what else and so what

December 6, 2003

I was wondering besides conventionally accepted or PRC standardized

textbook s/s, what diagnostics people use to identify liver patterns. Just

because other methods and s/s are recognized by american px, let's not be

so quick to dismiss. Just because abdominal dx was undeveloped in China

does not mean we cannot use this well developed methodology. If one

regularly palpates patients (admittedly, this is currently a small part of

my week), then one will discover a fairly high GENERAL correlation between

things like kidney yang xu with cold lower back and abdomen or liver

constraint with hypochondriac pain. These signs may not be reported, but

I believe they are accurate. If one detects these signs, it is wise to

question further to confirm the dx. I would not make either of these dx

from palpatory sx alone, but we should consider how prominent these

confirmations may be in our patients before rejecting them because they are

not PRC stamped for approval. what about the nei jing signs of odor,

emotion, color and sound. Wosrsley used these in a stylized way, but we

should not just reject them. I often find noticing these attributes does

point me towards further questioning that confirms a previously

unconsidered zang-fu syndrome. So what place, if any, should such

qualities have in an American standard?

And then there is also the issue of outright errors in thought that have

become entrenched. Well, if an outright error in theoretical thought has

become entrenched or is the basis of an idea, that does disqualify it. let

us not forget about wang qing ren and the mansion of blood (xue fu).

so based upon Flaws compendium of TCM patterns and sionneau voume 1

indecisiveness - often considered to identify a GB pattern. however the

only chronic GB pattern of GB qi vacuity does not include this as a symptom,

nor do any of the acute ones. yet it is listed on the intake form for the

PCOM clinic as if the answer to this question is a key part of the patient'

s medical hx. Is it?

alternating constipation and diarrhea - believed by many to be a keynote

sign of liver qi depression or at least liver overacting on SP. Is it?

history of grief - does a current hx of grief help one diagnose a lung

ailment. It is not listed as a separate dz or keynote sx in sionneau or

flaws

inappropriate laughter - a disease to be differentiated, but not a keynote

sx of heart patterns in general according to sionneau. while the heart is

always involved, phlegm or the liver may be the root.

stress - what does this mean? where does it go in the scheme of things?

the term originally was applied to structures and how they were affected by

factors that stressed their stability. Like the foundation of the building

was stressed by movements in the soil. so the idea that the

structure/function of the body also is stressed by various factors arose.

That slight stresses accumulate and damage tissues leading to diseases.

these stresses include diet (like vitamin deficiencies), environmental

(like exposure to cold) and emotions (like fear leading to so-called stress

hormone release). At least this what the founder of this idea, hans selye,

thought. sound familiar? if the idea of stress includes all the causes

of disease in CM, the report of being stressed can hardly point to a single

zang organ like the liver or can it? Perhaps it must be reframed such as

how does one respond to stress - anger, depression, worry, fear, escape.

but since any enduring emotional excess can damage the liver, does this

apply?

Chinese Herbs

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

Albert Einstein

December 6, 2003

Alot of good questions now that I'm getting a better idea of what your standards

project is. So I would ask what does American acupuncture mean if not the

conglomeration of different countries and concepts. Would an American Chinese

standard run counter to american inclusiveness? And then can or should we name

one

" standard " ? Should there be one standard with footnotes of possibilities without

endorsing them outright? For example, I give credence to abdomen diagnosis but

am

sceptical about ion pumping cords. Is my failure to recognize ion pumping an

ignorance or does ion cords fail to meet my Chinese-centric standards....

Now, I encorporate that sore neck and upper back as a sign, often, of liver Qi

stagnation. This is something I picked up on from Keiko, I believe. Her other

stuff I'm

not so sure about (ignorant) but where should the cut-off be?

Anyway... I'm sure you've thought if not discussed these things before... now a

few

responses (with no eye towards standards or proofs) ...

>

> indecisiveness -

I take this to mean a lot of thoughts in the head that go back and forth in the

brain...

a result of liver qi stagnation affecting the GM as if mimicing the side of the

head of

the GB channel. I use GB 8 as it frees this stuck qi.

>

> alternating constipation and diarrhea - believed by many to be a keynote

> sign of liver qi depression or at least liver overacting on SP. Is it?

yes

>

> history of grief - does a current hx of grief help one diagnose a lung

> ailment. It is not listed as a separate dz or keynote sx in sionneau or

> flaws

I don't think a history is the correct way to approach it. I think the patient

feeling grief

at the time of the appointment is appropriate to address throught the lungs. A

History doesn't mean they haven't dealt with it. Too much projection is

problematic....

>

> inappropriate laughter - a disease to be differentiated, but not a keynote

> sx of heart patterns in general according to sionneau. while the heart is

> always involved, phlegm or the liver may be the root.

It's a phlegm pathology, not a heart pathology really.

>

> stress - what does this mean?

Stress doesn't mean much on it's own. Like " depression " for many it simply means

" not happy " . Some patients have incredibly stressful things going on their

lives. It is

the response to them that matters.

So my intake goes like, Whats you general mood like? are you pretty happy or do

you

tend to get depressed, or angry or sad or frustrated? People generally can

relate one

of these and yes, I then put them into one of the organ systems.

Perhaps it must be reframed such as

> how does one respond to stress - anger, depression, worry, fear, escape.

> but since any enduring emotional excess can damage the liver, does this

> apply?

I would accept one and/or both truisms that all emotions affect the liver and/or

heart.

It just makes clinical sense to keep this in mind rather than assigning too many

attributes solely to each organ. The flowing of emotion " rooted " to the liver

function

leads us away from the essentialism and circular thought of say, Lonnie Jarrett

or

earlier, Leon Hammer.

December 6, 2003

On Dec 6, 2003, at 1:13 PM, wrote:

> If one

> regularly palpates patients (admittedly, this is currently a small

> part of

> my week), then one will discover a fairly high GENERAL correlation

> between

> things like kidney yang xu with cold lower back and abdomen or liver

> constraint with hypochondriac pain.

Here's a sign that I see a lot, but have never read or heard anything

about. On many of my patients who have some sort of diarrhea

happening, there is a crease found horizontally on the abdomen,

commonly intersecting the midline right at Ren 12. In some of the more

severe cases, there is a second crease at around Ren 10.

I like to use Ren 6, 12, and Stomach 25 for any diarrhea or

constipation. After a while, I just decided that the crease was where I

was supposed to needle and stopped measuring the midpoint from Ren 8 to

16 in favor of just needling the midline at the crease.

Anybody else heard of this?

> indecisiveness - often considered to identify a GB pattern. however

> the

> only chronic GB pattern of GB qi vacuity does not include this as a

> symptom,

> nor do any of the acute ones.

I try to grok what these things such as indecisiveness really mean in

the context of a personality type. When I think about that GB Qi

deficiency, I think of timidity. One who is afraid of everything, a

light sleeper and one who jumps when a car backfires a block away.

They're deficient, but also hyper-excitable neurologically. I find the

indecisiveness to be another expression of that timidity.

I had a patient a while back. I asked her if she had trouble making

decisions. She couldn't answer my question. It was amazing. She did

have a Qi deficiency and had been complaining of anxiety. I gave her

some An Shen Ding Zhi Tang and she was very pleased with the results.

> alternating constipation and diarrhea - believed by many to be a

> keynote

> sign of liver qi depression or at least liver overacting on SP. Is it?

I believe so, yes. However, you're always going to have that patient

who doesn't conform.

Also, we have to differentiate circumstances where there might be

constipation with diarrhea such as the green diarrhea that you can get

in the Yang Ming Fu disease. This is a high fever which depletes the

body fluids in the Large Intestine giving rise to a mass of really dry

stuck fecal matter. However, behind this there backs up a bunch of

chyme which may be able to leak past the constipated mass giving rise

to diarrhea amidst constipation.

> history of grief - does a current hx of grief help one diagnose a lung

> ailment. It is not listed as a separate dz or keynote sx in sionneau

> or

> flaws

I take grief as an etiological factor. Grief depletes the Qi. When

I'm trying to determine if grief is causing a problem, I look for a

loss in one's life, such as a loved one or a relationship that broke

up. In the wake of that, giving rise to fatigue, I'll connect those

dots. However, grief is a little like " stress " in that it isn't very

well defined. In my mind, I always assume a loss of something or

someone to cause grief.

> inappropriate laughter - a disease to be differentiated, but not a

> keynote

> sx of heart patterns in general according to sionneau. while the

> heart is

> always involved, phlegm or the liver may be the root.

That makes sense. Here's a guy with inappropriate laughter:

http://www.thesimpsons.com/bios/bios_townspeople_hibbert.html

> stress - what does this mean?

> Perhaps it must be reframed such as

> how does one respond to stress - anger, depression, worry, fear,

> escape.

Yeah, I'd say so. We don't generally treat the stressors, only the

patient's response to that stress. But when push comes to shove, if it

presents as Liver Qi stagnation then I treat that. If it all ends up

looking like Qi deficiency, or whatever, I still treat what I see.

Diagnosis is the art of knowing which signs and symptoms to consider

and which to ignore.

--

Pain is inevitable, suffering is optional.

-Adlai Stevenson

December 6, 2003

alternating constipation and diarrhea - believed by many to be a keynote

sign of liver qi depression or at least liver overacting on SP. Is it?

>>>Funny we were taught it is more spleen related

alon

December 6, 2003

I like to use Ren 6, 12, and Stomach 25 for any diarrhea or

constipation. After a while, I just decided that the crease was where I

was supposed to needle and stopped measuring the midpoint from Ren 8 to

16 in favor of just needling the midline at the crease.

Anybody else heard of this?

>>>>In musculoskeletal stuff i find creases to often correlate with areas of

greater mechanical stress.

Alon

December 8, 2003

, " Alon Marcus "

<alonmarcus@w...> wrote:

> alternating constipation and diarrhea - believed by many to be a

keynote

> sign of liver qi depression or at least liver overacting on SP. Is

it?

> >>>Funny we were taught it is more spleen related

> alon

>

Me too..

This pattern could be due too a spleen yin vacuity, or in other

words a stomach yin vacuity with a spleen qi vacuity. When the

spleen qi vacuity predominates there is diarrhea and when the stomach

dryness or yin vacuity predominates there is constipation.

matt

>

December 8, 2003

if the idea of stress includes all the causes > of disease in CM, the report of

being stressed can hardly point to a single

> zang organ like the liver or can it? Perhaps it must be reframed such as >

how does one respond to stress - anger, depression,

worry, fear, escape. but since any enduring emotional excess can damage the

liver, does this > apply?

Depends on how you define stress. If you are defining it a la Hans Selye, than

it covers all three categories of diseases causes.

Hwever, if we are talking about emotional stress, that is something else. Please

consider my opinion that all stress is nothing other

than an unfulfilled desire. Example, we desire to arrive some place faster than

we seem to be. We desire to avoid a tax audit since

we've cooked the books. We desire to have a full ehad of hair but we are going

bald. We desire our kid to be brilliant but she's a

dunce. We desire to pay off our credit card but the econmy's in the dumpster.

Etc., etc., etc. If I am correct in identify all

psychoemotional stresses as species of unfulfilled desires, then we can say that

all psychoemotional stresses do damage the liver.

Bob

December 8, 2003

Me too..

This pattern could be due too a spleen yin vacuity, or in other

words a stomach yin vacuity with a spleen qi vacuity. When the

spleen qi vacuity predominates there is diarrhea and when the stomach

dryness or yin vacuity predominates there is constipation.

>>>>I was taught that if alternating consp and diar is qi stag related there

should be abdom pain or bloating preceding movement, otherwise it is more spleen

December 8, 2003

On Dec 8, 2003, at 11:26 AM, Bob Flaws wrote:

> If I am correct in identify all

> psychoemotional stresses as species of unfulfilled desires, then we

> can say that all psychoemotional stresses do damage the liver.

While we're tip-toeing on the eight fold path, I'd just like to restate

this a bit...

The wood element opens to the eyes. It is about goals and personal

growth (i.e. wood likes to grow).

The stress that most effects the Liver is not getting what you want, or

getting what you don't want.

Liver Yin nourishes the tendons and provides them with flexibility. I

tell my patients that the best treatment for frustration is

flexibility. I have not yet seen a Liver Yin tonic formula make people

more flexible emotionally, though. I wish that I could see herbal

medicines treating people on this level as we're often told it can, I

just haven't seen the herbs work on this type of situation.

But there are other kinds of stress too. Certainly the death of a loved

one is getting something that you don't want, but it ends up feeling

like a loss (grief depletes the Qi, look to the Metal element) rather

than frustration which is the emotion that I apply to the wood element.

Frustration is anger, but in a sort of " I can't get what I want "

context.

To respond to Alon's question about the clinical realities of this...

obviously if grief is depleting the Qi, you'll want to tonify it

somehow and it may be a better treatment principle to address this

through the Lungs rather than the Kidneys or Spleen. As always, we

treat what we see, and should the patient present with a recent loss of

a loved one, we can't automatically reach for the Huang Qi until we see

corroborating signs and symptoms. Perhaps the " loved one " wasn't all

that loved, but abusive, in which case you're likely going to have to

calm down the patient's excessive joy or whatever other response may

induce their pathology.

We're trying to come up with one-to-one signs and treatments and I

don't think that's fair. Just like the alternating constipation and

diarrhea can be Stomach Yin and Spleen Qi deficiency. However, when we

see that wiry pulse and a history of significant " stress " then we've

got our Liver/Spleen disharmony.

--

Pain is inevitable, suffering is optional.

-Adlai Stevenson

December 8, 2003

, Al Stone <alstone@b...> wrote:

>

> We're trying to come up with one-to-one signs and treatments and I

> don't think that's fair. Just like the alternating constipation and

> diarrhea can be Stomach Yin and Spleen Qi deficiency. However, when we

> see that wiry pulse and a history of significant " stress " then we've

> got our Liver/Spleen disharmony.

>

Al

We are not really trying to come up with one to one signs. It is not about

whether alternating constipation and diarrhea or any other number of

symptoms COULD be due to liver constraint, but whether a certain sign or

symptom is typically considered a keynote. Perhaps this is a homeopathic

term, but I think it applies equally well here. While alt.

constipation/diarrhea,

cold hands and feet and stiff upper back and neck are sometimes (even often)

due to liver depression, the sole pathomechanism of the liver failing to course

the qi does not explain these symptoms (or even overcoursing ala qin bo wei) .

It is necessary to involve another organ or pathogen in order to do this. Now

one might argue that in real life, the sole pattern of liver qi or liver

depression

is rare. I will not dispute this. but the fact that liver/spleen/stomach

disharmony is more likely than liver depression alone does not change the

keynotes for liver depression. It just reminds us not to get pidgeonholed in

the single organ pattern.

So one can have all the above symptoms together, yet they can be explained

pathomechanically by other means. So spleen qi and/or yin xu with or

without blood xu could also explain all of these sx as well. As you said, in

one

case it might be justified as spleen yin, another liver/spleen. The point is

how

does one distinguish between these two diagnoses. I believe the answer is

that one identifies key core symptoms, that when taken together, must point

to one or the other. So the pale tongue, fatigue, weak pulse tell us one thing,

while the wiry pulse, moodiness and sighing another. But unless we have

these agreements, how are we to have any type of clinical discussion. If you

believed, as I know you do not, that pale tongue, weak pulse and fatigue are

core liver depression symptoms, how can we even have a discussion.

If one believes symptoms other than commonly agreed keynotes (as evidenced

ad nauseum in countless books from the PRC) are acceptable bases for

diagnoses, then the burden is on those who deviate from accepted PRC

standards to justify why. the PRC committees have done a lot of legwork and I

think it is more than fair to use their work as a jumping off point for

discussion, especially since the vast majority of the world's px of TCM were

trained in that system. So if liver depression should be expanded beyond the

current PRC definition. why? Is the current standard inadequate to make

diagnoses. In other words, it only matters that our patient have presentations

that differ greatly from PRC patients if they differ so greatly that we cannot

identify the keynote sx readily enough. Have people found this to be the case.

How many people try and practice this way to even see if it works. I am

admittedly playing both sides of the fence in these posts in order to reach

some understanding.

December 8, 2003

>

> We're trying to come up with one-to-one signs and treatments and I

> don't think that's fair. Just like the alternating constipation

and

> diarrhea can be Stomach Yin and Spleen Qi deficiency. However,

when we

> see that wiry pulse and a history of significant " stress " then

we've

> got our Liver/Spleen disharmony.

I agree... Although I do not find st yin and sp qi xu that common of

a pattern, do others? I also do not find it in the literature much.

But where does that alternating constipation and diarrhea being a LV„³

SP come from? I was taught this my 2nd semester in school, and

until now haven¡¦t questioned it much.. Looking at some sources, I

seem to be finding sloppy stools/ diarrhea listed under Liver /

Spleen patterns. I do not have many books here, so if someone could

point some other sources , that would nice¡K What does QBW say?

-

>

December 8, 2003

As always, we

treat what we see, and should the patient present with a recent loss of

a loved one, we can't automatically reach for the Huang Qi until we see

corroborating signs and symptoms.

>>>>That is my point. If someone is suffering from excessive grief can you

predict what will be the effects. And if yes is an association with the lungs is

more likely than one with liver symptom signs

Alon

December 8, 2003

If one believes symptoms other than commonly agreed keynotes (as evidenced

ad nauseum in countless books from the PRC) are acceptable bases for

diagnoses, then the burden is on those who deviate from accepted PRC

standards to justify why. the PRC committees have done a lot of legwork and I

think it is more than fair to use their work as a jumping off point for

discussion, especially since the vast majority of the world's px of TCM were

trained in that system. So if liver depression should be expanded beyond the

current PRC definition. why?

>>>>Todd since i am listening to PU i think the other question is also how much

of this is theory trying to be fitted into reality and howmuch is reality (ie

clinical truth) fitted than made into workable theory (ie which has come first).

These points that PU makes are extremely important to discuss in an open mind

yet critical one. How often do we look at a patient and ask such questions? we

usually try to fit the patient into these so-called agreed upon patterns. I am

suggesting (and i think so is PU) is that we question these associations at the

same time that we work with them. In other words look and study outcome

Alon

December 8, 2003

, " " <

@h...> wrote:

>

> But where does that alternating constipation and diarrhea being a LV„

> SP come from? Looking at some sources, I

> seem to be finding sloppy stools/ diarrhea listed under Liver /

> Spleen patterns.

tick-tock. I have no sources that list constipation as part of this compla=

int at

all.

December 9, 2003

Hi Al and all-

I have had experience with herbs creating the kind of emotional flexibility you

are talking about, but only with my female patients. I have found Yi Guan Jian

(Linking Decoction) helpful with this, and also Health Concerns' Astra Essence.

I've found moving stagnant Liver Qi, as with Xiao Yao Wan, to be less successful

in this regard than nourishing Liver (and Kidney) Yin. It seems that nourishing

Liver Yin is usually enough even if significant stagnation is present - perhaps,

in these cases, the root is the Yin Xu and the branch is the stagnation.

Andrea Beth

Al Stone <alstone wrote:

On Dec 8, 2003, at 11:26 AM, Bob Flaws wrote:

> If I am correct in identify all

> psychoemotional stresses as species of unfulfilled desires, then we

> can say that all psychoemotional stresses do damage the liver.

While we're tip-toeing on the eight fold path, I'd just like to restate

this a bit...

The wood element opens to the eyes. It is about goals and personal

growth (i.e. wood likes to grow).

The stress that most effects the Liver is not getting what you want, or

getting what you don't want.

Liver Yin nourishes the tendons and provides them with flexibility. I

tell my patients that the best treatment for frustration is

flexibility. I have not yet seen a Liver Yin tonic formula make people

more flexible emotionally, though. I wish that I could see herbal

medicines treating people on this level as we're often told it can, I

just haven't seen the herbs work on this type of situation.

Free Pop-Up Blocker - Get it now

December 9, 2003

Jason,

I seem to remember something about this in Maciocia's silver book.

< wrote: