Guest guest Posted February 13, 2004 Report Share Posted February 13, 2004 At 11:08 PM +0000 2/13/04, Bob Flaws wrote: >BTW, is anyone else having trouble with this site suddenly locking >up their web browser? This began for me about two weeks or so ago. >Maybe it's an omen to simply stop getting involved with this site. >However, it is an easy fix when I'm bored with whatever else I'm >doing (or not doing as the case may be). -- Bob, No, but I find it a lot easier to have the posts downloaded to my email client. The web-site is a bear. Is it possible your browser gets overloaded by all the ads, which get saved to cache. Perhaps clear the browser cache and see if that helps. Rory -- Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 16, 2004 Report Share Posted February 16, 2004 , " Bob Flaws " < pemachophel2001> wrote: > > > Sorry my reply pushed some buttons, but it is tiring, irksome, and frustrating when such simple issues raise all sorts of uncessary > wheel-spinning. This is exactly why I and others harp on the utility, nay necessity, of learning to read and study this stuff in its original > language. This kind of question is basically a non-issue in Chinese. that was not really my point here. I am a strong supporter of learning to read chinese, despite my personal struggles with the material. In fact, knowing what I know now, I would not have studied CM w/o first studying chinese or Iwould have done something else instead. But here I am with patients, struggling to understand and give good care. However, despite your assertion about reading chinese, it is definitely possible to read about asthma in chinese and walk away thinking something else than what you put forth as consensus. Keep in mind I agree with you about this consensus, but I have also identified other sources that dispute your claim about wind and asthma. and this whole thread got started because a chinese student who can read chinese natively disputed my presentation of acute asthma. she defended herself by quoting from the zhong yi da ci dian in class. I believe she was wrong in her assessment of the information, but how can I make my case when the mere fact she reads chinese gives her precedence over me. And I reiterate. she was wrong. My point is solely that reading chinese is no panacea all by itself. It takes more than that. Sometimes I think those who read chinese use that fact to silence further discussion (like this student in class). So lets get on the same page here. If you are not exceptionally intelligent and do not have good teachers, reading chinese alone will not make you good at CM. On the other hand, if you are exceptionally intelligent and have good teachers, those will serve you better than merely having the language skills. Do you disagree? Interestingly, in following up with this student, I explained to her that I had little expereince treating acute asthma. Most patients would not give up their inhalers and there was no regular opportunity to really address the issue of acute asthma with chinese herbs. Albuterol inhalers can be considered part of an herbal formula and are probably no more harmful than daily use of ma huang, IMO. I mostly work with chronic asthma in the remission stage and have seen quite a few cases go into remission long term. This chinese student was horrified that I did not have more FAITH in TCM.. She couldn't care less about my experience or my perspective that CM would be best used as a form of complementary and NOT alternative medicine. And she could not understand why as an asthmatic patient would not want to wait for a tea to boil or a pill to enter the bloodstream when they are wheezing severely. This idealistic fantasy land perspective will be the death of CM in america if it prevails. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 16, 2004 Report Share Posted February 16, 2004 This post raises a number of issues. First of all, the issue of faith. 1) Faith is a necessary component in human life, and can be expressed appropriately or inappropriately. Patients need to have faith in their physicians and treatments in order to undergo the discomfort, pain, or cost of such treatment. Physicians need to believe in the medicine they practice in order to inspire others with its value. This, however, doesn't preclude questioning such treatment or modalities, as one constantly has to make judgments and choices on what treatment methods to choose, whether Chinese medicine or any other system or modality. Part of our role as physicians is to motivate our patient's own healing powers to overcome diseases, and also to help them make choices about which treatment path to take. Students of any medicine or discipline tend to be overly enthusiastic and strident about what they are studying or practice, although there are often many skeptics as well in the ranks. 2) One of the things I've learned about Chinese medicine is timing. There are varying dosages and strengths of treatment that can be given, depending on the patient's constitution, and the strength and duration of the disease. Weak patients with a long disease process need long term treatment with supplementing medicinals with relatively mild treatment aimed at the disease. Acute diseases or episodes generally need strong medicine and/or treatment, sometimes beyond the speed at which Chinese medicine can deliver relief. As with diet, one usually cannot make radical changes in patients' lives, and one's expectations have to be tempered to this fact. Life-threatening diseases are an exception, as people will do anything to continue living. This is where desperation and blind faith can be abusive as well, and patients' expectations have to be addressed in a realistic fashion. If a patient is accustomed to using inhalers to relieve an asthma attack, there is no ready-made substitute in Chinese medicine to take its place. At best, they will have to be 'weaned' off the inhalers as their overall condition improves. Most asthma patients, as you point out, have a chronic condition that gradually can improve under Chinese medical treatment. Some can slowly give up their inhalers, others simply cannot, depending on their age, severity of condition, etc. However, some patients have either an emotional attachment or aversion to using inhalers, especially steroidal inhalers, because like other steroidal drugs, there can be a gradual buildup of undesirable side effects, such as emotional depression, disturbed sleep with vivid dreams, loss of bone density, etc. So patients are looking for some way to stop using these drugs. Most of the time we can help, but sometimes the case is too intractable to be treated with Chinese medicine alone. This will also depend on the skill and experience of the practitioner. Any Chinese treatment for acute asthma would have to be very strong, and potentially could have side effects as well. This is clear from looking at prescriptions for acute and severe conditions, they tend to have large doses and large numbers of very strong ingredients. They are also difficult to administer in comparison with inhalers (there are Chinese herbal inhalers I've seen, but I have no idea of their efficacy). We also need to be careful in these situations. I've seen strong acupuncture treatments with back shu points and strong stimulus used on asthma patients actually trigger asthma attacks (in a school clinic and private clinics in New Mexico and Colorado). 