Overweight – purge through sweating. Exercise within capacity can be measured by being able to speak while doing aerobic exercise or monitoring on a scale of 1 to 10). 1 is lying down and 10 is running flat out.

Then there is strengthening the spleen and removing damp from it (my major challenge).

The other dimension is the emotions – wood invading earth often enough. In the traditional way this was handled through meditation and directions about what to meditate on. Psychotherapy, affirmations and much else can fit here. Most of us in modern societies know the information on eating well. It is not information and rationality that is at issue – the reasons for overweight are other than this.

The one simple thing I’ve found most helpful in change is to keep a log. It helps to keep it in my mind all day – even if I only write in it once a day (or even when I forget).

Welcome back to blogging. Looking forward to how you go with this.

In the words of Dr. Shen, “If you can make a rule about it, it is not Chinese medicine.” I think it’s important to remember that the body, when pushed past its current comfort level, the body responds by changing its structure to match, whether we’re talking about organ function or muscular function. The amount of course is very dependent on the person we’re talking about. For example, my dad has been bodybuilding as his form of exercise for many years. Excepting a recent arrhythmia problem (which I would attribute more to some recent non-exercise related difficulties)not only is he healthy as an ox from any diagnostic POV I threw at him (including pulse) has less muscular tension in the typical American locations (UB/GB channels) than anyone I know, despite working a sedentary job.

Xingyiquan, despite having the reputation as being a “gentler” exercise, certainly doesn’t feel very gentle. In fact, it feels like it’s going to kill you. Yet, it has very strong changing effects on all parts of the body like Yi Jin Jing practice (which is also not an exercise I’d call particularly restful).

Yang family TJQ (from the Yang Cheng Fu/Yang Shou Zhong lineage) puts a pretty significant muscular and tendon strain on you in the early going. You have to be strong to do the form-often in places you aren’t used to using-and you’re going to be really sore until such time as your body catches up to what’s required of it. it’s not as bad as XYQ is of course, but its a lot more taxing than the Qi hugger YMCA TJQ you normally see.

Also I would add that (FWIW) Yang Jwing Ming theorizes that mechanical stress on the bones causes creation of bioelectricity.

Um, right, my point…physiology differs from person to person, patient to patient. Since we can’t hand out a universal herbal formula, diet food, or point prescription, neither can we make gross generalizations about exercise and expect them to be accurate. Now obviously there are BAD practices that you shouldn’t be doing (I want to get my hands on the pulse of a population sample of everyone in Orlando with “26.2″ bumper stickers)which you’ll see by the results on the people who do them. Otherwise, I support a certain amount of limit-pushing balanced with recovery time/methods and balance elsewhere.

I know I don’t know much yet — anyway, I think it all depends on the person. Some people are more frail while others are more muscular physically. Shouldn’t different types of exercise apply for these different types than others?

I am prone to bouts of hyperactivity if I don’t get some kind of tough exercise. Most of the qigong I’ve done hasn’t been enough for me. Ashtanga yoga will often work, but running, jumping jacks, hula hooping, long uphill bike rides and dancing all seem to work well. I come from a long line of farmers who were used to working from sun-up till sun-down, and now I’m stuck in the city where life is just really different.

I have also been really confused about the talk in school with ‘gentle exercise.’ I think that with our patients, in this city, we will have to keep in mind that there are great things that we can recommend for them. This is a very bike friendly city with lots of resources for people who have never biked before. We can become aware of the different cooperatives in town that offer free classes and bike repair help and recommend that our patients start biking to work or school, or wherever they need to go during their days.

Walking is also a major deal — I think I read somewhere that the average New Yorker walks 9 miles a day. This is a great way to commute or shop if our patients are living within the city limits. If not, maybe they could start a routine walk during the day just for the hell of it. It’s possible to get walking odometers that will track the number of miles walked every day, and that might be another thing we could recommend to over-weight or under-exercised patients.

I’m not sure what Chinese medicine says about swimming, but it’s certainly one of my favorite activites. It’s low impact but still aerobic, so I wonder what the idea is in terms of how it’s affecting the heart?? The community centers in town have low-cost memberships and many of them have pools. It’s an affordable exercise option. It’s also really nice at Mt. Scott pool during the winter time, when it seems as if the sun has completely disappeared, because they have the massive skylights over the pool.

One of the options I’ve been thinking about is just training well in qigong/yoga and then teaching classes at my office for my patients. I think this is a really great way to be a doctor as teacher.

Thanks for starting this! It’s something I’ve been trying to think about too.

Ross gets the “can o’ worms” award.

26.2=26.2 miles, as in the marathon. Marathons are BIG here. Everywhere you go there’s either someone with an oval 26.2 sticker on their car, or one of those license plate holders that says “I do 26.2.” There’s even starting to be a half-marathon fad (yes, with 11.3 stickers).

“I’d guess that the constructedness of your surface plays a role in the likelihood of disease in this case. If you have a very weak surface, I’d guess that you would quickly develop a dampness condition if you were swimming a lot… what do you think?”

Hmm…well, I think that where you’re swimming matters a lot. When I was in Hawaii, it certainly felt a lot healthier to swim in the warm ocean than it does here at one of the chlorinated community center pools. Even so, I think it all comes down to the moderation aspect as well as your constitution and whether or not you are going to stress out about the chemicals, or if you can be pretty mellow about the whole thing.

As far as the dampness, I don’t know. I’m pretty new at this whole CM thing, so tell me what you think: As far as what Jun Zhang seemed to be saying, these different qi (like the damp, wind, etc…) aren’t necessarily literal, but symbolic. I might be understanding this incorrectly, but I thought that dampness was a symbol of invasive qualities that are descending, sticky, coagulating/clotting, stinky, etc…, as well as the symptoms that pernicious qi might cause in a person. If this is correct, then swimming wouldn’t necessarily be putting one at risk for a dampness condition and could in fact be working against one.
Anyway, I’m going to think about this some more. It seems complicated!

Wow, great article. I was once a body builder and I was sick all the time and even though I looked great I never really felt great. Now with less time I still get exercise but I don’t try to make huge muscle gains and I feel much better. Maybe there is something to this!

Hi Condo tremblant,

Yes, that type of thinking is inconsistent with classical Chinese medicine theory that we learn at school and by studying the classics. The heart is emperor, and we must always protect and serve the emperor of the organ systems. Sweat is the fluid of the heart, and we think of sweating frequently and too much as a bad thing b/c it depletes the heart yang/qi as well as the yin/fluids leading to a state of deficiency over time. Sounds like your practitioner’s philosophy is not rooted in the classics. Chinese medicine does not usually promote vigorous activity like running, but rather more subtle exercise like qigong. People can certainly die from overworking the heart and losing too many fluids, no matter how fit.

-Delli

It’s been a while (if ever) that I posted a comment here but I check in and like reading your articles.

I highly agree that every patient is different and while the classics might point in a direction of no vigorous exercise, that was written at a time where people did more physical exercise on a daily basis. In a day and age when walking miles for food/water, handwashing, building your homes, taking care of farms and animals, ect.. compared to now?

Vigorous exercise might be called for in some patients but I have seen a trend of over-exercising in an almost manic pace. “Why does this hurt?? I exercise all the time??” Blown out knees from running excessively, spine issues from lifting extreme weights. The physical body can only take so much.

I recommend swimming to many patients. Mostly they are to addicted to their personal activity.

Tiffany

Hi Sunny,

I have to say I am perplexed by your response. Could you please explain what you mean by “Classical medicine has a purely atomistic view of human body and its processes. Unfortunately, it cannot really see and understand the underlying forces and energies.”

Are you refering to Western medicine, Chinese medicine, something else, or both? I am not sure how you are using the term classical here. No matter which way I think about it, I still can’t see any validity in this statement. Generally speaking, ancient medicine, be it from East or West, has a better understanding of formative forces and energy, in my opinion. Today, medicine is often viewed from an atomistic view, but ancient cultures didn’t know what an atom was, because the concept was not in existence since atoms were not discovered until fairly recently in history.

