Blog Intro (Part I): My (Terrifying) Start To Practicing Herbal Medicine
By
Travis Cunningham LAc. MSOM DICEAM
In East Asian medical school, my most influential teachers were herbalists. Of the doctors I was exposed to at the time, the herbal practitioners were the ones who showed me that dramatic and powerful change was possible in the clinic. The path to healing was opened through careful diagnosis and the prescription of an herbal formula.
When I graduated from school, I wanted to start my practice with an herbal pharmacy. I had the good wisdom to begin the venture of my business with my dear friend and colleague Travis Kern. Travis, was blessed with a pragmatic disposition. He had skill and experience in the fiscal and legal aspects of our society that I did not. By putting our heads together and our hands to work, we literally broke ground on our clinic and pharmacy space. Honoring the theory and affinity of our medicine, we called our business Root & Branch.
Seeing Patients
It was so slow at first! — torturous in fact. And then, there was a patient. A patient with digestive troubles. I remember having to hide the shaking of my hands as I took his pulse. You would think that a year of student clinic in school would have trained my nerves. But this was different. It was my practice. I had invested. And, I had a lot to lose.
I wrote the classical formula Lizhong Wan, but in decoction form. We cooked the formula for him in the pharmacy using our rigorously tested pressure cooking method. Unfortunately, we misinterpreted how much water to put into the cooker and gave the patient an inaccurate timeline for when it would be ready. He had to come back a second time to pick it up.
Did the formula work? Kind of. I remember awkwardly speaking to the patient on the phone one week later. He told me that the bloating and discomfort that he was experiencing had lessened but that he had decided to seek treatment from a Naturopath for help instead of continuing with Chinese herbs. My lack of confidence didn’t blame him.
It would be another few patients before I had a really solid herbal win. I had written successful herbal formulas in school, so I knew it was possible. One of the first challenges I faced in my herbal practice was feeling scattered in my diagnostic awareness. Which method of diagnosis should I pick to use? Which type of formula will work for this patient?
As an early student of East Asian medicine, I made the assumption that all diagnostic strategies should be learned and utilized. I thought that one should be versed in the methods of the classics - the Neijing and Nanjing. That one should internalize the stragegies of the Shanghan Zabing Lun, the works of Sun Si Miao, the masters of the Jinyuan dynasty, with wisdom of the Wenbing, and other modern scholars and doctors who left commentaries and case studies. Basically, one should learn everything.
A harsh truth of clinical practice hit me in the first few months of my work. I didn’t know what the heck to do!
With an ever-mounting wave of patients knocking at my door, I needed to figure out how to treat real medical problems and fast. Not only to serve my patients, but also, so that I could build a career doing the work that I had invested hundreds of thousands of dollars to be able to do. What I wanted was simple: to treat patients with a timeless medicine — a medicine that unifies classical ideas with modern situations; to make real the tools of acupuncture and, especially, herbal medicine for the people who were coming to me for help; and, to make a living doing so. It sounds so reasonable, doesn’t it?
Diving In
I scoured the internet for help. Hungry for answers, I quadrupled the number of required continuing ed. hours for my license renewal that first two years. I studied three different pulse diagnostic systems. I learned how to read kidney stones in a patient’s ears, anxiety by looking at the wrist, and low back pain by seeing the legs.
And then, I had a patient. A patient with unmanaged diabetes and peripheral neuropathy. The neuropathy was so painful, that he had difficulty standing. His family helped him into the clinic by wheelchair. I felt his pulse and asked a few questions. I wrote him the modern formula Xuefu Zhuyu Tang with the addition of Shuizhi and Tubiechong - an approach that I had learned from my first herbal teacher Dr. Greg Livingston.
The next week, the patient came back to the clinic with a smile on his face and without his wheelchair. He walked right up to me and shook my hand. “I can walk without pain,” he said. He was amazed. I was even more amazed.
It was occasional successes like these that put new life into me. Every time something really worked, it inspired me. I dove deeper. I studied more, and sought out new teachers. I made so many frustrating mistakes. My head was aswim with questions:
“Why the **** didn’t this work?”
“That last approach worked alright, but could it work better this way?
”Can herbs even help this person?”
”Why didn’t I asked about that obvious thing before now?”
The advantage of my frustration was that it pushed me to find more answers. I craved context and a baseline method for my clinical work and assessment.