reframing

[Guest guest]

This issue has come up on this list before. It concerns the pattern

identification of western diseases. Recently, it has become a stumbling

block in the development of advanced training in TCM. While TCM has a

long tradition of disease diagnosis going hand in hand with pattern

diagnosis, evident even in the nei jing, concern has been expressed that

modern patients present with a complexity that belies the apparent

simplicity of determining a single chief complaint. That it may no longer

make sense to identify a patient's chief complaint, when the typical

patient actually has multiple chief complaints. So if you reframe chronic

fatigue syndrome as fatigue or taxation vacuity, then one misses the

concomitant digestive, emotional and musculoskeletal symptoms that

typically present in such patients. So one ends up going round and round

chasing symptoms. It is argued that approaching illness from the

methodology of li-zhu medicine and yin fire theory allows one to avoid

this stumbling block. But does this mean that the importance of

identifying chief complaint is no longer important. Zhu dan xi himself

organized his books according to chief complaint, so there does not seem

to see a discrepancy here. So the question is whether it is better to

identify a chief complaint and then adapt any final formula to address

the entire picture or to dispense with identifying the chief complaint

altogether and just work on developing complex pattern diagnosis for

patients not diseases. I know Bob Flaws supports the identification of

chief complaints and sees no conflict with li-zhu medicine. And Paul

Unschuld has pointed out that the belief that chinese medicine treats

patients, not diseases, is always holistic and never reductionistic just

does not square with the historical facts.

 

So if we are saying that modern circumstances necessitate this change, we

need on one hand to make a strong case to prove it and on the other, to be

comfortable with the recognition that this is not how TCM was ever

typically practiced. Once upon a time, TCM was presented to the west as a

holistic bodymind healing modality. But in reality, isn't it only the

struggle of one culture to conquer disease? We may gravitate to that

which is different from western medicine in TCM. In fact, that is exactly

what commentators like Holbrook, Sivin, Scheid and Unschuld say we are

guilty of. I would suggest that if we want TCM to be the most effective,

we follow the historical foundation in this aspect as we do in others. I

see a disconnect where people argue about the importance of history and

the classics, but then pick and choose which aspects are important. I

know some will say my point is ironic because I do not read chinese nor do

I think it essential to practice. However, I believe my position

underscores my point. We are not even adhering to the massive amount of

already translated material that supports things like disease diagnosis

and decoction strength dosages. I see a lot of digging through classics

in a futile attempt to prove a priori biases about holism and energetics

and infinitesimal doses. Scholars much more knowledgeable than anyone on

this list have already said what you are looking for is just not there.

In the case of herbology, except for the fluke of the shang han lun, it

was a purely empirical medicine until the jin-yuan dynasties. the

widespread use of differential diagnosis in herbology is only about 700

years old. This may be the latest and greatest development in TCM (though

I think the interface with biomed will be just as important), but it is

hardly the sum total. If we ignore disease diagnosis in TCM, we are

actually not very holistic at all. Holism means everything, parts and

wholes. One of the great failing of the holistic health movement, as Ken

Wilber has ably pointed out, is that our embrace of wholes has been at the

expense of parts and thus we only have half the picture.

 

 

 

Chinese Herbs

 

 

" Great spirits have always found violent opposition from mediocre

minds " -- Albert Einstein

[Guest guest]

On Sunday, January 12, 2003, at 10:03 AM, wrote:

 

> This issue has come up on this list before. It concerns the pattern

> identification of western diseases. Recently, it has become a

> stumbling block in the development of advanced training in TCM. While

> TCM has a long tradition of disease diagnosis going hand in hand with

> pattern diagnosis, evident even in the nei jing, concern has been

> expressed that modern patients present with a complexity that belies

> the apparent simplicity of determining a single chief complaint. That

> it may no longer make sense to identify a patient's chief complaint,

> when the typical patient actually has multiple chief complaints. So

> if you reframe chronic fatigue syndrome as fatigue or taxation

> vacuity, then one misses the concomitant digestive, emotional and

> musculoskeletal symptoms that typically present in such patients. So

> one ends up going round and round chasing symptoms. It is argued that

> approaching illness from the methodology of li-zhu medicine and yin

> fire theory allows one to avoid this stumbling block. But does this

> mean that the importance of identifying chief complaint is no longer

> important.

 

(Z'ev): As I've pointed out in other discussions on other topics

before, when one is trying to make a point, one emphasizes one's point

sometimes to the seeming 'sacrifice' of the 'opposite' point of view.

There is no question that disease diagnosis is a strong part of Chinese

medicine. Or that biomedical disease diagnosis can be 'synthesized'

into a pattern diagnosis. If Chinese medicine is truly 'holistic', as

you point out, it must include disease diagnosis.

 

Having said that, I must say that I do see a lot of incomplete

diagnoses out there in our profession, and a lot of 'chasing symptoms

around.' I don't think this is from only an inability to see the whole

picture, but also lacking a pinpoint disease diagnosis. Many students

and practitioners just try to treat the Western disease symptomatically

with points and herbs. This is simply from inadequate sources of

knowledge.

 

If one looks at case histories such as Professor Zhu's in Volker

Scheid's latest book, he does both complex, multi-pattern diagnoses AND

simple disease diagnoses. Both are necessary. That's all I am saying.

If I look at the journal stuff and the direction of the Western TCM

schools, it seems biased in the direction of disease diagnosis. We

need to not forget the more complex and 'holistic' diagnosis as well.

 

> Zhu dan xi himself organized his books according to chief complaint,

> so there does not seem to see a discrepancy here. So the question is

> whether it is better to identify a chief complaint and then adapt any

> final formula to address the entire picture or to dispense with

> identifying the chief complaint altogether and just work on developing

> complex pattern diagnosis for patients not diseases. I know Bob Flaws

> supports the identification of chief complaints and sees no conflict

> with li-zhu medicine. And Paul Unschuld has pointed out that the

> belief that chinese medicine treats patients, not diseases, is always

> holistic and never reductionistic just does not square with the

> historical facts.

 

(Z'ev): Again, while I agree not only with Unschuld but also Wiseman on

the point that Chinese medicine embraces a reductionist point of view,

it doesn't sacrifice the holistic point of view to do so. Yin and

yang, global and local. We are used to separating opposites, in

Chinese thought, they are not mutually exclusive, one against the

other. We need to be flexible enough to do both.

>

> So if we are saying that modern circumstances necessitate this change,

> we need on one hand to make a strong case to prove it and on the

> other, to be comfortable with the recognition that this is not how TCM

> was ever typically practiced.

 

(Z'ev): Remember that some diseases are highly complex. They develop

over time and effect the entire body and mind. Diabetes, for one

example, comes to mind. Time, severity and intractability increase the

complexity of an illness, and then we need to apply multi-pattern

diagnosis. Li-Zhu medicine (and later authors such as Gong Ding-xian

and Zhang Xi-chun) provides a working method to deal with such

conditions, which common sense tells us is different than treating an

acute diarrhea.

) Once upon a time, TCM was presented to the west as a holistic

bodymind healing modality. But in reality, isn't it only the struggle

of one culture to conquer disease? We may gravitate to that which is

different from western medicine in TCM. In fact, that is exactly what

commentators like Holbrook, Sivin, Scheid and Unschuld say we are

guilty of. I would suggest that if we want TCM to be the most

effective, we follow the historical foundation in this aspect as we do

in others. I see a disconnect where people argue about the importance

of history and the classics, but then pick and choose which aspects are

important.

 

(Z'ev) I don't think that I've ignored the specific treatment of

disease in my own small but steady investigation of the classical

medicine of China. However, there is a unique clinical gaze that is

different from modern medicine, based on seeing the human being as a

microcosm of nature and the universe. This perspective informs the

relationship of visceral systems, the relationship of seasons,

environment, constitution and time on human health and disease. While

there are Western sources for these concerns, they are not, at this

point in time, major concerns in mainstream Western medicine. It also

seems sometimes to me that they are not emphasized enough in modern TCM

as well.

