For some women, a few sessions on the acupuncture table is enough to cool them off. For others, we need to enlist the help of a Chinese herbal formula.

In most cases, menopausal symptoms are related to a substance in your body called Yin, which acts a little like a moistening coolant. Heat symptoms associated with menopause tend to be caused by a reduction of Yin. This is relevant because the nature of estrogen and the other sex hormones are considered to be very Yin and cooling. When that Yin becomes depleted, it’s a little like being down a quart of coolant in your car–your engine boils over, causing your body to overheat in the form of hot flashes and night sweats.

As I mentioned earlier, in some cases acupuncture isn’t enough to cool the heat from Yin deficiency. In Chinese medicine, it may be necessary to supplement Yin with moistening, cooling herbal formulas. Here are a few of my favorites:

Six Flavors with Rehmania (Liu Wei Di Huang Wan)   This formula is all about nourishing Yin and not so much about cooling you off. The idea with this gentle formula is that if you supplement with some Yin-nourishing herbs, the resulting symptoms will take care of themselves. This formula is especially good for night sweats accompanied by a sore low back, light-headedness, dizziness, and dryness symptoms, like a dry sore throat, dry skin, and night time thirst.

Zhi Bai Di Huang Wan   This is the above formula with two additional herbs added that are very cooling. Like the Six Flavors formula, this one also nourishes Yin, but the added herbs also ramp things up a notch in clearing heat.

Great Tonify Yin Pill (Da Bu Yin Wan)    This is a cold formula primarily aimed at clearing heat, especially in the form of night sweats. It supplements Yin somewhat, but I often prescribe it if one of the above formulas hasn’t worked well enough in cooling a patient off, . Once the heat symptoms have calmed, I may recommend a more Yin nourishing formula later.

 Free and Easy Wanderer with Added Ingredients (Jia Wei Xiao Yao Wan)  In some cases, a woman’s symptoms are either caused or aggravated by stress. In that case, this is my go to formula for calming frayed emotions as well as calming heat. In fact, this is also a good formula for stressed out people in general who find themselves irritable, warm, thirsty and feeling like they’re at the end of their rope.

Two Immortals (Er Xian Wan)   I have used this formula in cases where both Yin and Yang are depleted. If Yin is considered to be your body’s nourishing coolant, then Yang is more like your warming, active pilot light. It’s possible to be depleted in both. I find that those woman who have tended to run cold before menopause, but have heat symptoms during are good candidates for this formula. Beyond feeling cold much of the time, symptoms of Yang deficiency might also include fatigue, depression, and urinary frequency.

In addition to an herbal formula, it’s possible to build up your body’s Yin (and Yang) through diet. There are foods that are considered to be very cooling and nourishing. Your Chinese medical practitioner can be helpful in choosing a plan specific to your needs.

I mean really, if you’ve had migraines for 30 years, do you expect to be completely cured after taking one pill? If your back has been hurting you for decades, do you expect complete relief after one physical therapy session? Why should acupuncture be any different? After all, it’s a therapy, and most therapies take some time.

That said, you should be feeling some results after a couple of treatments. Frequently what I see is that after a treatment or two, patients are sleeping better or feeling more relaxed, which is the beginning of the healing process. Your symptoms are worse and it’s hard to heal when you’re stressed out or tired.

Sometimes the pain or problem isn’t better after a treatment, but it’s different, and I consider that a good thing, too. When you have a long-standing pain or symptom, your body becomes used to it. That pain becomes your “new normal”, and it becomes a physiological habit. If, after an acupuncture treatment, that symptom has changed, it tells me that we’re beginning to alter that habit and the healing process is under way.

When a patient wants to know how long it will take for something to heal, there are a couple of factors I take into account. Among them:

-How long you’ve had the condition. If you’ve had irritable bowel symptoms for twenty years, it will most likely take longer than the person who began having similar symptoms last month.

-The nature of your complaint or illness. Many conditions are quickly resolved with Chinese medicine, including stress, anxiety, digestive issues, PMS, and many types of pain. On the other hand, deep-seated chronic illnesses, such as autoimmune conditions tend to take longer.

-Your general health. I have seen many young and healthy patients surprise me with how quickly they heal. However, older patients, those in really poor health, and those on numerous medications tend to need more time and treatments.

