yin fire & dx.

[Guest guest]

Todd sometimes it the combination of the herbs that you must look at like bai shao and gui zhi in gui zhi tang. You cant just say you see here is a spicy herbs and a blood tonic so we have two treatment principle

Alon

 

-

 

Monday, July 16, 2001 10:18 PM

Re: yin fire & dx.

, <alonmarcus@w...> wrote:> I think were Yin fire is helpful is in giving permission to mix patterns when it is difficult to be a truly skilful Dr (which is often easier said than done)> AlonI think it takes incredible skill to prioritize the patterns and appropriately balance the formula to address the myriad patterns. If one just throws in herbs for every pattern one sees, then results will be poor. It is the weighing of the treatment priciples that takes skill. I underscore Simon. Look at the formulas, not the diagnoses and you will generally see mutiple patterns treated at once by almost all Chinese docs I have worked with (and this would be about 15 fairly closely over the years). As for the way chinese doctors disparage each others methods, I don't even want to tackle that one except to say that we should not go down this path.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]

, " Alon Marcus " <alonmarcus@w...> wrote:

sometimes it the combination of the herbs that you must look at like bai

shao and gui zhi in gui zhi tang. You cant just say you see here is a spicy

herbs and a blood tonic so we have two treatment principle

 

 

I totally disagree. the formulas can be used to address patterns in

combination or as a function of the individual herbs. this is why gui

zhi tang has been modified slightly to address far more than the

original taiyang syndrome, including heart disease and digestive

complaints. Same for xiao chai hu tang.

 

[Guest guest]

On Wednesday, July 18, 2001, at 04:21 AM, Cara Frank wrote:

 

>

>

> >

> > I think it takes incredible skill to prioritize the patterns and

> > appropriately balance the formula to address the myriad patterns.

>

> >

> >

>

> before you get completely lost in the muck, always remember to

> prioritize

> the chief complaint!!

> Cara

>

>

>

Cara, what if the chief complaint is 'fibromyalgia'? Or 'lupus'?

 

In chronic disease, chief complaints are almost always constellations of

symptoms. Even if, for example, abdominal cramping during menstruation

is a major complaint, it cannot be separated out from the rest of the

pattern in terms of diagnosis and treatment in a chronic disorder, such

as fatigue, poor appetite, bloating, disturbed sleep from heat vexation,

low libido, and cold extremities.

 

For acute diseases, it is a different story. An acute wind/heat attack

is priority in treatment. Even here, however, one has to consider the

constitution of the patient (yin xu or yang xu) in treatment.

 

I like to paraphrase Mao Zi-dong on this: " when I hear the term chief

complaint, I reach for my gun " .

 

 

[Guest guest]

On Wednesday, July 18, 2001, at 09:55 AM, Alon Marcus wrote:

 

> I am not sure I understand what you mean. Are you saying that Yin huo

> theory is just a mix of patterns used as default if one is not skilled

> enough for the case? If so, please explain

> >>>>>My SH teachers used to say that if one grasps the main principle

> (formula) than no additions to the classical formula is needed and they

> often used small formulas and made fun of practitioners using large,

> multiple pricple formulas. However the so called grasping the main

> disease principal is easier said than done.  Having major TCM thinkers

> (Li Dong) using a system that often use so many complex and conflicting

> herbs such as cold and hot, drying and moistening etc makes it easyer

> to write such formulas (ie makes it more expectable).

> But again, some of my teachers especially the SH said that most of the

> time if one treats the patient true condition than all the so called

> other manifestations such as Yin fire (or Yang within Yin) would take

> care of themselves

> Alon

>

Alon,

I have tremendous respect and interest in SHL diagnosis and

prescriptions, and use both widely in my practice. However, several SHL

prescriptions, especially at the deeper stages such as jue yin bing, use

hot and cold, supplementing and draining ingredients such as in wu mei

wan/fructus mume pill, which contains both huang lian and fu zi. They

are truly elegant prescriptions, but there is more than meets the eye

here. Also, remember that Li Dong-yuan borrowed heavily from the SHL,

and used many of the same principles. This includes 1) using sweet warm

ingredients to expel evil heat 2) supplementing the spleen and stomach

to strengthen wei qi/defensive qi and ying qi/construction qi 3) using

ingredients with opposing qualities to harmonize (he fa), especially in

shao yang bing, as in xiao chai hu tang/minor bupleurum decoction.

 

In my opinion, Li/Zhu medicine is a further development of SHL

medicine.

 

 

[Guest guest]

Dear Folks,

 

Having read all the recent yin fire discussions, I'd like to say that

I agree with Jason that the Blue Poppy Press version of the Pi Wei Lun

is not a very good translation. It is another example of exactly why

translations need to be done by native-speakers of the arrival

language, not the departure language. Yang Shou-zhong's English

language credentials IN CHINA are excellent. So are his wen yi wen or

gu wen (classical Chinese) credentials. In fact, he spent years being

politically " rehabilitated " because of his classical Confucian

education. His Chinese med credentials (both theory and practice) are

also impressive, including his pre-TCM Chinese medical education.

However, when I read his translation today, I have to groan. By

educated native-speaker standards, Yang's English is stilted, archaic,

and infelicitous. This is why he no longer workds for Blue Poppy.

 

Unfortunately, at the time BPP published this book, my Chinese was not

good enough for me to take much of a hand in the actual translation.

Perhaps, some day, we will be able to completely redo this translation

and make it easier to read. Having retranslated sections of it for

various classes, I know it can be done better. (Our Great Masters

Series sells so poorly, it will be hard to sell such a project to the

accountant.)

 

That being said, I also acknowledge that my teaching of yin fire

theory is my own reading, understanding, and use of Li's work. Whether

or not Li would agree with me on every point is impossible to say

(regardless of the fact that Dr. Gong, director of the American

Academy of Acupuncture & Oriental Medicine of Minneapolis recently

introduced me as the modern incarnation of Li Dong-yuan). My teaching

of yin fire theory is based on several sources: 1) what Li says

himself, primarily in the Pi Wei Lun, 2) on primarily contemporary

Chinese commentaries and articles on Li, his formulas, and his

theories, 3) on discussions with other Chinese doctors, both Chinese

and Western, in the U.S., Europe, and China; 4) on an analysis of Li's

formulas as found in the Pi Wei Lun, Lan Shi Mi Cang, Nei Wai Shang

Bian Hou Lun, Huo Fa Ji Yao, Yi Xue Fa Ming, and Dong Yuan Shi Xiao

Fang, 5) my own clinical experience, and 6) in the last 18-24 months,

the clinical experience of a growing body of practitioners using

Li-Zhu formulas manufactured and marketed by Blue Poppy Herbs and

prescribed on the basis of yin fire theory.

 

As has already been pointed out, yin fire theory is not a part of

standard undergraduate Chinese medicine as taught in the PRC. If it

gets mentioned at all, it is in passing in a class on Chinese medical

history, and it is my experience that many contemporary Chinese

lecturers and writers on Chinese medical history have never personally

read the Pi Wei Lun. It is important to remember that, during the

Cultural Revolution, all the schools, including Chinese medical

schools were closed, based on the slogan, " Better Red than expert. "

That means a whole generation of Chinese doctors (what is known as the

" Lost Generation " in China and the Baby Boomers in the U.S.) is not,

as a group, all that well educated. (Of course, there are many

individual exceptions to the preceding statement.) Many of this

generation were taught during their most intelectually formative years

that everything ancient was feudal superstition. This included five

phase theory, and the work of the neo-Confucianist Jin-Yuan doctors,

such as Li and Zhu, was very much based on five phase theory.

