經方學

This October in Nanjing will be a unique opportunity to study constitution and the classic formulas of the Shang Han Lun and Jin Gui Yao Lue with Dr. Huang.

What you will gain from this special course:

• Learn the 10 basic constitutional types as outlined in The 10 Major Formula Families
• Understand the similarities and differences between the frequently used formulas families of the Shang Han Lun and Jing Gui Yao Lue.
• Observe and discuss clinical cases.
• Learn to use constitution diagnosis, and how to select appropriate prescriptions from within formula families.
• Become facile with the classic formulas.
• See Chinese medicine as it is practiced in China.
• Learn specific indications for particular formulas.

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When and where?
We will depart Seattle as a group on Oct 1st, begin classes on Oct 4th, and then leave China and return to the States on Oct 19th. Classes will be held in Nanjing in the conference room of our hotel, and clinic observation will be at the Nanjing TCM University, which is a 10 minute walk from the hotel.

What else?
There will be an optional day trip to Shanghai for a day of shopping, eating, and a trip to the top of the tallest building in China for a bird’s eye view of China’s biggest and most exciting city.
Of course, Nanjing itself is full of history, and colorful Chinese life to be explored.

China is a long way to go for just two weeks.
For those wishing to extend their stay in China, and explore the otherworldly natural beauty of Guilin, for an additional fee, we are offering an optional 5 days in Yangshuo. This lovely river town is at the very center of Guanxi province’s watercolor-like karst limestone mountains and meandering streams.

It all sounds great. How much for this adventure?
Price of $2,795 includes tuition, translation, accommodations, airfare from Seattle, ground transportation between Shanghai and Nanjing, and a Chinese visa.
Space is limited to 8 participants!
To reserve your place, a non-refundable US$300 deposit is required.

But wait, there’s more!
We are applying for NCCAOM PDA units.

Contact:
To be considered for this unique trip, email: michael@classicformulas.com
or call 206-788-5941.

It is not just that one can see more patients with a particular illness in a morning, than you might see in an entire year. Nor, is it that there is something about the busy as a bus station feel of a Chinese clinic, where patients jostle for position like horses at the starting gate.

It is not that it seems a bit odd that patients come in talking of body centered complaints like too much fire, stuffy chest feeling, or dizziness, instead of the oft heard Western psychological constructs of anxiety, depression or fatigue. And it is not that there are magic formulas that Chinese doctors use over on the Eastern side of the Western sea.

But, there is something.

A friend of mine that was recently studying for two weeks in Nanjing had this to say about her time there:

“While I’ve written all kinds of notes about formulas, herbs, tongues and their assorted coatings, what I notice is that I am just different in how I am with my patients, more directive, and without apology.”

There is something about as the Chinese say “opening your world eyes”, seeing how things are different precisely because your usual filters for how to see the world simply don’t work here. There is something about learning to navigate the Qi flow of traffic and crowds that force a completely different sense of movement and space. And then there are the ever present “why do they do it like this?” annoyances of life as it unreels in ways that bring us toe with toe with our assumptions, expectations and unspoken preferences.

Learning medicine in China comes peppered with fragrances and flavors we don’t have in the West. It can offer other views than those we have preciously cultivated. It is not always particularly pleasant, but it can be uniquely informative.
And vastly worthwhile.

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I have been fortunate in my time in Asia to have come across a number of doctors who have inspired and contributed to my journey of learning medicine. Doctor Huang has been particularly unique, as I’ve grown to know him through both his written words and the time we have spent together in his clinic, classes and discussing his book “shi da lei fang.” He is that rare combination of doctor, scholar, and teacher.

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This fall in early October we will hold in Nanjing the very first 2 week intensive for western practitioners. This course will be based on Dr. Huang’s understanding of constitutional types, formula families, and how it all comes together in the clinical setting. It will be an unusual opportunity to learn first hand how to use the classic formulas of the Shang Han Lun and Jin Gui Yao Lue to treat patients on both a constitutional and illness basis. Watch for more information here as we work out the details.

For more information, and to get on a mailing list so you can be immediately updated with the latest news on this event, send an email to: michael@classicformulas.com and prepare to deepen your own understanding of how these ancient formulas work in the modern world!

