CM pattern discrimination, genes & CAA

[Guest guest]

Issue #6, 2004 of Zhong Yi Za Zhi (Journal of ), p.

450-452, Sun Wei-zheng et al., " Study on the Correlation of CM Pattern

Discrimination, Chronic Aplastic Anemia (CAA) & MHC-DRB1 Allelic Genes. "

 

This study shows a correlation between the frequency of the MHC-DRB1

0301 gene in presenting a kidney yang vacuity pattern of CAA. This

suggests a genetic basis for the immunoregulative defect associated

with this disease and a particular CM pattern. The frequency of

MHC-DRB1 genes was not related to those with CAA who presented a

kidney yin vacuity pattern. In the authors' conclusion, they say this

is important or useful information because it is a step towards making

CM pattern discrimination more objective.

 

Bob

[Guest guest]

, " Bob Flaws " <pemachophel2001>

wrote:

In the authors' conclusion, they say this

> is important or useful information because it is a step towards making

> CM pattern discrimination more objective.

>

 

 

Bob

 

You know its kind of funny. But we debate this issue here as if the case was

still open.

But its really not. The chinese will proceed with this task whether we all

approve or not.

We can either embrace this trend and integrate into what we do or the day will

come when

there will enough data of this type for MD's to practice a semblance of bian

zheng style

TCM without us. If we have sit on the sidelines during this development, that

is where we

will ever remain, a quaint anachronism of days gone by. Embracing mysticism is

not our

only path to doom, rejecting science is right up there, too.

 

[Guest guest]

 

 

Mmm. Talk about Westerners heads in the sand, on pages 56-59 of issue

#6, 2004 of Shan Xi Zhong Yi (Shanxi ), there is long

article which is a literature review on the correlation of various WM

parameters and CM pattern discrimination specifically vis a vis DM.

Studies have correlated everything from fasting blood glucose, LDL,

HDL, total serum cholesterol, triglycerides, ACTH/cortisol ratios,

serum T3 and T4, serum ANF, endothelin, CD4/CD8 ratios, various types

of interleukins, TNF-a, HbA1C, and even zinc, creatine, copper, and

magnesium levels to various CM patterns of DM. And there's another 30%

of the article I haven't taken the time to look up what the WM

acronyms mean.

 

Bob

[Guest guest]

Mmm. Talk about Westerners heads in the sand, on pages 56-59 of issue

#6, 2004 of Shan Xi Zhong Yi (Shanxi ), there is long

article which is a literature review on the correlation of various WM

parameters and CM pattern discrimination specifically vis a vis DM.

Studies have correlated everything from fasting blood glucose, LDL,

HDL, total serum cholesterol, triglycerides, ACTH/cortisol ratios,

serum T3 and T4, serum ANF, endothelin, CD4/CD8 ratios, various types

of interleukins, TNF-a, HbA1C, and even zinc, creatine, copper, and

magnesium levels to various CM patterns of DM. And there's another 30%

of the article I haven't taken the time to look up what the WM

acronyms mean.

 

Bob

>>>>Bob can you translate the article

Thanks Alon

 

 

[Guest guest]

, " Bob Flaws " <pemachophel2001>

wrote:

 

Studies have correlated everything from fasting blood glucose, LDL,

> HDL, total serum cholesterol, triglycerides, ACTH/cortisol ratios,

> serum T3 and T4, serum ANF, endothelin, CD4/CD8 ratios, various types

> of interleukins, TNF-a, HbA1C, and even zinc, creatine, copper, and

> magnesium levels to various CM patterns of DM.

 

Its practically a fait accompli and we are still arguing about what the

classical

subjective criteria for a proper TCM dx are. Again, an issue which has largely

been settled

by consensus in China. Again, to reiterate to those who recoil in horror from

such posts, I

am talking about TCM, not CM as a whole. Meridian and 5 phase therapists can

set their

own standards and whether they use any modern science or not, I couldn't care

less. It is

also is of no concern to me if people want to practice some form of pure CM they

have

concocted in their minds. I just want to see this strand developed as I believe

it presents a

great hope for the future. But if we do not participate actively in this trend,

we will be

unhappy with the outcome.

 

Several years ago, when PCOM had a research director, I argued to apply for an

existing

project grant. The NIH really wants some validity studies done on traditional

diagnostics.

