Here are the last few paragraphs of my thesis in Chinese medicine for my MSOM degree at National College of Natural Medicine. As you can probably tell, I did not go as far with any of my research topics as I would have liked. I saw it mainly as a way to learn what resources existed, and sketch a general outline of where I would like to go with my investigations. I have to be frank, I haven’t yet taken the time to explore these topics much more deeply – I’ve been trying to rejuvenate myself from the rigors of school while also opening the clinic and writing more on this blog. However, I have all of the resources amassed and lots of brainstorms and outlines ready to be further explored. I’ll definitely share my ongoing investigations with Deepest Health readers.

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Read Part I of the final chapter of my thesis

Read Part II of the final chapter of my thesis

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First, the system must demonstrate a basic level of effectiveness. This could include evidence in the contemporary Western sense of controlled laboratory or clinical research, but could also include a mature history of effectiveness, such as Chinese medicine has in its extensive written record. Obviously, it could also include currently undeveloped research methodologies such as I discussed in Whole Systems Research. It will almost certainly also include so far undiscovered methods of obtaining knowledge.

Second, it must demonstrate its inclusion of a mature system of practitioner education and basic regulation of ongoing practitioner behavior. This simply means that an included system of medicine should show that it is making active attempts to behave ethically and to ensure that its practitioners obtain the highest level of education that is possible. External governmental controls could also be developed that both respect the integrity of the community of practitioners while providing the public with a sense of safety.

Third, a system of medicine should be open to discussion and evaluation by other systems. These interactions should be governed by an understanding that such interaction is for the benefit of all involved, not intended to discredit or eliminate one system in favor of another. Practitioners of each system should seek to become steeped in the foundational material of the other system before they seek to criticize it, as this will make for a more productive and scholarly interaction. My thoughts on this point resonate with the early philosophical work of Alasdair MacIntyre as developed in his book, After Virtue, published in 1981.

Finally, a system of medicine should not be integrated into the larger health care system until it demonstrates its safety for general use. As I’ve already mentioned, one of the biggest concerns about alternative medicine is whether it is safe. This is to be understood, since the primary guiding principle of all medical practice is to “first, do no harm.” Whether by laboratory testing, historical record or some other acceptable method, the system should indicate that its diagnostics and therapies meet a minimum standard of safety. Further, as stated before, the profession should be internally or externally regulated in an adequate way to ensure that practitioners are making safety a primary focus of daily practice.

Of course, there is a viable system of medicine that meets all of these criteria – Chinese medicine.

Chinese medicine not only meets the criteria above, but is also an ideal vehicle for avoiding the kind of objectification of patients that I am arguing against. In Chinese medicine, one always considers the more physical, measurable characteristics of a person as well as the less measurable, subtler features of his mental and social situation. In fact, such a separation of features of the person’s experience is simply not done. Every single identified sign or symptom is taken into the diagnostic framework and interpreted. This includes the more precise information as might be included on a laboratory report. But it also, and more commonly, includes the patient’s vague and self-defined complaints (“fuzzy headed,” “stuck,” and so on). Further, it relies on the complex and embodied senses of the practitioner to accurately observe and interpret the symbolic information inherent in face color and quality, pulse rate and quality, nail bed color and quality and so on. While this may seem a hopeless mess of factors that cannot possibly result in effective diagnosis, much less treatment, such is not the case. Diagnosis does happen, and so does healing. Chinese medicine, through its use of symbol, of metaphor, and its integration of the various subtle meanings and meetings within a human life both in diagnosis and in treatment – has a unique and time tested way to bring the interpretive meeting back into medicine.

In sum, I believe that medicine is not the kind of activity that can, or should, be governed by single-minded adherence to the analytical sciences as they are currently practiced in most places in First world nations. Such devotion to technological medicine encourages a compartmentalized way of viewing the body and the human being’s place in the universe while also producing a distance between doctor and patient that is not conducive to healing. We need not abandon the analytical tradition or the fine tools brought to us by contemporary Western medical practice. But nor should we attempt to eradicate all systems of medicine that fail to meet our ideological standards concerning evidence. Condemning disciplines based on ideological notions of “pseudoscience” cannot be helpful for patients. A more inclusive approach respects the integrity of safe, integral and mature disciplines while acknowledging the need for the public to feel reasonably assured concerning their safety and effectiveness.

