pulse precedes pathology?

[Guest guest]

On Thursday, May 2, 2002, at 04:12 PM, 1 wrote:

>

>

> If we prove the efficacy without proving the theories, then it will

> make it even more likely that people will use our methods

> outside their context.  And we will be diminished and

> marginalized in american healthcare.  As to the theories being

> internally consistent, I am not sure that carries any weight with

> decisionmakers.  Tolkien's Lord of the Rings is an internally

> consistent epic description of a fictional world.  If the initial

> premise is false, then an argument can still seem valid as long

> as the central premise is not challenged. 

>

 

how do you propose that we prove the theories? And to who? Who

are the 'decision-makers' who will decide that our theories make sense?

 

> Nevertheless, proving the validity of what we do does not negate

> what anyone else does.  Many people within TCM do not use our

> context, instead practicing NAET, auricular, etc.  Should we

> inform the public about these " charlatans " ?  I know people who

> practice herbology froma sophisticated biomedical perspective

> with excellent results.  I also know people who practice

> acupuncture from an orthopedic or osteopathic perspective or

> even do what's called medical acupuncture based upon modern

> physiology, all with good results.

 

It really depends on what results are expected by the patient and

practitioner. . .short term relief of symptom or pain, or longer-term

resolution of poor health and chronic illness. Some of the methods you

describe above are empirical techniques, not fully developed medicines.

They have benefits and limitations. Chinese medicine is not a

technique, but a system of medicine, a broad umbrella with many

offshoots. I don't think you can compare NAET or osteoacupuncture with

Chinese medicine for depth, history, or versatility.

>

> I don't think it is the presence of these other styles of practice

> that threaten the public or those of us who want to practice " in

> context " .  It is the fact that we are perceived as being unscientific

> and irrational.

 

Can you give me some examples of being considered 'unscientific and

irrational'? And, if we are, how do we explain yin-yang, five phase and

other theories in a 'rational' manner? How can you dress the Chinese

theoretical structure in modern clothes without losing the essence of

the subject? (My own feeling is that Chinese medical theory has to be

studied on its own merits as a subject, and without this, it will be

difficult to understand).

 

>   I don't want to inhibit these other styles from

> being practiced; I just want what I do to have equal credibility.  To

> consider how this is accomplished, put yourself in the shoes of

> those who make decisions about these matters.  For all they

> know, the medical style of acupuncture is superior to the

> traditional style (that's what the AAMA argues).  We can scream

> and point all we want, but until we prove that 2 + 2 = 4, our

> shouts will fall upon deaf ears. 

 

 

Credibility, in my opinion, begins with the public experiencing the

strength and efficacy of well-trained and experienced practitioners of

our medicine. There are grass-roots strategies (i.e. educating the

patient population) and 'trickle-down' strategies (i.e. studies, working

with the NIH, licensing agencies, etc.) Both are important, but it is

the patient population that put us on the map and sustains us.

 

 

[Guest guest]

I'd like to quote a text " Mental Methods (fa1) of Eruptive Disorder " by

Yin Zhong-cun (17th century), translated by Nathan Sivin, (he

translates fa1 as Dharma, connecting it with the influence of Buddhist

texts) in response to some of the recent posts on pathology and pulse:

 

" Yi1 (medicine) means Yi4 (meaning). {The inner meanings of medicine,

the patterns of vital processes} may be apprehended by the mind, but

cannot be transmitted in words. Because these inherent patterns attain

such arcane subtlety (wei ao), even though the mind may achieve great

constancy {in contemplating them}, in therapeutic doctrine there can be

no fixed rules. "

 

I find the recent discussions involving many members of our list,

including Bob Flaws, Al Stone, Jim Ramholz and Will Morris

fascinating. Bob, as usual, expresses his points eloquently and with an

formidable grasp of both biomedical and Chinese medical topics. I very

much enjoyed his response to Al Stone.

 

However, I cannot help but be concerned with the overall direction of

development in these discussions and our profession away from those

aspects of our medicine that are difficult to communicate outside of the

clinical encounter, or the gradual somatizing of how we look at Chinese

medicine. While the argument is correct that there is no difference

between body and mind in CM, the trend is clearly towards the body as

prima causa, not consciousness.

 

Perhaps you can say that I am too naive, too philosophical. But I

cannot deny my experience in clinic, day after day, week after week, for

over twenty years. There is something that happens in the clinical

encounter, something that is communicated just by the act of taking the

pulse. The environment in which I work, the qi that is exchanged, is

part and parcel of the process. There is a spontaneous, you can say

inspirational use of the mind in choosing diagnosis and designing

treatment strategies. This is part of the beauty of Chinese medicine.

Without this aspect, I might as well be treating computers instead of

people.

