yin fire & dx.

[Guest guest]

It seems to me that much of this discussion is based on peoples' not

having a very complete vision of the Chinese medical literature and,

therefore, practice in China. To think that even the growing body of

literature that we currently have in English gives an adequate picture

of Chinese medicine in the PRC is, I believe, naive.

 

In particular, what we are lacking the most of in the current English

language literature are the genres of the case history and so-called

medical essays. It is the case history literature which shows lao yi

sheng, i.e., masters, at work dealing with complex, difficult to treat

conditions. And it is the medical essay, particularly those essays

that are commonly titled, " Old Doctor So-and-so's Understanding of the

Chinese Medical Treatment of ________, " that discuss senior

practitioners' insights into real-life practice. It is these kinds of

work which give a more representative picture of real-life clinical

practice by people who have been in practice 30, 40, and, in some

cases, 50 years.

 

The kinds of textbooks which currently dominate the English language

CM literature AS A GENRE are not designed or meant to give an adequate

representation of real-life practice. In China, everyone knows these

kinds of textbooks are just the basic introduction, and everyone then

goes on to read the case histories, medical essays, etc. and work

under a personal mentor who can better convey the reality of CM

practice. Unfortunately, it is a fact of publishing life in the West

that this kinds of " second-level " literature just does not sell.

Publishers, such as Blue Poppy, have found that not enough people buy

these kinds of books to be able to continue publishing them. As a

profession, we just don't seem to be ready to support this level of

sophistication.

 

That being said, one commonly can see a more complex approach to CM in

the many clinical audits Blue Poppy publishes as Research Reports and

in our on-line quaterly journal. If one looks at the majority of

these, what one will see is that a single protocol (often with

individualized modifications) has been used on a particular condition.

In the majority of these studies dealing with complex, chronic

conditions, the authors have assumed that there is a complex set of

patterns requiring complex simultaneous treatment based on three or

sometimes more treatment principles. Rarely does one find a clinical

audit using a single pattern protocol. These multipattern protocols

are based on the authors' experience that certain conditions tend to

present with certain combinations of patterns.

 

Although I have said this ad nauseam before, so much of this

discussion is like the blind men and the elephant. As I see it, so

many of the foregoing questions and comments in this discussion are

based on an inadequate view of the CM literature in turn due to

inability to read the breadth and depth of that literature.

 

Bob

 

, " " <@o...> wrote:

>

>

>

> [zrosenbe@s...]

> Thursday, July 19, 2001 3:34 PM

>

> Re: Re: yin fire & dx.

>

>

> For me, this approach you describe from your teachers seems very

myopic and

> limited. But if it works for you, go for it.

>

>

> Myopic and limited as you may say.. This is as I

know/ see

> it, is taught in the western world (majority), and in China. Every

book I

> own takes this approach except possibly the pi wei lun (and there

are a

> multiple interpretations of this book, as even Bob admits) to name a

few

> books that deal with a 1-2 pattern style of writing:

> Bensky.'s herb books, Acupuncture Patterns and Practice- Case

Studies I &

> II, Handbook of Internal Medicine, Maciocia's books, all my

translated books

> from china, Steven Clavey's Fluid Physiology & Pathology in TCM,

Practical

> Therapeutics in TCM (yan wu) not to mention everything I have read

from C.S.

> Cheug – including his case studies, I could go on & on….

> So as reductionist or linear (Todd) or myopic and limited (Z'ev) as

it

> seems, I have not much evidence that things should be any other way,

or are

> taught any other way .. except for a small minority people. And I

must be

> in good company because I am currently in the boat with all of the

above

> authors and all Chinese prof.'s I have worked with. And to answer's

> question

> " whether you think it is more linear and reductionistic to find the

single

> causative factor

> for a disease or identify the complex web of interactions. "

> I do not think a key single patterned diagnosis is equivalent to a

single

> causative factor. The complex web I feel has been addressed above

and

> below.

> I feel it is eloquent to be able to look a very complex case and see

a

> simple solution.

>

> As for the idea that Communists China destroyed or took away the

true

> medicine (5 – element, spiritual or whatever) I have also seen no

evidence

> for this belief. In fact I felt Maciocia had an extremely strong

> presentation at the last PCOM symposium specifically debunking this

belief

> among many others surround the cultural revolution, medicine

practiced now

> vs. (pre-1949) etc.. One of the strongest points- if the Chinese

government

> (1949) somehow took all of this complexity, spirituality, five

phase, or

> whenever from the medicine then neighboring countries, specifically

Taiwan,

> would have this older form (pre-1949) of medicine. Maciocia

examined texts

> from Taiwan and concluded that the medicine was the same and could

find no

> deeper spiritual or five elements emphasis. He traces back

historically,

> very clearly to when various systems fell out of date, i.e. five

phase—this

> happened long before 1949.

> Secondly, my Chinese teachers, specifically Min Fan, has always been

very

> clear about his education and how he had access to any text, and if

anything

> the Communists saved Chinese medicine, did not destroy it. He does

not feel

> limited in anyway. I cannot at all agree with the idea that (these)

Chinese

> doctors are somehow limited because they learned in China during a

certain

> era, and that somehow we as Westerners, who most of us cannot even

read the

> language, have somehow a better or truer understanding. Min Fan has

read

> the pi wei lun, as well as a multitude of classical texts, has

thoroughly

> studied them, and has taught them (here & in Nan Jing Univ). His

> understanding of Chinese medicine, is definitely beyond anyone I

ever met.

> I will summarize:

> 1) yin-fire theory is rarely even mentioned as Bob points out

(despite

> what Simon says) approx. 6 out of 3840+ journal articles a year.

> 2) The 4-5 pattern type treating is not written about very

often…

> texts or journals… and few people practice it.

> 3) Understanding the 4-5 pattern approach through sheer

analyzation of

> ingredients of the formulas is subjective, controversial, and

unreliable (to

> the original author of the rx intent- evidenced by the PCOM files

> experiment).

>

> (zev) It seems to me, Jason, that you have generated an excellent

response

> to your questions, and should have all the information you need

between Bob,

and myself. It is now up for you to decide what is correct for

your

> work.

>

>

> (Jason) You are right, and I appreciate everyone's input. Finally,

I am not

> putting down anyone else's system one bit—it is one approach- a

quite

> possible the best for a given type a problems. Let us just

acknowledge this

> method for what it is, and what it is not, where it came from, how

popular

> it really is, who is really using it, what its strengths and

weaknesses are

> etc. etc. this is what I am trying to obtain. I feel Z'ev,

Bob and

> others are somewhat modern-day-pioneers in this system. I only

commend

> there initiative. I look forward to some material where I can learn

this

> style… I have ample sources discussing the 1-2 pattern approach.

Could

> advocates of the 4-5 pattern dx system supply some sources so that I

can

> read more about this, besides Bob's writings…

>

> --

[Guest guest]

Tenuously I began to incorporate these sorts of treatments withmy patients and found that I could very frequently get results where I wasstymied before.

