on the corner

July 20, 2003

, wrote:

> I see one fault of the student clinics is that patients are

encouraged to stick with one intern as long as possible. While the

intern gets to see the follow-up, sometimes it gets where a patient

with liver qi stagnation issues is seen week after week for a year,

depriving the student of seeing more of those 15% difficult cases.

Seeing the same supervisor should still be encouraged.>>>

doug:

I don't think it is so much a fault of the student clinic as simply

a problem of starting out. I think the greater need is for students

to be consistent with the same patients so that they can see the

relative success of their treatments, or lack thereof--establishing

the working pattern that they will have in their own practices. And

a realistic expectation of what their treatment strategies can

actually accomplish.

But I agree with you in the sense that students are not well

prepared for that 15% of difficult cases. But from my travels around

the country doing seminars, I would attribute that to a lack of

preparedness: few schools develop pulse diagnosis, 5-Elements, or

other diagnostic methods beyond 8-Principles. I would like to see a

more complete method of diagnosis like Fang Yaozhong's 7-Step

Pattern Differentiation Method (Scheid, 287).

Jim Ramholz

July 20, 2003

,

wrote:

> I see one fault of the student clinics is that patients are encouraged

> to stick with one intern as long as possible. While the intern gets to

> see the follow-up, sometimes it gets where a patient with liver qi

> stagnation issues is seen week after week for a year, depriving the

> student of seeing more of those 15% difficult cases.

Its a tough one to call. How long should an intern get with a patient.

Patients

don't like getting traded, but that could be explained away as a new rotation or

some such thing. What is best for patient care, though? Fact is, when you do

the math, clinical internship is quite limited. One already will only get to

see a

handful of ongoing patients under the current system. In the best case

scenario, one would see 25 patients for three months each, maybe a few a little

less and few a little more. that would get you your 250 patient visits for

graduation. But that's not how it goes. So maybe you actually get to follow 5-

10 cases for an extended time. And maybe 0-2 are the serious complex cases

to which I refer. So if you force a student to give up maybe the only case he

has of this nature just so another can learn from it, I am not sure anyone is

served.

I am not sure we could recruit enough patients to meet an increased

internship requirement. Has your school clinic been very busy this summer?

I find hard economic times hit the school clinic hard. We don't accept

insurance, so the vast majority of our patients are cash patients with low or

fixed incomes. This impacts frequency of treatments and herb compliance, too.

I do think the main difference in outcomes in learning TCM in china and the US

stems from the disparity in clinical training.

I studied chinese herbology with Subhuti Dharmananda for three years while I

went 20-30 hours per week to Naturapthic School, then went to OCOM for

3,ooo hours, then spent three years working in the school herbal pharmacy

about 15 hours per week while running my own private practice out of the

school clinic. It was at the end of 9 years of continuous education and

interaction with my teachers on a regular basis that I finally began to

understand this practice. I believe this time could have been greatly reduced

if there had been more good work available in english and/or I could read

chinese. However, that was not the case, so...

Now I was fortunate on one hand to have this opportunity, but I also chose to

make this sacrifice and was still earning less than $15 per hour 3 years after

graduation (plus fluctuating income from private practice). In hindsight, it is

hard to recommend this path to all, though. Without this consistent

reinforcement from experienced teachers, I easily would have strayed down a

variety of odd tangents, no doubt. However, my personal debt was immense

because of the time I did not spend devoted to marketing, etc. I don't think I

really deserved much more than the school paid me since I was a recent grad,

but the point is that the current educational structure does not really balance

economic and educational realities. I have also chosen to make other what

others might consider sacrifices in order to live a decent lifestyle pursuing

things I like. But this clearly would not work for a student who has children

and has already deprived themselves and their families for 4 years of school.

so what to do. even paid residencies are pretty meagre wages. Lets face it.

While I still think 2 years is enough to train acu techs, if we really want to

achieve MD status, when are our proposals going to really bite the bullet and

get serious. If we do go the entry level DAOM route or if that becomes one

option in a tiered system, do we we really need more classroom education as

part of this process. Or do we need more clinical training that actually

achieves the desired outcomes. MD's get 4 years of med school. the rest is

clinic. Lets consider whether additional training leading to a doctorate should

mainly be clinical (perhaps with case report writing). Who says we have to

adopt ACAOM's version of the DAOM anyway. 2 years of fulltime supervised

residency could give another 4000 hours in clinic. I think that might do the

trick.

