California Acupuncture Board Decreases Herb Portion of Exam

July 22, 2009

I recently was informed that the California state acupuncture board has

decreased the herb portion of the exam from 17% to 11%. They did this based on

an occupational analysis of existing practitioners. I don't know about any of

you, but I never received a questionnaire asking me about this. Apparently, they

found that so few practitioners use herbs, they needed to decrease the amount of

herb questions on the exam! They expect the schools to model their curriculum

based on this nonsense.

This will not affect the upcoming exam next month, but it will come into effect

in the winter exam. The board told me that they received no comments against

this proposal from the schools, but I doubt if many of them were aware of it.

The school where I teach plans to send them a letter, and I would recommend that

others do the same. We can't affect the winter exam, but maybe we can get this

ruling reversed for future exams.

There are numerous reasons why this is a bad idea:

1. The questionnaire should have been sent out to ALL California practitioners.

2. People will continue to use herbs, and insufficient training will only lead

to adverse events.

3. Education should not be determined by what people are doing in the field, but

it should be based on what is considered to be a proper education.

There are plenty of other reasons as well.

I know many of you don't practice in California, but your letters are still

welcome. Here is a web page with contact info:

http://www.acupuncture.ca.gov/contact_us.shtml

July 22, 2009

I know there is a response from one Los Angeles school and I thought I heard

that it would be a joint statement from many, if not all, of the California

schools.

I don't know to what degree this shift is mandated by the consumer Boards or

whether it comes from the testing agency. I believe it is the former and thus

will be a hard thing to change.

Doug

, " bill_schoenbart " <plantmed2

wrote:

>

> I recently was informed that the California state acupuncture board has

decreased the herb portion of the exam from 17% to 11%. They did this based on

an occupational analysis of existing practitioners. I don't know about any of

you, but I never received a questionnaire asking me about this. Apparently, they

found that so few practitioners use herbs, they needed to decrease the amount of

herb questions on the exam! They expect the schools to model their curriculum

based on this nonsense.

>

> This will not affect the upcoming exam next month, but it will come into

effect in the winter exam. The board told me that they received no comments

against this proposal from the schools, but I doubt if many of them were aware

of it. The school where I teach plans to send them a letter, and I would

recommend that others do the same. We can't affect the winter exam, but maybe we

can get this ruling reversed for future exams.

>

> There are numerous reasons why this is a bad idea:

>

> 1. The questionnaire should have been sent out to ALL California

practitioners.

>

> 2. People will continue to use herbs, and insufficient training will only lead

to adverse events.

>

> 3. Education should not be determined by what people are doing in the field,

but it should be based on what is considered to be a proper education.

>

> There are plenty of other reasons as well.

>

> I know many of you don't practice in California, but your letters are still

welcome. Here is a web page with contact info:

>

> http://www.acupuncture.ca.gov/contact_us.shtml

>

July 22, 2009

I teach Board exam prep classes and agree that reducing the herb/ formulas

portion

is ridiculous. Mind as well just burn all of the classics and dispense

vitamins.

K

On Wed, Jul 22, 2009 at 6:44 PM, wrote:

>

> I know there is a response from one Los Angeles school and I thought I

> heard that it would be a joint statement from many, if not all, of the

> California schools.

> I don't know to what degree this shift is mandated by the consumer Boards

> or whether it comes from the testing agency. I believe it is the former and

> thus will be a hard thing to change.

>

> Doug

>

> --- In

<%40>,

> " bill_schoenbart " <plantmed2 wrote:

> >

> > I recently was informed that the California state acupuncture board has

> decreased the herb portion of the exam from 17% to 11%. They did this based

> on an occupational analysis of existing practitioners. I don't know about

> any of you, but I never received a questionnaire asking me about this.

> Apparently, they found that so few practitioners use herbs, they needed to

> decrease the amount of herb questions on the exam! They expect the schools

> to model their curriculum based on this nonsense.

> >

> > This will not affect the upcoming exam next month, but it will come into

> effect in the winter exam. The board told me that they received no comments

> against this proposal from the schools, but I doubt if many of them were

> aware of it. The school where I teach plans to send them a letter, and I

> would recommend that others do the same. We can't affect the winter exam,

> but maybe we can get this ruling reversed for future exams.

