“What’s wrong with my liver?
My patient was confused and a little concerned.
“You have liver qi stagnation.” I said, “But don’t worry, there’s nothing physically wrong with your liver…” I went on to explain that in Traditional Chinese Medicine, or TCM, the liver governs a category of symptoms that relates to emotional regulation and flow. I was describing a constricted emotional flow, what we commonly refer to in the West as “stress”.
Acupuncturists and other East Asian practitioners can often sound like they are speaking another language, because in a way they are. I started college as a linguist and I have maintained that interest to this day, so I think of a lot of things in terms of “language”.
As Americans, we speak the “language” of Western medicine. During my internships at Regions hospital, Masonic Children’s Hospital and the University of Minnesota Medical Center I had to learn how to “translate” what I was saying because when I speak to my patients I often speak to them from the metaphor of Chinese medicine.
I’ve realized over time that it would be incredibly helpful to have a glossary for my patients to read, something I could reference over and over in future blog posts and newsletters.
So here it is: Acupuncture 101. I will cover some basic concepts (and misconceptions!) of commonly used words and phrases so that at your next appointment you can be prepared to talk to your acupuncturist.
The Acupuncturist Glossary: Foundations
Qi (pronounched “chee”) is the most basic and most misunderstood concept in TCM. I’m sure that if you’re in anyway familiar with TCM you have heard the term and you’ve probably heard it defined as “energy”. That isn’t quite accurate.
In fact (at least as of a few years ago) if you looked up qi in the Oxford English/Chinese dictionary you know what translation you wouldn’t find? “Energy.”
This is because there really is no good way to describe qi. Qi is an idea or a quality. Gu qi roughly means “nutrients” – it’s the words food and qi together. The Chinese word for soda is “qi water” because it is so bubbly and effervescent, it’s water with a qi like quality.
In terms of your body, da qi, or “great air” is inhaled and then circulated through your body by your lungs. Qi can even refer to the function of your muscles or a limb. When qi is stagnant in an area, that muscle, limb or organ is not functioning appropriately.
This makes qi more of a modifier than a directly translatable word. In some cases it can mean “oxygen”, so when we are moving qi to an area we are improving local blood flow and bringing more oxygen to the area. When qi refers to a limb or organ, to improve the qi would be to improve its function.
Qi is also a metaphor for things that do not have substance, like electricity, light, air, and yes, energy. Any movement, change or process – anything that doesn’t stay still – is brought about by qi.
Chris Kresser has an amazing break down of this on his blog that you need to check out. But for the purposes of this blog post, the take away is that qi is not energy but it can be the energetic quality of something, oxygen or function.
Blood is the yin to qi’s yang. (More on that in a minute.)
Where qi is movement, flow, change and effervescence, blood is nourishment and moistening. It is the substance of your muscles, and the dense material of your body. Blood contains your qi and takes it where it needs to be. It is created through the combination of your jing and your zong qi, or the qi the gathers in your chest when you breathe in. Basically, your blood is created from the air you breathe, the food you eat and your genetic potential.
Pre-natal essence is the essence you get from your parents, or your genetic potential. This is what is created when sperm and egg meet and is what governs the growth of a baby in utero.
Post-natal essence is essence you get from food and drink.
Essence governs your growth and development, your vitality, and your ability to conceive and carry or father a child. It is very difficult to supplement or improve and we all lose it slowly over our lifetimes, so it is important to protect it.
As women, we can protect our jing by taking care of ourselves during menses, postpartum, and during menopause. Dr. Lia Andrews has written extensively on the ‘Three Golden Opportunities’ and if you would like to work on this aspect of your health I highly recommend her book ‘7 Times a Woman’.
Yin and Yang
The concept of yin and yang is what all of TCM is founded on and it is both simple and profound. And like the concept of qi, it is often misunderstood in the west.
Western society is dualistic. It has a tendency to look at things as either yin or yang.
TCM is holistic, meaning that we can look at something as both yin and yang depending on what it is in relation to. For instance, this gray is yin compared to this white:
But yang when compared to this black:
Yin originated from the concept of water and the shadowy side of the mountain – we see this in its Chinese pictogram. It is everything cooling, damp, solid, watery, quiet, restful and inactive. It is darkness, winter, night time, inward, soft and feminine.
Yang originated from the concept of fire and the sunlit side of the mountain. It is everything warming, dry, immaterial but also a resistant hardness, fiery, loud, energetic and active. It is light, summer, day time, outward, hard and masculine.
Everything can be categorized as yin and yang because together yin and yang create everything.
The Acupuncturist Glossary: The Organ Systems
The organ systems are ways to divide various categories of function in TCM. While they do sometimes refer to the physical organ, more often they refer to a function such as digestion or emotional regulation. For this blog, I differentiate your physical organ from the TCM organ system with italics – heart vs heart.
Your heart is in charge of your blood. It moves it and controls the vessels, your veins and arteries. It contains your shen, or the conscious mind and how you interact with the world (the division of consciousness is enough for a post of it’s own and is definitely on the docket for the future.)
Its yang paired organ is the small intestine and they are related to the element fire.
The spleen and stomach (its yang paired organ) system is your digestive function. In TCM, the spleen governs the “transformation and transportation” of gu qi, the energy you get from food. It contains the blood in the vessels, preventing hemorrhage, and organs in the body, preventing prolapse.
