12 Weeks of Power : The beginning
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Engaging in the program I set out a couple of weeks ago hasn’t been much of a problem. Finding the extra moments to use for writing to the blog has been more of a challenge. :)
I have altered the program in a couple of important ways, however. It just hasn’t worked for me to limit the formulas to those I indicated at the outset. Instead, I find myself naturally gravitating to working with 3-5 formulas each week as I work with patients. Given that I’m not taking the Chinese herbs portion of my NCCAOM board exam until the summer, I’m okay with not doing a rigorous and systematic review of formulas in the next 12 10 weeks.
The Bladder and Kidney channels have gone alright. To be entirely honest, it’s been hard to get back into the kind of basic, point by point, review that I engaged in when I first learned the points. But, I’m keeping at it and having some success. I find that it’s better for me to cut the big channels into pieces. That shouldn’t come as much of a surprise.
Anyway, I will do my best to release material as often as I can – but I can’t promise much until graduation. When something really, really excites me. I’ll let fly. There’s so much to talk about, so much HAPPENING here in Portland (like my/our new clinic – Watershed Community Wellness : that’s just a placeholder page, but check it out!) and such quantum leaps occurring in the field of Classical Chinese Medicine, such unbelievable personal transformations happening on every level… it boggles the mind, and limits one’s time.
But, quickly, I’ll share something about herbs.
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One formula that has quickly become indispensable to me in clinic is 枳實薤白桂枝湯 Zhishi Xiebai Guizhi Tang. This formula, from Zhang Zhong Jing’s Jin Gui Yao Lue (JG) is in the 9th chapter of that text which bears the title ”
It contains the following herbs:
- 4 pieces Zhishi / (4 grams)
- 4 liang Houpo (12 grams)
- 1 liang Guizhi (3 grams)
- 8 liang “bakeri” (24 grams – opinions differ whether this is Xiebai or Congbai)
- 1 piece Gualou (15 grams – some say use only the seeds)
I have been taught to use the dosages in the parentheses. The question of dosage is an interesting one, but I don’t feel like getting into it right now. The whole debate hinges on the definition of various terms of measurement in the Han dynasty. All of the evidence I have seen indicates that the dosages above are as close to correct as we are ever likely to get. I use these dosages in clinic with great results. Of course, the Zhishi dosage would seem to be reduced from what is likely to be noted in the JG – this dosage is something I inherited and I haven’t looked much farther into it, I’m afraid.
Now, this formula is said to treat “chest obstruction syndrome” which comes with the following symptoms (from the Jiyuan translation) : obstructed Qi beneath the heart or bound Qi with distention in the chest and ribs, flushing Qi from the hypochondria to the heart. In the first edition of Bensky’s formulas text, I can’t even find the formula. On Rootdown, the functions of the formula are listed as: “unlocking the Yang,” “dissipating clumps,” “expelling phlegm,” and “directing the Qi downward.” What do we learn from all of this? The condition involves some blockage in the chest that prevents Yang from circulating there, and the condition most likely involves some variation of phlegm. This phlegm is meant to be moved downward, unblocking the Yang, and freeing the chest. Now, this is an incredibly simplistic description of the basics of the formula. I could easily write twenty pages on this formula alone!
I’ll talk more about this formula soon – I’d like to break down the individual herbs, looking at their flavor and Qi, both in a contemporary way and using both the Shennong Bencao Jing and the Tangye Jing. This will go a long way towards helping us understand the formula more fully. Then I will share some of what I’ve learned about the formula in clinic with Arnaud Versluys, including some novel applications. The rub of the whole thing is this : I’m starting to see this formula as somehow related to the series of clearing treatments that is often done in Worsley style five element acupuncture – like the Internal Dragons and Aggressive Energy treatment. It’s not a one-to-one correspondence, but there are some very interesting similarities and relationships there. I’d say about 75% of my patients end up needing this formula, or another Xiebai containing formula, incorporated into their treatment.
More later – share your thoughts in the comments!
Eric
How am I going to survive the next twelve weeks? A study in the power of Chinese medicine theory
Well, it’s finally come to this - the final quarter of my formal institutional training in Classical Chinese Medicine. Wow. I mean, really, wow. There are quite a few of you out there who are in the same boat I am – looking graduation in the face. It’s exciting, yes, but it’s also a little hard on the nerves. In my case, I have a number of personal and professional obligations criss-crossing through my schedule. They all have to be satisfied if I am going to end my NCNM career with a bang. I spent several hours today thinking about how best to approach the sheer cliff that is my next twelve weeks.
Along with my normal class obligations, my Student Government (SGA) duties, my family life and my thesis writing (and a whole lot more I won’t list here) – I have to get ready for my NCCAOM board exams. My plan is to have all the exams done before I graduate so I can get licensed as soon as humanly possible. I already have a clinic to move into which makes my desire to be done even more acute. However, this is an additional complication, as I also have a variety of duties related to the clinic as I am a primary manager and strategizer.
It may sound funny, then, that I plan to add just one more obligation to the pile – a weekly (at least) post to this blog. The post will cover particular material that I am reviewing. The reviews will nominally be “for boards,” but will also serve as a way for me to prepare for my clinical exit exams and just generally keep the material I’ve accumulated over four years fresh and memorized. I’ve received a few emails from students and practitioners saying that they want to see some of the “good old days” posts that cover pretty simple topics germane to the practice of Chinese medicine. In specific, people have requested discussions of herbal formulas and a classical view on acupuncture. I think this effort on my part will serve to satisfy the desires of my clamoring public. ;)
So, how shall I proceed? I’ve devised a structure based – perhaps predictably – on the organ clock. Each week, I will use one section of the organ clock to structure my boards/general study. This will also serve to keep that material fresh and refreshed, be a wonderful marker for the passing time AND help me to produce posts. I’ll write each week about the formulas and/or channels that I’m studying, perhaps going into depth with one point or formula, or doing an overview of some general topics. I may or may not weave in board (read: TCM) material in an explicit way. I may or may not weave in the ways that the organ systems manifest in my experience of the whirlwind that my life has become. Regardless, it should be informative for all. :) I’m also hoping that seeing, in some detail, how I manage these diverse obligations and the crushing time pressure will help others in a similar situation find some inspiration. Details below:
Week 1 (April 6-12) : Bladder organ system + Guizhi formula family
- Special information for context: End of this week is a first draft of thesis deadline, I will continue to work even after turning it in. I am fulfilling some community service hours by hanging out at the Oregon Association for Acupuncture and Oriental Medicine conference. Study for biomedicine board exam. Daughter starts back to school – several big projects due within 10 weeks which will require my helping her out.
Week 2 (April 13-19) : Kidney organ system + Fuzi formula family
- Special information for context: Biomedicine board exam during this week. This weekend is the last time we meet for Arnaud Versluys’ Canonical training.
Week 3 (April 20-26) : Pericardium organ system + Shengdi formula family
- Special information for context: Hope to get a case presentation slot for this week. Study for theory board exam.
Week 4 (April 27 – May 3) : Triple Burner organ system + Formulas with Xie Bai
- Special information for context: Study for theory and points board exams. Will use the relative lack of huge deadlines to work hard to push through a few Watershed (clinic) projects, particularly around marketing.
Week 5 (May 4-10) : Gallbladder organ system + Chaihu formula family
- Special information for context: Will most likely take CM theory board exam this week. Study for points board exam.
Week 6 (May 11-17) : Liver organ system + Danggui formula family
- Special information for context: My final draft of thesis due to readers/advisor. Study for points board exam. I’m going to need a lot of Liver this week. :)
Week 7 (May 18-24) : Lung organ system + Mahuang family
- Special information for context: Hope to get a case presentation slot this week. Study for points board exam. This weekend there will be a seminar with Brandt Stickley, LAc that I hope to attend.
Week 8 (May 25-31) : Large Intestine organ system + Dahuang formula family
- Special information for context: There are two important student government events this week/weekend. Craig Mitchell will also be teaching an all day seminar and I’m his main contact and will be attending his class (FREE TO THE PUBLIC, LIMITED SEATING, EMAIL ME IF YOU ARE INTERESTED – exciting! Study for points board exam.
Week 9 (June 1-7) : Stomach organ system + Stomach counterflow formulas (like Xuan Fu Dai Zhe Tang)
- Special information for context: I defend my thesis this week (what better time to study formulas for throwing up?) SGA elections will be prominent in my world. Study for points board exam.
Week 10 (June 8-14) : Spleen organ system + Ganjiang formula family
- Special information for context: Will most likely take points board exam this week. My daughter finishes 6th grade this week – so time becomes even more constrained. Awesome timing! I figure my Spleen will be pretty taxed by this time, so when better to immerse myself in the world of Ganjiang and Spleen 3?
Week 11 ( June 15-21) : Heart organ system + Formulas where Gancao is dominant (like Zhigancao Tang, which I will likely need at this point…)
- Special information for context: Likely will have our SGA handover retreat to usher in the new administration. Which means, in some ways, that my SGA duties diminish to some degree. Make sure everything is in place for applying for licensing in Oregon.
Week 12 (June 22-29): Small Intestine + Formulas for dysenteric conditions
- Special information for context: Last week of school at NCNM ever! Will be a lot of wrapping up SGA stuff, making sure requirements are finished, ordering transcripts and board exam passing certificates, and as soon as I am able – apply for licensing. I do plan to “relax” after this point, whatever that means for me.
** Note 1: I tried to pick formula and channel pairs that made sense, but not all of them are perfect. Sue me!
** Note 2: I’ll be limiting myself to approximately 6 formulas per week so I can dive deep, but there may be situations where several related formulas are included. I will also be focusing on the most commonly used points on channels so that I can leave time for learning about the rest of the channel system (luo, divergent, sinew, etc).
** Note 3: I will be using a variety of methods for study during this time, and if it strikes me, I will post about those methods. A lot of them I have already discussed on the blog. I will be using special memory techniques (like Roman Room) as well as iFlash flashcards on my computer for memorization. I will also be using all of my senses to deeply know both Chinese herbal formulas and acupuncture points and channels.
The acupuncture channels and Chinese herb flavors
This is a guest post from my friend and colleague, Michael Givens. Please enjoy and look forward to more posts from him in the future. :)
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It’s been a while since I’ve submitted an article for this blog, but I recently read something both inspiring and provocative, which has moved me to writing; this, and that I am in the thick of writing my classical Chinese Medicine thesis for NCNM on a related topic.
Interestingly, I found this article after I began searching for sources of the theory in classical herbalism of “Thick and Thin Qi and Wei (temperature and flavor)”, which I am using as a means of attempting to stir our theoretical constructs away from a more material/ substance based approach to herbalism, to a more “Qi” and “Wei” or “heavenly” and “earthly” based approach. My reasons for doing this are, firstly, to understand more clearly how the internal architecture of a formula works within human physiology, allowing it to have a specific direction; and secondly, to suggest that the “channel affinity” theory which dominates our profession is something quite distinct from classical theory.
The reason this is interesting is that the author, Tony Reid, used the very source I was planning on using to demonstrate how herbal theory was being superimposed upon acupuncture theory, essentially “herbalizing’ acupuncture by making both the herbs capable of moving into specific channels, and making acupuncture points fit a “prescription”. On the one hand, we are both looking at the same problem and trying to move back to the source of our medicine; yet, on the other, we are coming to a different conclusion about the importance of classical formula science.
