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For  Acupuncturist and Massage Therapists essential oils distilled from flowers have many benefits, especially when working with the Shen as they serve to calm the mind and soften the mood. Florals are often used to nourish yin and blood, calm the shen, soothe the skin and increase receptivity to healing and even sensuality. They are going cool and nourish excess an excess Fire element - meaning they help in cooling the Heart and are asset for symptoms of anxiety, restlessness and insomnia and focus. Although metaphorical, it is import to take a look at the meaning of a flower. Flowers symbolize grace, love and new beginnings. As they correspond to the Heart they are going to be beneficial for clients that are working on forgiveness and love.

These cooling and fragrant oils, such as Rose, Neroli and Jasmine are often the most precious and expensive. These oils take the most care in picking and distilling. Additionally, there is very little yield that comes from the flower. In other words, it takes an abundance of the flower to create a substantial amount of oil.

Although, florals are mostly associated with the Heart, they also serve other meridian/organ systems. For example, Neroli has affinities to the Heart and the Spleen and is an asset when anxiety is accompanied by digestive issues such as loose stools. Neroli has the function to Tonify the Spleen Qi and Nourish Heart Blood. Therefore, Neroli is recommended for students with such symptoms due to test anxiety. Often it is blended with Fennel to assist in the strengthening of the Spleen and can be found in the Meridian Biologix blend Return to Center. Neroli is often used on points such as Ren 17. Ren 12, St 36 and Sp 3.

Another example is Roman Chamomile, this oil is has affinities to the Heart, Spleen and Liver. Roman Chamomile is the premier oil to use when there are symptoms of Liver overacting on the Spleen and symptoms of Liver fire. Lavender is often used with Roman Chamomile for symptoms of Heart and Liver Fire as well as Liver overacting on the Spleen, The points used for Roman Chamomile include, Ren 17, Ren 12, LI 4, LV 3 Sp 3. Roman Chamomile is found in Meridian Biologix blends such as Night Journey, Cultivate Substance, and Relax Constraint. 


Check out Marc’s webinars series, for more information on essential oils and Chinese medicine http://www.marcjgian.com/essential-oil-pda-webinars/. Please note, that the price of $157 for 12 PDA’s will end on 7/19.

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The Practical Herbalist is not a list of shortcuts nor a substitution for a classical understanding of prescribing herbs from the Flavor and Nature paradigm that defined our medicine. It expects the reader to have this as a foundation and assumes this knowledge going forward. If the reader is new to the concept of prescribing from the Flavor Nature perspective that was established in the Nei Jing, or would like refreshing on its core principals, they are directed to the four excellent articles by JulieAnn Nugent-Head on classical herbalism published by the Journal of Chinese Medicine. If they wish more information, they can also watch her 3 hour introductory video The Nei Jing as Our Guide to Herbs or her complete online training program, The Classical Herbalist: an In Depth Training Course. Both are available on the Association for Traditional Studies’ online teaching platform: https://association-for-traditional-studies.teachable.com. Simply search for them in the search box to find them among our many online courses.

One of the issues of the current study of herbs is that many people are using formulas without understanding the Shen Nong Ben Cao Upper—Middle—Lower categorization of the herbs within the formula—all the while pontificating about the dangers of using Lower Herbs when they are unintentionally prescribing them for long periods in pill format. Of the more common occurrences of this are Da Huang, Ban Xia, Lian Qiao, Jie Geng, Xing Ren and Qing Hao. Recently the poster child for acceptance of Chinese herbs in modern science due to a recent Nobel Prize for its use in treating malaria, Qing Hao happens to be a lower herb in the Shen Nong Ben Cao and one of the more important ‘treat diseases’ herbs I use in the clinic.

 

There are many writings about the different kinds of Qing Hao and the confusions around it in both old and new texts, as the wormwood family contains a large number of medicinals. For this article we are going to assume we have a working Qing Hao with the correct flavor and nature along with intensity (it is a lower herb, after all) in the clinic. Despite the excitement of following the directions in the old books of soaking in cold water to use, we are also assuming that it works cooked given that is how we prescribe it and obtain results for our patients. We use a thermos cooking method (https://www.thealternativeclinic.org/herb-cooking-instructions/) which means the temperature never reaches nor sustains boiling, but even boiled by patients over the many years of use we have had excellent results. Please remember this: Qing Hao works if used in correct combinations and in correct circumstances at the right dose regardless of cooking method.

 

In our clinic, we tend to draw very sick patients who are often debilitated by their conditions. We do not practice a great deal of Wellness medicine at this phase in our careers, as our focus is on demonstrating how fast and effective Chinese medicine can be for serious illness to gain greater acceptance by the western medical field. Given the dangers of the western medications for auto-immune diseases and their growing prevalence in our population, we are treating Lupus, RA, AS, fibromyalgia, etc on a daily basis. The herb we rely on the most for these patients is Qing Hao. Qing Hao alone will rarely be effective enough for our patients to experience a shift in symptoms within just a few days, but paired correctly it can shift someone from a downward spiral to stable in the first week. It is for this reason that the first two herbs discussed in previous writings were Ma Huang and Gui Zhi. They are two of the most important herbs to be paired with Qing Hao to obtain fast results and work over the long term to put the patient into remission for their condition.

 

Chinese culture believes in similes, metaphors, and teaching fables to shed light on just about everything. From the foundations of the sunny and shady sides of a mountain (the actual pictograph meaning of the characters for Yin and Yang) to the 成語 cheng yu teaching stories, being able to visualize or mentally experience a concept is an important learning tool. For me, I visualize Qing Hao as going in and scouring the deep places, the hidden corners, the forgotten spots where latent pathogens (伏邪) can hide from the Upright Qi (正氣). But those pathogens can only hide in those places in people for whom the Upright Qi is not strong enough to penetrate into those corners or is moving too quickly to work into the crevices and do a thorough cleaning job as it is supposed to. Without a boost or calming of the flow of the Upright Qi, Qing Hao will not be as effective in treating severe or recalcitrant conditions such as Lupus, et al.

 

The dosages I use range from 6g to 30g per formula depending on whether we are at early stage treatment when the symptoms are severe or already mostly in remission. Nicknamed ‘swamp water flavor’ by my patients, it is not a delicious herb to use, so learning to lessen or increase dose based on severity greatly shortens the length of time they need such an unpleasant taste. Too little, and they are drinking it for longer periods with no visible effect to give them the will power to continue their formula; too large of a dose for too long and their stomach simply rebels with nausea despite the progress they are achieving. The Qing Hao is then paired with a clear strategy of strongly heating the patient or cooling the patient along with strong drivers to ensure it can reach every bit of the colonies of latent pathogens nesting in those deep places. The most important drivers are Gui Zhi, Ma Huang (or similar heart stimulator), Fu Zi. The most important warmers are Gui Zhi, Gan Jiang, Fu Zi. The most important cooling herbs are Shi Gao, Zhi Mu, Lu Gen, Hua Shi, and Han Shui Shi.  In Practical Herbalist #02, I wrote about using cooling herbs with Ma Huang. The same principal can be applied to Fu Zi. What is important to note in the cooling herbs is that they are all quite light in nature—not one strongly cold bitter heavy herb in that list; what is important to note in the warming herbs is they are all quite strong and heavy in nature and frequently used in large dosages in the Shang Han Lun.

