modeling

[Guest guest]

In the teaching clinic, one of the responsibilities of the supervisor is

to model for the students. this is important whether we are talking about

doctor/patient interactions or case assessment. In the clinic, the

supervisor should always takes the pulse and tongue of the patient with

chronic internal diseases. It is often necessary and useful to follow up

on questions asked by interns. Good followup questioning is a skill that

takes long practice. Of course, it is vital to model the method of case

assessment used in one's methodology over and over again.

 

It would follow then that one needs to appropriately model the creation of

individualized herbal formulae. so how is this best accomplished? Well

prior to beginning internship, interns are expected to have learned

materia medica, formulas and basic internal medicine. It should be

reasonably straightforward for them to identify the primary pattern of

imbalance in any patient and state the textbook base formula typically

used for that pattern and disease. At PCOM, students should be conversant

with the herbal treatment of selected GI, respiratory, neurological,

psychological and gynecological conditions before their internship begins.

 

It is in the classes taken during internship that students learn in detail

how to modify textbook formulas for actual patient and finally how to

craft novel formulae. In my own experience, it is necessary to master the

modification of classical formulae before one is able to discern the

recurring themes and patterns in formula construction that will allow one

to craft novel formulae. If one skips this stage and does not carefully

discriminate between the inherent properties of any given herb and its use

in a particular formula, the tendency is to craft formulae that are

hodgepodges of materia medica, based on no principle of dui yao or

historical antecedents.

 

It is clearly difficult for students to see the relationship between a

novel fomula written by a supervisor and its basis in classical

formularies. Often, the clinician is not aware of the evolution of their

own style. It appears to more of an art than an anthropological process

for the practicing clinican. It is only when we step back and analyze the

process that the contours appear more defined. If the supervisor cannot

make his own thought process explicit regarding formula construction and

the student cannot glean this on their own, then we are left with the

possibility that some sort of satori occurs at some point and one wakes up

and says, " aha! " . Actually, I do think this latter process actually does

occur, but it may take years to happen. Better to begin with trusty logic

and hope that insight and intuition develop over time.

 

Now it is my observation that most very experienced herbalists typically

craft novel formulae much of the time. I have begun to wonder if this

approach is the best clinical modeling at every stage of clinical training.

If one cannot explain one's novel formulae to the students, then perhaps

it would be better to model a more basic level of prescribing. Many

students have difficulty making the leap from selecting patents to

prescribing formulae. I don't think this is process is well served by

only modeling the most advanced stage of herbal practice.

 

So lately, I have been showing students how to use books to help them

select base formulae and modifications. Baby steps. there is a lot of

agreement from text to text on base formula, but much variation in

modification. In this area, I will also share my personal experience and

teacher's family lineage. But I have largely stopped just writing

formulae for my intern's patients. Sometimes it makes more sense for me

to write the rx if the case is exceedingly complex. But I always make the

my thought process overt in such cases. This has led to an interesting

scenario where some students are disappointed when I open a book to guide

them through the process. Its funny. When I was a student, one of my

inspirations to learn herbology was that it seemed challenging. At the

time and place I learned it, very few people pursued the study of anything

besides patents. But I used to watch some of my virtuoso supervisors whip

out these novel formulae that worked magic on their patients and I thought,

" I want to do that! " .

 

In addition to supervising intern shifts, I also treat private patients

with observers and assistants. In that setting, I demonstrate and explain

what I am doing in my most sophisticated style of practice. It is

important to get some exposure to more advanced styles of practice for

inspiration. But this should perhaps be balanced at other stages with

careful modeling appropriate to the interns level of development.

 

 

Chinese Herbs

 

 

" Great spirits have always been violently opposed by mediocre minds " --

Albert Einstein