Argument for a medical multiverse : Acknowledgements
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When you write acknowledgements for a thesis at a small college in Portland, you can be reasonably assured that almost nobody will read them. This is a shame, for they are meant to be read – meant to shout your love, respect and admiration from the rooftops! So, I hope you will indulge me and read the below and give a silent round of applause to the people that made my thesis, indeed my entire success at school and on this blog and in my life in general, possible. I couldn’t possibly mention everyone who was a part of it – so if you’re not mentioned below and should be – know that my love goes to you as well.
In the coming weeks, I’ll release more of my thesis, though the very thought terrifies me. Anyone who’s written a thesis, dissertation or book will know what I mean.
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ACKNOWLEDGEMENTS
To Amanda, the love of my life, without you life is bereft of meaning. I thank your for your persistence, your strength, your uncommon beauty and your belief that I’m not as crazy as I seem.
To Eden, without whom I would have had no reason to go to school at all, my debt to you can never be repaid. I love you, I love you, I love you.
To Sarah and Christopher, my dear friends, thank you for your patience with my idiosyncrasies. I cannot promise they will diminish with the final draft of this thesis. But, I can promise more beach trips.
To Heiner, my heartfelt thanks for guidance, for inspiration and for constant reminders of the power of this medicine. I will always be your student, if you’ll have me.
To Arnaud, my utmost gratitude – I hope one day I can be worthy of what you teach. Slowly – I’m starting to get it.
To Michael, remember: scrofula! I can only hope that our study together will continue until the end of our days.
To David Berkshire, thank you for giving me the space to learn from your teacher – nature.
To Brandt, to Abdallah, this end is a beginning. For us, for Watershed and of course – for our journey to God.
To all of my other teachers, too numerous to list individually, you have bestowed me with faith – in medicine, in myself and in a brighter future for humanity.
Love to my grandfather, who taught me the value of unimpeachable argument. Hopefully, one day, I will fully integrate the lesson.
To Kellen, thank you for your sincerity and unconditional love – you always have a home with me.
Finally, to my mother and father – Holly and Steve – what can I say? To you, I owe my life, my fortitude and the most important lesson I’ve learned: in the end, love conquers all.
5 Things to Look forward to after graduation : Chinese medicine post-graduate education
Since the arrival of my friend Brandt Stickley, I have been unfortunately unable to devote the amount of time I would like to living out our wild Portland-area Awareness Project dreams. We had so many late night chat and Skype conversations, whipping one another into a sleepless frenzy about the power and possibility in symbolism. The symbolism of the Classical texts of Chinese medicine, the symbolism of the body, of acupuncture points and herbal formulas, of ancient poetry and contemporary culture – but most of all – the symbolism living all around us in lived experience.
Well, there’s light at the end of the tunnel. I can TASTE the completion of this degree. I can FEEL the reality of my impending licensure. Our clinic is already running. We have meetings every week. I’m totally ready to see patients – and already have several ready to go. This deal is sealed, God willing things are now operating on the gravity created by hard work and not a little bit of Grace. Running a business takes time, lots of it. But, the fact is, I’ve been working hard on that all along. I set myself up precisely so I would actually experience some ease and freedom after graduation.
So, I thought I would make a list of the five things I’m most looking forward to doing after I graduate. This does not include the usual suspects : getting more sleep, spending more time with family and friends, taking fewer tests, etc… It also doesn’t include the very exciting new developments of running a business full-time, getting back into (and developing my skills within) blogging and – of course – developing as a clinician and scholar in Chinese medicine. All five of these things I see as being major contributors to the invigoration, development and eventual worldwide flourishing of the Awareness Project.
- City Safari - : Portland is, I think, one of the most wonderful cities in the world. It is easily the greatest city I have ever visited. There is simply no end to the nooks and crannies to be explored. From the urban mettle of the Eastside Industrial district (spitting distance to our clinic) to the gilded streets of the Pearl, the well-worn sidewalks of the Belmont and Hawthorne neighborhoods and all the other incredible districts and ‘hoods. Add to that the abundant Hill Walk
- Getting to know the Watershed – : Beyond the city limits, a smorgasboard of outdoor space awaits. From NCNM, I can see two mountains – absolutely surrounded with verdant forest, sublime foothills, rushing rivers and not a few glorious swimming holes. Both up and down the valley we have hotsprings, old growth, wine country, waterfalls and a hundred underused hiking trails and tent camping spots. This is to say nothing for the miles of undeveloped beaches, the endless expanses of highland desert, dunes, caves and lakes from outerspace. It’s not hard to understand why so many people love this state. Just as the city safari, the kind of surprises and encounters that come about while wandering the wildness of the world is an awareness building experience.