Phenomenology and Classical Chinese medicine : brief conclusions, opening doors

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For your Wednesday (or Thursday, depending on where you are) reading pleasure, I would like to offer the third piece of my Chinese medicine thesis, written at NCNM. As promised, I’m breaking it up into bite-sized chunks and only presenting the final chapter. The next installment will be the last. I hope, in weeks thereafter, to offer my further reflections on the subject and offer some resources for people interested in pursuing the topic further. I look forward to your comments. If you missed the first two installments, find the links below!

Chinese medicine and phenomenology thesis Part I

Chinese medicine and phenomenology thesis Part II

EDIT 8/5/09: I just realized that the portions linked above were mistakenly taken from an earlier draft of the thesis. I should be more careful! Please forgive me if there are any inconsistencies between the versions. I will most likely go back and repost the newer, more complete drafts soon. You may want to visit them, then, even if you have already read through.

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According to Svenaeus, important information that penetrates the clinical encounter is, in a way of speaking, pre-scientific. It is prescientific insofar that is minimally mediated by theory and not readily systematized by the analytical processes recognizable as the basis of contemporary science. In the terminology of philosopher Edmund Husserl (and later, Martin Heidegger and Maurice Merleau-Ponty), this information is all part of the lifeworld. The lifeworld is the sum total of lived experience, not as a static object, but as it is lived. It is those things and experiences that, woven together, make up what we refer to as our life. Things only have meaning insofar that they are situated within the lifeworld. Abstracted outside of that, they cease to have what most of us think of as “meaning” or “importance.” This is obviously a very deep philosophical concept, and I cannot elucidate its full meaning here.

However, it seems, when applied to medicine, as a clinical encounter between two human beings, this theory can inform practitioners that we should seek to engage the wholeness of each person during each encounter. If we incorporate information taken from laboratory tests, or other processes that isolate particular characteristics of our patient, we should situate that information in a field of everything else we know and can perceive about the patient. This would include demographic information filled in on a form, the subjective reports of the patients, our understanding of the world and regional situation the patient is confronting (war, weather, and so on) as well as all the information available to the senses of the physician. Physical palpation (including of the pulse), the visual presentation on all levels, the sound of the patient’s voice, any odors that can be perceived may all provide us with information of use in diagnosis. Before the advent of modern medical technology, of course, this was the primary source of information that physicians worked with. We can utilize this “lifeworld field” in the service of restoring the patient to a greater state of health. In this view, far from being extraneous information, the particular life characteristics of the patient are a key component in her disease process, physicians’ diagnosis of it the ongoing healing process.
Later, Svenaeus indicates that there are efforts in the mainstream medical community to take seriously the implications in the type of argument I am advancing. These enterprising physicians are attempting to construct a system of medicine that situates the lifeworld centrally in the clinical gaze. You can see evidence of this in the formation of medical centers that incorporate spa services, family and individual counseling and other such services. While the chapel has always been a feature of hospitals, increasing numbers of medical centers are also offering meditation, Taiji, yoga and other benefits that seek to address the spiritual side of its patient population. The inclusion of these services within the medical center itself shows an understanding that the healing of the physical body is not separate from the health of the rest of the human experience. Some of these medical centers have also begun to offer complementary and alternative medicine alongside Western medicine. It is obviously important to point out that complementary and alternative systems of medicine (CAM) take the wholeness of the patient very seriously. In fact, the primary focus of most CAM therapies is to restore the person to harmony within that wholeness of their being.

“One central goal of CAM is to improve the “wellness” of the patient. Rather than just removing a disease-producing agent, “quality of life” is emphasized by treating functional or somatic problems with ancillary and important psychological, social, emotional, and spiritual aspects” (Complementary and Alternative Medicine: An Evidence-Based Approach, John W. Spencer, Joseph J. Jacobs) 17.

