the role of branch treatment

[Guest guest]

Colleagues

 

As we all know, in crafting an herbal treatment strategy, one must consider

the relative emphasis on root versus branch. In order to do this, we must

be clear about the terms. Wiseman in the PD uses root and tip for biao ben.

His definition which essentially comes from the zhong yi da ci dian

(grand dictionary of chinese medicine) is contextual.

 

the cause of the disease is the root; the observable changes are the tip:

this could mean the root is any pattern (excess or deficient or hot or cold)

and the tip is the patients complaints (symptoms)

 

or

 

the imbalance of the zheng (correct/right) qi is the root, while evil is

the tip: this could mean any pattern of deficiency that led to an excess

such as spleen xu damp

 

or

 

the primary condition is the root and the secondary condition caused by the

primary is the tip: this could mean any pattern that comes first (whether

excess, deficient, hot or cold) could be considered the root and the

secondary pattern caused by the primary pattern (whether excess, deficient,

hot or cold) the tip: this could mean dampheat is the root and yin xu the

branch or spleen xu is the root and dampheat and/or yin xu the branch

 

As Brian Allen will tell you, these contextual differences lead to

difficulty in writing exam questions. So as an aside to teachers, one

should very clearly state to students in what context one is using root and

tip each time one uses these terms.

 

The context in which I am using these terms here is the first, in which the

branch I refer to is the patient's perceived source of suffering, such as

cough or bleeding (as opposed to the doctor's labeling of a pattern or

pathomechanism explaining those symptoms).

 

I believe such branch treatment is actually underaddressed in the american

practice of herbology. while it is perhaps overaddressed in the practice

of acupuncture, especially pain management. In fact, many people may

believe that herbs are most effective for root treatment like spleen or

kidney xu or liver qi depression. While acupuncture yields the most

benefit in acute symptom relief. I believe this is largely because people

have utilized relatively low dose patent medicines for much of their herbal

treatments. In fact, chinese herbal medicine was most well known for much

of the past for its effectiveness in acute complaints, a theme that

underlies Liu's warm diseases book. However, as even patent advocates like

Will Maclean have noted, dosage is the key to the effective use of patents

in acute illness or severe symptoms. Will, I believe, would in fact agree

that decoction is the best way to deliver the high dosages necessary in

very severe symptoms. However as both of us agreed, there are equivalent

ways to deliver high enough doses (for example, powdered extracts like KPC

or extract capsules like BP). So the questions are how important is branch

treatment and how to accomplish it effectively.

 

1. daily reinforcement of sx relief cannot be accomplished with the

american acupuncture system of 1/week tx.

 

2. compliance with therapy over the long haul for most patients demands

rapid symptom relief at the outset. treating the branch insures patients

will stick around to have the root rectified as well

 

3. relief of suffering is my main job. it is not to teach or philosophize

or psychoanalyze my patients. Certainly in the long run, some or all of

that may be necessary from me or others, but at the outset, suffering alone

is my focus. I do not believe CHM will ever make much headway in the

mainstream if we ignore this essential motivation of patients - to feel

relief now. Once you demonstrate the power of CM, patients will stick

around to learn how to live, etc. Most of our patients are not that

openminded to begin with or perhaps my role in a conservative city in a

college clinic gives me a slice of life that I did not see when I was in

elite private practice.

 

4. But even more critical from our professional perspective is the drain

on the root by the branch. It is very hard for the root to recover when

certain branch sx are prominent:

 

a. how does one recover one's qi and blood without stopping bleeding first?

 

b. how does one recover one's lung qi without stopping cough first?

 

c. how does one recover their yin and blood while diarrhea persists

 

d. how does one clear dampheat while constipation binds?

 

e. how does the patient gain the motivation to heal while they suffer

intensely

 

While I find acupuncture to bring palliative relief in all these cases

under some circumstances, I find the effects short lived in chronic

conditions. While I will not reject that acupuncture alone could possibly

" heal " some of these chronic conditions over time, I am merely talking here

about whether a weekly acupuncture treatment would typically give enough

round the clock symptoms relief for acute or severe symptoms in a way that

would satisfy my 4 criteria above. I will not speak for those who may have

skills in this area superior to myself, but I would have to give an

unequivocal no to this question. I do not believe weekly acupuncture would

be sufficient in many acute cases to either give the degree or duration of

relief I feel necessary to both relieve the patient's suffering, but also

protect their roots. thus using herbs to address the branch right from the

outset is essential. In some cases, the branch treatment should be the

sole heavily emphasized treatment. In others, it should be part of a

carefully crafted complex of strategies.

 

I personally use raw herbs for such complaints and I believe my relatively

high rate of compliance with my patients on raw herbs is due largely to my

insuring the branch is always adequately addressed at the outset. However

I have used very high doses of seven forests products in the past with

decent results in severe symptoms. Jim mentioned he saw no way that a

large number of tablets would be digested, however according to seven

forests, their tablets are tested for dissolution rates. In addition, the

chinese certainly used doses like 27 grams a day of liu wei di huang wan in

pills (that would be 54 500 mg tabs, BTW). I have also been happy with

high doses of KPC powders in treating branch sx.

 

 

 

Chinese Herbs

 

 

" Great spirits have always found violent opposition from mediocre minds " --

Albert Einstein

 

 

 

[Guest guest]

,

wrote:

> I have also been happy with

> high doses of KPC powders in treating branch sx.

>

>

 

 

 

Remind me, what you would consider an average dose vs high dose of

powdered extract (KPC, etc)? 10g vs 20g? More?

 

robert hayden

[Guest guest]

<<< 1. daily reinforcement of sx relief cannot be accomplished with

the american acupuncture system of 1/week tx. >>>

 

The issue of cost aside, that's why, in many cases, we do it several

times weekly. In acupuncture, symptom relief can be immediately and

last an indefinite time. The next treatment is scheduled according

to the patient's sense of relief from symptoms or the pulses.

 

Giving an herbal formula once a week would probably have the same

consequence of not being able to handle Sx relief.

 

 

<<< 3. relief of suffering is my main job. it is not to teach or

philosophize or psychoanalyze my patients. >>>

 

When their suffering begins with or is rooted in emotional issues,

it becomes your job. If not to psychoanalyse them, at least to draw

their attention to it and direct them to help if they need it. For

example, yesterday I interviewed a patient who has suffered from

insomnia for the last 14 years. Pharmaceuticals and supplements

sometimes helped, but would they finally be ineffective after a

while---interestingly at any dose.

 

From examining his pulses, it was apparent that within the span of a

year---14 or so years ago---a very bad breakup of a personal

realtionship, the death of his father, and having to move his aged

mother closer had combined to create the emotional/physical trauma

that was at root of his problem. It was clear that those emotional

states caused the kidney xu, liver depression, and blockage from

liver to heart. And, because that emotional trauma had never been

fully resolved (they were still evident in the pulses), he did not

recover organically either. From WM's point of view, there are no

separate networks in the brain and nervous system nor any separate

neurotransmitters for emotions. Psyche and soma are two sides of the

same coin both in CM and WM.

 

 

<<< I do not believe CHM will ever make much headway in the

mainstream if we ignore this essential motivation of patients - to

feel relief now. >>>

 

Agreed.

 

 

 

<<< 4. But even more critical from our professional perspective is

the drain on the root by the branch. It is very hard for the root to

recover when certain branch sx are prominent:

a. how does one recover one's qi and blood without stopping bleeding

first?

b. how does one recover one's lung qi without stopping cough first?

c. how does one recover their yin and blood while diarrhea persists

d. how does one clear dampheat while constipation binds?

e. how does the patient gain the motivation to heal while they suffer

intensely >>>

 

Excellent points.

 

 

<<< While I find acupuncture to bring palliative relief in all these

cases under some circumstances, I find the effects short lived in

chronic conditions. While I will not reject that acupuncture alone

could possibly " heal " some of these chronic conditions over time, I

am merely talking here about whether a weekly acupuncture treatment

would typically give enough round the clock symptoms relief for

acute or severe symptoms in a way that would satisfy my 4 criteria

above. I will not speak for those who may have skills in this area

superior to myself, but I would have to give an unequivocal no to

this question. I do not believe weekly acupuncture would be

sufficient in many acute cases to either give the degree or duration

of relief I feel necessary to both relieve the patient's suffering,

but also protect their roots. >>>

 

Don't handicap acupuncture from the start. You may argue cost and

compliance, but not effectiveness simply because your argument

restricts its use. For example, I often offer more than one

treatment a week and discount the cost for someone that is expected

to come for an indefinite time---for example, cancer patients. It

makes it financially possible for their long term care, and it makes

my job easier when dealing with their changing critical condition.

 

 

<<< Jim mentioned he saw no way that a large number of tablets would

be digested, however according to seven forests, their tablets are

tested for dissolution rates. In addition, the chinese certainly

used doses like 27 grams a day of liu wei di huang wan in pills

(that would be 54 500 mg tabs, BTW). I have also been happy with

high doses of KPC powders in treating branch sx.>>>

 

I simply asked a question, but the implication was certainly there

about a patient's digestive tract being able to absorb that amount

of herbal formula.

 

 

Jim Ramholz

[Guest guest]

>

>

>

 

 

12-15

[Guest guest]

, " James Ramholz " <jramholz>

wrote:

> <<< 1. daily reinforcement of sx relief cannot be accomplished with

> the american acupuncture system of 1/week tx. >>>

>

I think we can but it takes a lot longer... so really it is less cost effective

for the

patient. I point this out and they come back that second or third time that

week.

>

 

On this point of branch and root, I think it is implicit that by removing the

branch the

" root " often resolves. Basically in all of these examples the root may

re-establish

when the branch is taken care of. This is assuming that the patient will not

further

abuse the body with food or drink or lifestyle. For example, in constipation was

the

damp heat the outcome or the cause? Was the Cough causing the lung qi xu or vice

versa?

doug

 

 

> <<< 4. But even more critical from our professional perspective is

> the drain on the root by the branch. It is very hard for the root to

> recover when certain branch sx are prominent:

> a. how does one recover one's qi and blood without stopping bleeding

> first?

> b. how does one recover one's lung qi without stopping cough first?

> c. how does one recover their yin and blood while diarrhea persists

> d. how does one clear dampheat while constipation binds?

> e. how does the patient gain the motivation to heal while they suffer

> intensely >>>

>

> Excellent points.

>

[Guest guest]

I think it is not only a legitimate strategy to treat the branch, but

it is crucial in serving our patients well. Fortunately we can often

deal with both the root and the branch simultaneously. It is

interesting for me, teaching herbs at a 5-elem school. I said in the

last class- we have permission to fix stuff. Bronchitis this week.

existential issues next week.

But irreverance aside, it is important to triage the symptoms that a

patient presents: we can prioritize acute symptoms. but we can never

ignore constitutional patterns.

 

That said: we can stop cough and consolidate the lung qi in one

formula: they are not mutually exclusive

 

we can stop bleeding and address qi and blood deficiency in one formula

 

we can clear damp-heat even in the presence of constipation ( remember

the endless da huang discussion?)

 

we can convey compassion for suffering and motivation for moving

forward in one breath. we can relieve suffering in the face of our own

suffering as well.

 

with warm regards and a happy thanksgiving to all

Cara

 

On Wednesday, November 26, 2003, at 04:44 PM, wrote:

 

>

>

> > a. how does one recover one's qi and blood without stopping bleeding

> > first?

> > b. how does one recover one's lung qi without stopping cough first?

> > c. how does one recover their yin and blood while diarrhea persists

> > d. how does one clear dampheat while constipation binds?

> > e. how does the patient gain the motivation to heal while they suffer

> > intensely >>>

> >

> > Excellent points.

> >

>

>

<image.tiff>

>

>

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> healthcare practitioners, matriculated students and postgraduate

> academics specializing in Chinese Herbal Medicine, provides a variety

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>

[Guest guest]

I believe such branch treatment is actually underaddressed in the american

practice of herbology.

>>>>I strongly agree. Also may in the purging school for example see deficiency

as secondary to excesses that drain zhong qi.

Alon

 

 

[Guest guest]

, " "

wrote:

I think it is implicit that by removing the branch the

> " root " often resolves. Basically in all of these examples the root may re-

establish

> when the branch is taken care of.

 

I do not agree. when the vacuity is pronounced and chronic, I do not think

merely clearing the excess is sufficient to have the vacuity disappear. If this

were true, we would not age if we lived a clean lifestyle. So sometimes

vacuity requires herbs or the correct will never be restored, IMO.

 

[Guest guest]

, Cara Frank <herbbabe@e...>

wrote:

 

>

> That said: we can stop cough and consolidate the lung qi in one

> formula: they are not mutually exclusive

>

> we can stop bleeding and address qi and blood deficiency in one formula

>

> we can clear damp-heat even in the presence of constipation ( remember

> the endless da huang discussion?)

 

I agree with all of this. It was not that we should not address the root in the

same rx, just that we should not ignore the branch.

 

[Guest guest]

Of course, when the depletion is pronounced and chronic a branch treatment will

not

be adaquate. However treating the branch may (that's may) clear the root in

other

cases.

doug

 

, " " wrote:

> , " "

> wrote:

> I think it is implicit that by removing the branch the

> > " root " often resolves. Basically in all of these examples the root may re-

> establish

> > when the branch is taken care of.

>

> I do not agree. when the vacuity is pronounced and chronic, I do not think

> merely clearing the excess is sufficient to have the vacuity disappear. If

this

> were true, we would not age if we lived a clean lifestyle. So sometimes

> vacuity requires herbs or the correct will never be restored, IMO.

>