Maciocia'a book

[Guest guest]

Sam,

Your not confusing me you are just speaking the M.D. language. Again I

believe the book that you are looking for is written by: James So. He does

western diagnosis and then tells points. I personally believe they are crap

because they do not embody the true meaning of TCM but it really is what you

are looking for. Invest in them they are about $35.00 a piece and hold all

the answers to quick and dirty acupuncture.

 

One last point the Chinese did not master acupuncture thousands of years ago

so that it could be bastardized by the West. I really thought that you were

starting to understand that TCM is not a western thing therefore it cannot

fit the mold. Come on Dr Sam climb out of the box and broaden your horizons,

square pegs do not fit round holes. Sorry to be so short but your questions

seem to be circular in nature always arriving back to a formula to fix all

people.

 

If I have offended anyone other than Sam with my candid response please let

me know and I will be happy to leave the group. But I cannot handle one more

MD thinking that a medical degree gives them the rights and or the means to

travel in uncharted territory without the facts.

 

Sam writes:

I'm no doubt expressing myself poorly, but what I'm seeking is a way to

easily classify patients according to a TCM paradigm, without having to

memorize 50 different disorders, each disorder having 10 symptoms each!

 

Stick with what you know it does not appear that you are ready for something

that goes beyond a pill or formula for everyone.

 

Shane

[Guest guest]

Dear Victoria,

 

Maciocia's book, " The Foundations of " , arrived today via

interlibrary loan. I've read a few chapters already, and have skimmed

through the entire book. I like it.

 

I like the way he explains many of the basic concepts in easy to

understand language. He also does a good job describing which points to

needle for which root condition.

 

I was disappointed in two areas, and wonder if there are some other texts

which may be helpful.

 

1) He didn't describe which Chinese herbs to use for the various

disorders. Are there some good books for that?

 

2) I did not see a practical way to find out which TCM disease

classification a patient might fit into. It looks like the book is

organized into identifying disease patterns according to Internal Organs,

according to Five Elements, according to channels, etc.

 

Coming from a Western, sympthom-oriented approach...it would be MUCH

easier if a TCM book was organized according to the common patient

complaints and diseases I see everyday (like fatigue, cough, diabetes,

hypertension, anxiety, otitis media, bronchitis, etc.). I realize that

what I call bronchitis...TCM might call something else entirely. And yes,

I realize that TCM sees bronchitis not as an isolated disease, but as a

reflection of a larger root problem.

 

But it would be helpful if there was at least a chart or algorithm

somewhere which could walk one thru the diagnostic processes from a TCM

viewpoint.

 

For example, it would be nice to have an algorithm that went, for

example:

 

1) Western diagnosis: Bronchitis

 

TCM Diagnostic Algorithm: Look at the tongue. Check the pulse. If the

tongue is X and the pulse is Y, consider TCM disorders A, B, and C.

 

If the body shape is Z, consider disorders B, C, and D.

 

If the patient also has symptoms of M, consider disorders B, F, and G.

 

Using this algorithm, I would arrive at TCM diagnosis B.

 

I'm no doubt expressing myself poorly, but what I'm seeking is a way to

easily classify patients according to a TCM paradigm, without having to

memorize 50 different disorders, each disorder having 10 symptoms each!

<g>

 

Hope I'm not confusing you all,

 

 

Sam

 

 

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[Guest guest]

> 1) He didn't describe which Chinese herbs to use for the various

> disorders. Are there some good books for that?

 

The second Rocky Mountain Herbal Institute text book - Herbs,

Strategies, and Case Studies by Roger Wm. Wicke, Ph.D. This one you

probably can't get on interlibrary loan and will have to order. I

believe it is $60 counting postage and handling. It's worth it.

 

The address is Rocky Mountain Herbal Institute, P.O. Box 579, Hot

Springs, Montana 59845. I'll also post his email address on here so

you can email him if you wish.

