research and pattern dx

[Guest guest]

Bob Flaws (and, of course, anyone else who might have a thought on this),

You might know this since you read a lot of research reports on chinese

outcome studies. Would you say it is a consistent theme in the literature

to see evidence that pattern diagnosis yields better results than giving

the same formula to the entire group, regardless of their TCM pattern?

How much research is done this way? I ask because Alon abstracted

the Bensouusan irritable bowel study on another list. It makes the

point of saying the the study showed no added benefit from TCM pattern

differentiation. Apparently, in the whole article, it is stated that

in some cases of those on individualized formulas, improvements lasted

up to 14 weeks after stopping the herbs, though. This was not true

for any on the standard one size fits all rx. There was just no greater

symptom relief during the experimental period with pattern based tx.

I think the long lasting relief in the pattern based group is of great

significance, perhaps suggesting that root and branch were both treated

effectively. I do wonder how accurate the pattern based formulas

were. If one accepts that complex diagnoses like IBS often involve

several mutually engendering pathomechanisms (and I know not everyone agrees

with this), it may be folly to do research that breaks disease down by

textbook patterns and then fits patients into whatever group is the closest

match. For instance, don't the vast majority of IBS patients have

some combination of spleen vacuity, liver qi depression, damp-heat.

I also frequently see yang xu with this. What good would it do to

put people in one or the other group? Now if each test group had

some version of a formula that actually treated a complex multi-patterned

diagnosis, perhaps the test group would have fared better. Perhaps

one reason the standard formula did so well is because it did address a

more complex diagnosis.

-- ,

 

 

FAX:

 

[Guest guest]

You might know this since you read a lot of research reports on chinese outcome studies. Would you say it is a consistent theme in the literature to see evidence that pattern diagnosis yields better results than giving the same formula to the entire group, regardless of their TCM pattern? How much research is done this way?

 

>>>>Todd I hate to sound like a beating drum but that supposes good, trust worthy studies.

 

Also, I guess the study I posted was the JAMA study it looked like another. Do we know that the patients in the individualized group did not get so called complex prescriptions. Also if i remember the general treat all formula did covered all the principal you quoted.

 

Going back to patho-mechanics my teachers have always used the principles of such mechanisms to avoid too large formulas, (although like i said there was a very popular Dr that used about 30 herbs almost for all patients) and always said that in order to understand an individual patient one has to understand these mechanisms in order to get at the root or what they often called center of patient. Almost all, especially my teacher that was SHL and purging school, always used to say when looking at "complex patient" if one does not understand the center and uses too many herbs and treatment principles, the herbs are endup "fighting" each other.

He used to say find the patient circle and add a few herbs at low dose to deal with the individuals complications.

Alon

 

 

-

cha

Saturday, January 19, 2002 5:22 PM

research and pattern dx

Bob Flaws (and, of course, anyone else who might have a thought on this), You might know this since you read a lot of research reports on chinese outcome studies. Would you say it is a consistent theme in the literature to see evidence that pattern diagnosis yields better results than giving the same formula to the entire group, regardless of their TCM pattern? How much research is done this way? I ask because Alon abstracted the Bensouusan irritable bowel study on another list. It makes the point of saying the the study showed no added benefit from TCM pattern differentiation. Apparently, in the whole article, it is stated that in some cases of those on individualized formulas, improvements lasted up to 14 weeks after stopping the herbs, though. This was not true for any on the standard one size fits all rx. There was just no greater symptom relief during the experimental period with pattern based tx. I think the long lasting relief in the pattern based group is of great significance, perhaps suggesting that root and branch were both treated effectively. I do wonder how accurate the pattern based formulas were. If one accepts that complex diagnoses like IBS often involve several mutually engendering pathomechanisms (and I know not everyone agrees with this), it may be folly to do research that breaks disease down by textbook patterns and then fits patients into whatever group is the closest match. For instance, don't the vast majority of IBS patients have some combination of spleen vacuity, liver qi depression, damp-heat. I also frequently see yang xu with this. What good would it do to put people in one or the other group? Now if each test group had some version of a formula that actually treated a complex multi-patterned diagnosis, perhaps the test group would have fared better. Perhaps one reason the standard formula did so well is because it did address a more complex diagnosis. -- Chinese Herbs FAX: 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]

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

 

>

> >>>>Todd I hate to sound like a beating drum but that supposes good, trust

worthy studies.

 

I agree about the studies, but I don't think you really hate to sound

like a beating drum We all keep beating our drums, so its not just

you.

>

Do we know that the patients in the individualized group did not get so

called complex prescriptions.

 

there are no details in the original study. I am making an assumption

because some other studies I have seen tend to use one pattern

formulas. However,others do soemthing like treat all patients for the

sme branch (such as dampheat) and then add one more root pattern, such

as spleen xu or liver qi.

 

Also if i remember the general treat all formula did covered all the

principal you quoted.

 

I think you are right.

>

> Going back to patho-mechanics my teachers have always used the principles of

such mechanisms to avoid too large formulas, (although like i said there was a

very popular Dr that used about 30 herbs almost for all patients) and always

said that in order to understand an individual patient one has to understand

these mechanisms in order to get at the root or what they often called center of

patient.

 

I usually use under 12 herbs myself. We have a new supervisor at PCOM

who never uses less than about 25, up to 40.

 

Almost all, especially my teacher that was SHL and purging school,

always used to say when looking at " complex patient " if one does not

understand the center and uses too many herbs and treatment principles,

the herbs are endup " fighting " each other.

 

The majority of my teachers and almost all of the chronic diseases

formulas I have seen in other chinese supervisor's charts over the past

12 years address multiple patterns, though more than five is rare.

 

For example, in cases of IBS where liver/spleen disharmony and dampheat

are prevalent are often all in evidence, they are typically all

treated. Xiao chai hu tang addresses this complex without

modification. However, I often find that in peri-menopausal women, the

formulas are not effective unless I treat yin and/or yang xu as well.

And merely treating the kidney xu is not effective, either.

 

[Guest guest]

The majority of my teachers and almost all of the chronic diseases formulas I have seen in other chinese supervisor's charts over the past 12 years address multiple patterns, though more than five is rare.>>>>>

Remember that I am not saying that a formula has only one type of herbs. Obviously 99% of TCM formulas from the start cover a pattern of dysfunction which involves more than one type of herb categories. But, when you look carefully at your teachers formulas do you see some kind on central formula lets say harmonizing (which by definitions deals with mix pattern) and than do they just add let say few more types of herb categories in equal emphasis or do they add smaller doses of (like I said in my teaching 1-3) types of additional categories at somewhat lower emphasis (which from what I was taught were not patterns but secondary influences)

Alon

 

-

1

Sunday, January 20, 2002 12:39 AM

Re: research and pattern dx

, "Alon Marcus" <alonmarcus@w...> wrote:> > >>>>Todd I hate to sound like a beating drum but that supposes good, trust worthy studies.I agree about the studies, but I don't think you really hate to sound like a beating drum We all keep beating our drums, so its not just you. > Do we know that the patients in the individualized group did not get so called complex prescriptions.there are no details in the original study. I am making an assumption because some other studies I have seen tend to use one pattern formulas. However,others do soemthing like treat all patients for the sme branch (such as dampheat) and then add one more root pattern, such as spleen xu or liver qi.Also if i remember the general treat all formula did covered all the principal you quoted.I think you are right.> > Going back to patho-mechanics my teachers have always used the principles of such mechanisms to avoid too large formulas, (although like i said there was a very popular Dr that used about 30 herbs almost for all patients) and always said that in order to understand an individual patient one has to understand these mechanisms in order to get at the root or what they often called center of patient.I usually use under 12 herbs myself. We have a new supervisor at PCOM who never uses less than about 25, up to 40.Almost all, especially my teacher that was SHL and purging school, always used to say when looking at "complex patient" if one does not understand the center and uses too many herbs and treatment principles, the herbs are endup "fighting" each other.The majority of my teachers and almost all of the chronic diseases formulas I have seen in other chinese supervisor's charts over the past 12 years address multiple patterns, though more than five is rare.For example, in cases of IBS where liver/spleen disharmony and dampheat are prevalent are often all in evidence, they are typically all treated. Xiao chai hu tang addresses this complex without modification. However, I often find that in peri-menopausal women, the formulas are not effective unless I treat yin and/or yang xu as well. And merely treating the kidney xu is not effective, either.ToddChinese 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 Marcus " <alonmarcus@w...> wrote:

do they just add let say few more types of herb categories in equal

emphasis or do they add smaller doses of (like I said in my teaching 1-

3) types of additional categories at somewhat lower emphasis (which

from what I was taught were not patterns but secondary influences)

 

I have never heard the term secondary influences before. If an herb is

used, it is used to address sx in the context of a pattern,never just

the sx. In other words, you wouldn't choose an herb for h/a unless it

addressed the correct pattern (gou teng vs. chuan xiong, for example)

 

[Guest guest]

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

 

But, when you look carefully at your teachers formulas do you see some

kind on central formula lets say harmonizing

 

I am not sure what your point is here. If harmonizing is a common

treatment principle in modern practice (and indeed it is, IMO), then

indetification of multiple patterns must also be common. while to

harmonize may be construed as a single tx principle, it is only applied

when one has justified a multipatterned dx (like spleen xu, liver qi

depression and phlegm, for example).

 

However, just a cursory look at Bensky reveals that the majority of

formulas address multiple patterns; many address 3 or more tx

principles. I guess you could argue that the presence of a tx

principle being explicitly stated in the discussion of a formula does

not mean there is a pattern underlying it. In cases like stop bleeding

or stop cough, this may be true, but most treatment principles are

derived directly from pattern dx. The process is to identify patterns,

choose tx principles to address those patterns, choose herbs to address

those tx principles. and I think it is critical that this is done. To

clear dampheat in a spleen xu patient without protecting the spleen

will injur the spleen. to conversely just tonify the spleen will

worsen the dampheat. I could go on and on with examples. I am just

not sure how it is possible to argue the reverse, that to do just one

of these things would be safe, effective or makes logical sense in

terms of TCM theory. Can anyone point to a textual source, in english

or chinese, that makes this case?

