Guest guest Posted March 21, 2010 Report Share Posted March 21, 2010 Jason, Stephen, I wanted to remark first of all that I am impressed at the increased sophistication on CHA in recent months, the in-depth discussions and debates have been of great interest to me. I agree that there are different currents in Chinese internal medicine. Most of us are familiar with the Zhang Jin current, much fewer with the Suzhou current, which was solidly based in classical medicine, but highly eclectic. Ding Gan-ren was a great synthesizer, combining warm disease and cold damage currents, along with influences from such physicians as Li Dong-yuan and his spleen-stomach approach. I've looked over the case histories you've submitted (thank you so much Jason), and I must say that I have a difficult time following Ding Gan-ren's clinical reasoning in choosing his variation of gui zhi tang with the amount of clinical information that is there. I'll look over your other case histories this evening. It is a much more 'creative' method than the more 'conservative' Shang Han Lun approach. However, my opinion is that one has to have a great deal of study of classical texts to practice methods such as Ding Gan-ren's. If one reads Volker Scheid's text " Currents of Tradition " , he talks about how physicians such as Ding and more modern physicians such as Chen Meng-xue were deeply versed in such classics as the Jin gui yao lue and the Mai jing, among others. It is this steeping in the classics that allowed them to be 'creative' in their prescriptions. I thought a quote from Wu Ju-tong, the great warm disease current physician, would be useful at this point. I am using a translation from my colleague Yaron Seidman: " Master Ye Tianshi’s book is very difficult to understand. His book uses classical views the most, so the reader does not know where Ye is coming from and what are his profound ideas. If you are not well versed with the yellow emperor and the golden chamber (of Zhang Zhongjing) you cannot use this knowledge. " " Other then these few examples (he gives examples of post-partum disease or high fever), diseases are all Yang injuries (cold injuries like in the Shan Hanlun). Today’s practitioners always want to tonify the Yin. They use cool and cold herbs to do that. The injuries to the Yang are extreme. The ancient sages said: “If the Yang is not exhausted you cannot die” as well as “If a person doesn’t have Yang energy he can’t live”. Testimony to that you can see in that after a person dies his muscles and flesh are not missing even one ounce. Even though his Yin is full, it does not help him live at all. From all throughout the ages there is no one like Zhang Zhongjing who knows how to tonify deficiencies. This is a very interesting quote, considering that the warm disease current was considered to be a revolutionary approach to medicine in its time, and Wu Ju-tong was the architect of such famous formulas as yin qiao san and sang ju yin! (I translated an article by him on how to use gui zhi tang in warm disease several years ago). I agree that formula approaches such as those of Ye Tian-shi and Deng Gan-ren's are very sophisticated and deserve our respect. I tip my hat to those practitioners who are schooled in this approach to herbal medicine. But at this point of my practice in Chinese medicine, I put my trust in classical formulas with minimal modification, as I do not feel anywhere near Zhang Ji's level of practice (or that of Li Dong-yuan, Wu Ju-tong, or anyone of that elevated status). There is also a tremendous basis of evidence on use of classical formulas, whereas using prescriptions such as those of Ye Tian-shi's are very personal, and at least in the bits of his case history text I've seen, not well documented as to his methodology. More later, On Mar 21, 2010, at 3:01 PM, wrote: > Stephen, > > I'm not at all suggesting that you have to grow into this style that I > present. You're missing the point. I am merely presenting a different point > of view. Obviously, there are many lineages in SHL tradition and there are > more points of view then you can shake a stick at. > > But you so boldly start off your e-mail with " the formula you posted is not > a SHL formula " - actually there is no debate, they tell us it is a Shang Han > formula. It is in the Shang Han chapter and labeled gui zhi tang. You > though, instead of trying to understand why, are dismissing it, calling it a > warm disease formula. As stated before, you have a choice, you can try to > understand their thinking or completely dismiss it. You have opted to > dismiss it (and relabeled it) therefore of course I think that you " do not > understand it. " - Therefore, if you Steven, are only saying that you don't > prefer such a style, then okay. However if you are stating that such a style > is not valid Shang Han (which is how your e-mail read to me), then you have > a hard sell in my opinion. To elaborate... > > Ding Gan-Ren's style is one valid way of approaching the text and clinical > reality. Your disagreement is only based on your predilection towards a more > " traditional " style, and that is fine. I personally have no attachment > either way and try to embrace multiple perspectives, and actually have not > presented anything that is " my opinion " . Consequently, I see no reason to > have a restrictive viewpoint and won't be tied down to only one current of > thought. For example, sometimes I use chi shao instead of bai shao, > sometimes I use both chi shao and bai shao. I also sometimes use an > unmodified gui zhi tang and sometimes I give a 10 ingredients modified gui > zhi tang. I that the patient in front of me dictate how I treat them. > However, if I only have a hammer and every patient will be a nail. > > I have merely presented a very valid and well documented current in Shang > Han though that hopefully can expand the way people view gui zhi tang. > Although I knew people would argue, it always amazes me when this happens. I > personally just don't see any debate, it is what it is. > > Honestly, as much as I respect you as a person, a 15 year-old opinion, that > this is not a Shang Han formula or gui zhi tang method, doesn't remotely > come close to overturning someone like Ding Gan-Ren's opinion, and the > numerous other doctors, that think in this manner. We know you do not > disagree, but you definitely are not respecting his viewpoint when you start > off by saying this is " not a SHL formula. " He is telling you it is! - of > course it is not a unmodified SHL, but then again most Shang Han case > studies (that you read) are modified in ways that are not in the source > text. > > Finally, when we have two completely opposing views where one is restrictive > and the other is open and expansive, we have an interesting phenomenon. > Simply, the expansive view almost always incorporates the restrictive view, > however the restrictive view almost never incorporates the expansive view. > The expansive view allows for many viewpoints and the restrictive view only > sees that their own as valid. > > This is the same problem with orthodox religion. They have their point of > view and everyone else is wrong. It often seems that orthodox SHL > practitioners come off in this manner (this is not geared at any person on > this list, but a general observation). However, I will argue that it will do > us all good to try to see these stranger or less orthodox points of view, > especially when they come from an incredibly respected lineage of doctors. > Such doctors, including myself, are not trying to sell any certain style. No > one is saying this is better than anything else. We are only saying this is > another possible way to approach the Shang Han. How can one argue? > > For those who want to continue taking the ride, I posted two more gui zhi > tang cases using chi shao instead of bai shao. > > Chinese Medicine/case-studies/tai-yang-with-internal-damp-d > gr/ > > Chinese Medicine/case-studies/gui-zhi-tang-with-chi-shao/ > > -Jason > > > On Behalf Of stephen woodley > Sunday, March 21, 2010 9:11 AM > > > > Switch to: Text-Only, Daily Digest • Un • Terms of Use > . > > 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 March 22, 2010 Report Share Posted March 22, 2010 Z'ev, Thanks for the post, I wanted to echo and expand some of your thoughts. I too am impressed with recent CHA discussions and the desire to go deeply into difficult issues and expand our horizons. Our level as a profession in the West has been growing rapidly over the last 10-15 years. I remember when I started school, only a few good books existed, now there are many. However, we still only have access to a very small percentage of texts (probably <1%) as compared to China. We should always keep this in mind and hopefully it will keep us humble so we can continue to learn. Honestly, many people on the CHA have a fairly high level of herbal knowledge for the West, but really this does not compare to the seasons doctors in the East, especially masters like Ding Gan-Ren. I would be surprised if Z'ev (or others) could understand the " clinical reasoning " of this *single* Ding Gan-Ren case that I presented. Actually, one needs to read multiple case studies by the same doctor to start to try to understand his style. This one case is not about anything but " it can be done and is done. " Furthermore, reading case studies takes a special skill and something that many people on this list seem to not really understand how to do (evidenced by their comments). In the next week, I hope to present some translated material on a guide to reading case studies. I am actually surprised that Stephan has seen thousands of these type of Shang Han style formulas/cases. I personally have not. I am curious, where did you see these? Either way, as Z'ev stated, understanding them takes deep thought and dedication. There is no doubt that Ding Gan-Ren presents a more " creative " method as does Ye Tian-Shi, Qin Bo-Wei, and the Fei Family doctors. The treat via treatment principles for the individual presentation. One cannot at all expect to use their formulas for their own case (as is). One must grasp the underlying principles and use the ideas. This takes extensive study, contemplation, and reviewing of many cases. It actually is the complete opposite of many Shang Han approaches, where people like Huang Huang give you clear cut guidelines and formulas to use for specific conditions and patterns/constitutions. You can go out after the seminar and use it on Monday morning. Don't get me wrong, I love Huang Huang and have used much of his material. Z'ev is also correct that these eclectic approaches were heavily rooted in classical studies. They knew these texts inside and out. It is also correct that the warm disease doctors also knew Shang Han inside and out. Just for clarity sake, Wu Ju-Tong's yin qiao san and sang ju yin (and many others) were taken straight from Ye Tian-Shi's cases and " writings " . Hope other people find this material interesting... -Jason On Behalf Of Sunday, March 21, 2010 9:54 PM Cc: Y Seidman Re: Shang Han formula? Jason, Stephen, I wanted to remark first of all that I am impressed at the increased sophistication on CHA in recent months, the in-depth discussions and debates have been of great interest to me. I agree that there are different currents in Chinese internal medicine. Most of us are familiar with the Zhang Jin current, much fewer with the Suzhou current, which was solidly based in classical medicine, but highly eclectic. Ding Gan-ren was a great synthesizer, combining warm disease and cold damage currents, along with influences from such physicians as Li Dong-yuan and his spleen-stomach approach. I've looked over the case histories you've submitted (thank you so much Jason), and I must say that I have a difficult time following Ding Gan-ren's clinical reasoning in choosing his variation of gui zhi tang with the amount of clinical information that is there. I'll look over your other case histories this evening. It is a much more 'creative' method than the more 'conservative' Shang Han Lun approach. However, my opinion is that one has to have a great deal of study of classical texts to practice methods such as Ding Gan-ren's. If one reads Volker Scheid's text " Currents of Tradition " , he talks about how physicians such as Ding and more modern physicians such as Chen Meng-xue were deeply versed in such classics as the Jin gui yao lue and the Mai jing, among others. It is this steeping in the classics that allowed them to be 'creative' in their prescriptions. I thought a quote from Wu Ju-tong, the great warm disease current physician, would be useful at this point. I am using a translation from my colleague Yaron Seidman: " Master Ye Tianshi's book is very difficult to understand. His book uses classical views the most, so the reader does not know where Ye is coming from and what are his profound ideas. If you are not well versed with the yellow emperor and the golden chamber (of Zhang Zhongjing) you cannot use this knowledge. " " Other then these few examples (he gives examples of post-partum disease or high fever), diseases are all Yang injuries (cold injuries like in the Shan Hanlun). Today's practitioners always want to tonify the Yin. They use cool and cold herbs to do that. The injuries to the Yang are extreme. The ancient sages said: " If the Yang is not exhausted you cannot die " as well as " If a person doesn't have Yang energy he can't live " . Testimony to that you can see in that after a person dies his muscles and flesh are not missing even one ounce. Even though his Yin is full, it does not help him live at all. From all throughout the ages there is no one like Zhang Zhongjing who knows how to tonify deficiencies. This is a very interesting quote, considering that the warm disease current was considered to be a revolutionary approach to medicine in its time, and Wu Ju-tong was the architect of such famous formulas as yin qiao san and sang ju yin! (I translated an article by him on how to use gui zhi tang in warm disease several years ago). I agree that formula approaches such as those of Ye Tian-shi and Deng Gan-ren's are very sophisticated and deserve our respect. I tip my