In the healthy condition of man, the spiritual vital force (autocracy), the dynamis that animates the material body (organism), rules with unbounded sway, and retains all the parts of the organism in admirable, harmonious, vital operation, as regards both sensations and functions, so that our indwelling, reason-gifted mind can freely employ this living, healthy instrument for the higher purpose of our existence.
~Samuel Hahnemann

Introduction, Purpose, and Background
This topic of this article was inspired by some of the patterns that I was seeing in my own life as well as some of the experiences I have been part of while as a student in medical school. Part of this process and the spiritual energy that I was feeling led me to write an article titled "Rising Feminine Energy Revealed," which was published in a Houston-based magazine called Change in March 2010 (www.changemagazine.net, Past Issues). As a teacher of Traditional Chinese Medicine (TCM), for me writing this article created a springboard for understanding more deeply the dynamics of excessive masculine energy. That article touched upon how excessive yang can lead to personal and global conditions of disease/dis-ease, breakdowns of systems, collaboration, and community; increased conditions of crime and aggression; nonalignment with values; and an overambitious society that is overproducing, over­consuming, overdemanding, and overdeveloping in ways that are increasingly diminishing the powers of the natural, innate, simplified, and ancient ways of our ecosystems.

As an extension to that article, this one will provide a good research foundation in TCM concepts to describe the nature of excessive yang imbalances (masculine energy overexpressed) that specifically manifest through cardiovascular disease. In addition, it will discuss how to use acupuncture protocols to bring in feminine energy, balance, and life to shen (consciousness) to recreate homeostasis, which is an essential component of living whole and vital as a human being.

In TCM, the essence of life is called jing (Maciocia 2005), also known as jing-essence. It is composed of pre-heaven (inherited from parents through the blend of their sexual energies) and post-heaven (nourished by food and fluids) essence, which then create kidney-essence once a child has reached puberty (Maciocia 2005; Kaptchuk 2000). To clarify, pre-heaven essence specifically transforms into kidney-essence at puberty, and once transformed, it is affected and nourished by both pre- and post-heaven essence. Pre-heaven essence is can be nourished with right actions and good lifestyle habits, but it cannot be replenished; that is, what is given by parents is the child's lifetime amount of essence. Jing-essence can be nourished throughout the lifetime thus leading to longevity, or it can be roughed up and depleted by harmful behaviors, which can lead to a possible shortened life. Jing-essence gradually declines throughout life (i.e., aging) and when used up completely, life is extinguished (Maciocia 2005).

Kidney-essence is a primary catalyst for shen expression (Bienfield and Korngold 1991). Presented later in this article is the relationship among essence, shen, and blood, so that it is easier to understand what is going on behind the scenes when considering cardiovascular disease from a TCM perspective. At this moment, however, in considering the relationship between essence and shen, it becomes important to understand that when essence is not nourished, shen also becomes imbalanced; and when essence is nourished, shen is vital. Shen is stored in the heart, and because shen is the relationship to the mind and its vitality, it is also important to remember the relationship between the heart and the mind. When shen is nourished, the mind is nourished and vital; and when shen is depleted, disturbed, or imbalanced, then the mind is as well. Kidney-essence creates marrow, which is used to "fill the brain and spinal cord," and the brain depends on the heart for blood nourishment. The brain is responsible for intelligence, memory, concentration, and other primary functions, so the ability to cultivate the expression and communication of shen is also deeply connected to the brain (Maciocia 2005). So when cardiovascular problems arise, these relationships can help an acupuncturist and naturopathic doctor make connections among the kidney (kidney essence, pre-heaven essence), stomach and spleen (post-heaven essence), heart (shen), and the brain in understanding root causes and good treatment protocols. So it is from this foundation that this topic starts as a way to relate the formation of life to the cycles of life and the ways of rhythm and balance that sustain life.

