Herbalisation and methods of decoction

May 21, 2004

Hi Zev and John,

I heard that Bob Flaws was talking about the herbalisation of acupuncture,

in that acupuncture never really used tongue and pulse analysis or had

syndrome categorisation. In both hospitals, the acupuncture I saw is very

symptomatic, with slight alterations for different patients based upon what

is either a syndrome differentiation analysis or raw experience. So perhaps

acupuncture was always like this, I can't really say. Although I totally

agree that all aspects of TCM, whether herbal, acupuncture, Tuina or

nutrition, should be based upon a syndrome differentiation analysis and

treatment strategy (Bian Zheng Lun Zhi), otherwise what are we doing,

roaming around the world proclaiming that an ancient medicine has the power

to heal over allopathic medicine when our foundation is merely based upon WM

symptomatic treatment.

Personally, I'm still a little confused about the use of powders and

graduals. Isn't it the actual decoction, the act of cooking, that formulises

the therapeutic substances found in a formula? To increase patient

compliance, which is always a major problem with herbs is a difficult issue.

Powders, granules, pills, etc, go someway to resolving this issue. However,

during my stay in China I've noticed the hospitals and most pharmacies are

using a machine I believe was developed in South Korea. It cooks the whole

decoction, I.e. a weeks worth and packs and seals them into plastic bags.

Each bag is one dose, so one bag in the morning and one in the evening. The

bag can be either micro waved (shudder) or heated in boiling water. Of

course this doesn't get away from the question raised here about owning and

managing your own inventory of herbs. I have not encountered many

practitioners in the UK with these problems. What I am suggesting is the use

of this machine in an effort to increase patient compliance which is a major

stumbling block to the use of herbs (the decoction is refined and has no

nasty soil bits in it), and therefore increase treatment effect. This will

of course, benefit patients and TCM.

Kind regards

Attilio

<traditional_Chinese_medicine>

traditional_Chinese_medicine

[zrosenbe]

21 May 2004 01:44

Chinese Medicine

Re: R: Herbal Therapy: Bo He

I don't feel that high quality granular or liquid extracts are any kind

of compromise. There are several factors to consider when prescribing

herbal medicine or any other treatment (acupuncture/moxabustion, diet

therapy, etc.) to patients which includes compliance, dosage, length of

time taking herbs, specific conditions, etc. Different things work for

different people, and the important thing is to come up with the best

treatment for each patient that is possible.

This is why the 'weight loss' protocol thing irks me so much. It

completely bypasses one of the cornerstones of Chinese medicine, which

is individualized treatment based on pattern, pulse and tongue

diagnosis. To give the same point or herb prescription to patients is

completely forsaking the roots of our medicine.

May 21, 2004

Attilio,

I think the condenser machines that the Koreans developed are one of

the pathways to the future in terms of herb preparation and compliance.

My colleague Bob Damone has one, but the drawback is that it is quite

expensive to maintain and sell unless you have a centralized pharmacy

such as in a TCM hospital.

On May 20, 2004, at 7:29 PM, Attilio D'Alberto wrote:

>

> Personally, I'm still a little confused about the use of powders and

> graduals. Isn't it the actual decoction, the act of cooking, that

> formulises

> the therapeutic substances found in a formula? To increase patient

> compliance, which is always a major problem with herbs is a difficult

> issue.

> Powders, granules, pills, etc, go someway to resolving this issue.

> However,

> during my stay in China I've noticed the hospitals and most

> pharmacies are

> using a machine I believe was developed in South Korea. It cooks the

> whole

> decoction, I.e. a weeks worth and packs and seals them into plastic

> bags.

> Each bag is one dose, so one bag in the morning and one in the

> evening. The

> bag can be either micro waved (shudder) or heated in boiling water. Of

> course this doesn't get away from the question raised here about

> owning and

> managing your own inventory of herbs. I have not encountered many

> practitioners in the UK with these problems. What I am suggesting is

> the use

> of this machine in an effort to increase patient compliance which is

> a major

> stumbling block to the use of herbs (the decoction is refined and has

> no

> nasty soil bits in it), and therefore increase treatment effect. This

> will

> of course, benefit patients and TCM.

>

May 21, 2004

Hi Zev,

Many standard pharmacies were using them aswell. I also know of one clinic

in London using it.

Can you please explain the drawbacks of cost and maintenance in detail as I

and my colleagues are considering buying these machines.

Kind regards

Attilio

<traditional_Chinese_medicine>

traditional_Chinese_medicine

[zrosenbe]

21 May 2004 04:08

Chinese Medicine

Re: Herbalisation and methods of decoction

Attilio,

I think the condenser machines that the Koreans developed are one of

the pathways to the future in terms of herb preparation and compliance.

My colleague Bob Damone has one, but the drawback is that it is quite

expensive to maintain and sell unless you have a centralized pharmacy

such as in a TCM hospital.

On May 20, 2004, at 7:29 PM, Attilio D'Alberto wrote:

D uring my stay in China I've noticed the hospitals and most

> pharmacies are

> using a machine I believe was developed in South Korea. It cooks the

> whole

> decoction, I.e. a weeks worth and packs and seals them into plastic

> bags.

> Each bag is one dose, so one bag in the morning and one in the

> evening. The

> bag can be either micro waved (shudder) or heated in boiling water. Of

> course this doesn't get away from the question raised here about

> owning and

> managing your own inventory of herbs. I have not encountered many

> practitioners in the UK with these problems. What I am suggesting is

> the use

> of this machine in an effort to increase patient compliance which is

> a major

> stumbling block to the use of herbs (the decoction is refined and has

> no

> nasty soil bits in it), and therefore increase treatment effect. This

> will

> of course, benefit patients and TCM.

May 21, 2004

Clearly acupuncture has always relied on pulse diagnosis. Its roots

are in the Su Wen, Ling Shu and Nan Jing, which developed a pulse

system specifically for acupuncture. It remains the roots of much of

Japanese, Chinese and Korean methods of channel-based acupuncture.

Tongue diagnosis had a later development in Chinese medical history,

that is true. However, even TCM acupuncture as taught includes point

prescriptions based on tongue, pulse and pattern differentiation (even

though zang-fu pattern differentiation rather than jing-luo). It is

this fact that is the root of the different development and style of

TCM acupuncture, that it is based on the same zang-fu pattern

differentiation as herbal medicine.

However, using one point protocol for a problem such as weight loss is

not based on any pattern differentiation whatsoever. It undermines the

argument for comprehensive training in acupuncture/moxabustion, as

anyone with 100 hours of training can learn how to do a simple point

prescription like the one that has been discussed here.

On May 20, 2004, at 7:29 PM, Attilio D'Alberto wrote:

>

> I heard that Bob Flaws was talking about the herbalisation of

> acupuncture,

> in that acupuncture never really used tongue and pulse analysis or had

> syndrome categorisation. In both hospitals, the acupuncture I saw is

> very

> symptomatic, with slight alterations for different patients based

> upon what

> is either a syndrome differentiation analysis or raw experience. So

> perhaps

> acupuncture was always like this, I can't really say. Although I

> totally

> agree that all aspects of TCM, whether herbal, acupuncture, Tuina or

> nutrition, should be based upon a syndrome differentiation analysis

> and

> treatment strategy (Bian Zheng Lun Zhi), otherwise what are we doing,

> roaming around the world proclaiming that an ancient medicine has the

> power

> to heal over allopathic medicine when our foundation is merely based

> upon WM

> symptomatic treatment.

>

May 21, 2004

Attilio, I have about a billion pages worth of thoughts on these few

paragraphs you've written, but I'll summarize for all our sakes...

First, I have to vocalize a concern relating to an underlying beleif I see

a lot. There's a common idea that the Chinese know Chinese medicine better

simply because they're Chinese. Or, more pointedly, that a Chinese-trained CM

physician is 'better' or knows more or knows CM better than a non-Chinese

trained practitioner. And, related, CM, as practiced in China and taught in

Chinese hospitals, is the standard of what CM is. That is, the belief that

'it's done this way in China, therefore, that must be " right " '. And, along

these lines, people equate TCM, as the style currently dominating mainland

China, with CM.

What I want to say is the contemporary teaching and practice of Chinese

medicine in mainland China cannot be used as any absolute standard. The

communist inlfuence (and influence is a gross understatement) on resulted in

a... unique style of the medicine. Long story short, there are many different

ways of practicing CM that are very different from CM as practiced in China, yet

still very much Chinese medicine. In fact, in my belief (emphasis), there are

many ways of of doing CM that are closer to the roots/fundamentals/essential

aspects of CM than CM as practiced in China. In many, many ways, CM as taught

and practiced in China is categorically not true to the roots of CM. But I

diverge...

For a better picture of pre-TCM acupuncture, read the Jia Yi Jing

('Systematic Classic of Acupuncture' or 'ABC's of Acupuncture'), or, of course,

the Ling Shu or Nan Ching, or translations of the Zhen Jiu Da Cheng ('Grand

Compendium of Acupuncture') - all available in English. TCM acupuncture is

definitely different. Points were given herbal-type indications, instead of

meridian pathway, qi-flow type.

I'm, in fact, starting a low-income acupuncture clinic, and it's going to

rely heavily on non-TCM point selection methods, such as Zi Wu Liu Zhu Liao Fa

(Midday-midnight method) and Ling Gui Ba Fa (Eightfold Method of the Sacred

Tortoise). These have to do with point selection based on the the cyclical

movement of qi through the channels (i.e. 'open' points), not Qi-Blood-Body

Fluid or zangfu theory, and it's all very much CM.

So the core, defining characteistics of CM are not zangfu or six stage

theory. Yin-yang or five element theory isn't even the core. One could do all

these, and yet do them in a way that is counter to classical Chinese medical

practice. It's not these theories that make CM CM. It's the fundamental

philosophical paradigms they're rooted in, such as inductive reasoning versus

deductive, holism or synthetic reasoning versus reductionism. Whether you're

discussing yin vacuity or Spleen Qi vacuity, if you analize these things outside

of the context of that patient at that moment, then you're falling short of the

standard of CM.

Zev spoke of this when he wrote about 'individualized treatments'. We

treat people and the unique patterns they present with, not disease classes or

categories. Migraines cannot be treated, by deafult, as Liver Yang rising;

Weight loss cannot be treated as Spleen Qi vacuity with Damp with standardized

point protocols AND be called Chinese medicine.

Now, to tie it into your posting, in hopes of concealing the fact that I

just diverged as a means of venting over some deeper issues I hold, How do we

even begin by asking what the 'best' (please take note of the quotes) form of CH

is? Obviously, we're looking for a standard of some sort. One standard is

'What works?' Another is 'What's consistent with the essentials of CM as

discovered and proven over thousands of years?' Yet another would be 'What's

practical?'

I'm pretty stuborn with the essentials of CM one. Many things 'work'; I

want something (a system or model of healing) that offers a high level of

confidence in offering consistently accurate and effective treatments. What can

offer such confidence? I could spend my whole life experimenting or going with

what feels right, and if I keep good notes, this information would have some

value (i.e. could promise another person some level of confidence that they

could learn use it to do effective treatments). Now, imgaine if one hundred

generations of practitioners did this, inlcuding the occasional

sage-practitioner and outright masters? Now THAT system holds high value. If

you listened to their advice, learned from their experiences, you would be

pretty effective. You could listen to some of it, but try some new stuff, and

you'd lose some degree of confidence. You don't know how your new stuff will

work... 'cause it's new. This is what patents, pills, and powders are doing.

It's kind of based in tradition and kind of not (i.e. what's been proven to

work). There is nothing inherently wrong with any of it (very important point).

Patents do have effect. Powders do have effect. Yes, they 'work'. But how

well? How effective? There are a thousand unanswered questions. When I create

a bulk formula, I highly modify it. I'll add and substract herbs based on my

patient's presentation, AND I'll adjust the dosage of every single herb for my

patient. I, literally, create completely new formulas (via additions,

subtractions, and dosing) for every patient, and I do this based on the

collective experience of hundreds of thousands of practitioners and millions of

patient interactions. That's power! As Einstein, I think, said 'If I have seen

further than others before me, it is because I stand on the shoulders of

giants.' I offer my patients the wisdom of a hundred generations, not the

resutls of two decades of trying new things...

I'm going on and on, here. There's nothing wrong with new things and new

ways of doing things. I mean that. It's the only way traditional ways ever

come to be. But are we progressing or straying? I love CM because it's an

avenue for discovering/experiencing 'It'. I use it, essentially, as a tool for

assisting the evolving soul. Call it a return to the true self; call it a path

to enlightenment; call it 'perfect' health. 'It' can be found in CM (CM bigger

than TCM).

There yah go.

- John

Attilio D'Alberto <attiliodalberto wrote: