The successful chinese herbalist

2005 Pages·222·15.98 MB·english

by  Bob Flaws

The Successful
Chinese Herbalist
Bob Flaws and Honora Lee Wolfe
2005
Blue Poppy Press
Published by:
BLUE POPPY PRESS
A Division of Blue Poppy Enterprises, Inc.
5441 Western Ave., Suite 2
BOULDER, CO 80301
First Edition, May 2005
ISBN 978-1-891845-29-2
LCCN #2005923635
COPYRIGHT © BLUE POPPY PRESS, 2005
Printed at Central Plains Book Manufacturing, Winfield, Kansas
on acid-free paper and soy inks
Text and cover design by Eric J. Brearton
Contents
PREFACE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . V
CHAPTER 1. The Importance of Pattern Discrimination
in Crafting the Best Formula . . . . . . . . . . . . . . . 1
CHAPTER 2. Writing a Formula That Works for
Each Patient . . . . . . . . . . . . . . . . . . . . . . . . . 27
CHAPTER 3. Forms of Chinese Herbal Medicines & Their
Appropriate Use . . . . . . . . . . . . . . . . . . . . . . . . 63
CHAPTER 4. Potency Issues with Chinese Herbal
Medicine . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 71
CHAPTER 5. The Issue of Dose in Ready-made
Medicines . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 79
CHAPTER 6. The Phenomenon of Habituation in Long-term
Herbal Treatment . . . . . . . . . . . . . . . . . . . . . . . 87
CHAPTER 7. Possible Problems with Ready-made
Medicines . . . . . . . . . . . . . . . . . . . . . . . . 93
CHAPTER 8. The Three Important Types of Potential
Medicinal Toxicity . . . . . . . . . . . . . . . . . . . . . . 99
CHAPTER 9. Using Chinese Herbs During Pregnancy and
Lactation . . . . . . . . . . . . . . . . . . . . . . . . 107
CHAPTER 10. My Favorite Formulas . . . . . . . . . . . . . . . 113
CHAPTER 11. How to Set Up & Run an Effective Chinese
Herbal Pharmacy . . . . . . . . . . . . . . . . . . . . 141
CHAPTER 12. How to Work with Patients Who Are Taking
Western Medication . . . . . . . . . . . . . . . . . . 157
APPENDIX I: What’s Wrong with the Term “Patent
Medicines?” . . . . . . . . . . . . . . . . . . . . . . . . 163
APPENDIX II: List of the Most Common Treatment
Principles . . . . . . . . . . . . . . . . . . . . . . . . . . 169
APPENDIX III: Patient Herb Instruction Form . . . . . . . . . . . 177
APPENDIX IV: Problem Based Learning Exercise
Answers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 181
APPENDIX V: A Representative List of Pesticides and
Heavy Metals Tested by Western Companies
Producing Ready-made
Herbal Medicines . . . . . . . . . . . . . . . . . . . . . . . 205
Preface
Several years ago we published a book titled How to Write a
TCM Herbal Formu l a . This little volume was, for a time, popular
with schools and developed a small but loyal following.
Ho w e v e r , because the information it presented was limited to
the administration of Chinese herbal medicine in decoction,
and because it was really only an extra-long essay, at some
point it needed to either be revised or to go out of print. Since
its sales had never been huge, we allowed the book a quiet
demise and transplanted the most important information it
contained into other texts. In some senses, this new book is a
direct lineal descendant of that first modest, but useful essay,
now expanded to include a much broader range of subjects.
There is so much to learn about the practice of any medicine.
Some of the more practical elements of day-to-day practice and
solutions to some of the more thorny problems that are
inevitable can only be learned with time. Still, it is the job of
any good teacher to shorten the journey of his or her students
by sharing what they have learned by traversing a longer route.
Thus, we have, with the publication of this new book, tried to
address a variety of issues that are, for a variety of reasons, not
always able to be taught in the context of the school clinic.
We have written about our experience both as practitioners
and as business people because we feel that the owning and
operating of a dispensary is an integral part of the practice of
Chinese herbal medicine in the U.S. and other countries
where these medicines are not sold in standard pharmacies.
This book is not a materia medica or a formulary text.
Ho w e v e r , while limited to the practice of Chinese herbal medi-
cine, the scope of the book is fairly broad. It includes discus-
sions about everything we could think of that can and will
make a positive difference in any practitioner’s level of success.
No t a b l y , the information about how to determine dosages
using any and all types of Chinese medicines has not previous-
ly appeared in the English language literature in this depth.
Another chapter discusses the phenomenon of habituation,
which is well known in the world of Western medicine but is
rarely if ever discussed in Chinese herbal medicine texts.
There is also a small but, we believe, useful chapter about
working with patients who are taking Western drugs.
Although the information presented here is by no means
meant to be definitive and while we are working on a
lengthy book on this same subject to be released in 2006,
this chapter gives any practitioner a methodology to help
them determine the impact of any Western drug on their
p a t i e n t ’s health and how their treatments, herbal or other-
wise, might improve such patient’s situation.
Another important feature of this book from our point of
view and one that we plan to include in most of our future
publications is the problem-based learning exercises. These
include case studies and questions at the end of most chap-
ters. There is an answer key for these questions at the end of
the book. While it may seem that this feature is mostly
