tight muscles

December 1, 2002

Alon, MArk & Group,

Do you find that tight muscles (in general) CAN be adequately (theoretically)

explained by a diagnosis of just LV QI STAG/with no underlying deficiencies? Or

possibly just a general qi stagnation in the body -either way a) is this

supported in literature? b) has this been treated successfully with an

herbal-internal-treatment approach that just focuses on moving liver qi?

December 1, 2002

Do you find that tight muscles (in general) CAN be adequately (theoretically) explained by a diagnosis of just LV QI STAG/with no underlying deficiencies?

>>>No I do not. First this is a huge question and tight muscles reflect a range from health to dysfunctions. A simple example is tightness do to physical abnormality such as short leg. No amount of herbs would ever treat this until one levels the pelvis. We could write an entire book on examples of manifestations in muscles some of which may respond to an herbal approach and many that would not.

Also, Its my opinion as it applies to orthopedics that it is a mistake to think that so called excesses are the branches and deficiency are the roots. When many local excesses are treated effectively, even in very chronic patients the syndrome may resolve.If one is diagnosing local tissue accurately one often can show that the so called lesion (local excess) is the root of all the patients symptom

Alon

December 1, 2002

, " Alon Marcus " <alonmarcus@w...> wrote:

> Do you find that tight muscles (in general) CAN be adequately (theoretically)

explained by a diagnosis of just LV QI STAG/with no underlying deficiencies?

>

> >>>No I do not. \

So you are saying that tight muscles NEVER can be explained from an internal

cause of liver qi stag?

-

December 1, 2002

, " " <@h...> wrote:

> Alon, MArk & Group,

>

> Do you find that tight muscles (in general) CAN be adequately

(theoretically) explained by a diagnosis of just LV QI STAG/with no

underlying deficiencies? Or possibly just a general qi stagnation in

the body -either way a) is this supported in literature? b) has this

been treated successfully with an herbal-internal-treatment approach

that just focuses on moving liver qi?

This is far from a simple question to answer. Here are some thoughts:

1- Is the tightness short term or long term?

2- What exactly is the quality of these tight muscles?

3- An external(muscle layer) excess or deficiency may or may

not correlate to internal issues in the sense of treatment

effectiveness.

4- Although I have often seen LV Qi Stagnation associated with

tight muscles I have not seen herbal Tx of the LV Qi alone

as helpful in relaxing the musculature without " external "

Tx.

5- As stated in an earlier post I rarely use herbal Rx alone

to Tx an ortho problem. I use herbal Rx to support the

external Tx.

6- My basic approach is this- I make a TCM Dx for the overall

presentation of the patient. Then, I also do a PE using

very basic ortho principles combined with palpatory skills

I have developed through NMT and years of experience. I

combine all of these findings to create a combination

external and internal Tx plan.

7- Is this approach supported in CM literature? I do not

know, and I do not claim that this is pure TCM.

Mark

December 1, 2002

, " fradkin724 " <mfrad@b...> wrote:

> that just focuses on moving liver qi?

>

> This is far from a simple question to answer. Here are some thoughts:

> 1- Is the tightness short term or long term?

I am referring to a long term manifestation. Let me re-word my question and BTW

there is definitely external treatment being administered.. I am interested in

the cases that have an INTERNAL cause with no obvious deficiency. IS this

possible, and is this supported in the literature? What are the possible

patterns in such a situation? IF Liver qi (mentioned below) has been associated

and a formula given with no avail. Then is the DX wrong? I have seen and am

seeing patients that have chronic muscle tightness, no obvious structural cause,

and no underlying xu. I am just wondering what type of internal approach has

been successful? Have others tried moving qi in these situations with success.

I am currently trying to move qi, and relax tendons/ muscles.

> 4- Although I have often seen LV Qi Stagnation associated with

> tight muscles I have not seen herbal Tx of the LV Qi alone

> as helpful in relaxing the musculature without " external "

> Tx.

>

> Mark

December 1, 2002

, " " <@h...> wrote:

> , " fradkin724 " <mfrad@b...> wrote:

>

> > that just focuses on moving liver qi?

> >

> > This is far from a simple question to answer. Here are some

thoughts:

> > 1- Is the tightness short term or long term?

