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Eat To Heal: Qi Stagnation & Blood Stasis

Qi Stagnation and Blood Stasis Explained

“Stagnant qi” is something we treat every single day in the clinic. Of course, when you explain the concept of stagnant qi to a patient, they want to know more, including how the qi got stagnant in the first place, and what they should do about it. Because I explain this so frequently in clinic, I decided to write a blog post about it. Let’s start with the basics.

In Traditional Chinese Medicine, there’s an understanding that qi stagnation plays a role in most, if not all, imbalances in the body/mind. As you might imagine, symptoms of qi stagnation all involve a lack of “flow” and a feeling of “stuckness.” When qi is not flowing smoothly, one feels it in the body as tension, cramping, or pain, and in the mind as depression, anger, or frustration. There’s a common saying in Traditional Chinese Medicine: If there is free flow, there is no pain; if there is no free flow, there is pain.

It’s also key to understand that qi and blood are inseparable. Blood can be thought of as a “denser” form of qi. Its movement through the vessels and meridians is powered by qi, while at the same time, blood reinforces the strength of qi. In other words, if you experience qi stagnation, you are, to some extent, experiencing blood stagnation (technically known as blood stasis).  Blood stasis typically feels more ‘extreme’ than qi stagnation, and manifests as deep, stabbing, persistent pain anywhere in the body. The pain is localized, as opposed to the more diffuse discomfort of qi stagnation. (Blood stasis is often involved in dysmenorrhea, ovarian cysts, endometriosis, fibroids, cardiac events, and some cancers). Typically, if blood stasis is indicated in your particular health issue, your acupuncturist will likely suggest herbs, as blood stasis is best treated with a combo of acupuncture and “blood-moving” herbs.

I Just Feel…”Stuck”

Car stuck in mud
Feelin’ stuck?

At least a couple times a day, I have a patient who tells me they just feel “stuck.” It’s often a general feeling, and one that we often label as “depression.” Sometimes it’s more specific than this general feeling, and patients will point to a specific part of their body (common places include the chest, low back, and tops of shoulders). As an acupuncturist, I don’t think anything about this is weird. These areas are common places where people hold stress, and stress, in the most basic sense, is qi stagnation.

The Origins of Stagnation

So, how does qi stagnation and blood stasis happen? I’d make the argument that the most significant factor affecting the stagnation of qi involves an emotional/cultural component. In fact, 21st century living is a perfect environment for disrupting the free flow of qi and blood. Though I’d be a big jerk to overlook some of the wonders of being alive during this time (as hilariously illustrated by my bigtime love, Louis CK)…humor aside, it can also be an incredibly painful experience.

Here’s a quote from Daverick Leggett, from Recipes for Self Healing, that explains a little more about what I mean:

Qi Stagnates when the flow of the creative being is stopped. When the Qi is Stagnant, any aspect of harmonious flow can be affected. We may feel frustrated, indecisive or depressed in response to the constraint of our freedom to be ourselves. Physically we may experience uncomfortable digestion, irregular or painful menstruation, headaches, tenderness beneath the ribs, or all kinds of pain.

…It is helpful to consider Stagnation as having two levels of manifestation. The first is Constraint. This is the realm of the psyche, the subtle and shifting ways in which we stifle the more raw expression of who we are. Sorting out these patterns of Constraint means exploring the “shoulds” and “dont’s” which regulate our lives and deciding which of them provide useful and necessary containers and which of them we wish to reject because they stifle our true expression of vibrant aliveness.

Constraint arises from the relationship we have with the growing edges of our being as we shape ourselves against the rules imposed by family, authority, and culture. Wherever healthy assertion of aliveness is chronically suppressed and then internalized, patterns of constraint will develop as we struggle to assert who we are against the ‘controller’ we have taken on inside.

Treating Qi Stagnation and Blood Stasis

As you might expect, treating any type of stagnation involves movement. (It’s one of the reasons people love acupuncture; a well-placed needle is a miraculous thing in regards to moving qi).

The dietary approach to moving qi and blood isn’t overly complex, and can even end up being pretty fun to practice.

  1. Eat until you’re about 70 percent full. 80 percent works, too, if that quiche is especially tasty today.
  2. Pay attention to breathing and posture while eating. In other words, as often as possible, try to sit down (your car doesn’t count), breathe, and chew your food. Taste it!
  3. Incorporate qi and blood moving foods into your diet.