 

 

> 2) I did not see a practical way to find out which TCM disease

> classification a patient might fit into. It looks like the book is

> organized into identifying disease patterns according to Internal

Organs,

> according to Five Elements, according to channels, etc.

 

You're being overwhelmed. This is normal. Take some deep breaths. It

will make more and more sense the longer you stick with it. In fact,

I have a feeling you'll surprise yourself if you stick with it. But

it takes time. I didn't learn all this overnight, or even in a few

weeks. Make haste slowly.

 

> But it would be helpful if there was at least a chart or algorithm

> somewhere which could walk one thru the diagnostic processes from a

TCM

> viewpoint.

 

The first Wicke text, The Language and Patterns of Life. It's I

believe $60 too counting postage and handling. And it too is an

excellent bargain, packed full of info but presented like an

algorithm.

 

 

> For example, it would be nice to have an algorithm that went, for

> example:

>

> 1) Western diagnosis: Bronchitis

 

The Wicke text doesn't do it this way, but does it with a TCM

algorithm. The books I have seen that take the approach of " 1)

Western Diagnosis: " leave a lot to be desired. I haven't seen one

that I would recommend.

 

You're already getting an algorithm approach in Maciocia's book and

especially on here, but because you're still fairly unfamiliar with

TCM, you don't realize it. The Wicke book has even more of an

algorithm approach than the Maciocia book.

 

All that stuff about first the 8 Principal Patterns (Exterior,

Interior, Excess (Fullness), Deficiency (Emptiness), Hot, Cold, Yang,

& Yin) then the Fundamental Processes (Qi, Blood, Fluid, Shen, &

Jing), and then the Perncious Evils (Wind, Heat, Fire, Dampness,

Dryness, and Cold) is an algorithm. It's going from the most basic

(the 8 Principal Pattern) to the more complex. The next step after

these is learning to diagnose according to the organs. I'll give you

an example.

 

Yin Deficiency - Interior, Deficiency, Heat. I'm using Yin

Deficiency as the example because your patient said it sounds the

most like her. General symptoms of Yin Defcieny according to the

Wicke presentation:

 

" Symptoms:

 

" System: chronic symptoms or acute symptoms which have become more

severe in intensity, or the aftermath of high-fevers; fatigue; tends

to feel hot and dislikes heat, especially in the afternoon, with hot

palms, soles and head; night sweats.

 

" Respiration: breathing is shallow with perception of shortness of

breath.

 

" Intake: often thirsty and desires cold drinks.

 

" Outflow: urine dark-colored, constipation.

 

" Pain: pain and discomfort in the trunk of the body, application of

cold reduces discomfort, pressure and touch tend to relieve any

dicomfort or pain.

 

" Motion: body movements tend to be rapid and weak.

 

" Speech: speaks with a quiet but rapid voice.

 

" Behavior: outgoing manner, talkative, but with a passive appearance

and behavior, the type of person with lots of ideas but not the

energy to foow through. " (I want to add here that Yin Deficiency also

manifests as slight nervousness and agitation.)

 

" Signs:

 

" Tongue tissue: red, perhaps with fissures

" Topcoat: absent, or very thin white to yellow.

" Pulse: weak or thready, and rapid.

" Physical: face, especially cheeks reddish. " (Maciocia uses the

term " malar flush. It's a blotchy redness. If the entire face is

red, that points to Excess Heat.) Wicke, volume 1, p. 41.

 

Now that we have the barebones of Yin Deficiency, let's start to

narrow the diagnosis down in some of the meridians/ organ systems.

