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MAY, 2000

Clinical Story of the Month 

(Copyright Stemmler 2000)

   A Very Annoying Cough  

Alma McLehan had a very annoying cough. It was dry, it was raspy, and it was there all day long---for the last 3 years! Alma was extensively worked up by several doctors and many treatment approaches were tried without success. Her life was in good order and her health was otherwise quite good. "If I didn’t have this real irritating cough, I’d feel fine," she used to tell me. She would cough mostly during the day, but rarely at night. As many women her age, Alma had had her tonsils removed in her teens and had undergone a hysterectomy in her late ‘30’s. She was also taking two hormones commonly prescribed: thyroid and estrogen replacement therapy. A gastroenterologist had told her she had "reflux" (acid coming back up from the stomach), and some doctors suggested that this reflux could be causing Alma’s cough.

On my exam Alma’s cough was due to a deficiency in her lung energy, "lung Qi vacuity pattern", which also manifested as sinus allergies and a chronic postnasal drip, irritating her respiratory tract. Her pulses, tongue and her mental, spiritual and physical energy confirmed my diagnosis. I started the patient on an herbal combination to strengthen her lung "Qi". I then proposed a series of 8-12 acupuncture treatments once or twice a week to treat the cause of her cough. I used Chinese body acupuncture as well as Korean hand acupuncture and moxibustion. One week later the frequency of her cough had diminished significantly and it had become "looser". She also reported a full day without a cough. After two visits she was cough-free for one week. Three weeks and two treatments later she was happy to report only three short coughing attacks in two days. Less than a month since beginning treatment her cough had almost resolved. After the ninth visit she went for almost three weeks without a treatment and did very well. At this time she would have one coughing spell a day, mostly in the morning, but often not every day. I explained that although her daily, persistent cough pattern had resolved, she would still have an occasional coughing spell to clear out old secretions, accumulated over three years of continuous coughing. The patient felt completely satisfied with her results and did not return after the twelfth visit. A follow-up call two months later revealed that Alma was doing fine, reporting only an occasional coughing spell, just as we had predicted would occur for some time.

Ideally, after one completes a schedule of visits to eliminate the problem, a certain number of "maintenance visits" are recommended to further strengthen the patient’s constitution, so as to prevent any recurrences. In Alma’s case at least six monthly follow-up visits would have been my recommendation. The reasons for this is simple:

  1. Disease occurs because the constitution of the patient is weakened enough to fall ill.
  2. Treatment of the illness restores a balance that is sufficient to move the patient from a state of illness to a state of health.
  3. The recovery period --- the time after the illness has apparently disappeared and the patient’s return to health starts --- is a critical time. It is then when the patient is most vulnerable to fall back into a previous disease or develop a new one. The patient is in a delicate state of balance, between "a previous disease and a newly-acquired state of health". It is at this point when the immune and defense system needs to be strengthened to function at its best; "after winning the battle, the warrior has to be restocked with good energy to prevail over future disease…" American "patients" are "impatient". They want it now (or yesterday) and they do not want to go over their "quota". If I estimate 8-12 treatments to stop their symptoms of illness, they stick to those numbers with fervor when, after all, they are just averages.

But these are the lessons we have to learn together, both patients who receive and doctors who deliver this kind of medicine. And only with time will we understand and find better ways of restoring health and maintaining health through a safe, gentle and effective new medical approach.


Christina Stemmler, M.D.




MAY, 2000


"In strategy your spiritual bearing must not be any different from normal. Both in fighting and in everyday life you should be determined though calm. Meet the situation without tenseness yet not recklessly, your spirit settled yet unbiased. Even when your spirit is calm do not let your body relax, and when your body is relaxed do not let your spirit slacken. Do not let your spirit be influenced by your body, or your body be influenced by your spirit. Be neither insufficiently spirited nor over spirited. An elevated spirit is weak and a low spirit is weak. Do not let the enemy see your spirit."

"Small people must be completely familiar with the spirit of large people, and large people must be familiar with the spirit of small people. Whatever your size, do not be misled by the reactions of your own body. With your spirit open and unconstricted, look at things from a high point of view. You must cultivate your wisdom and spirit. Polish your wisdom: learn public justice, distinguish between good and evil, study the Ways of different arts one by one. When you cannot be deceived by men you will have realized the wisdom of strategy. The wisdom of strategy is different from other things. On the battlefield, even when you are hard-pressed, you will ceaselessly research the principles of strategy so that you can develop a steady spirit."

