May 28th, 2013 § § permalink
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.
April 24th, 2011 § § permalink
It seems that there are a lot of cooling herbs in comparison to warming herbs, at least regarding what we need to know of Chinese herbs for class. There are cool herbs to release toxicity, cool herbs to clear deficient heat, cool herbs to resolve damp-heat and phlegm, and of course, cool herbs to release the exterior.
Again, these are known diaphoretics and diuretics. And also again, they are working from a Chinese perspective to get some sort of invading pathogenic factor out of the body. We mostly think of pathogens as being microbes of some sort, in this case the common cold and influenza. But really, pathogenic factors can be all sorts of things – it just has to come from outside and make its way inside.
An example of this is seen in people who are sensitive to eating a lot a sugar or drinking alcohol. They may start off feeling a scratchy, sore throat, drippy nose, gummed up ears, low energy, and if they continue to eat sugar over the next few days or so, perhaps their lowered immune response will develop into a full-blown cold. I have seen this happen to people – something lowers their immunity, making them susceptible to a cold, rather than the cold making its way in by itself. This is also an example of a deficient condition rather than an excess one. In an excess condition, the individual will have strong, normal defenses, but the pathogen will be relatively stronger, as opposed to a deficient, run down individual whos wei qi will be weaker than simple run-of-the-mill illnesses.
Many of the cool herbs to release the exterior are acrid or bitter like the warm exterior-releasing herbs, which either lift and disperse, or collect and drain downwards. Some, like kudzu (ge gan), mulberry (sang ya), soy bean (dan dou zhi) and chrysanthemum (ju hua) are sweet. Kudzu and blue vervain help to release tension in the muscle layer to expel pathogens before they penetrate deeper, particularly in the upper back, shoulders and neck. Classic western diaporetics fit in here, yarrow and elderflower. Add mint to those last two herbs and you have the Gypsy Cold remedy.
Mints – lots of mints – are fitted to release the exterior, whether they are warm or cool in temperature. Catnip, lemon balm, peppermint (bo he) a few of the cooler ones. Catnip is excellent at releasing the exterior, it is quite gentle but effective for bringing on and releasing a fever. Again, like most mints, it is also a nervine sedative and a carminative, a perfect pair of action to add comfort and support during a cold or flu. Melissa is one of my favorite plants, it has so many actions, is easy to grow, and it tastes divine and combines well with other herbs. It is known to be anti-viral and vasodilating, and is an effective carminative and nervine as well. It differs from some of the Chinese herbs in this category because it is sour in flavor.
Bo he, Mentha haplocalix, is the Chinese mint we are learning. To me, it is fairly similar to both peppermint and spearmint, with a little wild, earthy mint undertone. It is indicated for attack of win-heat invasion (as all herbs in this category are), slow skin eruption, headache, sore eyes and sore throat (because it is light and dispersing, mint can ascend to and treat the head), and for liver qi stagnation manifesting in distention of the chest.
Burdock seed (Artica lappa, Nui bang zi) is used in Chinese medicine for treating a sore throat and skin problems caused by toxic heat (think measles, mumps, carbuncles, boils, eczema, acne, ect…). Being a seed, it also moistens the intestines. The lungs and large intestine are paired organs in Chinese medicine, so it is no surprise when an herb (or acupuncture point) acts on both organ systems. Sure enough, cooling and moistening burdock seed is used for cough with sticky, hard to expectorate phlegm. David Hoffmann quotes Priest and Priest on burdock (529):
“…General alterative: influences skin, kidneys, mucous and serous membranes, to remove accumulated waste products. It is specific for eruptions on the head, face and neck, and for acute irritable and inflammatory conditions.”
Feverfew (Tanacetum parthenium) and chrysanthemum (C. morifolium, Ju Hua) are closely related herbs that fit well into this category. Both are slightly cold, acrid and bitter and enter the Liver and the Lungs (Tierra, 83). Ju Hua is well-known in Chinese medicine and beyond as an excellent remedy for eye complaints like red, sore eyes or vision problems (often combined with Goji berries/lycii berries/go qi zi for this). It calms Liver yang, which can raise heat and excess activity to the head causing dizziness, vertigo, headache, sore eyes and hypertension. To paraphrase from Bensky, “All flowers lift and dissipate – only Ju Hua can contain, accept and drain downwards”. This is because it is bitter and sweet in addition to being acrid and aromatic.
Given the Chinese medicine understanding or Ju Hua, the common used feverfew makes a lot of sense even though it is a different herb from a different place and medical system. It has been used as a specific for migraines, and much research has been done to explore its chemical properties and action (which are many – good idea for another post!). Besides certain types of migraines, feverfew has been used for pain, especially joint pain, as an emmenogogue, bitter and diaphoretic.
One last note…
It is sometimes difficult to make connections between my Chinese herb class and what I know about Western herbs. I sometimes wish I could marry the energetic understanding of Chinese herbalism with the scientific world of chemical constituents and botany from the West. Attempts have been made, and really good ones at that. Chen, for one, included modern research, drug interactions and chemical constituents in his book on Chinese herbalism. But he has little information about the classic Chinese texts, comparisons between the herbs and notes on energetics (which is present in Bensky’s book).
Even with all the knowledge coming together, East and West, there is still the whole issue of context and clinical usage. It’s not just an issue of translating Liver Yang rising to migraines, and visa versa, it’s about understanding a particular plant in a multifaceted way.
Bensky, Dan. Materia Medica.
Hoffmann, David. Medical Herbology.
Tierra, Leslie. Healing with the Herbs of Life.
October 7th, 2010 § § permalink
One of the first books I read on herbalism and health was Elson Haas’ Staying Healthy with the Seasons. There were many interesting little bits of knowledge and graphics in that book, including one relating parts of herbs to actions in the body systems. Here is how I remember it:
Plant parts along a surface-deep continuum from a Western view.
A week ago, I checked out a neat book to help me learn more about Chinese herbal formulations. Traditional Chinese Medicine Formula Study Guide by Qiao Yi walks the reader through all angles of formulating and a bit about pathology. The more I read about Chinese herbalism, the more I see similarities with what I’ve learned studying Western herbalism. Take this categorization about plant parts and actions from the study guide:
Plant part actions, Chinese medicine view.
I have looked in a few other sources in attempt to find more information about plant part and action/direction for both Western and Chinese herbalism, to no avail. (If you know of a resource, let me know!) One aspect in particular I’d like to get more information about is the Chinese medicine view about seeds, nuts and fruits. Why were they not mentioned along with flowers, roots and the rest? Are they included in flowers (which is where they originate)? There are a plethora of fruits and seeds in the pharmacopoeia, which is why I am confused.
Speaking of seeds…
Over the years there have been times when I relied on aromatic herbs and seeds/fruits. Kitchen spices like coriander, fennel, anise, dill, cardamom were my go-to’s for abdominal distention, gas and lack of appetite, ect. It seems to me that many seeds are very centering and assist the digestive process. The aromatic qualities of many seeds seem to be earthy, grounding, spicy, musty, as opposed to pungent roots like ginger, floral high notes like lavender, or bitter, stinging goldenseal. Of course not all seeds are aromatic, and not all aromatics are seeds, but perhaps there happens to be a digestive quality to them. Hmmm… Milk thistle seeds support the liver and detoxification (important for digestion) and even hawthorn berries are used to help ease the effects of over-eating or eating too much fatty food. Seeds, nuts and beans are a good source of fiber, too. Yet another good reason to eat your herbs!
When I first saw Haas’ continuum of cleansing herb part-deeper acting one, I felt there were important exceptions. I have to remember that models are just that, models, not rules. That’s one thing I like about herbalism – the lack of rules!
February 1st, 2010 § § permalink
A native Minnesota variety of an astragalus relative.
Astragalus membranaceaus is a native to China and other areas of Asia and is a member of the Fabaceae (pea) family. It tastes sweet, starchy, slightly warm and moist. According to Lesley Tierra, astragalus has adaptogenic, diuretic, antiviral, cardiotonic, antioxidant and hepatoprotective properties. Astragalus has gotten a lot of press as an adapotgen and for helping people with cancer and rightfully so as it “…helps prevent immuosuppression caused by chemotherapy and has tumor-inhibiting activity”(Winston, 149). It is a personal favorite of mine for preventing and/or treating regular-old colds and related infections.
The Chinese name of this herb is huang qi, huang meaning yellow (the color of the root) and qi meaning leader, as it is considered a “leader” among the tonics in the Chinese pharmacopeia because it can be used by a wider range of people than other tonics like ginseng. Astragalus strengthens spleen qi to aid weak digestion, nausea and vomiting, bloating, assimilation and lack of appetite. It also bolsters wei qi (protective energy or immunity) and lung qi. Not surprisingly, astragalus has been adapted into Western herbalism because of its use in strengthening the immune system and aiding in defense of colds, flus and infections of the respiratory system.
Astragalus is usually sold in root slices or pieces. It is mostly prepared as a tea although it also comes n powdered and tinctured forms. To make astragalus tea at home, bring 4 cups of water to boil, add about 4 tablespoons of the root and simmer covered for 20 mins. Let cool slightly before pouring a cup or two and straining. It is quite palatable, and people don’t usually have a problem drinking 3 cups of it in a day. A little honey or a simmering a cinnamon stick along with the astragalus extenuates both the sweetness and the moistening quality.
I like to drink astragalus tea daily in the winter, often for a month or longer, when everyone around me is getting sick or when I feel on the verge of a getting a cold. Just recently my husband came down with a horrible cold. I knew I’d be next, so I loaded up on astragalus tea so when I got the cold myself it wasn’t that bad – just a runny nose without a cough or constricted chest. It also combines well with other immune enhancing herbs like shiitake, eleuthero, ginger and echincacea, and is safe for children, pregnant women and the elderly.