In this episode of the podcast, we talk to eminent scholar and owner of Legendary Herbs, Eric Brand.  In a somewhat briefer than normal conversation, we discuss topics of Chinese herb processing, the trade in Chinese herbs and questions of herbal access.  Eric is obviously a very knowledgeable person, sharing information that anybody with an interest in Chinese herbalism will be likely to find fascinating.

If you want to learn more about Eric’s work, or order some of his excellent Chinese herbal single & formula granules, visit Legendary Herbs.

You can also access his archived blog articles at the Blue Poppy blog.

Related posts:

1. Deepest Health Podcast 16 – Why bulk Chinese herbs?
2. Deepest Health Podcast 9 – Interview with Dr. Heiner Fruehauf, Part II
3. Deepest Health Podcast 17 – Z’ev Rosenberg – Chinese medicine as a profession, past, present, future

Update: If you’re going to comment on this post, please just remove the vitriol. There’s just absolutely NO reason to react to anything anybody has said with anything but respectful dialogue. I’ve had to delete several comments that just crossed the line. I’m the only one allowed to cross the line, here, folks.

Given a choice between practicing only Chinese herbs or only acupuncture, I would quickly choose the former.

That should be no surprise to anybody who has visited Deepest Health for any length of time. That being said, I have immense respect for acupuncture and find myself fascinated by it daily. My great hope is to someday have enough time to begin to devote myself to a deeper study of this modality that I use almost every day.

This is why, when it was released, I picked up the new iPad version of the iconic Manual of Acupuncture by Peter Deadman (and team). At $35.99, it’s cheaper than the both paper text and the interactive DVD, while preserving some of the best features of each. However, for an iPad app, it may be a little rich for some people’s blood.

For the record, I think it’s a steal of an app – particularly since I know it is under active development. I’ll provide a more robust review in a future blog post, though, because I’d like to focus on something else here.

While working with the iPad app, I ran across a bug, and pressed the in-app support button to shoot an email to the tech team. I had no idea the bug report would end up in front of Peter Deadman himself! I’ve never met him, nor heard him speak, so it was a treat to be introduced in such a roundabout and unexpected manner.

Ever looking for opportunities to come up with information my readers might find interesting, I asked whether he would be willing to answer a few questions. To my surprise, despite his busy life, he agreed. So, thanks to his kindness, I offer below his thoughts on an array of topics. He focuses particularly on the development of the Manual of Acupuncture in all its forms as well as the pros and cons of community acupuncture. I’m sure you will find the information as enlightening as I did.

Thanks, again, to Peter for offering his time to reach out to Deepest Health readers.

1. Could you please introduce yourself to the readers? Your name, where you’re from, where/how you were educated in Chinese medicine and your current/past work (teaching, books, clinic, whatever you think is relevant)

I was born and brought up in England, the second child of a Russian Jewish mother and an English/Scottish father. Both were committed socialists and atheists. After travelling and living the hippy life to the full, my first career was the co-founding of a natural foods restaurant, followed by a shop (Infinity Foods), bakery, warehouse distribution unit, and charitable natural health education centre.
I went to acupuncture college between 1975 and 1978 and followed that with acupuncture studies in Nanjing, China in the winter of 1981-82, and herbal studies in Nanjing in 1993. In 1979 I set up The Journal of Chinese Medicine which I still run. I have had a 30+-year career practising, lecturing on and writing about Chinese medicine. I also practise and occasionally teach qigong and have had parallel careers as violinist in a klezmer band and a creative writer.

In 1998 I completed the co-writing of A Manual of Acupuncture.

2. You are the man behind possibly the most iconic English language book in the realm of Chinese medicine and acupuncture that is currently published. What pushed you to release the book – and were there any surprises in its creation/publishing?

I was originally asked by a publisher to produce a points book but declined as I felt there were too many out there already. Then I realised that the fact there were so many meant that there was a hunger for a good points book and I felt confident that with the right partners I could produce something better. I have/had a great passion to communicate and in this case I felt that the Chinese medicine profession needed a book that reliably laid down as much of the tradition as possible before it spiralled off into ever more distant realms of imagination and wishful thinking.

Dedication to detail characterised every different aspect of the book, from text to illustrations, to design … and that’s why – instead of taking eighteen months as planned – it took eight and a half years. However it has paid off with the respect and even affection that the book has generated, some of which is down to probably unnoticed details that make the book user friendly (e.g. the lengthy work we did in the layout stage to try and get the point illustration on the same page as the location text).
Apart from the length of time it took, the main surprise was that its success meant I could cut down on work after many years of hard slog and a few years after publication I stopped practising – at roughly the same time I joined a working band (hard to come back at 3am from gigs and be in a clinical frame of mind.

3. You recently released a new version of the text – are there plans for future revisions? What might we expect?

The new version was just a tweak and there are no plans for any further changes.

4. What other books on Chinese medicine and acupuncture are interesting to you – what would we find on your bookshelves?

I am fascinated by the yangsheng [ed: "nourishing life"] tradition – not so much the esoteric aspects but the down to earth wisdom about behaviour and lifestyle. This is something I lecture on a lot and I am always amazed how bang on the ancient teachings are in the light of modern research.
To give one example from hundreds, it is only now (astonishingly enough) being acknowledged in scientific medicine how much the quality of life of the mother during pregnancy affects the future health of the child.This has been known in the Chinese tradition for a good two thousand years (how pregnancy conditions may affect the pre-heaven jing) – specifically under the heading of foetal education. So although I have handed on a lot of my clinical practice books, my shelves groan with qigong and health preservation texts.

5. You recently released an iPad application that is, essentially, an enhanced version of the textbook. What got you interested in creating this?

Technology seems to create its own demands. Once it becomes possible to do new things the imagination is easily caught. In the case of our digital publications, a lot of the credit goes to Tom Kennedy – a young practitioner with IT skills – and his wife Kate who has a BBC film production background. Tom pushed us into producing the initial DVD, and the point location videos we made for that found their way onto the iphone/ipad app.
We also wanted to replace the point card study set which we originally published alongside the textbook. That was because when I studied points and later herbs I found the best way to memorise was to write out cards and go for long walks. In a digital age, the smart phone can serve the same function.

6. What should people expect in future iterations of the iPad app?

We are working on a totally new version of the DVD (kickstarted by Apple whose new Lion operating system meant the DVD unexpectedly no longer worked – to our and our customers’ dismay). This will have several new features but additionally it will be ipad compatible so users can either opt for the cheaper, cut-down app version or the full text/full functionality multimedia/DVD version.

7. How do you see technology like the iPad and similar mobile devices changing the way that Chinese medicine is practiced and learned? How do you feel about it?

Traditionally Chinese medicine was learned by memorisation, which is why Chinese medicine books produced in China still have lousy indexes. I feel memorisation is still fundamental to good practice. Digital publications offer the best of both worlds … imaginative tools to help memorisation, but maximum searchablity for reference also.

8. If there is one thing you wish would be brought to mobile technology in the realm of Chinese medicine, what would it be? (eg – Bensky’s materia medica, a complete version of the Ling Shu in English, etc…)

The Bensky materia medica and formulas and strategies would be a good start.

9. Any advice you would like to offer to new students in Chinese medicine? What do you wish you would have known when you began?

The hardest thing is to get a rewarding (emotionally and financially) practice. So many new practitioners never get a practice off the ground – at least one that can give them a decent living. In my mind there are two answers. The first is the work being done in the field of community acupuncture … matching patients who simply can’t afford high fees with practitioners happy to work in multibed clinics. The other is the development of the highest level of skill and knowledge allied with a degree of specialisation.I think these two strands can find a way to co-exist.
There is a buzz about multibeds right now, and lots of patients benefit from the affordability, the communal atmosphere and the ability to have more frequent treatments. They are a pragmatic solution to a particular problem. However, I don’t think they represent best practice and I feel very strongly that best practice (which is almost inevitably more time consuming) risks being diminished by the need to offer quick treatment.

In fact I think that lots of practitioners need to raise their game – continuously studying to build on their initial education. How many practitioners for example know the diagnostic tests, natural progression and prognosis of the hundreds of different musculoskeletal disorders the human body can suffer from? This despite the fact that musculoskeletal problems probably form the majority of the cases we treat.

I also feel that acupuncture – having its roots in the Chinese medical tradition – has a lot to offer patients in terms of understanding cause of disease and what are helpful and unhelpful behaviours. The way I was taught, this was part of the job and Chinese medicine has extraordinary wisdom in this respect.

When community acupuncture offers three-minute consultations and tacitly or overtly expects ‘the needles to do all the work’ I think this is a betrayal of acupuncture as medicine. After all, much dismay accompanied the transition from the old-style GP who lived in a community, knew their patients and their lives, relationships, strengths and weaknesses, to the modern rushed GP whose main preoccupation is to find a way to stop their patient talking so as not to exceed the few minutes allotted to each consuation

Yet even they spend considerably longer than three minutes.

–

Thanks again to Peter for his time, not just for this brief interview, but over his long career. We’ve all benefitted from his dedication. If you’re interested in accessing his work, please visit the following links:

• Journal of Chinese Medicine
• A Manual of Acupuncture, print version
• A Manual of Acupuncture Multimedia DVD-ROM (V1.2)
• iPad app for the Manual of Acupuncture

So now Faith, Hope and Love abide, these three; but the greatest of these is love. (Corinthians 1:13)

Have you ever found yourself frozen?

In private practice in Chinese medicine (as in other medicine – I assume) this happens. A particularly difficult patient walks in, presenting with something you’ve never seen before. Or perhaps they are a challenge to deal with personally, challenging your every move and demanding special treatment. At times, particularly when other strains are involved, this produces a frozen state – you don’t know what to do, don’t know what to say. Mostly, you get through it.

The same thing happens as students, of course. Whether during testing, or practical courses (remember needling the first time?) or just during the normal decision making process that comes up frequently in school (should I take this elective? what do I want to do with my life?) – sometimes you get caught. Unable to determine direction.

This same thing has happened to me over the last couple of years, in both of the situations above, but also with regards to this site. In an effort to serve my community the best I can, but also in an ego-driven desire to be “something more” and relevant enough to be paid for my work here – I’ve forgotten my own voice and my own love. Sorry about that. But there’s a lesson, and an open door to a new world. So, there’s that.

For some of you out there, Chinese medicine may compel because of its practical aspects.

The ability to treat recalcitrant diseases, or to treat on a level that is less invasive, less toxic. Maybe you are one of those who was just looking for something to do after college, and this seemed fun and interesting. Or perhaps you are one of those community health crusaders, hoping to transform the contemporary medical landscape with low-cost, easily available medicine.

Or maybe you are like me – transfixed by the mystery and the Earth-bound beauty of what we do as practitioners. By the stimulating, multi-faceted life of study this profession invites us all into.

Maybe you are like me (and other multi-potentialites) unwilling to focus so intensely on one little sliver of the world that you become known the world over as the expert in THAT.

Maybe you have too many interests – delving into philosophy and technology and permaculture and cosmology and language and productivity and herbalism and acupuncture and patho-mechanisms and Pacific Northwestern geography.

If you are like me, you might find, like I did, that the world prefers you focus. Want to market a business? Pick a niche, they say. Want to learn to treat auto-immune disease using Chinese medicine? Well, then, build a practice that treats nothing else. I have been entranced by this view, the mastery-in-focus view, for many years. However, despite being entranced by the mastery-in-focus view, all my life I’ve been good at a little bit of everything. All my life I’ve gone from one passionate interest to another, and have been criticized for it.

Only today did I realize that I’ve had enough of that attitude.

It’s been killing my love for this medicine, it’s been killing my businesses, it’s been killing my personal life. Though the teachers in my life that I cherish most are masters at mastery, it’s the case that my path lies elsewhere.

Maybe you’re like me, and your path does, too. If so, I invite you in with open arms to this new Deepest Health. This place where we come to share how our diverse interests coincide to inform us as students, as practitioners, as people. This place where we are not afraid to confront our worries and fears head-on.

This place where we geek out about wise-use of technology, and music as healing, and the Shang han lun, and the best way to memorize Chinese herbs, and the magic of sensory perception, and the deep spiritual nature of being a healer, and the real cha-ching focus of being in business, and raising goats, and seeing the five elements in film and everything between, before, outside and beyond.

My love for Chinese medicine springs forth eternal – and that love breaks down all obstacles. May it be so for you, too.

Stay tuned.

However, second year is also the year of rote memorization in our program, and at the time that wasn’t a skill I possessed.  Not really.  I started to lose steam.  Things were a little precarious until my fourth, clinical, year.  Writing here helped.  Spending lots of time in nature helped.  Seeing patients helped.

Along the way, I was exposed to so many systems of understanding, so many schools of thought.  It was stimulating, and exhausting.  For almost a year after I graduated, I really didn’t want to have anything to do with studying Chinese medicine.

In fact, part of me wondered if I needed to study anymore – maybe just seeing patients was enough?

Since my second year in practice, I’ve redoubled my efforts in the realm of study.  I consider myself a lifelong student, and teaching people both at NCNM and here at Deepest Health has both necessitated and accelerated that learning process.  I expect I will be studying until I cannot study anymore.

I’ve heard similar stories and sentiments from practitioners in the field – even those who have been practicing for many years.  Students, obviously, have plenty to think about and say about studying.

Thus, the focus of this spring’s issue of Chinese Medicine Quarterly is, simply, Study.

What does it mean to study Chinese medicine?  How best to do it?  Is there more than one way to study?  As always, we invite students and practitioners to contribute articles based on their understanding of the simple concept at the center of the issue.  The result is our best issue yet, made even better by the incredible artwork of Eugene Lee.

Ready to buy the latest issue?  Just click this link to be taken to the Chinese Medicine Quarterly page.

You can read all the details about the issue there, of course.  Print versions are available at additional cost.  I just got mine in the mail and it’s gorgeous.  Something about that heft of paper really helps me get into it.

I hope to update you on the future of Chinese Medicine Quarterly soon, as well as letting you know how you can get involved.  Fancy yourself a writer?  There’s space for you here.  Wondering how you can let other people know about the magazine?  Opportunities abound!  Watch for that article soon.

In the meantime, thanks for buying the latest issue.  It helps us to get closer to making the magazine self sustaining.  Self sustaining means more resources available to make the magazine longer, to incorporate new elements like investigative stories and travelogues, as well as paying our editors and designer for all their dedicated, unpaid labor.

Happy spring!

Related posts:

1. Wind – the father of the 100 diseases – new issue of Chinese Medicine Quarterly
2. The importance of the Spleen in studying Classical Chinese Medicine

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

In this podcast, we mainly discussed the state & nature of the Chinese medicine profession.  Z’ev helps us understand the early history of the profession in the states, how things have changed, what troubling and promising streams he sees coming together now.  We cover topics like the community acupuncture model, how we should do integrative medicine, how to study Chinese medicine and more.

Do yourself a favor and listen to this without delay.

Some of the texts that Z’ev mentions (aff link)

1. Shang han lun (Treatise on Cold Damage, Zhang Zhongjing)
2. Jin gui yao lue (Pearls from the Golden Cabinet, Zhang Zhongjing)
3. Nan jing (Classic of difficulties)
4. Huang di nei jing su wen (Yellow Emperor’s simple questions)
5. Huang di nei jing ling shu (Yellow Emperor’s divine pivot)

He also references the Pacific Symposium, a West coast conference focused on Chinese medicine that comes up every year in the fall, coming again during the second week of November in 2012.

If you like the Deepest Health podcast, and hope I will do more, would you do me a favor and rate this in the iTunes store?  Just click this link, then click on “open this podcast in iTunes) and near the bottom of the page you will see the place to add your rating.  Thank you!

Related posts:

1. Deepest Health Podcast 6 – Schools of Chinese medicine and learning
2. Deepest Health Podcast 2 – Visualizing my way to Chinese medicine success
3. Deepest Health Podcast 1 – Lessons learned in Chinese medicine clinic

There is no use mentioning what has come before – the Dragon energy that has come my way through the yijing, through conversations, through my own presence as Dragon born, through the energy of this coming year – demands a focus on what is coming up and what is flourishing.

