questioning

November 3, 1999

In a message dated 99-11-03 17:54:20 EST, you write:

<< What I meant by questioning examination being lacking was not that

people don't ask enough questions, but

1. they do not follow up on patient's answers to questions with more

probing questions, but rather go through a rote list.

2. the results of the examination are then not carefully evaluated

before making diagnosis. >>

-

Are you referring to students here, or practitioners? I have a hard time

believing that any viable point or herb selection could be made by doing

otherwise. If not going through the TCM diagnosis to TCM treatment principle

to points and herb selection, then what rationale is being employed in

designing the treatment? Also, a few emails back, you mentioned seeing

patients according to a kampo formula picture, similar to the use of remedy

pictures in homeopathy. We were taught the use of kampo at Meiji, yet never

was this line of reasoning for their selection discussed let alone suggested.

Same with hara diagnosis - it was taught and presented as an additional tool

of diagnosis, or even as a confirmation, but never as a sole means. So at

this point I am really confused as to the state of TCM practice in this

country, and am somewhat alarmed as well. Perhaps this is why I hear such

statements as " I tried acupuncture, but it didnt work " ?

Gina

November 3, 1999

What I meant by questioning examination being lacking was not that

people don't ask enough questions, but

1. they do not follow up on patient's answers to questions with more

probing questions, but rather go through a rote list.

2. the results of the examination are then not carefully evaluated

before making diagnosis.

I find it very common for students (NOT professors from China) to make a

diagnosis based purely on palpation or some hunch they call intuition.

The majority of the time, these diagnoses are wrong and tend to

contradict actually gathered info, especially from the questioning exam.

I think it is essential for students to go through the motions of

diagnosis >> treatment principles >> point/herb selection, even if they

are practicing kampo or hara dx. Unless they are zen adepts, they will

have to develop intuition the hard way, which means discipline and

study.

Like craig, I also once thought that taoism was some wild free for all,

but have come to realize that taoism embraces both yin and yang. In

Thomas Cleary's translation of a taoist i ching, he emphasizes two

concepts throughout, firmness (yang) and flexibility (yin). If one

reads Allen Watts on taoism, you could certainly get the impression that

it is all about flexibility (yin). Watts position has permeated

american culture and TCM training, I believe, because his writing

dominated the popular study of taoism in the sixties and seventies. He

most certainly influenced many of the early students of TCM who later

went on to write and promote this yin version of taoism as the basis of

chinese medicine.

Because our society is very yang and active and deals poorly with yin

and quiescense, we tend to look for in TCM what is lacking in the west

and ignore that which is similar and from which we are revolting. Yet

as Unschuld points out in numerous books, TCM is as rife with miltitary

metaphors as naturalistic and holistic ones. However, this should not

surprise us as the great successes of modern medicine are based on

attack and destroy. The great failure of modern medicine is that it

attacks and destroys not only the pathogen, but also the host and

environment, too.

Without the yang to corral and direct the amorphous yin, no progress is

possible. In one's medical studies both firmness and flexibility are

required. Firmness is equated with discipline in this tradition, thus

if one pursues a path that transcends logical thought, they must still

pursue that path with discipline. While there may be a few acupuncture

mozarts out there, history suggests that would be very few indeed.

November 3, 1999

I am referring to a large minority of students in acupuncture school

during their clinical training. Unfortunately, I do not think this small

minority is affected by their teachers very much and continue their bad

clinical habits in their practices. Based on conversations with

clinical supervisors around the country, this seems not to be just my

experience.

Your kampo training exemplifies something I was thnking aout. Kam po

means chinese herbal medicine and does not specifcally refer to the koho

style. it also can refer to the li-zhu or other styles. You obviously

learned a more flexible approach that respects the actual tradition.

Many are exposed at workshops and try to apply what appeals to them

without proper study and discipline of the whole system.

With regard to homeopathy, some kampo practitioners match a formula to a

symptom complex in a way that is somewhat analogous to homeopathy. The

remedy (homeopathic or unchangeable kampo formula) is applied to a

specific set of signs and symptoms. It cannot be altered with

additional ingredients. It must be matched perfectly to the sho. This

does not sound like the kampo you learned, but t is a style.

If one uses this kampo method, then one goes from symptom complex to

fixed formulae without determining zangfu dx or tx principles. I am

alarmed by the failure of so many to use proper diagnosis and treatment

principles in practice. Even with hara dx, you gather info, you assess

that info and select treament based on your assessment. for example,

When kiiko matsumoto goes from exam to treatment without a dx, per se,

she is not revealing at that moment her deep internalized study of the

classics, yet they guide her, for sure.