Please help me out if I have misunderstood your comment or if you just said it backwards so we all can have some clarity on this thought.

Thanks,

Delli

Hi Eric

You’ve really chosen a toughie! There’s almost no info on TCM and challenging exercise, and pretty much none of it is postive.

At university they just told us that running is bad for you – it damages your Kidney Jing. Now I’m trying to write an article on the effect of long distance running on TCM physiology and there is not much for me to go on but my own observations of my patients.

When I did the London Marathon I’d had a bad back for two days, but I’d read an Osteopath’s article than running is good for your back, and even though I had to run slowly (5:10) my back felt great afterwards!! This does not exactly tie in with Kidney-Jing depletion.

However, my friend really pushed himself (ran it in 2.56) and went green and was vomiting for ages afterwards.

In a nutshell, it’s probably how hard you push yourself that makes exercise detrimental as opposed to beneficial. In terms of running this is (I think) mostly down to whether you’re in a relaxed fat-burning state or a “forced” sugar-burning state. Slow Burn is a good book to read regarding this.

I don’t know if this has helped! I’ll probably have more info after I finish my article!!!

So, we talked about this in dietetics a little yesterday, and some of what she said made sense: If you have qi stagnation (generally), then running, basketball, swimming, and other highly aerobic exercises can get your qi moving. However, if you have qi deficiency, those exercises shouldn’t be prescribed. Rather, you should be doing gentle yoga, gentle qigong and simple walking to try and rebuild your qi reserves. It makes sense that we’ve got to look at each patient differently, and each exercise as going with a different energetic quality of the Wuxing. To me, it seems like running goes with the pungent flavor type energetics because it is dispersing and moving (though I would have originally placed it in the summery categor), and so maybe goes with the Fall-time energy and the lung. If we could somehow find a place in ourselves where we can match the energetics of exercises to the wuxing classifications, we could then prescribe them the same way that we would with foods or herbs? Or, maybe that is just too simplistic?

One other thing I though of yesterday that I want to mention is that qigong can also be done at different levels of intensity. Just watch a teacher or master doing qigong with students, and it is easy to tell who is the teacher an who are the students b/c the teacher has the most focus and intensity.
The linneage we belong to at NCNM is very unique in that we do shaking to start every form. It is in the shaking part that we are releasing stagnation and evil qi from the body, so that we can empty our vessel to receive nourishment from the Heavenly and Earthly qi during the rest of the form. The shaking can be a gentle movement exteriorly with focus internally, or you can do a more vigorous shaking and focus more on the physical aspect of your body to really get the qi moving and start sweating to expel pathogens. I have done some really intense shaking that is comparable to running or playing sports if my body needs it on that particular day.
Our linneage is associated with Wood and Gallbladder since it focuses on really working the connective tissue. We are encouraged to really stretch out tendons and ligaments and exert ourselves physically as much as possible, but most students do it too lightly from my observation. We are actually trying to work our body hard in qigong, but most people don’t realize this or do not know how to do it correctly. Qigong students should seek to take every opportunity to fully exerty themselves during the movement so that they feel numb while stretching out fully. The numb feeling is actually the qi being stirred up in the channels. This is how we actually make changes and strengthen the body through qigong. Of course, this is just one aspect of qigong. The breathing and mental focus must also be part of a healthy qigong practice, not just the physical body.
Anyone who doesn’t believe qi exists or has never felt it should do 20 straight minutes of intense shaking and then slowly decrease outside movement until the the physical body is still. At that moment you will feel a strong tingling sensation throughout the whole body. This is qi. Go try it if you don’t believe me!

Also, I feel that sports are fine for kids and teens that are still growing, and thus have lots of yang. It is when we reach adulthood that we must really be careful to safeguard our qi and jing, and so depending on the individual, it might be a good idea to either stop strenuous exercise all together or do it less frequently once we reach our late 20′s.

Hi. I think it’s an interesting point regarding conditioning and the more efficient use/depletion of qi. But I also think that it’s important to consider a few things:

1. not all are created equal in terms of constitution or body condition
2. all work consumes qi and eventually jing. every organ system has qi and any work consumes it. if you work more than you rest or replenish, you deplete oneself. if you push a system hard, you will deplete its qi reserves faster
3. no matter what kind of car you drive, you use gas. whether it’s a sports car or SUV that guzzles it, or an energy efficient car that uses it more slowly. this depends on ‘body’ condition. but everyone has their breaking point. no matter who you are, if you push too hard, you will break.

So, to run 37 miles in a day can be done by one with strong constitution and conditioning, but at what cost? This is taxing no matter how one frames it. Is he strong enough to handle it, perhaps. Especially if he rests properly etc. But that doesn’t mean that significant qi wasn’t consumed here, just that he has a strong supply of it. Doing this regularly will deplete qi rapidly. I have treated many athletes in my career, marathon runners, triathletes, etc. and this always proves true.

And this is not just a question of KI qi-jing, but HT qi as well.

And this is specifically not a question of being fine right after exercise or taxing oneself. We are looking at future impact based on present taxation and even cycles of 7 and 8.

These must be evaluated from more objective means such as pulse.

Ross

These comments are great! I shall definitely consider what you said, Bex, when I write this article.

I think something that’s very important is that the adaptation of the body to exercise is not considered at all. For example – if my Mum ran for a mile now – it could almost use up her kidney-jing in one go (and she definitely wouldn’t forgive me for making her do it!!)

But my boyfriend ran 37 miles yesterday morning and is perfectly fine. So I don’t think we increase our Kidney Jing through exercise, but rather make our use of it much more efficient. I wonder if that’s why endurance exercise can have such a positive effect on bone density, fertility, life span, brain function etc… ie. have the opposite “sypmtoms” to Kidney-deficiency – as long as we increase slowly.

A point I’d like to weigh in with, though I’m certainly not pointing this particular finger at anyone here:

It is my opinion that CM doctors and students are overly conservative by nature and we tend to push that “Chinacon” attitude onto everyone around us. Because the focus of our work requires so much time in figuring out mechanisms of health and disease, how to conserve Qi and Jing, how to repair damage and inefficiency, a lot of us get bogged down in the fallacy that your health is the only thing in the world that matters. This is simply untrue. Our model, taken to an irrational extreme, ends with everyone having the “Buddha Pulse” and no one doing anything that could get categorized as an “above and beyond” effort in their lives. No one would stay up late, no one would put forth unusual effort in the pursuit of projects, fun, or even necessity. There’d be quite a shortage of things that add the color and texture to the mural of our lives. Everyone would be quite healthy and, well, mediocre.

The point is, Jing should be viewed like a bank account. When it’s gone, it’s gone, but it is very much up to the conscience, will, and imagination of the individual how that is spent. As someone who currently lives on the depleted side of the tracks, I personally am unwilling to leave the doing of great things to those who were born constitutionally more gifted than I, or who have met with less illness in their lives. I’m only going to be here once and there’s things that need doing. It would be well to remember that a lot of our patients feel this way as well.

It would also be well to remember the philosophical underpinnings of the value system CM is imbued with, and by that I mean how Confucianism viewed the uses of the people. In a society where individual aims are largely subjugated to the support of the state, it is in the best interests of the state for the individual to maintain a consistent level of health and therefore a consistent level of work. In the Confucian model, the farmer who produces his allotted load of produce consistently for 20 years is of significantly more use than the one who has seven lean years but creates a new kind of crop in 13 good ones, as someone is going to have to make up for that lack.

At any rate, conservation of the Jing and maintenance of the health cannot be the primary principle that people follow at the expense of everything else. People should be made aware that from a longevity standpoint, marathons are not a good idea. However, when faced with the fact that competing in marathons is the primary source of joy in a patient’s life and they feel it to be their calling, it is our job to support them as we may with the understanding that we’re all here once and once only and everyone has to choose according to their conscience and inspiration how that time is spent.

