Pathomechanisms

[Guest guest]

Hi folks,

 

First of all I would like to say that I think pathomechanisms are

important. They give us some way to think about the body and how it

works and, most importantly how to predict events, in order to prevent

the development of further problems and or trace events back in time

to a cause. A theory of how the body works is only as good as it can

explain where the body is, where it came from and where it may go. To

heal an illness you may not necessarily need to know all of these, or

any of these for that matter. Perhaps someone may just remember that a

formula they read treats x y and z symptoms and use it with success

while not really being clear as to the mechanism of why it worked.

Nevertheless I think that we probably all agree that in order to be a

better doctor we must have some idea of how the body works in order to

help us in those situations when the condition in front of us doesn't

match the books we learned in school, and the patient doesn't have

textbooks symptoms. In my opinion I don't believe the schools most of

us went to teach us how to think in this way.

At this point I must say I agree with what Jason is saying about these

theories, that is that they are just stories. We have no way to prove

what we are saying is true. The best test of the validity of any of

these stories is how well they help you successfully treat a disease.

I like the stories, and I like hearing different stories but what i

see happen is that some people seem to confuse the story with fact.

Again if it helps you fine, but I also have to agree with whoever said

it is important to remember that the things we learn are peoples best

hypothesis and best attempts at creating a cohesive theory.

Once you begin to read different sources of literature you of course

find out that different peoples different theories contradict each

other or sometimes the same person contradicts himself. This can be

very frustrating and I am not sure i agree with Zev in that this is

beneficial. Personally I would like it if there was one comprehensive

cohesive and clearly explained theory. But I do accept that this is

not the situation in Chinese medicine.

Or perhaps I am wrong. I have not read the entire Nei Jing which is of

course where this all began. But I think that it is fair to say that

it was vague enough in many respects that later generations felt the

need to elaborate on their personal understanding of it. And the rest

is history.

Of course I do believe that there are certain " facts " that we all

agree on and must in order to even begin talking Chinese medicine,

like the functions and the nature of the organs and pathogens to

mention a few. Personally I have been trying read enough different

sources so as to get my own story straight.

The last thing I would like to say is in response to is Jason's

comment about the Shang Han Lun not having a story. I disagree, I

think it does have a story but Zhang Zhong Jing assumes that we have

read all the books he mentions in his preface and so we are supposed

to have, at least, a familiarity with all the players in the story. I

assume the book was based in part on some story and also on a clinical

experience which proved that x treats y, regardless of any story.

Gee, this is the first time i have written in and I'm sorry if I have

babbled on too much. I am not even sure if I came to any clear point.

I have been wanting to respond to a number of post over the past few

weeks and if If I get a chance to I will and I'll try to keep it short.

Thanks all.

 

michael

[Guest guest]

, " fitzms " <fitzms wrote:

> First of all I would like to say that I think pathomechanisms are

> important. They give us some way to think about the body and how it

> works and, most importantly how to predict events, in order to prevent

> the development of further problems and or trace events back in time

> to a cause.

 

Nice to hear from you Michael, thanks for chiming into the discussion.

 

I think that a good start towards understanding our field is to simply

look objectively at the things that are valued by sophisticated

Chinese doctors. Any given individual may resonate with the more

integrative tracks or the more traditional tracks, and both offer a

lot. Within the subset of doctors that are prioritize a more

traditional perspective, there can be no doubt that topics such as

pathomechanisms and study of classical texts are highly valued by such

practitioners.

 

The reason that classics and CM theory are so valued is not because

they represent some solid and unbreakable truth, but rather because

they illuminate a road map to reproduce CM's effective results. The

many overlapping theories allow one to sort through various

perspectives to find an explanation that works for the case. In my

experience, sophisticated senior practitioners pioneer new territory

primarily by delving deeply into classical ideas and adapting an older

theory to a modern application- this is the way that people innovate

new strategies for complex " modern " disorders like autoimmune diseases

or HIV.

 

On a more mundane level, pathomechanisms inform most of our day-to-day

clinical decisions. We seem someone present with depressed heat signs

and have to analyze whether the depressed heat comes from liver

depression forming heat (jia wei xiao yao san) or whether it comes

from failure of the spleen's upbearing and the stomach's downbearing

(bu zhong yi qi tang), etc. If there weren't pathomechanisms to link

these things together, we couldn't arrive at the right treatment for

the chief complaint. If one hasn't studied Li Dong-Yuan's theories,

one might not think of using bu zhong yi qi tang for depressed heat,

then be confused by why the patient's constitution is screaming spleen

qi xu yet they have paradoxical symptoms of (apparently unrelated)

depressed heat.

 

Chinese medicine fundamentally requires critical thinking skills. One

has to weigh the evidence and assess which areas have consensus and

which have disagreement. For example, many Chinese materia medicas

say thay Dang Shen nourishes the blood. However, an approximately

equal number of equally-authorative materia medicas do not list a

blood-supplementing action under dang shen's monograph (except

indirectly via supplementing spleen qi). Clearly, there is a tendency

there, but not a consensus. Similarly, dang gui tails are sometimes

listed with a blood-breaking property, while other texts simply

describe their action as blood-quickening (suggesting a more mild

action). There is not a consensus on the strength of dang gui wei's

blood-moving action. But there is a clear consensus on the strength

of e zhu and san leng's action- all the books say that there two meds

break blood. Chinese medicine is continually evolving and it doesn't

have a standardized state of knowledge, but it does have clear trends

and a wealth of information. Knowing which stuff is agreed upon and

which stuff is variable is very useful.