Instead, this poor misguided gentleman devoted all his efforts to write a grant

for the use

of macrobiotics in prostate cancer. This was a personal interest of his and no

amount of

discussion could make him understand that macrobiotics was not TCM and that

existing

chinese studies suggested the chances of success in a dietary intervention for

cancer were

about nil. When I asked him about herbs, this fellow told me that herbs are no

better than

drugs and he would have nothing to do with them. This is the level of misguided

idiocy

that reigns supreme in the field. Know nothings with pet projects driving the

profession

to an early demise in an attempt to achieve personal glory and vindication of

long held

beliefs.

 

 

[Guest guest]

, " Alon Marcus " <alonmarcus@w...>

wrote:

 

>

> Bob

> >>>>Bob can you translate the article

> Thanks Alon

 

 

As many of you know, Bob translates such articles for a living and publishes

them in his

online quarterly journal. While formerly free, there is now a nominal charge

for the huge

volume of information you receive in what is without a doubt the best journal of

TCM in

english today. I would urge everyone who wants Bob to continue with this to pay

him to

do so. Contact BP to . I have no vested interest in this matter.

 

[Guest guest]

Alon,

 

Can I? Sure, I can. Will I? Hmmm, this is how I make my living. How

much you willing to pay? It's a long article by Chinese journal

standards. I reckon it'd cost around $2-300, i.e., several hours work.

 

Bob

[Guest guest]

Todd-

 

>Its practically a fait accompli and we are still arguing about what

>the classical

>subjective criteria for a proper TCM dx are. Again, an issue which

>has largely been settled

>by consensus in China. Again, to reiterate to those who recoil in

>horror from such posts, I

>am talking about TCM, not CM as a whole.

 

I would encourage you or whoever has access to these standards of

pattern discrimination to publish them, or make them available to the

TCM community in some fashion. Without a clear set of standards, it

will be impossible to do any clinical research on TCM as TCM.

Without a coherent set of standards as to what constitutes each

particular pattern, studies about how herbal formulas or acupuncture

protocols work to treat disease entities according to patterns will

be useless. A colleague of mine has spoken to several TCM researches

from China, and everyone there seems to know about these standards.

We are being remiss in the US if we do not even have a copy of these

to refer to, and we will have to waste precious time developing our

own standards without them.

 

>The NIH really wants some validity studies done on traditional diagnostics.

 

Richard Blitstein and I are working here in Chicago on some

preliminary research on traditional diagnostics. We are looking into

inter-rater reliability in tongue diagnosis first, and later hope to

do more work on inter-rater reliability with the other pillars of

diagnosis. If two clinicians cannot consistently see the same signs

and symptoms for the same patients (within reason of course), how can

we expect them to come up with similar pattern diagnosis? The next

step would be to have the list of standards of pattern

differentiation for clinicians to refer to. Then we could establish

what type of inter-rater reliability there is in coming to a pattern

diagnosis.

 

Patterns may as well be a figment of our collective imaginations

without studies verifying that two different clinicians can

consistently come to the same conclusions about the same patient.

Only after we can reliably demonstrate that clinicians see the same

patterns can we then test how to treat them. Unfortunately, all of

this research may take quite a while to get going by ourselves, and

we would love it if more people were working on this kind of thing.

We believe that without this work, we will never be able to establish

that patterns exist as a relevant entity, clinically speaking.

 

The work being done in China that Bob is talking about is clearly

where the medical field (biomedical or TCM) is going. Given all the

hoopla about the human genome and tailoring treatment to people based

on genotype, Western Medicine will get to a version of pattern

diagnosis sooner or later. We hope that TCM will be part of that

picture. If we continue to shy away from the scientific inquiry into

our methods, however, we may very well be relegated to a footnote in

the history of medicine.

 

-Steve

--

Stephen Bonzak, M.S., L.Ac.

Lecturer, Department of Herbal Medicine

Pacific College of Oriental Medicine - Chicago

773-470-6994

[Guest guest]

While I can appreciate Bob's response here........it makes it difficult

for Todd's (and mine) wish to come true in terms of TCM modernising and

approaching the Chinese standard for such things as Pattern/Lab-result

correlation's that are understood currently in China.

 

The problem is obviously that we can't approach this level of knowledge

without individually being translators of Chinese or paying $2-300

dollars a pop for an article to be translated.

 

If this information is as vital as some of us feel it is.........why

road-block it? Does the benefit of having this knowledge available for

a profession in English outweigh monetary gain? A dilemma I don't have

the answer to by the way.

 

I believe Bob should be compensated for his work and I also believe

there is merit in having this information freely available.