The continuing integration of CAM into hospitals and other large medical facilities indicates that many Western medicine practitioners are seeing the value of these services.All of these changes, and the important conversations they generate within the profession of Western medicine, are quite important. As CAM becomes increasingly integrated into mainstream medicine, it will begin to inform the practice of Western medicine even as it is informed by Western medicine. Perhaps, then, the holistic nature of the human being and the importance of considering the lifeworld of the patient when diagnosing and treating will become a more central principle in all of medicine.
There are a number of concerns that mainstream medical practitioners and Western scientists have about this integrative process – many of them discussed in my paper already. Much of the worry centers on two basic desires. First, people want to know that medicine, meant to heal, is not harmful for patients. Second, people are concerned that even if a therapy is not harmful, it may simply be an elaborate placebo-based swindle duping hapless patients. While there is much I have said and could say about this, I would like to suggest a few basic principles that can guide us when deciding what therapies and systems of medicine we would like to integrate into our unified health care system. These principles encompass elements of all the criteria of demarcation I have already discussed, while creating a system of holistic care that takes seriously the lifeworld and personhood of the patient. If a system of medicine or particular therapy does not meet these criteria, I contend that it must work to rectify any deficiencies before being embraced by the mainstream.

Phenomenology and Chinese Medicine : the lifeworld, holism and integrative medicine

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So, as promised – here is the next portion of my thesis written for my degree in Classical Chinese Medicine at NCNM in Portland. I hope you enjoy it! For those folks who requested the first chapters – I’ll get them to you soon. I’m trying to chop this into many smaller pieces so they may be more easily digested – thus hopefully compelling folks to speak up and discuss the ideas I very briefly lay out. Please go ahead and tell me what you think in the comments – I would enjoy some conversation around these simple topics.

If you missed the first installment, please go read about Phenomenology and Chinese Medicine (Part 1).

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The doctor possesses all the same complexities [as the patient]. When the two come together, they are also under the influence of the particular place and time where they meet. The multiple variables inhering on the situation boggle the mind. The weather, the paint, the particular complement of the room, what’s going on in the news and whether either is aware of it. This is all perceived, on some level, by everyone involved – though perhaps not consciously. I do not want to imply that each of these variables has some lasting, measurable effect on either one of the participants in the encounter. I simply want the reader to keep in mind that every single medical encounter is simply two human beings, with their messy lived experience, coming together for the purposes of rectifying or maintaining some particular state that each agrees is worth attaining – health or the cessation of disease – depending on one’s outlook.

I want to caution the reader against assuming that this “messiness” as I’ve called it is a detriment to medicine, as some might imply. It is attractive to some to believe that if we simply make diagnosis and treatment maximally objective, by using the mediator of advanced technology and standard diagnostic and treatment protocols based on sound science, we will come to a purer, more useful medicine. But if this results in the removal of the human being from the doctor, if this results in the replacement of the patient by a list of variables gleaned by diagnostic tests, it can do nothing but take us farther down the road of an impersonal medicine that makes mistakes because it does not know enough about the person of its patients. I do not want to imply that any particular medical system, in its totality, does this on purpose or by design. But it is a danger for any medical system, particularly one that seeks to become increasingly rooted in objectivity.

Several philosophers, particularly those who are categorized as “Continental” philosophers, such as Foucault, Heidegger and American Philosopher Richard Rorty can help us to understand why this subjective, messy and quintessentially human nature of medicine is so actually an important feature of its integrity and usefulness. To analyze all of these philosophers and develop a rigorous theory concerning this point is a dissertation-level project. Fortunately, philosopher Fredrik Svenaeus, in his book The Hermeneutics of Medicine and the Phenomenology of Health, does an admirable job of pulling together diverse thinkers in Continental philosophy and other traditions to develop a rigorous philosophy of medical practice. I will offer and annotate some of his argument here as I believe his work points a way forward in any discussion of whether and how

The central focus of Svenaeus’ argument is the examination of the clinical encounter – the functional unit of medicine. Svenaeus explains that technological medicine and an increasing reliance on laboratory research has created a separation between the patient and the doctor. This separation is produced when the patient is not seen as an integral human being with mind, body and cultural context but is instead seen as a kind of space in which particular biochemical reactions and microorganisms are present in specific concentrations and configurations. In essence, the patient has become an object to be carefully studied by the doctor. He explains,

“Negligence of the human side of medicine has been fostered and fed by a focus upon medical scientific research and its biological objects, as existing in a relation of opposition to, instead of connecting with, the encounter between doctor and patient with its specific ‘lived’ characteristics”(Svenaeus, 2001, p. 7).