 

Any of us could always say that pathomechanisms are BS, ascribed

herbal properties are BS, classics are dusty and useless, and

terminology of stuff like medicinal actions is too inconsistent to be

worth preserving. But I think it is hard to ignore the fact that

countless doctors who are more well-educated than most of us find

value in applying, preserving, and transmitting this knowledge. This

pathomechanism discussion is similar to our conversations about

terminology. It is easy for any of us to say that terminology is

fluffy and flexible and can be sufficiently and intuitively translated

based on the variable skills of the few marginally-bilingual

translators we have around at any given time. But it is hard to

ignore the fact that the WHO has a team of world experts that

unmistakably conclude that CM has a vast technical vocabulary that

must be preserved in translation. I've met a few such experts and I

can say that I wouldn't like to take on any of those scholars- it's a

lot harder to make a defensible and informed critique in Chinese with

an expert of 40 years' experience than it is to rant on CHA. I may

form my own ideas about how well dang shen nourishes the blood by

boiling a bunch of it into a syrup and taking it in isolation for a

few weeks, but ultimately I am not so impressed with my own youthful

knowledge that I'd go tell a true materia medica expert that I think

his monograph on dang shen is wrong. Everyone knows that

pathomechanisms are just a hypothesis, a theory just like the rest of

CM. But it is the theory that allows one to reproduce CM's mysterious

effects. Reproducing those effects is what counts, and well-applied

CM theory can often produce mysteriously powerful effects.

 

Eric

[Guest guest]

(see below)

 

 

 

_____

 

 

On Behalf Of Eric Brand

 

 

[Eric] I think that a good start towards understanding our field is to

simply

look objectively at the things that are valued by sophisticated

Chinese doctors. Any given individual may resonate with the more

integrative tracks or the more traditional tracks, and both offer a

lot. Within the subset of doctors that are prioritize a more

traditional perspective, there can be no doubt that topics such as

pathomechanisms and study of classical texts are highly valued by such

practitioners.

 

 

 

I think this statement is not necessary true for all GREAT doctors. For

example, the reason this discussion got started was because of Huang Huang's

interview. He is one of the most talked about SHL experts in China right now

(of course within certain circles). Nonetheless one of his points is that

pathomechanisms and " extra " theory are not that useful and only get in the

way of things. He focuses on clinical pictures and solutions. Unless I have

misunderstood something.:-)

 

I have studied with very famous doctors in Taiwan and China. Some emphasize

the classics, some emphasize the theory, some favor integration, some

emphasize the straight clinical reality, meaning no pathomechanisms. The

latter being very much about X=Y=Z.

 

 

[Eric] On a more mundane level, pathomechanisms inform most of our

day-to-day

clinical decisions. We seem someone present with depressed heat signs

and have to analyze whether the depressed heat comes from liver

depression forming heat (jia wei xiao yao san) or whether it comes

from failure of the spleen's upbearing and the stomach's downbearing

(bu zhong yi qi tang), etc. If there weren't pathomechanisms to link

these things together, we couldn't arrive at the right treatment for

the chief complaint. If one hasn't studied Li Dong-Yuan's theories,

one might not think of using bu zhong yi qi tang for depressed heat,

then be confused by why the patient's constitution is screaming spleen

qi xu yet they have paradoxical symptoms of (apparently unrelated)

depressed heat.

 

 

 

I would tend to also disagree with this. One does not need the

pathomechanism to treat such a patient successfully. As we have seen, BZYQT

has about 5 differing pathomechanisms attributed to why heat is caused by qi

xu. My point is that in this situation the story is not that helpful. What

is essential though is that one has the ability to recognize the s/s that

point out that the heat is coming about from qi xu. If one notices i.e. that

the patient's fever is worse upon exertion etc. then one can match it up.

This has nothing to do with the pathomechanism.

 

As I have wrote about in the past, the story that explains where the " heat "

comes from, i.e. depression, or qi sinking, or damp sinking (etc), is

essentially meaningless and can actually complicate things. For example, if

one uses the pathomechanism story that dampness is sinking into the lower

burner and misplacing ministerial fire which is then harassing the heart

etc. then one may have the urge to add in i.e. huang bai or cang zhu to deal

with " dampness in the lower " , when in actuality it is not needed at all. I

have seen students make this clinical mistake. Therefore one can understand

presentations and formulas (without the story) and successfully treat

patients. Huang Huang I think exemplifies this approach. I also think that

there are plenty of people that have not " studied " LDY's theories (more than

the basic presentation of the BZYQT) and successfully use BZYQT. There are

plenty of modern articles that demonstrate this.

 

Therefore to know if depressed heat is from X or Y, really comes down to

symptoms and signs probably more so than the story (pathomechanism), but

obviously both can be helpful.. I see two perspectives that are of value and

I agree that pathomechanisms can be helpful in explaining things and

conceptualizing versus rote memorization.

 

 

 

Eric says who are we to question the " countless " doctors? Hhhmm.. Funny. , I

see it as we are discussing something that clearly the " great " doctors do

not themselves agree on. We are not heathens to question the value of, for

example, a pathomechanism for BZYQT when the many expert have differing

opinions. There are plenty of doctors who just don't buy into it. I am to

some extent playing devil's advocate because I enjoy pathomechanisms, but I

also think a healthy skepticism toward them is important. Because in reality

I really do not know how much of my clinical results are the result of them.

It is hard to say once you know them because you think in those terms, but

there are other things, like more hands on approaches that I find just as

effective, if not sometimes more. Clearly Huang Huang is teaching to people

to treat what they see. They do not know the theory and pathomechanisms and

he is getting them to understand how to clinically treat people. He states

he studied " all of that " and just doesn't find it that useful.

 

 

 

This is true for terminology debate also. Just because there are

organizations that favor standardization of terminologies, there are others

who have differing opinions. One may have a linguistic degree, but that does

not make him more correct than someone that doesn't. There are very

intelligent people on both sides of the term debate. On a side note: I am

just curious has any Chinese organization adopted the Wiseman term set? I

know this was a big goal for Wiseman, but when I was in China last, I asked

around, and everyone that I spoke with (including the largest publisher on

CM) disliked it and favored other term sets. I am just curious if others

have heard different???

 

 

 

To sum up: I am not about to NOT question something just because a few

" experts " say otherwise. Of course I respect other's opinion, especially if

they are more experienced than I. But it doesn't mean we have to worship

what they say. The more I study the more I realize how diverse people

express themselves, conceptualized things, and therefore end up with

opposing viewpoints. I would like to keep " our " options open to embracing

multiple " valid " perspectives. It really is the essence of ,

in clinical practice and in language / communication. Such debate leads to

better decisions and hence better health care! To try to shut down opposing

views because " they are not worthy to speak " or " how can we argue with the

experts " screams of tyranny and absurdity.

 

 

 

Respectfully,

 

 

 

-

 

 

 

 

[Guest guest]

, " "

wrote:

Nonetheless one of his points is that

> pathomechanisms and " extra " theory are not that useful and only get

in the

> way of things. He focuses on clinical pictures and solutions. Unless

I have

> misunderstood something.:-)

 

To be sure, pathomechanisms are just a story. They are useful in

understanding which patterns tend to be involved in certain

complaints, and knowing them speeds up and improves diagnosis of the

current pattern. But I completely agree that correctly treating the

actual pattern that presents is more useful than speculating on the

theoretical origins of how it arose.

 

> One does not need the

> pathomechanism to treat such a patient successfully. As we have

seen, BZYQT

> has about 5 differing pathomechanisms attributed to why heat is

caused by qi

> xu. My point is that in this situation the story is not that

helpful. What

> is essential though is that one has the ability to recognize the s/s

that

> point out that the heat is coming about from qi xu.

 

If one correctly chose Bu Zhong Yi Qi Tang when it was indicated, the

exact secondary mechanism would be academic and probably comparatively

unimportant. But if one didn't know that heat can come from qi xu in

the first place, one wouldn't get to BZYQT to start with. To me,

knowing that qi xu can cause heat is the main pathomechanism we need

to be aware of, once one has identified the core pattern there is not

really much need to have an overly verbose pathomechanical explanation

for it. Keeping it simple and seeing the big picture is one of the

arts of CM. I think our perspective is not so different in this regard.

 

 

> Eric says who are we to question the " countless " doctors?

 

Make no mistake, I advocate questioning everyone and everything. I

believe that thinking critically is essential in CM. We probably all

know very advanced doctors that we disagree with, and I'm sure we've

all met some people with fancy titles and reputations that don't know

as much as they would like to portray. Many of us probably disagree

with some of CM's fundamental ideas, and all of us should certainly

question all of our concepts, sources, and assumptions.

 

I was just pointing out that some of the people in our community are

really heavyweights of knowledge, at least compared to me. I know

enough to know how much there is to learn, and when it comes to

quandries like medicinal actions or term meanings, I'm really grateful

that there are people in the field who have researched the topics

extensively.

 

On a side note: I am

> just curious has any Chinese organization adopted the Wiseman term

set? I

> know this was a big goal for Wiseman, but when I was in China last,

I asked

> around, and everyone that I spoke with (including the largest

publisher on

> CM) disliked it and favored other term sets. I am just curious if others

> have heard different???

 

I think that the World Federation of Societies is

publishing their term list right about now. The last time I saw it,

it looked like they supported a lot of the same general principles

that Wiseman endorses, but I think the actual terms chosen reflect

more popular words as well as more biomedicalized disease names.

Several of Nigel's term choices are unpopular, but his system is quite

comprehensive and practical. I think it will forever be more likely

that lasting independent term lists will draw upon Nigel's system and

philosophy but adopt more popular terms like excess and deficiency.

 

Eric

[Guest guest]

Not to belabor this analogy but I was taught that Shang Han Lun was mainly the

story of

missed diagnosis and treatment. The formulas were the proper resolution to these

" back-

stories " .

 

Doug

 

 

> The last thing I would like to say is in response to is Jason's

> comment about the Shang Han Lun not having a story. I disagree, I

> think it does have a story but Zhang Zhong Jing assumes that we have

> read all the books he mentions in his preface and so we are supposed

> to have, at least, a familiarity with all the players in the story. I

> assume the book was based in part on some story and also on a clinical

> experience which proved that x treats y, regardless of any story.

>-----------------

> Thanks all.

>

> michael

>

[Guest guest]

Hello all,

 

I read the interview with Huang Huang which was a nice follow up to

the last one. I am excited by Huang Huang and other really cool

material that is coming out these days. New dimensions are opening

in our medicine. I've also been reading with interest the

discussion on pathomechanisms.

 

Huang Huang, has discovered a way of thinking for himself that not

only proves effective but also enlightens his understanding of a

classic texts such as the Shang Han Lun. Lucky for us, he shares

this in his writings! Yet, as I read the interview I was aware of a

certain snobbery that too readily diminished the stepping stones that

brought him to the place where he was ripe for this new

understanding. It seemed clear to me that the years Huang Huang

spent studying so much material, including pathomechanisms, are now

so IN him that he takes it for granted. He now wants to toss it out

in favor of this more Haiku methodology. In the spirit of

questioning the " experts " my impression was, wow, he has wonderful

stuff but he seems so immature. He moved beyond his original

training, discovering it's limitations but pays no homage to it in

spite of the fact that it formed such a foundation. It's like a kid

going off into the world critical of the narrowness of his/her

parents without realizing (yet) that it was that narrowness that gave

him/her the health and foundation to go off.

 

In my clinical experience, as I have worked with and articulated

pathomechanisms over the years, they have become more and more

integral and instantaneous - I simply SEE what is happening in a

given situation and sometimes simply KNOW what to do. Not that this

happens all the time by any means but the process can be so direct

that there is no " story " created. What I see seems so obvious to me

and what to do seems so simple but that has only come after years of

study and practice and working through pathomechanisms regarding

individual patients.

 

I think I am balking a bit at the tendency to raise up new ideas and

to criticize the process that gets us to be robustly ready for them.

Language and stories can mislead if they are not used carefully but

they can also lead to deepening understanding. Younger practitioners

and all of us need language to guide us from the plethora of

information our patients give us to a concise focus for treatment.

Articulating what we see as the pathomechanisms in a particular case

can lead us to being able to SEE directly. Once we do start seeing

directly - why criticize the more bulky process of articulation as

passe?

 

I am interested, Jason, as to your thoughts regarding this since you

seem on the one hand quite critical of pathomechanisms as made up

stories and yet in your case study in the current Lantern, you use

the stories of pathomechanisms to work through, understand and focus

treatment in your case. What are your thoughts here?

 

 

 

 

Sharon

 

Sharon Weizenbaum

86 Henry Street

Amherst, MA 01002

413-549-4021

sweiz

www.whitepinehealingarts.com

 

 

 

 

 

[Guest guest]

Sharon,

 

 

 

This is a good question. Just for the record, as you can see from my lantern

article, I am not abandoning this idea of pathomechanisms. I am merely

pointing out the other side of things to further conversation and debate, as

well expand people's perspectives (including my own).

 

 

 

You may feel that Huang Huang is " immature " , but I am still interested in

his viewpoint. He has figured out a way to teach towards clinical reality

without all the pathomechanisms. From the article it does not sound like all

his " hard work " led him to the point he is at now. I think he actually says

that he was not getting the results he thought he should have using the

previous TCM (theory & pathomechanism) method. (back to our previous

discussion) he presents an out of the TCM box approach. Finally he did not

develop this system, he is clear about documenting and crediting his

sources.

 

 

 

I have used many of his ideas in the clinic for a couple of years now. I

find them extremely useful! Even in the latest Lantern article I mention

using his ideas. They definitely are not mainstream TCM, but they work. One

has to think about that.

 

 

 

Chinese medicine has a long history of physicians that don't practice

writing and dictating theory (among other things). There are others who are

in the trenches day in and day out. A further differentiation are physicians

that treat only wealthy and those that treat the common poor folk. All of

these divisions have potential of producing much different perspectives in

the actual clinical. Sometimes the more ivory tower approaches lose sight of

the clinic. I personally spend a lot of time in the clinic, therefore

whenever I see someone with very clinically applicable approach I have to

stop and say, " hhhmmmm.. " That is all I am saying. There are more than just

the basic TCM perspective and these approaches are just as valid and

sometimes better.

 

 

 

So why do I explain things using the pathomechanism story in my latest

article. 1) I think that presenting case studies in the typical Chinese

fashion (terse approach) is not useful for the Westerner. 2) An approach

like Huang Huang is not my forte. 3) I like pathomechanisms and their

language makes sense to me. But I am certain that at least some of them are

not necessary for clinical results / understanding real patients. Is it

troubling that I embrace something and also am critical of it? I find this

is quite healthy, and keeps me evolving.

 

 

 

Hope that answers the questions.

 

 

 

Respectfully,

 

 

 

-

 

 

 

_____

 

 

On Behalf Of sharon weizenbaum

Sunday, July 01, 2007 6:40 AM

 

Re: Pathomechanisms

 

 

 

 

 

I am interested, Jason, as to your thoughts regarding this since you

seem on the one hand quite critical of pathomechanisms as made up

stories and yet in your case study in the current Lantern, you use

the stories of pathomechanisms to work through, understand and focus

treatment in your case. What are your thoughts here?

 

Sharon

 

 

 

 

[Guest guest]

Is there a link for the huang huang interview?

 

thanks,

Warren Cargal,

>

> sharon weizenbaum <sweiz

> 2007/07/01 Sun AM 08:40:16 EDT

>

> Re: Pathomechanisms

>

> Hello all,

>

> I read the interview with Huang Huang which was a nice follow up to

> the last one. I am excited by Huang Huang and other really cool

> material that is coming out these days. New dimensions are opening

> in our medicine. I've also been reading with interest the

> discussion on pathomechanisms.

>

> Huang Huang, has discovered a way of thinking for himself that not

> only proves effective but also enlightens his understanding of a

> classic texts such as the Shang Han Lun. Lucky for us, he shares

> this in his writings! Yet, as I read the interview I was aware of a

> certain snobbery that too readily diminished the stepping stones that

> brought him to the place where he was ripe for this new

> understanding. It seemed clear to me that the years Huang Huang

> spent studying so much material, including pathomechanisms, are now

> so IN him that he takes it for granted. He now wants to toss it out

> in favor of this more Haiku methodology. In the spirit of

> questioning the " experts " my impression was, wow, he has wonderful

> stuff but he seems so immature. He moved beyond his original

> training, discovering it's limitations but pays no homage to it in

> spite of the fact that it formed such a foundation. It's like a kid

> going off into the world critical of the narrowness of his/her

> parents without realizing (yet) that it was that narrowness that gave

> him/her the health and foundation to go off.

>

> In my clinical experience, as I have worked with and articulated

> pathomechanisms over the years, they have become more and more

> integral and instantaneous - I simply SEE what is happening in a

> given situation and sometimes simply KNOW what to do. Not that this

> happens all the time by any means but the process can be so direct

> that there is no " story " created. What I see seems so obvious to me

> and what to do seems so simple but that has only come after years of

> study and practice and working through pathomechanisms regarding

> individual patients.

>

> I think I am balking a bit at the tendency to raise up new ideas and

> to criticize the process that gets us to be robustly ready for them.

> Language and stories can mislead if they are not used carefully but

> they can also lead to deepening understanding. Younger practitioners

> and all of us need language to guide us from the plethora of

> information our patients give us to a concise focus for treatment.

> Articulating what we see as the pathomechanisms in a particular case

> can lead us to being able to SEE directly. Once we do start seeing

> directly - why criticize the more bulky process of articulation as

> passe?

>

> I am interested, Jason, as to your thoughts regarding this since you

> seem on the one hand quite critical of pathomechanisms as made up

> stories and yet in your case study in the current Lantern, you use

> the stories of pathomechanisms to work through, understand and focus

> treatment in your case. What are your thoughts here?

>

>

>

>

> Sharon

>

> Sharon Weizenbaum

> 86 Henry Street

> Amherst, MA 01002

> 413-549-4021

> sweiz

> www.whitepinehealingarts.com

>

>

>

>

>

[Guest guest]

Not that I know of, but you can get it in the latest Lantern, it is well

worth the $.

 

 

 

-Jason

 

 

 

_____

 

 

On Behalf Of

wcargal9

Sunday, July 01, 2007 9:37 AM

 

Re: Re: Pathomechanisms

 

 

 

Is there a link for the huang huang interview?

 

thanks,

Warren Cargal,

>

 

 

 

 

[Guest guest]

Sharon and Group,

 

 

 

If interested, below is a link that contains the original unedited version

of the Lurking Pathogen case study that Sharon refers to from the Lantern.

It was chopped down because of size for The Lantern. The Intro and

Conclusion, as well as Chip's portion, are not contained at the link. (at

least not yet..)

 

 

 

Enjoy.. and if anyone has any comments please feel free..

 

 

 

-Jason

 

 

 

Chinese Medicine/index.php?page=Chinese_Medicine_Articles

 

 

 

 

 

 

 

 

 

 

 

_____

 

 

On Behalf Of sharon weizenbaum

 

 

I am interested, Jason, as to your thoughts regarding this since you

seem on the one hand quite critical of pathomechanisms as made up

stories and yet in your case study in the current Lantern, you use

the stories of pathomechanisms to work through, understand and focus

treatment in your case. What are your thoughts here?

 

Sharon

 

Sharon Weizenbaum

86 Henry Street

Amherst, MA 01002

413-549-4021

sweiz <sweiz%40rcn.com>

www.whitepinehealingarts.com

 

 

[Guest guest]

But I am certain that at least some of them are

not necessary for clinical results / understanding real patients. Is it

troubling that I embrace something and also am critical of it? I find this

is quite healthy, and keeps me evolving.

>>>>>>>

Jason

This is a prerequisite for critical thinking and in keeping one honest about

there own results and short comings

 

 

 

 

 

 

 

 

-

Sunday, July 01, 2007 8:21 AM

RE: Re: Pathomechanisms

 

 

Sharon,

 

This is a good question. Just for the record, as you can see from my lantern

article, I am not abandoning this idea of pathomechanisms. I am merely

pointing out the other side of things to further conversation and debate, as

well expand people's perspectives (including my own).

 

You may feel that Huang Huang is " immature " , but I am still interested in

his viewpoint. He has figured out a way to teach towards clinical reality

without all the pathomechanisms. From the article it does not sound like all

his " hard work " led him to the point he is at now. I think he actually says

that he was not getting the results he thought he should have using the

previous TCM (theory & pathomechanism) method. (back to our previous

discussion) he presents an out of the TCM box approach. Finally he did not

develop this system, he is clear about documenting and crediting his

sources.

 

I have used many of his ideas in the clinic for a couple of years now. I

find them extremely useful! Even in the latest Lantern article I mention

using his ideas. They definitely are not mainstream TCM, but they work. One

has to think about that.

 

Chinese medicine has a long history of physicians that don't practice

writing and dictating theory (among other things). There are others who are

in the trenches day in and day out. A further differentiation are physicians

that treat only wealthy and those that treat the common poor folk. All of

these divisions have potential of producing much different perspectives in

the actual clinical. Sometimes the more ivory tower approaches lose sight of

the clinic. I personally spend a lot of time in the clinic, therefore

whenever I see someone with very clinically applicable approach I have to

stop and say, " hhhmmmm.. " That is all I am saying. There are more than just

the basic TCM perspective and these approaches are just as valid and

sometimes better.

 

So why do I explain things using the pathomechanism story in my latest

article. 1) I think that presenting case studies in the typical Chinese

fashion (terse approach) is not useful for the Westerner. 2) An approach

like Huang Huang is not my forte. 3) I like pathomechanisms and their

language makes sense to me. But I am certain that at least some of them are

not necessary for clinical results / understanding real patients. Is it

troubling that I embrace something and also am critical of it? I find this

is quite healthy, and keeps me evolving.

 

Hope that answers the questions.

 

Respectfully,

 

-

 

_____

 

On Behalf Of sharon weizenbaum

Sunday, July 01, 2007 6:40 AM

Re: Pathomechanisms

 

I am interested, Jason, as to your thoughts regarding this since you

seem on the one hand quite critical of pathomechanisms as made up

stories and yet in your case study in the current Lantern, you use

the stories of pathomechanisms to work through, understand and focus

treatment in your case. What are your thoughts here?

 

Sharon

 

[Guest guest]

Sharon

I think Huang Huang approach is clearly influence by kampo and since they put so

little emphasis on pathomechanisms why than do you think his background is so

important in determine were he ended up. Perhaps he now sees the time he spent

learning " TCM " as wasted time and want to communicate this clearly. As always it

is dangerous to project one own experience when interpreting someone else's

message. I think Jason is clearly trying to communicate that there are many very

skilled approaches out there that have little to do with what many of us see as

gospel

 

 

 

 

 

 

 

 

-

sharon weizenbaum

Sunday, July 01, 2007 5:40 AM

Re: Pathomechanisms

 

 

Hello all,

 

I read the interview with Huang Huang which was a nice follow up to

the last one. I am excited by Huang Huang and other really cool

material that is coming out these days. New dimensions are opening

in our medicine. I've also been reading with interest the

discussion on pathomechanisms.

 

Huang Huang, has discovered a way of thinking for himself that not

only proves effective but also enlightens his understanding of a

classic texts such as the Shang Han Lun. Lucky for us, he shares

this in his writings! Yet, as I read the interview I was aware of a

certain snobbery that too readily diminished the stepping stones that

brought him to the place where he was ripe for this new

understanding. It seemed clear to me that the years Huang Huang

spent studying so much material, including pathomechanisms, are now

so IN him that he takes it for granted. He now wants to toss it out

in favor of this more Haiku methodology. In the spirit of

questioning the " experts " my impression was, wow, he has wonderful

stuff but he seems so immature. He moved beyond his original

training, discovering it's limitations but pays no homage to it in

spite of the fact that it formed such a foundation. It's like a kid

going off into the world critical of the narrowness of his/her

parents without realizing (yet) that it was that narrowness that gave

him/her the health and foundation to go off.

 

In my clinical experience, as I have worked with and articulated

pathomechanisms over the years, they have become more and more

integral and instantaneous - I simply SEE what is happening in a

given situation and sometimes simply KNOW what to do. Not that this

happens all the time by any means but the process can be so direct

that there is no " story " created. What I see seems so obvious to me

and what to do seems so simple but that has only come after years of

study and practice and working through pathomechanisms regarding

individual patients.

 

I think I am balking a bit at the tendency to raise up new ideas and

to criticize the process that gets us to be robustly ready for them.

Language and stories can mislead if they are not used carefully but

they can also lead to deepening understanding. Younger practitioners

and all of us need language to guide us from the plethora of

information our patients give us to a concise focus for treatment.

Articulating what we see as the pathomechanisms in a particular case

can lead us to being able to SEE directly. Once we do start seeing

directly - why criticize the more bulky process of articulation as

passe?

 

I am interested, Jason, as to your thoughts regarding this since you

seem on the one hand quite critical of pathomechanisms as made up

stories and yet in your case study in the current Lantern, you use

the stories of pathomechanisms to work through, understand and focus

treatment in your case. What are your thoughts here?

 

Sharon

 

Sharon Weizenbaum

86 Henry Street

Amherst, MA 01002

413-549-4021

sweiz

www.whitepinehealingarts.com

 

[Guest guest]

, " Alon Marcus " <alonmarcus wrote:

>

> Sharon

> I think Huang Huang approach is clearly influence by kampo and since they put

so little

emphasis on pathomechanisms why than do you think his background is so important

in

determine were he ended up. Perhaps he now sees the time he spent learning " TCM "

as

wasted time and want to communicate this clearly. As always it is dangerous to

project

one own experience when interpreting someone else's message. I think Jason is

clearly

trying to communicate that there are many very skilled approaches out there that

have

little to do with what many of us see as gospel

>

>

>

 

You are right Alon. Perhaps it really was a waste of time for Huang Huang to

spend all

those years practicing and studying before he discovered what he is doing now.

Who am I

to doubt what he says. I don't doubt that he believes what he says but I find I

do doubt

that it was a waste and find it " rings " of the immaturity I mentioned. It's

like practicing

classical music one's whole life then discovering jazz and then saying studying

classical

music was a waste. It can't be. It helped create skills, ways of thinking and

perceiving that

become so part of one that they are taken for granted. Perhaps even the reason

one can

understand Jazz now is because of the years of studying classical.

 

I also wonder about why his results previous to his kampo training were so poor.

I

observed in one herbal clinic in Hang Zhou every day for 5 months and my

teacher's

results were consistently phenomenal. Her diagnostic skills were refined and

quite a

wonder to behold. My own results are pretty good and get better year by year

through the

intersection of study and practice. And I think my expectations are quite high.

Though I

certainly don't diagnose or determine treatment in the standard TCM fashion I do

use

pathomechanisms to understand the dynamics of what is going on in most cases.

Maybe

Huang Huang just wasn't very good at the approaches he had studied and the Kampo

style

suits him better.

 

I think this is another reason I cringed a bit at Huang Huang's interview. How

easy it is

when one is enamored of the new to dismiss the old as old hat. But, what he

dismisses so

lightly is very rich, effective, complex and heterogeneous. Take for example

Clavey's book

Fluid Physiology and Pathology. It is largely a book about physio and patho

mechanisms,

TCM and how a variety of physicians think about things. It seems Huang Huang

would

toss this text. Perhaps it would be prudent for us to receive the wonderful

teachings of

Huang Huang without jumping on his dismissive band wagon. Yet his " immaturity "

does

not in any way influence my sense that what he is offering is brilliant and

valuable.

 

I do understand that there are so many approaches of value and that the

contradictions

between these methods offer us something worthwhile to chew on. I am also fully

in

agreement that what is being taught as TCM is deeply insufficient for clinical

reality.

 

The material Huang Huang is talking about is extemely interesting and very

useful. I

am on the edge of my seat waiting for this book to come out.

 

Sharon

[Guest guest]

Shron

By the way i tend to agree with you in that it is impossible to not benefit from

knowledge, and it is impossible to have previous growth and knowledge not be

apparat of the gestalt of one' current abilities and experiences. At the same

time i like to try to meet people at were their at. Perhaps he is purposely

inflating to make his point. But again i have to take him at his word. As far as

results go i have to go with my experience which is obviously very different

than yours

 

 

 

 

 

 

 

 

-

swzoe2000

Sunday, July 01, 2007 11:30 AM

Re: Pathomechanisms

 

 

, " Alon Marcus " <alonmarcus

wrote:

>

> Sharon

> I think Huang Huang approach is clearly influence by kampo and since they

put so little

emphasis on pathomechanisms why than do you think his background is so

important in

determine were he ended up. Perhaps he now sees the time he spent learning

" TCM " as

wasted time and want to communicate this clearly. As always it is dangerous to

project

one own experience when interpreting someone else's message. I think Jason is

clearly

trying to communicate that there are many very skilled approaches out there

that have

little to do with what many of us see as gospel

>

>

>

 

You are right Alon. Perhaps it really was a waste of time for Huang Huang to

spend all

those years practicing and studying before he discovered what he is doing now.

