ADD

[Guest guest]

Jim,

 

There are chapters on ADD/ADHD in both A Handbook of Traditional

Chinese Pediatrics and Chinese Medical Psychiatry. Both books are

available from Blue Poppy Press.

 

Bob

 

, " elkinjnj " <James.Elkin@A...> wrote:

> I have a good friend whose child has been diagnosed with it. I was

> wondering if anyone has had much experience with treating this kind

> of condition, and how they would approach it.

>

> Thanks,

>

> Jim

[Guest guest]

Bob,

 

You wouldn't perhaps be Bob Flaws would you?

 

Thank you so much for this information. However, I was looking for

someone who *actually* had experience with *successfully* treating

ADD. A lot of what is written in texts is not clinically meaningful.

 

Jim

 

, " pemachophel2001 "

<pemachophel2001> wrote:

> Jim,

>

> There are chapters on ADD/ADHD in both A Handbook of Traditional

> Chinese Pediatrics and Chinese Medical Psychiatry. Both books are

> available from Blue Poppy Press.

>

> Bob

[Guest guest]

, " elkinjnj " <James.Elkin@A...>

wrote:

A lot of what is written in texts is not clinically meaningful.

 

Why do you say that? Probably most people who have

successfully treated ADD have used texts for guidance. A

student said to me last night that he hated sionneau's 7 volume

seies. He grumbled about cookbook treatment. He said a good

practitioner didn't need internal medicine books, they just

needed to know the point and herb functions. This is an

interesting idea since most chinese clinicians seem to agree

that topics of internal medicine texts are essential to their daily

practices.

 

I think sometimes it is unclear what purpose such texts are

meant to serve. They are meant to be pointers. Since most

patients manifest with complexes of 2 or more patterns, one

must carefully decide how to treat the entire presentation, which

involves consideration of several base formulas and numerous

single herbs, the goal being to craft a formula suitable for the

unique presentation before you. these textbook formulas are

actually the summary and consensus of numerous practitioner's

actual experience. One might argue that the consensus

achieved amongst dozens of practitioners carries at least as

much weight as the anecdotal expereince of isolated

practitioners who have probably seen only a handful of such

cases. We need to value both.

 

I strongly recommend people read the intro to Flaws's tx of

modern western medical diseases where he painstakingly

details how to properly use a " cookbook " as one source of

guidance for crafting unique effective formulas. Personally, I

have had tremendous success using the formulas in

Sionneau's books. while one find many mainstays in that book,

there are also quite a few formulas unknown to me, which

reflects Philippe's actual training with his teachers. And one

should never underestimate the mainstays. Carefully modified

bu zhong yi qi tang or xiao yao san can effectively treat dozens of

different complaints.

 

With that in mind, I have treated several cases of ADD with

apparent success, though this condition being perhaps the

most overdiagnosed condition today, who knows. I did indeed

use Chinese Medical Psychiatry as my guide. One child

presented as spleen qi xu, heart blood xu with phlegm-heat

misting the mind. since he would only take patents, he received

a combination of gui pi wan and huang lian wen dan tang.

 

[Guest guest]

I have a good friend whose child has been diagnosed with it. I was

wondering if anyone has had much experience with treating this kind

of condition, and how they would approach it.

 

 

Jim,

 

I think Todd and Zev make valid points but I don't think their perspectives

invalidate your point regarding the direct value of cookbooks to the

uniqueness of many patients. It has its place and its limitations in many

cases. I have treated quite a few " ADD " kids and adults with herbs and

first of all, ADD is an incomplete diagnosis, although it is considered a

diagnosis by many in conventional medical circles. ADD is a description of

symptoms that is always part of a/several complex pattern(s). One

difficulty is that the patient may have several valid TCM diagnostic

presentations which are related to the ADD symptoms to widely varying

degrees, from " not at all " to " directly related " . My advice is to start by

looking at the patterns underlying food allergies and sensitivities. I find

that treatment of those patterns is a good place to start.

 

Stephen

 

 

Chinese Herbal Medicine, a voluntary organization of licensed healthcare

practitioners, matriculated students and postgraduate academics specializing

in Chinese Herbal Medicine, provides a variety of professional services,

including board approved online continuing education.

 

 

 

 

[Guest guest]

On Thursday, May 23, 2002, at 11:10 AM, 1 wrote:

 

> , " elkinjnj " <James.Elkin@A...>

> wrote:

> A lot of what is written in texts is not clinically meaningful.

>

> Why do you say that?  Probably most people who have

> successfully treated ADD have used texts for guidance.  A

> student said to me last night that he hated sionneau's 7 volume

> seies.  He grumbled about cookbook treatment.  He said a good

> practitioner didn't need internal medicine books, they just

> needed to know the point and herb functions.  This is an

> interesting idea since most chinese clinicians seem to agree

> that topics of internal medicine texts are essential to their daily

> practices. 

