Guest guest Posted March 25, 2002 Report Share Posted March 25, 2002 There is one generalization I could make about PRC practitioners who are in the West. That is that without the option of using Western medications, the Chinese doctor has to sharpen their own TCM skills. I have heard this many times from very experienced PRC doctors. They find it interesting that they learn more about TCM in America. (Welcome to America, like religions, fundamentalism flowers here.) I don't know if practitoners from Vietnam, Korea and Taiwan feel the same way. doug Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 25, 2002 Report Share Posted March 25, 2002 Doug, This was my point on earlier posts. When I was an intern at FITCM, my second patient had terrible sores on his legs, which were about to be amputated. This man was blind and through the years had hurt his legs by constantly hitting them on furniture, oven doors, etc. His legs were pre-gangrene and according to his MD amputation was the only way out. I found it interesting that all the Chinese doctors with such vast experience in Chinsese hospitals were lost with this case. One doctor said the legs would never heal and that the herbs needed were too toxic and not available here in the States. Long story short, the man's legs were saved by a combination of his body's innate desire to heal, my limited TCM knowledge, some Colombian folk medicine and high dosage of supplements. After his legs healed, I " prescribed " soccer shin guards as prophylactics. Here in the States we are limited by scope of practice to TCM protocols, and I consider this a blessing and not an issue to lament over.. ~Fernando " When your only tool is a hammer, everything looks like a nail " , wrote: > There is one generalization I could make about PRC practitioners who are in the West. That is that without the option of using Western medications, the Chinese doctor has to sharpen their own TCM skills. I have heard this many times from very experienced PRC doctors. They find it interesting that they learn more about TCM in America. (Welcome to America, like religions, fundamentalism flowers here.) > I don't know if practitoners from Vietnam, Korea and Taiwan feel the same way. > doug Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 25, 2002 Report Share Posted March 25, 2002 Doug, > There is one generalization I could make about PRC practitioners who are in the West. That is that without the option of using Western medications, the Chinese doctor has to sharpen their own TCM skills. I have heard this many times from very experienced PRC doctors. They find it interesting that they learn more about TCM in America. (Welcome to America, like religions, fundamentalism flowers here.) > I don't know if practitoners from Vietnam, Korea and Taiwan feel the same way. Interesting observation. Certainly it reflects the fact that what exists in China tends to be a far more integrated approach to dispensing medications and medical care in general. One of the common eye-opening experiences for those who go to China is their first visit to a large pharmacy in any of the large cities. Such large pharmacies invariably have both Chinese and Western sections. In general the population, that self medicates as much if not more than Americans, has a general sense of when to use Western medications and when to rely on traditional Chinese medicine. For most Chinese that I know, it's not in the slightest sense an ideological issue. They don't relate to Chinese medicine in terms of its implications as an expression of their lifestyle. They're not into it as a form of alternative anything. I agree that we can generalize about this, if only to represent the most common and general attitude that is widely held among those in China who credit traditional Chinese medicine at all: for acute disease use Western medicine because it is powerful and brings about rapid results; for chronic disease use Chinese medicine because it acts slowly and at a deeper level and can often treat conditions that Western medicine cannot reach. I've heard this refrain countless times when discussing tradtional Chinese medicine with Chinese from all backgrounds in China. With this in mind, it makes sense that doctors with a great deal of experience interacting with a population of patients that tends to hold such views would find themselves challenged, particularly in the treatment of acute conditions (if my amateur sociology is at all accurate), by not having the complement of Western medications to turn to for fast and easy symptomatic relief. And it follows naturally that their skills in dealing with illness of all kinds would noticably increase. The other factor that I think should also be borne in mind when evaluating the significance of what these veteran doctors you refer to say is that any doctor practicing anywhere probably steadily increases in competence owing to the accumulation of experience and deepening of understanding. And just being in a culture and society other than one's native land tends to sharpen the senses. An old Chinese saying advises to " sing the local tune " or in the English cliche, " when in Rome, do as the Romans. " And this, of course, is a version to some extent of " different patient, differnt time, different place: different treatment. " A further point here: If you look at the issues relating to Chinese vs. Western medicine from a longterm Chinese perspective, it appears quite obvious that the Chinese people have been engaged for millennia now in the development of medicine, both at a theoretical and clinical level. This long history is full of incidents of incorporation of foreign (i.e. non-Chinese in origin) ideas, substances, methods, etc. And the current integration of Chinese and Western medicine takes place in this context. To be sure, there are yet old veteran doctors of traditional Chinese medicine in China who utterly shun all " modern " medicine relying strictly on " traditional " means. I've heard such argue that the reliance upon Western medical understandings, let alone technologies, weakens both doctor and patient. But in my limited experience, this is a view held by a diminishing minority. And I'm not even sure that it could be accurately characterized as more " traditional " than the view that holds for greater integration of the two approaches to medical care, given what I've just pointed out about the longterm view of history and the incorporation of foreign ideas and medicines, which each would have been quite new and different upon arrival in China, even if now they all form part of our historical view. Of course, when you're in the clinic all that matters...or all that should matter is the patient in front of you, and decisions should be made not on the basis of ideological committments but by getting the best possible answers to what will help the patient. The call for higher standards of literacy among the Chinese medical community in the States is not an ideological campaign or an attempt to establish some sort of new or old orthodoxy. It is simply a recognition of two facts: 1) doctors need to know what they're talking about; and 2) as a group, we've been lax on this and now need to boost up what has been deficient. Ken Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 25, 2002 Report Share Posted March 25, 2002 , wrote: > There is one generalization I could make about PRC practitioners who are in the West. That is that without the option of using Western medications, the Chinese doctor has to sharpen their own TCM skills. Interesting point. Most docs from china I have met make liberal use of antibiotics, antidepressants, sedatives, etc. on their own families. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 26, 2002 Report Share Posted March 26, 2002 Fernando, This brings up the issue of the effect of knowledge on outcomes. I'm sure we've all heard the old saying, " Ignorance is bliss; t'is folly to be wise. " I have often seen practitioners who did not have much clinical experience get great results in cases they, perhaps, should not've simply because they did not know that such cases are commonly considered not well treated by Chinese medicine. Ted Kaptchuk once said that the universe gives all new practitioners their first 10 patients as cures, again, because as newbies, we don't know any better. My first Chinese doctor-teacher was Eric (Xi-yu) Tao. He once said that young practitioners who work on faith and enthusiasm, typically with rote memorized, disease-based formulas, typically get better results than practitioners who have been in practice longer and who know more. Then he said, if you are lucky, at some point, you figure things out for yourself, your confidence returns, and your results go back up again. As a practitioner, I sometimes wonder if my knowledge of the Chinese medical literature on a particular, difficult-to-treat condition works for or against my patients' best interests. Uterine myomas are a case in point which we have discussed before on this list. We have all heard anecdotal cases, commonly reported by neophytes, of large myomas completed resolving. However, the Chinese literature seems clear that the larger the myoma (and the more deeply situated), the less likely it is to significantly shrink or disappear. So, if the patient asks what the prognosis is and she has a large myoma, does it work against the patient to answer her question honestly. In my experience (and I have been in this situation many, many times), if I'm honest with myself, I think my honesty with the patient actually robs them of hope. Therefore, I sometimes wonder if I am doing a service or a disservice of reporting to students less than sterling outcomes, either based on my personal experience or on a reading of the Chinese literature. In reading your posting, it seems to me that your better than expected outcome (at least better than the other Chinese-trained doctors expected) was, at least partially based on your lack of experience and your faith in the medicine. So my question is, in the realm of Chinese medicine where the bottom line is the health and healing of the patient, is ignorance sometimes better? If not, how can we, as practitioners, not allow our knowledge to negatively affect our half of the placebo equation? Is this possible? Some of the most effective clinicians I have studied under were not the smartest or the best educated, but they were the most confident and confidence-inspiring. Dr. Tao never looked right or left, didn't read the literature, wasn't interested in talking about this or that theory, and couldn't care less what other practitioners were doing. I think he often hid behind his professed inability to speak medical English, and, when patients asked if he could help them, he always said nothing more than yes, he thought he could, and not to worry. I personally find this a very sticky issue. Any clarity anyone else can bring to this issue would be much appreciated. Bob , " fbernall " <fbernall@a...> wrote: > Doug, > > This was my point on earlier posts. When I was an intern at FITCM, my > second patient had terrible sores on his legs, which were about to be > amputated. This man was blind and through the years had hurt his legs > by constantly hitting them on furniture, oven doors, etc. His legs > were pre-gangrene and according to his MD amputation was the only way > out. > > I found it interesting that all the Chinese doctors with such vast > experience in Chinsese hospitals were lost with this case. One doctor > said the legs would never heal and that the herbs needed were too > toxic and not available here in the States. > > Long story short, the man's legs were saved by a combination of his > body's innate desire to heal, my limited TCM knowledge, some Colombian > folk medicine and high dosage of supplements. After his legs healed, > I " prescribed " soccer shin guards as prophylactics. > > Here in the States we are limited by scope of practice to TCM > protocols, and I consider this a blessing and not an issue to lament > over.. > > ~Fernando > > " When your only tool is a hammer, everything looks like a nail " > > > > > , wrote: > > There is one generalization I could make about PRC practitioners who > are in the West. That is that without the option of using Western > medications, the Chinese doctor has to sharpen their own TCM skills. I > have heard this many times from very experienced PRC doctors. They > find it interesting that they learn more about TCM in America. > (Welcome to America, like religions, fundamentalism flowers here.) > > I don't know if practitoners from Vietnam, Korea and Taiwan feel the > same way. > > doug Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 26, 2002 Report Share Posted March 26, 2002 Dear Bob, Thank you for such profound thoughts. Fernando , " pemachophel2001 " <pemachophel2001> wrote: > Fernando, > > This brings up the issue of the effect of knowledge on outcomes. I'm > sure we've all heard the old saying, " Ignorance is bliss; t'is folly > to be wise. " I have often seen practitioners who did not have much > clinical experience get great results in cases they, perhaps, should > not've simply because they did not know that such cases are commonly > considered not well treated by Chinese medicine. Ted Kaptchuk once > said that the universe gives all new practitioners their first 10 > patients as cures, again, because as newbies, we don't know any > better. > > My first Chinese doctor-teacher was Eric (Xi-yu) Tao. He once said > that young practitioners who work on faith and enthusiasm, typically > with rote memorized, disease-based formulas, typically get better > results than practitioners who have been in practice longer and who > know more. Then he said, if you are lucky, at some point, you figure > things out for yourself, your confidence returns, and your results go > back up again. > > As a practitioner, I sometimes wonder if my knowledge of the Chinese > medical literature on a particular, difficult-to-treat condition works > for or against my patients' best interests. Uterine myomas > are a case in point which we have discussed before on this > list. We have all heard anecdotal cases, commonly reported > by neophytes, of large myomas completed resolving. However, > the Chinese literature seems clear that the larger the myoma > (and the more deeply situated), the less likely it is to > significantly shrink or disappear. So, if the patient asks > what the prognosis is and she has a large myoma, does it > work against the patient to answer her question honestly. In my > experience (and I have been in this situation many, many times), if > I'm honest with myself, I think my honesty with the patient actually > robs them of hope. Therefore, I sometimes wonder if I am doing a > service or a disservice of reporting to students less than sterling > outcomes, either based on my personal experience or on a reading of > the Chinese literature. > > In reading your posting, it seems to me that your better than expected > outcome (at least better than the other Chinese-trained doctors > expected) was, at least partially based on your lack of experience and > your faith in the medicine. So my question is, in the realm of Chinese > medicine where the bottom line is the health and healing of the > patient, is ignorance sometimes better? > > If not, how can we, as practitioners, not allow our knowledge to > negatively affect our half of the placebo equation? Is this possible? > Some of the most effective clinicians I have studied under were not > the smartest or the best educated, but they were the most confident > and confidence-inspiring. Dr. Tao never looked right or left, didn't > read the literature, wasn't interested in talking about this or that > theory, and couldn't care less what other practitioners were doing. > I think he often hid behind his professed inability to speak medical > English, and, when patients asked if he could help them, he always > said nothing more than yes, he thought he could, and not to worry. > > I personally find this a very sticky issue. Any clarity anyone else > can bring to this issue would be much appreciated. > > Bob > > , " fbernall " <fbernall@a...> wrote: > > Doug, > > > > This was my point on earlier posts. When I was an intern at FITCM, > my > > second patient had terrible sores on his legs, which were about to > be > > amputated. This man was blind and through the years had hurt his > legs > > by constantly hitting them on furniture, oven doors, etc. His legs > > were pre-gangrene and according to his MD amputation was the only > way > > out. > > > > I found it interesting that all the Chinese doctors with such vast > > experience in Chinsese hospitals were lost with this case. One > doctor > > said the legs would never heal and that the herbs needed were too > > toxic and not available here in the States. > > > > Long story short, the man's legs were saved by a combination of his > > body's innate desire to heal, my limited TCM knowledge, some > Colombian > > folk medicine and high dosage of supplements. After his legs > healed, > > I " prescribed " soccer shin guards as prophylactics. > > > > Here in the States we are limited by scope of practice to TCM > > protocols, and I consider this a blessing and not an issue to lament > > over.. > > > > ~Fernando > > > > " When your only tool is a hammer, everything looks like a nail " > > > > > > > > > > , > wrote: > > > There is one generalization I could make about PRC practitioners > who > > are in the West. That is that without the option of using Western > > medications, the Chinese doctor has to sharpen their own TCM skills. > I > > have heard this many times from very experienced PRC doctors. They > > find it interesting that they learn more about TCM in America. > > (Welcome to America, like religions, fundamentalism flowers here.) > > > I don't know if practitoners from Vietnam, Korea and Taiwan feel > the > > same way. > > > doug Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 26, 2002 Report Share Posted March 26, 2002 Bob, To echo what Fernando just said, thanks for the profound thoughts. > This brings up the issue of the effect of knowledge on outcomes. It this isn't philosophy, I'm really not sure what is. I'm not complaining. Just bemused that one week you're fed up with philosophy and two weeks later you're probing into an extremely complex question that demands consideration of various philosophical as well as ethical issues. I'm > sure we've all heard the old saying, " Ignorance is bliss; t'is folly > to be wise. " But people don't usually repeat this on the way to see their doctor hoping that they will meet up with an ignoramus who will somehow stumble into a cure. I'm not saying there aren't people who do indeed prefer to rely on ignorance, i.e. the ignorance that faith requires, when it comes to healing. Faith requires ignorance because if we have knowledge or proof of a thing it is not worthy of nor does it require faith. Faith healers therefore are defined by their ignorance of anything other than their faith in whatever manifestation of spiritual forces they credit with their healing power. I have often seen practitioners who did not have much > clinical experience get great results in cases they, perhaps, should > not've simply because they did not know that such cases are commonly > considered not well treated by Chinese medicine. I think that that statement includes a number of assumptions and supposed causal relationships, which strictly speaking ought not be taken as fact simply because they are assumed. How can we know that of the many factors involved, most of which you haven't included in your description, it is the individual's ignorance that results in the effective cure? After all, everybody is an unexperienced beginner until they accumulate a little experience. Fernando in recounting his anecdote likewise jumps to the conclusion that because " veteran " doctors from China were unable to accomplish what, as a novice he could, that there is something questionable about the status of being a veteran doctor from China. I'm not at all convinced that that is so, and I want to point out that the assumption is not logically warranted by the evidence presented. I do very much recognize that there have been a number of " veteran doctors from China " who have come to the USA and proven to be less than admirable for many reasons. The interface between cultural, social, and political realities is a very complex field of view. I urge a great deal more caution and consideration before drawing conclusions. Maybe those particular veteran doctors for whatever reasons, simply lacked the skill to deal with it, or perhaps it was motivation. I've no idea about the particulars involved and do not mean to be making suggestions about them. But I do know that conditions for Chinese doctors at various schools around the country have been challenging over the years, and challenging conditions produce stresses and strains that always end up affecting clinical actualities. A doctor throwing up his hands on a patient may be an all too common occurrence, but it is never one to take lightly or about which we can assume that we know the reasons why without really finding out. Ted Kaptchuk once > said that the universe gives all new practitioners their first 10 > patients as cures, again, because as newbies, we don't know any > better. With all due respect all around, that doesn't make it so. > > My first Chinese doctor-teacher was Eric (Xi-yu) Tao. He once said > that young practitioners who work on faith and enthusiasm, typically > with rote memorized, disease-based formulas, typically get better > results than practitioners who have been in practice longer and who > know more. Then he said, if you are lucky, at some point, you figure > things out for yourself, your confidence returns, and your results go > back up again. Clearly, anybody who could make such a statement, by his own example, is living breathing evidence that ignorance loses out in the contest with knowledge. How else would he know? > As a practitioner, I sometimes wonder if my knowledge of the Chinese > medical literature on a particular, difficult-to-treat condition works > for or against my patients' best interests. Uterine myomas > are a case in point which we have discussed before on this > list. We have all heard anecdotal cases, commonly reported > by neophytes, of large myomas completed resolving. However, > the Chinese literature seems clear that the larger the myoma > (and the more deeply situated), the less likely it is to > significantly shrink or disappear. So, if the patient asks > what the prognosis is and she has a large myoma, does it > work against the patient to answer her question honestly. In my > experience (and I have been in this situation many, many times), if > I'm honest with myself, I think my honesty with the patient actually > robs them of hope. Therefore, I sometimes wonder if I am doing a > service or a disservice of reporting to students less than sterling > outcomes, either based on my personal experience or on a reading of > the Chinese literature. According to the maxim, different patient, different place, different time: different treatment, one would have to adjust one's revelation of information to any particular patient on the basis of an assessment, not of how such revelation affects patients in general but how revelation of the specific information about that patient will affect him or her. I don't see the issue here as to know or not to know, rather, to know thoroughly and completely. Generally over time one tends towards knowing. Bucky Fuller pointed out in Operating Manual for Spaceship Earth that metaphysical wealth, i.e., what we know, is always increasing. Even if we find out that everything we thought was true yesterday is wrong, today we know more because we are in possession of that one vastly superior bit of knowledge that allows us to evaluate earlier knowledge. Diagnosis means complete knowledge and Chinese medical theory does provide tools with which adequately trained practitioners can thoroughly know their patients conditions including their tolerance level for the kind of emotional challenge that the truth about what's happening to their bodies is likely to present. I think this is one particular clinical skill that doctors of all size and shape could learn well from their traditional Chinese colleagues. This sensitivity to the emotional state of the patient and its importance in both diagnosis and therapeutics are hallmarks of Chinese medical doctors as illustrated in the story of Hua Tuo who cures a patient by getting him angry and causing him to cough up a blood clot. > > In reading your posting, it seems to me that your better than expected > outcome (at least better than the other Chinese-trained doctors > expected) was, at least partially based on your lack of experience and > your faith in the medicine. So my question is, in the realm of Chinese > medicine where the bottom line is the health and healing of the > patient, is ignorance sometimes better? I asked my tai4 ji2 teacher, Martin Inn, who is also a veteran acupuncturist, if he would submit an article to CAOM. He answered my request by saying that he didn't know anything about Chinese medicine so what could he possibly write? The Daoists have been saying ignorance is better for thousands of years. Laozi says that to follow the Dao you lose every day, whereas to follow the path of knowledge, every day you accumulate. But he also says that to know yet seem not to is best and that one who knows does not speak. Do you think you can ignore Daoist philosophy and contemplate the question you have raised about the practice of Chinese medicine? > > If not, how can we, as practitioners, not allow our knowledge to > negatively affect our half of the placebo equation? I submit that the answer to this question lies in the realm of gong1 fu1. I don't think what you're talking about can be explained by asking is ignorance preferrable to knowledge. I think we should be focusing on the quality of the transmission of the knowledge in question. Is this possible? > Some of the most effective clinicians I have studied under were not > the smartest or the best educated, but they were the most confident > and confidence-inspiring. Dr. Tao never looked right or left, didn't > read the literature, wasn't interested in talking about this or that > theory, and couldn't care less what other practitioners were doing. > I think he often hid behind his professed inability to speak medical > English, and, when patients asked if he could help them, he always > said nothing more than yes, he thought he could, and not to worry. Sounds pretty typical to me. You don't mention whether or not he ever studied the classics or anything else. How did Dr. Tao become a Dr.? Did his teachers tell him ignorance was best? > > I personally find this a very sticky issue. Any clarity anyone else > can bring to this issue would be much appreciated. I doubt that I have brought any clarity. But am certainly willing to pursue it further. I suggest we consider the impact on the field of suggesting that ignorance is better than knowledge, as a way of further clarifying things. Ken Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 26, 2002 Report Share Posted March 26, 2002 Bob, this is a "sticky issue". This is the point that Erasmus, the Dutch scholar/theologian was making in A Praise of Folly. Thou often misquoted, his was actually a rhetorical question. "If ignorace is bliss, is it folly to be wise?". Laozi often councils to "abandon wisdom, discard knowledge...make use of raw silk and embrace the uncarved block" saying further that "daoists need no wide learning, they know that erudition is not wisdom." My sense is that neither are truly arguing that ignorace preferable to knowledge in all or any situation(s). Every one agrees that that would be ludicrus. We're all quite convinced of the superiority of knowledge and experience. These writers, as well as the case study and your anecdote about Dr. Tao cause us to reconsider the potency of the "raw silk and uncarved block". Given the oppurtunity, humans by nature exchange ignorance for what we consider to be knowledge, and it seems as though something is gained in that exchange. Perhaps it is useful to consider also what is lost. As a relative "newbe" to this practice this list presents an oppurtunity for me to consider these questions. Often in reading through the threads I discover how much I don't know and I learn, and I appreciate the knowledge and experience of others. And then I go to work, and can find myself inhibited if I feel that I don't know as much as so and so and therefore doubt that I can help someone. Sometimes, of course this seems to be a healthy and true response and causes me to refer to another practioner. Other times it is important to return to the direct relationship between myself and self and the person that has sought my help and honestly discover what we have to offer each other. I'm happy to say that we usually do just fine. As practioners we will never stop learning and this is as it should be, but as people and practioners I think that it is safe to say that any of us who are honestly checking will admit that what we don't know is always bigger than what we do know. That seems to be essential to the human conditon. The practice is in honestly discovering for ourselves if lack of knowledge is always a disadvantage and knowledge is always an advantage to success. And is there danger in the practice of medicine and in life in general to assume that knowledge gives us an advantage? Thanks for the oppurtunity to ponder. Dean ---- Original Message ----- pemachophel2001 Tuesday, March 26, 2002 8:34 AM Re: generalizations Fernando,This brings up the