Aging and Stagnant Circulation

(Originally published as a five part series of newsletters for The Dragontree Holistic Day Spa)

Part One

Over the past two millennia, Chinese medicine has seen the development of several different schools of thought, each championed by certain scholars. For instance, there is the school of the digestive system, which holds that problems with digestion are almost always the cause of chronic disease. Adherents of this philosophy recommend strengthening and repairing the digestive organs above all else. There is the school of “clearing heat,” which views pathogenic heat (or hyperactivity of inflammatory and immune mechanisms) as the reason for most chronic disease. Those in this camp promote the use of cooling herbs, which have anti-inflammatory and anti-microbial properties. There is the school of “warming the Yang,” which advocates the use of strongly warming and fortifying herbs, because it sees disease and aging as signs of waning energy and the slowing down of metabolism.

In recent decades, there has been a growing appreciation for the school of “blood stasis,” especially through the publication of a book on the subject by Chinese physician De-Xin Yan. It is founded on the philosophy that aging and the health problems that come in our later years are primarily the product of impaired circulation. Blood stasis has many negative consequences for the body. The most obvious one is that tissues that need blood don’t get enough of it and become malnourished or nonfunctional.

When it’s especially bad and it happens to the heart, we call this a myocardial infarction, or heart attack. When it happens to the brain, we call it a cerebrovascular accident, or stroke. Sometimes there are earlier symptoms of blood stasis to these organs, such as angina (sharp, stabbing chest pains from blood deprivation to heart muscle) and transient ischemic attacks (TIA’s), or mini-strokes. We can also see signs of blood stasis more generally through the color and tone of the skin. Stagnant blood leads to dusky or dark skin and visible blood vessels (especially purplish ones). Sometimes the skin becomes hard, too. We often see this first in the legs and feet. One of the key signs of blood stasis in Chinese tongue diagnosis is the darkening and thickening of the veins on the underside of the tongue. When circulation is good, these veins are almost invisible.

Another consequence of stagnant blood is the development of phlegm. The healthy movement of our blood is considered to be central to the maintenance of other fluids, and when circulation is sluggish, fluids tend to congeal: phlegm is the result. As a Chinese medical term, phlegm has a much broader meaning than the mucus that collects in our lungs when we’re sick. Its wide range of presentations involve the accumulation of something thick and stubborn, such as body fat, cholesterol, certain kinds of scar tissue, some tumors and cysts, and the brain plaques that occur in Alzheimer’s disease. A number of conditions, including coronary artery disease and some cancers, routinely involve a combination of stagnant blood and phlegm.

Although they don’t know it, many Western physicians subscribe to the school of blood stasis. Warfarin (known better by the trade name Coumadin) – an anti-clotting pharmaceutical or “blood thinner” – is one of the most prescribed drugs in America. Chances are, you know someone who has taken it, or is taking it currently. It is given to people with a history of blood clots or a condition that predisposes one to forming life-threatening clots (e.g., atrial fibrillation, stroke, heart attack, deep vein thrombosis, heart valve problems, certain post-surgery patients). It’s quite effective as a rat poison (its first commercial use), and it certainly has some benefits for humans, too. But it also has some significant drawbacks.

Warfarin works by interfering with the activity of vitamin K, which plays an essential role in blood clotting (in fact, it was named K for “klot”). Inhibiting vitamin K means a reduced risk of forming unhealthy clots, but it also means a reduced capacity to stop bleeding! Thus, there is a small but significant danger of hemorrhage when taking this drug. A study of 1.23 million people found that those on Coumadin have nearly double the risk of dying from a traumatic injury compared to those not taking a blood thinner. And those who had a stroke while on it had a tenfold increase in risk of brain hemorrhage.

Vitamin K also has a vital role in bone building. Thus, there appears to be an increased risk of developing osteoporosis while on Warfarin. (A 1998 study disputed this, but it was poorly conducted, and it nonetheless concluded that subjects who were taking Warfarin more often had poor health and frailty, compared to those who weren’t taking it.) Because dark leafy greens are rich in vitamin K, those taking this drug are often advised to limit their consumption of these vegetables, which means missing out on some nutritional powerhouses.