Much of the patient’s lived experience is disregarded as irrelevant in the situation at hand, unless a study has vindicated that some feature of that experience affects something that can be measured in a laboratory. This, he believes, takes medicine away from its purpose and power as a clinical practice. In sum, the ongoing pursuit of solely objective information as provided by the “causal” studies I discussed above is creating an undesirable side-effect: the removal of the human from the practice of medicine.

There are obvious ethical implications here. When we approach human subjects as objects, our ability to relate to them and, ultimately, to treat them as persons suffers. In the most extreme cases, this leads to sociopathic behavior such as is found in scenes of torture and police brutality. Obviously, in the medical context, the situation is not so extreme. The vast majority of physicians, regardless of their ideological stance, seek to help their patients. But, this is not only a philosophical or ethical issue. I contend that medicine that takes the intersubjectivity and embeddedness of its patients seriously, even makes that the very center of clinical thinking, is actually more effective.

In his discussion, Svenaeus recommends a variety of introspective turns that medical professionals can take. In essence, they all point to the same holistic conclusion. While technological advances and laboratory testing can provide valuable information, physicians must see these variables as only a couple among many. The amazing advances brought about by technological science allow us to, in a way, extend our senses. However, this happy development should not cause us to abandon those bodily tools that physicians have been using since medicine began.

—Thanks for reading!
Eric

Phenomenology and Chinese Medicine : Our body is the greatest medical technology

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I’m writing my thesis, which partly explains… you know… the silence. Anyway, in a brazen display of my newly born lack of worry about what others think about me, I offer this brief paragraph. It was lifted, reworked and reentered into my thesis in another form – but this is the raw stuff that came from my mind unbidden.

All scientific systems rest on claims about the universe that are fundamentally unknowable.  For instance, the currently popular system of Western science rests on a notion of the universe as fundamentally uniform.  This is an untestable hypothesis, but it is used in research every day.  Chinese medicine, similarly, contains information that is most simply described as metaphysical – untestable and unknowable information that is taken as given.  The difference between the Western and the Eastern contexts is that the latter makes these foundations clear and available for discussion.  While all Chinese medicine practitioners are aware of Yin and Yang and sometimes use these concepts in discussion physiology, pathology and treatment, no one I have ever encountered proposes that one could obtain a measure of either.  The discussion of Yin and Yang in Chinese medicine should be no more shocking than it would be to find a couple of Western researchers discussing Schrodenger’s cat.   While most Western researchers don’t engage daily with the philosophical and metaphysical underpinnings of their understanding of the world and things in it, this should not compel us to judge the Chinese medicine physician’s tendency to do otherwise.

Discuss.

The bottomless pit of our knowing

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Hey everyone,

Just a quick announcement.  Brandon Brown, colleague at NCNM and all-around fantastic guy, has written a fascinating article that dips into the cosmology of this time of year.  Here’s an excerpt:

“Here is my translation of the text from the YiJing for Hexagram 19.

《臨》元亨，利貞。至于八月有凶。
Successful, Benefitial. As for the 8th month (august) it is ominous.

《彖》 曰：《臨》，剛浸而長，說而順，剛中而應。大「亨」以正、天之道也。「至于八月有凶」、消不久也。
Gradually firm and enduring, speaking with direction, responding with a firm center. Big success with correctness, this is the way of Heaven. Ominous challenges will soon disappear.

《象》曰：澤上有地，《臨》。君子以教思�窮，容保民�疆。
The marsh above indicates earthliness. The noble man uses this to teach the poor of thought, and contains and protects those on the outside.”

To read the rest, just head over to Brandon’s blog.

The 12th Lunar month and Hexagram 19 : read Brandon Brown’s fantastic article!

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This is the final post in a three part series by Brandon Brown, blogger and student of Classical Chinese Medicine at NCNM.  You can read the first two parts here and here, and can read references for the article by visiting Brandon’s site here.

Salt in the Classics

Salt is mentioned a number of times in the classics. In the Neijing Suwen, salt is considered the flavor of the Kidney. But what does this mean exactly? What follows are the most descriptive and instructive references from the Suwen followed by my translations.