 

Perhaps this is an area the numerous political/professional

associations should sponsor for the benefit of our profession. Oh, but

that would require working as a team wouldn't it? Something the vested

interests of these bodies wouldn't know if they fell over

 

It is one thing to throw dollars at TCM research in the west; but

wouldn't an appropriate portion of this money be better spent giving us

access to the research already done in China? What is the point in

reproducing something that has been studied for decades in China that

will only be ridiculed by the WM machine and be of little benefit to

patients? I would rather see this money spent on bringing us out of the

80's in terms of TCM education in the west by increasing access to the

Chinese Research Literature. Even if much of it is of questionable

value; I am sure there are diamonds there that those of us that have

yet to master Chinese would benefit from.

 

Just some thoughts,

 

Steve

 

On 02/09/2004, at 2:06 AM, Bob Flaws wrote:

 

> Alon,

>

> Can I? Sure, I can. Will I? Hmmm, this is how I make my living. How

> much you willing to pay? It's a long article by Chinese journal

> standards. I reckon it'd cost around $2-300, i.e., several hours work.

>

> Bob

>

>

>

>

>

>

Dr. Steven J Slater

Practitioner and Acupuncturist

Mobile: 0418 343 545

chinese_medicine

 

 

 

[Guest guest]

Steve,

 

I second your encouragement for this to happen.

 

Unfortunately, everyone seems to have vested interests in today's

world. The sharing of information that will benefit our professional

and therefore our patients is still controlled by the few in the West

who have access to Chinese sources and utilised this control to make

money.

 

Sure, the individuals worked damn hard to obtain this access; but the

vested interest of " money above all " results in it trickling out while

the WM and the Chinese streak away into the future.

 

We no longer seem to have the traditional ethics of doctor's

past...............

 

Another Steve...

 

On 02/09/2004, at 2:38 AM, Stephen Bonzak wrote:

 

> I would encourage you or whoever has access to these standards of

> pattern discrimination to publish them, or make them available to the

> TCM community in some fashion.  Without a clear set of standards, it

> will be impossible to do any clinical research on TCM as TCM.

> Without a coherent set of standards as to what constitutes each

> particular pattern, studies about how herbal formulas or acupuncture

> protocols work to treat disease entities according to patterns will

> be useless.  A colleague of mine has spoken to several TCM researches

> from China, and everyone there seems to know about these standards.

> We are being remiss in the US if we do not even have a copy of these

> to refer to, and we will have to waste precious time developing our

> own standards without them.

>

>

Dr. Steven J Slater

Practitioner and Acupuncturist

Mobile: 0418 343 545

chinese_medicine

 

 

 

[Guest guest]

> I would encourage you or whoever has access to these standards of

> pattern discrimination to publish them, or make them available to

the > TCM community in some fashion.

 

The standards that you are talking about are protected by Chinese and

international copyright law. The publisher is the Nanjing University

Publishing Co., ISBN 7-305-02723-5. The standards are not for ideal

patterns. They are for CM patterns of specific diseases as well as for

judging outcomes. These standards were written and adopred

specifically to make the kind of research you want doable.

 

Because they are protected by copyright, there's no financial

incentive to translate these, at least not by a single person. I have

previously suggested that a consortium of people each translate a

section and that the sections could then be reassembled. Not enough

people with the skills and/or interest.

 

Without a clear set of standards, it

> will be impossible to do any clinical research on TCM as TCM.

> Without a coherent set of standards as to what constitutes each

> particular pattern, studies about how herbal formulas or acupuncture

> protocols work to treat disease entities according to patterns will

> be useless. A colleague of mine has spoken to several TCM researches

> from China, and everyone there seems to know about these standards.

> We are being remiss in the US if we do not even have a copy of these

> to refer to, and we will have to waste precious time developing our

> own standards without them.

 

This supports my long-held contention that anyone considered an

authority in CM must possess a basic reading knowledge of Chinese. I

believe that, at this point in time, all younger Chinese CM

practitioners are expected to have a basic reading knowledge of

English because that is the international language of Western medicine.

 

> Richard Blitstein and I are working here in Chicago on some

> preliminary research on traditional diagnostics. We are looking into

> inter-rater reliability in tongue diagnosis first, and later hope to

> do more work on inter-rater reliability with the other pillars of

> diagnosis. If two clinicians cannot consistently see the same signs

> and symptoms for the same patients (within reason of course), how can

> we expect them to come up with similar pattern diagnosis?

 

I recently read a Chinese article on correlating actual clinical signs

and symptoms in a particular respiratory disease (maybe COPD) with

those described in the traditional literature. The point of the study

was to see if the literature was accurate in terms of contemporary

clinical practice. In other words, they were attempting to see if the

patterns are real.

 

The next > step would be to have the list of standards of pattern

> differentiation for clinicians to refer to. Then we could establish

> what type of inter-rater reliability there is in coming to a pattern

> diagnosis.

 

Inter-rater reliability is a huge issue in CM, but one which the

Western rank and file are blissfully unaware of. The establishment of

inter-rater reliability has been the thrust of my own teaching of CM

pulse examination for years.

 

> Patterns may as well be a figment of our collective imaginations

> without studies verifying that two different clinicians can

> consistently come to the same conclusions about the same patient.

> Only after we can reliably demonstrate that clinicians see the same

> patterns can we then test how to treat them. Unfortunately, all of

> this research may take quite a while to get going by ourselves, and

> we would love it if more people were working on this kind of thing.

> We believe that without this work, we will never be able to establish

> that patterns exist as a relevant entity, clinically speaking.

>

> The work being done in China that Bob is talking about is clearly

> where the medical field (biomedical or TCM) is going. Given all the

> hoopla about the human genome and tailoring treatment to people based

> on genotype, Western Medicine will get to a version of pattern

> diagnosis sooner or later.

 

Interesting observation.

 

Bob

[Guest guest]

Richard Blitstein and I are working here in Chicago on some

preliminary research on traditional diagnostics. We are looking into

inter-rater reliability in tongue diagnosis first, and later hope to

do more work on inter-rater reliability with the other pillars of

diagnosis.

<<<ACTCM is also involved in doing a study with UCSF. I hope you guys get better

results than we got with our study

alon

 

 

[Guest guest]

, Steve Slater <dragonslive@h...>

wrote:

 

>

> Sure, the individuals worked damn hard to obtain this access; but the

> vested interest of " money above all " results in it trickling out while

> the WM and the Chinese streak away into the future.

 

Steve

 

You can hardly be suggesting that if a particular skill is vitally important to

the long term

viability of a larger community, then those few who possess that skill should

give away

that skill for free. I think the case is stronger for why people should learn

to read chinese.

In this case, the skill we are referring to is the ability to read chinese. It

is freely accessible

to all who are willing to try, so this skill is not really elitist. It is not

like if one person

knows the cure for cancer and won't share it. Translation is very hard work. I

personally

refuse to do it; just don't have the temperment for it. If we insist that a

text or article is so

essential that it must be freely distributed without regard for ownership, where

do we

draw the line?

 

Rather than demanding that privately owned companies do pro bono work for the

field,

why not demand that our professional organizations and schools step up to the

plate. I

believe the traditional responsibility for producing fair use documents of this

sort in the

US has lain with universities and the government, not with private enterprise.

If the other

Steve is correct that all the chinese he speaks with are familiar with these

standards, it

would seem there would be multiple avenues of access to the material and more

than a

few people who could easily translate such a document. By your argument that

ethics

should prevail here, we should all then give all our services away for free.

The care you

give to your patients, the education I give to my students, all the books

everyone writes,

these are all " essential " to someone somewhere.

 

[Guest guest]

, Stephen Bonzak <smb021169@e...>

wrote:

 

> We believe that without this work, we will never be able to establish

> that patterns exist as a relevant entity, clinically speaking.

 

 

Steve

 

I am very excited about your project with Rich. As you know,it is exactly what

I have been

suggesting here for years. It makes me even more pleased that two of our most

esteemed graduates of PCOM-Chicago have picked up this ball. Please let me know

anything we can do here in SD to help with this study in the future. I hope you

will be

applying for an NIH grant. They already have a number of project announcements

at this

page that might be appropriate to fund your research.

 

http://www.nccam.nih.gov/research/announcements/pa/index.htm#active

 

[Guest guest]

On 02/09/2004, at 7:32 AM, wrote:

 

>

> >

> > Sure, the individuals worked damn hard to obtain this access; but

> the

> > vested interest of " money above all " results in it trickling out

> while

> > the WM and the Chinese streak away into the future.

>

> Steve

>

> You can hardly be suggesting that if a particular skill is vitally

> important to the long term

> viability of a larger community, then those few who possess that

> skill should give away

> that skill for free.  I think the case is stronger for why people

> should learn to read chinese. 

> In this case, the skill we are referring to is the ability to read

> chinese.  It is freely accessible

> to all who are willing to try, so this skill is not really elitist. 

> It is not like if one person

> knows the cure for cancer and won't share it.  Translation is very

> hard work.  I personally

> refuse to do it; just don't have the temperment for it.  If we insist

> that a text or article is so

> essential that it must be freely distributed without regard for

> ownership, where do we

> draw the line? 

>

 

I agree the case for reading Chinese is important and I am personally

pursuing this at the moment. I never suggested the currently skilled do

translation for free (I am not that naive) and in fact stated they

should be rewarded. I was just stating what I believe is an objective

fact of modern life.......that people have a pathological vested

interest in money above all and don't think of humanity is important

enough to sacrifice this interest.

 

I am guilty of this modern attitude also; just not as much as some.

 

> Rather than demanding that privately owned companies do pro bono work

> for the field,

> why not demand that our professional organizations and schools step

> up to the plate. 

 

This is exactly what I suggested in my other post.

 

> I

> believe the traditional responsibility for producing fair use

> documents of this sort in the

> US has lain with universities and the government, not with private

> enterprise.  If the other

> Steve is correct that all the chinese he speaks with are familiar

> with these standards, it

> would seem there would be multiple avenues of access to the material

> and more than a

> few people who could easily translate such a document.  By your

> argument that ethics

> should prevail here, we should all then give all our services away

> for free.  The care you

> give to your patients, the education I give to my students, all the

> books everyone writes,

> these are all " essential " to someone somewhere.

>

> Todd

>

 

I didn't argue that ethics should prevail...........I just stated what

the current situation is. Simple as that. I didn't intend to give the

impression that I was casting judgement on the right or wrong of it

all......just how the ethics of doctors is not longer what it was. I

don't see issue with this fact.

 

So.......we need an alternative method for giving access of this

material in today's money driven world. Lobbying for funds for this

purpose by our professional bodies and educational institutions should

be encouraged as should funnelling some of our " fees " for membership in

this direction.

 

I don't know why you are so quick to jump to the defence of some

private enterprise when I never suggested they should give it all away

for the pleasure of helping our profession.

 

Unitl this happens; I will continue to spend around 10% of my gross

income on purchasing texts from quality publishers like Blue Poppy,

Paradigm et al. who produce such material for my/their benefit.

 

 

Best Wishes,

Steve

 

>

>

>

Dr. Steven J Slater

Practitioner and Acupuncturist

Mobile: 0418 343 545

chinese_medicine

 

 

 

[Guest guest]

After reading one of the latest UTNE articles, where $3 million were given

to study prayer, I can't imagine that we can't get some $$$.. What is the

problem???

 

-

 

 

 

Wednesday, September 01, 2004 3:43 PM

 

Re: CM pattern discrimination, genes & CAA

 

, Stephen Bonzak <smb021169@e...>

wrote:

 

> We believe that without this work, we will never be able to establish

> that patterns exist as a relevant entity, clinically speaking.

 

 

Steve

 

I am very excited about your project with Rich. As you know,it is exactly

what I have been

suggesting here for years. It makes me even more pleased that two of our

most

esteemed graduates of PCOM-Chicago have picked up this ball. Please let me

know

anything we can do here in SD to help with this study in the future. I hope

you will be

applying for an NIH grant. They already have a number of project

announcements at this

page that might be appropriate to fund your research.

 

http://www.nccam.nih.gov/research/announcements/pa/index.htm#active

 

 

 

 

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.

 

 

 

 

[Guest guest]

Steve,

 

My reply was meant specifically for Alon. I was trying to point out to

him the utility and value of reading Chinese for yourself. In the

past, Alon has said that this ability is not worth the time and effort

for him to acquire. I was simply pointing out to him what it costs in

real-world terms if you have to " rent " that ability from others. As

for my donations to the profession as a whole, they are a matter of

record. I'm quite willing to compare my contributions to anyone's.

 

Bob

[Guest guest]

On Sep 2, 2004, at 8:47 AM, wrote:

 

> After reading one of the latest UTNE articles, where $3 million were

> given

> to study prayer, I can't imagine that we can't get some $$$.. What is

> the

> problem???

 

We need to pray more? ; )

 

--

 

Pain is inevitable, suffering is optional.

-Adlai Stevenson

[Guest guest]

Ken, Simcha, Lorraine, Jason B, Z'ev, Holger, Emmanuel (and anyone else who I

may have left out)........

 

This has been a great conversation. I've been following along and enjoying the

give and take. Lorraine, I've been especially enjoying your musings on

translation. Z'ev- can we be in both the " spiritual world " and the world where

you don't see ghosts at the same time? This seems to be a skill that some have

and some don't. I don't see many ghosts but am told that I grew up in a house

where people were hearing, seeing and sensing an old lady all the time. I

believe that she's there even though I never saw her. As usual, Ken asks the

meta-questions that ultimately take centuries to answer- keeps us thinking

beyond the original strings. Jason B, thanks for bringing up the whole thread

on Unscheld in the first place. I also have my doubts about the vaunted

" biurfication " as well but need to be more informed on Unscheld's position

before I take my own.

