In the late 1980s, I attended the first International Congress of Healing in India and met Sai Baba. He spoke to a group of us about helping people heal and of all the things he said a practitioner could do, the most important one was to give people hope. This message stuck with me the last 25-plus years and now there’s growing scientific evidence behind the power of this statement.

You may think that giving people hope is nice and even obvious, but it actually has more import than that. New findings are pointing to the possibility that the "ritual" of medicine itself has a strong influence on a client’s healing outcome. This is fascinating to me as it illuminates the power of the body-mind complex in health and healing.

The ritual of medicine was highlighted in a study done by Ted Kaptchuk when he split 262 adults with IBS into three groups: a control group who didn’t receive treatment; a second group who received sham acupuncture and little interaction with the practitioner; and a third group who received sham acupuncture but with great attention from the practitioner (at least 20 minutes of time as well as compassionate comments and touch).

This study revealed that patients who experienced the greatest relief were those who received the most care. Even if the care was fake, clients still tended to fare better. In other words, the methods of administration of medicine were as important as the medicine itself. This means that a patient’s perception of the practitioner and healing session matters and the way practitioners frame their medicine has significant impact on a patient’s health.

This was further illuminated by another study where researchers set doctors in an fMRI machine in such a way that they could see their patients outside it and administer what they thought was a nerve-stimulating treatment. The results indicated that the doctors gave subtle cues to their patients that neither they nor their clients were aware of. In other words, thedoctors’ unconscious thoughts influenced the treatment administered!

Quantum mechanics describes this relationship in the Uncertainty Principle. It has determined that the process of observing a particle changes the behavior of the particle itself because of the measurement that must take place on one of the particles. Translating this to practitioners and clients, the act of a clinician observing and interacting with a client changes the outcome of the client’s condition because that observation includes subjective measurement. This is powerful indeed!

The clinician-client connection was further accentuated through yet another study published in the Proceedings of the National Academy of Sciences where a team projected images associated with pleasure on a screen for only a fraction of a second (too quick for conscious recognition). The outcomes determined that images patients linked with healing may have had a positive influence on the outcome of their health.

All of these studies lead to a fascinating finding – that the ritual of medicine is extremely important and perhaps as important as the medicine itself. To me, this is amazing and certainly points not just to the mind-body connection but also to the mind-body interaction with the clinician and the clinician’s environment. As practitioners this means it’s equally as important to learn how to administer our medicine as it is to study the medicine itself. How often are we taught that?

Not often enough. Many practitioners don’t attend to how they administer their medicine nor to the environment they provide, let alone to how much time they spend with a client. But beyond the time spent, there’s something else that’s even more important in client improvement – the quality of time spent together. Simply put, this part of the ritual has great impact on a client’s healing outcome.

So if you want to increase the effectiveness of your treatments and improve your clients’ healing potential, it’s important to take into account how you administer your medicine. Now what does this entail?

The ritual of medicine involves the care and environment that the practitioner provides to the client as well as the practitioner’s attitude. Here is a list of possibilities – add to it with your own ideas!

  • Environment – How inviting and calming are your waiting room, office, treatment rooms and equipment? Do they elicit expectations of healing?
  • Speech – This includes how the practitioner speaks to the client and the types of positive, encouraging and caring statements made, such as "I’m so happy to meet you;" "I know how difficult this must be for you;" and "This treatment has excellent results."
  • Time – How much time do you actually spend with a client?
  • Touch – Is encouraging touch a part of the treatment?
  • Perceptions – This includes how the clinician perceives the client, including unspoken and subconscious perceptions, and vice versa.
  • Manner – Do you engage with the client with friendliness, curtness, or indifference?
  • Beliefs and opinions – These influence subtle cues given to clients by the clinician, even subconscious ones such as expectation of treatment outcome, responsiveness to the client, assumed disease prognosis, and liking the client or not.

If you are not a clinician but working toward it, then definitely include these parameters in your preparation process. If you are a client, then look for these factors in your medical session. Choose practitioners who provide your needed sense of care, security and hope. You will have a better healing outcome if you feel such sympatico with your clinician.

I’ve personally experienced the impact of the clinician-client connection. I’ve had people come to me saying, "I know you can help me;" or "Everyone says you can help me." I’ve also had clients tell me how relaxing my clinic is even to the point of coming in just to sit and sip tea because they believe it is so peaceful. In such cases, I’ve often found these clients improve from whatever I do! I know of other practitioners who’ve had this experience as well and perhaps you have, too.

Obviously, there are as many ways to administer medicine as there are clinicians themselves. So how do you want to administer your medicine now? What changes would you make? What could you do differently? How will you think and behave toward your clients now that you know your presentation, interaction, and subconscious cues directly determine their health outcome?