 

The classic 溫病 Wen Bing formula from which our Qing Hao treatment strategy comes from is Qing Hao Bie Jia Tang. 青蒿三钱,知母二钱,细生地四钱,鳖甲五钱,丹皮二钱. Qing Hao 3 qian, Zhi Mu 2 qian, Sheng Di Huang 4 qian, Bie Jia 5 qian, Mu Dan Pi 2 qian. From the formula, it is obvious it is being used to treat the hot version I described which has been around long enough to damage the Yin and set off a sequelae of additional symptoms. It is also obvious as to the importance of Qing Hao not just in it being the main name of the formula, but that every other herb in the formula is either an upper or middle herb in the Shen Nong Ben Cao. We then immediately modify accordingly based on a few realities of our clinic: the first is we do not use animal products in which the animal is killed, which means we do not ever prescribe Bie Jia; the second is no one actually has Sheng Di Huang, as what is marketed as Sheng Di Huang is actually Gan Di Huang (please see JulieAnn’s excellent and free video on Di Huang in her Single Herb tasting series https://association-for-traditional-studies.teachable.com/p/single-herb-tasting). Frequent substitutes for those two herbs are Lu Gen, Mai Men Dong/Tian Men Dong and Xuan/Yuan Shen. Note that this classic formula is missing what I am calling a Driver as it is assumed the heat is already driving the Qi too intensely.

 However, while we certainly have pure heat auto-immune patients, they are rarely compared to the more common presentation we have for auto-immune disorders coming into our clinic. We see straight on cold/poor or weak circulation auto-immune patients and, more commonly, cold patients who suffer from hot spots or hot symptoms which can lead a practitioner astray in choosing herbs. For those patients who have pain, difficulty moving, exhaustion, brain fog and have no clear signs of true heat, a straight on strategy of large doses of warm acrid to move the Qing Hao through the system is our most frequent choice. Gui Zhi, Gan Jiang, Jiang Huang at doses of 30g or higher when severe paired with Qing Hao and then herbs to protect or stimulate the Middle Palace depending on their digestion will be our base formula.

 For patients who describe hot painful spots but wear lots of clothes or run cold while presenting herpes type outbreaks, the above strategy balanced with cool sweet herbs such as Lu Gen, Bai Mao Gen, Zhi Mu or Mai Men Dong and Qin Jiu/Jiao if there is joint pain at up to 30g can relieve the immediacy of the heat signs while not damaging the Qi or Yin needed to get the Qing Hao through the body. As a side note, many Chinese herbs have a secondary or different name used by the old doctors who were trained prior to 1949. I have mentioned two in this article: Xuan/Yuan Shen and Qin Jiu/Jiao. The former changed its original name from 玄Xuan to 元Yuan in the north as after an Emperor adopted the玄  Xuan character in his name, it was no longer used in common words. This was a very common thing in China as a sign of respect throughout the ages, such as the habit of never using Confucious’ first name丘 Qiu when talking about him. The second reason is more practical. Qin Jiao 秦艽 can easily be confused with the Jiao, or pepper family, if said with a strong accent or listened to by someone with little to no education. To avoid patients thinking they should put green peppers in their formulas, northern doctors pronounced the Jiao as Jiu.

 

For patients who do show straight heat conditions, the strategy of Ma Yi Shi Gan Tang and its substitutions apply (see Practical Herbalist #02). These days, it is often easier to obtain Fu Zi than it is to obtain Ma Huang, so it can be used as a first choice if it is on hand. Otherwise, while caffeine or large dosages of other stimulating herbs can help push the Qing Hao through, we tend to rely on Gui Zhi balanced heavily with cooling herbs, particularly Shi Gao in Shang Han Lun sized doses.

 

Of course, the building of formulas around Qing Hao can be used for any latent pathogen. Malaria is a classic example of this—the illness comes and goes, can disappear then return and, left untreated, does slow but fatal damage to the kidneys and liver. Another brief aside: spending time talking about diseases while in Kenya and then Botswana, the guides there do not favor the use of anti-malarial pills. They prefer to get the disease and identify it quickly, as it is very treatable. It is ignoring it or being unable to treat it for a length of time that makes it fatal. However, with anti-malarials on board, one can still get the disease but have its core symptoms masked. The person thinks they caught a cold or flu, but never gets too sick until irreparable damage is done to the organs.

 

Other examples in which we build formulas around Qing Hao are for Lyme, Mono, HIV/AIDS and just about every other disease in which the patient is run down and worn down by an illness until their system is so weak that they are consumed by their disease. It can also be a secondary herb to assist in treating gastro-intestinal opportunistic conditions in which bacteria colonies like candida have become established, or any other bacterial colonies such as chlamydia elsewhere in our patients—however, it is more common to see us turn to Yin Chen Hao as its fluffier nature also makes it more drying for damp heat bacterial conditions. Understanding and learning to use Shen Nong Ben Cao Lower herbs effectively can help shift those interested in moving beyond wellness/chronic conditions and into treating more acute conditions. Qing Hao is one of the best herbs to start with and used flexibly can make a huge difference in any disease focused practice. 

 

Andrew Nugent-Head

© Andrew Nugent-Head 2019, reprinted with permission only

 

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The use of essential oils continues to be gain popularity. Many people are finding the use of essential oils and aromatherapy are beneficial to uplift their mood, increase depth of respiration and prevent symptoms of common colds. Individuals are becoming more conscious of the importance, even necessity, of using natural remedies for healing and quality of life.

As practitioners rendering health-care services, we must be aware of this trend and educate ourselves on the best way to use essential oils and aromatherapy in practice. Especially as TCM practitioners it is integral to understand essential oils and aromatherapy based on Chinese medicine.

Essential oils represent the jing, or the essence of plants, and have a long-drawn history in Chinese medicine. Because of the foundational nature of oils, these substances can reduce physical complaints while assisting in the individual’s mental and spiritual development. Essential oils have the power to assist the healing of a wide range of health disorders, either as a stand alone modality or as a supplement to acupuncture treatments. However, the most effective use comes with acupuncture sessions.

The application of essential oils in TCM can be based on several classification and formulation systems. These include the law of five elemental associations, Ying and Yang, TCM functions and channel affinity. Many essential oils have functions that coincide with acupuncture points – this is one of the reasons that applying essential oils to certain points is so clinically effective. For example, Lavender and Palmarosa both have an affinity to Pericardium 6 as the oils both calm the shen and open the chest. Another example is Roman Chamomile on Lv 8 to nourish the blood and Lv 13 to harmonize the spleen and stomach.

