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musings on Yoga, Ayurveda and Chinese Medicine

Blue Beryl Blog

Back Pain and Acupuncture

by Hyoun Bae on 02/14/17

Back Care Basics

Yesterday, the American College of Physicians amended its guidelines of care for the treatment of low back pain. This statement echoes many a concern voiced over the years – that an over reliance upon muscle relaxants and opioid painkillers as a primary approach to care, simply masks an issue.

Acute or subacute pain tend to resolve, provided more serious injury is not the cause. In fact, the determination clarifies that for nonspecific pain with an occurrence of under 12 weeks generally improves through acupuncture, physical therapy, heat and other mindbody modalities.

Strain and sprain are common. There are things we can do to take care.

Clearly bodily usage, the connection between stress and muscle tension and routine, safe and therapeutic exercise are important factors in back care. Evaluation and discussion of history can often rule out more serious circumstances. Among them, manual palpation of the muscles can provide a significant degree of insight for best care.

Nondrug therapies (non-pharmacological) are now to be observed as the first line of care, which puts self-care strategies at the forefront. Acupuncture is no longer the safe alternative, and will perhaps be one of the routes your doctor may recommend.

Cupping, Moxibustion, heat therapy, electro-stimulation, manual therapy, therapeutic exercise, herbal medicine, compress - these combine to reveal just how comprehensive Asian medical care can be with respect to the treatment of back pain.

Flow: Open to Nature and Experience

by Hyoun Bae on 12/31/16

How do we express our greatest potential? How can we experience the utmost satisfaction?

Mihaly Csikszentmihalyi's research on optimal experience reveals something about the paradox of attention. In various areas of human activity – art, philosophy, athletics, dance and work – we can experience enjoyment and a sense of creativity, involvement and connection that stands apart from ordinary moments.

These experiences of “flow” can contribute to overall happiness and wellbeing. They also share something in common with processes of change, in relation to attention.

In order to shift less optimal behaviors, we often have to curb impulses and employ what McGonical called the “muscle of willpower.” Healthy choices require self-control. Long term changes require a certain amount of discipline.

In addition, replacing certain behaviors with others more healthful benefits greatly when we enjoy them.

Optimal experiences of flow that visit us through disciplined engagement are said to mirror greater complexity and organization. It is as if our energy and faculties find themselves in moments of alignment that somehow promote the type of ease, contentment and relaxed concentration that characterize such experiences.

Therein lies the paradox of attention. It must be consolidated, in a meaningful and often goal-oriented focus such that attention itself is consummated and released. In such moments, many of our impulses or “wants,” as well as the energy of mentation come together in apparently seamless experience of presence – even amidst stress, as many an athlete or performer will attest to.

Humanitarian Matthieu Ricard, in conversation with a neuroscientist, also came up with the notion that meditation, in its peak moments, is similar to the peak experience, or the experience of flow except it is one in which stillness predominates, rather than the active state of a mountain climber, or when things click on a family vacation after struggles with the luggage, when two lovers state at the perfect sunset – when we arrive.

The paradox of attention in relation to change again is that self-control becomes a resource when we recognize that the struggle between parts of the brain, or the self, sometimes requires a willful deployment of our discrimination to choose for the longterm. These same impulses, and their short term reserve, often related to reactiveness and the fear/flight response, are the basis of impulses and related to emotional patterns that also have to be brought into line when we attempt to master any art, or engage the body in crossfit, or perhaps running – which many experience flow.

The point here is that whether it is specific change or greater health and enjoyment, it’s often valuable that we dedicate some of our time and energy towards something that is meaningful, pleasurable and that can challenge us.

Some of them can be more physical such as gardening or hiking. Writing or painting, too, share this context for flow experience.

As we say in Chinese medicine, where there is free flow of vital energy, there is no pain. Where there blockage or obstruction, pain is concomitant. A previous mentor expressed health in terms of rhythm and flow, as central to the worldview and experience of the bodymind in integrity, wholeness and complexity.

