misconceptions persist?

[Guest guest]

, " Bob Flaws "

<pemachophel2001> wrote:

 

> 2. ... See the opening chapters of the Xue Zheng Lun's discussion of the

> relationship between qi and yin fluids.

--

At 7:20 PM +0000 1/7/04, wrote:

>I do not doubt that what you say is in the book you say, but that

>does not make it fact.

--

 

Jason,

 

Well, it is certainly evidence of a fact. It is sufficiently strong

evidence that we can assume that it is a fact unless someone shows

that it is not, ie you'd have to show that this idea does not exist

in Chinese medicine. Since this is far from the only source of this

information, that would be impossible. It could, of course, be a fact

in competition with another inconsistent fact, ie, if there was a

body of literature that claimed the fact that fatigue can be an

expression of other conditions not including qi vacuity. I think this

is why Bob is challenging you to give a citation.

 

It could also be a fact, but an erroneous fact, and this is what I

believe you (Jason) are trying to claim in your clinical reality

argument below. The problem with such an argument is that it does not

rely on the facts of Chinese medicine (unless you can show that it

does, by citing a source for the alternative facts). Clinical reality

in Chinese medicine relies heavily on the correct understanding and

application of the theoretical facts, rather than, in a situation

where you are having difficulty applying the facts to given

circumstances, claiming that the facts are wrong. Aside from this, a

counter argument can be made to each of your claims, that is

supported by the fact that fatigue is qi vacuity. I'm not going to do

that, as I have a cold and feel fatigued, and I'm going to lie down

and rest.

 

Of course, it could be that theory is inadequate to meet the clinical

needs, and this is when theory evolves and new facts become accepted.

For example, in the case of the evolution of wen bing theory,

recorded in the nei jing, this theory was still developing new

theoretical fact two millennium later. However, this does not appear

to be the case with the attribution of fatigue and qi vacuity.

 

Rory

 

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

>This is an idea and I think it is wrong, and

>there is much evidence to support this, IMO. I think more important

>than statements like this is clinical reality. For examples, case

>studies and pattern descriptions with treatments. For example, if

>one sees treatments that address fatigue as a complaint (among

>others) and do not include qi tonics, this says much. For example:

>vertigo, dizziness, tinnitus headache fatigue etc. red tongue yellow

>coating – TxP:subdue yang and search wind, level the liver and

>transform stasis – shanyangjiao, shi jue ming, dan shen, xuan shen,

>shan zhi, huangqin, gouteng, tianma,niuxi, yi mu cao, tongtiancao…

>(No tonics)

>Furthermore, there are plenty of yin xu Rx's that do not contain qi

>xu tonics. Take dabu yin wan for example. If such Rxs exist and

>they actually supplement yin and cure the condition then I have a

>hard time believing that all yin xu patterns have an element of qi

>xu.

>

>What do you think of someone who has liver fire -> insomnia ->

>fatigue.. DO you want to supplement, do they have qi xu.. I don't

>see it that way.

>

>Under vacuity taxation/ detriment (which I assume csn relate

>directly to the complaint of fatigue) it lists the 7 emotions,

>external damage etc. as a cause… as a pattern we have blood stasis

>and also there is yin xu (lung) pattern- and the Tx is

>shashenmaimendongtang – (note: no qi supplementing)

>

>Finally one of the #1 complaints in the US besides back pain is

>fatigue… I see it all the time. These people many times do have qi

>xu, but many times do not. Moving qi and blood many times cures

>them (among other things that are not qi supplementing), as Todd

>mentions.

>

>

>>

>> 3. If fatigue occurs with an external attack, then it is due to qi

>xu. Fatigue is not a standard symptom of wind cold or wind heat

> > external contraction.

>

>Almost every patient that I see that is sick (flu cold) has fatigue-

>AS my teachers always said, this is normal, and DO NOT supplement.

>Meaning for such a pattern one most likely will be fatigued. Maybe

>there is some terminology issue here, but when you give them an

>externally releasing Rx and you release the pathogen, they no longer

>have the fatigue, amazing.. It just seems like a no brainer. I do

>not see the qi xu if you cure a problem without supplementing qi.

>

>-Jason

 

 

--

 

 

[Guest guest]

sorry, this sounds like a " Ray Charles is God " arguement... It seems to me your

tendency to attribute so many complaints to Yin Fire can lead to this circular

arguementation.

 

, " Bob Flaws "

<pemachophel2001> wrote:

 

Further, liver fire typically evolves

> from depressive heat, and depressive heat is a species of yin fire. Li Dong=

> -yuan says that fortification of the spleen helps downbear yin

> fire. So, for that reason too I would likely add qi supplements. If handled=

> correctly, they will not aggravate liver fire but can actually

> hasten liver fire's recovering. But I have written about all of this at len=

> gth also. In any case, for me, this is, at least in part, the

> difference between a ming lao yi's practice and someone of lesser experienc=

> e and/or intellect.

> >

[Guest guest]

, " "

wrote:

> sorry, this sounds like a " Ray Charles is God " arguement... It seems

to me your

> tendency to attribute so many complaints to Yin Fire can lead to

this circular

> arguementation.