Lavender has a sweet and comforting aroma with a cooling effect on the nervous system. It is associated with the Lung, Liver, and Pericardium. Two of the primary functions of lavender is to promote the smooth flow of Liver Qi and have a calming effect on the Shen. Geranium also has a sweet and comforting aroma. Geranium has affinities to the the Heart, Lungs and Kidneys. Geranium, is often used to calm the mind, relax the nervous system,  promote the sense of peace and grace - it is commonly used for the early stages of menopause and can be found in the Smooth Transitions blend from Meridian Biologix. Another common essential oils is Lemongrass, also know as the known as the “Tendinomuscular oil” and is often used in cases western diagnosis of Sciatica and Lower back pain with weak muscles.To gain a foundation of essential oil based on Chinese medicine and obtain 12 PDA’s  click the button below.

If you are interested in learning more about essential oils within Chinese Medicine please visit: http://www.marcjgian.com/essential-oil-pda-webinars/

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Peppermint is a well-known and loved scent, commonly used for it’s soothing and uplifting effects. Peppermint is great for those that that desire to feel more awake and refreshed- and is great for those that struggle with damp conditions causing foggy headedness and inability to focus.

Peppermint is associated with the outward and spreading movements. 

Peppermint grows low to the ground and spreads outward rapidly. By the doctrine of signatures, this demonstrates Peppermint’s power to spread and direct Qi outward. It grows quick and easily and its roots are not deep. This shallow root system informs us that Peppermint is a top note that acts primarily on the Wei level -- the superficial space between the skin and muscles. This also shares with us that it is most beneficial for acute symptoms.

As a cooling top note, Peppermint has an affinity to the lungs and is one of the most beneficial oils to Release Exterior Wind-Heat, aka the common cold and is often blended with oils such as Eucalyptus, Basil and Tea tree. Peppermint assists this dispersion and release of energy by ensuring that a pathogen is expressed outward and does not penetrate deeper into the body.

It is especially effective at relieving symptoms associated with rhinitis and nasal congestion. For this purpose,  A 4% dilution can be placed on LI 20 to open up the nasal passages. It can also be placed on a tissue on a chair below the face cradle for while your client is prone to keep the nasal passages open.

Peppermint can also be applied  on Li 4 and Lv 3 to open the 4 gates to Promote the Movement of Qi. It is often used in blends as an assistant in blends with such oils as to such oils such as Rosemary, Lavender and Lemongrass to Promote the movement of Liver QI.

Along with its ability to Release the Exterior and spread Qi it has analgesic properties which make it a premier oil to use on acute neck pain. For this a 4% concentration of Peppermint can be used - or you can apply the Cool Passage blend from Meridian Biologix. Meridian Biologix blends that contain Peppermint include Joint Comfort, Outer Defense, Cool Passage, Relax Constraint and Rectify Borders.


QUICK TIPS FOR THE L. Ac and LMT

When a client is prone, one drop of oil can be placed on a tissue beneath the face to prevent nasal congestion, aiding in a more comfortable session. Topically, to release the exterior, Peppermint is applied in circular and outward strokes with light to medium pressure.  

Here is Video from the Webinar Series with More Info on Peppermint and Chinese Medicine

http://dreamwork.marcjgian.com/wp-content/uploads/2015/04/Peppermint-Teaser-.mp4


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Rigorous physical training can lead to chronic injuries which can affect performance or curtail training altogether. One chronic injury that can be particularly frustrating and debilitating is tendinitis. While tendinitis can be caused by a direct impact injury, more commonly it is the result of chronic misuse or overuse of the muscles around a joint. Most people who suffer from tendinitis cannot recall a specific injury, and there is usually no obvious acute stage accompanied by visible swelling or bruising. 

Tendons are the thick fibrous ends of the muscles, which attach muscles to bones.  Misuse and/or trauma create small micro-tears at these attachments.  These small traumas can cause the tendon to swell. The swelling in turn causes the tendon to rub against the tendon sheath or against adjacent structures creating irritation. Irritation creates further swelling, more rubbing and more irritation. While rest will relieve the pain, returning to training before the injured area is fully healed can easily stress the damaged tissue, perpetuating the cycle of pain, irritation and even inflammation.

Tendinitis occurs frequently in the: shoulder and elbow - the classic “tennis elbow” or “golfer’s elbow” -  however tendinitis can also occur in the tendons around the hip and knee or Achilles tendon. Repetitive tasks such as working at a computer and working with power tools, as well as exercises such as forced stretching, or weight training, may also contribute to the development of tendinitis.

There is no need for tendinitis to become a chronic, debilitating injury. Chinese medicine offers effective prevention, treatment and rehabilitation from tendon injuries through correct application of massage in conjunction with herbal liniments, the use of medicinal plasters (Gao), and exercise.

1.  Massage & Liniments

Gentle massage of the injured area with Dragon's Blood Tendon Lotion (Xue Jie Shu Jin Lu) is the key to breaking the cycle of pain and re-injury that characterizes tendinitis.  Place a small amount of the liniment on the painful area and work it gently into the tissue by making small circles with the pad your thumb or a finger for several minutes. Pressure should be even and slow penetrating only to the depth of the tendon, not down to the bone. Tendon Lotion contains herbs that kill pain, heal damaged tissue and draw circulation to the injured area.  This treatment can prevent a “tweaked “ tendon from developing into a chronic injury if performed immediately after class or training.

Tiger's U-I Oil (Hu Biao Ru Yi You) can also be useful for tendon injuries, particularly if used immediately before activities which may cause the tendinitis to flare up.

2.  Gao – Medicinal Oinments and  Plasters

Gao come in two forms, pre-made ointments that are packed on the local area like a pultice and left overnight or stick on plasters in which herbs have been impregnated into the adhesive. Both types of Gao are useful for both acute tendon injuries and chronic tendonitis.  When the tendon first begins to ache, applying the Herbal Ice (San Huang San Gao) or the Wu Yang Pain Relieving Plaster can relieve inflammation, disperse the stagnant Qi and blood that causes the pain and improve local circulation. Use these instead of icing the local area. If the injury is older and more chronic, a warming plaster, like the 701 Dieda Zhengtong Yaogao Medicated Plaster or a poultice of Bone-Sinew Gao (Gu Ji Wai Shang Xiao Tong Gao) may be effective.

 

3. Internal Herbal Formulas

An internal herbal formula like Bonesetter’s Special Pill (Zheng Gu Zi Jin Dan) can be useful with chronic injuries like tendinitis, when deficiency (of Qi and blood) is part of the picture. In cases of chronic tendinitis, there is also the potential for penetration of wind, damp and cold due to the impairment of the Wei Qi and the relative deficiency of normal Qi (Zheng Qi) in the local area. This formula moves stasis and kills pain but it also focuses on nourishing blood and aiding the spleen in moving This helps prevent the penetration of wind and dampness and allows the Zheng Qi to flourish.