Therefore, in the relatively recent political past, it was not PC in

the PRC to be too interested in Li-Zhu medicine. Thus, I routinely

meet Chinese doctors from the PRC who are not well educated or

informed about this topic. Simply being ethnically Chinese does not

make one an expert on Chinese medicine. Erudition and experience do.

 

In any case, yin fire theory is the sort of advanced Chinese medical

theory some practitioners discover and gravitate to in their personal

postgraduate studies. However, although this theory is not standardly

taught to all undergraduate Chinese medical students, it is hardly

" fringe. " As has already been pointed out, a number of famous

premodern and contemporary Chinese doctors have been heavily

influenced by yin fire theory. In terms of contemporary Chinese

doctors, Z'ev has mentioned Sun Bin-yan, the famous TCM oncologist. A

few representative others include Liu Feng-wu (see Blue Poppy's The

Essence of Liu Feng-wu's Gynecology), the famous contemporary

gynecologist; Wang Le-ting (see Blue Poppy's Golden Needle Wang

Le-ting), the famous professor of acupuncture in Beijing who died in

the mid-80s; the great John Shen of NYC, recently deceased; and Miriam

Lee (see Blue Poppy's Insights of a Senior Acupuncturist), the famous,

now retired acupuncturist of Palo Alto. To me, the number of adherents

to a theory or practice is less important than the quality of the

minds of those adherents. Given my high regard for Drs. Sun, Liu,

Wang, Shen, and Lee, I feel I'm in pretty good company.

 

Nevertheless, as has also already been pointed out, " The proof is in

the pudding. " The issue is whether or not yin fire theory is useful in

contemporary clinical practice. Personally, I find it very useful in a

large proportion of my patients. In part, this is because of the

statistical composition of my practice. As a gynecologist, all my

patients are female. In addition, 90% are 35-55 years old, and most

are seeking treatment for chronic, enduring conditions. However, I

think it is also useful to point out that 70% of patients of American

acupuncturists (based on insurance company statistics) are female,

between 35-55 years old, are ofice workers, and suffer from a chronic

(as opposed to an acute) condition. Therefore, it is not surprising to

me that a growing number of Western practitioners are joining me in

recognizing the clinical utility of this theory and its real-life,

practical implications.

 

My touting of yin fire theory is similar to Heiner Fruehauf's touting

of gu worm theory. Both are advanced, lesser known theories of Chinese

medicine but with unassailable historical pedigrees. Both theories are

very useful in a certain percentage of cases. They bring a fresh

perspective and help clarify confusion in certain situations. Other

practitioners like other theories. Craig Mitchell seems to like the

Shang Han Lun/Jin Gui Yao Lue. Chip Chase currently seems to be

enamored of Wen Bing theory when it comes to acute respiratory

conditions. However, no theory is universally applicable. In the Ming

dynasty, Li Zhong-zi wrote that one should not blindly adhere to a

single theory. One should use a theory where it is applicable and be

willing to use some other theory in another situation. This

flexibility later became the standard in Qing dynasty medicine and is,

in fact, a foundation of modern, or should I say postmodern, Chinese

medicine.

 

If the truth of a theory is how many articles are published on that

theory in Chinese medical journals per month, then yin fire theory

certainly falls short. I would estimate that I typically see six

articles per year on A) yin fire, 2) Li-Zhu medicine, or 3) one of Li

Dong-yuan's formulas where yin fire is specifically mentioned, in the

eight Chinese language journals to which I . Since each of

these journals publishes 40 articles per issue, 12 issues per year,

this means that yin fire is not that popular a topic (six articles out

of approximately 3840). However, the number of articles on a subject

is far less important to me than the intelligence, clarity, and

utility of a particular article.

 

In closing, let me say that I would be delighted if more people were

translating the Chinese medical literature. I agree that there is

something not quite right that virtually all articles on yin fire in

English come from a single source. However, since I am so interested

in yin fire, I'm the one who has spent the time looking for and

translating articles on it. Each author (and translator) writes from

their own point of view. There cannot be any other way. If others out

there suspect that I am somehow manipulating this literature to my own

ends, then they need to stop kvetching and step up to the plate with

their own translations.

 

Oh yes, one more thing. If some people think that yin fire is the

refuge of those who cannot pattern discriminate, I am willing to

travel (on your nickel) AT ANT TIME TO ANT PLACE to demonstrate my

diagnostic skill and compare that with ANY Chinese medical

practitioner IN THE WORLD. I am one of the only nationally and

internationally recognized teachers of Chinese medicine who routinely

demonstrates their diagnostic skill in public with random, previously

unscreened patients.

 

Bob Flaws

[Guest guest]

I totally disagree. the formulas can be used to address patterns in combination or as a function of the individual herbs. this is why gui zhi tang has been modified slightly to address far more than the original taiyang syndrome, including heart disease and digestive complaints. Same for xiao chai hu tang.>>>>Yes but even then you usually use the formula as a base that is not spicy warm to relieve surface, open collaterals, vitalize blood, tonify blood, harmonize spleen, replenish stomach, clear pathogenic heat and toxin, sooth and balance the liver. The formula is appropriate for many condition with modification if the pulse and abdomen are in within the gui zhi tang confirmation. Not for any of the above conditions

Alon

 

-

 

Wednesday, July 18, 2001 10:38 AM

Re: yin fire & dx.

, "Alon Marcus" <alonmarcus@w...> wrote: sometimes it the combination of the herbs that you must look at like bai shao and gui zhi in gui zhi tang. You cant just say you see here is a spicy herbs and a blood tonic so we have two treatment principleI totally disagree. the formulas can be used to address patterns in combination or as a function of the individual herbs. this is why gui zhi tang has been modified slightly to address far more than the original taiyang syndrome, including heart disease and digestive complaints. Same for xiao chai hu tang.Todd 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]

Just having some ingredients that have apposite effects (which can be done for example to handle side-effects) is not the same as treating 5 organ systems and several pathologies in one formula routinely

Alon

 

-

 

Wednesday, July 18, 2001 11:25 AM

Re: Re: yin fire & dx.

On Wednesday, July 18, 2001, at 09:55 AM, Alon Marcus wrote:

I am not sure I understand what you mean. Are you saying that Yin huotheory is just a mix of patterns used as default if one is not skilledenough for the case? If so, please explain>>>>>My SH teachers used to say that if one grasps the main principle (formula) than no additions to the classical formula is needed and they often used small formulas and made fun of practitioners using large, multiple pricple formulas. However the so called grasping the main disease principal is easier said than done. Having major TCM thinkers (Li Dong) using a system that often use so many complex and conflicting herbs such as cold and hot, drying and moistening etc makes it easyer to write such formulas (ie makes it more expectable).But again, some of my teachers especially the SH said that most of the time if one treats the patient true condition than all the so called other manifestations such as Yin fire (or Yang within Yin) would take care of themselvesAlonAlon,I have tremendous respect and interest in SHL diagnosis and prescriptions, and use both widely in my practice. However, several SHL prescriptions, especially at the deeper stages such as jue yin bing, use hot and cold, supplementing and draining ingredients such as in wu mei wan/fructus mume pill, which contains both huang lian and fu zi. They are truly elegant prescriptions, but there is more than meets the eye here. Also, remember that Li Dong-yuan borrowed heavily from the SHL, and used many of the same principles. This includes 1) using sweet warm ingredients to expel evil heat 2) supplementing the spleen and stomach to strengthen wei qi/defensive qi and ying qi/construction qi 3) using ingredients with opposing qualities to harmonize (he fa), especially in shao yang bing, as in xiao chai hu tang/minor bupleurum decoction.In my opinion, Li/Zhu medicine is a further development of SHL medicine.

