Medical Marijuana and TCM II

One of the complications I face with clinical practice in Florida is that for the past couple of years, the state has allowed the use of so called Medical Marijuana and Cannabis. Since the law went into effect, dispensaries have cropped up in every city and town and I am informed by a patient that acquiring a prescription for MM from an MD affiliated with a dispensary is as easy as showing up and signing a few forms. None of my patients who have been prescribed MM had a physical exam by the dispensing physician and there is no follow up unless the patient requests one. The non medical dispensary operators are given carte blanche to suggest dosage and delivery mechanisms and some patients who have expressed concerns about addiction and other negative side effects have been told that MM “works for everyone” and that there are “absolutely no negative side effects, ever”.

Because marijuana is currently classified by the US federal government as Schedule I, “a drug with no medical use”, studies that discuss medical marijuana are limited in both number and scope. Many studies compare smoking habits and respiratory distress among cigarette and cannabis smokers, as well as symptoms of abuse and addiction in recreational users, but few address the side effects of medical marijuana.

One study in Canada described the most common side effects of cannabis use in patients with non-chronic cancer pain as “cognitive side effects” and dry mouth. In the United States, nabilone may produce similar “cognitive side effects” or psychiatric symptoms, hypo and hypertension, and tachycardia if the prescribed dosage is too high. Dronabinol has also been associated with a “cognitive side effects,” sleepiness, or withdrawal symptoms lasting up to 48 hours that appeared in only one study, which promptly stopped dispensing the medication. The categorization of cannabis as Schedule I, therefore, is a double-edged sword: because few clinical trials have been run, few negative side effects have been reported.

Effect of cannabis use in people with chronic non-cancer pain prescribed opioids: findings from a 4-year prospective cohort study

 ~ The Lancet, British Medical Journal, July 2018

In conclusion, cannabis use is common in people with chronic non-cancer pain who have been prescribed opioids, and interest in medicinal use of cannabis is increasing. We found no evidence that cannabis use improved patient outcomes; those who used cannabis had greater pain and lower self-efficacy in managing pain. Furthermore, we found no evidence that cannabis use reduced pain interference or exerted an opioid-sparing effect. ~

Medical marijuana: Do the benefits outweigh the risks?

 ~ Current Psychiatry · January 2018

There is no clear and convincing evidence MM is beneficial for psychiatric disorders, and Cannabis can impair cognition and attention and may precipitate psychosis. The risks of deleterious effects are greater in adolescents. Cannabis use causes impairment of learn­ing, memory, attention, and working mem­ory. Adolescents are particularly vulnerable to the effects of Cannabis on brain develop­ment at a time when synaptic pruning and increased myelination occur. Normal brain development could be disrupted. Some studies have linked Cannabis use to abnor­malities in the amygdala, hippocampus, frontal lobe, and cerebellum. From 1995 to 2014, the potency of Cannabis (THC concen­tration) increased from 4% to 12%.58 this has substantial implications for increased abuse among adolescents and the deleteri­ous effects of Cannabis on the brain.

Heavy Cannabis use impairs motivation and could precipitate psychosis in vulnera­ble individuals. Cannabis use may be linked to the development of schizophrenia.59

There are no well-conducted Randomized Controlled Trails on the efficacy of MM, and adequate safety data are lacking. There is also lack of con­sensus among qualified experts. There is soft evidence that MM may be helpful in some medical conditions, including but not limited to CINV, neuropathic pain, epi­lepsy, and MS-related spasticity. Currently, the benefits of using MM do not appear to outweigh the risks. ~

Cannabis for Chronic Pain: Not Ready for Prime Time

  ~ American Journal of Public Health January 2019

The use of cannabis (particularly its principal psychoactive constituent, Δ tetrahydrocannabinol or THC) is associated with health risks including lung disease (when smoked), cardiovascular disease, acute pancreatitis, and cannabinoid hyperemesis syndrome. Cannabis users are also at increased risk for occupational injuries, and cannabis-associated “drugged driving”, sometimes fatal, is increasing. Cannabis use during pregnancy has been associated with increased neonatal morbidity or death.Finally, the myth that marijuana is non-addictive has been dispelled by studies of forced abrupt cessation of use indicating potential rebound hyperalgesia and craving. As the health risks associated with cannabis come under increasing scrutiny.

Diminution of gray matter in the brain in chronic cannabis users has long been recognized. Empirically established deficits following months to years of use involve—but are not limited to—executive functioning, information retrieval, learning, abstraction, motor skills, and verbal abilities, with use of higher-THC cannabis resulting in more profound deficits. Psychopathological consequences of cannabis use include acute psychosis, schizophrenia, worsened social functioning in schizophrenia, bipolar disorder, depression, and anxiety (particularly with increasingly common high-sativa content strains).

Objective data on the efficacy of cannabis for pain management are not particularly encouraging.Cannabis can be helpful in relieving neuropathic pain, with the magnitude of analgesia generally contingent on the amount of THC. Unfortunately, higher-THC cannabis, similar to opioids, also produces more cognitive side effects, often rendering patients impaired at work and in activities of daily living. Moreover, much of the earlier clinical trial literature on cannabis for neuropathic pain has been rendered obsolete.

Unfortunately, it remains extremely difficult to conduct clinically relevant medical cannabis research in the United States because of the drug’s Schedule I status, and the requirement that all cannabis used be obtained from a single farm at the University of Mississippi, and it is permitted to grow only 1000 pounds of cannabis for research purposes each year. Even more problematic is that until very recently, the University of Mississippi was permitted to cultivate cannabis with a maximum THC content of 7%, yet 67% of medical cannabis consumers choose to use oils and other concentrates with THC contents as high as 90%. Cannabis for investigation with a higher THC content (13.4%) was obtainable only recently from the National Institute on Drug Abuse (NIDA). Thus, research on the analgesic efficacy of what the DEA considers “strong marijuana” has been flawed.

Adding to these reservations concerning cannabis as an analgesic is that THC is not the most medically relevant constituent of cannabis. Cannabidiol (CBD) is a noneuphoriant cannabinoid with a good safety profile and has activity as both an analgesic and anti-inflammatory. Importantly, CBD modulates the euphoria produced by THC and provides mild anxiolysis. Although it is thought that cannabis contained equal amounts of THC and CBD in pre-agricultural times, when the plant grew wild, users’ and hence growers’ desire to maximize THC content for its euphoric effects has resulted in CBD being all but bred out of the vast majority of cultivated cannabis. Efforts to find cannabis that contains low concentrations of THC and high levels of CBD in dispensaries are often futile. Furthermore, the CBD that is found in common hemp (the most widely used source for commercial non medical CBD oil) is virtually nonexistent.

Few if any health care providers who authorize medical cannabis educate their patients specifically to seek the most “medicinal” forms of the drug. Even if this aspect of sourcing a uniform, well-characterized supply of cannabis for research or clinical purposes were overcome, another fundamental challenge for such studies is that (unlike for morphine or other opioids) blood levels of these agents do not consistently correlate with their in vivo effects. ~

In the last Blog we learned that traditional Chinese medicine and Chinese medical psychiatry do not condone the use of the use of medical cannabis or marijuana for indications of pain management, addiction withdrawal, constipation and lack of appetite does not advise its use given the historical understanding and the negative side effects involved.

In the light of the unsettling safety profile of cannabis, the lack of strong empirical support for its efficacy, the general absence of CBD in what is used “medically,” and the methodological challenges in conducting research suggest that, at present, cannabis should not necessarily be considered an optimal choice as a drug for pain management.

Yours in good health,

Robert Kienitz, DTCM

Medical Marijuana and TCM

One of the more frequently asked questions asked in my clinic is “what is Chinese medicine’s take on the use of medical cannabis or marijuana?” Over the course of the next few blogs I will share my thoughts on the subject and will begin with the Chinese medical understanding of the drugs.

Cannabis sativa or Hou ma jen was one of three hundred and sixty five herbs, animal parts and mineralsoriginally listed in theDivine Farmer’s Materia Medica” (Shen Nong Ben Cao). The Ben Cao is one of Chinese medicines oldest books and was cited by authors and scholars as early as the Qin Dynasty period around 221 BCE. Even by then however, the original manuscripts had been lost to history. In the Materia Medica the plant part of particular interest of cannabis sativa was the seed and it was listed as a “superior class cereal”.

The cannabis seed or Huo ma ren has a sweet and balanced nature, enters the spleen, stomach and large intestine, supplements the “center” and boosts the qi. Prolonged consumption of the seed may “make one fat (a good thing in ancient China), strong and never senile”. Contraindications are that overconsumption causes dizziness and vertigo. With women there was also a contraindication during pregnancy.

Hemp seeds are still widely used as medicine in both China and the west, they function to dredge wind, relax the spleen, moisten dryness, promote lactation and hasten delivery, disinhibit urination and defecation. We use them mostly for their effect of moistening the intestines to unblock the bowels and are the go to herb for any kind of constipation.

Cannabis seeds, like other herbs in the Moist Laxative category are various seeds and nuts. The major known ingredients in the seeds are unsaturated fats in the form of lipids and, what little cannabinol is in the seeds is inconsequential, and the seeds are processed so that they cannot germinate and are thus not a controlled substance. Having said that, the sesame seed Hu ma ren is as effective as cannabis seed in this capacity and has none of the stigma of being related to a schedule I drug.

The leafy and flowering or folium and flos parts of Hou Ma Jen are acrid, windy and balanced in nature and mainly treated the “seven damages” which are injuries to the spleen, liver, kidneys, lungs, heart, ‘storms and extreme climate’ injuries of the body, and ‘fear and indulgence’ injury to the will. Hou Ma Jen also disinhibited the five viscera, i.e. heart, spleen, lung, kidney and liver.  

Hou Ma Jen precipitated blood and cold qi but are cautioned that consuming too much of the folium causes one to ‘behold ghosts and frenetically run about’. Protracted consumption of the folium may also encourage one to ‘communicate with spirits’.

Due to the mind altering properties of Cannabis, the leaves, buds and flowers were not used much at all mostly because there were many other plant medicines to choose from with the same positive effects but none of the negative side effects. It is interesting to note that in ancient China, cannabis, when used at all, was taken as a liquid decoction or tea and never smoked.

From the point of view of Chinese Medical Psychiatry, the use of cannabis generally elicits one of two responses. In the first case many people experience a pleasant euphoria and sense of relaxation. Other common effects in this first scenario, which may vary dramatically among different people, include heightened sensory perception (e.g., brighter colors), laughter, altered perception of time, and increased appetite.

The euphoria and relaxation are due to the movement of qi via coursing the liver, changes in the intensity of light and color are the eyes responding to the relaxing quality of the drug on the liver. Laughter and giddiness are the typical response to the free flow of qi of the heart and the increased appetite is due to the unrestrained liver harmonizing and rectifying the spleen and stomach.

All of the above responses indicate an underlying mild condition of liver qi stagnation and some degree of spleen qi vacuity. Cannabis clearly helps alleviate these two conditions but only for a short period of time, 1-3 hours. Because the effects are short lived we can conclude two things, one is that cannabis is not an appropriate drug for liver qi stagnation because it does nothing to fortify the qi while releasing constrain. And that over consumption will eventually result in qi vacuity which will cause greater qi constraint and the drug will have to be taken more frequently and or at greater strength to achieve the same euphoric effect.

The above is one of the definitions of addiction, and with this understanding there is no relevant argument for cannabis being non-addictive.

Pleasant experiences with marijuana are by no means universal. Instead of relaxation and euphoria, many people experience anxiety, fear, distrust, or panic. People who have taken large doses of marijuana may experience an acute psychosis, which includes hallucinations, delusions, and a loss of the sense of personal identity. These unpleasant but temporary reactions are distinct from longer-lasting psychotic disorders, such as schizophrenia, that may be associated with the use of marijuana in vulnerable individuals.

This second scenario occurs in people who are already suffering from, for instance, heart timidity and gall bladder qi vacuity. The consumption of qi through the action of the acrid natured cannabis quickly lowers the resources of the already depleted heart qi and gall bladder meridians and organ systems which are very susceptible to acrid herbs. The consumption of qi and blood through cannabis use can affect other organ system conditions as well such as; spleen qi vacuity, spleen qi and heart blood vacuity, liver qi stagnation with blood vacuity and about twenty other commonly seen conditions.

Persons with any of those conditions are considered vulnerable and are at risk, over time and prolonged use, to longer lasting psychotic disorders.

As with the primary scenario, the substance is addictive by nature so the probability and risk factor is increased.

So, from a traditional Chinese medical and psychiatric perspective, the use of medical cannabis or marijuana for indications of pain management, addiction withdrawal, constipation and lack of appetite is not advised given the historical understanding and the negative side effects involved.

Next time I will explore conventional medical science regarding medicinal marijuana and cannabis.

Yours in good health,

Robert Kienitz, DTCM

Lunar New Year…

Nearly everyone is familiar with the animal symbolism associated with Chinese astrology and in particular about the association with the Chinese New Year. The Chinese New Year is actually the Asian Lunar New year which always falls on the second new moon after the Winter Solstice. The Lunar year is divided into twelve lunar cycles from absolute new or empty moon to the next. The zodiac animal symbols are representations of the progression of the twelve year energy cycle and are indicative of the nature of the individual Zodiac animal nature. The relative Yin or Yang nature of the animals themselves is one of the most debated aspects of Asian astrology.

The animal symbols for the zodiac cycle came to China from India about the same time as Buddhism during the first century CE. Buddhism contains certain sutras that mention the animal relationships to the year cycles. The ancient Chinese loved to incorporate, and as with all things, the Chinese incorporated the animals into their already very sophisticated astrological perspectives that were until that time solely based on the principles of the I Ching

In Chinese cosmology, the Chinese Zodiac follows a twelve year progression and the day is also divided into 12 time divisions with each division corresponding to two hours of a twenty four hour day. During each two hour time division one of the twelve organ systems is in a relative state of repletion while its opposite organ (on the Chinese clock) is in relative vacuity. As time passes, the Qi of the organs and their respective channels ebb and flow like the tides of the ocean. This is not to be confused with the concept of repletion and vacuity as pathological responses or factors of disease, this is a natural ebb and flow and, like the seas, the organs and channels at low tide are not pathologically empty any more than they are pathologically full at high tide. The I Ching tells us that this is the way of all things, that there is a constant ebb and flow of the energies and events of the universe, the I Ching demonstrates those energetic changes in the movement of the lines of the sixty four hexagrams in general and the twelve Tidal Gua in particular.

In the system of Chrono-acupuncture, Zi Wu means literally midday-midnight but more broadly is interpreted as ebb and flow. The Tidal Balance System of Acupuncture, developed and refined by Robert Kienitz, uses the relationships between the ebb and flow of Qi and blood in the human body and the ebb and flow of the heavens, earth and sea.

Within the I Ching there are many wave form cycles of change represented. Some wave forms are short and some are as long as the flow of the sixty four hexagrams in their entirety. The wave form that the Tidal Balance Method of Acupuncture uses is a series of hexagrams that create a wave form that corresponds to the wave forms of the natural cycles of lunar and annual solar change.

The I Ching tells us that the days, months and seasons of the year progress in an orderly flow of energy from greatest yang to greatest yin and back again. The hexagrams representing this flow of energy are referred to as Tidal Gua.

The Tidal Gua energy signatures represent any linear or temporal, series of events. The Tidal Gua can be used to balance any conditions that arise from time related phenomena or that reoccur consistently in the same time cycle. This is true for hours in a day, days in a lunar month, months in a year and years in a Zodiacal cycle. One of the best examples of this is the correspondence of a woman’s menstrual cycle to the lunar phases each month. The changes in hormonal and other physiological relationships can be easily modified and harmonized by using the Tidal Balance Acupuncture Method.

Robert Kienitz has drawn on his decades study of Acupuncture and Oriental Medicine and his lifelong study of the I Ching to develop the Tidal Gua and their relationship to acupuncture and Oriental Medicine and offers Tidal Balance analysis at our Vero Beach office.

Yours in good health,

Robert Kienitz, DTCM

Return to Spring…

If you travel to the Far East, especially China, Taiwan, Macao and Hong Kong you will invariably come across traditional herbal pharmacies. The oldest continuously operating pharmacy in China is the Tong ren tang which opened in 1669. The current establishment is on a side street of Qian men Avenue south of the Square of Heavenly Peace.

The names of Chinese pharmacies frequently contain allusions to the basic values of Buddhism and Confucian ethics so Tong ren tang translates to ”pharmacy of partaking in human virtue”. Other examples of names for traditional pharmacies are shen de tang “pharmacy of attention to virtue”, zhi de tang “pharmacy of utmost virtue” or ren de tang “pharmacy of human virtue”. The character tang has the meaning “pharmacy” in these contexts.

Other pharmacy names point out the goals of the medicines produced by the business like yong shen “eternal abundance”, bao yuan “preserving the original qi”, yi shou “benefiting longevity”, shou kang “longevity and health”, wan quán “myriad healing” and bao zi “protection and restoration”.

The figurative term “spring” meaning “health” also appears on many pharmacy names as hui chun “return to spring”. The variations on the term crop up so often that pharmacies are colloquially referred to as hui chun tang even when the pharmacy has another name or it may be known by the owners name as in hui chun Hua Tuo tang literally “Hua Tuo’s return to spring pharmacy”. It is also common to drop the character for “pharmacy” and simply have a sign in front of the store declaring Hui Chen “return to spring” which everyone knows refers to a traditional pharmacy.

The lack of trademark concerns in the East make the use of the term “return to spring” ubiquitous so many pharmacies will tout their lineage to show that they were established several generations past by famous doctors. Even this is an uncertain proposition for an unfamiliar person because many stores will usurp the famous name and while navigating a street you may see several stores proclaiming hui chen Hua Tuo Laodian “Hua Tuo’s original establishment”.

The Chinese pharmacy has several functions for their clientele, obviously the preparation of herbal medicines as prescribed by Chinese traditional doctors for their patients is foremost, but many pharmacies also have an onsite doctor so that a person can go in, have their pulse and tongue examined and be prescribed an herbal medicine on the spot. The herbal medicines vary from loose raw herbs that are taken home, boiled and drunk to pills, capsules, boluses and many other configurations of individually prescribed medicinal formulas.

The pharmacies also have their own brand of so called patent medicines that are good for anyone who wants to “return to spring” and maintain good health, these are over the counter medications without need for a prescription. These medicines are typically tonic formulas, that is, medicines that tone up or supplement specific organ functions and tissues. High on the list of this type of medicine are digestive formulas to improve nutritional intake, generally referred to as spleen tonics, medicines that improve the function of the kidneys and to promote sexuality and longevity, tonics for improved brain function and cognition called scholars tonics and medicines for calming the mind and improving sleep.

Atlantic Acupuncture has its own line of “return to spring” medicinals that are great supplements for any-body. Jian Fei Tang is our signature digestive formula to improve nutritional intake as a spleen tonic. Strength & Stamina is our medicine that improves the function of the kidneys and promotes sexuality and longevity. Brain Food is our scholar tonic promoting memory and cognition and Peace & Sleep calms the mind and improves sleep.

These four tonic formulas are available at our Vero Beach office and here on our online store. We urge you join the many others who have tried our formulas and felt the wonderful return to spring!

Yours in good health,

Robert Kienitz, DTCM

Chinese Medical Herbology 103

In medicine, the barometers of general health are mood and memory, energy and sleep, appetite, digestion and elimination. If these health indicators are regular and appropriate than there is health, if they are irregular they can be modified and usually quite easily.

Atlantic Acupuncture and Earth Wind Botanicals have developed four formulas that address the balance of all of these health barometers. We have designed four formulas that have a very broad therapeutic range and we use 5:1 concentrated granular herbal medicines to ensure maximum bioavailability and ease of use.

Strength & Stamina (S&S) is a tonic formula that nourishes kidney essence, promotes digestive functions, nourishes blood, protects the liver, enhances blood circulation, and calms the mind.

S&S is used for invigorating all organ functions and enhancing strength and endurance. S&S is an adaptogen and research shows that the herbal medicines in S&S; decrease stress levels, adrenal hypertrophy, and vitamin C depletion while increasing stamina.

S&S enhances immune system function, protects the brain, Increases bone density and strength. Protects the liver and increases levels of dopamine and nor epinephrine in the brain which are tied to mood and energy levels.

Runners given the key ingredients in S&S finished their 10-kilometer race in 45 minutes, versus 52.6 minutes in the placebo groups. Anyone who takes part in running knows that this is a huge improvement. Elite cyclists had a similarly profound effect with a 23.3% increase in total work performed and a 16.3% increase in time to exhaustion. This means the athletes not only worked longer but harder as well.

The trend here is simple: studies conducted with highly active, well-trained persons, and the ingredients in S&S consistently exemplified a profound ergogenic, performance-enhancing effect. In otherwise healthy persons, S&S reduced the changes in heart rate and blood pressure associated with states of chronic stress. In patients with chronic fatigue, the ingredients in S&S were found effective not only in reducing fatigue, but also in improving quality of life. In elderly subjects, S&S improved cognitive function, social functioning, and quality of life.

The ingredients in S&S have been shown to; increases strength, flexibility and bone density, lower resting heart rate, stabilize blood pressure, reduce LDL cholesterol, and improves microcirculation, peristalsis, decrease stress response while showing marked improvements in memory and concentration.

Brain Food is an herbal formula made up of the most effective balance of the finest and most potent brain enhancing herbal medicines and has the best potential for deterring all of the signs and symptoms that are associated with dementia, senility and Alzheimer’s.

The components of Brain Food have been extensively evaluated have been shown in clinical trials to treat attention deficit disorder and hyperactivity. This herb is also used to treat other kinds of brain dysfunctions, including epilepsy, mental retardation, and Alzheimer’s disease. Brain Food is shown to enhance brain functions by improving brain circulation. It has also been reported to be helpful in treating depression, peripheral neuropathy, and other blood circulation disorders.

Brain Foods constituents are antibiotic, anti-carcinogenic, and anti-diabetic. It also promotes endurance, regulates blood pressure, is anti-aging, protects the heart, liver and kidneys, reduces anxiety and depression, and greatly improves cognitive function. Benefits also include improved energy, better sleep, and improvement of digestive functions and all bowel conditions. Siberian ginseng invigorates blood circulation, lowers cholesterol, and is used to treat anemia, constitutional weakness, and helps offset conditions like macular degeneration, glaucoma and cataracts.

An Mian means peaceful sleep and in the diagnosis of disease in Traditional Chinese Medicine one of the important facts we need to know is if one has peaceful, uninterrupted sleep. Of the conditions we see at Atlantic Acupuncture, insomnia and other sleep issues are at the top of the list.

Both acupuncture and Chinese herbal medicine can help in the recovery of proper sleep and one of the herbal medicines we have developed that helps most people with sleep disorders is Peace & Sleep. This formula contains herbs that act as precursors to the manufacture of serotonin and melatonin in your body. By helping your body create its own supply of these hormones you are assured of a proper balance that cannot be achieved by taking the raw hormones from and outside source. This use of precursor herbs is fundamental to how Chinese herbal medicine works.

If the heart is not quiet the shen cannot abide there, if the heart is weak it cannot move the shen to the brain. If the body is malnourished there is no production of essence and if the brain is confounded by substances like alcohol and drugs including caffeine, nicotine and refined sugars the shen cannot settle and is not calm.

So the main reasons for insomnia and difficult sleep are weakness of the heart, improper diet and nourishment and the use of mind altering substances. All three of these causes are a response to stress.

When your body is sleep deprived, it goes further into a state of stress. The body’s functions are put on high alert, which causes an increase in blood pressure and the production of stress hormones. High blood pressure can increase your risk for heart attack and stroke, and the stress hormones make it harder to fall asleep. Learning relaxation techniques like meditation and Qigong can counteract the effects of stress and help you to fall asleep faster.

Jian Fei Tang is a very simple formula that has very complex number of bioenergetic functions. At its root, Jian Fei Tonifies Qi and strengthens the Spleen and Stomach to improve the transformation and transportation functions of the Spleen in cases of Spleen and Stomach Qi Deficiency.

Jian Fei is a Qi regulating formula with special focus on the Liver and its relationship with digestion and moving Qi evenly throughout the body. Because of this dual action we often use Jian Fei Tang as an adjunctive treatment in weight management protocols

Because Jian Fei is very balancing to the digestive system and the liver it has been shown to be successful in treating such bio-medically defined disorders as; chronic gastritis, gastric or duodenal ulcer, acid reflux, indigestion, vomiting, anorexia, irritable bowel, ulcerative colitis. Jian Fei also treats non digestive disorders like; hepatitis, irregular menses, premenstrual tension, uterine bleeding, leucorrhea, breast distention, pleurisy, neuropathy, neurosis, insomnia, optic nerve atrophy and retinitis.

You can purchase these formulas at our clinic in Vero Beach FL or here at our online store.

Yours in good health,

Robert Kienitz, DTCM

Chinese Medical Herbology 102

In our last blog we looked at the general principles of Chinese herbal medicine and how taste and flavor altered the properties of our herbal interactions. In this blog we will take a look at the movement of herbs and how they enter the channels and organs.

The actions of ascending, descending, floating and sinking refer to the upward, downward, outward or inward direction in which herbs tend to move through the body. Ascending action means moving or carrying the qualities of the herb to the upper parts of the body, head, neck, upper torso, while descending means just the opposite. Floating action means moving outward or sending to the surface, whereas sinking means going inside or purging away.

Ascending or floating herbs have an upward and outward direction and are used for elevating Yang, the motive warming aspect of bio energy. These herbs also relieve exterior syndromes like colds and flu by means of diaphoresis or sweating. These herbs dispel superficial symptom of wind and cold and can induce vomit or resuscitation.

Descending and sinking herbs have downward and inward directed actions and are often used for clearing heat and settling the mind. These herbs also purge, promote micturation, remove dampness, check the exuberance of Yang and redirect the adverse flow of Qi to stop vomiting. Descending herbs can relieve cough and asthma, improve digestion to remove stagnant food, and for herbs with heavy properties can be used for tranquilizing the mind.

Herbs of the same flavor generally have similar actions, while herbs of different flavors usually have quite different actions.

Channel Tropism

Channel tropism refers to an herb’s selective therapeutic effects on a certain part of the body. An herb may exert specific therapeutic action and physiological changes in certain channels and their related viscera, but with little effects on the others. For instance, among the heat-clearing herbs, some may clear the heat only in the lung channel and organ or in the liver channel or in the heart channel, etc. Also, among the tonics, some strengthen the lung while others strengthen the spleen or the kidney. The theory of channel tropism is summed up through clinical practice but the basic understanding is crucial to understanding the dynamics of herbal medicine.

The channel tropism theory should be associated with the theories of the four properties and five flavors and actions of Ascending, Descending, Floating and Sinking of herbs. Different herbs acting on the same channel have different effects owing to their different properties but herbs with similar properties can be used in con

So among the many herbs that clear heat we want one that also softens and purges phlegm we want to choose herbs that also have the action of outward movement and are focused on the organ and channel of the lungs.

Herb Toxicity

 Some herbs are labeled as slightly toxic, toxic, extremely poisonous or deadly poisonous these indicate that the therapeutic dosage of those drugs approaches the toxic level or is already within range of a toxic dosage and an over-dosage may lead to a toxic reaction. The toxic identifier may also indicate that an herb may give rise to severe side effects within this therapeutic dosage. The prerequisite concern is always safety for poisonous herbs and the toxicity of poisonous herbs can be eliminated or lessened by means of processing, dispensing and preparation.

Attributes and Actions of Herbs

The eight therapeutic methods are to promote sweating (Han), induce vomiting (Tu), purge (Xia), harmonize (He), warm (Wen), clear (Qing), tonify (Bu) and reduce (Xiao).

In the application of herbs, rarely is a a single herb is used alone and most often two or more herbs are used together. Using one herb to treat the disease is called going alone, single effect or Dan Xing.

The combined application of two or more herbs are known as mutual reinforcement, mutual assistance, mutual restraint, mutual detoxification, mutual inhibition or incompatibility. These expressions are referred to as the seven features of combined herbs.

Mutual reinforcement (mutual accentuation, Xiang Xu) Herbs of similar characters and functions are used in coordination to strengthen their effects.

Mutual assistance (mutual enhancement, Xiang Shi). Herbs that are similar in certain aspects of their characters and functions can be used together, with one as the principle and the other as subsidiary, to help increase the effects of the principle.

Mutual restraint (mutual counteraction, Xiang Wei). When herbs are used in combination, the toxicity and side effects of one herb can be reduced or eliminated by the other.

Detoxification (suppression, Xiang Sha). One herb can lessen or remove the toxicity and side effects of the other.

Mutual inhibition (mutual antagonism, Xiang Wu). When two herbs are used together, they inhibit or check each other to weaken or even lose their original efficacy.

Mutual incompatibility (Xiang Fan). When two herbs are used in combination, toxicity or side effects may result.

When two or more herbs are needed, they are chosen carefully according to the conditions of the patient, and the characters and function of herbs.

Mutual reinforcement and Mutual assistance make herbs work in coordination and enhance their effects, and therefore, should be employed as much as possible. Mutual restraint and Mutual detoxification can reduce or eliminate toxicity and side effects of herbs, and therefore, can be considered when using poisonous herbs.

Mutual inhibition and Incompatibility will weaken efficacy of herbs, or make them lose their efficacy, or even give rise to toxicity and side effects, and therefore, should be avoided.

Atlantic Acupuncture’s goal is to provide education and therapeutic support for people who are interested in alternatives to conventional medical models and modalities. As part of our ongoing educational outreach we are publishing a series of articles on acupuncture, herbal medicine, meditation and Qigong to help our patients and friends develop a greater understanding of the dynamics of Traditional Chinese Medicine.

In our next segment we will look at four botanical formulas that cover a myriad of conditions and concerns.

Yours in good health,

Robert Kienitz, DTCM

Chinese Herbology 101

Atlantic Institute is the parent company of Atlantic Acupuncture, Earth Wind Botanicals and Prof. K Enterprises. Our goal is to provide education and therapeutic support for people who are interested in alternatives to conventional medical paradigms and modalities. As part of our ongoing educational outreach we are publishing a series of articles on acupuncture, herbal medicine, meditation and Qigong to help our patients and friends develop a greater understanding of the dynamics of Traditional Chinese Medicine.

Herbal medicine is the primary foundation for the theory of Traditional Chinese Medicine. Until very recently, little information was available to the Western world regarding the practice of this medicine that existed since prehistoric times in China. Archeological evidence demonstrates that at the dawn of Chinese history, before the second millennium BCE, The primary health care providers were Shamans (Wu). This is true for all cultures throughout the prehistoric world.

Among the first written medical works on this planet was the Yellow Emperor’s Inner Classic (Huang Di Nei Jing also known simply as the Inner Classic), compiled by unknown authors between 500 BCE and 100 CE, during the period of Chinese Spring-Autumn Fighting countries. Also known as the Warring States Period this was the time period during which formal Confucianism, Taoism, Medicine and other Philosophies appeared in standardized written form.

The Inner Classic is divided into two sections, Basic Questions (Su Wen) and Miraculous Pivot (Ling Su), Ling Su is also called the canon of Acupuncture.

Foundation of Materia Medica

The Divine Husbandman’s Classic of the Materia Medica (Shen Nong Ben Cao Jing), also known as the Classic of the Materia Medica (Ben Cao) was the first written iteration of herbal research and the empirical processing of medicinal herbs. The Ben Cao was first developed to elucidate the secrets of longevity, primarily for the Imperial Court, and was compiled by unknown authors between 221 BCE and 200 CE.

The “great grandfather” of Herbal prescriptions was Zhang Zhong Jing; a  doctor in the Eastern Han dynasty (300 CE). His book Jin Kui Yao Lue (Synthesis of Prescriptions of Golden Chamber) contains 260 Herbal prescriptions. Prior to this time only single herbs were known to have been prescribed for illness.

The Ben Cao was a compilation of 361 medicinals that were mostly herbal in nature along with some animal and mineral sources. Medicines were classified by seven types, also called the seven forests. They were Jades and Stones, Herbs, Woods, Animals, Fruits, Vegetables and Cereals. Compare this number to contemporary volumes of the Materia Medica which list ten times as many medicinal substances all of which we loosely refer to as “herbs”.

General Principles

 Each herb has its own specific nature or character. The different natures of herbs are employed to treat diseases, rectify the hyperactivity or hypo activity of Yin or Yang, and help the body restore its health. The various natures and functions of these herbs concerning medical treatment include the herbs properties, flavors, actions (lifting, lowering, floating and sinking), channel tropism, toxicity, etc.

It needs to be understood that these principles of herbal medicines are true for Indian Ayurvedic herbs, European and North American herbs and any other herbs on the planet that can be used medicinally. The key is to use one’s knowledge of herbal medicines to decipher the nature, function and tropism of any herb, and translate that into the language of TCM.

Properties and Flavors of Herbs

 Properties and flavors are also known as the Four Qi and the Five Tastes. Every herb has its property and flavor. “Properties” or the Four Qi refers to the cold, hot, warm or cool nature of an herb. These properties of herbs are sorted out according to the different actions of the herbs on the human body and their therapeutic effects. For example, herbs which treat heat syndromes (Yang syndrome) have a cool or cold property, whereas herbs which treat cold syndromes (Yin syndrome) have warm or hot property.

Herbs of cold and cool natures and herbs of warm and hot natures are of opposite properties. A cold-natured herb is different from a cool-natured one only in degree, as is a warm-natured herb from a hot-natured herb. Herbal medicine is therefore allopathic medicine in that medicines are used to treat diseases that have the opposite nature. This is contrary to the concept of homeopathic medicine in which, for instance, a substance that produces fever like symptoms is used to treat febrile conditions.

“Flavors” or the Five Flavors of herbs are pungent, sweet, sour, bitter, salty, tasteless and astringent. Since sweet and tasteless usually correspond, and since sour and astringent herbs have the same effects, pungent, sweet, sour, bitter and salty tastes are the cardinal flavors and are known as five flavors.

The flavors don’t necessarily refer to the actual tastes of the herbs. Sometimes they are sorted out according to herbs actions as opposed to what the tongue actually tastes.

Pungent flavors disperse and circulate, and are for symptoms that are superficial or mild and tend to enter the lung. Herbs that are pungent in flavor have the effects of dispersing exo-pathogens from superficial aspects of the body and promoting the circulation of the vital energy and blood. Pungent herbs are usually used for the treatment of superficial and mild illness that are due to affection by exo-pathogens, stagnation of vital energy and blood stasis. Pungent herbs tend to have warm or hot natures.

Sweet flavors nourish and tonify or harmonize other drugs and relieve pain. Sweet flavor herbs typically enter the spleen and stomach. Herbs of sweet flavor have the effects of nourishing, replenishing, tonifying, or enriching the different organs or parts of the body, normalize the function of the stomach and spleen, harmonize the properties of different drugs and relieving spasm and pain. Sweet herbs tend to have warm natures.

Sour flavor herbs are astringent and usually enter the liver. Herbs of sour flavor have the effects of inducing astringency and arresting discharge. Sour herbs tend to have cool natures

Bitter flavor herbs clear heat, purge fire, correct the flow of Qi and enter the heart. Herbs of bitter flavor have the effects of clearing heat, purging fire, sending down the adverse flow of Qi to treat cough and vomiting, relaxing the bowels, eliminating dampness. Bitter herbs tend to have cold natures.

Salty flavor herbs purge, soften, and enter the kidney. Herbs of this taste have the effects of relieving constipation by purgation, and softening and resolving hard mass. Salty herbs tend to have cool to cold natures.

Tasteless or neutral flavor herbs eliminate damp and are for the urinary system. Neutral flavor have the effects of excreting dampness and inducing diuresis, and are commonly used for edema, disurea and others. This class of herbs is linked with sweet flavor herbs because they both focus on disharmonies related to the spleen and stomach. Neutral herbs tend to be slightly cool or warm in nature.

Astringent herbs are sour in nature. Herbs of this flavor have similar actions as those of sour flavor, are functionally interchangeable with them, and tend to have cool natures.

We mix and match the various flavors of herbs in order to provide a more complete therapeutic experience and to eliminate the potential for negative side effects. For instance, if we are using salty and bitter flavored herbs to relieve blockage due to an internal heat we would include in the formula some warming and moistening herbs to prevent the potential development of internal cold and dry causing constriction and blockage.

In our next segment we will look at the actions and “channel tropism” of herbal medicines.

Yours in good health,

Robert Kienitz, DTCM

So, Ya Wanna Live Forever?

While many are familiar with the herbs and acupuncture of traditional Chinese medicine, few understand the larger picture of what TCM is and how it came to be. There are several paths that have been taken in the development of this medicine, one path was and is to help an individual maintain good health and freedom from disease.

Another path is to ensure as long a healthy life as possible in order to develop the assets of the body mind toward a goal of spiritual and mental fulfillment. The goal of the Court Physicians throughout the history of China’s dynasties was to ensure the health of the emperor and the royal family but even more so to give the emperor the ability to remain strong and mentally bright throughout his long life.

Longevity and immortality were sought as a prize not simply to ensure a long dynastic reign, but also to promote the highest potential for the emperor.

Herbal medicine for the imperial court was largely the use of exotic herbs and minerals like jade, ginseng, cinnabar and antlers to create a state of “exceedingly good health” and long life.

But, why live so long?

The basic paradigm of our medicine is that from the food we eat and the water we drink, we collect sufficient nutrient to grow and nurture our physical body. The mechanism is that when we ingest food and drink it is sent to the stomach to be processed and subdivided, the pure usable substance is sent to the spleen for further processing and the mostly turbid matter is sent to the small intestine. At the spleen the pure usable substance is further processed and subdivided, the purer substance is sent on to the lungs while the more turbid matter is also sent to the small intestine.

In the small intestine the turbid substances are again processed and subdivided, the pure sent back up to the spleen and the turbid to the large intestine.

In the lungs the pure substance is again subdivided, pure fluid from pure substance. The pure fluid is transported by the lungs and “misted” throughout the body moistening the organs and tissues. The pure substance is alchemically mixed in the lungs with the clear air qi that we breathe and is transformed into blood.

The blood is carried by the heart to nourish the other organs and tissues. The blood, which is always replete in a healthy body, stores in the liver and some of that stored blood is transformed into qi, the warming and animating substance of the body. The motive functions of the qi move the blood and the blood, by nourishing the liver, creates more qi.

At this point the body is in harmony and all of the organs and tissues are suffused with qi and blood. If the diet and fluids that are taken in are of high quality and sufficient quantity any surplus of blood and qi will be stored in the kidneys and become jing or vital essence.

The kidneys store the jing essence like a battery stores electrical potential and when the jing itself becomes replete it is further transformed and rarified.

Through the combination of mind will, breathing techniques and physical movement the vital essence that is stored in the kidneys is transported up, through the spinal column to the “lucid orifice” i.e. the brain, where it becomes shen.

Mind will is the collective term for mental concentration and visualization, it is not enough to think a thing, one must also envision the thing. The most common way of thinking about this is a meditative mind but it is more than that because mind will asks the practitioner to see the process, of jing traveling up the spine for instance, in the mind’s eye.

Breathing techniques can be the regulated breathing of meditation but can also include the synchronized breathing of calisthenics or even running.

Physical movement is usually thought of in terms of Chinese yoga or dao yin, qigong and tai chi but so called external martial arts like kung fu and running can be used as the physical movement for this part of the triad of the movement of jing.

There are several types and kinds of shen which can refer to the complexion and general healthy demeanor of the body as well as the brightness in the eyes that shows us that “someone is home”.

Shen in its highest sense is consciousness and it is the natural inclination of human beings to expand their personal consciousness for the good of the self, the species and the environment.

Since ancient times the search for longevity foods, elixirs, exercises and spiritual practices has been to create a temporal platform in which the shen could thrive and the consciousness could grow to its fullest.

Atlantic Acupuncture offers herbal medicines like Brain Food and Strength & Stamina to encourage a state of “exceeding good health” and exercises and breathing techniques like Jade Dragon Qigong and Tai Chi. We also offer individualized programs for the enhancement of the body mind and the development of shen.

Yours in good health,

Robert Kienitz, DTCM


Cornell-China-Oxford Project

In the early 1980’s, nutritional biochemist Dr. T. Colin Campbell of Cornell University, in partnership with researchers at Oxford University and the Chinese Academy of Preventive Medicine, embarked upon one of the most comprehensive nutritional studies ever undertaken known as the China Project.

China at that time presented researchers with a unique opportunity. The Chinese population tended to live in the same area all their lives and to consume similar diets unique to each region. Their diets (low in fat and high in dietary fiber and plant material) also were in stark contrast to the rich diets of Western countries. The truly plant-based nature of the rural Chinese diet gave researchers a chance to compare, among other things, plant-based diets with animal-based diets.

Sixty five counties in rural China were selected for the study and dietary, lifestyle and disease characteristics were studied. Within each of the 65 counties, 2 villages were selected and 50 families in each were randomly chosen. One adult from each household (half men and half women), 6,500 people aged 34-64, for the entire survey, participated. Blood, urine and food samples were obtained for later analysis, while questionnaire and dietary information was recorded. The same counties and individuals surveyed in 1983-84 were re-surveyed in 1989-90, with the addition of 20 new counties in mainland China and Taiwan, and 20 additional families per county, for a total of 10,200 adults and their families.

The Project compared the eating habits the Chinese with the same number of Americans and Britons. This is the largest study, of any kind, ever undertaken. Ninety percent of the Chinese subjects were provincials who ate locally and followed a traditional diet.

Some of the findings of this study were:

  • Rural Chinese consumed many more grains, vegetables and fruits than the average American or Briton.
  • Daily fiber intake for the rural Chinese was three times higher than the average American.
  • The average Chinese derived 6-24% of their daily calories from fat vs. 39% for Americans and 45% for Britons.
  • In most Chinese provinces in this study people ate meat only one time per week. In counties where meat consumption was higher, incidence of cardiovascular disease was proportionately higher.
  • Rural Chinese ate more total daily calories per pound of body weight than their American counterparts did but virtually no obesity was reported.
  • The average Chinese serum cholesterol level was 127 (milligrams per deciliter) vs. 212 in the U.S.
  • Rates for chronic degenerative disease were overall much higher in the U.S. than in rural China but, in the areas of China where more meat products were consumed, rates of chronic degenerative disease were also on the rise.
  • It was noted in the second phase of the study that many previous participants had relocated to urban areas of China and because of the prevalence of western dietary culture in those cities the incidence of heart disease and other degenerative diseases were increasing.

There are a lot of people who extrapolate from this research that we should all become vegetarians or vegans but there is nothing further from the truth.

The reality is that the theory of the Chinese dietary therapy has one simple axiom that guides the rest of the theory, “eat a little bit of everything and not too much of anything”. The theory holds that if one eats from a wide variety of foods, not over-consuming any one thing, the full range of dietary therapy is made available and there is little or no need for remedial supplementation like vitamins and minerals.

Foreign visitors I have known coming to America for the first time are startled and amazed by our grocery stores, it is mind boggling to them that in out produce sections one can purchases any fruit or vegetable, locally in season or not. You can get a pineapple 365 days a year, and at a reasonable price. The problem most of us have is that we do not make use of the vast richness our local groceries provide, we tend to eat very few of the same fruits and vegetables year in, year out and that mundane diet makes for an unhealthy body.

The most frequently asked question by patients in my Vero Beach practice is, “what diet I should follow?” My answer depends a lot on what your diet is like now. The main things to consider are the ratios of foods you are eating. This is also the simplest way to modify your diet because it may only require you to change the quantity of foods you are eating as opposed to the types of foods you are eating.

In your mouth there are four basic types of dentition or teeth that perform three basic functions, half the teeth in your mouth are of the premolar, incisor and molar variety. These teeth are most useful in masticating or chewing fibrous foods that are of the fruit and vegetable variety. The canines and incisors make up about one fourth of your dentition and are useful for ripping and tearing meat. The third group of teeth is; the premolar and molar variety that are useful for grinding grains, seeds and nuts. The three types of dentition overlap in function and make it possible for us to be what we are: omnivorous, that is, we can eat just about anything we can fit in our mouth.

Simple logic implies that if our dentition is structured so that half our teeth are for fruit and vegetable matter, one fourth for seed, nuts and grain and one fourth for meat, then we should be following that as our basic dietary pattern.

My advice is simple and straight forward, let half of your daily caloric intake come from fruits and vegetables, fresh is best, as is wide variety. Let one fourth of your daily caloric intake come from grains, seeds and nuts (breads and pastas are included in this category), and let one fourth of your daily caloric intake come from protein sources (which include meat, poultry, dairy and some legumes).

The next question you have should be, “what is my optimum daily caloric intake?” The answer is “who are you and what do you do?” If you are a large person, 180 – 220 pounds for instance, and you have a sedentary job and home life you may only really need 1200 – 1500 calories per day for simple maintenance. If you have the same body type but you work high steel all day and train for triathlons at night you may need upward of 3000 calories per day for maintenance. The Food and Drug Administration has touted a 2000 calorie a day diet across the board for everyone the last thirty years and we are a nation of obese people as a result of it.  The FDA has also promoted that two thirds of your 2000 calorie a day diet come from grain products and we are a nation of hypoglycemics as a result of it.

I advise you to ignore the food pyramid in favor of the food circle, and as your mother used to say, “Eat your vegetables!”

Yours in good health,

Robert Kienitz, DTCM


You are getting sleeepy…

An Mian means peaceful sleep and in the diagnosis of disease in Traditional Chinese Medicine one of the important facts we need to know is if one has peaceful, uninterrupted sleep. Of the top conditions we see at Atlantic Acupuncture, insomnia and other sleep issues are at the top of the list.

A good night’s sleep makes you feel energized and alert the next day. Being engaged and active feels great and increases your chances for another good night’s sleep. When you wake up feeling refreshed and use that energy to get out into the daylight, do active things, and engage with your world. You’ll sleep better the next night and increase your daily energy at all levels. But why is that?

The TCM explanation of sleep is that the shen (mind/spirit) is produced by an abundance of jing (essence) in the body that is the result of normal physiological processes. The jing is produced mainly in the kidney and is transported to the brain via the heart along regular meridian pathways. Sleep is the nocturnal travel of shen to the heart and the jing from the kidneys to the heart to restore and refresh the shen.

If the heart is not quiet the shen cannot abide there, if the heart is weak it cannot move the shen to the brain. If the body is malnourished there is no production of essence and if the brain is confounded by substances like alcohol and drugs including caffeine, nicotine and refined sugars the shen cannot settle and is not calm.

So the main reasons for insomnia and difficult sleep are weakness of the heart, improper diet and nourishment and the use of mind altering substances. All three of these causes are a response to stress.

When your body is sleep deprived, it goes further into a state of stress. The body’s functions are put on high alert, which causes an increase in blood pressure and the production of stress hormones. High blood pressure can increase your risk for heart attack and stroke, and the stress hormones make it harder to fall asleep. Learning relaxation techniques like meditation and Qigong can counteract the effects of stress and help you to fall asleep faster.

Increased stress hormones caused by lack of sleep also raise the overall level of inflammation in your body. This again can create a greater risk for heart-related pathologies, as well as cancer and diabetes. Inflammation in fact, is thought to be one of the chief causes of physical deterioration as we age.

Sleep also plays an important role in a process called memory consolidation. During sleep, your body may be resting, but your brain is busy processing your day, making connections between events, sensory input, feelings, and memories. Deep sleep (Rapid Eye Movement or REM sleep) is a very important time for your brain to make memories and links, and getting more quality sleep will help you remember and process things better.

It has been found that people who sleep fewer than 7 hours per night are more likely to be overweight or obese and it is thought that a lack of sleep impacts the balance of hormones in the body that affect appetite. The hormones ghrelin and leptin, which regulate appetite, have been found to be disrupted by lack of sleep. If you want to maintain or lose weight, don’t forget that getting adequate sleep on a regular basis is a huge part of the equation.

Sleep impacts many of the chemicals in your body, including serotonin. People with serotonin deficiencies are more likely to suffer from depression. You can help to prevent depression by making sure you are getting the right amount of sleep: between 7 and 9 hours each night.

Sleep is a time to relax, but it’s also a time during which the body is hard at work repairing damage caused by stress, ultraviolet rays, and other harmful exposure. Your cells produce more protein while you are sleeping. These protein molecules form the building blocks for cells, allowing them to repair the damage. Sleep is crucial for athletes because this is the prime time for tissue recovery.

Both acupuncture and Chinese herbal medicine can help in the recovery of proper sleep and one of the herbal medicines we have developed that helps most people with sleep disorders is Peace & Sleep. This formula contains herbs that act as precursors to the manufacture of serotonin and melatonin in your body. By helping your body create its own supply of these hormones you are assured of a proper balance that cannot be achieved by taking the raw hormones from and outside source. This use of precursor herbs is fundamental to how Chinese herbal medicine works.

Peace & Sleep is available at both our Vero Beach clinic and our online store.

Wishing you peaceful sleep for good health,

Robert Kienitz, DTCM