(Excerpt from A Book of Five Rings, by Miyamoto Musashi, circa 1645, published in the U.S. by the Overlook Press, Woodstock, New York, 1982)


In this issue we travel from China, across the Sea of Japan, to the island of Kyushu in search of the Reigendo cave, where Miyamoto Musashi lived in total seclusion the last 2 years of his life. It was there when he wrote the Go Rin No Sho or A BOOK OF FIVE RINGS, which he completed just a few weeks before his death, on May 19th, 1645. Musashi was a famous samurai, who pursued the ideal of the warrior through the schools of KENDO, The Way of the Sword. Kendo teachings, still prevailing today, combined a grueling practice of fencing with the study of Zen, as a way of achieving the highest tests for a warrior and strategist. Musashi holds a very important place in Japan’s military and martial arts historical archives, as one of its most renowned warriors, and he is regarded as a "Kensei" or "sword spirit".

The Book of Five Rings is, according to Musashi, "a guide for men who want to learn strategy". It is used extensively in contemporary business corporations across boardrooms in Japan and much of the Western hemisphere. It is just as applicable in our daily lives as it is both in outdoors and in concrete-walled battlefields, regardless of our type of professions or lines of work.

The first book in the Book of Five Rings is the Ground Book; the third, fourth and fifth books are: the Fire Book, the Wind Book, and the Book of the Void. The excerpt I selected originated from the second book, the Water Book.

The first concept we can learn from is about "meeting the situation with tenseness, yet not recklessly, our spirit settled yet unbiased". Achieving this stage of performance will require some practice for us busy, stressed urban dwellers, but we may benefit greatly from doing so. Just watch a bird on a wire or a squirrel balancing on an oscillating branch. Both the bird and the squirrel may be enjoying the warm sunrays and the early morning breeze as you approach their space, but they don’t rest recklessly or unbiased. The birds’ wings are ready to fly; the squirrel’s muscles ready to bounce to a higher limb. Animals can teach us much of what we need to know to function at our best. That same bird will not perch on the wire all day, with its beak pointing to the ground and its feathers limp and dull. Nor will it sing at the top of its lungs all day long either; "be neither insufficiently spirited nor over spirited" – both a sign of weakness.

"Whatever your size, do not be misled by the reactions of your own body. With your spirit open and unconstricted, look at things from a high point of view." It is not the size of people that matters, but the level of their perspective in life. Monitoring and expecting high standards regardless of our size (measured in inches, status or wealth) or that of others, will keep us on a solid and focused track, leading to desirable outcomes in our lives.

"You must cultivate your wisdom and spirit…Polish your wisdom…when you cannot be deceived by men, you will have realized the wisdom of strategy." In our daily lives we have often "been deceived" by others. And we tend to blame them for our deception, calling them "liars, traitors and con men". But the reality is that we, ourselves, did not possess the wisdom, the strategy, to assess our deceptor. In all human interaction small battles are fought off and on --- battles of supremacy, communication battles, battles with our own internal demons – real or imaginary, yet still conflictive, ideological battles, political battles, and battles of battles. It is important that we recognize deception as our own lowered guards. It is crucial that we take full responsibility for our victories and defeats. A humbling experience, each time, yet still the best paved road to personal wisdom and enlightenment.

"On the battlefield, even when you are hard-stressed, you should ceaselessly research the principles of strategy so that you can develop a steady spirit." A steady spirit is our best insurance for physical and emotional wellness. According to the classical Chinese Medicine text, "a man should have control over his emotions as a rider controls his horse". Life resembles, in many ways, a battlefield. When we climb into our cars on our way to work every morning, we do not know what the day will bring – fortune or misfortune – war or peace. It is impossible to assess a city the size of Houston as Musashi was able to assess his own battlefield. Musashi’s job might have been a lot easier! But we definitely have control over the warrior in ourselves, as long as we can meet all our daily situations:

--- "with tenseness, yet not recklessly",
--- "be neither insufficiently spirited nor over spirited",
--- "with our spirit open and unconstricted, look up at things from a high perspective",
--- "polish our wisdom",
--- and "develop a steady spirit".

Christina Stemmler, M.D.

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