As I learn more about practicing with western and local herbs, I think of myself as working toward precision in my prescribing. But precise means different things to different people. This writing is meant to help me think about what my goals are.
One style of precision is very precise about the actions and indications of each herb employed. This style tends toward single-herb prescribing, and, as this style reaches its apogee, it begins to develop bizarrely specific herbal profiles, with guidelines that might read: “the patient who needs this herb tends, while thinking, to stroke downward along his or her nose, especially with the left hand.” While such an indication would certainly be useful to remember if you happen to come across such a patient, it is hard to draw from such an indication any more general understanding of what the herb is doing, what its range of applicability might be, or how it will work with other herbs. Nevertheless, this style is quite valuable for clarifying the specificity of each herb, so that we aren’t stuck with vague understandings such as “oh, that’s qi tonic.” When used in its pure form, this style will depend on a large and ever-growing materia medica; As one makes finer and finer distinctions between the herbs, one needs more and more herbs to fill out the spectrum of effect, or, seen another way, since the aim is to perfectly match an herb to a patient, one will need at least one herb for each of the 6 trillion people on the planet.
A second style seeks precision in its diagnostic categories. The aim here is to understand and perceive the fundamental dynamics of human health. The hallmark of this approach is that it seeks to be systematic: organized, integrated, and simplifying, thus I name this the systematic style. One still needs a good refined understanding of particular herbs to use such a system, but the attention is not on the herbs in their individuality, but on the way they affect the fundamental dynamics identified by the diagnostic system. This style moves toward using fewer and fewer herbs. To the extent that one’s system is truly fundamental, one can recognize a few basic dynamics underlying a variety of clinical manifestations. Consequently one can seek to treat using only the handful of herbs needed to rectify those dynamics. This style risks clipping one’s awareness of the individuality of both herb and patients - seeing the ways that they fit in one’s system, but failing to see the ways that they do not fit. In other words, it is unclear whether one really can shoehorn the blooming, buzzing biological world into a tidy system with only 5, 10, or 25 variables.
There is a third style which is not precise in an obvious way. In this style, herbal actions are again understood in terms of diagnostic categories. (I will call this the categorical style.) The difference from the second style is that instead of preferring to use one specific herb for each action, there is a tendency to use lower doses of several herbs from the same category. Instead of trying to choose between dandelion, burdock, or oregon grape, one would just blend the three, and that blend would represent one function within a formula. The categorical style seems especially suited to long-term treatments, which cannot afford to have too many rough edges. Even if a formula is carefully balanced, the eccentricities of one’s preferred herbs may create problems if they are given for several years. Moreover, this prescribing style allows one to rotate individual herbs out of the formula without changing the direction of the formula. It does seem that the categories of thought used in this style are also less precise than in the systematic style. Perhaps this is because the body cannot be told to go to a particular point 20 miles away, rather you can point it in a general direction and begin to refine matters as the destination draws closer.
One style of precision is very precise about the actions and indications of each herb employed. This style tends toward single-herb prescribing, and, as this style reaches its apogee, it begins to develop bizarrely specific herbal profiles, with guidelines that might read: “the patient who needs this herb tends, while thinking, to stroke downward along his or her nose, especially with the left hand.” While such an indication would certainly be useful to remember if you happen to come across such a patient, it is hard to draw from such an indication any more general understanding of what the herb is doing, what its range of applicability might be, or how it will work with other herbs. Nevertheless, this style is quite valuable for clarifying the specificity of each herb, so that we aren’t stuck with vague understandings such as “oh, that’s qi tonic.” When used in its pure form, this style will depend on a large and ever-growing materia medica; As one makes finer and finer distinctions between the herbs, one needs more and more herbs to fill out the spectrum of effect, or, seen another way, since the aim is to perfectly match an herb to a patient, one will need at least one herb for each of the 6 trillion people on the planet.
A second style seeks precision in its diagnostic categories. The aim here is to understand and perceive the fundamental dynamics of human health. The hallmark of this approach is that it seeks to be systematic: organized, integrated, and simplifying, thus I name this the systematic style. One still needs a good refined understanding of particular herbs to use such a system, but the attention is not on the herbs in their individuality, but on the way they affect the fundamental dynamics identified by the diagnostic system. This style moves toward using fewer and fewer herbs. To the extent that one’s system is truly fundamental, one can recognize a few basic dynamics underlying a variety of clinical manifestations. Consequently one can seek to treat using only the handful of herbs needed to rectify those dynamics. This style risks clipping one’s awareness of the individuality of both herb and patients - seeing the ways that they fit in one’s system, but failing to see the ways that they do not fit. In other words, it is unclear whether one really can shoehorn the blooming, buzzing biological world into a tidy system with only 5, 10, or 25 variables.
There is a third style which is not precise in an obvious way. In this style, herbal actions are again understood in terms of diagnostic categories. (I will call this the categorical style.) The difference from the second style is that instead of preferring to use one specific herb for each action, there is a tendency to use lower doses of several herbs from the same category. Instead of trying to choose between dandelion, burdock, or oregon grape, one would just blend the three, and that blend would represent one function within a formula. The categorical style seems especially suited to long-term treatments, which cannot afford to have too many rough edges. Even if a formula is carefully balanced, the eccentricities of one’s preferred herbs may create problems if they are given for several years. Moreover, this prescribing style allows one to rotate individual herbs out of the formula without changing the direction of the formula. It does seem that the categories of thought used in this style are also less precise than in the systematic style. Perhaps this is because the body cannot be told to go to a particular point 20 miles away, rather you can point it in a general direction and begin to refine matters as the destination draws closer.
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