Dialogue: Inflammation and the Triple Burner

Efrem Korngold, OMD, and Stephen Cowan, MD

Inflammation is a normal aspect of the adaptive response of the organism to challenge, essential to survival. But there has been an epidemic of inflammatory disorders in our era, particularly since World War II. From our perspective of Chinese medicine, the accelerated pace of modern life creates a condition of excess Heat. In Western terms, this is a result of sympathetic overdrive—too much cortisol and adrenalin—that sets the stage for inflammation.

Chinese medicine approaches to treating inflammatory problems emphasize restoring the inner terrain, supporting host resilience, and countering adverse environmental influences, termed Pathogenic Qi. The Triple Burner, one of the primary theoretical models in Chinese traditional medicine, is an elegant, holistic construct for understanding terrain, resilience and adaptation to stress. It not only provides a map of the territory in which inflammation takes root, but an integrated approach to treatment.

THE TRIPLE BURNER

Efrem Korngold, OMD:

We both see pediatric patients, and over the course of our collaboration in the past twenty years, we have formulated a developmental perspective for understanding inflammation, based on the Triple Burner model. The Triple Burner (the San Jiao) emerges as the central mechanism that organizes and guides growth and development. In this model, the Lower Burner (Jing) corresponds to the Kidney network, which governs the most essential functions of life. The Jing is our material root, our inherited source of vitality, and our primal capacity for making a life and a future. It is the soil from which we grow ourselves. The Middle Burner (Qi) corresponds to the Spleen, which encompasses all digestive, assimilative, and absorptive functions. The Upper Burner corresponds to the Heart/Mind (Shen) or consciousness of the individual.

Stephen Cowan, MD:

Recent advances in contemporary medical theory and research have given credence to a psycho-neuro-gastro-immunological perspective—replacing the view that the “immune system” is a discreet, isolated entity. This new conceptualization of immunity comes closer to the holistic model articulated in the classical literature of Chinese medicine. All too often allopathic medicine has oversimplified the concept of immune function, neatly compartmentalizing it as an independent system. In pediatrics, we have known for some time that 80% of immune activity is located in the gut. This “neuro-gastro-immune system” details a more comprehensive paradigm for understanding the mutual communication and coordination of biologic information processing, and this fits nicely into the Triple Burner model.

The Triple Burner also directs the integration, communication, and coordination of the five organ systems or networks of the body (Kidney, Liver, Heart, Spleen and Lung). As a “developmental organ,” it is responsible for managing our defensive (wei qi) and nutritive (ying qi) functions. Qi is ultimately the vital force or power that creates and sustains all life. Each of the three Burners has both immune and nutritional functions essential to coordinating healthy integration of growth and development whether we are well or ill. Metabolism and immunity can be thought of as two sides of the same coin, a Yin-Yang relationship, focused on maintaining a coherent conversation between the organ systems and the external environment.

Efrem has coined the term “euflammation” to describe the normal metabolic heat of the organism. Whenever the balancing, homeodynamic process in the body (the conversation) is overtaxed, the Triple Burner will facilitate greater communication by up-regulating metabolism to raise the temperature of the inner terrain. This is the genesis of a shift towards inflammation. Young children especially are in a highly active phase of growth and consequently, they are more naturally prone to acute inflammatory reactions and high fevers. Fever is a signal – it tells us that the Triple Burner is rallying the wei qi (our innate immune cells). Yet all too often, there is a tendency to suppress this totally normal adaptive response to stress. This can have significant long-term effects on an individual’s resilience. Indeed, several studies have shown that overuse of antipyretics will often prolong infections.

In simple terms, we can think of the Lower Burner as our root, our inherited ability to maintain healthy biorhythms (breathing, sleeping, digesting, eliminating, recycling). Too little attention paid to these basic rhythms (stress during pregnancy, too little sleep, too little time to eat or to think or to play) set the stage for chronic inflammation, what we refer to as “Hyperflammation.” The euflammatory state exists on a continuum of metabolic heat production, and it is only when things are pushed too far that we find the organism losing its balance.

