seizures and parkinsonism: an update on my wife

June 27, 2007

Jason, thanks for all the thoughts. I guess I like my story better

because there is a path that can be followed from symptom to symptom

with an explanation through the pathomechanism. The issue of

intelligence seems to be a wild card that allows for a degree of

randomness in treatment and lack of predictibility. But then I haven't

studied in this method like David has.

So my question as far as the Extreme Yin Xu with extreme damp is: How

is a patient with extreme Yin Xu treated as opposed to someone who

presents with Exteme Damp coming from Extreme Yin Xu?

Doug

, " "

wrote:

>

> This conversation between Doug and David is very interesting. David (or

> Yuen) is suggesting a story to explain what is an observable

phenomenon in

> the clinic. Doug does not like the story and favors a different

story. Doug

> favors a solid mechanism (?), and Yuen explains things through the

body's

> intelligence(?). (I hope I got that correct)

>

> I will riff a little here :-)

>

> I use the word story for a reason. It is the word that I use to

explain what

> a pathomechanism is to students. It is the story that gets you from

point A

> (pattern) to Point B (symptoms). If one has spleen xu with dampness and

> dizziness, the pathomechanism is the story that explains why and how

this

> happens. I think we all agree on that (?).

>

> But IMO essentially any pathomechanism (explanation) is pretty much

BS. It

> is a theatrical construct made up by the Human mind using the TCM

framework.

> Now don't get me wrong, I DO think that pathomechanisms are helpful

and I

> think in these terms often, but I try to stay realistic to what they

really

> are and how they really help us.

>

> One pitfall is that many times such stories are used to create

complex webs

> of interrelationships (confusion) when a patient that we totally don't

> understand are in front of us. We then label these people knotty or

complex

> cases and attribute them 4 or 5 patterns.

>

> Really we only know a couple of things. 1) what the patient presents

with 2)

> what gets them better (in retrospect of course). This is the historical

> basis for most of our theory / pathomechanisms. Why this or that happens

> (the story) is really only a side note. The pattern is also a (very

useful)

> secondary side note in the process. This again is a human

construction. I

> believe this is what Huang Huang (in the Latest Lantern) is getting

at. The

> SHL has no real complex theory, no patterns (zang-fu), no

pathomechanisms,

> just s/s, etiologies, and formulas (to a certain extent), Later

generations

> attribute all the extra stuff. Huang Huang seems to get back to this

type of

> thinking and really focuses on the clinical pictures. What do you

see (what

> pattern) and how do you treat it. I find this idea interesting.

>

> So what is my point?

>

> I think either story (Yuen or Doug's) is 100% valid and 100% BS. But why

> does one have to be correct and the other not? IF both can treat the

problem

> through i.e. nourishing yin the story is pretty much just icing on

the cake.

>

> -Jason

>

June 27, 2007

Doug,

Question: who do you think picks the best of these traditions (excluding

others) and inserts its solution into TCM? Furthermore, I think it is pretty

well documented that there is a large political force behind many of these

decisions. The inclusion or exclusion of certain ideas / traditions are not

based on pure efficacy as many would like to believe. How do you think such

decisions were and are made?

Furthermore, it is hard to really learn the " source of the formula " from

just the snapshot (meaning the formulas description in a modern book). I

find that studying the context that it was written and other surrounding

formulas and idea etc really sheds light on the thinking.

In Modern TCM you open a book for a disease and either get 1 of two

situations. 1) there are one or two formulas for a given pattern (for a

disease). This is of course biased and who knows how it ended up there.

Sometimes the formula idea works sometimes it doesn't. For any given

situation there might be 10-30 other ideas. The other situation is a list of

formulas, i.e. 10 formulas that treat menstrual pain due to blood stasis,

that one sifts through and picks. Of course more is better right? But this

is also problematic b/c it is snapshots of various doctors thinking. Doctors

have very idiosyncratic usages that are difficult to see in such snapshots.

Both methods are taken out of context from the original author. Sometimes

this does not matter, sometimes it does. Their thinking is rarely described

in these list books. The average student will never be able to find the

source of the formulas.

But of course it is all a matter of degree. And you are right there is

nothing that " really " stops one from understanding these deeper points,

except Chinese Language in many cases.

I am just not convinced that TCM has somehow arrived at the best of the best

through some magical distillation process as many like to believe. I am not

convinced that all the TCM ideas are based on sound clinical results. Volker

S. explores much of this in his writing. His point of view makes sense to

me.

Thoughts?

-Jason

_____

On Behalf Of

Wednesday, June 27, 2007 8:57 PM

Re: seizures and parkinsonism: an update on my wife

Perhaps, but the picking of the best of traditions has also been a

strength of TCM. Often a one tradition may work for some diseases, or

localities while being ineffective in other situations. I think

acupuncture has always been problematic. At the same time I don't

think we are precluded from learning the source of the formula or

acupuncture design. Using the modern bioscience model is something I

don't really want to persue except in very particular cases.

Doug

@ <%40>

, " "

wrote:

>

> I think David brings up some good points. I think this jumbled up TCM

> collage can many times do more harm than good. This also applies to

herbs.

> One doctor may use an herb in a certain way, which is very dependent on

> context, meaning diagnosis style as well as the medicinals that it is

> combined with. It really helps many times to understand the original

> doctor's thought process and tradition, instead of the taking the

formula.

> For example, one can try to make sense of the herbs's functions (in the

> formula) based on a modern MM- cohesive view. Many times the

intricacies of

> the original doctor are completely lost. I have found that this is a

> pitfall of modern TCM.

>

> Do other's have some thoughts on this?

