The following is an edited transcript from an audio recording with Mayway's President Yvonne Lau, Amy Mager, DACM, L.Ac., NBCA, and Janet Borges, L.Ac. and special consultant for Mayway.
Participants:
- AM—Amy Mager, DACM, L.Ac., NBCA
- YL—Yvonne Lau, President of Mayway Herbs
- JB—Janet Borges, L.Ac. and Special Consultant for Mayway Herbs
YL: Hi Amy, I really appreciate you joining us today.
AM: Pleasure.
YL: With school starting back up in August for many kids, we wanted to talk with you about teen health, specifically mental health, and how Chinese medicine and some everyday things can best support their developing brains.
: I want to include tweens in that. And for girls that can mean like 9, 10, 11, because our precious ones are menstruating earlier and earlier. I have 2 daughters. One didn't start menstruating until she was 14 and a half, and the other one started menstruating at 11, and it was like “Whoa”. And they both breastfed for over 2 years, and they both had really healthy diets. So, it's hard to say, “Oh, it's because of this, or because of that”.
YL: From a mental standpoint that must have affected them.
AM: It did. At first, she thought something was wrong with her body, but luckily a friend of hers had given her the American Girls Doll Book about my body and about menstruation, which is actually a great book.
And I had given her a different book, and she handed it back to me, and she said, No, thank you. But she loved the American Girls Doll book and part of why she loved it was her friend's mom gave it to her, and I think we cannot underestimate the power of calling on the allies of other moms in our community who we trust and who share similar values because our children can hear the same thing they can't hear from us, they magically hear from somebody else.
YL: I totally understand. So, with your two daughters, given the differences of when they entered menstruation, were there mental or other cognitive differences between the two of them, like maturity and whatnot?
AM: They were both incredibly mature, but they also had different natures. My elder child was much more Livery, and my younger child was more Spleeny and tended more towards “Oh, we need to work on Heart-Kidney communication”, whereas my older child was much more pent up. They're both in psychology as adults. One just earned her PhD in psychology and neuropsych testing. So, she actually works with kids with ADHD, with assessing them, writing programs for them, and working with parents to more effectively work with them. And my other daughter does research on transgenic mice in autism. So they're both super bright and doing good work in different ways, so I would say it was more about their physiology. Their bodies look different. They are different, but they will finish each other's sentences, so their brains work very similarly, even though their physiology is different.
YL: They sound amazing. For the folks who are not TCM oriented that listen to our podcast, what do you mean by "Livery versus Spleeny"?
AM: Thank you. Okay, so let's go over the organ systems and let's go over emotions. Anger is the emotion that most affects the Liver, and when someone feels like they're not able to express themselves, or they actually feel angry, both of those things create what in Chinese medicine we call Liver Qi stagnation, and that impedes the ability of the free flow of both the physical and emotional Qi. So, you're going to hear that person give a deep sigh and there may or may not be eye rolling. Thank God, my kids didn't do the eye rolling. But you know that that sighing and that sense of frustration and that sense of they're not telling you something that's going on as opposed to someone else (the "Spleeny" child) who just may be overthinking, right? That's the child that's going to perseverate and overthink everything. “Did I do this right?” “Should I have done this, mommy?” You know, one time, for example, we got a new washing machine, and my kids were responsible for doing their own laundry. Well, she didn't do her laundry for 3 months, because she didn't want to ask how to use the washing machine, and she didn't know how.
YL: 3 months. What did she wear? She wore her dirty clothes?
AM: Yes, and when I found out I was mortified. But you know our children. Each child is different, and we need to pay attention to them, and two of my sons have ADHD that manifests differently. But you know the ways that ADHD has affected them, and the way that Covid affected one of them, particularly with any kind of neurodivergence, right? Covid was much harder for these kids. Like some of them were super happy that they could go inside and didn't have to interact with human beings. But, on the other hand, some of those kids also didn't do well on Zoom.
And one of my kids in particular said, “Mommy, I didn't do what I needed to do. I did really well on the SATs, so I think it makes sense to send me to Community college first for 2 years, and then to go to 2 years of regular college.” And that's what he's doing. For that particular child, I wasn't sure if he had PANDAS for years, because he was just so incredibly sad, and exhibited some of the mental health challenges that can be part of PANDAS that are horrifying and terrifying for parents, which makes us want to be really sure and aware that we're using everything we know from Chinese medicine, but also from books, which helps all children learn to communicate effectively and helps us as parents communicate effectively, not only with our children, but with patients, with our community members and also our spouses.