The Middle Burner is responsible for facilitating the processing and digesting of food and information, received and incorporating it into our body-mind. Food is broken down, sorted, and becomes part of our physical self, energizing our mental and emotional experience. In this sense, education is also a process of digestion. The four most common causes of imbalance in the Middle Burner are improper eating, mental overstimulation, emotional overexcitement, and improper timing of vaccinations. When these imbalances overburden the Middle Burner, we begin to see congestion (stagnation of Qi and Blood) in the form of Phlegm, alterations of circulation (hot head and trunk and cold limbs), and a general increase in metabolic heat.

Efrem:

The concept of Phlegm is important in understanding how pathology is conceptualized in Chinese medicine. This term connotes a general distortion of the quality, viscosity and distribution of body secretions that can interfere with circulation, breathing, and cognition. When Phlegm and Heat accumulate in the Middle Burner, they are said to transform into a fog-like mist that rises upward, obstructing the organs of perception (eyes, ears, nose, mouth, tongue). The term for this is “Phlegm Heat misting the Mind.” In other words, the congestion of Qi, Blood and Fluids in the head impairs the ability to see, hear and think clearly, to learn, or make intelligent choices. Developmental disorders such as ADHD and ASD may be understood as chronic inflammatory processes that extend to the Upper Burner.

Steve:

The role of the Upper Burner is to take in information from our environment through our senses and to expand our awareness, our consciousness. The Upper Burner governs our desires and aversions, our curiosity and the intellectual and spiritual facets of our nature. In young children–and this is an extremely important point—the Upper Burner is the last of the three to fully mature. Consequently, children tend to be more vulnerable to overstimulation and are more easily overwhelmed.

SYMPATHETIC OVERDRIVE

Steve:

The distractions of modern life perpetually overstimulate us all. In our digital society, 90% of us live in urban areas, disconnected from the natural environment. Everything is too much, too fast: energy-rich, nutrient-poor food, food additives, vaccinations, polluted air and water, pesticides, artificial light, artificial heat, TV, video games, smart phones, and wi-fi magnetic field pollution are just a few examples. The Middle Burner can no longer moderate the conversation between outside and inside, between Upper Burner (cognitive/sensory) and Lower (genetic, biorhythmic) functions. Many of the chronic clinical inflammatory disorders we see today develop when the Middle Burner is caught in the crossfire.

From a Western medical perspective we can say that there is an imbalance between the sympathetic and parasympathetic nervous systems that leads to a state of chronic inflammation. Allergies are a clear example of this phenomenon. Like a false alarm, the allergic response is essentially an over-reaction to a perceived threat or invasion, when in fact there is none. Teaching the body to down-regulate this reaction pattern requires that we look first at what’s going on between the three Burners.

Efrem:

This type of meltdown gives rise to an array of conditions in our children such as indigestion, allergies, obesity, juvenile diabetes, and casein-glutenophobia, leading to other inflammatory disorders such as chronic asthma and eczema. Even neurological conditions such as ADD/ADHD and ASD may be associated with inflammatory changes in the CNS, also due to systemic inflammation. Similarly, in adults, systemic inflammation is contributing to the modern epidemics of metabolic syndrome, diabetes, IBS, IBD, hypertension, atherosclerosis, cardiovascular disease, and dementia. The individual is essentially overheating to such an extent that the body’s normal ability to “quench the fire” is disabled.

Many hyperinflammatory disorders are the result of a failure to process (absorb and incorporate) information that not only is contained in the food a child (or an adult) eats, but is embedded in her physical environment and social milieu. In children especially, these phenomena almost always arise from one fundamental problem: the Middle Burner functions are being caught in the crossfire. To optimally foster a child’s growth and healthy development, we need to enrich the soil of the inner terrain (Blood and Essence), manage the social environment (the family and community), slow down the rhythms of daily life, and reduce sympathetic overdrive.

These same principles are applicable to the treatment of adults who are suffering from stress-induced inflammatory disorders (adrenal overstimulation) and exhaustion due to diminishing reserves (adrenal fatigue). Consequently, one of the goals of treatment is to support the Triple Burner in order to restore equilibrium—the innate capacity to adequately regulate normal, adaptive, integrated responses to challenges.

In terms of development, it is the Middle Burner, the gut (the network of Stomach and Spleen) that is the primary source of nourishment for the young child, not the Upper Burner (the Shen/Mind). Too much emphasis by parents, educators, and politicians is placed on achieving levels of cognitive performance that are really beyond a child’s developmental stage and capacity. This also means allowing each child to mature at his or her own pace since every child is different and follows a unique developmental path. Close observation is necessary to determine the genuine nature (type) of the child (li) according to the Five Phase Model of Chinese medicine that Steve and I have describe in depth in our books (see Resources).

In every case, I pose this question: What are the conditions that will be optimum, not only for growth and development, but also for that particular individual to learn to cope with physical and psychological challenges and change?

THE VAGUS NEURAL NETWORK

Steve:

I want to introduce the idea of the vagus nerve as the governor of the inflammatory process and a functional component of the Triple Burner. When we talk about nutrition, for example, it’s not just what we eat, it’s also where we eat, how we eat, and when we eat, that bring about a kind of natural, healthy vagal tone. The vagus nerve is an amazing network that has the capacity to up regulate and down regulate our immune system by directly interfacing with macrophages and other immune cell lines. Like the Triple Burner, the vagus neural network modulates and promotes all the functions and processes of healthy digestion. We have the opportunity to directly influence vagal tone from the moment a child is born. Yet working with infants, I often observe that caregivers have a tendency to shove a bottle into a baby’s mouth as soon as she cries. Feeding becomes a kind of emergency intervention, and there is no time to activate proper vagal responses: saliva production, peristalsis, gastric acid production, and pancreatic digestive enzymes to prepare the Middle Burner to receive food. Consequently, many inflammatory problems begin here. It’s no accident that we see an epidemic rise in the treatment of infants with Zantac and Previcid for reflux in recent years, not to mention the rise in childhood obesity, now seen as early as six months of age.

The quality of food directly influences immune competence and resilience. Unlike over-processed foods, fresh, organically grown food contains a rich, array of phytochemicals that improve our capacity to mitigate the harmful effects of stress. I believe children may be prone to chronic ear infections in part because of the harm caused by industrially processed foods (particularly dairy) that cause excessive accumulation of Phlegm and subsequent Heat. One of the first steps in treating children with chronic ear infections is to look at their diet, environment, and lifestyle and remove those factors that are overloading the Middle Burner. Often this is all it takes to clear conditions such as Otis media and get the child back on track. Herbs and acupuncture provide additional interventions that can gently and effectively activate the parasympathetic vagus network to counterbalance sympathetic overdrive.

CLINICAL STRATEGIES

Efrem:

Over the past two millennia, Chinese medicine has developed as a vast repository of knowledge that embraces numerous paradigms, many of which merge and overlap and some that are even mutually contradictory. All pay homage to the overarching concepts of Yin Yang and Wu Xing (the Five Phases). When integrated together into one coherent paradigm, they provide a dynamic representation of how life works. Western science and medicine, beginning with the ancient Greeks, has always sought the one theory, a conceptual model that will wholly explain everything we know about the world and completely resolve all contradictions. Conceptualizing how the body works from an exclusive, internally consistent theory inevitably leads us to seek the one silver bullet that will cure each specific disease. In contrast, throughout Chinese history, doctors have chosen from among diverse models the ones that are most appropriate for solving the particular health problem at hand. Today, there is a well -developed movement within the professional medical community in China to integrate Eastern and Western models of care whenever possible. Chinese patients, quite often, will select traditional or modern medicine, or both, depending on how they perceive and understand their own condition.

