Language

[Guest guest]

Numbered are Z'ev questions, Will's responses below

 

1) How can a professional population (Western trained non-Chinese native

language speaking) who, the vast majority of, have not been exposed to

Chinese language, decide if Chinese language is important in their training?

 

This would be a good question to frame in a properly done needs

assessment. We are examining the value of language training for the

clinician - don't you think we should ask them?

 

2) Why define our profession as only containing licensed acupuncturists?

Does this mean we don't include writers, translators, administrators or

others that are important to our field?

 

Writers, translators and administrators should be included, however for

the purposes of this inquiry, they have a different agenda. I am merely

attempting to set a framework for accurate representation of what the

profession desires. They are the people who are in the trenches making a

living from this. Are you saying the writers, translators, and

administrators should make the decision? What happens in a forum like

this where the dominate voices are writers, translators, and

administrators? From my point of view, the result is skewed. Let's ask

the people whose lives depend on the practice about their perceived

value of Chinese language as it affects the clinical practice of TCM.

 

 

3) Why avoid the common sense wisdom of other professions, i.e. to have

as much access to materials of a profession as possible (or, as I see

it, why invest in willful ignorance of a vast body of material)? Ken is

a health professional who has trained and practiced in qi gong and tui

na with great teachers.

 

I have no problem using this information, we have been getting it. I am

merely trying to get a clean slate of data from those whose living

depends on the clinical practice. Then we can determine from that sector

what the perceived need is.

 

4) There are other very important individuals in our field who have not

trained in this country, couldn't gain a license, and yet have a much

broader base of knowledge than your average licensed acupuncturist. I

don't think your rationalization is correct or fair.

 

This is not a rationalization. It is a process. I am encouraging

practitioners have a voice rather than the administrators, teachers, and

those involved in publishing as primary fields of professional endeavor

as has been the case in the past for this profession. People of

knowledge from foreign countries have valid information, they are not

necessarily cognizant of the issues of practicing in this country. In

addition, those who are qualified can easily sit for examination and

gain practice rights here.

 

 

Will

[Guest guest]

What happens in a forum like this where the dominate voices are writers, translators, and administrators? From my point of view, the result is skewed

>>Will dont forget my loud mouth

alon

[Guest guest]

Will,

> Ken -

>

> I hope you had a good holliday.

 

Here in Beijing, the local merchants have

more or less figured out how to make a

profit from Xmas, but they still haven't

quite got the hang of what Thanksgiving

is all about. I've seen a couple of notices

on local news broadcast about how the day

after Thanksgiving signifies the start

of the Xmas shopping season. So we can

assume that soon enough Turkey day will

be elevated to its proper importance as

the market economy here continues to

thrive. My own holiday was pleasant.

Like you, I had some time for thinking.

 

I have thought about this comment for a while

> now and choose to further clarify.

 

Thanks for the opportunity to better understand

your thoughts.

>

> Ernestly, your arguments for language would hold more weight if

you were a

> practitioner who had completed a program, gained licensure in this

country

> and maintained a livelihood on that basis.

 

Understood. I am the first to admit if not

embrace my own lack of credentialling. I think,

in fact, I made my prior experiences very

clear to you when you hired me to teach

at Emperor's. Since you and Julie have

both recently alluded to my prior experiences

in the subject, I'll summarize them briefly

so that everyone who follows the discussion

will have the benefit of knowing where I'm

coming from.

 

My first exposure to Chinese medicine came

in 1970 at the California Institute of the Arts.

In fact, it was an exposure to tai4ji2quan2.

Marshall Ho'o taught tai4ji2 to the theater

school students as well as classes for the

whole institute. After a while, he took a few

of us tai4ji2 students under his wing and

began to teach us about massage, acupuncture

and herbs. I studiend with Marshall for four

or five years, and during those years he

introduced me to Martin Inn, with whom I

have continued to study off and on over the

years. I mention this because for me, the

study of tai4ji2 is the core of my study of

Chinese medicine.

 

In the early 70's when the acupuncture laws

were first enacted, a group of us who had

been studying with Marshall were given the

opportunity to be grandfathered into the

profession under the new provisions. Here

I have to point out that my early education

in the subject was not as a profession, but

as an adjunct to martial arts/meditation

training and practice. In those days I never once saw

money exchanged for an acupuncture treatment.

I brought friends who were not students

to see Marshall from time to time and he

took care of them. We treated each other.

We studied and trained together.

 

So the idea of turning this all into

a professioin seemed quite alien to me,

and I declined.

 

Over the years, I've kept up my study and

practice, while pursuing other professional

activities which all had mainly to do with

communication, writing, media, etc. In the late

1980s I realized that my life needed some

mid-course adjustments and decided to turn

my attention full time to Chinese medicine.

 

I enrolled at Emperor's, I think it was 1990

or 1991. You weren't there then. I completed

about a year or a year and a half, and then

I decided that the education being offered

wasn't what I wanted.

 

That's when I came to China. In 1992 In Chengdu I

studied and practiced in the clinic of

an orthopedic specialist named He Tian Xiang

off and on for a couple of years. I'm

doing a book on massage therapy and

go into my experiences in more detail

there, so I'll spare everyone the reading

for now.

 

I also studied and interned at the

Chengdu University of TCM (it was then

still a college), and after a couple of

years I was hired to do some teaching

there. Huang Qing Xian who is the

director of the foreign affairs office

at CDUTCM will tell you if you ask her

that the first thing I said to her

in 1992 when we met for the first time

in her office and she asked me what I

wanted to study was that I wanted to

be involved in the translation of

Chinese medical texts and in the

transmission of the knowledge of the

subject to the West.

 

She chuckled and worked around my

fantasies to help me construct a

course of study and practice in the

clinics.

 

I spent most of my time in Chengdu

from 1992 through 1998. There I also

met and began to study with another

boxer/bone doctor named Chen Wan Chuan.

 

I was in the States for several months

at the end of 96 - 97 working for a Chinese

herbal pharmaceutical firm that was exploring

the possibility of marketing products

in the States.

 

From 98 until now, primarily due to

family circumstances, caring for sick

and elderly relatives, my wife and I

have been dividing our time between

China and the States.

 

I thought I'd addressed the issue of

my qualifications the other day when

the question came up.