Foods That Move Qi Stagnation

Symptoms: tendency to depression, frequent sighing, flares of temper, sensation of something being stuck in the throat, pain in the ribs or abdomen, uterine cramping, tension in the body that seems stuck, IBS

One easy approach to mitigating a tendency to stagnation, especially if it’s coming from eating too fast, or eating while stressed, is to take a dropperful of bitters before or after you eat (I use bitters before and after meals, especially at a food-centric event, like Thanksgiving). I prefer to mix bitters with a small glass of seltzer water. Some find that eating a segment of section of grapefruit before a meal serves the same purpose.

Use the onion family more! Includes onion, garlic, leeks, and chives.

Embrace the Brassica! Cabbage, broccoli, Brussels sprouts, mustard greens, turnip, kale – all can help move qi!

Pungent/aromatic foods are your friends. Use radish, basil, cilantro, arugula, coriander seed, fennel, turmeric, cayenne, cardamom, and mint.

Incorporate sour flavored foods, in moderate to small amounts, like lemon, grapefruit, vinegar, plums, and green apples.

Try adding a little citrus peel to grain dishes or teas. Use organic citrus fruit for this. I especially love to add lemon rind to basmati rice before cooking. It’s wicked good.

tangerine peel on old wood table, shallow focus
Chen pi (citrus peel) does not directly go to the liver, but it can help move qi, especially when your digestion is feeling ‘stuck.’

Try starting your morning with a small glass of warm water mixed with organic, raw, apple cider vinegar and local honey.

Here’s simple tea for any time you’re feeling stagnant, especially digestively: Take equal parts cinnamon, ginger, and tangerine peel; simmer until a 1/3 of the water has evaporated. Add a small amount of honey. Drink up.

Limit: refined grains, sugar, fried foods, food additives, low fiber diets

Foods That Clear Liver Heat

If qi stays stagnant for long enough it will give off heat. An example of this? A traffic jam when tempers flare, or a compost pile in late spring – put your hand over the compost and feel how it gives off heat. Symptoms of liver heat, or the more extreme version of this, liver fire, include severe irritability and rage, pain and distension in the head (including migraines and headaches), insomnia, constipation, tight neck and shoulders, anxiety, ringing in the ears.

Use bitter foods to your benefit, since they are cooling. Celery, romaine lettuce, dandelion greens, asparagus, and rye are all good choices.

Other cooling foods include cucumber, summer squash, tomatoes, carrot, spinach, artichoke, burdock root (gobo), lemon, lime, grapefruit, green tea, mint, and chrysanthemum.

Limit spicy foods, alcohol, coffee, lamb, beef, and trout.

Foods That Treat Blood Stasis

Heap of Fresh Ripe Eggplants isolated on Rustic Wooden background
Eggplant is specific to moving blood stasis that affects the uterus. Cramping, colicky pain in that area? Try eggplant. (To be used with moderation during pregnancy, but a great addition when trying to induce labor!)

Like stated above, since qi and blood are so closely interdependent, know that qi-moving foods are, to some extent, blood-moving.

If blood stasis is an issue for you, focus on incorporating onion, garlic, scallion, ginger, vinegar, turmeric, saffron,eggplant, shiitake, hawthorn berry (Shan Zha), cayenne pepper, and chili pepper.

Limit cold foods (like iced water and riding the ice cream train too often), as well as refined foods.


Coffee: Good or Bad?

We’re All On Drugs!

Okay, maybe not all of us. But let’s start by pointing out the obvious. Coffee contains caffeine and caffeine is a drug. Though some of us like to imagine “drugs” as the stuff the neighbors do while we steam broccolini and knit wool hats for the grandkids, well, it just ain’t true. Caffeine is a powerful psychoactive drug consumed by 90 percent of adults living in North America. In other words, the majority of us begin our day wrapping our lips around a steaming mug of drug.

Coffee berries. Some ripe, some ripening.
Coffee berries. Some ripe, some ripening.

