herbs in practice

[Guest guest]

An important issue has been raised. While some on this list maintain that there

are plenty of colleagues in our field who regularly practice the administration

of individualized formulas, I believe the number is actually quite small. The

admission that herbal practice is often too time consuming to be economically

feasible is one I have been waiting to hear on this list for a long time. With

the excessive cost of acupuncture school (relative to the likely ROI) and the

unnecessary medicalization of chinese herbal practice, what can you do? There

are many on this list who understand that herbology is a separate field from

acupuncture and most cannot master both. In private practice, I prefer to do

herbs only or set up acupuncture protocols carried out by my assistants. I do

not have time to do proper herbology if I do the acupuncture myself most of the

time unless the patient wants to pay a premium. I would rather have a good

assistant spend 45 minutes coddling my patient rather than me throwing in some

needles in 5 minutes and moving on. The patient seems to respond quite well.

If one could spend 10,000 instead of 80,000 to learn herbology (minus all the

acupuncture and other extraneous trappings), then one could deliver herbal

services at an affordable price and make a good living in that field alone. But

the high price of acupuncture study necessitates the need for either a home

practice with no overhead or a large patient volume to pay the bills. For all

except those who have a photographic memory or many years of experience, there

really often is no time to prescribe.

 

The issue of time is also tangential to another one. The time to study the

subjects and texts necessary to enhance ones ability to think about herbolgy.

Books like the shang han lun and wen bing with commentary. Or qin bo wei or

jiao shu de or li dong yuan or zhu dan xi or zhang xi chun and so on. And what

about studying chinese so one can access even more in the source language.

Which all begs the question of how much one needs to know and when does the

effort to acquire more data come with diminishing gains in efficacy. Currently

I know few people who have mastered the contents of Bensky, much less the other

texts mentioned above. I could spend a lifetime on the SHL text and

commentaries in Mitchell's translation alone. Plus there is the modern

research. The list goes on.

 

The main genre, perhaps the only genre of substance, we truly lack in good

english translation is the case study literature. Thus the argument is one

should learn chinese largely to access this missing piece of the puzzle. In

fact, several of the presenters at CHA always emphasize classical case studies,

esp. Damone and Mitchell. I always find such presentations thought provoking,

but much moreso in the group discussion format than just reading the cases

myself. I see the emphasis for studying classical cases being twofold. One of

need and one of choice. The need comes when standard methods do not work, which

may be rarely or frequently depending on your practice. Just because one needs

or chooses this path does not mean it makes one more clinically effective. To

me, whatever achieves that goal is most important.

 

Personally I find standard methods usually fail when either diagnosis,

precription or dosage is wrong. The methodology is just fine. Dosage

especially is a major factor in failure. On the other hand, one may choose to

practice a classical style because you find it more rewarding or inspiring or

fun. I believe either approach is effective but the insights discovered by many

as they study the classics (including myself on occasion) would really just be

another thing not worth the trouble for most. When we have people saying that

just to process and apply the basic data learned in a master's program can be

overwhelming, which it is, how can we suggest that in order to really

effectively practice you also need to read chinese, study cases and classics,

etc.,etc. Unless its true.

 

While it is laudable that some pursue such studies, I think we have to separate

the highest goal from the reasonable goal. The failure to see that distinction

has caused much rancor here in the past. I maintain that the gains in clinical

efficacy from studying chinese and the classics and cases are slim. These

things may make the difference on occasion, but when it does, one can always

refer. It is disingenuous to set a bar too high to be achieved by the average

person and then be dismssive of those who cannot achieve it. Its like saying

you can only pitch if you can regularly throw 100 mile per hour strikes, when

there is a place for those who are not quite that good. In fact, those who can

throw the heat in any field are rare. So why not work instead towards the goal

of improving acquisition and application of knowledge to create a crop of grads

who are strong in the basics. Consistently hammering the idea that even if you

could master the material in core texts, you would still be unable to practice

effectively without doing _____________ (fill in the blank), is not only

untrue, but also discouraging to further study. Progressive case based, problem

solving oriented learning and computer assisted study and applications are the

key to these issues, IMO. But so is reasonableness.

 

 

[Guest guest]

 

 

You raise a number of good points. In general, I agree that we need to

identify as precisely as possible the core competencies and then

assure that those are met in a minimum of time, effort, and cost.

Consequently, I'm not a big promoter of the classics for entry-level

education. As for the the case history issue, we at BPP are making a

large effort to include case histories in all our new and up-coming

textbooks. I have also included 100 or more case histories in our new

translation with commentaries of the Pi Wei Lun.

 

However, if we do not teach a basic reading knowledge of modern

medical Chinese to entry-level students, then we have to be even more

sure that the English we are using faithfully conveys the logic and

clinically important technical information inherent in the Chinese.

IMO, a lot of the problems with Westerners trying to practice CM is

that they are working with faulty " operating systems " because of

incorrect, incomplete English language terminology and English

language materials. If you don't process the data correctly, you don't

get the right result. More incorrectly and incompletely translated

material will never result in easier, more accurate, or more effective

CM problem-solving. However, until teachers themselves bite the bullet

and consistently require their students to speak and read the most

accurate and faithful terminology and translations, I cannot see how

anything will fundamentally change.

 

We consistently hear from our Blue Poppy Institute students that we

have radically changed the way they do CM. But that doesn't mean we

taught them to read Chinese. What we do is use Nigel-speak rigorously

and present them with lots and lots of oral and written materials

which convey the step-by-step, problem-solving logic Chinese

practitioners in China use. If students don't have to read modern

medical Chinese, at least their teachers should.

 

Bob

[Guest guest]

Todd-

 

I really appreciate your bringing up[ the standards of reasonableness, as

well as Ted's comments on how much students are learning, given that they are

dealing with another language. If I were 25, I'd love to learn Chinese, but I

serve my patients better by learning about autoimmune disease, the energetics of

their medications and the effects of diet so I can effectively deal with

their yin fire. Someone needs to know the Chinese research, so I also refer, or

pay for mentoring, or read translations.

 

One of the things I appreciated about Robert Rister's Kampo book was that he

described the materia medica in English, as well as Japanese and Pinyin. When

I read that Mang xiao was usually Epsom salts, broader understanding

followed- after all who has any relationship to Mirabilitum? If ordering herbs

and

talking about them in school did not require pin yin I'd be all for a CM that

describes herbs in English and Latin, with Chinese or pin yin as reference.

That won't be possible for a generation or two when more is translated and

written in English..

 

Chinese medicine needs to be adapted for westerners and reading Chinese won't

appreciably help me deal with integrating CM with western diets and

lifestyles. Barley congee may help xiao ke if it is substituted for several

meals of

rice, but if our patients are eating bagles for breakfast adding on the congee

is useless and most of the diabetics I run into are too heated and damp to

stick with soups anyway. (Not to mention that Western diabetics are rarely

wasting.) We need to find paradigms that apply with our current patient

population,

who often differ from those in the classical case studies.

 

I got into Chinese medicine for the diagnosis and for the herbs. Putting in

the time to formulate the herbal prescriptions is not especially renumerative.

But, equally important, herbal formulas, especially at $30-50. a week

(Chinatown pharmacy prices) in addition to office visits means that my patients

often can't afford anything but patents. (And we won't get into counselling all

those who are afraid of herbs, or mixing them with their medications, usually

against the explicit advice of a frightened MD). It's a lot easier to stick

in pins and increase the patient volume. when the rent and student loan

payments are due.

 

And an herbal-only degree? Not in this climate. <sigh>

 

Karen S. Vaughan, L.Ac., MSTOM

Creation's Garden

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