After posting an earlier post discussing the first of my five maxims, a request came up to present the rest of them. Never one to shy from a good request, today I’d like to present Reynolds’ Second Maxim, which is “Don’t hear horses and think zebras” which could also be phrased “Thou shalt not overcomplicate!”

“This will be the seventh time we have destroyed Zion…”

I remember going to the movies to see “The Matrix Reloaded” during the course of which a neat and tidy story which everyone was familiar with was exploded into about a million little subplots and alternate storylines with a new cast of characters that became hard to keep track of and events and motivations that didn’t make a great deal of sense. That and some sort of rave/orgy. Upon leaving the theater, my girlfriend at the time turned to me and said “Uhh…that was needlessly complicated.” This I feel is an excellent example of the typical state we frequently find ourselves in, especially once herbs enter the picture.

I feel that this concept is heavily tied in to my first maxim (“What are the symptoms?”) in that you don’t want to make the mistake that many physicians have made throughout history, East and West, which is deciding what a great idea a particular path of treatment would be and  implementing it without bothering to first find out if it’s a good idea.

Not women, THIS woman

This very much applies to the TCM habit of protocol-making, where, in the example of one very popular protocol, a treatment method including both points and formulas is decided upon depending on what week of her menstrual cycle a woman is currently in. If it’s week one, she gets Formula A and Point Protocol A. Week two is Formula B and Point Protocol B and so on. Now at first glance this seems like it could be a great idea, as it appears to take into account the fact that a woman is likely to be in a slightly different physiological state depending on what week of her cycle is in. However, it fails to take into account the only thing that matters, which is the condition of the patient before you. It’s very easy to get caught up in thinking of things in broad strokes, the nature of women, the resonance between this or that herb and female physiology, lab results, and a million other things when in fact the only question of importance is still “what are the symptoms?” All information regarding symbology, tendencies, studies, typical clinical solutions, etc. is only of value insofar as it can be translated into a specific and accurate treatment for the individual. What works on “women” is of little use as we are interested in what works for this woman, whose specific menstrual complaints may have very little to do with Spleen Qi Deficiency, Blood Deficiency, etc. and may instead come from sources as varied as emotional trauma, overexercise, or acute stress.

Now this is not to say that I don’t use protocols, which would be the furthest thing from the truth. Technically, as long as we are  borrowing from someone else to match a situation, that’s a protocol. I just do my best to a) use the most powerful and effective protocols and b) only use protocols that are very strongly indicated for the case in question. The truth of the matter is that I tend to avoid overcomplication by using the most simple, direct, elegant, profound, and well…broad protocols we’ve ever had the privilege of being handed, which lie in the work of Zhang Zhong Jing.

Now those of you who attended NCNM have likely not experienced what those of us who are classic-minded but came through TCM schools have, so please try to put yourself in our shoes a bit. My particular experience frequently involved the presenting of a case to a supervisor who, especially the Chinese ones, would roll their eyes at my Shang Han Lun-based approach and instead begin rattling off piles of points, truckloads of herbs with dosages set to numbers gained via some inexplicable method that had more to do with cooking than herbology in my opinion, and sent off to make the patient better instead of doing whatever craziness I had been working on, despite the fact that 10 times out of 10 I could point to textual support in the Shang Han Lun or Jin Gui Yao Lue for what it was I was trying to accomplish. This to me is the ultimate overcomplication and unfortunately this “whatchagot” method of making formulas out of single herbs (or dui yao pairs amongst the more enlightened) is the hallmark of TCM herbology’s gross ineffectiveness.

An Example

I’ll give the following example which is, admittedly, a straw man, but one that will hopefully illustrate what I’m going on about to the non-TCM trained set. I can assure you that I have seen this very approach many times by TCM herbalists, even very experienced ones. Suppose a patient presents with the following: sore throat, somewhat mild all-over pain that is especially strong in head and back, fever, chills, yellow phlegm in chest and sinuses, headache in occipital, parietal, and frontal regions, coughing, sneezing, nasal drip, nausea, irritability. Tongue has thick white coat. Standout pulse qualities are floating and moderate at left cun position and slightly deep and tight at left guan position. I will present three different ways of dealing with this case:

Method #1: The completely wrong way: Diagnosis: Wind-Heat Treatment: Yin Qiao San, or failing that Chuan Xin Lian Pian + Bi Yan Pian. Rationale: , YQS is primary formula for early stage Wind-Heat. CXLP is extremely antiviral and antibacterial, BYP is good for runny nose and sneezing.

Method #2: The needlessly complicated way: Diagnosis: Wind-Cold invasion turning into Heat. Treatment: Make the following symptom-based custom formula (with rationale):

Lian Qiao + Jin Yin Hua: Good for Wind-Heat, clears Heat, reduce fever, soothes sore throat
Yan Hu Suo: #1 herb for pain
Du Huo+Ji Sheng: #1 combination for back pain
Gao Ben: relieves head pain, back pain, also good vs wind
Ban Lan Gen: clears Lung Heat, antiviral/antibacterial
Lu Gen: clears Heat Phlegm from Lungs
Jing Jie + Fang Feng=expel Wind
Niu Bang Zi: relieves cough, clears toxicity
Bo He: releases exterior, clears Heat, relieves irritability
Sha Ren: nausea
Gan Cao: clears Heat, harmonizes formula

Method #3: The right way : Diagnosis: Combined Taiyang-Shaoyang syndrome Treatment: Xiao Chai Hu Tang modifed as follows (as listed in the original SHL text):

