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Welcome to Chinese Medicine Bristol's official blog! Here, Acupuncture and TCM pracitioner Sandra Arbelaez will share information about Acupuncture and Chinese Herbal Medicine, how they work, and the latest research and developments related to TCM. You will also find knowledge and ideas on how to enjoy a full, healthy life that she has picked up over the course of 15 years of exploring the world of natural health

Tuesday, 10 January 2017

TCM causes of disease

According to the philosophy behind Traditional Chinese Medicine (TCM), everything is interconnected and one part of the whole can not only influence the whole but the opposite is also true. This applies to everything that exists including us, human beings. As part of the natural world, each of us constitutes a  part of the ecosystem we live in and of the planet at large. On the other hand, each of us is a "whole" made up of every single part of the body as well as the mind, emotions, and spirit. In terms of our health, this means that anything that happens in either our external or internal environments can have a definite effect on us either promoting our health or causing illness. When diagnosing and treating with TCM, the norm is to look at all aspects of the person's physical workings, as well as their relationships, lifestyle, diet, and general circumstances of their lives. This helps us determine all the factors contributing to their symptoms so that both the causes and the symptoms themselves can be addressed.

It may seem strange to us, with our Western way of thinking, that a variety of factors such as the weather conditions, our emotions, our relationships, specific aspects of our lifestyle and diet, and our exposure to pollutants can influence the workings of the body to the extent of determining the presence or absence of disease.

TCM causes of disease
Traditional Chinese Medicine classifies the causes of disease in this way:
External Causes, which refer to a variety of climatic and environmental factors
Internal Causes, which are specific emotional and mental factors
Miscellaneous Causes, which mostly refer to lifestyle  and infectious and polluting agents


External causes of disease

In this category, we find six climatic and environmental factors that can turn into pathogenic influences as they "invade" the body.  Each of these factors is predominant
Climatic and environmental factors can cause disease
during a specific season although they may also be present at other times of the year depending on the latitude and altitude we live in or because of unusual climatic changes. They can also be created artificially in our heated and air conditioned homes. The six external pathogens or "evils" are listed below:
  • Wind: Predominant in spring, and also produced by fans, airconditioning and drafts, Wind tends to cause a sudden onset of symptoms and affect the upper parts of the body. Wind often combines with other pathogens such as Heat, Cold and Damp, helping them penetrate the body. Sneezing, itching, headaches, twitching, and symptoms that rapidly change location can all be caused by Wind invasion.
  • Cold: Predominant in winter, and also easily contracted diving into cold water, Cold makes the body chilly and produce excessive watery discharges. Symptoms that can result include watery eyes, a runny nose, and frequent copious urination. As cold contracts matter, this pathogen can also cause pain and stiffness in different locations of the body.
  • Damp: Predominant in late summer - a humid season in some parts of China -, Dampness tends to affect the lower parts of the body more than the upper parts and, amongst other things, can cause a sensation of heaviness, aching joints, swellings, thick and sticky discharges, and sluggishness in the digestive system. In the SW of the UK where I live and work, this pathogen is prevalent throughout the year.
  • Heat: Predominant in summer, Heat can cause symptoms such as sensations of heat , fever, dryness in different parts of the body, thirst. inflammation, constipation, sweating, and dry skin.
  • Summerheat:  This pathogenic factor is like Heat but much stronger in its effect, and can also occur in summer. Summerheat can also easily combine with Damp pathogens causing symptoms such as nausea, vomiting, diarrhoea, heaviness and sticky discharges as well as severe fever, sweating, and thirst.
  • Dryness: Predominant in the autumn - although not where I live!-, Dryness can affect bodily fluids resulting in symptoms such as dry eyes, dry nose, dry mouth, dry cough, dry stools, and thirst. This pathogen can easily be caused by different types of heaters and air conditioning systems.

External pathogenic factors invade the body either singly or in combination. They start on the superficial layers of the body where, depending on the strength of the pathogen and of our defensive energy, they may be expelled back out or move inwards causing further symptoms and damage. Symptoms like chills and fever, skin rashes, body aches, sudden swelling of the joints, and headaches can be caused by external invasions.