-Your commitment to getting better. What you do at home in between treatments can make a huge difference in how quickly you heal. If you implement your practitioner’s suggestions regarding dietary therapy, heating or cooling an injury, herbal formulas, and lifestyle changes, you can speed up your recovery.

So what do I tell prospective patients when they ask me how many treatments they’ll need? My best answer is that acupuncture is a therapy and while some people may heal very quickly–in just a few sessions–others will take longer. I advise them to give acupuncture a fair try, say three or four treatments, to see how they’re improving. At that point, I will have a better idea of how many treatments they will ultimately need to heal completely.

In Chinese medicine, eye tics are considered to be a pathogen (something that makes you sick) called wind. Many of the concepts of Chinese medicine are based on the natural world, and what makes you sick is no exception.  Pathogens are a little bit like bad weather in your body.  When you have a fever or inflammation, you have heat; when your arthritis flares up during the cold weather, you have a cold pathogen; and when you retain lots of water, you have dampness. (This is a very simplified explanation.)

Wind is considered movement where there should be stillness, and as a pathogen, wind is dry, light and active.  It tends to be Yang in nature in that it’s slightly warm, and it generally moves upward and outward. In most cases, the symptoms of wind affect the upper part of your body, such as the eye tics this woman was experiencing.

There are actually two kinds of wind—internal and external.  External wind is the pathogen behind conditions such as colds, flu, allergies, and viral infections. However, it’s internal wind that’s the problem with tics and dizziness. Internal wind tends to affect your body on a deeper level.  It’s frequently associated with a malfunction of your Liver system to control the smooth flow of energy in your body, and can cause symptoms associated with movement—vertigo, tremors, twitches, and seizures.  Wind is usually the culprit behind illnesses such as Meniere’s and Parkinson’s.

While frequently related to a Liver system malfunction, internal wind can also be caused by systemic dryness or malnourishment.  Much like a dry tree, the brittle leaves at the top rattle in the wind.

Internal wind conditions are most frequently caused by a depletion, or a weakness of some kind in your body. As a result, treating it entails building up the depleted substance(s), such as Yin, Blood, or Qi (energy), which would ideally relieve the symptoms of wind.  In some cases, extreme emotions such as anger or severe stress can also bring on wind-type symptoms. Treating the symptoms associated with wind is done through the use of some combination of acupuncture, Chinese herbs, choosing the right foods, and getting adequate rest.

In the case of the woman in my clinic with the eye tics, she was definitely depleted and had some symptoms of dryness, including a dry itchy skin and dry pellety stools. This led me to believe that she was depleted in Yin, which is a nourishing, moistening, and cooling substance in the body. This dryness was the primary cause of her symptoms, so I added into her treatment plan an herbal formula for depleted Yin, and after a few days of taking the herbs, the tics were gone.

*Names and identifying details have been changed.

Our role is not to prescribe or advise people about their medications. What we can do is support those people who are looking for an alternative (when appropriate), a way to complement the meds they’re taking, or for support as they wean off their Western drugs. All of this must be done under the supervision of the Western doctor who prescribed the medications in the first place.

Our patients’ concerns about prescription meds are two-fold. First, they want to avoid taking them because of the side effects that frequently accompany these drugs. Second, if they are trying to wean off their medications, they may be faced with a rebound effect, in which the symptoms return more severely than before taking the medication.

So as Chinese herbalists, how is what we do any different from prescribing Western medications? Perhaps the biggest distinction is that in Chinese medicine we can’t prescribe an herbal formula until we have determined the underlying cause of the problem. This means that if someone is having trouble sleeping, we need to uncover why that’s happening–are they stressed out, depleted, not digesting well, or Yin deficient? In contrast, if you go to your Western doctor because you aren’t sleeping well, you’re likely to get the same medication as everyone else with insomnia.

A second difference between Chinese herbs and Western medications concerns side effects. A Chinese herbalist prescribes a formula, usually made from several herbs. The herbs have specific actions and are included in a formula because of those actions. For example, an herb can cool you off, calm you down, help your energy move, and even create a moistening effect in your body. These actions are very real, but can be subtle. Several herbs are included in a formula to promote and balance the effects of the other ingredients. Because the formulas are balanced in this way, side effects only occur if you are prescribed a formula that is not right for you. In addition, most Chinese formulas are not taken long term, which decreases the risk of a rebound effect.

Many Western medications are derived from herbs, many of which are Chinese in origin. These meds are made by distilling out the one or two ingredients from an herb with the strongest or desired effects. They are then concentrated into a medication with a very powerful action–so powerful that they can cause side-effects. These Western drugs work well and quickly, but can be accompanied by some funky side-effects.

Here’s the trade off: You can take a Western medication that works quickly and effectively, but may have unpleasant side-effects. Or you can take a Chinese herbal formula that is specific to your condition but takes some time to work. In many cases, the best option is the Western medication. However, there are many situations in which a Chinese herbal formula will get the job done in a kinder, gentler way.

Nobody wants to get this thing, but can you fight it off? Possibly. I believe that there is a day or so, when you feel like you’re on the verge of getting sick, and what you do during that time can make or break what happens next. Unfortunately, once this thing sets in, you just have to have it, sore throat, faucet nose, loopy cough and all. So what can you do during that day or so that you may or may not be getting sick?

First, a little background on immunity from the viewpoint of Chinese medicine. The Chinese believe that you are surrounded by something akin to a protective bubble that keeps pathogens away. Pathogens can take the form of viruses, bacteria, pollen, and in some cases, really annoying people or situations (seriously–these can make you sick, too).

Your protective bubble is a kind of body energy called Wei Qi. Your energy performs a number of functions. For example, it’s what keeps you warm, moves your muscles, and transforms your food into nutrients and more energy. It also protects you from outside invaders in the form of immunity. Keeping your energy strong is a good way to keep your immunity strong. So, again, what can you do to keep from catching the crud? Some tips:

-Lay low. Conserve your energy so you have enough to fight off that cold. Take a nap, postpone your workout for a couple of days, and don’t work too hard.

-Get enough sleep. For me, this is a key strategy in avoiding colds and flu. You heal while you sleep, so when I feel like I’m about to get something, I get some serious sleep in the form of a couple of nine-hour nights. I go to bed a little earlier and sleep in a little later.

-I start taking some Chinese herbs. My personal favorite and in my opinion, the most effective, is a formula that contains isatis root (Ban Lan Gen), which has anti viral, anti microbial properties and is good for a sore throat. This is a popular formula that is commonly used throughout China. It comes in granules that you dissolve into hot water and drink like tea. Look for it at your nearest Asian grocery store or Chinese medicine provider.

-Get some zinc, either in the form of ColdEeze lozenges, gel, or nasal spray, or as a mineral supplement. As a supplement, you can take 25 mg two or three times a day. Scientists believe that zinc works because it prevents the formation of the proteins a cold or a virus needs to replicate itself. Be sure to take your zinc with food, as it has the potential to upset an empty stomach.

-Stay warm. This is an energetic thing. If you’re using your energy to stay warm, you don’t have it to keep your protective immunity bubble strong. Bundle up, sit by the fire, and don’t get chilled.

I find that with a little proactive care, there are times when you can fight off that nasty cold before it sets in. Take it easy, take some zinc, drink some herbs, and stay warm.

Dan’s issue was that he had a couple of major projects at work that he needed to complete, and could not schedule the surgery until about four months from now. His question? The pain was considerable and getting worse; could acupuncture keep him functional until his surgery? While there are no guarantees, I told Dan that acupuncture can be fairly effective for pain, and that it would be reasonable to give it a try.

I saw Dan every week or two until his surgery. I performed acupuncture combined with electrical stimulation, and added heat therapy to the mix. We kept him comfortable, functional, and on some days, even pain-free. Like many patients, Dan would say that there is a role for acupuncture in supporting people who are undergoing hip or knee joint replacement. Clearly acupuncture cannot reverse joint damage from arthritis or replace cartilage. However, there are a couple of ways that acupuncture can help someone who already has or will soon be undergoing this kind of surgery:

Pain relief. Like Dan, many people see the writing on the wall. They know that they will need their joint replaced; they’re just not ready yet. Acupuncture treatments can be an effective and drug-free way to reduce the pain until replacement surgery. In some cases, I have treated patients who were able to hold off on surgery for months, and even years. In addition, acupuncture can be a great way to reduce post-surgical pain.

Getting ready for surgery. Acupuncture can optimize your health prior to surgery. Joint replacement surgery is a huge physical stressor on your body. Working with a practitioner of Chinese medicine with the goal of being in the best health possible prior to the event can help minimize the impact of surgery on your body. I consider these pre-surgical patients to be in training for a major event.