Today starts a practice that I know will bring value to all of us who gather to learn as deeply as possible. It will populate this blog for years to come. But, it starts here, at the birth of the year of the Dragon.

Shanghan lun line 12 – part 1

太陽中風，陽浮而陰弱，陽浮者，熱自發，陰弱者，汗自出，嗇嗇惡寒，淅淅惡風，翕翕發熱，鼻鳴乾嘔者,桂枝湯主之.

Tài yáng zhòng fēng, yáng fú ér yīn ruò, yáng fú zhě, rè zì fā, yīn ruò zhě, hàn zì chū , sè sè wù hán, xī xī wù fēng, xì xì fā rè, bí míng gān ǒu zhě, guì zhī tāng zhǔ zhī .

Mitchell-Ye-Wiseman translation (p60):  ”In Taiyang wind strike with floating yang and weak yin, floating yang is spontaneous heat effusion, and weak yin is spontaneous issue of sweat.  If [there is] huddled aversion to cold, wetted aversion to wind, feather-warm heat effusion, noisy nose, and dry retching, Guizhi tang governs.”

After this brief statement, the ingredients of the formula and how to make it are listed. Because there are multiple modifications listed, I will save that discussion for another day.  It’s worth digging into.

In the common way of my personal study of Chinese herbs and herbal formulas, I have added this line to digital flashcards, my Personal Brain, my private wiki and my Devonthink database. If nothing else, this means that I will always have access to the line and its translation and that I will have written it down many times — a proven memory aid.  All of these study/memorization methods will be discussed in upcoming posts, as well as in a resource I am creating to bring all my work in that field together.

Also as part of my study flow, I have found information online that relates to this Shanghan lun line, as well as pulled together my private lineage notes from courses I’ve taken with my teachers that relate to this line. Now it is on me to commit the line to memory and to associate everything that I can with it for future reference.  That’s the way this works.

I can’t share all of that with you, but my hope is to take this (and all future lines) – bring together all this information, and say whatever interesting things come forward.

This statement is one of those that is talked about in classical Chinese herb circles quite often. I think it’s about as far as most people make it into studying the Shanghan lun. There are a few symptoms listed here, and they are familiar to most of us.

1. The sensation of heat, or “fever” as we commonly call it – later qualified to refer to a rather light fever, nothing too intense
2. Sweating, though probably not a ton
3. Intense aversion to cold, making the patient cower & huddle away from cold
4. Aversion to wind, as though the patient were wet (think of how you feel when wet and waiting for the bus – a common Portland phenomenon)

One problem emerges immediately.

If a patient  walks into a Chinese medicine clinic with the above signs, the text suggests we should give them Guizhi tang, yes? But does the information provided by this line alone help us to prescribe Guizhi tang to our patients? No. I should note that the listing of ingredients with modifications based on clinical situations helps us a lot, and will be revisited in blog posts to come.

Looking at a line in isolation is often misleading.

Understanding this line at the deepest level seems to require an understanding of the whole text, but understanding the whole text would seem to require that one comprehends this line. A classic paradox.

However, we have no recourse except to continue – to keep track of results – and to return to the parts once we have some grasp of the whole and vice versa.  It’s the flow of information processing that takes us into new territory as well as keeping us grounded.  An ability to do that is something all our patients will surely be happy about.

One way to proceed even now, aside from memorizing and researching with this information in mind is to deconstruct the formula discussed in the line and, in so doing, come to understand the line more deeply as well as understanding that part of the text more deeply. As already mentioned, we will turn to this task before long.

Guizhi tang is a particularly interesting formula because of its ubiquity.

It is something everybody has learned about, though many fail to use it. It is featured in many other places in the text, for one thing. In a quick check, I identified nearly two dozen lines with different pathologies where guizhi tang was listed as a possible formula to consider.

It is also the core upon which many other formulas are built.

There are the obvious ones – Guizhi jia gui tang (Guizhi tang with extra Guizhi) and Guizhi jia Longgu Muli tang (Guizhi tang with longgu and muli added) and many other formulas which are basically Guizhi tang with additions or subtractions. But, there are also formulas that seem at first glance to be unrelated to Guizhi tang, yet contain it – the most obvious of which is Xiao jian zhong tang – which is guizhi tang with double Baishao and Yitang added.

This, among other reasons, is why I’m so bewildered when Chinese medicine practitioners dismiss Guizhi tang as a formula for clinical use. It’s possible to build an entire clinical practice on understanding this formula alone, in my opinion.  It appears that Zhang Zhongjing agrees.

On the blog, I will explore this line & its implications until I feel done (and until I’ve memorized it) and then we’ll move on to other lines.  We’ll do this until we’ve gone through the text, then move on to the Jin gui yao lue.  Along the way, as we break down formulas, we’ll make frequent and intense forays into Shennong ben cao jing territory.  It  will probably take a while, but it will be fun.

I find that working with texts and formulas produces all kinds of interesting insights.

This obviously includes stuff about medicine – formulas, pathology, preparation – but also cultural and language based information, insight into clinical practice, even business!  I hope you will enjoy the process, and contribute when you feel called to do so.

Speaking of your contribution…

What is one surprising use you’ve found for Guizhi tang. If you don’t have one, why not just mention something this blog post has taught you?

Related posts:

1. Chinese herb profiles – looking briefly at Guizhi / Cinnamon
2. From the front line : Thoughts on running a Chinese Medicine Clinic

My first group of students went through, and had a lot of nice things to say about the course.  I list some of those comments on the page where you can learn more about the course and register, if you are interested.  I hope you are.  Why?

Well, obviously, more students means that I can spend more of my time and energy on Deepest Health.  The more this site can support me and my family, the more I am able to devote myself to this site and the independent scholarship that takes it from being an interesting blog to being a real resource.

But, more than that, I just cannot tell you how excited I am to reach out to students all over the globe and create an interactive space where we can come together in our mutual interest in classical Chinese herbalism.  More students means more conversations, and also more people to tell me what I can do to make the course better.  It’s like having a big family – only the family is all over the planet and always talks about dorky Chinese medicine things.  Even better!

Anyway – once the next batch of students is all settled in I’m going to be launching a couple of things here at Deepest Health.  One is an herbal monograph series.  I’m writing a bunch of short books about individual herbs that will bring together data from the classical texts, more modern sources, botany, phenomenology and my clinical experiences.  I’m going to sell them, but will also be sharing lots of the information on the blog for free.  I’m also working on finding someone to write about classical acupuncture for the site – if you know anyone, send them my way!

So – check out the page for the newly open Shennong Relational Herb Learning Method – and sign up for the course!  You won’t regret it.  If you know someone else who might be interested, be sure to send them over as well.  I’ve got a couple of great bonuses for a limited time as well as a nice deal for people who want to sign up for Shennong 1 and Shennong 2 concurrently.

One more thing!  We’re currently pending approval for NCCAOM PDA (CEU) points, so you can use the courses to fulfill your recertification efforts if you are in a place that uses that kind of thing.  Just one more reason to join us.  :)

I’ve got a few articles on particular Chinese herbs from the archives coming your way – cleaned up and ready for consumption.  But in the meantime, I wanted to let you know that the newest issue of Chinese Medicine Quarterly is up.

This time, writers were asked to think about the concept of Wind in Chinese medicine.

Who hasn’t considered Wind as they study Chinese medicine?  Such a strange concept – do we really mean WIND?  And what’s with the association with wood?  So many types of wind!  How do we defend against it?  What happens when a person is impacted by it?  I’ve always had so many questions…
I can’t guarantee your questions about wind will be answered with this issue, but you will enjoy yourself nonetheless.

If you’re interested in reading more about the issue, just click this link.

Oh, and this time around you can get your issue in print, if you so desire.  That’s new!

Thanks for reading,

Eric

This is an old article I touched up and re-released.  I hope you enjoy it!

Guizhi – Cinnamon twig – Emperor of Emperors 

In my opinion, there is no more important herb in the materia medica than Guizhi.  It is used in so many formulas, spanning all organ systems and the vastest number of pathologies of any herb (save, maybe, Gancao/licorice).  It is fortunately also still quite affordable, and not yet being considered for banning by the FDA.  :)

The plant

• Latin name/Pharmaceutical name: Cinnamomum cassia/Cinnamomi Ramulus
• Other common names: Cassia, Chinese Cinnamon.  Note well that the cinnamon we use in Chinese medicine is NOT the same species as normal, culinary cinnamon.  I think you could probably use culinary cinnamon in a Chinese herbal formula in a pinch, but it wouldn’t be the same.
• The growing plant: As I have never seen the growing plant, I’m going to have to outsource the physical description of the plant to someone better qualified – see Ms. Grieve on Cassia.  Looking at pictures, I am impressed by the plant’s stature (it is a tree, you know).  The leaves strike a dashing profile, with strong parallel veining and a robust texture.
• The dried herb: I’ve seen a few different forms – but the most common looks as if it is cut on a diagonal – it typically includes the bark even though some sources indicate all but the very thinnest bark should be removed.
• Bensky’s Materia Medica indicates that one should look for “young twigs without leaves or any withered parts.” From what I understand the thinner the twig, the better.
• Common preparations:Many different parts of the Cinnamon plant are used, including the bark (Rou Gui) and twigs with bark removed (Gui Zhi Mu). As far as preparation goes, I could only find common use of honey-fried Gui Zhi – the addition of heat and honey increases the warming capacity of Gui Zhi but impedes its ability to release the exterior. Bensky lists dry frying as another preparation but that does not seem to be widely employed.

Chinese medicine properties

Gui Zhi is listed in the category of herbs called “herbs that release the exterior.” The most common way of thinking about this category is by relating them to the Western concept of diaphoresis. However, herbs that release the exterior are capable of much more than just promoting a sweat. In contemporary literature, Gui Zhi is considered to be warm in nature and both sweet and pungent in nature. It is said to enter the Heart, Lung and Bladder channels. In the Shen Nong Ben Cao Jing, Gui Zhi is said only to be warm in nature and pungent in flavor – omitting the sweet flavor.

This is common, the adding of a flavor in contemporary understanding of an herb.  It is a helpful memory aid for students, but I’m not sure it actually adds anything to our understanding of the herb.

It is interesting to note how the doctrine of signatures works in evaluating this herb. Compared to another part of the Cinnamon tree – Rou Gui or Cinnamon Bark – Cinnamon twig is relatively superficial, light and outward spreading. Rou Gui is closer to the heart of the tree, more protective and heavier.

Historical-cultural information about Gui Zhi

Classical text descriptions: As already discussed above, the Shen Nong Ben Cao Jing (SNBCJ) describes Gui Zhi as being pungent in flavor and warm in nature. Another interesting thing in the SNBCJ – Gui Zhi is said to be good for counterflow Qi (vomiting, hiccough, etc) and situations where the Qi or breath are “bound up” and unable to move freely. Both of these are cases of fouled up movement – in the first, the movement is going in the wrong direction and in the second, the movement isn’t happening. This may relate to the pungency of Gui Zhi – it is capable of righting wrong movement and getting things moving that are stuck.

Etymology of the characters: Let’s look at the characters for Gui Zhi again – 桂枝. The left character, guì, refers to the tree itself and doesn’t seem to be particularly interesting. However, the right hand part of that character – the 圭 – is both the phonetic but is also used to refer to a kind of jade tablet used by rulers as a symbol of their power.

Medical applications of Gui Zhi

Common uses of Gui Zhi: This is one of the rare cases where TCM usage of the herb approximates what Classical texts indicate. Gui Zhi is often used in what TCM calls “deficient wind-cold attacks” which are, essentially, externally contracted illnesses (colds, flus) that involve sweating without provocation. Gui Zhi’s pungency and similar appearance to the energetic channels of the body also make it a prime candidate for use in unobstructing blocked channels as in Bi syndromes (bad pain in the body as one finds in arthritis and similar conditions).

There are several other uses ranging from rectifying Heart Yang deficiency (with attendant palpitations and shortness of breath) to warming and tonifying the center to rectify deficiency cold of the Middle Jiao (with attendant diarrhea and noisy bowels.)

Shang Han Lun: In the Shang Han Lun we find support for the TCM notion that Gui Zhi (in the formula Gui Zhi Tang) should be used in cases where a pathogen has invaded and the balance between Ying and Wei has been disturbed, producing sweat where there should be none. Where TCM calls this “deficient wind attack” the Shang Han puts it in the category of Tai Yang disease.

Other Classical Texts: I’ve talked a lot in the last year about the classical text called the Tang Ye Jing (汤液经).  In this mostly lost text, the five elements are used in a theory of “mutual containment” in this text. Regarding Gui Zhi, it is said to be the “wood herb of the wood class.” It exemplifies wood energy in its pungency – mimicking the outward spreading nature of living wood as we know it.

Related posts:

1. The qualities and uses of the Chinese herb Mahuang / 麻黃 / ephedra
2. An Exploration into Chinese herb flavor combinations – continued!
3. An exploration into Chinese herb flavor combinations – the final chapter

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.

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

Because of this passion, I have always been keenly interested in the way individual herbs are prepared and the way those individual herbs are then offered to patients. One facet of that interest revolves around the difference between prescribing bulk herbs versus prescribing granules.

Tim Rudowsky of Green Tea Apothecary (at Cookmyherbs.com) shares my passion and has turned it into a business!  In this month’s podcast, we dig into the issue and have a good deal of fun along the way.  This podcast also features a new musical intro by one of my favorite new electronic music artists, Oleg Mokhov.

Show notes

1. Green Tea Apothecary : www.cookmyherbs.com
2. Tim’s great Classical Chinese herbalism manual is for sale online click here to view more details
3. Slate and Shell PDX, blog of a NCNM student and friend who made Wumei Wan
4. Nuherbs.com – herbal company Tim mentions as testing for pathogenic organisms
5. Book by Eric Brand, of Legendary Herbs, that Tim mentions. A Clinician’s Guide to Using Granule Extracts

Related posts:

1. Deepest Health Podcast 15 – Does where Chinese herbs are grown really matter?
2. Deepest Health Podcast 2 – Visualizing my way to Chinese medicine success
3. Deepest Health Podcast 6 – Schools of Chinese medicine and learning

If you want to sign up, just click this link to go to the sign-up page.

We have people from nearly every continent, from a variety of professions (veterinarians, stay-at-home-moms, lay herbalists, Chinese medicine practitioners with decades of experience, brand new Chinese medicine practitioners, students) and everyone is very excited to get started.

Join us – check out the course page today to learn more. Contact me with any questions.  

PS:  I’m recording a new podcast today, and hope to have it posted before the end of the month!  If you haven’t listened to the podcasts before, check out the Deepest Health podcast archive.

Related posts:

1. The relational method of learning Chinese herbs : herb families
2. It’s time for you to take control of your Chinese herb learning
3. Answers to frequently asked questions about the Shennong Chinese Herb Learning course

Many people have had questions about the course, and so I’ve updated the sign-up page to reflect my most clarified understanding.  But, to make things simpler for people, I am listing the answers to those questions here in question-answer format.  You might find a question you had answered here – so look through.

Above all, get your registration done sooner rather than later – I’m only accepting 50 people into this Founding Member class and I’ve been frankly surprised at how fast those spots are going.

Frequently Asked Questions

How long is the course?  What’s the pace?  What if I’m busy – will I have time to do it?

With modules and integration weeks included, the course runs 10 weeks. However, the course is ultimately self-paced. Modules are released on a given day, but will be available on the site far beyond the 10 week interval AND crucially all content is available for download to your computer. This includes the recordings of the mentorship calls, all worksheets and text documents, all video and audio, and so on. Thus, even if some major life event comes up, you can run through the course at your own pace at any time.

Two time-based parts of the course are the forums and the mentorship calls. The forums will be another permanent resource for you – even when a new iteration of the class beings – Founding Members will have access and be able to interact with the new students as well as your old friends from the course.

The mentorship calls, as I said, will be recorded so you can hear all the questions and answers later. You can also submit questions via email to be answered live on the call.

