As part of my study, since the very beginning of my time at NCNM, I have sought to use my entire body in the learning process.  While I learn quite well from reading, listening to lectures, and writing – I find that sensory input brings the information alive.  This improves my ability to remember, and also seems to increase my facility in using that information in the real world.

As I’ve worked on projects like my new course about Shennong Relational Herb Learning Method, I’ve seen how this is particularly important in learning and using Chinese herbs.  Herbs are physical things, full of life including smells, tastes and textures.  When we reduce them to data points – as is done in so many educational institutions – they die to us.

However, I’ve found it difficult to actually put this into practice.  This is particularly true of using my sense of smell – and I know from my teaching that I’m not the only one!  Students from Western countries, in particular, seem to struggle with the sense of smell… why is that?

In the United States, and I suppose in most Western countries, sensory experiences are controlled.  For the most part they are stifled, except for sight and hearing which are simply overwhelmed.  Actually, thinking about it, we overwhelm all of our senses – limiting what they experience to a set number of approved, mostly synthetic items and then amping those up to the nth degree.  Whether this is all due our relative affluence, our religious heritage, or some scientific sleight of hand, I do not know.

What I do know is that the classics have something to tell us about the importance of the senses, and have an interesting take on how the senses work.

Chinese medicine and the sense of smell

In Chapter 11 of the Neijing suwen, it says:

“故五氣入鼻藏於心肺．心肺有病．而鼻為之不利也”

This has been translated in a couple of different ways.  The basic translation says:

“When the five Qi/odors enter the nose, they are stored in the Heart and Lung.  Heart and Lung disease is detrimental for the nose.”

In his commentary on this line of the text, Maoshing Ni goes on to posit that the five scents are really “the five qi of environmental energy that we breathe in.”  Regardless of the fact that I don’t see this particular statement in the text (thus underscoring my basic problem with Ni’s translation) it is interesting to contemplate.  What is odor?  Certainly it is qi – but beyond that?  In thinking about this, consider the Neijing’s statement that the odors are 藏/cang/stored by the Heart and Lung.  The Lung makes a lot of sense given that the nose is the orifice of the lung in both a Western and Chinese context.  But what does it mean to say that the lung receives and stores these odors?  One could posit that they become part of the qi that then rains down on the body as heavenly restorative water/qi.  Again, I’m not sure this is in the text itself, but it’s an interesting notion to contemplate.

More interesting to me is the relation of odors and the Heart.  What can it mean that the Heart stores odors?  You’ll excuse me if I offer my own simple theories.  As famously studied by Gilles Laurent at Cal Tech, there is a powerful association between scent and human memory.  Nothing brings back a scene or person to the mind like a scent last experienced in that scene or with that person.

When considering this idea, I most naturally think about the smell of my clothing when I come back from my mother’s house on a visit.  I smell her for weeks afterward – and though the smell is created in part from her detergent, there is more to it than that.  The scent is wrapped up in emotion, the scent contains not just detergent fragrances, but her spaghetti sauce aroma, her hair, the smell of Idaho, cold winters, the essence of what comes from her pores as a product of all she eats, drinks… well, you get the idea.  The memories triggered are as complex.

Consider also the devotional aspects of scent – incense of various kinds have been used in religious ceremony and other spiritual activity since time immemorial.  The Catholics still use incense as part of Mass, as do some Episcopalian congregations.  Buddhist and Hindu shrines are nearly always adorned with incense censers.  We can also think about the effects of Moxibustion using artemesia.  While some people hate moxa for its thick smoke and messy nature, I find it to bring an essential element to treatments where it is indicated.  While not explicitly of a spiritual nature, I do believe that there is something of an offering that occurs when using moxa in treatment.

This relationship of memory and spirituality to the sense of smell helps me to link it to the Heart.  While we often talk about the Kidney as being the storehouse of memory in Chinese medicine, from what I’ve read and learned, the type of memory held by the Kidney is more primal, older and is less easily accessed by consciousness.  The heart seems a likely place (especially in its relationship to the Western concept of mind) to store the memories of this life.  The heart’s relationship to shen makes its connection to human spirituality quite clear.

In classical five element acupuncture, the art of smelling is still employed.  The five odors, discussed first in the Neijing, are assessed by the practitioner to help understand the primary pathology of the patient, as well as used as a key in discovering the patient’s landscape tendency (constitutional factor).  This is one of the most difficult diagnostic techniques for Westerners, as I’ve already hinted at.  I find it to be incredibly difficult, personally, particularly given how so many patients cover up their natural odor as a matter of course.

Scent and herbal medicine

Briefly, what is the role of scent in Chinese herbal medicine?  Most would say, “There is no role!”  I disagree.  One of the reasons I am a huge proponent of patients taking home and cooking their own bulk herbs is because of the experience they gain by doing so.  Looking at the herbs, smelling them in their dried state, allowing the smell to permeate their living space, smelling their powerful odors when drinking – all of this, in my opinion, is part of the therapy.

While many patients are unwilling to have this experience, it is one I encourage and have benefited from personally.  The worst case scenario with regards to this would be taking pills of granulated Chinese herbs.  I believe the move in this direction is detrimental, but understand when some patients choose this path.

Further, when we talk about the “flavor” or “taste” of herbs – scent is certainly part of that equation.  And as I’ve discussed many times, engaging this vital aspect of herbal alchemy is in my opinion the key to lasting learning in Chinese herbal medicine.

Fearless smelling

As I’ve said, one of the major ways I seek to increase my prowess in Chinese medicine is to activate all my senses to the greatest degree possible. So, how to proceed with the sense of smell?  My first trick will be simply to allow myself to smell everything, without reservation.  This means making a conscious effort to breathe deeply through my nose at all times.  I will also be going out of my way to smell things that are likely to be interesting or complex.  I will also be practicing this during tea drinking.  The difference in smell between two otherwise similar puerh teas, for example, can be remarkable and really impacts the experience of the tea.  This, of course, brings me around to the importance of smell for TASTE – but perhaps that’s for another article.

Do you have any ideas of how one can integrate the exercise of the sense of smell into daily living?  Willing to offer your thoughts on this or on the role of smell in learning Chinese herbs?  Join us in the comments below.

If you missed the first installment, please go read about Phenomenology and Chinese Medicine (Part 1).

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The doctor possesses all the same complexities [as the patient]. When the two come together, they are also under the influence of the particular place and time where they meet. The multiple variables inhering on the situation boggle the mind. The weather, the paint, the particular complement of the room, what’s going on in the news and whether either is aware of it. This is all perceived, on some level, by everyone involved – though perhaps not consciously. I do not want to imply that each of these variables has some lasting, measurable effect on either one of the participants in the encounter. I simply want the reader to keep in mind that every single medical encounter is simply two human beings, with their messy lived experience, coming together for the purposes of rectifying or maintaining some particular state that each agrees is worth attaining – health or the cessation of disease – depending on one’s outlook.

I want to caution the reader against assuming that this “messiness” as I’ve called it is a detriment to medicine, as some might imply. It is attractive to some to believe that if we simply make diagnosis and treatment maximally objective, by using the mediator of advanced technology and standard diagnostic and treatment protocols based on sound science, we will come to a purer, more useful medicine. But if this results in the removal of the human being from the doctor, if this results in the replacement of the patient by a list of variables gleaned by diagnostic tests, it can do nothing but take us farther down the road of an impersonal medicine that makes mistakes because it does not know enough about the person of its patients. I do not want to imply that any particular medical system, in its totality, does this on purpose or by design. But it is a danger for any medical system, particularly one that seeks to become increasingly rooted in objectivity.

Several philosophers, particularly those who are categorized as “Continental” philosophers, such as Foucault, Heidegger and American Philosopher Richard Rorty can help us to understand why this subjective, messy and quintessentially human nature of medicine is so actually an important feature of its integrity and usefulness. To analyze all of these philosophers and develop a rigorous theory concerning this point is a dissertation-level project. Fortunately, philosopher Fredrik Svenaeus, in his book The Hermeneutics of Medicine and the Phenomenology of Health, does an admirable job of pulling together diverse thinkers in Continental philosophy and other traditions to develop a rigorous philosophy of medical practice. I will offer and annotate some of his argument here as I believe his work points a way forward in any discussion of whether and how

The central focus of Svenaeus’ argument is the examination of the clinical encounter – the functional unit of medicine. Svenaeus explains that technological medicine and an increasing reliance on laboratory research has created a separation between the patient and the doctor. This separation is produced when the patient is not seen as an integral human being with mind, body and cultural context but is instead seen as a kind of space in which particular biochemical reactions and microorganisms are present in specific concentrations and configurations. In essence, the patient has become an object to be carefully studied by the doctor. He explains,

“Negligence of the human side of medicine has been fostered and fed by a focus upon medical scientific research and its biological objects, as existing in a relation of opposition to, instead of connecting with, the encounter between doctor and patient with its specific ‘lived’ characteristics”(Svenaeus, 2001, p. 7).

Much of the patient’s lived experience is disregarded as irrelevant in the situation at hand, unless a study has vindicated that some feature of that experience affects something that can be measured in a laboratory. This, he believes, takes medicine away from its purpose and power as a clinical practice. In sum, the ongoing pursuit of solely objective information as provided by the “causal” studies I discussed above is creating an undesirable side-effect: the removal of the human from the practice of medicine.

There are obvious ethical implications here. When we approach human subjects as objects, our ability to relate to them and, ultimately, to treat them as persons suffers. In the most extreme cases, this leads to sociopathic behavior such as is found in scenes of torture and police brutality. Obviously, in the medical context, the situation is not so extreme. The vast majority of physicians, regardless of their ideological stance, seek to help their patients. But, this is not only a philosophical or ethical issue. I contend that medicine that takes the intersubjectivity and embeddedness of its patients seriously, even makes that the very center of clinical thinking, is actually more effective.

In his discussion, Svenaeus recommends a variety of introspective turns that medical professionals can take. In essence, they all point to the same holistic conclusion. While technological advances and laboratory testing can provide valuable information, physicians must see these variables as only a couple among many. The amazing advances brought about by technological science allow us to, in a way, extend our senses. However, this happy development should not cause us to abandon those bodily tools that physicians have been using since medicine began.

Related posts:

1. Phenomenology and Classical Chinese Medicine

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!