Let the healing begin. Once surgery is complete, acupuncture is a great supportive therapy to assist in the healing process. It can speed healing, reduce pain, and help restore your body to its pre-surgical health. In fact many hospitals offer acupuncture to their patients in the day or two after their surgery. In addition, some patients who go through post-surgical physical therapy decide to schedule an acupuncture treatment after their PT session for pain relief and balance.

Long term support. While many patients are just fine months and years after their joint(s) have been replaced, some people experience aches and pains in the joint when the weather turns cold or damp. When this happens, the options are to tough it out, take a pain reliever, or…that’s right, get some acupuncture.

Many people don’t think about acupuncture when they’re facing joint replacement because acupuncture can’t change the basic structure of the joint. However, those patients who do choose acupuncture as a supportive therapy find that the benefits are surprisingly effective.

*Names and identifying details have been changed.

One of the most frequent conditions that we see at Acupuncture in the Park is shoulder pain. Shoulder pain responds well to acupuncture in most cases, but it is a complicated joint to treat in general. One of the reasons for it’s difficulty is that while your shoulder is a ball and socket joint (like your hip), it’s a shallow one, and as such depends on the surrounding muscles, tendons, and ligaments to hold the joint in place.

A common source of shoulder pain is a group of muscles that make up something called your rotator cuff. The rotator cuff muscles (supraspinatus, infraspinatus, teres minor, and subscapularis) are actually found on the back side of your shoulder, but act to stabilize the shoulder through a wide range of movements.

Over the years, I have found that much of the grief caused by rotator cuff problems comes from the supraspinatus muscle. This muscle runs horizontally across the top of your scapula (chicken wing), passes under the acromium (the bone at the top of your shoulder), and attaches at the top of your humerus (arm bone). Your supraspinatus muscle helps you lift your arm to the side and is used in overhead motions such as combing your hair, throwing, and swimming. When this muscle is injured or inflamed, the pain may come and go, but frequently it will feel achy—until you lift your arm. Typically you’ll be able to raise your arm to the side only so far before you experience a “catch” that sends a lightening bolt of pain through your shoulder and into your upper arm.

The supraspinatus muscle can become injured from overuse, such as too much keyboarding, lifting, or other repetitive motions. It can also become injured from trauma, such as a fall on the shoulder, having your arm yanked, or a direct hit. It may act up from bad biomechanics, such as poor posture or sitting all day in a bad office chair. Whatever the cause, the pain arises from the muscle and surrounding tendons, which can become torn, inflamed, or impinged (pinched) where it travels under the acromium. Unfortunately, this kind of injury has the potential to become chronic which can greatly limit your range of motion and activity.

If you’re suffering from shoulder pain, there are a number of things you can do to be heal your shoulder and become fully functional again. First, I recommend checking with your acupuncturist for an assessment and treatment. Your practitioner is likely to incorporate acupuncture with something called electric stimulation and a kind of bodywork called Tui Na. You are also likely to be sent home with some instructions for care (such as heat, stretches, etc.) in between visits. If you’re trying acupuncture for this kind of injury, plan to give it four to six weeks minimum to see improvements, as shoulder injuries tend to heal slowly.

Other suggestions to help your shoulder heal include:

-Rest. Yes, I’m sure you’ve heard this a million times before, but quit raising your arm if it hurts to do so. Let the flight attendant lift your bag into the overhead bin and learn to comb your hair with the other hand.

-If your arm was injured due to some kind of trauma, use ice during the first couple of days after the injury to keep the inflammation to a minimum. After that time, I like heat because it loosens up the muscles and increases circulation to the area.

-Check your posture. Pull your heart area upward, your shoulders back slightly, and quit slouching. It’s not helping your shoulder.

-Ladies—get that handbag off your shoulder. It doesn’t matter which shoulder you wear it on, using a shoulder strap causes you to dramatically raise one shoulder higher than the other and pulls your back and shoulders out of alignment, which can aggravate and even cause rotator cuff pain.

-Beyond acupuncture, try working with a physical therapist for a couple of sessions. They can give you some exercises to strengthen your rotator cuff muscles and stabilize your shoulder.

*Names and identifying details have been changed.