Nuances

[Guest guest]

All,

 

I believe that I grasp Bob Flaws' point: If case examples are not so

forthcoming, then the role nuance plays in clinical practice is not so great.

Although I am not a clinician, I agree that it is a significant point. On the

other hand, I believe that a detailed view of Chinese concepts as rooted in

Chinese philosophy has at least twice allowed me to resolve some nasty

clinical issues in my family life. Thus I find it hard to believe that this is

not

of value to people who practice for a living.

 

In one case, knowing that a SHL pattern involved heat effusion was the clue

that gave me the confidence to give a strong-acting formula to my middle

son in a circumstance that was scary. In another instance, it was the idea of

disinhibition that gave me the clue that lead me to ask for a particular

physical exam, that lead to a minor surgery, that eliminated what had been a

chronic problem immediately and thus far forever. So, while I am not a big

believer that individual experience is proof of anything, I do find it hard to

accept that in-depth knowledge is never clinically useful, even while

agreeing that clinical practice centers in the solid middle of the conceptual

foundations.

 

I believe that it is the conceptual foundations that are secured by a

grounding in philosophy. What I most commonly see when people are

discussing clinical cases is that they have not formulated a Chinese medical

analysis of the problem. They have not applied the CM concepts, or have

done so badly. I monitor four of these lists and have countless times

watched someone answering a clinical question need to begin by reforming

the case and the question in Chinese medical terms. One of the reasons that

I enjoy watching Bob Flaws or (among others) respond to

people's clinical questions is that I enjoy watching them order the

information in the Chinese medical context and manage it according to

Chinese medical logic. It is a very flexible system with a logical elegance

that I admire.

 

Chinese philosophical concepts are rich with relationships. They give us

patterns of thinking into which we can fit the clinical (or other)

observations and from which we can project (prognose) results. It seems to

me that the main benefit of knowing Chinese medical philosophy is that it

helps you learn how to think in the Chinese medical context and therefore

how to examine and solve problems using the foundation principles. Thus,

looking for evidence of its value in some sort of telling detail -- some

`smoking gun' proof -- seems to me like trying to measure water with a

yardstick.

 

I can understand Bob Flaws' having come to see the mountains as mountains

but I don't think that is a vision you get without the intensity of

philosophical appetite that I see in Bob's biography. I'm not saying that a

native Chinese doctor who would rather eat pizza and watch a Hong Kong

flick cannot be a master clinician. However, I do not accept that such an

example proves that most English-speakers who are educated and inured to

western logic will efficiently learn and apply a complex set of clinical

principles without some training in how that information is ordered and

used. Understanding is not in the detail, it is in the relationship among the

details. As my weird old sensei used to say virtually every day, `theory

without practice is stupid, practice without theory is dangerous.'

 

Finally, I don't get why people seem to think it is such a horribly onerous

chore to acquire a basic grasp of the Chinese philosophical and cultural

milieu, or why it should be thought of as an invasion of the curriculum.

More than 15 years ago Paul Zmiewski put together thirty-two classes and

reading assignments that gave someone with no foundation to acquire a

basic understanding of Chinese philosophy. This is something like 64

contact hours and maybe as much homework. Out of the figures I hear of

three to four thousand hours in class, this hardly seems a horrid chore.

>From my viewpoint, just being able to recognize when people are creating

philosophical differences that do not exist for the Chinese would save more

time and money than the course would demand.

 

This morning I spent two hours with an artist who is doing some work for a

book. He has no idea whatsoever that I am the publisher of people who

think that terms and philosophy are important. But, having practiced taiji

since T.T. Liang in the 70's he was saddened by the cheapening of taiji

because people are not looking at the ideas in their philosophical context.

His example was how presenting the concept of dan tian as solely the

location of an acupoint (instead of the idea of a field of transformation) had

confused the basic stricture of moving from the dan tian for a generation of

students.

 

It makes no sense to squelch Chinese philosophy. The buy-in is not so

expensive and the benefits are so potentially useful that it is easy to justify

the investment.

 

Bob

 

 

 

 

 

bob Paradigm Publications

www.paradigm-pubs.com 44 Linden Street

Robert L. Felt Brookline MA 02445

617-738-4664

 

 

---

[This E-mail scanned for viruses by Declude Virus]

[Guest guest]

It seems to me that the main benefit of knowing Chinese medical philosophy is that it helps you learn how to think in the Chinese medical context and therefore how to examine and solve problems using the foundation principles. Thus, looking for evidence of its value in some sort of telling detail -- some `smoking gun' proof -- seems to me like trying to measure water with a yardstick.>>>>Again I think we are mixing things here. To frame thought in CM just takes good basic clinical training. It has nothing to do with knowing philosophy or Chinese. When I was in China every case had to be presented in TCM terms from starting first with a so called disease name to pattern differentiation. It just takes intelecturtal understanding of the basics of TCM. Lets not make it more than it is

Alon

[Guest guest]

Alon,

 

> >>>>Again I think we are mixing things here. To frame thought in CM

just takes good basic clinical training. It has nothing to do with

knowing philosophy or Chinese. When I was in China every case had to

be presented in TCM terms from starting first with a so called

disease name to pattern differentiation. It just takes intelecturtal

understanding of the basics of TCM. Lets not make it more than it is

 

 

So when Sun Si Miao, who is widely regarded

as a God of Medicine in traditional Chinese

medical circles, writes that we need to study

all the various schools of thought and subjects

like astronomy and geography and be possessed

of wide learning in order to set ourselves well

on the path of medicine, does that fall within

the " basics of TCM? "

 

If not, then clearly you too have rejected the

classical transmission. One of the basics of

medical studies in China for thousands of years,

not just according to Sun but according

to widespread scholarship and broad cultural

understanding is that in order to be a good

Doctor of Chinese traditional medicine, an

individual needs to be widely educated and

is expected to be in possession of a deep

understanding of those factors that constitute

the challenges to life and survival about

which patients come seeking help. These,

of course, include the terms that constitute

the definitions of life, which are found

in the realm of philosophy. The well educated

doctor of Chinese medicine is taught to understand

that what people need and seek help with is

not merely their symptoms but their lives.

 

Part of that search for help involves the

desire to find someone in whom one can place

one's trust, having faith that the doctor's

higher education and deeper understanding

of things will enable him or her to guide

the individual through the illness and back

to health.

 

This, of course is a requirement of most

patients of all forms of medicine and different

patients naturally express it differently.

These differences reflect both individual and

group or cultural values and methods of

constructing relationships. And medicine

always reflects this matrix of values in

which it develops. I'm talking about real

clinical medicine. As Unschuld has noted in

Medicine in China, the primary influences

on medicine are social.

 

Thus the character of any medicine can only

be fully understood when it is studied within

its generative context. To suggest that our

study of it conform to this principle is not

trying to make something more of it. To suggest

that it can be adequately studied outside of

its linguistic and literary contexts is making

something less of it.

 

The trust between doctor and patient, however

it is considered to fit into the equations of

clinical interventions, does fit in. If the

patient had no trust in the doctor, he or she

wouldn't be in the clinic at all.

 

For an individual to promote to the public

that he or she is a doctor of Chinese medicine

suggests (even if the public is poorly educated

in what to expect) that that individual is in possession

of the various requirements and prerequisites

of the study of Chinese medicine. These

prerequisites are clearly delineated and even

in modern state run colleges and universities of

TCM, which do not necessarily hold ancient Chinese

ideals in a loftier position than modern scientific

ones, the prerequisites proposed by Sun Si Miao

are reflected in the curricula offered to students.

 

Of course it's done differently in China than

the same function would have to be done in places

where Chinese language and culture are not the

norm. And there is widespread debate and discussion

in Chinese medical circles these days in China

concerning the role of traditional values in

modern education in the subject.

