Standards for pattern discrimination & studying classics

[Guest guest]

Sharon & Group,

 

 

 

I would love to get together and chat when you are in Boulder, I am sure

Chip would also be interested.

 

 

 

I do not have your list therefore I cannot make comments about what cases I

have that contradict it. But from my recollection the list that I saw was

basically a list of basic diagnostic criteria (TCM) that I often find

exceptions to. It is not just a " list " that I find clinical exceptions to,

but modern TCM as a whole has many lacunas, that once one is exposed to

broader ways of thinking, they will find often.

 

 

 

The list had phrases like, if you have symptom X (or pair of symptoms) you

can definitely diagnosis pattern Y. Nothing IMO is definite. I think such

statements are good for starting points, but I find in the clinic they are

often not true and although good for the beginner to get their hands around

CM, if used past a certain point they tend to box you in more than help you

expand. I do not doubt that you keep a wider perspective in your classes and

teach the students about context. But many students get the ideas, like you

mention below (yin xu= night sweating), from such lists etc. Meaning if one

has these things (or thing) then there has to be X pattern. If you send me

your list I will be happy to give my feedback.

 

 

 

IMO, I have never seen 1 s/s ever equate only 1 pattern. (I am sure there

has to be one.) I know we have debated this before on the CHA, for example,

as you mention below, it was said that if you have fatigue you must have qi

xu. I hope we can all agree now that this is just false. If people can come

up with anything that is definitive to dx a certain pattern please let us

know, I think this is worth discussing, and I think Sharon's list could be a

good springboard for discussion. Sharon, would you share this list or parts

of it?

 

 

 

Just for my personal tastes, such lists (or thinking) is simplifying TCM

rather than showing its depth. I think that for 1st and 2nd year students

keeping it simple is useful, but after that, open the flood gates. But who

can argue that if a student doesn't understand the basics of diagnosis then

such methods I'm sure are completely useful.

 

 

 

An example not from any list (at least to my knowledge) is this statement of

fact (or whatever it is) that there are only 4 kinds of bleeding. I was

taught this in school at one point as:

 

1) sp xu, 2) heat 3) blood stasis, 4) trauma.

 

 

 

Well. anyone who has studied the SHL / JGYL knows that these are not the

only causes. This is precisely why I object to the distillation, color by

number, modern CM approach. It misses very useful strategies for common

illnesses. Can someone guess another cause of bleeding?

 

 

 

People have said studying the classics like SHL and JGYL is not useful in

the clinic. I sometimes wonder how this could be the case. Clearly if you

believe that there are only the above 4 causes of bleeding, which is still

common teaching in some schools, then you miss out. These type of exceptions

are not just theoretical novelties, but still useful in a modern day clinic.

 

 

 

 

Another example on some list I saw at some point was that if you have

nocturia then you must have kidney deficiency. This was taught to me as a

statement of fact at one point. I'm lucky that I didn't adhere to this

rigid rule for my patient who I cured by only moving liver qi constraint,

and if I remember correctly, in 1-2 weeks.

 

 

 

Granted, there is another side of the coin. There must be some framework to

work from. TCM offers a great starting framework, no doubt. Probably one of

the best ones out there. My objection is only to those who take this system

and turn it into this black-and-white algorithm. Just to be clear I am not

in the least bit accusing Sharon or anyone else of doing this. It is though

clear that many students (graduating) believe that this is the case.

 

 

 

This is the downfall of students not really studying classic material. It

is always been a part of the Chinese medical tradition to study past famous

doctors, one reason is because there are multiple viable perspectives. And I

don't mean just memorizing a bunch of formulas (from i.e. the SHL), but

really understanding the thinking methods of these doctors. These (other)

perspectives give real clinical options for the modern-day clinic. To even

start to think that all of the useful information from past doctors is

somehow integrated into one system like TCM is just foolhardy.

 

 

 

Regards,

 

 

 

 

 

 

 

 

 

 

 

_____

 

 

On Behalf Of sharon weizenbaum

Thursday, May 10, 2007 11:04 AM

 

Re: Standards for pattern discrimination

 

 

 

Hi Jason,

 

Since the definitive diagnosis lists are of my own creation I thought

it best I should reply!

 

First, these lists are not published for the general public and are

used as a teaching tool for my own students. They are not meant to

be taken out of context of the entire course on definitive diagnosis.

One of the main purposes of the lists is to help practitioners avoid

jumping to faulty conclusions in their diagnosis. This means that

what is NOT in the list is as important as what is on the list. For

example - hot flashes are not listed under Yin vacuity. Fatigue is

not listed under Spleen Qi deficiency etc. The conclusion that when

there are hot flashes there is Yin deficiency and when there is

fatigue there is Spleen Qi deficiency is such common ones for

practitioners to jump to that it is ubiquitous. Of course there are

many many others.

 

I'd love to hear what daily cases you have that contradict them

nonetheless. My guess is that, in this case, the lists are taken out

of context but I wonder.

 

You know what would be fun is to get together a few experienced

practitioners to diagnose a few patients and discuss our conclusions

and methods. I'll be in Boulder most likely this autumn teaching the

Integrative Mandala Acupuncture program - Maybe You, Chip and I could

do this and write up some or our insights? I'll ask Chip if he's

interested.

 

warm regards,

 

Sharon

 

writes

 

Finally I recently came across one of those definitive diagnosis lists,

where basically it lays out what you need to diagnosis a given pattern.

Although I found myself reminiscing at a time (1-2nd year school) where

everything was black and white, it became quickly apparent how flawed it

was. Clearly if one practiced in this manner one could help people,

but one

would not be a superior doctor, and miss many patterns. It is a great

tool

for beginners to grasp the concepts but for almost every pattern I could

think of obvious exceptions that I encounter in the clinic daily. I

am just

not convinced how realistic something like this is for the modern

clinic /

difficult to treat conditions. Comments?

 

Sharon Weizenbaum

86 Henry Street

Amherst, MA 01002

413-549-4021

sweiz <sweiz%40rcn.com>

www.whitepinehealingarts.com

 

 

 

 

 

 

[Guest guest]

Hi Jason, I always enjoy your posts. They are so thoughtful and

knowledgeable while retaining a deep openness and inquisitiveness.

 

You wrote:

 

Just for my personal tastes, such lists (or thinking) is simplifying TCM

rather than showing its depth. I think that for 1st and 2nd year

students

keeping it simple is useful, but after that, open the flood gates.

But who

can argue that if a student doesn't understand the basics of

diagnosis then

such methods I'm sure are completely useful.

 

My comment is: It is very clear to me that there is a way to

simplify that gives room for the depth to be understood. Simple and

Complex can mutually help each other or be polarized. When we

simplify as a way to avoid complexity, it's gonna be a mess. I think

you will find that definitive diagnosis (by the way, I am looking for

another word besides definitive if you can think of one - but one

that speaks to being grounded in what is as opposed to the story you

have made up about something) uses simplicity to open up the

diagnostic process to complexity.

 

One of the exercises we do in class is to look at cases that have

been written by masters of the past (when they have written an in-

depth intake) I have the students apply definitive diagnosis to the

case to see what they come up with. To a great extent the diagnosis

they come up with is the same as the master's and the formula is very

similar, even in complex cases. In my observation, it seems that

many masters actually use this method, or close to it, intuitively,

and I have just articulated it.

 

As for your patient with nocturia, Why would Liver Qi constraint

cause nocturia if the Kidney were not vulnerable is some way? (by

the way - in the lists it is chronic nocturia and it is not that

someone wakes up and then has to pee - it is that needing to pee

wakes them up that indicates Kidney involvement) One thing the lists

don't do is to give us the balance of how much to focus on different

aspects of a particular diagnosis. So, I wonder, with your patient

if Liver Qi constraint was such an outstanding aspect of the

diagnosis that the nocturia got better just by opening up the

constraint - but that the fact that the constraint caused nocturia

specifically is still an indication of some Kidney vulnerability.

Just to say that maybe we are both right?

 

As for the bleeding issue you wrote:

 

Jason wrote

" An example not from any list (at least to my knowledge) is this

statement of

fact (or whatever it is) that there are only 4 kinds of bleeding. I was

taught this in school at one point as:

 

1) sp xu, 2) heat 3) blood stasis, 4) trauma.

 

Well. anyone who has studied the SHL / JGYL knows that these are not the

only causes. This is precisely why I object to the distillation,

color by

number, modern CM approach. It misses very useful strategies for common

illnesses. Can someone guess another cause of bleeding? "

 

Sharon answers

 

I have studied the Shang Han Lun and seen the lines in which there

is bleeding and, tell me if I am wrong, they still are from the basic

causes of bleeding. But, I do think that the basic causes of

bleeding you learned in school are inadequate. Here are the ones I

teach:

 

1. Qi Xu

A. Spleen

B. Kidney

2. Heat

A. Full Heat (and then one must look at the possible conditions that

cause full heat and the things the heat can mingle with etc.)

B. Empty Heat (and then one must look at the possible conditions

that cause empty heat and the things the heat can mingle with etc.)

3. Blood stasis (and then one must look at the possible conditions

that cause the blood stasis and the things the stasis can mingle with

etc.))

4. Trauma

 

I can't think of a line in the Shang Han Lun in which the bleeding is

not from one of these. Can you?

