white glue like phlegm?

[Guest guest]

The way I see it, that bronchitis has to have inflammation to be a correct

diagnosis.

As far as know this means there has to be a heat element. Given the original

parameters of the case, unless the Western term was misapplied (very possible),

this

is a heat condition.

doug

 

> 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

> --

>

>

>

[Guest guest]

At 8:48 PM +0000 11/4/03, wrote:

>The way I see it, that bronchitis has to have inflammation to be a

>correct diagnosis.

>As far as know this means there has to be a heat element. Given the original

>parameters of the case, unless the Western term was misapplied (very

>possible), this is a heat condition.

--

 

Doug,

 

I don't think you can make that generalization between WM

inflammation and CM heat, and in particular both acute and chronic

bronchitis include non-heat patterns.

 

Rory

 

--

 

 

 

[Guest guest]

The way I see it, that bronchitis has to have inflammation to be a correct

diagnosis.

As far as know this means there has to be a heat element. Given the original

parameters of the case, unless the Western term was misapplied (very possible),

this

is a heat condition.

>>>You have to be careful here. Often things are label as itis even without

inflammation. For example, epicondylitis is often due to tendinosis and not

tendinitis. There are no signs of Heat or inflammation, yet still many MDs will

label it a tendinitis or epicondylitis. Just like in CM WM terms can be misused

alon

 

 

[Guest guest]

, " "

wrote:

> , " "

<@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.

 

 

I do think it is possible to say: a) how many times have you seen

tinglizi as a modification for lung heat (to clear heat?) I have

never seen it like this, I see huangqin, zhi zi, zhi mu, lug en etc.

b) I do not think with an overwhelming warm formula that just because

one herb is cold that it means there is heat… How many times do you

read that herbs counteract or balance out the temperatures of the

other herbs to a neutral ground… Why wouldn't it happen here? Why

would this lone tinglizi clear heat… that is a puzzle. More

importantly we should ask why tinglizi..? why not huang qin, I think

it is purely for its descending action etc.

 

 

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.

 

Well the doctor does explain himself and he clearly shows there is no

heat, with the herbs (IMO) and with the Dx. Of lung losing its

depurative and downbearing ability, phlegm and qi counterflwoing

upwards. There are no heat signs in the case….

 

 

All we can have are competing

> and possibly contradictory explanations of equal weight, IMO.

 

Not when the case study does not mention heat…

 

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

 

Yes but look at the wend an tang – It is no where nearly as warm as

the above, and it is debatable how much heat it could really clear.

I.e. Yeung mentions zero signs of heat in his description it is

actually more on the colder side. But I do think the Rx is way

closer to the neutral side (to cooling) than anything else, far

different than the above case study. Also the hear clearing is

taking place in different locations… I think this is more possible

than 1 cold herb for the lung and 1 warm herb for the lung – these

tend to cancel each other out (what do you think?) – Very few Rx's

treat mixed heat and cold patterns – But the majority of rx's are

made up of hot a cold herbs that are performing a certain fuction or

action.. I.e. in this case we have herbs that are know to work

together for a specific purpose and that is why they are there. I

think is it MSU to read into that more that it is.

 

>

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

adds only

> one herb of signficant heat clearing, huang lian.

 

But this is a major herb, and strong, and is know to clear heat even

with others around it like banxia, gan jiang.

\

>

> 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.

 

I disagree for this situation…. It is clear to me that tinglizi is

not added for that reason.

 

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

 

I would like to see a similar case study that shows tinglizi added to

such a warm formula to clear heat. –

 

I would like to here more ideas from you on this…

 

-

 

>

 

[Guest guest]

, " "

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.

