Earthly Branch Si – The Snake : Lesson – You can take in a lot more than you think, but don’t overdo it

The Spleen is associated with the 6th Earthly Branch 巳 – Si. This is one of the few earthly branches that actually is a picture of the animal that came to be associated with it – the Snake. However, I should note that many people also posit that it is a picture of an infant. The oracle bone figures look more like snakes than babies to me, and as a picture of a snake is how I learned it, but certainly you may disagree.

The snake is a fascinating animal that both attracts and repulses most people. There are many characteristics of the snake that relate to the Spleen in structure and function. I’d like to just mention one that has been particularly helpful to me this week. As the title of this section suggests, I’m interested in the ability of a snake to consume prey much larger than itself.

Now, on the one hand, the Spleen really doesn’t like to be asked to do too much at once – as anyone can attest after a big Thanksgiving dinner. So, perhaps it’s not a perfect symbolic match. On the other hand, the function of the Spleen is to take whatever has been consumed and release the pure essence of that sustenance at a reasonable rate to the rest of the body. Often, even with big meals, we surprise ourselves with our ability to take it in and use it with some effectiveness. As a student, I am consistently asked to shove more information into my head than I think is possible. However, by approaching things deliberately and with confidence, I consistently surprise myself. No jaw dislocation required.

Phase element Earth – the Center : Lesson – Having a solid substrate allows for great transformation

The Spleen is the Yin Earth organ of the body, and as such serves as the stable substrate through which all of the activity of the body takes place. One of our professors mentions how people talk about the Spleen in an inappropriately “active” way. In fact, it is the organ that exemplifies that Wu-Wei principle of getting everything done while doing nothing. It is the rich humus that nourishes everything, yet serves as only a medium for that nourishment – not an active partner in it. Sure, mycobacteria and various little critters serve a vital function in keeping plants healthy, but these are not part of the Spleen principle. The Spleen Earth serves as a healthy place for these organisms to do their work, simply that – and that is more than enough.

Creating a super stable life management system for myself has been vital in my success. Still, it is always a work in progress. Unfortunately instability in my system was one of the keys behind why I was not so productive this week. I thought my system was more or less functional, and that I could work out any kinks quickly and simply. I was wrong. Several scheduling issues emerged that required my immediate attention. I had not fully “cleared my mental inbox” during my last Weekly Review (leaving many projects in an implicit mental stage, cluttering my mind). Most importantly, I had not settled my finances and finished budgeting. Thus, about 80% of my time this week was devoted to rectifying those situations. By the end of this weekend, all of that work will be done and it will serve me for the rest of the term. It will be the medium through which I am able to do all of the other work I do.

Clock pair/hexagram pair with the Triple Burner : Keep a balance between Yin and Yang

Around the organ clock, we can find many interesting relationships among the organ systems. The relationship between Spleen and Triple Burner is particularly interesting because these organs are united by their hexagram relationship and their actual position around the clock. When two organs are directly across the organ clock, we call them clock pairs and as I’ve mentioned before, we were taught to think of them as being able to “take one another’s shift” so they share some type of functionality. Hexagram relationships are more subtle and difficult for me to understand. Here is a diagram I drew during my first year at NCNM showing the hexagram relationships around the organ clock. The drawing is, admittedly, a little shaky.

The Spleen is associated with Hexagram 1 – Qian 乾, often translated as force, heaven, the creative and, sometimes, simply as Yang. It is made of six Yang lines, and is the most Yang hexagram of the Yijing. Funny considering what I just said about Earth and the Spleen! That’s the way of Chinese medicine philosophy sometimes. The hexagram of the Triple Burner is #2 – Kun 坤, often translated as the receptive, Earth and sometimes, simply as Yin. It is made of 6 Yin lines and is the most Yin hexagram of the Yijing. Unlike the Spleen, this makes a lot of sense for the mysterious and seemingly immaterial Triple Burner organ system.

It’s easy to see the relationship between these two hexagrams – they are opposites and create the dynamic Yin-Yang tension that characterizes the fundamental state of the entire Universe. I’ll briefly explore the Triple Burner-Spleen relationship, but certainly there is much more to say about the shared symbolism of these two important organ systems.

The Spleen and Triple Burner are both responsible for aspects of fluid metabolism, in a way they help to keep a balance between wet and dry in the body. Another organ with a relationship with wet-dry balance is the Lung, which is united to the Spleen in its 6 conformation assignment as Tai Yin. Wet and dry are two obvious manifestations of Yin and Yang, respectively. Another Yin/Yang symbol within Spleen and Triple Burner is the relationship between being in the world and being removed from it. The Triple Burner is the mysterious organ system of deep darkness and in-between-ness. The Spleen is more straightforward, and engaged in the vital business of getting things done in the world, despite it’s passivity that I discussed before.

Extending these analogies, I found myself considering the vital importance of balancing two categories of intellectual activity. First, the more “Yang” activities of memorization, reading and listening to lectures, and studying explicitly for tests. On the other hand, the more “Yin” activities of contemplation, creative thinking, and experiencing Chinese medicine principles as they operate in nature. When I don’t achieve a balance between these two types of activity, pandemonium results.

I was experiencing strange digestive and mental symptoms all this week, and found myself really perplexed by it until I thought of Spleen. It is often said that student life harms the Spleen and Heart the most. The Heart because of the incessant use of the mind, which is related with the Heart in Chinese Medicine. The Spleen because of its association with pensiveness/overthinking and worry. When we find ourselves thinking something to death or being obsessively concerned with some event – our Spleen suffers. This was certainly happening to me and I definitely noticed. As a solution, I have decided to look at my schedule again and find a way to incorporate more straightforward “study” (memorization, reading and rewriting notes, etc) with more contemplative creativity. Although the latter may not help me on tests, it will definitely help me as a practitioner and help keep my Spleen from suffering overmuch.

Archetype : The Great Yu – Channel things away instead of damming them up

One of the archetypes we learn about being related to the Spleen is the Chinese folk hero the Great Yu. It is said that he was able to stem the great flood when his father failed. His father’s strategy was to create huge earthen dams to hold back the floodwater, which inevitably broke. Yu took a different perspective, creating great ditches to lead the water away to the ocean. We are often taught in Chinese medicine school that the Spleen does something similar in water metabolism of the body – guiding dampness away from the body at a steady clip, instead of trying to create barriers to keep it away from vital organs and processes.

I learned this Spleen lesson gradually through the week. A number of projects dumped on to my lap and it was only listening to David Allen’s Getting Things Done Fast on audiobook that jolted me into healthy Spleen mode. One of the things that Mr. Allen recommends is to look at every project/action you have in front of you and figure out whether it actually BELONGS to you. Many times we take on projects that are not properly or best left with us. Delegate! Delegate! Delegate! Lead the floodwaters away.

Related posts:

1. Learning classical Chinese is foundational – an interview with Rick Goodman
2. Phenomenology and Classical Chinese Medicine

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.

This is another repost of archived content.  In this case, it relates closely to the type of information I work with when teaching the relational herb method.  This is actually more advanced stuff – the kind of thing we dig into during the second stage of the training.  But, I thought folks might like to check it out, again, anyway!

Remember : if you’re interested in getting in on the ground floor of the new training (starting in mid October) AND receiving a free framework to help you transform your understanding of Chinese herbs – be sure to sign up for the special Shennong course interest list.  Thanks!

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I think about herbs in a similar way as I think about people.  They have names, faces, general personalities.  They have families, friends, favorite activities.  They like certain climates and not others.  They have jobs and hobbies.  If you really want to get to know a person – you are going to have to access a broad slice of their life.  The same is true of herbs.

What happens when we understand a person more deeply?

Well, for one, you reap great personal benefits from these kinds of relationships. It’s a personal benefit – close human friendships can be the difference between having a long, happy life and a shorter, more stressful one.  I honestly think the same is true of my relationships with herbs.  Certainly it’s a different kind of relationship, but it does have that kind of benefit.  It is, of course, also beneficial for your patients.  When you understand the herbs deeply – you prescribe with more accuracy and shooting for a deeper level of pathology.  You’re a better practitioner, in short.

In the Family

Those of you who have a significant other know that you learn quite a bit about that person by hanging out with their family.  The same is true of herbs, though certainly for different reasons.  I’m not talking ONLY about plant families from a Western botanical perspective, though I’m including that as well.  To learn the family life of an herb deeply you need to look into:

1. Western botanical herb family
2. TCM herb category
3. Shennong Bencao Jing herbal class
4. Related to #3, a family based on the broad “plant/animal/mineral” distinction and the specific part within it

Let’s look at these in turn, using an example – the seldom mentioned herb Xuan Fu Hua / Inula / 旋覆花.

Western botanical information

Inula (either japonica or brittanica) is a member of the Asteraceae family – a family it shares with sunflowers, goldenrod, dandelions among many others. It is a largely herbaceous family, without trees or significant  numbers of climbing and vining plants.  Now, I should note right now that I’m not a botanist, and while I do have a science background, this kind of information always sort of baffled me.  That’s why I’m so happy to be an herbalist – it gives me an excuse to learn this information as deeply as I please.

Now there is a ton of information we can find out about the species itself, and that’s definitely part of the method.  But here, we are largely concerned with the group that the plant is associated with – its family.  One interesting thing about this group of plants is that what looks like a single flower (the yellow mass in the middle) is actually a packed together bunch of little flowers – a composite flower head.

There is a ton of information we could get into with this family – but one of the most simple and common observations is how these flowers look much like a representation of the sun.  Sunflowers, dandelions and many of the members of this family all have a sunny disposition and thrive in sunny locales.

What does this tell us about Xuanfuhua?

Well – the association with the sun can certainly get us thinking.  There must be some kind 0f Yang affiliation, perhaps a Fire association.  Now, in some cases, the information we get from family is going to seem to contradict what we commonly know about the herb, or simply seem irrelevant.  I’m going to suggest that this is almost never the case.

In Xuanfuhua’s case, we don’t need to dig too far to help us find some confirmation for this information.  In the Tang Ye Jing, Xuanfuhua is considered to be the “fire herb of the fire class.”  In other words, it is the ultimate exemplar of fire within the 25 herbs mentioned in this text.  For those of you who aren’t familiar with this text, we’ll discuss it in more detail in the future.

So, in my opinion, we need to think about Xuanfuhua a little differently in light of this information.  While it is commonly thought of as an herb that deals with phlegm and counterflow, perhaps we understand this function in a slightly different way knowing of it’s strong sun, Yang and Fire associations.  Perhaps we even start to expand our understanding of the herb – can you think of some unique uses, or some more advanced understanding, that might transform the way you use this herb in clinical practice?

So many ways to look at family

We don’t have space in this short article to go through the example with each of the four family categories above, but I will provide a brief description of each…

TCM herb category

This is a family of another kind – an affinity group bound by basic effect.  Now, there’s information to be gained by diving deeply into the TCM category, but here we’re looking at the similarities in herbs within that family.  It can also be instructive if we find differences.  That tells us something about the herb, but also something about the ultimate utility of this method of categorization.

Shennong Bencao Jing herbal class

Now, obviously, this is only going to work for herbs that are actually contained in this text.  However, I think it’s pretty interesting to look at which herbs are put together within the SNBCJ.  This goes both for the categorization of upper, middle and lower class herbs as well as the various plant, mineral and animal classifications.  As an early record, perhaps more influenced by the Shamanic traditions in use at the time, the SNBCJ categorizes herbs in a different way than, say, TCM categories.

Layperson family classification

Is the herb animal, plant or mineral?  Within that categorization, what part of the plant (or whatever) is the herb in question?  In the case of Xuanfuhua, we are discussing the flower of an herbaceous plant.  What can we say about flowers, in general?  These are the kind of questions we ask as we examine this “family.”

Pulling it together

Along with all the information we gain from earlier layers of the relational herb method, this information about family can really supercharge our understanding of the herb in question.  Instead of being a couple of data points and some vague reference in a book, each herb becomes as rich and knowable to us as any person walking by on the street.  Because of this deeper knowing, we are better able to understand strange passages in classical texts, odd statements our revered teachers make, and most importantly, the right time to prescribe the herb to our patients.

Related posts:

1. Reawakening the faculty of touch in learning Chinese herbs
2. The qualities and uses of the Chinese herb Mahuang / 麻黃 / ephedra
3. Setting yourself up for learning success : First, know thyself

My students seem hungry for guidance, reassurance and anecdotes related to my path in learning Chinese medicine. When I look at the most popular posts on this blog, they are posts that point to that layer of experience. Thinking on this, I realize that there’s just not a lot of resources out there for people who want to learn about learning. In college, you may end up in some basic “study skills” course, and then are asked to seek out “tutoring” if you are having trouble absorbing the material. The same essential approach is in operation at NCNM, and likely at most schools around the country. While nobody ever teaches anyone how to learn most effectively, we’re all expected to know it, and if we don’t – we’re remedial.

So, we look for others’ stories. We listen to how people we admire learned things. When that information is not divulged readily, students will ask for it. But only if they get the sense that there is a willingness to discuss this all-important topic. I hope to make myself ready to take those questions, I hope to give stories that are helpful.

A student recently expressed frustration at their progress in learning Classical Chinese medicine. This is a first year student, very bright, with the world of Chinese medicine absolutely open and available to him. The problem he is having is similar to one I experienced as a first-year student. Simply, there’s just too much to learn. There is a seemingly endless field of modalities, philosophies, skills, bodies of knowledge – with a concurrently endless pit of internal work to be done. How to do this in four years? How to do this in a way that sets one up for future study, that opens one to a lifetime of deep, real Chinese medicine learning. It’s a painful question, and I empathized deeply with the student ask he spoke with me.

As we talked, I was reminded of a number of students who have spoken with me about similar topics over the last year. There seems to be a basic confusion about the whole process of learning. I’ve read a lot of texts and had a lot of experiences that might help clarify the confusion, but I haven’t been able to distill a simple message that I can communicate to people asking these types of questions. I’m still working on it. However, re-reading one of my favorite books, Wake Up To Your Life: Discovering the Buddhist Path of Attention (Ken McLeod) I ran across a very useful distinction that, I think, speaks to this issue.

In the book (p 59), Ken is discussing the problems that arise when people are beginning a formal meditation practice. In instructing his own students, he tries to orient them around a fourfold understanding:

1. The purpose of the practice : this is why we do what we do
2. The method of the practice : this is what we do to to achieve that purpose
3. The effects of the practice : these are experiences that arise in the day to day effort of practicing the method
4. The results of the practice : these are the long-term achievements that come about through diligent practice of the method – despite some days of negative results

He uses the example of running for exercise to illustrate his point. But one could just as easily apply it to learning Chinese medicine. To be fair, the topic “learning Chinese medicine” is much too broad (and thus part of the frustration I’m seeing in students) so let’s restrict it a bit.

Let’s say I am an aspiring (and/or practicing) herbalist. Let’s say that I have discovered that the essence of learning herbalism is to take the time to deeply know herbs – using a method that my teacher has revealed to me. This method consists of walking through several levels of understanding, beginning with direct sensory perception, progressing through ascertaining “community data” as present in texts like Bensky, through coming to understand these herbs in relationship to other herbs (in formulas and combinations) and all the way to seeing the effects of these herbs on patients.

The purpose of this method is to become an excellent herbalist. To be an excellent herbalist means to be able to prescribe Chinese herbal formulas in a way that is efficient, effective and satisfies some internally derived standard of achievement. That is just one way of describing excellence, surely it has some variation from person to person – but being relatively efficient (thus not taking 10 hours to write a formulas) and definitely effective (the sky’s the limit here) must be present.

So, the purpose and the method are established. It’s the final two elements where things get sticky.

If you sit down to use this method, you’re going to have good days and bad days. Sometimes the Qi is going to flow, you’re going to effortlessly know an herb and feel naturally excited about herbalism and your ability to practice Chinese medicine. Other times it’s going to feel boring, contrived, pointless and you will feel insecure about your student loans, your family’s perception of what you’re doing and your impending entry into clinic. These are the effects of practicing the method – sometimes great effects, sometimes not so great. But one MUST NOT confuse these ups and downs for the RESULTS of practicing the method. You’re not as incredible as you think on your good days, and certainly not as hopeless as you think on the bad ones.

Look at your progress over time. The results are an increasing mastery of the various aspects of herbalism, increasing ability to place your attention on the study at hand and an overall rising in your confidence with regards to Chinese medicine. Being aware that this is a process, that the effects from day to day are not reflective of the overall RESULTS, will do a lot to help you maintain some level of sanity as you learn. Another thing I like about this model is that it places attention on the need for a clear purpose and an overt method. The former doesn’t need to be the same as someone else’s and the latter doesn’t need to be set in stone. But YOU need to be clear about YOUR purpose, YOUR method.

I guess, overall, I think all four elements are deficient in me and my students. I think they’re pretty deficient in our culture overall. So, spend some time thinking about this. With regards to your learning of Chinese medicine (whether you are a brand new student or a long-term practitioner or anything in between) ask yourself:

1. What is my purpose? It’s probably best to restrict this to specific areas of learning – but it may be helpful for some people to have one, overarching purpose. Probably you will have several nesting
   sets. Write them down.
2. What is my method? Perhaps it has been taught to you. Perhaps you have to build one yourself – just try something, test it out, and refine it. It could be as simple as “Memorize and recall 5 formulas a day,” or as complicated as the herbal learning method I hinted at above. Perhaps it relies on learning Chinese and slowly translating Classical texts. More than anything, I want to emphasize that your professors are PROBABLY NOT GIVING YOU A METHOD. So don’t rely on them to do so. It’s just not the way things are, now.
3. What are the effects I experience? It might be helpful to keep a practice diary. Note the good days, the bad days, and the variations. Be very careful not to become too attached to any one particular practice session. Do your practice, and go on with your life.
4. What are the expected and realized results of practice? If you don’t have a teacher to help you figure out the results, again, you may need to posit some yourself. Where do you expect to be in a year, in two? In four? In ten? Who are your models? As you go, be as objective as possible in assessing your progress. Are you seeing results? Why or why not?

I’d love to hear from folks about their purpose, method, effects and results. This is a pretty raw blog post, I just pumped it out here after doing my daily reading. Do you see problems with what I’m saying? What are they? I always welcome opportunities to refine my own thinking!

Related posts:

1. The Lingshu and becoming a superior Chinese medicine practitioner

As I’m working on some of the foundational materials for the upcoming Shennong Relational Herb Learning course, I’m revisiting some material from classical Chinese medicine texts that I don’t know particularly well.  It’s prompted me to get out my Big Chinese-English Dictionary and start slogging through the tedious process of translating passages when you’re not fluent in Chinese.

So, when I was looking for which archived post I wanted to release today, this short text interview with Richard Goodman seemed a natural choice.  Richard has produced an excellent set of texts for Chinese medicine students and practitioners that helps even hopeless language learners like myself make sense of the process.  I really cannot recommend them enough.  I hope you enjoy the interview (below).

Deepest Health (DH): What is the biggest impediment for English speakers in learning to read Classical chinese?

Richard Goodman (RG): “Every aspect of Chinese, and especially classical Chinese, is different from English. From learning and memorizing characters to grappling with a grammar that has no tense, much of what we encounter in Chinese is difficult to understand. When I was finally at the stage that I could start approaching classical Chinese medical texts, I was overwhelmed-where does one begin? The vast number of medical books written before the 20^th century is alone enough to scare people away. This combination of learning a language that is different in every way from English with the sheer volume of classical texts available overwhelms people and even the most well intentioned people never begin.”

DH: How do your books help folks with that?

“My overall goal was to address as many of the frustrations I had in my own studies as I could in one series of books. The two I mentioned were two of my biggest frustrations and I addressed this first by just selecting texts that are fairly easy for beginners. Volume One starts out very slowly and builds very purposefully on the characters and grammar already taught. In both Volumes One and Two, 95% of the characters will be found in every medical text. I didn’t want any “filler” or terms that were rarely found. I was never trying to “wow” readers with impressive texts, but instead made language learning the priority. This does not take away all of the difficulty in learning Chinese, but learning slowly and building upon an ever increasing vocabulary makes the task seem a bit less daunting.”

“One thing I have heard from people over and over is that they did not feel overwhelmed by these books, and that is satisfying to hear because that was definitely one of my goals. Learners need confidence and they need it quickly.”

DH: Have you seen real clinical impact when people learn to read the classical Chinese medical texts? Why do you think this is?

“I think this very much depends on the type of practitioner one is when they begin to study classical texts. If one practices in a way that relies upon starting with a disease, moving on to its standardized differentiation, and then giving the formula and point prescriptions based upon that, that type of practitioner will not find classical texts clinically useful. There are virtually no classical texts that proceed in that way, which is why I suspect most people read translations of the classics and then decide learning to read classical texts is no longer relevant to modern day practice.”

“For practitioners who rely on understanding the underlying theories of Chinese medicine to treat patients, the classics are a treasure trove of information. Even rudimentary concepts like Qi, yin and yang, and the five phases are used to describe healthy and ill states with a depth that is quite astounding and much more refined than anything I have seen in English. I personally never had a really firm grasp on these basic ideas until I began reading them in the context they were originally discussed.”

“A lot of practical information also exists in the classics. For example, my views on pulse examination have transformed many times over by reading classical authors’ methods. Just one practical example is the relationship between the breath and the pulse. Most modern books teach us to use a watch, but rapid and slow pulses are determined in relationship to the number of times the pulse moves per breath. This changes the pulse dynamic considerably, leaving the focus entirely on the patient. Additionally, the terms for the pulses make much more sense to me in Chinese and the translations, such as slippery or choppy, do not really capture the image. Having access to all of the more detailed information on virtually every aspect of Chinese medicine, from prescriptions to diagnosis, will most certainly create a more refined practitioner.”

DH: Do you plan to write more books on the topic?

“There will be one final volume in this series which will focus more on herbal texts and their theories. I have already selected all of the texts and I expect that book to be available by early 2010.

I have already started working on what I am currently calling “learners’ editions” of the classics. That seems to me to be the next logical step so that people can continue studying while also tackling entire books. These will not be translations per se, but people who are not interested in learning the language could still use them as such. All together, I have about 10 books planned to come out over the next two years and all of them are related to Chinese classics and language.”

DH: What advice do you have for people in the field looking to write books? Any sagely advice? Tips and tricks? Things to avoid?

“I think the best advice I can give is simply do not try to force a book out of yourself. Everyone is different and I can really only share my own experience. I never really had the intention of writing books at this stage of my life and I just kind of fell into it. I found work as an editor at a publishing company to support myself while I studied Chinese. As my Chinese got better, I was moved to their Chinese language department and started translating Chinese language textbooks.”

“After editing what was probably hundreds of language teaching books, I got a real sense for what worked and what didn’t. My life circumstances were such that this series was just a natural extension of what I had been doing for the past five years. This is not to say that there weren’t times I struggled with the writing, but the idea and outline was very easy to come up with. Just write what you know and ask for help from others once you have something written—no one can write a book alone. “

Related posts:

1. Reawakening the faculty of touch in learning Chinese herbs

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?

Many people seem to believe that what they see at first glance is as much as there is to see. Nothing could be further from the truth. My hope is to encourage students, and consistently re-encourage myself, to really SEE things in their fullness. The subtle changes in color, the textures, the shadows cast, the subtle suggestions of where they were on the plant, how they were treated during growth and in processing. It isn’t as if this information is recorded as data and filed away for use in therapy – but just like getting to know a person, all of these tiny pieces of information fill in the skeletal lines of first impressions with color, depth, beauty.

Sight aside, I’ve had a lot of fun with the students at NCNM working with our underused faculty of touch. We have been working with two types of touch, though I haven’t had time to go into depth with either. One of the hardest things about this class is the fact that it’s only an hour. That’s why an online version will be so great – more time, more space! However, this limitation does force me to try to get the teaching down to essentials.

The two ways we are using touch:

1. The most basic – “just touching.” There is a ton of information a person can get from touching an herb, even at the most superficial level. You can get a sense for its density, its heft – particularly in relation to other herbs. You get a greater sense for the texture of the herb. With some herbs, like Mutong, you can start to understand what the herb does – it feels like a filter! Or think about something like Ganjiang that feels like it is, drying and warm. Aside from looking to get a sense for what part of the plant is, simple touching can also give you some good information for the doctrine of signatures. Light things may tend to rise, heavier things to sink – and so on.
2. A little deeper. At NCNM, we are taught a variety of ways to use our hands to perceive more subtle sensations. But, anyone can get good information by just sitting with an herb in their hands. I usually take some time to do some Qigong or prayer, just connecting with subtle reality. Then I close my eyes and touch the herb, allowing my mind to rest and eventually to wander. I may just hold the herb in place, or may manipulate it. Usually, going deeper in this way allows one to get information that is a little outside of what one would expect. Actions, temperatures, even colors start to flood the mind.

This week, with the class, we used blindfolds to isolate the feeling faculty. While in practice I encourage everyone to use all of their senses, it can sometimes be extraordinarily helpful to just focus on one at a time. Exhaust it! See what you can find.

Just using touch, the class interacted with Baihe – lily bulb. Now, note, these are second year students – just learning herbs. Here is the list of qualities they got, blindfolded, without knowing the name of the herb or anything about it beforehand.

• Lung
• Treats diabetes
• Treats arthritis
• Neutral to cooling
• Expels phlegm
• Whitish yellow (I kid you not)
• Slightly transparent (seriously)
• Taiyin
• Claws
• Relieves dampness
• Clears heat
• Pungent – bitter
• Cold
• Replenishing
• Moves, but not through Yang force

There are a lot of interesting observations here, I think you will agree!

Baihe is sweet, according to the Shennong Bencao Jing (SNBCJ) – though later commentators say it is sweet and slightly bitter. In the SNBCJ it is listed as neutral, though later commentators say it is slightly cooling. Of these basic affinities, only the bitter is out of place in what the students found. It does clear heat, and while the dampness and phlegm properties are contrary to basic understanding of the herb, it’s not so far out of the realm of possibility. It is indeed replenishing, related to Taiyin and interestingly, is known to treat diabetes!

Most interesting to me is the symbolic association of the Lung organ system. Lily, in channel affinity language, does enter the Lung (as well as the Heart). Again, we do have the relationship with Taiyin. But what about the claws?! Now Baihe in its dried form does feel a little like toenails, as many students jokingly remarked. The claw association could have something to do with that, but more than one student did get a sense of actual claws or talons. This, to me, is related to the Tiger – the animal associated with the earthly branch Tai and the Lung organ system. I just thought it was interesting that these associations came up so consistently.

We did several other herbs in class, and I was just astonished at how much information we could get with just an hour of holding the herbs. If you haven’t tried this before, I recommend it. Yes, just the dried herb. While fresh herbs are great, while plants are great, I do believe that the dried herb holds a lot of information in a holographic way. Students in class were getting senses of the way the plant grows, what kinds of conditions it likes, all without having any contact with the living plant at all. Give it a try!

I want to make clear that I’m not suggesting people just sit with herbs and use that information exclusively. It’s a matter of using our sensory experience to enhance and ground the head knowledge of which we get so much. Also, I wonder how long it will take for these students to forget that Baihe is related to the Lung? Won’t they have a slightly better understanding of the herb, having spent a little time with it? What if they were to use all their senses, and consistently reengage with it over a period of months, years? It gives me high hopes for their future as herbalists! Give it a try, and come back here to tell us how it went – add your thoughts in the comments!

Related posts:

1. Setting yourself up for learning success : First, know thyself
2. Listening my way to success in the NCCAOM acupuncture board exam

In my last article, I mentioned my idea that the best way to learn Chinese herbs is through what I’m calling the “relational method.” Before we can dive headlong into the process I am describing, we need to prepare some ground. Today, I want to talk a little about learning in general, relationship styles and relationships skills. My motivation for doing this is twofold.

First, I really believe that an astonishing number of people looking to learn aren’t really sure how they do that best. Yes, folks, there is more than one way to take in information. The way you learned in grade school is NOT necessarily the best one. Second, the nature of my developing theories on teaching and learning are deeply interwoven with the relational method of learning Chinese herbs. I think you’ll see how that works as time goes on.

As I’ve made clear in other posts, I’m a big fan of the concept of learning styles.

