TCM v WM DIagnosis - and why it could be crucial

[Guest guest]

Hi Phil,

 

This is a difficult topic to address due to restrictions placed upon me

by the moral, ethical and legal obligations I am under as a TCM

practitioner in Australia. They basically revolve around what I should

know and what I cannot know. In these situations, what " I should know "

and " what I cannot know " are the same. I will try to explain if I

can.......

 

As major part of professional TCM education here (Australia) we must do

basic training in all western medical sciences (from genetics and

histology, through anat. & phys., to pathology and differential

diagnosis). This is theoretically designed to address just the topic

and the related questions that are raised here in your post i.e. can

you diagnose a " potentially " crucial pathology and do you know when to

refer?

 

The Catch-22 position a TCM practitioner is placed in now is that we

SHOULD recognise a patients presenting signs and symptoms when they MAY

indicate a problem or condition out of their scope of practice and for

which immediate referral is indicated. The first problem is that I can

not actually (ethically or legally) make any diagnosis beyond a TCM

style one, but I am expected to be able to do so (at least

provisionally) to know when to refer.

 

Where that leaves TCM practitioners in Australia is in the position of

being expected to be a Medical GP (general practitioner) but without

the same training and access to referral resources, and all the while;

we would be breaking various medical acts if we actually did what was

expected of us.

 

I will say that I ALWAYS ask my patient what diagnosis and/or tests

they have had for the presenting condition, whether it is worsening

etc. as part of my initial case history. If they have symptoms that

have not been assessed by a WM practitioner that I feel could be a

concern based on my WM knowledge OR my knowledge of potentially

dangerous TCM Dx; I will tell them to get assessed by their

GP...............this is all I can do and I will apply my treatment

based upon TCM Dx regardless (anything else would be unethical and

illegal). If they return to me after seeing their GP and having

relevant tests; I will reassess the situation and discuss the options

with the patient.

 

On 28/09/2004, at 7:51 AM, wrote:

 

>

> Hi Steve, & All,

>

> IMO, a TCM diagnosis can miss crucial pathology that requires

> immediate WM intervention, such as surgery +/- chemotherapy /

> radiation therapy.

>

> Any delay in referring the client (while trying acupuncture or herbal

> medicine, based on the TCM Dx) could waste valuable time and

> increase the risk to the client's life.

>

I do not really agree with this on the whole if the term TCM here is

being used in terms of the recent TCM as taught in China and some

countries in the west.

 

I guess IMO it comes down to the practitioners awareness of what TCM Dx

are possible indications for referral for WM investigation or

treatment. This will obviously in large part depend upon their

theoretical and clinic training. Modern TCM includes such

knowledge.....however, I am certain other traditions do not as they are

much more independent of WM medical knowledge. This is one reason a

proper professional education is necessary for either practising or

giving advice that is the domain of a primary contact health care

provider (but I don't won't revisit that topic:-P).

 

What TCM patterns and conditions which require either WM investigations

and/or treatment or a combined approach are taught in China and this

was also the case in my studies in Australia which involved 1 year

clinical internship in China. I fully acknowledge that this may not be

the case in all countries and non-TCM Chinese medicine.

 

One problem I think needed addressing with my WM science training was

that it covered TOO much and allowed the important conditions to be

mixed up with all the possible WM differential diagnoses; including

conditions that respond better to TCM and thus don't require a WM

diagnosis or investigation. IMO the conditions should have been

restricted largely to those that really are best addressed by WM and

those that are indications for referral.

 

Having said all that; performing a proper TCM Dx WILL indicate areas

that I would consider for immediate referral eg. syncope due internal

" wind/phlegm " or or yin/yang " collapse " or " true " Heart pain/severe

zhong Bi due to Heart Yang collapse or blood stasis etc. Thus I would

be relying on my knowledge of both TCM and WM; but never offer a WM

diagnosis and use my TCM Dx as my treatment approach.

 

So, I believe TCM Dx certainly indicates conditions that should be

refereed for WM investigation and/or treatment.

 

Off the top of my head, perhaps we could say that conditions involving

syncope (loss of conscoiusness), seizures, and Wei syndromes without

consideration of WM are IMO not appropriate. I would refer a patient

with such a condition with the hope the GP would not delay in arranging

appropriate investigations and treatments and would be happy to

collaborate with any further treatment upon the patient wishes.

 

 

> My questions to experienced TCM clinicians are:

>

 

I would not include myself in this category, but I will offer an answer

as I assume you are addressing the question partly to me.

 

> (a) How long do you WAIT before referring patients with such

> symptoms to a specialist in neurology / oncosurgery?

>

 

Impossible to directly do this in Australia, I can only refer to a GP

for preliminary assessment. Which means, the GP must be competent

enough to refer to a specialist and appropriate tests. I can only

recommend that a patient see their GP or go to the ER (if condition is

possibly immediately dangerous), then their GP can refer on to a

specialist if THEY see fit to do more than give them an aspirin and

" see what happens " . Some TCM practitioners have developed referral

networks over time which allow them to get more direct referrals via

" knowing " a GP; I have not as yet.

 

> (b) In what circumstances would you TCM Tx for a few weeks /

> months before referral to WM specialists?

>

>

Generally speaking, in cases where symptoms or signs of an undiagnosed,

worsening or " new " nature involving loss of consciousness, seizures,

and other signs of CNS involvement (often related to CVA or masses) I

would ALWAYS refer. These are generally included in the TCM diagnoses

mentioned above.

 

Conditions which continually worsen or fail to improve with treatment

after a few weeks I would refer for further investigation if there is a

possibility of being related to a serious underlying pathology of which

may require specialist and/or WM treatment.

 

I have no desire to " try " or " experiment " with a patients

condition/pattern that is generally understood to be better treated by

WM.

 

> Below are 3 examples, where HEADACHE is a major presenting

> symptom, but with other significant S & Ss also.

 

> (1) HEADACHE; Nausea/vomiting; Lethargy; Seizures, head bobbing,

> visual impairment

>

> (2) HEADACHE, worse in the mornings; worse with coughing;

> nausea/vomiting, blurred vision/double vision, seizures, muscle

> spasms, periods of unconsciousness +/- one or more of the

> following: speech difficulties (slurring or inability to name objects),

> hearing problems, problems with sense of smell; drowsiness;

> concentration poor; weakness or paralysis in the limbs; personality

> change.

