Spring Cleaning: Shed that Fat - A New Look at Obesity

For weeks if not months, our living room resembled a battleground of littered toys and books.   Tiny flecks of green, blue, and red play-dough stuck to the carpet.  The coffee table hid beneath a miniature pet shop with its dozen or so of tiny inhabitants, as well as pieces of paper featuring various scribbles, crayons, etc. Dust bunnies huddled around the corners of the room. Big shoes and little shoes, big balls and little balls, and a bunch of deflated balloons from Trader Joe's scattered across the entry way. We finally decided this weekend that the mess was unbearable and tidied up the living room and vacuumed the carpet.  Ah, much better, as long as you do not look at the dining room, or the bathroom.

Families with small children and no maids probably all have living rooms resembling ours.  It's not sheer laziness that leads to such state of disorder.  We learned in high school physics that entropy is the eventual fate of the universe, that naturally things gravitated toward randomness.  Having order takes energy, and that's something that is highly lacking in parents of young children.  We are lucky if we get to eat or sleep, or have a brief moment for ourselves.  Cleaning up the room comes low on the list of things to do.

It turns out that being overweight also can be due to the lack of energy.  The body does its best to run its essential functions but has not enough energy to take care of the garbage, like useless fat.  Also, the body does not function properly, so that when it is given food, it makes junk like fat instead of good stuff like blood, muscles, and energy.

Wait a minute, isn't obesity due to excessive energy or calorie intake? We all learned in medical school that the problem of obesity can be explained by the following equation:

  excessive energy intake -  inadequate energy expenditure= fat

It sounds simple enough, but is it really true?  Probably not, or else why are there so many people struggling with their weight?

Mr. Alex Wu of The User's Manual for Human Body pointed out in his book that obesity is actually caused by the lack of energy, the lack of xie-qi, or life force.  Putting on excess weight signifies a decline in health or life force.  How is that so?  When you think about it, the extra fat on one's thighs, abdomen, or butt, is it really stored energy, or is it useless junk?  Useless junk, no question about it.  How did it get there in the first place?  Was it really due to our body thinking: oh, let's deposit some highly valuable fat globules in the tummy to guard against a rainy day? Or is it more like: gee, I'm running low on fuel so I'll just dump this crap right here; I'll clean it up some other time.  It's more like the latter, I'll bet.  

Do you know what TCM calls excessive fat? Fat belongs in the general realm of garbage in the body.  Traditional Chinese Medicine call all such garbage tan, which literally means mucous or phlegm. Fat is a special type of mucous, it's tan shi, which means wet mucous in literal translation. Yup, it ain't no energy store, that's for sure.  From the TCM point of view, people accumulate excess fat because their organs do not function properly.  When they eat, they convert the food ingested into excess fat instead of into useful energy for the body.  Such people actually suffer from the lack of xie-qi, or life force.  Obesity is the result of poor heart and digestive function.  

Yes, contrary to what most of us believe, obesity is the result of heart disease, not the other way around, and obesity is due to poor digestion and inadequate energy production instead of just excessive calorie intake.  How can that be?  Well, our heart's main function is to pump good oxygenated blood to all our body parts and used up blood through our lungs and livers and kidneys to get freshened up.  If this central pump and its pipes, the blood vessels, are not in their best shape, then circulation declines and lots of junk get left behind in our tissues instead of being taken away to waste-processing plants of our body: the liver and the kidneys.  That's how I think about it.

What about poor digestion?  People have the impression that overweight folks have too good a digestive system, and therefore absorbs too much energy which gets converted into fat.  Well, they actually suffer from poor digestion and the lack of nutrients, especially the ones that are dieting.  When healthy people eat, they convert whatever food they eat into useful parts for the body, such as building blocks for muscle, new blood cells, useable energy source, etc.  When overweight people eat, for some reason the food gets turned into useless fat.  Something went wrong in the conversion process where food is supposed to turn into stuff that sustain, nurture, and renew us, not to weigh us down.

In TCM, there's a disease state called strong stomach-weak spleen.  People with strong stomach but a weak spleen have great appetite and can put away a lot of food, but they don't get much out of it.  Such people can be overweight or overly thin, because they cannot convert the food they eat into useful muscle mass.  The spleen in TCM functions mainly to aide digestion and create new blood, so a weak spleen means a poorly operating power supply for the body.  

How do people get weak spleens?  There are lots of ways to do so.  Poor eating habits certainly play a major role.  Here in the U.S., motherland of fast-food, not only are people eating the wrong things, they are eating it the wrong way too, which is fast.  Fast-eating folks gobble down the food in seconds without even chewing much, usually because they are busy doing something else like watching TV, surfing the internet, driving, on the way to the next errand.  Giant pieces of food get dumped into their stomach, which is supposed to grind them up into smaller pieces so they can be properly digested.  No such luck for the stomach.  Too busy reading, watching, driving, not enough blood to go to the stomach, sorry you are on your own.  So the stomach dumps the slightly smaller, but still huge pieces of food into the small intestines, which can't do much about them because small intestines digest food on a molecular level, not giant piece level.  Where do they go next? The pieces of burger or fries? The large intestines, where they get converted into poop.  Story over. End result of fast-eating?  Lots of poop get made, very little useful energy gained.

So slow down! Whether you are eating burgers and fries, or a salad, chew what you eat so you can get something useful out of it instead of putting your poor digestive system on a run-around and waste precious blood-energy pushing all that undigested food through your system.  Don't do anything else when you eat! Just eat, enjoy the food.  It's one of the most basic pleasures of life, eating, don't treat it like a hassle or inconvenience.  Give you and your food some quality time together, and afterwards do some relaxing activities like taking a slow walk or listening to some nice music to help your stomach digest.  Don't hit the gym or pick up a book or turn on the TV.  All these activities divert blood flow away from the stomach when it needs it the most.  Be nice to your stomach and spleen. They work hard to keep you running.

Okay so how do we lose weight?  Well, we don't want to lose weight, not healthy weight anyway.  We want to keep all the good stuff like blood, muscles, bone mass, and lose the bad stuff like the fat clogging up our blood vessels and suffocating our heart.  Losing useless fat is easy and hard. Easy because there are no special requirements, no strenuous exercises needed, no expensive diets, no drugs.  Hard because we have to change some lifelong habits.  Ready? 

Step Number One: sleep well.

Sleep early and sleep plenty.  That is the most basic change you need to make if you want to become more healthy.  See my previous post on early sleep.  Sleep heals us, restores our energy, allows our body to make repairs, and help to produce more blood-energy or life force, which is so vital in maintaining our health.  If you have abundance life force, no illness, including obesity, can touch you, so start building it up by going to bed early, the earlier the better. Before 10 pm is the best if you can manage that, and you can if you really want to make that change.  You will feel so much better in a week or two.

Step Number Two: eat well.

What? What about the excess calorie stuff? Forget it. Eating keeps us alive.  Do not deny your body the food it needs.  To lose fat, we need to increase our metabolism, and that takes a lot of energy.  Eat regular meals, especially a really tasty nutritious breakfast.  Never skip breakfast, or else your metabolism will slow down and that causes more fat buildup.  Eat slowly and chew carefully so your body can digest every morsel and extract maximum energy out of it. Stop eating when you feel full.  That is the key.  Do not eat because you are bored or sad or upset.  Eat because it's time to eat and you feel hungry.  Referring back to our body's schedule, the Flow and Infusion of energy, we can see that the best time for breakfast is 7-9 am, lunch around 12 pm, and dinner around 7 pm.  Those are the times when our digestive system work the best. Again, morning is the best time to eat the good stuff because our digestive system is at its peak.  Lunchtime is good too, but do not eat a huge dinner, because as evening approaches, our body winds down to get ready for bed, so a large dinner means a lot of half-digested food in the stomach when you sleep.  Not only does that cause heart-burn, it puts extra burden on the heart and can even cause heart attacks.  A light dinner with mostly vegetables is best.

