I am experimenting with cacao bean infusions and am drinking about 6 freshly crushed beans in 100ml of boiling water right now.

There is a warm, soothing sensation around the lower hypochondriac region, reaching towards, but quite arriving at the lower back. This leads to a speculation that cacao may be warming and emolliating to the liver.

There may be a slight kidney fortification aspect as well. Quite appropriate for a dark, roasted, fermented bean.

I love this article, and may cite it in my bibliography for future students. I have taught classes in advanced theory and treatment planning for years, and have encouraged the students to use the principles of English grammar to correctly state thier treatment priciples: verb-then-noun. I love that this article tells the etiology of the format, and the array of words that are correctly applied to the patterns.
Thanks so much for helping to make students(and the rest of us) more clinically careful.
On a personal note, I handed over my practice recently to a colleague because I had to have some surgery. Had I not clearly identified my treatment prinicples and strategies, I would have had hours of work preparing my files for my colleague, rather than using my time to mentally, spiritually and physically prepare for my own healthcare.
So thanks again for stating it so eloquently.

Another great book for practitioners is "Overcoming Underearning" by Barbara Stanney. It helped me increase my money qi and keep it flowing freely in my practice.

Hi.

I was wondering where you got the information about most people coming for an average six times.

Thanks,
Brette

Thanks, Eric for your work, your sincerity, your dedication to Chinese medicine. We miss you but know you'll stay involved with growing and improving the profession of CM in the US for many years to come! Happy Trails.

Zhu sha is no longer commonly used in this formula, historically it acted as a preservative for the pill and as a spirit-quieting medicinal. However, zhu sha is rarely used internally in the modern day, and it isn't usually replaced with anything else in this formula.

Hi Eric what's your sense of the importance of zhu sha in this formula? Does it need to be replaced? How is this handled in China and Taiwan?

Thank you so much, Eric for your kind words, and for your comments in this blog. Bodywork is so important to me as a clinician. And yes, the places where our lives unexpectedly "touch" can be quite as magical as how we use touch with our patients..

This article was exactly what I had been looking for. Excellent information! - Thank you, Gwen

Thank you for this wonderful and informative article about versatile Er Chen Tang formula. I am a second year Chinese medicine student at AAAOM in Roseville, MN and studying herbs. I am also taking this formula for my own health, alternating it with Liu Wei Di Huang Wan, and finding this combination to be very effective for my condition and improving my health. Your article is a great teaching tool and I thank you very much, Eric Brand. I can only hope to be as knowledgeable as you some day, but I am aspiring to be so! Thanks, again, for sharing your knowledge.

Respectfully,
G Callahan

Liu Wei Di Huang Wan
Xiao Yao San
Si Ni San
Chai Hu Shu Gan San
Wu Ling San
Si Miao San
Huo Xiang Zheng Qi San
Cang Er Zi San
Sheng Mai San
Shen Ling Bai Zhu San
Yu Ping Feng San
Jin Gui Shen Qi Wan
Gui Zhi Fu Ling Wan
Zuo Gui Wan
You Gui Wan
Tian Wang Bu Xin Dan
Bao He Wan
Li Zhong Wan
etc., etc., etc.....
Many, many, many of the most tried and true Chinese formulas were not cooked at all. If not cooking the herbs together was good enough for the progenitors of Xiao Yao San and Liu Wei Di Huang Wan, I'm willing to take it on faith that it's not a critical process.

Love what you write, Eric. Thanks.

The problem is that the consumer/patient does not have a clue regarding the huge differences between the shelf lives of the various substances in their many bottles of supplements. In addition, storage temperatures can have a great effect on longevity. In the perfect world, that we will never see, there would be a manufacture date along with the manufacturers "guestimated" best by date. As you so appropriately wrote, some products will be far less potent 12-18 months after packaging and others will be fine after 100 years. Sincerely
David Getoff, CCN,CTN,FAAIM

I think # 3.... got a lot of flyers to let public aware of your great,, not expensive but excellent services. I think that will do.

How informative and effective ideas,, i think it work really when applied.

Well said David.

Here's what I have gleaned from the use of "Oriental" as a racial slur. "The Orient" is a correct place term. The term "Oriental" can be used correctly if referring to an inanimate object, i.e. an "Oriental rug" - which is precisely why it is considered a racial slur to refer to a human being in such a manner. When it comes to racial slurs, it behooves all of us to simply remove the offending terms from our vocabulary, regardless of whether doing so is considered PC by some or an inconvenience to others. The first thing you learn in conflict resolution is this - only one of the two parties needs to perceive a conflict for there to be a conflict. If this level of caution makes me politically correct... well, I'm a hell of a lot more comfortable being labeled that than racist.