>

> (3) HEADACHE, dizziness, restlessness, irritation, anger,

> insomnia, concentration poor, anxiety, depression, constipation,

> weight gain, fatigue

>

 

This would mean your examples #1 and #2 would be refereed if no prior

diagnosis of their condition ruled out CVA or masses as they involve

" internal-wind " , syncope, and Wei syndromes. I would refer cases 1 and

2 to their GP immediately, and to the ER if they are of short history

or sudden onset with worsening of symptoms. Case #3 seems rather benign

so to speak at this stage.

 

I would certainly be interested in the opinions of those on this list

who I am sure generally have more clinical experience and/or a

different educational background to myself.

 

Best Wishes,

Steve

[Guest guest]

just note aside.

sometimes you dont want a clear diagnosis...alot of intervention

diagnotic procedures have their risks...and I have seen many, too

many who had procedures for diagnosis of something as minor as a

chronic headache....and they are no longer with us...

your question is not one only for Oriental Medicine. The AMA pushed

the same argument for years against the DO's and DC's.

 

you question points out that the practice of oriental medicine is

best in collaboration with other providers, as overseas. Perhaps the

local establishment perpetuates the existing dictomy.

 

> Hi Steve, & All,

>

> IMO, a TCM diagnosis can miss crucial pathology that requires

> immediate WM intervention, such as surgery +/- chemotherapy /

> radiation therapy.

>

> Any delay in referring the client (while trying acupuncture or

herbal

> medicine, based on the TCM Dx) could waste valuable time and

> increase the risk to the client's life.

>

> Below are 3 examples, where HEADACHE is a major presenting

> symptom, but with other significant S & Ss also.

>

> All three histories (especially #1and #2) can arise due to brain

> masses (cycts / tumours) but #3 is a common history in a very

> minor condition - withdrawal signs after quitting smoking.

>

> (1) HEADACHE; Nausea/vomiting; Lethargy; Seizures, head

> bobbing, visual impairment

>

> (2) HEADACHE, worse in the mornings; worse with coughing;

> nausea/vomiting, blurred vision/double vision, seizures, muscle

> spasms, periods of unconsciousness +/- one or more of the

> following: speech difficulties (slurring or inability to name

objects),

> hearing problems, problems with sense of smell; drowsiness;

> concentration poor; weakness or paralysis in the limbs; personality

> change.

>

> (3) HEADACHE, dizziness, restlessness, irritation, anger,

> insomnia, concentration poor, anxiety, depression, constipation,

> weight gain, fatigue

>

> My questions to experienced TCM clinicians are:

>

> (a) How long do you WAIT before referring patients with such

> symptoms to a specialist in neurology / oncosurgery?

>

> (b) In what circumstances would you TCM Tx for a few weeks /

> months before referral to WM specialists?

>

>

>

> Best regards,

>

> Email: <@e...>

>

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

Ireland

> Mobile: 353-; [in the Republic: 0]

>

> HOME : 1 Esker Lawns, Lucan, Dublin, Ireland

> Tel : 353-; [in the Republic: 0]

> WWW : http://homepage.eircom.net/~progers/searchap.htm

>

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

interrupt man doing it "

[Guest guest]

syncope due internal

" wind/phlegm " or or yin/yang " collapse " or " true " Heart pain/severe

zhong Bi due to Heart Yang collapse or blood stasis etc.

>>>>A little too late at this point however. The question is what do you do when

somebody comes to you complaining of nausea for example. what enters your mind

or this simple symptom?

Alon

 

 

[Guest guest]

Too late perhaps, but until I see a patient I can do nothing.

 

I am not sure what you mean here Alon; I can't do anything with one

symptom........especially one as common as nausea. My investigations

will be as comprehensive as normal; and where that leads......it leads.

 

Best Wishes,

 

Steve

 

 

On 28/09/2004, at 12:40 PM, Alon Marcus wrote:

 

> syncope due internal

> " wind/phlegm " or or yin/yang " collapse " or " true " Heart pain/severe

> zhong Bi due to Heart Yang collapse or blood stasis etc.

>>>>> A little too late at this point however. The question is what do

>>>>> you do when somebody comes to you complaining of nausea for

>>>>> example. what enters your mind or this simple symptom?

> Alon

[Guest guest]

Hi Steve, & All,

 

IMO, a TCM diagnosis can miss crucial pathology that requires

immediate WM intervention, such as surgery +/- chemotherapy /

radiation therapy.

 

Any delay in referring the client (while trying acupuncture or herbal

medicine, based on the TCM Dx) could waste valuable time and

increase the risk to the client's life.

 

Below are 3 examples, where HEADACHE is a major presenting

symptom, but with other significant S & Ss also.

 

All three histories (especially #1and #2) can arise due to brain

masses (cycts / tumours) but #3 is a common history in a very

minor condition - withdrawal signs after quitting smoking.

 

(1) HEADACHE; Nausea/vomiting; Lethargy; Seizures, head

bobbing, visual impairment

 

(2) HEADACHE, worse in the mornings; worse with coughing;

nausea/vomiting, blurred vision/double vision, seizures, muscle

spasms, periods of unconsciousness +/- one or more of the

following: speech difficulties (slurring or inability to name objects),

hearing problems, problems with sense of smell; drowsiness;

concentration poor; weakness or paralysis in the limbs; personality

change.

 

(3) HEADACHE, dizziness, restlessness, irritation, anger,

insomnia, concentration poor, anxiety, depression, constipation,

weight gain, fatigue

 

My questions to experienced TCM clinicians are:

 

(a) How long do you WAIT before referring patients with such

symptoms to a specialist in neurology / oncosurgery?

 

(b) In what circumstances would you TCM Tx for a few weeks /

months before referral to WM specialists?