 

The practice of biomedicine potentially also has these gifts. Sir

William Osler certainly wrote about this in his works. But the modern

pressures on medical practice are exacting a toll on the

patient/practitioner relationship. (For an interesting discussion on

this phenomenon, see the upcoming NY Times Magazine article on doctors

and medical practice, out this Sunday 5/5/02. I'm sure it will be quite

interesting).

 

There are also phenomena for which I have no explanation. People who

have decrepit bodies but strong, clear minds and consciousness. People

who should have died years ago, according to medical wisdom, who

continue on through strength of will.

 

I am not writing this to negate anything anyone has said. I do not

refute the experience of anyone in this discussion so far. I would just

like to see yi4/meaning or intention (as translated by Volker Scheid and

Dan Bensky in their article " Medicine is Signification " ) returned to its

appropriate place in discussions on medicine. We shouldn't forget this

aspect of medicine simply because it is not so easily quantifiable.

 

A nice quote from this article, available at www.siom.com :

 

" Medicine is yì . It is not as good to use medicinals as it is to use

yì . Whether or not a treatment works is based on yì . If yì can enter

the fundamental subtleties [of the illness], one can achieve a

penetrating understanding. After this, when one uses medicinals , none

will not work as expected. "

(Zhao Xue-min)

 

 

 

 

 

 

On Thursday, May 2, 2002, at 08:45 AM, pemachophel2001 wrote:

 

> Al,

>

> 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.

[Guest guest]

Z'ev,

 

I think it is important not to prejudice either the soma or the

psyche. If it seems like I'm prejudicing the soma over the psyche,

it's only because I think there is an developmentally dangerous

undercurrent within this profession in the West of prejudicing the

psyche over the soma. For me, there is absolutely no difference

between the two. As one way to move past this false dichotomy, perhaps

we should adopt Ken Dychtwald's term " bodywind. " I did that in a

number of places in our psych book. Similarly, I do not believe there

is difference between the qi and the biochemical and physiological

activities of the bodymind.

 

I would be the last person to suggest that the mental-emotional

stimuli do not have an effect on the physiology of the body. I don't

think anyone in this conversation is suggesting that the seven affects

are not a hugely significant class of disease causes. In my personal

clinical experience, I rank internal damage from the seven affects as

right up there at the top of the most common and most important

disease causes (bing yin).

 

What I believe Todd and I are trying to do is to re-establish a

balance which we think has been lost among many members of this

profession. I have stated before on this list why I think many members

of this profession tend to prejudice the psyche over the soma; so I'm

not going to rehash this now. However, when I'm exercising at night

afrter work, I often watch Chris Matthew's Hardball on MSNBC. Matthews

has a habit of returning to his original question when people seem to

have blown past it without actually answering it.

 

Yesterday, I asked people on the the list to take a stand on whether

the qi of CM was some etheric energy separate from the body's

biochemistry and physiology, and neither you nor anyone else so far

has actually given their opinion. So, would you be willing to give a

succinct answer to this question? I think it is an important one.

 

Bob

 

 

, " " <zrosenbe@s...>

wrote:

> I'd like to quote a text " Mental Methods (fa1) of Eruptive Disorder "

by

> Yin Zhong-cun (17th century), translated by Nathan Sivin, (he

> translates fa1 as Dharma, connecting it with the influence of

Buddhist

> texts) in response to some of the recent posts on pathology and

pulse:

>

> " Yi1 (medicine) means Yi4 (meaning). {The inner meanings of

medicine,

> the patterns of vital processes} may be apprehended by the mind, but

> cannot be transmitted in words. Because these inherent patterns

attain

> such arcane subtlety (wei ao), even though the mind may achieve

great

> constancy {in contemplating them}, in therapeutic doctrine there can

be

> no fixed rules. "

>

> I find the recent discussions involving many members of our list,

> including Bob Flaws, Al Stone, Jim Ramholz and Will Morris

> fascinating. Bob, as usual, expresses his points eloquently and

with an

> formidable grasp of both biomedical and Chinese medical topics. I

very

> much enjoyed his response to Al Stone.

>

> However, I cannot help but be concerned with the overall direction

of

> development in these discussions and our profession away from those

> aspects of our medicine that are difficult to communicate outside of

the

> clinical encounter, or the gradual somatizing of how we look at

Chinese

> medicine. While the argument is correct that there is no difference

> between body and mind in CM, the trend is clearly towards the body

as

> prima causa, not consciousness.

