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Business planning, flow, currents &; acupuncture business vision

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In the last five months, I’ve had a lot of time to contemplate the reality of currents

We recently moved to a coastal Oregon community, with a home situated on the West facing slope of a hill with an unobstructed view of the Columbia River and Pacific Ocean. So, pretty much everything has started to look like a current! From my perch, I can see leaves floating through the air in uncommonly predictable patterns, dirt flowing along the asphalt propelled by the wind, traffic flowing from the highway to the bridge, flocks of pelicans and Canadian geese flowing along in a current of their own.

I have been seeing how the lessons and energies of currents play out in my everyday life. What can I learn from the free-flowing aesthetics of the currents all around me?

The lessons have been numerous, of course, but I’d like to talk about just one now. The lesson is simple : going with the flow is natural – and easy. Daoism, of course, has plenty to say about the benefit of moving to the lowest place, like water does, and emphasizes the critical importance of that flow state. In Daoism, being aware of and flowing with the current is highly desirable – the very foundation of health and spiritual centering.

Further, in Chinese medicine, we often say that the interruption of flow (blockage) creates pain!

Nì 逆 , or counterflow, is referenced in many other ways in our medicine – but this “going against the flow” always represents some difficult situation in the body – something to be avoided or treated. The currents are interrupted – and it is the duty of medicine to correct the situation. Again, we see evidence for the idea that to go with the current, with the flow, is powerful.

If we extend this idea a bit further, to consider society and individual human lives, we get another perspective. Even in human life, going with the flow is typically the easiest thing, productive of the least amount of pain. As opportunities arise, you take advantage of them. You follow the basic path that is set out for a person with your particular set of characteristics. You optimize within the context of what is currently flowing, but do your best to avoid disturbing the current – particularly so long as everything feels good.

And yet, we can start to see potential benefits in counterflow

Despite this reality, nearly everyone encounters a time when they must say, “No,” to the current that exists and forcibly join or create another. Going along, for whatever reason, becomes untenable or at least undesirable. It’s easy to see this principle at work in the case of social activism on behalf of disenfranchised groups of people in society. In this case, a person or group of people sees some injustice at work in the current social flow, and moves to interrupt it. This usually involves a great deal of upheaval, discomfort and difficulty, and can even result in provoking violence as the original flow tries desperately to assert itself.

We can also see this resistance at work in individual lives of course. People making the decision to leave primary relationships for their own growth or development, or to escape some damaging situation is an example. Switching careers relatively late in life, getting another degree when one already has an established job, spending weekends writing a novel – once you start thinking about it you can think of lots of examples where people have gone against the prevailing current of their lives and created positive change as a result.

The move I mentioned at the beginning of this article is a perfect example of what I’m referencing here. I fled the sexy city of Portland for a small, mostly off-the-radar coastal community. I reduced my formal academic teaching requirements to free up more time for balanced living.

Moving here required that I break with the prevailing current of my life

I could have ridden the wave of academic ascendance, becoming a deep part of the historic restructuring of my alma mater. I could have continued to grow my practice just where and how it is, the gradual accretion process of building and maintaining a reputation for excellence. I could have continued to have my online work be a hobby, something to do on my free time. I could have remained in the exciting, growing city of Portland. In fact, it felt NATURAL and EASY to do so.

But, instead, I chose to look closely at the trajectory of the flow of my life.

I compared that trajectory against the energy and intent of my vision, and recognized the need for a change. I realized I would have to force a radical reorientation of my life towards that which will fulfill me, make me a better practitioner, a better business owner, a better person. I had to turn away from what was easy (the flow), what was sexy (Portland, yes, still), and even what was comfortable (friends, communities, patterns of action) to embrace what was calling me.

The change has not always been rosy, of course. Counterflow, even when needed, does seem to provoke some kind of discomfort. But, overall, the move has been remarkable. Without getting into it too much here, I’d say it’s one of the top five most significant decisions in my life. Doors have opened inside and out that I didn’t expect. Rough edges are being smoothed away by the relentless action of the wind and water. Habits developed to resist the damaging effects of the previous flow are melting away. And business is better than ever – despite the fact that I now live two hours from my clinic.