This would require profit making clinics that made part of their profit by

having low paid residents on staff. Yes, I said paid. I do not think we can

realistically expect people to pay for six years of school. MD's pay for 4,

then

they start to get paid (dirt, but they get paid and their loans are on hold and

they can even cancel them altogether latr if they want to work in a rural area).

Its really a catch-22. Without a requirement for residency, there will not be

enough folks who go this route to make it profitable for clinic owners to

develop such programs. But with a requirement for residency, there will not

be enough opportunities to serve the grads.

The only solution is to use mainstream hospitals are our residency facilities.

Thus, more attention to integration may be the best plan for making possible a

real DAOM program, entry level or multi-tiered. Otherwise, it is somewhat a

sham. I believe the title doctor should be reserved for those who have seen

extensive patients in their specialty. On the other hand, if ND's and DC's

deserve the title, so do we. the question is, do they?

Of interest, while researching this, I came across the fact that the average med

student incurs about $75,000-100,000 in debt, much less if they go to an in

state school. could be as low as 50,000. You could specialize in internal

medicine and finish your studies including residency in 7 years after

graduating college. And you would get paid an average of 34,000 for those

last three years. It is hard to see how many people would be willing to pay

tuition for six years, do unpaid internships and get so little guaranteed ROI.

Some entry level DAOM proposals will grandfather existing L.Ac. into elevated

status and effectively close out the field to most new applicants, thus

eliminating most future competition. It would also drive most of the schools

out of business as the student population plummets. Unless an entry level

DAOM includes a paid residency, I will be highly suspect of the motivations or

value behind it.

July 20, 2003

(AT) (DOT)

>

> This would require profit making clinics that made part of their

profit by

> having low paid residents on staff. Yes, I said paid. I do not

think we can

> realistically expect people to pay for six years of school. MD's

pay for 4, then

> they start to get paid (dirt, but they get paid and their loans are

on hold and

> they can even cancel them altogether latr if they want to work in a

rural area).

> Its really a catch-22. Without a requirement for residency, there

will not be

> enough folks who go this route to make it profitable for clinic

owners to

> develop such programs. But with a requirement for residency, there

will not

> be enough opportunities to serve the grads.

this is a very good point Todd. more specialty clinics could

become more available for those of a lower income bracket. Grad

students pursueing further studies, would have a sigh of relief at

getting paid even a meager sum and clinical experience would be

emphasized. This is kinda how it works in China, isn't it?

matt

>

> The only solution is to use mainstream hospitals are our residency

facilities.

> Thus, more attention to integration may be the best plan for making

possible a

> real DAOM program, entry level or multi-tiered.

Hospitals seem more and more open to these things. A hospital nearby

has even started a scholarship program, in which they will pay off

your loans for you, if you work as a resident with low pay for two

years.

Otherwise, it is somewhat a

> sham. I believe the title doctor should be reserved for those who

have seen

> extensive patients in their specialty. On the other hand, if ND's

and DC's

> deserve the title, so do we. the question is, do they?

i don't know, but if they do, we certainly do as well.

>

> Of interest, while researching this, I came across the fact that

the average med

> student incurs about $75,000-100,000 in debt, much less if they go

to an in

> state school. could be as low as 50,000. You could specialize in

internal

> medicine and finish your studies including residency in 7 years

after

> graduating college. And you would get paid an average of 34,000

for those

> last three years. It is hard to see how many people would be

willing to pay

> tuition for six years, do unpaid internships and get so little

guaranteed ROI.

this is what i've been thinking about.

> Some entry level DAOM proposals will grandfather existing L.Ac.

into elevated

> status and effectively close out the field to most new applicants,

thus

> eliminating most future competition.

messy indeed.

It would also drive most of the schools

> out of business as the student population plummets. Unless an

entry level

> DAOM includes a paid residency, I will be highly suspect of the

motivations or

> value behind it.

exactly, let's be real here.

matt

>

July 20, 2003

I teach this protocol (Fang Yao-zhong) to students at PCOM as part of

the CHIM series, soon in the SHL course.

On Sunday, July 20, 2003, at 07:14 AM, James Ramholz wrote:

> But I agree with you in the sense that students are not well

> prepared for that 15% of difficult cases. But from my travels around

> the country doing seminars, I would attribute that to a lack of

> preparedness: few schools develop pulse diagnosis, 5-Elements, or

> other diagnostic methods beyond 8-Principles. I would like to see a

> more complete method of diagnosis like Fang Yaozhong's 7-Step

> Pattern Differentiation Method (Scheid, 287).

