RE: Flexibiltiy in medicine

[Guest guest]

Yes climate is an important component to many of these styles (previously

mentioned). As Greg and I have been discussing a bit privately, Boulder is a

difficult place to get certain styles of practice to work, like SHL.

 

 

 

Sometimes we hear lectures say that one style, e.g. SHL, can treat

everything, but I really have a hard time believing this based on climate

and also clinical experience and the numerous practitioners that have tried

in various climates. Wen Bing developed for a reason! I would like to hear

though from others who feel the contrary, especially ones from Boulder or

similar climate.

 

 

 

Of course there are lectures like Huang Huang who really just do one thing

(SHL). Some part of me admires this, but I wonder if sometimes one is just

fitting a square peg into a round whole, where there clearly might be a more

simple approach from another school of thought. I once heard a SHL

practitioner say mockingly that yin qiao san was a " good formula " , but they

had never seen an opportunity for it to be used. Hhhmm. I always found this

a statement strange.

 

 

 

Also I feel sometimes such lectures might be invested in a certain style

because their livelihood is wrapped up in the approach. Observing what

people who are fundamentally clinicians does bypass this issue. Hence

clinical results speak louder than theory.

 

 

 

I do agree with Z'ev though that focusing on one style can give a depth, but

I also see no reason one cannot get equal, and maybe even more, depth by

studying multiple schools of thought. Really, study is about understanding

disease and the human body, not memorizing every line of a single text.

Granted one might not know the deep intricacies of e.g. a single style with

a more eclectic approach, but one will IMHO, ultimately have a far more

versatile clinical choices and deeper understanding of disease process.

Really depth comes down (at least for me) in how do we help the patient the

best.

 

 

 

There are some very smart doctors that have come before us that have cherry

picked the essence of the greatest ideas in history, this is precisely why I

like to study eclectic doctors. Some have spent their lifetime pouring

through more classical texts than I could dream of working through, and

figuring out how to use such ideas in the clinic. These scholar doctors are

a great inspiration to me.

 

 

 

But I also like Z'ev's comment about taking the principles of SHL and

applying them to climate etc. Essentially that is what wenbing school did,

and then of course, took the medicine to a whole other level. But a large

portion of medicine is still rooted in NeiJing / SHL. Understanding these

fundamental ideas one can't go wrong. I just worry that some people get

wrapped up in the hype of a single system and at possible harm to their

patients, neglect all the other wisdom that CM has accumulated over the last

2000+ years.

 

 

 

Comments?

 

 

 

-

 

 

 

 

On Behalf Of Greg A. Livingston

Tuesday, April 14, 2009 9:34 AM

 

Re: Dose of herbs prescribed to Westerner in Beijing

 

 

 

 

 

 

 

 

Hi Daniel, Jason, et al,

 

I've just recently joined CHA, and have been following this thread with

interest. Daniel, you mention the " fire god school " , and I've recently been

reading a book on the subject

( & #24352; & #23384; & #24716; & #12298; & #20013; & #21307; & #28779; & #31070; & #27966; & #2

5506; & #35752; & #12299;). As you mentioned, some people in this line use huge

doses of hot and spicy herbs like fuzi, ganjiang, rougui, etc., supposedly

with good results. In fact, there are some case studies in the book where

people's lives are saved by this method. On the other hand, as Jason

mentioned, our main teacher here in Hangzhou gets very good results with

small formulas, and talks about cases where Qin Bowei and other teachers of

his saved people's lives with small formulas.

 

I think this shows that there is clearly no one " correct " methodology to

which one should dogmatically adhere. While I tend to think that there is

theoretically one " best " treatment for each patient (but figuring that out

is the trick!), there are probably many different treatments that can help

each patient. Obviously, we should strive to get as close to that " best "

treatment as we can, but I think this requires a very flexible and

open-minded approach.

 

Furthermore, Chinese medicine always has to consider the time, location, and

individual in treatment. Fire God School originated in Chengdu, Sichuan,

which is one of the dampest, cloudiest, least sunny areas of China, and

where the people are constitutionally quite tough, and where some people

actually take fuzi as food. I've never tried to dose fuzi anywhere near as

high as these guys, so I can't say from experience, but I imagine if you

take this method to say, where Jason lives, Boulder, Co, where it is super

dry, super sunny, and people have never taken a Chinese herb in their life,

let alone fuzi, and they have wimpier constitutions than the average Sichuan

nongmin(farmer), the results may be less than desirable.