> >

> > There are numerous reasons why this is a bad idea:

> >

> > 1. The questionnaire should have been sent out to ALL California

> practitioners.

> >

> > 2. People will continue to use herbs, and insufficient training will only

> lead to adverse events.

> >

> > 3. Education should not be determined by what people are doing in the

> field, but it should be based on what is considered to be a proper

> education.

> >

> > There are plenty of other reasons as well.

> >

> > I know many of you don't practice in California, but your letters are

> still welcome. Here is a web page with contact info:

> >

> > http://www.acupuncture.ca.gov/contact_us.shtml

> >

>

--

Turtle Island Integrative Health

TCM Review director

CA State Board Prep Courses

www.tcmreview.com

July 24, 2009

, " bill_schoenbart " <plantmed2

wrote:

>

> I recently was informed that the California state acupuncture board has

decreased the herb portion of the exam from 17% to 11%. They did this based on

an occupational analysis of existing practitioners. I don't know about any of

you, but I never received a questionnaire asking me about this. Apparently, they

found that so few practitioners use herbs, they needed to decrease the amount of

herb questions on the exam! They expect the schools to model their curriculum

based on this nonsense.

Well spoken, Bill. I heard about this change a few weeks ago, and I agree with

you that it is quite a tragic shift in policy. I wrote the following blog at

Bluepoppy.com to expand upon the discussion that you've raised here. While I

typically don't cross-post my blogs to our discussion group, this one seems

relevant because it was inspired by Bill's comments.

Below is the original from the Blue Poppy blog. By this point, we have nearly

200 articles on the blog, so one can find all manners of topics by digging

through the archives at http://www.bluepoppy.com/blog/blogs/blog1.php

California Acupuncture Licensing Exam Reduces Herbal Portion

By Eric Brand

The California Acupuncture Board recently announced that they will reduce the

proportion of herbal medicine questions on the licensing exam from 17% to 11%.

Apparently this decision was made following an occupational assessment-

practitioners weren't using herbs so the emphasis on herbal medicine will

decline in the exam. Yet again, instead of raising the bar so that people rise

to the challenge, the bar is being lowered. Like an army that can only march at

the speed of the slowest soldier, the entire Chinese medicine field suffers when

our professional standards drop.

In the past, the California board exam was harder than any other exam in the

country. The California exam required more comprehensive study of Chinese

medical theory than the old national exam required, because herbal medicine was

a mandatory aspect of the California test. Now that the new test will have only

22 questions on herbal medicine, there is a fear that the schools will reduce

their emphasis on herbs in response to the widespread student demand for easier

curriculum that teaches to the test.

The schools themselves would prefer to maintain a stronger emphasis on herbal

medicine, since this allows them to sell more classes and produces graduates of

a higher caliber. Word on the street is that some schools are organizing a

response to the Board, but the potential impact is still unclear. As they say in

Spanish, " cosas de palacio van despacio " (affairs of the palace move slowly).

Most practitioners would prefer to see the exams get progressively more

rigorous, because students will always rise to pass a harder test. By making the

test easier, we risk bringing in new practitioners who lack adequate training in

herbs. This will create more adverse events and more negative press and

regulation. The graduates of today are our public face of tomorrow, so already

licensed practitioners want to see only the most educated new practitioners

entering the market. We don't want the market flooded with poorly-trained

practitioners.

Already, our schools lack adequate training in many aspects of herbal medicine,

such as herbal pharmacy. Unlike China, where pharmacy is a specialized subject

and trained pharmacists manage ordering and dispensing, practitioners in the

U.S. are often doubling as both the doctor and the pharmacist. Yet our training

in pharmacy issues such as avoiding dangerous substitutes and ineffective

counterfeits is often lacking. Schools have no place for these classes in their

curriculum, and the many students that do not want to use herbs already complain

bitterly about the emphasis on herbs in California schools. Having an exam that

further reduces the herbal emphasis allows the non-herbally inclined students to

complain more vigorously, which further limits the potential of all students to

study herbs at an advanced level.