[Guest guest]

on 7/18/01 1:55 PM, at zrosenbe wrote:

 

>

> On Wednesday, July 18, 2001, at 04:21 AM, Cara Frank wrote:

>

>>

>>

>>>

>>> I think it takes incredible skill to prioritize the patterns and

>>> appropriately balance the formula to address the myriad patterns.

>>

>>>

>>>

>>

>> before you get completely lost in the muck, always remember to

>> prioritize

>> the chief complaint!!

>> Cara

>>

>>

>>

> Cara, what if the chief complaint is 'fibromyalgia'? Or 'lupus'?

>

> In chronic disease, chief complaints are almost always constellations of

> symptoms. Even if, for example, abdominal cramping during menstruation

> is a major complaint, it cannot be separated out from the rest of the

> pattern in terms of diagnosis and treatment in a chronic disorder, such

> as fatigue, poor appetite, bloating, disturbed sleep from heat vexation,

> low libido, and cold extremities.

>

> For acute diseases, it is a different story. An acute wind/heat attack

> is priority in treatment. Even here, however, one has to consider the

> constitution of the patient (yin xu or yang xu) in treatment.

>

> I like to paraphrase Mao Zi-dong on this: " when I hear the term chief

> complaint, I reach for my gun " .

>

>

>

Jeez, Ze'v,

 

I mean: don't' forget, when the cc is fibromyalgia to use herbs that

affect the channels. And then be specific about those channels. if I say

there's blood stasis and the shoulders are mostly affected, then I'll choose

jiang huang. if it's the lower body, I'll make another selection. I teach

my students that it's OK not to treat everything in the first pass if they

are overwhelmed. Sophisticated dx takes time. finess comes w/ experience.

furthermore: I really try to SLOW DOWN the process of dx for students. if

there's fibromyalgia, what do we know for sure? we know there is pain/bi

syndrome. then we can differentiate that pain because we know how: achey,

sharp, fixed, better w/ heat, movement, etc. we discriminate. THAT's where

to start. and I think it's OK, if there's confusion, to keep it smaller and

more focused for a week or two and then watch what sx resolve easily and

which are more more recalcitrant. ONLY when there's a greater degree of

comfort ( which comes from experience) can a newer practitoiner branch out.

Of course, if they've had a superior teacher like you, then they will be

brilliant and and navigate the myriad of complicated terrain's with ease.

And what the heck is wrong with a CC anyway? People come w/ stuff. we fix

it.

My position is that it's OK to treat symptoms. Symptoms are part of a

pattern. I can balance that pattern(s). OK?

 

Cara

[Guest guest]

On Wednesday, July 18, 2001, at 04:33 PM, Alon Marcus wrote:

 

> Just having some ingredients that have apposite effects (which can be

> done for example to handle side-effects) is not the same as treating 5

> organ systems and several pathologies in one formula routinely

> Alon

>

Ah,

But if you look at wu mei wan this is not the case at all. This

prescription was designed for a pattern of cold in the lower burner,

heat in the upper burner, spleen qi vacuity, and liver qi depression.

The ingredients are designed not for 'side effects', but to warm the

yang (fu zi), clear fire from the upper burner (huang lian), strengthen

the middle burner (ren shen), dispel chong (wu mei). As the commentary

in the Mitchell/Wiseman/Feng translation of the SHL states (pg. 530),

" this formula should not only be considered a formula for roundworm

reversal, but should be considered the primary formula for treating

reverting yin cold-heat complex patterns.

 

 

[Guest guest]

There's a very nice article in the Zhe Jiang Zhong Yi Za Zhi (Zhejiang

Journal of ), #5, 2001, p. 215-216, written by Chen

Ya-hua substantiating what Z'ev is saying about Wu Mei Wan (Mume

Pills). The title of the article is, " Raising the Borders of the Use

of Wu Mei Wan. " There are four case histories exemplifying the broad

range of application of this Rx: 1) post spinal surgery blood flukes,

2) postsurgical adhesive bowel obstruction, 3) Meniere's syndrome,

and 4) neurovascular headache. Each of these case displayed a pattern

of " jue yin heat above and cold below. "

 

, " " <zrosenbe@s...>

wrote:

>

> On Wednesday, July 18, 2001, at 04:33 PM, Alon Marcus wrote:

>

> > Just having some ingredients that have apposite effects (which can

be

> > done for example to handle side-effects) is not the same as

treating 5

> > organ systems and several pathologies in one formula routinely

> > Alon

> >

> Ah,

> But if you look at wu mei wan this is not the case at all. This

> prescription was designed for a pattern of cold in the lower burner,

> heat in the upper burner, spleen qi vacuity, and liver qi

depression.

> The ingredients are designed not for 'side effects', but to warm the

> yang (fu zi), clear fire from the upper burner (huang lian),

strengthen

> the middle burner (ren shen), dispel chong (wu mei). As the

commentary

> in the Mitchell/Wiseman/Feng translation of the SHL states (pg.

530),

> " this formula should not only be considered a formula for roundworm

> reversal, but should be considered the primary formula for treating

> reverting yin cold-heat complex patterns.

>

>

[Guest guest]

 

 

Wednesday, July 18, 2001 12:24 AM

 

Re: yin fire & dx.

 

 

I have been analyzing the prescriptions of 3 chinese docs at PCOM all

day and also querying students about docs who I am less familiar with.

I revise my earlier statement. Every chinese doc at PCOM writes

formulas that address 4-5 tx principles per case. regardless of

diagnosis, which indeed is often just two patterns, this multiple

pattern prescribing holds true in 100% of about 50 random files I have

checked. So again, to prove me wrong, show me chronic cases where this

is not the case.

 

todd

 

 

 

I did check this hypothesis... and at least 1 Chinese doc (you are referring

to) said this:

Even in the most chronic difficult cases I always pick 1-2 patterns max. (I

try to find the one place in the chain to break the ring that will help) -

Q: Do most Chinese think this way? Answer : yes.

She said: why do you want to treat multiple patterns , I said because

Americans are more complex.. She disagrees and says if a country is bigger

does one need 4 kings.. Although this was funny, her stance is clear.

She previously (to my questioning) ironically lectured class 20 min on this

exact topic. She said if there is only 1 thing that I want you to get out of

this class is that in difficult complex cases I want you to be able to weed

through the muck and pick the 1 pattern that needs to be picked. She said

most complex people will have signs of almost every organ, and students all

the time are trying to treat them all at once, with acupuncture this might

be possible, but not with herbs. Etc etc... And the above is no

exaggeration.

So my hypothesis, at least so far, about the thinking behind seemingly

complex formulas is that they truthfully reflect the diagnosis written and

are not the meaning to address 4 5 patterns. They make use of a sovereign

ingredient (as she says) with supporting herbs.. etc.. What does this mean?

This can be a few things about the principles constructing a formula, which

I will have to contemplate for the moment...

So I am unsure of your approach in analyzing of the formulas, saying that

100% of chronic cases are being treated 4-5 patterns. They say otherwise...

So... there are definitely two approaches here -- I currently believe the

mainstream Chinese approach is one of addressing 1-2 patterns only. I do

not believe either is more or less successful. This teacher and her

colleagues are getting results with complex cases using the 1-2 pattern

method. I do believe it is easier to make errors taking a multiple pattern

approach -- harder for students. I do believe there is less written on this

latter approach. I personally am more interested in this latter approach,

at the current time, and would appreciate some case studies submitted.

