Travis Cunningham MAcOM LAc
Ninety Percent of Chronic Pain Gone in One Week
“I hate to sound like a broken record,” said one of my teachers, “but a lot of her problem is due to blood stagnation.”
Dr. Greg Livingston and I were chatting before one of our herbal shifts at the school clinic. We were discussing the details of a diagnosis that one of our patients had been given on the shift the week before. Blood stagnation is the name of a pattern that we learn to identify and treat in Chinese medicine. According to the medicine, stagnant blood is the root of many illnesses. If blood doesn’t flow correctly, pain will result and various organ systems will become undernourished. Malnourishment and lack of flow will then cause other problems and lead to a whole host of diseases and bizarre symptoms.
I smiled at Greg’s remark. It was a familiar piece of advice, but one that bared repeating. Greg was one of the few westerners to go to China, learn chinese, finish a P.H.D. in Chinese medicine, and then study with various doctors who had decades of clinical experience. Greg got excellent results in the clinic. He consistently understood and could explain why he would give treatment the way that he did. He was one of the teachers that I had become closest to while in school. He is someone that I still consider a friend and mentor to this day.
“But why use the bugs Greg?” I asked after glancing at the patient’s herbal formula. “What would lead you to the conclusion that we need to break the blood?”
My question was linked to the way we learn to classify herbs as singular medicinals at school. The category in Chinese medicine that most of the insect medicinals are placed in, is called move the blood. The move the blood category has several gradients of intensity, the strongest of which is called break the blood. That is where the bug medicinals reside.
“Well,” he replied, “the bugs don’t necessarily move the blood any more intensely than Dang Gui 当归 (Angelica Sinensis) or Chuan Xiong 川芎 (Sichuan Lovage), what makes them unique is that they go to the luo mai.”
In Chinese medicine, when a person gets sick the disease is thought to go first into the main channels and collaterals of the body. These pathways are called the jing luo in Chinese. When the disease stays in the body for longer periods of time, it is thought to get into the tiny pathways and offshoots of the larger channels. These tiny pathways are referred to as the luo mai.
“Bugs get into tiny spaces, right?” he said, mimicking the movement of an insect with his hands. “So if you want to get into those tiny spaces of the body to get rid of that stubborn blood stagnation, you need the bugs.”
“Interesting” I replied.
Several weeks later, I was on a different clinical shift with one of my regular patients. This patient had had over ten surgeries on his abdomen leading to chronic abdominal pain. He had also been diagnosed with crohn’s disease, arthritis, and crohn’s-related arthritis. On a good day, his chronic pain was at a 5/10 intensity. On a bad day, it was 7 or 8/10. And it had been like this for years.
With weekly acupuncture, we had managed to get the scarring on his abdomen down “from the size of a dinner plate to the size of a salad plate,” he would say. Each week he would come in, we would needle around his abdominal scar in a technique known as “surround the dragon.” While progress was gradual, it was definite. Both the size of the scar and the local pain had decreased.
While our treatment had been somewhat effective, I wondered if there was more we could do to help him. That is when I remembered my conversation with Greg.
After convincing this patient to try a simple herbal formula that contained insect medicinals, we booked another appointed for the same time the following week.
As I went to greet the patient the next week, I could see he was smiling. When he got into the room, my patient said “Well, I think we’re on to something.”
“Oh yeah?” I replied, “How so?”
“Ninety percent of my arthritic pain has been gone since I’ve been taking the herbal formula you prescribed.”
“Ninety percent in one week?” I repeated, not fully believing my ears.
“Ninety percent in one week,” my patient confirmed.
The Use of Non-herbs in Traditional Herbal Medicine
In the Chinese herbal materia medica, there are a vast number of medicinals listed that we would not normally consider “herbs” in the english language. Some of these are mineral-based substances such as amber, hematite, pearl, and oyster shell. While others may come from (or be) insects or larger animals. In modern times, it can be difficult to conceive of why anyone would want to use animal-based materials for traditional herbal medicine. Isn’t there a plant-based alternative, we ask? In our time of cultural change and technological advancement, it seems like almost anything can be replaced by something else.
But if we look from the perspective of traditional people, we have to admit that animal products are different from plant or mineral-based ones. Animals are slightly different forms of life. They carry unique features of nature and bear a closer resemblance to humans than plants or minerals do. This uniqueness was noticed by ancient people, and those ancient people sought assistance from these animals in their medicine.