 

[Guest guest]

 

 

As I have learned it the major symptoms and signs that lead one to the "central issue", all the other symptoms that can involve any of the body systems and 10 different pattern differentiations can also accompany. I have learned to look at this as secondary developments not as patterns. For a pattern to exist one had to have the major symptoms and signs for it (being pulse and tongue). Now I would be very difficult to say that one patient has symptoms and signs of 8 patterns. Its true that most of my teachers looked at the major pulse image and not so much for all the different positions, except for ones that emphasized acupuncture (If they did perhaps it would be different). So they often criticized my formulas in the beginning of my hospital practice as not focusing to the "center". When I used to say well but this patient also has symptoms of this and that, many pathogens, and all these organs etc. They used to say you are not understanding the center. You are looking at symptoms and almost any symptom can arise from any system. They then said you must use a formula (ie treatment principle) and add or reduce for upto 3 complications.

Now since many my teachers were often not successful, I am very interested in hearing about usage of multiple (formulas) in one formula use. Perhaps Bob is correct in saying that its the best approach. I am just wandering since it contradicts everything I have learned.

Alon

 

 

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1

Sunday, January 20, 2002 12:26 PM

Re: research and pattern dx

, "Alon Marcus" <alonmarcus@w...> wrote:do they just add let say few more types of herb categories in equal emphasis or do they add smaller doses of (like I said in my teaching 1-3) types of additional categories at somewhat lower emphasis (which from what I was taught were not patterns but secondary influences)I have never heard the term secondary influences before. If an herb is used, it is used to address sx in the context of a pattern,never just the sx. In other words, you wouldn't choose an herb for h/a unless it addressed the correct pattern (gou teng vs. chuan xiong, for example)ToddChinese 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 Marcus " <alonmarcus@w...> wrote:

For a pattern to exist one had to have the major symptoms and signs

for it (being pulse and tongue). Now I would be very difficult to say

that one patient has symptoms and signs of 8 patterns.

 

see, I didn't learn that you needed tongue and pulse to confirm each

pattern. One could have sx of liver qi constraint confirmed by pulse,

spleen xu confirmed by tongue body shape, blood stasis confirmed by

stasis macules and distended sublingual veins and purple lips, phlegm

by the presence of sputum, etc.

 

 

> Now since many my teachers were often not successful, I am very interested in

hearing about usage of multiple (formulas) in one formula use.

 

I think this is a critical point that you have stated often in the

past. If they were not successful, this suggests something was wrong

in their methodology, n'est ce pas?

 

Perhaps Bob is correct in saying that its the best approach.

 

In my experience, Bob is only the latest and most eloquent to express

this viewpoint. I had teachers who studied with CS Cheung. didn't you

go to ACTCM when he was there. Did you know Tim Timmons? He read

chinese before he even started school there in the early 80's. He was

the first one to teach me the multipattern method and said he learned

it from Cheung. Tim was my first int. med teacher, BTW, so his

influence stayed with me. He was also the first very expereinced

herbalist I observed in clinic. My main eacher, Li Wei, also used this

approach. I was very impressed with their results and thus adopted

this approach long ago. I was always less impressed with those who

tried to identify the single linchpin pattern and so never even tried

that approach.

 

However, there is something else that also needs to be said. I don't

know if this has to do with language or some odd disconnect in the

minds of some other chinese supervisors I have known. As Jason stated

months ago, if you ask the chinese supervisors to whom I refer what

their dx is, they will typically state the central 1 or 2 dx alone.

Yet their formulas seem to address much more than this. However, if

one restates the question and instead asks what treatment principles

the formula addresses, then they state 4-5 principles. Perhaps someone

can explain this disconnect to me. why do they state one dx and then

4-5 treatment principles. Is the question not understood? Is what I

learned about the relationship between dx and tx principles inaccurate?

Out of deference to these teachers, I see no purpose in publicly

challenging them on what seems a logical disconnect to me. But perhaps

it is me who does not properly understand the logic due to my inability

to communicate in chinese.

 

Students often ask me to explain formulas that chinese supervisors

wrote, because they get a more detailed explanation from a native

english speaker. again,this points out the advantage one would have

knowing chinese and thus being able to have an extensive conversation

with one's teachers. The other day I was signing off on the correct

filling of a formula written by a chinese supervisor, one who answers

the question about patterns as described above. The formula ws clearly

a combination of liu jun zi tang plus gan mai da zao tang with

additions for blood stasis and to increase heart nourishment. So the

formula definitely tonified qi, transformed phlegm damp, nourished the

heart and moved blood stasis. It was prescribed for a student who,

when asked, reported that the formula was merely for qi xu. I just

don't see how that can be the case. whatever " secondary complications "

the blood stasis herbs were added for, they must have been added to

address blood stasis as the cause of those " complications " , so that

pattern must have been justifiable. This is just one example of many I

could present.

 

[Guest guest]

Tim Timmons?

>>>He was in my class and actually that is not what cheng was saying he was talking a lot about altering patterns

Do you know were Tim is now. I would like to get in touch with him

Alon

 

-

1

Sunday, January 20, 2002 1:45 PM

Re: research and pattern dx

, "Alon Marcus" <alonmarcus@w...> wrote:For a pattern to exist one had to have the major symptoms and signs for it (being pulse and tongue). Now I would be very difficult to say that one patient has symptoms and signs of 8 patterns.see, I didn't learn that you needed tongue and pulse to confirm each pattern. One could have sx of liver qi constraint confirmed by pulse, spleen xu confirmed by tongue body shape, blood stasis confirmed by stasis macules and distended sublingual veins and purple lips, phlegm by the presence of sputum, etc.> Now since many my teachers were often not successful, I am very interested in hearing about usage of multiple (formulas) in one formula use.I think this is a critical point that you have stated often in the past. If they were not successful, this suggests something was wrong in their methodology, n'est ce pas?Perhaps Bob is correct in saying that its the best approach. In my experience, Bob is only the latest and most eloquent to express this viewpoint. I had teachers who studied with CS Cheung. didn't you go to ACTCM when he was there. Did you know Tim Timmons? He read chinese before he even started school there in the early 80's. He was the first one to teach me the multipattern method and said he learned it from Cheung. Tim was my first int. med teacher, BTW, so his influence stayed with me. He was also the first very expereinced herbalist I observed in clinic. My main eacher, Li Wei, also used this approach. I was very impressed with their results and thus adopted this approach long ago. I was always less impressed with those who tried to identify the single linchpin pattern and so never even tried that approach.However, there is something else that also needs to be said. I don't know if this has to do with language or some odd disconnect in the minds of some other chinese supervisors I have known. As Jason stated months ago, if you ask the chinese supervisors to whom I refer what their dx is, they will typically state the central 1 or 2 dx alone. Yet their formulas seem to address much more than this. However, if one restates the question and instead asks what treatment principles the formula addresses, then they state 4-5 principles. Perhaps someone can explain this disconnect to me. why do they state one dx and then 4-5 treatment principles. Is the question not understood? Is what I learned about the relationship between dx and tx principles inaccurate? Out of deference to these teachers, I see no purpose in publicly challenging them on what seems a logical disconnect to me. But perhaps it is me who does not properly understand the logic due to my inability to communicate in chinese.Students often ask me to explain formulas that chinese supervisors wrote, because they get a more detailed explanation from a native english speaker. again,this points out the advantage one would have knowing chinese and thus being able to have an extensive conversation with one's teachers. The other day I was signing off on the correct filling of a formula written by a chinese supervisor, one who answers the question about patterns as described above. The formula ws clearly a combination of liu jun zi tang plus gan mai da zao tang with additions for blood stasis and to increase heart nourishment. So the formula definitely tonified qi, transformed phlegm damp, nourished the heart and moved blood stasis. It was prescribed for a student who, when asked, reported that the formula was merely for qi xu. I just don't see how that can be the case. whatever "secondary complications" the blood stasis herbs were added for, they must have been added to address blood stasis as the cause of those "complications", so that pattern must have been justifiable. This is just one example of many I could present.ToddChinese 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]

He read chinese before he even started school there in the early 80's.

>>>I don't think so. I think he started after

Alon

 

-

1

Sunday, January 20, 2002 1:45 PM

Re: research and pattern dx

, "Alon Marcus" <alonmarcus@w...> wrote:For a pattern to exist one had to have the major symptoms and signs for it (being pulse and tongue). Now I would be very difficult to say that one patient has symptoms and signs of 8 patterns.see, I didn't learn that you needed tongue and pulse to confirm each pattern. One could have sx of liver qi constraint confirmed by pulse, spleen xu confirmed by tongue body shape, blood stasis confirmed by stasis macules and distended sublingual veins and purple lips, phlegm by the presence of sputum, etc.> Now since many my teachers were often not successful, I am very interested in hearing about usage of multiple (formulas) in one formula use.I think this is a critical point that you have stated often in the past. If they were not successful, this suggests something was wrong in their methodology, n'est ce pas?Perhaps Bob is correct in saying that its the best approach. In my experience, Bob is only the latest and most eloquent to express this viewpoint. I had teachers who studied with CS Cheung. didn't you go to ACTCM when he was there. Did you know Tim Timmons? He read chinese before he even started school there in the early 80's. He was the first one to teach me the multipattern method and said he learned it from Cheung. Tim was my first int. med teacher, BTW, so his influence stayed with me. He was also the first very expereinced herbalist I observed in clinic. My main eacher, Li Wei, also used this approach. I was very impressed with their results and thus adopted this approach long ago. I was always less impressed with those who tried to identify the single linchpin pattern and so never even tried that approach.However, there is something else that also needs to be said. I don't know if this has to do with language or some odd disconnect in the minds of some other chinese supervisors I have known. As Jason stated months ago, if you ask the chinese supervisors to whom I refer what their dx is, they will typically state the central 1 or 2 dx alone. Yet their formulas seem to address much more than this. However, if one restates the question and instead asks what treatment principles the formula addresses, then they state 4-5 principles. Perhaps someone can explain this disconnect to me. why do they state one dx and then 4-5 treatment principles. Is the question not understood? Is what I learned about the relationship between dx and tx principles inaccurate? Out of deference to these teachers, I see no purpose in publicly challenging them on what seems a logical disconnect to me. But perhaps it is me who does not properly understand the logic due to my inability to communicate in chinese.Students often ask me to explain formulas that chinese supervisors wrote, because they get a more detailed explanation from a native english speaker. again,this points out the advantage one would have knowing chinese and thus being able to have an extensive conversation with one's teachers. The other day I was signing off on the correct filling of a formula written by a chinese supervisor, one who answers the question about patterns as described above. The formula ws clearly a combination of liu jun zi tang plus gan mai da zao tang with additions for blood stasis and to increase heart nourishment. So the formula definitely tonified qi, transformed phlegm damp, nourished the heart and moved blood stasis. It was prescribed for a student who, when asked, reported that the formula was merely for qi xu. I just don't see how that can be the case. whatever "secondary complications" the blood stasis herbs were added for, they must have been added to address blood stasis as the cause of those "complications", so that pattern must have been justifiable. This is just one example of many I could present.ToddChinese 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]