 

I've been translating for nearly two years now the thoughts of a particular

doctor from Beijing. Part of what I'm translating includes narrative

discussions that are sometimes led into by my own thoughts on subjects that came

up during my work in Beijing. If you guys are feeling indulgent, you may want

to read the following narrative. It kind of picks up a few of the strings

you've been talking about in the last week and adds a few thoughts on the

subject by a Chinese doctor who has mused on these incongruities as

well........................... If the formatting comes out right, the italics

are Dr. Wang Ju Yi speaking......

 

 

Narrative- The Spirit of

 

 

In the previous chapter, the concept of spirit was discussed. In our

conversations about the functions of the Shao Yin system, I would often try to

steer towards the subject of how Dr. Wang's understanding of spirit and the

interplay of the seven emotions is applied in the clinic. The discussion would

inevitably be very interesting not only because these are concepts about which

Dr. Wang has thought a great deal but also because of what it revealed about my

own pre-conceptions. Specifically, we both came to realize that there were some

fairly profound differences in what we both mean when we use the term " spirit "

(shen) or " spiritual " (xin ling de).

 

 

 

Many foreigners who come to the People's Republic in the early 21st century are

looking for the " spiritual side " of the medicine and are disappointed to find

huge, under-funded hospitals full of poor people with non-existential

complaints. A two week tour of a major big city hospital or even a four-year

course in undergraduate TCM training in China leaves gaping holes of

expectation. So many have had these types of experiences that we often hear

complaints about how the communists have vacuumed the 'spirit' right out of the

Nei Jing in their efforts to create a traditional medical edifice worthy of the

respect of their western scientific colleague s. What happened in the 21st

century to Chinese medicine? Where is the qi of the medicine today? Did the

medicine ever " have qi " as we understand that statement outside of China? In

fact, the very concept of qi seems to always be the goal on the ever-receding

horizon; that philosopher's stone within the minds-eye of Chinese medicine.

What is a clear, concise and (especially in the 21st century) provable

definition of " qi " ? Is it possible that we have built up a romanticized

edifice that existed neither in modern China nor in the mists of history?< SPAN

style= " mso-spacerun: yes " > These are the questions that many are asking as the

field enters a new stage of maturity where texts are not accepted

unquestioningly and the claims that we make as healers are coming under scrutiny

as more and more money is at stake. Unfortunately, my discussions with Dr. Wang

didn't answer all of these questions. In fact, questions of this type are

actually the subject of entire books and even careers.

 

 

 

Just finding a way to convey these questions as a foreigner in China is a

challenge. First of all- what exactly is the question? What do we mean as

students when we say that we are interested in the " spiritual side of Chinese

Medicine? Are we talking about qi gong, about applications for psychology,

about mystical Daoism or the Chinese understanding of the somatization of

disease? Often, foreign students don't even know specifically what it is they

want to learn. Instead, there is simply a sense that there must be more going

on beneath the surface given the tantalizing hints in basic textbooks about

spirit, souls and destiny.

 

 

 

The problem of framing the question is compounded by the fact that one of the

greatest gulfs that exists between the Chinese TCM establishment and foreign

students of is caused by subtle stereotypes. These stereotypes

have led to different expectations about the basic goals and motivations of each

side. For example, many Chinese practitioners who have had less experience

with foreigners believe that non-Chinese have a lack of interest in what are

often termed " superstitions. " This belief is compounded by a widely held

conviction in China on the part of many TCM professionals and the public at

large that Chinese medicine is a web of mystery upon mystery that the occ

idental mind will never be able to fully penetrate. Now, contrast these

perceptions with the expectations of foreigners who arrive in China to study.

They are often met by teachers and Chinese friends who believe that they have

little interest in the " mysterious " sides of Chinese medicine and that they

wouldn't really ever be able to understand them even if they tried.

 

 

 

On a cool fall day, Dr. Wang and I came back to the Ping Xin Tang after lunch to

talk over a backlog of questions that I had built up while trying to understand

the qi dynamic of the Shao Yin system. We had been going over and over the

concepts of essence and life gate and I had asked variations of the same

questions from a variety of angles. We were both a bit frustrated, I think, by

the inability of the other to understand what was being said. This had been one

of those situations where it wasn't so much that we were misunderstanding each

other's words but that we couldn't quite get to the heart of the other's

meaning. It was a clear case of a cultural gap. I had be en confused and

frustrated by a few concepts that had actually seemed fairly straightforward to

me a few years back. Basically, I kept asking questions along the lines of,

" what is the relationship of the essence to the ming men fire " and, " exactly how

do the heart and kidney regulate each other's qi dynamic? " Of course, I had in

my mind the explanations of many teachers, textbooks, fellow students and Dr.

