Mix and Match 30 Formulas

June 15, 2007

I am hoping for some opinions and comments on the value of a program of

using only 30 Chinese formulas in a typical American clinic. Would it be

broad enough to function as a general practice or be limited.

I know of a seminar being offered as such. I do not wish to critique any

particular seminar or instructor as I feel that would tend to personalize

the discussion and I am hoping for a wider range or a broader discussion. I

also know there are books out with suggestions of having a herbal pharmacy

in the range of 50-60 formulas.

30 formals appeal to me because it is much easier to learn and master for

beginners. As such it would seem to form a more solid foundation with less

mistakes and better results versus a huge selection and the chance of

picking (guessing) the right one. IMO it would offer better peer review.

Is it better to really know more about a few than a little of a great many?

Or does one just end up with a hammer and every thing looking like a nail?

The process of becoming an expert in a finite works well in the martial arts

and in war.

My thought would be for first year students to begin learning 30 formulas

and to continue working and stressing those same formulas over and over

again. Could they (and their teachers) resist the urge to go outside the

limited range.

Could this establish a general practioner level and a specialized level such

as is western practice?

Peace

Ed Kasper LAc.

Santa Cruz, CA

June 15, 2007

I think on this one you can answer your own Q. It depends how much you know

about formulas. You know for one that you can mix and match, and there's a lot

to mix and match. What good will it do if you have tons of herbs and not know

how

to use them? The more you know the more creative. The possibilities are

endless.

Regards,

Gloria

Happy Herbalist <eddy wrote:

I am hoping for some opinions and comments on the value of a program

of

using only 30 Chinese formulas in a typical American clinic. Would it be

broad enough to function as a general practice or be limited.

I know of a seminar being offered as such. I do not wish to critique any

particular seminar or instructor as I feel that would tend to personalize

the discussion and I am hoping for a wider range or a broader discussion. I

also know there are books out with suggestions of having a herbal pharmacy

in the range of 50-60 formulas.

30 formals appeal to me because it is much easier to learn and master for

beginners. As such it would seem to form a more solid foundation with less

mistakes and better results versus a huge selection and the chance of

picking (guessing) the right one. IMO it would offer better peer review.

Is it better to really know more about a few than a little of a great many?

Or does one just end up with a hammer and every thing looking like a nail?

The process of becoming an expert in a finite works well in the martial arts

and in war.

My thought would be for first year students to begin learning 30 formulas

and to continue working and stressing those same formulas over and over

again. Could they (and their teachers) resist the urge to go outside the

limited range.

Could this establish a general practioner level and a specialized level such

as is western practice?

Peace

Ed Kasper LAc.

Santa Cruz, CA

Moody friends. Drama queens. Your life? Nope! - their life, your story.

Play Sims Stories at Games.

June 15, 2007

Hi Ed,

I find this a rather provacative idea...although perhaps with a slightly

different view. From a student perspective, I think it is important to

present the information in a way that enables one to make, what in

relational-database design, we call a " one-to-many " relationship: taking one

idea, in this case, one formula, and being able to apply it to many

different applications with appropriate modification (i.e., other associated

formulas).

I tend to be a " whole-picture " type of person - meaning that pieces of

seemingly disjointed information don't fall into place for me until I can

frame it in the larger picture. Applying the " one-to-many " theory to

studying formulas and reframing the information really helped me in school

(as I struggled with the traditional method of presentation) and is

something I still use today in practice.

Recently, something that I started developing to help me with

reorders/inventory control is also helping me to apply metrics to the

formulas/herbs that I prescribe, looking for trends (i.e., what

formulas/ingredients are most commonly used in my patient population, what

base formulas pop-up the most, etc). It's quite fascinating what's coming

up...all because of that nifty one-to-many approach.

I think, however, if I was only initially presented with 30 formulas as an

end number...not sure I would have made as many connections to

modifications, uses, etc. Hard to say for sure as the study of herbs is an

ongoing journey and I have a more intimate connection to certain formulas

now in practice than as a student - partly because of practical

use/application, partly from the familiarity that comes with time and

partly, I think, from the intial introduction as a student and the work I

needed to do for myself to help make it all come together.

I'm not sure it's appropriate to reduce the study of herbs into something

" simple " (which I don't think you're necessarily suggesting). However, it is

possible to make it more " accessible " and that, to me, is the key to

transitioning from learning to application.

Joy

________

Joy Keller, LAc, Dipl.OM

Board Certified in Acupuncture & Oriental Medicine

Ramona Acupuncture & Oriental Medicine Clinic

Phone: (760) 654-1040 Fax: (760) 654-4019

www.RamonaAcupuncture.com

June 16, 2007

Ed,

What exactly are you proposing? A weekend class? A one term class? A novel

format for herbal studies in school?

