Detoxing in TCM -- does it exist?

[Guest guest]

Definitely

 

Z'ev

On Jun 19, 2009, at 10:48 AM, Alon Marcus wrote:

 

>

>

> Zev

> its not diff then LAcs giving yin qiao to anyone with a cold or flu.

> Bad practice is just that

>

>

>

>

>

>

>

>

>

[Guest guest]

Or as Li Dong-yuan said, " draining vacuity or supplementing repletion

is death at the hands of the physician " .

 

 

 

On Jun 19, 2009, at 9:14 AM, stephen woodley wrote:

 

> One of the consistent symptoms that is highly touted for the

> " need " to be detoxed is - Fatigue/malaise

> to me, this represents Qi Xu!! To use attacking purgation to

> treat deficiency/vacuity would place one with the practitioners

> that Zhang Zhong Jing so strongly attacked in his preface to SHL

> and then spent 1/2 the book trying to fix from wrong purgation

> (and those were repletion patterns treated incorrectly!!!) a

> Kokko reminds us...

 

 

Chair, Department of Herbal Medicine

Pacific College of Oriental Medicine

San Diego, Ca. 92122

 

 

 

 

 

 

 

[Guest guest]

OK, Z'ev,

 

I responded to your " one size fits all " commentary. My experience of the

naturopathic approaches is that they have a good deal of specificity when it

comes to detox, in terms of both location and process. It appears that you have

similar experience.

 

It doesn't seem to me that the dualism between east and west is as great as

people make it out, especially in early practice. For me, the dualism does arise

with imperial knowledge building systems post enlightenment. The advent of

mechanistic metaphor in the post industrial era furthered the separation of body

and mind, east and west.

 

I disagree with your assessment that Galenic/Hippocratic methods are " largely

folk medicine-based, without the rational structure. " They may have been in the

European folk redux. The Galenic/Hippocratic method were heavily influenced by

Asian systems of thought. Further, the Stoics who also influenced Hellenic

medical models had well developed models for humeral assessment. The pulse

methods, while temporally focused were also presented in depth.

 

Consider the Corpus Hippocraticum, a pleural body of works consisting of some 70

works. Similar to the Huang Di Nei Jing and the Nan Jing authorship, It is

debatable as to whether any were actually written by Hippocrates. Based upon

style and paleography, it appears that the corpus was produced by a variety of

authors between the 4th and 5th centuries.

 

Similar to the Huang Di Nei Jing, the Corpus Hippocraticum uses natural science

in the attempt to explain disease processes and without resort to evil spirits.

The diseases discussed in the Corpus are the result of natural events such as

the food one has eaten or the weather. Causes of disease for the Hippocratic

practitioner also involved malfunction of the veins leading to the brain.

 

Alcmaeon, in the fifth century BC, maintained that health consists of balanced

bodily elements. In the fourth century BC, cults entered Greece and with them,

the early roots of psychiatric practices involving the dreams and the use of

psychotropics by the cult of Aesclepious. Eventually, the theory of disease

contained in the Corpus came to predominate. By the time of Hippocrates it was

accepted that there were four elements, earth, air, fire, and water with their

corresponding qualities, coldness, dryness, heat, and wetness. If present in the

human body in the right amounts in the right places health resulted, but if

equilibrium was destroyed then so too was health.

 

Professional term sets were developed to describe pathological conditions, for

example, an excess of earth, produced an excess of black bile, while too much

water made one phlegmatic.

 

I do continue to agree with you about the perils of indiscriminate cleansing. As

for your patient who developed pancreatitis, it is possible that she had

exposure to infectious agents, autoimmune processes and any number of other

concerns. Regarding the rhubarb, I suppose that could contribute, however, Da

Chai Hu Tang is a consideration for treatment of the condition.

 

Warmly,

 

Will

 

 

, <zrosenbe wrote:

>

> Will,

> Your assumption is incorrect. There was another thread where

> Eclectic medicine was discussed in terms of pattern differentiation,

> and my appraisal was mainly positive.

>

> My original training was at a small naturopathic school (Dr. Jay

> Scherer) in Santa Fe in the early 70's, with teachers such as Michael

> Moore, the great herbalist, and both in school and out of school I

> researched the Eclectic and Native American/Southwestern traditions of

> herbal medicine, including Curanderismo, Zuni, Navajo (Yeibechei) and

> Hopi traditions of healing. There were various diagnostic and

> treatment approaches used (hot and cold herbs, hot and cold, weak and

> strong constitutions, etc.). Sadly, in the case of the apprentice-

> based systems of Native America and Mexico, much of this wisdom was

> lost.

>

> This is one of the advantages of Chinese, Tibetan and Ayurvedic

> medicine(s). They are literate rational systems, recorded in

> centuries of texts, with a continuation of teaching the essential

> materials. The West largely abandoned the literate/rational system of

> Galenic/Hippocratic medicine, and what we call 'European medicine'

> today is largely folk medicine-based, without the rational structure.

>

> Even in China, we need to distinguish between the rational Chinese

> medical system and folk medicine approaches. There have always been

> professional and lay levels of practice in medicine and healing, and

> the same applies to the topic at hand. Multi-level marketing of bowel

> and liver cleansing regimes is largely folk medicine at best, and has

> more consequences if promoted without discrimination.

>

> I had a patient last year who I was treating largely for anxiety

> based issues ( I don't have her chart handy, so I can't give all the

> diagnostic data I collected). I asked her for all medications and

> treatments she had taken recently. I gave her a Chinese herb formula.

> After a month or so, she developed sharp stomach pains, went to the

> hospital and was diagnosed with mild pancreatitis. I had a strong

> feeling that it wasn't the herb formula I prescribed, so I asked her

> again if she was taking anything else. As it turns out, she was using

> a strong bowel cleanser daily for months that she bought on-line from

> a web site daily, with rhubarb as a main ingredient. Combining with

> other herbs was as bad an idea as taking the bowel formula in the

> first place. . .

>

>

> On Jun 18, 2009, at 4:02 AM, Will Morris wrote:

>

> > It appears that you have an assumption that the European and Native

> > American traditions - from which these early eclectics find roots -

> > have no specificity. Further, I have seen Chinese be specific and

> > general in their practice of eliminating evil. It depends on how

> > well they localize the pathogen, if the pathogen is not systemic.

>

>

> Chair, Department of Herbal Medicine

> Pacific College of Oriental Medicine

> San Diego, Ca. 92122

 

[Guest guest]

Will,

I don't understand why you keep misreading my posts. I never said

that Galenic/Hippocratic methods were folk-based. I said that

unfortunately that Galenic/Hippocratic methods didn't survive intact,

and that European folk medicine lost contact with its roots in that

noble tradition, a true rational medical tradition.

 

 

 

On Jun 20, 2009, at 4:17 AM, Will Morris wrote:

 

> I disagree with your assessment that Galenic/Hippocratic methods are

> " largely folk medicine-based, without the rational structure. " They

> may have been in the European folk redux. The Galenic/Hippocratic

> method were heavily influenced by Asian systems of thought. Further,

> the Stoics who also influenced Hellenic medical models had well

> developed models for humeral assessment. The pulse methods, while

> temporally focused were also presented in depth.

 

 

Chair, Department of Herbal Medicine

Pacific College of Oriental Medicine

San Diego, Ca. 92122

 

 

 

 

 

 

 

[Guest guest]

What is the source for saying:

 

" The Galenic/Hippocratic method were heavily influenced by Asian systems of

thought. "

 

That would be a fascinating topic of discussion.

 

In my simple study of Classical Western Medicine, I've not come across any solid

references for this kind of influence. Galen, who lived in the cosmopolitan

Roman world would surely have had some kind of exposure to Asian traditions, but

'heavily....'? Sushruta Samhita of Ayurveda introduces a 4-humour system that

is similar to the Galenics (adding blood to the three doshas- which is akin to

the sanguine humour), but their elemental correspondences do have differences.

 

Then there is Hippocrates, who lived pre-Alexander (who definitely bridged at

least Persia and India with the West), his influence of the East seems even

further. Was there even much trade (that we know about) with the West in the

Warring States times? Surely wandering ascetics and immortals who aren't bound

by time and space can communicate without limitation, but as far as a tracable

historical influence...

 

Anyways, surely later on in the medieval and later times, there was much

exchange of information on both sided of the silk road. Have you all seen

references to Chinese medical theory or therapies being used in the West-

Europe, Islamic empires, etc?

[Guest guest]

Also... sometimes it's just easier to tell the patient what they want to hear.

