Symbolism, Chinese medicine and the birth of a new project
I’ve been working on a series about the Chinese medicine organ systems for the past few weeks. We’ve already covered the Lung, and then the Large Intestine in two parts. During that time, my understanding of the symbolism (including what’s available through the Chinese medicine organ clock) that is shot through Chinese medical literature has changed, deepened, opened up.
When I first started studying with Heiner Fruehauf, I was entranced by all the symbolism he introduced in his lectures at NCNM. I wasn’t sure if what he was talking about would bear clinical fruit, but I knew the ring of truth was there and I was resolved to understand it. Doctors that I worked with later put more or less emphasis on the symbolism, but regardless, the kind of imaginative and symbolic thinking was always a part of what they taught - because this kind of thinking is at the root of the development and practice of Chinese medicine.
What is a symbol? A symbol is something used to represent something else. It POINTS at something else. Generally, we use material representations to represent immaterial things - like how a religious symbol can be used to represent God, or human beings’ relationship to God. When I talk about symbolic thinking, I take it a bit farther. Everything can be a symbol. The human body is in resonance with the universe, in resonance with nature, and all of these things create a symbol field that points at something immaterial - the unifying concept behind all of those symbols. This is, of course, a quite Platonic concept. There is a perfect concept/idea of metal-ness, of which all METAL symbols here on Earth are only an imperfect representation. The fact is that the symbol field creates a kind of embodied conversation about this “concept/idea.” I want to point out that I’m not even sure that the Platonic idealist view of reality applies in the particular situation I’m describing, but many people will say that it does. For the sake of simplicity, let’s just say that all of the symbols I discuss are part of an overall embodied conversation that is attempting to describe a particular concept that may, or may not, be perfectly present anywhere in the world.
Confusing? Yeah, when I describe it that way it probably is pretty confusing. But, it’s important to understand. When I talk about the Stomach on the Chinese organ clock, you’ll hear me discuss the Dragon, Yangming, Earth, various acupuncture points and formulas, herbs and Classical passages, constellations, Earthly branches. What does all of this mean? It is part of a multi-sensory conversation attempting to define the Chinese medicine concept of the organ Stomach. But, it can go so far beyond that. Every time I walk out my door, I see Stomach. I see it in the muscle cars roaring past, I see it in the gourmet restaurants that dot my beloved city of Portland. I see it in the Earth yellow faces and wild smiles of friends and family, I see it in the high and dry Earth in mounds around the bike path. I hear it in certain songs, certain lines in movies. I hear about it in world news event reports. I smell it on the breath of my dog (gross!) and in my compost pile. Sometimes, the universe practically SCREAMS Stomach. It is a multi-sensory experience, a lived experience. Ultimately, all of this feeds back into me as a practitioner, my understanding of the human being and the universe, and bears important clinical results.
This is why it is so disturbing how some contemporary Chinese medicine practitioners have reduced “Stomach” to the Western medical organ. Of course, we can use that idea as part of the symbol field. How rich it is to include the information from Western medicine, but what a tiny little drop in the bucket it is - and how misunderstood. But, that little gripe is not what this post is about.
This post is about nothing less than the rebirth of Deepest Health. I am happy to say that Deepest Health is about to undergo a revolution in order to begin a revolution. A revolution of thought and feeling around Chinese medicine. You will still see the same great information that you’ve come to expect - but so much more. We want to create something that can’t be described in a sentence, but here are some half attempts by the project’s creators:
If you like what you read here, you may want to keep updated by using my RSS feed. Want to know more about RSS/feeds? - read more here. Thanks for visiting!
Tags: commitment, multimedia, organ system, Organ systems, revolution, study, studying, symbolism, writingRelated posts
What is Traditional Chinese Medicine (TCM)?
Preliminary note: If you are really looking for a definition of TCM and want to learn more about Chinese medicine in general, please check out this page of articles written especially for folks who are new to the world of Chinese medicine and want to learn more.
——
I was just reading over some old journal entries from when Deepest Health began last year. One of the blogging techniques that I was taught by Yaro Starak during the Blog Mastermind training program was creating definition posts. I did use that format to define various things, including Qigong, acupuncture and herbal medicine. However, because I started to get interested in a lot of more complicated things and attracted some fairly sophisticated readers, I moved away from those basic types of posts.
I found a note that I should write a post about TCM - which really got me thinking. There’s a fundamental problem with my blogging purpose. I am interested in getting good information out there about Chinese medicine, it’s practice, power and philosophical foundation. I’ve been putting that information out as I learn it, revising points as I’m able and hoping that my good intentions and transparency will make sure that the good information overcomes the bad.
But, I’m trying to do too many things at once. How so? Well, consider terminology. When most people think about Chinese medicine, they think about acupuncture. This is so much the case that most people simply call all of Chinese medicine “acupuncture,” even some practitioners. One of my mentors even names his business using the word acupuncture and says nothing about herbs. Why does he do this? Because when most people think about contacting a Chinese medicine physician, the word that comes into their mind is “acupuncture.” It just makes good business and marketing sense.
Which, apparently, I don’t have. :) By talking constantly about Classical Chinese Medicine on this blog, I end up missing out on picking up on a lot of folks who are searching for information about this medicine. What do they search for if they are little more savvy? Maybe “Chinese herbs” or even “traditional Chinese medicine,” and if they’re REALLY on it, “TCM.” Those words appear very few times in any of my content. :D So, while I’m sitting here pumping out quality content, fighting the good fight, I’m missing probably half of my intended audience. In some way, I’m hoping to change the language around Chinese medicine. I honestly don’t care if the word “classical” makes it in there - simply calling it Chinese medicine would be fine.
So, if in the coming months and years, you see me using TCM or Traditional Chinese Medicine or Acupuncture a little bit more in the way that I write - do forgive me. I’m simply using the common vernacular to try and get the information out to the people who are looking for it.
All that aside, I’m interested to know how terminology plays into your life around Chinese Medicine. If you have a business or work at a school, how is Chinese medicine discussed in your marketing materials? Do you think there is some value in trying to change the language through marketing, or is that just dooming one to failure? Do you find that your patients/students are confused about the language used to describe what we do? Please leave your thoughts in the comments and, as always, thanks for reading.
Eric
Tags: Blogging, Business, ccm, classical-chinese-medicine, language, tcm, traditional-chinese-medicineRelated posts
Book review: Clinical Handbook of Internal Medicine (Vol 1)
I have been using the first two volumes of Maclean’s Clinical Handbook of Internal Medicine for a couple of years, now. I find them to be the most useful basic TCM pathology texts available and want to share, briefly, my reasons.
General Information
This text is part of a series that, apparently, will include more volumes in the future. The first volume, pictured at left, covers the Lung, Kidney, Liver and Heart organ systems. The second volume, with blue lettering but a similar cover, looks solely at the Spleen and Stomach. I’ll focus on the first volume for this review, but the majority of what I say applies to both of them.
The authors, in their introduction, explain that their aim was to develop a workable clinical manual of Traditional Chinese Medicine (TCM) that “at least [begins] to take our cultural and social differences into account.” They seem to feel that because Chinese medicine was created and developed in a particular social and geographic location, it will be significantly different when practiced in other locations with differing social and natural environments. The book, then, is a clinical manual intended to make the basic information of TCM more accessible and relevant to Western readers.
The book is created primarily with herbalists in mind, thus the formula suggestions are extensive while the acupuncture suggestions are more sparse. The book is organized by organ system and then by basic TCM symptom picture - for instance the Lung section starts with external diseases (cold and warm) then moves into coughing, wheezing, etc… The Chinese names for the symptom pictures are provided, along with characters. This is helpful since people learn them using different English translations depending on where they study and I found it much easier to simply work with the Chinese. They provide Chinese for herbs, formulas, patents and acupuncture points - though the points have only pinyin, no characters. The general organization of the book is intuitive and the overall quality of the text is reasonable for the price.
