Guest guest Posted November 30, 2003 Report Share Posted November 30, 2003 , " " wrote: > I'm not optimist that the answers are out there. Isn't this what TCM was s= > upposed to > dispel...the confusion? And yes, we are all looking for a coherent way to p= > ractice the > medicine and any additional information would be helpful. an important point to consider and why I see a simultaneous need for both standards and classical study. People are practicing now. We cannot wait until Unschuld completes his nei jing in order to practice. So there are two sets of goals here. Short term and longterm- both worthy, I think. I think we all look forward to what the scholars will provide to us in the next few decades, esp. PU. More below in reply to Jason. > > > , Jason Robertson > <kentuckyginseng> wrote: > > clinical reality cannot be so neatly summarized. Jason, finally onto this. I completely agree. consider the triad used for diagnosing kidney yang xu of decreased libido, low back pain and cold hands and feet. while. IMO, this is likely to be kidney yang xu, it could also be all due to liver qi depression in some conceptions of this pattern. I see Sionneau lists liver qi depression as patterns for the first two, while the cold limbs is attributed regularly to si ni san patterns in some circles. If this was the case for a particular patient who was otherwise presenting as liver qi depression in pulse and appearance and demeanor, would that make one consdier that this was not kidney yang vacuity. Absolutely. but should one also consider this may indeed be kidney yang xu. Absolutely. No one should reduce any pattern to merely symptoms, but on the other hand, cold feet are not a keynote sx of liver qi deprssion even if they may appear there. they are a keynote symptom of kidney yang xu and thus must always be considered in this vein. As Heiner Fruehauf used to tell me, anything can be anything. One must tie the entire pattern together. No one is suggesting otherwise here. I have seen the symptom of cold feet and/or hands relieved in patients with yang vacuity, dampheat and liver qi depression. Part of this discussion here is actually to determine if symptoms like cold hands and/or feet actually figure more prominently in another pattern in american practice. One needs to understand the entire picture in order to use symptom/pattern lists with sophistication as an educational tool. But even in practice, common patterns are more likely than obscure ones, so pattern standards are a shortcut that give one a useful pivot into the archive of CM in order to develop clinical strategies in an efficent manner. I wonder if part of this discussion hinges upon what Bob Flaws has called hypothetico-deductive reasoning versus exhaustive vs. algorithmic. I believe my support for using hypothetico-deductive reasoning has been mistaken for supporting algorithmic reasoning. A hypothesis is formed by using prior knowledge to shape ones question as the patient discloses new data. this leads to subsequent questioning. However one of the main ways I have seen chinese docs efficiently manage patient loads is by ruling in and ruling out patterns according to some preconceptions, call them standards if you will. I think this method is clearly the dominant one amongst chinese from the PRC I have observed. Students marvel at the way an experienced doc rapidly eliminates patterns with well chosen questions and cuts to the chase. Iam not sure which approach you would advocate, so this reply is not personal. while one could argue that clinical success one be greater if the doctors considered each patient more closely and asked every possible question in order to exhaustively elicit any other nuances that would lead one to a kidney vacuity dx. first, that would have to be proven as I am not so sure this would make much clinical difference. But most importantly, exhaustive questioning and reasoning is just not an efficent way to deliver healthcare in general. Perhaps that should be left for specialists who deal with the small % of patients who require exhaustive consultation. The algorithmic approach instantly equates certain key symptoms with a pattern: such as nightsweats equal yin vacuity. That is somewhat different than investigating a hypothesis with questions to rule in or out, finally confirmed by pulse and/or tongue. On the other hand, if one is suggesting that diagnosing kidney vacuity by sole signs like cold lower back or hara upon palpation or weak chi pulses or blackness under the eyes (in other words, not exhaustive, but just nonstandard), then one must still be looking for patterns or the evidence or proof that is the main connotation of zheng (syndrome). So if it the issue is nonstandard pattern confirmations, that is the topic here. If the issue is that there are no standards possible or necessary for pattern confirmation, I think we have a bigger issue here. What about japanese styles of acupuncture, where particular diagnoses are confirmed by very specific abdominal or pulse pictures. I think diagnosis within any school of thought has standards; that is the source of what we call interrater reliability. different schools may have different standards, but without standards, there are no schools, IMO. I have no interest in imposing the standards I propose upon the field of CM or OM or whatever you call it. I only have an interest in seeing standards in the style I teach and use. In fact, the use of such diagnostic standards is already present in smaller schools of thought such as worsley and some japanese styles. I believe the modern practice of TCM is well grounded in precommunist and premodern texts, from what I have available to me. It may not be the oldest or purest style, but it is distinctly a style, especially with the liberal salting of western ideas so many oppose. I know this trend is repugnant to many. However there will always remain room in the field for those who shoot higher. As Jack Miller at PCOM has made clear, he considers the doctoral level to be the place where deeper issues are addressed. there is just no compelling public need to train all our students as scholar-doctors. FYI, Heiner Fruehauf's program at NCNM emphasizes exactly what Jason is advocating in his post on defining CM. Heiner was a very influential teacher upon me and will be speaking at the CHA 2004 conference. more at http://.org/conference_04.html Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 30, 2003 Report Share Posted November 30, 2003 an important point to consider and why I see a simultaneous need for both standards and classical study. People are practicing now. We cannot wait until Unschuld completes his nei jing in order to practice. So there are two sets of goals here. Short term and longterm- both worthy, I think. I think we all look forward to what the scholars will provide to us in the next few decades, esp. PU. More below in reply to Jason. >>>>>Todd just saying i hope that the change in our list would move us away from the term and langue discussions that are so easy to get caught in. I think you were right to say the list was highjacked by these topics. Lets get back at more clinical issues and questions if we can Alon Quote Link to comment Share on other sites More sharing options...
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