 

> I know some will say my point is ironic because I do not read chinese

> nor do I think it essential to practice. However, I believe my

> position underscores my point. We are not even adhering to the

> massive amount of already translated material that supports things

> like disease diagnosis and decoction strength dosages.

 

If you are talking about such sources as the modern TCM journal

reports, yes, this is mainstream contemporary Chinese medicine. This,

however, shouldn't negate other approaches. We should also never

forget that Chinese medicine is also preventative as well as curative.

My personal bias and approach works for me, is my area of interest, and

I would just like to see a place for this approach to Chinese medicine

in the future. I don't want to just see one 'standard' way of

practice, that doesn't allow our own experience, perceptions and

approaches to flourish.

 

> I see a lot of digging through classics in a futile attempt to prove a

> priori biases about holism and energetics and infinitesimal doses.

> Scholars much more knowledgeable than anyone on this list have already

> said what you are looking for is just not there.

 

What do you mean here? Can you clarify? What do you mean by holism

and energetics, so I can know if I agree with you or not?

 

Do I need to quote the Nei Jing again as I did a few weeks ago about

how human beings are framed as microcosms of the universe? Or that the

framework of yin and yang, five phase, viscera-bowel and the channels

is intimately tied up with this perspective?

 

Is this a futile attempt? Or do you just not accept this as an

outdated perspective?

 

Perhaps you need to make the effort yourself to investigate this

perspective more, if you haven't already. It is different than the

modern scientific paradigm, but does that make it any less valid? Not

in my mind.

 

> In the case of herbology, except for the fluke of the shang han lun,

> it was a purely empirical medicine until the jin-yuan dynasties. the

> widespread use of differential diagnosis in herbology is only about

> 700 years old. This may be the latest and greatest development in TCM

> (though I think the interface with biomed will be just as important),

> but it is hardly the sum total. If we ignore disease diagnosis in

> TCM, we are actually not very holistic at all. Holism means

> everything, parts and wholes. One of the great failing of the

> holistic health movement, as Ken Wilber has ably pointed out, is that

> our embrace of wholes has been at the expense of parts and thus we

> only have half the picture.

 

(Z'ev): Again, different aspects of the whole may be emphasized by

different individuals at different times. Many of us were attracted by

the perceived holism of Chinese medicine, only later discovering the

more disease-oriented approaches. I just choose to continue to deepen

my knowledge of the more 'holistic' aspects, since I rely a great deal

on pulse diagnosis, and am often asked to compliment existing Western

diagnoses with a different perspective.

 

 

[Guest guest]

Z'ev:

 

You've both been very eloquent in raising and reframing this issue.

But I think there is already a workable solution to putting many of

these diverse pieces of CM and WM together and making sense out of

them. Unfortunately, like translation, it is an area of study that

has been largely overlooked by the schools and most practitioners.

 

Pulse diagnosis provides the most immediate and objective insights

into the patient and their problem. It has the capability of framing

both Chinese and Western perspectives. But here I am speaking of

using not only the familiar classical systems, but incorporating the

innovations of the Shen/Hammer system and the Dong Han system.

Unique and reliable findings for many Western problems have been

found in the way these systems analyze, organize, and identify

pulses. While each is based on classical material, they are being

developed as a response to the complexity of contemporary life. Both

the Shen/Hammer and Dong Han systems have already demonstrated

insights into Western medicine from a CM perspective---for examples,

Shen/Hammer insight into mitral valve problems, and the Dong Han

insight into thyroid problems.

 

The newest innovation in this field isn't (and shouldn't be) 700

years old. Pulse diagnosis can and does provide at least one

important opportunity to reframe CM.

 

 

Jim Ramholz