the Anywhere Clinic

Nerdnote #135: a budget herbalist's solution for sprains!

I rolled my right ankle Monday morning while hiking the Lower Jordan Fire Trail in the Berkeley hills in the misty not quite rain. I was able to limp back to the car, leaning on my partner while she commented on what a miracle it is that I managed 7 months' worth of relaxin (a hormone released in pregnancy to relax the tendons and ligaments in preparation for childbirth) without spraining anything. I have very lax ankles that have both been sprained repeatedly before I ever got pregnant.

We went home and I did a self assessment to rule out ankle fracture (the Ottawa test) and spent the rest of the day on the couch with my ankle elevated, alternating ice and heat. I put some kinesiotape on in the fan cut to prevent swelling, too, instead of the usual recommended compression bandage.

Interestingly, even though I rolled my ankle clockwise, the lateral ankle felt fine, and pain was concentrated under the inner ankle bone ("inferior and anterior to the medial malleolus" in MDSpeak, "at Kidney 6 照海 zhàohǎi and Spleen 5 商丘 shāngqiū" in terms of acupoints). I think this is because I have sprained both my ankles laterally SO MANY TIMES that the ligaments are too stretched out to properly sprain anymore. If I'm ever not able to put weight on the foot for 4 steps after I roll my ankle I'll know I actually tore something completely, but usually I stop and do some range of motion exercises and then it's (mostly) fine.

It was still tender by bedtime, but not too swollen, so I put some more tape on to stabilize the joint and added a loose ankle brace on and propped the foot up on a pillow for sleeping. So far so R.I.C.E. (rest, ice, compression, elevation), the recommended course of treatment for all my previous ankle sprains.

The next morning, Tuesday, my ankle was too painful to bear weight. It was actually more comfortable to crawl to the bathroom on my hands and knees to pee at 3 in the morning. I spent that day alternating between resting and trying to get a pair of crutches from Kaiser. I learned that I cannot request crutches or other durable medical equipment from the advice nurse hotline, or at my prenatal appointment, but my PCP can do it through a telehealth appointment, after which you have to go to the hospital cast room in Orthopedics to get fitted. (There is a home delivery service for things like breast pumps and crutches, but they didn't get around to calling me until Thursday morning, which really makes me wonder how people who live alone deal with acute injuries during COVID-19 isolation.)

I realized after talking to the advice nurse that my ankle felt better without the soft brace on, so I removed all the tape and AROM immediately improved from zero to maybe 20% of my usual dorsi/plantar flexion. I decided that I don't have to compress the ankle if it's not so visibly swollen.

Then I recalled something I had read in a Chinese book as a child, years before I began to study medicine. In the story, the narrator's sister sprained her ankle very badly; it was very swollen and bruised and her doctor recommended that she stay off the foot for at least 2 weeks. Problem was, Busted Ankle Sister had an important basketball game with her high school team in less than 2 weeks. Grandma recalled a folk remedy from her childhood: rub vinegar-soaked ginger slices over the injured area to speed healing. Busted Ankle Sis spent the next week assiduously rubbing her sprained ankle around the clock with ginger and vinegar, and was able to play the game.

I sliced up some ginger and soaked them in a little dish of distilled white vinegar (the Chinese book I'd read wasn't specific about what kind of vinegar) and commenced my experiment. I found that my ankle liked the ginger more if I heated the vinegar up for 10-15 seconds in the microwave. Of course, this week the weather has been very cold and rainy.

By Wednesday I was able to stand on both legs with the weight distributed evenly. I enlisted a friend to drive me to see my housecall patient. On Thursday I could walk slowly and without pain, using a single crutch for balance. I was driven to two more housecalls. Whenever the ankle started aching from too much walking, I would rub it some more with the pickled ginger. Today (Friday, 4 days after the injury) I've been walking around crutch-free, and am considering venturing out to answer an urgent housecall request on my ownsome.