>

> -Jason

>

_____

>

> @ <%40>

> [@ <%40>

] On Behalf Of david appleton

> Wednesday, June 27, 2007 1:27 PM

> @ <%40>

> Re: Re: seizures and parkinsonism: an update on my wife

>

> Doug, I have studied with Jeffrey for 5 years and I am

> not sure you are correct in some of the statements you

> are making- 'the body produces phlegm to protect

> itself from yin xu'- I believe he means the body holds

> onto phlegm as a second class substitute for yin; the

> body's intelligence is misguided- Jeffrey offers the

> example to illustrate this of menopausal fibroids,

> where one would expect the fibroids to shrink but

> instead post menopause they increase in size as the

> body attempts to retain yin in any form; in jeffrey's

> view yin can be used to hold things latent. How the

> body decides to deal with a given pathology has more

> to do with constitutional factors- the shu points are

> not irrigated equally by the rising of jing, so each

> person presents with different tendencies- which

> becomes the basis of body types etc. I think the ideas

> jeffrey presents may seem contradictory because they

> are taken from different periods of chinese medicine

> and he will diagnose and treat based only on the

> tradition he is teaching that week- he may offer

> yehuda a completely different formula if he were

> treating this issue from a wai ke perspective- which

> also deals with neurological issues. Modern TCM tends

> to jumble up the traditions and present ideas that are

> contradictory when viewed from within the tradition-

> eg the school of cooling and cold, vs the ming men pai

> or the wai ke school; an example of this is the

> listing of point functions in say deadman's book- he

> lists all the functions from all the traditions, earth

> school, wen bing etc- but it may be that those

> functions only work well within the scope of the

> tradition and in combination with other points from

> the tradition for example in wen bing there is an

> emphasis on bloodletting. Hope this helps the

> discussion.

>

> sincerely,

>

> David Appleton

June 27, 2007

Jason,

I strongly feel that the thinking of the physician is as

important or more important than the final prescription or

treatment. I am much more interested in how the Chinese physician

arrived at their diagnosis and treatment than just a listing of a

pattern and formula. I call these the algorithms of the different

currents/schools/physicians.

TCM, in my opinion, has done an admirable job in compiling the

work of a multitude of physicians and sources,. However, there are

major shortcomings in terms of pathomechanisms and the

individualization of cases that is best illustrated by illuminating

both classical and modern physicians' thinking processes.

On Jun 27, 2007, at 9:12 PM, wrote:

> Doctors

> have very idiosyncratic usages that are difficult to see in such

> snapshots.

> Both methods are taken out of context from the original author.

> Sometimes

> this does not matter, sometimes it does. Their thinking is rarely

> described

> in these list books. The average student will never be able to find

> the

> source of the formulas.

>

> But of course it is all a matter of degree. And you are right there is

> nothing that " really " stops one from understanding these deeper

> points,

> except Chinese Language in many cases.

>

> I am just not convinced that TCM has somehow arrived at the best of

> the best

> through some magical distillation process as many like to believe.

> I am not

> convinced that all the TCM ideas are based on sound clinical

> results. Volker

> S. explores much of this in his writing. His point of view makes

> sense to

> me.

>

> Thoughts?

Chair, Department of Herbal Medicine

Pacific College of Oriental Medicine

San Diego, Ca. 92122

June 27, 2007

I think you understand also. The Taoism comes in as far as the body is

making decisions. Another question I would have is, if the body is Yin

Xu where is this extra Yin coming from?

Doug

, david appleton

<acuapple wrote:

>

> Doug- i think i understand- another example might be

> heat- which in jeffrey's thinking can invite dampness

> or fluids as a response to the pathogenic heat- is

> that response pathological? Is it an attempt to

> balance an excess? Are you questioning whether innate

> 'body intelligence' exists? In the menopause fibroid

> case if you nourish yin, the body can disregard the

> useless yin (pathogenic accumulation) and release the

> fibroid, because of the added usable yin- jeffrey

> differentiates useful and useless yin- the same idea

> might apply to prostatic hypertrophy where turtle

> shell can be used to nourish and move the yin stasis-

> as far as jeffrey's paradoxical thinking I think that

> naturally arises from his Daoist background- do you

> disagree with the strategies he proposes? If so what

> aspect do you find problematic?

>

> David

June 28, 2007

Correction, Doug. He did feel that she had underlying Yin Xu, but that there

was clearly signs of improvement based upon Chana's history. Unfortunately, I

feel that Dr. Qiu and Zhang each failed because they diagnosed and treated

according to orthodox TCM methods. TCM alone just didn't work in Chana's case.

Now that we are integrating the three factors that I mentioned: Dividing up the

formulas that I am now writing, applying the principles that Z'ev suggested, and

now integrating Jeffrey's powder after meals, I am optimistic that we will

continue to see progress and improvement.

Now, to explain further my understanding of the concept Jeffrey presented,

phlegm, from what I understand is the result of fluid stagnation. It is fluid,

but not just any fluid--pathogenic fluid, which the body produces in response to

heat pathogen or Yin Xu. As I mentioned in a previous post, how else can one

explain fluid in response to inflammation forming? Why does a blister have

fluid in it? Also please explain your discomfort with the concept of an inner

wisdom responding as a protective mechanism to protect against injury or

illness. Again, I refer to the examples I listed in the previous post. I'll

give you another one: The histamine response to severe allergy.

Doug, the issue is not giving the body free choice so that anything goes, the

issue is the mechanism of pathogenic fluid generated as a reaction to heat or

dryness. One other correction I will suggest: Though I have always called the

fluid that presents during Chana's seizures as phlegm, perhaps it really is not.

For it is clear, and phlegm is not. Therefore think of this this clear fluid as

a pathogenic response to the wind she creates by the movement of her jaw from

tremor, thus drying out the clear fluid, and making it thick and sticky--yet

clear.

Yehuda

wrote:

Discussing this is a little odd as Yuen decided that it wasn't Yin Xu

in Chana's case. Yehuda, I really hope that his formula works for

Chana. Having treated a number of cases like Sjorgeon's and

sarcoidosis where there is an abundance of phlegm but also deficiency,

I know the frustration. Especially with what seems to work TCM wise,

don't, as much as we would like. As I remember the formula had a

dynamic of going through the MJ that may be very helpful.

" bill_schoenbart " <plantmed2 wrote:

> Sounds like a re-wording of the same thing.

I almost want to say yes, it's a semantic issue, but ultimately I

would say no. (I also wonder how what Yuen says gets filtered to his

students.) Yuen has a lot of these paradoxes. I'll try to remember a

few, I hope they are accurate from my memory. " Yang holds Cold around

Cancer so that it won't spread. " " A pale tongue is actually a sign of

heat " . And now with this one, " The body produces Phlegm to protect

itself against extreme Yin Xu. "

I have no problem if some of these ideas are " true " in a phsiological

sense. What I don't like, again, is the idea of the " intelligent " body

making decisions for the good of the body. If there are (pathological)

changes then they should be named as such and not given agency. So

what happens if a body doesn't " decide " to create phlegm? Is the body

less intelligent, is it working less than optimumally?

