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As we approach spring, it’s a good time to discuss seasonal junctions. Both Ayurvedic and Chinese systems of medicine see the changes of seasons as times when we are more susceptible to being thrown out of balance as our body is challenged to adapt to the shift. Ayurveda has a saying that “diseases are generated at the junctions of the seasons.”
Other junctions are also challenging, with the challenge generally proportional to the magnitude of change. Ayurvedic teacher Robert Svoboda writes, “Ovulation and menstruation are the ‘joints’ of the menstrual cycle, dawn and dusk are the joints of day and night, and adolescence and menopause are the junctions of life.” If you have kids, you know that the “joints” of the day are the times you’re likely to have trouble, and if you’re clever, you find ways to make these transitions easy, such as the ever-popular “five more minutes until we’re leaving.”
Depending on where you live and your personal constitution, different seasons and junctions will be challenging for different people. For example, because spring tends to be wet, moving into this season means taking on more of what Traditional Chinese Medicine (TCM) calls dampness, or in Ayurveda an increase in kapha (“kaap-ha”). This will be most difficult for those who already have constitutional kapha or an accumulation of dampness in their system. Some of the signs and symptoms include: being overweight, having loose, sticky, or incomplete stools, a wide or coated tongue, feeling heavy and tired, finding it hard to wake up in the morning, and a tendency to be phlegmy.
Ayurveda might prescribe some therapeutic vomiting for such a condition, but these days, especially in the West, we prefer more pleasant medicine, ideally in gummy form, and we engage in therapeutic vomiting only after an excess of margaritas. Luckily, there are gentler ways to restore balance, and when it comes to management of the seasonal junctions, the most natural is to be aware of vulnerability during seasonal transitions and treat yourself with extra care. For someone with a delicate constitution or pre-existing health problems, this may be prudent at every season change. For others, only certain season changes may be troublesome. In any case, it’s a good idea to get extra sleep and to eat with greater care during the transition month.
If you have a personal challenge with the transition to spring, here are some more specific recommendations for this time.
- Eat more warm, cooked foods. Soups and stews are great. An ideal one is kitchari, made from rice and mung beans (there are lots of recipes online). If you have some of the kapha / damp challenges described above, you can add plenty of warming spices, including ginger, turmeric, cumin, coriander, turmeric, cinnamon, fenugreek, caraway, nutmeg, and black pepper. As the world gets warmer, start incorporating more fresh local produce.
- Avoid heavy, cold, and sweetened foods. These all tend to be cloying. Also, stop eating before you’re full, and let yourself get hungry between meals (don’t snack).
- Do some movement every day. Kapha / dampness tends to congeal in us when we’re immobile, sometimes making us feel achy, heavy, phlegmy, or groggy in the morning, after we’ve been horizontal for several hours. Daily movement, ideally with enough vigor to break a sweat, will help.
- Try a dry sauna. If you have access to a dry sauna, it can help counteract the effects of a damp environment. It doesn’t need to be too hot. You shouldn’t be pouring sweat. More sustainable is to have longer sessions in which your skin is just glistening.
- If you tend to get spring allergies, this is the time to prepare by babying your digestive system (eat slowly, deliberately, and only easily-digested foods) and taking some things to stabilize your immune system. Some of my favorites are quercetin (500mg twice a day), nettles (pick and steam your own if you can), local bee pollen, and homeopathic preparations of the things you’re allergic to. As for this last item, it’s akin to the old-school method of desensitization. There are companies that make super-dilute tinctures common allergens, such as tree pollen, grass pollen, animal hair, mold, dust, etc. I’ve had good experiences with ones made by a company called BioAllers.
For everyone – including those who have no particular challenge with the transition to spring – it’s worthwhile to pay attention to what’s happening in nature. Be fascinated by the return of new life. Notice the boisterous energy in the flowers and birds. Admire the vigor in the shoots that push their way through the crusted soil. The rising energy and lengthening days make it the ideal time for: planning, visualizing, cleansing, and shedding.