 

I would agree. I don't think anything published in Chinese internal

medicine texts is 'not clinically meaningful'. Because of the

complexity and variety of human illness, guidebooks as to some type of

consensus in the profession is necessary to understand how to diagnosis

and treat various illnesses and patterns. Even after twenty years of

practice, I am glad to have the Sionneau series on my bookshelf to give

me ideas and directions. While I don't always find the same patterns or

use the same prescriptions, it refreshes my perspective and guides my

thinking in the right direction.

 

These texts are there to give us a sense of direction, some

accountability in the professional treatment of unusual conditions like

ADD, and to provide a body of experience to build on. It is nieve to

'go it alone' in the clinic, without reportage or accountability to

anyone, patient or fellow practitioner.

>

> I think sometimes it is unclear what purpose such texts are

> meant to serve.  They are meant to be pointers.  Since most

> patients manifest with complexes of 2 or more patterns, one

> must carefully decide how to treat the entire presentation, which

> involves consideration of several base formulas and numerous

> single herbs, the goal being to craft a formula suitable for the

> unique presentation before you.  these textbook formulas are

> actually the summary and consensus of numerous practitioner's

> actual experience.  One might argue that the consensus

> achieved amongst dozens of practitioners carries at least as

> much weight as the anecdotal expereince of isolated

> practitioners who have probably seen only a handful of such

> cases.  We need to value both.

 

In valuing both, we also need to start reporting American practitioner's

experiences. I appreciated seeing the case history report of Neil

Gumenick in the latest 'Acupuncture Today', as I am often skeptical of

how the Worsley style is applied to real cases. Afterwards, I am still

skeptical, but he did a good job of reporting what he actually did and

diagnosed.

>

> I strongly recommend people read the intro to Flaws's tx of

> modern western medical diseases where he painstakingly

> details how to properly use a " cookbook " as one source of

> guidance for crafting unique effective formulas.  Personally, I

> have had tremendous success using the formulas in

> Sionneau's books.  while one find many mainstays in that book,

> there are also quite a few formulas unknown to me, which

> reflects Philippe's actual training with his teachers.  And one

> should never underestimate the mainstays.  Carefully modified

> bu zhong yi qi tang or xiao yao san can effectively treat dozens of

> different complaints.

 

Yes. . . the textbook is a starting point to build one's own application

of treatment principles.

>

> With that in mind, I have treated several cases of ADD with

> apparent success, though this condition being perhaps the

> most overdiagnosed condition today, who knows.  I did indeed

> use Chinese Medical Psychiatry as my guide.   One child

> presented as spleen qi xu, heart blood xu with phlegm-heat

> misting the mind.  since he would only take patents, he received

> a combination of gui pi wan and huang lian wen dan tang.

>

 

>

>

I have found ADD difficult to treat, not because of the lack of clinical

efficacy of TCM, but because of underlying issues that the parents

didn't want to face, such as diet, family dynamics, or problems with

educational methods.

 

 

[Guest guest]

, " " <

zrosenbe@s...> wrote:

>

> I have found ADD difficult to treat, not because of the lack of

clinical

> efficacy of TCM, but because of underlying issues that the

parents

> didn't want to face, such as diet, family dynamics, or problems

with

> educational methods.

 

 

Yes, indeed.

 

[Guest guest]

, " stephen " <stephen@b...> My

advice is to start by

> looking at the patterns underlying food allergies and

sensitivities. I find

> that treatment of those patterns is a good place to start.

>

 

yes, I have had best success with integrative medicine.

allergies are important here. see this page for promising

naturopathic approaches:

 

http://www.lef.org/protocols/prtcl-016.shtml

 

[Guest guest]

I agree with your points, Stephen.

 

I see so-called ADD or ADHD as a multi-factoral situation, not

necessarily an independent disease. . .. and think it is over-diagnosed,

leading to the over-prescribing of such drugs as ritalin.

 

At the same time, we need to have some reference point and meeting

ground in the medical literature and community, both biomedical and

Chinese. We need some way to reference other health professionals'

experiences with such patients, and what they've seen, how they've

treated their patients, and what has been recommended for them. We

also need some sense of direction in how the Chinese medical is dealing

with this phenomenon, and with what resources.