Surely the power of the practitioner-patient relationship underscores what Sai Baba told me all of those years ago about health and healing – that the very best medicine is to give people hope. Now I know why that was such a wise statement – it strongly promotes a positive healing outcome for the client.

Ted Kaptchuk is an acupuncturist, faculty member at Harvard Medical School and author of, The Web That Has No Weaver

"The Placebo Phenomenon", Harvard Magazine, by Cara Feinberg,, accessed March 2013.




When I first learned about herbs in the late '70s, they were usually taken as capsules, with food, or smoked! As I began to study Chinese herbs I learned that they were typically prepared as teas. Then the explosion of natural medicine occurred and a wide variety of herbal remedies became available – pills, capsules, tablets, tinctures, powders, syrups, and more.

Today there are so many different delivery methods for taking herbs. How do you know which is the best for your clients’ or your own health needs? You may actually feel that just getting herbs down people in whatever way they’ll take them is best – and there’s definitely truth and practicality to this. Yet, the delivery of herbs also does matter. It depends on knowing your herbs AND the person taking them.

I was recently reminded about this when I made a sleep tea for my elderly mother. I only had the formula she needed in “teapill” form (a Chinese patent medicine where the herbs are cooked as a tea, dehydrated and then formed into tiny pills). This was too dangerous for her to swallow as they could have become stuck in her throat so I dissolved them in hot water. When she ended up refusing the herbs, I drank the tea myself. And powerful it was! It was easy and quick to make, tasty, and most effective. But even more, this tea was much easier to digest than the concentrated dry extracts I normally take.

Some forms of herbs can actually aggravate symptoms regardless of the herbs used. Others may not be strong enough to create the desired effect. Still more might not even fully metabolize so there’s less impact from the herbs. For instance:

  • Is your client a child? That generally rules out alcoholic tinctures, pills, tablets or capsules.
  • Is your client elderly? That means small pills may be too difficult for them to handle. They might also have problems swallowing them, too, as well as tablets and capsules.
  • Does your client have Heat or Stagnation in their Liver (hypochondriac pain, sighing, hiccupping, depression, PMS, irregular or painful periods, nausea, vomiting, sour belching, splitting headaches, migraines, hard to fall asleep, or tight neck and shoulders)? Then tinctures could aggravate these symptoms.
  • Does your client have weak digestion (poor appetite, slow metabolism, gas, bloatedness, sleepiness after meals, tiredness, loose stools, fatigue, lethargy, weakness of the limbs, or acid reflux)? Then tablets, powders, pills, and concentrated dry extracts may create even more digestive sluggishness.

Your herbal delivery method is not just about patient compliance, although that is important to consider. Ideally, you find the best delivery method that extracts the most out of a particular herb AND that a person can most easily assimilate without causing other problems.

Following is a list of possible herbal delivery methods along with their uses, pros, cons, and shelf life so you can choose what best fits for your clients’ and your needs. Note that taking herbs is NOT like taking medications, quick-fix pills with lots of side effects. 


Uses: for the entire body or specific areas such as the hands, hips or feet; stimulates blood circulation; warms; treats colds, flu, chills, fever, aches, pains, cramps, spasms, headaches, some infection and inflammation; calms nerves and relaxes muscles 

Pros: fair absorption of herbal properties; especially useful and effective for treating infants and the elderly

Cons: only used topically; can be messy; takes time; person has to have a bathtub or access to one

Shelf life: none – make as needed


Uses: treats anal conditions and hemorrhoids plus vaginal infections, cysts, irritations and tumors

Pros: effectively treats localized health problems (anal/vaginal/genital)

Cons: can be messy; doesn’t travel well

Shelf life: none – make as needed; if frozen can last up to 6 months


Uses: treats internal conditions

Pros: useful for taking herbs in small amounts or for herbs that taste bitter, are strong or are high in mucilage; the small "0" size is user-friendly for many children and the elderly; convenient; travels well

Cons: quickly loses potency; can be difficult to digest (avoid if there’s poor appetite, slow digestion, gas, bloatedness, sleepiness after meals, tiredness, loose stools, fatigue, lethargy, weakness of the limbs, or acid reflux); not for vegetarians since most capsules are made from animal gelatin

Shelf life: short – about 1 year


Uses: treats internal conditions

Pros: highly digestible; potent with increased biological availability; especially beneficial for the elderly, infirm or those with poor digestion

Cons: takes time; can be smelly; may not be tasty

Shelf life: short – up to 3 days


Uses: treats internal conditions

Pros: highly potent with increased biological availability; preserves well; 2-5 times stronger than powdered herbs, so less needs be taken; convenient; easy to take for most people (put in hot water or directly into the mouth and swallow with water, or mix with honey and eat as an electuary/paste); can take in small or large doses; travels well

