When, exactly, is less more?

Japanese aesthetics come to mind: the clean lines, the minimalism we sometimes associate with that country. You don’t want to clutter up a haiku; or rather, as soon as you add clutter, the haiku ceases to exist. An art of omission, the form depends on empty space.

Music can be like this, with silence as important as any sounded note. Bebop isn’t the most minimalist of musics as a rule, but Miles Davis’ sly horn knows just where to cut out, and that’s what gives his sound its undeniable authority.

Then in cooking, there’s no improving upon certain elemental combinations of ingredients—bread and butter, or prosciutto and melon—provided quality is there to start. (If not, Do Not Pass Go).

We can probably agree that less is more applies in the realm of aesthetics. But what about in the practical world? Let’s consider (surprise, surprise) the realm of medicine and healing.

Here, too, it’s obvious that it’s possible to do too much. Safe herbs and drugs become toxic in the wrong dose (heck, so does water). Too many spinal fusions (maybe just one) can ruin someone’s back. Too many x-rays increase cancer risk. And so on.

What’s less is obvious is just how little is sometimes enough. It’s a lesson acupuncturists like myself are confronted with sooner or later in our clinical development—sooner, if we’re paying attention.

After only two or three needles, a patient may slip deep into beatitude, which is my shorthand for the tranced-out, angel-faced state a good treatment can occasion. Empirically, we might find that their neck tension has softened, the knot in their belly eased, their pain vanished. Then—we’re on a roll, after all—we practitioners may be tempted to do more. The patient didn’t come for just two needles, we might think. It’s only been 15 minutes. Commence phase two!

Sometimes doing more at such a point can work out okay. But just as often—and I fell into this trap not long ago—it can backfire. I had a patient go from beatific (I wish I could convey the glow) to skin-crawling-aggravated shortly after a second set of needles went in; by the time I returned to check on him, he had pulled them all himself, sometimes I’ve only encountered had one or two patients do in my decade of doing this work. (He felt fine as soon as the needles were out so this wasn’t an especially off-the-rails example—but those can definitely happen.)

Perhaps the most counterintuitive thing about the risk of over-treatment is sussing out who is most prone to it. As you may have surmised by now (if you haven’t experienced this yourself) it’s the most sensitive, delicate and weak patients—exactly those who would seem to need the most intensive help—who tolerate the least. For these patients, less truly is more.1

In the most dramatically weakened cases, a single needle or sesame-sized bit of moxa may be plenty, as illustrated in the research of Moxafrica. Working with HIV and TB patients too debilitated to get out of bed, Moxafraica researchers in Uganda found that a single cone of moxa once per day was enough to make meaningful improvements in these patients’ energy levels (subjective) and serological and immunological markers (objective)2. From the practitioner’s point of view, the road to mastery with these folks has a lot to do with learning when to stop. When to say “good enough for today.” It’s about building a fire twig by twig, holding in reserve the heavy log that would smother the flame.

In the face of it all, I'm thinking about Chinese medicine today and the small bits of magic that happen in clinic. I’m idly wishing—sure—that our political leaders would make themselves available for this kind of work: cleansing, tuning, purging if necessary (and oh, is it necessary). But mainly I’m thinking about how acupuncture allows for deep and intimate engagement with the elements, forces which live also within us.

In the Saam acupuncture style I practice, we supplement the Urinary Bladder to bring cold water into play. This treatment can be likened to turning on the garden hose or accessing a mountain stream. Naturally we tend to use this approach for hot, dry people and conditions. Cold water cools and moistens, after all: this is five elements 101. But water has other gifts as well, as a recent patient reminded me.

On the table, with the Urinary Bladder needles placed, the patient reported feeling a gentle river-like flow. The treatment seemed to be going in the right direction, so I gave him 30 minutes.

When I came back, he had a water story to tell. That gentle river flow had intensified, he told me, and caused a bit of panic as the felt sense of waters deepened. (I wondered if the water had been too much, assaulting his Heart fire, but what

he told me next allayed that concern.)

Strong emotions started floating to the surface, along with desires he hadn't let himself feel in too long. (Water can float things.) He got the distinct image of a pressure washer spraying off a mud-covered object (Water can cleanse and reveal.) Until the object’s contours became clear. (Water can clarify).

By the time the treatment was over, he had realized what he wanted at this point in his life. And was equally clear on what needed to happen to get there.

That's all: a simple moment of clarity for someone, a moment of getting back in touch with himself. A pivot point in his day and week that might echo out in larger ways in his life, or not. I’ll see him again soon, and will get to learn how things have unfolded. We’ll continue the intimate dance that happens in clinic, listening for the next right step.

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At just over 750 years old, Gui Pi Tang (“Decoction to Restore the Spleen”) is a new kid on the block as Chinese herbal formulas go. (Believe it to not, there are purists in the Traditional East Asian Medicine world who turn up their noses at anything later than the Han dynasty, which ended in 220 CE.) As for me, I have great respect for the medicine’s classical heyday but am not myself averse to a little innovation.

Anyway, let’s see what this newie-but-goodie recipe has to offer.

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Gui Pi Tang is for a clinical pattern that’s more common than ever these days. In a nutshell, we can call this presentation “nervous exhaustion with digestive weakness.”

My esteemed teacher Dr. Heiner Fruehauf describes the syndrome beautifully in his A Clinical Handbook of Chinese Herbal Formulas. But before we see what the good doctor has to say, let’s define a couple of terms:

Heart: Perhaps best translated “heart-mind,” the Heart is the seat of consciousness. Elementally, the Heart belongs to the Fire phase.

Spleen: Sometimes glossed as the pancreas, the Chinese Spleen is responsible for assimilation of nutrients and the generation of energy from what we eat. The Spleen is the primary seat of the Earth phase/element.

Note that, since Fire gives rise to Earth in the elemental cycle, Earth/Spleen can be called the “child” while Fire/Heart can be called the “mother.” Now we’re ready for Dr. Fruehauf:

The formula design [of Gui Pi Tang] emphasizes the mother-child relationship of Heart and Spleen. According to Chinese medical theory, both organs are involved in the process of thought processing and mental activity. Exhaustion of the “mother” (Heart) is said to affect the “child” (Spleen) and vice versa. The Spleen’s functional yang is in charge of transforming food into the body’s material yin, in this particular case the Heart blood, which is the structural residence of the spirit (shen). If there is insufficient blood, then the spirit has no place to rest, and insomnia and other nerve-related symptoms arise. Long hours of unrelenting mental activity, for instance, typically decrease the appetite and thus the ability to produce structural nourishment for the body’s brain cells. If this kind of imbalance becomes longstanding, body and mind easily get into a vicious cycle of spiraling weakness and anxiety without being able to restore themselves via the body’s main regenerative system and post-natal energy source, the Spleen. The traditional picture of the of the representative patient was the poor, exhausted student with an overwhelming load of work and worries on his mind. Today, the formula has become a favorite for a wide range of chronic diseases that involve both general lassitude and some neurotic symptoms [emphasis added].

The Spleen pathology addressed by the formula can include not just loss of appetite with consequent poor nutrition, but also chronic diarrhea. Indeed, this Gui Pi Tang can be a wonderful remedy for a range of disorders of “gut-brain axis“ disorders. I’m learning to think of this remedy whenever a patient is undernourished and anxious, and all the more so if there is diarrhea or insomnia in the picture.

An old-fashioned Euro-American way of describing these kinds of patients is “neurasthenic,” from “neurasthenia,” a term that describes a state of general weakness along with neurotic complaints. You don’t have to look far to spot such people today; in fact many of us are in danger of falling into neurasthenia if we don’t make real efforts to tear ourselves away from our screens and go play outside once in a while.

Playing outside is probably the best prescription most of us could hope for, but since screen time isn’t going away anytime soon, at least we have Gui Pi Tang. When well indicated, this near-miraculous brew simply works as advertised, helping to restore Heart and Spleen in tandem, regulate the gut-brain axis and break the vicious neurasthenic cycle. Those who need it find it deeply restorative, relaxing, nourishing and delicious.

I find it helps them get back in touch with their body’s needs and rhythms as they return to a more embodied existence.

Gui Pi Tang - Decoction to Restore the Spleen

Baizhu - Atractylodes rhizome

Huangqi - Astragalus root

Renshen / Dangshen - Ginseng / Codonopsis root

Fushen - Poria sclerotium

Danggui - Angelica sinensis root

Longyanrou - Longan fruit

Suanzaoren - spiny Zizyphus seed

Yuanzhi - Polygala root

Muxiang - Saussurea or Vladimiria root

Zhigancao - prepared Licorice root

Hongzao - Jujube fruit

Shengjiang - fresh Ginger rhizome

I’ll dose this formula at roughly 5-10g per ingredient per day in decoction, adjusting ratios according to patient constitution and concurrent condition.

Common modifications:

For more serious blood deficiency, add Dihuang (Rehmannia root); this forms Hei (black) Gui Pi Tang.

Without sleep problems, remove Suanzaoren.

For pronounced bloating, add Baibiandou (Dolichos bean).

For palpitations and signs of weak Heart yang, add Guizhi (cinnamon twig).

Interested in an herbal consultation?

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Consider the line in the Chinese classical text, Huangdi Neijing (The Yellow Emperor's Inner Classic) that translates as follows:

"Long-term sitting damages the qi, long-term gazing damages the blood."

Sitting for hours a day staring at a screen is kind of a double-whammy: qi and blood both. But the blood part is especially relevant.

In TEAM, blood goes with liver goes with eyes—all part of the same functional network. Overworking those eyes taxes the blood. Now, a thing to understand here is that the classical Chinese concept of blood encompasses the red liquid in our vessels, yes, but also a certain quality of hormonal juiciness and tissue plumpness. Good quantity and quality of blood keep us nourished and also buffered from the world, similar to how a jungle canopy shades and protect the forest floor from the harsh rays of the sun (an insight usefully spelled out in the Sa’am acupuncture tradition).

As the blood becomes taxed, we can start to feel dizzy, drained, burned-out and overexposed. In other words, many of the symptoms of so-called cyber sickness. Over time, severe blood deficiency can lead to more serious outcomes including anemia and cognitive decline. (A useful oversimplification: blood makes up part of the film on which memory is imprinted.)

