The Natural Therapist Journal Autumn 2021 Vol36 No.1

The

Natural

EDITION 36 NO. 1 | AUTUMN 2021

Therapist ISSN 1031 6965

Autumn 2021

The Official Journal of THE AUSTRALIAN NATURAL THERAPISTS ASSOCIATION

WWW.ANTA.COM.AU

Contents Edition 36 No. 1

|

Autumn 2021

ANTA News

From the Chair 4

6 ANTA News 8 2020 Bursary Award Winners 9 2020 Graduate Award Winners 9 2021 AIHFE Graduates

Executive Officer Report

12

20

Supporting Endometriosis Patients with Natural PostSurgery Care

Yu Ping Feng San (Jade Wind-Screen Formula)

Jade Walker explains her dealings with

Tony Reid explores Yu Ping Feng San (Jade Wind-Screen Formula) and its clinical applications to help treat your clients.

endometriosis and discusses the ways to reduce the pain naturally.

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40

46

Western Energetics: Humoral Theory in Practice

Heart Shock: Violations of the Jing Shen

Elizabeth Greenwood explains Humoral

explained within Chinese Medicine.

George Thouas reports on a clinical trial for

Thyroid Physiology During Pregnancy and Hypothyroidism: A Current Review of Current Literature

reducing menopause symptoms using a

Ashley Hillsley reviews the current literature

combination of dry extracts.

surrounding thyroid physiology and

27

A Combination Herbal Formula for Menopause Symptoms: Outcomes of a Clinical Trial

Kaitlin Edin explores trauma and how it’s

Theory and the four humors. Which of the humors are you?

hypothyroidism during pregnancy.

EDITION 36 NUMBER 1 – AUTUMN 2021

ISSN 1031 6965

ANTA BRANCH CHAIR PERSONS

The

Natural Therapist

The Natural Therapist is published by the Australian Natural Therapists Association (ANTA) for natural therapy practitioners. The opinions and views expressed by the contributors and advertisers are not necessarily the opinions and views of ANTA. Every effort is taken to ensure accuracy and ANTA accepts no responsibility for omissions, errors or inaccuracies. ANTA relies on contributors and advertisers to make sure material provided for The Natural Therapist complies with the Australian Consumer Law under the Competition and Consumer Act 2010. ANTA accepts no responsibility for breaches of the Australian Consumer Law by contributors or advertisers.

Material in The Natural Therapist is subject to copyright and may not be reproduced in any form without the permission of ANTA and its contributors.

Elizabeth Greenwood • National President • Director of ANTA • National Western Herbal Medicine Branch Chair • ICNM Ambassador • CPE/Seminar Chair • CMPAC Director • Registration Chair • Website & Media Chair • ANTAB Committee Member • ANRANT Committee Member Warren Maginn • National Vice-President • Director of ANTA • National Nutrition Branch Chair • TGA Chair • Ethics Panel Chair • ANTAB Committee Member • ANRANT Committee Member Shaun Brewster • National Treasurer • Director of ANTA • National Myotherapy Branch Chair • ANTAB Chair • ANRANT Committee Member • Health Fund Chair

Ananda Mahony • Director of ANTA • National Naturopathy Branch Chair Kaitlin Edin • Director of ANTA • National Acupuncture Branch Chair • ANTAB Committee Member • ANRANT Committee Member Isaac Enbom • Director of ANTA • National Remedial Therapy Branch Chair • ANTAB Committee Member • ANRANT Committee Member Mark Shoring • Director of ANTA • National Multi-Modality Branch Chair • ANTAB Committee Member • ANRANT Committee Member Tony Reid • Traditional Chinese Medicine Industry Advisor Jim Olds • Executive Officer • Company Secretary • Business Plan Chair • CMPAC Director & Secretary • ANRANT Chair

The

Natural Therapist

Marketing & Production Tasha Kemsley Circulation Enquiries 1800 817 577

Editorial & Advertising Enquiries thenaturaltherapist@anta.com.au Membership Enquiries info@anta.com.au

ANTA NATIONAL ADMINISTRATION OFFICE T: 1800 817 577 | F: (07) 5409 8200 E: info@anta.com.au P: PO BOX 657 MAROOCHYDORE QLD 4558 W: www.anta.com.au

ANTA Executive Welcome Autumn 2021

From the Chair Happy New Year to all ANTA Members and welcome to 2021! While I am sure we all look toward the cycle of a new year in the hope we will do better, I join with you in the assertion that we can and we will!

To all our Members, ANTA Administration Staff and Board Members offer you our congratulations in surviving the annus horribilis that was 2020! ANTA will continue to provide support and leadership to promote and protect the rights of all our Members to engage in training programs and clinical practice. The recovery of incomes is paramount as we return to the delivery of Health Care and the range of therapies required to fortify the health of our clients following the events of the past year.

NUTRITION

ANTA is currently involved in an action to protect our Nutrition Branch Members rights and ensure they can continue professional practice and provide their clients with essential health services through Nutritional Medicine and Clinical Nutrition therapies.

ANTA’s raisons d’être include decisions to allocate Member funds to the protection and promotion of all the therapies we have carriage over under the ANTA Constitution and our Quality Policies and Procedures. We seek to oppose a trademark application that has the potential to affect freedom of practice for ANTA Nutritionists. The National Administration Office will advise the progress of our action directly to the Members of the ANTA Nutrition Branch as it occurs.

NATUROPATHY

During 2020 we managed to continue strong support for all Members and experienced modest growth under challenging conditions. We have revived the case for Naturopaths to regain their Private Health Fund status through collaboration with Private Healthcare Australia (PHA). The PHA is the peak body for private health insurers across Australia. The PHA has acknowledged the right to practice for all certified naturopaths and the related natural medicine modalities that were forcibly removed from the private health fund lists in April 2019.

ANTA holds the view that the current “review of the review” has taken an inordinate period of time and taxpayer’s money while members of the public have been unnecessarily deprived of support to maintain and improve their lives through access to safe and effective PAGE 4 | AUTUMN 2021 | THE NATURAL THERAPIST VOL36 NO.1

Autumn 2021

therapies. Moreover, private health insurers were forced by the Government to remove cover for sixteen therapies many Australians relied on to improve their health, lifestyle and wellbeing. Former Prime Ministers have acknowledged that Australians are smart enough to make sound choices in regard to their futures; therefore, this decision alone needs to be reversed and the right of choice restored to Australian citizens.

COLLABORATION WITH LIKE-MINDED GROUPS

Throughout the pandemic ANTA collaborated with three other major professional Associations to ensure we were receiving consistent messaging from the respective state-based Health Authorities and intervened with a combined voice each time inconsistencies and mixed messages were received, causing confusion among our respective Members. This collaboration proved most valuable through the crisis-periods as they developed.

All therapists were kept up to date with consistent messaging to avoid risks and increase personal safety of all Members. I want to thank the CEOs of Myotherapy Association of Australia, the Australian Traditional Medicine Society and Massage and Myotherapy Australia for their contribution to a cohesive and strong approach to all Health Departments across Australia. Thank you all for your diligence and input to keep our collective Members safe and in practice for as long as we are able.

ONGOING ADVOCACY

ANTA has engaged an experienced lobbyist to assist our efforts to regain rebates through the ability to access key stakeholders in this process. We are also addressing gaps in the National Code of Conduct in relation to minimum education standards for entry to unregistered health care worker occupations and formal protection of title for all practitioners who have completed the standard, current, accredited qualification in their field.

STRENGTH THROUGH INTEGRITY

The ANTA Board of Directors has expanded exponentially to meet the demands of regulators and to provide promotion and protection over the growing ANTA Membership. During 2020, we expanded the Board as new Directors joined through 2019 and 2020. We continue to enjoy the support and guidance of highly qualified, experienced clinicians who are leaders in their field of

ANTA Executive Welcome Autumn 2021 practice, representing your interests. Our overarching interest is in your education, training standards, integration into clinical practice and ongoing support to ensure your success as a natural health professional continues in a meaningful way to secure your future.

PROMOTION OF ANTA AND ITS MEMBERS

The rebuild of the ANTA website approaches its time to go live and we will soon see many changes, smoother function and easier access. Organic growth will improve through our outward-facing pages that have been populated to inform and provide access to the public. Our efforts to provide ready access with higher quality and relevant information to our audience will also improve access to Members by the public.

The Practitioner Directory Upgrade is a major component of this rebuild and will change the current speed of access and accuracy users will experience. The ANTA Board and Administration Staff is confident this improved access will facilitate rapid interaction between natural therapists and

their clients, potential and existing. Our relationship with a first-class media service provider, we can rely on the best options for our Member services going forward.

I trust we can count on the support and patience of our Members through this period of change and rely on the leadership and support provided through the team of highly qualified and experienced therapists managing the professional and commercial support you deserve.

Regards

Jim Olds

ANTA Fellow ANTA Executive Officer & Company Secretary BHSc MST, BHSc Comp Med, GC Higher Ed, MSC, Dip Nut, Dip RM, Dip TCMRM.

THE NATURAL THERAPIST VOL36 NO.1 | AUTUMN 2021 | PAGE 5

ANTA News Autumn 2021

ANTA News Important!

New condition of Membership - Working with Children Check or Police Check ANTA has been advised by Health Funds that all Members will now require a Working with Children Check or Police Check to be eligible for Health Fund recognition and ANTA Membership going forward.

Please be aware that all Australian States and Territories have different policies and procedures when it comes to these Checks. ANTA requires your documentation to be emailed as soon as possible. If this is not completed, your Health Fund and Membership status will be in jeopardy.

AHPRA registered Members do not need to complete this requirement as it is a condition of AHPRA registration.

As an Association recognising practitioners within the healthcare industry, ANTA has an obligation to ensure the public’s safety by ensuring all Members have completed a clear criminal history check.

PAGE 6 | AUTUMN 2021 | THE NATURAL THERAPIST VOL36 NO.1

Membership Renewals for AHPRA Members ANTA Membership Renewal Notices for AHPRA Members were issued in Feburary 2021.

Payments have to be made by 31st March 2021.

Please check your junk/spam folder or contact ANTA if you did not receive your renewal.

ANTA and the Board of Directors would like to offer a big thank you to all the purchased a ticket for the first World Health Symposium.

Although the event ran with a few technical difficults, we would like to thank those that provided helpful feedback and asked some great questions for all presenters.

If you did not receive your certificates, please contact ANTA on 1800 817 577.

ANTA News Autumn 2021

Important Information for ANTA Members registered with Health Funds Members who are recognised by Health Funds need to be aware of some new requirements in regard to Bupa and Medibank (including AHM).

Bupa – as of 1st February 2021, Bupa will be implementing their new Ancillary Provider Terms.

Members who are eligible for Bupa provider recognition are advised to read the new terms and ensure that they are adhering to the requirements.

These new terms are available on ANTA’s website in the Member Centre under Health Funds > Bupa Recognised Ancillary Provider Criteria. You can also visit Bupa’s website https://www.bupa.com.au/forproviders for further information.

Medibank (including AHM) – as of 1st April 2021, Medibank’s recognition criteria will be updated to reflect the requirement for electronically issued or printed invoices/receipts. This means that after 1st April 2021 Medibank will no longer accept fully or partially handwritten invoices/receipts. Medibank have advised that if providers do not comply with this new rule, their status as a Recognised Provider of Medibank may be reviewed and they may be suspended or cancelled. The updated ancillary billing standards for Medibank (including AHM) are available on ANTA’s website in the Member Centre under Health Funds > Medibank Recognised Ancillary Provider Criteria. You can also visit Medibank’s website https://www.medibank.com.au/providers/ for further information. ANTA recommends that you start implementing this practice as soon as possible prior to 1st April 2021.

It has come to ANTA’s attention that a large number of practitioners are not adhering to the rules of the various Health Funds and we stress that it is very important to familiarise yourself with each of the Health Fund’s rules and regulations. By following the simple guidelines below, Members can greatly assist their clients in achieving a successful outcome with their Health Fund. Failure to provide any of the following requirements will result in your name and clinic details not being sent to the Health Funds and your client’s claims being rejected.

Change of Address or Name: Ensure any changes to your clinic address, e.g. new clinic address or leaving clinic address, and/or name (i.e. marriage etc.) are notified to ANTA as soon as any change occurs. If your change of address, change of name etc. is not provided to ANTA in a timely manner, your current

details will not be included on the lists of ANTA Members sent to Health Funds. If your name and/ or clinic address shown on receipts issued to your clients does not match your name and/or clinic address shown on the reports sent to Health Funds, your client’s claim will be rejected by the Health Fund.

Professional Indemnity Insurance: Ensure your Professional Indemnity (PI) insurance is renewed before it expires. You will be required to provide a copy of your Certificate of Currency to ANTA. Members who do not provide ANTA with a copy of their PI Certificate of Currency in a timely manner will not be included on lists sent to Health Funds and your current provider number/s will be cancelled.

First Aid Qualification (HLTAID003 or subsequent updates): Ensure your First Aid qualification is renewed before it expires and that you provide ANTA with a copy of the renewed qualification before the expiry date of your current certificate. Members who do not provide ANTA with a copy of their renewed First Aid qualification in a timely manner will not be included on lists sent to Health Funds and your current provider number/s will be cancelled.

