The nonsense about channel entry - gui1 jing1

[Guest guest]

 

 

Another note from Unschuld, to point

out that you are not the first to

question and even reject the notion

of channel entry.

 

This also from History of Ideas, p. 210:

 

" Among others, Hsu Ta-ch'un sought to refute one of the most

important innovations of Sung-Chin-Yuan medicine, namely Chang Yuan-

su's doctrine that medicinal drugs reach the intended locations

through specific transportation channels. Hsu termed such

notions 'nonsense' (ch'uan-tso). "

 

Your and Bob Flaws' comments about

the flavors of medicinals sent me looking

into various sources to see whether

or not there are any sources in the

classical literature to support such

a view. Haven't come up with much.

 

The more I think about, the more

I start to believe that I may just

not understand what your point is.

 

Ken

[Guest guest]

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

wrote:

>

>

> Another note from Unschuld, to point

> out that you are not the first to

> question and even reject the notion

> of channel entry.

 

I am aware of this. In fact, it is the basis of my opinion that

others before me have also questioned this attribute.

 

 

 

[Guest guest]

, " 1 " <@i...> wrote:

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

> wrote:

> >

> >

> > Another note from Unschuld, to point

> > out that you are not the first to

> > question and even reject the notion

> > of channel entry.

>

> I am aware of this. In fact, it is the basis of my opinion that

> others before me have also questioned this attribute.

>

 

I thought this might be the case, and

I have another question to raise. Unschuld

points out the example of Hsu Ta-ch'un

as one particular case of Ming-Ch'ing era

physicians who in general did not pick

up on the earlier, Sung-Chin-Yuan era

medicine's tendency to incorporate medicinal

drugs into the framework of systematic

correspondence.

 

My question is, to what extent do you view

the framework of systematic correspondence

as a legitimate theoretical framework

for study, understanding, and application

of medicinal drugs?

 

I'd be very interested in learning the

opinions of others on this broad question.

 

Ken

[Guest guest]

I think this question, Ken, brings into focus the way we look at

patients and the methods and theories by which we treat them.

 

The Jin-Yuan developments of systematic correspondence, and the four

schools it produced , greatly enlarged the body of Chinese medical

theory, increasing the nuance and detail in which we view patients,

especially with herbal medicine. While sometimes the authors disagreed

vehemently, what they discovered opened up new tools and pathways for

generations of physicians.

 

I don't think we should discard anything from the purgation school of

Zhang Zhe-he, the yin supplementation school of Zhu Dan-xi, spleen

stomach school of Li Dong-yuan, or cool-cold school of Liu Wan-su.

 

Different practitioners, according to their training, temperment, where

they live, or the era within which they practice, will be attracted to

different theories. They will work with certain kinds of patients who

fit with their approach to practice.

 

Some practitioners will be more empirical, like Todo Yoshimatsu in Japan

who abandoned nearly all theory, and practiced a more empirical approach

that was based on the purgative school and abdominal diagnosis.

 

Others will create elaborate bodies of theory to explain what they see

in the phenomenon of human health and sickness.

 

To me, it doesn't matter so much. I think the history of Chinese

medicine is fascinating and complex, and I am continuing the journey of

study and practice.

 

" The finger pointing at the moon is not the moon " . We are human beings,

conceptual beings, who communicate with words and theories. We need the

various maps developed in all systems of medicine to understand and

develop strategies of treatment. But in the end, these are maps of the

terrain, not the terrain itself. This is also true of biomedicine,

anatomy and physiology. The structures of the body may appear more

'real' than the channels and connecting vessels, but they are still seen

through conceptual glasses.

 

 

On Sunday, April 21, 2002, at 10:37 AM, dragon90405 wrote:

>

>

> I thought this might be the case, and

> I have another question to raise. Unschuld

> points out the example of Hsu Ta-ch'un

> as one particular case of Ming-Ch'ing era

> physicians who in general did not pick

> up on the earlier, Sung-Chin-Yuan era

> medicine's tendency to incorporate medicinal

> drugs into the framework of systematic

> correspondence.

