There is a clinical shift in my education program called Herbal Internship. Herbal Internship is solely dedicated to, you guessed it, herbal consultations. There are 4 one hour slots to treat 4 patients with herbs. Do an intake, take pulse and look at tongue, determine diagnosis and treatment principles, discuss a formula, send the formula off to be filled. Seems pretty basic, no?
Despite the fact that I have elected to do extra Herbal Internship shifts and know the drill, it is a far cry from basic.
First of all, people are complicated. There are often 3-5 major complaints. Rarely does someone have just one single thing as their chief complaint.
Secondly, conflicting signs are commonplace. Heat and Yang Xu (deficiency). Dampness in the Middle Jiao (digestion), which is an excess condition, and Blood Xu (deficiency).
Thirdly, we make it up as we go along. This is not a bad thing at all; it is simply challenging and pushes me to the limits and forces me to expand my way of thinking. There is a uncharted territory for a new practitioner. What I end up doing in the clinic can be completely different from what I learned in the classroom or what is laid out in a book. A neat things about Chinese medicine is that we treat the pattern, not the disease. With this, we don’t have to have figured out the pathology and etiology of every single disease state. We listen to how the body is expressing itself and use that to determine the course of action.
Then there’s the normal, worldly limits: time constraints, the dynamics of working in a group where we are all really nice and don’t want to be bossy, computer problems, ect…
I suppose this is what it would be like to have gone to an herbal medicine school. This is what you would do all day! IS this so, herbal school graduates? We do mostly acupuncture shifts which include herbal medicine and formula writing.
I shared the challenges. Now I would like to share the gems which come from these shifts.
First and foremost, my favorite part of Herbal Internship is the opportunity to be mentored by incredibly knowledgeable and experienced practitioners. Every supervisor is unique, with their own blueprint of background, world view, lineage, educational style, patient rapport, formulation style, ect…
This term my supervisor is Dr. Jin. There is so much I could say about Dr. Jin, but I’ll limit it to a few of the main things she has transmitted to our group. One is extremely practical and grounding – time management and doing brief intakes. For the first few weeks, she did the intakes and one of us wrote chart notes to demonstrate how to do an interview. Nobody had done this before, and it rocked my world in the best way possible. Take the intake on the chief complaints, take tongue and pulse, ask a few more questions to get a sense of the constitution and confirm or rule out a diagnosis. This is quite different from what we normally do, which is ask about the chief complaints and then every other body system, take tongue and pulse, then come up with a diagnosis.
The tongue and pulse tell us a lot; it is the major diagnostic tool we have, so listen to it sooner than later! If you do an intake with someone who’s chief complaint is anxiety and the pulse is slippery and the the tongue has a greasy yellow coat (indicating damp/phlegm), then different follow up questions will be asked than if the pulse was weak and deep and the tongue was pale pink and purple with a thin white coat (indicating deficiency of Blood). Asking all the body system questions can be too broad. You get so much information that you simply won’t use. I have heard in China that there are doctors who diagnose and treat simply by looking at the tongue and pulse; yet most will ask a few questions to get a clear picture.
Last term, my supervisor was John. There were two things I learned from working on John’s shift; one is to always keep the nature and flavors of the herbs in mind to help you make your herbal choices. The second thing that I took away was to write down tongue and pulse and come up with a clear, like really clear diagnosis and treatment strategies before thinking of herbs and formulas. You have to know where you are going before you can get there!
I did three make up shifts with another supervisor, Michael, who I will have next term. From those few shifts, I learned about formula families and the concept of people having formula constitutions (reminded me a bit of homeopathy or Matthew Woods), as well as the relevance and use of taking the meridian, organ, seasonal and cosmological influences into consideration. As above, so below. Microcosm, macrocosm. Really neat stuff.
There are other cool things about herbal internship, of course. Patients get better, which is awesome. Major patterns change, minor patterns transform, the person feels whole. Suddenly someone stops having vivid nightmares which make them feel exhausted all day, which they have had their whole life. Yes, herbs can do that (not that I had any doubt).
I am learning the art of formulation, which is something Chinese Medicine has down. I am learning new applications of herbs. With herbal medicine, you have to have a very clear picture of the diagnosis, because it is possible (not likely, but possible) to mess someone up with herbs if you don’t know what your doing, or there could be no improvement or not as much improvement. Acupuncture is much more forgiving, plus you have the body, channels and Qi to tell you what to do.
Herbal Internship is a group setting; 4 interns and a superiors working together. It is neat to work though cases with a group, what can I say. We all work together and have different ideas to bring to the table. One intern may be trained in a different pulse diagnosis, one may be a nurse and know the effects of medications like the back of her hand, one may be receptive to the emotional and spiritual state of the person through their tone and body language, one may of experienced the exact problem the patient is going through and can speak from experience. When all of these forces come together, it is can be magic.
As I write this, I feel my excitement rising up through my body. I feel like I have been handed the keys to the castle, and my gratitude for these talented teachers and herbalists is beyond words. I may not be ‘getting it’ or coming up with the best, most perfect formulas, but at least I feel I have been given the best education I could have to build a solid foundation to work from.