>

 

 

How have I overstated the case...??? I am just reporting what the

case study says and the DX says nothing about heat, period. One can

read into as much as one likes, but this is just MSU (in relation to

this case study) - You asked if white thick phlegm has to be heat? I

gave a clear example of where the CM doc says it doesn't... If there

was heat, the dx would have included it, because that would be a very

interesting part of the case... But the point of the case is more

about more congested lung qi, not heat nor cold... The herbs when

viewed in context with the others support this, vs. isolating one

cold herb in the bunch and theorizing... Bob D. may be right, but

this is one example that shows that a CM book/ author thinks

otherwise... My senior pract is the author of the case study, and I

don't need much more than that... You asked, and I gave an answer

that is backed up in the literature… (IMO) This is BTW a mod of

banxiahoupotang, that also says a lot of how they are thinking about

things.

 

-

[Guest guest]

, " "

wrote:

> , " 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

>

 

I agree 100%, it is always about context!

 

>

> 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.

 

Well, the standard....??? You seem too be looking for some black and

white answer, I feel that will never happen. TCM is always about

context and 1 symptom almost never is definitive... This can be 1

point of the case. This also IMO is not some idiosyncratic case. I

have seen many cases that have similar veins, and are representing

practical lessons. Case studies are the real life issues that come

up vs. what the text books says. Textbooks are IMO farther from any

clinical truth than case studies. Just my opinion... So teaching

such black and white statements to students may sometimes be helpful,

but not any truth… For example we once learned that sorethroat in

exterior attacks meant Wind-heat… this is of course not true.

 

-

[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.

>

 

 

Not reverse engineer, look at the formula and read the dx and

understand what is going on, this is very clear to me. And btw this

was from a mainstream formula book (chinese) - Not some crazy

personal doctors case studies.. I.e. The cases were all chosen for

specific reasons.

 

-

[Guest guest]

, " "

wrote:

> The way I see it, that bronchitis has to have inflammation to be a

correct diagnosis.

> As far as know this means there has to be a heat element. Given the

original

> parameters of the case, unless the Western term was misapplied

(very possible), this

> is a heat condition.

 

A) inflamation (internal) does not have to be heat... IMO, this is a

very common mistake. But I agree if something is hot, swollen, red

etc. then it is clearly heat. But this is different

b) IF there is heat, why is it not in the dx? - Your assumptions are

not clear...

c) bronchitis can clearly be multiple patterns and many are not heat,

check the chinese sources...

 

The case is posting in the next msg. - You tell me where the heat is?

 

-

 

 

> doug

>

> > 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

> > --

> >

> >

> >

[Guest guest]

>

>

> 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).

 

Well here it is the case, please show me where I have overstated my

case:

Actually I think If one looks at how tinglizi is written about in the

materia medica and the way it is used in other case studies and

formulas it becomes even more clear that it is not in there to clear

heat from the lung.

 

Li was a 64 year old male who suffered from chronic bronchitis for

many years. HE also had pulmonary emphysema. When the weather turned

cold he would 'catch a cold " He presented with cough and much white

glue-like phlegm. There was panting counterflow and he was unable to

prostrate. Tongue was white and greasy, pulse was thin, wiry, and

slippery. The pattern belonged to the lung losing its depurative and

downbearing ability, phlegm and qi counterflowing upwards. The root

formula (banxiahoupotang) + san zi yang qin tang + sanju(?)tang +

modifications. 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. 3 packs were given and the panting counterflow was

calmed. The cough was gone. He continued to take chen xia liu jun

tang with mods to recuperate until every symptom was relieved.

 

-

[Guest guest]

Jason,

 

First of all, thanks again for posting this case. We need a lot more

of this sort of thing in English.

 

There are always variations in the way the diagnosis is expressed,

and in the exact herbs given, but I believe this case illustrates my

earlier point that knowledge of disease, particularly in serious long

term diseases, is important in getting to the correct pattern and

treatment. Simply doing a pattern differentiation from the symptoms

and signs in such cases can lead to confusion.

 

As to the issue of whether you overstated your case, I've reread the

thread and I don't think you did. You said:

 

At 2:42 PM +0000 11/4/03, 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.