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The most sensitive or delicate among us will feel the effects first, but so will anyone who spends long enough hours at the computer, sooner or later.

In my healing arts practice, I'm seeing more and more people who are burnt out by screens and whose systems gratefully soak up treatments that nourish and harmonize the blood.

Personally, as a writer who runs blood-deficient to begin with, I don't know how I'd cope without the TEAM toolkit of needles, herbs and dietary measures. They’ve been a godsend, and I dearly wish I could go back in time to offer them to my dad, whose early-onset Alzheimer’s was a clear-cut case of blood deficiency exacerbated by “long-term gazing.”

I heartily recommend Chinese herbal medicine and Sa’am-style acupuncture to anyone suffering from screen symptoms. But you can get some decent mileage out of dietary therapy as well.

Foods that nourish blood

Kvass (personal favorite = salty fermented beet drink from the Ukraine)

Red meat

Liver

Gelatin and collagen-rich broths

Pastured Eggs

Beets

Blackstrap molasses

Cooked leafy greens

Goji berries and Jujube Dates (make tea)

Black and Red berries

Pomegranate

If you’d like to discuss how to support your blood or other aspects of health, I’m reachable at info@jonathanhadasedwards.com. Sessions available here.

When I was an acupuncture student at what’s now called NUNM in Portland, Oregon, I was dazzled by the beauty of the classical Chinese cosmology that we spent most of our first year soaking up. Under the tutelage of Dr. Heiner Fruehauf, I marveled at the intricate correspondences between macrocosm (the world out there) and microcosm (the world within). Here was an entirely organic, process-oriented vision of the body as an ecosystem of mountains and rivers, constellations and climate zones.

If that sounds nebulous or hopelessly abstract, it took a practical turn once we began learning herbal medicine (herbs were Dr. Fruehauf’s specialty, and the reason I had entered the program). Things got more practical skill once it was time to start prescribing herbal formulas to actual patients in the clinic, “where the rubber meets the road,” as Heiner likes to say. Happily, I found that the use of classical formulas was a natural outgrowth (if not always a straightforward one) of the way of thinking I’d been steeping in.

When it came to herbal medicine, theory flowed beautifully into practice. But I didn’t have an analogous experience when it came to learning acupuncture.

Sure, the channels and points made reference to the theory, but it all seemed tangential, somehow. The TCM (relatively modernized, institutionalized “traditional Chinese medicine”) we had to learn for the sake of board exams seemed less like a coherent system than a hodgepodge of ideas and techniques. I think most of my classmates and I could sense on some level that somewhere along the way lineage transmission had faltered when it came to TCM acupuncture. Most of us gravitated towards other acupuncture styles (in my case, these included exacting subtleties of Japanese Meridian Therapy, though that style never fully took root as my main approach). In the end, like many I graduated with a ‘little bit of this, a little bit of that’ in my acupuncture toolkit. Not a terrible foundation by any means, but also less than a fully functional, complete system of medicine.

My first few years in practice bore out these concerns. Whether working in a community acupuncture setting or in my small private practice, I felt ten times more confident with herbs than with needles. My acupuncture treatments clearly helped some times; at other times they didn’t, but at no point was I clear on how to identify my mistakes, learn from them or course-correct. I felt stuck in my development as a practitioner, and increasingly frustrated. I thought of throwing in the towel and sticking with herbs, my first love.

That’s when I caught wind via the Qiological podcast and community forum of Saam acupuncture. The word was that Saam was a self-contained system based on familiar classical Chinese principles put together in a unique way by a 17th century Korean Mahayana monk. Apparently the treatments were simple but dramatic: dramatically good if you got it right, dramatically bad if you didn’t. One way, the patient improved and you learned something. The other way, at least you learned something and—here was the key that really piqued my interest—you knew what to do to turn things around (more on this aspect in a bit).

Reading through the practitioners forum where colleagues were discussing Saam principles and cases, my appetite was whetted. Within a couple months I found myself taking an intro weekend course in Saam taught by one Toby Daly.

Mr. Daly was cut from a familiar cloth, I must have thought: lanky, cerebral, laser-focused (both of us San Jiao excess types, as I’d soon learn). Moreover, like me he had spent some formative time traveling in South Asia in his twenties, and (again like me) had ended up rather the worse for the wear. As he writes in the Introduction to his new book, The Saam Acupuncture Tradition:

Traveling on a budget in India had wreaked havoc on my digestive system. I had been plagued with diarrhea for months and had completely lost my appetite. My normal weight of 190 pounds on a six-foot-four-inch frame had been reduced to a mere 150 pounds.

The monk and I traveled together for the next six weeks…it was apparent from my frequent trips to the bathroom and emaciated body how ill I was. My new traveling companion repeatedly offered to help me with his acupuncture needles.

Since my grandfather had been a medical doctor, and my background was in science, I was reluctant. I felt very confident that needles without any medicine going through them intravenously could do nothing for me. After a few weeks of traveling, I relented, thinking, “He’s such a nice man, this won’t do anything for me, but it will make him feel better if he thinks he’s helping me.”

He inserted four needles into my hands and feet, and I rested for twenty minutes. I got up from my first acupuncture treatment and ate an entire meal with three desserts. I could not believe it. My digestive system normalized and my fascination for and appreciation of acupuncture was born.1

The monk eventually became Daly’s teacher. “He freely gave me so much and only asked that if I ever had the opportunity to share this tradition, I should do so.”2 For the last six or seven years, he’s been doing just that, first through classes and now through this clearly-written, well-edited volume.

Having taken the Saam intro class (and another couple of Saam weekends) with Toby Daly, I can say that The Saam Acupuncture Tradition is an elegant, pithy distillation of the class’s core content. As in the weekend course, Daly starts with a foundation of first principles: yin-yang, the five phases, the six qi. In the second chapter he comes to the “twelve divisions in the macrocosm,” writ-large versions of the body’s 12 organs or channel systems, as Daly calls them (Fruehauf uses the term organ networks; like much of Chinese medical terminology, there are endless translations).

For each of the twelve channels, Daly gives us a full-page color photo of a place on earth that best embodies the qi: the Amazon river (yin, warm, damp throughout), for example, or the fiery Kilauea rift zone (a combination fire and water). With descriptions and images he drives home that this medicine operates not merely by paying lip service to natural processes, but taking its most basic cues and core strategies from the larger world and applying them directly to the smaller one contained within our skin.

In the body, that Amazon river jungle ecosystem—warm, steamy, squishy—corresponds to the Spleen [capitalized here to differentiate the East Asian Medical concept from its biomedical counterpart].

As Daly explains at the start of the book’s third chapter, “the qualities inherent in each channel system are revealed when that system is in a state of excess.”3 When it comes to excess of the Spleen channel in particular, “the patient is likely to display some of these symptoms and signs:

• The outside of the body, most notably the skin, will be moist

• The inside of the body, most notably the abdominal cavity, will have abnormally high deposits of visceral adipose tissue

• The body will be slightly warm, heavy and soft

• They will be prone to laziness and boredom

• They will have a sweet tooth

• They will have weak bones, teeth and gums

• They will have severe numbness

• They will exhibit pathology along the Spleen channel and Large Intestine channel [the counterbalancing channel] trajectories”4

Why? It’s hard to resist quoting Daly’s clear exposition at more length here:

Since the Spleen channel system has a Tai Yin [i.e. damp] conformation and an Earth [i.e. damp] phase, a patient with excess in this system will exhibit signs of outer and inner dampness, including an obese body and moist or oily skin. Like a compost pile, their damp body will generate extra warmth. Their body will feel subjectively heavy, and soft to palpation.

The heaviness of their double-damp body will lead these patients to feel lethargic and unmotivated. To sustain the dampness patients will be drawn to consume foods with a sweet taste. Like metal corroding in a damp jungle, the patient’s bones, teeth and gums will decay in this damp inner environment. Since dampness muffles normal body sensations, patients with Spleen channel system excess will experience profound numbness.5

Doing much the same for each of the twelve channels, Daly takes us through the nuances of the Saam system’s characteristic synthesis of the five phases with the six qi (or six conformations). Elsewhere in the acupuncture world, these two theoretical structures are rarely integrated so neatly—and therein lies the clinical power of Saam, which is able to exploit the fact that (continuing our example) the Spleen is not only damp in nature, as every acupuncture student knows, but doubly damp, i.e. damp both inside and out. (This fact turns out to be key to its leveraging the Spleen and its counterbalancing channel, the Large Intestine, successfully.)

The qualities of the eleven other channels are teased out in detail as well. For acupuncturists not familiar with Saam, some of these channel qualities will be familiar (i.e. Heart excess gives rise to heat signs like a rapid pulse and flushed skin), while others will be novel: Triple Warmer excess yields bright, piercing eyes, while Urinary Bladder excess is evident in a tight, cool abdominal midline. The Saam tradition has correlated dozens of these clinical pearls, extremely useful in clinic, and Daly is careful to convey them all just as learned them from his teacher with the help of a few carefully-chosen photos: a cracked medial heel (sign of Small Intestine excess), a full, inflated thenar eminence (sign of Lung excess) or a deflated one (Stomach excess).

Throughout, he peppers the text with well-chosen quotes from the Chinese medical classics (Nei Jing and Nan Jing) as well as from later authors such as Xu Dachun and some non-Chinese thinkers of relevance. From the Nei Jing, for instance: “It is by virtue of the twelve channels that human life exists, that disease arises, that human beings can be treated, and illness cured. The twelve channels are where beginners start and masters end. To beginners, it seems easy; masters know how difficult it is.”6

After laying out the channels, their respective qualities and clinical characteristics, the exposition moves towards treatment strategies. At its core, the Saam system is brilliantly simple. Once a channel excess is identified, treatment consists in supplementing the counterbalancing channel—for each channel does indeed have exactly one counter-balancer. In the case of Spleen excess, one would supplement Large Intestine, which is as dry as the Spleen is damp, in order to move the system toward harmony. (On occasion, an advanced practitioner might actually drain the Spleen instead of supplementing its opposite number, but Daly opts not to get into the draining strategies in this introductory book, as draining contains more inherent potential for harm.)

