Wholistic Family Healthcare Blog

Winter & Kidney Energy

2012-01-11T14:55:00.000-05:00

When one thinks of Chinese medicine or acupuncture the first thing that usually comes to mind is qi. Qi is loosely translated in English as energy and these are the terms I will use here in this blog.

As it is now winter the energy that is dominant in our bodies is kidney energy. The energy of the kidneys is responsible for our bones, teeth, our sexual function, the health of our lower back, drawing air deeply into our lungs and our over all constitution is said to reside in our kidneys. Our kidney energy also governs our bladder, as the bladder is the yang pair to the kidney, which is yin (a discussion of yin & yang will be on another post).

According to Chinese medicine winter is the absolute worst time for strenuous exercise, as the winter is a time for taking care of your body and of conserving energy. It is the time of year that should be used for replenishing our energy levels so that when spring and summer come and the qi is very active we will have the energies we need. That is not to say that we should become couch potatoes or imitate bears and hibernate. Moderate exercise is what is needed as it gets energy moving, circulates blood and warms the body.

It is a good time of year to eat hardy foods such as stews and soups. Use of ginger, cloves, cinnamon and garlic are recommended as they are warming and move the energy. Black kidney beans, black sesame seeds nourish the kidney energy. Mulled wines are also a good energy mover and warmer. Sweet potatoes, yellow winter squashes and root vegetables are good and hardy foods for this time of year.

As wintertime is the cold and flu season, bear in mind that Chinese medicine has excellent herbal formulae to help prevent and deal with these two problems. Acupuncture also plays a tremendous role in cold and flu prevention and cure. But one must come into winter prepared. Getting your energies strong should be part of your game plan in preparation for winter. Soon will be the time to prepare for spring and allergy season so don't delay, as an ounce of prevention is better than a pound of cure.

Low Back Pain

2012-01-11T14:54:00.000-05:00

Ouch! Oh No I can't stand up! I can't move!!!! What happened to my low back? It was fine just a minute ago.

This scenario sound familiar to you? If it does, there are two words that you should know - Quadratus Lumborum, AKA the Q.L.

I know what you're thinking E Pluribus Unum to you too. What has that got to do with my low back pain and the fact that I can't get off my couch! Stop speaking in tongues and help me.OK, but I was using the Latin name for the muscles that are located in your lower back that have probably gone into spasm. They are usually the cause, in my experience, for most low back pain and for turning you into a pretzel.

A good percentage of my practice is dealing with back pain, either upper or lower. Upper back pain will be a topic for another day. As a low back pain sufferer myself I am acutely aware of the problem and how it is affecting or can affect your life.

Let's go back to that muscle the Quadratus Lumborum (see the illustration above). This muscle originates at the twelfth rib and inserts on the P.S.I.S (the hip) on both sides of your spine. This muscle is a postural muscle; that is a muscle that helps keep you upright. If it goes into spasm on one side or the other you will be pulled in one direction or the other. You will also lose the ability to twist, turn or stand up straight (without pain that is).Well I am sure you are thinking about now thanks for the anatomy lesson, but what can you do for my achin' back? Right?What I do for people who suffer from acute spasming of the Q.L. is take a multi-disciplinary approach. I use heat, electro-acupuncture, massage, herbal liniments and stretching, to help relieve your pain and get you moving again. I might also throw in some ear acupuncture it really helps, believe it or not. Usually I would see a patient for three sessions, instruct them in home self-care and how to prevent this problem in the future.Honestly, regular massage sessions, being careful in your daily activities and taking care when doing activities that you usually don't do can prevent most of the low back pain I treat. Problem is we take our backs for granted and we are just too busy to bother with prevention. I think I hear my next patient climbing onto my table gotta go I have another low back to fix.

Stress and You

2012-01-11T14:51:00.000-05:00

Let me ask you something; what is the one thing in your life you could have less of and be a much happier person? If you said stress, you were right. I'll have you know, stress in and of itself is not a bad thing. It is our body's natural early warning system. It is the system that makes your hair stand on end when your gut tells you something is wrong. It initiates what is called the fight or flight response in your body.The problem with stress is when we have too much of it, when we have it all the time. It is like I tell my patients; you can't always have the army out looking for a perceived enemy. The soldiers get burned out and tired. It is the same thing with stress. Having constant stress is like always having your army on high alert. The system that governs it the autonomic nervous system - gets burned out, so to speak.

So what to do? what to do? Well let me suggest a few ideas. First, take a walk and think about something pleasant. Second, pick up the phone and schedule a massage for yourself. Massage of any type is very calming. According to the Touch Research Institute in Florida, touch has unique ability to reduce stress hormones and improve immune system function. According to one study they did, it was found that massage therapy reduced anxiety, depressed mood, salivary cortisol (stress hormone) levels and body dissatisfaction.

Massage increases endorphin levels in the body. Endorphins are the body's natural feel good hormone that helps with pain relief. Endorphins (or more correctly Endomorphines) are inherent opioid biochemical compounds. They are peptides produced by the pituitary gland and the hypothalamus in animals with spines, and they resemble opiates in their abilities to produce pain relief and a sense of well-being. In other words, they might work as "natural pain killers". In fact the receptors in the brain that endorphins attach to are the same receptors that morphine would attach to.

In1999 clinical researchers reported that inserting acupuncture needles into specific body points triggers the production of endorphins. In another study, higher levels of endorphins were found in cerebrospinal fluid after patients underwent acupuncture.

In my clinic I use a combination of massage, acupuncture and aroma therapy to induce a state of relaxation. This powerful treatment which I have used on many patients in combination with required "homework" has been a boon for my patients. Many have related being a "different person" at home and not being so quick to anger at other times.Don't you owe it to yourself as well as your loved ones to be the best person that you can be? Wouldn't you love to be more relaxed and calmer? It is possible, you can do it! Calm happy people are productive people. Who today would not want to be more productive? So take some time each week to focus for an hour on yourself. Invest in yourself, the dividends could be enormous.

Rainy Days & Mondays Always Bother My Arthritis

2012-01-11T14:47:00.000-05:00

You know the song; Rainy Days & Mondays Always Get Me Down, come on now sing along. Anyway it is another rainy day here in Silver Spring and many of you are probably thinking about Sunday's Super Bowl between the Colts and the Bears. Anyone remember when the Colts were the Baltimore Colts? Hello you Hoosiers.Well I am sure that there are a few people who are not thinking about Sunday but are just trying to get through today. What is the problem with today you ask? Well look outside; it is damp & cold and in my mind I am thinking about my patients who have arthritis. I am hoping that they remember to drink some ginger tea. I am hoping that they are applying the Po Sum On oil that they have gotten from me. I hope they remember to do all the other things that I have advised them to do.My arthritis patients are a great group of people. They are just in pain and are stiff even when the rest of us are not giving our joints a second thought. How lucky to be care free. Well, when you have arthritis you are not care free and you are probably a better barometer than any one that any weatherman has. If this is you did you ever think that acupuncture and Chinese herbal medicine could help you?In the Annals of Internal Medicine it was reported that in a clinical trial it was found that acupuncture was able to reduce the pain in osteoarthritis of the knee. Well just think, if it works for the knee it can work for any joint. They just studied one joint is all. http://www.annals.org/cgi/content/abstract/141/12/901

Well just remember that the Chinese have been dealing with arthritis for thousands of years and I bet they learned a thing or two about how to deal with it. Unfortunately there is no cure as arthritis is an auto-immune disease. I hope and pray that one day a cure will be found (without negative side effects). But absent this it is all about management of the pain and stiffness. Ask yourself how are you managing your arthritis? Are there any unwanted side effects from the medications that you are taking for your arthritis? If you are satisfied with your answers, then keep on trucking. If you are not than maybe acupuncture and Chinese herbal medicine is for you.If you are not suffering from this painful disease then enjoy the Super Bowl, but as you watch it remember to thank G-d that your are able to not give your joints a second thought.
Go Colts! Oh I mean, Go Bears!

Oh I mean....

Essentials of Chinese Nutrition

2012-01-10T13:29:00.000-05:00

Just last night I was discussing the topic of nutrition with a patient. This is a subject that comes up repeatedly during treatment sessions. It comes up because I ask about it at the first appointment and then again at subsequent appointments. Why, you may be thinking, does he ask about a person's diet? The answer is because Chinese medicine demands that a practitioner evaluate all aspects of a person and one of the main influencing factors in a person's life is the food that they eat. Chinese nutrition is vastly different from Western nutrition in many ways. You will need to drop your pre-conceptions and open your mind in order to read further.

It is funny to see all the self-confidence that my patients exhibit when they begin to tell me about all the salads that they eat and how they don't eat red meat or any meat at all. It is sad to hear about all the store bought, pre-made and pre-packaged food that they do eat.

Chinese medicine views what we eat as a very important component to our daily health and well being and as such it categorizes food into areas of energetics. Namely it looks at - the taste of the food, the temperature of the food (not what you think) and the season that one finds oneself living in. It also considers the person's energetics at the time. Then all those concepts need to be blended to best compliment the patient. Confused yet? It also considers the environment and way in which one eats.

Let me explain for example as I write this it is winter time here in the Greater Washington, D.C. area. Yet, if one were to go into a grocery store one could find peaches, plums nectarines, grapes, strawberries, all looking ripe & yummy. So what's the problem? The problem is that these are all summer fruit and have summer energies as they were grown in the Southern hemisphere and we live in the Northern hemisphere and are not having summer now. Your body is in winter mode and not summer mode. In Chinese medicine this means conservation of energy, eating hearty foods that will build a reserve within you that can be tapped for the seasons of growth and renewal, namely spring & summer. One needs, as I wrote earlier, hearty foods, warming foods, foods that will build you up and strengthen you in order to fight colds and flus. What you do not need are foods that are light and cooling, which summer foods are as they should be, summer is hot and "heavy."

In Chinese medicine we speak about energies and within the body there are different organs that govern the energies of the body (for an in-depth explanation of the theories of Chinese medicine there are many textbooks available). In the case of digestion, it is the Spleen. Chinese medicine says that the spleen governs digestion, rules the muscles, holds blood in the in the vessels, produces phlegm and is the main partner in producing De QI, the main energy that keeps the body functioning. It is said that the spleen likes warm and dry conditions and operates most efficiently in that environment.

According to Chinese medicine raw fruits and vegetables are cold & damp in nature and adversely affect the spleen's energy & function if eaten in abundance. Dairy is considered a phlegm producer and is also tough on the spleen. Meat is said to build blood and strengthen the body. Vegetables and fruits are best if cooked somewhat stir-fried, steamed or souped, well in the case of fruits stewed.

Herbs and spices are also categorized into temperature and taste and can influence the foods we eat.

As you can see this is an involved topic that deserves its own lecture, a lot of time to digest (ha! ha!) and understand. There are many fine books on the subject as well.

Happy eating!!

Upper Back Pain

2012-01-10T13:05:00.001-05:00

Upper back pain and stiffness is a common problem in today's world. How many hours a day do you sit in front of your computer? Four, five, six hours a day? What position are you in for those many hours?

I would like you to take a trip and have an out of body experience. I know, I know, you think I am being flaky and new age like. Hold on for a minute and give me some latitude here. Go ahead, close your eyes wait!!!!!! You have to finish reading this first so that you will know what to do when you close your eyes. OK, when you close your eyes I want you to see yourself sitting at your desk, or wherever it is that you work on your computer. Can you see how your are bent forward and how your shoulders are slightly rounded as you bring your arms in position to type? Well this becomes a problem when it is done for hours on end, day after day. Couple this with daily stress, insecurities and lack of exercise and proper stretching (note, I said proper) and no wonder you're in pain, feel stiff & tight.

For those of you who are saying, wait a minute I am not on a computer all that much and my shoulders still hurt and feel tight. What about me? Well here are a few other things to think about. Do you carry a heavy purse, backpack, children? Do you drive a lot? Al these things a daily repetitive tasks that create stress on your shoulders and if not attended to will lead to tightness and stiffness.

The major muscle in the upper back is the trapezius, commonly called the traps. The traps are a huge muscle that spans a large part of your upper back. See the picture below where the green shaded area is?Â That is the trap.

If you look carefully you will see how this muscle spans the shoulders and goes up into the base of your occiput (the back of your skull). True there are many other muscles in the upper back that will also become tight, and they will need to be addressed as well when being treated. However, this muscle needs to be worked on first, because if the traps are tight and as it is the most superficial muscle the lower layers can't be gotten to with out experiencing a lot of pain. So for those of you who want deep tissue massage all the time or ask for it on your very first massage be careful what you ask for. I always work muscle in layers, superficial first, and deeper ones later. Working faster than that can create more pain and soreness than you might want.

It is also very important for you to take frequent breaks during the day. I always tell my patient to get up and stretch every 20-30 minutes. This does not have to be a 15 minute calisthenics event, you just need to do some shoulder shrugs and rotations. I always recommend the doorway stretch as well. With this stretch you have to be careful of your fingers though. To do it in front of a doorway with your feet about shoulder width apart, put your palms on the door frame and lean into the doorway. As you do this you should feel a stretch in you pecs. Hold this position for a few seconds then come back upright. Doing these exercises will help prevent some of the tightness that you experience. You also need massage work to help keep the muscle soft and supple. Massage will also bring fresh blood to the area by relaxing the muscles. Massage will also relax you in general and this too will allow your muscles to stand down.

You need to be proactive (work to prevent problems) as well as reactive to keep your body functioning in the best way it can. This is the idea behind massage and Chinese medicine. What a novel idea?

What the Heck is Gua Sha?

2012-01-10T13:04:00.001-05:00

I would like to introduce you to a term that many people have never heard of Gua Sha.

What is Gua Sha (pronounced Gua sa)? Well Arya Neilson the premier practitioner of Gua Sha in the U.S. explains it thusly:

Gua Sha is an East Asian healing technique. Gua means to scrape or rub. Sha is a 'reddish, elevated, millet-like skin rash' (aka petechiae). Sha is the term used to describe Blood stasis in the subcutaneous tissue before and after it is raised as petechiae. Gua Sha is one technique that intentionally raises Sha rash or petechiae. In Vietnam the technique is called Cao Yio, in Indonesia: Kerik, in Laos: Khoud Lam.

She goes on to say:

Gua Sha is used whenever a patient has pain whether associated with an acute or chronic disorder. There may be aching, tenderness and/or a knotty feeling in the muscles. Palpation reveals Sha when normal finger pressure on a patient's skin causes blanching that is slow to fade. In addition to resolving musculo skeletal pain, Gua Sha is used to treat as well as prevent common cold, flu, bronchitis, asthma, as well as any chronic disorder involving pain, congestion of Qi and Blood.

All this and more can be found on her website at: http://www.guasha.com

I have personally used Gua Sha on patients who have had stubborn coughs or tight muscles that have not responded to other modalities for one reason or another. My patients are usually flabbergasted at how fast they see results.

I do warn my patients that Gua Sha should not be done if they are planning to go to the beach in the days following treatment, and that they should forewarn their special someone before showing them what the area that was worked on looks like. Although it does not hurt to get Gua Sha (it can be uncomfortable) or to touch the treated area afterwards, it can look quite shocking.

I have also used this technique quite successfully on children. They are usually more amenable to this technique and it can and has produced dramatic and positive results.

Recently, I was talking to a member of my BNI group (http://www.bnibethesda.com), who happens to hail from China. Well she got so excited to find someone who knows what Gua Sha is that we talked about it for 15 minutes or so. She then called over her husband, who is not from China, and told him excitedly what we were just talking about. It made her happy and I think, connected to China on some level.

It is feeling that my practice is unique in this way. I am able to and do incorporate different modalities into my treatments. I feel this greatly enhances the treatments that I offer my patients. I customize each treatment for my patients each time they visit with me.

Stress and You II

2012-01-10T13:02:00.001-05:00

A colleague of mine just told me about a wonderful thing she did for herself. She went on a spiritual retreat. It was not with a revival group or anything like that. It was just her and some things she does to revive her spirit.

What she did was so simple, yet so powerful. Here is her secret (don't tell anyone. It is only for those of you who read my blog). She spent 3 days on the shore in a bed and breakfast. She wrote, she read and she enjoyed the solitude. She brought back beautiful pictures of sunrise, so I know she was drawing in energy, rejuvenating energy from nature.

This is someone we can all take a lesson from. What she did was to get off the merry-go-round of work, responsibilities to everyone else and their overwhelming stresses. She took time to re-charge her batteries and took care of herself.

Now some of you might call this selfishness YOU'RE WRONG! This was pure genius! So many of us get caught up in our work, our families, our social circles, the thousand and one things we have to do, the thousand one things we have to have, the thousand and one things that are expected of us by family, friends, customers, patients and employers that we lose our perspective. We lose our sense of self.

Let me ask you something how are you going to get it back? One way is to get a weekly massage, where someone spends an hour working and concentrating on you. Another is to take a bath in a darkened bathroom with candles burning (I like this one). Another is to do what my colleague did; she went on a retreat. This is something best done without the kids, laptop, cell phone, television or other disturbances. I bet you after three to six days of this and you will be a different person. Stress, what stress?

What is important is to plan what it is you will be doing during your retreat that will nourish your spirit, your soul. What will you do that will revive your optimism, your smile. Without proper planning you will probably get board quickly. Also it is best to go somewhere quiet, where there are no large crowds or loud activities going on. What I am saying is that a casino, crowded resorts, places that are having their peak season should not figure into your plans.

So go ahead plan a retreat for yourself and your significant other and replenish, rejuvenate and reinvigorate yourself. Everyone who knows you and spends time around you will thank you for it.

Stress and You

2012-01-10T13:01:00.001-05:00

Let me ask you something; what is the one thing in your life you could have less of and be a much happier person? If you said stress, you were right. I'll have you know, stress in and of itself is not a bad thing. It is our body's natural early warning system. It is the system that makes your hair stand on end when your gut tells you something is wrong. It initiates what is called the fight or flight response in your body.The problem with stress is when we have too much of it, when we have it all the time. It is like I tell my patients; you can't always have the army out looking for a perceived enemy. The soldiers get burned out and tired. It is the same thing with stress. Having constant stress is like always having your army on high alert. The system that governs it the autonomic nervous system - gets burned out, so to speak.

So what to do? what to do? Well let me suggest a few ideas. First, take a walk and think about something pleasant. Second, pick up the phone and schedule a massage for yourself. Massage of any type is very calming. According to the Touch Research Institute in Florida, touch has unique ability to reduce stress hormones and improve immune system function. According to one study they did, it was found that massage therapy reduced anxiety, depressed mood, salivary cortisol (stress hormone) levels and body dissatisfaction.