Chai Hu
Huang Qin
Ban Xia
Gan Jiang
Zhi Gan Cao
Wu Wei Zi
Gui Zhi
Gua Lou Shi

Rationale: These are the modifications given by Zhang Zhong Jing to match this very situation. Even if you didn’t know these, by having a working knowledge of the SHL/JGYL you would know enough of the approach to work this out for yourself. There’s no fishing around for herbs to match up vs symptoms and having to guess which option is better than another, its all there already. The problem is primarily blockage in the Shaoyang network with some accompanying Taiyang symptoms. Xiao Chai Hu Tang is the primary formula for resolving this type of blockage with a couple modifications made to assist. Note that the point of this formula is to unblock Shaoyang, unblock Taiyang, unbind the chest, drain damp, strengthen Taiyin and that all curative actions are based out of that without having to make the World’s Biggest Formula in an attempt to solve a relatively simple problem that was solved (and written down) a couple thousand years ago. As Arnaud Versluys says, “there’s really no reason to re-invent hot water every time you need to cook something.”

Even in the case of chronic disease, the approach remains the same: choose the correct root that most accurately fits the situation and modify to match specifics. It also helps to have reliable information to draw from, which is of course why I insist that Zhang Zhong Jing’s work must be the toolbox that all Chinese herbology reaches into when it needs a tool. Before you start thinking “Ok, I’m going to take this formula and mix it with that formula and then add these herbs and then refer them to that doctor for this therapy and…” first see if there is a simple solution to the problem, as is so often the case. Don’t be afraid ti mix and match with formulas, herbs, modalities, etc. but make sure it’s necessary first.

I’m sure I will expound upon this at a later date but for now I hope this gets you thinking in the right direction.

Overcomplicating Things

Related articles

• Thoughts from the Front Line (9)
• The Life-giving Sword: version 2.0 (0)
• Strategy in Chinese Medicine: Timing and Momentum, pt. 3 (2)

Let’s conclude this series on strategy in Chinese medicine with our final two points.

Treating Erratically

Martin Luther once said that Mankind is like a drunkard who upon falling off his horse on one side overcompensates and promptly falls off the other side. In Chinese medicine, the opposite of sticking with the same protocol no matter the situation is constantly changing what you’re doing. Now, I want to draw an important distinction here. The speed with which you have to make adjustments will depend on many factors, especially the modality being used. The very nature of acupuncture is such that you’re both creating and reacting to changes in the patient’s energy field, which by its nature is subtle. This just naturally leads to treatments in most cases being completely different from week to week in a lot of patients.

In the case of herbs however, what you don’t want to do with a chronic case if you can possibly help it is to leap from formula to formula. If you have legitimately resolved a layer of the condition and are ready to move to the next thing, that’s one thing. What you don’t want to do however is “Ok this week I think I’ll give you You Gui Wan because last week I gave you Si Jun Zi Tang and the week before I gave you Xiao Yao Wan, so I feel like we’re covering all the bases.” As I have heard Heiner Fruehauf eloquently state, you have to have the courage to decide on a base formula that adequately meets the conditions and then stick with it long term by regularly alternating a small amount of the ingredients.

That said, I don’t want to discourage anyone from having the courage to take a well-calculated risk when they aren’t 100% sure of the outcome. Let’s be honest, not many of us are completely sure about exactly what’s going to happen every time they hand their patient a bottle. I certainly am not. In fact, I find myself white-knuckling the patient’s chart, re-re-checking my conclusion long after they’ve gone home more than I care to admit. Its part of the Chinese medicine experience in our age, in my opinion.

In short, treat what you see and not according to pre-conceived notions if you can possibly help it. When in doubt, remember Reynolds’ First Maxim!

Too Many Doctors Spoil the Case

A huge problem in Chinese medicine-and one not easily resolved-that you will run into with many of your patients is the fact that you are only one of a small army of medical practitioners that they are currently seeing, and often the last one to the party, so to speak. You will often find yourself having to cope with not only the patient’s original condition, but also the added side effects and pulse-obscuring properties of drugs given to them by their team of MDs, the pile of supplements procured from their local health food store, their ill-advised Medifast diet/candida cleanse/detox protocol, their equally ill-advised weight room habit, their Reiki practitioner, their support group, and oh yes, their OTHER acupuncturist. Different doctors I’ve talked to have had different things to say on this subject. Dr. Leon Hammer has said that he typically suggests that if the patient would like to try these other methods that perhaps they come back after having first exhausted their possibilities. A famous Taiwanese doctor that a couple of my friends learned under is reputed to have refused treatment to patients who were currently under the care of someone else. How you handle this is your business of course, but suffice it to say that the more factors there are in the treater equation the more difficult it’s going to be to get anywhere with the case.

In America at least, most of the people who seek us out are in a high degree of physical and energetic chaos. The nature of our societal demands such as our crazy “rest is for the weak” work ethic, our fetishization of requiring the absolute best of the best of everything we come into contact with, keeping up with not just the Joneses anymore but the rich, famous, and Hollywood-employed as well, our terrible diets, our masochistic exercise programs, our sense of entitlement and lack of tradition, our rejection of the old and glorification of the young, our out and out INSANITY in every corner of our existence produces a patient who is coming apart at the seams on their best day. The introduction of any more chaos whatsoever into this picture can cause nothing but further catastrophe. It is absolutely not surprising that our most common “big” diseases are cancer and autoimmune conditions. We are chaos personified, the absolute opposite of peaceful growth and progression like the seasons. Nearly every patient that walks through our doors will be in this state and it would be well to keep in mind.