Police Check or Working with Children Check: Ensure you have provided ANTA with your current Police Check or Working with Children Check. Members who provide new clinic address details and do not have a current Police Check or Working with Children Check will be required to supply a check before Health Funds are notified of your new address change.

Continuing Professional Education (CPE): Ensure that you complete and log 20 hours of CPE each calendar year (January to December) on your personal profile within the ANTA Member Centre.

Renew your ANTA Membership: Ensure that you renew your ANTA membership before it expires.

Membership expires on the 31st December each year and your renewal notice will be forwarded to you in October each year. [Note: Acupuncture and Chinese Herbal Medicine members expire 31st March each year – renewal forwarded to you in February each year].

Members who do not renew their membership in a timely manner, i.e. before the 31st December [or 31st March for Acupuncture and Chinese Herbal Medicine practitioners], will not be included on lists sent to Health Funds and your current provider number/s will be cancelled.

THE NATURAL THERAPIST VOL36 NO.1 | AUTUMN 2021 | PAGE 7

ANTA News Autumn 2021

2020 Bursary Award Winners ANTA would like to congratulate the following Bursary Award Winners for 2020. Each winner received $1000 plus 12-months complimentary ANTA Membership upon completion of their course.

Shiki Coppola

Bianca Vogel

Cassi Stewart

Renee Lynch

Lachlan Mullen

Thanaporn Vatcharayan

Cassandra Howard

Bronwyn Campbell

Cheuk Yan Yam

Casper Sela

Miriam Cullen

Jack Roney

Maryanne Torok PAGE 8 | AUTUMN 2021 | THE NATURAL THERAPIST VOL36 NO.1

ANTA News Autumn 2021

2020 Graduate Award Winners Round 2

ANTA would like to congratulate the following Round 2 Graduate Award Winners for 2020. Each winner received $200 plus 12-months complimentary ANTA Membership.

Katrina Harrington

Tara Austin

Patricia Yetsenga

Judith Rose

Holly Barnes

Lorraine English

2021 Australian Institute of Higher and Further Education Graduates

Laurel Sepkus - ANTA Award for Outstanding Performance in the Advanced Diploma of Ayurveda

Alena Speed - ANTA Award for Outstanding Performance in Ayurveda Clinical Practice

Samantha Moran - ANTA Dux Award for Ayurveda Sharene Gittins - ANTA Award for Commitment to Excellence in Ayurveda

THE NATURAL THERAPIST VOL36 NO.1 | AUTUMN 2021 | PAGE 9

MANAGING COLIC ASSOCIATED WITH LACTOSE INTOLERANCE Developmental lactose intolerance has been found to be an important causative factor for colic. Clinical studies show that approximately 40% of babies medically diagnosed with colic suffer from “colic associated with lactose intolerance” 1.

Colic in a nutshell Colic occurs in approximately 1 in 5 babies, usually between 2 weeks of age and 4 months, who show significant periods of distress at predictable times during the day. In all other respects, the baby is well-fed and healthy, and no underlying cause or illness can be found.

Developmental Lactose Intolerance During digestion lactase enzymes are needed to break down lactose into simple milk sugars, which can then be absorbed by the body.

Studies show human foetuses between 26 and 34 weeks of gestation have only 30% of the lactase activity of fullterm babies1, commonly leading to developmental lactose intolerance.

This is not to say these babies do not suffer from colic, simply that the colic has an underlying cause - a shortage of lactase enzymes in the digestive system.

Managing Colic associated with Lactose Intolerance Pre-treating baby’s feeds with lactase enzymes reduces the lactose content, making the feeds more easily digestible.

PAGE 10 | AUTUMN 2021 | THE NATURAL THERAPIST VOL36 NO.1

Simply add a few drops of Lacteeze Infant Drops to baby’s feed to reduce the lactose content. If breast feeding, Mum can express 2 tablespoons of foremilk prior to feeding, add the drops and give this mixture to baby. Baby can then go to the breast naturally, eliminating the need to move to formula feeding. There is no need for Mum to change her diet.

Studies show that pre-treating babies’ feeds with lactase enzymes can reduce crying time in babies whose colic is associated with transient lactose intolerance by a staggering 45%1.

For more information visit www.lacteeze.com.au or email info@lacteeze.com.au.

1

References available on request.

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ANTA Member Article Autumn 2021

Jade Walker

BHSc (Naturopathy)

Supporting Endometriosis Patients with Natural Post-Surgery Care Background

Endometriosis now affects 1 in 9 Australian women1.

The gold standard to receive a diagnosis is still invasive laparoscopic surgery of which there are around 34,000 endometriosis-related hospitalisations annually.

Endometriosis can have a devastating effect on the quality of life of sufferers due to the painful symptoms that the disease carries and the fact that it is the biggest cause of infertility in women.

Given its prevalence, complementary medicine and dietary modifications can play an important role in improving the patient’s experience with post-surgical healing and prevention of further growth.

My Story, My Clinic

As a Naturopath with endometriosis, I have experienced its full array of challenges; the General Practitioner (GP) dismissals, an unsuccessful laparoscopy at 21 years of age, hospitalisations from significant dysmenorrhoea, and a 17year road to a diagnosis at 29, this is a condition you can say I am more than passionate about.

Unfortunately, I’m not alone. Diagnosis and management of endometriosis is complex and there is no known cure.

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Every March Endometriosis Month takes place across the world, with the aim of increasing awareness and highlighting the symptoms of this debilitating condition that affects an estimated 176 million women worldwide.

In my clinic, I now see people with endometriosis on a weekly basis and not one patient is the same. One may have stage 4 endometriosis and experience no pain, whilst one may have stage 1 endometriosis and have debilitating pain every day of the week. For some, they will respond really well to herbal medicines and key dietary changes.

For others, you can throw the whole book at them, and Not one endometriosis patient is the same.

One may have stage 4 endometriosis and experience no pain, whilst one may have stage 1 endometriosis and have debilitating pain every day of the week.

ANTA Member Article Autumn 2021 you barely touch the sides.

Common Misconceptions

Unfortunately, there are still some common misconceptions amongst our profession about how we should support endometriosis. Often people assume that you should avoid surgery, saying things such as “surgery will make it worse” or “you’ll just end up with more adhesions”. Whilst that can be true for some poorly performed surgeries, and surgery always comes with its risks, this advice is ill-informed.

Endometriosis Diagnosis

Firstly, a laparoscopy is the only way to truly confirm endometriosis.

For many, that diagnosis can be a validating and relieving experience. There are some highly skilled specialists who can pick up some forms of endometriosis on a transvaginal ultrasound. However, many types of endometriosis won’t be detected using this non-invasive method. Thus, telling someone they do or don’t have endometriosis off the back of an ultrasound alone, is incorrect (and unfortunately, I still see this happen all too often).

Secondly, the surgeon makes all the difference to the patient’s outcomes. The one thing that would have sped up my diagnosis, had I known at 21 years of age, was understanding just how important this factor is.

There are many gynaecologists who perform laparoscopies who can identify the classic “chocolate cysts” and other visually obvious lesions. But not all gynaecologists have added several years of further training to become an “advanced trained excision surgeon in endometriosis”.

There are two key differences. One is that they understand how to identify some of the more inconspicuous looking lesions and explore deeply in and around all organs. Another being that they use excision surgery as opposed to ablation.

Think of ablation like burning off a mole; you only get the top, meaning it can grow back. Meanwhile excision is like cutting the root of a mole and all of its surrounds. It’s the same principle with endometriosis. Excision surgery can make a significant difference to the time in between further surgeries, or ever needing another one at all.

Again, endometriosis can significantly vary in severities, and thus some need several surgeries, whilst one might only need one.

Supporting Patients’ Post-Surgery

What is just as important as the excision of endometriosis, is supporting the patient’s healing, reducing pain, and correcting imbalances that could be enabling the condition.

Reducing Pain

Combining natural analgesics, anti-inflammatories and warming circulatory stimulants is key. Corydalis, californian poppy, black haw, cramp bark, cinnamon, turmeric and ginger are just some of the most commonly used herbs. A new herbal pain reliever that is showing promise as being highly effective is Khaya senegalensis, which is currently only found in the aptly named fastacting formula “Khapregesic” by BioActive Natural Health.

As Khapregesic comes in tablet form, patient compliance is greatly increased as they can take it to replace or reduce the need for over-the-counter pain medications such as paracetamol or NSAIDs, without the abrasive side effects on the GI tract from the NSAIDs. Also be mindful when it comes to recommending paracetamol. Often seen as a benign analgesic, recent research says that “even taking one or two more tablets than recommended can cause serious liver damage and possibly death”. Accidental paracetamol overdose is one of the leading causes of liver failure2.

Furthermore, as nausea is also a common complaint with both dysmenorrhoea and post-surgery, liquid herbs may not always be appropriate.

Palmitoylethanolamide (PEA) is also another promising product that can act on both acute and chronic pain, which can in some ways serve as an alternative to CBD oil.

It goes without saying that high doses of magnesium

Figure 1: A Laparoscopy is the only way to truly confirm endometriosis

Commonly used herbs such as corydalis, californian poppy, black haw, cramp bark, cinnamon, turmeric, and ginger round out the more common herbal pain relievers. For fastacting pain relief, however, a newly rediscovered traditional medicine herb Khaya senegalensis, has been found to be effective for some patients using the Khapregesic formulation.

THE NATURAL THERAPIST VOL36 NO.1 | AUTUMN 2021 | PAGE 13

ANTA Member Article Autumn 2021 and fast answer as to whether or not someone could avoid surgery. However, you may also meet some patients who do not wish to have surgery, which is why the majority visit a natural therapist.

Figure 2: Lipopolysaccharides (LPS) in the peritoneal fluid can promote early endometrial growth

bis-glycinate or citrate must be used daily. Magnesium citrate can provide the added benefit of softening the stools as constipation is common post-surgery after using opiates. Acupuncture can also be a great adjunct to the patient’s care plan if finances permit.

Preventing Further Growth

Key treatment aims in endometriosis include modulating the immune system, reducing inflammation, correcting gut flora imbalance (dysbiosis) and supporting detoxification pathways. This must be commenced immediately post-surgery.

Studies have found those with endometriosis have a higher presence of gram-negative bacteria, specifically, endometriosis appears to be associated with an increased presence of Proteobacteria, Enterobacteriaceae, Streptococcus and Escherichia coli across various microbiome sites3, and thus lipopolysaccharides (LPS) in the peritoneal fluid promoting early endometrialperitoneal interactions4.

In addition to promoting early endometrial growth, LPS has been proven to drive up inflammation and disrupt the immune response5.

These gram-negative bacteria translocate from a dysbiotic gastrointestinal tract, thus treating the gut with products such as berberine, probiotics, calcium-D-glucarate and gut healing nutrients should be the first priority.

Interestingly, the newly rediscovered traditional medicine herb Khaya senegalensis, a strong natural COX-2 inhibitor is also rich in prebiotics and has been shown to help with Irritable Bowel Syndrome (IBS), which is a common comorbidity with endometriosis sufferers. Other clinically trialled essentials include using daily N-acetyl cysteine, curcumin, and immune supporting nutrients such as Vitamin D and zinc.

Can a Patient Avoid Surgery by Using Natural Medicine?

Given how much endometriosis varies, there is no hard PAGE 14 | AUTUMN 2021 | THE NATURAL THERAPIST VOL36 NO.1

For patients who present with some small nonobstructive lesions, natural medicine can provide a path to avoid surgery. However, for some forms of endometriosis, there is no herb or massage technique that will free up several adhesions sticking the bowels together or obstructing tubes. If patients fail to respond to natural medicine, the gold-standard for diagnosis, laparoscopic surgery should be recommended. Contact your GP or Endometriosis Australia for more information regarding endometriosis diagnosis6.

For some forms of endometriosis, there is no herb or massage technique that will free up several adhesions sticking the bowels together or obstructing tubes.

Is There a Non-Invasive Alternative to a Laparoscopy?

As we look into alternatives to a laparoscopy, we need a specialist to also determine how severe the endometrial adhesions are?

A transvaginal ultrasound and pelvic exam with a skilled specialist will at least be able to get a sense of what’s going on. For example, my first appointment with my surgeon, before surgery, involved him having a feel “up there” and seeing if the left or right side felt hitched up, feeling for how mobile the organs were. A transvaginal ultrasound can also provide some clues, however, in isolation these tests should not be relied on for a final diagnosis for endometriosis.

Key Strategies to Adopt

So what are some of the key strategies you can adopt with your patients to avoid surgery?

As always, determine what your patient’s key priorities are. For some it’s only the dysmenorrhoea often accompanied with painful intercourse (dyspareunia).

For some it’s menorrhagia, looking out for athletes and the physically fit as research has confirmed that close to one third of female athletes suffer heavy bleeding leading to anaemia and fatigue7. It should be noted further that 20% of those with menorrhagia have a blood clotting disorder8 which can be tested through their GP. As always, determine your patient’s key priorities to give them peace of mind. Is it: • Painful periods only (dysmenorrhoea) • Painful intercourse (dyspareunia) • Heavy bleeding (menorrhagia) • Fertility (or the risk of infertility)

ANTA Member Article Autumn 2021 For others it’s fertility or the dark shadow of infertility as endometriosis is the leading cause of infertility. Always start your patient’s key priorities to give them peace of mind, then move on to finding relief as soon as possible. Just by using key analgesic and anti-inflammatory herbs like those

mentioned, NAC, supporting gut health, and adopting an anti-flammatory diet you could make a profound difference without the need for surgery in those mild cases.