>

> My question is, to what extent do you view

> the framework of systematic correspondence

> as a legitimate theoretical framework

> for study, understanding, and application

> of medicinal drugs?

>

> I'd be very interested in learning the

> opinions of others on this broad question.

>

> Ken

>

>

 

>

>

> Chinese Herbal Medicine, a voluntary organization of licensed

> healthcare practitioners, matriculated students and postgraduate

> academics specializing in Chinese Herbal Medicine, provides a variety

> of professional services, including board approved online continuing

> education.

>

>

>

>

[Guest guest]

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

wrote:

 

>

> My question is, to what extent do you view

> the framework of systematic correspondence

> as a legitimate theoretical framework

> for study, understanding, and application

> of medicinal drugs?

 

I think the thing that struck me most about Unschuld's history of

pharmaceutics was the evidence that systematic

correspondence was not widely applied to herbology before the

jin-yuan dynasties. there were notable exceptions like the shang

han lun, but this book was lost till around the jin-yuan anyway.

So all the enduring applications of systematic correspondence

(SC) to herbology have occurred in the last 1000 years.

 

I think we have to consider each category of SC data in its own

right. for instance, flavor attribution goes back to the shen nong

ben cao, but there are so many exceptions to the standard

actions of flavors, it can hardly be called a rule in the modern

sense. What I mean is that the presence of a flavor in a given

herb does not guarantee it does something in particular. Not

like the presence of caffeine means there will be a stimulation

effect. for example, there are quite a few sweet herbs that have

no supplemental effect (jin yin hua, gou teng).

 

Channel entry is much more recent and still debated. OTOH,

applications of herbs according to zang fu seems to have

dominated herbal practice for a very long time. There seems to

be the most consensus on this. So all this newfangled stuff

called systematic correspondence needs to be evaluated

carefully. If there seems to be widespread consensus about an

application, that carries more weight with me than an idea being

merely interesting. for example, the quantification of yin and

yang in herbs also mentioned by unschuld (for example, an herb

is 3 parts yin and 1 part yang, etc.) never caught on at all.

 

And then how much of this so-called herbal pharmaceutics was

merely a mental exercise on the part of ivory tower scholars?

Books about the treatment of disease (as opposed to those

about materia medica) seem to pay much less attention to these

theoretical concerns. I think there has probably always been this

parallel development of ideas in china. Harris Coulter has

documented that the development of medicine in western

cultures always involved a tug of war between rationalists and

empiricists. This was also true in china. the herbalists were

basically empiricists for most of chinese history. When the

rationalistic school of thought called systematic correspondence

(SC) was applied to herbology, I think there were varying

degrees of acceptance. those who were appealed to by

rationalism and speculation focused themselves on applying

" chinese science " to explain every aspect of herbology. Those

who were more pragmatic and suspicious of rationalization

adopted only those ideas that were clinically useful. I think many

of the pragmatists found no additional utility with the extensive

layers of theory elaborated by the scholars.

 

It must also be remembered that many of the scholars who

wrote extensively on the application of SC to herbology in the jin-

yuan era were apparently not doctors, per se. they were

bureaucrats who studied medicine as a family obligation. But

they did not have extensive practices. So a lot of what they

speculated may have been of no interest to their peers who

actually spent their days practicing medicine. I think this

dichotomy between materia medica still exists in modern china.

Materia medica still list attributes like channel entry, but texts and

articles on disease treatment rarely mention them. Some

people like to think of TCM as a complete body of integrated

knowledge. But it is really the product of several historical trends

that developed largely independently (acupuncture, internal

medicine, pharmacy). And there have always been a large

number of educated practitioners who eschew some, most or all

the theory of systematic correspondence. Z'ev mentioned one

japanese school of thought, but there are others as well.

 

So while the knowledge of herb flavor and entering channel has

been developing in the materia med lit for over 2000 years, the

question is whether this was always more of a scholarly than a

clinical pursuit? Are we erring to devote so much attention in our

curriculums to what is more correctly part of traditional chinese

pharmacy than it is of medicine, per se? It has been argued and

noted that even in modern china, these three subjects

(acupuncture, internal medicine, pharmacy) remain largely

separate. Yet we expect our students with limited english

language resources and limited internship opportunities to be

competent in all three, often in programs that are only 3 years

long. So to say that these nuances of materia medica have

always been part of TCM is certainly true, but to say they have

always been integral to the actual practice of medicine is less

evident to me.