 

Within the four above - given that there are many causes of heat and

of blood stasis - there are of course hundreds of treatment

strategies. These strategies also vary depending on the severity of

the bleeding and the whole context of the patient's case. So here is

an example of a simplification, i.e. 4 causes of bleeding, that does

not limit the depth of possible treatment. The four causes are a

scaffolding to organize our deepening understanding of bleeding.

It's not that there are 4 formulas or strategies to stop bleeding.

 

In general, the definitive diagnosis methodology is such a

scaffolding that leaves room for the complexities to be understood

and worked with. " Pattern differentiation " which I see as the lists

of possible patterns (with each pattern containing a list of

symptoms) for a particular symptom or disease or disease factor (i.e

Kidney Yin Xu, Liver qi constraint, phlegm etc) is MUCH more of a

simplification and it closes down the possibilities and misleads - a

much longer conversation to be sure.

 

As for the Shang Han Lun being useful for clinical practice?

 

Jason wrote

" People have said studying the classics like SHL and JGYL is not

useful in

the clinic. I sometimes wonder how this could be the case. Clearly if

you

believe that there are only the above 4 causes of bleeding, which is

still

common teaching in some schools, then you miss out. These type of

exceptions

are not just theoretical novelties, but still useful in a modern day

clinic. "

 

Sharon replies

 

One could almost say that without the Shang Han Lun and JGYL there

would be no clinical practice! But, it has taken me years of study

to learn to begin to see the real depth of that text. I think the

way it is taught in schools misses the boat and so, it is rendered

rather useless seeming. I also think there is a difference between

understanding how to use some or many of the Shang Han Lun formulas

and understanding the Gestalt of the entire way of thought. I don't

know too many who I have felt have a deep understanding beyond the

use of some formulas - or even a lot of formulas.

 

I've also observed the tendency for practitioners to separate out SHL/

JGYL style as if it is totally separate from TCM. Like you either do

SHL style or TCM or some other style. One cannot understand SHL

formulas without understanding outside/inside, hot/cold, upper/lower,

Zang/Fu, Qi and Blood or phlegm etc. It's one thing to memorize the

symptom complex of Xiao Chai Hu Tang and to use it when that complex

shows up - but it's another thing to understand how the formula works

and to understand why it is called a " Shao Yang " formula and why it

may be placed after Yang Ming in the text etc. For this one must

have a much deeper understanding. One will never be good at using

Shang Han Lun formulas is one does not know the basics of diagnosis

in general.

 

Thanks for the enjoyable dialogue!

 

Sharon

 

 

Sharon Weizenbaum

86 Henry Street

Amherst, MA 01002

413-549-4021

sweiz

www.whitepinehealingarts.com

 

 

 

 

 

[Guest guest]

Dear Jason,

This is really the key to learning prescriptions and diagnosis,

in my opinion. I am hoping that one of us, perhaps you or myself,

will find a way to develop expert systems to teach the thinking

methods of classical and modern CM physicians, as this will greatly

improve the diagnostic and clinical outcomes of CM practitioners.

Certainly Sharon is working in this direction.

 

 

On May 10, 2007, at 12:37 PM, wrote:

 

>

> This is the downfall of students not really studying classic

> material. It

> is always been a part of the Chinese medical tradition to study

> past famous

> doctors, one reason is because there are multiple viable

> perspectives. And I

> don't mean just memorizing a bunch of formulas (from i.e. the SHL),

> but

> really understanding the thinking methods of these doctors. These

> (other)

> perspectives give real clinical options for the modern-day clinic.

> To even

> start to think that all of the useful information from past doctors is

> somehow integrated into one system like TCM is just foolhardy.

 

 

 

 

[Guest guest]

I don't know how anyone can say this. Again, the thinking processes

of Zhang Ji are the key, and the more I study these texts, the deeper

my knowledge of Chinese medicine is.

 

 

On May 10, 2007, at 12:37 PM, wrote:

 

> People have said studying the classics like SHL and JGYL is not

> useful in

> the clinic. I sometimes wonder how this could be the case. Clearly

> if you

> believe that there are only the above 4 causes of bleeding, which

> is still

> common teaching in some schools, then you miss out. These type of

> exceptions

> are not just theoretical novelties, but still useful in a modern

> day clinic.

 

 

 

 

[Guest guest]

Jason, Zev

Can you guys start on a regular basis give clinical examples of your application

of SHL and other classical applications? perhaps when you see a pt that such

thinking is changing your approach just share it with us. That would be greatly

appreciated

 

 

 

 

 

 

 

 

-

sharon weizenbaum

Friday, May 11, 2007 9:41 AM

Re:Standards for pattern discrimination & studying classics

 

 

Hi Jason, I always enjoy your posts. They are so thoughtful and

knowledgeable while retaining a deep openness and inquisitiveness.

 

You wrote:

 

Just for my personal tastes, such lists (or thinking) is simplifying TCM

rather than showing its depth. I think that for 1st and 2nd year

students

keeping it simple is useful, but after that, open the flood gates.

But who

can argue that if a student doesn't understand the basics of

diagnosis then

such methods I'm sure are completely useful.

 

My comment is: It is very clear to me that there is a way to

simplify that gives room for the depth to be understood. Simple and

Complex can mutually help each other or be polarized. When we

simplify as a way to avoid complexity, it's gonna be a mess. I think

you will find that definitive diagnosis (by the way, I am looking for

another word besides definitive if you can think of one - but one

that speaks to being grounded in what is as opposed to the story you

have made up about something) uses simplicity to open up the

diagnostic process to complexity.

 

One of the exercises we do in class is to look at cases that have

been written by masters of the past (when they have written an in-

depth intake) I have the students apply definitive diagnosis to the

case to see what they come up with. To a great extent the diagnosis

they come up with is the same as the master's and the formula is very

similar, even in complex cases. In my observation, it seems that

many masters actually use this method, or close to it, intuitively,

and I have just articulated it.

 

As for your patient with nocturia, Why would Liver Qi constraint

cause nocturia if the Kidney were not vulnerable is some way? (by

the way - in the lists it is chronic nocturia and it is not that

someone wakes up and then has to pee - it is that needing to pee

wakes them up that indicates Kidney involvement) One thing the lists

don't do is to give us the balance of how much to focus on different

aspects of a particular diagnosis. So, I wonder, with your patient

if Liver Qi constraint was such an outstanding aspect of the

diagnosis that the nocturia got better just by opening up the

constraint - but that the fact that the constraint caused nocturia

specifically is still an indication of some Kidney vulnerability.

Just to say that maybe we are both right?

 

As for the bleeding issue you wrote:

 

Jason wrote

" An example not from any list (at least to my knowledge) is this

statement of

fact (or whatever it is) that there are only 4 kinds of bleeding. I was

taught this in school at one point as:

 

1) sp xu, 2) heat 3) blood stasis, 4) trauma.

 

Well. anyone who has studied the SHL / JGYL knows that these are not the

only causes. This is precisely why I object to the distillation,

color by

number, modern CM approach. It misses very useful strategies for common

illnesses. Can someone guess another cause of bleeding? "

 

Sharon answers

 

I have studied the Shang Han Lun and seen the lines in which there

is bleeding and, tell me if I am wrong, they still are from the basic

causes of bleeding. But, I do think that the basic causes of

bleeding you learned in school are inadequate. Here are the ones I

teach:

 

1. Qi Xu

A. Spleen

B. Kidney

2. Heat

A. Full Heat (and then one must look at the possible conditions that

cause full heat and the things the heat can mingle with etc.)

B. Empty Heat (and then one must look at the possible conditions

that cause empty heat and the things the heat can mingle with etc.)

3. Blood stasis (and then one must look at the possible conditions

that cause the blood stasis and the things the stasis can mingle with

etc.))

4. Trauma

 

I can't think of a line in the Shang Han Lun in which the bleeding is

not from one of these. Can you?

 

Within the four above - given that there are many causes of heat and

of blood stasis - there are of course hundreds of treatment

strategies. These strategies also vary depending on the severity of

the bleeding and the whole context of the patient's case. So here is

an example of a simplification, i.e. 4 causes of bleeding, that does

not limit the depth of possible treatment. The four causes are a

scaffolding to organize our deepening understanding of bleeding.

It's not that there are 4 formulas or strategies to stop bleeding.

 

In general, the definitive diagnosis methodology is such a

scaffolding that leaves room for the complexities to be understood

and worked with. " Pattern differentiation " which I see as the lists

of possible patterns (with each pattern containing a list of

symptoms) for a particular symptom or disease or disease factor (i.e

Kidney Yin Xu, Liver qi constraint, phlegm etc) is MUCH more of a

simplification and it closes down the possibilities and misleads - a

much longer conversation to be sure.

 

As for the Shang Han Lun being useful for clinical practice?

 

Jason wrote

" People have said studying the classics like SHL and JGYL is not

useful in

the clinic. I sometimes wonder how this could be the case. Clearly if

you

believe that there are only the above 4 causes of bleeding, which is

still

common teaching in some schools, then you miss out. These type of

exceptions

are not just theoretical novelties, but still useful in a modern day

clinic. "

 

Sharon replies

 

One could almost say that without the Shang Han Lun and JGYL there

would be no clinical practice! But, it has taken me years of study

to learn to begin to see the real depth of that text. I think the

way it is taught in schools misses the boat and so, it is rendered

rather useless seeming. I also think there is a difference between

understanding how to use some or many of the Shang Han Lun formulas

and understanding the Gestalt of the entire way of thought. I don't

know too many who I have felt have a deep understanding beyond the

use of some formulas - or even a lot of formulas.