--

Perhaps this was not read the way you intended. As I'm sure we all

know, there are formulas that have only one herb that is cold, the

rest being warm, that are intended to clear heat -- e.g., da qing

long tang, ma xing shi gan tang, in which shi gao is the herb of

choice to clear heat.

 

I agree with you that inclusion of ting li zi does not indicate a

heat case. In downbearing the lung qi, it quickly removes fluid from

the lung, something like a diuretic, yet not so strong as to be

cathartic. This is an somewhat urgent case, so a quick effect is

important.

 

In other words, there are cold herbs that are used to clear heat, and

there are cold herbs that are used for some other function, and not

specifically to clear heat. Shi gao is an example of the former; da

huang and ting li zi are examples of the latter (there are obviously

many other examples). The materia medica categories help show the

difference.

 

Rory

 

 

=========================================

At 7:45 AM +0000 11/5/03, wrote:

>Well here it is the case, please show me where I have overstated my

>case:

>Actually I think If one looks at how tinglizi is written about in the

>materia medica and the way it is used in other case studies and

>formulas it becomes even more clear that it is not in there to clear

>heat from the lung.

>

>Li was a 64 year old male who suffered from chronic bronchitis for

>many years. HE also had pulmonary emphysema. When the weather turned

>cold he would 'catch a cold " He presented with cough and much white

>glue-like phlegm. There was panting counterflow and he was unable to

>prostrate. Tongue was white and greasy, pulse was thin, wiry, and

>slippery. The pattern belonged to the lung losing its depurative and

>downbearing ability, phlegm and qi counterflowing upwards. The root

>formula (banxiahoupotang) + san zi yang qin tang + sanju(?)tang +

>modifications. 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. 3 packs were given and the panting counterflow was

>calmed. The cough was gone. He continued to take chen xia liu jun

>tang with mods to recuperate until every symptom was relieved.

 

 

--

 

 

[Guest guest]

, " " <@h...>

wrote:

You asked if white thick phlegm has to be heat? I

> gave a clear example of where the CM doc says it doesn't... If there

> was heat, the dx would have included it, because that would be a very

> interesting part of the case...

 

where was the DX? I diden't see one given.

 

[Guest guest]

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

wrote:

 

>

> In other words, there are cold herbs that are used to clear heat, and

> there are cold herbs that are used for some other function, and not

> specifically to clear heat. Shi gao is an example of the former; da

> huang and ting li zi are examples of the latter (there are obviously

> many other examples). The materia medica categories help show the

> difference.

>

 

Jason

 

It would have been helpful if you provided t,p and dx fromthe outset. As

given, there was not enough information and the case was overstated in that

light. now with the missing info, it is clearer. but from the herbs alone, the

doc could definitely been thinking brewing heat. I talked with 2 professors

about this (tan tan huang and damone). Damone showed me his reference, but

I didn't get a chance to write it down. Tan tan felt this type of phlegm could

be what he called wan tan - stubborn or persistent phlegm. We could not find

this in wiseman. He said this was sometimes a type of old cold phlegm.

However then he said meng shi and the rx gun tan wan are examples of one

guiding rx for such a case. This is a cold formula, so wan tan could be hot or

cold. Finally we could not between us 3 and 1 other chinese doc identify a

citation to support gluelike phlegm being cold. We only have this one case so

far. The others felt this was not an easily sorted out matter, but cases like

Jasons and formulas like gun tan wan suggest that matter is not b/w. again, I

am not interested in what any doc may have done, but rather the PRC

standard, if there is one. I wonder if the tongue coat is yellow in the

standard

text despite the white phlegm.

 

[Guest guest]

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

wrote:

> Jason,

>

> First of all, thanks again for posting this case. We need a lot

more

> of this sort of thing in English.

 

Don't worry I am working on a book as we speak, translating hundreds

of these case studies to demonstrate various ideas... Hopefully they

will be more polished than what I sent over to CHA last night (sorry

did not have the time to reword it)...