At the moment, we are fighting just to maintain our right to practice herbal

medicine. The new generation of FDA laws requires greater vigilance on the part

of the herbalist, and the increasing scrutiny on our profession demands that we

be well-informed on the safe practice of herbal medicine. Herbs are the most

effective tool we have, but their responsible use requires solid training. Many

practitioners have never even heard of high-profile safety issues like

aristolochic acid and substitute medicinals. We are already sitting ducks for

regulators because most schools offer no training on the key public safety

issues of herbal pharmacy. The last thing we need to do is reduce the amount of

herbal medicine material on our exams.

On the bright side, the field of herbal medicine is expanding tremendously.

Acupuncture had explosive growth in the early arrival of Chinese medicine to the

West, and the next era of explosion will revolve around herbal medicine. Anyone

wishing to distinguish themselves can easily focus on herbs, simply because

there is so little professional competition. Assuming that poorly trained

practitioners don't get herbs banned for all of us, it will be progressively

easier to distinguish oneself as a TCM internal medicine specialist if most of

the community lacks sophisticated herbal skills. But it seems a bit twisted to

squeeze even a drop of optimism out of such a poor shift in examination policy.

July 24, 2009

Having dug into the Shang Han Lun tradition via Arnaud Versluys this Spring, it

has crossed my mind more than once that there are some problems in the way the

herbal education is structured in our T.C.M. schools in Ca. It occurs to me that

it might be easier for students to learn a more concise materia medica than the

several hundred that students are required to memorize as a foundation. I also

believe that it could be useful to give students more information about

classical formulas and their construction earlier in the curriculum as to give

more time to see the rubber meet the road. Knowing that Arnaud teaches students

around the world, including M.D.'s who are quickly implementing the SHL methods

in hospital settings, helps confirm this belief.

From my observation, and this comes from only a couple of years supervising

students in a clinic in one school, many students will see very little modeling

of the bulk of the materia medica they are required to study. I have even heard

students in their internships say that they saw bulk formulas made only a couple

of times and that they didn't know what the formulas were yet so it didn't sink

in.

We also have most students taking formulas classes up into their 6th semester

thus having little chance to implement, let alone see modeling of these formulas

in action after having studied them.

Another problem seems to be that many of the formulas required for study are not

representative of classics nor current standards of Chinese hospital internal

medicine formulas. I know a lot of people on this list could speak more

authoritatively than I could about this and I welcome this. Is there a way to

make this officially updated?

While I will personally write a letter to support the retention of the current %

of testing in the Ca. exam, I think there are a lot of problems with the ways

students and practitioners enthusiasm is being retained for herbal medicine. I

think that if students had herb-centric externships and other residency type

settings to look forward to towards the end of their education or after they've

completed the standard education, the value might be realized.

Pardon the disjointed nature of this as I am concurrently doing some post haste

baby proofing of the home.

Ben

_______________

Bing™ brings you maps, menus, and reviews organized in one place. Try it now.

http://www.bing.com/search?q=restaurants & form=MLOGEN & publ=WLHMTAG & crea=TXT_MLOGE\

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July 24, 2009

Ben, there is no way to write a linear analysis of this... All these issues

swirl around endlessly. Let me throw my thoughts into the vortex.

I would say to Eric that I don't think that the Exam will be any easier because

of this change. It will just be easier for the student to justify spending less

time on herbs throughout the program. But I'm not sure they would be wise to do

so because...

Looking at the criteria on their website, one sees that all of herbal medicine

is " still' 17 percent when factoring in herbal identification. Diagnostics is 20

percent (minus 4 percent for biomed) so if we add these two together potentially

there is 33 percent that could concern " CM herbs " . One has to get through

diagnosis to eventually circle one of those 11 (or 17) percent herbal answers.

To tell you the truth I don't see that as an unrealistic assessment of what I do

in my own office. The herbs are one answer to the many problems I have to answer

for my patient. Critical - more than 17 percent critical- but still just one

answer to circle. ( a little devil's advocate here)

I think the community has to answer for the push for the increase in Western

curriculum a few years back. I'm one of those who believes that the program has

been drained of CM emphasis.

Doug

_______________________

Examination Content

The content of the California Acupuncture Licensing Examination is based on the

results of a comprehensive occupational analysis, which is revised every four or

five years, most recently in 2001. Licensed acupuncturists in California were

surveyed in order to identify the tasks, knowledge, skills and abilities that

are important components of the acupuncture professions.

The following percentages indicate the portion of the test devoted to each major

topic. For further definition of the content areas, please refer to Table 13

(page 15) in the 2001 Occupational Analysis / Validation Report found on this

web site

Content Area: Patient Assessment

25%

The practitioner obtains patient's history and performs a physical examination

to determine presenting complaint and interrelationship among symptoms. The

practitioner determines the effects of Western medications the patient is

taking. The practitioner uses modern diagnostic testing procedures to augment

traditional assessment methods.

1. (A) Obtaining Patient History (12%)

2. (B) Performing a Physical Examination (9%)

3. © Evaluation for Western Pharmacology (2%)

4. (D) Implementing Diagnostic Testing (2%)

Content Area: Developing a Diagnostic Impression

20%

The practitioner evaluates clinical manifestations to determine the relative

strength and progression of disease. The practitioner evaluates patterns of

disharmony according to theories of Oriental medicine to arrive at a final

diagnosis. The practitioner demonstrates a knowledge of how pathology in Western

medicine relates to disease in traditional Oriental medicine.

1. (A) Forming a Diagnostic Impression (8%)

2. (B) Differentiation of Syndromes (5%)

3. © Biomedical Disease (4%)

4. (D) Oriental Treatment Planning (3%)

Content Area: Providing Acupuncture Treatment

29%

The practitioner implements knowledge of the therapeutic effects of points and

combinations of points in modifying pain, normalizing functioning, and treating

disharmonies. The practitioner uses anatomical landmarks and proportional

measurements in locating points on or near body surfaces. The practitioner

identifies clinical indications for using alternate treatment modalities.

1. (A) Point Selection Principles (6%)

2. (B) Point Categories in Acupuncture Treatment (7%)

3. © Point Location and Needling Technique (4%)

4. (D) Performing Auxiliary Treatment (4%)

5. (E) Implementing Microsystems in Treatment (1%)

6. (F) Treatment Observation and Modification (2%)

7. (G) Acupuncture Treatment Contraindications (5%)

Content Area: Prescribing Herbal Medicinals

17%

The practitioner prescribes herbs and formulas based on diagnostic criteria. The

practitioner modifies formulas and dosage of herbs according to patient's

condition. The practitioner identifies situations and conditions where herbs and

formulas would produce undesired effects.

1. (A) Identification of Herbs (6%)

2. (B) Prescribing and Administering Herbs (11%)

Content Area: Regulations for Public Health and Safety

9%

The practitioner understands and complies with laws and regulations governing

hygiene and the control of pathogenic contaminants. The practitioner applies

legal guidelines for office practices and maintenance of patient records. The

practitioner adheres to legal requirements for reporting known or suspected

child, elder, or dependent adult abuse.

1. (A) Practice Requirements (2%)

2. (B) Patient Protection (7%)

July 24, 2009

I have recently seen Huang's 10 Key Formula Families and it is Good.

To take your idea, using a book such as this as required for the State Board

would get us more in line with Kampo. We could bridge the TCM and Western. (oh

lord, what am I saying???!!) At least, there would be a positive way for us to

show the Japanese-Western health care system works with Chinese herbs.

(Prescribed only by MD's unfortunately).

It is clear that our herbal teaching has a lot to be desired. As Dr. Huang says

in the introduction, this is not just confined to the West.

The California State Board is now (is it too late?) reviewing its Book list.

Doug

, ben zappin <btz23 wrote:

>

> Having dug into the Shang Han Lun tradition via Arnaud Versluys this Spring,

it has crossed my mind more than once that there are some problems in the way

the herbal education is structured in our T.C.M. schools in Ca. It occurs to me

that it might be easier for students to learn a more concise materia medica than

the several hundred that students are required to memorize as a foundation. I

also believe that it could be useful to give students more information about

classical formulas and their construction earlier in the curriculum as to give

more time to see the rubber meet the road. Knowing that Arnaud teaches students

around the world, including M.D.'s who are quickly implementing the SHL methods

in hospital settings, helps confirm this belief.

>

> From my observation, and this comes from only a couple of years supervising

students in a clinic in one school, many students will see very little modeling

of the bulk of the materia medica they are required to study. I have even heard

students in their internships say that they saw bulk formulas made only a couple

of times and that they didn't know what the formulas were yet so it didn't sink

in.

>

> We also have most students taking formulas classes up into their 6th semester

thus having little chance to implement, let alone see modeling of these formulas

in action after having studied them.

>

> Another problem seems to be that many of the formulas required for study are

not representative of classics nor current standards of Chinese hospital

internal medicine formulas. I know a lot of people on this list could speak more

authoritatively than I could about this and I welcome this. Is there a way to

make this officially updated?

>

> While I will personally write a letter to support the retention of the current

% of testing in the Ca. exam, I think there are a lot of problems with the ways

students and practitioners enthusiasm is being retained for herbal medicine. I

think that if students had herb-centric externships and other residency type

settings to look forward to towards the end of their education or after they've

completed the standard education, the value might be realized.

>

> Pardon the disjointed nature of this as I am concurrently doing some post

haste baby proofing of the home.

>

> Ben

>

_______________

> Bing™ brings you maps, menus, and reviews organized in one place. Try it now.

>

http://www.bing.com/search?q=restaurants & form=MLOGEN & publ=WLHMTAG & crea=TXT_MLOGE\

N_Local_Local_Restaurants_1x1

>

July 24, 2009

, ben zappin <btz23 wrote:

>

> Ben: Having dug into the Shang Han Lun tradition via Arnaud Versluys this

Spring, it has crossed my mind more than once that there are some problems in

the way the herbal education is structured in our T.C.M. schools in Ca. It

occurs to me that it might be easier for students to learn a more concise

materia medica than the several hundred that students are required to memorize

as a foundation.

Eric:

Maybe, but I worry that this just lowers the bar even further. I can appreciate

the take of a Shang Han Lun scholar, and my most respected teachers all had a

great appreciation for the classics. Personally, I felt like I learned much

more about herbs after revisiting my Shang Han Lun studies, simply because so

many of the eloquent dui yao combinations that make up everyday practice come

from the SHL and Jin Gui.

But nonetheless, the simple fact is that fewer medicinals were available during

the era in which the Shang Han Lun was written. A SHL practitioner may think

that all the later developments were less sophisticated than the earliest

classics, and indeed some of the most advanced herbal pairs that have persisted

for centuries did come out of those early classics. However, limiting the range

of herbs studied to the major ones that appear in classical texts does a

disservice to all the progress of the last 1800 years. Major schools of thought

that came much later were very innovative, such as Li Dong-Yuan's work or Wen

Bing theory. Important medicinals (such as Dang Shen and Xi Yang Shen) did not

come into play until only a few centuries ago, but knowing how to use these

herbs is essential if one is to be a properly educated and versatile

practitioner.

Ben:

> From my observation, and this comes from only a couple of years supervising

students in a clinic in one school, many students will see very little modeling

of the bulk of the materia medica they are required to study. I have even heard

students in their internships say that they saw bulk formulas made only a couple

of times and that they didn't know what the formulas were yet so it didn't sink

in.

Eric:

This is a true shame, and it is all too common. But mostly it reflects the fact

that there is too little consistency in the education and the supervisors. A

school should have a clear goal. If they want to train people in Chinese

medicine based on primary sources and the standard professional level of care,

they need instructors that can model this approach. If the school tries to be

too many things to too many people, it loses direction and the students don't

get a consistent message on how they should be thinking clinically. Something

is wrong if students are going through their clinical training without good

examples of everyday herbalism.

> Another problem seems to be that many of the formulas required for study are

not representative of classics nor current standards of Chinese hospital

internal medicine formulas. I know a lot of people on this list could speak more

authoritatively than I could about this and I welcome this. Is there a way to

make this officially updated?

Different people have different priorities on which formulas are the most

essential. However, if the teachers can access primary sources (i.e., a normal

Chinese formula 101 textbook), basically all the formulas they cover will be the

main ones. Generations of doctors in China have already organized the main

representative formulas, so if someone is arbitrarily making their own list, it

is a completely unnecessary endeavor. The Chinese books break down the

different formula types, and once one knows the principles, the formulas can be

modified endlessly to fit all the spaces between the neat textbook categories.

The problem is simply that most schools have few instructors in a position of

authority that can read the primary literature.

Just my two cents.

Eric Brand

July 24, 2009

I agree. The increase of biomedical subjects, if at the expense of

CM, is a cause for concern.

On Jul 24, 2009, at 11:15 AM, wrote:

> Ben, there is no way to write a linear analysis of this... All these

> issues swirl around endlessly. Let me throw my thoughts into the

> vortex.

>

> I would say to Eric that I don't think that the Exam will be any

> easier because of this change. It will just be easier for the

> student to justify spending less time on herbs throughout the

> program. But I'm not sure they would be wise to do so because...

>

> Looking at the criteria on their website, one sees that all of

> herbal medicine is " still' 17 percent when factoring in herbal

> identification. Diagnostics is 20 percent (minus 4 percent for

> biomed) so if we add these two together potentially there is 33

> percent that could concern " CM herbs " . One has to get through

> diagnosis to eventually circle one of those 11 (or 17) percent

> herbal answers.

>

> To tell you the truth I don't see that as an unrealistic assessment

> of what I do in my own office. The herbs are one answer to the many

> problems I have to answer for my patient. Critical - more than 17

> percent critical- but still just one answer to circle. ( a little

> devil's advocate here)

>

> I think the community has to answer for the push for the increase in

> Western curriculum a few years back. I'm one of those who believes

> that the program has been drained of CM emphasis.

>

> Doug

>

> _______________________

>

> Examination Content

>

> The content of the California Acupuncture Licensing Examination is

> based on the results of a comprehensive occupational analysis, which

> is revised every four or five years, most recently in 2001. Licensed

> acupuncturists in California were surveyed in order to identify the

> tasks, knowledge, skills and abilities that are important components

> of the acupuncture professions.

>

> The following percentages indicate the portion of the test devoted

> to each major topic. For further definition of the content areas,

> please refer to Table 13 (page 15) in the 2001 Occupational

> Analysis / Validation Report found on this web site

> Content Area: Patient Assessment

> 25%

>

> The practitioner obtains patient's history and performs a physical

> examination to determine presenting complaint and interrelationship

> among symptoms. The practitioner determines the effects of Western

> medications the patient is taking. The practitioner uses modern

> diagnostic testing procedures to augment traditional assessment

> methods.

>

> 1. (A) Obtaining Patient History (12%)

> 2. (B) Performing a Physical Examination (9%)

> 3. © Evaluation for Western Pharmacology (2%)

> 4. (D) Implementing Diagnostic Testing (2%)

>

> Content Area: Developing a Diagnostic Impression

> 20%

>

> The practitioner evaluates clinical manifestations to determine the

> relative strength and progression of disease. The practitioner

> evaluates patterns of disharmony according to theories of Oriental

> medicine to arrive at a final diagnosis. The practitioner

> demonstrates a knowledge of how pathology in Western medicine

> relates to disease in traditional Oriental medicine.

>

> 1. (A) Forming a Diagnostic Impression (8%)

> 2. (B) Differentiation of Syndromes (5%)

> 3. © Biomedical Disease (4%)

> 4. (D) Oriental Treatment Planning (3%)

>

> Content Area: Providing Acupuncture Treatment

> 29%

>

> The practitioner implements knowledge of the therapeutic effects of

> points and combinations of points in modifying pain, normalizing

> functioning, and treating disharmonies. The practitioner uses

> anatomical landmarks and proportional measurements in locating

> points on or near body surfaces. The practitioner identifies

> clinical indications for using alternate treatment modalities.

>

> 1. (A) Point Selection Principles (6%)

> 2. (B) Point Categories in Acupuncture Treatment (7%)

> 3. © Point Location and Needling Technique (4%)

> 4. (D) Performing Auxiliary Treatment (4%)

> 5. (E) Implementing Microsystems in Treatment (1%)

> 6. (F) Treatment Observation and Modification (2%)

> 7. (G) Acupuncture Treatment Contraindications (5%)

>

> Content Area: Prescribing Herbal Medicinals

> 17%

>

> The practitioner prescribes herbs and formulas based on diagnostic

> criteria. The practitioner modifies formulas and dosage of herbs

> according to patient's condition. The practitioner identifies

> situations and conditions where herbs and formulas would produce

> undesired effects.

>

> 1. (A) Identification of Herbs (6%)

> 2. (B) Prescribing and Administering Herbs (11%)

>

> Content Area: Regulations for Public Health and Safety

> 9%

>

> The practitioner understands and complies with laws and regulations

> governing hygiene and the control of pathogenic contaminants. The

> practitioner applies legal guidelines for office practices and

> maintenance of patient records. The practitioner adheres to legal

> requirements for reporting known or suspected child, elder, or

> dependent adult abuse.

>

> 1. (A) Practice Requirements (2%)

> 2. (B) Patient Protection (7%)

>

Chair, Department of Herbal Medicine

Pacific College of Oriental Medicine

San Diego, Ca. 92122

July 24, 2009

Eric,

I agree with you that at the school level, one should learn the

broad spectrum of herbs and formulas required in the PRC and Taiwan.

However, as the Yi Jing says, 'limitation brings success'. I think at

some point in one's training, one could greatly benefit from focusing

on, say Shang Han/Jin Gui formulas and theory, and work within those

limitations, then branching out. I am working right now on a course/

seminar based on a historical overview of different schools/currents

in Chinese medicine, in terms of theory, prescription families,

strengths and weaknesses. Of course, the Cold Damage current is the

root of all further developments, and should be required study at all

CM schools (as it is at PCOM).

On Jul 24, 2009, at 11:42 AM, Eric Brand wrote:

> , ben zappin <btz23

> wrote:

> >

> > Ben: Having dug into the Shang Han Lun tradition via Arnaud

> Versluys this Spring, it has crossed my mind more than once that

> there are some problems in the way the herbal education is

> structured in our T.C.M. schools in Ca. It occurs to me that it

> might be easier for students to learn a more concise materia medica

> than the several hundred that students are required to memorize as a

> foundation.

>

> Eric:

> Maybe, but I worry that this just lowers the bar even further. I can

> appreciate the take of a Shang Han Lun scholar, and my most

> respected teachers all had a great appreciation for the classics.

> Personally, I felt like I learned much more about herbs after

> revisiting my Shang Han Lun studies, simply because so many of the

> eloquent dui yao combinations that make up everyday practice come

> from the SHL and Jin Gui.

>

> But nonetheless, the simple fact is that fewer medicinals were

> available during the era in which the Shang Han Lun was written. A

> SHL practitioner may think that all the later developments were less

> sophisticated than the earliest classics, and indeed some of the

> most advanced herbal pairs that have persisted for centuries did

> come out of those early classics. However, limiting the range of

> herbs studied to the major ones that appear in classical texts does

> a disservice to all the progress of the last 1800 years. Major

> schools of thought that came much later were very innovative, such

> as Li Dong-Yuan's work or Wen Bing theory. Important medicinals

> (such as Dang Shen and Xi Yang Shen) did not come into play until

> only a few centuries ago, but knowing how to use these herbs is

> essential if one is to be a properly educated and versatile

> practitioner.

>

> Ben:

> > From my observation, and this comes from only a couple of years

> supervising students in a clinic in one school, many students will

> see very little modeling of the bulk of the materia medica they are

> required to study. I have even heard students in their internships

> say that they saw bulk formulas made only a couple of times and that

> they didn't know what the formulas were yet so it didn't sink in.

>

> Eric:

> This is a true shame, and it is all too common. But mostly it

> reflects the fact that there is too little consistency in the

> education and the supervisors. A school should have a clear goal. If

> they want to train people in Chinese medicine based on primary

> sources and the standard professional level of care, they need

> instructors that can model this approach. If the school tries to be

> too many things to too many people, it loses direction and the

> students don't get a consistent message on how they should be

> thinking clinically. Something is wrong if students are going

> through their clinical training without good examples of everyday

> herbalism.

