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 9 September 2014

What lies behind a symptom

Are we a collection of un-related organs?
Our modern model of thinking makes us try to make sense of the world by searching for the single cause behind each specific phenomenon. This is true also for symptoms of disease. To this, add the shared view of the body as a collection of separate organs, tissues, and chemicals that somehow have very little to do with each other despite the fact that they are contained in the same package, sharing the same fluids, and being kept alive by the same source. 

These views result in an extremely limited understanding of the workings of the body and of how illness my develop, which in turn makes us unable to effectively maintain our health. No matter how many “single causative factors” of specific diseases we address, we do not seem to improve our chances of fending off illnesses. This is constantly shown by the reports on the increase of chronic, often incurable, conditions all around us.  

In addition to this, we have come to regard feeling unwell as a nuisance that prevents us from carrying on with our usual tasks. This is due partly to societal pressures regarding productivity and a competitive environment that makes many people feel like they should try harder; and partly to lacking a basic understanding of our own needs. Thus, we have developed a tendency to be oblivious of small symptoms -those little niggles we notice but which don’t really bother us that much- in the hope that they will go away by themselves. By the time chronic illness sets in, often stopping us from doing things that we would usually do without thinking, we will have probably experienced minor symptoms over months, even years. Only then, we start to visit doctors expecting them to find the single thing that is causing all our symptoms, to then give us a magic treatment that will take it all away so that we can go back to “normal”.  This may work or, as in so many cases, may not. 

I know this not just because I see it in my clinics all the time, but because I have experienced it myself. We all seem to expect our body to be able to carry us without giving us trouble, no matter what we do to it. So, like most people around me, I spent many years of my life under immense stress, eating rubbish, drinking too much alcohol, overdosing on coffee, sugar, and tobacco, not drinking enough water, not eating enough vegetables, over-exercising or at times not moving at all for months on end, and never sleeping enough. I was still rather annoyed and even surprised when -while still in my twenties- everything stopped working, and the doctor could not find how to fix me. At the beginning, the drugs from the doctor did bring some relief, but the relief became increasingly short-lived until chronic kidney failure became evident and I felt like an exhausted and achy 90 year old inside my youthful body. Somehow I had got to believe that, after years of mistreatment, my toxicity-laden, malnourished, stressed, and exhausted body should be able to fend off disease and move freely, always.  And when it didn't, I then regarded it as a massive nuisance that would just not let me carry on with my life. I just wanted it all to go away so that I could go back to “normal”. 

What I eventually realised was that “normal” was in fact a major cause of my symptoms. Thus, going back to “normal” every time I felt a little better, was only ever going to make the symptoms come back, either in the same way, with greater intensity and severity, or at a different level of my system; and it did. This is what happens. It may take weeks, months, or years - it doesn’t really matter - the point is that even if we get some respite from our symptoms, if we go back to not meeting the basic needs of our bodies, they will most probably come back to haunt us. 

The good news is that once we acknowledge the fact that what we do in our daily life can have enormous impact on our health orillness, and start taking responsibility for our own well-being, the possibility of improving our health in the short and long terms opens up in front of us. This is no fast or easy route for sure. It took me many years to "undo" the damage I had done to my body and to develop enough understanding of my own physical, emotional, and mental needs to be able to maintain my health. This involves ongoing effort to understand the changing needs of my body that occur in response to the aging process and to the constant changes in my external environment.  The pay back for all this work and the work that countless amazing practitioners have done with me over the years, is that I feel stronger, happier, and more supple now that I am in my forties than I did during my twenties. More importantly, when I do succumb to self-indulgence and excess, as one does from time to time, I know what I need to do to restore balance. Although I do not see this as warranty that I will never be ill or that I will live to be over 100, I know for sure that cultivating my own well being is not only enhancing my health but enabling me to fully enjoy my present life.

The holistic view
A symptom is a warning that something is wrong
In holistic medicine, a symptom is viewed as a message from our internal body, telling us that something is wrong. Just in the same way as the little lights on the dashboard of the car announce that the engine is overheating or that petrol is running low, a symptom is there to call our attention to a specific area or function of the body or just to the fact that something, somewhere, is not working properly. Just like it would happen if we ignore the dashboard lights, ignoring a symptom will not necessarily make it go away.

