"The Boards"

One year ago...

The California Acupuncture Licensing Exam is upon us once again! At this very moment hundreds of anxious test takers are hunched over their tables in a cold, cavernous convention center in Sacramento. Some might be done already.

I sincerely hope that in the future, acupuncture schools in the U.S. and worldwide will focus on transforming students into excellent Chinese medicine doctors, rather than teaching to pass the licensing exams. The exams, as anyone who has taken them will tell you, are in no way a measure of how good a doctor you are. It's a multiple choice test! Fill in the bubbles! All it does is ensure basic knowledge of theory and book learning - certainly an important milestone, but not at all something worth spending four years and tens of thousands of dollars preparing for.

The best teachers I had in school would give a nod towards the exam but focus their time on what they considered most important for the medicine. In California, for instance, that means studying more than the 63 herbal formulas that are on the test. Dr. John Pai once said "The exam is like an old stinky shoe. Use it once and throw it away." Which sums it up pretty well!

Professional Diversity in the TCM Field

Pharmacy counter at the Beijing University of Traditional Chinese Medicine

Eric Brand makes a very important point in a recent blog about professional diversity in the U.S. TCM field. The recently-released NCCAOM survey says that over 93% of people in the field describe themselves as "practitioner" rather than educator, administrator, or funded researcher - "pharmacist" wasn't even an option, that's how few of us there are! Eric comments:

This stat is also very interesting because it appears that nearly 94% of the people in our profession essentially have the same job. In the Asian world, the profession is much more diverse. Many professionals in Asia are funded researchers, pharmacists, merchants, scholars, advisors, etc. In the NCAAOM survey, 91% of respondents said that they were self-employed, while 30% were both self-employed and employed by others.

Overall, these numbers suggest to me that we tend to focus too much on a single model of a professional identity and lifestyle. Over 35% of respondents said that they felt “poorly prepared” in terms of marketing and PR, and we constantly hear complaints that students find difficulty finding work after graduation. Perhaps we are too focused on the idea that private practice is the ultimate goal of all graduates. Many graduates like to work for other companies rather than fending for themselves, and there are many potential industry jobs available in areas such as herbal quality control. Unfortunately, our teaching programs rarely introduce students to career tracks and lifestyle models beyond private practice. We often have little training in areas such as research or advanced herbal pharmacy, and there is hardly any competition for the jobs in these sectors. Unfortunately for the academic community and industry, there are relatively few graduates that have the skills to fill these jobs.

Hear hear! This is exactly why Nini and I started Fat Turtle Herbs. As the TCM field grows in America, there will be a corresponding need for the specialized field of TCM pharmacy to grow as well. Successful Chinese medicine practitioners simply don't have the time to be their own pharmacist - on top of being your own secretary, business manager, insurance biller, janitor, and assistant, imagine assembling raw herbal formulas or granule formulas for every single patient. It's just not do-able. This time crunch leads many people to rely on pills or simply give up on herbs altogether, which besides being very sad is doing your patients a disservice.

That's where we come in. You might not have the capital or the space for a front office person or insurance biller, but you can always send your herbal formulas to us. In the L.A. area we have a convenient pickup location close to the 405 freeway, and we ship all over the United States (regular shipping arrives the next day in Southern California, two days to the Bay Area).

I was fortunate to have Tom Leung as my Herbs 3 teacher at my TCM school in New York - later I was able to work at his herbal pharmacy Kamwo, which is a traditional Chinatown herb store that's been modernized, upgraded and made friendly to non-Chinese speaking practitioners. That's when I looked around and realized I was surrounded by people who had deep knowledge of herbs, herbal formulas, over-the-counter herbal remedies, herbal preparation and TCM theory. They knew much much more than a new graduate of a typical acupuncture college, were involved in Chinese medicine every day of their working lives, and yet none of them ever touched a needle or treated a patient.

When I moved to Los Angeles to finish my TCM schooling, I looked around for a Kamwo equivalent. Surely there must be one, I thought, this kind of herbal pharmacy is so vital to the TCM community. Herb King in Santa Monica used to perform that role, but the owner unexpectedly died in a car crash and it was bought by the owners of a medical marijuana dispensary, who quickly started selling pot there. The owner of the building then booted them rather than risk having his property seized by the DEA, and that was the end of Herb King. Although they still sell Chinese herbs, it's truly a side line - the vast majority of their business comes from marijuana.

(I worked for a little more than a year at the successor to the Herb King, and I can tell you from personal experience that Chinese pharmacy service is little more than window dressing for them. There are certainly good, earnest L.Acs working there who will assemble an herbal formula for you, but without the support of upper management the Chinese herbs displayed are, as I say, window dressing. Fat Turtle is truly focused on professional Chinese herbal pharmacy services - we don't sell pot. I support medical marijuana and I'm glad it's available to those that need it, but it falls into a special category that L.Acs legally have absolutely no jurisdiction over, and associating ourselves with medical marijuana does nothing to advance the profession or help our patients.)

Whenever I tell L.Acs and TCM students what I do, and that I don't treat patients, I get one of two reactions. 1) The students and newer practitioners get a look on their face like they heard someone died, and say "Oh, wow. That's... I mean..." 2) The more experienced practitioners say "Wow, that's great! How do I order?"

The students and new practitioners are thinking of themselves - everyone is afraid of being "one of those" who doesn't end up practicing, who puts in four years of study and borrowed money and "doesn't use it." I'm here to tell you, don't worry about it! Yes, we need lots of wonderful doctors. But we also need teachers, administrators, researchers, and yes, pharmacists, all working in the TCM field. So if you're halfway through TCM school and are realizing that you don't want to be a doctor, come talk to me. I may have a job for you.

Herbal Remedies for your Gym Bag

Our poor neglected blog is coming back! Take a look at this article featuring Tom Bisio and Frank Butler's Zheng Gu Tui Na physical medicine: Herbal Remedies for your Gym Bag.

Fat Turtle Herb Company carries most of the products mentioned in the article, so give us a buzz at orders@fatturtleherbs.com or 310-691-5226 if you want to try these in the clinic or for yourself.

Nini and I will be attending the Zheng Gu Tui Na seminar in San Diego in a few weeks. This is excellent stuff to know and will be immediately useful in practice. I actually met Tom Bisio when I was working at Kamwo - he seems like a nice guy.

Third Root Community Health Center in Brooklyn

Third Root Community Health Center just celebrated its one-year anniversary! In their own words:

Third Root Community Health Center is a worker-owned cooperative business providing accessible, empowering, and collaborative healthcare in the Flatbush neighborhood of Brooklyn, New York. We want holistic medicine, the oldest form of healthcare, to be available to everyone, as it has been for millenia. Our Center is shaped by our very own clients, community, and students, who inform us about their needs and what would help them feel the most at home at Third Root.

Third Root offers community-style acupuncture, private acupuncture appointments, herbal medicine, yoga, massage and health workshops. Take a look!

Health Care Reform

Famous ancient Chinese physician Hua Tuo

If you follow the news at all, you've heard something about this "health care reform" thing people seem to be all excited about. You've read the editorials, you've seen the politicians speechifying. Maybe you've seen the video clips of people shouting things like "We are ALL afraid of Obama" and crying things like "I want my country back!" (What does this have to do with health care? I don't know either.) You've heard the phrases "death panels" and "public option".

So far the debate seems to be framed as "Health Care For All - For or Against?" People on both sides loudly declare the other side stupid, or evil. I'd like to point you towards a voice that asks us to focus on a different aspect of this whole debate - the very nature of the medicine that people either want to extend or not extend to the whole country.

But what's missing, tragically, is a diagnosis of the real, far more fundamental problem, which is that what's even worse than its stratospheric cost is the fact that American health care doesn't fulfill its prime directive -- it does not help people become or stay healthy. It's not a health care system at all; it's a disease management system, and making the current system cheaper and more accessible will just spread the dysfunction more broadly. -Dr. Andrew Weil: The Wrong Diagnosis at the Huffington Post

This is an extremely important point. The health care system is broken, and getting the last 40 or 50 million uninsured Americans into this same system is not going to improve the health of our nation.

It reminds me of a story I heard during my TCM (traditional Chinese medicine) education. There was a doctor in ancient China who became famous for saving lives. He could cure diseases in their most advanced state, when a patient was near death. Everyone called him a genius, some even said he had magical powers.

The doctor laughed when people praised him. "My skill is actually quite low. I can only cure disease when it has gone nearly out of control, and I have to use severe herbs and acupuncture techniques. I have two older brothers who are much better at medicine than I am."

Of course people went in search of these brothers. When they found the middle brother he said "I'm still not very good at medicine. I can only catch diseases in their initial stage. I still have to feel the pulse and look at the tongue before prescribing mild herbs and acupuncture. If you want to know real medical skill, you should find our eldest brother."

Of course the people went to search for this wonder-worker. When they found him he said "When people come to me I use neither acupuncture nor herbs. I do not feel their pulse or look at their tongue. I diagnose them by observing the color of their face and the tone of their voice. I tell them how to eat in accord with the seasons and their locations, and sometimes I give them some simple exercises to do. However, if they could sit quietly every day and listen to the natural wisdom of their own body they would not even need my advice."

The eldest brother was the only one practicing real health care - the other two were doing different forms of disease management. Of course we can't abandon those who are already in advanced disease states, but we should put equal and perhaps even more emphasis on encouraging health - what the chinese call 養生 Yang Sheng or "nourishing life."

Treating Winter Diseases in Summer

Children getting herbal plasters

Here's an interesting story about the use of herbal plasters in the summertime to prevent illness in the winter. It might strike you as an odd idea, but here's the theory...

With the cold weather in winter, the human body tends to contain excessive yin energy due to insufficient yang energy, which makes people liable to attract diseases such as bronchitis, rheumatism, bronchial asthma and cold in the spleen and stomach.

Treating winter ailments in summer means that summer, a season when yang energy peaks, is the time to nourish yang energy for winter, thus relieving and preventing those chronic cold-related ailments that plague people during the chillier months.

You can read the whole story here...

California Acupuncture Licensing Exam on August 5th, 2009 in Sacramento

It's coming.

I'm taking it.

Nini's taking it.

We're studying. We finally got in our studying groove. Right now I could rattle off the ingredients to almost all the 63 board formulas, or most of them. Other random facts: 威灵仙 Wei Ling Xian can be used to dissolve fish bones stuck in the throat. 陰溪 Yin Xi (HT6) and 復溜 Fu Liu (K7) for night sweats. Posterior pituitary releases ADH and oxytocin, anterior pituitary releases all the other ones, LH, FSH, prolaction, ACTH, etc. In case of a broken needle, remove with forceps. If below the skin, contact a physician (seriously, that's the law).

By September 5th, we'll know the results. My personality dictates that I treat this exam as an enemy to be destroyed, and right now I'm deep in training. Wish us luck!

Statement of Fact: Your Heart is Dirty

浊气归心

Zhuo qi gui xin.

Turbid qi goes to the heart.

This statement is usually interpreted to mean that the turbid part of the clear goes to or gathers in the heart where it becomes the blood. To understand this concept, we must know that, just like yin and yang, clear and turbid each can be subdivided into clear and turbid. Thus the clear of the clear goes to the lungs to become the qi, while the turbid of the clear goes to the heart to become the blood.

• Statements of Fact in Traditional Chinese Medicine, by Bob Flaws

Yosan Graduation!

Hey everybody, your blog authors just graduated!!! (Sort of - we have a few more weeks of classes and clinic before it becomes official.)

It's been a long journey - when I started four years ago at the Pacific College of Oriental Medicine in New York, I was married and living in suburban Queens. Now I'm no longer married (whew) and live on the west side of L.A. with a dog and cat and a lovely lady named Nini.

I want to send out a few thank you's to the universe... Dr. Alex Feng, 师夫, mentor, inspiration. Dr. John Pai Wen-Chiang of PCOM NY, for your passion and the lovely way you sing the name 血府逐瘀汤 Xue Fu Zhu Yu Tang, I still remember it. Dr. Roger Tsao, pulse master and karaoke legend. Dr. Steve Jackowicz, for lighting the fire and expanding the way I thought about TCM. Tom Leung, for giving me a chance. The whole Kamwo crew - Jenny, Judy, J2, Rocky, Mandy, Ming Jie, Yangguang, Ray, Jacky, Stacy, Matthew "celebrate good times" Weitzmann, Jonti, Will, Hongwei and Helen holding it down at Grand Meridian, all the guys behind the herb counter including my drinking buddy Mr. Chen... 凉瓜牛肉饭，夏枯草饮，咖啡没糖阿... all my supervisors at the Yosan clinic including Dr. Naiqiang Gu, Dr. Joseph Chang-Qing Yang, Dr. Yuhong Chen, Dr. Zhang, Dr. Jin... and to all my lovely classmates at both schools, some of whom have taught me far more than I could learn in a classroom. To all of you, thank you for making me who and what I am today. I love you.

And to Nini, for healing me, for letting your light shine, for your beauty both inside and out, thank you. I love you.

To my parents and my family, for giving me life, for shaping my life, for being you, you're all wonderful. I love you.

To everyone at Wu Tao Kuan, Zhi Dao Guan, Oishi Judo, Sawtelle Judo, Bryan Hawkins Kenpo Karate, Park's Tae Kwon Do Long Beach, Wu Jian Pai New York, 上海体育大学，Benzene Dojo in Asakusa, thank you thank you thank you. Martial arts and Chinese medicine are inextricably intertwined, all training in one leads to the other, like two sides of the same coin, as a wise man once said...

To the Great Spirit, God Almighty, The Universal Mother, Guanyin, Jesus Christ, the Jade Emperor, all the various spirits and demons that helped me or hindered me and gave me a lesson, thank you. George Clinton said everything is on the one. Everything is on the one. Everything is on the one.

Microcosm/Macrocosm

I'm not sure the origin of these pictures, but they were found at totallylookslike.com, one in the family of lolcat websites.

One of the principles of Daoist medicine is that the body is a microcosm of the universe. Just as there are five planets visible to the naked eye, so there are five major organs in the body, each corresponding to one of those planets (Jupiter, Mars, Saturn, Venus, Mercury to go with the Liver, Heart, Spleen/Pancreas, Lung, and Kidney). Click here for a fun website where you can check other Five Phase correspondences.

In some systems of Daoist meditation and cultivation, there are techniques for bringing the universe inside yourself, harmonizing your energy with that of the universe, and ultimately gaining the awareness that there is no separateness between your "self" and everything else that is.

These lofty ideas have not been included in modern, materialist TCM and certainly would seem out of place in any American university science course - it sounds too much like astrology. The closest you'll find is the idea that the weather has an influence on your health. If it's cold, you could catch a cold. But the link is there - if the sun, at least 91 million miles away, can grow plants here on earth, why shouldn't Jupiter and Mars have some kind of influence on us as well? Why not the moon, smaller and colder but so much closer? We already know the moon influences the tides and menstrual cycles.

It's easy to dismiss these ideas because there is no scientific evidence for them yet, but it's quite possible that our instruments just aren't advanced enough yet. In the Daoist tradition, your body can be the most finely tuned instrument in the universe, and physical practices such as qi gong and dao yin are the methods of refinement.

Medical traditions across all cultures, until recently, put higher value on the doctor's ability to wring information from the body with her questions, hands, eyes and nose than the ability to order tests. What will you do if you have no X-rays, no MRI machines? Throw up your hands and give up? In TCM, we learn to pull information by palpation, feeling the abdomen and the pulse, looking at the tongue, even observing a particular patient's odor. There is a wealth of information there - it's just a matter of sorting and ordering it with this system we call Chinese medicine and giving a diagnosis, which then gives us a roadmap for treatment.

Happy AOM Day!

What is AOM? AOM is an acronym for Acupuncture and Oriental Medicine, and it refers to the system of medicine that uses acupuncture, herbs, body work, nutrition counseling, exercise and more as the tools to get people back in balance and therefore back to health.

What's the difference between AOM and TCM? TCM stands for Traditional Chinese Medicine, and is the official system of Chinese medicine that is taught in China. The terms, theory and methodology are all standardized and thus are used in many non-Asian countries for educational purposes.

Here in the United States we use both terms to refer to the medicine. Some people prefer the term AOM because it encompasses all systems of Asian medicine with roots in Chinese medicine. The traditional medicine systems of Korea, Japan, Vietnam and many other Asian countries are all based on Chinese medicine, but have developed their own unique theories and treatment methods as well, and thus cannot be called TCM.

Still other people prefer the terms East Asian Medicine, Traditional Asian Medicine, or Classical Chinese Medicine. In the end it doesn't matter what you call it - just use it! If you're a patient, take a moment to reflect on how your Chinese medicine practitioner has helped you, and tell a friend. If you're a practitioner or a student, let's give thanks for being in this profession and use today to let people know about why they need Chinese medicine in their lives.