Also worth noting is that the primary problem in the chaotic state is that the very Yin and Yang of our beings is separating and with that separation comes greater and greater vulnerability to more disastrous diseases of every sphere. In my opinion, this separation begins at the level of the Gui Zhi Tang-type Taiyang invasion (note that Gui Zhi Tang’s most famous characteristic is that of “harmonizing Ying and Wei” which is nothing less than putting Yin and Yang back into contact with each other) and ends in death. Everything else along that continuum is some degree of separation of Yin and Yang and needs to be accounted for thusly. I fervently recommend that anyone not intimately familiar with this concept read the following article by Dr. Hammer entitled,” Towards a Unified Theory of Chronic Disease with Regard to the Separation of Yin and Yang and ‘The Qi is Wild.”

How do these two topics relate to timing and momentum? Simple. If you’re trying to walk to Albuquerque you’ll never get there if you walk toward Portland for a day, then San Diego for a day, then Atlanta for two days. You also won’t get there if you ask directions from everyone you meet and they all tell you something different. Timing and momentum is doing the right things at the right time consistently. Cure doesn’t happen without it.

That concludes this series. I hope you’ve gotten something useful out of it. If you’d like to go back and read the previous segments, here they are again:

http://deepesthealth.com/2010/strategy-in-chinese-medicine-timing-and-momentum-pt-1/

http://deepesthealth.com/2010/strategy-in-chinese-medicine-timing-and-momentum-pt-2/

http://deepesthealth.com/2010/strategy-in-chinese-medicine-timing-and-momentum-pt-3/

Strategy in Chinese Medicine, pt 4: Timing and Momentum

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• Strategy in Chinese Medicine: Timing and Momentum, pt. 1 (6)
• Strategy in Chinese Medicine: Timing and Momentum, pt. 2 (1)

We hope you have enjoyed Mitesh’s fine work about Chinese herb flavors and their combinations.  What I loved about this project was the willingness to examine cherished Chinese medicine concepts – testing them using the most sophisticated laboratory known on Earth – the human body.

—–

If you missed any of the series, just read through the links below.

Part 1 (Beginning of the Pungent + Sweet = Yang Qi experiment)

Part 2 (Continuation of the Pungent + Sweet = Yang Qi experiment)

Part 3 (Conclusion of the Pungent + Sweet = Yang Qi experiment)

Part 4 (Beginning of the Sweet + Sour = Fluids experiment).  You’re on part 5, the conclusion of the Sweet + Sour = Fluids experiment, right now!

Flavors Experience

This section contains the experiences felt during the ingestion of each herb and pairings.

Calibration Herbs

The calibration process was to know the intimate experience of the herbs from a personal perspective and have a knowing that converged in a way that the authors of the Tang Ye Jing had.  Therefore, much of this is poetic serving a pivot role for the further experiences. This is a rehashing from the first experiement.

Dang Shen
The simple act of sipping this herb allowed for relaxation to pour through my entire body. Hints of warm milk were hidden in this and  spun me back to childhood.

All I wanted was to cuddle up and under a comforter, turn on a movie and rest.

Ancient tension fell away.
Worries melted into peace.
And a smile held me in her embrace.

My breath grew deeper and unhurried and my brow opened and tingled in delight.

(Sheng) Di Huang
Wafting past my nose
my heart flows with joy
Exhale
Joy settles

Gently blowing on the hot medicine
Sip
Sip
Sip
This dark mistress grabs a hold on my mind
the initial joy of heart is hidden because
the over powering grounding of mind
Sip
Sipsip

The bottom of my tongue holds true
as if waiting for the fog on the horizon
to clear
I grip the ground and straight
my neck
peering into the depths

Breathe
Breathe
sip

Gulp

My sides now ground
and the imminence of what may be subsides
I am Here
Somber
Salty
But bound
My upper heart beats
in unison with the first

I feel a turtle shell hold me together above my head

Peacefully and powerfully she commands me not to drink anymore…
What do I do with the rest.
Offer it to a friend.

Xuanfu Hua
Bitter!
My eyes jump from my head!
Never let that touch your lips again!
Hold on… a phone call… let me answer that
I’m back.
Feeling cleaver.
Not so sure if that’s a good thing.
But reverent now.
This goes to my heart
Tears that otherwise fog my mind
Lift in wondrous praise like steam
Something shines through
Quasar like
Going to surrender as stairway to heaven plays
Drink her all. in deepened brightened ming-yi.
Sometimes all of our thoughts are misleading.
super cold

That one was particularly hard on my stomach and had to neutralize it with a little Sheng Di Huang and a little more of Dang Shen.

Wu Wei Zi
I’ve tasted you before… have I not?
What a joy to pucker my lips
But taxing this time.
My spine straightens into a J
Relax but strong
My sides again.
But especially my shoulders come to life
Thank you for being warmer than XuanFu
You shook me all night long!!!!!
Did you know that the electromagnetic field of the earth is one of several qualities that allows it to be habitable for life? We’d be with out a subtle protection and possibly a way of thinking without it.
You are beautiful!
When the levee breaks

Gui Zhi
Pungent.
Mud that has been hardened flaking off the back of my neck
Flavorful breathing
Gentle muscle relaxant
Effervescent smile
Delicate
Does it even work?
I think  so.
A little fiery
Playful?
Giggling
Gypsy!
I’m working hard to keep my spirit in my body

Combinations

These combinations are explored in a more prose and scientific sense. It lacks the poetic nature of above because I’m looking for a convergence of experiences.

Sheng di Huang and Wu Wei Zi

Water and Metal

Salty and Sour

At first it settled my energy. But then it started to awaken my senses after about 10 minutes of sipping.As time comes on, its effects become more powerful. It seems to settle me and awaken me a little at a time. Eventually it started to kick out some stagnation in my body which was delightful. As a flavor combination, I found it rather consolidating and grounding.

Xuan Fu Hua and Sheng Di Huang

Fire and Water

Salty and Bitter

The first thing that jumps out at me is the intensity of smell and flavor of Xuan Fu. The powerful nature of the Xuanfu Hua forced me to consolidate myself into a meditative state. It drew me into my heart’s warmth and asked that I shut my senses. Once inside, the qi moved along the most primal pathways in my body with ease and authority. Its not they were excited to do so, rather that when all else was withdrawn, this was what held its ground out of necessity.This take lot of stomach energy to digest. And so proceeded cautiously waiting for my energy in my stomach to return. In fact I hesitate to take another sip at this time.

Gui Zhi and Sheng Di Huang

Wood and Water

Pungent and Bitter

The three fire centers in my body, ming men, heart and third eye warmed immediately.The expansive nature of pungency is contained by the sinking nature of water and water is then bought to its bounds through the pungency. I feel like this is living water.

Xuan Fu Hua and Gui Zhi

Fire and Wood

Salty and Pungent

This is great! Its the first time Xuan Fu Hua hasn’t just shut me down. That coldness is spread through the rest of the body and has a warming and protective effect. Its still meditative but gently so. There’s an internal external balance here.

Gui Zhi and Wu Wei Zi

Wood and Metal

Pungent and Sour

There’s is something unbelievably beautiful about this combination! I found an area or stagnation in my right side started to pulsate and move. This was rather impressive how it was able to awaken and  circulate energy around my body.

Wu Wei Zi and Xuanfu Hua

Metal and Fire

Sour and Salty

This basically wants to run through my body rather quickly. Its like a brick in my digestion. Which seems to lay on top of the lower half of my digestion. I was careful not to ingest too much of this as it seemed to most potent combination yet. This is the closest to what was said in the Suwen regarding Sour and Bitter “gush forth Yin.”

Conclusions

There is definitely need for further investigation. I still have quite a bit of confusion with the Fire Calibration Herb of Xuanfu Hua and the Water Calibration Herb of Sheng Di Huang. However, when paired together, the classical Fire and Water reference didn’t fail to impress.

I was also astonished with the effects of Wood and Metal working together. This was powerfully circulating on a more surface level compared to the primal circulation of Fire and Water.

I would like to continue working with the Bitter and Salty Herbs according to Tang Ye Jing assignments and -see if I truly understand what they were trying to say with these.

————–

Appendix 1 – Further Combinations

Three Taste Combinations
Pungent + Sour + Sweet
Pungent + Sour + Bitter
Pungent + Sour + Salty
Sour + Sweet + Bitter
Sour + Sweet + Salty
Sweet + Bitter + Salty

Four Taste Combinations
Pungent + Sour + Sweet + Bitter
Pungent + Sour + Sweet + Salty
Sour + Sweet + Bitter + Salty

Five Taste Combinations
Pungent + Sour + Sweet + Bitter + Salty

Appendix 2 – Herbs Selected

Any notes on the selected herbs will be given here including Shen Nong Ben Cao entries and TCM assignments.  SNBCJ information is taken from the Blue Poppy Press translation of the text.

Ren Shen (Dang Shen) – Sweet Calibration Herb (Sweet of Sweet)

The Ren Shen mentioned in the Tang Ye Jing maybe, as Dr. Fruehauf suspects, actually Dang Shen. Here is his explanation as to why this may be true:

One of the two stellar constellations that are associated with the 4th month of the year is called “Shen”–the Three Stars (Orion), the original character for Renshen (Human Trinity: ginseng). In ancient China, every region of the sky was considered to be linked to a region of China, in this case the state of Wei. Wei includes the district of Shangdang, where China’s best Dangshen grows. Dangshen, therefore, represents the earthly Shen grown in Shangdang, the region on which the Heavenly Shen projects its qi. From a purely clinical perspective, any northern type of ginseng would have overpowered formulas such as Xiao Chaihu Tang or Banxia Xiexin Tang, where Chaihu/Banxia is supposed to be the lead herb.

For this reason, I selected Dang Shen to be the Sweet of Sweet Herb. Although this herb was not used this time, I wanted to share this information again.

There is no Shen Nong Ben Cao entry for Dang Shen however, the entry for Ren Shen, a Superior class Herb, is given below:

Ren Shen is sweet and a  little cold. It mainly supplements the five viscera. It quiets the essence spirit, settles the ethereal and corporeal souls, checks fright palpitations, eliminates evil qi brightens the eyes, opens the heart, and sharpens the wits. Protracted taking may make the bod light and prolong life. Its other name is Ren Xian (Human Incarnation). Yet another name is Gui Gai (Ghost Shield). It grows in mountains and valleys.

The TCM listing of Dang Shen is as follows:

• Category: Herbs that Tonify Qi
• Channels: LU, SP
• Properties: Sweet, Neutral
• Latin: Radix Codonopsitis Pilosulae
• Chinese: 党参

Wu Wei Zi – Sour Calibration Herb (Sour of Sour)

According to the Shen Nong Ben Cao, Wu Wei Zi is a Middle Class Herb. It goes on to state:

Wu Wei is sour and warm. It mainly boosts the qi, treating cough and counterflow qi ascent, taxation damage, and languor and emaciation. It supplements insufficiency, fortifies yin and boosts male’s essence. It grows in mountains and valleys.

The TCM listing of Wu Wei Zi is as follows:

• Category: Herbs that Astringe, Stabilize, Bind
• Channels:HT, KI, LU
• Properties: Sour, Warm
• Latin: Fructus Schisandrae Chinensis
• Chinese: 五味子

Gui Zhi – Pungent Calibration Herb (Pungent of Pungent)

According to the Shen Nong Ben Cao, Gui Zhi is a Superior Class Wood. It goes on to state:

Jun Gui is acrid and warm. It mainly treats hundreds of diseases, nurtures the essence spirit, and renders the facial complexion harmonious. It may serve as an usher or envoy for various medicinals Protracted taking may make the body light, prevent senility, and render the face bright and efflorescent, thus forever looking charming like a child’s face. It grows in the mountains and valleys of Jiao Zhi.

The TCM listing of Gui Zhi is as follows:

• Warm, Spicy Herb that Releases the Exterior
• Channels: HT, LU, BL
• Properties: Spicy, Sweet, Warm
• Latin: Ramulus Cinnamomi Cassiae
• Chinese: 桂枝

Xuanfu Hua – Fire Calibration Herb (Salty of Salty)

According to the Shen Nong Ben Cao, Xuanfu Hua is a Middle class Herb. It goes on to state:

Xuan Fu Hua is salty and warm. It mainly treats bound qi, rib-side fullness, and fight palpitations, removes water, eliminates cold and heat in the five viscera, supplements the enter, and down bears the qi. Its other name is Jin Fei Cao (Boiling Gold Weed). Another name is Sheng Zhan (Profound Clearness). It grows in rivers and valleys.

The TCM listing of Xuanfu Hua is as follows:

• Warm Herb that Transforms Phlegm-Cold
• Channels: LIV, LU, ST, SP
• Properties: Bitter, Spicy, Slightly Warm
• Latin: Inulae Flos
• Chinese: 旋覆花

(Sheng) Di Huang – Water Calibration Herb (Bitter of Bitter)

According to the Shen Nong Ben Cao, Di Huang is a Superior class Herb. It goes on to state:

Gan Di Huang is sweet and cold. It mainly treats broken [bones], severed sinews from falls, and damaged center. It expels blood impediment, replenishes the bone marrow, and promotes the growth of muscles and flesh. When used in decoctions, it eliminates cold and heat, accumulations and gatherings, and impediment. Using the uncooked is better. Protracted taking ma make the body light and prevent senility. Its other name is Di Sui (Earth Marrow). It grows in rivers and swamps.

The TCM listing of Sheng Di Huang is as follows:

• Category: Herbs that Cool the Blood
• Channels: HT, KI, LIV
• Properties: Sweet, Bitter, Cold
• Latin: Radix Rehmanniae Glutinosae
• Chinese: 地黄

An exploration into Chinese herb flavor combinations – the final chapter

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You will remember not too long ago when Mitesh, a student at NCNM, released some very interesting information about an experiment he was doing concerning the flavors of Chinese herbs, their combinations, and their impact on human physiology.  Well, he completed a continuation of the project for this latest term project and has consented to let me share his findings with all of you.

I want to apologize for the formatting – I’m actually on vacation and have limited time to put this together.  Sometimes, copying and pasting from other programs (like Microsoft Word) can be pretty tricky.  Hopefully, it will still be readable.

I’ll also have another student project to share sometime soon.  It’s one student’s multi-disciplinary exploration of the energetics of Chaihu – I think you’ll find it to be very interesting.  Enjoy!

—

Purpose of Experiment

This experiment is a continuation of last term’s experiment in which I combined Chinese herb flavors to see if a particular effect arose. For example, did Sweet and Pungent create an inner sensation which I would call Yang Qi? Using the Tang Ye Jing herb flavor assignments, I would combine Ren Shen, the sweet archetypal herb, with Gui Zhi, the pungent archetypal herb, assess the inner experience and see if it converged on something I would consider Yang Qi. This proved to be true.

Table 1: Tang Ye Jing Primary and Secondary Flavors

I continued this Chinese herb paring for Sweet and Sour, whose outcome, according to my teachers, should be the creation of fluids. This too proved true.

I further investigated the other two pairing with Sweet, that being Bitter and Salty. I then attempted to create descriptive markers to note the inner experience after which I then attempted to attribute my best Chinese Medicine term to the experiences.

The flavor combination testing was preceded with a calibration effort in which I poetically described the effect of the archetypal herb flavors. This allowed me to then have an authentic experience of what was meant to be Sour or Pungent.

Furthermore, I then take the a combination of primary and secondary flavors and see if the single herb would also have the same effect as the combined archtypal herbs. Therefore, would the herb with a primary flavor of Sweet and secondary flavor of Pungent, Gan Cao, create Yang Qi? And would the herb with a primary flavor of Pungent and Secondary flavor of Sweet, Sheng Jiang, create  Yang Qi as well? This proved not to be true for this case and there was no convergence is experience between any combination o f archetypal herb flavors and single herb with matching primary and secondary flavors. As such, I decided to drop this portion of the experiment and only proceed with testing of archetypal herb flavor combinations.

Background Information

The Tang Ye Jing assigns organs to flavors differently than the NeiJing. The Tang Ye Jing assigns flavors based upon shared gesture. The NeiJing assigns flavors based upon contrary gestures. For example, the Lung has a natural gesture of contraction, that akin to Metal and Fall. Therefore then NeiJing would assign Pungent to the Lung because its gesture is dispersive. Therefore, it would counteract the over-contractive pathology of the Lung. However, the Tang Ye Jing would assign the flavor of Sour to the Lung because they share the same gesture.

Another way of describing this difference is what is referred to as Tǐ Yòng體用, translated as body and use. Tǐ shows bones next to a ritual vessel. Yòng shows either a target with an arrow through it or bronze ritual tripod vessel. The Tang Ye Jing assignments focus on Tǐ whereas the NeiJing assignments focus on Yòng.

Table 2: Flavors and Organs according to Tang Ye Jing and NeiJing SuWen

Unknown to me at the time of the conception of the experiment, a line in Chapter Five of the SuWen states:

酸苦涌泄為陰
Suān kǔ yǒng xiè wèi yīn
Sour and bitter gush and leak forth yin

Originally I hadn’t tasted this flavor combination, but this time it was on the docket. Knowing that results like this were possible, I proceeded with a little more caution than when all the combinations had Sweet as a flavor.

Table 3: Two Flavor Combinations

In the future I would like to investigate triple, quadruple and all five flavors. A list in the appendix shows the possible combinations.

Methods and Design

The real question is if there was a convergence of experiences amongst herbs on a subjective level.  As mentioned previously, a primary baseline of subjective experience harmonized to the Tang Ye Jing flavors was done with the primary flavors from Table 2 above.

There was 6 oz of each herb decocted in 16 oz of water and gently boiled to a 8 oz reduction. They were ingested slowly savoring the experience. Each tasting lasted about 20 to 30 minutes for the full effect and about 10 minutes between tasting to clear the experience…

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During the next portion of this article – Mitesh will reveal the results of this, his latest experiment.  Look for it coming this week!

An Exploration into Chinese herb flavor combinations – continued!

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The past two weeks we’ve been discussing timing as it pertains to acupuncture and herbology. Let’s now tackle momentum.

As you may recall, the quote we have been referencing from the Art of War is this:

“When a falcon strike breaks the body of its prey, it is because of timing. When torrential water tosses boulders, it is because of momentum.”

What Sun Zi is talking about here is the accomplishing of something difficult, moving mountains as it were. In Chinese medicine this can be compared to dealing with difficult and intractable cases, the likes of which unfortunately are rapidly increasing in number here in the U.S. These cases are often created by incorrect or ineffectual treatment of a condition that is made orders of magnitude more complicated by the failed treatment itself. Here I’m talking about things like disease suppression, medication side effects, and the results of surgery, all things that most of our patients will have experienced in spades before they ever walk through our doors as their “last hope”. Leaving aside for now the problems of what to attack and how (something I’ll cover at a later date), let’s now assume that we have intervened in some way and had some sort of positive effect on the patient. This is where momentum comes in.

Consecutive intervention

The process is almost always going to be the same for deciding on treatment: gather the symptoms, look at the whole picture, make a decision. The next time the patient comes in this decision-making process has to be repeated. Even if the decision is to continue the treatment from the previous session, you’re still having to make the call of “what do they need me to do right now?” The time-honored TCM school clinic technique of “I did these points last week and they feel better so I’m just gonna do them again” is just not going to fly unless a proper examination reveals that yes, that combination of points is appropriate here. This is the primary component of establishing momentum, doing the right thing at the right time, repeated.

Uprooting

Borrowing from the Chinese martial art Taijiquan: in Taijiquan, a primary goal is to “uproot” your opponent (meaning, remove their structural stability) so that you can basically do whatever you want with them. My teacher’s teacher once compared this to a job he used to work at a loading dock in a harbor in Taiwan moving giant barrels from ship to land and vice versa. By themselves, the barrels were absolutely impossible for even 2-3 people to move. Yet, if you uprooted it by tilting it up onto its edge a bit you could now sort of roll it by yourself to wherever you needed it to go.

Treating chronic disease is very much like this. Your first task is to make enough initial headway against the condition that now it starts responding to what you want to do, which I can tell you is not always the easiest thing in the world. However, once you finally achieve that uprooting, now you have to keep it uprooted so that you can keep pushing it where you want it to go, like the aforementioned barrels. Explaining what to do to achieve this would take its own series, and really is the sum of all other treatment knowledge you are able to bring to bear. So instead I will tell you what not to do, otherwise known as a group of pitfalls that will effectively kill whatever momentum you have built. Note that some of these pitfalls will be of your doing and some will be of your patients’ doing. It’s part of your job to make clear to them what needs to happen in order for the desired result to be achieved, meaning achieving health.

Pitfall #1-Failing to modify

Something that is abundantly clear in Western medicine that somehow we in Chinese medicine lose sight of is the idea of habituation. A short explanation of this phenomenon is this: when the exact same treatment-of any kind-is repeated enough, the body or the agents of disease will adapt to it making the treatment no longer effective. This can actually be viewed from a couple different viewpoints. One is that the patient is rarely in the exact same situation two visits in a row (“you can never step in the same river twice”), especially where acupuncture is concerned. Another is that if you are dealing with an intelligent pathogenic agent (virus, bacteria, spirochete, etc.) if you continually show it the same attack it will eventually adapt, making the attack ineffective. Think MRSA.

This is fairly easy to deal with in acupuncture, as you can throw in subtle variations to the treatment that meet the patient exactly where they are at that moment in very specific detail. With herbs it’s more difficult as in these types of cases you’ll need the same formula for months at a time. The key to this then is having a good enough grasp of your root formulas and also of the nature of your individual herbs so that you can switch in and out appropriate substitutions that still get you where you want to go. Now obviously, no two herbs are a perfect trade for each other as even different parts of the same plant behave very differently and have very different properties. In the context of a carefully modified formula, however, the structure that is not changed will help keep what has been changed moving in the right direction.