>>>This is good to here. Can we get case histories with meaningful follow up

Alon

 

-

Mark Reese

Friday, July 20, 2001 8:20 AM

Re: Re: yin fire & dx.

Jason,I have lurked in the background during this whole fascinating give and take.You have certainly done a wonderful job of pulling wonderful explanationsand arguments from the group. I do want to echo et al in reiteratingthat you may well change your views in practice. When I graduated I wasconvinced of the eloquence inherent in discovering the most importantpattern occurring in a patient and treating it --- a part in my owneducation and internship. Unfortunately, outside of acute disorders andpediatric cases (uncomplicated, textbook cases), I could only get goodresults for 30-40% of my chronic cases. This was a constant source offrustration to me.Also, like you, I found Bob Flaw's early works grating and irksome.However, when I went back and worked my way through them, and particularbegan to study the more recent publications, I was impressed by the way inwhich the whole yin fire approach seemed to echo my patients' symptompictures. Tenuously I began to incorporate these sorts of treatments withmy patients and found that I could very frequently get results where I wasstymied before. I now, not infrequently, will get patients who have been toChicago's Chinatown and had disappointing results from well known (Chinese)herbalists there who seem to respond to my more organic (yin fire) approachquite well. This, of course, may be due to many things: language skills,etc.In any case, you'll see what works best. It is clear that you've got abrilliant and penetrating mind and that you'll continuously evaluate yourmethods throughout your life of practice. Our field needs more people withyour skepticism and fervor.Mark ReeseChinese Herbal Medicine, a voluntary organization of licensed healthcare practitioners, matriculated students and postgraduate academics specializing in Chinese Herbal Medicine, provides a variety of professional services, including board approved online continuing education.

[Guest guest]

 

 

Thursday, July 19, 2001 10:54 PM

 

Re: yin fire & dx.

 

, " " <@o...> wrote:

>

 

>

Every book I

> own takes this approach except possibly the pi wei lun (and there are a

> multiple interpretations of this book, as even Bob admits) to name a few

> books that deal with a 1-2 pattern style of writing:

> Bensky.'s herb books, Acupuncture Patterns and Practice- Case Studies I &

> II, Handbook of Internal Medicine, Maciocia's books, all my translated

books

> from china, Steven Clavey's Fluid Physiology & Pathology in TCM, Practical

> Therapeutics in TCM (yan wu)

 

 

(Todd) these are all basic texts; none of them endeavor to address real live

cases; this makes no impression on me.

 

(Jason) Disagree... Clavey's, Bensky's, Cs Cheug elementary,? Clavey is

very in depth.. very sophisticated, every thing is sourced... yet simple...

I have over 500 pages of various CS Cheug literature, including all his case

studies... although these may not be real case studies - Many of the cases

are very complex, with again 1-2 pattern diagnosis. His other more specific

writings on disease and herb combos give no indication or roadmap of a 4-5

pattern approach - and as it seems, he uses real cases to demonstrate

patterns associated with the disease.

Acupuncture Patterns and Practice - Why do you feel these are not real case

studies?

Maciocia gold has real case studies demonstrating how to use the supposed

" cookbook style " approach in real life situations. Who BTW studied at the

same time/school with Min Fan in China.

Clavey includes real case studies in his book.

[Quote: This is especially true in TCM. Patients test our skills. Case

records - success or failure - are the Golden Mirror of the past for the

healers of the present and future - anonymous

Learning Medicine w/o books is going to see w/o charts... (sir William

osler) - Both from CS cheug's infertility writings]

 

So if these are all basic, where are the advanced texts? I also look at the

SHL (Mitchell) and sift through the commentary (which is a compilation of

authors throughout the ages) also finding no four-five pattern system. So I

find nothing in the classics nor in modern English.

 

So I ask, again, show me where I can read about this style. I think we

agree that using a 4-5 pattern diagnosis system can be complicated, and one

can easily make mistakes, correct? All that I hear is that there is this

system, it works, try it, the others didn't work for me. This is valid, and

I respect this, that is why I want to learn about it. But the 1-2 pattern

system, so prevalent in my sources, gives a very detailed roadmap on how to

use it, and I feel takes years to actually master. I can follow this

roadmap. But I see no roadmap for the 4-5 system. I hear, try it and

see... try what? Please give me something to read (besides a website)

describing how to think about this system in a proper way.

 

 

> So as reductionist or linear (Todd) or myopic and limited (Z'ev) as it

> seems, I have not much evidence that things should be any other way, or

are

> taught any other way

 

(Todd) I am sorry your exposure has been so limited. I count myself blessed

that mine was so much broader. My teachers all emphasized multiple

pattern dx. I am no pioneer, merely a follower of my mentors.

 

 

(Jason) Q: So where did your mentors learn this system from?

> I feel it is eloquent to be able to look a very complex case and see a

> simple solution.

 

(Todd) I guess time will tell. All I can say is that all of us who now hold

our position once held yours and we changed due to our experience.

 

[Jason] (see above) - and let us not forget about the 10,000's of others who

have found success with this 1-2 pattern system and haven't deviated...

 

-

[Guest guest]

Bob

Do you consider your new formula for chronic constipation a multi pattern situation? to me its a strait forward Qi/Sp def with dryness. The use of rou cang roug does not necessitate k def, tao ren (blood stasis), Zhi ke (qi stagnation) etc. These are common addition for the condition of chronic constipation due to Qi def and dryness. I am wandering if we are talking crossly and actually clinically do the same things. In most of my Rx there is a major treatment principle and additions for the disease as well as other secondary complications. These however are not major syndromes and the amounts and number of herbs that deal with them is usually much smaller than the main treatment principle

Alon

 

-

 

Friday, July 20, 2001 12:32 PM

RE: Re: yin fire & dx.

Thursday, July 19, 2001 10:54 PM Subject: Re: yin fire & dx., "" <@o...> wrote:>>Every book I> own takes this approach except possibly the pi wei lun (and there are a> multiple interpretations of this book, as even Bob admits) to name a few> books that deal with a 1-2 pattern style of writing:> Bensky.'s herb books, Acupuncture Patterns and Practice- Case Studies I & > II, Handbook of Internal Medicine, Maciocia's books, all my translatedbooks> from china, Steven Clavey's Fluid Physiology & Pathology in TCM, Practical> Therapeutics in TCM (yan wu)(Todd) these are all basic texts; none of them endeavor to address real livecases; this makes no impression on me.(Jason) Disagree... Clavey's, Bensky's, Cs Cheug elementary,? Clavey isvery in depth.. very sophisticated, every thing is sourced... yet simple...I have over 500 pages of various CS Cheug literature, including all his casestudies... although these may not be real case studies - Many of the casesare very complex, with again 1-2 pattern diagnosis. His other more specificwritings on disease and herb combos give no indication or roadmap of a 4-5pattern approach - and as it seems, he uses real cases to demonstratepatterns associated with the disease.Acupuncture Patterns and Practice - Why do you feel these are not real casestudies?Maciocia gold has real case studies demonstrating how to use the supposed"cookbook style" approach in real life situations. Who BTW studied at thesame time/school with Min Fan in China.Clavey includes real case studies in his book.

