diagnostic correlations

[Guest guest]

I don't use western info to correlate with five phase dx because I do

not explicitly use five phase dx in my practice. However I do correlate

high blood lipids with phlegm and high platelet aggregation with blood

stasis. Both of these correlations are based on modern chinese

research. research from china also correlates increased 24 hour

urinary excretion of 17-hydroxy corticosteroids with yang xu and

abnormal cyclic GMP/AMP ratios with spleen qi xu. I think this is an

exciting area of research that should be seriously explored and could be

used to lend an objective component to our diagnostics and thus increase

our mainstream credibility. Classical scholars like yan de xin fluidly

integrate this info with passages from the nei jing. I think taoist

observers of nature would not deny the importance of any information

yielded through observation. Now that modern technology has extended

the reach of our senses with microscopes, MRI's, etc., I think it makes

perfect sense to include these observations in our methodology. It is

worth noting that western medicine was considered very unscientific by

serious scientists until about 50 years ago. that was because all dx

was based on subjective analysis of signs and symptoms, which research

showed to be highly variable and erroneous. this gets back to the issue

of interrater reliability in TCM. Unless px are trained rigorously in

specific methods of dx, IR reliability is very low in TCM, just as it

was in nonrigorously trained MD's a half century ago. Associating

objective parameters from lab tests with classical TCM patterns can help

overcome this weakness. It is a fallacy to say WM is objective and TCM

is subjective. Both are both and WM dx has only been improved by

reliance on objective tests. Since TCM zheng are based upon

preponderance of s/s, lab tests would only complement classical s/s, not

replace them. You would still need to pull the whole pattern together

to treat properly. the fact is that to rely solely on subjective

parameters requires at least two things.

1. phenomenal teachers who really have these skills to impart. 2.

adequate time to learn them. Both of these are questionable in modern

training. Determining blood lipids is very reliable, on the other

hand. OK, I'm ready to be crucified for my heresy. Just an easter

joke from a jew.

 

--

 

Chinese Herbal Medicine

 

[Guest guest]

On Wednesday, April 18, 2001, at 11:15 PM,

 

> I don't use western info to correlate with five phase dx because I do

> not explicitly use five phase dx in my practice. However I do correlate

> high blood lipids with phlegm and high platelet aggregation with blood

> stasis. Both of these correlations are based on modern chinese

> research. research from china also correlates increased 24 hour

> urinary excretion of 17-hydroxy corticosteroids with yang xu and

> abnormal cyclic GMP/AMP ratios with spleen qi xu. I think this is an

> exciting area of research that should be seriously explored and could be

> used to lend an objective component to our diagnostics and thus increase

> our mainstream credibility. Classical scholars like yan de xin fluidly

> integrate this info with passages from the nei jing. I think taoist

> observers of nature would not deny the importance of any information

> yielded through observation.

 

I think this is clearly possible, and I wouldn't deny the

possibilities. However, I must point out that I take the pulse first,

and if there is a noticable slippery quality that feels like the vessel

is deep and constrained, I will THEN ask about blood lipid levels, or

suggest testing. Sometimes you can detect cholesterol problems before

they reach what WM would consider to be dangerous levels. We still need

to rely on our diagnostics first and foremost, as this is our training,

and should be our strength.

 

I also like Yang De-xin's work, However, I am also concerned about

recent Chinese journal articles that replace pulse and tongue diagnosis

with exclusively biomedical testing and then call it Chinese medicine.

This seems to be a larger trend than the former.

 

 

> Now that modern technology has extended

> the reach of our senses with microscopes, MRI's, etc., I think it makes

> perfect sense to include these observations in our methodology.

 

Certainly, we must account for all findings, and include the effects of

all medications and treatments on the patient. For example, after

surgery, we must determine which channels and xue/holes (points) have

been effected, and use acupuncture or moxabustion to restore normal qi

flow as much as possible. However, there are many phenomena directly

related to a person's health that don't always show up on lab tests,

such as emotional states and subjective symptoms such as headache,

nausea, fatigue, etc., that CM diagnostics and pattern differentiation

can include in a larger, more comprehensive picture.

