Knowledge needed for APv CHM

[Guest guest]

November 19.2003

 

Dear Listmembers,

 

I have been following this thread for a couple of days now and I have

not pitched in my comments because it needed some deep thought and

research. The main issue before us is the practical connections between AP

(acupuncture which Marco refers to as 'acumoxa') and CHM (Chinese herbal

medicine). I am still wondering how we ended up in this situation wherein

we have a dichotomized AP v CHM. Was it the television screen which brought

acupuncture to the world during the Nixon China visit' is it due to the

'integrated system' in China where nei ke or internal medicine (where CHM

is used) is separated as a discipline from AP ; is it due to our habit of

separating and dividing reality; it is because some of us first studied AP

and are now discovering CHM and learning it or vice-versa; is it because of

the pedagogic literture available to us which on the whole dichotomizes the

two .

 

When we are feeling our own pulse (mo mai ) or that of our patients we are

doing both AP and CHM . When we inspect the tongue we are doing the same.

When we do acupuncture we access the acupoints and the acutracts (jing mai )

.. When we prescribe herbal preparations to our patients we have to make sure

that we make a correct diagnosis that is founded upon the conditions of the

Five Visceral and Six Hollow Organs (Wu Zang Liu Fu) and the manifestations

of their respective Qi transformations . As Tang Zong Hai stated in his

volume on The Quintessence of the Medical Classics

 

" The acu-tracts jing mai , they are the pathways lu jing of

the Qi transformation originating from theVisceral and hollow

organs "

 

 

To deny the 'real' and (not illusionary ) connections between AP and CHM

is to perpetrate the artificial 'fragmentation ' in our practice, between

us practitioners and using Alwin's words ,between our microworld and the

macroworld . On the otherhand to affirm the connections can only enhance

the 'wholism' in and between us , between us and our patients, between us

and the living natural ecological world.

 

Regards,

 

Rey Tiquia

 

 

 

 

[Guest guest]

Dear Rey,

 

Thank you for such a refreshing and inspiring post.

 

Warm Regards,

 

Fernando

 

 

 

, " rey tiquia " <rey@a...>

wrote:

>

> November 19.2003

>

> Dear Listmembers,

>

> I have been following this thread for a couple of days now

and I have

> not pitched in my comments because it needed some deep thought and

> research. The main issue before us is the practical connections

between AP

> (acupuncture which Marco refers to as 'acumoxa') and CHM (Chinese

herbal

> medicine). I am still wondering how we ended up in this situation

wherein

> we have a dichotomized AP v CHM. Was it the television screen which

brought

> acupuncture to the world during the Nixon China visit' is it due to

the

> 'integrated system' in China where nei ke or internal medicine

(where CHM

> is used) is separated as a discipline from AP ; is it due to our

habit of

> separating and dividing reality; it is because some of us first

studied AP

> and are now discovering CHM and learning it or vice-versa; is it

because of

> the pedagogic literture available to us which on the whole

dichotomizes the

> two .

>

> When we are feeling our own pulse (mo mai ) or that of our

patients we are

> doing both AP and CHM . When we inspect the tongue we are doing the

same.

> When we do acupuncture we access the acupoints and the acutracts

(jing mai )

> . When we prescribe herbal preparations to our patients we have to

make sure

> that we make a correct diagnosis that is founded upon the

conditions of the

> Five Visceral and Six Hollow Organs (Wu Zang Liu Fu) and the

manifestations

> of their respective Qi transformations . As Tang Zong Hai stated

in his

> volume on The Quintessence of the Medical Classics

>

> " The acu-tracts jing mai , they are the pathways lu

jing of

> the Qi transformation originating from theVisceral

and hollow

> organs "

>

>

> To deny the 'real' and (not illusionary ) connections between AP

and CHM

> is to perpetrate the artificial 'fragmentation ' in our practice,

between

> us practitioners and using Alwin's words ,between our microworld

and the

> macroworld . On the otherhand to affirm the connections can only

enhance

> the 'wholism' in and between us , between us and our patients,

between us

> and the living natural ecological world.

>

> Regards,

>

> Rey Tiquia

>

>

>

>

[Guest guest]

Bob and Rey,

 

I do love that this was my favorite radio comedy team, but I digress.

 

I'm not sure how Rey's comments could be called " new agey " . Maybe he actually

likes to " feel good " which many Calvinist Americans look down upon, and I don't

suspect that he's " feeling good " for illegitimate reasons. Rey is sufficiently

rigorous in his lifestyle ... not too much of a hippie considering his vast

academic efforts, but again I digress.

 

Paul Unschuld addressed your comments, Bob, specifically as a " bifurcation " of

Daoists who supported herbal and nutritional therapies versus Confucianists who

supported their cool acupuncture approach. This dichotomy of counterpoints

existed for more than 1,000 years before some creative fusion of these elements

occurred in the Song Dynasty. It's not clear to me that just because the

treatment techniques were different that the diagnostic approaches were

different. Certainly by the Song Dynasty, by somewhere around 900 to 1,000 A.D.

practitioners were doing both with the same diagnostic procedure. But I'm not

well read enough in this are to know. So I'd like to hear about that from those

like, you Bob, or Rey, or Marnae who might know.

 

I'm intrigued, Bob, that you take the time to go on to place emotionality in

counterpoint to rationality ... with emotions getting the short shrift of your

assessment. How about a dialectic of considerations? Wouldn't you like to be

in touch with your emotions as well as you cognitive faculties when making an

informed decision? Seems a more complete approach, no? Dialectical functioning

is a lot of work, but then we don't want to digress into " feel good New

Agey-ness " right? Or in even " think-logically-Calvinism " while maintaining a

stiff upper lip.

 

Respectfully,

Emmanuel Segmen

 

-

Bob Flaws

Wednesday, November 19, 2003 11:25 AM

Re: Knowledge needed for APv CHM

 

 

> Thank you for such a refreshing and inspiring post.

>

> Warm Regards,

>

> Fernando

 

I would call it demagogic. To me, Rey's response panders to the New Agey

elements of this profession. The fact is that, in China,

Japan, and Korea, there has always been a dichotomy between the practice of

acupuncture and Chinese herbal medicine. To deny

this is to deny the Chinese medical literature, the history of Chinese

medicine, and the standards of care in clinical practice in the

birthplace and world's largest user and supporter of acupuncture and Chinese

herbal medicine, the China. Sorry if we don't like this

reality, but you can't say it doesn't exist as a sociological and medical

anthropological fact. (Marnae, chime in if I am grossly wrong

here.) I think it is extremely important for us to cop to the fact that, by

trying to teach and practice these two modalities at the same

time, we are not doing something supported by thousands of years of precedent.

