Overcomplicating Things

After posting an earlier post discussing the first of my five maxims, a request came up to present the rest of them. Never one to shy from a good request, today I’d like to present Reynolds’ Second Maxim, which is “Don’t hear horses and think zebras” which could also be phrased “Thou shalt not overcomplicate!”

“This will be the seventh time we have destroyed Zion…”

I remember going to the movies to see “The Matrix Reloaded” during the course of which a neat and tidy story which everyone was familiar with was exploded into about a million little subplots and alternate storylines with a new cast of characters that became hard to keep track of and events and motivations that didn’t make a great deal of sense. That and some sort of rave/orgy. Upon leaving the theater, my girlfriend at the time turned to me and said “Uhh…that was needlessly complicated.” This I feel is an excellent example of the typical state we frequently find ourselves in, especially once herbs enter the picture.

I feel that this concept is heavily tied in to my first maxim (“What are the symptoms?”) in that you don’t want to make the mistake that many physicians have made throughout history, East and West, which is deciding what a great idea a particular path of treatment would be and  implementing it without bothering to first find out if it’s a good idea.

Not women, THIS woman

This very much applies to the TCM habit of protocol-making, where, in the example of one very popular protocol, a treatment method including both points and formulas is decided upon depending on what week of her menstrual cycle a woman is currently in. If it’s week one, she gets Formula A and Point Protocol A. Week two is Formula B and Point Protocol B and so on. Now at first glance this seems like it could be a great idea, as it appears to take into account the fact that a woman is likely to be in a slightly different physiological state depending on what week of her cycle is in. However, it fails to take into account the only thing that matters, which is the condition of the patient before you. It’s very easy to get caught up in thinking of things in broad strokes, the nature of women, the resonance between this or that herb and female physiology, lab results, and a million other things when in fact the only question of importance is still “what are the symptoms?” All information regarding symbology, tendencies, studies, typical clinical solutions, etc. is only of value insofar as it can be translated into a specific and accurate treatment for the individual. What works on “women” is of little use as we are interested in what works for this woman, whose specific menstrual complaints may have very little to do with Spleen Qi Deficiency, Blood Deficiency, etc. and may instead come from sources as varied as emotional trauma, overexercise, or acute stress.

Now this is not to say that I don’t use protocols, which would be the furthest thing from the truth. Technically, as long as we are  borrowing from someone else to match a situation, that’s a protocol. I just do my best to a) use the most powerful and effective protocols and b) only use protocols that are very strongly indicated for the case in question. The truth of the matter is that I tend to avoid overcomplication by using the most simple, direct, elegant, profound, and well…broad protocols we’ve ever had the privilege of being handed, which lie in the work of Zhang Zhong Jing.

Now those of you who attended NCNM have likely not experienced what those of us who are classic-minded but came through TCM schools have, so please try to put yourself in our shoes a bit. My particular experience frequently involved the presenting of a case to a supervisor who, especially the Chinese ones, would roll their eyes at my Shang Han Lun-based approach and instead begin rattling off piles of points, truckloads of herbs with dosages set to numbers gained via some inexplicable method that had more to do with cooking than herbology in my opinion, and sent off to make the patient better instead of doing whatever craziness I had been working on, despite the fact that 10 times out of 10 I could point to textual support in the Shang Han Lun or Jin Gui Yao Lue for what it was I was trying to accomplish. This to me is the ultimate overcomplication and unfortunately this “whatchagot” method of making formulas out of single herbs (or dui yao pairs amongst the more enlightened) is the hallmark of TCM herbology’s gross ineffectiveness.

An Example

I’ll give the following example which is, admittedly, a straw man, but one that will hopefully illustrate what I’m going on about to the non-TCM trained set. I can assure you that I have seen this very approach many times by TCM herbalists, even very experienced ones. Suppose a patient presents with the following: sore throat, somewhat mild all-over pain that is especially strong in head and back, fever, chills, yellow phlegm in chest and sinuses, headache in occipital, parietal, and frontal regions, coughing, sneezing, nasal drip, nausea, irritability. Tongue has thick white coat. Standout pulse qualities are floating and moderate at left cun position and slightly deep and tight at left guan position. I will present three different ways of dealing with this case:

 

Method #1: The completely wrong way: Diagnosis: Wind-Heat Treatment: Yin Qiao San, or failing that Chuan Xin Lian Pian + Bi Yan Pian. Rationale: , YQS is primary formula for early stage Wind-Heat. CXLP is extremely antiviral and antibacterial, BYP is good for runny nose and sneezing.

Method #2: The needlessly complicated way: Diagnosis: Wind-Cold invasion turning into Heat. Treatment: Make the following symptom-based custom formula (with rationale):

Lian Qiao + Jin Yin Hua: Good for Wind-Heat, clears Heat, reduce fever, soothes sore throat
Yan Hu Suo: #1 herb for pain
Du Huo+Ji Sheng: #1 combination for back pain
Gao Ben: relieves head pain, back pain, also good vs wind
Ban Lan Gen: clears Lung Heat, antiviral/antibacterial
Lu Gen: clears Heat Phlegm from Lungs
Jing Jie + Fang Feng=expel Wind
Niu Bang Zi: relieves cough, clears toxicity
Bo He: releases exterior, clears Heat, relieves irritability
Sha Ren: nausea
Gan Cao: clears Heat, harmonizes formula

Method #3: The right way : Diagnosis: Combined Taiyang-Shaoyang syndrome Treatment: Xiao Chai Hu Tang modifed as follows (as listed in the original SHL text):

Chai Hu
Huang Qin
Ban Xia
Gan Jiang
Zhi Gan Cao
Wu Wei Zi
Gui Zhi
Gua Lou Shi

Rationale: These are the modifications given by Zhang Zhong Jing to match this very situation. Even if you didn’t know these, by having a working knowledge of the SHL/JGYL you would know enough of the approach to work this out for yourself. There’s no fishing around for herbs to match up vs symptoms and having to guess which opti
on is better than another, its all there already. The problem is primarily blockage in the Shaoyang network with some accompanying Taiyang symptoms. Xiao Chai Hu Tang is the primary formula for resolving this type of blockage with a couple modifications made to assist. Note that the point of this formula is to unblock Shaoyang, unblock Taiyang, unbind the chest, drain damp, strengthen Taiyin and that all curative actions are based out of that without having to make the World’s Biggest Formula in an attempt to solve a relatively simple problem that was solved (and written down) a couple thousand years ago. As Arnaud Versluys says, “there’s really no reason to re-invent hot water every time you need to cook something.”

Even in the case of chronic disease, the approach remains the same: choose the correct root that most accurately fits the situation and modify to match specifics. It also helps to have reliable information to draw from, which is of course why I insist that Zhang Zhong Jing’s work must be the toolbox that all Chinese herbology reaches into when it needs a tool. Before you start thinking “Ok, I’m going to take this formula and mix it with that formula and then add these herbs and then refer them to that doctor for this therapy and…” first see if there is a simple solution to the problem, as is so often the case. Don’t be afraid ti mix and match with formulas, herbs, modalities, etc. but make sure it’s necessary first.

I’m sure I will expound upon this at a later date but for now I hope this gets you thinking in the right direction.

 

 



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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.

View all posts by Eric Grey - Website: http://deepesthealth.com