Looking Deeper
Let’s investigate a single section. Consider Gan Mao - the “common cold” or external invasion. The book begins with a concise and readable description of the disease in general, providing some historical background and discussion of the severity of the illnesses in question. This moves on to a page on etiology and a fine mindmap of the most common causes. Following this is the section on specific causative factors and their treatment. Fortunately, they begin the discussion in this chapter with Wind Cold. Shang Han Lun fans will be snickering, now. ;) But, not for long - as the first prescription suggested is Jing Fang Bai Du San. Thus begins my basic problem with the text - which is predictable given my trepidation about non-classical formulas.
That being said, the layout of the various treatment options (with confounding symptoms, etc) is clear and descriptive enough without being confusing. Several formula suggestions are followed by standard acupuncture protocols (LI4, GB20, BL12, BL13, GV14) and modifications based on presenting symptoms. The section is completed by other advise to the physician such as, “Acupuncture treatment can be applied 2-3 times in severe cases,” and a list of biomedical (Western) conditions that might fit this picture. In general, all of the sections flow in this way. Some have more extensive descriptions or finer distinctions between symptom patterns, but the basic flow is similar.
My assessment
Positive: I have looked at quite a few books trying to find one that would helpfully and concisely explain syndrome differentiation from a TCM perspective - in good English. I found it in these texts. It could be helpful as a clinical manual, I suppose, but I found it more helpful in my TCM studies as a way to understand the way that your average TCM doctor treats any particular condition. Its breadth, completeness and pleasing layout, as well as inclusion of Chinese characters and pinyin puts it heads above anything else I’ve found. It’s also fantastic as a way to quickly see the basic TCM treatment protocol for a given disease with points AND formulas included.
Negative: The authors seem allergic to Classical formulas. Gui Zhi Tang and Ma Huang Tang are not even mentioned in the Wind-cold section. Um…? I suppose this has to do with the oft repeated refrain that “Westerners are too deficient for such strong formulas.” I must be a strange Westerner, indeed. My daughter, too. Oh, and the rest of my family. Oh, and a big chunk of the patients I’ve seen treated in clinic. Ok, ok - sorry. My point is this - I think it’s a dramatic oversight to leave out Classical formulas. I understand if you want to include others, perhaps put a caveat on the “too strong” formulas - but… honestly?
There are some holes in the texts - I understand future volumes may address this. For instance - no women’s diseases as far as I can see. Also, the organization according to “diseases” (gan mao, yi jing, etc…) sometimes made it difficult to find a formula or point protocol for some simple set of symptoms that doesn’t necessarily fit into one of those categories. That’s not so much a problem of the book, but a problem of that system of categorization. All things being equal, I think this is a relatively minor problem.
Should you buy it?
If you’re interested in having a basic, clear manual for understanding TCM syndrome differentiation and the way that a large majority of TCM physicians treat patients - these books are indispensible. I sold all of my other TCM texts - all my Maciocia included. There is enough theory in here to do the job, and in combination with all the treatment advice it’s just a fantastic resource.
Click here to buy the Clinical Handbook of Internal Medicine Volume 1 from Amazon.com
Thanks for reading,
Eric
Tags: book-review, books, ccm, external invasion, formulas, internal medicine, tcmRelated posts
Experiments in Chinese herbalism : on the dangers of Yin Qiao-itis
What follows is a guest post by my friend and comrade in Shang Han Lun love, G. Michael Reynolds over at the Lifegiving Sword. I think it demonstrates a couple of things.
- That experimenting with herbs can - obviously - bring mixed results. :)
- That there’s real peril in standardized systems of medicine. I believe, in general, they tend to make lazy practitioners. I mean, seriously, do you see Yin Qiao in that tongue?
- The power of Classical formula principles.
