Post-Pandemic Clinical Complexities

woman rock climbing

I don’t think I’m becoming a worse herbalist—I think that there are more and more truly complex and challenging cases out there. I think that everyday life has become not just more difficult, but in many cases more paradoxical and internally contradictory, than ever before in my lifetime as a healer.

I noticed the first major change after 9/11. There were many fear and shock-related patterns, and over time, as the fear and shock were not resolved in most of the population, this led to a broad array of underlying complications. More and more people showed up in my practice with a wider diversity of co-existing patterns of disharmony.

For instance, before 9/11, most of my clients were either Kidney Yang deficient or Kidney Yin deficient, but probably not both. Since 9/11, most people who walk through my door are both. 

difficult hiking sign

Also since 9/11, more and more clients are “Knotty Problem” clients, or clients with more than 3-5 patterns of disharmony. Traditionally, if you were fairly new practitioner (less than 5 years experience), you would refer “Knotty Problem” clients to a more experienced herbalist. But since 9/11, almost everyone is a Knotty Problem client—which means that entry-level for the profession is much higher than it used to be! This is hard on new herbal practitioners, who often feel underequipped for what they are asked to respond to in the treatment room. 

In my experience, there has been another major jump in the level of complexity of what’s going on inside of our clients since the presidential election of 2016, and then along came the pandemic… For sure, some great things have come out of the pandemic, like a more acute awakening to many systemic social issues that have been obvious to those who have been silenced for a long time. But for herbalists, it’s been really rough!

Not only are many of us working with a more stressed and internally conflicted population than ever, but we’ve been trying to diagnose over Zoom. Making the levels of contact necessary for diagnosis while online is quite a learning curve—I’m still learning. I’ve learned a lot, enough to feel more comfortable, but I still feel like I’m taking risks without taking a pulse. At least we can see the tongue.

east Asian medicinal herbs

So what are we to do? I find that I am needing to work more slowly and carefully. It’s easy to start feeling pressured while working out a safe yet effective treatment for a suffering person who wants help NOW—but we honestly need to take it step by step, so as to first do no harm.

I find that I am relying more and more on very basic formulas that are split between triage and the constitution—addressing the worst emergency and the deepest foundations of health, and working my way towards the middle of the tangle. I’m making charts based on old hand-outs that I used when teaching herb clinic, because it keeps my thought process clear and traceable.

I believe that in order not to get overwhelmed and discouraged, we need to go back to basics, but with more margin for avoiding error. I’m finding myself bringing more complexity to diagnosis, but more simplicity to treatment. I’m taking things in stages, and more quickly looking outside of herbalism for adjunct support from other modalities. 

child falling off skateboard

I’m saying all of this because I’ve been talking to a lot of discouraged herbalists who think that they must be bad herbalists if it’s this difficult. It’s not you. This is difficult. We need to acknowledge that what is showing up in our clients is not nearly as simple as what shows up in textbooks. We also need to go out of our way to break our isolation, and make the time to talk to other practitioners about what we’re struggling to address—so that we know it’s not just us.

I’m starting to host Herbs On Common Ground, an herbal round table for herbalists to bring our tanged ponderings, and share about what it’s like to be an herbalist these days. I’m going to bring different focus topics to each of the sessions, as well as making time to talk about our specific clients. 

Some proposed topics:

Where Do I Start?
I will share the diagnostic process that I use in my own practice for especially knotty, complicated clients. Lots of handouts!

herbal supplement

What Do I Do Next? 
Often the first formula that we give a client is on a triage level—they need help, and we want them to see results quickly. Then comes the moment when it’s time to shift to another formula—usually because there has been improvement in some areas, but not others. Often this is a challenging moment for practitioners—but actually, it’s a wonderful opportunity to take stock and revisit aspects of the diagnostic process that are now revealed as unfinished.

Tonifying Or Relieving?
Many practitioners love to tonify, but often it’s clearing strategies that can bring the swiftest relief to a client’s symptoms. 5 Element practitioners often hesitate because it’s not “treating the root.” But trimming the branches can make the roots much easier to support.

Do you have questions you’d like to take to an herbal round table? Let me know; we can make it happen together.

To join the discussion, find us on my Perennial Medicine discussion listserv (all are welcome).

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