pulse precedes pathology?

[Guest guest]

Here is an example of what I mean. One might feel a floating pulse in a

patient who has no symptoms of a cold yet. Yet the patient develops

symptoms a few hours later. So the pulse preceded signs and symptoms.

But I would lay any odds that changes in biochemistry had already occurred

by the time the pulse became floating. the virus entered the system and

began to incubate. The immune system detected it and began to produce

antibodies. It is well known that this process takes hours or even days

before symptoms appear. So we could have measured either a virus titer or

an antibody titer at the same time the pulse changed. Now it is not

really possible to do such lab tests on a routine basis and that is not my

suggestion. My point is merely that biochemical changes have occurred in

this scenario. they are silent and invisible and the ancient chinese had

no clue about this aspect of physiology. So they could not comment on it.

To say that energetic changes always precede physical ones is an

unsupported speculative statement. Since it flies in the face of modern

science, it seems the burden is on the claimant to prove his case. I know

every time I do lab tests, I find something. can anyone say they know for

a fact that the changes are purely energetic when no such tests have been

done? this reminds me of psychology. Over the past 20 years, many

diseases of the " mind " have been identified with changes in the brain.

 

 

 

Chinese Herbs

 

 

" Great spirits have always been violently opposed by mediocre minds " --

Albert Einstein

[Guest guest]

wrote:

 

>My point is merely that biochemical changes have occurred in this

scenario. they are silent and invisible and the ancient chinese had no

clue about this aspect of physiology.

 

I understand your point about the pulse preceding pathology from

the TCM perspective, but not necessarily preceeding biochemical markers

or other lab diagnostics. But haven't you ever treated someone who's

been through all sorts of tests from biomedical practitioners and

everything comes up normal, and yet the patient presents with a specific

TCM syndrome complete with pathological pulse?

 

That happens a lot with my patients. The tests show normal, nothing but

normal. Not high normal, not low normal, but smack dab in the middle,

median, center of the graph normalcy. And yet patients limp in with

whatever problem they have and we treat it. Sometimes successfully,

sometimes not.

 

What about the overweight individual who shows signs of yin deficiency?

I ask about diabetes in the family in cases such as this and 90% of the

time get a positive response. Do they have any biomedical markers of

diabetes? Not from what they report.

 

--

Al Stone L.Ac.

<AlStone

http://www.BeyondWellBeing.com

 

Pain is inevitable, suffering is optional.

[Guest guest]

, Al Stone <alstone@b...> wrote:

 

But haven't you ever treated someone who's

> been through all sorts of tests from biomedical practitioners

and

> everything comes up normal, and yet the patient presents with

a specific

> TCM syndrome complete with pathological pulse?

 

that's really not my point, either. sure, standard biomedical lab

tests often tell us bupkis. but that doesn't mean biochemical

changes have not occurred. It means the tests used did not

measure any pathology. But if you include functional tests like

intestinal permeability, stool cultures, liver detox function,

mineral levels, DHEA, growth hormone, etc., none of which are

commonly done in WM, then it is typical to come up with

abnormal results in ill patients. Only if all these tests have been

exhausted can one rule out the presence of physiological

abnormalities. But again, I am not suggesting spending money

on such tests for all or even any patients. I am merely saying

that every event associated with qi in TCM has a biochemical

correlate (correlate, not CAUSE), whether it is easy to measure

or not. All studies that have attempted to verify this have found

corroborating evidence. Even qi gong studies have shown that

qi gong practices correlate with biochemical changes. Or the

new MRI research that shows acupoint stimulation correlating

with changes in brain imaging.

 

And why do I care? Because if I am correct, research can

validate the core theories of TCM. Unless this happens, I

believe we will be coopted by WM, which will steal our

techniques/substances and dismiss our unproven medieval

theories. If we can validate the theories, then we get to dictate

the terms of research and practice. Just proving the medicine

works is a dangerous undertaking without validating the

concepts. there may be another way to do this, but this one is

simple and satisfying.

 

for the pulse and pure CM enthusiasts out there, there is a silver

lining inside this idea for you. It will always be too expensive to

perform these lab tests to evaluate patients on a weekly basis.

but if the traditional method of dx is proven to correlate with

objective reproducible lab tests, this will allow people to use the

traditional method with the authority of Western science behind

it. Instead of reducing CM diagnostics to lab testing, it might

actually elevate our methods to the position of respect they

deserve. If my pulsetaking is as good as your lab test, but my

method costs 10 times less, what's the reasonable course of

action?

