Diaphragmatic (Kidney) Breathing to Potentiate the Healing Effect of Acupuncture and Chinese Herbal Medicine

An exploration…

Acupuncture and Chinese herbal medicine have been proven to be effective treatment modalities for various illnesses over multiple millennia. Many people seek out the treatment of acupuncture and Chinese herbal medicine to reach a state of ‘balance.’ This state can also be referred to as the ventral vagal state, which will be defined and explored further later on.

Another way that clients of acupuncture and Chinese herbal medicine can explore this ventral vagal state is through the practice of simple breath work. This paper serves the purpose of describing why teaching simple breath work is not only important in treatment but also necessary for the wellbeing of clients. This paper also shows that the practice of simple breath work can potentiate the healing effects of acupuncture and Chinese herbal medicine. The simple style of breath work that will be offered throughout the paper will be Diaphragmatic breathing, also known as Kidney breathing. In this paper, these two terms will be used interchangeably.

We are working from the idea that the point of acupuncture is to help clients regulate their nervous systems. What does this mean? This means helping to bring a patient into a ventral vagal state, which is a part of the parasympathetic nervous system. However, as we all know, we can’t just stay in a place of joy and balance forever. Stress and difficulty will strike; this is normal! So, the regulation of the nervous system is to experience these waves of stress and disruption and then return back to the ventral vagal state, i.e. regulation is sincerely like surfing. We will experience difficulty, may even be totally thrown off our board and tossed into the ocean; but then we resurface, swim back to shore and rest.

Further, regulation can be described as completing a full stress response when aroused and return to a ventral vagal state when the stress response cycle has concluded. From the perspective of Peter Levine, creator of Somatic Experience therapy, regulation of the nervous system doesn’t mean to never experience stress; rather, it means to be able to experience the natural stressors in life and move smoothly between sympathetic and parasympathetic states (Levine).

How does an East Asian Medicine (EAM) practitioner know that clients are in a ventral vagal state? There are many ways. This could be done by checking their vital signs like blood pressure, heart rate, pupil dilation, etc. Also, this can be gauged through signs of improvement for what they are being treated for and by the clients’ own subjective experience of their overall experience and wellbeing on and off the treatment table.

It is common for patients to reach a ventral vagal state while on the treatment table. The ventral vagal state is the state of most engagement, connection and curiosity within the nervous system. Within the parasympathetic state there is the dorsal state which gives the freeze response, which is a state of shut down in the nervous system. The Vagus nerve is made up of two branches, the ventral and dorsal aspects. Then there is the sympathetic aspect of the nervous system, which encompasses the fight or flight responses. Both the dorsal vagal and the sympathetic states are survival states, while the ventral state is an engaged and curious state. All three aspects of the nervous system work together. It is natural to come in and out of different states of the nervous system. No state of the nervous system is bad to experience or will cause disease, unless it is experienced in a chronic and unrelenting way (Levine). 

It would be impossible to never feel stress, that is not the point of the treatment of Chinese medicine or the practice of breath work. However, how can one feel stress and also feel and notice their breath? Would this even be helpful? If so, how?

As previously mentioned, it is natural for the body and nervous system to feel stress. The point at which disease can arise is when nervous system gets stuck within the stress response cycle and isn’t able to complete the cycle and orient toward safety. It can take time and practice to reintegrate the nervous system into a ventral state after experiencing stress. The ventral aspect is the social engagement branch and allows people to come out of sympathetic activation in a smooth and regulated way, opposed to the other option, which is the parasympathetic dorsal vagal freeze/collapse option. 

Through acupuncture and Chinese medicine practices, patients are able to experience the ventral state of the nervous system. However, it can be difficult to come into a curious open state of being, the ventral state, while outside of the treatment room. One way that the patient can not only access a grounded curious state of being outside of the treatment space, but also the healing effects of acupuncture and Chinese herbal medicine treatment can be potentiated, is through conscious breath work and movement. 

From a Chinese Medicine perspective, being in a ventral vagal state could be described as the channels being open and free flowing. In the next couple of paragraphs, the terms ‘health’ and ventral vagal state’ will be used interchangeably. From a Chinese Medicine perspective, health or vitality can be defined through two characters tong (通) and ying (應). These two characters refer to the openness and resonance of the channels. Further, this describes not only the ability of qi, blood and fluids to circulate unimpeded throughout the body; but also the ability of the channels, networks and systems in the body to communicate with one another (Robertson 2020). 

Ed Neal, MD, MSOM trained in both Western and Eastern medicine, describes his work as an acupuncturist as helping his patients’ tissues all be reached by illumination. He asks the question “where is illumination traveling and where is it not?” He then uses his needles to help irrigate the tissues where illumination is not flowing (Neal). Neal practices Chinese Medicine from the perspective that the universe is made up of a rocking motion, an inhale and exhale; and that health is the free flow and transition between expansion and contraction. Conversely, disease manifests when this rocking motion of expansion and contraction is disrupted. 

Further, in the book Decoding the Dao, Tom Bisio writes, “In the body Qi is often discerned by its actions, the balanced and orderly vitalities, partly derived from air we breathe, that cause physical changes and maintain life. When we say that someone is healthy, it is because the functioning of their body (the manifestation of their Qi) is orderly and without dysfunction” (Bisio 42-43). Another term for understanding health is offered by Bisio, “In Chinese medicine, the term Zheng Qi (“correct” or “upright” Qi) refers to the harmonious, smooth and active flow of the Qi in the body. This creates a state of balance and adaptability” (43). The word adaptability is particularly important here because it gets down to the essence of what is understood as health, which is not the lack of disease, but rather the ability to return to a state of open circulation and nourishment during and after disease. It is also taught from a Somatic Experience perspective, that health or safety is not the absence of threat, but rather, the presence of connection (Levine). This moreover shows that ‘health,’ ‘safety,’ and ‘regulation’ are not about the lack of stress or potential threat, but rather about a tether or connection to safety. What feels safe will vary from person to person, however, an anchor of safety that all human beings can access is the breath.

How can this information be used clinically by an East Asian Medicine Practitioner? 

Each practitioner has their own style of practice and ways to gauge success in treatment. Coming down to the basics of the body’s breath and noticing through palpation, interview and intuition, which areas of the body are not being irrigated by breath, qi, illumination, then acupuncture can be used to create more circulation so the body can do what is wired to do - function physiologically for means of survival, which requires a supply of oxygenated blood to all of the tissues in the body.

Further, teaching patients simple breath exercises can help them reach a ventral vagal state, an open state of circulation, even when they are not on the treatment table. Simple breathwork exercises can help potentiate the treatment effects of acupuncture and Chinese herbal medicine by creating more openness, tone and resilience in the channels due to the qi dynamic being less impeded.

It is understood in Chinese medicine that if the channels are open and resonant, disease and emotional disruption can and will still take place, but the system will have an easier time recovering. The ‘goal’ of health is not to not experience stress or disease, rather, it is to build flexibility and resilience and maintain circulation so that diseases, pathogens and disruptions can be digested properly. 

Later, it will be explored how qi becomes constrained when the nervous system is in either survival state, the sympathetic states of fight or flight or dorsal vagal states. 

It has been proven that conscious breathwork and movement practices help to regulate the nervous system, which in turn, give the body more capacity to respond to the healing effects of acupuncture and Chinese herbal medicine (Courtney). For the purposes of this paper, there will not be a heavy focus on the Western medical side of why and how breathwork can regulate the nervous system. In lieu of that, here are a few articles that can give more information and be explored outside of this paper: Article 1, Article 2, Article 3.

How does the breath affect the Qi dynamic? 

From a Chinese Medicine perspective, the Lung governs the qi, which takes place through the oscillations of the breath. Chapter eight of the Su wen, one part of the classic texts of Chinese medicine, The Huangdi Nei Jing, states, “The Lung holds the office of prime minister and is the issuer of management and regulation” (Huangdi).

The Lung is in charge of rhythmic respiration and regulating the movement of qi in the body. The air that is breathed in is acted upon in the Lung, then the air taken in that has been acted upon is released and sent along to the body. This is the point of exchange of gasses, the exchange from Carbon Dioxide to Oxygen, which is a phenomenon of qi transformation from the perspective of Chinese Medicine. What is needed is taken in, clear qi, and what is not needed is dispelled. This clear qi in combo with food qi becomes the fundamental basis for postnatal qi in the body. The Lung also sets the rhythm for ascending, descending, entering and exiting of qi in the entire body. This has a global effect on how the qi moves throughout the body. If the Lung is impaired in some way then the process of the exchange of the gasses in the air is undermined and compromised, which in turn, can undermine the rhythm of the overall body.

The Lung also governs dispersing and descending. It should be noted now that qi moves blood and fluids in the body, so when the qi moves it does not move in a silo; it moves the blood and fluids along with it. The dispersing aspect of the Lung activates the flow of qi, essence and body fluid in the body. The descending aspect of the Lung is the action of the Lung inhaling and sending down fresh air, body fluid and essence. This act of inhalation is supported by the stabilization of the Kidneys (Taromina). 

With the understanding from the above information, it can be seen how relaxing the diaphragm and allowing it to expand and contract optimally will allow the breath to descend from the Lung and be stabilized by the Kidney. This is a sort of merging of Western and Eastern ideas, but it is supported in Tom Bisio’s book mentioned above (Bisio). 