Specifically, what will be discussed is geared more toward a specific imbalance, excessive yang (masculine qualities), which has led to some of the highest forms of health issues and crises in our American society. Excessive yang conditions can be self-induced by bad habits through lifestyle and diet, heredity, or being inwardly affected by environments that create or catalyze highly masculine behaviors, thus instilling a cycle of accepted behaviors that perpetuate. According to the Centers for Disease Control and Prevention, the leading cause of death in the US in 2009 was cardiovascular disease. These are the statistics reported overall, with the causes of death in 2009 listed from highest to lowest, the figures indicating how many people died due to each cause:
•   heart disease: 631,636
•   cancer: 559,888
•   stroke (cerebrovascular diseases): 137,119
•   chronic lower respiratory diseases: 124,583
•   accidents (unintentional injuries): 121,599
•   diabetes: 72,449
•   Alzheimer's disease: 72,432
•   influenza and pneumonia: 56,326
•   nephritis, nephrotic syndrome, and nephrosis: 45,344
•   septicemia: 34,234

The nature of American society has been one of ambition, driven toward success and the best, and we as a country are typically symbolized as the "world's powerhouse." Given that these stereotypes (whether true or not) are prevalent in our society as the standard to live up to, it is a condition of health in naturopathic medicine that is worthy of deeper evaluations for caring of patients and the philosophy by which medicine is applied.

Often when a patient is presenting, the most defining symptoms to a diagnosis will be the ones that are seen and felt. This is often the foundation in the nature of TCM evaluations. In Westernized medicine, this is also combined often with laboratory tests or exploratory surgery/tests to look more distinctly at levels of fluids in the body and at inner conditions of the body to make a diagnosis. These evaluations are important because they help show what the picture of health is or the pathological condition of a patient, but it is the inner listening and understanding that will reveal the root cause(s) of these conditions. Often, if a list of the most commonly treated pathologies in American society is reviewed, a deeper look will reveal the true nature of disease/dis-ease in TCM (i.e., whether it is more yin or yang based). For this particular article, the nature of disease regarding excess yang conditions, more specifically cardiovascular problems and shen disturbances, will be evaluated more deeply along with the application of acupuncture and vitalistic (authentic naturopathic) medicine with the TCM perspective of healing, natural balance, and holism.

How Feminine (Yin) and Masculine (Yang) Energy is Expressed in Health
To begin to understand the nature of disease/dis-ease from both TCM and Western perspectives, it is necessary to understand the essence that creates life, how human beings experience their vital force, (i.e., life energy), and how challenges to vital force affect the innate ability to experience health. This understanding is represented by the continuum of health and disease/dis-ease as pictured below. This picture shows a foundation of how depletion and excess build and their relationship to homeostasis and jing (essence).

Depletion------------------- Health------------ Excess
(disease, yin imbalance) (homeostasis)    (disease, yang imbalance)
(jing lowering)              (jing longevity)  (jing lowering)

Often an imbalance of yang is letting a naturopathic doctor or acupuncturist know the messages (sign/symptoms) that are presenting but rooting from an inner yin condition. When yin and yang are balanced, there is a flow of receptive and expressive energy, good communication between yin and yang organs and tissues of the body, and the interrelationship is balance and moving continuously. When yang is in excess, its masculine energy is overriding or diminishing the presence of yin energy. Symptoms of yang excess include tightness, buildup, inflammation, and heat.

Blood is yin in nature and the movement of blood is yang in nature, so if there is obstruction in its flow, this would be a blockage in yang or buildup in yang energy (i.e., clogging or hardening of arteries, etc.). In relationship to shen, blood is also its "material" foundation, which means that it "houses and anchors" the vitality of the mind (Maciocia 2005). Since blood is also transformed from "kidney-essence," or jing, this also provides the relationship to jing and moisture in the body. Blood is originally birthed from the blend of pre-heaven qi that is created in the kidneys and post-heaven qi from the stomach and spleen, so when blood disorders arise to manifest cardiovascular conditions, it is very helpful to look to these sources when creating acupuncture protocols for inspiring vital force, strengthening of jing/shen, and homeostasis (Maciocia 2005). Psychologically, the vitality of blood is also meaningful. Blood in TCM is representative of "effortless acknowledgment of accomplishment," where an insufficiency of blood can indicate "poor self-esteem, lack of a sense of self-worth, or poor memory" or physical conditions of heart palpitations, shyness, and insomnia (Kaptchuk 2000). When blood is not moving with good flow (i.e., it "congeals"), the effortless of smooth flow is diminishes and thus blood builds up and "accumulates in a manner that is contradictory and opposite to its nature," which manifests in physical conditions of sharp and stabbing pains, presentation of tumors and cysts, or a swelling of internal organs (Kaptchuk 2000). Psychologically, this condition manifests as feeling threatened, increased vigilance, skepticism and suspiciousness, and issues associated with paranoia (Kaptchuk 2000). As we look at these relationships, it becomes important to understand where the excess in yang energy shifting the homeostasis balance of buildup and excess can lead to physical, emotional, mental, and spiritual imbalances in the heart.

