plurality

May 13, 2007

(Jason) 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.

(Sharon) I think there is one confusion here which is the difference

between a doctor's diagnosis and a doctor's choice of prescription

and medicinals. There is plurality in the ways particular doctors

come to their diagnosis or articulate their diagnosis for sure. But

there is way more plurality in the prescriptions and herb use - i.e.

the way the doctor's act on their diagnosis. Diagnosis is one step

and choice of treatment is another. In a well written case study

(i.e. one in which there is enough information) we can see how the

doctor came to their diagnostic conclusion - these are the case

studies we see definitive diagnosis or FDM at work. Prescription

choice and use of herbs is highly idiosyncratic. This varies

according to region, availability of herbs, the doctor's lineage, how

much his patients can afford etc.

Many case histories I read in Chinese have the scantiest of intake

information so that it is really impossible to know what the doctor

based his or her diagnosis on. I personally don't find these very

useful. For modern case studies I believe this is in large part due

to what Volker Scheid talks at length about in his chinese medicine

in contemporary china.

" Contemporary clinical record keeping...resembles pulse records

( " pulse records cases are much shorter, consisting of the

prescription and brief appended clinical information " ) in both form

and centrality of the prescription as the only invariable element.

modern records (also) differ from classical ones in their frequent

inclusion of biomedical diagnoses and examination results. " And

" The composition of case records in hospital inpatient departments

requires a continual disciplining of their composers by the state "

Cases like those of Jiao Shu-De are much richer. With these cases it

is often easy to see his use of FDM. When we see and understand his

diagnostic process, then we are really in a position to learn from

his herb use. If we can't even understand how a doctor came to a

diagnosis then we can't really learn much from that doctor's use of

herbs. It may be said that it is through the doctor's use of herbs

that we understand the diagnosis but - what if we don't already know

the doctor's way of using herbs? This would often be the case since

the use of herbs is so individualized, pluralistic, idiosyncratic.

Sharon Weizenbaum

86 Henry Street

Amherst, MA 01002

413-549-4021

sweiz

www.whitepinehealingarts.com

May 13, 2007

Sharon,

I disagree with (I think) your contention that doctors diagnosis is

relatively uniform and it is just the herbs that are different.

But lets examine your idea that if we read a case study and there is no

explanation we may have no idea why the doctor is picking the herbs. Such

terse cases, as you know, are pretty much the norm in Chinese Case

literature, especially pre-modern. They use to bother me, now I relish in

them. Notice the Lurking pathogen case study by LBY that Chip and I

published in the lantern. There was little commentary and I actually spent

about 3 years (off and on) digesting it and adding commentary before

publishing it. There was so much there, and I learned so much. There was no

mention of why the author used the herbs, one had to think!

I have found that this is precisely why it helps to not study case studies

in isolation. Meaning it is helpful to pick a doctor for example, and

immerse themselves in his material to understand his thinking. There are no

silver platters like some modern case studies. I also recently picked up a

good book in China on how to read case studies. Action packed which shows

there is really an art to the whole process.

One could easily dismiss one of the most treasured collection of cases

studies as meaningless because of " lack of enough information " , meaning Ye

Tian-Shi's. His cases are terse and difficult to understand, they give the

read little to grasp onto. Therefore why do so many great doctors say it is

mandatory to study them? One must not just read a few, and expect to have

the answer right in front of them, but study them. I believe all the

information are in these case studies. Furthermore, there are (some)

commentaries from people much smarter than us to help us out. That is also

the case with SHL and other systems. But I firmly disagree that generally

doctors diagnose the same. Volker firmly includes " diagnosis " first in the

list of things that separate doctors, and create plurality. SHL case studies

firmly demonstrate that there is plurality in Dx.

Furthermore, I could easily see how someone like Jiao Shu-de's cases fit

with the method you teach. They are very straightforward (cases) and based

on modern TCM (he is known for his modern integration of TCM and western).

He is a straight shooter. I personally find many of those cases boring. Like

I said, I like the cases that have results that you would least expect. One

can either dismiss (such out of the norm cases) because things are unclear

and not explained, or sit and ponder on why such choices may be the case.

The latter clearly takes much more time and thought. Therefore you learn how

a doctor uses the herbs by repetition, thought, research, and commentary. It

really is not that hard.

Therefore, just because one doesn't understated a doctor's " strange " herbs

choices hence sometimes strange diagnosis (not fitting into one's system of

thought) doesn't make it not useful. To dismiss things that one does not

understand and gravitate towards things that do make sense is really just

gathering evidence to keep oneself in a certain box. I argue that these are

the best teachers and one should hold them in highest regard and search for

the answer to such difficult quagmires.

-

_____

On Behalf Of sharon weizenbaum

Sunday, May 13, 2007 7:43 AM