rhyme or reason?

July 29, 2003

>

> I believe students should be guided by books that reflect consensus

and living

> teachers who have studied and practiced the traditions. For me to

accept that

> that personal experiences of the herbs are the best guide to

practice would

> only be possible if I also accepted that all studying the medicine

were also

> highly refined qi gong masters. I strongly recommend students to

> experimentation with herbs, but I remain wary of catering in any

way to an

> already rampant anti-intellectualism in our field.

T,

This is actually a very real concern, just last week a colleague and

I were talking, and I asked why he was using an herb, and he gave me

a very bizarre answer. I further questioned on where that

information was from, and he said from handling the herb, the color,

and his 'observation' in how is works in his formulas. As great as

this sound, I am skeptical (as usual) of this process... It seemed

actually a misinterpretation and expansion of the MM, that was

justified by his `personal experience'. But is there a method to

this madness?

Where do our herb functions come from, doesn't somebody have to come

up with them? Isn't this the process that `the ancients' obtained

information? It seems that most people trust their own observations/

experiences more than others… A good portion of our understanding of

herb (functions) is said to come from the SHL, 1 book…

I agree with but where do you think the line is drawn… Where

and how does experience factor into the equation… I wonder if it is

even possible to see what an herb does in formulas that are usually

more than 10 ingredients…? It seems almost impossible to determine

what an herb is doing unless one (multiple times) gives a formula and

then gives it again with only 1 addition or subtraction. Maybe since

herbal medicine started with singles there was more opportunity in

the past to understand and explore herb functions due to much smaller

formulas, if not singles…? Any comments? How do we expand without

biomedicine?

-Jason

July 29, 2003

It appears to me that your colleague is using what I would call his

poetic understanding of the herb, certainly inspiring, and insightful,

but it hardly replaces the logical process needed to diagnose and

design an herbal prescription. It is more like spice than rice. I've

had the experience where personal inspiration has been confirmed in my

studies, and that certainly is a wonderful thing.. . .to see where

independent study can be confirmed by the medical tradition.

As far as growing in our herbal skills, I like to use the adage that 'a

tree grows as tall as its roots grow deep'. The more we learn the

Chinese medical tradition, or steep ourselves in texts like the Shang

Han Lun, the more creative and forward looking we get. This also

applies to applying biomedical data as well, in my opinion.

Presently, I've slowly, but steadily began to study Zhang Xichun's

Yixue Zhongzhong Canxilu/(Heartfelt) Study of with

Reference to the West, his 'integrative' medical work. Dr. Zhang was

strongly based in classical Chinese medicine, but also able to 'absorb'

and apply biomedicine as well without disturbing the 'root ' of Chinese

medicine. It took me five years to find a decent copy, so I hope over

the next several years I'll be able to do something with the text.

Maybe translate a bit.

By the way, Steven Clavey's article on Shang Han Lun case histories on

your website was fascinating and inspiring.

On Tuesday, July 29, 2003, at 06:45 PM, wrote:

> Where do our herb functions come from, doesn't somebody have to come

> up with them? Isn't this the process that `the ancients' obtained

> information? It seems that most people trust their own observations/

> experiences more than others… A good portion of our understanding of

> herb (functions) is said to come from the SHL, 1 book…

> I agree with but where do you think the line is drawn… Where

> and how does experience factor into the equation… I wonder if it is

> even possible to see what an herb does in formulas that are usually

> more than 10 ingredients…? It seems almost impossible to determine

> what an herb is doing unless one (multiple times) gives a formula and

> then gives it again with only 1 addition or subtraction. Maybe since

> herbal medicine started with singles there was more opportunity in

> the past to understand and explore herb functions due to much smaller

> formulas, if not singles…? Any comments? How do we expand without

> biomedicine?

>

> -Jason

July 29, 2003

, " " wrote:

> This is actually a very real concern, just last week a colleague

and I were talking, and I asked why he was using an herb, and he

gave me a very bizarre answer. I further questioned on where that

> information was from, and he said from handling the herb, the

color, and his 'observation' in how is works in his formulas. As

great as this sound, I am skeptical (as usual) of this process...

It seemed actually a misinterpretation and expansion of the MM, that

was justified by his `personal experience'. But is there a method to

this madness? >>>

Jason:

Can you be more specific about what his " observations " were? Is he

thinking along some line of CM theory or not?

Jim Ramholz

July 30, 2003

, " " <@h...>

wrote:

It seems almost impossible to determine

> what an herb is doing unless one (multiple times) gives a formula

I think that is the crux of the issue. The volume of the experience with a

substance. Personal experience of herbs is valuable, but if it causes one to

create new properties for herbs or dismiss old ones, then it would seem the

conservative thing to do would be to first check one's inferences against an

extensive range of written sources. If one could not find any recorded use of

the herb in such a way, I would be immediately suspect. Of course, being able

to do this thoroughly would require access to chinese language materials.

Failing this, one might check with chinese teachers to see what they think of

this " new idea " . However be forewarned that most chinese physicians frown

on just making stuff up unless it is textually grounded in some way. At the

very least, run the idea past other members of the professional community to

see if the logic of one's conclusions is really ironclad. I really think

anything

less is careless.

And why would one need to expand the properties of the materia medica in

this way? It would seem safer and more ethical to use herbs that had known

effects to accomplish the goals rather than risk a more speculative use based

upon so-called personal experience. It is like the case with western herbs or

other non-TCM supplements. I often speculate on the properties of such

medicinals for a number of reasons. In some cases, I think they are

convenient for certain purposes (like enzymes). However, my main interest is

that my patients take them and I want to know what they do. However I am

loathe to prescribe freely on this basis. Since I certainly do not believe the

dictum that one is better adapted to local plants (evolution does not work that

way - that is long discredited pre-darwinian Lamarckian theory), I see no

reason to use local plants for their purported TCM properties when I have

access to chinese herbs with known properties.

On the other hand, I have no problem with prescribing these other medicinals

as supplements to TCM, but being sure they are justified by their own

rationales (from lab lests to traditional european herbalism depending). And

then if one want to speculate on their TCM properties after years of use and

careful thought, I am quite interested to hear it. But my fear is that people

will freely substitute non TCM medicinals in their clinical practice based upon

very preliminary speculations. As long as people understand they are

basically doing living experiments when they practice this way, so be it, but

please don't mistake speculative " insights " into either chinese or western herbs

as having any more authority than, well, a grain of salt.

Finally, I must underscore something vital. In order to effectively expand the

materia medica in any fashion absolutely requires that at least some of those

involved in the process have access to chinese source material. Because if you

heed the words too closely of those who do not have such access, you must ask

yourself where did it come from? If the answer is that it purely comes from

personal expererience with no actual grounding in chinese medical literature, I

would just gently remind that this is not the way the chinese do things and it

is hard to imagine this could have any lasting value. Ken continually reminds

us that is difficult for many Chinese to imagine us practicing the medicine as

it

is without language access, much less making up new ideas. If people are

serious about this pursuit, they will ground themselves in extensive study of

the classics and explore how the chinese themselves expanded materia medica

over the years. Only then, can we take this enterprise seriously.

July 30, 2003

, " " wrote:

> Finally, I must underscore something vital. In order to

effectively expand the materia medica in any fashion absolutely

requires that at least some of those involved in the process have

access to chinese source material. Because if you heed the words too

closely of those who do not have such access, you must ask yourself

where did it come from? If the answer is that it purely comes from

personal expererience with no actual grounding in chinese medical

literature, I would just gently remind that this is not the way the

chinese do things and it is hard to imagine this could have any

lasting value. >>>

:

Your comments are useful if you're doing research on something

already known or in the literature. The significant difference from

what the fellow practititioner was doing is that the Chinese were

doing the same thing but had the historical time to wait, verify,

arrive at consensus. We don't have that scale of time.

But what about innovation? The Chinese don't have all the answers

and much of what they do have may be obsolete.

Jim Ramholz

August 1, 2003

....But what about innovation? The Chinese don't have all the

answers

and much of what they do have may be obsolete.

Jim Ramholz

Jim,

You bring up an important point. It's my belief that the relatively

predictable correlations between TCM diagnostic parameters and the

actions of herbs used in TCM offer a unique opportunity for innovation.

By contrast, the bridge between biomedical diagnosis and the

physiological actions of herbs or other therapeutic substances is often

bridged by expensive and clinically impractical methods. That is why

drug discovery or " discovery " of new western-based therapeutic

applications for natural medicines is so costly. It's very hit and

miss, mostly the latter.

I also think innovations are important to the vitality of Chinese

medicine. You mention obsolescence. I agree that certain therapeutic

applications may be obsolete in current day patient populations but

fortunately the system by which herbs are applied to pattern diagnosis

would only become obsolete in the unlikely event that the laws of nature

are somehow altered. I am disappointed that innovation seems to be so

frowned upon in the TCM community. Hopefully those voices will not

inhibit the creative juices of responsible innovators among us.

Best regards,

Stephen Morrissey OMD

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.

August 1, 2003

I am disappointed that innovation seems to be sofrowned upon in the TCM community. Hopefully those voices will notinhibit the creative juices of responsible innovators among us. >>>>>Yep

Alon

August 1, 2003

, " Stephen Morrissey " wrote:

I am disappointed that innovation seems to be so frowned upon in the

TCM community. Hopefully those voices will not inhibit the creative

juices of responsible innovators among us. >>>

Stephen:

Likewise. Have you given any thought to how details from WM could

fit into CM models--especially with herbs?

Jim Ramholz

August 1, 2003

On Friday, August 1, 2003, at 08:16 PM, James Ramholz wrote:

> Likewise. Have you given any thought to how details from WM could

> fit into CM models--especially with herbs?

I'm just waiting for some MD with some TCM training to suddenly get the

idea that one anti-depressant is best for Lung type sadness while

another is more for Qi stagnation type, versus a third that is going to

get at that pesky phlegm cold in the Heart...

--

Pain is inevitable, suffering is optional.

-Adlai Stevenson

August 1, 2003

Jim, Stephen,

> ...But what about innovation? The Chinese don't have all the

> answers

> and much of what they do have may be obsolete.

> Jim Ramholz

>

> Jim,

> You bring up an important point.

It is an extremely important point, and I,

for one have never once raised so much

as a whisper against innovation. In fact

I've gone so far as to invest years in

developing contacts and content on the

subject of complexity and Chinese medicine,

worked with people at the Santa Fe Institute

and other research-oriented outfits in China

and elsewhere looking for ways to explore

and express what seem to be important and

highly innovative ways of bridging the gaps

that exist between contemporary scientific

investigators and ancient Chinese sources.

I am a great fan of innovation, and innovation

has approximately nothing to do with the

point that I am making. In fact, if you

think about it, there is a strong argument

to be made for knowing the basics of a subject,

method, procedure, etc. ...before...rather than

after you set about to innovate based on it.

No?

It's my belief that the relatively

> predictable correlations between TCM diagnostic parameters and the

> actions of herbs used in TCM offer a unique opportunity for

innovation.

> By contrast, the bridge between biomedical diagnosis and the

> physiological actions of herbs or other therapeutic substances is

often

> bridged by expensive and clinically impractical methods. That is

why

> drug discovery or " discovery " of new western-based therapeutic

> applications for natural medicines is so costly. It's very hit and

> miss, mostly the latter.

All science and all R & D can be described as

a few rare hits in a sea of misses. Of

course, from the point of view of science,

the misses are hits, because they tend to

indicate areas that need not be further

explored...although previously discarded

avenues do reemerge from time to time

as fruitful pathways of investigation.

Another fact that suggests that having

a firm foundation in a subject may prove

useful to those who want to champion

innovation in it.

>

> I also think innovations are important to the vitality of Chinese

> medicine. You mention obsolescence. I agree that certain

therapeutic

> applications may be obsolete in current day patient populations but

> fortunately the system by which herbs are applied to pattern

diagnosis

> would only become obsolete in the unlikely event that the laws of

nature

> are somehow altered. I am disappointed that innovation seems to

be so

> frowned upon in the TCM community. Hopefully those voices will not

> inhibit the creative juices of responsible innovators among us.

In my altogether limited experience

of the TCM community, there are many

innovators...at least those who think

of themselves and promote themselves

as innovators. Whether or not they

actually develop any meaningful innovations

is another matter.

I applaud their spirit of adventure

and specifically of innovation. What I

find fault with as often as not unfortunately

is that people go off on innovative flights

of what turns out to be as much fancy as

fact based upon rather slim connections

to the substantive roots of the subject.

If that sounds like I'm assuming for myself

some sort of authorative position from

which I can render such judgments, well,

no doubt there is that flavor. But my

own self-perception is simply that I

have been knocking around China and Chinese

medicine long enough to recognize that it's

a really vast field and that it requires

a dedicated and rigorous committment to

study and practice...and self cultivation...

if one seriously expects to find oneself

in a position from which one could engage

in meaningful innovation.

I do not think of myself as an expert in

anything, but one need not be an expert

to recognize that people who cannot speak

the language of a subject are neither

masters of that subject nor qualified

to be innovators.

Ken

August 2, 2003

, " kenrose2008 " wrote:

In fact

> I've gone so far as to invest years in

> developing contacts and content on the

> subject of complexity and Chinese medicine,... >>>

Ken:

Has anything more developed along this line recently?

Jim Ramholz

August 2, 2003

Jim,

>

> Ken:

>

> Has anything more developed along this line recently?

>

There were a couple of meetings originally

planned for this fall in Beijing, which

had to be postponed due to the whole

SARS fiasco.

The article that Prof. Zhu and I wrote

is out there, along with some additional

pieces that address different aspects

of the subject. I believe that Sonya Pritzker

is incorporting some of the theoretical

perspectives involving metaphor and

psychology/cognitive science in her

current research on the treatment of

depression with traditional Chinese medicine.

So ripples continue to appear on

the surface of the pond.

I'm not sure what a " next step " is or

ought to be. What's your take?

Ken

August 2, 2003

Ken: I'm not sure what a " next step " is or

ought to be. What's your take? >>>

Ken:

Since the articles in the CJOM were very general. Why not explore

the parallels in more detail? While not an expert on the subject, I

like to introduce it during my pulse diagnosis seminars. Examining

pulses using the Nan Jing 3-depth method is akin to seeing the pulse

as the state space or phase space of the body since it's range is

from the emotional to solid physical structure.

Paul Cilliers, in Complexity & Postmodernism (Routledge, 1998): " At

least three levels of organization are required to describe living

biological systems (just as three terms are needed to describe

fundamental physical forces) with a degree of detail and richness

that approximates the behavior of real systems.

A minimum of three levels (the task or goal level as a special

kind of boundary constraint, collective variable level, and

component level) is required to provide a complete understanding of

any single level of description.

Patterns at all levels are governed by the dynamics of

collective variables. In this sense, no single level is any more

important or fundamental than any other.

Boundary constraints, at least in complex biological systems,

necessarily mean that the coordination dynamics are context or task

dependent. I take this to be another major distinction between the

usual conception of physical law (as purely syntactic, nonsemantic

statements) and the self-organized, semantically meaningful laws of

biological coordination. Order parameters and their dynamics are

always functionally defined in biological systems. They therefore

exist only as meaningful characteristic quantities, unique and

specific to tasks. " [end quote]

We often find this three-fold symmetry in Chinese medicine and

Taoist philosophy. We have heaven, earth, and man; qi, jing, and

shen; the trigrams of the I Ching; the three yin and three yang of

the Six Qi Theory (Liu qi); and the three jiaos of the body. When we

examine three discrete levels in the pulse diagnosis we can find and

appreciate the complexity and richness of living systems. By

comparison, if we use only one or two levels, we develop a somewhat

perfunctory model that largely ignored the extensive details found

in the Nan Jing and Mai Jing.

In biological systems as well as pulses, one level interacts with

the environment, a middle level involves the dynamics and

maintenance of homeostasis, and the third level consists of the

physical constitution of the organism. The parallel to the Nan Jing

pulse method is clear and direct.

Some biological examples in humans would be gestures and words for

the first level; blood sugar, electrolyte balance, and lung capacity

for the second level; and the chemical composition of bone or how

one molecule's geometry fits like a key into a lock with another

molecule at the third level.

As in complexity theory so in pulses, we can see that properties of

the system as a whole emerge from the interaction of all three

levels, as opposed to viewing the action of the parts as being

imposed by a dominant central source.

Jim Ramholz

August 2, 2003

James

In you pulse diagnosis are the depth in a fixed level, or patient dependent?

Alon

August 2, 2003

, " Alon Marcus " wrote:

> In you pulse diagnosis are the depth in a fixed level, or patient

dependent?

Alon:

We actually can work both ways. We usually start from where the

pulse is felt to where it diappears to acquire the information from

the 3 depths; but that needs to be compared to the where you first

feel the artery if that is different.

Our layout of 3-depths is slightly different than that of the

Shen/Hammer group on the large scale. We divide the artery depth

into three even spaces; while Hammer shows an 'above the qi' depth.

But that may have more to do with looking at it from the center of

the depth, rather than a range. The Dong Han system is very similar

to Shen/Hammer when each of those 3 depths are subdivided into their

own qi/blood/organ depths, to create a 9-depths system.

I'm hoping Will Morris will help develop a pulse conference next

year where we can work together and compare some of these details.

Jim Ramholz

August 2, 2003

....Have you given any thought to how details from WM could

fit into CM models--especially with herbs?

Jim Ramholz

Jim,

As part of my involvement in laboratory and clinical research on Chinese

herbs for the past ten years I am always looking for correlations

between biomarkers, TCM diagnostic parameters, and the application of

herbal ingredients/formulations. As you know, it's certainly not an

exact science. I have not identified any one to one correlations that

apply in all circumstances, i.e. Ki yang xu causes X biomarker to change

in a particular and relevant way in all those with the Ki yang xu. (Key

word being " relevant " ) However the same applies to the variable

correlations between differential diagnosis and western defined

diseases. Yet, correlations can be made and biomarkers can be targeted

that are consistent enough to obtain statistically significant results

when the treatment effect is strong enough in an appropriately sized

study. For example, our controlled study on lactic acid clearance rates

following exercise showed a doubling of clearance after 30 days on an

herb formula. But if you look at the actual data, some people tripled

their clearance and some had little change, resulting in an average

change of doubled clearance.

If you are able to see physiological correlations that are somewhat

consistent for a particular TCM diagnosis, through whatever means, pulse

or otherwise, I would be very interested.

Best regards,

Stephen

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.

August 2, 2003

Al,

Thank you for this especially apt insight. I have no doubt that you are correct in your amused expectations. It will be doubly amusing if the Merck Manual in it's 19th or 20th edition then postulates this as one of the normal options for therapy.