So if these are all basic, where are the advanced texts? I also look at theSHL (Mitchell) and sift through the commentary (which is a compilation ofauthors throughout the ages) also finding no four-five pattern system. So Ifind nothing in the classics nor in modern English.So I ask, again, show me where I can read about this style. I think weagree that using a 4-5 pattern diagnosis system can be complicated, and onecan easily make mistakes, correct? All that I hear is that there is thissystem, it works, try it, the others didn't work for me. This is valid, andI respect this, that is why I want to learn about it. But the 1-2 patternsystem, so prevalent in my sources, gives a very detailed roadmap on how touse it, and I feel takes years to actually master. I can follow thisroadmap. But I see no roadmap for the 4-5 system. I hear, try it andsee... try what? Please give me something to read (besides a website)describing how to think about this system in a proper way.> So as reductionist or linear (Todd) or myopic and limited (Z'ev) as it> seems, I have not much evidence that things should be any other way, orare> taught any other way(Todd) I am sorry your exposure has been so limited. I count myself blessedthat mine was so much broader. My teachers all emphasized multiplepattern dx. I am no pioneer, merely a follower of my mentors.(Jason) Q: So where did your mentors learn this system from?> I feel it is eloquent to be able to look a very complex case and see a> simple solution.(Todd) I guess time will tell. All I can say is that all of us who now holdour position once held yours and we changed due to our experience.[Jason] (see above) - and let us not forget about the 10,000's of others whohave found success with this 1-2 pattern system and haven't deviated...-Chinese Herbal Medicine, a voluntary organization of licensed healthcare practitioners, matriculated students and postgraduate academics specializing in Chinese Herbal Medicine, provides a variety of professional services, including board approved online continuing education.

[Guest guest]

I most defintely see Blue Poppy Herbs' modification of Zhang

Jing-yue's Ji Chuan Jian as treating a multipattern presentation of

spleen-kidney yang vacuity with blood vacuity, qi stagnation, and

depressive heat. This is how I was taught to see the indications and

rationale of the basic formula by my teachers at the Shanghai College

of and its modifications by my clinical mentor, Dr.

Yu Min of the Yue Yang Hospital.

 

Bob

 

, " Alon Marcus " <alonmarcus@w...> wrote:

> Bob

> Do you consider your new formula for chronic constipation a multi

pattern situation? to me its a strait forward Qi/Sp def with dryness.

The use of rou cang roug does not necessitate k def, tao ren (blood

stasis), Zhi ke (qi stagnation) etc. These are common addition for the

condition of chronic constipation due to Qi def and dryness. I am

wandering if we are talking crossly and actually clinically do the

same things. In most of my Rx there is a major treatment principle and

additions for the disease as well as other secondary complications.

These however are not major syndromes and the amounts and number of

herbs that deal with them is usually much smaller than the main

treatment principle

> Alon

> -

>

>

> Friday, July 20, 2001 12:32 PM

> RE: Re: yin fire & dx.

>

>

>

>

> @i... [@i...]

> Thursday, July 19, 2001 10:54 PM

>

> Re: yin fire & dx.

>

> , " " <@o...>

wrote:

> >

>

> >

> Every book I

> > own takes this approach except possibly the pi wei lun (and

there are a

> > multiple interpretations of this book, as even Bob admits) to

name a few

> > books that deal with a 1-2 pattern style of writing:

> > Bensky.'s herb books, Acupuncture Patterns and Practice- Case

Studies I &

> > II, Handbook of Internal Medicine, Maciocia's books, all my

translated

> books

> > from china, Steven Clavey's Fluid Physiology & Pathology in TCM,

Practical

> > Therapeutics in TCM (yan wu)

>

>

> (Todd) these are all basic texts; none of them endeavor to address

real live

> cases; this makes no impression on me.

>

> (Jason) Disagree... Clavey's, Bensky's, Cs Cheug elementary,?

Clavey is

> very in depth.. very sophisticated, every thing is sourced... yet

simple...

> I have over 500 pages of various CS Cheug literature, including

all his case

> studies... although these may not be real case studies - Many of

the cases

> are very complex, with again 1-2 pattern diagnosis. His other more

specific

> writings on disease and herb combos give no indication or roadmap

of a 4-5

> pattern approach - and as it seems, he uses real cases to

demonstrate

> patterns associated with the disease.

> Acupuncture Patterns and Practice - Why do you feel these are not

real case

> studies?

> Maciocia gold has real case studies demonstrating how to use the

supposed

> " cookbook style " approach in real life situations. Who BTW

studied at the

> same time/school with Min Fan in China.

> Clavey includes real case studies in his book.

> [Quote: This is especially true in TCM. Patients test our skills.

Case

> records - success or failure - are the Golden Mirror of the past

for the

> healers of the present and future - anonymous

> Learning Medicine w/o books is going to see w/o charts... (sir

William

> osler) - Both from CS cheug's infertility writings]

>

> So if these are all basic, where are the advanced texts? I also

look at the

> SHL (Mitchell) and sift through the commentary (which is a

compilation of

> authors throughout the ages) also finding no four-five pattern

system. So I

> find nothing in the classics nor in modern English.

>

> So I ask, again, show me where I can read about this style. I

think we

> agree that using a 4-5 pattern diagnosis system can be

complicated, and one

> can easily make mistakes, correct? All that I hear is that there

is this

> system, it works, try it, the others didn't work for me. This is

valid, and

> I respect this, that is why I want to learn about it. But the 1-2

pattern

> system, so prevalent in my sources, gives a very detailed roadmap

on how to

> use it, and I feel takes years to actually master. I can follow

this

> roadmap. But I see no roadmap for the 4-5 system. I hear, try it

and

> see... try what? Please give me something to read (besides a

website)

> describing how to think about this system in a proper way.

>

>

> > So as reductionist or linear (Todd) or myopic and limited (Z'ev)

as it

> > seems, I have not much evidence that things should be any other

way, or

> are

> > taught any other way

>

> (Todd) I am sorry your exposure has been so limited. I count

myself blessed

> that mine was so much broader. My teachers all emphasized

multiple

> pattern dx. I am no pioneer, merely a follower of my mentors.

>

>

> (Jason) Q: So where did your mentors learn this system from?

> > I feel it is eloquent to be able to look a very complex case and

see a

> > simple solution.

>

> (Todd) I guess time will tell. All I can say is that all of us

who now hold

> our position once held yours and we changed due to our experience.

>

> [Jason] (see above) - and let us not forget about the 10,000's of

others who

> have found success with this 1-2 pattern system and haven't

deviated...

>

> -

>

>

>

>

> Chinese Herbal Medicine, a voluntary organization of licensed

healthcare practitioners, matriculated students and postgraduate

academics specializing in Chinese Herbal Medicine, provides a variety

of professional services, including board approved online continuing

education.

>

>

>

>

[Guest guest]

Some more thoughts on Li-Zhu medicine.. . ..

 

About twelve years ago, as a professor of Chinese internal medicine

first at Southwest Acupuncture College and then at Pacific College of

Oriental Medicine, I struggled with the problem of complex patterns.

With no access to Chinese language medical literature, and precious

little source material in English (include indecipherable translations

of the Shang Han Lun), I found myself looking more and more at

homeopathic literature. In the work of Francisco Eizayaga, I found the

idea of treating complex diseases in layers, one at a time, and

prioritizing treatment in that way. I developed a method of doing so

with herbal prescriptions. I wrongly assumed that Chinese medicine had

the same idea, and found that this approach didn't work for me

clincially as well. It took the publication of the Pi Wei Lun to change

my focus, and abandon this former approach.

 

I still deeply respect homeopathy and continue to study the literature

on occasion, but one cannot superimpose one theory on another so

easily. I am glad that there are more resources available, and I agree

with Bob Flaws that still more resources, such as case study and medical

essay literature, that need to be read and/or translated.

 

When a decent translation of the Shang Han Lun came out a few years ago,

I saw that the concepts of bian zheng/transmuted patterns, he

bing/combination diseases (more than one channel/stage) and bing

bing/dragover disease were important concepts in the text. It became

apparent to me that complex disease patterns are also discussed in the

Shang Han Lun, and have further been developed by later medical

authors. Transmuted patterns are those that become more complex as the

result of wrong medical treatment, underlying disease patterns in the

patient, or constitutional factors. So to say that the SHL only covers

treatment for simple patterns is simply incorrect.

 

 

[Guest guest]

So to say that the SHL only covers treatment for simple patterns is simply incorrect

>>>>I think we are having a bit of communication crosses of what is a complex or simple pattern. I have a feeling that many of what you call complex patterns I not what I would call multiple patterns but regular patterns with secondary issues

Alon

 

-

 

Friday, July 20, 2001 4:18 PM

Re: Re: yin fire & dx.

Some more thoughts on Li-Zhu medicine.. . ..About twelve years ago, as a professor of Chinese internal medicine first at Southwest Acupuncture College and then at Pacific College of Oriental Medicine, I struggled with the problem of complex patterns. With no access to Chinese language medical literature, and precious little source material in English (include indecipherable translations of the Shang Han Lun), I found myself looking more and more at homeopathic literature. In the work of Francisco Eizayaga, I found the idea of treating complex diseases in layers, one at a time, and prioritizing treatment in that way. I developed a method of doing so with herbal prescriptions. I wrongly assumed that Chinese medicine had the same idea, and found that this approach didn't work for me clincially as well. It took the publication of the Pi Wei Lun to change my focus, and abandon this former approach.I still deeply respect homeopathy and continue to study the literature on occasion, but one cannot superimpose one theory on another so easily. I am glad that there are more resources available, and I agree with Bob Flaws that still more resources, such as case study and medical essay literature, that need to be read and/or translated.When a decent translation of the Shang Han Lun came out a few years ago, I saw that the concepts of bian zheng/transmuted patterns, he bing/combination diseases (more than one channel/stage) and bing bing/dragover disease were important concepts in the text. It became apparent to me that complex disease patterns are also discussed in the Shang Han Lun, and have further been developed by later medical authors. Transmuted patterns are those that become more complex as the result of wrong medical treatment, underlying disease patterns in the patient, or constitutional factors. So to say that the SHL only covers treatment for simple patterns is simply incorrect.Chinese Herbal Medicine, a voluntary organization of licensed healthcare practitioners, matriculated students and postgraduate academics specializing in Chinese Herbal Medicine, provides a variety of professional services, including board approved online continuing education.

[Guest guest]

Well definitely different views. The question is however what constitutes a syndrome or pattern

Alon

 

-

pemachophel2001

Friday, July 20, 2001 2:28 PM

Re: yin fire & dx.

I most defintely see Blue Poppy Herbs' modification of Zhang Jing-yue's Ji Chuan Jian as treating a multipattern presentation of spleen-kidney yang vacuity with blood vacuity, qi stagnation, and depressive heat. This is how I was taught to see the indications and rationale of the basic formula by my teachers at the Shanghai College of and its modifications by my clinical mentor, Dr. Yu Min of the Yue Yang Hospital.Bob, "Alon Marcus" <alonmarcus@w...> wrote:> Bob> Do you consider your new formula for chronic constipation a multi pattern situation? to me its a strait forward Qi/Sp def with dryness. The use of rou cang roug does not necessitate k def, tao ren (blood stasis), Zhi ke (qi stagnation) etc. These are common addition for the condition of chronic constipation due to Qi def and dryness. I am wandering if we are talking crossly and actually clinically do the same things. In most of my Rx there is a major treatment principle and additions for the disease as well as other secondary complications. These however are not major syndromes and the amounts and number of herbs that deal with them is usually much smaller than the main treatment principle> Alon> - > > > Friday, July 20, 2001 12:32 PM> RE: Re: yin fire & dx.> > > > > @i... [@i...]> Thursday, July 19, 2001 10:54 PM> > Re: yin fire & dx.> > , "" <@o...> wrote:> >> > >> Every book I> > own takes this approach except possibly the pi wei lun (and there are a> > multiple interpretations of this book, as even Bob admits) to name a few> > books that deal with a 1-2 pattern style of writing:> > Bensky.'s herb books, Acupuncture Patterns and Practice- Case Studies I & > > II, Handbook of Internal Medicine, Maciocia's books, all my translated> books> > from china, Steven Clavey's Fluid Physiology & Pathology in TCM, Practical> > Therapeutics in TCM (yan wu)> > > (Todd) these are all basic texts; none of them endeavor to address real live> cases; this makes no impression on me.> > (Jason) Disagree... Clavey's, Bensky's, Cs Cheug elementary,? Clavey is> very in depth.. very sophisticated, every thing is sourced... yet simple...> I have over 500 pages of various CS Cheug literature, including all his case> studies... although these may not be real case studies - Many of the cases> are very complex, with again 1-2 pattern diagnosis. His other more specific> writings on disease and herb combos give no indication or roadmap of a 4-5> pattern approach - and as it seems, he uses real cases to demonstrate> patterns associated with the disease.> Acupuncture Patterns and Practice - Why do you feel these are not real case> studies?> Maciocia gold has real case studies demonstrating how to use the supposed> "cookbook style" approach in real life situations. Who BTW studied at the> same time/school with Min Fan in China.> Clavey includes real case studies in his book.>

> > So if these are all basic, where are the advanced texts? I also look at the> SHL (Mitchell) and sift through the commentary (which is a compilation of> authors throughout the ages) also finding no four-five pattern system. So I> find nothing in the classics nor in modern English.> > So I ask, again, show me where I can read about this style. I think we> agree that using a 4-5 pattern diagnosis system can be complicated, and one> can easily make mistakes, correct? All that I hear is that there is this> system, it works, try it, the others didn't work for me. This is valid, and> I respect this, that is why I want to learn about it. But the 1-2 pattern> system, so prevalent in my sources, gives a very detailed roadmap on how to> use it, and I feel takes years to actually master. I can follow this> roadmap. But I see no roadmap for the 4-5 system. I hear, try it and> see... try what? Please give me something to read (besides a website)> describing how to think about this system in a proper way.> > > > So as reductionist or linear (Todd) or myopic and limited (Z'ev) as it> > seems, I have not much evidence that things should be any other way, or> are> > taught any other way> > (Todd) I am sorry your exposure has been so limited. I count myself blessed> that mine was so much broader. My teachers all emphasized multiple> pattern dx. I am no pioneer, merely a follower of my mentors.> > > (Jason) Q: So where did your mentors learn this system from?> > I feel it is eloquent to be able to look a very complex case and see a> > simple solution.> > (Todd) I guess time will tell. All I can say is that all of us who now hold> our position once held yours and we changed due to our experience.> > [Jason] (see above) - and let us not forget about the 10,000's of others who> have found success with this 1-2 pattern system and haven't deviated...> > -> > > > > Chinese Herbal Medicine, a voluntary organization of licensed healthcare practitioners, matriculated students and postgraduate academics specializing in Chinese Herbal Medicine, provides a variety of professional services, including board approved online continuing education.> > > >

[Guest guest]

, pemachophel2001 wrote:

 

a pattern may be major or minor; it may be addressed by a few

herbs or many, but it is still a pattern.

 

 

Bob: I most defintely see Blue Poppy Herbs' modification of

Zhang

> Jing-yue's Ji Chuan Jian as treating a multipattern

presentation

>

> , " Alon Marcus "

<alonmarcus@w...> wrote:

In most of my Rx there is a major treatment principle and

> additions for the disease as well as other secondary

complications.

> These however are not major syndromes and the amounts

and number of

> herbs that deal with them is usually much smaller than the

main

> treatment principle

[Guest guest]

but it is still a pattern

>>>OK. But this is not how I was taught to view it. Just secondary manifestations. For example, if Sp weakness results in Liv failure of moving Qi I was taught to think of it as a spleen weakness pattern with secondary liver symptoms as compared to the pattern of liver spleen disharmony. And therefore the formula must be a spleen formula with a small addition (and only if needed) to address liver qi stag. And I guess this can be viewed as simple somatics. But to me it a question of herbal formulation and emphasis

Alon

 

[Guest guest]

I personally am more interested in this latter approach,

at the current time, and would appreciate some case studies submitted.

 

--

 

YES YES

 

Heiko

[Guest guest]

Re:Pemachopel's case

Thanks for submitting that case.

I would of looked at that case slightly differently, ( One because my

understanding of yin fire is rudamentry), however , the main focus of me

would be to harmonize liver/spleen first probably using xiao yao san as

the basis. I would of added mu dan pi and shan zhi zi (dan zhi xiao yao

san) as I think the zits were due to liver qi depression transforming to

fire, and added hong hua for the blood stasis.I would of left out tao

ren because of her history to sometimes get loose stools.To me it would

be hard to ascertain if her kid xu signs were due her spleen or just

because of her age, ie 42 and natural declining of kidney qi. I would of

avoided any yang tonis initially , in case they agravated the heat and

caused more zits. I would of addressed the kid xu later , or possibly

gone with a more neutal type medicinals like shan yao or jin ying zi.

 

My formula is different to as what was prescribed , but not that

different.

Do you think my formula would of aggravated her condition, if not ,

would I of treated Yin Fire unknowingly . This is where I get confused

about yin fire. My pulse skills are not at the " ideal " , so I would of

homed in on the bow string pulse and concluded liver.

 

Heiko

[Guest guest]

, pemachophel2001 wrote:

> It seems to me that much of this discussion is based on peoples'

not

> having a very complete vision of the Chinese medical literature

and,

> therefore, practice in China. To think that even the growing body

of

> literature that we currently have in English gives an adequate

picture

> of Chinese medicine in the PRC is, I believe, naive.

>

....

 

I wanted to echo and underscore Bob's remarks

in this post. We were recently working in the

libary at the Beijing Academy of TCM. This

library holds over 80,000 volumes in its

collection of rare medical books. Some of these

are the only surviving copies of a work.

 

To be sure, these 80,000 copies do not come

close to representing a complete vision of

Chinese medical literature. These are just the

rare volumes. They represent a portion of the

body of the literary transmission of Chinese

medicine that is currently at risk of being

lost.

 

What would ensure this loss is the

ignoring of its existence on the part of

individuals who see themselves as the forward

guard of Chinese medical development in the

modern age. What will prevent this loss is

a growing recognition on the part of all who

practice, teach, and study Chinese medicine

of their deep dependence on and responsibility

to and for this body of literature and knowledge.

 

When we talk about the literature of Chinese

medicine and about the inadequacy of our

reception of this literature, this point

about relative mass of English-language

books compared to what's available in Chinese

must be considered, if only from time to time.

 

Ken

[Guest guest]

Alon,

 

You seem to be confusing two different things here. One is what a

pattern is. A pattern is a professionally recognized, named grouping

of signs and symptoms. The other is how important such a group of

symptoms are in a given patient's situation. While practitioners may

differ as to whether every pattern needs to be addressed in a given

patient at a particular moment in time, that does not negate the fact

that several patterns may exist simultaneously. I think you're mixing

apples and oranges here.

 

Bob

 

, <alonmarcus@w...> wrote:

> but it is still a pattern

> >>>OK. But this is not how I was taught to view it. Just secondary

manifestations. For example, if Sp weakness results in Liv failure of

moving Qi I was taught to think of it as a spleen weakness pattern

with secondary liver symptoms as compared to the pattern of liver

spleen disharmony. And therefore the formula must be a spleen formula

with a small addition (and only if needed) to address liver qi stag.

And I guess this can be viewed as simple somatics. But to me it a

question of herbal formulation and emphasis

> Alon

[Guest guest]

A pattern is a professionally recognized, named grouping of signs and symptoms

>>>>I make a distinction between a pattern or syndrome and a few symptoms that accompany a pattern. Since almost all symptoms can be explained by different ways, for example to me PMS with swollen breasts does not automatically mean Liv disorder. And treatment of other the major syndrome often resolves such secondary symptomes. So I have a difficult time calling any group of symptoms a pattern or syndrome just because it is similar to a common pattern even if all the main signs are missing.

Alon

 

-

pemachophel2001

Monday, July 23, 2001 8:21 AM

Re: yin fire & dx.

Alon,You seem to be confusing two different things here. One is what a pattern is. A pattern is a professionally recognized, named grouping of signs and symptoms. The other is how important such a group of symptoms are in a given patient's situation. While practitioners may differ as to whether every pattern needs to be addressed in a given patient at a particular moment in time, that does not negate the fact that several patterns may exist simultaneously. I think you're mixing apples and oranges here.Bob, <alonmarcus@w...> wrote:> but it is still a pattern> >>>OK. But this is not how I was taught to view it. Just secondary manifestations. For example, if Sp weakness results in Liv failure of moving Qi I was taught to think of it as a spleen weakness pattern with secondary liver symptoms as compared to the pattern of liver spleen disharmony. And therefore the formula must be a spleen formula with a small addition (and only if needed) to address liver qi stag. And I guess this can be viewed as simple somatics. But to me it a question of herbal formulation and emphasis > AlonChinese Herbal Medicine, a voluntary organization of licensed healthcare practitioners, matriculated students and postgraduate academics specializing in Chinese Herbal Medicine, provides a variety of professional services, including board approved online continuing education.

[Guest guest]

Alon,

 

No patient displays all the textbook signs and symptoms of any

pattern. Each patient displays only a certain idiosyncratic selection

of signs and symptoms. Further, different textbooks may give slightly

different signs and symptoms. However, all signs and symptoms must be

consistent with the primary disease mechanisms associated with

pattern. Within different patterns, different signs or symptoms are

considered more important than others. However, it is clear from the

contemporary Chinese literature on pattern discrimination and also

on case histories that one only needs a certain grouping of signs and

symptoms in order to identify a pattern. For instance, in real life,

all you really need to establish liver depression qi stagnation is a

bowstring pulse and irritability since there are no other disease

mechanisms for irritability (literally, " easy anger " ) given in the

standard literature. All the other textbook signs and symptoms, such

as chest, breast, rib-side, and abdominal distention and fullness,

burping-bleching, great sighing, etc. are all possible but not

absolutely necessary. On the other hand, one could, in theory, have

chest, breat, rib-side, and/or abdominal distention and fullness and a

bowstring pulse without irritability and still identify liver

depression qi stagnation. In the first instance, irritability is

pathognomonic by itself, whereas, in the second, it is the

preponderance of symptoms which extablish the pattern.

 

Similarly, there are certain other key signs and symptoms which are

dependable signatures for other patterns. For more on this issue, you

might to check out A Handbook of TCM Patterns & Their Treatments by

Danile Finney and myself.

 

Bob

 

, " Alon Marcus " <alonmarcus@w...> wrote:

> A pattern is a professionally recognized, named grouping

> of signs and symptoms

> >>>>I make a distinction between a pattern or syndrome and a few

symptoms that accompany a pattern. Since almost all symptoms can be

explained by different ways, for example to me PMS with swollen

breasts does not automatically mean Liv disorder. And treatment of

other the major syndrome often resolves such secondary symptomes. So I

have a difficult time calling any group of symptoms a pattern or

syndrome just because it is similar to a common pattern even if all

the main signs are missing.

> Alon

> -

> pemachophel2001

>

> Monday, July 23, 2001 8:21 AM

> Re: yin fire & dx.

>

>

> Alon,

>

> You seem to be confusing two different things here. One is what a

> pattern is. A pattern is a professionally recognized, named

grouping

> of signs and symptoms. The other is how important such a group of

> symptoms are in a given patient's situation. While practitioners

may

> differ as to whether every pattern needs to be addressed in a

given

> patient at a particular moment in time, that does not negate the

fact

> that several patterns may exist simultaneously. I think you're

mixing

> apples and oranges here.

>

> Bob

>

> , <alonmarcus@w...> wrote:

> > but it is still a pattern

> > >>>OK. But this is not how I was taught to view it. Just

secondary

> manifestations. For example, if Sp weakness results in Liv failure

of

> moving Qi I was taught to think of it as a spleen weakness pattern

> with secondary liver symptoms as compared to the pattern of liver

> spleen disharmony. And therefore the formula must be a spleen

formula

> with a small addition (and only if needed) to address liver qi

stag.

> And I guess this can be viewed as simple somatics. But to me it a

> question of herbal formulation and emphasis

> > Alon

>

>

> Chinese Herbal Medicine, a voluntary organization of licensed

healthcare practitioners, matriculated students and postgraduate

academics specializing in Chinese Herbal Medicine, provides a variety

of professional services, including board approved online continuing

education.

>

>

>

>

[Guest guest]

Um, I went to look for the book to look it over again and found: A

Compendium of TCM Patterns & Their Treatments...by DF and BF. Just checking:

is there another " Handbook " of similar title that i missed? Also, just in

case someone happens to be looking for it alphabetically.

ann

>

> Similarly, there are certain other key signs and symptoms which are

> dependable signatures for other patterns. For more on this issue, you

> might to check out A Handbook of TCM Patterns & Their Treatments by

> Danile Finney and myself.

>

[Guest guest]

bowstring pulse and irritability since there are no other disease mechanisms for irritability (literally, "easy anger") given in the >>>I think any heat and pain can give rise to bowstring pulse and irritability for what I have learned

Alon

 

-

pemachophel2001

Friday, July 27, 2001 7:57 AM

Re: yin fire & dx.

Alon,No patient displays all the textbook signs and symptoms of any pattern. Each patient displays only a certain idiosyncratic selection of signs and symptoms. Further, different textbooks may give slightly different signs and symptoms. However, all signs and symptoms must be consistent with the primary disease mechanisms associated with pattern. Within different patterns, different signs or symptoms are considered more important than others. However, it is clear from the contemporary Chinese literature on pattern discrimination and also on case histories that one only needs a certain grouping of signs and symptoms in order to identify a pattern. For instance, in real life, all you really need to establish liver depression qi stagnation is a bowstring pulse and irritability since there are no other disease mechanisms for irritability (literally, "easy anger") given in the standard literature. All the other textbook signs and symptoms, such as chest, breast, rib-side, and abdominal distention and fullness, burping-bleching, great sighing, etc. are all possible but not absolutely necessary. On the other hand, one could, in theory, have chest, breat, rib-side, and/or abdominal distention and fullness and a bowstring pulse without irritability and still identify liver depression qi stagnation. In the first instance, irritability is pathognomonic by itself, whereas, in the second, it is the preponderance of symptoms which extablish the pattern. Similarly, there are certain other key signs and symptoms which are dependable signatures for other patterns. For more on this issue, you might to check out A Handbook of TCM Patterns & Their Treatments by Danile Finney and myself.Bob , "Alon Marcus" <alonmarcus@w...> wrote:> A pattern is a professionally recognized, named grouping > of signs and symptoms> >>>>I make a distinction between a pattern or syndrome and a few symptoms that accompany a pattern. Since almost all symptoms can be explained by different ways, for example to me PMS with swollen breasts does not automatically mean Liv disorder. And treatment of other the major syndrome often resolves such secondary symptomes. So I have a difficult time calling any group of symptoms a pattern or syndrome just because it is similar to a common pattern even if all the main signs are missing. > Alon> - > pemachophel2001 > > Monday, July 23, 2001 8:21 AM> Re: yin fire & dx.> > > Alon,> > You seem to be confusing two different things here. One is what a > pattern is. A pattern is a professionally recognized, named grouping > of signs and symptoms. The other is how important such a group of > symptoms are in a given patient's situation. While practitioners may > differ as to whether every pattern needs to be addressed in a given > patient at a particular moment in time, that does not negate the fact > that several patterns may exist simultaneously. I think you're mixing > apples and oranges here.> > Bob> > , <alonmarcus@w...> wrote:> > but it is still a pattern> > >>>OK. But this is not how I was taught to view it. Just secondary > manifestations. For example, if Sp weakness results in Liv failure of > moving Qi I was taught to think of it as a spleen weakness pattern > with secondary liver symptoms as compared to the pattern of liver > spleen disharmony. And therefore the formula must be a spleen formula > with a small addition (and only if needed) to address liver qi stag. > And I guess this can be viewed as simple somatics. But to me it a > question of herbal formulation and emphasis > > Alon> > > Chinese Herbal Medicine, a voluntary organization of licensed healthcare practitioners, matriculated students and postgraduate academics specializing in Chinese Herbal Medicine, provides a variety of professional services, including board approved online continuing education.> > > >

