Fertility and Gynecology - Biomedicine, Chinese Medicine, and Common Sense
Let me start by quoting the obvious (from Sun Simiao’s Bei Ji Qian Jin Yao Fang, vol. 5 on Pediatrics:
“Now the present collection of treatments is arranged by placing the treatments for women and children first, and those for husbands and the elderly afterwards. The significance of [this structure] is that it venerates the root.”
Exactly three weeks ago, I was very fortunate to present an afternoon lecture on pediatrics at the Sixth International Community of Chinese Medicine Congress in Tel Aviv, Israel. The topic was "Venerating the Root: An introduction to Sun Simiao’s Teachings on Pediatrics," with wonderful clinical commentary provided by Dr. Assaf Mor, an experienced CM pediatrician and dedicated organizer of the Congress. As the presenter, I may not be objective, of course, plus I was a bit jet-lagged, but nevertheless, I left this conversation feeling so inspired by the cumulative energy of the people in the room, and our shared heart-felt desire to make a lasting impact in people's lives by giving them the best possible start.
Some of the information in the 7th-century classic that I introduced at this talk might strike even experienced practitioners as new knowledge and might affect the way pediatricians in the Chinese medicine world interpret and treat conditions in early childhood. To pick just one topic, the concept of the "Transformations and Steamings" elicited a heated discussion and is definitely in need of serious clinical research. Chao Yuanfang, a famous court physician and author of the Zhu Bing Yuan Hou Lun 諸病源候論 explains it this way: “They signify the growth of blood and qì. ‘Transformation’ means the ascent of qi, while ‘steaming’ means generalized heat. The key sign by which to differentiate transformations and steamings from conditions of heat or cold damage is that the body is hot but the ears and buttocks are cold.” According to Sun SImiao, “In all cases, there are ten transformations and five minor steamings, and then three major steamings, which take place within a total of 576 days [after birth]. When the major and minor steamings are all finished, [the baby] has become a human being. The reason why babies pass through these transformations and steamings is so as to make their blood and vessels thrive and alter their five zàng organs. For this reason, as soon as the first transformation is finished, you can sense a difference in their condition right away.” Repeatedly throughout the following pages, Master Sun warns against the reckless use of moxibustion or needles to treat a condition as pathological that is an essential and physiological aspect of neonatal development. Considering the current widespread practice, at least in the US, of aggressively treating any elevated temperature in newborn babies by lowering the fever with popular over-the-counter medications, this may be very important clinical information. Whether you want to place your faith in the words of a seventh century Chinese gentleman or not, the possibility that periodic elevated temperatures can be seen as a normal and healthy, and even NECESSARY, part of babies’ physiological development might affect the way you choose to treat or not treat certain conditions.
In addition to more general information on neonatal development, care, diagnosis, and therapy, the text contains mountains of medicinal formulas, some quite strong, mostly to stimulate the baby’s digestive system, to discharge accumulating food by breaking up accumulations, and to get rid of pathogenic heat and toxins that the baby sometimes received from the mother while still in utero, most notably the concept of 丹毒 (“cinnabar toxin”). There are also massage treatments, powders to sprinkle on the baby, advice on breastfeeding and other aspects of infant care, and some moxibustion protocols. Discussed at great length, the topics of fright and seizures, differentiated by the three etiological factors fright, wind, and food, appear to constitute the most serious threat to pay attention to in newborns, because their “zang organ qi is not balanced yet” and hence “the five zàng organs fail to contract, the blood and qi fail to gather, the five vessels fail to flow, and the bones are timid and incomplete.” PTSD is a topic that is receiving much attention these days in adults, but what about trauma experienced in early childhood, whether internal or external, physical or emotional, or even on deeper levels through the mother’s experiences during pregnancy (consider the importance of the mother’s ability to build a healthy placenta, and the biomedical concept of epigenetics) or while breastfeeding, or even in the form of ancestral “miasm” or “karma”? So many wonderful questions were raised, and I only wish we had had more time for back and forth with such a highly engaged and educated audience. Collective knowledge-building is a beautiful thing!
