Those Pesky Nuances

March 13, 2002

Todd:

The only problem with this statement is the section: " a successful

treatment that could have only been accomplished by one with this

special knowledge. " Many pathways can lead to similar cures; not

becausethey are equal but because the body's own intelleigence

manages them. But there are also many cases where a more experienced

physician is able to successfully treat someone by using a

specialized knowledge---often after they have been seen by the

everyone else in town. Long ago, Ted Kaptchuk told a case history

about one of his favorite physicians, Sun si-miao. The gist of the

story is that a woman was seen by everyone else in town and had been

treated with acupuncture and herbs, but without success. Sun's

specialized knowledge of the pulses (she had a wiry movement from

the GB going to the heart, and a knotting movement in the spleen)

allowed him to cure her because he recognized that the root of the

problem was emotional and not physical. First, he yelled at her,

which resolved the wiry movement going to the Ht. Then he soothed

her, which resolved the knotting in the spleen. All her physical

symptoms vanished. And there are many other examples where a

different system of thought, often considered exotic or esoteric, is

able to resolve problems that 8-Principles, what most practitioners

employ, can not. It was simply a matter of employing the correct

methodology for the particular problem. While the universality of 8-

Principles suggests great authority, it is not always effective.

This issue comes at an propiceous time. Early last week, saw a

number of patients with a very similar liver pulse movement,

indicating stagnation, along with heat building in the physical

organ. More than half of my patients that one day showed this

feature. Being curious as to why there was such a statistically

significant increase in this type of movement, I thought about it

and finally checked a book on 9-Star Fengshui---not a system I have

much expertise with. During 2002, 5 is in the East and 2 is in the

South. Interestingly, the month starting on March 6 and going to the

beginning of April has the same energy as that of the year. Both 5

and 2 are Earth and are markers for illness and inauspiciousness.

The doubling up of this energy profile created the condition that

became acute and statistically significant in the pulses---not

unlike the way the pulse changes with the season, but in a shorter

cycle. Had I read ahead, it would have been easy to predict these

types of symptoms. In the latter half of the 11th century in China,

physicians using 5-Phases and 6-Qi were able to cure patients that

the palace physicians were not. This system attained official

acceptance because of its innovation and greater success. Many other

esoteric philosophical perspectives---I Ching, Daoist canon, etc.---

also generate treatment strategies. I'm always surprised at how

little of what has already been translated into English is discussed

or considered clinically. Yet, much more remains untranslated.

Jim Ramholz

, " 1 " <@i...> wrote:

> I think the evidence Alon wants and Bob wants and that which would

certainly interest me is a concrete example of an instance when a

nuanced understanding of qi, yin and yang led one to make a

diagnosis that he would not have otherwise made. And that this

diagnosis led to a successful treatment that could have only been

accomplished by one with this special knowledge. It is one thing to

provide historical or cultural evidence as to why something seems to

make logical sense, but this does not address the pragmatic clinical

need at hand. Members of this list are being told by erudite,

respected scholars and px in the field that unless they bite this

bullet, they will be forever consigned to a low level of practice

and commensurate poor clinical results. This position just cries

out for an example of how to use this material in clinic. Until

such an example can be provided, I see no reason for the skeptical

to do anything but continue with the status quo.

March 14, 2002

Friends -

Usually there is no correlation. The people who are successful practitioners are working rather than dealing with the nuances of a term. Dr. Shen would scoff at such a notion as a waste of time - he would rather be at a cheap marshal arts flick or eating a fine meal. Leave the scholarly work to scholars and the clinical work to the clinicians. I side with Bob and Alon on this.

Now change the discussion to the various forms of Qi. Include the physiology and pathophysiology and the resulting treatments. In addition consider the Qi transformation according to stems and branches as James suggests and we have some useful clinical considerations. Dr. Tian De Yang is often reading discourse on the transformation of the Qi of heaven. Understanding the warp and woof of Yin and Yang is vital to clinical practice. It is so refreshing to see the most senior of practitioners studying Yin and Yang rather than the terms.

A topic may include an extensive discussion of disharmony of Ying Qi and Wei Qi beyond the conversations in the Shang Han Lun which are relatively minimal. There is tremendous clinical value in the Nei Jing regarding these matters - any opinions? I think this area provides a discussion of the nuances which arrive at clinically useful and verifiable outcomes.

Will

concrete example of an instance when a nuanced understanding of qi, yin and yang led one to make a diagnosis that he would not have otherwise made.

March 14, 2002

Comrades -

Here is a post from the pulsediagnosis list discussing Ying Qi. I think it demonstrates practical discussion of this type of Qi and it's flow. Let me know if it is too fragmented with assumptions of previous discourse and I'll fill in the gaps.

I also find the three circuits considered as macro units a useful model. I think it was Yoshio Manaka who coined the term circuit very early on, correct me on this if I am wrong.

These frontal, sagital and posterior planes are especially useful for creating treatments that are confluent and focused. This also places reality into a simpler picture with three pieces. So the question might be does the pathology exist within the circuit or between the circuits?

I find the two-hour movement from channel to channel a useful as a reminder of the influence of heaven on humans. The shifting of the sun along along the ecliptic from sector to sector matches perfectly the movement of Ying Qi in the channels. The character for Ying contains two fire radicals implying a relation to the heart and to the sun. The lower part of the character contains the water radical showing the influence of the heart or the sun into the movement within our vessels.

Those who are trained in Shen-Hammer use the lifting method for analysis of the Blood depth. According to my research, the pressing method at the same depth will reveal the status of the Ying Qi and the Sea of Grains. Herbs with influence on the Ying Qi include Bai Shao, Gui Zhi, Chuan Xiong, and Huang Jing.

Acupuncture treatments may involve the circuits as we have been discussing, the depth of needling, and the process of the physiological generation of Ying Qi. This is evaluated on the right wrist, comparing the strength of each position to determine whether the Zong Qi, the Gu Qi, or the Yuan Qi are the weakest link in the process. Then tonify.

Will

My understanding of the 3 circuits is that they are somewhat closed

systems. They are cyclical loops within themselves.

For example, in one circuit Ht flows to SI, which flows to Bl, which

flows to Kd, which then flows back to Ht continuing the loop over and

over. This loop would reach its peak time in the mid-afternoon, and its

low time in the mid-morning.

Another way to look at the diurnal pattern of meridians is that instead

of seeing the 12 individual meridians expressing one after the other, I

tend to look at them as 3 circuits expressing one after the other. Each

circuit being an expression of the balance between its four meridians.

For me, it is not the meridians exactly that are raising and lowering in

energy during the cycle, but it is the expression of the circuits

themselves that are fluctuating.

What is your take on this?

March 14, 2002

Will,

I beg to differ. I have a full-time practice and am a professor

teaching Chinese internal medicine. I take much time studying the

nuances of Chinese medical terminology. It improves my work, and helps

me walk my talk. The separation between scholarship and practice,

again, as Ken, myself, and others have said, is artificial and

dualistic. They have always informed each other. Reductionism of

Chinese medical concepts serves no purpose. If a practitioner doesn't

know that there are different ways to supplement or drain, different

nuances of subtlety, how will that reflect in their ability to prescribe

herbal medicine?

The topics you mention below are also scholarly ones. I certainly

would be interested in discussing them here.

P.S.: I also enjoy a good meal once in awhile:) Even a good movie or

concert.

On Thursday, March 14, 2002, at 07:42 AM, WMorris116 wrote:

> Friends -

>

> Usually there is no correlation. The people who are successful

> practitioners are working rather than dealing with the nuances of a

> term. Dr. Shen would scoff at such a notion as a waste of time - he

> would rather be at a cheap marshal arts flick or eating a fine meal.

> Leave the scholarly work to scholars and the clinical work to the

> clinicians. I side with Bob and Alon on this.

>

> Now change the discussion to the various forms of Qi. Include the

> physiology and pathophysiology and the resulting treatments. In

> addition consider the Qi transformation according to stems and branches

> as James suggests and we have some useful clinical considerations. Dr.

> Tian De Yang is often reading discourse on the transformation of the Qi

> of heaven. Understanding the warp and woof of Yin and Yang is vital to

> clinical practice. It is so refreshing to see the most senior of

> practitioners studying Yin and Yang rather than the terms.

>

> A topic may include an extensive discussion of disharmony of Ying Qi

> and Wei Qi beyond the conversations in the Shang Han Lun which are

> relatively minimal. There is tremendous clinical value in the Nei Jing

> regarding these matters - any opinions? I think this area provides a

> discussion of the nuances which arrive at clinically useful and

> verifiable outcomes.

>

> Will

>

> concrete example of an instance when a

> nuanced understanding of qi, yin and yang led one to make a

> diagnosis that he would not have otherwise made.

>

> 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.

>

March 14, 2002

Will,

> Usually there is no correlation.

Between what and what? Does this sentence

refer to what follows or to something said

earlier?

The people who are successful practitioners

> are working rather than dealing with the nuances of a term. Dr.

Shen would

> scoff at such a notion as a waste of time - he would rather be at a

cheap

> marshal arts flick or eating a fine meal. Leave the scholarly work

to

> scholars and the clinical work to the clinicians. I side with Bob

and Alon on

> this.

So is your point that usually there is no

correlation between scholarship and medicine?

A curious assetion from the Dean of a School.

I have to admit, as I often do about so many

things, to complete ignorance on the subject

of Dr. Shen. But I accept your characterization

of him, although I don't find that it reflects

well on a person whom you seem to hold in high

esteem. I would anticipate that anyone who

valued good entertainment and fine food would

have cultivated the capacity to appreciate

the subtleties of language.

Do you think Dr. Shen would have scoffed at

the advice of Sun Si Miao, as Bob Flaws now

does?

>

> Now change the discussion to the various forms of Qi. Include the

physiology

> and pathophysiology and the resulting treatments. In addition

consider the Qi

> transformation according to stems and branches as James suggests

and we have

> some useful clinical considerations. Dr. Tian De Yang is often

reading

> discourse on the transformation of the Qi of heaven. Understanding

the warp

> and woof of Yin and Yang is vital to clinical practice. It is so

refreshing

> to see the most senior of practitioners studying Yin and Yang

rather than the

> terms.

Maybe you can help me understand better

where this urge comes from to denigrate

the study of words. You seem to have a

clear cut sense of a dichotomy existing

between words and action. If words are

so meaningless, why do you think that

there are Daoist texts? The superficial

reading of Daoist paradoxes that concludes

that words are valueless overlooks the

fundamental fact that the texts which

are thus construed are composed of words.

There is a great gong1 fu3 involved in

the study of words, particularly Chinese

words. Yin1 and yang2 are words. They

are symbols that connect us with a whole

realm of ideas. In my experience there is

no contradiction or conflict between the

study of words and the study of yin1 and

yang2, i.e. the cultivation of qi4. These

things are mutually beneficial.

But as I've noted in the past there is

a definite theme of denigration of the

nomenclature in the academic establishment,

and I see this reflected in your comment.

Can you help me to better understand?

>

> A topic may include an extensive discussion of disharmony of Ying

Qi and Wei

> Qi beyond the conversations in the Shang Han Lun which are

relatively

> minimal. There is tremendous clinical value in the Nei Jing

regarding these

> matters - any opinions?

Before I get to my opinion about notions you

mention in these two texts, I want to point out

that we're squarely in the realm of medical

philosophy here. My opinion is that Chinese

medical lore, both literary and that which

has been principally transmitted through

oral teachings that may not have been committed

to paper, should be considered as an aggregation

of data, information, knowledge, and wisdom.

