Simple Horse

Mangos and Pork

2012-01-09T08:30:00.001-08:00

Mangos and pork

Who needs a fork?

Dive right in!

Life is for living

The Laboratory and the Real Work

2011-09-16T11:07:00.000-07:00

Many years ago I started making herbal liqueurs and tinctures for fun. Along the way I went back to school to learn more about herbs and healing, and ended up with a master’s degree in traditional Chinese medicine and state certification as a Licensed Acupuncturist. For a couple of years I worked solely as a clinician, but then, to supplement my meager income and to get good benefits for my family, I took a day job as a research administrator at the local university, and treated people in the evenings and on weekends.

I stayed at my university job for ten years. It was a good job, with very little supervision and a lot of autonomy. The scientists that I worked with came to trust and like me, and to rely on me to manage their grants. We developed a ritual where, with every successful grant submission, we would share a glass of schnapps. Over the months and years the drink would vary depending on what I had most recently produced: it could be a strong clear liquor made from the plums growing in my yard, or absinthe, or a mix of spring bitters. Hanging out with my scientist friends, I came to admire them immensely for the work that they did as well as for the individuals that they were. Many of them work in biomedical research, peering into the workings of cells and the molecular basis of life, and finding out things that are resulting in a deepened understanding of, and eventual cures for, diseases such as cancer and Alzheimer’s Disease. But the work they did was so different from my work. Seized by a problem or a question, they devised experiments to test hypotheses, they ran labs that were devoted to figuring out stuff they were interested in. I distinctly remember once overhearing a researcher in the hallway, remarking incredulously to a colleague, “I can’t believe we get paid to fuck around!” I knew immediately that he meant “fuck around” in the best sense of the word, as in trying things out, playing, experimenting, figuring out the problem that occupies you. I wished I had a job where I could get paid to fuck around!

My administration job changed quite a bit in the last year or so. With the economy tanking, the trend was for fewer and fewer people to do more and more work. Plus, I had a new boss who managed to turn my job into that of a glorified clerk. I used to feel like a valued consultant, advising my PIs (Principal Investigators) on grant-related issues, but more and more I felt like an overheated machine, scrambling to stay on top of never-ending bureaucratic tasks that the University would have done better to hire a student helper for. While I still enjoyed working and hanging out with my PIs, I came to resent the middle and upper management who were, in my view, making bad decisions, ruining my job for me and diminishing the research enterprise at our university. So, two months ago, I quit my job.

For the first time in a while, I feel a tremendous sense of freedom. I still treat patients, but now I have some free time to fuck around! The place I do it is in my lab. When I left my university job, my PIs gave me a beautiful apparatus for extracting the active constituents from medicinal herbs. I set it up in my garage this summer, and have really been enjoying experimenting with it. I should clarify right away that would I actually do in my lab is quite different from what my scientist friends do. They seek to find out new things: the application of nanomaterials to the detection of cancer, for instance, or figuring out how tRNAs move on the ribosome during protein synthesis. I am interested in very old things: medicinal herbs and fungi that were first described a couple thousand years ago. My PIs use very expensive cutting-edge technology to arrive at their results, whereas my equipment is very low-tech, consisting of glass columns, jars, grinder, recycled pressure cooker, and coils of copper tubing. And, they are way smarter than me, have tons of education, and are eminent in their respective fields. (I myself am something of a hermit and an unknown). And, my lab is far dirtier than any of theirs (Environmental Health and Safety would probably frown at my spiders-per-square-foot statistic).

Nonetheless, the spirit of fucking around is the same. Will the MAO inhibition caused by the beta-carbolines in passionflower increase the antidepressant or sleep-inducing effects of some of the other herbs in this formula? Should I change the ratio of ethanol to water in the solvent to better extract the active polysaccharides from the ganoderma fungus I just harvested? Or would it be better to do two separate extractions, one in boiling water and one in pure ethanol, and combine them later? Should I add some fennel seed extract to the absinthe after distillation, to soften and sweeten the final product, or some fresh melissa? How will it affect the final product if I don’t first decarboxylate the herb with heat prior to extracting it? These are the kinds of questions that occupy me, and that I can play around with on my equipment. There is also a more sensual aspect to this fucking around. Tasting my herbal extracts, combining them, mixing them until they taste right to me and make me feel good, this is also an essential part of the process.

There is a sign that hangs over the door that leads from my office to my lab. The sign says LABOR. On the one hand, “labor” is the German word for laboratory. But there is a double and even a triple meaning. Labor, of course, also means “work.” And labor is also a special kind of work – the hard work that leads to birth. I like to think of my laboratory as the place where I do my “real work.” It’s not that I don’t consider treating patients to be real work, or unimportant work. But it’s a very different kind of work, so much so that it doesn’t feel like work to me. I am fortunate in that I have wonderful patients who are more like old friends. When I see them, we get to catch up on each other’s lives, chat and hang out while I am cupping their backs, sticking them with needles, or what have you. My work in the lab is different. There is a certain rhythm that I get into when I am measuring out herbs, grinding them up, mixing them, packing them in the percolation column, mixing solvents, controlling levels of heat and rates of drip. There is something ritualistic about it that speaks to me at a very deep level. I am doing real, time-consuming, physical work, work that takes preparation and clarity and an unhurried sense of purpose. Making a formula is an all-day, or even a multiple-day affair. At the end there is a final product – an amber-colored or deep green elixir that, when imbibed, has some sort of predictable effect on one’s body and mind. I think of myself as an essentially creative person, and when I have created a medicine, it feels like a kind of a birth to me. The labor has produced something unique, and useful, which then goes out into the world, into my community, where it can do good.

All this talk of labor may seem odd for someone who professes to embrace an easygoing kiraku life philosophy. But, in fact, I am not opposed to working hard. It’s just that there has to be a balance. The kind of work that many jobs entail – forty or more hours a week of brain-frying stress while sitting in front of a keyboard processing tasks with little or no relevance to your day-to-day life aside from the fact that they put a roof over your head and food on the table – is just not healthy. But to do work that you enjoy is a good thing. My goal is to work hard in the lab to produce herbal medicines for my patients and friends, continue treating patients in a leisurely and enjoyable way, and have time left over for gardening, hiking, and other fun things.

Kiraku: Health and the Take-It-Easy Attitude

2011-09-01T10:29:00.000-07:00

When people ask me what I consider to be the single most important factor in maintaining health and dealing with disease, my response is simple: Attitude. On the one hand, this may be so self-evident as to not be worth saying (OF COURSE the better your attitude, the better you can handle life and everything it throws your way). On the other hand, it may sound like I’m blaming the victim (“if only your attitude were better you wouldn’t have gotten your illness in the first place”). So I’d like to take a few minutes to explain what I mean.

The fundamental core belief of traditional Chinese medicine is that in health there is flow, and in illness there is a blockage of flow. This “flow” refers to the flow of qi (energy) and blood in the body. By feeling the pulse, palpating the musculature, looking at the tongue, and asking a lot of questions, the acupuncturist diagnoses where the flow of qi and blood is blocked, and applies needles to help restore proper flow. This is why patients almost always feel better after an acupuncture session: they are nudged back towards balance, they experience less pain and discomfort, their overall sense of wellbeing increases. This unblocking and rebalancing allows the body to rise to the occasion and apply its own innate healing force to confront whatever health challenge it faces.

What are the things that can impede flow in the body? Traumatic injury certainly can, as can exposure to environmental toxins. Unhealthy foods “gunk up” the system, as do drugs and alcohol. Various diseases cause their own particular stagnations in the channels and organs. But life itself can create stagnation. Stress, worry, chaos are some of the biggest contributors. Stress causes the qi to stagnate, and over time, if the stress doesn’t let up, this qi stagnation goes deeper and turns into blood stasis, turning less energetic and more material. Eventually the blockage can manifest as a physical accumulation – a cyst or lump, or in the worst case a cancerous tumor.

There is certainly a random element in illness; you can do all the right things and still get sick. Nevertheless, it behooves us to do everything in our power to stay well or get well: eat healthy foods, avoid bad fats, exercise regularly, sleep enough, have loving relationships, a supportive community, and a rich spiritual life. But the single most important factor is your attitude, since without the positive attitude you wouldn’t do those other things in the first place!

Another way of looking at it is that the biggest culprit here is modern living. We have to pay our rent or mortgage, we have to put food on the table, we have to raise our children, go grocery shopping, pay the bills, but in order to do all those things we have to work, and that takes up most of our time, leaving precious little time for all the rest. Fitting it all into a 24-hour day and a seven-day week means we get stressed out. Getting sick on top of it all stresses us out even more. What can you do to break the cycle? Not everyone can afford a radical fix, like quitting your job or moving to Tahiti. But what you CAN do, right now, is take a deep breath, let it all the way out, take a break from whatever you’re doing, relax, get some sun on your face and fresh air in your lungs. Sit and enjoy. Maybe chat with a friend, have a glass of wine, share a simple meal. You may not be able to change how the world works, but you can change your attitude towards it.

There is a wonderful Japanese word, kiraku. Kiraku evokes a sense of leisure and enjoyment, of taking it easy and enjoying life. The word is composed of two Chinese characters: the first, ki, is the Japanese pronunciation for qi, energy or breath. The second character, raku, means enjoyment or pleasure. In its ancient form, the pictograph for raku depicts a drum and bells on a stand. So raku (actually its alternate reading, pronounced gaku) also means “music,” as well as the pleasure produced by listening to music. When your ki is raku, when your qi is flowing in a leisurely way through the channels, there is health. I imagine kiraku as the quintessential attitude of the ancient sages, enjoying an unhurried life and appreciating the qi pulsing in their own bodies and in all of nature. The kiraku attitude is the antidote to modern-day craziness. I believe that it is also the best preventative and treatment for all ills. My studio in Santa Cruz is called Kiraku-An, the “Take-It-Easy Hut” or “Qi Appreciation Hermitage*.” Maybe one day you will visit me there and together we will enjoy the music of leisurely qi. But even if not, that’s OK too. Because the beauty of kiraku is that it doesn’t require a doctor, or fancy equipment, or any money: it starts right now, right where you are, with you.

*An, “hermitage,” is an interesting character, consisting of a radical denoting a dwelling, plus a phonetic component consisting of a character meaning something like “to cover.” But a further breakdown of this component yields the image of a man, and below it the ancient Chinese character shen, originally derived from the image of two hands extending a rope, and therefore the idea of extension or expansion. And, indeed, a hermitage is a dwelling where a man sits in contemplation until he feels a sense of expansion. I prefer an alternate version of the an character, and a different interpretation: the dwelling radical is replaced with the grass radical, giving the image of a rustic thatched hut. And the character shen has long been associated in Chinese cosmology with the ninth of the twelve Earthly Branches, symbolized in the popular Chinese “zodiac” as the Monkey. So the hermitage (or at least my hermitage) is a place where a person (the human figure with arms and legs akimbo, in the middle) can ingest medicinal herbs (the grass radical on top) and enjoy the easy-going life of a monkey (the shen character, on the bottom, with its tail curving out towards the right). Or, if you prefer, the hermitage is a hut where a monkey sits down, and, expanding his consciousness, becomes a man.

In Memoriam: Gus Turpin 1963 - 2010

2011-02-28T12:09:00.000-08:00

I first met Gus sixteen years ago as a first-year student of traditional Chinese medicine at Five Branches Institute in Santa Cruz, California. He was a couple years ahead of me, and with his long flowing hair and imposing stature (Gus is well over six feet tall), he made quite an impression. But what impressed me more was the depth and breadth of his knowledge. One afternoon during that first year of school, Gus led an herb walk in the alleys around the school. From the gnarled albizzia tree that greeted me every morning as I arrived for class, to the tenacious passionflower vines that took over entire neighborhoods and astounded passers-by with their blooms of alien ultraviolet, to the humble prunella that grew on the edges of dusty walkways, Gus knew the medicinal uses of all these plants. As a newbie to the world of herbal medicine, I was surprised first of all that these plants I had taken for granted had medicinal uses at all, and secondly by how much there was to know about them! For Gus possessed an encyclopedic knowledge of healing plants, and his unrehearsed lectures gave me a first glimpse of how his mind worked – synthesizing Chinese energetics with biochemical understanding and mixing in a dollop of Ayurveda here and a tidbit of medieval alchemy there.

As I got to know him better, I came to understand that Gus’ mastery of herbs came from his own intense curiosity about the world. His passion was the rich, deep realm where mind, spirit, and plants overlap and interact and play. His company, Shamanic Tonics, specialized in “spirit herbs,” and each and every one of his formulations was only offered up to the public after rigorous in vivo testing conducted on himself (and his lucky friends!). I remember one day Gus announced, quite dramatically for him, that he had “tamed the wild mahuang!” Back in those days ephedra was still legal, though the FDA was taking an interest in it due to a few unfortunate incidents in which people had abused it as an “herbal upper” to the point of death. Gus wanted to tone down mahuang’s stimulant properties, and hit on the combination of mahuang and reishi (a spirit-calming and immune system stimulating medicinal mushroom) to do just that. I remember some really fun and interesting hikes trying out that stuff. It came to market as Fungalore, and became quite the hit at dances and parties before mahuang was banned.

Gus was a very spiritual guy, a true seeker, whereas I was and am more of a skeptic. Yet, we had great discussions about everything from Tibetan Buddhism to Shinto animism to Amazonian shamanism. Regardless of our fundamentally different orientations, we shared a deep interest in religion and consciousness. I took an anthropological interest in history and religion as a record of humanity’s attempts to understand the world; for him spiritual traditions were a practical guide for his own explorations of mind and nature. He revealed to me once that he thought we had known each other in a past life. Though I would ordinarily shoot down such a statement in my usual rational way, at the time I paused and savored it, because I had to agree that we shared a bond that, whether or not it involved reincarnation, demonstrated some kind of karmic connection that I could not deny. And, not insignificantly, I took it to mean that he considered me his friend, and that made me happy.

In the years after we finished our master’s degrees in Chinese medicine, Gus moved away from Santa Cruz, settling in Northern California near Mendocino. I think the slower pace of life and immersion in lush forest suited him well. We kept in sporadic touch by email and phone, and every now and then I’d find a package in the mail stuffed with fresh matsutake (Gus and I shared a love of mushrooms), or a sample pack of a new herbal formulation, or an article on kanna or blue lotus or whatever else was occupying his interest at the time. This was typical of Gus: so generous, so giving.

Some years ago Gus gave me a piece of writing he had authored. It was about his fascination with the young god Dionysus. I wish I had kept it, so I could read it over again in my effort to understand him better, to try to understand why he is gone. Because I still don’t understand. I saw Gus a couple of months before he died. We went on a hike in the Berkeley hills with our friend Andy. He was in the process of moving from Mendocino to the Bay Area, and was excited about some new prospects for his company, about reinventing himself and his business. He seemed content. We had a great time; it was like old times, Andy driving like a crazy man, Gus with his long stride leading the way as we hiked, pointing out flowers, talking about plants. He would have made a really great teacher at any Chinese medicine or naturopathic school.

Soon after we became friends, Gus gave me a baby gotu kola plant. Gotu kola is an Ayurvedic herb that is revered for its effects on the brain and nervous system, circulation, and skin. It has since become one of my favorite herbs. Gotu kola is easily propagated, as it spreads runners that put down new sets of roots and establish babies that can be dug up and given away. Over the years I have given away many such babies, to friends and patients, as well as tinctures and teas that I made from the harvested plant (I’ve eaten quite a bit of the fresh leaf as well). I think of the gotu kola as Gus’ good influence, spreading outwards in an infinite web, doing good, humans and plants working together for the betterment of all. Like I said, I’m not so sure about reincarnation. But if anybody would consciously reincarnate as a plant, it would be Gus. Perhaps his consciousness is spreading through the world as gotu kola. Perhaps, every time I take a nibble, I re-enter that Dionysian wave. Perhaps, as I graze, I will get my friend back, just a bit at a time, in subtle explosions of metabolism and neurology, as plant and mind merge and my grief (I hope) slowly diminishes to be replaced entirely by a love and appreciation that grows only deeper with time.

I Dream of Judo

2010-02-16T16:24:00.000-08:00

A couple nights ago I had a wonderful dream: I was playing judo with my childhood judo teacher, Umeki Masaru Sensei. It's no mystery why I had the dream. The day before I had begun reading Higher Judo by Moshe Feldenkrais. Feldenkrais is best known as the originator of the school of movement education that bears his name. He was also a physicist and engineer as well as an early student of Jigoro Kano, the founder of judo. We see in his writing some early glimmers of how judo would inform his method, as in this passage: "Many people have never made any but the most primitive use of their feet, with the result that the only use and idea associated with them, is that of a plate-like support to the body. This being the only use made of the feet for many years on end, the muscles are most of the time maintained in a fixed state of contraction - precisely the one that makes the feet fit for the service demanded of them. In extreme cases the exclusion of other patterns is so complete, that the feet become frozen in the flat, plate-like position and are useless for any other purpose than motionless standing."

Reading Higher Judo, I was struck by the degree to which Feldenkrais was obviously influenced by Kano's vision of judo as something that went beyond martial art, as a physical/educational/developmental system with a unique pedagogy that helped the practitioner achieve a certain completeness as a human being: "The understanding Judo teacher does his best to further the maturing process of his pupils in this respect, showing them that it is essentially a question of learning and not of infirmity. He, therefore, literally helps his pupils on the way to adult maturity."

The introductory chapters of Feldenkrais' book helped me remember the impact that judo had on me as a child (the rest of the book, on judo groundwork, would have been better served by an instructional DVD, to my Youtube-generation mind). From age eight until fourteen, I strove to perfect my skills in judo under Umeki Sensei's tutelage. I was a skinny boy, something of an egghead, and not at all a natural athlete. I am convinced that, were it not for judo, I would have turned into an ungrounded intellectual with very few physical skills and very low confidence in my bodily abilities. As it was, I learned from an early age to fall and roll and throw and pin, and I believe that has made all the difference. Though I didn't get in fights often, when I did I would throw my opponent to the ground and that was usually the end of it. My favorite pin is a wonderful move called katagatame ("shoulder pin") that to this day nobody I have fought has ever escaped from, including a fellow soldier in the Swiss Army who challenged me to a friendly wrestling match and had at least twenty pounds on me. Judo fostered in me, as Feldenkrais puts it, "a degree of independence of gravitation" that demonstrated to me that, with the rational application of the correct method, one could free oneself of other types of restraints one might come across in life.

Which is not to say that the journey to be free from gravity or other forces was always easy. For instance, I had a natural affinity for leg techniques such as ashi-barai and osoto-gari, and was not very good at applying upper-body throws such as seoi-nage in competitive situations. Somehow I never overcame the mental block that kept me from using seoi-nage. I am not naturally very aggressive, and seoi-nage requires a certain chutzpah and quickness that I didn't think I possessed. In hindsight, I wish I had applied myself to push past this limiting self-definition.

Shortly before leaving Japan for the United States at the end of the ninth grade, I tested for black belt and didn't make it. Black belt testing consisted of entering a tournament of aspirants of the same age, and competing in round-robin fashion. If you won three matches in a row, you got your first degree black belt. I lost my first match, and over the following weeks was a little jealous of my friends Fujita, Wakamiya, and Arakawa, who got to sit up at the front of the class next to Umeki Sensei with their impressive new black belts on.

When it came time to leave Japan, I went to say good-bye to Umeki Sensei. I was surprised and honored when he gave me his black belt as a parting gift. I believe that what he meant by this was not "Here, you deserve this," but rather, "You may not be very good, but I've come to like you so here, keep this to remember me by."

In my dream, Sensei and I were doing judo on the familiar mats of the old dojo, he throwing me around and I occasionally throwing him when he deemed my technique good enough to work had I been matched with someone closer to my ability. The smell of rough cotton gi blended with sweat and Sensei's Mild Seven tobacco aroma, the feel of the cold tatami mats as I was slammed down time and again, the thrill of throwing my teacher, it all came back to me and I was just so happy. Thank you, Sensei, for playing judo with me again after so many years.

The Hokey Pokey: Acupuncture, Placebo, and the Persistence of Bias

2009-08-04T14:53:00.000-07:00

Title of the front page article in the July 2009 ACUPUNCTURE TODAY: “Acupuncture Found Effective for Back Pain: Study finds it superior to usual care.”

Title of a June 1, 2009 article in NEWSWEEK by science writer Sharon Begley: “Hooked on a Feeling: This is your brain on a placebo.”

Believe it or not, these articles report on the exact same recent acupuncture research. As their titles reveal, they reach basically opposite conclusions. The research in question, conducted by Daniel C. Cherkin et al and published in the Archives of Internal Medicine, May 11, 2009, under the title “A Randomized Trial Comparing Acupuncture, Simulated Acupuncture, and Usual Care for Chronic Low Back Pain,” utilized a cleverly constructed experiment to try to determine whether acupuncture was effective as a treatment for low back pain. 638 adults with chronic low back pain were split into three groups. One group received “individualized acupuncture,” in which the acupuncturist could use any points he or she wanted, as long as the patient was lying prone. The second group received “standardized acupuncture,” an eight-point combination consisting of the points Du-3, UB-23, UB-40, K-3, and a low back ashi point (an excellent prescription, though the ashi point, referring to a tender point, makes this “standardized acupuncture” somewhat individualized to my mind). The third group received “simulated acupuncture,” or, as acupuncture detractors prefer to call it, “sham acupuncture.” In this group, the patient would lie face down as in the other groups, and the acupuncturist would press an acupuncture needle guide tube against the same points used in the “standardized acupuncture” group, then simulate needle insertion by tapping a toothpick gently against the patient’s skin. None of the patients in any of the groups knew which group they were in, and, presumably, all thought they were receiving some kind of acupuncture. All patients received ten treatments over seven weeks, and outcomes were assessed after eight, twenty-six, and fifty-two weeks using the Roland-Morris Disability Questionnaire and a 0-10 range “symptom bothersomeness” scale.