How Masculine Energy is Expressed in Excess and Related Pathologies
Out of the Five Elements, those that are most prone to yang excess are the Fire and Wood elements, because their nature is mostly yang orientation. The organs that represent these two elements are heart, small intestine, pericardium, triple warmer, gallbladder, and liver. The yang organs are small intestine, triple warmer, and gallbladder, while the yin organs are the heart, pericardium, and liver (Kaptchuk 2000). The focus, however, is on the manifestation and excessiveness of yang conditions which can affect either yin or yang organs.

Why would a patient who has mostly Fire and Wood qualities in his personality or constitution be more prone to yang imbalances, and what does this mean exactly? A Fire personality is mostly a charismatic and "life of the party" individual, and is often warm and extroverted (Beinfield and Korngold 1991). There is much warmth and "fire" energy to these people and, due to this, they are more prone to overexertion and high-energy lifestyles. These patients can be inclined to anxiety, irritation, inflammation, and shen imbalances. Those patients who exhibit more Wood element characteristics are known to be more ambitious, adventurous, pioneering, and pushing the limits of convention (Bienfield and Korngold 1991). They are more "Type A" individuals and are known more for the push and force action of yang energy rather than the listening and receptivity of yin energy. They are the natural leaders and are driven toward perfectionism and high extremes when in excess. These patients present with more buildup and tightness as a general rule, and stress is usually high in their lives. Pathologies with these individuals can be related to hypertension, liver-fire aggression and anger emotions, and buildup of toxicity. Often as well, there is buildup of muscle tension and tightness along with tension headaches. Foremost, when we are looking at the yang excesses with these two elements, there is a good possibility that the heart is involved physically or spiritually. This is because both of these elements are driven by consciousness, newness, and expansion. Due to the nature of these elements' more outward drive and expression, there is more likelihood toward imbalances of excess without full consideration of inner resources, as shown below. While other conditions can manifest as well, for this focused topic, the heart is the concentration both through the prevention of cardiovascular disease and shen imbalances.

Fire Yang Excess (cited directly from Beinfield and Korngold 1991)
•   Pathologies: Heart arrhythmias; heart cramps; heart enlargement due to excessive stress; profuse/frequent perspiration; flushed face; chest pain; painful urination; strong/erratic pulse; overheats easily; sores of the mouth, tongue, and lips; pulmonary hypertension; dry and painful eczema; easy sexual excitement but difficult to please; disturbed sleep; speech and sensation disorders; vascular disorders
•   Qualities: anxiety, confusion, overloaded, hyperactive, nervous, difficulty focusing attention, disjointed thoughts, senseless babbling, homelessness of spirit, inability to discern self from other (i.e., continuous merging)
•   Personality: light-filled, charmer, salesperson, demanding, burns until the fuel is gone, creating exhaustion, excitable, garrulous, seductive, grandiose, "Pollyanna," hypersensitive, sentimental, merging, adoring, avid, anxious
•   Needs for Harmonious Heart: peacefulness and spirit, tranquility of mind, balance of Shen