Chinese medicine theory provides a framework to help us determine the origin of a symptom so that both the symptom and its cause can be addressed at the same time. In this theory, all the internal organs are connected to each other and to all parts of the body through a network of vessels and channels that allow the flow of Blood, energy, and fluids between them. When an organ fails to function properly or the free flow is interrupted in a particular vessel or channel, this can have a knock on effect on different parts of the body, resulting on a symptom that, when using our Western understanding, could seem totally unrelated to the originating organ. Through detailed questioning and examination, a TCM practitioner seeks to map out all symptoms into a coherent diagnosis that will link them to the internal imbalance that has caused them. Once the underlying cause of the symptoms has been identified, a practitioner can determine the best treatment options, as well as the most suitable dietary, and life-style changes that will not only enhance treatment effects but prevent their recurrence.

True TCM in fact regards the prevention of illness as the most important form of treatment. This is why in the Chinese culture, the talk of health and longevity is commonplace and many of the traditional customs reflect an understanding of what the body needs at different times of the year and at different times of life. This understanding is what we have lost in the West. We have grown accustomed to hand the responsibility for our health and well-being to other people – scientists, pharmacists, doctors, nutritionists, therapists, etc. –, and lost the ability to look after our most basic needs in the process. We also lost sight of two important sources of knowledge:
  • Our instincts regarding what is good and bad for us: This is how other animals know what to eat or not when they live in the wild. Without it, they would be very confused and even keep poisoning themselves, just like we do.
  • The experience of past generations: This is how our grandmothers found out that garlic and elderberry were good remedies during the cold season, and where they got their knowledge of what nutritious food consisted of. They, unlike us, did not need experts to tell them that both garlic and elderberry contain immune boosting, infection-fighting compounds, or that fresh, locally grown, seasonal food was the best nutritional choice for the family. They just trusted the experience of the many generations before them and acquired the knowledge passed on from their elders.

So there is a strong need to go back to basics and relearn how to look after ourselves. Only then, we will be able to wisely integrate the incredible amount of knowledge acquired by science in the last few hundred years with the much older knowledge ingrained in our cells and in our culture so that we try to stop the current trends that will make the next generation become disease-ridden far too early in life.

But a change of attitude is also needed here. We need to develop self-care, self-love, and self-respect, and to understand that giving ourselves everything that we crave is not conducive to long lasting wellness or happiness. 

Your body is for life, not just for Christmas
Changing our ways
I find it interesting that we tend to look after our cars much better than we do our bodies. Our cars are considered deserving of a good weekly clean inside and out, a regular check-up, and at least one full service per year. We are acutely aware that petrol cars shouldn’t get filled with diesel, and that we regularly need to supply them with air, water, and oil. We would not expect our cars to run smoothly without the appropriate care. Yet, although we have at least a vague idea of the kind of things we should be doing to maintain our bodies in working order, not only do we fail to do them but also expect the body to be just fine for it. You can argue that it is a question of safety and that we look after cars so that we do not kill ourselves on the road. This is of course right, but let me ask you if you think it is “safe” to treat your body in a way that you know is going to make it prematurely degenerate with the possibility of spending decades of your life dying in painful slow motion? 

I often hear the argument of “enjoying life while we're here since we’re going to die anyway” as an excuse for complete disregard to the body’s needs. I don't really think it is about dying or not dying- it's going to happen to all of us anyway! -or even about how old we are when we die, but about how well we want to feel when the time comes. After all, diabetes, chronic pain, arthritis, depression, anxiety, IBS, or Chronic fatigue syndrome - just to name some common chronic conditions that any of us could develop- will not necessarily kill us any faster. What they can do, is take increasing amounts of pleasure out of our lives over a period that can easily expand between years and decades. After my experience of daily pain, exhaustion and a host of debilitating symptoms over several years, I am convinced that every effort we make to stay healthy is well worth the long-lasting pleasure of knowing that every morning when we get out of bed I can look forward to the fullest experience of life we can possibly get. 

In the end, our choices will mostly affect our own selves, so it is our body, our health, our life, and our death we are playing with. The sooner we assume this responsibility, the happier and healthier we will be in the long run.

Thursday 20 February 2014

TCM substances: Shen, the spiritual aspect of health

This is the fourth post on the series on basic body substances in Traditional Chinese Medicine. The basic substances are Qi, Blood (Xue), Essence (Jing), Spirit (Shen), and Body Fluids (Jin Ye). I will be sharing some ideas about Shen, its concept, functions, symptoms of imbalance, and tips to maintain its health.

In the mainstream of our culture, the words “spirit” and “spiritual” are often associated
with scary films, and with people who are either “far out”  or subscribe to a particular
Spirituality is much more than our belief system
religion or religious sect.  However, in the Oriental philosophies which gave origin to Chinese Medicine, Spirit is seen as that which gives us our sense of self and identity as individuals.  It is that which fuels our deepest desires and inspiration, our ability to see the big picture, learn, and gain insight from our experiences; and the love and compassion that we feel for others. As a result, “spiritual” entails much more than our belief system and our relationship with the divine, it encompasses how we experience our inner and outer worlds, our understanding of this experience; and the way we relate to ourselves, others, our circumstances, and the world at large. Spirit is in fact our Consciousness in the broader sense of the word.