Much to the delight of acupuncturists everywhere, the results showed that acupuncture “improved function and decreased symptoms,” and, furthermore, the improvement was significantly better than that resulting from usual care, even one year later. Interestingly - and here is the crux of the dispute between the pro- and anti-acupuncture camps – it didn’t make a difference whether a patient received “real acupuncture” of the individualized or standardized variety, or whether they received the non-penetrating “sham acupuncture.”

Now, this is food for thought. It is quite easy for the acupuncture-uneducated reader to leap to the conclusion, as NEWSWEEK’s Begley does, that “the most parsimonious explanation for that finding is inescapable: it is possible to think yourself out of pain.” In other words, if sham acupuncture works as well as real acupuncture, then all acupuncture must work because of the placebo effect.

Let me make my own bias clear: I am an acupuncturist. I believe that there is something going on other than mind over matter when I treat my patients and they get better. I think that acupuncture is a connective tissue therapy par excellence, and that the traditional East Asian approach to treating the human body’s ailments via the skin and connective tissue is far more sophisticated than the cutting edge of conventional medicine.

That said, I believe that there is also something to the whole placebo thing. Of course the placebo effect is part and parcel of how acupuncture works! Placebo effects are part of how any healing method works. It is a credit to the ancient Chinese doctors that they incorporated into their medicine methods that improve clinical outcomes through, to use the medical lingo, “nonspecific effects.” Yes, it helps patients to listen to them! It helps patients to palpate them, to look at them, to spend more than five minutes with them! My hope is that one of the outcomes of placebo research is that conventional medicine will reincorporate some of these things, to give it a softer edge, more compassion, less arrogance, and yes, better outcomes.

It appears to me that acupuncture has reached a tipping point in modern society. There are so many people who have benefited from acupuncture that it is simply getting accepted by the mainstream as a viable therapeutic method. Acupuncture poses a challenge only to those hardcore skeptics who cannot stand the thought that a method utilizing unscientific concepts like “qi,” “the five elements,” and “yin and yang” could possibly work. Their disbelief of acupuncture is akin to someone not believing that a samurai sword can cut because they disagree with the Shinto ritual that dictated the ancient swordmaker’s forging. Such people seize upon a study such as Cherkin’s as proof that acupuncture only works because patients believe that it does. They fail to consider alternate explanations, even though the authors of the study themselves spell out the possibility that “superficial acupuncture point stimulation directly stimulates physiological processes that ultimately lead to improved pain and function.” The research of MacPherson et al with functional magnetic resonance showing that superficial and deep needling elicit similar blood oxygen level-dependent responses in the brain suggest as much (Neuroscience Letters 434, 2008).

My strong suspicion is that acupuncture works not through a single mechanism but through multiple mechanisms. Something very physical happens when you insert a needle through the skin and tap at the surface of a myofascial trigger point until it releases with a palpable and visible fasciculation. Other acupuncture techniques are more “energetic” and mysterious but equally effective. There are entire schools of non-insertive acupuncture that rely on the practitioner feeling a pulsation or tingling where the needle meets the skin (the patient often feels something as well) to assess its effects during a treatment. I believe that this type of acupuncture is a means of interacting with a primitive electrical signaling system that utilizes the body’s connective tissue as a conductive direct current network. Deep needling may or may not utilize the same mechanism to produce its therapeutic effects. Ear acupuncture most likely utilizes yet a different mechanism – probably neural. For Sharon Begley or any other skeptic to decide for the public what “real acupuncture” is represents the height of arrogance. Perhaps there are many types of “real acupuncture,” and “sham acupuncture” is actually a type of real acupuncture!

There is an excellent quote in the book Herbal Emissaries by Steven Foster and Yue Chongxi, in which the authors state (about ginseng, not acupuncture): “Chinese researchers…have focused on how ginseng works, whereas western researchers focus on if it works. This reflects a fundamental difference in research approaches between the East and the West. In Asia, the efficacy of an herb is already established in a cultural context. In the West, we presuppose that traditional uses have no rational scientific basis.” The same could be said for acupuncture. There are already plenty of studies showing that acupuncture is effective for back pain, or nausea, or whatever. It’s great that these clinical studies are getting more sophisticated. But as the response to the Cherkin group’s research shows, people read into these studies what they already believe. The Acupuncture Today article never once uses the word “placebo” in discussing the possible interpretation of the results, and the NEWSWEEK article never once entertains the possibility that acupuncture works by a mechanism other than placebo.

I wish that instead of these sorts of studies, and in addition to better and more placebo research, scientists would do more basic research into how acupuncture actually, physically, works. It’s hard to argue with fMRI imaging that shows that the needling of points associated with the treatment of vision disturbances lights up the visual cortex of the brain (as Cho et al report in PNAS, vol. 95 no. 5, 1998), or that needle twirling at acupuncture points results in mechanical signal transduction in the connective tissue with far-ranging effects (Langevin, in the Journal of the Federation of American Societies for Experimental Biology 16:872-874, 2002). I don’t feel any particular need to validate what I do to skeptics. I’m quite comfortable with the witch doctor element in what I do, and it’s good enough for me that my patients are satisfied with the care they receive. But I do realize that strong scientific evidence would ultimately result in more people benefiting from acupuncture. And I think that fundamental research in the biophysics and biochemistry of acupuncture would serve this end better than clinical research, which somehow just seems to strengthen one’s bias, whatever it might be. Perhaps I am being naïve, and no amount of studies will convince either camp that the other is wrong. For some reason acupuncture rubs some people the wrong way much like astrology or intelligent design do. But I predict that, with or without studies, acupuncture will continue to gain acceptance simply because more and more people are benefiting from it and its usefulness is becoming a matter of conventional wisdom in the same way that people accept the validity of many surgical procedures that have never been tested but continue to be used because of their self-evident efficacy.

If the placebo effect is hokey, then there is something hokey about acupuncture. The placement of needles at acupuncture points, with or without penetration of the skin, is certainly pokey. There is a magic that happens between the mind and the body, that unites and transcends the hokey and the pokey. That magic is called “healing.” When it comes to healing, maybe the Hokey Pokey IS what it’s all about. Just put your left hand out and I’d be happy to show you.

Adventures in Integrative Medicine: My Rash

2008-04-14T14:36:00.000-07:00

Shortly before my sister Akemi visited from Japan, which would put it sometime in the first half of February, I noticed a mildly irritated spot of skin on my face not far from the left corner of my mouth. My friend Annie had invited us to spend the day with her at her club, and I was very happy for the chance to swim and use the sauna. It was the heat of the sauna that irritated the spot and made me notice it. I didn't think much of it because it didn't itch or hurt, and because I figured it would go away on its own.

Some weeks later, my sister came and went, and I noticed the irritated area had spread to the border of my lip. Having nothing else in my medical history to compare it to, I thought I must be in the early phases of an oral herpes outbreak. I called my doctor and convinced her to prescribe me some Acyclovir to knock out the virus. She ordered a five-day course along with regular swishing with Stanford Mouthwash (a combination of cortisone, an antifungal, tetracycline, sugar, water, and artificial red color). I followed her directions dutifully, and the rash did not get worse but it also did not go away.

A few days later I noticed that the rash had spread to the other corner of my mouth, and was making inroads into my upper and lower left lip. It also began to itch. So I went to the doctor, and she confidently announced that I suffered from cheilitis (which, it turns out, just means "cracked lips"), that it was caused by a yeast, and that the cure was Nystatin. I was relieved that we now knew what the problem was, and a little ashamed that I had not gone to see her sooner. I picked up the Nystatin mouthwash at the pharmacy, and rinsed my mouth several times daily, and applied some to the affected skin around my mouth, as she instructed.

So I was very unhappy when, after several more days, my skin problem was not only not gone, it was worse! The Nystatin made the skin angry and red, and my doctor instructed me to discontinue it. I tried all kinds of topical treatments from aloe gel to shea butter to cortisone cream, but they all made things worse. Even Kazi Dama's Magic Balm didn't help. I was getting quite self-conscious around my patients, since, as a health care provider, having weird sores around the mouth was kind of yucky and didn't advertise my skills as a healthy person much less as a healer. Besides, I had to leave in a few days for an NIH conference in Texas, and I did not want to be dealing with this then.

So, unable to get an appointment in time with the dermatologist, I went in to urgent care. The doctor there, perhaps sensing my frustration with my regular doctor, defended his colleague, saying that cheilitis is most often due to a yeast. It was a good guess, he said, and since we had now eliminated both virus and fungus as the cause, the perp was most likely a bacteria. So he prescribed me some MRSA-killing Mupirocin antibiotic ointment. The stuff smelled like cheap Mexican beauty product, but I applied it several times daily as instructed. Unfortunately, it also made my rash worse. The inflammation pretty much circled my entire mouth, turned red and itchy, then over the course of a day or two dried up and calmed down, then the dry skin flaked off. I was initially excited and encouraged by the flaking off part of this life cycle, thinking that it signified a movement towards resolution and cure, but quickly discovered that the rash was only taunting me; that it would cycle through these phases regardless of what I did.

I went to Texas feeling like the Elephant Man and continued my antibiotic ointment regimen even though it was clearly not working. Finally, in a hyperpruritic frenzy at two or three in the morning on the second night of my trip, I decided to take matters into my own hands. I doused my mouth with hydrogen peroxide. My rash hissed and foamed rabidly and I thrilled in the piercing sting and eventual numbness that settled around my beleaguered piehole. The next day the skin around my lips was crusty and dry, but at least it didn't itch and it didn't seem to be entering into the angry red phase of its life cycle.

By the time I returned to Santa Cruz the rash was swollen, red, itchy, and uncomfortable so I purchased some calendula gel and applied it liberally. I was glad to find that it was the one thing so far that didn't seem to irritate the rash. But it didn't get rid of it either. So, being the resourceful type, I ground up some berberine (from the Chinese patent medicine Huang Lian Su Pian) and mixed up a batch of alkaloid-enhanced calendula gel. If there's a microbe there, I reasoned, the berberine might kill it. For my efforts all I got was a ridiculous-looking yellow ring around my mouth and taunts (and some sympathy) from my family.

I started to get scared. What if this rash was some bizarre autoimmune condition, like pemphigus? Can you get pemphigus from cats? (Charlie scratches himself a lot despite the flea and tick medication we give him). What if it was early stage squamous cell carcinoma? I called the dermatology clinic to see if I could get in right away. The earliest appointment they could give me was over a week away. What should I do? I decided I would wage all-out CAM war on the rash. I would cure it by myself before my dermatology appointment! I started taking Huang Lian Shang Qing Wan ("Coptis Clear Heat from the Upper Body Pills") internally and continued the calendula gel (minus berberine) topically. At my friend Gerhardt's insistence I applied some Swiss medicine called NEGATOL (an antiseptic/hemostatic whose chemical name is policresulen). He claimed that if there was something there to kill, NEGATOL would kill it. I figured, with that ringing endorsment and such a promising name, why not? Like the peroxide, it hurt like hell and dessicated the skin around my mouth. I returned to the calendula gel to try to soothe the dry painful skin.

Rather late in the game, I turned to acupuncture. I bled Stomach-40, the connecting-luo point of the stomach channel, since the stomach channel goes to the corners of the mouth and even around it to connect to the Du and Ren Vessels. I got bleeding-happy and also bled Spleen-1 and Liver-1 around the big toe, since visual examination revealed that there was some blood stasis there (my teacher Anryu Iwashina aka Dr. Bear says that before you do anything else you bleed where there's stasis). This got me thinking that my rash might be more a problem of blood stagnation than of heat, dampness, and toxin, so I made a salve of St. Johnswort/gotu kola and Yunnan Baiyao powder and applied it as an experiment this morning. It didn't inflame the skin, but it didn't seem to help much either, so eventually I switched back to calendula gel. I did more acupuncture, to sedate the stomach channel and tonify the spleen, to aim at the dysfunctional channel via its "opposite" partner the pericardium, etc. etc.

The rash settled into a status quo of not itchy and inflamed, but nevertheless chapped and discolored at the edges of the lips. Continuing on the hypothesis that the problem was one of blood stagnation, I began a course of self-treatment three times daily with a cold laser, at 680 nm wavelength. Lasers are used instead of needles by some acupuncturists, and they seem to stimulate unhealthy cells to perk up and regain homeostasis. RISE AND SHINE MOTHERFUCKERS! became my mantra as I blasted my lips with the dazzling red light.

Slowly, the rash subsided. I don't know if this was due to the acupuncture, the herbs, the calendula gel, the NEGATOL, or the red laser. Or if the disease was nearing the end of its natural course. By the time of my appointment with the dermatologist all I had was a faint discoloration of the skin around my lips. I was tempted to blow off the appointment, but, hyperaware of the potential criticism that I hadn't given western medicine a fair shake, I went. Predictably, the dermatologist spent about five minutes with me and prescribed a corticosteroid ointment. "Shouldn't you take a biopsy or a culture?" I asked, visions of pemphigus-unglued skin flapping in my brain. "You read too much," he laughed, and sent me on my way.

I applied the ointment, and at first my skin reacted by getting itchy and slightly inflamed. Here we go again, I thought, overcome with a familiar frustration. But I persisted, and the skin calmed down, and now a week later at about Week 70 of my odyssey I am finally about back to normal (although after a one-day experiment of no cortisone yesterday the rash came back this morning).

What conclusions can we draw from my ordeal?

1) My doctor should have taken a culture at my first visit, to determine what microbe, if any, was involved in my cheilitis.

2) I should have begun the "complementary and alternative" assessment and treatment earlier.

3) Cortisone is a wonder drug.

4) The integrative medicine approach needs to be flexible and open-ended, rather than codified and inflexible.

To expand a little bit on Item 4 above, I'd like to discuss what I see as the conundrum of integrative medicine. Western medicine and most traditional non-western medical systems are unlike each other in many ways, but most fundamentally they are different because western medicine subscribes to the notion of a "standard of care" which follows disease categories and specific diagnoses, whereas non-western medical systems famously "treat the whole person." What does this mean? This phrase "treating the whole person" is so vague as to be meaningless, and in integrative medicine has often come to mean that the patient applies a variety of approaches to their care, often including methods to address the mind (biofeedback, relaxation and visualization, for instance), the body (drugs, massage, herbs), and the spirit (prayer, meditation). In my opinion, the treasure of non-western systems such as traditional Chinese medicine and Ayurveda is not necessarily their ability to treat mind, body and spirit per se, but their ability to treat each patient's constitution or "pattern" and remedy a person's "deficiencies" and "excesses" (to use acupuncture-speak) in a way that is simply outside the paradigm of biomedicine.

To the western doctor, the patient suffers from an active herpes simplex infection (for instance), and the standard of care is to prescibe an antiviral like Acyclovir. A practitioner of traditional Chinese medicine would choose from any of a virtually limitless range of options, depending on his assessment of the patient's condition. Do the lesions present on the stomach channel, or do they manifest on the liver channel or the Conception Vessel? Is the patient primarily yin-deficient, or qi-deficient? Does the deficiency outweigh the current excess manifesting in the outbreak, and will the herb formula prescibed focus more on strengthening the constitution or on quelling the excess fire and dampness? These may be archaic and poetic terms but they are also phenomenological and clinical. In other words, "treating the whole person" is not simply a matter of throwing the patient a variety of practices and nutrients; it is a way of assessing their clinical picture - and treating disease - in a way that is utterly different from western medicine, and is often very effective.

The problem is that the gold standard of integrative medicine when it comes to complementary and alternative therapies is the notion of "evidence-based medicine." Typically, the informed western doctor will only recommend non-western therapies if there is "evidence" (read: scientific studies) that they work. While this makes perfect sense on the surface of things (why recommend something if it hasn't been shown to work?), the multifactorial nature of non-western therapies makes them problematical from the point of view of establishing efficacy. Do separate studies need to be done for the herbal treatment of liver-channel herpes and for stomach-channel herpes? How do you separate out the effects of acupuncture from the effects of herbs? Should practitioners only do one thing at a time? Does scientific evidence have to be established for the treatment of every disease before doctors can recommend a procedure or a style of healing to patients? Should the results of the research prescribe a standard of care for complementary and alternative therapies?

My answer is yes and no. Yes, more research should be done on CAM therapies and the integrative approach. This will only help to legitimize what we do in the medical and scientific communities. But no, this research should not change the heart and soul of what we do into a subcategory of conventional medicine, with standards of care that dictate how we treat. As reactionary as this sounds, I think that we practitioners of non-western therapies should continue to practice as our forebears have been practicing for the last several thousand years. Chinese medicine is an art, in addition to being an empirical multi-faceted clinical science. The Yellow Emperor would roll over in his urn if acupuncturists started practicing out of a book: "for hepatitis B, needle Liver-3." Unfortunately, much of Chinese medicine in the modern age has in fact been reduced to this. My advice to western medical doctors interested in integrative medicine is to seek out the artists, the practitioners who have mastered the non-western therapies on their own terms, who are creative and resourceful and masterful in their approach to treating patients. Collaborate with or employ people whose individual reputations speak for themselves; don't just rely on studies that show that acupuncture (or whatever) is good for treating A, B, or C, and pick an acupuncturist out of the phone book. I am not saying that evidence-based medicine should be tossed out the window. In this age of the Internet there is much that masquerades as integrative medicine that at its core is simply hokum and marketing. Machines that read the resistance at acupuncture points and, hooked up to a computer, miraculously match your "vibration" to the proper homeopathic remedy or electronic frequency spring to mind (beware of any method that uses the word "quantum" in its advertising).

Certainly, physicians should not blindly recommend things with no rational reason for those recommendations. But I would beg a kind of special status for medical systems such as Chinese medicine or Ayurveda. They are backed by a very long history of continuous use that has, on the whole, demonstrated their usefulness in strengthening patients in their ability to heal. My vision for integrative medicine is one of qualified healthcare practitioners from a variety of traditions, working side by side for the good of their patients, each honoring the integrity and value of the others' traditions and experience. In addition to the cumulative and by its nature always incomplete evidence produced by scientific studies, the evidence these practitioners observe in the clinical domain will drive integrative medicine forward into the future.

The Dew of Immortality

2007-05-05T18:07:00.001-07:00

Today is May 5th, my son Lukas' birthday, the ancient Celtic fire festival Beltane (give or take a day or two), Cinco de Mayo, and the Japanese festival known as Boys' Day. Although it has since morphed into a more inclusive "Children's Day", all Japanese know that the festival always was and actually still is Boys' Day (girls have their own Girls' Day on March 3). The quintessential symbol of Boys' Day is the koinobori, large carp-shaped streamers that fill with wind and swim in the air from long bamboo poles. We fly our koinobori every May, and I love how it soars through the air, and I love this celebration of my son's life and good health. The Japanese revere the carp as a symbol of strength and determination, because it fights through obstacles with great spirit, swimming upstream, even scaling waterfalls, to get to where it's going. Some time ago my parents sent me a beautiful little silk painting, of a boy hanging onto the back of a big koinobori. And I thought, all of us boys ride on the back of a monster fish. The fish takes us up and down and all over the place, and we hang on because it is one exhilarating ride - truly the ride of our lives, and in some Darwinian sense the reason for our lives. This fish, of course, is our sexuality.

This essay explores the sex drive from a male, East Asian, alchemical/religious perspective. I vacillate between thinking there's something to it and thinking it's delusional nonsense. I like the idea that we can recognize the tremendous energy of our sexuality and put it to spiritual use. But I have this deep suspicion that most people are better off just enjoying sex as sex, rather than trying to control it for supposedly spiritual ends. Anyway, here it is. Happy Boys' Day!

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There is a curious notion, prevalent among certain sections of the alternative medicine and New Age subcultures, that one can improve health and possibly even attain states of spiritual perfection, by recycling one’s sperm. There are many ways to do this. You can be celibate, thereby limiting the number of emissions to those few nighttime incidents that are beyond your control. Or, you can have sex, but refrain from ejaculating through the use of certain tricks of sphincter control and qi redirection. Finally, when all else fails, you can push with your finger on the so-called “Million Dollar Point” located between the anus and the scrotum, to block the escape of semen and reabsorb it in your body.

The origins of this practice are lost in the mists of prehistory, but they almost certainly have to do with ancient man’s realization that sperm holds within it an awesome power – the power to co-create life. What if this power could be harnessed for self-cultivation? This is the origin of celibacy in most Asian religious traditions: a focusing inward of life’s energies, rather than the outward focus of the householder or “man of the world.” Many religious sects rejected sex because it represented attachment to the body and the world, the misdirection of life force into karmic entanglements and away from enlightenment. But a few schools, most notably some South Asian tantric traditions and certain Daoist sects in China, figured out how to have it both ways. They opted to utilize the energies generated by sexual activity, and incorporated non-ejaculatory sex into their rituals. Central to the doctrines of these schools is the importance of what the Chinese have termed jing: the primal “substance” variously translated as “essence,” “sperm,” and “sexual energy.”

In China, what was originally a religious practice became somewhat secularized into what we now call “internal alchemy.” In contrast to the earlier external alchemists, who attempted to create an elixir of immortality out of various minerals and herbs, the internal alchemists believed the elixir was to be created within the body, using many different psycho-spiritual techniques. The goal of the alchemist was to take the awesome life-creating power of jing, transform it into the life-serving vitality of qi (life energy), then finally transmute the qi to arrive at the elixir: a refined force of spiritual potency that circulated through the meridians and conferred health and longevity. Some alchemists insisted that the creation of elixir was a purely internal solo process; others believed the dew of immortality was to be found in the merging of yin and yang that occurred during sex. Whether pro-sex or anti-sex, the alchemists all agreed that the conservation of jing was of paramount importance.

What is interesting to me is that these ideas have become so popular now, in the West. In a culture that regards ejaculation as a healthy “clearing of the pipes,” the popularity of sperm retention seems unlikely. But then again, maybe it’s not so strange that our sex-obsessed society has latched onto this particular aspect of Asian culture.

One man is largely responsible for the current popularity of sperm retention. He is Mantak Chia, a self-proclaimed Daoist master from Thailand who runs workshops and has written a whole slew of how-to books on this topic. Chia has managed to cash in on people’s longing for transcendence, as well as their interest in sex. He teaches basic qigong techniques that are central to all Chinese meditation schools and internal martial arts, but I suspect that his popularity is due primarily to the sexual angle of his instruction. He teaches couples ways of squeezing their muscles and clenching their teeth during sex to re-direct their orgasms inward and upward. For practice prior to attempting the real thing, and as a form of self-cultivation in its own right, Chia teaches methods of self-stimulation combined with breathing and visualization: you might call this "transcendental masturbation". Chia has single-handedly made internal alchemy into a booming business.

In case I sound overly critical, let me point out that I am a firm believer in Chinese methods of meditation and self-cultivation. As an acupuncturist, I teach patients qigong techniques to quiet the mind and circulate the qi. But to me, sperm conservation has the ring of neurosis. I believe that sperm retention thinking is part of a broader cultural pattern prevalent in patriarchal Asia, a pattern that fears female sexual vampirism (and female sexuality generally, since women can have all the sex they want without losing jing) and reacts to this fear by hoarding sperm. This pattern appears in folk tales about fox-women preying on young scholars; it shows up in the large number of acupuncture points and herbal formulas designed to treat spermatorrhea (“sperm leakage”); one could even argue that China’s huge Three Gorges Dam is its national jing obsession writ large.

The main reason I object to the currently popular methods of sperm retention is that they exhibit an extremism that runs counter to the generally middle-of-the-road common sense of traditional Chinese medicine. Suppression of a natural outward energy just seems like it would lead to qi stagnation and possibly even medical problems (in fact, I know of several cases of “blue balls” and benign prostate hyperplasia among would-be internal alchemists; one needed a year of acupuncture with a senior Chinese acupuncturist to undo the energy blockage created after attending one workshop). There is a popular saying in Chinese, “xing ming shuang xiu,” which is commonly translated as something like “A sound mind in a sound body.” What it literally means is the dual cultivation (shuang xiu) of self-nature (xing) and life energies (ming). This saying, which lies at the root of all Chinese methods of health improvement and self-cultivation, reminds us that personal conduct and moral bearing, which have to do with xing, are just as important as the development of the life energies that comprise ming. I believe that the commercialization of qigong and related practices in this country has led to an unhealthy overemphasis on the latter, with a concomitant surge in the popularity of the more unusual, and especially sexual, aspects of Asian health culture.

My goal is not to malign practitioners or instructors of qigong and other Chinese health disciplines. Instead, I caution against dangerous literalism of any sort. I resist the idea that the dew of immortality is any one thing. Our jing, the innermost and deepest source of our creativity, is the energy of the universe transforming matter, spreading over the surface of our planet as streams of lovers, as children, descendants, nucleotides, alkaloids, neurotransmitters, brainwaves, photons, memories, stories, words, artifacts coarse and fine, a mystery spreading like a plague through these strange, pulsing, living, mortal things that we are. The elixir bubbles forth through all of creation, shimmering and radiant, if only we are present enough to appreciate it.

Eating and Being Eaten

2007-01-04T15:24:00.000-08:00

The winter season always makes me appreciate the joys of feasting. The Thanksgiving turkey and the Christmas ham urge me to take it easy, get comfortable, sleep a lot. “Time to hibernate,” they purr from deep inside my gut. There’s something about the cold weather that triggers this ancient mammalian drive. Most of the time we ignore it. But during the holidays the kids don’t have school, my wife has two weeks off from work, the clinic slows down, and for a few glorious lazy days I eat more and do less than I normally do.

Now, don’t get me wrong. The post-feast sloth is a joy in its own right, but the eating is definitely the main event. To prepare a large meal with family and friends, to sit down and eat together when you are hungry is a joy that’s hard to beat. In fact, whether or not it’s the holidays, eating for me epitomizes the joy of being alive.

Clearly, just as evolution has wired us to enjoy sex, we are programmed to enjoy eating. DNA “wants” us to keep on living so that we increase our chances of making babies and hence more DNA. Ergo, we like to eat, and we like to make love.

Speaking of food and sex, Chinese medicine describes our vitality, our qi, as coming from two main sources. The first source is our parents, and by extension our ancestors. This type of qi, called “pre-natal qi,” is passed on genetically and is said to be stored in the kidneys. Pre-natal qi is the qi of sexuality and reproduction, and we only get a finite amount of it. We can’t really build it up, but we can squander it through too much sex and drugs and rock n’ roll. The second type of qi, called “post-natal qi” because we start to absorb it after we are born, comes from the air we breathe and the food we eat. The lungs and digestive system are the domain of this kind of qi.

How can these theories contribute to our health? Well, number one is: don’t over-spend your pre-natal qi through fast living and reckless habits. Younger readers will scoff at this advice, but older readers will nod knowingly. Number two is: keep breathing (if you feel you need help with this, find a good qigong instructor or a yoga class). Number three is (you guessed it): keep on eating.

But what to eat? Since I believe that all food is good, I don’t like to give lists of “good” and “bad” foods. So here are a few health-oriented suggestions instead: Cook your own food. Eat regularly. Don’t overeat (except at infrequent feasts). Eat seasonal, local foods. Incorporate in your own diet what your ancestors ate many generations ago. Eat a varied diet. Set time aside to enjoy your meals.

Ultimately, all diets from macrobiotics to vegan are based more on ideology than on anything else. Often, in the New Age circles in which alternative medicine thrives, there is an unspoken assumption that cleanliness is next to Godliness, that if you could only cleanse all those toxins from your liver or manage to avoid certain karmically incorrect foods, you will ascend to the “next level,” a realm that by definition you are not in now. I’m not arguing that these diets are necessarily unhealthy, but I do think that they can create guilt and neurosis, neither of which contributes to good health.

My own food ideology has to do with honoring our biology, and embracing enjoyment. By honoring our biology, I mean that the human digestive system evolved into its present form over the course of at least two million years of hunting and gathering. What this means is that we are optimally fueled by an omnivorous diet consisting of a large variety of fruits, vegetables, roots, tubers, grains, seeds, and meats. Archeological evidence shows quite plainly that the shift to agriculture, with its reliance on a few key foods, had a disastrous effect on human health (it also triggered the population explosion that we are reeling from today).

As for embracing enjoyment, I believe that pleasure is inherently healthy. Those French studies showing that red wine is good for you probably have as much to do with the attitude towards food of the people studied as they do with the chemical properties of red wine. We will all be eaten one day. But until life eats us, let us eat life! Bon appetit!

Doing Acupuncture

2006-12-05T14:42:00.000-08:00

Doing acupuncture is kind of a funny thing. What points do you pick? What is the process you go through when you give someone a treatment? You'll get a lot of different responses if you ask different acupuncturists. Here's mine:

For me, acupuncture has become a kind of energetic interaction with the patient. A person will come in with some symptom - a headache, for instance, or a skin problem. I usually spend some time asking questions: what part of the head hurts? Does your itching get worse at night? Is it worse or better when you get your period? Etc. I usually look at the tongue and feel the pulse, both standard Chinese medical practice. I was trained in acupuncture school to come up with "patterns" based on the presenting evidence, then treat by using points that fit the pattern. For instance, based on the location and type of pain, you might decide the patient has a "dampness headache," and pick points such as Stomach-40, which drains dampness, and Large Intestine 4, which alleviates pain especially in the face and head. You might also throw in Spleen 3, which strengthens the digestion, thereby treating the "root" as well as the "branch" (weak digestion is thought to create "dampness" in the body).

What I have found, however, is that this type of cookbook acupuncture often doesn't work. What has happened historically is that in the re-packaging of "traditional Chinese medicine" (TCM) in the modern era, acupuncture took a back seat to Chinese herbal medicine. So much so that acupuncture, which has always had its own set of theories and classical writings associated with it, got reformulated to better fit the theories of herbal medicine. So acupuncture points, which had formerly been thought of as apertures through which one could drain or supplement qi ("energy") to restore balance in an interconnected series or loops of channels in the body, were assigned functions or actions much like herbs. Hence in TCM we now say that Stomach 40 "drains dampness," much like a diuretic herb such as alisma is said to "drain dampness."

It was only after graduating from acupuncture school that I regained a sense of wonder and appreciation for acupuncture. This was because I began studying with Dr. Anryu Iwashina (a.k.a. "Dr. Bear"), a blind master acupuncturist from Morioka, Japan. Dr. Bear challenged my entire concept of acupuncture by treating patients - quite spectacularly and effectively, I might add - without ever puncturing their skin with his needles. At first I couldn't really tell what he was doing. With one hand he would feel the patient's skin on the arm or belly,and the other hand would gently hold the needltip against the skin somewhere else. Sometimes he would stay at a point for a long time, as if waiting for something to happen, holding the tip with his index finger and thumb, and the shaft with the thumb, index finger, and middle finger of his other hand. Other times his hand would dance over the surface of the patient's skin, the needle gently tapping the skin over a large area. Sometimes he would hold a thick golden needle on one point and a thick silver needle on another point, and wait. The impression I got was that he was constantly trying things out, waiting for a response, then moving on. Suddenly, he would announce that he was done, and the patient would get off the table with an amazed look on his or her face.

I've been studying with Dr. Bear for about ten years now, and use his method about 90% of the time (I still use TCM methods of physical medicine such as scraping and cupping, as well as TCM-style herbal medicine). It took me a couple years of trying his technique before I really felt anything happen between my fingertips. I was treating a patient who suffered from breast and liver cancer. She was going through chemotherapy and different experimental drugs, and I was fortunate enough to be able to join her inspiring support team. Maybe it was because she had gotten so weak that the "noise" of her various bodily processes was less than it normally would have been. Or maybe it was because in the process of preparing for death she had become so energetically "clear" that that clarity of energy could be felt even by a beginner like me. In any case, when I placed the needle against her skin, I felt a faint tingle, a mild electrical tingle that came and went, signifying according to Dr. Bear that the "qi had come."

So I've been practicing this way ever since. I haven't abandoned the theories and "patterns" that I learned in school. But I consider them working hypotheses rather than diagnoses per se. I test these hypotheses by trying out different points, and seeing if something happens. That something can be the tingly feeling that I feel between the fingertips holding the needle; it can be the patient reporting feelings of movement or warmth or tingliness at the point or elsewhere in the body; it can also be a shift in the patient's pulse or a relaxing of her musculature.

I find that the best acupuncture happens when I just "play", when I don't attach to outcomes or to particular theories of what is going on. I may notice a tight area, and needle there. The patient reports a warm flowy feeling down the leg and into the big toe, so I palpate the ribs and umbilical area (which are associated with the liver and spleen, whose channels run down the leg and into the big toe) and check points on the liver and spleen channels. While I'm working on the leg,I might notice that the whole right leg is sort of stuck, and begin pushing muscles and points and joint edges around the knee, working my way up and ending up treating stuck points in the hips and sacrum. I often end up doing something completely different from what I set out to do, following the thread until what needs to happen happens.

Sometimes, especially if I'm feeling stuck, I'll over-intellectualize things and start applying models like crazy, like "now that I've drained the gallbladder connecting-point I'll tonify the spleen source-point," or "let's try that right knee point for this left elbow pain." And that can be fun too, and the theories that have been worked out over many centuries of observation and experimentation are truly useful and sometimes work great. But what I have learned from Dr. Bear is that you always have to try things out and check for an effect; don't just apply theories blindly and then leave the room to put together an herb formula. And I think that the best treatments happen when you leave the theory behind, or just leave it running in the background as a kind of hunch-provider, and act spontaneously. It's also more fun that way!

That's why I have so much fun doing acupuncture. Each treatment is an exploration. If I find small "blood stasis" venules I might bleed them. If I find a mushy deficient spot I might burn moxa on it. If the patient reports a new pain I'll try out different things until the pain goes away. I get to combine hands-on experimentation with rational problem-solving and a kind of artistic sensibility. And best of all, I get to experience my patient feeling better!

I've benefited so much, and I believe my patients have benefited too, from Dr. Bear's teachings. Acupuncture is a very mysterious thing, and when acupuncturists start talking about "energy" and "yin" and "yang," it's easy for Westerners to dismiss it as hopelessly unscientific. And, indeed, if acupuncturists memorize the Chinese theories and terminologies by rote and spout them to whomever will listen, they will only serve to confuse and alienate people. But I don't think that we should do the opposite, namely talk about acupuncture only in scientific terms such as endorphins or the gate theory of pain. I believe that when we scientize acupuncture, we substitute a rich living empirical tradition with an incomplete and clinically inferior model. Certainly we should research acupuncture and try to figure out how it works. But if you want to learn acupuncture, I say, learn from a real acupuncturist! I consider myself fortunate that I have been able to do just that.

The Art of the Herbal Liqueur

2006-09-01T11:10:00.000-07:00

The first time I ever distilled my own liquor, I experienced something of the excitement that must have been felt by Jabir-ibn-Hayyan, the eighth-century Mesopotamian alchemist who is said to have discovered the distillation of alcohol. It was the year that our apricot tree fruited like never before, an embarrassment of riches that yielded apricot pies, apricot sauce, and finally, due to sheer neglect (some over-ripe apricots left in a bowl, then accidentally submerged in water), apricot beer. The beer got me all excited, but my excitement waned when I tried it, then reached a new height as I was hit by the inspiration to extract the alcohol from the beer. I rigged a crude still out of a pot, a ceramic vegetable steamer, and a bag of ice, and produced a few milliliters of clear, strong, and deliciously fruity-flowery-aromatic moonshine. Tasting it, I was transformed by the spirit, the essence of apricot as it melted into my tongue then shone out of my every pore. This, I thought to myself, is definitely something I could do full-time.

As it turned out, I never did become a big-time producer of whiskey or rum or apricot liquor. Fortunately, there are other ways of extracting plant essences with alcohol. When I was a child, I used to help my parents make umeshu, the traditional “plum wine” of Japan. My sister and I would carefully wash and dry the unripe fruit (actually a variety of apricot), then poked them full of holes with a fork. My mother put the fruit into large glass jars, together with rock sugar, and poured shochu (grain spirits) over them. A couple of years later, we enjoyed the resulting liqueur, neat or mixed with soda water and ice as a refreshing summer drink.

This, essentially, is the art of the herbal liqueur: you take a plant, soak it in strong alcohol to bring out its flavors and other qualities, then (after a wait of at least two weeks) drink this extract in small amounts over time to appreciate its effects on your mind and body. You can do this with all sorts of things: ginseng, astragalus, angelica, walnuts and Chinese wolfberries all yield decent tonic liqueurs. And you can experiment with a variety of solvents – rum is one of my favorites, although you can use vodka, tequila, or any strong liquor.

There’s a lot of discussion among students of herbal medicine as to the proper percentage of alcohol in the solvent, in relation to the type of plant being extracted. For our alchemical purposes, I suggest any strong liquor of about 100 proof. That way, you’ll end up with a balance of water-soluble and alcohol-soluble herb constituents. Also, to create a pleasant-tasting brew it’s good to start with more liquor and less herb, significantly less than the one to five ratio (one ounce dried herb to five fluid ounces of solvent) that is considered standard strength for herbal tinctures. Better yet, begin with something that tastes good to start with, like peaches or cherries or any kind of berry! There’s a lot to be said, in terms of antioxidants, bioflavonoids, and other phytonutrients, for the health benefits of fruit. One of my fantasies, yet to be fulfilled, is to travel the length of the West Coast one summer with a huge jar of Kirsch or Calvados or some other fruity spirits, throwing in large handfuls of wild berries as I come across them in my travels. Olallieberries, raspberries, strawberries, huckleberries, currants, even the somewhat medicinal-tasting berries of the California Spikenard and Devil’s Club would all be welcome to the mix. By the end of the summer I’d have a quantity of berry elixir to last me through the rest of the year, to share with friends and loved ones, to stretch a little bit of the summer’s sweet goodness into the cooler days of fall and winter.

The satisfaction that comes from making stuff, especially stuff that tastes good and makes you feel good, is a feeling that many people do without. In this day of instant gratification and 40-hour workweeks, few of us take (or make) the extra time and effort necessary to cook our own meals, much less concoct our own medicines and dessert wines. Why bother, when our natural food stores and supermarkets offer us everything we need, pre-made and ready to go? I bother because I find this type of activity to be deeply satisfying in a way that’s difficult to describe. To be in touch with the flux of the seasons, to pick an herb when its qi has sunk into its roots in the fall or risen into its flowers in the summer, to harvest by the time of day and phases of the moon, to extract the essence of a plant and then to ingest it – these are activities that are so ancient that their re-enactment awakens in us an almost shamanic appreciation of the natural world that we are a part of. Why not take the time to appreciate, in some small way, the great cosmic cycles that shape and influence all life on our planet? Watching the sunset or the moonrise, or the Milky Way on a clear night, can do the trick. But to drink the light that was captured by a plant – that is the unique pleasure, and the rare medicine, of the herbal liqueur.

Martial Arts and Medicine

2006-07-15T15:52:00.000-07:00

In previous posts I have written a little about martial arts and a lot about medicine. Here I’d like to explore the connections between the two. The most obvious connection is that the practice of martial arts comes with the occurrence of injuries, and the treatment of those injuries requires some sort of medical knowledge. Because the major martial arts developed in East Asia, the treatment of martial arts injuries tends to utilize the methods and theories of traditional Chinese medicine – especially acupuncture, massage, and medicinal herbs. Conversely, martial artists throughout history have contributed to the medical arts of Asia their own field-tested methods and formulas, so much so that a large part of traditional East Asian traumatology – the treatment of bone, tendon, and sinew injuries – can be said to be descended from martial arts traditions. The various Shaolin lineages of China are the best-known example, with their "dit da jow" trauma liniments used by martial artists wordwide. Much of "tui na" (traditional Chinese massage and physical therapy), especially bonesetting techniques, co-developed with martial arts as well. In Japan, there has also been a close historical relationship between martial arts schools (especially styles of jujutsu) and bonesetting, and wandering martial artists in search of teachers to study with (or to challenge!) would look up the bone doctors when they first got to a new town.

Because of their common cultural origins, martial arts and traditional Chinese medicine share a common terminology and worldview. Most importantly in this regard, they both take as a fundamental premise the existence of qi, the life force. Qi, also known as “ki” in Japanese and Korean traditions, is thought of as the animating principle in all life, indeed in the whole universe. It is qi that the acupuncturist affects as he inserts fine needles into the channels or meridians through which the life energy flows. It is this same qi that is affected in a martial arts strike to a pressure point. The exact same point can be used to hurt or to heal; what varies is the amount and direction of qi flow through the point. It is said that the ancient sages sat in contemplation and felt the life force flowing through their bodies. From their initial observations developed three interrelated studies: martial arts, medicine, and meditation.

My own introduction to traditional Chinese medicine came through the martial arts. I grew up in Japan, and attended the local judo dojo since I was seven years old. The way we trained in those days was basically free play, or “randori,” all the time. We would get a partner, bow, and go at it, trying to throw our partner to the tatami-mat ground. At our teacher’s command, we would switch to ground-fighting: after the next throw, we would try to pin each other. After about age twelve or so, we were allowed to incorporate chokes into the ground-fighting. Most of the time, the person being choked would tap out and nobody got hurt. But every once in awhile, someone would lose consciousness, and our teacher would revive him. He would use the resuscitation techniques known as “kappo”, and the unconscious student would promptly revive. My interest was piqued.

As a teenager, my family moved to Southern California, and I had the great fortune to study with Joo Bang Lee, the grandmaster of a Korean martial art known as hwarangdo, and with his eldest son Henry Taejoon Lee. Grandmaster Lee is also an acupuncturist, and it was from him that I received my first acupuncture treatment, after a wrist injury sustained at a demonstration. I was fascinated with this exotic healing art, and by the fact that in its advanced levels hwarangdo incorporated "kookup hwal bop" (acupuncture for resuscitation), "chim goo sul bop" (acupuncture for the treatment of disease), and "jyub gol sul" (bonesetting). During the course of training I learned several first aid techniques, such as pressing the middle knuckle into the acupuncture point Du-26 between the nose and upper lip to revive an unconscious opponent, and slapping (or jumping on) the point Kidney-1 on the bottom of the foot, for injuries to the testicles.

Finally, when I was in college I studied taijiquan for a few years. My teachers, Tsuei Wei and Jim Douglas, were both licensed acupuncturists. With taiji I was introduced to the idea that martial arts techniques themselves – movement and breathing – could be healing. In judo we didn’t talk much about ki, and in hwarangdo we practiced techniques to develop and circulate the ki but didn’t really incorporate it into our martial arts techniques (except for breaking techniques, which were basically an extension of “kihap chagi” ki coordination methods). But taiji was different – in taiji, it was all about qi. With taiji it all came together for me, and I began to see the human body not as a conduit through which a mysterious energy flowed, but as a kind of concresence of energy itself. If energy and matter are a continuum, then qi is something more on the energy end of the spectrum, and blood and flesh are more on the matter end. But it’s all the same stuff, and acupuncture is more about affecting the body from the energy end, and herbs are more about affecting it from the matter end. It was ideas like this, plus the persuasion of my teacher Jim Douglas, that made me consider acupuncture as a career.

These days, I am not as active as I once was, and no longer practice martial arts regularly. But it gives me great satisfaction to watch my son Lukas train under instructor Michael Laird of Laird’s Academy of Martial Arts. Instructor Mike teaches ho kuk mu sul, a style that is very similar to the hwarangdo of my youth. Training in martial arts has improved Lukas’ coordination, memory, and motivation, to say nothing of the self-defense skills he is learning. It might seem ironic that an activity that produces injuries is actually health-promoting, but in fact the practice of martial arts does improve health. There are the obvious cardiovascular benefits from the aerobic exercise aspect of training. There are the benefits to bone and muscle from all the stance work, blocks, kicks, and strikes. The qi gets a workout from the "kicho chagi" breathing techniques. All the stretching keeps the body limber. The entire body gets conditioned from the "nak bop" falling techniques. Perhaps most importantly, martial arts training produces an attitude of calm confidence and in-the-moment awareness that counters the stresses and ills of our modern lifestyle and lets us face life with courage and balance. So if you are a martial artist, I would be honored to treat your injuries and illnesses using the techniques of traditional Chinese medicine. But you should know that you are already doing something far more important for your health: you are treating yourself daily by training in the martial arts. And if you have no experience in martial arts, you may want to start - it's good medicine.

Into the Yang

2006-06-08T13:01:00.000-07:00

As we head into the summer, it’s hard to feel separate from the explosion of life around us. Green leaves soaking up sunshine, flowers blooming everywhere, spewing their genetic matter out into the atmosphere to ensure that there is a next generation of flowers (and that many of us get sneezy, wheezy, and itchy-eyed). We too get that surge of life, love, lust, call it what you will – it’s the yang rising in us as in the rest of nature.

When I was a child growing up in Japan, we celebrated the coming yang by going outdoors on the last night of winter and throwing handfuls of hard little soybeans out towards the street while shouting, “Oni wa soto! Fuku wa uchi!,” meaning something like “Devils OUT! Blessings IN!” Some years the neighborhood men would dress up like ogres and we would pelt them with soybeans, giddy with the feeling that with our violence we were somehow assisting the transition to sun and light.

As we approach the peak of summer, the yang energy grows daily, bathing us in more and more sunlight and heat. While Asian folk traditions equate yang with blessings and yin with devils, Chinese medicine characteristically preaches balance over absolutism. Yang energy has a tendency to flow upward and outward (witness the flowers and their pollen), and although it is fine to enjoy the yang coursing through our bodies, it is wise not to overdo it. Upward and outward pushed to the extreme can, in the human body, translate into having a stroke or throwing up. Too much activity during the hot months can consume our yin and literally “burn us out.” Since there is a natural preponderance of heat, it is healthy to balance it with cooling foods like cucumber, mung bean soup, and watercress. This is especially true for people who suffer from “hot” conditions like acne or rheumatoid arthritis. Children, who tend to be quite yang to begin with, may become susceptible to fevers and diarrhea. To prevent these and other summertime health problems, they should be fed a bland diet with an occasional cooling treat like fresh sugarcane juice or a few slices of watermelon. Overall, for everybody, moderation is the key to good health.

That said, summer is the time of excess. I feel like it’s been one long party since it finally stoped raining: birthdays, graduations, barbecues, concerts, a wedding. And, of course, there are more parties to come: Summer Solstice, Fourth of July, all those summer birthdays. Are the fun times ever going to end?

Seasonally speaking, the fun times do end. Which, for most of the world, is all the more reason to party all summer long, and into the fall harvest. When winter comes, it is the time to rest, to conserve our strength and nibble on the nuts, grain, preserves, and dried fruit we have saved (which is why the heavily commercialized stress-drenched modern Christmas, going counter-current to the natural seasonal energy, leaves us drained). Then, as the days start to get longer again, we celebrate the coming spring and look forward once again to the rising yang.

Yin to yang, yang to yin, the seasons provide the background and energetic charge to everything else in our lives. No wonder that an appreciation of seasonal changes underlies every celebration of every cultural tradition in the world: the seasons come before religion, came before there were human beings. Our planet was formed of the same hot stuff as the sun. As it cooled, a crust formed. On that very thin layer between the coldness of space and the warmth of our planet’s molten core, an even thinner layer of life – the biosphere – emerged. We, and all of life with us, evolved in the ever-shifting play between yin and yang, between the vastness of space and the womb of the earth, between the fire of sun and the water of ocean, between the cold of winter and the heat of summer. Of course we celebrate the seasons; they are the crucible from which we emerged.

But, of all the seasons, summer is special. During the last Ice Ages, we survived a hundred thousand years with no summer. Imagine our ancestors, emerging from their caves that first warm day after countless generations of cold, warming their bones in the sunlight, watching the first green plants poke out of the melting snow. Having lost summer once, we do our best to capture it when it comes around: in pickled peppers and home-canned tomatoes, in memories of summer romances, days at the beach, favorite vacations and camping trips. On Double-Five Day (the fifth day of the fifth lunar month, which usually falls in June), my children and I collect mugwort leaves in the mountains, capturing their yang essence to burn in the winter as moxa to strengthen my patients’ immunity and ward off colds.

We will always yearn for the pure yang at the beginning of time, a dim memory of the cosmos prior to life, prior to matter, burning inexorably through all of our cells. In the summertime we come as close as we’ll get to the to the great yang mystery of life and light, and we celebrate it. Happy Summer! May the devils stay out and the blessings keep pouring in.

Forty

2006-05-22T10:18:00.000-07:00

The river is strong from the long rain
Maybe I'm still strong too, despite the moaning and groaning.

After the Flood

2006-03-20T09:28:00.000-08:00

I had a very vivid dream last night, in which I was visiting my friend Greg Livingston, who is working on his doctorate in Chinese medicine in China. In my dream, I was sitting in the back of a large classroom. Everyone, including me, was wearing black uniforms kind of like Japanese high school kids wear. At the head of the class was a senior student, who pretty much ran the class. To the side of the class was a large vat bubbling on a gas flame. I asked Greg what it was, and he explained that it was boiling oil, "in case we get attacked."

Like I said, it was a very vivid dream, down to the detail of Greg giving me a pinch of some freeze-dried pickled mustard greens - very delicious, with that yummy MSG flavor that most Asian prepared foods have. The dream was so vivid that it woke me up, and kept me up, my mind racing. I had this sudden appreciation for learning, for scholarship, for universities, for the accumulation of knowledge that they represent. When people go to school, they join a stream of knowledge that has continued onward from the earliest days. And, if they go on to earn their higher degrees, to publish and teach, they continue the stream, and even create their own rivulets of knowledge that continue on. There are thousands, no, millions, of these rivulets squirming into the future, streaming repositories of our civilization's knowledge. It doesn't matter that many of these rivulets are utterly trivial (does society really benefit from another doctorate on the poetry of Lionel Ray?). Surplus has been the luxury and the fuel of civilization ever since agriculture, and our surplus of knowledge is a mark of the richness of our civilization.

Maybe our universities are worth defending with boiling oil. When the jihadists come rolling in, after Tel Aviv is nuked with Iranian weapons and we destroy Mecca in retaliation, after they open an Al-Jazeera station in LA but before they visit Vegas, they will surely come after our universities. After all, they are citadels to infidel blasphemies. Arm the undergrads, I say! Or maybe the graduate students - they're less likely to riot in peacetime.

It may never come to that, of course. It may be global warming that does us in, or the dreaded bird flu gone airborne. Whatever it ends up being, the universities should prepare. There should be a federal mandate that each university create a 100-DVD set, "Essentials for rebuilding apres le deluge." It would force researchers and academics to focus on stuff that'll really come in useful later, and break it down so people other than their proteges can understand it. You know, things like how to make a photovoltaic cell. Or basic obstetrics. How to build a house. Permaculture. Things like that. Keep all the rest, too, if you can. But in the little black box, put the 100-DVD set along with a few solar-powered DVD players. I would've said, "A hundred-volume encyclopedia," - you know, books - but you never know, the survivors might be unable to read.

I like to think that, if we have to rebuild from scratch, we'll come to appreciate not just the millions of rivulets we have lost, but some of the deep and ancient rivers that have persisted. Like the Chinese medicine that Greg is studying in Hangzhou. In order to earn his doctorate, Greg may very well have to create an obscure rivulet and write a monster thesis on "The Effects of Microcurrent Electroacupuncture on Mouse Cowper's Gland Contractions," or "Analysis of Verb Usage in the Huang Di Nei Jing." But, more importantly, he will be thoroughly trained in a tradition that treats sick people with a minimum of technology, that will benefit humankind even after the infrastructure is gone. I like to think that, after the flood, barefoot doctor acupunks will be scurrying among the rubble, quelling infectious disease with their homemade extracts of coptis and isatis, treating the injured with their thin metal needles, telling the survivors that it's all going to be OK.

Healing, Authority, and Experiment

2006-03-16T12:07:00.000-08:00

Being in the healthcare business, I've had plenty of opportunity to reflect on what it means to be a healer. I have to say that I maintain a certain amount of discomfort around the idea that I am a "healer" at all. The reason for my discomfort is my anti-authoritarian nature. I am so anti-authoritarian that I don't like being an authority! And to be a physician is intrinsically to be an authority. This is the conundrum that I am faced with every day.

It is a great responsibility, to accept a patient's trust, to treat them and to advise them about their health. It is a responsibility I take very seriously. My dislike of being an authority doesn't have to do with an unwillingness to take responsibility. Rather, it has to do with my unwillingness to claim to know anything special. Granted, I went to school and studied hard for years; granted, I have been in practice for eight years and have accumulated a certain amount of clinical experience; granted, I have happy patients who would testify that I helped them with their injuries, their coughs, their premenstrual symptoms, and so on. But when a patient looks at me and says, after I have been poking and prodding and feeling the pulse, "Is it my liver?": what I am thinking to myself is that I don't even know what that means. All I know is that when I assess what is going on and apply needles and herbs, something shifts. Was there something wrong with their "liver" if the liver pulse was wiry? Who the hell knows?

I think that, on the whole, it is True Believers who become successful doctors. Their embracing of a model - whatever model, western medicine, Asian energetics, it doesn't really matter - gives them the authority to say, "Yes, it's your liver, and I have just balanced it." These are the same people who confidently tell their patients that a weekly chiropractic treatment, or regular acupuncture for three months, will make them better. I envy them their confidence, even as I wonder whether their belief in their model, plus the economic motive, has clouded their ethics.

I am not a True Believer. I think that a lot of what passes for medicine is bullshit. I am skeptical, rational, creative, and experimental by nature. I had a teacher once who said, "Medicine is a series of experiments that you engage in with your patients. The more experienced you are, the more refined your experiments get." Most patients prefer authority to experimentation. They don't want to be guinea pigs. They want a doctor who tells them what's wrong with them, then proceeds to fix them. My patients are different. They know that I'm not experimenting ON them; they sense that I'm experimenting WITH them. Like me, they see that there is a playful and curious aspect to healing. They experience healing as an exploration, as an embodiment and metaphor for life.

I can't remember which philosopher it was who said, "Life is a mystery to be appreciated, not a problem to be solved." I'd rather help patients explore the mystery, than claim to solve their problems. It is immensely rewarding when they start to feel better as a side effect of this exploration.

On Mushrooms

2006-03-09T09:31:00.000-08:00

One morning not too long ago, I woke up early and, unable to go back to sleep, decided to head out for a hike in the pre-dawn chill. As I walked uphill towards one of my favorite dells, I savored the crisp morning air and basked in the light of the recently-full moon setting in the west. I felt myself slipping into that state of mind which only a rhythmic entrainment with nature induces in me: energized yet calm, introspective but wide open, happy and fully alive.

Call it a hunch, call it the effect of a few stray spores floating in the moist air and alerting the olfactory centers of my brain, call it what you will - but for whatever reason I veered off the path and followed a deer trail into a damp area of tan oak, bay, and poison oak. There, as the first rays of the sun hit the leaves on the forest floor, I found my first chanterelles of the season. With the combination of the recent rains and dropping nighttime temperatures, the forest had produced a beautiful little crop of golden-orange manna for me to gather. After picking enough for breakfast (I left the babies for another day, or perhaps for another mushroom-lover), I headed home and made a delicious buttery mushroom omelet for me and my family. What a way to start the day!

Here in Santa Cruz, many people share my passion for mushrooms. But in much of this country, indeed in much of the Western world, mushrooms are looked upon with great suspicion if not revulsion. The great mycologist G. Gordon Wasson divides the peoples of the world into two classes: the “mycophiles” and the “mycophobes.” Fortunately for me, my parents both come from strongly mycophilic cultures. Growing up in Japan, I grew to love the plentiful shiitake, the long and skinny enokidake, the rare and fragrant matsutake which evoked for us the joys within the sad beauty of autumn. My father, who is Swiss, is an avid mushroom-hunter who goes foraging in the hills of Binningen, where he lives outside the city of Basel. His father, a civil servant in the town of Thalwil on the shores of Lake Zurich, served as the mushroom inspector for the community. If people were unsure about the edibility of the mushrooms they had collected, they would bring their harvest to my grandfather to have it checked out.

Aside from a genetic propensity to dwell on mushrooms, to long for them when they aren’t around and to cook and eat them with great gusto when they are, I have maintained a longtime professional interest in fungi. As an herbalist, I prescribe them daily in my practice, usually in the form of the mildly tonifying fuling, sometimes as the more strongly diuretic zhuling, often as part of a formula containing the immune-strengthening, spirit-calming polypore known as reishi or lingzhi. From the Chinese point of view, mushrooms are a yin phenomenon, growing as they do in dark, moist places. The biggest part of the mushroom’s body is the mycelium, a fine network of thready matter that grows through the soil of the forest floor. But the above-ground sexual organ bursts out into the yang of daylight to spread its spores into the greater world. Thus the mushroom when eaten nurtures the dark wet places within us, but also animates our creative and libidinous energies – what Chinese medicine calls “tonifying yin and yang.”

Mushrooms are the great alchemists of the forest, transforming tons of dead and decaying matter into beautiful, edible, perhaps even spiritual morsels. From the delectable morel to the medicinal lingzhi to the psychedelic ‘shrooms that have spread like spores on the wind from the huts of obscure Mazatec medicine women to living rooms and raves around the world, mushrooms have shared with humans a symbiotic intimacy since the dawn of time. When we forage for fungi in the wild, cook them with a few simple ingredients and eat them, we get a taste of Eden. Something in us remembers a time before supermarkets, a time before we left the safety and abundance of the forest for the open plains, a time when a field was just a field and not a place where we planted stuff. When we eat mushrooms, we embrace the long lineage of hunter-gatherers from which we are descended. And, embracing what we truly are, we feel good, and we are healthy.

The Virtues of Gentle Exercise

2005-10-19T08:54:00.000-07:00

East Asian medicine, always ahead of its time, has long stressed the importance of exercise when it comes to maintaining health. Yet, with our culturally-conditioned preconception of fitness as having to do with aerobic exercise and its cardiovascular benefits, it is easy to dismiss Chinese health exercises, at first glance, as soft and ineffectual.

I remember when I was eighteen or nineteen, my roommate introduced me to a Chinese health exercise known as Ba Duan Jin, or the Eight Pieces of Brocade. As a longtime martial artist who was accustomed to doing "real exercise" with exciting leaps, spinning kicks, and sparring that got you real sweaty and tired, I smiled to myself as we went through the eight gentle calisthenics. There was one where you raise your arms up over your head, palms to the sky, as you breath in. In another, you stand in a low horse stance while turning your torso sideways and making a motion like you're an archer pulling a bow. Another one has you stand straight and gently turn your head from side to side. You get the picture: boring!

I dismissed the Eight Pieces of Brocade as a useless exercise that fell in the same category as the calisthenics that you see old Asian people doing in the park in the early morning, forming a big circle around the pile of their backpacks and thermoses, circling the wagons so gui luo thugs can't steal their belongings.

Years later, when I was in acupuncture school, I was re-introduced to the Ba Duan Jin by a wonderful kung fu teacher named Linda Darrigo. As an earnest student of traditional Chinese medicine, I practiced faithfully, paying more attention to my breathing and the movement of qi (internal energy) within my body in the hope that this would make me a better doctor. But, as I got caught up in the excitement of treating patients in the student clinic, my interest waned and I stopped practicing the exercises.

Now that I'm pushing forty and discovering that my body doesn't maintain its elasticity all by itself, and that injuries that would have fixed themselves ten years ago now stick around for months and turn into chronic pain, I have developed a new regard for the Eight Pieces of Brocade. I'm realizing that there is great wisdom in this type of exercise that moves every body part in a gentle manner but with a big range of motion. You see, as we get older, we tend to settle into a very limited range of movements. If you're like me, you very seldom have to reach your arm higher than the level of your shoulders in your daily life. It's no wonder that people get "Fifty-Year Shoulder," if they've stopped moving the shoulder joint through its natural arc. The same is true of all our other moving parts, but especially our backs because with our sedentary lifestyles it's just as easy to stop moving the back through its range of motion as it is the shoulder. How often are you doing something other than sitting, standing, walking, driving, or lying down?

Doing your daily Eight Pieces of Brocade, with their gentle flowing, twisting, and bending movements, can really help to combat the stiffening that comes with age and inactivity, and the injuries that come with that stiffening. Come by the clinic sometime and I'll show you the movements. If I get my shit together I'll even have a handout for you to refer to when you do them at home. Aside from the value of the exercises themselves, there's something very healing about starting each day with some fresh morning air and the day's first light on your face, your body and mind waking up as the world wakes up around you.

Vicodin-Assisted Physical Therapy

2005-10-12T08:04:00.000-07:00

Some weeks ago I woke up one morning, and before my bones had a chance to settle in, squatted down to pet our cat. The next thing I knew, I was seized with a terrible pain, and I knew that my upper back had gone out. It felt like some kind of structural slippage, like a rib attachment to the backbone sliding out of kilter, so after four or five days of hoping it would get better by itself, I went to a chiropractor that one of my patients recommended. He proceeded to crack my back, measure my legs, etc., and I went on my way. Unfortunately there was no difference in my level of discomfort. It hurt so much that I could barely shift gears in my car, or put my backpack on.

So I took matters into my own hands. I took an extra-strength Vicodin, and an hour or so later, as I slowly began to feel my consciousness disengage from the Sex and the City that my wife Annette was watching, I placed a hard rubber ball on the floor and lied down on it. I had tried this the day before, since the ball - a medium-sized bouncy ball a little smaller than a tennis ball - generally works great for sore spots on the back, but my back muscles were so seized up that the ball was unbearably painful.

With the Vicodin, the ball was painful but not unbearably so. For about an hour, I lay on the floor, shifting the ball every few minutes and making big circles with my left arm. As I inched the ball towards the epicenter of pain between my left shoulder blade and backbone, it got more and more painful. As I made the big circles with my arm, layers of muscle and fascia would shift and I would find new positions of ever more extreme pain. I would hold the arm position until the pain subsided, then moved on to the next position of pain.

In case I'm sounding like I like pain, I should point out that I dislike pain very much (hence the Vicodin). In fact, I was inspired to use the rubber ball as a therapeutic tool after surviving a treatment by a Korean healer named White Cloud, who tortured me with a pair of stone balls for half an hour or so. I vowed that I would never inflict such pain on anybody in the name of healing. But, time passed, and I got worked on by White Cloud's disciple Andy, who is one of my best friends. Andy took a gentler approach, and I had to admit that the ball was a wonderful healing tool. The great thing about using the ball on yourself is that you get to control the level of pain you inflict on yourself. The great thing about using the Vicodin is that you get to open up places that would have been too painful to approach without the narcotic.

To make a long story a little less long, the next day my pain was about 90% better. Yesterday I had the opportunity to try Vicodin-Assisted Physical Therapy again, after messing up my lower back. I first got an acupuncture treatment from my colleague Ben Zappin (Ben runs the best herb pharmacy in town; call him at Five Flavors Herbal Pharmacy 831-239-6900 for all your herb needs). It was a great treatment, but, eager to try VAPT again, I raced home, popped a Vicodin, and got out my ball. Today, thanks to Ben and my home treatment, my back is about 60% better. After another round of VAPT, I'm sure I'll be back to normal. Trouble is, I'm running out of Vicodin. If you have any, please find a way to send it to me ASAP.