 

I've also observed the tendency for practitioners to separate out SHL/

JGYL style as if it is totally separate from TCM. Like you either do

SHL style or TCM or some other style. One cannot understand SHL

formulas without understanding outside/inside, hot/cold, upper/lower,

Zang/Fu, Qi and Blood or phlegm etc. It's one thing to memorize the

symptom complex of Xiao Chai Hu Tang and to use it when that complex

shows up - but it's another thing to understand how the formula works

and to understand why it is called a " Shao Yang " formula and why it

may be placed after Yang Ming in the text etc. For this one must

have a much deeper understanding. One will never be good at using

Shang Han Lun formulas is one does not know the basics of diagnosis

in general.

 

Thanks for the enjoyable dialogue!

 

Sharon

 

Sharon Weizenbaum

86 Henry Street

Amherst, MA 01002

413-549-4021

sweiz

www.whitepinehealingarts.com

 

[Guest guest]

Good idea, I'll keep that in mind.

 

 

On May 11, 2007, at 11:12 AM, Alon Marcus wrote:

 

> Jason, Zev

> Can you guys start on a regular basis give clinical examples of

> your application of SHL and other classical applications? perhaps

> when you see a pt that such thinking is changing your approach just

> share it with us. That would be greatly appreciated

>

>

>

>

>

>

>

>

> -

> sharon weizenbaum

>

> Friday, May 11, 2007 9:41 AM

> Re:Standards for pattern discrimination & studying

> classics

>

> Hi Jason, I always enjoy your posts. They are so thoughtful and

> knowledgeable while retaining a deep openness and inquisitiveness.

>

> You wrote:

>

> Just for my personal tastes, such lists (or thinking) is

> simplifying TCM

> rather than showing its depth. I think that for 1st and 2nd year

> students

> keeping it simple is useful, but after that, open the flood gates.

> But who

> can argue that if a student doesn't understand the basics of

> diagnosis then

> such methods I'm sure are completely useful.

>

> My comment is: It is very clear to me that there is a way to

> simplify that gives room for the depth to be understood. Simple and

> Complex can mutually help each other or be polarized. When we

> simplify as a way to avoid complexity, it's gonna be a mess. I think

> you will find that definitive diagnosis (by the way, I am looking for

> another word besides definitive if you can think of one - but one

> that speaks to being grounded in what is as opposed to the story you

> have made up about something) uses simplicity to open up the

> diagnostic process to complexity.

>

> One of the exercises we do in class is to look at cases that have

> been written by masters of the past (when they have written an in-

> depth intake) I have the students apply definitive diagnosis to the

> case to see what they come up with. To a great extent the diagnosis

> they come up with is the same as the master's and the formula is very

> similar, even in complex cases. In my observation, it seems that

> many masters actually use this method, or close to it, intuitively,

> and I have just articulated it.

>

> As for your patient with nocturia, Why would Liver Qi constraint

> cause nocturia if the Kidney were not vulnerable is some way? (by

> the way - in the lists it is chronic nocturia and it is not that

> someone wakes up and then has to pee - it is that needing to pee

> wakes them up that indicates Kidney involvement) One thing the lists

> don't do is to give us the balance of how much to focus on different

> aspects of a particular diagnosis. So, I wonder, with your patient

> if Liver Qi constraint was such an outstanding aspect of the

> diagnosis that the nocturia got better just by opening up the

> constraint - but that the fact that the constraint caused nocturia

> specifically is still an indication of some Kidney vulnerability.

> Just to say that maybe we are both right?

>

> As for the bleeding issue you wrote:

>

> Jason wrote

> " An example not from any list (at least to my knowledge) is this

> statement of

> fact (or whatever it is) that there are only 4 kinds of bleeding. I

> was

> taught this in school at one point as:

>

> 1) sp xu, 2) heat 3) blood stasis, 4) trauma.

>

> Well. anyone who has studied the SHL / JGYL knows that these are

> not the

> only causes. This is precisely why I object to the distillation,

> color by

> number, modern CM approach. It misses very useful strategies for

> common

> illnesses. Can someone guess another cause of bleeding? "

>

> Sharon answers

>

> I have studied the Shang Han Lun and seen the lines in which there

> is bleeding and, tell me if I am wrong, they still are from the basic

> causes of bleeding. But, I do think that the basic causes of

> bleeding you learned in school are inadequate. Here are the ones I

> teach:

>

> 1. Qi Xu

> A. Spleen

> B. Kidney

> 2. Heat

> A. Full Heat (and then one must look at the possible conditions that

> cause full heat and the things the heat can mingle with etc.)

> B. Empty Heat (and then one must look at the possible conditions

> that cause empty heat and the things the heat can mingle with etc.)

> 3. Blood stasis (and then one must look at the possible conditions

> that cause the blood stasis and the things the stasis can mingle with

> etc.))

> 4. Trauma

>

> I can't think of a line in the Shang Han Lun in which the bleeding is

> not from one of these. Can you?

>

> Within the four above - given that there are many causes of heat and

> of blood stasis - there are of course hundreds of treatment

> strategies. These strategies also vary depending on the severity of

> the bleeding and the whole context of the patient's case. So here is

> an example of a simplification, i.e. 4 causes of bleeding, that does

> not limit the depth of possible treatment. The four causes are a

> scaffolding to organize our deepening understanding of bleeding.

> It's not that there are 4 formulas or strategies to stop bleeding.

>

> In general, the definitive diagnosis methodology is such a

> scaffolding that leaves room for the complexities to be understood

> and worked with. " Pattern differentiation " which I see as the lists

> of possible patterns (with each pattern containing a list of

> symptoms) for a particular symptom or disease or disease factor (i.e

> Kidney Yin Xu, Liver qi constraint, phlegm etc) is MUCH more of a

> simplification and it closes down the possibilities and misleads - a

> much longer conversation to be sure.

>

> As for the Shang Han Lun being useful for clinical practice?

>

> Jason wrote

> " People have said studying the classics like SHL and JGYL is not

> useful in

> the clinic. I sometimes wonder how this could be the case. Clearly if

> you

> believe that there are only the above 4 causes of bleeding, which is

> still

> common teaching in some schools, then you miss out. These type of

> exceptions

> are not just theoretical novelties, but still useful in a modern day

> clinic. "

>

> Sharon replies

>

> One could almost say that without the Shang Han Lun and JGYL there

> would be no clinical practice! But, it has taken me years of study

> to learn to begin to see the real depth of that text. I think the

> way it is taught in schools misses the boat and so, it is rendered

> rather useless seeming. I also think there is a difference between

> understanding how to use some or many of the Shang Han Lun formulas

> and understanding the Gestalt of the entire way of thought. I don't

> know too many who I have felt have a deep understanding beyond the

> use of some formulas - or even a lot of formulas.

>

> I've also observed the tendency for practitioners to separate out SHL/

> JGYL style as if it is totally separate from TCM. Like you either do

> SHL style or TCM or some other style. One cannot understand SHL

> formulas without understanding outside/inside, hot/cold, upper/lower,

> Zang/Fu, Qi and Blood or phlegm etc. It's one thing to memorize the

> symptom complex of Xiao Chai Hu Tang and to use it when that complex

> shows up - but it's another thing to understand how the formula works

> and to understand why it is called a " Shao Yang " formula and why it

> may be placed after Yang Ming in the text etc. For this one must

> have a much deeper understanding. One will never be good at using

> Shang Han Lun formulas is one does not know the basics of diagnosis

> in general.

>

> Thanks for the enjoyable dialogue!

>

> Sharon

>

> Sharon Weizenbaum

> 86 Henry Street

> Amherst, MA 01002

> 413-549-4021

> sweiz

> www.whitepinehealingarts.com

>

>

[Guest guest]

_____

 

 

On Behalf Of sharon weizenbaum

Friday, May 11, 2007 10:41 AM

 

 

 

[sharon]My comment is: It is very clear to me that there is a way to

simplify that gives room for the depth to be understood. Simple and

Complex can mutually help each other or be polarized. When we

simplify as a way to avoid complexity, it's gonna be a mess. I think

you will find that definitive diagnosis (by the way, I am looking for

another word besides definitive if you can think of one - but one

that speaks to being grounded in what is as opposed to the story you

have made up about something) uses simplicity to open up the

diagnostic process to complexity.

 

Maybe something like, Fundamental Diagnostic Criteria (or

Methodology). Definite, IMHO, is just a little grandiose. I am unsure how it

opens complexity, but await further dialogue examples to understand this. I

am sure you have figured out a way to do this through your teaching that a

mere list cannot capture.

 

 

 

[sharon] One of the exercises we do in class is to look at cases that have

been written by masters of the past (when they have written an in-

depth intake) I have the students apply definitive diagnosis to the

case to see what they come up with. To a great extent the diagnosis

they come up with is the same as the master's and the formula is very

similar, even in complex cases. In my observation, it seems that

many masters actually use this method, or close to it, intuitively,

and I have just articulated it.

 

I image this relies largely on the cases chosen. Do you

think i.e. SHL case studies would also fit into your system? I also present

cases to students, but the formulas / dx of the cases I pick are usually

nothing like the student comes up with. I pick those on purpose to

demonstrate how different one can view things and how seemingly opposing

views can co-exist. I have shown such cases to people that have studied a

definitive dx system to demonstrate my point.

 

As for your patient with nocturia, Why would Liver Qi constraint

cause nocturia if the Kidney were not vulnerable is some way? (by

the way - in the lists it is chronic nocturia and it is not that

someone wakes up and then has to pee - it is that needing to pee

wakes them up that indicates Kidney involvement) One thing the lists

don't do is to give us the balance of how much to focus on different

aspects of a particular diagnosis. So, I wonder, with your patient

if Liver Qi constraint was such an outstanding aspect of the

diagnosis that the nocturia got better just by opening up the

constraint - but that the fact that the constraint caused nocturia

specifically is still an indication of some Kidney vulnerability.

Just to say that maybe we are both right?

 

I am unsure if both can be right. If one treats the liver

(with success) I pretty much assume the problem is with the liver. It is not

about vulnerability. It is about how to fix the problem! One can always spin

a circular web of relationships between organs to justify involvements.

Therefore, for me, the treatment dictates the true problem. Let me explain.

 

Of course one may say that the constraint was influencing the Kid/BL, there

was a urination problem! But in this situation one treats the root not the

organ effected. If one treated the kidney and things got better, I would say

it was a kidney problem. This example clearly shows the problem with

thinking that nocturia must be a kidney problem. Because once you tell a

student it must be a kidney problem, they will treat the kidney (and usually

every other organ they think is problematic.) In this situation, there was

no other " kidney " signs.. Clearly it was not necessary and probably would

have inhibited the healing process in this situation to do anything with the

kidney. BTW- This was a chronic nocturia, as you describe above, waking

from the need to pee. So yes the kidney may be vulnerable, but you don't

name it for Dx, nor do you have to always treat it. I am sure people have

treated cough through just opening up constraint in the liver. Etc etc.

 

I think this is a very important issue. I see students spin webs all the

time, because they do exactly what I mention above. Hence they end up with a

laundry list for a diagnosis.

 

 

Sharon answers

 

I have studied the Shang Han Lun and seen the lines in which there

is bleeding and, tell me if I am wrong, they still are from the basic

causes of bleeding.

 

 

 

I disagree. It misses cold. But I clearly understand your scaffolding

thinking. That is why " they " lump Sp, Kid with qi xu, and Empty and full

heat with heat. Etc etc.. But cold is not there.

 

In general, the definitive diagnosis methodology is such a

scaffolding that leaves room for the complexities to be understood

and worked with. " Pattern differentiation " which I see as the lists

of possible patterns (with each pattern containing a list of

symptoms) for a particular symptom or disease or disease factor (i.e

Kidney Yin Xu, Liver qi constraint, phlegm etc) is MUCH more of a

simplification and it closes down the possibilities and misleads - a

much longer conversation to be sure.

 

I agree that lists of patterns are more limiting. Either way

your system, what ever it entails, gets people to think.

 

 

 

Further thoughts?

 

 

 

Regards,

 

 

 

 

 

 

 

 

[Guest guest]

On 5/11/07, wrote:

>

>

> I agree that lists of patterns are more limiting. Either

> way

> your system, what ever it entails, gets people to think.

>

> Further thoughts?

>

 

 

 

 

 

 

 

I agree with Jason on how a treatment can confirm a diagnosis. As the

example was presented about qi constraint causing nocturia.

 

I'm not entirely sure what this list is supposed to entail, but when you

look at the various causes of nocturia, when it is small but frequent

amounts its a question of what biomedicine might consider insufficient

bladder contractability while TCM would suggest that the fluids aren't

flowing because the qi that moves stuff is stagnated in the area. Not

directly a Kid/UB thing, even though the symptom takes place in the UB's

neighborhood.

 

The point is this, that with asking about the quantity of urinary output,

one can differentiate qi stagnation from Kidney qi deficiency. I'm sure that

this kind of differentiating information can help with some sort of master

differentiation list.

 

We also need to consider its usage when thinking about how simple or complex

it should be. Is this to help students pass tests, or practitioners to

clarify thinking, or practitioners bill insurance companies? The end use

will help define what it needs to include I think.

 

-al.

 

--

 

Pain is inevitable, suffering is optional.

 

 

 

[Guest guest]

Alon,

 

 

 

Typing up case studies to do this type of thinking justice is time

consuming, but if there is something simple I will try. But in the latest

issue of the Lantern (coming soon?) I do just this and give an extensive

explanation of how I treated a patient using classical ideas, both SHL and

WenBing theory that IMO would never have occurred if I stayed within the

strict confines of a standard TCM paradigm. Nothing is overly profound, but

by me studying specific wenbing doctors as well as SHL commentary I utilize

a slightly different perspective on a very difficult case. IMO, there are

many ways one could have viewed the case, I just happened to choose one that

made sense to me, and in this specific case, it just happened to end up with

a good outcome. I poresent it only to show one way of thinking. You can let

me know what you think.

 

 

 

I think Volker Scheid sums up my sentiments on plurality (and standards) in

the first page of in Contemporary China. He states,

 

 

 

" the concrete realities of such diversity are rendered visible by even the

most fleeting visit to any hospital or outpatient clinic of traditional

medicine in contemporary China. No two doctors diagnose, prescribe, or

treat in quite the same way. It would be most unusual, for instance, if

after consulting 10 senior physicians for the same complaint one did not

walk away with 10 different prescriptions. Chinese physicians and their

patients seem little perturbed by this. Both through personal experience,

accumulated through years of study and clinical practice and by definition

diverse, as a cornerstone of Chinese medicine. Doctors pride themselves on

their individual styles of prescribing or needling.... Senior doctors state

that no good physician ever writes out the same prescription twice... "

 

 

 

With this reality, I find it surprising that one could present master's case

studies (without selecting one's to match a desired result) and expect

students to come up with the same formulas. If this did happen, I would

think that the case study was of little value.

 

 

 

Regards,

 

 

 

-

 

 

 

_____

 

 

On Behalf Of Alon Marcus

Friday, May 11, 2007 12:13 PM

 

Re: Re:Standards for pattern discrimination & studying

classics

 

 

 

Jason, Zev

Can you guys start on a regular basis give clinical examples of your

application of SHL and other classical applications? perhaps when you see a

pt that such thinking is changing your approach just share it with us. That

would be greatly appreciated

 

 

 

 

 

 

 

 

-

sharon weizenbaum

@ <%40>

 

Friday, May 11, 2007 9:41 AM

Re:Standards for pattern discrimination & studying classics

 

Hi Jason, I always enjoy your posts. They are so thoughtful and

knowledgeable while retaining a deep openness and inquisitiveness.

 

You wrote:

 

Just for my personal tastes, such lists (or thinking) is simplifying TCM

rather than showing its depth. I think that for 1st and 2nd year

students

keeping it simple is useful, but after that, open the flood gates.

But who

can argue that if a student doesn't understand the basics of

diagnosis then

such methods I'm sure are completely useful.

 

My comment is: It is very clear to me that there is a way to

simplify that gives room for the depth to be understood. Simple and

Complex can mutually help each other or be polarized. When we

simplify as a way to avoid complexity, it's gonna be a mess. I think

you will find that definitive diagnosis (by the way, I am looking for

another word besides definitive if you can think of one - but one

that speaks to being grounded in what is as opposed to the story you

have made up about something) uses simplicity to open up the

diagnostic process to complexity.

 

One of the exercises we do in class is to look at cases that have

been written by masters of the past (when they have written an in-

depth intake) I have the students apply definitive diagnosis to the

case to see what they come up with. To a great extent the diagnosis

they come up with is the same as the master's and the formula is very

similar, even in complex cases. In my observation, it seems that

many masters actually use this method, or close to it, intuitively,

and I have just articulated it.

 

As for your patient with nocturia, Why would Liver Qi constraint

cause nocturia if the Kidney were not vulnerable is some way? (by

the way - in the lists it is chronic nocturia and it is not that

someone wakes up and then has to pee - it is that needing to pee

wakes them up that indicates Kidney involvement) One thing the lists

don't do is to give us the balance of how much to focus on different

aspects of a particular diagnosis. So, I wonder, with your patient

if Liver Qi constraint was such an outstanding aspect of the

diagnosis that the nocturia got better just by opening up the

constraint - but that the fact that the constraint caused nocturia

specifically is still an indication of some Kidney vulnerability.

Just to say that maybe we are both right?

 

As for the bleeding issue you wrote:

 

Jason wrote

" An example not from any list (at least to my knowledge) is this

statement of

fact (or whatever it is) that there are only 4 kinds of bleeding. I was

taught this in school at one point as:

 

1) sp xu, 2) heat 3) blood stasis, 4) trauma.

 

Well. anyone who has studied the SHL / JGYL knows that these are not the

only causes. This is precisely why I object to the distillation,

color by

number, modern CM approach. It misses very useful strategies for common

illnesses. Can someone guess another cause of bleeding? "

 

Sharon answers

 

I have studied the Shang Han Lun and seen the lines in which there

is bleeding and, tell me if I am wrong, they still are from the basic

causes of bleeding. But, I do think that the basic causes of

bleeding you learned in school are inadequate. Here are the ones I

teach:

 

1. Qi Xu

A. Spleen

B. Kidney

2. Heat

A. Full Heat (and then one must look at the possible conditions that

cause full heat and the things the heat can mingle with etc.)

B. Empty Heat (and then one must look at the possible conditions

that cause empty heat and the things the heat can mingle with etc.)

3. Blood stasis (and then one must look at the possible conditions

that cause the blood stasis and the things the stasis can mingle with

etc.))

4. Trauma

 

I can't think of a line in the Shang Han Lun in which the bleeding is

not from one of these. Can you?

 

Within the four above - given that there are many causes of heat and

of blood stasis - there are of course hundreds of treatment

strategies. These strategies also vary depending on the severity of

the bleeding and the whole context of the patient's case. So here is

an example of a simplification, i.e. 4 causes of bleeding, that does

not limit the depth of possible treatment. The four causes are a

scaffolding to organize our deepening understanding of bleeding.

It's not that there are 4 formulas or strategies to stop bleeding.

 

In general, the definitive diagnosis methodology is such a

scaffolding that leaves room for the complexities to be understood

and worked with. " Pattern differentiation " which I see as the lists

of possible patterns (with each pattern containing a list of

symptoms) for a particular symptom or disease or disease factor (i.e

Kidney Yin Xu, Liver qi constraint, phlegm etc) is MUCH more of a

simplification and it closes down the possibilities and misleads - a

much longer conversation to be sure.

 

As for the Shang Han Lun being useful for clinical practice?

 

Jason wrote

" People have said studying the classics like SHL and JGYL is not

useful in

the clinic. I sometimes wonder how this could be the case. Clearly if

you

believe that there are only the above 4 causes of bleeding, which is

still

common teaching in some schools, then you miss out. These type of

exceptions

are not just theoretical novelties, but still useful in a modern day

clinic. "

 

Sharon replies

 

One could almost say that without the Shang Han Lun and JGYL there

would be no clinical practice! But, it has taken me years of study

to learn to begin to see the real depth of that text. I think the

way it is taught in schools misses the boat and so, it is rendered

rather useless seeming. I also think there is a difference between

understanding how to use some or many of the Shang Han Lun formulas

and understanding the Gestalt of the entire way of thought. I don't

know too many who I have felt have a deep understanding beyond the

use of some formulas - or even a lot of formulas.

 

I've also observed the tendency for practitioners to separate out SHL/

JGYL style as if it is totally separate from TCM. Like you either do

SHL style or TCM or some other style. One cannot understand SHL

formulas without understanding outside/inside, hot/cold, upper/lower,

Zang/Fu, Qi and Blood or phlegm etc. It's one thing to memorize the

symptom complex of Xiao Chai Hu Tang and to use it when that complex

shows up - but it's another thing to understand how the formula works

and to understand why it is called a " Shao Yang " formula and why it

may be placed after Yang Ming in the text etc. For this one must

have a much deeper understanding. One will never be good at using

Shang Han Lun formulas is one does not know the basics of diagnosis

in general.

 

Thanks for the enjoyable dialogue!

 

Sharon

 

Sharon Weizenbaum

86 Henry Street

Amherst, MA 01002

413-549-4021

sweiz <sweiz%40rcn.com>

www.whitepinehealingarts.com

 

 

[Guest guest]

Jason

that was my experience in china as well, we had such a variety of approaches

from classical drs to many family traditions to TCM. What i have got from

studying SHL is the idea of a pt being a formula, that was the approach of the

SHL dr i followed for a while. While at times i still find a pt that this

approach works for me it is not common, obviously because i am not trained

enough and cant be as flexible as one needs to be using SHL. I find after all

these years in practice (and i did have a period when i did practice more SHL)

the approach that i use the most is the first one i learned from Dr Lai at

ACTCM. It is a very flexible approaching of combining herbs based on 8 parameter

using multiple patterns, not classical formulas. When doing this i can often

hear in my head the SHL dr i followed in china looking down at such

prescriptions as being chop sue, i often use 12-15 herbs. I am vary curious to

see how you use classical approaches with US pts.

I hope you take the time from time to time and share

thanks

 

 

 

 

 

 

 

 

-

Friday, May 11, 2007 7:38 PM

RE: Re:Standards for pattern discrimination & studying classics

 

 

Alon,

 

Typing up case studies to do this type of thinking justice is time

consuming, but if there is something simple I will try. But in the latest

issue of the Lantern (coming soon?) I do just this and give an extensive

explanation of how I treated a patient using classical ideas, both SHL and

WenBing theory that IMO would never have occurred if I stayed within the

strict confines of a standard TCM paradigm. Nothing is overly profound, but

by me studying specific wenbing doctors as well as SHL commentary I utilize

a slightly different perspective on a very difficult case. IMO, there are

many ways one could have viewed the case, I just happened to choose one that

made sense to me, and in this specific case, it just happened to end up with

a good outcome. I poresent it only to show one way of thinking. You can let

me know what you think.

 

I think Volker Scheid sums up my sentiments on plurality (and standards) in

the first page of in Contemporary China. He states,

 

" the concrete realities of such diversity are rendered visible by even the

most fleeting visit to any hospital or outpatient clinic of traditional

medicine in contemporary China. No two doctors diagnose, prescribe, or

treat in quite the same way. It would be most unusual, for instance, if

after consulting 10 senior physicians for the same complaint one did not

walk away with 10 different prescriptions. Chinese physicians and their

patients seem little perturbed by this. Both through personal experience,

accumulated through years of study and clinical practice and by definition

diverse, as a cornerstone of Chinese medicine. Doctors pride themselves on

their individual styles of prescribing or needling.... Senior doctors state

that no good physician ever writes out the same prescription twice... "

 

With this reality, I find it surprising that one could present master's case

studies (without selecting one's to match a desired result) and expect

students to come up with the same formulas. If this did happen, I would

think that the case study was of little value.

 

Regards,

 

-

[Guest guest]

I agree with Jason on how a treatment can confirm a diagnosis.

>>>>>

Anything else is just empty theory

 

 

 

 

 

 

 

 

-

Al Stone

Friday, May 11, 2007 7:09 PM

Re: Re:Standards for pattern discrimination & studying classics

 

 

On 5/11/07, wrote:

>

>

> I agree that lists of patterns are more limiting. Either

> way

> your system, what ever it entails, gets people to think.

>

> Further thoughts?

>

 

I agree with Jason on how a treatment can confirm a diagnosis. As the

example was presented about qi constraint causing nocturia.

 

I'm not entirely sure what this list is supposed to entail, but when you

look at the various causes of nocturia, when it is small but frequent

amounts its a question of what biomedicine might consider insufficient

bladder contractability while TCM would suggest that the fluids aren't

flowing because the qi that moves stuff is stagnated in the area. Not

directly a Kid/UB thing, even though the symptom takes place in the UB's

neighborhood.

 

The point is this, that with asking about the quantity of urinary output,

one can differentiate qi stagnation from Kidney qi deficiency. I'm sure that

this kind of differentiating information can help with some sort of master

differentiation list.

 

We also need to consider its usage when thinking about how simple or complex

it should be. Is this to help students pass tests, or practitioners to

clarify thinking, or practitioners bill insurance companies? The end use

will help define what it needs to include I think.

 

-al.

 

--

Pain is inevitable, suffering is optional.

 

[Guest guest]

I do just this and give an extensive

explanation of how I treated a patient using classical ideas, both

SHL and

WenBing theory that IMO would never have occurred if I stayed within the

strict confines of a standard TCM paradigm. Nothing is overly

profound, but

by me studying specific wenbing doctors as well as SHL commentary I

utilize

a slightly different perspective on a very difficult case. IMO, there

are

many ways one could have viewed the case, I just happened to choose

one that

made sense to me, and in this specific case, it just happened to end

up with

a good outcome. I poresent it only to show one way of thinking. You

can let

me know what you think.

 

(Sharon) As for Shang Han Lun " diagnosis " , I find myself resistant

to classifying this as " another method of diagnosis " . I understand

that there is a way of looking that picks out " key signs and

symptoms " for a specific formula - and that a formula IS the

diagnosis (Minor Bupleurum Pattern for example) but - my hesitation

to consider this a separate diagnostic method is for the following

reason (by the way, it's a gut feeling that I haven't had time to

really think out so this is off the top of my head.....) I think that

Zhang Zhong Jing clearly understood the dynamics of physiology and

pathology - Yin/Yang, Hot/Cold, Up/Down, Inside/Outside, Qi/Blood,

Phlegm/Dryness, Movement/Stasis, as well as Zang Fu dynamics - the

whole shebang. His methods described in the SHL and JGYL grow out of

his profound understanding. We too must have a firm grasp of these

physiological and pathological dynamics to really understand the " key

symptom " way of choosing a formula. So, from my point of view, the

Shang Han Lun method is an advanced method that can only be used well

by those who know how to diagnose with " regular " methods. It is when

our more bulky form of diagnosis becomes so seamless that we start to

" see " the core dynamic and can use these pithy formulas. If we put

SHL diagnosis in one bag and " regular " diagnosis in the other then

choosing a SHL formula becomes just another - when you see this - do

that. I think it should be taught as a refinement of diagnosis. I

think that it is also good to understand how a SHL formula works

from a 'regular' diagnostic perspective.

 

 

What are your thoughts on this all?

 

Sharon

 

Sharon Weizenbaum

86 Henry Street

Amherst, MA 01002

413-549-4021

sweiz

www.whitepinehealingarts.com

 

 

 

 

 

[Guest guest]

Sharon,

 

 

 

Hmmm.. Well all CM diagnosis, to some degree, has the common threads of CM,

yin and yang etc. We agree on that! But I do believe to really get good at

SHL you must put aside your basic TCM belief structure and put a new hat on.

Yes there are commonalties, but there are enough differences where it takes

a lot of retraining to start to use many of the ideas effectively in the

clinic. Surely there are many overlapping concepts, precisely because such a

large number of our formulas come from ZZJ. Many of ZZJ's ideas are

integrated into TCM. TCM is by definition a synthesis of past ideas. But

when one starts to use seemingly external formulas, i.e. ma huang tang for

long term problems, like dysmenorrhea, then one must really step back and

say hhhhmmm. Yes it is still hot, cold, excess and deficient. But there is

so much more than the basics (FDC). At one point I presented 5 or so case

studies that all used GZT to treat it successfully. The students were just

mind boggled. " How could GZT treat XYZ, that is heat in the blood " (or

whatever). There was little chance relating such treatments to a basic TCM

approach.

 

 

 

I actually find it somewhat harmful to just relate SHL formulas to its

zang-fu /TCM equivalent. In such cases one loses the opportunity to look

outside the box. I know that many modern teachers in our schools will teach

SHL formulas in this way. For example, formula X is for spleen yang

deficiency. Granted this is somewhat helpful because they can allow the

student to put that information into some sort of framework that they are

comfortable with. In my opinion, students that have done this really have no

further understanding of what the SHL is about, or be able to use SHL

formulas in the myriad of peculiar ways that modern SHL experts are known to

be able to do. They basically know how to use SHL formulas within a TCM

diagnostic system. This, in my humble opinion defeats the purpose.

 

 

 

So call it refinement, call it a separate system, either one is fine. I just

know it takes some serious reconditioning to really get it, therefore that

is why I consider it generally a different system, but I am comfortable with

acknowledging it just as a refinement. Semantics. I also know that many

times I can see a patient and think of 3 ways I could approach them, 1 might

be the basic TCM model (FDC), but the others are not.

 

 

 

This doesn't even mention the 1000's of doctors that just have idiosyncratic

diagnostic methods that just seem strange to TCM onlookers. Then there is

acupuncture. but you are right, it is still all yin and yang (I think?). :-)

 

 

 

My 2 cents.

 

 

 

Regards,

 

 

 

-

 

 

 

_____

 

 

On Behalf Of sharon weizenbaum

Sunday, May 13, 2007 7:52 AM

 

Re: Standards for pattern discrimination & studying classics

 

 

 

I do just this and give an extensive

explanation of how I treated a patient using classical ideas, both

SHL and

WenBing theory that IMO would never have occurred if I stayed within the

strict confines of a standard TCM paradigm. Nothing is overly

profound, but

by me studying specific wenbing doctors as well as SHL commentary I

utilize

a slightly different perspective on a very difficult case. IMO, there

are

many ways one could have viewed the case, I just happened to choose

one that

made sense to me, and in this specific case, it just happened to end

up with

a good outcome. I poresent it only to show one way of thinking. You

can let

me know what you think.

 

(Sharon) As for Shang Han Lun " diagnosis " , I find myself resistant

to classifying this as " another method of diagnosis " . I understand

that there is a way of looking that picks out " key signs and

symptoms " for a specific formula - and that a formula IS the

diagnosis (Minor Bupleurum Pattern for example) but - my hesitation

to consider this a separate diagnostic method is for the following

reason (by the way, it's a gut feeling that I haven't had time to

really think out so this is off the top of my head.....) I think that

Zhang Zhong Jing clearly understood the dynamics of physiology and

pathology - Yin/Yang, Hot/Cold, Up/Down, Inside/Outside, Qi/Blood,

Phlegm/Dryness, Movement/Stasis, as well as Zang Fu dynamics - the

whole shebang. His methods described in the SHL and JGYL grow out of

his profound understanding. We too must have a firm grasp of these

physiological and pathological dynamics to really understand the " key

symptom " way of choosing a formula. So, from my point of view, the

Shang Han Lun method is an advanced method that can only be used well

by those who know how to diagnose with " regular " methods. It is when

our more bulky form of diagnosis becomes so seamless that we start to

" see " the core dynamic and can use these pithy formulas. If we put

SHL diagnosis in one bag and " regular " diagnosis in the other then

choosing a SHL formula becomes just another - when you see this - do

that. I think it should be taught as a refinement of diagnosis. I

think that it is also good to understand how a SHL formula works

from a 'regular' diagnostic perspective.

 

What are your thoughts on this all?

 

Sharon

 

Sharon Weizenbaum

86 Henry Street

Amherst, MA 01002

413-549-4021

sweiz <sweiz%40rcn.com>

www.whitepinehealingarts.com

 

 

[Guest guest]

Actually i wander if i Japan they learn the usual pathophysiology like we

conceder in TCM when studying kampo SHL?

Anyone knows?

 

 

 

 

 

 

 

 

-

sharon weizenbaum

Sunday, May 13, 2007 6:51 AM

Re: Standards for pattern discrimination & studying classics

 

 

I do just this and give an extensive

explanation of how I treated a patient using classical ideas, both

SHL and

WenBing theory that IMO would never have occurred if I stayed within the

strict confines of a standard TCM paradigm. Nothing is overly

profound, but

by me studying specific wenbing doctors as well as SHL commentary I

utilize

a slightly different perspective on a very difficult case. IMO, there

are

many ways one could have viewed the case, I just happened to choose

one that

made sense to me, and in this specific case, it just happened to end

up with

a good outcome. I poresent it only to show one way of thinking. You

can let

me know what you think.

 

(Sharon) As for Shang Han Lun " diagnosis " , I find myself resistant

to classifying this as " another method of diagnosis " . I understand

that there is a way of looking that picks out " key signs and

symptoms " for a specific formula - and that a formula IS the

diagnosis (Minor Bupleurum Pattern for example) but - my hesitation

to consider this a separate diagnostic method is for the following

reason (by the way, it's a gut feeling that I haven't had time to

really think out so this is off the top of my head.....) I think that

Zhang Zhong Jing clearly understood the dynamics of physiology and

pathology - Yin/Yang, Hot/Cold, Up/Down, Inside/Outside, Qi/Blood,

Phlegm/Dryness, Movement/Stasis, as well as Zang Fu dynamics - the

whole shebang. His methods described in the SHL and JGYL grow out of

his profound understanding. We too must have a firm grasp of these

physiological and pathological dynamics to really understand the " key

symptom " way of choosing a formula. So, from my point of view, the

Shang Han Lun method is an advanced method that can only be used well

by those who know how to diagnose with " regular " methods. It is when

our more bulky form of diagnosis becomes so seamless that we start to

" see " the core dynamic and can use these pithy formulas. If we put

SHL diagnosis in one bag and " regular " diagnosis in the other then

choosing a SHL formula becomes just another - when you see this - do

that. I think it should be taught as a refinement of diagnosis. I

think that it is also good to understand how a SHL formula works

from a 'regular' diagnostic perspective.

 

What are your thoughts on this all?

 

Sharon

 

Sharon Weizenbaum

86 Henry Street

Amherst, MA 01002

413-549-4021

sweiz

www.whitepinehealingarts.com

 

[Guest guest]

Sharon, Jason,

I've been looking over a preliminary chapter from Volker Scheid's

new book " Currents of Tradition " (you can download it from the

Eastland Press website), and he translates 'pai4' not as school, but

as current (i.e. a moving stream, which can definitely be derived

from the character, which contains the shui/water radical and flowing

water element). In this way of thinking, we can see different

teachers and their schools not as fixed, rigid entities but flowing

streams that intersect with each other, cross-fertilizing and

enriching the entire fabric of Chinese medicine. Part of the beauty

and complexity of Chinese medicine is its ability to contain

different patterns of thinking and diagnosis, whether based on yin

yang, five phase, six channels, four aspects, and various hybrids or

divergent paths. Zang fu pattern differentiation and six channel/SHL

approaches are not really separated, although the zang fu pattern

differentiation is certainly predominant in the present-day TCM

approach.

 

Having taught a Shang Han Lun class as a required course at PCOM

for two semesters, I find students very enthusiastic as we tackle the

code behind the prescriptions and the thought streams that flow

through the text. Teaching this material has inspired my own

thinking, both clinically and intellectually as well.

 

 

On May 11, 2007, at 9:41 AM, sharon weizenbaum wrote:

 

One could almost say that without the Shang Han Lun and JGYL there

would be no clinical practice! But, it has taken me years of study

to learn to begin to see the real depth of that text. I think the

way it is taught in schools misses the boat and so, it is rendered

rather useless seeming. I also think there is a difference between

understanding how to use some or many of the Shang Han Lun formulas

and understanding the Gestalt of the entire way of thought. I don't

know too many who I have felt have a deep understanding beyond the

use of some formulas - or even a lot of formulas.

 

I've also observed the tendency for practitioners to separate out SHL/

JGYL style as if it is totally separate from TCM. Like you either do

SHL style or TCM or some other style. One cannot understand SHL

formulas without understanding outside/inside, hot/cold, upper/lower,

Zang/Fu, Qi and Blood or phlegm etc. It's one thing to memorize the

symptom complex of Xiao Chai Hu Tang and to use it when that complex

shows up - but it's another thing to understand how the formula works

and to understand why it is called a " Shao Yang " formula and why it

may be placed after Yang Ming in the text etc. For this one must

have a much deeper understanding. One will never be good at using

Shang Han Lun formulas is one does not know the basics of diagnosis

in general.