Massage increases endorphin levels in the body. Endorphins are the body's natural feel good hormone that helps with pain relief. Endorphins (or more correctly Endomorphines) are inherent opioid biochemical compounds. They are peptides produced by the pituitary gland and the hypothalamus in animals with spines, and they resemble opiates in their abilities to produce pain relief and a sense of well-being. In other words, they might work as "natural pain killers". In fact the receptors in the brain that endorphins attach to are the same receptors that morphine would attach to.

In1999 clinical researchers reported that inserting acupuncture needles into specific body points triggers the production of endorphins [1]. In another study, higher levels of endorphins were found in cerebrospinal fluid after patients underwent acupuncture.

In my clinic I use a combination of massage, acupuncture and aroma therapy to induce a state of relaxation. This powerful treatment which I have used on many patients in combination with required "homework" has been a boon for my patients. Many have related being a "different person" at home and not being so quick to anger at other times.Don't you owe it to yourself as well as your loved ones to be the best person that you can be? Wouldn't you love to be more relaxed and calmer? It is possible, you can do it! Calm happy people are productive people. Who today would not want to be more productive? So take some time each week to focus for an hour on yourself. Invest in yourself, the dividends could be enormous.

The $895.00 Pain Reliever - Want One?

2012-01-10T13:00:00.000-05:00

Recently arrived in the mail was a newsletter from some institute in California promoting a new wonder cure for back pain. It trumpeted something called the Infratonic something or other and the L-5 Protocol. This cure entailed your buying a machine for only $895.00. The newsletter said that this machine would help with all types of pain, but touted its help in back pain with treatment lasting only 10 minutes a day. I have the newsletter in my office for anyone who wants to see it.

The catch was that one would have to treat oneself. No therapist along to tell you if you were doing the treatment correctly, or what to expect throughout the course of treatment.

The hook or sales tool was to offer free shipping and parts replacement for three years. Wow! What a bargain some bargain.

My mother always said, if it sounds too good to be true, it usually.

Besides being less expensive my treatments come along with someone to guide you and apply the treatments correctly.

This machine is supposed to relieve back spasms and accelerate healing. No where in the newsletter did it explain how this machine worked to help one heal. It also did not discuss or outline any possible side effects.

Well I am here to tell you that I have helped many people with back pain, and for a lot less money. I use tried and true techniques, techniques that are literally thousands of years old. True some of the methods that I can employ are more modern and use technology, but I can explain how they work and what they are supposed to do. I also aim to get at the cause of your problem (preferably once you are out of pain) so that your issue won't come back repeatedly.

I use acupuncture, massage, heat, and stretching. These are among the effective tools that I have at my disposal to help you. Through time and information gathering I can often pinpoint the cause of your pain and suggest ways to relieve it and to stop it from re-occurring.

The machine this newsletter was touting amounted to a very expensive painkiller. Cheaper models are on every supermarket and drugstore shelf in America. However if you want more that just pain relief, if you want to possibly end your pain by getting to the source, call me. 'nough said!.

Back Surgery - What Should I do?

2012-01-10T12:58:00.001-05:00

Someone just today asked me about back surgery and what I think of it. Well lets start off by saying that I am not a medical doctor and can't give medical advice. But I can tell you that I know muscles and work with pain relief all the time. So I feel comfortable talking to people about the subject.

Let me say that I have had at least two patients who were able to stave off surgery (both were not back surgeries, but one was) because of the work we did together. I stress that because they followed my advice, in other words they did their homework as I instructed them to do.

Acupuncture and massage are not miracle cures but they can be very effective against pain. I am working with another neck-pain patient currently, who is looking at the prospect of surgery for herniated discs. Stay tuned.

Another point to ponder if you have back pain that a doctor has told you comes from a herniated disc, what will be the outcome of the surgery? Are all surgeries successful? Will you have continued pain after the surgery? What will you do then?

Now, I am not saying that surgery is bad. I am saying, proceed with caution and perhaps exhaust all other possibilities first. Once you cross over to the other side, there is no coming back. The surgery can't be undone.

That said I am sure you are asking, What should I do? My answer is to try acupuncture and massage therapy first. For how long? you may ask and honestly I can't give you definitive answer. I ask my patients to give me approximately four months of care and of following my instructions. Then we can reevaluate and see if any progress has been made. Then we can see if you and I want to continue with care. But by then it will be an informed decision.

I also would ask any reader of this comment and blog to seek out a Licensed Acupuncturist, not a doctor with an, add on certificate, for care in this area, really in any area of acupuncture. Licensed Acupuncturists have studied Chinese medicine on average 3-4 years and have received a Master's Degree in Acupuncture or in my case Oriental Medicine. For referrals outside of my local area please go to one of the links for the acupuncture professional societies on this blog or my web site

Who's Afraid of Acupuncture?

2012-01-10T12:56:00.001-05:00

Not me, I don't want acupuncture. I am afraid of needles. Can you hear yourself talking? I have met many people who have expressed this sentiment to me. Some of these people can get away with other types of treatment while some are denying themselves the best type of care for the problem they are experiencing.

I think we all have a fear of needles because from the time w were born people were always jabbing us with the things. And honestly they hurt. So when all your life you associate needles with pain, why in your right mind would you submit your self to having more of them stuck into your body? This is a very valid question.

Because not all needles are created equal. Hypodermic needles are thick and hollow and cut into the flesh. That is why they are painful. Acupuncture needles are as thin as the hair on your head and they are very sharp. Acupuncture needles are solid and do not cut into the skin. They sort of part their way into the body. The example I like to give and I know this has happened to you. You are working in the kitchen and suddenly you see blood on counter surfaces or the food that you are working on. Where did that blood come from, you ask yourself and you begin to look around. It is then that you notice that you were cut. How is that I did not notice being cut, you ask yourself. Well the answer is that the knife was so sharp you did not feel a thing.

Acupuncture needles work the same way. Because they are solid and sharp for the most part you won't feel them going in. I'd be lying to you is I said that there is never any pain associated with acupuncture, but it should be minimal. But as the saying goes No Pain No Gain.

You are the only one who can decide which pain is worse the pain you are living with or the slight pain from an acupuncture needle. The pain from the needle only lasts for a few seconds. You are living with pain all day long. Which is worse? Honestly.

I always tell my prospective patients and my current patients the pain you are experiencing every day is yours and I wouldn't dream of taking away from you if you want it so badly.

It is your choice as always. I choose not to suffer with pain long term. What's your choice?

Listen to Jackie talk about her first acupuncture experience.

The Three Legs of Chinese Medicine

2012-01-10T12:55:00.000-05:00

Chinese medicine is said to stand on three legs namely, Acupuncture, Herbs and body work/Massage. Exercise is also very important, so activities like walking, qi gung or tai qi, are excellent ways of strengthening your qi. In today's post I will talk about all three but primarily about herbs as this is the area people know the least about.

All of Chinese medicine is focused on moving energy or qi (pronounced chee) in your body. If the energy in your body is strong enough, plentiful, and moving well then you should be and stay healthy. In utopia this would be the case. However, in today's world this is not possible. Most of us don't eat well, don't sleep enough, have too much stress and don't relax. All of these factors injure our energy/qi. The ways to restore our qi and repair the damage done is through Chinese medicine.

Acupuncture is one way to help the body utilize the energy it has to the best of its ability. Acupuncture however cannot add energy to the body. It acts as a director of the energy.

Body work/massage also acts in the same capacity as acupuncture. However bodywork has the additional advantage of being more hands-on. Touch has been shown (as discussed in a previous post) to have many positive and beneficial effects on the on the nervous and limbic systems.

Chinese Herbal Medicine is the modality that gets the least fanfare. This is probably due to the American palate & temperament. You see Chinese herbs require preparation and the time needed to prepare (in their most beneficial form) them. Additionally, they don't have a particularly good taste or smell. Plus people often don't like to think about what the herbs are.

There are three forms that Chinese herbs are available in raw herbs, freeze-dried powders and pill form. They are listed in most to least effective. Raw herbs usually come in dried form and require cooking to make the tea. The powders are mixed with water to form a tea. The pills are just swallowed.

Chinese herbs are classified into many categories and by channel/meridian affinity. Chinese herbs are also almost never prescribed singly, but rather in formulae. This gives the practitioner the ability to manipulate the formula to suit the individual patient (this is not possible in the pill form). It also give the practitioner the ability to moderate certain attributes in the herbs in the formula that maybe either too strong or too weak.

The use of herbs also allows the effects of the patient's treatment to be extended and enhanced. It also allows the practitioner to treat problems that may not have been able to be addressed during the acupuncture session for whatever reason.

The use of Chinese herbs does require the guidance of an educated practitioner. It would be very difficult to just pick up a text and start self-treating. I don't say this so that you would be tied to me as a guide, rather as a statement of caution and fact. Chinese herbology is very complex and a lack of knowledge or a little bit of knowledge can be very harmful. That said, understand that Chinese herbs are very safe and have been used safely for many thousands of years in many countries and for millions of people. In fact some of the formulae have remained basically unchanged for many thousands of years because they work. Used safely Chinese herbs have no negative side effects and except for a few herbs, don't interact negatively with modern drugs.

I hope this information is helpful to you. I encourage you to do your own research and to learn more about the wonderful effects of Chinese Herbal Medicine.

Cancer Care II

2012-01-10T12:53:00.001-05:00

Previously I wrote about two patients of mine whom I have treated. I would like to write an update on one of them today. I pick one not because the other is not doing well, she is, but because one patient is now undergoing radiation.

The patient undergoing radiation is a patient who suffered breast cancer. She had surgery followed by chemotherapy. The chemotherapy lasted for seven treatments. She suffered with side effects such as hair loss, nausea, mouth sores, sore throat, mouth dryness and fatigue.

Now as I mentioned in my previous post, Chinese Medicine offers no cure for cancer and so one needs to consult with a qualified physician for cancer care. What I can offer is adjunct or ancillary care for the side effects of chemotherapy and radiation therapy.

I was able to successfully help my patient with eliminating her nausea, sore throat, mouth sores, mouth dryness and fatigue. The fatigue was a constant battle as was the nausea, although the nausea got worse with each chemotherapy treatment the acupuncture helped alleviate it. The acupuncture worked relatively quickly in eliminating the mouth sores and sore throats. These symptoms also did not require multiple treatments.

Now that she is on to radiation, she has commented that she is now more fatigued than she was during the chemotherapy process. She actually felt better before the radiation began.

So now we are working together to help relieve her fatigue and to care for her skin in the area where the radiation is being concentrated.

Because of her doctor and her doctor's own personal fear she won't take any supplements. Chinese medicine has many formulae that can help a person deal with the side effects of chemo. I also suggest that patient either eat or take mushroom supplements as the beta-glucans found in mushrooms are being proven as cancer fighters. In fact I recently saw an article with mushrooms have more anti-oxidants that chicken liver (the previous top biller). But fear of the unknown, usually on the doctor's part, stops patients from getting the benefits of these supplements.

I wish everyone only the best of health!

Cancer Care

2012-01-10T12:52:00.001-05:00

" I just heard from the Dr. and I have cancer." Are there any scarier words that can be spoken?

I have heard these words spoken by my patients. They then asked me, "what can you do to help me?"Chinese medicine is many thousands of years old and has been dealing with cancer as well as other diseases for all those years. Yet, there is no cure for cancer either from Chinese medicine or from western medicine. So you are asking - what does he have to offer with his Chinese medicine?

Well, let me share with you two recent cases. One patient came in with malignant lung cancer, the other with malignant breast cancer.

The lung cancer came to be many years after this patient stopped smoking. The surgeons advice was that one of the lobes of the right lung would have to be removed. So we started the patient right away on mushroom supplements. Mushrooms are leading the way right now in cancer research studies. The next generation of cancer fighting drugs may very well come from mushrooms.

Following the surgery I worked on strengthening my patient with acupuncture as well as treating the incisions from the surgery with acupuncture and Chinese herbal liniments. This treatment was instrumental in helping the scars heal well and remain pliable. My patient attributes her quick recovery to acupuncture.

One of her complications from surgery was constipation, which by the way, the surgeon had told my patient was a common side effect often seen in lung surgery patients and that he did not know why. Well Chinese medicine provided me with insight into why constipation is a side effect of lung surgery. I recommended a course of action that quickly resolved the constipation.

Another patient was diagnosed with breast cancer. I recommended here to that mushrooms be incorporated into the diet.

Currently chemotherapy is the treatment being administered by the oncologist. I am administering another treatment. One based on Chinese medicine and the two principles used when working with cancer patients. I have been using acupuncture to help with nausea and maintaining her strength. My patient recently commented that she felt so good over the weekend. She said that she felt the way she did before she started chemo.

I have also made dietary recommendations based on Chinese medicine's nutritional guidelines. This is directed at keeping up her strength combating other side effect of the chemotherapy and preventing her liver from storing the toxins from the chemotherapy. So far so good.

I feel confident that Chinese medicine, via acupuncture, Chinese herbal medicine and Chinese nutrition, is and will continue to make an important contribution to cancer care.

Acussage - Did you know?

2012-01-10T12:51:00.000-05:00

Acussage, is a term I like to use to describe the unique way I combine acupuncture and massage, two very powerful treatment methods to relieve painful muscle spasms and tightness.

Many people come to me seeking relief from low back pain & tightness, neck stiffness, cramps in the arms, legs and just about anywhere else in the body.

Why is it that I can combine these two techniques into one powerful treatment when other therapists can't? The answer is, because I am both an acupuncturist and massage therapist. These two healing modalities require separate education and training. They also require separate licensing and or certifications by most states in the union.

Being able to bring these two modalities to the table (pun intended) greatly benefits my patients as one can plainly hear in the video testimonials given by real patients of mine. Just click on the testimonial pages to hear what they have to say.

If you would like to experience Acussage for yourself and realize a reduction in your pain and tightness, call and make an appointment today! (301) 495-0303

What flag are you waving?

2012-01-10T12:49:00.000-05:00

Who are you? What are you? Are you an illness? Are you a diagnosis? Are you laughing yet? What sort of questions are these you probably asking your computer monitor. Hopefully it is not talking back. If it is, I can't help you.

As silly as this may sound to you, it is true of many people. Many of may patients have come into my office and the first words out of their mouths after being asked what can I do for you? is I have such and such diagnosis. They sort of wave this flag, use these words that probably to them - have no meaning.

People are so happy to have a label to what they are feeling. I guess it sort of validates that one is not feeling well to have a label, to have a diagnosis. Here is one for you Fibromyalgia. What is fibromyalgia? Can you tell me what would be part of a definitive diagnosis of this disease? What do doctors look for before saying, you have fibromyalgia or chronic fatigue syndrome.

Honestly these fancy words are a way for doctors to tell you, without sounding stupid, I don't know what you have. But yet people wave this flag high and proud. They go from treatment to treatment, year after year with no relief. What a shame.

I have had a few of these patients and they have responded very positively to acupuncture and Chinese herbs. I will be honest with you; they did not have quick recoveries. On the contrary it took many months to get these patients better. It took a lot of work on my part as well as on the part of my patients. This treatment like most of the treatments in Chinese medicine takes time to have an effect. Remember they are not medicines. We are working on your energy system. Your energy may be weak and unable to heal you quickly. You may have many intermingled symptoms and energetic problems. All this takes time to unwind.

Chinese medicine does not operate from a western diagnosis. Every Chinese medical practitioner must figure out what problems exist within your energetic system. There may be multiple problems that need to be addressed. Chinese medicine is a holistic medicine. You are viewed as a whole and not reduced to your parts, symptoms, & signs. The whole of you is truly greater than the sum of your parts.

Are you an allergy sufferer? Why?

2012-01-10T12:47:00.000-05:00

Late winter and early spring is the beginning of allergy season here in the Washington, DC area. In fact many people to whom I have spoken tell me that they experience allergies for the first time in their lives after moving to the climes.

So give me your tired, your red and runny of eye, your sneezing ones, your miserable ones.

Are you one of those sufferers who have red watery eyes, runny noses/stuffed noses, and sneezing fits? If so, are you taking allergy shots weekly? Are you taking antihistamine drugs that are making you drugged out and spacey? I know it can't be fun.

I remember when I was young; I used to watch my younger cousin suffer terribly with allergies. It seemed like he suffered all year long. I felt so sorry for him and secretly thanked G-d that I did not have seasonal allergies.

Well I would like to clue you in on what Chinese medicine has for you and what it can do for you. First off one should start with acupuncture and herbal medicine treatments a few weeks prior to the onset of the season. We do this in order to strengthen the lung energies. Hold on to your seat, as I try to explain how Chines medicine views what the lung energy does for the body. Chinese medicine sees the lungs as the delicate organ. It is so designated because it is the most easily affected by and exposed to the environment in which one finds oneself. By breathing the lungs are exposed to whatever is in the air. Sure there is hair and mucus that line the nose and throat, whose job it is to filter the air you breathe. However microscopic particles like viruses, allergens and the like blow right past these natural defenses and right into your lungs.

In the view of Chinese medicine part of the job of the lungs is to defend the body against invasion by these microbes and allergens. This special defensive energy is called the wei qi (pronounced way chee). If the lung qi/energy is weak, the wei qi will be weak and then you guessed it, your sick or sneezing. That is why we start be strengthening the lung qi. It is always smart to train the army and equip it properly before sending it out to defend the borders.

After strengthening the lung qi, we need to reinforce the wei qi and we do this by using an herbal formula called Yu Ping Feng San or Jade Windscreen. This formula acts like sort of an armor all coating to protect the body from invasion. Although it is not fool proof, many of my patients love what it does for them and without the side effects like drowsiness.

I would also add acupuncture and an herbal formula to help with reducing phlegm production and make dietary recommendations to cut down on foods that produce phlegm.

This is a muti-faceted approach to deal with the cause and effect of seasonal allergies. This is a much wiser and much sounder approach than just dealing with the symptoms. If this approach interests you, give my office a call and set up an appointment soon.

Are you getting enough Caffeine?

2012-01-10T12:46:00.000-05:00

I just read an article in US News & World Report, in which the subject was caffeine and how much is being consumed by Americans. It said in the article that caffeine is not only found in chocolate, coffee & tea the traditional sources but was also now being added to beer, hi energy drinks and in other types of food.

It is truly scary how people today want to cram more & more into their lives. It is as if we are trying to somehow figure out how to get more than 24 hours into our day. Momma always told you that you couldn't burn the candle at both ends did she not? Yet here we are ignoring her sage advice.

It is getting so bad that according to the article teenagers and college students are devouring caffeine so that they can stay up later studying. All so that they can get into the college of their choice or get accepted to many colleges so that they can pick the one they want to get into. They are also drinking caffeine-laced beverages so that they can stay up partying later. People in their late twenties and early thirties are doing the same so that they can keep up with the twenty something crowd.

I was just amazed at what I was reading. There was no sanity in what people are doing to themselves. People according to this article are sacrificing sleep, proper hydration (caffeine dehydrates you), and I can assure you these people are not eating properly. The end result is burnout, health issues down the road, infertility problems I can just see it coming like a train wreck.