Cons: expensive; can’t use with herbs high in volatile oils, as these constituents may be lost during the preparation process; may be difficult to digest for some

Shelf life: long – lasts up to 5 or more years


Uses: treats internal conditions  

Pros: tasty; easy to take; great for children; travels well; easier to digest (from the honey) and assimilate (if ghee is added); helpful for taking strong-tasting herbs

Cons: messy; takes time

Shelf life: short from 3 days to 3 months 


Uses: treats swellings, pain, coldness, sprains, injuries, sore throats, colds, and swollen glands and organs (neck, breast, groin, kidney, liver, prostate, bladder); helps restore circulation to an area that’s been immobilized or weakened

Pros: stimulates fresh blood circulation; warms the area where placed; great for the elderly or infirm

Cons: only used topically; takes time; can be messy; can’t travel; only used topically

Shelf life: none – make only as needed


Uses: treats throat, gum and mouth conditions

Pros: treats localized conditions; can use strong herbs; convenient; travels well

Cons: only used topically

Shelf life: varies – can last up to 3 days if a tea; 10 years if made with alcohol


Uses: treats strained muscles and ligaments, muscle spasms, bruises, arthritis, rheumatism, injuries, trauma, swelling, some inflammations; stimulates blood circulation

Pros: potent topical treatment of localized conditions; good delivery for strong or potent herbs; convenient; travels well

Cons: only used topically; can be messy; can be smelly 

Shelf life: varies – up to a year (made with oil) or 10 years (made with alcohol)


Uses: treats nasal and throat conditions, sinus infections, allergies, post nasal drip, plugged ears, poor sense of smell, colds, flu

Pros: potent treatment of localized conditions

Cons: only used topically; can be messy, smelly, and irritating

Shelf life: none – make only as needed 


Uses: for sore and aching muscles and joints, cuts, stings, swellings, and pain; calming and relaxing or stimulates blood circulation

Pros: potent topical treatment of localized conditions; convenient; travels well; good delivery for strong or potent herbs

Cons: only used topically; can be messy; can be smelly

Shelf life: short – up to a year 


Uses: treats internal conditions of all types; certain ones may be sucked to treat the throat

Pros: potent; generally good for vegetarians; generally easy to swallow (except for the elderly and some children); herbs don’t need to be as finely ground as those for capsules; can be made into a tea; can be tasty

Cons: may have to take a lot for proper dosage; can be difficult to pick up for the elderly or those with motor dysfunction; may not be tasty; may be difficult to digest for some

Shelf life: medium – from 1 to 5 years


Uses: muscle spasms, swelling, arthritis, rheumatism, tumors, fevers, mucous congestion in the chest, bronchitis, pneumonia, enlarged glands and organs (neck, breast, groin, kidney, liver, prostate, bladder), various eruptions (boils, abscesses); fibrous tissue

Pros: treats localized or internal conditions

Cons: potent topical treatment of localized conditions; takes time; can be messy; can be smelly; takes time; can’t travel 

Shelf life: none – make as needed


Uses: treats skin aliments, cuts, stings, bites, eruptions, bleeding

Pros: treats localized conditions

Cons: only used topically; can be messy; can’t travel 

Shelf life: none – make as needed


Uses: treats internal or external conditions

Pros: can use to make any number of other delivery methods

Cons: can be difficult to digest (avoid if there’s poor appetite, slow digestion, gas, bloatedness, sleepiness after meals, tiredness, loose stools, fatigue, lethargy, weakness of the limbs, or acid reflux); messy; if not able to purchase desired herbs already powdered, need strong equipment to powder herbs and some herbs can’t be powdered fine enough or are too gummy to powder

Shelf life: short – 6 months


Uses: reduces pain; stops itching; treats bites, stings, cuts, sores, scrapes, burns, itching, dryness and skin problems

Pros: treats localized conditions; easy to use; travels well

Cons: only used topically; can be messy

Shelf life: short – lasts 1 year


Uses: treats cough, sore throat, tickling and irritation of the throat, lung conditions; loosens phlegm and helps its expectoration

Pros: potent; easy to take; can be tasty; easy to digest; great for children

Cons: can be messy

Shelf life: short – about 1 month refrigerated 


Uses: treats internal conditions; as a wash treats certain external conditions, too

Pros: potent; highly digestible; most herbal properties are extracted in water

Cons: takes time; can be smelly; can be messy; might not be tasty; difficult to drink if using very bitter or stimulating herbs; doesn’t travel well; often teas are not made strong enough to be effective – it is necessary to use 1 oz dried herbs/1 pint water; 2-3 oz herbs fresh herbs/pint water; or 1/2 oz herbs/1 cup water

Shelf life: short – up to 3 days


Uses: treats internal conditions; depending on the herbs, may be used as a liniment for external conditions