These are related to the element earth.
The lungs govern qi and respiration. They move qi and body fluids and control the exterior of the body. They play a large part in your wei qi, or ability to defend yourself from disease. If your acupuncturist is treating you for allergies or a cold, they will likely treat your lungs.
Their yang paired organ is the large intestine and they are related to the element metal.
The kidneys store your jing and govern growth and development, reproduction and vitality. They also govern the functioning of the nervous system and the development of your bones.
Their yang paired organ is the urinary bladder and they are related to the element water.
The liver is the organ that stores your blood. It ensures the free flow of everything in your body and when it can’t do its job the other organs tend to have issues too. Where your heart generations emotions, your liver is what moves them. Where the spleen and stomach digest your food, your liver is what helps move it through your body. Where your ren and chong move through their monthly process (the menstrual cycle), your liver is what smooths it, preventing cramps and menstrual discomfort.
Its yang paired organ is the gallbladder and they are related to the element wood.
The Basic Pathologies
Stagnation or Stasis
Qi stagnation or blood stasis is simply something not moving when it should be moving. Its most obvious symptom is pain, but it can also manifest as anger, depression or stress. Stagnation and stasis should be moved.
An excess is too much of something. This can either be more than is healthy or more than its complement can balance out. Excess should be reduced.
A deficiency is too little of something. This can either be less than is healthy or less than its complement can compensate for. Deficiency should be “tonified” or added to.
Wind can be two things – either a symptom that moves or moves around like a tremor, an itch or an achy pain. Or it can be an infection that usually manifests as a cold or a flu.
Heat is any pathological warmth, often an inflammatory reaction.
Cold is a pathological lack of warmth.
Putting it all together
Okay. So this is where the metaphor concept starts to make sense. Let’s say that you come to my clinic with difficulty conceiving. You are very stressed because your family is breathing down your neck for grandbabies and you are starting to feel depressed because you feel it should have happened by now. Your menses tend to be a little late, somewhat painful with cramps and you occasionally get headaches.
Based off these symptoms a possible diagnosis is liver qi stagnation. Your body functions are having difficulty flowing. This is probably because of the impact stress is having on your endocrine system, or your hormones. I would help you move this qi stagnation by supporting your endocrine system and helping you relax.
Let’s say a parent brings in their little baby who has been spitting up milk every time they eat. They are gaining weight so their pediatrician isn’t worried but the parent knows their child is uncomfortable and wants to help them out.
All children have some amount of spleen qi deficiency because their digestive systems are still developing. So their digestive systems don’t have enough oomph to function properly. I would do a shonishin treatment to help support their digestion.
One more: a woman is going through menopause. She is having night sweats, hot flashes and mood swings. She doesn’t want to stop menopause, she just wants to get through it more easily. A common diagnosis would be liver kidney yin deficiency.
Her liver is having trouble moving qi, like we saw in the fertility example above. But since it is also yin deficient it’s having trouble anchoring her yang emotions, leading to frustration and angry outbursts. Her kidney yin has been depleted as a natural result of aging and so she isn’t as nourished at night leading to sweats. This all comes back to regulating hormones as well. We would treat her to help with the night sweats and emotional regulation and probably make some dietary recommendations.
Medicine is medicine
“By definition (I begin), alternative medicine (I continue) has either not been proved to work or been proved not to work. Do you know what they call alternative medicine that’s been proved to work? Medicine.”Tim Minchin
He is not a fan of acupuncture (or any other complementary medicine, really). But it’s because people refer to it as “alternative medicine”. That’s the problem with thinking of acupuncture as alternative medicine – it’s not an alternative to anything. It’s just medicine. We just happen to be talking about it in an esoteric and unscientific way.
We compound the problem when we think of qi as energy; it makes TCM seem a bit like magic. And when we talk about spleen qi deficiency when there’s nothing wrong with your physical spleen, it makes it seem like TCM practitioners don’t know what they’re talking about if you don’t understand that your acupuncturist is speaking in metaphor.
When we recognize that all of these terms are just a way to talk about the same exact conditions that your Western medical provider treats from within a natural and ancient poetic model, it starts to make a lot more sense. This isn’t a matter of Western Medicine versus Traditional Chinese Medicine, complementary versus allopathic – it’s just a matter of medicine.
Have more questions?
Chris Kresser’s article on “The Meridian Model, debunked” which is part of his Chinese Medicine Demystified series
Are you interested in talking to me about acupuncture? Make an appointment online today!
Disclaimer: I am an acupuncturist in the state of Minnesota, and the information falls within my scope of practice in my state. However, unless I have directed you here as your homework I am probably not your acupuncturist. The information in this post is for general purposes only and does not constitute medical advice. As always, check with your own acupuncturist or primary care provider before making any lifestyle changes. This post does not create a patient-practitioner relationship and I am not liable for any losses or damages resulting or relating to the content in this post.
Jessica Gustafson is a licensed acupuncturist in St Paul, MN specializing in women’s health and fertility. She loves working with patients through the Health Foundations Birth Center on Grand Avenue in St Paul and doing home visits in the Twin Cities area. Check out the services page for more information!
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