 

I am a student.

 

I also happen to be a writer and to

have written some books about my studies,

together with my wife.

 

Turth be told, Will, I don't seek to

have my words carry any more weight

than they either do or do not carry.

 

I have said many times on this list

that I'm not trying to convince anybody

of anything. I report my experience and

I am all too happy to argue my point of

view.

 

I am not trying to do anything other than

what I have made it very clear that I am

trying to do. I am conducting a grass

roots campaign to increase literacy with

respect to Chinese medical language and

literature among the community of individuals

who currently study and practice Chinese medicine

with no or limited access to these important

dimensions of the subject.

 

Why?

 

Well, that is an even more difficult question

to answer. But you see, I have been trained

by martial artists and imbued with a sense

of my responsibilty to the subject, not as

a profession but as a transmission that has

survived for thousands of years by being

passed down from one generation to another.

 

The phrase one generation to another is

quite important because it symbolises

the mind to mind or, if you will, heart

to heart transmission that is such an

important part of traditional Chinese

medicine.

 

Another of the books I've been working on

for some time is on the wordless teaching,

so you can see that I haven't given up

my fantasizing.

 

I recognize that my own personal experiences

and attitudes are just that. I never try

to impose my thoughts or ideas on others

and therefore have no desire whatsoever

to have my words carry more weight.

 

What I am always looking for are minds

that can receive the transmission and

be responsible for it. Being a student,

it turns out, entails taking up the

responsibility of teaching from time

to time. And the first duty of a teacher

is to find a capable student.

 

I pursue the point about language so

vehemently only because I believe it is

so vital to the forward movement of the

profession. I just can't imagine how

the subject can survive if some care

isn't taken to developing a common

language in which all those who are

concerned and active can exchange

accurate and reliable information.

 

Developing a language means having

people use it, and people can only

use a language that they have learned.

 

I do not expect everyone to learn

Chinese and for Chinese to become

the language of the subject in the

States or anywhere else. I do expect

that before we go off and invent

our own language...not to mention

our own set of concepts...we will

care enough and bother ourselves to

establish a comprehensive linkage

to the traditions that have survived

so long.

 

 

 

 

The same is true for anyone else

> whose livelihood is extracted from means other than the practice

of OM. Let's

> do needs analysis with those who are in the profession 100%. These

are the

> people we should be asking about language requirements. If we

remove the

> people who have anything other than practice as the sustaenance,

we may have

> a very different picture. This was certainly the tone at the

accreditation

> commission doctoral task force public hearings.

 

The great sportscaster Red Barber once said

that he always refused to make predictions

about the outcome of a game because to do

so clouded his vision. IF he did so, he became

invested in his prediction and thereafter couldn't

see or call the game clearly. A survey may be

an important tool for someone engaged in

marketing a school, but I doubt that it

will let you see the outcome of your

actions. It's only a way to form a prediction.

 

I think those who purvey education in Chinese

medicine need to do more than marketing

surveys in order to ensure the coherence

of the subject and its fidelity to its

ancient sources.

 

This is not a matter of kabbalistic devotion

to mystical texts, by the way. In my own experience,

the clinical efficacy of Chinese medicine springs

directly from these ancient sources.

 

 

Thanks, again, Will. I thin it is important

to extend the discussion into these areas

so that we consider the implications of

our thoughts and decisions.

 

Ken

[Guest guest]

Julie,

 

 

> Why do people continually refer to Ken as a " health care

professional " ? What is his " profession " and how did he get this

professional training?

 

I can't really answer for people. I've just posted a

brief description of my past experiences in the

subject, which I think you are already well

familiar with. So I'm not really sure why

you're making such a point of it.

>

> Your school even listed him as L.Ac. on your advertising brochure,

until I called both you and Ken on this misrepresentation.

 

Other than the one typo in the PCOM materials,

has there been some widespread misrepresentation

going on that I'm not aware of?

 

>

> This is not meant to disrespect Ken and his knowledge -- I

wouldn't have hired him to teach a course at Yo San if I didn't

respect him, and he would be the first to admit he is not a licensed

professional -- let's just have some professional and academic

accuracy here.

 

Precisely. So professionally and academically

accurately speaking now, has there been some

other misrepresentation about who I am or

what my background is?

 

>

> If I'm wrong or out of line, I'll admit it.

 

I'm not asking you to admit anything. I'd

just like to know if you are aware of some

misrepresentations involving me that I

don't know about. I'm constantly telling

people who write to me in my capacity as

the editor of CAOM the " I'm not a doctor "

when they assume that I am one and address

me as " Dr. Rose. " So I'm alert to the

situation and try to be responsive whenever

I get wind of having been misidentified.

 

The only thing that seems to me to be

in any way out of line is that you

either have more infomration than you've

shared...and there is some widespread

situation here...or you're making a single

typo on PCOM's literature seem as if it's

a widespread misrepresentation about me.

 

I look forward to learning which it is.

 

Ken

[Guest guest]

[understood. I am the first to admit if not

embrace my own lack of credentialling. I think,

in fact, I made my prior experiences very

clear to you when you hired me to teach

at Emperor's. ]

 

Ken -

 

My issue is not your lack of credentials, you obviously had a background and intelligence that caused me to have interest in your hire. Let's not discuss that here, it digresses from the objective. My purpose is to remove the extraordinary amount of discussion (Alon not withstanding ;-) that comes from people who's primary revenue stream is not based on practice here in America. This is so we can get what the practitioner's opinion is - we've been getting it from the administrators (including myself), teachers, writers, translators, students, and publishers. I want to know what people with no vested interest in those fields of endeavor have to say - straight from the needs of clinical practice in the US. My citing of your back ground only speaks to the veracity of this exploration, I would expect to do the same for anyone else taking a strong stand.

 

[From 98 until now, primarily due to

family circumstances, caring for sick

and elderly relatives, my wife and I

have been dividing our time between

China and the States.]

I understand your situation as I am going through similar circumstances. My heart is with you having met and enjoyed the company of your side of the family.

 

[Turth be told, Will, I don't seek to

have my words carry any more weight than they either do or do not carry.]

 

The words have the weight they carry, and the experience of that weight is relative to context. I exclude them for the purposes of getting data from the clinician in the US about perceived needs because of the technical qualifications I cited. This is neither good nor bad I am merely rendering factual observations and defining filters for examining the issue of language needs.