It's popular for the demographic of (our) typical patients to seek detoxing. If

you can blame a toxin, beats the pants off of taking responsibility. I don't

know how ethical issues tie into this (and I don't loose any sleep worrying

about it), but if you try to convince certain patients that they don't need to

be detoxed, then you just end up with a still-sick, pissed off patient with

bad-will towards you (and one mad patient tells ten others, one happy one tells

one other), and terminated treatment. As long as you do your treatment, give

them the herbs and life-style advice, seems like there's no harm in indulging

the patients need to blame the bugs.

 

Geoff

 

 

, " "

wrote:

>

> Again, we can't get over what is meant by " detox " .

[Guest guest]

Geoff, I agree with you.

 

I think that this is roughly the equivalent of treating biomedically

diseases. For instance, we can treat diabetes as an upper, middle, or lower

jiao yin deficiency, or qi level dampness, or stomach fire, etc... so the

diagnosis becomes " diabetes due to Stomach fire. " Formulas such as Qing Wei

San can be used.

 

Why not apply that to self-diagnosed fad diseases? Parasites due to Stomach

fire? Use Qing Wei San!

 

On Mon, Jul 6, 2009 at 11:19 AM, G Hudson <ozark.canuck wrote:

 

>

>

> Also... sometimes it's just easier to tell the patient what they want to

> hear. It's popular for the demographic of (our) typical patients to seek

> detoxing. If you can blame a toxin, beats the pants off of taking

> responsibility. I don't know how ethical issues tie into this (and I don't

> loose any sleep worrying about it), but if you try to convince certain

> patients that they don't need to be detoxed, then you just end up with a

> still-sick, pissed off patient with bad-will towards you (and one mad

> patient tells ten others, one happy one tells one other), and terminated

> treatment. As long as you do your treatment, give them the herbs and

> life-style advice, seems like there's no harm in indulging the patients need

> to blame the bugs.

>

> Geoff

>

 

 

 

--

, DAOM

Pain is inevitable, suffering is optional.

 

 

 

[Guest guest]

What if there is no disease state to treat?

 

What if a person's desire to 'detox' is based on hearsay?

 

Do you then treat them?

 

This to me would be dishonest at best. . . supporting a delusion,

whether the patient's own or implied by another health professional.

 

 

 

On Jul 6, 2009, at 11:28 AM, Al Stone wrote:

 

>

>

> Geoff, I agree with you.

>

> I think that this is roughly the equivalent of treating biomedically

> diseases. For instance, we can treat diabetes as an upper, middle,

> or lower

> jiao yin deficiency, or qi level dampness, or stomach fire, etc...

> so the

> diagnosis becomes " diabetes due to Stomach fire. " Formulas such as

> Qing Wei

> San can be used.

>

> Why not apply that to self-diagnosed fad diseases? Parasites due to

> Stomach

> fire? Use Qing Wei San!

>

> On Mon, Jul 6, 2009 at 11:19 AM, G Hudson <ozark.canuck

> wrote:

>

> >

> >

> > Also... sometimes it's just easier to tell the patient what they

> want to

> > hear. It's popular for the demographic of (our) typical patients

> to seek

> > detoxing. If you can blame a toxin, beats the pants off of taking

> > responsibility. I don't know how ethical issues tie into this (and

> I don't

> > loose any sleep worrying about it), but if you try to convince

> certain

> > patients that they don't need to be detoxed, then you just end up

> with a

> > still-sick, pissed off patient with bad-will towards you (and one

> mad

> > patient tells ten others, one happy one tells one other), and

> terminated

> > treatment. As long as you do your treatment, give them the herbs and

> > life-style advice, seems like there's no harm in indulging the

> patients need

> > to blame the bugs.

> >

> > Geoff

> >

>

> --

> , DAOM

> Pain is inevitable, suffering is optional.

>

>

[Guest guest]

On Mon, Jul 6, 2009 at 11:35 AM, <zrosenbe wrote:

 

>

> This to me would be dishonest at best. . . supporting a delusion,

> whether the patient's own or implied by another health professional.

>

>

>

 

 

 

 

 

 

 

 

We all support each other's delusions, depending on how you want to define

reality.

 

There are oodles of patients who are out there taking stuff that isn't good

for them in the name of maintaining their medical worldview. When I attempt

to change that worldview and it is successful, it's a win-win. However it

can be very difficult to get patients to recognize the difference between a

pathology that is in their thoughts and a problem that is presenting in

their signs and symptoms. In such a case, it is still incumbent on me to do

no harm. So, I still treat what I see, even when it doesn't come from the

anti-parasite chapter of a CM book.

 

I admit that it isn't as honest as sending them away saying that I won't

treat their self-diagnosis or Western disease. But at least they get what (I

believe) they need.

 

I'm sure that you don't see a legitimate Western diagnosis as a delusion,

but naturally you treat what you see from within CM principles, right? Does

it make you a liar if you try and speak their (biomedical) language?

 

-al.

 

--

, DAOM

Pain is inevitable, suffering is optional.

 

 

 

[Guest guest]

Al,

I don't think the goal of medicine is to support delusion, quite

frankly. I think it is to help the patient see more clearly what

their situation is, and how to improve it.

 

If they have a clear diagnosis, whether biomedical or naturopathic

of parasites, they need to get treated, whether by other professionals

or by us. If they've read something in a book or was sold a MLM detox

kit, or was told by an amateur without professional skills that they

had a 'toxic liver', I feel no need to support that whatsoever.

 

I don't think we need to turn people away. We reframe what is

going on, whether a biomedical diagnosis or self-perception, or

something someone read in a book.

 

 

 

On Jul 6, 2009, at 12:10 PM, Al Stone wrote:

 

>

>

> We all support each other's delusions, depending on how you want to

> define

> reality.

>

> There are oodles of patients who are out there taking stuff that

> isn't good

> for them in the name of maintaining their medical worldview. When I

> attempt

> to change that worldview and it is successful, it's a win-win.

> However it

> can be very difficult to get patients to recognize the difference

> between a

> pathology that is in their thoughts and a problem that is presenting

> in

> their signs and symptoms. In such a case, it is still incumbent on

> me to do

> no harm. So, I still treat what I see, even when it doesn't come

> from the

> anti-parasite chapter of a CM book.

>

> I admit that it isn't as honest as sending them away saying that I

> won't

> treat their self-diagnosis or Western disease. But at least they get

> what (I

> believe) they need.

>

> I'm sure that you don't see a legitimate Western diagnosis as a

> delusion,

> but naturally you treat what you see from within CM principles,

> right? Does

> it make you a liar if you try and speak their (biomedical) language?

>

> -al.

>

> --

> , DAOM

> Pain is inevitable, suffering is optional.

>

>

[Guest guest]

Can we say both Al and Z'ev are saying we need as CM practitioners to re-frame

the paradigm presented by the patient. I would add that as CM practitioners we

can also up the ante by saying that each patient is special and in Your case

what you call parasites (candida,toxicity etc...) shows Spleen Qi deficiency

(Stomach heat etc...).

Doug

 

 

 

, <zrosenbe wrote:

>

> Al,

> I don't think the goal of medicine is to support delusion, quite

> frankly. I think it is to help the patient see more clearly what

> their situation is, and how to improve it.

>

> If they have a clear diagnosis, whether biomedical or naturopathic

> of parasites, they need to get treated, whether by other professionals

> or by us. If they've read something in a book or was sold a MLM detox

> kit, or was told by an amateur without professional skills that they

> had a 'toxic liver', I feel no need to support that whatsoever.

>

> I don't think we need to turn people away. We reframe what is

> going on, whether a biomedical diagnosis or self-perception, or

> something someone read in a book.

>

>

>

> On Jul 6, 2009, at 12:10 PM, Al Stone wrote:

>

> >

> >

> > We all support each other's delusions, depending on how you want to

> > define

> > reality.

> >

> > There are oodles of patients who are out there taking stuff that

> > isn't good

> > for them in the name of maintaining their medical worldview. When I

> > attempt

> > to change that worldview and it is successful, it's a win-win.

> > However it

> > can be very difficult to get patients to recognize the difference

> > between a

> > pathology that is in their thoughts and a problem that is presenting

> > in

> > their signs and symptoms. In such a case, it is still incumbent on

> > me to do

> > no harm. So, I still treat what I see, even when it doesn't come

> > from the

> > anti-parasite chapter of a CM book.

> >

> > I admit that it isn't as honest as sending them away saying that I

> > won't

> > treat their self-diagnosis or Western disease. But at least they get

> > what (I

> > believe) they need.

> >

> > I'm sure that you don't see a legitimate Western diagnosis as a

> > delusion,

> > but naturally you treat what you see from within CM principles,

> > right? Does

> > it make you a liar if you try and speak their (biomedical) language?

> >

> > -al.

> >

> > --

> > , DAOM

> > Pain is inevitable, suffering is optional.

> >

> >

[Guest guest]

Z'ev,

 

Excellent. I totally agree. As you know, the word " doctor " comes from the Latin

docere, to teach. If the doctor isn't first and foremost a teacher, I think they

are selling their patients short.

[Guest guest]

If the patient is balanced and healthy, I don't often find that they would be

obsessing about being 'full of toxins'. I was trying to illustrate that this is

my strategy only for those patients who are 110% invested in being 'full of

toxins'. You may be able to finally convince them that their hours of their

'exhaustive' internet chat room forum research was baloney, but I just don't

have the will / Qi to bother **in this group of patients**. For other patients

who *think* they need detox, that's a totally different matter, and 'doctoring'

the patient is absolutely on the mark.

 

All that to say, the patients coming in may not agree with what you think is

their main problem, and that may or may not have bearing on the outcome of the

treatment. If the patient feels better, then is your responsibility

accomplished? If you try to argue with the patient they are not right about

their problem, are you going to win and then accomplish your responsibility?

 

In the not-so-distant past, the western profession would give patients sugar

pills for various 'neurotic' conditions and often give good results (I think the

placebo research said 70% effective). The ethics people then took charge of the

profession and said that wasn't ethical, now they get medications with side

effects and the Hippocratic folks are in the dust.

 

Geoff

 

 

, <zrosenbe wrote:

>

> What if there is no disease state to treat?

>

> What if a person's desire to 'detox' is based on hearsay?

>

> Do you then treat them?

>

> This to me would be dishonest at best. . . supporting a delusion,

> whether the patient's own or implied by another health professional.

>

>

>

> On Jul 6, 2009, at 11:28 AM, Al Stone wrote:

>

[Guest guest]

Geoff,

I don't concur with your analysis or your analogies. No one is

saying that we should tell a patient that they are 'full of baloney'.

It is more of a gentle reframing, giving patients a clearer mirror

than a website in the form of a real human being who cares about their

well being.

 

A patient has free will, as we all do, to accept our advice or

not. But I think you underestimate the power of fear, which can come

from lack of information or slanted media. I just had a patient, a

hairdresser, who developed stomach area pain after a trip to Mexico,

and was convinced that it was helicobacter pylorii, and that it could

become stomach cancer, after one of her hair clients mentioned it. It

was simply a pulled muscle in her upper abdomen from scuba diving,

along with a bout of diarrhea.

 

Of course the placebo effect is a large part of medicine. But it

is a red herring to use that in our discussion, no one is suggesting

we should 'ban' the placebo effect and give powerful drugs with toxic

side effects.

 

 

 

 

 

On Jul 10, 2009, at 11:01 AM, G Hudson wrote:

 

>

>

> If the patient is balanced and healthy, I don't often find that they

> would be obsessing about being 'full of toxins'. I was trying to

> illustrate that this is my strategy only for those patients who are

> 110% invested in being 'full of toxins'. You may be able to finally

> convince them that their hours of their 'exhaustive' internet chat

> room forum research was baloney, but I just don't have the will / Qi

> to bother **in this group of patients**. For other patients who

> *think* they need detox, that's a totally different matter, and

> 'doctoring' the patient is absolutely on the mark.

>

> All that to say, the patients coming in may not agree with what you

> think is their main problem, and that may or may not have bearing on

> the outcome of the treatment. If the patient feels better, then is

> your responsibility accomplished? If you try to argue with the

> patient they are not right about their problem, are you going to win

> and then accomplish your responsibility?

>

> In the not-so-distant past, the western profession would give

> patients sugar pills for various 'neurotic' conditions and often

> give good results (I think the placebo research said 70% effective).

> The ethics people then took charge of the profession and said that

> wasn't ethical, now they get medications with side effects and the

> Hippocratic folks are in the dust.

>

> Geoff

>

> ,

> <zrosenbe wrote:

> >

> > What if there is no disease state to treat?

> >

> > What if a person's desire to 'detox' is based on hearsay?

> >

> > Do you then treat them?

> >

> > This to me would be dishonest at best. . . supporting a delusion,

> > whether the patient's own or implied by another health professional.

> >

> >

> >

> > On Jul 6, 2009, at 11:28 AM, Al Stone wrote:

> >

>

>

>

 

 

Chair, Department of Herbal Medicine

Pacific College of Oriental Medicine

San Diego, Ca. 92122