- Reading (and experiencing) Widely – : I have a reading list a mile long. There is a lot I want to read within the field, but even more outside of it. There is just so much to learn, so much to imagine, so many people writing down so many incredible things. Finally, finally – I may have some time to take it all in. The reality is that I will probably stay more or less in the range of Chinese medicine related materials – but for me – that field is pretty broad. I also have a whole lot of Continental Philosophy to burrow into. Also, Rorty. Oh, and I started playing roleplaying games again, so there’s plenty to read there. All of this helps build a richness of worldview that can only help me as a practitioner. Like some guy once told me.
- Learning and Using Chinese language – : The most important new project I’m taking on over the next decade is to deeply learn Chinese language. I’ve got a lot of materials for homestudy, as I won’t be able to afford (or stomach) formal education for at least a year or two. I’m hoping between that and the resources of my peers and friends, I’ll be able to make a go at it. I’m going to be doing the arduous task learned in Classical Texts classes at NCNM – going through texts character by character, and trying to drink them in. I believe that a mastery of this language is a crucial key in unlocking my potential in the field. I don’t intend to put that off, if I can help it. The deeper I fall into the symbols of the language, the deeper my awareness, the more profound my connection, the more effective the medicine. Or so some other guy told me.
- Redoubling my efforts in Self Cultivation - : I have experienced first-hand the difference between the treatments of practitioners who attend closely to their self-cultivation and those who do not. I don’t expect to be a saint, and I don’t expect any other practitioner to be. However, the degree to which we learn to become still, to connect deeply (both inward and outward) and care for our health on every level is the degree to which we will become not just technicians, but deeply skilled care providers. I have been working on this throughout my four years at NCNM, but I must admit that the rigors of my life have sometimes made me less than totally devoted to practice. I’m looking forward to a chance to change that.
Onward!
Eric
Listening my way to success in the NCCAOM acupuncture board exam
As I said before, I’ve been spending a significant amount of time studying for and taking my NCCAOM board exams. As I said in my last post…
“…I’ve successfully completed the foundations and biomedicine exams already. I found them to be much different from what I was expecting. I know I am not allowed to share much about my experience – but I’ll just say that I don’t think any commercially available study aid helped me…”
This includes the much lauded TCMTests.com. Don’t get me wrong, I think they offer a great service. If nothing else, they allow you to have some degree of comfort with the format and general content of the test. However, the specific topics covered in the real test were not touched on much by the practice tests on that site or on the official NCCAOM site. Others may not share my experience, I know.
As an alternative, I recommend you go through the list offered by NCCAOM (content outline) and read through the texts they indicate as sources for question writing. I found that these outlines were quite accurate, and I would pay attention even to those topics that seem less important. While some of the more minor subjects may not come up often, one really unexpected question can really throw you off your rhythm.
Also, it will help you to be a good test taker and – perhaps most importantly – to be lucky. ;)
Now, I’m studying for the “big one,” the exam about acupuncture and point location. I actually postponed the test once, because as I dove into studying the material I really found out how unprepared I am – at least by my reckoning. Why? Certainly not because my education has lacked quality. It doesn’t reflect on my ability to treat patients. It doesn’t reflect on some lack of scholarly rigor on my part. Quite the reverse is true, I think. Why?
Simply, NCNM doesn’t teach to the test. We don’t read Maciocia as a textbook. We learn TCM pattern differentiation, sure, but we learn so much more that is (in my opinion) far more compelling. So, as students, most of us choose not to focus much on the TCM stuff we are taught. Even those professors who might be thought of as “more TCM” on our faculty have a wealth of Classical information and clinical pearls they are constantly divulging – so the TCM stuff tends to get swept under the rug a bit. So, what’s a guy to do?
