This article appeared in the Fall 2001 issue of the California Journal of Oriental Medicine.

Treating teenagers in the clinic can be a challenge, but being a teenager is harder still. I've never talked to any teenager who felt he/she was the center of the "in crowd." Most teenagers feel alone, isolated, and unappreciated, while at the same time being utterly self-absorbed. Most feel unimportant to the people from whom they seek attention. They are scared: scared of change and scared of being unable to live up to families' expectations.

As practitioners of Chinese medicine, we are in a privileged position to help guide parents and teenagers towards a more balanced and integrated family structure while considering individual needs. The acupuncturist can help by applying a good dose of perspective and information, along with a few needles, herbs, and supplements. As practitioners of Chinese medicine, we are in a privileged position to help guide parents and teenagers towards a more balanced and integrated family structure while considering individual need. This dynamic balance is the wisdom of Chinese theory that spans time and culture.

Julie, a fifteen year old in full adolescent rebellion, came to my office with her mother because she didn't have a regular period, had poor skin, rashes, and as she put it, "a bad attitude." She would allow me one opportunity to "fix" her. Her mother indicated it was up to me to convince her to cooperate with the treatment and return for any follow-up visits. What did I do? I asked her to talk about herself. She talked, we laughed, I received permission to use needles, she agreed to take herbs, supplements, eat protein, and return three times over the next three months.

Why did I do this? No matter what a teen says about his/her family or how intense their rebellion, I can't emphasize enough the importance of the family in the life of a teen. By family I mean those people who love and live with the teen.

I could have done many other things. What I deem important is my intention in working with people. In this case I conceptualized in Five Element terms and explained it to Julia. Sorting the unimportant issues that confuse the Heart strengthens the yang function of the Small Intestine. We strengthen Earth to ground the family structure and give a teen a solid foundation upon which to build her own life. By strengthening Metal, a teen will develop a strong physical skeleton, form clear, ethical principles to guide a teen through rough decisions-and keep the skin clear. By creating healthy channels for the exuberant Wood, the teen will keep out of most trouble by reinforcing her own creative choices. Strong Water function fuels and regulates the life process, along with the heart.

The results? She did begin getting periods monthly, her skin improved, moods became less dramatic, and the mother learned to look beyond the immediate teenage insolence, and a hug or two every day which softened the situation all the way around.

Regardless of the overt reason that brings the teen to the acupuncturist's office, I rely on the following mental checklist.

Provide a safe place where the teen and members of their family can come to air their burdens. Assure the teen that your conversation will be held in professional confidence.

Provide information and appropriate referrals.

Help the teen and family set a larger and more long-term perspective to the process and function of their family life. In many cases, stress can be significantly reduced when families choose to do less. Encourage teens and parents to simplify their lives.

Do a classical Chinese medical assessment of the teen's physical, emotional, intellectual, and spiritual balance.

I assess diet, exercise, personal hygiene, and anticipated body changes, along with the adolescent's study skill, school attitudes and performance, life goals, and ambitions.

I also review the teen's own life style and habits, to support treatment and diminish reoccurrence of the problem. I believe in connecting "what I do" to "how I feel," a practice that simultaneously empowers the teen and makes the world seem a safer place. It's important to have an adult to sort out feelings and ideas.

I push teens to participate in group activities. One Italian teen, Franchesca, taught me about group dating, popular in Europe. Five or six teens invite dates to the same coffeehouse or dance hall and sit and have fun together. As Franchesca put it, if you don't particularly like the person you invited, there are other people to talk to or dance with throughout the night and you may wind up meeting someone you really do like for the next date. I suggest group activities to teens if there is an appropriate context.

If the problem stems from emotional blockage, I try to delve into the various parts of a teen's life that may be the source. How does it feel to see your body change? How are things at home? How are relationships with others in your family? School? Grades? Friends? Special Friends? Unrequited love? The additional layer of complexity when explicit sexual relationships are involved is beyond the scope of this article. It is, however, an extremely major part of a teenager's life and suggesting a visit to Planned Parenthood or a gynecologist may be appropriate.

When the answer to these questions are upbeat and positive, I move on. If there is any hesitation or loss of eye contact, I probe. I ferret out the blockage with the teen, then try to move into the blockage and help the teen create more space and movement about the issue. For example, if the problem focuses on family dynamics, let the teen identify where the hitch exists. Then reduce the conflict your teen is describing to a Five Element framework to illustrate the responsibilities, priorities, and values of both the parent and the teen in each situation. Teenagers may need to be reminded that parents want the best for their children.