 

Bob's inclusion of yin fire was an additional reason in support of

supplementing qi in cases of fatigue. His other reasons stand on

their own, so there is no need to worry about circular reasoning in

this instance.

 

Brian C. Allen

[Guest guest]

I have to agree with Bob on this one, Doug. While circular logic can

be abused, so that one ends up with 'everything is everything', qi

transformation is a core principle in mainstream Chinese medicine, not

just yin fire theory. Raising the clear yang helps downbear the turbid

yin. And, by the way, the roots of yin fire theory are in the Shang

Han Lun, where the idea of using warm, sweet medicinals to clear

vacuity heat was introduced.

 

For some modern case histories that illustrate this approach, look up

Professor Zhu's cases in Volker Scheid's book " in

Contemporary China " .

 

 

 

On Jan 7, 2004, at 3:24 PM, wrote:

 

> sorry, this sounds like a " Ray Charles is God " arguement... It seems

> to me your

> tendency to attribute so many complaints to Yin Fire can lead to this

> circular

> arguementation.

>

> , " Bob Flaws "

> <pemachophel2001> wrote:

>

> Further, liver fire typically evolves

>> from depressive heat, and depressive heat is a species of yin fire.

>> Li Dong=

>> -yuan says that fortification of the spleen helps downbear yin

>> fire. So, for that reason too I would likely add qi supplements. If

>> handled=

>> correctly, they will not aggravate liver fire but can actually

>> hasten liver fire's recovering.

[Guest guest]

, " Bob Flaws "

<pemachophel2001> wrote:

> > I do not doubt that what you say is in the book you say, but

that

> > does not make it fact. This is an idea and I think it is wrong,

and

> > there is much evidence to support this, IMO. I think more

important

> > than statements like this is clinical reality. For examples,

case

> > studies and pattern descriptions with treatments. For example,

if

> > one sees treatments that address fatigue as a complaint (among

> > others) and do not include qi tonics, this says much. For

example:

> > vertigo, dizziness, tinnitus headache fatigue etc. red tongue

yellow

> > coating – TxP:subdue yang and search wind, level the liver and

> > transform stasis – shanyangjiao, shi jue ming, dan shen, xuan

shen,

> > shan zhi, huangqin, gouteng, tianma,niuxi, yi mu cao,

tongtiancao…

>

> Not all Chinese doctors are equal in knowledge, experience, and

simple inte=

> lligence. This is why it has been recongized for at

> least 2000 years that Chinese doctors come in at least three

grades: superi=

> or, mediocre, and inferior. So a single case history from a

> single Chinese doctor is meaningless.

 

Let's look at your argument. First and foremost, the above case/

information that you poo poo'ed is from a book called, " aging and

blood stasis " ... wait you translated that , and on the back cover

it says, " yan de-xin is one of the leading 'old chinese doctors' in

the PRC today. His theories on blood stasis and againg have

revolutionized 2,000 years of TCM geriatics " (should I continue?) So

I picked this example for that reason, because I thought you might

pull the one case study argument. But the reality is there are

numerous case studies that demonstrate that they treat fatigue

without spleen tonics. I just picked an example from something you

respect.

 

 

there is

If you've read the body of my work, y=

> ou will see that I have published numerous translations of

> Chinese materials where the Chinese has made some terminological

or procedu=

> ral faux pas. The point of these published pieces is

> exactly that one has to be careful when pointing to a single

Chinese source=

> . Simply coming from China does not make it right, as

> Alon has aptly pointed out on numerous occasions. When you go to

China to s=

> tudy and if you study with a number of different

> teachers, you will see that some are simply better, more

knowledgable, smar=

> ter than others.

 

Hey, I agree 100%. But my opinion is not some minority. Here it

is. 1) I have already given an example from a book you translated.

2) the other examples were from a basic zhong yi nei ke (internal

medicine book), 3) My contact with many Chinese and respected

western practitioners have concurred what I say. So there are all

degrees of understanding, so Why should I trust you over all of

them? I just see two different opinions and I like mine better,

because it seems much more broad and less pedantic.

 

 

> >

> > Furthermore, there are plenty of yin xu Rx's that do not contain

qi

> > xu tonics. Take dabu yin wan for example. If such Rxs exist and

> > they actually supplement yin and cure the condition then I have

a

> > hard time believing that all yin xu patterns have an element of

qi

> > xu.

>

> Da Bu Yin Wan is a formula we all have to study in school, but

look at the =

> literature and you'll see it's not that commonly sed in its

> pure form in clinical practice. As a building block, ok. As stand-

alone, ra=

> rely and, even then, questionably. Compared to Liu Wei Di

> Huang Wan, it's use is minimal, and that's precisely because,

among other d=

> efinciency, it does not address qi vacuity. Liu Wei Di

> Huang Wan is the famous Rx it is because it contains Shan Yao and

Fu Ling, =

> both of which supplement the qi, even if they are not

> both categorized as qi supplements.

 

The point is not that LWDHW is used more than DBYW. Not at all. The

point is that there are mainstream examples that that do not use qi

supplementing medicinals for yin vacuity. There was a heavy hitter

Chinese doc in SD that used DBYW variations all the time). So there

again 1) I have seen successful doctors use zero qi supplementing

herbs to treat yin xu. 2) there are case studies for this , ( I

have already pointed to examples.)

