Interview with Laurie Ayers, LAc (UK)

I’m happy to welcome Laurie Ayers to the Deepest Health podcast. Laurie is a rising star in the field of Chinese medicine whom I met through his involvement with the Institute of Classics in East Asian Medicine (ICEAM). He is someone who consistently inspires me to be a better student, and has helped me unlock more than one difficult case. Also, as a Chinese medicine practitioner in the United Kingdom, he has a few interesting notes to share with those of us who practice elsewhere. Learning about the differences in how this medicine is practiced in various countries is always illuminating.

In the podcast, we discuss a lot of topics related to the study of Chinese medicine. We focus particularly on the purpose of memorization, as well as digging into how everyday practitioners and students can make real study a way of life. Enjoy!

If you would like to find Laurie online, use the links below:

Laurie Ayers at Eastern Healing Arts
Laurie Ayers at ICEAM Instructors page

Related posts:

1. Deepest Health Podcast 7 – Clinical confidence and memorization
2. Deepest Health Podcast 11 – Interview with Dr. Arnaud Versluys (Part 1 of 3)
3. Deepest Health Podcast 1 – Lessons learned in Chinese medicine clinic

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

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

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.

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!