I personally LOVE coffee, especially with a bit of sugar and a hearty splash of REAL, full-fat cream. Occasionally, I have a big fight with coffee, and we break up in order to reestablish healthy boundaries; but the truth is, coffee is my eternal love and I never stray too far. Green tea is calming and lighthearted and looks great in a chawan, but it just doesn’t give me the warm, earthy, kick-in-the-pants that coffee does. Because no one loves me like my coffee. My coffee understands me, and though it might be overly loud sometimes, in our quieter moments we share a deep, intimate understanding. Are you getting uncomfortable? Let me tell you more.

Though I normally don’t consume more than a 8-10 ounces a day, I do drink a strong cup of french-pressed coffee in the morning to help shake off the desire to stay in bed until 10 am. I’m sure many of you can agree with me on this one – it can be difficult (read: impossible) to start your day without a’cuppajoe.

According to wikipedia, the word coffee entered English language after a series of mutations of the Arabic word qahhwat al-bun, which means wine of the bean. Perfect, isn’t it? Wine of the bean. The coffee bean actually comes from a bright red berry that is plucked from an evergreen shrub (usually Coffea arabica, sometimes Coffea robusta). The berry is dried and the seeds are extracted. Those seeds (the coffee beans) are roasted to varying degrees (explaining the difference in taste according to roast).

A very strong cuppa’ joe can contain up to 300 mg of caffeine (average range, depending on how it’s brewed, is 80-170 mg of caffeine). For comparison, a cup of black tea, depending on how long it’s steeped, will have about 30-60 mg of caffeine. Curious about how much caffeine you’re consuming? Check this out.

La Vino de la Beano

You can smell it, can't you?
You can smell it, can’t you?

According to Traditional Chinese Medicine, coffee is a powerful medicine and should be used as such. Even a small amount (a single cup, even half a cup for some) can dredge stagnant liver qi. When the liver qi is constrained, the body/spirit will also feel constrained (i.e. tense and/or depressed).  Substances that move liver qi will usually result in a temporary but strong sense of mental and physical relief (the sludge has been moved through the pipes and now everything feels better). This is why people love coffee so much – it’s very effective at moving “stuck” liver qi. It’s also why we become addicted to it.

So, I Drink 12 Cups of Coffee A Day? IS THIS OKAY?

Caffeine is clearly the most prevalently used stimulant in the world. Coffee, tea, chocolate, cocoa, many soft drinks, diet pills, aspirin, various analgesics used for migraine headache and vascular pain, and even some herbal preparations contain either caffeine or very closely related substances. Examples of such caffeine-like substances are theobromine in chocolate and cocoa and theophylline in tea. When caffeine and similar compounds are taken in excess, any of several symptoms usually result: anxiety and nervousness, insomnia or light sleep patterns, various types of heart disease, stomach and intestinal maladies, and moodiness. When consumed regularly, as little as two cups of coffee can initiate these symptoms. Children who exhibit hyperactivity are often victims of diets rich in chocolate and cola drinks. – Paul Pitchford, Healing with Whole Foods

So, no, if you are interested in a healthy relationship with coffee, you probably don’t want to be drinking 12 cups of coffee a day. And by the way, Paul Pitchford’s Healing With Whole Foods is considered the “bible” of nutrition (if you’re interested in learning about the Traditional Chinese Medicine approach to food). It’s hundreds of pages of densely-packed information about one of our best medicines – FOOD!

So, here’s the problem with coffee. Like I mentioned above, coffee is strong medicine, and should be used as such. We tend to overdo it with coffee since we, culturally-speaking, tend to be so stagnant (in theory, alcohol and cigarettes are also potent qi-movers, which can help explain some of the addiction issues that surround those substances as well). Some of us do a lot of sitting at our computers, a lot of being “polite,” and a lot of stuffing down of emotions. And we don’t sleep or exercise enough. And sometimes we don’t have enough opportunity to laugh and love. At the end of the day, that makes for some tense shoulders, some unpredictable digestion, and a good dose of irritability. So, it makes sense that we crave substances that move qi, which is, understandably, stuck.

But here’s the downside of coffee. While it can effectively release ‘stuck’ liver qi, it does not necessarily regulate it. Some people, if overusing coffee, will feel mild to extreme negative effects – for instance, since coffee’s moving effect is so much more potent than it’s tonifying effect, those with a weak spleen or a blood deficiency may feel agitated after coffee, or experience gastrointestinal distress. When consumed over a long period of time, coffee can damage the blood (this could manifest as heart palpitations, anxiety, dizziness, “adrenal fatigue”). Excessive amounts of coffee can also agitate the liver and create ‘wind’ (manifesting as shakes/tremors) and exacerbate issues of “counterflow” (including complaints like acid reflux/GERD, belching, nausea, gastritis, insomnia, and panic attacks).

So, Should I Drink 2 Cups of Coffee a Day?

So, what to do with this  wonderful bean that tempts all the sensory organs of your face? (It blends sooooooo well with chocolate, too).

In the case of coffee, which should be thought of as a medicinal plant, emphasis should be on how well the plant matches the needs of the individual. If the two of your aren’t well-matched, well, it’s like an unending bad date. Consider giving it up or substituting with green/black tea. If you’re not well-matched but you love coffee too much to leave it, get creative. Consider ways in which you can make it a more balanced beverage (see below). If you try to do this and coffee just can’t meet your needs…well, I’m sorry to say but it’s time to pack up and leave (and take the dog, since the dog loves you best and you’re the one who takes care of it anyway).

But what does the research on coffee say, you ask? For a interesting, concise overview of research on coffee, see here (you can listen to the podcast or read the transcript). If you don’t feel like listening, here’s the summary: coffee is associated with numerous health benefits in the scientific literature.  However, it’s best when coffee consumption does not interfere with HPA axis function (the relationships and signals that exist between the hypothalamus, the pituitary gland and the adrenals). In other words, it shouldn’t be used to compensate for the fact that you’re run down, overworked, or over-stressed.

All of this, BELIEVE IT OR NOT, is right in line with the TCM theory of how coffee can work to your advantage…or not.

Practical Suggestions From Your Friendly, Coffee-Loving Acupuncturist

Matcha is a jewel-green, powdered, green tea that is rich in catechin polyphenols (compounds with high antioxidant activity). Frothed with .
Matcha is a powdered, emerald-colored, green tea that is rich in catechin polyphenols (compounds with high antioxidant activity). The l-theanine in green tea can also help bring you to nice, calm place.

1.) Use coffee as medicine. Many Americans use massive mugs/cups and drink coffee all day. Don’t do that.

2.) Experiment with green tea. Camellia sinensis is pretty awesome. Period. It’s a potent source of antioxidants and it contains a unique amino acid called l-theanine,  which is associated with “alert relaxation” making the buzz quite different from the coffee buzz. According to Traditional Chinese Medicine, green tea is cooling, as opposed to warming (if you’ve forgotten, coffee is warming). It’s said to brighten the eyes, open the meridians, improve digestion, and drain dampness. If coffee leaves you agitated in any way, try green tea instead.

Oh. And if you like green tea, check out matcha. It’s wonderful.

3.) Add organic virgin coconut oil or grass-fed butter to your coffee. In some circles, this is known as “Bulletproof  Coffee.” This mix is more appropriate for those who eat more plants than meat, and who tend to be more ‘cold’ than ‘warm.’ By adding butter/coconut oil to your coffee, you can ‘soften’ the extreme release of liver energy. Many people report that drinking their coffee in this way gives them much more extended energy throughout the day, sans jitters. According to Traditional Chinese Medicine, coconut oil is warm, sweet, strengthening, and can quell ‘wind.’ Butter/ghee is warm, yin-tonifying, and ever so slightly blood-moving.

Start by adding 1 tsp. of  coconut oil and/or 1 tsp. of grass-fed butter to your coffee. Blend it to emulsify the fats (a small immersion blender is helpful). Some people add up to 1 tbsp of coconut oil or butter to their coffee. I feel like 1 tsp. of each is enough, but that’s me. 

4.) If you’re blood deficient, experiment with adding Si Wu Tang to your coffee.  Si Wu Tang (a blood-tonifying formula) tastes pretty good, and mixes decently with coffee (depending how committed you are to a specific taste). For example, let’s say your period just ended. You’re feeling tired, stressed, and kind of anxious. You really want a warm mug of coffee, but you wonder if it will make you feel worse. Well, try adding Si Wu Tang granules to your coffee! The herbs in this formula not only tonify blood, but help ‘soften’ and regulate the liver. If you’re interested, granules are available at Wildwood Community Acupuncture.

Well, that’s a wrap! May you find your sweet spot with this beverage, and if not, may you find your sweet spot with another.