 

But basically it seems your mind is closed. 1) You will not accept

the personal experience of doctors that I have worked with that have

seem many many more patients than you. 2) You will not accept case

studies that I have read in Chinese. All this because you have some

idea that is actually not even mainstream , IMO.

 

>

> > What do you think of someone who has liver fire -> insomnia ->

> > fatigue.. DO you want to supplement, do they have qi xu.. I

don't

> > see it that way.

>

> The first thing is to put them to sleep. However, yes, if I were

treating t=

> hem and they said they were fatigued, I would supplement their

> qi. One of the causes of insomnia is unconstructed and

malnourished heart s=

> pirit.

 

Yes but that is not the pattern. The pattern is one of excess… You

may choose to supplement qi that is fine. But there are plenty of

others and Chinese literature that says otherwise. Tell me who will

not feel fatigued after a week of not sleeping?? I can tell you,

that I have seen and written rx myself that clear heat and settle

the spirit etc.(and do not supplement qi) to cure the problem. Case

studies and textbooks are plentiful that support this. SO you have

your way and I have mine. There is no way I will except there is a

black and white answer for this, Although I think you think there is.

 

Lack of sleep damages and consumes the qi as

> does " vigorous fire " which " eats " qi. So yes, I probably would

also use one=

> or more supplements. Further, liver fire typically evolves

> from depressive heat, and depressive heat is a species of yin

fire. Li Dong=

> -yuan says that fortification of the spleen helps downbear yin

> fire.

 

Yes … circular, red herring argument… and again only one idea…

 

So, for that reason too I would likely add qi supplements. If

handled=

> correctly, they will not aggravate liver fire but can actually

> hasten liver fire's recovering. But I have written about all of

this at len=

> gth also. In any case, for me, this is, at least in part, the

> difference between a ming lao yi's practice and someone of lesser

experienc=

> e and/or intellect.

 

Oh great Bob ming lao yi , I am not worthy, my intellect and

experience is so much less… Oh but actually I am quoting others who

are quite experienced.

 

> >

> > Under vacuity taxation/ detriment (which I assume csn relate

> > directly to the complaint of fatigue) it lists the 7 emotions,

> > external damage etc. as a cause… as a pattern we have blood

stasis

> > and also there is yin xu (lung) pattern- and the Tx is

> > shashenmaimendongtang – (note: no qi supplementing)

>

> Seems to me that you need to learn that both Sha Shen and Mai Men

Dong do s=

> upplement the qi even though they are not

> categorized as qi supplements.

 

Not mainstream at all.. again only an opinion. I have never once

seen a modification say in case of qi vacuity (s/s) add MMD and sha

ren.. You see the basic qi tonic herbs… You do see mods for fluid

dryness etc add MMD, SH. As you said people have all sorts of

ideas, why should I believe you over Bensky and the other 2 Chinese

MM I just checked.

 

From my point of view, your understanding is=

> not very sophisticated. Seems simplistic and

> sophomoric. But, hey, that's just me speaking.

 

Well hey, as far as CHA goes I think this is an uncalled for

personal attack. Hence my long rebuttle. But I can only say that :

 

The reality is there is a different and equally viable opinion as

yours. The reality is I trust all my Chinese doctors from San Diego

and Chip Chace's opinions, what I have read in case studies (etc.),

more than you. I don't even need to mention anything I think or any

of my personal experience. My stance is actually far less

simplistic than yours. You state ALL fatigue is qi vacuity. How

much more black and white/ simplistic do you need to get. I see

that yes that is the case many times, but there are certainly

examples (that ARE valid) that state otherwise. You can like it or

not.

 

 

>

> > Finally one of the #1 complaints in the US besides back pain is

> > fatigue… I see it all the time. These people many times do have

qi

> > xu, but many times do not. Moving qi and blood many times cures

> > them (among other things that are not qi supplementing), as Todd

> > mentions.

>

> Sorry, in my 26 plus years of studying and practicing CM, I have

never seen=

> a fatigued patient who did not have qi vacuity.

 

This is about as circular as it gets. You are saying that all

fatigue is qi vacuity, of course you are going to only see qi

vacuity in fatigue patients. Others disagree.

 

Maybe you

> haven't learned all the necessary signs and symptoms and the right

ways to =

> query. That all took me many years to. Sorry, no

> shortcuts except studying with a very experienced, very educated

teacher.

>

> > > 3. If fatigue occurs with an external attack, then it is due

to qi

> > xu. Fatigue is not a standard symptom of wind cold or wind heat

> > > external contraction.

> >

> Almost every patient that I see that is sick (flu cold) has

fatigue-

>

> Agreed. Me too!

 

**** Well here we go… I can give you 100's and 100's of case studies

from some of the most famous doctors in history that treat cold and

flues without tonifying qi. But are those valid to you?? Or will

you pull the old, well `yin qiao and lian qiao really supplement to

qi' you (Jason) just have a sophomoric understanding… " So I think if

you except case studies and don't change the function of the herbs

then there is no debate. People DO USE no supplementing medicinals

to treat people that have fatigue especially clear in external

attacks.