 

 

 

 

On Thursday, May 23, 2002, at 11:12 AM, stephen wrote:

>   I have treated quite a few " ADD " kids and adults with herbs and

> first of all, ADD is an incomplete diagnosis, although it is

> considered a

> diagnosis by many in conventional medical circles.  ADD is a

> description of

> symptoms that is always part of a/several complex pattern(s).  One

> difficulty is that the patient may have several valid TCM diagnostic

> presentations which are related to the ADD symptoms to widely varying

> degrees, from " not at all " to " directly related " .  My advice is to

> start by

> looking at the patterns underlying food allergies and sensitivities.  I

> find

> that treatment of those patterns is a good place to start.

>

> Stephen

[Guest guest]

, " 1 " <@i...> wrote:

> yes, I have had best success with integrative medicine.

> allergies are important here. see this page for promising

> naturopathic approaches:

>

> http://www.lef.org/protocols/prtcl-016.shtml

>

>

 

In my limited experience, I have found that children who are treated

with tcm for ADD and also enroll in a martial arts class do very well

in the long run.

 

~Fernando

[Guest guest]

Zev, You are quite right about having reference points and a meeting ground in the literature. Yet it is a real challenge to discern the relative efficacy and value of the perspectives presented in a literature that is being stretched to accommodate new causes of disease that result from changes in lifestyle and our physical environment that did not influence the originators of the perspectives presented in historical literature. I see published information as options to be considered and in many cases, new perspectives to put in the tool belt. Is it possible that some of the best innovation goes unpublished because of the scrutiny that comes with suggesting new ideas? I certainly appreciate the historical precedent that comes with TCM. I think it has fascinated everyone involved in the field of TCM. But when suggesting ways to improve upon what has been historically published, it is looked at with serious skepticism. And rightfully so. How do we know that what has been published or is innovated has validity unless it is put to some kind of scrutiny. That's one area where the field of TCM lags behind the pharmaceutical model. But as we know, that model is also quite flawed, although it offers ways to validate new ideas. The ADD issue brings up a case in point. There isn't historical precedent for its treatment, so we look at the presentation of as many ADD cases as we can and try to make correlations to the historical perspectives that form the models into which we place the pieces of the picture that we are presented. But that historically developed model may not have an elaborate enough structure to accurately describe the diagnostic information that will lead us to the most effective treatment. What then? The model needs to expand to accommodate new diagnostic and therapeutic concepts and methods of implementation that don't necessarily fit into the old model but in most cases don't necessarily contradict it either. Because of the globalization of societies, we are privileged to be stewarding a transformation of TCM, along with those practicing it in China and around the world, that will eventually redefine its value and role in the world's medical practices. The fact that Will, or was it James, claim to have a way to perceive chemical and metal toxicity from the pulse is quite interesting and provides an example of the possibilities. But if they publish it, should it then become an accepted part of the practice of CM? What is the process someone would need to undertake before that method is taught in schools? Shouldn't we put a few of the historically accepted protocols to the same test?

 

Stephen

 

... At the same time, we need to have some reference point and meeting ground in the medical literature and community, both biomedical and Chinese. We need some way to reference other health professionals' experiences with such patients, and what they've seen, how they've treated their patients, and what has been recommended for them. We also need some sense of direction in how the Chinese medical is dealing with this phenomenon, and with what resources. On Thursday, May 23, 2002, at 11:12 AM, stephen wrote:

 

I have treated quite a few "ADD" kids and adults with herbs andfirst of all, ADD is an incomplete diagnosis, although it is considered adiagnosis by many in conventional medical circles. ADD is a description ofsymptoms that is always part of a/several complex pattern(s). Onedifficulty is that the patient may have several valid TCM diagnosticpresentations which are related to the ADD symptoms to widely varyingdegrees, from "not at all" to "directly related". My advice is to start bylooking at the patterns underlying food allergies and sensitivities. I findthat treatment of those patterns is a good place to start.Stephen

[Guest guest]

, " elkinjnj " <James.Elkin@A...> wrote:

A lot of what is written in texts is not clinically meaningful.

 

 

Jim:

 

Unless you keep up with what is going on in your field and compare

different styles, simply trying to create formulas out of point or

herb functions would be futile and very short-sighted. Even though I

don't practice TCM in the way most Blue Poppy Books indicate, I make

an effort to buy many of them simply for reference. Bob Flaws has

made a valuable contribution in translating and publishing this

literature. In my mind, they represent mainstream, conservative CM.

Unless you are expert translator in Chinese, Korean, or Japanese,

one person's imagination is very limited and would be impossible to

reinvent.

 

Jim Ramholz

[Guest guest]

Thank you all for your wonderful assistance. I have to admit that I

am playing a lazy devil's advocate here. I have not had the

opportunity to assess the child's condition, I merely received a

request for a report on the efficacy of TCM as a tool for managing

ADD. You have been extremely helpful in your responses and I again

thank you.

