Guest guest Posted July 18, 2001 Report Share Posted July 18, 2001 .. Therefore I have ahard time saying that 6 gentlemen regulates qi. >>>I totally agree. - Wednesday, July 18, 2001 3:39 PM RE: Re: yin fire & (multiple patterns) Wednesday, July 18, 2001 10:39 AM Subject: Re: yin fire & dx., "Alon Marcus" <alonmarcus@w...> wrote: sometimes it the combination of the herbs that you must look at likebai shao and gui zhi in gui zhi tang. You cant just say you see here is aspicy herbs and a blood tonic so we have two treatment principleI totally disagree. the formulas can be used to address patterns incombination or as a function of the individual herbs.(Jason) That later part I would like to understand better, especially incontext of traditional approaches to writing formulas. Firstly, I am havingproblems understanding that some of these simple formulas (mentionedpreviously) are treating multiple (4-5) patterns.. Maybe I ammisunderstanding on a purely semantical level, but with my limitedexperience I would like to put forth a proposition (or two):Firstly I agree with alon. Does seeing a herb (i.e. ban xia) in a rx meanthe rx is transforming phlegm? I say no... Just because one sees i.e. mahuang in a formula does not mean that you are releasing the exterior(especially coupled with shi gao). One must look at the other herbs in aformula and understand that there is synergy that is created by combiningthem that treats a given tx principle for a pattern. What is the pattern?(I say the diagnosis). I find that naming off the actions of a formula (astodd mentioned a few msg.'s ago) is different than the pattern(s) beingtreated. One can ask if a patient comes in with a blood stasis problem(with underlying xue xu) (or xue xu with xue yu) would one give si wu tang?It contains chuan xiong and dang gui... I would not. I would something liketao hong si wu tang - this moves blood. So... I would not say that si wutang invigorates the blood. Of course severity is an issue, but just from atheoretical perspective trying to understand the chinese method of dx --> txprinciples --> formula - I see that this is important -- for at least me tounderstand.I propose that many times these herbs that could be used for other things incontext with herbs in a given formula are sometimes not. Noting how theChinese assign various titles to placement of the herbs (i.e. chief, deputy,assistant etc...) elaborates on this concept. Herbs many times are justthere to support the Chief herb, not really acting truly on its own.. I feelthis is holistic and the way Chinese formulas have been understood in thepast. For example, a moving herb is commonly added to a rx to keep thingsfrom becoming too cloying, so yes one might say the formulas' action mightbe moving, but it is not treating a stagnation pattern. Todd suggests: 6gentlemen regulates qi (ala chen pi?) - > I feel if the patient came in witha diagnosis of spleen qi deficiency (w/ damp) and qi stagnation, the formulawould not be 6 gentlemen. The chen pi is to transform damp /plegm in thissituation - following the dx associated with this rx. -- with other herbsit could be used to address a qi stagnation pattern. Therefore I have ahard time saying that 6 gentlemen regulates qi. Am I wrong to think in thisway?So I propose that our Chinese forefathers still thought in relatively simplepatterns (1-2) and still do, but include other supporting herbs that maylook like the formula is doing a tremendous amount of things, but in regardto the actual patient is still focusing on 1 or 2 areas. This is alsoevidenced by every Eastern case study manual I own and almost every book.Also the argument that Americans are complex and need complex formulas , Iam unsure, I am contemplating this. But if xia yao san or any of thesebasic formulas mentioned previously are actually treating 4-5 patterns thenthis would suggest that the Chinese were also complex since the beginning offormula writing.. But again I propose that it is not the patient that is anymore or less complex but the practiontioners thinking.As an exercise one could take many of the larger formulas (12+ ingredients)and name off 8+ supposed different patterns that it treats -- looking atherbs individually. I personally find this a Cartesian approach that seemssomewhat un-Chinese. This is not to say that it is not valid or even lesseffective -- my argument seems to center around the original thinking behindpatterns and formulas/diagnosis of historical formulas and cases -- and thenof course how that relates to present day.Finally does any of this actually matter... I have seen Todd's formulas andhave always thought highly of them; being well-balanced and effective. Ifone says they are treating 1-2 patterns or 4-5 patterns and comes up withthe same formula does it matter? I think it only matters when you're not ata very sophisticated level (i.e. students) -- it seems that many studentsthat take on multiple pattern philosophy forget about Synergy and how herbswork together, picking one herbs for this, one herb that, one for that etc..That is my feeling why diagnosis is kept simple and clear in the books --which forms a solid foundation for the treatment principle.Question: case studies that I have read take this simple approach; they arethe majority of the time real cases. Are they dumbed down for educationalpurposes (1-2 patterns) or is the practitioner actually thinking on thislevel? This is my question- trying to understand thought patterns of greatphysicians of the past/present.Question2: Why then do Chinese Dr.'s (as Todd noted from the PCOM files)keep the dx. to 1-2 patterns if they are actually treating 4-5 patterns.. Orare they not, and are we just interpreting something from their formulas?If they are they must obviously be making a priority and then other'patterns' are supporting the main focus correct? Again a semantical wordgame?this is why guizhi tang has been modified slightly to address far more than theoriginal taiyang syndrome, including heart disease and digestivecomplaints.