I am taking this language issue on because there are those who would render it a requirement for all schools given the opportunity. I don't deny the need for the profession to have translational skills. I do wonder as Alon does whether it is best for the clinician who may have no interest in translation, and has a wall of clinical skills to acquire for entry into practice.

I don't have the answer, it is the question we must pursue. The idea that Chinese language is a priori a mandatory skill in order to be great at this medicine may or may not be true and in varying shades. Let's find out.

 

 

Will

[Guest guest]

, WMorris116@A... wrote:

I want to know what people with no

> vested interest in those fields of endeavor have to say - straight from the

> needs of clinical practice in the US.

 

we do know one thing. surveys show extremely high patient satisfaction with

their acupuncture care. we also know there are few adverse events and

minimal liability issues. whether people are getting well is something else.

Now I don't read chinese, though I am familiar with most of the terms in

Wiseman's PD. the main factor in increasing my clinical UNDERSTANDING

was relying on rigorous source material. But I had no fewer successful cases

back when all I knew was english language materials from ITM and Subhuti

plus my apprenticeship with Li Wei. As Bob Flaws has stated numerous times

(while still arguing for the importance of language) the majority of failed

cases

presented to him are due to dosage issues. In most cases, diagnsis, etc. is

correct and dosage is just too low. this suggests people are learning how to

think in TCM terms and thus usually make correct diagnosis and choose

correct treatment plans.

 

It is easy to dismiss someone as not being a scholar; most of us are not and

do not want to be. But that does not translate into a lack of understanding or

clinical efficacy. In fact, as Bob has noticed, as did my teachers Subhuti, Li

Wei, Heiner, Tim Timmons and many more, the more mundane factors of

dosage and form are more commonly obstacles to success. I have also

observed that while some of my chinese teachers have a scholarly bent, most

don't. As far as I am aware, most of my chinese teachers spend no times

themselves reading case studies or the classics. I think it is erroneous to

suggest that all or even most TCM docs spend much time in scholarly

pursuits. In fairness, they could if they wanted to, since they read chinese.

But I watch how they practice, relying on their vast memories of textbook

patterns, herbs and formulas. that seems to be the standard, not the scholar-

physician. We need scholars; that is a given. But arguably, if you are not a

scholar yourself, you are better off reading the commentaries of others rather

than making your own interpretations. a little knowledge is dangerous. I

know my limitations so I allow others to guide me. it has served me and my

patients well. As for my students, they seem to like the fact that I don't talk

about things I don't understand fully.

 

[Guest guest]

we also know there are few adverse events and minimal liability issues. whether people are getting well is something else

>>>>This is a very important issue. As it stands acupuncturist see about 1% of the population 95% of which are for tertiary care. That is, they have already seen many medical practitioners and their diagnosis are well know (when possible). Now if we are to become truly primary care providers, see lets say about 10% of the population and about 2% of these right of the street. I am sure that the record of so called safety would evaporate very rapidly.

Alon

[Guest guest]

I agree with Alon. We are primarily providing tertiary care for

patients who have a biomedical diagnosis and have been tested

thoroughly. This is one reason that I think it is important to

emphasize pattern diagnosis and treat accordingly.

 

An interesting quote from Manfred Porkert in " The Debasement of Chinese

Medicine " :

 

" Toda, Chinese medicine does not carry any social or legal

responsibility. Never in recent decades have I heard of a case in

China or the United States where a so-called Chinese doctor or " a

doctor of oriental medicine " was taken to account for lack of

theoretical or practical competence in the methods of Chinese medicine!

The only incompetence entailing legal pursuit is if he fails to

perceive that the case he has before himself is slipping away, getting

out of control...and hence must be treated by " real medicine " , that is

referred to a Western physician or hospital. So in truth, in China and

elsewhere, what today bears the label of Chinese medicine is hiding

behind the big back of Western medicine. "

 

An interesting challenge to our profession.

 

 

On Tuesday, December 3, 2002, at 10:28 AM, Alon Marcus wrote:

 

> we also know there are few adverse events and

> minimal liability issues.  whether people are getting well is

> something else

> >>>>This is a very important issue. As it stands acupuncturist see

> about 1% of the population 95% of which are for tertiary care. That

> is, they have already seen many medical practitioners and their

> diagnosis are well know (when possible). Now if we are to become truly

> primary care providers, see lets say about 10% of the population and

> about 2% of these right of the street. I am sure that the record of so

> called safety would evaporate very rapidly.

> Alon

>

<image.tiff>

>

>

> 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]

In , " " <zrosenbe@s...> wrote:

> I agree with Alon.

> [Porkert says] The only incompetence entailing legal pursuit is if

he fails to perceive that the case he has before himself is slipping

away, getting out of control...and hence must be treated by " real

medicine " , that is referred to a Western physician or hospital. So

in truth, in China and elsewhere, what today bears the label of

Chinese medicine is hiding behind the big back of Western medicine. "

 

 

 

I don't disagree with Alon's statement either. And, yes, TCM pattern

diagnosis would be useless in many cases for primary care.

 

But Porkert's statement also troubles me. Porkert's implication is

that WM is only effective medicine; but it isn't all that black and

white. Isn't what happens with Western MDs is that usually simple

patterns are diagnosed and treated (the average time with a patient

is 6 minutes)? Then, if the patient continues to worsen, they are

sent to a specialist. Unless something in the symptomology overtly

suggests a much graver diagnosis, many things are missed; sometimes

by a number of doctors. Many patients are motivated to try

alternative treatments due to the lack of effectiveness of WM.

 

In WM, the treatment can be as bad or worse than the disease itself.

How many times is the standard of treatment, used for years, later

found to be ineffective (for example, bone marrow transplants for

breast cancer)? And how many times has alternative medicine helped

keep someone alive or comfortable when undergoing those procedures?

 

Besides the above stated issues. The " big back " that Porkert alludes

to also needlessly kills 125,000 people a year even when drugs are

correctly prescribed; more through abuse and incorrect prescribing.

It kills another 120,000 or so through incompetence and neglect in

its hospitals. Perhaps Porkert meant to include those issues and

figures in a later edition.