Will we be studying… “X disease” “X herb” “X formula” (and similar questions)

In the course of my teaching, I inevitably talk about various herbs, formulas, treatment profiles and case studies. However, this first course is more about building a solid foundation for an entirely engaged, classically informed, lifelong relationship with herbs. Thus, I won’t be speaking extensively about any particular disease, herb or formula family in any intentional way.

Still, during mentorship calls and on the forums, you can ask specific questions about topics of interest to you. I will give more details to members about what types of questions will be fielded on the mentorship calls.

What materials are required for the course?  Will there be required texts?

After registration, you receive a materials list with “required” and recommended resources both listed. Long story short, whatever you don’t already have you can probably get on various websites dedicated to Chinese medicine. The only exception is dried Chinese herbs. Anyone with a grocery store with a bulk section should be able to acquire some simple Chinese herbs without trouble. I will also be delivering information about how to find them online, and will mentor individual students who are having trouble locating materials.

Regardless, there shouldn’t be hugely significant materials costs. You could probably get away with spending less than $20 total for all the materials in the course. If you went crazy, you could spend more than $300!

What’s the flow of the course?  What are the integration weeks?

Each element listed on the sales page represents one week, including the modules and the integration weeks. Thus, the 10 week timeframe (6 modules and 4 integration weeks). The first two modules are foundational, and will get you ready for the rest of the material in the course. After that point, there is an integration week where folks can continue to gather their materials, process the foundational information, ask questions in the forums and on the mentorship call, and generally get excited to start engaging with the herbs on a sensory level. That’s what integration weeks are for – just a way to slow down, take stock of what you’ve learned, and figure out if you’ve got any questions.

The remaining modules will take you step-by-step through the sensory part of the relational model, expanding on various theories & practices, and helping you grow more deeply connected to these plants that are the most incredible medicine on the planet. Integration weeks are dispersed throughout, particularly in places where I have learned students need more time.

During the flow of the class, students will be creating a project by doing individual exercises, and at the end of that time will have a close, personal relationship with a particular Chinese herb as well as having internalized a method for engaging with any medicinal substance they choose in the future. They will also be perfectly poised to move into the next, more symbolism and text-focused, part of the Shennong method in the second stage of the course (coming in 2012).

Do I have to be present for the modules at a particular time?  I live in a different time zone and am worried I won’t be able to attend!

As I said above, the course is self-paced, so being in a different time zone should not be a problem. I will be offering various times for mentorship calls so that everyone has a chance to be “live” on the line to ask their questions and interact.

Is the course taught from a particular standpoint?  Do you bash other ways of practice than your own?

I believe very strongly in the power of the classics of Chinese medicine as well as the ultimate classic – nature. I was educated by scholars who have pretty strong standpoints. However, I am an integrator and mediator by nature. While I sometimes let my excitement get ahead of me and make stronger statements than I would have otherwise, I deeply respect all ways of entering into this medicine, and seek to learn from everyone I meet.

I believe the classical texts of Chinese medicine are the ultimate arbiter, the one reference which we can all agree is foundational. If others choose to go beyond the classics, innovating to create new combinations of herbs, that is certainly their prerogative, and I do not begrudge them that. We can have healthy and lively conversations about these different viewpoints in the forums and on the mentorship calls – but all those conversations will be held with respect, enthusiasm for healing, and the goal of building a global community of colleagues.

Are there prerequisites?  What if I haven’t taken any formal herbs courses, yet, or don’t plan to?

There are no official prerequisites for this course.

I believe anyone can benefit from the Shennong Relational Herb Learning method if they are passionate about growing a deep, lifelong relationship to herbs. In some ways, the ideal student would be taking this class before their herbs education so they can benefit most from their medical school education. However, any stage in a program of study is fine, and the more herb names you know, the less you will have to look up in the course of my lecturing.

For people who have a strong interest in herbalism, but are not planning formal education, this course is an ideal way to engage with a very deep current of Chinese medicine. While you will find many of the words and concepts foreign (they are!) with a little work you will have a very solid understanding that will serve you well moving forward.

How can I get Chinese herbs to work with during the class?

I will be helping students to acquire herbs for personal research use. I know that some students live in countries where acquisition of herbs is more challenging. We will do our utmost to find plants with which you can work. If you have very specific concerns that pertain to your situation, please contact me.

I hope this FAQ has been helpful. In the course of writing, it more students have registered for the course!

So, again, I urge you to click here and register for the course if you are interested.

Related posts:

1. It’s time for you to take control of your Chinese herb learning
2. These symbols are meant to be questioned (they just don’t often give clear answers)
3. The relational method of learning Chinese herbs : herb families

First – I apologize for the recent bombardment with podcasts!  The good news is that the podcast is fully updated, and new episodes are already lined up through October, November and December!  Listening to those old podcasts is very interesting for me, and I’ve heard it’s helpful for listeners as well.

You can check out the new, improved podcast archive page by clicking this link.

Second – and maybe most importantly…

I’m excited to announce that the Shennong Chinese Herb Learning Course is live and ready for new students to enroll.

Enrollment will be limited to 50 Founding Members (as described on the sign-up page) and will only be open until October 20.  The first module will be posted to the site on October 25, 2011.

There’s plenty to do between now and then, though, including downloading the syllabus, getting your accounts set up, interacting with your fellow students, and getting PUMPED for the course.  So sign up soon - spots are already filling fast.

In this course, we will delve into sensory exploration of herbs, learning to trust our bodies as laboratories.  We will work with the classical texts of our medicine to come to a greater understanding of herbs and their properties.  We will build a co-creative community of engaged learners sharing their wisdom and experience.   It’s going to be fantastic.

Please check out the details of the course, feel free to email me with questions (eric@deepesthealth.com) and tell any of your friends who might be interested.  I’m hoping to have a diverse, engaged, international group of students creating excitement and community around an invigorated Chinese herbalism.

As always, please feel free to contact me with any questions.

Related posts:

1. The relational method of learning Chinese herbs : herb families

Topics covered

1. Why I love the herb method I teach

2. Why location matters when it comes to Chinese herbs

3.  Small application of the herb learning method with one of your friends and mine, Chenpi – aurantium – citrus peel

Back to podcast archive

Related posts:

1. Deepest Health Podcast 2 – Visualizing my way to Chinese medicine success
2. Deepest Health Podcast 6 – Schools of Chinese medicine and learning
3. Deepest Health Podcast 14 -Interview with Dr. Arnaud Versluys (Part 3 of 3)

1. What to do when you cannot secure the herbs you need (for instance, Mahuang and Xixin)

2. What about growing our own herbs locally and using them in Chinese herbal formulas?

If you are interested, please check out parts I and II of this interview.

Back to podcast archive

Related posts:

1. Deepest Health Podcast 11 – Interview with Dr. Arnaud Versluys (Part 1 of 3)
2. Deepest Health Podcast 12 – Interview with Dr. Arnaud Versluys (Part 2 of 3)
3. Deepest Health Podcast 9 – Interview with Dr. Heiner Fruehauf, Part II

When I contacted Mark Silver, founder of the Heart of Business and Portland local, I was hoping to entice him to come and speak to students at NCNM.  I succeeded in that, with the additional bonus that he was kind enough to offer to do a podcast interview with me for Deepest Health! After a few fits and starts, we managed to make our schedules line up nicely and we sat down for a chat on an early spring morning.

Topics covered

1.  Should healthcare practitioners worry about the recession?

2.  How you can get more patients without constantly explaining what we do

3.  What Chinese medicine practitioners should watch out for when starting their own businesses

4.  Technology & business : are they antithetical to holistic medicine?

Back to podcast archive

Related posts:

1. Deepest Health Podcast 11 – Interview with Dr. Arnaud Versluys (Part 1 of 3)
2. Deepest Health Podcast 5 – Interview with Brandt Stickley
3. Deepest Health Podcast 8 – Interview with Dr. Heiner Fruehauf

Topics covered

1. How one uses the Shang han lun in contemporary clinical practice, particularly concerning complex diseases typically seen in modern times

2. The importance of specializing in a particular style of Chinese medicine

3. Some advice to those of us seeking Chinese medicine knowledge

I think you’ll really enjoy the information AND the audio quality – I think I finally got it right.    Check it out at the bottom of this article!

Note : Dr. Versluys uses a few names that may be unfamiliar to listeners – I want to clarify these things for you.  Li Dong Yuan is the author of The Treatise on the Spleen and Stomach: (Pi wei lun). Zhang Zhong Jing is the author of the Shang Han Lun and the Jin gui yao lue (originally united as the Shang Han Za Bing Lun).

If you are interested, please check out Part I and Part III of this interview

Back to podcast archive

Related posts:

1. Deepest Health Podcast 11 – Interview with Dr. Arnaud Versluys (Part 1 of 3)
2. Deepest Health Podcast 9 – Interview with Dr. Heiner Fruehauf, Part II
3. Deepest Health Podcast 8 – Interview with Dr. Heiner Fruehauf

This is the first section of a three part interview with Dr. Arnaud Versluys of the Institute of Classics in East Asian Medicine. Arnaud has been part of my education and inspiration in Chinese medicine since the beginning.  As well as leading & teaching at ICEAM, he practices his craft in NW Portland, OR.

Topics covered

1. The relationship of the Classical texts to the practice of medicine

2. The importance of careful study

3. Food for thought regarding the various schools of Chinese medicine

Note: Please pardon the relatively low volume of this podcast – we had some technological problems.  If you are interested, please check out Part II and Part III of this interview.

Back to podcast archive

Related posts:

1. Deepest Health Podcast 9 – Interview with Dr. Heiner Fruehauf, Part II
2. Deepest Health Podcast 8 – Interview with Dr. Heiner Fruehauf
3. Deepest Health Podcast 5 – Interview with Brandt Stickley

1. My reflections as I come to the end of my first term/quarter in clinic at NCNM

2. The importance of memorization

3. The weirdness of caring for patients

4. Using all our gifts

Note: The book about Davinci that I reference in the podcast is an easy, inspiring read How to Think Like Leonardo da Vinci: Seven Steps to Genius Every Day (affiliate link)

Back to podcast archive

Related posts:

1. Deepest Health Podcast 7 – Clinical confidence and memorization
2. Deepest Health Podcast 5 – Interview with Brandt Stickley
3. Deepest Health Podcast 6 – Schools of Chinese medicine and learning

Topics covered

1. How a classical understanding can transform our understanding of medicine

2. The real importance of legendary figures in Chinese medicine history

3. What the classical approach lends to a contemporary Chinese medicine context & the importance of lineage

Back to podcast archive

Related posts:

1. Deepest Health Podcast 8 – Interview with Dr. Heiner Fruehauf
2. Deepest Health Podcast 5 – Interview with Brandt Stickley
3. Deepest Health Podcast 3 – The Power of Self Cultivation

Topics covered

1. What is Classical Chinese medicine?

2. Different models of learning and teaching Chinese medicine – the importance of transmission

3. Upper, middle and lower level physicians in Chinese medicine

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Related posts:

1. Deepest Health Podcast 5 – Interview with Brandt Stickley
2. Deepest Health Podcast 3 – The Power of Self Cultivation
3. Deepest Health Podcast 7 – Clinical confidence and memorization

1. What it means to have confidence in clinic

2. Shy I believe memorization is so important for Chinese medicine practitioners

3. Best practices for memorization

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Related posts:

1. Deepest Health Podcast 4 – Cancer, pulse taking & trust
2. Deepest Health Podcast 3 – The Power of Self Cultivation
3. Deepest Health Podcast 6 – Schools of Chinese medicine and learning

Topic covered

1. Different schools of Chinese medicine and how students should look at the possibility of “choosing” between them (it’s a big topic, and the only one in this podcast)

Back to podcast archive

Related posts:

1. Deepest Health Podcast 1 – Lessons learned in Chinese medicine clinic
2. Deepest Health Podcast 2 – Visualizing my way to Chinese medicine success
3. Deepest Health Podcast 3 – The Power of Self Cultivation

Topics covered

1.  Contemporary Pulse Diagnosis

2.  Working with and learning from the incomparable Dr. Leon Hammer

3.  Dr. Stickley’s basic understanding of Classical Chinese Medicine

4.  Entering the mystery, the importance of the senses, and other exciting stuff

Links of note:

1. Dragon Rises.org : site containing articles, links and information about seminars pertaining to Contemporary Pulse Diagnosis
2. Dragon Rises College of Oriental Medicine

Dr. Leon Hammer’s two most well-known books are Dragon Rises, Red Bird Flies and Chinese Pulse Diagnosis: A Contemporary Approach (Revised Edition) (both affiliate links)

Back to podcast archive

Related posts:

1. Deepest Health Podcast 4 – Cancer, pulse taking & trust
2. Deepest Health Podcast 3 – The Power of Self Cultivation
3. Deepest Health Podcast 2 – Visualizing my way to Chinese medicine success

Topics covered

1. What can Chinese medicine do for cancer?

2. Difficulties in pulse diagnosis

3. Confidence in prescribing herbal formulas

Note: The natural medicine business blog I mention in the podcast no longer exists.

Back to podcast archive

Related posts:

1. Deepest Health Podcast 2 – Visualizing my way to Chinese medicine success
2. Deepest Health Podcast 3 – The Power of Self Cultivation
3. Deepest Health Podcast 1 – Lessons learned in Chinese medicine clinic

1.  The power of self-cultivation for Chinese medicine practitioners

2.  Caring for patients from the moment they arrive until the moment they leave

Note : You can find most of the links discussed in the post in the recommendations vault.

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Related posts:

1. Deepest Health Podcast 1 – Lessons learned in Chinese medicine clinic
2. Deepest Health Podcast 2 – Visualizing my way to Chinese medicine success

1.  My clinical experience thus far: difficulties and excitement

2.  How I use visualization as a way to learn to be more effective and efficient in clinic

3.  A few questions I have about clinical practice

Note: The new blog (about natural medicine and business) mentioned is now defunct, its content mostly absorbed into Deepest Health.

Back to podcast archive

Related posts:

1. Deepest Health Podcast 1 – Lessons learned in Chinese medicine clinic
2. Reintroducing Deepest Health – a center for learning and living deeply rooted Chinese medicine
3. Listening my way to success in the NCCAOM acupuncture board exam

Topics covered

1.  Focus and intention: getting out of one’s own way

2.  How it was needling “real” people for the first time

Back to podcast archive

Related posts:

1. From the front line : Thoughts on running a Chinese Medicine Clinic
2. Reintroducing Deepest Health – a center for learning and living deeply rooted Chinese medicine
3. 7 Life Changing Habits I have learned through Chinese Medicine study

Chinese language is symbolic – it uses pictures (now highly stylized and simplified) to represent concepts. Chinese culture, even today, is infused with symbolism.  What is a symbol?  There are many potential definitions, naturally.  For my purposes, I will simply say that a symbol is something perceptible that “points towards” a larger concept. There are many elegant and powerful systems of understanding symbols – one of my favorites comes from the work of Carl Jung.

To use a common example, the Apple logo () has come to represent a whole host of products, services, even people & communities.  You can, of course, look to religious symbols like the Christian cross, the Jewish Star of David, and so on.  These symbols hold great potency in many cases – in some real way they go beyond themselves.

Classical Chinese medicine takes the symbolic elements of the medicine very seriously. Over the thousands of years of the development of the medicine, a mind-boggling amount of symbolic information has been amassed and recorded.  So for those of us who are committed to a deep practice of this ancient medicine, nothing else could be more important in our study and practice.

Vast amounts of information usually ends up organized into more manageable chunks.  In Chinese medicine, various ways have been used to organize and help us find greater meaning in the symbols we encounter.  One of the ways we organize the symbolism concerning the organ systems of Chinese medicine is through the use of a 12 section “organ clock.”  Most people have heard about the organ clock – it’s one of the most popular Google searches that brings people to this website!  To get a sense for the basic layout of the organ clock – see my unbelievably amazing artistry below.

HT = Heart, SI = Small Intestine, BL = Bladder, KID=Kidney, PC=Pericardium, TW=Triple Warmer/Heater/Burner, GB= Gall Bladder, LIV=Liver, LU=Lung, LI=Large Intestine, ST= Stomach, SP=Spleen.

