Case histories, case analysis, case discussion

[Guest guest]

and All,

 

I hope I've already clarified my earlier

comments that started the discussion about

case histories. Just to sum it up, I was

describing difficulties that I personally

experience in discussing cases in this

forum and was in no way arguing against

the practice of doing so. I think that

writing up cases, presenting them for

analysis by others, discussion, critiquing,

etc. are all very valuable tools and

should be done more and more effectively.

 

As Bob mentions, Chinese medicine has

a very adequate nomenclature that makes

such writing and exchange of information

feasible, and an enormous body of case

history literature that testifies to

the fact that it is a long established

tradition in medical circles in China.

 

The reason I don't participate in it

more than I do, as I originally said,

stems from my personal training and

approach to clinical practice and

therefore clinical analysis and discussion.

 

It's very hands on and there's just

too much information involved that

as yet I have not been able to figure

out how to communicate effectively.

 

I encourage more people to get involved

in the presentation of cases, and perhaps

as I work on my book on tai4 ji2 and

massage therapy I can compile some

case discussions and deal with the

challenges that this kind of work

presents to me.

 

I just want to make it very clear that

I'm not in any slightest way opposed

or in disagreement with the practice

of presenting case histories for

analysis and discussion.

 

And if the very adequate nomenclature

that exists is very adequately understood

by all involved, the process tends to

go even better.

 

Ken

[Guest guest]

Ken:

 

What style of CM or " personal training and approach " do you do that

doesn't lend itself to analysis and discussion?

 

 

Jim

 

 

 

, " dragon90405 " <yulong@m...> wrote:

> The reason I don't participate in it

> more than I do, as I originally said,

> stems from my personal training and

> approach to clinical practice and

> therefore clinical analysis and discussion.

[Guest guest]

Jim,

>

> What style of CM or " personal training and approach " do you do that

> doesn't lend itself to analysis and discussion?

>

I'm a student of tai4 ji2 quan2 and

much of my training and therefore my

approach to clinical interactions

is based in the principles of tai4 ji2

and their application to medical intervention

and health care strategy.

 

My training in China was focused on

two main modalities: acupuncture

and massage therapy. I prefer working

on patients with my hands because it

enables me to constantly gather

diagnostic information while engaging

in therapeutic actions. I work

on the basis of some pretty fundamental

theortical notions: change, differentiation

of yin1 and yang2, " using four ounces

to deflect a thousand pounds " , to name

a few.

 

Although I am quite verbose on some

subjects, I tend to talk rather little

in the clinic including during the

course of teaching in the clinic.

When treating patients, after the

initial interview, I seldom say more

than one or two words. And even if

patients talk, I try to encourage

them to engage in silence and communicate

with me directly through their bodies.

 

I am more focused on getting people

to feel and to receive information

from the patient directly.

 

A large part of what I do focuses

on physical assessments that derive

entirely from visual assessment of

bodies and work to develop acuity

of perception so that internal

and external dynamics and images

can be correlated and assembled into

complete diagnostic pictures.

 

Writiing about these issues is challenging.

I've been working on a book on the

subject for ten years now.

 

Ken

[Guest guest]

, " dragon90405 " <yulong@m...> wrote:

> I'm a student of tai4 ji2 quan2 and

> much of my training and therefore my

> approach to clinical interactions

> is based in the principles of tai4 ji2

> and their application to medical intervention

> and health care strategy. . . . I work

> on the basis of some pretty fundamental

> theortical notions: change, differentiation

> of yin1 and yang2, " using four ounces

> to deflect a thousand pounds " , to name

> a few.

 

Me too. I often use Taiji to describe how needling methods can move

and neutralize perverse qi, or change it back to zheng qi.

 

 

 

> Writiing about these issues is challenging.

> I've been working on a book on the

> subject for ten years now.

 

Are you familiar with Mark Seem's work on TCM osteopathy?

 

 

Jim Ramholz

[Guest guest]

Jim,

>

> Me too. I often use Taiji to describe how needling methods can move

> and neutralize perverse qi, or change it back to zheng qi.

 

You mean li4 qi4? I'm not really

sure what you mean by changing li4 qi4

to zheng4 qi4. When I first read it

I thought, yeah. But when I think it

over, I'm not sure what you mean.

 

What do you tell patients about this?

 

I'm very interested these days in the

perspective of identifying the dynamics

of the body and the interaction between

the body and the environment, as well

as the various interactions taking place

within the body that we have in mind

when we use various terms.

 

What actually happens to change perverse

qi4 back to zheng4 qi4?

 

I think if I were talking to a patient

about li4 qi4 and zheng4 qi4 I would

refer to Chapter 12 of the Dao De Jing

and the line from Chapter 10 that

asks, " Can you concentrate your qi4

and be like a baby? "

 

I find that Lao Zi provided a good deal

of medical advice, as Cheng Man Ch'ing

points out in Lao Tzu: My Words Are

Very Easy to Understand.

 

Chapter 3 says that

 

" the sage governs himself by

relaxing the mind

reinforcing the abdomen

gentling the will,

strengthening the bones.

 

And in chapter 50 it states:

 

" those who cultivate the life principle can travel

without encountering a tiger or wild buffalo;

In battle no weapon can penetrate their armor.

The wild buffalo's horns find nothing to gore,

the tiger's claws nothng to flay, and weapons

find no place for their points to penetrate.

Why is this so?

Because for them, there is no province of death. "

 

>

> Are you familiar with Mark Seem's work on TCM osteopathy?

