söndag 11 december 2011

Acupuncture, winter treatments, and Shakespeare´s views on moxa

We are heading into winter, the first shift has come and gone. Now the cold is coming: there´s a smell of snow in the air like a whisper from our past. In this post we are going to look at winter, and how chinese medicine sees it and treats patients in it. If you want to get more out of this text I recommend you to read the previous post about autumn, where we talked more about the Daoist/Taoist skills in blending with the seasons and how their view on natural change has become one of the fundamental building-blocks of Chinese medicine.

The time for stillness is here.
  But just when we think about stillness we discover the hidden knowledge of Fire in Water; of joy in winter, and how these lessons should be studied deeply to make our internal winter warm. With the Midwinter Solstice on December 21st a new year begins; here is the deepest Water meeting the first of Fire. Then comes the long cold months where we need to nourish our own Fire too, while each day brings a little bit more of the life and growth of Wood in a new spring.
  A curious thing is that later in this post, we will see that even though most know that Chinese medicine has been doing these treatments for more than 2000 years, surprisingly few know that Shakespeare talked about using moxa and acupuncture to treat the cold of medieval English winter...

Winter is a time of rest.
  Well, no, not really.
  It should be a time of rest. But in the 1st world industralized society this is rarely the case.We can change that quite easily of course, and if we are smart we do – it is very important for our systems to rest during winter. The amount we rest now will strengthen and heal our health for the entire next year. And in the long run, the amount we rest in winter will help heal our health throughout our entire life.

In Chinese medicine and Daoism, winter is linked to the Water Element. The Water Element includes the functions and health of our kidneys, adrenals, urinary bladder and bones. The Water Element governs the function of the entire lower body, including the area of lower back, sexual health and ability, hips, knees and feet. When it comes to emotions it covers fear and, often forgotten in lists like these, the incredibly important ability to savor and enjoy life – joie de vivre. We will look at the Water Element in Chinese medicine and Daoism more in depth in a future post. But one important facet of it as part of winter is that the kidneys and Water links to long-term memory and the roots of yuanqi, the bank of energy we are born with, and which should last our entire lifetime.
  In Chinese medicine, the kidneys are the very root of our life, and winter is the best time to regenerate and heal them.

Here is one of the core texts on the subject of winter in Chinese medicine from the Neijing, from about 2300 years ago:

In the three months of winter, all grasses and most of the trees are withered, the insects are in hibernation, the water ices up and the ground is frozen with gaps. Things mostly are shut up or go into hiding to guard against the cold. It is called the season of ”shutting and storing”. In this period, one should be kept warm in the room, dress warmly and take strict prevention against the cold, so that the Yang energy may not be disturbed; he should get to bed early in the night and get up late to wait for contacting the sunlight; keep the spirit hiding and subsiding, like having a secret you don´t tell anyone, or an idea in mind already for meeting the situation. Since the weather is cold in winter, one should avoid the cold and move toward warmness, prevent the skin from much perspiring to guard against the consumption or exhaustion of Yang energy. These are the ways of preserving health in winter. If these principles are violated by a person, his kidney will be hurt, as the kidney associates with water and water is prosperous in the winter. If one fails to adapt to the property of winter energy which is ”storing”, she will be apt to contract muscular flaccidity and coldness of the muscles in spring. This is becaue the adaptability to spring energy has been weakened due to his inability of following the property of winter energy which is ”shutting and storing” to preserve health.
            – Huangdi Neijing, all quotes are from the Wang Bing version, 762 AD, Tang Dynasty, Yellow Emperor´s Canon of Internal Medicine, translated by Wu and Wu, China Science and Technology Press, 2005, page 15, chapter 2, On preserving health in accordance with the Four Seasons

Winter is the time for quiet, rest and regeneration. The Neijing really talks about simple common-sense things; keeping warm in winter, resting more, protecting both our body and spirit so they can rest undisturbed. This is important to help support and preserve our health for the next year. Someone who burns the energy in winter is in actual fact also burning some of their store for health for the entire next year. If a person does this every winter, they will burn energy in the long run of their life too, something that can decrease energy on deeper levels and create ripple-effects on our health that become more serious.
  Yuanqi, Original Qi, is the core energy of a person´s entire life. It´s like a bank-account we are born with, and it has its home in the kidneys. If we take care of this nest-egg it allows us to both enjoy life and live it with good health. We are supposed to live it up, that´s what it´s there for – but if we start taking out higher and higher sums at the ATM every day, we will lose energy that was meant to keep us healthy and able to live life well into old age.

Now, let´s look a bit at channels and organs. The warming protection during winter is linked to the division in the body called the Taiyang channels (”Great Yang channels), primarily the Bladder channel which is a pair with the Kidney channel in the Water Element. The Taiyang division covers almost the entire back of our body, and the Bladder channel goes from our little toe and then in pathways all the way along the back up to the head.
  In the Water Element, the Bladder also releases old fears that might bind us, our life and our destiny. The Bladder is about releasing excess fluid and waste through urine, but also in releasing old fears so we can leave them behind us and the kidneys can regenerate and move on without being burdened by them.
  The Bladder channel has a wide variety of applications but is commonly used in treatments for the lower back, back, nourishing the body and freeing the shen. It is also used exactly to release old fears and old problems stuck in the body to make us more free and our movement through life lighter.

Chinese medicine uses a few different levels to treat someone during winter.
  One is a patient whose system is badly affected by the change into winter, or who is affected the deeper they move into it. Someone whose system is unprotected and lacks internal energy to support their weiqi (Defensive Energy, see earlier post) and who feels the cold badly is one example. Someone who suffers from winter depression in the dark is another. Both are fairly easily treated with acupuncture and moxa.
  The second version would be to treat a patient to move more easily with winter. This is more of a seasonal treatment that focuses on helping us move with the change of seasons. Doing this kind of treatment means that the patient moves more easily with the season they are heading into, and their health moves with it more in balance rather than fighting it.
  The second easily moves into the third: to enjoy the season fully. This becomes part of the first two to a certain extent, but can be done more than that to balance the person´s system or nourish things in it to let them enjoy the season more. This goes partially into Daoist medicine (daoyi) and its uses of acupuncture, moxa and diagnostics, and is not always found in standard Chinese medicine (TCM), or even Classical Chinese Medicine (CCM).
  All treatment-possibilities depend on the health of the patient. What version can be done depends on where they are and what treatment their system can support in a balanced way. Someone who already is healthy can go for version three, but someone who turns up with version one will just move better with the season in much better health than they otherwise would. For them, that will be version three compared to how they otherwise would feel, and they get a chance to avoid negative effects that could hit their health as winter shifts into spring and the Wood Element. If one has a bad time with a previous season, problems often move along and deepen in the next one.

To make the Water Element a bit more alive for you, here is a good quote about both Water and the winter:

Water is as subterranean as an underground stream, as dark and fertile as the womb, as enduring as the jade-colored sea. Water ascends to fullness in the frost of winter as plants sumbmerge their energy into their roots, as matter and energy concentrate. This is a time of apparent quiescence and stasis, yet beneath the surface is the hidden activity of gestation and germination that will bring forth renewal in spring. Before seeds and bulbs germinate, they demand a spell of chilly slumber. During this period of hibernation the essence of life persists in its most primitive state. The bear huddled in the corner of a darkened cave may be mistaken for dead except for his subtle warmth and slow, shallow breath. During winter he lives from accuulated reserves, resting until aroused by the hunger that swells as spring signals the intense activity of a new cycle. The Kidney abides within us like the bear in its cave, harboring the germ of being, the Essence, that feeds and renews our life force.
        - Between Heaven and Earth, Beinfield and Korngold, Ballantine 1991, p218, chapter 12, Water

An interesting facet of our kidneys and their energy is what is called root.
  The meaning of this word varies depending on if it´s used in Chinese medicine, Daoist practices, qigong, Internal martial arts (IMA) – and even when talking about different organs and emotions inside Chinese medicine itself.
  Yuanqi, ”Original Qi”, is the bank of energy we are born with. It resides in the kidneys and is the root of our life. But root is also physical in us, in our ability to be rooted in our life and in our feet, on the ground we walk, in where we are in life – strengthening this is part of the core practices in qigong, Tai Chi and Daoist spiritual work. Getting better root makes us more stable in our emotions, more able to stand where we stand and stand our ground when someone else pushes us, whether it is a physical or emotional push. If you have good root, your reaction to other people´s emotions or projections becomes much more stable.
  Part of the root in our kidneys is the place where we grow up. Someone who is forced from their home can get a deep shock to their kidneys, and a refugee can sometimes still have part of their energetic root back in their home country. This can have a bad effect on our health. Sometimes it heals well – a new root is put down for mind and body in the country they move to, but sometimes it doesn´t work. Both instances will affect the kidneys and other systems in us, and can be treated to heal better and make the person more of one being again, with less fractures in both body and mind.
  Winter is the time to regenerate and heal all kinds of root. If we can rest more in ourselves and more in one place than usual, we let our root heal and our system become more stable, both for next year and for the rest of our life.

And in the midst of that stillness there should be fire and warmth, the fire of a warm hearth in the middle of the house, the fire of good conversation, the fire of festivities that light up both us and the winter darkness.
  The Water Element in us is dependent on the Fire in us working well. This makes the energy of Water become fluid and alive, with steam and warmth and movement, makes it free and flowing; without the warmth of the Fire Element Water risks becoming stagnant, still, cold, stubborn and stuck in one place. Then the concept of root becomes dominated by fear instead, and the Water Element doesn´t move at all, just becomes stuck and stuck with fear in one place.
  In acupuncture this dance is seen between the kidney, bladder, and the Sanjiao, the Triple Burner (see previous post on the Sanjiao) – the organ that is no organ but instead an energetic function that weaves through our entire body and literally weaves us together. It is part of the Fire-side of the Water Element and makes sure it moves warmly and freely through the body.

The dance of Fire and Water teaches us how to enjoy life. In the middle of the darkness of winter, this is the friends we talk to; Christmas dinners (preferably with very little stress, or at least less stress, if that can be arranged) and the image of the old big hearth-fire that people sat around in the house or the hall, weaving tales and stories that brightened the darkness of winter nights.
  Part of balancing Water and making it alive all through the year is to enjoy food, sex, life – just enjoying things as fully as we can. This needs to be balanced with the rest of our system; if it becomes too much, it will instead burn kidney energy and deplete our resources. Like Daoism has been teaching since before Chinese medicine began: it´s all about balance.

Talking about warmth in the cold of winter now brings us to moxa. Moxa, mugworth in English, (på svenska, gråbo) is a herb which is lit and then gently smoulders to spread warmth and nourishment into a patient. It has been used in Chinese medicine for many thousands of years. You can see a sample video of a treatment done here:

Moxa is used all year around, but during winter it really helps patients who are affected by the cold and the dark. It can treat uncountable problems but shines even more during cold and damp seasons. Some quotes from my patients this week who had moxa during treatments were ”That is amazing...I feel so soft and warm now”, ”Wow, that feels great”, and, said one who easily gets winter depressions, ”I feel really good now, the winter doesn´t affect me as much as before”. We will write more about moxa in posts to come here on Acupractitioner21.

Curiosly enough, and fascinating to those who study Chinese medicine history as well as English Litt studies, we here at Small Change have found little-known proof that Shakespeare himself not only knew about acupuncture and moxa, but seems to have been positive to them both – maybe from personal experience...

First, from Richard III:

SCENE: England

King Richard the Third


SCENE I. London. A street

[Enter GLOSTER.]

Now is the winter of our discontent -
My Lord, those ill humours
wracking your countenance divine
can be treated! Ere tomorrow, my hands
could treat your body with no leeches,
only herbs, needles, warmth to drive that winter out!

[Enter CLARENCE, guarded, and BRAKENBURY.]

Sir, I am most astounded by your tales.
The grimness of my mind could with physic´s trade be treated?
Ah, brother, good day: what means this armed guard
That waits upon your grace?

His majesty,
Tendering my person's safety, hath appointed
This conduct to convey me to the Tower.
Who may this be? I know not your face.

Upon what cause?
A physic, brother, he claims to know treatment
for ill humours of my Winter´s mind.

Because my name is George.
Well, tell me then,
can your physic treat an ailment such as mine?
Treat the fallen balance of a name?

No, my grace, for even though my skill
runs ´twixt Heaven and Earth, no man
can change fate or tempt the waves of destiny
that endows us with our gifts and challenges.
But to treat – there I find no fault in training, nor
in limber hands,
nor in mine ability to feel the energy of living things.

Alack, good doctor, that fault is none of yours;
He should, for that, commit your godfathers:--
O, belike his majesty hath some intent
That you should be new-christen'd in the Tower.
But what's the matter, Clarence? may I know?
Perchance the physic still can treat it?

Yea, Richard, when I know; for I protest
As yet I do not: but, as I can learn,
He hearkens after prophecies and dreams;
warm-hearted needles lit by moxa perchance
could treat him too - ´tis no misrule of destiny
that this acupuncturist is here.

Further mentions of moxa and acupuncture in Shakespeare´s texts can be found in many places, including in the Tempest:

That´s my noble master.
What shall I do?
Say what; what shall I do?

Go make thyself like smoke of moxa, be
To no sight but thine and mine; invisible
To every eyeball else: go take this shape
And hither com in´t: go: hence with diligence!

And, famously, of course, in Hamlet´s soliloquy:

To moxa, or not to moxa – that is the question:
whether ´tis nobler in the mind to suffer
the slings and arrows of outrageous fortune
or to take needles against a sea of troubles
and by opposing end them. To treat, to be healthy -
no more – and by treat say we end
the heartache and the thousand natural shocks
that flesh is heir to. ´Tis a consummation
devoutly to be wished.

Students of Old English will be quite at home with the mentions of moxa and acupuncture in texts such as Beowulf, Deor, the Seafarer, the Battle of Maldon etc. In OE moxa is moxen (n). It is also mentioned in treatment protocols for the anchoresses in Ancrene Wisse. Some of the more common Old English names for acupuncture are scinn naedl (skin-needle, probably because the earlier needles were thicker, and hence didn´t go too deep); gold naedl, gold-needle, like the gold-needles that existed early in China, and moxen for moxa, or forst-wearm (frost-warm), sometimes combined to moxen forst-wearm.

Here we see a clear mention in the poem The Ruin, emphasizing how important they thought moxa and acupuncture was in that day:

Wall stood,
grey lichen, red stone, kings fell often,
stood under storms, high arch crashed -
stands yet the wallstone, hacked by weapons,
by files grim-ground...
...shone the old skilled work
...sank to loam-crust.

Moxa quickened mind, and a man of wit,
cunning in rings, treated by needles,
bound bravely the wallbase
with iron, a wonder.

Bright were the buildings, halls where springs ran,
high, horngabled, much throng-noise;
these many mead-halls men filled
with loud cheerfulness: weird changed that.

Came days of pestilence, on all sides men fell dead,
death fetched off the flower of the people;
where they stood to fight, moxa healed,
needles treated, those lacking - waste places
and on the acropolis, ruins.

(almost correct excerpt from The Ruin, in The Earliest English Poems, transl. Paul Alexander, Penguin Classics 1966)

But enough of this gentle Christmas tounge-in-cheek-look at old and brilliant litterature. We can discuss the various aspects of the Water element and channels and treatments and effects for a long, long time and still miss one of the most fundamental things: that we simply need to allow ourselves to change into winter.
  Here is a quote from Zhang Jiebin, a famous doctor of Chinese medicine who lived between 1563-1640 in the Ming dynasty:

In treating illness, channels and medicines have a primary importance that must not be neglected; but he who seeks to grasp the deep natural structure, li, must little by little succeed in understanding the changes, yi.
                                       – Zhang Jiebin, author of Leijing and commentator to the Neijing, quoted in Rooted in Spirit, the Heart of Chinese Medicine, translated from chinese and comments by Claude Larre and Elisabeth Rochat de la Vallée, Institut Ricci 1995

Part of Daoism´s training in change is simply to allow us to move with it. Like we saw in the previous post, we find this quote in the Neiye, the Classic of Internal Cultivation from 300 BC, about the same time as the earliest versions of the Neijing were collated:

Therefore, the Sage:
alters with the seasons but doesn´t transform,
shifts with things but doesn´t change places with them.
                                            – Neiye, Original Tao, Inward Training and
                                            the Foundations of Taoist Mysticism, Harold Roth, 1999.

The training-techniques that create this in us exist and are still used today. They are not known within the TCM-version of Chinese medicine anymore, but Daoism´s way of looking at reality and moving with it has come to permeat the entire Chinese medical tradition.

If we let ourselves relax and just move with winter, most of our system will fall into place and relax with the season, both to rest in it and to enjoy it. Soon the Midwinter Solstice is here; the Fire in Water that heralds a whole new year, and the first murmurs of those seeds that are spring.

I hope you have a good winter.

Daniel Skyle © 2011