Note: Focus on the general picture as some of the elements will not be explained right now (such as the constellation names “Wie, Mao, Bi,” etc).

The organs are laid out in the order of the energy flow through the channel system, then information known to be related is inserted in each section.

There are a lot of pieces of symbolic information that come in twelves. This is, I assume, why a twelve piece pie is so often used in discussing organ systems. We can use all of these to help us understand the organ systems, and thus the human body. Some of these groups twelves are:

• The names of the organ systems, and thus the etymology of the Chinese characters associated with those organ systems. Also included here: information from a variety of medical systems concerning the physical organ associated with each organ system, information pertaining to the acupuncture channel associated with each organ system, etc…
• Earthly Branches and their associated zodiac animals
• YiJing (I Ching) tidal hexagrams
• Two hour periods of the day
• Month in the Chinese calendar, but also the related Western time of the year
• Agricultural nodes – two per month, 24 total

We can also overlay information onto the twelve-part organ clock that comes in other multiples including (but not limited to):

• The phase element (fire, earth, metal, water, wood) associated with each position (multiple of 5)
• The direction of the compass and trigrams of the bagua (multiple of eight)
• The six atmospheric influences or conformations (multiple of 6)
• The relative concentration of Yin/Yang (multiple of 2)
• The participation of each organ in one element of the Heaven, Earth, Human Being triad (multiple of 3)

Just imagine drawing several circles on tracing paper, one divided into twelve parts, one into eight, one into six and so on. Then imagine putting a representation of each piece of information in the correct section. When all of this information is put together, one begins to understand the complexity of the organ systems. For example, take the Heart. The Heart is explained as being the sovereign of the human body, keeping under control all of the other organ systems so they may work together in harmony. Using the organ clock we see that the Heart (only a partial list):

• Is called Xin (心) in Chinese. This is often described as being a picture of the human heart organ with three drops of blood above it. Not particularly interesting, perhaps – though why there are three drops of blood is worth investigating. They could represent the ancient triad of Heaven, Earth and Human Being. Some primitive forms of the character look like a uterus, prompting an association between the Heart and femaleness.
• Is associated with the Earthly Branch Wu (午), associated with the summer solstice and the animal of the Horse. The Horse is an interesting animal and deserves a post of its own, but everyone can agree that horses can work tirelessly (like the Heart) and that they tend to be very sensitive animals.
• Is related to the Chinese agricultural periods (solar terms) called Xiao Shu and Da Shu, which are Small and Big/old summer heat, respectively. Summer heat is a heat with a damp quality – something anyone who has travelled in the American south in the summer can attest to. So, then, the Heart is related to this quality of intense heat.
• Is associated with the element fire, in particular the Imperial fire that is pure, constant and the light of the whole body.

These are just a few of the elements we can use to expand our idea of what the organ system “Heart” represents. Now, because this is just a bit of an introduction and getting too long already, I won’t go into any greater detail. Let it suffice to say that when one investigates these elements to their fullest and combines it with more obviously medical information (like the kinds of herbs used to treat the organ, classical descriptions of physiology and pathology, etc) one has a true understanding of that system that is of great help in understanding difficult and complex diseases.

I hope to be able to continue to unpack the organ clock in future blog posts and possibly a course.  I’m particularly interested in demonstrating to others how this information can be used in Chinese herbal treatment.

Related posts:

1. Phenomenology and Chinese Medicine : Our body is the greatest medical technology
2. The six conformations: an exploratory post
3. The Yijing and Chinese medicine : Hexagram 11, Tai 泰

1. She has an unflinching dedication to lifelong scholarship. This is absolutely, positively ESSENTIAL. A good doctor is a good student (the reverse is not always true). Several thousand years of the practice of Chinese medicine have resulted in an avalanche of information.  With the Internet and text digitization, more and more of that information is becoming available to people from all parts of the world.  One could spend a lifetime investigating only a tiny portion of that information.  Further complicating matters, human beings and nature are in a constant state of transformation – meaning there is always something new to understand!  Knowing more doesn’t guarantee a practitioner will be able to treat more effectively, but it lays the foundation.

2. She has excellent clinical abilities.    Every moment of the patient-doctor relationship has the potential to be therapeutic – so this doesn’t apply only to a person’s skill with needles.  Combine this with the first feature and you should also have a doctor who is constantly at work improving their clinical skills, from the first handshake to holding space for your experience to creating a follow-up treatment plan.

3. He is familiar with other systems of medicine.  I don’t think a great doctor of any tradition can be a jack-of-all-trades. Every medical tradition is deep and broad, so a lifetime of study and practice cannot exhaust its secrets.  Still, basic familiarity with other systems – particularly Western medicine in all its youthful exuberance – shows a willingness to understand the human body and experience from many angles.  Whether or not a practitioner actually uses this information in daily clinical practice is not important.  Being conversant enough to make appropriate referrals when necessary is important.

4. He will understand the Classical basis of the medicine. Chinese medicine is a tradition based on… well, tradition. In a youth and future obsessed culture this can seem a little quaint.  However, Chinese medicine works best when it takes seriously the proposition that the past holds vast wisdom. Being well acquainted with the foundational texts of Chinese medicine, being engaged in the process of understanding what they mean, and being capable of using classical technique is utterly essential to utilizing the true power of Chinese medicine.  Do all practitioners need to be “classical” to be effective?  Probably not.  But you must know what you are rejecting, or moving beyond, in order to do so with any kind of authenticity.

5. She will have an impeccable personal character. I do not believe you can separate the medicine from the (wo)man.  A good Chinese medicine practitioner will be honest, forthright, ultimately gentle and in every way the picture of ethical behavior.  Obviously, none of us are saints.  But, I do believe that sincere efforts and ongoing improvement in this is essential.

6. She will have a reasonable pricing structure and be reasonably skilled in basic business. I feel that developing a pricing structure that is both fair and yet allows the physician to make a living shows that the doctor cares about the medicine.  Charging exorbitant prices on the one hand, or on the other not securing enough material resources to survive?  Neither is a viable strategy.  The former price deserving people out of a powerful medicine.  The latter creates burned out, sullen, ineffective practitioners.  Money is a sore issue for many people in this profession – nothing inspires such spirited debate.  I encourage you to look carefully at your attitudes around money and making a living as a practitioner.  Perhaps a gift economy type model is best for you and your value system.  Perhaps not.  Don’t make that decision lightly.  Relevant business training by someone like Mark Silver may help you in your discernment.

7. He will have an approachable manner and willingness to answer questions and concerns. One of the things I always found frustrating about my Western primary care physician was his unwillingness to discuss with me the questions and concerns I had. Often, I would be brushed off with a casual explanation of a problem, even when I demonstrated that I knew a fair bit about the subject and simply needed clarification or a slightly more advanced understanding. I understand that often this attitude is due to the high time pressure so many PCPs are under.  There may be other important reasons.  However, I feel it is even more vital in Chinese medicine that doctors are willing to address patient questions.  Why?  Because there is little knowledge about Chinese medicine in Western culture. Patients may have questions about the theory behind a treatment or diagnostic procedure, they may have concerns about herb-drug interactions, they may want to discuss lifestyle options that would assist or hinder their treatment… all of these questions should be addressed in a compassionate manner.

There are obviously many lists that could be made to address the essential features of Chinese medicine practitioners.  We could go into more detail with any of these points, and more.  I’d say that this list is more practical, more patient-focused.  Given this, would you add anything to the list or take anything away?  Click below and leave a comment to share your wisdom.

Note: I’m quietly working on a resource I’d like to give away for free, in advance of the launch of the upcoming herbs course. It will be a helpful framework for you to build (and/or strengthen) your lifelong relationship with herbs. However, I don’t want to make this, nor go through the effort of building the upcoming course, if nobody is interested in getting any of it. So, I need your help again to gauge interest – details at the end of this article.

I’ve learned a lot, especially, in teaching Chinese herbs

There’s just so much frustration out there, and so much misguided (if well intentioned) teaching. But, herbs are such a powerful resource for us as practitioners – I hate to see people struggle so much. That’s why I teach – to help ease the burden a bit.  I just feel so enormously blessed to be able to share what I’ve learned – even more blessed that I learned it in the first place.  I mean, the number of incredible practitioners (peers and teachers included) in a 50 mile radius from my clinic is truly astounding!

But not everybody lives in Portland

The reality is that some people are already through their formal education, or don’t have the resources to enter into formal training just yet.  Still others just don’t have access to the wealth of resources that a place like Portland offers.  So, the number of people these teachings can reach is limited. That’s too bad for them (because struggle doesn’t have to be the norm) but also too bad for me (because I love the community that learning brings).

…So, I thought one day, why not create a course for the public, in that global classroom of the Internet?

A feedback request, and a promise

If this is really going to happen, I want it to be truly helpful to the people who join me.  That’s why I want to put a question to you – a simple one – in the hopes that you’ll help me make this resource an incredible benefit to all participants.  To answer, all you have to do is mosey over to the contact form and send me a note.  You could also post a response to this blog entry.  Ok, the question….

What resources have been most helpful in your herbs learning journey?

This can be a book, a website, something in your environment, a teaching technique, etc… just send me a quick message with that information, and I’ll use it to create this offering.

Thanks for helping out.

This teaching will be ready in October – people are already showing interest.  I’ve got a special email list just for people who want to get early notice.  Interested?  Join up here, if you haven’t already.

Related posts:

1. Reawakening the faculty of touch in learning Chinese herbs
2. The relational method of learning Chinese herbs : herb families

For long time readers, especially those of you that read by email subscription or RSS, I implore you – come check out the site!  It’s been entirely redesigned, and I would really love to hear your thoughts about the changes.  For those of you who are new, you’ve come on board at an exciting time.

Why redesign?

For the last year, I have labored on this site.  The low rate of content production might make you think that was not true.  Indeed, I’ve not been putting out posts at the high clip of my earliest days, or even at the medium clip of the middle days.  This was not for a lack of something to share, nor a lack of caring.  It was equal parts rising to the reality of clinical practice, business owning & raising a teenager peppered with a healthy dose of relaxation, getting married & reconfiguring my life outside of the rigor and schedule of institutionalized education.  A lot to manage.

So, if I wasn’t writing, how was I laboring?

Chiefly, I was coming to understand the reason for this site’s existence.  If it is no longer to be the record of a student journeying through formal Chinese medicine education, then what?  Delving into mission, vision and how I want this site to interface with the rest of my life occupied a great deal of my time and energy.  I had some great help from business mentors Jonathan Mead at Illuminated Mind and Mark Silver at Heart of Business, as well as various conversations with family, friends and colleagues.  Where would any of us be without our companions?

Some help from the Yijing

Speaking of companions, one of the constants for me has been The Yijing (aff link). Always ready with sage wisdom combined with jabs to the ribs, I asked again and again for clarification about Deepest Health.  Two themes stood out, exemplified by two hexagrams.

First, the aim of this site is characterized by hexagram 20 – 觀 guan – translated by Stephen Karcher in his Total I Ching (linked above) as “Viewing.”  In my education, I learned that this hexagram is the “tidal hexagram” for the kidney organ system.  This simply means that this hexagram has something very important to teach us about the kidney, when we’re talking about medicine.  In the context of this reading, it tells me that I have to take the whole cosmological universe of the kidney seriously as I am contemplating the future and direction of Deepest Health.  In some real way, the Yijing is telling me, Deepest Health is to do kidney work in the world.

What can this mean?  At the moment of the reading, a few things became clear:

1.  We take the deep, wide, big view.  This includes focusing on material that feeds from the deepest level.

2.  We nourish from the root.  This is related to #1 of course, but came to me as an important intuition.

3.  We don’t try to be everything to everybody.  Part of coming from the depth is that we reach everything, without having to focus on everything.

Ultimately, this means that our view remains resolutely “classical” however that is defined through time.  More importantly for me, though, I feel encouraged to focus closely on that which feeds me most deeply.  Herbs, in other words.  While acupuncture is an undeniably important part of Chinese medicine, it is not my primary passion.  As soon as I was able to focus there, my energy was released and all kinds of movement began to happen.

The second major message from the Yijing came in the form of hexagram 37 – 家人 – jia ten – translated by Karcher as “Dwelling people.”  This hexagram is affiliated with the heart organ system, and all the energies and associations therein.  In some ways, then Deepest Health is defined by the pole of association between kidney and heart.  This hexagram is particularly interesting to me because it speaks of nourishment, of coming together with others, and of the value of language.  Karcher’s translation of one portion of the text states, “This is a time when Noble One uses words to connect the beings and movement to preserver on the path.”

While I’m not sure I’m a Noble One, I certainly aspire in that direction.  This gives me heart that reaching out, building a community, and helping people through teaching is a positive direction.  There is, of course, a lot to unpack in all of these associations – but these were the immediate insights.

What does this mean for you?

During this visioning time, I came to understand the real heart of this site and my work with it.  So, I set about to figure out how to make it a viable part of my life, how to give it energy, how to make it of service to others.  What you’re seeing before you, and what you will see in the coming years, is the result of all that thinking, consulting, meditating and working.  For now, focus on the following four aspects of Deepest Health’s evolution.

Publications and products

I am going to focus on the creation of highly relevant, classically informed, real-world tested courses and publications. This will take the majority of my time as a writer, and the majority of the space on the site. While free content will always be a major companion, the hope is that paid products will help increase the quality and quantity of information coming from the site through supporting this independent scholarship.

Products will tend to be herbally focused. I’m hoping to eventually find someone with a passion in acupuncture to join the staff and offer acupuncture focused products to the eager CM public. If you think you might be that person, please contact me.

I’m currently working on an offering that will really help to transform people’s experience with Chinese herbs by tapping into what they already know and their innate talents. Now is the time to get in on the ground floor, as whomever accompanies me now will get more individualized attention and get to have a hand in shaping the course itself.  If you think you might be interested, given these sketchy details – get on the early interest list by clicking this link.

Blog content and other resources

The blog will continue to be regularly updated. For the first couple of months, we will be re-releasing important information from the archives. We will also be purging a huge amount of lower quality, unfocused, or date specific information from the site. This is part of the Autumnal metal energy necessary to bring about abundant new growth!

The blog content will vary in topic, but often be focused around whatever publication or Chinese Medicine Quarterly issue we’re currently working on. As such, it will be more actionable, more engaging, and more topical than the blog content has been in the past.

I am re-launching the Deepest Health podcast. New episode will come out monthly, and you can visit that page to view the preliminary schedule. The podcast will mostly focus on clinical reflections from myself, teachers and colleagues. Interviews will mostly cover current events in Chinese medicine as well as discussions of the future of Chinese medicine. Many people have written to me in the last several weeks asking for new podcast episodes, so I trust this information will be exciting to at least those people.

I am going to start publishing videos as well. At this point, videos will probably be brief discussions about particular topics, but may include some interviews or clinic tours. This is the most unformed and experimental part of Deepest Health, as I just don’t know what will best serve folks. If you have some ideas for great video content, please let me know by clicking the link.

There are more bits and pieces on the new site, so please visit often to check them out!

Chinese medicine quarterly growth and development

Chinese Medicine Quarterly, a new digital magazine for Chinese medicine practitioners and students, is going to be publishing its third issue soon. We’ve learned a lot through the first two issues, and hope to incorporate our learning into every successive issue. Moving forward, we hope to offer a print-on-demand option, increasingly interesting and high quality writing, subscription service, and free issues to new Chinese medicine students to increase engagement and community participation.

If you haven’t already checked out the magazine, please consider purchasing the inaugural issue or the second issue, a meditation on spirit.

Social media as primary space for interaction

I recently eliminated the Deepest Health forum. It wasn’t being used very heavily, and was becoming overrun with spambots. I decided that withdrawing and slowly considering a relaunch sometime in the future was the right way to go. This doesn’t mean that the age of interaction is over, however. You can hook up with Deepest Health on Facebook, you can find me tweeting away on Twitter and figuring out Google+, and can always post comments to individual blog entries. Feel free, also, to contribute a letter to the editor at Chinese Medicine Quarterly, and be published in our next issue! Hopefully, these elements will be sufficient to help encourage dialogue – the wellspring of so much positive growth for our profession.

Please explore the site and feel free to contact me if you have questions!

If you come in the next couple of days (it is now September 20, 2011) you may find things shifting around a bit, still. The continuing education page will be under constant evolution for the next several months. The blog is going to be going through a process of repopulating – publishing archived content that has been refreshed and updated. I hope you will visit often & celebrate with me! More soon…

Recently I found myself “eavesdropping” on an online conversation between two professors at NCNM, namely Roger Batchelor and Ed Neal, on the subject of the Pericardium in the Classics. What came out of it was more than a little enlightening and inspired me to talk about the Pericardium a bit this week.

The essential point of the discussion was as follows: what we call Pericardium in the modern Chinese medicine disciplines is referred to as (quoting Ed’s translation here) “Mai vessel of the heart encircling luo vessel (network), following the hand (upper) Jue Yin six confirmation terrain, relating to the function whose (domain of responsibility) is the heart.” Usually this is shortened to Xin Bao, or Heart Wrapper or Heart Encirclement. Usually this is assumed to equal the Western anatomical structure of the pericardium, the membrane that protects the heart. However, what Roger and Ed pointed out is that in it’s discussion of the function of the Xin Bao, which is always the important thing to the Classical Chinese mind, it has almost nothing to do with the pericardium whatsoever and instead equates much more closely to the coronary artery network. This, to my mind, answers a boatload of questions about what the Hand Jueyin (and the not-particularly-easy-to-understand Jueyin as a whole) actually does.

First, for our TCM readers, let me clarify a misconception that seems to be prevalent: contrary to what we learn in school, Jueyin does not refer to a seldom seen and horrifying state where the patient is vomiting roundworms (something that the average Westerner can’t fathom) and occurring just before spectacular death.  Rather, Jueyin, which deals with-amongst other things-the Heart and Pericardium organs, is the “closure” of Yin, the function that causes Yin to shrink and decrease so that it may change properly into Yang. The Liver stores the Blood and supplies said Blood throughout the body. The Heart moves the Blood, but how does the Blood get there? Via the Jueyin network. The Liver feeds blood to the Heart via the Pericardium/Xin Bao. How much more sense does this process make if the Xin Bao is really the coronary artery network?

Also notice that the representative  true Jueyin formula, Dang Gui Si Ni Tang, is a Blood-oriented formula. If Dang Gui is the Emperor herb, you can bet the house that Blood is the primary issue at stake, especially given the construction of the rest of the formula: Gui Zhi to invigorate the Blood, Tong Cao to decrease vascular rigidity, Xi Xin to warm the Blood as it reaches the Lungs, Sheng Jiang to bolster Taiyin function in the construction of Blood and Da Zao and Zhi Gan Cao to supply material to the Blood and Yang to the Heart when used with Gui Zhi and Sheng Jiang. Blood, Blood, and more Blood. If the Xin Bao was just the wrapper of the Heart (something that always mystified me) this wouldn’t make a great deal of sense. However, if it instead is equated  with a) the coronary artery system that is responsible for feeding Blood directly to the heart and b) a more formless and function-oriented idea of the system of channels, Luo networks, etc. that encircle the Heart and supply it with Yin and material fuel, suddenly both Xin Bao and Jueyin make a lot more sense. Also if you consider that the Kidneys have to provide the ultimate Yin Water that nourish and protect everything in the upper Jiao from the overwhelming Imperial Fire of the Heart, it makes complete sense that this Yin would travel up through its child Wood (meaning the Yin Wood network of the Liver, but which the Chong Mai adds its influence to) and onto Wood’s child Fire (being the Xin Bao and Heart).

Let’s also look at the Xin Bao/Pericardium from psychological perspectives. The Pericardium is normally seen as the Heart protector, a point of view I agree with fully. However, I think in the context of viewing Xin Bao as a network instead of reducing it to just one physical entity (as is our modern wont) the protective membrane of the pericardium is only a small part of the story. In the primary lineage I have been trained in (Leon Hammer’s Contemporary Oriental Medicine which, despite the name, is actually very classically informed) as the Heart pulse begins to tighten there is both a restriction of circulation into the Heart proper as well as a decrease in communication with the outside world. The patient is often quite far into nervous exhaustion and is beginning to close off and isolate himself emotionally from society, loved ones, possibly also even himself, especially if a Slippery quality is also found. The tighter the pulse gets the more the constriction develops on every plane, introducing emotional rigidity (frequently accompanied by the “character armor” of muscular rigidity) and impeded circulation in the chest, frequently with sharp pains over the heart. It’s much easier to see this constriction mirrored by a constriction of the arteries that feed the Heart rather than what amounts to a lubricated bag somehow constricting.

I would also add in a comment from Arnaud Versluys on this subject in a lecture where he stated that the Heart’s job is to primarily serve as a container for the Shen and that in fact the Pericardium-which is also represented by the entirety of the vascular network-does the actual beating, “squeezing the heart” as it were. Again, the coronary artery network theory really works well.

So what does this mean practically? To begin with, this really clarifies the (manifold) uses for the Pericardium channel in acupuncture. Given the usage of Pc-4 for treating acute myocardial infarction, we can see its power over the physical structure of the Heart and its Vessels. However, we can also see the benefits of providing nourishment to the Heart via the combination of K-22, Pc-1, and Pc-2 using the Exit and Entry points of the Kidney and Pericardium channels to bring the Yin influence of Water to the Fire networks, essentially mimicking the natural activity of the Jueyin. This combination is very useful for patients whose Imperial Fire is beginning to run amok causing insomnia, flight of thought, anxiety, and other symptoms.

This does however raise interesting questions about the true function of Pericardium-oriented herbs such as Zhi Mu, which is frequently used to cool down and protect the Heart and Pericardium, relieving cases of delerium as well as less serious psychological difficulties along the same spectrum.

I would love to hear from our more experienced practitioners on this subject in the comments section.

Related posts:

1. The six conformations: an exploratory post

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.

For those of you who do not acknowledge having a “spiritual life,” what role does your “inner life” play in your practice of Chinese medicine?  To say it another way, how does the development of yourself as a person, as a body, as a qi sensing individual in the contemporary world play into your practice of Chinese medicine?

The answers I seek will focus on active practice, not just belief or interest.  I’ve asked this question of many people, and those whom I’ve not asked I’ve tried to “ask” by observing them carefully.  Many times, particularly when “asking” happens – the person will say something quite vague and usually related to what they BELIEVE and how this allows them to hold a particular intention, or something similar.

That’s fine as far as it goes.  But, just as I expect my practice of medicine to become an integral part of my entire life, I expect my spiritual development to become an integral part of my entire life. As such – they will influence eachother.  In my experience of working with patients, the more grounded I am in my own development and centeredness, the better listener I become.  But, there’s more.  I notice very distinct changes in my practice when I make overt attempts to – say – meditate during acupuncture treatment.

It is, of course, a different kind of meditation – being there with a person, focusing on their physical needs, focusing on the sounds and space around me.  This isn’t Zazen or anything.  But, going into a meditative place very clearly helps me to perceive, to respond, and to treat.  This isn’t a popular notion in all circles.  In those circles where it is popular, I think it frequently goes a little far.

I want to be clear.  Because I am grounded in my own spiritual and personal development does not mean that I am talking about this with patients, actively seeking to help them do the same, or anything else.  I’m not necessarily talking about “spiritual medicine” or even something like Worsley style five-element acupuncture as a model.  I’m just talking about your own effort to develop yourself and its influence on your practice of medicine.

I simply see my meditation practice, my Qigong practice, my efforts to actively root out my own insufficiencies and remedy them, and all the rest as the ground from which study of medicine and practice of medicine is possible.  But, I want to hear from others.  Have you had a difficult time integrating these parts of yourself?  On the other hand, have these parts of your life never seemed to be “parts” but instead seamless parts of a whole?

Comment away, my friends.  Note well that language is always, always tricky when discussing these things and if you are thinking with some degree of indignation that I’m not “getting” something – interrogate the language first.

Here’s a simple collection of thoughts about being in clinical practice in a Chinese medicine clinic from someone new to the profession, G. Michael Reynolds.

1. It’s hard being a natural medicine practitioner when you’re relatively sickly. I’m a fairly good sized guy.When I was born my mom’s OB/GYN declared I was going to play for the Tampa Bay Buccaneers when I grew up. (This was not a curse, I’m from Tampa.) You don’t really think “poor health, very deficient” when you look at me. However, I’m kinda sickly and I’ve kind of been that way my whole life, for reasons multifarious. I feel like I’ve come a long way in the last few years, but I still tend to be on the weak side, not able to do all that much in the way of physical activity, coming down with things a lot, etc. (When I moved in January, afterward I was sick until sometime mid March). The point here is that I frequently find myself (like today, for instance) in the middle of a diagnosis with a patient thinking “How exactly is this person supposed to believe in my ability to improve their health when, despite my best efforts, my own personal health is so poor?”

2. Treating chronic disease is an exercise in patience and frustration management. Chronic disease is what I look for, my preferred type of case. The really difficult, chronic, life-crippling stuff. This is because these are the patients I most want to help, whose lives would be the most changed by a positive result. Despite having the tools at my disposal to do just that and making observable progress, it’s still a very frustrating process. Sometimes these things really do take four or five years to pull off, and that with hitting a home run every week. Patients get frustrated and drop out, really committed patients have other disasters befall them or are being crippled by their Western treatment regimens, patients that are doing absolutely everything right still continue to suffer greatly in the process of improvement. Some days it’s hair-pulling. Some days it’s heart breaking. This is part of the acupuncturists life that they seemed to have missed in school.

3. Doing things in the right order takes a lot of faith and self-confidence. I have multiple patients who have some sort of chronic pain who, to my mind, are great examples of the Neijing maxim that “all pain, sores, and itching come from the Heart.” They have chronic pain that

is being directly or indirectly caused by upper jiao blockage due to emotional distress followed by a walling off of the psycho-emotional energies of the Heart and Lungs. In both cases a powerful resistance to dealing with the loss of loved ones is crippling circulation and leading to a variety of additional symptoms, like dysmenorrhea. However, it’s not the easiest thing in the world to be charging a pretty good sized sum of money to someone who has come to you for elbow pain which isn’t really getting better and having to tell them “look, we gotta keep focusing on that emotional blockage first in order to get to your pain, otherwise we’re just knocking our heads against the wall.” Is it the truth? Absolutely. Do I still kinda worry that it’s going to make me and every other acupuncturist alive look bad and one day she’ll stop coming in and tell her friends about what a waste it was and…you bet. After all, you can’t have a good neurosis without a lot of work.

4. Some days you feel like you did everything wrong, and yet everything right happens. I’ll never understand this one. You needled these two points and…just didn’t “feel it.” Like there was no real connection. You had to more or less guess on the formula and just kinda threw it out there, not really knowing what would happen. You were too beat to take a proper pulse and so had to work out what to do from other angles, and even then things didn’t seem right. You were sure that what you did was going to fail utterly. However, the next time you talk to the patient, they’re thrilled with the results. Go figure.

5. Some days you feel like you did everything right and the case barely budges. See #2

6. You really do have to get used to the idea that patients are frequently so closed off, out of touch with themselves/reality, and self-unaware that they have no idea what’s really wrong with them. Frequently they can’t even tell you if things are better or worse because they literally have no idea. See #3

7. The practices of other practitioners is going to make you really mad some days. You’re going to hear about people who are essentially running a health food store/supplement supply under the guise of a medical license for all the hawking of goods they do. They will practice lousy medicine, though their patients probably don’t realize it. They will have evolved into the Monte Hall model by force of necessity, because their actual CM acumen is so poor. So in order to survive, they will pull in every modality, every product, everything in existence into their practice and sell it all. Their practice will be bigger than yours, they will be making more money than you, their car/address will be nicer, they will be in the local magazines. They will still not know what they are doing, they will not be reaching the level of results our ancestors expect from us, however they will be feeding the consumer culture of our society, and that is why they will be doing well. You will know this, but it will still make you mad.

8. Your practice is going to make you really mad some days. You will find yourself saying “if this stuff is so great, if I’m practicing such a superior modality, if my herbs are such high quality, if I have it on absolute fact that I am doing what my patient needs when they need it, then why in the hell aren’t any of them completely cured? If my way is better, then why is it such a small operation? If I’m so great then why do I ride the bus instead of my Mercedes/Porsche/whatever? Why aren’t I better at treating emergency/acute/chronic/mystery/women’s/men’s/children’s/animals illnesses? Why do I have so few answers?”  Again, neurosis takes work.

9. All of these things will come and go along with this thought: man, this stuff is really great and I feel good. Yin transforms into Yang and Yang transforms into Yin. Good days, bad days, they’re all part of it it seems. I personally think that people who only have good days (residents of Portland notwithstanding) need psychological evaluation and a lie detector test. Just try to remember that when things are bad that soon it will turn around and that when things are good that you don’t have all the answers just yet.

After posting an earlier post discussing the first of my five maxims, a request came up to present the rest of them. Never one to shy from a good request, today I’d like to present Reynolds’ Second Maxim, which is “Don’t hear horses and think zebras” which could also be phrased “Thou shalt not overcomplicate!”

“This will be the seventh time we have destroyed Zion…”

I remember going to the movies to see “The Matrix Reloaded” during the course of which a neat and tidy story which everyone was familiar with was exploded into about a million little subplots and alternate storylines with a new cast of characters that became hard to keep track of and events and motivations that didn’t make a great deal of sense. That and some sort of rave/orgy. Upon leaving the theater, my girlfriend at the time turned to me and said “Uhh…that was needlessly complicated.” This I feel is an excellent example of the typical state we frequently find ourselves in, especially once herbs enter the picture.

I feel that this concept is heavily tied in to my first maxim (“What are the symptoms?”) in that you don’t want to make the mistake that many physicians have made throughout history, East and West, which is deciding what a great idea a particular path of treatment would be and  implementing it without bothering to first find out if it’s a good idea.

Not women, THIS woman

This very much applies to the TCM habit of protocol-making, where, in the example of one very popular protocol, a treatment method including both points and formulas is decided upon depending on what week of her menstrual cycle a woman is currently in. If it’s week one, she gets Formula A and Point Protocol A. Week two is Formula B and Point Protocol B and so on. Now at first glance this seems like it could be a great idea, as it appears to take into account the fact that a woman is likely to be in a slightly different physiological state depending on what week of her cycle is in. However, it fails to take into account the only thing that matters, which is the condition of the patient before you. It’s very easy to get caught up in thinking of things in broad strokes, the nature of women, the resonance between this or that herb and female physiology, lab results, and a million other things when in fact the only question of importance is still “what are the symptoms?” All information regarding symbology, tendencies, studies, typical clinical solutions, etc. is only of value insofar as it can be translated into a specific and accurate treatment for the individual. What works on “women” is of little use as we are interested in what works for this woman, whose specific menstrual complaints may have very little to do with Spleen Qi Deficiency, Blood Deficiency, etc. and may instead come from sources as varied as emotional trauma, overexercise, or acute stress.

Now this is not to say that I don’t use protocols, which would be the furthest thing from the truth. Technically, as long as we are  borrowing from someone else to match a situation, that’s a protocol. I just do my best to a) use the most powerful and effective protocols and b) only use protocols that are very strongly indicated for the case in question. The truth of the matter is that I tend to avoid overcomplication by using the most simple, direct, elegant, profound, and well…broad protocols we’ve ever had the privilege of being handed, which lie in the work of Zhang Zhong Jing.

Now those of you who attended NCNM have likely not experienced what those of us who are classic-minded but came through TCM schools have, so please try to put yourself in our shoes a bit. My particular experience frequently involved the presenting of a case to a supervisor who, especially the Chinese ones, would roll their eyes at my Shang Han Lun-based approach and instead begin rattling off piles of points, truckloads of herbs with dosages set to numbers gained via some inexplicable method that had more to do with cooking than herbology in my opinion, and sent off to make the patient better instead of doing whatever craziness I had been working on, despite the fact that 10 times out of 10 I could point to textual support in the Shang Han Lun or Jin Gui Yao Lue for what it was I was trying to accomplish. This to me is the ultimate overcomplication and unfortunately this “whatchagot” method of making formulas out of single herbs (or dui yao pairs amongst the more enlightened) is the hallmark of TCM herbology’s gross ineffectiveness.

An Example

I’ll give the following example which is, admittedly, a straw man, but one that will hopefully illustrate what I’m going on about to the non-TCM trained set. I can assure you that I have seen this very approach many times by TCM herbalists, even very experienced ones. Suppose a patient presents with the following: sore throat, somewhat mild all-over pain that is especially strong in head and back, fever, chills, yellow phlegm in chest and sinuses, headache in occipital, parietal, and frontal regions, coughing, sneezing, nasal drip, nausea, irritability. Tongue has thick white coat. Standout pulse qualities are floating and moderate at left cun position and slightly deep and tight at left guan position. I will present three different ways of dealing with this case:

Method #1: The completely wrong way: Diagnosis: Wind-Heat Treatment: Yin Qiao San, or failing that Chuan Xin Lian Pian + Bi Yan Pian. Rationale: , YQS is primary formula for early stage Wind-Heat. CXLP is extremely antiviral and antibacterial, BYP is good for runny nose and sneezing.

Method #2: The needlessly complicated way: Diagnosis: Wind-Cold invasion turning into Heat. Treatment: Make the following symptom-based custom formula (with rationale):

Lian Qiao + Jin Yin Hua: Good for Wind-Heat, clears Heat, reduce fever, soothes sore throat
Yan Hu Suo: #1 herb for pain
Du Huo+Ji Sheng: #1 combination for back pain
Gao Ben: relieves head pain, back pain, also good vs wind
Ban Lan Gen: clears Lung Heat, antiviral/antibacterial
Lu Gen: clears Heat Phlegm from Lungs
Jing Jie + Fang Feng=expel Wind
Niu Bang Zi: relieves cough, clears toxicity
Bo He: releases exterior, clears Heat, relieves irritability
Sha Ren: nausea
Gan Cao: clears Heat, harmonizes formula

Method #3: The right way : Diagnosis: Combined Taiyang-Shaoyang syndrome Treatment: Xiao Chai Hu Tang modifed as follows (as listed in the original SHL text):

Chai Hu
Huang Qin
Ban Xia
Gan Jiang
Zhi Gan Cao
Wu Wei Zi
Gui Zhi
Gua Lou Shi

Rationale: These are the modifications given by Zhang Zhong Jing to match this very situation. Even if you didn’t know these, by having a working knowledge of the SHL/JGYL you would know enough of the approach to work this out for yourself. There’s no fishing around for herbs to match up vs symptoms and having to guess which opti
on is better than another, its all there already. The problem is primarily blockage in the Shaoyang network with some accompanying Taiyang symptoms. Xiao Chai Hu Tang is the primary formula for resolving this type of blockage with a couple modifications made to assist. Note that the point of this formula is to unblock Shaoyang, unblock Taiyang, unbind the chest, drain damp, strengthen Taiyin and that all curative actions are based out of that without having to make the World’s Biggest Formula in an attempt to solve a relatively simple problem that was solved (and written down) a couple thousand years ago. As Arnaud Versluys says, “there’s really no reason to re-invent hot water every time you need to cook something.”

Even in the case of chronic disease, the approach remains the same: choose the correct root that most accurately fits the situation and modify to match specifics. It also helps to have reliable information to draw from, which is of course why I insist that Zhang Zhong Jing’s work must be the toolbox that all Chinese herbology reaches into when it needs a tool. Before you start thinking “Ok, I’m going to take this formula and mix it with that formula and then add these herbs and then refer them to that doctor for this therapy and…” first see if there is a simple solution to the problem, as is so often the case. Don’t be afraid ti mix and match with formulas, herbs, modalities, etc. but make sure it’s necessary first.

I’m sure I will expound upon this at a later date but for now I hope this gets you thinking in the right direction.

Let’s conclude this series on strategy in Chinese medicine with our final two points.

Treating Erratically

Martin Luther once said that Mankind is like a drunkard who upon falling off his horse on one side overcompensates and promptly falls off the other side. In Chinese medicine, the opposite of sticking with the same protocol no matter the situation is constantly changing what you’re doing. Now, I want to draw an important distinction here. The speed with which you have to make adjustments will depend on many factors, especially the modality being used. The very nature of acupuncture is such that you’re both creating and reacting to changes in the patient’s energy field, which by its nature is subtle. This just naturally leads to treatments in most cases being completely different from week to week in a lot of patients.

In the case of herbs however, what you don’t want to do with a chronic case if you can possibly help it is to leap from formula to formula. If you have legitimately resolved a layer of the condition and are ready to move to the next thing, that’s one thing. What you don’t want to do however is “Ok this week I think I’ll give you You Gui Wan because last week I gave you Si Jun Zi Tang and the week before I gave you Xiao Yao Wan, so I feel like we’re covering all the bases.” As I have heard Heiner Fruehauf eloquently state, you have to have the courage to decide on a base formula that adequately meets the conditions and then stick with it long term by regularly alternating a small amount of the ingredients.

That said, I don’t want to discourage anyone from having the courage to take a well-calculated risk when they aren’t 100% sure of the outcome. Let’s be honest, not many of us are completely sure about exactly what’s going to happen every time they hand their patient a bottle. I certainly am not. In fact, I find myself white-knuckling the patient’s chart, re-re-checking my conclusion long after they’ve gone home more than I care to admit. Its part of the Chinese medicine experience in our age, in my opinion.

In short, treat what you see and not according to pre-conceived notions if you can possibly help it. When in doubt, remember Reynolds’ First Maxim!

Too Many Doctors Spoil the Case

A huge problem in Chinese medicine-and one not easily resolved-that you will run into with many of your patients is the fact that you are only one of a small army of medical practitioners that they are currently seeing, and often the last one to the party, so to speak. You will often find yourself having to cope with not only the patient’s original condition, but also the added side effects and pulse-obscuring properties of drugs given to them by their team of MDs, the pile of supplements procured from their local health food store, their ill-advised Medifast diet/candida cleanse/detox protocol, their equally ill-advised weight room habit, their Reiki practitioner, their support group, and oh yes, their OTHER acupuncturist. Different doctors I’ve talked to have had different things to say on this subject. Dr. Leon Hammer has said that he typically suggests that if the patient would like to try these other methods that perhaps they come back after having first exhausted their possibilities. A famous Taiwanese doctor that a couple of my friends learned under is reputed to have refused treatment to patients who were currently under the care of someone else. How you handle this is your business of course, but suffice it to say that the more factors there are in the treater equation the more difficult it’s going to be to get anywhere with the case.

In America at least, most of the people who seek us out are in a high degree of physical and energetic chaos. The nature of our societal demands such as our crazy “rest is for the weak” work ethic, our fetishization of requiring the absolute best of the best of everything we come into contact with, keeping up with not just the Joneses anymore but the rich, famous, and Hollywood-employed as well, our terrible diets, our masochistic exercise programs, our sense of entitlement and lack of tradition, our rejection of the old and glorification of the young, our out and out INSANITY in every corner of our existence produces a patient who is coming apart at the seams on their best day. The introduction of any more chaos whatsoever into this picture can cause nothing but further catastrophe. It is absolutely not surprising that our most common “big” diseases are cancer and autoimmune conditions. We are chaos personified, the absolute opposite of peaceful growth and progression like the seasons. Nearly every patient that walks through our doors will be in this state and it would be well to keep in mind.

Also worth noting is that the primary problem in the chaotic state is that the very Yin and Yang of our beings is separating and with that separation comes greater and greater vulnerability to more disastrous diseases of every sphere. In my opinion, this separation begins at the level of the Gui Zhi Tang-type Taiyang invasion (note that Gui Zhi Tang’s most famous characteristic is that of “harmonizing Ying and Wei” which is nothing less than putting Yin and Yang back into contact with each other) and ends in death. Everything else along that continuum is some degree of separation of Yin and Yang and needs to be accounted for thusly. I fervently recommend that anyone not intimately familiar with this concept read the following article by Dr. Hammer entitled,” Towards a Unified Theory of Chronic Disease with Regard to the Separation of Yin and Yang and ‘The Qi is Wild.”

How do these two topics relate to timing and momentum? Simple. If you’re trying to walk to Albuquerque you’ll never get there if you walk toward Portland for a day, then San Diego for a day, then Atlanta for two days. You also won’t get there if you ask directions from everyone you meet and they all tell you something different. Timing and momentum is doing the right things at the right time consistently. Cure doesn’t happen without it.

That concludes this series. I hope you’ve gotten something useful out of it. If you’d like to go back and read the previous segments, here they are again:

http://deepesthealth.com/2010/strategy-in-chinese-medicine-timing-and-momentum-pt-1/

http://deepesthealth.com/2010/strategy-in-chinese-medicine-timing-and-momentum-pt-2/

http://deepesthealth.com/2010/strategy-in-chinese-medicine-timing-and-momentum-pt-3/

Related posts:

1. Strategy in Chinese Medicine: Timing and Momentum, pt. 3
2. Strategy in Chinese Medicine: Timing and Momentum, pt. 1
3. Strategy in Chinese Medicine: Timing and Momentum, pt. 2

—–

If you missed any of the series, just read through the links below.

Part 1 (Beginning of the Pungent + Sweet = Yang Qi experiment)

Part 2 (Continuation of the Pungent + Sweet = Yang Qi experiment)

Part 3 (Conclusion of the Pungent + Sweet = Yang Qi experiment)

Part 4 (Beginning of the Sweet + Sour = Fluids experiment).  You’re on part 5, the conclusion of the Sweet + Sour = Fluids experiment, right now!

Flavors Experience

This section contains the experiences felt during the ingestion of each herb and pairings.

Calibration Herbs

The calibration process was to know the intimate experience of the herbs from a personal perspective and have a knowing that converged in a way that the authors of the Tang Ye Jing had.  Therefore, much of this is poetic serving a pivot role for the further experiences. This is a rehashing from the first experiement.

Dang Shen
The simple act of sipping this herb allowed for relaxation to pour through my entire body. Hints of warm milk were hidden in this and  spun me back to childhood.

All I wanted was to cuddle up and under a comforter, turn on a movie and rest.

Ancient tension fell away.
Worries melted into peace.
And a smile held me in her embrace.

My breath grew deeper and unhurried and my brow opened and tingled in delight.

(Sheng) Di Huang
Wafting past my nose
my heart flows with joy
Exhale
Joy settles

Gently blowing on the hot medicine
Sip
Sip
Sip
This dark mistress grabs a hold on my mind
the initial joy of heart is hidden because
the over powering grounding of mind
Sip
Sipsip

The bottom of my tongue holds true
as if waiting for the fog on the horizon
to clear
I grip the ground and straight
my neck
peering into the depths

Breathe
Breathe
sip

Gulp

My sides now ground
and the imminence of what may be subsides
I am Here
Somber
Salty
But bound
My upper heart beats
in unison with the first

I feel a turtle shell hold me together above my head

Peacefully and powerfully she commands me not to drink anymore…
What do I do with the rest.
Offer it to a friend.

Xuanfu Hua
Bitter!
My eyes jump from my head!
Never let that touch your lips again!
Hold on… a phone call… let me answer that
I’m back.
Feeling cleaver.
Not so sure if that’s a good thing.
But reverent now.
This goes to my heart
Tears that otherwise fog my mind
Lift in wondrous praise like steam
Something shines through
Quasar like
Going to surrender as stairway to heaven plays
Drink her all. in deepened brightened ming-yi.
Sometimes all of our thoughts are misleading.
super cold

That one was particularly hard on my stomach and had to neutralize it with a little Sheng Di Huang and a little more of Dang Shen.

Wu Wei Zi
I’ve tasted you before… have I not?
What a joy to pucker my lips
But taxing this time.
My spine straightens into a J
Relax but strong
My sides again.
But especially my shoulders come to life
Thank you for being warmer than XuanFu
You shook me all night long!!!!!
Did you know that the electromagnetic field of the earth is one of several qualities that allows it to be habitable for life? We’d be with out a subtle protection and possibly a way of thinking without it.
You are beautiful!
When the levee breaks

Gui Zhi
Pungent.
Mud that has been hardened flaking off the back of my neck
Flavorful breathing
Gentle muscle relaxant
Effervescent smile
Delicate
Does it even work?
I think  so.
A little fiery
Playful?
Giggling
Gypsy!
I’m working hard to keep my spirit in my body

Combinations

These combinations are explored in a more prose and scientific sense. It lacks the poetic nature of above because I’m looking for a convergence of experiences.

Sheng di Huang and Wu Wei Zi

Water and Metal

Salty and Sour

At first it settled my energy. But then it started to awaken my senses after about 10 minutes of sipping.As time comes on, its effects become more powerful. It seems to settle me and awaken me a little at a time. Eventually it started to kick out some stagnation in my body which was delightful. As a flavor combination, I found it rather consolidating and grounding.

Xuan Fu Hua and Sheng Di Huang

Fire and Water

Salty and Bitter

The first thing that jumps out at me is the intensity of smell and flavor of Xuan Fu. The powerful nature of the Xuanfu Hua forced me to consolidate myself into a meditative state. It drew me into my heart’s warmth and asked that I shut my senses. Once inside, the qi moved along the most primal pathways in my body with ease and authority. Its not they were excited to do so, rather that when all else was withdrawn, this was what held its ground out of necessity.This take lot of stomach energy to digest. And so proceeded cautiously waiting for my energy in my stomach to return. In fact I hesitate to take another sip at this time.

Gui Zhi and Sheng Di Huang

Wood and Water

Pungent and Bitter

The three fire centers in my body, ming men, heart and third eye warmed immediately.The expansive nature of pungency is contained by the sinking nature of water and water is then bought to its bounds through the pungency. I feel like this is living water.

Xuan Fu Hua and Gui Zhi

Fire and Wood

Salty and Pungent

This is great! Its the first time Xuan Fu Hua hasn’t just shut me down. That coldness is spread through the rest of the body and has a warming and protective effect. Its still meditative but gently so. There’s an internal external balance here.

Gui Zhi and Wu Wei Zi

Wood and Metal

Pungent and Sour

There’s is something unbelievably beautiful about this combination! I found an area or stagnation in my right side started to pulsate and move. This was rather impressive how it was able to awaken and  circulate energy around my body.

Wu Wei Zi and Xuanfu Hua

Metal and Fire

Sour and Salty

This basically wants to run through my body rather quickly. Its like a brick in my digestion. Which seems to lay on top of the lower half of my digestion. I was careful not to ingest too much of this as i
t seemed to most potent combination yet. This is the closest to what was said in the Suwen regarding Sour and Bitter “gush forth Yin.”

Conclusions

There is definitely need for further investigation. I still have quite a bit of confusion with the Fire Calibration Herb of Xuanfu Hua and the Water Calibration Herb of Sheng Di Huang. However, when paired together, the classical Fire and Water reference didn’t fail to impress.

I was also astonished with the effects of Wood and Metal working together. This was powerfully circulating on a more surface level compared to the primal circulation of Fire and Water.

I would like to continue working with the Bitter and Salty Herbs according to Tang Ye Jing assignments and -see if I truly understand what they were trying to say with these.

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Appendix 1 – Further Combinations

Three Taste Combinations
Pungent + Sour + Sweet
Pungent + Sour + Bitter
Pungent + Sour + Salty
Sour + Sweet + Bitter
Sour + Sweet + Salty
Sweet + Bitter + Salty

Four Taste Combinations
Pungent + Sour + Sweet + Bitter
Pungent + Sour + Sweet + Salty
Sour + Sweet + Bitter + Salty

Five Taste Combinations
Pungent + Sour + Sweet + Bitter + Salty

Appendix 2 – Herbs Selected

Any notes on the selected herbs will be given here including Shen Nong Ben Cao entries and TCM assignments.  SNBCJ information is taken from the Blue Poppy Press translation of the text.