*Please note that the activities described in this post are those of a fictional persona named Soma Uemura, and that the real-life author does not in any way advocate the illegal use of Vicodin without a prescription.

On Herbs

2005-10-11T12:44:00.000-07:00

Plants are the original chemists and alchemists of our planet, synthesizing out of water, air, earth and sunlight thousands upon thousands of bioactive chemicals. Many of these chemicals are used in the plants’ own self-repair, self-defense, and health maintenance. Since individual plants exist not in a vacuum but in complex communities including other plants and animals, their various antimicrobial, anti-cancer, immune system strengthening, and other therapeutic compounds benefit all the members of their community. Until quite recently, human beings were also part of that community, and they also benefited from the wide range of nutrients and medicinal compounds that they encountered in the wild plants that they foraged. Fortunately, the healing properties of plants were remembered and passed on. This body of knowledge is what has come to be called herbal medicine.

Unfortunately, with the rise of agriculture and modern monoculture, modern humans eat an appallingly small selection of foods (and those that we eat have often had their healthiest phytochemicals bred out of them in favor of blandness, uniformity, and long shelf life). The result is that we don’t get the same range of beneficial substances from the foods that we eat. And, generally speaking, we are less healthy than our ancestors (we may live longer, but that is primarily due to advances in sanitation rather than to changes in diet).

I suggest that rather than run to the nearest herb store to buy herbs with which to supplement your diet, head into the woods and gather stinging nettles, edible mushrooms, miner’s lettuce, or other locally-growing herbs to cook at home. The experience of foraging in the wild will itself be a healthy and deeply satisfying activity, with the health benefits of wild foods an added bonus. If you are unsure about what plants to pick, check with your local natural foods store – most cities have an herbalist or two who lead herb walks in the local woods or hills.

In addition to incorporating herbs in your diet, I suggest that you consider making herbal medicine your primary healthcare modality. Many of our most common health complaints, including colds and flu, menstrual problems, and digestive disorders, are not very effectively addressed by conventional medicine. Herbs often help, with fewer side effects than pharmaceuticals. The truth is that many of us run to the doctor far too quickly and far too often, and end up using medications that cause unpleasant side effects, pollute the environment, and often don’t work. By using herbal preparations for your healthcare needs, you increase your own innate vitality and immunity, and do your small part towards decreasing the growing environmental impact of excreted pharmaceuticals on the biosphere.

Using herbs is one way to wake ourselves up out of the hypnosis of modern living. Head for the woods! Eat wild plants! Taste all the flavors! Your senses will come alive, and your organs, your blood, your entire being will remember what it was like to be an integral part of the living environment as we once were not too long ago.

We Call It a Practice, But It's Real Life

2005-10-11T06:55:00.000-07:00

There are many issues that come up in the practice of East Asian medicine, or really any medicine, in the modern setting. On the face of it, healthcare seems very straightforward: people get sick or hurt, and they come to you for help. You poke them with needles and give them some herbs, and they get better (or not).

But the reality is that we live as part of a society, and as part of an economy, and there is no escaping the fact that the care we provide is in fact a series of financial transactions that accumulate to provide us practitioners with a livelihood. I have struggled with this for a long time, because I have always been troubled by the psychology of on the one hand wanting my patients to get better, but on the other hand wanting them to keep coming back for more treatment so that I could pay my bills. I believe that our need to pay our bills, and our desire to do better than that - to accumulate some kind of wealth and a comfortable lifestyle - has resulted in the industrialization of our medicine. What I mean by this is that even though acupuncture and herbal medicine are supposed to be holistic and natural, economic pressures have forced many of us to adopt a model that is very similar to Western medicine, in which we treat as many patients as possible, using three or more rooms and demanding that we devote only fifteen minutes or less per patient.

It's easy to justify such a style of treatment not only on economic grounds but also with the reasoning that the patients don't seem to mind and in fact derive great benefit from our speedy ministrations. There are whole systems of medicine built on this model. And besides, we argue, when you get good you can just book, you get into a groove and treat those patients, bam bam bam!

But I have to wonder. I think that a large part of the care in healthcare has to do with caring enough about our patients to spend some time with them. Especially with a hands-on medicine like ours. How can you notice that this patient's spleen channel has little lumps and dips along it, or that patient has telltale little blood stagnation venules around UB-40, if you don't have the time to palpate and look? Is it enough to feel the pulse and look at the tongue and, within the five minutes you have allotted, declare your diagnosis and stick a few needles before moving on to the next room? Often, it may be enough. But sometimes, it may not be enough, and we don't make a difference when we could have. And always, we should ask ourselves: is this the best we can do for our patients?

We like to call what we do a practice. The practice of medicine. Or even sexier, a spiritual practice: "The medicine that I practice is just an extension of my spiritual path." This is fine and dandy, but for the patient it's not just practice. It's real life. Their real lives. So I think that for us it should be real life too. Let's take the time to live our medicine the way it was meant to be, with great care and attention and authenticity, even if that means we have to slow down. Slowing down and taking a breath - that's good for you, right? It'll be good for our patients too.

On Acupuncture

2005-10-10T06:49:00.000-07:00

My first exposure to acupuncture was when I was sixteen years old. As a youth I was a gung-ho martial artist, and my instructor’s father, the grandmaster, also happened to be an acupuncturist. We did a lot of demonstrations, and, as a senior student I usually got to be my instructor’s fall guy. At one particular demo, I took a rough fall and watched my right wrist swell up. When we got back to the training hall, the grandmaster stuck a few needles in my wrist and hand, and (more interestingly, I thought,) in my uninjured left ankle. The pain and swelling went away.

Most people, by personal experience or through success stories like mine, are familiar with acupuncture as a method of inserting needles into the body to control pain. As a licensed acupuncturist, I am happy that acupuncture has helped so many people with their pain. As a direct result of its obvious clinical efficacy, my profession has reached an unprecedented level of acceptance and popular appeal. However, because of the focus on the treatment of pain, acupuncture’s other benefits remain virtually unknown in the popular culture.

Most laypeople, for instance, don't know that acupuncture tends to induce a mildly altered state. Typically, patients receiving an acupuncture treatment will get very relaxed. Some experience a streaming of energy, felt as tingly or bubbly sensations in different parts of the body. Others fall into a deep sleep. I half-jokingly tell my patients that the reason acupuncture makes them feel better is that it pins them down for a half-hour rest which they otherwise would not take. I do believe that acupuncture is an excellent form of stress reduction, and that because so many modern diseases are directly or indirectly caused by stress, they are helped by regular treatment.

But acupuncture’s complex and subtle effects in treating a wide range of diseases cannot be explained away by stress reduction. So how does it work? The Chinese postulate a kind of vital energy, called qi, that drives all of our life processes. Qi is said to flow through the human body in distinct pathways called channels or meridians. The channels connect not only to each other, but to organs and tissues within the body as well. When the body is diseased, the flow of qi is disrupted. Acupuncture, quite simply, is the use of needles to un-block stagnant qi in the channels. With the qi flowing smoothly in the channels, the organs regain their optimal function, and health is restored.

As intuitively correct as the Chinese medical explanation may sound, it is somehow not satisfactory to the Western scientific mind. After all, what is this qi? And what are these channels that have been so neatly mapped out? They certainly don’t correspond to known anatomical structures. It is not surprising that scientists have for many years pooh-poohed acupuncture, considering that it is based on a mysterious “energy” that does not correspond to blood, or electricity, or any equivalent concept in modern science.

My own suspicion is that qi is not a hitherto unmeasured energy, but a convenient cultural construct that explains observable reality and informs all traditional Asian arts. My experience of life acknowledges a vitality that flows through me, and I practice Chinese medicine as if qi exists, but at the same time I cannot help but wonder what is really happening when I stick a needle in someone’s flesh.

I speculate that acupuncture’s effects are best explained by the same mysterious process that guides the development of an embryo. Our bodies can be thought of as very large colonies of single cells, descendants of the fused sperm and egg that was the original Big Bang of our personal existence. Out of this singularity, our cells differentiated, unfurled to form distinct tissues, organs, limbs. How did they know where to go, what to become? What coordinates the whole thing? Who’s running the show? At this point the rational mind breaks down and we invoke God, or qi, and simply marvel at the mystery of it all. But my hunch is that the original connections are not lost, that in its streaming the embryonic protoplasm leaves very fine trails, that far flung cells continue to communicate, and that the acupuncture channels are the functioning remnants of these gossamer trails and communication lines. When communication breaks down, illness results. The application of needles at the right places somehow, perhaps by affecting subtle bioelectrical or biophotonic signals, restores communication and health.

While my intellect strives to understand acupuncture scientifically, as a practicing acupuncturist I find the old Chinese worldview the most satisfying. The ancient Chinese described the body as a microcosm of the world. Just like the terrestrial landscape, the human body consisted of mountains and rivers, marshes and plains. To this day we use acupuncture points with names like yongquan, “Bubbling Spring,” and zhongzhu, “Middle Island.” It was the job of the acupuncturist to maintain the ecology of the human landscape, by draining this ditch or setting fire to that hill. It’s a pity for this rich profession to be reduced to being medical technicians or pain therapists. My hope is that more and more people will use acupuncture not just to make pain go away, but to get (or stay) healthy and explore their human existence in a deep and immediate way.

Treating Poison Oak

2005-08-26T16:32:00.000-07:00

Summer and fall are the seasons when many people go hiking and camping to enjoy the outdoors. Inevitably, some of those people are going to come down with cases of poison oak dermatitis. Typically, a day or two after contact, they will notice raised red spots and intense itching at the places where the poison oak scratched them. If left untreated, those areas can get quite swollen and even painful (they will be painful AND itchy, not just painful), and the raised bumps may crack and ooze. The offending chemical in the plant's oil, urushiol, can also rub off the points of initial contact and cause itching at secondary sites. All in all, it's a very unpleasant affair that lasts a couple of weeks. Fortunately, there is a lot you can do to avoid it, and failing that, to treat it very effectively. I will outline here my basic approach, perfected over years of suffering and experimentation. I just got back from backpacking with buddies Dave and Andy, and Dave ended up with some real bad poison oak, thus inspiring this post.

1. DON"T GET IT IN THE FIRST PLACE.
This doesn't have to involve avoiding wild areas. Educate yourself as to what poison oak looks like in every season. Google "poison oak" (or, on the East Coast, "poison ivy") and take a look at photos of the plant. Better yet, go on a hike with someone who is familiar with poison oak and have him point the plant out to you. Then, when you are hiking and exploring in the woods, be careful and respectful. Poison Oak is one of the great teachers of the forest, and its lessons are awareness and humility. We left the forests a couple of million years ago, and when we return to them now, we are visitors. If we break the rules of care and appreciation, if we stumble through like bulls in the china shop, we are bound to pay in some way, and a couple weeks of itching is one of the less subtle ways that we can pay.

2. ONCE YOU'RE HOME, ACT AS IF YOU HAVE BRUSHED AGAINST IT.
Do this even if you are quite positive that you were very careful and attentive and avoided all the poison oak that you saw. I cannot tell you how many times I skipped this step and then started itching a couple days later. The main thing you want to do is go to the drugstore and buy a bottle of a product called TEKNU. TEKNU, as far as I can tell, is a kind of body lotion made out of mineral spirits. You rub it on your arms, legs, neck, face, any body part that might possibly have been exposed. You leave it on for a few minutes, then you rub the excess off with a paper towel. This serves to dissolve the offending urushiol, which you then remove with the paper towel. Finally, take a shower to wash off the remaining TEKNU plus urushiol.

3. IF YOU GET ITCHY DESPITE FOLLOWING THE STEPS ABOVE, USE A SEVEN-STAR HAMMER.
This is the single most effective natural poison oak treatment option available. The seven-star hammer, also known as the plum-blossom needle, is an acupuncture tool consisting of a flexible plastic handle and a small hammerhead with a number of sharp needles sticking out. If you are an acupuncturist, the best thing to do for your patients who are suffering from poison oak dermatitis is to send them home with a seven-star hammer of their own, to self-treat at home. If you are not an acupuncturist, go to your acupuncturist and ask her to give you one of these miracle-working implements. This is what you do: the minute you notice an itchy area, get out your seven-star hammer and pound the heck out of the itchy area. Actually, all you have to do is tap lightly all around, preferably until you draw a little blood. Then, wipe the area with a cotton ball soaked with rubbing alcohol. The itching will go away, usually for a whole day. If it starts itching again, pound and disinfect again. Repeat for all new areas that begin to itch. Following this procedure will usually keep your dermatitis from getting to the nasty, inflamed, oozing, crusty phase. And you will be virtually itch-free for the two weeks or so that it takes for the poison oak reaction to completely subside. I'm not sure why this method works so well when regular scratching with the fingernails usually makes the itching worse, but it does work!

4. IF YOU ARE STILL ITCHY EVEN AFTER THE SEVEN-STAR HAMMER, USE TOPICAL MEDICATIONS.
You can try calamine lotion, the Chinese burn ointment called Ching Wan Hung (a.k.a. Jing Wan Hong), witch hazel, tea tree oil, aloe vera gel, hydrocortisone creme, or any of the pharmaceutical or herbal treatments that are available commercially. In my experience, the seven-star hammer is vastly superior to any topical preparation, as a primary treatment. But if you are still itching, try whatever is available.

5. AS A FINAL RESORT, OR IN CONJUNCTION WITH TOPICAL TREATMENT, USE INTERNAL MEDICATIONS.
If you are still itching after all of the above, treat the problem from the inside. If you are in really bad shape, with a thigh that is as thick as a tree trunk, or a face that looks like the Elephant Man, you should probably go to the doctor and get a cortisone shot (but beware - long ago, before I knew anything of the Healing Secrets of the East, I got a cortisone shot after my first bad poison oak attack, and it got even worse because it turned out I was allergic to something in the preparation! Oral cortisone did the trick). Less extreme options include homeopathic Rhus toxicodendron 200C ("potentized" poison oak extract); Chinese herbs to clear heat and toxin and cool blood heat such as rhubarb root, phellodendron, honeysuckle, and coptis; and cooling, detoxifying foods such as watermelon and mung bean. My experience with internal treatments for poison oak is that they are hit or miss - they seem to work sometimes, and other times not at all.

I will end with a few words about poison oak "vaccinations." There is this idea out there that you can immunize yourself against poison oak by ingesting small amounts of it early in the season. Being of a scientific bent, I have tried this out on several occasions. The first time, I made an alchohol extract of fresh poison oak, thinking I would take a daily dose of a few drops in water, increasing the dose each day. But I was not disciplined enough, and ended up forgetting to take my dose a lot of the time. Another time, I ate a few fresh poison oak flowers when they were in bloom, thinking the flowers might not be as oily and hence as toxic as the leaves or stems. That particular year I didn't experience any bad rashes, but I don't know whether it was because of the flowers or because by that time I had learned to be more careful in the woods. Last year I ate a couple of poison oak berries and ended up with an itchy butt for a week or so. I was not scientific to the point of purposely scratching myself with poison oak after these attempts at vaccination, and my results are overall inconclusive. If you are thinking of trying to immunize yourself against poison oak, I can only say: proceed at your own risk.

Whatever else you may have gotten out of this post, if you do nothing else, get yourself a seven-star hammer if you're going to be spending any time out in nature.

Lab Notes II

2005-08-12T12:26:00.000-07:00

Last night was a good night. First, I ground up a bunch of herbs in the big grinder down at the clinic and made some big tea bags of mugicha (roasted barley), dokudami (houttuynia) and jiaogulan (gynostemma). The inspiration was the Japanese dokudami migraine tea that my mom sends us for Sara (who now hasn't had a headache in close to a year). Dokudami is an interesting herb that the Chinese use primarily for hot phlegm in the lungs. It's said to be broadly antiviral and antibacterial, and is mildly diuretic and laxative as well. The Japanese adore this herb; since ancient times it's been valued as a detoxifier, and it's hailed as a panacea for everything from migraines and acne to cancer and malaria. The mugicha's roasted nutty flavor does a good job of masking the more intense flavors in the other herbs. Anyway, I figured I might as well make some migraine tea myself, and experiment with other herb combinations. This one I'm calling CLEAR, with the idea that both the jiaogulan and the dokudami clear heat, damp, and toxins, but that overall the formula is pretty balanced and even slightly tonifying because of the barley and jiaogulan. The companion formula, NOURISH, will also have both clearing and nourishing properties, but will be slightly more nourishing, with nettles and gotu kola instead of the dokudami and jiaogulan. Gus says he would switch the jiaogulan and the gotu kola, and now that I'm treating a new teenaged female migraine patient, I can see how that might actually be a very nice combination: heat-clearing,toxin-flushing, liver-moving and liver-tonifying,but also nerves/brain soothing and calming (remember that in ancient days gotu kola was given to epileptics and the insane - which many migraine sufferers can relate to!). Very satisfying to hold in my hands a final product in professional-looking heat-sealed teabags, and even more satisying to be drinking it right this minute. Mental note: market CLEAR to smokers and people trying to stop smoking, also high cholesterol and high blood pressure, as well as migraine headaches and PMS. NOURISH for stressed-out people, anemia, chronic skin problems, and as a post-menstrual (and general) tonic.

AND, I ran my still for the first time this season! It was a three-hour operation, me sitting anxiously in the garage while the cider warmed slowly, worrying that the copper tubing had gotten crimped, or even worse punctured when I wound it up from the pressure cooker over the beams of the garage and then through my new 2-gallon condenser. Played with Charlie, our adopted stray cat (I'm not sure who adopted whom), who was very active, one moment flopping around on the ground meowing to be stroked, then suddenly shooting into the dark garage after a mouse. Then, about two hours into the operation, a splutter and a start and the moonshine began to flow! I discarded the "head", then proceeded to collect about 200 ml of clear fruity goodness. Around midnight I shut the operation down, feeling like an alchemist who has successfully concentrated the elixir. And an elixir it is! Fruity, floral, but with a firewater kick. I estimate by bioassay a strength of 50-60% alcohol. Looking forward to taste tests with different batches, and trying to establish the differences between the two trees, ripening times of the apples after they're picked, fermentation times and temperatures, distillation times and temperatures, etc.

Cheers!

Lab Notes I

2005-07-21T10:31:00.000-07:00

Very active lately on the laboratory front. Finally cleaned out my corner of the garage, moved my herb stuff there, artfully arranged old Ladle Brand bottles, set up the still. Very excited about this next round of distillation. Am constructing new condenser unit that will allow replacement of cooling water while distilling continues. Boiler unit perfectly sealed and works great. Have juiced almost two gallons of apple juice from Tree Number One; will begin fermentation when I reach two gallons. Am so excited! It'll be interesting to compare the final product from Tree Number One versus Tree Number Two. Last year's #2 eau de vie was my favorite of all the experiments. Am looking forward to trying #1.

Improved moxa-making machinery works great. Made a bunch of beautiful fluffy white moxa from last year's mugwort. Also experimenting with using a magnifying glass to focus sunlight on St-36, Sp-6, etc. And left K-4 area which has been sore recently due to fucking up my rib and lower back. Am feeling impending old age, don't bounce back so well anymore. Sunlight moxa feels really good when you get on the edge of burning and move the point around in little spirals. I think it works pretty good. Sensei: "Pull away as soon as you feel heat." And, "Please do not forget that applying one time and even number can result in a sedating effect." (I kind of wonder about that odd and even stuff - smacks of typical Chinese numerological thinking). And, "Be careful not to over do this being carried away by its fun."

Also recently made a new all-purpose balm out of almond oil, beeswax, St. Johnswort, and gotu kola. Makes me think of first time Grossmuetti showed me how to macerate Johannischruut in olive oil many years ago. I really think it's better as a wound-healer than as an anti-depressant. Plus the gotu kola is an amazing skin herb; figured why not use it topically (interesting that they're both brain/nerve herbs and also both good for the skin. Skin as the outer physical boundary of mind? Maybe what's good for the one - antioxidants, circulatory stimulants - is good for the other). A little too herb-stinky for commercial use. The addition of a dollop of sandalwood oil hardly made a difference. Works great on moxa burns, and used it to good effect on Luki's butt, which was hypersensitive and painful from overconsumption of apricot pie.

Will hang up old Garlic Grotto sign, or maybe make a new one: "Ye Olde Brimming Laydle." Gotta get back to work.

Animal Koan

2005-07-11T11:42:00.000-07:00

Q: Does a cow have the Buddha-nature?

A: Moo.

Iron Pork 101

2005-06-21T06:35:00.000-07:00

I thought back to the first time I met Kazi Dama, on Dave's and my second night hike with Pischering. When we got to our usual meeting spot, there he sat, chatting with Pischering. He appeared to be in his fifties, dressed in loose-fitting faded black cotton clothes, with close-cropped greying hair and an Asiatic or Native American look to him. When we approached he stood up and gave a short little bow. “Hi. I am Kazi Dama,” he said.

Pischering introduced us, and we started walking. Pischering and Kazi Dama raced ahead; clearly Pischering had been making an effort to accommodate our slower pace in previous weeks. As we scrambled to keep up with them, Dave slipped and twisted his ankle. When we finally caught up with them, we were out of breath, and Dave was limping painfully.

“Am so sorry,” Kazi Dama said. “Pischering and me no see each other long long time. We been so busy catching up we didn’t see you hurt. Let me look your ankle.” He removed Dave’s shoe and sock, and whistled when he saw the red and swollen ankle. Before we knew what was happening, Kazi Dama took what looked like a curly piece of bone out of a small bag he carried, and with one quick stroke slashed Dave’s ankle with it.

“Holy shit! What are you doing?” Dave yelled, looking at the squirt of dark blood pooling in the grass next to his foot.

“So sorry. Must move out bad blood,” said Kazi Dama, wiping the incision with a folded handkerchief. He then proceeded to apply what looked like a smooth grey stone to various parts of Dave’s leg and foot. Miraculously, the swelling seemed to subside. “Better?” he asked.

Dave stood up, incredulous. He walked in a small circle, then jumped up and down. “That is so weird! The pain is gone – it feels like I never twisted it at all! What kind of magic was that?”

Kazi Dama shrugged. “That is what to do, if you sprain ankle,” he said. “No is magic.”

“Kazi Dama, I’d like you to teach these boys about Iron Pork ,” said Pischering. “They move like old men, and if they want to hike with me, which they assure me they do, they need to get healthy.”

“Iron Pork?” we asked in unison. It sounded like a bad kung fu movie.

“Well,” said Kazi Dama. “Where to start?” He folded his legs under him and lit a cigarette. He inhaled, and then blew the smoke out slowly. “In my country,” he said, “people and pigs are good friends. You see, we live in the high mountains, and long long time ago, my ancestors had to survive for a long, long time what we call ‘the Great Cold’. During the Great Cold, winter never end. Always cold! Always ice and snow! No plants to eat. So, during Great Cold we eat pigs. Pigs were so strong, they survive good. They dig into ice and ground, find roots and other things to eat. My ancestors hunt pigs, and eat pig meat, use pig fur and pig skin for making many things. And you know what? Wild pig meat very good for them! Make strong! Best hunters make friends with pigs. They wait, in the cold, very still, until pig come. They talk with pig! They talk long time, all night long. Only if the pig say, ‘Take me,’ then hunter kill pig.”

“No living thing wants to die, unless maybe it’s sick,” Dave said skeptically.

“Ahh…,” said Kazi Dama, puffing on his cigarette. “You see, pigs do get sick, or hurt. Before Great Cold, pigs take care themself pretty good. They find wild herbs to heal themself. But during Great Cold, no more herbs! So we help them. They come to our caves and cry, and my ancestors take them in and help them. Pigs and people make deal: pigs give us food, and we help them when they sick or hurt. We also make promise to pigs, promise to never keep them in fences, promise they are always free. So Iron Pork come from killing and healing, together. Iron Pork maker, Khazan Doshi, was mighty hunter in Great Cold. He play with the pigs, ride on them in mountains, play with them in snow. Pigs teach him about healing roots. The hunting and healing art that he make, he call Iron Pork. Eating pigs make my people strong like iron, and pigs’ family love also strong like iron. Also, in our medicine we use iron for healing.”

“Iron for healing?” I said. “You mean, like iron pills?”

Kazi Dama laughed. “No,” he said. “Long ago, even before Great Cold, there was one terrible, beautiful night when fire snakes and dragons fill the sky. Then, people find smooth black and grey stones on ground. My ancestors think stones magic! They rub on pain places, on baby in belly, all over body, and they find out stones good for healing. Actually, stones are…” Kazi Dama quickly conferred with Pischering about the correct word choice. “…meteorites. Mostly iron! During Great Cold, we use stones to heal, because no herbs. On Dave’s leg, after bleed with sharp pig tooth, I use small meteorite.”

“So you fixed my ankle with a meteorite?” said Dave. “How does that work?”

“Don’t know,” Kazi Dama said. “I just know it work! When you hold in your hand you feel something,” he added mysteriously. He handed it to Dave.

Dave held onto the stone for a few minutes, and announced, “I don’t feel a thing!” I tried as well, and was similarly oblivious.

“Well,” said Kazi Dama. “Maybe nothing wrong now so feel nothing. Or, maybe you no pay enough attention! Mostly, stone seem to be…” He checked with Pischering again, then said with great difficulty, “…in-for-ma-tion amp-li-fi-er.”

“Information about what?” asked Dave.

At this point Pischering interjected, feeling perhaps a need to augment his friend’s limited skills in the English language. “We are getting ahead of ourselves here,” he said. “Kazi Dama is trying to educate you to get you ready to learn the basics of Iron Pork, and here you are asking him about the Pischering Field.”

“The Pischering Field?” Our curiosity was piqued. “What does Pischering have to do with Iron Pork?” we asked Kazi Dama.

“Pischering is a great Iron Pork master!” Kazi Dama said, with great delight.

“When I say ‘Pischering Field,’ I use the word ‘Pischering’ in its literal meaning of ‘human being’,” explained Pischering. “The human body emanates a kind of force field, which carries information about what’s going on inside the body. It is this information that the stone can help you sense,” he explained. “It is a basic human thing, not unique to Iron Pork. In my childhood we were taught to speak of this emanation as the Pischering Field.” He paused for a few seconds, as if wondering whether what he was going to say next would just confuse us even more. “You see, all people, all living things, hell – all things, period! – exist in one great field that connects all of us.”

Using Pischering as a translator, Kazi Dama added, “In my country we have our own word for the field. We call it ha. Ha is what animates all living things, ha is in the movements of the wind, the changes in the weather. Ha is the essence of life. It is what connects us to everyone and everything else. We celebrate it every time we laugh: Ha ha ha!” This statement seemed to trigger some genuine feelings of wellbeing in Kazi Dama, for he was seized by a fit of mirth that continued for some time: “Ha ha ha ha! Ha ha ha ha ha ha!”

Seeing that Dave and I were thoroughly baffled, Pischering added, “The important thing that Khazan Doshi learned from the pigs is how to be, how to simply be. You see, people are too smart for their own good. Khazan Doshi learned from the real world of animals how to simply be, how to live, to inhabit the body and enjoy existence. He learned how to cut through the crap and experience our drives, our needs, our lives in a healthy way. The tradition that he founded is called Iron Pork.”

Kazi Dama calmed down and cleared his throat, a comical, self-importance cough. He ceremoniously applied some lip balm and turned very serious. “Now I give you first lesson in Iron Pork,” he said. “Master these things and you will find contentment.”

I thought Kazi Dama would launch into a speech, but instead he pulled out two large business cards and handed one to me and one to Dave. I looked at mine, and was struck at what an odd thing it was. It was clearly handmade, cut out of a thick rice paper, with squiggly black ink markings that, I finally realized, were not Champogrlan but English. This is what the business card said:

IRON PORK LESSON ONE: THE FIVE APPETITES

TO UNDERSTAND YOURSELF, TO LIVE A HAPPY LIFE, KNOW THE FIVE APPETITES:

1. THE APPETITE FOR LIFE
2. THE APPETITE FOR LOVE
3. THE APPETITE FOR FOOD
4. THE APPETITE FOR POWER
5. THE APPETITE FOR SEX

THE KEYS TO THE HEALTHY FULFILLMENT OF THE FIVE APPETITES ARE ENJOYMENT AND APPRECIATION.

Love Is The Answer

2005-06-13T14:02:00.000-07:00

Love is the answer.
But what is the question?
The question is, "What is the meaning of life?"
Seems to me the meaning of life is whatever meaning you give it.
So why not give love?
Or consider yourself lucky if you get it?

Do You Believe in Qi?

2005-06-01T16:22:00.000-07:00

We acupuncturists are in a pickle. On the one hand, we want so much to be accepted by the modern world, by science, by the medical community, and by the insurance companies that reimburse us. So we gather respectable-sounding research that validates the things we do, we learn orthopedic testing and ICD-9 codes, some of us even wear white lab coats. On the other hand, we cannot escape the fact that the foundation of our medicine is an invisible “energy” – qi – that is not only not scientifically demonstrated to exist; we ourselves squabble about what it is and what it isn’t. Do you believe in qi? This is a very important philosophical and epistemological question, one that every single one of us acupuncturists would do well to ponder.

There are those who argue that there’s no problem to begin with, that qi is simply air and jingluo the blood vessels; that the ancient Chinese were scientists first and foremost, that there is no need to debate this since, clearly, the ancient Chinese view of health and illness fits very closely to that of modern science. I call this the “It’s Just Air, Nerves, Muscles, and Blood, Stupid” school of thought, perhaps best exemplified by Donald E. (“Deke”) Kendall. I don’t doubt that Mr. Kendall is an excellent teacher and practitioner, and I think that his Dao of Chinese Medicine is a beautiful book. And I think it’s great to have research that shows how acupuncture affects the afferent and efferent nerve pathways, or whatever. But I also think it’s the height of arrogance for Kendall to proclaim that he has finally figured out what those ancient Chinese were really talking about. “Mysteries of Chinese Medicine Finally Revealed!” boasts the order form for his book. Does he really think that everyone including the Chinese had it wrong all this time, and that he has singlehandedly set the record straight? Or does he have an agenda that is distorting his critical faculties? I believe that the answer is “Yes,” on all counts. Mr. Kendall is so invested in integrating East Asian medicine with Western medicine that he has convinced himself that the concepts behind acupuncture, when viewed through the cipher that he provides, are basically identical to concepts from Western physiology.

I believe that words such as qi, xue, jing, shen, zangfu and jingluo have been problematical from the translator’s point of view precisely because they are embedded in a cultural and medical worldview that is intrinsically different - extremely different - from the Western scientific worldview. The problem is not that Soulie de Morant willy-nilly decided to call qi “energy;” the problem is that qi is a term that has no exact Western equivalent, a term that in the context of acupuncture could justifiably be thought of as a kind of energy. Does it help you in your practice to think of qi as the same thing as the air you breathe or the oxygen that is diffused in your blood? I don’t think so; you probably have an understanding of qi, learned from your teachers, your textbooks, and your clinical experience, as an invisible stuff/non-stuff that animates your being, flows through channels in the body, and can be affected with thin metal needles. The main advantage of the Kendall model is that it allows us to sidestep any discussion of the essential differences between Western and East Asian medicine when communicating with people who are not familiar with what we do. This is fine as far as it goes, if your main goal is impressing the chief orthopedist you're having lunch with, or an insurance company representative. My problem with Deke Kendall is not that I disagree with him; my problem with him is that I believe he is misrepresenting East Asian medicine.

But the opposite of redefining our medicine in Western terms – accepting wholesale the concepts of East Asian medicine as literal truth – is also unappealing to me. I don’t believe that I have three hun spirits living in my liver and seven po souls inhabiting my lungs. I don’t think that the categorization of anything and everything into a five phase scheme is necessarily meaningful or productive. And I don’t believe in qi. Or maybe I should say, I don’t believe that qi is any one kind of substance or force or energy or anything like that. Rather, it seems to me that the word “qi” is a descriptor of reality, so that whenever there is a sense of movement or animation, the ancient Chinese evoked qi in their word for it. So whether we are talking about the weather, physical forces, emotions, or bodily or mental functions, “qi” is a handy way to refer to that sense of movement. The Japanese language inherited many of these qi words and phrases from Chinese, and to this day we talk about tenki (“heaven’s qi,” or weather), denki (“electric qi” or electricity), tanki (“short qi” or short temper), and kichigai (“changed qi” or craziness). It’s almost like the English word ending “-ation,” as in “condensation” or “manifestation,” indicating that some sort of process is going on. If some Chinese guy announced publicly his discovery that “-ation” actually means “air,” you’d think he was an imbecile. To argue whether or not “-ation” actually exists is just as meaningless.

One of the things that makes acupuncture so great is that it is based so solidly on empirical observation, on real-time sense data in practitioner and patient, on noticing even minute changes in felt bodily sensations and movement – that is to say, changes in qi. When you feel your patient’s pulse turn from jagged to smooth, that is feeling qi. When you feel a pulsing electrical tingle between your fingers as you hold a needle against your patient’s skin, that is feeling qi. When your patient feels an opening and softening in the chest when you needle a point on the wrist, that is feeling qi. Who cares what qi “really is?” That’s not even the most important question. If we ask instead why it’s so important for us to pin it down, to define it and isolate it, we come to the root of what is wrong with the Western paradigm.

Do you believe in qi? I suspect that most of us do because we are vital beings who cannot help but notice the vitality that flows around and through us. The ancient Chinese noticed this too, and kept meticulous records about the changes wrought via their interactions with this vitality. The five phases, the pairing of yin and yang channels, the order of the transport points, the midnight/noon method, the husband/wife relationship, the “direction” of different zangfu organs, the “qi clock,” the Nei Jing, the Nan Jing – these are all codified records of their observations and experiments. Let’s not pretend that our medicine is something that it isn’t. Let’s instead honor what it actually is, and practice it as well as we can.

Celebrate the Red!

2005-05-31T08:05:00.000-07:00

You’re hot, baby. Feel it. The sun in the center of your chest, radiating life and love out to the farthest reaches of the Solar System of You. And beyond! How far out is your love? How awesome is your life's radiance? Open the door and step into the blasting sunlight. Don’t worry about UV – it’s not like you do this every day. Get a little burnt. You can handle it. You don’t spend enough time outdoors. It’s kind of harsh out there. If you’re like most people, you prefer TV. Or shopping. So get real! Burn some wood, get the grill going. Sweat. Drink some beer. When the wood has burned down to coals, throw some steaks on there. Ribeyes, or tri-tips. Maybe a skirt steak. Smell that searing flesh. Mmmm. Salt, pepper, you don’t need much more than that. Don’t overcook it. In fact, take the meat off the grill pretty quick. Cut it open, see the pink, see the red juice sweating out, stick a piece in your mouth. Oh God that’s good. IF GOD DIDN”T WANT US TO EAT ANIMALS, WHY DID HE MAKE THEM TASTE SO GOOD? There’s a deep truth to that bumper sticker. The sun that was trapped in that cow just fused with your internal sun. And your sun shines on, and on, sending its red goodness to every little cell. Just can’t wrap your brain around the fact it’s gonna stop one day. But not just yet. You take another bite. Mmmm. Celebrate the red.

The Fire Sermon

2005-05-27T07:50:00.000-07:00

A couple of months after I started acupuncture school, Pischering made his first appearance at SCCCM. It was evening, and Pischering had come to pick up Kazi Dama at the end of a clinical teaching shift. I believe they were planning on going out for a steak dinner at the Hindquarter. That same evening, there was a class going on in one of the larger classrooms. It was called Exploring the Five Elements, and it was being offered to students and to interested members of the general public. Chinese medicine utilizes this idea of the five elements, or five phases – Wood, Fire, Earth, Metal, and Water – quite extensively, and it is a model that is applicable not only to medicine and human physiology, but to all aspects of life. The class was being offered as a five-seminar series, with each seminar exploring one element from a variety of viewpoints. The organizer and facilitator was Dr. Finkelstein, a popular teacher of a style of acupuncture that was based almost completely on the five elements.

Quite by chance, the last speaker of the evening, someone promoting firewalking for personal growth, canceled at the last minute. Dr. Finkelstein intercepted Kazi Dama just as he was leaving the building, and asked him to fill in for the firewalker. “All you have to do is talk about fire for an hour!” he pleaded.

Kazi Dama patted Dr. Finkelstein reassuringly on the back. “I can do much better than that,” he said. “I will have my friend Pischering speak. He is a much better teacher than me. Look! Here he comes now!”

And that was how Pischering got roped into talking to a class full of acupuncture students and a handful of Surf City residents. After hearing that Pischering had spent part of his life as a healer in Africa, I was glad to have this opportunity to hear him speak to this group of future doctors. Maybe he would say something about being a doctor. I sat in on the class.

“Good evening,” Pischering began. “My name is J. Pischering. I am a good friend of Kazi Dama’s” – he bowed briefly in his friend’s direction – “and I understand I am to talk about fire this evening!” He paused for a moment, closing his eyes and gathering his thoughts.

Pischering opened his eyes and began his lecture. “If you think about it, numerology is the basis of all systems of thought,” he said. “Why do we have a seven-day week? A twenty-four hour day? A sixty-minute hour? Twelve inches to a foot? These measures are artifacts of the numerological thinking of our ancestors. Most systems of thought start with a numerology of Two: Nothing and Something. Space and Time. Matter and Energy. The Yin and Yang of Chinese culture. Among my people, the fundamental duality was expressed as Earth and Sky. I believe that the Chinese have something very similar – Heaven and Earth. They introduce Man in between, creating a numerology of Three. But the subject of this seminar series, as I understand it, is the numerology of Five.

“Let’s consider the five elements, shall we? Let’s start with another system of five elements, one that is utilized by the Hindus and Buddhists: Earth, Water, Fire, Air, and Ether. What you will notice right away is that this series is a progression – a progression from the most substantial to the most rarified. This tells you that the worldview of the system in which it originated is based on the idea of transcendence, of ascending to ever more subtle realms until one arrives at the ‘quintessence’ , the highest and most subtle element that is beyond this realm. And indeed, this is the agenda of Hinduism and Buddhism and many other religious or spiritual systems.

“And what about the Chinese five elements – Wood, Fire, Earth, Metal, Water? Wood burns to form fire; fire then makes ash which becomes earth; deep in the earth metals form; on the cold metal water condenses; water feeds the tree that makes wood, which feeds the fire, and so on. You immediately see that this is a cycle, not an ascending series like the Hindu/Buddhist five elements. What does this tell you about Chinese thought?”

“That it’s based on cycles?” ventured an enthusiastic first-year student.

“Exactly!” said Pischering. “And that is why your medicine works so well – because it understands interacting cycles, which is what human physiology is all about. Does this mean that the Chinese model is right and the other one is wrong? Of course not! They are simply different models. If the Shaivite yogi visualizes fire in his shoulder blades, and the Taoist alchemist visualizes fire in his heart or under the cauldron of his kidneys, is one of them putting the fire in the wrong place? Of course not! But is fire something that both of them, and every other human being, can relate to? Absolutely.

“I would like to argue tonight that fire is primary in a way that the other elements are not, and that an understanding of fire is very important if we are to come to an understanding of human nature. Why is fire primary? Well, think back to the fundamental dualities. Einstein’s mass and energy. Fire is energy. The fireball of the Big Bang. The Something in the Nothing/Something pair was originally pure energy. Fire. It is tempting, for us as water-based organisms, to think that water is primary. But long before there was water for the first organisms on this planet to evolve in, long before there was earth for the water to collect in, long long before there were plants to grow out of the water and earth, long before there was metal or any other kind of matter, there was energy. There was fire.

“In our neck of the universe, the immediate, obvious emanation of fiery energy is the sun. When we speak of ‘fire’ in the everyday sense, we are talking about the raw energy of the sun, trapped in matter by a plant, then released back out of matter as light and heat via the breaking of chemical bonds. Our metabolic ‘fire’ is one step removed; the solar energy that has been trapped by plants (or by animals who have eaten plants), then released within our bodies by the fire of digestion to fuel our life activities.

“Because our life itself is essentially solar fire expressing itself, it is very important to understand the nature of fire, to understand our own nature. Have you ever been camping, and it turned dark, and cold, and you got the fire going? How good it felt? How you were compelled to keep the fire going, how primal that need was? Imagine if you were the first human being to discover how to make fire! Before that, when it got dark at night it was that much easier for a tiger or lion to pounce on you and eat you for dinner! Imagine how cold it must have been in the winter, even under several layers of animal skin! With the fire, the animals were scared and stayed away. With the fire, you could stay warm. With the fire you had light at night, you could extend the activities of your day. With the fire you could cook! How much better life suddenly must have gotten!

“But there is a downside. All this burning of wood produces smoke, which as we now know contains carbon gases that trap solar radiation and cause global warming. All this burning of wood as the human population grows causes deforestation and desertification, and air pollution. Plants do this amazing thing where, powered by sunlight, they take carbon out of the carbon dioxide in the air, combine it with hydrogen and oxygen from the water in the ground, and make solid matter, make themselves out of these molecular building blocks. As a waste product they make the oxygen that we breathe. Every time we burn wood or any plant product, we release not just the stored solar light and heat; we also release carbon, in the form of greenhouse gases, back into the atmosphere. As we get more and more clever, we find other things to burn – gas, coal, petroleum – and the problems get worse and worse. The funny thing is, we are now so clever that we understand the damage we are doing, but we can’t stop! The reason we can’t stop is that this fiery spirit, this tendency to expand and spread and destroy, is in our very nature. We are fire, and how can fire control itself?

“So this, my friends, is the conundrum of our species. Can we change our nature? Can we transcend? Or is our fire nature part and parcel of what we are and will it continue to ruin our world? This is your homework! Meditate on fire!”

And that was the end of what would come to be known as Pischering’s Fire Sermon. Some people clapped; the environmentalists in the crowd yelled, “Right on!”; quite a few people looked dazed or bummed out. One woman raised her hand and said loudly, “But what about the Nothingness that preceded the Something? You say that fire is primary; well, what about the Void that comes before? Maybe that’s our true nature.”

Pischering was halfway out the door, but he stopped, turned, looked at the woman, nodded admiringly, and said, “Very good! We have a Buddhist in the crowd! This is an excellent philosophical point, and worthy of our consideration. The numerology of One* is very appealing indeed. Good bye!”

A lot more people had questions, but Pischering and Kazi Dama were very hungry and they politely but quickly extricated themselves from the buzz around them so they could go eat their steaks.

*On this confusing point of the equivalence of the Void (zero) with what he calls the “numerology of One,” Pischering later explained to me that in his view, the yearning for the original state that is thought to precede existence is the same “yearning for the One” in all religions – whether they call it God or the Void or whatever.

Grateful

2005-05-23T07:23:00.000-07:00

I immersed myself in my studies with an obsessive zeal, learning all I could about traditional Chinese medicine (“TCM”). I even finagled a part-time job with SCCCM as their continuing education coordinator, so that I could invite famous teachers from all over the country to give seminars for the local acupuncturists and interested students. This meant that in addition to the regular coursework, I arranged and attended courses on specialties such as traumatology, women’s health, pediatrics, qigong (Chinese breathing/exercise techniques), and moxa (a type of heat therapy, using burning mugwort herb over acupuncture points). But I learned the most from Kazi Dama. Because he wasn’t trained in traditional Chinese medicine, yet was an accomplished healer whose methods overlapped with acupuncture and Chinese herbal medicine, he was able to push me to think outside the TCM box. For instance, when he saw me memorizing the locations of acupuncture points by anatomical landmarks and proportionate measurements as I had been taught in class, Kazi Dama would instead have me press my thumb along the grooves between muscle groups, stopping whenever I felt a spot that seemed tight, loose, painful, energetically “sticky,” or otherwise odd. “That’s where the points really are! Find the real points!” he insisted. And he was always making me taste the herbs, not just memorize what they were good for.

But most of all, what I learned from Kazi Dama I learned by example. And the biggest lesson I learned from him was appreciation. Before meals, he would clap his hands together and mumble something in Champogrlan. Once, we were walking down the street and it started to rain. He looked up at the sky with a big smile on his face, and mumbled the same words. I asked him what he was always mumbling, and he looked at me and translated: “Thank you.”

“Thank you?”

“Yes. Thank you,” he repeated. “There is always something to be thankful for.”

And he was right. There was so much to be grateful for. My beautiful, wonderful wife A., who stuck by me through years of my figuring out what I wanted to do – how many people are lucky enough to meet, much less marry, their soulmate? And my amazing daughter S. – writer, musician, spelling bee winner, basketball player, back-scratch lover and soon-to-be teenager – so intelligent and athletic and just such a great kid. And my son L., the brave Red Hawk of our self-created tribe the White Tigers of the West (named after the ancient Chinese constellation; no white supremacy going on here), a boy with so much heart that it spills out and touches everyone around him, an inquisitive and sensual tiger cub who is as comfortable snuggling into bed with a stuffed animal and a good book as he is swordfighting with a stick or inventing things out of Lego.

This feeling of appreciation extended to every detail of my life, to my friends, to Pischering and Kazi Dama, to my teachers of Chinese medicine, to every patient I came into contact with at Scum’s teaching clinic, each of whom let me and my classmates into their private worlds of illness and pain. It was such an honor to be allowed in, to have a look-see via pulse and breath and a lot of questions, then to try to help them with our needles and herbs. And it was so satisfying when they felt better.

Kazi Dama’s and Pischering’s influence on my self-concept as a future healer was driven home to me one afternoon during a lunchtime demonstration at Scum. These brown bag meetings were organized by the student council, and usually consisted of a lecture or demo by a visiting healer of some type or other. On this particular day, the guest was a fifty-something Korean healer who went by the name of Blue Mountain . He was billed as a “Taoist master” (why was everyone calling himself a Taoist master?) whose specialty was the use of two tennis ball sized stone balls that he rolled around on you as a form of massage. He had been invited by my classmate Andy, who had undergone several treatments with Blue Mountain and was impressed with what they had done for his bad back.

Superficially, Blue Mountain was not unlike Kazi Dama. They looked to be of similar age, they were both Asian, they both wore funny clothes, they were both charismatic, and they were both healers who used stones in their work. But their approaches to healing were diametrically opposed. Kazi Dama was sensitive, rational, and did his best to produce no pain in his patients. Blue Mountain’s method was basically to find tight areas on the patient’s body, then crush those areas repeatedly by rolling his stone balls over them. The process was extremely painful, as I would find out.

Blue Mountain’s worldview was quite different from the views of either traditional Chinese medicine or Iron Pork. He did not apply the theories of Chinese medicine to arrive at a sophisticated diagnosis. He just asked people where their discomfort was, then proceed to flatten those areas with his stone balls, ignoring their screams of pain. He believed that all pain was due to ghosts, not qi stagnation or bad circulation or some problem with the acupuncture channels. He believed that it was his calling to exorcise those ghosts – in his approach he was really more of a shaman and an exorcist than a physician.

Blue Mountain needed a volunteer to demonstrate his method, and I raised my hand. He had me sit on a thin futon he had unrolled in the student lounge, and asked me when my birthday was. He scribbled the information down on a notepad and made some quick calculations. He shook his head, saying “Ahh, very bad karma, very very bad.”

I grew a little concerned, wondering what bad omens his Korean astrology had yielded. He showed me his scribbled notes, pointing with a finger at the three lines of my birthdate. I gathered that he wasn’t doing astrology at all, but a simple numerology based on adding up the integers of my birth year, month, and day. His mathematics revealed that the year and day were “male,” but the month was “female.” This meant, Blue Mountain said, that my heart was a woman’s heart. This was an extremely bad configuration, he said, if you happened to be male. Fortunately, Blue Mountain had a fix. He announced that he would fix my karma: “Heaven tell me you very very bad karma. But no problem – Blue Mountain change your karma.” Apparently, Heaven told him all kinds of stuff: that he would attract disciples from all over the world, that he would start a school in the United States, that his stone balls could cure anything from kidney stones to cancer, that he should go to Reno for a weekend gambling trip.

Then, Blue Mountain asked me what my health problems were. I was actually not feeling too bad, but have a slightly arthritic left hip that sometimes bothers me, and my right shoulder had been hurting lately, so I pointed those areas out to him. He had me lie face down with my left knee bent out to the side, then proceded to roll the balls on my butt and hip. It was painful, but bearable if I breathed with it. Then, he had me roll over and he immediately began rolling the balls on the right side of my chest, on the pectoral muscles near the sternum. It was excruciating – it felt like he had plunged a dagger into my chest and was twisting it around in there. I screamed, but he didn’t let up. With difficulty, I overcame the urge to flip him over and knock him senseless or choke him. Finally, after several long minutes, he stopped. He had me get up and move around. “Better?” he asked.

Not wanting him to torture me anymore, I immediately nodded my head and said, “Better.” No wonder he thought he cured everyone he ever worked on! Blue Mountain positioned himself opposite me, sitting with knees crossed and hands together as if praying. His eyes were closed, and I wondered if Heaven was talking to him. He opened his eyes and announced, “Now Blue Mountain change your karma.” Then he started making a strange sound. It sounded like a big fly buzzing. Then he chanted another, higher-pitched sound, and announced that my bad karma had changed. I thanked him and took a seat in the audience, and he went on to treat several other people.

Blue Mountain was quite a hit with my schoolmates. He had the look: baggy Asian clothes, grey hair in a topknot, grey wispy beard. And he was a Taoist master! I think that acupuncture students are just naturally drawn to Taoist masters, especially if they do some kind of astrology. But I was not impressed. It seemed to me that he had something of a New Age scam going on, that capitalized on people’s insecurities and their wishes for health and wholeness. By first diagnosing your bad karma he brought out the insecurity, then he held out his treatment as a way to fix your aches and pains and the bad karma too – what a deal! And it seemed that many people felt they had to suffer to achieve health, or good karma, or whatever. I sure wasn’t one of those people! I much preferred Kazi Dama’s style of healing, which emphasized treating disease with minimal intervention, with subtle energetic interactions out at the periphery of the patient’s being – with gentle contact at the skin, usually on the limbs and usually away from the site of pain.

My experience with Blue Mountain made me realize that my training with Kazi Dama and with Pischering had molded my perceptions about life, about people, and about what it means to work as a healer. Blue Mountain was an extreme example, but he illustrated the psychology behind much alternative medicine: many people who are suffering are willing to suspend their disbelief it they are presented with a possible solution to their pain. Often, the more colorful and unbelievable the solution, the more appealing it is. I don’t doubt that Blue Mountain helped people; perhaps, sometimes getting your muscles crushed is just what you need, and maybe sometimes it’s good to face your pain. And shamanic healing is certainly valid; the expulsion of ghosts has been standard medical practice for many thousands of years, all over the world. But my encounter with Blue Mountain brought home the fact that my training with Pischering and Kazi Dama was shaping my overall attitude towards life, which was that compassion and appreciation and balance and clarity were the important things.
I couldn’t understand how Blue Mountain could claim to be a healer – an alleviator of suffering – if he caused so much pain to people all day long . I went home grateful that day, grateful to Blue Mountain for showing me what I am not, grateful to Kazi Dama and Pischering for helping me define what I am, grateful for the sun that shone on my back as I rode my bicycle home. My body flooded with endorphins, I went home to my family that day feeling grateful, just extremely grateful.

On Tea

2005-05-20T05:20:00.000-07:00

It is said that when Bodhidharma, the first patriarch of Zen Buddhism, arrived in China from India in the fifth century, he sat down facing a wall and meditated for nine years. During that time, he fell asleep once. When he woke up he was so angry with himself for this lapse in concentration that he tore out his eyelids and threw them to the ground. Where they landed, so the legend goes, the first tea plants grew. Ever since that time, monks have been using tea to keep their minds clear during meditation.

This story is interesting in its depiction of tea as a stimulant herb, but it is known that the origins of tea use go much farther back than the time of Bodhidharma. In fact, tea is one of those drug plants that humans have probably been foraging in the wild, then cultivating on their own, for many thousands of years. And why not? Tea tastes good, refreshes the mind, and is an important medicine in its own right.

Scientists now know that tea contains potent antioxidant chemicals known as polyphenols. A University of Kansas study shows that EGCG, one of the strongest known polyphenols, is about a hundred times more effective than vitamin C in its power to protect against the ravages of the body’s cell-damaging free radicals. The presence of EGCG and other compounds makes tea (especially green tea) an important weapon in the fight against cancer. In fact, Japanese research shows that people who drink four to six cups of green tea every day have a much lower incidence of liver, lung, breast, esophageal, pancreatic, and skin cancers, compared to people who don’t drink tea at all, or drink less. Other research shows that tea lowers the risk of stroke and heart attacks, lowers blood sugar levels, fights viral infections, and helps control allergies.

Because tea has received much publicity for its health benefits, you can buy it in the form of concentrated and caffeine-free pills and capsules. These products are fine for people who truly dislike the taste of tea or wish to avoid caffeine. But, I would ask those who place themselves in either of these categories, have you ever tried a cup of really good tea? Tea is made from the leaves of a flowering plant, Camellia sinensis. Since the best leaves are picked in the springtime before the budding of flowers, the floral essence of the bloom-to-be is captured in the leaves and stems, giving some teas a delightfully sweet, floral scent. Other teas, especially those green teas that have been steamed before drying to prevent the oxidation that would otherwise produce an oolong or a black tea, have a fresh vegetal quality to them that reminds one of an ocean breeze or cut grass in the summertime. My point is that tea drinking is as complex and enjoyable a sensory experience as is wine tasting, and if you think you don’t like tea, it just may be that you’ve never had a decent cup. So give tea a chance and treat yourself to the good stuff! Get high-quality leaf tea (avoid the finely chopped and oxidized tea that comes in tea bags) at specialty stores, or buy online at http://greentealovers.com/ or http://www.imperialtea.com/.

As for caffeine, tea is an altogether different beast than coffee. Or, perhaps more accurately, if coffee is a beast then tea is more like a wise friend. It is the great fallacy of modern pharmacy that the effects of a natural substance can be reduced to a single active ingredient. Unfortunately, this type of thinking has led some to believe that tea, because of its caffeine content, is an unhealthy stimulant. The reality is quite different. Coffee contains about five times more caffeine, cup for cup, than green tea, and its many volatile oils, acids, and other components make for a much rougher ride through our metabolism. Green tea does contain some caffeine, but it exists in an organic matrix of healthy substances, including chlorophyll, vitamin C, and the antioxidant polyphenols. In any case, the overall mental effect of tea is quite different from that of coffee, more the heightened awareness of a samurai warrior than the mile-a-minute mental chatter of the coffee addict.

But all this talk about health benefits, antioxidants and caffeine is almost beside the point. The true value of tea, in my opinion, is that its proper preparation and ingestion require us to pause for a few moments in our mad scramble through life. This is how you do it: you let the dry leaves fall into a favorite ceramic teapot, cover them with hot but not boiling water, put the lid on, and wait. After a couple of minutes you pour the tea, and let its sweet fragrance waft up and enter into you. The fertile earth, the monsoon rains, the blazing sun have conspired to place in your hands a bowl of jade-colored dew. You drink it with gratitude, then go about your day.

Celebrate the Green!

2005-05-19T08:11:00.000-07:00

Set aside a whole day. Pack a sandwich, some drinking water, a large paper bag, a pair of garden shears or scissors, and gloves. Head for the nearest woods. Find a stream. Follow the water until you come across a stand of nettles. They're usually a couple feet tall, with square spiky stems and beautiful dark green leaves with serrated edges and hairy silvery-colored undersides. If you're unsure about identification, rub your hand across some leaves. If they sting, you've found the right plant!

Take your shoes and socks off and play in the stream. Eat your sandwich. Take a nap, if you feel like it. Approach the nettles and ask if you can harvest some leaves. They usually say "Yes." (It helps if you don't automatically take the stinging to mean "No.") Put on your gloves, get out your shears, and start clipping healthy leaves into your paper bag. Gather a lot, but just a few from each individual plant. Stop just as you're starting to feel greedy.

When you get home, wash the leaves in a colander. Dry them in a salad spinner or by swinging them hard in a cotton bag. Cut individual leaves off of stems. Make a batter by mixing a cup of flour with an egg and a cup of iced water. Don't mix too hard - lumpy is good. If you're feeling adventurous you can substitute chilled carbonated water for the water. Heat a pan with at least an inch of cooking oil, or use a deep-fryer if you have one. Coat one side of each nettle leaf with a thin layer of batter, and throw these into the hot oil. Fry until the batter is crispy but not burnt. The uncoated side of the leaves should turn a brilliant translucent emerald green. Dip the leaves in tempura sauce or any sauce that you like. A bowl of rice, some kimchi or sauerkraut, and a cup of miso soup rounds the meal out nicely.

If you don't care for tempura (or next time you do this), make a delicious cream of nettle soup: in a pot, saute a chopped onion in melted butter until it is golden brown. Set aside a couple of baby nettle leaf-pairs. In a blender, blend up the rest of your fresh nettle leaves with some water, a boiled potato, and the sauted onions. Pour back into the pot, and add chicken broth until you have the amount of soup you want. Heat until it's boiling, then reduce to a simmer. Let it simmer for half an hour, stirring occasionally and flavoring with salt and pepper, to your liking. Add a dollop of sour cream or whipping cream, garnish with the baby leaves, and serve with crusty fresh bread and a glass of wine. Enjoy!

The Problem with Oriental Medicine

2005-05-18T16:49:00.000-07:00

As a practitioner of acupuncture and Chinese herbal medicine, I cringe a little every time I see the phrase “Oriental medicine.” It shows up everywhere in my profession: in the names of professional organizations and journals, colleges and clinics, on business cards and websites. I don’t care enough about it to air my grievance in letters to editors or diatribes against my colleagues, but this is my blog so I’ll feel free to vent here.

What is wrong with “Oriental medicine?” For starters, “oriental” is a terribly outdated word with colonialist overtones. Something or someone is “oriental” – literally “of the East” (from the Latin oriens, “rising sun”) only from the vantage point of the Occident, i.e., the countries of Europe and the Western Hemisphere. The term developed to distinguish between the powerful “civilized West” and the “mysterious East” that was to be conquered and exploited over hundreds of years of warfare and subjugation. For us to call what we do “Oriental medicine” is about as anachronistic as African-Americans referring to themselves as negroes. Look up the word “oriental” in the dictionary. My American Heritage College Dictionary lists this among the definitions:

"Oriental. Offensive. Used as a disparaging term for an Asian person."

Part of the problem with the word “Oriental” is the implications of strangeness, exoticism, inferiority, and weakness that lie embedded in the term. I suspect that some acupuncturists secretly relish the former associations (“I am a qigong master and an initiate into Oriental mysteries, and I can cure you”), but I submit that none of us would like to be associated with weakness and inferiority, especially in implied contrast with Western – or should I say “Occidental?” – medicine. For a detailed analysis of the Western conceptualization of the “Oriental” as Other, I refer the interested reader to Edward Said’s landmark book titled (aptly) Orientalism.

I have heard arguments in support of “Oriental medicine,” based on the notion of inclusiveness. Following this reasoning, calling our profession “traditional Chinese medicine” or some such would alienate the Japanese, Koreans, Vietnamese, and other non-Chinese practitioners. This may be true, but on top of the derogatory connotations of the word "oriental," the term is in fact overly inclusive: we don't typically mean to include the traditional medicines of the Middle East and India, for instance, when we say "Oriental medicine" - yet, clearly, they are Oriental regions as defined historically and etymologically. I think we should reject “traditional Chinese medicine” for an entirely other reason: because it (the “TCM” of post-Mao China) is a clearly defined style of medicine that not everybody in our profession practices. So what should we call the set of therapies that we collectively practice? Why not simply “East Asian medicine?” One non-Asian practitioner I have come across objects to the term “Asian medicine” because he thinks it discriminates against white acupuncturists (!) But I think that “East Asian medicine” is a purely descriptive term denoting the geographical origin of our art and science in the eastern part of Asia. In fact, under the entry for the word “Asian,” my dictionary states:

"Usage Note: The term Asian is now preferred for persons of South and East Asian ancestry, such as Indians, Southeast Asians, Chinese, Koreans, and Japanese, in place of Oriental, an older term for some of these groups. Oriental has been objected to because it suggests racial rather than cultural identity and identifies the place of origin in terms of its location relative to the West (that is, “from the East”), rather than in absolute terms."

Extending this logic beyond the people in an area to a form of medicine that originated and was developed in various countries within that area, I find “East Asian medicine” to be an accurate, objective, and inclusive term. Why it might be perceived as offensive, or exclusionary, or inferior in any way to “Oriental medicine,” I cannot figure out. “Oriental” is a word best reserved for rugs, if that. Let’s drop it and join the 21st century.

Martial Arts and the Value of Ritualized Violence

2005-05-18T15:02:00.000-07:00

The appetite for power is rooted in our capacity for violence. In ancient times, before laws or civilization, our power rested in our ability to fight and kill. Of course, in the modern world, most of us exercise our power in non-violent ways. However, our bodies respond to the stress of perceived attacks (and to stress generally) the same way they did a million years ago: by pumping adrenaline and cortisol into our blood, shutting down our digestion, increasing our heartrate, sending blood to our large muscles so we can fight or flee. In ancient days, running away from that mountain lion or fighting that aggressive neighbor provided the perfect outlet for this kind of stress response, and our bodies quickly regained equilibrium (or died). These days, we accumulate stresses but often don’t have an appropriate outlet for them. So we store the stress in our bodies - in tight neck/shoulders/jaw, or ulcers - or release it as inappropriate aggression towards others.

Martial arts, because they place us in situations of ritualized violence, allow us to exercise our power in a healthy way. Through martial arts training, we gain mastery over our bodies, our minds, and our potential attackers. We take the aggression that is an innate part of our genetic make-up, and rather than deny that it exists or vent it where it’s not welcome, we exercise it.

If you are considering taking up martial arts, shop around. There is a wide variety of styles, from the more grappling-oriented judo, to the kicks and punches of karate or taekwondo, to the music and rhythm of Brazilian capoeira, to the meditative grace of taijiquan. Keep in mind your needs and preferences: do you want a competitive sport, bare-bones self defense, or a form of meditative self-cultivation? Also keep in mind the fact that many martial arts styles are in essence gangs and corporations, with strictly codified rules of behavior, longstanding animosities or alliances with other styles, and the expectation of loyalty and allegiance to the leader. Do your homework first so that you know what you are getting yourself into! The most important thing is to pick a school and instructor that feels right for you.

The Heart Sutra

2005-05-18T09:41:00.000-07:00

When I was a child growing up in Japan, I would often help my mother in the kitchen, drying the dishes as she washed them. Occasionally, my concentration would lapse and I would drop a dish and break it. I always felt bad about breaking dishes, but my mother never berated or punished me. Instead, she quoted a line from the Heart Sutra: “All that is form is emptiness; all that is emptiness is form.” I didn’t quite understand what she was talking about, but I was glad to escape punishment.

Many years later, as I prepared to take the acupuncture licensing exam in California, my mother embarked on a 1,400 kilometer walking pilgrimage on the Japanese island of Shikoku. At each of the eighty-eight temples on this most famous of Japan’s Buddhist pilgrimages, she prayed for (among other things) my success on this exam and in my chosen profession. I think it was at around this point in her life that my mother started to take a great interest in the Heart Sutra. She chanted it daily on her pilgrimage, and wrote it down in black Chinese ink for shakyo – the religious practice of copying sacred texts. She sent me several versions of these handwritten sutras, including one with furigana (phonetic Japanese transliterations of each Chinese character), and even one with romaji (English transliteration) just in case my Japanese had deteriorated to the point that I couldn’t read the furigana. It was obvious she wanted me to chant the Heart Sutra.

I wasn’t raised in a religious household, and, being an atheist since childhood, I rejected most religion. But I reserved a special place in my heart for Buddhism and the native Japanese religion Shinto, perhaps because they had always been for me religions of place rather than of belief, religions that I inherited by virtue of ethnicity and which I always associated with local temples and shrines and seasonal celebrations like New Year’s Day. And, as I got older and read more about Buddhism, I was impressed with what seemed more like a razor-sharp assessment of the human condition than a religion per se. This “religion” that prescribed meditation for its practitioners so that they could see more clearly into their self-nature seemed so different from most religions. But I held a negative bias towards those sects of Buddhism whose central practice was chanting. Observing my grandmother and other relatives chanting, it seemed to me they were essentially praying – for the souls of the dead, for my cousin’s acceptance into the college of her choice, etc. For an atheist like me, prayer – even Buddhist prayer – didn’t make any sense. Also, there was in Japan at that time a strong association between chanting and certain sects of Buddhism that were rather militant and political, which I found distasteful. So, as you can imagine, I was reluctant to chant. But I love my mother and want to make her happy, so I thought heck, it wouldn’t hurt to read the sutra out loud. It would be my way of thanking her (I passed my acupuncture exam).

I unfolded one of her hand-written copies, and started reading in a loud voice:
“MA KA HAN NYA HA RA MITTA SHIN GYO”

I was surprised. Just reading the title out loud, I felt each syllable resonate in my skull, my chest, my throat. I chanted slowly, and felt the sounds massage my insides. It was actually quite pleasant. I read through the entire text, and then did it again. Much to my embarrassment, I became a semi-regular chanter. In the act of chanting, my intellect would disengage, I would lose the educated human being persona that I usually identify with, and I would feel happy – happy and alive as I imagine a singing bird must feel on a sunny morning. I have come to believe that chanting is a skillful means, a way to use speech – almost always used in the service of the ego – to temporarily bypass the ego and experience one’s existence as part of the vast unfolding moment rather than as the isolated self that we usually take so seriously.

I no longer think of the chanting-centered Buddhist groups as deluded or necessarily unsavory (although I’m still against aggressive proselytizing by anyone, religious or otherwise). I have come to see that chanting has been for centuries the mechanism by which the Dharma has been transmitted from one generation to the next, in all sects of Buddhism. It is no wonder that its value as a practice in and of itself was recognized early on and embraced by large numbers of people. I am convinced that human beings, regardless of their religious beliefs or lack of them, are designed by evolution to have religious experiences. Chanting is one way of eliciting such experiences, which are almost always perceived as positive. I believe that my original disdain for chanting is shared by many non-Asian Buddhists, who have placed a much greater emphasis on meditation than on chanting and other traditional Buddhist practices. This attitude, which may stem historically from a perception that the meditation practices of the Buddhist “pros” (monks/nuns) were superior to the devotional practices of the laity, is in my opinion a big mistake. If a practice brings you to a place of non-duality, it shouldn’t matter so much how it got you there.

I sometimes chant in my clinic, while driving, when alone outdoors. Most of all, I enjoy chanting on mountains. There’s something special about walking the ridge of a mountain range, your voice chanting syllables in cadence with your steps. Chanting in the beauty of nature, I feel a connection to the gyoja mountain ascetics of old Japan, and even further back to the yogis and shamans who’ve been singing and chanting in the wild ever since human beings figured out they could string sounds together for dramatic, magical, and practical effect.

One evening a couple of summers ago, I read the Heart Sutra while backpacking in Big Sur. As the sun went down and Venus got brighter and brighter and the sky turned shades of red, orange, and purple, I developed a new appreciation for these wise and ancient words. The central phrase of the sutra, “SHIKI SOKU ZE KU, KU SOKU ZE SHIKI” is usually translated as something like, “Form is emptiness; emptiness is form.” But the character for “form,” SHIKI, also means “color.” And the character for “emptiness,” KU, also means “sky.” Standing there under the brilliant and ever-changing sky, I got a sense of the ancient Buddhists as astronomers and naturalists, contemplating our ephemeral existence on this earth ball. Colors in the sky: that’s what this – us, life, existence – is.

The Heart Sutra functions as a summary of a much larger body of literature: the Prajnaparamita or “Perfection of Wisdom” texts of Mahayana Buddhism. As a summary, it essentially consists of lists of various sorts, all designed to show that when the things on the list are logically broken down (e.g., the five skandhas or “aggregates” that describe human experience – material form, feeling, perception, impulse, and consciousness), there is only emptiness – no Self is hidden in there somewhere. This radical notion, so contrary to our self-important nature, is the “heart” of Buddhist teaching. I believe that it is also what sets Buddhism apart from the other world religions, in that it does not ask us to add anything (God, Heaven, etc.) to what we see, hear, experience; it invites us instead to strip away what we take for granted, and see what is left.

Yet, the emptiness of Buddhism is not nihilistic or purely intellectual and philosophical. Buddhism is rooted in a tradition of practices that are designed to bring the practitioner beyond the non-existent self to a religious experience, a transcendent non-duality, the realm “beyond the beyond.” In the words of Buddhist scholar and historian Edward Conze, the Prajnaparamita is “nothing but the Absolute, over and over again.” Because of the luminous clarity and power of the unconditioned world that it describes, or perhaps because it mimicked for early converts the magical chants of the religions they were already familiar with, the Heart Sutra has been considered from the earliest times to be a magical text, a spell or dharani that protects against all manner of bad luck and encourages the chanter’s (and audience’s) entry into the Buddha-realms. The fact that it is simultaneously rational, religious, and magical attests to the Buddhist understanding of human nature, which is surely a combination of all these elements.

The Heart Sutra is structured as a kind of sermon by the bodhisattva Avalokitesvara, who at the beginning of the text sits in deep meditation and has the insight that emptiness is the true nature of our existence. The bulk of the sutra is an explanation of this insight to the disciple Sariputra. Towards the end, Avalokitesvara reveals that the way to the Perfection of Wisdom is to chant. And he gives us a mantra, meticulously preserved in a close approximation of the Sanskrit in which it was originally chanted some two thousand years ago. Millions of Buddhists around the world take Avalokitesvara’s teaching to heart, and they chant. Whether they are highly educated Buddhist priests or regular folks with little knowledge of the Buddha’s teachings, they chant the Heart Sutra as an expression and embodiment of the Dharma. Whether you chant with faith, with understanding, with curiosity or with skepticism, the Heart Sutra will have you thrumming along as part of a vast chord of humanity, one node in a vibrant wisdom-tradition that endures and spreads by voice, by breath, and ringing bone.

The word sutra means literally, “thread” (interestingly, the early Chinese translators rendered it as "jing," the same word that is used in medicine to mean "channel" or "meridian," the threads that run through our bodies). As you chant with singlemindedness, you are absorbed by the sounds emanating from you, and eventually there is no more subject or object, no chanter or chant, just the universe expressing itself as sound. Freed of the illusion that there is a “you” running the show, you sit as the paradox that is simultaneously form and emptiness. From this timeless place of simple existence, you hear the words reminding you that this is just how it is, and you appreciate the sutra, an ongoing pulse in a pulsing universe, a living thread that connects you to the past, holds you in the present, and guides you into the future.

The Order of the Green-Lipped Monkey

2005-05-15T12:47:00.000-07:00

I drove to the Surf City College of Chinese Medicine and parked in the lot kiddy-corner to the school, across the street from the beach. What a great location for a school – I could go for dips in the ocean in between classes! I was a little bit anxious, since I hadn’t been in school for years and didn’t really know what to expect. It was true, I had signed up almost on a whim, in response to Kazi Dama’s invitation, but the fact was that I was ready for a change in my life. I had been working as a university administrator for about five years, and although I felt capable and appreciated in that capacity, a part of me was dissatisfied with my job. I wanted to help people in an immediate, one-on-one way. Having seen Kazi Dama perform his miracle on Dave’s sprained ankle, and intrigued by what little I knew about the Iron Pork tradition, I decided that I would explore the healer’s path as a possible new career.

Also, at about this time, Dave had started hanging out with Pischering more and more, just the two of them. This was a new pattern, as we had until then always spent time with him together, the three of us. I have to admit that I was a little jealous. But overall I was secretly relieved. Dave had for the past year or so been suffering through the aftershocks of a particularly messy breakup, and I had been his chief counselor and emotional support. Naturally, when Pischering started talking about Rohini and how devastating the end of that relationship was, Dave’s ears perked up and he shifted his attention from me to Pischering, who appeared to know far better than I how to balance the appetites and regain sanity. This left me with more free time than I was used to, and the recognition that I wanted to spend some of that time learning about health and healing.

I walked into the school building and asked some students where the “Bamboo Room” was. According to my schedule, that was where my first class, Fundamentals of Traditional Chinese Medicine, would meet. The semester had started a couple of weeks earlier, and I was acutely aware of how much I had missed. The teacher, a friendly Chinese doctor named Geoffrey Wong, was lecturing about the different kinds of qi, or vital energy, about how it was produced, how it flowed through the body in channels, and so on. It was fascinating, but it might as well have been taught in a foreign language. As a matter of fact, I was convinced at times that he was speaking in a foreign language, between Dr. Wong’s heavy accent and the many Chinese medical terms he was using. Nevertheless, I enjoyed his class and looked forward to buying the textbook and catching up with my classmates.

The next class, Acupuncture 101, was less satisfying. The teacher, an older American woman with white hair and a no-nonsense manner, launched immediately into a review of the Lung and Large Intestine acupuncture channels. I was greatly discouraged because I had missed the previous two classes, and thought I would never catch up. She taught the location of the acupuncture points with a cartographer’s precision, and I doubted whether I would ever be able to locate the points accurately enough to pass her exams.

Finally, at the end of the day, it was time for Kazi Dama’s class. Because he was not trained in traditional Chinese medicine, and was not a licensed acupuncturist, the school officially called him a “visiting practitioner” and allowed him to teach clinical classes, provided he didn’t pierce patients’ skin. As I would soon find out, the skin-piercing provision did not present a problem.

The first patient that day suffered from excruciating menstrual cramps, and was actually in the throes of cramps at the time of her visit. She lay curled up in pain on the massage table. Kazi Dama approached the woman with calm compassion, asked her a few questions, then gently touched her temples with great reverence. He stayed in this position for a few minutes, then walked slowly around the table, seeming to be feeling for something with his fingertips in the air around the patient and at the surface of her skin. Once he had worked his way down to the foot of the table, he appeared to find what he was looking for, and touched a point on the patient’s ankle with his index finger. “Liver 4,” some of the students whispered to each other. “Feel better now?” Kazi Dama asked. The woman nodded, then fell into a deep sleep. One of the students, who had his fingers on the patient’s pulse, gasped. “Her pulse just calmed right down!” he exclaimed. Kazi Dama smiled. Then, he pulled one of his stones out of his pocket and applied it to the point on the woman’s ankle, and held the tip of a fat gold needle at several points on her belly, using his other hand. Then he herded us out of the treatment room, saying, “Now we let her rest.”

Once we were back in the herb pharmacy, where Kazi Dama gave the students free rein in the creation of an appropriate herb formula for the patient, the students pummeled him with questions. “How did you pick Liver 4?” “Why didn’t you check her pulse?” “What were you doing when you held her head?”

Kazi Dama laughed, and said, “You want to make things more complicated than they are! Always, what I do is the same: feel the Pischering Field, feel the ha, find where it is out of balance, then balance it. Your Chinese medicine is essentially the same, but you rely on intermediate steps – check the pulse, look at the tongue, etc. Why not just perceive the field? Anybody can do it!”

One of the students, a pretty young lady in her third year, asked, “And why did you use Liver 4? Is it because it’s the Metal point on a Wood channel, and metal controls wood?”

I had no idea what she was talking about, but Kazi Dama apparently did, or maybe he didn’t and considered the question irrelevant. “I did not ‘use Liver 4’!” he said emphatically. “I used the point that needed to be used. This is the big mistake with your Chinese medicine! You think that individual points ‘do’ specific things! In truth, they are a way to access a field in your body that is out of balance with your overall Pischering Field, and possibly with the greater fields in which you live. You want to make things simple, to believe that a point does something, like stop cramps or eliminate nausea, but treating the point won’t do those things if the patient’s imbalance is due to something else. So cut through the in-between steps! Don’t prescribe a point like it’s a drug! Just feel the imbalance and correct it!”

There was some mumbling and grumbling of the “easy for you to say” variety, then finally one student asked the question that everyone wanted to ask. “Why don’t you use needles? I mean, why don’t you insert needles into the skin?”

Kazi Dama seemed to weigh in his mind what he was about to say, then said, “I know you are here at this school to become acupuncturists, to learn how to stick needles in people. Your acupuncture is good medicine, and it works. I come from another tradition, one that is similar, but a little different, that also works. If they both work, then no problem! But I will tell you why I don’t insert needles. I believe that metals affect the Pischering Field directly by their physical properties. There is something about skinny metal wires that directly affects the Pischering Field by being nearby, by simply touching the skin – maybe they function as a kind of antenna that emits or absorbs ha as necessary, or maybe they interact with the electromagnetic signaling system of our cells and tissues.” He sounded out the word “electromagnetic” as if he had been practicing it in front of a mirror. “But you don’t have to pierce the skin! The only advantage of piercing the skin with needles, as far as I can tell, is that you create a way to keep the needle where it is so you can do other things. Like work on your herbs!” he said, prompting us to get to work on the formula.

Since this was my first day in school, all I did was weigh out herbs that the more senior students had decided should go into the formula. The pretty senior showed me how to use the quaint Chinese hand scales that we were expected to utilize, and I got to work weighing out the fragrant roots, bark, and leaves with another freshman. For the most part, Kazi Dama ignored us, but occasionally he would sniff the air, glance over at what we were doing, come over, and nibble on a small piece of this or that herb. Most of the time he just grunted and left us alone, but a couple of times he would taste an herb and tell us not to include it in the formula.

“What’s wrong with this herb?” asked one of the seniors.

“Nothing wrong with it. Just not the right herb for her.”

“What do you call it in your tradition?”

“Don’t call it anything. We don’t have this herb. Probably not a mountain herb.”

“Then how do you know it’s not right for her?”

Kazi Dama sighed. “Herbs are a little more straightforward than acupuncture points,” he explained. “They actually work in the body and ‘do things.’ You can generally tell what herbs do based on how they taste. This one is too pungent and warm for her. She’s already too hot. It will just dry her out.” This response was extremely puzzling to me, but it seemed to make sense to everybody else, so I didn’t say anything.

One of the students appeared to get frustrated that Kazi Dama was rejecting some of their herb choices. “But it’s part of the formula,” he protested.

Kazi Dama sat the student down, then gathered all of us together, saying, “Listen everyone – this is important. Herbs are superficially like pharmaceuticals, but they are not the same. Herbs are creatures, like you or me. Even if they are dead and dried, their essence, their ha, is still there. It is their ha that interacts with the patient’s ha, and brings about healing. Don’t treat herbs like little medicines. Treat them as wise beings who will help your patient. It is too easy to simply prepare a formula that somebody else came up with. Instead, you must think and feel which herbs are the correct ones. Too many of your formulas are far too large – there are so many personalities at work that the patient’s ha gets confused. Always keep in mind: who is the king herb? Who is the queen? Who are the advisors? A nation with too many rulers, or weak rulers with a huge army, or with too many advisors, is not good – this will only breed only chaos.”

After the woman with cramps left, pain-free and extremely grateful, the next patient failed to show up so we had an hour free. I seized the opportunity to ask Kazi Dama about being a healer. “Kazi Dama, how do you know, I mean really know, that this is the right profession for you?”

Kazi Dama pondered my question for a few moments, then replied. “Unfortunately, at this point in your career it is very hard to know. You have interest in helping people, and that is a good start. But also, maybe you also have fantasies about helping people. What I mean is, if you have not worked in a healing profession before, maybe you like the idea of healing; you can’t know anything about the actual practice of healing. But the idea is good too, the interest is good. They are both signs that you have compassion for your fellow human beings, and that is the root of all healing. As to whether you will be a good doctor, or whether you will like being a doctor, you will find out only after you have been doctoring for a while.”

Kazi Dama appeared to be lost in thought for a minute or two. Then, he said, “In my case, medicine was what I grew up with. It was simply expected that I would be a healer. There were times when I was bored with it, with endless lines of sick people outside the door. There were times when I did other things, but I always came back to medicine. There are worse things you could do with your life. There are more and more sick people, and more and more unhappy people, in the world. It is good, to help people. But also, I think I am lucky. I have the temperament for it.” He paused, then pointed at a scroll on the herb room wall. It was a Chinese painting of a scruffy-looking man wearing clothes made out of leaves. The man, who had two little horns sticking out of his messy hair, was chomping on some green herbs – you could see the stems and some leaves sticking out of his mouth. “Who is that man?” Kazi Dama asked.

Nobody seemed to know, so a student went to get Geoffrey Wong from the teachers’ lounge. The affable teacher took one look at the scroll and said, “That is Shen Nong. He is the Divine Farmer. He is the god of herbal medicine.”

“What is he eating?” Kazi Dama asked.

“Herbs,” replied Dr. Wong.

“Do you know what kind of herb?” Kazi Dama queried.

Dr. Wong walked up to the scroll, looked closely, then hazarded a guess in Chinese: “Ma…? Da Ma?”

Kazi Dama repeated the word: “Da Ma? Dama?! Just like my name!” Then he laughed and laughed. “Dama! Dama! This Shen Nong is definitely a member of the Order of the Green-Lipped Monkey! Ha ha ha ha!”

By this point, a number of students from other classes had gathered around, curious about the loudly-laughing new teacher. I asked the obvious question. “Kazi Dama, what is the Order of the Green-Lipped Monkey?”

When he regained his composure, Kazi Dama said, “Well, since you are asking about what it takes to be a good doctor, I might as well start from the beginning. You see, there are different kinds of doctors. I will tell you now about one kind. People get interested in medicine for different reasons. Some of you have yourselves been ill, or you feel a lack of wholeness and seek ways to remedy this. Some of you are interested in acupuncture, in how the energy of the body flows and works to regulate health. Others of you are naturally drawn to herbs. Some of you got interested in the last five to ten years, maybe after watching a TV show or reading a book. But some of you have been very interested in herbs as long as you can remember. You are the ones who liked to eat strange plants in the yard, or on walks in the woods, when you were a child. You eat strange plants – even if they are very bitter – because you are curious, and you like the interaction with the plants, you like how they make you feel. You are members of the Order of the Green-Lipped Monkey. You are my kind of doctor.”

With a little prodding, Kazi Dama continued. “The founder of my tradition was a man named Khazan Doshi. He was a member of the Order of the Green-Lipped Monkey. But the Order is much much older than even him. We say that long ago, before there were people, there were monkeys. Of course, all monkeys eat leaves, so you could say they all had green lips. But a few monkeys discovered special plants, special bitter dark green plants, that had a special effect. The plants made the monkeys wise. The monkeys liked this, so they ate the special plants quite regularly, staining their lips and mouths a dark green. My tradition, the Iron Pork lineage of Champogrla, is directly descended from those monkeys. It is said that Khazan Doshi ate champo leaves, and that is how he saw into the future, saw how our people could avoid extinction during the Great Cold. Until quite recently in Champogrla, on special occasions like our New Year’s Day in the springtime, clowns would wear green lipstick to show this association. The clown-monkeys are fools, rascals, but in their craziness they are also wise.”

One of my classmates, a friendly New Yorker named Andy, asked, “Kazi Dama, what do you mean, the plants made the monkeys wise? What kind of effect did the plants have? And what does this have to do with being a doctor?”

Kazi Dama looked very pleased with Andy. “Ahh, now you ask the good questions,” he said. He took a sip from a cup of tea he kept on the herb room table. “The plants let the monkeys see the big picture. The plants let the monkeys take a step back from playing the monkey game, to see deeply into life. And that is what a good doctor must do: see deeply into life.”

Andy said, “Are you talking about drugs?”

Kazi Dama looked him squarely in the eye and responded, “That is a very good choice of words. What are drugs? ‘Drug’ means medicine, but ‘drug’ also means a substance that affects the mind. These plants are both. From the very beginning, members of the Order of the Green-Lipped Monkey were in the minority. Most monkeys, and now most people, are not compelled to have this sort of relationship with plants. Indeed, one could argue that such plants can cause great harm. I understand the public health aspect of this argument. But I will tell you this: if you are this kind of doctor, no laws, no prejudice will change you. This is simply the way you are. And because there have always been people like you, we have what we now call herbal medicine. Most people won’t try strange, bad-tasting herbs. But the green-lipped monkey tries them all! I consider myself lucky to be a green-lipped monkey! If you are one too, you have chosen a good profession for yourself!” Then, he hastened to add, “If you are not a green-lipped monkey, that’s OK too! You can still be a great doctor! You can still see deeply into life! Thank you everybody! Good night!”

What Is Life?

2005-05-05T05:55:00.000-07:00

What is life?
Seeking the shade when you are hot,
Moving closer to the fire when you are cold.
Eating when you are hungry,
Drinking when you are thirsty.
Making love when the passions stir,
Raising children,
Planting a garden.
Loving, laughing,
Fighting, crying.
Thinking,
Wondering.

Sleeping and waking,
Living and dying.
More than this I cannot say.

- from The Songs of Khazan Doshi
(approx. 1500 BCE)