Using herbs to improve the effectiveness of Chinese medicine
Combining Herbs and Acupuncture
At the White Crane Academy we maintain herbal medicine is Yin to acupuncture’s Yang. They are both essential facets of Chinese medicine that are different yet complementary, and when used together can dramatically enhance your ability to deliver an effective treatment.
What does this mean in practice?
Chinese medicine has traditionally used case studies to demonstrate principles of treatment so let’s consider the instance of a 36-year old woman with endometriosis related dysmenorrhoea, abdominal pain, and infertility. This woman has Liver qi stagnation leading to Blood stasis with an underlying condition of Kidney Yang deficiency. I use acupuncture at key points in the woman’s cycle, to promote ovulation, to move Qi and Blood before her period. At the same time I prescribe daily herbs to nourish the Kidneys in the first half of the cycle followed by stronger Blood and Qi moving herbs in the second half of the cycle. As the abdominal pain and dysmenorrhoea subside the woman also reports feeling more energetic and notices more obvious signs of ovulation. After 4 months she conceives at which point herbs are given to consolidate the pregnancy and prevent miscarriage whilst acupuncture is used to help manage her morning sickness and to help her relax. She completes her pregnancy and gives birth to a much loved baby daughter.
This is a typical example of acupuncture and herbs working well together. In some instances, such as lower back strain or osteoarthritis of the knee, acupuncture predominates whilst in other conditions such as eczema or urinary tract infections herbs are the treatment of choice. If I could only apply either acupuncture or herbs then I would feel as if I was working with one hand tied behind my back and I have no doubt that I would be a less effective practitioner.
A secure future for herbal medicine
In recent years the number of acupuncture graduates opting to train in Chinese herbal medicine appears to have diminished. There are a number of possible reasons for this. Training in Chinese medicine has become more expensive, time consuming and exhausting. Many people who complete their acupuncture training feel they don’t have the personal or economic resources to follow this with another 2-3 year course in herbal medicine. This reluctance may have been compounded by the uncertainty in recent years over the availability of herbal products and the status of herbal practitioners. Hopefully resources recover with time, but what is really going on with regard to the ability of herbalists to administer their medicines?
Changes in the availability of herbal products relate mostly to over the counter remedies distributed without any consultation via health food stores and pharmacies. These products must now be licensed under the Traditional Herbal Medicines Product Directive. This does not relate to dried, granular or decocted herbs prescribed by a herbalist after a one-to-one consultation, which are under the jurisdiction of the 2012 Human Medicines Regulation Act and have no need for a separate product license. These herbs are, and will continue to be, readily available from qualified practitioners.
The status of herbal practitioners is another area where there has been considerable confusion. Despite the recommendations of several government working parties that herbalists become statutorily regulated, the most recently commissioned ‘Walker report’ considers this un-necessary. The UK government has yet to make a formal response to Professor Walker’s recommendations but it seems likely, especially given the over-riding demands of Brexit negotiations, that they will accept them. Whilst this is an unfortunate U-turn and a wasted opportunity to regulate professional standards, it will not affect the right of a herbalist to practice.
So herbalists and the herbal medicines they use are as secure now as they have been for many years and there is nothing on the horizon threatening to undermine these positions.
Studying Chinese herbal medicine
Studying herbal medicine is still a demanding proposition and is not something for the faint hearted, but for those who relish a challenge and want to optimise their practice, the rewards of a herbal training are well worth the effort required. The next most important consideration for anyone interested in becoming a Chinese herbal practitioner is to identify a course that will equip you to practice herbal medicine with confidence and competence.
At this point I would like to share something from my own experience.
My first tentative steps along the path of herbal medicine came in my first year at university when I was studying English literature, but also heavily involved in a busy extra curricular schedule of martial arts, Chinese Yoga, Chinese hand analysis, and a rather esoteric form of Japanese Shingon Buddhism. One of our teachers was also a Western herbalist and I remember clearly walking with him in a small park in Norwich. Every few steps he would stop and point out an innocuous plant like dandelion, chickweed, nettle, and plantain and tell me what they were used for in herbal medicine. This for me was my ‘light bulb’ moment! The fact that these mundane weeds could be used to treat common medical conditions created a sense of wonder about the natural world we live in. I still have this sense of wonder 35 years later and if anything my appreciation of its potency and the importance of our need to recognise its value have increased over time.
As I was so involved in Oriental healing arts it was natural for me to gravitate towards studying Chinese medicine. At the time you could only study Chinese herbal medicine (CHM) as part of an acupuncture training so I found a small college run by an intense, maverick, Cantonese doctor in a basement in Baker Street. I spent most weekends over the next 3 years at this college going nowhere slowly until I realised I needed to start again and that I would never be able to practice if I did not feel confident that I had the basics of Chinese and Western medicine in place. I spent another 4 years studying acupuncture and herbs at a number of different colleges. My rather haphazard and inefficient learning experience taught me a few things. First of all CHM was a subject of great depth, subtlety, and therapeutic potency that I loved and wanted to dedicate my life to studying. Secondly I also felt that the standard of education for Chinese medicine was, in general, inadequate, and my basic training lacked theoretical and clinical rigour. I needed to fill the obvious holes in my training…and find and fill the other holes that I was still unaware of.
In many ways the past 25 years have been about filling these gaps. Un-surprisingly like the legendary hydra…once one gap has been filled two more appear, but at least the foundations feel solid, I feel capable of treating serious medical conditions, and I manage a busy and successful herbal practice.
I mention this background because these are some of the key experiences that have informed the development of the White Crane Academy. There are four primary domains to our course that form the bedrock for our training and which I believe will equip our students well for the challenges they will meet en route to becoming a successful CHM practitioner.
1. Academic rigour
The first domain is academic rigour. There is no question in medicine that the more you know the better a practitioner you become. If we are to succeed as individual practitioners and collectively as a profession we have to know our Chinese medicine in detail and depth…and we have to keep learning throughout our professional lives. This is demanding but it is also one of the great joys of Chinese medicine and we are very lucky indeed to have such a rich and varied tradition that we can explore and apply in our work. One aspect of CHM that I am absolutely certain is key to future success is a proper learning of the basics. This means learning by heart the properties and actions of the herbs we use, and the formulations that have been handed down to us by generations of previous practitioners. If the practice of CHM is a language then the herbs are the alphabet and formulae are common words and phrases. Before we can compose our own prescriptions (poetry?) we need to master the basic building blocks of this language. For these reasons I believe it is essential that each student finds a way to learn their herbs and to become familiar with the key formulae that inform CHM practice. We will find ways to explain the herbs that will facilitate this process but it will take time and commitment from you to master these fundamentals.
2. Clinical competence
The second domain is clinical competence. CHM, in my experience, suffers from the disconcerting fact that often what is written down in text books is not what experienced practitioners actually do to get the best clinical results for their patients. There are a number of reasons for this. Researchers like Volker Scheid have deconstructed the ways in which Traditional Chinese medicine (TCM) was formulated in the early 60s by young practitioners, prematurely promoted due to the horrors of the Cultural Revolution. Chinese medicine, as Volker has also exposed, contains multiple strands and forms. Much of what is written is the work of elite scholars who may not have had much hands-on experience of the diseases they were describing. Successful practitioners also conveyed their experience to their chosen disciples orally or in books that were both priceless and un-published. Whatever the reason I know from my own experience that what works in practice frequently differs from what is described in the common textbooks. For this reason it is essential that you are taught by practitioners who know their field, have tested their theories in the coal face of clinical practice, and who can pass on this hard won knowledge to the next generation of students. At the White Crane Academy we are committed to making sure your teachers are some of the most experienced and successful practitioners working in the UK and abroad.
3. Combining research and tradition
The third domain is combining modern research with the classical tradition. I have been involved in researching CHM at The University of Southampton for 15 years now and have conducted two clinical trials, several systematic reviews, and pioneered ways of synthesising available evidence to define best practice. I have learnt sufficient Chinese to be able to read Chinese medical journals. There is no question this body of research provides a treasure trove of theoretical and practical gems that can enhance clinical practice. There are well over 64,000 RCTs in the Chinese database and, in my experience, most of the diseases we encounter in the clinic will have some form of research describing the aetiology, pathology and treatment of the condition. At the White Crane Academy we will endeavour to present the most up to date research findings. We also have links to Beijing University of TCM that will help us identify clinical research in areas where there is no English language equivalent.
However whilst modern research can provide a wonderful resource it is essential not to forget the centuries of clinical experiences that are encoded within the classical tradition. A lot of modern research simplifies or standardises this tradition in order to fit it into an RCT. Whilst we gain generalisability and potentially more widespread use, we may lose some of the nuances and adaptability that makes Chinese medicine such an elegant, precise and effective treatment. Both tradition and modern research are essential aspects of CHM and they need to be taught together as part of your herbal training. If you look at our prospectus you will see that many of our teachers have PhDs. They are all research literate but also clinically experienced. The best of both worlds!
4. Developing a connection with the natural world
The final domain returns us back to the beginning of this essay: the importance of developing a deep connection to the natural world. This is our beginning and our end. An appreciation and love of nature is vital for us as herbal practitioners and is something that we can convey to our patients. Modern life increasingly leads to a disconnection from the natural world that makes people depressed and alienated and contributes to the growing destruction of the flora and fauna of our planet. As herbal practitioners we will be tapping into this interconnected living network to heal physical diseases, to calm and refresh minds, and to revitalise peoples’ spirit. At the White Crane Academy we are committed to spending time together in a natural environment with experienced teachers who can help us to find our own way in to this network and to remind us that healing is about restoring and strengthening connections internally, with other people, and ultimately between ourselves and the beautiful planet we live on.
I do hope you will consider studying at the White Crane Academy. I am incredibly excited at the prospect of helping to forge a new generation of really competent herbal practitioners. It will be a tough journey but we are looking for students who are prepared to work hard to achieve excellence and fully realise their potential.
If you have any questions or concerns, please don’t hesitate to contact me. You can email us at firstname.lastname@example.org or ring me at 0207 586 6639.
Andrew Flower August 2016