Understanding Chinese herbs using Classical Chinese Medical thinking
Sometimes I learn small things that turn out to be very useful. I would like to start sharing these as bite sized treats interspersed in between the thicker cuts that many of you are accustomed to here on Deepest Health. Today, I would like to offer one of those which is a way of thinking about herbs (and, thus, formulas) that I initially learned from my mentor, Dr. Arnaud Versluys. It’s a simple thing, maybe, but hopefully helpful to you.
In our Classical Chinese Medicine education here in Portland, OR, we are given a variety of types of information. I’ve talked about this several times before. We are sometimes told that truly Classical Chinese Medicine includes the information in the standard TCM system and includes information in the Western/allopathic system, but then goes outside of those reaching back to the Classical texts and cultivated ways of knowing. All of this information must be explored and, ultimately, integrated. We are encouraged to find that which really drives us and dive deep into that, but always asked to keep our minds open to the whole symbol field of information that human striving has uncovered.
In that spirit, consider the study of Chinese herbs. There’s a huge amount of information one could associate with any given single herb. The information has many different aspects - let us consider the relative materiality and the relative size (in time and/or space) of the information. We can create two axes. One from grossly material to highly immaterial, and one from microscopic to quite macroscopic. We can find useful information anywhere in the field created by these two axes. Let me provide a partial list of information along these two axes that I use to understand single Chinese herbs. The information will be listed from more material and more microscopic to less material and more macroscopic (obviously not a perfect gradation).
- Specific biochemical constituents, chemical bonding (for example, discussion of specific alkaloids)
- Classes of biochemical constituents, herb-herb interaction (for example, what are alkaloids?)
- Western medical physiological understanding (for example, discussion of the endocrine system)
- This might include information from Western medical studies/clinical trials
- Habitat and other botanical information (what kind of plant is this?)
- Chinese herbal category information (qi, flavor, channel affinity) and dosage information
- Contradictions (both Chinese and Western)
- Use of the herb through history in China (what formulas? what doctors? what contexts?)
- Understanding via various systems of differentiation (Ba Gan/8 Pillars, 6 Conformations, 5 Element)
- Information in various Classical texts concerning this herb other than what’s already been covered in another category
- Symbolism behind any of the previous categories of information (for instance, given the relevant habitat in which the herb grows - how can we understand it symbolically)
- Use of categories of information associated with the organ clock (If this is a Spleen herb, how can the symbolism of the snake help us think about it?
Let’s just look at a quick example on a very basic level using just some of the partial list above. Bai Shao, anyone?
白芍 Bái Sháo (Yào)
Biochemical constituents/other minute level Western information
- Paeoniflorin, albiflorin, oxypaeonifloring, benzoylpaeoniflorin, paeonin, hydorxypaeoniflorin (glycosides), gallotannin, d-catechin, eugeniin (tannins), benzoic acid, proteins and other constituents
- To extend this into the next category, we might be interested to look more deeply at the general function of glycosides and tannins, their function in the body and the families of things on the planet that either create or use them in high amounts. Of course this must all be evaluated symbolically.
- Herb-herb interaction? We might consider that Bai Shao is often paired with Gui Zhi, look into the chemical constituents of Gui Zhi and investigate, from a Western standpoint, what those interactions tend to produce.
- Herb-drug interaction? What drugs does Bai Shao resemble? What drugs does Bai Shao work poorly with? For instance, one is asked to have care when using Bai Shao for patients on anti-coagulants. What does this mean?
We could definitely find many clinical studies about Bai Shao and isolate what pharmacological effects allopathic medical researchers have found. A quick look tells me that some researchers have found that Bai Shao has:
- CNS suppressant, gastrointestinal, antibiotic, antipyretic, anti-inflammatory, anti-platelet and cardiovascula effects
Habitat and other botanical information
Bensky tells us that Bai Shao is Paeonia lactiflora with the bark removed and that Chi Shao is a wildcrafted version of the same species - with bark intact. It would be interesting to know more about this distinction and to understand whether this distinction held during the Han dynasty. Anyone with information to that effect?
It is native to a large part of the area from Tibet through China up to Russia. It enjoys a wide range of habitats and the entire plant can be used medicinally or as food. This may help us to understand its rather broad range of effects and its extensive use in the classics.
Chinese herbal category information, inclusion in formulas
- Wei/Flavor: Bitter and sour
- Qi/Temperature: Slightly cold/cool
- Channel affinity: Liver and Spleen
- Dosage: Typically 6-15 grams
A quick search at Rootdown.us shows us that Bai Shao is included in 48 formulas. As the formula database is not complete on that site (it’s growing every day!) I’m certain the number is much higher. We could look at the usage of Bai Shao in each of those formulas and come to some conclusions about what kinds of effects it has and use those findings to further dive into the symbolism associated with the herb.
Use of the herb through the history of Chinese medicine, inclusion in various Classical texts
How did Zhang Zhong Jing use Bai Shao? How is this different from the way later physicians used it? What is said about Bai Shao in the Shennong Ben Cao Jing? This entry is getting a bit too long already, so I won’t delve into these questions — but you can see how the information would be very useful in coming to a full understanding of Bai Shao.
Understanding some of the above information more symbolically
Just as a quick example take the broad habitat adaptation of Bai Shao. It’s a relatively easy plant to grow - and it grows quickly. The Earth seems to want to give it to us in abundance. An herb that adaptable has to be important for the basic physiology of the body - one might think. Perhaps it lends itself to a certain adaptability in us as well.
Various systems of differentiation
Again, to save time I will be very brief. One way to understand Bai Shao is that it backs Wood off of Earth. This doesn’t mean that Wood has to be very excessive. Earth merely needs to be a bit under the weather (so to speak) and the normal amount of Wood will be too much for it. This is part of the way we can come to understand Bai Shao’s use in Xiao Jian Zhong Tang. One symptom one might find in a XJZT syndrome is mild muscle cramping or mild abdominal cramping due to a weak Earth being unable to resist the basically “normal” Wood energy. Bai Shao mildly backs Wood off of Earth so it can recover.
Organ clock and other high level theoretical constructs
Bai Shao is basically a Wood herb. How can we use the symbolism behind the Wood organs - Liver and Gallbladder, to come to a fuller understanding of Bai Shao? We can consider, perhaps, the symbol of the Ox or the Wood constellations in Chinese astronomy. We could look at the clock pair of the Liver and try to uncover any mysteries there.
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Ok, so this turned out a little longer than I expected. My gut level instinct is simply this. While I am not personally interested in going down every little rabbit hole that the current information culture serves up for me, I am certainly open to embracing a wide variety of information sources. I find that when I am able to see an herb (and by extension a formula) from many angles, my relationship with it deepens. I can only assume that this is molding me into a better clinician. I’d be very interested to hear anyone else’s thoughts on this topic in the comments. Go on - take a chance!
Eric
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Tags: chinese-herb, chinese-herbs, formula-science, formulas, herbs, integrative-medicine, scholar, study-methods, studying, western researchRelated 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
Don’t call it a comeback
Wow, sorry folks. I didn’t consciously stop blogging which tells you that I must be pretty busy. :) This term has been a lot more intense than I expected it to be - mostly because I’m so engaged in everything that I’m learning that I don’t even WANT to do anything but study (aside from stuff with my family). However, I have plenty to share and over the weekend I’m going to be doing my best to write a few articles. I’ll give you a quick preview as well as open up a discussion about different approaches to herbal medicine.
What’s coming up on Deepest Health?
1. Report on the Student Caucus at the AAAOM Conference in Portland. // I’ll just go over what I took away from all the student networking that went on at the conference and my hopes for a stronger, broader professional Chinese medicine community in the United States and beyond.
2. Review of the Acupuncture Desk Reference, a good looking little book put together by David J. Kuoch. // It’s a good attempt at a basic reference book helpful for students and new practitioners. I’ll share what I love and what I think could be improved.
3. Review of the beautiful “Living Meridian” charts available from the folks at The Fifth Element. // I’ll discuss my experiences using the charts in keeping up with my points study and some recommendations for getting the most out of this useful study tool.
4. Review of Blue Poppy Press’ release of a new translation of Yi Lin Gai Cuo, a fascinating work in relatively modern Chinese medicine. // I’ll consider how this book might be useful to students and how it has expanded my understanding of both the history and content of our profession.
5. Discussion about the future of health care in North America and what place I see for Chinese medicine in the overall fabric of medical practice.
6. Many discussions that have come from this term of school including: balancing competing teacher perspectives, the importance of humility in learning and practicing medicine, developing peer relationships in a busy world and comparison of electronic and low-tech methods of study and organization.
I hope you’ll stick around.
A broad question about Chinese herbal medicine practice
I have been learning quite a bit about Chinese formula science these last weeks. This information combined with what I had already integrated through study and watching patients in the clinic has led me to a few conclusions. The first, and most important, is that the “broad spectrum” approach represented by many more contemporary formulas (for instance, RenShen Bai Du San 入參敗毒散 ) is fundamentally bankrupt. It wasn’t until my teacher Arnaud Versluys suggested to us the similarity between the approach of this class of formulas to the use of broad spectrum antibiotics that I really understood how important this principle is for the integrity of our medicine.
Where Zhang Zhong Jing’s formulas were extremely tight in structure, extremely focused and strong in action, “broad spectrum” formulas can hardly be said to have a structure and seem to want to be everything to everybody. They are the John Kerry of the herbal medicine world (sorry John). They seem to characterize a way of looking at medicine that says, “Hey, we don’t REALLY know what’s going on at all, so let’s just cover all of our bases and see what happens.” The fact is that most people do improve, over the short term, with these formulas. Their root pathology, however, may simply sink beneath the surface only to eat away at vital substances and/or resurface at some later time with renewed ferocity. Why not improve our diagnostic skills, improve our understanding of the science behind our medicine and be confident enough in our diagnoses that we can prescribe strong, focused and time-tested formulas?
I don’t know enough to say that all non-Han dynasty formulas are worthless, baseless or are going to harm people in the long run. In fact, I’m sure that’s not the case. But why (and here’s my question to you) not learn very well the principles behind truly Classical formulas, pay careful attention to their clinical effects and proceed in that direction? I would love to hear your thoughts in the comments.
Eric
Tags: Acupuncture, Blogging, book-review, books, Character, chinese-herb, formula-science, formulas, herbs, professional-development, versluysRelated posts
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