 

If the breathing is particularly emphasized, you know that's Lung Yin

Deficiency. Wicke gives the following symptoms when it's Lung Yin

Deficiency: " tendency to clear one's throat; irritating dry cough, or

generally unproductive cough with occasional expectoration of thick,

sticky mucus, possibly with bloody streaks. " " Pattern derived from:

Deficiency of Yin (Interior-Heat-Deficicney). " (Wicke, vol. 1, p. 99)

 

Now let's look at Heart Yin Deficiency. The nervousness and agitation

is going to tend to be more emphasized for this one than for general

Yin Deficiency. Wicke adds the following differenciations: " Senses:

heart palpitations. Sleep: insomnia characterized by frequent

reawakening; excessive dreaming. Behavior: forgetfulness. " The

pattern of Heart Yin Deficieny is derived from Interior-Heat-

Deficiency (Deficiency). This mean that the general symptoms of Yin

Deficiency apply with the additional ones listed for Heart Yin

Deficiency.

 

With Stomach Yin Deficiency, the accent is on, you guessed it,

digestion. Wicke adds the following symptoms and signs and

modifications for Stoamch Yin Deficiency to those of Yin Deficiency

in general: " Intake: thirsty and desires cold drinks, but may not

wish to swallow; no appetite. Outflow: urine dark-colored,

constipation " (really more of a problem when it's Stomach Yin

Deficiency than when the Yin Deficiency is in other organs). " Pain:

pain and discomfor inthe epigastrium, ... dry mouth and lips.

Topcoat: absent, or absent in patches ( " geographic tongue " )

especially in the central region of the tongue surface, or very thn

white to yellow. " The more severe the Stoamch Yin Deficiency, the

more of the tongue lacks a coat. (Wicke, p. 102)

 

Now let's look at Kidney Yin Deficiency. Any time a person complaints

of low back pain and weak and sore knees, suspect the Kidneys are

involved. Kidney Yin Deficiency, Kidney Yang Deficiency, Kidney Qi

Deficiency, and Kidney Jing Deficiency all have the symptom of lower

back pain and soreness. Any time a patient presents with problems

with the ears and/or hearing, suspect Kidney problems (or in some

cases Liver problems) because the ears are a part of the Kidney

system in TCM. (You'll be surprised how often a person with Kidney

problems will, when questioned, tell you of earaches, problems with

hearing, etc. either in the present or past.) So how do you tell if

it's Kidney Yin, Yang, Qi, or Jing Deficiency? With Kidney Yin

Deficiency, like with Yin Deficiency in general, the person feels hot

a lot, especially in the afternoon. There are night sweats. With

Kidney Yang Deficiency the person feels cold a lot and has trouble

warming up. With Kidney Qi Deficiency, the person tends to sweat

during the day. One of the general symptoms of Qi Deficiency is the

person sweats during the day. With Kidney Jing Deficiency, these are

the most severe problems. You see stuff like " slow physical or

mental development; premature aging and senility; brittle bones. "

Wicke, vol. 1, p. 125)

 

The algorithms of TCM use a lot of arrays, and you learn to think

forward and backwards. It's really very logical once you get the

basics down.

 

> TCM Diagnostic Algorithm: Look at the tongue. Check the pulse. If

the

> tongue is X and the pulse is Y, consider TCM disorders A, B, and C.

>

> If the body shape is Z, consider disorders B, C, and D.

 

You always check the tongue and pulse. And you've been given some

simple algorithms on here concerning tongue diagnosis in a post a few

days ago:

 

IF tongue = red THEN suspect Heat;

IF tongue = pale AND Dry Then suspect Blood Deficiency ELSE suspect

Yang Deficiency (pale and moist)

 

IF tongue = purple THEN suspect Qi Stagnation and/or Blood Deficiency.

IF tongue = reddish purple THEN suspect Heat with Qi Stagnation

and/or Blood Stasis.

IF tongue = bluish purple THEN suspect Cold with Qi Stagnation and/or

Blood Stasis.

 

IF tongue = blue AND client is pregnant female THEN start warming and

tonifying the Qi and Blood immediately via acupunture and/or herbs

because she's in danger of imminent miscarriage.

 

> I'm no doubt expressing myself poorly, but what I'm seeking is a

way to

> easily classify patients according to a TCM paradigm, without

having to

> memorize 50 different disorders, each disorder having 10 symptoms

each!