 

 

Jim Ramholz

[Guest guest]

Jim,

I don't think Porkert would disagree with you on your points about

Western medicine, elsewhere in his book he discusses similar themes.

I, for one, agree with what you say 100%.

 

I think his point is that there is a lack of accountability in

Chinese medicine, because we have the big safety net of Western

medicine under us if we screw up, or if we do nothing to help. There

is no accountability for faulty diagnosis and treatment, so, basically,

anyone can do anything.

 

For example, a patient with a wind-heat attack with sore throat and

swelling of glands can either be given an effective, potent

prescription based on pattern diagnosis, or, like so many patients, be

given zhong gan ling and the like, whether or not a pattern diagnosis

was given. The latter situation doesn't work much of the time, so, off

to the doctor for antibiotics.

 

We don't have any apparatus set up to differentiate scenarios like

this. I am talking clinical feedback, not some regulatory agency thing.

 

 

On Tuesday, December 3, 2002, at 11:52 AM, James Ramholz wrote:

 

> In , " " <zrosenbe@s...> wrote:

>> I agree with Alon.

>> [Porkert says] The only incompetence entailing legal pursuit is if

> he fails to perceive that the case he has before himself is slipping

> away, getting out of control...and hence must be treated by " real

> medicine " , that is referred to a Western physician or hospital. So

> in truth, in China and elsewhere, what today bears the label of

> Chinese medicine is hiding behind the big back of Western medicine. "

>

> I don't disagree with Alon's statement either. And, yes, TCM pattern

> diagnosis would be useless in many cases for primary care.

>

> But Porkert's statement also troubles me. Porkert's implication is

> that WM is only effective medicine; but it isn't all that black and

> white. Isn't what happens with Western MDs is that usually simple

> patterns are diagnosed and treated (the average time with a patient

> is 6 minutes)? Then, if the patient continues to worsen, they are

> sent to a specialist. Unless something in the symptomology overtly

> suggests a much graver diagnosis, many things are missed; sometimes

> by a number of doctors. Many patients are motivated to try

> alternative treatments due to the lack of effectiveness of WM.

[Guest guest]

Julie replies:

 

Why would we want to do this, since we do not have the diagnostic tools at our disposal, nor the biomedical knowledge to be the sole provider to someone with a serious illness who might come to us "right off the street"? Do you really want to be the doctor who decides if a person has prostate cancer based on a physical exam? Do you want to treat a woman in her 50's with uterine bleeding without having the ability to read an ultrasound? Maybe you do feel confident to do this, but personally, I would rather be part of a treatment team that includes the professionals who have the sophisticated technology...we can still practice our medicine as part of the team.

 

 

Now if we are to become truly primary care providers, see lets say about 10% of the population and about 2% of these right of the street. I am sure that the record of so called safety would evaporate very rapidly.

Alon

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]

This is not a black and white situation, it is quite complex, actually.

There are areas where Chinese medicine excels, and where Western

medicine excels. We are obviously weak in the areas of inpatient care,

and have little funding, no hospitals, and are a new profession in the

Western milieu. However, there are many areas where we are very

effective, and the area of respiratory infections, for one, is an area

where we could benefit many patients and reduce the dependency on

antibiotics that has led to a health care crisis in this area.

 

 

On Tuesday, December 3, 2002, at 12:51 PM, Julie Chambers wrote:

 

> Julie replies:

>  

> Why would we want to do this, since we do not have the diagnostic

> tools at our disposal, nor the biomedical knowledge to be the sole

> provider to someone with a serious illness who might come to us " right

> off the street " ? Do you really want to be the doctor who decides if a

> person has prostate cancer based on a physical exam? Do you want to

> treat a woman in her 50's with uterine bleeding without having the

> ability to read an ultrasound? Maybe you do feel confident to do this,

> but personally, I would rather be part of a treatment team that

> includes the professionals who have the sophisticated technology...we

> can still practice our medicine as part of the team.

[Guest guest]

"Toda, Chinese medicine does not carry any social or legal responsibility. Never in recent decades have I heard of a case in China or the United States where a so-called Chinese doctor or "a doctor of oriental medicine" was taken to account for lack of theoretical or practical competence in the methods of Chinese medicine! The only incompetence entailing legal pursuit is if he fails to perceive that the case he has before himself is slipping away, getting out of control...and hence must be treated by "real medicine" , that is referred to a Western physician or hospital. So in truth, in China and elsewhere, what today bears the label of Chinese medicine is hiding behind the big back of Western medicine."An interesting challenge to our profession.

>>>Well hopefully times are changing and we will see more primary cases. To me this is why a good practical biomedical training needs to be part of the education. That means in classes and the clinics. Students need to be able to actually think in a biomedical TRIAGE way. They should incorporate PE and labs on a regular bases so that they know how to apply it. From my conversations with a few of the engineers of modern TCM training in China the reason why biomedicine is included is that Pattern Diagnosis was not enough to pick up sick people and many have died.

Alon

[Guest guest]

Besides the above stated issues. The "big back" that Porkert alludes to also needlessly kills 125,000 people a year even when drugs are correctly prescribed; more through abuse and incorrect prescribing. It kills another 120,000 or so through incompetence and neglect in its hospitals. Perhaps Porkert meant to include those issues and figures in a later edition.>>How true, nothing is black and white. These are known figures do we have any idea what is going on with herbal med. No, and we should not make assumptions just because if there is harm it is usually much slower and hard to quantify. Again the question is knowledge is one better off knowing or not

Alon

[Guest guest]

Why would we want to do this, since we do not have the diagnostic tools at our disposal, nor the biomedical knowledge to be the sole provider to someone with a serious illness who might come to us "right off the street"? Do you really want to be the doctor who decides if a person has prostate cancer based on a physical exam? Do you want to treat a woman in her 50's with uterine bleeding without having the ability to read an ultrasound? Maybe you do feel confident to do this, but personally, I would rather be part of a treatment team that includes the professionals who have the sophisticated technology...we can still practice our medicine

>>>Many of your examples are not primary care. If we want to control our future I think being a primary care provider is important. Not only because we can then work independently but because to me this means a standard of education that should be on par with community standards for primary care providers. I think that would make better and safer clinician. Hopefully with time allow us to actually work in situation were such sick people hang out.

alon

[Guest guest]

Will,

 

Thanks for your thoughtful reply.