Pros: potent; highly digestible; good delivery for herbs that taste bitter, are too strong to drink in teas, are taken over a long period of time, and that don’t extract well in water but do in alcohol; easy to take; convenient; travels well

Cons: avoid with children, people with alcohol sensitivity, or those with Excess Heat or Qi Stagnation (hypochondriac pain, sighing, hiccupping, depression, PMS, irregular or painful periods, nausea, vomiting, sour belching, splitting headaches, migraines, hard to fall asleep, or tight neck and shoulders); often tinctures are not taken in high enough doses to be effective (1 teaspoon doses are frequently needed for best results, much higher than a dropperful); can be expensive if proper dose is taken

Shelf life: long – up to 3 years (vinegar or glycerin) or 10 years (alcohol)


Uses: treats swellings, pain, coldness, injuries, sore throats, colds, fever, chills,

Pros: can be potent for infants, the elderly or the infirm

Cons: only used topically; can’t travel; can be messy

Shelf life: none – make as needed

gymnastIn Part 1 we learned about the many signs and symptoms of Qi stagnation and its far reaching affects on physical and mental health. In this segment we’ll cover how to treat and prevent Qi stagnation. Of course you’ll be immediately interested in the herbs and formulas to use, but first I’ll cover other therapies since they are integral, even essential, to preventing and treating this issue.


Therapies for Qi Stagnation:


Diet Therapy:

Foods to Eat: Foods that decongest and aid the Liver include vegetables, bitter foods and dark leafy greens such as kale, collards, dandelion, mustard, beet and mustard greens. Lemon juice also helps decongest the liver. A good morning liver cleanse is a fresh squeezed lemon in water with 1 or 2 teaspoons of olive oil and a couple of "00" sized capsules of cayenne pepper. This is followed with fennel seed tea.

Foods to Avoid: Avoid fried, fatty and oily foods, nuts and nut butters, avocados, cheese and dairy, chips of all kinds, turkey and red meats, alcohol, spicy foods, caffeinated foods and drinks, coffee, black tea, cocoa, colas and chocolate, recreational drugs and stimulants.


Emotional Therapy: Turning the "vices" of the Liver into "virtues" helps smooth Liver Qi Stagnation. The Liver’s vices are anger and frustration; its virtues are benevolence, forgiveness, esteem, respect and kindness. Ever hear of that saying, "Do acts of kindness?" Such actions actually cultivate the positive aspects of the Liver and help Qi flow smoothly and regularly. There are many ways to do this; choose ones that express and release emotions in constructive ways and cause no harm to you or others. Above all, do not repress or stuff your emotions, as this is what helped create these physical symptoms in the first place. Of course my new book, Metaphor-phosis: Transform Your Stories from Pain to Power, is a perfect tool to help you do this!


Lifestyle Therapies: To rebalance the Liver, go to sleep by 11 PM at the latest, move regularly through walking, dancing, swimming, cycling, jogging, exercise, hiking (especially in the woods), Tai Chi, Qi Gong, yoga or another physical activity and regular exercise, and engage in creative projects as this releases pent-up Liver energy and moves Qi. For computer work (and other electronic tools) and desk jobs, be sure to move and/or stretch for five minutes every 30 – 60 minutes. 


Other Therapies: Participate in regular life activities, sex and exercise as regularity of habits helps regulate Qi. Go to sleep by 11 pm at the latest since the Wood Element time of the Liver and Gallbladder does its major work from 11 pm – 3 am (if there’s also Deficient Kidney Yin, go to bed by 9 - 9:30 PM). Find work and jobs you enjoy and are fulfilling.Alternate work with rest and play as over-working can cause this pattern. Do cupping (especially over the back), dermal hammer where needed, breathing exercises, abdominal massage, massage therapies, singing and wear a haramaki around the waist to keep the kidneys warm, the "mother" of the Liver.

Herbal Therapy: Finally - herbal therapy for Qi stagnation! This encompasses so many herbs and formulas that we can’t cover them all here, but I’ll give you enough juicy ones to start exploring. First of all, herbs that move Qi are those that help it move smoothly, regularly and in the right direction. In Western herbalism this includes carminatives. Examples include:


  • Bupleurum(Bupleurum falcatum; chai hu)
  • Citrus peels (Pericarpium citri reticulatate; chen pi, qing pi, zhi ke, zhi shi, fo shou)
  • Cyperus (sedge root, Cyperus spp. Especially C. rotundus, xiang fu)
  • Chinese rose buds (Rosae rugosa; mei gui hua)
  • Mint (Menthae haplocalycis; bo he)
  • Fennel seed (Foeniculi fructus; xiao hui xiang)
  • Saussurea (Aucklandiae lappa; mu xiang)
  • Aquilariae (aloeswood; Aquilaria sinensis; chen xiang)
  • Persimmon calyx (Calyx Diospyros kaki; shi di)
  • Sandalwood (Santalum album; tan xiang)
  • Lindera (Lindera spp.; wu yao)
  • Chinese garlic (garlic chive; Allium macrostemon; xie bai)
  • Cumin (Cuminum cyminum)
  • Vitex (V. Agnus-castus)
  • Areca peel (Arecae pericarpium; da fu pi)
  • Melia (Sichuan chinaberry, Sichuan pagoda tree; Melia toosendan; chuan lian zi)