We blundered into this by historical accident and

have now become emotionally attached to " what we do. "

 

Recently I translated an RCT where the combination of acupuncture and Chinese

herbal medicine was compared in the treatment of

rotator cuff tendinitis with internal Chinese meds alone, and the combination

proved superior (no great surprise in this particular case).

However, a better study might have been to compare acupuncture alone to

Chinese herbs alone for this complaint.

 

In any case, what I have said before and will say again are exactly and only

these things:

 

1. Historically in Asia there has been a dichotomy in the practice of

acupuncture and Chinese herbal medicine.

2. While they MAY be practiced using the exact same theories, they do not

logically REQUIRE to be. In historical fact, many great

Chinese doctors have chosen to practice according to either mainly

acupuncture-appropriate or herb-appropriate theories and have

denigrated the other theories in their writings. That is an individual choice.

3. If there is not the requirement to teach and practice these together, there

may be differences in prerequisites to the study and

practice of these two modalities.

4. The de facto combination of these two modalities in the West has led to

both benefits and problems with their study and practice

which need to be looked at again and again in order to know that we are doing

the best things we can for both ourselves and the

patients we serve.

 

This last item is offered in, I believe, the same vein as Ken's repeated calls

for self-examination and critique. While I know that

emotional attachment is and always will be the bottom line for decision-making

in all human beings, I nevertheless hold out the option

and importance of also using rationality for determining what we should as we

move forward in this constantly changing endeavor we

call medicine.

 

Bob

 

 

 

[Guest guest]

Oh, Bob (Flaws),

 

I forgot to ask. Wasn't your use of the word demagogic self-referential? You

had previously posted that you viewed yourself as an elitist. So then ... you

weren't referring to Rey as being anything like yourself were you? Or perhaps

you were. I'm intrigued by your terminology and willingness to include others

in your own circle of consideration. I figured that you would have a rational

explanation for all this. I can't imagine that you were having an " emotional "

moment.

 

Respectfully,

Emmanuel Segmen

 

-

Emmanuel Segmen

Wednesday, November 19, 2003 3:36 PM

Re: Re: Knowledge needed for APv CHM

 

 

Bob and Rey,

 

I do love that this was my favorite radio comedy team, but I digress.

 

I'm not sure how Rey's comments could be called " new agey " . Maybe he actually

likes to " feel good " which many Calvinist Americans look down upon, and I don't

suspect that he's " feeling good " for illegitimate reasons. Rey is sufficiently

rigorous in his lifestyle ... not too much of a hippie considering his vast

academic efforts, but again I digress.

 

Paul Unschuld addressed your comments, Bob, specifically as a " bifurcation " of

Daoists who supported herbal and nutritional therapies versus Confucianists who

supported their cool acupuncture approach. This dichotomy of counterpoints

existed for more than 1,000 years before some creative fusion of these elements

occurred in the Song Dynasty. It's not clear to me that just because the

treatment techniques were different that the diagnostic approaches were

different. Certainly by the Song Dynasty, by somewhere around 900 to 1,000 A.D.

practitioners were doing both with the same diagnostic procedure. But I'm not

well read enough in this are to know. So I'd like to hear about that from those

like, you Bob, or Rey, or Marnae who might know.

 

I'm intrigued, Bob, that you take the time to go on to place emotionality in

counterpoint to rationality ... with emotions getting the short shrift of your

assessment. How about a dialectic of considerations? Wouldn't you like to be

in touch with your emotions as well as you cognitive faculties when making an

informed decision? Seems a more complete approach, no? Dialectical functioning

is a lot of work, but then we don't want to digress into " feel good New

Agey-ness " right? Or in even " think-logically-Calvinism " while maintaining a

stiff upper lip.

 

Respectfully,

Emmanuel Segmen

 

-

Bob Flaws

Wednesday, November 19, 2003 11:25 AM

Re: Knowledge needed for APv CHM

 

 

> Thank you for such a refreshing and inspiring post.

>

> Warm Regards,

>

> Fernando

 

I would call it demagogic. To me, Rey's response panders to the New Agey

elements of this profession. The fact is that, in China,

Japan, and Korea, there has always been a dichotomy between the practice of

acupuncture and Chinese herbal medicine. To deny

this is to deny the Chinese medical literature, the history of Chinese

medicine, and the standards of care in clinical practice in the

birthplace and world's largest user and supporter of acupuncture and Chinese

herbal medicine, the China. Sorry if we don't like this

reality, but you can't say it doesn't exist as a sociological and medical

anthropological fact. (Marnae, chime in if I am grossly wrong

here.) I think it is extremely important for us to cop to the fact that, by

trying to teach and practice these two modalities at the same

time, we are not doing something supported by thousands of years of

precedent. We blundered into this by historical accident and

have now become emotionally attached to " what we do. "

 

Recently I translated an RCT where the combination of acupuncture and

Chinese herbal medicine was compared in the treatment of

rotator cuff tendinitis with internal Chinese meds alone, and the

combination proved superior (no great surprise in this particular case).

However, a better study might have been to compare acupuncture alone to

Chinese herbs alone for this complaint.

 

In any case, what I have said before and will say again are exactly and only

these things:

 

1. Historically in Asia there has been a dichotomy in the practice of

acupuncture and Chinese herbal medicine.

2. While they MAY be practiced using the exact same theories, they do not

logically REQUIRE to be. In historical fact, many great

Chinese doctors have chosen to practice according to either mainly

acupuncture-appropriate or herb-appropriate theories and have

denigrated the other theories in their writings. That is an individual

choice.

3. If there is not the requirement to teach and practice these together,

there may be differences in prerequisites to the study and

practice of these two modalities.

4. The de facto combination of these two modalities in the West has led to

both benefits and problems with their study and practice

which need to be looked at again and again in order to know that we are

doing the best things we can for both ourselves and the

patients we serve.

 

This last item is offered in, I believe, the same vein as Ken's repeated

calls for self-examination and critique. While I know that

emotional attachment is and always will be the bottom line for

decision-making in all human beings, I nevertheless hold out the option

and importance of also using rationality for determining what we should as

we move forward in this constantly changing endeavor we

call medicine.

