The Mother of All Diseases: Stagnation (Part One)

Written by Lesley Tierra

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

Congestion, or stagnation as its called in Traditional Chinese Medicine (TCM), is one

of the major causes of all illness, particularly chronic and degenerative issues. Quite
often when someone doesnt feel good, feels off in some way, has low energy, gets sick
easily, or cant heal an illness no matter what they try, the underlying cause is stagnation.

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

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

The Five Stagnations

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

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

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

General Treatment for Stagnation

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

2) DIET AWARENESS: Along with lack of movement, improper diet is the next cause of
stagnation. Definitely avoid over-eating (you know that post-holiday meal feeling of stuffiness
and discomfort? Thats food stagnation.) As well, shun cold foods and drinks, raw foods,
excessive meat intake and foods that are too spicy.
3) WRITE: Writing in a journal is one of the best ways to express and release emotional
issues. Stuck emotions is one of the major causes of stagnation, yet because they
subconsciously influence our thoughts, health and behaviors, they are not accessed by just
thinking about them, emoting or dwelling on them over and over. Rather, we need to access
the subconscious in order to release them. Writing and speaking out loud do this, which is
why journal writing is so emotionally productive. When you access the subconscious through
writing, linked connections arise such as past memories, cause and effect relationships,
realizations or understandings. This is what allows them to truly release.

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

The Mother of All Diseases: Stagnation (Part Two)

Written by Lesley Tierra

In Part I of this blog, I discussed the Five Stagnations in general along with some non-herbal treatments.
Here are two general herbal formulas that can be used for all types of stagnation.

Stagnation Relieving Pills (Yue Qu Wan)

This formula can be found as a patent medicine easily from Chinese herb stores or herbal suppliers. As a
bonus, for each Chinese herb ingredient Ive included a substitution easily found in your spice cabinet!

Indications: This formula moves all five stagnations, treating symptoms of feeling congestion in the chest
and abdomen, possible hypochondriac pain, bloating, belching, acid regurgitation, nausea, vomiting, mild
coughing, and indigestion with a lack of appetite. It may be considered for nervous stomach,
gastrointestinal ulcers, pain in the chest, hepatitis, cholecystitis, or gallstones.

Kitchen
Chinese herb pinyin Latin
equivalent
9-12g cyperus xiang fu Cyperus rotunda citrus peel
9-12g black
cang zhu Atractylodes lancea cloves
atractylodes
chuan
9-12g ligusticum Ligusticum wallichii cayenne
xiong
9-12g medicated Massa fermentata
shen qu hawthorn
leaven medicinalis
9-12g gardenia fruit zhi zi Gardenia jasminoides turmeric
Preparation: Grind into a powder. Slowly stir in enough water until the powder becomes workable
enough so that you can roll the mixture into pills the size of an azuki bean. Or, take 6-9 g powered herbs
with warm water. If using granulated extracts, take 3-6 g three times daily depending on body weight.
Variations:

1. For Cold with stagnant Qi, add galangal (gao liang jiang or Alpinia galanga).

2. For dysmenorrhea or mental depression, add curcuma root (yu jin or Curcuma longa)

3. For Heat and stagnation in the Liver with hypochondriac pain, yellow tongue coat, and a wiry, rapid
pulse, add corydalis (yan hu suo or rhizome Corydalis yan hu suo)

Universal Stagnation-Dispersing Formula

This second formula was the first herbal treatment given to all his patents by a master Chinese herbalist.
Michael later learned from Jeffrey Yuen (a famous Taoist acupuncturist and herbalist) that it was created
and used by his Chinese herb teacher. This formula can be taken twice daily for a week prior to the use of
any other formula and regardless of the presenting symptoms. Jeffrey said that it looks like a modified Five
Accumulations Formula with Dang Gui and Magnolia Combination.

Chinese herb, properties and actions pinyin Latin

6 g cinnamon twig
Ramulus
gui zhi
(sweet, spicy, warm; moves Yang Qi, removes Cold stagnation) cinnamomi

4 g field mint
Mentha
bo he
(spicy, cool; relieves Liver Qi stagnation) haplocalyx

6-9 g siler
fang Ledebouriella
(pungent, sweet, warm; removes Cold and Damp stagnation) feng seseloides

6-9 g white peony

(bitter, sour, cool; nourishes Blood, which can be depleted and dried bai shao
Paeonia alba
from the use of too many strongly moving herbs; also moves Blood yao
stasis)

6-9 g ligusticum
chuan Ligusticum
(pungent, warm; Moves Blood and Qi stagnation) xiong wallichii

6-9 g fu ling

(sweet to bland, neutral; dispels Damp stagnation) fu ling Poria cocos

6-9 g Angelica dahurica

Angelica
bai zhi
(pungent, warm; clears Heat and calms Wind) dahurica

6-9 g prepared pinellia

ban xia Pinellia ternata
(pungent, warm; dispels Damp and removes Phlegm)

3-6 g bitter orange (no seeds)

