Developing Clinical Thinking - The Theory of Dents

and thoughts on the limits of categories in herbal medicine

Someone asked me recently how I categorize the herbs that other people call adaptogens. It’s a reasonable question—if I’ve abandoned the adaptogen category, what do I use instead?

I’m going to answer that directly. But then I want to talk about something bigger: how we think about herbalism, the stages of learning, and why categorical thinking—while absolutely necessary when you’re starting out—often becomes the very thing that keeps herbalists stuck. Not because categories are wrong, but because nobody told them that categories are training wheels. You need them to start. But at some point you have to take them off.

The Nature of Categories

Some categories carve nature at its joints. Philosophers call these “natural kinds”—they correspond to real discontinuities in the world that exist independently of human interests. Carbon is different from nitrogen. Gold is different from iron. The periodic table is full of natural kinds.

Other categories are what we might call practical kinds—useful heuristic constructs that carve up some domain in ways that serve our purposes. They’re not arbitrary (they have to track something real to be useful), but they don’t correspond to sharp boundaries in nature. They’re tools, not discoveries.

Many medical categories are practical kinds. “Hypertension” isn’t a natural kind—blood pressure exists on a continuum, and any cutoff is a decision point, not a discontinuity in nature. The line 140/90 is a practical kind real enough to be useful, but it doesn’t mark a discontinuity in nature. Someone at 139/89 isn’t fundamentally different from someone at 141/91.

What matters is that practical kinds can be more or less well-constructed. A good practical kind tracks something real, predicts outcomes, and guides intervention. A bad practical kind gives you the feeling of understanding without the predictive power.

“Adaptogen” is a poorly constructed practical kind. It groups together plants that have almost nothing in common except that Soviet scientists studied them during the Cold War and they don’t fit neatly into other categories. Ashwagandha, rhodiola, eleuthero, schisandra, cordyceps—these plants have wildly different chemistry, different physiological effects, different safety profiles. The category implies a shared mechanism (”normalizing stress response”) that doesn’t actually exist. The strongest version of the adaptogen concept is something like: plants that tend to improve stress tolerance, fatigue resistance, or recovery in at least some contexts, often via HPA-axis modulation. That’s not nothing—it’s a real cluster of effects. The problem is it’s still too coarse to guide herb selection safely, because plants in this cluster have nearly opposite qualities and contraindications.

Contrast this with a category like “cholagogue”—herbs that stimulate bile production. This is also a practical kind (there’s no sharp line between “stimulates bile” and “doesn’t stimulate bile”), but it’s well-constructed. The mechanisms vary—bitters work through vagal reflexes, lipotropics support hepatocyte function, direct choleretics like artichoke act on bile production itself—but the clinical outcome is consistent enough. Give someone with sluggish bile flow a cholagogue, and you tend to get improved bile flow and better fat digestion. Even good categories have edge cases, but this one predicts more than it obscures.

With “adaptogens,” the clinical outcome is incoherent. “Normalizes stress response” could mean stimulating (rhodiola), calming (ashwagandha), immunomodulating (cordyceps), or liver-supporting (schisandra). These aren’t interchangeable. The category implies a unified therapeutic effect that doesn’t exist.

The question isn’t whether to use categories. The question is whether your categories are earning their keep.

So to answer the original question. I don’t categorize the “adaptogens” as a group at all. I think about each of those plants individually, in terms of their qualities, actions, and effects—which I’ll explain later in this piece. Ashwagandha and rhodiola have almost nothing in common. Grouping them together obscures exactly the information you need to use them well.

But this raises a deeper issue. The problem isn’t just that “adaptogen” is a bad category. Categorical thinking itself—while essential for learning—becomes an obstacle to clinical development if you don’t eventually move beyond it.

The Seduction of Categories

Categorical thinking is efficiently wrong.

When I say categorical thinking, I mean the kind of reasoning that goes: “This herb is an adaptogen. Adaptogens help with stress. I’m stressed. I’ll take this herb.” Or slightly more sophisticated: “Ashwagandha is a calming adaptogen. Rhodiola is a stimulating adaptogen. I need calming, so I’ll take ashwagandha.”

This is how we all start learning anything complex. Categories give you handles to grab onto. They let you make decisions without understanding the underlying complexity. And for a lot of purposes, that’s exactly what you need.

Categories also work by flattening. They take something complex—a plant with dozens of active compounds, multiple physiological effects, and different impacts depending on who’s taking it—and reduce it to a single label. That label lets you make quick decisions. But it does so by discarding exactly the information you need when the quick decision doesn’t work.

Where Categories Actually Work

Before I tear into categorical thinking too much, let me be clear about the context where it works just fine.

If you’re taking care of yourself and your family—in the long tradition of what my friend Stephany Hoffelt called domestic herbalism—categories are often adequate. You’re working with gentle remedies, the stakes are relatively low, and trial-and-error is a perfectly reasonable approach. Chamomile didn’t help you sleep? Try valerian. That made you groggy? Try passionflower. You’re iterating based on your own experience, and you can afford to iterate because you’re using herbs with wide safety margins on someone you know well.

In this context, “nervines for anxiety” and “adaptogens for stress” are fine starting points. They get you into the right neighborhood. Your body provides the feedback that categories can’t. This isn’t because the stakes are lower—ashwagandha can still aggravate a hyperthyroid family member. It’s because the feedback loop is different. You’re embedded in the person’s life, noticing subtle shifts daily, adjusting in real-time. If your partner gets agitated, you see it at breakfast. That relational proximity does some of the work that clinical skill has to do explicitly. The feedback is continuous rather than delayed by weeks between appointments. When chamomile works for you, you don’t need to understand why it works—you just need to know that it does.