This process was made possible by the fact that I engage in visioning on a regular basis

I take very seriously, and teach my students to take very seriously, the importance of articulating, and utilizing, a WRITTEN vision for life and work. Without a clear vision, I tend to end up in places I don’t intend, and don’t prefer. A strong vision helps me avoid that. With a vision ready at hand, I’m able to make spontaneous choices in the moment that are in deep alignment with my larger goals. With the power of a vision behind me, my actions are more sure, my confidence is high, and each action I take contributes to the development of the new flow I am creating in my life.

Vision as I discuss it is complex and multi-valent. It’s not as easy as just writing down what you want, or describing some ideal acupuncture clinic that will exist when you reach your goals. A vision, in fact, isn’t “goals” at all. A vision isn’t a tasteless, corporate-speak paragraph hanging on the conference room wall. A vision is a window into the world you are creating for yourself and those close to you through your business.

The foundation of everything good I do at my clinic is built on my vision, but it does not stop there

There is a lot more to the process of planning the operations of a busy acupuncture clinic than simply establishing a vision. You must operationalize that vision by developing it into a robust mission. You must come to understand the values and principles that serve as the moral fiber of your business. You must think about the ways in which your own personality, your background, and the prevailing situation in the acupuncture profession impact the kind of business you can create, and so on…

It’s a process! Fortunately, it’s an understandable and teachable process. And by learning and implementing it, you will be well on your way to establishing the kind of flow that you’ve dreamed of ever since you started thinking of running a Chinese medicine practice of your own.

 

Necessity is the mother of learning acupuncture points

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One of the things I have noticed in my scant 20 or so weeks of hands-on clinical practice is the great difficulty of accurately locating acupuncture points.  At times the body seems an intolerably huge landscape – full of unfamiliar landmarks and confounding convolutions.  Yes, at other times the complications diminish and it seems as easy as anything.  I find the latter times become more frequent as I go along.

Along with a general increase in my confidence and ability comes a deep interest in REALLY learning the points and channels.  Before clinic, acupuncture very obviously played second fiddle in my hierarchy of my interests in Chinese medicine.  I have always recognized its power, but simply didn’t feel drawn to study or understand it that much.

Now, with my struggles in clinic, I find myself fascinated by each point and driven to learn more on multiple levels.  I am also developing my non-intellectual skills, my ability to feel Qi, to palpate channels and to connect with the patient.  I note this because most often when I relate my problems I have people telling me that I need to get out of my head and just “connect” with the energy of the patient.  While I recognize the importance of that, it certainly isn’t the whole answer.

My methods

Before I talk about how I’ve been working with the points, I’d like to make one small note.  I’ve divulged various study methods and tips before on Chinese Medicine Central.  With the exception of a few suggestions, these have all been methods I’ve used.  However, they were methods that I learned directly from others or developed after reading ideas in a book or on a blog.  This is a great way to pick up new strategies, and I certainly will continue to use it.  On the other hand, the methods I list below are different.  They emerged organically to solve particular problems.

In other words, in response to a particular experience, I desired some particular skill or understanding and worked out the best way to obtain it on my own. Ad hoc.

This may seem to be a minor point, and I don’t want to hammer away at it.  However, it definitely feels different.  I feel more committed to consistently using these methods, and they seem to be more effective.  Each new thing I learn inflames my desire to learn even more.  A similar thing is happening to me regarding formulas, but the effect isn’t so dramatic since I’ve always been interested in understanding them.  I expect clinical practice will create some new developments in that arena, however.

In essence, what I’ve been doing is simply making a list of all the points I use in a given week and then reviewing them in great detail.  This is the bulk of my “method.”  It has several parts, which I will describe in detail below.  However, there are more subtle things that I’ve been doing in the treatment room.  I don’t know if I’m quite ready to describe those pieces of the puzzle.

One recent development was the return of very focused attention on sensing the layers of the body that the needle is passing through.  This is something we learned in our first needling class, as one of our points Professors places a high importance on needling and manipulation in the various layers.  I think being in clinic and having to manage so many things at once found me being a little neglectful in this realm – I’m glad I’ve remembered it now.

Anatomy : Descriptions, 2D, 3D, palpation and multiple sources

I’ve never been particularly interested in gross anatomy.  In fact, this new revolution in my thinking has helped me to understand that I have an odd detachment from the physical nature of the body in general.  Working with the anatomy has helped unravel that personal issue, yet another example of the many benefits of dedication to study.

Anyway, we did take anatomy during our first year, but given my general reluctance described already and the fact that I was so enthralled with learning the cosmology and symbolism of Chinese medicine, I frankly didn’t pay much attention.  I’ve used various sources to help deepen my understanding of anatomy.

Descriptions:  Sometimes a word is worth a thousand pictures.  While seeing what things look like on the body is very important, often it has been a stray description of a particular bony landmark in relation to a point that has really solidified its location for me.  I use Deadman as a primary source here.

2-D:  Again, Deadman’s Manual of Acupuncture has lovely drawings – including the ones at the back of the book that show points by region of the body.  I also use some simple illustrations by Worsley’s group, my Living Meridian Location Charts and some compilations of Chinese sources put together by NUNM Professor Jim Cleaver.  Jim has also provided some schematic representations of body areas so its easy to get a feeling for the cun relationships among channels on the same part of the body.  I just leaf through these sources at random seeking to really understand where the point is, in general, located.

3-D: I have an old version of Qpuncture that has 3D renditions of a needle in various commonly used acupuncture points.  While some of the anatomical accuracy has been sacrificed, it is very helpful to see how the needle penetrates with reference to the anatomical markers we cannot see with the eye.  I also subject my partner and daughter to infrequent channel palpation and point location (“Is this sensitive?  What about this?  This?”) which is often very helpful.  Of course, while I’m studying the above sources, I palpate my own channels and feel the points on myself.

“Actions”, prescriptions and theory

The point location has been most bothersome for me, mostly because I’m obsessed with being sure that every needle has a real effect.  That may seem to be a stupid statement.  However, I’ve been needled by many interns and practitioners who don’t seem too interested in actually working with the POINTS – content just to needle anywhere on the body.

I gather this from my perception of their lack of intention when needling, the obvious lack of accuracy based on where the needles end up as well as my conversations with them.  I do believe that the “points” as they were laid out in ancient times are very special places on the human body that have powerful effects on the human being – I don’t think that “just anywhere” will do.

Despite my obsession with fully knowing where the points are, I haven’t lost sight of the importance of understanding “what they do.”  I put “what they do” and “actions” in quotations for a reason.  Acupuncture points are not like buttons on a machine.  It’s not as if you press the red one and you get a cherry candy, blue one and you get a razzleberry one.

It’s not as if some little ghost in the machine stands behind the point ready to report your instructions via the CNS with exactness and machine-like one-to-one correspondence.  If a person asks me for “a point for asthma,” I’m reluctant to report the points we all know to be commonly used in prescriptions for that Western defined condition.  It isn’t that points don’t “do something” and it isn’t that I’m afraid to talk about certain points as unequivocally treating some particular pathological state, it’s just that the way we try to simplify things for easy consumption result in overly simplistic ideas about how Chinese medicine works.

I think about acupuncture points like areas where one can access a river. They come in big and large sizes, they have varying ranges of ease of access, some put you in at a furious current, others at gentle pools.  The direction you’re heading when you put in at any given point makes a difference, as does your intention when you do so – will you paddle upstream or let the current carry you down?  Are you fighting the flow or not?  Are you dredging the channel a bit to allow greater flow in a given area?  Are you moving boulders that have obstructed your path?

The river metaphor breaks down a bit when we drill down a little more.  Each point has its particular characteristics based on its location on the channel, its symbolic power given the part of the body and its physical features as well as a whole range of correspondences that fit the channels and points and the human being in with the consistent patterning of the universe.  Thus five elements, yin-yang, six divisions and all their permutations and combinations are peppered throughout the system in remarkably predictable and usable ways.

When we needle a patient, we are not pushing buttons, but mixing colors and flavors, textures and spirits in alchemically beautiful ways with the purpose of influencing the body in particular ways for the creation of health.

All that being said, I’m not just going to abandon myself to studying nature and meditating as a way to understand what KINDS of mixtures are effective in what kinds of situations.  I’m not comfortable with that, frankly.  Instead, I look to the classics and the theories passed down by the ancients. I use Deadman and some sources given to me by my teachers to understand the Classical point prescriptions.  I study closely the theory of the five elements and six conformations as well as point categories to fully comprehend the effect of a given point within a particular clinical context.

All of this is really helping my clinical confidence a great deal and I find that more often than not I am able to recall most of this information when I next encounter a particular point.  Sweet!  I’ve talked enough about this for now, but I would like to pose a couple of questions.  Have you encountered the kinds of troubles I started out this article by describing?  If so, how did you get past it?  Do any of the methods or ideas above resonate with you?  If so, how?  If not, why not?  I’d really like to hear about others’ experiences.  Reply in the comments!

 

How the Chinese organ clock yields a more nuanced view of the Heart

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chinese_medicine_heartHere I will present a basic overview of TCM information concerning the Heart and then add a layer of information gleaned from the Organ clock (a more CCM way of looking at things).  I want to do this to demonstrate how the Classical approach yields a more nuanced view than the straight organ-based TCM approach does, including a small aspect of the clinical relevance of this approach.

Disclaimer : This article was written in 2008, when I was still a student!

The Heart is a central organ system.

From the perspective of governmental metaphor, the Heart is most easily compared to the Ruler of feudal society. What does the ruler do? It’s tempting to simply say that he rules and leave it at that. However, most rulers through history have acted less as hands-on managers of their empires and acted more as figureheads – acting as moral compasses, inspiring and motivating the people when needed, acting as interpreters of Divine law and generally providing a center point around which the wheel of government turned.

The Heart is said to provide a similar function for the human body. To look at this and say that the Heart is “most important” would be erroneous. The Emperor without his ministers, without the workers, without the land – is nothing. It is an interdependent system.  But, still, the Emperor is crucial and a lot of attention should be paid to those things that are crucial.  We’ll do so now.

In Chinese medicine, the Heart is said to have many functions/associations:

  • The Heart contains the Shen, which rules the other “spirits” of the Zang organs
    • Shen, as I have explained briefly elsewhere, can be translated as “Spirit” but it contains more meaning than the normal English concept of Spirit. Many contemporary commentators talk about Shen simply as consciousness, but I feel it is more than that.
  • The Heart governs the Blood Vessels
  • The Heart acts as Ruler of the other organ systems
  • The Heart, as related to the brain and consciousness, is in charge of many mental processes (one can see this as similar to the Heart’s function via its relationship to Shen – the fire of consciousness)
  • The Heart propels the Blood
  • The Heart governs speech
  • There are other attributes, but these are the main ones mentioned in a variety of texts.

In truth, despite all of these things, most Heart related pathologies diagnosed in TCM have to do with mental function or, sometimes, heart organ abnormalities (such as blood stasis in the Heart yielding angina).  In clinic, I mostly see Heart Qi/Blood deficiency (with palpitations and poor memory) and some version of the confusingly named “Heart Fire” resulting in insomnia, anxiety and some type of vexation.

Rarely do I see doctors diagnosing a problem with the heart when there are circulation problems (blood vessels) or speech problems.  Further, I think that there should be more attention paid to the fact that, as EMPEROR of the other organ systems, the Heart may be a great place to look when a seemingly unrelated pathology is difficult to cure with the methods we would normally utilize.  While I will not focus much on blood vessel or speech problems in this article – I would like to do so in the future.

For now, to help us understand the Heart a little more deeply, I offer a brief exposition of some of the basic symbols associated with the Heart on the Chinese medicine organ clock.  I will then describe some ways we can use this understanding to expand on the basic information we learn from TCM literature.

What do we learn about the Heart organ system from the organ clock?

Temporal nature : 11-1pm (High Noon) and the Summer Solstice

At first glance, the pairing of the Heart with high noon makes intuitive sense.  This is the time we associate with the zenith of the sun, the burning off of morning fogs, the time when all things are apparent, illuminated, complete.  But look again at the symbol for the taiji and superimpose this over the organ clock.  Remember these symbol fields are multi-layered and taiji_yin_yangwhile some aren’t meant to be compared one-to-one, the flow of Yin and Yang through the organ clock (and through the days on Earth) is a crucial piece of information in our understanding of organ systems.

This is the time of the birth of the Yin.  Which brings us to another temporal aspect of the Heart – it is situated at the time of the Summer solstice.  The solstice is the time of the greatest day length – so again, it is all flourishing and awake and alive.  However, the hidden principle is the one of the birth of the dark – for the zenith of a thing always brings about its immediate descent into expiration.  What goes up must come down.

What does this tell us about the Heart?  That while it is a very Yang organ, as the Emperor should be, but it also contains a deep Yin principle within it.  Our professor, Heiner Fruehauf, often relates the Heart to the feminine principle – which makes sense given this information.  In that way, it may be more accurate for us to think of the Heart as the Empress – or some amalgam of the Emperor and Empress.  Here is perfect control, high intelligence, beauty, grace, compassion, mercy and power.  It is an intensely active principle – Yang – but with this huge strength of the Yin.

Why do I say that the strength of Yin is large when it is, in reality, just the beginning of the growth of Yin?  Because the entire momentum of Yin’s growth starts at this point – it somehow contains the whole force of the future splendor of Yin’s fullness.  It is strong in the sense that is young, vital, and on the ascent.

I think this Yin principle is very important. At the height of summer, at the height of noon, this is when we may have the tendency to go all upward and outward – but it is crucially important that we go within, nourish our deep spiritual nature.  Some cultural customs bear this out – such as the tradition of the midday siesta and the many spiritual activities that go on around the summer solstice.  I think that, in some ways, the failure to do this can be seen in American capitalist culture.

The principle of constant up, out, grow, flourish is often not balanced with careful reflection, willingness to “stand down,” controlled descent and respect for the more passive aspects of the universe.  This failure has penetrated the consciousness of many American people and others affected by this philosophy and may have something to do with much of the pathology we see today.  More about this later.

Earthly Branch Wu : combined with the symbolism of the Horse in the Chinese zodiac

The Earthly branch Wu 午, reinforces what we’ve already discussed about the Summer Solstice – given that it is the Earthly branch associated with that part of the year.  It is a picture of either a battering ram or a mortar and pestle, and thus we see again the idea of death or destruction in this life affirming and light giving symbol of the Heart.   Wu 午 is also associated with the number five insofar that it is pronounced the same as 五, Wu – “five.”

This brings us to consideration of the association of the number five and the Heart.  We should note that we’re talking about the fifth month when we talk about the Heart.  The number five is extremely important in Chinese cosmology – witness the deep symbolism of the five elements and a whole variety of other symbolism assocaited with five.  There’s just so much that I could say in this realm (and actually did, but then deleted to save your poor eyes) but I will have to stop here for the sake of article length.

The Earthly Branch Wu 午 is related to the Horse in the Chinese Zodiac.

Remember, the Earthly Branches were associated with an animal to help them be easier to understand by the common people.  The Horse is a particularly fascinating symbol for the Heart, which I could talk for a long time about.  But consider just a few simple items.  The horse is tireless, constantly galloping away, carrying great loads, even fighting in battle – just as our physical Heart mustchinese_medicine_zodiac_horse persist throughout our lifetimes.

The horse seems to share a Shen level connection with the human being – a really close rider and horse seem to read one another’s minds, few verbal commands are needed when the relationship is strong.  The horse is one of the most beloved animals in all cultures, people sometimes take better care of their horses than they do their children!

I am certain there is more to understand about the horse – I would love to hear what people come up with in the comments to this post – please post below!

As always, there are many  more symbols that we can pull from the organ clock to help us understand the Heart more deeply – but let’s work with what we have so far.

How does this help us understand the Heart more completely?

There’s a lot one could say about these symbols.  The most important take-home message I have received is the crucial nature of respecting the Yin nature of the Heart.  However, I don’t think you should start dousing your anxiety ridden patients with cooling herbs!  On the contrary, they probably need Fu Zi.  Which actually brings me to an important relationship and my overall point.  You’ll excuse me if I diverge a bit into conjecture and philosophical exploration?  Thanks.

We often talk about the relationship of the Heart and Kidney – fire and water.  They are obviously related via their Liuqi designation of Shaoyin, or lesser Yin.  We learn that the Shaoyin fire of the Heart must descend through the Earth to reach the Shaoyin water of the Kidney.  In doing so, the cold Kidney water, the depth of our wisdom and lineage, is animated by the pure fire of Spirit and consciousness.  Wisdom without use of that wisdom is nothing but a lifeless puddle.  Likewise, the pure Kidney water must be steamed up to cool and contain the sometimes over-exuberant Heart Shen.  Consciousness without wisdom quickly becomes tyranny and zealotry.

This is one way that I understand the importance of using Fu Zi even in the case of patients who appear to have lots of flaring Heat – such as patients with intense insomnia and anxiety.  So many TCM physicians would balk at serving Fu Zi to such a patient.  To provide one example of a powerful use of this principle, let’s go to that little book known as the Shang Han Lun.

下之後．復發汗．晝日煩躁不得眠．夜而安靜．不
嘔不渴．無表證．脈沈微者．乾薑附子湯主之

Xià zhīhòu．fù fāhàn．zhòurì fánzào bùdé mián．yè ér ānjìng．bù
ǒu bù kě.  wú biǎozhèng．mài chén wēi, shēn wú dà rè zhě,gān jiāng fùzǐ tāng zhǔ zhī.