issue of the effect of knowledge on outcomes. I'm sure we've all heard the old saying, "Ignorance is bliss; t'is folly to be wise." I have often seen practitioners who did not have much clinical experience get great results in cases they, perhaps, should not've simply because they did not know that such cases are commonly considered not well treated by Chinese medicine. Ted Kaptchuk once said that the universe gives all new practitioners their first 10 patients as cures, again, because as newbies, we don't know any better.My first Chinese doctor-teacher was Eric (Xi-yu) Tao. He once said that young practitioners who work on faith and enthusiasm, typically with rote memorized, disease-based formulas, typically get better results than practitioners who have been in practice longer and who know more. Then he said, if you are lucky, at some point, you figure things out for yourself, your confidence returns, and your results go back up again.As a practitioner, I sometimes wonder if my knowledge of the Chinese medical literature on a particular, difficult-to-treat condition works for or against my patients' best interests. Uterine myomas are a case in point which we have discussed before on this list. We have all heard anecdotal cases, commonly reported by neophytes, of large myomas completed resolving. However, the Chinese literature seems clear that the larger the myoma (and the more deeply situated), the less likely it is to significantly shrink or disappear. So, if the patient asks what the prognosis is and she has a large myoma, does it work against the patient to answer her question honestly. In my experience (and I have been in this situation many, many times), if I'm honest with myself, I think my honesty with the patient actually robs them of hope. Therefore, I sometimes wonder if I am doing a service or a disservice of reporting to students less than sterling outcomes, either based on my personal experience or on a reading of the Chinese literature.In reading your posting, it seems to me that your better than expected outcome (at least better than the other Chinese-trained doctors expected) was, at least partially based on your lack of experience and your faith in the medicine. So my question is, in the realm of Chinese medicine where the bottom line is the health and healing of the patient, is ignorance sometimes better?If not, how can we, as practitioners, not allow our knowledge to negatively affect our half of the placebo equation? Is this possible? Some of the most effective clinicians I have studied under were not the smartest or the best educated, but they were the most confident and confidence-inspiring. Dr. Tao never looked right or left, didn't read the literature, wasn't interested in talking about this or that theory, and couldn't care less what other practitioners were doing. I think he often hid behind his professed inability to speak medical English, and, when patients asked if he could help them, he always said nothing more than yes, he thought he could, and not to worry.I personally find this a very sticky issue. Any clarity anyone else can bring to this issue would be much appreciated.Bob, "fbernall" <fbernall@a...> wrote:> Doug, > > This was my point on earlier posts. When I was an intern at FITCM, my > second patient had terrible sores on his legs, which were about to be > amputated. This man was blind and through the years had hurt his legs > by constantly hitting them on furniture, oven doors, etc. His legs > were pre-gangrene and according to his MD amputation was the only way > out.> > I found it interesting that all the Chinese doctors with such vast > experience in Chinsese hospitals were lost with this case. One doctor > said the legs would never heal and that the herbs needed were too > toxic and not available here in the States.> > Long story short, the man's legs were saved by a combination of his > body's innate desire to heal, my limited TCM knowledge, some Colombian > folk medicine and high dosage of supplements. After his legs healed, > I "prescribed" soccer shin guards as prophylactics.> > Here in the States we are limited by scope of practice to TCM > protocols, and I consider this a blessing and not an issue to lament > over..> > ~Fernando> > "When your only tool is a hammer, everything looks like a nail" > > > > > , wrote:> > There is one generalization I could make about PRC practitioners who > are in the West. That is that without the option of using Western > medications, the Chinese doctor has to sharpen their own TCM skills. I > have heard this many times from very experienced PRC doctors. They > find it interesting that they learn more about TCM in America. > (Welcome to America, like religions, fundamentalism flowers here.)> > I don't know if practitoners from Vietnam, Korea and Taiwan feel the > same way.> > dougChinese 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 March 26, 2002 Report Share Posted March 26, 2002 Bob, >Some of the most effective clinicians I have studied under were not >the smartest or the best educated, but they were the most confident >and confidence-inspiring. This is an interesting point, and I have noticed it as well. I have learned from watching my mentors that to convey the assurance that we can provide help is one of the most effective ways to begin successful treatment. Is this because the patient then has more confidence and is then more open to healing? That answer requires a leap of faith, but it could play a part. I think Ken's point about different patient, different time, different treatment, etc. is quite apt. For if we truly believe in that, then we won't necessarily have our confidence shaken by negatively reported case histories, or a statement in a Western-based lit review that CM doesn't do well treating this or that. This confidence in the medicine is especially hard to maintain when we see with our own eyes, as you have, that many conditions do not respond perfectly to CM treatment. I see how sometimes our willingness to try to help can be dampened (no pun intended) by literature that says we don't have an ice cube's chance in hell of treating this condition sucessfully. I don't necessarily think that staying away from the literature is a productive way to maintain a good patient base. It reminds me of the quote " The more you read, the less you know. " But is this telling us not to read? I've never understood it that way. Take care, Sonya _______________ Send and receive Hotmail on your mobile device: http://mobile.msn.com Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 26, 2002 Report Share Posted March 26, 2002 Dean, > Bob, this is a " sticky issue " . I'd be happier calling it a slippery issue. This is the point that Erasmus, the Dutch scholar/theologian was making in A Praise of Folly. Thou often misquoted, his was actually a rhetorical question. " If ignorace is bliss, is it folly to be wise? " . Laozi often councils to " abandon wisdom, discard knowledge...make use of raw silk and embrace the uncarved block " saying further that " daoists need no wide learning, they know that erudition is not wisdom. " My sense is that neither are truly arguing that ignorace preferable to knowledge in all or any situation(s). Every one agrees that that would be ludicrus. We're all quite convinced of the superiority of knowledge and experience. These writers, as well as the case study and your anecdote about Dr. Tao cause us to reconsider the potency of the " raw silk and uncarved block " . Consider this. Without a good deal of scholarship, such as results in transmission and translation of texts which mention raw silk and uncarved blocks and the traditions that have grown up around such ideas for thousands of years, we would never even know that there was anything to reconsider...or consider in the first place. My point about philosophy is not a " philosophical " one. It's simply that given the bind in which the Daoists, Erasmus and many other thinkers have noticed that human minds exist slipping back and forth from thought to word to action to perception and so on, we are bound into complex systems of knowledge that require certain amount of study to bring to light and clarity. Given the oppurtunity, humans by nature exchange ignorance for what we consider to be knowledge, and it seems as though something is gained in that exchange. Perhaps it is useful to consider also what is lost. As a relative " newbe " to this practice this list presents an oppurtunity for me to consider these questions. Often in reading through the threads I discover how much I don't know and I learn, and I appreciate the knowledge and experience of others. And then I go to work, and can find myself inhibited if I feel that I don't know as much as so and so and therefore doubt that I can help someone. My teachers taught me that the study of theory, language, literature and so on is analgous to building a fire in the burner and readying the vessel, to use the language of Daoist alchemy. It renders the student or doctor ready to engage in the process whereby the knowledge comes to life. That process does indeed involve a certain divorcing of knowledge, i.e. implementation of the Daoist strategy to have no fixed mind. Thus one should be able to empty the vessel once it has been well built and thoroughly readied, and attracting to emptiness, the doctor can thereby gain the actual information from the patient and discern the root cause of the disharmony as well as feel the path that will lead to relative balance. Sometimes, of course this seems to be a healthy and true response and causes me to refer to another practioner. Not a trivial matter. Other times it is important to return to the direct relationship between myself and self and the person that has sought my help and honestly discover what we have to offer each other. I'm happy to say that we usually do just fine. Understandably so. As practioners we will never stop learning and this is as it should