Internal causes of disease
 In Chinese medicine, it is understood that the body, mind, emotions, and spirit are but different manifestations of Qi. Rather than being separate from each other, these different aspects of ourselves constitute a fluid continuum of energy that goes from the density of the physical body to the lightest, more ethereal Spirit. TCM explains that when Qi, or any of its manifestations, does not flow smoothly or its flow is impaired, this can result in the development of symptoms. It is in this way that an imbalance in our emotions can transfer into a denser form of our Qi and cause physical symptoms. The internal causes of disease consist of seven specific emotions that can turn into pathogenic factors because of our failure to healthily express or otherwise deal with them,  or because of the emotions being so sudden and excessive that we cannot protect ourselves from their effect.


Emotional imbalances are Internal causes of disease
- Suppressed emotions -  for example, unexpressed anger, frustration, or grief - can cause Qi to stagnate. This can in turn cause a myriad of symptoms which may include pain in any part of the body.
- Chronic emotional states - such as constant worry, stress, anxiety, and sadness that are not addressed or resolved- not only disturb our mind and general wellbeing but can also consume our energy which may result in a gradual decline in the functioning of the whole body.
- Sudden, strong emotions - such as fright, trauma, and euphoric or elated states like those artificially caused by chemical substances - can scatter Qi and may interrupt and disrupt its flow to such an extent that it may be hard for it to be restored again. This can result in ongoing mental, emotional and physical disturbances.

The close relationship between each of the seven emotions and a specific organ of the body means that when a particular emotion is out of balance its related organ will be affected first. As all TCM relationships are reciprocal, this also means that when an organ is out of balance its corresponding emotion will be exacerbated. In addition to this, all types of emotional imbalances affect the Heart which, in TCM theory, is the seat of consciousness and of the spirit, and whose energy is involved in any type of emotion we experience.

These are the seven emotions and their corresponding organs:

  • Anger and related emotions such as rage, annoyance, frustration, jealousy, etc; affect the Liver and its functions causing Qi to ascend and go the "wrong way". This can result in a variety of symptoms ranging from headaches and digestive difficulties, to pain and disturbances in the menstrual cycle
  • Joy, as well as elation, euphoria, overexcitement, etc; affect the Heart and may cause the Qi to slow down and scatter around as well as produce excessive heat that can result in sleep disturbances, nightmares, agigation, and an inability to concentrate or relax.
  • Sadness - which includes gloom, despair, etc- affects the energy of the Lungs and tends to deplete the Qi resulting in lack of energy, weakness and weak immunity
  • Grief affects the  Lungs and Heart and has a similar effect on the energy as Sadness, weakening the Qi.
  • Pensiveness, which manifests as overthinking, circular thinking, and worry, affects the Spleen, causing Qi to get knotted and stuck,often resulting in digestive difficulties
  • Fear affects the Kidneys and causes the Qi to descend. This is the reason why in times of extreme fear there may be incontinence of urination or defecation.
  • Fright (shock) also affects the Kidneys, causing Qi to become chaotic. It then may take a long time for Qi to recover its normal course as it happens in some cases of PTSD


Miscelaneous causes of disease
Our constitutional weaknesses, what we eat and how we eat it, the amount and type of exercise that we do, and our exposure to chemicals, pollutants, and to parasitic or infectious agents, can all be factors involved in the development of disease and are classified in TCM as miscelaneous causes of disease.

Having healthy parents greatly contributes to our health
Our constitutional strength is a direct result of the health of our parents at the time they conceived us, and the health of our mothers during pregnancy. When we are born, this constitutional strength is further shaped by the appropriateness of the nourishment we are given as well as the environment we live in. Just as we may end up with a weak or strong immune systems, we may be more or less able to cope with certain activities, foods, or environmental factors. It is common in the West to be oblivious of this. We instead tend to believe in the "once-size-fits-all" approach to lifestyle, exercise, and diet and often unwittingly cause harm to our bodies by doing and eating things that are detrimental to our individual health. Becoming aware of our own constitutional strengths and weaknesses and honouring them by adopting a lifestyle that promotes our wellness is one of the keys to good health and it is something that Chinese medicine is particularly good at because of its deep understanding of how the body works and how it relates to the outside environment. I consider this the most important part of my work as a TCM practitioner as I believe it is not enough to alleviate symptoms but it is also necessary to find ways to prevent their recurrence so that each person has control of their own health.


