Guest guest Posted November 4, 2003 Report Share Posted November 4, 2003 The way I see it, that bronchitis has to have inflammation to be a correct diagnosis. As far as know this means there has to be a heat element. Given the original parameters of the case, unless the Western term was misapplied (very possible), this is a heat condition. doug > I agree with you that Jason may have overstated his case a bit (but > then, he has the original case study). My approach to this is that I > want to see evidence of heat, such as irritability, before I make > that part of my Dx. The Dx of turbid phlegm accounts for the > information that we were given. Of course, in the case of an acute > illness (bronchitis), it is entirely possible that there would be > heat, even if the chronic condition is cold. > > Rory > -- > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 4, 2003 Report Share Posted November 4, 2003 At 8:48 PM +0000 11/4/03, wrote: >The way I see it, that bronchitis has to have inflammation to be a >correct diagnosis. >As far as know this means there has to be a heat element. Given the original >parameters of the case, unless the Western term was misapplied (very >possible), this is a heat condition. -- Doug, I don't think you can make that generalization between WM inflammation and CM heat, and in particular both acute and chronic bronchitis include non-heat patterns. Rory -- Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 4, 2003 Report Share Posted November 4, 2003 The way I see it, that bronchitis has to have inflammation to be a correct diagnosis. As far as know this means there has to be a heat element. Given the original parameters of the case, unless the Western term was misapplied (very possible), this is a heat condition. >>>You have to be careful here. Often things are label as itis even without inflammation. For example, epicondylitis is often due to tendinosis and not tendinitis. There are no signs of Heat or inflammation, yet still many MDs will label it a tendinitis or epicondylitis. Just like in CM WM terms can be misused alon Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 4, 2003 Report Share Posted November 4, 2003 , " " wrote: > , " " <@h...> > wrote: > > > > > I doubt that this assumption is correct... meaning there is not > > heat! Just b/c one has a cold herb in the formula does not mean > > there is heat. Why tinglizi? > > Jason > > Its really impossible to say. As I said if heat is mild or brewing, I may use > only one clear heat herb as my teacher would. So ting li zi may be there for > the reasons you state or those Doug state. I do think it is possible to say: a) how many times have you seen tinglizi as a modification for lung heat (to clear heat?) I have never seen it like this, I see huangqin, zhi zi, zhi mu, lug en etc. b) I do not think with an overwhelming warm formula that just because one herb is cold that it means there is heat… How many times do you read that herbs counteract or balance out the temperatures of the other herbs to a neutral ground… Why wouldn't it happen here? Why would this lone tinglizi clear heat… that is a puzzle. More importantly we should ask why tinglizi..? why not huang qin, I think it is purely for its descending action etc. And I should clarify that Damone > meant that white thick phlegm was heat, but less heat than yellow phlegm, so > perhaps only a single cool herbs is called for. I guess this is a modern case > study - silly of me to ask. But it does illustrate the pitfalls of analyzing cases > in this fashion. Same with Damone'c classical cases. If the doctor himself > doesn't explain things, its pretty much MSU. Well the doctor does explain himself and he clearly shows there is no heat, with the herbs (IMO) and with the Dx. Of lung losing its depurative and downbearing ability, phlegm and qi counterflwoing upwards. There are no heat signs in the case…. All we can have are competing > and possibly contradictory explanations of equal weight, IMO. Not when the case study does not mention heat… It is worthwhile > intellectual exercise, but we can hardly say one is right or wrong. > > for ex, the phlegm heat clearing formula wen dan tang has no signifcant heat > clearing function, zhu ru being much milder than huang qin or ting li zi Yes but look at the wend an tang – It is no where nearly as warm as the above, and it is debatable how much heat it could really clear. I.e. Yeung mentions zero signs of heat in his description it is actually more on the colder side. But I do think the Rx is way closer to the neutral side (to cooling) than anything else, far different than the above case study. Also the hear clearing is taking place in different locations… I think this is more possible than 1 cold herb for the lung and 1 warm herb for the lung – these tend to cancel each other out (what do you think?) – Very few Rx's treat mixed heat and cold patterns – But the majority of rx's are made up of hot a cold herbs that are performing a certain fuction or action.. I.e. in this case we have herbs that are know to work together for a specific purpose and that is why they are there. I think is it MSU to read into that more that it is. > > or bensky's modification for er chen with damp heat in the middle adds only > one herb of signficant heat clearing, huang lian. But this is a major herb, and strong, and is know to clear heat even with others around it like banxia, gan jiang. \ > > I think it is incorrect to say that just because only a single cold herb is in a > formula that the author was not thinking that heat was present, but for some > other reason. I disagree for this situation…. It is clear to me that tinglizi is not added for that reason. > It could go either way and I bet case studies show both. I would like to see a similar case study that shows tinglizi added to such a warm formula to clear heat. – I would like to here more ideas from you on this… - > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 4, 2003 Report Share Posted November 4, 2003 , " " wrote: > , " " <@h...> > wrote: > > > The question was answered IMO, that glue like white phlegm does not > > have to mean heat, and this is demonstrated by the herbs... > > > again, I believe you have overstated your case and would like senior > practitioners to chime in this matter. > How have I overstated the case...??? I am just reporting what the case study says and the DX says nothing about heat, period. One can read into as much as one likes, but this is just MSU (in relation to this case study) - You asked if white thick phlegm has to be heat? I gave a clear example of where the CM doc says it doesn't... If there was heat, the dx would have included it, because that would be a very interesting part of the case... But the point of the case is more about more congested lung qi, not heat nor cold... The herbs when viewed in context with the others support this, vs. isolating one cold herb in the bunch and theorizing... Bob D. may be right, but this is one example that shows that a CM book/ author thinks otherwise... My senior pract is the author of the case study, and I don't need much more than that... You asked, and I gave an answer that is backed up in the literature… (IMO) This is BTW a mod of banxiahoupotang, that also says a lot of how they are thinking about things. - Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 4, 2003 Report Share Posted November 4, 2003 , " " wrote: > , " Alon Marcus " < > alonmarcus@w...> wrote: > > > >>>>Todd even adding gua lou pi would not make it heat phlegm, one can use > it for damp-turbid-phlegm, -cold-qi stagnation that results in difficult phlegm > and then even with xi xin and gon jian > I agree 100%, it is always about context! > > that case is clearly one of " not enough info " to make any valid conclusion > > I wonder what standard government manuals such as those done in the PRC > every few years says on this matter. that is what I was referring to, though > perhaps that was not clear. You can always find idiosyncratic cases. I am now > curious about the official standard of the PRC on glue like white phlegm. I am > pretty sure that is what Bob Damone was talking about, too. Well, the standard....??? You seem too be looking for some black and white answer, I feel that will never happen. TCM is always about context and 1 symptom almost never is definitive... This can be 1 point of the case. This also IMO is not some idiosyncratic case. I have seen many cases that have similar veins, and are representing practical lessons. Case studies are the real life issues that come up vs. what the text books says. Textbooks are IMO farther from any clinical truth than case studies. Just my opinion... So teaching such black and white statements to students may sometimes be helpful, but not any truth… For example we once learned that sorethroat in exterior attacks meant Wind-heat… this is of course not true. - Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 4, 2003 Report Share Posted November 4, 2003 , " " > > All this is well and good. Does anybody have an authoritative chinese citation > on this matter or conflicting citations? All we have done so far is share > anecdotes and try and reverse-engineer formulas. That does not really prove > anything. > Not reverse engineer, look at the formula and read the dx and understand what is going on, this is very clear to me. And btw this was from a mainstream formula book (chinese) - Not some crazy personal doctors case studies.. I.e. The cases were all chosen for specific reasons. - Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 4, 2003 Report Share Posted November 4, 2003 , " " wrote: > The way I see it, that bronchitis has to have inflammation to be a correct diagnosis. > As far as know this means there has to be a heat element. Given the original > parameters of the case, unless the Western term was misapplied (very possible), this > is a heat condition. A) inflamation (internal) does not have to be heat... IMO, this is a very common mistake. But I agree if something is hot, swollen, red etc. then it is clearly heat. But this is different b) IF there is heat, why is it not in the dx? - Your assumptions are not clear... c) bronchitis can clearly be multiple patterns and many are not heat, check the chinese sources... The case is posting in the next msg. - You tell me where the heat is? - > doug > > > I agree with you that Jason may have overstated his case a bit (but > > then, he has the original case study). My approach to this is that I > > want to see evidence of heat, such as irritability, before I make > > that part of my Dx. The Dx of turbid phlegm accounts for the > > information that we were given. Of course, in the case of an acute > > illness (bronchitis), it is entirely possible that there would be > > heat, even if the chronic condition is cold. > > > > Rory > > -- > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 4, 2003 Report Share Posted November 4, 2003 > > > I have enough grey hair to allow myself to labelled senior on this occasion. > > I agree with you that Jason may have overstated his case a bit (but > then, he has the original case study). Well here it is the case, please show me where I have overstated my case: Actually I think If one looks at how tinglizi is written about in the materia medica and the way it is used in other case studies and formulas it becomes even more clear that it is not in there to clear heat from the lung. Li was a 64 year old male who suffered from chronic bronchitis for many years. HE also had pulmonary emphysema. When the weather turned cold he would 'catch a cold " He presented with cough and much white glue-like phlegm. There was panting counterflow and he was unable to prostrate. Tongue was white and greasy, pulse was thin, wiry, and slippery. The pattern belonged to the lung losing its depurative and downbearing ability, phlegm and qi counterflowing upwards. The root formula (banxiahoupotang) + san zi yang qin tang + sanju(?)tang + modifications. Ban xia 9, hou po 4.5, fu ling 12, su zi 9, laifuzi9, tinglizi9, ma huáng4.5, xing ren 9, gan cao 4.5. 3 packs were given and the panting counterflow was calmed. The cough was gone. He continued to take chen xia liu jun tang with mods to recuperate until every symptom was relieved. - Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 5, 2003 Report Share Posted November 5, 2003 Jason, First of all, thanks again for posting this case. We need a lot more of this sort of thing in English. There are always variations in the way the diagnosis is expressed, and in the exact herbs given, but I believe this case illustrates my earlier point that knowledge of disease, particularly in serious long term diseases, is important in getting to the correct pattern and treatment. Simply doing a pattern differentiation from the symptoms and signs in such cases can lead to confusion. As to the issue of whether you overstated your case, I've reread the thread and I don't think you did. You said: At 2:42 PM +0000 11/4/03, wrote: >I doubt that this assumption is correct... meaning there is not >heat! Just b/c one has a cold herb in the formula does not mean >there is heat. -- Perhaps this was not read the way you intended. As I'm sure we all know, there are formulas that have only one herb that is cold, the rest being warm, that are intended to clear heat -- e.g., da qing long tang, ma xing shi gan tang, in which shi gao is the herb of choice to clear heat. I agree with you that inclusion of ting li zi does not indicate a heat case. In downbearing the lung qi, it quickly removes fluid from the lung, something like a diuretic, yet not so strong as to be cathartic. This is an somewhat urgent case, so a quick effect is important. In other words, there are cold herbs that are used to clear heat, and there are cold herbs that are used for some other function, and not specifically to clear heat. Shi gao is an example of the former; da huang and ting li zi are examples of the latter (there are obviously many other examples). The materia medica categories help show the difference. Rory ========================================= At 7:45 AM +0000 11/5/03, wrote: >Well here it is the case, please show me where I have overstated my >case: >Actually I think If one looks at how tinglizi is written about in the >materia medica and the way it is used in other case studies and >formulas it becomes even more clear that it is not in there to clear >heat from the lung. > >Li was a 64 year old male who suffered from chronic bronchitis for >many years. HE also had pulmonary emphysema. When the weather turned >cold he would 'catch a cold " He presented with cough and much white >glue-like phlegm. There was panting counterflow and he was unable to >prostrate. Tongue was white and greasy, pulse was thin, wiry, and >slippery. The pattern belonged to the lung losing its depurative and >downbearing ability, phlegm and qi counterflowing upwards. The root >formula (banxiahoupotang) + san zi yang qin tang + sanju(?)tang + >modifications. Ban xia 9, hou po 4.5, >fu ling 12, su zi 9, laifuzi9, tinglizi9, ma huáng4.5, xing ren 9, >gan cao 4.5. 3 packs were given and the panting counterflow was >calmed. The cough was gone. He continued to take chen xia liu jun >tang with mods to recuperate until every symptom was relieved. -- Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 5, 2003 Report Share Posted November 5, 2003 , " " <@h...> wrote: You asked if white thick phlegm has to be heat? I > gave a clear example of where the CM doc says it doesn't... If there > was heat, the dx would have included it, because that would be a very > interesting part of the case... where was the DX? I diden't see one given. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 5, 2003 Report Share Posted November 5, 2003 , Rory Kerr <rory.kerr@w...> wrote: > > In other words, there are cold herbs that are used to clear heat, and > there are cold herbs that are used for some other function, and not > specifically to clear heat. Shi gao is an example of the former; da > huang and ting li zi are examples of the latter (there are obviously > many other examples). The materia medica categories help show the > difference. > Jason It would have been helpful if you provided t,p and dx fromthe outset. As given, there was not enough information and the case was overstated in that light. now with the missing info, it is clearer. but from the herbs alone, the doc could definitely been thinking brewing heat. I talked with 2 professors about this (tan tan huang and damone). Damone showed me his reference, but I didn't get a chance to write it down. Tan tan felt this type of phlegm could be what he called wan tan - stubborn or persistent phlegm. We could not find this in wiseman. He said this was sometimes a type of old cold phlegm. However then he said meng shi and the rx gun tan wan are examples of one guiding rx for such a case. This is a cold formula, so wan tan could be hot or cold. Finally we could not between us 3 and 1 other chinese doc identify a citation to support gluelike phlegm being cold. We only have this one case so far. The others felt this was not an easily sorted out matter, but cases like Jasons and formulas like gun tan wan suggest that matter is not b/w. again, I am not interested in what any doc may have done, but rather the PRC standard, if there is one. I wonder if the tongue coat is yellow in the standard text despite the white phlegm. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 5, 2003 Report Share Posted November 5, 2003 , Rory Kerr <rory.kerr@w...> wrote: > Jason, > > First of all, thanks again for posting this case. We need a lot more > of this sort of thing in English. Don't worry I am working on a book as we speak, translating hundreds of these case studies to demonstrate various ideas... Hopefully they will be more polished than what I sent over to CHA last night (sorry did not have the time to reword it)... > > There are always variations in the way the diagnosis is expressed, > and in the exact herbs given, but I believe this case illustrates my > earlier point that knowledge of disease, particularly in serious long > term diseases, is important in getting to the correct pattern and > treatment. Simply doing a pattern differentiation from the symptoms > and signs in such cases can lead to confusion. > > As to the issue of whether you overstated your case, I've reread the > thread and I don't think you did. You said: > > At 2:42 PM +0000 11/4/03, wrote: > >I doubt that this assumption is correct... meaning there is not > >heat! Just b/c one has a cold herb in the formula does not mean > >there is heat. > -- > Perhaps this was not read the way you intended. As I'm sure we all > know, there are formulas that have only one herb that is cold, the > rest being warm, that are intended to clear heat -- e.g., da qing > long tang, ma xing shi gan tang, in which shi gao is the herb of > choice to clear heat. Sorry if my words did not come out as I intended.. I thought it was clear, but that is the problem with the internet and my lack of ability to sense how others interpret my words... -Jason Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 5, 2003 Report Share Posted November 5, 2003 Reverse engineering, by the way, is a great teaching tool for students to understand the architecture of prescriptions and how they are related to patterns. By examining combinations of ingredients in prescriptions, you can often figure out the disease pattern. A great exercise. On Nov 4, 2003, at 11:28 PM, wrote: > Not reverse engineer, look at the formula and read the dx and > understand what is going on, this is very clear to me. And btw this > was from a mainstream formula book (chinese) - Not some crazy > personal doctors case studies.. I.e. The cases were all chosen for > specific reasons. > > - Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 5, 2003 Report Share Posted November 5, 2003 >where was the DX? I diden't see one given. It was many many msg.'s ago.. prob got lost in the chaos of cyberspace.. > Jason > > It would have been helpful if you provided t,p and dx fromthe outset. As > given, there was not enough information and the case was overstated in that > light. now with the missing info, it is clearer. but from the herbs alone, the > doc could definitely been thinking brewing heat. I think with the Dx and herbs, it is clear. I also think that the Rx alone speaks ... and still don't believe such a Rx would ever be used to treat heat... You should show just the Rx to tan tan (or others) and see what they think, I am curious... Why so interested in the PRC standard? The PRC standard, I assume is for teaching purposes. ANd this seems to be only a guideline to practice. There are so many things that aren't clinical facts that are presented as such in any diagnosis book... just curious? I am not clear also about your request for knowing the tongues coat color in the original text... (the case study?) if so it was white... Notice the case study said tongue (and it should be tongue coat-> I think this was evident from context, but non the less a typo, and one reason I didn't want to post the whole case earlier... I didn't proofread for typos yet. And didn¡¦t want to ƒº - Hope that helps... - I talked with 2 professors > about this (tan tan huang and damone). Damone showed me his reference, but > I didn't get a chance to write it down. Tan tan felt this type of phlegm could > be what he called wan tan - stubborn or persistent phlegm. We could not find > this in wiseman. He said this was sometimes a type of old cold phlegm. > However then he said meng shi and the rx gun tan wan are examples of one > guiding rx for such a case. This is a cold formula, so wan tan could be hot or > cold. Finally we could not between us 3 and 1 other chinese doc identify a > citation to support gluelike phlegm being cold. We only have this one case so > far. The others felt this was not an easily sorted out matter, but cases like > Jasons and formulas like gun tan wan suggest that matter is not b/w. again, I > am not interested in what any doc may have done, but rather the PRC > standard, if there is one. I wonder if the tongue coat is yellow in the standard > text despite the white phlegm. > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 5, 2003 Report Share Posted November 5, 2003 , " " <@h...> wrote: > I think with the Dx and herbs, it is clear. I also think that the Rx > alone speaks ... and still don't believe such a Rx would ever be used > to treat heat... clealry not everyone here agree with you. would you use er chen with huang to clear heat? You should show just the Rx to tan tan (or others) > and see what they think, I am curious... good idea > > Why so interested in the PRC standard? because schools need standards, not set in stone, but as jumping off points for professors to debate. PCOM may be convening a committee to get some institutional consensus on these things. I am > not clear also about your request for knowing the tongues coat color > in the original text.. I was curious about the tongue coat in the PRC standard. I saw it was white in your case. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 5, 2003 Report Share Posted November 5, 2003 There are always variations in the way the diagnosis is expressed, and in the exact herbs given, but I believe this case illustrates my earlier point that knowledge of disease, particularly in serious long term diseases, is important in getting to the correct pattern and treatment. Simply doing a pattern differentiation from the symptoms and signs in such cases can lead to confusion. >>>It also illustrates that the quest for simple definitions and mechanism is not CM Alon Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 5, 2003 Report Share Posted November 5, 2003 , " " wrote: > This is one of the benefits of discussing disease progression as > presented in the Shang Han Lun. One gets a sense of how diseases > develop, progress, and change course along the way, and any 'detours' along the way (transmuted patterns). >>> Z'ev: Don't forget the Wen Bing and Suwen (especially chapters 66-73). They also discuss how diseases develop, progress, and change. Jim Ramholz Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 5, 2003 Report Share Posted November 5, 2003 , " " wrote: > > clealry not everyone here agree with you. would you use er chen with huang > to clear heat? > You are right, our opinions differ, that is alright... Would I use a huang (?) with er chen tang to clear heat.. Clearly I would this is a totally different situation. Huang (lian) has that action as it primary role. Er chen tang is also not overwhelmingly hot… it is drying (for drying phlegm) – the huang lian for clearing heat. Er chen tang is clearly used in may cases of phlegm-heat. Again the chenpi and banxia are not about temp but the huanglian is. (IMO) – AS rory stated, certain herbs are picked for temperature and certain herbs are picked for actions. I have never seen tinglizi picked to clear heat for the lung.. I would like to see this somewhere… - Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 5, 2003 Report Share Posted November 5, 2003 Don't worry Jim, I won't forget Just giving an example. On Nov 5, 2003, at 8:21 AM, James Ramholz wrote: > , " " wrote: >> This is one of the benefits of discussing disease progression as >> presented in the Shang Han Lun. One gets a sense of how diseases >> develop, progress, and change course along the way, and > any 'detours' along the way (transmuted patterns). >>> > > > Z'ev: > > Don't forget the Wen Bing and Suwen (especially chapters 66-73). > They also discuss how diseases develop, progress, and change. > > > Jim Ramholz > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 5, 2003 Report Share Posted November 5, 2003 , " " <@h...> wrote: > fu ling 12, su zi 9, laifuzi9, tinglizi9, ma huáng4.5, xing ren 9, > gan cao 4.5. 3 packs were given and the panting counterflow was > calmed. The cough was gone. He continued to take chen xia liu jun > tang with mods to recuperate until every symptom was relieved. > > - Jason, A careful read of what you wrote may be interesting. The formula that is presented " calmed " the " panting counterflow " . Also, " the cough was gone. " However, no mention is made that it actually cleared the phlegm. It then goes on to say that another formula with mods (not named) were given until every symptom (including the phlegm, I suppose) was relieved. Brian C. Allen Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 5, 2003 Report Share Posted November 5, 2003 , " " <@h...> wrote: The root > formula (banxiahoupotang) + san zi yang qin tang + sanju(?)tang + > modifications. Ban xia 9, hou po 4.5, > fu ling 12, su zi 9, laifuzi9, tinglizi9, ma huáng4.5, xing ren 9, > gan cao 4.5. 3 packs were given and the panting counterflow was > calmed. The cough was gone. He continued to take chen xia liu jun > tang with mods to recuperate until every symptom was relieved. > > - thinking maybe the third rx is San Ao Tang (Mahuang, Xingren, Gancao). Chen Xia Liu Jun Tang is reg'lar ol' Liu Jun Tang, just stating that the two additions to Si Jun are Chenpi & Banxia? robert hayden Quote Link to comment Share on other sites More sharing options...
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