Wang himself to this same question. It just didn't seem like enough that,

simply put, " The water-natured kidney acts to balance the fire-natured heart in

a raising and lowering pivot that provides movement " Thinking back on the

conversation, I think that I wanted an answer that spoke of " ancestors " and

" spirit " . Because of my own expectations, I wan ted to hear something like,

" the yin essence of the ancestors is enlivened by the yang presence of the

spirit. " Even more confounding though was the fact that sometimes Dr. Wang

would in fact make " spiritual " statements about the relationships of the organs

to the five minds.

 

 

 

After about an hour of conversation that ranged from the etymology of the

Chinese character we translate as " essence " (jing) to the various uses of the

term " spirit " in modern Chinese, we put the question aside. The results of that

conversation and many others like it are drawn out as carefully as possible in

the previous chapter.

 

 

 

Finally, we both sat back for a moment and I put the question to him in a

different light, " Dr. Wang, you've taught in foreign countries and run into

foreigners of all types who are interested in Chinese medicine. You must know

what I mean when I describe the tendency of students to want to hear more about

the 'spiritual side' (xin ling) of Chinese medicine. We often hear people say

that the communists have removed everything that had soul and left a shell that

tries to satisfy the ideological framework of western medicine. Students always

wake-up if the teacher makes any mention of the seven emotions or ghost points

or Daoist acupuncture styles. What do you ma ke of all of this? Is it

accurate to say these things? Is it worthwhile to pursue these aspects of

classical Chinese medicine? "

 

 

 

I know what you mean by asking this question. In the 1970's, during the early

stages of the recent interest in Chinese medicine, there were more than a few

instances where foreigners came to me wanting to study midday-midnight point

selection (zi wu liu zhu), five periods and six qi (wu yun liu qi) and the

Daoist spiritual turtle tradition (ling gui ba fa). We studied some of these

acupuncture styles as part of our training back in the 1950's and I was

initially very interested as well. It's a misconception, in my opinion, to say

that the communist party conducted an active campaign to 'remove superstitions'

from Chinese medicine in the early stages of developing the system that we now

call 'TCM'. It might be true to say that in the realm of religion or other

aspects of daily life that government policy later, especially during the

Cultural Revolution, did serve to eliminate what were termed 'feudal relics of

thought'. With regards to Chinese medicine though, the official policy at

first was to collect all of the traditions that could possibly be found under

one roof and then to research which ones had merit.

 

 

 

You should remember that this codification was going on during the decade before

the especially disruptive Cultural Revolution. In the 50s, we studied with

teachers who taught the detailed methods for determining the 'open' point in the

midday-midnight theory while other teachers discussed the possibilities for

using the five periods and six qi to predict in advance the onset of illness and

to guide herbal treatment. These ideas were very prevalent in the early decades

of the Beijing University of TCM and, in fact, there are still official

textbooks today on some of these subjects.

 

 

 

I spent some time in the clinic with the doctors who taught these theories

however, and found that often they wouldn't really be applying the approach on

real patients. For example, if they were treating a patient using the

midday-midnight approach, they might use the open points but would always add a

few other points that were addressing the patient's chief complaint. Whether or

not this is part of that style of acupuncture, the most important thing to me is

that there didn't seem to be a difference in clinical results when they used the

open points verses simply using more common acupuncture approaches. Also, I

tried using the midday-midnight approach myself for awhile in the clinic in the

1970's and was neve r impressed with the results.

 

 

 

In my opinion, the same is true for so many of these styles that don't place

emphasis on symptom differentiation and physiological considerations as the

primary determiner of treatment strategy. Yes, they have survived for centuries

in China; often as a means by which doctors can create a mystique around

themselves while enhancing their reputation for depth of study and breadth of

perception. Of course, as we know, there is a certain benefit to treatment

outcomes when a patient believes strongly in the skills of the doctor. In the

end, the reason why there has been less and less emphasis on these traditions in

recent decades is not because of any concerted effort on the part of the TCM

authorities but instead it is a reflection of the fact that they have proven to

be less effective at treating actual patients. I think these ideas are

important as reflections of Chinese culture and the history of Chinese medicine

but shouldn't become the object of huge amounts of effort by students looking

for clinical effectiveness.