>

> Perhaps you can say that I am too naive, too philosophical. But I

> cannot deny my experience in clinic, day after day, week after week,

for

> over twenty years. There is something that happens in the clinical

> encounter, something that is communicated just by the act of taking

the

> pulse. The environment in which I work, the qi that is exchanged,

is

> part and parcel of the process. There is a spontaneous, you can say

> inspirational use of the mind in choosing diagnosis and designing

> treatment strategies. This is part of the beauty of Chinese

medicine.

> Without this aspect, I might as well be treating computers instead

of

> people.

>

> The practice of biomedicine potentially also has these gifts. Sir

> William Osler certainly wrote about this in his works. But the

modern

> pressures on medical practice are exacting a toll on the

> patient/practitioner relationship. (For an interesting discussion

on

> this phenomenon, see the upcoming NY Times Magazine article on

doctors

> and medical practice, out this Sunday 5/5/02. I'm sure it will be

quite

> interesting).

>

> There are also phenomena for which I have no explanation. People

who

> have decrepit bodies but strong, clear minds and consciousness.

People

> who should have died years ago, according to medical wisdom, who

> continue on through strength of will.

>

> I am not writing this to negate anything anyone has said. I do not

> refute the experience of anyone in this discussion so far. I would

just

> like to see yi4/meaning or intention (as translated by Volker Scheid

and

> Dan Bensky in their article " Medicine is Signification " ) returned to

its

> appropriate place in discussions on medicine. We shouldn't forget

this

> aspect of medicine simply because it is not so easily quantifiable.

>

> A nice quote from this article, available at www.siom.com :

>

> " Medicine is yì . It is not as good to use medicinals as it is to

use

> yì . Whether or not a treatment works is based on yì . If yì can

enter

> the fundamental subtleties [of the illness], one can achieve a

> penetrating understanding. After this, when one uses medicinals ,

none

> will not work as expected. "

> (Zhao Xue-min)

>

>

>

>

>

>

> On Thursday, May 2, 2002, at 08:45 AM, pemachophel2001 wrote:

>

> > Al,

> >

> > 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.

[Guest guest]

, " pemachophel2001 " <

pemachophel2001> wrote:

> Z'ev,

>

> I think it is important not to prejudice either the soma or the

> psyche. Similarly, I do not believe there

> is difference between the qi and the biochemical and

physiological

> activities of the bodymind.

 

I have the same opinion about body and mind. there is no

mental event that does not have a biochemical correlate. I do

not claim that biochemistry is the cause of mental activity or even

consciousness. Just that in the manifest physical world, mental

and physical and bioenergetic, if you will, exist as an integrated

whole. One part does not precede or cause the other. And every

physical event has correlates that can be measured in the mind

or in the qi. People on this list talk about how they like chaos

and complexity and information and systems theory over

standard science. Well, these disciplines do not conceive of an

etheric force that drives the body, but rather that order and

organization are inherent properties of all systems. I think this

idea is also in sync with ancient chinese ideas. the etheric idea

has no strong basis in either TCM or modern science. In z'ev's

defense, he has already presented evidence that he does not

believe the etheric model to be representative of chinese

thought. But if it is not etheric and it is not biochemical, by what

method does qi cause change in the body?

 

[Guest guest]

>

>I don't think it is the presence of these other styles of practice

>that threaten the public or those of us who want to practice " in

>context " . It is the fact that we are perceived as being unscientific

>and irrational. I don't want to inhibit these other styles from

>being practiced; I just want what I do to have equal credibility. To

>consider how this is accomplished, put yourself in the shoes of

>those who make decisions about these matters. For all they

>know, the medical style of acupuncture is superior to the

>traditional style (that's what the AAMA argues). We can scream

>and point all we want, but until we prove that 2 + 2 = 4, our

>shouts will fall upon deaf ears.

 

I have no objection to these other styles of practice, even within EAM we

have many styles, but what I do object to is the fact that often we and our

professional organizations don't object, rebut or try to prevent

advertisements/articles with insulting and inflammatory language stating

that EAM is " superstition and confusing principles. " It's scientific based

on observation, just as much of allopathic medicine actually is based on

observation and trial & error. Aspirin has never undergone the kind of

studies that FDA currently requires of new drugs, but MDs recommend it

anyhow. Decades of experience tells them what it's good for, more recent

problems made known the risks for Reyes syndrome, which changed how aspirin

is prescribed for children, but that was learned by error. I just object

to people who advertise themselves as " medical acupuncturists " being

hypocrites. This person was a DN and DC, not an MD. I don't object to MDs

or DNs practicing acupuncture, but there are certain standards of education

everyone else in the field is expected to know (whether they later decide

to practice only Worsley or NAET or colorpuncture), and they don't have

that minimum knowledge base.