Shen, the TCM concept of Spirit, is considered not only one of the basic substances that make us up but, along with Qi and Jing, is also one of the “three treasures” or essential energies without which human life cannot be sustained. The Shen in Chinese medicine is much more than an ethereal concept and translating it as spirit is a bit of a simplification that does not take into account its part-taking in our cognitive functions. For this reason, I use the term “Spirit-mind”, unless relating to the Shen qualities that do not apply to the mind.

What is Shen

The concept of Shen is twofold: it relates both to the “spirit” of the Heart, and to the conjunction of all the “spirits” associated to the main TCM organs. These “spirits” are actually the various manifestations of our mental, emotional and spiritual aspects: the Corporeal soul (Po) of the Lungs, the Ethereal soul (Hun) of the Liver, the Intellect (Yi) of the Spleen, and the Will (Zhi) of the Kidneys (for more on these refer to the posts covering each of the TCM organs).

Both types of Shen are inter-dependent and, in essence, cannot exist without one another. As a result, the distinction between them is not absolutely necessary to achieve results in a clinical context.

According to Taoist theory, Shen originates after the Jing (Essence) of our mother and father unite to create our own Jing and give us life. From that moment onwards, our own Jing – which gives rise to the Qi and Blood that make our physical body - will provide the foundation to our Shen, resulting in who we are: an integrated body-mind-spirit entity. A healthy Shen thus relies on a strong Jing – the constitutional strength inherited from our parents - and, by extension, on a strong Qi that supports and preserves it. Blood is also closely linked to Shen, providing it with nourishment and giving it “weight”: when the Blood is insufficient, the Shen can be disturbed or “unrooted” causing anxiety, insomnia, dream-disturbed sleep, etc. As in TCM all relationships are reciprocal, this not only means that strong Qi and Blood (our physical body) are important for Shen health: but that a balanced Shen is a necessary requirement for our general health.

Shen is housed in the Heart, and it is greatly influenced by the state of this organ. Because of this, imbalances affecting the Heart can easily result in a disturbance of Shen (see below for more on this).

Shen manifests in the eyes, which it infuses with brightness, vitality, and with the ability to dwell on other people’s eyes that comes from a sense of self confidence and inner peace.

Functions of Shen
Shen allows us to experience the world

Our psychological and emotional integrity depend, to a great extent, on the health of Shen. A balanced Shen allows us not only to experience the world to the full, but also to be aware of this experience. This comprises our sensory perceptions and how we process them, as well as how we relate to everything in life including nature, people, our circumstances and surroundings, ourselves, and the divine. Shen is also the enabler of our memory and intellect on which the acuity of our thought and speech depend. A balanced and well-nourished Shen will also provide the background for restorative sleep and for a sense of calm and comfort within ourselves that enables us to relate and connect to others and to truly express ourselves. Shen fuels our self-confidence and gives us a sense of purpose and the feeling that we are safe in the world.

The table below details the different aspects of our being that dependent on the Spirit-mind:

Shen influence
Enables the integration of all our psycho-emotional aspects, the ability to relate to others and our surroundings, the ability to feel emotions and to experience them appropriately, the acuity of thought and speech, the ability to learn from our experiences, our self confidence and inner comfort
Responsible for the awareness of self and of our circumstances, our understanding of our place and responsibilities in the world, our perception, motivation, insight and our ability to acquire wisdom
Enables the five senses to perceive what happens around us, and the processing of this information
Responsible for our ability to feel emotions, and for the appropriateness of our emotional responses
Fuels our acuity of thought and speech, our ability to concentrate and to absorb, analyse, remember, and communicate ideas and information
Enables deep, restorative sleep, peaceful dreaming, and a relaxed and calm state during our waking hours
Responsible for our self-awareness and self-confidence, our ability to experience healthy emotions and feel connected to others, and our ability to communicate, be understanding, loving and compassionate.  

Shen Disharmony

While a balanced Shen gives us an inner sense of comfort and enables us to easily connect with others and express our thoughts freely, lack of balance may result in social anxiety and difficulty relating to others, as well as distortion in our thoughts and emotions. The eyes, whose brightness reflects the health of Shen, can also become dull and inexpressive when Shen is out of balance.