Remember we want to increase muscle mass (our heart is a muscle too) and decrease fat production, so eat lots of high quality proteins like lean beef/lamb, shrimp, eggs, beans, etc.  Eat plenty of vegetables and fruits.  Nuts and seeds are good too.  Do avoid simple starches (white bread, pasta, rice, any form of sugary food/drink) as these encourage our body to synthesize more fat.  Avoid salty foods too, those can cause fluid overload and are bad for your heart.

Cut out the fried and greasy stuff, and also cut out the iced drinks, sugary or not. These all hurt our digestive system and our heart.  Forget them.  When hungry, please do not grab a candy bar, that's not food.  Nor is Hot Cheetos or anything in that whole isle.  Eat whole grains, fresh produce and meats/dairy as much as possible, and eat at home as much as possible.  A lot of people think only wealthy people can afford to eat healthy.  That's so wrong.  The poorest people on this planet eat healthier than we do because they can only afford what's local and fresh, nothing processed.  Eating out is one of the most expensive habits that can wreck your budget; it can cost literally hundreds and even thousands of dollars per month.  Even fast-food gets expensive if you get it regularly.  So save that money and cook and enjoy your meals at home with your family.

Step Number Three: be happy.

Unhappiness, brooding, stress all hurt your body, your heart and digestive system in particular.  Brooding injures the spleen and stomach, so don't keep that stress inside of you.  TCM says: "hundred illnesses arise from the heart".  Keep yourself happy, then your whole body will stay healthier. Let go of all those non-essential things that keep you worried or stressed.  Be grateful and appreciate all that you have.  Keep your wants and needs simple and few.

What about exercise?  Aren't we suppose to burn the calories?  Yes, but the body knows how to do that by itself. It'll take out the garbage if you give it enough rest and nourishment.  Keep in mind that the good stuff: bones, blood, muscles weigh more than fat, so don't weigh yourself everyday, or at all!  It's how you feel and what size clothes you can fit into that matters. In fact, one can gain weight or look bigger in the process because the fat that's been hanging around for months or years need to be broken down in order to be taken away, and whenever the body engages in this breaking down process, the body part that's involved can look bulkier.  Be patient and let your body do the work.  Just take good care of it, and it will take good care of you.

There are exercises that we can do to help the body along.  Mild, enjoyable exercises like walking can strengthen our heart and lungs, refresh our blood, and encourage muscle growth.  It can also improve our appetite and sleep.  So do go for a walk and enjoy the beautiful spring weather.  Avoid strenuous exercise or any exercise that your body does not want to do.  The body has to enjoy it too for your to reap any benefit of the exercise.  Remember a lot of overweight folks have weaker hearts, so vigorous exercise is not a good idea.  We need to build up energy, not using up a lot of energy torturing ourselves.

In addition to walking, there are several simple exercises you can do to help let go of the fat.  One is walking on your knees, which I talked about in a previous post.  Another is to massage the belly, or anywhere you have unwanted fat.  This increases circulation to that area and help the body take out the garbage.  Belly massage is simple: use your hands, palms, fingers, thumbs, or fists, up to you, and start from your stomach, just below the ribs, and work down to the belly button or the pelvic area.  Use how every much pressure that feels good to you.  Do this for a few minutes before sleep and after awakening.  This will not only help you get rid of fat in the abdomen, but also help take care of other chronic problems.  It also helps to improve quality of sleep.  If you feel gas bubbles or rippling water in the belly, good!  Push that stuff out.  You don't want that gas or stagnant water in your belly.  If you feel pain or lumps, gently massage them away.  See your doctor if you feel any lumps that do not move or go away.  If you happen to have constipation, you can also gently tap your waist using your fists while lying down, about 100-200 times before sleep.  This will get your bowels moving and get rid of all that poop that's weighing you down. (Do not do if pregnant.)

Remember, we don't want dirty air (gas), stagnant water (edema), or accumulation of poop inside of us.  Massaging the belly will help get rid of these disease-causing garbage, and fat!  Farting or burping are great ways to let out the dirty air, so don't hold it in!  Let it out, just do it with discretion while in public.

There's one more exercise, simple one too.  Hit yourself in the outer thighs, which happen to be where our gallbladder meridian runs through.  What the heck is the gallbladder meridian?  Meridians and pressure points are the coolest things in TCM.  I will devote more time to them in another post.  Briefly meridians or channels form a huge network, kind of like the human internet, that sends information between our organs and coordinate their functions.  They run along distinct lines found on every human body, and along each meridian are specific points that are more sensitive to pressure, temperature, and pain.  These points are the very ones that acupuncturists use to help relieve pain or rebalance the patient's organs.  They, in very few words, are our god-given tools to heal ourselves.  They are the very medicines that we are born with!  I believe everyone should know about them so that everyone can start healing themselves. 

Let's get back to the gallbladder meridian.  The gallbladder stores bile, which helps us digest fat.  Lots of people eat and love eating, but are not really digesting all that well, like we discussed above.  Stimulating the gallbladder meridian will stimulate our body to produce ample bile to help us digest and turn food in to energy that helps us gain muscle and lose fat.  This exercise will also release a lot of what I call emotional/psychological garbage because our liver takes a hit whenever we get angry or stressed. The liver in turn dumps its garbage on the gallbladder, so there are lots of emotional garbage building up along our thighs. Hit them and get them out of there!  How do you do it?  Place your foot on the sofa, a chair, or the bed, so that you can easily reach your outer thigh without bending your back.  Use your fist, preferably the knuckles, and hit your outer thigh firmly in four evenly spaced points, starting from your butt and work toward your knees.  Where you hit doesn't matter as long as you stay in the middle of the outer thigh. You should feel a sharp line of pain running through the middle of your outer thigh: that's the gallbladder meridian getting jolted.  Repeat this 50 times on each thigh (so 200 hits).  It should take about 5 minutes.  You can also do a little here and a little there if you don't have time to finish in one session.  Don't do this if you are pregnant or having your period.  (Pregnant women secret bile just fine, and having the period already takes a lot out of you.)  Don't do this after 11 pm because you should be sleeping, also because doing this late can keep you awake and cause insomnia.  If insomnia becomes a problem (because the emotional garbage has been disturbed), pat yourself gently in the back of the head, neck, and back (use the wall or a soup spoon if no one can pat your back for you) before bed.  Doing so will activate the bladder meridian which runs along our backside and help release all that garbage so you can sleep better.

One more thing, try not to sit in front of the TV or computer for too long.  TCM says sitting too long causes us to lose our muscles.  Looking at things for too long causes us to lose blood (not literal bleeding, but the using up of too much energy).  Remember we want more muscle and blood, so keep the screen time under control (like less than 2 hours per day).

All that sounds easy right?  It should be easy.  The human body is smart.  Just help it get rest and nourishment, and it will take care of the rest.

Cold: Our Number One Enemy

The cold season has officially descended upon us, in, well, March.  The unusually warm and dry winter had delayed the peak of cough and colds we see in our pediatric office until now.  When parents bring their kids in for cough and colds, they are often told that their child has caught a "virus" at daycare/school, and will be better soon with rest and fluids.  I used to tell parents that all the time, and I used to roll my eyes inside my mind when grandmas came in and told me that their grand baby got sick because the weather was cold.  Well, I don't do that anymore.  Sure, viruses are real, especially the flu virus, and I believe in flu shots, as well as all immunizations, but the weather certainly plays a big role in illness.  After some rain and a cold spell, a wave of sick kids would come in with almost exactly the same symptoms and the same duration of illness.  Sure looks like a coordinated attack on the virus's part!  