The fact that we are perceived as unscientific and irrational is exactly

what I object to, but let's use the same ACTUAL standards and not let

ourselves be bullied or maligned just because we don't have controlled

double blind studies. If you learn about allopathic medicine, you can call

them on the fact that in actuality, much of traditional and many new

allopathic treatments are not done on the basis of the golden standard

research study. Many of those studies are flawed, such as the recent review

showing that mammograms may not actually help prevent breast cancer as

previous flawed studies supposedly proved, yet they recommended for all

women over 50 anyhow. If they aren't actually held to it, why should they

insist we are? Hormones are given to women and doctors admit to me that

it's not well understood how it all works. Even the medical style of

acupuncture treatments are not all based on solid " Western " research, but

it's practiced anyhow and deemed valid by them. I say we can do the

research you advocate, which will make our future better, but we still need

to educate and advocate minimum competency standards for ALL practitioners

now. I know it's a losing battle, as most MDs will not want to bother with

a full education and will never give up their right to practice ANY

medicine they want regardless of how little training they have, but I have

to keep saying it for our patients' sakes. I think allopathic

practitioners should just refer to us, because we're the specialists. I

refer to them when appropriate. If they really want to practice

acupuncture, then learn the minimum competency standards like everyone else.

[Guest guest]

Will,

 

Since you raise the term " neoplatonism, " perhaps we should be debating

neoplatonic idealism. Since there are numerous different definitions

and interpretations of ether, maybe we should not use this term in

this particular discussion. I may have muddied the waters even further

by mentioning Ayurveda. Perhaps we should confine ourselves to whether

or not A) there is some immaterial, energetic body which coexists (or

pre-exists) the corporeal body and B) changes in this energetic body

precede changes in the physical body, i.e., anatomocal and biochemical

changes. Isn't this basically neoplatonism?

 

Bob

 

, WMorris116@A... wrote:

> Bob -

>

> Ether is quintessential, it is the fifth element. The problem is

again one of

> translation. Thomas Taylor assigns the Gods to ethereal bodies in

Iambluchus'

> On the Mysteries. In such Neoplatonic philosophy, these Gods are the

planets.

> Other Western mystery traditions such as the Brotherhood of Light

define the

> etheric body as an electromagnetic body that is composed of the

planetary

> spheres as well.

>

> According to my home course on Ayurveda from David Frawley:

> " Ether manifests the idea of connection allowing for interchange

between all

> material mediums, communication, and self expression " This certainly

fits

> both the Ayurvedic and Hellenistic conception of planetary spheres.

>

> Frawley continues: " Ether is the original element. It derives from

the mind

> and is it's outer manifestation. Through movement it becomes air,

which is

> nothing but the idea of motion inherent in the idea of space..... "

from here

> he goes into processes of densification as each element

> manifests. " ...Similarly, all elements are derivations from the same

basic

> etheric substance. They are latent in it like butter in

milk......The five

> elements are nothing but reduplicated ether. "

>

> Will

>

>

>

> > In Greco-Roman medicine, ether is one of the elements (four or

five?).

> > If I remember correctly, it is conceived of as a nonmaterial

energy

> > which pervades the universe. It cannot be seen, felt, tasted,

weighed,

> > or measured, but is the prime mover of everything else. As a

concept,

> > it was retained in Western scholastic medicine (meaning Galenic

> > medicine) until the early to mid 19th century. I've found

Coulter's

> > Divided Legacy is a good history of Western medicine. I believe it

> > discusses the concept of ether vis a vis the human body and

medicine.

> >

> > In Auyrvedic medicine, I believe ether is equivalent to the

akasha.

[Guest guest]

Bob -

 

I raised the term Neoplatonism because of the trend in the conversation toward Greco-Roman and Aristotelian notions of the elements and discussion of ether. I agree with the decision to move away from the term ether because it is virtually meaningless save its subtle implications. This is primarily due to poor translation and I think the word has suffered far greater abuses than qi.

 

Neoplatonism is rather complex in it's philosophical contrasts of the one and the many. There are distinct parallels within certain Taoist cosmologies. There are also statements regarding the preexisting nature of absolute principles such as beauty or goodness.

From this point of view it might be easier to state psychosomatic vs. somatopsychic. Such notions of causality can allow for interpolation and mixing to any degree one might expect from an infinitely convoluting mix of Yin and Yang.

Will

 

 

Since you raise the term "neoplatonism," perhaps we should be debating neoplatonic idealism. Since there are numerous different definitions and interpretations of ether, maybe we should not use this term in this particular discussion. I may have muddied the waters even further by mentioning Ayurveda. Perhaps we should confine ourselves to whether or not A) there is some immaterial, energetic body which coexists (or pre-exists) the corporeal body and B) changes in this energetic body precede changes in the physical body, i.e., anatomocal and biochemical changes. Isn't this basically neoplatonism?