Who would you rather get a treatment from? Someone who really understands 30

formulas or someone who can write down 300 from memory?

There would appear to be three approaches here (though I will be the first to

admit that the distinctions, like so many, are largely arbitrary):

1)Base and modification

2)Modular

3)Unmodified formulas

Lets take them on their individual merits and compare the possible results.

A base+modification approach is more or less classically endorsed, in that most

formula descriptions use some variation of it, and there is so much literature

to back it up you end up with an embarrassment of riches. You also end up with a

variety of popular formulas that are well understood, and, while thirty might be

pushing the low end of the envelope in terms of treatment principles that you

may want to embody, you can probably pull it off. There are examples of

clinicians who use fewer than thirty formulas very effectively. In pedagogical

terms the difficulty arises in having to make everybody become very literate in

single herbs and their actions, such that they can totally parse each formula

and really understand how they are constructed, and how they interact with any

given pathology, as many classical formulas could be somewhat unwieldy and would

absolutely need proper modification to be broadly applicable.

A modular approach (to my mind at least) is reached by taking the smallest

working units in more complex formulas and learning to work with them. I think

of this as a " small formulas " approach. This has the advantage of being easier

then classical formula wrangling on some levels, in that once you have

identified a set of treatment principles you more or less have your formula. But

the method does not really have any pedigree that I know of outside of a few

people I have met who throw herbs XY and Z in to an Rx when they see symptom or

pattern A or B. This is not to say that these people aren't effective

herbalists, but their method is somewhat idiosyncratic and not well documented.

Using unmodified formulas is basically a patent approach, which can be

effective, but doesn't necessarily give you the flexibility you'd need in a

variety of clinical settings. Basically it would be a curtailed formulas class.

There are some fascinating essays on expanding the use of this or that formula,

and there is a lot of value in being able to switch up tools to do different

jobs, so even this approach could probably work, or at least be useful for

thinking about the formulas in novel ways.

If you took all of these and combined them you might end up with a pretty cool

class; a preliminary run through the unmodified formulas, followed by a

classical approach to modification and finally a look at the internal dynamics

of each formula and modification showing how the parts make the whole, and how

perspective shifts can adapt a formula to a totally different pattern without

much in the way of formula modification. You could probably so it in one term of

30-45 hours.

In general the idea of a much smaller pool of formulas for study makes a lot of

sense to me. We went through F & S one page at a time. A more wholesome and

pedagogically sound approach would be to pull a few relatively clear formulas as

exemplars of various treatment principles and then explore them thoroughly,

perhaps contrasting their function with other formulas the students would not be

responsible for. This is one of those " teach a man to fish " situations. Giving

students the ability to tear down and build formulas is much more useful then

having them go through rote paces like people learning some dance they have no

feeling for. Most of the students I have TA'd for can barely remember the last

chapter's formulas when they are being tested on the new material. I really

enjoy F & S as a book, but as a pedagogical method it doesn't make much sense. Er

chen tang is at the end of the book, while its main elements are used as

building blocks all over the place; expulsion of exterior evils is the first

thing one learns about, but it is a very difficult, controversy laden, and

complex topic that touches on supplementation, expelling cold and heat, and

various mechanisms of addressing dampness. I could go on, but I think you get my

point. I really enjoyed Bob Flaws' book on essential formulas for beginners

because it took a really long look at modification. A course teaching people how

to parse and build like that would be very useful. Given that ability any new

formula would be easy to assimilate and modify, so anybody who could really use

thirty formulas would probably be able to use as many as they wanted to given a

reference book and the will to do it.

Do you have a list of what you consider to be the 30 formulas? I would be very

interested to see it.

Par Scott

-

The Traveler

Friday, June 15, 2007 12:01 PM

Re: Mix and Match 30 Formulas

I think on this one you can answer your own Q. It depends how much you know

about formulas. You know for one that you can mix and match, and there's a lot

to mix and match. What good will it do if you have tons of herbs and not know

how

to use them? The more you know the more creative. The possibilities are

endless.

Regards,

Gloria

Happy Herbalist <eddy wrote:

I am hoping for some opinions and comments on the value of a program of

using only 30 Chinese formulas in a typical American clinic. Would it be

broad enough to function as a general practice or be limited.

I know of a seminar being offered as such. I do not wish to critique any

particular seminar or instructor as I feel that would tend to personalize

the discussion and I am hoping for a wider range or a broader discussion. I

also know there are books out with suggestions of having a herbal pharmacy

in the range of 50-60 formulas.