Also, consider the very common "seasonal allergies".  A lot of times I hear parents tell me "he's got a runny nose and sneezing on and off all the time, I'm not sure if it's a cold or allergies".  I believe there are true allergies out there, but most so-called allergies are actually chronic colds.

In Traditional Chinese Medicine (TCM), we have six main external factors that lead to illness, and these are excessive wind, cold, heat, wetness, dryness, and fire.  (The internal factors, in case you are dying to know, are excessive joy, anger, worry, thinking/brooding, sadness, fear, and startle.  Other factors include irregular eating and sleeping habits, external trauma and injuries.)  Note the modifier "excessive".  As Mr. Alex Wu of The User's Manual for Human Body pointed out,  we who live in the developed world tend to accumulate excessive cold due to our ability to control the ambient temperature of our living environment and go against the seasons.  I remember taking a long-distance bus in Mexico in the warm month of May.  The air-conditioning was turned so high in the bus that everyone needed thick blankets.  (Luckily we read about this in the guide book beforehand).  I overheard a man muttering after a break "It's time to go back to the refrigerator!"  Yup, many office buildings can freeze you to death in the middle of summer.  Sure it feels good to walk into a cool building after walking in the hot sun, but I would much rather walk into a shaded breezy courtyard than a store with icy air blowing at me full blast.  People who grow up in this type of artificially manipulated environment tend to lose their sensitivity to cold and think icy air on the face feels nice, and flip-flops in the winter are perfectly comfortable.  Their bodies have given up on sending signals of distress when exposed to cold because why bother?  No one seems to be listening.  No one bothers to put on an extra sweater or a pair of socks when the body feels cold.  So the body stops complaining, but tries to protect itself by putting on extra fat, making the nose run, sneezing, or simply internalizing the cold damage if it is too weak to mount any immediate defense.

As it turns out, a little bit of cold here and there can add up and cause big problems down the road.  If we think about it, we are warm-blooded animals for a reason: we can move faster and think better being warm-blooded.  Being warm-blooded takes extra energy.  I think it's amazing that we stay around 98.6 degrees regardless of our ambient temperature and that our bodies can stay agile thru a wide range of temperature variation.  Cars need anti-freeze to run in freezing weather.  Our bodies run well even in snowy weather provided we give them the help they need to stay warm and comfortable.  Why is being cold so bad? Cold makes fluids, including blood, more viscous and sluggish.  When blood becomes sluggish, our internal garbage disposal system malfunctions and toxins and waste accumulate in our body.  Our organs and tissues do not get the best nourishment they need.  Muscles and tendons tighten up and cause pain. TCM has a term for cold damage - han qi, which in literal translation is something like chill air.  I think of it as chill residue when it is internalized into our body, because it is something that can be accumulated through time, most of time without any symptoms in the short term.  In the long term, however, it causes gradual decline of one's health until symptoms manifest as heart disease, chronic back/leg pain, arthritis, headaches, premature gray hair/hair loss, menstrual cramps or other menstrual complaints, infertility, you name it.  

Really!  You say.  Really.  Severe hypothermia kills.  We all know that.  Mild hypothermia kills too, just not as fast or dramatic.  Are there ways to tell if someone has accumulated chill residue in the body?  Sure.  I'm a perfect example of having accumulated chill residue and as a result, having stagnant blood (thru swimming in cold weather/water, taking outdoor showers while camping, not blow-drying my hair after showering, etc, etc, etc.)  I have pale/purplish lips, tongue, and nails, and the purple hue darkens with cold weather.  I am prone to cold hands and feet, and my complexion appears dark and lacks that reddish glow of health.  I have white crescents at the base of my nail bed on my thumbs only, not on my fingers (a sign of a lot of accumulated chill residue). 

How do you accumulate this han-qi, or chill residue?  No one knows for sure.  Mr. Alex Wu postulates that when the body experiences cold temperature that prevents it from functioning optimally, some kind of chemical reaction happens to generate heat internally to keep our organs running properly, and in the process, certain waste metabolites are generated and stay in the body.  If our xie-qi, or blood energy flows with abundance, we can expel this han-qi, or chill air/residue easily by sneezing a few times or having a little bit of runny nose.  However, if we do not happen to have enough energy to expel the damage right away, the waste metabolite stays inside the body and can build up through time.  If the degree of the cold damage stays light, the chill residue accumulate only in the superficial areas of our body like beneath the skin (think fat layer).  If the degree of cold damage is severe, then we can accumulate deeper chill residue in our vital organs such as heart and lungs, and this can become very dangerous. 

The good news is, as always, the human body knows how to get rid of han-qi, or chill residue.  The common cold serves as a perfect demonstration of the body's way to expel cold: fever, chills, sore throat, runny nose, cough, sneezing, headache, body aches, sometimes coupled with stomachache, vomiting and/or diarrhea.  People often feel tired and sleepy during a cold or flu because the body actively engages in combat with cold and needs to cut down on unnecessary energy use and get more rest.  Sure the symptoms feel uncomfortable, but most people get better in one to two weeks with increased rest and fluids alone.  

What about cold medications?  The American Academy of Pediatrics recommends against the use of cough and cold medications because they have not been shown to be helpful at all, and they can have potentially serious side effects such as over-sedation and death.  If you look at the ingredients in cold and cough preparations, you will find decongestants such as pseudoephedrine (which temporarily shrinks the blood vessels in our nose so we feel temporarily less congested, but with repeated use, the nose can become even more congested) and diphenylhydramine (which is an anti-histamine that can make us drowsy and have super dry nose and mouth).  The cough suppressant dextromethorphan (DM) is an opioid (related to morphine, codeine, etc.) that acts on our brain to suppress cough.  We have to remember that the cough is a protective mechanism that serves to bring up junk (virus, bacteria, mucous) from our lungs.  If we force our body not to cough, then all that junk gets left behind in our lungs.  What good does that do?  We essentially work against our body's attempt to heal itself from the cold if we take cough and cold medications.

The cure for the common cold lies in prevention.  Be sensitive to your body's signals. If you walk outside and start to sneeze or feel your nose get stuffy, go back and get another layer, maybe a scarf, hat, and gloves.  Be very careful in the springtime.  In China we have a saying: "bundle up in Spring, go freezing in the Fall".  Why? In Spring the weather changes rapidly. Many days seem sunny but air remains chilly.  Our body, like the plants around us, senses the change in season and opens up the pores in response to increased sunlight and warmth.  Chilly air can rush into those open pores easily and cause colds. 

Other ways to avoid accumulating the life-consuming han-qi are: stay dry, use an umbrella or raincoat in the rain.  Blow-dry your hair right away after showering instead of letting it dry "naturally".  When it dries "naturally", your poor head actually serves as the heat source, and in the process can suck up a lot of chill.  Be careful when swimming, especially when you get in and out of the water, even if you use a heated pool.  Wear long pants, socks, and warm shoes in cold weather. Avoid skirts, shorts, flip-flops or sandals in cold weather.  If you look around you, a lot of overweight people wear T-shirt, shorts, and sandals when other people are still in long sleeves.  They are probably less sensitive to cold and may benefit from wearing more weather-appropriate clothing.  Some people find it invigorating to run in cold weather, and it does feel invigorating, but dress appropriately and keep your body relatively warm.  Don't change into those shorts too soon.

What if you do end up getting the cold or flu?  I typically like to drink lots of hot liquids, especially a hot ginger tea that can chase away the chill.  It is super simple to make: slice a few slices of raw ginger (cheap in Asian stores), add to boiling water with some brown sugar, boil for a few minutes, and drink hot.  Go to bed early and frequently to rest up.  If early in the cold, I do something that is really weird but wonderful: I tickle my nose with something fine to stimulate sneezing.  Headaches and congestion can be relieved with a few good sneeze.  Sometimes entire colds can be prevented this way if done early.  I read of this method in Better to Ask Yourself book mentioned before; it really works!  What works well for me is a pair of very thin "tickle sticks" I cut out from a regular plastic straw, about 1-2 mm thick and 15 cm long.  I make the ends a little rounded so they do not cut the nasal mucosa. Insert the rounded ends and lightly tickle your nasal septum. Be gentle and don't injure your nose, and enjoy the relief sneezing brings.  Don't do this on small children because we don't want to injure their delicate noses.