hat to those practitioners who are schooled in this approach to herbal medicine. But at this point of my practice in Chinese medicine, I put my trust in classical formulas with minimal modification, as I do not feel anywhere near Zhang Ji's level of practice (or that of Li Dong-yuan, Wu Ju-tong, or anyone of that elevated status). There is also a tremendous basis of evidence on use of classical formulas, whereas using prescriptions such as those of Ye Tian-shi's are very personal, and at least in the bits of his case history text I've seen, not well documented as to his methodology. More later, oo.com/info/terms/ Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 22, 2010 Report Share Posted March 22, 2010 Group, After re-reading my last post I can see how it might sound a bit condescending. I want to clarify. Understanding case studies does take a specific mind-set and practice. In the west few are trained in how to interpret these terse (limited information) cases. Actually we only have a hand full of cases even translated to look at. Consequently it is a bit difficult to understand what these doctors are talking about, at least for me. It does sometimes take deep contemplation to unravel the secrets and a certain methodology to follow to " ask the right questions " can be helpful. NOW, I am not at all inferring that I have this skill or have any greater talent for this subject than anyone else. I just like them and spend time doing reading them. Consequently, because I got the impression some people were having difficulty on how to approach these I wanted to share some material I have found personally useful in understanding these. Of course one can approach these anyway they like, but I have found that certain methods can aid in getting information out of the cases. Actually one of the reasons I started posting cases is so that all levels of practitioners and students can comment on the them and we can together have a discussion unraveling the mysteries of this all so important aspect of transmitting Chinese medicine. Hope no one took personal offense by my previous off-the-cuff response. -Jason Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 22, 2010 Report Share Posted March 22, 2010 Jason, I certainly didn't take your post in any negative way. Au contraire, I think you've pointed out one of the major weaknesses in our continuing study adventures in Chinese medicine. While there is a lot of modern-style research out there, case histories of great teachers, both modern and historical, are greatly lacking. Whether our exposure to these comes as a further development of Chinese language skills or translation of case studies and texts, it is very important that we learn the treatment methods of great practitioners. On Mar 22, 2010, at 1:54 PM, wrote: > Group, > > After re-reading my last post I can see how it might sound a bit > condescending. I want to clarify. > > Understanding case studies does take a specific mind-set and practice. In > the west few are trained in how to interpret these terse (limited > information) cases. Actually we only have a hand full of cases even > translated to look at. Consequently it is a bit difficult to understand what > these doctors are talking about, at least for me. It does sometimes take > deep contemplation to unravel the secrets and a certain methodology to > follow to " ask the right questions " can be helpful. > > NOW, I am not at all inferring that I have this skill or have any greater > talent for this subject than anyone else. I just like them and spend time > doing reading them. Consequently, because I got the impression some people > were having difficulty on how to approach these I wanted to share some > material I have found personally useful in understanding these. Of course > one can approach these anyway they like, but I have found that certain > methods can aid in getting information out of the cases. > > Actually one of the reasons I started posting cases is so that all levels of > practitioners and students can comment on the them and we can together have > a discussion unraveling the mysteries of this all so important aspect of > transmitting Chinese medicine. > > Hope no one took personal offense by my previous off-the-cuff response. > > -Jason > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 22, 2010 Report Share Posted March 22, 2010 Love the quote (actually the analysis too). There's an old Chinese saying that the 'Shang Han Lun saved a lot of people and killed a lot of people'. I remember when I was first starting out on my own and I tried to mimic a great herb teacher we had at NIAOM, Sunny Chu, and I really messed up an AIDS patient for a couple days. She used strategies that seemed to contradict what we learned in school and with wild doses. For example (I know I've wrote this before), where we would use Huang Qi cautiously with high blood pressure patients, she would give doses upwards of 100+gms, and we would use the standard 9-12. IIRC she said anything less than 60gms would raise the blood pressure and more than 100 would lower it. Well, cocky me in the first few months of private practice I had a tough AIDS patient and thought I would be brave and try a 'Dr. Chu' kind of strategy - well, several horrible hours on the toilet for my patient taught me a good early lesson and with my tail between my legs I went back to the basics with minor modifications, just like the book. Geoff , <zrosenbe wrote: > I agree that formula approaches such as those of Ye Tian-shi and Deng Gan-ren's are very sophisticated and deserve our respect. I tip my hat to those practitioners who are schooled in this approach to herbal medicine. But at this point of my practice in Chinese medicine, I put my trust in classical formulas with minimal modification, as I do not feel anywhere near Zhang Ji's level of practice (or that of Li Dong-yuan, Wu Ju-tong, or anyone of that elevated status). Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 22, 2010 Report Share Posted March 22, 2010 Geoff, It is really not your fault. We all learn by trial and errors The bottomline is the cure does not have to be worse the disease. If you had had the opportunity to stick with this Dr or any other superior doctor say for one year or even few months and if he had guided you along with no reservation, .... Sung, Yuk-ming Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 22, 2010 Report Share Posted March 22, 2010 Jason, I adore your idea about sharing your case studies work with us. We all know that to read between lines and appreciate the wonders of other's case studies require a comprehensive knowledge of prescribing formulas by oneself. I guess the best way to unravel such case studies is to focus upon one particular disease. By seeing the formula, we can understand the thoughts of how indvidual TCM doctor treats this disease. Looking forward to your posts. Sung, Yuk-ming Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 22, 2010 Report Share Posted March 22, 2010 I definitely agree that it is important to view multiple case studies from an effective experienced doc for one desease or perhaps several related diseases, in order to understand their thinking. This is one of the advantages of studying in modern TCM hospitals. You don't get to ask much about theory but you do get to see very skilled doctors prescribing for hundreds of only slightly different cases. Sent on the Sprint® Now Network from my BlackBerry® Yuk Ming <sxm2649 Tue, 23 Mar 2010 01:48:34 Re: Shang Han formula? Jason, I adore your idea about sharing your case studies work with us. We all know that to read between lines and appreciate the wonders of other's case studies require a comprehensive knowledge of prescribing formulas by oneself. I guess the best way to unravel such case studies is to focus upon one particular disease. By seeing the formula, we can understand the thoughts of how indvidual TCM doctor treats this disease. Looking forward to your posts. Sung, Yuk-ming Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 23, 2010 Report Share Posted March 23, 2010 Kokko: unless you follow a doctor outside of school for a few years, who sees a lot of patients, it IS difficult to see a lot of prescriptions. Jason: ....many schools do not even do herbs for a good half of the clinic shifts (meaning acupuncture only). Many times the same patient is seen over and over and the formula is not changed. Stephen W: The lack of patient contacts is the biggest weakness of the schools. I agree with John that the use of " BBs " - Teapills at school clinics retards learning. It's hard to learn what is in a formula when you are simply handing over a plastic bottle...even harder to ever think of modification. Stephen B Furthermore, the stock formulas can be quite flexible to use in clinic when you learn, for instance, how ZZJ modified them... If they do not know the " stock " modifications and how they work, then how can they know if they need to use other modification? Stephen W Excellent point - perhaps a further barrier to becoming proficient with herbs is that students are not given enough experience with a clear system, but rather a mixture of too many different approaches. The inconsistency is not conducive to learning. Stephen Woodley LAc www.shanghanlunseminars.com -- http://www.fastmail.fm - Choose from over 50 domains or use your own Quote Link to comment Share on other sites More sharing options...
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