white glue like phlegm?

[Guest guest]

Jason,

 

, " " <@h...>

wrote:

 

>

>

> To elaborate on this topic, I just translated a case study and the

> patient had chonic bronchitis and pulmonary emphasema with WHITE GLUE

> like phlegm. Here are the herbs : Ban xia 9, hou po 4.5,

> fu ling 12, su zi 9, laifuzi9, tinglizi9, ma hung4.5, xing ren 9,

> gan cao 4.5. You decide on the Dx....

 

 

looks like a heat clearing formula to me. :-)

 

just kidding. was this a modern case study or from another era?

 

I am curious what others have learned or how they practice. Would one

consider this type of phlegm to typically be heat

 

a) sometimes

b) always

c) never

 

does it actually depend on the other s/s?

 

[Guest guest]

Let's back up a second. The question I believe revolves from Bob Damone's l=

ecture is

that the white glue like phlegm means it is a Heat condition. Certainly the=

 

prescription sees it mainly as Cold condition. But wait there is tinglizi a=

s a very cold

herb and for heat. Is this the herb used instead of say Huang Qin that I wo=

uld be

tempted to thrown in because it is a chronic condition of phlegm.

The chronic Bronchitis, unless loosely applied would suggest a heat. Where =

elements

lead us to the bronchitis diagnosis? Are those the signs and symptoms not

mentioned?

 

 from (http://www.hyperdictionary.com/dictionary/bronchitis)

Webster's 1913 Dictionary

Definition:

\Bron*chi " tis\, n. [bronchus + -itis.] (Med.)

Inflammation, acute or chronic, of the bronchial tubes or any

part of them.

Medical Dictionary

Definition:

Inflammation (swelling and reddening) of the bronchi.

 

So it's interesting to go from symptoms to herbs... Is this a case where " o=

fficially " it's

got a heat diagnosis but most of the herbs are for cold? (We've all done it=

, admit it.)

 

In answer to Todd's question I would consider this as lung heat creating a =

cold

phlegm. HA! ;-)

doug

 

 

 

> , " " <@h...=

>

> wrote:

>

> >

> >

> > To elaborate on this topic, I just translated a case study and the

> > patient had chonic bronchitis and pulmonary emphasema with WHITE GLUE

> > like phlegm. Here are the herbs : Ban xia 9, hou po 4.5,

> > fu ling 12, su zi 9, laifuzi9, tinglizi9, ma hung4.5, xing ren 9,

> > gan cao 4.5. You decide on the Dx....

>

>

> looks like a heat clearing formula to me. :-)

>

> just kidding. was this a modern case study or from another era?

>

> I am curious what others have learned or how they practice. Would one

> consider this type of phlegm to typically be heat

>

> a) sometimes

> b) always

> c) never

>

> does it actually depend on the other s/s?

>

 

[Guest guest]

At 3:36 AM +0000 11/3/03, wrote:

>To elaborate on this topic, I just translated a case study and the

>patient had chonic bronchitis and pulmonary emphasema with WHITE GLUE

>like phlegm. Here are the herbs : Ban xia 9, hou po 4.5,

>fu ling 12, su zi 9, laifuzi9, tinglizi9, ma huáng4.5, xing ren 9,

>gan cao 4.5. You decide on the Dx....

--

Good Lord! I was off-line fro about 36 hours and there were about 200

hundred new messages on this list. Same old subjects mostly though.

 

So thanks Jason, and to Todd for separating the clear from the turbid.

 

To start with, neither emphysema nor bronchitis are CM diseases, so

we can only work by inference to arrive at a CM diagnosis, and base

it mostly on the herbs. My diagnosis is:

 

Lung distention with accumulation of turbid phlegm in the lung.

 

The background here is likely to be deficiency and damage to the lung

caused by long term repeated lung illnesses. The repletion syndrome

is due an acute episode of one of the repeated illnesses typical in

patients with lung distention/emphysema.

 

Rory

--

 

 

[Guest guest]

Hi list...

 

Maybe way out but my " impression " cold constitution but complication with

localised heat in lungs not due to heat per say but due to long term

(chronic disease and dis-ease)

 

The Earth Spleen stomach by " now " is probably also affected?

 

Rory I like your diagnoses is it more about it in Wiseman and Fengs

dictionary?

 

Rory and Jason and whom ever...

would you mind posting a case history where you diagnose lung distension

with phlegm turbity?

 

I sincerely appreciate these postings too...

 

And Jason what was your diagnoses and what did they say in the article?