YL: Can you explain what you meant by PANDAS?
JB: It stands for Pediatric Autoimmune Neuropsychiatric Disorders that are associated with streptococcus.
AM: When children have strep or typically, it's strep, but it can also be cellulitis, and they have very intense antibiotics, children can have an adverse reaction or something can be released in their nervous system. These are kids that will refuse to get out of bed. They will refuse to get dressed. They will tell you they want to die, and it's horrifying and finding a provider to take you seriously and not just say it's just a mental health issue is a really big challenge.
It's scary for parents, because your child has big anxiety. Big mood swings, says scary things. For us, it was an every night breakdown, absolute breakdown of sobbing, of saying, I want to kill myself. Okay, precious one. Do we need to go to the psychiatric hospital. Do you want to work with this with us? Let's do some breathing. My husband happens to be a chiropractor. So my child got adjusted and then I did acupressure on this child. And while I was using Chinese medicine, I was thinking about Dr. C.S. Chung, who Janet also had the privilege of studying with, I believe, at ACTCM. And he said, you know you have your diagnosis grid. You have a treatment grid. When you know what something is you put it on your diagnosis grid. When you know how to treat it, you put it on your treatment grid.
YL: I'd love it if we could talk about the stages of their brain development and whether there's a correlation in Chinese medicine.
AM: If we look at 7 by 7, at 14 there are changes that happen in teens around prepubescence, and they do correlate with growth and challenges of teens where again we're back to individuation and giving them a little bit more space, but also being there and being present with them as they grow and work to become more fully themselves and separate from their parents a little bit. And I would tell my sons from the time they were 7, “You've got this thing called testosterone running through your veins, and I just want to remind you that it's going to make you seem like something's a really good idea, and your friends are going to tell you it's a really good idea, and I want you to take a pause and think about it.” And I tell parents to pick the most strict grandparents. “Would you do it in front of them? And if you did it in front of them, would you be proud for them to see you doing it?” A moment to reflect. And our kids need those kinds of reminders, you know.
(Editorial comment: Comparatively, Amy noted the difference between a younger person and older boys and girls in the context of hormonal changes, emotions, and biochemical changes.)
AM: Ask any woman how she feels when she's premenstrual. You're going to get a really different response when they say post-ovulation, and what's going on there? Biochemically, different things are going on. And so when those differences happen, it affects mood. And even boys. I don't think we understand yet the rhythms of testosterone, because it's not as clear and direct as the rhythms of the menstrual cycle. Live with men and those of us that do can speak to that, you know. They're not always the same either. It's the rhythm of life and the rhythm of what's going on for them. And again we're back to emotions. When we are sad, what's most deeply affected, the Lungs right? And we see that in a lot of preteen girls that just come home and sob and they're grieving. And so, the question is, are they sad about something? Sometimes the answer is yes, sometimes the answer is no, sometimes it's hormonal, and often the answer is yes because somebody said something, did something, and teaching them the tools and skills to be resilient matters. And I believe it affects our biology. Every thought we have, every emotion we experience has a direct, measurable biochemical reaction in our body.
(Editorial comment: This discussion pivots back to neurodivergence.)
AM: ADHD is a brain difference. It's not a shameful thing, and I think the biggest thing that I see with patients in my office and with parents that I know is they don't want their child to get that diagnosis, because, you know, well, “they'll want to do this, so they'll want to do that”. And you know what? Sometimes this or that can be really helpful and help your child be more functional.
YL: Absolutely. If they don't get that diagnosis, then they won't get those IEPs--Individual Educational Plans. And so their kid will actually be at a disadvantage.
AM: And if your child is at grade level, you're not going to get an IEP, even if they need services. They're going to get something called a 504, which is a plan for children who are at grade level, and if your child is in a public school, it must be honored. If your child is in a private school, guess what? They don't have to honor it. We really want to be focusing on seeing and bringing out the best in these children and looking at what are the tools we need for these precious ones who are having mental health challenges, and rule number one is breathe in through your nose and out through your mouth. You can teach that to a toddler.
JB: So, you're talking, and I'm listening to you as I always do. I don't personally work with kids, nor do I have them. And so my question. I presume that you work with kids in clinic who are in this teen to pre-teen cohort, correct? How do you approach this? Because presumably you're also working with their parents. They don't come in to see you by themselves. They come in with their parents. So, in that setting, how do you collect all these things together to make a treatment plan for a child, and just maybe pick an example.
AM: Okay. So an 8-year-old came in for all sorts of digestive issues, and she'd never heard of lactate. I'm going to use the name, Susie, not the child's name. I'm going to say, “So, Susie, there's something”, because every time she ate dairy her tummy hurt. I said “So, Susie, there's this thing called Lactate. Would you be willing to try it? And can I teach mama about it? What do you think about that? Because when you take this with the 1st bite of dairy, it may help your tummy hurt less”. Now this is a child that had been to Boston Children’s. This is a child that had been constipated for her entire life. We talked about it. She started the lactate. She was no longer constipated. And was that Chinese medicine? Yes, and no. Is lactate Chinese medicine? No. But is the thinking that brought me there in line with everything Dr. Chung taught me? A hundred percent.
So, I have conversations with the kids and their parents when they're there, and sometimes the parent will come in for their own issues, and then the parent will just download all this stuff about their child. So, I give the parent resources for the child that aren't herbal medicine related, but are resources for the parent to choose to see and bring out the best in the child, like getting a neuropsych exam if that's what that child needs.
It all depends on who comes in. If Mom comes in, it's easier in that sense. And if the child comes in. I create a dialogue with child and parent, and I have the child's permission. And I always check in beforehand, like every time, because things change, and everyone needs to feel safe and comfortable. I'm the kind of provider that before I leave the room, I say, “Do you feel safe? Do you feel comfortable with me? Do you have any concerns? Is there anything you want your parent to be here for” because it's really important that kids be seen and heard, particularly kids who are anxious.
YL: For the teens that don't have a neurodivergent diagnosis, but they come to you with anxiety or sleeplessness and stuff, you just diagnose them using regular TCM principles.
AM: Absolutely. Regular TCM principles that are also in line with polyvagal theory. Thank you, Miriam Lee. I had the privilege of studying with Miriam and I studied with her student Raven Lang. And you know, Miriam had everybody, basically, whenever there's heat rising, whether it's from hot flashes, whether it's high blood pressure, whether it's anxiety, to soak their feet in hot water with a cup of Epsom salts up to Spleen 6, which is the top of a crew sock, basically getting your Achilles tendon. And that does a number of things from a Chinese medicine perspective. It roots Heat under the cooking pot, right? It brings Heat down. It helps bring the body into the dynamic balance that generates life, nourishes the Kidneys because we want heat at the Mingmen Fire in the low back, on Kidney 1 Yongquan to just nourish our Kidneys and ourselves. And also breathing. These are things that make perfect sense, right? No breath, no life. When we think about the extra channel pair of Lung 7 and Kidney 6, what does that do? It beautifully helps the Kidneys grasp the Lung Qi to embrace that breath, right?
JB: Do you change your approach when the school year approaches? Do you tend to have kids that would come in and be nervous or anxious around school starting again? And if so, how would you treat them.
AM: For some kids, it's a really big deal, and you treat them with a big, loving, open heart, like a soft place for them to land. “Hey, what was your favorite thing about this summer? You know I want to remind you that when you feel really stressed at school, you can close your eyes. I want you to close your eyes with me just right now and I want you to think about what was your favorite thing you did this summer, and I want you to breathe that in like you're drinking a glass of lemonade, and I want you to feel that fun that you had to the top of your head, the ends of your fingers, and the tips of your toes. And then I want you to breathe out. How's that make you feel?” And I let them reflect. And I see what tools they respond to, because different kids respond to different tools. So being aware and being able to be flexible and pivot with each particular child and what they need but teaching our children that they can meet their own needs. They can decrease their own stress by using their breath, by using manipulatives and having fidgets teaches them how they can be more productive, and at the same time not disruptive in a classroom setting.
YL: So, when it comes to teens, at least my boys, they kind of go through this stage at the beginning of high school, where they withdraw a little bit. I guess they're trying to understand themselves and they get a little moody. Is that something parents can do something about like with acupuncture, or some other thing?