Qi-regulating herbs tend to be aromatic, warm and acrid or bitter in energy, treating symptoms of pain that comes and goes, and/or changes location and severity; distention, stifling feelings in the chest, belching, nausea, vomiting, wheezing, acid regurgitation, loss of appetite, diarrhea or alternating diarrhea or constipation, pain in the flanks or under the ribs, depression, mood swings, and hernias.

Qi-moving herbs are rarely used alone; rather they are combined with others based upon the nature of the condition being treated. Typically, they are combined with Blood-moving herbs as Qi and Blood are intricately intertwined. For this reason, when one tonifies Qi, it’s important to tonify Blood and when one moves Qi, it’s also important to move Blood.

Kitchen medicine: For quick use around the home, I find citrus peel tea to be very effective to move Qi. While the Chinese use mandarin orange peels, in Italy I was surprised with lemon peel tea after one dinner. As well, rose buds make a wonderful jam, delighting the senses and spirit as well as moving Qi. Fennel seeds, normally found mixed with sugar and taken after dinner in Indian restaurants, are great as a tea, eaten raw or toasted and cooked with vegetables and meats.

Caution: Because Qi-moving herbs tend to be warming and drying, use with caution in those with Deficient Blood or Yin, or Excess Heat; because they are dispersing, use with caution if there’s Deficient Qi.

Qi-Moving Formulas:

There are lots of formulas that move the Qi and many are available in Chinese patent teapill form, which are easy to find and take. Because bupleurum is one of the major Qi-moving herbs, there are literally dozens of formulas based on this herb alone. Perhaps one of the best known is Bupleurum and Dang Gui Formula (Xiao Yao San) and its variation, Bupleurum and Peony Combination (Jia Wei Xiao Yao San). These two formulas treat most symptoms of Liver Qi stagnation. The first is more warming while the second also clears Heat.

Bupleurum and Dang Gui Formula (Rambling Powder, Xiao Yao San,or in Planetary Formulas: Bupleurum Calmative):

  • Bupleurum (chai hu), 6-9g
  • Dang gui (dang gui), 6-9g
  • White peony (bai shao), 9-12g
  • White atractylodes (bai zhu), 6-9g
  • Poria (fu ling), 9-15g
  • Mint (bo he), 1-3g
  • Fresh ginger (shen jiang), 1-3g
  • Baked licorice (zhi gan cao), 3-6g

Bupleurum and Peony Formula (Jia Wei Xiao Yao San):

Add to the above formula:

  • Gardenia fruit (zhi zi), 1-3g
  • Moutan peony (mu dan pi, tree peony), 3-6g

Uses: Both formulas regulate the function of the Liver and Spleen, move Liver Qi stagnation and replenish Blood. They are used for anemia, costal pain, headache, mouth and throat dryness, dizziness, lassitude, loss of appetite, irregular menses, leukorrhea, uterine bleeding, PMS, mood swings, depression, breast distention, chronic hepatitis, and alternating chills and fevers as in shao yang stage diseases.

Other Bupleurum Formulas to Consider:

  • Minor Bupleurum (Xiao Chai Hu Tang)
  • Major Bupleurum Formla (Da Chai Hu Tang)
  • Bupleurum and Chih Shih Formula (Frigid Extremities Powderor Si Ni San)
  • Bupleurum and Cinnamon Combination (Chai Hu Gui Zhi Tang)
  • Bupleurum and Dragon Bone Combination (Chai Hu Jial Long Gu Mu Li Tang)
  • Bupleurum and Schizonepeta Formula (Shih Wei Pai Tu Tang)
  • Bupleurum Formula (Yi Gan San)


More Useful Qi-Moving Formulas:

  • Pinellia and Magnolia Combination (Ban Xia Hou Pu Tang)
  • Powder to Disperse Vital Energy in the Liver (Chai Hu Shu Gan San)
  • Pills of Tangerine Seed (Ju He Wan)

Happy Spring to you! May your Qi flow smoothly and your energy rise with the sap in trees!