All I have been objecting to is the phrase: " he body produces phlegm

" In Response to Yin xu " . If one says phlegm is produced " because of "

Yin Xu I would be perfectly OK with that. That is a pathomechanism. So

I'm also OK when Yehuda states: " But it also makes perfect sense, that

the tremendous amount of clear sticky phlegm that accompanies Chana's

seizures is probably this very pathogenic fluid resulting from severe

Yin depletion. " I don't think I'm being overly picky (eyes roll) to

say this is different from " pathogenic fluids is a response (the

subtext is " a protection " ) from severe Yin depletion " .

Again, if you give the body free agency to decide then all things can

be true. This perhaps is my issue with Yuen and the many students I

have met over the years.

Doug

, " bill_schoenbart "

<plantmed2 wrote:

>

> Sounds like a re-wording of the same thing.

>

> , " "

> <taiqi@> wrote:

> >

> > I'm not convinced that the body produces phlegm in response. I see

> > that fluids get disordered because of a Yin Xu and that manifests as

> > phlegm.

> > Doug

> >

>

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June 28, 2007

As I stated, I agree, Z'ev, and it continues to be a foundation of the approach

I am taking, but with one exception: When she is close to seizures or is still

vulnerable for more seizures, I have modified her formulas by omitting thick

sticky ingredients such as Ji Zi Huang, E Jiao, Bie Jia, and Gui Ban, and I

have lowered the dose of Sheng Di Huang. Remember, that Jeffrey specifically

felt that the 2 formulas I am using were beneficial and should continue to be

used, but that the powdered formula he wrote based upon Liu Wan Su, was to be

taken additionally right after meals. BTW, yes, I agree, that the approach of

other schools would have resulted in different formulas, but consider if you

would the background and approach of Liu Wan Su, as well as the personality of

Chana, her drivenness and inability to relax. IMVHO, they really do resonate.

All the best,

Yehuda

<zrosenbe wrote:

I'd like to add that I still think that formulas such as da ding feng

zhu should be the root of treatment in Chana's case, and not just

because I suggested it I understand that in such difficult,

frustrating scenarios that there is a tendency to switch from

modality to modality, approach to approach, formula to formula, but I

don't think this is a healthy thing to do. Jeffrey is a multi-

perspective teacher, and he was giving a seminar on Liu Wan-su's cool-

cold school, and trying to illustrate cases in this approach. Would

he have prescribed Chana differently if he was giving a Li Dong-yuan

spleen-stomach seminar, I wonder?

On Jun 27, 2007, at 11:32 AM, wrote:

> Discussing this is a little odd as Yuen decided that it wasn't Yin Xu

> in Chana's case. Yehuda, I really hope that his formula works for

> Chana. Having treated a number of cases like Sjorgeon's and

> sarcoidosis where there is an abundance of phlegm but also deficiency,

> I know the frustration. Especially with what seems to work TCM wise,

> don't, as much as we would like. As I remember the formula had a

> dynamic of going through the MJ that may be very helpful.

Chair, Department of Herbal Medicine

Pacific College of Oriental Medicine

San Diego, Ca. 92122

June 28, 2007

Again, Z'ev, nothing was switched, only added to.

<zrosenbe wrote: This was the entire point

of my last posting. Chana's prescription

was a reflection of what Jeffrey was teaching in this specific

seminar. I wonder if such a switch from a more kidney nourishing

prescription isn't a bit too radical, however.

On Jun 27, 2007, at 12:26 PM, david appleton wrote:

> I think the ideas

> jeffrey presents may seem contradictory because they

> are taken from different periods of chinese medicine

> and he will diagnose and treat based only on the

> tradition he is teaching that week- he may offer

> yehuda a completely different formula if he were

> treating this issue from a wai ke perspective- which

> also deals with neurological issues.

Chair, Department of Herbal Medicine

Pacific College of Oriental Medicine

San Diego, Ca. 92122

June 28, 2007

Jason,

I like alot of what you are saying here. I would like to offer one more

point: That which is a tradition, oral or written for that matter, has deep

roots which support its integration and clinical integrity. That which is

innovative and proposed, is only valid until exceptions are found. Then it's

adapted to account for those exceptions, and so too each time another objection

is presented as to why it doesn't work. It's the same with science. Even

reproducable results sometimes don't work. But to quote Miles Davis, " So what? "

We mortals (of both the Chinese and Biomedical persuasions) can never conjure

up a perfect way to treat and heal all sick or injured people, no matter how

good we are and no matter how many trillions of dollars are invested, but if we

continue to humbly think, share and learn, especially from our patients, we can

grow as fine artists, representing our tradition and our profession with

distinction.

SIncerely,

Yehuda

wrote:

This conversation between Doug and David is very interesting. David

(or

Yuen) is suggesting a story to explain what is an observable phenomenon in

the clinic. Doug does not like the story and favors a different story. Doug

favors a solid mechanism (?), and Yuen explains things through the body's

intelligence(?). (I hope I got that correct)

I will riff a little here :-)

I use the word story for a reason. It is the word that I use to explain what

a pathomechanism is to students. It is the story that gets you from point A

(pattern) to Point B (symptoms). If one has spleen xu with dampness and

dizziness, the pathomechanism is the story that explains why and how this

happens. I think we all agree on that (?).

But IMO essentially any pathomechanism (explanation) is pretty much BS. It

is a theatrical construct made up by the Human mind using the TCM framework.

Now don't get me wrong, I DO think that pathomechanisms are helpful and I

think in these terms often, but I try to stay realistic to what they really

are and how they really help us.

One pitfall is that many times such stories are used to create complex webs

of interrelationships (confusion) when a patient that we totally don't

understand are in front of us. We then label these people knotty or complex

cases and attribute them 4 or 5 patterns.

Really we only know a couple of things. 1) what the patient presents with 2)

what gets them better (in retrospect of course). This is the historical

basis for most of our theory / pathomechanisms. Why this or that happens

(the story) is really only a side note. The pattern is also a (very useful)

secondary side note in the process. This again is a human construction. I

believe this is what Huang Huang (in the Latest Lantern) is getting at. The

SHL has no real complex theory, no patterns (zang-fu), no pathomechanisms,

just s/s, etiologies, and formulas (to a certain extent), Later generations

attribute all the extra stuff. Huang Huang seems to get back to this type of

thinking and really focuses on the clinical pictures. What do you see (what

pattern) and how do you treat it. I find this idea interesting.

So what is my point?

I think either story (Yuen or Doug's) is 100% valid and 100% BS. But why

does one have to be correct and the other not? IF both can treat the problem

through i.e. nourishing yin the story is pretty much just icing on the cake.

Further example:

YinFire - As we discussed a few months back there are multiple explanations

on how this process happens. Some say qi sinks, some say dampness sinks,

some say nothing sinks and it is really about constraint, yet another says

" the yang is too weak to externalize, but rather

remains within the yin where it heats up " . I think there are more. But the

reality is that they all use the same treatment. Therefore the story is just

that. How does understanding and investing one's belief in any of these

stories help us clinically?

To sum up - I think theory is useful, I for some reason enjoy it, but

sometimes I think that the theory in medicine is similar to what happened

with Jazz. Early Jazz musicians played what they heard. They rarely knew the

theory. Later musicians starting documenting all the complexities and

developed theory to explain what was happening in the live moment. Anyone

that has studied Jazz (modern day) knows that the theory books are

outrageously large and cumbersome. I, as well as many others, believe that

this is one reason that many modern jazz musicians are not that great. They

can play all the scales, they can play all the songs, they can solo over any

change, but can they feel the music and play from the heart? Sometimes they

get so wrapped up in the details they forget about what is right in front of

them. Can we say the same about medicine? Has modern TCM turned everything

into a paint by numbers, or play this scale over this chord type of

approach. Are we losing how to really see what is going on right in front of

us, the patient????

Just curious what people think about this?

-Jason

_____

On Behalf Of david appleton

Wednesday, June 27, 2007 3:58 PM

Re: Re: seizures and parkinsonism: an update on my wife

Doug- i think i understand- another example might be

heat- which in jeffrey's thinking can invite dampness

or fluids as a response to the pathogenic heat- is

that response pathological? Is it an attempt to

balance an excess? Are you questioning whether innate

'body intelligence' exists? In the menopause fibroid

case if you nourish yin, the body can disregard the

useless yin (pathogenic accumulation) and release the

fibroid, because of the added usable yin- jeffrey

differentiates useful and useless yin- the same idea

might apply to prostatic hypertrophy where turtle

shell can be used to nourish and move the yin stasis-

as far as jeffrey's paradoxical thinking I think that

naturally arises from his Daoist background- do you

disagree with the strategies he proposes? If so what

aspect do you find problematic?

David

June 28, 2007

Doug,

Again, let me clarify: (BTW, when do you guys find time during the day to

engage in this long and brilliant discussions?) The pathomechanism which

produces pathogenic fluid is heat, mostly excess heat, but also vacuititous

heat, ie, Yin xu. I think that the in the case of yin xu it comes more as a

result of stagnation, whereas in the case of repletion, it comes more directly,

as an inflammatory response. Remember that the fluid in either case is a

pathogenic fluid, and so the method of treatment would not be to dry dampness or

transform phlegm, which would just exascerbate the problem, but instead to

nourish yin and blood, and move Qi and possibly Blood as well. The key is to

determine the root.

Yehuda

wrote:

Jason, thanks for all the thoughts. I guess I like my story better

because there is a path that can be followed from symptom to symptom

with an explanation through the pathomechanism. The issue of

intelligence seems to be a wild card that allows for a degree of

randomness in treatment and lack of predictibility. But then I haven't

studied in this method like David has.

So my question as far as the Extreme Yin Xu with extreme damp is: How

is a patient with extreme Yin Xu treated as opposed to someone who

presents with Exteme Damp coming from Extreme Yin Xu?

Doug

, " "

wrote:

>

> This conversation between Doug and David is very interesting. David (or

> Yuen) is suggesting a story to explain what is an observable

phenomenon in

> the clinic. Doug does not like the story and favors a different

story. Doug

> favors a solid mechanism (?), and Yuen explains things through the

body's

> intelligence(?). (I hope I got that correct)

>

> I will riff a little here :-)

>

> I use the word story for a reason. It is the word that I use to

explain what

> a pathomechanism is to students. It is the story that gets you from

point A

> (pattern) to Point B (symptoms). If one has spleen xu with dampness and

> dizziness, the pathomechanism is the story that explains why and how

this

> happens. I think we all agree on that (?).

>

> But IMO essentially any pathomechanism (explanation) is pretty much

BS. It

> is a theatrical construct made up by the Human mind using the TCM

framework.

> Now don't get me wrong, I DO think that pathomechanisms are helpful

and I

> think in these terms often, but I try to stay realistic to what they

really

> are and how they really help us.

>

> One pitfall is that many times such stories are used to create

complex webs

> of interrelationships (confusion) when a patient that we totally don't

> understand are in front of us. We then label these people knotty or

complex

> cases and attribute them 4 or 5 patterns.

>

> Really we only know a couple of things. 1) what the patient presents

with 2)

> what gets them better (in retrospect of course). This is the historical

> basis for most of our theory / pathomechanisms. Why this or that happens

> (the story) is really only a side note. The pattern is also a (very

useful)

> secondary side note in the process. This again is a human

construction. I

> believe this is what Huang Huang (in the Latest Lantern) is getting

at. The

> SHL has no real complex theory, no patterns (zang-fu), no

pathomechanisms,

> just s/s, etiologies, and formulas (to a certain extent), Later

generations

> attribute all the extra stuff. Huang Huang seems to get back to this

type of

> thinking and really focuses on the clinical pictures. What do you

see (what

> pattern) and how do you treat it. I find this idea interesting.

>

> So what is my point?

>

> I think either story (Yuen or Doug's) is 100% valid and 100% BS. But why

> does one have to be correct and the other not? IF both can treat the

problem

> through i.e. nourishing yin the story is pretty much just icing on

the cake.

>

> -Jason

>

Luggage? GPS? Comic books?

Check out fitting gifts for grads at Search.

June 28, 2007

Dear Yehuda,

This sounds interesting. Thank you for the clarification, and

please keep me posted on her progress. . .

On Jun 28, 2007, at 1:42 AM, yehuda frischman wrote:

> As I stated, I agree, Z'ev, and it continues to be a foundation of

> the approach I am taking, but with one exception: When she is close

> to seizures or is still vulnerable for more seizures, I have

> modified her formulas by omitting thick sticky ingredients such as

> Ji Zi Huang, E Jiao, Bie Jia, and Gui Ban, and I have lowered the

> dose of Sheng Di Huang. Remember, that Jeffrey specifically felt

> that the 2 formulas I am using were beneficial and should continue

> to be used, but that the powdered formula he wrote based upon Liu

> Wan Su, was to be taken additionally right after meals. BTW, yes, I

> agree, that the approach of other schools would have resulted in

> different formulas, but consider if you would the background and

> approach of Liu Wan Su, as well as the personality of Chana, her

> drivenness and inability to relax. IMVHO, they really do resonate.

>

> All the best,

>

> Yehuda

>

> <zrosenbe wrote:

> I'd like to add that I still think that formulas such as da ding feng

> zhu should be the root of treatment in Chana's case, and not just

> because I suggested it I understand that in such difficult,

> frustrating scenarios that there is a tendency to switch from

> modality to modality, approach to approach, formula to formula, but I

> don't think this is a healthy thing to do. Jeffrey is a multi-

> perspective teacher, and he was giving a seminar on Liu Wan-su's cool-

> cold school, and trying to illustrate cases in this approach. Would

> he have prescribed Chana differently if he was giving a Li Dong-yuan

> spleen-stomach seminar, I wonder?

>

> On Jun 27, 2007, at 11:32 AM, wrote:

>

> > Discussing this is a little odd as Yuen decided that it wasn't

> Yin Xu

> > in Chana's case. Yehuda, I really hope that his formula works for

> > Chana. Having treated a number of cases like Sjorgeon's and

> > sarcoidosis where there is an abundance of phlegm but also

> deficiency,

> > I know the frustration. Especially with what seems to work TCM wise,

> > don't, as much as we would like. As I remember the formula had a

> > dynamic of going through the MJ that may be very helpful.

>

> Chair, Department of Herbal Medicine

> Pacific College of Oriental Medicine

> San Diego, Ca. 92122

>

June 28, 2007

Dear Jason,

I always remember the statement, " using a feather to move a

mountain " in situations such as this. Clear, concise diagnosis that

understands the pathomechanisms, utilizing the insight and experience

of the physician.

On Jun 27, 2007, at 6:34 PM, wrote:

> I think David brings up some good points. I think this jumbled up TCM

> collage can many times do more harm than good. This also applies to

> herbs.

> One doctor may use an herb in a certain way, which is very

> dependent on

> context, meaning diagnosis style as well as the medicinals that it is

> combined with. It really helps many times to understand the original

> doctor's thought process and tradition, instead of the taking the

> formula.

> For example, one can try to make sense of the herbs's functions (in

> the

> formula) based on a modern MM- cohesive view. Many times the

> intricacies of

> the original doctor are completely lost. I have found that this is a

> pitfall of modern TCM.

>

> Do other's have some thoughts on this?

>

> -Jason

>

> _____

>

> On Behalf Of david

> appleton

> Wednesday, June 27, 2007 1:27 PM

>

> Re: Re: seizures and parkinsonism: an update on my wife

>

> Doug, I have studied with Jeffrey for 5 years and I am

> not sure you are correct in some of the statements you

> are making- 'the body produces phlegm to protect

> itself from yin xu'- I believe he means the body holds

> onto phlegm as a second class substitute for yin; the

> body's intelligence is misguided- Jeffrey offers the

> example to illustrate this of menopausal fibroids,

> where one would expect the fibroids to shrink but

> instead post menopause they increase in size as the

> body attempts to retain yin in any form; in jeffrey's

> view yin can be used to hold things latent. How the

> body decides to deal with a given pathology has more

> to do with constitutional factors- the shu points are

> not irrigated equally by the rising of jing, so each

> person presents with different tendencies- which

> becomes the basis of body types etc. I think the ideas

> jeffrey presents may seem contradictory because they

> are taken from different periods of chinese medicine

> and he will diagnose and treat based only on the

> tradition he is teaching that week- he may offer

> yehuda a completely different formula if he were

> treating this issue from a wai ke perspective- which

> also deals with neurological issues. Modern TCM tends

> to jumble up the traditions and present ideas that are

> contradictory when viewed from within the tradition-

> eg the school of cooling and cold, vs the ming men pai

> or the wai ke school; an example of this is the

> listing of point functions in say deadman's book- he

> lists all the functions from all the traditions, earth

> school, wen bing etc- but it may be that those

> functions only work well within the scope of the

> tradition and in combination with other points from

> the tradition for example in wen bing there is an

> emphasis on bloodletting. Hope this helps the

> discussion.

>

> sincerely,

>

> David Appleton

> --- <taiqi (AT) taiqi (DOT) <taiqi%40taiqi.com>

> com> wrote:

>

> > Discussing this is a little odd as Yuen decided that

> > it wasn't Yin Xu

> > in Chana's case. Yehuda, I really hope that his

> > formula works for

> > Chana. Having treated a number of cases like

> > Sjorgeon's and

> > sarcoidosis where there is an abundance of phlegm

> > but also deficiency,

> > I know the frustration. Especially with what seems

> > to work TCM wise,

> > don't, as much as we would like. As I remember the

> > formula had a

> > dynamic of going through the MJ that may be very

> > helpful.

> >

> > " bill_schoenbart " <plantmed2 wrote:

> > > Sounds like a re-wording of the same thing.

> >

> > I almost want to say yes, it's a semantic issue, but

> > ultimately I

> > would say no. (I also wonder how what Yuen says gets

> > filtered to his

> > students.) Yuen has a lot of these paradoxes. I'll

> > try to remember a

> > few, I hope they are accurate from my memory. " Yang

> > holds Cold around

> > Cancer so that it won't spread. " " A pale tongue is

> > actually a sign of

> > heat " . And now with this one, " The body produces

> > Phlegm to protect

> > itself against extreme Yin Xu. "

> >

> > I have no problem if some of these ideas are " true "

> > in a phsiological

> > sense. What I don't like, again, is the idea of the

> > " intelligent " body

> > making decisions for the good of the body. If there

> > are (pathological)

> > changes then they should be named as such and not

> > given agency. So

> > what happens if a body doesn't " decide " to create

> > phlegm? Is the body

> > less intelligent, is it working less than

> > optimumally?