Who am I

to doubt what he says. I don't doubt that he believes what he says but I find

I do doubt

that it was a waste and find it " rings " of the immaturity I mentioned. It's

like practicing

classical music one's whole life then discovering jazz and then saying

studying classical

music was a waste. It can't be. It helped create skills, ways of thinking and

perceiving that

become so part of one that they are taken for granted. Perhaps even the reason

one can

understand Jazz now is because of the years of studying classical.

 

I also wonder about why his results previous to his kampo training were so

poor. I

observed in one herbal clinic in Hang Zhou every day for 5 months and my

teacher's

results were consistently phenomenal. Her diagnostic skills were refined and

quite a

wonder to behold. My own results are pretty good and get better year by year

through the

intersection of study and practice. And I think my expectations are quite

high. Though I

certainly don't diagnose or determine treatment in the standard TCM fashion I

do use

pathomechanisms to understand the dynamics of what is going on in most cases.

Maybe

Huang Huang just wasn't very good at the approaches he had studied and the

Kampo style

suits him better.

 

I think this is another reason I cringed a bit at Huang Huang's interview. How

easy it is

when one is enamored of the new to dismiss the old as old hat. But, what he

dismisses so

lightly is very rich, effective, complex and heterogeneous. Take for example

Clavey's book

Fluid Physiology and Pathology. It is largely a book about physio and patho

mechanisms,

TCM and how a variety of physicians think about things. It seems Huang Huang

would

toss this text. Perhaps it would be prudent for us to receive the wonderful

teachings of

Huang Huang without jumping on his dismissive band wagon. Yet his " immaturity "

does

not in any way influence my sense that what he is offering is brilliant and

valuable.

 

I do understand that there are so many approaches of value and that the

contradictions

between these methods offer us something worthwhile to chew on. I am also

fully in

agreement that what is being taught as TCM is deeply insufficient for clinical

reality.

 

The material Huang Huang is talking about is extemely interesting and very

useful. I

am on the edge of my seat waiting for this book to come out.

 

Sharon

 

 

 

 

 

 

[Guest guest]

Sharon,

I agree with you. My impressions reading this interview were the

same. I have his book in Chinese, so I've read some of his stuff,

including his 'family groups' of prescriptions, mostly from the SHL

and JGYL. What is interesting to me is that I've been teaching my

own family grouping of prescriptions for years now, and some it is

similar. Of course, other physicians such as Zhu Dan-xi and Liu Yi-

ren (The Heart Transmission of Medicine) have done similar groupings

of prescriptions. Huang Huang also spent time in Japan studying, so

there is no surprise that there are similarities to Kampo medicine as

well.

 

What is most important in my mind in Huang Huang's work is the

emphasis on constitutional types. This is already implied in the

Shang Han Lun when it describes " xiao chai hu tang " and " gui zhi

tang " patterns without listing the symptoms, and it can be applied

constitutionally as well.

 

I don't buy the story that all of his previous study was for

naught, or that studying pattern differentiation is a waste of time.

We have plenty of evidence to the contrary, as you've pointed out.

He is also not the first to take this stance historically, Yoshimasu

Todo comes to mind, who rejected all other knowledge outside the

Shang Han Lun as 'speculative', and relied on abdominal palpation to

diagnose all of his patients.

 

 

On Jul 1, 2007, at 11:30 AM, swzoe2000 wrote:

 

> You are right Alon. Perhaps it really was a waste of time for Huang

> Huang to spend all

> those years practicing and studying before he discovered what he is

> doing now. Who am I

> to doubt what he says. I don't doubt that he believes what he says

> but I find I do doubt

> that it was a waste and find it " rings " of the immaturity I

> mentioned. It's like practicing

> classical music one's whole life then discovering jazz and then

> saying studying classical

> music was a waste. It can't be. It helped create skills, ways of

> thinking and perceiving that

> become so part of one that they are taken for granted. Perhaps even

> the reason one can

> understand Jazz now is because of the years of studying classical.

>

> I also wonder about why his results previous to his kampo training

> were so poor. I

> observed in one herbal clinic in Hang Zhou every day for 5 months

> and my teacher's

> results were consistently phenomenal. Her diagnostic skills were

> refined and quite a

> wonder to behold. My own results are pretty good and get better

> year by year through the

> intersection of study and practice. And I think my expectations are

> quite high. Though I

> certainly don't diagnose or determine treatment in the standard TCM

> fashion I do use

> pathomechanisms to understand the dynamics of what is going on in

> most cases. Maybe

> Huang Huang just wasn't very good at the approaches he had studied

> and the Kampo style

> suits him better.

>

> I think this is another reason I cringed a bit at Huang Huang's

> interview. How easy it is

> when one is enamored of the new to dismiss the old as old hat. But,

> what he dismisses so

> lightly is very rich, effective, complex and heterogeneous. Take

> for example Clavey's book

> Fluid Physiology and Pathology. It is largely a book about physio

> and patho mechanisms,

> TCM and how a variety of physicians think about things. It seems

> Huang Huang would

> toss this text. Perhaps it would be prudent for us to receive the

> wonderful teachings of

> Huang Huang without jumping on his dismissive band wagon. Yet his

> " immaturity " does

> not in any way influence my sense that what he is offering is

> brilliant and valuable.

>

> I do understand that there are so many approaches of value and that

> the contradictions

> between these methods offer us something worthwhile to chew on. I

> am also fully in

> agreement that what is being taught as TCM is deeply insufficient

> for clinical reality.

>

> The material Huang Huang is talking about is extemely interesting

> and very useful. I

> am on the edge of my seat waiting for this book to come out.

>

> Sharon

 

 

Chair, Department of Herbal Medicine

Pacific College of Oriental Medicine

San Diego, Ca. 92122

 

 

 

 

 

 

 

[Guest guest]

S,

 

 

 

I don't think it matters why his results were bad. He says the results

didn't suite his expectations. Who are we to judge him?