Modulating the Terrain: A Case of Cellulitis

Efrem:

Cellulitis is an inflammation under the skin involving the lymphatic tissue and the small vessels, causing massive edema, heat, and pain. It can be caused by trauma or infection, and when it is the result of bacterial infection such as strep, staph, or particularly MRSA (Methicillin-resistant Staphylococcus aureus), it can be quite serious.

One of the most extreme examples of inflammation I’ve seen was the case of a woman who suffered from chronic recurring cellulitis in both legs. This woman had been treated with several series of antibiotics that would temporarily resolve the problem. The condition continued to recur, an indication that she was dealing with a stubborn, entrenched inflammatory process. Over several months, treating her with acupuncture and herbal medicine to clear Heat, dispel Toxins, and to strengthen her Liver and Spleen, the condition gradually resolved and did not return.

If we use the analogy of a forest fire that continues to burn in spite of heroic efforts to suppress it, similarly, a recurring inflammatory process that resists resolution requires that we first alter the environment, the terrain that is allowing the fire to rage on and the inflammation to fester. This approach underscores the importance of supporting and modulating normal physiological processes in order to restore the patient’s body to a condition in which his or her innate homeodynamic mechanisms are able to re-assert themselves.

Herbs and Acupuncture:

In treating less severe cases, the usual approach is to counter toxicity with herbs that enable the body to clear Heat (inflammation), neutralize Toxins, and discharge them from the body. At the same time, we remember to support healthy Qi (the terrain) by using herbs or medicines that nourish the Blood and activate the circulation of blood and body fluids. These tonic herbs provide nourishment, activate digestion, and improve absorption of nutrients, having the restorative properties of both food and medicine.

Terrain and Type

Efrem:

To effectively address inflammation, we need to determine what is out of balance that is allowing this problem to emerge. Everything is important to note: how a person lives, where she lives, how she thinks, what she feels, how she spends her days at school or at work, how she sleeps, what she eats, when she eats, how she eats, who she eats with—these different spheres that an individual inhabits reveal her nature, how she relates to herself and her world, her way or pattern of being.

We tend to pigeonhole hole these patterns as someone’s “lifestyle,” but it can be something deeper. The patterns are reflections of that person’s temperament on the subtlest level. When considering the health concerns of the patient, whether they are as simple as a headache, as stubborn as chronic eczema, or as frightening as cancer, if we can understand the pattern of our patients’ development and the way they approach the world, we can maximize the beneficial results of whatever treatments they are receiving. For example, two people with colitis may respond in completely different ways to the same dietary changes, so we must consider their developmental patterns and constitutional makeup, what we call their type.

Essentially what we are attempting to achieve is a harmonic “conversation,” a coherent and coordinated dialogue within and between the Three Burners and the Organ Networks (Kidney, Liver, Heart, Spleen and Lung) that execute all of the body’s functions. These domains of process integrate the metabolic transformations necessary to foster, empower, and preserve the life of the person. We call this supporting a person’s bodily life (xing), affirming her true nature (li) and empowering the fulfillment of her mission or purpose—her destiny (ming).

Treating to Type: ADHD

Steve:

In the Five Phase model, treatment is predicated on the characteristics of temperament or adaptive style that reflect the essential nature of the patient, as well as their symptoms. A patient who is described as a “Fire Child” (one of five basic temperaments or types) typically has a metabolism that tends to burn too hot, making him predisposed to dramatic bouts of inflammation. We monitor these patients for mood swings, excessive sweating and blood sugar instability, which are common complaints in Fire Children who are becoming imbalanced. We would want to address this to reduce the tendency towards production of excessive metabolic heat without suppressing the innate regulating response: i.e. we do not want to suppress physiologic function, but rather support the body’s ability to accomplish tasks more effectively and to maintain homeostatic equilibrium. In addition we would want to recommend counter balances to these tendencies by asking his parents to encourage more water intake, increase sleep time, reduce overstimulation, and eliminate excess carbohydrates and sugars.

