Unproductive questions in TCM

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I've starting re-reading Wicke's first volume of his text.

 

There's a section in chapter 5 called " Common Mistakes in Logic " that I want to

share with you.

 

These are examples of the types of questions that are unproductive in TCM.

 

" What herbal formula would be appropriate for duodenal ulcer? " Duodenal ulcer -

like astham, diabetes, and most Western medical entities - is a manifestation

which can occur with more than one TCM syndrome. While it's true that gastric

and duodenal ulcers frequently will be a manifestation of Stomach Heat (Stomach

Fire Blazing), gastric (in the stomach) and duodenal (first section of small

intestine) ulcers can also occur in Deficiency Cold (not enough Yang)

conditions.

 

You always look at the total picture. In the first part of chapter 5 Wicke gave

a case study of a 31-year-old man who had suffered from a duodenal ulcer for

over a year. " During the past year, he constantly perceived a 'dreadful cold'

sensation trapped in his epigastric region, but otherwise not much pain. He

dressed with several layers of clothing in an attempt to keep warm. He had a

diminsihed appetite, did not eat much, was easily fatigued and unable to work at

manual labor. His stools were loose. On inspection, his tongue coating was

thick, white and slimy. On palpation of the radial pulses at both wrists, his

pulses were slower than normal, and had a bowstring (wiry) quality. "

 

Is this duodenal ulcer a manifestation of Heat or Cold? Obviously Cold. These

are classic symptoms of a Cold disorder, in particular Spleen Yang Deficiency.

" The pattern of Deficiency of Spleen Yang, as defined in TCM, includes the

symptoms of loose stools, poor appetite, a perception of feeling easily chilled,

and chronic fatigue; the physical signs are a weak, slow pulse and a tongue that

is pale and has a thin coating (fur). " Classic symptoms of Spleen Yang

Deficiency.

 

But in this case the man's tongue coating is thick and slimy, and his pulse,

though slow like in Spleen Yang Deficiency, has a bowstring (taut like a violin

string) quality to it. In addition there is that very cold sensation in his

epigastrium. These things are not accounted for by the diagnosis of Spleen Yang

Deficiency. Very often, a bowstring pulse is associated with Stagnation. There

are some other conditions that can manifest a bowstring pulse, like Liver Wind

(internal Wind), pain associated with Liver Wind, and Shao Yang-stage Evil (more

about this in future posts). But for the time being whenever you read that the

pulse has a bowstring quality, automatically consider Stagnation problems

somewhere in the body.

 

Stagnation problems often are accompanied by pain. This man had a mild pain

which registered to him as a " cold sensation " . A thick tongue coating often

indicates that there is an Excess condition, and Stagnation problems are

classified as Excess conditions even though they may be coming from a Deficiency

state. A while coating is either normal (as in a thin, white coating) or an

indicator of Cold. (A yellow tongue coating frequently indicates Heat (but not

always).) A slimy (or a slippery or greasy) appearance to the coating often

indicates Dampness and/or Phlegm.

 

Add to this the fact that the functions of the Spleen system include moving

fluids in the body and maintaining proper fluid levels through the body, and

that Dampness disorders frequently accompany Spleen Qi and Spleen Yang

Deficiency, and the second part of the diagnosis is arrived at: Stagnation of

Cold Dampness in the Middle Burner (the stomach and spleen area). We know that

the Dampness Stagnation is in the Middle Burner because that is where the pain

and cold sensation is.

 

The complete diagnosis is Spleen Yang Deficiency with Stagnation of Cold

Dampness in the Middle Burner. The Stagnation of Cold Dampness in the Middle

Burner developed as a result of the Spleen Yang Deficiency going untreated for

so long. (I'm talking about for longer than one year. This man had Spleen Yang

Deficiency getting worse and worse before the duodenal ulcer developed.)

 

So from this example you can see that a question like " What herbal formula would

be appropriate for duodenal ulcer? " is not an appropriate question. Where it's

true that perhaps most cases of gastric or duodenal ulcers are due to Heat, they

can be due to Deficiency Cold. The appropriate herbal formual will depend on the

root cause of the ulcers. There is no one size fits all herbal formual.

 

Another example of an unproductive question is " What herb would be appropriate

for improving the appetite? " Wicke says this question is not specific enough. An

appropriate question is, " What herb would help to improve the appetite in a

condition of Spleen Qi or Yang Deficiency? " (BTW, he says " Rz Atractylodis

Macrocephalae " .

 

Wicke also warns against taking symptoms out of context by asking a question

like " What pattern does fatigue indicate? " While it's true that fatigue almost

always will be associated with a Deficiency state, this does not narrow it down

enough to be assured of proper treatment. The Deficiency may be one of Blood,

Qi, Yin, or Yang. The herbs that are appropriate for and helps one of these are

inappropriate for and can make the person sicker in the case of the other

Deficiencies. If you log onto the Rocky Mountain Herbal Institute website, Wicke

gives the example on there of how ginseng can be great for a person whose

fatigue is coming from Qi Deficiency but do nothing for or even worsen symptoms

in a person who has a Blood, Yin, or Yang Deficiency.

 

The final unproductive reasoning that Wicke warns about is " If a little bit is

good, much more is better. " Very wrong. Herbs are medicine. If they didn't have

medicinal effects, they would be worthless. The controversial herb Ha Huang can

be a godsend when taken for some conditions and when taken in the proper dose.

When taken for reasons other than those medically indicated or when taken in

higher than recommended dosages, it can kill.

 

Also, TCM healers are constantly reevaluating the patient's status. As it

improves, the herbal formula is changed. Otherwise, the patient would be

overbalanced. Like in the case of the man with the Spleen Yang Deficiency with

Stagnation of Dampness in the Middle Burner. If he continued to stay on Yang

tonics and warming and drying herbs, the day will come when the herbs have

over-compensated and he now is suffering from Heat and Dryness conditions.

 

Most people only need herbs a relatively short period of time in order to

correct an imbalance. There are some cases where a person will have to stay on

herbs for a very, very long time. Phlegm disorders in particular are very hard

to resolve and can take a long time to resolve.

 

The section on " Common Mistakes in Logic " is found on page 48 of the vol. 1 of

the Wicke texts. The case study of the man with Deficiency Cold of the Spleen is

found on pages 44-46.

 

Victoria

 

 

 

 

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