 

--

[Guest guest]

, " " <@o...> wrote:

 

>

>

>

> I did check this hypothesis... and at least 1 Chinese doc (you are referring

> to) said this:

> Even in the most chronic difficult cases I always pick 1-2 patterns max. (I

> try to find the one place in the chain to break the ring that will help) -

 

jason

 

I guess all I have left to ask on this matter is whether you think it

is more linear and reductionistic to find the single causative factor

for a disease or identify the complex web of interactions. I would

venture that the view of those trained during the cultural revolution

(CR) is very westernized and reductionistic and ignores complex

interactions that are based on " feudal " ideas like the five phases. I

think their formulas still reflect these complexities because the

empirical practice has remained largely unchanged even as the overt

rationales have changed in a new political era. so doctors use the

prescription structures passed on by their teachers and theory has

often seemed almost an afterthought for many chinese docs I have worked

with. to paraphrase Bob, while yin fire theory may not be the practice

of the masses, it was most certainly the practice of the elite scholar

physicians whom I seek to emulate. there was also a strong trend

against intellectual elitism and sophistication during the CR. this

has really colored people's biases. You will have to decide for

yourself after years in solo practice what works best for you. For

now, look around and see where the best results in chronic disease seem

to be coming from. I know how my patients do. I have no idea how

successful others are.

 

todd

[Guest guest]

But if you look at wu mei wan this is not the case at all. This prescription was designed for a pattern of cold in the lower burner, heat in the upper burner, spleen qi vacuity, and liver qi depression. The ingredients are designed not for 'side effects', but to warm the yang (fu zi), clear fire from the upper burner (huang lian), strengthen the middle burner (ren shen), dispel chong (wu mei).

>>>>>>There are many formulas that have been designed for complex issues such as ban xia xie sum tang etc. But these are specific situation and specific formulas. I think the discussion is theoretical. Following rules is about elegance of the art. Real life may be different, and if people are getting better results with the so called yin fire approach I do not have any problems and think it is quite important discussion. All I am doing here is repeating some of what I heard in China. Dr Lai in ACTCM on the other hand always uses complex large multi principles formulas and has a very good reputation.

Alon

 

-

 

Wednesday, July 18, 2001 9:30 PM

Re: Re: yin fire & dx.

On Wednesday, July 18, 2001, at 04:33 PM, Alon Marcus wrote:

Just having some ingredients that have apposite effects (which can be done for example to handle side-effects) is not the same as treating 5 organ systems and several pathologies in one formula routinelyAlonAh,But if you look at wu mei wan this is not the case at all. This prescription was designed for a pattern of cold in the lower burner, heat in the upper burner, spleen qi vacuity, and liver qi depression. The ingredients are designed not for 'side effects', but to warm the yang (fu zi), clear fire from the upper burner (huang lian), strengthen the middle burner (ren shen), dispel chong (wu mei). As the commentary in the Mitchell/Wiseman/Feng translation of the SHL states (pg. 530), "this formula should not only be considered a formula for roundworm reversal, but should be considered the primary formula for treating reverting yin cold-heat complex patterns.

[Guest guest]

get out ofthis class is that in difficult complex cases I want you to be able to weedthrough the muck and pick the 1 pattern that needs to be picked.

>>>>>That is what I was told time and time again, even by Dr Lai and he uses large formulas with multiple function herbs. I think much of the problem here is in how people analyze the formulas not taking classical herb combination into account.

Alon

 

-

 

Thursday, July 19, 2001 8:52 AM

RE: Re: yin fire & dx.

Wednesday, July 18, 2001 12:24 AM Subject: Re: yin fire & dx.I have been analyzing the prescriptions of 3 chinese docs at PCOM allday and also querying students about docs who I am less familiar with.I revise my earlier statement. Every chinese doc at PCOM writesformulas that address 4-5 tx principles per case. regardless ofdiagnosis, which indeed is often just two patterns, this multiplepattern prescribing holds true in 100% of about 50 random files I havechecked. So again, to prove me wrong, show me chronic cases where thisis not the case.toddI did check this hypothesis... and at least 1 Chinese doc (you are referringto) said this:Even in the most chronic difficult cases I always pick 1-2 patterns max. (Itry to find the one place in the chain to break the ring that will help) -Q: Do most Chinese think this way? Answer : yes.She said: why do you want to treat multiple patterns , I said becauseAmericans are more complex.. She disagrees and says if a country is biggerdoes one need 4 kings.. Although this was funny, her stance is clear.She previously (to my questioning) ironically lectured class 20 min on thisexact topic. She said if there is only 1 thing that I want you to get out ofthis class is that in difficult complex cases I want you to be able to weedthrough the muck and pick the 1 pattern that needs to be picked. She saidmost complex people will have signs of almost every organ, and students allthe time are trying to treat them all at once, with acupuncture this mightbe possible, but not with herbs. Etc etc... And the above is noexaggeration.So my hypothesis, at least so far, about the thinking behind seeminglycomplex formulas is that they truthfully reflect the diagnosis written andare not the meaning to address 4 5 patterns. They make use of a sovereigningredient (as she says) with supporting herbs.. etc.. What does this mean?This can be a few things about the principles constructing a formula, whichI will have to contemplate for the moment...So I am unsure of your approach in analyzing of the formulas, saying that100% of chronic cases are being treated 4-5 patterns. They say otherwise...So... there are definitely two approaches here -- I currently believe themainstream Chinese approach is one of addressing 1-2 patterns only. I donot believe either is more or less successful. This teacher and hercolleagues are getting results with complex cases using the 1-2 patternmethod. I do believe it is easier to make errors taking a multiple patternapproach -- harder for students. I do believe there is less written on thislatter approach. I personally am more interested in this latter approach,at the current time, and would appreciate some case studies submitted.-- 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]

On Thursday, July 19, 2001, at 08:52 AM, wrote:

 

>

I did check this hypothesis... and at least 1 Chinese doc (you are

> referring

> to) said this:

> Even in the most chronic difficult cases I always pick 1-2 patterns

> max. (I

> try to find the one place in the chain to break the ring that will

> help) -

>

 

> She said: why do you want to treat multiple patterns , I said because

> Americans are more complex.. She disagrees and says if a country is

> bigger

> does one need 4 kings.. Although this was funny, her stance is clear.

> She previously (to my questioning) ironically lectured class 20 min on

> this

> exact topic. She said if there is only 1 thing that I want you to get

> out of

> this class is that in difficult complex cases I want you to be able to

> weed

> through the muck and pick the 1 pattern that needs to be picked.

 

This will be impossible if there is heat above, cold below, damp heat in

the lower burner, etc. If you do this, you will leave out a large part

of the case, and end up exacerbating the condition.

 

 

>   She said

> most complex people will have signs of almost every organ, and students

> all

> the time are trying to treat them all at once, with acupuncture this

> might

> be possible, but not with herbs. Etc etc... And the above is no

> exaggeration.

 

There is a difference between symptoms/signs and patterns. She is

describing students who are trying to treat every symptom, a point or

herb for this, a point or herb for that. I agree with her on this. A

symptom or sign is not a pattern. A pattern is a constellation of

symptoms/signs.

 

>

 

[Guest guest]

I'd like to present a real-life case history as an example of how I

suggest yin fire theory might be used.

 

The patient was a 43 year old female whose major complaint was early

menstruation. In addition, she suffered from facial acne, especially

around the corners of her mouth and on her chin, and restless sleep at

night. These zits were primarily red papules. The patient had a medium

(shao yang) build. Her menses were coming every 22-24 days for the

last year. Previously, her menses had always tended to be late, coming

every 31-35 days. Also, before her menses started coming early, she

had bad PMT and premenstrual breast distention and pain. However,

since her menses had been coming early, she no longer had much PMT or

breast distention and pain. Likewise, previously she had often (but

not always) had pretty severe dysmenorrhea. Now she did not. When her

menses came, they were darkish red in color and did contain clots. BBT

charting showed a clear luteal phase defect.

 

In addition, the patient was anxious, worried and thought a lot,

tended to cry easily and for little reason, had occasional heart

palpitations which were worse when she was tired, and she was often

fatigued. She craved sweets, but got " sugar blues " after eating them.

Her bowel movements were often hard and not every day. However, when

she became nervous, her stools became loose. In the last year, the

woman had noticed that her low back was often sore and her libido was

definitely decreased. She got up nightly to pee 1-2 times, and her

feet were cold enough at night that she often wore socks to bed.

Further, she sometimes experienced orthostatic hypotension and her

husband made fun of her because her nose was always cold. The

patient's facial complexion was somewhat sallow and wan, her nails

were pale and brittle, and she complained of difficulty seeing at

night. She had spider nevi on her thighs and often found black and

blue spots on her thighs at night for no rememberable reason. The

patient's tongue was darkish over-all and red on its tip and edges,

enlarged with teethmarks on its edges, and had thin, white fur. Her

pulse was surging in both inch positions, was soggy in the right bar,

bowstring and fine in the left bar and cubit, and deep, fine, and

forceless in the right cubit. It was neither fast nor slow in speed.

 

Based on these signs and symptoms, we know the patient had a basic

liver-spleen disharmony. Spleen vacuity is evidenced by the fatigue,

orthostatic hypotension, craving for sweets, easy bruising, etc. Liver

depression is evidenced by the bowstring pulse, the history of PMS,

delayed menstruation, and dysmenorrhea, the dark tongue, and the

tendency to irregular bowel movements. That the liver is invading the

spleen, at least on occasion, is evidenced by the constipation

transforming into diarrhea when under stress or when nervous. As the

symptoms of vacuity increased with age, the symptoms of repletion,

such as qi stagnation and blood stasis, had gotten less prominent, but

that does not mean those disease mechanisms had disappeared.

 

However, we also know that there was some sort of heat evils causing

the zits (red papules) as well as the surging pulse in the inch

positions and red tip and sides of the tongue. Since there are no

particular signs or symptoms of damp heat, vacuity heat, or phlegm

heat, that leaves depressive heat as the mostly likely source of these

heat evils. This was confirmed by an occassional bitter taste in the

patient's mouth when she woke in the morning and eventually confessing

to fairly pronounced irritability. These heat evils were transforming

from liver depression, from whence they floated up to accumulate in

the stomach, heart, and lungs. In the lungs and stomach, they caused

acne on the skin located along the route of the yang ming. The heat

evils in the lungs were also, in part, responsible for the emotional

lability and easy crying. In the heart, they caused restlessness and

anxiety.

 

Unfortunately for the patient, we also know that spleen disease had

eventually reached the kidneys, resulting in spleen-kidney dual

vacuity. This is evidenced by the low back pain, decreased libido,

nocturia, and cold feet. To make matters even worse, the spider nevi,

clots in the menstruate, and the history of dysmenorrhea indicate

blood stasis, while the sallow complexion, brittle fingernails, and

nightblindness indicate blood vacuity. Because the qi and blood were

too vacuous and weak to construct and nourish the heart spirit, the

spirit was disquieted by both depressive heat counterflowing upward

and malnourishment and nonconstruction.

 

The reason the pulse was not rapid is that the spleen vacuity leading

to heart vacuity tempered the effects of the heat on the pulse. Vice

versa, the reason the pulse was not slow is that the depressive heat

counteracted the vacuity cold in the pulse signs. Nevertheless, the

surging pulse in the inch positions is, according to Li Dong-yuan, a

prime indication of yin fire (when corroborated with other signs and

symptoms).

 

Therefore, it is easy to see that this patient suffered from the

following several patterns: 1) liver depression, 2) heart-spleen

vacuity (including qi AND blood vacuity), 3) kidney yang vacuity, 4)

depressive heat in the liver, stomach, lungs, and heart, and 5) blood

stasis. While some may suggest that one should simply treat the most

prominent of these patterns or disease mechanisms, since they are

xiang sheng, " mutually engendering, " in real life, that is simply not

possible. There's no way to treat liver depression in this case (for

instance by simply rectifying the qi) without nourishing the blood to

emolliate the liver, warming the kidneys to warm and steam the liver,

and clear the lungs. This is because blood vacuity, heat in the lungs,

and kidney yang vacuity may all cause or aggravate liver depression qi

stagnation. In this case, one also cannot supplement the blood without

simultaneously quickening the blood and transforming stasis, since

static blood impedes the engenderment of new or fresh blood. Vice

versa, blood vacuity leads to blood stasis. But then, so does qi

stagnation, enduring heat stewing the blood, AND vacuity cold

congealing and constricting. Similarly, in this case, one must address

both the spleen and kidneys simultaneously, since the former and

latter heavens are mutually supporting and bolstering. Further, one

cannot clear heat from the lungs and stomach without dealing with the

root of that heat, the liver depression. However, the web is even more

tangled than that since it is spleen vacuity which, according to Li

Dong-yuan, allows ministerial fire (in the liver-gallbladder) to

become hyperactive and then counterflow upward.

 

Therefore, in this case, one MUST course the liver and rectify the qi,

resolve depression and clear heat (from the liver, stomach, lungs, and

heart), fortify the spleen and nourish the heart, supplement the

kidneys and invigorate yang, and quicken the blood and transform

stasis. Unless one addresses all these interlocked, interpromoting

disease mechanisms simultaneously, there is simply no way to eliminate

any individual one of them. However, to do address all these disease

mechanisms simultaneously, one does not necessarily need a huge number

of medicinals: Chai Hu, Huang Qin, Huang Qi, Ren Shen, Ban Xia, Fu

Ling, Chen Pi, Zhi Gan Cao, Da Zao, Dang Gui, Bai Shao, Gui Zhi, Tao

Ren, and Hong Hua are a relatively simple formula which accomplishes

all the above treatment principles. By adding one or two more

ingredients, we could then boost the effect of any one of the above

principles. For instance, to treat kidney yang vacuity, we might add

Xian Ling Pi and Xian Mao (in which case we might remove the Gui Zhi).

To increase the effect of quickening the blood, we might add Yi Mu

Cao. To clear heat more, we might add Huang Lian. Etc., etc. As Z'ev

noted the other day, this is nothing other than the continuation of

the principles of prescription embodied in the formulas recorded by

Zhang Zhong-jing in the Shang Han Lun/Jin Gui Yao Lue. This is

definitely not an " everything but the kitchen sink " approach. It is

also far from fringe. In addition, this patient's constellation of

mutually engendering patterns is a very common one in my patient

population.

 

Bob Flaws

 

 

, " " <zrosenbe@s...>

wrote:

>

> On Thursday, July 19, 2001, at 08:52 AM, wrote:

>

> >

> >

> >

> >

> >

> >

> >

> > I did check this hypothesis... and at least 1 Chinese doc (you are

> > referring

> > to) said this:

> > Even in the most chronic difficult cases I always pick 1-2

patterns

> > max. (I

> > try to find the one place in the chain to break the ring that will

> > help) -

> >

>

> > She said: why do you want to treat multiple patterns , I said

because

> > Americans are more complex.. She disagrees and says if a country

is

> > bigger

> > does one need 4 kings.. Although this was funny, her stance is

clear.

> > She previously (to my questioning) ironically lectured class 20

min on

> > this

> > exact topic. She said if there is only 1 thing that I want you to

get

> > out of

> > this class is that in difficult complex cases I want you to be

able to

> > weed

> > through the muck and pick the 1 pattern that needs to be picked.

>

> This will be impossible if there is heat above, cold below, damp

heat in

> the lower burner, etc. If you do this, you will leave out a large

part

> of the case, and end up exacerbating the condition.

>

>

> >   She said

> > most complex people will have signs of almost every organ, and

students

> > all

> > the time are trying to treat them all at once, with acupuncture

this

> > might

> > be possible, but not with herbs. Etc etc... And the above is no

> > exaggeration.

>

> There is a difference between symptoms/signs and patterns. She is

> describing students who are trying to treat every symptom, a point

or

> herb for this, a point or herb for that. I agree with her on this.

A

> symptom or sign is not a pattern. A pattern is a constellation of

> symptoms/signs.

>

> >

>

[Guest guest]

 

-----Original

Message-----

 

[zrosenbe]

Thursday, July 19, 2001

11:03 AM

To:

 

Re:

Re: yin fire & dx.

 

 

 

 

 

I did check this hypothesis... and at least 1 Chinese doc (you are

referring

to) said this:

Even in the most chronic difficult cases I always pick 1-2 patterns max. (I

try to find the one place in the chain to break the ring that will help) -

 

 

 

She said: why do you want to treat multiple patterns , I said

because

Americans are more complex.. She disagrees and says if a country is bigger

does one need 4 kings.. Although this was funny, her stance is clear.

She previously (to my questioning) ironically lectured class 20 min on this

exact topic. She said if there is only 1 thing that I want you to get out of

this class is that in difficult complex cases I want you to be able to weed

through the muck and pick the 1 pattern that needs to be picked.

 

This will be impossible if there is heat above, cold below, damp heat in

the lower burner, etc. If you do this, you will leave out a large part of the

case, and end up exacerbating the condition.

 

 

 

She said

most complex people will have signs of almost every organ, and students all

the time are trying to treat them all at once, with acupuncture this might

be possible, but not with herbs. Etc etc... And the above is no

exaggeration.

 

There is a difference between symptoms/signs and patterns. She is

describing students who are trying to treat every symptom, a point or herb for

this, a point or herb for that. I agree with her on this. A symptom or sign is

not a pattern. A pattern is a constellation of symptoms/signs.

 

 

 

(Jason) – No, She is specifically saying patterns not symptoms,

she was very clear about that.

She will only treat 1 or 2 patterns max at a time.

 

-

 

 

 

 

 

[Guest guest]

Signs of every organ are not patterns. And, no, most students don't

know how to treat complex patterns, and become confused. Then diagnosis

and treatment become chaotic, and they are all over the map. Complex

patterns are interrelated to each other and mutally engendering. For

this, there has to be knowledge of five phase theory at the least.

Without it, more than one or two patterns make no sense.

 

For me, this approach you describe from your teachers seems very myopic

and limited. But if it works for you, go for it.

 

It seems to me, Jason, that you have generated an excellent response to

your questions, and should have all the information you need between

Bob, Todd and myself. It is now up for you to decide what is correct

for your work.

 

 

On Thursday, July 19, 2001, at 03:21 PM, wrote:

 

>   She said

> most complex people will have signs of almost every organ, and students

> all

> the time are trying to treat them all at once, with acupuncture this

> might

> be possible, but not with herbs. Etc etc... And the above is no

> exaggeration.

>

>

> There is a difference between symptoms/signs and patterns. She is

> describing students who are trying to treat every symptom, a point or

> herb for this, a point or herb for that. I agree with her on this. A

> symptom or sign is not a pattern. A pattern is a constellation of

> symptoms/signs.

>

>  

>

> (Jason) – No, She is specifically saying patterns not symptoms, she was

> very clear about that.

>

> She will only treat 1 or 2 patterns max at a time.

>

>  

>

> -

[Guest guest]

This will be impossible if there is heat above, cold below, damp heat in the lower burner, etc. If you do this, you will leave out a large part of the case, and end up exacerbating the condition

 

>>>>>I think we are missing something here. The question here is for example, is the heat above due to stagnation because of cold below, is cold below is because of obstruction above do systems have a connecting thread or are we using a symptomatic approach. I do not see any difference between western medicine and the approach of saying well there is heat above so lets give antibiotic and cold below so we will give some kind of lets say thyroid hormone, and shen disturbance so lets use an antidepressant etc. If we are saying that TCM is formulations are holistic then the idea is to find the key (when possible)

Why is any different?

 

-

 

Thursday, July 19, 2001 11:03 AM

Re: Re: yin fire & dx.

On Thursday, July 19, 2001, at 08:52 AM, wrote:

I did check this hypothesis... and at least 1 Chinese doc (you are referringto) said this:Even in the most chronic difficult cases I always pick 1-2 patterns max. (Itry to find the one place in the chain to break the ring that will help) -

She said: why do you want to treat multiple patterns , I said becauseAmericans are more complex.. She disagrees and says if a country is biggerdoes one need 4 kings.. Although this was funny, her stance is clear.She previously (to my questioning) ironically lectured class 20 min on thisexact topic. She said if there is only 1 thing that I want you to get out ofthis class is that in difficult complex cases I want you to be able to weedthrough the muck and pick the 1 pattern that needs to be picked.This will be impossible if there is heat above, cold below, damp heat in the lower burner, etc. If you do this, you will leave out a large part of the case, and end up exacerbating the condition.

She saidmost complex people will have signs of almost every organ, and students allthe time are trying to treat them all at once, with acupuncture this mightbe possible, but not with herbs. Etc etc... And the above is noexaggeration.There is a difference between symptoms/signs and patterns. She is describing students who are trying to treat every symptom, a point or herb for this, a point or herb for that. I agree with her on this. A symptom or sign is not a pattern. A pattern is a constellation of symptoms/signs.

 

[Guest guest]

Since there are no particular signs or symptoms of damp heat, vacuity heat, or phlegm heat, that leaves depressive heat as the mostly likely source of these heat evils.

>>>>Why not? the soggy surging pulse and red tip could indicate damp-heat from spleen def and explain fatigue, craving sweets, swollen breasts, early menses, irregular bowel movements, diarrhea, bitter taste, acne, and even possibly cold feet.

My point here is that symptom can be interpreted in various ways depending on the CM theory one follows. The signs suppose to organize the symptoms into a comprehensive complex. The question is does one need to use a formula such as Bob suggest or another from a different perspective and which get a better result.

 

Would treating the spleen be sufficient to mobilize the blood and clear stasis, could it be enough to result any liver symptoms as liver symptoms can easily arise from weak spleen etc.

 

I would like to here from followers Li dang and have them share cases.

Alon

 

 

[Guest guest]

 

-----Original

Message-----

 

[zrosenbe]

Thursday, July 19, 2001 3:34

PM

To:

 

Re:

Re: yin fire & dx.

 

 

For me, this approach you describe from your teachers seems very myopic and

limited. But if it works for you, go for it.

 

 

Myopic and limited as you may say.. This is Chinese

Medicine as I know/ see it, is taught in the western world (majority), and in

China.  Every book I own takes this

approach except possibly the pi wei lun (and there are a multiple

interpretations of this book, as even Bob admits) to name a few books that deal

with a 1-2 pattern style of writing:

Bensky.’s herb books, Acupuncture Patterns and

Practice- Case Studies I & II, Handbook of Internal Medicine, Maciocia’s

books, all my translated books from china, Steven Clavey’s Fluid Physiology

& Pathology in TCM, Practical Therapeutics in TCM (yan wu) not to mention

everything I have read from C.S. Cheug – including his case studies, I could go

on & on…. 