For more daily education on natural medicine for endometriosis, you can follow @jadewalkerhealth on Instagram or join Facebook groups, “Natural Medicine for Endometriosis”, “PCOS/Endometriosis Natural Support Group” or “Endo Diet support group & Natural remedies Endometriosis”.

For references log into your ANTA Member Centre > The Natural Therapist > Journal Articles

Jade Walker (BHSc Naturopathy) is a Naturopath with a special interest in endometriosis and reproductive health. After a long battle with debilitating dysmenorrhoea and navigating a health care system that was not set up for recognising endometriosis, it took her 17 years to finally get a diagnosis. Jade now dedicates her online practice to helping people across Australia find a better quality of life with endometriosis and other reproductive conditions. Jade can be found at www.jadewalkerhealth.com or @jadewalkerhealth on Instagram.

THE NATURAL THERAPIST VOL36 NO.1 | AUTUMN 2021 | PAGE 15

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Naturally Good Expo Returns to ICC, Sydney in May 2021 After a somewhat unusual and disruptive year that was 2020, Australia’s largest trade event for the natural, organic and healthy products industry will take place in the ICC Sydney this May. The pandemic year had not only changed drastically the way people went about their everyday lives, but also sparked the urge to better care for the body and the planet. 2021 is set to be another thriving year for all things natural, healthy and organic across food, drink, beauty, personal care, home and living, and particularly the natural healthcare sector. With environmental issues now of the utmost importance, it’s expected consumers will increasingly buy with a higher level of altruistic, conscious intent.

Returning to Sydney’s International Convention Centre (ICC) on Sunday 30th May to Monday 31st May for a big sixth edition, the Naturally Good Expo will this year be more innovative than ever, featuring over 330 exhibitors and 15 presentations showcasing the hottest products and trends. Feedback from exhibitors and visitors are indicating the eagerness to attend a face-to-face trade event. The organisers are re-shaping the attendee experience to better suit the current climate, and as a result, Naturally Good 2021 will look and feel different.

Rest assured there will be a range of protective measures in place to ensure a safe and controlled environment for you to conduct business.

Partnering with key industry bodies, including Australian Natural Therapists Association, Complementary Medicines Australia and Australian Organic, industry visitors at the Business-2-Business (B2B) event can check out the most diverse businesses, producers and brands in this growing sectors.

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This year, the natural health zone will feature close to 50 exhibitors showcasing vitamins, supplements, herbal remedies and complementary medicine products. Key exhibitors will include THS Nutrition, Fiji Kava, Kiwi Manuka, Rochway, Glimlife, Hab Shifa, Regul8 and Oborne Health Supplies.

The show is the perfect platform for practitioners to see the latest developments in natural health and the newest trends in food and drink products to recommend to clients. There is also the opportunity to have indepth conversations directly with the team behind these brands.

Naturally Good will continue to host a free to attend speaker series over the two day event, covering key areas such as emerging consumer trends, practical tips from leading retailers, insights into key consumer segments and marketing strategies.

Other exhibitors will include leading food brands such as Ceres Organics, The Healthy Chef, Tropeaka, Hemp Oz and more. Returning will be the Start Up Zone featuring the

most innovative products from emerging brands that have launched within the past two years including Cobram Harvest, Nutty Bay and Koala Black Garlic.

This year’s Pitch Fest competition will be held on the show floor allowing all trade buyers to sit in on the industry’s most enthusiastic product pitches alongside industry judges and hear live from the entrepreneurs behind these emerging brands.

The Business Summit will also be held Friday 28th May. Aimed at manufacturers and brands in the natural and organic space, the summit will cover consumer strategy, capital raising and ecommerce, as well as the always popular topic of upcoming trends and insights in 2021.

The expo is free to attend for all ANTA members by registering online; and the Business Summit is a ticketed event.

Event details: Exhibition Sunday 30th – Monday 31st May 2021 ICC Sydney, Darling Harbour, Halls 3 & 4 10am-5pm daily Register online at naturallygood.com.au Business Summit Friday 28th May 2021 ICC Sydney, Darling Harbour Convention Building 9am-5pm Tickets can be purchased at naturallygood.com.au Enter code: ANTA to receive $100 discount off the early bird rate

THE NATURAL THERAPIST VOL36 NO.1 | AUTUMN 2021 | PAGE 19

ANTA Member Article Autumn 2021

Tony Reid

M.Ac (Acupuncture) M.TCM (Traditional Chinese Medicine)

Yu Ping Feng San Classical Sources

(Jade Wind-Screen Formula)

Yu Ping Feng San (Jade Wind-Screen Formula) (YPFS) was first recorded in ‘Effective Prescriptions from Generations of Physicians’ (shi yi de xiao fang) by Wei Yi-lin (1277– 1347). This is a compilation work in 20 sections that details the accumulated medical and surgical knowledge of the Wei family over the previous five generations. It covers all branches of Traditional Chinese Medicine (TCM), including internal medicine, gynaecology, orthopaedics and traumatology, as well as surgery and health maintenance.

In this comprehensive text Dr Wei revealed many of his family’s ‘secret’ herbal formulas, along with the ingredients of an effective surgical anaesthetic. Although there is some disagreement about the origin of YPFS1, Dr Wei’s text contains the earliest extant record of this formula.

YPFS consists of three ingredients only: Astragalus root (huang qi), Atractylodes rhizome (bai zhu) and Saposhnikovia (a.k.a. Ledebouriella) root (fang feng).

The combined therapeutic action of these three herbs is to promote resistance against an attack by exogenous pathogens by strengthening the defence Qi (wei qi) to consolidate the Exterior, closing the Striae (cou li) and the pores of the skin. The main clinical applications of YPFS are in patients with sensitivity to drafts, spontaneous PAGE 20 | AUTUMN 2021 | THE NATURAL THERAPIST VOL36 NO.1

sweating and frequent upper respiratory infections, together with signs of Qi deficiency1.

Astragalus (huang qi) is generally regarded as the principal herb as it serves two functions. One is to tonify the Spleen to assist replenishment of the defence Qi. The other function of raw Astragalus root (i.e. not preprepared) is to consolidate the Exterior and stop abnormal sweating. The two assistant herbs are Atractylodes (bai zhu) and Saposhnikovia (fang feng). The former tonifies the Spleen, while the latter consolidates the Exterior and directs the action of the formula to the Exterior2.

As noted by Bensky et al.1 there has been a certain amount of controversy over the synergistic interactions of the herbal ingredients of YPFS, centred on those of Saposhnikovia (fang feng). This herb is classified as ‘Exterior releasing’ and is normally used in formulas to dispel pathogens from the Exterior through diaphoresis.

However, in this formula the aim is to stop sweating, not increase it. In order to achieve this, Saposhnikovia (fang feng) is used at a lower dosage and is pre-prepared by dry frying. This process alters the herb’s actions, attenuating the diaphoretic action and enhancing the herb’s inherent Yang properties. Thus, in combination with Astragalus (huang qi) it directs the action of the formula to the Exterior and supports the defence Qi, while

ANTA Member Article Autumn 2021 in combination with Atractylodes (bai zhu) it tonifies the Yang Qi of the Spleen (i.e. the lifting and spreading functions) to reinforce and support the main actions of this formula3.

Botanical Features, Phytochemistry and Pharmacological Actions Astragalus Root (huang qi)

Astragalus membranaceus is a perennial herb, belonging to the legume family, Fabaceae. It grows in temperate regions of the northern hemisphere and is found throughout Asia. It is cultivated mainly in northeast China, which produces the best quality roots, referred to as ‘bei (northern) qi (Astragalus)’. Astragalus Root is used in TCM to strengthen the Spleen and tonify the Qi. The root of the plant contains saponins, flavonoids, polysaccharides, amino acids, coumarin, folic acid, trace elements and various organic acids. Over 100 different compounds have been isolated to date. Studies on rats, mice and cell cultures have shown that extracts of Astragalus Root have the following actions: • Immunomodulatory effects: enhances immune responses and restores suppressed immune responses through actions on dendritic cells, B cells, macrophages, mononuclear cells and lymphocytes • Antihyperglycemic • Anticholesterolemic: reduces serum triglycerides and low-density lipoprotein cholesterol and increases high density lipoprotein cholesterol • Anti-inflammatory: reduces the expression of various inflammatory mediators, such as inducible nitric oxide synthase (iNOS), cyclooxygenase-2 (COX-2) and TNF—α • Antioxidant: direct antioxidant activity of the flavonoid content as well as an indirect effect by increasing antioxidant enzyme activity • Antiviral: promotes antiviral activity though actions on the immune system4.

Atractylodes Rhizome (bai zhu)

Atractylodes macrocephala is a perennial herb of the Compositae family. It is found on hill or mountain slopes at altitudes between 600–2800m. The herb has been cultivated for more than 700 years, the best quality rhizomes coming from the mountainous regions of

Astragalus Root (huang qi)

Zhejiang. The rhizome is used in TCM to tonify the Spleen and boost the Qi. The rhizome contains a variety of biologically active components including sesquiterpenoids, triterpenoids, polyacetylenes, polysaccharides, flavonoids and flavonoid glycosides. About 80 different compounds have been isolated to date. Studies on animals and isolated tissues have shown that extracts of Atractylodes Rhizome have the following actions: • Improves gastrointestinal function: by accelerating intestinal epithelial growth and migration; improves intestinal microbiota composition and upregulates microvilli growth • Anti-tumour activity: by increasing apoptosis of tumour cells • Immunomodulatory effects: increasing cytokine mRNA expression, antibody production and lymphocyte proliferation • Anti-inflammatory activity: specifically on the intestinal epithelium by decreasing the expression of inflammatory mediators, such as COX-2, iNOS, IL-1β, TNF-α and NF-KB • Neuroprotective and anti-Alzheimer’s disease: in mouse and rat models • Anti-ageing and antioxidant: in rat models by inhibiting lipid peroxidation and increasing antioxidant enzyme activity • Gonadal hormone and tocolytic (stops premature labour): in pregnant rat model by normalising gonadal hormone production, alleviating hyperandrogenism and inhibiting myometrial smooth muscle contraction • Stimulates mitochondrial function and energy metabolism: in muscular tissue • Reduces adipocyte differentiation and plasma triglycerides: in high fat diet rat model • Prevents abnormal bone loss: by inhibiting the differentiation of osteoclast precursor cells into osteoclasts5.

Saposhnikovia Root (fang feng)

Saposhnikovia divaricata is a branched perennial flowering plant of the family Apiaceae (a.k.a. Umbelliferae). The Chinese name, fang feng, means ‘protect against the wind’, alluding to the medicinal uses of the root in TCM. The plant is able to grow in cold and dry conditions and is found throughout Northeast Asia. The roots have been used medicinally for over 2,000 years. It is cultivated in north-east China, the best quality roots coming from the

Atractylodes Rhizome (bai zhu)

Saposhnikovia Root (fang feng)

THE NATURAL THERAPIST VOL36 NO.1 | AUTUMN 2021 | PAGE 21

ANTA Member Article Autumn 2021 most northerly provinces, such as Heilongjiang. Traditional uses are centered on the herb’s actions of dispelling pathogenic Wind: releasing Wind-Cold from the exterior through diaphoresis and dispelling Wind-Cold Damp from the Channels to relieve rheumatic pain. The root contains a variety of chromones, coumarins, acid esters, polyacetylenes, polysaccharides and volatile oils. Over 100 different compounds have been isolated to date. Studies in rodents and tissue cultures have shown that extracts of Saposhnikovia Root have the following actions: • Analgesic and antinociceptive: most likely through opioid receptors in the central nervous system, as well as through local anti-inflammatory action on peripheral sensory nerves • Anti-inflammatory: by inhibition of major inflammatory pathways, such as NF-KB, mitogen activated protein kinases (MAPK’s), cAMP response element-binding protein (CREB) and nitric oxide production • Antioxidant: mainly through scavenging free radicals and inhibiting lipid peroxidation • Antiproliferative and antitumor: through boosting macrophage activity as well as directly inhibiting the proliferation of tumour cells • Immunoregulation: by stimulating the production of lymphocytes, macrophages and other immune cells • Antiallergic: reducing production of pro-inflammatory cytokines, such as IL-6 and IL-8 to attenuate the delayed hypersensitivity reaction6,7.

Yu Ping Feng San: Empirical Research

While studies on each of the ingredients in the formula may provide information about therapeutic actions and the physiological mechanisms behind them, it is important to look at how the complete formula works. Beginning with studies in animals and tissue cultures, and then moving on to humans, this section outlines the empirical knowledge base to date.