For any members of the general public currently reading, please don’t become too alarmed by this story. In all systems of medicine, there are ok practitioners, good practitioners, great practitioners and a few folks who shouldn’t but somehow DO make it into the practitioner pool. The difference between Chinese and allopathic medicine in this regard is that Chinese medicine is highly unlikely to kill people even when practiced badly, while allopathic medicine is somewhat less blessed.
This is one reason I am so passionate about the style of Chinese medicine that I am learning. In my experience the kinds of mistreatment problems described below are far less likely to happen within Classical styles. Enjoy this fun read.
Eric
__________________________________________________________________
From Michael: “This story involves a whole host of mistakes, the first and second of those made by me personally, the rest made by three different supervisors in the school clinic. The 3 doctors who led me down the wrong path will remain nameless, however I will point out that the doc who set things to rights is none other than our own Abdallah Stickley. Make what you will of it!”
So here’s the story. On a Sunday evening, I get suddenly sick right before bed. I mean instantaneously sick. My ear started kind of hurting, throat bothering me a little, was sort of dizzy, a slightly productive cough appeared, and some urethral pain (which i have sporadically anyway, but it changed quality a little and intensified). I went to bed determined to do something about it in the morning.
In the morning all the symptoms were the same, but with a little added intensity and a headache that would only appear at pinpoint locations on the GB channel (like GB-2, GB-14, GB-20) and only on one side. Also some retching, mostly due to the cough. I checked my pulse as best I could (always dodgy when you’re sick) and it seemed to me like it could have been considered (in TCM pulse parlance) rapid, slippery, and a bit tight, but also a bit deep at the same time. A mid level pulse, not coming up to the Qi level. So, determined to handle this via SHL style medicine, i wrote the following formula:
Chai Hu
Huang Qin
Gan Jiang
Ban Xia
Bai Shao
Zhi Gan Cao
Fu Ling
Wu Wei Zi
At this point I made a fateful mistake which this whole story turns on. I probably could have booted the whole thing out of my system had I added Gui Zhi. However, I panicked and did not put my full faith in the method I was using. Instead of thinking “quick onset, minor ear and throat irritation=Taiyang, Urethra and bladder pain=Water inhibition=Shaoyang,” I thought “TCM says ear pain is treated with Long Dan Cao. It also treats Liver channel issues like urethral pain. The throat part is covered by the Shaoyang part of this formula” and instead added Long Dan Cao. This formula was made with Teacher #1’s blessing.
That evening I woke up with the same symptoms more or less (adding in sneezing), except now I was getting some dark urine, a tiny bit of dark phlegm, and my pulse was now showing superficial, rapid, and slippery over all. I really panicked at this point, as I begin to think that I did the whole thing wrong. I started to think that the pathogen had time to turn into a heat condition, that despite evidence to the contrary, SHL formulas cannot treat Heat conditions, Wen Bing is right, TCM is right, and a whole other host of lunatic thoughts brought on by someone with Phlegm-Fire problems getting hit by a phlegm producing illness and waking up in the middle of the night….
In my panic I made my second mistake. I took a big hit of Yin Qiao Pian. It will not surprise you to know that within an hour I found myself on the couch thinking “wow…im FREEZING now…” In the morning, I took another YQP dose but half that of the previous one and trotted off to school, feeling worse. I decided that I’d swallow my pride and find a clinic supervisor to look me over and tell me what they thought, because clearly I had blown my own diagnosis and treatment. So, Teacher #2 gave me a looking over and suggested that I stick with the YQP, as it sounded like a heat condition due to the rapid pulse (which was now back down to the Blood depth again) and the dark urine in the morning coupled with the small amount of yellow phlegm. I complied and finished off my YQP that night.
The next morning, I felt worse (keep in mind that I’d already felt bad enough to leave school after an hour or two on both Monday and Tuesday). While in the truck, I got the Missus to take a picture of my tongue, which I present here:
(It may be hard to tell since this is a photo, but that coat-outside of the back area-is definitely a WHITE coat)
I went to school again, toughed it out for my half day class, arranged to be absent from my clinic shift the following day, came home, crashed. The next day, I was still worsening. By the end of the day, I broke down and went back to the clinic hoping to find another supervisor to evaluate. I managed to catch one on her way out the door and Teacher #3 gave me 10 minutes worth of diagnosis and prescription. She wrote a formula which I dont have in front of me, but which I think goes something like this:
Huang Qin
Long Dan Cao
Yu Xing Cao
Xing Ren
Gui Zhi
Wu Wei Zi
Ban Xia
Bai Shao
(It actually had 13 herbs, but these are the only ones i can remember. I’ll get the full list off my chart tomorrow. Basically its a cold, cold formula.)
So I filled this one, took it, next morning woke up feeling like I was going to suffocate. i had to cough for about 5 minutes solid to establish normal breathing. Not happy. However, continued to take the formula. Over the course of the next few days (Fri-Mon) I got marginal improvement at best but still felt horrendous. On Tuesday, I had class followed by clinic. By Clinic time I felt like I was going to die, so I threw myself on the mercy of Dr. Stickley, who did the diagnostics and Rx’ed the following formula:
Chai Hu
Huang Qin
Gan Jiang
Bai Shao
Ban Xia
Fu Ling
Wu Wei Zi
Gan Cao (we were out of Zhi gan Cao in the pharmacy)
Jie Geng
I took a dose in the clinic and then went home afterwards and went to bed.
Next morning, 75% improvement.
So there you have it. I still haven’t finished kicking this thing but I’ve only been on the sensible formula for a day. I’m thinking it may need a little Gui Zhi at some point if it doesnt resolve itself.
G. Michael Reynolds
Tags: chinese-herbs, errors, guest-post, shang-han-lunRelated posts
Learning from Chinese medicine masters : Liu Lihong visits Portland, OR
Since arriving in Portland to study acupuncture and Chinese herbalism, I have been unbelievably lucky with regards to the teachers to which I have been exposed. In fact, not a day goes by that I don’t find myself pretty much floored when I consider my good luck. You know that old adage that “When the student is ready, the teacher will come?” Well, I must be ready - because I’ve got some pretty incredible teachers. I’ve talked about only a few of them on the blog, but hope to feature more about them - even in their own words - in the coming year.
We have been blessed to have the presence of a true modern day master, Dr. Liu Lihong, at NCNM for the past couple of weeks. He gave a public lecture along with his colleague, Dr. Tang Nong, about the state of Classical Chinese Medicine in China and has since lectured on a number of other topics in an impromptu fashion. He also gave a more structured lecture to a small group of people with connections to Heiner Fruehauf and NCNM on the topic of the “Fire Spirit” school of herbalism of which he is a part. Every single opportunity I have had to listen to Dr. Liu has been a treasure. As someone new to the field, I appreciated his simple, yet deep, explanations on topics that mean a lot to me such as: What is a lineage and what is its meaning? What does it mean to be a physician in this day and age? What is the meaning of calling one way of practicing Chinese Medicine “Classical?” He also discussed more in depth topics such as the appropriate use of Fu Zi, the essential salient features of treating in a “Fire spirit” school way and a way to understand the theories of the five elements and six conformations.
To tell you the truth, it’s been so much information, I’ve almost willfully avoided going back over it because I’ve got so much on my plate already! But, I would like to share with you some of what I’ve learned and what it has sparked in me in terms of new ways of looking at Chinese medicine. It will likely take a few articles. I’ll try not to make you wait. :)
I’ll actually have to start with first things first - the series of talks was kicked off by Dr. Tang Nong, who is the chair of the Institute at Guangxi College of Traditional Chinese Medicine, where Dr. Liu is a senior professor, medical director and co-chair. The Institute they co-chair is the only of its kind - solely devoted to research into the clinical applications of Classical Chinese Medicine. Here patients are treated with Chinese medicine only. In other hospitals, even those that seem to be “Chinese medicine” oriented, patients are often treated more with Western medicine with Chinese medicine only as adjunct or supportive therapy. How then, are we supposed to know what Chinese medicine can do in a clinical context? This is the very question that Dr. Tang Nong addressed throughout his lecture.