A troubled young man who first came to my practice when he was thirteen years old, at the peak of hormonal changes, was a quintessential “Fire Child.” His impulse control was getting worse rather than better as he got older, he was doing poorly in school, and he complained that everything bored him. He’d been diagnosed with ADHD and placed on a stimulant medication, but the drugs were no longer helping. At this point he could not retain anything he learned in school and began having panic attacks.

Fortunately he was able to relax during our visits. (He called them his “cool out” sessions.) During acupuncture I introduced him to some breathing exercises, coupled with a visualization in which he imagined that he was sitting at the bottom of the sea. Taking gentle Chinese herbs and a few key supplements (omega-3 fish oils, magnesium glycinate, and 5-HTP) dramatically reduced his impulsivity. Today he is doing well in his first year of college and thinking about becoming an acupuncturist.

The approach I use in pediatric treatment includes giving a child herbal formulas that support his own individual nature (type) and at the same time bolster the Middle Burner (the Spleen and Stomach), vital to healthy development. I use a line of herbal formulas from Kan Herb Company called Peacemakers for this approach to promote adaptogenic balance (See Resources for additional information). I also use acupuncture to treat the specific characteristics of the problem, remaining mindful of the fact that inflammation has its own developmental path. My selection of herbs and acupuncture points will be based on the child’s response to treatment and the progression of his condition.

Utilizing Traditional Remedies: Severe Infant Eczema

Efrem:

In addition to the sophisticated paradigms of Chinese medicine, there are traditional folk remedies that have been passed down over the millennia, some of which are highly effective.

This case involves an 18-month old boy who had suffered from severe eczema since birth. Eczema can be due to any number of factors, including genetic predispositions passed on by parents who had allergies or eczema during childhood or congenital events that occur during fetal development. This was a classic case of infant eczema that covered his entire body and face. I treated him using a traditional Chinese folk remedy, the Egg Cure, which resolved his condition within a few weeks.

The remedy involves soaking a whole fresh egg in a jar of rice vinegar or malt vinegar. Once the shell is completely dissolved, the egg and its membrane are carefully removed, placed in a dish, and beaten with a wisk, creating a paste-like substance. The egg mixture is then painted over the entire body. Initially, there is a mild aggravation for 24 to 48 hours which resolves with continued applications. Twice daily, the mixture is applied, and later washed off and reapplied. Within a few days, the eczema will begin to resolve. Complete resolution may take up to 3-4 weeks, after which it will not recur. However, if it does return, repeating the treatment will almost always resolve the problem, in less time and without any aggravation of symptoms.

I learned about this remedy from a patient who had been afflicted with terrible eczema his entire life and had seen all manner of doctors. Through his search for a cure, going from healer to healer, he heard about this remedy, tried it, and was cured. I have been using this treatment since that time, particularly for children. It is highly effective, and is sometimes almost as good as steroids for resolving inflammation and painful itching.

In Chinese medicine, eczema is believed to be caused by Heat and Toxins in the Blood. One of the means of purifying the Blood is to enrich it with special nutrients, and eggs, particularly the yolk, are considered restorative because of their Blood-nourishing properties. The principle is that the more good nutrients that are present in the Blood (healthy ying and wei), the more effectively the Blood can detoxify and purify itself. In traditional medicine, the skin (couli) is considered to be a functional aspect of the Triple Burner. Steve and I have come to view the three dermal layers as a microcosmic representation of the Upper, Middle, and Lower Burners.