Ironically, now at the end of my education, I feel that I’ve finally settled on some winning learning strategies. As I studied for this test, I started to use every trick in the book to get the stuff to stick. I had huge pieces of easel pad paper taped up all over my house, I was using innovative mindmapping software, I was making flashcards, I was making diagrams… All of these strategies were definitely helping, but then I ran across an article discussing multiple intelligences, then through some web searching another one about the VARK learning styles theory. The particulars aren’t super important, but it got me thinking about how I learn most effectively.
For me, it’s all about the auditory. I learn very well from lectures – even better if I record them and listen to them a hundred times. I learn well from music, from silly songs, and also from speaking things aloud. It was a small insight, but when I really realized this – I went to town with it. I’d like to share some of the strategies I am using that appeal to my auditory learning style. I should mention that I feel that I learn quite well from reading and writing things as well – but I wanted to talk particularly about the auditory aspects today.
1. I am a big fan of Cal Newport’s blog, Study Hacks. Among a lot of other great advice, he recommends that students use a method called “quiz and recall.” Using this method, you collapse lecture notes (or other material) into “big ideas” with one sentence prompts. You then move through those one sentence prompts and give a pretend lecture to nobody in particular. I do this in the backyard, pacing through my living room and on my daily walks. You can follow the link above to learn more.
With the material I’m studying now, I’ve had to alter the method a little bit. Because I’m not really working off of any notes, I simply let my prompt be the name of a channel or TCM syndrome. With the latter, I actually break it down a bit – working off of a list of diseases and their differentiations. So, I might come to a prompt that says Gan Mao due to Wind-cold. Then I lecture passionately concerning the points involved, their categories and locations, the needling method employed and so on. This has been incredibly powerful.
2. There are a couple of commercially available audio products designed to help you learn and review Chinese medicine related information. I’ve tried Tunes for Tangs and Songs for Sans as well as the product I review below. I’ll talk about Tunes for Tangs in another blog post in the future.
Radioqi.com offers a set of MP3’s called AcutherapeuticA that are meant to be used in learning and reviewing the acupuncture points by channel. These recordings include a soothing female voice speaking over some repetitive trip-hop style electronic music. The voice lists the point designator (HT1, etc), the Chinese name and an English translation, any pertinent categories (Yuan source, etc) and finally some basic TCM actions. Sometimes, they will offer a little more – such as a particular contraindication (like LI-4 being contraindicated in pregnancy). They also include a two-file set of the 100 most popular acupuncture points set against more upbeat music. I have not tried the second product, but I own several of the channels set over the more soothing music.
It’s undeniable that this product has helped jog my memory about some of the less used points. Because I’m largely an auditory learner, the stuff goes in my head with the music and sticks there. There is something quite compelling about the ability to go on a walk in the dawning summer sun and be studying at the same time. As I’ve discussed elsewhere, and doubtless will again, I’m a huge fan of audio learning for that very reason. However, I’m very disappointed that Radioqi has not included location information! I also feel that the voice speaks a little too quickly through the action information. Because of these shortcomings, and also because I can’t afford the ~$100 it takes to buy all the channels, I hit on one final (and my favorite) acupuncture audio learning solution.
3. I have a MacBook, which has a great built-in microphone. I also own the excellent free audio editing program Audacity. Sitting here, frustrated with my limited choices as far as audio learning of acupuncture goes, I hit on a natural solution. Make my own MP3’s! I simply recorded myself reading out of my favorite text for studying for the acupuncture exam, adding commentary as I thought of it. For instance, when talking about a Yuan source point, I might mention everything I know about that category of point. In a couple of instances, I played the excellent Yi Ching Music for the Health CDs, in the background, using the element corresponding to the channel I was studying. I then exported these as WAV files from Audacity, and added them to my iTunes library, converting them to MP3s in the process. Finally, I loaded these onto my iPhone for listening to on the go.
While it’s a bit weird listening to myself talking about acupuncture channels, it has been very helpful. The points are sticking in a way they haven’t before. I’m going to try this technique for syndrome differentiation as well. After this exam, when my time opens up a bit, I plan to use some version of this technique to continue learning about formulas.
If you know of other audio learning techniques – let us know in the comments!
Eric
12 Weeks of Power : The beginning
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.
What am I up to?
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Updates from my personal blog (Ericgrey.com)- Some lyrics… May 12, 2009
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- Quiet versus moving Qigong practices March 7, 2009
- A new perspective on the healthcare crisis February 26, 2009