I think that the material associated with this concept can help stuck students get unstuck pretty quickly. I don’t know about you, but when I was growing up, I was quite sure that there was only one way to learn – words, words and more words. Fortunately, I’m good with them so I didn’t suffer TOO much. However, some people learn more readily by using their bodies in the learning process. Others really excel when listening, even music, is involved. Still others are visual – but not so verbal – they like pictures and diagrams. These are the basic learning styles most frequently discussed in the literature. Obviously, we’re missing some important learning methodology that we will use in our study of Chinese herbs – the more subtle faculties that have been the tools of herbalists for centuries.

In addition, I find that different types of material often require different methods. That’s actually one place I diverge a bit from the traditional “learning style” literature – I don’t necessarily think that every person has a single method that works well in all cases. Some material lends itself better to one method or another, or a combination of methods. One person may find that using sound to learn herbs is the best method, others may find it to be completely useless. Yet, that same person might find that they can’t use sound to learn points at all. Further, there are some teaching and learning strategies that seem to work well for everyone – for instance associating very vivid imagery with something you are trying to remember. All of that aside, the core of what I’m saying is simply that there are a lot of ways to learn new information.

The first thing you need to do is figure out how you learn best.

Now, some of you will scoff – thinking that such material is below you, you “instinctively” know how best you learn. Fine. For most of you, however, you’re a little bit intrigued by the idea and want to know more. You’re the ones I’m talking to. There are a variety of great tools out there to help you investigate your own learning style. One of the simplest is here. I encourage you to give it a try. Answering the questions honestly is very important – and note that you can tick more than one box. The results of this simple quiz will help you get started in your quest to understand your own learning style. You will get a list of your preferences for free – showing which are the strongest preferences. You can also purchase a downloadable report and e-book to learn more information. I have not tested either of the paid options myself, instead researching more about my preferred learning styles (Read/Write and Aural) on my own using Google.

An online quiz won’t give you all the answers, of course. Fortunately, most of the deepest information is readily available to you – in your memory. You need to reflect on your prior learning experiences. Sit for a minute and think about your prior learning experiences – positive and negative, formal and informal. Accept the possibility that you have a unique learning style – be curious about finding it. Consider this a voyage of internal discovery that will help you to excel, not just in Chinese herbalism, but in anything you choose to learn. Here is some guidance you can use in your quest.

• When have you really excelled in a learning situation?
• Better yet, when have you been so immersed in your learning that it didn’t feel like work – you couldn’t even stop if you wanted to – and you retained the information?
• Maybe it was a situation where you were able to explore a topic of your choice in as much detail as you wanted. On the other hand, perhaps it was in a multiple-choice testing environment.
• Perhaps it was during a lecture where the teacher was very animated, using lots of examples and stories. On the other hand, maybe you prefer being nestled deep in the library stacks with a book.
• Perhaps you always study best when there is music playing, or when the information is presented in a musical way?
• Try writing a really vivid description of the times you have enjoyed the most in learning – and make a list of the characteristics of that time. Reflect on those characteristics and try to get a sense for yourself, in general, as a learner. This is also a good time to reflect on those characteristics you prefer in instructors – both formally and informally.

Give yourself time with this exercise, perhaps reflecting on what you’ve found over a couple of days. This information will become useful as we continue.

Leaving that important information aside, I will ask to delve into your own habits and talents yet again.

This time, I would like you to focus on yourself as a person in relationship. When you meet someone for the first time – what do you do? How do you interact with them? Are you forward, asking lots of questions? What kinds of questions? Are you more reserved, responding to questions and observing? What are you looking for? What is the most basic information you feel like you need about a person before you feel that you “know” them on some level? What kind of deeper information do you require before you consider a person “a friend?”

There are lots of possibilities here, I’ll mention just a few to get you started:

• When you meet someone and are getting to know them, are you always fascinated by where they have lived and travelled, and want to know more about their hometown, or where they hang out in the current town where they live?
• Do you prefer to talk about people’s families – their parents, partners, children and friends? Are you always excited to talk about their relationship problems and how they are making things work within their significant relationships?
• Perhaps instead you are attracted to people based on what they do – their activities and work, their function in the world?

There are many ways to know people – some easier to explain than others. Just give it a try – think about the last 10 relationships you have formed (whether shallow or deep relationships) and consider how the relationship developed. What do you talk about? Do you notice any patterns? For those people with whom you share a close bond – how do you know that this bond is close? What do you know about that person, what types of experiences have you shared, that make that a very special relationship?

Obviously – one of the reasons we go from acquaintance to friend often has to do with shared experiences – that will come into play as we continue to talk about a relational method of knowing Chinese herbs. For now, just keep it in mind. Allow yourself to reflect further, both on your learning style and your relationship/communication style. Think about the interactions you have with other beings, even your pets. Jot down what you notice in a journal, and feel free to share it with us here, in the comments.

The next post will discuss how to use what you’ve noticed to go from stranger to acquaintance with our herbal friends. I’ll use myself as an example and my very favorite herb. Look forward to it soon.

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If you are interested in reading more about learning styles, I can recommend the books below:

“Learning Styles” (Marlene LeFever)

“So Each May Learn: Integrating Learning Styles and Multiple Intelligences” (Harvey F. Silver, Richard W. Strong, Matthew J. Perini)

Related posts:

1. Listening my way to success in the NCCAOM acupuncture board exam

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.

Here are the last few paragraphs of my thesis in Chinese medicine for my MSOM degree at National College of Natural Medicine. As you can probably tell, I did not go as far with any of my research topics as I would have liked. I saw it mainly as a way to learn what resources existed, and sketch a general outline of where I would like to go with my investigations. I have to be frank, I haven’t yet taken the time to explore these topics much more deeply – I’ve been trying to rejuvenate myself from the rigors of school while also opening the clinic and writing more on this blog. However, I have all of the resources amassed and lots of brainstorms and outlines ready to be further explored. I’ll definitely share my ongoing investigations with Deepest Health readers.