 

[Guest guest]

I have always felt that Coulter's metaphor (in Divided Legacy, part I)

is one of the great threads that runs through the history of medicine,

east and west.

 

It is interesting as well how the empirical and rationalist threads wind

around each other.

 

For example, Coulter states that Homeopathy is largely an empirical

medicine, based on clinical observation. However, since its renaissance

in the West in the last 25 years, there is more of a demand for a

rationalist structure, with adaptations of theories developed by

Eizayaga (layers), miasm theory, and even five phase theory borrowed

from Chinese medicine. Is this a good trend? Too soon to say, perhaps,

but obviously there is a perceived demand and need for this development.

 

Bob Flaws once stated in his writing that he felt that TCM was a

rational medicine. I don't know if he still holds this view. I believe

that, largely, it is, but that there is room for empiricism as well.

Much discovery occurs at the empirical level.

 

The problem with an empirica approach to medicine, in my opinion, is

that while one sharpens one's clinical acumen and uses it for reference,

it tends to leave one in a narrow band of thought that limits one's

focus and potential clinical success. This may be good for a

specialist, as in orthopedics, cupping, tui na, or a specific disease,

but not so good for a general practitioner. Most modern practitioners

of CM in the West are G.P.'s, so to speak, for better or for worse.

 

A broad view of medicine requires continuing scholarship and exposure to

a wide range of theories. It allows flexibility and openness, and a

more spontaneous response to the ever-changing manifestations of human

health and disease.

 

 

On Sunday, April 21, 2002, at 12:37 PM, 1 wrote:

 

> Harris Coulter has

> documented that the development of medicine in western

> cultures always involved a tug of war between rationalists and

> empiricists.  This was also true in china.  the herbalists were

> basically empiricists for  most of chinese history.  When the

> rationalistic school of thought called systematic correspondence

> (SC) was applied to herbology, I think there were varying

> degrees of acceptance.  those who were appealed to by

> rationalism and speculation focused themselves on applying

> " chinese science " to explain every aspect of herbology.  Those

> who were more pragmatic and suspicious of rationalization

> adopted only those ideas that were clinically useful.  I think many

> of the pragmatists found no additional utility with the extensive

> layers of theory elaborated by the scholars.

[Guest guest]

My feeling is, like yours, that three years is not enough time to get

all of this stuff into student's heads, hearts and hands. However, I

feel even more strongly that, for now, this is where they are going to

get the most exposure to the breadth and depth of Chinese medicine. If

they don't hear about spleen-stomach theory here or Nan Jing five phase

acumoxatherapy, where will the get it?

 

Teaching materia medica merely as memorizing the Bensky, Yeung or OHAI

texts is like a Reader's Digest version. I think we need to allow for

exposure to the total picture as much as possible, so that there is less

confusion when prescriptions use ingredients in 'non-standard' ways.

This is why material from the Shen nong ben cao/Divine Farmer's Materia

Medica, or the Great Dictionary of Chinese Medicinals/Zhong yao da ci

dian is important. It shows that there are differing views and

information on Chinese medicinals, and studying these helps develop

flexible thinking. The use of channel entry and flavors helps us get a

broader view of how medicinals work.

 

Recently, a student took me to task for not basing case history analysis

on (solely) major complaint and the ten questions, or finding one single

pattern to cover complex cases. This attitude supposes that the ten

questions are the cornerstone of the questioning diagnosis. . . yes,

they are there, but not necessarily all used in every case, or in the

same order. We must be careful not to create a rigid, arbitrary entity

of medicine by limited access to information.

 

 

On Sunday, April 21, 2002, at 12:37 PM, 1 wrote:

 

> So while the knowledge of herb flavor and entering channel has

> been developing in the materia med lit for over 2000 years, the

> question is whether this was always more of a scholarly than a

> clinical pursuit?  Are we erring to devote so much attention in our

> curriculums to what is more correctly part of traditional chinese

> pharmacy than it is of medicine, per se?  It has been argued and

> noted that even in modern china, these three subjects

> (acupuncture, internal medicine, pharmacy) remain largely

> separate.  Yet we expect our students with limited english

> language resources and limited internship opportunities to be

> competent in all three, often in programs that are only 3 years

> long.  So to say that these nuances of materia medica have

> always been part of TCM is certainly true, but to say they have

> always been integral to the actual practice of medicine is less

> evident to me.

[Guest guest]

, " " <

zrosenbe@s...> wrote:

 

> Bob Flaws once stated in his writing that he felt that TCM was

a

> rational medicine. I don't know if he still holds this view. I

believe

> that, largely, it is, but that there is room for empiricism as well.

> Much discovery occurs at the empirical level.

 

 

I think TCM is a rational framework overlaid on an empirical body

of data. the question in my mind is not whether one should

blend both for a holistic approach. that is a given. the question

is how much rational structure does one need. I argue it is the

minimum necessary to get the job done. some people get lost

in the intricacies of theory totally divorced from practice. I think

much of the data on channels is of this nature. theory is only of

interest to me to the extent that it gives me clinical guidance. So

channel entry and flavor may or may not provide useful data. But

in any event, that data is always of lesser significance to me than

actions and indications.

 

[Guest guest]

Ken:

 

What criteria or evidence did Hsu use to refute Chang Yuan-su's

doctrine?

 

 

Jim Ramholz

 

 

 

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

> " Among others, Hsu Ta-ch'un sought to refute one of the most

> important innovations of Sung-Chin-Yuan medicine, namely Chang

Yuan-

> su's doctrine that medicinal drugs reach the intended locations

> through specific transportation channels. Hsu termed such

> notions 'nonsense' (ch'uan-tso). "

[Guest guest]

Jim,

 

> What criteria or evidence did Hsu use to refute Chang Yuan-su's

> doctrine?

 

Excellent question.

 

Two more quotes from Medicine in China: A History of Ideas

by Unschuld begin to point a way to an answer.

 

p. 210, a translation of a passage by Hsu himself

reveals his attitude about such matters:

 

" The darkness enveloping medical teaching has continued now for a

long time. During the Ming period, the instructions of the Four Great

Masters were followed, and Chang Chung-ching [i.e., Chang Chi], Liu

Ho-chien [i.e., Liu Wan-su], Li Tung-yuan [i.e., Li Kao], and Chu Tan-

hsi [i.e., Chu Chen-heng] were revered as the founders of medicine

itself. This is nothing but ignorant and inane foolishness! Chang

Chung-ching was truly a sage whose renown will continue throughout

eternity. He is like K'ung-tzu, the ancestor of Confucianism. Liu Ho-

chien and Li Tung-yuan, however, left us only ill-considered

teachings. Chu Tan-hsi did nothing more than reflect on and rearrange

the views of all earlier authors, leaving out something here and

borrowing something there. He thus created an easy entrance for

beginning students. And these men are generally called renowned

physicians! "

 

In other words, his criteria and evidence

seems to be based upon a general reevaluation

of the whole enterprise represented by the

work of these four writers. I think your

question also gets at something quite basic

that comes into play when we consider the

relative merits of the findings of Chinese

physicians, scholars, and writers from various

time periods, namely the modes of thinking

employed and the contexts in which these modes

of thought were operating. To this point,

Unschuld speaks quite directly on p. 231:

 

" The history of Chinese ideas about the nature of illness and the

optimal treatment of physical and mental suffering is only

comprehensible when perceived as an integral component of the larger

context of sociopolitical objectives and developments. "

 

In short, " criteria " and " evidence " did not

mean the same things to Chinese thinkers

and writers that they mean to modern Western

readers. In order to understand what they

were thinking and why, we have to take

a wide range of issues into consideration.

 

It's somewhat analagous to trying to parse

the current media's discussion of therapeutic

cloning. If you don't take into consideration

the various ideological positions that come

to bear on the issues involved, they tend

to lose their significance.

 

The chore is obviously far more difficult

when we're reading not newspapers printed

last night but books written centuries ago.

 

But in both cases, one is well advised not

to jump to conclusions.

 

Ken

[Guest guest]

Ken:

 

Your comparison doesn't work here because the therapeutic cloning

debate is unresolvable on ethical or moral grounds, not scientific

or technical grounds.

 

How, technically, can the debate over herb/channel association or 5-

Phase correspondence be resolved? Especially if they are not already

resolved in the originating culture?

 

 

Jim Ramholz

 

 

 

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

> But in both cases, one is well advised not to jump to conclusions.

[Guest guest]

, " jramholz " <jramholz>

wrote:

> Ken:

>

> What criteria or evidence did Hsu use to refute Chang Yuan-

su's

> doctrine?

>

 

 

He uses a logical argument. but the question should be turned

around. What evidence did Chang have for his ideas? If you

prope a new idea, the burden is on you to prove it. all a

dissenter needs to prove is that you have no evidence on your

side.

 

[Guest guest]

The point is, they can't, like you say. But, still, the full range of

information on each medicinal should be made available to all

practitioners, so they have a full body of information to make clinical

decisions on. We need to render the Chinese medical literature as

accurately as possible to do so.

 

 

On Monday, April 22, 2002, at 09:34 AM, jramholz wrote:

 

> How, technically, can the debate over herb/channel association or 5-

> Phase correspondence be resolved? Especially if they are not already

> resolved in the originating culture?

[Guest guest]

Jim,

 

> Your comparison doesn't work here because the therapeutic cloning

> debate is unresolvable on ethical or moral grounds, not scientific

> or technical grounds.

 

I'm not talking about resolving debates.

I'm talking about understanding the issues

involved in those debates. The mere fact

that you can state that the moral and ethical

debates are unresolvable reflects a relatively

deep appreciation on your part of the complex

issues involved. And that's the point of

the comparison: these issues are involved.

 

You wanted to know how Dr. Hsu came to his

conclusions. But in order to know that you

have to know something about the intellectual

environment in which he lived, how he thought

about things or more precisely how he expressed

his thoughts about things, and how his ideas

fit into the larger picture of which they

form one part.

 

 

 

>

> How, technically, can the debate over herb/channel association or 5-

> Phase correspondence be resolved? Especially if they are not

already

> resolved in the originating culture?

 

Again, I don't really see resolution of a debate

as the principal objective. I see the task at hand

as learning to use the tools that have been developed

by people of another era to solve problems that we

face in our own, while preserving the knowledge for

future generations. As I've noted in the past this

trans-generational perspective is a key feature

of the " sociopolitical objectives and developments "

that constitute the larger context in which

" Chinese ideas about the nature of illness

and the optimal treatment of physical and

mental suffering " must be understood.

 

 

Ken

[Guest guest]

 

>

> He uses a logical argument. but the question should be turned

> around. What evidence did Chang have for his ideas? If you

> prope a new idea, the burden is on you to prove it. all a

> dissenter needs to prove is that you have no evidence on your

> side.

 

Hence the prerequisite of knowing Chinese

medical language. How can anyone expect

to resolve such issues through the exclusive

use of translated fragments?

 

Your earlier position was that channel

entry was, along with flavor, largely

irrelevant. You've since mollified that

stance stating that whereas identification

of flavors of medicinals appears to be

a long established feature of the literature

the validity and clinical relevance of

channel entry seem less evident to you.

 

But I believe that if you look quite

frankly at the situation here you'll find

that we have not examined the primary

sources and beyond saying that we don't

really know what they say and how their

arguments are constructed there is really

nothing of any significance whatsoever

that we can say. I haven't read Dr. Chang's

work. Have you? I only know what I've

read that others have said about his work.

 

This is the juncture at which many choose

to " make stuff up " . And indeed sooner or

later we always come to the limits of our

understanding and have to just make stuff

up in order to proceed. But we don't need

to make up the past. It's lying there just

waiting to be discovered.

