Depression, not just Qi Stag./ research + rant

January 9, 2007

Al,

I am not sure about different formulas for each pattern, b/c I saw none

listed. Actually I have no idea what this study has to do with any reality

in clinical practice. Thoughts? To elaborate, one can pick any number of

categories and put people into one of the boxes. That may be 2 or 16. But I

never understood how this type of data helps us. Can one really say that

because 23.7% of people had ¡ÈXin-Pi deficiency with dampness retention

type¡É this will help inform in the clinic? IMO percentages are useless

and

only hinder one¡Çs ability to see clearly in the clinic.

Anyway, I have a translated a piece on ¡ÈDepression Pattern¡É (yu

zheng)

that contains 15 different patterns with appropriate formulas and

modifications. This is located at:

Chinese Medicine/index.php?page=Chinese_Medicine_Articles

Furthermore, a disease (or syndrome) for better or worse,

can be simplified into a few patterns, or one can dive into the depths of CM

and see the true flexibility and power of the medicine. Personally the more

possibilities the better. I think this brings up an interesting quagmire.

Over and over people say that we have to treat what we see, and that

patients do not fit into a textbook presentation. Yet everywhere I look

(i.e. translated modern TCM research etc.) we see a given disease reduced

into a few ¡Èmajor¡É patterns and then put it to the test. Companies

are

then marketing catch all formulas for a given Western Disease. These

formulas contain i.e. herbal percentages from for each pattern. The formulas

have little elegance. Now, I do not have enough research experience to say

if this approach works or not. I don¡Çt to it at this point in

time. Case studies from prominent doctors do not support this way of

thinking. But I acknowledge that many believe that this approach is valid. I

think it gets back to the (political) agenda (conscious or subconscious) to

be part of the western medical paradigm more than any proven efficacy. Or

maybe these formulas are created for pure marketability via ¡Èpatent

medicines (cheng yao)¡É to practitioner that do not or cannot write their

own prescriptions. But I have a hard time believing that such an approach

will ever be superior to customized formulas. Even when a Chinese doctor

writes about simplifying a disease into a few patterns, his case studies

formulas rarely resemble such a simplified thinking. They are flexible and

take into account individual characteristics of the patient. Again pointing

to essntail need to study case studies. Others thought on this?

IMO, the real CM, hits like an arrow, a direct shot to the problem, and not

a shotgun hoping to quell the issue. Todd has mentioned that there is no

proof polypharmacy is safe for the long-term. I agree, we do not know!

Therefore the simplest most direct formulas logically seem to have the

potential of causing the least side-effects. Meaning a 15 ingredient MONSTER

catch all formula, treating every pattern possible, is much more likely to

cause side-effects in the long-term, because clearly there are going to be

aspects of the formula that are just incorrect. And I don¡Çt believe that

balancing out a formula with other herbs (sometimes harsh ones) allows the

body to receive it without potential damage. No matter what, your liver is

processing all of it!

This shines light back on our previous question, what is missing in our

schools? Quite simply, how to THINK . When one learns how to

think and evaluate the proper pathomechanism causing the s/s, one can

construct a formula with simple elegance. This is what we need to learn, not

to rely on shotty modern research that reduces a disease into 4-6 boxes.

Look at the Menopause fiasco. We have a prominent doctor correlating its s/s

to hormone loss and hence kidney (yin) deficiency and all of sudden 90% of

cases are kidney yin xu. I have seen classes where teachers present a

western disease and present one or two formulas that treat it. Hhhmmm, very

peculiar.

Just some thoughts, would like to hear what others have to say,

-

_____

On Behalf Of Al Stone

2007Ç¯1·î9Æü 12:09

Chinese Herbal Medicine List

Depression, not just Qi Stag.

In another study story, 397 patients with a Western diagnosis of depression

(In China) were differentiated by TCM syndrome with the following findings:

(Source: *http://tinyurl. <http://tinyurl.com/yd7nw8> com/yd7nw8 *) Organ

names in parenthesis are my

additions.

Gan (Liver) -Qi stagnation with mental uneasiness type (108 cases, 27.2%);

the Xin (Heart) -Pi (Spleen) deficiency with dampness retention type (94

cases, 23.7%);

the Xin-Gan Qi-stagnation with Phlegm retention type (76 cases, 19.1%);

the Xin-Gan Qi stagnation with Jing-Luo disharmony type (57 cases, 14.3%);

the Xin-Shen (Kidneys?) Qi stagnation with collateral obstruction type (34

cases, 8.6%);

and the Xin-Gan Qi stagnation with Heat interfering mental type (28 cases,

7.1%).

*

*If anybody would like to suggest different formulas for depression

associated with these syndromes, that would be great. Also, I'm not sure

what Xin-Shen Qi stagnation with collateral obstruction type is. Kidney and

Heart Qi deficiency with bi syndrome?.

--

Pain is inevitable, suffering is optional.

January 9, 2007

On 1/9/07, wrote:

>

> Can one really say that

> because 23.7% of people had " Xin-Pi deficiency with dampness retention

> type " this will help inform in the clinic? IMO percentages are useless and

> only hinder one's ability to see clearly in the clinic.

>

Hi Jason,

My goal was to further make the point that one Western term such as

" depression " cannot always apply to one TCM syndrome such as " qi stagnation "

in the same way that menopausal syndrome does not always equate to Kidney

yin deficiency.

I saw a patient today who had been treated for hypertension with Tian Ma Gou

Teng Yin, but I didn't see Liver yang rising or Kidney/Liver yin deficiency.

I believe that this was something of a knee jerk response based on the type

of practice that has been the topic of a few threads lately.

I saw phlegm damp accumulation and a lot of it. So I set her up with a

modified Ban Xia Bai Zhu Tian Ma Tang. I treated what I saw. Hopefully I'll

see her blood pressure come down too. I would add though, that I did

include Gou Teng and Du Zhong in the formula using their Western

anti-hypertensive mechanisms as the reason. I treated what I saw, but

because I also saw that her BP was raised (150/95 - 45 year old female), I

chose to include the anti-hypertensives as they didn't really present any

particular contraindication from the TCM standpoint for this patient.

I think that if there is anything wrong with treating what you see is that

you may not adequately honor those who came before. I understand now that

there are protocols in circulation that were created by political needs and

not an old herb master, but for the most part, I assume that while these

books may not be perfect, I can learn more from them than the authors can

learn from me.

So treating what you see is good, but contrary to what I said last week, I

think that we need to be sensitive to those who've gone before us too. I'm

just taking my first baby steps in formula writing and can't always see the

nuance that a more experienced practitioner would.

Tiande Yang speaks of a " lock and key " approach and seeing the details in a

patient's presentation. His formulas are made up of a number of dui yaos or

pairs of herbs used together such as Shan Zha and Mai Ya, or Bai Shao and

Chai Hu. Its amazing to watch him.

Another supervisor recently suggested that if I ever use a formula, I

shouldn't make any modifications to anything, including the dosages which he

believes is the secret in the formula. He suggests that until one is really

experienced, one should seek to do what the masters have left behind and has

withstood the test of time. He still treats what he sees of course, but

chooses not to modify the formula.

Perhaps that's a good idea when " treating what you see " is too overwhelming.

You look at some of the classic formulas and you see that the originator of

those formulas saw this key issue, but also this or that secondary issue and

this or that problem if the dosage of this or that herb was too high or too

low, etc... it's mind boggling. There's something to be said for just doing

what others have done before you, at least until you can start to make sense

of those signs and symptoms that don't conform to the traditional

presentation for a given formula.

> This shines light back on our previous question, what is missing in our

> schools? Quite simply, how to THINK . When one learns how

> to

> think and evaluate the proper pathomechanism causing the s/s, one can

> construct a formula with simple elegance.

>

Maybe you can present a case study, something short and sweet that gets to

the point of understanding pathomechanisms and how a formula is constructed.

I'd be interested in reading that.

--

Pain is inevitable, suffering is optional.

January 10, 2007

" a 15 ingredient MONSTER

catch all formula, treating every pattern possible, is much more

likely to

cause side-effects in the long-term, because clearly there are going

to be

aspects of the formula that are just incorrect. "

I heard Dan Bensky say once that when we give formulas to cover our

bases we are treating the practitioner, not the patient. The

practitioner's disease is Not Having a Clear Diagnosis.

Sharon Weizenbaum

86 Henry Street

Amherst, MA 01002

413-549-4021

sweiz

www.whitepinehealingarts.com

January 10, 2007

At the same time we need to remember that there is a lot or traditions that use

large formulae successfully.

I do not think we know the answer. I think i shared it before but the most

popular Dr at the hospital i worked in used huge formulas in ways no one could

figure out. He was very old with almost a century of practice and a HUGE

following

Oakland, CA 94609

-

sharon weizenbaum

Wednesday, January 10, 2007 8:19 AM

Re: Depression, not just Qi Stag./ research + rant

" a 15 ingredient MONSTER

catch all formula, treating every pattern possible, is much more

likely to

cause side-effects in the long-term, because clearly there are going

to be

aspects of the formula that are just incorrect. "

I heard Dan Bensky say once that when we give formulas to cover our

bases we are treating the practitioner, not the patient. The

practitioner's disease is Not Having a Clear Diagnosis.

Sharon Weizenbaum

86 Henry Street

Amherst, MA 01002

413-549-4021

sweiz

www.whitepinehealingarts.com

January 10, 2007

I also don't see fifteen ingredient prescriptions as necessarily

monster prescriptions, if the pattern calls for it (in its

complexity). Many traditional physicians used large scripts, such as

Gong Ding-xian, Li Dong-yuan, and Wang Qing-ren. It depends on the

situation.

On Jan 10, 2007, at 6:13 PM, wrote:

> At the same time we need to remember that there is a lot or

> traditions that use large formulae successfully.

> I do not think we know the answer. I think i shared it before but

> the most popular Dr at the hospital i worked in used huge formulas

> in ways no one could figure out. He was very old with almost a

> century of practice and a HUGE following

>

> Oakland, CA 94609

>

> -

> sharon weizenbaum

>

> Wednesday, January 10, 2007 8:19 AM

> Re: Depression, not just Qi Stag./ research + rant

>

> " a 15 ingredient MONSTER

> catch all formula, treating every pattern possible, is much more

> likely to

> cause side-effects in the long-term, because clearly there are going

> to be

> aspects of the formula that are just incorrect. "

>

> I heard Dan Bensky say once that when we give formulas to cover our

> bases we are treating the practitioner, not the patient. The

> practitioner's disease is Not Having a Clear Diagnosis.

>

> Sharon Weizenbaum

> 86 Henry Street

> Amherst, MA 01002

> 413-549-4021

> sweiz

> www.whitepinehealingarts.com

>

January 10, 2007

Z¡Çev and group,

This is true, there are modern and pre-modern physicians that have large

formulas that treat complex situations. A few herbs for this, a few herbs

for that etc. This method works, that is not in question. My point is that

if one has a choice of hitting the target with a slim arrow vs. a large

bazooka, which would you rather choose? I personally find the smaller more

concise formulas (that directly hit the pathomechanism) versus a few herbs

for every seen pattern much more eloquent and instructive. They have

something, sometimes very profound, to teach. And my point earlier is that

with simplicity comes potentially less toxicity. I know Z¡Çev uses a Kan

modular system where one might end up with 20+ herbs in a formula. But this

method bypasses the toxicity issue, because it does not increase the overall

dose of herbs in the formula. No matter how many herbs there is a relatively

low overall dosage. Would you say this is true Z¡Çev? Compare this to a

recent formula I saw, from a famous Beijing doctor, for a child with

enuresis. It started out with mu li 30, long gu 30, shi jue ming 30 with

about 10 other herbs. The total came to about 180+ grams a day. Wow! - The

reported effect was that the child obeyed their parents better and was

¡Èbetter behaved¡É - Funny right?

Don¡Çt get me wrong there is a time and place when I write large formulas

(for complex situations), but as Sharon mentioned, I feel in these

situations, sometimes I just don¡Çt see the essence of the problem

clearly.

From a educational standpoint, there is nothing mind expanding about looking

at a 15-20 ingredient formula that treats every aspect of the disease. So

what, I say! IMHO, it is more difficult to learn anything really profound,

from such an approach. I learn the most from a formula that doesn¡Çt seem

to

address the s/s directly but somehow cures the problems. This, to me, is the

way of the true master.

Al asked for an example, just 2 weeks ago a patient came in for nosebleeds

that had continued for 9 days, he also was constipated and had abdominal

fullness. He had a ¡Èstomach flu¡É 1 week prior. Now if I gave a

formula

that contained herbs for bloating (i.e. hou po, mu xiang etc), gave some

purgatives (da huang, zhi shi), gave some herbs to clear heat, gave some

herbs to stop bleeding (i.e. bai mao gen). Gave some to drain some damp heat

via the urine. Some to move the liver (constitution), and some herbs to

evict a lingering pathogen (or whatever), all and all it would have

contained about 12+ herbs. This was my first instinct. It may have worked!

GREAT! But instead I saw a common underlying thread and gave ban xia xie xin

tang. I don¡Çt think any mainstream zang-fu book would have suggested this

for constipation or nosebleeds. Therefore by understanding the

pathomechanism I had a simple direct hit which teaches a lot on how the body

works! Now with such an approach one can more easily make errors. It is less

safe (for results). With the former approach, one can expect many of the s/s

to improve, who is not going to have a bowel movement with enough da huang

and zhi shi? This is a no brainer. The latter approach you can fall on your

butt very easily.

So if the large formula method is valid, why deviate? One answer is that,

the reward is the possibility to correct underlying mechanisms that cause

all sorts of problems, and actually cure people. I know this can happen with

large formulas, but many times I see the larger formula approach quell the

s/s and never cure the patient. One constantly shifts the formula for

whatever comes up, going on and on forever¡Ä I strive for ways to keep the

patient off herbs. This is just my bias and viewpoint.

So there are great doctors that write huge formulas, no doubt I have seen

them work. And I do think we can learn from them. As Z¡Çev said there is a

time and place. So are there some times that a monster formula is the only

way to go? I do not know, but probably! But the more and more I study, the

more I see very complex looking patients get treated with very simple

formulas. These same patients could have easily been given 15+ herb

formulas. I strive for the former! The only criteria that I can think of

that would suggest that one is superior to the other are a) side-effects and

b) toxicity, otherwise I guess it comes down to personal preference.

Comments,

-

_____

On Behalf Of

2007Ç¯1·î10Æü 19:59

Re: Re: Depression, not just Qi Stag./ research + rant

I also don't see fifteen ingredient prescriptions as necessarily

monster prescriptions, if the pattern calls for it (in its

complexity). Many traditional physicians used large scripts, such as

Gong Ding-xian, Li Dong-yuan, and Wang Qing-ren. It depends on the

situation.

On Jan 10, 2007, at 6:13 PM, wrote:

> At the same time we need to remember that there is a lot or

> traditions that use large formulae successfully.

> I do not think we know the answer. I think i shared it before but

> the most popular Dr at the hospital i worked in used huge formulas

> in ways no one could figure out. He was very old with almost a

> century of practice and a HUGE following

>

> Oakland, CA 94609

>

> -

> sharon weizenbaum

> @ <%40>

> Wednesday, January 10, 2007 8:19 AM

> Re: Depression, not just Qi Stag./ research + rant

>

> " a 15 ingredient MONSTER

> catch all formula, treating every pattern possible, is much more

> likely to

> cause side-effects in the long-term, because clearly there are going

> to be

> aspects of the formula that are just incorrect. "

>

> I heard Dan Bensky say once that when we give formulas to cover our

> bases we are treating the practitioner, not the patient. The

> practitioner's disease is Not Having a Clear Diagnosis.

>

> Sharon Weizenbaum

> 86 Henry Street

> Amherst, MA 01002

> 413-549-4021

> sweiz <sweiz%40rcn.com>

> www.whitepinehealingarts.com

>

January 10, 2007

I agree

One of my Teachers who did his masters on the Shang Han Lun back in the late

70's,

always stessed the importance of trying to use the simpler and smaller formulas,

as Zhang

Zhong Jing would have prescribed- like Ban Xia Xie Xin Tang. The practice of

adding a

little herbs for this and that ( which my teacher pointed out is a very western

way of

making a formula, or cook book style), as compared to using a Traditonal formula

that can

address the core problem and offer a cure can be so rewarding. Of course there

are times

that the monster formulas are needed and are used because, as already stated,

the

practitioner is covering his butt or is unclear of the proper Dx, which is easy

to do. I think

that it is a greater art to be able to take a smaller Traditional formula and

see how it could

apply to something like nose bleeds combined with constipation. We need to

stretch our

little minds and see the formuals for the depth that they offer in their pure

form. A skill

that I must admit to be miles away from but can sure see the beauty.

Thanks,

Trevor

, " "

wrote:

>

> Z¡Çev and group,

>

> This is true, there are modern and pre-modern physicians that have large

> formulas that treat complex situations. A few herbs for this, a few herbs

> for that etc. This method works, that is not in question. My point is that

> if one has a choice of hitting the target with a slim arrow vs. a large

> bazooka, which would you rather choose? I personally find the smaller more

> concise formulas (that directly hit the pathomechanism) versus a few herbs

> for every seen pattern much more eloquent and instructive. They have

> something, sometimes very profound, to teach. And my point earlier is that

> with simplicity comes potentially less toxicity. I know Z¡Çev uses a Kan

> modular system where one might end up with 20+ herbs in a formula. But this

> method bypasses the toxicity issue, because it does not increase the overall

> dose of herbs in the formula. No matter how many herbs there is a relatively

> low overall dosage. Would you say this is true Z¡Çev? Compare this to a

> recent formula I saw, from a famous Beijing doctor, for a child with

> enuresis. It started out with mu li 30, long gu 30, shi jue ming 30 with

> about 10 other herbs. The total came to about 180+ grams a day. Wow! - The

> reported effect was that the child obeyed their parents better and was

> ¡Èbetter behaved¡É - Funny right?

>

> Don¡Çt get me wrong there is a time and place when I write large formulas

> (for complex situations), but as Sharon mentioned, I feel in these

> situations, sometimes I just don¡Çt see the essence of the problem clearly.

> From a educational standpoint, there is nothing mind expanding about looking

> at a 15-20 ingredient formula that treats every aspect of the disease. So

> what, I say! IMHO, it is more difficult to learn anything really profound,

> from such an approach. I learn the most from a formula that doesn¡Çt seem to

> address the s/s directly but somehow cures the problems. This, to me, is the

> way of the true master.

>

> Al asked for an example, just 2 weeks ago a patient came in for nosebleeds

> that had continued for 9 days, he also was constipated and had abdominal

> fullness. He had a ¡Èstomach flu¡É 1 week prior. Now if I gave a formula

> that contained herbs for bloating (i.e. hou po, mu xiang etc), gave some

> purgatives (da huang, zhi shi), gave some herbs to clear heat, gave some

> herbs to stop bleeding (i.e. bai mao gen). Gave some to drain some damp heat

> via the urine. Some to move the liver (constitution), and some herbs to

> evict a lingering pathogen (or whatever), all and all it would have

> contained about 12+ herbs. This was my first instinct. It may have worked!