I often talk about yin and yang to teenagers and find that it helps in defusing teenage angst. It is easy for teens to identify with the concepts of the "creative" and destructive" cycle when judgments of "good" and "bad" are taken out of the equation. Teens readily grasp how harmony can be achieved by well-intentioned "give and take" among the Elements: learn to be patient (Wood), be joyful (Fire), be compassionate (Earth), be truthful (Metal), and be courageous (Water). If the teen hasn't heard sentiments like this expressed before, it's great that he/she hears it in the office of the acupuncturist. If they have heard them before (and most have), it doesn't hurt to have them repeated with an Oriental spin.

If the emotional problem is serious, or complicated by substance abuse, the teen and/or family should be referred for counseling. The Chinese practitioner can facilitate teen/family rapport by listening and providing information. In addition to professional organizations, I often suggest cultural activities of interest. Listening to a teen's interests is a frequently overlooked part of improving teen/family communication.

As a rule acupuncturists spend more time talking with patients than many physicians do. We take more time to listen and provide perspective ­- as we should.

It is important to also involve the parents. They may need to be reminded what it was like being a teenager. You may ask a parent, "Have you ever met anyone willing to go back and be a teenager a second time?"

Emotions

Marlene is a fifteen-year-old who had been a model student and energetic, loving child before becoming sullen, and moody. When referred to me, her moods alternated between being withdrawn and flying into sudden outbursts of rage. Her parents didn't know what to do. The drama was so great that all members of the family were adversely affected. Most of all, her parents could see that Marlene was miserable, isolated, and scared.

In this case explaining the behavior helped the family, especially Marlene, understand it. I referred the entire family for counseling to learn conflict resolution skills. The entire family participates in this program. As one family member changes behavior, it is important that other members know new freedom to express themselves in creative ways as well. I worked with Marlene using acupuncture, herbs, vitamins and minerals.

Young people rarely feel secure. Have you ever met a teen that thinks he/she looks "right"? Add to that the notoriously poor teen diet consisting of vast amounts of sugar, hydrogenated fats, and lack of fresh vegetables, fruits, and protein and you have a recipe for disaster. Chinese theory goes a long way to explain the erratic emotional behavior we see in our teenagers.

Hormones

Hormones probably dictate the majority of what is happening in the life of a teen-mood, reproductive function, cognition, and skin. Hormones are fat molecules, so dietary oils and fats are crucial to hormonal health. Short chain fatty acids essentially come from animal sources and are utilized by the body for energy within hours. Long-chain fatty acids derive largely from vegetable sources, and are emulsified before being available to rebuild the cell structure. The basal membrane of each of our cells is composed of three layers of lipid material. The body partially deconstructs complex fat and manufactures its own version of fatty hormone molecules.

Sources of high quality fats include fish oils, flaxseed oil, nut oils, and nuts, high quality butter, plugra, ghee, extra-virgin olive oil, peanut oil, hemp oil, European grapeseed oil, uncooked poultry egg yolk and liver (chicken, duck, goose), caviar, bee pollen, evening primrose, borage, and black currant oils, cream (no BGH), meat, fowl, and fish. I specifically exclude from this list: canola (gene altered), low grade butter (high milk casein content), soy oil (gene altered and possible allergen for many), olive oil (lowest grade extracted with toxic chemicals), corn oil (possible allergen), or any margarine or hydrogenated or partially hydrogenated fats.

When using acupuncture to re-establish the processing of hormones, harmonize the energy of the liver, kidney, and ming men.

Attention Deficit Hyperactivity Disorder

ADHD responds well to Chinese medicine. Creating a family structure and rhythm helps re-establish the rhythm of the teen's inner world. Every teenager needs to find his/ her own individual "drumbeat" perhaps through music, song, poetry, or sports. I use Chinese herbs that support the Liver and Kidney, in addition to the digestive functions. I use nutritional supplementation with a ratio of 5:1::B5:B6 when the kidney yang is weak. Herbal mixtures such as An Mien Pien, Tien Ma Gou Teng Tin, passion flower, and essential oil of lavender or bergamot have also been useful. I find it useful to order environmental and food allergy testing. The ELISA is especially sensitive and has been useful to isolate some unusual items that would have taken a long time to identify using trial and error.

The ADHD teen is often symptomatic a larger family issue. A referral to a conflict resolution class or family wellness program may be called for to learn some new behavior patterns around dysfunctional issues. Often family issues that disturb children deeply can not be altered, for instance, divorce and death. However, patterns of communication based on positive, forthright, non-critical, non-judgmental expressions can be taught and learned by all family members. Some amount of acknowledgment and accepting responsibility goes a long way to soothe troubled souls.

Using acupuncture to train or re-train the energy along the bladder and gall bladder meridians, calm the pericardium or heart fire, purge liver heat, and support the kidney yang can be very helpful in cases of ADHD. Many times the school placement is inappropriate for the talent of the individual teen. Our education system is set up for the average student. Individual teens will sometimes do better in a hands-on, self-styled learning approach. These are finally becoming more available via home schooling and alternative high school programs.

Some of the most creative teens I have had opportunity to work with have been labeled ADHD as they are bored beyond belief by an educational setting that goes counter to the creative forces inside them. While it is true that teens are supposed to behave in school, not all of them are mature enough to do so especially when their needs are essentially being ignored. If this is the case, I encourage parents to have the courage to validate their teen and help find or create an appropriate, affordable setting for their teen.

Body Image

Negative body image and self-consciousness is one of the biggest challenges for many teenagers to overcome-male and female. As teenagers learn to accept and appreciate themselves for who they are and what they can do, they hopefully learn to put the importance of a "perfect body" into perspective. Smoothing liver Qqi with Liv 3 and Liv 5 can help soften the negative influence of our skin-deep culture. If dietary analysis indicates excess carbohydrates and insufficient nutritious food (and it usually does), a discussion about the importance of balancing dietary ratios in food is helpful.

Skin

Of all the issues for which teens come to my office, the one that affects them most is the condition of their skin. When I discuss improvement of skin appearance, I usually have the teenager's full attention. I talk about the importance of sleep, exercise, perspiration, hormone balance, hygiene, healthy foods, and good attitude. Washing and scrubbing the skin is important.

I point out where shoes are wearing unevenly or not fitting properly. Finding supportive, well-fitting shoes helps prevent corns and calluses. Going barefoot is healthy as long as it is done where there it is done safely. If a teen has rough, chicken-like skin anywhere on his/ her body (especially the triceps area of the San Jiao channel), I recommend a supplement of essential fatty acids.

Breathing exercises and physical exercise that increase oxygenation and induce perspiration can keep the lymph and skin clean, healthy, and glowing. Washing with hot water and finishing with cold water is useful. The world abounds with different kinds of external facial cleansers. My favorite is using fresh papaya skin after eating half on one. Smear the face with the inside of the skin and allow it to set a minute or two before rinsing with water.

The intestinal tract can be encouraged to function better by a routine of regular meals and daily elimination. Such regularity, ultimately, helps the skin, which is only as clean as the blood. Implanting the gastro-intestinal (GI) tract with friendly intestinal flora helps improve teen skin very quickly. I use commercially available L. acidophilus, L. bifidis, and any of the other hundred's of known healthy bacteria that inhabit a healthy GI tract. Using fermented food such as kim chee, yogurt, kefir, buttermilk, unpasturized sauerkraut, shen chu cha, and other fermented teas help accomplish this goal.

One half hour of sunshine helps the skin and keeps the body supplied with enough vitamin D for healthy bones as well. Using massage and touch help more than just the skin; parents would do well to give their teens a couple hugs every day. Collagen and elastin are two proteins specific to firm healthy good-looking skin. To ensure adequate protein available for the skin, encourage consumption of small amounts of a wide variety of proteins. There are so many Chinese herbal formulas useful for skin conditions. As healthy life style habits are cultivated, the skin quality improves and the need for remedial support diminishes rapidly.

If a teen will do only one thing to help his/her skin, I suggest he/she use two to four ounces of aloe vera gel in juice or water on a daily basis-either in the morning or preferably before bed. In my experience this is most useful in assisting the skin of the teen through turbulent times.

Summary

Often working with teens comes down to reminding people of what they already know, want, and have. Use gentle cajoling ways to get people out of their ruts, whether these are bad habits or bad attitudes. Remind them of the power to make a difference in people's lives and thereby make their own life better. At times I feel like a combination of a wise woman, a confessor, a sermonizing minister, a buffoon, and a fall guy. Other times I feel like the cat that silently and knowingly holds the family council.

Martha Serrie Benedict, M.A., O.M.D., Lac., received her master's degree from Stanford Medical School and was on the faculty of the University of California's medical school before she began studies in Taiwan and then mainland China. This led to her becoming the first non-Asian woman to be certified to practice Traditional Chinese Medicine (TCM) in California in 1976. She integrates Native American medicine, naturopathy, and homeopathy into Chinese and Western Medicine in her practice in Santa Cruz, CA.