5

Sealing the Portholes

Osteoporosis

At age forty-seven, two years after her hysterectomy, Wendy tripped over a tree branch and fractured her hip bone. She remembers thinking right after her fall that it was just a little thump, yet she couldn’t figure out why it was so difficult to get up again! Frightened by this experience, she visited her doctor. He diagnosed her with Stage 3 osteoporosis and prescribed 1,500 milligrams of calcium per day.

At age fifty-three, she was told by her doctor that her osteoporosis had worsened despite decades of supplementing with calcium and vitamin D. He discussed how our bones do not absorb calcium without exercise and asked if she had an exercise routine. “Of course I exercise!” she responded. “I get up, rush to work, run around the office doing this and that errand, and clean the house.” Her doctor chuckled and asked again if she set the time aside for exercise. Wendy fell silent, wondering how on earth she would ever find the time. Her doctor continued, “It’s the rhythm and consistency of brisk walking outside or on a treadmill, bicycling, or other cardiovascular activity that encourages our bones to regenerate.” Wendy reluctantly began a daily walking routine and reduced her calcium intake to 750 milligrams, and her follow-up bone density test results at age sixty-seven were astonishing! Not only had her bone density increased, but Wendy felt overall healthier too.

The importance of calcium intake after menopause and/or hysterectomy cannot be understated, but as with other supplements, it is often ingested in excessive amounts because many of us subscribe to the idea that more is better. Excessive intake of calcium may lead to hypercalcemia, a condition that has been linked to a higher risk of heart and kidney disease. Some sources argue that excess calcium supplementation may result in calcium deposits, in the form of calcium carbonate stones, within the arteries and kidneys.¹

While declining levels of estrogen after menopause might sound like a sure path to osteoporosis, this is not always the case. Loss of bone mass can be delayed or prevented, and bone mass can even be increased, by taking care of your bones as early as possible. Calcium intake coupled with vitamin D and exercise are indispensable ways to maintain and potentially increase bone mass. With that said, consuming higher than recommended levels of calcium won’t necessarily add further benefit. The current recommended dietary intake of calcium established by the Food and Nutritional Board (2010) for postmenopausal women is 1,200 milligrams/day, and for vitamin D, it’s 500 international units/ day, which increases to 800 after age seventy. Yet a recent study demonstrated that 750 milligrams of calcium a day is sufficient, and anything more doesn’t decrease the risk of bone fracture further.²

Estrogen also has an important role to play in bone growth and sustainability, although the exact mechanism behind this relationship is still unknown. We know that bones have estrogen receptors, but what role they play in stimulating healing and increasing absorption of calcium still remains a mystery. The fact that bone density often decreases from lack of estrogen after menopause is convincing enough to confirm that a strong relationship nevertheless exists. Studies show us that bone mass reaches its peak in females at ages twenty-five through forty and then slowly declines until menopause. From age fifty-two to age sixty—the period of time when estrogen levels sharply decline—the body experiences its greatest reduction of bone mass. Yet from age sixty-five onward, the decline in bone mass slows to a crawl, as the body adjusts and finds alternative methods (other than estrogen) to maintain it.

Since the body’s natural estrogen has a direct effect on bone mass, wouldn’t estrogen replacement be the best option after menopause? While some studies suggest that low levels of estrogen replacement may decrease the risk of fracture by 20 to 35 percent,³ potential side effects such as vaginal bleeding, breast tenderness, risk of myocardial infarction, and ovarian cancer may outweigh the benefits.⁴ Although these side effects may be mediated by closely regulating the dose and type of estrogen, conflicting evidence regarding its ability to address osteoporosis portrays how there’s no absolute one-size-fits-all approach. Moreover, there are several factors that influence the effects of estrogen such as age, extent of osteoporosis, health history, and so on.

With the estrogen debate still lingering, doctors have turned to other methods to prevent and treat osteoporosis. Bisphosphonates, for example, are currently the most frequently prescribed medication. This medication group, consisting of brand names like Fosamax and Actonel, inhibit osteoclast cell activity to prevent the breakdown of bone cells. A review of available research conducted in 2002 showed that bisphosphonates are capable of preventing bone fracture in an average of 27 to 49 percent of all trial participants.⁵ Despite boasting this ability, bisphosphonates aren’t easily absorbed through the stomach and tend to result in indigestion. Other side effects may include flu-like symptoms, bone pain, and/or low blood-calcium levels.

The World Health Organization recommends that women with a bone density loss of −2.5 or greater should consider taking pharmaceutical medication to prevent bone fracture.⁶ If your bone density test scored in this range, then I’d suggest discussing the above options with your medical doctor. Regardless of your T-score results, I believe you’ll find the methods in this book, either in combination with a pharmaceutical approach or by themselves, to be of significant benefit.

THERE’S MORE TO OSTEOPOROSIS THAN CALCIUM AND ESTROGEN

At age thirty-eight, osteoporosis was the last thing on Jill’s mind. Sure, she wondered why her mom had fractured her hip twice at the age of forty, but never did she think it would happen to her. Jill’s first fracture, which happened when she was helping a friend move a file cabinet, came as a complete surprise. Jill always had a robust upper body, making her the go-to woman when her friends needed a helping hand. She was so proud of it that she never told anyone how weak her lower body felt most of the time. After her first fracture, it all slowly but surely started to make sense: she and her mom both looked stronger than most of their acquaintances, but only in areas that others could see. Hidden underneath was a weaker foundation that was prone to cracking.

Studies show that genetics may also contribute to the onset and extent of osteoporosis,⁷ and as we will soon discover, so does your yin yang body type. A genetic tendency toward osteoporosis doesn’t mean that it will inevitably become an issue. Bone mass improvement relies on three basic factors: having the intention of enhancing health, holding the belief that it is possible, and taking the appropriate action based on the unique requirements of your body type.

Did You Know?

Osteoporotic fractures often do not produce significant pain. Hairline fractures are common among individuals with osteoporosis. This type of fracture forms an extremely thin line across the bone, is difficult to detect in X-rays, produces minimal to no pain, and often goes undiagnosed. Hairline fractures commonly occur at the femoral (hip) joints and facet joints (between the vertebrae) in serious cases. With Stage 4 osteoporosis, hairline fractures may occur with light injury or simply from everyday bone stress.

Osteopenia is considered a lighter form of bone mass reduction than osteoporosis, though it still describes a significant loss of bone mass with a higher risk of fracture. One in ten sixty-year-old women and one in five seventy-year-old women have osteoporosis. Forearm fractures are the most common type of osteoporotic fracture, followed by hip, shoulder, and spine fractures. Once an osteoporotic fracture occurs, there is an 86 percent increased chance of another fracture occurring in the same location.⁸ So be very careful!

Taking action doesn’t mean excessive exercise. Instead it requires that you develop the ability to know what constitutes too much and too little activity. Strike a balance with your body, compromising at times and pushing along when necessary. If you feel pain or excess strain, then stop or at least slow down. If you walk daily, don’t forget to take into consideration the distance back home. Challenge yourself to exercise every day, or at least every other day, within your limits. Emotional and physical health is in your hands. But remember, before you step on the gas pedal and drive, you have to know your vehicle. The amount of pressure you apply depends on whether it is a race car or a lemon. Even a lemon can get you from place to place, although it may take longer. Knowing your body’s limits and capabilities is the first step toward maximizing your bone health. Slow down when slowing down is called for and don’t be ashamed or blame it on getting older. There is a time to slow down and a time to speed up. Listen to and be aware of what your body is telling you and steer clear of an overenthusiastic mind.

WESTERN AND EASTERN PERSPECTIVES ON OSTEOPOROSIS

Whereas in the West, loss of bone mass during and after menopause is associated with fluctuations in estrogen and progesterone, in Eastern medicine, it is associated with a deficiency of kidney function, which is responsible for producing and sending bodily essence, or ek gi (in Korean), to the bones, storing it in the form of marrow. Modern medicine also associates the kidneys with bone health, crediting a hormone called erythropoietin that stimulates the production of marrow, which, in turn, produces white and red blood cells within the bones. Erythropoietin deficiency contributes to a loss of bone marrow and bone cell (osteoclast/osteoblast) production. The kidneys are also said to activate vitamin D within the body.

Even though modern medicine acknowledges the association between the kidneys and bone health, treatment of osteoporosis is primarily focused on the bone itself by administering drugs that delay the process of bone degeneration. In traditional Eastern medicines, strengthening and supporting the kidney function is a priority. As we will soon discover, each body type has its own approach depending on its inherent organ-related strengths and weaknesses.

THE YIN AND YANG OF OSTEOPOROSIS

In Eastern medicine, the kidneys are said to be the source of yin energy—the mother of all fluid and essence within the body. An abundance of yin may sound like an ideal condition for nourishing our blood, skin, muscles, and bones, but actually, it’s not all that simple. Excessive yin production will naturally weaken opposing yang energy, causing the stagnation of blood and energy within the body and inhibiting the flow of essence from the kidneys to the bones. Yang energy is responsible for pushing yin from one place to another. Yin is not always fond of yang’s pushy behavior, but without a little nudge, yin will stay put and eventually cause health issues. Simply stated, even though they oppose one another, yin and yang depend on each other for all body functions. Although bone health is primarily a yin-dominated process, without yang, it is useless.

Try the following tips to enhance your bone strength no matter what body type you are. Check each one off the list to make sure you are covering all the bases before jumping into the specific suggestions for your body type.

Tip #1: Take Vitamin D

Without vitamin D, calcium cannot find its way to your bones. This precious substance also protects us from numerous illnesses such as breast, prostate, and colon cancers, depression, insomnia, and an unbalanced immune system.⁹ Supplementing with vitamin D (with calcium) may suffice, but keep in mind that your body produces it naturally when exposed to sunlight. If you do not get enough time out in the sun, start thinking about doing so. The Vitamin D Council recommends approximately fifteen minutes of bare skin exposure to the sun for fair-skinned individuals, and at least twenty minutes for those with darker skin.¹⁰ Your skin cannot produce Vitamin D from indirect sunlight, so sitting in front of a window won’t do the trick. If you are a fair-skinned sun worshipper, remember that the sun’s rays can also be damaging, and intense sun exposure for more than twenty minutes can easily burn your skin.

In my neck of the woods—the Pacific Northwest—a condition called SAD (seasonal affective disorder), which is caused by a lack of sunlight, affects up to 9.9 percent of the population. Especially in the winter, many of my patients suffer from SAD, which makes them feel drowsy, depressed, and unmotivated. From my experience, acupuncture and exercise along with vitamin D supplementation are effective in treating this condition. If you do not get enough sun exposure or have low levels, then eating foods or consuming supplements with vitamin D (see tables 5.1 and 5.2) is the way to go. The recommended daily intake of vitamin D for women ages fifty-one to seventy is 600 international units, and after the age of seventy it increases to 800 international units.

The use of artificial UV sunlight is becoming increasingly popular in the Pacific Northwest, offering promising results. A study performed in 2010 demonstrated how exposure to UV light for ten to fifteen minutes, five times a week for eight weeks, significantly enhances vitamin D levels in patients who suffer from malabsorption.¹¹ Before you go out and buy a sunlamp, there are a few factors to keep in mind: Most sunlamps on the market do not emit UV light and therefore cannot facilitate the production of vitamin D inside your skin. Second, UV lamps are often used for tanning, and excessive exposure may cause serious skin burning. UV light exposure should be done in short spurts (as the study above suggests) and with the use of UV protective eyewear. I couldn’t find the UV light brand, Sperti Del Sol, mentioned in the above study, but others, like Sperti Fiji and Sperti Vitamin D, can easily be found online.

Tip #2: Exercise to Strengthen Your Bones

Even though emotional stress can lead to illness, physical stress on our bones makes them stronger. Actually, without stress, our bones cannot grow at all! The pulling and prying of tendons and ligaments on our bones is what elongates and gives them shape. Hence a sedentary lifestyle after menopause will more than likely contribute to the onset and/or exacerbation of osteoporosis. How much is enough? First, it depends on the type of cardiovascular exercise. Running may do wonders for cardiovascular health but can cause damage to the knees and soft tissue of someone forty years or older. If you are a runner, try to limit running time, combining it with walking and other cardiovascular activities such as bicycling, elliptical, swimming, aerobics, and so forth. If you were diagnosed with osteoporosis or arthritis in your lower extremities, eliminating running altogether and sticking to the latter exercises is the way to go. Are you an avid walker/hiker? These are excellent methods to encourage your bones to absorb more calcium. For the postmenopausal individual, I suggest using walking poles to prevent fractures from slipping. Tai Chi is another form of exercise that helps promote balance and build bone mass through a series of slow and fluid movements. A study performed by S. L. Wolf and colleagues showed how a group of women with a mean age of eighty who performed fifteen minutes of Tai Chi a day over four months had a 47 percent lower risk of falling compared to a control group.¹² Another study showed how daily performance of Tai Chi significantly reduced the loss of bone mass in postmenopausal women.¹³

Excessive twisting, such as swinging a golf club, or high-impact loading from lifting excessive weight can increase chances of fracture. Occasionally something as simple as bending forward to lift an object may also cause fractures in individuals with osteoporosis. Eliciting the help of a cane, chair, or other sturdy piece of furniture may suffice, but if necessary, bend both knees to pick up the object to avoid placing too much stress on your lumbar spine.

Tip #3: Consume Calcium-Rich Foods

To prevent kidney issues and encourage efficient absorption, I suggest getting most if not all of your calcium intake from body-type-specific foods (see tables 5.3 and 5.4 below) and supplementing only when necessary. The menopausal yang types need higher dosages of calcium (up to 1,200 milligrams/day) than the yin types (up to 750 milligrams/day) because of their tendency to lose bone mass more quickly.

Tip #4: Consume Isoflavone-Rich Foods

As we have discussed above, estrogen is an important component of bone health. Isoflavones are food components that resemble the structure of estrogen and are treated as such within the human body, where they mimick estrogen’s actions. Soybeans are by far the richest isoflavone food, boasting 128 milligrams per 100-gram intake. For the yang type, pretty much any soy-based product will do, but for the yin types, fermented soy-based foods such as tofu, tempeh, and miso soup are a bit easier to digest than soy milk, which often causes them digestive upset. Although not as rich in isoflavones as soy, other foods such as red clover sprouts, chickpeas, lentils, flaxseed, and lima beans may be easier on the digestive system of the yin types (refer to the discussion of phytoestrogens in the appendix for more details).

Tip #5: Watch Your Sodium Consumption

Sodium, according to Eastern medicine, guides energy to the kidneys and supports bone health, but excessively salty foods overwhelm the kidneys and eventually weaken them. So how much is too much? The problem is that the typical modern diet already contains too much sodium. Most sources recommend a maximum of 1,500 to 2,300 milligrams a day. The weaker kidneys of the Yang Type A benefit from ingesting closer to the higher end of this spectrum, while the stronger kidneys of the Yin Type B appreciate no more than 800 milligrams. Accordingly, foods that are naturally salty, like seafood, shellfish, and seaweed, are more compatible for the Yang Type A than for the Yin Type B. So how about the Yang Type B and Yin Type A? I’d recommend no more than 2,000 milligrams for the Yang Type B and up to 1,500 milligrams for the Yin Type A. If you are diabetic or suffer from high blood pressure, then further limiting your salt intake is advisable. As a general rule, consuming foods that naturally contain salt is a healthier option than ingesting it from sodium chloride (table salt), MSG, and other chemically derived sources.

OSTEOPOROSIS AND THE YIN YANG BODY TYPES

Osteoporosis does not favor a particular body type, since nobody, yin or yang, can avoid the process of aging. Yet the yin types in general have an advantage over the yang types because bone health relies on the kidneys, which are yin organs. If the kidney-strong Yin Type B takes care of herself, she is likely to have the strongest bones of all four types. Because of all their yin energy, the kidneys are also responsible for cooling the body. Born with weaker kidneys and abundant heat, the Yang Type A’s bones are always looking for attention and are prone to osteoarthritis. Still, unless Yin Type Bs cultivate their yang heat energy through exercise and yang (warm or hot) foods, their bones may never get to see their fame and glory.

Sasang medicine holds that an essential bond exists between what we eat and the health of our skin, muscles, tendons and bones. The bones are produced by ek (essence), originating from the breakdown of food in the large intestine. This process requires the cold and congealing energy of the kidney system, where the large intestines reside. The digestion of food in the stomach, on the other hand, relies on the warmth of the spleen system, where the stomach resides. The warmth of the esophagus and cool nature of the small intestines also play a significant role in transforming food into essential body tissues. Please see table 5.5 for further details.

Each of the four body types sends energy from their stronger organ to the kidneys in order to maintain bone health—a process that depends on balancing our emotions and eating habits and sticking to a consistent exercise routine. The Yang Type A’s bones benefit from “cooling” the anger produced from an inherently stronger spleen and choosing foods and exercises that don’t overheat her system. The Yang Type B could always work on slowing down to avoid overburdening her aging joints and refraining from ingesting foods and drinks that are too stimulating. The Yin Type A, on the other hand, may have to fight the natural urge to relax and motivate herself to exercise regularly. The Yin Type B’s stronger kidneys may freeze up, making her bones brittle, if she doesn’t stay warm and interact with others, especially during the colder months.

Now let’s explore how osteoporosis relates to each of the four body types in more detail.

YANG TYPE A

As we’ve discussed above, Yang Type As are most prone to bone-mass loss owing to their weaker kidneys. Yet not all Yang Type As experience significant bone loss after menopause. Above all else, the Yang Type A’s bone health depends on how grounded her kidney energy is. Excessive uprooted anger from a stronger spleen pushes her energy upward and away from the kidneys, while rooted anger is capable of nourishing them. So what does it mean to “root” anger? Anger is a vital part of the Yang Type A’s psyche, and it’s behind everything she says and does. For her, the challenge isn’t to suppress anger but to know how to express it without offending or injuring herself or others. Her sudden bursts of excessive anger are often a result of having too many irons in the fire and feeling as if she has to do all the dirty work. From a scientific perspective, this triggers the release of excessive amounts of cortisol into the bloodstream, which in turn inhibits the production of osteoclasts (bone cells). If any of the four Sasang predominant emotions of sadness, anger, joy, and calmness are given free rein, they can easily injure our weaker organs. Health depends on balancing the yang and yin emotions, anger with calmness and sadness with joy. The balanced Yang Type A reflects inward, taking a deep breath and calming her mind before getting angry, but unbalanced, she lashes outward.

If the Yang Type A experiences chronic hip or lower back pain, light rather than excessive exercise may be the answer. The sacroiliac joint, which connects the pelvis to the sacrum, is often the first joint of the back to dislocate. Going to a chiropractor, osteopath, and/or acupuncturist to monitor and address this situation could potentially avoid further issues down the line. I once met a seventy-five-year-old Yang Type A who kept herself in excellent shape and was admired by her neighbors as she walked and exercised in the park every morning. A few years back she experienced hip pain and decided that she would address it by exercising harder. As the weeks went by she was in even better shape, but her hips continued to hurt even more. Her X-rays showed severe degeneration of her hip bones, to the point of no return. Unfortunately, only a few weeks later, she was unable to walk without severe pain and became housebound.

Impulsiveness is one of the Yang Type A’s strongest traits. She often acts before thinking, always ready for the next move before finishing her last one. This way of thinking sometimes comes in handy, especially when accompanying yin folks, who often think too much before taking action. The yin types may continually question whether or not they are making the right decision, while the Yang Type As “think” with their body. There is no time for the Yang Type A to dwell or fret about this or that issue. As the Yang Type A ages, however, her body has trouble catching up. Menopause is a time for Yang Type As to reflect on their actions, health, and well-being. While they do not have to aspire to be as slow-moving and slow-thinking as the Yin Type B in order to stay healthy, since this would be counterintuitive, they can “borrow” certain Yin Type B traits, such as do ryang—the ability to plan and strategize.

Hei Mei
(Common: Blackberries; Latin: Rubus fruticosus)

In my home state of Oregon, many of us are all too familiar with blackberries. This fruit, which was introduced from Europe to the eastern United States in the early 1800s, traveled rapidly toward the Pacific Northwest, taking over fields and roadsides along the way! Most Oregonians view blackberries as a menace rather than a medicine. However, blackberries are an invaluable medicine for Yang Type As because they strengthen the kidneys, their weakest organ. Since the kidneys support the lower back and legs, this herb addresses chronic lower back pain. Blackberries, which target the hips, knees, ankles, and toes, are very rich in nutrients, such as dietary fiber, vitamins C and K, folic acid, and manganese. They are ranked one of the best antioxidant foods by the National Institutes of Health. Antioxidants eliminate free radicals and help the body fight off infection.¹⁴ The tiny seeds in blackberries are high in omega-3 and omega-5 fatty acids and protein. Lastly, blackberries are highly concentrated with phytoestrogens, a natural source of estrogen that plays a major role in keeping the bones strong and the tendons flexible after menopause.

Common Uses

Blackberries alleviate joint pain (e.g., hips, knees, ankles, and toes), bone pain, postmenopausal issues (osteoporosis, osteopenia), and frozen shoulder.

Sources

Blackberries are seasonally available fresh or frozen at most supermarkets. Off-season (winter) supplies are sometimes available in supermarkets on the West Coast. Dried blackberries are available all year round from Nuts.com. Freeze-dried blackberries, which can be easily dissolved in water, are available from the Z Natural Foods website.

Preparation and Dosage

A handful of fresh or dried blackberries a day can provide plenty of energy to the Yang Type A’s kidneys. Three cups of blackberry tea a day can help prevent bone-related issues. Blackberry tea is prepared by boiling a handful of dried blackberries in two to three cups of water. Let the tea simmer for fifteen minutes and drink it cool or warm, depending on your preference. Blackberries also make a yummy ingredient or garnish in salads, oatmeal, or yogurt.

Herbal Friend: Sheng Di Huang (Common: Rehmannia or Chinese Foxglove; Latin: Rehmannia glutinosa)

Sheng Di Huang, or rehmannia, is commonly used for Yang Type As because it supports their weaker kidneys in several ways. First, it is one of the strongest herbs to nourish the kidneys. Second, it is commonly used for nourishing the blood, which is considered the “mother” of yin. Third, it strengthens the lower back, knees, and ankles—areas that are particularly vulnerable to bone-related issues among the Yang Type As. Rehmannia is also capable of preventing bone-mass loss—a property that is believed to be the result of its effect on estrogen.¹⁵ Modern science is still not sure how and why rehmannia supports bone function even though, for thousands of years, Chinese medicine has been aware of its yin- and bone-nourishing qualities. Together, rehmannia and blackberry nourish bone marrow, strengthen the bones, and nourish the blood.

Rehmannia can be purchased as a tincture on the Herb Pharm website. The Sasang-based formula Dokhwal Jihwang Tang, which contains rehmannia and several other herbs to help nourish and support the reproductive organs, is available on sasangmedicine .com: Click “Sasang Store” from the main menu and then the “Add to Cart” icon beneath “Herbal Pills.” Type “Dokhwal Jihwang Tang” under “Ordering Instructions.”

YANG TYPE B

Deficient yin, which correlates with the lower body, often makes Yang Type Bs appear clumsy, as they experience difficulty stabilizing their weaker legs. An abundant upper body energy with a wobbly foundation gives them a robust and occasionally monstrous appearance, despite being inwardly feeble. Yang Type Bs’ weaker lower body is due to weaker lower body organs (liver and kidneys) that have trouble feeding their bones. In general, Yang Type Bs have less risk of osteoporotic bone fracture compared to Yang Type As, since their kidneys are not their weakest organ. Yet to avoid the risk of fracture, they also have to be extra careful not to lose their balance, being mindful of their lower body and rooting their energies.

The connection with heaven, or chon shi, comes from the Yang Type B’s stronger lungs. This trait gives her a profound sense of connection with the cosmos. Once she gets a taste of it, the Yang Type B may lose her connection with the earth, disregarding the needs of her own flesh and bones. If her head is in the clouds, she may also be completely unaware of obstacles in the way, tripping over things left and right.

The feeling of oneness with the cosmos sounds pretty awesome, right? This feeling is so important to the Yang Type B that she will do anything in her power to sustain it. Those who have had such an experience know how difficult it is to return to earth. The Yang Type B transforms this feeling into her everyday reality. The other types may also get a glimpse of it by achieving something great, taking psychedelic drugs, or engaging in a spiritual practice. For the Yang Type B, it’s there no matter what, and if she doesn’t take action to sustain and tame it, she’ll get ill. Internally, this trait shifts her energies upward, toward the head and away from the lower extremities. Hence arthritis and bone density loss in the lower extremities are a common issue for the Yang Type B. When balanced, she is capable of feeling at home within her own body, while simultaneously reaching up to the heavens.

Song Jie
(Common: Chinese Red Pine/Masson Pine; Latin: Pinus massoniana)

In winter, deciduous tree branches become brittle while the leaves wither away, but conifers like the Masson pine retain their leaves and branches and stay flexible and nourished all year round—a sign of incredible structural integrity! Just about every part of the pine tree can benefit the health of a Yang Type B. Its pollen stimulates blood movement, its bark helps with skin abrasions and tendon and muscle pain, and its nodes assist with joint and bone issues. The bark and nodes of the Masson pine tree contain a healing flavonoid that can be found in Pycnogenol, a trademarked formula that has anti-inflammatory, antioxidant, immune-supporting properties and helps strengthen blood vessel walls. A study performed in 2012 showed that Pycnogenol also has positive effects on bone strength and mineral density.¹⁶

Common Uses

Masson pine supports bone health and alleviates allergies, common colds, water retention, joint pain, and muscle and/or tendon pain.

Sources

Masson pine bark extract is available from the Planetary Herbals and Puritan’s Pride websites. Be careful! Even though there are several other sources of pine bark extract, they are often mixed with ingredients not suitable for Yang Type Bs.

Preparation and Dosage

Follow the manufacturer’s instructions for dosage.

Herbal Friend: Wu Jia Pi (Common: Devil’s Club; Latin: Oplopanax horridus)

In Sasang medicine, Masson pine bark is often mixed with devil’s clubto treat allergies and common colds by supporting the immune system and assisting with the flow of lung energy. They are also combinedto strengthen the liver and kidneys of the Yang Type B, thus assisting with bone health and rehabilitation. Use two parts devil’s club to one part pine bark extract. Follow the manufacturer’s instructions to determine the recommended dosage range for each supplement. Devil’s club is available from manufacturers such as Herb Pharm and HerbalRemedies.com.

YIN TYPE A

Generally speaking, Yin Type As inherit stronger bones than the yang types, making it relatively easy for them to maintain bone mass after menopause thanks to a stronger liver, which feeds the muscles, sending them energy and blood. Muscles increase bone mass by pulling and increasing pressure on the surface of each bone, stimulating the absorption of calcium. Also with a stronger liver comes the tendency to absorb excessive fat and by-products from food, contributing to weight gain. While not all Yin Type As are heavyset, those who do pack on a few extra pounds put even more pressure on their bones, stimulating bone growth. While I do not suggest gaining excessive weight, it’s a fact that lighter postmenopausal women are more prone to osteoporosis compared to those who are heavyset. Excessive weight gain over a shorter period of time, however, may increase the risk of fracture. Moreover, significant body weight forces the tendons to pull excessively on the bones, causing them to thicken and become arthritic.

Did You Know?

Were you ever diagnosed with arthritis? If so, welcome to the club. Most of us show at least some sign of arthritis after the age of thirty. Yet it’s not until we experience joint pain that the A-word becomes a concern. Arthritis (osteoarthritis) isn’t a disease or the beginning of the end of one’s youth. Actually, it’s nothing but another word for “bone growth.” The pulling of our tendons and ligaments on the bones is what increases height, but when our bones stop growing vertically, they start extending horizontally. That’s right! We keep growing (laterally) and experience growing pains throughout our entire lifetime.

The Yin Type As’ temperament of joy gives them a profound ability to live in the moment, relax, and chill out. If they take this ability to the extreme, then inactivity and idleness become the norm. A lack of physical activity leads to an impaired neuromuscular function and an increased fracture risk. Hence it is essential that the Yin Type A challenge herself to stay active. Her stronger liver is also paired with skill and talent, a trait brought out through heng gom, or self-reflection. In short, if the Yin Type A reflects on her actions, her liver will radiate with joy and share energy with the rest of her body. Without self-reflection, it will hoard the body’s energies, crave joy only for itself, and disregard the ability to express profound talent. The tendons of an unbalanced and unreflective Yin Type A lose their flexibility, constantly yank away at the bones, and bring about arthritis and/or osteoporosis. The Sasang medicine association between liver health and bone density might seem a bit far-fetched, but modern research is beginning to recognize this connection. Recent studies have linked liver disease with a 40 percent increase in bone fractures.¹⁷ As science advances, such findings reveal just how integrated and mutually dependent the different components of our body are. The Sasang medicine model stretches things even further by emphasizing the influence of our thinking on organ and bone health.

Wouldn’t it be great to feel joyful all the time? Who, in their right mind, would rather be angry? Joy is an emotion that just about everyone defines as a positive one. The Yang Type A’s anger, on the other hand, is almost always interpreted as negative. Sasang medicine does not label emotions as good or bad, since each one has its place. Joy, if taken to the extreme, can breed stagnation, while anger embraced with calmness could be motivating and stimulating. The Yin Type A balances her joy by accepting other emotions like anger and sorrow, without feeling that joy has left her in the dust. Balanced joy from the liver sends energy downward to the kidneys, which then send energy to the bones, lower back, and extremities. The Yin Type A who lacks joy, or desperately holds on to it, often experiences lower back pain and weakness. So spread the word that balanced joy can enhance your bone density! But remember that joy without sorrow is like having a liver without lungs. We need both emotions and organs to stay alive and function. If you look hard enough, you’ll find joy within anger and sorrow, and anger and sorrow within joy.

Song Zi
(Common: Pine Nuts; Latin: Pinus spp.)

Pine nuts are ingested to strengthen the bones, making them a suitable remedy for osteopenia or osteoporosis. Pine nuts are especially beneficial for the lower body skeleton, such as the lower back, hips, knees, ankles, and/or toe joints. Each pine nut has up to 35 percent of its weight in protein, therefore making it a great source of cellular energy. In Sasang medicine, pine nuts, like many other Yin Type A herbs, have the added benefit of nourishing and protecting the lungs from infection and boosting the immune system.

Common Uses

Pine nuts ease lower-body joint pain (e.g., toes, ankles, knees, and hips), osteoporosis, osteopenia, tooth decay, tooth pain, skin dryness, and menstrual issues.

Sources

Several varieties of pine nuts are available. European pine nuts, also called stone nuts, are slender and longer than the Asian variety. Despite a difference in shape, the two varieties are equally beneficial for the bones. Less expensive pine nuts can be purchased in bulk from Nuts .com. Organic pine nuts are available on the Woodstock Foods website and at Trader Joe’s natural food stores.

Preparation and Dosage

Pine nuts make a good snack and can also serve as a valuable ingredient in numerous delicious recipes. In Korea, pine nuts are often sprinkled into teas to add a pleasant nutty taste. Try it with your favorite tea!

Herbal Friend: Li Zi (Common: Chestnuts; Latin: Castanea spp.)

Eating roasted chestnuts beside an open fire at Christmas may be the only time we pay any attention to them in the West. In the Sasang medicine clinic, however, they are prescribed for bone-related issues such as osteoporosis, osteopenia, and lower-body joint issues because of their significant potassium and magnesium content. Chestnuts are also prescribed for indigestion caused by cold accumulation in the body, which is signaled by a sensitivity to cold, a lack of appetite, and watery dark brown/tarry stools. Chestnuts make an excellent nutritious snack because they are high in minerals, vitamins, and phytonutrients, while still keeping a low-calorie/low-fat profile. They are also gluten-free, making them a good option for those with gluten sensitivities. Roasted, dried, and powdered chestnuts can be purchased by the pound from Nuts.com.

Chestnuts are commonly peeled and ingested directly from the shell. Chestnut powder (also known as chestnut flour) can be used as a gluten-free white-flour alternative for baking. After being soaked and peeled, dried chestnuts also become a yummy ingredient for a variety of healthy dishes. A tea made of dried chestnuts is prepared by combining four raw and peeled chestnuts with two cups of water; bring to a boil and then simmer over low heat for thirty minutes. Drink two to three warm cups per day to relieve diarrhea and indigestion. Chestnuts and pine nuts can be ingested together for added bone benefit along with immune and digestive support.

YIN TYPE B

While Yin Type Bs are less prone to osteoporosis than the other types, they are not completely immune to it. It all depends on whether or not they preserved their health through the premenopausal years. Even our strongest organs may suffer the consequences of a poor diet, lack of emotional balance, or both. As we have discussed previously, the kidneys feed energy to and nourish the bones via the ek, or bodily essence. Calmness, the emotion associated with the kidneys, facilitates this process, so the calmer we are in general, the more essence we produce. But if the Yin Type Bs’ calmness gets out of hand, locking them into their own little world and lacking interaction, then the bones will not have enough opportunity to develop. On the contrary, active Yin Type Bs tend to suffer less from fractures than the other types. The trick is to stay calm and active at the same time!

With a weaker spleen group, which is in charge of food metabolism, the Yin Type B’s digestive system tends to lag behind the rest of her body, often producing fatigue and grogginess. The spleen group also correlates with our tendons, giving the Yin Type B a fragile stooped-over appearance. Our bones rely on the constant pull of the tendons in order to grow and rebuild. So a healthy digestive system is essential for bone health. If the Yin Type B does not focus on keeping her digestive system healthy, then no matter how strong her kidneys are, she will not be able to produce enough essence to maintain bone integrity. How does the Yin Type B know if she has a healthy digestive system? The answer is simply whether or not she has a good appetite and can ingest cold water without indigestion. Both scenarios indicate that she has enough yang energy to metabolize food and keep her body warm.

The Yin Type B can experience remarkable improvements in her health if she stays active most of the time, while the opposite is true for the Yang Type A, who mostly benefits from slowing down. With strong kidneys, also associated with basal energy, the Yin Type B can keep going, slowly but surely like the Energizer Bunny, whereas the Yang Type A, with weaker kidneys, tends to burn out easily. From the outside the Yin Type B often looks weaker and more fragile than the Yang Type A, her energetic opposite, because bone strength is less impressive than muscle. So keep it moving, Yin Type Bs, even if the mirror doesn’t appreciate it as much as your bones do.

If you are a Yin Type B who somewhere along the way swayed off the path of well-being, then it may be necessary to turn over a new leaf while giving your kidneys a little boost with Sasang medicine herbs. It may be tempting to take this or that over-the-counter remedy promising to increase your bone mass, but most will overstimulate the Yin Type B’s already vibrant kidneys, instigating digestive issues. Below you’ll find herbs that enhance bone health by cultivating the yang of her weaker digestive system.

Rou Gui
(Common: Cinnamon; Latin: Cinnamomum cassia)

Rou Gui, or cinnamon, has the dual function of supporting the digestive system and strengthening the bones. The latter function stems from its ability to reinforce the kidneys, which are in charge of bone and joint health. Cinnamon has high levels of manganese, essential for building bone and other connective tissue. It is also rich in fiber, calcium, and iron, all of which help strengthen the bones. In a Copenhagen University Hospital study, 200 patients with arthritis pain were given half a teaspoon of cinnamon powder with one tablespoon of honey—another Yin Type B friend—every morning. Most patients showed significant relief of knee pain after one week. After one month, 75 of the 200 participants who had been immobile before the study were able to walk without any pain at all.¹⁸

Common Uses

Cinnamon relieves headaches, circulatory issues (numbness, tingling, and/or coldness of the extremities), joint and muscle inflammation, lower back and knee pain, and sensitivity to cold.

Sources

Cinnamon bark can be purchased from most supermarkets throughout the United States. Suppliers such as Nature’s Answer, Solaray, and Gaia offer a capsulated extract form of cinnamon on their websites.

Preparation and Dosage

Raw cinnamon bark is prepared by boiling three two-to three-inch slices of bark in two cups of water. Let the tea simmer over low heat for fifteen minutes. More or less cinnamon can be added depending on your taste preference. If you’re using capsules, refer to the manufacturer’s dosage guidelines. Cinnamon can also be added in powder form to protein drinks.

He Shou Wu
(Common: Fleece flower Root; Latin: Polygonum multiflorum)

This herb is called He Shou Wu, meaning “Mr. Black Hair,” because it is believed to delay the graying of hair thanks to its essence-nourishing properties. It is also known as fleeceflower root and has been used for thousands of years in Eastern medicine for nourishing and supporting the essence, or ek, of the body, which is produced in the kidneys and resides within the bones, where it builds and nourishes the blood. A study performed in 2004 showed that fleeceflower root can prevent bone calcium loss.¹⁹

Common Uses

He Shou Wu strengthens the kidneys, benefits the bones, nourishes the blood, and is often used in formulas to address premature graying of the hair, lower back and knee soreness/pain, and nocturnal emissions.

Sources

He Shou Wu, also known as Fo Ti, can be purchased in capsule form on the Nature’s Way website by typing “Fo Ti” in the search bar. It can also be purchased in tincture form from Nature’s Answer on the Swanson Health Products website.

Preparation and Dosage

Follow the manufacturer’s dosage recommendations. Both fleeceflower root and cinnamon can be taken together in one sitting.