I have a feeling I’m going to get in trouble for my teaching. It’s not that I’m that revolutionary, or that I really even know that much more than my students. It’s just that my fundamental orientation towards the universe is to be always, always asking questions. I don’t always need to let those questions come out of my mouth (undergrad philosophy students, take notice!) but they are always in there. In particular, I tend to question fundamentals. Fundamentals, here, are those basic concepts that act as building blocks for entire edifices of knowledge. Fundamentals, here, are also those things that people most often tend to take for granted.

It’s just the philosopher in me, some might say. But, I could just have easily learned the habit in my work in a microbiology lab in my undergrad years. Or in my work as a forest ranger. Or in my all-important work as a father. I think almost any situation can be helped by a willingness to ask very simple, very essential, very difficult questions with a willingness to be surprised. The clarity of thought that can emerge from such investigations is worth the effort. It is effort, though, there’s no doubt.

So, what are these trouble-making lectures I’m giving? Well, I probably inflate myself unnecessarily. Some of it is just introducing the students to interesting concepts at an early stage – such as the flavor/element combinations introduced in the “lost” Yiyin Tangye Jing (伊尹湯液經). I’m assuming that a number of you have already read the eye-opening article by Wang Shumin, found in the book Medieval Chinese Medicine: The Dunhuang Medical Manuscripts after her extensive research into the remnants of the text found in the Dunhuang caves. While it’s not instigating trouble as such, I do think that being forced to consider these things makes the students more inquisitive, and more likely to think deeply about what they are learning in other classes. But, again, maybe I am congratulating myself a little too quickly.

Not familiar with the text I’m referencing?  The essence is this : twenty five herbs are categorized according to the five elements. This would be cool enough, particularly given that the text was likely referenced by Zhang Zhongjing in his writing. What an insight into the construction of Han dynasty formulas! But the herbs are also given flavors, some contradictory to those we know in modern times and the flavors are in turn related to the five elements in a unique way.

• You know wood as being affiliated with sour. In the Tangye – it’s affiliated with pungent. Think of the spreading action of wood, its reaching and movement and activity.
• You know fire as being affiliated with bitter. In the Tangye – it’s affiliated with salty. What is softer than fire? And what better to soften than salt?
• You know earth as being affiliated with sweet. Ok, no changes there.
• You know metal as being affilated with pungent. Perhaps predictably, the Tangye talks about sour instead. Think about the condensing and gathering power of sour, and the condensed and gathered nature of metal.
• You know water as being affiliated with salty. Bitter anyone? Bitter is a downward draining flavor, one that is almost universally associated with cooling and making things more dense for their eventual expulsion. That is fitting for water, our “lower” (but Northern!) element, and while not condensed as such – is certainly the coolest of our elements.

In class we have been making use of these flavors as we work with our senses to understand herbs. I’m learning, of course, just as much as they are – it’s a wonderful journey so far.

Established readers : this is one of many reposted articles you will see in the coming months.  It is part of the redesign process.  I hope you agree that all of these articles are worth another look!

I have to admit to some weirdness around the concept of “constitution.” This is absolutely unfounded, I have no clinical or theoretical information to back up my feeling. I think I’ve just seen this concept be misused. Once you get an idea in your head that a patient is a “Chaihu person,” or a “Bladder CF,” or a “Shaoyang patient,” it seems to be a little difficult to think outside that box. It offends my desire to meet the patient where they are without preconceptions.

Now, don’t get me wrong, I realize that this is part of what WE DO in Chinese medicine in particular and natural medicine in general. We look at the gestalt of the patient, and we make a helpful generalization about their condition and the treatment that is likely to rectify it. We look into past and future and consider how the patient came to be where they are and where they might be going, and treat them based on all of this information. I have no problem with that. But, I find myself a little worried when I persistently think about a person as, say, a “Chaihu” person, even before they come in – and use that lens to view whatever it is they might be presenting with in the current moment.

Before you click on the comment button prematurely – know that this is an attitude that is changing for me. The more patients I see, the more I see really weird cases. These cases involve patients who present with a certain picture that so strongly speaks to a particular treatment strategy but for whom that treatment strategy does not work. Searching for a remedy usually guides me in a very unexpected direction. In retrospect, looking through the patient’s case, I usually see a certain pattern emerge.

Here’s an example from my time in the student clinic.

A patient presenting with very serious symptoms (serious blood stasis, ongoing memory loss, digestive chaos, emotional instability and more) also had a *very* excess pulse – pounding, tight and wiry at all depths with some choppiness throughout. A dong (flicking bean) pulse was found on both sides between the first and second positions. A lot of stasis in the tongue. The supervising doctor and I discussed the case for a while, trying to seek out the best formula. For the next six or eight weeks, we used some variation of Taohe Chengqi Tang + Zhishi Xiebai Guizhi Tang with some incorporation of Guizhi Fuling Wan. We wanted to treat the most excess, the most “outward” of the symptom picture first.

As the treatment progressed, however, it… uh, didn’t. The patient’s symptoms didn’t lessen much, the pulse picture didn’t change. We decided to work from another direction. Following the recommendation from one of my mentors, I used a modification of Shenqi Wan with some additional blood movement incorporated. The patient found almost immediate improvement and continued to improve for the next several months. Later acute episodes found us changing our formula strategy a bit, but Fuzi has always been involved and when the Fuzi is removed, the patient worsens.

Now part of this is just my clinical immaturity and maybe my inability to see signs that, for a more experienced practitioner, would seem obvious. I’m sure there are several of you in the audience shaking your heads sagely – ah yes, of course, Fuzi. But, one could easily see something about “constitution” in this case. I’ve had similar experiences otherwise. It’s not always obvious in the pulse, it’s not always clear in the history, but when you go with it – improvement is found on all levels.

There doesn’t seem to be something that binds these cases together in every case. For instance, I am in no way convinced that if a different person with a similar presentation as above were to come to the clinic that I would be able to resolve their situation in the same way. But, I may be able to look at this person and – over time – learn some basic characteristics that help me to identify patients who might need this approach… this is, to me, constitution.

I’ve been reading the Classicalformulas.com blog over the last couple of months.  I’ve also read through the book the blog is affiliated with, Ten Key Formula Families in Chinese Medicine.  I enjoyed reading it.  One thing I couldn’t quite get into was the classification of people based on their body type.  While I, of course, pay attention to body type – I don’t think I’ve gone as far as thinking that a person fell into a certain class of formulas because of that body type.  I’d love to hear from anyone who has used, or currently uses, this type of classification.  Have you found it works all the time?  90% of the time?  Something else?

This is a fascinating topic, in general, and one that I know has a lot of traction out there.  So, even if you haven’t read the book above, I’d like to hear your thoughts.  What do you think about constitution?  Where is the classical support for this method? What have you been learning in your classes and seminars about constitution?

Herbs are not tools

When I learned Chinese herbs in school, I fell in love. In part, that was because the teacher used the Shennong Bencao Jing as part of his teaching materials. This connected me to the larger stream of my tradition while also adding some interesting flavor to the information – those of you who have perused this text will know what I mean. I have seen class notes from other herbs classes, and what I see there helps me to understand why so many people don’t enjoy learning herbs.

The herbs are reduced to a series of bits of data : flavor, nature, channel affinity, primary indications, maybe some formulas or combinations. The students are then asked to absorb a huge number of such bits of data, in preparation for the even more data heavy formulas class. Many students leave this experience feeling more than a little dismayed and disillusioned. That is true even for those who come to school really excited to learn this stuff. I can’t even imagine what it must be like for those of you who don’t like herbs to begin with!

While knowing the basic information is important (flavor, nature, etc) dwelling too long in the lap of this information without moving beyond is deadening. It causes one to relate to the herbs as tools, as objects, as things to be manipulated. Theories and ideas come to the foreground and drown out the mutable, messy relationship that has been the experience of herbalists for centuries. All of you know that I’m a sucker for data (and databases) and also have a deep and abiding love for theory. However, I know their place, and I know their peril.

Ultimately, I see herbs as Beings with which I can have a relationship. This relationship has many of the same facets, and requires many of the same skills, that I use in my relationships with human beings. When I come into this fully, I am more easily able to understand herbs, remember herbs and – most importantly – accurately and effectively prescribe herbs to my patients. Yep, folks, this is clinically relevant stuff. Seriously!

Even if you don’t believe it is TRUE, try thinking of herbs as Beings with a capital B

What would it be like if you were to think of herbs as something with which you can have a relationship? I mean a real relationship. I’m talking about “getting to know them” and “developing rapport” and “sharing experiences” and “building memories” and all the rest. What if you thought about herbs as multi-faceted Beings with likes, dislikes, a home, a family, preferred activities, favorite places, present, past and future? What if you used the same skills you’ve learned in building relationships to get to know herbs? It’s possible, it’s powerful and it’s what helped me to learn herbs so deeply that they infiltrate my dreams on a regular basis!

I would like to share some best practices about this, and some stories about how it has helped me move into a whole different world with regards to my herbalism. I’ll break it down into bite-sized chunks, however, and release it over the next few days. So, please read tomorrow to learn more about building your relationship with Chinese herbs. As always, I’m interested to hear what you have to say in the comments. Have you done something similar to what I’m describing, either with Chinese herbs or something else? Has this post stimulated any thoughts or discussion? Let us know – it’s easy to leave a comment on the post – no sign up is required.