I would like to direct the reader to the article [www.chinesemedicinetimes.com/section.php/265/1/the_neglected_art_of_channel_palpation], for I think it is a very important one, and in reading it, I think my point will be easier to make. Nonetheless, here it is: There is a problem with the institutionalization of Chinese medicine, yet the problem is not only that it, as Reid clearly explains, personal and individual palpation of the patient on the table (channel, abdominal, pulse, tissue…) can only be taught through a “discipleship” or “mentorship” and is so essential to classical medicine (yet left out of TCM education), but also that the “herbalist” model which is overwhelming the profession and education of Chinese medicine, is not the classical model of formula science.
Classical “formulism” and classical acupuncture have the same source, the same theory and the same approach. This should by no means lead us to create “acupuncture prescriptions” based on “point actions” just as it should by no means lead us to create herbal prescriptions based on “herbal actions”, though in both cases, knowing the points and the herbs is nonetheless essential. It is the channels and the conformations of the patient, right in front of us, which should inform us of how to treat. Thus, I now see the great importance of understanding classical palpation and meridian acupuncture in conjunction with classical formula science.
Therefore, we are now challenged to investigate how our medicine works without relying on TCM materialism and Western science. To do this, we must work from deeper understanding of the classics.
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(Michael is eagerly awaiting responses to this article – please leave your thoughts and research in the comments!)
Herbal quality : the Fuzi (aconite) dilemma
As you all know, herbs are my passion. More accurately, formulas are my passion. Formula science is my passion! :) But, I do have a strong affinity for the herbs as plants and study them as such. Further, I have a real desire to get as close as possible to the original way of prescribing the herbs in formulas, where “original” means Han dynasty or thereabouts. If you read the Shang Han Lun, there are very specific instructions for how herbs are prepared and how they should be processed. Many of these instructions appear to be ignored in contemporary times, and I can only imagine that this is having some effect with regards to our herbal effectiveness.
However, even if we prescribe and prepare the herbs exactly as indicated it means nothing if the quality of the herbs is terrible. Recently, in a class at NCNM, a professor allowed us to taste Fuzi from different sources. We had three samples of bulk Fuzi. One was from a popular herb company, the second was from China, specially prepared in the traditional way at the instruction of Heiner Fruehauf. The third was raw Fuzi – unprepared – from China.
We were asked to observe how the herb tasted, its texture, and how it made us feel. The first batch was – depressing. It was brittle, soft, had almost no flavor and absolutely no bodily sensation resulted from tasting it. This is similar to what is found in many clinics. We tasted the second batch a few minutes later, the differences were striking! There was an almost immediate pungency and quite a bit of numbness on the tongue. This numbness continued for quite a while. We have been told by several professors that we want to find this quality in the Fuzi we prescribe to our patients – it indicates that the living potency of the herb is retained.
The best fun happened when we tasted (just a bit) of fresh Fuzi. Oh boy! My THROAT was numb after that one. You could really feel the medicinal quality – it was incredible. The only thing I could think after this little taste test was, “How can we get more of the good stuff and less of the bad stuff?” The consensus seems to be that the best quality Fuzi is not available in the states or really anywhere in the West. Further, the recent earthquake in China apparently did great damage to the areas where much of the high quality Fuzi is produced – creating even greater shortages.
The quality of the initial herb is only part of the problem – processing is the next piece of the puzzle. Fresh Fuzi is often brined, and then treated in various ways. Reports have indicated that industrial chemicals and harsh processes are used in the preparation of lots of commercial Fuzi. At the very least, you can tell that much of what’s available from the major herb companies is wildly over-brined. The brining process reduces the toxicity of the herb – but we have to remember that the “toxicity” of herbs (usually produced by alkaloid content) is a large part of why it is clinically effective! Skilled herbalists know how to exploit the positive nature of the herb while minimizing the potential for harm from the strong compounds contained within. When we overprocess herbs, we don’t do anyone any favors.