Chapter 67
北方生寒，寒生水，水生鹹，鹹生腎，腎生骨髓，髓生肝。其在天為寒，在地為水，在體為骨，在氣為堅，在藏為腎，其性為凜，其德為寒，其用為，其色為黑，其化為肅，其蟲鱗，其政為靜，其令，其變凝冽，其眚冰雹，其味為鹹，其志為恐。恐傷腎，思勝恐，寒傷血，燥勝寒，鹹傷血，甘勝鹹。

“The north generates cold, cold generates water, water generates salty, salty generates kidneys, kidney generates the marrow, marrow generates the liver. In heaven it is cold, on earth it is water, in the body it is bone, its qi is hard, in the Zang it is the Kidney, its nature is cold(shivering), its virtue is cold, it is “use”, its color is black, it changes into solemn-ness(seriousness), it is worms and fish-scales, its government is stillness(jing), it causes, its pathological change is congealing coldness, its natural disaster is ice hail, its flavor is salty, it is will by fear. Fear impairs the kidney, thought defeats fear, cold damages blood, dryness defeats cold, salty damages blood, sweet defeats salty.”

Chapter 3
味過於鹹，大骨氣勞，短肌，心氣抑。
Excess salty flavor, causes great hardening of bone Qi, shortens the muscles, and restrains heart Qi.

Chapter 5
鹹勝苦。
Salty defeats bitter.

Chapter 10
是故多食鹹則脈凝泣而變色 。
Therefore, much eating of salty makes the pulse concrete and the color changing.

Chapter 22
心欲耎，急食鹹以耎之，用鹹補之，甘寫之。
The Heart desires softness, anxious people eat salty that softens it, use salty to mend it, sweet drains it.

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These excerpts from the Suwen indicate the myriad functions of salt. In Chinese Medicine, the Salty flavor is typically used to soften nodules as mentioned in Chapter 22, but we also see in Chapter 3, 10, and 67 that salt can pathologically also create hardness of Bone Qi, restrain Heart Qi, damage blood, and cause the pulse to be very firm. We can read these lines in typical Chinese Medicine fashion: that as a remedy, the salty flavor has a purpose in softening nodules, in moderation salt perhaps allows the Kidney to perform its function of storing, but pathological excess consumption of salt can lead to sclerosis.

In Chinese Medicine, the 5 flavors that go with the 5 organs typically counteract the nature of the targeted organ. For example, the energetic nature of the Liver is up and out whereas the flavor Sour astringes and contracts. The Heart, the fire organ, is up and bitter is down. For the Lung, its nature is contracting down and in, whereas pungent is the opposite: up and out. For the Kidney, as we see in Chapter 67 above, the energetic nature is definitely to store by freezing. Salt, must counteract this freezing nature, as we know that it does from our experience: salt both reduces the freezing point of water and raises the boiling point. The presence of salt liquefies ice, and thus can soften hardness (tumors, goiter, etc.). But because salt has an affinity with the Kidney it counteracts the storing nature of the organ, liquefying the Kidney energy (perhaps Jing) to be used in the body as Qi. Therefore we see again that, salt pushes out from the inside.

In their paper on the Classical Energetics of the Five Flavors (find in references section), Arnaud Versluys and Jessica Atkins describe the therapeutic actions of the five flavors in terms of tonification and purgation. In cases of excess or deficiency, the organs can be respectively purged or tonified with the appropriate flavor as shown in the figure below.

Figure 2: The actions of the 5 flavors

Organ:  Excess of, purge with : Deficiency of, tonify with
Fire :  Sweet : Salty
Earth : Bitter : Sweet
Metal : Pungent : Sour
Water :  Salty :  Bitter
Wood :  Sour :  Pungent

According to their interpretation, the salty flavor purges excess in the Kidneys and tonifies the Heart. In the case of SSH, chronic overexposure to dietary salt may act medicinally and impair or purge the storing function of the Kidney and thus over-tonify the Heart. Because the Kidney is also said to store pre-natal essence if there is no pathological influence to expel in the Kidneys, it is possible that what is purged is actually pre-natal essence (Jing). This essence is circulated throughout the body, transformed to Qi by the Liver function, and transformed and stored as Shen by the Heart. Shen, and thus consciousness, have as a substrate the brain, but Shen is housed in the Heart.

Therefore, the use of salt habitually may increase the Jing-Qi-Shen generation cycle, which makes us sharp and awake, but has the detrimental effect of possibly depleting pre-natal essence if the Kidneys are not constantly tonified. In the Suwen it mentions that at 8 times 7 years (56 years old), the hair (ruled by the Kidney) turns gray and the signs of aging begin to become visible. “The kidneys’ ability to excrete sodium declines gradually with age. If, with age, salt consumption is not reduced, sodium balance is maintained by raising fractional sodium excretion, which requires elevation of BP” (Khalil 2005). The accumulation of salt in the ocean over the years has begun to take its toll.

Because purgation of the Kidney in a non-pathological condition also tonifies the Heart, an interesting consequence of excess in the Fire element is that it easily overflows onto its child organ, the Earth. This would lead the Earth to become overwhelmed and thereby inhibiting it to control the Water element, whose function is diminishing due to the natural processes of aging. In CM, we say that the “Earth rules the muscles” and in the SSH case this clearly relates to the smooth muscle of the vasculature losing its ability to contract. Due to an excess in the Heart domain, the smooth muscle becomes dry, stiff, and brittle. The patho-mechanism of this is illustrated below.

The standard American diet is predominantly made of the flavors salty and sweet. The overwhelming absence of bitter (with the exception of Shen disturbing coffee and beer) and the overwhelming abundance of salt and sugar in the standard American diet may explain the danger of increased exposure to dietary salt.

Conclusion

It is not surprising that decreasing daily dietary salt intake will help in treatment SSH. However, what we learn from the classics and the physiology of salt in the body is that Kidney tonification is essential for SSH.

Because the Earth element has become so affected by this chronic exposure to salt, purging the Earth of excess with the bitter flavor will be important. Like a lone neuron in the brain, salt consumption is entangled in the higher social structures that predominate our times: working long hours, using the mind instead of physical labor for generating a living, exposure to a barrage of psycho-sensory information in terms of television, music, and people, along with increasing anxieties about all of it. Seen in this context it really is no wonder why SSH is a modern disease of the “developed” world.

Brandon Brown

Salt Sensitive Hypertension and Classical Chinese Medicine, Part 3

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This is the second part in a three part guest article series by Brandon Brown, student at National College of Natural Medicine and Chinese medicine blogger. You can access the first part of the article which covers salt in the macrocosm – nature. I should note that he has posted references for the entire series on his blog, you can access those references by clicking on this link. -Eric

Salt in the Microcosm

By preserving meat with salt, mankind was unknowingly creating a vicious cycle that would change the health of all people up to the present day. It is estimated that before the advent of this preservation technique people consumed no more than 0.5 grams of naturally occurring salt per day (g/d). After brining was put to use, daily consumption jumped to an estimated 10 g/d (because even though the meat is soaked in water to reconstitute it, no amount of soaking can remove a large amount of salt). This continued to climb throughout the centuries, upwards to nearly 18g/d (some estimates in Scandinavia indicate consumption near 100g/d) until the advent of refrigeration techniques which brought estimated consumption back down to its present day levels of 10 g/d. It is hypothesized that one reason for the stabilization at 10g/d instead of 0.5g/d is the addictive nature of salt: in the presence of continued salt loads the taste receptors on the tongue down-regulate their sensitivity to the salty flavor. However, as we will see, salt plays a crucial role in the nervous system, and it could be this current cultural bias for all things cerebral that creates our hunger for the briny crystal.

One of the most prolific cellular mechanisms in the body is the sodium-potassium pump. These pumps are found in a number of cells throughout the body, but most importantly in the nerve cells of the Central Nervous System. This mechanism, called Na+/K+-ATPase, regulates cellular chemistry and polarity by using ATP to remove 3 Na+ intracellular ions and replace them with 2 K+ ions. Na+/K+-ATPase is the mechanism that is responsible for the nerve’s ability to achieve the resting potential of approximately -70 mV by removing a net positive charge from the intracellular fluid with each pumping action. The creation of this potential primes the neuron to do work, in this case to release its charge as a rush of electrochemical ions, creating a signal that releases neurotransmitters at the terminal end of the neuron. The charging of this battery comes at a cost of a single phosphate group from ATP (converted to ADP). Because the pump is operating against the normal flow of the concentration gradient, energy is required to create this potential difference. This process is such that a large differential between sodium and potassium is created:

Table 1: Concentration of fluids by ion type (mmol/L)

Therefore the exterior of the cell is essentially salt water (NaCl), and the interior of the cell is largely dissolved potassium ions.

This is striking for a couple of reasons. First, in the resting state we see that salt water is kept on the outside of the membrane and only when an action or graded potential occurs is it allowed to rush into the cell. To reach the resting potential the cell must actively store potassium, and excrete sodium. In other words, the movement of salt (in this case sodium) into the cell causes the transmission of an electrochemical action potential. It is this action potential that is thought to give rise to all cognition and movement in the body. The axon, the long transmitting portion of the neuron, propagates the signal through voltage controlled sodium channels. The inward movement of salt is giving birth to movement and thought, whereas the expulsion of salt promotes stillness and thusly, stores great potential.

Secondly, the regular and crystalline lattice structure is perhaps more than metaphorical. In cognitive neuroscience, most theories of the mind involve describing the geometrical structure of the neural lattice as an explanation of functional capabilities. For example, the visual cortex is organized in columnar functional groups that serve to detect edges in the visual field. The creation of memory involves creating a new pathway on an already established lattice. Therefore, as sodium enters the cell it gives its organizational properties over to the cell to provide for the creation of new synaptic connections and lattice-like structures. The lattice-like structure of the salt is reflected in the lattice-like structure of the brain.

Figure 2: Columnar structure of neurons in the visual cortex and the octahedral geometry of sodium chloride

In terms of SSH research, it seems that excess dietary salt may not only change the sodium levels in the plasma but also in the cerebrospinal fluid, inhibiting Na+-K+-ATPase in both locations, perhaps giving rise to cognitive changes (Khalil 2005).

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In the next and last installment of this series, Brandon discusses salt from the perspective of Classical Chinese texts and brings the various ideas together. Please look forward to it tomorrow. -Eric

Salt-sensitive hypertension and Classical Chinese Medicine, Part 2

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Editor intro

This is a Guest Post by 3rd year Classical Chinese Medicine student (and Chinese medicine blogger) Brandon Brown.  Brandon is a friend of mine and an excellent student.  He approached me with this paper and I immediately knew it would be a fantastic contribution to the site as many folks have asked me for rigorous examinations of the cross-pollination between Western and Chinese science as expressed in medicine.  This will be a 3 part series released over the next 3 days, please feel free to leave comments – Brandon is a regular reader of the site.  I should note that he has posted references for the entire series on his blog, you can access those references by clicking on this link.  -Eric

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Author intro

The following three posts are from a paper I wrote in the Winter of 2008 for Dr. Edward Neal’s Clinical Physical Diagnosis course at NCNM. It is my attempt to apply classical Chinese medical knowledge to a modern disease processes that is pervasive, salt-sensitive hypertension. In looking at all modern diseases, I believe it is extremely beneficial as CCM practitioners to understand the patho-mechanism as presented to us by current research in Western materialism. Because yang (energy) leads and yin (substance) follows, by knowing the yin we can garner important clues that can allow our yang treatments to strike with more clarity, force, and efficacy. I welcome your thoughts and comments. – Brandon

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Salt-sensitive hypertension : Western science and the macrocosmic view

“The highest good is like water, it settles in the lowest place where people do not like to be.”

Dao De Jing

It is estimated that salt-sensitive hypertension (SSH) accounts for over two-thirds of people over 60 who have primary hypertension . Though there are genetic variants to the tolerance of the amount of salt that effects hypertension, dietary sodium is considered the most important environmental influence. This begs the question: why are some people who are hypertensive experience a salt sensitivity and others do not? The answer to this question may lie in the theories of Chinese Medicine and in the fundamental nature of salt, and its relationship to water and the Kidney. I will first give a summary of hypertension in western terms and discuss current research theories.  Following this, I will discuss salt: cultural symbology, the natural formation, and specific references in the medical classics. By so doing, I hope to show how an ancient medicine sheds important light on this modern disease, through the connection of the Kidney and the Heart.

Hypertension – a more Western perspective

Primary hypertension is defined as chronically elevated blood pressure where systolic arterial blood pressure consistently exceeds 140 mmHg or greater. To be considered primary, the hypertension must be idiopathic, and not due to secondary factors such as kidney disease or adrenal tumors, for example. Primary hypertension is considered to be a major risk factor for strokes and cardiovascular disease, and is a leading cause of chronic renal failure . Heart disease is the number one killer in the United States, leading to well over half a million deaths per year.

It was observed in a strict rice and low-sodium diet study performed in 1944 that patients with kidney disease and hypertension were able to lower their blood pressure by as many as 100 mmHg in some cases .  Current theories of the pathological mechanism of SSH posit abnormalities in renal sodium transport in the nephron structure of the kidneys . The cause for these kidney abnormalities are thought to be caused by both genetic and environmental factors. Because salt generally attracts water through osmosis, increased blood sodium not excreted by the filtering mechanisms in the kidney causes an increase in the water content of the blood, thereby causing the vessels to swell.  This increased swelling, is an increase of “total peripheral resistance of the vasculature”, and is thought to create a long-term load on cardiac output ultimately leading to heart failure. Therefore, we can say that the presence of salt in the blood pushes out from the inside. This is contrary to the renin-angiotensin mechanism of the Kidney, which vasoconstrics and thus pushes in from the outside.

Salt in the Macrocosm

“Ye are the salt of the earth; the best of the human race.”

Jesus Christ in Matthew 5:13

The creation story of salt begins with fresh water falling from the sky as rain, and landing on the elevated earth. The nature of water is to always seek the lowest point of any terrain. The rain water falls on the hills at first as drops, which coalesce to form a trickle, which then join to form streams and these eventually join to form massive rivers, which empty into the sea.  On this journey, constant erosion takes place as minerals are stripped from the earth and mountains and carried to the ocean. Because of its polar nature, water acts as a solvent to all matter.  Place any material in water, and given enough time, transformation will occur. Metal will rust, vegetation will decay, and other liquids will eventually diffuse and become one with the water. The mineral rich streams, which still taste like fresh water to us, empty into the vast oceans that today are heavily salted and totally unpalatable, even though they are only 3.5% salt . The oceans continue to accumulate more and more salts because over millions of years evaporation extracts the water from the ocean, but not the minerals.  The minerals are too heavy and earthbound to be steamed up to the heavens. This process is depicted in Figure 1.

Figure 1: The generation of saltwater

Of special interest in Figure 1 is how it reflects the generating cycle of the 5 Phases (五行). That is, Water falls from Heaven onto Earth and Metal, flowing down to Water, where through the energy of Fire, the fresh water is evaporated upwards toward heaven by the process of Wood. What is left behind is a storehouse of salt. Because of this, we would expect to find that places of warmer climate would have oceans with higher salt content. This is in fact the case, as places such as the Mediterranean Sea have a much higher salinity than that of cold water oceans (the Arctic and Northern Pacific, for example).

Salt is very much a dissolved solid from the Metal sphere. It is highly organized and crystalline, and looks almost identical to ice (Figure 2). Salt was the first currency of the civilized world, due to its value as a preserver of meat. As Richard Manning writes in Against the Grain, it was the ability to preserve and store meat which essentially lead to the creation of wealth and signaled the shift from nomadic hunter-gatherer societies to those of sedentary agrarian caste systems.  Earlier than 800 A.D., the Yellow Emperor himself is said to have fought the very first war over the precious commodity . In 450 B.C., iron was put to use to boil sea water in huge pots to extract salt, a method that was used for the next 2000 years. By expediting the evaporative process, larger amounts of salt could be garnered more quickly and thus a greater amount of wealth could be amassed. Even in these ancient times salt stored, or preserved, wealth. To this day, the word “salary” comes from the Latin “salarium”, or “to be payed with salt.”

Not surprisingly, then, salt as a symbol of wealth came to symbolize all that is good. It is common practice to throw salt over the shoulder to ward off the devil, sumo wrestlers throw salt in the wrestling ring to purify it before a match, and placing piles of salt in tombs purifies the soul’s journey from earth to heaven, for example. Throughout history and across the world, in almost every culture, salt has been used in religious, medical, and cultural contexts to purify and clean the soul and the body from evil and disease . Ultimately, however, it is argued that salt is a often a cultural metaphor for semen, and the essence of man.

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In the next article in this three part series, Brandon will dive into the microcosm – discussing the mechanisms above as they reflect into the human body.  Look for it coming soon.

Salt-sensitive hypertension and Classical Chinese Medicine, Part 1

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