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Read Part I of the final chapter of my thesis

Read Part II of the final chapter of my thesis

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First, the system must demonstrate a basic level of effectiveness. This could include evidence in the contemporary Western sense of controlled laboratory or clinical research, but could also include a mature history of effectiveness, such as Chinese medicine has in its extensive written record. Obviously, it could also include currently undeveloped research methodologies such as I discussed in Whole Systems Research. It will almost certainly also include so far undiscovered methods of obtaining knowledge.

Second, it must demonstrate its inclusion of a mature system of practitioner education and basic regulation of ongoing practitioner behavior. This simply means that an included system of medicine should show that it is making active attempts to behave ethically and to ensure that its practitioners obtain the highest level of education that is possible. External governmental controls could also be developed that both respect the integrity of the community of practitioners while providing the public with a sense of safety.

Third, a system of medicine should be open to discussion and evaluation by other systems. These interactions should be governed by an understanding that such interaction is for the benefit of all involved, not intended to discredit or eliminate one system in favor of another. Practitioners of each system should seek to become steeped in the foundational material of the other system before they seek to criticize it, as this will make for a more productive and scholarly interaction. My thoughts on this point resonate with the early philosophical work of Alasdair MacIntyre as developed in his book, After Virtue, published in 1981.

Finally, a system of medicine should not be integrated into the larger health care system until it demonstrates its safety for general use. As I’ve already mentioned, one of the biggest concerns about alternative medicine is whether it is safe. This is to be understood, since the primary guiding principle of all medical practice is to “first, do no harm.” Whether by laboratory testing, historical record or some other acceptable method, the system should indicate that its diagnostics and therapies meet a minimum standard of safety. Further, as stated before, the profession should be internally or externally regulated in an adequate way to ensure that practitioners are making safety a primary focus of daily practice.

Of course, there is a viable system of medicine that meets all of these criteria – Chinese medicine.

Chinese medicine not only meets the criteria above, but is also an ideal vehicle for avoiding the kind of objectification of patients that I am arguing against. In Chinese medicine, one always considers the more physical, measurable characteristics of a person as well as the less measurable, subtler features of his mental and social situation. In fact, such a separation of features of the person’s experience is simply not done. Every single identified sign or symptom is taken into the diagnostic framework and interpreted. This includes the more precise information as might be included on a laboratory report. But it also, and more commonly, includes the patient’s vague and self-defined complaints (“fuzzy headed,” “stuck,” and so on). Further, it relies on the complex and embodied senses of the practitioner to accurately observe and interpret the symbolic information inherent in face color and quality, pulse rate and quality, nail bed color and quality and so on. While this may seem a hopeless mess of factors that cannot possibly result in effective diagnosis, much less treatment, such is not the case. Diagnosis does happen, and so does healing. Chinese medicine, through its use of symbol, of metaphor, and its integration of the various subtle meanings and meetings within a human life both in diagnosis and in treatment – has a unique and time tested way to bring the interpretive meeting back into medicine.

In sum, I believe that medicine is not the kind of activity that can, or should, be governed by single-minded adherence to the analytical sciences as they are currently practiced in most places in First world nations. Such devotion to technological medicine encourages a compartmentalized way of viewing the body and the human being’s place in the universe while also producing a distance between doctor and patient that is not conducive to healing. We need not abandon the analytical tradition or the fine tools brought to us by contemporary Western medical practice. But nor should we attempt to eradicate all systems of medicine that fail to meet our ideological standards concerning evidence. Condemning disciplines based on ideological notions of “pseudoscience” cannot be helpful for patients. A more inclusive approach respects the integrity of safe, integral and mature disciplines while acknowledging the need for the public to feel reasonably assured concerning their safety and effectiveness.

Related posts:

1. Phenomenology and Classical Chinese Medicine
2. Phenomenology and Chinese Medicine : the lifeworld, holism and integrative medicine
3. Phenomenology and Chinese Medicine : Our body is the greatest medical technology

Chinese medicine and phenomenology thesis Part I

Chinese medicine and phenomenology thesis Part II

EDIT 8/5/09: I just realized that the portions linked above were mistakenly taken from an earlier draft of the thesis. I should be more careful! Please forgive me if there are any inconsistencies between the versions.

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According to Svenaeus, important information that penetrates the clinical encounter is, in a way of speaking, pre-scientific. It is prescientific insofar that is minimally mediated by theory and not readily systematized by the analytical processes recognizable as the basis of contemporary science. In the terminology of philosopher Edmund Husserl (and later, Martin Heidegger and Maurice Merleau-Ponty), this information is all part of the lifeworld. The lifeworld is the sum total of lived experience, not as a static object, but as it is lived. It is those things and experiences that, woven together, make up what we refer to as our life. Things only have meaning insofar that they are situated within the lifeworld. Abstracted outside of that, they cease to have what most of us think of as “meaning” or “importance.” This is obviously a very deep philosophical concept, and I cannot elucidate its full meaning here.

However, it seems, when applied to medicine, as a clinical encounter between two human beings, this theory can inform practitioners that we should seek to engage the wholeness of each person during each encounter. If we incorporate information taken from laboratory tests, or other processes that isolate particular characteristics of our patient, we should situate that information in a field of everything else we know and can perceive about the patient. This would include demographic information filled in on a form, the subjective reports of the patients, our understanding of the world and regional situation the patient is confronting (war, weather, and so on) as well as all the information available to the senses of the physician. Physical palpation (including of the pulse), the visual presentation on all levels, the sound of the patient’s voice, any odors that can be perceived may all provide us with information of use in diagnosis. Before the advent of modern medical technology, of course, this was the primary source of information that physicians worked with.

We can utilize this “lifeworld field” in the service of restoring the patient to a greater state of health. In this view, far from being extraneous information, the particular life characteristics of the patient are a key component in her disease process, physicians’ diagnosis of it the ongoing healing process.

Later, Svenaeus indicates that there are efforts in the mainstream medical community to take seriously the implications in the type of argument I am advancing. These enterprising physicians are attempting to construct a system of medicine that situates the lifeworld centrally in the clinical gaze. You can see evidence of this in the formation of medical centers that incorporate spa services, family and individual counseling and other such services. While the chapel has always been a feature of hospitals, increasing numbers of medical centers are also offering meditation, Taiji, yoga and other benefits that seek to address the spiritual side of its patient population.

The inclusion of these services within the medical center itself shows an understanding that the healing of the physical body is not separate from the health of the rest of the human experience. Some of these medical centers have also begun to offer complementary and alternative medicine alongside Western medicine. It is obviously important to point out that complementary and alternative systems of medicine (CAM) take the wholeness of the patient very seriously. In fact, the primary focus of most CAM therapies is to restore the person to harmony within that wholeness of their being.

“One central goal of CAM is to improve the “wellness” of the patient. Rather than just removing a disease-producing agent, “quality of life” is emphasized by treating functional or somatic problems with ancillary and important psychological, social, emotional, and spiritual aspects” (Complementary and Alternative Medicine: An Evidence-Based Approach, John W. Spencer, Joseph J. Jacobs) 17.

The continuing integration of CAM into hospitals and other large medical facilities indicates that many Western medicine practitioners are seeing the value of these services.All of these changes, and the important conversations they generate within the profession of Western medicine, are quite important. As CAM becomes increasingly integrated into mainstream medicine, it will begin to inform the practice of Western medicine even as it is informed by Western medicine. Perhaps, then, the holistic nature of the human being and the importance of considering the lifeworld of the patient when diagnosing and treating will become a more central principle in all of medicine.
There are a number of concerns that mainstream medical practitioners and Western scientists have about this integrative process – many of them discussed in my paper already. Much of the worry centers on two basic desires. First, people want to know that medicine, meant to heal, is not harmful for patients. Second, people are concerned that even if a therapy is not harmful, it may simply be an elaborate placebo-based swindle duping hapless patients. While there is much I have said and could say about this, I would like to suggest a few basic principles that can guide us when deciding what therapies and systems of medicine we would like to integrate into our unified health care system.

These principles encompass elements of all the criteria of demarcation I have already discussed, while creating a system of holistic care that takes seriously the lifeworld and personhood of the patient. If a system of medicine or particular therapy does not meet these criteria, I contend that it must work to rectify any deficiencies before being embraced by the mainstream.

Related posts:

1. Phenomenology and Chinese Medicine : Our body is the greatest medical technology
2. Phenomenology and Classical Chinese Medicine

“…Ling Shu Chapter 55

The superior physician treats that which is not yet ill. The inferior physician treats that which is already ill.

This is a fairly famous statement, which is often interpreted to be a call to preventative medicine. Modern physicians often complain that patients come in with specific complaints and it is impossible to treat what is not yet ill. I find this stance strange, as if we are to believe if someone has a disease which has already become manifest, the practitioner is prevented from treating what is not yet ill.

At any rate, the following quote from Nanjing has a completely different interpretation of the above passage:

Treating what is not yet ill means that when one sees illness in the liver (for example), this (can be) transmitted to the spleen. First fill (shi2) the spleen qi so that there is no way for it to accept the liver’s evil qi. This is what is called treating what is not yet ill.

As you can read, the writer of the Nan Jing felt that the meaning of treating what was not yet ill did not mean some psychic rendering of signs and symptoms, but a way of treating a person who comes with a specific complaint. ”

Talking with my friend and colleague Michael Givens, he stated his conviction that this Classical passage tells us succinctly how we must proceed as Classically trained physicians. I agree! When a patient comes in to see us, we must be doing a number of things simultaneously. We must see the present complaint as it is an express of physiology gone awry, and we must situate that within a matrix of time and space that helps us understand the root of the disease as well as its potential for adverse development.

While your chronic cough may be easy to ignore and seemingly innocuous, not to mention related only to the “Lung,” as Classically minded practitioners, we need to see under, around, beyond and between that.

This asks a lot of practitioners. We need to understand physiology in all of its manifestations, with all of the conceptual systems we have to understand them. This is particularly true of the six conformations, as they are the broadest, most comprehensive, and least misleading structures we have available. But, we must also know the five element model (and all of the interrelationships therein), the complexity of the channel system (from minute luo to cutaneous regions), and yes, we can also take into account the Zangfu information (particularly as contained in the Neijing and other Classical texts) and everything else we have learned. It is my preference to stick with the six conformations and five elements, and others may have other preferences.

We need to understand the manifold ways that physiology can be disturbed, and understand the diverse ways this can express in patients. We must understand how disease progresses through time, and what factors might upset the “normal” progression.

This is to say nothing of all we must know for treatment. This is to say nothing of the intense rectification of the self that must take place in order for our true healing power to come forth. It is to say nothing of a lot of things, but a lot about a little. And that little is critically important, so important that it was enshrined in the foundational texts of our medicine.

I don’t know if I will ever “be” a superior physician – it seems to me the kind of thing that one continually strives for, a moving target that helps to keep the thirst for excellence alive. But, I do know that the rest of my life will be devoted to attempting to understand the above, and attempting to let that understanding flow into my treatment, and to let my treatment be of service to my patients.

What about you? How do you understand the above line? Do you feel prepared to strive for the “rank” of superior physician? Discuss here in the comments or on Richard’s fine site.

Update : I passed!  :)

As I said before, I’ve been spending a significant amount of time studying for and taking my NCCAOM acupuncture 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 (link broken – no longer available online), adding commentary as I thought of it.  For instance, when talking about a Yuan source point, I might mention e
verything 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!