The same goes for mild acute problems. Your kid has an upset stomach? Peppermint or ginger. Either one is likely to help, neither one is going to cause harm, and you don’t need a sophisticated understanding of carminative action versus prokinetic effects to make a good choice.

Categories fail when you need precision. When the gentle remedy didn’t work. When the person has a complex presentation. When they’ve already tried the obvious things. When the stakes go up. When you’re responsible for someone else’s outcome and they’re trusting you to see what they can’t see themselves.

That’s clinical work. And clinical work requires a different kind of thinking.

The Dreyfus Model: How Expertise Actually Develops

In the 1980s, two philosophers named Hubert and Stuart Dreyfus studied how people actually develop expertise—chess players, pilots, nurses, anyone mastering a complex skill. They found that people move through recognizable stages, and that each stage involves a fundamentally different way of thinking and relationship to rules and categories.

Categorical thinking isn’t just one way of thinking among many. It’s a developmental stage. And like all developmental stages, you have to move through it to get beyond it.

Dreyfus Stage One: The Novice

Novices follow rules. They have to—they don’t have anything else. A novice chess player learns “control the center” and “develop your pieces early.” A novice herbalist learns “adaptogens for stress” and “nervines for anxiety.” These rules are context-free. They apply the same way regardless of the situation.

Here’s what novice thinking looks like:

[stress = adaptogen] [anxiety = nervine] [indigestion = bitters] [dryness = demulcent]

Or on the assessment side:

[fatigue + stress = adaptogen deficiency]

Clean categories. Clear boxes. This goes here, that goes there. The novice mind is a filing system—efficient, organized, and completely inadequate for the complexity of real people.

Someone in your family complains of fatigue and poor stress tolerance. You think: “Fatigue plus stress equals adaptogen. Ashwagandha is a well-researched adaptogen. I’ll recommend ashwagandha.”

This isn’t wrong, exactly. It’s just thin. You’ve matched a symptom to a category to an herb. You’ve followed the rule correctly. For domestic practice with gentle herbs, this works fine. Your family member tries it, tells you how it went, you adjust.

The novice stage is necessary. You have to start somewhere. The problem isn’t being a novice—it’s staying one.

Dreyfus Stage Two: The Advanced Beginner

As you gain experience, you start noticing that context matters. The rules don’t always apply. Some situations feel different from others, though you might not be able to articulate exactly how. You’re developing what Dreyfus calls “situational recognition”—the ability to notice when a situation has features that matter, even if you can’t yet say why they matter.

Now the mental structure starts getting more complex:

[stress = adaptogen (unless also low mood which might be depression like I had so maybe mood elevators) (unless overstimulated → calming adaptogen)] [anxiety = nervine (unless exhausted-type anxiety → maybe adaptogen?)] [indigestion = bitters (unless already cold → warming bitters / skip bitters)]

Notice that categorical thinking isn’t limited to how we think about plants. It shapes how we think about conditions too—and often through the lens of our own history. ‘Depression’ is as much a category as ‘adaptogen’—and heterogeneous disorders get the same problematic flattening that herb categories create. Your experience of depression becomes the template for what depression looks like. The person in front of you has fatigue and low mood and loss of interest, so they go in the depression box—which is really your depression box—and the depression box has its standard interventions. But depression isn’t a natural kind any more than adaptogen is. It’s a practical kind that groups together wildly different presentations, etiologies, and trajectories under one label.

Your partner complains of fatigue and poor stress tolerance—similar to what you helped your friend with last month. But something feels different. This person seems... wound up. Anxious. Their fatigue has a wired quality, not a depleted quality. You think: “This might be a situation where stimulating adaptogens would make things worse—I learned that one the hard way. Maybe I should try something more calming first.”

Notice what’s happening: you’re still thinking in categories (”stimulating adaptogens” vs “calming adaptogens”), but you’re starting to recognize that different situations call for different categorical choices. You’re not just following rules; you’re noticing exceptions to rules. Dreyfus calls these context-dependent guidelines maxims. Unlike the context-free rules of the novice (’stress equals adaptogen’), a maxim requires you to have already experienced the situation to interpret it. ‘If the person looks wired, avoid stimulation’ is a maxim. It sounds like a rule, but it’s useless until you’ve seen enough people to recognize what ‘wired’ actually looks like in a clinical context. You can’t look up ‘wired’ in a dictionary; you have to have seen it.

Thinking with maxims is progress. But you’re still fundamentally operating within a categorical framework. You’ve added nuance to which category you apply, but you haven’t questioned the categories themselves.

Both novice and advanced beginner are appropriate stages for domestic herbalism. You’re working with people you know, herbs with wide safety margins, feedback loops that let you adjust. Categories, exceptions and maxims work well enough here. The danger zone is the domestic herbalist who starts doing clinical work with domestic tools—taking responsibility for strangers’ health trajectories while still thinking in categories and maxims.

The Advanced Beginner Wall

Here’s where most herbalists stop.

You can get to advanced beginner through study. You can read books, take classes, memorize herb profiles, learn differential indications. You can accumulate exceptions to rules until you have a fairly sophisticated decision tree. You can talk about advanced concepts. Maybe you’ve been taking classes for decades.

But clinical work—working with people you don’t know intimately, with complex presentations, where you’re responsible for seeing what they can’t see themselves—requires a different kind of thinking. And that different kind of thinking can’t develop just from books, classes, or your own body’s feedback.

Think about it this way: your mind is like a soft surface. Experiences make dents in it. Those dents become the shapes that let you recognize patterns later. But if the only dents you have are from your own body and the handful of people you’ve given herbs to, you only have a handful of dents. The ashwagandha personpattern requires seeing dozens of ashwagandha responsive people before your mind has enough dents to recognize the shape.

I’m going to say this a different way, and I ask that you read this slowly, because this is what took me years to understand and where the whole piece hangs.

Categories are maps. You consult them. You look at the territory—the person in front of you—then look at the map, then decide where you are. The map is separate from you, a tool you use.

Dents aren’t maps. Maps represent territory from outside. Dents are the organismenvironment relationship itself—not an impression left on a passive surface, but the mutual shaping that happens when you and ashwagandha, you and ashwagandha-patternpeople, encounter each other repeatedly. You don’t consult your dents. You are your dents.

Stuart Dreyfus—one of the brothers who created the model—eventually coined a term for these dents. We all know System 1 (fast, instinctual) and System 2 (slow, analytical). Dreyfus proposed System 0. System 0 is not ‘fast reasoning.’ It is instruction that has been physically inscribed into the neural pathways of the brain through experience. It is the literal shaping of the instrument. When you have enough dents, you don’t ‘think’ about the answer; the answer is simply the shape of your mind reacting to the shape of the problem.

The novice has maps. The expert has become territory.

That’s why you can hand someone a map—teach them categories—but you can’t hand someone dents. And it’s why the expert often can’t fully explain what they know. They’re not reading a map they could show you. They’ve been shaped. The knowing is in the shape itself.

Classes convey categorical knowledge—maps. That’s what classes are for—organizing information into teachable units. There’s nothing wrong with this; it’s how you build the scaffolding. But taking a class on pattern recognition isn’t learning pattern recognition. You can only develop pattern recognition by exposing yourself to patterns. By making dents. By letting the territory walk through you and you through it.

This means the transition to competence requires specific stimuli that self-study and domestic practice can’t provide:

Observing experts work. Not reading about how experts work. Watching them. Seeing how they conduct intakes, how they follow threads of information, how they formulate assessments. Your mind makes dents from watching that it can’t make from reading.

Working with many different people. Your own body is one data point. Your family is a few more. You need variation—different constitutions, different presentations, different responses—to develop the pattern recognition that clinical work requires.

Getting feedback. Having someone more experienced say “you missed something there” or “here are three other possibilities.” This calibrates your pattern recognition against reality.

Without these specific stimuli, you can take every workshop and read every book and your pattern recognition won’t develop. You’ll have more maps, more detailed maps, more exceptions annotated on your maps. But you won’t make the transition to actually being shaped by the territory.

Dreyfus Stage Three: Competence

The competent herbalist sees broader patterns and makes conscious choices. They can prioritize among competing considerations. They engage in deliberate analysis and feel genuinely responsible for outcomes in a new way—because they’re making real choices, not just following rules.

The mental structure is getting messier now—still structured, but the branches multiply:

[ FATIGUE | ANXIETY | COLD ] → [ MATCH: Ashwagandha ] → [ STOP: Thyroid Stimulating? ] → [ STOP: Serotonergic / SSRI? ] → [ AMBIGUITY: Palpitations == Warming? OR Anxiety? OR Thyroid? ] → [ RECALL: Hyperthyroid Case (Negative Outcome) ] → [ PLAN: Verify Thyroid Status First ]

Notice how much machinery this requires. The competent mind is working hard.

A client presents with fatigue, anxiety, and poor stress tolerance. You notice: runs cold, poor sleep, feels ungrounded and scattered, history of prolonged stress, tends toward obsessive thinking. You think: “This person needs warming, grounding, something that supports sleep. Ashwagandha fits that pattern—but wait, they also mentioned heart palpitations and feeling jittery sometimes. I need to ask more about that. Could be anxiety, could be thyroid, could be the palpitations are unrelated. If it’s thyroid and they’re hyperthyroid, ashwagandha’s thyroid stimulation could be a problem. Let me ask about thyroid history before deciding.”

The competent herbalist is doing real clinical thinking. They’re weighing multiple factors, making judgment calls, feeling the weight of being wrong. This is progress. But they’re still reasoning about categories and rules, even as those categories and rules get more complex and context-dependent. The thinking is still sequential—if this, then that; but what about this other thing; okay, but then consider this. Categories, exceptions, context that shapes the exceptions, all swirling around but still being consciously processed.

For some clinical tasks, this is exactly the right level. There are domains where systematic approaches outperform expert intuition—rare presentations, cognitive bias traps, anything where the base rate is low and the cost of missing something is high. Checklists beat experts at ‘did you rule out X.’ But ‘what intervention fits this personpattern’ isn’t a checklist question. You can’t algorithimize resonance. The sequential checking of competence is genuinely valuable—and it’s also not the destination.

Dreyfus Stage Four: Proficiency

At the proficient stage, something shifts. Situations start presenting themselves as wholes rather than as collections of features you have to consciously analyze. You walk into a room and something about the person in front of you suggests a direction before you’ve consciously thought it through.

The mental structure is compressing—the categories are dissolving into patterns:

[ Cold-Ungrounded-Depleted-Scattered—that quality of fatigue where they just look like they’ve never slept—Obsessive-quality-thoughts-get-trapped—she keeps ruminating—pale-weak-thinning-eyebrows—she hasn’t mentioned thyroid but I should ask because feels like match to ashwagandha—Warming-Grounding-Moistening-Settling—the cold anemic woman who slept again—Calms-the-mind-ruts—that five hour drive with fresh dug ashwaganda where I felt like I’d sink into the road I was so grounded—builds-blood-thyroid-stimulating-check-TSH ]

The proficient herbalist sits with a new client. Before the client has finished describing their situation, something clicks. The herbalist doesn’t think “fatigue plus cold plus ungrounded equals ashwagandha.” They just... feel an ashwagandha patternperson. They still deliberate about dosing, about whether to combine it with other herbs, about whether to ask about thyroid first. But they no longer deliberate about what’s relevant. The relevant features just show up.

