relief although short-term relief can be easily achieved with acupuncture. Once the causative factors have been determined, a suitable diet and relevant changes in life-style should be recommended so that headaches are not unwittingly being triggered by daily habits.

The most common TCM patterns involved in chronic primary headaches are detailed in the table below, based on Maciocia's  in-depth explanation of TCM patterns of heada
ches (3). Bear in mind this is not a comprehensive list, just the most common patterns encountered at the clinic, and that your individual constitutional traits should be part of the picture too.
Possible TCM diagnosis
Headache characteristics
Other possible symptoms
Excess patterns:

Liver Yang rising
Intense, severe, throbbing/stabbing pain, affects one or both temples/eyebrows and can be felt behind the eyes acute pain. May be accompanied by nausea/vomiting, visual disturbances, can occur during the weekend after an intense/stressful week.
Dizziness, tinnitus, deafness, dry throat, insomnia and irritability may be part of the picture.
Liver Fire
Similar to headache from Liver Yang rising but more intense and more fixed in one place. More likely to be accompanied by nausea/vomiting
As above but more intense symptoms plus symptoms reflecting fire such as thirst, bitter taste in the mouth, constipation, red eyes.
Liver Qi Stagnation
Intense pain, not throbbing. Affects forehead or temples. May move from side to side. May be caused by anxiety/stress.
Pain or distension in the rib area, nervous tension, poor digestion, belching, flatulence, bloating.
Dull/heavy pain, may feel as if head is tight. Affects the whole head or forehead. Thinking may be difficult and symptoms may be worse in the morning.
Persistent catarrh, nausea, poor appetite, fullness in chest/epigastrium.
Deficiency Patterns:

Liver Blood deficiency
Pain may be moderately severe. Affects top of the head and sometimes forehead. May be worse in the afternoon or evening or occur at the end of menstrual period. Lying down can bring some relief. May be worsened by tiredness.
Low energy, poor concentration, poor memory. Insomnia, dream-disturbed sleep, irritability. Tired and dry eyes and floaters in visual field.
Kidney deficiency
Dull ache, felt in whole head or “inside the brain”; sometimes affects the occiput. Dizziness and a feeling of emptiness in the head may accompany headache. May be triggered by strenuous or sexual activity.
Lower back ache, weak knees, frequent urination, dizziness, tinnitus. Either night sweating and hot flushes or constant feeling of cold.

TCM treatment:

Acupuncture for headaches
Acupuncture can be very effective for relieving pain during an episode of acute or chronic headache and will also aid relaxation which will further contribute to bringing pain relief. I have seen how regular acupuncture treatment can dramatically reduce the severity and frequency of recurrent headaches. This is more often than not supported by suitable changes in life-style and the reduction in analgesic medication.

Chinese herbal remedies may be needed in cases of very severe headaches or in cases where the headaches have been occurring over a long period of time. Herbal remedies will also help solve underlying disharmonies particularly when there is a deficiency behind the chronic headaches.

What you can do:

 1. The following foods and substances can by their very nature contribute to the imbalances underlying chronic headaches. In addition, caffeine and other stimulating substances literally force Qi upwards thus directly contributing to the headaches themselves, so all of these should be avoided by all chronic headache sufferers:
  • Stimulants such as coffee, tea, coca cola, and other caffeinated drinks.
  • Alcohol and drugs
  • All artificial chemical substances which can produce toxicity and blockage in tissues and in the digestive system thus preventing the absorption of real nutrients. These include chemicals additives, preservatives, colourings, and flavourings. Pre-pepared meals and junk foods will invariably contribute to the underlying causes of your headaches unless you actually recognise the contents of the products you buy as "food". If the packaging says "natural" colourigns and flavourings, it does not mean the product is natural. What it means is that there is as substance "extracted" from or "chemically similar" to something natural, so do not fall for this.
  • Spicy, greasy and heavy foods, and eating late at night: This will create heat in the body and contribute to stagnation in the Stomach and in the Liver channel. When Qi becomes blocked or stagnant and cannot flow properly through the channels, pressure may build up which sends the Qi upward quite vigorously like vapour in a pressure cooker. This can result in many symptoms including severe headaches.
  • Mature cheeses, chocolate, red wine, coffee, oranges, and orange juice are notorious headache triggers so best to stay away from them.
    2. Instead, all headache sufferers would benefit from:
    • Nourishing yourself according to your needs: A balanced diet consisting of freshly prepared food and adequate amounts of protein depending on your level of activity is key for the management of chronic headaches. TCM regards food and drink as the fuel that provides the whole body with Qi and Blood. Without this, there cannot be long-lasting improvements in any chronic condition. Consuming the right foods, in the right amounts, and at a suitable time of day is recommended. A TCM practitioner can give you specific advice on this but a general overview of diet and digestion according to TCM can be found here. 
    • Sufferers of Excess type headaches need to exercise moderation with food and drink especially heavy and difficult to digest foods as they can create further blockage and increase the severity of their symptoms
    • Those who experience Deficiency type headaches may be able to consume moderate amounts of spices such as ginger and cinnamon and should make sure to consume good quality protein on a daily basis. Meat eaters may get away with good quality chicken or meat once per day but vegetarians need to ensure a constant supply of protein and consume some form of it with every meal, preferably not cheese but pulses, nuts, seeds, soya products, or quinoa.