Shen disharmonies comprise what in Western medicine would be classified as “psychiatric disorders” as well as milder disturbances in perception, cognition, behaviour, relationships, emotional stability, speech, and sleep.

Symptoms arising from Shen disturbance may include:

Aspect under Shen influence
Signs of imbalance

Depression, anxiety, panic attacks, palpitations
Inability to relate to others, or communicate ideas
Oversensitivity, emotional liability (outbursts of emotions for no apparent reason)
Difficulty relating to others, inability to look people in the eye, social anxiety, phobias, extreme timidity, being easily startled or jumpy, hyperactivity
Distorted perceptions of reality
Delirium, mania, psychosis, agitation, paranoia
Loss of consciousness, coma, seizures
Mental cloudiness or confusion
Feeling disconnected from the world or “numb”
Inability to learn from experiences and take responsibility for own actions and their consequences 

Distorted perceptions of reality, sensory hallucinations, inability to feel sensory stimulation.
Feeling disconnected from the world or “numb”, oversensitivity

Anxiety, constant fear, excessive worry
Panic attacks, palpitations
Feeling disconnected from the world or “numb”, oversensitivity
Emotional liability: outbursts of emotions for no apparent reason such as incessant laughter or crying
Confused or incoherent speech
Difficulty finding words and expressing ourselves
Being overly talkative
Mental cloudiness or confusion
Lack of concentration, loss of memory
Inability to retain or process information
Dream disturbed sleep, nightmares
Restless sleep, waking easily
Sleep walking

Low self-esteem
Feeling disconnected or oversensitive
Difficulty relating to others, feeling shut down
Inability to look others in the eye, anxiety 
Extreme timidity
Being easily startled or jumpy
Hyperactivity, lethargy, lack of motivation
Emotional liability (outbursts of emotions for no apparent reason)
Difficulty communicating ideas or emotions

Because the balance of Shen is so closely related to a harmonious life experience, anything that strongly disturbs or interferes with our physical or emotional balance can result in Shen imbalance.  Examples or this are heavy-duty surgery (especially of the Heart), accidents, trauma, shock, acute or chronic illness, unremitting stress, and a long-term poor life style. All of these can affect us not only at a physical level but can also result in severe emotional imbalance, anxiety, insomnia, panic attacks, depression and many other symptoms of Shen disturbance.

The health of the Heart is inextricably linked to Shen balance. Thus, anything that negatively affects the Heart can potentially disturb the stability of our mind and emotions. To find out more about this organ and how to nourish and protect its energy visit the posts on the Heart and the Heart and Pericardium.

Looking after the Spirit-mind

These are some tips to maintain a healthy Shen:

Nourish yourself:
Good nutrition promotes Shen balance
The stability of Shen relies on plentiful Qi and Blood. While following the general TCM advice for a healthy diet will provide a good basis for this, the very close relationship between Blood and Shen means that we may need to pay special attention to nourishing the Blood. In order to do this we need:

  • Enough protein for our individual needs: The adequate supply of protein is determined by your metabolism and by the amount of activity that you perform. The more energy you burn (particularly in the form of sweat), the more Blood you are using and the more protein you will need. Extra-nourishment is needed if you are a breast-feeding mother, experience any kind of bleeding including heavy periods, have a chronic illness, or are recovering from an acute disease.
  • Naturally dark foods: Dark green leafy vegetables such as curly kale, spinach, dark cabbages, black soya beans, kidney beans, aduki beans, watercress and nettles are all considered in TCM to be specially nourishing to the Blood, and are "coincidentally" rich in iron.
  • Naturally sweet foods: Beetroot, grapes, molasses, and all dry fruits particularly dates, figs, and unsulfured apricots are also iron rich and highly nourishing to the Blood. Note that consuming excessive amounts of sweet foods can have a detrimental effect on the digestive energy of the Spleen.
  • Reduced amounts of spicy foods and stimulants: Very hot spices such as chilli and black pepper, and stimulants such as alcohol, caffeine, and drugs can scatter the Blood and heat up the Heart affecting Blood circulation. Stimulants can not only affect Blood flow and impair its ability to soothe the Shen but also directly affect the stability of Shen.
Both excessive exercise and profuse sweating are considered to take a toll on the Blood and hence on Shen. Thus, although moderate exercise can contribute to proper flow of Qi and Blood and a stable mind and emotions, strenuous exercise or exercise that is too heavy for the individual constitution is always harmful to the Blood. Sweating in excess such as when exercising heavily or spending long periods in saunas or steam baths can also be detrimental to the quality and quantity of our Blood. As always, it all depends on the individual constitution or condition so it is important to determine what your energetic needs are before assuming that something is either good or bad for you.