3) I wouldn't worry too much about this student. He/she is not a typical patient, but an idealistic student who will wisen up quickly when exposed to clinical reality. Students often tend to be this way. It doesn't reflect any patient I've seen, or the average practitioner. On Feb 16, 2004, at 9:32 AM, wrote: > Interestingly, in following up with this student, I explained to her > that I had > little expereince treating acute asthma. Most patients would not give > up their > inhalers and there was no regular opportunity to really address the > issue of > acute asthma with chinese herbs. Albuterol inhalers can be considered > part of > an herbal formula and are probably no more harmful than daily use of ma > huang, IMO. I mostly work with chronic asthma in the remission stage > and > have seen quite a few cases go into remission long term. This chinese > student > was horrified that I did not have more FAITH in TCM.. She couldn't > care less > about my experience or my perspective that CM would be best used as a > form > of complementary and NOT alternative medicine. And she could not > understand > why as an asthmatic patient would not want to wait for a tea to boil > or a pill > to enter the bloodstream when they are wheezing severely. This > idealistic > fantasy land perspective will be the death of CM in america if it > prevails. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 16, 2004 Report Share Posted February 16, 2004 Agreed, just being able to read Chinese is definitely not enough. No argument there. One then has to read widely and critically. As you well know, part of reading critically is looking at the bibliography of sources used to create an article or book. Of course, as you pointed out, one also has to be intelligent. On the other hand, not being able to read Chinese (or some other primary source Asian language) relegates a person to hear-say informant no matter how intelligent they are. If the student you mention continues to read Chinese, I have more hope that she will eventually evolve her point of view that if she did not read Chinese. Eventually, the Chinese literature itself will challenge her naive assumptions and beliefs. And then there's always practice... Bob Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 16, 2004 Report Share Posted February 16, 2004 .. And she could not understand why as an asthmatic patient would not want to wait for a tea to boil or a pill to enter the bloodstream when they are wheezing severely. This idealistic fantasy land perspective will be the death of CM in america if it prevails. >>>>>Hell just have her go to china and see how many patients are still on high dose steroids inspite of TCM interventions. Asthma in more serous cases was one of my biggest disappointments working in China Alon Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 16, 2004 Report Share Posted February 16, 2004 , " " wrote: > , " Bob Flaws " < > pemachophel2001> wrote: > > > > > > Sorry my reply pushed some buttons, but it is tiring, irksome, and > frustrating when such simple issues raise all sorts of uncessary > > wheel-spinning. This is exactly why I and others harp on the utility, nay > necessity, of learning to read and study this stuff in its original > > language. This kind of question is basically a non-issue in Chinese. > > > that was not really my point here. I am a strong supporter of learning to read > chinese, despite my personal struggles with the material. In fact, knowing > what I know now, I would not have studied CM w/o first studying chinese or > Iwould have done something else instead. But here I am with patients, > struggling to understand and give good care. > > However, despite your assertion about reading chinese, it is definitely > possible to read about asthma in chinese and walk away thinking something > else than what you put forth as consensus. Keep in mind I agree with you > about this consensus, but I have also identified other sources that dispute > your claim about wind and asthma. and this whole thread got started because > a chinese student who can read chinese natively disputed my presentation of > acute asthma. she defended herself by quoting from the zhong yi da ci dian in > class. I believe she was wrong in her assessment of the information, but how > can I make my case when the mere fact she reads chinese gives her > precedence over me. And I reiterate. she was wrong. I am curious, what do you mean, she was wrong? If she is just quoting the ZYDCD, why is she wrong? She is just stating a valid or different point of view, no? You may disagree with that point, but that seems to be a different issue… But my main issue here is along this `consensus' line of thinking… I am hard pressed to think there is this great consensus that many of us dream of… China is too big and there are too many things at the moment to believe anything else. I DON'T think just because Bob wrote something in his " consensus " book this makes it a FACT… I.e. I think what Bob presents is just a foundational understanding and the MANY gross oversimplifications (black and white) issues that have popped up lately are demonstrating the gap between text books and clinical reality. There may be a basic standard of information for textbooks (I will acknowledge that), but statements like all asthma are phlegm, all acute attacks are exterior wind, just do not hold up in the clinic. There is a wealth of clinical information that differs and expanded from what is written in textbooks. For example, the information that I use for asthma, translated by Chip Chace, is far from basic asthma understanding, but very clinically based, written by experts in TREATING asthma. I think to believe that any one source, Bob's