In studies on animals and tissue cultures YPFS has been shown to have the following therapeutic actions: • In allergic rhinitis (guinea pig model): curative as well as preventative actions8 • In allergic rhinitis (murine model): both curative, by stimulating immune responses after the antigen had been administered intraperitoneally, as well as preventative by increasing the capacity of the nasal mucosa to block entry of the antigen9 • In allergic rhinitis (human cell cultures): restores immune suppressor function of the regulatory B cells (Bregs) (in PAGE 22 | AUTUMN 2021 | THE NATURAL THERAPIST VOL36 NO.1

patients with allergic rhinitis the ability of Bregs to suppress immune function by reducing effector T cell proliferation is compromised)10 • In acute dermatitis (murine model): anti-allergic and anti-inflammation actions, with decreased production of IL-4, IL-5, IL-13, and IgE. In addition, defects in the tight junction (TJ) were repaired through upregulation of TJ proteins CLDN-1 and occludin, which restored epithelial barrier function11, 12 • In chronic obstructive pulmonary disease (rat model): anti-inflammatory (suppressed the release of pro-inflammatory cytokines). Suppressed collagen deposition, reduced inflammation (down-regulation of the TGF-β1/Smad2 signalling pathway), with reduced injury to lung tissue13 • Anti-bacterial and anti-viral (cultured murine macrophages)14 • In inflammatory bowel disease (tissue cultures): anti-inflammatory action through modulating the expression of iNOS, COX-2, and intestinal alkaline phosphatase (IALP). The action of YPFS on cytokine expression by macrophages is bi-directional, in that it will induce expression under some conditions and suppress expression under others15, 16 • In asthma (murine model): alleviation of symptoms by reducing inflammatory cell infiltration, reducing mucus secretion and MUC5AC production, as well as reducing the production of mRNA and levels of IL-1β, NLRP3, Caspase-1 and ASC17 • Asthma remission phase (murine model): YPFS restored bronchial epithelial barrier function by upregulating tight junction proteins, upregulating expression of desmoglein 1 (DSG1) and decreasing the overexpression of thymic stromal lymphopoietin (TSLP)18

Yu Ping Feng San: Humans Studies

To date, over 350 compounds have been isolated from YPFS and the potential targets of 250 have been elucidated19. In tandem with this approach there is an expanding pool of clinical research on human populations, which is summarised below.

• In children with repeated respiratory tract infections: preventative as well as therapeutic action20 • In patients with acute cerebrovascular disease: preventative action on hospital acquired pneumonia, with improvements in immune function as well as in lung function21 • In adult allergic rhinitis: reduction of symptoms, possibly with increased effectiveness when used for more than three weeks. When

ANTA Member Article Autumn 2021 used in conjunction with pharmacotherapy, better results are gained than with either alone22, 23 • In childhood asthma: improved total clinical response rates, when combined with Western pharmacotherapy24 • In end stage cancer patients: reduction or cessation of abnormal sweating and improvement in appetite25

Discussion

In contemporary practice, YPFS is often prescribed on its own or as a component of more complex prescriptions in the treatment of recurrent upper respiratory tract infections, allergic rhinitis, chronic urticaria, remission stage therapy for asthma and chronic bronchitis, and recurrent otitis media in children1.

Of interest are two observations from the above studies: the upregulation of tight junction mediators to restore epithelial barrier function and the biphasic action of the herbs on immune and inflammatory processes. These correlate with some of the unique concepts in TCM: the defence Qi (wei qi) and the Striae (cou li), which were discussed over 2,000 years ago in the Emperor’s Cannon of Medicine (Huang Di Nei Jin) (HDNJ).

In the HDNJ we see that the defence Qi and the Striae were well established concepts of traditional Chinese medical theory at the time that the text was compiled, during the Warring States period (475–221 BCE). In this text they are discussed in the context of diseases caused by external pathogenic factors26, 27. Subsequent medical scholars elaborated on this, explaining that the defence Qi supports and controls the functions of the Striae which provide passageways for the distribution of the defence Qi and also create a barrier against the entry of pathogens from the outside28.

As noted by Unschuld, a leading contemporary translator of classical Chinese medical texts, there is really no adequate single word in English that is able to encompass all of the shades of meaning of the Chinese ‘Qi’ when it is used in a medical context29. Moreover, the situation is complicated by the fact that in much of TCM medical literature, particularly within Chinese herbal medicine paradigm, ‘Qi’ is generally combined with a second character, a ‘qualifier’, which narrows down the particular meaning within a given context, e.g. Lung Qi, defence Qi, evil Qi. This is a feature of the Chinese language: two characters are generally used to denote a single concept. In my view, to always translate Qi as ‘energy’ is inadequate because it fails to emphasise the concept of purposeful function that is implicit in the Chinese medical understanding.

A good working definition of ‘- Qi’ in a medical context would be ‘a group, or series, of physiological activities that are directed towards a specific purpose’. Thus,

‘defence Qi’ denotes all of the biological functions that are involved in dealing with pathogenic factors that can enter the body from the outside. From the perspective of contemporary medicine, these pathogenic factors include viruses, bacteria, toxins and potential allergens.

Looked at in this way, the ‘defence Qi’ correlates very closely with the concept of immune system surveillance, while the Striae, together with the defence Qi, correlate with epithelial barrier function. Western medical research has only recently begun to focus on barrier function in relation to various atopic and inflammatory disorders.

Over the past 20 years, studies on the epithelial barrier in the gut, respiratory tract and skin has been gathering momentum, supporting the view that compromised barrier function with increased epithelial permeability is the primary initiating factor in allergic rhinitis, chronic sinusitis, asthma, atopic dermatitis, inflammatory bowel disease, celiac disease and irritable bowel syndrome30, 31, 32, 33 . This appears to align with TCM theories that were developed, elaborated and applied clinically over the past two millennia.

Clinical Applications

In line with the therapeutic principle of treating both branches (biao) and root (ben) simultaneously, during the acute stage of a long-term or intermittent disorder YPFS is generally prescribed in combination with other herbs that primarily address the acute symptoms. This is an important aspect of TCM practice: that of interpreting symptomatology in terms of underlying causes (ben) against acute manifestations (biao).

In patients with underlying deficiency conditions, the overall treatment strategy is generally to address both the acute manifestations together with the underlying root during the initial phase of treatment, rather than to solely focus on the former. As YPFS is essentially a tonifying formula, it is used clinically to address the underlying factors, i.e. weakness or deficiency of the defence Qi and, partially or wholly underlying that, deficiency of the Spleen Qi.

THE NATURAL THERAPIST VOL36 NO.1 | AUTUMN 2021 | PAGE 23

ANTA Member Article Autumn 2021 In the remission stage of a chronic or intermittent condition, YPFS may be given alone, or in cases where the underling deficiency goes deeper (e.g. to include the Kidney), it may be combined with an appropriate tonifying formula (e.g. one that tonifies the Kidney).

Protocols with Prepared Chinese Herbal Medicines

Various diseases may arise as a consequence of deficient defence Qi. How YPFS may be used in these clinical scenarios is outlined below. The following protocols were developed in consultation with Dr Shu Wang34. They are given as a basic guideline – to be modified appropriately according the individual case.

Atopic Eczema

Acute stage: Yu Ping Feng San (Jade Wind-Screen Formula), a.k.a.

Defence Plus Formula + Pi Fu Bing Jie Du Fang, a.k.a. Acute Eczema Formula Remission stage, to prevent recurrence: Yu Ping Feng San (Jade Wind-Screen Formula), a.k.a.

Defence Plus Formula (1 – 3 months course)

Asthma

Acute stage (to reduce reliance on inhaled medications): Yu Ping Feng San (Jade Wind-Screen Formula), a.k.a.

Defence Plus Formula + Xuan Fei Tan Chuan Fang, a.k.a. Lung Function 1 Formula Remission stage: Yu Ping Feng San (Jade Wind-Screen Formula), a.k.a.

Defence Plus Formula + Fu Zheng Ding Chuan Fang, a.k.a. Lung Function 2 Formula

Chemotherapy Side Effects (with Low White Cell Count)

Yu Ping Feng San (Jade Wind-Screen Formula), a.k.a.

Defence Plus Formula + Bu Zhong Yi Qi Wan, a.k.a. Ginseng & Astragalus Combination – Spleen Qi deficiency OR + Zhuang Yang Yi Jing Wan, a.k.a. Epimedium & Ginseng Formula – Kidney deficiency

Hayfever

Acute stage: Yu Ping Feng San (Jade Wind-Screen Formula), a.k.a.

Defence Plus Formula + Bi Min Gan Wan, a.k.a. Magnolia & Scute Formula, OR + Bi Min Gan Te Xiao Fang, a.k.a. Hayfever Formula Pre-season preventative treatment: Yu Ping Feng San (Jade Wind-Screen Formula), a.k.a.

Defence Plus Formula (1 – 3 months course)

Mouth Ulcers

Yu Ping Feng San (Jade Wind-Screen Formula), a.k.a.

Defence Plus Formula + Zhi Yin Gan Lu Yin, a.ka. Rehmannia & Asparagus Formula

Anxiety with Excessive Sweating

Yu Ping Feng San (Jade Wind-Screen Formula), a.k.a.

Defence Plus Formula + Gan Mai Da Zao Wan - Jia Wei, a.k.a. Wheat & Jujube Combination

Recurrent Middle Ear Infections in Children

Yu Ping Feng San (Jade Wind-Screen Formula), a.k.a.

Defence Plus Formula + Xiao Chai Hu Wan, a.k.a. Minor Bupleurum Formula + Si Miao Yong An Wan, a.k.a. Lonicera & Scrophularia Formula

Sinusitis (Chronic or Recurrent), Remission Stage Yu Ping Feng San (Jade Wind-Screen Formula), a.k.a.

Defence Plus Formula + Xin Yi San, a.k.a. Magnolia Flower Formula

Urinary Tract Infections, Recurrent

Yu Ping Feng San (Jade Wind-Screen Formula), a.k.a.

Defence Plus Formula + Ba Zhen Tong Lin Fang, a.k.a. Uro-Clear Formula

Chronic Bronchitis

Remission stage: Yu Ping Feng San (Jade Wind-Screen Formula), a.k.a.

Defence Plus Formula + Fu Zheng Ding Chuan Fang, a.k.a. Lung Function 2 Formula

For references log into your ANTA Member Centre > The Natural Therapist > Journal Articles PAGE 24 | AUTUMN 2021 | THE NATURAL THERAPIST VOL36 NO.1

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ANTA Member Article Autumn 2021

George Thouas, PhD

Head of Research & Development Max Biocare Pty Ltd

A Combination Herbal Formula for Menopause Symptoms: Outcomes of a Clinical Trial Introduction

Menopause is a naturally occurring process in women approaching their early 50’s, indicated by the cessation of monthly cycles for at least 12 months. Most women experience varying degrees and forms of physical and/ or psychological symptoms during this time, caused by declines in the processes of the body that depend on the reproductive hormones, particularly estradiol.

Herbal medicines have provided a valuable alternative to conventional treatments for these symptoms1. This article highlights the outcomes of a recent clinical trial of a combination herbal extract, produced in Australia, involving a sample of Thai women with menopause.

Study Design

The study, published by Rattanatantikul and colleagues (2020)2 in the Journal of Dietary Supplements presents the outcomes of a randomised, placebo-controlled trial of a commercially available combination of dry extracts of soy isoflavones, black cohosh, chasteberry and evening primrose oil. The study was conducted at the Dhurakij Pundit University College of Integrative Medicine and Women’s Center, and VitalLife Scientific Wellness Center,

Bumrungrad International Hospital, Bangkok, Thailand.

It involved a group of 110 women (45-60 years) who were randomly allocated to take either the intervention tablet product, or a placebo (soybean oil) tablet once daily for a period of 12 weeks. Menopause symptoms were assessed before and after the trial based on responses to the standardised menopausal rating scale (MRS), and safety assessments were monitored throughout the trial period based on vital signs and blood sample analyses of liver, kidney, cardiovascular, endocrine and inflammatory status.

Outcomes

A compliance rate of 98% suggested that the test product was very well tolerated. Blood levels of estradiol were consistently low (5-7pg/ml), with elevated Luteinizing Hormone (LH) (~20 mIU/ml) and Follicle-Stimulating Hormone (FSH) (~60mIU/ml) across both placebo and test groups, which is typical of a post-menopausal hormone profile. Significant decreases were observed within the treatment group for Low-Density Lipoprotein (LDL)cholesterol, triglycerides and the C-reactive protein inflammatory marker (Figure 1), indicating a beneficial THE NATURAL THERAPIST VOL36 NO.1 | AUTUMN 2021 | PAGE 27

ANTA Member Article Autumn 2021 effect on some important indicators of cardiovascular status. This result was promising, considering these are common risk factors for cardiovascular disease in menopausal women3.

Amongst the menopausal symptoms that were assessed, the most significant improvements were observed

Figure 1:

as declines in the occurrence of severe hot flushes or sweating (~40%); sleep disturbances (~30%); depressed mood (~30%); irritability (~30%) and vaginal dryness (~20%), in comparison to all other cases (Figure 2).

There were no statistically significant changes in heart discomfort, joint or muscular discomfort, anxiety, exhaustion, sexual problems or bladder problems. Overall, there were no significant changes across the trial period in vital signs (blood pressure, pulse, Body Mass Index (BMI)),

Figure 2:

Figure 1. Treatment with the herbal test product resulted in progressive declines in serum LDL-cholesterol, triglycerides and C-reactive protein (hsCRP) at week 6 and 12, relative to baseline. No corresponding changes were observed in the control group at the same time points.

PAGE 28 | AUTUMN 2021 | THE NATURAL THERAPIST VOL36 NO.1

ANTA Member Article Autumn 2021

liver or kidney dysfunction indicators, suggesting the product was safe during the time of administration.