If it’s not already clear, Daly’s book is aimed squarely at practitioners with a solid background in East Asian medicine concepts and an acupuncture license. It’s not overly technical, but it does assume some basic acupuncture knowledge such as point locations, especially in the later, more clinically-oriented chapters. That said, a motivated layperson reader would stand to learn a good deal about how a living East Asian Medicine tradition works, even if some of the technical details go over their head.

After a chapter on the four-point combinations used to supplement each of the twelve channel systems (and the elegant rationales for these combinations), a “Clinical Practicalities” section details such matters as Saam-style abdominal palpation, which is used to help confirm certain diagnoses, and assessing the suitability of a treatment once the needles go in. In print, Daly emphasizes the important of seeing an improvement in complexion, though in class he has also emphasized watching the degree to which the patient settles—a factor I’ve found to be extremely relevant.

To slow down for a moment around this crucial topic: with a system as powerful as Saam can be, it’s critical to heed these subtle signs that a treatment is moving in the right direction, for an unsettled treatment response on the table (e.g. a fidgety patient, one who keeps opening their eyes, or whose complexion becomes blotchy) translates to a worsening of symptoms and the need for a reverse treatment using the counterbalancing channel at the earliest opportunity. With Saam, there are no half-measures or harmonizing strategies: you’re going all in, so the stakes are higher than with other styles. But it’s exactly this built-in feedback mechanism that allows the practitioner to course-correct and learn from mistakes, and that creates safety for the patient in the form of built-in “antidotes” to potential mis-steps.

Back to the text. Helpfully, the Practicalities section also includes photos of faces characteristic of the various excess patterns, from a highly symmetrical Kidney excess face to a red, flushed Heart excess face. There is little here on the pulse, for Saam almost completely de-emphasizes this form of diagnosis in favor of a combination of observation and palpation (of abdomen and skin quality, combined with skillful questioning.

A penultimate chapter covers technical considerations (such as needle gauge, needling technique, retention time, etc.) before things wrap up with a set of three case studies. The cases are clear and convincing, and beautifully illustrate Saam’s principles in action. Each study allows us to follow the clinical narrative of a patient over the course of three to seven treatments, each of which alters the inner landscape in the direction of harmony.

Of course, in reality, as Daly likes to say, “clinic is hard,” and not every case (even of Daly’s) proceeds as smoothly as the ones he’s chosen to highlight in the book.

It’s certainly understandable to choose ideal, unequivocally successful cases to illustrate the system under discussion.But as a practitioner who’s had to learn through a certain amount of trial and error (as we all do), I can’t help wishing that Daly had included at least one example of a case that got off track, as he does in his Saam teaching. Dealing with such mis-treatments is part and parcel of learning and practicing Saam, and there’s a missed opportunity here for the student to witness what it can look like when the needles send someone in exactly the wrong direction—and how to recover. Daly does, however, discuss the general procedure for reversing a wrong treatment in an earlier section, so the newbie isn’t left entirely without a line. And part of the beauty of Saam is that each mis-step has a clearly defined way to correct it, provided the practitioner has gone slowly and not overextended by doing too much at once.

As mentioned, Daly does opt to omit any mention of more advanced aspects of the tradition, such as draining strategies, bilateral treatments, modified point combinations, and the simple Ren and Du channel treatments. This is definitely understandable in an intro text, as a little knowledge can dangerous; Daly probably doesn’t want to give folks ideas. But here’s hoping a sequel is eventually forthcoming to lay out the missing pieces.

Back in the Preface, Toby Daly stated his misgivings about writing a book like this one. “I have real concern about compromising the dynamic vitality of a living oral tradition by codifying it into an unchanging book…”7 Thankfully, with Saam enjoying a renaissance in the States and beyond, the tradition seems unlikely to become ossified or unchanging any time soon. And that’s thanks in large part to Daly, his teacher, and the long line of needle-wielding monks before him.

Here’s to them, and to all of the practitioners doing their part to keep the flame of this remarkable wisdom tradition burning bright. The future is going to need every bit of this medicine.

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JE: Tell us more about your Ayurvedic teacher Vaidya Mishra's lineage: what's distinctive about it, what are some of the hallmarks?

NP: Vaidya Mishra referred to his family lineage as the "Shaka Vansya Ayurveda" lineage. He traces it back to Lord Krishna, but this is likely just mythology. There are several hallmarks of his approach which could be summarized as "sutra to science" and "pulse and marma." Vaidya was an amazing herbalist and after coming to the United States, he noticed that Western patients were not metabolizing herbal medicines properly, due to conditions of toxicity. In response to this, he formulated transdermal herbal applications that allowed for absorption via the skin rather than through the already-burdened digestive system of most patients. He also created "herbal memory nectar drops," in which only the vibrational imprint of the herb remained in a base of vegetable glycerin. This approach was rather homeopathic, as there was no detectable physical herb, but only its energetic "memory." He referred to his unique herbal delivery system as the "transdermal marma system," as the transdermal herbs would be clinically applied to marma points. This treatment style he referred to as "pulse and marma”––emphasizing a complex pulse diagnosis system and marma therapy as a primary treatment paradigm. Suśruta describes 107 marma points––Vaidya's lineage expanded on this and had preserved many additional point locations not found in classical texts. 

Other interesting aspects of Vaidya's teaching include his emphasis on the four types of toxins (ama, amavisha, garvisha, indravajravijanavisha). The first (ama) is familiar to all Ayurvedic practitioners, but the remaining three less so. Amavisha is a development of long-standing ama––it refers to a "hot" (or acidic) toxin. Garvisha refers to environmental toxins of all kinds, a significant issue in today's world. And indravajravijanavisha was seen by Vaidya as a reference to electromagnetic frequencies. He was unique in considering EMFs a major etiological factor that could interfere with effective treatment. 

JE: Regarding Tibetan Medicine, I’ve always been curious about how it accomplishes its synthesis (or reconciliation, if that's a better word) of two quite disparate sets of roots—Ayurvedic and Chinese—plus a third set, really, in Vajrayana Buddhism. For instance, do practitioners use the five phases and the 12 organ networks (i.e. Chinese Medicine theory) some of the time and the three doshas (Ayurvedic theory) at other times, or is there a broader framework that integrates all of the above?

NP: Tibetan Medicine is the original "integrative medicine" of the world. While Ayurveda and Chinese medicine are major influences, Tibetan medicine also incorporates aspects of Greek and Persio-Arabic medicine, alongside indigenous Tibetan shamanism. Tibetan medicine developed its synthesis over many centuries by inviting physicians from neighboring cultures to share their medical systems. One such example was Galen, who is said to have become a resident physician in the Tibetan courts. In terms of Ayurvedic influence, the Astanga Hridayam was a primary textual transmission from India to Tibet, because Vagbhata was a Buddhist. Significant aspects of Ayurvedic medicine are now preserved in Tibetan medicine due to the transmission of Buddhism from India to Tibet. In this sense, we could see Tibetan medicine as a "Buddhist" stream of Ayurveda. However, the Tibetans also preserved and perfected rasa shastra, and have clear influences from the South Indian Siddha tradition. The "precious pills" of Tibetan medicine still use mercury [note: always in a purified, stable form as mercury sulphide -JE], and I had the honor of meeting a Tibetan herbalist once who was renowned for his alchemical preparations. 

The Tibetans use tridosha to evaluate the compositional quality of things––constitution and materia medica––as these are seen as having "fixed" natures. Thus, when classifying foods, herbs, and constitutional types, tridosha remains the reigning paradigm. Yet, the Tibetans use Chinese five-phase theory to examine the pulse and to account for a number of astrological / divinatory factors. These are seen as having a more dynamic and present-time value where the cyclical phases become relevant. I always found the Tibetans' contextual application of these theories to be fascinating.

Tibetan medicine does place more emphasis on the twelve organs than Ayurveda does, a clear Chinese influence. But the twelve organs are not connected to each other via a functional network of meridians. There is channel theory in Tibetan medicine, but it is based on Indian and Tibetan tantric traditions, rather than Chinese meridian theory. Given how much the Tibetans incorporated from China, the lack of a meridian paradigm still surprises me. 

JE: I’ve marveled at times at the efficacy of the Tibetan herbal tradition and how much it manages to rely on sui generis medicinals and high-elevation Himalayan plants (though I recognize that they do import triphala, spices, etc. from India, and presumably some things from China as well). I'm curious about the history of their herbal formulas - do we know you wrote them, and how they emerged? Was there a (mythical or historical) Shennong-like figure in Tibet? 

NP: As for herbs, you are right––they use materia medica unique to the Tibetan plateau and import Ayurvedic medicinals / spices. There is also some significant crossover with Chinese materia medica, suggesting a clear influence from Chinese herbalism as well. Most of the herbal formulas in Tibetan medicine have mythological origins––they were revealed in dreams as a kind of hidden treasure (terma) to great Masters. Nagarjuna, for example, is credited with writing (or "revealing") a number of such formulas. This topic has been well-studied by anthropologist Barbara Gerke in "The Signature of Recipes: Authorship, Intertextuality, and the Epistemic Genre of Tibetan Formulas."

JE: I love seeing this reference to Barbara Gerke’s work—she was part of my earliest exposure to these traditions when my undergrad study abroad program visited her then-center in the Darjeeling Hills of India. Small world department. Now, zooming back out for a moment, it's rare to meet someone versed as you are in all three of these great Asian medicine traditions (we might need to add Unani to the list of great Asian medicine traditions, too). From your unique perspective as a student/practitioner of these three, would you share a little about what you see as the respective strengths of Ayurveda, Chinese Medicine and Tibetan Medicine? What unique contributions does each tradition bring? And how might a prospective patient go about deciding which kind of practitioner to visit?  

