經方學

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The most exciting phrase to hear in science, the one that heralds the most discoveries, is not “Eureka!”, but “That’s funny…”
~Isaac Asimov

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We have these kinds of opportunities all the time in our clinical work. The pulse that does not feel quite like any pulse we have felt before. The odd reaction a patient has to a formula. The strange way that an acupuncture point that seems unrelated to a person’s problem, when palpated suddenly unfreezes a stuck joint.

Moments of discovery, more often than not first manifest as a head scratching annoyance. If we are quick enough and can turn it to curiosity, we have the opportunity to learn something new.

One of the first concepts we hear upon walking through the gate of Chinese medicine is that of excess and deficiency (xu虛 & shi實). Deceptively simple at first glance, this is one of the foundations of accurate diagnosis that tends to become more slippery as time goes on and we see patients in the clinic with strange mixes of symptoms. All the practitioners here in Nanjing have at least 10 years of experience, and like anyone seeking mastery,  some of us are still working on refining the basics as a way to sharpen our clinical eye.

Today’s guest post comes from one of the participants of the Nanjing seminar. It gives us a fresh insight into issues of excess and deficiency and the use of Ma Huang.

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The single most important thing I learned in the first week of studying with Dr. Huang in Nanjing is his explanation of “shi”and “xu”, most often translated as”excess” and “deficiency”. The usual translation to German is “Fülle” and “Leere”, which literally brought into English is expressed as “fullness” and “emptiness”.

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Even though we are used to the relational nature of terminology in Chinese medicine, it never was really satisfying when teachers spoke about a Gui Zhi Tang situation as “exterior deficiency”, while at the same time saying that there was no “real deficiency”, but only compared to the Ma Huang Tang situation, which is “exterior excess”. And on the other hand both the Ma Huang Tang and Gui Zhi Tang situations are “excess” in relation to, lets say: Yu Ping Feng San or Gui Zhi Jia Fu Zi tang conditions.

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Dr. Huang provided us with a new perspective by switching the focus to movement and function. On every level of the body there are doors, which have to open and close in appropriate ways, for example at the exterior of the body, the doors are the pores. If they stuck close (in other words don’t open properly) this is “shi”, if they stuck open (in other words: don’t close properly) this is “xu”. So in a Gui Zhi Tang Situation “Xu” means: the exterior doors are stuck open, and in a Ma Huang Situation “Shi” means: the exterior doors are stuck close.

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Ma huang is the primary herb used to open glands, which are considered to be one kind of door, like the sweat glands of the skin. Therefore it is used for acne to open the pores which are clogged shut. It can be used as well as to help release eggs of the ovaries, or for insufficient lactation. Whether a formula (like Gegen tang) is appropriate, depends on the constitutional body type and if the formula presentation fits with the disease presentation. Another example of how Dr. Huang uses Ma Huang for problems with glands is Zhen Wu Tang together with Ma Huang Fu Zi Gan Cao Tang and Dang Gui Shao Yao San for hypothyroidism.

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Furthermore the opening function of Ma Huang is also used for other “closed” types of problems, for example Bi-Syndrome. Dr. Huang even uses it together with Wen Dan Tang for patients with schizophrenia, who are mentally locked in by the use of anti-psychotic drugs.

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I’m sure that the new perspectives provided by Dr. Huang will allow us to expand the use of herbs and formulas even further.

Like those magic eye pictures, where when the vision is loosened just so a completely three dimension image appears. Learning to acquire an clinical gaze that is soft enough to take in the entire landscape of a patient’s presentation, and sharp enough to see clearly the shape and structure of dysfunction, is an acquired skill. Usually facilitated by guidance from an experienced teacher who has both the skill and inclination to share it. Dr. Huang is just such a teacher.

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Our class here in Nanjing uses The Ten Key Formula Families as a starting point. Unlike our last trip to Nanjing two years ago, he is not teaching the book; it is simply background for his current way of thinking and approaching clinical work. The ten constitutional types he introduced in that work have been expanded to include a number of other medicinals, and are now elements of a broader structure that helps us to better understand the predilections and disposition of our patients.