The treatment of eczema always includes acupuncture points for the Lung and Large Intestine (the two organs that comprise the Lung Network), since in Chinese medicine the skin and the colon are viewed as the external expression of Lung Qi. Western physiology also recognizes the skin as a respiratory organ that, in a sense, functions as a third lung. Western doctors have long observed that respiratory problems like asthma are often associated with intestinal problems such as constipation. In CTM, we also use points that improve the function of the Liver, because the Liver has a commanding influence over the quality and distribution of the Blood. Finally, we include points that improve the function of the Stomach and the Spleen, since they are the source of the nourishment necessary for restoring the Blood. We do not aggressively detoxify without adding nutrients at the same time or immediately following a period of discharge and elimination. Otherwise we run the risk of damaging healthy Qi and Blood.

Promoting Immune Equilibrium: Chronic Arthritis

Steve:

In treating inflammation, Efrem and I encourage a holistic view of what balanced immunity means, in the sense of resilience.

When treating a child with chronic arthritis, one goal of treatment is to address Lower Burner function (genetic predispositions, promotion of healthy sleep, hydration, and elimination). Middle burner functions are supported through dietary changes that reduce inflammatory triggers (elimination diet, gluten free-casein free diet, GAPS diet, SCD diet), and improve absorption of nutrients (probiotics, Spleen tonic herbs, glutamine). I recommend avoiding overstimulation of the immune system with too many vaccines all at once. Acupuncture directed at Spleen and Stomach disharmonies has a powerfully positive effect on arthritis. Vagal nerve tone can be influenced by ear acupuncture in particular. Upper Burner function is promoted by reducing sensory overstimulation (cutting down on screen time), improving emotional regulation (learning to express emotions more effectively), and shifting attention down from the Upper and into the Middle and Lower Burners. Diaphragmatic breathing exercises help the child to “get out of her head” and back into her body, quieting the over-thinking often evident in systemic inflammation. Meditation and Qigong practices also help develop healthy vagal tone and support a balanced immune-nutritive conversation (wei qi-ying qi). Heart rate variability is another interest of mine. HRV has been linked to immune resilience and can be used effectively with children, as well as adults. When variability is optimized, DHEA levels rise, wounds heal better, and emotional reactivity is tamed, simply by learning to consciously alter breathing.

INTEGRATIVE PRACTICE

Efrem:

A large body of outcomes research in China, Japan, and Korea focuses on an integrative approach, for example in cancer care, utilizing Chinese herbal medicine and acupuncture in concert with conventional protocols of surgery, radiation, and chemotherapy. What the studies repeatedly demonstrate is that patients who use Chinese traditional medicine along with conventional care have significantly better outcomes than people who only do one or the other. Using CTM in conjunction with standard care or together with functional medicine produces greater benefit to patients than reliance on a single approach.

My own predilection is to be collaborative. In my practice, when I see patients that I cannot adequately treat with acupuncture, herbal medicine, diet, and nutritional supplements, I refer them to a provider who has tools that I do not possess or cannot use because of the limits on my scope of practice. I have no hesitancy in referring patients to my medical colleagues, including chiropractors, osteopaths, homeopaths, naturopaths, surgeons, endocrinologists, gynecologists, integrative docs, and holistic pediatricians. Unfortunately, our medical care system is severely Balkanized, which prevents like-minded health care providers with differing medical specialties and methodologies from really working together in an environment that would maximally benefit our patients.

Steve:

I frame clinical recommendations within a context that demonstrates how everything fits together, how all the dots are connected. Rather than simply encouraging patients to “get more sleep,” for example, we want to be clear that the goal is specifically to restore a natural rhythm by providing counterbalances to asynchronies both internally and externally. In physiologic terms, our emphasis is on restoring healthy biorhythms associated with heart rate variability, breathing, sleep-wake cycles, eating, and elimination. We have found that we get much better outcomes when we help to promote harmony of the Triple Burner by reducing sympathetic overdrive, achieved through more exercise, more time in nature, mindful eating (taking the time to really relax and enjoy a meal)

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time spent with loved ones, and simple pleasures such as storytelling. Building on this foundation, we add herbs and supplements to target specific organ networks. In tandem, these efforts help promote healthy immune regulation and detoxification by recalibrating the immune response and fostering a more resilient way to meet the challenges of life.

Resources

Efrem Korngold, OMD, Dipl Ac (NCCAOM), RH (AHG), LAc

Efrem Korngold is a pioneer in the education and practice of Chinese medicine in the West. He studied Chinese herbal medicine in Kunming, China in 1980, acupuncture in Shanghai in 1984, and subsequently continued his training with Asian herbalists in the U.S. Applying his 40 years of scholarship and clinical experience, Korngold has developed unique practice models that blend ancient and modern knowledge. A Diplomate of the National Certification Commission of Acupuncture and Oriental Medicine (NCCAOM), he is also a charter member of the American Association of Acupuncture and Oriental Medicine (AAAOM) and a founding and Advisory Board member of the Holistic Pediatric Association. He has lectured nationally and internationally at sites such as the UCSF School of Medicine, University of Arizona, Beth Israel Hospital in New York, and the American College of Traditional Chinese Medicine in San Francisco. Efrem and Harriet Beinfield, LAc are founders of Chinese Medicine Works, an acupuncture clinic and herbal pharmacy in San Francisco.

Chinese Medicine Works

Efrem Korngold, LAc, OMD, and

1201 Noe Street

San Francisco, CA 94114

415.285.0931

www.chinesemedicineworks.com

Herbal Formulations.

Efrem and Harriet are formulators of an innovative repertoire of 68 Chinese herbal formulas manufactured and distributed by Kan Herb Company

www.KanHerb.com.

Book.

Between Heaven and Earth is their seminal work on Chinese traditional medicine, which has sold more than 250,000 copies and been translated into eight languages. Beinfield, Harriet, Korngold, Efrem. Between Heaven and Earth. Ballantine Books, 1992. (442 pp.)

Stephan Scott Cowan, MD, FAAP, CAc

Stephen Cowan is a board-certified pediatrician with 30 years of clinical experience working with children. Steve has a subspecialty in Developmental Pediatrics and is certified in Medical Acupuncture. He has developed a unique holistic approach to the evaluation and treatment of children struggling with chronic physical, emotional, and cognitive disorders. Steve is a Fellow in the American Academy of Pediatrics (AAP), a member of the AAP Section on Children with Disabilities, member of the American Academy of Medical Acupuncture, and clinical faculty at New York Medical College. He is a founding and Advisory Board member of the Holistic Pediatric Association and practices in Mt. Kisco, NY and New York City.

Practice

. Dr. Cowan provides in-depth, holistic developmental/medical evaluations that explore the child within the context of his or her life to treat the root cause of chronic health conditions and not just the symptoms. Dr. Cowan sees patients at two offices:

491 Lexington Ave,

Mt Kisco, NY 10049

914-882-9335

29 W 57th St. 6th floor

New York, NY, 10019

http://stephencowanmd.com

Book

. Fire Child, Water Child is innovative guide to parenting a child with attention deficit hyperactivity disorder (ADHD). Utilizing the wisdom of Chinese medicine, Dr. Cowan describes five distinct temperaments and how they play out in children with ADHD. The book offers individualized approaches to each temperament, as well as strategies to reinforce their strengths and reduce stress. Cowan, Stephen, MD. Fire Child, Water Child: How Understanding the Five Types of ADHD Can Help You Improve Your Child’s Self-Esteem and Attention. New Harbinger, 2012.

Workshops.

Efrem and Harriet collaborate and lecture internationally with Stephen. Dr. Cowan has achieved significant positive clinical outcomes applying the Five Phase Types in his busy pediatrics practice.

Editorial

This article is drawn from interviews and the writing of Efrem Korngold, OMD, and Stephen Cowan, MD. Editorial services were provided by Nancy Faass, MSW, MPH, director of the Health Writers’ Group, based in San Francisco; for more information contact info@HealthWritersGroup.com.