Deepest Health Chinese Medicine Podcast : Interview with Dr. Arnaud Versluys LAc, PhD (Part 2 of 3)
I’m glad so many people enjoyed the first episode of this podcast interview with Dr. Arnaud Versluys LAc, PhD. The second part finds Dr. Versluys expanding on his definition of Classical Chinese medicine by discussing how one uses the Shang Han Lun in contemporary clinical practice, particularly concerning complex diseases typically seen in modern times. He also discusses the importance of specializing in a particular style of Chinese medicine and gives some advice to those of us seeking knowledge in this profession. I think you’ll really enjoy the information AND the audio quality - I think I finally got it right. :) Check it out at the bottom of this article!
If you missed the first part of the interview with Dr. Versluys you can find it here. For more background on the six conformations read the article linked here. I also encourage you to check out Dr. Versluys’ website, particularly the forums - a great place for discussing Canonical Chinese Medicine.
Dr. Versluys uses a few names that may be unfamiliar to listeners - I want to clarify these things for you. Li Dong Yuan is the author of The Treatise on the Spleen and Stomach (Pi Wei Lun)
and Jin Gui Yao Lue
I’ll release the final part of the interview early next week - it’s a short piece focusing specifically on the issue of herb substitution and the possibility of growing Chinese herbs in the United States. I hope you enjoy today’s podcast! As always, feel free to leave any comments - discussion is a great thing! :)
Eric
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Tags: arnaud versluys, ccm, herbs, interview, Learning, Podcast, six conformations, tcm, versluys, Zhang Zhong JingRelated posts
Deepest Health Chinese Medicine Podcast : Interview with Dr. Arnaud Versluys LAc, PhD (Part 1 of 3)
Happy Election day to all of my readers in the United States of America! I’ve cast my vote for Classical Chinese Medicine by publishing the first part of my podcast series with Dr. Arnaud Versluys. :D
This is a pretty brief piece where he answers the question, “What is Classical Chinese Medicine?” I think you’ll find some great information in there about the relationship of the Classical texts to the practice of medicine, the importance of careful study as well as some food for thought regarding the various schools of Chinese medicine. I’ll release the second part of the podcast before the end of the week and release the conclusion, a little vignette about herbal access and herb substitution next week.
Look also for my regular Saturday podcast this week - ok, so it hasn’t been very regular lately, but I hope we can get past that. ;) Enjoy the podcast!
Tags: arnaud versluys, classical-chinese-medicine, interview, Podcast, studyRelated posts
Why Chinese herbal formula science is the most advanced medicine out there
I’ve been working on reviewing my Fall term notes. It’s been a fun process, one I haven’t done before. I can recommend it highly to any student. I find that it helps me consolidate the knowledge I internalized during the prior three months, making me feel much clearer and ready to receive the new influx.
The course that I have been anticipating since I began at NCNM is most certainly Chinese Herbs V - Formulas with Arnaud Versluys. I’ve already talked a little about Dr. Versluys and really you need only look over his website to understand what an honor it is to study with him. Despite my excitement, I was pretty nervous coming into this class. I did very well in single herbs, but formulas is a whole different beast. My success in single herbs would not automatically translate into success in formulas. I knew I would have to bring my memorization skills to a higher level and resolve to dedicate a large amount of time to assimilating the material. I managed to do both, and my experience in the class was incredible as a result. I’d like to briefly discuss what I consider to be the three most important things I learned in the class. Because there was some overlap in concepts between this class and shift with Dr. Versluys, I’ll pick three new lessons.
The formulas themselves
I would be remiss if I didn’t point to the formulas themselves as one of the greatest lessons in this course. Dr. Versluys is incredibly good at bringing the formulas to life, which makes you desperately want to get to know them better. This is particularly true of the Classical formulas (those found in Zhang Zhongjing’s writing) as they are the only formulas he uses in clinic, and thus he knows them best. We learned formulas in three categories developed by our faculty. First, primary formulas. These are formulas we are expected to have fully memorized. Memorization includes knowing the herb names and basic properties (nature, flavor), their dosages (and thus ratios) and their positions within the formula (Emperor, Minister, Assistant, Servant). Beyond that, we are supposed to be able to explain HOW THE FORMULA WORKS. Not just that, but we need to be able to do this to the extremely high standards of Dr. Versluys. The second category of formulas is called appropriately, secondary formulas. These we needed to know less about. We need to know all of the same memorized information above for the Emperor and Minister herbs, but not the Assistants or Servants. We needed to be able to explain what the formula did - but not in as much detail as for the primary formulas. Finally, we had tertiary or reference formulas. For these, we simply needed to be able to have some general understanding of what the formula does and what it contains and be able to know where to look up the information should we need it in the future.
Learning about the intricacies of the primary formulas was a joy. Dr. Versluys has devoted his life not just to memorizing and clinically testing formulas, but to truly understanding the SCIENCE behind them. He does this first by having a very rigorous understanding of Chinese medical physiology, with its resultant comprehension of pathology. For instance, panting is a symptom that, with a complex of other symptoms, leads us to think about using Ma Huang Tang. Why? The Lung system includes the pores of the skin. The pores are actually part of what allows the Lung to inspire. In a cold damage scenario, the pores are frozen shut. This decreases the available volume of inspiration. However, the body still needs the same amount of air - so it increases its rate to compensate, creating panting. Ma Huang is our best herb for breaking the closure brought about by cold! Our whole class, every day, was filled with insights like this. They not only enriched our understanding of the material but made the formulas much easier to remember.
Don’t modify formulas so quickly
Dr. Versluys cautioned us against modifying classical formulas at will. This was an interesting lesson, because it seems so common for formulas to be modified. It’s almost a point of pride for CM practitioners that we modify formulas “to fit the patient’s constitution” or the special symptoms that are being presented. We were urged to trust our feeling of the pulse and its leading us to a specific classical formula. Unless extenuating circumstances warrant it, we should simply use the classical formula as it is written and have the patient come back soon in order to modify it (using ZZJ’s stated modifications) if necessary. I think this is particularly good advice for newer practitioners as they have not amassed enough clinical experience to be able to intuit excellent modification strategies. Of course, some of us will have received modification knowledge from our clinical mentor. That’s fine, but I think the principle of this lesson is sound. Do I really presume to understand more about medicine than Zhang Zhong Jing? No. I think I’ll wait a while and see how his formulas work before changing them. I’ll learn to walk before I start running, thanks.
Truly understanding a formula makes you a more effective practitioner
As I discussed above, we were asked to really dig deep into the formula’s structure and history of use to understand why each herb is there and why it is in there in that specific ratio to other herbs. Further, we were asked to learn about the physiology and pathology that matches that particular formula with its classical indications. This process was definitely helpful in the learning process, but I also believe it will make me a better doctor. Because the actual written information we have about Classical formulas is so sparse, we have to reverse engineer a lot of our understanding from the formulas themselves. Doing this rigorously has enabled Dr. Versluys to be a highly effective practitioner. I hope to mirror his success.
This is a great argument for learning a smaller number of formulas really well. I know in many schools (including those in China) folks memorize many hundreds of formulas. But how many do they understand? Further, what is the purpose of knowing all of those formulas? Do you need a formula for every possible condition? Dr. Versluys used an analogy that I found to be very instructive. Consider two individuals. One has a garage that contains a specialized tool for every job imaginable. A tool for taking the feet off couches, a tool for opening jars, a tool for removing bolts from the dishwasher, a special saw for hardwoods, fifty types of wrenches for different situations, etc… The other has a garage with a relatively small number of widely applicable tools. A hammer, a screwdriver, a couple kinds of wrenches, an awl, a saw, etc… When an emergency situation comes up, who is most likely to be able to address it quickly, elegantly, and accurately? Consider who is most likely to be able to find the “right tool for the job” and know the tool well enough to apply it to the specific situation encountered? I would rather be in the second person’s place - to have a small arsenal of tools that I know as well as I know myself. This is what Dr. Versluys seeks to teach us and I think he does a good job of that.
We have the second part of this series coming up this term. I’m beside myself with excitement.
Eric
Tags: arnaud versluys, chinese-herb, chinese-herbs, classical-chinese-medicine, formula-science, formulas, Learning, ncnm, studyRelated posts
Term in review part I : On shift with Arnaud Versluys
I’d like to go back over Fall term 2007 and distill what I feel to be the essence of what I learned in each course or clinic shift. It’s really fascinating to me how full of importance every single class turns out to be, regardless of my feeling of any one class at the onset. Over time this has taught me to be utterly open to the content of every course, the offerings of every teacher.
At NCNM, we begin our clinical education working in the Chinese herbal medicinary, and then graduate to Observation shifts, finally moving on to Internship the summer of our third year. Observation shifts are well named - mostly you watch. To some this may sound boring, but it is anything but. Trying to follow the doctor’s reasoning, observing the minute action of fingers on the pulse, the flashes of understanding as the patient reveals some seemingly minor detail… it’s all so valuable. We are able to take the pulse and look at the tongue, and with some doctors we are able to ask questions of our own. Some doctors have students remove needles or do some of the less intrusive therapies, like indirect moxibustion. During the “down time” when patients are lying with their needles inserted, some doctors will teach in quite a formal way, others simply take questions, still others like to joke around and get to know their students. We are in Observation for two years, beginning in the second year.
This term, I had the distinct pleasure of being one of four students on Arnaud Versluy’s Observation II shift. I have been on three other observation shifts so far, all of them were wonderful learning experiences and each so unique! However, Arnaud’s shift was a different animal altogether. I’m not sure if this is just because of something inherent in Arnaud or if it is because of my deep resonance with his basic medical philosophy and enjoyment of our interactions - either way, I learned so much on this shift I wish I could repeat it for my remaining Observation shifts!
Pulse taking
All of our doctors use the pulse in their diagnosis, but none so far have done so in such detail as Arnaud did this term. This may be due to the fact that he is a scholar and clinician in the Shang Han Lun tradition and in this school the pulse is emphasized. We began to learn a whole Shang Han Lun based pulse system, but really had to piece things together for ourselves. I believe he reveals more about this system in his mentorship tutorial, which is a fourth year opportunity. From what I can tell, the system has similarities to that espoused in the Nan Jing especially in terms of pulse positions and incorporates a system of formula differentiation as distilled from the Shang Han Lun text. The idea is to learn the pulses and their correspondences so well that as soon as you feel a pulse, you prescribe a formula without much question. There are, of course, exceptions to this rule - but our trust in the pulse should be above our trust in the patient’s ability to fully articulate their pathological process.
This makes sense to me, above all, because of my own experience as a patient. It is rare that I can tell a doctor “what’s wrong” and while I can sometimes articulate very strange, and very diagnostically helpful symptoms - most of the time, I just don’t feel right. :D
We also learned some basic pulse taking mechanics. It’s funny, because for all that we learned pulse qualities and the history of the view of pulse positions - we never learned “how to take a pulse” in any systematic way. Sometimes these basics get lost in the shuffle, I suppose. Arnaud gave us those basics on shift and I can tell you that my ability to learn from each pulse I take increased immeasurably.
Modular character of classical formulas
Arnaud is a formula guy, first and foremost. His point selections are intriguing, but it is in the realm of formulas that his brilliance is clearest to see. The easiest way to get him to talk a blue streak was to ask an insightful, but simple, question about a particular formula or formula modification. I’m sad to say that I probably didn’t take enough advantage of this resource - but when I did, the results were both deep and broad.
What I learned most was that the nature of classical (or canonical, as he likes to say) Chinese herbal formulas are exceedingly modular. What this means is that if you take half a dozen of the most used Shang Han formulas you will see numerous overlaps that make it simple to combine formulas without adding too many ingredients or making the formula too big. This creates an extremely wide therapeutic output with just a small number of different herbs. It also means that the dosages and combinations in classical formulas are EXTREMELY tight. If there are 9 grams of Gui Zhi and 9 grams of Bai Shao in a formula, changing one of those dosages to 6 grams produces an entirely different effect. So, the practice of willy nilly modifying formulas based on wanting “a little more of this and a little less of that” probably isn’t a great idea.
Thinking about formulas this way has completely changed the way I study them. Instead of looking at formulas in relative isolation or placed in arbitrary categories (as found in most formula text books) I look at formulas as in relationship with one another. All of the formulas that contain a similar ratio of two herbs are going to be related in some deep way. This allows me to more fully understand the function of the formulas and be more effective with them in clinic. Practically, whenever I learn a new formula, I spend some time searching for related formulas usually using electronic resources I have created myself. Then I read all I can about these related formulas, particularly anything included in the Classical texts. I seek to comprehend the similarities and differences. In some cases, I have also looked at all formulas with a particular two or three herb combination, regardless of dosage. This is also instructive.
Learning to ask good questions
As I’ve already mentioned, we usually got the most out of shift when we were brave enough to ask bold, yet succinct, questions. I tend not to speak up in academic group situations. Because of the rambling and pointless nature of some questions asked in many classes (Chinese medicine or not) I tend to wait until I have a truly important, well-informed and brief question to ask of a professor before I’m willing to put myself out there. However, I know that this policy has probably negatively impacted my educational experience in some small ways. My academic relationship with Arnaud is helping me to get better at quickly coming up with relevant and insightful questions. I hope this skill continues to develop.
In sum, my term with Dr. Versluys was quite enriching. I’d be interested to hear the stories of other people, even in other schools, about their early clinical experiences. Any disasters? Any moments of earth-shattering insight? Let us know in the comments. If you’re interested in hearing more about my experiences in medical school, be sure to subscribe to this blog via RSS feed or via email.
Eric
Tags: academics, arnaud versluys, Character, chinese-herb, clinic, education, ncnm, pulse, studyRelated posts
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