 

Bob

 

 

[Guest guest]

Hi Emmanuel and others

 

--- " Emmanuel Segmen " wrote:

> Paul Unschuld addressed your comments, Bob, specifically as

> a " bifurcation " of Daoists who supported herbal and nutritional

> therapies versus Confucianists who supported their cool acupuncture

> approach. This dichotomy of counterpoints existed for more than

> 1,000 years before some creative fusion of these elements occurred

> in the Song Dynasty.

---------------------->

And in a sense, IMO, such a dichotomy still exists (and probably in

more than one way) between the people who support the view " it's

placebo and I keep my scepticism until you prove me how it works "

(the structural Confucianists) and the people who support the

view " if it works, I don't care how (because it is unknowable

anyway) " (the natural Daoists).

 

I don't think this dichotomy has ever left the world or the

profession and I don't think it ever will (or should).

 

 

> It's not clear to me that just because the treatment techniques

> were different that the diagnostic approaches were different.

> Certainly by the Song Dynasty, by somewhere around 900 to 1,000

> A.D. practitioners were doing both with the same diagnostic

> procedure.

 

In my interpretation from PU's book " Was ist Medizin " I read that in

Han-Dynasty this dichotomy was already present and that both parties

wouldn't have had different methods of anamneses (which doesn't say

anything about diagnosis though).

 

The Daoist, and the medicine they supported, were opposed to all

these new laws forced upon society which created pressures that were

cause for many disputes. They rejected this kind structuring-by-law

of medicine as well and for example they did not support the 5-

elements theory.

Herbal medicine was at first not part of the *new* medicine of that

time (AP was part of it, and the ideal for AP was to use it in

prevention, like a good ruler rules his empire) because it was not

integrated with the new laws of nature, the systematic

correspondence, not directed towards creating a harmonious balance

but towards fighting intruders (according to Confusianists).

 

The Daoist disagreed of course on the latter part and held belief

that their long known herbal medicines relieved the body from

material burdens and brought the body back into harmony with nature.

 

In 200 CE Zhang Ji tried to connect both views for the first time by

connecting herbal medicines to channels in the body, it found no

support. Only in the 11th-12th era CE, the Neo-Confusianistic doctors

incorporated the workings of the herbal medicine within the laws of 5-

elements the yin-yang theory and created the Chines Pharmacology. The

(political) reason for this was to show the all encompassing validity

of Confusianism. Thereby also creating a stronger position of the

doctors as opposed to the pharmacists. Because it then required a

diagnosis by a doctor to know what was realy wrong in the body ( " we

can see what you can't see " ).

 

PU's book really is a very nice book to read, I hope an english

translation will be available soon.

 

Alwin

[Guest guest]

All,

 

It has been personally frustrating to watch this whole discussion about the

importance of theory and technique in acupuncture play out in the last week. In

the past year here in Beijing I have seen over and over and over again how an

acupuncturist with a formiddable command of classical Chinese medical theory in

his brain consistently gets significantly better results than other

practitioners. I see acupuncture successfully treat conditions that both

western medicine and Chinese herbal medicine have tried to treat (sometimes by

some of the most famous herbalists on earth -no kidding-).

 

This whole discussion represents part of the growing pains of Chinese medicine

in western countries. There is a problem with access to thorough, logical,

teachable acupuncture theory. This is even true in Chinese by the way.

 

I'm not speaking as a wild-eyed hippie with a mind clouded by new age delusions.

Hell, I came here to study herbal medicine and have been totally diverted by the

staggering depth of acupuncture. I have spent as much time as most of you out

there studying herbal medicine. If anything, I came here with a strong bias

against acupuncture.

 

If anyone on this list would like to see concrete examples of how theory and

technique can significantly improve the results of acupuncture treatments, come

to Beijing. Bring your thinking cap- it isn't easy. My phone number is at the

bottom of this e-mail.

 

respectfully,

 

Jason Robertson

 

 

 

Jason Robertson, L.Ac.

Ju Er Hu Tong 19 Hao Yuan 223 Shi

 

Beijing, Peoples Republic of China

 

home-86-010-8405-0531

cell- 86-010-13520155800

 

 

 

 

Free Pop-Up Blocker - Get it now

 

 

[Guest guest]

here are some thoughts about your recent response to my post:

 

 

>>>>>>>>>in what part of the shanghanlun is the relationship between herbs and

acupuncture channels mentioned. I believe it is understood by most commentators

that zhang zhong jing was using the six channels in a different way than they

were used in the nei jing and this does not constitute a linkage between

herbology and acupuncture

 

I'm not sure who you refer to when you say " most commentators " . My information

is otherwise but I possibly wasn't clear as to what I meant by " acupuncture " . I

mean to describe the entire concept of meridians that is part of

(sophisticated?) acupuncture training. The relationship is not explicit but

implicit in the mode of thinking which prevailed at the time that the Shang Han

Lun was written. Basically, it all comes down to classical physiology (qi hua-

aka qi dynamic). The idea is that each of the six channels is responsible for

the integration of one or another of the six qi of the environment. This

concept is exactly the same for acupuncture and herbal medicine. It was just

the way that many doctors at that time understood the human body. For this

reason, an understanding of meridian theory is also important because it was

woven into the mind set of physicians in the 3rd century AD.

By the way, this is not just a trivial fact that should only be considered by

Shang Han Lun historians but can provide significant diagnostic clarity in the

modern clinic. In other words, knowing about how the authors of classical texts

understood acupuncture meridians (and thus physiology) is helpful for writing

formulas.

 

The same general line of thinking also applies to the channels to which various

herbs " home " (the channel they go to-gui jing).

 

respectfully,

 

Jason Robertson

 

 

 

 

 

 

 

 

Jason Robertson, L.Ac.

Ju Er Hu Tong 19 Hao Yuan 223 Shi

 

Beijing, Peoples Republic of China

 

home-86-010-8405-0531

cell- 86-010-13520155800

 

 

 

 

Free Pop-Up Blocker - Get it now

 

 

[Guest guest]

Dear Jason,

 

I am intreg by your coments and reconginse a seriouse sincer student

practitioner.

 

Can you please to some extent elaborate more on acumoxa?

 

Maybe present case histories?

 

Or do a on line course with CHA?

 

I sincerly would like to understand this aspect more.

 

Which books do you recomend in the English language of list if we have gone

through this many times before...

 

How often are people treated? as in frequency of treatment?

 

When I came to guatemala I had quite a bit of predejuice agianst acumoxa now

since there are no chinese medicinal avaliable here the acumoxa needs to be

higly developed.

 

Can I contact you of list?

 

How long are you in Bejing for?

 

If you go back to USA could you not make a slight detor and come to the

52:nd or 53:rd state of USA (albiet slightly under recognised as such and no

benefits) i.e. Guatemala:-)

 

Marco Bergh

[Guest guest]

Dear Jason,

 

Intresting so the book On cold damange is the a good start for us who do not

speak Chinese...

 

Is this relation ship about nature and man the " same2 as when some books

talk about wind - liver - wood, fire (in this case heat?) - Heart - Fire (as

in five phases?)

 

or is it Jue yin track-channel conducit wind which somohow would incoperate

pericardium aspect as well as liver aspects?

 

How are are the circulation tracts channels and collatorals seen interelated

to the five phases?

 

e.g. Shao yin circulation tract conducts which aspects of qi

dynamic-transformation are " most " created-process " there " and how is it

related to say water phase fire phase?

 

and which qi dynamics-transfromations are " created " " process " in the water

phase fire phase?

 

and how is this related to the kidney aspect and heart aspect and which qi

dynamics transformations are " created " " process " and related to this aspect?

 

and the " individual " channels kidney heart the same question?

 

Really intresting this type of acumoxa then gives me the impression to

trying to " catch " the change before and whilts it is happening?

 

Please do a on line course for with CHA:-)

 

write an article or thousands say for the journal of chinese medicne:-)

 

Marco Bergh inspired to study once more (I was going to be lazy and just

improve on my aftershave and smile as to improve my acumoxa skills, btw a

lot if not all acumoxa in guatemala at least the one I have seen is based on

showman ship and hence acumoxa is not contributing much either privetly or

publicly...)

 

 

 

By the way your explination is begining to make sense as why Unsculd

translate chanels and vessels?; as conducts; i was alwyas under the

impresion that the conduct was merly qi per say but this makes it diffrent;

would this not have ramification to practice qi gong?

 

-

" Jason Robertson " <kentuckyginseng

 

Friday, November 21, 2003 6:09 AM

Re: Re: Knowledge needed for APv CHM

 

 

> here are some thoughts about your recent response to my post:

>

>

> >>>>>>>>>in what part of the shanghanlun is the relationship between herbs

and acupuncture channels mentioned. I believe it is understood by most

commentators that zhang zhong jing was using the six channels in a different

way than they were used in the nei jing and this does not constitute a

linkage between herbology and acupuncture

>

> I'm not sure who you refer to when you say " most commentators " . My

information is otherwise but I possibly wasn't clear as to what I meant by

" acupuncture " . I mean to describe the entire concept of meridians that is

part of (sophisticated?) acupuncture training. The relationship is not

explicit but implicit in the mode of thinking which prevailed at the time

that the Shang Han Lun was written. Basically, it all comes down to

classical physiology (qi hua- aka qi dynamic). The idea is that each of the

six channels is responsible for the integration of one or another of the six

qi of the environment. This concept is exactly the same for acupuncture and

herbal medicine. It was just the way that many doctors at that time

understood the human body. For this reason, an understanding of meridian

theory is also important because it was woven into the mind set of

physicians in the 3rd century AD.

> By the way, this is not just a trivial fact that should only be considered

by Shang Han Lun historians but can provide significant diagnostic clarity

in the modern clinic. In other words, knowing about how the authors of

classical texts understood acupuncture meridians (and thus physiology) is

helpful for writing formulas.

>

> The same general line of thinking also applies to the channels to which

various herbs " home " (the channel they go to-gui jing).

>

> respectfully,

>

> Jason Robertson

>

>

Jason Robertson, L.Ac.

> Ju Er Hu Tong 19 Hao Yuan 223 Shi

>

> Beijing, Peoples Republic of China

>

> home-86-010-8405-0531

> cell- 86-010-13520155800

>

>

>

>

> Free Pop-Up Blocker - Get it now

>

>

[Guest guest]

" It has been personally frustrating to watch this whole discussion about the

importance of theory and technique in acupuncture play

out in the last week. In the past year here in Beijing I have seen over and

over and over again how an acupuncturist with a formiddable

command of classical Chinese medical theory in his brain consistently gets

significantly better results than other practitioners. "

 

Yes, but are his or her superior outcomes based A) on that knowledge or B) on

some other factor imparted by that knowledge, such

as confidence? That's what we are talking about. Conceivably, his or her

superior outcomes could be due more to the condifence the

practitioner has in him/herself due to this knowledge and the confidence the

status imparted by that knowledge inspires in his/her

patients.

 

Also, we are NOT talking about whether or not acupuncture can treat things more

or less effectively than other modalities. That is

categorically not the issue. I absolutely agree that acupuncture can treat many

conditions bettwe than either WM or Chinese herbal

medicine. I absolutely agree that acupuncture is a very powerful and mysterious

healing modality. The issue is whether or not Chinese

medical theory plays any part in those outcomes and, if so, what part. This is a

different issue altogether.

 

Let's try to stay " on point " here.

 

Bob

[Guest guest]

" Yes, but are his or her superior outcomes based A) on that knowledge or B)

on some other factor imparted by that knowledge, such as confidence? That's

what we are talking about. Conceivably, his or her superior outcomes could

be due more to the condifence the

practitioner has in him/herself due to this knowledge and the confidence

the status imparted by that knowledge inspires in his/her

patients. " Bob Flaws

 

So, in order to test this, you will need a group of confident practitioners

and a group of non-confident practitioners with the same knowledge. Is

this confidence in the ability to do the work or confidence in oneself as a

person? How to distinguish this? Will the practitioners self-identify in

this regard? " I have low self-esteem, therefore I should be in this

group? " This would doubtless be a very interesting study, though perhaps

demoralizing for all concerned. But it does raise another related issue:

what is bedside manner? Is confidence a necessary part of this? If one

has confidence as a practitioner (or a person), does this matter more to

the outcome than the actual techniques or theory employed? This latter

seems to be the implied question here. The answer to this might be rather

demoralizing too.

 

Pat

 

 

 

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[Guest guest]

A further confounding question is why a practitioner might, or might

not, be confident. A practitioner might not be confident precisely

because he had had bad clinical results, and a confident person

because she had. So, if you test one person's results against the

other, and confidence seems to be a relevant factor in outcomes, it

may simply indicate that the practitioner made a valid

self-assessment in the first instance. One would then have an entirely

new set of hypotheses to research...

 

Bob is posing questions that cannot be answered at the moment because

they require answers from research that hasn't been done.

 

The most basic issue, I feel, is that when you can't carefully control

variables, such as in double blind RCTs, you can't answer many

questions in a precise or satisfactory way. If it is true, as I think

most of us believe is the case, that a significant proportion of

acupuncture's efficacy has to do with factors besides the mere

insertion of needles in specific locations, then so many variables are

introduced that I don't think research can possibly determine

accurately what these variables are, or what their exact signficance is.

 

Wainwright

 

 

 

-

" Pat Ethridge " <pat.ethridge

 

Friday, November 21, 2003 5:23 PM

Re: Re: Knowledge needed for APv CHM

 

 

> " Yes, but are his or her superior outcomes based A) on that

knowledge or B)

> on some other factor imparted by that knowledge, such as confidence?

That's

> what we are talking about. Conceivably, his or her superior outcomes

could

> be due more to the condifence the

> practitioner has in him/herself due to this knowledge and the confidence

> the status imparted by that knowledge inspires in his/her

> patients. " Bob Flaws

>

> So, in order to test this, you will need a group of confident

practitioners

> and a group of non-confident practitioners with the same knowledge. Is

> this confidence in the ability to do the work or confidence in

oneself as a

> person? How to distinguish this? Will the practitioners

self-identify in

> this regard? " I have low self-esteem, therefore I should be in this

> group? " This would doubtless be a very interesting study, though

perhaps

> demoralizing for all concerned. But it does raise another related

issue:

> what is bedside manner? Is confidence a necessary part of this? If one

> has confidence as a practitioner (or a person), does this matter more to

> the outcome than the actual techniques or theory employed? This latter

> seems to be the implied question here. The answer to this might be

rather

> demoralizing too.

>

> Pat

[Guest guest]

The most basic issue, I feel, is that when you can't carefully control

variables, such as in double blind RCTs, you can't answer many

questions in a precise or satisfactory way. If it is true, as I think

most of us believe is the case, that a significant proportion of

acupuncture's efficacy has to do with factors besides the mere

insertion of needles in specific locations, then so many variables are

introduced that I don't think research can possibly determine

accurately what these variables are, or what their exact signficance is.

>>>Again here we get into magnitude of effects. If the results are so close that

these effects are making the difference than I think most of the time you can

consider the active treatment a failure

Alon

 

 

[Guest guest]

On Nov 21, 2003, at 10:25 AM, wainwrightchurchill wrote:

 

> A further confounding question is why a practitioner might, or might

> not, be confident. A practitioner might not be confident precisely

> because he had had bad clinical results, and a confident person

> because she had.

 

Yeah, this is an issue for me. I am slow to claim success in my

clinical experiences while others around me need only the fist hint of

improvement before they proclaim that they've cured the patient. So,

while I may actually get patients better, the one who has much lower

requirements for personal assessment will feel more successful and

probably attract more patients for this reason.

 

Sort of a problem for the growth of a practice to be kind of

skeptical...

 

--

 

Pain is inevitable, suffering is optional.

-Adlai Stevenson

[Guest guest]

Yeah, this is an issue for me. I am slow to claim success in my

clinical experiences while others around me need only the fist hint of

improvement before they proclaim that they've cured the patient. So,

while I may actually get patients better, the one who has much lower

requirements for personal assessment will feel more successful and

probably attract more patients for this reason.

 

Sort of a problem for the growth of a practice to be kind of

skeptical...

>>>>>Good for you and yes you may loose some people but not your integrity

Alon

 

 

[Guest guest]

Bob,

 

If you don't mind, I'd like to cast a scientifically sceptical gaze at

your email.

 

 

<<[Jason] " >> " It has been personally frustrating to watch this whole

discussion about the importance of theory and technique in acupuncture

play

out in the last week. In the past year here in Beijing I have seen

over and over and over again how an acupuncturist with a formiddable

command of classical Chinese medical theory in his brain consistently

gets significantly better results than other practitioners.>>

 

I'll note that a scientist would question whether Jason's formidable

acupuncturist was getting these signficantly better results. But,

provisionally, let's assume that this acupuncturist does get better

results than a normal acupuncturist.

 

<< [bob]Yes, but are his or her superior outcomes based A) on that

knowledge or B) on some other factor imparted by that knowledge, such

as confidence? That's what we are talking about. Conceivably, his or

her superior outcomes could be due more to the condifence the

practitioner has in him/herself due to this knowledge and the

confidence the status imparted by that knowledge inspires in his/her

patients.>>

 

a) Is this a reasonable question? Why aren't outcomes satisfactory in

their own right?

b) Assuming that it is desirable to understand the reason for

outcomes, do you think that it is possible to arrive at such answers

in any rigorous way, such as scientifically? If so, how would one go

about doing so?

 

<<Also, we are NOT talking about whether or not acupuncture can treat

things more or less effectively than other modalities. That is

categorically not the issue.>>

 

OK, let's assume that this conversation is based on this understanding.

 

<<[bob] I absolutely agree that acupuncture can treat many conditions

bettwe than either WM or Chinese herbal

medicine>>

c) What is the basis of this assertion?

 

<<[bob] I absolutely agree that acupuncture is a very powerful and

mysterious healing modality.>>

 

Presumably, by powerful, you mean efficacious, so question c) is

relevant - what is the basis of your assertion?

d) What do you mean when you say that acupuncture is a mysterious

healing modality? If this seems too personal a question, it can be

ignored.

 

<<[bob] The issue is whether or not Chinese medical theory plays any

part in those outcomes and, if so, what part. This is a different

issue altogether.>>

 

If this is the issue, and for many scientists, this question would

only become relevant once the efficacy of acupuncture had been

determined, then the question is:

e) how are we to determine this?

 

I'm asking these questions so that we can develop this theme, by

considering more deeply points that have already been raised.

 

Best wishes,

Wainwright

[Guest guest]

someone wrote:

> " It has been personally frustrating to watch this whole discussion about the

importance of theory and technique in acupuncture play

> out in the last week. In the past year here in Beijing I have seen over and

over and over again how an acupuncturist with a formiddable

> command of classical Chinese medical theory in his brain consistently gets

significantly better results than other practitioners. "

 

I don't know who wrote this, but this type of anecdote proves nothing. Alon

has told us that some of the most " classical " docs he watched in China got

terrible results when long term followup was done. Research shows that

allopathic style acupuncture also works. And despite the misnomer of

japanese acupuncture, the predominant style in that country is what would be

called medical acupucnture here. And I have heard plenty of worsleyites say

that anything but their style just causes illness despite any appearance of

success. Who's right. Only research will tell and I suspect research would

prove Bob Flaws right.

 

My anecdote is that for better or worse I have long been exposed to patients

who were regularly treated by experts in many other styles than my own. I

can say unequivocally after 17 years of such observation since my student

days at NCNM that any style in the hands of a confident expert is as good as

any other. I wonder how many of those who are saying classical acupuncture

works best have spent much time in clinics where classical acupuncture was

done side by side with TCM and worsely and orthopedic styles. I know Alon

will tell you that orthopedics is essential in his practice. If you have not

observed thousands of cases of differing styles in the same setting, upon what

basis does one make this judgement? Affection? allegiance?

 

 

[Guest guest]

Terms such as 'anecdotal' are used regularly in the biomedical arena to

dismiss anything that doesn't fall under their radar. This is the

game that the biomedical world plays, and I don't think we need to do

this here. I also find it dismissive when individuals such as Paul

Unschuld are described as an anthropologist, a profession which 'no

hard scientist respects.' Are we hard scientists now? Do we need to

be?

 

I've seen terms such as 'orientalist', fundamentalist, demagogue,

speculative, and anecdotal used on this list to dismiss what I feel are

valuable experiences of various practitioners. If this continues on

CHA, these people will be less and less likely to share their valuable

experiences and thoughts.

 

I am much more interested in the experiences of an individual who

practices Chinese medicine, what they observe, and what they feel than

the results of research data which has not even happened yet. I don't

think this is a reason to shut people down. I see this happening more

and more on the CHA. The experience of individuals is regularly being

discounted, and this is to the detriment of our group.

 

You also say you expect the research to confirm your point of view.

But the research hasn't been done, so how could you know? Experience?

Intuition?

 

I have no problem with anyone who is skilled and trained in other

styles of acupuncture. I refer, for example several musculoskeletal

cases to a colleague here in town who specializes in an osteopathic

style.

 

However, there is a skill set for acupuncture, and I think we are

shooting ourselves in the proverbial foot by suggesting that research

that hasn't even been designed yet will somehow confirm that one

hundred hour training is enough.

 

 

On Nov 21, 2003, at 1:46 PM, wrote:

 

> I don't know who wrote this, but this type of anecdote proves nothing.

> Alon

> has told us that some of the most " classical " docs he watched in China

> got

> terrible results when long term followup was done. Research shows that

> allopathic style acupuncture also works.

[Guest guest]

Z'ev,

 

" The experience of individuals is regularly being discounted, and this is to the

detriment of our group. "

 

Individual experience is NOT a sufficient criteria for making certain claims or

judgements of a general or universal nature. It is and

must remain just that, individual. Certain types of evidence are generally

believed adequate or inadequate to prove or disprove

assertions affecting more than a given individual. You can personally accept any

criteria you want when deciding what you personally

want to believe, but please do not obscure the fact that there are standards of

RATIONAL discourse among groups.

 

By arguing about contemporary RCT design, statistics, mainstream science, and

the like, we must be careful not throw the baby out

with the bathwater. No conceptual system is perfect. However, if one treads the

middle path, one can use an imperfect tool to achieve

certain limited but, nonetheless, valuable ends. When arguing about such things,

it is important to stay within the parameters of a

particular discussion. To jump levels or throw in a red herring does no good and

may do great harm. If I personally have criticized any

respondents to this list, it has been prompted by what I saw as irrational

thinking -- mostly jumping levels and throwing in red herrings.

Logic is still logic. If one decides that logic is not useful and that they

choose to act based on something other than logic, that's also

ok with me. But I think it's important for all to recognize that such a willful

act has occurred.

 

" You also say you expect the research to confirm your point of view. But the

research hasn't been done, so how could you know?

Experience? "

 

We don't know, but we (meaning myself, and Alon) do have enough experience

to suggest that this would be a good line of

research. Perhaps you've never been involved in research. Typically, anecdotal

evidence builds to a certain point where it suggests a

certain line of more objective research, research designed to validate

generalizations. Anecdotal evidence has its place in a graduated

series of reasonable criteria for proof. The only problem with anecdotal

evidence or individual experience is when one tries to use it in a

way to justify something that it is not suited to justify.

 

" However, there is a skill set for acupuncture "

 

Yes, certainly I agree that we SAY there is. But we have never objectively

ascertained the actual clinical importance of this skill set.

 

" I think we are shooting ourselves in the proverbial foot by suggesting that

research that hasn't even been designed yet will somehow

confirm that one hundred hour training is enough. "

 

Ah, now I think we're getting to the heart of the matter: fear of shooting

ourselves in the foot. Personally, I think your problems with

this discussion have mostly to do with fear. Fear about what might happen if

such research did not validate the necessity of our

current skill set. As a bread-winner teaching that skill set, I can completely

understand such fear. I have no problem with a person

saying to me that they don't want to go somewhere, either physically or

intellectually, because of fear. Fear is a hugely powerful

emotion, and I think fear requires being handled with great respect. But I also

think it is very salutory to know that one's real reason for

doing or not doing something is fear as opposed to the rational arguments they

initially were using to camouflage that fear.

 

Bob

[Guest guest]

, " " <zrosenbe@s...>

wrote:

> The CHA group does not follow certain criteria for a user's group, one

> of which is that the moderator moderates divergent points of view and

> makes room for them. If only one view is seen as correct, then

> divergent views to that view automatically are invalid. The tone of

> CHA has been perceived by several individuals, not just myself, as

> recently being biased and not open to divergent points of view on such

> subjects as research, the work of Paul Unschuld, or the validity of the

> ideas and work of certain individuals who are members of the group.

> This means that CHA is, at the present time, not an open forum for all

> individual members.

>

Sounds like there can be no accountability to things stated in a public forum,

no criticism. " It's all good. "

 

> I was never aware of the criteria you mention in your post as being a

> standard for the discussions taking place on this list.

> >

 

No one said there are standards for posting ON THIS LIST. But there are

standards of reasoning and standards of proof.

 

Bob

[Guest guest]

Jason,

 

I still don't think you get what the issue is. Are superior results in clinic

the direct result of the application of theory or an indirect result

of other factors derived from possessing more theory? So far, you have not

presented any proof of the first assertion. I'm not arguing

with your assertion. I'm arguing with the lack of proof of your assertion. Those

are different things.

 

Bob

[Guest guest]

The tone of

> > CHA has been perceived by several individuals, not just myself, as

> > recently being biased and not open to divergent points of view on such

> > subjects as research, the work of Paul Unschuld, or the validity of the

> > ideas and work of certain individuals who are members of the group.

 

> > This means that CHA is, at the present time, not an open forum for all

> > individual members.

 

I am sorry you feel that way and its ironic as the list has been clearly

dominated for months by those with such " divergent " points of view.

Perception' s a funny thing. I guess it all about who you like again. some get

a pass. Well the majority here perceives these " certain individuals " as rude

and arrogant and as Paul said, let them write a book and get some followers.

But until then, they are outsiders and never belonged here in the first place. A

forum such as this is only " open " to those who meet the membership criteria. I

mistakenly allowed certain unqualified friends of members to join the group

and that was a mistake that will never happen again. It has taken me a long

time to rectify this and I have lost friends as a result, but luckily my life is

full

and happy and the good of america's healthcare is far more important to me

than any of this tripe.

 

[Guest guest]

Bob

 

 

 

Once again, thanks for responding. I want you to know that I also share your

sense that somehow a point is being missed in the vagaries that arise from this

form of communication. I do suspect however that you did not completely follow

my previous two posts- I am somehow not making myself clear. Basically, I

thought that I had provided at least some form of proof to my assertion that

there is a need for theory and technique in order to achieve superior

acupuncture results. In the next few days, I will not be providing the results

of a double blind clinical trial but I hope that you will consider the

following:

 

 

 

Of course I understand that you’re trying to ask me how one can know with

absolute certainty that theory and technique are necessary prerequisites for the

practice of superior acupuncture. You contend that it is equally likely that

some other non-defined action is at work that produces the results that (we both

agree) arise when needles are placed in a human body. I agree that this is an

interesting proposition but, respectfully, believe that you are going down a

track that has been followed repeatedly by Chinese practitioners of Taoist

acupuncture styles, Ba-Gua acupuncture chronoacupuncture and various other

traditions that you yourself have already dismissed in previous posts. In

other words, you are observing that there is something going on during an

acupuncture treatment but are somehow placing the reason for those effects

outside the realm of the physically palpable meridians. By “palpable” I mean

meridian pathways on the surface of the body that can be felt by one person

and then shown to another person who can feel the same thing- nodules,

thickening of the skin, tenderness etc. In my opinion, this line of thinking

seems to re-surface over and over in Chinese acupuncture traditions and recent

questions posed by westerners are simply more of the same.

 

 

 

By focusing now on the point that I’m trying to make, our entire discussion can

stay within the realm of the real instead of deviating into your opinion verses

mine (or, in this case, the opinion of a doctor here in Beijing with much more

experience with acupuncture than either you or I). If you are willing to

concede that you still may have something to learn on the subject, you may want

to continue reading. If not, we may just have to agree to disagree on this

subject and move on.

 

 

 

I have spoken with Dr. Wang Ju Yi here in Beijing and have posed your question

to him. I hope that you will also concede to me that thoughts of this nature

have occurred to him as well. He spent 6 of his semi-retired years as editor of

the Journal of the Academy of Traditional and was very

unforgiving of authors he accused of sloppy thinking. Here is how he thinks

about the question that you posed:

 

 

 

1) Yes, there is something going on during an acupuncture treatment that cannot

be fully explained by acupuncture theory and technique alone. He defines that

variable as depending on the ability of the practitioner to focus the heart (ju

xin). You referred to it as confidence and he conceded that it might be an

acceptable way of putting it- he doesn’t speak English so I translated the term

as xin-4 ren-4.

 

 

 

2) The combination of zang-fu theory and meridian theory with meridian palpation

provides a powerful diagnostic tool for coming up with the most likely affected

meridian in a particular patient.

 

 

 

3) Following the selection of the most likely affected meridian, further

consideration of the effects on qi dynamic (qi hua) of the various points will

guide one to appropriate point selection. These considerations should always be

tempered with the results of palpation. In other words, palpable change along

the course of a meridian that has been determined to be a suspect after the

previous steps indicates a likely acupuncture point.

 

 

 

4) Technique is valuable for getting proper qi sensation- radiation which, in

his mind at least, is very closely connected to the clinical effectiveness of

his treatment.

 

 

 

5) A focused heart (aka confidence) is an important part of technique but cannot

completely replace a strong command of the physiological principles alluded to

above.

 

 

 

He bases this opinion on his observation of many other acupuncturists and his

own patients over 42 years of near-constant clinical experience. It is not a

double-blind clinical study with all variables removed but, I would argue, does

provide some interesting food for thought. Assuming that you don’t think that

I’m a stark raving lunatic (which you very well may) or that I’m making the

whole thing up, I think that you must respond to these particular points.

Otherwise, we don’t really have a debate on our hands but instead a situation

where you are just disagreeing until I either agree that you are right or give

up in frustration.

 

 

 

I say all of this with the most friendly demeanor and mean only to hear your

thoughts on a subject which I think merits reconsideration on your part. My

offer to show you what I’m talking about here in Beijing stands if you should

ever find yourself in the Big Smoke.

 

 

 

Respectfully,

 

Jason Robertson

 

 

 

 

 

 

Jason Robertson, L.Ac.

Ju Er Hu Tong 19 Hao Yuan 223 Shi

 

Beijing, Peoples Republic of China

 

home-86-010-8405-0531

cell- 86-010-13520155800

 

 

 

 

Free Pop-Up Blocker - Get it now

 

 

[Guest guest]

These considerations should always be tempered with the results of

palpation. In other words, palpable change along the course of a meridian

that has been determined to be a suspect after the previous steps indicates

a likely acupuncture point.

 

>>>>Jason i am glad to see palpation being discussed. Unfortunately i have

seen to many TCM acup in both china and US basically use theory alone to

choose points and techniques. To me that is not acup

Alon

[Guest guest]

Jason,

 

" In other words, you are observing that there is something going on during an

acupuncture treatment but are somehow placing the

reason for those effects outside the realm of the physically palpable

meridians. "

 

I'm not placing anything anywhere. I'm just saying that no one has ever

conclusively demonstrated that doing acupuncture according

to Chinese medical theory achieves better clinical outcomes than other

approaches, whatever they may be. Since I no longer practice

acupuncture, I have no great personal investment in this. I do not have any

definite ideas about how acupuncture works, nor am I a

proponent of some other, non-Chinese approach.

 

" By 'palpable' I mean meridian pathways on the surface of the body that can be

felt by one person and then shown to another person

who can feel the same thing- nodules, thickening of the skin, tenderness etc.

In my opinion, this line of thinking seems to re-surface

over and over in Chinese acupuncture traditions and recent questions posed by

Westerners are simply more of the same. "

 

I agree that you can " make a case " for the existence of some of the main

channels. However, there is no universal agreement on this,

with different authorities claiming the existence of different channels, both in

trajectory and number, viz. Zen shiatsu and Jin Shi

Jyutsu. Or are we simply going to discount anything held by " little brown

dwarves? " (For those unfamiliar with Chinese slang, this is

not my term or my belief. Jason knows what I'm talking about here.)

 

" He defines that variable as depending on the ability of the practitioner to

focus the heart (ju xin). "

 

Likely a student or colleague of Wang Le-ting given that you are both in

Beijing.

 

" The combination of zang-fu theory and meridian theory with meridian palpation

provides a powerful diagnostic tool for coming up

with the most likely affected meridian in a particular patient...

 

" Following the selection of the most likely affected meridian, further

consideration of the effects on qi dynamic (qi hua) of the

various points will guide one to appropriate point selection. These

considerations should always be tempered with the results of

palpation. In other words, palpable change along the course of a meridian that

has been determined to be a suspect after the

previous steps indicates a likely acupuncture point. "

 

Sorry, I don't see this as any type of " objective proof, " and objective proof is

what I, Alon, and Todd have been suggesting is

necessary. Worselyans would say the proof is the change felt in the pulse

according to Nan Jing style pulse reading. Others would

say the proof is in the applied kinesiology or muscle-testing. Otheres would say

the proof is in the change in Kirlian aura picture.

Yet others would say the proof is in the change in reading of their Reichian

black box, et.c, et.c, etc. We would need to come up with

some way of blinding the person doing the acupuncture and the person doing the

outcomes assessment before we can determine

conclusively if A is producing B.

 

" Technique is valuable for getting proper qi sensation- radiation which, in his

mind at least, is very closely connected to the clinical

effectiveness of his treatment. "

 

A widely held Chinese belief. I have heard this many times in China from many

different Chinese, many of whom espoused his or her

own technique. However, this is not supported by clinical practice in much of

the rest of the world as anyone who has observed

acupuncture in N. America, Europe, Japan, or Australia, NZ can tell you. If so,

then you are saying that many whole schools of

non-Chinese acupuncture are ineffective or at least less effective. Again,

Alon, and I are suggesting that some sort of objective

study would need to be done in order to prove the relative importance of de qi

to outcomes. Chinese studies seemingly attempting to

prove this have not been blinded and, therefore, have not filtered out other

potential factors. That's why those studies are not deemed

conclusive.

 

" A focused heart (aka confidence) is an important part of technique but cannot

completely replace a strong command of the

physiological principles alluded to above. "

 

That's an opinion. That's not been proven. And, frankly, I've seen just the

opposite. I once shared an office for a year or more with a

very incompletely trained naturopath who got great results from her acupuncture

because of her immense confidence even when she

was all wrong according to standard Chinese teachings and practices. I

constantly used to shake my head in disbelief at our staff

meetings and case presentations, but she got exceptionally good results.

 

" He bases this opinion on his observation of many other acupuncturists and his

own patients over 42 years of near-constant clinical

experience. It is not a double-blind clinical study with all variables removed

but, I would argue, does provide some interesting food for

thought. "

 

It only provides anecdotal evidence, with all the problems of culture-bound,

anecdotal evidence. It suggests that there's a reasonable

line of research that could be done, but that is all. It does not present

objective proof (and there is such a thing as relatively objective

proof in the realm of relative reality). If you spend time in the U.S., Europe,

Australia-NZ, you will see that many, many other

practitioners are getting as good results with acupuncture using contradictory

theories and techniques based on their own deeply held

beliefs. Nothing that you have said takes that into account. Having studied in

China myself on several occasions over a period of

years, I came back convinced on the superiority of what I saw and experienced

there. However, years later and much more experience

of every kind, I am no longer so impressed and am much more open to other

possibilities.

 

Miriam Lee and Wang Le-ting, both Chinese practitioners, advocated twisting the

needles in different directions after obtaining the qi in

order to supplement and drain. However, they advocated diametrically opposed

methods of directional twisting. Logically, if such a

technique actually was objectively important, we would expect one to have gotten

better clinical results than theother. However, both

were in practice for more than 40 years and both were famous for the success of

their outcomes.

 

I have shared with this list before my experiences with an old practitioner in

Loveland, CO. This man had more than 40 years clinical

experience when I met him. He was very highly regarded in his community as a

healer. I watched him in clinic a number of times and

can tell you that his patients did seem to get better from my perspective. The

man said that he had originally studied acupuncture in

Shanghai during the Second World War in Shanghai (I knew him in the 1980s). This

practitioner diagnosed his patients by feeling the

patients' channels from above the surface of the skin. He did not use the

channels in CAM. He did not use the tongue or pulse. He

tried to teach a friend how feel and needle the channels he felt, but, after six

months of trying, my friend could still not feel what the

old doc was feeling. Can you see the procedural problems with trying to assert

the validity of this approach? That's all I'ever been

trying to get at.

 

If and when I do do acupuncture, I do it the way I was taught in Shanghai. My

guess is that Todd also does it a la a modified Chinese

style; I don't know. However, many Western practitioners with study in China,

such as Dan Bensky and Chip Chace, do it according

to Japanese style and get very good results.

 

" My offer to show you what I'm talking about here in Beijing stands if you

should ever find yourself in the Big Smoke. "

 

Thanks. At this point in my life, I doubt if I'll be taking you up on it, but

you never know. However, the same offer stands if you ever find

yourself in Lafayette, CO.

 

Also respectfully,

 

Bob