 

>

> There are always variations in the way the diagnosis is expressed,

> and in the exact herbs given, but I believe this case illustrates

my

> earlier point that knowledge of disease, particularly in serious

long

> term diseases, is important in getting to the correct pattern and

> treatment. Simply doing a pattern differentiation from the symptoms

> and signs in such cases can lead to confusion.

>

> As to the issue of whether you overstated your case, I've reread

the

> thread and I don't think you did. You said:

>

> At 2:42 PM +0000 11/4/03, 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.

> --

> Perhaps this was not read the way you intended. As I'm sure we all

> know, there are formulas that have only one herb that is cold, the

> rest being warm, that are intended to clear heat -- e.g., da qing

> long tang, ma xing shi gan tang, in which shi gao is the herb of

> choice to clear heat.

 

Sorry if my words did not come out as I intended.. I thought it was

clear, but that is the problem with the internet and my lack of

ability to sense how others interpret my words...

 

-Jason

[Guest guest]

Reverse engineering, by the way, is a great teaching tool for students

to understand the architecture of prescriptions and how they are

related to patterns. By examining combinations of ingredients in

prescriptions, you can often figure out the disease pattern. A great

exercise.

 

 

On Nov 4, 2003, at 11:28 PM, wrote:

 

> Not reverse engineer, look at the formula and read the dx and

> understand what is going on, this is very clear to me. And btw this

> was from a mainstream formula book (chinese) - Not some crazy

> personal doctors case studies.. I.e. The cases were all chosen for

> specific reasons.

>

> -

[Guest guest]

>where was the DX? I diden't see one given.

It was many many msg.'s ago.. prob got lost in the chaos of

cyberspace..

 

 

> Jason

>

> It would have been helpful if you provided t,p and dx fromthe

outset. As

> given, there was not enough information and the case was overstated

in that

> light. now with the missing info, it is clearer. but from the

herbs alone, the

> doc could definitely been thinking brewing heat.

 

I think with the Dx and herbs, it is clear. I also think that the Rx

alone speaks ... and still don't believe such a Rx would ever be used

to treat heat... You should show just the Rx to tan tan (or others)

and see what they think, I am curious...

 

Why so interested in the PRC standard? The PRC standard, I assume is

for teaching purposes. ANd this seems to be only a guideline to

practice. There are so many things that aren't clinical facts that

are presented as such in any diagnosis book... just curious? I am

not clear also about your request for knowing the tongues coat color

in the original text... (the case study?) if so it was white...

Notice the case study said tongue (and it should be tongue coat-> I

think this was evident from context, but non the less a typo, and one

reason I didn't want to post the whole case earlier... I didn't

proofread for typos yet. And didn¡¦t want to ƒº - Hope that helps...

 

-

 

I talked with 2 professors

> about this (tan tan huang and damone). Damone showed me his

reference, but

> I didn't get a chance to write it down. Tan tan felt this type of

phlegm could

> be what he called wan tan - stubborn or persistent phlegm. We

could not find

> this in wiseman. He said this was sometimes a type of old cold

phlegm.

> However then he said meng shi and the rx gun tan wan are examples

of one

> guiding rx for such a case. This is a cold formula, so wan tan

could be hot or

> cold. Finally we could not between us 3 and 1 other chinese doc

identify a

> citation to support gluelike phlegm being cold. We only have this

one case so

> far. The others felt this was not an easily sorted out matter, but

cases like

> Jasons and formulas like gun tan wan suggest that matter is not

b/w. again, I

> am not interested in what any doc may have done, but rather the PRC

> standard, if there is one. I wonder if the tongue coat is yellow

in the standard

> text despite the white phlegm.

>

 

[Guest guest]

, " " <@h...>

wrote:

 

> I think with the Dx and herbs, it is clear. I also think that the Rx

> alone speaks ... and still don't believe such a Rx would ever be used

> to treat heat...

 

clealry not everyone here agree with you. would you use er chen with huang

to clear heat?