 

Marco

 

 

-

" Rory Kerr " <rory.kerr

 

Tuesday, November 04, 2003 8:08 AM

Re: white glue like phlegm?

 

 

> At 3:36 AM +0000 11/3/03, wrote:

> >To elaborate on this topic, I just translated a case study and the

> >patient had chonic bronchitis and pulmonary emphasema with WHITE GLUE

> >like phlegm. Here are the herbs : Ban xia 9, hou po 4.5,

> >fu ling 12, su zi 9, laifuzi9, tinglizi9, ma huáng4.5, xing ren 9,

> >gan cao 4.5. You decide on the Dx....

> --

> Good Lord! I was off-line fro about 36 hours and there were about 200

> hundred new messages on this list. Same old subjects mostly though.

>

> So thanks Jason, and to Todd for separating the clear from the turbid.

>

> To start with, neither emphysema nor bronchitis are CM diseases, so

> we can only work by inference to arrive at a CM diagnosis, and base

> it mostly on the herbs. My diagnosis is:

>

> Lung distention with accumulation of turbid phlegm in the lung.

>

> The background here is likely to be deficiency and damage to the lung

> caused by long term repeated lung illnesses. The repletion syndrome

> is due an acute episode of one of the repeated illnesses typical in

> patients with lung distention/emphysema.

>

> Rory

> --

>

>

[Guest guest]

, " "

wrote:

> Let's back up a second. The question I believe revolves from Bob

Damone's l=

> ecture is

> that the white glue like phlegm means it is a Heat condition.

Certainly the=

>

> prescription sees it mainly as Cold condition. But wait there is

tinglizi a=

> s a very cold

> herb and for heat. Is this the herb used instead of say Huang Qin

that I wo=

> uld be

> tempted to thrown in because it is a chronic condition of phlegm.

 

I doubt that this assumption is correct... meaning there is not

heat! Just b/c one has a cold herb in the formula does not mean

there is heat. Why tinglizi? you have to ask... IMO, it is because

it downbears the qi for blocked lung qi, especially with herbs like

ban xia, su zi etc.. It also balances the other warm other herbs...

It also probobly was picked because of its ability to drain phlegm

out through the urine. If there was heat it would be a cold formula.

THis is not. The formula is more about the dynamic of blocked lung

qi.

 

> The chronic Bronchitis, unless loosely applied would suggest a

heat.

 

Diasagree...

 

Where =

> elements

> lead us to the bronchitis diagnosis? Are those the signs and

symptoms not

> mentioned?

 

YEs...

 

>

>  from (http://www.hyperdictionary.com/dictionary/bronchitis)

> Webster's 1913 Dictionary

> Definition:

> \Bron*chi " tis\, n. [bronchus + -itis.] (Med.)

> Inflammation, acute or chronic, of the bronchial tubes or any

> part of them.

> Medical Dictionary

> Definition:

> Inflammation (swelling and reddening) of the bronchi.

>

> So it's interesting to go from symptoms to herbs... Is this a case

where " o=

> fficially " it's

> got a heat diagnosis but most of the herbs are for cold? (We've all

done it=

> , admit it.)

 

Unclear what you are getting at.

>

> In answer to Todd's question I would consider this as lung heat

creating a =

> cold

> phlegm. HA! ;-)

> doug

>  

 

Where is this from? I have never come across this...

 

-

[Guest guest]

, Rory Kerr <rory.kerr@w...>

wrote:

> At 3:36 AM +0000 11/3/03, wrote:

> >To elaborate on this topic, I just translated a case study and the

> >patient had chonic bronchitis and pulmonary emphasema with WHITE

GLUE

> >like phlegm. Here are the herbs : Ban xia 9, hou po 4.5,

> >fu ling 12, su zi 9, laifuzi9, tinglizi9, ma huáng4.5, xing ren 9,

> >gan cao 4.5. You decide on the Dx....

> --

> Good Lord! I was off-line fro about 36 hours and there were about

200

> hundred new messages on this list. Same old subjects mostly though.

>

> So thanks Jason, and to Todd for separating the clear from the

turbid.

>

> To start with, neither emphysema nor bronchitis are CM diseases, so

> we can only work by inference to arrive at a CM diagnosis, and base

> it mostly on the herbs. My diagnosis is:

>

> Lung distention with accumulation of turbid phlegm in the lung.

>

> The background here is likely to be deficiency and damage to the

lung

> caused by long term repeated lung illnesses. The repletion syndrome

> is due an acute episode of one of the repeated illnesses typical in

> patients with lung distention/emphysema.

>

> Rory

>

- The case study is from a modern book, and the inclusion of

modern western dx I would assume that it is a modern case study...

never know though...

 

Rory & others - Like it or not, modern TCM loves to mix information

like emphysema, bronchitis, Staph, etc into there case studies ,

textbooks, discussion etc... This IMO, is TCM as it is in much of

China. This information is extremely valuable and should not be poo

pooed... I find too often westerners are only comfortable with

patterns and classical diseases like running piglet. But the disease

(modern or classical) gives us an extreme amount of information,

especially about the progression of the disease. Patterns alone give

us very little info on the progression! Students think about the

disease not often enough. I have noticed that the Chinese

information does not just say Chronic Bronchitis, but also gives TCM

information. This is integration, and I personally think it rocks.

They often include modern lab tests in case studies, and I think this

rocks... Even inclusion of the patients temp is a modern discovery

and this also gives us incredible amount of information... So rory,

you are right that we cannot base a dx only on the diseases mentioned

above, and that was the point! we can only base the dx on the herbs.

The question was answered IMO, that glue like white phlegm does not

have to mean heat, and this is demonstrated by the herbs...

 

-

[Guest guest]

Jason:

Like it or not, modern TCM loves to mix information

> like emphysema, bronchitis, Staph, etc into there case studies ,

> textbooks, discussion etc... This IMO, is TCM as it is in much of

> China. This information is extremely valuable and should not be poo

> pooed...

 

Marco:

 

Agree, the challenge is yet again how to interpret and make use of such

valuable information...

 

Jason:

I find too often westerners are only comfortable with

> patterns and classical diseases like running piglet.

 

Marco:

 

really?

 

I am surprised and confuse I found that maybe certain pattern as zang fu is

well fleshed out but you guy's start talking about phlegm turbidity and lung

distension finally we are getting somewhere...

 

Then the crux of the matter is to " superimpose " this onto western medical

knowledge and extract the clear from the turbid which depends not just on

the information but the interpret (beauty is in the eye of the beholder,

what is more I tend to say we are detectives and as such need to learn how

to untangle the mysteries that the body and life has...)

 

i.e. I tend to try to say lets see the body and the world around it as

transparent sheets that can be separated and connected...

and always there:

 

" one sheet " - the western concept and diagnoses

" two sheet " - The CM concept(s) and diagnose(ies)

 

Jason:

I would be really interested in how you Jason and others make use of western

medical information (the time factor you mention and so forth)

 

It is a great new thread!!!!

 

 

 

Jason:

But the disease

> (modern or classical) gives us an extreme amount of information,

> especially about the progression of the disease.

 

Marco:

 

new thread please!

 

Jason:

Patterns alone give

> us very little info on the progression! Students think about the

> disease not often enough. I have noticed that the Chinese

> information does not just say Chronic Bronchitis, but also gives TCM

> information. This is integration, and I personally think it rocks.

 

Marco:

 

Jason come to Guatemala we need rock and roll...

 

Jason:

> They often include modern lab tests in case studies, and I think this

> rocks... Even inclusion of the patients temp is a modern discovery

> and this also gives us incredible amount of information...

 

Marco:

 

Will have to go for now but this then is truly new thread where one can

contemplate various diagnosis and make various " correspondences " and various

associations(and that which does not fit these two

categorization/clasification) and meanwhile the language to communicate this

would be developing...

 

It is well worth a master and a Ph.d. theses Rey did you not do a master

thesis on this very topic one I would love to read!!!

 

 

Marco

[Guest guest]

, " " wrote:

But wait there is tinglizi a=

> s a very cold

> herb and for heat. Is this the herb used instead of say Huang Qin that I wo=

> uld be

> tempted to thrown in because it is a chronic condition of phlegm.

 

good point. I also often solely use huang qin in an otherwise heat warming

formula like er chen wan. But usually the phlegm is not so gluey in these

cases or I would add gua lou pi, maybe even delete ban xia depending on

tongue coat. Was this given?.

 

[Guest guest]

I am curious what others have learned or how they practice. Would one

consider this type of phlegm to typically be heat

 

a) sometimes

b) always

c) never

>>>>>Always dependent on other symptoms and signs

alon

 

 

[Guest guest]

, " " <@h...>

wrote:

 

>

> I doubt that this assumption is correct... meaning there is not

> heat! Just b/c one has a cold herb in the formula does not mean

> there is heat. Why tinglizi?