 

 

 

 

 

[Guest guest]

But

when one starts to use seemingly external formulas, i.e. ma huang

tang for

long term problems, like dysmenorrhea, then one must really step back

and

say hhhhmmm. Yes it is still hot, cold, excess and deficient. But

there is

so much more than the basics (FDC).

 

(Sharon) I saw the video in which Craig gave a case study in which

the Dr. used Ma Huang Tang to treat dysmenorrhea. Is this the case

you are referring to? It is rather a case in point so here it is.

 

(Case Craig Presented)1. The patient was a 30-year-old woman with

a ten-year history of dysmenorrhea, which had increased in severity

with each passing year. For 1-3 days prior to her period, she would

experience severe intermittent pain or distending pain in the smaller

abdomen. The pain was difficult to bear and would continue through

the second or third day of her menstrual flow at which point she

would pass some membranous material and the pain would greatly

decrease. The dysmenorrhea was accompanied by distending pain in the

breasts and the rib-sides. Her menstrual blood was dull and contained

clots. Exposure to cold made the pain worse and warmth made it

slightly better. During the most recent period the abdominal pain was

severe, her emotional state was poor, there was distention in the

lesser abdomen, and her lower limbs lacked warmth. Her extremities

tended to be cold and she disliked the cold. Her smaller abdomen was

typically cold and distended. She reported copious vaginal discharge

that was thin and clear. Her pulse was stringlike and slow. Her

tongue was dull with a white fur. The patient had previously tried

Tao Hong Si Wu Tang and Xiao Yao San without good effect.

 

RX: Ma Huang 10, Gui Zhi 12, Xing Ren 10, Zhi Gan Cao 6, Shui Zhi 4

(take as a draft)

 

 

 

After the first pack, the pain decreased and the menses started.

After two more packs, the menses was without pain. After the menses,

the patient was prescribed Fu Zi Li Zhong Wan. However, for three

days prior to her period, she would again take the modified Ma Huang

Tang. She remained on this regimen for six months. She did not have

any more menstrual difficulties. "

 

 

 

(Sharon) A few things regarding this case. From a TCM point of view

this patient suffered from excess cold in the womb. So, we can see

that both Xiao Yao San and Tao Hong Si Wu Tang were addressing the

wrong disease factor - Xiao Yao San - Qi stasis and Tao Hong Si Wu

Tang - blood stasis but not cold.

 

During the presentation, Craig interacted with the audience before

giving the formula the SHL doctor gave. This was an audience of

practicing herbalists, not students. Here were their suggestions of

what to do:

 

Practitioner 1. Sheng Hua Tang with Hou Po, Qing Pi and Mu Xiang

 

(wrong illness (Sheng Hua Tang clear out the old to generate the new

and stops bleeding - the only hot herb is Pao Jiang which is very

styptic. The additions are for Qi stasis - wrong disease factor)

 

Practitioner 2. Jin Gui Shen Qi Wan

 

(Wrong disease factor as this rx is for deficiency of Yang of the

Kidney as opposed to excess cold in the womb)

 

What was interesting is that not one of the practitioners articulated

a diagnosis but rather started picking formulas. In my mind, not

only did this lead them to off the wall formulas, how could it ever

help them understand what the doctor did in the end.

 

So, what the doctor did was to treat the correct disease factor -

excess cold and he used Shui Zhi to bring it to the blood - right

location. It's clever and unusual but not out of the TCM box.

 

 

 

I agree it is fascinating and educational that a Dr. used Ma Huang

Tang in this way but it's still TCM diagnosis with a Shang Han Lun

formula. I don't see the " different hat " stuff. It makes me wonder

if the different hat needs to be worn exactly when the diagnosing,

physiological and pathological mechanisms are not considered deeply

enough.

 

 

 

And my other point with this is that the experienced herbalists in

the audience do not even have the basics of diagnosis and hence

formula selection. In fact, they did not even diagnose but jumped

right to formulas - a practice I see all the time on this list and

elsewhere. This video goes on with other interesting cases and each

time the practitioners " guess " without thinking anything through and

in each case the doctor's formula is based on the basics of a sound

diagnosis - excess/deficiency, hot/cold etc. This gap in many

practitioners ability to diagnose on even a fundamental level is what

I am attempting to address with the FDM. (Fundamental Diagnostic

Method)

 

This point speaks to the agenda that informs my posts in this

conversation: I see generations of herbal practitioners practicing

at a very very low level compared to the potential of Chinese herbal

medicine. This is primarily due to the lack of diagnostic skills -

which is further due to the fact that a FDM is not taught just about

anywhere - including in China. What my agenda wants to avoid is

practitioners, who very much lack the confidence to practice in a

strong and focused way, jumping to a new, super cool, advanced method

like SHL method because of this lack of confidence as opposed to

learning SHL as a deepening of their well developed skills.

 

So, basically I do agree with you that there are countless, exciting

ways to " think out of the TCM box " but, geez, you have to have the

box before you can think out of it or it just adds to the mess. I do

teach such cases in which the Doctor is practicing in a different and

eye opening way and I feel that after the FDM training, the students

are really ready to go the next step.

 

thoughts?

 

 

 

Sharon

 

 

 

 

 

 

On May 13, 2007, at 7:24 PM, wrote:

 

> But

> when one starts to use seemingly external formulas, i.e. ma huang

> tang for

> long term problems, like dysmenorrhea, then one must really step

> back and

> say hhhhmmm. Yes it is still hot, cold, excess and deficient. But

> there is

> so much more than the basics (FDC).

 

Sharon Weizenbaum

86 Henry Street

Amherst, MA 01002

413-549-4021

sweiz

www.whitepinehealingarts.com

 

 

Sharon Weizenbaum

86 Henry Street

Amherst, MA 01002

413-549-4021

sweiz

www.whitepinehealingarts.com

 

 

 

 

 

[Guest guest]

(Jason)At one point I presented 5 or so case

studies that all used GZT to treat it successfully. The students were

just

mind boggled. " How could GZT treat XYZ, that is heat in the blood " (or

whatever). There was little chance relating such treatments to a

basic TCM

approach.

 

I actually find it somewhat harmful to just relate SHL formulas to its

zang-fu /TCM equivalent. In such cases one loses the opportunity to look

outside the box. I know that many modern teachers in our schools will

teach

SHL formulas in this way. For example, formula X is for spleen yang

deficiency. Granted this is somewhat helpful because they can allow the

student to put that information into some sort of framework that they

are

comfortable with. In my opinion, students that have done this really

have no

further understanding of what the SHL is about, or be able to use SHL

formulas in the myriad of peculiar ways that modern SHL experts are

known to

be able to do. They basically know how to use SHL formulas within a TCM

diagnostic system. This, in my humble opinion defeats the purpose.

 

 

(Sharon) By studying these doctors who used GZT in the interesting

ways, our goal, I presume, is to see if we can learn to see and think

as we observe these doctors seeing and thinking - even if that

challenges our habitual ways of perceiving and making decisions.

Still, we must at some level, have to articulate to our students or

to ourselves, what the process is, what the dynamic of the formula is

and how it addresses dynamic of the patient's disharmony. What other

language do we have other than hot/cold, ying/wei, up/down.........?

It makes me wonder if, because the understanding of the profound

depth of the 8 principles, yin yang theory, and patho-physio

mechanisms is so deficient in our educational institutions, when you

say " TCM " you are talking about something much more limited than

what I am talking about.

 

Sharon

 

 

Sharon Weizenbaum

86 Henry Street

Amherst, MA 01002

413-549-4021

sweiz

www.whitepinehealingarts.com

 

 

 

 

 

[Guest guest]

Actually i wander if i Japan they learn the usual pathophysiology

like we conceder in TCM when studying kampo SHL?

Anyone knows?

 

 

 

 

I wonder too. I am taking a class with Nigel Dawes in a few weeks

which I am excited about. We'll see.

 

Sharon

 

 

Sharon Weizenbaum

86 Henry Street

Amherst, MA 01002

413-549-4021

sweiz

www.whitepinehealingarts.com

 

 

 

 

 

[Guest guest]

Sharon,

 

 

 

I cannot disagree with you at all. Clearly if there are people that can't do

basic diagnosis then such a system is needed. I also agree that there are

many graduating students (and practitioners) that just are very unclear

about diagnosis, let alone herbal prescribing. I really am unclear what is

going on with the educational systems. When I went to school at PCOM within

the first year such a system (similar to the FDC) was taught to us. Because

the teacher was so good, and essentially made of things black and white, I

still debate if this method was good or bad, but we definitely had a box

that we could break out of. I was having a recent conversation with Dan B, I

think at SIOM they make a point very early on to demonstrate how pluralist

the medicine really is by purposely showing the students varying angles.

 

 

 

So I don't have any doubt that what you're teaching can help people

progress, my only contention was a) the word " definitive " , b) that there are

many exceptions and different ways to look at the human body and students

walk away thinking that it is just cut and dry and there is just 1 way to

look at a given problem. That is it.

 

 

 

In regard to the MHT case: I have never heard the DVD, nor know which

people were in the audience. Just generally speaking, these type of seminars

attract students as well as aspiring herbalists. But although someone may

come up with a similar diagnosis, cold in the uterus, clearly the SHL expert

is thinking about it a bit differently, hence a radically different formula.

There are many rx's in the SHL that dispel cold and rx's that work at much

deeper level than MHT. Your job is not to try to figure out what is the same

between your thinking (and the expert) but what is different. Either way

you look at it, a basic TCMer is not going to give MHT for such a patient

and it would be incorrect to think that you can scratch out your standard

formula for cold in the uterus and write in MHT. This is IMO (and theirs) a

different diagnostic and treatment system. I

 

 

 

In such a case there must be some diagnostic clues that let you know that

this is the type of situation that will be helped. That is the question one

must figure out. I doubt that that same doctor would give MHT to just any

cold in the uterus dysmenorrhea. Again sometimes one must study multiple

cases from the same doctor to really figure it out. In my experience, there

is always something that clues people in. If you don't ask those questions

and say hey we have the same dx, then what does one learn?

 

 

 

-Jason

 

 

 

_____

 

 

On Behalf Of sharon weizenbaum

Monday, May 14, 2007 5:50 AM

 

Re: Standards for pattern discrimination & studying classics

 

 

 

But

when one starts to use seemingly external formulas, i.e. ma huang

tang for

long term problems, like dysmenorrhea, then one must really step back

and

say hhhhmmm. Yes it is still hot, cold, excess and deficient. But

there is

so much more than the basics (FDC).

 

(Sharon) I saw the video in which Craig gave a case study in which

the Dr. used Ma Huang Tang to treat dysmenorrhea. Is this the case

you are referring to? It is rather a case in point so here it is.

 

(Case Craig Presented)1. The patient was a 30-year-old woman with

a ten-year history of dysmenorrhea, which had increased in severity

with each passing year. For 1-3 days prior to her period, she would

experience severe intermittent pain or distending pain in the smaller

abdomen. The pain was difficult to bear and would continue through

the second or third day of her menstrual flow at which point she

would pass some membranous material and the pain would greatly

decrease. The dysmenorrhea was accompanied by distending pain in the

breasts and the rib-sides. Her menstrual blood was dull and contained

clots. Exposure to cold made the pain worse and warmth made it

slightly better. During the most recent period the abdominal pain was

severe, her emotional state was poor, there was distention in the

lesser abdomen, and her lower limbs lacked warmth. Her extremities

tended to be cold and she disliked the cold. Her smaller abdomen was

typically cold and distended. She reported copious vaginal discharge

that was thin and clear. Her pulse was stringlike and slow. Her

tongue was dull with a white fur. The patient had previously tried

Tao Hong Si Wu Tang and Xiao Yao San without good effect.

 

RX: Ma Huang 10, Gui Zhi 12, Xing Ren 10, Zhi Gan Cao 6, Shui Zhi 4

(take as a draft)

 

After the first pack, the pain decreased and the menses started.

After two more packs, the menses was without pain. After the menses,

the patient was prescribed Fu Zi Li Zhong Wan. However, for three

days prior to her period, she would again take the modified Ma Huang

Tang. She remained on this regimen for six months. She did not have

any more menstrual difficulties. "

 

(Sharon) A few things regarding this case. From a TCM point of view

this patient suffered from excess cold in the womb. So, we can see

that both Xiao Yao San and Tao Hong Si Wu Tang were addressing the

wrong disease factor - Xiao Yao San - Qi stasis and Tao Hong Si Wu

Tang - blood stasis but not cold.

 

During the presentation, Craig interacted with the audience before

giving the formula the SHL doctor gave. This was an audience of

practicing herbalists, not students. Here were their suggestions of

what to do:

 

Practitioner 1. Sheng Hua Tang with Hou Po, Qing Pi and Mu Xiang

 

(wrong illness (Sheng Hua Tang clear out the old to generate the new

and stops bleeding - the only hot herb is Pao Jiang which is very

styptic. The additions are for Qi stasis - wrong disease factor)

 

Practitioner 2. Jin Gui Shen Qi Wan

 

(Wrong disease factor as this rx is for deficiency of Yang of the

Kidney as opposed to excess cold in the womb)

 

What was interesting is that not one of the practitioners articulated

a diagnosis but rather started picking formulas. In my mind, not

only did this lead them to off the wall formulas, how could it ever

help them understand what the doctor did in the end.

 

So, what the doctor did was to treat the correct disease factor -

excess cold and he used Shui Zhi to bring it to the blood - right

location. It's clever and unusual but not out of the TCM box.

 

I agree it is fascinating and educational that a Dr. used Ma Huang

Tang in this way but it's still TCM diagnosis with a Shang Han Lun

formula. I don't see the " different hat " stuff. It makes me wonder

if the different hat needs to be worn exactly when the diagnosing,

physiological and pathological mechanisms are not considered deeply

enough.

 

And my other point with this is that the experienced herbalists in

the audience do not even have the basics of diagnosis and hence

formula selection. In fact, they did not even diagnose but jumped

right to formulas - a practice I see all the time on this list and

elsewhere. This video goes on with other interesting cases and each

time the practitioners " guess " without thinking anything through and

in each case the doctor's formula is based on the basics of a sound

diagnosis - excess/deficiency, hot/cold etc. This gap in many

practitioners ability to diagnose on even a fundamental level is what

I am attempting to address with the FDM. (Fundamental Diagnostic

Method)

 

This point speaks to the agenda that informs my posts in this

conversation: I see generations of herbal practitioners practicing

at a very very low level compared to the potential of Chinese herbal

medicine. This is primarily due to the lack of diagnostic skills -

which is further due to the fact that a FDM is not taught just about

anywhere - including in China. What my agenda wants to avoid is

practitioners, who very much lack the confidence to practice in a

strong and focused way, jumping to a new, super cool, advanced method

like SHL method because of this lack of confidence as opposed to

learning SHL as a deepening of their well developed skills.

 

So, basically I do agree with you that there are countless, exciting

ways to " think out of the TCM box " but, geez, you have to have the

box before you can think out of it or it just adds to the mess. I do

teach such cases in which the Doctor is practicing in a different and

eye opening way and I feel that after the FDM training, the students

are really ready to go the next step.

 

thoughts?

 

Sharon

 

On May 13, 2007, at 7:24 PM, @

<%40> wrote:

 

> But

> when one starts to use seemingly external formulas, i.e. ma huang

> tang for

> long term problems, like dysmenorrhea, then one must really step

> back and

> say hhhhmmm. Yes it is still hot, cold, excess and deficient. But

> there is

> so much more than the basics (FDC).

 

Sharon Weizenbaum

86 Henry Street

Amherst, MA 01002

413-549-4021

sweiz <sweiz%40rcn.com>

www.whitepinehealingarts.com

 

Sharon Weizenbaum

86 Henry Street

Amherst, MA 01002

413-549-4021

sweiz <sweiz%40rcn.com>

www.whitepinehealingarts.com

 

 

[Guest guest]

Sharon,

 

 

 

I don't think I am talking about something different. I do not gauge TCM's

ability on students (in the US) understanding, but my own. I feel I have a

pretty decent grasp to realize when an any idea is out of the ordinary

realm.

 

 

 

In regard to GZT. One popular style of diagnosis and treating with SHL is

the ability to understand constitutional types that fit with various herbs

or formulas. This is far from TCM as we know it. This is not easy and hence

the seemingly simplistic diagnosis of this is a GZT person/problem can be

perplexing. It is easy to write this type of thinking off because one does

not understand, but one can dive deeper and actually find good books in

Chinese (and hopefully soon to be English) that explain this. I wrote a bit

about this in my Huang Qi article.

 

 

 

The more I study SHL and the hundreds of commentaries that have issued

from, I firmly believe that it is generally a system that does not fit in

the normal realm of TCM. And when one can realize this one can open up to

different possibilities. Just my humble opinion.

 

 

 

-

 

 

 

_____

 

 

On Behalf Of sharon weizenbaum

 

 

(Sharon) By studying these doctors who used GZT in the interesting

ways, our goal, I presume, is to see if we can learn to see and think

as we observe these doctors seeing and thinking - even if that

challenges our habitual ways of perceiving and making decisions.

Still, we must at some level, have to articulate to our students or

to ourselves, what the process is, what the dynamic of the formula is

and how it addresses dynamic of the patient's disharmony. What other

language do we have other than hot/cold, ying/wei, up/down.........?

It makes me wonder if, because the understanding of the profound

depth of the 8 principles, yin yang theory, and patho-physio

mechanisms is so deficient in our educational institutions, when you

say " TCM " you are talking about something much more limited than

what I am talking about.

 

Sharon

 

 

 

 

[Guest guest]

Alon,

 

 

 

The Japanese stuff I studied is far removed from TCM. It diagnosis is

different and treats differently. Its pathoophysiology had a different

slant, based on NanJing. Can't think of any good examples off the top of my

head.

 

 

 

-Jason

 

 

 

_____

 

 

On Behalf Of sharon weizenbaum

Monday, May 14, 2007 6:20 AM

 

Re: Standards for pattern discrimination & studying classics

 

 

 

Actually i wander if i Japan they learn the usual pathophysiology

like we conceder in TCM when studying kampo SHL?

Anyone knows?

 

 

 

I wonder too. I am taking a class with Nigel Dawes in a few weeks

which I am excited about. We'll see.

 

Sharon

 

Sharon Weizenbaum

86 Henry Street

Amherst, MA 01002

413-549-4021

sweiz <sweiz%40rcn.com>

www.whitepinehealingarts.com