 

 

 

> Unless px are trained rigorously in

> specific methods of dx, IR reliability is very low in TCM, just as it

> was in nonrigorously trained MD's a half century ago. Associating

> objective parameters from lab tests with classical TCM patterns can help

> overcome this weakness. It is a fallacy to say WM is objective and TCM

> is subjective. Both are both and WM dx has only been improved by

> reliance on objective tests. Since TCM zheng are based upon

> preponderance of s/s, lab tests would only complement classical s/s, not

> replace them.

 

Agreed. This is the Tao of Zhang Xi-chun.

 

 

> You would still need to pull the whole pattern together

> to treat properly. the fact is that to rely solely on subjective

> parameters requires at least two things.

> 1. phenomenal teachers who really have these skills to impart. 2.

> adequate time to learn them. Both of these are questionable in modern

> training. Determining blood lipids is very reliable, on the other

> hand. OK, I'm ready to be crucified for my heresy. Just an easter

> joke from a jew.

 

Nothing heretical. . . .actually pretty mainstream. I don't think that

teachers have to be phenomenal to impart these skills, but those of us

who teach should be working to improve both our diagnostic and teaching

skills.

 

 

>

[Guest guest]

abnormal cyclic GMP/AMP ratios with spleen qi xu.

>>>Do you have any information on this one

Alon

[Guest guest]

, <alonmarcus@w...> wrote:

> abnormal cyclic GMP/AMP ratios with spleen qi xu.

> >>>Do you have any information on this one

> Alon

 

there is a book called Pharmacology of chinese herbs by huang from

redwing. Has lots of stuff on this, yang tonics and blood movers.

paradigm will publishing a mjor work in this area down the road, too.

 

[Guest guest]

thanks

 

-

 

Thursday, April 19, 2001 9:13 AM

Re: diagnostic correlations

, <alonmarcus@w...> wrote:> abnormal cyclic GMP/AMP ratios with spleen qi xu. > >>>Do you have any information on this one> Alonthere is a book called Pharmacology of chinese herbs by huang from redwing. Has lots of stuff on this, yang tonics and blood movers. paradigm will publishing a mjor work in this area down the road, too.ToddChinese 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.

[Guest guest]

MALPRACTICE FOCUS: A FATAL REACTION TO OVER-THE-COUNTER MEDICATION?Physicians should know what their patients are taking with regard toover-the-counter drugs, especially herbal medicines.http://primarycare.medscape.com/36573.rhtml?srcmp=pc-042701<a href="http://primarycare.medscape.com/36573.rhtml?srcmp=pc-042701">Read it Here</a>

[Guest guest]

I must say that's an inaccurate summary of the linked article-

according to the article, the only way that the herb involved could

have been a co-agent in the patient's CR arrest was if it were an MAO-

inhibiter, and it has not been shown to be one. Even if the

practitioners involved had known about the herb, it would not have

prevented the death. According to the article, the actual cause of

death was inadequate monitoring and resuscitation efforts.

 

Regardless, suggesting that physicians need to know what herbs their

patients are on would make sense IF most physicians knew what info

there is out there about drug-herb interactions... and my

understanding is that there is some but not a lot of definitive info

about such interactions.

 

Brian Carter

 

 

, <alonmarcus@w...> wrote:

> MALPRACTICE FOCUS: A FATAL REACTION TO OVER-THE-COUNTER MEDICATION?

> Physicians should know what their patients are taking with regard to

> over-the-counter drugs, especially herbal medicines.

> http://primarycare.medscape.com/36573.rhtml?srcmp=pc-042701

> <a href= " http://primarycare.medscape.com/36573.rhtml?srcmp=pc-

042701 " >

> Read it Here</a>

[Guest guest]

, enthusinator@o... wrote:

> I must say that's an inaccurate summary of the linked article-

> according to the article, the only way that the herb involved could

> have been a co-agent in the patient's CR arrest was if it were an MAO-

> inhibiter, and it has not been shown to be one.