 

 

 

Best regards,

 

Email: <

 

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

Mobile: 353-; [in the Republic: 0]

 

HOME : 1 Esker Lawns, Lucan, Dublin, Ireland

Tel : 353-; [in the Republic: 0]

WWW : http://homepage.eircom.net/~progers/searchap.htm

 

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

it "

[Guest guest]

I am not sure what you mean here Alon; I can't do anything with one

symptom........especially one as common as nausea. My investigations

will be as comprehensive as normal; and where that leads......it leads.

 

>>>My question is what goes into the differential. I like this simple symptoms

as it shows to me how quickly one knows how to rule out some nasty causes by the

questions the practitioner asks. I have yet to ask this question of TCM trained

practitioners in the USA and get a reasonable answer that shows a reasonable

training in primary care.

Alon

 

 

[Guest guest]

Hi Alon,

 

I think I see what you are getting at now, but perhaps a different

symptom may be more telling.

 

As I do my basic TCM diagnostic procedure I always have one part of my

mind looking for danger signs (incl. WM ones); if anything, I have been

told I am over paranoid when it comes to ruling out what the worst

could be.

 

The accompanying symptoms and patient history are what go into the

differential........ such as is it just nausea or accompanied by

vomiting, anorexia, pain (headache, chest pain, ab pain etc.),

dizziness/vertigo, visual problems, fainting/sycope,

loss-of-cordination/strength etc.

 

Isolated nausea would not cause me much concern unless it was

associated with several more obvious danger signs of a serious

condition.

 

I personally have no idea of the differential diagnosis training TCM

practitioners undertake in the USA. My lecturer for WM DD was the

author of " Differential Diagnosis for Primary Practice " published by

Chucrhill-Livingstone; so perhaps I have no idea of how fortunate I was

in this regard.

 

Best Wishes,

Steve

 

On 28/09/2004, at 3:47 PM, Alon Marcus wrote:

 

> I am not sure what you mean here Alon; I can't do anything with one

> symptom........especially one as common as nausea. My investigations

> will be as comprehensive as normal; and where that leads......it leads.

>

>>>> My question is what goes into the differential. I like this simple

>>>> symptoms as it shows to me how quickly one knows how to rule out

>>>> some nasty causes by the questions the practitioner asks. I have

>>>> yet to ask this question of TCM trained practitioners in the USA

>>>> and get a reasonable answer that shows a reasonable training in

>>>> primary care.

> Alon

[Guest guest]

Hi Phil,

 

This is a difficult topic to address due to restrictions placed upon me

by the moral, ethical and legal obligations I am under as a TCM

practitioner in Australia. They basically revolve around what I should

know and what I cannot know. In these situations, what " I should know "

and " what I cannot know " are the same. I will try to explain if I

can.......

 

As major part of professional TCM education here (Australia) we must do

basic training in all western medical sciences (from genetics and

histology, through anat. & phys., to pathology and differential

diagnosis). This is theoretically designed to address just the topic

and the related questions that are raised here in your post i.e. can

you diagnose a " potentially " crucial pathology and do you know when to

refer?

 

The Catch-22 position a TCM practitioner is placed in now is that we

SHOULD recognise a patients presenting signs and symptoms when they MAY

indicate a problem or condition out of their scope of practice and for

which immediate referral is indicated. The first problem is that I can

not actually (ethically or legally) make any diagnosis beyond a TCM

style one, but I am expected to be able to do so (at least

provisionally) to know when to refer.

 

Where that leaves TCM practitioners in Australia is in the position of

being expected to be a Medical GP (general practitioner) but without

the same training and access to referral resources, and all the while;

we would be breaking various medical acts if we actually did what was

expected of us.

 

I will say that I ALWAYS ask my patient what diagnosis and/or tests

they have had for the presenting condition, whether it is worsening

etc. as part of my initial case history. If they have symptoms that

have not been assessed by a WM practitioner that I feel could be a

concern based on my WM knowledge OR my knowledge of potentially

dangerous TCM Dx; I will tell them to get assessed by their

GP...............this is all I can do and I will apply my treatment

based upon TCM Dx regardless (anything else would be unethical and

illegal). If they return to me after seeing their GP and having

relevant tests; I will reassess the situation and discuss the options

with the patient.

 

On 28/09/2004, at 7:51 AM, wrote:

 

>

> Hi Steve, & All,

>

> IMO, a TCM diagnosis can miss crucial pathology that requires

> immediate WM intervention, such as surgery +/- chemotherapy /

> radiation therapy.

>

> Any delay in referring the client (while trying acupuncture or herbal

> medicine, based on the TCM Dx) could waste valuable time and

> increase the risk to the client's life.

>

I do not really agree with this on the whole if the term TCM here is

being used in terms of the recent TCM as taught in China and some

countries in the west.

 

I guess IMO it comes down to the practitioners awareness of what TCM Dx

are possible indications for referral for WM investigation or

treatment. This will obviously in large part depend upon their

theoretical and clinic training. Modern TCM includes such

knowledge.....however, I am certain other traditions do not as they are

much more independent of WM medical knowledge. This is one reason a

proper professional education is necessary for either practising or

giving advice that is the domain of a primary contact health care

provider (but I don't won't revisit that topic:-P).

 

What TCM patterns and conditions which require either WM investigations

and/or treatment or a combined approach are taught in China and this

was also the case in my studies in Australia which involved 1 year

clinical internship in China. I fully acknowledge that this may not be

the case in all countries and non-TCM Chinese medicine.

 

One problem I think needed addressing with my WM science training was

that it covered TOO much and allowed the important conditions to be

mixed up with all the possible WM differential diagnoses; including

conditions that respond better to TCM and thus don't require a WM

diagnosis or investigation. IMO the conditions should have been

restricted largely to those that really are best addressed by WM and

those that are indications for referral.

 

Having said all that; performing a proper TCM Dx WILL indicate areas

that I would consider for immediate referral eg. syncope due internal

" wind/phlegm " or or yin/yang " collapse " or " true " Heart pain/severe

zhong Bi due to Heart Yang collapse or blood stasis etc. Thus I would

be relying on my knowledge of both TCM and WM; but never offer a WM

diagnosis and use my TCM Dx as my treatment approach.