Finally, vitamin K appears to help prevent arteries from hardening (by blocking calcium deposition in them) – a critical factor in heart disease. By blocking vitamin K’s activity with Warfarin, we may be paradoxically elevating our risk of cardiovascular disease even while reducing our tendency to form clots. Therefore, as a medicinal agent for holistically addressing the problem of blood stasis, Warfarin is mediocre.

If you or a loved one is taking Warfarin, please don’t stop – talk to your doctor if you want to do this. Even with its risks, its use may still be warranted. But there are some decent alternatives. First, there is good old exercise. Second, fish oil also helps prevent clots from forming, and has numerous other health benefits, like improving your energy, enhancing cognitive function and mood, slowing buildup of atherosclerotic plaques, lowering triglycerides, modestly lowering blood pressure, and reducing the risk of heart attack, stroke, and death in those with diagnosed cardiovascular disease.

Two caveats. One, in very high doses over a long period of time, like Warfarin, fish oil may increase the risk of brain hemorrhage (bleeding) if a stroke does occur. For most people, one tablespoon of fish oil morning and night is safe and effective. (It’s not easy to get a therapeutic dose using soft gels, unless you like swallowing lots of pills.) Two, fish oil can contain dangerous pollutants, like pesticides and heavy metals. Only use the stuff that has been independently tested for contaminants. I like Carlson’s and Nordic Naturals. Fish oil should be combined with vitamin E, which also has some blood thinning effect. Look for a brand that lists “mixed tocopherols” on the label, and always choose the “d-“ form of vitamin E, not “dl-“, which is synthetic and less effective.

Aging and Stagnant Circulation

Part Two

In part one of this article I introduced the blood stasis school of thought in Chinese Medicine, which holds that the signs of aging and the health problems associated with getting old are largely the product of stagnant blood circulation. Sluggish blood means that nutrients aren’t optimally distributed throughout the body. Skin, muscle, and organs deprived of blood lose their tone and decline in function. And when outright blockage of blood flow occurs, we experience severe consequences such as heart attack and stroke.

I explained that many Western doctors subscribe to the blood stasis school of thought, even if they don’t know it. They frequently prescribe drugs that prevent clot formation, such as Warfarin (Coumadin), which has some clear benefits but also significant drawbacks. Even more common is the prescription of cholesterol lowering drugs, particularly a group of drugs called statins (Lipitor, Crestor, Mevacor, Zocor, and many others). These medications are roughly equivalent to the Chinese medical approach of dissolving phlegm and promoting blood circulation. They do an excellent job of lowering cholesterol. But they also have a risk of side effects, most commonly muscle aches, weakness, liver damage, and occasionally muscle destruction, cognitive decline, or other serious conditions.

Some of these problems may result from statins’ ability to block the body’s production of Coenzyme Q₁₀ (CoQ₁₀), a substance that plays a vital role in the way our cells generate energy. Organs with the highest demand for energy (such as the heart) contain lots of CoQ₁₀ – early in life, anyway. Later in life, the heart’s supply of CoQ₁₀ diminishes, and this is a key factor in heart disease. CoQ₁₀ is the third most popular nutritional supplement in the U.S., primarily because of its proven benefits to the heart and the cardiovascular system as a whole. Statins’ depletion of this valuable substance makes for an interesting paradox.

The first statin drug, lovastatin (Mevacor), entered the market in 1987. Simultaneously, its manufacturer, Merck, began a large scale campaign to convince the public that elevated cholesterol is a major cause of cardiovascular disease (particularly atherosclerosis and coronary heart disease), and that lowering cholesterol reduces this risk. This notion (the lipid hypothesis) was first proposed in the 1850s and became increasingly popular over time, though it was not quite accepted as fact at the time of Mevacor’s debut. Lovastatin and a handful of newer statins have now been prescribed millions upon millions of times, and their value is rarely disputed. They do appear to slow or prevent the development of atherosclerosis and reduce the risk of ischemic heart disease events (e.g., heart attack) and stroke.