 

It's really not that much memorization. Once you learn the basics, a

lot of facts start sticking naturally. It's just that it's

overwhelming in the beginning because it's so different from what

you're used to. The underlying assumptions are different.

 

You do need to learn the basics and be familiar if you're to be

effective using acupuncture and herbs. Otherwise, you risk either

being non-effective or actually making the client sicker. TCM really

works. It's not something that is having no effect. TCM can be

extremely powerful. Also, TCM healers adjust treatment as the need

arises. Let's say for example that your patient has both Kidney Yin

and Kidney Yang Deficiency. This is not an uncommon occurence when

the Kidneys are involved because the Kidneys supply Yin and Yang to

the entire body. One will always predominate. In this case, we'll

assume Kidney Yin. You come up with the right herbs and acupuncture

points to treat Kidney Yin Deficiency. She starts to improve. She

feels less hot, the night sweats start to cease, etc. But she starts

to feel too cold. Back pain is still a problem. She starts to have

edema. Does this mean your original diagnosis was wrong? No, it

means that the severe Kidney Yin Deficiency is no longer as severe

and no longer masking the Kidney Yang Deficieny. You adjust

treatment accordingly. You cut back some on the Yin tonification

and/or increase the Yang tonification. If you're unfamiliar with the

TCM syndromes you won't know when and how to adjust treatment when

it's time to adjust treatment. You won't be able to finetune and

individualize treatment. If a patient starts to have a bad reaction,

you won't know how to counter it if you don't know the TCM concepts.

 

It gets easier. It's just very overwhelming in the beginning.

 

Victoria

[Guest guest]

Sam, concentrate on learning the 8 Principal Patterns, particularly

the part about Hot and Cold. You'll be surprised just how much the

concept of Hot and Cold will add to your healing arsenal.

 

If the symptoms are acute and effect the head, limbs, muscles, and in

some cases, the bones, it's Exterior attack. Interior conditons are

characterized by pain in the trunk, chronic problems or acute

symptoms that have gotten much worse, and changes in bowel movements,

urination, and behavior.

 

Exess conditions are caused by there being too much of something.

Too much spicy food, too much infection, too much External Heat or

External Heat that has invaded the body and become Interior Excess

Heat in the case of Heat conditions. Too much raw and Cold foods,

too much External Cold that is attacking the Exterior (head, limbs,

muscles) or has invaded the body and become Interior Cold Excess in

the case of Cold conditions. Deficiency conditions are caused by

there not being enough of something. Yin cools the body and sedates;

thus, the Heat and agitation in Yin Deficiency comes from there not

being enough cooling and sedating energy in the body. Yang energizes

and warms. The Cold and slowness in Yang Deficiency comes from there

not being enough Yang energy to rev up and warm the body. Think of

the sympathetic and parasympathetic branches of the nervous system.

It's not an exact analogy, but it will give you insights.

 

Victoria

[Guest guest]

> Coming from a Western, sympthom-oriented approach...it would be MUCH

> easier if a TCM book was organized according to the common patient

> complaints and diseases I see everyday (like fatigue

 

IF patient has fatigue THEN suspect Deficiency - Qi, Blood, Yin,

and/or Yang Deficiency and/or Dampness accumulation.

 

IF fatigue characterized by feelings of heaviness in limbs and/or

body THEN suspect Dampness

 

IF tongue = pale, moist, and swollen AND patient = too cold and

problems warming up THEN suspect Yang Deficiency

 

If tongue = pale, dry, and thin THEN suspect Blood Deficiency

 

If client sweats a lot during day (spontaneous sweating not caused by

activity and/or external temperature) THEN suspect Qi Deficiency.

(Tongue may be pale to normal, though usually pale.

 

Both Blood Deficiency and Qi Deficiency are characterized by a pale

face. In Qi Deficiency the paleness will tend to be shiny ( " a bright

sheen " ). With Blood Deficiency the paleness will tend to be dull

( " lack luster " ).