This concept is most vitally important for cases where there is an organism on the other end that is being dealt with as part of the process (like Lyme Disease for instance), but this also holds true for other deep diseases, though you may not need to rotate as often. In a fast-reacting case (like Lyme) I generally look to rotate ingredients every three weeks or so. I usually look to rotate major (and powerful) components of the base formula I’m using that I’m confident I can get a good trade for. So if the base formula is Gui Zhi Tang, I would have the option to rotate just about any ingredient in the formula. Rou Gui for Gui Zhi, Gan Jiang or Pao Jiang for Sheng Jiang, Chi Shao for Bai Shao, Gan Cao for Zhi Gan Cao. In this particular case I would probably only rotate two ingredients (unless I had a very good reason for doing otherwise-always a caveat!) and try to stick to the soul of the formula by changing Gui Zhi less frequently than the other ingredients. Obviously this applies to any formula that you could use long-term. Note that in some cases (and with some patients) you’ll need to rotate more frequently or more creatively, with other cases you can get away with longer waits. Your mileage will vary.

If you fall into the pitfall of failing to modify you will certainly see the case stall out, which can mean not only a simply stalling of progress but can frequently be the first step into a quick regression depending on what else is going on in the patient’s life. You want to avoid this at all costs.

Next week we’ll discuss the pitfalls of Treating Erratically and Too Many Doctors Spoil the Case.

Strategy in Chinese Medicine: Timing and Momentum, pt. 3

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Another aspect to the more advanced Chinese herb learning method that I teach is diving into the huge amount of information concerning where herbs grow up.  Using the metaphor of the growth and development of a human being, it is undeniable that where we grow up influences the people we end up becoming.  The same is true of Chinese herbs!

I was going to write out this article, but I just couldn’t manage to sit in front of the computer, typing.  So, I made a podcast instead.  Enjoy it!  Inside, I talk about why I love the herb method I teach, why location matters when it comes to Chinese herbs, and I do a very small bit of application with one of your friends and mine, Chenpi – aurantium – citrus peel.

If you are having trouble playing the podcast in your browser window – you have two options.  First, you can just click the link below to download the podcast and listen to it from your computer.  It’s virus free, I promise.  Second, you can go to iTunes and subscribe to the podcast there – the newest episode should be listed.  Sometimes the iTunes feed doesn’t work so well, but it’s been behaving lately.

Let me know if you have any trouble - and please come back and comment to let me know how you liked it.

Learning Chinese herbs : does where they grow really matter?

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Quite some time ago, before the changes that are currently sweeping Deepest Health, I promised that I would discuss an “herb learning method” and eventually develop it into a course of some kind.  Well, those wheels are turning again.  You can already get a basic report about the first stages of the method by signing up for our newsletter.

Over the next couple of weeks, I’ll unpack some more advanced pieces of the method – including some application.  We’re getting closer to the point where I can release a fuller version of the method.

First, I want to refresh your memory with some basic background material.  I think about herbs in a similar way as I think about people.  They have names, faces, general personalities.  They have families, friends, favorite activities.  They like certain climates and not others.  They have jobs and hobbies.  If you really want to get to know a person – you are going to have to access a broad slice of their life.  The same is true of herbs.

What happens when we understand a person more deeply?

Well, for one, you reap great personal benefits from these kinds of relationships. It’s a personal benefit – close human friendships can be the difference between having a long, happy life and a shorter, more stressful one.  I honestly think the same is true of my relationships with herbs.  Certainly it’s a different kind of relationship, but it does have that kind of benefit.  It is, of course, also beneficial for your patients.  When you understand the herbs deeply – you prescribe with more accuracy and shooting for a deeper level of pathology.  You’re a better practitioner, in short.

In the Family

Those of you who have a significant other know that you learn quite a bit about that person by hanging out with their family.  The same is true of herbs, though certainly for different reasons.  I’m not talking ONLY about plant families from a Western botanical perspective, though I’m including that as well.  To learn the family life of an herb deeply you need to look into:

1. Western botanical herb family
2. TCM herb category
3. Shennong Bencao Jing herbal class
4. Related to #3, a family based on the broad “plant/animal/mineral” distinction and the specific part within it

Let’s look at these in turn, using an example – the seldom mentioned herb Xuan Fu Hua / Inula / 旋覆花.

Western botanical information

Inula (either japonica or brittanica) is a member of the Asteraceae family – a family it shares with sunflowers, goldenrod, dandelions among many others. It is a largely herbaceous family, without trees or significant  numbers of climbing and vining plants.  Now, I should note right now that I’m not a botanist, and while I do have a science background, this kind of information always sort of baffled me.  That’s why I’m so happy to be an herbalist – it gives me an excuse to learn this information as deeply as I please.

Now there is a ton of information we can find out about the species itself, and that’s definitely part of the method.  But here, we are largely concerned with the group that the plant is associated with – its family.  One interesting thing about this group of plants is that what looks like a single flower (the yellow mass in the middle) is actually a packed together bunch of little flowers – a composite flower head.

There is a ton of information we could get into with this family – but one of the most simple and common observations is how these flowers look much like a representation of the sun.  Sunflowers, dandelions and many of the members of this family all have a sunny disposition and thrive in sunny locales.

What does this tell us about Xuanfuhua?

Well – the association with the sun can certainly get us thinking.  There must be some kind 0f Yang affiliation, perhaps a Fire association.  Now, in some cases, the information we get from family is going to seem to contradict what we commonly know about the herb, or simply seem irrelevant.  I’m going to suggest that this is almost never the case.

In Xuanfuhua’s case, we don’t need to dig too far to help us find some confirmation for this information.  In the Tang Ye Jing, Xuanfuhua is considered to be the “fire herb of the fire class.”  In other words, it is the ultimate exemplar of fire within the 25 herbs mentioned in this text.  For those of you who aren’t familiar with this text, we’ll discuss it in more detail in the future.

So, in my opinion, we need to think about Xuanfuhua a little differently in light of this information.  While it is commonly thought of as an herb that deals with phlegm and counterflow, perhaps we understand this function in a slightly different way knowing of it’s strong sun, Yang and Fire associations.  Perhaps we even start to expand our understanding of the herb – can you think of some unique uses, or some more advanced understanding, that might transform the way you use this herb in clinical practice?

We don’t have space in this short article to go through the example with each of the four family categories above, but I will provide a brief description of each…

TCM herb category

This is a family of another kind – an affinity group bound by basic effect.  Now, there’s information to be gained by diving deeply into the TCM category, but here we’re looking at the similarities in herbs within that family.  It can also be instructive if we find differences.  That tells us something about the herb, but also something about the ultimate utility of this method of categorization.

Shennong Bencao Jing herbal class

Now, obviously, this is only going to work for herbs that are actually contained in this text.  However, I think it’s pretty interesting to look at which herbs are put together within the SNBCJ.  This goes both for the categorization of upper, middle and lower class herbs as well as the various plant, mineral and animal classifications.  As an early record, perhaps more influenced by the Shamanic traditions in use at the time, the SNBCJ categorizes herbs in a different way than, say, TCM categories.

Layperson family classification

Is the herb animal, plant or mineral?  Within that categorization, what part of the plant (or whatever) is the herb in question?  In the case of Xuanfuhua, we are discussing the flower of an herbaceous plant.  What can we say about flowers, in general?  These are the kind of questions we ask as we examine this “family.”

Join me next week as we unpack another piece of this relational herb learning method.  Thanks for reading.

The relational method of learning Chinese herbs : herb families

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If there’s one lesson that everyone learns very quickly once they start treating, it’s that modern patients have complex conditions that don’t readily fit into any of the ready-made boxes we have formed for them, whether from a Classical or TCM standpoint. Patients usually have multiple ailments all stacked on top of each other like a messy garage. Like said messy garage, some things are new, some things have been there a long time, some things no one knows where they came from, and sometimes there are even animals and insects hiding out. All of this is what you have on your plate the second a patient comes into your clinic, sits in front of you and says “my shoulder hurts” (the ubiquitous ailment).

We’re all familiar with that momentary surge of apprehension (or outright panic) that wells up in this situation, especially if the patient has a Western diagnosis with a scary name like cancer, Lyme disease, autism, etc. However our tools are absolutely equal to the task of even the most complex cases. As the Ling Shu says, “Thorns can be pulled out, even those embedded for a long time; stains can be cleaned, even old ones; knots can be undone, even those formed long ago; accumulation can be demolished, though it be very old.”

One of the keys to successfully treating complex conditions is to be able to competently combine already-extant herbal formulas into a single prescription to match the situation. More accurately, the trick is to use the best tools to perform the right actions at the right times continuously (a subject which I will discuss further in my column on Friday). Over the next few weeks I hope to help those having trouble with formula combining to get a better grasp on it.

So, let’s begin at the beginning.

Reynolds’ First Maxim

There’s one thing that trips up everyone at the beginning (and some folks forever), which is the basis of what I like to call “Reynolds’ First Maxim.” The joke is that I only answer any question my students ask with about five possible responses, so to save time they can be referred to by number. What typically happens is this: a student gets a patient in clinic who comes in with three different “named” diseases like, say, Crohn’s disease, PCOS, and Fibromyalgia. The student gets intimidated, panics, runs through their mandatory battery of questions, needles the Four Gates per supervisor, then calls or emails me with “I have a Crohn’s disease patient. Can you tell me what formula is for that?”

To this I always have the same response:

What are the symptoms?

It’s very easy to get bogged down in the details of what someone else has decided about a patient, whether they are from your side of the healthcare fence or not. We have to be very very careful to not slap names on conditions and try to treat those, whether we are discussing biomedical diagnoses or Zang Fu patterns. Any case that you see is only going to open up to you (like the proverbial flower to the bee) once you start diagnosing, which means using the tools at your disposal to find out what’s really going and making your own judgment. Remember the Four Pillars of Diagnosis? Asking, Looking, Listening, and Touching. These are absolute  necessities for any type of case, no matter how easy or difficult. It’s no good just saying “I’m watching this patient for Bob who is on vacation and he says she has Spleen Qi Deficiency so I’m gonna give her Si Jun Zi Tang.” That absolutely won’t cut it. It also won’t do to say “Well, I saw on the internet a study that says Huang Qi is good for autoimmune conditions and since Crohn’s is an autoimmune condition I’ll give her that Huang Qi-based patent we have in the pharmacy.”

You absolutely must do your due diagnostic diligence and find out specifically and systemically what is going on with the patient. Then you can begin to make choices. As long as you are confined to throwing herbs and points at a name, you won’t see results and the patient won’t be sticking with you for very long.

The next step is to make sure that you are using a diagnostic model that is going to steer you in the right direction and provide useful information about what to actually do about the problem, which is what we will discuss next week. For now, remember that the first thing you absolutely must do is find out what is going on with the patient in order to have something to work with.

In other words, what are the symptoms?

Combining Chinese Herbal Formulas, pt. 1: Reynolds’ First Maxim

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