I found the article here:
http://thebostonphoenix.com/boston/news_features/other_stories/multipage/documents/02229150.htm

MR: I agree that life would lose it’s color, were everyone to worry constantly about expending Jing, to the point of not expending any. It would be boring and lame.

If we talk about Jing like a bank account though – isn’t there a healthy way to deal with a bank account? My dad was big on this when I was in high school. He had all of these rules about how to handle a bank account in a “healthy” way. He said that I should always keep at least a hundred dollar ‘cushion’ in my account (yeah right, welcome to studenthood dad), and this way, in case I overwrote a check, or there was some kind of trouble, I had this cushion to fall back on…rather than going into the red. Also, I should consider a budget for each two week period, and take cash out of the bank to match that budget. If I overspent and didn’t have cash at the end of the two weeks, no more withdrawing from the account until the new period starts, etc…

I know that my dad’s rules aren’t the same as everyone’s, but I watch him in his life, and he seems to manage his Jing like he manages his money. He is the energizer bunny, waking at 5am and heading to the gym to play racketball for 2 hours every day. He then goes to work and takes a little nap at lunch. When he comes home, he spends hours working in his shop, and then goes to bed between 8:30 and 9pm. He eats healthy foods and he gets more done than almost anyone I know.

I think that people who are good at managing their money (and jing) tend to seem very energetic, because they know when and how to spend the money. I think that’s part of what we’re learning in school, in terms of being doctors. It’s not so much about taking the color out of the world, but educating people in such a way that they can utilize that bank account in order to achieve what they need to do.

I suppose one thing I would talk with a marathon-running patient about would be the reason for the running. Is this a once in a lifetime thing that they are doing to prove something to themselves? Is there an overly competitive nature that they are feeding? Do they think that marathon running is healthy for them? Are they doing this to raise money for a cause? Those reasons are really important to find, and if there is a way to satisfy the necessity, that doesn’t cost so much of their internal resources, isn’t it our job, as their doctor, to advocate the less costly option?

But money isn’t vitality and jing is. Which is maybe the point of the comment about a healthy way to use the bank account.

I think the point about the values is important too. Preserving health at all costs leads to shells of people on life support forever.

As was suggested I think we need to be clear about our values and help others be clear about theirs. As someone said asking people about why they like marathons.

I had thought the discussion was about running marathons rather than in exercise in general?

I can argue with the better fertility–highly athletic women often have so little body fat that they go through phases of amenorrhea because there is no blood for menses. I haven’t seen studies of how many of these women are runners but I am sure that no particular sport is a particular problem–rather it is the level at which one does it. I suspect that marathons would do it for running.

I find this discussion intriguing. I M. Reynolds had a good point about the issue of letting people live their lives. However, does anyone here not tell their damp people that the large bowl of ice cream they eat for dinner every night might be a part of their symptoms?

In this case, shouldn’t we talk to our high intensity athletes about balance? Someone who runs marathons regularly often runs several hours every weekend to keep and to get into shape. That’s not balanced. While I’m not going to tell them to stop, I want them to know what the signs are that their body is telling them to stop.

One knee injury may not be it but they should understand that anything can be overdone–and then they need to know what they can do to help themselves if they really aren’t ready to give it up. They do need to understand that sometimes injuries are telling them that they are pushing too hard and their body needs more rest. How they go about that rest is up to them (do they take 6 months off and just walk or do they start a new sport like swimming or do they just run less or do they one marathon every few years to prove they still can rather than four marathons a year?)

It’s never about telling them what to do. However, it’s about educating them about the signs that something has gotten out of balance and what behaviors may help that in addition to acupuncture

This is still falling under the umbrella of what I consider to be the conservative attitude of medicine-from both camps, not just the Oriental.

I think we make the mistake-and I think it’s being made in this discussion as well-of deciding that health is the highest priority and the one thing that all other factors must fall in line behind. It is not. This is an easy mistake to make because health is what we spend all our time focusing on. Its our priority because it’s our profession. However, it is not the top priority of everyone else and in some cases they are right.

Here’s a lateral example: when I was a computer tech, I would frequently hear technicians telling customers what sorts of things they should do with their computers, what kinds of upgrades would be useful, etc. The techs would invariably rattle off the best of the best parts, software, configurations, etc. for the customer. This processor with this RAM configuration, that type of hard drive, this high end video card, your drive partitioned in this way, dual booting with LINUX to take advantage of multiple operating systems, and so on. From the point of view of an expert on how computers work and what they can really do, this was really the way to go. However, from the point of view of the customer who needed something reliable to run their business off of and just needed it to bring up Quickbooks every time, without fail, and without losing information, this was a complete nightmare. It had almost nothing to do with their needs.

The same thing here. It would be a mistake to think that any of us are going to do something other than die someday. It would be an equal mistake to think that perfect health equals perfect contentment and fulfillment. It does not. We humans have a limited amount of time to spend a limited amount of resources. There are some behaviors that are just plain dumb and no doubt. However, there are other behaviors that may seem like a bad idea due to their heavy cost, but we may not see the real payoff for that person. Trading a larger amount of Jing for a place in the athletic annals might very well be worth it for some. That’s not our call. That’s also not to say that the young NFL player won’t come back to you in 30 years with devastated joints saying “oh man, I wish I’d taken it easier.” Such is our plight as children of dust. Deterioration happens, aging happens, and the ebbing of youth and life just isn’t a happy process. So yes, we need to educate the patients on how the machine works but then we need to be the actuator of their lifestyle choice (within certain bounds obviously) rather than carping on about that choice like I see a lot of people doing.

Pointing out the errors of someone behaving foolishly is one thing, but being myopic and overweening is quite another.

Bex-that’s what I was trying to say, except stated significantly better than I did.

And FWIW, I’ve got mad at the world syndrome of late and should generally be ignored.

Bex, I think you said it beautifully. I do think that’s the sort of thing we need to impart to our patients. I’m not sure I said that very clearly.

I guess the issue for me is that I’m not seeing my patients because they are healthy but because they AREN’T. Exercise is mostly going to come up as a lifestyle issue because someone either needs to move more or run around less.

My yoga teacher always reminds us that balance isn’t a static thing. It’s a constant struggle of adjustments. Sometimes they’re small and we hardly even notice that we are doing it. Sometimes we throw our hands out and have to make more major adjustments. Sometimes we even fall and have to get back up again. That’s still balance. Maybe next time we fall the other way.

Actual conversation between my teacher and I:

Teacher: “People who run 26.2 miles (marathon distance)for fun/exercise do not understand Chinese Medicine”

Me: “However, people who run 26.2 miles because they are being CHASED are on the right track.”

That’s also what my teacher said – however I bumped into him at the end of the London marathon – he was looking for his daughter who had just run it!

Most of our problems are caused by ourselves. We stress ourselves so much. We need some time for meditation to relax our minds.

Wow, great article. I was once a body builder and I was sick all the time and even though I looked great I never really felt great. Now with less time I still get exercise but I don’t try to make huge muscle gains and I feel much better. Maybe there is something to this!

A very informative and full of insight article. Ten years ago, I had a sedentary lifestyle and I didn’t feel great. I started to exercise (running / weight lifting) everyday 4 years ago: I looked better and I still didn’t feel great (always tired, depressed and sick most of the time…). I didn’t understand at the time why I was feeling so low, because some articles I read just kept telling you that exercising was good for your health… I think I was overworking myself. Since the beginning of last year, I’ve been exercising less (only 4 times a week: just walking) and I’ve been taking some qigong class (no more weight lifting for me…): I wasn’t sick this last year and now I feel really better

By the way, I am from China, where many people who do qi gong everyday, avoid drinking beer or eating junk food, but can’t make it up 5 flights of stairs without panting. I say, if a person is reasonably healthy. they should work their way up to hard exercise 3 times per week, and gentler exercise on the other days. Also, proper breathing is just as important for exercise, as it is for inner work. Finally, mildly emotionally disturbed people (depression etc. ) can really benefit from hard exercise. I agree with the idea that china was an agricultural society, so most people were already over worked. But people today are not. .