 

Ken

[Guest guest]

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

> Again, I don't really see resolution of a debate

> as the principal objective. I see the task at hand

> as learning to use the tools that have been developed

> by people of another era to solve problems that we

> face in our own, while preserving the knowledge for

> future generations.

 

 

Ken:

 

But resolving the debate **is** the principle objective. Researching

the history of Chinese medicine should have the objective of

aquiring useful clinical information---otherwise we would be

ethnographers and not acupuncturists. What is it all for? What---

exactly---are you preserving for future generations---another

academic monograph?

 

If you bypass the debate process and chooses simply to not use that

type of information in decisions for treatments (as I believe Todd

has done), that's another way to resolve or defer it. But to leave

the issue ambiguous or undecided, just a battle of sound-bites from

historical figures, is unacceptable and has no relation to the

reality of clinical practice.

 

Again, how do we resolve the debate?

 

 

Jim Ramholz

[Guest guest]

Z'ev:

 

But even after rendering the Chinese medical literature as

accurately as possible, isn't this debate is still going on

unresolved today? How do you help the student distinguish between

what is demonstrable clincally and what is merely of historical

interest if this debate is yet unresolved?

 

It begs the question, " is this debate unresolved? " In the past and

today, practitioners seem to use channel induction and the system of

correspondences. Why the controversy in the past and why does it

continue now?

 

 

Jim Ramholz

 

 

 

 

, " " <zrosenbe@s...>

wrote: The point is, they can't, like you say. But, still, the full

range of information on each medicinal should be made available to

all practitioners, so they have a full body of information to make

clinical decisions on. We need to render the Chinese medical

literature as accurately as possible to do so.

[Guest guest]

Jim -

 

Again, how do we resolve the debate?

 

The body of Chinese medical literature was constructed by individuals and groups of individuals. The question is at what point is the material rendered sacred? At no point, all materials must be clinically verified in my opinion --- regardless of historical basis.

 

A far as the entering channels system concerned, it provides concise nomenclature for the organ tropism of medicinal substances. If there is a conflict or seeming inaccuracy, let's take it up agent by agent. Washing the whole system of entering channels under the table because it is a more recent advent seems illogical. In addition, reducing value of material due to one's personal understanding seems potentially dangerous.

Will

[Guest guest]

On Monday, April 22, 2002, at 04:08 PM, jramholz wrote:

 

> Z'ev:

>

> But even after rendering the Chinese medical literature as

> accurately as possible, isn't this debate is still going on

> unresolved today? How do you help the student distinguish between

> what is demonstrable clincally and what is merely of historical

> interest if this debate is yet unresolved?

 

This is part of the process. . . to try different things out clinically

and report back. For example, your work with Nan Jing five phase

acupuncture theory, or my work with yin fire theory. And, remember, we

have the modern clinical experience of the Chinese reported voluminously

in the journals to refer to and check our own experience.

>

> It begs the question, " is this debate unresolved? " In the past and

> today, practitioners seem to use channel induction and the system of

> correspondences. Why the controversy in the past and why does it

> continue now?

>

I think this has to do a lot with how Chinese medical theory is

constructed. Since there are a number of theories and methods to treat

individual patients, much more so than in modern biomedicine, there will

be more disagreement and controversy on what is the ideal method.

While, historically, there has been a refinement of theories and

approaches in CM, we still see differences in diagnosis and treatment

strategies. This, again, depends largely on the point of view of the

physician, training, technique and many other factors.

 

 

[Guest guest]

Jim,

 

> But resolving the debate **is** the principle objective.

 

I'm not at all opposed to debate, whether

that be the beginning, continuation, or

ending of a debate...regardless of the

degree to which that end represents and

reflects a resolution of the issues

discussed for the debaters and for

those who listen. I simply believe that

the primary and principal objective

remains providing access to the language,

literature, and knowledge base of the

subject so that those who, like yourself,

experience the vital need to debate

such matters can benefit from the

debates that have preceeded ours

and from a shared set of the most

fundamental ideas and definitions.

 

 

Researching

> the history of Chinese medicine should have the objective of

> aquiring useful clinical information---otherwise we would be

> ethnographers and not acupuncturists.