Although in TCM identifying infectious agents is not important per se, treating infections and intoxication from different types of chemical pollutants is possible through identifying the manifestation of their toxicity in a particular individual and treating them accordingly. Preventing the development of diseases caused by toxicity from infections and chemicals is essential in our modern world where we are subjected to increased pollution and to a chemical overload in our food and many household products, and where our immune systems have been bombarded with antibiotics while we are exposed to increasingly strong infectious agents. Fortunately, it is possible to reduce our exposure to toxins by choosing more natural products and we can also strengthen our immune system through our diet and lifestyle. TCM treatment for this kind of condition consists of aiding the detoxification of the body while strengthening the body's resistance to disease. This is done with a combined strategy that would include diet and lifestyle changes as well as herbal remedies and acupucture.


In contrast with the simplistic view of disease we have in the West, where we think that a complex chronic disease can result from a single cause (sugar- diabetes, cholesterol- heart disease/stroke, depression- chemical imbalance in the brain, and so on); in TCM, disease - particulary when chronic - results from a distorsion or diruption of the equally complex relationships between internal and external factors. As a result, prevention and treatment of disease are processes that involve identifying and addressing the pathogenic factors that have caused the symptoms so that there is relief, as well as harmonising the relationships both between the internal organs and between the individual and the environment so that the symptoms are corrected in the long term.

Tuesday, 26 January 2016

An acupuncture journey: volunteering as acupuncturist in rural India


This December just  gone, I spent two busy weeks in Chaparda, a tiny rural place in the Indian Western province of Gujarat, with a team of volunteer acupuncturists from the UK. We went as part of a project run by UK-based charity World Medicine which organises projects such as this in different parts of the world. Our aim was to offer free acupuncture to the nearby villagers, mostly poor farmers unable to access healthcare,  and also to give basic ear acupuncture training to members of the local charitable hospital set up to serve the community.

Our team of UK acupuncturist at Jay Ambe Hospital
The most exciting thing about this project was not that I’m totally in love with India and its people and I’m always up to visiting the country, it was the fact that the project didn’t only consist of giving treatments but it contained that magic element of teaching simple techniques that would allow the local hospital to continue offering some kind of treatment after we left. “Teaching the man to fish” is definitely the only way in which we can truly help anybody.

It took me a few days to grasp the extent of the work of our host organisation which not only comprised the charitable hospital we were to give treatments from – the Jay Ambe hospital-  but also several schools and homes for disadvantaged children and adults in need. Our accommodation was next door to the homes for elderly men and women who were often happily sitting in the sun to get the early morning chill out of their bones and would greet us as we walked past to get our breakfast. Every morning when I saw them, I thought to myself that if it weren't for this local charity, they would all have been living in the streets without any shelter or food. 

The work in the hospital started the day after our arrival.  The project consisted of two body acupuncture multi-bed clinics – one for men and one for women - , an ear clinic which would provide pain relief ear acupuncture in group sessions that run throughout the day (up to 6 per day) and, during the first few days, the ear acupuncture teaching clinic in which 4 or 5 members of the hospital staff would be taught the 5 point protocol that was being used in the ear clinic.

After some unsurprising hiccoughs that made us start relatively slowly, by the fourth day we were up and running at full capacity at the body and ear acupuncture clinics. Several ear acupuncture sessions were offered through the day, each time treating over 20 people, while the body clinics had queues outside their door at all times. The final countdown of treatments came up to over 700 given in the body clinics. By the time of writing we were waiting for the Ear clinic numbers

People awaiting treatment outside our treatment rooms
Ear acupuncture group session

We mostly treated farmers from the nearby villages that had been summoned by people sent out by our host organisation to give the news of our arrival. Quite a lot of them were visibly in pain and discomfort. The men tended to be very skinny and sinewy while the women were larger but could hardly walk from the stiffness in their backs and legs.  I was mostly at the ladies clinic but also spent some time at the male and ear acupuncture clinics and saw that, on the whole, the bulk of the people we treated was made up of over 50’s with quite severe joint and lower back pain resulting from working hard in the fields, crouching over the fire to cook, and generally a life full of hardships.