 

 

>

> > AS my teachers always said, this is normal, and DO NOT

supplement.

> > Meaning for such a pattern one most likely will be fatigued.

Maybe

> > there is some terminology issue here, but when you give them an

> > externally releasing Rx and you release the pathogen, they no

longer

> > have the fatigue, amazing.. It just seems like a no brainer. I

do

> > not see the qi xu if you cure a problem without supplementing qi.

>

> Sorry, Jason, your teacher is, IMO, simply wrong. It is typical of

many mod=

> ern Chinese doctors point of view.

 

So now we throw out all the modern Chinese and western CM

doctors.??? So what do we have left. No modern doctors. No case

studies. No personal experience. No text books. Just the books

you have and your experience count? Come on…

 

It is an example of the

> overly simplistic thinking of many practitioners of modern CM.

It's what a =

> lot of Westerners criticize as on this forum on a regular

> basis.

 

Again in defense.. I find this approach not simplistic at all.. It

is actually more complex. For example, they will treat some colds &

flu with qi (or xue, yin, yang) supplementing medicinals. But, that

is a) not the majority of the time b)only if they have that

underlying pattern. I have a Chinese book just on gan mao. It has

100's & 100's of Rx's and only a small part are dedicated to

underlying deficiencies were supplementing herbs are employed

(which, BTW, it says are best for children post partum etc., not the

general public). So are all the formulas that do not supplement

wrong and ineffective? I have a hard time believing that.

 

However, you might want to look into the phenomenal success of

OHCO'=

> s Cold Snap and BPH's Cold Quell. Might give you

> something more to think about. BTW, OHCO's formulator has been in

practice =

> longer than I have.

 

This is meaningless to me… There are many factors, marketing could

be one… In my limited time here in Boulder, I see people use this

stuff all the time, and yes some like it. But others come in and say

that it did not help and I have to treat them for a lingering

pathogen that was created from a Rx that was too supplementing for

what they needed, and did not release the pathogen. Many people it

does nothing for… Again no one Rx is right for everyone and one

always remembers success stories.

 

Warm regards,

 

-

[Guest guest]

But the reality is there are

numerous case studies that demonstrate that they treat fatigue

without spleen tonics. I just picked an example from something you

respect.

>>>Yin-excesses are often treated without spleen tonics and all can cause

fatigue

Alon

 

 

[Guest guest]

, Rory Kerr

<rory.kerr@w...> wrote:

> , " Bob Flaws "

> <pemachophel2001> wrote:

>

> > 2. ... See the opening chapters of the Xue Zheng Lun's

discussion of the

> > relationship between qi and yin fluids.

> --

> At 7:20 PM +0000 1/7/04, wrote:

> >I do not doubt that what you say is in the book you say, but that

> >does not make it fact.

> --

>

> Jason,

>

> Well, it is certainly evidence of a fact. It is sufficiently

strong

> evidence that we can assume that it is a fact unless someone shows

> that it is not, ie you'd have to show that this idea does not

exist

> in Chinese medicine. Since this is far from the only source of

this

> information, that would be impossible. It could, of course, be a

fact

> in competition with another inconsistent fact, ie, if there was a

> body of literature that claimed the fact that fatigue can be an

> expression of other conditions not including qi vacuity. I think

this

> is why Bob is challenging you to give a citation.

 

I agree, but did I not give examples?

 

>

> It could also be a fact, but an erroneous fact, and this is what I

> believe you (Jason) are trying to claim in your clinical reality

> argument below. The problem with such an argument is that it does

not

> rely on the facts of Chinese medicine (unless you can show that it

> does, by citing a source for the alternative facts). Clinical

reality

> in Chinese medicine relies heavily on the correct understanding

and

> application of the theoretical facts, rather than, in a situation

> where you are having difficulty applying the facts to given

> circumstances, claiming that the facts are wrong. Aside from this,

a

> counter argument can be made to each of your claims, that is

> supported by the fact that fatigue is qi vacuity.

 

Please explain. My evidence is case studies and texts that use

other herbs besides qi supplementing herbs to treat conditions with

fatigue. Simple as that. I agree there can be counter arguments for

all of this, but they are all valid. That is my point. And I did

give examples that support the other side.

 

-

[Guest guest]

, " Bob Flaws "

<pemachophel2001> wrote:

>

> > AS my teachers always said, this is normal, and DO NOT

supplement.

> > Meaning for such a pattern one most likely will be fatigued.

Maybe

> > there is some terminology issue here, but when you give them an

> > externally releasing Rx and you release the pathogen, they no

longer

> > have the fatigue, amazing.. It just seems like a no brainer. I

do

> > not see the qi xu if you cure a problem without supplementing qi.

>

> Sorry, Jason, your teacher is, IMO, simply wrong. It is typical of

many mod=

> ern Chinese doctors point of view. It is an example of the

> overly simplistic thinking of many practitioners of modern CM.

It's what a =

> lot of Westerners criticize as on this forum on a regular

> basis.

 

There is also something peculiar I find about this statement. You

are talking about this modern mainstream TCM standard. Something

you want to publish. Yet you are putting down these modern CMers

thought process – who are trained at Beijing, nanjing etc…

(mainstream schools)… Also you cling to non-mainstream ideas like

yin-fire and sha shen and MMD tonifing qi, which do not fit into the

standard approach (which hey I think is great), but you can't have

your cake and eat it too… It just seems anyone that differs from

you, you have a line for them.. i.e. 1) well li dong yuan said so

and so, so it must be true. 2) Well my modern CM `standard' book

says so and so, so it must be true. One can find evidence in theory

for almost anything in CM, this is given right? So why do you think

these modern CM doctors that I reference are wrong? Most of them

have treated 10x more patients than any of us…

 

-

[Guest guest]

, " Bob Flaws "

<pemachophel2001> wrote:

>

>

> The question is not whether patient's symptoms can recuperate without specific

treatment. We all know they can and do. The

> question is if addressing the qi makes the healing faster, better, more

complete.

My experience says yes.

 

Bob,

 

Actually the question in my mind was how we explain the phenomena of patients

who

are relieved from fatigue without it being addressed directly as vacuity. the

question

of whether it would be better to apply a little qi tonification in these cases

is a

separate but corollary question. I was trying to clarify why people's

experiences

seemed to differ. We can now address the latter question. So I open that to

the floor.

I personally think it depends on what kind of patients you are dealing with.

You have

stated in the past that the bulk of your patients were middle aged females.

Well, my

patient load was once of this sort, mostly chronic illness and mostly

middle-aged,

though not overwhelmingly female. Now, while I still see just as many of those

folks,

but because students and their families get low cost care at PCOM, literally

half my

practice involves the care of relatively healthy young 20-somethings. Most are

fitness oriented with decent diets and many do yoga or tai ji or meditate daily.

However, they are under tremendous stress and pressure to lapse on diet and

other

things just to blow off steam. I can say unequivocally these patients generally

are not

in need of much supplementation and benefit more in every way from dispersing.

They are not chronically ill and I do not see why they would need tonics to

prevent a

cold or flu.

 

[Guest guest]

, " "

<zrosenbe@s...> wrote:

> I have to agree with Bob on this one, Doug. While circular logic

can

> be abused, so that one ends up with 'everything is everything', qi

> transformation is a core principle in mainstream Chinese medicine,

not

> just yin fire theory. Raising the clear yang helps downbear the

turbid

> yin.

 

I don't think there is any disagreement: YINFIRE is NOT mainstream

Chinese theory. It is included in discussions, but it is not the1st

line of defense for most problems. And as we have seen, there is

not that much literature that comes out using it.

 

And, by the way, the roots of yin fire theory are in the Shang

> Han Lun, where the idea of using warm, sweet medicinals to clear

> vacuity heat was introduced.

 

Again this is one idea in the way of dealing with vacuity heat. I

just started translating about 50 pages (Chinese) just on `fa re'

(heat effusion) – There are many many many ways to skin a cat….

Furthermore, just b/c some idea has its roots in SHL or Neijing does

not mean it is superior, good, or even correct. The mainstream view

on yinfire (from my understanding) is that it has its place nothing

more nothing less…

 

-

[Guest guest]

, " "

<@h...> wrote:

 

> Please explain. My evidence is case studies and texts that use

> other herbs besides qi supplementing herbs to treat conditions with

> fatigue. Simple as that. I agree there can be counter arguments for

> all of this, but they are all valid. That is my point. And I did

> give examples that support the other side.

>

> -

 

If I read Bob correctly, he never said that a disease that presents

with fatigue could not be treated without qi supplementing medicinals.

Rather, he stated that if fatigue was present in a disease, that it

would be a more effective treatment if qi were supplemented in those

cases. Then, it seemed that he implied that it required a certain set

of skills or experience to see the vacuity and to pick the correct

supplementing medicinals.

 

I realize that you feel insulted, but I do not see anything wrong with

Bob's claims. It makes sense to me, but I do not have the clinical

experience with which to give a more learned evaluation of the claims.

 

Brian C. Alen

[Guest guest]

, " " <@h...>

wrote:

 

I

> do

> > > not see the qi xu if you cure a problem without supplementing qi.

 

I already wrote my schpiel on this, but I'm curious if anyone still does not see

the

need to rectify some of these issues with standards. If more than one point of

view is

valid, let's prove it with citations and case studies. Our standards would be

different

if it turned out only one position could actually be jusitified. It is a

serious issue if

the most complete healing hinges on the proper application of theory. Otherwise

our

work is palliative at best, iatrogenic at worst.

 

[Guest guest]

, " "

wrote:

> , " Bob Flaws "

> <pemachophel2001> wrote:

> >

> >

> > The question is not whether patient's symptoms can recuperate

without specific

> treatment. We all know they can and do. The

> > question is if addressing the qi makes the healing faster,

better, more complete.

> My experience says yes.

>

> Bob,

>

> Actually the question in my mind was how we explain the phenomena

of patients who

> are relieved from fatigue without it being addressed directly as

vacuity. the question

> of whether it would be better to apply a little qi tonification in

these cases is a

> separate but corollary question. I was trying to clarify why

people's experiences

> seemed to differ. We can now address the latter question. So I

open that to the floor.

> I personally think it depends on what kind of patients you are

dealing with. You have

> stated in the past that the bulk of your patients were middle aged

females. Well, my

> patient load was once of this sort, mostly chronic illness and

mostly middle-aged,

> though not overwhelmingly female. Now, while I still see just as

many of those folks,

> but because students and their families get low cost care at PCOM,

literally half my

> practice involves the care of relatively healthy young 20-

somethings. Most are

> fitness oriented with decent diets and many do yoga or tai ji or

meditate daily.

> However, they are under tremendous stress and pressure to lapse on

diet and other

> things just to blow off steam. I can say unequivocally these

patients generally are not

> in need of much supplementation and benefit more in every way from

dispersing.

> They are not chronically ill and I do not see why they would need

tonics to prevent a

> cold or flu.

>

 

 

 

 

I Also see a patient population that includes some very fitness

oriented people. I do see some that have over taxed themselves and

need supplementation. But many do not need supplementation, just

regulation etc. How many people out there have given si ni san to a

someone that complains of being tired (fatigue) and they get more

energy, feel more vitality, and mood is better. I cannot imagine

this is uncommon.

 

Furthermore, what about someone that comes in that is 'depressed ' -

(tired type) – Is this fatigue? I think it includes fatigue and they

many times are helped by just regulation. Hell, put in 4 gates in

many of these people all of sudden feel better and have more energy…

What do you all think of that?

 

-

[Guest guest]

On Jan 7, 2004, at 9:49 PM, wrote:

 

> Furthermore, what about someone that comes in that is 'depressed ' -

> (tired type) – Is this fatigue? I think it includes fatigue and they

> many times are helped by just regulation. Hell, put in 4 gates in

> many of these people all of sudden feel better and have more energy…

> What do you all think of that?

 

I'm of the belief, from personal and clinical experience, that Qi

stagnation traps Qi and can cause fatigue in the same way that as the

polar ice caps expand, the sea level drops. Melt the ice, and the sea

level rises. Remove the stagnation and all that Qi is back available in

circulation.

 

--

 

Pain is inevitable, suffering is optional.

-Adlai Stevenson

[Guest guest]

Yin fire theory is not designed for wai gan/external contractions, it

is mainly designed for nei shang/internal damage diseases. So,

certainly, for earlier stage, exterior patterns, or simple, acute or

recent diseases, other approaches may be more germane. Michael

Broffman taught me that we should have as many tools of pattern

differentiation as possible and be flexible. At different stages of

long-term illnesses, SHL theory, yin fire theory, or blood stasis

theory may be appropriate. Experienced physicians in Chinese medicine

often use different theories and change approaches all the time.

 

I was simply responding to Doug's argument about yin fire theory being

circular logic, not to Bob's critique of your ideas on qi vacuity and

fatigue.

 

 

 

 

On Jan 7, 2004, at 9:40 PM, wrote:

 

> I don't think there is any disagreement: YINFIRE is NOT mainstream

> Chinese theory. It is included in discussions, but it is not the1st

> line of defense for most problems. And as we have seen, there is

> not that much literature that comes out using it.

[Guest guest]

, " bcataiji " <bcaom@c...>

>

> If I read Bob correctly, he never said that a disease that presents

> with fatigue could not be treated without qi supplementing

medicinals.

> Rather, he stated that if fatigue was present in a disease, that

it

> would be a more effective treatment if qi were supplemented in

those

> cases. Then, it seemed that he implied that it required a certain

set

> of skills or experience to see the vacuity and to pick the correct

> supplementing medicinals.

 

That is fine, I get that... But he is then saying that everyone out

there, many famous doctors (modern and pre-modern), that have taken

the approach of not using qi supplementing medicinals with fatigue,

are incorrect and just wrong. This is possible, but hard to believe.

That is my point. When I can demestrate a valid approach contrary

to what he is saying, it is real easy to say, yeah but supplementing

qi is just better and all those of kooks are inferior... So he is

then saying that all of these other doctors (BTW, almost all of the

PCOM Chinese, among others) do not have the skill to see the

vacuity. I just don't think it is that simple and easy. I know that

I see and read stuff all the time that says otherwise… So why trust

Bob?

 

>

> I realize that you feel insulted, but I do not see anything wrong

with

> Bob's claims.

 

Not the claims… It was the personal attack saying that since I held

the mainstream view on what SS and MMD functions were – It was " not

very sophisticated. Seems simplistic and

sophomoric. "

 

Which seems like a statement way out of the context and spirit of

the discussion. To call someone sophomoric is blatantly slamming

there thought process.

 

-This is in my book, a personal attack.. but I am over it now so oh

well… I can assume that 99% of people on this list actually also

thought that Sha shen and MMD supplemented yin fluids etc and did

not supplement qi… but maybe I am wrong on that one

 

 

-

[Guest guest]

, " "

<zrosenbe@s...> wrote:

> Yin fire theory is not designed for wai gan/external contractions,

it

> is mainly designed for nei shang/internal damage diseases. So,

> certainly, for earlier stage, exterior patterns, or simple, acute

or

> recent diseases, other approaches may be more germane. Michael

> Broffman taught me that we should have as many tools of pattern

> differentiation as possible and be flexible. At different stages

of

> long-term illnesses, SHL theory, yin fire theory, or blood stasis

> theory may be appropriate. Experienced physicians in Chinese

medicine

> often use different theories and change approaches all the time.

>

> I was simply responding to Doug's argument about yin fire theory

being

> circular logic, not to Bob's critique of your ideas on qi vacuity

and

> fatigue.

>

>

>

\

Z'ev,

 

I agree with what you say above 100% and thanx for clarifying.

 

IS Bob's statement really circular? I also think so.. For example

he is saying that liver fire is from liver constraint (heat) - and

liver constraint with heat is a yinfire. therefore one must

supplement the spleen. This is forcefully bringing the argument to

the spleen to demonstrate the use of the spleen. There are plenty

of examples that treat liver fire (excess) without supplementing the

spleen, therefore not viewing it as yinfire. Granted Bob is right,

one may choose to view it as yinfire and he might get great success

with this approach. Some people you BZYQT for almost everything.

Some use guizhitang. Some sinisan. All valid. But one has to ask,

if the yinfire was so great, why hasn't it taken over??? People

still use long dan xie gan tang for liver fire. and this is, I

would bet, from a standard PRC position, a major choice for liver

fire, not a yinfire Rx with a bunch of spleen tonics. But in some

cases maybe the latter is best... Who knows.

 

-

[Guest guest]

I don't get the sense in reading his post that Bob is saying that all

liver constraint is yin fire, just that liver qi depression can be

concurrent with spleen qi vacuity. The nature of yin fire is fire from

yin, fire from vacuity, not a repletion fire like liver fire in a LDXGT

pattern. This pattern doesn't manifest with spleen qi vacuity, so the

prescription has little in the way of qi supplementing medicinals (just

gan cao).

 

 

On Jan 7, 2004, at 10:20 PM, wrote:

 

> But one has to ask,

> if the yinfire was so great, why hasn't it taken over??? People

> still use long dan xie gan tang for liver fire. and this is, I

> would bet, from a standard PRC position, a major choice for liver

> fire, not a yinfire Rx with a bunch of spleen tonics. But in some

> cases maybe the latter is best... Who knows.

[Guest guest]

, " " <zrosenbe@s...>

wrote:

> Yin fire theory is not designed for wai gan/external contractions, it

> is mainly designed for nei shang/internal damage diseases. So,

> certainly, for earlier stage, exterior patterns, or simple, acute or

> recent diseases, other approaches may be more germane.

 

 

Z'ev

 

That has been my point also. I certainly find yin fire theory useful in many of

the

most complex diseases we face (mostly autoimmune). However while some of us

have patient loads largely comprised of such illnesses as I did for many years,

such

patients make up a minute fraction of those who receive complex herbal

prescriptions nationwide. the main reason is that these patients are typically

on

immunosuppressives and 90% of the time their doctors ban the use of any herbs

that

might stimulate the immune system. so much for bu zhong yi qi tang and all its

variations.

 

according to studies, the bulk of patients in general practice are neuromuscular

(60%). And most these are injury, repetitive stress, osteoarthritis, emotional

stress

and idiopathic. A much smaller number are autoimmune. this is my specific

observation at PCOM. the PCOM clinic sees 2000 pt. per month. No more than 3%

of

patients come for any other chronic internal condition according to nationwide

stats.

So the bulk of our patients may not be experiencing the complex yin fire

scenarios.

Thus, as you said, other approaches maybe more germane.

 

I am just thinking here about what constitutes the most essential master's

education.

One that stresses how to treat diseases not commonly seen in practice or one

that

does. Now on one hand, we have a lot to offer in the diseases you speak of,

thus it is

essential that students be exposed and apply these ideas. but I wonder if the

bulk of

their time would be better spent learning how to address more common things in a

thorough fashion. As for yin fire theory, who am I to say? However, I think I

am

correct that PCOM chose to NOT include li dong yuan in their classics series at

the

DAOM level. Though I suppose some might say this represents a certain type of

limited thinking Bob referred to earlier.

 

[Guest guest]

, " " <zrosenbe@s...>

wrote:

The nature of yin fire is fire from

> yin, fire from vacuity, not a repletion fire like liver fire in a LDXGT

> pattern. This pattern doesn't manifest with spleen qi vacuity, so the

> prescription has little in the way of qi supplementing medicinals (just

> gan cao).

 

 

According to Wiseman among others, one of the main causes of liver fire flaring

up

(gan huo shang yan) is liver depression transforming into fire. The treatment

for this

pattern is long dan xie gan tang (LDXGT). Now this formula is indeed not at all

supplementing. However liver depression often occurs in concert with spleen

vacuity,

either because etiological factors in the patient's life affect both organs or

because of

the wood/earth relationship. Now is it possible that a person with liver

depression

and spleen vacuity has that depression transform at times not merely into heat,

but

fully into fire with all the ascendant repletion symptoms (headache, red face,

bitter

taste, yellow tongue coat). Perhaps due to extreme emotional stress and/or

alcohol

use. However in the background remains signs of the spleen vacuity. Thus, is

it

possible the patient has both a spleen vacuity and a replete liver fire flaring

up. How

does one treat this? and if liver depression heat in a spleen xu patient is an

example

of yin fire, what are we to call the type of heat when it escalates further into

liver fire

flaring up. Is this still a yin fire then? Or is the point that liver

depression heat only

transforms to fire in a person with no spleen qi vacuity

 

 

[Guest guest]

Z'ev, the concept of yin fire is not circular in reasoning but I question if the

application of Yin Fire to such a broad range of complaints leads one to

circular

thinking.

