cause and effect

[Guest guest]

I was listening to a commentary on the radio about that case in FL with

the feeding tube removal. The doctor said something that stuck with

me. He referred to the persistent vegetative state (PVS) as a

syndrome. He then went on to explain the meaning of syndrome in

western medicine, which is a collection of signs and symptoms that may

be associated with numerous different diseases. But he went further.

Syndromes are, he stated, caused by various pathophysiologies. For

example, PVS is diagnosed by a set of signs and symptoms, but it could

be caused by trauma, infection, drugs and various illnesses.

 

As I heard this, I was reminded of something I read one time about an

MD's view of TCM. Which is that we confuse cause and effect in our

field. We work with the assumption from day one that the patterns we

learn to identify are the CAUSES of the diseases our patients

experience. Depending on how one conceptualizes things, one might

think either spirit, energy or some deeper organizing principle of

physiological systems has been disturbed and the result is a cascade of

changes that eventually manifest in a clearcut disease that western

medicine can label and study on a reductionistic level. But whatever

one's worldview, we all seem to agree that the syndromic change

precedes the manifestation of disease and that the measurable

biochemical changes of disease are the end result of some as yet not

completely understood process (whether natural or supernatural).

 

In other words, we deal with the root of illnesses and WM only

addresses branches. However, some of you may be surprised to know that

that amongst many in WM who are familiar with what we do, there is not

so much lack of understanding as rejection of that basic idea. Just as

Paracelsus rejected the humoral ideas of his contemporaries and

proclaimed that there were 100s of diseases and the humoral syndromes

were not causes, but effects, modern docs feel the same way. Very few

can articulate it since this debate ended a long time ago in WM. But

those who can are adamant that the syndromes of TCM are likewise the

effects of specific disease process and not vice versa. Let me give an

example of the two types of thinking.

 

Lupus -

 

In TCM, this could present as spleen qi xu (fatigue, et. al.), blood

heat (red skin rash), yin vacuity (nightsweats, et. al.) and hot damp

bi (red swollen joints) with blood stasis (focal, sharp pain). An

analysis that assumes a priori that patterns cause disease rather than

vice versa would go something like this. The patient's spleen is

weakened thru diet, dampheat accumulates and burns off the yin,

generating heat in the blood. The combination of internal dampheat and

external invasion results in obstruction of qi and blood. blood stasis

results. On a physiological level, this obstruction in qi flow leads

to gross biochemical and possibly structural changes. Depending on who

you believe, either there is a separate force called qi that controls

gross physiology or there are subtler changes in physiology not

currently measured with current tests, yet still biochemical in nature.

Either way, it is assumed in this analysis that the disease would

never have occurred if the patient had not fallen out of " balance " in

the first place.

 

But from a WM perspective, the disease process, autoimmunity in this

case, disrupts a number of body tissues as it attacks them. This

results in certain syndromes associated with fatigue, rash, etc.

However these syndromes are the result of various disease processes,

not the cause. If an autoimmune process attack the joints, one will

feel pain. One will also feel joint pain if one has a degenerative

process such as osteoarthritis or a bone cancer such as multiple

myeloma. In each case, we might diagnose bi syndrome with qi and blood

stagnation. But what if the disease process has its own life and the

disruptions of qi and blood we treat in TCM are manifestations of

something deeper and that something deeper is the reductionistic world

of biochemistry and WM. In other words, biochemistry and western

pathology explain a level of illness not addressed or explained in any

way by TCM. I think this may be part of the point Alon has tried to

make in the past in his posts about the futility of trying to

differentiate a western disease according to TCM as if TCM so clearly

is the more fundamental of the two medicines. But that is really an

unexamined assumption that I have held myself until just about this

week.

 

So say the reason a person gets lupus may come down to genes and

viruses. The bi syndrome of TCM is then caused by these other more

fundamental processes. You can alter the course of the illness by

addressing the resulting syndrome in the most noniatrogenic way, but

there is really no evidence that any chinese herbal therapy can

actually cure the illness. All the research I have seen only claims

full remission for no more than 15-20% of the patients. And I have

seen no studies that claim to have maintained this cure in long term

followups of 5-10 years. And in fact, all patients I know of are

susceptible to periodic remissions. In other words, you can

successfully control the syndrome, but the disease still lurks below

the surface. Thus many in our field speculate on the deeper causes of

these syndromes such as heavy metals or allergies or stress or latent

pathogens or gu toxins because merely treating the presenting pattern

so often does not suffice in illnesses like lupus. Yet we would not

dare to speculate that the deeper cause is actually already described

accurately in many cases by WM. Why? The other popular root causes of

illness I just listed are pretty reductionistic themselves. The idea

that if you identify the heavy metal that is doing the poisoning or the

allergen that is causing the hypersensitivity or the yeast that is

colonizing the bowel or the emotion that is destroying the mind, then

the syndrome will just disappear. Don't get me wrong, I think all

these things are true in given cases. But if so, we must also accept

that viruses affecting gene expression altering immunity may be one

more fundamental cause of illness. And that TCM in general addresses

a more superficial level of illness than the actual causes.