This is a qualitatively different kind of cognition. The proficient herbalist isn’t applying categories faster—they’re recognizing patterns directly. Categories have become transparent; the herbalist sees through them to the underlying reality they were trying to track.

You can only get here by making a lot of dents. By seeing the ashwagandha patternperson so many times that your mind has a deep groove for that shape. There’s no shortcut.

Dreyfus Stage Five: Expertise

The expert doesn’t think in categories at all. Or rather—they think in categories when it’s useful, but the categories have become malleable. Something to play with, smash together with other concepts, compress or stretch as the situation requires.

For a novice, “warming” is a box. You learn what goes in it. Ashwagandha: warming. Ginger: warming. The box has edges.

For an expert, “warming” is more like... a texture? A tendency? Something you can stretch thin across a formula or concentrate in one plant. You can dial it up or down. You can offset it with something cooling elsewhere. The category hasn’t disappeared—it’s become a tool you can manipulate rather than a box you sort things into.

When I think about ashwagandha now, I don’t think “nervine tonic” or “adaptogen.” What I have in my mind is more like:

[warminggroundingthyroid-stimulatingserotonergicnervytonic*—thatfivehourdrivewithfiftypoundsoffreshlydugrootfeltsogroundedIwasgoingtosinkthroughthedriverseat*smelledsomuchlikedirtandsomethingsweet—thecoldanemic-lookingwomanwhosleptfortenyearsagainafterthreemonthsshecriedinthefollowupTSHGTGtheobsessiverutsofthoughttheygetcaughtinpalenailbedsdarkundereyesrunningonfumes*thatonetimeIgaveittosomeonehotterthantheyletonearlyandshefeltagitatedforaweekandIlearned.....feelsmatchescantnameitsometimeintonemaybeherdaughterwhocamebackyearslaterwiththesamepatterngeneticsmaybeorjustfamiliesmysassygirldiedthatweekandIrememberthemomwhosleptsodeeptheyfeltlikemotherearthembracedtheminoldgrowthdirtrenewalrootednessandwhatholdsustotheearthandwhyweneedthat*wintermorningprocessingrootsmyhandssmelledlikeitfordaysphyllisasayingoncethatashwagandhaisbetterforpeoplewhocantletgothantensepeopleandthatchangedeverythingthewomaninfrontofmerightnowhershouldersthewayherbodysaysexhaustedbuthereyessaywired**maybethyroidmaybe—no—thisfeelsrightlisteningquietwhatremainstobemadewholebutthisisastart]

That isn’t a compressed list of associations. It’s one gestalt. One bodymindplant relationshipunderstanding that you thinkfeel through when you encounter a personpattern and sense the appropriateness—or inappropriateness—of this plant for this person. You can’t separate it into categories because it doesn’t live as categories. It lives as a unified way of knowing that includes your body’s experience of the plant, every person you’ve given it to and what happened, the theoretical knowledge underneath, and something harder to name about how all of that feels when it fits.

First Categories. Then the embodied experience that you can’t fully articulate.Then exceptions. Then context that shifts everything. Then memorable cases that break the rules in ways that teach you something. Eventually it all becomes one thing—not swirling anymore, but settled into a shape. And when a personpattern walks into your practice, that plantpattern shape either resonates with them or it doesn’t. You thinkfeel the fit.

Case formulation and herbal formulation follow this same process. You thinkfeel through what’s missing in the intervention and can reasonably be added. What’s excess and can be tempered. What plantpatterns address which aspects of the personpattern. The formula emerges not from rules about combining categories but from sensing what the picture needs for wholeness, for balance.

To be clear, the expert isn’t allergic to categories. They simply keep them in their back pocket. When the gestalt fails—when a case is weird, or the intuition says ‘something is off’ but no pattern emerges—the expert deliberately downshifts. They ‘break the glass’ and return to the analytic, categorical thinking of the Competent stage to double-check their work. Expertise isn’t abandoning logic; it’s knowing when to transcend it and when to return to it.

A necessary caution: Advanced beginners can convince themselves that this gestalt is what they’re experiencing. They feel something that presents as intuition—a plant dream, a strong sense, an immediate knowing. But it’s false confidence parading as intuitive gestalt. Feels with few dents is illusion.

The difference between actual pattern recognition and premature certainty is the dents. The expert who “just knows” has seen this pattern hundreds of times. The advanced beginner who “just knows” has seen it twice and read about it once. Both experiences feel like intuition from the inside. Only one of them is.

The expert gestalt is non-ergodic. It’s path-dependent. It forms differently depending on which experiences you had, in what order, and how you processed them. Too many failures you didn’t understand, too many dents that didn’t get explained—and the swirl becomes overwhelming rather than settling into shape. The gestalt gets noisy. You start second-guessing patterns that are actually reliable because you can’t distinguish signal from noise in your own experience.

My personal method of gestalt verification is to track outcomes prospectively rather than remembering them retrospectively. After consultations, I share my expectations for the case with my practice partner, Shana. We discuss it after rechecks. I also seek feedback from practitioners trained in different lineages than mine to reduce the risk of lineage bias. Most importantly, I try to notice when my patterns fail, and let the failures reshape the gestalt rather than explaining them away.

This work, or something like it, is required because the gestalt isn’t self-validating. It has to keep being tested against bodies that don’t know what I expect. When the pale, obsessive, depleted woman takes ashwagandha and sleeps for the first time in years—and she had no idea that’s the pattern I saw, no idea why I chose that plant—that’s the pattern meeting reality.

But I hold it loosely. I’ve been wrong enough times to know the feeling of being wrong often arrives late, if it arrives at all.

These complexities are why the transition to competence requires external feedback. Your own felt sense can’t tell you whether your felt sense is trustworthy. You need someone with more dents to say “you’re seeing something real” or “you’re pattern-matching to noise.” Without that calibration, confidence grows faster than competence.

I’ve been telling you what doesn’t work. Now the practical question: what do you actually do instead?

What Replaces Categorical Thinking: The Three Dimensions

So if categories are scaffolding, what’s the structure you’re building toward?

When I teach, I ask students to think about herbs along three dimensions: qualities, actions, and effects. These aren’t categories—they’re dimensions. And that distinction matters.

A category asks: “What box does this belong in?” A dimension asks: “Where does this fall along a continuum?”

When you ask “Is ashwagandha an adaptogen?”, you’re asking a categorical question. The answer is yes or no (or maybe “sort of,” which really means the category isn’t well-constructed).

When you ask “How warming is ashwagandha?”, you’re asking a dimensional question. The answer is “moderately warming”—more warming than chamomile, less warming than ginger, about the same as cinnamon. That answer locates ashwagandha in relationship to other herbs along a continuum.

The dimensional framework is still a human construct—we chose to track temperature, moisture, tension. These aren’t the only ways to organize perception; they’re the ways that have proven clinically useful. But unlike categorical boxes, dimensions preserve gradation. They don’t flatten ashwagandha into ‘adaptogen’ or rhodiola into ‘stimulating adaptogen.’ They keep the information you need to make distinctions. Dimensional thinking is harder than categorical thinking because it requires you to hold multiple relationships in mind rather than just labels. But it’s also more accurate, because the underlying reality is dimensional.

Qualities: What You Can Directly Perceive

Qualities are what you can feel when you take an herb. The warming of ginger, the cooling of peppermint, the moistening of marshmallow, the drying of sage. These affect how people feel in real time. When you drink ginger tea, you feel warmer. That’s not a metaphor—your subjective experience of temperature actually shifts.

Qualities matter for two reasons.

First, sometimes shifting someone’s felt sense is exactly what they need. A person who feels cold and contracted might benefit from warming, relaxing herbs regardless of what else those herbs do. The quality itself is therapeutic.

Second—and this is important—you should try to never make someone’s existing state worse. If someone already feels super hot, dry and inflamed, you don’t give them ginger regardless of how good of an anti-inflammatory it is. This is basic safety, and it requires attending to qualities.

Qualities exist on continua. Temperature: cooling to warming. Moisture: drying to moistening. Density: lightening/dispersing to grounding/consolidating. Tension: relaxing to stimulating/toning.

Every herb has a profile across these dimensions. Ashwagandha is moderately warming, somewhat moistening in a fat extract, drying in infusion or tincture, strongly grounding, and mildly relaxing. Rhodiola is moderately cooling, strongly drying, lightening/dispersing, and stimulating. These profiles are nearly opposite—yet both get lumped into “adaptogens.”

Actions: What Herbs Do to Tissues Over Time

Actions are what herbs do to tissues and organs with repeated use. Cholagogues stimulate bile production. Galactagogues support breast milk. Carminatives reduce intestinal gas. Antispasmodics relax smooth muscle. Diuretics increase urine output.

You might not feel actions the first time you take an herb. But with repeated use, the effects become apparent. Actions are more predictable across people than qualities—most people who take a cholagogue will produce more bile, though how that feels will vary.

Actions also exist on dimensions, though they’re often described categorically for convenience. The value of thinking dimensionally about actions is that it lets you be precise about degree. Chamomile is mildly antispasmodic. Cramp bark is strongly antispasmodic. Knowing where each herb falls on this continuum helps you match intervention to severity.

Effects: How Herbs Interact with Disease Processes

Effects are how herbs interact with disease processes at the cellular and molecular level. Anti-inflammatory, antimicrobial, antifungal, immunomodulating, hepatoprotective. These often operate independently of qualities and actions.

A cooling herb might have anti-inflammatory effects, or it might not. A warming herb might be antimicrobial, or it might not. You can’t predict effects from qualities, and you can’t always predict them from actions either.

This is where modern research becomes useful. We can measure anti-inflammatory effects. We can test antimicrobial activity. We can study hepatoprotection. These are empirical questions with empirical answers.

The dimensional aspect here is dose-response. Most effects are dose-dependent—a little boswellia has mild anti-inflammatory effects, a lot has strong effects (and also starts causing GI upset in many people). Understanding where an herb sits on the dose-response curve for a particular effect helps you calibrate your recommendations.

Dimensional Independence

Here’s what categorical thinking misses entirely: these three dimensions can operate independently of each other.

When you call something an “adaptogen,” you’re implying it has a single unified property that operates the same way across all three dimensions. You’re implying that its qualities, actions, and effects all align toward “stress adaptation.” But plants don’t work like that.

Ashwagandha demonstrates this clearly:

Qualities: Warming, drying to moistening, grounding, mildly relaxing. These qualities make it appropriate for people who run cold and feel scattered—and inappropriate for people who run hot or feel agitated.

Actions: anxiolytic, nervine tonic. These actions explain its primary benefits (better sleep, less anxiety)

Effects: Thyroid-stimulating, serotonergic, possibly neuroprotective. These effects are largely independent of the qualities and actions and point towards its problems (overstimulation in hyperthyroid individuals, tolerance and withdrawal in a subset of users, and rare but clinically important destabilization—up to mania or psychosis—in vulnerable people).

The category “calming adaptogen” captures almost none of this. It flattens the warming quality that makes ashwagandha wrong for some people. It obscures the thyroid stimulation that explains why some thyroid folks paradoxically feel agitated. It implies a coherent mechanism (”calming stress response”) that doesn’t actually describe what the plant does.

Dimensional thinking is a powerful tool for organizing complexity, but it is still a form of analysis. It is the primary tool of the Competent practitioner. It forces you to stop filing and start measuring. But the Expert eventually transcends even this. They don’t consciously plot the client on X, Y, and Z axes before choosing an intervention. They perceive the shape of the need directly. Dimensions are the ladder you climb to get to that view; do not mistake them for the view itself.

Thinking in Patterns

Over time, herbalists develop an understanding of the pattern of qualities, actions, and effects that each plant has. And this is the key shift: plants resist being understood through single categories because each plant has a pattern. Clinical thinking means learning to see these patterns and match them to the patterns you see in people.

When I think about ashwagandha now, I don’t think “nervine tonic” or “adaptogen.” I think: this is the herb for someone who feels cold and depleted, often in the pelvis, maybe anemic, but who is also ungrounded—spacey, head in the clouds, could use some anchoring. This pattern often arises from poor sleep and prolonged stress. The person might be a little obsessive, stuck in thought ruts, unable to let things go. They might have dark circles under their eyes, pale nail beds, a tendency to startle easily.

That’s not a category. That’s a pattern—a picture of a person that the herb fits. And when someone walks into my practice who matches that picture, ashwagandha suggests itself. Not because I’ve matched a category to a symptom, but because I’ve recognized a pattern.

The pattern is multidimensional. It includes qualities the person manifests (cold, dry, scattered), actions they need (thyroid support, better sleep, less anxiety), and effects that would help their situation (maybe serotonergic, maybe neuroprotective). The herb’s pattern and the person’s pattern interlock.

This is what clinical expertise looks like. Not knowing more categories, but seeing patterns directly.

The Swirl and the Untangling

Let me try to make visible what this actually feels like from the inside.

When a person sits in front of you, they present as a whole. They’re not a checklist of symptoms—they’re a living complexity. Their words and their body tell slightly different stories. Their chief complaint might be fatigue, but you notice their jaw is clenched and their shoulders are up around their ears. They say they’re sleeping fine, but their eyes have that hollow, depleted look. They mention they’ve been stressed at work, but the way they say it suggests they’ve been stressed for years, not weeks.

All of this is information. And at first, it’s just a swirl. Too much to track, too much to hold, too much to make sense of.

Categorical thinking is one way to handle the swirl: grab onto something recognizable. “Stress and fatigue—that’s an adaptogen situation.” The category simplifies the complexity enough to act on it. This works sometimes. And when it doesn’t work, you grab a different category.

Dimensional thinking handles the swirl differently. Instead of reaching for a category, you start tracking along dimensions. How does this person feel—warm or cold? Moist or dry? Tense or depleted? You’re not trying to categorize them; you’re trying to locate them in a multidimensional space.

As you track, patterns start to emerge. This person is cold, dry, tense, and scattered—that’s a recognizable configuration. It’s not a category (there’s no name for it), but it’s a pattern you’ve seen before. Certain herbs fit this pattern. Others don’t.

Then you cross-reference. What actions does this person need? Better sleep, yes. Less anxiety, yes. But also—looking at their pallor and their tongue—maybe some blood-building, some digestive support. What effects might help? Given their inflammatory markers, is something anti-inflammatory warranted or is health building sufficient?

Now you have a three-dimensional picture. You’re looking for herbs whose pattern of qualities, actions, and effects matches this person’s pattern of needs across all three dimensions.

And when you’ve done this enough times, it stops feeling like analysis. The pattern just presents itself. You see the person and you see the herbs that fit. The swirl untangles itself.

This is what happens when you’ve made enough dents that the shapes become recognizable. The categories dissolve because you no longer need them. You’re seeing directly.

Everything I’ve said so far describes what expertise looks like. But how do you actually get there?

Making the Transition

If you’re practicing domestic herbalism—taking care of yourself and your family with gentle remedies—categorical thinking is fine. Keep doing what you’re doing. The herbs are gentle, the stakes are low, and your body provides the feedback that categories can’t.

If you want to develop clinical thinking, you need to understand what actually builds it. The answer isn’t more studying, though study has its place. The answer is making dents—accumulating experiences that shape your perception into patterns you can later recognize. But not all experiences make dents equally, and some things that feel like learning aren’t.

The Foundation: Embodied Experience

There’s a chicken-and-egg quality to how expertise develops. You need some categorical framework to even know what to pay attention to—it’s hard do a blind tasting and describe your bodily responses if you don’t have enough words for what you’re sensing, and you probably wouldn’t taste an unfamiliar plant without first knowing it’s safe. So categories come first in some sense. But categories without embodied experience are empty containers. They give you labels without referents.

This is why I teach qualities before actions and effects, and why I have students do blind tastings early. The qualities—warming, cooling, moistening, drying, relaxing, stimulating—are names for poles along dimensional continua. They're still practical constructs; we chose these dimensions because they've proven clinically useful. But unlike categorical boxes, these words point you toward your own body. They train perception rather than replacing it.

The embodied experience of taking herbs yourself is where everything starts. Not reading about what chamomile does, but drinking chamomile tea and noticing what happens in your body over the next hour. Not memorizing that ashwagandha is “warming and grounding,” but taking it for two weeks and discovering what warming and grounding actually feel like from the inside.

This experience deepens through variation. Taking the plant in different preparations—tea versus tincture versus capsule—teaches you how extraction method changes the experience. Taking it at different doses teaches you where the thresholds are. Taking it for different lengths of time teaches you what’s immediate versus what accumulates. Growing the plant, if you can, adds another dimension entirely. Even reading non-categorical plant narratives—writing that describes plants as complex individuals rather than filing them into therapeutic boxes—can extend your sense of what a plant is, though I’m not sure this makes dents in the same way direct experience does.

The point is that embodied experience gives you something to hang categories on. When you later learn that ashwagandha is “thyroid-stimulating” and “anxiolytic,” those words connect to something you’ve felt. Categories become descriptions of experience rather than substitutes for it.

It Takes Time and Volume

You probably edge into competence—meaning safe enough to work unsupervised, with still plenty of room to grow—after somewhere around 400 to 500 hours of clinical experience (roughly the experience level required for Registered Herbalist status with the American Herbalists Guild). But that number only means something if the hours include the right kind of feedback.

Clinical hours without feedback are just repetition. You might be repeating the same mistakes, reinforcing the same blind spots, building confidence without building accuracy. The problem is that outcomes in herbal practice are ambiguous. When someone improves, it might be your intervention. It might also be the natural course of their condition, or the Hawthorne effect, or something else they changed that they didn’t mention, or simple regression to the mean. When someone doesn’t improve, the same ambiguity applies. Without external feedback, you’ll systematically misattribute outcomes in ways that feel like learning but aren’t.

This is why mentor feedback matters. A mentor sees what you’re not looking for. They catch the attribution errors you’re making before those errors calcify into false confidence. They ask “why did you reach for that?” in ways that force you to articulate reasoning you didn’t know you had. Watching an expert work is valuable; having an expert watch you work and push back on your thinking is more valuable.

Follow-up appointments with clients provide a different kind of feedback—outcome data rather than process correction. You need both. The follow-ups tell you whether your interventions are working; the mentor helps you understand why they’re working or not working, and whether your explanations are accurate or just plausible-sounding stories.

So when I say 400 to 500 clinical hours, I mean hours that include both: feedback from follow-ups that lets you track outcomes, and feedback from mentors that critique your reasoning process. Hours without this dual feedback still count for something, but they count for less than you think.

Thoughts On Mentoring

The job of a good mentor is to help shape the forming gestalt. To affirm the dents that actually apply and explain why. To say “yes, that pattern you’re noticing is real—here’s what’s underneath it” or “no, that was a coincidence, don’t build on it.” And to soothe the pain of dents that hurt—the failures, the times you got it wrong—with the understanding of shared lessonsexperience. “I made that mistake too. Here’s what it taught me. Here’s how it fits.”

The mentor’s gestalt resonates with yours. Their settled shape helps yours settle. Not by giving you their patterns—you have to form your own—but by providing the relational container in which pattern formation happens cleanly rather than chaotically.

This is what you can’t convey in a class. Not because teachers are holding out on you—because the knowledge itself resists being organized into teachable units. The gestalt can only form through dents, and dents can only form through experience. But whether those dents form signal or noise depends on whether someone helped you make sense of them.

Given this responsibility, the person mentoring you should be substantially further along the developmental path than competent. Competence means you’re safe to practice independently—you’ve developed enough pattern recognition to avoid major errors and enough self-awareness to know when you’re out of your depth. It doesn’t mean you understand your own clinical thinking well enough to teach it.

Proficiency takes longer. If competence begins around 400 to 500 clinical hours, proficiency probably requires something like 1,000 to 2,000 hours—a couple of years of full-time clinical practice after you’ve reached competence. This is when you start to understand what you actually know and think, and how that’s different from what you were taught. Before proficiency, you’re still working within frameworks you inherited. At proficiency, you’ve had enough cases surprise you, enough predictions fail, enough exceptions accumulate, that your clinical understanding has genuinely become your own.

Expertise takes longer still. The commonly cited figure of 10,000 hours—roughly a decade of full-time clinical practice, constituting thousands of individual appointments and rechecks—is probably in the right neighborhood. At expertise, pattern recognition is largely automatic. You’re not applying frameworks; you’re seeing directly. You’ve encountered enough variation that new presentations register as variations on patterns you already carry rather than as novel problems requiring conscious analysis.

This matters because mentorship from someone who’s merely competent can actually impede development. I’ll say this plainly: competent practitioners shouldn’t be teaching clinical herbalism. There’s a difference between being ready to practice and being ready to teach clinical practice. Around the 400–500 hour mark, a student can often become “safe enough” to begin working independently in a limited scope—especially with conservative herbs, good intake habits, and follow-up. But teaching clinical herbalism is a different responsibility. When you teach “this herb for this presentation,” you aren’t just helping one person. You’re creating a replicable move that potentially dozens of students will carry into hundreds of clients. That multiplies your blind spots into other people’s outcomes. At that stage, most people don’t have enough dents yet—not enough pattern repetition, not enough failures, not enough edge cases—to reliably teach pattern-specific recommendations overgeneralizing from a small clinical world. This is exactly how advanced-beginner thinking spreads: it gets taught as if it were clinical reasoning.

That doesn’t mean early clinicians have nothing valuable to teach. They can be excellent teachers of medicine making, botany, safety, foundations, and general health-building. But pattern-specifics—especially for complex presentations—should have a higher bar, because the cost of premature certainty is paid by the people we haven’t met yet.

A few years of full-time practice after reaching competence tends to move you toward proficiency—and proficiency brings something competence usually lacks: a lived awareness of your own edges. You’ve been surprised enough times, wrong enough times, that you can feel where your patterns don’t reliably hold. That self-awareness protects students. You can say: “I’m teaching you this because it works often—here’s where I’ve seen it break.” That’s a fundamentally different kind of teaching than presenting a framework as if it were complete.

This creates a real bottleneck. There aren’t enough proficient and expert practitioners to mentor everyone who wants to learn clinical herbalism. That’s a problem. But the solution isn’t to lower the bar and call it “access.” The solution is to admit the constraint and build systems that protect the public while practitioners develop. Better to learn slowly from someone who knows their limits than quickly from someone who can’t yet see them.

Productive Struggle

Not all difficulty is productive. You can be confused for years without developing expertise if the confusion doesn’t drive curiosity. Productive struggle is the kind that makes you want to understand, that creates a tension between what you expected and what happened, that won’t let you rest until you’ve figured something out.

Some experiences reliably create productive struggle:

The case that almost fits a category but not quite. These teach more than cases that clearly don’t fit, because they force you to articulate what the category is actually tracking. When someone presents as “nervine territory” but something feels off and you can’t say what, that dissonance is productive. The work is learning to name what you’re sensing.

The herb that works when it shouldn’t, or fails when it should work. Categorical thinking predicts certain outcomes. When predictions fail, you can dismiss the failure as an anomaly, or you can let it make a dent. The second choice requires revising your mental model rather than protecting it, which is harder and more valuable.

The follow-up that surprises you in either direction. Unexpected improvement teaches you something; unexpected failure teaches you something different. Both are dents. But you have to be tracking predictions to notice when they’re violated—which means you have to make your predictions explicit rather than letting them remain vague intuitions that can be retrofitted to any outcome.

The expert who disagrees with your reasoning. Not just watching experts work, but having them push back. “Why did you reach for that?” is a different kind of learning than “watch what I do.” It forces you to articulate your implicit reasoning, which is often where the categorical shortcuts are hiding.

The case you got wrong and had to revisit. These are painful but disproportionately instructive. A case where you were confident and wrong teaches humility about your own pattern recognition. A case where you were uncertain and wrong teaches you what uncertainty feels like so you can recognize it next time.

Intermediate Practices

If you’re still working primarily within categories—and most people are for years—there are practices that build toward dimensional thinking without requiring you to abandon categories entirely.

Every time you reach for a category, note three things about this person that don’t fit the category. This is harder than it sounds. When someone walks in with anxiety and you think “nervine,” your mind wants to stop there. Making yourself articulate what’s different about this person—what doesn’t fit the nervine picture—trains you to see individuals rather than instances of categories.

Track your predictions explicitly. Before a follow-up appointment, write down what you expect to happen and why. When the outcome differs from your prediction, you have a record of what your mental model got wrong. This is how you catch your own attribution errors before a mentor has to point them out. It’s also how you build calibrated confidence—learning not just whether you’re right, but how often you’re right when you feel certain versus when you feel uncertain.

Practice dimensional description without category words. Take someone you’re working with and describe their presentation using only qualities, actions they need, and effects that might help. No category labels allowed—not “anxious,” not “depleted,” not “liver stagnation.” This forces you to actually look at what’s in front of you rather than pattern-matching to a label.

Compare herbs within the same category. Take two herbs you’d put in the same box—two “nervines,” two “adaptogens,” two “carminatives”—and list every way they’re different. Qualities, actions, effects, contraindications, the kind of person each one fits. This trains you to see through categories rather than stopping at them. If you can articulate why chamomile and valerian are different despite both being “nervines,” you’re already doing dimensional thinking.

Steelman the alternative. When you choose one herb or approach, articulate why a different choice might also have been right. This prevents premature closure and keeps you holding multiple possibilities, which is what dimensional thinking actually requires. It also protects against the confirmation bias that makes you remember your successes and forget your failures. Dreyfus calls this ‘deliberate rationality.’ It is the necessary check on intuition. Because expert pattern recognition feels like immediate perception, it can be seductive. Forcing yourself to rationally construct the alternative argument is how you verify if you are reacting to a genuine pattern or just your own bias.

Retrospective case analysis with a specific question: what did I notice that I didn’t act on? Often you’re sensing something that doesn’t fit your categorical framework, but you don’t have permission to trust it yet. Looking back at cases where your gut was right but you overrode it builds confidence in pattern recognition. Looking back at cases where your gut was wrong keeps you humble.

None of these practices require abandoning categories. They just prevent categories from becoming the ceiling of your development. You’re still using the training wheels, but you’re also starting to feel what balance is like.

Conclusion: Trusting the Dissonance

The transition from domestic to clinical herbalism is really the transition from categorical thinking to pattern recognition. It’s the journey from novice to expert. And concepts like “adaptogen”—which dress up categorical thinking in scientific clothing—actively prevent that journey. They make you feel like you’ve arrived when you’ve barely started.

Categories. Then embodied experience. Then exceptions. Then context that shifts everything. Then memorable cases that break the rules. Eventually it settles into something that isn’t categories anymore—a bodymindplant relationshipunderstanding you thinkfeel through.

That’s what clinical thinking looks like:

[shefeelscoldbutnottheusualcoldwarminggroundinglikethatfivehourdrivesinkingintotheseathershoulderssaysomethingaboutnotlettinggocantnameitstevensaidthatoncecantletgopeoplenottensepeoplepalenailbedsbuildsbloodthatwomanwhosleptfortenyearshereyessaywiredbutherposturesaysexhausteddepletedandwoundupIknowthispatternfromsomewherethyroidmaybebutnoashwagandhasuggestsitselfquietlisteningforthewhole]

—except it isn’t a list. It’s one thinkfeeling. The personpattern in front of you resonates (or doesn’t) with the plantpatterns you carry. When it fits, you know. When it doesn’t, you keep looking.

You can't get there by studying. You can only get there by making dents. By seeing people. By being wrong and learning from it. By watching experts and absorbing how they move through complexity. By letting someone with more dents help you make sense of yours.

The categories were never the point. The categories were training wheels. At some point, you have to take them off and actually learn to ride.

-Thomas Easley, Registered Herbalist (AHG)

Eclectic School of Herbal Medicine