Wishing you a harmonious junction and beyond,
Peter
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Previously I wrote about how community is like medicine. Our circle of fellow humans goes through this amazing journey with us . . . encouraging us, witnessing us, screaming with us on the roller coasters, and holding our hand when we take our last breath. My orientation in that article was toward what community can do for us, but it’s at least as important to look at what we can do for our community.
I was reading about a Native American grief ritual described by Black Elk, and while the ritual itself was interesting, what stuck with me was his assertion that long-held grief isn’t good for a person or the community to which that person belongs. That is, when someone is mired in suffering, this can have a negative impact on their community.
You can probably think of plenty of examples where a glaring state of imbalance, such as rage or terror, could result in behaviors that are detrimental to others. But the effects of less dramatic, often chronic negative states are subtler. What happens – besides their own discomfort – when a person is trapped in depression, anxiety, or grief for years? One repercussion is that they have a diminished capacity to fully show up in their community. We might think, “Well, the community doesn’t really need me to be at my best,” but imagine going to a place where almost everyone was depressed, afraid, or angry. Such places do exist, of course, and you can feel it as a palpable mass degradation of the human spirit.
These days we may feel that we don’t have any real obligation to our community, which is so different from how humans have operated for most of our history. Today community may be seen as an entirely optional part of life. We can live in near isolation while anonymous members of our community manage the utilities that provide us with power, water, and internet, take away our garbage, maintain our roads, even deliver our groceries. It feels like independence, but in truth we’re more dependent than ever on an infrastructure other humans maintain – we just don’t know who those humans are.
We’ve lost our sense of responsibility to our community. It’s due in part to the feeling that our government is huge, remote, and corrupt. But if our response is to disengage, the situation can only get worse. If anything, the sense of disconnection from our elected representatives and neighbors should magnify the need to do what we can to make a positive difference. It’s not just an obligation, it’s also an opportunity. If we can recognize and accept that our quality of presence affects others, this may inspire us to be our best selves. And it’s not just a matter of what we do but also who we are and how we are. Becoming fundamentally well inside helps heal the community. Imagine how healthily a community of fundamentally well people manages challenges.
If you’ve been struggling, I don’t mean to make you feel guilty as well; that won’t help you or your community. Rather than focusing on the negative impact your unwellness might have on your community, consider that getting well is good for you and it’s good for your community. Sometimes it’s easier to do it for others than for yourself.
Years ago, I read A Course in Miracles with friends. If you’re unfamiliar with it, it’s a book on spiritual awakening with a section of scripture and a year-long workbook of daily lessons. It’s not for everyone, but I gained some valuable insights from going through it. One of those insights occurred when I encountered this passage: “Lesson 66: My happiness and my function are one.”
Whereas I had tended to think of my happiness as a personal thing – sometimes even a selfish thing – this spiritual book was telling me that being happy (true, causeless happiness) is one of the greatest things I can do for the world. As I meditated on it, I saw clearly that the happy people I’ve known were like lights in every setting they entered. Without even intending it, they had a therapeutic effect on everyone they encountered. Not only did they tend to uplift those around them, in an unspoken way they communicated that this is a possibility for you, too. Happiness is a perspective, a choice. If I can choose it, you can choose it.
Being happy makes us more peaceful, compassionate, and creative. It gives us the freedom to see a bigger picture, rather than focusing on what’s wrong or bad. Even just one happy person in a room full of scared people can change the whole atmosphere – and the choices that community makes.
So I encourage you to consider this week:
- Who am I and what role do I play in my various communities?
- How have I been affected by the genuinely happy people I’ve known?
- What do I believe stands between me and being one of those happy people?
- What happens when I make a conscious choice of how I’m going to show up in a given setting?
- When I give, what do I receive?
- How do I feel when I put myself in service to others?
- Where could I dedicate myself to more actively resolve any unhealthy patterns of thought, communication, or behavior?
- How will I be different as I heal, and how will I affect my community differently as I release my baggage?