 

I realized while reading it that more than

a difference in opinion about the importance

of language, we differ in our perspective.

As you are a professional educator, your

income stream depends upon the success

of your school at attracting and enrolling

students.

 

Honestly, all I've been getting at is

the idea that it's a good idea for everyone

in the field to know what the basic

terms of the subject really mean.

 

The preliminary list of terms that has

recently been circulating among those

involved in the term standardization

project underway in the China Academy of

Science runs to approximatley 5,000

terms. If look at comprehensive

dictionaries of the subject published

here in China, you find on average more

than 10,000 terms and as many as 20,000

and more listed.

 

So let's say there are a couple thousand

terms that would constitute an irreducible

minimum basic vocabulary. There's also

a chunk of knowledge needed about what

a Chinese character is and how they

work together to convey meaning.

 

 

>

> I don't have the answer, it is the question we must pursue. The

idea that

> Chinese language is a priori a mandatory skill in order to be

great at this

> medicine may or may not be true and in varying shades. Let's find

out.

 

Agreed. Let's find out.

 

I don't think you can find out with an opinion

poll, however. I think we can only find out

by encouraging people to acquire the knowledge

and discovering the benefits. The competition

for time argument creates the unfortunate

impression, I believe, that there is some

sort of downside risk to learning Chinese.

As if years from now people will be throwing

up their hands in dismay as they realize they've

wasted so much time learning Chinese characters.

 

I don't really think there is anything to lose.

 

I understand that from the perspective of a

professional educator, this whole topic poses

a significant challenge and that issues of

budgeting time in the classroom are non-trivial.

 

But we can't resolve anything by taking a vote.

We have to think our way through the problems.

 

Do you and I agree that it is a good thing

for people to know the meanings of the

terms that they use? And if so, do we

further agree that one has to have some

basic knowledge of Chinese to know the

meanings of the Chinese medical terms?

 

If your answer to the second question is

No, i.e., if you believe that it is not

at all necessary for a student to know

much if anything about the Chinese language

in order to fully and competently understand

Chinese medical terms, on what do you

base this opinion?

 

Thanks, again, for taking on the issue.

 

Ken

[Guest guest]

In a message dated 12/3/02 4:00:20 PM Pacific Standard Time, yulong writes:

 

As you are a professional educator, your

income stream depends upon the success

of your school at attracting and enrolling

students.

 

 

Ken -

 

This is true - however, my income stream is distributed between administration, practice, teaching, and writing. This is why I would not include myself in a process to identify perceived need among the grass roots practitioners.

Honestly, all I've been getting at is

the idea that it's a good idea for everyone

in the field to know what the basic

terms of the subject really mean.

 

I agree with this notion with the exemption of the idea 'really mean.' To whom? On what basis?

 

So let's say there are a couple thousand

terms that would constitute an irreducible

minimum basic vocabulary. There's also

a chunk of knowledge needed about what

a Chinese character is and how they

work together to convey meaning.

 

 

How many hours would this take? It seems an arbitrary set point. And it does not necessarily correlate with the idea 'basic terms.' This is a daunting task (as communicated by others on this list) for those in practice and in school unless the curriculum is specifically designed for such purposes. I maintain such curricular design is experimental and it will take another five to ten years to see the impact on leadership and publications coming out of SIOM.

 

But we can't resolve anything by taking a vote.

We have to think our way through the problems.

 

 

I disagree with you diametrically. We can design surveys that are psychometrically sound. The professionals are still unheard. You are maintaining through a rational process the language need. This is a rational opinion and valid as such. However, there is no balanced evidence for the language requirements you propose.

 

Do you and I agree that it is a good thing

for people to know the meanings of the

terms that they use?

 

It is my opinion that knowing the basic terms is useful.

And if so, do we further agree that one has to have some

basic knowledge of Chinese to know the

meanings of the Chinese medical terms?

 

 

We don't have an answer to this question since optimal outcomes for language training based on sound educational research has yet to be defined.

 

- Will Morris

[Guest guest]

 

 

It's been a long time since I've been able to get onto this site.

Today, it just happened to work for me. Hopefully, it'll keep working

for me. I've really missed the repartee.

 

In any case, I would not say that " most " failed cases I have seen are

due to insufficient dosage. I would say many are due to that, but I do

also see a high percentage of cases that have failed to get the

intended therapeutic effect due to mistaken pattern discrimination

and, therefore, erroneous treatment.

 

This is a very complex problem because, if one does acupuncture along

with herbal medicine, one can typically get a good effect via the

acupuncture often in spite of misprescription of the herbs. This is

because, after 23 years of doing this medicine, I do not think that

acupuncture's effectiveness has all that much to do with the theories

of Chinese medicine and, therefore, with pattern discrimination.

Please note that I am not saying that acupuncture has nothing to do

with Chinese medicine. However, I do not think a correct pattern

discrimination is a sine qua non for getting a good therapeutic effect

with acupuncture.

 

Therefore, what I often see is people getting mettzo-mettzo (Chinese:

ma-ma hu-hu) or even satisfactory results with combined acupuncture

and Chinese herbs even when the Chinese herbs appear to be wide of the

mark. To make this matter even more complex, typically all herbs in a

given formula which, as a formula is incorrect, are not individually

incorrect. Since we never know how many meds in an Rx have actually

achieved the intended result, just getting some of the meds correct

seems to work in a number of cases.

 

It is my impression that the fact that most practitioners treat their

patients with at least a combination of herbs and acupuncture is a

double-edged sword. On the one hand, I believe it is what earns us a

large proportion of our success due to the many nonspecific effects of

acupuncture on top of the nonspecific effects of good bedside manner,

etc. On the other hand, I think it keeps many practitioners from

really developing their skills as pattern-discriminators and,

therefore, Chinese medicinal prescribers. In a nutshell, if it weren't

for the magic of acupuncture, I don't think we would have as many

satisfied patients as a group that we do.

 

It was only after I stopped doing routine acupuncture and also gave up

any and all non-Chinese treatment modalities (such as orthomoleculars,

enzymes, etc.) that my pattern discrimination and prescribing of

Chinese medicinals really became good. This was also exactly the same

time that I really devoted the time to teach myself to read medical

Chinese. Now, since I only use a single modality, I get very clear and

immediate feedback about the effectiveness of my application of that

modality. Until then, all I could really say was that the combination

of therapies I employed seemed to get satisfactory results. Further, I

know of no better way of really getting clear about 1) pattern

discrimination and 2) the prescription of Chinese medicinals than

learning to read about these arts in their original source language.

And here I am including even apprenticing live with a master of the

art. If one cannot understand the master in the original language,

ma-ma hu-hu translation still skews and distorts the transmission. I

have seen marked differences in the understanding and abilities of

students studying with the same Chinese clinical preceptor depending

on which students could understand their teacher in Chinese or only in

translated English.

 

These are all such multifactorial issues. As a group, I think it would

be very useful to tease apart as many of these factors as possible so

that our discussions are as perspicacious as possible.

 

Bob

 

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

> , WMorris116@A... wrote:

> I want to know what people with no

> > vested interest in those fields of endeavor have to say - straight

from the

> > needs of clinical practice in the US.

>

> we do know one thing. surveys show extremely high patient

satisfaction with

> their acupuncture care. we also know there are few adverse events

and

> minimal liability issues. whether people are getting well is

something else.

> Now I don't read chinese, though I am familiar with most of the

terms in

> Wiseman's PD. the main factor in increasing my clinical

UNDERSTANDING

> was relying on rigorous source material. But I had no fewer

successful cases

> back when all I knew was english language materials from ITM and

Subhuti

> plus my apprenticeship with Li Wei. As Bob Flaws has stated

numerous times

> (while still arguing for the importance of language) the majority of

failed cases

> presented to him are due to dosage issues. In most cases, diagnsis,

etc. is

> correct and dosage is just too low. this suggests people are

learning how to

> think in TCM terms and thus usually make correct diagnosis and

choose

> correct treatment plans.

>

> It is easy to dismiss someone as not being a scholar; most of us are

not and

> do not want to be. But that does not translate into a lack of

understanding or

> clinical efficacy. In fact, as Bob has noticed, as did my teachers

Subhuti, Li

> Wei, Heiner, Tim Timmons and many more, the more mundane factors of

> dosage and form are more commonly obstacles to success. I have also

> observed that while some of my chinese teachers have a scholarly

bent, most

> don't. As far as I am aware, most of my chinese teachers spend no

times

> themselves reading case studies or the classics. I think it is

erroneous to

> suggest that all or even most TCM docs spend much time in scholarly

> pursuits. In fairness, they could if they wanted to, since they

read chinese.

> But I watch how they practice, relying on their vast memories of

textbook

> patterns, herbs and formulas. that seems to be the standard, not

the scholar-

> physician. We need scholars; that is a given. But arguably, if you

are not a

> scholar yourself, you are better off reading the commentaries of

others rather

> than making your own interpretations. a little knowledge is

dangerous. I

> know my limitations so I allow others to guide me. it has served me

and my

> patients well. As for my students, they seem to like the fact that

I don't talk

> about things I don't understand fully.

>

 

[Guest guest]

, " Bob Flaws " <pemachophel2001>

wrote:

 

>

> It was only after I stopped doing routine acupuncture and also gave up

> any and all non-Chinese treatment modalities (such as orthomoleculars,

> enzymes, etc.) that my pattern discrimination and prescribing of

> Chinese medicinals really became good.

 

Bob

 

are your overall clinical results better now or is it just that you are

effective

with chinese herbs alone. It might technically make you a better prescriber to

focus solely on one modality and you certainly know what worked? but if the

combination of herbs, acupuncture and nutraceuticals is equally effective,

then from a public health standpoint, it would be equally advantageous to

foucs on herbs or be more eclectic. If being more eclectic is more forgiving in

that one might not be exactly correct in their prescribing, then playing devil's

advocate, why would we want our students to take the riskier approach with

no gain (and even possibly loss) in clinical efficacy?

 

also, you have written that legal issues were at least one factor in turning you

away from nutraceuticals. I enjoyesd your earlier eclectic books, like the one

on cervical dysplasia. many of us have made very successful use of the ideas

you espoused there. It might not be pure TCM, but it works. would you have

abandoned this method if you were free to do as you please in Colorado?

 

[Guest guest]

 

 

All good questions.

 

First of all, I would say, unequivocally, that my clinical results

with Chinese herbs are better today than ever. At the risk of

sounding arrogant (there's no use for false humility), I feel like I

have this system pretty well wired in terms of diagnosis and writing

effective prescriptions. Because I have specialized both in terms of

clinical department (gynecology) and modality (Chinese medicinals), I

believe that I can be more therapeutically AND cost and time effective

for my patients. I have a pretty good idea of what I can and cannot

treat, how long it will take, and how much it will cost. There is

little in the realm of gynecology I have not seen or heard before, and

I have access to the entire Chinese medical literature (at least in

theory) due to my being able to read medical Chinese. I know what I

can treat just with herbs (which, I believe, are cheaper and more time

efficient in the long run), and I know what to refer to an

acupuncturist (typically my wife). In a pinch, I can still provide

acupuncture and tui na services on my own, but rarely do.

 

As for whether or not this is a good model for other practitioners,

that's a very complicated discussion. It is the model that is used in

the PRC. So a lot of people with a lot more knowledge and experience

than me think it is a good model. Nevertheless, I am quite willing to

consider if it is the best model for practice here in North America.

As you mention, if treating with acupuncture and Chinese medicinals at

the same time results in patients getting a mostly good outcome even

if their practitioner's diagnosis and Chinese medicinal Rx are not

totally correct, then isn't it better to continue doing that?

 

My answer to that question is yes and no. If one only has a duty to

the patient, then the answer is yes. If all that matters is the

patient getting well, then empirical pragmatism is all that is

necessary. But, while I agree that getting the patient better is the

MAIN job of the practitioner, it is not the ONLY duty the practitioner

has. I believe that the practitioner also has an obligation to their

art. If we reliquish the importance of an accurate pattern

discrimination and, therefore, a methodologically correct Rx based on

that discrimination and say that anything goes as long as the patient

gets better, then pretty soon our educational process will degenerate

even further. Not only won't we help to raise the art to new levels of

refinement and efficacy but we won't be able even to teach future

students the current state of the art. If one of the benefits of CM is

its rational methodology, then preserving and refining that

methodology is one of the responsibilities each of us who practice

that methodology share, and especially those of us who activiely

participate in that educational process.

