KEYNOTE S&Ss before one can Dx a given Pattern?

[Guest guest]

Hi All, & Hi Alon, Julie, Todd & James,

 

Great discussion!

 

Alon Marcus wrote:

> Do people think there is a symptom or sign that must be present

> for a pattern to exist. For example, if one has K-Yang def does

> one have to have some urinary symptoms? alon

 

Alon, IMO, that a very important question!

 

I would rephrase it as: " Is/are there ONE/MORE KEYNOTE S/Ss

that MUST be present before one can Dx a specific Pattern? " .

 

As a starting-point for discussion, please consider the following.

My area of professional research/expertise is in trace-element

deficiency in cattle. Let us consider a very common problem -

iodine deficiency in cattle.

 

Depending on the textbooks and clinical articles at one's disposal,

the more common S & Ss of bovine iodine deficiency include:

 

late abortion/stillbirth/early neonatal death;

 

" lazy calving " [slow calving that often needs assistance;

 

retained placenta +/- postpartum metritis;

 

" lazy neonates " (slow to stand, dopy, slow to suck);

 

immunosuppression with high incidence of infections (scour,

pneumonia, joint-ill, protozoal infection, etc);

 

goitre, sometimes palpable but often marginal (verified only by

thyroid weights >25g and/or histopathological changes);

 

haircoat~poor, esp in neonates or still-born calves;

 

infertility/reproductive inefficiency (anoestrus or repeat-breeders);

 

growth/milk yield depressed.

 

In almost 40 years working with cattle, I have not seen the entire

spectrum of those S & Ss in a single HERD!

 

Now to the kernel of Alon's question. How many of those S & Ss

MUST be present to Dx iodine deficiency? IMO, any ONE of those

S & Ss can suggest iodine deficiency as a possibility, but

confirmation of the Dx requires elimination of OTHER disorders

which can present the same Sx.

 

For example selenium deficiency [and some other conditions] can

present many of the same S & Ss as iodine deficiency. Blood tests

(for plasma inorganic iodine and glutathione peroxidase) can

sometimes differentiate Se and I deficiency, BUT the TWO of these

often occur TOGETHER!

 

If one wanted a specific Dx, one would need to split the herd at

random into three groups, and confirm that the groups were

matched in terms of age, reproductive status, breed, genetics, etc,

and give:

(a) an iodine supplement;

(b) a selenium supplement;

© both iodine and selenium supplement.

 

Then one would need to monitor the outcome in all three groups.

The group with the best outcome would confirm the best Dx!

 

So back to Alon's question, or my rephrasing of it: " Is/are there

ONE/MORE KEYNOTE S/Ss that MUST be present before one

can Dx a specific Pattern? "

 

I look forward to further discussion! For example:

 

Alon wrote:

> Do people think there is a symptom or sign that must be present

> for a pattern to exist. For example, if one has KI Yang Xu does one

> have to have some urinary symptoms?

 

Julie wrote:

> ... I think the answer is no. For example, a woman can have KI Yang

> Xu and just have edema, clamminess and cold limbs. No urinary

> symptoms. You might say, then why not Dx SP Yang Xu just as

> easily? I might also add, she has dry hair, slightly hypothyroid,

> constipation, etc. No digestive symptoms either. Julie

 

Paraphrasing Todd:

> ... according to Flaws, decreased libido PLUS 2 of the following 3

> Sxs MUST be present: 1. nocturia; 2. lowback & / knee pain; 3.

> cold feet. So nocturia is not essential according to Flaws, but

> what about the libido issue? We discussed what was libido before,

> not whether we thought it to be essential or not. Why or why not

> would it be essential to this Dx? Todd

 

Jim Ramholz replied:

> While this may be true generally, it is not necessarily true

> in all cases. I had a patient with decreased libido wo other

> symptoms. He had all the WM tests and didn't exhibit any of the

> pulses for the other symptoms. It turned out to be a problem of the

> communication of the hypothalamus; showing up as a blockage in the

> KI Yang pulse (right proximal). At first I suspected that it may be

> blockages in the blood vessels networking with it; but it quickly

> resolved. The only thing we could figure was that he spent long

> hours as an engineer working with electrical equipment. The

> electrical and magnetic fields may have did something to his brain.

> The situation was resolved with herbs and 3 acupuncture treatments.

> Jim

 

Julie wrote [re Bob Flaws' List, above]:

> I wouldn't want to oppose Mr. Flaws, who has more experience than

> I...but what would the diagnosis be then, for a patient with the

> signs and symptoms I mentioned: cold limbs, clamminess, edema, dry

> hair, constipation, hypothyroid? What if she doesn't have decreased

> libido, either because it was already low, or it's now higher

> because she has a fantastic new boyfriend, etc. I just can't see

> how anyone can say " three Sxs MUST be present, and one MUST be

> decreased libido. " Julie

 

 

 

Best regards,

 

Email: <

 

WORK : Teagasc Research Management, Sandymount Ave., Dublin 4, Ireland

Mobile: 353-; [in the Republic: 0]

 

HOME : 1 Esker Lawns, Lucan, Dublin, Ireland

Tel : 353-; [in the Republic: 0]

WWW : http://homepage.eircom.net/~progers/searchap.htm

[Guest guest]

Phil,

 

Unfortunately, I think the answer to your question is that it depends on the

pattern in question. Some patterns do have essential signs

and symptoms, others do not. I try to address this issue to some extent in my

and Dan Finney's Handbook of TCM Patterns and their

treatments. Since that writing, I do teach on this subject in my Master's Class

in CM Diagnosis. Sorry I can't be more specific. This is

a big question, and some of the my answers are proprietary.

 

Bob

[Guest guest]

Dear Phil,

 

I would emphasize one more point, which, if I recall, Bob Flaws alluded

to in a previouspost. Besides the other signs, many of which could be

yang or qi xu, and pi and/or shen qu, is not the key symptom, whether or

not we can differentiate a patient as being clearly shen yang xu, with

the other, particularly cold symptoms, low back and/or knee pain. And is

it clearly not shen yang xu in the absence of that?

 

Yehuda

 

On Mon, 1 Dec 2003 14:40:15 -0000 " " <

writes:

> Hi All, & Hi Alon, Julie, Todd & James,

>

> Great discussion!

>

> Alon Marcus wrote:

> > Do people think there is a symptom or sign that must be present

> > for a pattern to exist. For example, if one has K-Yang def does

> > one have to have some urinary symptoms? alon

>

> Alon, IMO, that a very important question!

>

> I would rephrase it as: " Is/are there ONE/MORE KEYNOTE S/Ss

> that MUST be present before one can Dx a specific Pattern? " .

>

> As a starting-point for discussion, please consider the following.

> My area of professional research/expertise is in trace-element

> deficiency in cattle. Let us consider a very common problem -

> iodine deficiency in cattle.

>

> Depending on the textbooks and clinical articles at one's disposal,

> the more common S & Ss of bovine iodine deficiency include:

>

> late abortion/stillbirth/early neonatal death;

>

> " lazy calving " [slow calving that often needs assistance;

>

> retained placenta +/- postpartum metritis;

>

> " lazy neonates " (slow to stand, dopy, slow to suck);

>

> immunosuppression with high incidence of infections (scour,

> pneumonia, joint-ill, protozoal infection, etc);

>

> goitre, sometimes palpable but often marginal (verified only by

> thyroid weights >25g and/or histopathological changes);

>

> haircoat~poor, esp in neonates or still-born calves;

>

> infertility/reproductive inefficiency (anoestrus or

> repeat-breeders);

>

> growth/milk yield depressed.

>

> In almost 40 years working with cattle, I have not seen the entire

> spectrum of those S & Ss in a single HERD!

>

> Now to the kernel of Alon's question. How many of those S & Ss

> MUST be present to Dx iodine deficiency? IMO, any ONE of those

> S & Ss can suggest iodine deficiency as a possibility, but

> confirmation of the Dx requires elimination of OTHER disorders

> which can present the same Sx.

>

> For example selenium deficiency [and some other conditions] can

> present many of the same S & Ss as iodine deficiency. Blood tests

> (for plasma inorganic iodine and glutathione peroxidase) can

> sometimes differentiate Se and I deficiency, BUT the TWO of these

> often occur TOGETHER!

>

> If one wanted a specific Dx, one would need to split the herd at

> random into three groups, and confirm that the groups were

> matched in terms of age, reproductive status, breed, genetics, etc,

> and give:

> (a) an iodine supplement;

> (b) a selenium supplement;

> © both iodine and selenium supplement.

>

> Then one would need to monitor the outcome in all three groups.

> The group with the best outcome would confirm the best Dx!

>

> So back to Alon's question, or my rephrasing of it: " Is/are there

> ONE/MORE KEYNOTE S/Ss that MUST be present before one

> can Dx a specific Pattern? "

>

> I look forward to further discussion! For example:

>

> Alon wrote:

> > Do people think there is a symptom or sign that must be present

> > for a pattern to exist. For example, if one has KI Yang Xu does

> one

> > have to have some urinary symptoms?

>

> Julie wrote:

> > ... I think the answer is no. For example, a woman can have KI

> Yang

> > Xu and just have edema, clamminess and cold limbs. No urinary

> > symptoms. You might say, then why not Dx SP Yang Xu just as

> > easily? I might also add, she has dry hair, slightly hypothyroid,

> > constipation, etc. No digestive symptoms either. Julie

>

> Paraphrasing Todd:

> > ... according to Flaws, decreased libido PLUS 2 of the following 3

> > Sxs MUST be present: 1. nocturia; 2. lowback & / knee pain; 3.

> > cold feet. So nocturia is not essential according to Flaws, but

> > what about the libido issue? We discussed what was libido before,

> > not whether we thought it to be essential or not. Why or why not

> > would it be essential to this Dx? Todd

>

> Jim Ramholz replied:

> > While this may be true generally, it is not necessarily true

> > in all cases. I had a patient with decreased libido wo other

> > symptoms. He had all the WM tests and didn't exhibit any of the

> > pulses for the other symptoms. It turned out to be a problem of

> the

> > communication of the hypothalamus; showing up as a blockage in the

> > KI Yang pulse (right proximal). At first I suspected that it may

> be

> > blockages in the blood vessels networking with it; but it quickly

> > resolved. The only thing we could figure was that he spent long

> > hours as an engineer working with electrical equipment. The

> > electrical and magnetic fields may have did something to his

> brain.

> > The situation was resolved with herbs and 3 acupuncture

> treatments.

> > Jim

>

> Julie wrote [re Bob Flaws' List, above]:

> > I wouldn't want to oppose Mr. Flaws, who has more experience than

> > I...but what would the diagnosis be then, for a patient with the

> > signs and symptoms I mentioned: cold limbs, clamminess, edema, dry

> > hair, constipation, hypothyroid? What if she doesn't have

> decreased

> > libido, either because it was already low, or it's now higher

> > because she has a fantastic new boyfriend, etc. I just can't see

> > how anyone can say " three Sxs MUST be present, and one MUST be

> > decreased libido. " Julie

>

>

>

> Best regards,

>

> Email: <

>

> WORK : Teagasc Research Management, Sandymount Ave., Dublin 4,

> Ireland

> Mobile: 353-; [in the Republic: 0]

>

> HOME : 1 Esker Lawns, Lucan, Dublin, Ireland

> Tel : 353-; [in the Republic: 0]

> WWW : http://homepage.eircom.net/~progers/searchap.htm

>

>