According to Bisio, a multitude of structures are influenced by the movements of the diaphragm and the breath; including but not limited to, the vena cava, GI system, scalene and neck muscles, liver, stomach, flexures of the colon and the psoas muscle (27). This shows how the breath is directly related to the functions and movements of other organ systems in the body. When the diaphragm is not stuck or resisting the breath, it does the job of rhythmically massaging the organs and structures around it so that their intrinsic movements can take place. If this free movement of the diaphragm does get stuck, perhaps because someone is in a perpetual state of sympathetic response in their nervous system, then the organs may also not move well and carry out their jobs optimally, leading to many symptoms and diseases. 

It is important to go no further without touching on the relationship between qi and breath. In some translations, the character for qi is translated directly as breath. There are more nuanced approaches as well. Bisio writes, “In common usage, Qi can refer to air, gasses and vapors, smells, spirit, vigor, morale, attitude, the emotions (particularly anger), as well as tone, atmospheric changes, the weather, breath and respiration” (42). This shows how breath is an exemplification of the movement of qi; as are other movements in the body, from subtle to gross. 

In this paper, the term Qi/Breath will be used to describe the inextricable connection between these two forces. This idea comes from Tom Bisio; he writes, “Because of the indivisible connection of Qi and breath, some scholars substitute “vital breath” for Qi” (44). Bisio writes, “Respiration is one of the body’s most basic rhythms. This is why breathing exercises can have profound effects both physical and psychological, on the entire human organism. Paying attention to our breath is as important as brushing our teeth, getting enough sleep and eating right” (25). Acupuncturists and Chinese Herbalists Jason Robertson and Dr. Wang Ju-yi describe Qi as the smallest unit of potential in the body (Robertson, Wang). It regulates and potentiates all of the functions in the body. The breath and qi cannot be separated, on a conceptual level and on a physiological level. If the breath is moving smoothly then that can create an internal environment that is less likely to fall ill or stay stuck in illness or dysregulation. 

In the book, The Healing Promise of Qi, Jahnke states, “The breath is the most powerful tool for gathering, circulating, purifying and directing Qi” (34). Further he says, “It is worthwhile to note that one of the definitions of the Chinese character for Qi is “breath” and Qigong is often translated as “breath practice” or “breath exercise” (Jahnke, 36).

In his book, Bisio writes, “Breathing exercises (Tu Na) are some of the oldest recorded medical exercises in China. Regulating the breath is an indispensable part of meditation, Daoist alchemical longevity practices and health promoting exercises such as Qi Gong” (7). Bisio continues “Life is a result of concentration of the Qi/Breath and death its dissolution. Thus it is said that what courses through the entire world and causes it to communicate is the unitary breath” (16-17). Here, Bisio is describing how the concepts of breath and qi are not separated and that breath is the foundation of life, communication and expression. Bisio continues, “By reconnecting with Heaven’s virtue and Earth’s breaths, we reconnect and replenish from the well of life itself and recover the authenticity and wisdom which was implanted within us at our inception” (17). In this context, Heaven is not meant to describe a religious view of the afterlife or a kingdom in the sky, but rather the fullest expression of yang; and Earth represents the fullest expression of yin.

It is important to note here that regulated, conscious breath is one aspect of healing and wellbeing, but it is not the only aspect. However, it can be a great place to start and return to as one is being confronted with the fluctuations of ever-changing reality that impair the connection to regulation. To sum it up, Bisio writes, “Although Daoism and life nourishing practices frequently reference life and immortality as goals, it is implied that the real goal is to live as a fully integrated human being” (17). 

What happens when the Diaphragmatic (Kidney) breathing is disrupted? 

Just as the smooth flow of breath can create potential for free flow and health in the body, the disruption of the free flow of breath can create a disruption in the qi dynamic; which can lead to many different patterns of disease in the body. 

Bisio writes, “Worldly affairs - our wants, desires, likes, dislikes, obsessions and fixations - pull us away from the unity into countless divisions and differentiations that disperse our own Qi/Breath. The ultimate dispersal of Qi/Breath on a physical plane is death, but in another sense these fixations create impediments that impair our connection to the limitless changes of Heaven and Earth, thereby creating another kind of death” (17). Here, Bisio is referring to the emotional, mental and spiritual ways in which the qi dynamic can be disrupted. It is thought that where the attention goes, the qi follows. So here, it is understood that fixations of any kind can disrupt the qi dynamic in the body. 

It has been proven by Jean-Pierre Barral, an Osteopath, that the “piston-like action” of the diaphragm influences the mobility and motility of the viscera (Bisio). One of the foundational aspects of the action of breath is the diaphragm. As one inhales, the diaphragm contracts and spreads laterally to create space in the pleural dome. As one exhales, the diaphragm relaxes and domes to lessen space in the pleural dome. The diaphragm has connective tissue attachments to the viscera, particularly the stomach and the liver, along with the esophagus. Disruption in the flow of breath could not only cause issues in the lung, but in other organ systems as well. And from a Chinese Medicine perspective, if the Lungs aren’t governing the rhythmic flow of qi, that could cause disruption in any organ system in the body. 

Further, Bisio writes, “Qi that is dysfunctional and inharmonious is called Xie Qi… In the human body the presence of Xie Qi leads to pain, dysfunction, mental and spiritual confusion, and premature death. The Qi can become disordered due to disease, injury, imbalanced emotions, over-thinking, working too hard, improper diet, and an unharmonious lifestyle that is not in tune with the natural order of things. Daoist practices such as meditation attempt to prevent the influence of Xie Qi by connecting to and balancing the universal energies of Heaven and Earth and returning our interaction with them to the primordial state. The first step in this process is the practice of diaphragmatic or “Kidney” Breathing” (43).

A very common way that pathology of Qi/Breath shows up due to inefficient breathing is through constraint. Constraint is a term used in both Western and Eastern medicine. For the purposes of this paper, the term constraint will be defined from a Chinese medicine perspective. This will be done through an article written by Dr. Wang Ju-yi and his apprentice Jonathan Chang; they write, “The symptoms that arise from constraint can be understood by considering the original definition of yù (郁), which describes dense forests, strong aromas and thick clouds - in other words, constraint involves a kind of stuffy, muggy stagnation. Associated symptoms include, feeling depressed, a stifling sensation or fullness in the chest, lack of appetite, irritability, insomnia and plum-pit qi” (Chang, Wang).

This shows how constraint arises when the Qi/Breath is not allowed to move smoothly. This can be related to the concept of trauma being a stuck stress response in the body. From a Somatic Experience perspective, trauma does not live in the event, it lives in the body. The body not being able to complete the stress response cycle leaves the nervous system in a stuck place of fight, flight or freeze, which can manifest with similar symptoms of constraint that were offered previously (Levine).

So, all of this is to say, let’s practice Kidney/diaphragmatic breathing as a foundational support in our lives and healing journeys. The breath is something we can always come back to and that can be a portal into the present moment, where the real healing (and living) takes place. The patient practicing Kidney breathing during an acupuncture / body work session and then going back to that practice daily throughout their lives will potentiate the healing effects of Chinese medicinal practices. It will also give the patient a glimpse into the innate healing ability of our bodies and beings.

As a practitioner of EAM, I am really interested in tools that patients can use as a resource off the treatment table. Kidney breathing is the one that I have seen to be the most effective in my time of practice. I think this is because it is the basis for all other movement and meditation practices.

Please use the hand out below as instructions on how to start your practice of Kidney breathing. Please reach out to me with any questions. If you do a health consultation with me, this will likely be one of our foundational practices together.

Let’s practice Kidney Breathing!

So, how can we restore an optimal qi dynamic and regulate any disruptions? We can start with Kidney breathing. See to the left for a small handout of step by step directions on how to practice Kidney breathing.

References

Bisio, Tom. Decoding the Dao, Nine Lessons in Daoist Meditation. Denver, Colorado, Outskirts Press, Inc., 2013. 

Courtney, Rosalba. “The Vagus Nerve and Resonance Frequency Breathing for Healing Mind and Body.” Functional Breathing. 

Chang, Jonathan, Wang Ju-yi. “The Treatment of Constraint According to Applied Channel Theory.” Journal of Chinese Medicine, February 2017, 44-53. 

Jahnke, Roger. The Healing Promise of Qi, Creating Extraordinary Wellness Through Qigong and Tai Chi. NYC, New York, McGraw Hill, 2002. 

Levine, Peter. In an Unspoken Voice: How the Body Releases Trauma and Restores Goodness. Berkeley, California, North Atlantic Books, 2010. 

Neal, Ed, Guest. “Ed Neal.” Apricot Jam Podcast, July 10, 2021. 

Robertson, Jason, Wang Ju-yi. Applied Channel Theory in Chinese Medicine. Seattle, Washington, Eastland Press, 2008. 

Robertson, Jason. “Acupuncture Points and Channels.” October 2020, Seattle Institute of East Asian Medicine, Seattle.  

Taromina, Kathy. “Chinese Medicine Fundamentals.” October-November 2020, Seattle Institute of East Asian Medicine, Seattle.