 

 

Brian

 

Since the headline (not summary) was written with a question mark, I

did not perceive it as erroneous. The author seemed to be asking if

the SJW was the cause, not stating that it was. He then presented

evidence that it was not, with the caveat that in the absence of info,

one should err on the side of caution. If SJW is an MAOi, then it

should not be used with demerol. since it may be, the cautious

approach would have been to have stopped this herb or used a different

analgesic. even though failure to properly resuscitate was the

proximate cause of death, this may have been avoidable if the incident

had never occurred. In potentially life threatening situations, I

think all herbs should be stopped if we don't know about possible

interactions. first, do no harm. You are right that info is scanty,

so all the more reason to err on the side of caution. By the way, I

will be downloading a very comprehensive herb-drug interaction program

on the PCOM clinic computer on tuesday. You may be surprised how much

info there actually is out there.

 

>

> Regardless, suggesting that physicians need to know what herbs their

> patients are on would make sense IF most physicians knew what info

> there is out there about drug-herb interactions... and my

> understanding is that there is some but not a lot of definitive info

> about such interactions.

>

> Brian Carter

>

>

[Guest guest]

Todd wrote " By the way, I

will be downloading a very comprehensive herb-drug interaction program

on the PCOM clinic computer on tuesday. "

, will you be able to put that up on the CHA library somewhere .It would be

good , so that the NZ and Aust. assos. could link it on their websites for

members.

 

Heiko

[Guest guest]

According to the article, the actual cause of death was inadequate monitoring and resuscitation efforts.>>>Yes but think of potential future medilegal ramification

alon

[Guest guest]

In potentially life threatening situations, I think all herbs should be stopped if we don't know about possible interactions.

>>>I agree. and should not be used befor surgery

Alon

[Guest guest]

While at our present status of practice of CM in the West, at our present level of training (without emergency medicine), and lack of experience, I agree with the statements below, the implications of these statements have potential consequences for our future.

 

Namely, that Chinese medicine, specifically Chinese internal medicine cannot treat life threatening situations. This simply is not true. There are still parts of the world and situations where CM will be the treatment in these situations, and historical records confirm that CM was used to do so.

 

I personally do not give herbal medicine before or after surgery, to patients on immunosuppressive drugs such as cyclosporine (I won't even accept them as patients), or on dialysis (again, I will not accept them as patients).

 

 

 

 

On Sunday, April 29, 2001, at 06:47 PM, <alonmarcus (AT) wans (DOT) net> wrote:

 

 

> In potentially life threatening situations, I

> think all herbs should be stopped if we don't know about possible

> interactions. 

> >>>I agree. and should not be used befor surgery

> Alon

>

>

 

 

[Guest guest]

I believe Zev's cautions regarding surgerical patients is the best

and safest response.

 

I have not had the opportunity to work on someone using

immunosuppressive drugs. Has anyone? If so, what has that experience

been like?

 

Jim Rmaholz

 

 

 

> I personally do not give herbal medicine before or after surgery,

to patients on immunosuppressive drugs such as cyclosporine (I won't

even accept them as patients), or on dialysis (again, I will not

accept them as patients).

>

>

>

>

> On Sunday, April 29, 2001, at 06:47 PM, <alonmarcus@w...> wrote:

>

> > In potentially life threatening situations, I

> > think all herbs should be stopped if we don't know about possible

> > interactions. 

> > >>>I agree. and should not be used befor surgery

> > Alon

> >

> <Attachment missing>

> >

[Guest guest]

One case:

a woman who wanted to lose weight, stop smoking (!!!) clear her skin,

and overcome fatigue (back in 1984 in Denver). She was on cyclosporine

and prednisone, and had the symptoms of moon face and weight gain

associated with prednisone use. The pulse was rapid and slippery,

tongue very swollen with greasy coat. She was taking the medication for

a kidney transplant. I gave her acupuncture, and, foolishly, liu wei

di huang wan. I treated her twice, and both times she developed a

fever, in this case possibly indicating that the acupuncture

mobilized the rejection response. So I discontinued treatment.

 

I don't think that acupuncture can support necessary immunosuppression,

as in the potential for organ rejection after transplant

 

 

On Sunday, April 29, 2001, at 09:19 PM, jramholz wrote:

 

> I believe Zev's cautions regarding surgerical patients is the best

> and safest response.

>

> I have not had the opportunity to work on someone using

> immunosuppressive drugs. Has anyone? If so, what has that experience

> been like?

>

> Jim Rmaholz

>

>

>

>> I personally do not give herbal medicine before or after surgery,

> to patients on immunosuppressive drugs such as cyclosporine (I won't

> even accept them as patients), or on dialysis (again, I will not

> accept them as patients).

>>

>>

>>

>>

>> On Sunday, April 29, 2001, at 06:47 PM, <alonmarcus@w...> wrote:

>>

>>> In potentially life threatening situations, I

>>> think all herbs should be stopped if we don't know about possible

>>> interactions. 

>>>>>> I agree. and should not be used befor surgery

>>> Alon

>>>

>> <Attachment missing>

>>>

>

>

>

>

> 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.

>

>

>

>

[Guest guest]

There are still parts of the world and situations where CM will be the treatment in these situations, and historical records confirm that CM was used to do so.>>>>To me this is a medilegal question. In China 1/2 of my time was spent in the surgical department so I saw a lot of combining of surgical procedures and TCM.

Alon

 

-

 

Sunday, April 29, 2001 7:42 PM

Re: Re: diagnostic correlations

While at our present status of practice of CM in the West, at our present level of training (without emergency medicine), and lack of experience, I agree with the statements below, the implications of these statements have potential consequences for our future.Namely, that Chinese medicine, specifically Chinese internal medicine cannot treat life threatening situations. This simply is not true. There are still parts of the world and situations where CM will be the treatment in these situations, and historical records confirm that CM was used to do so.I personally do not give herbal medicine before or after surgery, to patients on immunosuppressive drugs such as cyclosporine (I won't even accept them as patients), or on dialysis (again, I will not accept them as patients). On Sunday, April 29, 2001, at 06:47 PM, <alonmarcus wrote:

In potentially life threatening situations, Ithink all herbs should be stopped if we don't know about possibleinteractions. >>>I agree. and should not be used befor surgeryAlon

 

 

 

 

 

 

 

[Guest guest]

Heiko Lade wrote:

>

wrote " By the way, I

> will be downloading a very comprehensive herb-drug interaction program

> on the PCOM clinic computer on tuesday. "

 

What is this program?

 

--

Al Stone L.Ac.

<AlStone

http://www.BeyondWellBeing.com

 

Pain is inevitable, suffering is optional.

[Guest guest]

jramholz wrote:

>

> I believe Zev's cautions regarding surgerical patients is the best

> and safest response.

 

What kind of time frame are we looking at here? Stop taking herbs two

weeks prior? Two days?

 

--

Al Stone L.Ac.

<AlStone

http://www.BeyondWellBeing.com

 

Pain is inevitable, suffering is optional.

[Guest guest]

I usually say five days to one week before. . . .depending, of course on

the prescription, diagnosis and or nature of the surgery. For example,

I have one patient who was taking xue fu zhu yu tang, and I told her to

stop the formula one week before her surgery. Three weeks later, she

cannot use the prescription, because she has major abdominal scars that

are having difficulty to heal, so one cannot use blood movers. On

reappraisal of her diagnosis after surgery, it has been replaced by a

modification of bu zhong yi qi tang anyway.

 

 

On Monday, April 30, 2001, at 12:02 PM, Al Stone wrote:

 

>

>

> jramholz wrote:

>>

>> I believe Zev's cautions regarding surgerical patients is the best

>> and safest response.

>

> What kind of time frame are we looking at here? Stop taking herbs two

> weeks prior? Two days?

>

> --

> Al Stone L.Ac.

> <AlStone

> http://www.BeyondWellBeing.com

>

> Pain is inevitable, suffering is optional.

>

>

> 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.

>

>

>

>

[Guest guest]

wrote:

 

> Three weeks later, she

> cannot use the prescription, because she has major abdominal scars that

> are having difficulty to heal, so one cannot use blood movers.

 

So blood activators " thin " the blood and can lead to additional bleeding

while a wound is healing.

 

Does this also apply to the stop bleeding subcategory of blood

activators?

 

--

Al Stone L.Ac.

<AlStone

http://www.BeyondWellBeing.com

 

Pain is inevitable, suffering is optional.

[Guest guest]

, Al Stone <alstone@b...> wrote:

>

>

> Heiko Lade wrote:

> >

> wrote " By the way, I

> > will be downloading a very comprehensive herb-drug interaction program

> > on the PCOM clinic computer on tuesday. "

>

> What is this program?

>

>

It is called Interactions from ibismedical.com

 

It is not freeware, so you must purchase it if you want it. I wrote

the chinese herbology section, whichis not extensive, but the program

is well researched and worth the $99, I think. It is mostly about

western herb and supplement interactions and I don't get a kickback.

 

 

[Guest guest]

, Al Stone <alstone@b...> wrote:

 

> So blood activators " thin " the blood and can lead to additional bleeding

> while a wound is healing.

>

> Does this also apply to the stop bleeding subcategory of blood

> activators?

>

 

I think herbs in this latter category (the blood activating subcategory

of the stop bleeding herbs) are not only safe in this case, but highly

desirable. the main example being sanqi, which is actually used for

knife wounds. I have used it freely in such cases on the advice of my

chinese teachers with extensive hospital experience.

 

[Guest guest]

Al:

 

Usually a week is sufficient to clear herbal formulas from the

system. Afterwards, using herbal formulas to stop any bleeding,

inflammation, swelling, bruising, or to promote tissue repair are

acceptable.

's idea use of San qi is a very good one. But, unlike I've

never treated anyone with a knife or gunshot wound; so I never used

the tiny pill accompaning the San qi in the blister pack. I use a Hua

T'o formula in tincture (it's similar to some Shaolin trauma

formulas) that contains San qi. The faster healing times are often

noticeable to both the patient and the doctor.

 

Jim Ramholz

 

 

 

 

, Al Stone <alstone@b...> wrote:

>

>

> jramholz wrote:

> >

> > I believe Zev's cautions regarding surgerical patients is the best

> > and safest response.

>

> What kind of time frame are we looking at here? Stop taking herbs

two weeks prior? Two days?

>

> --

> Al Stone L.Ac.

> <AlStone@B...>

> http://www.BeyondWellBeing.com

>

> Pain is inevitable, suffering is optional.

[Guest guest]

, jramholz wrote:

 

>

's idea use of San qi is a very good one. But, unlike I've

> never treated anyone with a knife or gunshot wound; so I never used

> the tiny pill accompaning the San qi in the blister pack.

 

My attorney advises me to neither confirm nor deny my reputation as a

mob acupuncturist during my days in New Jersey.

the Needle

[Guest guest]

>> the main example being sanqi, which is actually used for knife wounds. I have used it freely in such cases on the advice of my chinese teachers with extensive hospital experience.Todd << That is external use ?

[Guest guest]

, " Patrick Rudolph " <patim.rudolph@g...>

wrote:

>

>

> >> the main example being sanqi, which is actually used for

> knife wounds. I have used it freely in such cases on the advice of my

> chinese teachers with extensive hospital experience.

>

> Todd <<

>

> That is external use ?

 

 

both.