It takes practice this abdominal diagnosis method. It is not just a matter of feeling where there is tension, or where the patient experiences discomfort. Getting a sense of how differences in skin, moisture, innate muscular tension, where there is fullness, and how emptiness can be easily not found are all part of the process.

The more I touch patient’s abdomens, the more I approach it with a sense of inquire and curiosity, rather than with the demand to find something, the more I discover patterns and presentations that at times lead to a clear sense of a patient needs, and at other times leads to further questions.

Here is part two of the abdominal palpation article that Steve Clavey and I did last year. It originally was written in Japanese, translated to Chinese where I found it in Taiwan, and then appeared for the first time in English in The Lantern, which of course, you are already subscribed to.

What? You haven’t yet?  Well, then click below, and remedy that situation!

Through the miracle of MP3, I’ve been having discussions with Dr. Huang on my morning walks to work. Actually, re-listening to the discussions we had in Nanjing. But, since words in Chinese have this sneaky way of going transparently through my ears when engaged in thinking and making sense, listening again to our conversations yields all kinds of new information.I have recently begun to translate the Ma Huang (麻黃類方) chapter, and in the Ma Huang Constitution it includes the sign of “aversion to cold.” People with the Gui Zhi Constitution also have that. So, I asked Huang about it.

This feeling of aversion to cold, is it different for Ma Huang and Gui Zhi types? 

His answer was surprising to me in that it had little to with the patient’s subjective sense, and more to do with an intersection of their feelings and objective perception of the practitioner.

Yes, they are different. The Ma Huang type has sensitivity to cold, but there is a lack of sweating, their skin is course and even sandy looking. Those Gui Zhi types, they also dislike cold, but their skin is fine, moist, and tends to be pale. 

It is not helpful to simply go on what the patient says. People all have different ways of experiencing themselves and body. Of course, listen to a patient’s subjective experience, but then back it up with your own objective observation. There is a more dimensional image that emerges when the observable and reported mutually inform each other.I rather like this approach of Dr Huang’s. That there are concrete physical signs that help us to differentiate a patient’s particular constitution. It is this background, along with the various signs and symptoms that help us to to determine how best to help a patient.It is not just a matter of what symptoms are present, but more importantly, the kind of person that is having those symptoms.

It is not common in the practice of acupuncture to use palpation as a method of gathering information to help one decide on a course of treatment. In herbal medicine, this has been a much less used method. At least here in the United States.

When living in Taiwan, I came across a book called the Medical Dictionary of Kampo Diagnosis and Treatment, (漢方診療醫典 Han Fang Zhen Liao Yi Dian), it was written by Dr. Otsuka Yoshinori, a Japanese practitioner of Chinese medicine, and translated into Chinese. It is a fine collection of the author’s clinical experience, written in a refreshingly candid fashion. Most interesting to me, was a section in the front, where he outlines a variety of abdominal patterns which indict which classic formula would be appropriate.

Abdominal signs are discussed in both the Ling Shu and Su Wen in the Yellow Emperior’s Internal Classic. While it appears abdominal diagnosis was a part of Han dynasty medical practice, and indeed there are lines in the Shang Han Lun that mention palpatory abdominal findings, it fell out of favor in later years. In Japan, however, that portion of the tradition has been preserved, and is part of the Kampo (漢方 han fang) tradition, where abdominal signs are the confirmation for prescribing various formulas.

The translation of this material on abdominal palpation and formula selection was a collaborative effort with Steve Clavey, editor of the fine Australian English language journal on Chinese medicine, The Lantern, where this article was first published. Get it here: SHL Abdominal Patterns I

While Michael Max and Steve Clavey retain the copy write on this article, it may be downloaded for individual use.

Watch for part two, coming to this blog in the near future!

Most Westerner’s exposure to the Shang Han Lun is that is an an old book that has something to do with the common cold, and the various complications that result. We get a smattering of it in acupuncture school, but it is a book that really has nothing to do with acupuncture. It does, however, have a lot to do with herbal medicine.

I am no expert in the Shang Lan Hun, but I have been fortunate enough to have teachers and friends who are. And Dr. Huang is no slouch when it comes to this classic text of herbal medicine. In fact, he reads it not as a book about the progression of acute infectious disease, he reads it as a manual of how to use herbs to treat a wide wide range of issues.

My time in Nanjing is winding down, three weeks goes by in the blink of an eye. We share a home-cooked meal and discuss history. He loves history, and in fact, history of medicine and medical theory is what his Master’s study was about.

“War is a catalyst for medical advancement”, he says.

Of course, this is true. Plastic surgery got its start in treating the injuries of WWII, and most people are aware of the advances in prosthetics that has resulted from America’s current adventure in Iraq.

The late Han dynasty was a turmoil of war and upheaval. The usual story is that Zhang Zhong Jing, the author of the Shang Han Lun cultivated his skill because so many people were suffering the resulting effects of scarcity, injury and want. Dr. Huang agrees on this point, but his opinion has a twist.

“Those days were not so different from now, all the good stuff went to the army. The best of the food, clothing and medical care too. ZZJ, a doctor of his skill and talent was most likely an army doctor. All the good ones were.”

It is never boring around being around Dr Huang. He has bright quick eyes, iconoclastic opinions, a distaste for the status quo, and a fierce dedication to helping people get better. He is a rare voice in committee approved and sanctioned China. It is never a dull moment.

“Gui Zhi Tang (Cinnamon Twig Decoction)”, he says with a smile as he knifes through golden ginger that is on its way to becoming the soup for our lunch.
“You know, it is not just for colds and those miscellanious sweating conditions.”

Think about it this way. Imagine a soldier who has seen battle, he is beat and weary. Probably in a state of shock from the bloodshed and watching his friend’s head rolling about on the ground. Imagine exposure to the elements, days of not eating well, no real rest. He stumbles into camp, half death and starving. What do you do?

He is certainly not in a state to eat much solid food. He has lost blood and is cold and without vital energy. His spirit is disordered, anyone’s would be after this kind of experience.

Now, think about Gui Zhi Tang. Cinnamon and ginger to warm, peony to nourish the blood and calm the heart, licorice to settle the frayed nerves, and plums to build the digestion. Chase it down with a nice easy to digest bowl of rice gruel, and have a nap.

The thing about Dr. Huang is that he makes a lot of sense, even when he is talking about medicine in ways I’ve never heard or imagined.

I’m thinking Gui Zhi Tang would be the perfect thing for those people that get lost in the woods for a few days.

I did not expect so many comments so quickly. If this continues I will have to look into setting up a discussion forum on this site as well.I love going to Chengdu for the ma-la hotpot, cheap foot massage, and teahouses. I also love to visit there because I get to hang out with Eran Pupkin, an Israeli friend who is about to begin a 5 year Masters program there. I’m jealous!A recent email of his had this:

Can you write more about the gui zhi type, and what happened if the person does not sweat at all, but have all the other symptoms, does he/she still consider a gui zhi type? 

Oddly enough, this was the question that was at the top of my list to ask Dr. Huang when I met with his last week to discuss some questions I had about the book.He had this to say:This is tricky. First of all, you can not really rely on your patients for much useful information. Often they really don’t know what it is that you are looking for. Then, there are those that will try to tell you what they think you want to hear. Others, will exaggerate. Still others, just do not really pay much attention to their experience. So, if you ask them questions like “do you sweat easily”, they either misunderstand what you are asking about, or just plain don’t know.What to do? Look for yourself at the skin, if it is coarse, dry, and looks kind of sandy, they are NOT a gui zhi type. If, however, they have skin that is fine, more white in color and is moist, then this is can be seen as an indication that they are a gui zhi kind of person.You as the doctor need to use your own eyes and hands to make sense of the person in front of you. Do not overly rely on what they have to say!

Will Cooper writes:

“By the presentation, prescribe the herbs” as being the rationale and foundation of Dr. Huang’s approach to treatment. Dr. Huang obviously has decided for himself what is meant by “presentation”, but do we know what the original author meant by that use of the word?

In a sense, yes, it is “root.” I was talking with him the other day, and told me about an insight he had at one point. That what originally he was seeing as “symptoms” in a patient was not really “symptoms” at all. It was just who they were.

Let’s take for example a “gui zhi” constitution person. They tend to have fair and fine skin, generally are thin and wispy, they are prone to stomach aches, they tend to sweat easily.

Now, you can look at their tendency to sweat and think “qi deficiency” or you could look at it and think “gui zhi people, they just are like that.”