 

I would not normally make such an inquiry without actually presenting

you with meaningful signs & symptoms, but, as you can see, I do not

have any as yet. What I was seeking was a reply on the amount of

success that anyone out there has had in treating it and what to look

for. You have fulfilled that quest perfectly. Of course, I would

pursue methods and techniques from the available literature, but I

have found that the highly experienced clinicians that I have

encountered do not always agree with the most commonly recommended

solutions to a certain condition. Hence, I sought to discover

whatever clinical experience I could find from this forum.

 

Stephen brings up an extremely important problem regarding TCM.

Before Mao, there was no TCM proper. There were a lot of different

practitioners of many varieties of folk medicine, and the medicine

practiced in the emperor's court. Mao collected these varieties,

classified them into a working system (or discarded those that didn't

seem valuable) and labelled it TCM.

 

Since it has moved into the rest of the world, TCM is returning to

the original state: everyone doing what they find meaningful with

standard TCM as a basis or core to their approach. This a wonderful

situation for allowing TCM to evolve (which would make it no

longer " traditional " ).

 

However, it seems that it is necessary for some sort of central

authority to certify any innovations to be accepted as part of the

basis (i.e., TCM). In ancient China, the Nei Jing was the central

authority. Any treatment innovations would have to find justification

based on it or other classics. What do we use as a central authority

today?

 

Thanks again,

 

Jim

[Guest guest]

> Before Mao, there was no TCM proper. There were a lot of different

> practitioners of many varieties of folk medicine, and the medicine

> practiced in the emperor's court. Mao collected these varieties,

> classified them into a working system (or discarded those that

didn't

> seem valuable) and labelled it TCM.

 

Jim,

 

Your assertions about TCM are simply historically incorrect. Mao

didn't do anything to Chinese medicine other than support it. The

systematization of Chinese medicine that was carried on ALL THROUGHOUT

the 20th century was actually begun in the mid 1700s in the Qing

dynasty. The systematization that was carried on during the mid 20th

century was a continuation of that historical trend and was

accomplished by many national convocations of the best " old Chinese

doctors " of their day. While five phase and I Ching theories were

expunged from CM during the height of the Cultural Revolution as

being politically incorrect, they were restored within 10 years. The

CM libraries were not burned, and Chinese doctors have access to the

total body of historical CM literature. You're repeating a mythology

which is not true. It suggests that you are not familar with the

actual history and development of Chinese medicine over the last 300

years. You're promoting half-truths which you are giving your own

political spin.

 

Bob

[Guest guest]

Jim: Stephen brings up an extremely important problem regarding TCM.

Before Mao, there was no TCM proper...

 

Stephen: Just to clarify, that was not a point that I made.

 

 

Bob: The systematization that was carried on during the mid 20th

century was a continuation of that historical trend and was

accomplished by many national convocations of the best " old Chinese

doctors " of their day.

 

Stephen: Wouldn't you agree that the systematization that began in the

1700's took a completely new tack in the 20th Century when Western medical

diagnostic parameters (i.e. hypertension, etc.) were integrated into the TCM

teaching textbooks at every level? Has this been good for TCM? If so, how

much further can this integration progress before it is not good for TCM?

 

 

 

 

 

Chinese Herbal Medicine, a voluntary organization of licensed healthcare

practitioners, matriculated students and postgraduate academics specializing

in Chinese Herbal Medicine, provides a variety of professional services,

including board approved online continuing education.

 

 

 

 

[Guest guest]

, " pemachophel2001 " <

pemachophel2001> wrote:

The

> systematization of Chinese medicine that was carried on ALL

THROUGHOUT

> the 20th century was actually begun in the mid 1700s in the

Qing

> dynasty.

 

In fact, even the older writings of zhu dan xi have always struck

me as clear antecedents to modern TCM. His emphasis is

clearly on zang-fu, pathogens, depressions, pathomechanisms

and treatment principles and he expresses these ideas in a

decidedly modern way. At least in herbal medicine, this has

apparently been the dominant style of practice for many

centuries.

 

This is also evidenced in formulas and strategies, in which

numerous source texts from the last 1800 years or so are

referenced, all of which contributed to the development of TCM.

So even today, practicing acording to the shang han lun and jin

gui yao lue is still considered " TCM " . The method of practice that

was adopted as standard by the PRC was adopted largely

because it was ALREADY the dominant style of herbal practice.

 

As for folk and family and oral traditions, people are free to

pursue whatever path they choose, but I want to express what

drew me to TCM 15 years ago and still keeps me there today.