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While there is still a sharp focus on the patient’s constitution based on the herbal formula family they fall into, he also casts a broader net of discernment using the parameters of cold, heat, deficiency, excess, qi stagnation, blood stagnation, phlegm and dampness. Like the crosshatch pattern of a sieve, it gives us a finer granularity with which to shift a patient’s complaints and constitution into a formula that fits the lock of their dysfunction.

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Watch for more posts from Nanjing, as the lessons from the classes, observations from the clinic, and discussions over foot massages make their way to these pages!

This entry is a guest post from Australia’s Greg Bantick. It is a case study that reminds us how easy it is to dream into what we think our patients think and feel and how stepping back and getting a clear view their presentation can help to leverage their innate resources and healing process.

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72 year old, male patient. First visit, in November ’05.

Initial observations: About 5’ 11”, thin, wiry build. Alert, but with a hesitant gaze; collapsed, weary sitting posture; quietly spoken with an unanimated, tired voice; sluggish gestures; deeply troubled and really wanting relief.

Chief complaints his words: general debility, chronic constipation, sharp abdominal pain on and off since he was in his teens.

From questioning: sharp, stinging epigastric pain, with spasms and visibly quivering from Ren 12 up to ribs. Sharp radiating pain to the rib sides is strong enough to make him jump, with the right side being worse. The pain is aggravated by deep breathing, constipation, frustration and stress; eating tomatoes, salt, and especially oily, greasy foods. Contrarily he has a deep, gnawing, constant hunger. All of these were made much worse since the bitter breakup of a relationship last year. In the months after breakup he was hospitalized for two weeks with cholelithiasis and he is now waiting for a cholecystectomy. The pain is relieved by relaxation, and the hunger with dry, bland biscuits. He also complains of long-term chronic constipation years, and will often go without a bowel movement for 4 – 5 days. When he does go the stools are loose, greasy, smelly and dark.

Secondary complaints: Frequent, often daily, dull temporal headaches, Or less often they can be sharp, unilateral, mostly on the right side when right side rib pain worse. Left side around Sp 9 had a boil like lump, now several small lumps, pricking pain, feels “like a maggot running around in it”. Right side thigh, UB channel sciatica, when sitting on hard seats or when sitting a long time.

Other observations: Broken sleep due to acid reflux, sleep easily disturbed by noise and also because he has to urinate 2 -3 times a night. Very tense abdomen especially midline above navel. Many long surgical scars on the abdomen, including one from around Ren 9-14. Most of the abdomen is tender to light touch, making him wince when palpated.

History: As we spoke, he became more talkative and engaged with a remarkable ability to view his life objectively, and with a dry sense of humor. He has faced many difficult challenges in his life. In the interest of brevity, I will only mention a few that influenced my thinking. The abdominal scars were the result of several unnecessary surgeries up to age 19, performed at the insistence of his mother who suffered Munchausen by proxy syndrome. In his late twenties, he became a bank manager in a small town. He married, had 4 children, and lived happily in their small community. Much later, when his children were adults, he learnt from a friend that none of them were his. They were all fathered by his wife’s various lovers, and the reason she was late for their wedding was that she was having a “quickie” with the best man, then his best friend. Later, during his second marriage, in his sixties, he was kicked and beaten; including several kicks and blows to his abdomen. The beating was at the hands of his new wife’s son and daughter in law, following a dispute over her money. His wife was beaten too.

P: thin, deep, collapsing on pressure. ST and GB pulses had a rising up, floating sensation

T: thin, tending pale, moderately thick, dirty white coat

Diagnosis: focal distention in the epigastrium with counterflow of ST qi

My thinking: The patient had tried acupuncture with limited success. He was willing to give it another try, but had been referred to me primarily for herbs. I suggested we do both as I thought acupuncture, plum blossom hammer and moxa locally for the scarring would be useful. I was uncertain of my ability to help with his heavy burden, both psychological and physical. I thought that the pain in the abdomen, given its onset and duration, must be contributed to by the scar tissue, and was uncertain if herbs would help so long after the surgeries. I felt confused and saddened hearing his story, thus making it difficult to feel clear about my diagnosis. It felt easier to go with Liver qi constraint invading the Stomach based on the pain radiating into the hypochondria, long term frustration and anger (although in conversation he did not seem bitter, I just couldn’t imagine he wasn’t), aggravation by oily, greasy foods and temporal headaches all seemed to fit that diagnosis. Other factors made me go in a different direction. In thinking of his history and the impact on his health, I was drawn to a wider view of treating the qi mechanism.

Some key indicators to me;

-the main belly symptoms were on, or originated near the midline

-qi movement was unsmooth; there was pain in the epigastrium, tension in the abdomen depression and irritability, alternating constipation and loose stools

-qi was rising; reflux, headaches, poor sleep, sensitivity to noise, gnawing hunger, much rumination, constipation

-qi was sinking: frequent urination at night

Initially I was thinking I would need to use strong qi and blood moving herbs, especially in treating the scar tissue. I was also uncertain of his ability to digest and persevere with raw herbs. Given the duration, I was thinking this was going to be a long course of treatment. I was not confident that I had understood the case well and was tempted to write a long formula trying to address everything. In the end, I decided on a modification of Pinellia Decoction to Drain the Epigastrium (bàn xià xiè xïn täng) based on the midline focal distention and stomach symptoms and because I wanted to adjust the qi mechanism and harmonize counterflow. Aside from the other indicators for the formula I was thinking;

Pinelliae Rhizoma preparatum (zhì bàn xià) 9g and Zingiberis Rhizoma (gän jiäng) 6g; for their acrid flavors, which penetrate the qi and disperse. To dissipate epigastric focal distention and improve the ascending and descending of qi.

Scutellariae Radix (huáng qín) 6g, Coptidis Rhizoma (huáng lián) 3g; bitterness clears heat and drains downwards. Coptidis Rhizoma (huáng lián) clears heat in the heart, further encourages the descending action, clears heat and calms the spirit.

Ginseng Radix (rén shën) 6g, Glycyrrhizae Radix preparata (zhì gän câo) 6g, Jujubae Fructus (dà zâo) 6 pieces; Glycyrrhizae Radix (gän câo) is sweet and neutral. Jujubae Fructus (dà zâo) and Ginseng Radix (rén shën) are sweet and warm. One reason for epigastric focal distention is due to inhibition of the descending and ascending movements of qi. These sweet medicinals harmonize the center, freeing both above and below.

+ Salviae miltiorrhizae Radix (dän shën) 6g; one of my favorite herbs, it is bitter and slightly cold. It invigorates the blood, dispels stasis, clears heat, soothes irritability, as well as nourishes the blood and calms the spirit.

+ Aurantii Fructus immaturus (zhî shí) 6g; is bitter and acrid and slightly cold. It breaks up qi stasis in epigastrium and abdomen

Cooking instructions: cook each packet in 10 cups of water, cook down to 6 cups, remove ingredients and cook again until 4 cups remain. Take 1 cup in the morning and evening over the course of two days.

Second visit one week later. His pain was markedly reduced, and with a complete lack of sharp pain episodes. Reduced frequency and intensity of reflux, and bowel movements were regular for the first the days of taking the formula. No change to headaches or gnawing hunger. He looked more relaxed and energetic, but complained of being more irritable. He described some episodes where he had gotten angry. I considered this a step in the right direction as his qi was moving, he was not depressed, and could more easily acknowledge his anger.

P: thin, deep, stronger. No floating quality. Liver pulse weak on pressure. Continued acupuncture and the original formula.

Third visit one week later. Only one short, painful abdominal spasm that radiated toward the right side, otherwise no pain. No reflux and now sleeps through the night. Less gnawing hunger, able to eat a wider range of foods and enjoying eating. Frequency of headaches reduced, less irritability, more energy and he was clearly happier. Lumps at Sp 9 were minimal. Still tending toward constipation. P: less thin and tight, the liver pulse was stronger. Continued acupuncture and the formula adding Ophiopogonis Radix (mài mén döng) 6g, to moisten the intestines, clear heat and irritability, as well as supplement and preserve Stomach yin and Rhei Radix et Rhizoma (dà huáng) 3g, as its bitterness and cold clear heat and it also resolves blood stasis.

Fourth visit one week later. No epigastric or abdominal pain, no gnawing hunger, only one headache, much less irritable, more energy and a happier disposition. Missed a bowel movement one or two days, but didn’t feel uncomfortable not having gone. I continued to see the patient a few more times with continued improvement, until he moved interstate. During this time I also saw his second wife. They reconciled and were going to buy a place in the country and grow organic vegetables and herbs. Both were happier and healthier. As far as I know he has not needed the surgery.

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I see many patients with mood disorders, most of them with histories of real difficulties and trauma. While often being touched by their willingness to share so personally and deeply, I am sometimes thrown by the depth of their suffering. It can be hard to reduce their narrative to an easy syndrome differentiation. I sometimes doubt mine, and my medicines ability to heal and bring real change in these peoples lives. However, when I do my best to follow our elders and their understanding of qi medicine, and I borrow their ideas as encapsulated in their formulas, I am often really surprised at how effective our medicine can be. I also learn that adjusting the qi mechanism clearly resolves physical problems and also soothes deep emotional hurt as well. Many other SHL formulas share with Pinellia Decoction to Drain the Epigastrium (bàn xià xiè xïn täng) its simple, gentle and elegant construction, which focuses on adjusting and harmonizing the qi mechanism.

The back of Richard Goodman’s book says it best “Why not go deeper?”

I ran into Rick back in 2005. He was just arriving in Taiwan, I was on my way back to the USA; he rented the penthouse studio that overlooked Eternal Harmony City and the Xin Dian river that I’d been living in for the past year plus. Our paths crossed again when I purchased his book. Journeys through Chinese into medicine have a way of crisscrossing from time to time.

Anyone who has read the Mitchell/Wiseman/Feng translation of the Shang Han Lun knows that there are appendixes in the back that are a treasure trove of translation gold. Especially, for understanding the Chinese of The Discussion of Cold Damage.

Rick Goodman gives us some basic vocabulary, and more importantly, grammatical parsing that helps us to crack the code of Classic Chinese. Is it a comprehensive text that spills out all the gems of the Nei Jing, Nan Jing, and Jia Yi Jing? Of course not, the process of learning Chinese can in no way be captured in one book. Does it give us some keys that coax open those doors? Absolutely! It is a clearly written, carefully explained text that gives the reader access to the treasure house of Chinese medicine. Indeed, this book will give the dedicated reader an opportunity to go deeper.

Rick also has a second volume of what will be a three part series that will be published soon. Get the details here on his blog.

Thanks Rick for your contribution!

Like so many foreigners, soon after I first got to  Taiwan I experienced the joy of illness in a strange land. The lungs are my weak organ system, and given the Brillo pad atmosphere of Taipei, intensely cold AC mixed with murky heat and subtropic humidity, and stress of calling a very foreign country “home” it is not surprising that I came down with one frighteningly nasty respiratory condition.

It is hard enough to stand outside oneself and get enough perspective on how to treat your own condition, and it is even worse when your Americanized “pinyin-speak” rings nothing but confusion into the ears of the local herb store laoban. Luckily a friend, who was also there to study medicine, suggested we go to see this “old doctor” that a friend had recommended. We rode the subway to the “Eternal Harmony” district in search of a cure for my uncommon cold.

Like most Taiwanese clinics it is a storefront affair. Sandwiched in between a tiny lumber shop and bakery on a scooter littered sidewalk we found Dr. Jiang’s clinic, took a number and waited on the bowling alley-like plastic chairs. The TV blared pop Taiwanese music and news. I thought for sure I was going to end up in some hospital.

What little language study I had had in the States was completely useless in Taiwan. Classroom mandarin and real life full tilt language are two completely different animals. My friend translated my discomfort and fever to Doc Jiang. He wrote notes in what I would later come to recognize as a grass style type calligraphy, even the Taiwanese have a hard time reading his writing. I understood nothing of the exchange. It was his assistant that helped me to translate the formula into a language I could understand. And when I did I thought for sure this old doc should have been put out to pasture years ago.

What he prescribed was nothing like I’d been taught in school.

Doc Jiang’s idea of treating a Taiwanese cold was to prescribe, in granule form, five different complete formulas, which were then modified with several single herbs. Had I come up with a formula like that at school I would have had my tuition refunded. I considered flushing those herbs down the toilet, but then figured I was in Taiwan to learn something new about medicine. That this doc’s formula was off my radar was not necessarily a bad a thing. It was just…different…and different is no fun when you are sick. I took the herbs and went to sleep. Slept through the night, and woke the next day feeling 80% better and coughing slippery, wet phlegm from my lungs. I’m the guy who gets the dry cough. Clearly, this doc had a perspective that was worth exploring.

In the years that followed, I would spend a lot of time with Dr. Jiang. I came to find that his way of using herbs was a cross between what he learned from his father on the mainland, and the Japanese influence that is so intertwined with Taiwanese culture.

I came to see that he used formulas much how we would think of individual herbs. And that when treating almost any condition that involved the respiratory system he would see there being some kind of tai yang involvement. There were five herbs that he liked to use to resolve the exterior and clear toxin: jing jie, fang feng, bai zhi, yu xing cao, and a little bitty pinch of xi xin. This was added to any formula that he used to treat colds or allergies. In his way of thinking, opening the exterior would open the Lung. Indeed, there were many cases where I would have focused on clearing Lung heat, or nourishing Lung fluids, but he would simply resolved the exterior and give the qi mechanism a little push. The patient’s own zheng qi would take over and set them right. Elegant!

It has been a long journey and I am delighted to share the news that The 10 Key Formula Families in Chinese Medicine is now available. You will be able to find it at the usual outlets, and of course from Eastland Press. To help celebrate the occasion Eastland Press is offering a discount on the book from now, until the end of August.

From Huang’s forward to the Chinese edition:

While there are no less than dozens of formula categories in Chinese medicine, large and small, in this book we will discuss ten key families. While becoming familiar with theses formula categories and their constituent herbs, will not enable the reader to have complete mastery over all aspects of Chinese medicine. It will however, allow practitioners to grasp the rules in general for using Chinese herbal formulas, to understand the basic principles of Chinese medicine’s differentiation of patterns as a basis for treatment, and to handle these with ease in the clinic. Thus, laying down a firm foundation for the further study of Chinese medicine.

It is deceiving how much time and effort is required to dig the English out of one thin, little book on Chinese medicine; nor is it a solitary endevor. The assitance of my editor, Dan Bensky; the ongoing conversations both in person and by email with Dr. Huang; the patients that have visited Yong Kang clinic over the past few years and various collegues who have proofed the material and offered up their insights and suggestions, all of them share the responsibily for this book making its way into English. All have played a role in helping me to bring Dr. Huang’s words and ideas to the Western reader. I owe a deep debt of gratitude to all who have helped bring this project to fruition.

How did you develop your interest in the Shang Han Lun?

My interest in the Shang Han Lun was a result of my search for source materials in Chinese medicine, and my fascination with medical anthropology. Perhaps it has something to do with my Jewish background, as in Talmudic scholarship there is a strong incentive toward accessing source material and commentaries. I’ve always had the incentive to dig into the classical literature of Chinese medicine, but it took many years to find reliable translations.  I also began studying medical Chinese relatively late, about ten years ago.
When I first heard of the Shang Han Lun the translations that were available, such as OHAI’s Treatise on Febrile Disease or the New World Press translation were not very good.  I couldn’t make the text work for me. The Mitchell, Wiseman and Feng’s translation allowed me to finally immerse in the text, as it includes glossaries, and the Chinese, Pinyin and English translation are all pegged to each other.

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How did you learn your Chinese?

I began with a tutor ten years ago, Fred Wong, and then continued mostly on my own.  I utilized such texts as Paul Unschuld’s How to Read Chinese, and the Wiseman Chinese Medical Chinese series and Paradigm Press character series.

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Are there any kinds of issues that you think the classic formulas are particularly well suited for treating?

Quite frankly, everything; the classic formulas of the Shang Han Lun and Jin Gui Yao Lue are the essence of simplicity, but they can treat rather complex patterns by specific modifications or combining with other prescriptions from the texts. You can think of the classic formulas as the trunk of the great tree of Chinese herbal prescriptions. The Shang Han Lun is the template for later schools of thought and prescriptions, such as the Spleen/Stomach current and Warm Disease current.

I usually do not modify the formulas very much. These classic formulas tend to be good for cases that require finding the key to specific qi transformations.  For example, using Si ni san to treat dribbling urination by unblocking qi transformation in the San Jiao channel. Sometimes I combine a couple formulas together. They are really quite elegant in the way a simple addition or subtraction can shift the emphasis of the prescription.

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The use of classic formulas is more about matching a formula to a particular presentation, than it is about considering the Zang/Fu. Much of the schooling in modern Chinese medicine schools revolves around Zang/Fu diagnosis. How do you reconcile these two approaches in your clinical work?

I see it as having different prisms, which allow you to observe different phenomena. I call it the “Picasso Principle”, in that one can view a patient from several angles at the same time.  The Shang Han Lun provides other views of symptomatic phenomena effecting our patients, by seeing a continuum of change of medical conditions through a six channel warp or gradation.

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What are your thoughts about constitution and the treatment of illness?

I think it is both important and quite under-emphasized in modern TCM. For me, constitution is about observing the manner in which people tend to get ill. It comes from both their constitution and any changes brought about due to damage to the system over time, from illness, medications, poor diet, or emotional taxation. People get habituated to how they get sick, stuck in specific patterns; addressing constitution helps in these situations.

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Many people believe that the classic formulas of the Shang Han Lun are only for treating acute illness or the aftermath of acute illness. However many doctors use these classic formulas to treat chronic illness as well. Can you give us an example of using a Shang Han Formula to treat a chronic condition.

It is important to remember that the original name of the book was Shang Han Za Bing Lun, or Treatise on Cold Damage and Complex (Miscellaneous) Ilnesses. And do keep in mind that the Jin Gui Yao Lue is very much focused on chronic illness. There are sections on gynecology, water swelling diseases, skin problems, malaria-like disorder, and diseases of taxation.

If you read the Shang Han Lun/Jin Gui commentaries, you will find it is talking about all kinds of approaches to treatment and strategies, not just external contractions/wai gan. Really, it is a template for getting into a deeper level of understanding and application of medicine.

The other thing to remember about the Shang Han Lun is that it treats those illnesses that have become complex because they did not resolve, or were aggravated (huai bing) by inappropriate treatment. Purging/precipitation is not just about the misuse of da huang. Modern use of laxatives, or the currently popular colon cleansers, which purge people when they are in the midst of a tài yáng illness.  These products, or enemas, are recommend for the common cold.  Or large doses of Vitamin C which cause diarrhea. Another example would be the excessive use of diuretics that dry people out and as a result cause tremors and shaking. These are examples of the “mistakes” that Zhang Zhong-Jing talks about that can be reinterpreted in line with modern treatments or lifestyle.

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Any tips you have for our readers on ways of approaching the study of the Shang Han Lun and Jing Gui Yao Lue?

First of all, while it is important to read the book itself, and re-read it again and again; in addition, it is essential that you find a teacher who has experience. We are fortunate these days that there is are people like Arnaud Versluys who has developed extensive courses on both the Shang Han Lun and Jin Gui Yao Lue, and quality translations like the Mitchell/Wiseman/Ye translation. Soon we will have a Wiseman/Ye translation of the Jin Gui Yao Lue as well. To really make the material yours, constant review and study are required. I remember seeing Miki Shima at a conference once a few years ago. His copy of Mitchell’s translation was beaten and battered and had the cover torn off; the margins were filled with his own notes and observations. This kind of constant review, this kind of going back over the material again and again as we gain more experience is essential to unlocking its wealth.

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Andy Ellis is one of the significant contributors to our field. He is the co-author of The Fundamentals of Chinese Acupuncture, Fundamentals of Chinese Medicine, and Grasping the Wind. Author of Notes from South Mountain, and part of the team that has given us the latest edition of Eastland Press’s Formulas and Strategies. He is the founder of Springwind Herb Company; not only does he find time to teach and practice, but he manages to mix it up on a basketball court several times a week as well.

While our paths often cross in Taipei, this time we had to catch up on online.

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How did you manage to find your way to Taiwan in the 80’s, and what was your motivation at the time?

I first went to Taiwan in 1983 to further my studies in acupuncture. I had studied with Dr. So at the New England School of Acupuncture for a year or so and then Dr. So got ill. I wanted to learn the real thing and since China was not accessible at that time I opted for Taiwan. At that time I had no intention to study herbs but when I got to Taiwan I realized that Chinese medicine there was largely herbal. There were, and still are, herb shops in every neighborhood.

You have spent time both in Taiwan and Mainland China. How would you say the medicine traditions differ between these two places?

It is hard to characterize an entire population. There are many traditions in Taiwan and many in Mainland China. In herbal practice there has been a great influence by Japan in Taiwan. The most obvious one being the use of concentrated granules. Like the Japanese, Taiwanese doctors emphasize formulas from the Discussion of Cold Damage (傷寒論 Shang Han Lun) and the Restoration of Health from the Myriad Diseases (萬病回春 Wan Bing Hui Chun). In modern mainland China the Restoration of Health from the Myriad Diseases is largely ignored. The Cultural Revolution, which had a large influence on China also influenced the medicine. Much of the spiritual nature was removed and a more dialectical approach was substituted for primarily political reasons. That is not to say that there were not many wonderful schools of thought that survived this purging but it was definitely an influence and can be seen in the modern writings.

Both Taiwan and China seem to feel a need to have their medicine be taken seriously by the West. They have taken slightly different approaches to gaining this approval. That is a long topic perhaps for another discussion.

Dr. Shi was a real influence for you. What about your time with him informs the way you approach medicine today?

Dr. Shi was the kind of doctor that I had hoped I would find in China. His unending patience and kind manner set an example that my better self recognized immediately. His approach to the medicine was not dogmatic and he felt truly that he was the fortunate recipient of a tradition that dated back to the early Han. Anyone who spent time with him gleaned immediately that he felt privileged to be able to help others with the information and tradition that had been handed down to him. I can only hope to emulate his manner and the unending study he engaged in order to help his patients.

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Andy’s book about Dr. Shi, not only is part of his contribution to us in the West, but also passes along some of the essence of Dr. Shi’s experience, learning and teaching. You can download THIS pdf file that contains a few pages from the book; it gives  a glimpse into the mind of Dr. Shi. Andy is making the book available at a 10% discount to the readers of classicformulas.com.

Click HERE to go directly to the Springwind site, at the checkout page simply enter classicformulas in the coupon space. This book not only gives great clinical tips, it also gives you a taste of how a gentleman/doctor thinks and works. We don’t have many books like this.

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It may not be a trip to China, but it is an opportunity
to engage the mind of a true doctor of the art!

One of the really interesting things about use of the “jing fang” is that the change of a single herb, or even the amount of an herb used, can have a significant impact on the function of the formula.

A friend of mine who has shelves full of books concerning the Shang Han Lun once mentioned over tea and cookies that because the classic formulas are not made of many herbs, it is easy to understand how a small change can have significant results. Thus, studying and using the prescriptions from the Shang Han Lun and Jin Gui Yao Lue are a great way to both save your patients money, as these prescriptions tend not to be expensive, and for you as the practitioner to hone your skill in understanding how the change of a single herb can have profound clinical effects.

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As Dr. Huang says, this is part of the “beautiful attraction of the Classic Formulas.”

It is rare that I find really amazing books about Chinese medicine. The vast majority of mind opening books in my collection have been recommended to me by someone else. I am ever in the debt of others who also walk this path. Recently, over a plate of dumplings, Gabriel Fuentes and I were discussing medicine in Taiwan. Taiwan is a goofy place as it is possible to be a well skilled doctor and not have a license. For that matter, it is possible to study for years and years abroad with deeply skilled doctors, but if you don’t have the pedigree of a Taiwanese diploma; no license for you. However, if you have the “stuff” to be a doctor, you open a clinic anyway. If you have the ability to help people; they will come to you.  I just love Taiwan!

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Over those dumplings I found out about this guy, Dr. Zhang,  who is rumored to be good with the pulse, and spot-on with herbs. A bunch of both students and licensed doctors ride up into the mountains outside of Taichung to study with him, and they have written down the methods and clinical reasoning of this guy.

The great thing about knowing how to read Chinese is that you get access to material as far away from English as Taipei is from Tennessee.

One of the collections of notes concerns dui yao, the pairing of herbs. While these herbal couplets are useful when thinking about any formulation, the changes they make to a “jing fang” formula are even more pronounced. Here is a taste of Dr. Zhang Guo-Yang’s work. I hope you find it helpful in your clinical practice!