 

I have been saying for months now that I think TCM's best role is in

its historical strength, the noniatrogenic treatment of daily

suffering. That we probably have little to offer in the permanent cure

of any chronic illness. We can control the symptoms and course of an

illness without making things worse. this is a great thing. But we

can't make the disease go away with our medicine. Even the diseases

that are clearly caused by lifestyle such as lung and colon cancer,

atherosclerosis, diabetes and liver disease cannot be cured by TCM. We

may know what causes them, but we can only offer the same lifestyle

advice as WM. Palliative treatment may decrease blood sugar, protect

against liver damage, decrease cholesterol, etc. But we cannot correct

the root pattern and the symptoms will return. Interestingly,

treatment of blood stasis has shown to have some promise in some

reversal of these conditions, but that also is a fairly modern and

reductionistic allopathic application of chinese herbs based largely

upon modern research into circulation.

 

Now I am not saying that WM has been successful at curing most of these

conditions either. And those in which it has had some success, the

results are mixed. Consider HIV. While some, like Deusberg, may

still insist that AIDS is not caused by the HIV virus, I find their

arguments specious at best. The drug cocktail does suppress the

replication of HIV. And for the majority of patients, there is

dramatic relief from the illness or prevention of the progression. I

have worked with hundreds of AIDS patients as has Mark and Misha and we

all know that without viral inhibition, TCM cannot stop the pathology

from progressing. Non cocktail using Long term survivors who attribute

their health to TCM are a fluke. Research shows that most long term

survivors have no lifestyle or treatment choices in common, but they do

share a weak strain of the virus and good safe sex habits. I watched

dozens of HIV patients decline and die under TCM care before the

cocktail and I also watched them all leap off their deathbeds soon

after receiving the drugs. In other words, the virus caused a

syndrome, not vice versa. Many old timers in our field still associate

AIDS with lifestyle and jing deficiency from excessive sex. Yet if

this was the case, then why did merely suppressing a virus cure most of

these patients. Sure, not without side effects, but far better than

anything TCM has to offer (and those who say otherwise I can guarantee

have not seen many AIDS patients). Jing vacuity should be incurable.

 

No, I think we have to seriously consider that the western analysis of

the disease process may be more fundamental than that described by TCM.

This might be a necessary part of our profession maturing and

accepting its proper role in modern healthcare. Admittedly, western

medicine has largely failed to correctly address the pathologies

described by modern science. But this may reflect only a failure to

properly apply the truly sound fundamental premises and findings of

medical science. Yet this is changing. We are already seeing the

development of much safer and targeted approaches to dealing with

pathology that will result in far fewer side effects. However as long

as diseases persist, so will their associated syndromes. And as long

as WM is unable to address the syndromes adequately, their will be a

vital role for whoever can. In fact, I expect less and less of WM

research will be focused on syndromes and control of signs of symptoms

at the branch and more and more on their perceived roots (mostly at the

gene and stem cell level). This creates a great opening for us if we

want to grab it as our role. Drugstore or healthfood store not meeting

your needs, but not ready to go on Rx drugs: try TCM first. Best

part, no side effects, no toxicity.

 

One final thought. Now I suppose some would say that the fact that

people start to feel poorly years before they actually have an illness

like lupus is proof that syndromes precede disease (the prevailing TCM

worldview, as it were). Well, for one thing, that is not always true.

Many such illnesses are quite sudden in nature. Type diabetes struck

down robust healthy adolescents up until 75 years ago or so, often

killing them in 2-3 weeks without prior warning or any sign of

infection. And even if the syndrome developed slowly, who is to say

that is was not the western disease that was still the cause. In lupus

or other AI illness, a virus one is exposed to in childhood may plant

the seed for a fullblown autoimmune reaction later on. Along the way,

as one ages, one will feel more tired, perhaps sleep poorly, develop GI

problems, etc.

 

But it is possible that these symptoms are just due to aging and diet

and stress and just affect when you get the illness and how badly, not

whether you get it. And in fact, the illness may exist all along, but

it may progress gradually. So that growing fatigue is not a sign of qi

vacuity that will someday lead to lupus, but rather the autoimmune

begins to injur the body soon after infection and the syndromes are

caused by the autoimmunity rather than vice versa. So AI processes

affect blood formation and one becomes anemic and fatigued. After many

years, a full blown lupus pattern might emerge and then one mistakenly

assumes the AI process is the endstage instead of the beginning. I

really see no way to determine these matters by argument. Only some

objective analysis could tell. The one interesting piece of evidence

in this regard of which I am aware is the fact that many teenagers have

signs of atherosclerosis and diabetes. Yet most of them are lively and

full of energy with no symptoms of any kind. But they will likely die

of heart disease early in life. We assume lifestyle caused the

problem, yet even teenagers who are not obese still have these problems

in much higher than expected numbers. No doubt getting fat compounds

things. But what if there is a genetic tendency (we know there is for

DM and there are skinny type 2's) to develop artery plaques or tissue

resistance to insulin and these tendencies are what causes spleen qi

xu, which leads to more problems along the way. We may be able to

identify what worsens the syndromes, such as diet, but it may be what

we have thought of as effect is actually the cause as was there along.

At the very least, we should realize that this is a major unspoken

barrier between WM and TCM, which is the actual nature of syndromes in

the pathomechanisms of illness.

 

 

 

 

Chinese Herbs

 

 

 

 

 

 

[Guest guest]

I think this may be part of the point Alon has tried to

make in the past in his posts about the futility of trying to

differentiate a western disease according to TCM as if TCM so clearly

is the more fundamental of the two medicines. But that is really an

unexamined assumption that I have held myself until just about this

week.

