A professional.
It’s an idea in the mind.
We all know when something or someone is “professional;” there is a certain quality involved, a trust; a standard of expectation.
As an ideal standard for a Chinese medicine practitioner, however, “a professional standard of practice” should be only the starting point. Our ancient tradition calls for more than this. It calls for self-cultivation, a development of insight and intuition, an empathy with the patient that provides a deep understanding for patterns of imbalance occurring within, and realisation of exactly which interventions can bring that patient back to themselves, as they should be.
To achieve this we cannot limit our study to medicine, but must expand our own richness of experience, in a wide variety of fields. Nothing is irrelevant to this. Everything can teach us something that, if only by analogy, might suddenly trigger that particular clinical insight we may need to break through our current barrier.
But we have to think, to puzzle out for ourselves exactly what the mechanism of pathology is, for each patient. We have an extremely flexible theory of physiology set out for us, in Chinese medicine: just detailed enough to be accurate, yet not so complicated that it cannot be held in the head, all at once. This is important when we want to imagine the consequence of any particular intervention:
“Hmm; this patient has fluid retention, I need to clear the fluids. But they also have a tendency toward loose stool and dizziness, so if I just use downward-draining diuretic herbs, it will probably exacerbate the tendency for Spleen qi to descend instead of ascend, and could make the dizziness and loose stool worse.”
Or:
“Hmm; this patient has fluid retention, I need to clear the fluids. But they also are constipated. I’ll bet what is happening here is that those fluids being retained in the tissues are just exactly the same fluids that should be in there moistening the bowels. So by regulating the fluid metabolism the constipation should resolve by itself. Let’s try it and see.”
Or:
“Hmm; this patient has fluid retention, I need to clear the fluids. Not only that, but her periods have stopped. Blood is mainly fluid, and the disruption to the fluids could be interfering with the normal menstrual blood flow. The crucial question is, which came first, the fluid retention or the amenorrhea? Ah, the fluid retention. So if I regulate the fluid metabolism the periods should return. I’ll try Dao Shui Fu Ling Tang.”
We believe that the advantages of this “fuzzy physiology” have not yet been fully appreciated, even by those of us who employ it everyday. In another piece we examined the consequences of the flip side, the addiction to concrete detail that can paralyse action in the face of uncertainty. But as a profession we have not begun to examine, in any explicit way, how the level of our Chinese medicine approach to clinic can open the door of creativity and insight in the treatment of patients, and free us from the trap of prescription-by-rote that will eventually spell the end of “evidence-based medicine” as an ideal.
We believe that it is this fuzzy physiology, and none other, that constitutes our identity, and our primary contribution to society. Where else can people turn when the biomedical model has seized up for them? A naturopath?
Naturopaths use herbs, but mainly based on a Western bio-medical model, so no hope of a new angle there. Hell, they are using OUR herbs, more and more, perhaps believing they are somehow more powerful than their own. Likewise, all sorts of people are “dry needling”. What they seem not to know is that it is the system, the world-view, the understanding of connectivity that makes Chinese medicine powerful.
As most new graduates of a Chinese medicine school discover, however, the system is anything but a prescription-by-rote. It all seems straightforward enough, in the beginning. We learn typical groups of symptoms that often occur together, and learn what can lead to that condition, the mechanism of pathology, and what to do about it. But in clinic it is not that simple. Not only that, those patterns we learned are only examples. We certainly can check the accumulated experience of our tradition, which is a tremendous resource, but much of the time we have to think the whole thing out for ourselves. An example we are all familiar with: petrol fumes leading to headaches and dizziness. Not going to find the mechanism for that in the classics. But your patient is sitting there in front of you, looking at you with those big trusting eyes: you’d better come up with something. And it has to work. You have two appointments, generally, before they quit in disgust.
Ok, apply the brain. Let’s see, he’s a bit fat with thick fingers, definitely a phlegm body-type. But what’s that got to do with petrol? Hmm, fumes, though; fumes are fragrant, fragrant things are yang and expand outward. What if the yang-natured fumes are breaking up the congealed yin-nature of the phlegm? Yang also rises, perhaps these fumes are carrying up that now-dispersed phlegm into the head. Presto—a theory. Let’s test it: transform phlegm and direct it downward. Oh good, it worked!
There are few things as satisfying as that.
But the next patient has the same primary presenting symptom: headaches and dizziness when exposed to petrol or perfumes. This woman, though, is not fat at all, and moreover has a thin red tongue with little coat, thready left side pulse, and a tic in her left eye. She lights a Fatima in a holder and sits back coolly, suspicious. You wave away the smoke and try to think. What did the classics say about Fatima brand smokers? No, that’s a dead end. Fumes. Yang. Expansion. No phlegm to break up here, obviously. But wait: yang expansion is balanced by yin contraction, it’s everyday experience. She is clearly yin deficient, and her whole manner screams Liver. Could it be Liver yin deficiency with a tendency toward Liver yang rising? Then all it would take is petrol or perfume to trigger the rising of yang, and bang! Headache. Ok, it’s a theory. Test it.
This type of thinking is crucial to continued growth as a Chinese medicine practitioner. The satisfaction provided by each little success as we solve each puzzle along the way supplies much of the motivation for being on the front line with the public, every day. As we gather experience over years of clinic, we become more adept at this kind of thinking, and of course achieve better results. We are therefore more valued as we get older. How many professions can say that?
One thing that will derail this whole process, however, is adopting the Western medicine viewpoint as the final word in diagnosis in clinic. From then on, you are crippled, forever waiting for someone else to “do the research” and tell you what to do. Furthermore, you are stuck with the blindspots of the Western biomedical model, with all of its unexamined assumptions. Sure, it’s the main thoroughfare these days.
Use biomedical findings as reference by all means. But do the thinking yourself. Use our fuzzy physiology and let it lead you off the main thoroughfare, into that side street, down a weeded lane and through a little vine-covered door, into the hidden garden where, right in the centre, there is this tree …
The Fat Monk 