July 20, 2003

In the best case scenario, one would see 25 patients for three months each, maybe a few a little less and few a little more. that would get you your 250 patient visits for graduation.

>>>>That it pathetic. To me this is much more basic for a clinician education than if he can read Chinese. With that no wander people believe too much of what they read

July 20, 2003

, " " wrote:

> I teach this protocol (Fang Yao-zhong) to students at PCOM as

part of the CHIM series, soon in the SHL course. >>>

Z'ev:

I wish more teachers and schools were interested---and more authors.

In the Dong Han pulse system, we examine the Fang Yaozhong patterns

from the perspective of the pulses.

Jim Ramholz

July 20, 2003

, " Alon Marcus " wrote:

>>>>That is pathetic. To me this is much more basic for a clinician

education than if he can read Chinese. With that no wonder people

believe too much of what they read. >>>

Alon:

Ditto.

Jim Ramholz

July 21, 2003

'Ok, I'm going to throw another curve out and see who hits. (with apologies to any of my students listening in)

I see one fault of the student clinics is that patients are encouraged to stick with one intern as long as possible. While the intern gets to see the follow-up, sometimes it gets where a patient with liver qi stagnation issues is seen week after week for a year, depriving the student of seeing more of those 15% difficult cases. Seeing the same supervisor should still be encouraged.

doug'

sure, doug, hand over the bat and i will be happy to take a few swings at your topic, all in good humor....

when i was in school in washington state, we had many discussions regarding how hindering it is to clinical education to have requirements that allow an average of 4 visits per patient. nothing was said about including goals and outcomes in tx planning, and four visits/patient certainly won't lead to any experience with outcomes. that is enough experience with each patient to get them started, and no more. i consider starting the easier part. follow-up is where planning is more crucial. certainly, when it is time to change students, the supervisor ought to be consistent. in any school clinic billing insurance, staying with the same student is often not an option b/c insurance companies do not like frequent changes in providers. even if you are not primary care and the insurance allows frequent changes, you will provoke the insurer to ask for more records, more documentation, more forms, ad nauseum. that means it takes you more labor and time to get paid. ugh.

after graduation, i had opportunity to guest lecture in several clinic entry classes at my alma mater. i was thrilled to see the clinical program coordinator encourage students to focus on outcomes. she pointed out that if a patient is coming to see you weekly after a year, it is not time to say, wow, this patient really likes me. it actually means that the treatment is not working well, or they would still not be coming in weekly! if it started as effective treatment, it will not be after a year of treating weekly whether it's needed or not. the instructor also told the students that if they went into clinical training with this focus on outcomes, they would be far ahead of most interns.

i have had more than one patient say, wow, couldn't i do this every week, forever? i say, no, as the tx works and the effect lasts longer, it would interfere to keep treating every week. it could be flattering, but earning flattery is not the point in healthcare. helping people effectively is the point. i do not know of any acupuncture modality where it would make sense to tx weekly for a year. perhaps someone else has more information in this area than do i.

btw, having pt's coming in frequently for long periods is one of the quickest ways to earn bad scores in the rest of the healthcare community. i.e., it is one of the most effective ways to ruin our credibility as healthcare professionals. in the real world, not in school clinic settings, where people and/or their insurance companies are putting out significant money, long term frequent tx's simply do not happen. physical therapy runs $200 in this part of the states. can you imagine doing even 1/2 a week of therapy for a whole year? no, no, no.

July 21, 2003

Lynn,

Your post prompted a variety of thoughts

that I offer for your consideration.

When I was interning in the outpatient

clinics at the hospital attached to the

Chengdu University of TCM in the acupuncture

wards, we often treated patients for weeks,

day after day, week after week...and this

went on for months some times. In fact

there was one little girl being treated

for congenital brain defects (actually it

was injuries sustained during birth that

had resulted in a complicated pattern of

dysfunction) who had been in therapy for

more than 18 months when I first saw her

and who remained in treatment for the next

two years or more that I remember.

The frequency of visits was varied, and she

was given " vacations " from treatment to ensure

that her jing luo were not enervated...for

lack of a better word...it's not a description

of a particular Chinese medical term here.