What struck me the most was to see so many people well under 60 not only toothless but also with signs of aging that made them look closer to 80 than 50. I spent the first day or two convinced that the people at the reception desk who were filling in the forms were mistaking people’s age, but then I realised that, in fact, most people I treated looked at least 20 years older than they actually were. I suppose this is a result not just of a lifetime of hard work but also of lack of nourishment and, most probably, of having being conceived by parents who were themselves undernourished.  On the other hand, these people living in obvious poverty and suffering from - sometimes quite extreme- physical discomfort would most of the time come in with a smile on their faces even when they reported no improvement in their symptoms. This is the beauty of Indian people, what makes their eyes so alive and their smiles so bright, they can see joy and a reason to be grateful where most people I know in the West could not.

Giving a treatment for knee pain at the ladies clinic

Giving free acupuncture to people who can’t afford it has always been something that appeals to me. I did it for many years in Bristol, where I gave weekly acupuncture treatments at a drugs project down the road from where I live. This was one of the most gratifying experiences I have ever had, not because of what I did but because of what I received from the people I came across who lavished me with gratitude and taught my na├»ve self so much about life, about being human, and about acupuncture itself!  Doing this in a faraway country is a completely different thing though, I wondered for some time if offering free treatments for a limited period of time was not going to be even worse for the people we were trying to help. What if soon after we left their symptoms came back and then they could find no relief in anything else? I realised I was wrong when a few of the people we treated in India, some of whom had arrived in severe pain which they had had for anything up to 20 years, after the 4th or 5th daily treatment came in all relaxed and smiling saying that they were pain free. I could see then how selfish my thinking had been, if even one person could get this much benefit then we were definitely doing the right thing for them.

I have rarely felt as exhausted as I did at the end of this trip, but it felt great that we had made a difference –even if small- to the lives of some of these villagers not only because our treatments brought relief to some of their symptoms, but because we left everything in place for our work to continue in the ear acupuncture group clinic now run by the people trained during our stay.  The latest news we received from them was that the ear clinic was up and running again after receiving new needle supplies from Delhi – they had gone through the incredible amount of needles we took we us and run out on our very last day in India! – and hundreds of villagers are still turning up for treatment.

Most of our hard-working hospital team
There is of course much to be learnt from this project to improve on future ones that any of us may be taking part of but, on the whole, we can say it is mission accomplished and everyone who got involved and gave their good will, time, money, and work, should feel proud of their contribution. Above all, this work is testimony that we can create a global family of people who care about each other... where there is a will there is definitely a way!!

Deep gratitude to each of those who made this experience possible: to those who donated money to help me get there, to the project organisers, my colleagues and fellow travellers, our lovely committed interpreters and helpers, the members of staff at the hospital who worked extremely hard, the staff in our host organisation who fed us and put up with our requests, and of course to all those who used our services in Chaparda for it could not have happened without them!







Monday, 19 October 2015

Autumn lifestyle

Autumn - the beginning of the Yin part of the year
The yearly cycle, like everything else that exists, is an expression of Yin and Yang energies. With the summer over, the cusp of Yang energy is now gone and we enter a calmer, quieter, and more introspective season which is the beginning of the Yin part of the year. Many of us may already be feeling a need for extra rest, and may have even fallen with a change-of-season cold.  These are natural responses to the many changes happening in our environment which are an expression of the sudden inward movement of autumnal energy following the climax of expansion reached during the summer months. 

In the West, we tend to regard the seasons as mere climatic phenomena which can affect the landscape but do not affect us. This is a common misconception rooted in the removal from nature that so many of us experience today: we feel hot in winter and frozen in summer in our air-conditioned spaces, live under artificial lights unaware of day or night, and throughout the year buy all kinds of fruit and vegetables coming from all over the world in the local supermarkets. 

Something that the healthiest people on the planet have in common is not that they purposefully do things because they are considered healthy or eat specific foods because of the omega oil or antioxidant contents, it is that they eat what their particular land produces at each time of the year and observe traditional ways of living and preparing the foods that go in accordance with their environment and needs. In contrast with this, health-minded people in the West tend to go for the consumption of out of season “super foods” and relentless healthy regimes which do not necessarily keep us healthy or enable us to fight disease more efficiently.

Observing the changing needs of our bodies during each season is undoubtedly one of the keys to good health. This involves a fluidity in our habits that allows for seasonal produce to constantly be at the centre of our diets, and for adjusting our levels of activity and rest according to our bodies' requirements.