Happy Brain

by Hyoun Bae on 12/27/16

Is happiness contingent upon relative circumstances?

It’s actually a complex question. Mindfulness often reveals that our perceptions and stories are quite constructed and not so solid. The things we might not feel jazzed about, can change.

And so, something that can be draining in one period of life – even a person, or relationship – can be a source of happiness, and much of that has to do with perspective.

This holiday period I reflected upon the cultural, rather than religious aspects, of the festivities. With all of the gift-giving I focused upon generosity, and how it contributes to happiness.

I felt gratitude for being able to share time with family and friends, and mostly, to have my daughter connect with the joy of giving. We made many inexpensive gifts to offer to our extended community. In the long run, I’d like myself to foster a nourishing relationship with the holiday experience.

 

If we take at face value contemplative wisdom, we might assume that trying really hard to be happy will only contribute to a vicious cycle. Chasing for happiness can be a drag. It’s what we do in a consumerist society and can lend not to compassion fatigue, but wallet fatigue and perhaps a well of inadequacy. Perhaps we wish we could give more, or had more basic facility – financially or otherwise – to do things, and even be of great service with our lives.

Pretty quickly we undoubtedly realize that yes, material circumstances do provide a foundation for happiness to flourish. So that’s not what the samsaric clamor is all about, but rather our stance on life and moreso, how or how not, we are promoting happiness or suffering based upon our motivations and take on things – our relationship to experience.

 

Neuroscientist Rick Hanson emphasizes that happiness is experience dependent, and that to cultivate the embodied foundations of happiness, it’s important to understand the brain-based underpinnings of how our experience is shaped and has come to evolve.

One of the main things Hanson is known for is highlighting the negativity bias, which undermines our ability to be open-minded about experience. Evolutionarily speaking, we are prone to seek safety and security, in relationships and to the environment and so our nervous system records and orients to the world, based upon our early experience. That’s called the saliency system, we have mentioned in previous posts.

Strangely, we’re wired to recognize pain and danger – a species’ survival mechanism that reads the environment for mishap.  Like a scrooge or ghost of Christmas past, the implicit stores of memory can override our ability to assimilate the good, to see possibility and have hope, even in relationships or work, because we can remain conditioned to believe that all circumstances are destined to failure or have preconceived notions about everyone and everything.

This negativity bias is important to understand, and if there is a science of happiness we must regard the value of integrating positive experiences, to note the saliency of happiness. That’s one of the buzzes in the neuroscience field regarding rewiring the brain with respect to neuroplasticity. Hanson suggests deeply imbibing nourishing experiences so that the neural patterning around those circuits register, and over time, can be a mainstay, establish a network or habit of happiness.

These are the types of structural brain change that are the relative or embodied foundations of happiness and psychological health.

So if you’re having some great holiday time, take a moment to let it sink in. Perhaps not fretting that you’ll be back at work soon is the contemplative wisdom bit – nonattachment. From a brain-based perspective, we might just have so much past as fodder for positive change and by letting the joyful experience seep in, they can imprint.

If not, there are equally powerful ways to till the field such that our difficult emotions and challenging relationships can be sources of inner nourishment or happiness. Again, that all depends upon perspective and our capacity to engage such tools.

An analogy before parting here is found in traditional medicine around emotional and physical healing, toxicity and medicine, suits.

If we are strong than we can apply strong measures. We can also use poisons as medicines, in the right dosages. If we apply a strong measure, and our body resists, it becomes toxic even if it were a hundred year-old ginseng. If our body is in a deficient state, it must be propped up – supported – with minimal intervention such that we can register a gentle nudge toward self-regulation.

Similarly, if we want to change, we don’t always need drastic measures. A spoonful of sugar will do. Sometimes sweet is needed, and not only bitter. We can focus on the positive and implement small changes – dietary or otherwise. Some rest and encouragement.

If we’re feeling robust and want to work away at behaviors or even feelings that have shaped our emotional lives, our immune response, ways that we engage work and the world that are obscuring rather than vitalizing, we go at it with an axe, and fell the tree – or certain branches of experience – at their root. Some prefer cold turkey. Others a purgation. Something demonstrative.

These are applications of medicine, and they relate to personal change, as well . One of the great things about healing is the capacity for change and of each of us becoming skillful with our experience, learning skills of nourishment – how to build up, break down and genuinely create more optimal experiences that contribute to happiness. This will make us better parents, teachers, lovers and friends.

To cultivate happiness, we often speak of generating equanimity, kindness and care, and a mind bent to prosocial emotions because they allow us to flourish. Of lesser note are the strategies of self-healing and care that support our reworking of experience or rewiring of the brain. As we come towards New Year’s we’ll again share some thoughts about how to find nourishment in our experience.

Food and Mood: Gut Microbiome

by Hyoun Bae on 09/29/16

Reflections on the Microbiome
 
Fall weather tends to inspire creativity in the kitchen.
 
These days, it might feel more of a treat to have a day off to stay in and cook, rather than a chore or sacrifice as it had been when the sunlight spanned greater periods of the day. Rest and nest - a self-care day to replenish - the body welcomes autumn and holiday foods; Mind and senses too recognize the need for substantial nourishment.
 
 
 

Research has suggested that our earliest environments and forms of nourishment - from the fetal environment, breastfeeding as a newborn, and on through to the toddler years - are not only formative for our brain and nervous system through maternal contact and social/emotional regulation, but also for the development our gut system, which not only includes the viscera, but the gut microbiome.

We usually think of this process in terms of digestive capacity and immunological function, but clearly all of these functions - social, interpersonal, regulation with the environment - are all intertwined
 
Strangely, similar to some of the subcortical systems that are shaped by our early experience and remain seemingly stable, the dominant players of our gut ecology establish relatively stable positions, enacting a vital role in the interaction between the enteric nervous system and its relationship to the brain (and perhaps how we feel and our prone to interact with the environment), but also reflecting change capacities relative to the diets we choose to foster optimal health, in the years to come.

In the Mind-Gut Connection (2014), Mayer calls this the gut-brain axis (similar to the neuraxis, or HPA Axis) which attempts to invoke the specious link between what we normally think as the slimy underbelly of the gut environment, to an image more of an information super highway. There seems to be an alien intelligence inside of us, that's more 'us' than 'we' - the stuff of sci-fi lore, as if tied to the unconscious. Mayer even invoked the salience system referring to memory, attention, the seeking and reward circuits. I'm bringing the spook just in time for Halloween.
 
As the enteric nervous system has been touted as the second brain, relating to "gut feelings" and the highly diverse, elaborate and extensive nervous and endocrine regulation imparted by it, attention is now brought to the almost surreal unconscious of immune, affective and behavioral influence the gut microbiome appears to exhibit. Have you heard that the majority of serotonin is stored here - what might be the implications of this innocuous fact?
 
Like in a fabled underground - could the gut microbiome be running our world? We know the shamanic folklore surrounding this tale, but I'm not totally swayed. The connections between digestive, allergic, autoimmune and neurodegenerative disorders - that much is clear - but the recent hypothesis upon it's regulation of social interaction, requires further investigation.
 
The science behind the microbial world of the gut has us reminisce upon the warnings of Taoist ascetics and their fastidious dieting and occasional fasting, who were apparently quite scrupulous about where and whence grains were introduced to their internal ecologies. Sure, they might ingest prepared mercury, but what we'd call comfort food might have them rolling in their graves. Selective shopping for ancient grains may too, not be the answer.
 
The astounding rise of neurodegenerative, autoimmune and chronic digestive issues that maintain some undercurrent of inflammation is approaching endemic levels, proposing serious concerns for the future. Some folks you know have a belly of steel, but while you may not have a more explicit digestive issue such as IBS, colitis or GERD, most of us do experience some sort of low level intolerance. Many suffer from the "bloat," or the bowling ball belly after eating something specific, or something undetected or unintended.

Obviously, when we are doing a dietary overhaul it might just be helpful to stock only those foods whose sources we are aware of, and ingredients that are explicit and which we know we won't respond poorly to. Omitting overtly problematic items such as the sugary foods, pro-inflammatory goodies - excess coffee, alcohol and the like - will quickly begin to streamline our diet. One of the upsetting realities we might be familiar with is that food can transform from a great source of pleasure to something we have to be cautious of.
 
Our medical approach is often not overly concerned with low grade symptoms of intolerance. Yet, for those who have benefited from antibiotic use, which may have staved off certain infections, but tend to host a chronic underperformance of the gut, the process can undermine our overall health efforts. In the name of health, we pile up more complex issues and often become prone to other infections - uti's, and the like.

Lets not forget the intrinsic role the sensitive digestive system plays in relationship to our mood, immune function and vitality - not to speak of providing fuel for our bodies. The metabolites of these gut microbes can be a cause for serious health detriment, relative to inflammatory processes, and maybe also our mood, as emphasized here.
 
We can be eating the right foods, at the right times and amounts. Perhaps we do take in enough variety and enough plant-based food, regular replenishment of probiotics and take prebiotics - those foods that feed the beneficial bacteria. Some will tend to lean meats, and pay a high price at the local butcher or the newly minted Wholefoods.

With all this in place, we begin to see how integrally related our mood is in relationship to the types of foods we grab for, how well we digest them, and what our bodies can make out of what we put in it.
 
It's helpful to examine, without judgement - what types of foods we eat when things go south. What are the cravings that we have and what kind of satiation do they bring? Are they healthy cravings? "What do I want to eat that will really nourish me-right now?" Sometimes your body knows, sometimes its habit - is it really your gut sense and is our gut sense conditioned, or some innate hookup to the cosmic juice?
 
Let's get this one out of the way - Shake Shack may arguably fill your soul's comfort cravings - strawberry milkshake, greasy yellow cheese, double-decked, pickle splattered burgers... fries, whatever's your game-but it won't make you really happy, or your gut ultimately satisfied. The longterm picture asks not so much what our comfort foods are, but on a more daily basis, what do our habits and regular consumption promote in terms of the status of the microbiome and what do we crave (those guys crave), when we deplete them of certain foods and sugary items, and how is our mood and energy, in fact, manipulated by these omissions?

The dark story of the belly's unconscious unfolds.
 
Happiness can be simple or complex, and as Mayer points out neither a primal diet or a vegan conversion is going to change the landscape entirely. There is an adaptive facet of the microbiome that begins early. It's not only what we host, but how mood, emotion, nourishment and even the neuroception of safety and self-sense are intertwined, that give rise to a joyful belly. There's also epigenetics - environmental influences-and the medications we take.

It's an endless dance is what I'm getting at.
 
Obviously these relationships are reciprocal (between food and mood). We need to cope with stress and be mindful of how our mood is impacting our digestive health, and also recognize how much better we can feel by eating well. If we consider the predominance of serotonin that is stored in the gut and regulated by the enteric nervous system, and that of the vagus nerve, this gut-brain axis not only becomes obvious, but the notion of mood regulation vis a vis the digestive system will have us paying much more attention to what's going on in our belly - to many of the sensations and rumblings, amidst a sea of endless chatter.
"Stomach no good, head no good," a wise one once spoke.
 
Sometimes if our energy is low, or mood is poor, or we're overly anxious and stressed, food may be a primary source of healing, or self-soothing. The overarching consideration is to make sure we periodically do a revamp, check in with the state of our digestive system, the microbiome, our diet and unresolved emotions and somatic distress, which may be cups of joe or booze away from a more volatile discussion or self-health sitdown. And also to continue to use food as medicine.

Our human microbiome encompasses a variety of bacteria that populate key areas of the body. These include the skin (eg. staphylococcus), orifices and mouth (streptococcus), the gut system (bacteroides)– it’s different stretches -as well as the vagina (lactobacillus). Like the Big Island of Hawaii, these stretches contain site specific bacteria like bioregions and their given micro-climates.

In terms of gut and vaginal microflora, fermented foods and drinks - those rich with probiotics – and probiotic supplements may aid in rebiosis, or fostering a better balance, or reboot.

Probiotics (such as Bifidobacterium and lactobicilus) are fostered by prebiotics, which directly feed them. Probiotics need to be able to be introduced into the system, and not be broken down by gastric acid, adhere and colonize.

Metabolites from gut bacteria influence mood, energy, behavior and are involved in epigenetic regulation, as well as the immune response – positively or negatively. Some bacteria contribute to vitamin synthesis.  Many chronic health concerns may involve gut dysbiosis, or microbial imbalance (including asthma, diabetes, obesity, cancer and autism; Yong, 2016). Overuse of antibiotics, medications and other factors can disrupt this balance.

The microbiome is in contact with several environmental agents, known as xenobiotics, or foreign chemical substances that are often registered as toxic. We respond to them, often negatively, or cumulatively. Begin to look around the house, the environment, check water quality and what’s in the food. It’s often a good starting point.

Raised in a medical culture where vaccines and antibiotics are often life-saving but also over-used, we can benefit from limiting them and knowing when to implement a safe alternative. Some medical conditions benefit greatly from antibiotic use, but many may indeed may cause or exacerbate chronic issues.

 

The microbiome has become a fashionable area of research. Many traditional medicine enthusiasts have been quick to state that Ayurveda and Asian medicine maintained these same ideas between digestion, the immune system and the enteric nervous system. As with the neurosciences, it’s important to acknowledge the differences and to highlight the cultural and historical differences, and most importantly the health practices and strategies relevant to each.

In following posts, we’ll be unpacking key immunological concepts and mechanisms to show what each medical system is focusing upon, to better understand the analogous relationships and divergences.

Dietert (2015). The Human Super Organism.

Yong (2016). I Contain Multitudes.

Acupuncture, Wisdom of Loss; Miscarriage

by Hyoun Bae on 09/25/16

Appropriate words are not always found when friends, family members and coworkers experience loss. We have so many natural responses to loss, and it is one of the universal feelings that connects us together. There is a wisdom in loss and sanity in grieving.

We are not always meant to counsel, but to connect, be a partner in presence, reflect. We don't always understand, but we can be with one another.

Some experiences of loss allow for new growth. Many are confounding, and in some case grieving merely has its own time and is not linear.

Often, when we bottom out from a job loss, relationship breakup, or that of any dream – chaotic breakdowns can reveal the lack of ground, with the hysteria of grasping and holding on. Anger and disbelief do not sequentially give way to acceptance and integration. Our lives are not organized in one way, nor is a process of resolution.

Growth and wisdom underlying change is a highly personal process. I learn a great deal from some of the elders, and even senior patients, I know and work with. I recognize the role of reflection and the tone of understanding that is imparted in their contact - often empathetic and accepting. Life is filled often with what we least expect; our paths are hardly ever fully carved out, in so much as walked.

 

Knowing is often a solitude in itself. There are many things we know, and don’t have the words for, or can’t share publicly. Can’t speak of because others won’t relate, or it won’t help a situation. In those cases, creative work can regenerate, and can open us up to dreams, in the way that dreams help us digest experience. The relationship between knowing, feeling and embodying - all underlie how we heal and integrate the past and bring it onto the trail.

 

Not knowing what to say is common, pointing to the solitude of grieving and letting go. For that reason, I took a detour here to address something a bit more personal – that of pregnancy loss – as such conversations require sensitivity. We don't need to rush words when they'll fumble undoubtedly. We can get to the point indirectly, like a sidelong glance, or when washing dishes while another is watching tv, or while shopping, because such distraction can also allow for softening, acting as a buffer, and also allow people to occupy the same space... then the same heart space.

Indirectness can be a cultural way, but also something I’ve learned from moms, counselors and children.

 

One of the loneliest forms of loss is pregnancy loss, and can be equally shared by couples trying to conceive, but often weighs more on the mother, regardless of how far along a pregnancy was from the time of conception. While Asian medicine posits some notions of when life, consciousness and sentience is aroused, often aligning with the feeling connection a mother may develop with the fetus, it is this experience alone – biological, emotional, maternal, social and spiritual – that can evade others understanding.

There are several causes of miscarriage, including: Abnormalities, uterine, immunological, hormonal and environmental. The last of these has come to include more interpersonal and social reflections, aside from toxic exposure, and now we are beginning to look more at this facet of the supportive environment of a couple or family system, the epigenetic factors that influence growth and pregnancy outcome. We can now openly discuss our experience and not see something so magic as something so mechanical or sterile. We can look at our lives, frustrations and feelings as confluences as well.

This should expand the concept of maternal and paternal factors in reproductive physiology and psychology, in Asian medicine. Chinese medicine etiologies have a way of couching these psychobiological contexts – some of kidney weakness, lack of nourishment from deficiency of qi and blood, the compounding of stress and emotions causing stagnation, heat, as well as traumatic falls and injuries. We may be diagnosed with incompetent cervix, a structural/functional condition which modern medicine, addresses.

These are all presentations that are important in cases of threatened or habitual miscarriage, described according to traditional medicine etiology. Chinese medicine also utilizes herbs and strategies for ‘calming a restless fetus,’ to secure a pregnancy, noting the distinct psychobiological connection between mother and fetus, and dual focuses on both, from early on.

It’s quite difficult to write about these things. Clinicians share many private conversations, even in the case of abortions. In some instances, miscarriages are seen as blessings, preparations. Everyone reacts uniquely, with understanding, perseverance, resilience - or despair and confusion. Sometimes a loss will inform us of where we are. Only the individual can make sense of these narratives.

The holding environment of our lives – which in a previous post I mentioned as the garbha – is metaphorically personal and social, but also more importantly personal, individual, embodied and in some senses private. To nourish at these depths often requires that our commitments focus on this primary goal, and even with all the dedication, metaphors switch and we can be confounded by not achieving outcomes, right away, or of missed opportunities. Or the sense of failure.

 

For those who are not trying to achieve pregnancy, we can relate to the wider experience of wanting and missing, or of hopes and dreams in general.

 

 

 

Chinese medicine offers treatment for the inner experience of health processes – change. Many formulas are restorative not only for our physiological status, but also our hearts and minds. We experience glaringly obvious bodily metaphors when we are going through rough experiences – the holding – weight gain, shifts in bowel regularity, social/emotional withdrawal, pauses and silences.

Following pregnancy loss, it’s important to allow for processing, restoration – noting fertility as an experience, as part of psychobiological process, and to only consider the reproductive window as a concern of timing.

The reproductive body is linked to several key organ systems, each of which ties into our everyday biological functioning – nervous, autonomic, immunological, sensory. Whether it’s flirting and coupling, deeper emotional intimacy or coming together for children, Chinese medicine acknowledges many interwoven matrices of connection within each of us that align and open - reservoirs of energy, experience and impulses we awaken to that may be as startling, or natural, but often powerful.

We can be deeply impacted by our sexuality, intimacy and reproduction, which involve both conscious and unconscious parts of our experience. These come into vivid play, full swing especially when trying to get pregnant and dealing with medical information, costs and relational needs. Things get complex.

This whole discussion revolves around compassion, empathy, self-care and love, whether we are talking about love and loss, reproductive medicine or resonances of autumn upon our bodies and minds.

So yes, there are treatments for the body, but there is also therapy for experience, and the magical medicine potion of experience.

 

As I am writing a book, and living life day to day, I am profoundly moved by what wisdom Asian medicine has offered me. We’ll address some dietary and behavioral considerations at another time, but I hope you are similarly benefitted by the wisdom and knowledge that is there in these ‘nourishing traditions.’

Alaya 
Traditional Medicine Research Database