 

Jason

 

Its really impossible to say. As I said if heat is mild or brewing, I may use

only one clear heat herb as my teacher would. So ting li zi may be there for

the reasons you state or those Doug state. And I should clarify that Damone

meant that white thick phlegm was heat, but less heat than yellow phlegm, so

perhaps only a single cool herbs is called for. I guess this is a modern case

study - silly of me to ask. But it does illustrate the pitfalls of analyzing

cases

in this fashion. Same with Damone'c classical cases. If the doctor himself

doesn't explain things, its pretty much MSU. All we can have are competing

and possibly contradictory explanations of equal weight, IMO. It is worthwhile

intellectual exercise, but we can hardly say one is right or wrong.

 

for ex, the phlegm heat clearing formula wen dan tang has no signifcant heat

clearing function, zhu ru being much milder than huang qin or ting li zi

 

or bensky's modification for er chen with damp heat in the middle adds only

one herb of signficant heat clearing, huang lian. the other, yi yi ren, is not

a

powerful herb, definitely more for damp than heat. plus two other warming

herbs are also added, huo xiang and hou po.

 

I think it is incorrect to say that just because only a single cold herb is in a

formula that the author was not thinking that heat was present, but for some

other reason. It could go either way and I bet case studies show both.

 

[Guest guest]

, " " <@h...>

wrote:

 

> The question was answered IMO, that glue like white phlegm does not

> have to mean heat, and this is demonstrated by the herbs...

 

 

again, I believe you have overstated your case and would like senior

practitioners to chime in this matter.

 

[Guest guest]

Phlegm and excretions are almost never the main deciding factor if a condition

is def/ex, hot/cold

alon

 

 

[Guest guest]

This information is extremely valuable and should not be poo

pooed... I find too often westerners are only comfortable with

patterns and classical diseases like running piglet. But the disease

(modern or classical) gives us an extreme amount of information,

especially about the progression of the disease. Patterns alone give

us very little info on the progression! Students think about the

disease not often enough. I have noticed that the Chinese

information does not just say Chronic Bronchitis, but also gives TCM

information. This is integration, and I personally think it rocks.

>>>This is the only way to practice safe medicine, like or not.

alon

 

 

[Guest guest]

So rory,

you are right that we cannot base a dx only on the diseases mentioned

above, and that was the point! we can only base the dx on the herbs.

The question was answered IMO, that glue like white phlegm does not

have to mean heat, and this is demonstrated by the herbs...

 

>>>>Again based on if somebody has active arthritis or arthrosis one can already

know 60% of what will be done for the patient. Truly understanding WM and its

presentations can more often than not be immediately translated into tcm.

However, this must not be taken as the sole information and TCM logics and

additional information should be integrated within each case. The problem is

that often only a cursory or partial WM dx is given. So for example one can not

know how to treat rheumatoid arthritis, but if it is in an active stage than 60%

of the information is there.

alon

alon

 

 

[Guest guest]

good point. I also often solely use huang qin in an otherwise heat warming

formula like er chen wan. But usually the phlegm is not so gluey in these

cases or I would add gua lou pi, maybe even delete ban xia depending on

tongue coat. Was this given?.

 

>>>>Todd even adding gua lou pi would not make it heat phlegm, one can use it

for damp-turbid-phlegm, -cold-qi stagnation that results in difficult phlegm and

then even with xi xin and gon jian

alon

 

 

[Guest guest]

I would be really interested in how you Jason and others make use of western

medical information (the time factor you mention and so forth)

 

It is a great new thread!!!!

 

>>>Much more to come on this on my next book'

alon

 

 

[Guest guest]

, " Alon Marcus " <

alonmarcus@w...> wrote:

 

> >>>>Todd even adding gua lou pi would not make it heat phlegm, one can use

it for damp-turbid-phlegm, -cold-qi stagnation that results in difficult phlegm

and then even with xi xin and gon jian

 

 

that case is clearly one of " not enough info " to make any valid conclusion

 

I wonder what standard government manuals such as those done in the PRC

every few years says on this matter. that is what I was referring to, though

perhaps that was not clear. You can always find idiosyncratic cases. I am now

curious about the official standard of the PRC on glue like white phlegm. I am

pretty sure that is what Bob Damone was talking about, too.

 

What do Clavey or Deng say on this matter?

 

Bob Flaws?

 

 

[Guest guest]

I think it is incorrect to say that just because only a single cold herb is in a

formula that the author was not thinking that heat was present, but for some

other reason. It could go either way and I bet case studies show both.

>>>Todd as i also said in the past in one the hospital formulas i worked in

huang qin was added to a drying and warming formula to so-called protect Yin

Alon

 

 

[Guest guest]

The question was answered IMO, that glue like white phlegm does not

> have to mean heat, and this is demonstrated by the herbs...