be, but as people and practioners I think that it is safe to say that any of us who are honestly checking will admit that what we don't know is always bigger than what we do know. That seems to be essential to the human conditon. Well said. The practice is in honestly discovering for ourselves if lack of knowledge is always a disadvantage and knowledge is always an advantage to success. I think I understand what you're getting at, but here the issue becomes slippery for me, as it seems like this simply redefines " knowledge " since " knowledge " in Chinese medical terms is always sensitive to circumstances. Thus stating that knowledge might be disadvantageous redefines knowledge to eliminate this adaptive potential. That I would characterize as incomplete knowledge of the matters involved, and not a contest between knowing and not-knowing. When we talk about the need to study traditional Chinese epistemology, i.e., that aspect of philosophy that deals with the nature and character of knowledge itself and provides patterns for knowing and modes of thinking, this is precisely the sort of issue that comes to mind. To ban it from the education of clinicians is potentially disastrous. What's the disaster? It's an epidemic of that sickness described by Laozi: not knowing yet appearing to know. And is there danger in the practice of medicine and in life in general to assume that knowledge gives us an advantage? Thanks for the oppurtunity to ponder. I encounter people frequently who justify their anti-intellectualism with quotes from Laozi. And I always ask them, if those who developed those traditions were so opposed to knowledge and the transmission of it via words, why did they write down 5,000 of them? And why have they so steadfastly copied them over and over century after century? Remember what the Old Guy's legendary job was before he departed from society to seek refuge beyond the pass? He was a librarian. Ken Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 26, 2002 Report Share Posted March 26, 2002 Ken, Thanks for the points you make. Your empty vessel analogy is well taken and perhaps makes the same point that I was trying to. I was not, nor do I believe was Laozi making a case for "anti-intellectualism". That would be simplistic and absurd. We will always seek knowledge, as Laozi says we will fashion tools from the uncarved block. This is as it should be. The point is more subtle and not an argument at all. We all know that knowledge is important that tools are effective. But can we "return to the uncarved blockempty the vessel" or must we always use our knowledge like sharpened tools to shred each paragraph and possibly miss the point entirely? Dean - dragon90405 Tuesday, March 26, 2002 1:01 PM Re: generalizations Dean,> Bob, this is a "sticky issue".I'd be happier calling it a slippery issue.This is the point that Erasmus, the Dutch scholar/theologian was making in A Praise of Folly. Thou often misquoted, his was actually a rhetorical question. "If ignorace is bliss, is it folly to be wise?". Laozi often councils to "abandon wisdom, discard knowledge...make use of raw silk and embrace the uncarved block" saying further that "daoists need no wide learning, they know that erudition is not wisdom." My sense is that neither are truly arguing that ignorace preferable to knowledge in all or any situation(s). Every one agrees that that would be ludicrus. We're all quite convinced of the superiority of knowledge and experience. These writers, as well as the case study and your anecdote about Dr. Tao cause us to reconsider the potency of the "raw silk and uncarved block".Consider this. Without a good deal of scholarship,such as results in transmission and translationof texts which mention raw silk and uncarvedblocks and the traditions that have grown uparound such ideas for thousands of years, wewould never even know that there was anythingto reconsider...or consider in the first place.My point about philosophy is not a "philosophical"one. It's simply that given the bind in whichthe Daoists, Erasmus and many other thinkershave noticed that human minds exist slippingback and forth from thought to word to actionto perception and so on, we are bound intocomplex systems of knowledge that require certainamount of study to bring to light and clarity. Given the oppurtunity, humans by nature exchange ignorance for what we consider to be knowledge, and it seems as though something is gained in that exchange. Perhaps it is useful to consider also what is lost. As a relative "newbe" to this practice this list presents an oppurtunity for me to consider these questions. Often in reading through the threads I discover how much I don't know and I learn, and I appreciate the knowledge and experience of others. And then I go to work, and can find myself inhibited if I feel that I don't know as much as so and so and therefore doubt that I can help someone.My teachers taught me that the study oftheory, language, literature and so onis analgous to building a fire in the burner and readying the vessel, to use the language of Daoist alchemy. It renders the student or doctor ready to engage in the processwhereby the knowledge comes to life.That process does indeed involve a certaindivorcing of knowledge, i.e. implementationof the Daoist strategy to have no fixed mind.Thus one should be able to empty the vesselonce it has been well built and thoroughly readied,and attracting to emptiness, the doctor can thereby gain the actual information fromthe patient and discern the root cause ofthe disharmony as well as feel the paththat will lead to relative balance.Sometimes, of course this seems to be a healthy and true response and causes me to refer to another practioner.Not a trivial matter.Other times it is important to return to the direct relationship between myself and self and the person that has sought my help and honestly discover what we have to offer each other. I'm happy to say that we usually do just fine.Understandably so. As practioners we will never stop learning and this is as it should be, but as people and practioners I think that it is safe to say that any of us who are honestly checking will admit that what we don't know is always bigger than what we do know. That seems to be essential to the human conditon.Well said. The practice is in honestly discovering for ourselves if lack of knowledge is always a disadvantage and knowledge is always an advantage to success.I think I understand what you're getting at,but here the issue becomes slippery for me,as it seems like this simply redefines "knowledge"since "knowledge" in Chinese medical terms isalways sensitive to circumstances. Thus statingthat knowledge might be disadvantageous redefinesknowledge to eliminate this adaptive potential.That I would characterize as incomplete knowledgeof the matters involved, and not a contestbetween knowing and not-knowing.When we talk about the need to study traditionalChinese epistemology, i.e., that aspect of philosophythat deals with the nature and character of knowledgeitself and provides patterns for knowing and modesof thinking, this is precisely the sort of issuethat comes to mind. To ban it from the educationof clinicians is potentially disastrous.What's the disaster?It's an epidemic of that sickness described by Laozi: not knowing yet appearing to know. And is there danger in the practice of medicine and in life in general to assume that knowledge gives us an advantage? Thanks for the oppurtunity to ponder.I encounter people frequently who justify theiranti-intellectualism with quotes from Laozi.And I always ask them, if those who developedthose traditions were so opposed to knowledgeand the transmission of it via words, whydid they write down 5,000 of them? And whyhave they so steadfastly copied them overand over century after century?Remember what the Old Guy's legendaryjob was before he departed from societyto seek refuge beyond the pass?He was a librarian. KenChinese 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 March 26, 2002 Report Share Posted March 26, 2002 Dean, > Thanks for the points you make. Your empty vessel analogy is well taken and perhaps makes the same point that I was trying to. I was not, nor do I believe was Laozi making a case for " anti- intellectualism " . That would be simplistic and absurd. We will always seek knowledge, as Laozi says we will fashion tools from the uncarved block. This is as it should be. The point is more subtle and not an argument at all. We all know that knowledge is important that tools are effective. But can we " return to the uncarved block " " empty the vessel " or must we always use our knowledge like sharpened tools to shred each paragraph and possibly miss the point entirely? Dean Not sure that I understand the point you're making, but it seems to me that the only limits that matter are the ones we place on ourselves. Ken Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 26, 2002 Report Share Posted March 26, 2002 If not, how can we, as practitioners, not allow our knowledge to negatively affect our half of the placebo equation? Is this possible? Some of the most effective clinicians I have studied under were not the smartest or the best educated, but they were the most confident and confidence-inspiring. Dr. Tao never >>>>Miriam Lee used to say its all about clear intension Alon Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 26, 2002 Report Share Posted March 26, 2002 Am I missing something here? (chuckles softly to self) It seems like what is being suggested here is the concept of beginner's mind. Is it like beginner's luck? Sort of. When i was out in New Mexico a few months ago, driving with a friend back down to Albuquerque, my friend suggested we stop in one of the casinos on the highway and take a " gambling break " . I had never gambled before, not even once, so i said ok. The rule was to start w/ $3 (we were short of time) and quit as soon as that was gone or we