 

So, I believe TCM Dx certainly indicates conditions that should be

refereed for WM investigation and/or treatment.

 

Off the top of my head, perhaps we could say that conditions involving

syncope (loss of conscoiusness), seizures, and Wei syndromes without

consideration of WM are IMO not appropriate. I would refer a patient

with such a condition with the hope the GP would not delay in arranging

appropriate investigations and treatments and would be happy to

collaborate with any further treatment upon the patient wishes.

 

 

> My questions to experienced TCM clinicians are:

>

 

I would not include myself in this category, but I will offer an answer

as I assume you are addressing the question partly to me.

 

> (a) How long do you WAIT before referring patients with such

> symptoms to a specialist in neurology / oncosurgery?

>

 

Impossible to directly do this in Australia, I can only refer to a GP

for preliminary assessment. Which means, the GP must be competent

enough to refer to a specialist and appropriate tests. I can only

recommend that a patient see their GP or go to the ER (if condition is

possibly immediately dangerous), then their GP can refer on to a

specialist if THEY see fit to do more than give them an aspirin and

" see what happens " . Some TCM practitioners have developed referral

networks over time which allow them to get more direct referrals via

" knowing " a GP; I have not as yet.

 

> (b) In what circumstances would you TCM Tx for a few weeks /

> months before referral to WM specialists?

>

>

Generally speaking, in cases where symptoms or signs of an undiagnosed,

worsening or " new " nature involving loss of consciousness, seizures,

and other signs of CNS involvement (often related to CVA or masses) I

would ALWAYS refer. These are generally included in the TCM diagnoses

mentioned above.

 

Conditions which continually worsen or fail to improve with treatment

after a few weeks I would refer for further investigation if there is a

possibility of being related to a serious underlying pathology of which

may require specialist and/or WM treatment.

 

I have no desire to " try " or " experiment " with a patients

condition/pattern that is generally understood to be better treated by

WM.

 

> Below are 3 examples, where HEADACHE is a major presenting

> symptom, but with other significant S & Ss also.

 

> (1) HEADACHE; Nausea/vomiting; Lethargy; Seizures, head bobbing,

> visual impairment

>

> (2) HEADACHE, worse in the mornings; worse with coughing;

> nausea/vomiting, blurred vision/double vision, seizures, muscle

> spasms, periods of unconsciousness +/- one or more of the

> following: speech difficulties (slurring or inability to name objects),

> hearing problems, problems with sense of smell; drowsiness;

> concentration poor; weakness or paralysis in the limbs; personality

> change.

>

> (3) HEADACHE, dizziness, restlessness, irritation, anger,

> insomnia, concentration poor, anxiety, depression, constipation,

> weight gain, fatigue

>

 

This would mean your examples #1 and #2 would be refereed if no prior

diagnosis of their condition ruled out CVA or masses as they involve

" internal-wind " , syncope, and Wei syndromes. I would refer cases 1 and

2 to their GP immediately, and to the ER if they are of short history

or sudden onset with worsening of symptoms. Case #3 seems rather benign

so to speak at this stage.

 

I would certainly be interested in the opinions of those on this list

who I am sure generally have more clinical experience and/or a

different educational background to myself.

 

Best Wishes,

Steve

[Guest guest]

Phil Et Al,

When I wrote the Acupuncture Practice act (Colorado) I wrote in a

duty to refer with these issues in mind.

 

That said I often see patients who have been misdignosed by MDs.

 

Recently a patient came to me with shoulder pain, stiffness, and -

after much questioning- a lump in her breast, tiredness.....

These symptoms were of eight months duration.

Tongue and pulse indicated a tumor.

I refered her to an Oncologist.

Her MD called me with great anger *How dare i scare his patient.*

He refused to sign off on the referal.

The next day she collapsed and in the ER she was diagnosed with a

metatastic cancer which started with the tumor that 4 MDs had

missed.

Or

perhaps I can tell you about the patient with a rare and hard to

diagnosis form of cancer. THe entire Alopathic Oncology world was

unable to find the cancer but MB of CA diagnosed her with

traditional TCM methods and she is alive and well because of TCM

diagnostics.

 

Please do not discount the ability of CM based pulse and tongue

diagnosis to find even the most hidden illnesses.

 

It is not either or it is a mix of what woreks when..

 

Doc

[Guest guest]

Hi Phil and all...

 

--- < wrote:

 

> medicine, based on the TCM Dx) could waste valuable

> time and increase the risk to the client's life.

 

While I largely agree with Phil I feel it is very

important to make a point which I have not seen to be

explicitly stated very often - as far as I am

concerned, there is the explicit and there is the

implicit, both the elegant and the brute. It is

obvious how proper tx can be delayed via inappropriate

tx by CM...it is not so obvious how consistently and

systemically proper tx is delayed through

procrastination and ignorance on the part of WM since

it only looks and treats for end-stage disease...like

a mechanic saying " don't bother coming to see me until

your axles break on the highway " . I work with MDs and

I am APPALLED at how their patients are permitted to

deteriorate for FIFTY YEARS - and these, of course,

are the people who end up with very serious disorders

which are currently either intractable or immediately

life-threatening. And, of course, CM / TCM are not

appropriate by this time.

I sometimes get the impression that systems exist

only to create what they are able to deal with, and to

therefore justify their own existence through their

funneling of information and influence. Both WM and

CM.

 

> My questions to experienced TCM clinicians are:

 

Not experienced, but I'd like to sign in...

 

> (a) How long do you WAIT before referring patients

> with such

> symptoms to a specialist in neurology / oncosurgery?

 

1 and 2 are serious presentations as far as I am

concerned and I would refer to their gp or er

immediately. # 3 as presented by you has insufficient

information for me to say whether it could be serious

or not. I do not hesitate to refer out though.

 

> (b) In what circumstances would you TCM Tx for a few

> weeks /

> months before referral to WM specialists?

 

I always refer anything weird or with strangely mixed

S & S immediately. People like this light up on my

radar, a look at their face gets me going already. I

will not take resposibility for what may happen

therefore I refer out. I am willing to work with

certain cases if I am asked to, but I don't put myself

in the way.

 

Something I've found is that people who have grown up

with poor diet (in CM terms) and sedentary lifestyle

are delicate and tend to collapse - i.e. a dangerous

patient population to be treating. Very little

internal strength, all wai kung (external power) and

bun lik (stupid strength).

 

There are further issues involving how most of my

patients are not willing (or even consider) that I

could be their primary care 'physician' and are

therefore not able to understand and follow my

recommendations and therefore cannot extract the

potential effect of the CM therapy. Not that I should

be a primary care physician, but rather that one can't

fully extract efficacy if one isn't into it.

 

My shining examples of the efficacy and power of

chinese medicine are those few people who love me and

have honoured me by delving intimately into the

possibilities offered.

 

Thanks for your patience...these issues you bring up,

Phil, are often on my mind and are very important, as

you know, see my following post titled " HELP! " .

 

Hugo

 

 

 

 

 

_________ALL-NEW

Messenger - all new features - even more fun! http://uk.messenger.

[Guest guest]

Hi DOc, & All,

 

Doc Rosen wrote:

> Phil et al, ... Please do not discount the ability of CM-based

> pulse and tongue diagnosis to find even the most hidden illnesses.

> It is not either or it is a mix of what works when..

 

Doc, I accept that SOME practitioners, including WM MDs and

those using CM-based methods, are excellent diagnosticians.

 

However, IMO, their diagnostic skill is based more on accurate

intuition [6th sense, using dowsing, kinesiology, VAS Pulse,

visualisation, imagining themselves " in " the body of the subject,

etc] than on TCM pulse and tongue diagnosis.

 

Recognition that dogs (and possibly other animals) can be trained

to " smell out " specific types of cancer in humans is a recent

development in WM. Dogs also can be trained to sense the onset

of epileptic seisures before they occur, thereby alerting the dogs'

owners to take their sedatives ASAP.

 

These animal skills are NATURAL (i.e. not paranormal). They are

based on the animal's acute sense of smell, and its ability to

sense subclinical / preclinical agitation in its handler.

 

Animals have highly developed ability to sense pheromones. It is

probable that people with certain diseases emit minute amounts of

pheromone-type chemicals that are specific for those diseases.

 

It is even possible, IMO, that sensitive diagnosticians may be

sensing pheromone emissions by the subliminal (but normal)

sense of smell, i.e. that their use of the 6th-sense methods merge

with their ability to detect specific combinations of pheromones

subliminally.

 

Best regards,

Phil

 

>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>

 

Doc Rosen wrote:

 

> When I wrote the Acupuncture Practice act (Colorado) I wrote in a

> duty to refer with these issues in mind. That said I often see

> patients who have been misdignosed by MDs. Recently a patient came

> to me with shoulder pain, stiffness, and - after much questioning-

> a lump in her breast, tiredness..... These symptoms were of eight

> months duration. Tongue and pulse indicated a tumor. I refered her

> to an Oncologist. Her MD called me with great anger *How dare i

> scare his patient.* He refused to sign off on the referal. The

> next day she collapsed and in the ER she was diagnosed with a

> metatastic cancer which started with the tumor that 4 MDs had

> missed. Or perhaps I can tell you about the patient with a rare and

> hard to diagnosis form of cancer. THe entire Alopathic Oncology

> world was unable to find the cancer but MB of CA diagnosed her

> with traditional TCM methods and she is alive and well because of

> TCM diagnostics. Please do not discount the ability of CM based

> pulse and tongue diagnosis to find even the most hidden illnesses.

> It is not either or it is a mix of what works when.. Doc

 

>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>

Best regards,

 

Email: <

 

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

Mobile: 353-; [in the Republic: 0]

 

HOME : 1 Esker Lawns, Lucan, Dublin, Ireland

Tel : 353-; [in the Republic: 0]

WWW : http://homepage.eircom.net/~progers/searchap.htm

 

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

it "

[Guest guest]

--- < wrote:

 

> Doc, I accept that SOME practitioners, including WM

> MDs and

> those using CM-based methods, are excellent

> diagnosticians.

 

I agree, this is an essential point. I woudl also say

that we need to have much more apprenticeship. Too

many working alone, it holds us all back.

 

Thanks,

Hugo

 

 

 

 

 

_________ALL-NEW

Messenger - all new features - even more fun! http://uk.messenger.

[Guest guest]

Hi Steve and Phil,

 

I and my colleagues have the same problems in the UK. We are taught a

certain amount of WM and are expected to refer serious cases to GPs as we

find them.

 

This of course, relies upon the fact that we are indeed diagnosing in WM

aswell as TCM. I for one find this difficult. Often a patient will come to

see you with a WM name to the disease, that we can 'match' with a TCM

version. However, this initial disease analysis is usually flawed. WM looks

at what it wants to see and treats that, whereas a TCM practitioner looks at

the root and branch and systematically analysis's which disorder to treat

first. An example of this is a patient I'm treating at the moment. He has

serious asthma for 3 years and is being given a large amount of WM drugs to

combat it, including a number of steroids. This is drying him out causing a

serious hacking dry cough. I am therefore treating the cough first to

stabilise the exterior and then will treat the asthma later. His GP doesn't

even recognise the cough as a serious problem.

 

Kind regards

 

Attilio

 

 

Steven Slater [laozhongyi]

28 September 2004 00:55

Chinese Medicine

Re: TCM v WM DIagnosis - and why it could be crucial

 

 

Hi Phil,

 

The Catch-22 position a TCM practitioner is placed in now is that we

SHOULD recognise a patients presenting signs and symptoms when they MAY

indicate a problem or condition out of their scope of practice and for

which immediate referral is indicated. The first problem is that I can

not actually (ethically or legally) make any diagnosis beyond a TCM

style one, but I am expected to be able to do so (at least

provisionally) to know when to refer.

 

Where that leaves TCM practitioners in Australia is in the position of

being expected to be a Medical GP (general practitioner) but without

the same training and access to referral resources, and all the while;

we would be breaking various medical acts if we actually did what was

expected of us.

 

I will say that I ALWAYS ask my patient what diagnosis and/or tests

they have had for the presenting condition, whether it is worsening

etc. as part of my initial case history. If they have symptoms that

have not been assessed by a WM practitioner that I feel could be a

concern based on my WM knowledge OR my knowledge of potentially

dangerous TCM Dx; I will tell them to get assessed by their

GP...............this is all I can do and I will apply my treatment

based upon TCM Dx regardless (anything else would be unethical and

illegal). If they return to me after seeing their GP and having

relevant tests; I will reassess the situation and discuss the options

with the patient.

 

 

 

 

[Guest guest]

Hi All,

 

I agree with Steven's reply. I would add that whenever a patient comes in with

symptoms and a history that even might imply a condition requiring WM care, I

always recommend that they see a MD, and note in their chart that I did so. If

they choose not to see a MD, I will periodically remind them of this

recommendation, and again note it in their chart.

 

I once had the experience as an intern of having a patient who complained of

chest pain, and in reviewing her history with her, discovered that she had been

diagnosed earlier in the year with high cholesterol. I asked whether she had

seen a MD for her chest pain, and she said no. My instinct was to refer her to

a hospital right away. I conferred with my supervisor on this, who said it was

ok to treat her first. If I had been in private practice at the time, I would

have refused to treat her until after she had been medically evaluated. In her

case, I thought time could have been of the essence. When a patient has

symptoms that seem less acute, or less urgent, I will treat them first and also

make recommendations for WM evaluation. I do this routinely. I place higher

priority on my patients' well-being and safety than on having an " I-do-it-all "

ego kind of practice.

 

 

 

Steven Slater <laozhongyi wrote:

Hi Phil,

 

This is a difficult topic to address due to restrictions placed upon me

by the moral, ethical and legal obligations I am under as a TCM

practitioner in Australia. They basically revolve around what I should

know and what I cannot know. In these situations, what " I should know "

and " what I cannot know " are the same. I will try to explain if I

can.......

 

As major part of professional TCM education here (Australia) we must do

basic training in all western medical sciences (from genetics and

histology, through anat. & phys., to pathology and differential

diagnosis). This is theoretically designed to address just the topic

and the related questions that are raised here in your post i.e. can

you diagnose a " potentially " crucial pathology and do you know when to

refer?

 

The Catch-22 position a TCM practitioner is placed in now is that we

SHOULD recognise a patients presenting signs and symptoms when they MAY

indicate a problem or condition out of their scope of practice and for

which immediate referral is indicated. The first problem is that I can

not actually (ethically or legally) make any diagnosis beyond a TCM

style one, but I am expected to be able to do so (at least

provisionally) to know when to refer.

 

Where that leaves TCM practitioners in Australia is in the position of

being expected to be a Medical GP (general practitioner) but without

the same training and access to referral resources, and all the while;

we would be breaking various medical acts if we actually did what was

expected of us.

 

I will say that I ALWAYS ask my patient what diagnosis and/or tests

they have had for the presenting condition, whether it is worsening

etc. as part of my initial case history. If they have symptoms that

have not been assessed by a WM practitioner that I feel could be a

concern based on my WM knowledge OR my knowledge of potentially

dangerous TCM Dx; I will tell them to get assessed by their

GP...............this is all I can do and I will apply my treatment

based upon TCM Dx regardless (anything else would be unethical and

illegal). If they return to me after seeing their GP and having

relevant tests; I will reassess the situation and discuss the options

with the patient.

 

On 28/09/2004, at 7:51 AM, wrote:

 

>

> Hi Steve, & All,

>

> IMO, a TCM diagnosis can miss crucial pathology that requires

> immediate WM intervention, such as surgery +/- chemotherapy /

> radiation therapy.

>

> Any delay in referring the client (while trying acupuncture or herbal

> medicine, based on the TCM Dx) could waste valuable time and

> increase the risk to the client's life.

>

I do not really agree with this on the whole if the term TCM here is

being used in terms of the recent TCM as taught in China and some

countries in the west.

 

I guess IMO it comes down to the practitioners awareness of what TCM Dx

are possible indications for referral for WM investigation or

treatment. This will obviously in large part depend upon their

theoretical and clinic training. Modern TCM includes such

knowledge.....however, I am certain other traditions do not as they are

much more independent of WM medical knowledge. This is one reason a

proper professional education is necessary for either practising or

giving advice that is the domain of a primary contact health care

provider (but I don't won't revisit that topic:-P).

 

What TCM patterns and conditions which require either WM investigations

and/or treatment or a combined approach are taught in China and this

was also the case in my studies in Australia which involved 1 year

clinical internship in China. I fully acknowledge that this may not be

the case in all countries and non-TCM Chinese medicine.

 

One problem I think needed addressing with my WM science training was

that it covered TOO much and allowed the important conditions to be

mixed up with all the possible WM differential diagnoses; including

conditions that respond better to TCM and thus don't require a WM

diagnosis or investigation. IMO the conditions should have been

restricted largely to those that really are best addressed by WM and

those that are indications for referral.

 

Having said all that; performing a proper TCM Dx WILL indicate areas

that I would consider for immediate referral eg. syncope due internal

" wind/phlegm " or or yin/yang " collapse " or " true " Heart pain/severe

zhong Bi due to Heart Yang collapse or blood stasis etc. Thus I would

be relying on my knowledge of both TCM and WM; but never offer a WM

diagnosis and use my TCM Dx as my treatment approach.

 

So, I believe TCM Dx certainly indicates conditions that should be

refereed for WM investigation and/or treatment.

 

Off the top of my head, perhaps we could say that conditions involving

syncope (loss of conscoiusness), seizures, and Wei syndromes without

consideration of WM are IMO not appropriate. I would refer a patient

with such a condition with the hope the GP would not delay in arranging

appropriate investigations and treatments and would be happy to

collaborate with any further treatment upon the patient wishes.

 

 

> My questions to experienced TCM clinicians are:

>

 

I would not include myself in this category, but I will offer an answer

as I assume you are addressing the question partly to me.

 

> (a) How long do you WAIT before referring patients with such

> symptoms to a specialist in neurology / oncosurgery?

>

 

Impossible to directly do this in Australia, I can only refer to a GP

for preliminary assessment. Which means, the GP must be competent

enough to refer to a specialist and appropriate tests. I can only

recommend that a patient see their GP or go to the ER (if condition is

possibly immediately dangerous), then their GP can refer on to a

specialist if THEY see fit to do more than give them an aspirin and

" see what happens " . Some TCM practitioners have developed referral

networks over time which allow them to get more direct referrals via

" knowing " a GP; I have not as yet.

 

> (b) In what circumstances would you TCM Tx for a few weeks /

> months before referral to WM specialists?

>

>

Generally speaking, in cases where symptoms or signs of an undiagnosed,

worsening or " new " nature involving loss of consciousness, seizures,

and other signs of CNS involvement (often related to CVA or masses) I

would ALWAYS refer. These are generally included in the TCM diagnoses

mentioned above.

 

Conditions which continually worsen or fail to improve with treatment

after a few weeks I would refer for further investigation if there is a

possibility of being related to a serious underlying pathology of which

may require specialist and/or WM treatment.

 

I have no desire to " try " or " experiment " with a patients

condition/pattern that is generally understood to be better treated by

WM.

 

> Below are 3 examples, where HEADACHE is a major presenting

> symptom, but with other significant S & Ss also.

 

> (1) HEADACHE; Nausea/vomiting; Lethargy; Seizures, head bobbing,

> visual impairment

>

> (2) HEADACHE, worse in the mornings; worse with coughing;

> nausea/vomiting, blurred vision/double vision, seizures, muscle

> spasms, periods of unconsciousness +/- one or more of the

> following: speech difficulties (slurring or inability to name objects),

> hearing problems, problems with sense of smell; drowsiness;

> concentration poor; weakness or paralysis in the limbs; personality

> change.

>

> (3) HEADACHE, dizziness, restlessness, irritation, anger,

> insomnia, concentration poor, anxiety, depression, constipation,

> weight gain, fatigue

>

 

This would mean your examples #1 and #2 would be refereed if no prior

diagnosis of their condition ruled out CVA or masses as they involve

" internal-wind " , syncope, and Wei syndromes. I would refer cases 1 and

2 to their GP immediately, and to the ER if they are of short history

or sudden onset with worsening of symptoms. Case #3 seems rather benign

so to speak at this stage.

 

I would certainly be interested in the opinions of those on this list

who I am sure generally have more clinical experience and/or a

different educational background to myself.

 

Best Wishes,

Steve

 

 

 

Chinese Herbal Medicine offers various professional services, including board

approved continuing education classes, an annual conference and a free

discussion forum in Chinese Herbal Medicine.

 

 

 

 

 

 

[Guest guest]

The accompanying symptoms and patient history are what go into the

differential........ such as is it just nausea or accompanied by

vomiting, anorexia, pain (headache, chest pain, ab pain etc.),

dizziness/vertigo, visual problems, fainting/sycope,

loss-of-cordination/strength etc.

 

Isolated nausea would not cause me much concern unless it was

associated with several more obvious danger signs of a serious

condition.

>>>>>What i usually look for is seeing what questions are being asked by the

practitioner. With nausea one may have no other symptoms and it can still be

related to a dangerous syndrome. A clue, what brings on the nausea? There are

many such examples that are not simple text book presentation that must be

understood by any primary care provider. Now I now many MDs that have missed

real life cases such as I am presenting here. But in a " examination test " they

will get it

Alon

 

 

[Guest guest]

Alon,

 

What are you looking for?

 

 

 

Alon Marcus <alonmarcus wrote:

I am not sure what you mean here Alon; I can't do anything with one

symptom........especially one as common as nausea. My investigations

will be as comprehensive as normal; and where that leads......it leads.

 

>>>My question is what goes into the differential. I like this simple symptoms

as it shows to me how quickly one knows how to rule out some nasty causes by the

questions the practitioner asks. I have yet to ask this question of TCM trained

practitioners in the USA and get a reasonable answer that shows a reasonable

training in primary care.

Alon

 

 

[Guest guest]

What are you looking for?

>>>>No guesses?

Alon

 

 

[Guest guest]

Hi Alon,

 

Saying the single isolated symptom of nausea can be related to a

serious syndrome is not helpful to anyone IMO without you giving the DD

you are worried about. The nausea not being accompanied by other S/S

(eg. no fever, vomiting, rebound tenderness, constipation) and being

related to a dangerous syndrome may very well be possible, but IMO it

is highly unlikely and simply can't be determined without further S/S

or obvious history. In such cases I see no harm in proceeding with

normal TCM Dx and treatment protocols.

 

I understand you have an interest in acute abdomen.........is this

where you are headed? Could you be talking about rebound tenderness?

Fever? If positive; these are other S/S and will certainly lead to

closer investigation and monitoring of a patients condition.

 

IMO what " brings on the nausea " will be discovered during intake and

taking the patient record.....it is the one of the basic questions

about a chief complaint! ie. when did it start? is it getting worse?

have you had this before? do you have any allergies? others close to

you have this problem and ate with your recently (food poisoning) etc.

 

Would be be so kind as too actually supply an answer to all of us who

are incapable of reasonable answers and lack reasonable training in

primary care? :-P

 

Best Wishes,

 

Steve

 

Instead of playing the " give me an answer and I will challenge " game.

 

On 30/09/2004, at 3:13 AM, alon marcus wrote:

 

> What are you looking for?

>>>>> No guesses?

> Alon

>

 

On 29/09/2004, at 4:13 AM, wrote:

 

> Alon,

>

> What are you looking for?

>

>

>

> Alon Marcus <alonmarcus wrote:

> I am not sure what you mean here Alon; I can't do anything with one

> symptom........especially one as common as nausea. My investigations

> will be as comprehensive as normal; and where that leads......it leads.

>

>>>> My question is what goes into the differential. I like this simple

>>>> symptoms as it shows to me how quickly one knows how to rule out

>>>> some nasty causes by the questions the practitioner asks. I have

>>>> yet to ask this question of TCM trained practitioners in the USA

>>>> and get a reasonable answer that shows a reasonable training in

>>>> primary care.

> Alon

>

 

 

On 29/09/2004, at 3:41 AM, Alon Marcus wrote:

 

> The accompanying symptoms and patient history are what go into the

> differential........ such as is it just nausea or accompanied by

> vomiting, anorexia, pain (headache, chest pain, ab pain etc.),

> dizziness/vertigo, visual problems, fainting/sycope,

> loss-of-cordination/strength etc.

>

> Isolated nausea would not cause me much concern unless it was

> associated with several more obvious danger signs of a serious

> condition.

>>>>>> What i usually look for is seeing what questions are being asked

>>>>>> by the practitioner. With nausea one may have no other symptoms

>>>>>> and it can still be related to a dangerous syndrome. A clue, what

>>>>>> brings on the nausea? There are many such examples that are not

>>>>>> simple text book presentation that must be understood by any

>>>>>> primary care provider. Now I now many MDs that have missed real

>>>>>> life cases such as I am presenting here. But in a " examination

>>>>>> test " they will get it

> Alon

>

>

[Guest guest]

Hi Steven et al.

 

Actually the nausea may be the only symptom the patients is aware of. What i am

looking for is nausea as being a symptom of angina. There are a fair number of

atypical patients that have nausea, toothache etc as the only symptom of angina.

I have two patients that lost several teeth because their dentists were asleep

at the wheel. I have also seen two patients in China that were having angina and

were treated for Damp related nausea with no-one picking up upon, including the

patient, that the nausea comes on only on exertion (I just happened to see the

patient walking to the clinic and noticed his fascial expression which became

comfortable after he rested in the waiting room so I asked the right questions

and we had him transferred into the inpatient clinic. He was actually having a

heart attack).

In real life clinical situations you often see patients that have never read

text books and so may have very unusual presentations. Any primary care provider

must be aware of such cases. Here in the US we get almost zero real western

clinical training. When students go to clinic most of the time do not do a real

physical (they often only do a TCM physical). To me this is more than just a

safety issue, even though in real life, at this point in the US, it is not a big

issue because we mostly see chronic disorders and are not the first to see the

patient. However, knowing good clinical western medicine will be a must if we

become more popular and really start seeing large number of primary care

patients. I also believe it makes one much more capable in practicing TCM. I

know many disagree.

Alon

 

 

[Guest guest]

Hi Alon,

 

Thanks for this information, I will add this to my future

considerations in clinic. One of my TCM lecturers mentioned belching

and or/hiccup (no nausea from memory) related to exertion as a

possible symptom of angina/heart disease. Have you also heard of or

seen this relationship clinically?

 

Best Wishes,

 

Steve

 

On 30/09/2004, at 5:35 AM, alon marcus wrote:

 

> Hi Steven et al.

>

> Actually the nausea may be the only symptom the patients is aware of.

> What i am looking for is nausea as being a symptom of angina. There

> are a fair number of atypical patients that have nausea, toothache etc

> as the only symptom of angina. I have two patients that lost several

> teeth because their dentists were asleep at the wheel. I have also

> seen two patients in China that were having angina and were treated

> for Damp related nausea with no-one picking up upon, including the

> patient, that the nausea comes on only on exertion (I just happened to

> see the patient walking to the clinic and noticed his fascial

> expression which became comfortable after he rested in the waiting

> room so I asked the right questions and we had him transferred into

> the inpatient clinic. He was actually having a heart attack).

> In real life clinical situations you often see patients that have

> never read text books and so may have very unusual presentations. Any

> primary care provider must be aware of such cases. Here in the US we

> get almost zero real western clinical training. When students go to

> clinic most of the time do not do a real physical (they often only do

> a TCM physical). To me this is more than just a safety issue, even

> though in real life, at this point in the US, it is not a big issue

> because we mostly see chronic disorders and are not the first to see

> the patient. However, knowing good clinical western medicine will be a

> must if we become more popular and really start seeing large number of

> primary care patients. I also believe it makes one much more capable

> in practicing TCM. I know many disagree.

> Alon

[Guest guest]

, " alon marcus "

<alonmarcus@w...> wrote:

 

>primary care provider must be aware of such cases. Here in the US we

get almost zero real western clinical training. When students go to

clinic most of the time do not do a real physical (they often only do

a TCM physical). To me this is more than just a safety issue, even

though in real life, at this point in the US, it is not a big issue

because we

 

Who here gets a " real physical " when they go to a Western MD? I never

have unless getting a " real physical " was the purpose of the visit.

 

Brian C. Allen

[Guest guest]

i have not seen belching, hiccups is definitely possible, especially with

inferior MI

Alon

 

 

[Guest guest]

Who here gets a " real physical " when they go to a Western MD? I never

have unless getting a " real physical " was the purpose of the visit.

>>>>You get problem oriented physicals all the time. If you dont change your MD

Alon

 

 

[Guest guest]

, " alon marcus "

<alonmarcus@w...> wrote:

> What are you looking for?

> >>>>No guesses?

> Alon

 

The following is related to the above discussion:

 

Yesterday a patient whom I hadn't seen in over a year came to ask

for my support in her upcoming chemotherapy. Two years ago she had

a cancerous lump removed on her breast, she had radiation treatment

afterwards. She said she had never regained her appetite afterwards.

 

For the past three months she has been nauseous and went to her MD

who finally gave her a liver biopsy last week. She has matastisized

cancer in the liver, possibly lungs(some sob)and a scan showed a

spot on the Rt fibula, which is interesting because she has had

right hip and leg pain since I have known her. She even had back

surgery last year because her orthopedist thought the leg pain was

from a disk problem. The pain did not change after the back

surgery. However acupuncture and cupping does have a temporary

effect from a couple of days to weeks.

Had she come to me for the symptom of nausea I would have treated

her and wonder how long it would have taken me to send her back to

her MD. She also has lots of broken veins on her right lower ribs.

 

Jill Likkel

[Guest guest]

past three months she has been nauseous and went to her MD

who finally gave her a liver biopsy last week. She has matastisized

cancer in the liver, possibly lungs(some sob)and a scan showed a

spot on the Rt fibula,

>>>Any symptom in a patient with a history of cancer is cancer until proven

otherwise.

Alon