    Relax and rest 
    Relaxation can help reduce the severity of headaches
    • Avoiding stress as much as possible could help you avoid a potent headache trigger. If this is not possible, you can follow some of the tips in my previous post on stress. 
    • Migraines and headaches related to the menstrual cycle are often associated with stress and with lack of rest. Avoiding stress, practising relaxation techiniques, and having enough rest is particularly important especially in the days preceding menstruation, and during it. Becoming familiar with what happens with your hormones throughout the month and how to maintain a healthy cycle could be helpful. Visit my post on the menstrual cycle for some tips.
    • Relaxation techniques can help us cope with pain. The normal response to any kind of pain is to tense up in an attempt to feel less pain. However, tensing the body can only contribute to increased pain and easily initiate a vicious circle in which pain levels increase due to our physical reaction. Learning to relax through breathing, yoga or meditation techniques can greatly contribute to our ability to cope with pain as it enables us to “relax through the pain” thus making it more bearable. Similarly, treatments such as massage, acupuncture, and reiki can induce deep relaxation and a parasympathetic response that can counteract headaches. 
    • Sufferers of chronic headaches need to make an effort to balance rest and activity. Both not moving at all and doing too much – work, exercise, sexual activity- and comparatively getting the wrong amount of rest needed to restore your energy, will contribute to the imbalances that cause chronic headaches. Making an attempt to use your available energy wisely will have a beneficial effect on you whole health.
    • Moderate exercise encourages the movement of Qi and alleviates symptoms produced by the blockage of Qi and Blood particularly in sufferers of Excess type headaches. Conversely, strenuous exercise such as running, may provide temporary relief but can also contribute to the mechanisms behind headaches so be careful about the type of exercise that you choose. A qualified TCM practitioner can offer you individualised advice as to the most suitable types of exercise for you.
    • Those who experience Deficiency type headaches need to be more careful about exercise and only do any if their energy levels permit it. Exercising when tired, during the menstrual period, or just after it, may exacerbate deficiencies and contribute to headaches.

    Try not abuse pain killers    
    • As mentioned at the beginning of this post, frequent use of pain killers can induce what is called “rebound headaches”, which is a type of secondary headache. This only occurs in people who are susceptible to headaches and makes life extremely difficult when the primary headaches are frequent and severe and pain killers are necessary.  
    • Apart from therapeutic approaches that can provide pain relief such as acupuncture, massage, healing, or aromatherapy; exploring ways of coping with pain such as relaxation techniques, yoga, and self-hypnosis may be worth a try so that you do not have to resort to pain killers all the time.   

     The TCM organs most frequently involved in chronic headaches are the Liver, Kidneys, and Spleen. It may be useful to read my previous posts on these organs to learn how they work and how to prevent them from getting more out of balance.

    Chronic headaches make life very difficult, and often there is not much help to be found from the medical profession.  As with many other chronic conditions, headache sufferers often do not realise that their diet and life-style may be not only contributing to headaches but also triggering them. Becoming aware of this and learning to adjust your life-style will not only give you tools to improve your symptoms but will most certainly benefit your general health and well-being as a whole.


    1. The informative fact sheet on headaches from the World Health Organisation. Found online here: http://www.who.int/mediacentre/factsheets/fs277/en/
    2. The NHS informative page on headaches caused by painkiller overuse. Found online here: http://www.nhs.uk/Livewell/headaches/Pages/Painkillerheadaches.aspx
    3.  Maciocia, Giovanni (2008) The Practice of Chinese Medicine: The treatment of diseases with acupuncture and Chinese herbs. 2nd edition. pp. 1-64.