A Doctrine of Signatures
The doctrine of signatures is a common method of investigation inside many forms of traditional medicine. This principle suggests that what something looks like in nature, suggests what it has an affinity for in the body. Fro example, Walnuts appear somewhat like the human brain and so tend to promote brain function. Beats are red like blood and contain vitamins and minerals that create healthy blood. Examples of this principle are numerous and found constantly in different cultures all over the world.
It’s important to remember that the doctrine of signatures is not the end of an investigation, but the beginning. After a similarity is witnessed with a substance and the body, experimentation begins. And after experimentation has been exhaustively conducted, there is debate about the usage and function of each particular substance in a given context.
Far too often, we ascribe a kind of archaic simplicity to the reasoning of our ancestors. But the more we examine ancient people, the less foolish they appear to be. The symbols earlier humans used to describe life often have a multidimensional meaning and function. The non-specific nature of each symbol allows it to outline a broad type of experience without being constrained by particular details. This makes a symbol the perfect articulation for a kind of experience instead of an individual one. The doctrine of signatures is just one way that the natural intelligence of bodies and their environments manifests.
Worms for Wind
Worms move in a way that appears very similar to humans when we are convulsing (like in a seizure or stroke). Convulsions may come on without much warning and be chaotic in nature. This quality of movement and appearance is like wind.
Once the convulsions end, certain parts of the body may be closed down or opened inappropriately. Paralysis may ensue. The channels that the body uses to communicate information have become obstructed. This obstruction requires the influence of an agent that knows how to get into tiny places and unblock them. This is where the worms come in.
It’s Important to remember that the doctrine of signatures is a method of explaining the gesture of a medicinal and not necessarily a description of its physical action. The application of an insect medicinal takes place after the insect has died and been processed. In the case of Chinese medicine, our bug medicinals are most commonly put together with other herbs and then simmered in water to be taken in the form of a decoction or tea. In certain applications, they are charred and powdered for topical remedies but never used in live form.
The heading information for each medicinal was taken from Benskey’s Materia Medica (3rd Edition) unless otherwise stated. Please refer to this text for more detailed information.
Dì Lóng 地龙
Properties: Salty, Cold
Channels Entered: Bladder, Liver, Lung, Spleen
Functions: Drains Heat, Extinguishes Wind, Stops Spasms & Convulsions, Calms Wheezing, Unblocks the Channels, Facilitates Urination
One of my teachers in Chinese medicine school would emphasize that earthworms look a little bit like the bronchioles of the Lungs. This, he thought, gave them an affinity to deal with long-standing lung problems.
During the Spring, di long crawls through the soil and begins the aeration process for the season ahead. It’s important to note that including air, the soil is opened up for the water cycle of Spring rain. Unclogging the tight soil for air and water to flow is precisely what di long helps the human body to do; unblocking the body’s breathing and urination.
Internally, di long is most often used in post-stroke and seizure remedies to unblock the channels and help a person recover the functioning of paralyzed tissues. But di long can also be used in a variety of chronic lung problems. It makes a great combination with sang bai pi (mulberry root bark) and si gua luo (luffa) for folks who have a cough with lung weakness due to a history of suppressed lung problems (such as pneumonia during childhood).
Dosing di long does not even need to be that high! As few as three to nine grams per day is enough to make a substantial difference in a person’s case. The most common way for internal administration of this medicinal is through ingestion via decoction, powder, or pill.
Externally, di long can be ground with sugar and applied topically to treat burns and ulcerations.
Jiāng Cán 僵蚕
Latin: Bombyx Batryticatus
English: Mumified Silkworm
Properties: Acrid, Salty, Neutral
Channels Entered: Liver, Lung
Functions: Eliminates Wind, Drains Heat, Transforms Phlegm, Disperses Clumping
Jiang can is a white silkworm in its cocooned stage. Not only does the silkworm move in a similar fashion to the earthworm (like convulsions or wind), but the processing involved in preparing this medicinal for use includes stopping its growth or life by wind. Because this medicinal has been mummified by wind itself, it has an extra affinity for treating disorders that appear wind-like in the human body.
Internally, jiang can is often combined with di long to treat post-stoke and seizure disorders. It can be combined with other herbs to treat acute febrile illnesses, especially ones that include phlegm and congestion.
Jiang can separates itself from di long in two ways. The first has to do with it’s white color and acrid flavor. These two characteristics allow for the ability to treat phlegm and thick fluids in the body. One of my teachers used to say that if you crush jiang can up, it actually looks like phlegm. While one might argue that this could be the case for many herbs, it is certainly true of jiang can.
The acrid flavor of jiang can also helps to vent superficial pathogenic influence. Sensation of itching or bugs crawling underneath the skin, can be treated by this medicinal (with or without the manifestation of a rash).
The second and perhaps more notable difference in the focus of these two medicinals is that jiang can goes to the throat and treats nodules of phlegm and stagnation there. It performs this action quite well when combined with xia ku cao (prunellas spica), zhe bei mu (fritillariae thunbergii bulbus), and mu li (oyster shell).
Similarly to di long, dosing jiang can does not need to be very high! Three to nine grams per day is a more than effective dose to begin in most cases.
Yin Crawlers for Yin Problems
Some bugs happen to live and grow in the murky places of our planet. What may we deduce from this? Well, a creature who thrives in the cold, dark, and damp may have an affinity for Yin.
In ancient Chinese cosmology, Yin and Yang represent the two apparent opposing aspects of our living experience. All things may be divided into Yin and Yang. Yang can be classified by the qualities of brightness, expansion, warmth, and expression. Yin can be classified by the qualities of darkness, contraction, cold, and introspection. Both are needed for the other to exist. Both may create or destroy the other. Either may be used to antagonize the other. Studying the way Yin and Yang interact is a basic study for any of the classical Chinese arts - including medicine.
Bugs that live and grow in water have a special ability to treat problems that are water-like. These are Yin problems of the body - lack of movement, stagnation and decay of fluids, the formation of tumors and masses, and poorly circulating blood. These symptoms, while variant, often result in the creating same experience - horrible amounts of pain. For when Yin gets stuck without enough Yang, disharmony is conclusive.
Shuĭ Zhì 水蛭
Properties: Salty, Bitter, Neutral, Slightly Toxic
Channels Entered: Liver, Bladder
Functions: Breaks up Static Blood, Disperses Stagnation
As the primary example of a water bug, shui zhi crowns itself queen of the medicinals that conquer Yin pathogenic influence in the human body. As shui zhi’s nature implies, pathologies that have landed in the lower body are its specialty to work on. Shui zhi’s salty flavor enters the blood aspect of the liver, targeting patterns of static blood which have yielded masses in the abdomen.
Shui zhi is perhaps the most focused bug medicinal. In addition to its action of guiding other herbs deeply within the body, shui zhi is said to have the ability to “break up old blood stasis without damaging new blood.” (WAtR, 135) According to the revered physician Zhang Xi-Chun, the hirudo leech has an affinity for carefully finding old blood because it seeks out and consumes blood during the course of its life. Whatever the reason may be, shui zhi’s medicine seems to be the most precise and effective bug medicinal to use in the case of chronic blood stasis, especially in the presence of substantiated accumulations.
Because of the growing popularity of shui zhi as a medicinal, prices on the herbal market have begun to increase making shui zhi quite an expensive ingredient. In the interest of keeping the price of herbal medicine affordable, the practitioners at Root & Branch have discovered that adding even as little as one to two grams of shui zhi to an herbal formula per day is enough to make a huge difference in most cases. It should be noted however, that for best results, three to five grams per day is recommended.
Tŭ Biē Chóng 土鳖虫
English: Wingless Cockroach
Properties: Salty, Cold, Slightly Toxic
Channels Entered: Liver, Heart, Spleen
Functions: Breaks up Blood Stasis, Renews Sinews, Joints and Bones
Salty and cold, tu bie chong lives in the ground or in the walls and floors of urban buildings. Its affinity for darkness makes it an ideal medicinal in the conquering of Yin based accumulations: static blood, masses & tumors in the abdomen.
In addition to Yin pathogenic influence, tu bie chong works exceptionally well at healing injuries, bone breaks, and sinew or tissue damage. This is because the cockroach heals itself well in life. If tu bie chong is cut in half and then re-attached, it will heal and continue to live! The doctrine of signatures suggests that this potential is activatable in medicine. This is especially the case when tu bie chong is combined with the resins of trees: Olibanum (rŭ xiāng) and Myrrha (mò yào).
The recommended dosage of tu bie chong is between three and twelve grams per day. One of the best things about this medicinal is that its cheap! For the time being, tu bie chong makes a great add-in to any herbal formula needing guidance into the deeper blood level of the body. It also makes for a good substitute for shui zhi or meng chong on a tight budget.
Yang Fliers for Fast Action
Some insects can fly and are attracted to light. They move and exhibit a buzzing sound, rapidly flapping their wings. This activity makes these creatures more like Yang. Yang is fast, agile, bright and big in its movement. It transforms turbidity and stuckness through an excited kind of Qi. While Yang transformation is successful, it normally requires a more stable partner for its transformations to be lasting.
Méng Chóng 虻虫
English: Horse Fly
Properties: Bitter, Slightly Cold, Toxic
Channels Entered: Liver
Functions: Quickly Breaks up Blood Stasis
Widely regarded as the most Yang bug medicinal, meng chong specializes in its fast-acting approach to transforming static blood accumulations and masses.
Meng chong flies in the air, buzzing around with a high frequency in life. When taken as a medicinal, meng chong’s bitter flavor combines with its Yang nature to quickly transform and purge accumulations. Though fast-acting, meng chong’s activity is relatively short lived. For this reason, it is normally combined with a more Yin-natured medicinal such as shui zhi to lengthen its medicinal effect.
Because of the rarity of meng chong as a medicinal, prices on the herbal market have begun to increase making meng chong quite an expensive ingredient. In the interest of keeping the price of herbal medicine affordable, the practitioners at Root & Branch have discovered that adding even as little as one to two grams of meng chong to an herbal formula per day is enough to make a huge difference in most cases. It should be noted however, that for best results, three to five grams per day is recommended.
Case Study: Chronic Cough
62 yr. Sys Male
Patient reported a history of chronic dry cough for ten plus years (no memory of initial onset). The cough was mild and unremarkable unless the patient would catch a cold. Once caught, the cold would move quickly into the chest and linger for as long as two or three months. The cold would typically manifest with a dry cough, extreme fatigue, and difficult to expectorate phlegm.
The patient also reported catching pneumonia when he was eight years old that was treated with antibiotics.
Patient caught a cold six weeks prior to the initial visit. Though the acute symptoms had mostly resolved, a dry cough and fatigue remained. The cough was bothersome throughout the day and only through the night if the patient awoke for a time. No phlegm was expectorated while coughing, but there was a sensation of fullness in the chest and the epigastrium. Patient reported a neutral body temperature, but a preference for warmth, and no sweating. “I never sweat,” he said. Patient was able to fall asleep easily, but would sometimes wake around 3 AM with racing thoughts and heart palpitations. Occasionally he would be unable to fall back asleep for several hours. The patient had to get up 2-3 times per night, on average to urinate. Appetite, digestion, and bowel movement were all unremarkable.
Slightly pale, thicker white coat, red tip, engorged sublingual veins.
Overall: tight, muffled, robust
Cun positions felt very muffled but robust and superficial.
Right Cun was slightly scattered, with a Yang Wei pulse indication.
Guan Positions were wiry and tight.
Chi positions were deep and weak.
Wind-Cold Painful Obstruction of the chest (Bi Syndrome)
Obstruction of the upper burner resulting in clumping of the Qi
Lung Qi unable to descend
Zhi Shi Xie Bai Gui Zhi Tang (Granule)
Gua Luo Xie Bai Ban Xia Tang 60 g
Zhi Shi 8 g
Gui Zhi 10 g
Hou Po 8 g
Dosage: 6 grams 2 times per day for 7 days.
Second Appointment (one week later)
Patient reported improvement with both cough and energy level. He had expectorated some very thick yellowish phlegm throughout the week and was feeling much better. His middle of the night waking had also decreased, as did the palpitations and feeling of fullness.
Because the patient had to leave town for several weeks, I gave him two more weeks worth of the same formula and told him to get in touch with me once he was back in town.
Third Appointment (one month later)
Patient reported gradual improvement for the first week after the second appointment and then no more improvement. His cough had “gone back to normal” and was now mild, dry and intermittent throughout the day. His sleep had improved, but he would still wake up 2-3 times to urinate per night. He was slightly fatigued throughout the day. All other reviewed systems were unremarkable.
Pale-red, dusky, thin white coat, red tip, engorged sublingual veins.
less tight than before…
Cun positions were now deeper (about mid depth) and very scattered, but still robust.
