Guest guest Posted November 5, 2003 Report Share Posted November 5, 2003 Further information: I presented just the herbs to Chip Chace, and asked him, what is the Dx? HE quickly said phlegm lung congestion leading asthma... HE as many of you know, probably has translated more information (cases discussion etc) on respiratory than anyone... I told him about Todd's inquiry about sticky phlegm. He pointed out that he has translated passages on sticky phlegm (sinus) being from spleen xu (no heat) – so, I guess people all have their opinions…. I am still trying to figure out what a PRC standard is...?? - Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 5, 2003 Report Share Posted November 5, 2003 My perception is that a PRC standard is an evolving one, not set in stone. On Nov 5, 2003, at 11:51 AM, wrote: > I am still trying to > figure out what a PRC standard is.. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 5, 2003 Report Share Posted November 5, 2003 I am still trying to > figure out what a PRC standard is...?? > > - according to bob flaws, as I have stated several times recently, the PRC releases an offical diagnostic guide every few years based upon committee consensus from all the schools. points such as these are regularly debated at both schools and on the national level. educational foundations have to start with an assumption. And I work on the assumption that thick phlegm may be part of a heat presentation and the lack of yellow color of the sputum is not a rule-out (but thickness is not a rule-in). I think too often white phlegm is treated as cold when other signs point to heat. and thus this makes it clinically relevant as well. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 5, 2003 Report Share Posted November 5, 2003 , " " wrote: And I work on the assumption that thick phlegm may be part of a heat presentation and the lack of yellow color of the sputum is not a > rule-out (but thickness is not a rule-in). I think too often white phlegm is treated as cold when other signs point to heat. and thus this makes it clinically relevant as well. : I brought this up with a new practitioner in town and she said that her teacher had mentioned that the heat might be blocked from entering the upper jiao and the tongue. So the tongue in this case may not always be a reliable sign. 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: > I am still trying to > > figure out what a PRC standard is...?? > > > > - > > according to bob flaws, as I have stated several times recently, the PRC > releases an offical diagnostic guide every few years based upon committee > consensus from all the schools. tODD, Sorry, with so many msg.'s recently I have to admit I haven't read all of them and seemed to have missed this one... This was prob already asked, but where do we get this (publisher?) (or does someone have the latest one), and when was the last one released... Interesting concept... - Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 5, 2003 Report Share Posted November 5, 2003 Z'ev, , " " < zrosenbe@s...> wrote: > My perception is that a PRC standard is an evolving one, not set in > stone. > > > On Nov 5, 2003, at 11:51 AM, wrote: > > > I am still trying to > > figure out what a PRC standard is.. Last year the Chinese Ministry of Science and Technology announced the funding of an $18 million (USD) project to promote the development of standards in Traditional . This is the official, government sanctioned brand of traditional Chinese medicine, as we now all know very clearly. The Chinese see themselves, understandably enough, as the source and current custodians of the subject; and they have now invested themselves anew in preparing a presentation of the subject in terms of modern scientific proof that will enable the development of standards of efficacy, safety, purity, strength, and so on. I'm actually not familiar with the details of the current plan or with whether or not they have even been elaborated at this point. The envisioned project is a ten-year initiative. What I've witnessed on the ground in Chengdu and to a lesser extent in Beijing and other major centers of TCM education in the PRC over the past decade or so is a competition for the position of standard bearer. In typical Chinese fashion, all the competitors survive and thrive on the competition, at least those who are perceived by the other members of the game as playing by the rules. The politics are complex and unmistakably Chinese, but they are not really all that hard to understand by anyone who is familiar with academic politics almost anywhere. And of course, PRC standards and PRC politics are inseparable. I agree with Z'ev's assessment, therefore, that when we speak of PRC standards we are talking about an extremely dynamic set of variables that are on the cusp of an enormous potential shift in their nature and detail. It will be fascinating to see how the current evolution unfolds over the coming years and what impact it has on our perception and practice of the subject in the West. Ken Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 5, 2003 Report Share Posted November 5, 2003 , " kenrose2008 " <kenrose2008> wrote: > I agree with Z'ev's assessment, therefore, > that when we speak of PRC standards > we are talking about an extremely dynamic > set of variables that are on the cusp of > an enormous potential shift in their > nature and detail. but we should be versed in the current dynamic and all succeeding changes. to operate in ignorance of such things is arrogant, to say the least. plus some of these variable may have changed little over the years and those that are generally accepted consensus must be carefully considered before we deviate. for example, a question that has come up in both my class and Z'ev's. Can a person have pulse that is both slippery and choppy overall? Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 5, 2003 Report Share Posted November 5, 2003 > > but we should be versed in the current dynamic and all > succeeding changes. to operate in ignorance of such things is > arrogant, to say the least. Agreed. How do you envision being and remaining versed in current dynamics? I just spent a year doing little else but talking to prominent people in TCM circles in Beijing, interviewing them, researching their work and current planning; and I really don't feel that I am versed on the current dynamics. I only grasp enough to know that making generalizations about it is a risky business at best. I think these dynamics are best dealt with as specifics and not as generalities. plus some of these variable may have > changed little over the years and those that are generally > accepted consensus must be carefully considered before we > deviate. Well, I'm not sure what you have in mind when you talk about variables that have changed little over the years or what generally accepted consensus might actually mean. Certainly if you pick up the standard teaching texts used in the TCM colleges and universitites, you find a king of orthodoxy that embodies certain consensus understandings of theory and practice. But in my very limited experience with specific teachers at specific schools, what is taught and what is practiced in the clinics...in Chengdu for example, can vary widely from such generally accepted consensus. Again, such deviations from the " party line " have to be done in typically Chinese ways, and it's often not easy to document or even track down who really thinks what. It's one of the factors that makes study in China challenging for outsiders (literally the Chinese designation for foreigners is " outer country people " or simply " old outsiders " ). It takes time, generally speaking, for non Chinese to develop an understanding of and appreciation for the ways in which Chinese people express agreement, acceptance, and conformity to generally accepted consensus about such things and how they go about manifesting their urges to deviate from such norms. In my experience there is not a more fiercely individualistic bunch of people that I've ever met than Chinese scholars and doctors of TCM. Yet many of these people who harbor very indivdiualistic and some very far out creative, even imaginative ideas and interpretations of Chinese medical theory often publically express their acceptance of the generally accepted " norms " . Conscientious scholars and educators who want to see the consensus change characteristically have grand strategies in which they see themselves engaged that will bring about gradual and lasting changes. Few seek to revolutionize things or upset what is always a delicate balance in their lives in terms of their relationships with the power structures that run the society and the institutions that still form the basic infrastructures that make up things like Chinese medical education. for example, a question that has come up in both my > class and Z'ev's. Can a person have pulse that is both slippery > and choppy overall? > My rule of thumb on such issues is that the patient gets to determine what the patient can have or not have. Patients do not know or feel the least bit obligated to conform to theory. So when theory doesn't conform to patients, it's simply the job of the practitioner to find a more suitable theory for that case. If I were to feel a pulse in a patient that was both slippery and choppy then the answer would be a resounding yes. And while not feeling such a pulse the answer is no. But I'm not sure what difference that makes in terms of the point at hand. Ken Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 5, 2003 Report Share Posted November 5, 2003 , " " wrote: Can a person have pulse that is both slippery and choppy overall? : Overall? In all positions and at all depths? Not likely. But then I haven't seen all trauma or ER cases. But in seperate positions or different depths in the same position, you can see one or the other. Only someone with poor pulse skills would say that the pulses were overall only one thing. It is a generalization so sweeping that it becomes meaningless. Jim Ramholz Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 6, 2003 Report Share Posted November 6, 2003 , " kenrose2008 " < kenrose2008> wrote: > > If I were to feel a pulse in a patient > that was both slippery and choppy > then the answer would be a resounding > yes. And while not feeling such a pulse > the answer is no. since these are defined as opposite pulse, then you would also say that pulse can be both fast and slow or superficial and deep simultaneously. if what you are saying is valid, then pulse diagnosis is worthless. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 6, 2003 Report Share Posted November 6, 2003 > > since these are defined as opposite pulse, then you would also say that pulse > can be both fast and slow or superficial and deep simultaneously. if what you > are saying is valid, then pulse diagnosis is worthless. > As we seem unable to avoid digressing into meaningless banter. I'll cede this point to you. I'm not entirely sure what you were driving at, but that you seem to have arrived there is just fine with me. Ken PS. I am indeed comfortable with things being themselves and their opposites. And I don't agree with you that this suggests to me or anyone else that pulse diagnosis is useless. But again, I'm lost. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 6, 2003 Report Share Posted November 6, 2003 , " " wrote: > > Ken wrote: If I were to feel a pulse in a patient > > that was both slippery and choppy > > then the answer would be a resounding > > yes. And while not feeling such a pulse > > the answer is no. > : since these are defined as opposite pulse, then you would also say that pulse can be both fast and slow or superficial and deep simultaneously. if what you are saying is valid, then pulse diagnosis is worthless. : You hit the nail on the head. The basic pulses are like an alphabet or musical scales. They are combined with, for example, the Nan Jing's use of positions to make the patient's diagnosis clear. The general general lack of interest in the pulses, both here and in China, belies their usefulness and importance. Even though I use every model in the Nan Jing and Suwen, there are still new things I am learning about them even after more than 20 years of wanting to specialize in the subject. Jim Ramholz Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 6, 2003 Report Share Posted November 6, 2003 I have a techinical question about slippery and choppy. It seems to me that they aren't opposites but a continum. A pulse may at first touch it may seem slippery but Within the pulse on more careful examination you can feel the choppiness. I guess the metaphor would be looking at a river from the sky and then getting close seeing the rocks and turbulence. comments? doug > > > > If I were to feel a pulse in a patient > > that was both slippery and choppy > > then the answer would be a resounding > > yes. And while not feeling such a pulse > > the answer is no. > > > since these are defined as opposite pulse, then you would also say that pulse > can be both fast and slow or superficial and deep simultaneously. if what you > are saying is valid, then pulse diagnosis is worthless. > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 6, 2003 Report Share Posted November 6, 2003 Doug, , " " wrote: > I have a techinical question about slippery and choppy. It seems to me that they aren't > opposites but a continum. A pulse may at first touch it may seem slippery but Within > the pulse on more careful examination you can feel the choppiness. I guess the > metaphor would be looking at a river from the sky and then getting close seeing the > rocks and turbulence. comments? > doug I like your image, and all I can say is that my teachers, who tend to base everything they do in the sensory experience directly, urged me to shun the descriptions in favor of the sensations. " Understanding " pulses can only proceed once the sensory capacity is exercised and cultivated to an extent at which the sense perceptions are clearly enough received and processed through one's own body to be able to interpret whatever messages they contain about the patient's body/mind. Once one has the method, the more practice the more skill. I see this as an example of how we have to know these basic tools clearly in order to be able to see beyond them... to the patient. Ken Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 6, 2003 Report Share Posted November 6, 2003 I agree with your sentiment, Doug. Pulses can have a 'continuum' of qualities. I want to point out something here that I feel is important. Forgive my rough writing, as time is short before Pacific Symposium, so I am writing quickly between patients. I support the idea of a standard in TCM, even though it is a changing, evolving one, as Ken points out. I respect that Bob Flaws, Todd and others on this list respect the hard work of physicians such as Qin Bowei and Fang Yaozhong to standardize education of the subject, and to create a national TCM healthcare system. However, the standard TCM taught in such excellent textbooks as Dao's Practical Diagnosis is a blueprint, not an absolute. There are other divergent styles of medicine from China, Japan and Korea, models that Michael Broffman calls 'eclectic Chinese medicine' or 'alternative Chinese medicine'. This includes Nan Jing styles, which are ancient and well-documented. The other day, a student quoted a major teacher in Chinese medicine as saying if one is practicing professional standard TCM, one should not do, for example, abdominal palpation on that patient. I think this teacher has a good point. We don't want to confuse students with conflicting information, or too much mixing of styles. However, this doesn't mean we shouldn't open up possibilities for students to connect with later on, or insure their exposure to a wider spectrum. One can master more than one style of practice. This is certainly true if many teachers espouse a 'pure' TCM, and then freely mix in biomedical testing and diagnoses. As far as pulse diagnosis goes, while one would be hard pressed to feel fast and slow qualities at the same time, when one differentiates positions and depths on the pulse, it is certainly possible to feel both slippery and wiry pulses. Patients present mixed vacuity and repletion, yin and yang, exterior and interior patterns. There is a depth of complexity in the pulse that should be available to all comers. If not, statements like 'it is impossible to have both a slippery and wiry pulse' become a dogma, and close students minds to the possibilities of Chinese medicine. As I've often said. . .. The jury is still out. Let's not draw premature conclusions. On Nov 6, 2003, at 10:18 AM, wrote: > I have a techinical question about slippery and choppy. It seems to me > that they aren't > opposites but a continum. A pulse may at first touch it may seem > slippery but Within > the pulse on more careful examination you can feel the choppiness. I > guess the > metaphor would be looking at a river from the sky and then getting > close seeing the > rocks and turbulence. comments? > doug > >>> >>> If I were to feel a pulse in a patient >>> that was both slippery and choppy >>> then the answer would be a resounding >>> yes. And while not feeling such a pulse >>> the answer is no. >> >> >> since these are defined as opposite pulse, then you would also say >> that pulse >> can be both fast and slow or superficial and deep simultaneously. if >> what you >> are saying is valid, then pulse diagnosis is worthless. >> > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 6, 2003 Report Share Posted November 6, 2003 On Thursday, November 6, 2003, at 07:45 AM, wrote: >> If I were to feel a pulse in a patient >> that was both slippery and choppy >> then the answer would be a resounding >> yes. And while not feeling such a pulse >> the answer is no. > > > since these are defined as opposite pulse, I've heard that the slippery and choppy pulses are defined as opposites too, but I'm not too crazy about this designation. I've heard of three definitions for the choppy (se) pulse. 1) Variable in amplitude, or the height of the wave. 2) Variable in the speed " 3-5 pulse " meaning fast, then slow, then fast, then slow. 3) Variable in the smoothness of the wave form, where it rises and falls with hesitation. " Se " is sometimes translated to " hesitant " which I quite like, having felt this pulse a few times. It even arrived with a purple tongue. However, this last type of choppy has levels of intensity to it. When it is just beginning, it can fell like it arrives normally. The pulse rises normally, but as it drops, it does so in tiny little steps rather than one or two. This can arise from within a slippery pulse. If the pulse is VERY choppy, it may be difficult to call it slippery. The choppy pulses that I've felt always required a moment of silence to really key into it. But once you do, its very much there, and very much hesitant like scraping a knife on a bamboo. If you have a more auditory relationship with pulses, you might perceive it as a heavy sigh on the downward edge of the pulse. So, I question the opposition of slippery and choppy. > then you would also say that pulse > can be both fast and slow or superficial and deep simultaneously. Fast and slow are obviously opposites. Unless perhaps you have a really really irregular pulse, which might be considered choppy by the above definition #2. Superficial and deep are opposites too, but of course then can appear simultaneously in the hollow/scallion stalk pulse, or the leather/drum-skin pulse. -- Pain is inevitable, suffering is optional. -Adlai Stevenson Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 6, 2003 Report Share Posted November 6, 2003 This should be Deng's Practical Diagnosis, not Dao's. Typo, sorry. On Nov 6, 2003, at 10:43 AM, wrote: > However, the standard TCM taught in such excellent textbooks as Dao's > Practical Diagnosis is a blueprint, not an absolute. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 6, 2003 Report Share Posted November 6, 2003 OK Ken, you caught my attention with this one. Would you mind elaborating a little on Steven's comment regarding getting a therapeutic result on a patient by inserting a needle more or less anywhere in the body, even if someone else were to choose the point and guide his hand to it. Not that I disagree. I am interested in your interpretation as to why he could do that. Thanks, Chris In a message dated 11/6/2003 7:04:39 PM Eastern Standard Time, kenrose2008 writes: The genius lies in the hands of the diagnostician. And the way is in training. Steve Birch talks about the importance of technique in terms of acupuncture efficacy and says he can get a therapeutic result on a patient by inserting a needle more or less anywhere in the body, even if someone else were to choose the point and guide his hand to it. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 6, 2003 Report Share Posted November 6, 2003 << Al Stone: So, I question the opposition of slippery and choppy.>> Well, Wiseman says so. Wiseman: " A slippery pulse is commonly seen in pregnancy, particularly in the early stages where extra blood is needed to nourish the fetus. It is also sometimes seen in healthy people, indicating an abundance of qi and blood. " When the pulse is Slippery the first thing you know is that the yang energy condition is becoming overly active. It sometimes also indicates that moisture, especially mucus secretion, is excessive. So when the pulse is Slippery, first two important things that you should think of is that there might be some activity with the heat and, secondly, you have to ask yourself if the heat is caused just by the qi or also the xue as well. The quality of the Slippery pulse often indicates localized excessive heat when it is in one position or in a sector of a position. In this case, it can indicate excessive localized mucus production. It will manifest when the source qi is unable to hold kidney fire, causing heat at the blood level. Wiseman (se mai): " A pulse opposite to the slippery pulse, i.e., one that does not flow smoothly and that is classically described as " a knife scraping bamboo. " The rough pulse is sometimes termed a choppy or dry pulse in English. It tends to be somewhat fine, is generally slightly slower than the normal pulse, and has been described as being " fine, slow, short, dry, and beating with difficulty. " The rough pulse is often seen in blood stasis patterns and dual vacuity of blood and qi. " Choppy or rough in clinical practice is a very general term, and almost anything that is neither Soft nor Slippery may be considered as a Choppy pulse as long as it does not have the smooth type of a texture characteristic of the Slippery pulse. It can even feel like very fine sandpaper. A Choppy (also Sandy, Rough, or Fine) pulse is a yin pulse indicating a cold syndrome; the rougher it gets, the colder it is. It is usually found as a cold syndrome in the deeper area of the body, indicating a circulatory imbalance or poor blood circulation. Jim Ramholz Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 6, 2003 Report Share Posted November 6, 2003 , " kenrose2008 " wrote: > ... all I can say is > that my teachers, who tend to base > everything they do in the sensory experience > directly, urged me to shun the descriptions > in favor of the sensations. >>> Ken: I agree. This is also a premise of both the Dong Han and Shen/Hammer pulse systems. There is a priority of clinical practice contantly informing and updating the past. Jim Ramholz Quote Link to comment Share on other sites More sharing options...
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