NP: Each system certainly has its strengths, which I think of as emphases. Ayurveda is largely a diet and lifestyle medicine––it is primarily oriented to counseling patients in appropriate diet and healthy routines. This focus comes from the Vedic tradition which relied on a highly ritualized form of life to receive the favor of the gods––everything is thus "timed" to enact a harmony between microcosm and macrocosm. If we look at Ayurveda, we see that it can keep us busy all day with lifestyle practices! Ayurveda has re-emerged in the West via "spa therapies", but its main strength is as a diet and lifestyle medicine, and therefore as a preventative paradigm. Ayurveda's unique theoretical contribution is likely its constitutional paradigm––its emphasis on understanding the unique individual constitution and the importance of living in accordance with it. I also find that Ayurveda's ability to differentiate constitution from imbalances (or prakriti from vikriti) is very helpful, and not as strongly delineated in other traditions. For example, in Chinese medicine, constitutional ideas do exist [editor’s note: see recent post on Dr Huang Huang’s new book and constitutional approach to Chinese herbal medicine - JE] but they are less defined, and are not as clinically significant as they are in Ayurvedic practice. Ayurveda also has a unique therapeutic paradigm in panchakarma, its traditional detoxification regimen, and in its emphasis on rejuvenation (rasāyana). 

Chinese medicine gives us a unique physiological framework with the twelve meridians and organ networks. While Ayurveda has marma therapy, the Chinese are the ones who have truly developed an energy medicine. The Chinese application of acupuncture and moxibustion on points and meridians has no real parallel in Ayurveda or Tibetan medicine, and it is a remarkably powerful clinical therapy. Ayurveda and Tibetan medicine have rich anatomical paradigms, but the Chinese have observed the esoteric anatomy of the human being in unique detail, and formulated a clinical approach in relation to it. I think it is essential for Ayurvedic and Tibetan medicine practitioners to at least gain some knowledge of acupuncture, though this can be challenging in the climate of licensure / accreditation in America. Acupuncture stands out as the unique contribution, but the Chinese herbal tradition is also quite rich and sophisticated. Chinese five-phase theory, as first expounded in the Nan Jing, is also an indispensable contribution to medicine as a whole.  

Tibetan medicine is an integrative system, because it functions as an umbrella for so many other medical systems, all elegantly synthesized in its theory and praxis. This gives Tibetan medicine an historical wholeness that other traditions sometimes lack. For example, Tibetan medicine still utilizes demonological concepts that stem from its indigenous (and animistic) worldview. This "eco-demonology" is a significant emphasis in Tibetan medicine, where the human relationship to the non-human world is regarded with great importance, and where human disturbance of the natural world is tied to complex etiologies of illness. Tibetan medicine has its holism intact, it offers a complete worldview without eschewing older ideas, and offers a framework where differing worldviews can comfortably co-exist. In contrast, Chinese medicine has been moving away from demonological ideas since the Han dynasty, favoring an agrarian framework that was conceived as being more rational and empirical than ideas of spirit-caused illness.

In terms of unique contributions, Tibetan medicine has a very sophisticated approach to bloodletting, not found in the same way as Ayurveda or Chinese medicine. There is good reason to accept moxibustion as an indigenous Tibetan practice, making this an interesting contribution––we do also see a highly developed approach to moxibustion in Chinese medicine and in Japanese styles of acupuncture. Medicinal baths (lums) are another unique contribution from Tibetan medicine, with many types of baths described and employed in treatment. As we can see, Tibetan medicine has a rich array of external therapies!

As for which system to choose, some patients have their natural inclinations. Many who are interested in Indian philosophy and yoga gravitate toward Ayurveda as a compatible paradigm. Buddhist practitioners, especially Tibetan Buddhists, will find Tibetan medicine more appropriate for their worldview and spiritual practice. Practitioners of Qigong, martial arts, and Daoist alchemy in general will appreciate Chinese medicine as a continuation of these practices and ideas. All three medical systems are rooted in unique worldviews, spiritual traditions, and cultural paradigms––it is for the patient to discover which resonates. We can also examine this more clinically: patients who are interested in nutritional counseling, detoxification, and rejuvenation will find Ayurveda quite useful; patients seeking a directly energetic and even psychotherapeutic approach to healing will find it satisfied in Chinese medicine and five-phase based approaches in general; and patients who desire a spiritually-informed medicine will find these principles most active in Tibetan medicine. 

That being said, patients often come to see without a clear preference for a system. They know that I specialize in traditional Asian medicine and are looking for help with their concerns. In these cases, I become naturally eclectic. I think my intake style is most influenced by the "traditional diagnosis" of J.R. Worsley, and I use his system of pulse-taking as well. I will typically make dietary and lifestyle recommendations based on Ayurveda, because it just has so much to offer. People need to learn about the benefits of ghee, tongue scraping, abhyanga, neti, nasya––and these pearls are rather unique to Ayurveda. If I'm going to recommend herbs, then I will use Tibetan herbs. I gravitate to Tibetan herbs because the formulas are beautifully designed and the herbs are very high quality–– the plants are grown in a pristine environment, processed according to seasonal and astrological factors, and ritually empowered. Tibetan formulas also tend to "fit." In other words, I can listen to a patient and a classical formula can come to mind that fits their clinical portrait. I think we have to use whatever tools give us that sense of resonance, matching the patient as closely as possible. In terms of an external therapy, I make moxibustion a cornerstone of my sessions, and find it adequate in addressing a spectrum of concerns. 

JE: There are so many threads here we could follow further here—I’m especially interested in the animist roots and ritual aspects of Tibetan Medicine, something that has indeed been largely lost in perhaps all but the most Daoist-influenced of Chinese medicine lineages—and we’ve barely touched on Jyotish and astrology! But we’ll wrap it up here for today. Thanks so much for sharing with us from your theoretical, academic and clinical expertise. It’s been a pleasure.

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It starts with fresh Skullcap tincture from Scutellaria lateriflora, one of our best all-around “nervine” herbs. Skullcap is a safe and non-toxic member of the mint family. Sounds innocuous enough, and it is, but skullcap’s medicine is quite profound. As the name suggests it seems to work from the top down, with a tangible cerebral affinity. It quiets excessive mental activity in a balanced way without dulling the mind or senses (the way that, say, Valerian does).

As an aside, here’s a lovely meditative piece by Sophia Rokhlin in part about a local North Carolina skullcap species.

Skullcap’s good on its own: it’s the “perfect nervine,” as NYC herbalist William LeSassier liked to call it. But to take things deeper, we can add Milky Oatseed tincture, Avena sativa. This stuff has to be genuinely milky, mind you: this means whoever prepared the tincture ought to have put the immature (milky-stage) oats and water-alcohol mixture in a blender for about a half a minute and gotten a pale green frothy milkshake for their trouble. Even after straining, this stuff remains on the thick side and should be decidedly sweet like—yes—milk. For those who need it, anyway, Milky Oats proves to be one of the most delicious of tinctures (along with peach leaf, hawthorn berry, and one or two other candidates). You can just feel it nourishing the nerves as it elicits deep sighs of contentment. A true balm.

Skullcap primarily cools and quiets, and secondarily feeds the nerves. Milky Oatseed primarily feeds and settles. The synergy between these two is ideal; together they both settle down and build up the nervous system. A technical term we can invoke here is “tropho-restorative,” something that normalizes and restores tone. You can almost hear the myelin sheath saying “ahhhh.”

This herbal pair of Skullcap and Milky Oatseed is the heart of the formula, but I like to go a step further and invoke one of Traditional East Asian Medicine’s most useful nervines. A little bit of context is in order here, in that the concept of “nervine” is foreign to TEAM (just as the concept of “nerve” is to begin with). What we do have, however, are herbs that supplement the yin of the lung. It turns out that when the lung yin is fried, the nerves are fried. (If you’ve ever been through a fire or simply smoked too much then you know this to be true.) In many cases we can supplement the lung yin to support the nervous system.

One of the best lung yin medicinals is baihe, a bland, edible type of lily bulb. This seemingly mild item gets a lot of attention in the Jin Gui Yao Lue, one of our seminal Chinese medicine classical herbal texts. There, it is recommended in the treatment of something called baihe bing or “lily bulb disease.” In this condition the patient “desires to eat but cannot eat, desires to lie down but cannot lie down…” In other words, the lily bulb patient is fretful, restless, exhausted and yet unable to sit still. Not so far from ADHD, come to think of it.

Baihe or Chinese Lily bulb treats this syndrome, typically in combination with another yin herb (either Rehmannia root [more supplementing] or Anemarrhena root [more cooling]). But I find it goes very nicely with Skullcap and Milky Oatseed.

I’ll sometimes supplement the baihe tincture with a bit of shatāvari or tianmendong (both forms of Asian asparagus root), a lily-family cousin of baihe with similarly soothing, yin-nourishing effects. Unfortunately not all baihe is up to snuff, and I find this addition helps round things out and make it work like it should.

For severe cases of nervous overstimulation I’ll sometimes add a percentage of something stronger, but most of the time these three medicinals are enough to make a major impact on quality of life for the stressed-out patient. This kind of treatment may not get to the root, but it can buy some time for deeper underlying patterns to be addressed.

As for dosage, I’ll typically recommend 1-2 droppersful up to 4 or 5 times daily, decreasing over time down to 10-15 drops twice a day.

Nerve Balm

roughly equal parts:

Fresh Skullcap tincture

Milky Oatseed tincture (blended, opaque, sweet)

Lily bulb tincture

I'll also typically add a small amount of licorice root tincture to harmonize the formula and sweeten it, though this is not strictly necessary here.

Possible Modifications

• For pronounced agitation with red tongue tip, add Peach Leaf, Melissa and/or danshen (Salvia miltiorrhiza)

• For pronounced tension and rumination, add Passionflower or Peony

• For lack of grounding and disconnection from the body, use or add Wood Betony

• For adrenal depletion and exhaustion, add Rehmannia (dihuang) and Schisandra (wuweizi)

• For chronic nervous weakness with poor sleep in a chilly constitution, add ashwagandha / Withania somnifera

• For nervous hypertension or extremely agitated states, add Rauwolfia (experienced practitioners only)

Whenever I post about formulas like this, I get emails asking if I sell whatever it is. The answer is that I make enough to use in my practice, for those under my care. The skullcap and milky oatseed tinctures I stock are from my own garden and in limited supply. I’m not sure who else makes a good, rich milky oatseed tincture, but try your local herbalist or check out HerbPharm, the big Oregon-based tincture company whose line is available in many retail shops.

For those called to more individualized care, I am accepting new patients at this time. You can learn more about my practice here, or go ahead and schedule a consult here.

Peace and calm to one and all _/\_

One of the things I love about the formula featured in today’s post, Wen Jing Tang, is that it’s herbal equivalent of the Chinese dish red-cooked pork belly (braised bacon, essentially)1. I also love that in Chinese medicine, such a dish (and formula) is understood to be healthy. Not for everyone all the time, certainly, but for some people some of the time. Such a far cry from the neurotic-about-fat (and neurotic-due-to-lack-of-good-fat) American mindset.

Wen Jing Tang translates as “Decoction to warm the channels” (sometimes translated “warm the menses”). It’s a famous women’s health and beauty formula that is, however, “not just for the ladies” as my teacher Brandt Stickley once said. What do I mean by “beauty formula?” That’ll become clear in a moment, once we understand the formula’s gestalt, or what we call its “presentation.”

A presentation is akin to a syndrome, a constellation of signs and symptoms; a pattern.

As I’ve described recently, classical Chinese medicine formulations work not by treating the disease alone, nor by treating the person alone, but by treating something in between. This something is the presentation. It’s the way a disease manifests in a person.

So, what is the presentation for this formula?

The patient—classically female—is rather chilly and dry. Their complaint may be infertility, menstrual pain, fatigue, low libido, thinning hair, brain fog or any number of other issues. Their complexion tends pale or ashen, with a tender-looking, pale or dusky-purple tongue (never a dry, red tongue or a thickly-coated one). Their pulse is likely to be on the thin side. Abdominal palpation may reveal a comparatively narrow sterno-costal angle and a thin abdominal wall, with or without much tension in the rectus abdominis muscle, and pulsations along the midline. The skin may feel dry and/or cool to the touch.

What this patient is missing is a certain hormonal juiciness. They’re blood-deficient, if by “blood” we understand not only the red fluid in our vessels, but a general quality of tissue plumpness. These patients, in other words, are rather undernourished. They’re also chilly. And yet, due to the relative lack of yin and blood, they may have localized heat signs: thirst, night sweats, or hot palms and feet.

But the telltale sign is the lips. If I’m already considering Wen Jing Tang and then discover that the patient has dry lips, either visibly or reportedly, then the finding seals the deal. I can sit back and watch as from week to week they regain a glow and sparkle. The relief is something akin to a dry sponge expanding and relaxing as it finally soaks up some moisture.

Now we’re in a position to understand how this combination of herbs can function as a beauty formula: by restoring tissue plumpness, skin moisture, and something less tangible that the Chinese call “peach luck” and that we can gloss as hormonal magnetism.

Besides helping people to look and feel their best, my favorite part of prescribing Wen Jing Tang is that I get to tell the patient to go and eat plenty of pork belly, braised lamb shanks, and other fatty, collagen-rich foods. Genuinely, truly, for their health.

Although this is something of an '“off-label” use, Wen Jing Tang is also of great potential utility in cases of early-stage cognitive decline such as Alzheimer’s. Of course, the presentation has to be right. A warm, obese patient with oily skin should never take this formula (but may do quite well with something like Chaihu jia Longgu Muli Tang). A thin, dry, pale, chilly patient with memory issues will probably do wonderfully.

Wen Jing Tang

Dosages are given in grams per day as a decoction and may vary. Wen Jing Tang may also be given in granular extract form or cooked into a concentrated gao (syrup) with honey and/or molasses.

Guizhi / Cinnamon Twig 6

Danggui / Angelica sinensis root 6

Chuanxiong / Ligusticum root 4

Baishao / Peony root 6

Wuzhuyu / Evodia fruit 3

Maimendong / Ophiopogon tuber* 10

Ejiao / donkey hide gelatin** 8

Banxia / Pinellia rhizome 6

Dangshen / Codonopsis root*** 8

Shengjiang / fresh ginger 6

Mudanpi / Tree peony root bark 4

Zhigancao / stir-baked licorice root 4

*I’ll often use Tianmendong (Asparagus root, known in Ayurveda as Shatāvari) in addition

** I’ll typically omit ejiao (an animal product )due to ethical considerations or will substitute a dense, sticky tonic plant material like Huangjing or Dihuang.

*** Originally renshen, ginseng root

Potential modifications are many, and perhaps too technical to get into (but do leave a comment if you’d to see more shop talk here). Suffice to say there are a number of directions this formula can be taken in order to deal with various concurrent conditions such as fluid metabolism issues, insomnia, Raynaud’s, etc. As long as the basic gestalt, the dry-thin-chilly presentation is there, it’ll likely serve as an excellent starting point.

Be sure to check out Neeshee-ji’s substack, Somaraja, where he delves deep into all sorts of topics of interest Seeds readers. Keep your antennae up for more part two, along with other new voices gracing these pages in the weeks and months to come. -JHE

JHE: Tell us about your background and how you found your way to this field of traditional Asian medicine. Were Ayurveda and Tibetan Medicine on your radar screen from an early age as a possible career path, or were you going in some other direction initially?

NP: My parents immigrated to the United States from India, but I was born in the US. For most of my childhood, my grandparents also lived with us, and since they did not speak English, I became naturally bilingual at a young age. My grandfather, in particular, was a significant influence on me. I remember him grinding and preparing very pungent herbal preparations when I was young. He was a professor of history, but he had a keen interest in Ayurveda, Astrology, and Spirituality––and we would often discuss these topics together. So I was exposed to Ayurveda at a young age, though at the time I had no idea I would end up pursuing it as a career path. Much of Ayurvedic wisdom is embedded in Indian culture––in the use of spices in food and in simple home remedies. If anyone had digestive symptoms, my parents would pull open the drawer and give them a piece of sunthi (Ayurvedic dry ginger with limestone). My grandmother kept cloves in her purse and would often keep one in her mouth. When my cousins were babies, they had terrible colic, and my grandfather treated them with his own herbal preparation, the smell of which I can still recall! 

My conscious interest in medicine began around age 15, when my father gave me a book on Chinese face diagnosis. I was fascinated with the book and the way it described the human body as a system of correspondences. From there, I somehow found my way to Ted Kaptchuck's Web That Has No Weaver, an excellent introduction to Chinese medicine that solidified my interest in acupuncture. At the time, there was only one acupuncturist where I was living, and I went to see her to experience what it was all about. It was at this time that I also started reading Dr. Lad's classic, Ayurveda: The Science of Self-Healing, a copy of which had been floating around my house since I was a child. I have to admit that I found the Ayurvedic doctrine difficult to parse and much more abstract than the Chinese medicine books I had been reading. It is a strange thing to feel more interested in the arts of a culture other than my own, but this has been an enduring pattern in my life.  

My interest in medicine was concurrent with a spiritual revolution in my life. I was raised Hindu, but by the time I was 16, I had done a 10-day vipassana retreat and was embracing Tibetan Buddhism. I attended a local Tibetan center and became a student of Chögyal Namkhai Norbu Rinpoche. He is an important figure in my life because he founded the Shang Shung Institute, where I would study Tibetan Medicine exactly 10 years later. At this time, Tibetan Medicine was not at all on my radar. I have some recollection of the Tibetan lama at the center mentioning Tibetan medicine once. My awareness of Tibetan Medicine was in seed form. By the time I was graduating high school, I had encountered another spiritual giant in Adi Da Samraj, whose autobiography (The Knee of Listening) deeply impressed me. I was a satisfied Buddhist, but a friend implored me to read Adi Da's works. At first, I was less than interested, but over the course of two years, Adi Da's presence in my life grew tremendously and mysteriously. I began to experience his spiritual transmission moving and working in my body, especially when I would look at his photo or read his words. He would come in my dreams, embrace me, and fill me with his brightness. I began to enjoy a spiritual relationship to him that felt more real than anything else. 

This led me to become a formal devotee of Adi Da in 2008. After high school, I forwent college, and moved to Adi Da's ashram in northern California. From 2008-2023, I lived either in or adjacent to one of Adi Da's ashrams. The ashram was a place of spiritual refuge and depth for me, a holy place where I felt Adi Da's spiritual transmission with incredible potency. I lived like a monk, living the daily cycle of meditation, puja, chanting, study, and service. Early on, I also became involved in the editorial department that edited and prepared Adi Da's manuscripts for publication. I have worked as one of Adi Da's editors now for 15 years. 

It was amidst this spiritual concentration in my life that I successively pursued Ayurveda, Tibetan Medicine, and Chinese Medicine. I decided to study Ayurveda not only because it was my heritage, but because it was available. As an unlicensed and unregulated profession, Ayurvedic education has a level of flexibility that Chinese medicine does not. This means I was able to complete most of my Ayurvedic education at a distance, without having to re-locate for full-time school. After I finished the programs at the California College of Ayurveda, I went on to study with Vaidya R.K. Mishra who was the lineage holder for his family tradition of Shaka Vansya Ayurveda. Vaidya's emphasis was deeply classical, he could quote the Caraka Samhita at random, and described his approach as "sutra to science". He had a special focus on pulse diagnosis and marma therapy. 

Shortly thereafter, I decided to pursue what became a five-year study of Tibetan Medicine. I was very interested in how the Tibetans synthesized Ayurveda and Chinese Medicine. I had a feeling they had preserved another current of Ayurvedic thinking that was perhaps lost in India (and certainly absent in the West), and that it would bring me closer to my original interest in Chinese Medicine. In Tibetan Medicine, I found a unique holism and integrative approach, where a multitude of medical systems had been articulated into a coherent framework of theory and practice. I also learned in a traditional context, where my teacher, Dr. Phuntsog Wangmo, recited every verse of the Four Tantras to us, emphasizing oral transmission and the importance of lineage. She treated me like family and embodied the meaning of medicine as a spiritual practice. She has been a tremendous influence on me. Tibetan Medicine shares a number of modalities with Chinese Medicine––moxibustion, bloodletting, cupping, herbs, etc. All of this revitalized my interest in acupuncture. 

Finally, in 2020, I began my formal study of Chinese Medicine. I started in an unusual manner by training in Worsley Five-Element Acupuncture. This was technically a post-graduate program, so I went somewhat in reverse. I learned the system I was interested in practicing and then enrolled in a 3-year Chinese Medicine program. I'm currently in the final months of the Master's program at the Middle Way Acupuncture Institute. In looking back, I'm very happy I decided to study all three systems, as each have completed something for me that would have remained unknown. For me, there was always a need to look further and to cross boundaries of knowledge and culture. All three systems agree with each other in significant ways, but they also each have very unique contributions and I feel the need for all of them. I am very grateful to all the teachers who were lights on my path and who continue to show me the way.  

Part two coming soon.

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Neeshee Pandit is a practitioner of Ayurveda, Tibetan Medicine, and Vedic Astrology. As a practitioner, Neeshee values the traditional pedagogy of lineage, oral tradition, and the teacher-disciple relationship. In 2021, Neeshee trained in Worsley Five-Element Acupuncture at the Worsley Institute and subsequently enrolled in a Master's program at the Middle Way Acupuncture Institute in Mt. Vernon, WA, where he is currently in the final months of the program. In addition to his private practice in Boulder, CO, Neeshee spends his time writing about medicine, teaching at The School of Ayurveda, and serving on the Worsley Institute Board of Trustees.  s a practitioner of Ayurveda, Tibetan Medicine, and Vedic Astrology. As a practitioner, Neeshee values the traditional pedagogy of lineage, oral tradition, and the teacher-disciple relationship. In 2021, Neeshee trained in Worsley Five-Element Acupuncture at the Worsley Institute and subsequently enrolled in a Master's program at the Middle Way Acupuncture Institute in Mt. Vernon, WA, where he is currently in the final months of the program. In addition to his private practice in Boulder, CO, Neeshee spends his time writing about medicine, teaching at The School of Ayurveda, and serving on the Worsley Institute Board of Trustees. 

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Whether you call it TCM (Traditional Chinese Medicine), CCM (Classical Chinese Medicine) or TEAM (Traditional East Asian Medicine), most people here in the States think of it under the umbrella of yet another acronym: CAM (complementary and alternative medicine).

One can’t help but wonder whether this branding wasn’t a canny move on the part of pharmaceutical companies and other healthcare profiteers to keep potential “alternative” competitors out of the mainstream, by definition.

In any case, Chinese Medicine (as I’ll call it here for simplicity) is fully capable of functioning in a primary care capacity1, and it’s heartening to see a new translation of the work of Dr. Huang Huang (黃 煌) underscoring this capacity.

Expertly translated by Daniel Eng, Eran Even and Craig Mitchell and published by Eastland Press, A Manual of Classic Formulas for Primary Care continues Huang’s longstanding work with jing fang (classical formulas), a term that is “shorthand for formulas from the classics [i.e. ancient medical texts], or for experiential formulas that have been passed down from generation to generation.”2 In a field with a written record extending back more than two millennia, a classical focus can also simply be taken to mean an emphasis on the oldest extant texts and their approach, in particular Zhang Zhongjing’s seminal herbal manual, the Shanghan Zabing Lun (Discussion of Cold Damage and Miscellaneous Diseases).3

Huang Huang’s work has long focused on these Shang Han Lun formulas by Zhang Zhongjing, but with a twist. Drawing in part on the classically-based Japanese Kampo herbal tradition, Huang has developed ideas about constitutional type (tǐ zhì 體質) and elucidated the relationships between families of herbal formulas and the types of patients for whom these formula families are appropriate.

For instance, to start with a canonical example, formulas based on the herb guizhi (cinnamon twig) are mainly suitable for those Huang has helped delineate as the guizhi constitution, otherwise known as the delicate bookworm. In other words, these people—thin, chilly, prone to anxiety and weak digestion—are a good match for formulas like guizhi tang and its many variants (wen jing tang, xiao jian zhong tang, zhi gancao tang, etc).

Contrastingly, formulas featuring the bitter purgative dahuang (rhubarb root) are usually only suitable for big, robust patients prone to internal heat and constipation. These patients typically have dry, tough, yellow-coated tongues and big, hard bellies. They would do as poorly on guizhi tang as the bookworms described above would do on a dahuang purgative formula.

Needless to say, prescribing in the style of Dr Huang is about much more than recognizing the constitution of the patient. But recognizing the constitution allows one to get into the right ballpark before concerning oneself, as it were, with the pitch.

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In terms of Huang’s corpus, his best-known earlier book, Ten Key Formula Families, probably remains the place to start for the Chinese medicine student looking to familiarize themself with Huang Huang’s thinking, as that book discusses the constitutional types in depth and gives more of the theory.

However the new book, A Manual of Classic Formulas for Primary Care, is perfect for the practitioner looking for further support in applying Huang’s principles and techniques in clinical practice. This is because A Manual preserves the hallmarks of Huang’s style while presenting a more disease-centric approach to the material.

Taking the book’s second half first, this section is organized by disease and presents several potential formulas for each of these disease categories: cancer (several types covered), diabetes, menstrual disorders, skin diseases, renal diseases, hypertension, GI diseases, common cold and influenza, bone and joint diseases, coughing and wheezing, and diseases of the oral mucosa.

While not pretending to be comprehensive, Huang good covers a good deal of clinical ground here and clearly demonstrates how to apply constitutional, formula-families type thinking to various diseases. As always, one key is to treat the presentation or pattern4 as opposed to the disease. Each formula discussion in these disease chapters includes at least one brief case study. Huang also takes the opportunity both in this section and in the first half (discussed below) to discuss such practical tactics as the “five-two method” (five days on a formula, two days off). These kinds of practice notes can be invaluable for the younger practitioner still refining his methodology.

As for the book’s first half, this section goes through forty plus herbal formulas in some depth, including a number of formula not discussed in Ten Key Formula Families. (In most cases because they were omitted because belong to a family other than the ten discussed there.) New additions include baitouweng tang, da xu ming tang and zhuling tang. For each formula, Huang gives the following: a brief introduction, textual references, recommended dosage and preparation, summary of clinical presentation, patient characteristics (constitution), suitable disease patterns, modifications, important issues, and commentary.

The commentary is quite extensive in some instances and includes valuable clinical pearls from Huang’s extensive prescribing experience. For instance, regarding the (not strictly classical) Kampo dermatology formula jingjie lianqiao tang, Huang notes in the commentary that “this formula is very effective in treating acne, especially when the pimples are red, protrude, have pustulated, and contain thick, sticky, and yellow fluids.”

For another example of Huang’s commentary, this time on da xu ming tang, a formula that will be unfamiliar to many practitioners, see this footnote.5

Regarding the translation, Eng, Even and Mitchell have done an admirable job. The book is readable and well-formatted, the terminology well-chosen and the phrasing clear and direct. The formatting and cover art are in accord with that of Ten Key Formula Families, providing a pleasing continuity to the canon of this important modern Chinese Medicine physician.

May more and more patients and practitioners alike be encouraged to lean on the richness and depth of Chinese Medicine for primary care.

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A Manual of Classical Formulas for Primary Care can be ordered directly from the publisher, Eastland Press.

Covid 19 itself, and the vaccines developed for Covid 19, frequently trigger the kind of circulatory issues known in East Asian Medicine as “blood stagnation” or “blood stasis.” This accounts for the marked increase in menstrual issues and heart problems among both Covid patients and Covid vax recipients, as well as a number of “long Covid” syndromes involving neurological symptoms, brain fog and chronic pain. A common denominator among these various conditions is impaired systemic (micro)circulation, or blood stasis.

The good news is that blood stasis is highly treatable. I have seen Covid vax injury symptoms resolve with a week-long course of an herbal formula to ‘invigorate’ or ‘move’ the blood1. I’ve also seen long Covid respond favorable to this treatment approach, (although in the case of long Covid, treatment is not as quick or straightforward).

Blood stasis may easy to treat, but it’s not easy to spot if you’re not trained to look for it. Signs are variable and can include a purplish tongue, varicose veins, dry scaly skin, poor sleep, tender points on the abdomen, and a dozen other possible signs, any one of which may not be present. The sensible approach is to take a course of blood-moving herbs if you have long covid or Covid vax injury issues.2

If you or someone you know is in this boat, any well-trained East Asian Medicine practitioner should be able to help promptly and affordably.

Please help spread the word by forwarding or sharing this announcement, as the current censorship realities make it difficult to disseminate these (in some cases life-saving) perspectives via social media. Thanks, all.

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Note: this post is the first in the new Medicine Seeds section, which will allow herbal and healing-focused content like this piece to group together in one place under the larger Seeds from the World Tree umbrella.

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So, a little something for the heart-mind1: for anguish and anxiety, depression and despair, and also for the health of the physical heart and the vessels. To be clear, this is not a cure-all nor a remedy for every heart condition (there’s no such thing). Rather this is a cordial, in the original, heart-centric sense of the term.

One quick note before we dive in. It’s true that in traditional herbalism and East Asian Medicine, we often seek to treat the person first and the disease second. Two patients with depression may need two completely different formulas. However, it’s also possible at times to target commonly seen syndromes without too much regard for constitution. This is such a case. Still, for best results any other presenting patterns should be treated concurrently.

With that said, we begin with a lead herb, an “emperor” who embodies the spirit of the medicine as a whole. An archetypal herb for the heart.

In the past I used hawthorn here (berry, leaf and thorn), and I still like hawthorn and her cousin rose in this context. But since listening to a recent interview with Toby Daly (my teacher of Sa’am acupuncture) in which he discusses Red-root Sage (a.k.a danshen or Salvia miltiorrhiza) I’ve been inspired to use danshen in place of hawthorn, and I must say I like the change.

Danshen is a one-stop shop as far as herbs for the blood go: it nourishes as well as “moving” the blood or dispelling stagnation. It is also cooling and calming, wonderful for any kind of irritability. Giving danshen alone (as a decoction or tincture), can be wonderful for the heart, kind of like chocolate alone can make a pretty nice dessert. But like with chocolate, we can do more with it if bring in a supporting cast.