- When will I choose happiness?
Be well,
Peter
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I am often asked, “What’s the difference between acupuncture and dry needling?” So, I thought I’d answer the question for everyone in our community who might be interested, and offer some history and science along the way.
“Dry needling” is a term that has grown tremendously in usage over the past decade because it’s a newly adopted practice by many physical therapists. It essentially consists of inserting acupuncture needles into tight muscles. In many states, acupuncturists have fought physical therapists’ attempts to expand their scope of practice to include this procedure. However, physical therapists outnumber acupuncturists by about seven to one, which means stronger state organizations and greater legal power.
Acupuncturists argue that physical therapists are essentially stealing their medicine and calling it something different. In some states physical therapists can practice dry needling with no training in it; in others they typically complete a 55-hour course. By comparison, a licensed acupuncturist generally receives about 500 hours of instruction in the acupuncture-specific portion of their training.
For a few centuries in the West and a couple millennia in China, observers of the human body have known about nodules that occur in tight muscles and are associated with chronic, complex pain patterns. You might just call them “knots.” In the mid-1900s a doctor named Janet Travell coined the term myofascial trigger point to describe this phenomenon. About 90% of them are found at the locations of acupuncture points, which were mapped out on bronze statues at least 1,000 years B.C.E.
Travell explained that myofascial trigger points are irritable regions in our connective tissue (muscle and fascia) that get stuck in a contracted state. They make muscle fibers taut, reducing muscle strength and range of motion, and causing pain, numbness, and other symptoms that often spread to areas far from where they originate. In many cases, what we perceive to be a visceral problem (heart attack, ulcer, migraine, irritable bowel, urinary tract infection, etc.) is actually the symptom of one or more trigger points. I believe trigger points are responsible for most of the physical pain humans experience.
Travell and her colleague David Simons went on to chart the locations and symptoms of trigger points in every major muscle. Travell became John F. Kennedy’s doctor (the first female presidential physician) and his family credited her with saving Kennedy’s political career by curing his back pain through the release of myofascial trigger points.
Travell (and researchers before her) discovered that it’s possible to release a trigger point through a simple procedure she called “ischemic compression.” It basically entails pressing firmly on the center of a trigger point for about half a minute until it softens. Travell’s maps and manual techniques for releasing trigger points were adopted by physical therapists over the following decades. (For what it’s worth, body workers have probably been doing ischemic compression for ages, without calling it ischemic compression.)
Travell also found that she was able to release trigger points by injecting them with numbing agents or saline. However, it emerged that the most effective aspect of this practice wasn’t the injection of fluid, but the mechanical act of probing at the trigger point with a needle. That is, a release could be accomplished even with a “dry” needle, without injecting anything.
Based on this new expression, one could say that all acupuncture is “dry needling.” This is precisely what acupuncturists have always done, although the insertion of needles into these local epicenters of pain is generally just one aspect of an effective acupuncture treatment. What makes an acupuncture treatment holistic (i.e., addressing the whole person) is that the treatment also addresses the underlying mechanisms that led to the surface issue (e.g., stress, diet, digestive problems, more global structural or energetic imbalances, etc.).
In the 1980s, an osteopath and acupuncturist named Mark Seem, founder of Tri-State Acupuncture College in New York City, began integrating Travell’s trigger point maps into traditional acupuncture. He met with Travell and demonstrated his approach. Travell immediately recognized the value of using a much thinner, solid, and springy acupuncture needle (which has a cone-shaped tip), as compared to the hypodermic needles she had been using (which have a scalpel-like hollow beveled tip).
Over the following decades, physical therapists gradually discovered that “dry needling” with acupuncture needles is often a faster and more effective trigger point release method as compared to the various forms of pressure, friction, stretching, exercise, and structural education that have been part of the physical therapists’ palette for their hundred-ish year history. In court cases between acupuncturists and physical therapists, PTs often argue that the insertion of needles into trigger points is a simply an extension of these “manual therapies” described in their scope of practice, and the decision comes down to whether or not the judge agrees.