30 formals appeal to me because it is much easier to learn and master for

beginners. As such it would seem to form a more solid foundation with less

mistakes and better results versus a huge selection and the chance of

picking (guessing) the right one. IMO it would offer better peer review.

Is it better to really know more about a few than a little of a great many?

Or does one just end up with a hammer and every thing looking like a nail?

The process of becoming an expert in a finite works well in the martial arts

and in war.

My thought would be for first year students to begin learning 30 formulas

and to continue working and stressing those same formulas over and over

again. Could they (and their teachers) resist the urge to go outside the

limited range.

Could this establish a general practioner level and a specialized level such

as is western practice?

Peace

Ed Kasper LAc.

Santa Cruz, CA

Moody friends. Drama queens. Your life? Nope! - their life, your story.

Play Sims Stories at Games.

June 17, 2007

Par thank you for the commentary.

Lotus Institute has a seminar in October they are hosting based upon 30

formulas. (I really don't know anything about it)

And Chinese Modular Solutions appear to me to do the same - though not in a

Classical Formulas.

IMO, to be critical I find most practioners a " Jack of all trades and King

on None " .

I was thinking along the lines of mixing and matching 30 core formulas. All

as patent medicines where no single herb additional or subtractions were

possible. Maybe more so as Kampo is done in Japan ( ??)

Can the majority of patients be adequately treated using non-modified core

Classical formulas?

If they can should schools in their clinics stress his approach? Whenever

the non-conforming case presents itself it would be " kicked up " to a

" specialist " who then would review the case - explain why and what made the

case special - and modify the formula to fit. I see this as a two-tier

system. One of a general practice and the second of a specialist.

There seems to be value in such a system towards the western mindset. As it

fits neatly into a pigeon-hole data structure. As long as it is kept in a

TCM (and not western) framework case study-work becomes more acceptable and

accessible. Initial confusion over terms (Qi stasis, etc) for both

practiobners and patients, will erode over time and IMO resolves conflicts

with western medicine terroritorial rights, while presenting a clearer body

of evidence

If, as I still believe, that the real strength of TCM is in dealing with one

individual one case at a time still presents itself on the second tier and

to those specialists where the patient stands a better chance of success.

As it stands now [our profession] treat anybody anytime fashion. Most often,

or to a large extent, many who have tried everybody else without any success

and then wanders into our office. To the first tier practioner who has

experience successfully treating a wide range of " simpler " disorders will be

better able to recognize a complicated case and be able to define a TCM

treatment strategy (second tier) that offers hope to a impatient patient.

IMO, the schools would turn out general practioners. Then their Doctors

program could focus on specialists.

Peace

Ed Kasper LAc. & family

Santa Cruz, CA

........original message .....

Re: Mix and Match 30 Formulas

Posted by: " Par Scott " parufus parufus22

Sat Jun 16, 2007 5:42 pm (PST)

Ed,

What exactly are you proposing? A weekend class? A one term class? A novel

format for herbal studies in school?

Who would you rather get a treatment from? Someone who really understands 30

formulas or someone who can write down 300 from memory?

There would appear to be three approaches here (though I will be the first

to admit that the distinctions, like so many, are largely arbitrary):

1)Base and modification

2)Modular

3)Unmodified formulas

Lets take them on their individual merits and compare the possible results.

A base+modification approach is more or less classically endorsed, in that

most formula descriptions use some variation of it, and there is so much

literature to back it up you end up with an embarrassment of riches. You

also end up with a variety of popular formulas that are well understood,

and, while thirty might be pushing the low end of the envelope in terms of

treatment principles that you may want to embody, you can probably pull it

off. There are examples of clinicians who use fewer than thirty formulas

very effectively. In pedagogical terms the difficulty arises in having to

make everybody become very literate in single herbs and their actions, such

that they can totally parse each formula and really understand how they are

constructed, and how they interact with any given pathology, as many

classical formulas could be somewhat unwieldy and would absolutely need

proper modification to be broadly applicable.

A modular approach (to my mind at least) is reached by taking the smallest

working units in more complex formulas and learning to work with them. I

think of this as a " small formulas " approach. This has the advantage of

being easier then classical formula wrangling on some levels, in that once

you have identified a set of treatment principles you more or less have your

formula. But the method does not really have any pedigree that I know of

outside of a few people I have met who throw herbs XY and Z in to an Rx when

they see symptom or pattern A or B. This is not to say that these people

aren't effective herbalists, but their method is somewhat idiosyncratic and

not well documented.

Using unmodified formulas is basically a patent approach, which can be

effective, but doesn't necessarily give you the flexibility you'd need in a

variety of clinical settings. Basically it would be a curtailed formulas

class. There are some fascinating essays on expanding the use of this or

that formula, and there is a lot of value in being able to switch up tools

to do different jobs, so even this approach could probably work, or at least

be useful for thinking about the formulas in novel ways.

If you took all of these and combined them you might end up with a pretty

cool class; a preliminary run through the unmodified formulas, followed by a

classical approach to modification and finally a look at the internal

dynamics of each formula and modification showing how the parts make the

whole, and how perspective shifts can adapt a formula to a totally different

pattern without much in the way of formula modification. You could probably

so it in one term of 30-45 hours.

In general the idea of a much smaller pool of formulas for study makes a lot

of sense to me. We went through F & S one page at a time. A more wholesome and

pedagogically sound approach would be to pull a few relatively clear

formulas as exemplars of various treatment principles and then explore them

thoroughly, perhaps contrasting their function with other formulas the

students would not be responsible for. This is one of those " teach a man to

fish " situations. Giving students the ability to tear down and build

formulas is much more useful then having them go through rote paces like

people learning some dance they have no feeling for. Most of the students I

have TA'd for can barely remember the last chapter's formulas when they are

being tested on the new material. I really enjoy F & S as a book, but as a

pedagogical method it doesn't make much sense. Er chen tang is at the end of

the book, while its main elements are used as building blocks all over the

place; expulsion of exterior evils is the first thing one learns about, but

it is a very difficult, controversy laden, and complex topic that touches on

supplementation, expelling cold and heat, and various mechanisms of

addressing dampness. I could go on, but I think you get my point. I really

enjoyed Bob Flaws' book on essential formulas for beginners because it took

a really long look at modification. A course teaching people how to parse

and build like that would be very useful. Given that ability any new formula

would be easy to assimilate and modify, so anybody who could really use

thirty formulas would probably be able to use as many as they wanted to

given a reference book and the will to do it.

Do you have a list of what you consider to be the 30 formulas? I would be

very interested to see it.

Par Scott

June 17, 2007

Hi Ed,

If you want to treat with unmodified classic formulas Kampo would be the place

to start for resources. I haven't seen much good literature but it is probably

out there. Do they do whole formula mixing in Japan? Someone on here mentioned a

while back that it is done in Taiwan. It seems like a very strict limitation. My

feeling is that people who are good generalists with a small number of formulas

get that way through years of practice rather than starting with a small pool of

formulas, and modification is still a big part of how they work.

" Chinese modular solutions " sounds interesting, is there a list of the

constituent formulas and their ostensible functions? I've always only had a

single herb pharmacy, but I've been thinking about small,

one-treatment-principle units as a novel teaching method for a while now.

Comparing and contrasting small units of herbal formulas and dui yao that

ostensibly have the same function has always been enlightening.

What do you consider a specialist, a generalist with more herb experience, or

someone who is good at treating a particular type or category of disorder?

I'm not exactly sure what the advantage of this system would be, outside of

allowing for lowered expectations around herbal care. The approbation of the

Western establishment has never been a really high priority for me and I'm not

entirely sure what territorial rights you're talking about. If you mean between

practitioners, yes, it might be an overall improvement for patients if bad

herbalists passed difficult cases along, but they wouldn't really get a chance

to become good herbalists... : )

In your initial note you said something to the effect of " if the only tool is a

hammer than everything looks like a nail " and I think that might end up being

the case with this. Ostensibly fully trained clinicians of my acquaintance are

making very simplified diagnoses all the time, and typically it is because there

is virtually no training in formula modification or multiple pattern cases in

school. They will happily disregard fairly important symptoms, or guess about a

diagnosis based on very tenuous premises. I don't think training them to

appreciate fewer types of disorders with a mind of sending complicated things on

up the chain of command would encourage much critical thinking or necessarily

increase prompt referrals of " difficult " cases.

To my mind the only reason to limit formula selection in education is to

INCREASE formula comprehension and give it better connections to pathology given

a limited training time. One problem with the current system is that the focus

tends to be on rote memorization, and that alone doesn't build comprehension.

Setting up mentorship relationships, or internships with more experienced

practitioners makes sense, as would the establishment of some herbs-only

programs, and the decoupling of herb and acupuncture education for those who are

essentially wasting their time studying both. Consider that in Massachusetts

herbs are elective and at most about 30-40% of us who studied them use them in

our practices. I can't imagine where herbs are mandatory in California the rates

would be higher. Time in school is quite precious (and expensive) so it seems

logical that we should be able to educate people in the stuff that they will

use. It often seems that herb education is used as remedial TCM theory/pathology

education, where they really are decidedly different things.

Take care,

Par

-

Happy Herbalist

Sunday, June 17, 2007 2:04 PM