> GREAT! But instead I saw a common underlying thread and gave ban xia xie xin

> tang. I don¡Çt think any mainstream zang-fu book would have suggested this

> for constipation or nosebleeds. Therefore by understanding the

> pathomechanism I had a simple direct hit which teaches a lot on how the body

> works! Now with such an approach one can more easily make errors. It is less

> safe (for results). With the former approach, one can expect many of the s/s

> to improve, who is not going to have a bowel movement with enough da huang

> and zhi shi? This is a no brainer. The latter approach you can fall on your

> butt very easily.

>

> So if the large formula method is valid, why deviate? One answer is that,

> the reward is the possibility to correct underlying mechanisms that cause

> all sorts of problems, and actually cure people. I know this can happen with

> large formulas, but many times I see the larger formula approach quell the

> s/s and never cure the patient. One constantly shifts the formula for

> whatever comes up, going on and on forever¡Ä I strive for ways to keep the

> patient off herbs. This is just my bias and viewpoint.

>

> So there are great doctors that write huge formulas, no doubt I have seen

> them work. And I do think we can learn from them. As Z¡Çev said there is a

> time and place. So are there some times that a monster formula is the only

> way to go? I do not know, but probably! But the more and more I study, the

> more I see very complex looking patients get treated with very simple

> formulas. These same patients could have easily been given 15+ herb

> formulas. I strive for the former! The only criteria that I can think of

> that would suggest that one is superior to the other are a) side-effects and

> b) toxicity, otherwise I guess it comes down to personal preference.

>

> Comments,

>

> -

>

_____

>

> On Behalf Of

> 2007Ç¯1·î10Æü 19:59

>

> Re: Re: Depression, not just Qi Stag./ research + rant

>

> I also don't see fifteen ingredient prescriptions as necessarily

> monster prescriptions, if the pattern calls for it (in its

> complexity). Many traditional physicians used large scripts, such as

> Gong Ding-xian, Li Dong-yuan, and Wang Qing-ren. It depends on the

> situation.

>

> On Jan 10, 2007, at 6:13 PM, wrote:

>

> > At the same time we need to remember that there is a lot or

> > traditions that use large formulae successfully.

> > I do not think we know the answer. I think i shared it before but

> > the most popular Dr at the hospital i worked in used huge formulas

> > in ways no one could figure out. He was very old with almost a

> > century of practice and a HUGE following

> >

> > Oakland, CA 94609

> >

> > -

> > sharon weizenbaum

> > @ <%40>

>

> > Wednesday, January 10, 2007 8:19 AM

> > Re: Depression, not just Qi Stag./ research + rant

> >

> > " a 15 ingredient MONSTER

> > catch all formula, treating every pattern possible, is much more

> > likely to

> > cause side-effects in the long-term, because clearly there are going

> > to be

> > aspects of the formula that are just incorrect. "

> >

> > I heard Dan Bensky say once that when we give formulas to cover our

> > bases we are treating the practitioner, not the patient. The

> > practitioner's disease is Not Having a Clear Diagnosis.

> >

> > Sharon Weizenbaum

> > 86 Henry Street

> > Amherst, MA 01002

> > 413-549-4021

> > sweiz <sweiz%40rcn.com>

> > www.whitepinehealingarts.com

> >

January 10, 2007

Jason

I think the best thing about a small formula is that you get a clear answer to

your clinical assumption and therefore learn more. So if an approach does not

work you know what is going on as compared to complex formulas. I actually use

smaller less complex formulas when i am confused

Oakland, CA 94609

-

Wednesday, January 10, 2007 8:15 PM

RE: Re: Depression, not just Qi Stag./ research + rant