 

More than one of these can be present in a person at the same time.

That's where diagnosis gets a little harder. Ok, it can get a lot

harder.

 

Victoria

[Guest guest]

I know you said to not bother analyzing this one, but I can't help it. Fish

gotta swim, birds gotta fly, and Victoria analyzes.<G>

 

>I hope so! Interestingly, today I had a complex patient, who seemed to

>complain of almost everything. Her migraines headaches were acting up

>(again!); her back hurt; she thought she had a bladder infection; her

> " nerves " were making her grouchy and irritable; her right leg ached; she

>had a chest cold; and she had a rash from contact with poison ivy. I

>found myself thinking --- ok now. I see this as several isolated problems

>that need to be fixed. But I could hear you and Shane and Dagmar saying

> " Look for the connection between these symptoms. Find the root cause.

>Treat the whole rather than the parts. "

 

This is not a diagnosis because obviously one cannot diagnose via email.

This is just some ideas that occur to me as I read.

 

The common cold is called Wind Cold in TCM because that is what creates it.

This does not mean that viruses play no part in causing a cold. It's why 20

people can be exposed to those viruses, and some of them catch colds and

some don't. The ones who catch the cold are under attack by Exterior Wind

Chill AND their Protective Qi (Wei Qi) is too weak to keep the Wind Chill

from invading.

 

It's interesting that she had a migraine at the same time as the cold. Some

migraines (not all are the result of Wind Cold attacking Externally. Wind

Cold also can make one's back sore. BTW, I used to have migraines because

of Wind Cold and weak Protective Qi. I found the Small Intestine 3 point

worked wonders. The Sea of Vitality (Bladder 23 and Bladder 47) also played

a role in relieving them in my case. I don't want to overwhelm you with too

much at this point, but when someone is under attack by an Exterior

Pernicious Evil, the Small Intestine and Bladder meridians are the first to

be affected. Interesting that she also thought she may have a Bladder

infection.

 

The common denominator for most of these symptoms is Exterior attack.

Poison ivy on the skin, headache, cold, and right leg hurt. Exterior

syndromes are characterized by aches and soreness in the head and limbs, the

muscles, and the bones. Skin conditions often are due to Exterior attack

though in some cases they can be due to an Interior condition. It sounds

like this woman's Protective Qi is being overwhelmed.

 

The symptoms that could be Internal are a possible bladder infection and the

irritability, nerves, and grouchiness. Interior conditions are

characterized by changes in urination and often by changes in behavior. But

I want to qualify that last by saying that Wind can make some people nervous

and irritable - if they lack sufficient Protective Qi and/or they're already

run down. What have the weather conditions been like lately where you're at?

You'll find that you will tend to have more people coming in for things

like allergies, arthritic pains, blood pressure complaints, stuffiness in

the nose and sinuses when the wind is blowing a lot. When there's a Cold

and Damp component to the arthritis, you'll tend to see these arthritis

patients more when it's cold and damp. In TCM you learn to pay attention to

the weather because it so often impacts people's health, especially when

there's an underlying weakness and imbalance. And the weather conditions

that impact the most are those that are unseasonable - like a cold snap in

the summer or a warm spell in the winter - and those that are extreme and

happen suddenly. As I said, the people who are going to be the most

vulnerable, the most affected are those with weak Protective Qi and/or those

with underlying imbalances. For example, people who suffer from Internal

Cold tend to be more affected by cold weather than those who do not have

Internal Cold.

 

BTW, TCM says that people are most vulnerable to Wind when the pores are too

open. The times you want to be especially careful about avoiding wind are

when you first wake up, right after you've taken a bath, and if you've

worked up a good sweat via physical labor or exercise.

 

Victoria

 

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[Guest guest]

Dear Victoria,

 

You wrote:

> You're being overwhelmed. This is normal. Take some deep breaths. It

> will make more and more sense the longer you stick with it.