My main objection from Bob was especially in the 3rd and 4th sentences below...

 

" Lack of sleep damages and consumes the qi as

does " vigorous fire " which " eats " qi. So yes, I probably would also use one=

or more supplements. Further, liver fire typically evolves

from depressive heat, and depressive heat is a species of yin fire. Li Dong=

-yuan says that fortification of the spleen helps downbear yin

fire. So, for that reason too I would likely add qi supplements. "

 

 

sorry, to set off such a " fire storm " ... the main thing is that many don't

equate the

clincial complaint of fatigue as qi xu. Certainly, the clearing formulas have

worked

well many times for my patients. And no one will argue that some amount of

tonification " if handled correctly " will help, just as anything " handled

correctly " will

help.

 

 

If handled=

correctly, they will not aggravate liver fire but can actually

hasten liver fire's recovering. But I have written about all of this at len=

gth also. In any case, for me, this is, at least in part, the

difference between a ming lao yi's practice and someone of lesser experienc=

e and/or intellect.

 

 

 

, " " <zrosenbe@s...>

wrote:

> I don't get the sense in reading his post that Bob is saying that all

> liver constraint is yin fire, just that liver qi depression can be

> concurrent with spleen qi vacuity. The nature of yin fire is fire from

> yin, fire from vacuity, not a repletion fire like liver fire in a LDXGT

> pattern. This pattern doesn't manifest with spleen qi vacuity, so the

> prescription has little in the way of qi supplementing medicinals (just

> gan cao).

>

>

> On Jan 7, 2004, at 10:20 PM, wrote:

>

> > But one has to ask,

> > if the yinfire was so great, why hasn't it taken over??? People

> > still use long dan xie gan tang for liver fire. and this is, I

> > would bet, from a standard PRC position, a major choice for liver

> > fire, not a yinfire Rx with a bunch of spleen tonics. But in some

> > cases maybe the latter is best... Who knows.

[Guest guest]

So why do you think

these modern CM doctors that I reference are wrong? Most of them

have treated 10x more patients than any of us.

 

>>>>>Jason this just goes back to people trying to make CM what it is not,

clinging to a so-called standard approach, which they can not even do by them

self's. As you and i said many times you can show evidence for support for just

about anything in CM literature, both modern and old. If we are to allow for

this plurality or as PU calls cognitive aesthetics notion of contradictions,

which i think is a potential strength of CM, then these arguments are really

silly. Also they only have meaning as clinical tools, that is which herbs would

work on a patient? If we see patients in which fatigue gets better with herbs

that do not tonify qi and possibly get worse with the addition of herbs that

tonify qi, which i can not believe anyone who has been in real life practice has

not seen, then perhaps it can be said that patients do not read text books.

At the same time, i do not know about you guys but i have had long lectures and

scolding for using qi tonics to treat patients complaining of fatigue when i

worked under supervision in China. By more than one " old " doctor or " master, "

all of whom also did official training of TCM (although being the first collage

program), tell me that fatigue in just as often due to Yin pathogens as it is

due to Qi-def, and to be careful when adding qi tonics to such patients (even

when combined with other herbs, or ie as done by the beloved Dong's Yin-fire.

Alon

 

 

 

[Guest guest]

that it

would be a more effective treatment if qi were supplemented in those

cases.

>>>Well i can tell you from real life experience that in many patients this is

simply not true

Alon

 

 

[Guest guest]

transforms to fire in a person with no spleen qi vacuity

>>>Todd at the same time it is said " when treating the liver first treat the

spleen " so again you can find support for anything

Alon

 

 

[Guest guest]

At 5:24 AM +0000 1/8/04, wrote:

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

> I think this

> >is why Bob is challenging you to give a citation.

>

>I agree, but did I not give examples?

--

Jason,

 

The facts of Chinese medicine are those that are established in the

literature as facts. For you to state a fact of Chinese medicine, eg

'fatigue is a symptom of yin vacuity' (I think this was one of your

claims) requires you to source that in the literature. If this cannot

be done, then it isn't a fact of Chinese medicine. That does not

necessarily invalidate your observations, but you cannot claim it as

a fact of Chinese medicine.

 

 

>Please explain. My evidence is case studies and texts that use other

>herbs besides qi supplementing herbs to treat conditions with

>fatigue. Simple as that. I agree there can be counter arguments for

>all of this, but they are all valid. That is my point. And I did

>give examples that support the other side.

--

 

I believe you are using backwards logic to reach your conclusion.

Which herbs a practitioner uses to treat a given patient on a given

day does not establish a fact of Chinese medicine. There are many

reasons clinical choices are made, and often they remain unstated in

case studies.

 

Rory

--