Autumn in TCM
Generally speaking, autumn is the season of harvesting, gathering, and preparing for the winter months, a time when the lushness of summer ripens up and gives way to falling leaves and fruits.  As we harvest and gather we also find all those fruits that, having gone off, need to be discarded.  This perfectly represents the most important functions of the TCM Lungs and Large intestine, the organs of the metal element whose energy is at its peak during this season.  The Lungs main function consists of gathering air and extracting from it the nourishment – in the form of oxygen – that serves as one of the principal ingredients for the making of Qi which will in turn fill our bodies with strength and vitality. The Lungs and Large intestine are also in charge of the elimination of waste products from respiration –carbon dioxide- and digestion so that they don't stay in the body and cause harm.  The TCM Lung governs Qi and its proper functioning manifests in vitality and constant renewal of our energy. Visit my post on the Lungs to learn more about this organ and how to maintain its health.


Another important function of the metal organs is to protect us from disease, which is an aspect of immunity. Being the most external of organs, the Lungs have the function of projecting outwards a protective energy  - Wei Qi - which is partly derived from the nutrients that we consume and acts as a barrier to invasive external pathogens. The Large intestine is also a main organ in our immune response as is the skin which in TCM is regarded as an extension of the Lungs. They are both in charge of fending off and eliminating harmful substances and waste products so that they don’t enter deeper into the body .  External pathogens most easily enter the body through the respiratory and digestive systems so the strength of the metal organs is considered of great importance.

If the energy of the Lungs is low or its flow impaired by blockage – usually in the form of phlegm and mucus along the respiratory passages – we may be more prone to catching colds, and develop coughs or allergic reactions during this season.

Staying healthy in autumn
In Traditional Chinese medicine texts, autumn is regarded as the season when dryness can injure the body. This is because in mainland China dryness is a prevalent condition at this time of year. Here in SW England however, the opposite is true. Our already humid environment becomes increasingly so, the air can turn soggy while moulds develop on trees and on the falling leaves.  For this reason, some of the Chinese medicine advice for this season needs to be adjusted to our different climate.

Whether we live in a humid or dry area, autumn is always about gathering what we need to be comfortable and well in the winter months, letting go what needs to be discarded so that we are not unduly burdened during winter, and setting up boundaries to protect us from the cold and from harmful external influences. 

Gathering and collecting:
At a physical level, this is represented by the need to prepare ourselves for the winter months when a strong body and immune system can ensure health throughout the cold season. After the more exuberant lifestyle of the summer, autumn calls for resting more and for consuming foods that are denser and richer than those we had in the summer to provide warmth and nourishment to the body.  

At a deeper level, the beauty of autumn leaves, the shortening days, and the chillier evenings invite contemplation and a look in. It is a good time to centre ourselves after the summer holiday and collect our thoughts so that we can start to plan and project into the months ahead.

Letting go:
This refers to an innate ability of the body to identify and discard harmful substances and waste products. This ability can easily get impaired when we either overburden the body with toxicity and/or allow tension and stress to build up inside us until we are literally unable to let anything out. Letting go thus implies a need to allow the body to do its job by helping it cleanse itself through the consumption of healthy food and plenty of fluid, as well as staying physically and mentally relaxed so that we allow things to flow in and out.

We may also need to eliminate certain foods and undergo a cleansing process to get rid of toxicity accumulated through the summer so that our immune system is not burdened and can protect us from illness in the colder months. The Lungs and Large intestine are particularly susceptible to accumulation and this can be very detrimental to their proper functioning. Making sure that we consume a diet that provides good nutrition as well as promoting proper evacuation is of particular importance to prevent disease. In addition, avoiding chemically-laden foods and reducing the consumption of mucus-forming foods such as processed foods, refined sugar, wheat and milk products can help our respiratory and digestive systems remain free of accumulations and blockages. This is more relevant when we live in cold humid climates like the one we have in SW England as environmental dampness and moulds can contribute to this type of accumulation and to the development of respiratory and skin problems.

At a deeper level, just as the lush trees need to lose their fruit and their leaves so that they can concentrate their energies inside themselves, also us need to focus on what goes on inside us. In TCM, grief and sadness are regarded as emotions of the metal element and many of us can indeed experience them more strongly at this time of year. Acknowledging and processing any unresolved emotions is necessary for us to be healthy and happy. Only when we let go of the past we open ourselves to enjoying our present life and plant the seeds of our future. After all, finding inspiration and energy for new projects and growth cannot happen while we are still attached to events, things, and people from the past.

Setting boundaries:
Amongst the TCM Lung functions it is that of providing a boundary between the body and the environment that enables goodness to enter – i.e. Oxygen – and keeps out harmful pathogens. Similar functions are performed by the skin and intestines both of which filter out what is harmful and allow nourishment of different kinds to go further into the body. In order for this protective energy to work optimally, we need to keep ourselves strong and also protect ourselves from harmful environmental influences. Keeping strong in this context is done by consuming nutritious food, accessing clean air, and performing breathing exercises, as well as getting enough rest to avoid over-exhaustion. All of this will ensure that plentiful Qi is made by the body.

A strong Qi however, may not be enough to protect us when pathogens are particularly strong. Because of this, we also need to put up physical barriers against the elements in the form of coats, hats, and scarves, and keep our bodies and environment clean and free of germs.  In TCM, Wind is considered an external pathogen which is the carrier of a 1000 diseases. This pathogen can “invade” the body easily during the autumn particularly through the neck and head, although it can also invade the skin when we are particularly susceptible to it. Wind can be a main factor in many conditions including the common cold, headaches, allergies and rashes.


At emotional and mental levels, the setting of boundaries involves understanding when we are allowing people or situations to override our needs, opinions, and desires. We often wait until we have become stressed, anxious, and even physically ill before we dare acknowledge that a situation or relationship is affecting us in a negative way. Yet it is always down to us to make things better for ourselves as we cannot expect a person or circumstance to go away or change on its own accord. I have experienced this myself and seen countless examples of it in the clinic: in the fear of disappointing others or speaking up, we may push ourselves to the point of making ourselves chronically ill. We then realise that there is no job or person in the world worth our health and that in fact we need to ensure our own wellness before we can be truly reliable, do our best, or look after others. Putting ourselves first and saying no without aggression or guilt are in this case important self-preservation tools born of self-respect rather than selfishness.                                         


Autumn diet
Although there are many diets around which seem to work for at least some people, the one thing that a healthy diet must consist of - for the most part- is natural fresh foods that do not contain any chemical additives, and which preferably are cooked from scratch. All the better if these fresh foods are in season and locally produced as well. Food loses nutrients in time so the further fresh food travels the less nourishing it is. 

If we make at least 50 % of our food fresh vegetables and fruit and ensure that our supply fluids and protein is adequate for our needs, we will be providing ourselves with good nutrition, protection from disease, and constant fuel for our energy. Following TCM views of the digestive process, it is preferable for us to consume cooked warming foods in the colder months. This means that soups and stews are commonly recommended over cold and raw foods. For more on this, have a look at the posts on TCM diet.

To enhance the energy of the Lung we invariably need to increase the energy of the whole body.  Making sure that we eat well and in a way that takes into account our digestive power is essential here as our ability to digest directly relates to our ability to transform food into energy or Qi. This means that for those whose digestive system struggles to process food, eating foods that are easily digested needs to be the focus of their diet so that food can be transformed into energy which will in turn fuel the digestive power itself. My posts on Qi and on the Lungs expand on this and explain how to maintain a strong Qi and healthy Lungs.


For humid areas like SW England, particular recommendations for this time of year are aimed to reducing mucus and phlegm formation as they can easily accumulate in the Lungs, respiratory passages and Large intestine and impair their function. Those with a tendency to congestion anywhere in the respiratory or digestive systems can benefit from avoiding mucus-producing foods such as milk and wheat products and refined sugar. Alcohol, sweeteners, processed and chemically-laden foods, and rich greasy dishes can also produce mucus and are best avoided. Adding small amounts of spices can be a good way to prevent phlegm and mucus from accumulating. Fresh ginger, thyme, and mustard seeds are particularly effective at this and can be added to meals on a daily basis. However, if there are signs of fever, flushing - especially night –, acid reflux or dryness anywhere in the body it is best to avoid these herbs as they are warming and drying.

Keeping the respiratory and digestive tracts free from blockage and accumulation benefits the functioning of these systems and results in enhancing the ability of the body to produce Qi. This can have a direct impact on our energy levels and immune response and can help us stay healthy through the coming winter months.