Another Case Study

A cardiologist prescribed cardiac catheterization for a 70 year-old woman, with type 2 diabetes, after detecting a congenitally small heart valve while prepping her for surgical removal of a skin cancer.  This Five Element approach interprets insulin resistance blocking receptivity to sweetness, obstructive earth qi. Her heart valve symptoms indicate fire qi disturbance. The skin cancer manifested as a disturbance in metal qi. She worked full time running her own business, teaching drama to children by putting on musicals. This had required sufficient organization, social participation, and creativity to succeed and grow the business over more than three decades, indicating ongoing exercise of metal, fire, and water qi respectively.  Fear (water qi) prevented her from carrying out the catheterization procedure, even though her son rescheduled his own business plans and flew into New York City from the West Coast to be with her on three separate occasions. She also failed to complete a fourth solo appointment.

Diagnosis: Excess water qi (the emotional root cause) prevented her ability to follow through with this procedure.

Plan: Playful use of meditation within a ritual to channel excess water qi toward creating a new story about positive outcomes, or in Five Element terms, wood qi guides water qi to create a story that will reduce stress about the procedure and enable her to complete the appointment.

I gave her the following instructions.

The secret to spiritual healing (the most powerful kind of healing – E=mc²)

There are no accidents.

Everything happens for a reason.

The reason is always good.

Find the good.

Grandmaster Nan Lu, Digesting the Universe: A Revolutionary Framework for Healing Metabolism Function.

Without getting involved in the complicated quantum physics and epigenetics of this premise I present the following ritual.

On the physical level doctors have diagnosed you with a “too small” heart valve. Taken literally this means you cannot move Love/blood through your heart at optimal levels. They want to use a catheter to look around and see if you have other blockages. In addition, you have type 2 diabetes, insulin resistant diabetes; as opposed to type 1 diabetes, insufficient insulin). This means that your cells cannot/will not take in sweetness/glucose.

We have been working on an energetic/emotional level in our talks, but now let’s get physical with a ritual – using metaphoric language & activity to direct a healing intention/story.

Ultimately, the story is yours and it will unfold, with or without language, as you do this ritual. Just as I said “embrace the drugs” this ritual, should you choose to do it, will “embrace the catheter” and give it spiritual direction, leaving the physical operation up to the surgeon. It means you will be in God’s hands and you and God will have conversed (metaphorically & ritually) about this. I think that the ritual will leave you feeling calmer, centered and grounded. That’s what rituals do.

You can dress this up or down according to your tastes and available time.

1. Find an icon – an image that embodies and represents the good. My suggestion would be a beautiful image of the sacred heart of Jesus or Mary. You seem to be very good at finding art so I can’t wait to see what you find. There is a lot to choose from on the internet.  If you can print it – great. If not you will still have it in your mind’s eye.

2. Put together a small altar – you may already have one – a place where you put special things. If it’s cluttered, clean it up. If you want to formalize it here is my suggestion:
   1. In the center place an object, jewelry or something of yours, to represent yourself and your connection to the Earth.
   2. To the East – something made of Wood, or a flower or plant.
   3. To the South – a candle to represent Fire
   4. To the West – a rock or crystal to represent Metal
   5. To the North – Water, preferably water you have collected from rain, snow or a living body of fresh water.

3. Light your candle. Take a sip of water. Sit and meditate on the following:
   1. The beautiful landscape that lives inside your sacred heart.
   2. Find all the places of beauty and joy – if you find anything that doesn’t belong there (i.e. not beautiful or joyful) let the sacred blood wash it away to your kidneys to get rid of it!!!!!
   3. Enjoy the beauty and the joy you find there.
   4. Let your sacred heart and the sacred heart of God merge.

4. When you are ready finish your meditation. You can blow out your candle or let it burn out itself (if it is in a really safe place). Let the water evaporate or pour it back into nature.

5. Now that you know there is nothing but beauty in your heart, you can relax and be assured that the catheter will only find beauty and joy, because you have the power (God’s power) to see everything as beauty. All outcomes will work to your greater good!

She did the ritual three times before her appointment, and sailed (balanced water) through it on her own. Since then she has seemed calmer, less fearful (balanced water) and more accepting of upcoming medical procedures, expecting positive rather than negative outcomes.

Interpretation from Five Element Approach

Fear (water qi) overwhelmed her ability to logically analyze her risks (metal qi), and receive support from her son (earth qi unable to receive affection /fire qi). By directly counteracting her fears with faith (water qi opposites) she harnessed all the other elements and used them for courage (fire qi) to envision positive outcomes (wood qi), and receive reassurance from her doctor (earth qi) that the procedure would go smoothly – as it did (metal qi).  The catheterization showed no arterial problems.

Conclusion

TCM’s Five Element approach to health offers a powerful paradigm from which to view occupation making it possible to integrate sensory experiences, body tissues, and emotions with environmental influences via five occupations Eating, Sleeping, Working, Playing and Loving. In the hands of an occupational therapy practitioner who understands the relationship of these occupations to stress and inflammation, the TCM paradigm provides a powerful tool for developing interventions with symptoms such as pain, loss of mobility, emotional distress, and poor self-regulation.

Acknowledgements

Thanks to: Grand Master Nan Lu, OMD for opening the door; to the teachers who led me through The Dragon’s Way, Elaine Katen, Irma Jenne, Deborah Cromarty Hallahan; to my OT Qi sisters, Margery Szczepanski, and Liz who listened and shared so many helpful comments; and my Qi sister poet, Hermine Meinhard who helped so much with editing.

Applying Healing Occupations to Practice

The only difference between an Activity of Daily Living and a Healing Ritual is mindfulness. 

[See the previous blog for references and graphic of the healing occupations.]

Eating connects us to food, the earth and the wider community of people who provided us with something to eat. Think of all the people involved. No wonder sometimes we have trouble receiving such gifts. Instead of obsessing anxiously over what to eat, get a massage, lift weights, plant a garden, or go to the spa. Sweeten your life with a bit of honey from time to time!

Playing keeps us flexible – body, mind, emotions and spirit. With these in balance, we can process foods, emotions and thoughts. When out of sync, look for problems with sprains and strains of all types – in the body and in relationships. Restore clearer vision of the situation through active movement and competition (including losing!). Put a plant on your desk and take time to connect with nature!

Love binds us in social groupings and rules through the mindful heart by helping us digest food, emotions and thoughts. Our joyful heart attends to our social attachments even when we’re not aware of it.  Does bitterness take away your joy? Try spinning on the dance floor, tasting some gourmet food, or sharing a joke. Definitely include red underwear in your wardrobe!

Once upon a time work meant attending to simple tasks like chopping wood and carrying water. Our lives have gotten more complicated. What do we do first? And where will we find the time? Don’t break out in a rash. Make a list. Use a scheduler. Take a deep breath and smell the roses. Spice up your life with something fun!

To sleep, perchance to dream…Ah, who can? Worries become fears and sleepless nights turn into the dark grind of perpetual fatigue. Memory slips. Teeth fall out. Joints ache. Hair goes gray. Turn down the lights. Queue up some soft music. Take a warm bath. Slip into your black, silk PJs and sail off to dreamland. Don’t even get up to pee!

Methodology

A practitioner intent on helping a client integrate and balance all aspects of life needs to understand how they and their body respond to stress. How does the mind interpret the physical environment and emotional responses? What stories does it tell? Each elemental occupation resonates with a host of related physical, mental, emotional, and social processes. Can the practitioner connect intuitively with the underlying metaphors and messages?

Once a pattern emerges, intervention requires adjusting and manipulating environmental and occupational areas to stimulate and feed deficiency, or calm and guide excess.  Each occupation resonates with one of Traditional Chinese Medicine’s five elements (earth, wood, fire, metal, water) which will guide us to an intervention strategy. Understanding natural laws governing the five elements helps inform our choice of action.

Case Study #1

A 4 year old boy diagnosed with cortical blindness arrived at the clinic for an evaluation. TCM associates visual problems with wood qi because of the eye’s inherent flexibility adjustments made for near and far acuity.  Developmental and neurological problems generally associate with water qi, so we begin with deficiency of wood and water qi. We interviewed the child’s mother while he rolled from side to side in supine, stimulating his own water qi, via oscillating movement, to self-regulate. When placed prone he could barely lift or turn his head to breathe. In addition to confirming deficiency of water qi (related to low muscle tone) this would indicate deficient earth qi (lack of muscle strength), and deficient metal qi (which resonates with coordination and praxis). He did not respond to his name, or orient to sound and lights. He had no obvious affectionate connection with his mother (deficient fire qi). Lack of visual or auditory responses confirms deficient wood and water qi.

Diagnosis: Deficient water qi (the neurological root cause) due to inherent developmental and neurological conditions as well as constant drain from deficiencies among all other elemental systems.