>

> I am referring to a long term manifestation. Let me re-word my

question and BTW there is definitely external treatment being

administered.. I am interested in the cases that have an INTERNAL

cause with no obvious deficiency. IS this possible, and is this

supported in the literature? What are the possible patterns in such a

situation? IF Liver qi (mentioned below) has been associated and a

formula given with no avail. Then is the DX wrong? I have seen and am

seeing patients that have chronic muscle tightness, no obvious

structural cause, and no underlying xu. I am just wondering what type

of internal approach has been successful? Have others tried moving qi

in these situations with success. I am currently trying to move qi,

and relax tendons/ muscles.

>

> > 4- Although I have often seen LV Qi Stagnation associated

with

> > tight muscles I have not seen herbal Tx of the LV Qi

alone

> > as helpful in relaxing the musculature without

" external "

> > Tx.

> >

> > Mark

Your Dx and internal Tx maybe be correct. We cannot under estimate

the value of diet, regular & correct strecthing, and regular aerobic

exercise. At the same time I do agree with you that although you may

not see internal signs of blood def I believe that soft tissues do

suffer from restricted blood flow to them due to muscle tightness. We

also must make sure that our blood nourishing herbs get to the muscle

layers by using appropriate envoys.

BTW, in my opinion there is almost always a " structural cause " to

muscle tightness. Even if the complex pattern starts as just LV Qi

Stag the structure becomes part of the " cause " that must be dealt with

in most cases. Again, I do not intend speak in absolutes, this simply

has been my experience.

Mark

December 1, 2002

Mark,

Then is the DX wrong? I have seen and am seeing patients that have

chronic muscle tightness, no obvious structural cause, and no

underlying xu. I am just wondering what type of internal approach

has been successful? Have others tried moving qi in these

situations with success. I am currently trying to move qi, and relax

tendons/ muscles.

I think you ask the right question

and that the diagnosis is almost

certainly wrong. I don't know if

I can do anything at all to help

as so much of the diagnostic information

I process in the course of such

cases would be through touch.

But I realized when I read this

just now that I don't really know

what you mean by " chronic muscle

tightness " . Is there any further

description you can give?

Do I understand correctly that you

are seeing the same condition in

several patients? What makes it the

same from one patient to the next?

I just wondered about you seeing

a series of patients with the

same complaint which seems to be

of mysterious causes and etiologies.

Is it something of environmental origin?

In a general sense I'd say that " tight

muscles " could result from a wide

range of internal conditions. Pain

makes tight muscles, including emotional

pain. And virtually the whole gamut of

interal patterns can result in pain.

So I'd say any medicinal approach to

the case would depend entirely to

the individual patient's diagnosis.

But I got intrigued by the idea that

you've actually got a group of patients

there that are suffering from " the

same thing " that you are describing

as " chronic tight muscles " and wanted

to ask you about that.

Ken

>

> > 4- Although I have often seen LV Qi Stagnation

associated with

> > tight muscles I have not seen herbal Tx of the LV Qi

alone

> > as helpful in relaxing the musculature

without " external "

> > Tx.

> >

> > Mark

December 1, 2002

> exercise. At the same time I do agree with you that although you may

> not see internal signs of blood def I believe that soft tissues do

> suffer from restricted blood flow to them due to muscle tightness.

MArk (others),

Ok... now we are getting somewhere... I would assume that this is almost a =

'statement of fact', if qi is not flowing to an area then blood is not nouri=

shing the muscles.. contributing to the tightness. If so would you almost a=

lways include herbs to nourish and circulate blood, as well as move qi? The=

reby considering tight muscles as XUE XU/ (xue yu)?

Interesting lv qi herbs DO NOT have any indications (that I am aware of) th=

at include muscle tightness. This is interesting to me! yet herbs like mu =

gua, bai shao, qin jiao, yi yi ren etc. all have properties of relaxing sine=

ws, implying that there is a either a blood xu (bai shao), w-c-damp (qin jia=

o), damp (mu gua), wind-damp (yi yi ren) CAUSES. SO from our current reason=

ing above

a) why doesn't liver qi stag herbs have indications that mention relaxing s=

inews. AND why do formulas for sinews/ muscles NOT contain liver qi moving h=

erbs? did you come up with the observation that patterns in Sionneau =

never included lv qi stag, I can't remember?

b) If blood xu, w-c-d, w-d, and damp are common causes one would expect to =

see systemic signs correct? OR with your palpation skills (i.e. MARK) are y=

ou able to ascertain the status of local tissue and then able to differentia=

te what is the local cause w/o systemic s/s, thereby knowing which herbal ap=

proach to take? THis is what interests me much right now, especially since =

systemic signs are not showing up. I am seeing some world-class athletes, a=

nd they eat well, stretch, exercise etc. They are in top shape. Purely Str=

uctural/ muscular approaches have failed in the past, which is why I am seei=

ng them... I mainly am taking a acu based approach but am still puzzled herb=

ally since no clear patterns emerge.