LDL-cholesterol and vaginal cytology7. Cardiovascular benefits have also been observed previously for soy isoflavones on their own8. The main actives in soy isoflavones and black cohosh (phytoestrogens) are not hormones, but structurally similar to them, and are known to stimulate estrogen receptors and their signaling pathways9, thus mimicking the effects of estradiol even when circulating levels are diminished. This includes effects in non-reproductive tissues, such as the skin, musculoskeletal and connective tissues, that normally rely on estradiol for repair and regeneration. As a corollary to the present study, a second series of analyses was performed on facial skin profiles in the same sample of women (results not yet published). Overall, the results suggest herbal medicines in combination retain their potency and diversity of effects when acting in synergy, and have additional benefits on general health and wellbeing, beyond their known effects on menopausal symptoms.

Implications of the Study

Conclusion

Figure 2. Treatment with the herbal test product resulted in decreased incidence of severe hot flushes, sleep disturbances, vaginal dryness, depressed mood and irritability. No corresponding changes were observed in the control group for the same time-points.

These results demonstrate that supplementation with the commercial herbal preparation was safe, well-tolerated and beneficial for several menopause symptoms and cardiovascular risk indicators. These results agree with previously reported improvements following intake of the individual ingredients, in particular soy isoflavones4, black cohosh5 and evening primrose oil6, and agree with their known effects as naturopathically administered preparations. The SoyLife® patented isoflavone extract used in the investigational product, for example, has previously been demonstrated to result in a similar degree of improvement in hot flushes (44%), as well as improved

The present study highlights that controlled and defined extracts of medicinal herbs have measurable efficacy, with favorable safety profiles in older women. The published results also provide more support for herbal medicines as alternatives to hormone replacement, which may remain unsuitable for some women, and provides another instrument in the naturopathic toolbox.

For references log into your ANTA Member Centre > The Natural Therapist > Journal Articles

THE NATURAL THERAPIST VOL36 NO.1 | AUTUMN 2021 | PAGE 29

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THE NATURAL THERAPIST VOL36 NO.1 | AUTUMN 2021 | PAGE 33

ANTA Member Article Autumn 2021

Ashley Hillsley

GradCertSci, BMedSci, AdvDip Naturopathy Program Director of Health Sciences, Torrens University Australia

Thyroid Physiology During Pregnancy and Hypothyroidism: A Review of Current Literature Introduction

From the onset of pregnancy, the maternal thyroid undergoes physiological changes to its function. These are required to ensure a successful pregnancy and for normal offspring development to occur1. It is therefore important to note that thyroid disorders can have significant impacts on the health of both mother and fetus. Some of the adverse reproductive outcomes which may present due to maternal thyroid dysfunction can include neonatal central nervous system underdevelopment, increased prevalence of abortion, postpartum haemorrhage and gestational hypertension2. Current research has further developed on evidence accumulated from over the last two decades, to highlight the significance and impact of thyroid hormones in fetal neurodevelopment and placentation3.

Recent reviews have identified that a combination of the maternal thyroid and the developing fetal thyroid function play an essential role in pregnancy. The maternal thyroid output is most important in first trimester when significant development occurs. The fetus increases its thyroid output in the second and third trimesters4.

This significance of early pregnancy maternal thyroid function highlights the need for accurate thyroid function testing against pregnancy-based reference ranges early on in pregnancy. Early and accurate detection of the most common thyroid conditions during pregnancy is an essential step in being able to provide appropriate intervention to avoid complications in fetal development5.

PAGE 34 | AUTUMN 2021 | THE NATURAL THERAPIST VOL36 NO.1

This paper will outline the thyroid physiology changes that occur in pregnancy and play a key role in fetal development and on differentiating this output from the most common thyroid disorder, hypothyroidism.

Thyroid disorders have the second highest in prevalence of the endocrine disorders after only diabetes in women of the reproductive age6. The most common of the thyroid conditions in pregnancy which has evidence of significant impact to the fetus are the hypothyroidism disorders. Hypothyroidism can be further categorised as overt or subclinical hypothyroidism7. The epidemiology, pathophysiology of these conditions during pregnancy will be discussed in this review along with the associated significance of definitive pregnancy reference ranges to allow for measuring of the key thyroid hormones needed in the identification of thyroid disorders during pregnancy.

Overview of the Physiology of the Thyroid during Pregnancy

The Thyroid gland plays a key physiological role in the production of hormones that are essential for maintenance of the healthy adult such as regulating metabolic rate but are also critical for early brain development and somatic growth4. The thyroid gland undergoes significant changes in thyroid hormone (TH) regulation during pregnancy. During pregnancy, thyroid disorders can affect both the pregnant woman and the fetus. Research over the last 20 years shows significant evidence that maternal thyroid dysfunction

ANTA Member Article Autumn 2021 and subclinical presentations can have negative impacts on the pregnancy8. Additionally, insufficiency of TH during development may impair brain development of the fetus.

Specific clinical impacts of the lack of thyroid hormones depend on the gestational age or stage of pregnancy of the fetus affected. Extensive research has focused on the crucial role of TH on brain during neurodevelopment9.

The role of ensuring adequate iodine supply has been highlighted as essential for increased thyroid hormone production requirements during pregnancy.

Thyroid Hormone Levels

During pregnancy, there is a requirement for increased TH production. To be able to ensure normal thyroid function and supply of the fetus, between 20–50% increase in thyroxine is needed6. For this to occur adequate iodine must be present. This results in an increase demand for iodine during pregnancy and ensuring the absence of destructive autoimmune conditions of the thyroid becomes a greater focus to ensure there is no diminished function10.

Thyroid hormone production is impacted by some key changes during pregnancy. The clearance of iodine increases and serum levels of thyroxine binding globulin (TBG) increase. Importantly, an increase in the inner-ring of triiodothyronine (T3) and thyroxine (T4) deiodination by the placenta occurs11.

In normal functioning, the anterior pituitary regulates secretion of thyroid-stimulating hormone (TSH) via a negative feedback. Human chorionic gonadotropin (hCG) is increased during pregnancy and reduces the output of TSH12. Free Thyroxine (FT4) is available to both the fetus and the mother and provides the best indicator

of quantity of biologically active TH. Serum TBG does not affect the concentration of FT4 which is modulated by iodine levels. Increased TBG results in elevated first trimester T4 concentrations which decline in the second and third trimesters2.

Thyroid Hormone Maternal Supply vs Fetal Production

Thyroid hormones are supplied to the developing fetus tissues through two sources, the maternal thyroid gland and the developing fetal thyroid gland. Maternal TH supply is especially important during the first half of the pregnancy when the fetal thyroid is not yet developed.

The transfer of thyroid hormones from the maternal thyroid occurs via the placenta. Placental deiodinases regulate the amount of T4 that can pass to the fetus13.

Maturation of fetal thyroid function involves development of key structures that include the pituitary, hypothalamus and the thyroid gland and ability to secrete hormones.

The development and initiation of function in these structures is mostly completed at the 12–14 week mark. T4 and T3 can begin being detected at the 11–12 week mark in the fetal serum. At this stage TH is supplied by both mother and fetus. TSH in the first trimester has an upper reference range of 2.5mIU/L14.

Key Factors that Influence Thyroid Hormones Supply in Pregnancy As TBG is a globulin binding thyroid hormone that is modulated in part by estrogen levels, the high levels of TBG in pregnancy cause an overall higher binding of the thyroid hormones that results in less free hormones in the blood. Increased TBG leads to TSH production being

Figure 1: Thyroid Gland and the main Thyroid Hormones

THE NATURAL THERAPIST VOL36 NO.1 | AUTUMN 2021 | PAGE 35 THE NATURAL THERAPIST VOL36 NO.1 | AUTUMN 2021 | PAGE 35

ANTA Member Article Autumn 2021 stimulated and increased TH levels follow6.

Tissue levels of TH are regulated by iodothyronine deiodinases. These remove iodine from various TH molecules such as inactivating T3 into reverse T3.

There are three types of iodothyronine deiodinases which regulate supply of TH molecules in activated and inactivated forms13. The iodothyronine deiodinases purpose is to prevent the negative effects of excessive amounts of active TH molecules.

The type 1 iodothyronine deiodinase (D1) catalyses T4 to T3 conversion. D1 is less active in pregnancy which results in lower T3 concentrations in the fetus13.

The other two deiodinases are both present in the fetal brain from the seven week mark in low concentrations.

These are the type 2 deiodinase (D2) and the type 3 deiodinase (D3). D2 catalyses the T4 to T3 conversion, while D3 catalyses the T4 to T3. These are the main deiodinases present in the fetus and play a key role in maintenance of the T3 levels of the fetal brain9.

It is important to note that D3 is present as an enzymatic barrier in the placenta. D3 limits the exposure of the fetus to maternal thyroid hormones protecting the fetus from overexposure to maternal T46.

Thyroid Disorder Pathophysiology, Detection and Clinical Significance During Pregnancy Iodine Deficiency Iodine deficiency is considered a major public health issue and evidence indicates it affects two billion people worldwide, not only in extreme deficiency, but mildmoderate cases6. Iodine deficiency is noted as the main cause of preventable mental impairment. Iodine deficiency is noted as the most frequent cause of hypothyroidism in countries with factors that limit iodine intake, and it is directly linked to hypothyroxinaemia. During pregnancy, maternal iodine intake must increase by 50%6. This is as a result of the fetal iodine needs for TH production, increased maternal thyroid hormone production occurs to offset increased iodine losses15.

During iodine deficiency Thyroglobulin (Tg) is released in higher quantity into the blood, and its levels align with thyroid volume. Tg levels also increase in early pregnancy, remain static during mid-pregnancy and then increase during late pregnancy5. Tg returns to level after birth. Recent studies have reported on the potential for assessment of serum Tg level as a marker for iodine deficiency16. While the possibility of Tg in estimation of iodine status appears promising, some issues have been noted with this method. The results are influenced by age and pregnancy and have high variability within data. If it were possible to find a solution for these concerns this could prove a useful test for early identification of iodine deficiency in pregnancy in the future.

A cross-sectional study of approximately 7,000 pregnant women was able to show that high urinary iodine PAGE 36 | AUTUMN 2021 | THE NATURAL THERAPIST VOL36 NO.1

Figure 2: Late Developmental Stage of Pregnancy was an indicator for an increased risk of subclinical hypothyroidism and hypothyroxinaemia. This study demonstrates another example of potential early identification method for iodine deficiency5.

Hypothyroidism Hypothyroidism is the most prevalent disorder of the thyroid gland in pregnancy. Hypothyroidism affects around 0.3–0.5% of pregnant women17. Overt hypothyroidism is diagnosed by TSH elevation and simultaneous hypothyroxinemia. The exception to this is in pregnancy where TSH readings of 10.0mIU/L or higher are categorised as overt hypothyroidism regardless of the FT4 levels present.

In circumstances where TSH elevation is present but with normal Thyroxine levels, this not overt hypothyroidism but rather termed subclinical hypothyroidism18. Subclinical hypothyroidism is identified when TSH exceeds the 4mIU/L reference range for first trimester19, and therefore; is significantly more common. Iodine deficiency and autoimmunity are the most common causes of both types of hypothyroidism18.

It has been well described across the literature that hypothyroidism in pregnancy can lead to significant adverse effects and cause irreversible damage to the fetus including mental underdevelopment, failure of sexual development, failure of the nervous system cells to differentiate9. There are also significant studies showing that maternal hypothyroidism can lead to psychomotor underdevelopment including significant intelligence

ANTA Member Article Autumn 2021 quotient (IQ) score reductions. When maternal TSH is greater than 6mIU/L during the second trimester, there is a four times higher risk of fetal death5.

Considerations for Reference Values for Thyroid Markers During Pregnancy

There have been numerous studies on thyroid function test parameters during pregnancy published over the last two decades20, 8. These have explored and identified the importance of some of the risk factors for the development of hypothyroidism during pregnancy. These include iodine intake, Body Mass Index (BMI), ethnicity and hCG concentrations and these provide further considerations for how to assess thyroid dysfunction4.

Ethnicity considerations encompass genetic differences, dietary variations and both environmental and cultural factors and as a result the population-based reference ranges vary around the world for TSH and T45.

Around the world several immunoanalytical systems are used for the measurement of thyroid parameters. Each of these use with significantly different reference intervals recommended by the manufacturers5. This raises the issue of quantifying an agreed TSH cut off to ensure accurate defining of thyroid dysfunction. The commonly agreed upper cut off for TSH in the first trimester has been set at 2.5mIU/L by the World Health Organisation (WHO)20.

Research has consistently demonstrated that BMI is also a determinant of thyroid function during pregnancy. Higher BMI is directly correlated to higher TSH levels with T3/ T4 variations and in early pregnancy the sharp increase in hCG levels lead to a spike in T4 levels and the result is a reduction in TSH21.

It is recommended that new trials and research be conducted that investigate further tests that can incorporate these outlined risk factors more effectively.

These factors are currently not well represented in the current test methodology22. Combining new innovative methods with the current test methods to ensure better evaluation of the development of thyroid disease in pregnancy should enable more accurate testing for

varying circumstances.

Conclusion

Appropriate identification and treatment of thyroid disorders as early as possible during gestation is essential for improving the developmental and health outcomes of the fetus. Current research and literature from the last two decades have provided significant advances in our understanding of the differences of normal physiology of the thyroid during pregnancy and in disorder states.

Thyroid disorders in pregnancy are common and they constitute a major epidemiological risk. Pregnant women with reduced thyroid function due to iodine insufficiency or thyroid autoimmunity fail to increase the thyroid hormone production significantly to meet maternal requirements and develop subclinical or overt hypothyroidism.

The most accepted way in the literature to define reference ranges for detection of disorder states is still by using population study data. There are a significant number of studies, including some as recent as 2018 testing TH levels to ensure the evidence is available for the establishment of population data driven threshold values. It must also be noted that a significant number of studies have indicated that references ranges may not be the best approach as the results can be an incorrect diagnosis if looked at in isolation without the context of the individual presentation including ethnicity and BMI. Many of the negative developmental outcomes outlined also appear to be correlated to physiological factors not measured for in the reference ranges such as hCG concentrations. Further exploration into other assessment methods to complement the reference ranges is critical with other novel tests being proposed for specific concerns such as the noted Tg assay and urinary iodine tests for iodine deficiency with a view to developing more detection methods that may provide the right mixture to indivualise tests ordered based on clinical presentation.

Further research is needed to address these concerns.

For references log into your ANTA Member Centre > The Natural Therapist > Journal Articles

Figure 3: Fetal Development Stages

THE NATURAL THERAPIST VOL36 NO.1 | AUTUMN 2021 | PAGE 37

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PAGE 38 | AUTUMN 2021 | THE NATURAL THERAPIST VOL36 NO.1

Monomethylsilanetriol (MMST): a bioavailable silicon for connective tissue support

By Samuel Peters (BHSc Naturopathy)

Silicon is an essential mineral for human health, and after iron and zinc, it is the third most abundant trace element in the human body. Silicon is found in all cells and tissues but is especially prevalent in connective tissues, such as bone, skin, cartilage, tendons and blood vessels.1 It provides a vital role in the production and elasticity of collagen, a major component of connective tissue. Silicon is needed for the formation of glycosaminoglycans, such as hyaluronic acid and chondroitin sulfate, which, together with collagen, form the extracellular matrix of connective tissue.2 As silicon levels decrease with age, supplementation with a bioavailable form of silicon may be of benefit.3

Silicon absorption and bioavailability Silicon is a common dietary component; however, dietary silicon exists in numerous chemical forms, which determines its absorption and bioavailability. Larger molecules (polymers) and colloidal forms of silicon are more poorly absorbed due to the need to be broken down into soluble single molecules (monomers) in the gastrointestinal lumen before absorption.4 Accordingly, foods that have high levels of silicon are not necessarily good sources of silicon because the absorption of the silicon species present depends on how readily they are degraded to monomeric forms in the gastrointestinal tract.5

MMST: a bioavailable form of silicon Various silicon supplements are available on the market; however, these vary in their bioavailability. Organic compounds, such as monomethylsilanetriol (MMST), address significant issues with other supplemental sources of silicon by providing a highly bioavailable source of silicon.6 MMST is a clinically trialled monomeric form of silicon. Absorption of this form of silicon (64%) is significantly higher than other supplemental forms including choline-stabilised orthosilicic acid (Ch-OSA) (17%), and colloidal anhydrous silica, silicon dioxide (silica), bamboo, and horsetail (0.5 – 1.0%).5-7 Orthosilicic acid (OSA) is the biologically active form of silicon, and

plays a role in the release of Silicon into cells. It has been found that OSA is readily released from MMST.8

Silicon in human health Silicon in nutritional amounts promotes bone and connective tissue health; and supplementation with a bioavailable form may be beneficial in individuals with a variety of connective tissue disorders. In joints, silicon is a critical component of articular cartilage and provides structural integrity by binding to glycosaminoglycans within the matrix of joints.9 In the skin, silicon is required for synthesis and cross-linking of collagen fibres, which is important for improving skin strength and elasticity and cross-linking of glycosaminoglycans, which attracts and maintains water in the skin. Silicon helps to slow skin aging, and also brings strength and resistance to hair and nails.10 Silicon is an important initiator of bone mineralisation and facilitates the deposit of calcium and other minerals into bone tissue.1 It inhibits osteoclast-mediated bone resorption and bone loss. Increased intake of bioavailable silicon has been associated with increased bone mineral density.11 Silicon supplementation in animals and humans has been shown to increase bone mineral density and improve bone strength.1 Silicon promotes the synthesis of collagen and elastin fibres, which are a significant component of the connective tissue of blood vessels, such as arteries, and supplementation has been shown to prevent the formation of atherosclerotic plaques in preclinical stuides.12,13 For further clinical support, see BioMedica’s technical sheet ‘Silicon absorption and bioavailability – an essential clinical consideration’ at biomedica.com.au References available on request

BioMedica Nutraceuticals P 1300 884 702 | www.biomedica.com.au

THE NATURAL THERAPIST VOL36 NO.1 | AUTUMN 2021 | PAGE 39

ANTA Member Article Autumn 2021

Elizabeth Greenwood

ANTA National President Master of Herbal Medicine, Naturopath & Aromatherapist

Western Energetics: Humoral Theory in Practice Humoral Theory is the Western Herbal Medicine version of Traditional Chinese Medicine (TCM) and Ayurvedic Medicine theories. There are parallels between Humoral Theory and other energetic models, which are interesting to observe and practice. In this article I will detail certain aspects of Humoral Theory that practitioners can relate to, or use in professional practice. I am passionate about keeping this traditional knowledge as part of our modern natural healthcare practice. Many western natural health practitioners have an interest in western energetics, or have heard of it, but might not have a working knowledge of how this knowledge can add to an existing modality to enhance clinical practice and improve patient outcomes.

Humoral Theory was the dominant medical paradigm in the West in the time of Hippocrates and Galen. This was well before they started looking at the body a bit more closely through the reductionist model. Before they started seeing that this bone was connected to that bone, that there was a nervous system and identifying how the muscles all connected together, the study of the humors was what physicians used in their practice to effectively treat people.

Humoral Theory primarily focuses on four types of fluid in the body. It incorporates influences from diet, lifestyle, seasons, nutrition and herbal medicines as well as an individual’s attitudes and emotions. All these factors create a truly holistic approach to treatment. Lifestyle activities and dietary practices were seen to have a very important impact on the body. Today, there is a large PAGE 40 | AUTUMN 2021 | THE NATURAL THERAPIST VOL36 NO.1

focus on the physical attributes of disease presentations.

Natural health practitioners still consider the emotional and mental, but the physical approach to disease mechanisms garners more attention and validation than emotional or mental approaches. In Humoral Theory the mental, physical and emotional aspects of a person’s health are just as important as each other.

Naturopaths often look towards Eastern medicine to give us those energetic answers we seek, when they also occur within traditional Western medicine. Humoral Theory is not well understood today, perhaps because in the West the science paradigm prevailed, whereas in Eastern medicine, the traditional approach survived our pharmaceutical revolution. Ayurveda and TCM are holistic energetic models that survived the test of time, whereas western energetics got phased out and fell into disrepute.

However, there is a growing interest in this model of energetic understandings. Strong parallels between Humoral Theory, TCM and Ayurveda do exist, but they don’t match exactly. For example, one difference is in the naming and understanding of the elements.

The essence of Humoral Theory is the humors (fluids) and temperaments (constitutions). Practitioners saw a person’s body through the humoral lens as ‘a big bag of fluid’. What happens when you get sick, when you get unwell? Fluid comes out! They saw that health was a matter of balancing these fluids – Blood, Yellow Bile, Black Bile and Phlegm. For example, when a person has a cold, an excess of phlegm (cold and wet) is produced, so you

ANTA Member Article Autumn 2021 would have to balance that excess phlegm with hot and dry. If you had intestinal upset, you might be vomiting or you might have diarrhoea and an imbalance of fluid there as well, which would be the yellow bile (hot and dry).

Every person is made up of all these four humors that can vary in predominance depending on many factors including constitution, lifestyle and dietary habits. Here I will detail the most common characteristics and patient management tips that I can offer based on my own clinical practice when looking through the humoral lens.

Choleric: Yellow Bile

Yellow bile is the humor and is related to the element of fire, which is characterised by hot and dry. Yellow bile is also known as the Choleric temperament.

The Choleric person is one who is predominant in the yellow bile, which is basically the digestive bile within the body, related to the organs of the liver and the gall bladder. They are known as an unstable extrovert.

Choleric is the element of fire and these people tend to run hot - hot to trot. Even in winter, they can be found in shorts and a t-shirt. They have got the natural heat of radiant fire in their body, mind and emotions. A Cholerics facial features tend to be quite sharp, with strong jaws, sharp noses and piercing eyes that look straight through you. They tend to be active sporty types and naturally feel a need to exercise to burn up their fire energy. They are quite competitive and so sport is a good outlet for them.

They’re not so much a team player, and are more likely to be found in marathons and triathlons.

Cholerics are extremely motivated. They’re your A-type personality. Prone to extremes, they don’t do things by halves. Cholerics are the movers and shakers in society, these are the people who get things going. If you want to organise a rally or create a change in society, you can motivate a Choleric and they’ll make it happen. They’re the fearless leaders and don’t really focus on details, they’re more big picture kinds of people. Imagine how you would treat these kinds of people in your clinic – ideally you would give them a very comprehensive treatment plan and don’t hold back on the big goals. Give them as many treatment goals as they need, because these people are goal driven and work best when they are in action.

Keep in mind, this is the fire element, any imbalances that are inflammatory, or ‘hot’ in nature, will often present. Any inflammations, redness, heat, burning hot pain sensations will be the Choleric humor. Digestive conditions such as overactive digestion and heartburn are classic. If it’s got the word ‘burn’ in it, its fire! Headaches and migraines can frequently occur because excess heat rises up into the head. A classic sign can be that Cholerics always seem to get hot at night, so they sleep with one leg outside of the covers or with the covers off entirely.

Cholerics don’t usually visit you in clinic unless they’re really unwell. They’re not likely to seek out help for

general maintenance, like a Sanguine or Phlegmatic would. They’ll just keep going. They’re most likely to come and see you when it’s for menopause, heartburn or gastrointestinal disorders, or they’ve been told to come and see you by a frustrated partner. You might also see them in adrenal burnout because as a type A personality, they can push themselves too hard.

Cholerics tend to have a yellow tinge to their stools.

What we’re looking at, through Humoral Theory, is trying to understand the nature of the fluids and their interactions in the body rather than pinpoint different disease states into a humor box. Some disease symptoms are characteristic, but you can have an imbalance of a few different fluids causing a disease state. For example, hot flushes in menopause is typical of an increased Choleric humor and acute Rheumatoid arthritis is characteristic of a hot, burning Choleric natured condition.

Cholerics tend to favour hot spicy foods, which is not ideal as it heats them up even more. Moderation is not a strong suit for them. They love that motivated feeling, and thrive on to that fire energy to motivate and inspire them. Gently introducing salads and leafy greens will help to cool them down and alkalise their body if they are out of balance. Their tendency towards gastrointestinal concerns such as reflux, diarrhoea, over acidic conditions, or inflammatory states can be tempered through substances with cold and wet energetics. Even though they do better on salads, they would never survive on salad alone. They have so much digestive fire that they need to eat constantly and need high protein sources.

They often wake up hungry, and I joke that if they’re not found running around somewhere, they’re hungry or eating more fuel!

Sanguine: Blood

Traditional text often say that a Sanguine personality is the temperament that everybody wants to be. They’re outgoing, optimistic, extroverted, a can-do positive kind THE NATURAL THERAPIST VOL36 NO.1 | AUTUMN 2021 | PAGE 41

ANTA Member Article Autumn 2021 of person. Sanguine is the blood humor, the air element, and are characterised by hot and wet energetics.

When in balance a Sanguine is cheerful and exudes enthusiasm. They have thick luscious hair, an acorn shaped head and an elegant swan-like neck, as written in the older text. They tend to be very optimistic, pleasant, spontaneous, they enjoy dinner parties, or parties in general, and they’re known as a stable extrovert. They have this child-like sense of enthusiasm about them.

Sanguines volunteer for jobs because of this boundless enthusiasm they have. They tend to take on too much and get overwhelmed quite easily. They find it hard to say no as they like to help people. A classic thing that you find a Sanguine will do, is that when they’re talking to you, they will physically hold onto you to engage your attention. They are naturally engaging story tellers, but when they’re out of balance, they get a little bit egotistical and they demand the room give them attention, even if they have told the story before!

Sanguines often have a sense of community and a sense of belonging, bringing groups together. Sanguines are here for a good time and like their fine foods and fine wine and to feel special. Because they tend to eat a lot of these fine foods, fine wines and all sorts of MasterChef style creations, they can suffer from toxicity and congestion in their blood. Traditionally, they called it dirty blood, where the blood would become congested and full of toxins unable to be excreted, therefore impacting the health of the whole body and optimal functioning of the cells. Therefore, Sanguines tend towards high cholesterol and gout presentations. The blood humor is a very important fluid to help to bring nutrients and oxygen to areas and remove toxins, but if the blood is ‘toxic’ and congested, then it cannot communicate and feedback its needs effectively. Much like the mind and emotions of the Sanguine! We then look towards traditional herbal actions such as alteratives and depuratives, the blood cleansers.

Sanguines do best on a predominant plant-based diet. It’s not to say that they should avoid meat, but the trouble comes when they eat meat to excess. They can be seen with a red beefy tongue, as they are hot and wet, which is also known as hot and damp.

Whenever you have a patient who might have blood disorders, for example heavy menstrual bleeding, irregular menstrual bleeding, or high/low blood pressure, look to blood excess or deficiency.

Today, natural health may too often focus on which part of the liver is required to enhance detoxification, when in some situations, we really should take a few steps back and look at the blood. Does the person present with fatigue, do they present with signs of toxicity such as fatigue, pallor and impaired functioning of hormonal feedback mechanisms? When was the last time you put somebody on a good detoxification program that was focused on the blood instead of primarily on the liver?

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Sanguines do very well on an occasional good old green leafy juice detox.

When I was studying, holistic detoxification of the blood was a very important aspect of most treatments and it’s interesting to see that over the past twenty years that it’s not utilised as much as it used to be. I think the resurgence in popularity of celery juicing is a prime example of the inherent need to clean the blood. If you can clean the blood you basically clean the whole body.

One of the main benefits of understanding Humoral Theory is to improve patient management and therefore outcomes. When you’re treating a Sanguine type person, know they are motivated by optimism and enthusiasm.

They like to feel like the treatment plan that you’re giving them is going to be somewhat fun.

Phlegmatic: Phlegm

Now to the water element and the Phlegmatic temperament which is characterised by wet and cold. It is the phlegm humor or fluid. Phlegm is not just phlegm as you know it, which is mucus, it’s actually the plasma and the lymph and interstitial fluids, all the clear fluids throughout the body. It is the cerebrospinal fluid and the synovial fluid between the joints. When a person has dry, cracking joints, that’s a sign the phlegmatic fluid has been decreased. The primary purpose of these clear fluids in the body is to help to detoxify and hydrate. They help to keep the body moving, albeit slowly, as it is a very slow-moving fluid. The phlegm fluid is nourishing, hydrating and cool.

Phlegmatic people also move slowly. They’re methodical in their approach to life. Phlegmatics are willing to take their time. They tend towards overweight or underactive metabolic conditions because their natural state is to move slowly. Phlegmatics are happy to listen to others and go with the flow. They’re known as a stable introvert, so they might not mind the isolation so much as their natural state is introversion, so they’re happy at home or with their creature comforts. They love their routine so much so that they might have had the same routine for years. It’s a challenge for them to be spontaneous.

If you’re treating someone who is predominantly Phlegmatic, because they tend to move slowly and they’re

ANTA Member Article Autumn 2021

Melancholic: Black Bile

Last, but not least, is our Melancholic. The word Melancholic tends to receive an apprehensive response from today’s Choleric and Sanguine driven society.

Melancholics are the black bile humor and the Earth element, characterised by cold and dry energetics.

Black bile can be challenging to describe as a fluid compared to the other humors. It’s a cold, dry, thick and heavy fluid. When the body slows down and may become stagnant, that is when the black bile occurs. It is also described as left-over toxins from metabolism, or stale blood that has not been eliminated, such as the ‘chocolate cysts’ in endometriosis.

not in a rush and they’ve got their routine, they don’t like making too many changes at once. They tend to only like to make one change at a time. If you give them too much to do at once, they’ll just get overwhelmed and they won’t do any of it. Phlegmatic practitioners will do best to remember that making one change at a time is unique to this constitution.

Phlegmatics are very family orientated, they cherish their long-term friends and are good natured. They’re benevolent and religious. They can be spiritual but they tend to like the routine of organised religion. They are very compassionate and make great practitioners, because they’re patient, methodical and very caring and extremely empathic.

As the Phlegm fluid is cold and wet it cools down excess fire in the body. Phlegmatics might gain weight because of their tendency to slower metabolism. They often present with hypothyroidism or systemic congestion, particularly lymphatic or respiratory congestion. They need to keep moving and even if it’s slowly, just keep them moving. They feel worse by cold and wet foods, which are classically dairy and wheat. Most Phlegmatics don’t eat dairy because they correlate the negative effects of doing so at such a young age. You can tell a Phlegmatic tendency in iridology with the presence of a lymphatic rosary. They may also have a thick greasy coating on the tongue.

Melancholics are known as unstable introverts. They can be quite highly strung, often moody and prone to depression and nervous anxiety. This is because they are quite deep thinkers and natural philosophers. They like to discuss the ways of the world and figure out how things work, whether that be the pharmacokinetics of micro nutrients or analysing the delicate interplay of political conflicts. Melancholics like to analyse, then analyse their analysis.

They are also practical and realistic, and largely quite creative people. It is important for a Melancholic to tap into their creative side because they’re very philosophical people and require an outlet for all those thoughts.

Melancholics often have an eclectic library of books and enjoy collecting information.

When they present in clinic, it’s common to see them stressed, depressed, anxious, exhausted with insomnia and perhaps some unhealthy habits that have become coping mechanisms. They tend to drink a lot of coffee or tea, stay up late at night, may smoke cigarettes and drink alcohol and have a penchant towards escapism.

These are people who don’t eat when they’re anxious, thinking, or working on a creative project. They tend to skip meals and can end up with nutritional deficiencies.

Because they are cold and dry, often warm soups and slow cooked meals can help to balance this, as well as getting many needed nutrients into them in an easy to digest form.

If you are a Phlegmatic practitioner, because you’re naturally caring, make sure that you set your boundaries in practice. I recommend to not take on too many patients and at the end of the day have a bit of a routine after clinic to highlight those physical and energetic boundaries.

Ideally involving water, which is your element, such as a shower, swim or your favourite room cleansing spritz!

THE NATURAL THERAPIST VOL36 NO.1 | AUTUMN 2021 | PAGE 43

ANTA Member Article Autumn 2021 The ideal way to treat a predominant Melancholic person is by understanding their philosophical nature. They love to learn how and why things work, particularly the recommended remedies. A Melancholic will follow your treatment plan if they know ‘the why’. So, give them reading material. Melancholics are the ones you give the whole clinical paper to. You don’t need to break it down into bite sized chunks so they can understand it, you just give them the whole study that highlights this herb works on this mechanism for this and they will read that and then take the remedy as directed.

Melancholics love discussing philosophical ideas and sitting drinking coffee with friends for hours discussing the state of the world. However, it is really important for them to actually do something about it. Otherwise, they can get stagnant and disillusioned with that cold and dry nature. Once they have figured out a solution, they need to go and talk to a Choleric and inspire them into creating the action!

Balancing Constitution

Every person is a combination of all four humors; yet may be predominant in one over another. The humors are fluids and as such their very nature means they inter-relate, so by balancing one, you can affect the balance of them all.

We can correlate the humors with disease states, but rather we are observing the ‘nature’ of the disease in the body. We’re actually looking at the movement of the disease rather than the disease itself. What we’re doing is asking what is the nature of that disease? How does that disease move through the body? And, how does it present in this particular individual?

For example, Choleric (hot and dry) is the opposite to Phlegmatic (cold and wet). Hot and cold are at the opposite ends, as is dry and wet. By understanding the varying nature of these energetics, we can begin to balance the humors. Furthermore, with knowledge of

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the energetics of herbs and foods, we can match the energetics of the remedy to the presentation of the humor, keeping in mind that this is fluid and can change between consultations. This is the art of clinical practice, the ability to critically evaluate the patient and the herbs and match them to the energetics while supporting your choice of treatment with pharmacological evidence.

There are many aspects to consider with this huge topic of Humoral Theory. Here, I have covered the most characteristic elements and telling personality traits for each temperament. We are yet to cover the physical characteristics, the deeper understanding and presentations of humors and imbalances, how to treat specific disease states and the foods, habits, seasons and the pharmacology and plant chemistry that matches each temperament.

As a classic Sanguine myself, with a secondary Melancholic tendency, I am known for creating fun, informative, educational experiences backed by well thought out theories and levels of evidence. If you would like to learn more about how to apply Humoral Theory in your practice, join me in a brand new and comprehensive interactive online course. In this course, we will go into each of the temperaments in more detail, look at treatments and review some case studies through the humoral lens. You will have access to weekly video tutorials, a practitioner discussion forum, regular support from myself and much more! For more information, please visit www.holisticstudio.com.au

For references log into your ANTA Member Centre > The Natural Therapist > Journal Articles

ANTA Member Article Autumn 2021

Kaitlin Edin

Acupuncturist | Eastern Herbal Medicine Chinese Medicine Practitioner National Acupuncture Branch Chair - ANTA

Heart Shock: Violations of the Jing Shen Heart Shock, another word for trauma, is a term first coined by Dr John Shen and refers to ‘the systematic instability resulting from trauma and its sequela’ 1. The term is used not because it only affects the heart organ, but rather because the heart, recognised as the supreme authority, ‘the Emperor’ within Chinese medical thinking, is the organ that holds and symbolises the sovereign nature of the person.

For Chinese medicine practitioners ‘[t]here is no difference between the heart which moves towards authenticity, while remaining more and more rooted, and the heart which spreads the blood into the limbs and pushes them to move spontaneously and appropriately. This visible continuity between the body (which has form) and the spirit (which is formless) is assured in and by the heart’ 2.

From the perspective of Eastern medicine ‘all these aspects of the heart inter-communicate, cross-refer and inter-relate. The psychological, physiological, intellectual, and spiritual interact’ 2.

Before we get to Shock though, what do we really know of the heart?

We know it in common parlance across cultures and language mostly through the power of symbolism, and in more mechanistic or linear ways. We use the concept of the heart to refer to things as varied as heartburn and cardiac problems, to be in love or to be in despair, to be exsanguinating ourselves for a cause or to feel there is no kindness and warmth, to be at the centre of things or to be uninterested and unmoved. When we know something by it, wear it on our sleeve, or have had it assaulted or temporarily stopped from fright or grief, it is the deep wellspring of our own experience that we are speaking of.

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And even as we speak of the heart, we cannot help but also speak and consider the blood. Indeed, they go together as a bonded pair, (heart and blood, blood and qi), and like all successful love stories when we talk of one, we are also talking of and considering the other.

But the heart, what do we know of the heart?

From the classics, we are told that the heart contains and is the residence of the Shen, what we might call the spirit.

The Shen is that aspect of our existence that captures the light of ‘heaven’, that internal sun of insight, clarity, and divinity which manifests as the best and highest in and of ourselves. It can be best expressed as coherence.

The Taoist perspective reminds us that the heart as the most important organ of the body both expresses the shape of this energetic force (the Shen) and implements its frequencies and designs, together with the jing and the blood, to create the curriculum of our lives3. As sovereign ruler, the heart embodies the sacred dynamics of enriching the blood with this spirit, and then circulating it, through the networks of the vessels.

With modernity, we have simultaneously had our deeper visions clipped with the rejection of the metaphorical and poetic language of the classics by science and its exactness and been given by that same method and framework the capacity to test and validate the ancient wisdom.

With the embrace of Newtonian science, we have been led in medical learning to accept the reductionist and linear ways of thinking about the heart as merely a mechanical pump. It is often miscorrelated by instructors to a steam engine that provides motive force to water

ANTA Member Article Autumn 2021 which is then passively moved around the system by the engine’s mechanism4. The heart is no steam engine and the blood no passive force.

‘While the most powerful ventricle of the heart can shoot water six feet into the air, the amount of pressure actually needed to force the blood through the entire length of the body’s blood vessels (some sixty thousand miles of it…yes that’s correct, sixty thousand miles), it would have to be able to lift a one hundred pound weight one mile high…. it is simply incapable of producing the pressure [all by itself] to circulate the blood’4.

‘In 1932, Bremer of Harvard filmed the blood in the very early embryo circulating in self-propelled mode in spiralling streams before the heart was functioning….so impressed with the spiralling nature of the blood flow pattern, … he failed to realise that the phenomena before him had demolished the pressure propulsion principle’5.

In 1995 Ralph Marinelli and others5, evidenced the heart is not a pump and finally refuted the pressure propulsion principle that had been taught to so many. ‘The blood is not propelled by pressure, but rather moves with its own biological momentum and with its own intrinsic flow pattern’5.

come from if not ‘heaven’?

It has its own momentum, and we now know the blood also carries pulse waves as well as electrical messages and impulses through the body. This moment of rhythm in the blood is the very beginnings of human life. The blood is the source of movement and ‘[t]he rhythm of the beating of the heart echoes, or rather expresses and implements, the primordial rhythm, the yin yang alternation which starts the process of giving life to each being’ 2.

‘Within a day of gastrulation, the embryonic heart begins to beat and creates blood flow in the developing cardiovascular system…the onset of blood flow is of primary importance to vascular development’6.

‘Gastrulation is the process during embryonic development that changes the embryo from a blastula with a single layer of cells to a gastrula containing multiple layers of cells’7. Days before that there is the impetus of genes and cellular energy, the process that will coalesce into a being. This inherent biological momentum in the blood flow is life’s yearning for itself. The poets always know and express more beautifully, more accessibly what science confirms for us: ‘Your children are not your children.

They are the sons and daughters of Life’s longing for itself.

They come through you but not from you, And though they are with you yet they belong not to you’8.

With the bright light of modern science, we can know the realities that the post-natal ‘heart constantly monitors the blood through sensitive receptors embedded throughout the heart and arterial tree, and alters its functioning constantly to make subtle, second-to-second shifts in the flow of blood’4. The heart generates pressure waves but also synchronises and stabilises the intricate pressure waves coming from the blood and the organs. It facilitates an exquisitely timed dialogue and facilitates the oxygen of the blood to affect and reach every cell in the body.

It is a primary endocrine gland and ‘the most powerful biological electromagnetic oscillator in the body’4. The other electromagnetic fields are created by the brain and the gastrointestinal tract.

Further observations of animal embryos showed that ‘blood begins to move in regular circulating patterns before the heart has developed sufficiently to begin pumping it’4. The flow of blood is composed of two or three streams, which spiral around each other in the direction of flow, creating as they go something a little like a double helix, and at the centre of these spiralling streams is nothing, or rather a vacuum4. ‘The blood has its own form, the vortex, which determines rather than conforms to the shape of the vascular lumen and circulates in the embryo with its own inherent biological momentum...’5.

The murmurings of my questing mind reach for the ancient tongue of the classics; where does ‘this inherent biological momentum’

As a receptor organ, the heart processes not only the information from within but also the impacts of the external environment upon the body. By constantly monitoring the flow of blood, synchronising its own rhythms, waves, pulsations, and electrical output, it shifts the temperature, hormonal functioning, and neurochemical output4. It’s awe-inspiring to realise how subtle the role of the physiological heart is, how calibrated the heart and vessels are to each other, how everything is monitored moment by moment.

If we all had a greater sense of this, perhaps we might slow down or be more mindful, we might think twice before we uttered unkind words to ourselves or others.

For all the emotions are felt by the heart, and as internally THE NATURAL THERAPIST VOL36 NO.1 | AUTUMN 2021 | PAGE 47

ANTA Member Article Autumn 2021 generated responses to our environment, they too are being calibrated and processed and monitored by the heart, moment by moment.

(especially if painful), but also sites where the meridians have been cut or interrupted and the flow without them changed.

‘Both the heart and arteries move spirally, actually twist, as they work to enhance this spiral motion of the blood… This kind of spiralling in the heart and vessel tissues enhances the flow’4. Once we recognise just how extraordinary the action of the heart is, but also how much the blood is a living, moving source that has a partnership and conversation with the vessels, there evolves within us a more embodied awareness of how the impacts of shock and trauma are rendered.

We must remember that whiplash and the scars of injuries or surgeries don’t only affect the physical body.

Physically upsetting, or invasive events may also have a significant emotional impact.

As the beautifully lyrical Phoebe Bridgers (2017)9 reminds us ‘I have emotional motion sickness Somebody roll the windows down There are no words in the English language I could scream to drown you out…

I have emotional motion sickness I try to stay clean and live without And I want to know what would happen If I surrender to the sound’ Systemic instability is the impact that profound shock has on the body. It warps and turns that beautifully orchestrated movement and song of the ever-present, neutral surveillance of the conductor, our ‘classical Emperor’ into a discordant static, with the tension in the strings all wrong. What was once coherent begins to disassemble. And moving away from authenticity, from the original nature of the sovereign, dysregulation commences and life begins incrementally to unwind.

The resources of the blood and oxygen get reallocated, eventually exhausted until the inherent biological momentum, the spirit of the blood is unable to bear the weight of memory and fades.

The reallocations show in the tensions of the pulse, the irregular or ectopic beating of the heart, the catch of the breath, the disorganisation of the hormones and neurotransmitters, the intensities of the emotions, or the forever shifting moods, the disordered sleep patterns, the driving, unrelenting aching of the hands or feet, head, back or neck, the tendency to obsessive thinking, becoming easily flustered, or fatigued.

We hardly need to ask what causes Heart Shock. Fright, fear, threat, stress, and emotional disconnection, whether it be low level chronic or acute and traumatic, and the compounding and compressing sequela of each.

Some are physical, like car accidents, surgeries or injuries.

The physical trauma, of, say a car accident where there has been whiplash will produce physical symptoms in the soft tissue. It is very important to treat this in the first instance as shock. The scars of surgeries or sports injuries are also important to recognise as possible sites of not only latent infection at the deeper levels of the soft tissue PAGE 48 | AUTUMN 2021 | THE NATURAL THERAPIST VOL36 NO.1

The kinds of Heart Shock can be many and varied, and thankfully ‘not all shocks are created equal’ 1. How we determine which require more attention than others is partly led by the narrative of the patient themselves and partly from experience10. Clinical experience has at its heart the increasingly sophisticated ability to read the ways the body and spirit lose coherence with each other and to treat it accordingly.

Other kinds of traumas that impact the nervous system can be familial, intergenerational, cultural, religious, gendered, or national. (For a helpful discussion on meditation and trauma, see Rupert Spira, Trauma is the Trace Left on the Bodymind, 2019)11. Of course, it is an individual’s body-mind upon which these traces of shock are etched, so it is personal to a degree. But it doesn’t have to have happened to us for the ripples to still be felt. There may be narrative memories continued through families, or suppression of narratives, a silence that creates another kind of dynamic or there may be no access to the memory of events.

The trauma of colonisation, of dispossession, and/or intergenerational disenfranchisement for example, all of these are within the psyche of an individual and their family who have experienced them. Their existence may be ubiquitous in our upbringing, or we are so normalised to their existence that we are unable to recognise them without particular challenges or perception shifts. The effects of these traumas may or may not be manifest in the social context but will be laid down in the jing of a person, deep in the yuan qi.

ANTA Member Article Autumn 2021 In my own family of origin, the remarkable but deeply traumatic story of one of my female ancestors, a woman who lived over 200 years ago is still current in the family narrative. As a child of two, she was witness not only to the massacre, mutilation, and cannibalism of more than 70 people, but the death of her own mother. She was one of only four people to survive the ordeal. It is in part because her survival, and later flourishing, as well as her being a person of means that my family knows anything of it, and with time and generations, the impact of that particular shock lessened. Of her 17 children, many died too young, her grandchildren too. Her great-grandchildren were more fortunate, and now among the later generations the impact is hardly visible. It is nevertheless a story around which our lives as even far-flung family members seem to subtly orbit. By knowing the story, we know something of ourselves and in the retelling, we reassert ourselves.

Damage done during delivery can include what would be considered natural causes of ‘prolonged labour, improper positioning of the fetus [including breech presentations], excessively narrow outlet, deformation of the placenta, a weak uterus or a variety of problems with the umbilical cord’ 12. The result is respiration is affected by there being ‘a delay in the onset of normal respiration while at the same time, an enormous circulatory distress in the placenta’ 12. From a Chinese Medicine perspective it is called ‘qi is trapped in the Lungs’ and this may lead to a range of respiratory or allergic disorders throughout life. ‘Any impediment to the complete oxygenation of the blood will have its primary effect on the nervous system’ 12. ‘… iatrogenic factors, such as high forceps, excessive sedation, and premature induction also have profound effects on the nervous system for similar reasons as stated above’ 12.

Perhaps too it is easier looking down the short end of the telescope, to feel like its impact has less effect on our individual personhood and familial fortunes. The less brutal but still relevant traumas of those closer in, my grandparents and parents are interestingly easier to recognise and acknowledge, but simultaneously harder to manage and cope with because they seem to form the matrix of personhood and relationship. If I pull this thread will the whole fabric tear? Closer in it feels less like narrative and more like the stuff of the everyday.

Whether a birth trauma or a shock received later on in life, in our considerations around diagnosis and treatment, there are three main regions of impact seen through the Chinese medicine lens. And when we consider these three aspects, with the view to treat and evaluate, we need to keep in mind that it is less venn diagram and more like looking at a multiple exposure of different images on the same light-sensitive emulsion; a layering.

When the impact of certain violations is passed to the next generation, it might express as a genetic health issue, sometimes as a familial ‘history’ or lineage and sometimes we will only see the patterning in micro-expressions, or the vibrations of the nervous system.

Firstly, and obviously, the Heart, its circulation of, and relationship to, the blood and therefore emotional stability1. Because the Heart is said to control the mind, (well why wouldn’t it, it has a supreme capacity to monitor the blood and its movement) this instability can often be expressed in a patient’s (or one’s own) lifestyle, in disordered or chaotic emotional and mental responses, a diminished ability to organise internal and external demands.

In the classical texts and within the cultural ethos of Chinese medicine and acupuncture there is a theme that runs through everything about what makes a good practitioner a superior physician. ‘The good practitioner guards the body, the great acupuncturist guards the spirits...that the superior physician guards the spirits, means that (s)he guards the blood and qi – which are nothing other than the expression of the spirits’ 2.

Acupuncturists will often consider the impacts of Birth traumas, (and I would include circumcision under this term) as significant factors to be considered. And while the effects or impacts of these assaults to the nervous system are etched into the body, they may not be readily accessible from within the waking state memory.

The blood and qi are one of those bonded pair mentioned earlier, and while the heart and its relationship to blood is central, the role of the lung in oxygenation is also fundamental. For a fascinating and helpful understanding of how breathing techniques can be used to assist in the ongoing repair and healing of Post-Traumatic Stress Disorder (PTSD) and trauma states see the extended interview with Dr Pat Gerbarg and Dr Richard Brown (2020)13 on their explanation of the ‘Coherent Breathing’ technique.

Secondly, the nervous system has a complex set of relationships1 expressed through the paradigm of the six divisions and the view it gives us of the yang, the functional aspect of the oxygenated blood through the THE NATURAL THERAPIST VOL36 NO.1 | AUTUMN 2021 | PAGE 49

ANTA Member Article Autumn 2021 meridian systems is pretty spectacular. Of particular interest in shock states is the relationship between the Tai Yang, the Shao Yin, and the Tai Yin. Here we find the narratives of the personality, as well as what Hammer (2015)12 calls ‘the soft neurological problems’, the moods and pain states.

I should briefly point out here what is understood from a Chinese medicine perspective when we talk about the nervous system. Dr Shen’s elucidation is perhaps the best. ‘The ‘nervous system’ is simply another name for what is generally considered Tai Yang, that is, the outermost energy of the body, which in some ways might also be equated with the wei qi…the outermost defensive layer of energy’ 12. While this doesn’t conflict with the understandings of Western biological views of nerve pathways, the complex communication network of brain, spine, and hormonal axes, or the Sympathetic and Parasympathetic system functioning, it is useful to remember that much of these aspects are left to the role of the kidneys, the curious fu (of the brain and the uterus for example), and the interplay of yin and yang.

The eight extraordinary meridians engage with the deeper sources of yuan qi, (the deep memories), while the primary and sinew channels express the wei and ying level of the qi, blood, and fluids, and give a snapshot of the organ system and its current state of health.

And thirdly the kidneys, and their relationship to the brain and the hormonal responses to stress, (adrenaline, cortisol), their relationship to the Triple Burner mechanism1 (the hypothalamus and pituitary), as well as their relationship to the memory marrow holds, whether it be in the brain, the bones or DNA.

These days, (and perhaps in all days it was so), many people carry around and present in clinic with some degree of Heart Shock. Traumas can occur early or late in life, at any age and level of the individual’s development.

Although we do know through research around childhood traumas that the earlier the brain and the nervous system are exposed to profound stressors, the greater the impact is likely to be15. It is how those traumas are understood and recognised by the individual and society that may also determine the significance and burden of the impact1.

Important and considerable variables in determining how fully we suffer, whether health can be recovered and how fully we heal, include the individual constitution and the personality, whether there has been a community who has nurtured us or a single extraordinary human who deeply loved and cared for us. The social aspect of medicine (put another way the medicine of social engagement and connection) is paramount, and we continue to fracture our communities and reduce our presence and engagement with each other, to our peril. It is one of the continuing traumas of our time.

Considerations for how to treat these various shocks, traumas and sequela within an acupuncture paradigm will form the basis of the next article. We will look at the use of the ion pumping cords and some treatments to use for whiplash and nervous system tension. We will cover some classical moxa techniques and how to apply them, we will look at the role of essential oils within an acupuncture practice and look at point combinations and balances within the channel system in more depth.

I look forward to having you with me for the next instalment.

It is interesting to me that the ways we tend to speak of the Kidneys within Chinese medicine is usually without reference to the blood. If we discuss the Liver, Spleen, or Heart we are generally discussing the blood of each, in part because the relationship of those organs to the blood is more obvious. The red streams of life that hold oxygen, qi, electrical messages, and molecular information we call hormones, neurotransmitters, enzymes move with their own and the heart’s energy, responsive to inner and outer worlds and create the interface of connection and feedback. In this straightforward way, blood connects the kidneys to the brain and the heart, it can’t not.

But the role of kidneys, and particularly their management of the yuan qi and jing speak more to those aspects of being that are about survival, not only our own (which engages the nervous system) but the ability to reproduce and benefit the human species. The kidney’s role is also about enabling us to regulate interaction with the external world, and in doing so we learn more about ourselves and perhaps become clearer about the purpose of our lives. Introspection but also the connection and interaction with others and the world is the way we truly understand ourselves, and this coherence is a gift of the kidneys14.

PAGE 50 | AUTUMN 2021 | THE NATURAL THERAPIST VOL36 NO.1

untitled #6.

Vita Brevis Est 2008 George Schwarz Used with permission For more work by George Schwarz go to george-charis.net

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