5-10 patterns?

June 1, 2000

Jason, I think you are wise in your observation. One of my best teachers

advised us: " You must be clear in your diagnosis. It is easy to say in clinic

'I see a little spleen deficiency and I see some blood stagnation and I see

some damp heat, etc.' " He did not mean that they did not have more than one

pattern happening, but that we must clearly see and understand the

pathogenesis so we know what we want to treat.

I have read a lot of Bob Flaws' books (just finished reading the one for

patients on fibromyalgia) and always find them useful, and I have had mixed

feelings about the

" 5-10 patterns " philosophy. On the one hand, it is somewhat reassuring

because you don't have to decide. You can cover all bases. On the other hand,

how do you choose a formula? How to you make a focused treatment plan? One of

the best herbal teachers we had at Yo San advised that an herbal formula

should not try to accomplish more than three objectives, otherwise it is too

scattered.

This dilemma is going on right now with me and my Interstitial Cystitis

patient (which when I have time I will present to the group for ideas): I do

recognize that this disorder must come from kidney deficiency (as David Cohen

likes to say: " the bladder does what the kidneys tell it to do " ), but in her

case, all symptoms are worse before her period (liver stagnation) and her

tongue shows a yellow coating at the rear (damp heat lower jiao). She does

have slightly cold, clammy puffy ankles and wrists, dark circles under eyes,

fatigue, low back pain and coldness (Kidney yang deficiency)...so what do I

treat first? I will give full details as soon as possible.

Thanks, Jason.

Julie Chambers

June 1, 2000

Z'ev, thank you. I probably looked at that book while I was a student, but I

will read it again. I appreciate the way all these topics being discussed are

rekindling my desire to learn more and especially to go back to the roots and

the basics.

Julie

June 1, 2000

Bob,

Robert Flaws [bobflaws]

Thursday, June 01, 2000 7:19 AM

RE: Re: ok, i'm human and i need help.

However, once you understand that most of our American patients present

with combinations of 5-10 patterns, then there is a huge amount of

variability in this system that can account for virtually anyone. The issue

is not fitting the patient into the system but building the system to fit

the patient

I have heard this comment numerous times lately and am puzzled. (American

patients present with combinations of 5-10 patterns...) Is this statement

saying that other people (i.e. Chinese) do not? Or is it, that our ability

to see clearly the 'true' pattern is not developed. The are a couple of

reasons why I bring this up...

1) My experience in our school clinic: there are obviously great

practitioners, and one's that aren't as great. The really good

practitioners seem to always give one simple diagnosis. Where others seem

to be giving diagnosis's and etiologies such as " they have obvious spleen qi

deficiency with liver (qi stagnation) invading earth, blood deficiency due

to the weekend spleen therefore not supplying blood to the heart (creating

insomnia) and because of their age they have obvious kidney deficiency)

(therefore...we have sp qi xu, liv qi shi, kid xu, xue xu, and ht xue xu and

BTW that thick coat means Dampness, so we must deal with that too) and then

they make their point and herb px from their... I am not saying this is

wrong for the patient or even a wrong approach, it just seems very confusing

and intuitively unsatisfying. This specific example actually happened where

then a very respected practitioner (Chinese) saw the same patient and

clearly gave a one-line diagnosis. My experience is usually that the

Chinese or very clear westerners have this ability. Is it because they

actually know TCM? I am unsure?

2) 2) Are we to believe that in other countries and in other time period's

patients were less complicated? If one looks into the classics, I

personally see cases that are much more complex especially to the mere fact

that many of them are life-threatening with all of these underlying,

previously-mentioned deficiencies/stagnations/stasis's etc. And yes... our

theory is derived from the classics, and they present their cases in such a

way that we create the theory from that, but to the practitioner is the

patient less complicated (back then)? Hard to say... Maybe they just had

less conflicting theory in their head and were masters of 'what they new.'

Maybe you could explain the advantage of this approach, or better explain

the multi-pattern approach... and then how it enables one to pick better

herbs...

Just making note of the differences in styles, and wondering, what people

think...

-Jason

June 1, 2000

Julie,

For right now, I'd just like to suggest that you read Li Dong-yuan's

" Treatise on the Spleen and Stomach " to understand what Bob is talking

about. It is not about treating 5 things at the same time, it is seeing a

macro-pattern with inclusive micro patterns (involving zang fu pattern

diagnosis, five phase pattern diagnosis, eight principle pattern diagnosis,

or jing-luo pattern diagnosis). Based on the spleen-stomach as the

central pathology, Dr. Li developed a way to synthesize the contrary

symptoms, repletions and vacuities that complex patients develop.

>Jason, I think you are wise in your observation. One of my best teachers

>advised us: " You must be clear in your diagnosis. It is easy to say in clinic

>'I see a little spleen deficiency and I see some blood stagnation and I see

>some damp heat, etc.' " He did not mean that they did not have more than one

>pattern happening, but that we must clearly see and understand the

>pathogenesis so we know what we want to treat.

>

>I have read a lot of Bob Flaws' books (just finished reading the one for

>patients on fibromyalgia) and always find them useful, and I have had mixed

>feelings about the

> " 5-10 patterns " philosophy. On the one hand, it is somewhat reassuring

>because you don't have to decide. You can cover all bases. On the other hand,

>how do you choose a formula? How to you make a focused treatment plan? One of

>the best herbal teachers we had at Yo San advised that an herbal formula

>should not try to accomplish more than three objectives, otherwise it is too

>scattered.

