Guest guest Posted November 12, 2007 Report Share Posted November 12, 2007 Jason, if I understand you well you are (also) referring to trying to treat everything together (all the complaints a patient has) as opposed to treating the specific complaint. I believe I read an article by Peter Deadman in the latest JCM that advocated the latter: do not try to treat every complaint but tackle them one at a time. And there are other practitioners that prescribe large formulas (a little for this and a little for that, as you say) and also get results. So this may have to do with one's personal beliefs and insights. People from the SHL camp or the one needle treatments will love their elegant treatment (who wouldn't?) and people from the other camp may argue they are being more realistic. Personally I do not have enough experience to choose sides here, so my answer would have to be: 'de gustibus et coloribus non discutandum est.' > I think all of this rests on what the patient actually wants and if the > practitioner and patient communicate honestly, then there should be no > issues. It seems only be a concern we suggest we can treat a western number > (without " proof " ) and then are not clear with the patient. If people communicate to their patients that they may be able to treat their acid reflux, or depression, or chronic fatigue by balancing LIV and SP than that is what they believe. I agree that some practitioners may diagnose LIV/SP disharmony all the time. or KID yin insufficiency (I know for a fact that LWDHW is the most often prescribed formula in Belgium), appropriate or not. I do think that often has to do with incorrect diagnosis. But I can't say I have heard many practitioners say " just treat this pattern and everything will get better. " That would be a false assumption and, I agree, ethically slippery. Tom. > Often, I have patient's come in with serious problems after > seeing a CM practitioner for sometime. There treatment might be something > like xiao yao san. Not that this is inherently wrong, and not even that > these patient's might not have had Lv-> Sp, but IMO, many of these cases had > nothing to do with the disease process. Many of these patient's reported > feeling much less stress and better sense of well-being, but the disease (or > chief complaint) had not improved. One may blame it on bad Dx or Tx, but I > think the issue is bigger. I think it has to do with our belief that we just > can treat one of a few patterns and everything gets better. , " " wrote: > > Doug (and group), > > > > I am not sure I agree. Maybe I am unclear about the specific goals of the > patient, but it seems that if she is coming in with a specific complaint I > think it your ethical obligation to treat that, unless she (and you) decide > otherwise. IMO, we too often just say " treat what you see " and not really > understand and focus on the main complaint / disease process. Which brings > up a larger question, do we believe that we can just treat just patterns and > all diseases will vanish. Sometimes this is true, but clearly not always. > This is especially true (and becomes a more complicated question) when > patient's come in with a solid western goal / diagnosis. Sometimes it takes > a more advanced understanding, than one may possess. > > > > This ties into Kate's case study. Her patient is coming in for a specific > issue, very very low testosterone. If that is what he wants improved then > what are the concerns around just treating a pattern (i.e. liver -> sp). > Here are possible scenarios to be considered and communicated to the > patient: > > > > 1) One is not going to treat the testosterone number and just treat " the > pattern " and hope for the best, (and is the patient comfortable with that)? > > 2) The practitioner knows from some research or experience that his pattern > (i.e. Lv->Sp) can actually influence testosterone levels. > > 3) The practitioner decides with the patient that the number (or western > disease) is not important (and hence not a goal) and together just strive > for optimal health. > > > > Otherwise we are walking a fine line. (BTW- I know that Kate in this > situation communicated clearly with the patient, so I am not pointing any > fingers here, just using the case as a springboard). > > > > I would like to hear other's input on this, because I really think it is a > large question. Often, I have patient's come in with serious problems after > seeing a CM practitioner for sometime. There treatment might be something > like xiao yao san. Not that this is inherently wrong, and not even that > these patient's might not have had Lv-> Sp, but IMO, many of these cases had > nothing to do with the disease process. Many of these patient's reported > feeling much less stress and better sense of well-being, but the disease (or > chief complaint) had not improved. One may blame it on bad Dx or Tx, but I > think the issue is bigger. I think it has to do with our belief that we just > can treat one of a few patterns and everything gets better. > > > > The thing that gets me is the approach and communication to the patient. The > practitioner (i.e. in the above cases) had led that patient to believe that > they were able to treat the disease, by just balancing their liver and > spleen. Do others see this as a problem or not so much?? IMO, it is one > thing to " strive for optimal health " , but another for treatment of a > specific condition. I think CM is fairly good at mapping out what patterns > and herbs treat specific diseases. If