AM: Sure, acupuncture is really helpful for the kids that are irritated and crabby and withdrawing. If there's more of that pent up feeling, then we're going to look at Liver formulas, whether that's Xiao Chai Hu Tang, whether kids with extreme anger and intensity that maybe have symptoms of having a lot of testosterone coming in really quickly can be the right formula for them.
For the kids that are melancholy, Gui Pi Tang. Are they more deeply weak? Is Bu Zhong Yi Qi Tang the right formula for them and just paying attention to your precious ones and finding a provider that you trust. And again, we're back to adults that your child will talk to that are not you. The fact that I have 6 children really helped because I could say something, and they didn't believe it. But if an older sibling said it, they could really take that in. So, building our village and filling our village with people you trust and people you love really matters. And, making sure that our young men have the ability to and are encouraged to feel their feelings, and to have places to talk about these things and process their feelings.
And so back to what you said about withdrawing. That's about individuating. As I said to one of my kids in particular, it's your job to test limits and boundaries, and it's my job to set them and let you know that they actually exist, be flexible when I can, and to let you know what's immovable and why it's immovable, and how that protects you, because my primary job is to keep you safe.
JB: It also sounds like your job as a practitioner is really one of making sure that they can function at the best level for them at this time period. Whatever you know, whatever is the right thing, you will do it, whether that be working from a strictly TCM perspective, which you know doesn't always make a lot of sense to me, because there's so many other factors at play, and you don't want to work from a reductionist point of view. It sounds like the bottom line is number one to make sure that you are able to be a neutral, helpful point in time for them to feel safe around, like you just said, and that they can have a safe place from which to go to school on Monday, right?
AM: Yep, and a safe place to be who they are. Who they are and know that there's nothing weird, that they're not strange, that normal's a setting on a dryer. Nobody's normal, and there is no normal family, right?
But yeah, to support them where they are stuck, to help them get to where they want to be. What kind of plan can we make for you to do that right? How can I support you? What do you need for that to happen?
It's also really important to honor yourself and know what does bother you and ask for help. It doesn't have to be from me, but it has to be from someone. But that's what therapy is for, too, right, to look at what's going on in your life? And how do you want to make these changes?
You know your feelings follow your thoughts, so when you change your thoughts, you change your feelings, you change your circumstances. And that's where tools like EFT tapping--the emotional freedom technique tapping can be really valuable. That's something kids can do for themselves. Parents can do it with them. They can teach them.
And again, we're back to breath and soaking your feet in hot water, as I tell patients every day. You know there is no magic bullet. There is no one thing. The question is, how do we find the constellation of things that work for you at this moment in time. And 6 months from now, a year from now that might change that constellation of things. But the good news is we're teaching you tools to have in your box, so you can pull them out as you need them to be the best version of yourself.
Because that's all we can do, especially right now, when there's so much despair in the world, right? What can we do concretely in this moment to help you breathe, to help you feel better, to help you remember that you're loved, that you're valued and valuable and lovable and loved.
YL: So, for acupuncturists out there, who want to treat teens for anxiety and depression, besides diagnosing them and treating them in a TCM way, should they get involved with the therapist?
AM: You have to ask the parents’ permission, and what we can do is say, I would love to be a part of this team. I was trained in school to be a valuable integrative team member, and I'm happy to serve as it supports your family, even if that doesn't make sense for your family right now. If it does, I'm here, and I want you to know that I'm here to support your precious one.
(Editorial comment: Amy wanted to expand a bit on the importance of considering vagus nerve function in a clinical setting.)
AM: There are so many things that can affect the vagus nerve. When we stimulate the vagus nerve and calm the nerve system and breathing into one number and out twice as long [is something] we can do. That's going to bring a kid down. Some therapists do EMDR, and for some kids, that's an incredibly powerful tool. EMDR is a form of eye movement therapy that therapists are trained to do that can really help shift patterns, as can EFT tapping--Emotional Freedom Technique tapping. I teach kids to use a hair dryer on their low back to warm their Mingmen Fire because it changes their thinking, and on their low belly on Ren 4, a hand breath below their belly button, because that's something they can do on their own. It doesn't involve a match. It can be Moxa. But again, back to Dr. Chung's grid. Find something that does this, and I actually have a handout about using a hairdryer to support the Mingmen Fire. And then someone said, Oh, Alex Tiberi used to do that. And I was like, Okay, so I'm in good company.
It works super-fast, and if people have 10 seconds you can use a hair dryer on your low back, and it will help you feel centered. Help you feel grounded. Shift your perspective and change something.
YL: That’s great advice. I'm thinking of all the teens and the college students as they restart school. That’s an easy thing for them to do--they're blowing their hair, anyway, right?
AM: Do it till it's hot and rub it in. And then just soaking their feet. You don't need fancy herbs. Just Epsom salts, because when you get the Achilles tendon relaxed with hot water and Epsom salts, it automatically relaxes the cervical spine and neck muscles. That's going to stimulate the vagus nerve, calm the nervous system. Help people be more relaxed, help them sleep better.
YL: How hot should the water be? How long should they soak for? How much salt should be in the water?
AM: That's a great question. If you're soaking your feet, one cup of Epsom salts to a foot, soak for 15 to 20 min. And ideally for the bonus round, I have people breathing in through their nose and out through their mouth. Otherwise, I have them watch Netflix, or listen to a podcast, or whatever will get them to soak their feet. 3 to 5 times a week, and if they're really having a lot of trouble sleeping, every night before bed, because for some people right sleep hygiene makes a huge difference.
Kids going off to college for the 1st time. Maybe their roommate doesn't want a shade. Maybe there you need blackout curtains, and there are manta and other masks that block out all light that can be super helpful for those teens and college students, or even high school students to just make sure they're getting the rest that they need, because it's not just screens. It's any light, even a nightlight. If you have a roommate that likes to sleep with a nightlight, that can be incredibly disruptive to your brain because our brains need dark. Miriam Lee used to say, go to sleep with the chickens. It gets dark, go to bed. You have to know works for you.
JB: List 3 things, Amy, that you would commonly see going back to school in your clinical cohort, like the people who come to see you regularly. You've already got a buy-in with them. That you would see, maybe, as they're going back to school. Say, between the age of 11 and 14.
AM: Anxiety. Stomach upset. Migraine.
YL: I have a girlfriend whose daughter in high school would before every exam have diarrhea because she had such high anxiety.
AM: At least she wasn't throwing up. I mean, other kids throw up. I see kids with stomach migraines.
JB: So in those scenarios, do you use herbs with them? Do you use acupuncture?
AM: That's such a great question. If they're open to herbal medicine, absolutely. I have some kids that love their herbs. I have other kids that don't. It's about what works for that child in that moment. What are they willing to do? And if they don't have a buy-in for needles, I do acupressure, or some Traeger work, or just moxa. I use moxa on teens if they don't want acupuncture and have kids that'll say you can have 4 needles today. And we all know that one needle can change the world. So, it just depends on what they’ll tolerate. If they don't do herbal medicine, we talk about food as medicine.
(Editorial comment: Circling back to the most important component, that of listening to the individual's needs, while also being aware of the science and research.)
AM: Well, I just want to say that it's really important for us to continue to look at science and continue to be present with our precious ones, and to choose providers who we feel listen to us and our children. And if your provider, whether it's an acupuncturist, whether it's your PCP is not listening well to you, find another provider, because we work for you. I see it most often in women with gynecological issues and around birth where people feel like, “oh, I've known this person for so many years”. You don't owe them anything. You don't owe me anything. If I'm not the right match for you, tell me what you're looking for, so I can help you find what you need to lift yourself up and be the best version of yourself, because it's not about us. It's about you and making sure you get your needs met.
JB: Thank you, Amy.
YL: Yes, thank you. It's been fun and wonderful. I've learned a lot.
AM: Thank you for the opportunity to chat with both of you. I hope this inspires somebody to do something differently, that they didn't know that they could, to help their precious one or the patients they serve.
Resources Recommended by Amy
- The Blessing of a B minus, Raising Resilient Teenagers, Wendy Mogul, PhD., C. 2011, Scribner.
- Molecules of Emotions: The Science Behind Mind-Body Medicine, Candace B. Pert, C. 1999, Simon & Schuster.
- Simon's Hook, A Story about Teases and Put-Downs, Karen Gedig Burnett, C. 1999, Great Publications.
- Bully Proofing Your Child, A Parent's Guide, C. Garrity, 2000, Sopris West Publishers.
- American Girls Doll Book (series) The Care and Keeping of You, updated 2024, American Girl Publishing.