 

 

 

Furthermore, It doesn't matter if other doctors use pathomechanisms, TCM, or

any other system for that matter, successfully. It doesn't have to be black

and white. There can be multiple approaches that work. The fact remains

Huang Huang is using a system that does not include the things you and

others value so much. And more importantly he is teaching it to people and

getting results! So even if he spent 50 years studying other stuff, it is

his prerogative to decide what he feels was useful and what was useless. He

is still teaching a system that does not include those things (like

pathomechanisms), and one has to respect that and if one chooses, they can

learn from it.

 

 

 

To add to your music analogy. One can study classical music for 30 years and

move to Jazz. You are right that no one can fairly say that the classical

skills did not assist in the Jazz. I can also firmly say that playing Jazz

is a whole NEW set of skills that most (even professional) classical

musicians can never obtain. But lets say this person obtains it and decides

to teach Jazz music to new students. And lets say she says, " Classical music

is not at all important for Jazz, here is how you do it. " One cannot argue

with that. A) classical music is not necessary for Jazz. (Just like

pathomechanism are not needed for Huang Hunag's system) B) Once a system

passes from teacher to student successfully we can pretty much say that the

previous training of the teacher is not that meaningful for the practice of

the new system (i.e. you can play jazz without classical).

 

 

 

There are plenty of things that I have studied that if a student asked me I

would tell them to forget this or that and focus on XYZ. It is all about

where the student wants to get to, as well as the perspective of the

teacher. Every teacher will feel certain things are important. I taught

music for 13 years, and I placed a medium emphasis of theory etc., but I am

clearly aware there are great musicians (as well as teachers) that felt most

of it was BS, and others that thought much more was a necessity. All

perspectives are valid, and both tracts can produce musicians of exceptional

caliber. But if a student wanted to be a academic or teacher, one would have

to say you must learn the theory. But if the student just wanted to play in

his band (treat patients), well maybe the theory isn't 100% necessary. But

in the same breath you could say, " it doesn't hurt " .

 

 

 

To sum up: No one is saying pathomechanism can't be helpful for some people

in the clinic. There are just people saying that many of them are

unnecessary in the clinic, meaning there are other approaches. One cannot

argue with this, it is a fact. You can practice or teach anyway you like.

There are many ways to practice and heal patients within the scope of CM.

 

 

 

 

 

-Jason

 

 

 

 

 

_____

 

 

On Behalf Of swzoe2000

Sunday, July 01, 2007 12:31 PM

 

Re: Pathomechanisms

 

 

 

@ <%40>

, " Alon Marcus " <alonmarcus wrote:

>

> Sharon

> I think Huang Huang approach is clearly influence by kampo and since they

put so little

emphasis on pathomechanisms why than do you think his background is so

important in

determine were he ended up. Perhaps he now sees the time he spent learning

" TCM " as

wasted time and want to communicate this clearly. As always it is dangerous

to project

one own experience when interpreting someone else's message. I think Jason

is clearly

trying to communicate that there are many very skilled approaches out there

that have

little to do with what many of us see as gospel

>

>

>

 

You are right Alon. Perhaps it really was a waste of time for Huang Huang to

spend all

those years practicing and studying before he discovered what he is doing

now. Who am I

to doubt what he says. I don't doubt that he believes what he says but I

find I do doubt

that it was a waste and find it " rings " of the immaturity I mentioned. It's

like practicing

classical music one's whole life then discovering jazz and then saying

studying classical

music was a waste. It can't be. It helped create skills, ways of thinking

and perceiving that

become so part of one that they are taken for granted. Perhaps even the

reason one can

understand Jazz now is because of the years of studying classical.

 

I also wonder about why his results previous to his kampo training were so

poor. I

observed in one herbal clinic in Hang Zhou every day for 5 months and my

teacher's

results were consistently phenomenal. Her diagnostic skills were refined and

quite a

wonder to behold. My own results are pretty good and get better year by year

through the

intersection of study and practice. And I think my expectations are quite

high. Though I

certainly don't diagnose or determine treatment in the standard TCM fashion

I do use

pathomechanisms to understand the dynamics of what is going on in most

cases. Maybe

Huang Huang just wasn't very good at the approaches he had studied and the

Kampo style

suits him better.

 

I think this is another reason I cringed a bit at Huang Huang's interview.

How easy it is

when one is enamored of the new to dismiss the old as old hat. But, what he

dismisses so

lightly is very rich, effective, complex and heterogeneous. Take for example

Clavey's book

Fluid Physiology and Pathology. It is largely a book about physio and patho

mechanisms,

TCM and how a variety of physicians think about things. It seems Huang Huang

would

toss this text. Perhaps it would be prudent for us to receive the wonderful

teachings of

Huang Huang without jumping on his dismissive band wagon. Yet his

" immaturity " does

not in any way influence my sense that what he is offering is brilliant and

valuable.

 

I do understand that there are so many approaches of value and that the

contradictions

between these methods offer us something worthwhile to chew on. I am also

fully in

agreement that what is being taught as TCM is deeply insufficient for

clinical reality.

 

The material Huang Huang is talking about is extemely interesting and very

useful. I

am on the edge of my seat waiting for this book to come out.

 

Sharon

 

 

 

 

 

 

[Guest guest]

Michael Max, who interviewed Dr. Huang for the Lantern article and is currently

translating

one of his books, is organizing a 2 week trip to Nanjing to study with him this

fall. Info. is

listed at www.classicformulas.com.

 

David Lerner

 

 

 

I think this statement is not necessary true for all GREAT doctors. For

example, the reason this discussion got started was because of Huang Huang's

interview. He is one of the most talked about SHL experts in China right now

(of course within certain circles). Nonetheless one of his points is that

pathomechanisms and " extra " theory are not that useful and only get in the

way of things. He focuses on clinical pictures and solutions. Unless I have

misunderstood something.:-)