To modify or not to modify, that is the quest...

March 23, 2010

Jason,

at ACTCM in SF, most of the supervisors prescribed a combination of pills,

powders and raw herbs.

Some only did pills, some only did raw herbs,

but I would say that we gave some herbs to just about every single patient

who came into the clinic.

I agree that mentorship is essential, not only for the students sake,

but also for the mentor, because teaching is a skill that needs to be

cultivated in order to master the medicine

on all levels. Some are better at the teaching part, some are better at

listening or analyzing the case,

but I believe that teaching completes the circle,

making us better practitioners and more well-rounded human beings.

In the few years of teaching now, I've grown leaps and bounds from learning

from students,

just as patients are our best teachers and getting direct feedback on

strengths and weaknesses,

challenging us to become more creative and succint.

I've always respected my teachers, (especially the good ones) but now I

revere those

who can embody the authenticity of the medicine, not because of any ego

persona.

These spars we have over ideas are certainly healthy and challenge us to

push the envelope.

Whatever philosophy we " own " today, may change in a few years or with the

meeting of a new teacher.

For some, this goal is to know how to use the classic formulas well and

modify them minimally,

in order to have a clear vision of what the formula did for the patient.

There are numerous commentaries, records and reports of Zhang Zhong Jing's

formulas over 1800 years.

We have an idea of what they do in the accurate situation and he himself

documented

the effects and the presentation when they are modified by even dosage alone

ie. Gui zhi tang vs Gui zhi jia gui tang

For some, this worthy goal is not as you say using " stock formulas "

without utilizing originality or creativity nor precise diagnostics for

clinical efficacy,

but " classic formulas " that are much more complex as we give them credit

for.

By knowing the formulas well, we can hone in our treatment with pin-point

accuracy.

It can take lifetimes to master the intricacies of Zhang Zhong Jing's

formulas

and then I can see manipulating them, if you already have a 7th degree black

belt.

What Stephen wrote is what I experienced with many supervisors at school,

who learned in China...

using TCM base formulas and then mixing Dui-yao pairs and single herbs

into the formulas for branch signs/symptoms.

If " stock formulas " you mean TCM formulas in pills that we give

unconsciously to patients

based on symptomatology, instead of constitution, then I completely agree

with you.

Again, great conversation,

K

March 24, 2010

To clarify, when I am referring to " stock formulas " I am essentially

referring to the basic 50 or so core formulas that people memorize in school

for various patterns. For example, Xiao Yao San for liver and spleen

disharmony. Being able recognize this connection is formulas 101 and only

the first step. Unfortunately, many leave school with only this level of

herbalism. Hence, people are reduced to looking in " cheat books " where they

look up a disease, pick a pattern, and give a formula. Or as many see, just

giving patent formulas.

The next level is being able to modify these formulas based on traditional

modifications. This should not be rocket science because most books will say

if they have XYZ symptom then add this Herb.

The next step is being able to flexibly modify formulas for mixed patterns

as well as adding modifications that are not standard.

The final step, is to transcend all of this and be able to write a formula

from scratch using ideas from all of the above.

Actually my comments about " stock formulas " have nothing to do with SHL,

which I merely view as one of many books to learn from.

Again, this is only my opinion and I'm sure the SHL purists who think the

ultimate goal of herbalism to give a unmodified or only slightly modified

SHL formula would disagree. That is fine, but I believe people are much more

individual than a handful of formulas that any one book contains and that

the more one can learn to modify the better herbalist they will be.

Granted, any system, including SHL, may be able to address the large

percentage of problems, although I question that in our climate here in

Colorado. However, it is my belief that just learning SHL and its

modifications is far from optimal in addressing all clinical complaints.

Just as, giving Xiao Yao San may address the majority of liver and spleen

disharmony, but it will definitely fall short for other cases.

One thing that should be kept in mind, is that many doctors over the

centuries have written down formulas in " their " books. However, when one

compares their actual case studies to the formulas they wrote down one

rarely finds the doctors giving these same " stock " or " unmodified " formulas.

First one learns the book knowledge and then learns to apply it to the

clinic. Even the modifications that the doctors themselves mention are not

always used when the real patient is in front of them. They are merely

guidelines for us to start thinking about how to address the individual.

This is precisely what these later doctors such as DGR did and I have no

proof (because there are no case records) but I image ZZJ and doctors of

that time were did similarly.

However, we do know that the very first person (Xu Shu-Wei) to publish SHL

case studies and (I think) commentary on the SHL did make modifications to

core formulas that were not in the original text. This trend never changed.

Remember the SHL was just a compilation of formulas (found in the Imperial

Library) of that time that ZZJ put together. Although there are some

guidelines and system inherent in the book generally speaking the " system "

came from later commentators.

Of course one must take one step at a time.

-Jason

March 24, 2010

Jason-

I would argue that there is a very deep and profound system that

underlies the " compilation of formulas " in the SHL (and JGYL, which I

think you are including, but I will mention it for readers who are

not getting that) and that the point of the text was this system.

This system can be reverse engineered by looking at the formulas and

the modifications of the formulas in the text, looking at the

chapters not included in the English translation of the text, and

studying some of the books mentioned by ZZJ in his preface, not the

least of which is the Neijing. This system was designed so that the

person confronted with epidemic disease could " understand the origin

of illnesses encountered " and " think out over half [of all medical

problems]. " How can anyone claim that the system " came from later

commentators " ? Maybe the exegesis of the text that clarified the

system, but not the system itself.

Let me make it clear that I do not think that the SHL/JGYL is the

only system of herbal medicine that people should practice, however.

I know there are a lot of other great herbalists and systems of

herbal medicine in the history of Chinese medicine. I am not

claiming that my preference should be every one else's preference.

What I advocate is choosing a system and working those ideas so that

you develop a very deep understanding of the methods of that system.

I believe it is better for people to be a master of one system than a

jack of all trades.

The SHL/JGYL is clearly a very robust and alive system that works in

a superior fashion in the treatment of many many diseases, which has

been shown generation after generation. If one so chooses to use

that system, and only that system, they can be very effective

physicians.

-Steve

Stephen Bonzak, L.Ac., Dipl. O.M.

http://www.health-traditions.com

sbonzak

773-470-6994

On Mar 24, 2010, at 8:41 AM, wrote:

>

> Remember the SHL was just a compilation of formulas (found in the

> Imperial

> Library) of that time that ZZJ put together. Although there are some

> guidelines and system inherent in the book generally speaking the

> " system "

> came from later commentators.

>

March 24, 2010

As to what students should know I'll repeat what I saw in doctors who had just

come from China to work in the US. Many of them had decades of experience in

their specialities and they would get hired to work the eclectic cases that

showed up in the student clinics here. Many of them had two small books tucked

in their lab coats that they were constantly referring to. Eventually I asked

someone what they were. It was then that I was made aware of the two Jiao Shu-de

books. Of course, in Chinese they are small enough to carry around like this.

Interestingly, when the translations came out and I showed them to Dr. Yang,

(the Nanjing- SHL expert that Al and I keep referring to) he kind of sneered.

ooops. He quickly apologized and told me I should keep learning them. hahaha. of

course. He is very direct.

As to those who feel the US education is lacking, my young translator friend in

Beijing has the same comments about not remembering formulas, short term

memorization for tests, etc... And in China there is an overlay of the focus on

Western medicine and Western medications. Of course, she has access to a number

of post graduation opportunities but I get the feeling that this learning is

bought or otherwise traded in following her " master " .

Doug

, " " wrote:

>

> To clarify, when I am referring to " stock formulas " I am essentially

> referring to the basic 50 or so core formulas that people memorize in school

> for various patterns. For example, Xiao Yao San for liver and spleen

> disharmony. Being able recognize this connection is formulas 101 and only

> the first step. Unfortunately, many leave school with only this level of

> herbalism. Hence, people are reduced to looking in " cheat books " where they

> look up a disease, pick a pattern, and give a formula. Or as many see, just

> giving patent formulas.

>

March 25, 2010

There is no doubt that the educational system in China is also problematic.

However, there is much more availability in regard to following senior

practitioners and post graduate studies as you mention. This is the key. Not

to mention just the sheer access to massive university libraries. It is

really just about potential opportunity.

However, Chinese medicine in China has a large problem in that a large

percentage of students do not want to even be studying Chinese medicine. A

single CM undergraduate program might have 10,000 students with the average

age of around 20. Most only want to graduate and make money, hence they go

into all sorts of side businesses. I've heard that 50% of graduates do not

practice (sound familiar?).

Furthermore, for those that do practice, it is much easier to make money

working at a hospital practicing integrated Western medicine than working in

a clinic practicing just Chinese medicine. This is because essentially you

are competing with all of the old doctors and it is very hard to get

clients. Therefore, finding " authentic unadulterated " (whatever that means)

Chinese medicine doctors is usually hard to find unless they are much older.

Consequently, many of the doctors that come to the US are not high-level

doctors, even though many claim to be. Many just see it as an opportunity to

make money. Some lie about their credentials (or exaggerate them) to get the

job. Some may have been primarily acupuncturists but because they studied

basic Chinese herbalism (and they are Chinese) they are now heading up

herbal classes in the US. Unfortunately, a little bit of herbal studies in

China can many times be far superior to some Westerners' training. This is

not at all to put down Western teachers, because there are some very amazing

Western teachers that I have had.

My point is, there is a wide range of levels in both China and the West and

we must be discriminate.

But isn't learning always bought on some level? How much do you pay for a

doctorate degree now in the US? Do people take these seriously? You could

take half that money, go to China, and get a much better education in my

opinion. I find the minimal amount of fees to study with great doctors in

China is usually only a token of your appreciation. Any doctor who charges

high prices I stay away from anyway.

I am curious why Dr. Yang would apologize?

-Jason

On Behalf Of

Wednesday, March 24, 2010 12:14 PM

Re: To modify or not to modify, that is the quest...

As to what students should know I'll repeat what I saw in doctors who had

just come from China to work in the US. Many of them had decades of

experience in their specialities and they would get hired to work the

eclectic cases that showed up in the student clinics here. Many of them had

two small books tucked in their lab coats that they were constantly

referring to. Eventually I asked someone what they were. It was then that I

was made aware of the two Jiao Shu-de books. Of course, in Chinese they are

small enough to carry around like this.

Interestingly, when the translations came out and I showed them to Dr. Yang,

(the Nanjing- SHL expert that Al and I keep referring to) he kind of

sneered. ooops. He quickly apologized and told me I should keep learning

them. hahaha. of course. He is very direct.

As to those who feel the US education is lacking, my young translator friend

in Beijing has the same comments about not remembering formulas, short term

memorization for tests, etc... And in China there is an overlay of the focus

on Western medicine and Western medications. Of course, she has access to a

number of post graduation opportunities but I get the feeling that this

learning is bought or otherwise traded in following her " master " .

Doug

March 25, 2010

There is no question that SHL is a robust system. I enjoy it immensely.

However clinically experienced practitioners that actually *just* practice

SHL/JGYL are few and far between. For example, most SHL practitioners

incorporate other ideas into it, or when " other " problems are encountered

use other modalities (e.g. wen bing). Actually one of the most knowledgeable

people in the West on SHL, Dan Bensky, has published his favorite formula

paper on San Ren Tang. Also Huang Huang routinely adds modern modifications

into his formulas. However, all of this surely makes sense to me.

My point is really that *most* SHL experts do other things besides just what

is in the text. AS mentioned this has been going on since we have written

record of SHL usages.

But no doubt, in the beginning it is helpful to pick a system and master it

and stick to the basics, but at a certain point it is nice to see what the

pros do in the real life clinic.

For the record, I have searched years to study with a practitioner that just

does SHL. In Chinese / Taiwanese clinics / hospitals I have been in, the SHL

" experts " almost always had " other " modifications. It is a very hard thing

to find a pure SHL practitioner. At one point in time I was disappointed,

but then I realized ohhhh, this is just another way (and probably most

common way) to approach these texts. That is, a more " creative approach. " I

would though here of " some " guy in such and such a city that one could try

to go study with. I have never made the 5-10 hour trek though. If anyone

knows anyone in the Zhe Jiang area to study with please let me know!

AS far as when the system was developed. I agree there is an inherent system

" built " into the text. But later generations took this an ran with it and

many of the ideas that we hold are from " interpretations " on the text. That

is one reason there is so much debate in what things mean and how to use it.

Thoughts?

-

On Behalf Of Stephen Bonzak

Wednesday, March 24, 2010 8:51 AM