How to Decide on Treatment (was Shanna)

[Guest guest]

Hi Shanna and Lon,

 

If you do not mind, just to add some of my thoughts:

>

> There are three large sources of input.

>

> 1. An impression the moment I see the person based on spontaneous

>recognition prior to thought.

>

> 2. Discussion.

>

> 3. Pulses, tongue, etc.

 

This is what I observed from my own doctor and what I have modified a bit:

 

1) I agree that I first start with a visual impression.

 

2) This is followed by any other impressions that I might have based

upon my other senses.

 

3) Then a verbal discussion from which I take more than the actual

words but a sense by how the discussion transpires.

 

4) Then, sinice I use tuina and qigong, I use touch. Touch is my

primary medium of sensing. It is especially good since I hve been

practicing taiji and qigong for so long, I can feel the energy move. I

palpate all of the tendo-muscular regions as well as energetic

meridians. I ask my client to tell me where it hurts and any other

feelings they may have. I look for " energetic " as well as physical

motion. The " dantien areas " or more acurately the area that is called

the Hara in Japanese shiatsu is particularly revealing. Wherever there

is " stagnation " , I seek to move the energy through it.

 

5) I do not do any diagnosis of any sort. It is not only unnecessary

but I also feel it is a subjective manifestation of my own biases - I

in psychology I guess this would be called " projection " . :-) This

phenonmenon became very clear to me as I observed over a period of

time how each practitioner would " diagnose " me and my family based

upon their own history and perspective. I believe that the only way to

get around personal biases and subjectivity is to allow the

client/patient to guide the treatment - as opposed to the other way

around. They show me where the stagnation exists and I try to move it.

Just like a good plumber. :-) You tell me which pipe is stuck and I'll

try to release the energy. :-) To do this, it is necessary to work at

both the physical and energetic level. Something else that I have

observed.

 

6) Once the session is completed, I again have discuession and

observation. Sometimes too little is releases, sometimes just the

right amount (a mild healing release) and sometimes too much (i.e. a

significant healing crisis). But that is the uncertainty relating to

health maintenance and treatment. Even my doctor with 30 years

experience cannot predict. He just does what he believes will release

stagnation and let the energy flow again. However, experience helps to

modulate the treatments and to make the client aware of the potential

reactions.

 

7) I provide the patient/client a set of qigong exercises designed to

loosen up muscles and joints and move energy so that they can go into

a seven day self-help process. This is optimal since then they are

being treated seven days a week. Some perform these exercises most do

not. Those who do have a higher quality of health but it is up to each

individual to decide for himself/herself the quality of life that they

wish to lead.

 

My years with my doctor have led me to believe that diagnosis of any

substantial sort is interesting but not a requirement. What does seem

to be required is a very good " sense " of the situation? In order to

heighten these senses, the mind and body have to be trained. Not by

books but my activities that are designed to augment all of one's

senses - including their sixth sense. :-) I believe to learn to heal

from books is not that much different from learning to hit a golf ball

from a book. It may be possible, but the best way is to learn to relax

teh body, trust your senses and body, and " feel " the ball as you connect.

 

Just a different perspective which I hope some forum members may find

interesting enough to investigate.

 

Regards,

Rich

[Guest guest]

Chinese Medicine , " Rich "

<rfinkelstein@a...> wrote:

>

> Hi Shanna and Lon,

>

> If you do not mind, just to add some of my thoughts:

> >

> > There are three large sources of input.

> >

> > 1. An impression the moment I see the person based on

spontaneous

> >recognition prior to thought.

> >

> > 2. Discussion.

> >

> > 3. Pulses, tongue, etc.

 

Shanna: I agree. Though I think I am using thought on some level in

the spontaneous recognition. I was trained as to what a dark

complexion signifies, puffy face, blemishes in different areas of

the skin, tone of voice. I'm not so sure these are " prior to

thought " in the strictest sense. Is this what you mean?

 

>

> This is what I observed from my own doctor and what I have

modified a bit:

>

> 1) I agree that I first start with a visual impression.

>

> 2) This is followed by any other impressions that I might have

based

> upon my other senses.

>

> 3) Then a verbal discussion from which I take more than the actual

> words but a sense by how the discussion transpires.

>

> 4) Then, sinice I use tuina and qigong, I use touch. Touch is my

> primary medium of sensing. It is especially good since I hve been

> practicing taiji and qigong for so long, I can feel the energy

move. I

> palpate all of the tendo-muscular regions as well as energetic

> meridians. I ask my client to tell me where it hurts and any other

> feelings they may have. I look for " energetic " as well as physical

> motion. The " dantien areas " or more acurately the area that is

called

> the Hara in Japanese shiatsu is particularly revealing. Wherever

there

> is " stagnation " , I seek to move the energy through it.

 

I agree with you up to here. I have done " bodywork " for 15 years and

began my studies of Oriental styles in 1996 along with Tai Ji and Qi

Gong. Tui Na is indispensible in my work. I also did a one year

course in Medical Qi Gong--this I feel may take a lifetime to

develop for me; especially since I also have a BS in Biology and my

decisions as to what to do are, many times, begging for intellectual

support for my intuitions (projections? you say). But I really don't

think this poses a problem for me. I sense that the more areas from

which a person is gaining information and synthesizing this, the

better for the precision and refinement of the treatment. If I get a

strong intuition, I see no problem with also trying to gain input

from the other methods of diagnosis to validate the intuition.

 

>

> 5) I do not do any diagnosis of any sort. It is not only

unnecessary

> but I also feel it is a subjective manifestation of my own biases -

I

> in psychology I guess this would be called " projection " . :-) This

> phenonmenon became very clear to me as I observed over a period of

> time how each practitioner would " diagnose " me and my family based

> upon their own history and perspective. I believe that the only

way to

> get around personal biases and subjectivity is to allow the

> client/patient to guide the treatment - as opposed to the other way

> around. They show me where the stagnation exists and I try to move

it.

> Just like a good plumber. :-) You tell me which pipe is stuck and

I'll

> try to release the energy. :-) To do this, it is necessary to work

at

> both the physical and energetic level. Something else that I have

> observed.

 

I understand what you are saying but instances of projection, IMHO,

may be more due to operating from the exact opposite end of the

spectrum as do you. What about coming from the middle where

intuition and syndrome differentiation meet? As to moving

stagnations and the like with out diff dx, this is much more

appropriate in Tui Na and Qi Gong practice. I, too, have done this;

especially when I find my training and experience inadequate to get

me to the " right " acu/herbal dx and treatment. I don't consider this

a higher refinement, however. I look at it like having to push start

a car when, for some reason, the key won't work. Eventually you want

to get the ignition, battery, starter or points fixed. But until

then, it's possible to push start it--just not too elegant. Do you

also use these methods ie no diagnosis, when prescribing herbs?

This, I think, could prove kind of dangerous. However, I do try to

suspend disbelief with respect to others' methods. Perhaps you have

found a way. Do you ever modify formulas and if so, is it done by

intuition too?

 

 

>

> 6) Once the session is completed, I again have discuession and

> observation. Sometimes too little is releases, sometimes just the

> right amount (a mild healing release) and sometimes too much (i.e.

a

> significant healing crisis). But that is the uncertainty relating

to

> health maintenance and treatment. Even my doctor with 30 years

> experience cannot predict. He just does what he believes will

release

> stagnation and let the energy flow again. However, experience

helps to

> modulate the treatments and to make the client aware of the

potential

> reactions.

 

Shanna: Is there, in your system, a wrong treatment and, if so, how

would you determine the difference between wrong and healing crisis?

Could it be that when less then optimal results occur that something

was supplemented that should have been dispersed or vice versa?

Perhaps the wrong merdians were addressed leaving the " ill "

meridians more wanting than before treatment? This seems the long

way round. If my patient doesn't feel better, I change my approach.

Though I have seen what I might call " healing crisis " it is usually

very slight. Example: A woman with painful, heavy, clotted menses

every other month, recedeing hairline, varicose vein of the leg

after about 4 treatments to address Blood xu/Blood stasis presented

with " snakeskin " legs. I considered this a good sign that stasis at

the skin level was clearing out and by the next treatment her skin

was vibrant and pliable. She now has a halo of new, healthy hair at

her hairline and her menses are becoming less problematic with few

clots last time and moderate flow after two months of treatment.

BTW, she had no blood stasis or blood xu signs on her tongue. I

operated off the questioning aspect of diagnosis using her history

to substantiate treatment in this case. The pulse was, however,

somewhat choppy. I think it's important that we consider that if a

patient is not markedly better after treatment, perhaps our

treatment needs refining. Many times I resort to more questioning,

especially history both pre and post natal, and childhood

expereinces such as wheather the person was beaten regularly

(retained blood stasis). The latter has proven especially telling in

longterm depression patients who may show few signs (even toungue

and pulse in the beginning) of blood stasis--maybe just persistent,

stabbing, shoulder pain. After beginning to move blood stasis,

static macules appear on the tongue (mild healing crisis or

experience of signs in reverse order) and depression lifts.

 

 

>

> 7) I provide the patient/client a set of qigong exercises designed

to

> loosen up muscles and joints and move energy so that they can go

into

> a seven day self-help process. This is optimal since then they are

> being treated seven days a week. Some perform these exercises most

do

> not. Those who do have a higher quality of health but it is up to

each

> individual to decide for himself/herself the quality of life that

they

> wish to lead.

 

Shanna: I doubt most people want to lead a less than optimal quality

of life. But many do feel overwhelmed by too much " homework " and

unless they are feeling pretty significant results in the clinic,

they won't be that inspired to try many of the practitioners

suggestions. I try to plant the seed with the patient that as they

experience more well-being from the treatments, that they will

automatically gravitate toward performing the qi gong exercises,

improving their diet and abstaining from poisons or self-medication

such as alcohol, cigarettes, pot etc.

 

>

> My years with my doctor have led me to believe that diagnosis of

any

> substantial sort is interesting but not a requirement. What does

seem

> to be required is a very good " sense " of the situation? In order to

> heighten these senses, the mind and body have to be trained. Not by

> books but my activities that are designed to augment all of one's

> senses - including their sixth sense. :-) I believe to learn to

heal

> from books is not that much different from learning to hit a golf

ball

> from a book. It may be possible, but the best way is to learn to

relax

> teh body, trust your senses and body, and " feel " the ball as you

connect.

>

> Just a different perspective which I hope some forum members may

find

> interesting enough to investigate.

>

> Regards,

> Rich

 

Shanna: Thanks for sharing, Rich. I can see that you are a

passionate, caring practitioner and feel honored to have a mentor to

reference your practice to. Good luck with your patients and your

practice.

 

Regards, Shanna

[Guest guest]

Hi Shanna,

 

>

> Shanna: I agree. Though I think I am using thought on some level in

> the spontaneous recognition. I was trained as to what a dark

> complexion signifies, puffy face, blemishes in different areas of

> the skin, tone of voice. I'm not so sure these are " prior to

> thought " in the strictest sense. Is this what you mean?

 

Yes. Some things I noticed are those that I may have learned, such as

those that you mention - others are things that I " know " (e.g. a

hunched back). They all provide a certain picture of the person. It is

getting to know the person, just like picking up a golf club and

beginning the process of understanding.

 

 

> I agree with you up to here. I have done " bodywork " for 15 years and

> began my studies of Oriental styles in 1996 along with Tai Ji and Qi

> Gong. Tui Na is indispensible in my work.

 

Yes, I have found that these skills are at the root of Chinese

medicine, and therefore, as you indicate, indispensible. I believe

that through these practices (meditative and movement), the concept of

qi and yin/yang were conceived and from that an " understanding " of the

human life and spirit from which the road to better health can be

better understood.

 

>I also did a one year

> course in Medical Qi Gong--this I feel may take a lifetime to

> develop for me; especially since I also have a BS in Biology and my

> decisions as to what to do are, many times, begging for intellectual

> support for my intuitions (projections? you say).

 

Yes, I understand the paradoxes since I am a System Engineer and

Computer Analyst by training. It is true that anything like Qigong can

be a lifetime of training, but it can be useful within a very short time.

 

 

>But I really don't

> think this poses a problem for me. I sense that the more areas from

> which a person is gaining information and synthesizing this, the

> better for the precision and refinement of the treatment. If I get a

> strong intuition, I see no problem with also trying to gain input

> from the other methods of diagnosis to validate the intuition.

 

I think this is a very nice way to put it.

 

 

 

>

> I understand what you are saying but instances of projection, IMHO,

> may be more due to operating from the exact opposite end of the

> spectrum as do you. What about coming from the middle where

> intuition and syndrome differentiation meet?

 

I have tried this, but there are a whole host of problems. No matter

how I try, I cannot unify the two perspectives, so I have decided to

look at everything from the point of view of the " whole " . I begin with

a perspective that the human body is designed to adapt, to heal itself

and it does this through a system that is designed to " flow " . A

particular problem can be caused by obstructions at any location

within the system, though the manifestation may be at one location.

Just like a blockage in a sewer system can cause overflow in any

number of locations in the complete system. So I stay away from the

notion of looking at the " symptoms " (e.g. the points of overflow) and

just look for obstructions - mental, physical, spiritual. If the

system is flowing, the " overflows " (or deficiencies) will naturally go

away whereever they manifest themselves. I have observed that his

model works at least as well as the TCM diagnosis model - and maybe

much better. But to remove " obstructions " it is necessary to work on

all layers - the physical (compressed energy or qi) and energetic

(uncompressed qi) - thus the need for Tuina and Qigong skills.

 

 

As to moving

> stagnations and the like with out diff dx, this is much more

> appropriate in Tui Na and Qi Gong practice.

 

Yes, I very much agree.

 

I, too, have done this;

> especially when I find my training and experience inadequate to get

> me to the " right " acu/herbal dx and treatment. I don't consider this

> a higher refinement, however. I look at it like having to push start

> a car when, for some reason, the key won't work. Eventually you want

> to get the ignition, battery, starter or points fixed. But until

> then, it's possible to push start it--just not too elegant. Do you

> also use these methods ie no diagnosis, when prescribing herbs?

 

I have not been trained with herbs though I did use them - with doctor

guidance - for over 15 years. My family and my friends no longer use

any herbs since we have found that Tuina sufficient - and more effect

- in all cases that we have come across so far. This view may change -

as it likely will over time - but I have not idea what my new views

will be since they haven't happened yet. :-) But I do agree, that I

were to use herbs in an " intuitive " way, it would probably yield very

undesirable results. The reason we and are friends have modified our

approach and no longer use herbs is because it appears to be very safe

to massage our bodies and exercise our joints to maintain good health

and does not require much training. In fact, it is very, very natural.

Qigong itself is very safe if practiced in a relaxed (i.e., not

willful, non-goal-oriented) manner. There is always a problem though

if one " pushes " to hard - whether it be herbs, acupuncture, qigong or

massage.

 

 

>

..

>

> Shanna: Is there, in your system, a wrong treatment and, if so, how

> would you determine the difference between wrong and healing crisis?

 

A healing crisis can be observed by the " direction " of the healing

effect. I found Herings Law to be of tremendous use throughout my

years. For example when my newborn son was being treated, using

and Homeopathy, for asthma and an extreme case of

eczema, we observed that the skin rashes were getting much worse but

his " moods " were getting better (e.g. less crying more smiling). Thus

we saw the emotions suggesting to us that the direction was correct

and the rashes were getting " worse " because the body was releasing the

toxins in his body (most likely caused by the vaccinations he took).

The asthma went away within a couple of weeks and the rashes cleared

slowly over the course of months.

 

Yes, there can be wrong physical treatments - e.g. pressing too hard

that it actually causes injury, so it is best to start very easy. The

course of treatment is longer but it is safer. As for qigong, it is

possible for the " negative energy " to " backup " into the practitioner

but there are ways to " clear " the energy first and create a " block " to

prevent this problem. I have observed that qigong practitioners who do

not take these steps seem to get tired very quickly. It does take a

certain amount of training and apprenticeship but it is not

overwhelming. In any case, much faster and simpler than learning the

Chinese language, culture, and interpreting classics.

 

> Could it be that when less then optimal results occur that something

> was supplemented that should have been dispersed or vice versa?

 

I never think about supplementing. Just oppening up the energetic and

physical " pipes " . I may " jumpstart " with some qigong, but it is

interesting that it is really the client that is deciding when and how

much qi to take in. This is very, very interesting and I have observed

it many times.

 

> Perhaps the wrong merdians were addressed leaving the " ill "

> meridians more wanting than before treatment?

 

Actually all meridians are addressed. " Painful areas " usually indicate

obstruction, but everything is massaged to make sure that there is flow.

 

 

> I think it's important that we consider that if a

> patient is not markedly better after treatment, perhaps our

> treatment needs refining.

 

This is an interesting example. I usually rely on the client/patient

to decide if they are feeling better. Usually they will " feel better "

first before it shows physically. A client may look abysmal after

cupping but feel great! :-) I have found cupping to be another

indispensible aspect of bodywork practice.

 

 

> Many times I resort to more questioning,

> especially history both pre and post natal,

 

I think it is a great idea to maintain conversation. I am always

talking to my client while I am treating him/her. I want to understand

what they are feeling and I would like them to feel that they are in

control of the process. They guide me and I am there to facilitate.

 

> >

> > 7) I provide the patient/client a set of qigong exercises designed

> to

> > loosen up muscles and joints and move energy so that they can go

> into

> > a seven day self-help process. This is optimal since then they are

> > being treated seven days a week. Some perform these exercises most

> do

> > not. Those who do have a higher quality of health but it is up to

> each

> > individual to decide for himself/herself the quality of life that

> they

> > wish to lead.

>

> Shanna: I doubt most people want to lead a less than optimal quality

> of life. But many do feel overwhelmed by too much " homework " and

> unless they are feeling pretty significant results in the clinic,

> they won't be that inspired to try many of the practitioners

> suggestions.

 

I agree. I also think that people do not have much time in their lives

and they tend to continue to spend " time " as they have in the past

unless there is sufficient reason to change. Unfortunately, many

(most?) people do not change until there is a crisis. They like the

bodywork but they do not want to do it on themselves because they have

other things they want to do. This is their choice and I do not second

guess because I have been there also. :-)

 

 

> Shanna: Thanks for sharing, Rich. I can see that you are a

> passionate, caring practitioner and feel honored to have a mentor to

> reference your practice to. Good luck with your patients and your

> practice.

 

Thank you for your kind thoughts and comments. It seems to me that you

are investigating different approaches as I am because you would like

to bring the best care to your patients and I am very thankful that

you have found the time to share some of your thoughts with me.

 

Kind regards,

Rich