Guest guest Posted May 18, 2007 Report Share Posted May 18, 2007 I had a question about some of the recent posts in which described treating nocturia successfully with a diagnosis of LV Qi Stasis and no KD involvement. The question is why did the LV Qi Stasis manifest as a urinary disturbance and not manifest in another location such as respiratory issues of GI distress. I can understand treating based on the pattern, and so it makes sense that by treating the constraint the nocturia was relieved. However, it seems that there must have been some underlying KD deficiency which is why the constraint manifested in that area. Are there other reasons that this would have happened? Since the symptoms cleared we can see in the short term that the treatment was successful, but I wonder about what the long term prognosis is if the KD is not treated. Thanks for your response. I also wanted to thank Jason and Sharon and the others involved in some of the recent posts. As a student I have found them very interesting and relevant to what is going on in our education. ~Jason Henson Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 19, 2007 Report Share Posted May 19, 2007 Jason, Your point is the same point as Sharon's, and a valid question. I also clearly understand that you and Sharon's point is not that one should solely diagnosis kidney deficiency (from such information), but one should include it in within the whole constellation of other signs and symptoms. This is obvious I hope to everyone. This is basically a zang-fu style diagnosis. My belief, though, is that 1 symptom no matter what, is not enough to diagnosis an organ involvement, one must look at the whole picture, tongue, pulse etc. This, in my experience, and leads one to more refined and focused treatments. In my nocturia case the patient was a 23 year old male, who was anxious from school (or something) and just had heat (from liver constraint). This heat agitated the bladder. It in no way shows the kidney is weak, or at least IMO, enough to be treated. After the nocturia clears one then can reevaluate the picture (which I did). There was not one deficiency sign (let alone kidney), therefore I am not worried about the state of his kidney. If one reads Chinese case studies one sees this type of reasoning all the time. There is a sign that many will assume means something particular, and because of the other s/s it will not be treated. This is just one method, there are other cases (especially from the west) where people treat everything under the sun. Just a style. But the real question is why you assume that " there must be underlying kidney deficiency. " Your whole question is based on some fundamental axiom that you must have learned that says, nocturia must equal kidney deficiency. This is exactly what I am challenging. If you evaluate cases, examples, & patient's through a system that you learned ( " A " must = " B) and hold as truth, then you can only see what you believe. If you didn't believe that nocturia must = kidney xu then you would not have this problem. All that it takes is one example to prove that such " A " must = " B " equation is not true, or at least not true all the time. This is precisely the point when you study SHL. One soon realizes that these basic zang-fu rules that you " learned " just are not the only way to look at reality. Remember SHL uses no zang-fu system and the way of thinking is much different than the way we analyze cases in the modern day. SHL cases over and over demonstrate situations that defy basic axioms like you mention below. The reason I always bring SHL up, is because there is so much commentary discussing this and because it is so much older and hence farther removed from our modern approach. One can though find examples (deifying basic axioms) from the modern and pre-modern eras. But challenging your basic beliefs is important because with such axioms in place it is very difficult to give something like " zhu ling tang " for nocturia, especially if one keeps thinking " kidney deficiency " . I am leery of any statement that says A=B, even if it is not describing the whole picture, IMO to even think that aspect " B " must be contained in the treatment can seriously mislead someone. Hence the debate. Everyone has an opinion, this is just mine. Hope it helps. -Jason _____ On Behalf Of jasonnesa Friday, May 18, 2007 8:46 AM Nocturia - LV Qi Stasis I had a question about some of the recent posts in which described treating nocturia successfully with a diagnosis of LV Qi Stasis and no KD involvement. The question is why did the LV Qi Stasis manifest as a urinary disturbance and not manifest in another location such as respiratory issues of GI distress. I can understand treating based on the pattern, and so it makes sense that by treating the constraint the nocturia was relieved. However, it seems that there must have been some underlying KD deficiency which is why the constraint manifested in that area. Are there other reasons that this would have happened? Since the symptoms cleared we can see in the short term that the treatment was successful, but I wonder about what the long term prognosis is if the KD is not treated. Thanks for your response. I also wanted to thank Jason and Sharon and the others involved in some of the recent posts. As a student I have found them very interesting and relevant to what is going on in our education. ~Jason Henson Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 19, 2007 Report Share Posted May 19, 2007 Jason & Jason, So, regarding this Liver Qi constraint nocturia case - From the point of view of my particular way of diagnosing, if the nocturia came on relatively recently as opposed to being chronic - I would not call it Kidney involvement. It seems this patient's nocturia was situational rather than chronic so I would agree that there is no Kidney involvement. Yet " relatively recently " is a rather subjective idea. This points to the fact that, no matter how sophisticated a diagnostic method is, in the end there is the judgement of the practitioner. This judgment is easier when a patient is in front of us and it comes from experience and education. If the nocturia was more chronic - I would be considering the patient's Kidney (Qi, Yin, Yang or Jing) But the question remains - to what extent? Since the nocturia went away - maybe I would just keep an eye on my patient and have my antenae up for other Kidney signs. Maybe I would do a bit for what ever aspect of the Kidney was primary. But again - this would be a judgement call. I certainly see Jason B's point and think that, since the nocturia went away with Liver constraint treatment, it makes sense to not consider the Kidney - But, then it's a matter of style - I would at least have my attenae up for Kidney. Maybe that is just my style. But, Jason B's question regarding whether any one symptom - like chronic nocturia (which it sounds like his patient didn't have) - can ever ALWAYS mean and one pattern is important. ALWAYS is a big word! Though I feel definitely hesitant to say ALWAYS ALWAYS - I would say unequivicolly that all signs and symptoms are not equal in their ability to give us, let's say " firm " information. For me - chronic nocturia is pretty darn firm for Kidney involvement - but it doesn't tell me 1. How profound the Kidney involvement is or 2. what aspect of the Kidney (Yin, Yang, Qi or Jing) Another example of a " firm " sign is scalloped edges on the tongue for Spleen Qi deficiency. Another - weak achey chronic low back pain (must be of a deficient nature) is an example of a symptom that indicates Kidney (Yin, Yang, Qi or jIng) involvement pretty firmly. There are countless signs and symptoms that are extemely non-definitive such as night sweats, frequent urination, constipation, dry skin, hot flashes, fatigue, amenorrhea, miscarriage. Here are the erroneous conclusions I see students jumping to regarding these particular very non-definitive signs and symptoms: night sweats = Yin xu frequent urination = Kidney Qi Xu constipation = Qi stagnation or Blood Xu or heat dry skin = blood xu hot flashes = Yin xu fatigue = Qi deficiency, especially spleen Qi amenorrhea = blood xu miscarriage = Qi and/or blood xu. When a conclusion based on very non-definitive signs and symptoms is jumped to and a diagnosis is formed around this - treatment will definitely be off track. The practitioner will sense the wobbly ground of the diagnosis and lack confidence, loose focus by trying to cover bases etc. It's important to know the relative " firmness " of signs and symptoms. What I have seen is that this is not so differentiated so often a diagnosis is created that is not based on anything solid. Signs and symptoms can be evaluated based on their relative firmness or definitive quality. A diagnosis should be based on the relatively more definitive signs and symptoms. Yet, even when a diagnosis is based on pretty solid ground that is not the end of the story in terms of determining treatment: A practitioner still has to put the various aspect of the diagnosis together to view the gestalt of the patient's issues. Then the practitioner has to make a decision as to where to focus and why. Then the practitioner has many choices as to how to choose and modify prescriptions. This might be done from a Shang Han Lun perspective or following the experience of other doctors. At least the practitioner has a diagnosis that is on solid ground to explore the possibilities from and is not just throwing a formula at a disease. A practitioner may choose to actually ignore the diagnosis and treat in an unconventional way - but at least this is an educated and thought out choice. The process of diagnosing is not abandoned and yet the practitioner can work in very creative, out of the box, ways. I'd be interested in other's experience with the relative firmness of various signs and symptoms. Sharon , " " wrote: > > Jason, > > > > Your point is the same point as Sharon's, and a valid question. I also > clearly understand that you and Sharon's point is not that one should solely > diagnosis kidney deficiency (from such information), but one should include > it in within the whole constellation of other signs and symptoms. This is > obvious I hope to everyone. This is basically a zang-fu style diagnosis. > > > > My belief, though, is that 1 symptom no matter what, is not enough to > diagnosis an organ involvement, one must look at the whole picture, tongue, > pulse etc. This, in my experience, and leads one to more refined and focused > treatments. In my nocturia case the patient was a 23 year old male, who was > anxious from school (or something) and just had heat (from liver > constraint). This heat agitated the bladder. It in no way shows the kidney > is weak, or at least IMO, enough to be treated. After the nocturia clears > one then can reevaluate the picture (which I did). There was not one > deficiency sign (let alone kidney), therefore I am not worried about the > state of his kidney. If one reads Chinese case studies one sees this type > of reasoning all the time. There is a sign that many will assume means > something particular, and because of the other s/s it will not be treated. > This is just one method, there are other cases (especially from the west) > where people treat everything under the sun. Just a style. > > > > But the real question is why you assume that " there must be underlying > kidney deficiency. " Your whole question is based on some fundamental axiom > that you must have learned that says, nocturia must equal kidney deficiency. > This is exactly what I am challenging. If you evaluate cases, examples, & > patient's through a system that you learned ( " A " must = " B) and hold as > truth, then you can only see what you believe. If you didn't believe that > nocturia must = kidney xu then you would not have this problem. All that it > takes is one example to prove that such " A " must = " B " equation is not true, > or at least not true all the time. > > > > This is precisely the point when you study SHL. One soon realizes that these > basic zang-fu rules that you " learned " just are not the only way to look at > reality. Remember SHL uses no zang-fu system and the way of thinking is much > different than the way we analyze cases in the modern day. SHL cases over > and over demonstrate situations that defy basic axioms like you mention > below. The reason I always bring SHL up, is because there is so much > commentary discussing this and because it is so much older and hence farther > removed from our modern approach. One can though find examples (deifying > basic axioms) from the modern and pre-modern eras. But challenging your > basic beliefs is important because with such axioms in place it is very > difficult to give something like " zhu ling tang " for nocturia, especially if > one keeps thinking " kidney deficiency " . I am leery of any statement that > says A=B, even if it is not describing the whole picture, IMO to even think > that aspect " B " must be contained in the treatment can seriously mislead > someone. Hence the debate. Everyone has an opinion, this is just mine. > > > > Hope it helps. > > > > -Jason > _____ > > > On Behalf Of jasonnesa > Friday, May 18, 2007 8:46 AM > > Nocturia - LV Qi Stasis > > > > I had a question about some of the recent posts in which > described treating nocturia successfully with a diagnosis of LV Qi > Stasis and no KD involvement. The question is why did the LV Qi Stasis > manifest as a urinary disturbance and not manifest in another location > such as respiratory issues of GI distress. I can understand treating > based on the pattern, and so it makes sense that by treating the > constraint the nocturia was relieved. However, it seems that there > must have been some underlying KD deficiency which is why the > constraint manifested in that area. Are there other reasons that this > would have happened? Since the symptoms cleared we can see in the > short term that the treatment was successful, but I wonder about what > the long term prognosis is if the KD is not treated. Thanks for your > response. I also wanted to thank Jason and Sharon and the others > involved in some of the recent posts. As a student I have found them > very interesting and relevant to what is going on in our education. > ~Jason Henson > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 19, 2007 Report Share Posted May 19, 2007 , " Alon Marcus " <alonmarcus wrote: > Alon, I like how you always bring the discussion back to the most clinical aspects. I have a coupe of questions for you. First, I don't understand exactly what you mean - physical signs are pulse, tongue and abdomen and symptoms are what the patient complains about? So, you prioritize pulse, tongue and abodomen right? Why do you think you have the bias you do? Is this bias in relation to acupuncture or herbs or both? In a case like this, how then do you make sense of the symptoms? Sharon (alon) In the case of nocturia my question is what if the physical signs conflict with the symptoms. For example if the pt complain of symptoms that suggest kid yang def including age and chronicity but pulse, tongue and abdomen do not suggest any deficiency. I see such cases all the time and my bias is to put more emphasis on physical signs than symptom complex. what do others do > > > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 19, 2007 Report Share Posted May 19, 2007 Physical signs are things the practitioner assesses while symptoms are things the patient tells the practitioner. I think my preference to treating signs came about when i just could not have pt describe symptoms in the same way i learned them or seen pt describe them in china. I also distrust any so called statement of fact in Chinese medicine, ie in chronic disease treat K, blood stasis etc. This is an evolution for me as i have seen patients that just did not make sense using " traditional basic approaches " did not get better when treated using these approaches and improved only when i treated what the physically presented with (ie signs), i always say patients do not read text books. I often strongly sedate elderly patients, chronic diseases, getting the best results. I tend to often not believe what patients tell me. First patient do not want to OFFEND me and their practitioners if they like me/them and will tell me they feel better even when my clinical physical findings do not suggest any improvement. They tend to exaggerate symptoms even when clinical finding show very little is wrong or much improvement. They tend to feel bad when they perceive some else is responsible for their suffering, and so on and so on. The majority of my practice is pain so perhaps i see more of this stuff than others. All of this has lead me to trust my hands more than what patients tell me. I definitely trust what is see and feel rather than what i read in any text, classic and definitely modern, especially studies coming from china (the studies i was involved in china were just so deceptive lost all faith). As many of you can tell, at this point of may career, after 25 year in medicine i am very skeptical of anything i hear form CM to WM to any " alternative " medicine. I anyone really thinks they get great results i would love to be invited to follow their practice so i can assess the cases for my self in objective methods and learn. I know many functional problems are helped and i see this every day, but again i still say many patients tell us they feel much better even when clinical assessment does not show much change. Perhaps my expectation are two high, i was told that by students and friends some of whom are on this list. Maybe they can put their 2 cents worth. www.int\grativehealthmedicine.com - swzoe2000 Saturday, May 19, 2007 11:21 AM Re: Nocturia - LV Qi Stasis , " Alon Marcus " <alonmarcus wrote: > Alon, I like how you always bring the discussion back to the most clinical aspects. I have a coupe of questions for you. First, I don't understand exactly what you mean - physical signs are pulse, tongue and abdomen and symptoms are what the patient complains about? So, you prioritize pulse, tongue and abodomen right? Why do you think you have the bias you do? Is this bias in relation to acupuncture or herbs or both? In a case like this, how then do you make sense of the symptoms? Sharon (alon) In the case of nocturia my question is what if the physical signs conflict with the symptoms. For example if the pt complain of symptoms that suggest kid yang def including age and chronicity but pulse, tongue and abdomen do not suggest any deficiency. I see such cases all the time and my bias is to put more emphasis on physical signs than symptom complex. what do others do > > > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 19, 2007 Report Share Posted May 19, 2007 S, Note: The case I brought up was not just an acute case of nocturia. Although it was situational, this was a (semi)chronic case of nocturia with no kidney involvement. But I also agree that one would be a fool not to have their antennae up in such situations. I agree with you general sentiments, meaning " Always " is a very strong word. You stated, " Another - weak achey chronic low back pain (must be of a deficient nature) is an example of a symptom that indicates Kidney (Yin, Yang, Qi or jIng) involvement pretty firmly. " - And I agree that many times (probably most of the time) it equals kidney xu. But this is far from definite (not that you are saying this). Just for the record, I am looking at a Qing dynasty case study by one of the most important doctors of the time, who treated a deficient chronic lower back pain with the dx and tx of essentially Spleen and Heart deficiency (as well as a ying xu). Therefore one can find exceptions to every rule (at least in CM) and I stand by the statement that there are no definites (in CM). Thanks for the input. -Jason _____ On Behalf Of swzoe2000 Saturday, May 19, 2007 7:55 AM Re: Nocturia - LV Qi Stasis Jason & Jason, So, regarding this Liver Qi constraint nocturia case - From the point of view of my particular way of diagnosing, if the nocturia came on relatively recently as opposed to being chronic - I would not call it Kidney involvement. It seems this patient's nocturia was situational rather than chronic so I would agree that there is no Kidney involvement. Yet " relatively recently " is a rather subjective idea. This points to the fact that, no matter how sophisticated a diagnostic method is, in the end there is the judgement of the practitioner. This judgment is easier when a patient is in front of us and it comes from experience and education. If the nocturia was more chronic - I would be considering the patient's Kidney (Qi, Yin, Yang or Jing) But the question remains - to what extent? Since the nocturia went away - maybe I would just keep an eye on my patient and have my antenae up for other Kidney signs. Maybe I would do a bit for what ever aspect of the Kidney was primary. But again - this would be a judgement call. I certainly see Jason B's point and think that, since the nocturia went away with Liver constraint treatment, it makes sense to not consider the Kidney - But, then it's a matter of style - I would at least have my attenae up for Kidney. Maybe that is just my style. But, Jason B's question regarding whether any one symptom - like chronic nocturia (which it sounds like his patient didn't have) - can ever ALWAYS mean and one pattern is important. ALWAYS is a big word! Though I feel definitely hesitant to say ALWAYS ALWAYS - I would say unequivicolly that all signs and symptoms are not equal in their ability to give us, let's say " firm " information. For me - chronic nocturia is pretty darn firm for Kidney involvement - but it doesn't tell me 1. How profound the Kidney involvement is or 2. what aspect of the Kidney (Yin, Yang, Qi or Jing) Another example of a " firm " sign is scalloped edges on the tongue for Spleen Qi deficiency. Another - weak achey chronic low back pain (must be of a deficient nature) is an example of a symptom that indicates Kidney (Yin, Yang, Qi or jIng) involvement pretty firmly. There are countless signs and symptoms that are extemely non-definitive such as night sweats, frequent urination, constipation, dry skin, hot flashes, fatigue, amenorrhea, miscarriage. Here are the erroneous conclusions I see students jumping to regarding these particular very non-definitive signs and symptoms: night sweats = Yin xu frequent urination = Kidney Qi Xu constipation = Qi stagnation or Blood Xu or heat dry skin = blood xu hot flashes = Yin xu fatigue = Qi deficiency, especially spleen Qi amenorrhea = blood xu miscarriage = Qi and/or blood xu. When a conclusion based on very non-definitive signs and symptoms is jumped to and a diagnosis is formed around this - treatment will definitely be off track. The practitioner will sense the wobbly ground of the diagnosis and lack confidence, loose focus by trying to cover bases etc. It's important to know the relative " firmness " of signs and symptoms. What I have seen is that this is not so differentiated so often a diagnosis is created that is not based on anything solid. Signs and symptoms can be evaluated based on their relative firmness or definitive quality. A diagnosis should be based on the relatively more definitive signs and symptoms. Yet, even when a diagnosis is based on pretty solid ground that is not the end of the story in terms of determining treatment: A practitioner still has to put the various aspect of the diagnosis together to view the gestalt of the patient's issues. Then the practitioner has to make a decision as to where to focus and why. Then the practitioner has many choices as to how to choose and modify prescriptions. This might be done from a Shang Han Lun perspective or following the experience of other doctors. At least the practitioner has a diagnosis that is on solid ground to explore the possibilities from and is not just throwing a formula at a disease. A practitioner may choose to actually ignore the diagnosis and treat in an unconventional way - but at least this is an educated and thought out choice. The process of diagnosing is not abandoned and yet the practitioner can work in very creative, out of the box, ways. I'd be interested in other's experience with the relative firmness of various signs and symptoms. Sharon Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 19, 2007 Report Share Posted May 19, 2007 Alon, I agree with your idea, share your skepticism, and also tend to trust what I feel and see more than the patient's story. I have studied with a doctor that essentially asked nothing and just felt the body and told the patient what was wrong with them, if he was wrong, then he would be very hesitant in treating them . Interesting eh?. - _____ On Behalf Of Alon Marcus Saturday, May 19, 2007 1:59 PM Re: Nocturia - LV Qi Stasis Physical signs are things the practitioner assesses while symptoms are things the patient tells the practitioner. I think my preference to treating signs came about when i just could not have pt describe symptoms in the same way i learned them or seen pt describe them in china. I also distrust any so called statement of fact in Chinese medicine, ie in chronic disease treat K, blood stasis etc. This is an evolution for me as i have seen patients that just did not make sense using " traditional basic approaches " did not get better when treated using these approaches and improved only when i treated what the physically presented with (ie signs), i always say patients do not read text books. I often strongly sedate elderly patients, chronic diseases, getting the best results. I tend to often not believe what patients tell me. First patient do not want to OFFEND me and their practitioners if they like me/them and will tell me they feel better even when my clinical physical findings do not suggest any improvement. They tend to exaggerate symptoms even when clinical finding show very little is wrong or much improvement. They tend to feel bad when they perceive some else is responsible for their suffering, and so on and so on. The majority of my practice is pain so perhaps i see more of this stuff than others. All of this has lead me to trust my hands more than what patients tell me. I definitely trust what is see and feel rather than what i read in any text, classic and definitely modern, especially studies coming from china (the studies i was involved in china were just so deceptive lost all faith). As many of you can tell, at this point of may career, after 25 year in medicine i am very skeptical of anything i hear form CM to WM to any " alternative " medicine. I anyone really thinks they get great results i would love to be invited to follow their practice so i can assess the cases for my self in objective methods and learn. I know many functional problems are helped and i see this every day, but again i still say many patients tell us they feel much better even when clinical assessment does not show much change. Perhaps my expectation are two high, i was told that by students and friends some of whom are on this list. Maybe they can put their 2 cents worth. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 19, 2007 Report Share Posted May 19, 2007 Jason Who and where is he? - Saturday, May 19, 2007 5:33 PM RE: Nocturia - LV Qi Stasis Alon, I agree with your idea, share your skepticism, and also tend to trust what I feel and see more than the patient's story. I have studied with a doctor that essentially asked nothing and just felt the body and told the patient what was wrong with them, if he was wrong, then he would be very hesitant in treating them . Interesting eh?. - _____ On Behalf Of Alon Marcus Saturday, May 19, 2007 1:59 PM Re: Nocturia - LV Qi Stasis Physical signs are things the practitioner assesses while symptoms are things the patient tells the practitioner. I think my preference to treating signs came about when i just could not have pt describe symptoms in the same way i learned them or seen pt describe them in china. I also distrust any so called statement of fact in Chinese medicine, ie in chronic disease treat K, blood stasis etc. This is an evolution for me as i have seen patients that just did not make sense using " traditional basic approaches " did not get better when treated using these approaches and improved only when i treated what the physically presented with (ie signs), i always say patients do not read text books. I often strongly sedate elderly patients, chronic diseases, getting the best results. I tend to often not believe what patients tell me. First patient do not want to OFFEND me and their practitioners if they like me/them and will tell me they feel better even when my clinical physical findings do not suggest any improvement. They tend to exaggerate symptoms even when clinical finding show very little is wrong or much improvement. They tend to feel bad when they perceive some else is responsible for their suffering, and so on and so on. The majority of my practice is pain so perhaps i see more of this stuff than others. All of this has lead me to trust my hands more than what patients tell me. I definitely trust what is see and feel rather than what i read in any text, classic and definitely modern, especially studies coming from china (the studies i was involved in china were just so deceptive lost all faith). As many of you can tell, at this point of may career, after 25 year in medicine i am very skeptical of anything i hear form CM to WM to any " alternative " medicine. I anyone really thinks they get great results i would love to be invited to follow their practice so i can assess the cases for my self in objective methods and learn. I know many functional problems are helped and i see this every day, but again i still say many patients tell us they feel much better even when clinical assessment does not show much change. Perhaps my expectation are two high, i was told that by students and friends some of whom are on this list. Maybe they can put their 2 cents worth. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 20, 2007 Report Share Posted May 20, 2007 (Sharon) Jason, I would be interested to see the formula this Qing dynasty Dr. used. I have found in my reading of Chinese case studies that often the formula reflects a more in depth treatment approach than the brief articulated diagnosis expresses. So what was the formula in this case? just for the record....Better yet, if you could, I'd love to see the case in Chinese. If you feel comfortable sending it to me off line. Who is the dr.? Nonetheless, point taken - I believe you and know that, if one is looking for exceptions, they no doubt can be found. Personally I have never read a case in which there was weakness and soreness in the low back in which there were no herbs to enter the Kidney to strengthen the low back. Best, Sharon (Jason)is an example of a symptom that indicates Kidney (Yin, Yang, Qi or jIng) involvement pretty firmly. " - And I agree that many times (probably most of the time) it equals kidney xu. But this is far from definite (not that you are saying this). Just for the record, I am looking at a Qing dynasty case study by one of the most important doctors of the time, who treated a deficient chronic lower back pain with the dx and tx of essentially Spleen and Heart deficiency (as well as a ying xu). Therefore one can find exceptions to every rule (at least in CM) and I stand by the statement that there are no definites (in CM). Thanks for the input. Sharon Weizenbaum White Pine Healing Arts 86 Henry Street Amherst, MA 01002 www.whitepinehealingarts.com sweiz 413-549-4021 Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 21, 2007 Report Share Posted May 21, 2007 This is exactly why I prefer to treat dermatologic cases, because I can see with my own eyes the change. Even if the main symptom from the patients perspective is itch, I can measure the change according to the amount of excoriation I can see. The changes in skin are measurable and objective, I can photograph the changes and show myself and patient the before and after. Subjective symptoms that are based only on the patients awareness I find difficult, at times, to deal with. Best Trevor , " Alon Marcus " <alonmarcus wrote: > > > Physical signs are things the practitioner assesses while symptoms are things the patient tells the practitioner. I think my preference to treating signs came about when i just could not have pt describe symptoms in the same way i learned them or seen pt describe them in china. I also distrust any so called statement of fact in Chinese medicine, ie in chronic disease treat K, blood stasis etc. This is an evolution for me as i have seen patients that just did not make sense using " traditional basic approaches " did not get better when treated using these approaches and improved only when i treated what the physically presented with (ie signs), i always say patients do not read text books. I often strongly sedate elderly patients, chronic diseases, getting the best results. I tend to often not believe what patients tell me. First patient do not want to OFFEND me and their practitioners if they like me/them and will tell me they feel better even when my clinical physical findings do not suggest any improvement. They tend to exaggerate symptoms even when clinical finding show very little is wrong or much improvement. They tend to feel bad when they perceive some else is responsible for their suffering, and so on and so on. The majority of my practice is pain so perhaps i see more of this stuff than others. All of this has lead me to trust my hands more than what patients tell me. I definitely trust what is see and feel rather than what i read in any text, classic and definitely modern, especially studies coming from china (the studies i was involved in china were just so deceptive lost all faith). As many of you can tell, at this point of may career, after 25 year in medicine i am very skeptical of anything i hear form CM to WM to any " alternative " medicine. I anyone really thinks they get great results i would love to be invited to follow their practice so i can assess the cases for my self in objective methods and learn. I know many functional problems are helped and i see this every day, but again i still say many patients tell us they feel much better even when clinical assessment does not show much change. Perhaps my expectation are two high, i was told that by students and friends some of whom are on this list. Maybe they can put their 2 cents worth. > > > > > > > > www.int\grativehealthmedicine.com > - > swzoe2000 > > Saturday, May 19, 2007 11:21 AM > Re: Nocturia - LV Qi Stasis > > > , " Alon Marcus " <alonmarcus@> wrote: > > > Alon, I like how you always bring the discussion back to the most clinical aspects. > > I have a coupe of questions for you. First, I don't understand exactly what you mean - > physical signs are pulse, tongue and abdomen and symptoms are what the patient > complains about? So, you prioritize pulse, tongue and abodomen right? Why do you think > you have the bias you do? Is this bias in relation to acupuncture or herbs or both? In a > case like this, how then do you make sense of the symptoms? Sharon > > (alon) In the case of nocturia my question is what if the physical signs conflict with the > symptoms. For example if the pt complain of symptoms that suggest kid yang def > including age and chronicity but pulse, tongue and abdomen do not suggest any > deficiency. I see such cases all the time and my bias is to put more emphasis on physical > signs than symptom complex. what do others do > > > > > > > > > > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 22, 2007 Report Share Posted May 22, 2007 Trevor I use to love treating skin problems for the same reason. I do not see them that often any longer - Trevor Erikson Monday, May 21, 2007 9:21 AM Re: Nocturia - LV Qi Stasis This is exactly why I prefer to treat dermatologic cases, because I can see with my own eyes the change. Even if the main symptom from the patients perspective is itch, I can measure the change according to the amount of excoriation I can see. The changes in skin are measurable and objective, I can photograph the changes and show myself and patient the before and after. Subjective symptoms that are based only on the patients awareness I find difficult, at times, to deal with. Best Trevor , " Alon Marcus " <alonmarcus wrote: > > > Physical signs are things the practitioner assesses while symptoms are things the patient tells the practitioner. I think my preference to treating signs came about when i just could not have pt describe symptoms in the same way i learned them or seen pt describe them in china. I also distrust any so called statement of fact in Chinese medicine, ie in chronic disease treat K, blood stasis etc. This is an evolution for me as i have seen patients that just did not make sense using " traditional basic approaches " did not get better when treated using these approaches and improved only when i treated what the physically presented with (ie signs), i always say patients do not read text books. I often strongly sedate elderly patients, chronic diseases, getting the best results. I tend to often not believe what patients tell me. First patient do not want to OFFEND me and their practitioners if they like me/them and will tell me they feel better even when my clinical physical findings do not suggest any improvement. They tend to exaggerate symptoms even when clinical finding show very little is wrong or much improvement. They tend to feel bad when they perceive some else is responsible for their suffering, and so on and so on. The majority of my practice is pain so perhaps i see more of this stuff than others. All of this has lead me to trust my hands more than what patients tell me. I definitely trust what is see and feel rather than what i read in any text, classic and definitely modern, especially studies coming from china (the studies i was involved in china were just so deceptive lost all faith). As many of you can tell, at this point of may career, after 25 year in medicine i am very skeptical of anything i hear form CM to WM to any " alternative " medicine. I anyone really thinks they get great results i would love to be invited to follow their practice so i can assess the cases for my self in objective methods and learn. I know many functional problems are helped and i see this every day, but again i still say many patients tell us they feel much better even when clinical assessment does not show much change. Perhaps my expectation are two high, i was told that by students and friends some of whom are on this list. Maybe they can put their 2 cents worth. > > > > > > > > www.int\grativehealthmedicine.com > - > swzoe2000 > > Saturday, May 19, 2007 11:21 AM > Re: Nocturia - LV Qi Stasis > > > , " Alon Marcus " <alonmarcus@> wrote: > > > Alon, I like how you always bring the discussion back to the most clinical aspects. > > I have a coupe of questions for you. First, I don't understand exactly what you mean - > physical signs are pulse, tongue and abdomen and symptoms are what the patient > complains about? So, you prioritize pulse, tongue and abodomen right? Why do you think > you have the bias you do? Is this bias in relation to acupuncture or herbs or both? In a > case like this, how then do you make sense of the symptoms? Sharon > > (alon) In the case of nocturia my question is what if the physical signs conflict with the > symptoms. For example if the pt complain of symptoms that suggest kid yang def > including age and chronicity but pulse, tongue and abdomen do not suggest any > deficiency. I see such cases all the time and my bias is to put more emphasis on physical > signs than symptom complex. what do others do > > > > > > > > > > > > > > > > > > > > > > Quote Link to comment Share on other sites More sharing options...
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