 

3. Exercise

Correcting the misuse of the joint and surrounding soft tissue is both the key to preventing tendinitis and to rehabilitation. Incorrect technique, unnecessary tension and the inability to engage and relax muscles at the proper time is often the cause of tendon injuries. This is very common in sports like tennis or golf, where incorrect form can cause the tendons in the elbow to overwork in the wrong way leading to chronic tendon pain.

Another common training error is to practice in such a way that muscles are used repetitively in isolation, rather than  connecting them in groups  to the core muscles in the center of the body. This can overstress one tendon setting it up for injury. This is why many martial arts exercises focus on  the development of “tendon strength” (fascial strength and integrity), and whole body power, as opposed to isolating individual muscles, or performing exercises which focus on increasing the size and strength of the belly of the muscle. Qi Gong exercises are particularly useful for rehabilitating injured tendons and developing tendon strength, because they train the fascia and move Qi (and therefore blood and fluids) through the injured area, while developing the whole length of the muscle evenly.

Ice and Tendinitis

Although it is very common to ice tendon injuries, most current sports and physical therapy research has indicated that ice does nothing to heal the injury, and icing the area may in fact interfere with proliferation of the fibroblasts that create new, healthy tissue. Often tendinitis is not accompanied by heat, and redness, or even swelling, so it does not meet the medical definition of inflammation. In Chinese medicine, “tendinitis” is often considered to be related to lack of circulation in the locally tissues, a problem that increased, rather than decreased, by the use of ice.

By: Tom Bisio

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Muscle injuries are very common complaints in orthopedic practice, occurring both among athletes and among non-athletes We regularly read about top athletes in almost any sport who are sidelined for weeks due to a strained, pulled or torn muscle. Although these kinds of injuries may seem minor, compared to a broken bone or torn ligaments, they present a challenge due to the slow recovery time, during which athletes and exercise buffs are unable to take part in training or competitions. And these injuries have tendency to recur, sidelining the athlete yet again. Muscles crossing two joints are more prone to a muscle pull because they are more often subject to acceleration and deceleration forces. Bruises generally affect the muscle belly, while strain-type injuries more often occur at the muscle-tendon junction, closer to a joint.

Preventative measures can be taken to reduce the likelihood of strains and tears, but when bruising, strains, and sprains occur, treatment should take place as soon after the injury as possible, and should follow correct treatment principles. Traditional Chinese medicine actually does quite well with these kinds of injuries, often much better than Western medicine. This is largely due to the fact that in Chinese medicine, we take advantage of the inflammation response rather than attempting to suppress it with ice and anti-inflammatories. The evidence against the use of RICE (Rest, Ice, Elevation, Compression) in Sports injuries is virtually overwhelming, so much so that one of the creators of this protocol has since disavowed it. Ice and anti-inflammatories actually interfere with tissue healing, and therefore can keep you on the bench longer.

In Chinese medicine, the first step in a muscle injury is to restore free-flow of the local circulation, which aids in flushing out the dead cells and debris that are stuck in local area of the injury, while simultaneously bringing in cell building blocks and fibroblasts, which create new tissue. Restoring free-flow of circulation also reduces pain, because it is precisely the lack of free-flow that creates the pain. Restoring free-flow is best achieved by a multi-modal approach.

In the case of pulled muscle (which means that there are torn muscle fibers), direct application of Extra Strength Trauma Liniment (Qiang Li Die Da Jiu) helps to kill pain and restore free-flow. If muscle fibers have rolled up or bunched up to a hard knot, they should be ironed out with techniques like Pushing (Tui Fa) and Round Rubbing (Mo Fa) as the muscle is stretched. In the case of hamstring pull, this means extending the leg to its maximum as you literally “iron out” and realign the muscle fibers manually.

If the muscle has extensive bruising apply a thick layer of Herbal Ice: (San Huang San Gao) or Stage 1 Trauma Ointment (Die Da Gao Yi Bu) over the inured and discolored area, cover with a bandage and leave overnight or for 24 hours. This kind of injury occurs more often at the belly of the muscle, because this part of the muscle is highly vascularized. The blood vessels, can rupture with an impact or severe torsional force.

With both tears and bruises, it is often useful to also approach the problem form the inside out with a trauma formula like the Blood Stasis Trauma Pill (Huo Xue Die Da Wan). Generations of martial arts practitioners have used the Blood Stasis Trauma Pill (Die Da Wan) to clear blockages of Qi, blood and fluids that have accumulated at the site of an injury. This trauma pill is carefully formulated to prevent blood from congealing in the tissues of the injured area, and to address “dead blood” before it can develop.

Later when the initial heat and pain are gone, herbal soaks can be applied by immersing towels in the liquid of the soak, and then applying them as warm compresses to the local area. A key soak for this purpose is Extra Strength Tendon Relaxing Soak (Shu Jin Huo Xue Jin Ji). Extra Strength Tendon Relaxing Soak is very effective in the treatment of strains and sprains and muscle pulls. This soak relieves spasm, relaxes sinews, kills pain and moves stasis. It can be used in conjunction with Tui Na massage methods. Compresses can be applied for 15 minutes twice a day.

If the muscle pull or tear is at the tendinous portion of the muscle near the joint, after the initial pain and swelling are dissipated by the methods described a above small amounts of Dragon's Blood Tendon Lotion (Xue Jie Shu Jin Lu) can be massaged into the local area several times a day.

In a chronic injury where, the muscles are tighter in cold weather or feel cold, warming liniments like Dragon's Blood Tendon Lotion (Xue Jie Shu Jin Lu) can be used. Massage can also be performed with Tiger's U-I Oil (Hu Biao Ru Yi You).  For cold in the muscles, Tiger’s Yu-Yi Oil can be soaked into cloths or paper towels which are placed over the local area in conjunction with wet heat (hydroculator), a hot water bottle or even a heat lamp. In more severe instances of cold penetrating into the muscles, or lack of circulation with a feeling of cold in the local area, one can use the Warming Soak (Wen Jing Huo Luo Jin Ji).

The following chart shows the various factors that can set up, complicate or compound an injury to the muscles.

Strengthening weak muscles is important in order to prevent muscle strains and tears, but more recent studies seem to indicate that it is more important to correct muscle imbalances, between the two sides of the body or imbalances within a grouping of agonist and antagonist muscles like the quadriceps and hamstrings.

Making sure muscles are flexible can also be important in preventing injury. This means undertaking a program of intelligent flexibility exercises that engage breathing and relaxation in order to lengthen the muscles and increase their suppleness. Flexibility and stretching routines can be enhanced by applying Yoga Stretching Oil (Yoga Shen Jin You) before and after stretching. Yoga stretching oil is specifically formulated to help the muscles and sinews lengthen and relax.

If you are doing everything right and a muscular injury simply won’t heal, consider life style factors - are you eating well and getting enough rest? And sometimes the body just needs a boost to help it heal damaged tissue. In these cases a formula like Strengthen Sinew Pills (Bu Jin Wan), that nourishes the blood and the liver and kidneys in order to strengthen and heal the muscles, tendons and ligaments, can be an important addition to treatment.

By: Tom Bisio

Tom Bisio is a world-renowned martial artist and a licensed practitioner of Chinese medicine. He heads a clinic in New York City where his unique background in Western and Eastern approaches to healing has helped him create and implement effective rehabilitation program

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From the strong upward and outward direction of Rosemary, it follows suit that we discuss Lavender. Lavender also moves energy both upward and outward, but differently than Rosemary. As it is a flower, it calms with a cooler, gentler quality, being less direct, more accommodating and softer. It has a ‘friendlier’ smell. Its upward and outward direction is more like energy spreading up and out like the rays of a sunrise reaching up from the horizon. This can be seen in the way the Lavender bush grows.

The Lavender bush looks as if it is spreading. One of the major functions of Lavender is to Spread and Soothe Liver Qi, making it one of the premier oils to work on symptoms such as dull hypochondriac pain, irritability, dull pain before menstruation (especially as a compress),  bloating, anger, and frustration. These symptoms often lead to Spleen Qi Vacuity or Dampness. Like Rosemary, Lavender will ascend energy, yet will execute with more softness and ease.

One of the major functions of the liver is to ensure a smooth flow of energy throughout the body. As Lavender has the function to Soothe Liver Qi, it gives a feeling of ease. It may assist the client in letting go of minor frustrations and irritations of the day.

Lavender has many functions for the massage therapist and the acupuncturist. As a flower it will be beneficial for emotional issues of the heart – such as anxiety and restlessness.  It can also gently bring feelings and emotions out of the upper aspects of the body (both lungs and the heart). Lavender, also beneficial to the outer aspects of the body, most specifically as it has the ability to Release the Exterior. And, Lavender can gently stimulate the sympathetic or parasympathetic system by regulating the nervous system.

Lavender is more forgiving and accepting of other oils. Lavender is famous for gently calming the mind and nervous system, and to ease the outward expression of emotions. It can be uplifting in times of grief and sorrow by allowing deeper breathing when used with Frankincense, Pine and/or Cypress. This is accomplished through its ability to promote the movement of Qi. Keep in mind, however, Lavender moves Qi, it does not tonify it. So if there is Qi Vacuity, Lavender should be used with an oil that tonifies the Qi such as Ravensara or Tea Tree which Tonify the Qi and Release the Exterior.

In the case of a Wind-Heat with symptoms of dry skin, Lavender and  Palmarosa should be a major component of the blend. Palmarosa will aid in the nourishing of dry or chapped skin due to wind and heat. Lavender has the uniqueness of being the only flower to Release the Exterior.  Palmarosa, on the other hand is a grass with functions similar to flowers having the ability to also Release the Exterior while at the same time hydrate the skin.

Lavender’s affinity to the Liver Qi, and its ability to Promote the Movement of Qi makes it an integral oil to alleviate pain before menses. It promotes the movement of Stagnant Qi in the lower abdomen, thereby increasing circulation. If the pain is sharp and shooting it is best to blend Lavender with an oil that Invigorates the Blood and alleviates pain such as Frankincense. For a dull ache, it can be blended with Roman Chamomile which will reduce the inflammation.  To treat menses is best to use a compress on the lower abdomen in combination with acupressure points.

A few of the Meridian Biologix blends where Lavender is used include, Relax Constraint, Unwind Repression, Rectify Borders, and Quiet Moment.

By Marc Gian, L.Ac, LMT

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The Practical Herbalist #03: Gui Zhi in the Clinic

 INTRODUCTION: The Practical Herbalist is not a list of shortcuts nor a substitution for a classical understanding of prescribing herbs from the Flavor and Nature paradigm that defined our medicine. It expects the reader to have this as a foundation and assumes this knowledge going forward. If the reader is new to the concept of prescribing from the Flavor Nature perspective that was established in the Nei Jing, or would like refreshing on its core principals, they are directed to the four excellent articles by JulieAnn Nugent-Head on classical herbalism published by the Journal of Chinese Medicine. If they wish more information, they can also watch her 3 hour introductory video The Nei Jing as Our Guide to Herbs or her complete online training program, The Classical Herbalist: an In Depth Training Course. Both are available on the Association for Traditional Studies’ online teaching platform: https://association-for-traditional-studies.teachable.com. Simply search for them in the search box to find them among our many online courses.  

By far the herb that I prescribe the most frequently and in greatest quantity in my practice is Gui Zhi. Classified as Warm and Acrid, I discussed in Practical Herbalist #02 that it is physically warm and thus moves Yang, as opposed to moving Yang and thus being classified as Warm. Being warm and acrid, it goes into the body and dispels cold with its warmth, and breaks apart tightness and blockages with its acrid Qi. This makes it one of the most versatile herbs to warm the flesh, reach the extremities, and dispel stasis that is keeping flow from happening due to poor circulation. While I of course consider and do use it for patients coming in with the common cold or flu, it is the work horse I rely on in my formulas for internal conditions, musculoskeletal issues, masses, as well as auto-immune compounded by cold weak constitution leading to pain.

Classically, Zhong Zhongjing shows us how to pair Gui Zhi to accomplish what we need. We see it with Mu Li and Long Gu when we need to warm the lower Jiao and Ming Men; we see it paired with Fu Ling when there are masses or a concern of Ben Tun; we see it paired with bai shao when the Ying (Nutritive Qi) and Wei (Defense Qi) have lost harmony; we see it with Fu Zi to rescue Yang; we see it paired with Ma Huang both in large and halved doses to resolve cold; with Ge Gen for tight muscles; balanced with Shi Gao to warm without creating sweat; with Gan Cao for an exhausted heart condition; with Yi Tang to nourish weakness and cold; with ginseng when a person is weakened from purging; with Bai Zhu, or with Da Huang to address stagnation in the middle... It appears in cold formulas, hot formulas, to directly attack the Pernicious Qi or to protect the Upright Qi of the person.

This is just in the Shanghan Lun, and not addressing its uses in the Jin Kui nor by the many other doctors through the ages who made use of this herb. I once found myself a part of a lunch conversation between two professors at a Chinese medicine university in China. Both professors, one saying that he never had a reason to prescribe Gui Zhi as in his specialty no one ever came in with a cold and the other trying not to spit out his food at a statement which indicated a clear lack of any study of the classics. Even western medicine is recognizing cinnamon for its use in heart patients, and naturopaths are excited about its antioxidant polyphenol properties, anti-inflammatory properties, sensitivity boosting for insulin, anti-diabetic effects, and neurogenerative diseases. It is now also in studies for cancer prevention. Clearly, if used correctly, Gui Zhi is a very versatile herb with wide reaching applications in eastern or western medicine.