 

Shhh...you're going to get the ethnographers

riled up and they'll be over here screaming

at us, " What's wrong with being an ethnographer!??? "

 

Actually, data, information, knowledge, even

wisdom can be put to any use that those who

possess it intend. It's the possession of it

that concerns me.

 

If people do not know what is in the material

how can they debate its relative merits?

 

 

What is it all for? What---

> exactly---are you preserving for future generations---another

> academic monograph?

 

Much of the information on which we

base our practice comes from two

sources: the mouths of our teachers

and the pages of academic monographs,

which just happen to have been written

long ago. And when you consider that

much of what teachers have to say is

in turn based on those same writings,

the value of academic monographs can

be appreciated in a different light.

 

Don't get me wrong. Academia is a scary

place.

>

> If you bypass the debate process and chooses simply to not use that

> type of information in decisions for treatments (as I believe Todd

> has done), that's another way to resolve or defer it. But to leave

> the issue ambiguous or undecided, just a battle of sound-bites from

> historical figures, is unacceptable and has no relation to the

> reality of clinical practice.

 

I really think it's a big mistake to

disparage the discussion. And I don't agree

that Todd bypassed the debate process.

He said he undertook the subject as

an early debate topic when he got to

PCOM. And he brought it to this list

obviously with the intention to let

it serve as the focus of further debate,

which it has proceeded to do. So I

don't think it's accurate to say he

has bypassed the debate process.

>

> Again, how do we resolve the debate?

 

Good question. How?

 

Ken

[Guest guest]

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

> Much of the information on which we

> base our practice comes from two

> sources: the mouths of our teachers

> and the pages of academic monographs,

> which just happen to have been written

> long ago. And when you consider that

> much of what teachers have to say is

> in turn based on those same writings,

> the value of academic monographs can

> be appreciated in a different light.

 

I think you are exaggerating our situation. That was probably true

in the 70s, but today access to that material is more easily

available. Now we have more schools with Chinese faculty (who

presumably have access to all the literature), trips to Chinese

clinics (who presumably have access to all the literature) sponsored

by the schools, books and essays translated into English by major

researchers, more classics translated into English, and more

practitioners translating and publishing exerpts from modern

clinical journals. So, we are not short on information.

 

The real limitation, today, is how much can be done in 4 years of

education, and whether the student will become a practitioner that

continues to read and study after graduation.

 

 

Jim Ramholz

[Guest guest]

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

wrote:

 

>

> Your earlier position was that channel

> entry was, along with flavor, largely

> irrelevant. You've since mollified that

> stance stating that whereas identification

> of flavors of medicinals appears to be

> a long established feature of the literature

> the validity and clinical relevance of

> channel entry seem less evident to you.

 

While I said flavor had a longer history in materia medica texts

than channel entry, my point was that both of these attributes are

not mentioned much in internal medicne literature. that there is

a disconnect between texts that focused completely on theory

and those that focused on practice. While access to the

complete body of medical literature would be helpful in sorting

out this matter, unless the existing translations are not

representative, then there is sufficient data to support these

generalizations. All materia medicas in english stress this

issue and basically no texts on disease treatment do. Whether

these attributes (channel and flavor) are useful to explain the

actions of chinese herbs is not my point, either. they certainly

play a role as a educational tool.

 

But once one knows the actions, I still find the explanatory

information of little practical relevance. I would offer as an

analogy in western medicine that most doctors do not

understand the pharmacology of the drugs they use and they

couldn't possibly be expected to. It is highly specialized

knowledge that requires lengthy study in its own right and

mastery of this knowledge is not considered essential to the

practice of medicine. I would offer the supposition that this

same basic opinion has been held by many literate doctors in

chinese history. While they may not have said it so overtly as

Hsu, it is implicit in their writings on disease.

 

Pharmacy and materia medica are subjects of interest to me

personally. However, the TCM explanation of actions is no more

or less satisfying to me than biochemical ones. they are both

" interesting " , but how important are they? the question is, there

being limited time, how much emphasis to put on teaching

pharmacy at the expense of internal medicine.