My conception of TCM has always included everything from basic

texts like Fundamental of CM, materia medica, nei ke to

classical texts and case studies. Perhaps because my teachers

from china definitely had access to all this information in their

studies. I have also been convinced for a long time that it

reflected mainstream practice. I think Jim underscores this

position when he uses the term conservative to describe TCM. I

have no trouble with that label and I think it also accurately

reflects mainstream chinese culture throughout much of history.

If the mainstream culture was conservative, so was their

mainstream medicine.

 

So many of these other " lost " or abandoned or secret styles may

indeed have value, but I have never been drawn to ideas that are

not supported by some sort of consensus. in fact, in the

absence of objective scientific proof, consensus is the only

mechanism humans have ever had for deciding what is valid. If

the mainstream medical literature suggests such a consensus,

that is what attracts me. When ideas are written and

desseminated widely for criticism, this leads to a quantum leap

in development. When ideas are controlled through secrecy and

authority, who knows what value they are.

 

And as I have said many times, if I was dissatisfied with the

efficacy of TCM, I would look elsewhere. But I have found that

when practiced in its broadest context, it is extremely effective.

To say that TCM has been stripped of its essence is really a

matter of opinion. Confucians never had much use for the

metaphysical and they were an important force in the creation of

the medical literature. So this hardly a new phenomena. sure,

you can probably find any number of texts that support a more

esoteric take on CM. but these texts never were the primary

influence on herbal practice. When I use the word mainstream, I

am referring to texts that were constantly referred to by other

books that came after them. If some texts are constantly cited,

then they obviously played a large role in mainstream practice.

 

Other styles may have been practiced by one family in one town

on a limited number of patients or may have been practiced only

by one doctor who then recorded his thoughts which were never

acted upon again. consider how much is written these days in

print and on the internet and how little of that will turn out to have

lasting value and impact. When I went to naturopathic school, I

was fascinated by the Library there. It included books on every

imaginable form of medicine. I was particularly intrigued with

books written throughout the late 1800's into the 1930's. In

those days modern medical science was just developing.

everyone was jumping on the bandwagon and writing about

various dubious methods of healing and " explaining " them by

reference to contemporary science. However, most of these

interpretations turned out to be wrong (my favorite: white blood

cells are actually a cellular waste product that needed to be

purged from the body; this idea was taught to me in my first year

of naturopathic school using a text from 1905 even though

modern science had clearly elucidated that white blood cells are

part of a complex information network).

 

But imagine if one stumbled across such ideas 1000 years from

now and assumed they were valid because they had never been

tested. They may indeed be efficacious, but I would still rather

put my faith, as it were, in historical consensus. We take a leap

already in adopting the unproven medicine of another culture.

So I have to set some criteria by which I judge this beast. to

embrace that part of the medicine that had the least consensus

just does not suit my nature.

 

As a caveat, I will stipulate that what I am saying applies to

herbology. the acupuncture, qi gong and lay literature is much

more diverse. but it is my understanding that these genres of

medical literature did not have tremedous influence on the

development of mainstream professional herbal practice. And

the topic is herbology.

 

[Guest guest]

Please understand. I am not implying that TCM has been stripped of

its essence, nor am I bemoaning the fact that lots of valuable

alternatives may have been lost due to the codifying of TCM. I am

noting that there have been significant contributions to Chinese

Medicine since before the Nei Jing until today. It has been an

evolving process. Previously, it took conventions of authorities to

decide what would be taught as the standard. Today, there is no such

authority (unless we want to look to the government of China as the

final word). How could some of the recent innovations that are

cropping up become candidates for acceptance as one of the next steps

in this evolution? Who is the deciding body for TCM? Or is it a

static system that should just be what it is?

 

Jim

[Guest guest]

, " elkinjnj " <James.Elkin@A...> wrote:

 

I was looking for

> someone who *actually* had experience with *successfully* treating

> ADD. A lot of what is written in texts is not clinically meaningful.

 

The above might be overstated but isn't it the case that

practitioners who

frequently and succesfully treat a condition often seem to develop

away fom the standard pattern diagnoses for that problem? Firstly,

they seem to often simplify pattern diagnosis and secondly, choose

certain key herbs whose application is indicated more by disease

rather than pattern. So the empirical finding comes first and any

theoretical explanations are secondary. It is my experience that

there are a number of conditions where no matter how well one chooses

a formula from a book according to disease and then how subtly

modifies it according to pattern differentiation, unless the key

herbs and, crucially, their dosage are known, results are less than

good. This infomation is more available in journals but often the

value of, eg, ye ju hua for seborrheic dernatitis, bai zhi for itchy

scalp, dan shen for kidney function, tu fu ling and bi xie for gout,

xi xian cao for hyperlipidaemia etc, is only clear from experienced

practitioners... And this infomation really does need to be spread

around.

 

Simon

[Guest guest]

Part of the problems is that our whole study of Chinese

medicine in the West tends to be hearsay, and we all know how

unreliable hearsay evidence is.

 

Bob,

 

Thanks for the excellent history lesson. I will take it as better hearsay

than previous versions that I have heard said.

 

In " Chen's History of Chinese Medical Science " it states that the

integration Chinese and Western Medicine took place with the founding of the

Peking Union Medical College in 1921, a Rockefeller Foundation financed

Western Medical School in Beijing. What you appear to be saying is that was

actually an acceleration of a process that had been started centuries

earlier. I have assumed that the missionaries from Europe were fairly

limited in what they introduced about Western medicine since basic

physiological anatomy was first introduced by Wang Ching Jen in 1830 from

work not directly influenced by Westerners, but based on his personal

evaluation of corpses at executions and tombs.

 

But the key point that you have made, IMO, is the long historical precedent

of using a dual diagnostic reference of disease name and pattern

identification. The integration of Western and Eastern medicine would seem

a natural continuation of that process.

 

Stephen

 

 

 

Chinese Herbal Medicine, a voluntary organization of licensed healthcare

practitioners, matriculated students and postgraduate academics specializing

in Chinese Herbal Medicine, provides a variety of professional services,

including board approved online continuing education.

 

 

 

 

[Guest guest]

Wouldn't you agree that the systematization that began in

the > 1700's took a completely new tack in the 20th Century when

Western medical > diagnostic parameters (i.e. hypertension, etc.) were

integrated into the TCM > teaching textbooks at every level? Has this

been good for TCM? If so, how > much further can this integration

progress before it is not good for TCM?

 

Stephen,

 

Happily, today I have some time for real rebutttal.

 

No, I don't agree that the systematization of CM begun in the mid

1700s took a completely new tack in the 20th century. What I was

mainly referring to was that, in the Qing, the big innovation was not

a lot of new theories or new patterns but a systematization and

combination of all the previous existing theories which had borne out

over time. You can see this in the work of Li Zhong-zi and in Wu Qian

et al.'s Yi Zong Jin Jian (The Golden Mirror of Ancestral [or

Accumulated] Medicine). For instance, Wang Ken-tang was a famous

member of the so-called " compromise school " who was quite happy to use

patterns from different schools as long as the patterns fit the

patient's presentation. (Interestingly, Wang also associated with and

exchanged medical views with the Western missionaries, Matteo Ricci,

Diego Del Pantoja, etc.) This is when you start getting the

multipattern breakdowns of different diseases, with patterns coming

from a number of different schools of thought. You can see this

progression quite well in the history section of my, Lynn Kuchinski &

Dr. Robert Casanas's The Treatment of Diabetes Mellitus with Chinese

Medicine due out in early July. In the first millenium, the emphasis

was on heat, in the Jin-Yuan and Ming dyansties, the emphasis was on

the kidneys. In the Qing, we get the liver and blood stasis added to

the mix, and, in ther 20th century, people began emphasizing the role

of the spleen and phlegm dampness, so that now, we have a much more

complete system of pattern discrimination when it comes to xiao

ke/diabetes.

 

As for the integration of Chinese and Western medicines, this began

very soon after the Portuguese arrived in the South China Sea and

gained momentum after the Yankee Prostetants opened so many hospitals

and clinics in the 19th century. To think this is a Maoist, 20th cent.

phenomenon is quite incorrect. This has been a big movement in Chinese

medicine since not later than the second half of the 19th century. For

instance, Wang Qing-ren (1768-1831) was a notable early proponent of

the integration of Chinese & Western medicines. Simon Becker is

translating his Yi Lin Gai Cuo (Corrections in the Forest of Medicine)

now. This trend continued with the likes of Tang Rong-chuan

(1863-1918), author of not only the Xue Zheng Lun (Treatise on

Bleeding Disorders, which I am currently translating) but also the

Zhong Xi Hui Tong Yi Jing Jing Yi (Essentials of Confluent Chinese and

Western Medicine). Other important names in the development of modern

Chinese medicine include Zhu Pei-wen (mid 19th cent.), He Bing-yuan

(1861-1929), Zhang Zi-chun (1860-1933, author of Yi Xue Zhong Zhong

Can Xi Lu (Records of in Reference to the West), and

Yun Tie-qiao (1878-1935). Without a passing knowledge of these men and

their writings, it is difficult to say one knows anything really about

the historical development of integrated Chinese-Western medicine in

China.

 

In particular, you question the use of modern Western disease

categories in contemporary Chinese medicine, such as hypertension.