However, the lipid hypothesis has some opponents. (One of the more prominent groups is The International Network of Cholesterol Skeptics, led by Uffe Ravnskov, MD, PhD, author of The Cholesterol Myths). In particular, while most doctors believe there is a correlation between high cholesterol and hardening of blood vessels, not everyone agrees that this proves cholesterol is the cause of this process. Also, studies on statins clearly indicate they produce positive changes in cholesterol and other measures of cardiovascular disease, but opponents claim the research does not prove they significantly lower death rates from cardiovascular disease.

Meanwhile, progressive doctors are changing the way they look at cholesterol. Many feel the traditional approach to evaluating cholesterol is an unreliable indicator of cardiovascular risk. It’s a complicated subject, and a thorough discussion is beyond the scope of this article, but there are a few basic points worth mentioning. Cholesterol, a substance produced mainly in the liver and consumed in small amounts through food, is an essential component in the membranes of every cell in our body and a primary ingredient in the production of hormones, bile acids, and several vitamins. Too little of it can cause serious heath problems.

The “good” and “bad” cholesterol measured in typical blood testing (high density lipoproteins – HDL and low density lipoproteins – LDL, respectively) are actually proteins that carry cholesterol around in the body. LDL brings cholesterol to be deposited in tissues (such as damaged cells needing repair) and HDL brings cholesterol back to the liver to be recycled.

LDL has long been the primary focus of treatments for hypercholesterolemia (high blood cholesterol), but elevated LDL is less of a predictor of cardiovascular disease in women than it is in men. Furthermore, many doctors believe HDL is at least as important a factor, since it represents the body’s ability to take unneeded cholesterol out of circulation. Also, when HDL levels are low, blood levels of triglyerides (another form of fat that has been linked to atherosclerosis) tend to be high, and vice versa.

The combination of high triglycerides and low HDL is a much better predictor of cardiovascular disease than elevated LDL or total cholesterol. The presence of these two factors also tends to indicate high insulin levels, which usually means we’re eating too much sugar and/or not exercising enough. (I use the term “sugar” broadly here, to mean not just white sugar, but all caloric sweeteners, juice, everything made from flour, and perhaps too much fruit and grains in any form.) High insulin also means we’re headed toward diabetes, which itself causes cardiovascular disease.

Meanwhile, LDL, the “bad cholesterol” many people think they should eradicate from their bodies, serves a vital function in cell growth and maintenance. Whenever there is cell damage, LDL is needed for repair. LDL plays a role in fighting off infection, particularly by Staphylococcus bacteria – and antibiotic-resistant Staph is a major public health emergency. LDL is also a primary carrier for CoQ₁₀ and Vitamin E in the bloodstream – antioxidants that help prevent the oxidation of LDL, which is implicated in the formation of arterial plaques. Finally, we have known for at least fifteen years that the size of LDL and HDL particles greatly affects how they behave. Very small LDL particles tend to become stuck to the interior walls of blood vessels and larger ones do not. A test called the lipoprotein subfraction can determine the percentage breakdown of different sized LDL particles in our blood. There is no drug yet that favorably shifts LDL particle size or specifically targets the smallest particles.

So, what do you do with all this information? I’ll be providing you with some comprehensive recommendations later in this series, but meanwhile, given what we’ve already discussed, a few steps may be worthwhile:

1. If you’re taking a statin drug, talk to your doctor about also taking the supplement CoQ₁₀. I usually recommend 100-200 mg a day for preventive care. Unfortunately, it’s not cheap stuff, and when you do find it cheap, it’s probably low quality. (Jarrow is one brand I’ve found that offers better quality CoQ₁₀ at a fair price.)

