Guest guest Posted August 2, 2004 Report Share Posted August 2, 2004 If a patient has a life threatening illness, how does one decide the best course of action. Most of our patients are not gravely ill, so we have a rather wide latitude in choosing treatment options. But when a patient has been given a short time to live, according to WM, the circumstances are different. In this case, hep C, stage 4 cirrhosis, hi viral load, hi enzymes, ascites; 50% 1 year survival. The patient has both the money and the desire to do anything necessary to beat this. too bad for the late stage dx. Anyway, in such a case, if there is a standard proven protocol, even if fairly allopathic, is it best to use this approach or to use pure pattern dx, completely individualized without regard for modern disease data. What I mean by standard proven protocols is the use of various supplements, such as glutathione, NAC, vitamin C, milkthistle plus formulas like xiao chai hu tang. At oregon health sciences university, they have been using such a protocol for about 8 years now. They reportedly have reversed and halted cirrhosis in numerous patients, though still not enough to qualify as controlled research. I believe they are either applying for an NIH grant or are in the process of a study. They use a variation of xiao chai hu tang and they may modify it slightly based upon presentation. But the treatment is largely allopathic. But it appears to work in almost all patients to some degree. The question is whether it is better for the patient to treat them all with xiao chai hu tang (jia jian, let's say to be fair) or to treat them with whatever formula seems best from any perspective deemed fit by the herbalist. Some will use latent heat ideas, others ribside pain, others yin fire, other wen bing damp heat, other jaundice, other accumulations and gatherings. All valid, IMO. But this nagging thought that its the xiao chai hu tang. Part of this comes down to the disease/pattern issue. But without evidence that another approach works (as not all will), what is the most ethical course of action in a patient for whom time is of the essence. You know you have a pretty good shot with the standard protocol, but you may have a better (or worse) shot with the pure CM approach. I recall in the famous Bensoussan IBS study that short term results were more impressive in the standard group, while longterm was better in the tailored group. Would that perhaps argue for using a standard protocol to get the Disease under control followed by a tailored approach for long term consolidation of the Pattern. Chinese Herbs FAX: Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 2, 2004 Report Share Posted August 2, 2004 , wrote: > The patient has both the money and the desire to do anything necessary > to beat this. too bad for the late stage dx. > The question is whether it is better for the patient to treat them all > with xiao chai hu tang (jia jian, let's say to be fair) or to treat > them with whatever formula seems best from any perspective deemed fit > by the herbalist. Some will use latent heat ideas, others ribside While I cannot help you with the technical aspects of this case, the ethical issue does not seems so complicated as long as the patient makes the choice, rather than you. If you present the patient with different treatment plans along with whatever information you have about the efficacy of those treatments, along with any risks involved, then the patient can make the choice. I realize the patient cannot make as informed as a decision as you can, but this happens in WM all of the time. Someone see a doctor, he recommends knee surgery. Now it is up to the patient to decide if he wants his knee operated on or if he wants some form of physical therapy. The treatment is not forced on the patient. The patient is the one that decides based on whatever information they have. Brian C. Allen Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 2, 2004 Report Share Posted August 2, 2004 The question is whether it is better for the patient to treat them all with xiao chai hu tang (jia jian, let's say to be fair) >>>>I always vote for proven approaches than theoretical ones. If the protocol truly works then it is almost malpractice to use unproved pathways Alon Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 2, 2004 Report Share Posted August 2, 2004 I think its a great question but I think you will find a dozen or so protocols that use something other than Xiao Chai Hu Tang. The question is whether these other protocols are " proven " to one's satisfaction by your/our standards. They come from China and because they use theory less familiar to our rather well observed and understood Xiao Chai Hu Tang, one naturally becomes suspicious. If one weren't versed in less common theoritical models then I would go with the Xiao Chai Tang. doug , " alon marcus " <alonmarcus@w...> wrote: > The question is whether it is better for the patient to treat them all > with xiao chai hu tang (jia jian, let's say to be fair) > >>>>I always vote for proven approaches than theoretical ones. If the protocol truly works then it is almost malpractice to use unproved pathways > Alon > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 3, 2004 Report Share Posted August 3, 2004 The other issue here is that someone in this condition would probably not be the subject of the clinical trials. Xiao Chai Hu Tang helps people for the most part when they are non- symptomatic. In this case a different tact when be in order. My first patient as an intern was in this kind of shape with diabetes thrown into the mix. With the expert herbal help of Yang Yetian he lived for several years longer at least. doug , wrote: > If a patient has a life threatening illness, how does one decide the > best course of action. Most of our patients are not gravely ill, so we > have a rather wide latitude in choosing treatment options. But when a > patient has been given a short time to live, according to WM, the > circumstances are different. > > In this case, hep C, stage 4 cirrhosis, hi viral load, hi enzymes, > ascites; 50% 1 year survival. > > The patient has both the money and the desire to do anything necessary > to beat this. too bad for the late stage dx. > > > The question is whether it is better for the patient to treat them all > with xiao chai hu tang (jia jian, let's say to be fair) or to treat > them with whatever formula seems best from any perspective deemed fit > by the herbalist. Some will use latent heat ideas, others ribside > pain, others yin fire, other wen bing damp heat, other jaundice, other > accumulations and gatherings. All valid, IMO. But this nagging > thought that its the xiao chai hu tang. Part of this comes down to the > disease/pattern issue. But without evidence that another approach > works (as not all will), what is the most ethical course of action in a > patient for whom time is of the essence. You know you have a pretty > good shot with the standard protocol, but you may have a better (or > worse) shot with the pure CM approach. I recall in the famous > Bensoussan IBS study that short term results were more impressive in > the standard group, while longterm was better in the tailored group. > Would that perhaps argue for using a standard protocol to get the > Disease under control followed by a tailored approach for long term > consolidation of the Pattern. > > > > Chinese Herbs > > > FAX: > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 3, 2004 Report Share Posted August 3, 2004 Xiao Chai Hu Tang helps people for the most part when they are non- symptomatic >>>From what Todd wrote the use of xiao chi hu is integrative within a protocol. I do not think you can then apply the outcome or information when used on its own within TCM practice. Alon Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 4, 2004 Report Share Posted August 4, 2004 , " bcataiji " <bcaom@c...> wrote: > > If you present the patient with different treatment plans along with > whatever information you have about the efficacy of those treatments, > along with any risks involved, then the patient can make the choice. good point. thanks. informed consent. how does one present the options in an unbiased way? Quote Link to comment Share on other sites More sharing options...
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