The other common argument by PTs is that there are many differences between dry needling and acupuncture. In my opinion, having observed PTs doing dry needling and having studied many styles of acupuncture, there’s clear evidence that acupuncturists have been doing everything encompassed in dry needling for a very long time. PTs have insisted that because they know nothing of the acupuncture meridians (energy circuits along which acupuncture points are located), dry needling therefore isn’t acupuncture. But this is like saying that because you haven’t studied anatomy, when you cut into someone with a scalpel you’re not actually doing surgery. Further, there are many systems of acupuncture, several of which don’t utilize meridians.
Enough about the arguments. My purpose isn’t to determine whether or not it’s right for physical therapists to do dry needling, but to clarify the differences in the consumer’s experience.
While acupuncture is great for pain, not all acupuncturists are pain specialists, and most acupuncturists don’t specifically target the trigger points mapped by Travell. If that’s what you’re looking for, it may be worth seeking out an acupuncturist who specializes in pain. Or you might be happy with a skilled physical therapist who does dry needling.
Both acupuncturists and physical therapists run the spectrum from mediocre to brilliantly talented. I have no doubt that there are some masterful PTs out there who get great results doing acupuncture (dry needling) – perhaps better for structural issues than an average-level acupuncturist. I have had patients ask me to “fix” them after a painful dry needling session from a PT that worsened their condition, and I’ve had other patients report good results from dry needling.
If you are skittish about needles, you may not enjoy dry needling from a physical therapist, since it tends to be more intense than the average acupuncture treatment. That said, any form of acupuncture that specifically focuses on releasing trigger points is unlikely to be painless. Regardless of the style of acupuncture I’m performing, I always tell my patients I’m not the person to see if they don’t want to feel anything; I believe a certain degree of sensation is productive.
If you’re someone who cares about how much training your practitioner has received, perhaps it’s meaningful to you that an acupuncturist typically spends ten times as many hours learning their craft than a physical therapist spends learning dry needling. (And virtually all of the acupuncturist’s continuing education will be in acupuncture as well.)
If your primary concern is having your treatments covered by insurance, you’re more likely to get this from a physical therapist. There are some acupuncturists who bill insurance, but more often it will be up to you to submit your receipts and hope for reimbursement.
If it’s important to you that your treatment gets to the root and addresses the whole you, including non-structural issues, you’ll probably be more satisfied with treatment from an acupuncturist. The common experience of “going to acu-land” as some of my patients call it – i.e., becoming deeply relaxed or even having a transcendent experience – isn’t part of the dry needling session. Some would consider the peaceful effect of acupuncture merely a pleasant bonus, but I believe it’s often much more instrumental in the overall outcome than people realize. How often do we stop, rest, and drop all of our concerns? It can be akin to the benefit of a session of deep meditation. The alleviation of stress and a nervous system “reset” is no small thing, especially when stress is the root cause of so much pain.
That said, I find that many patients honestly aren’t concerned with a holistic treatment, and that’s fine. They want a practitioner who will get right into the painful area and work the hell out of it. It might be intense and they might feel beat up afterwards, but there’s a time and place for this kind of work if it’s effective. Personally, I don’t mind receiving aggressive treatments. Occasionally they’ve been miraculous (other times they’ve left me temporarily crippled with no relief). And of course, if the pain itself is one’s primary stressor, one could argue that getting rid of the pain should be a higher priority than alleviating stress (though we don’t have to choose one or the other). In my experience it’s a slight minority of acupuncturists who work this way, while it’s quite common for a physical therapist.
Whew! That was a long-winded exploration of this topic. I thought about removing parts of this article to shorten it, but having had this conversation so many times, I’ve found that many people are curious about all the facets of this subject. I hope I offered some clarity.