Right Cun position still had a Yang Wei pulse indication
Middle positions had become more superficial but were mostly unremarkable
Chi positions were slightly stronger, but still deep and weak overall.
Blood Stasis in the Upper Jiao
Kidney Qi Deficiency
Kidney failing to grasp Qi
Jin Fei Cao San with modifications (bulk decoction)
Xuan Fu Hua 9g
Bai Shao (Chao) 9g
Gan Cao 6g
Tao Ren 9g
Dang Gui (Chao) 9g
Di Long 3g
Sang Bai Pi 9g
Zi Wan 9g
Si Gua Luo 6g
Dosage: per day.
After one week, the patient’s cough had completely subsided. I prescribed a similar version of the above formula over the next few months, slowly removing the stop cough and heat clearing medicinals and replacing them with herbs to supplement the Kidney and Lung Qi.
Six months later, the patient’s cough had not returned.
The patient’s medical history indicated a long-standing lung weakness. This was likely due to, or aggravated by the occurrence of pneumonia during childhood. In my clinical experience, the Yang Wei pulse indication is a confirmation of this weakness.
The patient’s presenting symptoms of cough, feelings of fullness and pulse led me to believe that the pathogenic influence was stuck in the chest. Preference for warmth and lack of sweating made me lean toward a cinnamon based remedy. This case is clearly one of mixed excess and deficiency. I chose Zhi Shi Xie Bai Gui Zhi Tang to restore the functional movement of Yang Qi, dissipate clumping and expel phlegm.
Once the acute pattern of obstruction was addressed, the residual, more deeply rooted pattern of blood stasis began to show itself. The cun pulses got deeper and more scattered. The engorged sublingual veins and the continuation of the Yang Wei pulse all pointed to the need for herbs that could enter the luo mai.
Xuan Fu Hua, Bai Shao Yao and Gan Cao were chosen as chief ingredients in the formula. These herbs were selected to liberate the Qi dynamic from obstruction and allow the descent of the Lung Qi. Xuan Fu Hua has a salty flavor and some sources say that it assists the Kidney in grasping the Qi. It is also commonly thought of as the only flower that directs downward. Bai Shao and Gan Cao make up the formula Shao Yao Gan Cao Tang, which is used moderate the spasmatic deficiency-related tendency for cough.
Tao Ren and Dang Gui were used to open the blood vessels and move the blood. These two ingredients also have a slightly moistening affect on the Large Intestine. The Large Intestine is the yang pair of the Lungs. Keeping the Large Intestine clear is a useful strategy when promoting the descent of Lung Qi.
Di long and Si Gua Luo are an herb pair used by Dr. Greg Livingston to drive the formula into the luo mai. Di long was selected because of its affinity for the lung and bladder channels - opening up the bronchioles of the lungs and promoting the smooth movement of the water passageways. Si Gua Luo is the luffa vegetable sponge. It looks like the lung’s bronchioles and is one of the only non-bug medicinals that is able to access the luo mai.
Sang Bai Pi and Zi Wan are dynamic cough medicinals used in cases of both excess and deficiency. Sang Bai Pi is sweet and cold, while Zi Wan is acrid, bitter, and warm. Together they are able to able to treat a variety of cough-related consumption patterns.
Why No Qi Tonics?
Because of the robust nature of the pulse in the cun pulse positions, I decided not to include medicinals that directly tonify the Lung’s Qi in the first formula. I felt that the salty flavor of Xuan Fu Hua and Di long were enough to encourage the movement of the Kidney’s grasping ability. In future renditions of the formula, I included various aspects of the formulas Sheng Mai San and Shen Qi Wan in order to tonify deficiency.
The Cultivation & Understanding of Traditional Medicine
Practicing a traditional medicine in modern times has many challenges. One of the biggest challenges comes when we try to communicate the difference of perspectives between the ancient and modern worlds. Perspective shapes the reasoning for action. It creates a context for why a particular medicinal would be prescribed or not. Understanding perspective is necessary before judging the method. And far too often today, we learn to judge before attaining this understanding.
Using insect-based medicinals has been one of the most valuable clinical insights for me. In the short span of my career as a Chinese medicine practitioner, I have been able to help numerous people with the knowledge that I have shared above. I am certainly no where near mastery of the art and science of Chinese medicine. Even so, I hope that the information presented in this article may be of use to practitioners who have the intelligence and skill to employ it.