It's hard to remember that Tuesday morning I couldn't put any weight on that ankle at all. Right now my right foot is tucked under my sleeping cat, and I'm putting weight on it to prop up my laptop so that the screen is almost high enough to be ergonomic. Last night my hands hurt more from using crutches than my ankle. My sacrum was also complaining of all the sitting I've done this week.

Ginger slices soaked in vinegar, who knew? I'm considering using this on my past injuries, to restore function. We'll see how it goes!

Today is the beginning of fall, 立秋 lìqiū by the Chinese agricultural calendar.

This is the season and the element I had the most trouble translating, even though the essence of the silent, killing season resonates in me so strongly that I started invoking her as ying in high school, years before I would learn about 容平 róng píng, acceptance and balance, reserve and poise. Contained. Flat.

It is the season when the weather is tense, and the landscape is bright.「天氣以急，地氣以明」tiān qì yǐ jí, dì qì yǐ míng (SW:2)

You're supposed to go to bed early and rise early with your chickens and make yourself calm and collected, to ease the 刑 xíng of autumn. I think 刑 is printed in my book as "punishment" but that doesn't feel like it covers the connotation of often horrific penalties exacted upon the body for convicted crimes. The first emperor of Qin who built the Great Wall by mortaring the bodies of conscripted slave laborers into his paranoia put his unified kingdom into a perpetual autumn, the way that Disney's Princess Elsa set off an endless winter in Frozen One. Autumn, 秋 qiū, the character where 'edible grains still on their stalks' 禾 hé are being set on 'fire' 火 huǒ. It is the season of judgment, of executions, of grief. It is unforgiving. The silence echoes with a respect so profound it looks like fear.

Sùwèn Chapter 70 has more to say about every season than Chapter 2. I'm reviewing just one season today, as we enter the eighteen days of earth between:

審平之紀，收而不爭，殺而無犯，
shěn píng zhī jì, shōu ér bù zhēng, shā ér wú fàn
Judgment and Equality takes without argument, and kills without transgression.

五化宣明，
wǔ huà xuān míng
Five transformations diffuse brightness.

其氣潔，其性剛，
qí qì jié, qí xìng gāng
Its aura is clean. Its nature is indomitable.

其用散落，其化堅斂，
qí yòng sàn luò, qí huà jiān liàn
Its functions are scattering and dropping. Its transformations firm and restrain.

其類金，
qí lèi jīn
Its category is metal.

其政勁肅，其候清切，
qí zhèng jìn sù, qí hòu qīng qiè
Its government is force and reverence. Its climate is clear and cutting.

其令燥，
qí lìng zào
It commands dryness.

其藏肺，肺其畏熱，其主鼻，
qí zàng fèi, fèi qí wèi rè, qì zhǔ bí
Its organ is lung; lung, which shrinks from heat, and masters the nose.

其穀稻，其果桃，其實殼，
qí gǔ dào, qí guǒ táo, qí shí ké
Its grain: rice, its fruit: peach, its part: shell.

其應秋，
qí yìng qiū
Its resonance: autumn.

其蟲介，其畜雞，
qí chóng jiè, qí chù jī
Its creatures: shelled. Its livestock: chicken.

其色白，其養皮毛，其病欬，
qí sè bái, qí yǎng pí máo, qí bìng kài
Its color: white. It nourishes skin and fur. Its disease: cough.

其味辛，其音商，
qí wèi xīn, qí yīn shāng
Its flavor: spicy. Its sound: Re (the merchant).

其物外堅，
qí wù wài jiān
Its objects have firm exteriors.

其數九。
qí shù jiǔ
Its number is nine.