 

No. I'm not at all well read in the

subject. My education in Chinese massage

therapy is virtually all orally taught,

mainly from couple of doctors in Chengdu.

 

Ken

[Guest guest]

, " dragon90405 " <yulong@m...> wrote:

>> You mean li4 qi4?

I meant liu yin (6 excesses).

 

 

>> What do you tell patients about this?

I try to speak to whatever level they are comfortable with. Less

often, I use genereal CM models and Western medicine terms---people

used to just roll their eyes or go " un huh " but not understand. Now,

I usually use the metaphor of their body being like a credit card---

compliance is much better.

 

 

> What actually happens to change perverse

> qi4 back to zheng4 qi4?

 

Often liu yin can be mixed back into the general qi flow. For

example, someone with damp impediment (shi bi) in a deeper channel

or joint, using qi gong style needling to draw that qi up to a

higher channel, often yang ming, to dispel (qu) it. Or, for example,

using the channels associated with the microcosmic or macrocosmic

orbit to return the qi movement of a menopause hot flash to the

lower jiao, returning it to its source.

 

The key is to think of the 5-Phases not as objects or elements, but

as processes (rising, spreading, etc.).

 

 

 

Jim Ramholz

[Guest guest]

In a message dated 4/9/02 2:33:26 AM Eastern Daylight Time, jramholz writes:

 

 

I usually use the metaphor of their body being like a credit card---

 

Could you please explain this?

 

Thanks,

Sherril

[Guest guest]

Jim,

 

> >> You mean li4 qi4?

> I meant liu yin (6 excesses).

 

Try as hard as I might, I just don't

seem to be able to avoid issues related

to the meanings of terms. If I understand

what you've said now, you use tai4 ji2

to explain to your patients how certain

needling methods can change liu4 yin2

to zheng4 qi4.

 

I can construct a relationship in

my mind between these three terms,

but I want to understand what you

mean, and I have to ask you to define

your terms.

 

 

>

>

> >> What do you tell patients about this?

> I try to speak to whatever level they are comfortable with. Less

> often, I use genereal CM models and Western medicine terms---people

> used to just roll their eyes or go " un huh " but not understand.

Now,

> I usually use the metaphor of their body being like a credit card---

> compliance is much better.

 

Hmmm...

 

I like the economic metaphor. What orders

or suggestions do you give that you find

this useful to encourage compliance with?

 

I think if I were to talk with patients

along similar lines, I'd try to get

them to understand that their bodies

can act like savings accounts. But

I prefer to use an analogy between

the body and a garden, not because of

poetic pleasures but from very practical

considerations such as a gardener faces,

eg., paying attention on a daily basis

to the changes; harmonizing with the

alternations of yin1 and yang2 throughout

the course of the day, the month, and

the seasons of the year; ensuring adequate

water and nutrition; vigilance against

invasions; and the importance of investing

continually in the maintenance of the

soil/substance in which growth occurs.

 

 

>

>

> > What actually happens to change perverse

> > qi4 back to zheng4 qi4?

>

> Often liu yin can be mixed back into the general qi flow. For

> example, someone with damp impediment (shi bi) in a deeper channel

> or joint, using qi gong style needling to draw that qi up to a

> higher channel, often yang ming, to dispel (qu) it.

 

This makes more sense to me than the idea of

changing liu4 yin2 to zheng4 qi4, but I don't

understand the term " qi gong style needling. "

 

And I'm interested in your notion of the

dynamics involved in drawing an excess which

has become an impediment, such as dampness, to a

higher channel. Since this is an herb forum

rather than acupuncture, if you want to

pursue this, maybe we can deal with it

either in terms of medicinal therapy

or simply in terms of the physiological

and anatomical dynamics involved.

 

Or, for example,

> using the channels associated with the microcosmic or macrocosmic

> orbit to return the qi movement of a menopause hot flash to the

> lower jiao, returning it to its source.

 

Curious treatment principle. Do you take

some further actions to address the

condition that resulted in the heat

flashing upwards? Or do you find that

you simply " return the qi movement "

and that's that?

>

> The key is to think of the 5-Phases not as objects or elements, but

> as processes (rising, spreading, etc.).

 

 

I agree that it's important to understand

5 phases as dynamics, but I didn't notice 5

phase theory in your previous explanations,

so I'm not sure how this key plays or

in which lock.

 

Ken

[Guest guest]

Sherril:

 

After discussing the usually medical explanations, I sometimes tell

them that their body is like a credit card. They can do anything

they want---shoot heroin, sky dive, watch TV forever---but they have

to pay for it; it creates a certain type of debt (depending on the

activity) to their body. When they rest for a little while, it's

like paying the monthly statement, but often the debt still can

accumulate because they don't eat right, never rest, etc. Resting,

eating right, lifestyle changes, and getting treated helps pays down

that debt. How much " debt " has accumulated depends on their

chronicity and how well they have taken care of themselves.

 

How close they are to the limit on their " line of credit " depends on

how well the zang can store qi and jing, which will be evident from

the pulses.

 

People identify closely with credit card debt and, therefore, with

the metaphor.

 

 

Jim Ramholz

 

 

 

, sherrilgol@a... wrote:

> In a message dated 4/9/02 2:33:26 AM Eastern Daylight Time,

> jramholz writes:

>

>

> > I usually use the metaphor of their body being like a credit

card---

>

> Could you please explain this?

>

> Thanks,

> Sherril