... Ready, set, GO!
Last night I led the interrogation and assessment of a new client in our clinical class at herb school. A young couple came to us with a host of complaints. I took the gentleman to one of our treatment rooms, in fact the same treatment room where I received structural therapy when I first started attending school here. I sat on the low massage table while he chose a chair across from me. Behind me, two of my classmates quietly took notes and observed the process.
I love talking to people. I love interviewing them, making them feel at ease, helping them find words when they have difficulty expressing themselves. I love the investigative process of the intake, picking up a thread and seeing where it goes. I love taking a patient's hands to feel their pulses, the quiet calm we enter when I "listen" to those pulses in all their different positions. I love holding their hands once more as I look them in the eye and thank them when I let them go. Heck, I even enjoy examining the tongue for more clues as to what patterns of disharmony they may have.
And last night I enjoyed all of that. Our new patient was totally open to the process, friendly, and he had a sense of humor to boot.
But then we were released into the main classroom to identify the patterns of disharmony and come up with a formula or two to treat them. And it had to be done in about 20 minutes.
I mapped out the patient's symptoms on a five-element chart (like the one in the last post, just without all the fun cartoon characters). He was all over the place, but his main issues were concentrated in two or three places. I could identify the man's patterns fairly well, steered back on course by Ima when I went off track.
But when it came to formulary...
We had about 15 minutes to come up with activator and tonic formulas, and I swear, it's as though I'd spent the last four years daydreaming through my materia medica classes. I could remember most of the energetics of the herbs we looked at, but if you asked me for three herbs, say, that treated Heart Qi deficiency but didn't interfere with his other patterns or were not contraindicated with some of the more troublesome symptoms, I couldn't tell you. Not last night anyway.
So here we were, under the gun, and I felt like Robin Williams' character in "Moscow on the Hudson," freshly defected from the U.S.S.R., standing in the coffee aisle at the grocery store and about to have a nervous breakdown.
The beauty of Chinese herbalism is that umpteen herbs do umpteen different things. Just like there is no one can labeled "coffee," there is no one herb indicated for one condition, and when you create a formula to treat multiple symptoms you introduce a synergy of herbs that will do the job according to their energetic, the organ meridians they enter, their direction, etc. The system, with all its choices, offers the practitioner and patient as much flexibility as it does precision, but the catch is: YOU HAVE TO KNOW YOUR MATERIA MEDICA.
Alas, I felt as though I'd checked that part of my brain at the door last night.
With Ima's help, my team and I put together two formulas for this man, and while my classmates prepared the formula in the pharmacy I went out into the front room to talk to him and his wife about what we were putting together and why, dosages, diet, etc. I told them to support each other and to set small, achievable goals for themselves. I also encouraged them to be patient with the process, as herbs work more gently than prescription drugs. I was so grateful that they would allow us students to question, poke and prod them. I was grateful for their trust and openness. I wanted to deliver the best that I could. I wished I could have spent more time with them.
Most of all, I wished I could have done the formulary part of my job better. It's my weakest point. I know I could have come up with something good if I'd had all my books around me and an evening to devote to it, but who has that luxury in the field, in real life?
I had a hard time falling asleep last night, Metal type that I am, always wanting to be perfect, hard on myself when I can't live up to my own standards. When I was in journalism school, we were faced with a similar challenge at least once a week. After an interview process, you'd be given 20 minutes to write a story that could be no less than 500 and no more than 550 words, and it had to be perfect. One misspelling, one factual error, one AP style mistake -- any single one of these earned you an automatic F. You had no team and no guidance from the professor. You were on your own.
I never got an F. Ever.
The thing about medicinal herbalism is, the stakes are much higher. Someone's life and health may hang in the balance. If you screw up, you can't publish a retraction, dreaded in the world of journalism as retractions are. Of course, you can tweak formulas that don't work, and these experiences may serve as guides, filling in missing gaps of information. But if you can nail it the first time, you earn confidence in yourself and trust from your patient. With herbs, the more tools you have, the more possibilities you may have to heal, but it doesn't mean a whit if you don't know your tools inside and out.
Looks like it's going to be an Autumn full of flash cards.
Above: Apothecary at Star Child in Glastonbury, UK. I took this photo about three years ago and they've since changed the look of the store. If you're ever in Somerset, please visit them!
P.S. Last night before clinical intake Ima pushed copies of the Nei Jing Su Wen, Shang Han Lun and one other book into my hands and told me to read them. What, my beloved teacher, learning TCM by South Park isn't serious enough? :)