I’ve been working on reviewing my Fall term notes. It’s been a fun process, one I haven’t done before. I can recommend it highly to any student. I find that it helps me consolidate the knowledge I internalized during the prior three months, making me feel much clearer and ready to receive the new influx.
The course that I have been anticipating since I began at NCNM is most certainly Chinese Herbs V – Formulas with Arnaud Versluys. I’ve already talked a little about Dr. Versluys and really you need only look over his website to understand what an honor it is to study with him. Despite my excitement, I was pretty nervous coming into this class.
I did very well in single herbs, but formulas is a whole different beast. My success in single herbs would not automatically translate into success in formulas. I knew I would have to bring my memorization skills to a higher level and resolve to dedicate a large amount of time to assimilating the material. I managed to do both, and my experience in the class was incredible as a result. I’d like to briefly discuss what I consider to be the three most important things I learned in the class. Because there was some overlap in concepts between this class and shift with Dr. Versluys, I’ll pick three new lessons.
The formulas themselves
I would be remiss if I didn’t point to the formulas themselves as one of the greatest lessons in this course. Dr. Versluys is incredibly good at bringing the formulas to life, which makes you desperately want to get to know them better. This is particularly true of the Classical formulas (those found in Zhang Zhongjing’s writing) as they are the only formulas he uses in clinic, and thus he knows them best. We learned formulas in three categories developed by our faculty. First, primary formulas.
These are formulas we are expected to have fully memorized. Memorization includes knowing the herb names and basic properties (nature, flavor), their dosages (and thus ratios) and their positions within the formula (Emperor, Minister, Assistant, Servant). Beyond that, we are supposed to be able to explain HOW THE FORMULA WORKS. Not just that, but we need to be able to do this to the extremely high standards of Dr. Versluys. The second category of formulas is called appropriately, secondary formulas. These we needed to know less about. We need to know all of the same memorized information above for the Emperor and Minister herbs, but not the Assistants or Servants. We needed to be able to explain what the formula did – but not in as much detail as for the primary formulas. Finally, we had tertiary or reference formulas. For these, we simply needed to be able to have some general understanding of what the formula does and what it contains and be able to know where to look up the information should we need it in the future.
Learning about the intricacies of the primary formulas was a joy. Dr. Versluys has devoted his life not just to memorizing and clinically testing formulas, but to truly understanding the SCIENCE behind them. He does this first by having a very rigorous understanding of Chinese medical physiology, with its resultant comprehension of pathology. For instance, panting is a symptom that, with a complex of other symptoms, leads us to think about using Ma Huang Tang.
Why? The Lung system includes the pores of the skin. The pores are actually part of what allows the Lung to inspire. In a cold damage scenario, the pores are frozen shut. This decreases the available volume of inspiration. However, the body still needs the same amount of air – so it increases its rate to compensate, creating panting. Ma Huang is our best herb for breaking the closure brought about by cold! Our whole class, every day, was filled with insights like this. They not only enriched our understanding of the material but made the formulas much easier to remember.
Don’t modify formulas so quickly
Dr. Versluys cautioned us against modifying classical formulas at will. This was an interesting lesson, because it seems so common for formulas to be modified. It’s almost a point of pride for CM practitioners that we modify formulas “to fit the patient’s constitution” or the special symptoms that are being presented. We were urged to trust our feeling of the pulse and its leading us to a specific classical formula. Unless extenuating circumstances warrant it, we should simply use the classical formula as it is written and have the patient come back soon in order to modify it (using ZZJ’s stated modifications) if necessary. I
think this is particularly good advice for newer practitioners as they have not amassed enough clinical experience to be able to intuit excellent modification strategies. Of course, some of us will have received modification knowledge from our clinical mentor. That’s fine, but I think the principle of this lesson is sound. Do I really presume to understand more about medicine than Zhang Zhong Jing? No. I think I’ll wait a while and see how his formulas work before changing them. I’ll learn to walk before I start running, thanks.
Truly understanding a formula makes you a more effective practitioner
As I discussed above, we were asked to really dig deep into the formula’s structure and history of use to understand why each herb is there and why it is in there in that specific ratio to other herbs. Further, we were asked to learn about the physiology and pathology that matches that particular formula with its classical indications.
This process was definitely helpful in the learning process, but I also believe it will make me a better doctor. Because the actual written information we have about Classical formulas is so sparse, we have to reverse engineer a lot of our understanding from the formulas themselves. Doing this rigorously has enabled Dr. Versluys to be a highly effective practitioner. I hope to mirror his success.
This is a great argument for learning a smaller number of formulas really well. I know in many schools (including those in China) folks memorize many hundreds of formulas. But how many do they understand? Further, what is the purpose of knowing all of those formulas? Do you need a formula for every possible condition? Dr. Versluys used an analogy that I found to be very instructive. Consider two individuals. One has a garage that contains a specialized tool for every job imaginable. A tool for taking the feet off couches, a tool for opening jars, a tool for removing bolts from the dishwasher, a special saw for hardwoods, fifty types of wrenches for different situations, etc…
The other has a garage with a relatively small number of widely applicable tools. A hammer, a screwdriver, a couple kinds of wrenches, an awl, a saw, etc… When an emergency situation comes up, who is most likely to be able to address it quickly, elegantly, and accurately? Consider who is most likely to be able to find the “right tool for the job” and know the tool well enough to apply it to the specific situation encountered?
I would rather be in the second person’s place – to have a small arsenal of tools that I know as well as I know myself.
About Eric Grey
Hi - I'm the founder of Deepest Health. When I'm not writing here, you can find me reaching out to the Chinese Medicine community across the web and in my own backyard. I currently teach Chinese herbs at my alma mater, the National College of Natural Medicine. Additionally, I'm the founder of Watershed Community Wellness, a thriving local clinic in Southeast Portland in Oregon. No matter where I'm working, you'll find my focus on the Classical approach to Chinese medicine laced throughout everything I do.