Ren Shen (Dang Shen) – Sweet Calibration Herb (Sweet of Sweet)

The Ren Shen mentioned in the Tang Ye Jing maybe, as Dr. Fruehauf suspects, actually Dang Shen. Here is his explanation as to why this may be true:

One of the two stellar constellations that are associated with the 4th month of the year is called “Shen”–the Three Stars (Orion), the original character for Renshen (Human Trinity: ginseng). In ancient China, every region of the sky was considered to be linked to a region of China, in this case the state of Wei. Wei includes the district of Shangdang, where China’s best Dangshen grows. Dangshen, therefore, represents the earthly Shen grown in Shangdang, the region on which the Heavenly Shen projects its qi. From a purely clinical perspective, any northern type of ginseng would have overpowered formulas such as Xiao Chaihu Tang or Banxia Xiexin Tang, where Chaihu/Banxia is supposed to be the lead herb.

For this reason, I selected Dang Shen to be the Sweet of Sweet Herb. Although this herb was not used this time, I wanted to share this information again.

There is no Shen Nong Ben Cao entry for Dang Shen however, the entry for Ren Shen, a Superior class Herb, is given below:

Ren Shen is sweet and a  little cold. It mainly supplements the five viscera. It quiets the essence spirit, settles the ethereal and corporeal souls, checks fright palpitations, eliminates evil qi brightens the eyes, opens the heart, and sharpens the wits. Protracted taking may make the bod light and prolong life. Its other name is Ren Xian (Human Incarnation). Yet another name is Gui Gai (Ghost Shield). It grows in mountains and valleys.

The TCM listing of Dang Shen is as follows:

• Category: Herbs that Tonify Qi
• Channels: LU, SP
• Properties: Sweet, Neutral
• Latin: Radix Codonopsitis Pilosulae
• Chinese: 党参

Wu Wei Zi – Sour Calibration Herb (Sour of Sour)

According to the Shen Nong Ben Cao, Wu Wei Zi is a Middle Class Herb. It goes on to state:

Wu Wei is sour and warm. It mainly boosts the qi, treating cough and counterflow qi ascent, taxation damage, and languor and emaciation. It supplements insufficiency, fortifies yin and boosts male’s essence. It grows in mountains and valleys.

The TCM listing of Wu Wei Zi is as follows:

• Category: Herbs that Astringe, Stabilize, Bind
• Channels:HT, KI, LU
• Properties: Sour, Warm
• Latin: Fructus Schisandrae Chinensis
• Chinese: 五味子

Gui Zhi – Pungent Calibration Herb (Pungent of Pungent)

According to the Shen Nong Ben Cao, Gui Zhi is a Superior Class Wood. It goes on to state:

Jun Gui is acrid and warm. It mainly treats hundreds of diseases, nurtures the essence spirit, and renders the facial complexion harmonious. It may serve as an usher or envoy for various medicinals Protracted taking may make the body light, prevent senility, and render the face bright and efflorescent, thus forever looking charming like a child’s face. It grows in the mountains and valleys of Jiao Zhi.

The TCM listing of Gui Zhi is as follows:

• Warm, Spicy Herb that Releases the Exterior
• Channels: HT, LU, BL
• Properties: Spicy, Sweet, Warm
• Latin: Ramulus Cinnamomi Cassiae
• Chinese: 桂枝

Xuanfu Hua – Fire Calibration Herb (Salty of Salty)

According to the Shen Nong Ben Cao, Xuanfu Hua is a Middle class Herb. It goes on to state:

Xuan Fu Hua is salty and warm. It mainly treats bound qi, rib-side fullness, and fight palpitations, removes water, eliminates cold and heat in the five viscera, supplements the enter, and down bears the qi. Its other name is Jin Fei Cao (Boiling Gold Weed). Another name is Sheng Zhan (Profound Clearness). It grows in rivers and valleys.

The TCM listing of Xuanfu Hua is as follows:

• Warm Herb that Transforms Phlegm-Cold
• Channels: LIV, LU, ST, SP
• Properties: Bitter, Spicy, Slightly Warm
• Latin: Inulae Flos
• Chinese: 旋覆花

(Sheng) Di Huang – Water Calibration Herb (Bitter of Bitter)

According to the Shen Nong Ben Cao, Di Huang is a Superior class Herb. It goes on to state:

Gan Di Huang is sweet and cold. It mainly treats broken [bones], severed sinews from falls, and damaged center. It expels blood impediment, replenishes the bone marrow, and promotes the growth of muscles and flesh. When used in decoctions, it eliminates cold and heat, accumulations and gatherings, and impediment. Using the uncooked is better. Protracted taking ma make the body light and prevent senility. Its other name is Di Sui (Earth Marrow). It grows in rivers and swamps.

The TCM listing of Sheng Di Huang is as follows:

• Category: Herbs that Cool the Blood
• Channels: HT, KI, LIV
• Properties: Sweet, Bitter, Cold
• Latin: Radix Rehmanniae Glutinosae
• Chinese: 地黄

Related posts:

1. An Exploration into Chinese herb flavor combinations – continued!
2. The qualities and uses of the Chinese herb Mahuang / 麻黃 / ephedra
3. Fuzi : exploration of the growing regions and conditions of aconite

I want to apologize for the formatting – I’m actually on vacation and have limited time to put this together.  Sometimes, copying and pasting from other programs (like Microsoft Word) can be pretty tricky.  Hopefully, it will still be readable.

I’ll also have another student project to share sometime soon.  It’s one student’s multi-disciplinary exploration of the energetics of Chaihu – I think you’ll find it to be very interesting.  Enjoy!

—

Purpose of Experiment

This experiment is a continuation of last term’s experiment in which I combined Chinese herb flavors to see if a particular effect arose. For example, did Sweet and Pungent create an inner sensation which I would call Yang Qi? Using the Tang Ye Jing herb flavor assignments, I would combine Ren Shen, the sweet archetypal herb, with Gui Zhi, the pungent archetypal herb, assess the inner experience and see if it converged on something I would consider Yang Qi. This proved to be true.

Table 1: Tang Ye Jing Primary and Secondary Flavors

I continued this Chinese herb paring for Sweet and Sour, whose outcome, according to my teachers, should be the creation of fluids. This too proved true.

I further investigated the other two pairing with Sweet, that being Bitter and Salty. I then attempted to create descriptive markers to note the inner experience after which I then attempted to attribute my best Chinese Medicine term to the experiences.

The flavor combination testing was preceded with a calibration effort in which I poetically described the effect of the archetypal herb flavors. This allowed me to then have an authentic experience of what was meant to be Sour or Pungent.

Furthermore, I then take the a combination of primary and secondary flavors and see if the single herb would also have the same effect as the combined archtypal herbs. Therefore, would the herb with a primary flavor of Sweet and secondary flavor of Pungent, Gan Cao, create Yang Qi? And would the herb with a primary flavor of Pungent and Secondary flavor of Sweet, Sheng Jiang, create  Yang Qi as well? This proved not to be true for this case and there was no convergence is experience between any combination o f archetypal herb flavors and single herb with matching primary and secondary flavors. As such, I decided to drop this portion of the experiment and only proceed with testing of archetypal herb flavor combinations.

Background Information

The Tang Ye Jing assigns organs to flavors differently than the NeiJing. The Tang Ye Jing assigns flavors based upon shared gesture. The NeiJing assigns flavors based upon contrary gestures. For example, the Lung has a natural gesture of contraction, that akin to Metal and Fall. Therefore then NeiJing would assign Pungent to the Lung because its gesture is dispersive. Therefore, it would counteract the over-contractive pathology of the Lung. However, the Tang Ye Jing would assign the flavor of Sour to the Lung because they share the same gesture.

Another way of describing this difference is what is referred to as Tǐ Yòng體用, translated as body and use. Tǐ shows bones next to a ritual vessel. Yòng shows either a target with an arrow through it or bronze ritual tripod vessel. The Tang Ye Jing assignments focus on Tǐ whereas the NeiJing assignments focus on Yòng.

Table 2: Flavors and Organs according to Tang Ye Jing and NeiJing SuWen

Unknown to me at the time of the conception of the experiment, a line in Chapter Five of the SuWen states:

酸苦涌泄為陰
Suān kǔ yǒng xiè wèi yīn
Sour and bitter gush and leak forth yin

Originally I hadn’t tasted this flavor combination, but this time it was on the docket. Knowing that results like this were possible, I proceeded with a little m
ore caution than when all the combinations had Sweet as a flavor.

Table 3: Two Flavor Combinations

In the future I would like to investigate triple, quadruple and all five flavors. A list in the appendix shows the possible combinations.

Methods and Design

The real question is if there was a convergence of experiences amongst herbs on a subjective level.  As mentioned previously, a primary baseline of subjective experience harmonized to the Tang Ye Jing flavors was done with the primary flavors from Table 2 above.

There was 6 oz of each herb decocted in 16 oz of water and gently boiled to a 8 oz reduction. They were ingested slowly savoring the experience. Each tasting lasted about 20 to 30 minutes for the full effect and about 10 minutes between tasting to clear the experience…

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During the next portion of this article – Mitesh will reveal the results of this, his latest experiment.  Look for it coming this week!

Related posts:

1. The qualities and uses of the Chinese herb Mahuang / 麻黃 / ephedra
2. Reawakening the faculty of touch in learning Chinese herbs
3. The relational method of learning Chinese herbs : herb families

The past two weeks we’ve been discussing timing as it pertains to acupuncture and herbology. Let’s now tackle momentum.

As you may recall, the quote we have been referencing from the Art of War is this:

“When a falcon strike breaks the body of its prey, it is because of timing. When torrential water tosses boulders, it is because of momentum.”

What Sun Zi is talking about here is the accomplishing of something difficult, moving mountains as it were. In Chinese medicine this can be compared to dealing with difficult and intractable cases, the likes of which unfortunately are rapidly increasing in number here in the U.S. These cases are often created by incorrect or ineffectual treatment of a condition that is made orders of magnitude more complicated by the failed treatment itself. Here I’m talking about things like disease suppression, medication side effects, and the results of surgery, all things that most of our patients will have experienced in spades before they ever walk through our doors as their “last hope”. Leaving aside for now the problems of what to attack and how (something I’ll cover at a later date), let’s now assume that we have intervened in some way and had some sort of positive effect on the patient. This is where momentum comes in.

Consecutive intervention

The process is almost always going to be the same for deciding on treatment: gather the symptoms, look at the whole picture, make a decision. The next time the patient comes in this decision-making process has to be repeated. Even if the decision is to continue the treatment from the previous session, you’re still having to make the call of “what do they need me to do right now?” The time-honored TCM school clinic technique of “I did these points last week and they feel better so I’m just gonna do them again” is just not going to fly unless a proper examination reveals that yes, that combination of points is appropriate here. This is the primary component of establishing momentum, doing the right thing at the right time, repeated.

Uprooting

Borrowing from the Chinese martial art Taijiquan: in Taijiquan, a primary goal is to “uproot” your opponent (meaning, remove their structural stability) so that you can basically do whatever you want with them. My teacher’s teacher once compared this to a job he used to work at a loading dock in a harbor in Taiwan moving giant barrels from ship to land and vice versa. By themselves, the barrels were absolutely impossible for even 2-3 people to move. Yet, if you uprooted it by tilting it up onto its edge a bit you could now sort of roll it by yourself to wherever you needed it to go.

Treating chronic disease is very much like this. Your first task is to make enough initial headway against the condition that now it starts responding to what you want to do, which I can tell you is not always the easiest thing in the world. However, once you finally achieve that uprooting, now you have to keep it uprooted so that you can keep pushing it where you want it to go, like the aforementioned barrels. Explaining what to do to achieve this would take its own series, and really is the sum of all other treatment knowledge you are able to bring to bear. So instead I will tell you what not to do, otherwise known as a group of pitfalls that will effectively kill whatever momentum you have built. Note that some of these pitfalls will be of your doing and some will be of your patients’ doing. It’s part of your job to make clear to them what needs to happen in order for the desired result to be achieved, meaning achieving health.

Pitfall #1-Failing to modify

Something that is abundantly clear in Western medicine that somehow we in Chinese medicine lose sight of is the idea of habituation. A short explanation of this phenomenon is this: when the exact same treatment-of any kind-is repeated enough, the body or the agents of disease will adapt to it making the treatment no longer effective. This can actually be viewed from a couple different viewpoints. One is that the patient is rarely in the exact same situation two visits in a row (“you can never step in the same river twice”), especially where acupuncture is concerned. Another is that if you are dealing with an intelligent pathogenic agent (virus, bacteria, spirochete, etc.) if you continually show it the same attack it will eventually adapt, making the attack ineffective. Think MRSA.

This is fairly easy to deal with in acupuncture, as you can throw in subtle variations to the treatment that meet the patient exactly where they are at that moment in very specific detail. With herbs it’s more difficult as in these types of cases you’ll need the same formula for months at a time. The key to this then is having a good enough grasp of your root formulas and also of the nature of your individual herbs so that you can switch in and out appropriate substitutions that still get you where you want to go. Now obviously, no two herbs are a perfect trade for each other as even different parts of the same plant behave very differently and have very different properties. In the context of a carefully modified formula, however, the structure that is not changed will help keep what has been changed moving in the right direction.

This concept is most vitally important for cases where there is an organism on the other end that is being dealt with as part of the process (like Lyme Disease for instance), but this also holds true for other deep diseases, though you may not need to rotate as often. In a fast-reacting case (like Lyme) I generally look to rotate ingredients every three weeks or so. I usually look to rotate major (and powerful) components of the base formula I’m using that I’m confident I can get a good trade for. So if the base formula is Gui Zhi Tang, I would have the option to rotate just about any ingredient in the formula. Rou Gui for Gui Zhi, Gan Jiang or Pao Jiang for Sheng Jiang, Chi Shao for Bai Shao, Gan Cao for Zhi Gan Cao. In this particular case I would probably only rotate two ingredients (unless I had a very good reason for doing otherwise-always a caveat!) and try to stick to the soul of the formula by changing Gui Zhi less frequently than the other ingredients. Obviously this applies to any formula that you could use long-term. Note that in some cases (and with some patients) you’ll need to rotate more frequently or more creatively, with other cases you can get away with longer waits. Your mileage will vary.

If you fall into the pitfall of failing to modify you will certainly see the case stall out, which can mean not only a simply stalling of progress but can frequently be the first step into a quick regression depending on what else is going on in the patient’s life. You want to avoid this at all costs.

Next w
eek we’ll discuss the pitfalls of Treating Erratically and Too Many Doctors Spoil the Case.

Related posts:

1. Strategy in Chinese Medicine: Timing and Momentum, pt. 1
2. Strategy in Chinese Medicine: Timing and Momentum, pt. 2

Note:  This is the first of a series of posts that will be released every 1-3 days.  The majority is archived content that many of you may not have caught the first time round.  This will rebuild our blog archive after the big website update so that much of the old information will be available to new readers.  Enjoy.

As Chinese medicine students at NCNM, we are grounded in Chinese symbolism and cosmology before anything else.  It is the first, mind-blowing, introduction we get to the medicine we must attempt to master.  Because of the research interests of the school’s founder, Heiner Fruehauf, we chiefly use the organ clock as a way to organize our thinking about these symbols.  Along with the many other layers of symbolism we learn (Yin/yang, the five elements and so on) an incredibly rich, clinically valuable, picture of the human body arises.

The Lung organ system

Most of us know the Lung as being the “upper source of Qi,” the source of attack for many external invasions, and the “sensitive organ” easily perturbed by cold, heat and various toxins (environmental and otherwise).

Lung is Taiyin, the first of the Yin layers of the body – paired with the oft-assaulted Spleen.  The two together are responsible for the majority of our “taking in” of nourishment from the world.  With the Yangming organs of Stomach and Large Intestine, they make up the rhythm of the body.  Breathing in, eating regularly, having regular bowel habits and distributing the energy to the four corners of the body.

What does Hexagram 11′s name mean?

Hexagram 11, Tai 泰 – sometimes translated as Pervading (Karcher) – is the tidal hexagram (十二消息卦) associated with the Lung organ system due to its assignment to the first month of the Chinese year, around the Gregorian calendar’s February. 

The name Tai  泰 anciently looked like two hands with water flowing in between them and so recalls the benevolent flow of water/nourishment coming down from above – an apt description for the Lung.  The name lives in an etymological word field with 太 and 大 and so is associated with bigness, greatness – recalling the Prime Minister, the elevated position of the Lung.  Other English words that can be associated with Tai are peace, harmony, flow and balance.

What else can we learn about Hexagram 11?

Hexagram 11 talks about the great sacrifice on Mount Tai that only the great Kings could make.  They received the benefit of heaven which was then dispensed to the people.  It is the balancing of the forces of Heaven and Earth, the optimal arrangement of Yin and Yang (Yang below where it should be, physiologically, for human beings and Yin being above).

What does Hexagram 11 tell us about the Lung?

Well, I’ve already mentioned several things.  It does reinforce some of what we already know about the Lung.  It is above, it dispenses the blessings of Heaven down to the entire body.  It is a very important organ system, Great, the Prime Minister.  It likes or strives for balance – and thus may be very sensitive to imbalance.  It lives at the intersection of Heaven and Earth, taking in the air we breath in from Above and introducing it into the Earthly body.

Like you, I’m interested in the information above – it’s fascinating, it gives us another layer of interpretation about something we thought we knew.  But, there’s nothing really earth shattering in that information.  That’s fine, but I believe these symbols have layer upon layer of meaning – revealing themselves through introspection, clinical experience, and the simple passage of time.

I decided to sit with Hexagram 11 for a little while and derive what else I could from it.  Here’s where I veer a little bit, folks, hang on.

The contrasting hexagram for Tai is Pi, hexagram 12 – the tidal hexagram for the BL, clock pair to Lung.  Its name is often translated as Obstruction.  It is the Tai hexagram reversed – the reversed relationship of Yin and Yang.  For human beings, at least, not an optimal relationship.  It recalls, of course, Pi disorder where there is a blockage at the epigastrium.

In the text for hexagram 12, we are told (again from Karcher, linked above), “What is important is departing, along with your ability to realize your plans.  The time that is coming is small and mean.”  This is in great contrast to hexagram 11, where we learn, “What is unimportant is departing, along with the necessity to be small and adapt to whatever crosses your path.”

What can this mean for the Lung?

In my experience, the worst thing you can do when treating someone who has a dysfunction in the Lung organ system is obsess over the little details.  The Lung is one of the most powerful organ systems in the body, second only to the Heart, the Emperor.  It knows how to do the right thing, and it will do so, given the appropriate reminder.  You do not need to hammer it, pester it, or overwork it.  You do not need to introduce a hundred herbs for clearing this and that kind of phlegm.  You need only help reestablish the normal downward motion, and the flow returns.

For me, this has great consequence in the cleanup phase of a common cold.  Many patients end up with some phlegm in the Lung – sometimes with a cough, sometimes not.  I have always had the greatest impact when I do something very simple – adding downward drawing Xingren to a formula, for instance, or relying on the powerful downward energy of Sheng/unprocessed Banxia pinella (available through Classical Pearls).  I have also had great success using the very simple classical modification of Wuweizi + Ganjiang.  The former is the metal herb of the metal class in the Tangye Jing – thus giving a powerful reminder to the Lung of what “metal” really means.

These are, of course, just some simple and preliminary observations about this single hexagram and its relationship to a single organ system – what a wealth of information out there for us to dive into!  I’d love to hear from folks who may have a different interpretation of Tai, or who can add their wisdom to the conversation.  Feel free to comment below this post – or join us on Facebook to interact.

Last week we began by exploring the concept of timing in acupuncture. This week we’ll move on to herbs.

Timing in Herbology

Timing is equally important in herbology, as knowing where in the system the disease currently is will dictate what formula you prescribe and what modifications have to be made (I discuss this in an upcoming free PDF entitled “Beginners Guide to Acute Respiratory Disease”).

For this, the Six Conformation model used by Zhang Zhongjing (called the Six Channel Model in TCM) is without question the most powerful tool we have at our disposal, telling us where the disharmony is, what its nature is, and what principles are required to fix it.  This applies in acute as well as chronic cases. For example – If the problem is diagnosed as a Cold invasion of the channels of Taiyang we know several things at once:

1. We know that since the invasion has penetrated into the channel that the surface is open, which removes the need for the pure surface opening action of Ma Huang Tang.
2. We know that Taiyang is a Yang conformation. Therefore, our efforts are going to be centered on expelling the Cold pathogen and that if resolved correctly there won’t be any long term consequences of the invasion having taken place (as opposed to an invasion of the Yin conformations which tends to leave the need for a significant cleanup operation after being resolved).
3. We know that according to the Five Phase (or Five Element) model Taiyang is associated with Cold Water of the North. Taiyang invasions tend to be accompanied by all over muscular aches of varying degrees (depending on the situation). If we envision the Taiyang channels (UB/SI) as being rivers of cold water coming down from the mountains to nourish the plains (read about Mt. Kailash for the ultimate example of this) we can see that when those rivers get more cold, they freeze over and stop flowing. The Chinese characters for pain 疼痛 (teng tong) indicate a state of cold and of obstruction of movement, much like the frozen river analogy. This tells us that we need to “melt the ice” by warming up the channels and re-establishing uninterrupted flow.

The formula that answers all of these requirements is Gui Zhi Tang. If given on time (meaning before the pathogen passes on to, say, the Shaoyang level) the patient will recover quickly. Aside from the diagnostic timing, however, the Shang Han Lun tells us about another necessary element of timing.  An all important feature of timing and momentum in Chinese herbalism is the method and length of time to apply treatment.

The text that introduces Gui Zhi Tang makes very clear that the formula must be prescribed under very specific conditions. One of them is the instruction to give the decoction to the patient warm, then have them bundle up to await sweating. However it also makes very clear that once the patient sweats the formula must be stopped immediately.

The danger here (one that I have seen happen many times and have even experienced personally) is that the patient over-sweats and suffers damage to their Yang Qi, thus creating a different or more complex condition that now has to be treated.  In a Gui Zhi Tang type situation, over-sweating can lead to a combined Taiyang-Shaoyin condition of external invasion with underlying Yang deficiency (needing a formula such as Gui Zhi Jia Fu Zi Tang).

Strength and Focus

The other side of this is the question of strength and focus. A principle that Heiner Fruehauf often points out is that you must have not only the right formula with the right herbs, but also of sufficient quality and enough of them.

A practice of a lot of TCM-trained herbalists (including those from China and even those who have been in practice since the early days of the PRC) is one of adjusting downward individual herb dosages in formulas for the purposes of safety or according to someones weight. This is especially true for Shang Han Lun formulas, which seem overly aggressive in comparison with modern “gentle” formulas.

TCM herbalists will take a formula like the aforementioned Gui Zhi Tang and begin stripping it of its curative power by ratcheting downward the dosages of the warming herbs Gui Zhi and Sheng Jiang by as much as half, then playing around with the amounts of Da Zao, Bai Shao, and Zhi Gan Cao according to some paradigm known only to themselves. The result is the equivalent of cooking a complex dish in the kitchen while randomly choosing ingredient amounts and never tasting the results. This results in a grossly ineffective formula (I’ll save a critique of the practice of ingredient carpet-bombing for another time).

Native Dosage

An absolute fact in Chinese herbology is that each herb we use behaves differently in both different dosages and different ratios within each formula. Each herb also has what I think of as a “native dosage”, meaning the amount that you are most likely to see it prescribed at effectively. For example, Gui Zhi at 9g, Chai Hu at 24g, Ban Xia at 12g, etc. Going away from these amounts (without very good reason) usually translates into outright failure in my experience. If you need Gui Zhi Tang, you also need Gui Zhi at 9g. If you need Xiao Chai Hu Tang, you need Chai Hu at 24g. Going away from this is a good way to not be successful vs. the condition you are treating.

When you change the dosage of herbs you change the functional emphasis of that herb within its formula. The best example of this principle in my opinion is with Fu Zi. Fu Zi in most TCM clinics-if used at all-is used at a very low dosage, usually in the range of 3-6g. The fear is that because Fu Zi is so “toxic” that more than a small amount will give the patient headaches, nosebleeds, hot flashes, etc.

Paradoxically, Fu Zi in this small amount causes its energy to rush outward to the exterior and to the head, causing the very situation that they were trying to avoid in the first place. However, once the dosage crosses a certain line (around 18g in my experience) its entire behavior changes. Now instead of warming the Yang and sending it rushing outward and upward, it grabs the Yang qi of the body and causes it to descend into storage (the lower Dantian in Qigong parlance) where it is now able to recharge. Rather than feeling hyperactive, patients on the receiving end of recharge formulas like Qian Yang Dan (in which I usually use 30g of Fu Zi) have the overwhelming urge to go to sleep, which is exactly the aim of the formula.

Ratio

Finally, one must account for the ratios of herbs in formulas. In the Shang Han
Lun there is an army of formulas that are essentially Gui Zhi Tang with one ingredient changed in some way. This small shift significantly changes the impact of the formula.

For example, if in the case of Gui Zhi Tang you increase Gui Zhi to 15g you now have the formula Gui Zhi Jia Gui Tang.  Now, instead of treating a case of the common cold, the formula treats the anxiety disorder known as Running Piglet Syndrome. The increased Gui Zhi stokes the Fire of the Heart.  The Heart, in turn, is now able to descend and overcome the amassed cold in the Lower Jiao.  This amassed cold was what the patient’s Yang qi was counterflowing away from -  causing the Running Piglet sensation.  Problem solved.

Another example starting with Gui Zhi Tang.   If we remove Bai Shao altogether we get the formula Gui Zhi Qu Shao Yao Tang, which treats conditions of fullness in the chest and skipping pulse.  These symptoms  point toward Upper Jiao blockage as well as deficiency of the Heart itself. Removal of sour flavored Bai Shao also removes the formulas restraints on the Wood energy of the body (due to Bai Shao’s affinity with Metal and Metal’s husband-wife relationship with Wood).  Wood is now more  able to feed the Fire energy (due to Mother-Son relationship) and release the body’s Earth energy (again, husband-wife relationship) which makes up half the Middle Jiao!

Formula Strength

There is also the question of amount of herbs taken. Zhang Zhong Jing was very clear on the necessary amounts to be taken for all of the formulas in his book, as well as specific preparation instructions. A close inspection of the Shang Han Lun’s preparatory methods reveals formulas that are orders of magnitude more concentrated than their modern descendants, using significantly less water both at the start of decocting as well as the final dose.

In both individual herb dosages as well as the total amount to be taken, these formulas were very much built upon the idea of the right intervention at the right time and in concentrated strength. It’s no good to just try and push a boulder any old way in hopes that it will move. You have to push at the right spot (the fulcrum) and use sufficient force  in order to accomplish the task.

The point here is that as herbalists we absolutely must know what our herbs do inside and out, right down to the effects of differing amounts. This will prevent the useless (and potentially dangerous in the hands of the over-enthusiastic) practice of trying to assign random amounts and percentages to our formula components.

Next week we’ll begin tackling the issue of momentum.

Related posts:

1. Strategy in Chinese Medicine: Timing and Momentum, pt. 1

“When a falcon strike breaks the body of its prey, it is because of timing. When torrential water tosses boulders, it is because of momentum.”

Timing

In the current culture of TCM, the evidence-based protocol is king. A hypothetical example: “On 6-14/09 Patient K. was diagnosed with asthma. UB-13, UB-23, Ding Chuan, and Lu-9 were needled with reinforcing method for 30 minutes. Treatment was repeated daily for 7 days. Upon re-evaluation patient’s spirometer performance increased 15%. Therefore, this protocol is useful in treating asthma. ” This is how case studies are presented to us in our primary textbooks. This is also the primary research method in Chinese TCM hospitals presently, thus making it the perceived superior method of research and treatment amongst the standardized professional Chinese medicine community in the West.

However, this method has an ocean of problems, chiefly that it doesn’t work very well when replicated in clinic. Leaving alone for now the problem of misunderstanding what particular points/methods/herbs/formulas really do, it also neglects the necessity of meeting the patient exactly where they are at that very moment. This is what I mean by timing.

No matter how effective a formula or protocol has been in the past, if applied to the wrong situation it will not only not be effective, it may actually make the situation worse.

The importance of accurate diagnosis cannot be overstated. As a clinician, it’s the heart of your job to figure exactly what is going on with the patient in front of you at that moment, work out specifically what needs to be done, and apply it correctly. It’s no good giving a patient Gui Zhi Tang because they have a “Wind-Cold Invasion” when in fact the disease has moved on to a deeper level and the patient now needs Xiao Chai Hu Tang. You may have been needling St-36 and Sp-3 for the past three visits and seeing improvement in the patient’s digestive condition, but continuing to needle it would be a huge mistake if this week they’re having back spasms and can’t walk.

Timing in Acupuncture

The image of a falcon crashing into its prey from a steep dive at a hundred miles per hour is an accurate description of how effective doing the exact right thing at the exact right time is. However if we imagine the situation from the reverse angle, we can imagine the falcon arriving at the wrong time and completely missing its intended target. As the Lingshu says: “At the moment the energy arrives, [the physician] does not stray even by a hair; and if he is unaware of it, no results are produced. Therefore it is necessary to discern the arriving and departing movements of energy in order to intervene in time. The mediocre physician ignores this rule; the skilled physician respects it.”

This is a good time to clear up a common misconception among acupuncturists about this “arrival of energy”, usually referred to as De Qi. The commonly held belief is that De Qi is when the patient experiences a jolt or shocking sensation. This is held to be the sign that things are working and that now the patient should be left to relax with needles in for twenty minutes or so in order to allow the Ying Qi to make a full circuit through the body.

What the text is actually referring to when it talks about the arrival of Qi is the moment of regulation, the specific and clearly perceivable moment when the channel imbalance has been corrected. The higher level of perceiving this moment of regulation relies upon the acupuncturists ability to experience the unseen energy of the patient, a subject I don’t feel currently qualified to address. However the lower method (one that can be used by everyone fairly easily) is to monitor the state of channel balance via the Renying-Cunkuo pulse method where the very moment of balance can be felt by comparing the strength of the pulse at Renying St-9 and Cunkuo Lu-9 while needling the affected channels.  The timing for this is so delicate and vital that the Lingshu says: “When needling, if the energy does not arrive, the number of needles is insignificant. If the energy arrives, stop needling.”

This timing is important not only for good results, but also for avoiding bad ones. You can imagine the falcon missing its target so badly that it crashes into the ground face-first. This is a very real possibility in everything we do. Contrary to popular belief, the Lingshu makes very clear many times throughout its text that the patient can be significantly harmed by incorrect acupuncture technique. To wit:

“Needling presents two risks:

1. Not removing the needle once it has reached the affected zone, which may cause the loss of Jing
2. Removing the needle as soon as it reaches the affected zone, which may cause the Xie Qi to return.

The loss of Jing exacerbates the illness with nervous exhaustion, and the return of Xie Qi is the origin of abscesses and ulcerations.”

Our primary concerns for harming the patient in our schooling are things like puncturing the pleura, the peritoneum, or an organ. However, the Lingshu rarely talks about physical damage due to incorrect needling and instead frequently cites examples of energetically-caused damage from doing the wrong thing at the wrong time, including different forms of insanity and even death. Clearly, the acupuncture needle is a powerful tool, one that must be treated with the same respect as a sharp knife or sword.

My point here isn’t to scare people, but rather to insist that if we are going to use any tool in the pursuit of altering the health of  another person for a fee it’s our responsibility to be very very good at what we do and to not mistakenly believe that we can get away with following a protocol cookbook. Our practice of a natural and holistic medicine in no way lessens our responsibility to practice safely and effectively to the utmost of our abilities and the ability of our medicine. Acupuncture is capable of a lot, and the Neijing repeatedly talks about it in the context of treating very serious illness. However, it only works when you do it correctly.

Next week in this column we’ll discuss timing in herbology. If you want to talk more, please leave a comment or drop by the Deepest Health Community Forum.

See you Wednesday.