 

[Guest guest]

 

 

 

Here is an example of what I mean. One might feel a floating pulse in a patient who has no symptoms of a cold yet. Yet the patient develops symptoms a few hours later. So the pulse preceded signs and symptoms.

But I would lay any odds that changes in biochemistry had already occurred by the time the pulse became floating. the virus entered the system and began to incubate. The immune system detected it and began to produce antibodies. It is well known that this process takes hours or even days before symptoms appear. So we could have measured either a virus titer or an antibody titer at the same time the pulse changed.

 

I will agree here because the pulse reflects a vegetative NS response to microbes. Infection leads to secretion of adrenaline and noradrenalin which causes vasoconstriction

in the intradermis and/or epidermis depending on whether it is a Shang Han or Zhong Feng

pattern.

 

 

To say that energetic changes always precede physical ones is an unsupported speculative statement. Since it flies in the face of modern science, it seems the burden is on the claimant to prove his case. I know every time I do lab tests, I find something. can anyone say they know for a fact that the changes are purely energetic when no such tests have been done? this reminds me of psychology. Over the past 20 years, many diseases of the "mind" have been identified with changes in the brain.

 

 

I never said 'energetic' nor 'always'. I said the pulse precedes pathology - I should add it can also follow.

These are merely tendencies. Waiting for the sign symptom complex to arrive is like waiting for war to begin to make arrows. However, in the practice of preventative medicine, the pulse has proven to be

one of the more reliable indicators. For instance, when there are early sensations of atherosclerosis in say a 28 year old man, it is easy to suggest correctly that there is a family history of cardiovascular disease. This person will be at a higher risk of heart disease and usually has one or more close family members who have died prematurely due to heart disease. Proper preventative methods may then be utilized to prolong life.

Dr's Shen and Hammer call the atherosclerotic pulse 'ropy' I have never seen it identified as anything but wiry in any clinic I have visited or inspected - this is plain wrong. There is a completely different pathophysiology taking place, and properly identified, it allows one to engage in treatments that can improve longevity. If is identified as wiry and one pursues the strategy of coursing liver qi, it fails to capture the correct treatment for the condition.

 

Will

[Guest guest]

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

> And why do I care? Because if I am correct, research can

> validate the core theories of TCM. Unless this happens, I

> believe we will be coopted by WM, which will steal our

> techniques/substances and dismiss our unproven medieval

> theories. If we can validate the theories, then we get to dictate

> the terms of research and practice.

 

:

 

While finding parallels between CM and WM is fascinating, if we need

to validate the core theories of CM through WM, won't the opposite

effect occur? Isn't this what many Westerners already believe

and " medical " acupuncturists are eagerly trying to prove---that herb

and acupuncture effects are really biochemical in nature, nothing

more? Consequently, qi (which can't be satisfactorily defined) and

other aspects of CM theory would be found antiquated and moot. Herbs

would probably then be regulated by the FDA if their effect is

decided to be pharmacological.

 

Validity of CM theories should be found in their intellectual

consistancy and clinical efficacy.

 

Jim Ramholz

[Guest guest]

Al,

 

Excellent example. Having just finished 12 months or more working on a

400 plus page book on CM and diabetes (coauthored by Lynn Kuchinski &

Dr. Robert Casanas, MD, prof. med, UCBerkeley), I'd like to add my two

cents to this example.

 

You say the patient manifests a pattern of yin vacuity, is overweight,

and has a familial history of diabetes (presumably type 2) but

you say he tests negative for DM. By this, I asume you mean his FBG,

PPBG, and OGTT are all within normal ranges. However, there is

something referred to as syndrome X or insulin resistance syndrome.

This is a triad of hypertension, hypertriglyceridemia, and

hyperinsulinemia which typically does lead to the eventual development

of type 2 diabetes (as well as coronary artery disease and increased

mortality and morbidity). Because many nonendocrinologist MDs are not

up to speed on this, this diagnosis is not made as often as it should

be. Typically, routine blood work includes blood glucose but not

insulin levels.

 

Ok, so here's my point, it seems to me that you are saying that the

patient has the signs and symptoms of a pattern that is commonly seen

in type 2 DM and that they have definite risk factors for type 2 DM.

However, at the moment, lab tests do not indicate that the patient

actually has type 2 DM. But I don't think any of this in any way

refutes what Todd is trying to say.

 

The patient may not have the diagnostic indications of DM, but they

may have the diagnostic indications of syndrome X, and syndrome X is

now an established disease category in the contemporary CM literature

(viz. the July '02 issue of Blue Poppy's Online CM Journal). In other

words, although the patient does not have DM, they probably do have

other abnormalities in certain clinical and laboratory tests (though

not blood glucose) that, based on WM theory, often lead to DM. So they

are still diseased. In both WM and CM, simply being overweight is a

pathological condition. In the last five years or so, fatness (i.e.,

being overweight or obese) as a disease category is a not uncommon

topic for research articles in Chinese medical journals. So, if

nothing else, the patient's current disease diagnosis is either being

overweight (if less than 20% over ideal weight) or obesity (if more

than 20% over ideal weight). In WM, there is an algorhithm (sp?) that

says: if a person is x pounds overweight, they will develop type 2 DM

in x number of years. In addition, some WM practitioners say that if

your waist is more than 39 " in circumference, then you do, in all

probability, suffer from insuline resistance. Similarly, hypertension

and hyperlipidemia are both disease categories in contemporary WM and

CM.

 

Bottom line, I don't think you can say that this patient is wu bing,

without disease (Wang Shu-he's words quoted by Jim from the Mai Jing),

even though they may be without DM.

 

Further, if they do manifest the signs and symptoms of yin vacuity,

then they do currently suffer from at least one or more other CM

diseases. Dizziness, tinnitus, low back pain, polyuria, profuse

night-time urination, night sweats, insomnia, heart palpitations are

not only the commonly presenting pathognomonic s & s of yin vacuity,

in CM, these are all disease categories in their own rights. If the

patient doesn't have a certain number of the forgoing s & s, then you

cannot say the patient manifestest the pattern of yin vacuity. I think

we have covered this before on this list, but, in Chinese, you " have "

(you) a disease, but you " present " (xian, literally " see " ) a pattern.

There is no pattern if the patient does not present the s & s of that

pattern, and no single sign or symptom establishes a pattern. A

pattern is, ipso facto, made up of at least two or more elements.

 

If there's dizziness, if there's polyuria, if there are night sweats,

if there are heart palpitations, there are WM pathophysilogical

mechanisms causing each and every one of these. For instance the

subjective sensations of palpitations may associated with the

following ECG abnormalities: sinus node problems, premature atrial

contraction, premature ventricular contraction, atrial fibrillation,

ventricular fibrillation, and bundle branch block (there may be

others; I'm not a cardiologist). Palpitations may also be associated

with mitral valve prolapse, dysregulation of serotonin, and

hypocalcemia (again, they may be other reasons as well; this ain't my

field of expertise). All these things are testable. Granted, if the

Western doc picks the wrong tests, the patient comes up negative, and

one of the problems Western docs have is knowing which tests to do in

any given case. (This is where I think CM pattern discrimination could

be added to WM to help target differential diagnosis more

efficiently.)

 

What I think Todd is saying is that, if there are signs and symptoms,

there are pathophysiological reasons for these signs and symptoms, and

these either are testable by current technology or will be testable as

technology become more and more sophisticated and sensitive. As in the

situation above where syndrome X is defined by the congruence of three

tests but not blood glucose, complexity theory may also play an

increasing role in this kind of testing where no one test is

indicative by itself but conclusions are drawn from the patterns

created by several tests. Nevertheless, I think the single most

important thing we need to agree on is whether or not all signs and

symptoms correspond (ying1) to pathophysiological changes within the

physical (i.e., biochemical body). If not, then we are back to the

alternative of some nonphysical, etheric (I'm using this term in its

original Greco-Roman, Galenic sense, not some new Age wu-wu

definition), " energetic " sheath idea whether we like it or not.

 

But, lest anyone jump to embrace this second point of view, I would

like to point out that the Jian Ming Zhong Yi Ci Dian (Simple, Clear

Dictionary of , People's Health & Hygiene Press,

Beijing, 1986, p. 163), defines qi in terms of CM as " the [most]

profound and finest material substance which supplies the construction

and nourishment (i.e., nutrition) for coursing and stirring (i.e.,

movement) within the body. " Here I would like to emphasize the words

" material substance. "

 

Bob

 

, Al Stone <alstone@b...> wrote:

>

>

> wrote:

>

> >My point is merely that biochemical changes have occurred in this

> scenario. they are silent and invisible and the ancient chinese had

no

> clue about this aspect of physiology.

>

> I understand your point about the pulse preceding pathology

from

> the TCM perspective, but not necessarily preceeding biochemical

markers

> or other lab diagnostics. But haven't you ever treated someone who's

> been through all sorts of tests from biomedical practitioners and

> everything comes up normal, and yet the patient presents with a

specific

> TCM syndrome complete with pathological pulse?

>

> That happens a lot with my patients. The tests show normal, nothing

but

> normal. Not high normal, not low normal, but smack dab in the

middle,

> median, center of the graph normalcy. And yet patients limp in with

> whatever problem they have and we treat it. Sometimes successfully,

> sometimes not.

>

> What about the overweight individual who shows signs of yin

deficiency?

> I ask about diabetes in the family in cases such as this and 90% of

the

> time get a positive response. Do they have any biomedical markers

of

> diabetes? Not from what they report.

>

> --

> Al Stone L.Ac.

> <AlStone@B...>

> http://www.BeyondWellBeing.com

>

> Pain is inevitable, suffering is optional.

[Guest guest]

, WMorris116@A... wrote:

 

I said the pulse precedes pathology -

> I should add it can also follow.

> These are merely tendencies. Waiting for the sign symptom

complex to arrive

> is like waiting for

> war to begin to make arrows.

 

Will

 

I agree. My posts had nothing to do with this. You have amply

demonstrated that the pulse precedes the manifestation of

symptoms and signs, a point I never contested. My sole point

was that changes occur in biochemistry at the same time as one

feels the pulse change. and both biochem changes and the

pulse precede symptoms. I think the problem in communication

stems from the use of the word pathology. Pathology means a

change in physiology towards disease. So the pulse does not

really precede pathology. In fact it reveals pathology that is not

yet manifest in symptoms. But the pathology is already there.

Pathology is not equivalent to signs and symptoms, but some of

the posts here have used the term as if that's what it means. If

pathology is the actual term used in the texts that have been

quoted, I think this is poor and misleading choice of translation

terms.

 

[Guest guest]

Will,

 

To equate a bowstring pulse with liver depression and only liver

depression is incorrect. That seems to be what you are imnplying in

your post, i.e., if there's a bowstring pulse, this only means to

rectify the qi. As part of a pattern (i.e., more than a single sign

or symptom), a pulse image (mai xiang) only means something in

relationship to other signs and symptoms. Depending on these other s &

s, the bowstring pulse may indicate liver depression, food

stagnation, blood and/or yin vacuity, dampness, phlegm, and/or blood

stasis. At least three of these may be and often are involved with

arteriosclerosis and, more specifically, atherosclerosis.

 

Bob

 

, WMorris116@A... wrote:

>

>

>

> > Here is an example of what I mean. One might feel a floating

pulse in a

> > patient who has no symptoms of a cold yet. Yet the patient

develops

> > symptoms a few hours later. So the pulse preceded signs and

symptoms.

> > But I would lay any odds that changes in biochemistry had already

occurred

> > by the time the pulse became floating. the virus entered the

system and

> > began to incubate. The immune system detected it and began to

produce

> > antibodies. It is well known that this process takes hours or

even days

> > before symptoms appear. So we could have measured either a virus

titer or

> > an antibody titer at the same time the pulse changed.

>

> I will agree here because the pulse reflects a vegetative NS

response to

> microbes.

> Infection leads to secretion of adrenaline and noradrenalin which

causes

> vasoconstriction

> in the intradermis and/or epidermis depending on whether it is a

Shang Han or

> Zhong Feng

> pattern.

>

>

> > To say that energetic changes always precede physical ones is

an

> > unsupported speculative statement. Since it flies in the face of

modern

> > science, it seems the burden is on the claimant to prove his case.

I know

> > every time I do lab tests, I find something. can anyone say they

know for

> > a fact that the changes are purely energetic when no such tests

have been

> > done? this reminds me of psychology. Over the past 20 years,

many

> > diseases of the " mind " have been identified with changes in the

brain.

> >

>

> I never said 'energetic' nor 'always'. I said the pulse precedes

pathology -

> I should add it can also follow.

> These are merely tendencies. Waiting for the sign symptom complex to

arrive

> is like waiting for

> war to begin to make arrows. However, in the practice of

preventative

> medicine, the pulse has proven to be

> one of the more reliable indicators. For instance, when there are

early

> sensations of atherosclerosis in say a

> 28 year old man, it is easy to suggest correctly that there is a

family

> history of cardiovascular disease.

> This person will be at a higher risk of heart disease and usually

has one or

> more close family members who

> have died prematurely due to heart disease. Proper preventative

methods may

> then be utilized to prolong life.

>

> Dr's Shen and Hammer call the atherosclerotic pulse 'ropy' I have

never seen

> it identified as anything but

> wiry in any clinic I have visited or inspected - this is plain

wrong. There

> is a completely different pathophysiology

> taking place, and properly identified, it allows one to engage in

treatments

> that can improve longevity. If is identified as

> wiry and one pursues the strategy of coursing liver qi, it fails to

capture

> the correct treatment for the condition.

>

> Will