> >

> > All I have been objecting to is the phrase: " he body

> > produces phlegm

> > " In Response to Yin xu " . If one says phlegm is

> > produced " because of "

> > Yin Xu I would be perfectly OK with that. That is a

> > pathomechanism. So

> > I'm also OK when Yehuda states: " But it also makes

> > perfect sense, that

> > the tremendous amount of clear sticky phlegm that

> > accompanies Chana's

> > seizures is probably this very pathogenic fluid

> > resulting from severe

> > Yin depletion. " I don't think I'm being overly picky

> > (eyes roll) to

> > say this is different from " pathogenic fluids is a

> > response (the

> > subtext is " a protection " ) from severe Yin

> > depletion " .

> >

> > Again, if you give the body free agency to decide

> > then all things can

> > be true. This perhaps is my issue with Yuen and the

> > many students I

> > have met over the years.

> >

> > Doug

> >

> > @ <%

> 40>

> ,

> > " bill_schoenbart "

> > <plantmed2 wrote:

> > >

> > > Sounds like a re-wording of the same thing.

> > >

> > > @ <%

> 40>

> ,

> > " "

> > > <taiqi@> wrote:

> > > >

> > > > I'm not convinced that the body produces phlegm

> > in response. I see

> > > > that fluids get disordered because of a Yin Xu

> > and that manifests as

> > > > phlegm.

> > > > Doug

> > > >

> > >

> >

>

> ________

> oneSearch: Finally, mobile search

> that gives answers, not web links.

> http://mobile. <http://mobile./mobileweb/onesearch?

> refer=1ONXIC>

> /mobileweb/onesearch?refer=1ONXIC

>

June 28, 2007

Jason,

I respectfully disagree. Pathomechanisms in my mind are gems.

They are conceptual indeed, but they are tools to help people and

alleviate their suffering. We are creatures of mind (and body), and

designed to interpret the universe through the tools we are given to

do so.

On Jun 27, 2007, at 7:53 PM, wrote:

>

> But IMO essentially any pathomechanism (explanation) is pretty much

> BS. It

> is a theatrical construct made up by the Human mind using the TCM

> framework.

> Now don't get me wrong, I DO think that pathomechanisms are helpful

> and I

> think in these terms often, but I try to stay realistic to what

> they really

> are and how they really help us.

Chair, Department of Herbal Medicine

Pacific College of Oriental Medicine

San Diego, Ca. 92122

June 28, 2007

Y,

I think that it is safe to say that the fluid / situation you describe fits

under the category of phlegm. Do others disagree?

-Jason

_____

On Behalf Of yehuda frischman

Doug, the issue is not giving the body free choice so that anything goes,

the issue is the mechanism of pathogenic fluid generated as a reaction to

heat or dryness. One other correction I will suggest: Though I have always

called the fluid that presents during Chana's seizures as phlegm, perhaps it

really is not. For it is clear, and phlegm is not. Therefore think of this

this clear fluid as a pathogenic response to the wind she creates by the

movement of her jaw from tremor, thus drying out the clear fluid, and making

it thick and sticky--yet clear.

Yehuda

June 28, 2007

I agree with Yehuda here. The body has many responses that are deemed

pathological " substances " in TCM (i.e. swelling) that are essentially

protective measures - body's innate intelligence. I have no problem with

that. Maybe TCM does not describe it in this way. Therefore maybe this is a

shortcoming of TCM or maybe another tradition within CM describes it better,

i.e. Yuen.

Comments?

-Jason

_____

On Behalf Of yehuda frischman

Thursday, June 28, 2007 2:32 AM

Re: Re: seizures and parkinsonism: an update on my wife

Now, to explain further my understanding of the concept Jeffrey presented,

phlegm, from what I understand is the result of fluid stagnation. It is

fluid, but not just any fluid--pathogenic fluid, which the body produces in

response to heat pathogen or Yin Xu. As I mentioned in a previous post, how

else can one explain fluid in response to inflammation forming? Why does a

blister have fluid in it? Also please explain your discomfort with the

concept of an inner wisdom responding as a protective mechanism to protect

against injury or illness. Again, I refer to the examples I listed in the

previous post. I'll give you another one: The histamine response to severe

allergy.

Doug, the issue is not giving the body free choice so that anything goes,

the issue is the mechanism of pathogenic fluid generated as a reaction to

heat or dryness. One other correction I will suggest: Though I have always

called the fluid that presents during Chana's seizures as phlegm, perhaps it

really is not. For it is clear, and phlegm is not. Therefore think of this

this clear fluid as a pathogenic response to the wind she creates by the

movement of her jaw from tremor, thus drying out the clear fluid, and making

it thick and sticky--yet clear.

Yehuda

June 28, 2007

One of the things I think we all need to accept about Chinese

medicine is its multi-perspective orientation. In other words, there

are phenomenologically different ways of looking at a patient.

Another way of expressing this would be that one can see a patient as

a complex system, and there are a number of ways to interact with a

complex system to restore equilibrium to that system.

On Jun 28, 2007, at 10:38 AM, wrote:

> Z'ev,

>

> I thought you might disagree. I also somewhat disagree with my

> statements.

> Meaning I also think pathomechanism are gems. But I would like to

> hear more

> about how they are " tools to help people heal. "

>

> And do you think there is any inherent truth in a pathomechanism?

> Any time I

> see multiple doctors explaining the same phenomenon with different

> pathomechanisms I have to wonder how truthful any of them are. That

> is why I

> believe they are all useful and at the same time all just a story.

> Is there

> value in having multiple pathomechanisms to explain a single

> situation.

> (i.e. yinfire). ???

>

> How do people conceptualize the value of pathomechanisms?

>

> -Jason

Chair, Department of Herbal Medicine

Pacific College of Oriental Medicine

San Diego, Ca. 92122

June 28, 2007

On 6/28/07, wrote:

>

> How do people conceptualize the value of pathomechanisms?

>

One value of pathomechanisms is that it cuts down dramatically on the amount

of memorization one needs to do while studying TCM (or practicing with swiss

cheese for brains).

Understanding pathomechanisms also helps one to think outside of the box.

Sometimes, I'll see a patient with a chief complaint for which there are

specific syndrome differentiations. However perhaps the patient's

presentation doesn't show up on that page of differentiations. At that

point, you have two choices: 1) Get another book or diff-di source to

consult, or 2) treat what you see.