>>>>Todd i have heard for example the same teacher Bob studies with in china (we

studied with the same person) say that old phlegm even if green (not yellow)

does not have to mean heat. For example, often morning phlegm is green when the

rest of the day the phlegm may be while or even clear. He used to say that this

is not nessuseraly evidence of heat.

Alon

 

 

[Guest guest]

, " Alon Marcus " <

alonmarcus@w...> wrote:

For example, often morning phlegm is green when the rest of the day the

phlegm may be while or even clear. He used to say that this is not nessuseraly

evidence of heat.

 

 

All this is well and good. Does anybody have an authoritative chinese citation

on this matter or conflicting citations? All we have done so far is share

anecdotes and try and reverse-engineer formulas. That does not really prove

anything.

 

[Guest guest]

I wonder what standard government manuals such as those done in the PRC

every few years says on this matter. that is what I was referring to, though

perhaps that was not clear. You can always find idiosyncratic cases. I am now

curious about the official standard of the PRC on glue like white phlegm. I am

pretty sure that is what Bob Damone was talking about, too.

>>>>And that is the problem of trying to speak of CM as standards you loose what

CM as and is. Its nice as far as students basics but as far as learning the art

of CM. If you are to teach a deeper level of practice its the gray areas that

must be explored or by Zev words the case histories

Alon

 

 

[Guest guest]

> >>>Much more to come on this on my next book'

Yet another book on the hit list!

Looking foward to it being avaliable when is due to be in print?

Marco

[Guest guest]

All this is well and good. Does anybody have an authoritative chinese citation

on this matter or conflicting citations? All we have done so far is share

anecdotes and try and reverse-engineer formulas. That does not really prove

anything.

 

>>>>Are we trying to prove anything Todd? The need for authoritative conclusions

goes against what CM has been. We may what to change this, and i think TCM is a

good attempt, but we will never have authoritative answers to questions that

many have had different opinions on

alon

 

 

[Guest guest]

At 2:57 PM +0000 11/4/03, wrote:

>Like it or not, modern TCM loves to mix information

>like emphysema, bronchitis, Staph, etc into there case studies ,

>textbooks, discussion etc... This IMO, is TCM as it is in much of

>China. This information is extremely valuable and should not be poo

>pooed... I find too often westerners are only comfortable with

>patterns and classical diseases like running piglet. But the disease

>(modern or classical) gives us an extreme amount of information,

>especially about the progression of the disease. Patterns alone give

>us very little info on the progression!

--

Jason,

 

You'll note that I included the Chinese medicine disease in my

diagnosis: lung distention. This is not exactly equivalent to the WM

disease emphysema, just close enough when playing an on-line guess

the Dx game.

 

It is much better to get the Chinese disease/bing before deciding on

the pattern. Often the WM disease is also helpful in filling out

knowledge of what is going on, and in talking to the patient in a way

that they and their WM doctor can understand, an important part of

practice IMO. However, deciding the CM disease is a much more

important part of the diagnostic process than knowing the WM Dx.

Knowing the CM disease allows you understand the cause, location and

pathogenesis in terms of CM theory, which the WM Dx cannot give you.

With only WM Dx you are left jumping between paradigms that are at

their very best only tangentially consistent in describing the same

phenomena, and often leaves you not knowing quite where to beach your

boat in the " vast conceptual gulf " (nod to Wainwright).

 

In other words, I believe that to practice skillful integrated

medicine does not mean that you have to integrate the medicines. When

TCM books and articles are organized according to WM disease, it is

simply a matter of convenience for practice in an integrated setting,

such as a Chinese hospital. That is not to say that we have no need

to understand and use CM bing.

 

End of sermon.

 

BTW, would you mind giving us the whole case?

 

Rory

 

 

 

 

 

--

 

 

 

[Guest guest]

At 3:52 PM +0000 11/4/03, wrote:

> , " " <@h...>

>wrote:

>

>> The question was answered IMO, that glue like white phlegm does not

>> have to mean heat, and this is demonstrated by the herbs...

>

>

>again, I believe you have overstated your case and would like senior

>practitioners to chime in this matter.

--

 

 

I have enough grey hair to allow myself to labelled senior on this occasion.

 

I agree with you that Jason may have overstated his case a bit (but

then, he has the original case study). My approach to this is that I

want to see evidence of heat, such as irritability, before I make

that part of my Dx. The Dx of turbid phlegm accounts for the

information that we were given. Of course, in the case of an acute

illness (bronchitis), it is entirely possible that there would be

heat, even if the chronic condition is cold.

 

Rory

--