So Mark, Alon – Do you find different DX for local tissue vs. systemic, and=

if so then how do you balance that herbally… ?

-

We

> also must make sure that our blood nourishing herbs get to the muscle

> layers by using appropriate envoys.

>

> BTW, in my opinion there is almost always a " structural cause " to

> muscle tightness. Even if the complex pattern starts as just LV Qi

> Stag the structure becomes part of the " cause " that must be dealt with

> in most cases. Again, I do not intend speak in absolutes, this simply

> has been my experience.

>

> Mark

December 1, 2002

, " fradkin724 " <mfrad@b...> wrote:

> We also must make sure that our blood nourishing herbs get to the

> muscle layers by using appropriate envoys.

Since there is a very wide spectrum of herbs for this purpose,

have you found any specific herbs which gives better results?

Danny

December 1, 2002

Ken,

>

> But I realized when I read this

> just now that I don't really know

> what you mean by " chronic muscle

> tightness " . Is there any further

> description you can give?

>

> Do I understand correctly that you

> are seeing the same condition in

> several patients? What makes it the

> same from one patient to the next?

These are athletes that overuse their bodies. They have tight muscles, yoga

actually will agravate. What makes them the same is that they don't exhibit any

systemic internal patterns. Tongue is normal, pulse is WIRY and strong... THis

is the common link. Or maybe Most athletes are WIRY (?)

>

> I just wondered about you seeing

> a series of patients with the

> same complaint which seems to be

> of mysterious causes and etiologies.

> Is it something of environmental origin?

It's called Boulder.

>

> In a general sense I'd say that " tight

> muscles " could result from a wide

> range of internal conditions. Pain

> makes tight muscles, including emotional

> pain. And virtually the whole gamut of

> interal patterns can result in pain.

WEll this is what I am toying with, lets say they have emotional pain, or

" pressure " to win or whatever... affecting the LV --> wiry pulse --> cutting off

free flow of qi...

-Jason

December 1, 2002

In , " " <@h...> wrote:

>>> These are athletes that overuse their bodies. They have tight

muscles, yoga actually will agravate. What makes them the same is

that they don't exhibit any systemic internal patterns. Tongue is

normal, pulse is WIRY and strong... This is the common link. Or

maybe Most athletes are WIRY (?) >>>

The primary characteristic of the wiry pulse is absorption, storage,

and stagnation of qi. It belongs to Shaoyang type of energy. The

location of the heat or cold combining with this Wiry pulse is

between skin surface and organ, so usually it is in the sinews,

tendons, or connective tissues. For example, if such pulse is shown

moving from liver to the heart or from spleen to the heart, then you

can assume that the muscular tightness is right on the diaphragm. So

this pulse indicates the problem is not right on the surface or

right in the middle, but rather in between; showing problems

associated with the muscles and connective tissues. If this pulse

combines with any type of heat it can indicate inflammation of the

muscles or connective tissues.

This is a common problem among athletes because this pulse also

develops from the nervous system's creating the muscular tension---

all those fast twitch and slow twitch firings which are at the heart

of the athlete's training. The amount of stretching done may be

enough to prevent injury but typically takes up a much shorter

amount of time in their training. Most of the time their activity

focuses on the contraction of muscles rather than elongates the

muscles; plus the the physical shock of the muscular system hitting

the ground and the emotional/mental will or pressure to win. Then

you can further complicate the problem through inadequate diet or

insufficient relaxation or recovery period that helps develop

replenish yin and blood.

Even without athletic training there is the typical stress of life

and the emotional/mental pressures that makes everyone else's

muscles almost as tense. Which is why we can see similar wiry

movements in people who are not athletes but wind up with tight

muscles---usually upper back but also calves and hamstrings---

because of emotional or mental problems.

Jim Ramholz

December 1, 2002

Jason,

There's a line in the tai4ji2 classics

that says, " where there is li4 there is

no qi. "

Li4, in this passage, can be understood

as " muscular exertion " or " the force that

develops from muscular exertion " . In tai4ji2

it is contrasted to jin4 or " internal power " .

I mention this to point out that the

condition you are talking about, tight

muscles, can develop from a variety of

disturbances.

One pattern that I frequently see in

athletes is a kind of starvation, exhaustion

of the spleen qi4 due to constant overworking

of the muscles. This can be seen in patients

who not only look healthy but can be seen

as icons of physical health. Beautiful

statuesque bodies, well defined muscles,

lots of performance potential on the track

or field...and of course the presenting

symptoms, that can often appear quite

mysterious in such " healthy " individuals.

Over exertion of the muscles, as frequently

occurs in athletic training and competition

results in damage to the sinews

(liver) and diminshes the capacity of the

qi4. This, as someone else pointed out

can be closely inter-related with diet.

But as the passage quoted above warns,

simply over exertion of muscular force

can damage the qi4.

Such conditions are perhaps more common

in runners and particularly distance runners

where the long periods of impact exacerbate

the problem, as repetitive impacts damage

the sinews. But I've seen it in tennis players,

baseball pitchers, and in some martial

artists who practice particularly hard

styles.

On balance I would say that you are

better off diagnostically looking for

the peculiarities of individual cases

rather than trying to generalize some

sort of pattern that might apply to

many or all such cases.

The variances in tolerances and experiences from

one individual to another make that kind

of generalization marginally useful, in

my experience, and potentially counter-

productive to effective diagnosis and

treatment.

>

> WEll this is what I am toying with, lets say they have emotional

pain, or " pressure " to win or whatever... affecting the LV --> wiry

pulse --> cutting off free flow of qi...

>

Makes sense. But again, I suggest that

it makes most sense when it applies to

a particular individual.

Ken

December 2, 2002

, " dragon90405 " <yulong@m...> wrote:

> Jason,

>

> '

>

> On balance I would say that you are

> better off diagnostically looking for

> the peculiarities of individual cases

> rather than trying to generalize some

> sort of pattern that might apply to

> many or all such cases.

>

> The variances in tolerances and experiences from

> one individual to another make that kind

> of generalization marginally useful, in

> my experience, and potentially counter-

> productive to effective diagnosis and

> treatment.

>

> >

> > WEll this is what I am toying with, lets say they have emotional

> pain, or " pressure " to win or whatever... affecting the LV --> wiry

> pulse --> cutting off free flow of qi...

> >

> Makes sense. But again, I suggest that

> it makes most sense when it applies to

> a particular individual.

>

> Ken

Ken:

You make some excellent points and at the same time I do not think

that Jason is really wanting to make generalizations at all. I here

him seeking insight into what have been some difficult cases that have

some common traits. My sense is that Jason like most of us who post

on this list really does develop an individualized strategy for each

patient.

The point of blood xu in muscles in otherwise " healthy " athletes makes

sense to me. In fact, after unsuccessfully using herb Rx's that focus

on blood moving and Lv Qi dispersing with patients suffering from long

term tight, hard and knotty muscle tissues I went back to the drawing

board. After much reevalution of my Dx and Tx strategy I realized

that the texture of the muscles give me an important clue. The

texture of these tight muscles " tell " me, as you said Ken, that they

are starved for blood. Without adequate blood supply muscles cannot

be supple, i.e. healthy. Finally, this word picture has helped me

understand the muscular blood xu. My analogy starts with the desire to

soften hard dried out leather. Now, to some extent we can soften the

leather by working it(blood moving herbs and massage,etc.). To fully

soften and keep the leather soft we must " nourish " it with oil(blood

nourishing herbs). As Alon mentioned in an earlier post, breaking up

the " lesion " (blood stasis in many cases) for some patients maybe the

primary or only Tx needed. Again, this is not a generalization just

an idea or theory that maybe helpful with some people. Always, I

agree that we must Tx what we see, and not work from generalizations.

Mark

December 2, 2002

Mark,

I am interested to hear what herbs or formulas you tend to use to resolve these leather " terrains " .

Cara

Cara O. Frank, R.Ac

herbbabe

China Herb Company

.. My analogy starts with the desire to