Saturday July 13, 2019 7:20am

My childhood best friend had a middle school teacher who allowed his students to use curse words in class if they looked up the dictionary definitions first. I wonder if cultural literacy can be used similarly to prevent or transform appropriation, drag it back over the boundaries of offensive into the territory of appreciation. For example, is it okay for a non-Indian person like myself to practice yoga if I research the origins of the yoga I practice (and resist the consumerism of lululemon)? Would it be okay for a non-Buddhist person to have statues of buddhas in their home if they knew the name and origin of each effigy? It's the Buddha heads that are chopped off their originals that are most offensive to me; I've seen temples in China with headless gods and goddesses, and those memories jolt me when I see people with Buddha head effigies in their home intended to evoke peace, even when they are replicas. Is it enough to question people who are selling pieces of their culture about the origins of the trinkets and garments I purchase from them? If I know what it is and where it came from, does that make it less offensive if I wear or use it?

I believe if significant, continued effort is put toward cultural literacy, and if the acquisition of cultural literacy is done with cultural humility and not fetishization, then the commodification of culture can be elevated from appropriation to appreciation.

Because if someone asks about the beads you are wearing, you can become a cultural ambassador and tell them all about the culture it came from. This only works if you have enough depth of knowledge not to sound like a tourist.

Thursday July 18, 2019 11:07am

I am disturbed, not for the first time, by how my students seem to be dividing themselves along the gender binary on the topic of cultural appropriation. Thus far all the men have written generalized essays reflecting (and critiquing) the reading assignment, while only women actually gave real life examples of how they have witnessed or experienced cultural appropriation. While I'm fairly lax with the class about the specifics of each assignment so long as they participate to the full extent of their abilities, and I am aware of how delicate this topic is, I want people to think of real examples, from their personal experiences. How do I ask for that without losing the guys completely? They don't seem to understand the impact of their generalizations.

Friday, July 19, 2019 7:34am

Just because I didn't mean to doesn't mean the impact didn't happen. The example I gave in class stands, despite all excuses and absolving comments: I participated in the disenfranchisement of a woman I respect and admire, by taking over the last two clinic shifts that tied her to this school. Agh! And I was so proud when I was hired here, to think that I would be working alongside her. Secretly hoping that I would learn more from her just by osmosis, by being in proximity to her as a supervisor, because she never supervised (or taught herbs) at my school.

The fact that she was ready to leave is no excuse. I know better than anyone, having actually been in her class (yelled at memorably on the day we met, for tardiness: "We don't have enough time together as it is!"...I was never late again for her class) how passionate she is about teaching, about giving us solid clinical content that we can take into the field with us and do some good with. It's hard to imagine how much oppression had to be piled on her, how many classes taken from her and given to white teachers, how many covert and overt insults would have to come from her colleagues, her students, the deans, before she would give up.

In some ways I AM the ideal token Chinese professor, because (like Obama) I am American as well as Chinese (or black), and more able to codeswitch into whitespace. Grr.

7:47am This is why it's important to purchase herbs from the Chinese vendors in Chinatown and Wan Fung Herbs in Albany, and not online from sites like Amazon. I need to stop taking the living from my own people and paying white people instead.

Sunday, July 21, 2019 6:10am

I am privileged to have my racial, ethnic, cultural background aligned with my first language and my profession of choice. It's like being cisgendered; the body I was born into happens to be of the gender I identify. I am lucky that my body and blood are aligned with my life and loves. For those who resonate strongly with Eastern Medicine but have no lineage relating to it, and who may be perceived as appropriating, I wonder if some of their experiences are dysphoric. If trans folk have gender dysphoria, can my students have cultural dysphoria? It's very painful to watch. Even more confusing to experience, I imagine. However, power and privilege do not evaporate simply because you are trying to align your being with your heart's desire. History continues to impact the present, and needs to be acknowledged and handled with care, not wishfully disregarded and then repeated in ever more subtle ways.

