With the cooler fall season in full swing following an unseasonably hot summer, now is a perfect time to begin laying the foundation for health and vitality in the winter season.
Traditional Chinese medicine has always emphasized living in harmony with the seasons. Teaching patients how to modify diet and lifestyle based on the season is a critical aspect of patient education, but an important facet of this is for practitioners themselves to think ahead of the curve and begin to ponder presentations they will most likely encounter in the clinic as the seasons change.
In this installment, I cover three important concepts clinicians can keep in mind to prepare patients for the upcoming winter season and adroitly treat complex patterns that may emerge during the predictable “cold and flu season.”
Concept #1: “Treating the Illness Before It Arises”
This concept is one of the most important, yet most often overlooked aspects of Chinese medicine. In order to truly apply this concept in a clinical setting, the practitioner must deeply understand the constitution of the patient, as well as understand the patient’s medical history. When accomplished, it is possible to prevent a large percentage of issues usually considered “inevitabilities” of the winter season.
When preparing a patient for the winter season, practitioners typically consider supplementing the wei qi in order to ward away invasions of wind cold / wind heat. While there are many concepts applicable to nourishing the wei qi, supplementing the qi of the spleen / stomach and concomitantly clearing / preventing qi stagnation are paramount.
To achieve this goal, I find it highly effective to treat the back shu points, along with the spleen / stomach meridian points. The following two acupuncture point prescriptions are examples of such an approach:
- BL 17 + BL 20 + BL 23 (back treatment)
- Sp 3 + St 36 + Ren 6 + Du 20 (front treatment)
This point prescription uses the back shu points, which influence the circulation of blood, as well as the spleen and kidneys. It is important to remember that the kidneys are a root source of the wei qi, and blood stasis can systemically cause issues; therefore, using the back shu points, which target these issues, is highly effective.
The front point prescription boosts the qi, moves the qi to prevent stagnation, and calms the shen, which is so important for the body’s systems to function smoothly. Another possible option for the front treatment could be:
- Sp 3 + Sp 6 + Ren 12 + Du 20 + Yin Tang
This front point modification focuses more on moving the qi and boosting qi for individuals who may suffer from digestive issues and /or stress-related digestive issues. It strongly courses the qi, while at the same time calming the shen.
Concept #2: “Simultaneous Supplementation & Attack”
This vastly underappreciated concept is extremely applicable in the modern clinical setting, where patients commonly present with significant deficiencies coupled with acute invasions of wind cold / wind heat. Acupuncture point prescriptions are particularly suited for this, as prescriptions can be highly individualized as needed based on the unique symptoms or constitution of the suffering patient.
These clinical scenarios are very common in the winter season; therefore, clinicians should ponder this concept deeply and prepare potential approaches that can be implemented with ease.
It is common to create point prescriptions that boost and clear at the same time in cases of wind invasion and constitutional deficiency. Such point prescriptions can be created while keeping in mind the preponderance of deficiency versus excess. Some of the potential point prescriptions I often utilize in these complex presentations include the following:
- LI 11 + ST 44 + Ren 6 + Sp 6
This point prescription is highly effective for cases of wind heat invasion with a background of qi deficiency / qi stagnation. The points LI 11 and ST 44 strongly clear heat and can be drained, while the remaining points can be evenly needled to support the underlying deficiencies.
In such cases, if the approach is to only clear heat, often the patient’s recovery will be slow and result in “long disease,” much like allopathic cases in which only simple medications are used and nothing is done to help support the strength of the patient. Another possible point prescription in such cases could be:
- LI 11 + Lu 10 + Sp 6 + St 44
This point prescription strongly clears heat from the lung meridian and yang ming meridian, while also coursing and gently boosting the qi.
Both of these point prescriptions for this more complex concept can be customized as needed based on the unique presentations of both the invading pathogen and the potential underlying deficiencies. This concept is so important to consider in cases of “long disease.”
Clinicians should always extensively inquire about state of the patient in the months and weeks before acute wind cold / wind heat invasion to evaluate the state of deficiency if experiencing an acute attack of an external pathogen.
Concept #3: “Clinical Action According to Time, Place, and Person”
This is a foundational clinical paradigm that guides all aspects of my practice. Clinicians should always consider the time of year, geographical location, and the overall strength of the patient suffering discomfort; and use all of this information to intelligently craft a customized treatment protocol.
Treatment according to time takes into account the current seasonal influences and how the seasons influence the movement of qi throughout the organs and meridians. Treatment according to place takes into account the unique geographical location of the patient. Is it a hot and dry locale; or cold and damp? How does the patient feel in this location? Treatment according to person takes into account the patient’s overall health status and age.
Each of these facts of time, place and person can be used to fashion unique acupuncture point combinations that embody the concept of “treating the patient not the disease” so foundational to the practice of Chinese medicine.