>>>>>>

Correct, and its simplest projection is that prognosis is much better known

based on modern pathogenesis than CM categories. Relying on syndromes only is

the whole mark of older medical systems but the assumptions often made by

proponents that these can change pathological processes without clear scientific

evaluation is a big mistake we often do in " alternative " medicine, Chinese and

others.

That has been one of my battle cries for a long time.

 

 

 

[Guest guest]

When discussing models of thought, includin disease models, no one

model is true in all situations. In medicine, this will depend on what

we are actually treating. There are all kinds of diseases manifesting

in different ways, with different causative factors. Sometimes humoral

imbalances can lead to diseases, or visa versa. One of the strengths

of Chinese medicine traditionally was its ability to see the

development of imbalances before organic disease would manifest, and

change the course of the pattern before organic disease became 'set in

stone'. Once there are clear morphological changes, it is much more

difficult to change course. So, treating patterns in earlier stages of

certain diseases is, then, more fundamental. This is also part of

Chinese medicine. Severe organic disease requires much more force to

correct than more functional patterns.

 

However, much or most of the time, we are asked to treat patients not

to prevent patterns of disharmony from worsening into organic disease

later in time, but after organic diseases are manifesting in full

force. Also, some patients have diseases related to what Chinese

medicine calls 'former heaven endowment', i.e. constitutional or

genetic disorders. In some of these scenarios, our role may be more

supportive than primary.

 

There are other methods of pattern differentiation, of course that we

should utilize other than zang-fu, such as five phase, six channel, or

four aspect as needed. Also, in the West, we are still very weak in

understanding necessary pathomechanisms that lead up to an existing

pattern. We lose an entire dimension of time in understanding pattern

development.

 

There are cases where Chinese medicine can treat by itself.

 

There are cases where Western medicine only can treat.

 

There are cases where both Chinese and Western medicine can be used.

 

We need to be flexible, and not bind ourselves to trying to find one

final conclusion or way of doing things. Medicine is a field as vast

as life itself, and the possibilities are almost endless as to

scenarios and possible treatment strategies and modalities.

 

 

On Mar 26, 2005, at 6:51 PM, wrote:

 

> In other words, we deal with the root of illnesses and WM only

> addresses branches. However, some of you may be surprised to know that

> that amongst many in WM who are familiar with what we do, there is not

> so much lack of understanding as rejection of that basic idea. Just as

> Paracelsus rejected the humoral ideas of his contemporaries and

> proclaimed that there were 100s of diseases and the humoral syndromes

> were not causes, but effects, modern docs feel the same way. Very few

> can articulate it since this debate ended a long time ago in WM. But

> those who can are adamant that the syndromes of TCM are likewise the

> effects of specific disease process and not vice versa. Let me give an

> example of the two types of thinking.

[Guest guest]

This will depend on how how chooses to fill in one's canvas. Perhaps

such a simple zang-fu diagnosis is not sufficient in detail to

understand this scenario. While I am not suggesting that one ignores

the biomedical reality, there is more depth possibly available to

provide more detail in a Chinese medical diagnosis as well.

 

 

On Mar 26, 2005, at 6:51 PM, wrote:

 

> If an autoimmune process attack the joints, one will

> feel pain. One will also feel joint pain if one has a degenerative

> process such as osteoarthritis or a bone cancer such as multiple

> myeloma. In each case, we might diagnose bi syndrome with qi and blood

> stagnation. But what if the disease process has its own life and the

> disruptions of qi and blood we treat in TCM are manifestations of

> something deeper and that something deeper is the reductionistic world

> of biochemistry and WM. In other words, biochemistry and western

> pathology explain a level of illness not addressed or explained in any

> way by TCM.

[Guest guest]

I don't think this is always true. There are many conditions that are

more easily visible and treatable through the lens of Chinese medicine,

in my opinion and experience. For example those patients who have

been run through batteries of tests, are found to have no organic

disease, but still feel lousy, often respond very well to pattern

differentiation and Chinese medical treatment.

 

I also think that there is a difference in applying science to Chinese

medicine and applying biomedical research to Chinese medicine. When

you stick Chinese medicine into a biomedical threshing machine, it

comes out as biomedicine, not Chinese medicine. Show me one study

conducted outside of our field that maintains the integrity of Chinese

medicine theory/praxis.

 

 

On Mar 26, 2005, at 7:44 PM, wrote:

 

> Correct, and its simplest projection is that prognosis is much better

> known based on modern pathogenesis than CM categories. Relying on

> syndromes only is the whole mark of older medical systems but the

> assumptions often made by proponents that these can change

> pathological processes without clear scientific evaluation is a big

> mistake we often do in " alternative " medicine, Chinese and others.

> That has been one of my battle cries for a long time.

[Guest guest]

Zev,

For this answer I would point you to the works of Dr. Kim Bonghan and Kwang

Soh on physical structures that seem to follow the jing luo mai pahtways,

connect to organs and also have substances that can influence hormones and

genetic makeup.

 

 

 

Mike W. Bowser, L Ac

 

 

 

> " " <zrosenbe

>

>

>Re: cause and effect

>Sat, 26 Mar 2005 20:52:45 -0800

>

>I don't think this is always true. There are many conditions that are

>more easily visible and treatable through the lens of Chinese medicine,

>in my opinion and experience. For example those patients who have

>been run through batteries of tests, are found to have no organic

>disease, but still feel lousy, often respond very well to pattern

>differentiation and Chinese medical treatment.

>

>I also think that there is a difference in applying science to Chinese

>medicine and applying biomedical research to Chinese medicine. When

>you stick Chinese medicine into a biomedical threshing machine, it

>comes out as biomedicine, not Chinese medicine. Show me one study

>conducted outside of our field that maintains the integrity of Chinese

>medicine theory/praxis.

>

>

>On Mar 26, 2005, at 7:44 PM, wrote:

>

> > Correct, and its simplest projection is that prognosis is much better

> > known based on modern pathogenesis than CM categories. Relying on

> > syndromes only is the whole mark of older medical systems but the

> > assumptions often made by proponents that these can change

> > pathological processes without clear scientific evaluation is a big

> > mistake we often do in " alternative " medicine, Chinese and others.

> > That has been one of my battle cries for a long time.

>

[Guest guest]

 

More recently AT Still, founder of modern osteopathy made similar claims

about humors and illnesses.

 

 

 

Mike W. Bowser, L Ac

 

 

 

> <

>

>cha

> cause and effect

>Sat, 26 Mar 2005 18:51:31 -0800

>

>I was listening to a commentary on the radio about that case in FL with

>the feeding tube removal. The doctor said something that stuck with

>me. He referred to the persistent vegetative state (PVS) as a

>syndrome. He then went on to explain the meaning of syndrome in

>western medicine, which is a collection of signs and symptoms that may

>be associated with numerous different diseases. But he went further.

>Syndromes are, he stated, caused by various pathophysiologies. For

>example, PVS is diagnosed by a set of signs and symptoms, but it could

>be caused by trauma, infection, drugs and various illnesses.

>

>As I heard this, I was reminded of something I read one time about an

>MD's view of TCM. Which is that we confuse cause and effect in our

>field. We work with the assumption from day one that the patterns we

>learn to identify are the CAUSES of the diseases our patients

>experience. Depending on how one conceptualizes things, one might

>think either spirit, energy or some deeper organizing principle of

>physiological systems has been disturbed and the result is a cascade of

>changes that eventually manifest in a clearcut disease that western

>medicine can label and study on a reductionistic level. But whatever

>one's worldview, we all seem to agree that the syndromic change

>precedes the manifestation of disease and that the measurable

>biochemical changes of disease are the end result of some as yet not

>completely understood process (whether natural or supernatural).

>

>In other words, we deal with the root of illnesses and WM only

>addresses branches. However, some of you may be surprised to know that

>that amongst many in WM who are familiar with what we do, there is not

>so much lack of understanding as rejection of that basic idea. Just as

>Paracelsus rejected the humoral ideas of his contemporaries and

>proclaimed that there were 100s of diseases and the humoral syndromes

>were not causes, but effects, modern docs feel the same way. Very few

>can articulate it since this debate ended a long time ago in WM. But

>those who can are adamant that the syndromes of TCM are likewise the

>effects of specific disease process and not vice versa. Let me give an

>example of the two types of thinking.

>

>Lupus -

>

>In TCM, this could present as spleen qi xu (fatigue, et. al.), blood

>heat (red skin rash), yin vacuity (nightsweats, et. al.) and hot damp

>bi (red swollen joints) with blood stasis (focal, sharp pain). An

>analysis that assumes a priori that patterns cause disease rather than

>vice versa would go something like this. The patient's spleen is

>weakened thru diet, dampheat accumulates and burns off the yin,

>generating heat in the blood. The combination of internal dampheat and

>external invasion results in obstruction of qi and blood. blood stasis

>results. On a physiological level, this obstruction in qi flow leads

>to gross biochemical and possibly structural changes. Depending on who

>you believe, either there is a separate force called qi that controls

>gross physiology or there are subtler changes in physiology not

>currently measured with current tests, yet still biochemical in nature.

> Either way, it is assumed in this analysis that the disease would

>never have occurred if the patient had not fallen out of " balance " in

>the first place.

>

>But from a WM perspective, the disease process, autoimmunity in this

>case, disrupts a number of body tissues as it attacks them. This

>results in certain syndromes associated with fatigue, rash, etc.

>However these syndromes are the result of various disease processes,

>not the cause. If an autoimmune process attack the joints, one will

>feel pain. One will also feel joint pain if one has a degenerative

>process such as osteoarthritis or a bone cancer such as multiple

>myeloma. In each case, we might diagnose bi syndrome with qi and blood

>stagnation. But what if the disease process has its own life and the

>disruptions of qi and blood we treat in TCM are manifestations of

>something deeper and that something deeper is the reductionistic world

>of biochemistry and WM. In other words, biochemistry and western

>pathology explain a level of illness not addressed or explained in any

>way by TCM. I think this may be part of the point Alon has tried to

>make in the past in his posts about the futility of trying to

>differentiate a western disease according to TCM as if TCM so clearly

>is the more fundamental of the two medicines. But that is really an

>unexamined assumption that I have held myself until just about this

>week.

>

>So say the reason a person gets lupus may come down to genes and

>viruses. The bi syndrome of TCM is then caused by these other more

>fundamental processes. You can alter the course of the illness by

>addressing the resulting syndrome in the most noniatrogenic way, but

>there is really no evidence that any chinese herbal therapy can

>actually cure the illness. All the research I have seen only claims

>full remission for no more than 15-20% of the patients. And I have

>seen no studies that claim to have maintained this cure in long term

>followups of 5-10 years. And in fact, all patients I know of are

>susceptible to periodic remissions. In other words, you can

>successfully control the syndrome, but the disease still lurks below

>the surface. Thus many in our field speculate on the deeper causes of

>these syndromes such as heavy metals or allergies or stress or latent

>pathogens or gu toxins because merely treating the presenting pattern

>so often does not suffice in illnesses like lupus. Yet we would not

>dare to speculate that the deeper cause is actually already described

>accurately in many cases by WM. Why? The other popular root causes of

>illness I just listed are pretty reductionistic themselves. The idea

>that if you identify the heavy metal that is doing the poisoning or the

>allergen that is causing the hypersensitivity or the yeast that is

>colonizing the bowel or the emotion that is destroying the mind, then

>the syndrome will just disappear. Don't get me wrong, I think all

>these things are true in given cases. But if so, we must also accept

>that viruses affecting gene expression altering immunity may be one

>more fundamental cause of illness. And that TCM in general addresses

>a more superficial level of illness than the actual causes.

>

>I have been saying for months now that I think TCM's best role is in

>its historical strength, the noniatrogenic treatment of daily

>suffering. That we probably have little to offer in the permanent cure

>of any chronic illness. We can control the symptoms and course of an

>illness without making things worse. this is a great thing. But we

>can't make the disease go away with our medicine. Even the diseases

>that are clearly caused by lifestyle such as lung and colon cancer,

>atherosclerosis, diabetes and liver disease cannot be cured by TCM. We

>may know what causes them, but we can only offer the same lifestyle

>advice as WM. Palliative treatment may decrease blood sugar, protect

>against liver damage, decrease cholesterol, etc. But we cannot correct

>the root pattern and the symptoms will return. Interestingly,

>treatment of blood stasis has shown to have some promise in some

>reversal of these conditions, but that also is a fairly modern and

>reductionistic allopathic application of chinese herbs based largely

>upon modern research into circulation.

>

>Now I am not saying that WM has been successful at curing most of these

>conditions either. And those in which it has had some success, the

>results are mixed. Consider HIV. While some, like Deusberg, may

>still insist that AIDS is not caused by the HIV virus, I find their

>arguments specious at best. The drug cocktail does suppress the

>replication of HIV. And for the majority of patients, there is

>dramatic relief from the illness or prevention of the progression. I

>have worked with hundreds of AIDS patients as has Mark and Misha and we

>all know that without viral inhibition, TCM cannot stop the pathology

>from progressing. Non cocktail using Long term survivors who attribute

>their health to TCM are a fluke. Research shows that most long term

>survivors have no lifestyle or treatment choices in common, but they do

>share a weak strain of the virus and good safe sex habits. I watched

>dozens of HIV patients decline and die under TCM care before the

>cocktail and I also watched them all leap off their deathbeds soon

>after receiving the drugs. In other words, the virus caused a

>syndrome, not vice versa. Many old timers in our field still associate

>AIDS with lifestyle and jing deficiency from excessive sex. Yet if

>this was the case, then why did merely suppressing a virus cure most of

>these patients. Sure, not without side effects, but far better than

>anything TCM has to offer (and those who say otherwise I can guarantee

>have not seen many AIDS patients). Jing vacuity should be incurable.

>

>No, I think we have to seriously consider that the western analysis of

>the disease process may be more fundamental than that described by TCM.

> This might be a necessary part of our profession maturing and

>accepting its proper role in modern healthcare. Admittedly, western

>medicine has largely failed to correctly address the pathologies

>described by modern science. But this may reflect only a failure to

>properly apply the truly sound fundamental premises and findings of

>medical science. Yet this is changing. We are already seeing the

>development of much safer and targeted approaches to dealing with

>pathology that will result in far fewer side effects. However as long

>as diseases persist, so will their associated syndromes. And as long

>as WM is unable to address the syndromes adequately, their will be a

>vital role for whoever can. In fact, I expect less and less of WM

>research will be focused on syndromes and control of signs of symptoms

>at the branch and more and more on their perceived roots (mostly at the

>gene and stem cell level). This creates a great opening for us if we

>want to grab it as our role. Drugstore or healthfood store not meeting

>your needs, but not ready to go on Rx drugs: try TCM first. Best

>part, no side effects, no toxicity.

>

>One final thought. Now I suppose some would say that the fact that

>people start to feel poorly years before they actually have an illness

>like lupus is proof that syndromes precede disease (the prevailing TCM

>worldview, as it were). Well, for one thing, that is not always true.

>Many such illnesses are quite sudden in nature. Type diabetes struck

>down robust healthy adolescents up until 75 years ago or so, often

>killing them in 2-3 weeks without prior warning or any sign of

>infection. And even if the syndrome developed slowly, who is to say

>that is was not the western disease that was still the cause. In lupus

>or other AI illness, a virus one is exposed to in childhood may plant

>the seed for a fullblown autoimmune reaction later on. Along the way,

>as one ages, one will feel more tired, perhaps sleep poorly, develop GI

>problems, etc.

>

>But it is possible that these symptoms are just due to aging and diet

>and stress and just affect when you get the illness and how badly, not

>whether you get it. And in fact, the illness may exist all along, but

>it may progress gradually. So that growing fatigue is not a sign of qi

>vacuity that will someday lead to lupus, but rather the autoimmune

>begins to injur the body soon after infection and the syndromes are

>caused by the autoimmunity rather than vice versa. So AI processes

>affect blood formation and one becomes anemic and fatigued. After many

>years, a full blown lupus pattern might emerge and then one mistakenly

>assumes the AI process is the endstage instead of the beginning. I

>really see no way to determine these matters by argument. Only some

>objective analysis could tell. The one interesting piece of evidence

>in this regard of which I am aware is the fact that many teenagers have

>signs of atherosclerosis and diabetes. Yet most of them are lively and

>full of energy with no symptoms of any kind. But they will likely die

>of heart disease early in life. We assume lifestyle caused the

>problem, yet even teenagers who are not obese still have these problems

>in much higher than expected numbers. No doubt getting fat compounds

>things. But what if there is a genetic tendency (we know there is for

>DM and there are skinny type 2's) to develop artery plaques or tissue

>resistance to insulin and these tendencies are what causes spleen qi

>xu, which leads to more problems along the way. We may be able to

>identify what worsens the syndromes, such as diet, but it may be what

>we have thought of as effect is actually the cause as was there along.

>At the very least, we should realize that this is a major unspoken

>barrier between WM and TCM, which is the actual nature of syndromes in

>the pathomechanisms of illness.

>

>

>

>

>Chinese Herbs

>

>

>

>

>

>

>

[Guest guest]

I don't think this is always true. There are many conditions that are

more easily visible and treatable through the lens of Chinese medicine,

in my opinion and experience.

>>>>>Zev, what i was referring to is actual disease processes not

syndromes.Functional disorders, i.e. where no " disease " is playing a major part,

is were CM and other " terrain " systems shine. These however do not have issues

with prognosis. While these syndromes cause suffering they do not progress

unless a pathogenic process takes place, which is more likely to be determined

by genetic factors and toxicity, than so-called terrain. Many often state that

treating the " imbalance " will prevent any disease process from developing, this

is, at this point of our dependable knowledge, only a belief and is not

supported by any real data.

Also, there is no conflict between science and CM. I agree with you that since

most of the studies are done by people that are not properly trained by both CM

and the scientific method most of the studies we have are poor in terms of

allowing for full evaluation of CM. This however should not be used as a blinder

for the information that is coming out as it is still informative but limited.

For example, when assessing acupuncture most studies compromise CM flexibility

which is they way we practice CM, at the same time if absolutely no difference

is shown between shame points and real points one still has to ask why? It is

also why we as a profession must increase our scientific training so that we can

do better studies. To say that if you use science you get science and not CM is

so ridiculous its not funny. I know Emmanuel likes to use this statement but

that is a dogmatic statement implying that CM should not be looked at in an

evaluative perspective.

 

 

 

 

[Guest guest]

Also, in the West, we are still very weak in

understanding necessary pathomechanisms that lead up to an existing

pattern. We lose an entire dimension of time in understanding pattern

development.

>>>>>Zev, I agree we often start the discussions at the pattern stage, lets not

forget however that the so called pathomechanisms (or what should be viewed as

risk factors), in CM is a very narrow and always general perspective. There is

no real cause and effect discussion. Once these general effects are plugged into

pathomechanistic processes it is ALWAYS a theoretical construct not supported by

real objective data. It will change depending on tradition, focus, style, the

therapy, and such. You do not have a gold standard.

I agree with you that we are not in a place in which any conclusion can be made

on CM limitations or were and in what situations it is best used. We need much

more reliable information. We need to enter this evaluative process as a

profession. We should not leave this to MDs if we want better quality

evaluations. But as long as we keep blinded to modern science we cannot go

beyond dogmatic traditional thinking.

 

 

 

 

[Guest guest]

The term was not science, but western medicine. Western medicine and

science are not necessarily the same thing. The point being, that the

predominance of studies done in the West are designed to fit CM into

the WM paradigm as outcome. I know we've debated this many times, but

to me and I think others in our field, the underlying paradigm is what

is largely essential in how we treat our patients. One can use

different paradigms, but one has to be clear on intellectual bias of

biomedicine and how that influences how Chinese medicine is looked at.

 

 

On Mar 27, 2005, at 8:47 AM, wrote:

 

> To say that if you use science you get science and not CM is so

> ridiculous its not funny. I know Emmanuel likes to use this statement

> but that is a dogmatic statement implying that CM should not be looked

> at in an evaluative perspective.

[Guest guest]

West are designed to fit CM into

the WM paradigm as outcome.

>>>>Actually the drug research model and i agree with you on these points.

There is an " intellectual bias " and blindness to both biomedicine and CM.It is

our job to resolve these and do proper research.We cannot keep relying on

so-called historical ref and unfortunately we cannot rely of PRC research.

 

 

 

 

[Guest guest]

" We work with the assumption from day one that the patterns we

learn to identify are the CAUSES of the diseases our patients experience. "

 

Patterns (zheng) are not disease causes (bing yin), nor are they

necessarily disease mechanisms (bing ji). They are the patterns of

signs and symptoms a patient displays in response to certain disease

mechanisms set in train by certain disease causes in a certain patient

at a certain time in a certain place. Patterns are nothing more or

less. Patterns do not, in any way, precede disease. Any confusion

about this is due to our generally crappy Western CM education and our

inability to read this stuff in its original.

 

Bob

[Guest guest]

Any confusion

about this is due to our generally crappy Western CM education and our

inability to read this stuff in its original.