Wood Yang Excess (Beinfield and Korngold 1991):
•   Pathologies: high blood pressure; oily skin and hair; boils; cramps of the long muscles, hands, and feet; vertigo; ringing in the ears; constipation with cramps and spasms; sciatica; pain in the ribs; heartburn; difficulty swallowing; eye/ear pain; shingles; awkward and accident prone; hard and thick nails; breast pain; tendon injuries; occipital/lateral headaches; migraines; TMJ syndrome; facial neuralgias; peripheral nerve dysfunction; sexual dysfunction; painful menses; PMS; substance abuse
•   Qualities: excess tension and pressure producing hyperactivity, heat, spasm, and volatility; overwork/overdrive, lack of proper nutrition, and prolonged emotional intensity will deplete the blood and moisture of the body
•   Personality: arrogant, aggressive, reckless, driven, antagonistic, tyrannical, confrontational, com­pulsive, impulsive
•   Needs for Harmonious Liver & Heart: relieving pressure, dispelling heat, relaxing spasms, replenishing blood and moisture, restoring flow of qi

Awakening Feminine Energy and Feminine Based Protocols For Balance and Health
Because excess yang conditions are a depletion of yin, it is necessary to tune in and tonify the yin energy as a way to reestablish the balance and optimal flow of yang, which also helps to balance both the inner and outer factors that lead to disease/dis-ease. Often when listening to someone with a yang imbalance, you might be able to pick out the areas where there could be excess or buildup, whether in the muscles, arteries, or emotions. It is possible to identify those key symptoms and make acupuncture protocols for a patient simply based on the external presentation. However, in aligning with the authentic nature of TCM and naturopathic philosophies of medicine, it is important to look further and listen more to the patient to identify what is causing the yang/external condition that you can see. The listening that comes from the practitioner as well as the evaluative process will also give the patient the opportunity to reveal what could be hidden behind the force of the outer expression. Listening in itself is also a source of trust, not only in the patient/practitioner relationship, but also in the ancient way of medicine which is to believe in the innate abilities of the body and spirit to heal itself. If the listening is stopped or blocked, part of the picture could be missing which could be significant in making an accurate diagnosis and authentic treatment plan in relationship to the patient.

The purpose of realigning the excess conditions of yang is to essentially bring energy back into the source (yin) for revitalization. In the cases presented below, the focus is on Fire and Wood yang excesses which are manifesting in heart and shen conditions which are then affecting the emotions, moisture, mind, and relationship to life. As doctors, we may find it easy to look at a person as a subset of symptoms and pathologies, yet it is important here to consider the entire picture, the nature of the person involved, and what represents the individualized sense and feeling of balance, consciousness, and vitality. So, the cases themselves represent a culmination of what I have learned from personal and educational study in TCM as a massage and medical student. The cases have been originally created and evaluated based on external and class resources, and the best effort has been given to present acupuncture treatment plans that would align well with the case presentations.

In the efforts to balance out the masculine energies that create excess yang conditions which thus cause health imbalances and depletion of jing and vital force, acupuncture can be used to settle the buildup of yang and reestablish the stability and life of shen. Because acupuncture is one of the many modalities of authentic naturopathic medicine, an extended focus with these patients can also include looking at diet, environmental stressors, and preventive mechanisms and tools to help sustain vitality and commitment. The following protocols include two examples of excess yang conditions wherein acupuncture (or acupressure) would be appropriate. The protocols include a brief patient presentation and acupuncture points chosen to help alleviate and balance the symptoms while addressing underlying root issues.

Case #1: Excess Fire Yang
•   Patient Presentation: For the last two weeks, a 40-year-old extroverted woman has been experiencing regular bouts of heart palpitations; has been profusely sweating (not at night, most noted when stressed); her face is flushed; her speech is jittery, jovial, and active; and she has been experiencing stress levels at 5–6 out of 10 due to some tension and anxiety at work with meeting deadlines and having difficulty managing her team of workers to get anything done. She worries that she might be pushing her team too hard and is trying to make everything work, but overall feels exhausted and is having difficulty sleeping at night. While alert, she appears a little flustered as she is asked questions to pinpoint some of the root causes, and has trouble focusing in speaking to share a clear line of thought. She has come to your office for acupuncture to feel more relaxed and focused and learn ways to reduce stress in her life.
•   Patient Needs: Calming of shen to calm the heart and speech, relaxation of the mind to focus, balance of fluids and sleep patterns, reducing stress
•   Acupuncture Protocol and Treatment Plan:

Acupuncture Points (Liangyue et al. 1999)
   •   HT 3 (absentmindedness, calms the spirit)
   •   HT 5 (heart palpitations, aphasia with stiffness of tongue, anxiety)
   •   HT 7 (heart palpitations, insomnia)
   •   SP 1 (calms shen)
   •   ST 40 (insomnia)
   •   ST 9 (speech impediment)
   •   ST 12 (calms shen)
   •   ST 36 (fatigue)
   •   ST 40 (headache [HA], insomnia)
   •   ST 45 (disturbed sleep, mental confusion)
   •   KI 1 (calms the spirit)
   •   KI 3 (exhaustion, fatigue, insomnia)
   •   KI 6 (palpitations caused by stress, insomnia, chronic fatigue, calms the spirit)
   •   K7 (spontaneous sweating)
   •   UB 14 (heart palpitations, back shu for PC)
   •   UB 15 (heart palpitations)
   •   UB 17 (influential point for the blood – blood is material foundation of shen)
   •   UB 20 (fatigue)
   •   UB 44 (shen calmer, heart palpitations)
   •   UB 49 (obsessive worry, anxiety, psychoemotional manifestations of the spleen)
   •   UB 62 (insomnia)
   •   UB 64 (foggy thought due to chronic fatigue)
   •   ST 9 (speech impediment)
   •   SP 6 (insomnia, nervous issues)
   •   SP 2 (mental fatigue, poor concentration)
   •   DU 4 (mental and physical exhaustion)
   •   DU 14 (clears heat, invigorates yang, calms shen)
   •   DU 20 (lifts yang, clears heat in yang channels, calms shen, clears the senses)
   •   PC 3 (heart palpitations, opens heart qi, drains heat from heart)
   •   PC 4 (heart palpitations, insomnia)
   •   PC 5 (heart palpitations)
   •   PC 6 (heart palpitations, anxiety, insomnia)
   •   PC 7 (heart palpitations, insomnia)
   •   LV 3 (insomnia)
   •   GB 12 (insomnia)

Case #2: Excess Wood Yang
•   Patient Presentation: A 35-year-old intelligent and self-aware man with a large athletic build has come to your office to work on anger management. He tells you that he has had regular rages/arguments with his former wife lately about custody of their two young children, and he has gotten angry enough that he has felt sudden urges to hit her while arguing even though he knows that it's not the right thing to do. He has been experiencing strong migraines and tension headaches because the pressure is starting to affect his effectiveness at his job and his boss has given him a written warning to get his act together. Normally, he is an ambitious and adventurous man and a natural leader; now he has been feeling more confrontational as well as noticing more aggressiveness and recklessness to his behavior, and he has started drinking to escape the stress of it all. Knowing, however, that he is going down a path that could get worse and he cares very much about being a good father to his children, he has come to your office to help manage his anger and reduce his stress and headaches so that he can focus and feel more compassion in his life as he works through his challenges. His MD has told him that he has high blood pressure and will need to go on medication if he has not improved by his next visit. Since he wants to try some natural remedies first, he has come to you for acupuncture to see if it would be effective.
•   Patient Needs: Reducing cardiovascular pressure creating headaches and high blood pressure (nourishing blood through toning spleen and kidneys); relaxing and calming shen and qi (liver is responsible for qi movement); reducing anger emotions and aggression; educating on stress management, meditation, and coping mechanisms
•   Acupuncture Protocol and Treatment Plan:

Acupressure/Acupuncture Points (Liangyue et al. 1999)
   •   LU 7 (migraines HA, HA)
   •   LU 9 (influential point of blood vessels)
   •   SJ 5 (migraine HA, moves stagnant qi)
   •   SP 1 (calms shen)
   •   ST 8 (HA and migraines)
   •   ST 9 (high blood pressure)
   •   ST 12 (calms shen)
   •   KI 1 (calms the spirit)
   •   UB 17 (influential point of blood)
   •   UB 18 (back shu point of the liver)
   •   UB 44 (shen calmer)
   •   UB 47 (psychoemotional manifestations of the liver)
   •   DU 14 (clears heat, invigorates yang, calms shen)
   •   LV2 (draining liver fire, extreme liver HA, angry outbursts)
   •   LV3 (draining liver fire, HA, hypertension)
   •   LV 5 (helps to circulate liver qi)
   •   LV8 (liver blood headache)
   •   GB 44 (migraine HA)
   •   GB 20 (strong pt for HA)
   •   GB 8 (migraine HA)
   •   GB 19 (migraine HA, the Chinese general point)
   •   GB 12 (HA)
   •   GB 43 (HA)
   •   GB 41 (HA)
   •   GB 1 (HA)
Note: There are many points for HA, and focus will be given to the points that most attribute to this patient's current condition.
•   Treatment Plan: The plan will start out with a series of 3 visits within 2 weeks to work with the acute symptoms, with follow-up at the end of the visits to assess improvement and create a new plan as needed. All of the acupuncture points mentioned here are possible points to be used, and each session will be designed to include points that meet the chief complaint for the visit as well as appropriate comfort for the session (i.e., some points are more on the back and some primarily on the front of the body, so discernment will be used to create individualized protocols to meet patient needs). For each session, a series of 5 to 10 acupuncture points will be chosen to focus on the chief complaint and work with the energy of the body without excess agitation. The first session will start with the chief complaint to reduce anger, his migraine and tension headaches, and hypertension, while increasing and calming his shen and spirit. Subsequent visits will begin with a follow-up intake to receive any feedback and updates to make adjustments to protocol. Complementary therapies to acupuncture may include shiatsu to tonify movement of energy in the meridians and health of the body.
•   Patient Education: Patient will be educated about the purpose and process of acupuncture so that he knows what type of therapy he is receiving, how to "receive" acupuncture, and what it feels like to be pricked by an acupuncture needle. Attention will also be given to receive feedback on sensitive points to know when a point is not appropriate or tolerated. After the session is complete, the patient will be educated on realistic practices to better stress/anger management, work–life balance, diet, meditation, sleep patterns, creating a support network, and possible alternatives to alcohol consumption. Patient will be asked to begin one "freedom" activity a day (regardless of time commitment) that reduces stress and is enjoyable. On follow-up visit, patient will be evaluated on blood pressure and asked about the quality of migraines and stress headaches, quality of interactions with family and coworkers, stress levels, and the degree of aggression he still feels. If the patient has time, he will be requested to begin a diet diary to look at possible food factors that could be leading to his condition and if further nutrition education or counseling referral is needed.

Closing
This article is a proposal of relationships among essential foundations in TCM and manifestation of disease/dis-ease, that being the relationship between cardiovascular disease and the expression of shen (consciousness), circulatory health, and yang imbalances (heat, buildup, inflammation). Relationships are vitally important in TCM because of its inherent foundation in natural law, or the relationship between humanity and its environment and nature's rhythms (Haas 2003; Kaptchuk 2000). The essential aspects of TCM are always asking us to listen and, in this case, to listen to the balance that yin (feminine) energy can bring to correcting the shift from homeostasis that is produced from yang excesses (excessive masculine energy). One of the most important aspects of being a good health practitioner is the ability to listen, a feminine/yin trait itself. When we forget to listen, a health crisis often becomes bigger than it needs to because we missed or ignored the signs along the way. This article is shared with the invitation to listen and to understand these important relationships which can help doctors and patients understand their health better and promote health education and preventive care. May this be a welcome breakthrough of the heart to the greatness of our field of naturopathic medicine, as well as all those who support our profession and the vitality that natural health and its tools bring.

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Jennifer Coomes, BA, LMT, RYT, a vital lover of the art, heart, and science of naturopathic medicine, has been a student of Traditional Chinese Medicine (TCM) for over 10 years. She teaches classes in the philosophy and applications of TCM for massage students and therapists as well as the general public. It is with great honor to the path of her own healing as well as promoting the healing within others, especially in the heart, that she brings consciousness to new ways of understanding personal and environmental health to preserve our innateness and the Earth.