I find that option 2 is enhanced by understanding pathomechanisms, its like

back-up logic, a TCM thinking spell-check if you will. If you have to make

up new pathomechanism, you may be deluding yourself. Perhaps after 30 years

of practice, one can begin to do that, but I find too much tweaking of TCM

theory by those with little real-world experience to be problematic. I'm not

applying that to Jeffrey Yuan, but rather some of the odd-ball theories that

come up in the wake of solid TCM framework.

--

, DAOM

Pain is inevitable, suffering is optional.

June 28, 2007

Al,

I totally agree.

-Jason

_____

On Behalf Of Al Stone

Thursday, June 28, 2007 12:22 PM

Re: Re: seizures and parkinsonism: an update on my wife

On 6/28/07, <@chinesemed

<%40Chinese Medicine> icinedoc.com> wrote:

>

> How do people conceptualize the value of pathomechanisms?

>

One value of pathomechanisms is that it cuts down dramatically on the amount

of memorization one needs to do while studying TCM (or practicing with swiss

cheese for brains).

Understanding pathomechanisms also helps one to think outside of the box.

Sometimes, I'll see a patient with a chief complaint for which there are

specific syndrome differentiations. However perhaps the patient's

presentation doesn't show up on that page of differentiations. At that

point, you have two choices: 1) Get another book or diff-di source to

consult, or 2) treat what you see.

I find that option 2 is enhanced by understanding pathomechanisms, its like

back-up logic, a TCM thinking spell-check if you will. If you have to make

up new pathomechanism, you may be deluding yourself. Perhaps after 30 years

of practice, one can begin to do that, but I find too much tweaking of TCM

theory by those with little real-world experience to be problematic. I'm not

applying that to Jeffrey Yuan, but rather some of the odd-ball theories that

come up in the wake of solid TCM framework.

--

, DAOM

Pain is inevitable, suffering is optional.

June 28, 2007

Yes, but to take a conglomeration of different systems and try to integrate them

together (or dumb them down--reductionism?) may not work, as has been expressed.

BTW, it would seem to me that the clinical success of a TCM treatment has as

much to do with the practitioner/patient relationship as it has to do with the

therapy.

<zrosenbe wrote: One of the things I think

we all need to accept about Chinese

medicine is its multi-perspective orientation. In other words, there

are phenomenologically different ways of looking at a patient.

Another way of expressing this would be that one can see a patient as

a complex system, and there are a number of ways to interact with a

complex system to restore equilibrium to that system.

On Jun 28, 2007, at 10:38 AM, wrote:

> Z'ev,

>

> I thought you might disagree. I also somewhat disagree with my

> statements.

> Meaning I also think pathomechanism are gems. But I would like to

> hear more

> about how they are " tools to help people heal. "

>

> And do you think there is any inherent truth in a pathomechanism?

> Any time I

> see multiple doctors explaining the same phenomenon with different

> pathomechanisms I have to wonder how truthful any of them are. That

> is why I

> believe they are all useful and at the same time all just a story.

> Is there

> value in having multiple pathomechanisms to explain a single

> situation.

> (i.e. yinfire). ???

>

> How do people conceptualize the value of pathomechanisms?

>

> -Jason

Chair, Department of Herbal Medicine

Pacific College of Oriental Medicine

San Diego, Ca. 92122

July 9, 2007

Hi Yehuda

Can you direct me to the page you wrote with all her chinese related

symptoms? Hot cold, sweat no sweat, time of day, what is different

during before and after attack compare to normal state shi xu,etc.

Kelvin

Chinese Medicine , yehuda frischman

< wrote:

>

> Dear friends, colleagues and teachers,

>

> It has been some time since I wrote to you of my wife's

progress. To recap: 17 years ago, she started having seizures which

have occurred cyclically, every 3-4 weeks. Four years later, she

started presenting with symptoms in some ways resembling Parkinson's

disease. Yet, 5 MRIs, and other scans have all been benign. She is

also unable to take Western pharmaceutical medicine, as she has had

severe allergic reactions on multiple occasions. What has helped has

been seven years of drinking Chinese herbal decoctions. Particularly

encouraging has been that in the past year or so, sleep has been much

more sound and undisturbed, urination is no longer frequent, and

constipation is no longer an issue. But, unfortunately, she

continues to have the seizures. Also, her pulses and tongue have

also changed in the past year, and she no longer has a dry baked

brown coating as before. One other significant consideration that I

have mentioned to you before, is the presence of

> thick, clear phlegm particularly, during the time that seizures

are either expected or have occurred.

>

> At this time I want to relate to you three significant bits of

input that have either contributed within the past 9 months, or I

expect will shortly: 1) Last fall when we were in London, we met

with a Vietnamese herbal master, Thong Tinh Nguyen. Thong felt that

part of the problem was that my wife Chana was not absorbing the

nutrients in her formulas. He therefore suggested dividing the

formula in half, and since then, Chana has been taking primarily

herbs to supplement Qi and transform phlegm AM and herbs to nourish

Yin and calm Shen PM. 2) about 4 months ago, we had the pleasure of

spending a few hours with my dear friend and our colleague Z'ev

Rosenberg, in San Diego. Z'ev remarked that it seemed to him that

Chana's liver was doing the work of the Kidneys as well as its own.

He suggested that I integrate into her formulas, " Da Ding Feng Zhu "

to get to the root of the liver wind: complete exhaustion of the True

Kidney Yin. 3) As most of you are reading this, I

> am probably in the middle of a second day of seminars with Jeffrey

Yuen. (BTW, Chana was chosen as a demonstration patient, and I will

report back, G-d willing, on how he viewed her and how it went). On

the first day I attended, Friday, he presented a plethora of

information, much of which I had never heard nor seen before. (I

also had the pleasure of meeting our esteemed colleague, Chris

Macie). Among the details was one that hit me like a lead balloon:

Jeffrey mentioned that in the presence of heat or severe Yin

deficiency, the body produces as a reaction, pathogenic fluid. This

can be seen in fluid resulting from inflammation. But it also makes

perfect sense, that the tremendous amount of clear sticky phlegm that

accompanies Chana's seizures is probably this very pathogenic fluid

resulting from severe Yin depletion. Though it would be completely

inappropriate, it would seem to me, to use herbs transforming phlegm

as we have in the past, and instead, the focus

> should be on engendering Yin while at the same time moving the Qi,

to prevent stagnation and accummulation.