or otherwise hold some ultimate truth, at this point, is a little premature. I think the mere fact that your student is reading something from a credible source, demonstrates my point exactly. There are different views, and to dismiss her's because you don't agree is a bit puzzling. Finally, textbooks presented like Bob's are pretty much only Zang-Fu based. Remember that there are very valid alternatives, which are practiced at a high level, like SHL styles, that are not included in such a book. I don't for a second believe your consensus stance. I.e. if it isn't in the `main' text then it is wrong… Personally I don't have the answer on your wind question, I have presented what I have read.. but, the proof in the pudding would be to look at the formulas used, and see if they work with your theory… If you find an `expert' asthma source that is different, then the theory is only partially true (IMO). But I do agree with you, that a Chinese source means little without knowing where it comes from… and this takes experience. I personally do not have enough (experience) to always decide, so I either stick to mainstream sources, or run it by people like Chip… (but that is just me)… I think that many black and white statements are for students, good teaching tools…but the pros realize that there is too much ambiguity in the medicine, not to believe otherwise… BTW – I think Bob's latest book's have rocked and are a great resource (just not the final note on anything.) - > > My point is solely that reading chinese is no panacea all by itself. It takes > more than that. Sometimes I think those who read chinese use that fact to > silence further discussion (like this student in class). So lets get on the same > page here. If you are not exceptionally intelligent and do not have good > teachers, reading chinese alone will not make you good at CM. On the other > hand, if you are exceptionally intelligent and have good teachers, those will > serve you better than merely having the language skills. Do you disagree? > > Interestingly, in following up with this student, I explained to her that I had > little expereince treating acute asthma. Most patients would not give up their > inhalers and there was no regular opportunity to really address the issue of > acute asthma with chinese herbs. Albuterol inhalers can be considered part of > an herbal formula and are probably no more harmful than daily use of ma > huang, IMO. I mostly work with chronic asthma in the remission stage and > have seen quite a few cases go into remission long term. This chinese student > was horrified that I did not have more FAITH in TCM.. She couldn't care less > about my experience or my perspective that CM would be best used as a form > of complementary and NOT alternative medicine. And she could not understand > why as an asthmatic patient would not want to wait for a tea to boil or a pill > to enter the bloodstream when they are wheezing severely. This idealistic > fantasy land perspective will be the death of CM in america if it prevails. > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 16, 2004 Report Share Posted February 16, 2004 I am hard pressed to think there is this great consensus that many of us dream of. >>>>There is none and even me that does not read Chinese have seen it quite clearly. Mpre importingly what do you see in the clinic and what is the response to treatment. I can tell you that i have seen many patients that clearly do not have phlegm and in fact mosting is the only treatment that was helpful. Well perhaps patients do not read Chinese as well Alon Alon Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 17, 2004 Report Share Posted February 17, 2004 , " " < @h...> wrote: > > > > I am curious, what do you mean, she was wrong? If she is just quoting > the ZYDCD, why is she wrong? She is just stating a valid or different > point of view, no? she was wrong about the case because she did not really understand what acute means or the nature of wind. she just read me a list that I did not think applied. in the case I presented to the list, was it exterior wind or not? remember the pulse was fake, so the absence of it being floating was meaningless. If I had " added " the TCM finding to this case, I would have made the pulse float to satisfy my assessment. However I do not think the pulse has to float in such a case anyway,does it? here is the case again: Patient, 21, asthma for ten years. uses steroid inhaler daily and bronchodilator several times daily, more as needed. She runs out of meds 5 days ago and last night in bed, she developed a crisis with tachypnea, cyanosis. etc. and went to the emergency room. There was no known precipitating factor in the form of food or infection or emotional stress. The patient did not produce sputum, however she was wheezing (phlegm by definition) and also had " fake " scalloped tongue with greasy white coat. Pulse was tight, but not floating according to " fake " TCM findings that were appended to a case from a medical textbook. It is common to modify western medical cases for practical applications in our integrative medicine classes at PCOM.. The expectation is that students will work with the findings as given. In the first class of this series, the absence of a floating pulse and fever or chills is code for the absnece of an exterior condition. Yet if this is not an exterior condition, what precipitated an attack in a patient who had been doing so well that she had not even needed her meds in the past five days? Was it the accumulation of phlegm due to lack of inhaler use (do these meds decrease phlegm? is that their TCM mechanism?). Or was it a wind invasion? Phlegm builds up slowly. Wind comes on suddenly. While I definitely think this patient has deep-lying phlegm as evidenced by her hx and tongue/pulse. It seems that there must be a precipitating factor to stir the phlegm in such a case. My assumption is that if the attack is due solely to an accumulation of phlegm that reaches the crisis point that there would be phlegm symptoms developing for a period of time prior to the attack. And if the patient had no need for her inhalers for many days, my assumption is that she had been sx- free for that time. Does that type of acuity that comes seemingly out of nowhere fit the bill for wind? Quote Link to comment Share on other sites More sharing options...
Recommended Posts
Join the conversation
You are posting as a guest. If you have an account, sign in now to post with your account.
Note: Your post will require moderator approval before it will be visible.