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— updated 2012-02-28

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Herbalist Review, Issue 2012-#1:
RMHI's aptitude test for aspiring TCM herbalists

by Roger W. Wicke, Ph.D.

Chinese herbology has a reputation for being challenging to learn; it requires a certain level of skill in pattern recognition and ability to solve puzzles, much like medical diagnosis or detective work. These challenges are discussed as well as methods for overcoming them. At the end is a link to RMHI's admissions aptitude test, included within our HerbalThink-TCM software package.

Subtopics on this page…

 
Copyright ©2012 by RMH-Publications Trust; all rights reserved. 

 

Introduction

I've been teaching Chinese herbology to health professionals and highly motivated students for over 20 years. Over these 20 years, RMHI's board of directors and I have continually evolved our curriculum to improve the clinical results of our graduates. That is our sole criterion; we do not pad our curriculum with subjects merely to impress other academics, yet that are not necessary to practice effectively and safely. Unlike many schools of TCM, we do not believe that knowing Chinese is essential, though knowing a bit of Chinese terminology specific to the herbal profession is helpful in practical matters like ordering herbs. On the other hand, our admissions requirements are probably more stringent than any other school of traditional Chinese medicine. In this article I explain why, what qualities we are seeking among potential candidates for admission, and provide an introduction to the aptitude test for aspiring TCM herbalists that may be downloaded from our website. 

 

The primary difficulties in learning Chinese herbology, common clinical mistakes

C.S. Cheung, M.D., has been my teacher, friend, and collaborator for over 28 years in our many projects related to Chinese herbology, including our biggest project to date, the HerbalThink-TCM software that now serves as the primary reference and teaching tool in all our courses. Dr. Cheung has translated thousands of clinical case reports from Chinese hospitals and clinics. Several hundred of these case reports have intrigued me since the late 1980's, because they reveal the nature of the traditional Chinese clinical paradigm, its difficulties, and the most common mistakes that even experienced practitioners make. In each of these special case reports, the physician-herbalist in charge of the case initially makes a mistake which results either in lack of results or in worsening of the condition with side effects; the individual is then referred to another practitioner or to a committee of practitioners who discuss the case and debate alternative strategies; finally, a new strategy is implemented and the results reported, and this process is repeated until the symptoms and symptom patterns improve or resolve.

I spent hundreds of hours analyzing and pondering these case reports to see if I could spot common reasons why these initial attempts did not yield satisfactory results. For those readers unfamiliar with TCM herbal theory, the traditional literature describes about 100 to 140 distinct syndromes — patterns of symptoms and clinical signs like pulse and tongue qualities and body type. Clinical evaluation requires that an individual be classified according to which of these syndromes are present and to what relative severity, based on the number and severity of symptoms comprising each syndrome's criteria. This paradigm is described in greater detail in references •[a1-a2]•. 

 

Jumping to conclusions with incomplete or ambiguous data

What I found was quite surprising. The vast majority of cases for which the initial strategy did not succeed were due to relatively simple errors of the type explained in high-school-level algebra courses (set theory, Venn diagrams, etc.): jumping to conclusions with incomplete or ambiguous data. Very few of these cases required the aid of esoteric or arcane TCM theory or the study of ancient masters in the original Chinese. On the contrary, these errors were a direct result of not obtaining enough symptom-sign data to allow complete differentiation among the set of 140 symptom-sign patterns. The case report collections of C.S. Cheung strongly suggest that skills in symptom-sign pattern recognition are poor among the majority of TCM practitioners in Chinese hospitals. The situation in the U.S. is no better. 

 

Pattern recognition and set theory

The claim that, instead of studying ancient Chinese manuscripts, modern TCM herbalists might be better served by studying the application of algebraic set theory and the mathematical principles of pattern recognition to Chinese herbology will probably be greeted with cries of "Heresy!" by many traditional herbalists. Yet that is the conclusion I've arrived at after 20 years of studying the problem. Why do so many graduates of TCM schools do poorly at traditional TCM theory and clinical assessment, to the point that many give up and revert to the simplistic method of giving "formula X for medical disease Y"? This is a disgrace to our profession, yet that is the end result of teaching generation after generation of students by traditional rote memorization without comprehension. Rarely do traditional Chinese texts explicitly address the problems of pattern differentiation when only subsets of symptoms from the textbook definition are present, yet that is the very problem that mystifies students and experienced practitioners alike. How many symptoms must be present from the pattern definition before one can conclude that that pattern is really present? The correct answer is that it depends on the context, there is no such magic number. (See references •[a1-a2]•.)

Many of us take algebra and the modern number system for granted. In ancient Rome, however, performing addition, subtraction, multiplication, and division with Roman numerals (for example, try multiplying  MCMLIV  times  DLIX !) required prodigious skills in symbol manipulation that challenged all but the most dedicated and methodical practitioners of the numerical arts. Yet it was not until the 11th century that the Hindu-Arabic number system (0123456789 and decimal arithmetic) were introduced to Europe by Arab traders. Today, we routinely expect public grade school students to master multiplication and long division, all because the adoption of Arabic number notation in the 11th century greatly simplified the tasks of basic arithmetic.

Like the invention of the decimal number system, algebra has been an important tool in scientific discovery for thousands of years. It can frequently describe seemingly complex phenomenon with elegant and simple equations. That is certainly the case with the pattern recognition algorithm that lies at the heart of Chinese herbology, and the HerbalThink-TCM software package includes articles explaining in detail how this works. The problem is actually much simpler than the one that Google software engineers deal with on a daily basis in designing software algorithms to detect patterns of meaning within data on the Internet, though many of the principles and required mathematical tools are similar. I suspect that the recognition of the importance of algebraic set theory in TCM clinical evaluation will spread slowly due to an entrenched dogmatism and an archaist mindset among many practitioners and instructors. In the meantime, we have implemented interactive computer game software that specifically exercises and develops students' ability to identify the significance of randomly generated symptom sets of the type commonly seen in clinical practice. In these identification games, students must determine at any given stage of a game:

  • Whether additional information is needed to reliably determine if a specific pattern is present.
  • If enough information is present, what is the identity of the underlying pattern?

Analogous to how the adoption of the Hindu-Arabic number system greatly simplified arithmetic calculations, understanding of basic algebraic set theory greatly clarifies what really underlies the process of differential clinical pattern assessment in traditional Chinese herbology. 

 

Why the practice of effective TCM herbology is more like gardening than medicine

If you are still puzzled as to why giving "herbal formula X for medical disease Y" is not such a good idea and often leads to either side effects or poor results, let's shift our focus from human health care to that of organic gardening. Suppose that a novice gardener asks a master gardener "How do I keep my potato plants from being infested with potato blight?" (Potato blight is a fungal infection that affects the entire potato plant and greatly reduces yield.) As in western medicine, the industrial agricultural approach is to douse the plants with a strong chemical that kills the fungus, while ignoring many other factors that affect potato plant health like crop rotation, amount of water and moisture, soil nutrients, companion plants that may inhibit mold and pests planted adjacent to the potatoes, time of planting appropriate for climate, amount of sunlight exposure, and dozens of other factors, including electromagnetic fields in the vicinity; even music has been shown to significantly affect plant growth, either positively and negatively. To ask for a single "magic remedy" to prevent potato blight reveals the questioner as a novice; it is absurdly simplistic. A true master gardener not from your region would probably respond "it all depends..." and would refrain from giving any advice at all until he or she learned more about the precise circumstances, like the geographical area, climate, altitude, soil type, variety of potato, etc.

The master organic gardener will be an expert at recognizing and evaluating patterns of multiple factors, all of which must reasonably converge to create a hospitable environment for specific species and varieties of plants. Likewise, the answer to how to grow a healthy human is a complex one; human cultures and civilizations have created their own implicit instruction manuals embodied in cultural traditions, including diet, exercise forms (e.g.: tai qi, yoga), herbal medicine, massage, hydrotherapy, singing and dancing. Traditional Chinese herbology, of all the world's herbal traditions, perhaps comes closest to respecting this implicit instruction manual by acknowledging and identifying the complex patterns relevant to growing healthy humans. 

 

RMHI's aptitude test for applicants for admission

We now been using the interactive game software in HerbalThink-TCM for almost 10 years now in all our courses. Following are some observations and results from those 10 years of experience:

  • Though our courses are quite challenging, ability to complete course requirements has absolutely no correlation with level of higher education that a student may have previously achieved. We have had students just out of high school successfully complete the courses as well as MD's, chiropractors, acupuncturists, nurses, pharmacists, massage therapists, and adult non-health professionals.
  • Those who successfully complete our courses tend to have certain personality traits: independent-minded, persistent, self-motivated, not easily discouraged by initial difficulties, iconoclastic, willingness to question and scrutinize the statements of established authorities, good at abstract reasoning.
  • Most of our successful graduates have a background of broad life experiences, with especially strong practical connections with nature, such as organic gardening and horticulture, raising animals or pets, hiking, mountaineering, etc.
  • An excess of academic study without practical experience tends to negatively correlate with likelihood of graduating. In contrast, homeschooled individuals often do very well in our courses. This result initially surprised me and all the other staff at RMHI, though after reading John Taylor Gatto's book The Underground History of American Education, I now understand why: the public school system and conventional colleges and universities actually dumb students down by an overemphasis on neat and tidy problems to which there are always definite right-or-wrong answers. Unfortunately, this often leads to poor judgment in the real world where things are often not quite so clear. Life is full of ambiguities, for which we need to make decisions with partial data, basing our decisions on a messy combination of sensory data, logic, intuition, and gut instinct. I've concluded that colleges and universities actually tend to suppress students' intuitions and instincts, and when this is done over long periods of time, even the logical faculties suffer atrophy. John Taylor Gatto would probably agree with me; I first began to consider these ideas after reading his book.
 

References

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The following related articles explain the principles of symptom-sign pattern recognition and its implications for clinical practice of TCM herbology:

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