I don't find the term "Traditional East Asian Medicine" long at all. I have loved it since I first came across it, and have been using it in everything I write since discovering it. Not only does it do away with the problems mentioned above, the acronym implies inclusiveness. This is a great thing for practitioners of Worsley 5 Element acupuncture, a Korean acupuncture tradition, or Japanese Meridian Therapists like myself, precisely because it implies that we, as a "TEAM", are all in this together. And while we all may disagree with each other about theory, traditional authenticity etc, we are most certainly all under one banner in terms our licenses, the power of our licensing bodies, political clout, etc.

You don't need to spend a lot of money on flash. The people who come to my office see a spare but lovely space. The colors I chose for the space have elicited a lot of comments about how wonderful it feels to just be there. It was my "intention" to set up an atmosphere that I spent a lot of time and attention on (not money) and that intention is felt by all who come in that space, relax and open up very easily on their very first acupuncture consultations. I believe hospitality makes a wonderful first impression and part of that is when some time and attention is devoted to the space to create a welcoming, hospitable atmosphere. While everyone may not notice the cleanliness or lack thereof, it never hurts to be clean, especially the bathroom!

Hi Eric--

I look forward to hearing some good comments on this blog. This is an interesting and controversial subject that deserves our attention.

When I first transitioned from Asian Studies to traditional Asian medicine, the popularity of the term 'oriental' seemed very odd to me. In the modern study of Asia, 'oriental' is more often than not associated with 'orientalism' and is considered pejorative. Although the classic book on this topic centers on the Middle East, this term in academic circles can also infer an antiquated, prejudicial view of Asia and its cultures. By eschewing the use of the word 'oriental', I think that we, as a profession, both demonstrate an understanding of academia beyond our own field and also distance ourselves from concepts of Asian culture that are archaic and inaccurate. Failure to do so can only hinder our progress and garner us an unfortunate perception of being uninformed.

Moreover, it behooves us to use the term 'TCM' to refer to a proper style of CM and not fall prey to the lazy habit of deeming any form of CM or traditional Asian medicine as 'TCM'. There is no hierarchy in the various schools of traditional Asian medicine, but each approach has its own distinct concepts and characteristics. By being scrupulous in our terminology, we are recognizing the diversity and richness in our professional community and avoiding the mistake of conflating disparate, even contradictory, medical models under a common rubric.

David.

I vote for both, Honora. Having been on the receiving end of competent care in a dirty office by my first acupuncturist, I only returned out of sheer necessity. Once I found someone who could provide effective care in a clean office, I was outta there. Feedback from my own clients is that my office is like a spa so they feel relaxed as soon as they enter. Then I provide loving, caring acupuncture treatment. My first profession is massage therapy so the comfort factor is first and foremost to set the tone for needling. Interestingly I once read an article where a study showed that people's perceptions are influenced by exposure to soft vs. hard surfaces and warm vs. cool surfaces. Test subjects rated their experience of a woman in an elevator who asked them to hold a cold drink or a hot drink while she wrote on a clipboard, or similarly, a hard object or a soft object. Their ratings corresponded to the quality of the surface they touched. The woman with the clipboard was perceived as warm and friendly by test subjects who were asked to hold a warm drink or a soft object. Food for thought!

Hi Eric--

Thanks for the great blog! I learned something new about just how large an area anatomically is covered by the term 'yao'. This is similar to the region described by 'xie' or rib-side, which is not relegated only to the hypochondrium but does, in fact, cover the area from the axilla down to the portion below the most inferior floating rib. These bits of Chinese medical precision are, I believe, much more than semantics, and often prove significant in the clinic. Moreover, being able to easy retrieve an accurate definition from Wiseman's Practical Dictionary of Traditional Chinese Medicine is reason enough, I think, to embrace his standardized language--especially in a classroom context.

David.

I love it. Is this not the point? And yet it occurs to me that the shift that is 2012 is well underway and all around us - so much so that indeed, many may not recognize it in the same way that fish do not recognize water.

And what is that shift? It seems to me it has everything to do with the riddle of our human empowerment. Is choice actually choice if one does not recognize it as such? The new age would have everyone know that 'you create your own reality.' To be sure there is something poignant and important in this statement. Yet it is more accurate to acknowledge that one can only ever co-create one's reality. No one can make the sun come up in the west tomorrow simply from positive thinking. How therefore does one balance this paradox - viz. that humans have as yet no clear grasp of the extent to which we create our individual / collective reality; while simultaneously all are ruled by the law of our mortality and the certainty that humans alone know and cannot deny; namely that we and everyone and everything we have known will one day die and be erased like a passing cloud. The Maya prophecy is - of course - best understood metaphorically. The 'end of time' may indeed be the tolling of a bell that announces the end of our dallying indecision as to how we will or will not acknowledge our common humanity and the now obvious fact that - nations and races aside - we are indeed all on one planet. Lovely. This is after all the very song that mythology and even (once upon a time) organized religions have sought to play since the beginning of human culture's memory.

Er Chen Tang is very great which has many varieties and combinations.Thank you for the info.

Hi Eric--

Thank you for your comments on the disparity between our modern system of organizing the materia medica versus the classical approach. We should always keep this difference in mind when approaching the question of categorization.

You described the potential for classifying sang ji sheng mistletoe as a yin-supplementing agent. This reminded me of questions I have long had regarding agents which 'supplement liver and kidney'. Referring back to your recent on the liver's governance of the sinews and my thoughts on that topic, my inclination is to understand supplementing liver and kidney as relating to blood and yin, respectively. Nevertheless, the liver-kidney supplementing agents that readily come to mind--sang ji sheng, wu jia pi, and niu xi--range from balanced to warm, and wu jia pi is not only warm but also acrid and bitter (i.e. not sweet). In other words, as a group, these agents lack the basic qi and flavor typical of yin-supplementing agents, despite their actions. Moreover, yin-supplementation is augmented by securing and astringing, as exemplified in the use of shan zhu yu and shan yao in Liu Wei Di Huang Wan, while the former group of medicinal agents is, on the contrary, remarkable for their draining actions of dispelling wind-cold-damp and quickening the blood. Being draining, acrid, bitter, and warm, it intrigues me that these agents have the ability to nourish yin at the deep level of liver and, even, kidney.

Here are my questions. Is it most likely that the yin-supplementing action of this group is primarily derived directly from empirical usage as opposed to being deduced theoretically? Also, do you have any examples of these agents being used for simple yin vacuity in cases which do not require the specific action strengthening of sinew and bone? Finally, are there cases of medicinal agents ascribed the property of supplementing liver and kidney where this property implies treating liver blood and kidney yang or liver and kidney yang insufficiency?

Best,
David.

Hi Nancy, I am just seeing your comment for the first time. So sorry! If faxing works better, that's good to know. The only suggestion I can give for being sure that the MD will receive and read the letter is to ask the patient to mention your care the next time she goes in to see her MD. You might also tell the MD you are open to speaking with her/him on the phone about the patient's care. Depending on the case, this could actually be useful. If appropriate, you could include an SASE along with a form that has some specific questions you want the MD to answer (would have to have the initials of the patient in order to be HIPAA legal). Those are the only things I can think of at the moment. I would also send those follow-up letters telling them how the patient is doing. If you gain more intelligence about this, please let me know in a regular email! Blessing to you, Nancy.

HI,
HIPAA forms are required for getting informatuon about your patients. Don't just send them a letter but send it with a gift. Doctors are used to getting gifts from detailers. But that has stopped. Send an adverising cup.

Hi Eric--

Thank you for this clarification. I often discuss this point in my teaching, and I appreciate your detailed breakdown of the various tissues involved according to biomedical A & P. You make the point much better than I ever have.

As a corollary, I also like to teach my classes the statement 'the knee is the residence of the sinews'. All too often we may assume that limpness, weakness, or pain of the knees essentially pertains to a kidney vacuity. In fact, it is my understanding that the 'sore and aching lumbus and knees' symptom so frequently mentioned in kidney insufficiency patterns actually reflects a liver-kidney vacuity, with lumbar pain as a direct manifestation of the latter and knee pain indicative of the former. Owing to the fact that the 'liver and kidney have the same source', there are many cases where the pattern identification, treatment methods, and the points or formulas used should cover the spectrum of this deficit. Just as rendering 'jin' as sinew expands the possibilities in understanding and treating patients, I think understanding the specific relationships of the liver and kidney to their resident locations allows for more nuance and sophistication in our practice. Another level of comprehension is available when one recalls the statements 'the liver stores the blood' and 'the kidney stores essences, along with the axiom 'blood and essence have the same source'. The rigorous logic of ancient Chinese doctors is wonderfully evident in the parallel construction of all of these resonant, and illuminating, statements of fact, invaluable gems of insight to those willing to ruminate on the multivalent nature of the language.

David.

A beautiful post...thanks for telling your story, Malia, and reminding us about what really matters & what we most remember when all is said and done...kindness.

Si ni san is one of the most elegant formulas ever written. Besides being the root of so many qi stagnation relieving formulas, it has cooling properties.

It is ironically very useful for restoring circulation and warmth to the extremIties. When heart heat has created a firestorm in the chest, the yangqi is blcoked at the shoulders sand hips, leaving distal parts cold.

Si, fascinante! Igual que el mecanismo que hace que una estasis de sangre impida la generación de sangre nueva. Esperamos tu descripción al respecto con impaciencia!

Wonderful and inspiring!
Are they teaching any workshops?

Thanks, Honora...very good thoughts indeed. Thanks for sharing and don't mind if I borrow... :D

Hi Allyndreth,

Yes, pearled barley is different than medicinal Yi Yi Ren. Yi Yi Ren generally refers to coix (Job's tears), which is the item used in Chinese medicine; it is slightly larger than pearled barley. However, both pearled barley and coix (Job's tears) share the Chinese name Yi Yi Ren and are commonly sold in pharmacies as a large and small form (the large form is true Yi Yi Ren, the Job's tears used in TCM, the small form is pearled barley, which lacks the same medicinal effect).

Isn't pearled barley from the barley plant instead of Job's tears which is what I learned as Yi Yi Ren?

Thank-You. I have taken each of these ideas to heart!

Holla!

Great, to-the-point article, Honora!

This article has now confirmed something I've been thinking for a while now- based both off of your writing here and FB posts- you are my soul sista from anotha motha.

Hey there! I just wanted to ask if you ever have any trouble with hackers? My last blog (wordpress) was hacked and I ended up losing months of hard work due to no back up. Do you have any solutions to protect against hackers?

It seemed to be an allergic reaction to something.

Hi Robin, I think it is just mechanically removed and it is naturally white. I don't know how to explain your experience with it, I'm sorry.

Do you know what method or substance is used to remove the outer parts for the official Deng XinCao and make it so white ? My daughter was taking a raw formula with the official one, and I noticed that raw it had a very acrid, chemical smell, and cooked an acrid taste. My daughter had a sore, burning tongue after she drank it.

Thanks for this post, I was just talking about this recently. I've seen some old Taoist/medical texts (I think from the misogynistic Tang dynasty c. 900 CE) that state the biggest health harm from sex can come from having just one female sex partner, and that the cure is to have lots of sex with many younger women to get their Yin essence. It seems useful to point this out to show some of the gaps in the 'wisdom' of the ancients. I've been meaning to write a cautionary piece on trusting the Yin Care herbal wash for treating STDs (as it is promoted by some distributors) as while Chlamydia may appear to go away, it is still there and can cause a newborn to be born blind or dead.

Great article, it is always important for us trained in TCM to pick the best modality or combination to treat our patients. Thank you for all your insights.

Thank you so much, Honora. Your thoughtful article will help my practice tremendously.

Hi Jeanine,

I've only heard of this treatment for herpes zoster, I wouldn't be as inclined to use it for chicken pox because there is a wide area affected, the patients are usually children, and there isn't much pain involved. In Sichuan, they use the Deng Xin Cao pictured above (just the juncus pith), so your teacher is talking about the same thing.

One of my acupuncture teachers, also from Sichuan (Cheng Du) once lectured on this use of Deng Xin Cao for the topical treatment of herpes zoster. Though his instructions included soaking the Deng Xin Cao in vegetable oil for 20 minutes, removing the extra oil, lighting it, then putting the lit end directly on the vesicle to break it. But the topic of using "real" Deng Xin Cao did not come up. Any idea if there is a difference?

Also, I was taught this treatment was good for herpes zoster, but no mention was made of chicken pox. Can it be used for chicken pox as well?

Thanks Ashley...I appreciate your comment. WE all have some type of issue with money...it's so elemental in our culture. Glad if it is helpful!

Does it work at all?

Bob, thanks for sharing your experience- it brought back precious memories.
I spent 2 months in Nepal in 2002 as part of a year long freelance mission offering acupuncture treatments mostly in Tibetan exile communities in India & Nepal- at that time the Shechen clinic in Boudha was under construction & not yet operational. A Belgian Nurse (Ani Elisabeth) was the Shechen Monastery's "Medical Officer". She used to take Tsering & I up to Nagi Gompa where I would treat the nuns. Your description really takes me back to one of the most satisfying and fulfilling times in my life- it's hard to believe that it's been almost ten years. I would go again in a heartbeat- perhaps when the kids are a little older...

Beautiful, thank you!

Jim, I think the main advantage of using a granule form would be the ease of grinding. The crude product is tricky to grind finely.