2. Since the oxidation of LDL is necessary for its insinuation in vessel walls, consume plenty of antioxidants.

3. Since sugar/simple carbohydrate consumption contributes substantially to elevated triglycerides, cut way down on it.

4. Exercise lowers insulin levels, which favorably affects your trigylceride/HDL balance. When exercise contributes to weight loss it’s all the better, since losing excess weight is almost guaranteed to improve your blood lipid profile.

Aging and Stagnant Circulation

Part Three

As I mentioned in the last installment, while LDL has long been the cholesterol-carrying protein targeted in the fight against cardiovascular disease, HDL may be a more important substance to focus on, and it seems to be a more useful indicator of cardiovascular risk. One’s ratio of triglycerides to HDL is another important key to cardiovascular risk. The combination of high triglycerides and low HDL is particularly likely to be implicated in vascular disease. It’s also likely to indicate high insulin levels and a diabetic or pre-diabetic condition. Finally, the ratio of total cholesterol to HDL also appears to be a more accurate indicator of cardiovascular risk than LDL or total cholesterol alone.

The more of our total cholesterol HDL comprises, the better. If you have a copy of the results of a recent cholesterol test, consider this: Total cholesterol divided by HDL should ideally be below 3.5, which means essentially no risk of cardiovascular disease (at least as far as blood fats are related to it). 3.5 to 4.5 indicates a low risk, 4.5 to 5.5 indicates a medium risk, and above 5.5 indicates a high risk.

Because this approach to risk evaluation is based entirely on the proportion of HDL to total cholesterol, it shows how one could have very high total cholesterol, say 300 (normally considered high risk), but also high HDL, which may result in a total cholesterol-to-HDL ratio that puts one in the lowest risk range. Furthermore, it demonstrates how detrimental low HDL can be. One might have low total cholesterol, which would normally represent the lowest risk of cardiovascular disease (although it may also put one at higher risk for cancer and other health problems), but combined with very low HDL, this could result in a high total cholesterol-to-HDL ratio which would indicate a high risk of cardiovascular disease.

So, where do we go from here?

If you’re on a statin drug, I recommend you don’t change anything without your doctor’s approval, especially if you feel good and your blood lipids (fats) are optimal. If, however, your doctor is recommending a statin and you’d rather avoid it, or if you currently take one and feel bad from its side effects, here are some other options to discuss with your healthcare provider. First, consider taking some CoQ₁₀, which I discussed in the last installment of this series. It protects against oxidative damage to blood vessels, supports energy production in heart muscle, raises HDL and lowers total cholesterol and LDL. And, because statins deplete our supply of this nutrient, replenishing CoQ₁₀ will help us avoid side effects.

Statins were originally isolated from fungi, so there are natural, non-prescription sources for them, the most popular of which is a Chinese food/herb called hong qu, or red yeasted rice. It is rice that is covered with a purplish fungus (Monascus purpureus) which contains lovastatin (called monacolin in this form). It is frequently used as a natural red dye in Asian foods and is quite safe.

The lovastatin in red yeasted rice performs identically to lovastatin with two important differences. One, a recent study showed that most people who had intolerable side effects from statins had minimal or no side effects from taking a comparable amount of red yeasted rice. Two, smaller amounts of lovastatin are needed when it is provided in red yeasted rice than when it is taken as an isolated drug. This indicates there is some synergy between the various compounds in the natural product that is sacrificed in the pharmaceutical (a common phenomenon in drugs isolated from plants and fungi). In Traditional Chinese Medicine, hong qu is used to promote blood circulation and eliminate stagnation; thus, the use of this substance to treat stagnant circulation preceded any knowledge of its statin content.

One main drawback to red yeasted rice is that lovastatin content varies widely between different sources, so, unless you get an extract that is standardized to contain a certain amount of it, you will not know what effect it is having until you have follow-up blood testing. Moreover, the FDA’s official stance is that, since lovastatin is a prescription drug, red yeast rice should not contain any lovastatin. Some companies comply with this by providing lovastatin-free red yeasted rice, but the real, unadulterated stuff is still widely available.