However, if one restates the question and instead asks what treatment principles the formula addresses, then they state 4-5 principles.

>>>Todd I have always learned this as a question of dose. Yes it is common to add herbs but the so called diagnosis had to do the main formula and dose.

PS both me and Tim had the same teachers ( he had a strong influence from Brofman.

Alon

 

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1

Sunday, January 20, 2002 1:45 PM

Re: research and pattern dx

, "Alon Marcus" <alonmarcus@w...> wrote:For a pattern to exist one had to have the major symptoms and signs for it (being pulse and tongue). Now I would be very difficult to say that one patient has symptoms and signs of 8 patterns.see, I didn't learn that you needed tongue and pulse to confirm each pattern. One could have sx of liver qi constraint confirmed by pulse, spleen xu confirmed by tongue body shape, blood stasis confirmed by stasis macules and distended sublingual veins and purple lips, phlegm by the presence of sputum, etc.> Now since many my teachers were often not successful, I am very interested in hearing about usage of multiple (formulas) in one formula use.I think this is a critical point that you have stated often in the past. If they were not successful, this suggests something was wrong in their methodology, n'est ce pas?Perhaps Bob is correct in saying that its the best approach. In my experience, Bob is only the latest and most eloquent to express this viewpoint. I had teachers who studied with CS Cheung. didn't you go to ACTCM when he was there. Did you know Tim Timmons? He read chinese before he even started school there in the early 80's. He was the first one to teach me the multipattern method and said he learned it from Cheung. Tim was my first int. med teacher, BTW, so his influence stayed with me. He was also the first very expereinced herbalist I observed in clinic. My main eacher, Li Wei, also used this approach. I was very impressed with their results and thus adopted this approach long ago. I was always less impressed with those who tried to identify the single linchpin pattern and so never even tried that approach.However, there is something else that also needs to be said. I don't know if this has to do with language or some odd disconnect in the minds of some other chinese supervisors I have known. As Jason stated months ago, if you ask the chinese supervisors to whom I refer what their dx is, they will typically state the central 1 or 2 dx alone. Yet their formulas seem to address much more than this. However, if one restates the question and instead asks what treatment principles the formula addresses, then they state 4-5 principles. Perhaps someone can explain this disconnect to me. why do they state one dx and then 4-5 treatment principles. Is the question not understood? Is what I learned about the relationship between dx and tx principles inaccurate? Out of deference to these teachers, I see no purpose in publicly challenging them on what seems a logical disconnect to me. But perhaps it is me who does not properly understand the logic due to my inability to communicate in chinese.Students often ask me to explain formulas that chinese supervisors wrote, because they get a more detailed explanation from a native english speaker. again,this points out the advantage one would have knowing chinese and thus being able to have an extensive conversation with one's teachers. The other day I was signing off on the correct filling of a formula written by a chinese supervisor, one who answers the question about patterns as described above. The formula ws clearly a combination of liu jun zi tang plus gan mai da zao tang with additions for blood stasis and to increase heart nourishment. So the formula definitely tonified qi, transformed phlegm damp, nourished the heart and moved blood stasis. It was prescribed for a student who, when asked, reported that the formula was merely for qi xu. I just don't see how that can be the case. whatever "secondary complications" the blood stasis herbs were added for, they must have been added to address blood stasis as the cause of those "complications", so that pattern must have been justifiable. This is just one example of many I could present.ToddChinese 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]

One could have sx of liver qi constraint confirmed by pulse, spleen xu confirmed by tongue body shape, blood stasis confirmed by stasis macules and distended sublingual veins and purple lips, phlegm by the presence of sputum,

 

>>>Correct but for example if one has yellow phlegm inferring damp-Heat and to decide if this damp-heat is a major factor or just let say transormative accumulation due to deficient Spleen failing to transport for example

which then results only in

accumulation of Damp-Heat. One had to have a major diagnosis.The formula would in my example would have to be mostly a

worming and tonify Spleen.The dose of herbs for Damp-Heat must be small.

That is how I learned it. And that is how CS Chang talked about it. Now CS Chang is an MD with no formal training in TCM. I had no contact with him past 1983 so he may have taught things differently after that,ashis knowledge from reading and translating increased.

He is one of the smartest people I have learned with

and at our first class one of the first things he told us was

not to get to blinded by TCM principles and treatments

but to remember that the we have many pain pills because no one pill (ie methodology) worked all the time.

