Conceptual gulfs

[Guest guest]

>>However, deciding the CM disease is a much more

important part of the diagnostic process than knowing the WM Dx.

Knowing the CM disease allows you understand the cause, location and

pathogenesis in terms of CM theory, which the WM Dx cannot give you.

With only WM Dx you are left jumping between paradigms that are at

their very best only tangentially consistent in describing the same

phenomena, and often leaves you not knowing quite where to beach your

boat in the " vast conceptual gulf " (nod to Wainwright).

 

In other words, I believe that to practice skillful integrated

medicine does not mean that you have to integrate the medicines. When

TCM books and articles are organized according to WM disease, it is

simply a matter of convenience for practice in an integrated setting,

such as a Chinese hospital. That is not to say that we have no need

to understand and use CM bing. Rory>>

 

I agree with Rory.

 

This brings me to two responses to other things that have been said in

the group recently.

 

1) Re. Chinese CM doctors who understand WM and CM and integrate them

in their practice - I've studied with Chinese doctors who, in their

personal working methodology, did integrate CM and WM. For them, this

worked. However, for me, it was a mish-mash. I could understand what

they were getting at, but only by deconstructing what they were

talking about as they did talk about it. It may have been very well

and good as a discussion at that moment, but if one were taught like

that from the beginning, rather than learning CM and WM separately, it

would be impossible to distinguish how they were integrating the two

systems. This type of confusion is, in my opinion, not good for the

further development of CM. With any concept of integration, one has to

remember that one is talking of thousands of years of CM experience,

in interaction with a relatively immature medical system which is

changing all the time. Integrated CM/WM in a hundred years time would

undoubtedly be very different from integrated CM/WM now. The best

method of keeping CM alive, including preserving its potential to be

utilised alongside WM as the latter develops, is to keep the two

systems conceptually separate.

 

2) With terminology - for example different types of qi: I think here

that the important thing is not merely to be able to define the

different types of qi, but to get to understand them with one's own

experience. CM is a system of medicine based on experience, and this

applies to CM concepts. How do you experience your own Wei Qi, SP Qi,

etc., and how can you relate to those concepts in an experiential way

with your patients? That's bringing CM alive, as it should be.

 

Wainwright

[Guest guest]

, " wainwrightchurchill "

<w.churchill_1-@t...> wrote:

> >>However, deciding the CM disease is a much more

> important part of the diagnostic process than knowing the WM Dx.

> Knowing the CM disease allows you understand the cause, location

and

> pathogenesis in terms of CM theory, which the WM Dx cannot give

you.

> With only WM Dx you are left jumping between paradigms that are at

> their very best only tangentially consistent in describing the same

> phenomena, and often leaves you not knowing quite where to beach

your

> boat in the " vast conceptual gulf " (nod to Wainwright).

>

> In other words, I believe that to practice skillful integrated

> medicine does not mean that you have to integrate the medicines.

When

> TCM books and articles are organized according to WM disease, it is

> simply a matter of convenience for practice in an integrated

setting,

> such as a Chinese hospital. That is not to say that we have no need

> to understand and use CM bing. Rory>>

 

I agree with Rory above and Wain below, to a certain extent... For

example I do not think it is for mere convenience, from an integrated

setting, that the WM disease becomes important. A few examples :

Which is more useful the dx: the classical hypochondriac pain or

cirrhosis of the liver? Chronic COPD or chronic xiao chuan???

Endometriosis or abd. pain. I think the western disease in `many'

instances (also very useful is some infectious disease) tells us much

more about the pathogenesis of the disease, which can be translated

in terms of CM, or just left in WM to get clear on what is going to

happen etc... There are plenty of mainstream Chinese medical books

that organize by modern disease... I also think in many skin diseases

the western disease is useful. There are many examples, and I agree

we need to be cautious, but one can not say that the WM disease is

not useful? I have never argued for only a WM approach to CM, I think

everything is useful… for this is medicine!

 

-

 

 

>

> I agree with Rory.

>

> This brings me to two responses to other things that have been said

in

> the group recently.

>

> 1) Re. Chinese CM doctors who understand WM and CM and integrate

them

> in their practice - I've studied with Chinese doctors who, in their

> personal working methodology, did integrate CM and WM. For them,

this

> worked. However, for me, it was a mish-mash. I could understand what

> they were getting at, but only by deconstructing what they were

> talking about as they did talk about it. It may have been very well

> and good as a discussion at that moment, but if one were taught like

> that from the beginning, rather than learning CM and WM separately,

it

> would be impossible to distinguish how they were integrating the two

> systems. This type of confusion is, in my opinion, not good for the

> further development of CM. With any concept of integration, one has

to

> remember that one is talking of thousands of years of CM experience,

> in interaction with a relatively immature medical system which is

> changing all the time. Integrated CM/WM in a hundred years time

would

> undoubtedly be very different from integrated CM/WM now. The best

> method of keeping CM alive, including preserving its potential to be

> utilised alongside WM as the latter develops, is to keep the two

> systems conceptually separate.

>

> 2) With terminology - for example different types of qi: I think

here

> that the important thing is not merely to be able to define the

> different types of qi, but to get to understand them with one's own

> experience. CM is a system of medicine based on experience, and this

> applies to CM concepts. How do you experience your own Wei Qi, SP

Qi,

> etc., and how can you relate to those concepts in an experiential

way

> with your patients? That's bringing CM alive, as it should be.

>

> Wainwright

[Guest guest]

, " " <@h...>

wrote:

I think the western disease in `many'

> instances (also very useful is some infectious disease) tells us much

> more about the pathogenesis of the disease, which can be translated

> in terms of CM, or just left in WM to get clear on what is going to

> happen etc...

 

I agree completely. And let's get real here. The ancient daoists are described

by Joesph Needham as proto-scientists. They observed nature to get their

ideas. They were very curious and inventive. Does anybody really believe

that these lovers of natural knowledge would NOT have looked in a microscope

or analyzed the invisible contents of the blood if they could have. Of course

they would have. The methods of modern science are completely in keeping

with ancient chinese natural philoosphy. As Unschuld has pointed out, the

early taoists who founded herbal medicine in china were pragmatists who

eschewed theory and used what they discovered work empirically. I think the

overlay of systemtatic correspondence on herbology was a great leap forward

and I think the same thing about the integration of WM. If you talk to chinese

teachers, you will gernally find this resistance to integration is largely an

american new age phenomena. Should we reject systematic correspondence as

well because of its newness.

 

[Guest guest]

 

 

If you talk to chinese

> teachers, you will gernally find this resistance to integration is largely an

> american new age phenomena. Should we reject systematic

correspondence as

> well because of its newness.

>

 

 

I agree with much of what you say about the

flux of knowledge and the resulting ever-changing

face of Chinese medicine. Truly one of the key

factors underlying the durability of Chinese

culture has been its ability to adopt and adapt

to new influences. And Chinese medicine is

a cultural phenomenon.

 

There is, as well however, a counterpoint to this

characteristic, i.e., a respect for the tradtions of

the past. This all has to do with the conception

and experience of time in Chinese culture, which

remains a subject to be fully explored.

 

But I've spent the better part of the past eleven

years talking to Chinese teachers in China and

I want to point out that there are many who have quite

a different view than those with whom you

have conversed.

 

I have known many teachers who express

grave concerns over not the fact of integration

and modernization of the medicine but the

current approaches and methodologies that

are being pursued, developed, applied

and codified.

 

There is a substantial movement in the PRC

to emphasize the respect for past traditions

as a counterpoint to the ongoing modernization

drive. This is a very lively topic in Chinese

society in general and in Chinese medicine in

particular and has been for more than a century.

 

The great debates between Lu Xun and Lin Yu Tang

in the 1920's illustrate the vitality of arguments on

many sides of many issues related to the

same theme you are discussing, namely

how do the Chinese people face up to the

pressures of the modern world and bear

their cultural legacy with them as they go.

 

Of course it plays out in medical circles,

and in my limited experience of them there

is no unanimity of view among " Chinese

teachers " such as you represent exists in

your remark. There is significant resistance

to integration among a growing number

of doctors and teachers of Chinese medicine

in China. This is difficult to document because

of political reasons. People risk trouble of

various kinds if they express their views

openly. The Chinese have become quite

familiar and adept at living with such

restraints, not only in the modern PRC

era but for much of the imperial era as

well. It is a classical theme in Chinese

life, i.e., the expression of one idea by

the utterance of another.

 

I really think it is important that we not

allow our discussion of such topics to

collapse a multi-dimensional scene into

a one or two dimensional set of images.

 

If you go to China and you talk to Chinese

teachers, you will find an incredible variety

of views on the subject of integration. In

my experience, once you get knowledgable

teachers going, you tend to discover that

everyone has their own ideas on how

integration should occur, and these run

the whole gamut from none at all, i.e.,

utter reliance on what their teachers taught

them and on what they have gleaned and

synthesized through their own experience,

to those who envision a thorough melding

of theoretical perspectives, such as the

authors of the paper we published in CAOM

a few issues back on the subject of the

relationship between complex systems

science, non-linear dynamics and traditional

Chinese medicine.

 

In fact, some of the leading scientific minds

in China of the past fifty years have endorsed

this kind of approach. I heard a lecture

about this time last year in Beijing from

a member of the NPC who was talking to

a group of scientists from the Santa Fe Institute

and a congregation of Chinese scientists

from the China Academy of Science. His topic

was Complex Systems Science and Chinese

Medicine, and he was attempting to outline

a blueprint for integration.

 

To sum up: virtually all views exist in China and are

alive and well. Some get government endorsement

and become resultingly prominent, but the

Chinese are extremely well practiced in

maintaining their own ideas in the face of

government sponsored orthodoxy of one

kind or another.

 

I've taken the time to spell this out in

some detail so that you can understand

what I mean when I object to your generalizations

about " Chinese teachers. "

 

Ken

 

Ken

[Guest guest]

, " kenrose2008 " <

kenrose2008> wrote:

 

>

> If you go to China and you talk to Chinese

> teachers, you will find an incredible variety

> of views on the subject of integration.

 

no doubt, but then why here in the US where everyone can speak freely is the

integrationist view so widely held. perhaps the integrationists are more likely

to leave china??

 

[Guest guest]

Ken,

 

, " kenrose2008 " <

kenrose2008> wrote:

 

>

> If you go to China and you talk to Chinese

> teachers, you will find an incredible variety

> of views on the subject of integration.

 

 

 

Again, while I do not doubt the content of your conversations, Volker Scheid's

study in China seemed to suggest to me that while there were many differing

views about how to proceed with integration, the majority position was in

favor of some form of integration. Is it Ok to use the word generally when

referring to a majority? Not if that majority is only 51%, I think. I got the

sense from scheid that it was more than that. However, in the absence of

knowing, would it be fair to say " most " ? If pretty much 100% of the chinese

docs I have worked with over the years are integrationists (and that's about

30 or so), I find it hard to believe in China, less than half feel this way.

But

again, the ratios may be skewed because of who emigrates. What was your

sense, if any, of the actual breakdown? More in favor or more completely

opposed to integration.

 

I have made it pretty clear where I stand on this issue myself over the years.

I do not feel comfortable using western medical diagnostics to take precedence

over TCM, such as how Alon described using heat clearing herbs based on

gastroscopy even inthe absence of confirmation by the four exams. But I find

the method helpful in assessing results and as supplemental info when it

comes to prescribing. Also revelations of toxicity have been very important

and application of scientific manufacturing techniques. Others might subsume

CM to WM or, conversely, reject WM altogether.

 

[Guest guest]

 

 

Excellent question. I have no idea really.

 

I would have to talk to your sources before

I could hazard a guess as to why any of

them holds any particular view, let alone

why the consensus your report exists.

 

Ken

 

, " "

wrote:

> , " kenrose2008 " <

> kenrose2008> wrote:

>

> >

> > If you go to China and you talk to Chinese

> > teachers, you will find an incredible variety

> > of views on the subject of integration.

>

> no doubt, but then why here in the US where everyone can speak freely is

the

> integrationist view so widely held. perhaps the integrationists are more

likely

> to leave china??

>

 

[Guest guest]

 

 

I'm not arguing the point of integration, and I'm not

saying anything about the ratio of beliefs and

opinions in China. I have various views on

the former, many of which I have stated elsewhere;

and I know far too little about the latter to

hazard a guess.

 

I'm simply pointing out that there is diversity.

 

You can and no doubt will continue to make

the statement that you do based upon your

own sense from your own encounters.

 

I was simply sharing with you and with others

who read your post that what you said reflects

those personal encounters, just as what I

have to say reflects my own.

 

I think neither of us has studied the subject

enough to be drawing conclusions at this

point or saying that " this is the way it is

in China " or among the Chinese.

 

And because of the enormously complicated

pressures that come to bear on individuals

in China these days, I would be very suspect

of any study or survey that professed to

reflect contemporary attitudes on this question.

 

Ken

[Guest guest]

I have made it pretty clear where I stand on this issue myself over the years.

I do not feel comfortable using western medical diagnostics to take precedence

over TCM, such as how Alon described using heat clearing herbs based on

gastroscopy even inthe absence of confirmation by the four exams.

>>>Why is this an absence of four examinations? that is the question. The Drs

that were doing this were clear in saying they believe this is modern four

examinations. They stated that just like in many other CM condition local signs

may take precedence over other signs such as pulse and tongue so can

gastroscopy. The only difference is that they use technology to see these signs.

Alon

 

 

[Guest guest]

At 3:35 PM +0000 11/5/03, wrote:

>And let's get real here... If you talk to chinese

>teachers, you will gernally find this resistance to integration is largely an

>american new age phenomena.

--

 

 

Who's resistance to integration is that? I certainly wasn't expressing any.

 

In any event, I think the discussion of Jason's case is a good

example of how using the WM diagnosis can easily lead to a wrong

diagnosis in CM.

 

I agree it's useful, even very important, to study WM. I don't think

it helps me much in making a Chinese diagnosis. It should not replace

learning about Chinese diseases/bing, the study of which is sadly

inadequate in American TCM education -- perhaps that's a new age

phenomena.

 

Rory

--

 

 

 

[Guest guest]

, Rory Kerr <rory.kerr@w...>

wrote:

> At 3:35 PM +0000 11/5/03, wrote:

> >And let's get real here... If you talk to chinese

> >teachers, you will gernally find this resistance to integration is largely an

> >american new age phenomena.

> --

>

>

> Who's resistance to integration is that? I certainly wasn't expressing any.

 

I wasn't talking about you or anyone on this list actually. Just people I know.

 

 

[Guest guest]

On Wednesday, November 5, 2003, at 11:22 AM, wrote:

 

> , Rory Kerr <rory.kerr@w...>

> wrote:

>> At 3:35 PM +0000 11/5/03, wrote:

>>> And let's get real here... If you talk to chinese

>>> teachers, you will gernally find this resistance to integration is

>>> largely an

>>> american new age phenomena.

>> --

>>

>>

>> Who's resistance to integration is that? I certainly wasn't

>> expressing any.

>

> I wasn't talking about you or anyone on this list actually. Just

> people I know.

 

This is actually a documented phenomena according to that article

" Acupuncture Wars " in which the history of OM in the USA was described.

I can't remember the author's name, but you can get a copy from her,

the notice of this was originally sent out on to the CHA list a few

months ago.

 

There are basically two schools of thought in American OM: those who

want to be more integrated into the existing medical delivery system

and expand our " primary healthcare provider " status, and those who came

from a counterculture new-age background who want to maintain distance

from the existing power base of the medical community.

 

The tendency of the TCM practitioners is to favor greater

responsibility, education, and integration, while the tendency of the

non-tcm practitioners, especially the Five element practitioners is the

opposite.

 

This is a somewhat rough synopsis of what this long report states. It

was very interesting reading, and if you're interested in the way in

which OM is evolving in the USA, this is a good article to read.

 

--

 

Pain is inevitable, suffering is optional.

-Adlai Stevenson

[Guest guest]

I agree with both of you. I think we need to primarily use the CM

protocol of diagnosis. However, those areas where technology can add

to the information we access, there should be no problem in using

results of western tests as well.

 

 

On Nov 5, 2003, at 9:51 AM, ALON MARCUS wrote:

 

> I have made it pretty clear where I stand on this issue myself over

> the years.

> I do not feel comfortable using western medical diagnostics to take

> precedence

> over TCM, such as how Alon described using heat clearing herbs based on

> gastroscopy even inthe absence of confirmation by the four exams.

>>>> Why is this an absence of four examinations? that is the question.

>>>> The Drs that were doing this were clear in saying they believe this

>>>> is modern four examinations. They stated that just like in many

>>>> other CM condition local signs may take precedence over other signs

>>>> such as pulse and tongue so can gastroscopy. The only difference is

>>>> that they use technology to see these signs.

> Alon

>

>

[Guest guest]

I think that many mainland Chinese haven't had the same cultural

experience with Western medicine that many westerners have had, i.e.

the excesses of overtreatment, iatrogenesis, antibiotic and

prescription drug abuse. I think new age may be an inappropriate

description of some of the resistance to integration. There are some

real issues here, and I think they need to be addressed fully and

openly.

 

I agree with Rory. We need more and more information on how to

diagnose and treat according to the principles of Chinese medicine.

 

 

On Nov 5, 2003, at 11:21 AM, Rory Kerr wrote:

 

> At 3:35 PM +0000 11/5/03, wrote:

>> And let's get real here... If you talk to chinese

>> teachers, you will gernally find this resistance to integration is

>> largely an

>> american new age phenomena.

> --

>

>

> Who's resistance to integration is that? I certainly wasn't expressing

> any.

>

> In any event, I think the discussion of Jason's case is a good

> example of how using the WM diagnosis can easily lead to a wrong

> diagnosis in CM.

>

> I agree it's useful, even very important, to study WM. I don't think

> it helps me much in making a Chinese diagnosis. It should not replace

> learning about Chinese diseases/bing, the study of which is sadly

> inadequate in American TCM education -- perhaps that's a new age

> phenomena.

>

> Rory

> --

>

>

>

[Guest guest]

Western medicine that many westerners have had, i.e.

the excesses of overtreatment, iatrogenesis, antibiotic and

prescription drug abuse.

>>>>O boy. Its much worse in china than US

alon

 

 

[Guest guest]

, " "

<zrosenbe@s...> wrote:

> I agree with both of you. I think we need to primarily use the CM

> protocol of diagnosis. However, those areas where technology can

add to the information we access, there should be no problem in

using results of western tests as well. >>>

 

 

Z'ev:

 

If we try to answer Robert Hayden's question, don't we have more to

do than look at Western tests? The risk (of effectiveness and of

liability) is that one treatment method could block another and

reduce the patient's chance of success, not simply work in parallel.

I feel that the need to even ask whether CM will interfere with

Western meds means that a much deep integration is necessary and

inevitable.

 

 

Jim Ramholz

[Guest guest]

May I add a third group? One which maintains a romantic relationship

with CM by way of the martial arts. Most of my constituents who

practice both disciplines shun talks of integration. This does not

mean that one is not willing to learn as much WM as possible. I for

one am and have been prior to studying CM and continue up to this day

mainly in matters of brain chemistry and neurology.

 

It seems to me that the level of WM training at TCM schools in our

parts of the world is not enough for us to pretend that our practices

are integrated. Reading in Chinese journals about practitioners in

China where students have more in depth training is one thing.

Implementing it here in the States where one is lucky if a cat or rat

is dissected during A & P class is another.

 

Fernando

 

, al stone <alstone@b...> >

There are basically two schools of thought in American OM: those who

> want to be more integrated into the existing medical delivery

system

> and expand our " primary healthcare provider " status, and those who

came

> from a counterculture new-age background who want to maintain

distance

> from the existing power base of the medical community.

>

> The tendency of the TCM practitioners is to favor greater

> responsibility, education, and integration, while the tendency of

the

> non-tcm practitioners, especially the Five element practitioners is

the

> opposite.

[Guest guest]

My comments are not directly specifically at your post, Fernando, and I

am aware of the cross-fertilization of CM and the martial arts.

However, it does seem at times that there is a bias prevailing in many

posts and circles that WM is somehow more 'real' than spiritual or

physical cultivation practices, and that the reality of CM needs to be

determined by biomedical criteria. This to me is a counterproductive

bias, and rather than start up the 900 pound elephant spinning again,

I'd just like to point this out.

 

There are other realities in the world of medicine than biomedicine,

its procedures and tests.

 

 

On Nov 5, 2003, at 2:07 PM, Fernando Bernall wrote:

 

> May I add a third group? One which maintains a romantic relationship

> with CM by way of the martial arts. Most of my constituents who

> practice both disciplines shun talks of integration. This does not

> mean that one is not willing to learn as much WM as possible. I for

> one am and have been prior to studying CM and continue up to this day

> mainly in matters of brain chemistry and neurology.

[Guest guest]

Can you share some data or experiences with us? I don't doubt this is

true, but I wonder how much it is reported.

 

 

On Nov 5, 2003, at 1:39 PM, ALON MARCUS wrote:

 

> Western medicine that many westerners have had, i.e.

> the excesses of overtreatment, iatrogenesis, antibiotic and

> prescription drug abuse.

>>>>> O boy. Its much worse in china than US

> alon

[Guest guest]

Good question, Jim.

 

This will require studies, which is another area than reading Western

tests. I find it interesting, however, that the mainstream-mainland

Chinese system, which is more or less 'integrated', puts little

emphasis so far on drug-herb interaction studies, and seamlessly uses

both drugs and herbal prescriptions with patients.

 

I am not worried about this too much, to tell the truth.

 

 

On Nov 5, 2003, at 1:55 PM, James Ramholz wrote:

 

> , " "

> <zrosenbe@s...> wrote:

>> I agree with both of you. I think we need to primarily use the CM

>> protocol of diagnosis. However, those areas where technology can

> add to the information we access, there should be no problem in

> using results of western tests as well. >>>

>

>

> Z'ev:

>

> If we try to answer Robert Hayden's question, don't we have more to

> do than look at Western tests? The risk (of effectiveness and of

> liability) is that one treatment method could block another and

> reduce the patient's chance of success, not simply work in parallel.

> I feel that the need to even ask whether CM will interfere with

> Western meds means that a much deep integration is necessary and

> inevitable.

>

>

> Jim Ramholz

>

[Guest guest]

, " " wrote:

I find it interesting, however, that the mainstream-mainland

> Chinese system, which is more or less 'integrated', puts little

> emphasis so far on drug-herb interaction studies, and seamlessly

uses both drugs and herbal prescriptions with patients.

 

 

Z'ev:

 

I suspect you are correct for just those reasons. But I wonder if it

won't become a political football in the US.

 

 

Jim Ramholz

[Guest guest]

It already is, I think.

 

 

On Nov 5, 2003, at 2:59 PM, James Ramholz wrote:

 

>

> Z'ev:

>

> I suspect you are correct for just those reasons. But I wonder if it

> won't become a political football in the US.

>

>

> Jim Ramholz

[Guest guest]

, " Z'ev

Rosenberg " <zrosenbe@s...> wrote:

> It already is, I think.

 

ditto.

 

todd

[Guest guest]

Can you share some data or experiences with us? I don't doubt this is

true, but I wonder how much it is reported.

>>>First their use of antibiotics is extremely negligent. Not only way over used

but also the use of potent antibiotics such as gent is unbelievable. Same with

steroids. I have seen many questionable surgeries (not that we do not see it

here) but which were quite aggressive. Such as removal of large portions of

stomachs for mild ulcers

Alon

 

 

[Guest guest]

I second this.

 

It is much more the viewpoint that WM is better or more encompassing

than CM that annoys me, especially when you see the bad way WM is

sometimes performed (overtreatment, iatrogenesis, antibiotic and

prescription drug abuse).

 

Only when WM is willing to see CM as medicine on an equal level is

IMO integration an option. And only from the viewpoint of equality.

Integration where the partners are not on an equal level leads to

annihilation of the lesser one. Just look at company mergers where

one partner is stronger than the other. The smaller one may have very

good things to bring in, but it usualy won't survive.

 

So IMO best to keep things separate until there is mutual recognition.

 

Alwin

 

--- " wrote:

> I think that many mainland Chinese haven't had the same cultural

> experience with Western medicine that many westerners have had,

i.e.

> the excesses of overtreatment, iatrogenesis, antibiotic and

> prescription drug abuse. I think new age may be an inappropriate

> description of some of the resistance to integration. There are

some

> real issues here, and I think they need to be addressed fully and

> openly.

>

> I agree with Rory. We need more and more information on how to

> diagnose and treat according to the principles of Chinese medicine.

 

Other post of Z'ev:

> There are other realities in the world of medicine than biomedicine,

> its procedures and tests.