>

> > Another problem seems to be that many of the formulas required for

> study are not representative of classics nor current standards of

> Chinese hospital internal medicine formulas. I know a lot of people

> on this list could speak more authoritatively than I could about

> this and I welcome this. Is there a way to make this officially

> updated?

>

> Different people have different priorities on which formulas are the

> most essential. However, if the teachers can access primary sources

> (i.e., a normal Chinese formula 101 textbook), basically all the

> formulas they cover will be the main ones. Generations of doctors in

> China have already organized the main representative formulas, so if

> someone is arbitrarily making their own list, it is a completely

> unnecessary endeavor. The Chinese books break down the different

> formula types, and once one knows the principles, the formulas can

> be modified endlessly to fit all the spaces between the neat

> textbook categories. The problem is simply that most schools have

> few instructors in a position of authority that can read the primary

> literature.

>

> Just my two cents.

>

> Eric Brand

>

Chair, Department of Herbal Medicine

Pacific College of Oriental Medicine

San Diego, Ca. 92122

July 24, 2009

Thanks for posting this, Eric. It thoroughly covers many of the areas of

concern.

I have already seen the damage that can be caused by " teaching to the test " . Do

we really want our schools to model their educational policies along the theme

of " No Acupuncturist Left Behind " ? I don't know about others, but nobody has

ever asked me about my school grades in nearly 20 years of practicing. They ARE

concerned that I have proper training in herbs, since they are ingesting unknown

substances simply based on their faith in my education. I don't think I would

have the confidence to do this if I had attended a school with a watered-down

herb program.

- Bill

> The California Acupuncture Board recently announced that they will reduce the

proportion of herbal medicine questions on the licensing exam from 17% to 11%.

Apparently this decision was made following an occupational assessment-

practitioners weren't using herbs so the emphasis on herbal medicine will

decline in the exam. Yet again, instead of raising the bar so that people rise

to the challenge, the bar is being lowered. Like an army that can only march at

the speed of the slowest soldier, the entire Chinese medicine field suffers when

our professional standards drop.

>

> In the past, the California board exam was harder than any other exam in the

country. The California exam required more comprehensive study of Chinese

medical theory than the old national exam required, because herbal medicine was

a mandatory aspect of the California test. Now that the new test will have only

22 questions on herbal medicine, there is a fear that the schools will reduce

their emphasis on herbs in response to the widespread student demand for easier

curriculum that teaches to the test.

>

> The schools themselves would prefer to maintain a stronger emphasis on herbal

medicine, since this allows them to sell more classes and produces graduates of

a higher caliber. Word on the street is that some schools are organizing a

response to the Board, but the potential impact is still unclear. As they say in

Spanish, " cosas de palacio van despacio " (affairs of the palace move slowly).

>

> Most practitioners would prefer to see the exams get progressively more

rigorous, because students will always rise to pass a harder test. By making the

test easier, we risk bringing in new practitioners who lack adequate training in

herbs. This will create more adverse events and more negative press and

regulation. The graduates of today are our public face of tomorrow, so already

licensed practitioners want to see only the most educated new practitioners

entering the market. We don't want the market flooded with poorly-trained

practitioners.

>

> Already, our schools lack adequate training in many aspects of herbal

medicine, such as herbal pharmacy. Unlike China, where pharmacy is a specialized

subject and trained pharmacists manage ordering and dispensing, practitioners in

the U.S. are often doubling as both the doctor and the pharmacist. Yet our

training in pharmacy issues such as avoiding dangerous substitutes and

ineffective counterfeits is often lacking. Schools have no place for these

classes in their curriculum, and the many students that do not want to use herbs

already complain bitterly about the emphasis on herbs in California schools.

Having an exam that further reduces the herbal emphasis allows the non-herbally

inclined students to complain more vigorously, which further limits the

potential of all students to study herbs at an advanced level.

>

> At the moment, we are fighting just to maintain our right to practice herbal