Branch v Root: What constitutes a diagnosis?

September 20, 2004

Hi All, & Steve

Steve wrote:

> To me, abdominal pain is a diagnosis, just not a specific or

> particularly helpful one. So perhaps we are in conflict over what

> is a TCM Dx versus a different type of investigation/Dx

IMO, abdominal pain (or headache, or insomnia, or prostate

cancer, etc) is NOT a proper Dx! It is merely a MANIFESTATION

(BRANCH, clinical sign or symptom) of an underlying problem.

IMO, the best Dx, whether in WM or TCM, tries to specify the

ROOT cause(s) of the problem.

For example, the cardiomyopathy (lesion, sign) that killed many

children in Keshan Province might have been diagnosed by TCM

practitioners [who probably had no knowledge of mineral nutrition]

as HT Xue Stasis, HT Xue Xu, Xue Stas in SJU, or a hundred other

attempts at TCM Dx. WM experts at the time of the earliest

outbreaks might have diagnosed " idiopathic cardiomyopathy " - also

a futile and useless Dx.

Would those TCM or WM diagnoses have led to effective Tx and

prevention of Keshan Disease? I doubt it very much!

Only after many years of concerted multidisciplinary research was

the most important causal factor (endemic selenium deficiency)

confirmed. Once that was known, effedtive prevention was easy:

supply adequate amounts of selenium supplements (Na selenate

or selenite tablets) to at-risk children. That (as far as I know) was

the end of Keshan Disease.

See:http://www.medterms.com/script/main/art.asp?articlekey=4101

and http://www.healthwell.com/hnbreakthroughs/jan99/news3.cfm

Unfortunately, once the cardiomyonecrosis of selenium deficiency

is present, supplementation with Se can do little to reverse (treat)

it. See: http://tinyurl.com/5mrmx Most selenium in the body is

contained in glutathione peroxidase. Tissue levels of selenium

reflect geographical location. Many regions of the US, including the

Southwest, are low in selenium. Keshan disease (named for the

Chinese province where it was discovered) is a cardiomyopathy of

children living in areas where the soil is low in selenium. Keshan

disease can be prevented by supplementation of individuals at risk.

However once established, Keshan disease is not reversed by

selenium supplementation. Selenium intake also may be related to

cancer mortality. Patients with cancer have lowered plasma

selenium levels and risk of cancer may be higher in individuals with

low selenium intake. A 10-year study of more than 1,300 subjects

at the Arizona Cancer Center taking 200 µg selenium per day

showed a 63% reduction in prostate cancer, a 58% reduction in

colon cancer and a 46% reduction in lung cancer, but no effect on

skin cancer. Although these results are extremely encouraging,

further studies are needed before making public health

recommendations regarding selenium supplementation.

IMO, any TCM practitioner who thinks that TCM Dx is sufficient for

all cases is a menace to society. Equally, any MD or Vet who

thinks that their WM Dx is sufficient can be an equal menace. We

all are learning slowly, and we should make great attempts NOT to

remain stuck (blocked) in PAST thinking!

Medicine and healing is a huge field, with an incredible amount

published on it. For example, Medline adds circa 800,000 new

titles per year.

Despits all the writings (in WM and TCM), much of the murky

deeps of disease are unplumbed and uncharted. Those who must

try to navigate those areas have poorly drawn charts from which to

make their decisions.

Best regards,

Email: <

WORK : Teagasc Research Management, Sandymount Ave., Dublin 4, Ireland

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Chinese Proverb: " Man who says it can't be done, should not interrupt man doing

it "

September 21, 2004

On 21/09/2004, at 8:34 AM, wrote:

> Hi All, & Steve

>

> Steve wrote:

>> To me, abdominal pain is a diagnosis, just not a specific or

>> particularly helpful one. So perhaps we are in conflict over what

>> is a TCM Dx versus a different type of investigation/Dx

>

> IMO, abdominal pain (or headache, or insomnia, or prostate

> cancer, etc) is NOT a proper Dx! It is merely a MANIFESTATION

> (BRANCH, clinical sign or symptom) of an underlying problem.

>

> IMO, the best Dx, whether in WM or TCM, tries to specify the

> ROOT cause(s) of the problem.

>

Phil,

Perhaps my context was not clear in that statement due to the context

being lost in the snippet. My statement was made in a long conversation

regarding the necessity of some form of diagnosis it a TCM treatment.

Thus my reply was that ANY sign, symptom, manifestation, 'disease " etc

is part of a diagnosis (just not a complete one).

This reply was to the claim that TCM physicians often treat without ANY

diagnosis.The point I was trying to make was that no matter how general

or vague, something as simple as " abdominal pain " is part of a

diagnosis...... " just not a specific or particularly helpful one " .

I never said abdominal pain was a full nor proper diagnosis; in fact, I

tried to say that clearly in that sentence. However I hold that it is

PART of a diagnosis and is thus part of a diagnostic process.

As far as I have been taught, a TCM diagnosis is made of two main

parts. A disease diagnosis and the related pattern/syndrome

differentiation/s. What I call a 'disease' diagnosis may be what you

describe as a manifestation here. Personally, I thought the term

manifestation reffered to any sign or symptom.

I usually find that the 'disease' part of the diagnosis corresponds to

the cheif complaint of the patient, but may be a specific TCM disease

entity or a WM disease label the patient brings to me as their

condition.

IMO, finding the ROOT is the best approach for a chronic or long-term

condition. In my practice the root certainly is the most important as I

predominately deal with patients who have a long-term chronic illness

that they have not found relief from after years of more conventional

treatment.

The BRANCH however is often the most appropriate part of a condition to

address in acute conditions eg. unconciousness, bleeding, severe pain,

difficult breathing etc. These must be address initially so the patient

is given symptomatic relieve before the actual root of a condition is

addressed.

Root and branch differentiation's also assist me to clarify what

diseases processes are in action and can help to design more targeted

treatment principles in a case. Perhaps, they could be said to go

deeper than both a disease and syndrome/s differentiation.

As with all in TCM, I find that I will will rarely be neglecting one

aspect to the total exclusion to another. That is, I rarely find it

appropriate to only address either the root or branch; they will both

be addressed to some degree......just the emphasis will more often than

not be directed to one or the other.

>

> IMO, any TCM practitioner who thinks that TCM Dx is sufficient for

> all cases is a menace to society. Equally, any MD or Vet who

> thinks that their WM Dx is sufficient can be an equal menace. We

> all are learning slowly, and we should make great attempts NOT to

> remain stuck (blocked) in PAST thinking!

>

The process of a TCM diagnosis is all I can legally and ethically

engage in due to both professional training and access to pathology

services (although WM diagnosis and pathological investigations are

commonplace in China's TCM hospitals). I agree that a TCM Dx will not

be sufficient for all cases, but it is what I MUST to do provide

initial treatment and I will refer out when from clinical experience or

professional education has indicated that further investigations and/or

treatment methods (such as WM, bodywork, counselling etc.) should be

considered or recommended.

Just for the record, I am not one of those individuals who believe that

TCM can cure everything or has a monopoly on the best treatments for

all conditions. I particularly feel this way about acute trauma and

psycho-emotional conditions. I know my area of competence and have no

trouble referring patients on to those who can offer better and/or

different treatment strategies for the patients best benefit. What is

best for the patient comes first in all my practice.

I am sorry to hear about the tragedy of Keshan Province. This is a good

of example of all therapies having a lot to learn and the importance of

research, referral and communication between TCM, WM, nutritionists

etc.

So IMO, a diagnosis in TCM is constituted by two parts:-

1) A diseases diagnosis/es - usually either the chief complaint, the

previously designated WM condition, or the professionally recognised

TCM disease label. eg. " Headache " , " Anaemia " or " Bi zheng " .

2) A pattern/syndrome differentiation/s - that accounts for each

disease in 1) above.

Branch and Root are important considerations when designing the

appropriate order of syndromes and thus treatment principles to address

the patients condition at one particular moment.

It is nice to actually discuss some clinically orientated material

again; was this your intention Phil? :-D

Best Wishes,

Steve

September 22, 2004