Guest guest Posted January 17, 2001 Report Share Posted January 17, 2001 , <alonmarcus@w...> wrote: You should say CM as TCM does much of this theorizing. I'm not sure I get your position here. I would consider CM to be the entire body of chinese medical literature from the pre-han era till now. TCM, narrowly construed, would be the modern distillation of theory integrated with empirical evidence, dispensing with what is considered mere fancy. In the days of monolithic TCM, this distillation was heavily influenced by communist directives, but by all accounts,this has not been the case for over a decade now. Researchers and scholars are now free to explore most avenues of thought, but appear to continue with an emphasis on that which has empirical foundations, as well. While rampant speculation seems to run through many genres of chinese medical literature (materia medica, pulse study, basic theory), in contrast, the literature of prescriptions and internal medicine has a strong empirical pragmatic bent to it. I consider modern TCM to strongly favor the latter, not the former. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 18, 2001 Report Share Posted January 18, 2001 TCM, narrowly construed, would be the modern distillation of theory integrated with empirical evidence, dispensing with what is considered mere fancy. In the days of monolithic TCM, this distillation was heavily influenced by communist directives, but by all accounts,this has not been the case for over a decade now >>>>Many ideas in the TCM modern literature are completely theoretical, including the differential diagnosis of Western diseases in TCM. Alon Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 18, 2001 Report Share Posted January 18, 2001 In a message dated 1/18/01 7:50:26 PM Pacific Standard Time, alonmarcus writes: << It is always better to use pattern discrimination w/out regard to western disease name unless there is good research to back it up. Alon >> Along those lines, a student asked me yesterday what kind of illness in Chinese medicine is dizziness at high altitudes? I was not sure. A failure of yang qi to rise to the head? A deficiency of blood and qi nourishing the channels? I told her to look at the patient and see what was showing. Any ideas? Julie Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 18, 2001 Report Share Posted January 18, 2001 , <alonmarcus@w...> wrote: > >>>>Many ideas in the TCM modern literature are completely theoretical, including the differential diagnosis of Western diseases in TCM. > Alon I disagree. the dx of western disease in TCM seems to be based upon a reasoned comparison of the typical signs/sx of the modern disease with traditional chinese disease categories. for a great example of this, see Flaws new psych book. for a bad transaltion,but one that alsoincludes the chinese, see the Practical english-chinese library: clinic I and Clinic II. these books are organized according to western diseases, but in every case, the intro section notes the traditional TCM diseases that formed the basis of the analysis. For example, hypertension formulas are derived from traditional chinese discussions of dizziness, headache and windstroke. It only appears to be pure speculation if one relies on sources that obfuscate this reasoning process. the nice thing about clinic I and II is that one can see that the discussion is also in the chinese version, not just for our benefit, as the two texts are printed side by side. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 18, 2001 Report Share Posted January 18, 2001 , " " < zrosenberg@e...> Alon wrote: > >>>>Many ideas in the TCM modern literature are completely theoretical, > including the differential diagnosis of Western diseases in TCM. > Alon > > > This is something that concerns me. . . .I wonder sometimes if the patterns > listed in those textbooks that categorize by Western disease are basically > arbitrarily arranging patterns to fit the disease. > > It does not appear arbitrary, but highly reasoned. see my earlier post. what would be arbitrary is when one prescribes an rx based on disease dx alone without consideration of presenting s/s. so some folks give tian ma gou teng yin for all hypertension becasue it has many herbs that lower blood pressure, yet ban xia bai zhu tian ma fits another pattern often seen HT patients and xue fu zhu yu tang another. As another example, I had a patient the other day with hyperthyroidism. Tian wang bu xindan is indicated for one pattern of hyperthyroid in several texts. this pt. had sx of irritability,heat and restlessness, so the rx fit. However, she also had visible goiter and her MD had indicated goiter, as well, so I added herbs to disperse phlegm in the throat. Goiter is often phlegm and this patient had a greasy tongue coat, so it all fit. but I would not have added those herbs otherwise. BTW,I excluded the seaweeds altogether, even though they were used for goiter in ancient times. Modern research from both china and Us suggest iodine containing substances can cause a thyroid storm inhyperthyroidism. since goiter can also present in hypothyroid and Iodine deficiency cases, seaweeds should be reserved for those latter presentations. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 18, 2001 Report Share Posted January 18, 2001 on 1/18/01 4:33 PM, at wrote: > , " " < > zrosenberg@e...> > > Alon wrote: >>>>>> Many ideas in the TCM modern literature are completely theoretical, >> including the differential diagnosis of Western diseases in TCM. >> Alon >> >> >> This is something that concerns me. . . .I wonder sometimes if the patterns >> listed in those textbooks that categorize by Western disease are basically >> arbitrarily arranging patterns to fit the disease. >> >> > > It does not appear arbitrary, but highly reasoned. see my earlier > post. what would be arbitrary is when one prescribes an rx based on > disease dx alone without consideration of presenting s/s. so some > folks give tian ma gou teng yin for all hypertension becasue it has > many herbs that lower blood pressure, yet ban xia bai zhu tian ma fits > another pattern often seen HT patients and xue fu zhu yu tang another. > As another example, I had a patient the other day with hyperthyroidism. > Tian wang bu xindan is indicated for one pattern of hyperthyroid in > several texts. this pt. had sx of irritability,heat and restlessness, > so the rx fit. However, she also had visible goiter and her MD had > indicated goiter, as well, so I added herbs to disperse phlegm in the > throat. Goiter is often phlegm and this patient had a greasy tongue > coat, so it all fit. but I would not have added those herbs otherwise. > BTW,I excluded the seaweeds altogether, even though they were used for > goiter in ancient times. Modern research from both china and Us > suggest iodine containing substances can cause a thyroid storm > inhyperthyroidism. since goiter can also present in hypothyroid and > Iodine deficiency cases, seaweeds should be reserved for those latter > presentations. > > I have no problem, and agree with everything you have said above. There is no problem in integrating biomedical and TCM information in patterns, especially in the way you have described here. Certainly, I agree with the approach of Zhang Xi-chun in this regard, as I know you do. I am referring more to certain textbooks (OHAI put out a prescription text a few years back) that shove three or four patterns arbitrarily together for each western disease name. This leads to oversimplification at best, and reduces the rigor of pattern diagnosis carried out by the TCM practitioner. It is not the process, but how it is done in certain texts and clinical situations that concerns me. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 18, 2001 Report Share Posted January 18, 2001 It only appears to be pure speculation if one relies on sources that obfuscate this reasoning process. the nice thing about clinic I and II is that one can see that the discussion is also in the chinese version, not just for our benefit, as the two texts are printed side by side.>>>Although interesting to find historical records of somewhat similar symptoms these still have nothing to do with being the same disease and therefore this is still a theoretical process. This is not new when I was in China in 84 they always used this process to begin the analysis and discussions on western diseases, for example, dizziness and high blood pressure, which have nothing to do with each other as many patients are for example symptom Alon Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 18, 2001 Report Share Posted January 18, 2001 The one thing we should never forget is that individuality of patients can result in presentations that are completely different than the so called reasoned analysis done often in modern TCM. Unless such analysis is backed up with research it is theoretical. I have seen patients with hypothyroid and symptoms that look exactly like classical hyperthyroid and if one opens a book on hypothyroid then one will not find the appropriate formula. It is always better to use pattern discrimination w/out regard to western disease name unless there is good research to back it up. Alon Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 18, 2001 Report Share Posted January 18, 2001 At 5:16 PM -0800 1/18/01, wrote: >I am referring >more to certain textbooks (OHAI put out a prescription text a few years >back) that shove three or four patterns arbitrarily together for each >western disease name. This leads to oversimplification at best, and reduces >the rigor of pattern diagnosis carried out by the TCM practitioner. It is >not the process, but how it is done in certain texts and clinical situations >that concerns me. --- I'm not sure its fair to quote OHAI publications as representative of TCM. I also disagree with Alon that the TCM disease pattern analysis is in any way arbitrary - do you have any evidence of this? My understanding is that modern TCM was defined and described by very distinguished doctors of Chinese medicine, not party hacks as has been suggested. Given the interesting times in which this happened, there may be language that pays homage to political masters, just as there is in the nei jing. That does not negate the value of the medical material. Also, I think it is not quite right to view the TCM patterns described for diseases as either/or descriptions. In practice the patterns are usually mixed, but for clarity of teaching, and presentation in textbooks, the patterns are described separately. It is then up to the student or practitioner to use that information to understand how it applies to the patient. Examples of application are usually left to case studies, and to teaching clinic, where the complexities of actual patient presentation can be addressed. Rory Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 18, 2001 Report Share Posted January 18, 2001 on 1/18/01 7:10 PM, alonmarcus at alonmarcus wrote: The one thing we should never forget is that individuality of patients can result in presentations that are completely different than the so called reasoned analysis done often in modern TCM. Unless such analysis is backed up with research it is theoretical. I have seen patients with hypothyroid and symptoms that look exactly like classical hyperthyroid and if one opens a book on hypothyroid then one will not find the appropriate formula. It is always better to use pattern discrimination w/out regard to western disease name unless there is good research to back it up. Alon (Z'ev) Some of my concerns with some textbook approaches to biomedical diseases listed as patterns is that many diseases go through many stages. It is very difficult to match patterns to such diseases as lupus, for example, as lupus goes through many stages over many years. The pattern diagnosis is of extreme importance, and is often given short shrift in many integrative discussions. And, as Alon points out, individuality of patients can result in very different presentations from textbook diseases descriptions, whether Western or Chinese. Rory, I certainly understand that much thoughtful work has been done by mainland architects of TCM, and by no means do I think that the work done there is party hacks. I don't know how you extracted that from my earlier post. Nor do I think pattern differentiation of biomedical diseases is fruitless or futile. It is just that in the discussion of many conditions, the pattern descriptions are not yet mature when oriented in this way. I believe in pattern differentiation first, disease second (for CM practitioners). Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 19, 2001 Report Share Posted January 19, 2001 Julie, It would follow from basic TCM physiology that this may be due to the lack of da qi (air qi). Without this da qi the body is unable to as effectively make blood and qi which are usually manufactured from a combination of da qi and gu qi in the Lungs and Heart. When I examined the formulas used (see the Institute for Traditional Medicine's monograph on treating altitude sickness with Chinese herbs) they generally use heavy doses of qi tonics to help the Lungs and Spleen absorb more qi from food and air. Thus the dizziness (and nausea) usually seen with high alttitudes would be a qi (and perhaps) blood vacuity. Incidentally, the formulas listed in the above monograph have worked with the 5 patients for whom I've made them, extraordinarily well. No symptoms at 14,000 feet over the course of 1 week. Mark Reese > > Along those lines, a student asked me yesterday what kind of illness in > Chinese medicine is dizziness at high altitudes? I was not sure. A failure of > yang qi to rise to the head? A deficiency of blood and qi nourishing the > channels? I told her to look at the patient and see what was showing. Any > ideas? > > Julie > > Chinese Herbal Medicine, a voluntary organization of licensed healthcare practitioners, matriculated students and postgraduate academics specializing in Chinese Herbal Medicine, provides a variety of professional services, including board approved online continuing education. > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 19, 2001 Report Share Posted January 19, 2001 At 9:40 PM -0800 1/18/01, wrote: Rory, I certainly understand that much thoughtful work has been done by mainland architects of TCM, and by no means do I think that the work done there is party hacks. I don't know how you extracted that from my earlier post. -- At 8:29 PM -0800 1/18/01, Rory Kerr wrote: I also disagree with Alon that the TCM disease pattern analysis is in any way arbitrary - do you have any evidence of this? My understanding is that modern TCM was defined and described by very distinguished doctors of Chinese medicine, not party hacks as has been suggested. -- If it isn't clear, I did not mean to imply that you had having made this point, Z'ev. Rory Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 19, 2001 Report Share Posted January 19, 2001 juliej8 wrote: > Along those lines, a student asked me yesterday what kind of illness in > Chinese medicine is dizziness at high altitudes? I don't think this is pathology, but physiology. I asked a teacher about the fluid that fills in a heal blister once. I thought perhaps it had to do with dampness or something. He scratched his head, mumbled something in Chinese and with a little frustration admited that this is physiology, not pathology. -- Al Stone L.Ac. <AlStone http://www.BeyondWellBeing.com Pain is inevitable, suffering is optional. Attachment: vcard [not shown] Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 19, 2001 Report Share Posted January 19, 2001 is in any way arbitrary - do you have any evidence of this? My understanding is that modern TCM was defined and described by very distinguished doctors of Chinese medicine, not party hacks as has been suggested. >>>>>>I had many conversations in China with textbook writers I am not saying it is completely arbitrary but very analytical. Its one thing to try to find overlapping s/s complexes and to say that is appropriate for this or that Disease. The strength of western med is its ability to define specific pathologies and thus look at out come based on this specific disease. In CM the diseases are based on a symptom. And DD is on s/s complexes. Matching to two is a theoretical process and not a clinical process Alon Alon - Rory Kerr Thursday, January 18, 2001 8:29 PM Re: Re: TCM?CM (was evidence part 2) At 5:16 PM -0800 1/18/01, wrote:>I am referring>more to certain textbooks (OHAI put out a prescription text a few years>back) that shove three or four patterns arbitrarily together for each>western disease name. This leads to oversimplification at best, and reduces>the rigor of pattern diagnosis carried out by the TCM practitioner. It is>not the process, but how it is done in certain texts and clinical situations>that concerns me.---I'm not sure its fair to quote OHAI publications as representative of TCM. I also disagree with Alon that the TCM disease pattern analysis is in any way arbitrary - do you have any evidence of this? My understanding is that modern TCM was defined and described by very distinguished doctors of Chinese medicine, not party hacks as has been suggested. Given the interesting times in which this happened, there may be language that pays homage to political masters, just as there is in the nei jing. That does not negate the value of the medical material.Also, I think it is not quite right to view the TCM patterns described for diseases as either/or descriptions. In practice the patterns are usually mixed, but for clarity of teaching, and presentation in textbooks, the patterns are described separately. It is then up to the student or practitioner to use that information to understand how it applies to the patient. Examples of application are usually left to case studies, and to teaching clinic, where the complexities of actual patient presentation can be addressed.RoryChinese Herbal Medicine, a voluntary organization of licensed healthcare practitioners, matriculated students and postgraduate academics specializing in Chinese Herbal Medicine, provides a variety of professional services, including board approved online continuing education. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 19, 2001 Report Share Posted January 19, 2001 , " ALON MARCUS " <alonmarcus@w...> wrote: > >>>>>>I had many conversations in China with textbook writers I am not saying it is completely arbitrary but very analytical. Its one thing to try to find overlapping s/s complexes and to say that is appropriate for this or that Disease. The strength of western med is its ability to define specific pathologies and thus look at out come based on this specific disease. In CM the diseases are based on a symptom. And DD is on s/s complexes. Matching to two is a theoretical process and not a clinical process > Alon Textbooks are just guidelines. Of course, one needs to do careful pattern differentiation. I think Zev, Rory, Alon and I all agree on this point. If one does not find applicable patterns in the hypertension section of the internal medicine texts, then one should absolutely not use those formulas on a given HT patient. But the process of establishing the guidelines is still not at all arbitrary. Otherwise, why would classical formulas for dizziness be so effective in many HT patients and classical formulas for palpitations be so effective for so many hyperthyroid patients. And these rx do not just relieve sx, but lead to sustained measurable changes in BP and T3/T4/ TSH. That proves the validity of the process in my mind. As for disease staging, this also comes down to common sense. One is being a careless px if he prescribes tian ma gou teng yin when no confirming s/s are present. Quote Link to comment Share on other sites More sharing options...
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