…a more Japanese concept of the root is, “the root of the person, i.e., the background of who they are”, and that being resonant with the French concept of “terrain”, as being the background of who someone is as well. I remember when Volker Scheid was visiting us at SIOM, and he worked people up, it seemed that he utilized this approach also.

When he worked me up, he saw me as a “yang ming” type constitution, for example, and he used this ‘lens’ or perspective of what sort of constitution/terrain I had to then view my signs/symptoms/complaints, which then informed the herbal prescription he gave me.

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Yes, I think Dr. Huang is looking at it more like this.
Constitution, or as is said in Chinese 體質 (tî zhì), or the French concept of Terrain. If we use that lens to view our patients illnesses (or health for that matter) we come up with a different picture. It is another way of looking.

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Gui zhi people have a tendency to get sick in a certain way. Their illness tends to be different from, say, a shi gao person. Where this gets interesting is when the gui zhi person gets sick like a shi gao person, then you know you have an unusual problem on your hands.

I think one of the contributions of Dr. Huang’s work is bringing this concept of constitution, and its affinity toward the function of key herbs, into play.

Actually, there is a triangular  relationship that he uses. It involves Herbs, Person (constitution), Illness. But, more about that in another post!

It is not uncommon in life that failure opens a gate that otherwise would not have appeared. I’d gone to Beijing in the fall of 2002 to study with a Shang Han Lun doctor I’d been introduced to, but my Chinese just was not yet up to the task. It took jaw grinding days to read a few paragraphs, and my listening ability was like trying to tune in a broken radio. I gave up.

About that time Craig Mitchell was in Beijing, and sympathetic to my situation he encouraged me by handing me a thin book titled The Ten Major Formula Families (十大類方 shí dà lèi fäng). Told me that this Chinese stuff takes time, keep at it, and in the meantime read this. It is kind of an Idiot’s Guide to the Shang Han Lun. It’s a fun read, and has some really interesting ideas.

It has taken a few more years for the black holes in my understanding of Chinese to generate light and understanding. He was right, it is a fun read, and there are some tremendously interesting ideas. But, it is not an quite an idiot’s guide. In fact, it is a concise, thoughtful and clinically useful text. In it, Dr Huang looks at the “jing fang” the classic formulas of the Shang Han Lun and Jin Gui Yao Lue, not from the perspective of illness patterns and disease progression, but from the point of view of herb confirmations and formula presentations. In essence, he has taken the way we usually consider practicing Chinese herbal medicine, and turned it on its ear.

As Dr Huang says:

“In my practice I look at the what. I look at what kind of person is sitting in front of me. What is the condition of their muscular, their skin, their manner and eyes. This is how I come up with what kind of constitution they have. I then look to see what kind of signs and symptoms with which they present. Instead of tying all these to some abstract concept like liver fire, spleen xu, or qi stagnation, I map them to the well known functions of herbs that have been used in China for thousands of years.”

There is a saying in Chinese that sums this up:
“By the presentation, prescribe the herbs”
(對證下藥 duì zhèng xià yào).
That is what is helpful!

I’ve been thinking for a while that I would like to see this book in English. Last fall when I was traveling in China, I tossed it in my pack as the read on the train book. One day a Chinese friend asked me why the book was interesting to me. I told her it was one of the best books I’d read in any language on prescribing herbs. One day I’d love to translate it. She gave me a funny look and asked “So, what’s stopping you?”

Uh, the author’s permission to do so?
Um! Let’s call him and see if he would like to have it read by the English speakers of the world.
Twenty minutes, and a big dose of “yuan fen” later, I was talking to Dr Huang on the phone. Thus, began the journey of the “shi da lei fang” into English.

I’m spending most of the month of April here in Nanjing, sitting in Dr Huang’s clinic, attending his classes and discussing the book. This book might be thin compared to some of the tomes that have been written about our medicine, but in fact, it is the flower of tradition of looking at “jing fang” the classic formulas, from the perspective of the “herbs being the key.”

This website is dedicated to bringing that tradition to English speaking practitioners in the West. There will be occasional excepts from the book that I think are of clinical use, portions of discussions I’ve had with Dr Huang, and my own thoughts about herb confirmations and formula presentations as they relate to our daily clinical work.
I invite your comments and discussions. And most of all, hope that this information will serve to inform your practice in ways that allow you to help more people.