 

 

 

Nevertheless, there are aspects of Chinese medical theory that, in my mind,

represent under-researched areas of development for the future. I think that

the concepts of the seven emotions and the five minds, for instance, actually

represent a very subtle understanding of psychology as practiced here in China

for centuries. At first glance, they may seem very simplistic but by keeping

these general guidelines in mind, the practitioner can gain some very helpful

insights into pathology. For example, you remember that patient who came in

here this morning with chronic cough, chest pains and dizziness who was

absolutely terrified of getting SARS (severe acute respiratory syndrome) after

the outbreak here last winter ? She has undergone a battery of western medicine

diagnostic testing without any definitive conclusions. Meridian palpation and

zang-fu diagnosis also showed no real indication of serious disorder but she is

nevertheless obviously coughing and has pain in her chest. This is a type of

patient that can only be addressed by Chinese medicine using what you might term

the " spiritual " ideas from our tradition. This woman's condition remains one

that involves the seven emotions, specifically Shao Yin kidney as her overriding

emotional state is one of fear (kong). The condition is not so advanced that it

has actually affected one of her five minds in which case a western psychologist

might diagnose " psychosis " . Thinkin g along these lines can produce clinical

results. The specific lessons that classical Chinese medicine provides about

psychology are ones that do merit further research. Other ideas that you or

others might term " spiritual " and that I personally believe to have merit

include the eight extraordinary vessels and the multitude of techniques to

improve qi circulation among others.

 

 

 

I continue to believe that, by and large, the people who wrote the ancient texts

that have survived the test of time weren't kidding us. Problems with utilizing

all of the information that those texts provide are largely due to us not really

understanding what they are talking about. Sometimes, modern readers

misinterpret classical texts and end up taking discussions down roads that are

interesting in an academic sense but of little clinical use. This problem is of

course heightened by difficulties with proper translation and I hope that the

information in other languages can be as good as possible. To be honest, by the

way, I have no idea what term you are using in English for this idea of

'spiritual'. Even in Chinese, the term means different things to different

people. Remember that, to me, the character " shen " (shen) refers to the

intelligence of existence. It is an intelligence that, when the heart is

healthy, any person or even animal might have. This intelligence is also

present in the world at large. I know the definition is broad but so is its

meaning. People in China today even speak of the sounds of thunder or

earthquakes as somehow representing the mysterious intelligence of " shen " .

 

 

 

Whatever you might call them, there are certainly concepts in classical texts

that have been underemphasized in our schools and should at least be further

studied. In many cases, the main reason this hasn't been done before is that

resources and priorities were elsewhere. Primarily, resources were focused on

addressing the pressing issues of more commonly seen diseases.

 

 

 

Now there is another trend in the schools of Chinese medicine since the 1950s

that may also have contributed to the impression that many foreigners have after

coming to China to study. This is the trend towards an emphasis on western

medicine at the expense of Chinese medicine. When I studied at the Beijing

University of TCM, probably around 20 percent of our coursework involved western

sciences and treatment. Of course, we spent time learning modern anatomy and

physiology and basic principles of western medical treatment but when it came

down to preparing for clinical practice, it was about learning Chinese medicine.

In fact, some of the best teachers those days talk ed very little about western

medicine. Anyone will tell you now that up to 60 percent of the coursework and

clinical application these days involves western medicine. Because of this

shift in emphasis, many TCM doctors are more comfortable talking about diseases

within the framework of western medicine and are less inclined to discuss some

of the classical concepts that inevitably interest foreigners.

 

 

 

Another trend that began in the 1950's was a more western-style separation of

disease into strict types (fen xing). Although this approach still separated

disease into classical categories, it also created a kind of artificial

structure with very clear lines that were previously less so. For example, most

modern TCM practitioners in the west and even in China think very strictly in

categories like, 'spleen qi deficiency' and 'heart blood deficiency' as ways of

describing dysfunction in qi dynamic. While not necessarily being a direct

infusion of western medicine into our tradition, this represented instead a

fundamental modification of a way of seeing. It takes away s ome of the

flexibility inherent in the system. This is a hard thing for me to explain

clearly.

 

 

 

Well, is there a better way that you can think of to understand pathomechanism

in Chinese medicine?

 

 

 

That's just the thing. If you are going to teach students in a large university

setting, there really isn't a better option. It isn't hopeless though. The

thing to remember is that the categorization of disease taught in the TCM

schools is just a starting place; a kind of structure from which you must

eventually outgrow. Maybe the 'spirit' is found when you outgrow that initial

structure!

 

 

 

 

Jason Robertson, L.Ac.

Ju Er Hu Tong 19 Hao Yuan 223 Shi

 

Beijing, Peoples Republic of China

 

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