we do not have the information, we > have to be honest to ourselves and the patients. This to me centers on > ethical concerns, and I am not really interested in hearing about the > possible legal issues. We all know that we cannot i.e. " treat cancer. " > > > > On the other side of the coin, I am not suggesting at all that we focus on > herbs that just i.e. raise testosterone, I personally prefer a pattern > approach. However, knowledge of both the disease process and pattern is > imperative for proper treatment. For example, I thought Sharon's input was > extremely helpful, meaning she said that she has seen levels balance out > without Kidney yang tonics. But are we to take this to mean that any pattern > that we treat can theoretically balance out testosterone levels? Or are > there certain one's that will be successful and certain ones that won't. I > do not have a good answer here… Sharon can you relay which patterns you have > actually seen to successfully accomplish the goal of raising testosterone > without yang tonics, and have these been verified with lab results? > > > > I think we could extend this discussion to acupuncture, type of herbs given > etc. > > > > I think all of this rests on what the patient actually wants and if the > practitioner and patient communicate honestly, then there should be no > issues. It seems only be a concern we suggest we can treat a western number > (without " proof " ) and then are not clear with the patient. > > > > Comments? > > > > - Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 12, 2007 Report Share Posted November 12, 2007 Tom, Jason, My experience is that it depends on how chronic the problem being treated is. For example an entrenched disorder such as lupus after several years effects several organ systems, creating multiple pattern disorders. While sometimes using a focused, SHL-style prescription to mobilize the system will work ( such as using si ni san for a difficult urinary tract disorder) to shake up the decks, my experience is that a larger, more complex prescription is usually necessary. It was an interesting weekend of discussions at the Pacific Symposium. On one hand, you had Dan Bensky discussing the broad use of Shang Han Lun formulas, on the other hand, a private discussion with Michael Broffman about Dr. John Day, the Chinese herbalist who worked in Eastern Oregon 100 years ago and used prescriptions with up to 120 ingredients for the epidemic of 1911. . . On Nov 12, 2007, at 8:41 AM, Tom Verhaeghe wrote: > Jason, > > if I understand you well you are (also) referring to trying to treat > everything together (all the complaints a patient has) as opposed to > treating the specific complaint. > > I believe I read an article by Peter Deadman in the latest JCM that > advocated the latter: do not try to treat every complaint but tackle > them one at a time. > > And there are other practitioners that prescribe large formulas (a > little for this and a little for that, as you say) and also get > results. > > So this may have to do with one's personal beliefs and insights. > People from the SHL camp or the one needle treatments will love their > elegant treatment (who wouldn't?) and people from the other camp may > argue they are being more realistic. Personally I do not have enough > experience to choose sides here, so my answer would have to be: 'de > gustibus et coloribus non discutandum est.' > > > I think all of this rests on what the patient actually wants and > if the > > practitioner and patient communicate honestly, then there should > be no > > issues. It seems only be a concern we suggest we can treat a western > number > > (without " proof " ) and then are not clear with the patient. > > If people communicate to their patients that they may be able to treat > their acid reflux, or depression, or chronic fatigue by balancing LIV > and SP than that is what they believe. > > I agree that some practitioners may diagnose LIV/SP disharmony all the > time. or KID yin insufficiency (I know for a fact that LWDHW is the > most often prescribed formula in Belgium), appropriate or not. I do > think that often has to do with incorrect diagnosis. But I can't say I > have heard many practitioners say " just treat this pattern and > everything will get better. " That would be a false assumption and, I > agree, ethically slippery. > > Tom. Chair, Department of Herbal Medicine Pacific College of Oriental Medicine San Diego, Ca. 92122 Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 12, 2007 Report Share Posted November 12, 2007 This is a very interesting thread and one that I think all of us face on a day to day basis. Although I am still a novice practitioner, albeit busy with around 60 patients a week, I am constantly faced with the decision to treat as many patterns and disease categories as I can or just focus on the main chief complaint. Examples that I run into all the time are ones related to reproductive health when the patient also has a very obvious skin condition like atopic eczema or acne. Quite often I am using the dx of the skin to help me narrow down my approach to their fertility issue. I tell them that some of the markers we will see in terms of optimizing their fertility are: 1) changes in their menstrual cycle- ie more regular, less clots, pain, ect. and 2) Changes in their skin. For me these two disease categories combine well because quite often they are both related to pathologies within the blood. An example of this would be of a woman who came to me because