Let’s introduce the players:

Saffron: red gold, known for its blood-moving and mood-lifting effects. A little goes a long way, so we only need take up a small percentage of our formula with this potent addition. (As a side note, saffron tinctures beautifully and rapidly in vodka or brandy, and the tincture makes for an easy-to-use liquid form of the precious spice for culinary applications as well.)

Albizia julibrissin: the delicate-as-silk, poofy flowers from the He Huan tree, literally “Tree of Harmony and Happiness.” I used to live near a mature Albizia tree (sometimes called “Mimosa”), and in July when it was in full bloom, it would be covered in these magenta-pink poofs and teeming with dozens of nectar-drinking butterflies and always at least one pair of hummingbirds. This tree truly hosts the spirit of joy like no other. While the bark is potent in a spirit-anchoring sort of way, the lightweight flower is especially buoyant and uplifting.

Green Cardamom: with its wonderful piercing, camphorous flavor, cardamom awakens the mind, cutting through fog; its warmth also supports the gut and enlivens digestion. Given all we know about the gut-brain connection, it’s wise to include a carminative (digestive) herb like this. As with saffron, only a small percentage is needed, especially if cardamom is tinctured at high proof as it should be. Note: if using cardamom in decoction, it should be crushed and added at the end of cooking so its volatile oils don’t disperse.

Honey: long associated with the heart, honey brings together the flavors of the other materials and binds them into a delicious elixir. Any good, uncooked honey will do fine.

I often formulate by feel, rather than measuring, but the final formula looks something like this.

Red-Gold Cordial

Danshen / Salvia miltiorrhiza tincture 55%

Albizia flower tincture 17.5%

Saffron tincture 5%

Cardamom seed tincture 2.5%

Honey 20%

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Dosage and Instructions: 2 or 3 droppersful 2-3 times daily is generally enough to see an effect; give it a week or two. However, the cordial is tasty and non-toxic enough to take by the teaspoonful or even to sip an ounce out of a cordial glass on occasion, and such higher dosages can be helpful in pronounced or acute cases of distress.

Singing and playing by the one taking this formula are to be encouraged, along with all forms of emotional expression. Stuck feelings need to move, and this formula will facilitate that process, but not substitute for it. On the other side of the pain—through it—joy becomes more accessible.

Suggested Modifications:

+ add Rosa rugosa for PMS-associated mood problems; if menses are heavy, omit danshen and use Rosa instead

+ add Cinnamon twig for palpitations and anxiety with desire for weight on the chest in a thin, chilly patient

+ add American Ginseng for general debility

+ add Tianmendong / Shatavari and Baihe / Lily Bulb for restlessness, ADHD

+ add Rehmannia root (shu dihuang) in case of blood deficiency / iron-deficient anemia or postpartum depression

+ add Milky Oatseed in case of anxiety with nervous debility

+ add Zizyphus seed / suanzaoren in case of insomnia

+ Substitute Gymnostemma for honey in diabetes cases

Contraindications:

+ Bleeding conditions (except those caused by blood stasis)

+ Severe or suicidal depression (formula can be given but should not be relied upon exclusively in such cases)

Disclaimer:

Those with severe anxiety, clinical depression, heart disease or any other medical condition should consult a licensed medical provider; this information in this article is educational and not intended to substitute for professional care.

1

“Heart” and “mind” were concepts with a lot of overlap traditionally; even in many modern Indian languages, a single word covers both concepts fairly well (cf. man in Nepali, from the Sanskrit manas, heart-mind, as opposed to, say, buddhi, intellect).

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There’s little more associated with quackery in the Western mind than blood-letting. Isn’t that what killed George Washington, after all?

For the record: quite possibly.

After going to dinner in wet clothes to save time (face palm) and coming down with a sore throat and respiratory infection, the first president had an absurd +/- 40% of his blood let by a series of frantic physicians in a desperate attempt to cure him. Needless to say, the cure was not successful.

So yes, bloodletting has a bad rap these days, and the practice has long since gone out of fashion in the West.

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But it’s no huge surprise that I’m here to tell another side of the story—for the practice of bloodletting is alive and well in Chinese medicine, among other traditional medical systems. (Yes, leeches too, especially in Ayurveda; here’s a good article on the subject with pictures of the little parasites effecting a cure of the skin condition vitiligo.)

While I’ve seen significant quantities of blood let from a patient (using the so-called “wet cupping’ technique) most of the time we’re talking about micro bloodletting: pricking a point or set of points to remove a drop or two of blood. Often we look for dark or engorged veins, these being indicative of stagnation in the vessels, and bleed them with a quick prick of a lancet. The blood removed is easily absorbed by a single cotton ball, so for those awash in images of gore, it’s all disappointingly tame.

So, why do we bleed? Generally, to quicken the blood (removing stagnation), or to release heat.

Yesterday I had occasion to bleed a patient suffering from an illness known in Chinese as bi syndrome, or painful obstruction. After some exceptionally windy weather, not incidentally, the patient had woken up with a seized up thigh and hip, with assorted pains ‘wandering’ around her body. she was especially stiff and sore at GB 20 (behind the ear) and GB 31 (midway down the lateral thigh), two points that have “wind” in their names. This then would be wind-type bi, wind being a mobile force and general troublemaker when it comes to health.

One way of treating wind is via the blood. So in addition to giving an herbal formula and doing some regular (non-bleeding) acupuncture, I bled a few points on her legs. This more than anything gave some immediate relief, and she was able to walk up a flight of stairs without much pain for the first time in days.

This patient is becoming quite a fan of bloodletting, as several years ago when she presented with a severe sore throat, pricking a few points over the throat again gave immediate relief. This was an example of clearing heat: bleeding gives the heat an efficient outlet.

Pricking to bleed has other uses as well, mainly in connection with the specific points chosen. For instance, bleeding Lung 5 (a Lung channel point on the inner elbow) can be useful in treating cough. Bleeding the apex of the ear is well-known in Chinese medicine for treating hypertension and insomnia. And so on.

One misconception about bleeding, even within the Chinese medicine world, is that it’s only appropriate for cases of excess. While it’s true that we don’t want to go all George Washington on a weak or deficient patient (or any patient for that matter), judicious bloodletting is such an efficient way to remove obstructions and invigorate the blood that it can serve to open the way for more supplementing and nourishing therapies. Thus even delicate patients can benefit.

And what about ol’ George? I wasn’t there, but I imagine the president was shivering violently after catching his chill. Whatever his thermometer may have read, if he was indeed shivering and feeling cold, that would have been a sign that he needed to be warmed up: his system needed help mounting the fever to burn him clean. It didn’t need to be undermined by a cooling, depleting treatment like heavy bloodletting (and enemas and vomiting, both of which were also administered, inappropriately). It’s likely that blankets and hot tea would have been the right direction, although most likely a simple change of clothes immediately upon the president’s return home would have been the stitch in time that saved nine.

The cautionary tale here is not that bloodletting itself is dangerous (though there’s never cause for letting such quantities). It’s that bloodletting, like every other therapy, has to be administered appropriately—and the body’s innate intelligence must be heeded. A shivering patient should almost always be swaddled in blankets and warmed even if they’re running a 103 degree fever. Once the fever breaks, they’ll cool down naturally. But forcing them to cool down prematurely whether by means of an ice bath or by heavy bloodletting is almost always disastrous in such a case. Only in the most life-threatening of situations should the body’s intelligent preferences be overridden.

Those interested in further details on bloodletting can check out acupuncturist Henry McCann’s excellent manual, Pricking the Vessels: Bloodletting Therapy in Chinese Medicine. There’s even a free digital version available here.

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When I was a kid, my dad taught me a little game: he'd name a person, and I'd have to decide whether they were a horse, a bird or a muffin. It was silly, of course, but it was fun, and it had an element of truth: some people are definitely more muffin than horse, while with others you can spot the horsey-ness at fifty paces. Still others manage to be bird-muffin hybrids, somehow.

Sure, it's an oversimplification, but so are things like the seasons: in reality every day is a little different from the last, but it's still helpful to zoom out and notice the similarities. Same with people.

Every system of traditional (i.e. old-school) medicine that I'm aware of has its ways of recognizing different body types. People come in all shapes and sizes, and while the variety is nearly infinite, certain patterns can be usefully teased out.

Following the Ayurvedic way of thinking (that’s traditional medicine from India), for our purposes we can divide people into three main categories (keeping in mind that each of us will have at least a little from each category, and may be equally predominant in two or even all three). They are:

Sensitive Type (Bird)

Fiery Type (Horse)

Solid Type (Muffin)

Horses are vigorous, athletic, fiery, high-tempered—best not provoked unless you fancy a kick.

Muffins are solid and steady, unflappable, with deep reserves and a calm exterior.

Birds are, well, a bit flighty. They’re fickle, windy. light, creative, changeable.

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These “types” are really expressions of inner forces as expressed through our features, builds and personalities. In other words, we each have the inner principle that makes horses horsey, we just not have as much of it as our favorite horse does. If we didn’t have it, we wouldn’t be able to survive in winter. We all have the bird principle, wind, or else we’d be immobile. We all have some muffin principle (call it dampness), or we wouldn’t stick together. From a medical perspective, all this is a gross oversimplification, but you get the idea.

The point is that there aren’t really three types, it’s more like there are three ingredients, three principles that operate in all of us to varying degrees—but for simplicity’s sake we can talk about three types.

Horse Culture, Horse Medicine

Cultures can be classified this way as well as people can. American culture is (you guessed) horse-heavy—just think of the national obsession with horsepower. We value productivity, like to keep ourselves humming with coffee and to work long hours. Achievement is looked upon highly. Taking too much vacation (a typical muffin-y behavior) is not. And bird-like, outside-the-box creativity can be looked at askance. (Things we don’t like are “for the birds.”)

Since we live in a horse-dominated society, it's no surprise that our medicine (modern, conventional medicine) works relatively well for horses. These are robust people with plenty of inner fire. As a rule, they're not overly sensitive to things like caffeine or other drugs. They can stand up to a certain amount of punishment if they have to and still bounce back quickly.Their digestion is generally strong--these are the people who can down a full glass of ice water and then eat a giant burger and fries without any apparent problem. Though such arguments are beyond the scope of this book, there's an argument to be made that modern medicine was created by and for this category of people, to a fair degree.