 

[Guest guest]

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

wrote:

 

>

> Again, I don't really see resolution of a debate

> as the principal objective.

 

me neither. my goal is to expose people to the fact that these

issues are debatable so they are not just accepted uncritically.

this debate interweaves with the politics of TCM because

decision makers and power brokers in our field clearly have not

made critical analysis of these issues in determining

curriculum, licensure and examination. How many of our

colleagues have ever even read Unschuld?

 

[Guest guest]

Jim,

>

> I think you are exaggerating our situation. That was probably true

> in the 70s, but today access to that material is more easily

> available. Now we have more schools with Chinese faculty (who

> presumably have access to all the literature), trips to Chinese

> clinics (who presumably have access to all the literature)

sponsored

> by the schools, books and essays translated into English by major

> researchers, more classics translated into English, and more

> practitioners translating and publishing exerpts from modern

> clinical journals. So, we are not short on information.

 

It's not clear to me what you see as

exaggeration. I was not saying there

is a shortage of information. As Phil

pointed out, there's more information

out there than anyone could possibly

read in 100 lifetimes. He was talking

about medical information in general,

but the same can be said about Chinese

medical information.

 

I don't agree that we can just sum up

the English language literature as

providing significantly better access

to the traditional knowledge base of

the subject based solely upon the

recent proliferation of books. If you

compare the extent of the materials

available on the subject of Chinese

medicine in Chinese with those that

are available in English, you'll find

that there is an enormous shortfall

in the English language category.

 

And a more important question is

the extent to which the extant English

language literature, particularly those

texts that are widely used as the defacto

standards of the subject in the schools

and on the various licensing examinations

a) accurately reflect the scope of the

knowledge base of the subject; and

b) encourage students and practitioners

to increase their access to, understanding

and application of this knowledge.

 

 

>

> The real limitation, today, is how much can be done in 4 years of

> education, and whether the student will become a practitioner that

> continues to read and study after graduation.

 

I agree. That's why I continue to

agitate for increased study of the

language and literature. Folks who

share the dream of contributing to

a more effective approach to medical

and health care and who see Chinese

medicine as a source of potential

contributions to the realization of

this dream really ought to take

responsibility to see that the

traditional knowledge base is fully

represented in the organization of

the subject that we continue to construct.

 

These responsibilities only begin

in the years of formal education. But if

students are taught that there is

no need to know the Chinese nomenclature

and there is no need to have access

to the traditional knowledge base while

they are in school, why should we expect

that they will develop an appreciation

of the importance of such things after

graduation?

 

There are two large categories of

response to the situation we face.

One is to throw up one's hands and

say that the task is too big, grumbling

about fancied conflicts between clinical

and academic knowledge or whatever. The

other is to get to work.

 

How do we resolve the debate?

 

I think that is the question you

were wanting to get answered.

 

Step 1: provide far greater access

to the information people need in

order to think clearly about the

topics being debated.

 

Ken

[Guest guest]

, WMorris116@A... wrote:

 

>

> A far as the entering channels system concerned, it provides

concise

> nomenclature for the organ tropism of medicinal substances.

 

I agree, but that is all it does. It is an organizational tool. It has

no value more profound than that.

 

If there is a

> conflict or seeming inaccuracy, let's take it up agent by agent.

Washing the

> whole system of entering channels under the table because it

is a more recent

> advent seems illogical.

 

It is not dismissed because of its recency. It is challenged

because of its controversy. I am a big fan of recent ideas. I use

the concept of blood stasis as elaborated in the 18th century very

frequently in my practice, for example. I am not sure why people

keep accusing me of wanting to eliminate this entire body of

knowledge from education, when at every step of this argument I

have asked the question of how much emphasis to be placed

here. I have never once suggested eliminating it from study.

 

 

In addition, reducing value of material due to one's

> personal understanding seems potentially dangerous.

 

Actually, accepting information uncritically is far more dangerous

in my opinion. As to how one goes about making such a

critique, it would seem there is no other method than using

one's " personal understanding " . People are free to challenge

each other's understanding. I would say to the MSU crowd that

increasing the value of material due to one's understanding

without citing precedents is the true scourge of this profession.