"Qi gives movement, change, and transformation to the various expressions of life, and allows for the manifestation of specific qualities and aspects. My demeanor and body language are all a manifestation of Qi, as are my temper, temperament, and emotions." — Elisabeth Rochat Delavallee, in her book, A Study of Qi
In my last column, I discussed a variation on the popular "Four Gates" acupuncture combination most commonly used for the common clinical expression Liver Depression Qi Stagnation. In this installment I will discuss some key ideas which are connected to the concept of Liver Stagnation and how these ideas can help improve the clinical efficacy of acupuncture in cases of Liver Depression Qi Stagnation.
As a licensed health coach as well as a licensed acupuncturist, I always seek to find the root of patterns of imbalance in the behavior patterns of patients. In the majority of patient referrals that I encounter in my clinic, behavior patterns are rarely, if ever, discussed.
Finding Patterns of Disharmony
I find most clinicians, whether primary caretakers or acupuncturists, rarely ask patients about lifestyle behaviors which may be forming the foundation for patterns of disharmony. The above quote outlines some key ideas which form many structural foundations for Liver Depression Qi Stagnation. If these are not addressed, often simple use of the "Four Gates" acupuncture points will be only a temporary help in resolving patterns of disharmony.
Three key ideas which I always discuss with patients who present with the pattern of Liver Depression Qi Stagnation are: movement, change, and transformation. These three concepts are significantly important for truly resolving chronic cases of Liver Depression and empower patients to take part in the healing process. The concept of Liver Depression implies that the flow of Qi is stuck, stagnant, not moving. Like running water, if Qi is not flowing one's life expression will present at stagnant.
This can manifest as malaise, depression, physical pain, insomnia, hypertension and a myriad of other symptoms. As practitioners of TCM, we know that Qi stagnation can be at the root of a complex mixture of pattern presentations. Besides administering TCM formulas and acupuncture point combinations, we must look at the behavior patterns to effectively address the root of Qi stagnation.
Movement, Change & Transformation
In all cases of Liver Depression, I always have patients write out areas in their lives in which the concepts of movement, change, and transformation are lacking. These three concepts must be explored to stimulate creative pathways to correct patterns of behavior disharmony which may be contributing to the manifestation of Liver Depression Qi Stagnation. What areas of movement are stuck or lacking? Is the patient physically moving? This is a common issue and should always be addressed. Resolution of this does not require huge changes, it can be as simple as implementing walking daily. Ideally patients should be physically moving at least 350 minutes a week to help circulate the Qi and Blood. Always inquire about what is "moving" or not "moving" in cases of Liver Depression.
What areas in the patient's life is affected by change? Is there too much change occurring? This alone can be the cause of Liver Depression. In such cases patient's must be able to expect discomfort and seek to learn stress coping techniques to manages such changes. This can be as simple as meditation, tai chi classes or daily journaling. In many cases there is no change occurring, patients are stuck in monotonous life routines and this manifests as existential malaise or depression.
In these cases, the individual should be encouraged to step into new areas and new experiences in order to stimulate creativity and inspiration. In what areas of life are the patients experiencing or pursuing transformation? This final concept is extremely important for breaking out of patterns of disharmony rooted in Liver Depression.
The circulation of Qi is rooted in transformation. Any life which lacks transformation lack adequate circulation of Qi. Seeking out new areas in life for personal growth and transformation is a key idea for patients of all ages. This is one of the main reasons why I always give the "prescription" of joining a quality martial arts school to patients.
The path of martial arts is a constant journey of growth and transformation which the standard everyday life path does not often provide. There are many styles of martial arts which can suit any and every mental-physical type, young and old. Often this alone can address the concepts of movement, change, and transformation so needed to adequately circulate the Qi of one's life path. I have also found the use of Bach Flower remedies to be of significant help in stimulating movement, change, and transformation. In such cases, the Bach Flower remedies are always linked to the TCM concepts of pattern discrimination unique to each patient.
The concepts of movement, change, and transformation are key ideas to helping shift behavior patterns which are creating and reinforcing Qi stagnation in all areas of life: physical, mental and spiritual. No amount of Xiao Yao Wan, Chai Hu Shu Gan Wan, or endless acupuncture sessions of the Four Gates can be the sole solution to cases of Liver Depression Qi Stagnation.
Herbal medicines and acupuncture although extremely powerful, can often be just temporary fixes. Unless the root behaviors which formed the patterns of disharmony are addressed and resolved, the problem will continue to manifest. I hope these simple ideas inspire clinicians to help dive a bit deeper into the pattern presentations they encounter in the clinical setting and empower patients beyond the herb and the needle.
As modern medical standardization continues, the field of traditional Chinese medicine has the advantage of comprehensive personalization. For rare or complex cases, deeper consideration of constitution is invaluable. Proper constitutional assessment, especially with first-time clients, can guide desirable and predictable outcomes. This leads to a higher rate of return, and greater trust between you and your patient.
Though the creation of a financially sustainable, health-promoting model feels far away today, we are casting a vision for a full return on health, believing that this compels us to keep one foot firmly rooted in caring for the sick and the other foot firmly founded in maintaining health. Shifting from a fee-for-service model to value-based care using a phased approach is paramount.
Laser therapy has emerged as a powerful tool in the realm of traditional Chinese medicine (TCM). This new modality fits beautifully into the toolbox of the modern acupuncturist, as it can be used as a hybrid form of stimulation to acupuncture points, meridians, organs, nerves, and symptomatic areas in a new way that blends both moxa and energetic needle-like responses.