(Jason) Yes but modified is the key.. i.e. in gui zhi jia shao yao tang,doubling the bai shao sinks the gui zhi down into the abdomen to treat amore digestive complaint and not release the exterior.. It now is adifferent rx and different actions and treating a different pattern. Justbecause one sees gui zhi does not mean that bai shao and gui zhi areharmonizing the ying and wei.. or even releasing the exterior for thatmatter. The chief ingredient changes hands. Changing the focus.. So,changing the dosage changes the synergy of the herbs in the formula. Baishao significantly changes the way (where) gui zhi's actions are takingplace. If one just looks at things individually one could easilymisunderstand and prescribe the wrong rx.Same for xiao chai hu tang.(Jason) I am unsure how looking at the mods of these rx's demonstratesprescribing according to the "functions of individual herbs".-Chinese Herbal Medicine, a voluntary organization of licensed healthcare practitioners, matriculated students and postgraduate academics specializing in Chinese Herbal Medicine, provides a variety of professional services, including board approved online continuing education. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 19, 2001 Report Share Posted July 19, 2001 , " " <@o...> wrote: > One can ask if a patient comes in with a blood stasis problem > (with underlying xue xu) (or xue xu with xue yu) would one give si wu tang? > It contains chuan xiong and dang gui... I would not. I would something like > tao hong si wu tang - this moves blood. So... I would not say that si wu > tang invigorates the blood. say what you want, but I think you are wrong. si wu tang absolutely moves the blood. I mean half the formula is blood moving. It is only modern arbitrary categorization that calls this merely a blood tonic. to me that is what is linear; pidgeonholing a complex formula in a single category. Todd suggests: 6 > gentlemen regulates qi (ala chen pi?) - > I feel if the patient came in with > a diagnosis of spleen qi deficiency (w/ damp) and qi stagnation, the formula > would not be 6 gentlemen. The chen pi is to transform damp /plegm in this > situation - following the dx associated with this rx. -- with other herbs > it could be used to address a qi stagnation pattern. Therefore I have a > hard time saying that 6 gentlemen regulates qi. Am I wrong to think in this > way? yes, I think you are wrong. both ban xia and chen pi descend qi in the midjiao. thus this formula addresses qi stagnation as strong as damp or phlegm. how do you know what the originator intended? I only know what the herbs do. > Finally does any of this actually matter... I have seen Todd's formulas and > have always thought highly of them; being well-balanced and effective. If > one says they are treating 1-2 patterns or 4-5 patterns and comes up with > the same formula does it matter? well, I can certainly speak for myself in my own formulas. I am considering all the mutually engendering patterns, not just one or two. this is how I was taught to practice by my personal teachers, not by bob flaws, whom I have never met in person. Bob just gave me a theoretical understanding of what I do, after the fact. As for SHL formulas, we have no idea what zhang zhong jing was thinking. all analyses of his rx were done by later commentators, some of whom gave broad analyses, others who were narrow. Heiner Fruehauf exemplified the broad school and he was a personal teacher of mine. As for theory, all it does is guide my practical applications. I use what works for me not because it is somehow true, but because it works. I know the map is not the terrain. but I do know that narrowly interpreting formulas has been a clinical dead end for me. that's all I care about. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 19, 2001 Report Share Posted July 19, 2001 Fair enough.. Your points are well taken... I feel si wu tang was a bad example of what I am trying to say... Question: Do you then feel that other herbs in a rx do not effect how a given herb is working in the formula? It is my understanding that herbs get most of their 'single functions' from context, meaning how a given herb acts within a given rx. Taken out of that rx the herb might or might not perform that fx. Can we always expect gui zhi to release the exterior, of course that depends on the other herbs in the rx and the relative dosage as seen previous. From my view, this seems true with many of herbs/functions that I have learned ala Bensky. If true, how does one " know what the herbs do " without considering contextual functioning- or do you not? I can't imagine that one may pick any of the functions listed and assume that a given herb will do any of them at will in any formula...? IS there any such synergy created (a new entity) from putting a bunch of herbs together? Or am I missing the point.. (it is late in the night)... Joseph Roseman & I were talking and he mentioned a rx I have been thinking about the last couple of days... suan zao ren tang Suan zao ren, chuan xiong, zhi mu, fu ling, & gan cao. Does this formula - Calm the spirit, move the blood, drain damp, tonify the spleen, clear deficient fire, nourish yin, nourish blood and relieve irritiability? - Wednesday, July 18, 2001 11:20 PM Re: yin fire & (multiple patterns) , " " <@o...> wrote: > One can ask if a patient comes in with a blood stasis problem > (with underlying xue xu) (or xue xu with xue yu) would one give si wu tang? > It contains chuan xiong and dang gui... I would not. I would something like > tao hong si wu tang - this moves blood. So... I would not say that si wu > tang invigorates the blood. say what you want, but I think you are wrong. si wu tang absolutely moves the blood. I mean half the formula is blood moving. It is only modern arbitrary categorization that calls this merely a blood tonic. to me that is what is linear; pidgeonholing a complex formula in a single category. Todd suggests: 6 > gentlemen regulates qi (ala chen pi?) - > I feel if the patient came in with > a diagnosis of spleen qi deficiency (w/ damp) and qi stagnation, the formula > would not be 6 gentlemen. The chen pi is to transform damp /plegm in this > situation - following the dx associated with this rx. -- with other herbs > it could be used to address a qi stagnation pattern. Therefore I have a > hard time saying that 6 gentlemen regulates qi. Am I wrong to think in this > way? yes, I think you are wrong. both ban xia and chen pi descend qi in the midjiao. thus this formula addresses qi stagnation as strong as damp or phlegm. how do you know what the originator intended? I only know what the herbs do. > Finally does any of this actually matter... I have seen Todd's formulas and > have always thought highly of them; being well-balanced and effective. If > one says they are treating 1-2 patterns or 4-5 patterns and comes up with > the same formula does it matter? well, I can certainly speak for myself in my own formulas. I am considering all the mutually engendering patterns, not just one or two. this is how I was taught to practice by my personal teachers, not by bob flaws, whom I have never met in person. Bob just gave me a theoretical understanding of what I do, after the fact. As for SHL formulas, we have no idea what zhang zhong jing was thinking. all analyses of his rx were done by later commentators, some of whom gave broad analyses, others who were narrow. Heiner Fruehauf exemplified the broad school and he was a personal teacher of mine. As for theory, all it does is guide my practical applications. I use what works for me not because it is somehow true, but because it works. I know the map is not the terrain. but I do know that narrowly interpreting formulas has been a clinical dead end for me. that's all I care about. Chinese Herbal Medicine, a voluntary organization of licensed healthcare practitioners, matriculated students and postgraduate academics specializing in Chinese Herbal Medicine, provides a variety of professional services, including board approved online continuing education. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 19, 2001 Report Share Posted July 19, 2001 , " " <@o...> wrote: > Question: Do you then feel that other herbs in a rx do not effect how a > given herb is working in the formula? of course they do. But herbs have their single effects and their interactive effects. Unless one herb in a formula suppresses another herbs function, it will have all of its effects. But it will have more of the effects that are mutually enhanced or accentuated. But herbs have single effects and that doesn't disappear just cause they are in a formula. > It is my understanding that herbs get most of their 'single functions' from > context, meaning how a given herb acts within a given rx. Taken out of that > rx the herb might or might not perform that fx. I don't agree with that. Formulas balance the single effectsof herbs so they are harmonious for the patient. but the herb has inherent single effects. Can we always expect gui > zhi to release the exterior, of course that depends on the other herbs in > the rx and the relative dosage as seen previous. In the case of gui zhi, I think that function is highly dose dependent and is often restrained by other herbs that moderate that effect. On the other hand, I always think it is warming the channels to some degree. I can't imagine that one may pick any of the > functions listed and assume that a given herb will do any of them at will in > any formula...? the context is important and the examples I gave, I didn't assume anherb did all of its functions strongly. But I don't think it can be disputed that in liu wei di huang wan, that formula supplements yin (shu di, shan zhu yu, shan yao), strengthens spleen (fu ling, shan yao), drains damp (fuling, ze xie). And personally, I think the mre presence of shan zhu tu is enough to astringe and mu dan pi enough to cool. IS there any such synergy created (a new entity) from > putting a bunch of herbs together? Or am I missing the point.. (it is late > in the night)... the whole is greater than the sum of the parts, but the parts do not just disappear within the whole. > suan zao ren tang > Suan zao ren, chuan xiong, zhi mu, fu ling, & gan cao. > Does this formula - Calm the spirit, move the blood, drain damp, tonify the > spleen, clear deficient fire, nourish yin, nourish blood and relieve > irritiability? > In bensky's formula analysis, he does describe it as having those actions (and notes even four treatment princples in the actions section) and it can be modified to emphasize any one of them more strongly. I phrase this in reverse, would you use suan zao ren tang in a patient for whom you wanted to completely avoid blood moving? I wouldn't. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 19, 2001 Report Share Posted July 19, 2001 , " Alon Marcus " <alonmarcus@w...> wrote: > . Therefore I have a > hard time saying that 6 gentlemen regulates qi. > >>>I totally agree. gosh, I guess you better not use it for that function, then. It seems to work just great for my patients who experience qi xu and qi stag sx like bloating and distension in the midjiao, even in those without dampness signs. this way to understand formulas is the basis of using a few formulas to address a wide range of diseases. My teachers used this method rather than using dozens of different discrete formulas based solely upon their limited textbook definitions. some people limit ban xia xie xin tang to sudden turmoil disorders. Heiner fruehauf uses it for any condition that presents with spleen qi and yang xu, dampheat, phlegm-heat and unsettled spirit. When one agrees with a limited interpretation, is this merely a theoretical position or has one actually tried unsuccessfully to use the method I describe in their practice? the proof is in the pudding. I am a pragmatist. If it doesn't work, I don't do it. If it does, I will adopt whatever theory explains the observed phenomena. I think this is what they call the scientific method. the theory that best explains the observation is provisionally correct till a better one comes along. To say that ban xia xie xin tang only treats sudden turmoil disorder by addressing a hot-cold complex does not explain the observations I have made of its use. To say liu jun zi tang only addresses damp accumulation and not qi stagnation also does not address the clinical phenomena I have witnessed. Now arguably, I tweaked the spleen and the single causative factor was corrected and liu jun zi worked in spite of my inclusion of the unnecessary ban xia and chen pi. Yet in similar cases, the mere use of si jun zi has failed. I find ironic, Alon, that you, who has been so dismissive of the efficacy of TCM internal medicine over the past two years, consistently saying that longterm followup of patients treated by your teachers in china was disappointing, now takes the position that the methodology espoused by these very same teachers is somehow the only correct interpretation. You asked me one time why I do not share my skepticism about TCM more publicly. well, here it is. when people take limited approaches to understanding the complexity of their patients (and formulas) and use inadequate dosages of herbs, their results are quite lackluster. However I was always impressed with the results of several of my teachers who embraced the ideas I espouse. It is exactly short term success and long term disappointment which one sees when using the 1-2 pattern approach to serious disease. You have said you even stopped practicing much internal medicine years ago because of your frustration. Well, Bob, Z'ev, Chip and I (to name a few) found another angle on things that has led us out of this morass. Someone sent me an amusing email yesterday: " I (almost) wish I had children so I could tell them about the time Bob Flaws stole yin fire from the gods like some young Prometheus. " well, the gods punished prometheus and chained him to a rock and a bird of prey came and ate his liver every day. then it would grow back and the torture would start all over again for eternity. then one day, Hercules was on one of his quests and he happened to stumble upon the chained Prometheus. Hercules tore the chains that bound Prometheus and a great wrong was finally righted. todd Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 19, 2001 Report Share Posted July 19, 2001 In bensky's formula analysis, he does describe it as having those actions (and notes even four treatment princples in the actions section) and it can be modified to emphasize any one of them more strongly I personally do not equate actions of a rx with the pattern that it treats.. Bensky will many times list 4-5 actions.. But most every time only 1-2 patterns.. (2nd paragraph 1st line). This is the dx/ pattern that I have been referring to the whole time.. not actions. - Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 19, 2001 Report Share Posted July 19, 2001 To say liu jun zi tang only addresses damp accumulation and not qi stagnation also does not address the clinical phenomena I have witnessed. >>>>I was under the impression that this formula is used for sp def. Bloating being one of its symptoms, and the inclusion of the 2 herbs is to farther reduce the possibility of bloating from Qi tonics. To suddenly say this formula is for dampness and therefor if one does not use it for bloating they take a narrow view is flip flopping your own argument I find ironic, Alon, that you, who has been so dismissive of the efficacy of TCM internal medicine over the past two years, consistently saying that longterm followup of patients treated by your teachers in china was disappointing, now takes the position that the methodology espoused by these very same teachers is somehow the only correct interpretation. >>>>>In truth I am not talking about my practice just repeating some positions of well known TCM treachers of mighn. I reality I brake every rule in the book with my patient as results is the only thing I care about You have said you even stopped practicing much internal medicine years ago because of your frustration. >>>>>That is not true I said I do not use simple TCM for musculoskeletal disorders because of frustration. My practice is about 30% internal medicine and 60% mixed, and I use various methods from CM naturopathy, and osteopathy. With Chinese herbs I mostly use neutral school formulations, at times I use large formulas ala Dr Lai. When I find a patient that confirms to a simple SHL confirmation I use SHL as I spend 3 months in China with a strict SHL Dr. Alon - Thursday, July 19, 2001 10:56 AM Re: yin fire & (multiple patterns) , "Alon Marcus" <alonmarcus@w...> wrote:> . Therefore I have a> hard time saying that 6 gentlemen regulates qi. > >>>I totally agree. gosh, I guess you better not use it for that function, then. It seems to work just great for my patients who experience qi xu and qi stag sx like bloating and distension in the midjiao, even in those without dampness signs. this way to understand formulas is the basis of using a few formulas to address a wide range of diseases. My teachers used this method rather than using dozens of different discrete formulas based solely upon their limited textbook definitions.some people limit ban xia xie xin tang to sudden turmoil disorders. Heiner fruehauf uses it for any condition that presents with spleen qi and yang xu, dampheat, phlegm-heat and unsettled spirit. When one agrees with a limited interpretation, is this merely a theoretical position or has one actually tried unsuccessfully to use the method I describe in their practice? the proof is in the pudding. I am a pragmatist. If it doesn't work, I don't do it. If it does, I will adopt whatever theory explains the observed phenomena. I think this is what they call the scientific method. the theory that best explains the observation is provisionally correct till a better one comes along. To say that ban xia xie xin tang only treats sudden turmoil disorder by addressing a hot-cold complex does not explain the observations I have made of its use. To say liu jun zi tang only addresses damp accumulation and not qi stagnation also does not address the clinical phenomena I have witnessed. Now arguably, I tweaked the spleen and the single causative factor was corrected and liu jun zi worked in spite of my inclusion of the unnecessary ban xia and chen pi. Yet in similar cases, the mere use of si jun zi has failed.I find ironic, Alon, that you, who has been so dismissive of the efficacy of TCM internal medicine over the past two years, consistently saying that longterm followup of patients treated by your teachers in china was disappointing, now takes the position that the methodology espoused by these very same teachers is somehow the only correct interpretation. You asked me one time why I do not share my skepticism about TCM more publicly. well, here it is. when people take limited approaches to understanding the complexity of their patients (and formulas) and use inadequate dosages of herbs, their results are quite lackluster. However I was always impressed with the results of several of my teachers who embraced the ideas I espouse. It is exactly short term success and long term disappointment which one sees when using the 1-2 pattern approach to serious disease. You have said you even stopped practicing much internal medicine years ago because of your frustration. Well, Bob, Z'ev, Chip and I (to name a few) found another angle on things that has led us out of this morass.Someone sent me an amusing email yesterday:"I (almost) wish I had children so I could tell them about the time Bob Flaws stole yin fire from the gods like some young Prometheus."well, the gods punished prometheus and chained him to a rock and a bird of prey came and ate his liver every day. then it would grow back and the torture would start all over again for eternity. then one day, Hercules was on one of his quests and he happened to stumble upon the chained Prometheus. Hercules tore the chains that bound Prometheus and a great wrong was finally righted. :)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. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 19, 2001 Report Share Posted July 19, 2001 , " " <@o...> wrote: > > I personally do not equate actions of a rx with the pattern that it treats.. > Bensky will many times list 4-5 actions.. But most every time only 1-2 > patterns.. (2nd paragraph 1st line). This is the dx/ pattern that I have > been referring to the whole time.. not actions. > > - the actions of a formula address the treatment principles which are derived from the patterns. Again there is a linear reductionistic trend in TCM texts from this era. this was an attempt to gain legitmimacy by micmicking western med. Is that what we want to do? Quote Link to comment Share on other sites More sharing options...
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