Be well,
Dr. Peter Borten
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As we approach spring, it’s a good time to discuss seasonal junctions. Both Ayurvedic and Chinese systems of medicine see the changes of seasons as times when we are more susceptible to being thrown out of balance as our body is challenged to adapt to the shift. Ayurveda has a saying that “diseases are generated at the junctions of the seasons.”
Other junctions are also challenging, with the challenge generally proportional to the magnitude of change. Ayurvedic teacher Robert Svoboda writes, “Ovulation and menstruation are the ‘joints’ of the menstrual cycle, dawn and dusk are the joints of day and night, and adolescence and menopause are the junctions of life.” If you have kids, you know that the “joints” of the day are the times you’re likely to have trouble, and if you’re clever, you find ways to make these transitions easy, such as the ever-popular “five more minutes until we’re leaving.”
Depending on where you live and your personal constitution, different seasons and junctions will be challenging for different people. For example, because spring tends to be wet, moving into this season means taking on more of what Traditional Chinese Medicine (TCM) calls dampness, or in Ayurveda an increase in kapha (“kaap-ha”). This will be most difficult for those who already have constitutional kapha or an accumulation of dampness in their system. Some of the signs and symptoms include: being overweight, having loose, sticky, or incomplete stools, a wide or coated tongue, feeling heavy and tired, finding it hard to wake up in the morning, and a tendency to be phlegmy.
Ayurveda might prescribe some therapeutic vomiting for such a condition, but these days, especially in the West, we prefer more pleasant medicine, ideally in gummy form, and we engage in therapeutic vomiting only after an excess of margaritas. Luckily, there are gentler ways to restore balance, and when it comes to management of the seasonal junctions, the most natural is to be aware of vulnerability during seasonal transitions and treat yourself with extra care. For someone with a delicate constitution or pre-existing health problems, this may be prudent at every season change. For others, only certain season changes may be troublesome. In any case, it’s a good idea to get extra sleep and to eat with greater care during the transition month.
If you have a personal challenge with the transition to spring, here are some more specific recommendations for this time.
- Eat more warm, cooked foods. Soups and stews are great. An ideal one is kitchari, made from rice and mung beans (there are lots of recipes online). If you have some of the kapha / damp challenges described above, you can add plenty of warming spices, including ginger, turmeric, cumin, coriander, turmeric, cinnamon, fenugreek, caraway, nutmeg, and black pepper. As the world gets warmer, start incorporating more fresh local produce.
- Avoid heavy, cold, and sweetened foods. These all tend to be cloying. Also, stop eating before you’re full, and let yourself get hungry between meals (don’t snack).
- Do some movement every day. Kapha / dampness tends to congeal in us when we’re immobile, sometimes making us feel achy, heavy, phlegmy, or groggy in the morning, after we’ve been horizontal for several hours. Daily movement, ideally with enough vigor to break a sweat, will help.
- Try a dry sauna. If you have access to a dry sauna, it can help counteract the effects of a damp environment. It doesn’t need to be too hot. You shouldn’t be pouring sweat. More sustainable is to have longer sessions in which your skin is just glistening.
- If you tend to get spring allergies, this is the time to prepare by babying your digestive system (eat slowly, deliberately, and only easily-digested foods) and taking some things to stabilize your immune system. Some of my favorites are quercetin (500mg twice a day), nettles (pick and steam your own if you can), local bee pollen, and homeopathic preparations of the things you’re allergic to. As for this last item, it’s akin to the old-school method of desensitization. There are companies that make super-dilute tinctures common allergens, such as tree pollen, grass pollen, animal hair, mold, dust, etc. I’ve had good experiences with ones made by a company called BioAllers.
For everyone – including those who have no particular challenge with the transition to spring – it’s worthwhile to pay attention to what’s happening in nature. Be fascinated by the return of new life. Notice the boisterous energy in the flowers and birds. Admire the vigor in the shoots that push their way through the crusted soil. The rising energy and lengthening days make it the ideal time for: planning, visualizing, cleansing, and shedding.
Wishing you a harmonious junction and beyond,
Peter
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