added for the sake of students, we have done our best to
make the information and questions equally relevant for
p r a c t i t i o n e r s .
We feel we must say something here about the first chapter
of the book, which is a lengthy exposition on pattern dis-
crimination and the processes one uses with each and every
patient in the practice of Chinese herbal medicine. This
includes both diagnostic and prescriptive processes.
Advanced students and some practitioners may feel this
information is unnecessarily emphasized or overly drawn
out. Perhaps. However, as we always tell both our under-
graduate and post-graduate students, mastery is always mas-
t e ry of the basics, no matter what profession one is practic-
ing. And, as teachers working with students all over the U.S.
and Western Europe, we find repeatedly that the problems
practitioners have with prescribing Chinese herbal medicine
are most often due to a breakdown in understanding some
part or piece of this process. We want to be absolutely cer-
tain that readers at all levels of experience understand how
and why the successful prescription of Chinese herbal medi-
cine is based on this very clear, logical, and specific process.
For those of you who feel this information is already well
digested, we beg your indulgence. And who knows, even for
the seasoned practitioner, there may be a new kernal of
truth that is useful.
F i n a l l y, we must say a word about terminology. As in most
Blue Poppy books, we have mainly used A Practical
D i c t i o n a ry of Chinese Medicine by Nigel Wiseman and Feng Ye
as our standard for technical words with clinical implica-
tions. While attempting to make the book as accessible and
friendly a read as possible, our support of this terminology is
based on its precision relative to the Chinese language from
which our medicine springs and the fact that any given
word can, using this text, be traced back to its Chinese char-
acter and all the clinical implications of that character.
There simply is no other English language glossary that
offers us such precision.
We hope that readers, whether students, new practitioners
or seasoned professionals, find this book a welcome addition
to their herbal medicine library. As always, we welcome your
suggestions on how we might improve our efforts when the
time comes for a reprint of this book. It is our desire, with
this and every book we publish, to help all students and
practitioners of this medicine to be more effective clinically,
more successful financially, and more satisfied personally.
Thanks for reading,
Honora Lee Wolfe
Bob Flaws
March 2005
1 Masters Herb 4/20/05 10:50 AM Page 1
1
CHAPTER
The Importance of Pattern
Discrimination in Crafting
the Best Formula
The origins of Chinese herbal medicine
Standard professional Chinese medicine, or what is often
called Traditional Chinese Medicine (TCM) in the West, is a
specific style of Chinese medicine. Although standard profes-
sional Chinese medicine has its roots in the Warring States,
Qin, and Han dynasties, as a self-conscious style it was creat-
ed in the People’s Republic of China during the 50s, 60s, and
70s. While this last fact has produced some detractors who
believe its origins to be 20th century Communist materialism,
modern professional Chinese medicine actually incorporates
all of the best of both professional and folk medicine surviv-
ing in China from its beginnings. In terms of theory, howev-
er, it is primarily based on the highly literate and rational
approach to medicine of the ru yi or Confucian scholar-doc-
tors going back to the Han dynasty but whose writings
became preeminent in later dynasties. These scholar-doctors
were, by and large, fang ji jia or herbal practitioners and the
administration of internal herbal medicinals was their main
modality. Thus, modern professional Chinese medicine’s
defining methodology was developed specifically for the prac-
tice of herbal medicine.
1
1 Masters Herb 4/20/05 10:50 AM Page 2
Chapter 1 The Successful Chinese Herbalist
According to Chinese texts, the defining methodology of
standard professional Chinese medicine as a specific style of
Chinese medicine can be summed up in the words bian zheng
lun zhi. This means basing treatment primarily on the dis-
crimination of patterns.
Understanding patterns & diseases
The first chapter of this book is a treatise on the process of
pattern discrimination and the logical procedure we follow
with each patient in order to arrive at the correct Chinese
herbal formula and treatment plan. For some readers this
information may be a review. However, we include this some-
what lengthy exposition because it is the foundation upon
which good Chinese herbal medicine is always based. Also, as
teachers interacting with students all over the U.S. and
Western Europe, we find repeatedly that the problems stu-
dents and practitioners have with prescribing Chinese herbal
medicine are not necessarily because they do not know their
herbs or formulas, but more often due to a breakdown of
SAME DISEASE DIFFERENT PATTERNS, PART A
Disease Diagnosis
Hypertension
Disease
Hypertension Hypertension
Pattern A Pattern B
Hypertension is
Liver Kidney Yin Phlegm Fire
defined by a BP >
Vacuity Harassing Above
140/90mm/Hg.
Symptoms: May be Symptoms:
Dizziness, tinnitus, asymptomatic. Head distention,
blurred vision, nausea, chest
heart palpitations, oppression, profuse
BP > 140/90mm/Hg, dreams, profuse
dry mouth, phlegm, bitter taste
PM malar flushing, in the mouth,
fine, bowstring pulse BP > 140/90mm/Hg,
slippery, bowstring
rapid pulse
Female: Ectomorph, Male: Endomorph,
50 years old 40 years old
2