Another natural option for improving one’s cholesterol profile is relatively high doses of niacin (vitamin B3). It lowers LDL and triglycerides, and raises HDL. However, it can cause unpleasant “flushing” – a hot, prickly skin sensation – and large amounts occasionally cause liver problems. The best form to take is called inositol hexaniacinate, which doesn’t cause flushing and has minimal potential to harm the liver. Niacin is now frequently given in combination with statin drugs.

The above interventions work primarily by disrupting how the liver creates and/or processes cholesterol. If you’re on a statin or red yeasted rice, or taking high dose or sustained release niacin, you should have your liver tested every few months for any possible damage.

Here are a few of the many other natural approaches to improving your cholesterol profile:

Dietary fiber (soluble fiber, found in large quantities in pears, apples, nuts, seeds, konjac, beans, lentils, oats, and most other fruits and vegetables) lowers LDL and raises HDL.

Quitting smoking raises HDL, improves circulation, and significantly lowers overall cardiovascular risk.

Exercise improves your overall cholesterol profile and greatly enhances cardiovascular health.

Drinking small amounts of alcohol (a few ounces a few times a week) raises HDL and protects against hardening of blood vessels. Alcohol is understood in Traditional Chinese Medicine as having the property of enhancing blood circulation; herbs that are used to improve circulation are frequently prepared by soaking them in wine to enhance this effect.

Avoid consuming trans fats (these occur mostly in hydrogenated and partially-hydrogenated oils and deep fried foods), which lower HDL and raise LDL.

On the other hand, certain beneficial fats, such as olive oil, coconut oil, avocado, fish oil, and flax oil, raise HDL.

Avoid sugars and flour. They are a major contributor to triglyceride production, vascular inflammation, and obesity.

Lose weight if you’re overweight. Even modest weight loss is associated with a favorable improvement in blood lipids.

The amino acid taurine lowers cholesterol and benefits heart muscle.

Garlic mildly lowers total cholesterol and LDL, reduces inflammation, inhibits clot formation, kills a variety of microorganisms, and tastes good in all kinds of food.

The herb guggul (a relative of myrrh) lowers cholesterol and triglycerides and has strong antioxidant properties.

The herb hawthorn has a variety of benefits to cardiovascular health, including reducing the deposition of cholesterol in blood vessel walls, lowering blood pressure, and improving the heart’s rhythm and the strength of its contractions.

Now that we have delved thoroughly into the role of cholesterol in cardiovascular disease, let’s back up a bit. In my opinion, cholesterol is the small picture, and I prefer a more holistic, “big picture” approach to health, though the list of natural interventions above is nonetheless worthwhile.

Aging and Stagnant Circulation

Part Four

Let’s look more broadly at the big underlying mechanisms that lead to hard blood vessels, clots, vessels clogged with plaques, and poor blood flow. First is inflammation. There is a growing recognition of the central role chronic inflammation plays in a wide range of degenerative conditions, from arthritis to cancer to multiple sclerosis to cardiovascular disease. The reason for biomedicine’s focus on LDL (“bad cholesterol”) is because it high levels of it occur in tandem with hard vessels. But if we step back to consider why LDL is being brought to vessel walls, the answer seems to be inflammatory damage to these vessels. So, rather than seeking to reduce the “caulk” the body is sending to vessels in such large quantities, we might consider addressing the vascular inflammation head-on, especially since it is likely to reduce inflammation and its repercussions elsewhere in the body.

This shift in focus coincides with an increased use of the C-reactive protein (CRP) test as a diagnostic tool. Elevated levels of CRP are a nonspecific indicator of inflammation and infection, and they are associated with an increased risk of cardiovascular disease (among other problems). Testing for CRP is an important step in the right direction – primarily because it helps us keep our eye on the cause, rather than getting sidetracked with cholesterol management. However, with pharmaceuticals still viewed as our best hope for managing this process, many medical professionals fail to understand or convey to their patients the pivotal role that lifestyle can play in promoting and alleviating inflammation.

Where does chronic inflammation come from? There’s a wide array of contributing factors. The most prevalent are:

Toxic chemical exposure, both outdoors (pollution, pesticides, etc.) and indoors (building materials, synthetic carpet and other furnishings, cleaners, air fresheners, etc).

Dietary sources, such as trans fats, excessive sugar, food sensitivities.

Chronic muscle tension, postural stress, joint disorders, poorly healed injuries.

Immune dysfunction – since inflammation is a process mediated by our immune system, improper immune function is a fairly common cause of chronic inflammation (multiple sclerosis, lupus, and rheumatoid arthritis are just a few such conditions).

Infective agents, such as viruses, bacteria, and other parasites.

Regardless of the cause, it behooves us to take measures to reduce inflammation:

Avoid foods you’re sensitive to. Unless you feel great all the time, chances are there are certain foods your body reacts negatively to, and it is worth knowing what these are. Consider getting a food sensitivity test, or try an elimination diet, or check out the Coca Pulse Test book.

Consider an anti-inflammatory diet. If you Google “anti-inflammatory diet” or “anti-inflammation diet,” there is a trove of information out there. The basics are: Avoid sugars, wheat flour, fried foods, processed foods, hydrogenated oils, fruit juice and other soft drinks, and coffee. Be moderate with red meat and (skinless) chicken, dairy products, grains, alcohol, and polyunsaturated oils (corn, cottonseed, palm, sunflower, etc.). Eat plenty of vegetables, berries, olive oil, avocado, walnuts, coconut, salmon, sardines, green tea, fiber, mushrooms, spices (see below), pumpkin seeds, flax seeds, hemp seeds, chia seeds, and choose organic whenever possible.

Exercise regularly. I much prefer that people exercise for relative short periods at a time (15-30 minutes) every day (or multiple times a day, if your constitution can support it), rather than exercising for a long time (60+ minutes at a time) a couple times a week.

Reduce stress – physical, mental, and emotional. Get enough sleep. Don’t overwork. Avoid static postures – for example, don’t sit at a desk for too long at a time (break up the day with periods of movement and stretching). Practice focused relaxation (meditation, biofeedback, floating, restorative yoga, etc.).

Drink plenty of clean water (half the number of pounds you weigh as ounces of water per day), spread out evenly over the course of the day.

Consider supplementing with anti-inflammatory foods and nutrients. These include vitamin C, vitamin E, fish oil or flax oil, alpha lipoic acid, zinc, quercetin (derived from fruits and vegetables), MSM (organic sulfur), coconut oil, pineapple (or its derivative bromelain), and many spices, such as turmeric (or its derivative curcumin), cinnamon, dill, marjoram, parsley, ginger, basil, oregano, thyme, mint, sage, rosemary.

Reduce all sugars. Cane sugar, beet sugar, evaporated cane juice, fruit juice, honey, maple syrup, brown rice syrup, malt extract, high fructose corn syrup, agave nectar, etc. Sweeteners should be used sparingly. Learn to enjoy unsweetened food.

Inflammation goes hand in hand with oxidation. Oxidation is too broad a topic to cover in detail here, but in a nutshell, oxidation refers to any of a wide range of chemical reactions in which the oxidized molecule loses an electron. As it pertains to biological material, oxidation is usually a process that causes deterioration. (Although, both inflammation and oxidation are healthy and necessary when appropriate.) Many of the ways in which our cells become worn out through age, pollution, and junk food are due to oxidation. Cancer is frequently initiated through oxidative damage to our DNA. When there are high levels of LDL cholesterol circulating in our bloodstream, it is more likely to be retained in the walls of blood vessels if it becomes oxidized. Thus, oxidative stress plays a key role in the development of atherosclerosis.

Many of the contributors to inflammation (pollution, stress, poor diet, etc.) are also major contributors to oxidation, so the recommendations for reducing inflammation overlap with those for reducing oxidation. In addition, antioxidants can help undo oxidative damage and they can stabilize free radicals (unstable molecules that cause oxidation). Many vitamins, minerals, and foods have antioxidant activity. It seems every day brings news of a food or nutrient that is the new strongest antioxidant – blueberries, green tea, red grapes, garlic, beans, pomegranates… Just remember that the most potent naturally occurring antioxidants all come from plants. Plant matter should comprise the bulk of human diets. Some potent antioxidants are also available in pill form from natural food stores. These include vitamin C, vitamin E, vitamin A, selenium, beta carotene, coenzyme Q10, alpha lipoic acid, and glutathione, to name just a few.

When we broaden our focus to consider all the factors that contribute to inflammation and oxidative stress, and all the interventions that can favorably influence these conditions, the cholesterol issue is put into proper perspective. It is a consequence, after all, of these conditions, not a cause in itself of cardiovascular disease. Next month we will return to the language of Chinese Medicine, and see how these biomedical ideas fit into the concept of blood stagnation.

Meanwhile, in addition to the lifestyle changes I recommended above, consider this: Cardiovascular disease is primarily an issue of occlusion – shrinkage, hardening, and blockage of vessels – which ultimately impedes the heart’s performance and kills cells. Coming up on the 14^th, we have a day dedicated to love – an expression long seen as the dominion of the heart. Why not take the opportunity to open your heart and its whole network of vessels, imagining you are accepting love into every cell of your body and extending it to every atom in the universe. See what happens.

Aging and Stagnant Circulation

Part Five

Among the many mechanisms by which blood stasis develops, one of the most common is through the depletion of the digestive system. This occurs as a consequence of over-consumption of unhealthy foods (excessively sweet foods, alcohol, fried foods, to name a few), overeating, eating lots of cold foods (ice water and refrigerated or frozen things), eating in a rushed manner, eating while stressed, and erratic eating routine. The result is a weakened capacity to efficiently process our foods and absorb the nutrients they contain. Consequently, we can develop blood deficiency and/or phlegm, both of which amount to poor flow of energy and fluids through the body, resulting eventually in stagnant blood.

Another mechanism by which we can develop blood stasis is the development of dryness and heat. As we age, there is a tendency for the essential moisture of the body to wane. This isn’t mere dehydration, but a loss of the vital fluidity and suppleness that is abundant in youth. This dryness is called Yin deficiency in Chinese Medicine. Our skin becomes drier, thinner, and wrinklier. Our joints become stiffer. Our muscles lose flexibility and power. (Incidentally, essential fatty acids, such as those found in fish oil, flax seed, the yolks of free range eggs, hemp seed, chia seed, avocado, coconut, olive oil, and krill oil, are of great value in protecting and restoring our Yin.)

This loss of fluidity also means our blood is more viscous, more likely to congeal, and our vessels are harder. With a loss of moisture, there is also a diminished ability to temper inflammation. It’s like a dry landscape being prone to catch fire. Chinese Medicine explains it metaphorically as “insufficient water to control fire” in the body. If heat builds up (which may manifest as hypertension, diabetes, arthritis, and other conditions), it can further damage our vital fluids and exacerbate stagnant blood.

Cold can also contribute to blood stasis. Cold with aging occurs as our core fire (“Ming Men” or “Kidney Yang” in Chinese Medicine) begins to dwindle. It is this fire that liberates our potential into the world, and gives us our drives – our sex drive, our drive to plan and build, our drive to connect and experience, our drive to achieve and acquire, our drive to refine and improve. As this fire wanes, we slow down. It’s not a bad thing, just a different phase of life. We reflect more, we integrate, we let go. Biologically, the diminution of our essential fire means the body is less robust than it once was. Our blood moves with less vigor. We may become colder – cold hands and feet, especially. This, too, translates to more congealed or stagnant blood. (The most popular of many herbs for restoring this essential fire are ginseng root and aconite root. Ginseng, in particular, has legendary status in Asia, and high quality roots fetch extremely high prices on the market.)