Last month we discussed the five stagnations in Traditional Chinese Medicine (TCM) along with two formulas to treat all five. In honor of Spring, which begins this year on Feb 10 (Chinese New Year), we will focus on Qi stagnation now. Spring is represented by the Wood Element and its organs, the Liver and Gall Bladder. Since the Liver rules the smooth flow of Qi, now is a perfect time to discuss Qi Stagnation along with how to prevent and treat it.

trafficjamQi Stagnation

When Qi congests, flows improperly or moves in the wrong direction (called rebellious Qi), it stagnates. This is just like rush hour stop-and-go traffic, or cars piling up in a traffic jam. One of the most common disharmonies in the body, it affects not only the Liver, but the other Organs and the Seven Emotions as well.

When administering herbal therapy for Qi Stagnation, it is very important that tonics are not given as this could worsen the condition – like adding more cars to a bad traffic jam. In fact, it is for this reason that an important therapeutic herbal strategy is to first give moving herbs from the Regulate Qi and Move Blood categories along with Heat-clearing herbs before giving tonics, as we discussed in January’s blog on the Five Stagnations.


Signs of Qi Stagnation:

In terms of symptoms, Qi Stagnation has far-reaching effects on the body. Again, because the Liver is in charge of the smooth flow of Qi, this pattern is called "Liver Qi Stagnation." Since there are so many ways this pattern can appear, it is divided into categories of related symptoms. As with all patterns, it is not necessary for all these symptoms to appear to indicate this disharmony; three or more designate there’s Qi stagnation (those in bold are the main symptoms). See if you can find yourself here (hopefully, you can’t!):


1) Overall

  • distension of hypochondrium and chest
  • hypochondriac pain
  • pains that move from place to place, and change in severity or frequency
  • frequent sighing
  • hiccupping
  • burping
  • cysts, fibroids and abdominal masses that appear and disappear quickly

2) Emotions

  • depression
  • moodiness and mood swings 
  • frustration
  • inappropriate anger
  • unhappiness; a gloomy feeling
  • a lump or plum-pit feeling in the throat
  • feeling of difficulty in swallowing

3) Gynecological

  • PMS tension and irritability
  • swollen breasts before periods
  • irregular periods
  • painful periods

4) Digestion

  • nausea
  • vomiting
  • sour belching
  • abdominal pain
  • poor appetite
  • epigastric pain
  • diarrhea or alternating diarrhea and constipation
  • churning feeling in the stomach
  • feeling of pulsation in epigastrium
  • abdominal distension
  • borborygmi

5) In the meridians

  • lumps in the neck, breast, groin or flank

6) Pulse and Tonue

  • Pulse: wiry, difficult or choppy;I often find that with Qi stagnation, the pulse doesn’t move well, if at all, either just in the Liver position (the deep middle position on left hand), in another organ (such as the Stomach, the superficial middle position on the right hand – this is the Liver counteracting on the Stomach) or in the overall pulse. 
  • Tongue: body color may be normal or slightly purple; sides may curl up

Qi Stagnation in the Upper Warmer:

Emotional and mental signs, depression, hysteria, headaches, dizziness, vertigo, chest pains that change location and/or severity; cysts, fibroids and masses that appear and disappear quickly

Qi Stagnation in the Middle Warmer:

Burping, gas, bloating, tight abdomen or tightness in stomach, full feeling in the abdomen, pains that move or come and go, change severity and location

Qi Stagnation in the Lower Warmer:

Stiffness, heaviness, tightness in the lower abdomen and extremities, pains that come and go, change severity and location, cysts, fibroids and masses that appear and disappear quickly

Qi Stagnation in Abdominal Diagnosis

When the abdomen is gently palpated, if there is any discomfort beneath the ribs and/or on the left side right above, beside or below the navel, these indicate Qi Stagnation.


Rebellious Qi

When energy flows in the wrong direction, or opposite its normal functional flow, it is called "rebellious Qi." This is also a type of Qi Stagnation. Examples include:








Belching, burping, hiccups, nausea, vomiting





Diarrhea, prolapse



Excessively upward or horizontally –

to the Stomach

to the Spleen

to the Intestines


Nausea, belching, vomiting (Stomach)

Diarrhea (Spleen)

Dry stools (Intestines)




Cough, asthma








Mental restlessness, insomnia



Causes for Qi Stagnation:

There are many factors that can cause Qi to stagnate. Here are several:

Pathogenic Influences: The two External Pernicious Influences that affect Liver Qi are Wind and Dampness. Although Wind does not invade the Liver directly, it can aggravate an existing condition of Interior Wind in the Liver. When it does, it causes Liver Qi to stagnate, which can further result in Blood Stasis. It can also cause skin rashes and hives that appear and move quickly. As well, Blood Stasis can lead to Qi Stagnation.

Emotions: Any long-term suppressed or unexpressed emotion stagnates the Qi. This means it’s important to discover the underlying cause for these feelings and find constructive and beneficial outlets. Specific emotions that stagnate Qi are anger, frustration, resentment, irritability, mood swings and depression.

Diet: A diet rich in stimulants, fried, fatty and oily foods, dairy, chips of all kinds, recreational drugs, alcohol, coffee, black tea, chocolate, cocoa, colas, nuts and nut butters, avocados, turkey and red meats, and spicy foods (as in chili and curry) cause the Liver Qi to stagnate.

Lifestyle Habits: Inadequate activity, sex, or exercise, regularly going to sleep late at night (after 11 PM), working at jobs one doesn’t like, any type of stress, or overwork without sufficient rest cause Liver Qi stagnation.

In Part II we will discuss treatments and therapies for Qi stagnation. However, if you feel stagnant just by reading all of this, I suggest you immediately get up and MOVE! Movement is one of the great keys to circulating Qi. It can be exercise, but if you do what you love at the same time, it also smoothes emotions and nourishes you, preventing further stagnation.

Usually this time of year I write about resting more, doing less and in general, relaxing to replenish your vital kidney energy. Yet, it’s also important to balance rest with movement or exercise. Lying around too much or doing too little can be just as harmful as overdoing; being sedentary causes congestion.

stomachacheCongestion, or stagnation as it’s called in Traditional Chinese Medicine (TCM), is one of the major causes of all illness, particularly chronic and degenerative issues. Quite often when someone doesn’t feel good, feels ‘off’ in some way, has low energy, gets sick easily, or can’t heal an illness no matter what they try, the underlying cause is stagnation.

Have you ever wondered what was causing someone’s illness when they didn’t appear to be sick or the normal treatment didn’t work? I often see people with low energy who obviously have an Excess condition and it’s not appropriate to tonify (build or nourish them with herbs and foods). These conditions are caused by stagnation.

Stagnation is much like bad traffic during rush hour, heavy rain or a traffic jam when cars slow down, pile up, or stop altogether. In TCM, stagnation arises when there is "too much" of something in any given area for whatever reason – poor circulation, lack of movement, over-eating, bad diet and all types of stress. In and of itself, stagnation is considered an Excess condition, yet there can easily be stagnation co-existent with any type of Deficiency.

The Five Stagnations

There are five different types of stagnation: Qi, Blood, Fluid, Cold and Food stagnation. Any of these can stop moving and congest. Heat may appear to stagnate, yet it is considered and treated as one of the five types of Excess Heat. In addition to the abovementioned causes of poor diet, lack of exercise, emotional, and mental or physical stress, any one of the five stagnations can eventually cause another type to happen.

According to TCM theory, any substance that is in excess or not moving is potentially toxic and injurious. That means that to treat the Five Stagnations is ultimately about clearing toxicity. Because stagnation is so pervasive in our culture, many TCM practitioners first clear toxicity and only then give tonics if necessary.

In future blogs I will discuss how to identify and treat each type of stagnation. In two weeks I’ll give you two formulas that treat all five types together. In the meantime, here are some simple things you can do now to release and prevent stagnation this winter.

General Treatment for Stagnation

1) MOVE! The number one treatment for all stagnation is to move. This can be something "formal" such as exercise, tai chi, qi gong, or yoga, yet dancing, swimming, bicycling, hiking, and gardening are just as effective. In fact, choose a form of movement that nourishes you emotionally and mentally and you’ll be even more effective in releasing stagnation.

2) DIET AWARENESS: Along with lack of movement, improper diet is the next cause of stagnation. Definitely avoid over-eating (you know that post-holiday meal feeling of stuffiness and discomfort? That’s food stagnation.) As well, shun cold foods and drinks, raw foods, excessive meat intake and foods that are too spicy.

3) WRITE: Writing in a journal is one of the best ways to express and release emotional issues. Stuck emotions is one of the major causes of stagnation, yet because they subconsciously influence our thoughts, health and behaviors, they are not accessed by just thinking about them, emoting or dwelling on them over and over. Rather, we need to access the subconscious in order to release them. Writing and speaking out loud do this, which is why journal writing is so emotionally productive. When you access the subconscious through writing, linked connections arise such as past memories, cause and effect relationships, realizations or understandings. This is what allows them to truly release.

4) LIFESTYLE HABITS: Other useful techniques include massage – overall body massage or abdominal or foot massage; moxibustion or other heat applications through salt packs, heated stones, or hot buckwheat "pillows" (those wonderful cloth rectangular bags you can find in stores and heat in the microwave); and skin stimulation through scraping (gua sha), dermal hammer, electric "thumpers," or massagers, and even small buffers with cotton covers.

healingcrisisYou’ve just made an herbal formula for a new client. She took it for several days, but then began to get sick! You wonder: Is your client having a ‘healing crisis,’ or did you give her the wrong formula?