Dr. Tang was a very charismatic speaker, full of energy and clearly very passionate about the medicine. I understand he is a skilled clinician in his own right and, further, understands the basic philosophical principles underlying the medicine in a nuanced way. I really enjoyed hearing him speak.
I was particularly interested in his discussion of the essential failing of TCM as it is often practiced. Dr. Tang told us that the trend in Chinese medicine research and development is towards increasing:
1) Modernization
2) Standardization, and
3) Internationalization
These three words aren’t inherently bad. Certainly moving forward and keeping our minds open to greater efficiency and clarity are all good things. It’s the way that these principles are understood and executed that creates problems - at least that what Dr. Tang seemed to be communicating to us. He spoke most against the effort towards standardization. In standardization of Chinese medicine, efforts are made to create “standard” diagnoses based on “typical” symptom pictures. These diagnoses are attached to “standard” formulas and point prescriptions. I expect that even the modifications are standardized (if x, then y). Thus, anyone with skill enough to understand the basics can simply match up a + b + c and come up with a treatment plan that can easily be supported by everyone else trained in the system.
What is the point of standardization? Dr. Tang didn’t address this much during the lecture, but I found myself thinking about it quite a bit. Often, things that don’t turn out well started out as good ideas. The road to Hell, as they say, is paved with good intentions. I think the reasons behind wanting to standardize are many, but I feel that it all comes down to expediency and fear for safety. When the numbers of patients you are seeing increase dramatically, you need a quicker way to cycle through them. Further, you can see even more patients if you can quickly and easily teach others how to treat safely. This is expediency. With a standard system you can see more people in a shorter amount of time. Admirable.
Additionally, there is a fear for safety of patients. This is still related to an increase in numbers of patients coming through the system. If you want to train ever larger numbers of physicians, to see ever larger numbers of patients, ultimately a quick way to do this is to reduce standards for entry into the profession. While some people would say that standards are still quite high for entry into the highest levels of Chinese medicine education in China, others would strenuously disagree. Certainly everyone can agree that it takes less to become accepted as a physician in China today compared to a couple of hundred years ago. Regardless, when you reduce the standards for entering into a potentially dangerous profession, you have to build safety valves into the essence of the system to avoid costly errors. In all, if we reduce professional standards and standardize sufficiently to ensure patient safety, we can see huge numbers of patients in a relatively short period of time. Why NOT standardize, one might ask…
Because Chinese medicine doesn’t work very well when it’s standardized. In fact, the system relies pretty heavily on individualization. While we can agree on certain basic sets of symptoms as emblematic of particular disease states or formula patterns, ultimately each person’s manifestation is likely to be slightly different and thus take a slightly different formula. Ultimately the creation of a formula or point prescription needs to be highly individual, based on the interaction between doctor and patient, the particular manifestation of the patient on that day, the particular weather patterns current and expected, the tendencies in any given year, the dietary habits of the patient and so on. While a “standard” prescription may lessen symptoms, it’s unlikely to have the kind of dramatically positive impact that a more individualized treatment would have. I’ve seen this in clinic many times, and I’ve experienced it myself.
But more importantly, these eminent physicians have seen this in thousands upon thousands of clinical cases and are adamant that standardization (as it is currently practiced) is a degradation of our medicine.
Dr. Tang talked about many other things, but it will have to wait for another post. For now, I’d be interested to hear folks’ thoughts about what I’ve said here. Why do you think people are so eager to standardize Chinese medicine? How do you see the benefits and costs? What are the alternatives? What are their benefits and costs?
Eric
Tags: classical-chinese-medicine, events, liu lihong, Portland, standardization, traditional-chinese-medicine
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