Later writers often comment on earlier, and

as pointed out by Lin Yu Tang, the whole

industry of Chinese classical literature,

of which the medical literature is an example,

depends extensively on allusion and suggestion.

It is the job of readers to be broadly

versed enough to be able to perceive and

ascertain differences, just like the ones

that you're inquiring about. I'm forced to

wonder here what Bob and Alon would think

of such an enterprise? And how do you

equate your concern of the the comparison

between these two texts and the notion

that there is no correlation between

scholarship and medicine? And how does

all this fit into your work as a Dean?

I think this area provides a discussion of the

> nuances which arrive at clinically useful and verifiable

outcomes.

I agree. And I think we should have

this discussion. Can we continue with a

clarification from you of where you

concerns lie?

Do you want to discuss it in order to

demonstrate that such discussions are pointless

and do not belong in the realm of clinicians?

Ken

March 14, 2002

Will,

I have a lot of trouble understanding this post.

I've raised a few questions below, but in general

it seems to me that I'm missing an understanding

of a great many of the terms you're using.

> Here is a post from the pulsediagnosis list discussing Ying Qi. I

think it

> demonstrates practical discussion of this type of Qi and it's flow.

Let me

> know if it is too fragmented with assumptions of previous discourse

and I'll

> fill in the gaps.

>

> I also find the three circuits considered as macro units a useful

model. I

> think it was Yoshio Manaka who coined the term circuit very early

on, correct

> me on this if I am wrong.

>

> These frontal, sagital and posterior planes are especially useful

for

> creating treatments that are confluent and focused.

Here, for example. What does it mean for a treatment

to be confluent and focused?

This also places reality

> into a simpler picture with three pieces.

Simpler than what?

So the question might be does the

> pathology exist within the circuit or between the circuits?

Huh?

Aren't all the circuits sub-circuits of one

circuit? Are you looking for a restatement

of pattern differentiation?

>

> I find the two-hour movement from channel to channel a useful as a

reminder

> of the influence of heaven on humans. The shifting of the sun along

along the

> ecliptic from sector to sector matches perfectly the movement of

Ying Qi in

> the channels.

I think I follow this and that it reflects the

application of the same theoretical model to

the former as to the latter. But, just to

be sure, what precisely do you mean by the

phrase " movement of Ying Qi in the channels? "

The character for Ying contains two fire radicals implying a

> relation to the heart and to the sun. The lower part of the

character

> contains the water radical showing the influence of the heart or

the sun into

> the movement within our vessels.

Now I'm really confused. You are talking about

ying2, the complement of wei4? I have never

seen or heard anyone refer to the lower part

of this character as the water radical.

The meaning of the character as it is normally

given is a representation of the idea of troops

camped down by their fires. It is one of the

many metaphors in medical nomenclature that

invokes the whole strategic mode of thinking

that was so highly developed and valued among

martial artists and military writers in ancient

China. The correlation between ying2 and wei4

characterizes these two aspects of qi4 as

the substantive or constructive, i.e. the

troops hunkered down and ready for action;

and the guards, the wei4 qi4, alert on

the perimeter to ward off evil or xie2.

>

> Those who are trained in Shen-Hammer use the lifting method for

analysis of

> the Blood depth. According to my research, the pressing method at

the same

> depth will reveal the status of the Ying Qi and the Sea of Grains.

Herbs with

> influence on the Ying Qi include Bai Shao, Gui Zhi, Chuan Xiong,

and Huang

> Jing.

I'm not sure I follow this. But it seems

like something that is better demonstrated

than described. Perhaps the next time I'm

in your neighborhood, I'll drop by and you

can show me what you mean.

>

> Acupuncture treatments may involve the circuits as we have been

discussing,

> the depth of needling, and the process of the physiological

generation of

> Ying Qi. This is evaluated on the right wrist, comparing the

strength of each

> position to determine whether the Zong Qi, the Gu Qi, or the Yuan

Qi are the

> weakest link in the process. Then tonify.

>

I take this last bit to be a confirmation

of the very broad assertion that knowing

about qi4 benefits clinical interventions.

And this I certainly agree with.

Ken

March 14, 2002

Z'ev,

Dualism serves a purpose - existence;-)

You are arguing for what has the potential to be policy generating

discourse based on mere personal experience. I am quite certain there

are others who have similar experiences. However, lingering on

linguistic and etymological considerations is clearly not the province

of many a successful practitioner. Scholarship andpractice are not

absolutely linked. I happen to enjoy scholarship - it fulfills me and

enriches me. I have friends who are extraordinary practitioners with

profound results who have no such interest. As I have stated previously

let those who have such interest do it. As for your statement " If a

practitioner doesn'tknow that there are different ways to supplement or

drain, " I agree with this - it is a different issue than extended

philisophical discourse upon a single term.

Throughout the long diatribes on these topics, there has been precious

little material of clinical value. Let's see it expressed. Give me

something I can sink my teeth into, apply clinically and evaluate.

Will

> Will,

> I beg to differ. I have a full-time practice and am a professor

> teaching Chinese internal medicine. I take much time studying the

> nuances of Chinese medical terminology. It improves my work, and

> helps me walk my talk. The separation between scholarship and

> practice, again, as Ken, myself, and others have said, is artificial

> and dualistic. They have always informed each other. Reductionism of

> Chinese medical concepts serves no purpose. If a practitioner doesn't

> know that there are different ways to supplement or drain, different

> nuances of subtlety, how will that reflect in their ability to

> prescribe herbal medicine?

March 14, 2002

The only problem with this statement is the section: "a successful treatment that could have only been accomplished by one with this special knowledge." Many pathways can lead to similar cures; not becausethey are equal but because the body's own intelleigence manages them. But there are also many cases where a more experienced physician is able to successfully treat someone by using a specialized knowledge

>>>Miriam Lee used say it just having pure clear intension. What do we do with that'

Alon

March 14, 2002

The separation between scholarship and practice, again, as Ken, myself, and others have said, is artificial and dualistic

>>>I think Bob had write it personal. What seems to add to your understanding and insight may be a waste of time for me

Alon

March 14, 2002

Ying Qi

>>>Just one thought on Ying. I have been looking at neural trophic factor dysfunctions and comparing them to Ying Qi as anybody looked at it and have more information

ALon

March 14, 2002

, " jramholz " <jramholz> wrote:

Long ago, Ted Kaptchuk told a case history

> about one of his favorite physicians, Sun si-miao. The gist of the

> story is that a woman was seen by everyone else in town and had been

> treated with acupuncture and herbs, but without success. Sun's

> specialized knowledge of the pulses (she had a wiry movement from

> the GB going to the heart, and a knotting movement in the spleen)

> allowed him to cure her because he recognized that the root of the

> problem was emotional and not physical.

Jim

with all due respect, I don't think Alon, myself or Bob are looking

for a legendary anecdote from the tang dynasty to clarify this matter.

In addition, what Sun is using is skillfull pulsetaking, not an

application of arcane philosophy to achieve his goal.

In the latter half of the 11th century in China,

> physicians using 5-Phases and 6-Qi were able to cure patients that

> the palace physicians were not.

Again, not abstract philosophy, but medical concepts from the nei

jing. And how do we know they were reporting truthfully, not just

self aggrandizing

This system attained official

> acceptance because of its innovation and greater success.

did it? It hasn't seemed to stand the test of time.

Many other

> esoteric philosophical perspectives---I Ching, Daoist canon, etc.---

> also generate treatment strategies.

Any theory can generate a strategy. the question is why do some

theories have a long mainstream lifespan and others merely fill the

dustbins of history. Some may argue politics or conspiracy or

communism, but IMO, all systems of thought evolve. everything in the

manifest universe evolves. Whatever role these temporal factors play

in the unfolding of the tao, it all merely is part of the evolutionary

process. If something has adaptive cultural value, it will survive

and flourish. Whatever the value of the more arcane ideas you

espouse, they never hit it big in china because other concepts were

probably more effective. that doesn't mean the ideas you espouse

might not have their day in the sun yet. I mean mammals were an

evolutionary deadend till the comet killed all the dinosaurs.

Personally, I have not found TCM lacking in the slightest. My

education fortunately occurred during an era where there was an

explosion of books being written and translated on TCM. I think the

esoteric bent of the previous generation has a lot to do with the fact

that all you had was essentials, thus the impetus to look elsewhere

for guidance. I never looked elsewhere because I saw no need. I use

my simplistic TCM diagnosis and write my crude formulas and my

patients get better. that's enough for me. I also used to be very

interested in the spiritual and the esoteric, but now I find myself

bored with these topics. So the likelihood that my future will

involve explorations in this area seems very slim.

March 14, 2002

> with all due respect, I don't think Alon, myself or Bob are looking

> for a legendary anecdote from the tang dynasty to clarify this

matter.

> In addition, what Sun is using is skillfull pulsetaking, not an

> application of arcane philosophy to achieve his goal.

How does the the word arcane come into

play here? Why is it that the word

philosophy evokes this response?

I've never said anyone has to get

lost in the mists of arcane mysticism.

That's not my position.

You do recognize that Sun Si Miao

was an alchemist, a philsopher, a

sexologist, as well as a physician,

writer and scholar? I believe what

he has come to represent as a " god

of medicine " in Chinese culture is

the embodiment of various ideals.

Can you distinguish between his

arcane philosophy and his skillful

pulsetaking? If the answer is yes,

how? If the answer is no, then what

are you saying?

>

> In the latter half of the 11th century in China,

> > physicians using 5-Phases and 6-Qi were able to cure patients

that

> > the palace physicians were not.

>

> Again, not abstract philosophy, but medical concepts from the nei

> jing.

So you would include the Nei Jing

among the sound, practical medical

authority with which students and

practitioners should be familiar?

Why?

Many consider it a book of arcane

philosophical suppositions.

What do you make of the early chapters?

Why do they begin with a treatise on

harmony with the seasons and concern

highly philosophical notions?

Should these be read? Studied?

Applied to clinical education and

practice?

Should we pick and choose parts of

the Nei Jing? If so, which should we

keep and which should we ignore?

>

> Any theory can generate a strategy. the question is why do some

> theories have a long mainstream lifespan and others merely fill the

> dustbins of history.

What is your position on the need to

understand yin1 yang2 theory? Do you

believe like Bob has stated that one

needs to know little to nothing about

it in order to use it?

Should it be studied? Should it be

studied just precisely to the extent

of what is taught in CM 101, as Alon

seems to suggest? Or shall it be cast

into the dustbins of history?

I never looked elsewhere because I saw no need. I use

> my simplistic TCM diagnosis and write my crude formulas and my

> patients get better. that's enough for me. I also used to be very

> interested in the spiritual and the esoteric, but now I find myself

> bored with these topics. So the likelihood that my future will

> involve explorations in this area seems very slim.

I'm not really sure what you're saying here.

You never looked elsewhere as you saw no need

yet you used to be very interested and are

now bored. When you were interested did you

" look elsewhere? " What did you do with your

interest when you had it?

Personally, my own study of Chinese philosophy

has tended to simplify over the years. But it's

taken a good deal of study and practice to

begin to observe this in myself.

Again, I'm not offering my own experience up

as a model for anyone else. As I've said, it's

a highly personal matter when all is said and

done. But I remain fascinated by the strident

voices raised against the idea that people

should have a better understanding of these

issues. And I'm particularly interested in

the way that people who deny the efficacy of

philosophical concepts turn around and employ

them in the course of their own arguments, branding

philsophy with various adjectives (arcane,

abstract, irrelevant, etc.) when, as far as

I can tell, the limits of their own understanding

have been reached.

Ken

March 14, 2002