Plan: Use play (wood qi) to boost neurological development (water qi) by reducing stress load and introducing flexibility (i.e. providing a more varied sensory environment than rolling back and forth in supine) and fuel social participation within a peer-group setting (fire qi)

Our intervention used a weekly two-hour preschool play group that consisted of a 60 minutes of highly supervised/supported unstructured outdoor/active play, a 30-minute snack and 30 minutes of quiet indoor/fine-motor play while watching It’s Potty Time video and taking turns sitting on the toilet (ADL work). He attended the clinic once a week for nine months. During the entire time he attended, he received a continuous variety of sensory and neuromuscular facilitation to support his ability to participate. These facilitation consisted of: tapping which feeds & stimulates both muscle spindles (earth qi) and free nerve endings (water qi); brushing which feeds and stimulates dermal end organs (metal qi); joint compression which feeds and stimulates joints (water qi), TAMO²⁵ which feeds and stimulates responses to gravity (earth qi). During snack he sat at the table with the other children and received physical support to try the foods the other children ate. Eating stimulates earth qi and sharing food with others stimulates social participation (fire qi).   The fine-motor play provided another opportunity to facilitate movement stimulating through the previously mentioned sensory channels. Social participation with the typical and atypical children in the group gave purpose to these movements and stimulated a drive for mastery/praxis. We used fire qi to stimulate (heat up) metal qi.  After about 6 months his mother reported that her son would vocalize during the entire car ride to the clinic. He also spontaneously reached out to touch another boy in the sandbox on his last day at the clinic.

By the end of 9 months of treatment he could maintain balance for several minutes by sitting astride a wheeled toy with very close supervision, as he lacked the muscle tone to right himself once his vertebrae went out of alignment. He used awareness of his body in space coupled with co-contraction of vertebral muscles to participate in play with other children. From a Five Element perspective, play (wood qi) stimulated the use of vestibular and proprioceptive inputs (earth, water, and metal qi) to support social connection (fire qi), giving an improvement in neuro-musculoskeletal development (water, earth qi) and communication (fire qi).

Next week I’ll post an application for an adult client concerned with an upcoming medical procedure.

I’ll be giving seminars on Self-Regulation in Ohio, Pennsylvania, Iowa, and New York City during the next month. In June I’ll be giving a two-day seminar on Mealtimes in Danbury, CT.
Check out my schedule.

Sustainable Health

I’ve started a new blog to write about how we can achieve sustainable health. I will explore affordable, simple solutions that use locally available ingredients and offer effective results. Feeling good in your body is a birthright. Own it!

Five Healing Occupations

I attended the American Occupational Therapy Association annual conference in Chicago recently and presented a poster on Occupational Therapy from a Traditional Chinese Medicine paradigm. Lots of people came by and talked to me and seemed interested in the topic. I decided to share it on my blog. It’s pretty long so this post is the background and the information on the poster. Next post will have some application to practice and a case study.

I am testing out a new blog format – since I hope to really focus on this blog as a means to spread information about sustainable health – affordable, simple, effective. Let me know what you think about the blog and also what you think about the content.

Background

The past decade has led to an explosion of research demonstrating the role stress plays creating the inflammation underlying every chronic disease familiar to occupational therapy.^{4, 7, 10, 16, 19} Much research focuses the interplay between the gastrointestinal and nervous systems.^{2, 10, 13, 18, 23} through neuro-hormonal pathways related to the vagal nerve.²⁴  Eating serves as a meta-occupation involving every Area of Occupation either directly as in the case of food preparation, shopping, cleaning, and farming or indirectly in the case of Play/Leisure, Rest/Sleep, Work, & Social Participation.²¹ Sharing food has set human evolution on a path to our present day, and expanding our understanding of this complex ADL beyond the realm of eye-hand and oral-motor Performance Skills offers occupational therapists a powerful tool for life-changing health outcomes in almost every chronic disease we treat.

The past decade has also led to increased awareness about ancient healing traditions such as Ayurveda (from India) and Traditional Chinese Medicine (TCM). These have a long history of success and current research that backs up their claims to improved health outcomes.  Yoga (from the Ayurvedic practices of India) and acupuncture (from TCM) have received a great deal of interest.  These healing traditions have detailed, complex views of health that integrate body, mind (sensory), and spirit throughout 2500 years of written documentation.¹⁶

TCM views all forms of disease as energetic disharmony and uses six “pillars” of treatment: Qigong (movement); Tuina (touch/massage); lifestyle/psychology; food; herbs; and acupuncture.¹⁶ The first four of these pillars fall within the scope of occupational therapy practice. Like TCM occupational therapy also values the importance of self-regulation (body, senses, and emotions) to the healing process. TCM’s Five Element Theory offers a way to organize how to apply interventions using a paradigm that has worked for 5000 years.¹⁶ Modern quantum physics informs us that everything is energy and provides the means for understanding how these ancient healing traditions succeed in manifesting better health outcomes.

Each of the Five Healing Occupations in the graphic aligns with the element associated with that direction on a compass point: Earth in the center; Wood to the East; Fire to the South; Metal to the West; Water to the North. TCM uses these natural elements to understand relationships between all aspects of body, mind and spirit (energy or qi). The adept practitioner then applies her knowledge of these interactions to bring the person back into harmony so the body can heal itself.¹⁶ Stress (physical or psychic) leads to inflammatory processes resulting in physical ailments. Reducing stress, reduces inflammation and allows the body to heal.^{3, 8, 10, 15, 17, 23, 24}

A Brief Description of the Five Healing Occupations

EAT

Our food has changed dramatically over the past few decades.  Consumption of sugar has doubled since 1945. We have gone from “3 square meals a day” to constant snacking; from eating with others, to eating alone. All of these changes correlate with increases in chronic disease, many of them associated with the inflammatory role sugar and flours have on tissues.^{2, 8, 10, 13, 17, 18, 23}

PLAY

Nothing comes close to topping Play as the greatest of stress-relievers, and this reason may account for the fact that all mammals play – both young and old.^{4, 7, 8, 14, 19, 20, 22, 27} Evidence also points to play behavior in other vertebrate classes –reptiles, birds, and fish.¹

LOVE

Many physiological research studies have cited oxytocin, the love hormone, as pivotal in encouraging relationships and relieving stress. Decades of psychological research with both primates and humans has documented the importance of social bonding to emotional regulation.^{3, 7, 8, 11, 19, 20, 22, 24}

WORK

We all engage in habitual tasks that provide food, clothing and shelter for ourselves, our families, and our communities. Inability to do so creates stress and leaves us hungry, cold, and often alone. Occupational therapists have always understood the importance of these activities of daily living.^{8, 21, 28}

SLEEP

Even more ubiquitous than play, sleep affords living creatures a chance to regenerate, refresh, and process the day’s events. Lack of sleep, or interrupted sleep affects all aspects of our physiology and behavior.^{3, 8, 10, 12, 24}

A Brief Description of the Graphics Key

Element

TCM uses an understanding of the properties of and relationships between the Five Elements to diagnose and treat disharmony (illness).^{3, 16} Like most healing traditions which use an elemental approach (i.e. all of them I have studied over the past 30 years) they arrange these elements around the compass points (East, South, West, North). The elements may move around the compass, and their relationships may change in subtle ways, but the practitioner always begins with an understanding of the natural world and the laws which govern it. To put these elements into modern scientific terms: Earth=Matter; Fire=Energy; Wood=Organic Time; Metal=Cosmologic Time; Water=Space.

Organ Systems

TCM relates the five elements to five Organ Systems. These include both the physical organ itself as well as its energetic relationships to body, mind and spirit. Physical illness manifests through the body, but treatment encompasses the mind and spirit. TCM considers the first organ listed as Yin (or nutritive) and the second as Yang (or movement/bowels). ^3,16

Tissues

Each element and organ system has corresponding tissues. These also manifest disharmony and aid the practitioner in determining a root cause (from external pathogens, habits of thinking, emotions, or spiritual relationships to the natural world – including other people). ^3,16

Sensory System

TCM ascribes each of five senses to an element and organ system. The graphic lists the sensory organ first and its primary sensory response second.  Diagnosis considers disturbances in the various senses, and treatment often utilizes these sensations as a way to restore harmony to the body,^3,16 much like Occupational Therapy views Sensory Integration.

Vestibular Sensation

TCM ascribes metabolism function across all organ systems,¹⁶ in a manner similar to Occupational Therapy’s understanding of the multiple interconnections with the vestibular system and how it acts to balance an individual. I have taken the liberty of ascribing each of five movement patterns to the five elements. Gravitational security depends on a healthy relationship with the pull of gravity on our planet, Earth. Vertical movement mimics the push of plants upward toward the sun. Rotary movement corresponds with the slight spin of blood in the vessels as well as the intense, energetic sensation of spinning. Linear movement and acceleration/deceleration corresponds to the structured response of crystalline bonds in metals. Oscillating movement corresponds to the wavelike, floating motion of water.

Proprioceptive End Organs

These discreet tissues of sensation reside in the tissues ascribed by TCM to each element and organ system.¹⁶ As an occupational therapist designing interventions that promote self-regulation (i.e. harmony) understanding when and where to use particular sensory applications depends on knowing how to activate these sensory organs.⁶

Regulated Trait

Again I have taken the liberty of using terms familiar to occupational therapists, and relating them to characteristics of each element/organ system. Receptivity recalls the important work of the Stomach in receiving food. Flexibility relates to healthy Liver function.¹⁶ Affection and the demonstration of affection binds us together in social relationships. Organization mimics the molecular order of metal. Resilience relates to the TCM understanding of Kidney as the body’s “energy checking and savings account”. ¹⁶

Emotion

TCM associates each element and organ system with a particular emotion. When people express these emotions and let them go, the body releases stress and stays healthy. When an emotion becomes habitual (stagnation), then it often becomes the seed from which disharmony and illness grow. TCM always considers and treats these emotions.

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