How can we, in the contemporary West, make up for these various deficiencies? How can we prescribe herbs in the way they are meant to be prescribed – full of their vital force and particular benefits? How can we know if an herb has been processed appropriately? These questions can easily be added to the ones I’ve had about using local species and other related conversations on Deepest Health. I’m looking forward to hearing what you think about this important issue. Please voice your thoughts and share your research with us in the comments! No registration is necessary.
Eric
Chinese herb substitution and using local species
I thank you all for your patience as I adjust to my workload. The reality of the situation is that I’m going to have to post what I can, when I can. But, with the onset of clinic I find myself coming up with many new thoughts to share – I’ll do my best to get them up in a timely fashion. Look also for the return of the podcast this week. I know you’ve missed me. :)
Anyway, in a fantastic lecture by Dr. Arnaud Versluys this weekend, I was reinspired to consider a very real problem in Chinese herbal medicine. We use herbs that travel long distances, are sometimes beset with chemical and heavy metal toxicity, are sometimes banned by ill-informed government agencies and some of which are becoming rare and, thus, expensive. Given that I am very serious about a rigorously authentic Shang Han Lun
The particular herb that came up in discussion about this issue was Xi Xin – Asarum – Wild Ginger. I love this herb. It’s used in a couple of indispensible formulas, perhaps most importantly in Dang Gui Si Ni Tang. Most herbalists agree that there’s simply no substitute for Xi Xin, but I’ve seen or heard of people try to replace it with Wu Tou, Yu Jin, Sheng Jiang + Mai Men Dong (?!) and other interesting combinations. Most of these same herbalists agree that it’s simply not the same without Xi Xin.
The ban on Xi Xin for practitioners is ridiculous to the extreme and I’m not going to discuss that here. What I would like to hear people discuss is how they make substitutions in these cases. When an herb you need isn’t around, what do you do? What herbs have you had to learn to live without? I understand that UK herbalists are quite restricted in what they can prescribe – how have my UK readers dealt with this problem? Even when a governmental agency isn’t busy interfering, we sometimes lose herbs. Consider Xi Jiao, rhino horn. Consider the precarious state of Ren Shen, ginseng.
There are a couple of associated questions that come up when one considers this issue. One is – should we simply learn to work with fewer, simpler herbs? Dr. Versluys is known to say that he thinks he could do a fair job of treating patients with only 10 herbs – a set of cooling herbs in each of five flavors and a corresponding set of warming herbs. If you know formula science and architecture, such artistry is certainly possible. Is this the standard towards which we should strive? It seems far superior to the never ending quest for the “perfect herb for cancer” or memorizing five hundred herbs, over half of which are specialized for particular symptoms.
Taking this a little bit farther, we should consider the wisdom of relying on herb sources that can only be accessed by air shipments from another continent. Given peak oil, given the unstable political nature of our planet, given the environmental crisis we find ourselves in… should we at least consider the possibility that we may need to rely on local sources for our herbs at some point in the future?
My friend said an interesting thing to me today. In the course of discussing this various issue he said, “To be true Classical Chinese herbalists, we should use the herbs we find around us.” I didn’t question him any farther on this issue, but I think he’s right from some perspectives. Learning the Chinese herbs and formula science so deeply that it is second nature allows us to look at all plants, animals and minerals with the eyes of a Classical Chinese herbalist. Then it seems at least possible that we could, if necessary, find other materials that meet the needs of our patients.
I’d be interested to hear your thoughts on this rambling post. Doubtless there are many opinions out there – share them here on Deepest Health by responding in the comments. No registration is necessary and you can even post anonymously if you are respectful.
Thanks for reading,
Eric
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Updates from my personal blog (Ericgrey.com)- Some lyrics… May 12, 2009
- A bikeride into God May 8, 2009
- Quiet versus moving Qigong practices March 7, 2009
- A new perspective on the healthcare crisis February 26, 2009