When precipitation has been used, yet sweating is then promoted so that the person in the daytime is vexed, agitated and sleepless, but by night time becomes peaceful and retching, thirst, exterios signs and great generalized heat are all absent, and the pulse is sunken adn faint, then Gan Jiang Fu Zi Tang governs (Mitchell/Ye/Wiseman version).

While I would like to think that most doctors would see patient with this picture – particularly the faint pulse – and realize that an intensely warming formula can be indicated, I think that most would still shun such strength and instead use something milder, more cooling, and most likely less effective.

One more point and then I’ll close this article.  I believe that this fire-water relationship and the general Yin nature of the Heart leads us to realize the wisdom of having a well-developed spirituality.  Only by combining the deep wisdom of contemplation (dwelling in the water) with the animating ecstacy of consciousness (dwelling in the fire) can we have balance.  Advising our patients to nourish themselves in this way – of course without necessarily promoting a particular practice or tradition – may go a long way to helping them achieve greater health.

7 Ways to Keep Focused on a Lifelong Journey

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classical chinese medicine shiftToday, I truly start my experience as a practitioner of Classical Chinese Medicine.  It’s my first shift at Pettygrove Classical Chinese Medicine clinic in Portland.  I have the honor of learning from David Berkshire, LAc – a local practitioner who specializes in a variation of Worsley style five element acupuncture.  I have been excited about this for a long time.  At the same time, I’ve been anxious about my abilities and worried that I’ll do something horribly wrong!

Also, as I enter Year 4 of this medical training, I am beginning to feel a little fatigued.

My situation is familiar to many of you.  Anything worth doing takes time.  This medicine is complex and worth working on for a while.  Nonetheless, I have a family and a life and hopes and aspirations and sometimes I’d like to just get on with it.  🙂  Regardless of your profession or stage in life, I think you can appreciate this sentiment and the situation that inspired it.  Consider this got me thinking about how to keep energized when the road before one is long and potentially bumpy.  I figured I’d share my thoughts with you.  Please share your reactions and your own words of wisdom in the comments.

1.  Inspiring literature : One of the easiest ways I have found to stay focused is to maintain a small library of books that easily inspire me.  For my part, I choose writing that is closely related to Classical Chinese Medicine.  A partial list of my “inspiration library” reveals:

  1. Dao De Jing(Star Version)
  2. Huangdi Neijing
  3. Learning to be a Sage
  4. Notes from classes taught by Arnaud Versluys, Heiner Fruehauf and others
  5. The Web of Life
  6. Wholeness of Nature

2.  Old journals/writing : I’m not super reliable in my journal writing, but it is consistent enough that I can read back through and get a sense for where I was in the recent and distant past.  It is helpful for two reasons.  First, I can see how far I’ve come and become energized by my progress.  Second, I can sample my youthful (!) enthusiasm and use that to propel me through.

3.  Go back to the source : Everyone came to their profession/topic for a different reason.  When I get a little distant from my passion, I just think back to what motivated me in the first place.  For me, the essence is twofold.  First, I love the Classical Chinese way of thinking about human beings and the natural environment we live in.  Also, a deep desire to be part of a profession that demands of me total integrity and closeness to nature has always been part of my driving force.  To revisit these, I need to simply sit in a beautiful place (Portland abounds with them) and consider those things.  I might spend 20 minutes considering the interplay of Yin and Yang in everything around me.  Alternatively, I might vision the kind of practitioner I see myself being.

4.  Talk to people further along on the path : Talking to experienced Chinese medicine physicians goes a long way in keeping me energized.  When I am privileged to hear someone like Heiner Fruehauf talk about his method of treating patients and the beauty of those interactions, I feel renewed.  When I make time to talk with my friend Abdallah B. Stickley about his prolific and inspired practice, I am buoyed.  It’s also been helpful shadowing with some of the recently graduated interns during their rotations – watching the effortless way they interact with patients and wield the needles helps calm my fears and excite me about my future.

5.  Talk to people further back on the path : Nothing gets me going quicker than talking to folks new to the field of Classical Chinese Medicine.  It’s one of the reasons I love being associated with an institution of higher education.  Every year, new students come in – full of enthusiasm and wonder.  It lightens the heart and makes me forget my worries about my future or my irritation with the present.  At NCNM, we have a mentoring program where older students take on the responsibility for helping out new students.  That has certainly been a good experience.

6.  Brainstorming : Sometimes none of the above seems to work.  So, I start mindmapping.  I’ll put my central concern or question in the center of the page and just start working from there.  For instance, I might put the question, “Why become a physician?” in the center of my page.  From there I let the ideas flow.  “To have the privilege of accompanying fellow human beings on their path through life,” “To alleviate suffering in those who need it,” “To get paid to consciously work with my own energy,” and the list goes on.  From there I often get sparked to think of my chosen profession in new ways.  In fact, many of my blog articles come from brainstorming sessions like that one.

7.  Spiritual practice : Certainly there is nothing better to align me with my purpose as a student of Classical Chinese Medicine than my spiritual practice.  Whatever tradition (or no-tradition) you come from, simply dwelling in that place of spirit can deeply nourish every part of your life.  I find that when I am doing meditation, prayer, Qigong and reading sacred texts, peacefulness about my path comes without my forcing it.  If I sat down to meditate with worries on my mind or heaviness in my heart, I scarcely remember it when I stand back up.

Term in review part I : On shift with Arnaud Versluys

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I’d like to go back over Fall term 2007 and distill what I feel to be the essence of what I learned in each course or clinic shift. It’s really fascinating to me how full of importance every single class turns out to be, regardless of my feeling of any one class at the onset. Over time this has taught me to be utterly open to the content of every course, the offerings of every teacher.

At NCNM, we begin our clinical education working in the Chinese herbal medicinary, and then graduate to Observation shifts, finally moving on to Internship the summer of our third year. Observation shifts are well named – mostly you watch. To some this may sound boring, but it is anything but.

Trying to follow the doctor’s reasoning, observing the minute action of fingers on the pulse, the flashes of understanding as the patient reveals some seemingly minor detail… it’s all so valuable. We are able to take the pulse and look at the tongue, and with some doctors we are able to ask questions of our own. Some doctors have students remove needles or do some of the less intrusive therapies, like indirect moxibustion. During the “down time” when patients are lying with their needles inserted, some doctors will teach in quite a formal way, others simply take questions, still others like to joke around and get to know their students. We are in Observation for two years, beginning in the second year.

This term, I had the distinct pleasure of being one of four students on Arnaud Versluy’s Observation II shift. I have been on three other observation shifts so far, all of them were wonderful learning experiences and each so unique! However, Arnaud’s shift was a different animal altogether. I’m not sure if this is just because of something inherent in Arnaud or if it is because of my deep resonance with his basic medical philosophy and enjoyment of our interactions – either way, I learned so much on this shift I wish I could repeat it for my remaining Observation shifts!

Pulse taking

All of our doctors use the pulse in their diagnosis, but none so far have done so in such detail as Arnaud did this term. This may be due to the fact that he is a scholar and clinician in the Shang Han Lun tradition and in this school the pulse is emphasized. We began to learn a whole Shang Han Lun based pulse system, but really had to piece things together for ourselves. I believe he reveals more about this system in his mentorship tutorial, which is a fourth year opportunity.

From what I can tell, the system has similarities to that espoused in the Nan Jing especially in terms of pulse positions and incorporates a system of formula differentiation as distilled from the Shang Han Lun text. The idea is to learn the pulses and their correspondences so well that as soon as you feel a pulse, you prescribe a formula without much question. There are, of course, exceptions to this rule – but our trust in the pulse should be above our trust in the patient’s ability to fully articulate their pathological process.

This makes sense to me, above all, because of my own experience as a patient. It is rare that I can tell a doctor “what’s wrong” and while I can sometimes articulate very strange, and very diagnostically helpful symptoms – most of the time, I just don’t feel right. 😀

We also learned some basic pulse taking mechanics. It’s funny, because for all that we learned pulse qualities and the history of the view of pulse positions – we never learned “how to take a pulse” in any systematic way. Sometimes these basics get lost in the shuffle, I suppose. Arnaud gave us those basics on shift and I can tell you that my ability to learn from each pulse I take increased immeasurably.

Modular character of classical formulas

Arnaud is a formula guy, first and foremost. His point selections are intriguing, but it is in the realm of formulas that his brilliance is clearest to see. The easiest way to get him to talk a blue streak was to ask an insightful, but simple, question about a particular formula or formula modification. I’m sad to say that I probably didn’t take enough advantage of this resource – but when I did, the results were both deep and broad.

What I learned most was that the nature of classical (or canonical, as he likes to say) Chinese herbal formulas are exceedingly modular. What this means is that if you take half a dozen of the most used Shang Han formulas you will see numerous overlaps that make it simple to combine formulas without adding too many ingredients or making the formula too big.

This creates an extremely wide therapeutic output with just a small number of different herbs. It also means that the dosages and combinations in classical formulas are EXTREMELY tight. If there are 9 grams of Gui Zhi and 9 grams of Bai Shao in a formula, changing one of those dosages to 6 grams produces an entirely different effect. So, the practice of willy nilly modifying formulas based on wanting “a little more of this and a little less of that” probably isn’t a great idea.

Thinking about formulas this way has completely changed the way I study them. Instead of looking at formulas in relative isolation or placed in arbitrary categories (as found in most formula text books) I look at formulas as in relationship with one another. All of the formulas that contain a similar ratio of two herbs are going to be related in some deep way. This allows me to more fully understand the function of the formulas and be more effective with them in clinic.

Practically, whenever I learn a new formula, I spend some time searching for related formulas usually using electronic resources I have created myself. Then I read all I can about these related formulas, particularly anything included in the Classical texts. I seek to comprehend the similarities and differences. In some cases, I have also looked at all formulas with a particular two or three herb combination, regardless of dosage. This is also instructive.

Learning to ask good questions

As I’ve already mentioned, we usually got the most out of shift when we were brave enough to ask bold, yet succinct, questions. I tend not to speak up in academic group situations. Because of the rambling and pointless nature of some questions asked in many classes (Chinese medicine or not) I tend to wait until I have a truly important, well-informed and brief question to ask of a professor before I’m willing to put myself out there.

However, I know that this policy has probably negatively impacted my educational experience in some small ways. My academic relationship with Arnaud is helping me to get better at quickly coming up with relevant and insightful questions. I hope this skill continues to develop.

In sum, my term with Dr. Versluys was quite enriching. I’d be interested to hear the stories of other people, even in other schools, about their early clinical experiences. Any disasters? Any moments of earth-shattering insight? Let us know in the comments.

Should Chinese Medicine Be Modernized?

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Reading through my Chinese Medicine news feed, I came across this article – China to further modernize Traditional Chinese Medicine. Here’s their description of what modernizing means for the medicine.

“In modernizing TCM, efforts will be made to improve standards, study new applications and standardize planting, production and processing of medicinal herbs, according to the report of the center, which is under the Ministry of Science and Technology.”

This doesn’t sound too bad, actually.

I can understand the wisdom in standardizing planting, production and processing of herbs. Unfortunately, standardization too often means bringing everything down to the standard of the least excellent instead of bringing everything up to the standard of the most excellent! If they are going to standardize the herb industry they need to take care to:

  • Make sure the integrity of biological systems is maintained, or where already damaged, improved. The energetic quality of the herb is certainly impacted by its environment. In ancient times, these herbs grew wild – in harmony with their surroundings. The best quality of many herbs is still found in their wild counterparts! In standardized cultivation, one should do the best they can to replicate that environment – even if it harms yields.
  • Follow traditional guidelines in harvest and processing of herbs.  Some, like Heiner Fruehauf, are devoted to making sure this takes place.  If in the Materia Medica an herbs is meant to be mix-fried until yellow, don’t char it. If it is meant to be processed in salt water, process it in salt water. Perhaps contemporary research methods don’t pick up the difference between one processing method and another – but don’t kid yourself into thinking that the sages that developed this medicine were stupid. Their guidelines were precise and developed over centuries of testing. Respect that.
  • Use the implementation of standards to ensure the elimination of heavy metals, pesticides and non-edible products from the herbs.

Unfortunately, this isn’t likely to be all “modernization” has in store for Chinese medicine in China.

If history is any measure, it will almost certainly entail the purging of important information from the official canon and redoubled efforts to justify Chinese medicine from a Western scientific standpoint. Further, practitioners with diverse (yet vital and functional) theoretical standpoints, diagnostic methods and treatment principles may be forced to embrace the standard despite the fact that it is not clinically more effective. This, so the line goes, is the only way that Chinese medicine will be accepted into the mainstream.

If that’s what it takes to be accepted into the mainstream – I’ll take the tributaries.