So as reductionist or

linear (Todd) or myopic and limited (Z’ev) as it seems, I have not much

evidence that things should be any other way, or are taught any other way ..

except for a small minority people.  And

I must be in good company because I am currently in the boat with all of the

above authors and all Chinese prof.’s I have worked with. And to answer Todd’s

question

“whether you think it is more linear and

reductionistic to find the single causative factor

for a disease or identify the complex web of interactions.”

I do not think a key single patterned diagnosis is equivalent to a

single causative factor.  The complex

web I feel has been addressed above and below.

I feel it is eloquent to be able to look a very complex case and

see a simple solution.

 

 As for the

idea that Communists China destroyed or took away the true medicine (5 –

element, spiritual or whatever) I have also seen no evidence for this

belief.  In fact I felt Maciocia had an

extremely strong presentation at the last PCOM symposium specifically debunking

this belief among many others surround the cultural revolution, medicine

practiced now vs. (pre-1949) etc.. One of the strongest points- if the Chinese

government (1949) somehow took all of this complexity, spirituality, five

phase, or whenever from the medicine then neighboring countries, specifically

Taiwan, would have this older form (pre-1949) of medicine.  Maciocia examined texts from Taiwan and

concluded that the medicine was the same and could find no deeper spiritual or

five elements emphasis.  He traces back

historically, very clearly to when various systems fell out of date, i.e. five

phase—this happened long before 1949. 

Secondly, my Chinese teachers, specifically Min Fan,

has always been very clear about his education and how he had access to any text,

and if anything the Communists saved Chinese medicine, did not destroy it.  He does not feel limited in anyway.  I cannot at all agree with the idea that

(these) Chinese doctors are somehow limited because they learned in China

during a certain era, and that somehow we as Westerners, who most of us cannot

even read the language, have somehow a better or truer understanding.  Min Fan has read the pi wei lun, as well as

a multitude of classical texts, has thoroughly studied them, and has taught

them (here & in Nan Jing Univ).  His

understanding of Chinese medicine, is definitely beyond anyone I ever met. 

I will summarize: 

 

1) yin-fire theory is rarely

even mentioned as Bob points out

(despite what Simon says) approx. 6 out of 3840+ journal articles a year.

2) The 4-5 pattern type

treating is not written about very often… texts or journals… and few people

practice it. 

3) Understanding the 4-5

pattern approach through sheer analyzation of ingredients of the formulas is

subjective, controversial, and unreliable (to the original author of the rx

intent- evidenced by the PCOM files experiment).

 

(zev) It seems to me, Jason, that you have

generated an excellent response to your questions, and should have all the

information you need between Bob, Todd and myself. It is now up for you to

decide what is correct for your work.

 

 

(Jason) You are right, and I appreciate everyone’s

input.  Finally, I am not putting down

anyone else’s system one bit—it is one approach- a quite possible the best for

a given type a problems. Let us just acknowledge this method for what it is,

and what it is not, where it came from, how popular it really is, who is really

using it, what its strengths and weaknesses are etc. etc. this is what I am

trying to obtain.  I feel Z’ev,

Bob and others are somewhat modern-day-pioneers in this system.  I only commend there initiative. I look

forward to some material where I can learn this style…  I have ample sources discussing the 1-2

pattern approach. Could advocates of the 4-5 pattern dx system supply some

sources so that I can read more about this, besides Bob’s writings…

 

--

[Guest guest]

Jason:

 

Earlier, Zev brought up an important point regarding 5-Phases. Most

of the discussions about herbal formulas in this forum seem to be in

Zang-fu terminology which may further add to the confusion about yin

fire. Steven Birch has already described the important distinction

between 5-Phases and Zang-fu theory in his essay that was part of an

appendix to Manaka's " Chasing the Dragon's Tail " (Paradigm, 1995).

 

Birch (p.395): energy transferred between phases is " qualitative,

informational nature and not a quantitative physiological nature. The

various control parameters----engendering, restraining, counter-

engendering, and counter-restraining----are concerned solely with

physiological regulation and not physiological process or exchange. "

Further down the page: " Schools adhering to the descriptions of organ

theory (Zang-fu theory) as the sole basis of acupuncture have always

found that the 5-Phase parameters are unable to describe the

physiological functions and interactions of the Zang-fu. However,

when we take the view that these parameters are concerned solely with

the interactive regulation of the Zang-fu, the channels, and the

related phase-sets, and are not the physiologic interactions

themselves, then the conflicts are resolved. " Birch's argument

paraphrases how dynamic systems are discussed in contemporary science-

---this is not 5-Phases in the Worsley style.

 

If I may be allowed my perspective. The source of the confusion in

the postings is that herbs have familiar Zang-fu properties and treat

symptoms, but there is little discussion about their 5-Phase action;

it is a rather static presentation. Yin fire is more interesting and

persuasive in a 5-Phases----that is, how the dynamics of engendering

and restraining of organs changing each other, as per Birch.

 

If you think of the yin fire interlocking patterns as a kind of

mathematical equation, the 5-Phases triangle of interaction between

earth, water, and wood, you can more easily see how any one variable

influences and changes the rest. 5-Phases can illustrate many more

complicated patterns than yin fire. For example, the later chapters

of the Su Wen also offers complicated dynamic patterns----

interestingly, some patterns require the entire year to develop

(similarly in the Mai Jing). In pulse diagnosis, we can view

emotional (qi depth), functional (blood depth), and deeper patterns

(adapted level) separately and see how they change each other.

 

Jim Ramholz

 

 

 

 

" " <zrosenbe@s...>

Thu Jul 19, 2001 4:34 pm

Re: Re: yin fire & dx.

 

 

Signs of every organ are not patterns. And, no, most students don't

know how to treat complex patterns, and become confused. Then

diagnosis

and treatment become chaotic, and they are all over the map. Complex

patterns are interrelated to each other and mutually engendering.

For

this, there has to be knowledge of five phase theory at the least.

Without it, more than one or two patterns make no sense.

 

 

 

 

 

 

 

James Ramholz

Silk Road Acupuncture Center

112 E. Laurel

Fort Collins, CO 80524-3029

(970) 482-5900 Voice

(970) 482-4681 Fax

(303) 522-3348 Cell

 

 

 

 

, " " <@o...> wrote:

>

>

>

> [zrosenbe@s...]

> Thursday, July 19, 2001 3:34 PM

>

> Re: Re: yin fire & dx.

>

>

> For me, this approach you describe from your teachers seems very

myopic and

> limited. But if it works for you, go for it.

>

>

> Myopic and limited as you may say.. This is as I

know/ see

> it, is taught in the western world (majority), and in China. Every

book I

> own takes this approach except possibly the pi wei lun (and there

are a

> multiple interpretations of this book, as even Bob admits) to name

a few

> books that deal with a 1-2 pattern style of writing:

> Bensky.'s herb books, Acupuncture Patterns and Practice- Case

Studies I &

> II, Handbook of Internal Medicine, Maciocia's books, all my

translated books

> from china, Steven Clavey's Fluid Physiology & Pathology in TCM,

Practical

> Therapeutics in TCM (yan wu) not to mention everything I have read

from C.S.

> Cheug – including his case studies, I could go on & on….

> So as reductionist or linear (Todd) or myopic and limited (Z'ev) as

it

> seems, I have not much evidence that things should be any other

way, or are

> taught any other way .. except for a small minority people. And I

must be

> in good company because I am currently in the boat with all of the

above

> authors and all Chinese prof.'s I have worked with. And to answer's

> question

> " whether you think it is more linear and reductionistic to find the

single

> causative factor

> for a disease or identify the complex web of interactions. "

> I do not think a key single patterned diagnosis is equivalent to a

single

> causative factor. The complex web I feel has been addressed above

and

> below.

> I feel it is eloquent to be able to look a very complex case and

see a

> simple solution.

>

> As for the idea that Communists China destroyed or took away the

true

> medicine (5 – element, spiritual or whatever) I have also seen no

evidence

> for this belief. In fact I felt Maciocia had an extremely strong

> presentation at the last PCOM symposium specifically debunking this

belief

> among many others surround the cultural revolution, medicine

practiced now

> vs. (pre-1949) etc.. One of the strongest points- if the Chinese

government

> (1949) somehow took all of this complexity, spirituality, five

phase, or

> whenever from the medicine then neighboring countries, specifically

Taiwan,

> would have this older form (pre-1949) of medicine. Maciocia

examined texts

> from Taiwan and concluded that the medicine was the same and could

find no

> deeper spiritual or five elements emphasis. He traces back

historically,

> very clearly to when various systems fell out of date, i.e. five

phase—this

> happened long before 1949.

> Secondly, my Chinese teachers, specifically Min Fan, has always

been very

> clear about his education and how he had access to any text, and if

anything

> the Communists saved Chinese medicine, did not destroy it. He does

not feel

> limited in anyway. I cannot at all agree with the idea that

(these) Chinese

> doctors are somehow limited because they learned in China during a

certain

> era, and that somehow we as Westerners, who most of us cannot even

read the

> language, have somehow a better or truer understanding. Min Fan

has read

> the pi wei lun, as well as a multitude of classical texts, has

thoroughly

> studied them, and has taught them (here & in Nan Jing Univ). His

> understanding of Chinese medicine, is definitely beyond anyone I

ever met.

> I will summarize:

> 1) yin-fire theory is rarely even mentioned as Bob points out

(despite

> what Simon says) approx. 6 out of 3840+ journal articles a year.

> 2) The 4-5 pattern type treating is not written about very

often…

> texts or journals… and few people practice it.

> 3) Understanding the 4-5 pattern approach through sheer

analyzation of

> ingredients of the formulas is subjective, controversial, and

unreliable (to

> the original author of the rx intent- evidenced by the PCOM files

> experiment).

>

> (zev) It seems to me, Jason, that you have generated an excellent

response

> to your questions, and should have all the information you need

between Bob,

and myself. It is now up for you to decide what is correct for

your

> work.

>

>

> (Jason) You are right, and I appreciate everyone's input. Finally,

I am not

> putting down anyone else's system one bit—it is one approach- a

quite

> possible the best for a given type a problems. Let us just

acknowledge this

> method for what it is, and what it is not, where it came from, how

popular

> it really is, who is really using it, what its strengths and

weaknesses are

> etc. etc. this is what I am trying to obtain. I feel Z'ev,

Bob and

> others are somewhat modern-day-pioneers in this system. I only

commend

> there initiative. I look forward to some material where I can learn

this

> style… I have ample sources discussing the 1-2 pattern approach.

Could

> advocates of the 4-5 pattern dx system supply some sources so that

I can

> read more about this, besides Bob's writings…

>

> --

[Guest guest]

, " " <@o...> wrote:

>

 

>

Every book I

> own takes this approach except possibly the pi wei lun (and there are a

> multiple interpretations of this book, as even Bob admits) to name a few

> books that deal with a 1-2 pattern style of writing:

> Bensky.'s herb books, Acupuncture Patterns and Practice- Case Studies I &

> II, Handbook of Internal Medicine, Maciocia's books, all my translated books

> from china, Steven Clavey's Fluid Physiology & Pathology in TCM, Practical

> Therapeutics in TCM (yan wu)

 

 

these are all basic texts; none of them endeavor to address real live

cases; this makes no impression on me.

 

> So as reductionist or linear (Todd) or myopic and limited (Z'ev) as it

> seems, I have not much evidence that things should be any other way, or are

> taught any other way

 

I am sorry your exposure has been so limited. I count myself blessed

that mine was so much broader. My teachers all emphasized multiple

pattern dx. I am no pioneer, merely a follower of my mentors.

 

 

> I feel it is eloquent to be able to look a very complex case and see a

> simple solution.

 

I guess time will tell. All I can say is that all of us who now hold

our position once held yours and we changed due to our experience.

 

[Guest guest]

By definition, a pattern is collection of more than one sign or

symptom. Any sign or symptom only means something in corroboration

with other signs and symptoms. There simply are no other marked

corroborating signs or symptoms of damp heat. Besides, although I did

not continue the case history to describe outcomes, the patient

responded immediately to the formula described within three days in

terms of her fatigue, anxiety, and general dysphoria, and throughout

our subsequent work together, there was never any cooroborating sign

or symptom of damp heat.

 

Sorry if I didn't give a total and complete report on this case. I

thought I was giving enough for people to get what I was talking

about.

 

Bob

 

 

, " Alon Marcus " <alonmarcus@w...> wrote:

> Since there are no

> particular signs or symptoms of damp heat, vacuity heat, or phlegm

> heat, that leaves depressive heat as the mostly likely source of

these

> heat evils.

> >>>>Why not? the soggy surging pulse and red tip could indicate

damp-heat from spleen def and explain fatigue, craving sweets, swollen

breasts, early menses, irregular bowel movements, diarrhea, bitter

taste, acne, and even possibly cold feet.

> My point here is that symptom can be interpreted in various ways

depending on the CM theory one follows. The signs suppose to organize

the symptoms into a comprehensive complex. The question is does one

need to use a formula such as Bob suggest or another from a different

perspective and which get a better result.

>

> Would treating the spleen be sufficient to mobilize the blood and

clear stasis, could it be enough to result any liver symptoms as liver

symptoms can easily arise from weak spleen etc.

>

> I would like to here from followers Li dang and have them share

cases.

> Alon

[Guest guest]

Jason,

 

I have lurked in the background during this whole fascinating give and take.

You have certainly done a wonderful job of pulling wonderful explanations

and arguments from the group. I do want to echo et al in reiterating

that you may well change your views in practice. When I graduated I was

convinced of the eloquence inherent in discovering the most important

pattern occurring in a patient and treating it --- a part in my own

education and internship. Unfortunately, outside of acute disorders and

pediatric cases (uncomplicated, textbook cases), I could only get good

results for 30-40% of my chronic cases. This was a constant source of

frustration to me.

 

Also, like you, I found Bob Flaw's early works grating and irksome.

However, when I went back and worked my way through them, and particular

began to study the more recent publications, I was impressed by the way in

which the whole yin fire approach seemed to echo my patients' symptom

pictures. Tenuously I began to incorporate these sorts of treatments with

my patients and found that I could very frequently get results where I was

stymied before. I now, not infrequently, will get patients who have been to

Chicago's Chinatown and had disappointing results from well known (Chinese)

herbalists there who seem to respond to my more organic (yin fire) approach

quite well. This, of course, may be due to many things: language skills,

etc.

 

In any case, you'll see what works best. It is clear that you've got a

brilliant and penetrating mind and that you'll continuously evaluate your

methods throughout your life of practice. Our field needs more people with

your skepticism and fervor.

 

Mark Reese