What struck me most, though, about our discussion in sunny Tel Aviv was that much of the advice given in the text and discussed in the course was quite commonsensical and yet still relevant for our modern times. Or perhaps even more so, given how far removed we have become from living in harmony with nature. Some of this sort of advice present in Sun SImiao’s writings concerns topics such as:
- timing and procedure for cutting the chord and bathing and swaddling the newborn,
- exposing babies to sunshine,
- protecting babies from strong cold and fright but making them experience mild versions of these two pathogenic factors, to strengthen their systems and make them better prepared for serious exposures later on,
- the effects of maternal diet, lifestyle (STRESS!!!), and emotions on the breast milk and therefore on the future health of the child,
- breastfeeding regimens,
- apparently contradictory advice on the timing for introducing tiny amounts of grain early on to “open up the intestines and stomach to assist the grain ‘spirit’ (shen)” or to wait with feeding anything but breast milk for thirty days, otherwise ““they cannot overcome the qì of grain, which will cause the formation of diseases. On the head, face, and body, they will have a tendency to engender sores that will heal and then erupt again. This makes babies small and weak and difficult to nourish,” etc.
Much of this information strikes me as falling into the category of granny advice or midwife knowledge, similar to the type of advice given in the chapter on “Nurturing the Fetus” in Sun Simiao’s first volume on gynecology. When I teach this sort of material to classically oriented Chinese medicine practitioners, midwives, and people with an interest, education, and experience in “traditional” medicine from whatever part of the world, I sense from the audience signs of recognition, nods of agreement, and smiles of gratitude for validating what they already know and have been doing for countless generations, causing me to sometimes feel like I am “preaching to the choir.” And I wonder: Isn’t this stuff obvious? Don’t we all know about the importance of living with the seasons, getting away from the computer, eating unprocessed, naturally grown, happy foods, etc etc? Do we really need yet another voice promoting this stuff, even if it comes from the seventh century and might be exciting because of its history?
Well, I just attended a biomedical conference on “Preconception to Infancy” here in Portland, promoted as the latest and greatest groundbreaking new approach to a topic that I obviously feel strongly about. What I left with, besides some very interesting information and scientific research to validate and maybe refine what Sun Simiao was teaching more than a millennium ago, was actually a feeling of gratitude to be living and breathing in the bubble that I am surrounded with here in Portland at the School of Classical Chinese Medicine at the National College of Natural Medicine. I am excited and hopeful for the future of medicine at large that biomedicine is finally starting to catch up with knowledge that many midwives, N.Ds, and Chinese Medicine practitioners take as a given in their daily practice. This refers specifically to what the conference leaders presented as a revolutionary new concept: the importance of preparing the female body properly prior to conception, so that the mother can build and maintain the most ideal environment for the fetus to develop in during pregnancy and then lay the foundation for a healthy baby during and after birth, thereby preventing diseases that might not show up until many decades later when the aging body lacks the resources of pre-natal jing (“essence”) to fall back on. I don’t need to understand epigenetics, methylation, etiologic heterogeneity, or exposomics to intuitively know that to produce healthy babies and ultimately healthy adults, we have to start with a healthy female body. In spite of the genuine enthusiasm with which this supposedly new model was presented, the resulting clinical approach advocated in the practical sessions struck me as quite crude, mechanistic, and still limited to going after the branches instead of addressing the root. The main clinical model, if I may simplify, was to prescribe a large litany of tests pre-conception, during pregnancy, and then for the mother and baby during breast-feeding, and for the child later on. With the help of these increasingly sophisticated and sometimes very expensive tests (most of which are not covered by insurance and therefore out of reach of the people who need them most), toxins and insufficiencies are identified, which are then eliminated by means of aggressive supplementation and, if necessary, drugs, with some lifestyle advice to reduce stress and improve diet and exercise tangentially tagged on. Rather than spending millions on medical research on Vitamin D, for example, such as on safe levels of supplementation, cause-and-effect relations to different levels of deficiency, etc. etc., why not look at the root cause, a lack of exposure to outside time for most of our modern population, especially in the US? Why not work on creating social programs that ensure that new mothers get more time off from work to take their kids outside and have the rest and space and emotional and social resources to breastfeed? Why not work on improving access to fresh produce, clean air, and a non-toxic more “natural” environment for low-income women of child-bearing age or radically alter the food served at kindergartens and schools? Let’s “venerate the root,” please!
This post is already too long, but if you live in a bubble similar to mine, my message of the day is this: Don’t take what you think of as obvious common sense for granted. Make sure you clearly conceptualize these sorts of basic insights into the workings of the human body in such a way that you can communicate the insights of classical Chinese medicine to the larger world around you. The world needs us. For most of you, this presumably occurs by communicating with patients in your clinical practice, but also through conversations with your children, spouses, or at work, or in websites, radio interviews, or who knows how else. And more than anything, empower women to listen to their own bodies with all their heart and spirit, even down to their marrow, and encourage society to nurture and respect and support the female body. Don’t just talk about this with your colleagues and on friendly social sites but live your truth and demonstrate the ancient wisdom in your actions. Nothing is more important, in my world.