May I See Your Tongue, Please?

by Johanna Utter, L.Ac., FABORM

May I See Your Tongue, Please?, Johanna Utter, L.Ac., FABORM in Davis, CA

"May I see your tongue, please?"

Have you ever wondered what I’m looking for when I ask to see your tongue? In Chinese medicine, the tongue is thought to be like a map showing the health of the body, similar to foot or hand reflexology charts where different areas correspond with different parts of the body. When looking at the tongue, It’s best to view it in natural light, if possible. I need to look at it relatively quickly, because the tongue body will start to become more reddish-purple the longer that it is stuck out.

So, what exactly am I looking for? I am assessing the color, size, and shape of the tongue body, as well as the color, thickness, and distribution of the tongue coating. A normal tongue is pink (or light red), with a thin, white coating.

What does it mean if your tongue doesn’t look like that? Some variations indicate a condition affecting your whole body, while others may just be associated with a particular are of the chart.

For example, the tip corresponds with the chest (Heart and Lungs), the center part with the middle of the abdomen (Stomach and Spleen), the back corresponds with the lower abdomen (Kidneys and Intestines), and the sides correspond with the Liver and Gall Bladder. All of these organ names refer to the understanding of functions of organs and channels within Chinese medicine, not necessarily their Western anatomical counterparts.

Tongue body colors might be: pink or light red (normal), pale (deficiency), red (heat), or purplish (stagnation). A red tip is often associated with poor sleep, although it may also be due to heat damage to the Lungs from an illness or smoking. Sometimes there are raised red or purplish dots, which shows that there is more longstanding Heat or Stagnation.

Tongue coating that is thick usually indicates Dampness, often caused by a weak digestive system. A yellow coating indicates Heat, a “map” or “geographic” coating or no coating can mean a lack of fluids in a particular part of the body. A gray or black coating that is not due to a medication, such as Pepto Bismol, indicates a more serious problem.

Tongue shape: thin can mean a lack of fluids, swollen can be excess Dampness, toothmarks can either be from Dampness or a deficiency. Shaking indicates Wind, but can also show up with anxiety. Some cracks are congenital, but generally cracks indicate a more chronic lack of fluid.

Some practitioners also look for sublingual veins (swollen veins on the underside of the tongue.) The more prominent the veins, the more longstanding the stagnation.

The tongue is just one part of the diagnostic process. I put together my observation of all the different parts of the tongue: body color and shape/size, coating, and sublingual veins, along with what I observe about a person's overall physique, what I feel in the pulse, and their responses to my questions to form a diagnosis. Although Chinese medicine uses some very basic tools of assessment, they are based in thousands of years of empirical evidence.

Year of the Earth Pig

by Johanna Utter, L.Ac., FABORM

Year of the Earth Pig, Johanna Utter, L.Ac., FABORM in Davis, CA
It's the Year of the Earth Pig!

The Lunar Year of the Yin Earth Pig began February 5, 2019. The system of 12 animals combined with the five elements creates a 60-year cycle, with the Pig as the final animal of the cycle. The end of each 12-year cycle means that there is a lot of energy around completion and concluding things, so it’s a great year to finish projects, even if they are not done perfectly!

The Chinese character for ‘home’ is a roof with a pig under it. The Pig is the ultimate symbol of nourishment, nurturing, and generosity. The qualities of the Yin Earth Pig make it a good year to focus on home, farming, health, good food, rest, relaxation, and comfort. It’s a time to visit with family and friends, cook family recipes, do home projects, work in the garden, and revel in the senses. Enjoy yourself! Pig energy can be somewhat sedentary, so weight gain is likely this year, so light exercise, massage, stretching like yoga, Pilates and Tai Chi and walking are also good and enjoyable forms of exercise.

Paying attention to relationships of any kind will be important: family & friends, community, internal affairs, diligence, infrastructure, healing, compassion, introspection, social justice, conflict resolution, reconciliation and truth. Resolve past conflicts and practice forgiveness, lovingkindness, and compassion for yourself and others.