 

You should show just the Rx to tan tan (or others)

> and see what they think, I am curious...

 

 

good idea

 

 

>

> Why so interested in the PRC standard?

 

because schools need standards, not set in stone, but as jumping off points for

professors to debate. PCOM may be convening a committee to get some

institutional consensus on these things.

 

I am

> not clear also about your request for knowing the tongues coat color

> in the original text..

 

I was curious about the tongue coat in the PRC standard. I saw it was white in

your case.

 

[Guest guest]

There are always variations in the way the diagnosis is expressed,

and in the exact herbs given, but I believe this case illustrates my

earlier point that knowledge of disease, particularly in serious long

term diseases, is important in getting to the correct pattern and

treatment. Simply doing a pattern differentiation from the symptoms

and signs in such cases can lead to confusion.

>>>It also illustrates that the quest for simple definitions and mechanism is

not CM

Alon

 

 

[Guest guest]

, " " wrote:

> This is one of the benefits of discussing disease progression as

> presented in the Shang Han Lun. One gets a sense of how diseases

> develop, progress, and change course along the way, and

any 'detours' along the way (transmuted patterns). >>>

 

 

Z'ev:

 

Don't forget the Wen Bing and Suwen (especially chapters 66-73).

They also discuss how diseases develop, progress, and change.

 

 

Jim Ramholz

[Guest guest]

, " "

wrote:

>

> clealry not everyone here agree with you. would you use er chen

with huang

> to clear heat?

>

 

You are right, our opinions differ, that is alright... Would I use a

huang (?) with er chen tang to clear heat.. Clearly I would this is a

totally different situation. Huang (lian) has that action as it

primary role. Er chen tang is also not overwhelmingly hot… it is

drying (for drying phlegm) – the huang lian for clearing heat. Er

chen tang is clearly used in may cases of phlegm-heat. Again the

chenpi and banxia are not about temp but the huanglian is. (IMO) – AS

rory stated, certain herbs are picked for temperature and certain

herbs are picked for actions. I have never seen tinglizi picked to

clear heat for the lung.. I would like to see this somewhere…

 

-

[Guest guest]

Don't worry Jim, I won't forget Just giving an example.

 

 

On Nov 5, 2003, at 8:21 AM, James Ramholz wrote:

 

> , " " wrote:

>> This is one of the benefits of discussing disease progression as

>> presented in the Shang Han Lun. One gets a sense of how diseases

>> develop, progress, and change course along the way, and

> any 'detours' along the way (transmuted patterns). >>>

>

>

> Z'ev:

>

> Don't forget the Wen Bing and Suwen (especially chapters 66-73).

> They also discuss how diseases develop, progress, and change.

>

>

> Jim Ramholz

>

>

>

>

[Guest guest]

, " "

<@h...> wrote:

 

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

> gan cao 4.5. 3 packs were given and the panting counterflow was

> calmed. The cough was gone. He continued to take chen xia liu jun

> tang with mods to recuperate until every symptom was relieved.

>

> -

 

Jason,

 

A careful read of what you wrote may be interesting. The formula that

is presented " calmed " the " panting counterflow " . Also, " the cough was

gone. " However, no mention is made that it actually cleared the

phlegm. It then goes on to say that another formula with mods (not

named) were given until every symptom (including the phlegm, I

suppose) was relieved.

 

Brian C. Allen

[Guest guest]

, " "

<@h...> wrote:

 

The root

> formula (banxiahoupotang) + san zi yang qin tang + sanju(?)tang +

> modifications. 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. 3 packs were given and the panting counterflow was

> calmed. The cough was gone. He continued to take chen xia liu jun

> tang with mods to recuperate until every symptom was relieved.

>

> -

 

thinking maybe the third rx is San Ao Tang (Mahuang, Xingren,

Gancao). Chen Xia Liu Jun Tang is reg'lar ol' Liu Jun Tang, just

stating that the two additions to Si Jun are Chenpi & Banxia?

 

robert hayden