devil's advocate

[Guest guest]

I want to consider a few observations.

 

Many of the most clinically and financially successful px I know are

eclectic in their styles, do not concern themselves with issues like

term choices or herb dosage or form or classic texts or reading

chinese, etc. Students see this and they wonder why they should take

the supposedly " high road " of the scholar-physician. Incentives are

a big deal in this field as in any. We all see motivation problems

and the cost-benefit analysis is a typical one most humans make.

Especially consider that many of our students grew up in boom times

when both liberals and conservatives were reaping the rewards of the

stock market. Profit is no longer a dirty word. Compare that to the

more hippy sensibilities that guided a previous generation of

students. There needs to be a reason other than just being the high

road. It must be shown to have added value in some tangible way.

 

Many successful px only use patent medicines. they also often use

other supplements. I am sure this exceeds those who primarily

prescribe individualized formulas (perhaps not on this list, but

overall). If using prepared meds is the current standard of care in

the field, why are we putting huge effort into teaching the other

thing. Even BP has pretty much come to this conclusion. I still

think that knowing how to write a formula is the best training to

choose a proper prepared med. It also helps one deduce the TCM

properties of other supplements one might recommend. But this would

require practicing the art for many years after school. And if folks

will not be doing that anyway, than a shift in emphasis might be

called for.

 

If one is going to use prepared meds, how does one choose good ones?

How does one combine them with other TCM and nonTCM products.

Arguably, this would still be a modern form of TCM in places where

these other substances are in the scope (like CA). One would still

have to think about the treatment principles, etc. in a careful way.

But instead of choosing xiao yao san for PMS, you might give

digestive enzymes, sam-e and vitex agnus castus if you reasoned they

addressed the same treatment principles. It would be convenient to

give a really strong dose of these, so why not? It seems to embrace

the idea oft expressed by Qin Bo Wei that a formula is just an idea.

It is OK to change the words if the expression is still the same. If

this is the way the practice of TCM in America has evolved, why not

cultivate it to a high standard.

 

We all know that only a small number of the population will ever

embrace any liquid form of chinese herbs that they have to taste. So

that leaves prepared meds. but most are not strong enough to do the

job. there are exceptions. I like Golden flower and BP. But the

ability to strongly relieve symptoms quickly is diminished by not

being able to use very high dose raw or even granule herbs on most

patients. In these cases, a combination of a good prepared med like

those mentioned with other well chosen supplements might be just what

the doctor ordered, so to speak. So du huo ji sheng wan with

bromelain and curcumin plus glucosamine for OA might work as good or

better than high dose decoction of just raw chinese herbs. There is

no reason it couldn't. Its just a matter of selection. If you

prescribe the right constitutional formula, that seems to take care

of any imbalances that might have been caused by a single herb or

other supplement. They work together as a formula.

 

So why aren't we trying to teach this? If this is what people are

practicing, then they are all self-taught or learning by story and

observation of others in practice. And the story they hear seems to

be true. I think Will alluded to this role in transmission of

knowledge some time back. Are we shirking our duty to not attempt to

teach what is being practiced. While I agree that we cannot let

students dictate what is taught, we must consider the actual

experiences of the majority of veteran px out there when formulating

curricula. We don't have empirical evidence to support either point

of view, so the scholars just circle the wagons and vice-versa.

Well, the experiences of our rank and file are the closest thing we

have to empirical evidence and it doesn't bode well for the

purists. I hope we don't see the day when our own Paracelsus burns

the classic texts in the school courtyard and proclaims that it was

the witches and the midwives (symbolically meaning the nonelite rank

and file healers) who possessed all the true medical knowledge. If

it comes to be, we may have brought this upon ourselves. Keep in

mind, a conscious expansion of the materia medica and the ways to

apply it in clinic is not necessarily a dumbing down of TCM at all.

In fact, if the goal is sustained care for as many as possible, it

begins to seem quite sensible. It of course, goes without saying

that I only support the use of prepared meds that can actually

deliver the punch of raw herbs, meaning they must be a way of

determining the pharmacological equivalency of any product to a

reference range of raw herbs. For example, ma huang tang with no

ephedrines just wouldn't pass muster.

 

 

 

 

Chinese Herbs

 

 

 

 

 

 

 

 

 

 

 

[Guest guest]

If using prepared meds is the current standard of care in

the field, why are we putting huge effort into teaching the other

thing. Even BP has pretty much come to this conclusion.

>>>> i always say we should be teaching towards effective clinical

practice. As i have said many times to me that is the only important aspect a

MEDICAL SCHOOL should be concern with. Scalars should study using other avenues.

To this end however, it is important to teach high level herbal medicine and

acupuncture as well as all the other subjects needed to make an effective

clinician. As you say many times a high dose is needed (which can be done with

powders) as well as individualized formulation.Also, a school should good

foundations to its students. That is the only way they would be capable of

evaluating commercial products which more often than not are full of hype.

 

 

 

 

Oakland, CA 94609