she had 3 repeated miscarriages, was young and stressed because her family was putting the pressure on. She also had fairly significant rosacea, a late cycle with pain and clotted dark flow. The dx- blood heat with stasis. These two disease categories are very much related. By focusing on the health of her skin and as well her menstrual cycle over a 4 month period using CM herbals, she conceived, is now close to 8 months pregnant, and her rosacea improved by probably 90%. One the flip side, areas where I am chalenged with the decision to treat one or the other is in the treatment of Atopic eczema, when the patient also has allergic asthma. Do I try to focus on both? Do I pick one over the other in dependence on severity? Or do I just let the patient decide which one to focus on? I have tried all three and have been challenged with all three at different times. My derm teacher Mazin Al Khafaji shared with me that he used to try and treat both at the same time, but now tends to focus on one at a time. This is based on his 20 years or so experience and he does have a long history of success under his belt. It is obvious that different diseases have different sets of patterns attributed to them, ie we cannot really say that eczema is due to hidden phlegm in the lungs. If the treatment of eczema demands the use of an already large formula, does it makes sense to add another bunch of medicinals to clear out the hidden phlegm and stop wheezing?? If we only have a short time with a patient to make change, I do feel it is good to be really clear with them about what it is we are trying to achieve and the changes we expect to see. I feel it is important to educate the patient that, yes, CM can help them with their multitude of disorders, but that sometimes we need to focus on one first and then focus on the other. If we can combine treatments then great, but at least the patient should understand the changes that may happen and within what type of time frame. It is not really fair to say, look your asthma is better when they came for help with their eczema. Unless we can say, the progress we have made with your asthma is a steping stone towards helping your eczema, and the patient is happy and understanding of this approach. Anyways, I think the issue is dependent on the individual. Sometimes the patterns of multiple disease categories combine well and sometimes they do not. Trevor , <zrosenbe wrote: > > Tom, Jason, > My experience is that it depends on how chronic the problem being > treated is. For example an entrenched disorder such as lupus after > several years effects several organ systems, creating multiple pattern > disorders. While sometimes using a focused, SHL-style prescription to > mobilize the system will work ( such as using si ni san for a > difficult urinary tract disorder) to shake up the decks, my experience > is that a larger, more complex prescription is usually necessary. > It was an interesting weekend of discussions at the Pacific > Symposium. On one hand, you had Dan Bensky discussing the broad use > of Shang Han Lun formulas, on the other hand, a private discussion > with Michael Broffman about Dr. John Day, the Chinese herbalist who > worked in Eastern Oregon 100 years ago and used prescriptions with up > to 120 ingredients for the epidemic of 1911. . . > > > On Nov 12, 2007, at 8:41 AM, Tom Verhaeghe wrote: > > > Jason, > > > > if I understand you well you are (also) referring to trying to treat > > everything together (all the complaints a patient has) as opposed to > > treating the specific complaint. > > > > I believe I read an article by Peter Deadman in the latest JCM that > > advocated the latter: do not try to treat every complaint but tackle > > them one at a time. > > > > And there are other practitioners that prescribe large formulas (a > > little for this and a little for that, as you say) and also get > > results. > > > > So this may have to do with one's personal beliefs and insights. > > People from the SHL camp or the one needle treatments will love their > > elegant treatment (who wouldn't?) and people from the other camp may > > argue they are being more realistic. Personally I do not have enough > > experience to choose sides here, so my answer would have to be: 'de > > gustibus et coloribus non discutandum est.' > > > > > I think all of this rests on what the patient actually wants and > > if the > > > practitioner and patient communicate honestly, then there should > > be no > > > issues. It seems only be a concern we suggest we can treat a western > > number > > > (without " proof " ) and then are not clear with the patient. > > > > If people communicate to their patients that they may be able to treat > > their acid reflux, or depression, or chronic fatigue by balancing LIV > > and SP than that is what they believe. > > > > I agree that some practitioners may diagnose LIV/SP disharmony all the > > time. or KID yin insufficiency (I know for a fact that LWDHW is the > > most often prescribed formula in Belgium), appropriate or not. I do > > think that often has to do with incorrect diagnosis. But I can't say I > > have heard many practitioners say " just treat this pattern and > > everything will get better. " That would be a false assumption and, I > > agree, ethically slippery. > > > > Tom. > > > Chair, Department of Herbal Medicine > Pacific College of Oriental Medicine > San Diego, Ca. 92122 Quote Link to comment Share on other sites More sharing options...
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