A story is told about an old man who was in the hospital in the nicest room. One day a candy striper came by to visit with him and to see if there was anything he needed. He told her that he had everything he needed except one item. She asked what that was and that she would see to it right away. The old man replied that she could not get him his health back. This is what he was missing. You see, he said, I spent my whole life running after money at the expense of my health, and now you see me here in this expensive hospital room spending all that money trying to re-acquire my health.

I think it is a better strategy to take the time to slow down and take life one day at a time. It is important to get enough sleep 8 hours a night is average. It is important to eat right and drink enough fluids (not necessarily 8 glasses a day, it depends on your size and the heat of the day). It is important to relax and to exercise both mind & body. Children & teens are much more in need of enough sleep than the average adult, yet they tend to sleep less as the pressure of school and the pressure to achieve is too much to bear. Parents should do something to help their kids; they also have to set the example so that their kids can learn proper behavior.

Caffeine is not the answer to getting more energy; energy comes from fuel, not vapors. It is a simple equation and yet most people don't get it, so here it is:
Healthy Food+Water+Enough Sleep = Energy. I would like to see that taught in phys ed and stressed by parents. I would like to see that lived up to by adults. Anything less is well, just wasting time.

Don't Suffer from Sinus Headache & Infection

2012-01-10T12:44:00.000-05:00

As of late people have been coming in with sinus congestion and infections. Often the primary complaints are of a sinus headache and pressure. Some people are on antibiotics and some are not. Some people have taken multiple types of antibiotics and some just one. In all cases however the overriding theme is that they are not getting rid of the sinus congestion and headaches.

By this point you are probably asking yourself, as do these people who come to me is: Can acupuncture help a sinus headache? My succinct answer is yes!

Sinus problems are viewed in Chinese medicine and being related to the spleen & lung channels. Plainly there are issues with both, and the qi is not flowing as it should. A more detailed explanation can be had at your appointment, if you wish.

What can you do about it, you are surely asking. Well, I always like to take a history first to establish that what I wrote above is true in the case of every patient who has this complaint. Should that be so, the treatment would consist of acupuncture, essential oils, massage and herbs (the herbs you would have to take at home) and diet modification (also done at home). This course of treatment usually is very effective at getting rid of the sinus congestion, infection & post-nasal drip. In addition a neti pot can prove to be very helpful for cleansing the sinus cavities and nostrils. A net pot can be purchased at many health food stores.

So if you are sinus sufferer and don't want to suffer any longer come on in and try my treatment methods. It won't cure you in the first session, but then treatment consistency and patient compliance often brings results.

Strengthening Ourselves in Fall and Winter

2012-01-10T12:41:00.001-05:00

I was recently doing research on how to best prepare my backyard for growing new grass and to help make the lawn stronger and the earth richer for next year. I found articles in the newspaper and information in books. A large part of this preparation involved aerating the soil (punching holes into and removing plugs of soil), applying compost & seed.

Thinking about it I saw a great insight in this process that can be applied to how we live and prepare ourselves for the coming spring & summer. One can certainly choose to spend the fall and winter in inactivity and hibernation. Or one can choose to prepare for the winter and coming spring using the same principles as preparing the ground.

Fall and winter are perfect times of the year for improving your health. These months however can pose significant problems. Being indoors with windows closed and re-circulating air can be a perfect environment for passing or picking up germs & viruses. By the way frequent hand washing has been shown to be quite effective in reducing the transmission of viruses & germs.

That being said these months provide opportunity to eat heartier meals, breathe cool, clean air and exercise that can improve the yang energies. In the hotter months when we exercise, especially outdoors we tend to sweat in an effort to cool down. In the colder months our bodies need to produce more heat in an effort to stay warm, this keeps more of the yang energy inside our bodies. It also gets the qi moving, which helps with nourishment and circulation.

Needless to say it is vitally important to dress appropriately for the weather. Coats, hats & scarves all act as protective barriers. They block wind and cold out while keeping the heat in. Most of us tend to go out without any head covering. Considering the fact that we lose a lot of heat through our heads, we are basically leaving the door open while the heat is on. We need to keep that yang energy inside ourselves as it is the yang energy that protects us.

So let us takes these two colder seasons and make the best of them by strengthening ourselves, through exercise, acupuncture, massage therapy, proper nutrition and by dressing properly.

Wishing you a healthy Fall and Winter!

A Word to the Techie

2012-01-10T12:38:00.000-05:00

Recently I have trying to accomplish some things technical involving my website and the hosting thereof. I am now more than ever enjoying the low-tech world of Chinese Medicine. I have been at my computer more than I care to be and am being able to into practice that which I preach to my patients, who do this for a living.

I have had to get up after a time and stretch & move my shoulders periodically so that I don't get stiff and tight. Also I need get myself away from this frustration so that I don't get a headache or upset.

I guess to those outside of the Chinese medical world, what I do also looks complicated. However there is an elegant simplicity to Chinese medicine that once inside the appreciation for which grows tremendously.

I can truly say that I have a new found and greatly enhanced appreciation for those who sit all day where I am sitting now in front of a computer and make it all look so beautiful and easy.

For all those computer lovers out there, geeks and all, I invite you to explore my world and seek out the benefits that I and what I do have to offer you. It will greatly enhance your well being and productivity and thereby enhance your life.

Who Does Not Want to Have Your Period?

2012-01-10T12:36:00.000-05:00

Ugh! The Mess, the pain before, the pain during, the emotional roller coaster, being so tired, the bloating, the breast tenderness. Wouldn’t be great if you could just take a pill and be done with all of that? Wouldn’t be great not to have your period for a few months or only three times a year or not at all?

For a lot of women the answer would be a resounding Yea! This is what the pharmaceutical industry is banking on as the next generation of “The Pill” is being marketed.

Honestly, I can’t blame you if you are experiencing monthly episodes of the above. Who in their right mind would want to deal with that? Well, I am sorry to say that all is not right in fantasy land.

If you as a woman are experiencing any or all of those symptoms, the answer to your problems don’t lay in stopping your period. From a Chinese medical point of view this is like locking up a pressure cooker. One can only imagine the result.

In Chinese medicine everything is viewed as qi (pronounced chee) or energy. To have all or some of those symptoms indicates that ones qi is not flowing properly. As a healthy female one should not have any “symptoms” that we Americans associate with PMS or a period. They are all signs of dis-ease, that something is wrong in the energy system. Usually the issue is stagnation (qi not free flowing) to begin with.

Free flowing energy would result in a pain free period, with no PMS. Now how is that for a thought? The answer in other words is not to bottle up the energy, which would be the result of a drug that would stop ones period. The answer would be to create an environment within you that would allow the qi to flow and your body to function as it should.

All this playing with nature wreaks havoc on our energy systems which in turn takes a toll on the body. The long range implications that can only be imagined. I say this because we simply don’t know what will happen to women who take these drugs long term.

The organ system that governs the menstrual flow is the Liver. Its energy should be smooth and outward flowing. This energy is affected by emotions and effects the emotions. If it does not flow the result in women can be menstrual issues, like the ones mentioned above.

Acupuncture and Chinese herbs work to create an environment within the body that would enable the qi to flow as it should. This would allow the body to remain healthy and functioning as it should. This is a goal worthy of aspiring to! Anyone not interested in this goal – I guess you can take the pill. Let me know what going on with you in say 20 years.

Have You Ever Treated...????

2012-01-10T12:31:00.000-05:00

Have You Ever Treated…?

I get asked this a lot and I guess I can understand the question, what with today being the age of specialists. People want to know if I am a specialist? So I wanted to post some answers for one and all in this forum to answer this question and to explain how Chinese medicine views whatever ails you.

First off know that if I or anyone else would be in practice for 100 years we could not have seen everything out there. There are so many diagnosises that there would not be enough time in the day to get to them all.

Second, as I practitioner of Chinese medicine the diagnosis that your western medical doctor does not really help me to treat you in an overt way. It helps my western mind understand what you have, but my eastern mind can’t treat you from it.

As any practitioner of Chinese medicine knows we operate from a Chinese medical diagnosis based on signs and symptoms that are relevant to our way of thinking. This requires doing an in-depth intake and getting a complete medical history form the patient with information that Chinese medicine requires.

In my office this includes filling out a lengthy intake form followed by a lengthy interview (for the most part) and work-up. This only gives me an initial working theory of what to treat. I can and do often revise this theory based on new information that I get from the patient as the treatments progress. I often re-visit issues and ask questions a second & third time. Once a patient scolded me for asking her the same question each time she walked in. I told her that I am not senile and I am asking the same question for a reason. I also asked her to allow me to practice at my discretion and to allow me to decide what information was important and relevant.

Third, most practitioners of Chinese medicine do not specialize. Why? You may ask. It is because Chinese medicine is a holistic medicine. We do not see illness as an isolated event that happens to one organ or part of the body. Energy is dynamic and flows through the whole body and so there is a ripple effect. Let me ask you a question – let’s say you hurt your hand (the hand you write with or your dominant hand) and you can’t do your normal everyday tasks, how would this affect you and your day? I would venture to guess you would be fixated on it and it would affect every task you would want to accomplish. Just think, this is just your hand! Can you imagine that internal problems are ant different? When something is off it affects the entire body. How could I then treat “only” the problem that bothers you most?

Another interesting fact is that oftentimes when I help a person with one issue and it resolves, other issues that were not as primary as the one that brought the patient in pop up. I am then asked to treat that issue as well, and then the next issue. I call it peeling the onion.

So yes, Chinese medicine can help, for what and how much and for how long, remains to be seen. It depends on each person and how they present. For emergencies, please call 911.

So I am a specialist - a specialist in Chinese medicine and I specialize in YOU!

Top Ten List to Avoid Low Back Injury While Shoveling!

2012-01-10T12:29:00.000-05:00

Every Winter the snow falls and most people don’t think twice about grabbing that shovel and heading out the door to shovel the walk, driveway or dig the car(s) out. Every winter I get people coming in to see me for relief from their aching back. Most of the time it is their lower back that has seized up, or as I like to say - went into spasm.

These injuries are preventable for the most part. One needs to properly prepare mind & body for this work. Below I will put forth some wisdom that I have found while researching this topic along with some of my own thoughts.

Duke University, has put out a wonderful injury prevention guide on their website, just follow the link below.
http://www.durhamregional.org/healthlibrary/consumer_health/20070124155742141

Here is my very own Top Ten List! I am always talking or writing about recovering from an injury, so I thought it would be nice to write about preventing a low back injury.

First of all before attempting any strenuous exercise make sure you have been cleared for it by your doctor. Don’t kid yourself, snow shoveling is strenuous exercise! Just check out the amount of calories you burn per minute while shoveling snow.

Activity Your Weight in pounds:

105 – 115 Snow shoveling - light 7.9cal p/m Snow shoveling - heavy 13.8cal p/m

127 – 137 Snow shoveling - light 9.1cal p/m Snow shoveling - heavy 15.7cal p/m

160 – 170 Snow shoveling - light 10.8cal p/m Snow shoveling - heavy 18.5cal p/m

180 - 200 Snow shoveling - light 12.5cal p/m Snow shoveling - heavy 20.5cal p/m

1. Make sure you are fit for this activity physically.
2. Warm-up first. You will be using muscles that probably have not been used in a while. Make sure to warm your low back, shoulders and legs.
3. Go slow. Shoveling snow should not be a race.
4. Shovel in shifts. Waiting until it has stopped snowing before shoveling can leave you with a bigger job.
5. Shovel in layers. Believe it or not snow has weight to it when it is sitting on your shovel. Scooping up snow from the bottom of a pile is much more difficult than scooping it in layers, starting from the top.
6. When lifting a shovel full of snow, bend at the knees and then lift. Putting all that strain on the small muscles of the low back is more work than they were designed for. Use those powerful thigh muscles.
7. Don’t fill the shovel to the brim. What works for coffee, does not translate into snow shoveling. Better to do more reps than more weight. This by the way is advice I give to my patients who are weight lifters. Stamina is more important than shear strength.

8. Pick a shovel that is appropriate to your size. Don’t use one that is either to big or too small. Go to the hardware store(s) and try out different shovels. See which one works best for you.
9. Go through your warm-up routine again once you are finished shoveling. This will help the body cool down properly.
10. Dress appropriately. Too much bulk will not allow you to move properly. Too few layers and you will not stay warm – bad for the muscles and for the rest of your body as well.

To quote of a Civil War song (that was later co-opted to another war):
"Billy, don't be a hero! Don't be a fool with your life!