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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

 

 

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