[Guest guest]

No patient displays all the textbook signs and symptoms of any pattern. Each patient displays only a certain idiosyncratic selection of signs and symptoms

>>>>>>>Obviously but again as I learned it there is a different between a pattern and secondary symptoms many of which can also be explained by a pathophysiology dependent on the main Pattern/syndrome

Alon

 

-

pemachophel2001

Friday, July 27, 2001 7:57 AM

Re: yin fire & dx.

Alon,No patient displays all the textbook signs and symptoms of any pattern. Each patient displays only a certain idiosyncratic selection of signs and symptoms. Further, different textbooks may give slightly different signs and symptoms. However, all signs and symptoms must be consistent with the primary disease mechanisms associated with pattern. Within different patterns, different signs or symptoms are considered more important than others. However, it is clear from the contemporary Chinese literature on pattern discrimination and also on case histories that one only needs a certain grouping of signs and symptoms in order to identify a pattern. For instance, in real life, all you really need to establish liver depression qi stagnation is a bowstring pulse and irritability since there are no other disease mechanisms for irritability (literally, "easy anger") given in the standard literature. All the other textbook signs and symptoms, such as chest, breast, rib-side, and abdominal distention and fullness, burping-bleching, great sighing, etc. are all possible but not absolutely necessary. On the other hand, one could, in theory, have chest, breat, rib-side, and/or abdominal distention and fullness and a bowstring pulse without irritability and still identify liver depression qi stagnation. In the first instance, irritability is pathognomonic by itself, whereas, in the second, it is the preponderance of symptoms which extablish the pattern. Similarly, there are certain other key signs and symptoms which are dependable signatures for other patterns. For more on this issue, you might to check out A Handbook of TCM Patterns & Their Treatments by Danile Finney and myself.Bob , "Alon Marcus" <alonmarcus@w...> wrote:> A pattern is a professionally recognized, named grouping > of signs and symptoms> >>>>I make a distinction between a pattern or syndrome and a few symptoms that accompany a pattern. Since almost all symptoms can be explained by different ways, for example to me PMS with swollen breasts does not automatically mean Liv disorder. And treatment of other the major syndrome often resolves such secondary symptomes. So I have a difficult time calling any group of symptoms a pattern or syndrome just because it is similar to a common pattern even if all the main signs are missing. > Alon> - > pemachophel2001 > > Monday, July 23, 2001 8:21 AM> Re: yin fire & dx.> > > Alon,> > You seem to be confusing two different things here. One is what a > pattern is. A pattern is a professionally recognized, named grouping > of signs and symptoms. The other is how important such a group of > symptoms are in a given patient's situation. While practitioners may > differ as to whether every pattern needs to be addressed in a given > patient at a particular moment in time, that does not negate the fact > that several patterns may exist simultaneously. I think you're mixing > apples and oranges here.> > Bob> > , <alonmarcus@w...> wrote:> > but it is still a pattern> > >>>OK. But this is not how I was taught to view it. Just secondary > manifestations. For example, if Sp weakness results in Liv failure of > moving Qi I was taught to think of it as a spleen weakness pattern > with secondary liver symptoms as compared to the pattern of liver > spleen disharmony. And therefore the formula must be a spleen formula > with a small addition (and only if needed) to address liver qi stag. > And I guess this can be viewed as simple somatics. But to me it a > question of herbal formulation and emphasis > > Alon> > > Chinese Herbal Medicine, a voluntary organization of licensed healthcare practitioners, matriculated students and postgraduate academics specializing in Chinese Herbal Medicine, provides a variety of professional services, including board approved online continuing education.> > > >

[Guest guest]

Ann,

 

Handbook is the revised edition of Compendium

 

Bob

 

, snakeoil.works@m... wrote:

> Um, I went to look for the book to look it over again and found: A

> Compendium of TCM Patterns & Their Treatments...by DF and BF. Just

checking:

> is there another " Handbook " of similar title that i missed? Also,

just in

> case someone happens to be looking for it alphabetically.

> ann

> >

> > Similarly, there are certain other key signs and symptoms which

are

> > dependable signatures for other patterns. For more on this issue,

you

> > might to check out A Handbook of TCM Patterns & Their Treatments

by

> > Danile Finney and myself.

> >

[Guest guest]

Alon,

 

I had thought I could be done with this. Seems not.

 

In any case, according to the research we did for Chinese Medical

Psychiatry, irritability is the specific signature of liver

depression. In Chinese, irritability is yi nu, easy anger, and anger

is the affect of the liver. It is the subjective expression of the

liver's loss of orderly reaching (tiao da) in reaction to an

unfulfilled desire. There are two types of desires, positive desires

for that which we want and negative desires for that which we do not

want (or wish to be separated from). I grant you that pain can produce

irritability. However, as we know, " if there is pain, there is no free

flow. " Since the liver governs the coursing and discharge of the qi

mechanism, if there is no free flow, this negatively affects the

liver's control over coursing and discharge. If coursing and

discharge are inhibited, the liver is damaged. When the liver is

damaged, this means it becomes depressed. Thus the disease mechanism

for the irritability associated with pain is still associated with

liver depression qi stagnation. This is exactly why Yan De-xin says

that there is no chronic illness without liver depression.

 

It seems that you have a tendency to mix apples and oranges in your

discussions. Pain is NOT a pattern. In the case of your objection, it

is a disease cause which sets in motion a disease mechanism which then

manifests as a pattern. In Chinese, these are all very clearly

different things.

 

Depending on the type of heat, one can similarly create a Chinese

medical syllogism which explains why heat evils are commonly

associated with and/or aggravate liver depression. For instance, if

there is externally contracted wind heat evils, these evils lodge in

and obstruct the defensive exterior and also inhibit the lungs'

depuration and diffusion. Since the lungs and liver function

interdependently vis a vis the circulation of qi, anything which

inhibits either the flow of qi in the channels and network vessels

(including the grandchild network vessels of the defensive exterior)

or the diffusion of qi by the lungs may cause or aggravate liver

depression. If there is depressive heat, that is already associated

with liver depression. If there is vacuity heat, then yin vacuity

fails to enrich and moisten the liver. If the liver cannot obtain

enrichment and moistening, then it cannot govern its functions of

coursing and discharge. Therefore, yin vacuity also causes or

aggravates liver depression. If there is phlegm heat, phlegm

obstruction inhibits the free flow of qi. Thus, liver depression is

engendered or aggravated. Likewise for damp heat and the heat

associated with food stagnation. I could go on, but I hope you get the

picture.

 

As for the bowstring pulse, I did not say that there is only one

disease mechanism for a bowstring pulse. There are several.

However, all have to do with a lack of free flow of the qi and

blood. What I said is that there is only one disease mechanism for

irritability. I also said you can make the pattern discrimination of

liver depression with only the two pathognomonic signs-symptoms of a

bowstring pulse PLUS irritability.

 

Bob

 

, " Alon Marcus " <alonmarcus@w...> wrote:

> bowstring pulse and irritability since there are no other disease

> mechanisms for irritability (literally, " easy anger " ) given in the

> >>>I think any heat and pain can give rise to bowstring pulse and

irritability for what I have learned

> Alon

> -

> pemachophel2001

>

> Friday, July 27, 2001 7:57 AM

> Re: yin fire & dx.

>

>

> Alon,

>

> No patient displays all the textbook signs and symptoms of any

> pattern. Each patient displays only a certain idiosyncratic

selection

> of signs and symptoms. Further, different textbooks may give

slightly

> different signs and symptoms. However, all signs and symptoms must

be

> consistent with the primary disease mechanisms associated with

> pattern. Within different patterns, different signs or symptoms

are

> considered more important than others. However, it is clear from

the

> contemporary Chinese literature on pattern discrimination and also

> on case histories that one only needs a certain grouping of signs

and

> symptoms in order to identify a pattern. For instance, in real

life,

> all you really need to establish liver depression qi stagnation is

a

> bowstring pulse and irritability since there are no other disease

> mechanisms for irritability (literally, " easy anger " ) given in the

> standard literature. All the other textbook signs and symptoms,

such

> as chest, breast, rib-side, and abdominal distention and fullness,

> burping-bleching, great sighing, etc. are all possible but not

> absolutely necessary. On the other hand, one could, in theory,

have

> chest, breat, rib-side, and/or abdominal distention and fullness

and a

> bowstring pulse without irritability and still identify liver

> depression qi stagnation. In the first instance, irritability is

> pathognomonic by itself, whereas, in the second, it is the

> preponderance of symptoms which extablish the pattern.

>

> Similarly, there are certain other key signs and symptoms which

are

> dependable signatures for other patterns. For more on this issue,

you

> might to check out A Handbook of TCM Patterns & Their Treatments

by

> Danile Finney and myself.

>

> Bob

>

> , " Alon Marcus " <alonmarcus@w...>

wrote:

> > A pattern is a professionally recognized, named grouping

> > of signs and symptoms

> > >>>>I make a distinction between a pattern or syndrome and a few

> symptoms that accompany a pattern. Since almost all symptoms can

be

> explained by different ways, for example to me PMS with swollen

> breasts does not automatically mean Liv disorder. And treatment of

> other the major syndrome often resolves such secondary symptomes.

So I

> have a difficult time calling any group of symptoms a pattern or

> syndrome just because it is similar to a common pattern even if

all

> the main signs are missing.

> > Alon

> > -

> > pemachophel2001

> >

> > Monday, July 23, 2001 8:21 AM

> > Re: yin fire & dx.

> >

> >

> > Alon,

> >

> > You seem to be confusing two different things here. One is

what a

> > pattern is. A pattern is a professionally recognized, named

> grouping

> > of signs and symptoms. The other is how important such a group

of

> > symptoms are in a given patient's situation. While

practitioners

> may

> > differ as to whether every pattern needs to be addressed in a

> given

> > patient at a particular moment in time, that does not negate

the

> fact

> > that several patterns may exist simultaneously. I think you're

> mixing

> > apples and oranges here.

> >

> > Bob

> >

> > , <alonmarcus@w...> wrote:

> > > but it is still a pattern

> > > >>>OK. But this is not how I was taught to view it. Just

> secondary

> > manifestations. For example, if Sp weakness results in Liv

failure

> of

> > moving Qi I was taught to think of it as a spleen weakness

pattern

> > with secondary liver symptoms as compared to the pattern of

liver

> > spleen disharmony. And therefore the formula must be a spleen

> formula

> > with a small addition (and only if needed) to address liver qi

> stag.

> > And I guess this can be viewed as simple somatics. But to me

it a

> > question of herbal formulation and emphasis

> > > Alon

> >

> >

> > Chinese Herbal Medicine, a voluntary organization of licensed

> healthcare practitioners, matriculated students and postgraduate

> academics specializing in Chinese Herbal Medicine, provides a

variety

> of professional services, including board approved online

continuing

> education.

> >

> >

> >

> >

[Guest guest]

It seems that you have a tendency to mix apples and oranges in your discussions. Pain is NOT a pattern.

>>>>I was referring to the bowstring pulse

 

In the case of your objection, it is a disease cause which sets in motion a disease mechanism which then manifests as a pattern. In Chinese, these are all very clearly different things......ng on the type of heat, one can similarly create a Chinese medical syllogism which explains why heat evils are commonly associated with and/or aggravate liver depression. For instance, if there is externally contracted wind heat evils, these evils lodge in and obstruct the defensive exterior and also inhibit the lungs' depuration and diffusion. Since the lungs and liver function interdependently vis a vis the circulation of qi, anything which inhibits either the flow of qi in the channels and network vessels (including the grandchild network vessels of the defensive exterior) or the diffusion of qi by the lungs may cause or aggravate liver depression.

 

 

 

>>>>>I understand what you are saying and one can make a case for almost anything in almost any pattern, that is the nature of TCM. However I have heard irritability referred to as non-liver associated symptom often. I was thought to always remember that any symptom must be put in context and no symptom as a one to one association with any pattern.

When I worked in the In-patient department irritability was often related by senior physicians as heat affecting spirit especially in septic patients and was clearly not related by them as a liver associated symptom. Shi Gao was a favorite for many patients showing irritability, clearly not a Liver herb.

 

By the way I am not saying there is a right way or wrong way to look at TCM. I am just curious as your approach is very different than my training. This holds true for many of formulas that Yin Fire followers (as seen in blue poppy herbs and others are doing). I really appreciate all the input you can give especially if related to actual cases. I am always looking for new ways to treat.

What I do not understand is the doseing questions of herbs if one diagnoses a patient with several major patterns. I was thought that the major pattern receives a classic formula or combination of herbs at a much higher dose and emphasis than any of the secondary symptoms and signs (and therefore I do not like to call these patterns).

How do you go about the doseing question?

Alon