Women tend to experience han-qi more easily because we menstruate and have children.  The Chinese believe that after childbirth or during a period, the woman's body is substantially weakened because of the loss of a lot of blood energy.  At the same time her pores are more open and make her more susceptible to cold.  That is why the traditional Chinese family does not allow the post-partum mother wash her hair, go outside, eat or drink cold or raw foods, or let her feet touch the ground for at least a month.  I just learned this other tradition recently: women are not supposed to wash their hair during menses.  Yuck,  you say. Yes, sounds unimaginable for the modern world.  Yes, times have changed.  We can easily shower in heated bathrooms now and blow dry our hair.  Hardly any Chinese moms in the U.S. follows these traditions now.  The result? I do feel cold more easily after having my daughter.  Regardless of what you believe, a woman's body is no longer the same after having had a child.  That may be why some moms and most grandmas are constantly trying to bundle up their children, and the dads are constantly trying to take the clothes off.  Men do not understand the degree of cold sensitivity we women experience.

Talking about cold and children, I have many concerns, starting from the delivery.  I have noticed a strange phenomenon in my daughter and some of the babies in our practice.  Some babies have fair skin after birth, but in the following weeks and months, become darker in complexion, then lighten up again, sometimes very dramatically.  Quite a number of babies have chronic stuffy noses and noisy breathing but no other cold symptoms.  Mr. Alex Wu mentioned in his book that he could tell by looking at some babies where they delivered in Taiwan--they looked so dark and full of han-qi that they had to have been born in some of the coldest delivery rooms in Taipei.  The modern hospital delivery room runs on the cool side for the laboring mom's and the gowned-up doctor's comfort.  When I was born in a small provincial town in China, the room my mom delivered me had a roaring fire.  Everything was geared toward the newborn baby's comfort.  The newborn, having being in mom's womb and used to the constant 98.6 degrees, all of the sudden rushes into a room maybe at 60-70 degrees, must not feel very good and welcome.  It may feel like traveling from the tropics rapidly into San Francisco in the summer.  Of course the nurses and the doctor quickly dry up the baby and put him/her under the warmer, but the baby does spend minutes in coolish temperature getting weighed naked (no one ever looks happy on the scale, you invariably see a screaming baby on the scale), getting washed and shampooed etc.  We might be unwitting exposing our newborns to unnecessary cold damage from the very first seconds of their lives outside of the womb.  One Chinese mom mentioned to me "every night at midnight, when my baby was soundly asleep and bundled, the nurses would come and strip him naked and weigh him outside in the hallway. I thought to myself, it was time to leave the hospital!"  When hospitals talk about cultural competence, they should take this point into consideration. When I was a resident, I admitted a baby with jaundice for phototherapy.  The nurses that night were not experienced and put the baby unwrapped under the bili lights, not in a warmer.  The Chinese mother insisted on leaving and ended up leaving against medical advice.  She was so right.  Hardly any baby dies from jaundice, but leaving the baby unwrapped and cold could kill him.  Therefore, if I were to have another baby, I would make sure that the delivery room can be made nice and warm for my baby. 

 Words of advice to delivering and post-partum moms, please do not drink lots of iced water.  I realize that everyone is different, and that every race/ethnicity must have differences in body composition.  Think about this though: the body's main mechanisms for releasing heat is sweating.  Sweat evaporates and brings heat away.  Drinking a lot of iced water can rapidly cool down our core, including our heart, which happens to be working hard and pumping fast to get us to sweat the heat out.  Such rapid cooling of the active cardiac muscles cannot be good.  That is why Chinese people in the olden days drank hot tea in the summer in order to get a nice sweat and cool down more gradually and naturally.  Mr. Alex Wu postulates that rampant obesity in the United States probably in part came from our habit of drinking cold drinks.  Virtually everything is iced.  Iced drinks damage the heart and the digestive system.  Digestion becomes ineffective. Blood energy in turn declines due to inadequate nutrition.  Garbage, i.e. fat, builds up due to the lack of blood energy and cardiac function to carry junk away.  The fact that most iced drinks have tons of sugar does not help either.  I will definitely talk about obesity in another post--TCM offers a completely different view of obesity and holds excellent promise in terms of treatment of obesity, as opposed to the largely ineffective methods we currently try to convince our patients to use.

To wrap things up, our life force burns like a flame.  Keep it away from wind and rain, add a few sticks here and there, then it will burn bright and strong for a long, long time.  Don't let it succumb to our enemy: cold.

Master Your Life and Deliver Your Own Happiness

A friend recently lent me a DVD called The Secret.  It has everything to do with my interest in traditional Chinese medicine and wellness.  The most important point I have learned so far from reading books pertaining to TCM boils down to this: happiness equals health, and happiness comes from self-love.  The Secret says happiness, health, prosperity, greatness are all within your control.  You think what you become.  Your thoughts create your future.  The Secret talks about the Law of Attraction: what you think attracts what you will get in life.  Positive thoughts attract positive changes, negative thoughts attract negative changes.  Once you are aware of this law, you can minimize negative thoughts and negative emotions, and maximize positive thoughts and emotions.  The Universe will deliver your wish if you truly believe in it.  This is a very powerful message.  It says that you are in total control of your own happiness.  Once I realized this truth, for I do believe it is the truth, I thought: duh, why was I so stupid before?  Not that I wasn't a happy person. I have been happy in general, but I never really thought that I was responsible for my own happiness.  But I am, and you are too. 

I used to feel emotions based on events happening around me, based on how well my day was going, based on external factors like how other people treat me.  Obviously we cannot control these external factors, so if we let them dictate our emotions, we allow ourselves to be passively tossed around in the sea of random emotions.  Negative emotions tend to spiral downward into even more negative emotions.  That's what happens when we get up on the wrong side of the bed in the morning: one thing leads to another, and before we know it, it was the worst day ever.  

Well, that's certainly one way to live our lives.  There is a better way, as pointed out by the makers of The Secret and other enlightened people.  Be the master of your emotions and thoughts, and anything can become possible for you.  Think happiness, think health, think success, think love, and those you will find in your future.  It may be tough to feel positive when you are having a bad day, but there are techniques you can use to switch  your negative thoughts and feelings into positive ones.  You can learn the complete secret at The Secret's official site.  I just want to share with you a few techniques taught by the makers of The Secret that I found helpful.

First of all, be grateful for all that you have.  Grateful people are happy people; it doesn't take much to make them happy.  Being alive, be grateful for that.  If you are not, talk to any cancer survivor.  It's a miracle that you and I are here, on this Earth, living our lives as human beings who can create and think and love.  You are loved, be grateful for that. You are loved by your family, your friends, your boyfriend/girlfriend/husband/wife/partner, your cat/dog/turtle/iguana/bird/mouse/plant, and most of all if you are a parent, your child.  Your child, be grateful for him/her.  Our children are our pathway to heaven, to true joy and boundless love.   Once you've covered the basic requirements for being happy, you won't sweat the small things and let them get to you.

What to do if something bad happens to you during your day?  Use the images of your favorite things, you know, wild geese fly with moon on their wings, that sort of thing.  I think of my daughter wearing her warm flowery hat with ears cozily covered bouncing down the sidewalk with a proud and happy look on her adorable little face.   Nothing can stop me from smiling if I think of her, that image of her.  Images of your favorite child, pet, person will all help. Music helps. Start humming your favorite song. Your mood will change immediately.  Do not dwell on what makes you feel bad.  Feel good regardless of what happens to you.  Chances are, when you feel good and in control, you accomplish what you set out to do with half the effort.  Everything will go your way because you approach everything with an open, happy heart.

Make it a game! Make it fun. Try it out and make everyday the best day of your life.  Before you know it, you will become that happy, healthy, energetic, beautiful person you envision yourself to be.  To all the parents out there, your child deserves a happy, healthy, energetic, supportive parent, so become that parent for her/him.  It will be the best gift you can ever give to your child.  Teach your child how to love him/herself by setting yourself up as an example. then your child will learn how to be happy regardless of what life may hold in the future. 

Get On Your Knees for Better Health

We have a TV but rarely turn it on. The few times that we had it on recently were for the Olympic Games, the Super Bowl (and a few playoff games), President Obama's acceptance speech on the night that he won the election, his inauguration, and tonight, we watched the Oscars. My one and half year old daughter devoured more popcorn (yes, a choking hazard, she was closely supervised) than both me and my husband. While I watched the Oscars and my own little star stuffing her bouncy cheeks with popcorn, I walked on my knees.

As it turns out, walking on one's knees counts as practicing traditional Chinese medicine! What does it do? Lots of things for a little bit of wiggling. I read of this exercise in another phenomenal book called Better to Ask Yourself than Asking the Doctor (Qiu Yi Bu Ru Qiu Ji) by Zhong Li Ba Ren. It is a series of 3 books that came out a few years after The User's Manual for Human Body got published. It is immensely popular in China and had helped countless people who through learning the simple exercises and techniques illustrated in the books, cured or ameliorated many of their own chronic illnesses. My best friend's father-in-law used to take a dozen different medications for high blood pressure, high cholesterol, hepatitis, etc, and now, after practicing the exercises found in the first book of the series, now is completely off medications (and well). Unfortunately there is no English version available. I would like to share as much as I can of what I learned through reading these books, hoping that I might help someone out there who has a troublesome condition. The principles used in these books are of course principles of traditional Chinese medicine, and the techniques are those of acupressure.

Let's get back to our knees. Walking on the knees brings blood right down to the knees. A lot of people, especially the elderly and women, have poor circulation to their hands and feet. I had cold hands and feet all the time, and felt really bad for my patients when I had to touch them. A pair of icy hands don't exactly comfort the sick. It can be a little tough to bring blood flow directly down to the feet, so a good way to do it is to walk on your knees! Not on hard floor, but on a firm bed or soft thick carpet. I use a pilate mat on top of my carpet. Gone are the cold hands and feet! Not only is it good for improving circulation to your extremities, it can also cure nocturia, or getting up to pee in the middle of the night! If you are one of those people who always had to get up to urinate in the middle of the night, you probably have weak kidneys in the TCM sense. By wiggling your waist while walking on your knees, you strengthen the kidneys and probably the pelvic floor too. This has helped my mom and one of her coworkers shake this life-long, annoying problem. What else is it good for? High blood pressure, arthritis, fat in the hip and thighs, and most of all, knee pain! Yup, you can trim your thighs by walking on your knees. Take a measurement before and 3-4 weeks after, you'll be surprised. How long do you have to walk each day? 10-20 minutes, or less if you are busy. How fast to walk? Totally up to you. This exercise is great for elderly folks with knee pain and limited range of motion. They can start slow by first just kneeling on some pillows, then, when they are more used to it, begin to slowly walk on their knees. Remember, you have to walk on a padded surface so it doesn't hurt. My coworker who has rheumatoid arthritis now has improved flexibility after she started doing this exercise.

To sum it up, walking on your knees 10-20 minutes a day on a padded surface can help you lose weight in the thighs, get rid of cold feet and nocturia, improve range of motion and lessen knee pain (because improved blood flow helps heal old injuries), help with high blood pressure. There are probably even more benefits waiting to be discovered by you. It feels good too! Give it a try and be pleasantly surprised!

Addendum:

Some updates on benefits of walking on the knees: my mom has lost 15 pounds, mostly from her abdomen and thighs walking just 2-3 minutes on her knees per day. She used to have a lot of dead, rough skin on her feet, but no more. Her coworkers who also walk on their knees have found relief from insomnia and back pain. My aunt's constipation went away after she started walking on her knees. So keep it up. A little a day does you a lot of good! Tell me how you've benefitted from this exercise!

Optimal Recharge: Why Sleeping Early is Vital

These days I listen to a lot of children's songs because of my little daughter.  One line often comes to mind when I think about the benefits of going to bed early: "Early to bed and early to rise, makes a man healthy, wealthy, and wise."  Talk about a major pearl embedded in a children's song! Early to bed is the key to health and happiness.  Our grandmas and moms tried to tell us, but did we listen?

A lot of us have the misconception that as long as we get 8 hours of sleep a day, we are good.  In fact, many of us feel pretty guiltless about squeezing in 6-7 hours of sleep a day.  Sure we've all been told growing up that we need to go to bed early to be healthy, but how many of us actually took that seriously?  Going to bed late symbolizes the freedom and glamour of adulthood.  Kids all whine when told that it was time for bed: "How come you guys get to stay up late?" Night time is our time to unwind, to relax, to have fun.  It really belongs to us, and we can't seem to make it last long enough.  The majority of teenagers and adults, based on what I have gathered talking to folks in our practice, go to bed after 11 pm.  Most teenagers go to bed near or way after midnight.  Going to bed late seems to be the social norm nowadays. We have forgotten that all the other diurnal animals (animals who are active during the day, including us) go to sleep soon after nightfall.  In other words, we have forgotten that we are too, a part of nature, and that our body, whether you believe in evolution or creation, was designed to function in sync with the natural world.

Traditional Chinese Medicine believes that the human body is a miniature universe with its own internal rhythm, a rhythm that is comparable and intimately related to the change of season and the cycle of day and night of the natural world.  Like the plants and the animals around us, our body responds to the change in light and darkness, and the change in season.  We know that once a baby is born, the amount of daylight helps to shape his/her sleep cycle so that with time, the baby adjusts to sleeping longer at night and staying more awake during the day.  We call this phenomenon adjusting one's biological clock.  People who travel through different time zones experience jet lag because of the discrepancy in daylight hours.

TCM has a special term for the biological clock: Zi Wu Liu Zhu - Flow and Infusion (of energy) from Midnight to Noon.  Through perhaps thousands of years of careful observation, doctors in China found that the body, indeed, has its own rhythm.  Things do not happen randomly in the human body. Instead, there is a schedule that the body follows faithfully everyday.  TCM believes that our Xieqi, or blood energy, flows through our body organ by organ and nourishes each one in succession, following a timetable as predictable as the tides. 

The ancient Chinese marked time with twelve shi-chen. Each shi-chen is two hours long and corresponds to an organ in the concept of Zi Wu Liu Zhu.  In other words, every organ gets its 2 hours of maximal nourishment so that it functions best in its hour.

Here is the timetable of the human body:

5-7 am: large intestine active. Best time to defecate or poop.

7-9 am: stomach active. Best time to digest.

9-11 am: spleen active. Best time to absorb nutrients and produce blood.

11-1 pm: heart active. Best time to circulate blood through out the body and in turn, helps digestion.

1-3 pm: small intestine active. Best time to absorb nutrients once again.

3-5 pm: bladder active. Best time to get rid of excess fluids and toxins.

5-7 pm: kidneys active. Best time to store away the essence produced by each organ throughout the day. 

7-9 pm: the pericardium active. Once again the heart is strengthened and circulation is improved, aiding digestion.

9-11 pm: the three cavities active. The body sleeps and enters a resting state.

11-1 am: gall bladder active.  Old bile gets processed and new bile produced.

1-3 am: liver active. Liver filters blood, gets rid of toxins and purifies blood.

3-5 am: lungs active. Lungs distributes the refreshed blood stored in the liver to get ready for a new day.

Okay, some parts of this timetable may look funny to someone unfamiliar with traditional Chinese medicine.  What the heck is the pericardium or the three cavities?  The spleen helps with absorbing nutrients? The kidneys do what?  Don't we use the lungs to breath?  TCM does not view the organs exactly like we understand them based on anatomy and biochemistry.  Some organ functions correspond well to what we are familiar with, some sound more nebulous but actually make a lot of sense once we get familiarized with some TCM concepts. I will try to explain the organs in TCM terms in a later post. 

For now let's focus on the 11-3 am block on our timetable, which is vital for our beauty sleep. That block of time corresponds to the gallbladder and the liver, which are viewed as one system in TCM. That makes sense because the gallbladder is connected to the liver and stores the bile produced by the liver. Together the gallbladder and the liver makes the most powerful chemical factory in our body; its mission? To take out and break down all the garbage that our body dumped into the blood through a full day of activity and to put nutrients back into the blood.  If you think about it, the plumbing for your water source and your sewer system are separate entities. For our body, it's all one system in terms of molecular nutrients and waste.  Our body relies on our five liters or so of blood to deliver food and oxygen to all its parts, and at the same time, needs it to carry away all the chemical waste generated by millions of reactions necessary to keep us running.  Our liver has the most important job of making sure that our blood stays fresh and nontoxic, and it needs us to be soundly asleep to function its best. A lot of us are doing what between 11-3 am? Vegetating in front of the TV? Glued to Facebook? Chatting online? Or even worse, drinking and partying.  Our poor liver not only cannot do its job of detoxifying our blood, it needs to work extra hard to keep us going.  The liver can take a lot of damage.  We know how well it regenerates.  It will continue to work hard despite our abuse.  Thus in the short term, we do not feel any major effect of staying up late, but over a longer period of time, we will get more and more tired and look worse and worse because, guess what? Our blood has turned into dirty motor oil with globs of toxins and garbage floating in it. Garbage like what? Bad cholesterol, fat, uric acid (the stuff that causes gout if in excess levels), and many more.  Will dirty motor oil replenish our skin so we stay wrinkle-free, pimple-free, full of healthy glow? Probably not. Will our heart be happy pumping dirty motor oil through it 80 times a minute? Probably not.  Will we be able to think clearly when dirty motor oil percolates around our brain cells? Probably not. The result is that we get on the fast-track toward aging, illness, and death if we stay up late all the time.  

The good news is that even if we have been on the fast-track to aging for years due to innocent misuse of our body, we can make a change now for the better and start treating our liver with respect (and yes, reverse aging!). Get to bed by 10-11 pm, the earlier the better, and we will soon get our natural rhythm back and actually feel rested in the morning.  Our complexion will improve, wrinkles lessen, bags and dark circles diminish, and our mood dramatically better.  I find that my patience level and tolerance for stress directly depends on the amount of quality sleep I have had.  Our happiness truly depends on it.

Impossible you say.  There's no way I can fall asleep at 10 even if I go to bed then. May be not right away. A good way to deal with that is to listen to your body. If you are tired at 3 pm, go to bed then if you are able.  If you are tired at 8 pm, go to bed at 8 pm.  You are not acting crazy, you are just trying to get some rest.  The world will not come to an end if you failed to update your Facebook page or watch that one show on TV.  The world will come to an end for you sooner if  you stay up late to do those superfluous things all the time.  Mr. Alex Wu said it well: those who don't have time to sleep eventually find time to get sick.  Also, think of all the cool things you can do with all that extra time in the morning!  You can exercise, meditate, read the news, and may be even find time for a leisurely breakfast instead of just downing a cup of coffee.

So good night, sweet dreams.

Addendum: I often find out with dismay that many of my young patients (preschool age toddlers or even infants) go to bed late like their parents, some as late as 11 pm or 12 am!  This is simply not acceptable.  Sleeping late will seriously compromise the health of our young children.  My late-sleeping patients tend to have more illnesses, worse digestion, and poor weight gain.  Children depend on us to guide them and take proper care of them.  Healthy parents tend to raise healthy children because the parents know how to take proper care of themselves to start with.  Please set a proper bedtime for your child, something like 8 -8:30 pm for infants and young toddlers, 8:30-9 pm for older children, and 9-10 pm for teenagers.  Expect them to sleep at that time and enforce the bedtime.  Go to bed early yourself so your child will not want to stay up late with you.  Our children's future depend on us.  Please get them on the healthy track rather than the fast track.  Some of my patients have so many activities and homework that they cannot sleep early if they wanted to.  Parents, give them a break! Teach them to pace themselves and focus on what is important in life, which is happiness and health, not success in the conventional sense, i.e. wealth, fame or power.  If they stay happy and healthy, they will have accomplished the greatest accomplishment in life.

Gauging the Mileage of the Body

Graph based on those found in Mr. Alex Wu's The User's Manual for Human Body

Car Talk on NPR is a extremely funny and informative radio show. Tom and Ray, the guys hosting it, know cars inside and out. People call in with the weird noises their cars make, and with a few pieces of basic information and key questions, Tom and Ray can give the caller the correct diagnosis with confidence and lots of humor.  I wish I can be 1% as brilliant a diagnostician as these guys. 

Even brilliant diagnosticians need certain pieces of key information. For cars, they would be make, model, year,  and most of all, mileage.  All parts in the car has a specific lifespan, beyond which they will malfunction or stop working altogether. The same is true in the human body. Notice the age of the car does not necessarily correlate with mileage. The same is true in the human body.  Some young people can be very ill, and some old folks very healthy.

One problem with Western medicine is that we don't think too much about the mileage issue, and therefore have no good ways to gauge it.  Knowing the mileage on the body is so important though because not only can you correctly diagnose illnesses based on this piece of information, you can also predict what is going to give out next and take measures to prevent the next big break-down.

Traditional Chinese doctors know to gauge the mileage on the body. You can too! It's easy.  Basically, it is like finding where you are in the the unique trajectory of your life.  The good thing about the human body is that it continues to repair and regenerate itself as long as it is given the necessary rest and nourishment.  The car can't fix itself, but your body can.

So how do we do it? How do we gauge the mileage?  Well, let's first look at a generic body, or the standard curve.  In TCM, babies are born with 0 mileage. In other words, they have 200,000+ miles or 100% life force left, and they are highly capable of repairing themselves.  A scratch on a baby's face disappears in 2-3 days, but would take 1-2 weeks or more to disappear on our face.  As pediatricians, we all have seen kids bouncing up and down only a few days after major surgery.  TCM doctors don't use the term mileage of course.  They talk in terms of xieqi, or xueqi, (can be pronounced like chez-chi) which in literal translation is "blood-energy".  We are born with full xieqi, then it goes down hill until we run out and complete our life.  Therefore the life force, or xieqi curve, is a line that goes downward from 100% to 0% as we get old.  TCM doctors don't use percentage either, but divide the area under the curve into 5 levels.  Top level is healthy, and the bottom, very unhealthy.  They know how to place the patient into the appropriate level and therefore can predict what kind of illnesses that person is likely to have, and furthermore, decide on how to help the patient become healthier.  I find this top-down approach extremely simple and elegant, and everyone can use it to gain better awareness of his/her own body.

TCM describes these five levels in terms of Ying and Yang.  Ying and Yang can have many meanings and nuances in Chinese medicine, but Mr. Wu simplified the Ying Yang concept so we can all understand it easily.  When we talk about xieqi, or blood energy/life force, Yang means the blood energy we generate everyday through proper rest and digestion.  It can be compared to our liquid assets, our cash flow.  If our business or job generates enough profit or income, we have the ability to pay our bills and have extra to spend or save or invest.  Ying means our body's blood energy reserve.  It can be likened to our retirement, savings, or investment accounts.  We build our Ying reserve up through our childhood because our parents put us to bed early everyday and took good care of us.  When we become teenagers or young adults, we start dipping into our reserve by sleeping late and doing other crazy things to our bodies.

Now that we have Ying and Yang roughly defined in the xieqi context, let's take a look at the xieqi curve and its five levels above. This graph is based on the ones found in Mr. Wu's book. 

1. Healthy Level: 

At this level, our body possesses enough xieqi, or blood energy, to defend itself against internal and external causes of illness, and it heals itself easily.  A healthy person can be characterized by a well-proportioned body (not fat or thin), a healthy complexion (smooth red glow on the face and lips), a very even and consistent temperament, and he/she leads a very orderly life.  Such people are rare among today's adult population in the developed world.

2. Yang-deficient Level:

At this level, the body no longer generates enough energy to optimally run its systems and completely ward off illness, but it still tries to fend off disease-causing elements whenever we give it better rest. A Yang-deficient person has frequent colds and allergy symptoms because his/her body often puts up a good fight against external or internal insults.  We often think such persons are weaker in their immune system, but we might want to reconsider that conclusion.

3. Ying-deficient Level:

At this level, our body not only cannot generate enough energy to maintain optimal function, it needs to use its reserve energy.  TCM doctors describe people in this level with the term "Ying Xu Huo Wang", or Ying-deficient, Fire burning strong.  What is fire? It is the energy released when we burn our reserve. I think of it as taking out money from our savings account and start burning the dollar bills.  Ying-deficient people have a unique characteristic: they often feel very tired in the afternoon or evening, but as soon as 9 pm hits, they feel wide awake and full of energy.  They almost always are late sleepers and late risers. I should say we because I belong to this level too.  Ying-deficient people do not get sick often because their body no longer has the luxury to take care of minor offenses like colds.  One can spot these people easily, however, by the telltale signs left on their faces and skin and hair. They often have an ashy complexion. Their lips have lost the healthy red glow of youth and became pale or darker in color. They have bags and dark circles under or around their eyes.  Their hair start to fall out or turn gray.  Some of them start to put on extra weight. Why? The body, given limited amount of energy, only takes care of vital functions such as keeping our heart pumping, making sure we can breath and digest food etc.  It decreases blood flow to the skin surface and stops carrying away all the garbage that only cause cosmetic concerns.  Some disease entities  such as thyroid disease are often found in people belonging to this level. 

4. Ying-Yang Deficient Level

At this level, our body has run out of most of its reserve. A Ying-Yang deficient person feels tired all the time, day and night.  This symptom of persistent fatigue signifies our body's desperate call for rest.  It's like the light that turns on when our gas tank is running empty. We can still drive the car for a little while, but not very far unless we fill up.

5. Critically Low Level

At this level, the body has such low energy that it can no longer hold everything together.  Organ after organ breaks down and malfunctions.  Chronic, severe illnesses such as kidney failure or cancer occur at this level.  If the body cannot reverse this trend, then death soon follows.

I became very scared after reading this part in Mr. Wu's book.  I used to think that I was a relatively healthy person.  I am fairly young, I do not smoke or drink.  I try to eat properly and exercise regularly.  What was I doing wrong? Sleeping late.  Going to sleep early (like around 10 pm, at least before 11 pm) is the key, as Mr. Wu had pointed out.  I will elaborate on that later.

Scary as this curve might be to a lot of us, the good news is that we, by changing our habits, can move ourselves up the curve into a healthier level.  If our parents took good care of us when we were young, and we went to bed early most of time during our childhood, we have enough reserve to run about 40 years before symptoms of illness show up.  Once we make a positive change such as going to bed early, we can reverse the damages we've done to our bodies and change the trajectory of our life.  How fast does that happen? Pretty fast considering how many years of misuse we might have exerted on our bodies.  It takes months to undo years of damage. Of course the longer we have ignored our bodies' needs, the longer it would take for us to heal ourselves.  However, the moment we decide to treat our body with the respect and care that it deserves, we feel a difference right away.  We realize that we can take ownership of our body and no longer fear illness.  We do not need to ask our doctor if we are healthy or not. We know where we stand and we know where we want to go.

After all, our body, this wonderful, exquisite living creation, acts as the vehicle to our mind and spirit.  Without it, we cannot get anywhere.  We only get one vehicle per lifetime, so let's drive it with the utmost care.

Are we practicing upside-down medicine?

As doctors, do we truly know what is health and what is disease? Do we really understand how the human body works? Are we healing our patients or are we simply treating symptoms and lab values?  Is it possible that we've got it all wrong in some fundamental way? Do we even know how to take proper care of ourselves?

These are scary questions for a doctor to ask of herself. One week ago, I was just an ordinary pediatrician seeing kids for cough and colds, giving shots, and signing school forms. Then one book turned my world upside-down, or actually, right-side up.  This amazing book is called The User's Manual for Human Body, by Alex Wu.  Mr. Wu has an engineering background, and worked many years in the field of robotics and artificial intelligence, as well as business consulting and investment, and was very successful in his careers. However, his rapidly declining health acted as a wake-up call, and by chance he encountered the marvelous science that is traditional Chinese medicine. He left his previous fields and delved into the world of traditional Chinese medicine and made many important observations. Because he is not a doctor, he was able to think outside of the box that is modern medicine, and raised serious doubts about the fundamental theory and direction of modern medicine.  At the same time, he was able to use simple analogies and everyday language to describe and clarify the basic principles of traditional Chinese medicine and made them easy to understand for the lay person. Furthermore, he applied these principles and came up with a few simple steps for improving health. His book sold over a million copies in Taiwan and China despite the fact that it was already available and free online for 3 years before it was published.  Countless people in China and Taiwan benefited from this book, but as of yet, there isn't an English version available in print.  The entire Chinese version as well as English translations of certain sections can be found in his blog at: http://www.alexwu2300.blogspot.com, but I found the English translation a little harder to read compared to the immensely popular original version in Chinese.

My first reaction after the initial shock and joy of having experienced enlightenment was: everyone needs to read this book, especially doctors.  His logic made so much sense! The day after I read his book, I started using a different angle of thinking when seeing my patients, and the effects were magical.  Everything made sense. I actually felt like a healer.  Before I did enjoy my work mostly because I liked the kids a lot, and most of the parents too, but I didn't feel like I was offering them much.  The one real useful thing I did was giving vaccines, but a nurse could do that just as well.  Most of the time I sound like a broken record (with warmth and feeling of course): "Oh, he/she's just got a virus. The fever might last a few days, and the cough and runny nose for about a week or two. Give her tylenol for fever if she's uncomfortable from it, and give her plenty of fluids and rest. Call us if the fever last more than 3 days or if her cough gets worse." I went through medical school and residency just to say that? Anybody could have said the same thing.  Meanwhile I see more and more chronic illness such as asthma, allergies, eczema, obesity in my young patients, and most of the time I can only offer medications that can "control" them (meaning making the symptoms lessen or disappear temporarily).  For obesity I ask my kids carefully about their meal and sleep habits, food/beverage choices, exercise routines, computer and TV time, and make recommendations such as cutting out sodas and fast-food, decreasing electronic entertainment, and increasing exercise and sleep. Once in a while a kid does really well and returns to a normal weight, but most of the time they just stay overweight or get heavier.  I'm seeing obesity in babies as young as 4 months. I think a lot of pediatrician feel like me, that we are running into a brick wall in terms of the obesity epidemic.

The world of adult medicine is even worse.  The rate of chronic illnesses continues to rise despite rapid advancement in medical technology. Honestly I became a pediatrician because I prefer to prevent disease rather than managing more than a dozen medications for each patient.  I felt that many illnesses in the adult world were self-inflicted and therefore extremely difficult to treat. I and many others who went into pediatrics told ourselves: let's do our best to keep the kids healthy rather than trying to fix something that is already broken.  In this regard pediatrics is most similar to many older, more holistic medical systems.

Anyway, Mr. Wu's fresh views changed my thinking, and the important change is this:

as doctors, we have forgotten, or never realized, that the human body is much more intelligent than what we give it credit for.  It is capable of repairing itself, if given proper care and the necessary conditions and materials.  Just look at any newborn. Every parent feels amazed upon meeting his/her new baby.  Every baby is a miracle, a masterpiece, a work of art, even the imperfect ones, and we, besides the initial contribution of the sperm and the egg (and mom's 9 months of joyful suffering), have very little to do with its formation and completion.  If our body knows how to make a baby, would it know how to repair itself too?

Actually, a lot of smart doctors know this. They joke "the smartest cardiologist is dumber than the dumbest heart" etc.  They say "the more you know, the more you don't know" about the human body. It's true. A doctor trained in the current medical system does feel "the more you know, the more you don't know" all the time. The reason is, as Mr. Wu correctly pointed out, modern medicine as we know it is too concrete and compartmentalized.  We have wonderful doctors who dedicate their lives to making people healthier, but a lot of us are missing the big picture. Really missing the big picture. 

For example, what is health? Ideally, it should be defined as something like "the wholeness of body, mind, and spirit".  A healthy person is someone who is happy, balanced, at peace, who gives loving care to his/her body and spirit, and who feels closely connected to nature and the larger world.  Unfortunately, this is too lofty a goal for a doctor who only has 10 minutes to see his patients.  In our everyday practice, we lower our standards and define health as "the lack of disease or symptoms" because during most of our training, we were taught to treat symptoms and abnormal lab values.  We learned that certain group of symptoms correspond to a certain disease.  We listen to our patients, gather data such as patient complaints, symptoms, physical signs, and come up with a "differential diagnosis", meaning a melange of possible diagnoses, usually organized by categories such as "infectious disease", "endocrine", "autoimmune", and maybe order some tests to confirm or rule out our suspicions. Once the diagnosis is made, we prescribe the appropriate medication or treatment, or refer the patient to the specialist because today's medical world is highly specialized.  Eye problem? Go see the eye doctor. Heart problem? We'll send you to the cardiologist.  While in training, we were taught to write out our management of patients based on systems: health care maintenance, cardiovascular system, respiratory system, etc. Do you see a problem with this this kind of approach?  

First of all, we assume the patient was healthy before the symptoms started because we use the definition that health is lack of illness/disease.  Then we focus on the site of the complaint and categorize the patient into a diagnosis.  Are we really sure that this person was truly healthy before the symptoms started?  Even if our diagnosis is correct, do we treat this person like any other person with the same diagnosis?  The answer is most often yes. In fact, in speaking to each other, time-deprived doctors often use the diagnosis to label the patient rather than talking about the patient, for example, "in room 2300 we have a 2 year old with UTI (urinary tract infection), and he's on cephalexin." The practice of medicine becomes reflexive, automated, algorithm-based. In other words, cookie-cutter.  

Compartmentalization is another big problem. Each specialist only cares for disease entities in his/her specialty, and they have little knowledge or interest outside of their specialty.  The patient in such a medical system becomes a collection of different diseases, sees a range of specialists for each disease, takes a wide array of medications, and loses identity as a human being. 

When I take my car to a mechanic for repair, I think I understand how patients feel going to their doctors.  They have no idea what is going on with their bodies, and they are worried about certain symptoms, and they have to trust what their doctors tell them. It's a scary feeling. If you know and trust your mechanic, you don't worry too much and follow his advice, but what if you can't find a trusted mechanic? 

The problem is we treat patients like mechanics repair cars. The good doctor or mechanic knows how to diagnose a problem and fix the broken part. But human beings are not like cars (we are like cars in the way that we need to be well-maintained to have a long productive life).  We are more than a sum of parts, a mechanical system.  The human body is highly intelligent. No, not just the brain, but the whole body, is highly intelligent, and knows how to diagnose and treat its own problems.  And another thought: do symptoms really mean disease, or are they the result of the body doing some spring-cleaning?

This is what Mr. Wu pointed out to us: health does not mean the lack of disease or symptoms, and symptoms do not necessarily mean disease. 

Often we hear about such and such person died suddenly of some catastrophic illness shortly after "he's been given a clean bill of health by his doctor".  Because we focus on symptoms and illnesses rather than health, we are good at treating symptoms but very poor in assessing health and promoting health.  Promoting health, as I have learned, is much more than advocating good diet and exercise, smoking cessation etc, although those are very important too.

The good news is that there are ways to assess health, in ourselves and in our patients, and there are ways to promote health.  Other older medical systems have figure that out a long time ago, but because they lack the luster of new technology, they get shoved into the category of complementary and alternative medicine (CAM). Very few Western doctors are knowledgeable in these medical systems. At best we "tolerate" their use if our methods fail, but very few of us are knowledgeable enough to make any kind of recommendations on their use.

I will discuss the basic principles of traditional Chinese medicine and their application to our daily lives as doctors and as regular people who want to maintain optimal health. These principles were made clear to me by Mr. Wu, and I hope they will be of help to anyone who is interested.  In the past I knew very little of Chinese medicine, and now I am a convert. I still know very little, but the good thing about Chinese medicine is that it is very accessible once simply explained, and one concept can go a long way in promoting your health.

To sum it up: 

1. Our body is intelligent, more intelligent than any computer or doctor, and it can repair and restore itself. All we need is a user's manual to get started at achieving optimal health.

2. Modern medicine runs into a brick wall in dealing with chronic illnesses, because it fails to realize that the body is more than a sum of parts, health means more than the lack of disease, and most of all, many symptoms do not mean illness but are a result of our body repairing itself. In trying to make the symptoms disappear, we might be causing more harm than good.

3. It is worth while to look into other medical beliefs and learn something rather than simply "tolerating" the use of CAM.

4. Traditional Chinese medicine, like other ancient medical systems, is holistic and sees the body and mind as a small universe of balanced systems that are intimately connected to each other. Long before the emergence of modern science, doctors in China figured out the way each organ affected each other and how different external conditions and internal emotions give rise to illness. They did not know anatomy or pathology as well as we do, but they knew how the body worked, or how the body and the mind worked as a whole.  They have a very clear system of describing the characteristics of each individual person and the kind of illness he or she may have. Most of all they knew the body can heal itself and worked to aid it in its healing process instead of getting rid of symptoms as they arise.  A lot of TCM concepts are described in abstract-sounding terms, therefore hard to understand for a lot of people, up until Mr. Wu's book.  To use Mr. Wu's analogy of the human body to our personal computer, doctors of Chinese medicine knew the existence of human software and how it worked instead of delving deep and deeper into the analysis of its individual hardware.  Computers are nothing without software.  Knowing every last detail about the hardware will not enable us to know how the computer works if we do not even know the existence of software.  Evidence-base medicine is what we preach, but isn't it a bit concrete?  Yes, modern medicine is still at the concrete-operational stage of development, while older systems reached the ability to see the human body in abstract terms thousands of  years ago.  Let's borrow from these older, "unscientific" views and build a integrating system to organize our expanding sea of isolated pieces of scientific data.  I hope we all stop feeling "the more we know, the more we don't know" and start feeling "the more we know, the more we know".  Without a basic framework with which to learn about the body and mind as a whole, we soon become burnt out from the repetitious and often brainless "practice of medicine". But we can do better, and medicine can become rewarding again.