While this is a year to focus on family, friends, and community, it’s also a time to dig deep and start exploring the inner workings of your mind, the nature of who you are, and how you show up in the world. This is a time when that which has been hidden gets rooted out and comes to the surface.

The main goal of the year is contentment and enjoyment of life. Develop strong rhythms and routines, resting and healing to prepare for the next cycle, all while having fun and enjoying the moment!

Falling Into Bed By 10

by Johanna Utter, L.Ac., FABORM

Falling Into Bed By 10, Johanna Utter, L.Ac., FABORM in Davis, CA

Fall has always been a time of new beginnings for me - the start of a new school year with new teachers, classmates, classes, and the return to a more regular schedule after the freedoms, expansiveness, and later bedtimes of the summer. As we move into fall, I’m noticing that sunset is coming noticeably earlier and I’m starting to feel a pull to wrap up my evenings and go to bed earlier.

And until the advent of artificial light, this is what people have always done – we’ve followed the rhythm of the sun and the seasons. Despite the many wonderful advances in technology and artificial lighting over the past couple hundred years, our bodies have not caught up; biologically, we still follow the same circadian rhythm as our ancestors did centuries ago.

So, what is the circadian rhythm? It is a roughly 24-hour cycle of day and night, of activity and rest, which affects not only humans, but also animals, plants, fungi, and even cyanobacteria. In humans, the circadian rhythm affects the sleep-wake cycle, fluctuations in core body temperature, heart rate, and many cellular processes. Two important hormones for circadian rhythms whose levels fluctuate daily are melatonin and cortisol. Their rise and decline complement one another, just like the two halves of the Yin/Yang symbol.

Melatonin is secreted by the pineal gland in response to the decreased light that normally happens in the evening; its levels rise about two hours before bedtime and are naturally highest at night. The body’s melatonin production is suppressed by exposure to sunlight in the morning and to blue LED light (found in electronic screens any time of day), so it’s important to limit the use of screens in the evening. Synthetic melatonin is often suggested for people who have trouble falling asleep. The proper dosage, according to a 2001 study from the Massachusetts Institute of Technology, is 0.3 milligrams, about 1/10th of the amount in most pills or supplements. Because melatonin supplements are used to reset the body’s circadian rhythm, they are useful for jet lag, but should not be taken more than a few days. Do not use melatonin if you are pregnant or breastfeeding or have an autoimmune disorder, a seizure disorder or depression.

Cortisol, a hormone secreted by the adrenal glands, rises rapidly in the early morning, allowing us to be awake and alert, and gradually declines during the day, causing us to get sleepy at night. Its levels are highest in the morning. Cortisol levels also increase due to acute stress (think of the burst of energy you get when in “fight or flight” mode), during periods of chronic stress, and in response to meals. High cortisol levels can contribute to insomnia. Cortisol also spikes in response to caffeine. So when you drink coffee or tea to get going in the morning, you are artificially raising your cortisol levels to induce the hormonal response your body would normally produce on its own with sufficient sleep.

Fall, with its association with new beginnings, is the perfect time to introduce new routines and establish healthy rhythms. Having regular habits, such as going to bed and getting up at a regular time, helps your body to anticipate what’s coming next and to develop stability and reserves for future stressors. More sleep improves energy and balances hormone levels. This year, I invite you to join me in getting yourself to bed by 10 pm and together we'll see what a difference it makes.

Acupuncture and Trauma

by Johanna Utter, L.Ac., FABORM

Acupuncture and Trauma, Johanna Utter, L.Ac., FABORM in Davis, CA

We’ve been hearing a lot in the news recently about trauma and its long-lasting, damaging effects, but what is trauma and what does it have to do with acupuncture?

The word “trauma” comes from the Greek word for “wound”. A trauma can be a physical injury or a deeply distressing or disturbing experience, or it can be the emotional shock following a stressful event or physical injury. From a psychological perspective, traumatic experiences are those that are emotionally painful and distressing and which overwhelm an individual’s capacity to cope. An experience of powerlessness is a primary trait of traumatization.

Following an initial trauma, a person may be left with intrusive thoughts, memories, flashbacks, and nightmares, triggering the “fight, flight, or freeze” response. They may feel unsettled or unsafe and startle easily, becoming hypervigilant. Or they may struggle with anxiety, panic attacks, or depression. Sleep disturbances are common, as are changes in appetite, either too much or too little. Pain is often a result of trauma - pain from injuries, direct trauma, or severe migraines. Because a person may be hypersensitive to and easily triggered by certain sights, sounds, smells, or physical sensations, they will often withdraw from others or public places or restrict the type of activities they do so as to avoid the things that trigger them.

One of the most common ways that trauma is manifested is in chaotic emotions such as fear, anxiety, rage, guilt, and shame. In addition to trauma’s effect on emotions, traumatic experiences may also be stored in the tissues of the body as tightness or pain. Physical and emotional trauma can affect the mind, causing difficulty concentrating, remembering, or thinking clearly. Some people who’ve experienced trauma may not consciously remember the trauma, but their bodies do.

Some seek to numb the pain by using drugs, alcohol, or food. My first acupuncture job was doing detox work for Yolo County Drug and Alcohol and I was surprised to find out just how many of my clients had histories of trauma or abuse. Now we know about the connection between Adverse Childhood Experiences (ACES) and addiction, but at the time it was more commonly thought of as something to which people were genetically predisposed. While there is a hereditary component to addiction, it’s unclear how much is due to epigenetics and genes being turned on/off by the body’s response to trauma.

There is no clear pharmacological treatment for trauma and PTSD. Current treatment includes antidepressants, anti-anxiety, and antipsychotic drugs, cognitive behavioral therapy (CBT), and counseling.

Chinese medicine is primarily concerned with restoring balance to the mind and body and employs many techniques to bring extreme emotional and physical responses back into balance. In Chinese medicine, there is no separation between body, mind, spirit, and emotions; for centuries they have been viewed as a seamless whole - disharmony in one affecting the others. Because of this connection, by treating areas of the body affected by trauma, acupuncture can help release and heal the emotional pain held in the body.

One of the major benefits of acupuncture for trauma is that it helps to switch the autonomic nervous system, which regulates the body's unconscious actions, out of the sympathetic nervous system (“fight, flight, or freeze” response) into the parasympathetic nervous system (“rest and digest” mode). Acupuncture helps to provide relief from the incursion of stress hormones, allowing the body to rest and to begin the process of healing

Acupuncture can help with many of the symptoms that contribute to disrupted sleep patterns: anxiety, trouble falling asleep, nightmares and/or night-terrors. Many people report sleeping more deeply after an acupuncture treatment, even if they don’t have insomnia. For those with chronic trouble sleeping, regular acupuncture treatments can make a big difference.

A study published in June 2007 in the Journal of Nervous and Mental Disease that showed that acupuncture “provided large treatment effects for PTSD” similar to those seen after counseling and therapy. According to the study, acupuncture was able not only to reduce PTSD symptoms, but to keep reducing those symptoms even three months after treatment ended.

Acupuncture for trauma can be done in either private or group settings. Treatment in a group setting usually involves an ear treatment protocol because it is easy to administer while patients are seated in chairs and does not require the removal of clothing.

Acupuncture is currently being used to treat trauma and PTSD by Acupuncturists Without Borders (disaster relief) and by the US military (veterans).

Regardless of when a traumatic experience happened, the impact on a person’s life can be profound. Acupuncture is a safe, effective, and drug-free way to help people recover from the effects of trauma and return to living happier, fuller lives.

Fibromyalgia and Chinese Medicine

by Johanna Utter, L.Ac., FABORM

Fibromyalgia and Chinese Medicine, Johanna Utter, L.Ac., FABORM in Davis, CA

What Is Fibromyalgia?

Fibromyalgia is a chronic condition characterized by widespread musculoskeletal pain accompanied by fatigue, difficulty sleeping, and memory and mood issues.

Fibromyalgia is thought to affect up to 6% of the population, particularly middle-aged women, although it can start as early as the teen years. Most people will experience symptoms for the rest of their lives, however, many may experience periods in which their pain and fatigue lessen.

You May Have Fibromyalgia if You Have...

  • Widespread muscle and joint pain
  • Fatigue
  • Muscle pain, burning, twitching, or tightness
  • Low pain threshold or tender points
  • Trouble concentrating and remembering, often called "fibro fog"
  • Insomnia or not sleeping well
  • Feeling nervous, worried, or depressed
  • Belly pain, bloating, queasiness, constipation, and diarrhea (irritable bowel syndrome)
  • Headaches
  • Dry mouth, nose, and eyes
  • Sensitivity to cold, heat, light, or sound
  • Frequent urination
  • Numbness or tingling in your face, arms, hands, legs, or feet

What Causes Fibromyalgia?

The cause of fibromyalgia is unknown, but it seems to run in families and most often affects women. It may be triggered by a combination of factors such as infections, genetics, trauma, stress, hormonal fluctuations and lack of physical activity. Anxiety or depression are not a cause of fibromyalgia, but usually make the pain worse.

Although fibromyalgia has not been shown to be an autoimmune disease, having a rheumatic condition like lupus or rheumatoid arthritis may increase your risk.

How Is Fibromyalgia Diagnosed?

Fibromyalgia can be difficult to diagnose because there isn’t a lab test that can detect fibromyalgia. Its symptoms are similar to some autoimmune disorders, and in many cases, fibromyalgia occurs simultaneously with them.

How Does Conventional Medicine Treat Fibromyalgia?

There is no known cure. It is most often treated with drugs, cognitive behavioral therapy, and stress-relieving techniques, such as muscle relaxation, deep breathing or meditation.

There's Hope!

Chinese medicine can be extremely helpful in treating the pain and other uncomfortable symptoms of fibromyalgia .

  • Acupuncture reduces pain, improves blood flow, increases endorphins, and restores healthy body functioning.
  • Chinese herbs decrease pain, relieve stress, and improve energy, sleep, and digestion.
  • Treatment is holistic, individualized, patient-centered, and empowering.

What to Expect from Treatment with Chinese Medicine

  • gentle, non-invasive, personalized treatment
  • less pain
  • reduced stress
  • better digestion
  • more energy, strength, vitality
  • improved mood and well-being
  • improved immunity and reduced inflammation
  • increased comfort

Depending on the severity of symptoms, treatment may be more frequent in the beginning, and less frequent as things improve.

How Can You Help Yourself?

  • Regular weekly acupuncture treatment
  • Chinese herbs prescribed by a licensed herbalist
  • Regular, moderate exercise to improve blood flow, reduce pain, increase endorphins, and improve mood. Try yoga, Tai Chi, Pilates, walking, or exercising in a warm water pool.
  • Regular bed and wake-up times. Reduce the use of screens in the evening and be in bed by 10 pm.
  • Regular rest. Lie down for 20 minutes a day.
    An anti-inflammatory diet, rich in vegetables and lean protein. Avoid sugar, wheat, dairy, alcohol, caffeine, processed foods, artificial sweeteners, and nightshades. Add fish oils, coconut oil, olive oil, avocados, and grass-fed meats.
  • Regular mealtimes
  • No cold, frozen, or raw food or drinks.
  • Stress reduction, such as meditation, relaxation
  • Pace yourself. Practice moderation, set limits, and learn to say no, especially to things that drain your energy.
  • Massage

Chinese Herbs

by Johanna Utter, L.Ac., FABORM

Chinese Herbs, Johanna Utter, L.Ac., FABORM in Davis, CA
Although most people come to see me for acupuncture, it was my interest in herbal medicine that initially drew me to study Chinese medicine. I was recently asked to share more about Chinese herbs, how I use them in my practice, and what kinds of things they treat.

While studying Chinese medicine in school, I had 4-5 semesters each of classes on different topics: Chinese medical theory, acupuncture, and herbs (individual herbs and formulas.) Herbal medicine is the oldest form of medicine in every culture around the world. Medicinal substances fall on a spectrum from those that are mild and used as food, to those that are stronger and used more as medicine. Some examples of therapeutic foods include herbs that we use in cooking, such as garlic, ginger, cinnamon, nutmeg, cloves, mint, turmeric, and fennel. Not only do they make food more flavorful, they have additional benefits, such as killing parasites, improving circulation, and aiding digestion. In traditional Chinese dietetics, foods are considered one of the most basic types of medicine and are categorized by their effect on the body. For example, pears have the effect of clearing heat, moistening, and clearing phlegm from the Lungs.

When I was in school, we would write and mix up individual bulk herb formulas for patients based on our diagnosis. We would often choose a basic formula (like a recipe) as our starting point, then add, subtract, or change amounts of herbs based on that patient at that moment. As their symptoms would change or disappear, our formulas would also change. In Chinese medicine, the goal is not to put a patient on a formula and keep them on it to “manage” their symptoms or condition, but to elicit a change by treating the root of the problem.

Bulk Chinese herb formulas are usually given as a tea or “soup”. Most of these are cooked as a decoction in water for about 45 minutes and are strong-smelling and tasting. Patient compliance is not always very good with those! For that reason, I primarily use herb pills and tinctures. They are easy to use and in a form that is more familiar to most of us. The downside is that the proportions of herbs in the formula cannot be changed and the formula cannot be customized.

We are used to thinking in a relatively simple way, that this herb is good for this particular problem, but the way herbs work is far more complex than that. A formula will affect the entire body, not just one part.

In western medicine, we tend to think of a particular drug being good for a particular problem. Chinese medicine thinks about it differently: a Chinese medical practitioner makes a diagnosis for each person and treatment is chosen accordingly. Not everyone with the same problem (back pain, for example) will have the same diagnosis in Chinese medicine, and so are unlikely to have the same herbs. Just because an herb is “good” for a particular condition does not mean that it is a good match for each person with that condition. Just because herbs are natural, not all are necessarily safe to use indiscriminately. Treating yourself with herbs is not easy, which is why it’s usually best to consult with an herbalist.

Herbs can be used short-term, like antibiotics, or they can be used long-term for more chronic problems. Chinese herbs are categorized based on their function. Those that are in the “Tonifying” (strengthening) category are like taking vitamins or using a drip irrigation system. A little bit taken over a longer time is able to be absorbed more easily and benefit your body more than a massive dose taken once.

What kinds of conditions can be treated with herbs?
Just about anything: Insomnia, PMS, hormonal imbalances, digestive problems, joint pain, low energy, mood disorders, menstrual problems, infertility, blood pressure, urination problems, fibromyalgia, colds, allergies, immune system issues.

Can I use herbs if I’m taking medication?
It depends. Acupuncture is always safe to use if taking medications, but herbs may not always be appropriate.

Why do I have to take so many pills?
Chinese herb teapills are not as strong as most pharmaceuticals. This makes it much easier to vary the dosage, especially for children or more sensitive people.

I would be happy to have a conversation with you if you’ve ever wondered if herbs might be of help.

Sleep Essentials

by Johanna Utter, L.Ac., FABORM

Sleep Essentials, Johanna Utter, L.Ac., FABORM in Davis, CA

All living things on earth are affected by a circadian rhythm - a 24 hour rhythm of light and dark, of activity and rest. With the advent of the industrial revolution and electricity over the past 200 years, our society has rapidly changed from an agricultural society to an industrial and technological society. Despite our living in a culture that operates 24/7, we are biological beings and our biology hasn’t kept up with technology. To balance the fast pace of the technological world in which we live, deep, peaceful, restorative sleep is more important than ever.

Sleep is just as important as good nutrition and physical activity. What happens when people don’t get enough sleep? Ask any new parent and they’ll tell you that they are exhausted and have difficulty thinking clearly. Over time, our emotions are affected and we are more likely to experience increased irritability, anger, frustration, and impaired judgment. Our culture has a kind of machismo around sleep, that somehow it's not necessary. Some people boast of needing only 5 or 6 hours of sleep a night, yet sleep deprivation is a serious problem, not only affecting an individual’s health, but also that of our whole society.

Sleep enhances our memory and our learning capacity. It inspires creativity, helps rebalance emotions, refreshes our cardiovascular health, regulates metabolic and glucose processes, boosts our immune system, resets our brain and body health. And, there is a direct link between mental health, emotional stability, and lack of sleep. Decision-making, reaction time, situational awareness, communication, and memory are impaired by 20-50% when we don’t get enough sleep.

Sleep is one of the most effective things you can do to improve your energy, mood, metabolism, and cognitive abilities. During sleep, cerebrospinal fluid circulates through the brain at a very rapid pace, washing away waste proteins that are toxic to brain cells. This may explain why we don't think clearly after a sleepless night or why a prolonged lack of sleep can actually kill an animal or a person. One of these waste proteins is beta amyloid, the substance that forms sticky plaques associated with Alzheimer’s Alzheimer's and all other diseases associated with dementia are linked to sleep disorders.

Insomnia, which includes difficulty falling and/or staying asleep, is the most common sleep disorder in adults. It affects mood, memory, fatigue, and concentration because the arousal and emotional centers remain active. It is more common in women than in men, increases with age, and leads to sadness, depression, and brain fog. Sleep insufficiency is associated with risk for the development of most psychological disorders, including depression, anxiety, and PTSD.

Conventional medicine most commonly offers some sort of sleeping pill, yet most of those have sedative side effects that linger the following day. These medications are a temporary solution as insomnia usually returns once they are discontinued. Chinese medicine, on the other hand, works to restore the body’s normal functioning, and acupuncture and herbal treatment change as sleep improves.

The other main therapy used most frequently is cognitive behavioral therapy (CBT), and its results are longer-lasting. Although the suggestions may seem counterintuitive, most people who try them find that they make a big difference after 3-4 weeks. The principles of CBT are:

  • Reduce your time in bed.
  • Get up at the same time every day.
  • Don’t get in bed unless you’re sleepy.
  • Don’t stay in bed unless you’re sleeping.

Repeated insomnia predisposes people to adverse psychological outcomes. For example, while military veterans are trained to learn how to deal with challenging situations, they receive no training on how to calm down. Sleep hygiene or discipline can be helpful in reducing the incidence of hypervigilance.

Sleep Hygiene

  1. Regular bed and wake times.
  2. Keep the bedroom dark.
  3. Keep the bedroom cool.
  4. Keep the bedroom quiet.
  5. Keep media and technology out of the bedroom.
  6. Make the bedroom a safe haven.
  7. Avoid alcohol, cigarettes, and caffeine.
  8. If you wake, get out of bed and go into another room. Keep the lights low and do something boring until you get sleepy, then go back to bed.

Shift workers
People who work at night (swing or graveyard shifts) are more likely to have problems with diabetes, high blood pressure, and lose their body’s ability to control blood sugar properly as both insulin and glucagon are affected. Diabetes is essentially too much sugar in the blood. The body likes to regulate its blood sugar within a very narrow range. Too little of it and we lose consciousness, since sugar is the fuel of the brain. Too much of it, and it becomes toxic, destroying nerves and damaging the kidneys.

Sleep & TCM
Chinese medicine teaches us to live in harmony with our environment, which means honoring the signals of our body, as well as the season. In past centuries, people rose and went to bed with the rising and setting of the sun. Our 24-hour day is divided into night and day, and in Chinese culture, these correspond with Yin and Yang. It is normal and desirable to be awake and active during Yang time and quiet and sleeping during Yin time. Problems arise when activity and rest are not balanced.

Chinese medicine is very effective at treating insomnia, fatigue, irritability and other mood changes, unclear thinking, and can also help reduce hypervigilance.

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