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Funny, yesterday I re-read the first apendix to Volker Sheid's

in

Contemporary China about the reorganization of bian zheng lunzhi. Now I've been

asked to teach again a point selection class. I must say I'm drawn mainly to

pattern

differenciation although evidence seems to be its more recent adapation. For the

student though, rote memorization of points married to diseases is where trouble

starts. Yet CAM and other state Board books are written more to this disease

model.

Note there are no point selections for zang-fu or patterns. What to do?

doug

 

, wrote:

> The main organization of TCM treatment manuals seems to have always

> centered around disease or symptoms (bian bing), then subcategorized by

> patterns (bian zheng). This is evident in books ranging from nei jing

> ling shu to jin gui yao lue to dan xi xin fa to modern nei ke texts.

> Formulas are often indicated in internal medicine texts for a much

> broader range of chief complaints that are listed in formula texts.

>

> For example, if you look at Philippe Sionneau's 7 volume treatment of

> disease in TCM series, you would find bu zhong yi qi tang indicated as

> the base formula used in treating dozens of complaints that would not

> be found in a database that was limited to the data found in a formula

> text (like Bensky). For example, sionneau lists liu jun zi tang for

> remission stage wheezing due to spleen qi xu with phlegm, which makes

> perfect sense. However, Bensky does not indicate this formula for

> wheezing.

>

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>

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>

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You've written a long and interesting essay here with many different

subtopics to discuss that beckon comment. I'm going to try to offer a

few here.

 

1) You are proposing a computer-based model for the purposes of

designing herbal prescriptions based on complex pattern

differentiations of disease. I couldn't agree more that this would be

a quantum leap for our profession, going past the limitations of the

textbooks, which cannot possibly cover all of the possible combinations

of patterns. It would help counter the tendency for students and

practitioners to oversimplify diagnosis and treatment.

 

2) We do need two good English language textbooks, however, one on

multi-pattern diagnosis and treatment ( a how-to book with case

histories and prescriptions), and one that emphasizes pathomechanisms.

The English literature is poorly represented in explaining

pathomechanisms. This is the key to treatment of diseases, knowing how

they develop, how patterns become more complex over time, and the keys

to unravelling these complex patterns.

 

3) Because of this, I do not agree that there is enough material in

English to do justice to a computer database. Any computer program

would have to help students and practitioners determine the underlying

pathomechanisms first, before determining treatment strategies. Also,

we still do not have a comprehensive source for all available zang-fu

patterns, not to say patterns classified as jing-luo, six channel, four

aspect, three burner, qi/blood and fluids.

 

4) I think we need to look to individuals such as Bob Felt who are

investigating computer databases that could effortlessly access the

Chinese language CM literature and make it available to us, perhaps

with Wenlin-style tools. This way, there wouldn't be the unfortunate

lacunae that exist in the English language literature. However, we

also need real money and programmers to develop such a project.

 

When homeopathy turned to computer technology to organize its materia

medica and repertory of symptoms, it made the process of diagnosis and

treatment much faster and more efficient without sacrificing

intellectual/theoretical rigor or the judgment of the physician. In

fact, such programs as MacRepertory have revolutionized the homeopathic

profession. If, as you point out, Chinese medicine originally was

based on a disease-symptom-sign model (which clearly is the case in the

acupuncture literature, and earlier internal medicine literature), a

similar approach will suit us as well. I personally, when practicing

acupuncture/moxabustion, prefer a channel-based, symptom-sign model to

a zang-fu model for diagnosis and treatment (although I certainly

wouldn't discourage a zang-fu model for acupuncture when appropriate or

helpful). Premodern texts of acupuncture-moxa treatment were clearly

based on a channel model, with points listed according to specific

symptoms and signs.

 

 

On May 11, 2004, at 10:40 AM, wrote:

 

> The main organization of TCM treatment manuals seems to have always

> centered around disease or symptoms (bian bing), then subcategorized by

> patterns (bian zheng). This is evident in books ranging from nei jing

> ling shu to jin gui yao lue to dan xi xin fa to modern nei ke texts.

> Formulas are often indicated in internal medicine texts for a much

> broader range of chief complaints that are listed in formula texts.

>

> For example, if you look at Philippe Sionneau's 7 volume treatment of

> disease in TCM series, you would find bu zhong yi qi tang indicated as

> the base formula used in treating dozens of complaints that would not

> be found in a database that was limited to the data found in a formula

> text (like Bensky). For example, sionneau lists liu jun zi tang for

> remission stage wheezing due to spleen qi xu with phlegm, which makes

> perfect sense. However, Bensky does not indicate this formula for

> wheezing.

>

> Concerns have been raised in some quarters that books organized like

> sionneau's lend themselves to abuse. Because it is so easy to find any

> chief complaint imaginable in the series, there may be a tendency to

> ignore multiple patterns or complaints when using the texts. In

> Sionneau's defense, he does explicitly state that his intent in his

> books is NOT to encourage the correlation of any disease with a single

> pattern. But rather that the patterns listed in each chapter represent

> a network of mutually engendering possibilities. In order to properly

> treat a disease, one must actually consider that a number of different

> pathomechanisms are at play and that one's final formula will take all

> of these into consideration.

>

> I find internal medicine texts to be quite useful in that they tend to

> organize information on one page that could otherwise be found in

> several different sources (basic texts, materia medica and

> formularies). If students can avoid the tendency to treat diseases and

> do multipattern diagnosis, these books can be useful ways of accessing

> data. They are thus quite useful when relying on the printed word.

> However, would well designed computer databases obviate the need for

> such an independent organization of data. I hadn't really considered

> that before. I think the popularity of the internal medicine genre of

> literature in the past 800 years is probably because these books were

> the first attempts to " search and sort the database " . But they have

> always been tempting crutches after they become gospel.

>

> Once upon a time zhu dan xi brought his knowledge of materia medica,

> formulas and theory together into essays on the treatment of specific

> diseases, as so many others have also done. But in coming up with

> their successful strategies, didn't these doctors basically " search "

> their own brains for prior information about pathomechanisms, herb

> functions and classical prescriptions to develop their formulas. A

> modern database that has boolean search capabilities should allow one

> to access all the theory, herb and formula data that correlate to a

> precise set of parameters. If your herb and formula database was

> sufficiently broad enough, couldn't one access the information

> necessary to treat any symptom or chief complaint listed in a formula

> or herb texts without having to resort to a separate disease database.

>

> The question is whether internal medicine texts still offer something

> unique and valuable above and beyond a " sort and search " of patterns,

> herbs and formulas. Well, they provide detailed information on the

> pathomechanisms of symptoms , but this could also easily be digitized.

> They may record the valuable experiences of an individual. A random

> sort and search gives you rational choices, but only experience

> verifies if those choices are valid. We might combine any number of

> herbs as the primary strategy for treating phlegm, but instead we

> combine ban xia and chen pi. OTOH, perhaps we hold these experiences

> too sacrosanct. Qin bo wei says to respect the idea, not the formula

> itself. In chinese culture, great new ideas had to pass a test of

> literacy and cultural correctness. They were not subjected to any

> clinical testing. for example, for centuries, the prevailing theory

> about aging involved an extrapolation of zhu dan xi's ideas on yin xu.

> Now this premise has been challenged by yan de xin, who not only

> grounds his ideas in the classics, but for which modern research seems

> to offer strong confirmation. Clearly, it would be remiss to ignore

> past experience as it has been collected in int. med. texts. But it

> would also be remiss to not avail ourselves of the technology that will

> allow us to explore unexplored possibilities and novel ideas merely by

> having more powerful ways of sifting through existing data.

>

> I have long argued that there is more TCM data and essays already

> available in English than most folks would ever read in a lifetime. We

> have often heard the argument on this list that since 99% of chinese

> medical literature is untranslated, if you can't read medical chinese

> pretty well, you don't have access to what you need to practice

> effectively. However, no one is really saying that we need access to

> more herbs or more formulas in our pharmacies. The missing genres are

> largely case studies and internal medicine literature. But much of

> that " missing " int. med. data may actually be already available between

> existing materia med and formula texts. It just has not been sorted

> for convenient use. As for case studies, they are indeed useful, but

> educational theory shows that working through cases is infinitely more

> educational than just reading them. Clever software design can

> actually turn cases into exercises that reinforce basic knowledge and

> improve prescription writing.

>

>

>

> Chinese Herbs

>

>

> FAX:

>

>

>

> Chinese Herbal Medicine offers various professional services,

> including board approved continuing education classes, an annual

> conference and a free discussion forum in Chinese Herbal Medicine.

>

>

>

>

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On May 11, 2004, at 11:59 AM, wrote:

 

>

> 2) We do need two good English language textbooks, however, one on

> multi-pattern diagnosis and treatment ( a how-to book with case

> histories and prescriptions), and one that emphasizes

> pathomechanisms. 

> The English literature is poorly represented in explaining

> pathomechanisms.  This is the key to treatment of diseases, knowing

> how

> they develop, how patterns become more complex over time, and the keys

> to unravelling these complex patterns.

>

>

 

I would agree but also say these are both necessary for utilizing such

a database optimally, but not necessary to create one that is quite

comprehensive for 100's of herbs, formulas and points. but the lack of

such texts also inhibits current nondigitized practice and perhaps even

more than it would digitized access to the same data. Books cannot

display all relevant information on the one page if they are located in

different chapters or volumes. So even w/o such texts, the digitizing

of current material would not make matters any worse. In addition, the

digitizing of the data would begin to answer the question if there is

enough information out there. Finally, I learned this style of

practice from my personal teachers, including Wei Li, Guohui Liu,

Subhuti Dharmananda, Heiner Fruehauf and Tim Timmons. I was encouraged

further by the writings of Bob Flaws and CS Cheung. As for

pathomechanisms, more insight is always better, but I think the current

literature, between Wiseman's PD, Flaws work and Sionneau's plus

various other sources, is pretty ripe. More to be said for purely

academic purposes. Sure. But for increased clinical efficacy in

general practice, I am not so sure.

 

 

Chinese Herbs

 

 

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On May 11, 2004, at 11:59 AM, wrote:

 

>

> 4) I think we need to look to individuals such as Bob Felt who are

> investigating computer databases that could effortlessly access the

> Chinese language CM literature and make it available to us, perhaps

> with Wenlin-style tools.  This way, there wouldn't be the unfortunate

> lacunae that exist in the English language literature. 

 

 

This type of project is also something I have also suggested here and

would support in any way.

 

 

 

Chinese Herbs

 

 

FAX:

 

 

 

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On May 11, 2004, at 11:59 AM, wrote:

 

>

> 3) Because of this, I do not agree that there is enough material in

> English to do justice to a computer database.  Any computer program

> would have to help students and practitioners determine the underlying

> pathomechanisms first, before determining treatment strategies.  Also,

> we still do not have a comprehensive source for all available zang-fu

> patterns, not to say patterns classified as jing-luo, six channel,

> four

> aspect, three burner, qi/blood and fluids.

>

>

 

 

 

again,I believe all the problems you describe are real, yet even more

magnified when relying on print media.

 

 

 

Chinese Herbs

 

 

FAX:

 

 

 

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