Feeling like you are always sick??

I love noticing patterns in clinic as a sign of what is happening in the larger world.  

Last month I had a trend of patients who wrote on their intake forms things like: “rotating sicknesses”,  “I have gotten sick 3 times in the past 5 weeks”, “feel like I am always sick,” “rest does not help sicknesses,” and “lingering cold”.  This is part of the new post-covid landscape, where collectively we are experiencing immune suppression.

Here are a few lines from a Sloan-Kettering article on Long-term Covid-19 Immune Dysfunction (click the link if you want to go deeper and see the studies they reference):

“However, a new idea about how COVID can affect immunity has emerged: that even mild infections routinely cause consequential damage to our bodies’ defenses. This degradation was referred to as  “immunity theft” by T. Ryan Gregory, an evolutionary biologist, as a counterargument to "immunity debt" being the reason why respiratory infections were more severe than usual this past fall.

So while the acute infection may be one reason to not want to keep getting infected with SARS-CoV-2 over and over again, the idea that it can increasingly cause damage to the immune system should be a significant reason. Throughout the pandemic, scientific evidence has mounted that even mild COVID infections may be doing something to our immune systems, as well as our collective immunity.

For example, what if SARS-CoV-2 infection causes the immune system to be able to respond to SARS-CoV-2 in such a way that we no longer experience severe COVID infections, but rather it causes a subtler, long-term immunological changes that leave us more vulnerable to other infections or even chronic disease?”

I was just on a hike with a friend who is a researcher at Children’s Hospital, lamenting that this is not part of the public conversation.  She asked me what I have asked myself, “what would change if it were part of the public conversation?”  Covid is not going anywhere, most infections are now subtle and mild and the tests are very unreliable, easily giving false-negatives.  

The many steps I climbed before talking about covid-19 immune dsyregulation.

There does not seem to be an easy path from awareness to effective avoidance.  Of course, masks still work, but as a parent with a school-age child, vectors abound in an un-locked-down world.  This is why I know of three young and healthy (even hearty) friends/ acquaintances who were hospitalized with sepsis this past year, a very serious state of disease progression that is the last stop before death.  This is why, less-dramatically, there is a current spate of childhood acid-reflux in my community. (I talked about acid-reflux as a common post-covid symptom in adults here.)

But I would not be writing this if the only thing I could offer was doom and gloom, and you can probably imagine where this is going…this is the opportunity to lean on this weird and ancient medicine that for millennia has been treating lingering illnesses and boosting immune systems.  I love Traditional East Asian medicine for its ability to see the body as a wheel through which yang (life force) circulates.  When we find where on the wheel things are stuck, remove the stick from the spokes, the whole physiology can begin to turn again.  The first patient to initiate this trend of booking appointments for a hamster wheel of repeat illness has had full symptom resolution after 4 visits, and has now graduated to every-other week sessions to treat other chronic un-related, pre-pandemic issues.

In our own household I have noticed that we also get phlegmy more often, but, knock on wood, we are avoiding the frequent stomach bugs and lingering coughs that are happening around us.  I can only assume that our easy access to and frequent use of herbal medicines and needles has helped us stay above the fray.  I think it is so worth it to co-treat what before would have been routine seasonal illnesses with herbs and acupuncture.  One well-timed visit or teleconsult can help you resolve more fully what previously would have easily fully resolved on its own.

Please use me like you would use any health-care provider — judiciously and when-needed.  I love it when patients become more familiar with this medicine and what it can do, and know how to pop on and off of my schedule.

I wish you robust health that keeps you off of my schedule.  :)

Is perimenopause supposed to hurt??

I recently shared a house with a group of my lady colleagues; we had all gathered in a different city to study with one of our teachers, Eran Even, a very skilled herbalist who generously shares his insights.  It’s so great to have a weekend together…we get to gossip, share bits of our lives, and talk shop.  One of the many threads to our weekend conversation was PERIMENOPAUSE.  


This is not a surprise, because everywhere I turn there are posts, TikTok’s, memes, workshops, even classes on the subject.  And here I am, adding to the din with this blogpost.  As a group of practitioners, catching up in our shared house, we agreed that this is a necessary counterbalance for the general lack of conversation around this shared experience.  But over breakfasts, we also acknowledged that something is off about all this buzz.  


I’ll start by just describing what perimenopause is, so that we can better identify what it isn’t.  Perimenopause is a transition, a necessarily vague term describing the transition to the day that will be 1 year since your last bleed — menopause.  Just as you are not born a baby and then one day switch from a coo-ing, breast-feeding snuggle bug to a 13-year-old who wears a bra, this shift happens slowly, over a long time, with barely perceptible and perceptible shifts.  


Each season of life or of the year has its own unique expression.  The transition from perimenopause to menopause is analogous to Autumn, a time of harvest, a time to benefit from your earlier efforts, a time when the superfluous and dried up fall away, a time to select and collect the fruits that will soon go into deep storage.  The image here in Los Angeles might be a pomegranate tree -- as the leaves turn yellow and fall, the burgundy red fruit is heavy on the branches.  If picked at the right time and set aside for storage, the skin will dry taught over the seeds inside, which get juicier and sweeter as the outer skin shrivels.  

Southern California pomegranate harvest.


What does this mean in a human life?  This is a time of increasing wisdom and discernment.  The no-longer-necessary or no-longer-useful are shed, the beneficial fruits are cherished and accumulated.  As the menses slows and decreases, more blood (which houses our shen, or spirit) is stored in the body and can be put towards spiritual pursuits.  Instead of the outward thrust of energy of opening flowers and buzzing bees that occurs in summer, we turn more inward, bringing our sap and blood down into our roots.


Like all of life’s transition, this is another kind of miraculous change and one to be aware of, noticed, celebrated.  What was not quite sitting right with us practitioners is the confusion between what is common and what is normal.  So, for example, it is common for women to have fibroids that cause a lot of pain and heavy bleeding, but this is not normal.  We would never want to confuse these symptoms of pathology that occur during the period with the period.  Similarly, we observed, with all the current buzz around perimenopause, we are pathologizing a natural process.

It is important to know that hormonal changes can cause severe and debilitating mood or temperature changes, heart palpitations, or alarming increases in blood flow, for example.  While these symptoms may become more common during (peri)menopause, they are not normal.  Sometimes patients will say thing like, “since my perimenopause started,” when really what they mean is “since this troubling symptom started”. The distinction may seem subtle, but it is key to unlocking a longterm relationship to better health.


Typically, an unhealthy (peri)menopausal stage is the result of less intrusive symptoms or emotions that have gone unheeded, until finally, at this Autumn stage of life, every fiber of your being says “pay attention to me”!   Prioritize the precious, let the unnecessary fall away.


This is a great time of life to put your emotional and physical house in order.  Any efforts to use old strategies to push on through and tolerate the intolerable will no longer work.  Old traumas, pains, hurts, or sadness will no longer let you ignore them.  Instead they require that you feel them fully so that they can be expressed and stop exerting their influence on your body and mind. Similarly, difficult periods or postpartums that are left untreated can lead to more difficult perimenopausal symptoms.


In this post-Covid world, I would be remiss to not name Covid’s effects on normal hormonal fluctuations in the body.  I have seen in clinic that Covid can wreak havoc on a person’s hormones, causing difficult periods and unhealthy perimenopausal symptoms, among many other things.  Luckily, when diagnosing with a Chinese medical lens, we do not have to decide what causes what, only to understand the symptoms fully in order to be able to treat effectively.


Just as during a healthy menstrual cycle you might be more productive just after your period, be more outgoing during ovulation, more withdrawn and perhaps with some breast fullness before your cycle, it’s not that there are not perceptible changes during perimenopause.  I asked my own mother about peri/menopause and she described getting slightly warmer sometimes, but that it felt cozy.  I myself am noticing less predictable and scanty cycles, thinner skin, occasional mild night sweats, less tolerance for a glass of wine, and flabbier muscles, for example.  But also, for example, I feel strong, capable in my field, settled in with a rich social life, healthy, and more able to have difficult conversations.  


In other words, I, like many before and after me, am transitioning into becoming an elder.


If you are also in this stage of life and suffering from hormonal symptoms, something is wrong.  Mislabeling pathology as perimenopause may cause you to miss opportunities to get help with treatment.  As you may have guessed by now, this is something Traditional East Asian medicine practitioners are really good at treating.  

Delicious Dish Rich in Plant Protein for Pregnant People, Non Pregnant People, Vegans, and Omnivores

Hi everyone!  I’ve had a few pregnant people describe to me their aversion to meat, even in the 2nd and 3rd trimesters when I become more concerned about their appetite.  I also have quite a few vegetarians (including myself) who run out of ideas for yummy, easy plant protein rich eats.  Here is a recipe that is in heavy rotation in our household.  For those of you who might not know, I lived in Spain for 6 years.  This is a dish I learned there, and the way of cooking rice is central to many Spanish dishes, including paella. 

Ingredients:

Butternut squash

Red/ orange/ yellow pepper

Onion

Canned tomato (I usually use the peeled whole tomato that I break up when I add it, but I used what I had on hand which is pictured here)

Cooked garbanzo beans

Extra virgin olive oil

Short grain rice like Arborio or Calrose

Salt to taste

Lemon and mayonnaise to garnish according to taste



Start by cutting the butternut squash into uniform thin slices.  I use about ⅓ of the squash.   Add more olive oil than you think is respectable to a large round frying pan, and when it is heated but not smoking, add the slices of squash and stir it around, coating them and then letting them sauté in the oil.



Begin cutting your next vegetable.  In general you start with the longer to cook vegetables and end with the ones that cook more quickly, so the red pepper can go next.  I used one whole pepper.  When the butternut squash as started to soften, push it to the edges of the pan and put the pepper into the pool of hot oil in the center.  Then start dicing your onion.  I use half an onion here.

When the pepper is starting to soften and fry, mix it in with the butternut squash, push that all to the edges, and add the onion to the hot oil in the center.  Let that cook and soften, and then integrate with the other veggies, push to the edges, and add the can of garbanzo beans.  You can salt the veggies as you go along.  Once the garbanzo beans are warmed and getting slightly toasted, integrate them and make room for the tomatoes.  Let the tomatoes cook down in the oil enough that they start to get the rich caramelized flavor.  At this point you can add the rice.  I used one cup of rice that will become 2 cups of rice once cooked.  You can make a well for the rice, which I forgot to do, but basically you add the uncooked rice and let it get a bit sauteed in the oil so that it is soaking up the flavors of the dish.  After about 5 minutes, you can add 2x the water as the rice that you put in, plus a little bit more.  So I added 2 cups of water plus a smidge.  Add salt for the amount of rice and water you added.  Mix it all together until it is evenly combined, bring to a boil, and then turn the heat down to a very low simmer.  Do NOT move the rice again.  You may need to move the pan on the burner if it is bubbling unevenly (in other words your pan is bigger than the flame) so that all the parts get heat.  Slowly, the rice will grow.  You can take a fork to pick out a couple of grains to test for doneness.  If the ones on top are still a bit dry and the ones in the center well cooked, you can add a lid and keep the heat very low to let the steam cook the grains on top.  This is considered a less skillful way to do it, but I do it all the time and won’t tell anyone.  If the ones on top are mostly done, you can just turn off the heat and cover with a lid (or newspaper, as I commonly saw done).

Push the already softened to the edges of the pan to make a well of hot oil for each new ingredient.

This technique of toasting the rice in oil and maybe other ingredients, adding 2x plus a bit of liquid, stirring to mix and then not touching again, bringing to a simmer and then turning down the heat is the technique that is common to many Spanish rice dishes.  As you can see, it is quite versatile, and you can sub the vegetables and legumes of your choice.

Serve with lemon to squeeze on top, and a dollop of mayonnaise on the side.  You can graze each forkful by the dollop of mayonnaise on the way to your mouth and enjoy.  Our 6 year old is a huge fan of this dish, so it is kid tested and proven.

Is the Stomach Bug Flying Around your House Trying to Get In?

There's at least one point every year where patients start coming in telling me that they ate a [insert here the last thing they ate before getting sick] and got food poisoning.  Everyone is listing a different innocuous food because in fact it is a stomach flu circulating through the community.  Traditional medicine has many ways to avoid the bug getting into your digestive system or to make it unwelcome if it is already there.  Firstly, stay warm.  Keep your feet warm, your belly warm, your back warm.  Keeping your belly warm can look like drinking ginger tea, eating cooked vegetables over raw vegetables, or sitting on the sofa under the covers with a heating pad or hot water belly on your stomach.  Avoid iced beverages (including your coffees and lattes and waters) except in the hottest hours of the hottest days in order to keep your digestive cooking pot (your belly) appropriately warm.  This helps food to go down at the right speed and come out at the right speed.

A hand is holding the base of an orange butternut squash cut in half. The seeds inside are sprouting. This squash was used to make a medicinal congee.

To prevent or recover from a stomach bug, make a pot of congee with short grained rice.  Instead of the typical 2:1 water:rice ratio, add 8 to 10 times as much water to the rice.  If you have butternut squash or any other sort of orange pumpkin, add some peeled cubes to the mix, along with grated ginger and bay leaf.  The orange root vegetable will help to tonify your digestive system, ginger will warm your digestive fire, and the bay leaf is anti-diarrheal.  The thick rice water that is generated is absorptive, and will help redistribute fluids in your digestive system to where they should go.  Serve with a drizzle of sesame oil and soy sauce to taste; if someone is already feeling queasy they may prefer it without condiments.

Butternut ginger congee, drizzled with sesame oil and soy sauce. A medicinal and delicious porridge that strengthens the digestive system.

Another handy tool for your household's medicine cabinet is the Chinese medical formula 'huo xiang zheng qi san".  It is for "sudden turmoil disorder".  Sudden turmoil is when you are suddenly vomiting or diarrhea-ing or both at the same time.  You can use it at the onset of disease, or use it prophylactically if others in your household or in your community are sick.  While there are other formulas that very effectively treat sudden turmoil disease, this is a kind of generic formula that can be applied easily without need of diagnosis by a practitioner.  We were recently travelling abroad and I brought some.  We only used it once, after finding out friends that we had spent the week with were severely ill with a stomach bug.  It is excellent for foreign travel, when it can sometimes take longer to navigate a different health care system in a different language.  If you want to pick some up from the clinic to have at home or for travel, feel free to get in touch and let me know when you can stop by to pick it up.

Another very effective folk medicine technique comes to me via my Argentinian mother-in-law, and is practiced by women throughout Central and South America.  El empacho means blockage and can refer to just about any digestive upset.  Tirar el empacho is a technique of pulling quickly and sharply on the skin of the low back with the aim of producing a cracking sound.  I have learned it this way:  first apply talcum powder or corn starch to the low back to make it easier to grip.  Beginning just above the sacrum, and just on either side of the spine, grasp a roll of skin and tug upward quickly and firmly.  Repeat, going up the rest of the low back.  The more cracking sounds and the louder they are, the more needed the technique was and the more effective it will be.  Repeat 3 days in a row (although I confess to forgetting to repeat and the technique has still been very effective).  My mother-in-law used this recently on our daughter when she was home sick with no appetite.  Within an hour she announced she was hungry and wanted to eat.  Another example:  an elderly family member had diarrhea for one month, which was attributed to having eaten a chocolate (despite having eaten chocolates her entire life).  She visited her doctors several times but nothing could stop this diarrhea.  Long term diarrhea is quite serious in anyone, but especially in the elderly and in babies.  It wasn't until her caretaker, who grew up in Mexico and is also familiar with the technique, thought to "tirarle el empacho", that it stopped.

I hope that these techniques and remedies help your household stay healthy and free of acute digestive disorders.  If your digestion issues are long standing, East Asian medicine can also help.  If you have trouble going to the bathroom, or go to much, or have pain with digestion, these are all signs that you could benefit from a more personalized treatment. Always feel free to reach out with any questions, or book an appointment with the booking button below.

Chrysanthemum, chamomile, eyes, and herbal safety

an image of yellow chrysanthemum flowers

I picked my daughter up from daycare the other day and found myself studying the face of the lovely woman who makes her home a second home to my daughter and others. She looked different to me, in a way that I couldn’t identify but made me wonder why her features weren’t matching the image of her in my mind’s eye.  The next day I understood what I was seeing differently-- she had a red rash around her eyes and the area was puffy. “Tita Annie,” I asked “what’s going on with your eyes? Do they itch?” and she explained to me how she has eye rashes that come and go, that they are uncomfortable and last for a few days.  She was gesturing to them while she was explaining, and her husband, standing near-by, chided her not to touch them. Clearly they were both very familiar with this annoying rash. I told her I would be back shortly with some ju hua that would fix her problem.  

I dropped my daughter home and biked back with a mason jar of some ju hua, chrysanthemum flowers.  In the parts of America that have winters we know chrysanthemum morifolium as the multi-colored annuals that are put out around Halloween time.  In East Asian medicine, it is the yellow or white flowers that are used. I instructed her to boil a few for 10-15 minutes, drink the infusion, and put the steeped flowers, once cooled, on her eyes.  This was a Friday. I didn’t see her again until the following Monday, where she reported exactly what I was expecting: in about a day her eyes were fine. I have yet to see ju hua not work its magic.  In our medicine, it is known for being the number one choice for any type of eye irritation or discomfort. It also expels wind, which was indicated in this example because Tita Annie’s eyes itch and the condition comes and goes.  I used it when my daughter caught pink-eye at 9 months from her older cousins (in addition to breast milk; lactating mothers have the most superior treatment in this situation), and it worked like a charm. I was surprised that my daughter even ate the steamed and cooled flowers off of her high chair tray.  Though to be fair, she was also trying to eat rocks at that phase in her life.  

It is important to know that you should only get ju hua from the most reputable source. An executive of one of the most-trusted herbal companies shared with me that they reject many ju hua suppliers as this is an herb that tends to test positive for heavy metals.  Spring Wind is very rigorous with their testing and sourcing, as is Mountain Rose, who has not carried ju hua for some time now.

Here in Southern California, there is an alternative from the same family that can be picked up at the farmer’s market: chamomile.  One of my Mexican patients tipped me off to the traditional use of manzanilla in her home country.  It is also a member of the Astaracea family, family of origin to so many flower medicinals.  I have yet to use this clinically, so cannot report back. But maybe you have used chamomile for eye problems and can share your experience in the comments below?