 

If one retreats to simply whatever works on an ad hoc basis with no or

little regard to methodological precision and correctness, then pretty

soon all we will be able to teach is a bag of tricks, but we will have

lost our problem-solving methodology. We will be entirely in the realm

of empirical medicine and have forfeited our claim to empiricism plus

rationalism. In my experience, you can be an effective clinician if

you have a good bag of tricks and a good bedside manner. But what you

have to pass on to posterity may be limited.

 

I think, in part, this and similar questions arise because so many of

us know so little about Chinese medicine as it is studied and

practiced in its homeland. Not knowing first hand the benefits of

reading Chinese, of specializing in a single department and a single

modality, we only know what most of us are doing here, a style of

practice that has grown up out of series of mistranslations,

misperceptions, and historical accidents. Living in this milieu, it is

impossible to understand the benefits of the above skills and styles

of practice until or unless one can see them from both sides. Bottom

line for me, having studied English-only texts and practiced herbs AND

acupuncture as a generalist like most North American practitioners and

having learned to read Chinese and specialized in department and

modality, I can say that I AM a better clinician than I was before. I

am willing to demonstrate my skills (and regularly do all over N.

America and Europe) in public any time and any place and in comparison

with anyone. I can't be any more certain than that. Now if I could

only get the bedside manner thing.

 

Bob

 

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

> , " Bob Flaws " <pemachophel2001>

> wrote:

>

> >

> > It was only after I stopped doing routine acupuncture and also

gave up

> > any and all non-Chinese treatment modalities (such as

orthomoleculars,

> > enzymes, etc.) that my pattern discrimination and prescribing of

> > Chinese medicinals really became good.

>

> Bob

>

> are your overall clinical results better now or is it just that you

are effective

> with chinese herbs alone. It might technically make you a better

prescriber to

> focus solely on one modality and you certainly know what worked?

but if the

> combination of herbs, acupuncture and nutraceuticals is equally

effective,

> then from a public health standpoint, it would be equally

advantageous to

> foucs on herbs or be more eclectic. If being more eclectic is more

forgiving in

> that one might not be exactly correct in their prescribing, then

playing devil's

> advocate, why would we want our students to take the riskier

approach with

> no gain (and even possibly loss) in clinical efficacy?

>

> also, you have written that legal issues were at least one factor in

turning you

> away from nutraceuticals. I enjoyesd your earlier eclectic books,

like the one

> on cervical dysplasia. many of us have made very successful use of

the ideas

> you espoused there. It might not be pure TCM, but it works. would

you have

> abandoned this method if you were free to do as you please in

Colorado?

>

 

>

 

[Guest guest]

>>> However, I do not think a correct pattern discrimination is a

sine qua non for getting a good therapeutic effect with

acupuncture. . . In a nutshell, if it weren't for the magic of

acupuncture, I don't think we would have as many satisfied patients

as a group that we do.>>>

 

Your posting brings us to an important point. You seem to be saying

people get better with acupuncture and herbs even when the pattern

discrimination is poorly done. I think this is a testament to the

patient's own immune system and their body's own ability to maintain

homeostasis. Less is required of these cases. When I do pulse

seminars, I watch students and practitioners develop their own

treatment plans and then treat each other. The pulses offer a common

and objective ground for diagnosis, but the treatment strategies are

always widely varied. Sometimes I am amazed and delighted that some

persons actually got the pulses to change for the better since I did

not anticipate their treatment strategy being very effective. But

again, it has to do with the patient's resilience, their own dynamic

5-Phase interaction, and less with the practitioner's strategy. In

these types of cases, as long as the practitioner helps even a

little bit---and does not get in the way----the patient should

improve.

 

In only about 20-25% of patients whose immune function and ability

to maintain homeostasis has been severely compromised does a highly

precise diagnosis (pattern discrimination and other diagnostic

abilities) become a decisive factor. In chronic and catastrophically

ill patients, more precision is demanded.

 

 

 

>>> If one cannot understand the master in the original language,

ma-ma hu-hu translation still skews and distorts the transmission. I

have seen marked differences in the understanding and abilities of

students studying with the same Chinese clinical preceptor depending

on which students could understand their teacher in Chinese or only

in

translated English.>>>

 

Even understanding the original Chinese is no guarantee of

understanding its meaning or deriving successful treatments. Meaning

resides in the context and dynamic interaction with the

speaker/writer/text, not in the literalness of the terms. People

seem to forget that the current teaching of TCM today is already

informed by all the literature that has come before it, and is still

fuzzy at best. No reader of Chinese has come forward to our rescue

and provided " the definitive " explanation. This profession remains

more of an art than a science. For example, take the recent thread

on the CHA regarding the Shan Han Lun. No resolution or consensus

was reached; everyone added their perspectives; even the classical

SHL commentators referred to in some postings did not come to

consensus. And consider that the SHL was applied to the exclusion of

other classics, like the Suwen, simply because it offers crib notes

on herbal formulas. If we look at the commentaries of the Nan Jing

translated by Unschuld, many Chinese " experts " simply paraphrase the

original without comment or added insight; others speak of the

controversy of the interpretation in their own eras and ancient

times. That knowing the Chinese will automatically resolve all

issues has not been demonstated.

 

 

Jim Ramholz

[Guest guest]

I agree with you that learning herbal medicine well and practicing

rigorously according to pattern differentiation is essential. I also

agree that for Chinese medicine to survive, we need to practice it

according to its rationalist structure.

 

I am not so sure that the precent PRC (national medicine) model is the

best one for North America. It is my feeling that acupuncture and

moxa are very important for Western patients, and they respond very

well to it. It even seems to work when prescription drugs are being

used (with a few exceptions), and helps people in touch with their own

bodies and minds. It would seem, generally speaking, that acupuncture

is being used in a more limited capacity in the PRC national system,

largely musculoskeletal and neurological disorders.

 

Secondly, we do not have an integrated school/hospital setup in North

America at this time. While I wholeheartedly support the development

of a TCM hospital model with specialty departments, I hope there will

always be room for private practitioners here, in the role of a

'general practitioner'.

 

I think it is possible for at least some of us to do both herbal

medicine and acupuncture well. As you've pointed out, however, each

one is based on a different diagnostic model. I, for one, don't think

using the zang-fu model for acupuncture is always appropriate. So, if

a practitioner is using both acumoxa and herbal medicine with a

patient, they need to use different models, and therefore, different

diagnostic schemes for each one. It may be appropriate to use 5-phase,

Nan Jing style acupuncture along with zang-fu pattern differentiation

for herbal medicine. This is not an easy job, and for this reason, I

think in our profession further specialization will be the general

progression of things. I hope we will retain flexibility in this

matter, as politically I wouldn't like to see separate licensing for

herbalists and acupuncturists in North America. The loss of herbal

medicine to M.D.'s in Japan has relegated acupuncturists to a secondary

role in Japanese health care, from my point of view.

 

 

On Wednesday, December 4, 2002, at 11:48 AM, Bob Flaws wrote:

 

> As for whether or not this is a good model for other practitioners,

> that's a very complicated discussion. It is the model that is used in

> the PRC. So a lot of people with a lot more knowledge and experience

> than me think it is a good model. Nevertheless, I am quite willing to

> consider if it is the best model for practice here in North America.

> As you mention, if treating with acupuncture and Chinese medicinals at

> the same time results in patients getting a mostly good outcome even

> if their practitioner's diagnosis and Chinese medicinal Rx are not

> totally correct, then isn't it better to continue doing that?

[Guest guest]

Not knowing first hand the benefits of reading Chinese, of specializing in a single department and a single modality, we only know what most of us are doing here, a style of practice that has grown up out of series of mistranslations, misperceptions, and historical accidents.

>>>>I think we now have quite a few people that have witnessed TCM first hand in China. Regardless of quality of materials available to us here, seeing clinical practice in china transcends all this and is why I have a little trouble with this continued line or argument.

Alon

[Guest guest]

are your overall clinical results better now or is it just that you are effective with chinese herbs alone. It might technically make you a better prescriber to focus solely on one modality and you certainly know what worked? but if the combination of herbs, acupuncture and nutraceuticals is equally effective, then from a public health standpoint, it would be equally advantageous to foucs on herbs or be more eclectic. If being more eclectic is more forgiving in that one might not be exactly correct in their prescribing, then playing devil's advocate, why would we want our students to take the riskier approach with no gain (and even possibly loss) in clinical efficacy?

>>>Just like in herbal formulations there is always the question of synergy that at least in my practice seems to be additive. I find my eclectic practice, at least in orthopedics, to be superior to what I did before or what I have seen in china

Alon

[Guest guest]

Jim,

 

I agree that learning to read Chinese will not eliminate all

differences of opinion and " fuzzy " areas of knowledge. However, in my

experience as a clinician and as a teacher, I have seen learning

Chinese make expontential gains in a number of students' and

practitioners' understanding and application of Chinese medicine.

 

As for the SHL, I thought the discussion was largely a waste of time.

(That's just my opinion.) I don't find the SHL very important for

contemporary clinical practice. I am much more interested in knowing

what contemporary Chinese clinicians are doing and thinking. Until or

unless one has access to a large proportion of contemporary materials,

I think the " classics " are largely a waste of time. The fact that so

many Westerners are so fascinated by them is, to me, indicative of a

lack of familiarity with the contemporary literature and practice and

a mythological golden agism. Sorry.

 

Bob

 

, " James Ramholz " <jramholz> wrote:

> >>> However, I do not think a correct pattern discrimination is a

> sine qua non for getting a good therapeutic effect with

> acupuncture. . . In a nutshell, if it weren't for the magic of

> acupuncture, I don't think we would have as many satisfied patients

> as a group that we do.>>>

>

> Your posting brings us to an important point. You seem to be saying

> people get better with acupuncture and herbs even when the pattern

> discrimination is poorly done. I think this is a testament to the

> patient's own immune system and their body's own ability to maintain

> homeostasis. Less is required of these cases. When I do pulse

> seminars, I watch students and practitioners develop their own

> treatment plans and then treat each other. The pulses offer a common

> and objective ground for diagnosis, but the treatment strategies are

> always widely varied. Sometimes I am amazed and delighted that some

> persons actually got the pulses to change for the better since I did

> not anticipate their treatment strategy being very effective. But

> again, it has to do with the patient's resilience, their own dynamic

> 5-Phase interaction, and less with the practitioner's strategy. In

> these types of cases, as long as the practitioner helps even a

> little bit---and does not get in the way----the patient should

> improve.

>

> In only about 20-25% of patients whose immune function and ability

> to maintain homeostasis has been severely compromised does a highly

> precise diagnosis (pattern discrimination and other diagnostic

> abilities) become a decisive factor. In chronic and catastrophically

> ill patients, more precision is demanded.

>

>

>

> >>> If one cannot understand the master in the original language,

> ma-ma hu-hu translation still skews and distorts the transmission. I

> have seen marked differences in the understanding and abilities of

> students studying with the same Chinese clinical preceptor depending

> on which students could understand their teacher in Chinese or only

> in

> translated English.>>>

>

> Even understanding the original Chinese is no guarantee of

> understanding its meaning or deriving successful treatments. Meaning

> resides in the context and dynamic interaction with the

> speaker/writer/text, not in the literalness of the terms. People

> seem to forget that the current teaching of TCM today is already

> informed by all the literature that has come before it, and is still

> fuzzy at best. No reader of Chinese has come forward to our rescue

> and provided " the definitive " explanation. This profession remains

> more of an art than a science. For example, take the recent thread

> on the CHA regarding the Shan Han Lun. No resolution or consensus

> was reached; everyone added their perspectives; even the classical

> SHL commentators referred to in some postings did not come to

> consensus. And consider that the SHL was applied to the exclusion of

> other classics, like the Suwen, simply because it offers crib notes

> on herbal formulas. If we look at the commentaries of the Nan Jing

> translated by Unschuld, many Chinese " experts " simply paraphrase the

> original without comment or added insight; others speak of the

> controversy of the interpretation in their own eras and ancient

> times. That knowing the Chinese will automatically resolve all

> issues has not been demonstated.

>

>

> Jim Ramholz