Alon

 

 

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1

Sunday, January 20, 2002 1:45 PM

Re: research and pattern dx

, "Alon Marcus" <alonmarcus@w...> wrote:For a pattern to exist one had to have the major symptoms and signs for it (being pulse and tongue). Now I would be very difficult to say that one patient has symptoms and signs of 8 patterns.see, I didn't learn that you needed tongue and pulse to confirm each pattern. One could have sx of liver qi constraint confirmed by pulse, spleen xu confirmed by tongue body shape, blood stasis confirmed by stasis macules and distended sublingual veins and purple lips, phlegm by the presence of sputum, etc.> Now since many my teachers were often not successful, I am very interested in hearing about usage of multiple (formulas) in one formula use.I think this is a critical point that you have stated often in the past. If they were not successful, this suggests something was wrong in their methodology, n'est ce pas?Perhaps Bob is correct in saying that its the best approach. In my experience, Bob is only the latest and most eloquent to express this viewpoint. I had teachers who studied with CS Cheung. didn't you go to ACTCM when he was there. Did you know Tim Timmons? He read chinese before he even started school there in the early 80's. He was the first one to teach me the multipattern method and said he learned it from Cheung. Tim was my first int. med teacher, BTW, so his influence stayed with me. He was also the first very expereinced herbalist I observed in clinic. My main eacher, Li Wei, also used this approach. I was very impressed with their results and thus adopted this approach long ago. I was always less impressed with those who tried to identify the single linchpin pattern and so never even tried that approach.However, there is something else that also needs to be said. I don't know if this has to do with language or some odd disconnect in the minds of some other chinese supervisors I have known. As Jason stated months ago, if you ask the chinese supervisors to whom I refer what their dx is, they will typically state the central 1 or 2 dx alone. Yet their formulas seem to address much more than this. However, if one restates the question and instead asks what treatment principles the formula addresses, then they state 4-5 principles. Perhaps someone can explain this disconnect to me. why do they state one dx and then 4-5 treatment principles. Is the question not understood? Is what I learned about the relationship between dx and tx principles inaccurate? Out of deference to these teachers, I see no purpose in publicly challenging them on what seems a logical disconnect to me. But perhaps it is me who does not properly understand the logic due to my inability to communicate in chinese.Students often ask me to explain formulas that chinese supervisors wrote, because they get a more detailed explanation from a native english speaker. again,this points out the advantage one would have knowing chinese and thus being able to have an extensive conversation with one's teachers. The other day I was signing off on the correct filling of a formula written by a chinese supervisor, one who answers the question about patterns as described above. The formula ws clearly a combination of liu jun zi tang plus gan mai da zao tang with additions for blood stasis and to increase heart nourishment. So the formula definitely tonified qi, transformed phlegm damp, nourished the heart and moved blood stasis. It was prescribed for a student who, when asked, reported that the formula was merely for qi xu. I just don't see how that can be the case. whatever "secondary complications" the blood stasis herbs were added for, they must have been added to address blood stasis as the cause of those "complications", so that pattern must have been justifiable. This is just one example of many I could present.ToddChinese 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 guess what I am trying to say Todd is that the way I was taught to think about this is in the dosage of herbs. That is were they used terms such as what is the major diagnosis, what is the center of the formula. Even in so called harmonizing formulas there was always a major emphasis, was the spleen weakness or liver excess the major issue, was the blood stasis or the deficiency the major issue etc.

It all came back to what would be the dose of herbs. The same Dr that would have said your formula has no center may have kept my herbs but only changed the dosage of herbs.

When I went to China one of my stated purposes was to be an intern in the way its done with western med. That is to be the treating Dr and present my patient to a supervisor. That is how I spend the first four hours of each day at the hospital. And that is when I heard a lot of this kind of talk.

Alon

 

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1

Sunday, January 20, 2002 12:47 PM

Re: research and pattern dx

, "Alon Marcus" <alonmarcus@w...> wrote:But, when you look carefully at your teachers formulas do you see some kind on central formula lets say harmonizing I am not sure what your point is here. If harmonizing is a common treatment principle in modern practice (and indeed it is, IMO), then indetification of multiple patterns must also be common. while to harmonize may be construed as a single tx principle, it is only applied when one has justified a multipatterned dx (like spleen xu, liver qi depression and phlegm, for example).However, just a cursory look at Bensky reveals that the majority of formulas address multiple patterns; many address 3 or more tx principles. I guess you could argue that the presence of a tx principle being explicitly stated in the discussion of a formula does not mean there is a pattern underlying it. In cases like stop bleeding or stop cough, this may be true, but most treatment principles are derived directly from pattern dx. The process is to identify patterns, choose tx principles to address those patterns, choose herbs to address those tx principles. and I think it is critical that this is done. To clear dampheat in a spleen xu patient without protecting the spleen will injur the spleen. to conversely just tonify the spleen will worsen the dampheat. I could go on and on with examples. I am just not sure how it is possible to argue the reverse, that to do just one of these things would be safe, effective or makes logical sense in terms of TCM theory. Can anyone point to a textual source, in english or chinese, that makes this case?ToddChinese 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,

 

What if the spleen xu which led damp/heat caused reckeless blood?

Would you still use a warming supplementing spleen rx with low dosage

of herbs to address the d/h and reckless blood? At what point do you

choose to aggressively address the branches over the root?

 

fernando

 

 

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

> >>>Correct but for example if one has yellow phlegm inferring

>damp-Heat and to decide if this damp-heat is a major factor or just

>let say transormative accumulation due to deficient Spleen failing to

>transport for example which then results only in accumulation of

>Damp-Heat. One had to have a major diagnosis.The formula would in my

>example would have to be mostly a worming and tonify Spleen.The dose

>of herbs for Damp-Heat must be small.

[Guest guest]

Hey guys,

 

New here, but I think i'm reading up on a very interesting topic. From

my own understanding of treatment principles, I would say that the most

effective way to treat a patient is to focus on the chief or major

complaint / problem first. This is what I've been taught. My chinese

professors, who all seem to disagree about diagnosis and treatment, at

least teach that the most effective way to treat a patient is to use

acupuncture mainly to elliviate symptoms of illness and herbs to get at

the root problem in a conjunctive effort. The herbal therapies should

focus on the most serious problem and hopefully correct that. When the

patient returns his/her symptoms will have changed hopefully for the

better, then you can concentrate on the secondary complaints of the

patient. However, organ systems are all related. In the case of a

liver heat excess, you're going to want to reduce the heat, benefit the

liver yin and tonify spleen and probably benefit the heart as well.

Liver problems often affect the heart and shen. Always in a liver

disorder, the spleen should be benefitted first. That's my

understanding.

From what I understand of TCM every doctor uses his own creative

abilities to aid the patient. Its a very artistic discipline. And in

art, everyone has their own style and approach. Some people have a

stronger gift for creativity than do others. As long as it works, the

approach is good.

 

Wade

 

 

 

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[Guest guest]

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

> Tim Timmons?

> >>>He was in my class and actually that is not what cheng was saying he was

talking a lot about altering patterns

> Do you know were Tim is now. I would like to get in touch with him

>

 

Tim was dean at SAMRA for awhile, then he went to osteopathic school.

I lost touch with him after that. With all due respect, I'll have to

take Tim's word on his interpretation of Cheung, especially because Tim

spoke and read Chinese so well. I might think I had misunderstood Tim,

except that he provided detailed flow charts to our class that layed

out the process of making a complex multipatterned diagnosis.

 

[Guest guest]

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

> He read

> chinese before he even started school there in the early 80's.

> >>>I don't think so. I think he started after

 

No, he studied chinese for at least a year in undergrad school. At the

time he didn't even plan to study acupuncture. He always said it

helped him immensely in his education.

 

[Guest guest]

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

> However, if

> one restates the question and instead asks what treatment principles

> the formula addresses, then they state 4-5 principles.

> >>>Todd I have always learned this as a question of dose. Yes it is common to

add herbs but the so called diagnosis had to do the main formula and dose.

 

Alon

 

I really think this is a semantic argument. Are you saying that other

treatment principles are addressed, but they are just not considered

part of the diagnosis, per se? If that's the case, then we have no

argument on what the formula is actually doing, just how its explained.

It is true that first priority patterns receive more emphasis and

higher dosage, but according to my semantics, the other lower priority

patterns are still part of the dx and are treated accordingly, albeit

with less emphasis and often lower dosage.

 

[Guest guest]

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

> One could have sx of liver qi constraint confirmed by pulse,

> spleen xu confirmed by tongue body shape, blood stasis confirmed by

> stasis macules and distended sublingual veins and purple lips, phlegm

> by the presence of sputum,

>

> >>>Correct but for example if one has yellow phlegm inferring damp-Heat and to

decide if this damp-heat is a major factor or just let say transormative

accumulation due to deficient Spleen failing to transport for example

> which then results only in

> accumulation of Damp-Heat. One had to have a major diagnosis.The formula

would in my example would have to be mostly a

> worming and tonify Spleen.The dose of herbs for Damp-Heat must be small.

 

or vice-versa. no argument here. again, the crux seems to be

semantics.

 

[Guest guest]

Wade,

 

> From what I understand of TCM every doctor uses his own creative

> abilities to aid the patient. Its a very artistic discipline. And

in

> art, everyone has their own style and approach. Some people have a

> stronger gift for creativity than do others. As long as it works,

the

> approach is good.

 

Welcome to the fun.

 

I think you make an excellent point and

one that should be kept in mind during

discussions that take on the character

of a search for the right way.

 

One of the things I remember clearly from

my earliest instruction in Chinese medicine

is the aviso that ten traditional Chinese

doctors might deal with the same patient's

illness in ten distinctly different ways

and that all of them might have satisfactory

results.

 

Empiricism, as our friend Alon will no

doubt testify, is a powerfully persuasive

point of view. And the Chinese seem to

have blended it into their most fundamental

theories.

 

Ken

[Guest guest]

What if the spleen xu which led damp/heat caused reckeless blood? Would you still use a warming supplementing spleen rx with low dosage of herbs to address the d/h and reckless blood? At what point do you choose to aggressively address the branches over the root?>>>>It depends on severity. But even than if the "root"is truly Sp Def than from what I have learned you need to be careful with cooling blood. Since cold herbs could just make things worse. But again, as TCM is so subjective i think we are talking about things that different respected Chinese Dr apparently have very different ideas.

Alon

Alon

 

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fbernall

Sunday, January 20, 2002 4:16 PM

Re: research and pattern dx

Alon,What if the spleen xu which led damp/heat caused reckeless blood? Would you still use a warming supplementing spleen rx with low dosage of herbs to address the d/h and reckless blood? At what point do you choose to aggressively address the branches over the root?fernando, "Alon Marcus" <alonmarcus@w...> wrote:> >>>Correct but for example if one has yellow phlegm inferring >damp-Heat and to decide if this damp-heat is a major factor or just >let say transormative accumulation due to deficient Spleen failing to >transport for example which then results only in accumulation of >Damp-Heat. One had to have a major diagnosis.The formula would in my >example would have to be mostly a worming and tonify Spleen.The dose >of herbs for Damp-Heat must be small. 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 might think I had misunderstood Tim, except that he provided detailed flow charts to our class that layed out the process of making a complex multipatterned diagnosis.>>>>>You see I wander what you mean by this. Are talking about simple patho-mechanics? transmition of disease etc., or using many formulas together on the same patient.

That is all I am wandering about. I have never heard Dr Chang say you need to use a composite of as many as let say 5 formulas at one time.

Alon

 

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1

Sunday, January 20, 2002 5:07 PM

Re: research and pattern dx

, "Alon Marcus" <alonmarcus@w...> wrote:> Tim Timmons?> >>>He was in my class and actually that is not what cheng was saying he was talking a lot about altering patterns> Do you know were Tim is now. I would like to get in touch with him>Tim was dean at SAMRA for awhile, then he went to osteopathic school. I lost touch with him after that. With all due respect, I'll have to take Tim's word on his interpretation of Cheung, especially because Tim spoke and read Chinese so well. I might think I had misunderstood Tim, except that he provided detailed flow charts to our class that layed out the process of making a complex multipatterned diagnosis.ToddChinese 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]

Are you saying that other treatment principles are addressed, but they are just not considered part of the diagnosis, per se? If that's the case, then we have no argument on what the formula is actually doing, just how its explained

>>>>Yes.

 

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1

Sunday, January 20, 2002 5:15 PM

Re: research and pattern dx

, "Alon Marcus" <alonmarcus@w...> wrote:> However, if > one restates the question and instead asks what treatment principles > the formula addresses, then they state 4-5 principles. > >>>Todd I have always learned this as a question of dose. Yes it is common to add herbs but the so called diagnosis had to do the main formula and dose.AlonI really think this is a semantic argument. Are you saying that other treatment principles are addressed, but they are just not considered part of the diagnosis, per se? If that's the case, then we have no argument on what the formula is actually doing, just how its explained. It is true that first priority patterns receive more emphasis and higher dosage, but according to my semantics, the other lower priority patterns are still part of the dx and are treated accordingly, albeit with less emphasis and often lower dosage.ToddChinese 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]

 

- again, the crux seems to be semantics.

>>>>I think your correct. I guess I am reacting to all the times I was told that I was not focused in my formulas. That by looking at dosage one sees a clear major treatment principle.

Alon

1

Sunday, January 20, 2002 5:16 PM

Re: research and pattern dx

, "Alon Marcus" <alonmarcus@w...> wrote:> One could have sx of liver qi constraint confirmed by pulse, > spleen xu confirmed by tongue body shape, blood stasis confirmed by > stasis macules and distended sublingual veins and purple lips, phlegm > by the presence of sputum,> > >>>Correct but for example if one has yellow phlegm inferring damp-Heat and to decide if this damp-heat is a major factor or just let say transormative accumulation due to deficient Spleen failing to transport for example> which then results only in> accumulation of Damp-Heat. One had to have a major diagnosis.The formula would in my example would have to be mostly a> worming and tonify Spleen.The dose of herbs for Damp-Heat must be small.or vice-versa. no argument here. again, the crux seems to be semantics.ToddChinese 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]

One of the things I remember clearly frommy earliest instruction in Chinese medicineis the aviso that ten traditional Chinesedoctors might deal with the same patient'sillness in ten distinctly different waysand that all of them might have satisfactoryresults. Empiricism, as our friend Alon will nodoubt testify, is a powerfully persuasivepoint of view. And the Chinese seem tohave blended it into their most fundamentaltheories.>>>>Yes but one that still bags critical review

Alon

 

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dragon90405

Sunday, January 20, 2002 11:22 PM

Re: research and pattern dx

Wade,> From what I understand of TCM every doctor uses his own creative> abilities to aid the patient. Its a very artistic discipline. And in> art, everyone has their own style and approach. Some people have a> stronger gift for creativity than do others. As long as it works, the> approach is good.Welcome to the fun.I think you make an excellent point andone that should be kept in mind duringdiscussions that take on the characterof a search for the right way.One of the things I remember clearly frommy earliest instruction in Chinese medicineis the aviso that ten traditional Chinesedoctors might deal with the same patient'sillness in ten distinctly different waysand that all of them might have satisfactoryresults. Empiricism, as our friend Alon will nodoubt testify, is a powerfully persuasivepoint of view. And the Chinese seem tohave blended it into their most fundamentaltheories.KenChinese 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.