Clearly this kind of approach to treatment

is not in keeping with the administrative

models that you are describing, but I just

thought you should be aware that in at least

this one hospital, such long term and intensive

administration of acupuncture is routine.

It all depends, naturally, on the patient

and the condition being treated. No doubt

Chinese acpuncture clinics see a different

range of complaints, and the system is set

up to administer on a very flexible basis

so that the physician can determine what

each patient needs in the way of a treatment

plan.

I think it is a matter of some concern in

Chinese medicine as in any form of medicine

that third party payers get into the loop

of therapeutic decision making. It is a matter

of concern from various perspectives.

As Paul Unschuld points out, one of the key

determining characteristics of a professional

is someone who sets their own fees, low or

high as he or she sees fit.

So if third party payers are dictating what

you can and cannot receive in the way of payment

then some measure of professionalism has been

lost. And that is a concern.

It is perhaps a greater concern from the

closely associated point of view of efficacy,

since, after all, professionals in the field

are expected to be able to have effects.

But the idea that an insurance regulation

embodies the appropriate knowledge on which

effective treatment plans can be based seems,

well, Byzantine, bizarre, unthinkable to me.

And yet we seem to live with it...

because it exists.

Now I remember why we called it " alternative

medicine " way back when, when we first began

to sense how desperately an alternative to

the mainstream establishment model was needed.

Anyhow, thanks for taking a swing at doug's

curveball. Seems you hit one in my direction.

Ken

July 21, 2003

ken,

you are quite welcome, and thanks for the volley.

i did not explain my whole follow-up philosophy. i certainly do

believe in acupuncture for a lifetime, to address sx's and roots

and to emphasize prevention. i agree that frequency and intensity

of tx will depend on the patient and condition. i also agree that

people generally need treatment vacations. i do not want to

overtx. it is so much harder to tx patients of any age who are so

sick and fed up that they have no more patience for our medicine

than for any other kind. it is easier to tx before that point, while

people are apparently well - a philosophy straight of the nei

ching!,,,,, it is easier than doing damage control.

i do understand that the hospital model you describe is more

sophisticated than the educational model i participated in - if i

understood you correctly. translate sophisticated as having more

specific intent, as well as not basing tx frequency on how much

the patient likes us.

ah, the pains of insurance involvement. insurance is, however,

part of present world. i worked as support staff in a teaching

clinic as insurance billing was initiated. one good thing that

came of it was that patients really had to follow supervisors more

consistently. i would prefer that within that model, interns still

have more experience with following cases through and not just

starting patient's tx.

lynn

July 21, 2003

after graduation, i had opportunity to guest lecture in several clinic entry classes at my alma mater. i was thrilled to see the clinical program coordinator encourage students to focus on outcomes. she pointed out that if a patient is coming to see you weekly after a year, it is not time to say, wow, this patient really likes me. it actually means that the treatment is not working well, or they would still not be coming in weekly! if it started as effective treatment, it will not be after a year of treating weekly whether it's needed or not. the instructor also told the students that if they went into clinical training with this focus on outcomes, they would be far ahead of most interns.>>>>>>

Music to my ears

Thanks Alon

July 22, 2003

, " J. Lynn Detamore " wrote:

i do not know of any acupuncture modality where it would make sense

to tx weekly for a year. >>>

I'm not sure I follow your point. What about treating

catastrophically ill patients? Are you saying that you wouldn't use

acupuncture, but only give them herbs?

Jim Ramholz

July 22, 2003

lynn: i do not know of any acupuncture modality where it would make sense to tx weekly for a year.

jim: I'm not sure I follow your point. What about treating catastrophically ill patients? Are you saying that you wouldn't use acupuncture, but only give them herbs?

lynn: i am saying that i have a difficult time envisioning a case where tx weekly indefinitely, regardless of the waxing and waning of symptoms. i would want to continue herbs in the meanwhile.

is not the effect of tx supposed to deepen over time? is it not then a good idea to wait till a tx is needed to give another, particularly after tx is well-established and people are experiencing better health for longer between tx's? i imagine asking more and more of a person's whole organism, while it is still busy working with the last question.

i am open to having my mind changed. i know some of my reticence to do what seems to be over-treating comes from also having homeopathic training. it does influence my chinese medicine. i discovered homeopathy while i was in acupuncture school. in TCM classes, i heard that you cannot hurt people with acupuncture unless you give them a pneumothorax or some similar problem. this never made sense. if the medicine is so powerful, how could it be so harmless if the treatments did not suit the patient. i really thought about this as they had us tx each other in class without apparent respect for only giving people appropriate tx's. how could nature decided to help or do nothing? then i discovered homeopathy and was told that if you give people the wrong little sugar pills, even the pills with too few particles to measure by biochemical analysis, it is not harmless. it is not innocuous if done badly.

i hope the above makes sense to someone else here.

July 22, 2003

Lynn,

My perspective is that, again, it depends on the problem. There are

patients I see only one to three times total for acupuncture/moxa, when

there are specific, local problems. There are patients I see six

times, every other week for problems with (for example) menstrual

irregularity. However, I also have a few patients I've seen once or

twice a week with severe kidney problems for seven years, who otherwise

would be on the dead end dialysis road. My perspective is clearly that

deep, functional (and perhaps structural) disorders need repetitive

treatment. We can keep, for example, one of my patient's kidney

functional, but if we stop working, then it is dialysis or loss of life.

I am also influenced by the homeopathic (and to some degree Japanese

acupuncture) perspective that, sometimes, less is more. This is in

terms of stimulus, number of needles (or herbs, for that matter), time

treated, frequency, etc. However, there are times when more is more,

not only less is more.

On Tuesday, July 22, 2003, at 02:13 AM, J. Lynn Detamore wrote:

> lynn: i do not know of any acupuncture modality where it would make

> sense to tx weekly for a year.

>

> jim: I'm not sure I follow your point. What about treating

> catastrophically ill patients? Are you saying that you wouldn't use

> acupuncture, but only give them herbs?

>

> lynn: i am saying that i have a difficult time envisioning a case

> where tx weekly indefinitely, regardless of the waxing and waning of

> symptoms. i would want to continue herbs in the meanwhile.

>

> is not the effect of tx supposed to deepen over time? is it not then a

> good idea to wait till a tx is needed to give another, particularly

> after tx is well-established and people are experiencing better health

> for longer between tx's? i imagine asking more and more of a person's

> whole organism, while it is still busy working with the last question.

>

> i am open to having my mind changed. i know some of my reticence to do

> what seems to be over-treating comes from also having homeopathic

> training. it does influence my chinese medicine. i discovered

> homeopathy while i was in acupuncture school. in TCM classes, i heard

> that you cannot hurt people with acupuncture unless you give them a

> pneumothorax or some similar problem. this never made sense. if the

> medicine is so powerful, how could it be so harmless if the treatments

> did not suit the patient. i really thought about this as they had us

> tx each other in class without apparent respect for only giving people

> appropriate tx's. how could nature decided to help or do nothing? then

> i discovered homeopathy and was told that if you give people the wrong

> little sugar pills, even the pills with too few particles to measure

> by biochemical analysis, it is not harmless. it is not innocuous if

> done badly.

>

> i hope the above makes sense to someone else here.

>

<image.tiff>

>

> Chinese Herbal Medicine, a voluntary organization of licensed

> healthcare practitioners, matriculated students and postgraduate

> academics specializing in Chinese Herbal Medicine, provides a variety

> of professional services, including board approved online continuing

> education.

>

July 22, 2003

, " J. Lynn Detamore " wrote:

> i do not know of any acupuncture modality where it would make

sense to tx weekly for a year. ...i would want to continue herbs in

the meanwhile. is not the effect of tx supposed to deepen over

time? >>>

Lynn:

So, you're still treating for an indefinite time but simply choosing

a different method than acupuncture. That is, then, a personal

attitude and choice rather than any real criticism of acupuncture.

It's understandable since Chinese TCM acupuncture is very

simplistic. Korean and Japanese styles of acupuncture are far more

sophisticated.

From my perspective, you could say just as well that the herb

formulas weren't very working well and the patient required

acupuncture more often. It all depends on what skill sets you bring

to bear on a problem.

Jim Ramholz

July 22, 2003

i do not know of any acupuncture modality where it would make sense to tx weekly for a year.

>>>The only thing to remember is that we cant heal everybody. Sometimes palliative care is warranted. If a patient is paying for his/her care i do not have any problems seeing him/her for as long as they want, as long as it is clear that all we are doing is palliative care and that no real change can be expected. To me that is key. The patient must understand that he/she is only getting temporary relief of symptoms, since all claims of preventative care are speculative at this point

Alon

July 22, 2003

From my perspective, you could say just as well that the herb formulas weren't very working well and the patient required acupuncture more often. It all depends on what skill sets you bring to bear on a problem.>>>>Jim here we have a question of cost. What is more reasonably cost effective

Alon

July 22, 2003

, " Alon Marcus "

<alonmarcus@w...> wrote:

> From my perspective, you could say just as well that the herb

> formulas weren't very working well and the patient required

> acupuncture more often. It all depends on what skill sets you

bring to bear on a problem.

>

> >>>>Jim here we have a question of cost. What is more reasonably

cost effective. >>>

Alon:

Sure, it's another thing to consider; you can also add that to the

equation. I work that way, too.

Jim Ramholz

July 22, 2003

Zev: However, I also have a few patients I've seen once or twice a week

with severe kidney problems for seven years, who otherwise would be on the

dead end dialysis road. My perspective is clearly that deep, functional

(and perhaps structural) disorders need repetitive treatment. We can keep,

for example, one of my patient's kidney functional, but if we stop working,

then it is dialysis or loss of life.

Could you say little more about these cases -- what type or cause of kidney

failure, what sorts of treatment you found to be most helpful, and did you

give herbs? I feel very nervous about giving these folks any herbs and

wonder how far you can go with this.

Pat

==============================================================================

NOTE: The information in this email is confidential and may be legally

privileged. If you are not the intended recipient, you must not read, use or

disseminate the information. Although this email and any attachments are

believed to be free of any virus or other defect that might affect any

computer system into which it is received and opened, it is the responsibility

of the recipient to ensure that it is virus free and no responsibility is

accepted by Cadwalader, Wickersham & Taft LLP for any loss or damage arising

in any way from its use.

==============================================================================

July 22, 2003

Dear Professionals,

Forgive my ignorance, but as a student please help me understand where you are

coming from. Are we not attempting to promote balance with our patience? Do we

not theorize that with deficient patients, our therapies (all 5 branches

hopefully) are gently being used to tonify and strengthen? Why then the

question as to whether a therapy can continue indefitely, if it is augmenting

and supplementing what the patient has spent a lifetime depleting. I remember

hearing once that for every year of illness it hypothetically will take a month

of appropriate therapy to correct.

I await your comments,

Yehuda Frischman

______________

The best thing to hit the internet in years - Juno SpeedBand!

Surf the web up to FIVE TIMES FASTER!

Only $14.95/ month - visit www.juno.com to sign up today!

July 22, 2003

Thanks for this info. Do you have any cases caused by autoimmune disease?

Pat

" "

<zrosenbe. To:

com> cc:

Re:

Re: on the corner

Office:

07/22/2003 07:13

PM

Please respond to

chineseherbacadem

y

First of all, I won't give herbs to anyone already on dialysis, and I

am conservative with dosage and avoid toxic medicinals in patients with

kidney disorders.

One case that comes to mind is a man in his 70's, who has bipolar

depression, and has kidney damage (15% function) from years of lithium

chloride use. He discontinued 2 years ago and began Chinese medicine.

He is a candidate for dialysis, but we've succeeded in delaying that

step by weekly acupuncture/moxa treatments and the use of herbal

medicinals to supplement the kidney. He also continues to struggle

with stopping and starting new antidepressants which give him bad side

effects, and shattered his hip a few months ago by walking into a metal

post. He has his kidneys checked regularly, and Chinese medicine has

stopped the decline of kidney function now for the last year. In

addition, he has tremor (partially from depakote), a sometimes rapid,

wiry pulse, and a red, mirror-like tongue with a thick cheesy yellow

coat at the center and strong metallic smell to his breath.

I have other cases, but time doesn't allow me to discuss them right now.

On Tuesday, July 22, 2003, at 09:26 AM, Pat Ethridge wrote:

> Could you say little more about these cases -- what type or cause of

> kidney

> failure, what sorts of treatment you found to be most helpful, and did

> you

> give herbs? I feel very nervous about giving these folks any herbs and

> wonder how far you can go with this.

>

> Pat

Chinese Herbal Medicine, a voluntary organization of licensed healthcare

practitioners, matriculated students and postgraduate academics

specializing in Chinese Herbal Medicine, provides a variety of professional

services, including board approved online continuing education.

July 22, 2003