Does a good AP Cookbook relate to TCM?

[Guest guest]

Hi All,

 

Having visited many AP practitioners [whether treating animals or

humans] over the past 30 years, I have never seen any two of them

use exactly the same points in similar clinical cases. Excluding a

few specific symptomatic uses [GV26 in emergencies; PC06 in

vomiting, BL67 to induce foetal version, etc], between-practitioner

variation in point selection is the NORM for the common WM-type

conditions that I have seen treated.

 

> ...practicing a powerful placebo or a science in which we need to

> understand and enter this living system which operates in a

> energetic dimension and associated with laws of nature within the

> TAO background ? ( of course this is for those believe in

> something besides cookbook approach ) Vanessa

 

Listers are polarised on the question of Cookbook AP. Many of us

accept that [good] Cookbooks have many practical uses, and not

just for novices. Many of us KNOW [from discussion with many

expert practitioners, east and west] that standardised AP formulas

are widely used to great effect in clinical practice and research,

even in China.

 

However, many others disparage Cookbook AP as inferior to " TCM-

AP " , if not treasonous to its basic principles - especially that of

tailoring Tx to the individual needs of the subject, depending on the

TCM Dx in each case.

 

IMO, if " TCM-hardliners " understood HOW [good] cookbooks are

constructed, that their point-lists for consideration reflect solid TCM

principles, AND that they are only a guide/AID to point selection,

they might agree that the polarisation is more apparent than real.

 

Let us consider two types of AP Cookbook:

 

(1) Cookbook 1 is based on notes taken by a meticulously

accurate and earnest AP Student during his/her training in AP

School X. The notes listed every use of the points mentioned in the

Classroom- and Clinic over a period of 3 years. During that training,

the student studied under 4 teacher-clinicians, 1 Chinese [beijing-

trained and fluent in Chinese] and 3 western [with no first-hand

experience of AP training in China, and no ability to read Chinese].

 

After graduation, the student spent >2 months summarising and

abstracting the Notes to list [using frequency-citation methodology]

the most important points listed for the common clinical conditions

[in WM & TCM Dx] covered in the School.

 

(2) Cookbook 2 was constructed by a self-taught AP Student, who

had no formal teachers in the early stages. The project took 11

years to complete because the student allocated only 14-20

hours/week to the task.

 

As its base, she indexed [on computer] the clinical uses of every

acupoint mentioned in 60 textbooks, mainly in English [mainly

published in China, Japan, Hongkong, but some published in the

west], and a few texts published in French [notably by van Nghi

and Niboyet].

 

To the textbook data, the student added data from the proceedings

of several AP Congresses, several hundreds of clinical papers and

abstracts (for example from the American Journal of AP], and

notes gathered during visits to practitioners and AP clinics in the

west and in Taiwan and Japan. On completion of the database, she

had the computer output the " Top Twenty " points [in order of

decreasing frequency-citation-score] for each clinical condition,

symptom, organ and body part in the database.

 

Which of these Cookbooks (Type 1 or Type 2) is likely to reflect

TCM usage more accurately? Many might opt for Type 1 - the data

from professional teachers. I would disagree because those data

are likely to reflect a narrow view - the ethos of a particular school,

or a dominant teacher in the group. IMO, the Type 2 Cookbook is

more likely to reflect the marvellous variety, creativity and

individuality of a very wide base of TCM sources, both east and

west.

 

For outputs from Type 2 AP Cookbook, see the " Top Ten " point

lists at http://homepage.eircom.net/~progers/ad2.htm

 

The web version states the 12 Basic Laws of Pt Selection:1. TCM

Principles 8 Principles, 6 Levels, 6 Level Variant, 5 Phase Theory

and Pts for Specific TCM Syndromes 2. Pts by innervation 3.

AhShi (tender ) Pts (trigger , myalgic, fibrositic, motor, REPP Pts)

4. Local Pts or Pts locally on nearest Channels 5. Distant Pts on

Channels controlling problem area 6. Local + Distant Pts or

Yin+Yang Pts, incl Yuan+Luo: [Problem COS Yuan Pt + Linked

COS Luo Pt] 7. Fore+Aft, Above+Below, Left+Right, Circling

Dragon 8. Extra-Channel Pts for their symptomatic effects 9.

Back+Abdomen Pts: SHU+MU or Pts near SHU+MU 10. XI (Cleft)

Pt in acute diseases 11. Scar / neural therapy 12. Tianying Pt -

under the ulcer base, into the cyst etc. It stresses: Always seek

Ahshi (tender) Pts, esp. Trigger Pts!

 

It adds: Final selection of Pts: Experienced therapists treat what

they sense, NOW! Alternate Pts in later sessions because Pt

overuse may reduce efficacy

 

To the " TCM Hardliners (Adepts) " , I say:

 

(a) Such an approach to Cookbook AP still demands that the user

consider [most of] the basic Laws of Choosing effective acupoints.

Indeed, the outputs contain many [if not most] key points that they

would use themselves had they relied mainly on the TCM Laws of

choosing points.

 

(b) The Type 2 Cookbook uses a WM approach, and does not list

points for specific TCM Dxs because few of the source texts [used

in " my " Cookbook had points classified in that way.

 

I suggest that you [TCM adepts] ALSO use a Cookbook approach

if YOU routinely use your own " favourite " formulas to treat specific

TCM Dxs, for example to " Clear Heat " , " Move Xue, " Move Food

Stasis " , " Calm LV Yang Rising " , " Open the Orifices " , " Downbear

Rising Qi " , " Rectify SP Qi Sinking " , etc.

 

The Cookbook that YOU follow may be based on Wiseman,

Macciocia, Unscuhld, etc. Your Cookbook is based undoubtedly

in TCM, but is a Cookbook nonetheless!

 

The Discussion section of the lecture that accompanies the the

Cookbook states:

 

IN MOST LOCAL PROBLEMS (joint, muscle, superficial organ etc)

the best prescription combines AhShi points and local points +

distant points on the affected or related Channel. It is important to

check the location as regards the nerve supply and the Channel.

For example, the best combination for pain in the medial

epicondyle of the humerus will not be identical to the best

combination for the lateral epicondyle. However, in traditional AP, it

is not enough to pick any local point. (Some local points are better

than others, or, at least, are more frequently recommended than

others).

 

Modern neurophysiological concepts of AP stress that adequate

stimulation of the affected or related NERVES will produce results

as good as the traditional method but adequate clinical or research

testing of the traditional versus modern (nerve theory) methods has

not been done. For the moment, I give the benefit of the doubt to

the traditional system, which has stood the test of time.

 

2. IN DISEASE OF INTERNAL ORGANS, the most important

points lie near the organ in the thoracoabdominal area or in the

paravertebral area (the Mu, Shu and Huatojiaji (X_35) points, CV

and GV points). Where the organ has a named Channel (LU, LI,

ST, SP, HT, SI, BL, KI, PC, GB, LV) it is common to include one

or more points on that Channel (distant as well as local points).

Also, the course of the Channel is important. For example, the

liver, kidney and spleen Channels traverse the inner thighs and

groin area. Distant points on these Channels are important in

genital and lower abdominal conditions.

 

In general, if a symptom or abnormal function can be traced to a

specific COS, treat that COS. If more than one symptom/organ

system is involved, choose a combination of points which will

influence all the major symptoms or upset organs.

 

3. IN ACUTE SERIOUS CONDITIONS, WITH MULTIPLE

SYMPTOMS AND PATHOLOGY, it is unwise to rely solely on AP.

AP can often give considerable help (using points as indicated by

the main symptoms and pathology) but conventional or

unconventional (complementary) therapies may need to be used as

well.

 

4. IN CHRONIC COMPLICATED CASES, where immediate

lifethreatening symptoms or pathology are absent, one can rely

more on AP as the main therapy (in cases amenable to treatment).

At all times, however, the aim of good medicine is to help the

patient to the greatest extent, with the minimum of side effects.

Therefore, it is good practice to use whatever complementary

therapies seem best indicated.

 

Analysis of the database indicates that points from the list: LI04,

LI11; ST25, ST36; SP06; HT07; BL23, BL40; PC06; TH05; GB20,

GB34; LV03; CV06, CV12; GV04, GV12, GV14, GV20, GV26 arise

in a high proportion of cases. In complex cases, if one has difficulty

in deciding on a prescription, it is advisable to include a few points

from that list.

 

LIMITATIONS OF COOKBOOK AP: How would one treat the

following syndrome? The patient had the following symptoms (at

different times) during a period of 6 years, beginning two years after

radical right lung surgery: recurrent haemorrhagic nephritis;

cystitis; rightsided sciatica; right sided paravertebral pain (C6 T4

area); rightsided headache and bouts of acute conjunctivitis (right);

right ear tinnitus; waking at night with severe pain along the SI

Channel of the arm to the little finger, with the arm in spasm.

