Chapter 7Basic Protocols

Treating Addiction by Correcting Elemental Imbalances

According to TCM, we all embody the characteristics of all five elements — Water, Wood, Fire, Earth, Metal — but most of us have a dominant element, as indicated by our dominant character traits. We display the negative emotional attributes of that element when it is out of balance; conversely, we embody the positive characteristics and personal strengths of that element when we are well and our body and mind are in balance.

Opioid abuse has a strong negative impact on our elemental balance. Elemental imbalances manifest in different ways, depending on the individual. In this chapter, we’ll discuss some of the more common manifestations in people suffering from opioid dependency, and we’ll look at protocols for treating those imbalances. Recognizing elemental imbalances allows us to craft an effective strategy for addressing the emotional disorders that contribute to continuing opioid dependency, so that we can overcome our addiction and regain balance and wellness. These strategies can include acupuncture, acupressure, herbs, essential oils, nutrition, exercise, meditation, and more.

Let’s take a look.

Work with a Professional

Some of the therapies discussed in these protocols can be self-administered, such as herbs, acupressure, and flower essences. Others must be administered by a professional, such as a licensed acupuncturist. Ultimately, the responsibility for a full recovery from opioid use/abuse lies in the hands of the patient. No practitioner from any medicinal tradition can “fix” you, and no single remedy is a complete cure for addiction. The protocols detailed in these pages are intended to empower patients so that they can more clearly understand their treatment options and engage in their own healing. They are not “stand-alone” treatments; anyone looking to overcome opioid dependency should work with local health-care guidance to develop a plan of action for recovery.

Water/Kidney Imbalances

Water element imbalances are common in opioid dependency because stress consumes Kidney yin, and most opioid use is predicated on some type of stress, whether physical, social, or psychological. Ongoing opioid use and withdrawal are also stressful, exacerbating any yin deficiency. The Kidneys and the Water element are linked, so Water imbalances and Kidney deficiencies go hand in hand. Some practitioners would call this type of Kidney deficiency adrenal fatigue, and indeed, studies have shown that chronic opioid use results in adrenal insufficiencies. 137

From a TCM perspective, when opioids contribute to Kidney deficiency and a Water element imbalance, anxiety and panic attacks result. From a Western perspective, prolonged use of opioids damages neurotransmitters in the brain that play a central role in the anxiety response, which has the same effect. 138 In either case, using opioids nullifies anxiety, but once they are discontinued, feelings of unease, anxiety, and eventually panic begin to surface. These feelings contribute to cravings for opioids and increase the chance of relapse. 139

Because the Water element governs willpower, and giving up an opioid dependency requires tremendous willpower, reinforcing the Kidney energetic system becomes especially important during withdrawal and recovery. It’s also important to address adrenal fatigue.

The strengths of individuals who embody Water element attributes are resilience and the ability to overcome inevitable obstacles of recovery. Like the waters of a lake, their thoughts run deep and they bestow calm energy and deep wisdom on those who are in their company. Upon recovery of health and balance, the person’s clear insight and deep perception, which have been fortified by the experiences he or she has gained through dependency and recovery, lead to a purpose-filled life.

Kidney Yin Deficiency

The yin of the body originates with Kidney yin; therefore, a yin deficiency developing in any organ system in the body will indicate Kidney yin deficiency.

Patterns of Kidney Yin Deficiency

• Afternoon or evening sweats
• Dry mouth or throat
• Thirst
• Feeling of fever in afternoon or evening
• Tinnitus (constant ringing in ears)
• Pain or dull ache in the lower back
• Aching bones
• Weakness in the knees or lower back

Self-Treatment Options for Kidney Yin Deficiency

Clinic formula: Opioid Yin Tonic

Patent formula: liu wei huang wan

Acupressure point: KI 3

Single herbs: fo-ti, goji, privet fruit, schisandra

Essential oils: any of those correlating to the Water element with a cooling nature, such as geranium, lavender, or marjoram

Opioid Yin Tonic

This formula contains nourishing yin tonic herbs along with herbs that address common aspects of yin deficiency seen in addiction recovery, such as sweating and thirst. It would be appropriate for those who are experiencing Kidney yin deficiency symptoms and would be used over a matter of many months until the symptoms subside. This formula is cooling and nourishing for blood and organ tissue but is not cold in nature. For dosages, follow the recommendation of your licensed practitioner.

Chinese Name	English Name	Percentage of Formula
Shu di huang	Rehmannia (cooked)	14.9%
Shan zhu yu	Cornus	8.9%
Shan yao	Dioscorea	8.6%
Sang ye	Mulberry leaf	8.3%
Nu zhen zi	Ligustrum	8.0%
Mu dan pi (su)	Moutan	6.5%
Fu ling	Poria	6.2%
Ze xie	Alisma	5.9%
He shou wu	Fo-ti	5.6%
Ge gen (fen ge gen)	Pueraria root	5.3%
Gou qi zi	Lycium fruit	5.0%
Gu sui bu	Drynaria	4.7%
Yin chai hu	Stellaria root	4.4%
Ju hua	Chrysanthemum	4.1%
Long yan rou	Longan fruit	3.6%

Kidney Yang Deficiency

The Kidneys are also the origination point of yang in the body, and yang deficiency anywhere in the body can originate from Kidney yang. Yin is the material basis of yang, so a yin deficiency sometimes leads to a yang deficiency, and a yang deficiency is always indicative of a yin deficiency. Yang deficiency patterns present with slowed metabolic processes, such as hypothyroidism or even shallow breath. Kidney yang deficiency affects many aspects of health, including core energy, sexual energy, lower back strength, knee strength, hair health, and reproductive health. Many people who are kidney deficient experience a drop in energy in the afternoon around 3:00 p.m.

Someone suffering from a yang deficiency may look pale or anemic, may have dark circles under his eyes, and will have a weak voice. Women who are yang deficient will likely have pale or watery menstrual blood and backaches associated with their period.

Patterns of Kidney Yang Deficiency

• Pain or dull ache in the lower back
• Soreness in the knees
• Weakness in the lower limbs
• Coldness of the body, especially the hands and feet
• Social withdrawal
• A tendency to catch colds easily
• Impotence
• Infertility
• Loose morning stools
• Frequent urination
• Edema
• Anxiety, panic attacks, and fearfulness

Self-Treatment Options for Kidney Yang Deficiency

Clinic formula: Opioid Yang Tonic

Patent formula: you gui wan

Acupressure points: KI 3, KI 6

Single herbs: fo-ti, privet fruit, reishi

Essential oils: any of those correlating to the Water element with a warming nature, such as basil, cinnamon leaf, or nutmeg

Follow the suggestions for treating adrenal exhaustion

Opioid Yang Tonic

This formula contains warming yang tonic herbs along with herbs that address common aspects of yang deficiency seen in addiction recovery, such as adrenal fatigue. It would be used in cases of where the patient feels chronically cold. If heat symptoms of yin deficiency are present, such as sweating and thirst, one would combine the yin and yang formulas and take each at half strength so not to exacerbate the yin deficiency. For dosages, follow the recommendation of your licensed practitioner.

Chinese Name	English Name	Percentage of Formula
Shu di huang	Rehmannia (cooked)	14.3%
Tu si zi	Cuscuta seed	14%
Shan yao	Dioscorea	8.3%
Yin yang huo	Epimedium	7.4%
Ze xie	Alisma	7.1%
Gou qi zi	Lycium fruit	6.9%
Wu wei zi	Schisandra	6.6%
Shan zhu yu	Cornus	6.3%
Mu dan pi (su)	Moutan	6.0%
Gui zhi	Cinnamon twigs	5.7%
Bu gu zhi	Psoralea	5.4%
Fu ling	Poria	4.6%
Du zhong	Eucommia	4.0%
Huang jing (jiu)	Polygonatum (Solomon’s seal)	3.4%

Clinical Case Study

Water Element Imbalance

Patient: Linda S., female, 32 years old

Linda, a pharmaceutical sales representative who described herself as having a Type A personality, arrived at my office after almost 2 years of opioid use following a skiing accident that injured her lower back. While her back pain had dissipated greatly, her cravings for opioids had only grown. Linda’s story was a common one: she was able to continue her opioid use by doctor shopping. When one prescription ran out, she would simply visit another doctor complaining about severe pain to gain another prescription. Linda explained how she had gone from being a confident and successful young woman to an unmotivated individual experiencing anxiety and panic attacks on a regular basis.

Luckily, her family lived close by and noticed changes in Linda’s personality. After 6 months of suspicions, they pieced together their conclusion of ongoing drug use. The family organized an intervention, during which their powerful group admonition helped Linda recognize the truth of the matter. In the weeks that followed, she tried to quit cold turkey several times, but her efforts resulted in severe nausea, sweating, terror, and an eventual return to the seductive narcotic.

After checking her pulse at several points and examining her tongue, I determined that Linda had Kidney yin deficiency. The Kidney organ system belongs to the Water element. When the Water element is out of balance, the associated emotion is fear, as seen with Linda’s chronic anxiety and panic attacks. Linda also reported that, about 6 months earlier, she had begun waking with night terrors, covered in sweat. Those with Kidney yin deficiency experience worsened symptoms at night. Her left medial pulse was tight and pounding, suggesting Liver heat. The tip of her tongue was bright red, indicating Heart heat, and it is common in cases of insomnia for Liver heat to rise and attack the Heart.

A diagnosis of a Liver imbalance was also supported by the fact that Linda reportedly went from being an ambitious young woman with goals and dreams to being an unmotivated individual with little hope or vision for the future. The liver is involved with opioid metabolism, and chronic use of them often results in Liver qi stagnation and Liver yin deficiency. The Kidney organ system is the basis of all yin in the body, and Liver yin deficiency was indicated by the peeling yellow areas on the side of Linda’s tongue.

Linda’s case demonstrates how all of the organ systems are interconnected and must be brought in to harmony. Even Linda’s initial injury played in to her diagnosis: an individual with Kidney deficiency would have a weak back.

With these findings, Linda and I set forth in creating a treatment strategy that would fit into her life.

The Treatment Protocol

Weeks 1 and 2

• Acupuncture: three times per week
• Clinic formulas for withdrawal: Quell Quease, Calm Mind, and Ease Detox

Weeks 3 to 8

• Acupuncture: two times per week
• Clinic formulas: Opioid Liver Balancer, Opioid Yin Tonic, and Opioid Brain Tonic
• Supplements: amino acid blend of L-tryptophan and 5-HTP, L-tyrosine, and DL-phenylalanine (DLPA) at the recommended doses listed on the product label for 6 weeks

Ongoing Self-Treatment

• Acupressure: two or three times per day on points KI 3, HT 7 and HT 8, PER 7 and PER 8, LV 2 and LV 3, and ST 36
• Essential oils: any of those correlating to the Water element with a cooling nature, such as geranium, lavender, or marjoram
• Meditation: Five Element Meditation twice per day

Linda was fortunate enough to have accrued vacation days from her job. She was also fortunate in having an M.D. who helped her set a schedule for weaning off the opioids over the first 8 weeks of recovery. She decided to take the first week of treatment off from work and was able to come for an acupuncture treatment three times. Her withdrawal symptoms were minimal, but she was still experiencing her original symptoms of anxiety and insomnia, which did not begin to ease up until week 8. Thereafter, she continued the herbal therapy and received acupuncture one time per week for 6 more months, at which point she was free of drug cravings, anxiety, and sleep problems. Linda continued to visit the acupuncture clinic one or two times per month for 2 more years, during which time she received herbal prescriptions based on her presentation of imbalances. She was eventually restored to her original enthusiastic, energetic self.

Wood/Liver Imbalances

The organ system associated with the Wood element is the Liver. Because opioids are broken down in the liver, most people who take opioids for an extended period experience some level of liver damage. Damage to the liver causes a person to begin to harbor the negative feelings of the Wood element: anger, frustration, and resentment. Liver qi stagnation often results.

People who are prone to Wood imbalances tend to be more impulsive and reckless than most; this can create a predisposition to drug use. During withdrawal and early recovery, a Wood persona with Liver qi stagnation will be aggressive, confrontational, and angry at the world. Additionally, such people often display a false sense of confidence and arrogance that blocks them from being able to accept advice and wise teachings from others; this impedes recovery efforts.

As recovery progresses, those of the Wood type will begin to show their true nature as confident and highly motivated. Like a tree, they will develop attributes of flexibility and adaptability when the disruptive winds of life blow. They tend to have great foresight, and their ability to envision the future will allow them to create a strategic plan for a brighter future. As the Liver is soothed, their aggression turns to motivation, healthy competitiveness, and productive ambition. Once the post-withdrawal exhaustion lifts, those with the Wood personality type can burst forward with assertive drive and implement positive change in their life.

Liver Qi Stagnation

The Liver system is very powerful according to TCM; it is a yin organ, but it can be quite yang and reactive when it’s not happy and soothed. The Liver controls the smooth flow of qi throughout the body, which is crucial to the health of all of the organ systems. Left unchecked, Liver qi stagnation and imbalance will develop into aggression that is unleashed on other organ systems. Liver qi stagnation is arguably the most common pattern of imbalance in Western culture.

Symptoms of Liver Qi Stagnation

• Anger, irritability, and frustration
• Feeling stuck emotionally
• Depression
• Anxiety, stress
• Tenderness around the ribs
• Hard-to-swallow lump in throat
• Sighing often

Self-Treatment Options for Liver Qi Stagnation

Clinic formula: Opioid Liver Balancer

Patent formula: xiao yao wan

Acupressure points: LV 2 and LV 3, LI 4

Single herbs: dandelion, fo-ti, schisandra, white peony, yellow dock

Essential oils: any of those correlating to the Wood element, including fennel, marjoram, or Mandarin Orange/Tangerine

Follow the suggestions for detoxification

Clinic Formula: Opioid Liver Balancer

This formula nourishes and soothes the Liver while helping to calm the mind. It restores the Liver’s function of eliminating toxins. It would be most appropriate for people displaying indications of Liver qi stagnation, such as being quick to anger and frustration. It would be used over many months until symptoms have been resolved. For dosages, follow the recommendation of your licensed practitioner.

Chinese Name	English Name	Percentage of Formula
Xuan shen	Scrophularia	13.6%
Chai hu	Bupleurum	11.2%
Bai shao	White peony	10.8%
Xia ku cao	Spica prunellae	10.5%
Tian hua fen	Trichosanthes root	10.2%
Bai ji li	Tribulus	9.8%
Zhi mu	Anemarrhena rhizome	7.8%
Xiang fu	Cyperus rhizome	6.4%
He shou wu (zhi)	Fo-ti	4.4%
Han lian cao	Eclipta	4.1%
Qing pi	Citrus peel (green)	3.4%
Pu gong ying	Dandelion	2.7%
Xiao hui xiang	Fennel fruit	2.0%
Chen pi (ju pi)	Citrus peel (mature)	1.4%
Dang gui (shen)	Dong gui	1.0%
Suan zao ren	Zizyphus	0.7%

Clinical Case Study

Wood Element Imbalance

Patient: Walter V., male, 58 years old

Standing over 6 feet tall with a muscular build, Walter entered my office in a huff; he was frustrated by the lengthy patient questionnaire that he was required to fill out as a new patient. He made his complaint quite clear in a booming voice. For a moment I was put back on my heels, but I regained my composure as I recognized the Wood element personality. I pivoted from feeling attacked to feeling thankful for the diagnostic clues that would help me form an effective treatment plan for this patient.

As Walter began to share his story, more clues began to emerge. Though he had calmed down, his normal speaking voice sounded like a shout; his face was drooping on one side, likely due to a palsy resulting from a stroke; and the knuckles on his left hand were slightly deformed from arthritis. Before he had finished his first sentence, I had formed a large part of his diagnosis as long-standing Liver qi stagnation.

As it turned out, Walter had suffered a stroke 1 year earlier and had largely recovered with intensive physical therapy and medication. He had fallen during the stroke and fractured his arm, leading to an opioid prescription. A year later the pain was long gone, but he had become psychologically dependent on the drugs. He was angry at the doctor who prescribed the opioids, at his estranged wife for leaving him following the stroke, and at God for bestowing these curses upon him.

It was important that I clearly explain to Walter that his predicament was due to chronic illness. He had come to me expecting a speedy and painless opioid withdrawal. A deeper understanding of his condition would allow him to choose a short course of treatment for withdrawal only, or a longer course of treatment wherein he could achieve true, long-standing wellness.

His new-patient intake had indicated that Walter had been diagnosed 8 years earlier with high blood pressure and was taking a blood-thinning medication. Because 1 in 3 adults in the United States has high blood pressure, 140 patients often do not perceive of it as a significant health issue. Walter was aware that 80 percent of stroke victims had previously been diagnosed with high blood pressure, 141 but he did not link that diagnosis with his stroke since his blood pressure had been controlled with medication. I explained that it had first taken years of Liver imbalance for high blood pressure to develop in the first case. Additionally, I shared that in TCM a stroke is called a Wind-Stroke and is considered to result from internal wind created by Liver heat; his stroke, I told him, was due to a chronic condition that had been unchecked for over a decade, not a random bolt of lightning sent by God to strike him down.

A full evaluation of Walter’s tongue and pulse, along with his health history, painted a rather complicated picture of Liver qi stagnation, Kidney and Liver yin deficiency, and Heart heat. The opioid withdrawal process would take only about 3 or 4 weeks, but addressing his chronic health imbalances would take many months of acupuncture and herbal therapy. It was a great deal of information for Walter to digest, and we decided to begin with his opioid detoxification regimen while saving discussion of his long-term health issues for later.

Determined to rid himself of his addiction quickly, Walter wanted to quit the pain meds cold turkey that very day. I urged him to wean off the medications over at least 1 week’s time. (Unfortunately, because he had begun to purchase his opioids illegally several months prior when his prescriptions ran out, Walter did not have a prescribing physician to aid him with the weaning process.) He conceded, and we began our work together.

The Treatment Protocol

Weeks 1 and 2

• Acupuncture: three or four times per week
• Clinic formulas for withdrawal: Quell Quease, Calm Mind, and Ease Detox

Weeks 3 and 4

• Acupuncture: two times per week
• Clinic formula: Opioid Liver Balancer
• Supplements: amino acid blend of L-tryptophan and 5-HTP, L-tyrosine, and DL-phenylalanine (DLPA) at the recommended doses listed on the product label for 6 weeks

Months 2 to 5

• Acupuncture: once or twice per week
• Clinic formula: Opioid Liver Balancer
• Single herbs: hawthorn and motherwort

It would have been beneficial for Walter to practice self-treatment options such as meditation and acupressure, but they were not appealing to him. I was keen on him using my Heart Tonic herb formula, as it contained beneficial blood-moving Chinese herbs, but this caused the doctor who prescribed his blood-thinning medication concern. Also, Walter protested at the prospect of making and drinking teas; therefore, we decided on just the hawthorn leaf and flower capsules and the motherwort capsules.

To his credit, Walter attended his acupuncture sessions regularly and took his herb capsules consistently. His pulse lost its tight, wiry quality, and he reported that he felt much less stressed and frustrated with life in general. He was especially pleased that we were able to completely resolve the bit of paralysis that had remained in his face. His doctor was able to lower his dosage of blood pressure medication, but we were not able to reverse the damage already done. Similarly, we were able to alleviate the arthritic pain in his fingers, but the physical deformity remained. All in all, we were satisfied with the outcome. Walter continued to visit my community acupuncture clinic every few weeks for several more years, during which time he was able to maintain his sobriety and health improvements without regression.

Fire/Heart Imbalances

The yin organ associated with the Fire element is the Heart, which is said to house the mind and is associated with all emotions. Those who have a tendency toward Fire element imbalances can be especially prone to addiction because they tend to crave mind-altering substances and love to be the life of a party. Joy is the emotion associated with the Fire element, but in its negative aspect, joy becomes mania. During the early stages of dependency, opioids are known to induce a sense of euphoria akin to mania. Prolonged euphoria will damage the Heart system and create an imbalance of the Fire element.

The Fire element is unique in correlating to a conceptual organ system called San Jiao (Triple Burner). The San Jiao is partly responsible for moderating our body temperature on a physical level. Emotionally, a Fire element imbalance affecting the San Jiao can cause people to have emotions that fluctuate vastly; they can be warm and endearing one moment, cold and distant the next.

While the poetic association between love and the heart is well-known all over the world, love in TCM is directly related to the Heart: heartbreak can lead to Heart damage. The Fire element also encompasses the Pericardium (the membrane that encloses the heart), which is referred to as the “heart protector.” The Heart is unique as the only organ in the body that has an organ assigned for its protection. The Pericardium acts as a shield, absorbing personal emotional attacks. It also acts as a gate that opens (to allow for love to flow to the Heart) and closes (to protect the Heart from insult). If it is stuck open, an individual is especially vulnerable to emotional attacks. If it is stuck closed, an individual is unable to accept love.

As someone with dominant Fire-type personality traits begins to recover from dependency, he or she begins to reclaim joy. Easy conversation, a propensity for emotional warmth, and natural magnetism will allow this person to build a strong network of friends and family who support the recovery effort. This type of recovering addict will also tend to have a great sense of humor and enthusiasm. The Fire element, associated with summer, reflects warmth and abundance. Summer is when crops ripen and are harvested, and the Fire persona holds great potential for a life in which goals, hopes, and dreams come to full fruition.

Heart Blood and Qi Deficiency

The energetic organ system referred to as the Heart in Chinese medicine is quite similar to the western idea of the physical heart, but it also contributes greatly to emotional stability. In order to function properly, the Heart must receive abundant qi and blood so that it is nourished.

Self-Treatment Options for Heart Blood and Qi Deficiency

Clinic formula: Opioid Heart Tonic

Patent formula: tianwang buxin dan

Acupressure points: HT 7 and HT 8, PER 6 and PER 7

Single herbs: hawthorn, motherwort, red sage, schisandra

Essential oils: any of those correlating to the Fire element, including cinnamon leaf, clary sage, or frankincense

Opioid Heart Tonic

This tonic formula specifically repairs damage to the heart muscle and related tissues due to chronic opioid misuse or overdose. In addition to nourishing the heart, it moves blood and resolves blood stagnation. It also helps to clear heart heat, which is commonly seen in conjunction with sleep disturbances in people recovering from opioid abuse. The formula would be taken for 6 to 8 months, or until the symptoms resolve. For dosages, follow the recommendation of your licensed practitioner.

Chinese Name	English Name	Percentage of Formula
Ren shen (hong)	Ginseng	11.3%
He shou wu	Fo-ti	10.8%
Wu wei zi	Schisandra	10.3%
Bai zi ren	Biota seed	9.8%
Shan zha	Crataegus	9.8%
Sheng di huang	Rehmannia (fresh)	9.8%
Dang gui (shen)	Dong gui	9.3%
Dan shen	Salvia root	8.8%
Yuan zhi	Polygala	8.3%
Fu shen	Poria	6.4%
Da zao (hong)	Jujube dates (red)	2.9%
Suan zao ren	Zizyphus	2.5%

Clinical Case Study

Fire Element Imbalance

Patient: Janis R., female, 52 years old

Janis, a 52-year-old female, was referred to me after she had been in an automobile accident in which she sustained a back injury and was subsequently prescribed opioids. It had been 6 weeks since the incident, and the prescribing physician would write only one more script for her, allowing her the opportunity to wean off the medication. The problem was that she was still in pain and felt that she had become emotionally dependent on the narcotics. The healing strategy was obvious: alleviate pain and balance the emotions.

The pain aspect of the treatment process was straightforward. I prescribed Janis my clinic pain formula, which contains anti-inflammatory herbs such as turmeric, along with herbs that move blood and qi, as pain cannot manifest in the body without stagnation of blood and/or qi. Her pain was in her lower back located along the Bladder channel and the Du (Governing) channel (which runs over the spinal cord and brain), so I chose acupuncture points along those channels, along with other points that increase circulation. I also instructed her to apply a topical spray infused with healing herbs and essential oils to guide the remedies to the channels of the back.

The emotional balancing would prove to be more complicated. During the initial patient intake, Janis alternated from expressing warm feelings toward her children and grandchildren to explosive outbursts related to her accident and her suffering. Her hot-and-cold emotions continued during the initial weeks of treatment: she would sometimes express gratitude for the healing assistance, and other times strike out over the lack of quick progress. Along with physical symptoms such as palpitations, insomnia, and a burning tongue, it was clear that we would need to pay close attention to the Fire element to reach the best outcomes. In TCM, the Heart houses the mind during sleep. Unlike other elements, the Heart plays a role in all emotional imbalances. I instructed Janis to apply a carefully chosen mix of essential oils to specific acupoints to bring balance to the Heart.

While the Fire element has a propensity for flaring up when out of balance, so too does the Liver organ of the Wood element. Stress, toxins, and anger can lead to Liver qi stagnation. Beyond anger and frustration, Janis had been struggling with irregular bleeding and mood swings, which she associated with menopause. According to the ancient theories of TCM, the Liver controls the menstrual blood. In addition to Janis’s outward symptoms, her left middle pulse was tight and hard when palpated, further indicating Liver congestion. It is widely understood that opioids can have a negative impact on the liver, but the damage often occurs because many opioids are combined with the popular analgesic acetaminophen (which in large doses can be toxic to the liver). 142

The Treatment Protocol

Weeks 1 to 3

• Acupuncture: three times per week
• Clinic formulas for withdrawal: Quell Quease, Calm Mind formula, and Ease Detox

Weeks 4 to 11

• Acupuncture: two times per week
• Clinic formulas: Opioid Liver Balancer and Opioid Brain Tonic
• Supplements: amino acid blend of L-tryptophan and 5-HTP, L-tyrosine, and DL-phenylalanine (DLPA) at the recommended doses listed on the product label for 6 weeks

Ongoing Self-Treatment

• Acupressure: two or three times per day on points HT 7 and HT 8, PER 7 and PER 8, LV 2 and LV 3, and ST 36
• Essential oils: any of those correlating to the Fire element
• Meditation: Five Element Meditation twice per day

Janis came in for treatment three times per week for the first 3 weeks, and then cut down to two times per week for an additional 8 weeks. During weeks 1 through 3 she took formulas containing calming herbs as she weaned off of her opioid medication. While at this stage I considered adding an adaptogen formula, Janis’s emotions were leveling off quite nicely and we decided to reserve it for later, and only if needed, since she was already taking three formulas. At the end of the 11-week course of treatment, Janis had remained pain-free for over 2 weeks. I instructed her to continue the herbs for another 3 months and to come in for a treatment one time per month. At this stage I often release patients with instruction to simply schedule an appointment if they need to; however, I am much more guarded with patients coming off opioids and like to make certain that they are staying the course. Janis had a great outcome due to her commitment to wellness and excellent patient compliance.

Earth/Spleen Imbalances

The emotion related to the Earth element is worry. Earth-type opioid addicts will be fraught with fretful notions that they will be unable to stop ruminating about. While worrying does nothing to change a situation, their obsessive contemplations will keep them up at night and consume them during the day. This type of dominant personality is susceptible to developing obsessive-compulsive disorder (OCD). Studies suggest that people with OCD have a greater risk of developing substance abuse, as the ritualistic nature of substance use can appeal to those with OCD. 143

Those with an Earth-dominant personality will often complain that they do not feel grounded to the earth, and they will appear to be disorganized. With addiction, this persona may seem fretful to the point of being meddlesome or clingy.

Luckily, attributes associated with the Earth element can work to a person’s advantage after detoxing from opioids. Earth types are naturally very popular, nurturing, and empathetic; they are great listeners and can rebuild social networks and family ties easily following recovery. Instead of meddling or worrying, they develop innate abilities as natural facilitators who bring people together. Additionally, learning and intellect are attributed to Earth energies; this persona can quickly learn new and positive lifestyle patterns, adapting to a sober life easily.

Spleen Qi Deficiency

The pattern of Spleen qi deficiency is central to all other Spleen disharmonies; in fact, it is the precursor to all Spleen imbalances. If Spleen qi deficiency is not properly treated, it can lead to more serious patterns of imbalance. Any Spleen imbalance therefore indicates some form of Spleen qi deficiency.

Self-Treatment Options for Spleen Qi Deficiency

Clinic formula: Opioid Spleen Tonic

Patent formula: gui pi tang

Acupressure points: SP 3, SP 6, and SP 9; ST 36

Single herbs: astragalus, codonopsis, elecampane

Essential oils: any of those correlating to the Earth element, including anise seed, coriander, or fennel

Follow the suggestions for addressing poor digestion and fatigue

Opioid Spleen Tonic

This herbal formula contains nourishing Spleen tonic herbs that reinforce qi. Because it addresses an organ-level imbalance, it would take several months of use to resolve the deficiency/imbalance. This formula is also appropriate for treating internal dampness, as the Spleen is implicit in this condition. For dosages, follow the recommendation of your licensed practitioner.

Chinese Name	English Name	Percentage of Formula
Dang shen	Codonopsis	14%
Huang qi (bei)	Astragalus root	12.7%
Shan yao	Dioscorea	12.7%
Bai zhu	Atractylodes (alba)	12.1%
Shan zha	Crataegus	9.2%
Yi yi ren	Coix	8.7%
Da zao (hong)	Jujube dates (red)	6.9%
Cang zhu	Atractylodes	6.4%
Chen pi (ju pi)	Citrus peel (mature)	4.6%
Xiang fu	Cyperus rhizome	4.0%
Pei lan	Eupatorium	3.5%
Fu ling	Poria	2.9%
Huo xiang	Agastache	2.3%

Clinical Case Study

Earth Element Imbalance

Patient: Sarah C., female, 20 years old

Accompanied by her mother, Sarah appeared shy, thin, and frail as she entered the office. She sat quietly, looking away as her mother explained her predicament: Sarah had struggled with anorexia throughout high school and developed an opioid dependence during her first year of college, procuring the drugs from illicit sources around campus. When I inquired about her childhood, Sarah’s mother revealed that Sarah was born prematurely. Her mother nearly cried as she explained that it was necessary to leave Sarah in the neonatal unit for 2 months, making breastfeeding impossible. Sarah listened pensively as she gently pulled her fingers down through her hair, wadded strands into small balls, and placed them on her lap.

I turned my focus to Sarah and addressed her directly, asking for details. She answered only after her mother took her hand and began to reassure her in a melodic voice usually reserved for addressing babies. After a bit of stroking and cooing, Sarah began to open up. She described the tormenting feelings of ongoing anxiety that she experienced when her college roommate would not keep the room organized the way she liked. This caused her to fret throughout the night and lose sleep. The semester break was fraught with fights with her mother, who discovered that her reliably A student was barely making C’s. Sarah begged her mother to allow her to return home and attend a local college, to no avail. The opioid use began shortly after she returned to campus. She failed most of her second-semester classes, and it was agreed that she should return home.

For the Earth element to develop correctly, a baby must be nourished and nurtured, especially in utero and during the newborn phase. A baby’s bond with her mother, or lack thereof, plays an especially important role in her ability to feel safe and grow to become an independent and productive adult. The Spleen organ system is the yin organ of the Earth element and is responsible for the metabolism and absorption of food. The early events of Sarah’s life, including the fact that she was born before her Earth element was fully formed, created a predisposition to an Earth-element personality disorder. The emotion linked to the Earth element is worry, and those lacking in Earth can develop OCD.

Sarah’s eating and attachment disorders were further symptoms forming this diagnosis; however, I was especially concerned by the mother’s doting over her adult daughter. Overmothering is just as detrimental as undermothering when it comes to the health of a child’s Earth element. This was obviously a long-standing contributor to the disorder, but not something that I could address in my position. I had long known the TCM saying “When treating children, first treat the mother.” In our culture, many would see this as an attempt to blame the mother for a child’s behavior. As a mother myself, however, I know that mothers tend to be self-sacrificing and put the needs of their children in front of their own. Therefore, I understand that a mother who is not supported well cannot care for her children to her highest capacity.

The Treatment Protocol

Month 1

• Acupuncture: three times per week
• Clinic formulas for withdrawal: Quell Quease, Calm Mind formula, and Ease Detox
• Other clinic formula: a specially formulated Spleen qi tonic

Months 2 and 3

• Acupuncture: two or three times per week
• Clinic formula: Opioid Brain Tonic
• Other clinic formulas: specially formulated Liver and Spleen qi tonics
• Supplements: amino acid blend of L-tryptophan and 5-HTP, L-tyrosine, and DL-phenylalanine (DLPA) at the recommended doses listed on the product label for 6 weeks

Months 3 to 6

• Acupuncture: once or twice per week
• Clinic formulas: specially formulated Liver and Spleen qi tonics

Ongoing Self-Treatment

• Acupressure: two or three times per day on points HT 7 and HT 8, PER 7 and PER 8, SP 3 and SP 6, LV 2 and LV 3, and ST 36
• Essential oils: any of those correlating to the Earth element, including coriander, fennel, or marjoram
• Meditation: Five Element Meditation twice per day

After the fifth acupuncture treatment, Sarah began coming to her sessions on her own; this signified progress to me. Her anxiety levels lessened, but this was partly since she was back living comfortably at home with her parents. Nevertheless, it took a full 3 months for her to wean off the opioids. She had begun to eat regularly and put on weight, but the eating disorder would take 8 months to 1 year to resolve, as its causes were based on events that occurred at the very beginning of her life. With 6 months of regular treatment, herbal therapy, and other complementary modalities, Sarah made the bold move of getting a job and a small studio apartment. Her root imbalances were far from resolved, but her new job was 40 miles away. After she relocated, I never heard from her again.

Metal/Lung Imbalances

The Metal element is related to our personal boundaries; a person who has had those limits broken in early childhood often has dominant Metal characteristics. Many studies have suggested that there is a strong association between abuse (physical or sexual) and addiction. Most often, the abuse began in childhood. 144 Abuse in this light may be seen as a trigger for a Metal imbalance that results in opioid dependency.

Grief is the emotion most closely associated with the Metal element, and people who have emotionally based addictions related to this element may have failed to progress through all of the stages of grief after a loss and will appear to be sad much of the time.

People with this persona type will often present with a very rigid set of beliefs and will have trouble letting go of their dogma even if it is not logical or sensible and no longer serves them well. They may also regard structure and order to such a degree that they are impossible to placate, often being referred to as perfectionists who are critically judgmental of others. Interpersonal rigor, along with addiction and its complications, creates more loss and grief as friends and family distance themselves.

The Metal element correlates to the organ systems of the Lungs and the Large Intestine. The Lungs are a major pathway of detoxification; through our breath, we eliminate toxins that do not nurture or benefit us. On a physical level, a Lung imbalance may correlate with breathing problems and detoxification issues. On an emotional level, a person with Metal attributes may be unable to let go of negative emotions.

As the brain heals during recovery from opioid dependency, people with dominant Metal characteristics will draw strength from their ability to think logically and avoid conflict and chaos. They begin to regain trust of loved ones and form new friendships because of their innate integrity and ability to be fair. As they learn how to release obsolete expectations and motivations, they are able to act with methodical efficiency in rebuilding their lives.

Lung Qi Deficiency

Lung imbalances generally arise when the Lungs do not receive enough qi to adequately perform their functions, resulting in physical and emotional issues. The Lungs are vulnerable to damp accumulations; these can be caused by Spleen qi deficiency and internal dampness (see here) or from external pathogens causing dampness. Another common issue seen with opioid dependency recovery is heat in the lungs, or lung yin deficiency, caused by cigarette smoking.

Self-Treatment Options for Lung Qi Deficiency

Clinic formula: Restore Lung Tonic

Patent formula: xiao yao san

Acupressure points: KI 6, LU 7 and LU 9

Single herbs: elecampane, mullein, schisandra

Essential oils: any of those correlating to the Metal element, including cypress, marjoram, or thyme

Follow the suggestions for supporting the immune system

Restore Lung Tonic

This formula restores Lung function through the use of esteemed Lung tonic herbs. It is generally cooling if Lung heat is present and aids with the elimination of phlegm. For dosages, follow the recommendation of your licensed practitioner.

Chinese Name	English Name	Percentage of Formula
Kuan dong hua	Tussilago	13.9%
Xuan fu hua	Inula flower	13.5%
Sang bai pi	Mulberry bark	13.1%
Hou po	Magnolia bark	12.7%
Su zi	Perilla seed	11.6%
Dang shen	Codonopsis	8.2%
Shan yao	Dioscorea	7.9%
Wu wei zi	Schisandra	7.5%
Tian hua fen	Trichosanthes root	5.6%
Gan jiang	Ginger (dried)	4.5%
Chen pi (ju pi)	Citrus peel (mature)	1.5%

Clinical Case Study

Metal Element Imbalance

Patient: Justin T., male, 28 years old

After returning from Afghanistan with a traumatic brain injury (TBI), post-traumatic stress disorder (PTSD), and a leg injury from an improvised explosive device, Justin was prescribed opioid medications to control the pain. Following studies verifying that acupuncture is effective at treating symptoms related to TBI/PTSD, 145 the U.S. Veterans Administration (VA) began reimbursing for acupuncture treatments through veterans’ health coverage plans. 146 More recently, studies showing the effectiveness for chronic pain due to traumatic injury have garnered even further acceptance of acupuncture. 147 During a 2011 study of the VA, it was revealed that veterans are twice as likely to die from accidental opioid overdoses as nonveterans; with this revelation, the VA began cutting back on opioid prescriptions and began to recommend alternative treatments such as acupuncture. 148 Therefore, Justin was referred to me by his local VA.

Understandably, my first impression of Justin was that he seemed quite sad. He entered the office with the aid of a cane; his leg had been saved but was permanently disfigured. He briefly described the explosion, his treatments and surgeries, and the resulting symptoms. In addition to constant pain in his leg, he suffered from headaches, flashbacks, decreased cognition, and memory loss. Without looking directly at me, he reluctantly confessed to daily crying fits. The telling of his plight filled me with a sense of urgency; this young man needed quick and effective relief from not only pain but also mental suffering.

During each acupuncture session, Justin opened up to me a bit more. He described a difficult childhood with a broken home and an absentee father. Describing himself as a “weakling,” he said he was susceptible to frequent colds and suffered with childhood asthma. He had joined the military right after high school. It was a good fit for him, as he appreciated the structure of military life and had an affinity for discipline. He served for 6 years prior to the incident, and he mentioned on more than one occasion that his happiest memories were of that time. Upon returning to the States, he had felt a sense of low self-esteem when he was unable to procure regular employment. Additionally, he had not been able to form new friendships since leaving the camaraderie of the military. All of this, especially the abandonment by his father, pointed to a propensity toward Metal element imbalances.

In addition to treating points along the affected acupuncture channels related to his pain, I was also keen to focus on Lung acupuncture points during each session, because the Lung is the yin organ system associated with the Metal element. Like loss, grief, and an absentee father figure, PTSD is closely related to the Metal element, which works to reinforce personal boundaries: a traumatic attack severs the victim’s integrity of self. I combined the Lung points with auricular (ear) acupuncture points for PTSD and detoxing, scalp acupuncture for brain trauma, and the Heart source point to connect Justin with his innate joy. Luckily, Justin’s VA doctor worked with him to scale down the opioid medications over several months. This allowed us to build up a great amount of momentum through the acupuncture efforts, and Justin suffered no symptoms of withdrawal or increased pain during the transition.

The Treatment Protocol

Weeks 1 to 3

• Acupuncture: two or three times per week
• Clinic formulas for withdrawal: Quell Quease, Calm Mind formula, and Ease Detox

Week 4 to Month 5

• Acupuncture: two times per week
• Clinic formulas: Opioid Liver Balancer and Opioid Brain Tonic

Ongoing Self-Treatment

• Acupressure: two or three times per day on points KI 6, GB 41, HT 6, and LU 7 and LU 9)
• Essential oils: any of those correlating to the Metal element, including anise seed, nutmeg, or thyme
• Meditation: Five Element Meditation twice per day

Justin’s free schedule and the fact that the VA was paying for his treatment resulted in excellent compliance. He attended acupuncture sessions for 5 months until he relocated. During that time, his headaches, crying fits, and flashbacks abated, and he felt he could concentrate better. The most encouraging report was that he began volunteering most days at a youth center. He planned to move and promised to visit a community acupuncture clinic to which I referred him when he reached his new destination.