Tai Chi, Qi Gong, and gentle Yoga are most ideal for the Shen as they contribute to healthy movement of Qi and Blood throughout the body and promote emotional and mental balance.

Look after your mind and emotions  
Just as stability of mind and emotions depends on a harmonious Shen, Shen balance relies on a stable mind and emotions. Extreme emotions, over-thinking, and mental agitation can all have a detrimental effect on Shen balance especially when experienced over long periods of time. Some of these emotions and mental patterns may be natural consequences of loss, crises, and other life-changing events that we have no control over. However, they can -and often are- the result of relentless stress and pressure, a poor diet, and the use of stimulants and mind-altering drugs. As maintaining a calm disposition does not come naturally when we live under pressure we could all benefit from the regular practice of meditation, deep breathing, and relaxation techniques to help us cultivate emotional and mental balance.

Traumatic and disturbing experiences have a direct impact on the Shen and this is reflected in Shen-related symptoms ranging from memory loss to emotional and mental instability and nightmares. This kind of experience can be very difficult to process solely at a mental level and may need to be addressed through physical, mental and emotional approaches such as a combination of talking therapies, energy therapies such as acupuncture, and specific dietary and exercise regimes.

Slow down
Our fast-paced way of living is not conducive to the peaceful environment that both protects and nurtures Shen. This is the reason behind the increase in both stress-related and mental/emotional illness, and in the growing interest in meditation, mindfulness and spiritually oriented topics we see all around.

We may all feel the discomfort that results from living without caring for one of our most

basic needs – preserving our health – but many of us are far too busy to give this a second thought. The truth is, that unless we do something to prevent the physical, emotional, and mental damage that our Western life-style is doing to us; our body, mind, and emotions eventually collapse so that we are literally forced to stop and take stock. 
Practising "being": a health preserving gift to ourselves

It is never the wrong time to make our own well-being one of our priorities. Even those we support will benefit from this as an extension of the long term improvement in our health. One way in which we can kick-start this process is by putting aside just a few minutes of every day to sit with ourselves, still, and in silence so that we become more aware of what is going on inside us. Meditation, chanting, breathing, mindfulness, contemplation, or whatever else we choose to do during this time will also help us create a space within ourselves which we can resort to when the pressure is up and we can’t cope with what life is bringing us. This is the most valuable health-preserving gift that we can give ourselves and those who rely on us.

Feel connected
Every one of us, whether religious or not, has a deep need to feel part of something bigger than ourselves. It may be nature, a specific social or religious community, Creation, or the Universe; our longing to belong often drives us to find something that gives sense to our existence.  Once we find this, we may be bestowed with a sense of safety and feel inspired and full of purpose. 

Although Shen is always there fueling our very existence. it really comes to life when we feel part of something bigger than ourselves and when we feel connected to other beings, to the land, and to the whole world. This connection can in turn inspire our love and compassion towards others and drive us to perform acts of kindness and attempt to make the world a better place. We may then become aware that every one of our actions – no matter how small – could have an impact on somebody or something outside ourselves. When this awareness begins to infuse our every choice with purpose and intention, we are allowing Shen to express itself to the full. This is Spirit put into action at every moment of our lives, rather than confined to the isolated corner where we have been keeping it.  
TCM Treatment
In clinical practice the fire organs – the Heart and Pericardium – are always regarded as involved in the development of Shen disturbance. Thus, treating the Shen with acupuncture usually involves the use of points for the specific Heart disharmony, as well as points that have a calming effect. Other underlying pathologies in the organs overseeing the circulation or making of Blood or Qi may need to be addressed at the same time.

In more severe cases, herbal remedies may be prescribed to nourish and augment the Blood so that the Shen can be both nourished and soothed, or to remove the blockages that are clouding the Spirit-mind resulting in confusion, cognitive problems, and other symptoms. Herbs that have strong sedating effects or that calm the Shen via their nourishing and strengthening effect on the Heart may be added to a formula depending on the individual symptoms and constitution of the person.

The recurrent fear, anxiety, depression, and isolation that so many of us go through in the modern world are just some of the signs that our Shen is not being kept in balance. The pressures of society and the pursue of false ideals of “happiness” and “success” can make us override our own mental, emotional and physical needs and this has devastating effects on our sense of self and on our very Spirit; both of which constitute the Shen. Cultivating a connection with others and the world at large, being true to ourselves, and taking responsibility for ourselves and our role in the world, are all key ingredients for Shen to be in harmony and for each of us to live a life that is truly healthy, happy and fulfilling.