>>>>What about pulse patterns and their treatment prior to disease? What about

the " superior " physician? There are many traditions within CM and some do look

at signs with the idea of prodromal evidence for coming disease. Bob your

statement is a generalization, you have never seen Chinese practitioners

treating signs claiming its preventative? But i have to say that the approach of

so called keeping one balance with herbs or acup is practiced more in affluent

societies like us in the west. And again we have no real supporting data for

effectiveness.

 

 

 

 

[Guest guest]

Patterns (zheng) are not disease causes (bing yin),

>>>>Also lets put things in perspective, you can count bing yin on your two

hands.They are just a set of internal, external and not that try to explain

thousands of diseases and are the same for almost all.You can only go so far

with them. They can be used as risk factors for possible patterns and to a much

smaller extent diseases development in CM but are extremely rudamentary.

 

 

 

 

[Guest guest]

Alon,

If you read, for example, Li Dong-yuan or the Reverting Yin chapter

of the Shang Han Lun, you can find much more complexity in both

patterns and bing yin. While single patterns are relatively simple,

they can be combined to produce a fairly complex picture of illness.

 

 

 

On Mar 28, 2005, at 4:17 PM, wrote:

 

> Patterns (zheng) are not disease causes (bing yin),

>>>>> Also lets put things in perspective, you can count bing yin on

>>>>> your two hands.They are just a set of internal, external and not

>>>>> that try to explain thousands of diseases and are the same for

>>>>> almost all.You can only go so far with them. They can be used as

>>>>> risk factors for possible patterns and to a much smaller extent

>>>>> diseases development in CM but are extremely rudamentary.

>>>>>

[Guest guest]

If you read, for example, Li Dong-yuan or the Reverting Yin chapter

of the Shang Han Lun, you can find much more complexity in both

patterns and bing yin. While single patterns are relatively simple,

they can be combined to produce a fairly complex picture of illness.

>>>I have

 

 

 

 

[Guest guest]

While single patterns are relatively simple,

they can be combined to produce a fairly complex picture of illness.

>>>Zev, I am not talking about patterns but disease causes

 

 

 

 

[Guest guest]

> If you read, for example, Li Dong-yuan or the Reverting Yin chapter

> of the Shang Han Lun, you can find much more complexity in both

> patterns and bing yin. While single patterns are relatively simple,

> they can be combined to produce a fairly complex picture of illness.

 

not sure who wrote this, but it has nothing to do with my point. The fact that

mutually

engendering pathomechanisms CAN lead to complex illness does not mean that this

is the

sole or even predominant etiology.

 

Consider meniere's disease versus idiopathic vertigo. The latter can be easily

treated with

phlegm and spleen herbs and be eliminated. But in the case of Meniere's, what

if a gene

codes for abnormal fluid accumulation in the midear (i.e. making this a jing

problem and

thus untreatable by TCM). While the TCM causes will exacerbate this condition,

no amount

of good behavior or herbs will make the condition completely disappear. If it

does, it was

not genetic and probably not really Meniere's.

 

My point is that many such illnesses may turn out be jing problems and thus are

the cause

of syndromes, not caused by them. This is TCM, so what's anyone's problem with

this

idea. Professional hubris perhaps. We can do abdominal surgery with TCM, so

what of we

also can't do gene therapy. A holistic medicine embraces both the forest AND

the trees.

One who thinks its all about the forest is missing half the picture. Sometimes

the solution

is in stepping back and looking at the big picture and sometimes the devil is in

the details.

 

[Guest guest]

Alon,

 

Once again you don't seem to be able to understand my English. All I

was stating was the relationship between disease causes , disease

mechanisms, patterns, and diseases. These are technical terms withing

Chinese medicine.

 

I was not saying that we cannot or do not treat preventively. We do,

and when we do, we do it on the basis of particular signs (such as

pulse or tongue signs) or on the presence of patterns. But there is no

causal or temporal relationship between signs and symptoms or patterns

and diseases. One is not a priori to the other.

 

Again, this is all crystal clear in Chinese.

 

Bob

[Guest guest]

I don't know that anyone disagrees with you on this, I certainly don't.

The map is not the terrain, and no map can cover all the terrain in

its detail. We use our maps to navigate the body, and different

perspectives are helpful.

 

As far as jing problems go, I have a few questions.

 

1) Are you implying that a disease with a genetic component

automatically cannot be generated by other factors as well?

 

2) Does a genetic defect or predisposition mean that the patient

automatically gets the disease?

 

3) What percentage of cancers has been determined to be only

genetically determined? I think it is very small.

 

 

On Mar 29, 2005, at 10:09 AM, wrote:

 

>

> My point is that many such illnesses may turn out be jing problems and

> thus are the cause

> of syndromes, not caused by them. This is TCM, so what's anyone's

> problem with this

> idea. Professional hubris perhaps. We can do abdominal surgery with

> TCM, so what of we

> also can't do gene therapy. A holistic medicine embraces both the

> forest AND the trees.

> One who thinks its all about the forest is missing half the picture.

> Sometimes the solution

> is in stepping back and looking at the big picture and sometimes the

> devil is in the details.

>

[Guest guest]

But there is no

causal or temporal relationship between signs and symptoms or patterns

and diseases. One is not a priori to the other.

>>>Bob i did understand what you meant. The above is my point.

I would hope the relationship between " disease causes, " and syndrome

differentiation is quite clear to almost all on this list. I believe this is

first week school stuff. No chinese needed to understand the difference between

causes, patterns, pathomechanics and such. Any one that have read any case

history from the PRC is used to their standard presentations which usually cover

all of these in an arranged way. My point was and is that there are many methods

by which CM is practiced. Not all follow the nicely arranged modern TCM

structure to include the above. Depending on the system one uses many have

different entry points into treatments as well as explanation of mechanisms and

causes. I do not know, but i would think you have been exposed to none TCM, CM

styles.

 

 

 

 

[Guest guest]

But there is no

causal or temporal relationship between signs and symptoms or patterns

and diseases. One is not a priori to the other.

>>>>>>When i say that CM understanding of disease causes is quite limited that

is exactly what i refer to. While in generalities the causes of disease in CM

actually cover almost all the possibilities we know of currently, they do it in

such a generic way that there is no real causal or temporal relationship except

in hindsight and then usually not supported by real evidence but by some casual

relationship to patient reporting to support a treatment approach.

Bob, anyway I am sorry if i respond beyond your direct statements. What you have

wrote is truly basic and again should be clear to anyone that reads only in

English. Am I wrong? do most people on this list do not know the differences?

 

 

 

 

[Guest guest]

you can find much more complexity in both

> patterns and bing yin.

>>>>>>>

Zev, These are tools to understand progression and interactions, not much to do

with cause and effect.They also have little to do with Jing or genetics

 

 

 

[Guest guest]

I agree with Z'ev... Most of the time pathomechanisms are oversimplified or

glossed over in the English books... In Chinese you find much more abundant

information. I.e. I have 2 good size books just on pathomechanisms (in

Chinese)... And as Z'ev points out, straight TCM is one perspective, there

are many other traditions that have different viewpoints that can give a

much more complex understanding... IMO, TCM is great, but does present a

cookbook distilled style where one has to think somewhat simply... But I

agree with alon that compared to WM things may seem simplified.., but this

is apples and oranges.. Really the pathomechanism, IMO, is about really

nailing the DX and Rx by understanding how symptoms can fit into various

patterns, and not getting duped by into typical patterns. The more one

understands the pathomechanism the more patterns and variations one can see.

My 2 cents...

 

-

 

>

> [zrosenbe]

> Monday, March 28, 2005 6:05 PM

>

> Re: Re: cause and effect

>

>

> Alon,

> If you read, for example, Li Dong-yuan or the Reverting Yin chapter

> of the Shang Han Lun, you can find much more complexity in both

> patterns and bing yin. While single patterns are relatively simple,

> they can be combined to produce a fairly complex picture of illness.

>

>

>

> On Mar 28, 2005, at 4:17 PM, wrote:

>

> > Patterns (zheng) are not disease causes (bing yin),

> >>>>> Also lets put things in perspective, you can count bing yin on

> >>>>> your two hands.They are just a set of internal, external and not

> >>>>> that try to explain thousands of diseases and are the same for

> >>>>> almost all.You can only go so far with them. They can be used as

> >>>>> risk factors for possible patterns and to a much smaller extent

> >>>>> diseases development in CM but are extremely rudamentary.

> >>>>>

>

>

>

>

> 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]

I Apologize I got some msg.'s mixed up... I see Z'ev is not talking about

pathomechanisms (below)... So I agree with alon, disease causes are

seemingly simplified.... But my statements stand for whatever they are

worth...

 

-Jason

 

>

> []

> Wednesday, March 30, 2005 6:23 AM

>

> RE: Re: cause and effect

>

>

> I agree with Z'ev... Most of the time pathomechanisms are oversimplified

> or

> glossed over in the English books... In Chinese you find much more

> abundant

> information. I.e. I have 2 good size books just on pathomechanisms (in

> Chinese)... And as Z'ev points out, straight TCM is one perspective, there

> are many other traditions that have different viewpoints that can give a

> much more complex understanding... IMO, TCM is great, but does present a

> cookbook distilled style where one has to think somewhat simply... But I

> agree with alon that compared to WM things may seem simplified.., but this

> is apples and oranges.. Really the pathomechanism, IMO, is about really

> nailing the DX and Rx by understanding how symptoms can fit into various

> patterns, and not getting duped by into typical patterns. The more one

> understands the pathomechanism the more patterns and variations one can

> see.

> My 2 cents...

>

> -

>

> >

> > [zrosenbe]

> > Monday, March 28, 2005 6:05 PM

> >

> > Re: Re: cause and effect

> >

> >

> > Alon,

> > If you read, for example, Li Dong-yuan or the Reverting Yin chapter

> > of the Shang Han Lun, you can find much more complexity in both

> > patterns and bing yin. While single patterns are relatively simple,

> > they can be combined to produce a fairly complex picture of illness.

> >

> >

> >

> > On Mar 28, 2005, at 4:17 PM, wrote:

> >

> > > Patterns (zheng) are not disease causes (bing yin),

> > >>>>> Also lets put things in perspective, you can count bing yin on

> > >>>>> your two hands.They are just a set of internal, external and not

> > >>>>> that try to explain thousands of diseases and are the same for

> > >>>>> almost all.You can only go so far with them. They can be used as

> > >>>>> risk factors for possible patterns and to a much smaller extent

> > >>>>> diseases development in CM but are extremely rudamentary.

> > >>>>>

> >

> >

> >

> >

> > 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.

> >

> >

> >

> >