won something. I won $22 on my 2nd quarter. (for once in my life, i quit while i was ahead). So the concept of beginner's luck is well known in gambling circles...and in so many other things. And forever the gambler seeks to find that emptiness of mind that attracts the booty; as the wise man said, my hand is always open to receive. " IF Ignorance is bliss, is it folly to be wise? " " The more you learn, the less you know. " Aren't these really koan-like " haikus " rather than literal " statements of fact " ? Triggers to help us take a step back, sideways, up or down to view once more the matter at hand? To reach again that moment sought in zen archery when one can with equanimity of mind, breath and purpose release the arrow and know the target? Well, yes, but oh that chinese medicine could be so simple. I expect that few who enter acupuncture school realize the complexity of what they are about to encounter in taking that oh-so-lovely swan dive into that ocean. In the first semester one says, ok, i see, if i just learn and memorize this, this and this, i will understand acupuncture. The 2nd semester one learns there is a whole area of it all that one did not realize, so one says, ok,then this, this and this. And lo, this seems to happen at every semester...and then (the gods laugh drunkenly here) even continues after graduation. I suppose this could be said about any field of endeavor, but seems to me to be particularly so with chinese medicine...and oh yeah, there's the herbs. How, in the face of this complexity, to be able to stand back and assume that red-cheeked clarity and confidence so evident in the young lover (before disappointment, contradiction and, heaven forfend, criticism have taken their toll), or the young gambler with nothing to lose but 3 greenbacks, or the young soldier who rushes to enlist in the army full of conviction to serve his country? It certainly seems appropriate that chaos theory should arise in the collective mind at this time in history. Surely i have forgotten more than i know. Does that qualify me? (I guess the answer is a " qualified 'yes' " .) Before i wax more windy(no pun intended) on this damp and dreary day, i think what the task is is to seek that exquisite balance point between confidence and humility from which one can be empty to be filled and full to be empty...ie. to give whatever one has. Knowledge can be added to and modified, and the meaning of knowledge itself can change from moment to moment. If the recipient of a transplanted heart can receive the feelings, thoughts, even memories of the donor...where is that knowledge? cheers, ann Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 26, 2002 Report Share Posted March 26, 2002 ann, well waxed, dean - snakeoil.works Tuesday, March 26, 2002 2:37 PM Re: Re: generalizations Am I missing something here? (chuckles softly to self) It seems like whatis being suggested here is the concept of beginner's mind. Is it likebeginner's luck? Sort of. When i was out in New Mexico a few months ago,driving with a friend back down to Albuquerque, my friend suggested we stopin one of the casinos on the highway and take a "gambling break". I hadnever gambled before, not even once, so i said ok. The rule was to start w/$3 (we were short of time) and quit as soon as that was gone or we wonsomething. I won $22 on my 2nd quarter. (for once in my life, i quit while iwas ahead). So the concept of beginner's luck is well known in gamblingcircles...and in so many other things. And forever the gambler seeks to findthat emptiness of mind that attracts the booty; as the wise man said, myhand is always open to receive."IF Ignorance is bliss, is it folly to be wise?""The more you learn, the less you know."Aren't these really koan-like "haikus" rather than literal "statements offact"? Triggers to help us take a step back, sideways, up or down to viewonce more the matter at hand? To reach again that moment sought in zenarchery when one can with equanimity of mind, breath and purpose release thearrow and know the target? Well, yes, but oh that chinese medicine could beso simple. I expect that few who enter acupuncture school realize thecomplexity of what they are about to encounter in taking that oh-so-lovelyswan dive into that ocean. In the first semester one says, ok, i see, if ijust learn and memorize this, this and this, i will understand acupuncture.The 2nd semester one learns there is a whole area of it all that one did notrealize, so one says, ok,then this, this and this. And lo, this seems tohappen at every semester...and then (the gods laugh drunkenly here) evencontinues after graduation. I suppose this could be said about any field ofendeavor, but seems to me to be particularly so with chinese medicine...andoh yeah, there's the herbs.How, in the face of this complexity, to be able to stand back and assumethat red-cheeked clarity and confidence so evident in the young lover(before disappointment, contradiction and, heaven forfend, criticism havetaken their toll), or the young gambler with nothing to lose but 3greenbacks, or the young soldier who rushes to enlist in the army full ofconviction to serve his country? It certainly seems appropriate that chaostheory should arise in the collective mind at this time in history.Surely i have forgotten more than i know. Does that qualify me? (I guess theanswer is a "qualified 'yes'".)Before i wax more windy(no pun intended) on this damp and dreary day, ithink what the task is is to seek that exquisite balance point betweenconfidence and humility from which one can be empty to be filled and full tobe empty...ie. to give whatever one has. Knowledge can be added to andmodified, and the meaning of knowledge itself can change from moment tomoment. If the recipient of a transplanted heart can receive the feelings,thoughts, even memories of the donor...where is that knowledge?cheers,annChinese 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 March 26, 2002 Report Share Posted March 26, 2002 I like to call what you are describing the " mensch factor " . As I discussed before, we are examples for our patients, offering them hope and a direction to take. If we keep in mind that we also need to give our patients 'homework' to do (diet, exercise, attitude adjustment), and involve them in the healing process, we should be able to improve their health. Our success is determined by a few factors: 1) are we trying to improve overall health or cure a disease? Sometimes the first option is the only one, but is a good one 2) how cooperative is the patient? There are some patients I can really connect with, some I cannot. Those I cannot connect with, I refer out. 3) how confident are we? Factors here are based on our own self-worth, but also seeing long-term courses of treatment and development of a disease. It is here where I find many students and practitioners are weak. They are not taught how to manage cases that require relatively long-term care, and how to see the development of a disease from its origin to the present, and project a prognosis into the future. Maimonides taught, in his " Treatise on Asthma " , " the more a man is proficient in a given discipline, the more he thinks of it, the greater his doubts and the more weighty the problems he has to tackle. There is no end to the ideas and thoughts that surge in him and he can scarcely cope with them. On the other hand, to a man of little learning all the weighty problems seem easy to explain, all the remote things within reach, and so great is his conceit that he is prepared to come up with a ready answer at any time and to explain things he doesn't grasp at all. " He also said " the medical art looks easy and trifling to men of limited horizon but how profound and far-reaching was this art in the eyes of a physician like Hippocrates. " What I conclude from this is that we have two sides of one coin. On one side, we need to show confidence and encouragement to our patients, and mobilize their own healing power (Maimonides: " treat the patient, not the disease " ). On the other hand, we need to be working hard inside of ourselves to understand the patient and their disease, to continually study and grow in order to be ever more helpful to them. On Tuesday, March 26, 2002, at 08:34 AM, pemachophel2001 wrote: > As a practitioner, I sometimes wonder if my knowledge of the Chinese > medical literature on a particular, difficult-to-treat condition works > for or against my patients' best interests. Uterine myomas > are a case in point which we have discussed before on this > list. We have all heard anecdotal cases, commonly reported > by neophytes, of large myomas completed resolving. However, > the Chinese literature seems clear that the larger the myoma > (and the more deeply situated), the less likely it is to > significantly shrink or disappear. So, if the patient asks > what the prognosis is and she has a large myoma, does it > work against the patient to answer her question honestly. In my > experience (and I have been in this situation many, many times), if > I'm honest with myself, I think my honesty with the patient actually > robs them of hope. Therefore, I sometimes wonder if I am doing a > service or a disservice of reporting to students less than sterling > outcomes, either based on my personal experience or on a reading of > the Chinese literature. > > In reading your posting, it seems to me that your better than expected > outcome (at least better than the other Chinese-trained doctors > expected) was, at least partially based on your lack of experience and > your faith in the medicine. So my question is, in the realm of Chinese > medicine where the bottom line is the health and healing of the > patient, is ignorance sometimes better? Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 27, 2002 Report Share Posted March 27, 2002 Ann and all, Some really good responses to my original questions. In my now two decades plus experience, one of the things I have learned as a clinician is that not every clinician connects and is right for every patient no matter their technical brilliance or skill. I've seen some extremely arrogant, prideful, and superconfident Chinese practitioners get great results through very authoritarian behavior and attitudes in some patients, while other patients simply never returned to the clinic. We all talk about the technicalities of doing the medicine, and, often, there is the assumption that, if we get those technicalities right, we'll also get the right result. At this point in my experience, I think it is more a matter of fate, karma, luck, call it what you will. It is defintely a matter of connection, and, as a clinician, I find it very important to determine if a good connection between patient and practitioner can be made. If that connection isn't there, then I find it is better to refer the patient on. To be perfectly honest and at least in my own experience, sometimes that connection (or the lack of it) has to do with personality. Sometimes it has to do with communication. Sometimes it has to do with physical appearance. Sometimes it has to do with sex (but not sexual activity; I hope you know what I mean). Sometimes it has to do with commonly shared values and/or life experiences. Sometimes it has to do with age. However, I am not necessariloy saying that it always involves a hugely friendly, sympatico relationship. Sometimes the relationship can be difficult or trying, either at first or along the way. Clearly, for myself, I haven't figured out all the components of a successful patient-practitioner relationship. However, I think that relationship is ultimately more important than the technical sophistication or perfection of the treatment. I think I have reported before that it was my experience as a child to always feel better after the doctor had examined me (when doctors still did house calls) but before any treatment had been administered. While this may have to do with " good bedside manner, " some patients actually respond to what I would consider bad bedside manner, i.e., arrogant authoritarianism. So, while we talk about why our medicine does or doesn't work in this or that patient, I think we also have to keep in mind that there are certain possibly unknowable factors that hugely affect the outcomes we achieve. Perhaps knowing that helps to water the humility that, in many cases, patients respond to (evewn while we remember that other patients actually prefer and respond better to the superconfident uberdoctor). Bob , <snakeoil.works@m...> wrote: > Am I missing something here? (chuckles softly to self) It seems like what > is being suggested here is the concept of beginner's mind. Is it like > beginner's luck? Sort of. When i was out in New Mexico a few months ago, > driving with a friend back down to Albuquerque, my friend suggested we stop > in one of the casinos on the highway and take a " gambling break " . I had > never gambled before, not even once, so i said ok. The rule was to start w/ > $3 (we were short of time) and quit as soon as that was gone or we won > something. I won $22 on my 2nd quarter. (for once in my life, i quit while i > was ahead). So the concept of beginner's luck is well known in gambling > circles...and in so many other things. And forever the gambler seeks to find > that emptiness of mind that attracts the booty; as the wise man said, my > hand is always open to receive. > > " IF Ignorance is bliss, is it folly to be wise? " > " The more you learn, the less you know. " > > Aren't these really koan-like " haikus " rather than literal " statements of > fact " ? Triggers to help us take a step back, sideways, up or down to view > once more the matter at hand? To reach again that moment sought in zen > archery when one can with equanimity of mind, breath and purpose release the > arrow and know the target? Well, yes, but oh that chinese medicine could be > so simple. I expect that few who enter acupuncture school realize the > complexity of what they are about to encounter in taking that oh-so-lovely > swan dive into that ocean. In the first semester one says, ok, i see, if i > just learn and memorize this, this and this, i will understand acupuncture. > The 2nd semester one learns there is a whole area of it all that one did not > realize, so one says, ok,then this, this and this. And lo, this seems to > happen at every semester...and then (the gods laugh drunkenly here) even > continues after graduation. I suppose this could be said about any field of > endeavor, but seems to me to be particularly so with chinese medicine...and > oh yeah, there's the herbs. > > How, in the face of this complexity, to be able to stand back and assume > that red-cheeked clarity and confidence so evident in the young lover > (before disappointment, contradiction and, heaven forfend, criticism have > taken their toll), or the young gambler with nothing to lose but 3 > greenbacks, or the young soldier who rushes to enlist in the army full of > conviction to serve his country? It certainly seems appropriate that chaos > theory should arise in the collective mind at this time in history. > > Surely i have forgotten more than i know. Does that qualify me? (I guess the > answer is a " qualified 'yes' " .) > > Before i wax more windy(no pun intended) on this damp and dreary day, i > think what the task is is to seek that exquisite balance point between > confidence and humility from which one can be empty to be filled and full to > be empty...ie. to give whatever one has. Knowledge can be added to and > modified, and the meaning of knowledge itself can change from moment to > moment. If the recipient of a transplanted heart can receive the feelings, > thoughts, even memories of the donor...where is that knowledge? > > cheers, > ann Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 27, 2002 Report Share Posted March 27, 2002 I think this simply goes to underscore what recent neurobiological studies have been showing us, that that emotional patterns drive even the simplest activity---writing a shopping list or selecting a life partner. Besides whether or not they will like or connect to the practitiner, each patient's original physical problems usually have some emotional dimension---if it isn't directly caused by some emotional issue, then it is often underpinned by one. I often see unresolved emotional patterns in the pulses going back years. These patterns must be addressed in some way as well as the physical symptoms. Using 5-Phases is more effective in this regard because it describes nonlinear behavior. A number of times, for example, patients who were overcoming their painful daily migraine pattern would stop treatment simply because they didn't want to address the underlying emotional pain and issues---even when warned about them up front. It's not so much a matter of karma as complexity and sensitivity of interaction---how the practitioner, the patient, and the problems being addressed will interact. Even when technically proficient, a practitioner can't be all things to all people. It's like doing Taiji. You have to sense where your opponent is moving and be there with them. Jim Ramholz , " pemachophel2001 " We all talk about the technicalities of doing the medicine, and, often, there is the assumption that, if we get those technicalities right, we'll also get the right result. At this point in my experience, I think it is more a matter of fate, karma, luck, call it what you will. It is defintely a matter of connection, and, as a clinician, I find it very important to determine if a good connection between patient and practitioner can be made. If that connection isn't there, then I find it is better to refer the patient on. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 27, 2002 Report Share Posted March 27, 2002 Jim, you said " Using 5-Phases is more effective in this regard because it describes nonlinear behavior " . Could you please expand on this more. Seems a little simplistic to describe complex pyscho-spiritul behavior in terms of 5-phase. Warren Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 27, 2002 Report Share Posted March 27, 2002 As I pointed out in my previous post, this is the case for me as well. I can help who I connect with, there are patients who are sympatico with me, others not. Those I refer out. This is, in my opinion, because the clinical encounter in Chinese medicine is a partnership between willing individuals, who are working together on a problem to come to a solution. It is not the application of a technology to a passive individual who has no active role in the clinical encounter. As I remember, Bob, you discounted my earlier emphasis on the statement by Xu Shu-wei (1132 C.E.), that " to feel better before taking the medicine is the best method " , or the case histories mentioned in Vivian Ng's " Madness in Late Imperial China. " Does this mean you've changed your point of view on this subject vis-a-vis cognitive methods in CM clinical practice? On Wednesday, March 27, 2002, at 07:56 AM, pemachophel2001 wrote: > Some really good responses to my original questions. In my now two > decades plus experience, one of the things I have learned as a > clinician is that not every clinician connects and is right for every > patient no matter their technical brilliance or skill. I've seen some > extremely arrogant, prideful, and superconfident Chinese practitioners > get great results through very authoritarian behavior and attitudes in > some patients, while other patients simply never returned to the > clinic. We all talk about the technicalities of doing the medicine, > and, often, there is the assumption that, if we get those > technicalities right, we'll also get the right result. At this point > in my experience, I think it is more a matter of fate, karma, luck, > call it what you will. It is defintely a matter of connection, and, as > a clinician, I find it very important to determine if a good > connection between patient and practitioner can be made. If that > connection isn't there, then I find it is better to refer the patient > on. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 27, 2002 Report Share Posted March 27, 2002 Warren: There is no psycho-spiritual behavior separate and apart from 5- Phases. To say that spirituality has its own sphere of influence separate and apart from ordinary, physical life is counter to the tenants of Daoism, Zen, etc. Western science reiterates this idea when saying that emotion and thought—and therefore the religious sensibilities arising from them—do not have their own separate pathways in the brain. In Daoist thought, for example, jing is transformed into qi, qi into shen, and shen returned back into Void (xu). This spiritual alchemy is also a physiological process. And those processes can be tracked in the pulses using 5-Phases, by examining the interactions between different depths and different positions. In that sense, I believe I am repeating the efforts of Mananka and Birch (1995) in describing 5-Phases as a signaling system rather than solely as a way of keeping track of quantities as does 8- Principles. 5-Phases describes the dynamics of how these emotions and thoughts arise, influence, and interact with each other and with the physical body. We can follow that interaction in the pulses when examining the qi (emotional aspect), blood (physiological aspect), and organ or adapted (structural aspect) depth. Jim Ramholz , Warren Cargal <wcargal9@b...> wrote: > Jim, > you said " Using 5-Phases is more effective in this regard because it > describes nonlinear behavior " . > > Could you please expand on this more. Seems a little simplistic to > describe complex pyscho-spiritul behavior in terms of 5-phase. > > Warren Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 27, 2002 Report Share Posted March 27, 2002 Z'ev, No change in mind. I've been talking about the role of what I refer to as the placebo factor in CM for a number of years now, ever since I had to undergo an NIH training on placebo when we did the NIH-sponsored acupuncture study way back when. In addition, I quote several premodern Chinese authors on the necessity of what you are referring to as cognitive therapy in Chinese Medical Psychiatry. My position on that has not changed in many years either. However, these two things are different (i.e., the placebo factor and cognitive therapy). So I'm not sure what you are actually asking me. Bob , " " <zrosenbe@s...> wrote: > As I pointed out in my previous post, this is the case for me as well. > I can help who I connect with, there are patients who are sympatico with > me, others not. Those I refer out. This is, in my opinion, because the > clinical encounter in Chinese medicine is a partnership between willing > individuals, who are working together on a problem to come to a > solution. It is not the application of a technology to a passive > individual who has no active role in the clinical encounter. > > As I remember, Bob, you discounted my earlier emphasis on the statement > by Xu Shu-wei (1132 C.E.), that " to feel better before taking the > medicine is the best method " , or the case histories mentioned in Vivian > Ng's " Madness in Late Imperial China. " Does this mean you've changed > your point of view on this subject vis-a-vis cognitive methods in CM > clinical practice? > > > On Wednesday, March 27, 2002, at 07:56 AM, pemachophel2001 wrote: > > > Some really good responses to my original questions. In my now two > > decades plus experience, one of the things I have learned as a > > clinician is that not every clinician connects and is right for every > > patient no matter their technical brilliance or skill. I've seen some > > extremely arrogant, prideful, and superconfident Chinese practitioners > > get great results through very authoritarian behavior and attitudes in > > some patients, while other patients simply never returned to the > > clinic. We all talk about the technicalities of doing the medicine, > > and, often, there is the assumption that, if we get those > > technicalities right, we'll also get the right result. At this point > > in my experience, I think it is more a matter of fate, karma, luck, > > call it what you will. It is defintely a matter of connection, and, as > > a clinician, I find it very important to determine if a good > > connection between patient and practitioner can be made. If that > > connection isn't there, then I find it is better to refer the patient > > on. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 27, 2002 Report Share Posted March 27, 2002 I would like some time to think more about this (I'll be 'off line' until Sunday for Passover), but in my understanding, you can see the placebo factor as a type of cognitive therapy if done consciously. One example is when homeopaths give lactose pills as placebo to patients on followup visits after the first remedy (to give time for the first remedy to act). On Wednesday, March 27, 2002, at 02:01 PM, pemachophel2001 wrote: > However, these two things are different (i.e., the placebo factor and > cognitive therapy). So I'm not sure what you are actually asking me. > > Bob Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 28, 2002 Report Share Posted March 28, 2002 , " pemachophel2001 " < pemachophel2001> wrote: We all talk about the technicalities of doing the medicine, > and, often, there is the assumption that, if we get those > technicalities right, we'll also get the right result. At this point > in my experience, I think it is more a matter of fate, karma, luck, > call it what you will. It is defintely a matter of connection, this is an interesting point, which most teachers have probably observed. It of course begs the question that has been asked so often, then how will learning chinese or studying philosophy help my practice. People are already getting great results for reasons that have nothing to do with knowledge, so we clearly can't argue that knowing more is always better. I think this really drives home the point that the clinical utility of such pursuits (language, philosophy) is not a black and white issue at all. for some, it makes all the difference in the world (like me). for others, it serves no pragmatic purpose. I really think at this point that we are all going to have to agree to disagree about such issues because our biases are shaped by our personal experiences. If one person had great success with every advance in his knowledge, how could he perceive otherwise? I f another has never seen an difference whether he studied or not, how can you argue against that? Its really a fait accompli. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 28, 2002 Report Share Posted March 28, 2002 Dean, But can we " return to the uncarved block " " empty the vessel " or must we always use our knowledge like sharpened tools to shred each paragraph and possibly miss the point entirely? Dean I guess I'm slow. But tonight on a break between tai4 ji2 classes, I thought about something that seemed to be pertinent to this question that you asked the other day. As I recall, I didn't quite get what you meant at the time, and I'm not altogether sure that I understand you clearly now. But here's what came to mind. I study in a fairly large group of students. On average there's 30-40 in a class. On Saturdays the group can be as large as 50 or more. The more advanced students teach the beginners, and the senior teachers get together regularly to review progress and compare notes. I'm not doing any of the teaching at present, but I attend some of these get togethers. The other day the subject was correcting errors and what amounts to the " bedside manner " of a good tai4 ji2 teacher. Different people had differing ideas of how to deal with faults when they appear. And the discussion allowed me to think a bit about my own attitudes, both as a teacher and a student. The reason I study with my teacher is that he finds my faults and corrects them. Of course this presupposes that we share a common understanding of the principles that constitute the correct way to practice, and that is not stretching it, since I learned these principles from this teacher. But after more than thirty years of studying and practicing, the thing that I really value the most in my teacher is his ability to see my mistakes and to point them out to me and indicate how I can correct them. In martial arts, this is of particular interest to a student, since in theory, the difference between getting it right and getting it wrong can mean the difference between living and dying. But I don't think the stakes are any lower in medical arts. Again, I find the martial metaphor, which forms such a central theme in Chinese medical theory, to be of enormous benefit when it comes to assessing the relative values contained within the theoretical propositions of the subject. Point being, this is the spirit in which I engage in fault finding in this forum. Do we, does anybody have to? Of course not. But personally, if I'm going to pay attention to some process or communication, then I strive to engage myself fully. So when someone says something here that I disagree with or that I notice is an error of some kind, I will point it out. This does not mean to me nor should others infer from it that I consider myself to be anybody's teacher here. I don't. I consider that we are all students and I'm simply offering to fellow students what I hope I can expect to get from them, i.e. an intelligent and critical appraisal of statements made. When I thought about this, I realized more fully that you may have been complaining about my attitude. It seemed clearer to me this evening. So thanks for asking. As to whether I have missed the point entirely...no doubt. Ken Quote Link to comment Share on other sites More sharing options...
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