Muffins may not be as fiery and energetic as horses, but like a camel they have great reserves that can be tapped if needed. While emotionally sensitive, they are often the least sensitive types to physical stimuli (although they really don't do well with heavy, doughy foods and sweets). A rigorous, disciplined regimen can be a very good thing for a muffin. They can take harsh treatment if they have to and may show remarkable resilience to drying, heating therapies like radiation.

And then there are the birds. Here we have light-boned, thin, restless folks. These are the dreamers, the ones staring out the window in the back of the classroom. Inventive, erratic, creative--but above all, sensitive. Temperamental. Easily affected by things, for better or (as is too often the case) for worse. With great strength of imagination and intellect, birds are weaker in the physical department. Digestion is a particular vulnerability. So is the nervous system, so that birds tend to be high-strung and anxious when out of balance.

Medicine for the Birds

When I treat sensitive, delicate folks--a demographic that makes up over half of my practice--I've learned to do less. To use fewer and finer needles. Fewer cones of moxa. Lower dosages of herbal formulas. The weaker, more sensitive or more depleted someone is, the less stimulation it takes to make a difference, and the easier it is to do too much. It's counterintuitive, but think of it like this.

There are two carts, and one is full. The other is pretty emptied out--depleted. The full one requires quite a strong shove to get it moving. If you give the empty one that same shove, it'll go careening off the track, maybe even flip over. Easy does it.

In general, sensitive types (birds) require:

-lower dosages, not high ones

-lighter treatments, not stronger ones

-gentler flavors, not harsher ones

-supportive approaches, not aggressive ones

The more sensitive the person is, the truer these statements become.

When these principles are disregarded and a sensitive person is blasted with harsh, aggressive methods, things go downhill quickly. Pushed too hard, their systems go into the red zone, fight-or-flight. They may develop intense anxiety, tension, or insomnia. Their digestion may crumble, followed by energy levels and their already shaky confidence.

The good news is it's never too late to stop going down this road, whether as a sensitive patient or as someone treating a sensitive patient. The same body type that is reacting poorly to strong treatment can start responding well to gentle treatment. Things can turn around quickly. The key is awareness: that sensitivity exists, that many people exhibit it, that it can be recognized and addressed accordingly. Easy really does do it.

Interested in learning more about these ways of thinking about the body and working with sensitivity (which is also, let it be said, a superpower)? Drop a comment or check out my other online home, JonathanHadasEdwards.com.

Thanks for reading.

In his lineage of acupuncture, called Sa’am, the monks rely on those little needles (or not so little, as some patients will tell you) both to relieve suffering in others in fulfillment of their monastic vows, and to relieve it in themselves as well. After all, when monastic robes prove inadequate against winter’s chill, those four little needles can supplement the Heart and stoke the body’s core vitality. When the begging bowl fails to fill, those four little needles can supplement the Spleen, organ of nourishment and satiation—and while man can’t live on needles alone, those four little needles can sure help take the sting out of an empty belly. At day’s end, those four little needles can adjust and enhance physiology in a number of ingenious ways.

I’m someone who didn’t always pay much mind to this stuff, or even give it a second thought, but who now relies on it (much as those monks do) on a several-times-a-week basis. As such, I’m a bit fixated on helping others appreciate this curious, idiosyncratic healing art called acupuncture.

From the outside, it’s a practice that can seem uninviting at best (who wants to get stuck with a pin?), and also strangely impenetrable. ‘How does it work?’ is a question on every patient’s lips. What’s the meaning of all those points and meridians (or channels, as they’re more commonly known these days) criss-crossing the body like so many back roads? It can all seem esoteric to say the least, and answers to these questions are not easy to condense into a quick sound byte.

The way acupuncture is sometimes talked about—and sometimes taught—doesn’t necessarily help matters. As a beginning student, I remember being notably turned off by lists of points and their indications: a tired, seemingly endless litany of this point for that condition, without apparent rhyme or reason. No doubt some of it worked, I thought, but without knowing why, there was no poetry to the subject.

That ‘why’ turns out to be as strange and wonderful as anything I could have hoped for. For acupuncture is but one fruit of a magnificent, deep-rooted tree, one that spans philosophy, literature and scientific enquiry. Among its branches can be found music, religion, and every classical subject under the sun. And while all its flowers and fruits have virtue, in the end it’s the tree itself that’s worthy of veneration.

Its roots, sunk deep in the earth of matter.

Its crown, kissing the heavens, mingling with the stars above.

Its sturdy trunk, spanning the realms and joining them.

Its vital sap, enlivening every leaf, every cell.

Tree of life, Tree of knowledge, World Tree.

As far as I can tell, every traditional culture from the Dogon to the Cherokee has some version of the tree—differing in details, to be sure, but consistent in embodying an integrated vision of the world and a wise perspective on the human place within it.

In our age (which is to say, deep in the Kali Yuga), many of those trees of wisdom have withered or been chopped down. The ones that stand tall still—in the face of materialism undermining their root systems and the forces of capital seeking to strip their bark for profit—those who stand must be considered sacred.

There’s no guarantee the last few old-growth wisdom traditions will survive the coming times intact. Sentinels may fall amidst the turbulence of the next decades and centuries. Yet the trees take the long view. They know that every part of themselves contains the whole; every seed contains the tree.

The seed called acupuncture is no exception: encoded in its odd channel pathways and point names is in intricately woven structure, a beautiful worldview for which its potentially profound clinical results are the evidence.

In this understanding, the body is akin to an ecosystem, complete with rivers and oceans, mountains and fiery zones. Under stress, this dynamic landscape can slip out of harmony: perhaps a prolonged dry spell leads to a raging wildfire; perhaps a clear cut forest leads to erosion that silts up of a waterway. Each of these possibilities has correlates in the inner landscape of the body—the wildfires might be hot flashes, the silted waterway hyperglycemia. For just like the natural world at large, our inner harmony depends on a complex set of checks and balances, well described by the Five Element theory that mirrors nature’s dynamic processes.

The details of this study are wonderfully intricate, but the broad strokes are simple enough. We need to be nicely warm (not hot or cold); moist (not parched or soggy), full (not bloated or empty). We need movement, but not too much. Consolidation, but not stagnation. And so on.

In Sa’am acupuncture, we work with six main pairs of qualities, each of which can be adjusted to either side, tuned up or down like guitar strings. If this sounds deceptively simple, well, it is a bit oversimplified—for tuning one string affects everything else, and anyway, the human instrument lends itself to more than one tuning (not to mention the differences of individual constitution, among other variables.)

As my teacher likes to say, clinic is hard.

The tree doesn’t yield its secrets casually. Each oily kernel is encased in a tough rind that takes patience and care to crack.

For my part, I take heart in the resilient potency of every little seed. So tenacious, so intelligent, so full of life.

And I give thanks for these four little needles and all they can do in the hands of one who honors the tree in whose shade and rich litter they stand.

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Of course, like so many things, vitality exists on a spectrum, with a wide band stretching between ‘burning bright’ on one end and ‘keeled over’ on the other. Most of us exist somewhere in that grey zone most of the time.

The bad news is the terrain is tilted. It’s all too easy to slump towards the lifeless end of things as we age. You don’t slump all at once (usually), but by degrees. Especially during a pandemic, or when the Southern heat keeps you indoors for months, or when…you see, there’s always an excuse for ceding a little more ground. Insidiously, you don’t realize what’s happening, like the proverbial fish in the slowly heating (or in this case, slowly freezing) pot. You just wake up one morning and realize you’re lackluster, depressed, demoralized—and wonder why.

It would be irresponsible of me as an herbalist to suggest that all depression boils down to yang deficiency (in Chinese medicine terms) or low agni (in Ayurvedic ones), i.e. a lack of basic vitality. There are other ways we can get stuck, clogged or funked up, and each requires a particular treatment approach. (The herb liver qi-disinhibiting herb chaihu, or Bupleurum sinensis, deserves its own post in this respect—a good topic for springtime, when this herb is most badly needed.) But let’s not discount low fire, as we can call it, as a major culprit.

As my main herbal teacher, the eminent clinician Dr Heiner Fruehauf insists, yang deficiency is more like a modern epidemic, a result of dietary and lifestyle factors, environmental toxicity, antibiotic overuse, and a slew of other causes that conspire to sap vitality.

Deficient yang is rarely the only factor in a given case, but it’s rarely absent, either. It’s an underlying stratum that eventually must be addressed. Fruehauf likens treating this layer to scoring a goal in a game of soccer: all the rest, the dribbling and passing, is for the sake of this.  

And that’s the good news. In their experiential wisdom, East Asian herbal traditions have shaped potent tools to restore the yang. Chief among these is Aconite.

This herb constitutes a big and interesting topic I won’t go deep into here; for those interested, Fruehauf has written several articles on the subject of this most yang of medicinals. Suffice it to say that this plant, a deadly poison in its raw state, is transformed through a series of heat treatments into a life-giving medicine capable of recharging the life-battery of the Kidney yang.

Take it from the horse’s mouth.

My own recent slump was of the yang-deficient type, as it finally struck me after a timely divination session (another topic again).

Once I realized why I’d been flagging, I went out to the apothecary and made myself a formula containing 50 grams of zhi fuzi, Aconite slices rendered perfectly safe yet highly potent. The difference was immediate and tangible: after the first dose I went, quite simply, from lackluster to lively. I’ll spare you all the physiological details, but I’ll say my complexion brightened up and I had my first good workout in too long. (Granted, my system is unusually sensitive, making me something of a canary in the coal mine when it comes to herbal effects: what I feel after one dose might take others several days to note.) Overall I was reminded of the net effect of taking a formula like this, when needed: like having your pilot light re-lit. Not a bad working definition of yang.

It’s all enough to make you wonder who ever figured out that wild Wolfsbane from the Sichuan mountainside was worth experimenting with, and how many lives were lost in the process. But such is the way with ancient wisdom traditions: the good stuff gets passed down. It’s enough for us to pay attention, and be thankful.