For us as Chinese medicine practitioners, what is important with Gui Zhi is correct pairing. It is warm acrid, and if we are not careful with the companion herbs in our formulas, we can accidentally dry our patients out and aggravate a dormant or current HSV flare or any floating heat conditions. But rarely is the Gui Zhi to blame, as by itself it is not that drying but with other herbs can have a strong synergistic effect. With a flexible understanding of flavor and nature to guide what we want to happen and where we want it to happen, we can be sure we get the results we want without the side effects we don’t. By looking at pairings from the past for our sick patients, we can learn to use the acrid warm of Gui Zhi to travel without being too warm or moving up and out to the surface. Paired with cool sour Bai Shao, we can warm the muscles while holding the fluids in. Patient still cold but already more hot and drying out? Replace Bai Shao with Cold Sweet Zhi Mu in our Gui Zhi Tang to not just protect the Yin, but replenish the Yin. Patient afraid of wind but not showing any sweating or Tai Yang heat (please reread the first 12 lines of the Shang Han Lun if you are confused how Gui Zhi might be used when there is heat in the Tai Yang)–Replace the cool sour protector of fluids Bai Shao with a warm sweet acrid herb to help the Ying such as Dang Gui. If we look up traditional uses of Dang Gui, one is relieves the surface!

In terms of internal conditions, pairing it with heavy shells allows us to warm and anchor the Spirit at the same time, which can be otherwise tricky in minute pulse patients who seem hot and are manic but are, upon inspection, happily wearing lots of clothes and are easily cold. Has that mania moved to perhaps agitation and no fear of cold but the pulses remained minute? Paired with Da Huang, we can clear heat yet protect a collapse of Yang by the strong purge in a weak constitution undergoing what looks like an excess flare. Masses, fibroids, cysts due to cold in the lower jiao? Gui Zhi brings the warmth that allows the saltiness of the shells to shrink the masses as well as invigorates the blood when we are at a point of wanting to knock them out with bitter Da Huang. These same herbs along with Gui Zhi treat both these conditions if further paired weighted correctly, which means we can treat the Spirit or the body with Gui Zhi as our primary herb to do the job.

Arthritis? Paired with Jiang Huang, or Wei Ling Xian or other warm traveling herbs ensures the channels and flesh are warm enough that there is good flow to and away from the joints. The Chinese concept of 吐納 (expelling the turbid to bring in the new) is well known in Qigong practice but somehow seems to have not crossed over into modern herbal formula strategies. In Chinese, we must first ensure the old is moved out before we can bring in new vitality. We understand this in the theory of enlivening blood (breaking down old, stuck blood) before tonifying the blood, but we do not recognize this as a mechanism which is true across all aspects of our health and treatments. As Gui Zhi warms the channels and encourages flow with its warmth, we are able to dislodge much of the stuck debris in the joints so new flow can come in. 通則不通不通則痛 is another classic expression whose fundamental role in the clinic is underestimated when writing formulas. It means: When there is flow there is no pain, and where there is no flow there is pain. This is true for hot painful swollen joint arthritis as well as cold painful arthritis. The Gui Zhi provides the warmth to create the flow, the accompanying herbs, hot or cold, will then move out the old and allow the new to come in. I mentioned in the Practical Herbalist #02 how Ma Huang was paired with Shi Gao and Yi Yi Ren to treat arthritis—so can Gui Zhi be paired with cold herbs to be sure there is good exit and entry to the areas afflicted. If we need movement to and away from any part of the body, Gui Zhi is an ideal herb to do just that.

What if we need warmth but want that warmth to stay put? We pair our Gui Zhi with sweet herbs. Sweet slows, which allows the Gui Zhi to settle in and enliven without scattering due to its acrid nature. Here, we see classic combinations with Zhi Gan Cao or Yi Tang to nourish the heart or the spleen. I have never done a research study, but I think we would be hard pressed to find any other single herb (perhaps Gan Cao excepted) that is so widely paired with such different flavor and natures to address such a wide variety of internal and external conditions. It is even key in external liniments and soaks.

This does bring up a question I am often asked by observers in our teaching clinic. Why do I use Gui Zhi and not use Rou Gui? This is because 20+ years ago I had the good fortune and bad luck of discovering what true Rou Gui was. Traditionally, good Rou Gui was known as 紫油肉桂, or Purple Oil Rou Gui. Dragging down this Rou Gui with a finger nail showed a purple oil oozing out. This, according to my teachers, was critical for successful use of Rou Gui in internal formulas. The oil balanced the heat to bring warmth to the lower jiao without creating irritation or flaring heat signs like HSV. Without the oil, they preferred to use Gui Zhi well paired to avoid contemporary Rou Gui’s燥, or drying/aggravating nature. The loss of the oil meant that it had lost its Yin within Yang balance and was irritating. I do continue to use Rou Gui in external soaks and liniments, but find it much easier to avoid overly drying my patients with Gui Zhi for internal formulas. Interestingly, I was discussing this with a nutritionalist years ago who laughed and told me I was simply buying the wrong Cinnamon. It seems that there is Cassia cinnamon which we assume to be Rou Gui, but it is known for having negative properties in naturopathic/nutrition circles. But there is a better variety known as True Ceylon which has a different make up and is not irritating/toxic. I have never gone to the effort of sourcing freshly harvested True Ceylon to see if it would have the purple oil I experienced so many years ago, but the writings on the toxicity of Cassia cinnamon in large doses does match the old doctors’ concerns with currently sourced varieties being too irritating to use.

I have made Gui Zhi sound like a miracle herb, and we do use it in our clinic with miraculous responses from a wide variety of patients. But I do have to put in a caveat: we use traditional Shanghan Lun doses to get the great results we do. This means that a standard dose an observer might see in the clinic is 15 to 45 grams, with occasional need to follow the 桂枝加桂Gui Zhi Jia Gui formula in which there are 5 兩 Liang of Gui Zhi, or roughly 75 grams. The doses currently listed in the English language teaching texts of 3-9 grams can and will occasionally be successful, but for acute or severe conditions, we do need to consider using medicinal amounts. I am not encouraging anyone to be reckless, and I always suggest starting small and working up if needed. But, realistically, if the smaller doses could cure bigger illnesses, most people who put cinnamon in their oatmeal in the mornings would never get sick.

  

Andrew Nugent-Head

February 07, 2019

© Andrew Nugent-Head, reprinted with permission only

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There are 4 major directions when working on clients: Upward and Outward corresponding to Yang energy (as with Rosemary and Lavender), Inward and Downward- correlating to Yin (as with Myrhh and Spikenard)

To understand the directionality of Essential Oils, it is important to know the temperature and the depth that oils will penetrate into the body – or in terms of Traditional Chinese Medicine, the Wei, Ying or Yuan levels. It is also important to understand how and where the plants from which the oils are obtained grow.  Understanding these basics help us to accurately predict and anticipate the desired effect. As this is the first blog in a series, we will begin with the Upward direction.

The cardinal oil for the Upward direction is Rosemary. Rosemary’s temperature is warming. It enters the Ying level, the level of self or ‘I.’ This is the place where we can begin working with Emotions, Blood and Internal Qi. 

One way to remember the function of Rosemary is to consider its origin. Since it is indigenous to the land near the sea, it is thought to assist in balancing out its surroundings by absorbing the moisture from the terrain - making the environment less damp, less ‘muddy’ and firmer. Using this as an analogy, we can say that Rosemary essential oil will have a similar affect on the client. Rosemary will help the client become less soft, less passive and more assertive. This is also reflected in the way Rosemary grows in an upward and then outward direction. It is associated with the Masculine, the Yang. Its energy is Moving and penetrating.

Generally, oils that are warming will have the ability to penetrate into the organ level and stimulate this energy upwards. They are also more drying. Keep in mind that oils that go to the Ying level must move through the Wei level – and will necessarily have an impact on the Wei level as the energy moves through.  And the inverse is also true; any release of energy from the Ying level will to pass through the Wei level on its way out.

Rosemary in particular has the function to tonify the Wei Qi - the most external level of energy that is our defense against External Pathogenic Influences. This not only includes Wind, Damp, Dryness, Cold or Heat, but also people in our daily life that may be toxic to our health and situations that we find ourselves that elicit a “negative” emotional response. Rosemary will assist us in developing Personal Will and assist us in breaking the attachments from relationships that are no longer serving us providing the space to enter new ones.

In other words, Rosemary will assist in building the defense of clients, building resistance (Wei Qi) to external influences and assisting them with the ability to say no. This in turn will enable the Spleen Qi to properly Transform and Transport food, and ingest positive external events into nutrition for the body.  As energy is transformed with the use of Rosemary, Self-Assertion (Healthy Liver Qi) in the world and clear decision-making is another major effect. With that said, Rosemary will build and contribute to the character integrity. Again this happens through its ability to raise the Yang, tonify the Qi, and transform Dampness - enabling the creation of healthy personal boundaries.

In Chinese Medicinal Theory when the Spleen is healthy, it will ascend energy, and prefers dryness over dampness.  When the Spleen has a deficiency, the body will generate dampness/heaviness that impedes the proper flow of energy in the body.  Here we see a direct correlation with the Ascending and Warming function of Rosemary to the Spleen: Rosemary raises energy and assists in Maintaining Dryness, or Transforming Dampness with its warming function. This is also a correlation to where it grows. As it is often found to grow near the sea, it functions in balancing out damp conditions. This is similar to what it will do upon inhalation and application to the body.

A simpler way to understand this is to remember that heat rises and heat dries. First let’s define what it means to raise energy as it applies to massage therapy. As we know, basic massage techniques will increase circulation and increase sympathetic activity. The clear direction is upward strokes. For complimentary reasons, Rosemary is one of the best oils to use before a sports event like a cycling or running event, or any cardiovascular exercise. For this purpose, it may be blended with Frankincense and Lemongrass to help decrease or prevent injury while at the same time eliciting more endurance for cardiovascular exercise.


By: Marc Gian, L.Ac, LMT

March 7, 2019

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The Practical Herbalist #02: Ma Huang in the Clinic by Andrew Nugent-Head

INTRODUCTION: The Practical Herbalist is not a list of shortcuts nor a substitution for a classical understanding of prescribing herbs from the Flavor and Nature paradigm that defined our medicine. It expects the reader to have this as a foundation and assumes this knowledge. If the reader is new to the concept of prescribing from the Flavor Nature perspective that was established in the Nei Jing, or would like refreshing on its core principals, they are directed to the four excellent articles by JulieAnn Nugent-Head on classical herbalism published by the Journal of Chinese Medicine. If they wish more information, they can also watch her 3 hour introductory video The Nei Jing as Our Guide to Herbs or her complete online training program, The Classical Herbalist: an In Depth Training Course. Both are available on the Association for Traditional Studies’ online teaching platform: https://association-for-traditional-studies.teachable.com. Simply search for them in the search box to find them among our many online courses.

 It may be strange to begin a series entitled The Practical Herbalist with an herb many western practitioners may never have taken, prescribed or even held in their hand before. But Ma Huang’s use traditionally by Chinese medicine and currently in pharmaceuticals make it important to understand as we adopt a practical approach to customizing formulas. The first thing to understand about Ma Huang is it does not induce sweating. Its important effect is to move water, and where that water is moved to and through depends on what Ma Huang is paired with. If Ma Huang is paired with warm and acrid Gui Zhi, water is pushed up and out the surface, breaking a sweat—this is what most practitioners think of due to the fame of Ma Huang Tang and the lack of attention paid to other Ma Huang formulas. In Ma Xing Yi Gan Tang, the water Ma Huang moves is guided out through the urine by bland and slightly cool Yi Yi Ren. In Ma Xing Shi Gan Tang, it is used to unblock congested lungs within a formula designed to cool the body with Shi Gao—the opposite of how most people view Ma Huang as a Tai Yang Wind Cold invasion only herb.

 But the truth is Ma Huang does not move water, it excites and stimulates the Yang. With greater Upright Yang movement, pathogenic Yin (fluids/damp in this discussion) is dislodged and moved out. Thus, the movement of water is not an action of Ma Huang, but a result of its action: stimulating Yang. As we are stimulating Yang, the flavor assigned to it is a Yang nature and flavor: warm and acrid. But Ma Huang is not a ‘warm’ or ‘hot’ herb, it is a Yang stimulating herb. Drinking a cup of Ma Huang as a tea does not produce warmth in the mouth or stomach the way drinking a cup of Gui Zhi, Gan Jiang, garlic or chilis does. Known as Mormon or Brigham Young Tea in Utah, a cup of Ma Huang may excite the heart but is not spicy or warming at all in a sensory way. To our detriment as practitioners, we frequently confuse the end result with the mechanism that created the end result, just as we assume a flavor or nature to be what the herb is instead of a short hand description of how it effects Yin and Yang.

 Why is this important? Because Ma Huang is a fantastic herb to push Yang into places which are blocked by cold and/or damp pathogens, thereby clearing the roads and allowing the Upright Qi to regain a foothold where it has been denied. Gui Zhi by itself will simply not be strong enough to expel deep cold with chattering teeth and a tight, wiry pulse. Gui Zhi’s flavor and nature is warm acrid, but in this case it is literally warming and thus moves Yang, as opposed to Ma Huang’s ability to move Yang and thus create warmth. When a head cold or severe sinus infection sets in with completely blocked passages and intense pain in the head, very few herbs are going to be strong enough to break the Pathogenic cold and damp in one of the hardest regions to reach—the head. Ma Huang can excite the Yang enough that we can force our way into the head, allowing other warming and drying herbs such as Gao Ben, Chuan Xiong, and/or Bai Zhi to actually reach the head and clear the sinuses. We can then add some light cold bitter herbs to hop on the train heading up into the head such as Bo He, Jin Yin Hua and/or Da Qing Ye to tackle the toxicity of green yellow phlegm along with the sinus infection.