Telling the difference between a healing crisis or a reaction to the wrong formula is usually not difficult, but at some times of the year, it can be tricky. Transition periods between seasons are when people are more vulnerable to colds and flu, and summer to fall is the riskiest of these. A client like the one mentioned above might get sick now neither from a healing crisis nor wrong formula.

Seasonal influences aside, let's review how you can tell the difference between a healing crisis and when you have administered the wrong formula.

The Healing Crisis

A "healing crisis" manifests as an acute illness after beginning a healing protocol, such as change of diet or new herbal routine. The symptoms could be a cold, flu, fever, diarrhea, or minor skin eruption. A healing crisis could also evoke emotional responses such as vulnerability, fear and anger.

A healing crisis arises quickly and is short-lived. Afterward, the person usually feels better than before they began the healing process. Despite its alarming and confusing nature, a healing crisis is actually a sign of improvement. When such symptoms occur, they shouldn't be arrested; stop the formula and give herbs and formulas to treat the present symptoms. When the healing crisis is over, reassess the person’s condition before returning to the original formula, taking into account new signs and symptoms.

Sometimes a healing crisis manifests as symptoms of an old illness. This occurrence is described by the Law of Cure. Observed by Samuel Hahnemann in the 18th century when he founded homeopathy, the Law of Cure says that the various symptoms that arise during the course of recovery reflect the different stages at which the body is healing. Typically, the body heals its most recent disease first, then it works back through other diseases until the oldest one is healed. Generally, symptoms first occur on the surface of the body and move from the top of the body down.

For example, someone who suffers from recurrent bronchitis and begins a course of natural healing with herbs might experience a renewal of teenage chronic colds, and later on her childhood eczema might return. The eczema may start on the arms and then move down to the legs. In time, her body gathers enough strength and energy to throw it off entirely. These symptoms eventually disappear, and a healing of her chronic bronchitis can take place. Through this process, the root cause of her condition is eradicated.

Furthermore, a healing crisis usually occurs in the midst of much greater improvement. Examine all new symptoms and look for genuine indications of health, such as increased energy and vitality. If these are also present, the new discomfort is likely a part of the healing crisis.

Finally, from a long view, old physical or emotional symptoms eliminated through healing crises usually never return.


But what if your client’s sudden illness is actually the result of a wrong herbal formula?

In this case, her new acute symptoms will worsen. On the other hand, she may not manifest an acute condition at all, but she’ll get hotter, colder, dryer or damper or will feel "off" in some other way.

If your client’s undesirable symptoms disappear when the formula is stopped, then it is likely they received the wrong formula. If it’s a healing crisis, the symptoms continue for about three days or until the detoxification is complete, regardless of whether the formula is taken or not.

There are some exceptions of course. If you treat someone and they get worse, and yet when you stop the herbs they still don’t improve, then reassess and give a new formula for the current condition. If they immediately get better, you know your formula was wrong; if they don’t improve, ask the person how they feel. Often a person is aware they are cleansing and it "feels good" in some way, despite their new undesirable symptoms. If so, it’s a healing crisis. If not, reassess your herbs once more.

Generally, giving the "wrong" formula is a useful diagnostic tool. How someone reacts to particular herbs can give important information about what is actually going on. To determine if this is the case, first examine your formula to make sure it doesn’t contain herbs that could cause undesirable symptoms. If there are, then modify the formula. But if there aren’t, reassess the person’s patterns and constitution.

Always check your dosages. Symptoms of overdose or genuine allergic reactions to herbs usually appear soon after starting the herbs, and the symptoms disappear after the herbs are stopped.

If you think the formula is wrong, it’s possible that only an herb or two may need changing, or else another herb may need to be added to ameliorate the symptoms caused by the formula. For example, if the person feels angrier after taking a formula with bupleurum, either they need to ease into the full dose, or else Liver-softening herbs (like white peony), Blood tonics (for instance dang gui), or Yin tonics (such as eclipta) should be added.

If there’s little to no improvement with no signs of a healing crisis, first check to see if the person is ingesting enough of the formula and taking it frequently enough. Too many times have I seen someone take the right formula and not get results, only to find they weren’t consuming it often enough or taking too small a dose! This is often the case if the person is somewhat better but not enough to feel the formula is working; interrogation may reveal that the client took it in too small or infrequent doses. When this happens, don’t change the formula, but emphasize the right amount and times to take it and send them home with the same herbs (and a written reminder if needed).

Sometimes people don’t realize they are better until they run out of their formula and then feel worse. It’s not unusual for people to forget their symptoms once they disappear! In fact, it’s very useful during follow-up sessions to review the first intake and all the symptoms originally presented. Quite often people come in disappointed that one symptom still lingers, but then are pleasantly surprised to discover that the other five complaints they presented on their first intake have disappeared during the course of treatment. If several issues are gone or less severe, you are obviously on the right track and your formula just needs tweaking or another herb or formula needs to be added.

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