Guest guest Posted August 2, 2001 Report Share Posted August 2, 2001 I had some more thoughts on the issues surrounding complex patterns and diagnosis. Recently, Bob Damone discussed one of the shortcomings of CM education in America was the lack of emphasis in textbooks and classroom on bing4 ji2, or pathomechanisms. Pathomechanisms are equivalennt to etiology or pathogenesis in biomedicine. However, in Chinese medicine there is a progression of development of a pattern or disease which may lead to more complex patterns. For example, in one case I had, a woman in her late fifties came in. She wanted me to check her pulse first, so I did, finding extreme vacuity in the chi positions on both sides, thin and thready in the other positions. Her tongue was pale, dusky, no coat, deeply lined, peeled in spots. I asked her, based on the pulse, if she had either a serious illness or surgery in the lower abdominal region. It turns out it was both. . . endometrial cancer and a complete hysterectomy seven years before but with no recurrence of cancer. Since then, she complained of anxiety and restlessness, a chronic cough and wheeze with sparse clear sputum and difficulty lying flat, diarrhea and weak digestion, and serious fatigue. Her diagnosis including pathomechanisms was the following: surgery for the endometrial cancer (of course necessary) had led to collapse of the spleen qi, and weakening of the kidney qi (probably already vacuous). The weakened kidney qi could no longer grasp the lung qi, leading to shortness of breath, wheezing and cough. The weakened spleen could not produce sufficient blood, causing vexation to the heart. Counterflow qi from liver qi depression or mingmen fire counterflowing upwards further harassed the lung and heart. The weak spleen and kidney qi caused chronic diarrhea, often clear food diarrhea indicating debility of the kidney qi. The only repletion was in the liver (although not that replete, since there was no indication on the pulse, largely due to the overall pervading vacuity), causing liver counterflow to harass the lungs (wood insulting metal), and overact on the spleen (liver spleen dual disharmony) worsening the spleen qi vacuity. So, we have: Kidney qi vacuity Lung/kidney yang vacuity Spleen qi vacuity with downward fall Sp qi/heart blood vacuity Liver depression, spleen vacuity Wood insulting metal I originally gave her gui pi tang straight, but it caused flushing up. . ..so I decided to secure the kidney qi at the base with you gui yin/restore the right decoction with additional medicinals to supplement lung and kidney and relieve liver depression. It worked well, but gradually. Her chi pulses continue to strengthen, and she comes in once a month for acumoxatherapy to deal with ongoing anxiety aggravated by her business and political activities. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 2, 2001 Report Share Posted August 2, 2001 Zev to me this is an example of seeing a patient that has K def as a central issue with secondary symptoms as per the pathomechanisms. So just as you did there is a central formula with some addtions. This is not that has all these patterns. I guess one might say it is only a difference is words. But when looking at you treatment I think seeing it the way I do makes more sense Alon - Thursday, August 02, 2001 2:59 PM Re: yin fire & dx./some more thoughts I had some more thoughts on the issues surrounding complex patterns and diagnosis. Recently, Bob Damone discussed one of the shortcomings of CM education in America was the lack of emphasis in textbooks and classroom on bing4 ji2, or pathomechanisms. Pathomechanisms are equivalennt to etiology or pathogenesis in biomedicine. However, in Chinese medicine there is a progression of development of a pattern or disease which may lead to more complex patterns.For example, in one case I had, a woman in her late fifties came in. She wanted me to check her pulse first, so I did, finding extreme vacuity in the chi positions on both sides, thin and thready in the other positions. Her tongue was pale, dusky, no coat, deeply lined, peeled in spots. I asked her, based on the pulse, if she had either a serious illness or surgery in the lower abdominal region. It turns out it was both. . . endometrial cancer and a complete hysterectomy seven years before but with no recurrence of cancer. Since then, she complained of anxiety and restlessness, a chronic cough and wheeze with sparse clear sputum and difficulty lying flat, diarrhea and weak digestion, and serious fatigue.Her diagnosis including pathomechanisms was the following: surgery for the endometrial cancer (of course necessary) had led to collapse of the spleen qi, and weakening of the kidney qi (probably already vacuous). The weakened kidney qi could no longer grasp the lung qi, leading to shortness of breath, wheezing and cough. The weakened spleen could not produce sufficient blood, causing vexation to the heart. Counterflow qi from liver qi depression or mingmen fire counterflowing upwards further harassed the lung and heart. The weak spleen and kidney qi caused chronic diarrhea, often clear food diarrhea indicating debility of the kidney qi. The only repletion was in the liver (although not that replete, since there was no indication on the pulse, largely due to the overall pervading vacuity), causing liver counterflow to harass the lungs (wood insulting metal), and overact on the spleen (liver spleen dual disharmony) worsening the spleen qi vacuity.So, we have:Kidney qi vacuityLung/kidney yang vacuitySpleen qi vacuity with downward fallSp qi/heart blood vacuityLiver depression, spleen vacuityWood insulting metalI originally gave her gui pi tang straight, but it caused flushing up. . .so I decided to secure the kidney qi at the base with you gui yin/restore the right decoction with additional medicinals to supplement lung and kidney and relieve liver depression. It worked well, but gradually. Her chi pulses continue to strengthen, and she comes in once a month for acumoxatherapy to deal with ongoing anxiety aggravated by her business and political activities.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 August 3, 2001 Report Share Posted August 3, 2001 Z'ev wrote " Recently, Bob Damone discussed one of the shortcomings of CM education in America was the lack of emphasis in textbooks and classroom on bing4 ji2, or pathomechanisms. " Can anyone suggest any texts (in English) that may be usefull to students ( and me!) that may explain and outline this. Heiko Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 3, 2001 Report Share Posted August 3, 2001 Z'ev wrote also " so I did, finding extreme vacuity in the chi positions on both sides, thin and thready in the other positions. Her tongue was pale, dusky, no coat, deeply lined, peeled in spots. I asked her, based on the pulse, if she had either a serious illness or surgery in the lower abdominal region. It turns out it was both. . . " I am just curious as what made you think this from the pulse. Heiko Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 3, 2001 Report Share Posted August 3, 2001 Heiko, In the December issue of CAOM there will be an article by Prof. Yan Shi Lin of the Chengdu University of TCM on pathomechanisms of the heart. It's an excerpt from an upcoming book by Prof. Yan on the pathomechanisms of the five zang4. I don't know of any other English books/articles on the subject and would also like to hear of any that are out there. Ken , Heiko Lade <heiko@l...> wrote: > Z'ev wrote > " Recently, Bob Damone discussed one of the shortcomings of CM > education in America was the lack of emphasis in textbooks and classroom > > on bing4 ji2, or pathomechanisms. " > > Can anyone suggest any texts (in English) that may be usefull to > students ( and me!) that may explain and outline this. > Heiko Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 3, 2001 Report Share Posted August 3, 2001 Heiko, As Bob Damone says (and Bob reads Chinese), this literature does not really exist in English. There is, however, a nice little book titled, Zhong Yi Bing Yin Bing Ji Xue (A Study of Chinese Medical Disease Causes & Diseases Mechanisms, written by Wu Dun-xu and published by the Shanghai College of Publishing Co., Shanghai, 1989, ISBN 7-81010-026-2. This is the kind of materials one simply must read in order to be really educated in Chinese medicine. Not to have read this kind of material means one has a huge hole in their CM knowledge. This is yet one more example of, at least in my experience, the absolute necessity of reading basic modern medical Chinese if one wants to be a legitimate doctor of Chinese medicine. Bob , Heiko Lade <heiko@l...> wrote: > Z'ev wrote > " Recently, Bob Damone discussed one of the shortcomings of CM > education in America was the lack of emphasis in textbooks and classroom > > on bing4 ji2, or pathomechanisms. " > > Can anyone suggest any texts (in English) that may be usefull to > students ( and me!) that may explain and outline this. > Heiko Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 3, 2001 Report Share Posted August 3, 2001 On Friday, August 3, 2001, at 12:24 AM, Heiko Lade wrote: > Z'ev wrote also " so I did, finding extreme > vacuity in the chi positions on both sides, thin and thready in the > other positions. Her tongue was pale, dusky, no coat, deeply lined, > peeled in spots. I asked her, based on the pulse, if she had either a > serious illness or surgery in the lower abdominal region. It turns out > it was both. . . " > > I am just curious as what made you think this from the pulse. > > Heiko > > On a scale of one to ten, the pulse felt very sunken at a level of minus three. There was nothing there. My clinical experience is that hysterectomies especially cause very depleted pulses in the lower burner position on both wrists. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 3, 2001 Report Share Posted August 3, 2001 Actually, the quote below should have been Bob Damone and I discussed. . . . One pair of books that have some basic pathomechanisms are " Patterns and Practice " volumes one and two from Eastland Press. On Friday, August 3, 2001, at 12:21 AM, Heiko Lade wrote: > Z'ev wrote > " Recently, Bob Damone discussed one of the shortcomings of CM > education in America was the lack of emphasis in textbooks and classroom > > on bing4 ji2, or pathomechanisms. " > > Can anyone suggest any texts (in English) that may be usefull to > students ( and me!) that may explain and outline this. > Heiko > > > 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...
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