 

Same with the Jiangnan region of China (Jiangsu, Shanghai, Zhejiang), where

the Menghe docs are from, and where the " Shanghai School " Daniel mentioned

is from. The people here are not as tough as in Sichuan, the climate is damp

in summer, but winter is actually quite dry, they don't eat spicy food, and

certainly don't take fuzi as a food. Because of this, some docs here

developed a more " gentle " style, and they get good results with it here.

Maybe if they tried this method in Chegdu the results would be

dissapointing.

 

So, I think we should be careful not to latch on to one style and attempt to

force it to work with our patients. One must be much more thoughtful than

this, considering the constitution of the patient, the season, the weather,

etc., and then with careful observation over time figure out what works with

the people where you are at different times of the year.

 

I think this is an extremely important point, especially now that it seems

everyone in the west is getting so excited about studying Shang Han and Jin

Gui (I love these books too, and my PhD is centered around them). Jason

mentioned that his friend Chip Chase in Boulder, who is highly regarded by

many and has been in practice for many years, has been unable to make

certain Shanghan formulas work well in Boulder. Yet he gets good results

with other methods (I'm not saying he doesn't use any Shanghan/Jin Gui

stuff). If one gets over enthusiastic about a particular style, becomes

dogmatic about it, and tries to force it to work (I've recently heard of

people who after taking a Shanghan seminar decide they will only use

Shanghan/Jingui formulas), at best it will be effective some of the time, at

worst it may harm patients. IMHO, what is required is a more flexible,

thoughtful, and careful approach, that is refined over time to meet the

needs of our respective patients, location, weather, and season.

 

I'm tempted to go to Chengdu to study with a Fire God doctor, learn how to

use 200g of fuzi in one day (one case study the doc uses 500g per day!!),

and maybe even one day have the guts to try it out if the situation presents

itself. But I also like to study with my teacher here, using 0.5g of Wu Zhu

Yu per day, or 3g of Da Huang Tan per day. Then it's a matter of flexibly

drawing from your knowledge and applying what you think is most appropriate

for each patient during each season, etc.

 

Finally, just as an example, in my practice here in Hangzhou where the

weather is extreme and particularly in winter when it is quite cold and

there is no insulation in the housing here, I can get away with using fuzi,

ganjiang, rougui, etc. In the summer it is hot and humid, often over 100

degrees, and entirely different herbs are required. I also treat Chinese and

western patients differently. Westerners love cold drinks and raw food, and

Chinese never touch them. Westerners eat more rich food, such as meat and

dairy, and often less vegetables than Chinese. Westerners from northern

climates don't sweat as easily as local Chinese. etc, etc.

 

So, I think flexible is the key word. That said, I myself do tend to think

that small doses are preferable, just because I think that the job should be

done with the minimal amount of intervention possible. Figuring out that

minimum is the trick. However, regarding the common practice of large

formulas and heavy doses that I personally have seen a lot of in China, I

think a lot of it (not all of it) is the doctors and clinics/hospitals

trying to make money, and has nothing to do with the best interests of the

patients.

 

Respectfully,

 

Greg Livingston

 

 

 

 

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[Guest guest]

I don't think we are even at that point in our profession, Jason. Few

practitioners or students have even been exposed to essential SHL, Jin

Gui OR Wen Bing studies. The jingfang/SHL movement is still a tiny

blip on the radar.

 

 

On Apr 14, 2009, at 4:49 AM, wrote:

 

> But I also like Z'ev's comment about taking the principles of SHL and

> applying them to climate etc. Essentially that is what wenbing

> school did,

> and then of course, took the medicine to a whole other level. But a

> large

> portion of medicine is still rooted in NeiJing / SHL. Understanding

> these

> fundamental ideas one can't go wrong. I just worry that some people

> get

> wrapped up in the hype of a single system and at possible harm to

> their

> patients, neglect all the other wisdom that CM has accumulated over

> the last

> 2000+ years.

>

> Comments?

>

> -

 

 

Chair, Department of Herbal Medicine

Pacific College of Oriental Medicine

San Diego, Ca. 92122