Citrus
zhi ke
(sour, bitter, slightly cold; moves Qi and clears Heat) aurantium

6-9 g platycodon
Platycodon
(pungent, bitter, neutral; clears Phlegm, which is a type of Damp jie geng
stagnation) grandiflorum

3-6 g mature tangerine peel

(pungent, bitter, warm; regulates Qi, dispels Dampness) chen pi Citrus reticulata

6-9 g cyperus
Cyperus
(spicy, slightly bitter, neutral to warm; moves food, Qi and Blood xiang fu
stagnations) rotundus

6-9 g dried ginger

gan Zingiberis
(spicy, hot energy; removes Cold and Damp stagnations) jiang officinalis

6 g American ginseng
xi yang Panax
(cool, tonifies Yin; protects the Yin that can be exhausted and depleted
from the other strong-moving and drying herbs in the formula) shen quinquefolium

3-6 g honey-fried licorice

(warm; tonifies and protects the Qi

from being exhausted due to the zhi
Glycyrrhiza
combined effects of the strong-moving gan
uralensis
herbs in the formula) cao
The First Stagnation: Qi Stagnation, Part 1
Last month we discussed the five stagnations in Traditional Chinese Medicine (TCM) along
with two formulas to treat all five. In honor of Spring, which begins this year on Feb 10
(Chinese New Year), we will focus on Qi stagnation now. Spring is represented by the Wood
Element and its organs, the Liver and Gall Bladder. Since the Liver rules the smooth flow
of Qi, now is a perfect time to discuss Qi Stagnation along with how to prevent and
treat it

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

When administering herbal therapy for Qi Stagnation, it is very important that tonics are not
given as this could worsen the condition like adding more cars to a bad traffic jam. In fact, it
is for this reason that an important therapeutic herbal strategy is to first give moving herbs
from the Regulate Qi and Move Blood categories along with Heat-clearing herbs before
giving tonics, as we discussed in Januarys blog on the Five Stagnations.
Signs of Qi Stagnation:
In terms of symptoms, Qi Stagnation has far-reaching effects on the body. Again, because
the Liver is in charge of the smooth flow of Qi, this pattern is called "Liver Qi Stagnation."
Since there are so many ways this pattern can appear, it is divided into categories of related
symptoms. As with all patterns, it is not necessary for all these symptoms to appear to
indicate this disharmony; three or more designate theres Qi stagnation (those in bold are the
main symptoms). See if you can find yourself here (hopefully, you cant!):

1) Overall

distension of hypochondrium and chest

hypochondriac pain
pains that move from place to place, and change in severity or frequency
frequent sighing
hiccupping
burping
cysts, fibroids and abdominal masses that appear and disappear quickly
2) Emotions

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

PMS tension and irritability

swollen breasts before periods
irregular periods
painful periods
4) Digestion

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

lumps in the neck, breast, groin or flank

6) Pulse and Tonue

Pulse: wiry, difficult or choppy;I often find that with Qi stagnation, the pulse doesnt
move well, if at all, either just in the Liver position (the deep middle position on left hand),
in another organ (such as the Stomach, the superficial middle position on the right hand
this is the Liver counteracting on the Stomach) or in the overall pulse.
Tongue: body color may be normal or slightly purple; sides may curl up
Qi Stagnation in the Upper Warmer:

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

Qi Stagnation in the Middle Warmer:

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

Qi Stagnation in the Lower Warmer:

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

Qi Stagnation in Abdominal Diagnosis

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

Rebellious Qi

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

ORGAN NORMAL QI PATHOLOGICAL QI SYMPTOMS & SIGNS

DIRECTION DIRECTION

STOMACH Downward Upward Belching, burping, hiccups,

nausea, vomiting

SPLEEN Upward Downward Diarrhea, prolapse

LIVER Upward Excessively upward or
horizontally
Nausea, belching, vomiting
to the Stomach (Stomach)

to the Spleen Diarrhea (Spleen)

to the Intestines Dry stools (Intestines)

LUNGS Downward Upward Cough, asthma

KIDNEYS Downward Upward Asthma

HEART Downward Upward Mental restlessness,

insomnia

Causes for Qi Stagnation:

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

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

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

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

Lifestyle Habits: Inadequate activity, sex, or exercise, regularly going to sleep late at night
(after 11 PM), working at jobs one doesnt like, any type of stress, or overwork without
sufficient rest cause Liver Qi stagnation.

In Part II we will discuss treatments and therapies for Qi stagnation. However, if you feel
stagnant just by reading all of this, I suggest you immediately get up and MOVE! Movement
is one of the great keys to circulating Qi. It can be exercise, but if you do what you love at the
same time, it also smoothes emotions and nourishes you, preventing further stagnation.
The First Stagnation: Qi Stagnation, Part 2
Written by Lesley Tierra
In Part 1 we learned about the many signs and symptoms of Qi stagnation and its far
reaching affects on physical and mental health. In this segment well cover how to treat and
prevent Qi stagnation. Of course youll be immediately interested in the herbs and formulas
to use, but first Ill cover other therapies since they are integral, even essential, to preventing
and treating this issue.