 

As there should be here, as well, particularly

as we have entered this phase in the development

of the profession where a doctorate degree in the

subject is intended to attain a level of supposed

credibility that it has previously lacked.

 

Within this context it is vitally important

that we bring the discussion of the meaning of

certain terms into clear focus. What does it

mean to be a doctor of Chinese medicine? What

does a doctor of Chinese medicine do? How is

it done? According to what reasons? Principles?

Theories? Accepted practices?

 

These are more than reasonable questions.

They are the questions that must be asked during

the course of acculturation of the subject, among

many, many others.

 

I am not suggesting that there needs to be

a single answer to any question or even a

coherent set of answers. But the questions

have to be asked and people have to think

about what they mean, at least to themselves

as individual practitioners.

 

 

Ken

[Guest guest]

, " Robert L. Felt " <bob@p...>

wrote:

 

> In one case, knowing that a SHL pattern involved heat effusion

was the clue

> that gave me the confidence to give a strong-acting formula to

my middle

> son in a circumstance that was scary.

 

Bob

 

this is not what I was thinking of when I asked for an example.

You are talking about strictly medical knowledge here. I don't

think anyone is arguing against depth of knowledge in CM.

Flaws says the main reason to learn chinese is to be able to

have this depth and access. I would be more interested in an

example of how the knowledge of nonmedical use of terms also

used in TCM would enhance one in clinic. For example, if I learn

about how the term qi is used by Zen landscape painters, how

will that affect my diagnosis of qi disorders in clinic. The patient

still needs to have a preponderance of signs and symptoms that

point to qi stagnation or depression or vacuity. Nothing else can

substitute for this. And, in fact, it is a major problem in teaching

clinics to get students to think in these concrete terms and

refrain from being too loose and philoosphical in justifying their

diagnosis. Liver constraint is confirmed by wiry pulse,

distending sensations, emotional volatility. It is not confirmed

because the patient dreams of dragons (rationale: liver is wood;

wood color is blue-green, the same color as the scales of a

dragon).

 

On the other hand, I think there is immense benefit to learning

zen painting, meditation, tai ji, etc. These practices immerse

one in a state of mind that is conducive to all chinese arts and

sciences. But this state of mind is something wholly different

than the knowledge that comes from learning term meanings. I

can see how a state of mind that promotes seeing connections

and networks rather than linear causality is helpful. But I just

don't see how my intellectual understanding of qi or yang

outside the scope of medicine would cause me to make a

different dx.

 

If what is being said is that this intellectual study will alter my

consciousness in a way that likewise makes me more of a

chinese thinker, I can entertain that idea. However, I believe I am

not alone in my assessment of many native speaking chinese

docs I have worked with: quite a few exhibit very rigid, linear,

causal approaches to their TCM. thus, the mere knowledge of

chinese and being part of that culture is clearly not the crux of

this matter. there is something else more critical. In fact, when I

consider those who have taken up a chinese art (music,

painting, tea ceremomy, gong fu, qi gong, etc.) and compare

them to those who have merely made an intellectual study of

philosophy and language, I can say unequivocally that those

who have taken up the practices impress me far more in clinic

than those who are merely ivory tower scholars. I know those on

this list who are arguing the philosophy point are also involved in

chinese arts. So I am not suggesting that you are disconnected

scholars, but that perhaps much of the depth of understanding

you possess has more to do with your practice than your study.

 

[Guest guest]

This sounds similar to the argument that MDs and DCs make in their

desire to practice TCM with only 200 hours training.

 

 

Jim Ramholz

 

 

 

 

, " Alon Marcus " <alonmarcus@w...> It

just takes intelecturtal understanding of the basics of TCM. Lets

not make it more than it is

[Guest guest]

Jim,

 

> This sounds similar to the argument that MDs and DCs make in their

> desire to practice TCM with only 200 hours training.

>

> , " Alon Marcus " <alonmarcus@w...> It

> just takes intelecturtal understanding of the basics of TCM. Lets

> not make it more than it is

 

It is, of course, precisely the same argument.

 

There are different reasons why we debate.

As I've said, my reason is not so much to

try and change people's minds as it is to

use the process of exchanging opposing points

of view to provide people with the information

that they need to make up their own minds.

 

But I'm glad that we're making it clear where

the quick and easy approach leads. It gets so

quick and easy that it's gone.

 

I suspect that there are not many MDs on

this list, but I say the same thing when

I talk with MDs or with anyone else for

that matter. Anybody who aims to study

the subject responsibly, comprehensively,

and in a way that can sustain the repetitive

production of competent doctors has got

to pay attention to the language and the

literature.

 

To the degree that we haven't we are

suffering as a profession, and to the

degree that we do in the future we

enhance our chances of survival.

 

Ken

[Guest guest]

So when Sun Si Miao, who is widely regardedas a God of Medicine in traditional Chinesemedical circles, writes that we need to studyall the various schools of thought and subjectslike astronomy and geography and be possessedof wide learning in order to set ourselves wellon the path of medicine

>>>>>Like I said there is no Gods for me, only possibly audited clinical outcomes

Alon

[Guest guest]

astronomy and geography

>>>When somebody shows me it really makes a diffrent I will study more astronomy

Alon

[Guest guest]

that what people need and seek help with isnot merely their symptoms but their lives.>>>So should we all turn Chinese

Alon

[Guest guest]

character of any medicine can onlybe fully understood when it is studied withinits generative context.

>>>Except that I am interested in its application not its character.

Alon

[Guest guest]

On the other hand, I think there is immense benefit to learning zen painting, meditation, tai ji, etc.

>>>Are these different than lets say playing piano?

Alon

[Guest guest]

Alon,

 

> So when Sun Si Miao, who is widely regarded

> as a God of Medicine in traditional Chinese

> medical circles, writes that we need to study

> all the various schools of thought and subjects

> like astronomy and geography and be possessed

> of wide learning in order to set ourselves well

> on the path of medicine

> >>>>>Like I said there is no Gods for me, only possibly audited

clinical outcomes

 

Prescriptions become worth a thousand pieces

of gold when they are discovered to be capable

of successfuly bringing about clinical outcomes.

 

If the knowledge that leads up to the formulation

and use of such formulas is not pertinent, then

what are you saying about the subject? " God " in

this usage does not mean " God " in the sense that

it has in English. It means someone who is widely

reverred, and in the case of physicians such

reverance is reserved for those who were most

successful in saving lives and helping people

to be healthy.

 

Sun and many other great doctors have written

down their thoughts and methods.

 

Why do you scorn them?

 

You have not read them. You do not know

what they say. But you know that time

devoted to studying them is not well spent.

And yet you have adopted a position with

respect to their study that, if followed

by others, would lead to the utter abandonment

of the great majority of the knowledge base of the subject.

 

Where is your evidence that this approach

can be expected to succeed?

 

Only clinical results matter?

 

You are suggesting that we abandon this

vast accumulation of knowledge and

experience in how to bring about effective

clinical results because only clinical

results matter?

 

Does that make any sense at all?

 

Ken

[Guest guest]

I also don't believe in " Gods " . . . .but great historical luminaries, I

do.

 

And I don't know how you can audit history. . .and without history,

there are no roots, no branches, no legacy, and no place to grow.

 

 

On Sunday, March 17, 2002, at 01:36 PM, Alon Marcus wrote:

 

> So when Sun Si Miao, who is widely regarded

> as a God of Medicine in traditional Chinese

> medical circles, writes that we need to study

> all the various schools of thought and subjects

> like astronomy and geography and be possessed

> of wide learning in order to set ourselves well

> on the path of medicine

> >>>>>Like I said there is no Gods for me, only possibly audited

> clinical outcomes

> Alon

>

[Guest guest]

Chinese astronomy is a very interesting subject vis a vis medicine

because of its great influence on such things as wu yun liu qi/five

movements six qi. This is of great importance in acupuncture practice,

and has a strong influence in the Nei Jing, which devotes several

chapters to the subject, and in the Pi Wei Lun of Li Dong-yuan.

 

 

On Sunday, March 17, 2002, at 01:37 PM, Alon Marcus wrote:

 

> astronomy and geography

> >>>When somebody shows me it really makes a diffrent I will study more

> astronomy

> Alon

>

 

>

>

> 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]

What matters about Chinese medicine is not that it is Chinese, but that

it is one of the few relatively intact medical systems to predate modern

medicine that still is in use, and with a historical literature for

reference. Otherwise, we are in the dilemma of all the great medicines

of, for example, Native Americans that was handed down as oral

transmission and largely lost.

 

I don't have any particular attachment to any culture, and Bob Flaws

points on this are well taken. However, if we are going to devote

ourselves to the practice of the medicine that was given us by Chinese

culture, it makes sense we should know something about the cultural

context in which it developed.

 

 

On Sunday, March 17, 2002, at 01:38 PM, Alon Marcus wrote:

 

> that what people need and seek help with is

> not merely their symptoms but their lives.

> >>>So should we all turn Chinese

> Alon

>

 

>

>

> 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]

This, unfortunately, is also my experience with some native Chinese

docs, but certainly not all. It may speak to some of the problems with

TCM education in mainland China. . . I know the CAOM journal had an

article by a scholar in Chengdu who is a friend of Ken Rose, dealing

with this subject. Perhaps the educational model in some Chinese

institutions, or in the Western medical schools that have more

abbreviated TCM courses is the problem (many Chinese docs in the U.S.

were trained as M.D.'s). But since I have no direct experience with the

Chinese educational system, I will leave this just as personal

speculation, and wait to hear from individuals who have experience with

the Chinese educational experience.

 

 

On Sunday, March 17, 2002, at 10:56 AM, 1 wrote:

 

> If what is being said is that this intellectual study will alter my

> consciousness in a way that likewise makes me more of a

> chinese thinker, I can entertain that idea.  However, I believe I am

> not alone in my assessment of many native speaking chinese

> docs I have worked with:  quite a few exhibit very rigid, linear,

> causal approaches to their TCM.  thus, the mere knowledge of

> chinese and being part of that culture is clearly not the crux of

> this matter.  there is something else more critical. 

[Guest guest]

I would add to Ken's points with the following.

 

I think, as a profession, we need to better define our goals, especially

with people clamoring for D.O.M. licenses and doctorate programs

developing.

 

There is a demarcation between a physician and a therapist. A therapist

is a technician, one who specializes in one aspect of medicine, and

concentrates on technique. There is nothing wrong with being a

therapist, which can accomplish a great deal clinically, and doesn't

require as much broad study of other areas.

 

In every medical tradition I have studied about, from Greco-Arabic

(whose greatest practitioners were philosophers, poets, and

mathemeticians as well) to Ayurvedic and Homeopathic, a physician is

required to have a broad background in a variety of subjects, spanning

the arts and sciences. In modern times, the degree of specialization is

much greater in the sciences, but there are new attempts to bridge these

walls, such as in complexity theory.

 

In modern biomedicine, you notice that M.D.'s often have a broad range

of knowledge on different subjects, and sometimes even degrees in those

subjects. Physicians often write books of poetry, or essays on

political issues (see " Art and Science " by Leonard Schlain, M.D., Larry

Dossey's work, or the essays of the Argentine physiologist, Cabal). It

has become necessary, to be on the cutting edge of modern medicine, to

be aware of neuroscience, genomics, proteomics, computer science and a

host of other disciplines.

 

The more learned and erudite the practitioner, the broader his or her

mind, the better practitioner he or she will be.

 

Otherwise, do we really deserve to be primary health care

practitioners? Or are we more like physical therapists?

 

 

 

 

On Sunday, March 17, 2002, at 07:45 AM, dragon90405 wrote:

 

> Alon,

>

> > >>>>Again I think we are mixing things here. To frame thought in CM

> just takes good basic clinical training. It has nothing to do with

> knowing philosophy or Chinese. When I was in China every case had to

> be presented in TCM terms from starting first with a so called

> disease name to pattern differentiation. It just takes intelecturtal

> understanding of the basics of TCM. Lets not make it more than it is

>

>

> So when Sun Si Miao, who is widely regarded

> as a God of Medicine in traditional Chinese

> medical circles, writes that we need to study

> all the various schools of thought and subjects

> like astronomy and geography and be possessed

> of wide learning in order to set ourselves well

> on the path of medicine, does that fall within

> the " basics of TCM? "

[Guest guest]

Alon--Probably not, if one approaches playing piano like Keith Jarrett

does, and that is zen. The benefit is in the way of doing.

Frances

Alon Marcus wrote:

 

On the other

hand, I think there is immense benefit to learning

zen painting, meditation, tai ji, etc.>>>Are

these different than lets say playing piano?Alon

 

that what people need and seek help with is

not merely their symptoms but their lives.

>>>So should we all turn Chinese

 

I swear I can't 'turn Chinese,' hard as I try!

Frances

 

 

 

 

 

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]

The issue isn't scope of practice. . . .we have a physician's definition

by law in California. . . .but let's live up to our privilege! I don't

see where most acupuncturists are prepared for a CM doctor's level of

responsibility as defined in China or Taiwan.

 

 

 

P.S. Can you correct the date on your e-mail program?

 

 

On Saturday, April 6, 2002, at 04:05 PM, Teresa Hall wrote:

 

>  

>

> There is a demarcation between a physician and a therapist. A therapist

> is a technician, one who specializes in one aspect of medicine, and

> concentrates on technique. There is nothing wrong with being a

> therapist, which can accomplish a great deal clinically, and doesn't

> require as much broad study of other areas.

>  

> According to a Worker's Comp Labor Code Acupuncturist are included in

> the definition of physician, I am also giving these patients herbal

> medicinals, as herbs are very much a part of our scope of practice!

>  

> Teresa

>

>

 

>

>

> 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]

Why do you scorn them?>>>>No I do not scorn them but I do put anything anybody, be it modern or old, in to be evaluated box. No gods of info especially when written in such vague ways as do so many of CM literature. Again I have to judge everything I hear and read by what I have seen in REAL LIFE PATIENTS

Alon

[Guest guest]

You have not read them. You do not knowwhat they say. But you know that timedevoted to studying them is not well spent.And yet you have adopted a position with respect to their study that, if followed by others, would lead to the utter abandonment of the great majority of the knowledge base of the subject

>>>>Ken you have no idea what I have read or had translated or was exposed to. Dont make too many assumptions just because I may have a totally different conclusion of similar information.

Alon

[Guest guest]

And I don't know how you can audit history. . .and without history, there are no roots, no branches, no legacy, and no place to grow.>>>That is why we need reliable modern audits

Alon

[Guest guest]

Chinese astronomy is a very interesting subject vis a vis medicine because of its great influence on such things as wu yun liu qi/five movements six qi. This is of great importance in acupuncture practice, and has a strong influence in the Nei Jing, which devotes several chapters to the subject, and in the Pi Wei Lun of Li Dong-yuan.>>>Again I will wait for reliable data

Alon

[Guest guest]

Chinese, but that it is one of the few relatively intact medical systems to predate modern medicine that still is in use, and with a historical literature for reference.

>>>Agreed and that is why I choose to spend my time in studying it, even though we may disagree on what is important and how to study it

Alon

[Guest guest]

The more learned and erudite the practitioner, the broader his or her mind, the better practitioner he or she will be

>>>Z've again no argument except for we are talking about what will be required learning. Here I agree we should priorities and I am one that thinks there is much to add in the clinical arena. I think the question of language and translations are best left for people with special skills.

Alon