Tuesday, June 4, 2019 11:21am

Today I want to write about privilege. Today I want to reflect upon a privilege I spend very little time appreciating. I refer to the fact that I am practicing Chinese medicine as a Chinese-American. I am culturally aligned with my profession of choice. For all that I appreciate how my bilingual-ness gives me an edge over everyone (Chinese or not) who struggles to learn the language as an adult, I don't spend much time thinking about how lucky I am that I happen to be a Chinese person who likes Chinese medicine (and Chinese language, Chinese culture, Chinese food, etc. etc.) I have many students and colleagues who are not so lucky. In fact, since most of my community is not Chinese, most of the best practitioners I know are white. A couple have East Asian heritage (Vietnamese-American, Thai-American). But I witness my peers' and my students' struggles with cultural identity daily, watch them interrogate the line between appreciation and appropriation, answer judgmental questions from people who do not understand this experience, judged by patients who haven't even met them yet. I witness these things happening, without the kind of compassion I have developed for my trans friends with gender dysphoria.

I am aware of my privilege as a cisgendered woman, the fact that I feel aligned with the gender assigned me at birth by the doctor at the hospital based on my genitalia. I play with my gender presentation; I've even explored using the mens' room (the lines are always way shorter, and the restroom on the floor where my doctoral classes were held were men only...sometimes when the lecture is good you don't want to waste time running up or down stairs to pee...) but I've never really wanted to be a boy or a man, for all that I've been visually mistaken for one occasionally. Especially when my hair is short. I didn't like being a girl, but I love being a woman and wouldn't trade it for manhood, or manliness, even if the process were a lot less messy and invasive. I think my true identity is closer to androgynous in the older, both-and sense of that word, as in both male and female, at once. But I have never felt not at home in the body I was born into. I don't know what that feels like. I imagine it must be hard.

So I don't know what to say. I do not understand how it feels, because I am fortunate not to have those problems. But I see it. Culture dysphoria, I call it in my head. I know it is happening, all the time. I myself occasionally have to fend off tactless questions from my own relatives about why I am teaching 'the white people' who in our Chinese xenocentrist perspective "will never really understand our medicine/language/culture as a true Chinese could". To which I respond (usually a little snarkily) with the theme of Nerdnote #50: ...Effort matters.

Some of my worst students have been Chinese. Some of my worst classmates, too. Not to say that every Chinese person lives out the PTSD of our recent history (and I say 'recent' in the context of Chinese history, as in the last 150 years) but many of them reject the jewels of my cultural heritage, as a rich person is careless of his wealth, or an athletic young person, of her health. Many of the people I respect most in this field are not Chinese. Many, many Chinese-Americans are more whitewashed by their own parents as well as mainstream culture (thank you, assimilation) than my colleagues who resonate with the medicine we practice. I know people who approach my culture with effort and humility and a nostalgia that seems carried across lifetimes.

I sometimes wonder if their souls are more Chinese than mine. I, the firstborn child of parents who can trace their heritage back centuries to third largest clan in the Hundred Families, who spends most of her waking hours steeped in Chinese and whose love of it was infectious long before she became a teacher...I wonder. And I appreciate my luck, to be so aligned.

Today is 立春, lìchūn, the Beginning of Spring by the lunar calendar. Interestingly, the Spring Festival, AKA Chinese New Year, does not begin for another 12 days. It starts on February 16 this year, and traditionally lasts 15 days.

I haven't really figured out yet how New Year is calculated in relation to the end of winter and beginning of spring.

Back to the solar term though, today we move into the 18 days during which Earth Flourishes Between Seasons 土旺四時 tǔ wàng sì shí, and then into the season proper. We are moving from the season of hibernation into the season of moderate outdoor exercise, through a transition period where digestion is dominant. Nice, that one of our biggest holidays falls right in the middle of it, the better to digest all that sticky rice cake.

According to the Sùwèn Chapter 2, in the three months of Spring it is good to

clean out/express the dusty old clutter of our lives
sleep late, rise early
stroll in the courtyard (i.e. exercise outdoors)
let the hair down
wear looser clothing
generate new ideas (like New Year's Resolutions? or just ideas in general?)
live and let live
create instead of revise
give instead of take
reward instead of punish 

This reflects the qì of Spring and is the Way to cultivating life.