Therapies for Qi Stagnation:

Diet Therapy:

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

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

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

Lifestyle Therapies: To rebalance the Liver, go to sleep by 11 PM at the latest, move

regularly through walking, dancing, swimming, cycling, jogging, exercise, hiking (especially in
the woods), Tai Chi, Qi Gong, yoga or another physical activity and regular exercise, and
engage in creative projects as this releases pent-up Liver energy and moves Qi. For
computer work (and other electronic tools) and desk jobs, be sure to move and/or stretch for
five minutes every 30 60 minutes.
Other Therapies: Participate in regular life activities, sex and exercise as regularity of habits
helps regulate Qi. Go to sleep by 11 pm at the latest since the Wood Element time of the
Liver and Gallbladder does its major work from 11 pm 3 am (if theres also Deficient Kidney
Yin, go to bed by 9 - 9:30 PM). Find work and jobs you enjoy and are fulfilling.Alternate work
with rest and play as over-working can cause this pattern. Do cupping (especially over the
back), dermal hammer where needed, breathing exercises, abdominal massage, massage
therapies, singing and wear a haramaki around the waist to keep the kidneys warm, the
"mother" of the Liver.

Herbal Therapy: Finally - herbal therapy for Qi stagnation! This encompasses so many herbs
and formulas that we cant cover them all here, but Ill give you enough juicy ones to start
exploring. First of all, herbs that move Qi are those that help it move smoothly, regularly and
in the right direction. In Western herbalism this includes carminatives. Examples include:

Bupleurum(Bupleurum falcatum; chai hu)

Citrus peels (Pericarpium citri reticulatate; chen pi, qing pi, zhi ke, zhi shi, fo shou)
Cyperus (sedge root, Cyperus spp. Especially C. rotundus, xiang fu)
Chinese rose buds (Rosae rugosa; mei gui hua)
Mint (Menthae haplocalycis; bo he)
Fennel seed (Foeniculi fructus; xiao hui xiang)
Saussurea (Aucklandiae lappa; mu xiang)
Aquilariae (aloeswood; Aquilaria sinensis; chen xiang)
Persimmon calyx (Calyx Diospyros kaki; shi di)
Sandalwood (Santalum album; tan xiang)
Lindera (Lindera spp.; wu yao)
Chinese garlic (garlic chive; Allium macrostemon; xie bai)
Cumin (Cuminum cyminum)
Vitex (V. Agnus-castus)
Areca peel (Arecae pericarpium; da fu pi)
Melia (Sichuan chinaberry, Sichuan pagoda tree; Melia toosendan; chuan lian zi)
Qi-regulating herbs tend to be aromatic, warm and acrid or bitter in energy, treating
symptoms of pain that comes and goes, and/or changes location and severity; distention,
stifling feelings in the chest, belching, nausea, vomiting, wheezing, acid regurgitation, loss of
appetite, diarrhea or alternating diarrhea or constipation, pain in the flanks or under the ribs,
depression, mood swings, and hernias.

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

Kitchen medicine: For quick use around the home, I find citrus peel tea to be very effective to
move Qi. While the Chinese use mandarin orange peels, in Italy I was surprised with lemon
peel tea after one dinner. As well, rose buds make a wonderful jam, delighting the senses
and spirit as well as moving Qi. Fennel seeds, normally found mixed with sugar and taken
after dinner in Indian restaurants, are great as a tea, eaten raw or toasted and cooked with
vegetables and meats.
Caution: Because Qi-moving herbs tend to be warming and drying, use with caution in those
with Deficient Blood or Yin, or Excess Heat; because they are dispersing, use with caution if
theres Deficient Qi.

Qi-Moving Formulas:

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

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

Bupleurum (chai hu), 6-9g

Dang gui (dang gui), 6-9g
White peony (bai shao), 9-12g
White atractylodes (bai zhu), 6-9g
Poria (fu ling), 9-15g
Mint (bo he), 1-3g
Fresh ginger (shen jiang), 1-3g
Baked licorice (zhi gan cao), 3-6g
Bupleurum and Peony Formula (Jia Wei Xiao Yao San):

Add to the above formula:

Gardenia fruit (zhi zi), 1-3g

Moutan peony (mu dan pi, tree peony), 3-6g
Uses: Both formulas regulate the function of the Liver and Spleen, move Liver Qi stagnation
and replenish Blood. They are used for anemia, costal pain, headache, mouth and throat
dryness, dizziness, lassitude, loss of appetite, irregular menses, leukorrhea, uterine
bleeding, PMS, mood swings, depression, breast distention, chronic hepatitis, and
alternating chills and fevers as in shao yang stage diseases.

Other Bupleurum Formulas to Consider:

Minor Bupleurum (Xiao Chai Hu Tang)

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

More Useful Qi-Moving Formulas:

 Pinellia and Magnolia Combination (Ban Xia Hou Pu Tang)
Powder to Disperse Vital Energy in the Liver (Chai Hu Shu Gan San)
Pills of Tangerine Seed (Ju He Wan)
Happy Spring to you! May your Qi flow smoothly and your energy rise with the sap in trees!