 

To try cookbook prescriptions in such a case would be second-rate

AP. There was obviously a connection between all these

symptoms (all relate to SI, BL, KI) and most were right-sided

symptoms. On examination, the patient's thoracotomy scar was

badly twisted, with adhesions on the right BL line. This was the

clue. Blockage of the Qi flow (traditional concept) or reflex irritation

effects (Western concept) could cause all of these symptoms via

the Chinese SIBLKI energy cycle. Treatment was physiotherapy

+ injection of the scar, + a few AP sessions using BL points. All

symptoms were successfully cleared. Cookbooks have their

limitations and Chefs do not need them.

 

CONCLUSIONS Cookbooks or computerised prescribing is very

valuable for beginners and for those working in a clinic. However,

one should not rely too much on machines or computers.

Computers need electrical power. In national disaster and warfare,

and in many of the developing countries, electrical power, batteries

etc may be unavailable where they are needed most. Therefore, it

is important for the development of medicine and veterinary

medicine that as many professionals as possible should study the

basics of AP. One can accelerate this learning process by

interaction with a computerised database (Rogers 1984a)..

Adequate knowledge of AP will enable it to be used more widely in

fieldwork (large animal work, medics and paramedics in the bush).

 

Although the data reported in Appendix 1 are but a small fraction of

the database, it is obvious that for most conditions, the Top Ten

Points usually will be worth considering. However, in some

complicated cases, points not in the Top Ten may be most

relevant. The statistical method is very useful for population

medicine, but it may be disastrous for the unfortunate patients who

need individually designed care.

 

As a general rule, if a Cookbook prescription does not produce

definite results by 23 sessions, it is necessary to (a) change the

choice of points, or (b) consider other therapies, or © regard

yourself as unable to assist.

 

The enthusiastic amateur AP practitioner will get useful results with

the COOKBOOK but more complicated or deeply rooted problems

require more holistic (traditional + modern + complementary +

intuitive) therapy. Therefore, I strongly encourage you to continue

your study of Chinese AP in depth. To get the best results, use the

cookbook as the firstline of attack (in conditions amenable to AP)

but be prepared to fall back on traditional and other methods if

results do not follow quickly (Rogers 1984b). This assumes that

the user is trained in basic AP and is able to interpret the point

selections.

 

When using the prescriptions given in this paper, please note (a)

the number of references in the prescriptions, (b) the maximum

possible score, © the score of each point in the list (calculated by

ratio to the maximum possible score), and (d) the variation in

scores between points. If there are few references, the prescription

may be of doubtful value. If the maximum possible score is (say)

..90 and the max. score for any point is (say) less than .40, the

prescription may be doubtful. If there is little variation between the

scores and all scores are greater than .40, various combinations of

points should be equally effective.

 

Remember that the best prescriptions usually combine AhShi

points, LOCAL points, DISTANT points and (if internal organs are

involved) Mu + Shu + Yuan + Luo combinations. Thus, the wheel

turns full circle. The traditional methods of point selection were

best after all. Modern technology has merely reinvented the wheel

!

 

>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>

 

Colleagues interested in downloading a summary version of a Type

2 AP Cookbook for study or constructive feedback may do so at:

http://homepage.eircom.net/~progers/adtop.htm and its

hyperlinked component files:

 

Keywords Fast FInd Page:

http://homepage.eircom.net/~progers/ff.htm

 

Appendix 1 [notes on the structure of the Cookbook]

http://homepage.eircom.net/~progers/ad1.htm and

 

Appendix 2 [Acupoint Formulas - the Top Ten Points]

http://homepage.eircom.net/~progers/ad2.htm

 

Locate Points by their alphanumeric Code

http://homepage.eircom.net/~progers/ptc.htm

 

Re his successful use of AP to treat ulcerative colitis, Matthew

wrote:

> In light of recent discussions, I suppose some people on this list

> would consider this success to be " lucky. " (74% of the Chinese

> patients sure were lucky, too.) "

 

Yea, brother! I would love to see large-scale trials that compared

the clinical outcomes of " Standardised [ " Cookbook " ] AP with

expert individualised Tx.

 

If the standardised Tx can achieve 74% clinical success, and the

TCM-individualised Tx can do better, we all: (a) would have to take

our hats off to the TCM approach, and (b) LEARN it better to

improve our own results!

Best regards,

 

 

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