Chinese medicine since not less than the time of the Nei Jing has

always used two systems of diagnosis (called liang zhen, dual

diagnosis, in Chinese). By this I mean 1) named diseases and 2) named

patterns. Using this system of dual diagnosis, Chinese have, for many,

many years, discussed the patterns commonly seen under a given

disease. In that case, treatment is primarily predicated on the

patient's pattern but always does take into account the specific

disease. For instance, we do not use the same Chinese meds for the

treatment of yin vacuity nosebleed as we do for yin vacuity night

sweats. In terms of metaphysics, I see no conceptual difference nor

any real clinical difference between traditional Chinese diseases,

such as wasting and thirsting (xiao ke), and diabetes mellitus (tang

niao bing). In fact, in the cases of xiao ke, we now recognize that

this is identical to diabetes mellitus. Nevertheless, whether or not

there is a one to one identity between a traditional Chinese disease

category or a modern Western one, the role of disease categories in

Chinese medicine is unchanged.

 

(As an aside, in contemporary Chinese medicine, it is now a

convention that we typically begin discussions first of the Western

medical disease, then explain the traditional Chinese disease

categories corresponding to this Western diseases, and then discuss

the patterns and their treatments. Anyone who reads the contemporary

Chinese medical literature in Chinese will recognize the ubiquity of

this convention.)

 

Granted, if one does acupuncture or prescribes herbs on the basis of a

Western medical diagnosis of hypertension, then that is the practice

of Western medicine using Chinese treatment modalities. However, if

one identifies the patterns under hypertension, discriminates those in

a real-life patient, and then prescribes herbs or acupuncture based

primarily on that pattern but also taking into the disease diagnosis,

then that is Chinese medicine, and it is Chinese medicine as it has

been practiced since not less than the time of Zhang Zhong-jing's Shan

Han Lun/Jin Gui Yao Lue.

 

Unfortunately, there's quite a lot of misunderstanding about the

history of Chinese medicine, both premodern and modern. Like so many

other aspects of Chinese medicine in the West, certain half-truths or

outright myths have become established as truths and then are passed

around by people who simply are not well versed in the history of

Chinese medicine. I too believed some of these same half-truths and

am, in part, personally responsible for their spread in the early to

mid 80s. However, since then, I have tried to educate myself in that

history and now realize that my previous rants against " revisionist

Maoist medicine " were sophmoric, overly simplistic, and simply

uninformed.

 

What is perhaps most unfortunate is that, as I have explained before

on this list, we cannot afford to publish a more accurate and detailed

history of Chinese medicine from the 19th century to today which

would set some of these half-truths and misconceptions right. There

simply is not a large enough market. However, if one can read the

Chinese literature in its original language, then a lot becomes much

clearer. Part of the problems is that our whole study of Chinese

medicine in the West tends to be hearsay, and we all know how

unreliable hearsay evidence is.

 

Bob

[Guest guest]

Who is the deciding body for TCM? Or is it a static system that

should just be what it is?

 

Jim,

 

I would be the last one to say that CM is a static system. It is

constantly evolving and changing simply because that is the nature of

phenomenal existence.

 

As for who decides, we, the community of practitioners, decide through

consensus over time. Until such a consensus develops, each of us must

make their own choices. Hopefully, those choices are made on the basis

of a preponderance of evidence. In CM, that evidence can be statements

from past great practitioners, statements from living great

practitioners, one's own clinical experience, other people's case

histories, laboratory research, clinical trials, or, when none of the

preceding are available, our choices may be based on reasoning from

principles or ratiocination.

 

It is a fact that, in the PRC, symposia are routinely held at which

experienced Chinese doctors from all over a city, a county, a

province, or the country as a whole get together and discuss a certain

disease or group of diseases. If these " old Chinese doctors " reach a

consensus about pattern discrimination, treatment principles,

treatment methods, and determination of outcomes, then these are

published. It is these that become the standards of care (SOC) for

municipal, county, provincial, and national departments of health.

More and more, when reading the contemporary Chinese literature,

authors are citing the published sources of their criteria. These can

be criteria for disease diagnosis, pattern discrimination, treatment,

or assessment of outcomes. Often these cites bear such titles as

" Criteria for the Diagnosis, Treatment and Efficacy of (name the

disease) from the 6th National (or regional) Convention on (name the

disease or medical specialty). That it's the 6th suggests that there

was a 1st, 2nd, 3rd, 4th, and 5th and that, some time in the future,

there will be a 7th, 8th, etc., and, at such future convocations,

these criteria may be revised because of changes in the group's

experience based on new research and/or further clinical experience.

 

As a for instance, the Hu Bei Zhong Yi Za Zhi (Hubei Journal of

) publishes a set of SOC for four or so traditional

Chinese diseases on the inside back cover of each issue. Each section

begins with a definition of the disease category, the patterns most

commonly seen, the pathognomonic signs and symptoms of each pattern,

including tongue and pulse signs, and criteria for assessing treatment

outcomes. I'm not sure if these are national Chinese SOC or Hubei

provincial SOC. I do know the national government did publish national

SOC for CM a year or so ago, although I haven't been able to get ahold

of a copy yet.

 

As a practitioner, it is my experience that Chinese SOC are, by and

large, useful in our milieu. I would say that we are far too young and

uneducated as a profession in the U.S. to attempt to arrive at such a

consensus on our own. IMO, we simply do not have enough " old Chinese

doctors " in our midst with enough years of doing this medicine in this

milieu. Further, until our schools require a basic reading knowledge

of Chinese, I do not believe we can ever reach the level of education

necessary where we can come together the way they do in China to work

out such SOC on our own. At the moment, we don't even have a

lingustically and, therefore, technically accurate lingua franca for

this profession to converse in. (Actually, we do have one but most

people refuse to use it.) If we all read Chinese, at least we would

have that as our lingua franca.

 

Bob

[Guest guest]

Stephen: Wouldn't you agree that the systematization that began in the1700's took a completely new tack in the 20th Century when Western medicaldiagnostic parameters (i.e. hypertension, etc.) were integrated into the TCMteaching textbooks at every level? Has this been good for TCM? If so, howmuch further can this integration progress before it is not good for TCM?>>>>Its more than just that you can even see influences within the Organs patterns, such as in heart disease

[Guest guest]

The integration of Western and Eastern medicine would seema natural continuation of that process.>>>>Except that a biomedical disease is a very specific entity, unlike most CM "diseases"

Alon

[Guest guest]

, " ALON MARCUS " <.

>

> >>>>Except that a biomedical disease is a very specific entity,

 

some chinese diseases are specific, too. what else do we

associate xiao ke with besides diabetes, for example? In any

event, what is the significance of your comment? the specificity

of the biomed dx suggests to me a narrower selection of

possible TCM patterns underlying perhaps, but nothing else.

 

[Guest guest]

some Chinese diseases are specific, too. what else do we associate xiao ke with besides diabetes, for example? In any event, what is the significance of your comment? the specificity of the biomed dx suggests to me a narrower selection of possible TCM patterns underlying perhaps, but nothing else. >>>>>

Much more that just that. First a "disease"is (or should be) a very specific entity that has a defined course and outcome. Even in TCM, were most "diseases" are really symptoms, the disease is more specific as to outcome. Patterns are usually general and there is no difference in them i.e. Phlegm is Phlegm. However, Phlegm as it has to do with a specific disease gives one a clinical entity that has much more relevance as to outcome, which is what I care about. Its the specific herbs (formulas) applied to the disease and modified for phlegm as a pathogenic pattern (or any other pattern) that is more likely to result in clinical success (i.e., specific herb for the disease). Not just treating Phlegm, or Yin-def etc.

Otherwise we are left with the usual cliché of "we just need to see the pattern and balance the patient," which if anybody has enough clinical experience, and is honest, knows does not work very often, on a real disease state that can be objectively evaluated.

Now biomedical diseases are very specific and as I have said in the past just looking for similar symptoms in TCM (without a mechanistic underpinning which is specific to the disease) results in a theoretical process that has little to do with actual clinical outcome. And unfortunately is done all the time. We hear allot about the need to use pattern diffentiation but this has to be disease specific to be truly meaningful. Almost all patients can present with a patterns (syndrome) however their clinical relavense is disease more than pattern specific.

Now its true that some TCM disease like hemorrhoids are the same in both biomedical model and TCM. Most internal medicine diseases however are quite different. Those that TCM has developed specific treatment for such as small pox have always been the most successfully treated (or prevented) with TCM

Alon

[Guest guest]

, " Alon Marcus " <alonmarcus@w...> wrote:

 

> Now biomedical diseases are very specific and as I have said in the

past just looking for similar symptoms in TCM (without a mechanistic

underpinning which is specific to the disease) results in a

theoretical process that has little to do with actual clinical

outcome. And unfortunately is done all the time. We hear allot about

the need to use pattern diffentiation but this has to be disease

specific to be truly meaningful. Almost all patients can present with

a patterns (syndrome) however their clinical relavense is disease

more than pattern specific.

 

Absolutely. The more one treats the clearer it is that succesful

results are dependant on knowing what herbs work for what specific

disease within the broad,and often simple, parameters of a pattern. A

clinical hint can be the most valuable information of all.

 

Simon