The above contributors to stagnant blood (digestive depletion, phlegm, dryness, heat, and cold) can occur independently, but more often than not, they occur in combinations, sometimes all of them simultaneously. And virtually always, there is another factor present – the single most significant cause of blood stasis: Qi stagnation. Qi (“chee” – vital energy) stagnation means restricted flow of our energy. It can result from all sorts of causes, like insufficient exercise or being weak or tired, but mostly, it starts in our thoughts and emotions. It starts with resistance of life.

Everything we believe should be different about the world – our internal world and the outside world – amounts to resistance of life. Every negative thought we have is a form of restriction on our experience, by which we reduce the truth – that love, peace, acceptance, and openness are always available to us – to something less than the truth. And this impedes the flow of Qi through us.

Whenever we think to ourselves, China shouldn’t be tyrannizing Tibet, or, Those cars shouldn’t be cutting into my lane, or, Our political system shouldn’t be this corrupt, or, That kid shouldn’t have shot Representative Giffords, or, I should be a nicer person, or, I should be more spiritual, or, I should exercise more, or, I shouldn’t be getting acne at this age, or, It’s not fair that it’s so hard for me to stay thin, or, There’s too much fighting in the world, or, Babies shouldn’t die of horrible diseases, we are, in effect, denying a part of reality. This is resistance. It neither changes the world nor improves our situation.

This is not to say that it is wrong to want change or that we must like everything. But resistance makes us less effective at initiating positive change, and more importantly, it squelches life.

By refusing to truly accept all the things we dislike about the world, we reduce the river of life flowing through us to a mere trickle.

Mental and emotional constraint eventually manifests in the body as pain, inflammation, tight muscles, constipation, insomnia, fatigue, organ dysfunction, and all sorts of other disruptions of health. Any area can be affected, but apropos of our ongoing discussion, let’s look at how it impacts the heart.

It is instinctive, yet futile, to close our heart when we feel vulnerable. We clench around the heart because on some level we believe we can avoid pain this way. But instead, we stifle our capacity for love, and we feel less. If you ever wonder why life isn’t as engaging as it once was, look to your heart. Over a lifetime, many of us develop rigidity and congestion throughout the whole network of vessels that are connected to the heart. This makes our blood pressure rise and burdens the heart even more. This is blood stasis due to stagnation of Qi

The alternative response to things we don’t like about ourselves or the world is, of course, acceptance. Acceptance is openness. It dissipates discomfort and opens doors faster than we can imagine. When we open our heart, we allow ourselves to be a conduit, rather than a dam, for energy and love. I tell you this as someone who identifies much more as a doctor than a New Ager. While the impact on your cardiovascular system may be a difficult thing to measure in the short term, if you spend a single day focusing on opening your heart, accepting the things you resist and letting them go, you will experience a qualitative improvement in your life. And so, most likely, will the people around you.

When I tell this to people, they often ask, “But how do I open my heart?” There is no big secret, though. You just do it. Imagine it and make it happen. It’s like unclenching a fist. If you like visualizations, you can imagine a stream of light flowing into your upper back just behind your heart, and streaming out the front of your heart like a flood light. See if you can imagine this stream passing through you completely unimpeded. Meanwhile, you can see your heart opening like a big flower, shining love into the world.

Chinese medicine ascribes a certain sound to each of the organs, and the sound of the heart is laughter. There are two forms to this. One is the Daoist monosyllable version: ha. You simply take a deep breath and then let out a long, blissful, “Haaaaaaaaaaaaaaaaaaaaaaaaaaaaaaahhh…” You can do this several times while imagining the sound pouring out of your open heart. The second form is good old, natural laughter. Gather some of your favorite company, watch children playing, look at the beautiful world, hold someone’s hand, and just let yourself laugh at the marvelous gift of it all. Laugh deep into your body, into your heart, into your whole network of blood vessels. Blood stasis begone.