>

> Your thoughts?

>

> Sincerely,

>

> Now that's room service! Choose from over 150,000 hotels

> in 45,000 destinations on Travel to find your fit.

>

July 10, 2007

Hi Kelvin,

Unfortunately, I had forgotten that I had posted her history, S/S, and a

journal of progress and formulas changed under the guidance of Dr. Ji Zhang in

back in 2005, in a different group, Chinese Herbal Medicine. With the

permission of the moderators, below please find a couple of posts from that

time, the second a few months later in response to the query of a practitioner

with a similar scenario:

#1

" 15 years ago, my wife of 26 years had the first of many seizures which

have occured cyclically every 3 weeks, followed the next week by

post-ictal " aftershocks " . 4 years later, she developed Parkinson's like

symptoms. Yet the results of numerous MRIs, CTscans and EEGs came out

negative. To further complicate the picture, she has proven to be

pan-allergic to western medicine and nearly died from a Steven's Johnson

reaction to a state of the art anti-convulsant, lamictal. It was because

of her condition and the lack of success of the more than 250

practitioners: Western, Oriental, conventional and alternative that we

saw, that I decided to close my business of 21 years and study Oriental

medicine and Craniosacral therapy. Though the seizures have not yet

been resolved, I am seeing definite improvement in her symptoms, and am

very hopeful for a full resolution.

Western medicine has a passion for putting names to syndromes, and the

problem is when they don't fit into the cookbook. So, is it epilepsy?

(where's the lesion? They aren't pseudo seizures because they were

recorded through telemetry at UCLA) . Is there such a thing as functional

epilepsy without a structural hot spot? Is it Parkinson's? The hallmark

of Parkinson's is resting tremors, whereas Chana has motion tremors.

Bottom line, there are elements of both, but the Western DX has been

established as " Sympathetic hypertonicity " .

Over the 4 years in school, we worked with all of my clinical

supervisors, as well as many of my professors. Each time, it got to the

point where they either gave up, or we decided to move on as we were

unable to see any change or lasting improvement. Usually, we gave them

anywhere between 6 month to a year. A little over a year ago, we began

working with my professor, Zhang Ji. His approach has yielded results,

and my wife has been very responsive to extremely subtle changes in herbs

and dosages. As with any cycle, her tongue and pulse changes at the

different stages. As a result, her herbs change weekly. It is my hope

that as the fine-tuning process continues, the seizures will cease. In

summary, her condition has consisted of excess fire, mixed with

deficient heat, yin and blood deficiency, liver wind, and phlegm

accumulation.

What I would like to do, is bring you on board as we proceed week by

week, and present the signs symptoms and herbs with dosages chosen to

address them.

But before I begin with last Thursday's session, I want to let you know

what Ed Kasper has added to the picture. Two weeks ago, he mentioned

in a passionate CHA post, " the Parkinson's recovery project " in Santa

Cruz. They have apparently cured Parkinson's with just acupuncture and

tui na. I looked up their site, and sent for their practitioners

handbook. In sum, what Janice Walton-Hadlock found was that injuries to

the foot, usually around ST42, created electrical blockages in the Yang

ming channels, causing PD. The idea that the yang ming channels qi could

get stuck as a result of an injury, and diverted and eventually

completely blocked makes a lot of sense I have not received a response

from them yet as to whether they have come across cases like Chana's, but

it is eye-opening to consider that illness, and not just Parkinson's but

other illnesses as well, could be bio-chemically based imbalances, (Yin

disorders), electrically based imbalances (Yang disorders) or both.

Intriguingly, I began treating her with tuina and CST, in the areas of

ST35 and ST31 where in the past she had had significant injuries, and

guess what? Her tremors are less! Coincidence? Dumb luck? I don't

know. But intriguing and worthy of further study. This development,

too, I will appraise you of. Interestingly, as I write this, I flash

back to one of our stops, in Switzerland, where a naturopathic MD

injected scars, based upon " neural therapy " whereby it is believed that

scar tissue blocks the flow of the body's energy and leads to pathology.

It is based upon the research of the Huneke brothers in Germany 75

years ago.

Anyway, Chana's last seizure was Dec. 29. We saw Dr. Zhang on Jan 6. At

the time she had had a very difficult week. Sleep was very poor,

constant muscle spasms, very weak, increased nocturia, tongue and chin

constantly moving, difficulty comprehending, neck, chin and jaw very

sensitive to the touch. Her tongue had little coating, normal body

color, red tip and cracks. The pulses were wiry and choppy on both

wrists.

The formula prescribed was: Sheng di huang 30, xuan shen 15, mai men

dong 12, bai shao yao 15, gui ban 15, bie Jia 15, zhen zhu mu 15,

yu zhu 12, bai he 15, gou teng 15, sang piao xiao 12, di long 9, chan tui

9, suan zao ren 15, ye jiao teng 12, wu wei zi 9. Taken separately in

capsule form: quan xie 3 and wu gong 3, and da huang 3.5 grams daily.

Remember, before second guessing, this formula has evolved from more

than a year of weekly changes, and is anything but arbitrary. I would be

glad to expain or discuss any aspect of the formula should there be any

need for clarification. "

#2

" I don't know if you have been following my weekly posts concerning my

wife who started having seizures 15 years ago. Though she later

developed symptoms of Parkinsonism (similar to Parkinson's) 4 years

later, they seemed to be sequelae of the seizures. Her situation

parallels your brother in that she had 5 MRIs, as well as CTscans, and

EEG's all of which showed nothing. You are correct that the essence of

seizures is Phlegm which indeed originates from the spleen, and but which

also invariably has its origin in kidney yin deficiency and liver wind.

However what causes the seizures is the wind/phlegm rising upward and

misting the heart channel. Checking his tongue you will most probably

see a red tip and his pulses will probably be slippery and wiry. Also,

you might note that during or immediately following his seizures, you

will be able to hear a phlegmy raspiness in his breathing and he will

probably be drooling thick clear phlegm. BTW, my wife was also an artist

and a night person who had erratic sleep patterns, and invariably was

awake at 1AM (liver time). "

All the best,

Yehuda

acupuncturebeverlyhills <acupuncturebeverlyhills wrote: