Dysbiosis, Spleen Qi, Phlegm, and Complex Difficulties

Abstract

The incidence of complex chronic health conditions is rising. Some of these conditions might have their roots in gut disturbances, which in Chinese Medicine would be categorized as Spleen and Stomach Qi Disharmonies. In this article, the author explores these issues from an integrative perspective and suggests areas where acupuncture techniques could be helpful. Five cases are described briefly to illustrate the use of acupuncture.

Introduction

There has been a steady increase in the prevalence of a number of diseases in the past 60 years. These conditions include obesity, childhood diabetes, asthma, eczema, allergies, reflux, celiac disease, colitis, brain dysfunction, and cancer.¹ As political satirist Bill Maher puts it:

Fifty years ago, children didn't even get type 2 diabetes. Now it's an emerging epidemic, as are a long list of ailments that used to be rare and now have been mainstreamed—things like asthma and autism and acid reflux. … arthritis, allergies, adult acne, attention deficit disorder—and that's just the A's.²

While there may appear to be little connection between these conditions, there might, in fact, be a common underlying malfunction of the digestive system. From a conventional standpoint, these various conditions could share disturbances of the intestinal microflora, with altered transport mechanisms and subsequent autoimmunity. From a Chinese Medicine (CM) viewpoint, these diseases reflect a disturbance of Spleen Qi in its transporting and transforming functions, with subsequent accumulation of Damp and Phlegm.

Biomedical Concepts

The Leaky Gut

In a previous article, the current author discussed the leaky gut syndrome as being a concept that could bridge the philosophical gap between CM and modern biologic theory.³ To summarize, some researchers claim that increased intestinal permeability is a factor in dozens of diseases.⁴ According to the theory, gut absorption can become compromised by a variety of triggers, leading to the absorption of incompletely digested proteins. Such proteins form haptens, which, when attached to large carrier proteins, can activate immune cytokines through molecular mimicry and trigger a cascade of immune responses, leading to inflammation and the formation of auto-antibodies.

Although the notion of a leaky gut began largely as an alternative or naturopathic concept, its acceptance is growing. Alessio Fasano, MD, a pediatric gastroenterologist at the Massachusetts Institute of Technology, has proposed a biochemical mechanism that controls intestinal permeability, and has linked the leaky gut to diabetes, multiple sclerosis (MS), asthma, ankylosing spondylitis, inflammatory bowel disease (IBD), autism, attention-deficit hyperactivity disorder, chronic headaches, schizophrenia, ovarian and pancreatic cancer, and glioma.⁵

Although Dr. Fasano is writing with specific regard to celiac disease, this is certainly an extraordinary set of syndromes to all be related through a gut malfunction. Furthermore, the intestinal damage seen in celiac disease may not be unique. Similar changes in intestinal lining are also seen in areas of the world where malnutrition is rampant, a condition that has been called environmental enteropathy.⁶

Dr. Fasano suggests that the cells of the gut lining are not stuck together as previously thought. Rather, there is a paracellular pathway, known as a tight junction (TJ) that is controlled by a gate that opens and closes depending on the presence of an 8-unit peptide known as zonulin. Among other things, zonulin is upregulated by gluten, certain infections, pesticides, and various drugs. A simple image of the TJ and leaky gut is shown in Figure 1.

FIG. 1.

Tight junction and the leaky gut. Designed by Richard Greenwood, BFA, MA (www.richardgreenwood.ca).

The Microbiome

A closely related theory to the celiac model has as its central feature the biodiversity of gut bacteria (the microbiome).⁷ According to this theory, the intestinal flora has been radically altered in the past century by a number of mechanisms related to modern lifestyles.

A healthy adult human harbors some 100 trillion bacteria in the gut. That is ten times as many bacterial cells as there are regular cells in the body. These bacteria are diverse, expressing some 3 million genes, compared to the body's ∼23,000. Given that the microbiome has many useful digestive functions and marks our first line of defense from pathogenic microbes, it could be said that what appears to be a human being is actually a composite, a symbiosis of human and bacterial components. We are both genetically and functionally dependent on these organisms for proper growth and development. It only makes sense to ensure that people have healthy microbiomes.

The current consensus is that, for many of these chronic disorders to manifest, a triad of factors needs to be in place: (1) genetic susceptibility (antecedent); (2) an environmental trigger (trigger); and (3) increased intestinal permeability (mediator). This idea is not truly new, but its scientific basis is solidifying.⁸

Genetic susceptibility

Genetic predisposition simply means that people who carry certain specific genes are more likely to develop particular diseases. Research in this area is advancing rapidly, and the genetic basis of many diseases has been identified in recent years.^9,10 Suffice to say that, in CM, such susceptibilities would be seen as a weakness of ancestral (pre-Heaven) energy (i.e., a Deficiency of Kidney Qi or Jing).

Environmental triggers

The second factor to consider is an environmental trigger. Antibiotics, for example, are well known to alter the microbiome. Other drugs, too, may be suspect, such as proton pump inhibitors.¹¹ But drug effects may be just one facet of an emerging phenomenon, in which the unforeseen consequences of various biologic technologies are beginning to surface.

A review of the consequences of exposure to some ubiquitous modern stressors can be quite revealing. For example, vaccines have been linked to asthma, diabetes, autism, and various autoimmune disorders^12,13; genetically modified organism foods have been linked to food sensitivities, allergies, diabetes, Alzheimer's disease and cancer¹⁴; pesticides have been linked to IBD, autism, Parkinson's disease, depression, dementia, MS, and various cancers¹⁵; and artificial electromotive force fields have been linked to reproductive disorders, immune dysfunction, neurologic disease, and cancer.¹⁶

Vaccines can alter the microbiome both: (1) intentionally, by targeting specific strains of a potentially infectious agent; and (2) unintentionally, through the direct toxic effects of adjuvants. For example, by eliminating several strains of pneumococcus, the pneumococcal vaccine allows other strains and/or bacteria to come in to fill the gap. This leads to increased incidence of other, potentially more serious infections such as Staphylococcus and Hemophilus.¹⁷ In the same way, a flu vaccine may make recipients more susceptible to future flulike outbreaks involving a different virus (influenza-like illnesses [ILIs]).¹⁸ In addition, components such as thimerosol, aluminum, and polysorbate 80 could all have a more direct effect.^19,20

The impact of pesticides is particularly disturbing. Of all the thousands now out there, perhaps the most ubiquitous and well-studied one is glyphosate (the main ingredient in Roundup® weed killer), which has been shown to both (1) chelate and immobilize minerals in plants, leading to micronutrient deficiencies, and (2) damage the microbiome by interfering with the shikimate pathway.^21,22 This pathway is a seven-step metabolic route used by bacteria, fungi, algae, parasites, and plants for the biosynthesis of aromatic amino acids (phenylalanine, tyrosine, and tryptophan). Given that the pathway is not found in animals and humans, glyphosate has been touted as safe to ingest. However, although humans may not have the pathway, the gut bacteria certainly do. The net result of these multiple factors is a compromised microbiome that is skewed to contain increasing amounts of pathologic bacteria, such as Clostridium and Salmonella, and reduced amounts of beneficial bacteria, such as Bifidobacterium and Lactobacillus.^23,24

Chinese Medicine

A review of the above disorders in relation to the rubric of CM reveals a pattern of Disharmonies that could well be related to Dampness and Phlegm through Liver Qi Stagnation, and Spleen and Kidney Qi Deficiency (Table 1). The inferred CM syndromes are not written in stone, but rather, they are best-guess possibilities based on symptoms.

Table 1.

Side-Effects of Some Modern Environmental Triggers Plus Their Inferred CM Patterns

Categories	Conditions	Inferred CM patterns
Drugs & antibiotics	Allergies, rheumatic conditions, brain inflammation, mood disorders, & liver & kidney toxicity	Damp Heat, Phlegm, Qi/Blood Stagnation, Bi syndrome, Wind, ↓ Kidney
Pesticides	Neurologic conditions, such as autism, Parkinson's disease & dementia; cancer; low sperm count; & birth defects	Damp Heat, Phlegm Wind, ↓ Kidney
GMO foods	Food sensitivities, allergies, fibromyalgia, diabetes, dementia & cancer	Damp Heat, Phlegm Wind, Qi/Blood stagnation ↓Spleen, ↓Yin
Vaccines	Asthma, allergies, fibromyalgia, autoimmune disorders, diabetes & autism	Wind, Cold, Damp Bi Damp Heat, Phlegm ↓Spleen, ↓Lung Qi

CM, Chinese Medicine; GMO, genetically modified organism.

Spleen and Stomach Qi

In CM, the digestive process is related to Spleen and Stomach Qi. The Stomach receives and ripens food, sending the “pure” part to the Spleen for processing, and the “impure” part to the Small Intestine for sorting. In the meantime, the Spleen transforms and transports the food. Food is transformed into nutritive essence, and then transported to the Heart and Lungs to be converted into Qi and Blood.

An individual with a Deficiency of Spleen Qi may have typical symptoms of indigestion, such as gas, bloating, and general fatigue. Perhaps what the ancient Chinese doctors were describing with the term Spleen Qi is predominantly the collective action of the gut flora. What the ancient doctors lacked in microbiology they made up for with keen observation and an awareness of functional problems when the body's structures seemed to be otherwise healthy.

Damp

Although the phenomenon of Damp can arise because of external weather exposure, it arises more commonly today because of a weakness of Spleen Qi. Dampness generally feels like swelling and heaviness. Physically, this could manifest as muscular aches and pains, such as those encountered in polymyalgia or fibromyalgia. Mentally, Damp may be experienced as fogginess, cloudiness, or a feeling of “cotton wool” in the head, together with excessive anxiety, worry, or obsessive–compulsive features.

At the spirit level, Dampness might be understood as unmetabolized experience—unrecognized potential or soul tendencies that have not been permitted full expression by the developing ego.

Phlegm

In CM, it is often said that strange afflictions are usually Phlegm.²⁵ Phlegm arises when Damp is not cleared properly or is allowed to Stagnate for a period of time. Although the origin of Phlegm can be external (arising, for example, with a cough or cold), it is the more-hidden internal type that is involved in complex disorders.

Internal Phlegm is the consequence of a disruption of the body's fluid metabolism, which, in turn, is related to Spleen Qi. Symptoms can be manifold, ranging from poor general health and digestive dysfunction to obesity, heart disease, cognitive impairment, autoimmune disorders, and tumors (both benign and malignant).

Deficient Kidney

Genetic susceptibility roughly correlates with the CM notion of Kidney Deficiency. Given that Spleen Qi is ultimately rooted in the Kidneys and the Mingmen, if Fire of the Mingmen is Deficient, then the Spleen Qi will be Deficient too.

Kidney Yin moistens and nourishes the organs/tissues, while Kidney Yang warms and promotes the proper functioning of those same organs/tissues. The balance of Yin and Yang in the Kidneys produces Kidney Qi and the Fire of the Mingmen, which, in turn, supports a vigorous Spleen function.

Liver Qi Stagnation

Another key factor involved in Phlegm production is Liver Qi Stagnation. Qi Stagnation is experienced as anxiety and then worsens when that anxiety is suppressed.

Given that anxiety and its suppression are so widespread, they only need be combined with these other factors to lead to the Stagnation of Damp—something that then gives rise to Damp–Heat and Phlegm.

One of the most effective ways of addressing chronic anxiety and tension is through the use of meditation/relaxation techniques (such as Qigong, t'ai chi, or formal daily meditation), but few people avail themselves of such simple remedies until faced with a health challenge (Table 2).

Table 2.

CM Patterns Giving Rise to Phlegm

Pattern	Symptoms	Tongue	Pulse
Spleen Deficiency	Poor appetite, distention after eating, weakness of the four limbs, fatigue, loose stools	Pale, swollen with teeth marks	Empty
	Damp: Weakness; heaviness; numbness, coldness; tingling; shoulder/backache; vertigo; & blurred vision	Greasy white coat	Slippery & thin or empty
Kidney Deficiency	Weakness, tiredness, premature aging, withered pale complexion, tremor, low back pain, urinary issues
	↓Kidney Yang: Coldness; & urinary incontinence	Pale & wet	Weak
	↓Kidney Yin: Emaciation; blurred vision or loss of vision; vertigo; & tinnitus	Red, with little or no coat	Deep & thin
Liver Qi Stagnation	Chest distension, hypochondriac pain, nausea and/or poor appetite, Plum-Pit Qi, diarrhea, depression & dysmenorrhea	Normal	Wiry
Phlegm	Poor general health, ↓appetite, dizziness, heaviness, stuffiness, fixed stabbing pain, lumps, masses, purple or blueish lips, nails & bleeding with clots	Purple, sticky coat	Slippery & choppy

CM, Chinese Medicine.

Integrated Approach

An integrated approach to these types of illnesses generally requires more than just acupuncture. This approach might involve attention to gut health with detoxification, dietary changes, supplements, herbs, and probiotics, and introducing regular stress reduction/meditation techniques. At a spirit level, this approach might involve a shift in consciousness toward self-responsibility and ego-transcendence. Either way, the CM principles would be: mobilize the Qi, clear Stagnation; and strengthen the Spleen, Stomach, and Kidney Qi.

Diet

Conventional medicine is increasingly seeing the importance of nutritional intervention for complex syndromes. For example, Swank and Duggan first noted that diet had a significant influence on MS in 1987.²⁶ Since then, the Paleolithic diet has become a popular approach for tackling weak digestion.²⁷ More recently developed easy-to-digest diets include the Whole 30 and GAPS [Gut and Psychology Syndrome] diets.^24,28

Similarly, CM has always recommended dietary therapy for weak digestion. For example, to strengthen Spleen Qi, CM would suggest eliminating hard-to-digest foods (in particular raw or cold foods that can induce Dampness and Phlegm) while simultaneously eating more foods that tonify the Spleen. Table 3 illustrates some examples of the CM dietary approach. A more complete summary can be found elsewhere.²⁹

Table 3.

Some CM Dietary Recommendations for Weak Spleen Qi

Reduce intake	Increase intake
Raw fruits (salads, citrus, wheat) Overly sweet foods (refined sugars) Cold foods (ice cream, iced drinks)	Chicken, beef or lamb Mackerel, tuna Rice, cooked grains Sweet potatoes, squash, carrots, yams, stewed fruit, onions, leeks, garlic, turnip, mushrooms Black pepper, fresh ginger, cinnamon

CM, Chinese Medicine.

Supplements: Probiotics, Vitamin/Minerals, and Enzymes

Probiotics are used to recolonize the gut with friendly bacteria. However, although pharmacy shelves are full of different products, most contain only a single species, such as Lactobacillus. Many of these products are poorly studied and probably not very effective. Furthermore, some researchers have attached more importance to Bifidobacterium and Prevotella than Lactobacillus.^30,31,32

Clearly, the final word on what constitutes a healthy microbiome has not yet emerged. In the meantime, common sense would suggest that products with multiple bacteria and bigger doses could be a better option than the average single-species item. Some such products have considerable peer-reviewed literature behind them.³³

Vitamin/mineral supplements are used to replenish the body with nutrients that might be lacking in the diet. Of the limited research that has been done, most researchers suggest that a daily multiple vitamin/mineral supplement is probably a good idea.³⁴ There may also be a place for higher doses of specific vitamins, such as C and D.^35,36 However, once again, although pharmacy shelves may be well-stocked with options, many products are overpriced and have less-than-optimal ingredients.

It makes sense for a consumer to shop around for a broad-based vitamin/mineral product that at least contains recommended daily allowance amounts, has the United States Pharmacopeia seal of approval on the label, and is not too expensive.

Enzymes are used to provide assistance to a stressed digestive system. Such an approach is fairly standard for patients with chronic pancreatitis, but the idea of using them for Deficient Spleen Qi might be novel. Moreover, some enzymes have additional fibrinolytic and anti-inflammatory properties, making them potentially useful adjuncts for dissolving Phlegm. Serrapeptase, for example, has been found helpful for patients with conditions ranging from asthma, to arthritis, IBD, and diabetes, all of which fall within the spectrum of the complex disease profile.³⁷

Herbs

CM herbal formulas could allow the seeding of a new benevolent culture or provide the nutrients that promote the growth of a certain form of bacteria. Thus they may “kick-start” the reproduction of a healthier microbiome, rather like seeding a solution with a crystal. Although a detailed analysis of herbs is not possible in a short article, suffice to say that the general approach of strengthening the Spleen and Kidneys while relaxing the Liver Qi makes intuitive sense.³⁸ Table 4 contains some examples.

Table 4.

Some Common Herbal Formulas for Spleen/Kidney/Damp/Phlegm

Goal	Herb	Formula	Function
↑ Spleen & Stomach Qi	Shen Qi Da Bu Wan	Codonopsis & Astragalus Formula	↑Qi
	Si Jun Zi Tang	Four Gentleman Soup	↑Qi & Spleen
	Bu Zhong Yi Qi Tang	Strengthen the Middle Decoction	↑Qi &↑sunken Yang
	Xiao Jian Zhong Tang	Minor Construct the Middle Decoction	↑Spleen Yang
↑Kidney Qi	Ba Wei Di Huang Wan	Rehmannia Eight Formula	↑ Kidney Yang
	You Gui Wan	Replenish the Right	↑ Kidney Yang
	Zuo Gui Wan	Replenish the Left	↑ Kidney Yin
↓ Liver Qi Stagnation	Shao Yao San	Bupleurum & Tang-kuei Formula	↑ Spleen ↓Liver Stagnation
	Chai Hu Shu Gan San	Bupleurum Liver-Coursing Powder	↑ Spleen ↓Liver Stagnation
	Bao He Wan	Harmony-Preserving Pill	↓Liver Stagnation
↓ Phlegm	Liu Jun Zi Tang	6 Gentleman Decoction	↑ the Spleen, transform Phlegm
	Er Chen Tang	Citrus & Pinellia Combination	↑ Spleen expels Phlegm
	Qing Shi Hua Tan Tang	Clear Dampness Transform Phlegm Decoction	↓ Damp, transforms Phlegm

Acupuncture

Most CM sources suggest that the treatment of Phlegm should involve mobilizing the Qi, rather than doing anything specifically to remove Phlegm. The argument is that if the Qi is strengthened, then any Phlegm will disperse of its own accord. Moxibustion can also be helpful, especially on major Qi tonifying points, such as ST 36 and CV 4 or 6.

That said, it is hard to see how acupuncture alone might affect the multiple complexities of gut disturbances. In the current author's opinion, a broad-based approach would have more chance of success. This might involve (1) removing exposure to emerging external factors, (2) clearing Dampness, (3) removing Phlegm, (4) moving the Qi/Blood, and (5) tonifying the Spleen and Kidney Qi.

This leads to a large number of possible acupuncture treatment options, with points being chosen on the basis of the specific needs of the moment. For example, Majebe has offered a list of potential points for childhood autism.³⁹ Table 5 offers a shortened form of this list. These points can be used alone or incorporated into various energetic strategies, as described by Joseph M. Helms, MD (Table 5).⁴⁰

Table 5.

General Points for Spleen/Kidney, Liver Qi, Damp & Phlegm

Goal	Points	Name	Description
↑ Spleen Qi	LU 9	Taiyuan	Shu point of Lung
	ST 36	Tsusanli	He-Sea point of Stomach
	SP 3	Taibai	Spleen Shu point, strengthens Spleen Yang
	SP 4	Gongsun	Opens the Chong Mo, strengthens the Tai Yin
	SP 6	Sanyinchiao	Meeting point of Liver/Spleen/Kidney
	CV 4	Guanyuan	Tonifies Jing, Yin, Blood, calms the Shen
	GV 4	Mingmen	Tonifies Kidney Qi and Yang
↑ Kidney	KI 3	Taixi	Source point, Tonifies Kidney Yin/Yang
	KI 6	Shaohai	Opening point of Yin Qiao Mo
	KI 7	Fuliu	Tonifies Kidney Yang
Liver Qi Stagnation	LR 3	Taichong	Moves Liver Qi
	PC 6	Neiguan	Moves Liver Qi & Blood
	LI 4	Hegu	Moves the Qi in the upper body
	BL 18	Ganshu	Liver Shu point, strengthens the Liver
	LR 14	Qimen	Exit point, moves Qi into the Tai Yin
Damp	ST 40	Fenglong	Luo point of Stomach
	SP 9	Yinlingquan	Water/He-Sea point of Spleen
Phlegm	LU 7	Lieque	Luo point of Lung
	KI 26	Yuzhong	All Phlegm conditions
	GB 8	Shuaigu	Wind Phlegm
	CV 18	Yutang	Cold Phlegm
	GB 43	Xiaxi	Hot Phlegm
	M-HN 30	Bailao	Phlegm Misting the Mind

Another consideration is that these complex imbalances are likely less conducive to linear inputs. Unless there is a specific obstruction, resonating treatments make more intuitive sense. With resonating treatments, tonification of the Yang Ming or Shao Yin can be an effective general strategy.

For example, one common and effective resonating treatment, described by Dr. Helms, involves the Yang Ming Evolution Triangular Equilibration (ETE), incorporating points on the Yang Ming, Tai Yin, and Jue Yin, such as ST 36, SP 3, LU 7, LR 3 and 4, and PC 6, plus perhaps CV 17 or M-HN 30 to clear the mind. Or, alternatively, a Shao Yin ETE, incorporating points on the Shao Yin, Shao Yang, and Tai Yang, such as KI 3, PC 5, GB 34, BL 60 and 62, and SI 3, plus CV 17, with electrical stimulation between KI 3 and GB 34, to tonify the Kidney energy.

In the specific case of cancer, which is perhaps the ultimate Phlegm condition, a few other protocols might be utilized before using the above strategies. These might include Aggressive Energy, Husband–Wife, and 7-Dragon protocols. Such protocols have been discussed elsewhere,⁴¹ and can be found in any 5-Element text.

Dynamic Interactive Acupuncture

Beyond standard protocols, a deeper strength of acupuncture lies in its ability to help people transform their worldviews. Unfortunately, the notion that disease is caused by an external agent is so embedded in the collective consciousness that many people regard external remedies (such as antibiotics) as the only rational way to proceed when facing a health challenge. Acupuncture can change this default position by helping people to shift the focus of their attention inward.

The potential to move energy with acupuncture can be augmented by making it more dynamic and interactive.⁴² Dynamism encourages the free flow of Qi, and interaction allows free interplay beyond protocols. Such an approach places the locus of control firmly in the patient's hands. When the Qi flows unimpeded, people will often describe a sense of oneness and connection that transcends the conventional dualistic mindset. This process has been described in 5-Phase terminology as Traversal through the Mysterious Path or the Golden Gate.⁴³

One way or another, retrieving personal power is both the goal and intent behind all acupuncture strategies aimed at strengthening the true (Zhen) Qi. Without personal empowerment, therapy tends to go around in circles as patients oscillate between the desire for symptom relief and the fear of taking charge.

The Ideal Impact of Acupuncture

There are five ideal effects:

• (1) Symptoms are understood as repositories of lost energy.

• (2) The return of lost energy generally improves well-being.

• (3) Increased energy means less strain on the digestive system.

• (4) Improved digestion makes a positive impact on the leaky gut.

• (5) With better digestion, immune stimulation from molecular mimicry diminishes.

Case Studies

Case 1

A 65-year-old woman with a Fire constitutional type (CT) had gained a lot of weight despite not overeating. She had tried several diets, but none achieved more than temporary benefit. Moreover, all of the diets left her feeling undernourished. Clearly, her Spleen Qi was not functioning as it should. She eventually embraced a dietary approach that contained easy-to-digest, gluten-free cooked foods. This was supplemented by digestive enzymes and various Spleen tonifying herbs, mostly rooted in the base formula Liu Jun Zi Tang. Acupuncture was directed toward strengthening her Spleen and Stomach Qi, transforming Phlegm, and calming Liver Qi Stagnation, with points such as ST 36 and 40; SP 3, 4, and 6; and LR 3. The points were incorporated into an ETE of the Yang Ming, Tai Yin, or Jue Yin, and combined with dynamism. Treatments were initially 1–2 times weekly for 12 treatments, then monthly for 6 months, then periodically thereafter. Over the period of a year, she lost 20 pounds, a loss she was able to maintain.

Case 2

A 62-year-old woman with a Metal CT found herself increasingly prone to chronic sinus congestion, which was interfering with her sideline singing career. With every sinus flareup, she would take antibiotics. As her sinus issues continued, she also noticed increasing difficulties with flatulence, bloating, and sluggish digestion. Given that her regular job was in a medical office, she had attributed her frequent coughs and colds to daily exposure to patients, and she had been vigilant with her annual flu vaccines. When the current author pointed out to her that these routine vaccinations, while perhaps helpful for specific targeted viruses, might simultaneously be making her more susceptible to other flulike infections (ILIs), she was quite surprised but became more receptive to the idea when the current author showed her the relevant literature.⁴⁴

Acupuncture involved tonifying the Spleen/Stomach with moxibustion on points such as ST 36; SP 6; and ST 25; plus points to drain the sinuses, such as ST 2, LU 7, and LI 4. She took probiotics, digestive enzymes, and herbs such as Cang Er Zi Wan (Xanthium Powder to drain the sinuses) and Shen Qi Da Bu Wan (Abundant Qi to tonify the Qi). Over a period of 6 months, her symptoms largely resolved.

Case 3

A 68-year-old woman with a Yang Ming Earth CT presented with new-onset headaches after extensive air travel. She went to an emergency room and had a full workup, including head computed tomography, abdominal ultrasound, and blood tests, but nothing was found. A systems review revealed that she had had a sensitive digestive system for many years, diagnosed as irritable bowel syndrome, with a tendency toward periodic fluid retention. Acupuncture involved a number of sessions focusing on balancing the Yang Ming with points such as ST 36, SP 4, LU 7, LR 3, and PC 3 and 6. She altered her diet to be more digestible, and used probiotics and herbs to tonify her Spleen Qi. After the first treatment, her headaches were reduced by 50%, and they resolved after only 4 sessions.

Case 4

A 30-year-old man with promising musical talent became immobilized with obsessive–compulsive disorder (OCD). An irrational germ phobia gave rise to constant hand washing and showering, but, curiously, all symptoms disappeared when his mind was focused on music. He was given selective serotonin reuptake inhibitors (SSRIs) and referred to a 3-month long OCD retreat. On his return, and after reading some information on the negative long-term impact of SSRIs, he expressed a wish to stop taking them. He altered his diet in the ways previously noted, took herbs (such as Xiao Yao San), a multivitamin/mineral supplement, and probiotics. Acupuncture involved points to balance the Jue Yin, Tai Yin, and Yang Ming, such as LR 3, PC 6, ST 36 and SP 4, together with one or two specific points chosen from Table 4. After 3 months of biweekly treatments, he serendipitously was offered a teaching job at a prominent music store. After years of subsistence living, his life stresses were eased significantly, and, within a few months, his symptoms largely resolved.

Case 5

A 77-year-old woman with a Metal CT presented with postmenopausal bleeding and was subsequently found to have a pelvic mass that turned out to be a high-grade serous ovarian carcinoma. This diagnosis carried with it a median survival time of 1.7 years.⁴⁵ She had debulking surgery but refused chemotherapy or radiotherapy.

She explored a variety of alternatives, including herbs, digestive enzymes, vitamin C, and coffee enemas, and then came to explore acupuncture. During the initial intake, it was clear she had a lot of grief consistent with her CT. Acupuncture began with the 4 Gates (LR 3, LI 4), followed sequentially by Aggressive Energy release, 7 Dragons, and Husband–Wife protocols, then thereafter Yang Ming and Tai Yin ETE. Her diet was adjusted to an easy-to-digest regimen. At each session she began to tremble in her arms and legs, and expressed profound grief; but, for some time, her pelvic area remained somewhat blocked. Gradual coaxing improved movement in the lower chakras until energy passed through unimpeded. Six months post diagnosis, she remained well and, perhaps more astonishing, was at peace with the diagnosis. At 10 months she developed a right ureteric and partial bowel obstruction. Though an abdominal computed tomography scan showed no recurrence of the main tumor mass, she reluctantly agreed to start chemotherapy. Curiously, before things could get underway, she died suddenly of a cerebrovascular accident. The current author had the opportunity to talk with her on the morning before she died, at which point, he had the sense that she was ready to move on. Perhaps, given her peaceful state of mind, the transformational approach had been successful after all.

Discussion

There are many competing theories regarding the origin of emerging chronic complex health conditions, and no one knows for sure what is going on. Discussions that ignore the multifactorial nature of this issue, through the often vociferous advocating of one particular theory, miss the benefits that an open and critical mind can facilitate.

Perhaps, when various theories are all reasonable, none should be dismissed prematurely. It makes no sense to ignore, for example, concerns over vaccines or pesticides simply because public health and the manufacturers say these things are safe. Nor does it make sense to dismiss the benefits of those same things. The point is that placing too much emphasis on one side of inflammatory issues only aggravates the widespread Liver Qi Stagnation pervading the collective consciousness.

A more creative question might be: “Is it possible to integrate and transcend the various conflicting theories of complex conditions in a harmonious way?” Perhaps it might be so. However, it will likely require a shift of thinking away from “acting against” toward a more supportive treatment philosophy. In this regard, CM describes 3 levels of medicine (Table 6).⁴² Given that level 1 is largely based in acting against conditions, the fact that the acupuncture experience focuses more on levels 2 and 3 is perhaps one of its most potent features. Strengthening the Qi, supporting digestion, 5-Phase energetic equilibrations, stress-reduction techniques, and the acquisition of a broader perspective can be a fairly solid therapeutic philosophy.

Table 6.

The Three Levels of Medicine

Level		Description
1	Lowest (Symptomatic)	Conventional or allopathic (acting against)
2	Middle (Constitutional)	Diet, supplements, herbs (acting supportively)
3	Highest (Transformational)	Hidden traditions

Conclusions

Patients suffering from chronic complex conditions have essentially 3 options. They can: (1) Increase Yin (become more dependent); (2) Increase Yang (fight on with an adversarial mindset); or (3) Transcend Yin and Yang (Return to the Dao, transform, take charge).

Curiously, those patients who take ownership of their symptoms, make proactive decisions, and reduce reliance on practitioners often chart a surprisingly effective course of action. At CM's second level of medicine, this might involve multiple modalities including diet, supplements, exercise, sleep, meditation, and stress reduction. At level 3, the conscious acquisition of self-responsibility can become a guiding principle.

Although this transition is theoretically possible for anyone, the process is definitely not logical, predictable, or otherwise knowable in advance. In such a context, the acupuncture ritual is not an end in itself, but rather a forum in which such issues are explored. With these complex syndromes, practitioners actually have a great chance to embrace the principle of “not knowing” that is so fundamental to CM philosophy. Such an approach can be both freeing and empowering, transforming the therapeutic interaction into an adventure of possibilities.

Acknowledgments

Graphics were designed by Dr. Greenwood's son, Richard Greenwood, BFA, MA.

Author Disclosure Statement

No competing financial interests exist.