 

I hope so! Interestingly, today I had a complex patient, who seemed to

complain of almost everything. Her migraines headaches were acting up

(again!); her back hurt; she thought she had a bladder infection; her

" nerves " were making her grouchy and irritable; her right leg ached; she

had a chest cold; and she had a rash from contact with poison ivy. I

found myself thinking --- ok now. I see this as several isolated problems

that need to be fixed. But I could hear you and Shane and Dagmar saying

" Look for the connection between these symptoms. Find the root cause.

Treat the whole rather than the parts. "

 

Now, naturally I had no clue where to even begin looking for the

connections, but at least my mind set was going along that road!

 

Thanks for your teaching me!

 

Sam

 

PS. Don't bother to analyze the above patient for me...it was just an

example. I have more than I can digest right now.

 

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[Guest guest]

I don't know about the rest of you, but this one didn't make it out

to my email account. So I'm replying to my message from last night

in the hope it will make it out this time. I don't know if this

problem is unique to my email account or system wide. I had to

change email accounts yesterday because deja is going to be down for

several days.

*****************************

 

> Sam, concentrate on learning the 8 Principal Patterns, particularly

> the part about Hot and Cold. You'll be surprised just how much the

> concept of Hot and Cold will add to your healing arsenal.

>

> If the symptoms are acute and effect the head, limbs, muscles, and

in

> some cases, the bones, it's Exterior attack. Interior conditons

are

> characterized by pain in the trunk, chronic problems or acute

> symptoms that have gotten much worse, and changes in bowel

movements,

> urination, and behavior.

>

> Exess conditions are caused by there being too much of something.

> Too much spicy food, too much infection, too much External Heat or

> External Heat that has invaded the body and become Interior Excess

> Heat in the case of Heat conditions. Too much raw and Cold foods,

> too much External Cold that is attacking the Exterior (head, limbs,

> muscles) or has invaded the body and become Interior Cold Excess in

> the case of Cold conditions. Deficiency conditions are caused by

> there not being enough of something. Yin cools the body and

sedates;

> thus, the Heat and agitation in Yin Deficiency comes from there not

> being enough cooling and sedating energy in the body. Yang

energizes

> and warms. The Cold and slowness in Yang Deficiency comes from

there

> not being enough Yang energy to rev up and warm the body. Think of

> the sympathetic and parasympathetic branches of the nervous

system.

> It's not an exact analogy, but it will give you insights.

>

> Victoria

[Guest guest]

This is another message that didn't make it to my email account. I

apologize if these two messages are duplicates for others. At this

point I don't know if the problem is just with my email because I had

to change accounts or due to a glitch in eGroups.

*************************

 

> > Coming from a Western, sympthom-oriented approach...it would be

MUCH

> > easier if a TCM book was organized according to the common patient

> > complaints and diseases I see everyday (like fatigue

>

> IF patient has fatigue THEN suspect Deficiency - Qi, Blood, Yin,

> and/or Yang Deficiency and/or Dampness accumulation.

>

> IF fatigue characterized by feelings of heaviness in limbs and/or

> body THEN suspect Dampness

>

> IF tongue = pale, moist, and swollen AND patient = too cold and

> problems warming up THEN suspect Yang Deficiency

>

> If tongue = pale, dry, and thin THEN suspect Blood Deficiency

>

> If client sweats a lot during day (spontaneous sweating not caused

by

> activity and/or external temperature) THEN suspect Qi Deficiency.

> (Tongue may be pale to normal, though usually pale.

>

> Both Blood Deficiency and Qi Deficiency are characterized by a pale

> face. In Qi Deficiency the paleness will tend to be shiny ( " a

bright

> sheen " ). With Blood Deficiency the paleness will tend to be dull

> ( " lack luster " ).

>

> More than one of these can be present in a person at the same

time.

> That's where diagnosis gets a little harder. Ok, it can get a lot

> harder.

>

> Victoria