>

>This dilemma is going on right now with me and my Interstitial Cystitis

>patient (which when I have time I will present to the group for ideas): I do

>recognize that this disorder must come from kidney deficiency (as David Cohen

>likes to say: " the bladder does what the kidneys tell it to do " ), but in her

>case, all symptoms are worse before her period (liver stagnation) and her

>tongue shows a yellow coating at the rear (damp heat lower jiao). She does

>have slightly cold, clammy puffy ankles and wrists, dark circles under eyes,

>fatigue, low back pain and coldness (Kidney yang deficiency)...so what do I

>treat first? I will give full details as soon as possible.

>

>Thanks, Jason.

>

>Julie Chambers

>

>------

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June 1, 2000

Julie

I find the Blue Poppy classics can be hard to understand without

having

some expert commentary to guide you. I highly recommend reading some

of Bob Flaws articles about yinfire and mutual engenderment of

pathology. Several of the key articles can be viewed in the CHA

library at http://www.spiritone.com/~herb-t/articles.html and the

rest

can be found at http://www.bluepoppy.com

, juliej8@a... wrote:

> Z'ev, thank you. I probably looked at that book while I was a

student, but I

> will read it again. I appreciate the way all these topics being

discussed are

> rekindling my desire to learn more and especially to go back to the

roots and

> the basics.

>

> Julie

June 1, 2000

, " "

<@o...>

wrote:

> I have heard this comment numerous times lately and am puzzled.

(American patients present with combinations of 5-10 patterns...) Is

this statement saying that other people (i.e. Chinese) do not?

Jason,

my understanding of this statement is that people living in complex

urban societies, eating a fatty devitalized diet, getting no

exercise,

etc. present with likewise complex presentations. this is not to say

that chinese or others do not experience these scenarios. It is due

to

economics and lifestyle, not race.

Now, plenty of chinese aristocrats lived such a lifestyle, even in

ancient times and suffered similarly, by all accounts. On the other

hand, the vast majority of modern and ancient chinese are/were

overexercised and underfed, thus they present with different

patterns.

And one thing that both homeopaths and herbalists have long agreed is

that the illnesses of peasants are less complex and much easier to

treat than those of the aristocracy. And in some respects, it could

be

argued that ALL americans are essentially arisotocrats compared to

the

average chinese peasant. So this generalization rings true to me.

Basically, if you live on a bland diet of rice and vegetables, you

are

less likely to have chronic dampheat and phlegm. But over time, you

will become very xu from malnutrition. This is just one of the

reasons

basic texts focus on clearcut xu and shi patterns.

Or is it, that our ability to see clearly the 'true' pattern is not

developed. The are a couple of reasons why I bring this up...

> 1) My experience in our school clinic: there are obviously great

> practitioners, and one's that aren't as great. The really good

> practitioners seem to always give one simple diagnosis.

As for this latter statement, it does seem to fly in the face of a

basic principle of TCM, which is rarely addressed in school. Xiang

sheng or mutual engenderment refers to this interrelationship of

patterns in TCM. This concept is considered a key to advanced tx of

chronic illness.

I'm not sure what you mean by the " true pattern " , but it sounds a

little Worsleyan, so I should point out that Worsely's idea of the

causative factor came from homeopathy not TCM classics.

2 thoughts that come to my mind are:

1. How do you know the long term results of your one pattern

herbalist

were really satisfactory? For example, draining excess vigorously

can

often give amazing short term sx relief, but still cause long term

damage in a combined shi/xu patient.

2. I have seen many chinese practitoners make a simple dx on paper

and

then when you look at their prescribed formula, it actually addresses

multiple patterns.

todd

June 2, 2000

Jason,

Once one has identified the various patterns a patient is presenting, one

next states the treatment principles that logically rememdy each of those

patterns. These principles should be stated in the order of severity or

predominance of each pattern. The standard words of these treatment

principles are the same words that are used for the chapter titles in our

materia medicas (at least in Chinese) and our formulas and prescriptions

(fang ji xue) books. Therefore, one simply picks appropriate medicinals for

each of the stated treatment principles. By appropriate, I mean meds which

do the required functions AND are empirically know to address the patient's

personal symptoms and complaints. Voila. Easy as pie. Once again, it's the

methodology that sets you free, and the methodology is mainly based on a

technical understanding of the words used in this system.

I teach this basic methodology in every class I teach, and I discuss it in

some form in every book I write. It'll be a large part of the new book

Philippe Sionneau and I are co-authoring, " The Treatment of Modern Western

Diseases with Traditional . " This will be coming out in

January or February of 2001. However, I also go into this methodology in

detail in my Allergies & Autoimmune Program, our Chinese Herbal Medicine

Program, and in my Sticking to the Point Program. This last program is

focused solely on acupuncture and how to use this methodology for this

modality as opposed to Chinese meds. Likewise, I deal with it in our

product information guides for Blue Poppy Herbs, incuding a set of 12 or 14

hours of professionally recorded and edited audiotapes. These are all

available from Blue Poppy. Further, you can read a number of free articles

on this subject at www.bluepoppy.com.

When I first began studying Tibetan 30 years ago or more, the first word my

teacher taught me how to read was the word lao, " easy. " The reason " easy "

is always the first word anyone is taught to read in Tibetan is in order to

instill the idea in the student's mind that this study is easy. If one

approaches Chinese medicine from the same point of view, it is also easy.

However, if we romanticize this study and mysticize it, lo and behold, it

likewise becomes a self-fulfilling prophecy. It becomes and remains a very

opaque and mysterious study. It's each of our choice, clear and easy or

mysterious and difficult. At my age, I choose clear. I've wasted way too

many years on thinking all this is mysterious.

Good luck.