It is also fantastic for pushing Upright Yang out to the extremities to dislodge the Damp Bi of arthritis in the hands or feet. While large doses of Gui Zhi paired with pathogenic exiting herbs like Yi Yi Ren and a list of other ‘damp draining’ herbs can be effective, it often fails or requires unrealistically large doses of Gui Zhi if the case is severe or there is already deformation of the joints. At that point, using Ma Huang to drive through the blockages is more effective. Variations of Ma Xing Yi Gan Tang based on the patient in front of us easily and quickly stops pain and swelling of arthritic joints. Cold, atrophied arthritic joints do well with Ma Huang as the driving force paired with Gui Zhi or more warming but less moving herbs like Gan Jiang, Jiang Huang, etc. Without the other herbs, Ma Huang will not solve the arthritis. But the ‘arthritis fixing herbs’ we might default to won’t get a chance to work if they can’t get there without strongly moving Yang to bring new Qi and blood to the fingers and wash away the stagnation and stasis entrenched there.

What follows is an analogy, and it is not really how it works but can help understand what herb to use when needing to push Yang through the body. Think of Sheng Jiang as first gear in a car designed to warm. It is certainly warming, but how warming it is and how far we can go in first gear is limited by our being only in first gear. If we need second gear pushing of Yang, we then add or switch to Gui Zhi, and we get further and stronger than we were in first gear. Need a third gear push? That would be Ma Huang. Need to really get the car moving? We could switch into fourth gear and use Fu Zi. Our first two gears are truly warming and thus helping Yang; our second two gears are not warming at all if placed in the mouth but move Yang strongly and thus allow warmth to return. This is very important to understand, as when we realize Ma Huang is moving Yang, and it does so by increasing our heart rate and exciting the system, we can then start using other methods to do so in a day and age when obtaining Ma Huang is difficult or not permitted.

In my years in China, I personally loved using Ma Huang. It is stronger than Gui Zhi, but not the heavy hand that Fu Zi can be when the Yang simply needs moving and not rescuing. Learning to accentuate Ma Huang’s circulatory stimulation and extremity reaching properties with warm acrid herbs or tempering its effects by literally thickening the soup of the patient’s formula with not just Xing Ren (ground, it makes a patient’s formula milky and soothing), or Yi Yi Ren (the barley boils out into a thickish starch), but also Shan Yao (starchy yam) or anything else that would soften its stimulating abilities allowed me to reach the actual doses used in the Shang Han Lun of up to 45g per formula and apply that across a wide variety of conditions. Auto-immune pain from lupus, fibromyalgia, RA as well as other pain conditions quickly lessen and vanish with proper pushing of the Upright Yang to drive the pain away. Matching the stimulation of Yang in an herb that is not actually hot to the taste means Ma Huang can be paired with herbs to treat hot or cold auto-immune and other conditions.

Having had this discussion with so many fellow practitioners over the years, the question that inevitably arises is what can we do if we do not have Ma Huang? The reason we began as we did in Practical Herbalist #01 is to erase the idea that the specific herb is what defines the formula. It is the desire for a specific flavor and nature effect on the body which lead to the picking of an herb based on what was available to the practitioners of the time. This means what the practitioners chose was dictated by the seasonal availability of herbs at the time they penned the formula which would become classic, as well as whether they were southern practitioners with one set of flora available to them or northern or western or eastern practitioners with a different set of flora around them. The practitioner set about to affect the Upright Qi and the Pernicious Qi, chose the correct flavor and nature which would accomplish the stimulation they needed, then grabbed what was on hand at that time and place to do so. The next thing we know, people are believing that the herb used is magic and a formula without that herb’s name is not a classic formula—missing that it was classical thinking of flavor and nature combined with availability that skyrocketed the herb in question to fame.

Of course, some herbs are simply so good at it that it would not make sense to use another unless we did not have them available. Or, in the case of Ma Huang, for unfortunate reasons an herb was banned due to misuse in other industries (dieting teas and weight loss programs, sigh). So what do we do when Ma Huang is not available but we need to drive Yang up to the head? One clever doctor in the Song Dynasty thought to use a handful of acrid herbs powered by caffeine in the form of tea, inventing Chuan Xiong Cha Tiao San in the process. Once we have grasped that, we can start looking at a variety of caffeine delivery methods, including tea, coffee, energy drinks, No Doze pills, etc. Perhaps using a large enough dose of Wasabi with Gui Zhi or crushed scallions and fresh ginger might be enough to break the pernicious blockade and allow the Upright Yang to return. Or we could really be practical and use Ma Huang in its currently available forms along with a cup of our formula at the same time. Ephedrine, pseudo-ephedrine, and ephedrine mimicking products are available over the counter in the super market. While Sudafed is the most obvious, Claritin and many others will all increase the heart rate and dry the waters. Where and how effectively can be decided by the herbs we prescribe to take concurrently with these over the counter medicines.

How safe is Ma Huang as an herb or in its current over the counter delivery methods? I can get quite worked up about this, so if you have not heard the podcast in which I do, listen to: https://qiological.com/upper-middle-lower-herbs/ Everything is dangerous if misused, but as long as it is profitable to the pharma industry, it is given a pass. Extra Strength Tylenol can cause liver damage if taken more than 4 times in a 24 hour period. But my 9 year old can find it on aisle 7 of our local supermarket and buy it all by himself. Liver damage in less than a day, OTC product. There are currently over 600 OTC and prescription medications containing the same active ingredient, including NyQuil. Ma Huang is a very tame and safe little sibling compared to that danger. Classified as a middle herb in the Shen Nong Ben Cao, we know it can drive away deficiencies and help the physical body, but cannot be used for long periods. Misused as a daily diet tea along with caffeine or by body builders trying to drive off water weight, we certainly could see damage to the kidneys (diuretic action) or heart (circulatory stimulator). But it would take a very long time while ignoring a vast amount of warning signs in the former or a very large dose coupled with caffeine and extreme exercise in the latter.

Outside of blatant misuse or continued misuse, we do need to be cognizant of one concern which can happen to us as responsible practitioners. Ephedrine can potentially cause prostate swelling in at risk men—simply type ‘Ephedrine Prostate Swelling’ into google for not just an education on the risk but on what kind of forums it is being discussed. The top hit the last time I checked was bodybuilding. While in the past I used Ma Huang often for sinus infections or deep cold in men over 50 who concurrently had prostate enlargement without a negative side effect, there was one case in which there was. A gentleman I had seen for years in China came in with a sinus infection, and after not responding to gentler herbs I prescribed Ma Huang—what I did not know was he had been high dosing on allergy medicines and the Chinese equivalent of Claritin along with the Ma Huang made for a very uncomfortable 8 hours before he could urinate easily again. Alone, neither caused a problem. Together, the synergy and delivery lead to a swollen prostate. As you might expect, I was very cautious going forward, being sure of what OTC medications male patients with prostate issues were using before prescribing not just Ma Huang, but any diuretic herb. As a middle herb which gained its fame treating potentially life threatening influenza, its strength should be respected and prescribed with respect. But it should not be feared, and most importantly, it should be understood for its flavor-nature role in a formula so we can effectively substitute yet achieve the same desired results.

Andrew Nugent-Head

January 27, 2019

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