disease causes and disease mechanisms

[Guest guest]

There is some confusion that lingers in some student's minds between

disease causes and disease mechanisms. In light of several recent

threads, I thought a more in depth look was warranted.

 

Disease causes are the internal, external and miscellaneous causes of

illness. They include emotions, external factors (including ideas

similar to parasites, viruses and bacteria), diet, iatrogenesis,

trauma, exercise, taxation.

 

Disease mechanisms are the disruptions of physiology as understood in

TCM terms that are CAUSED by one or more of the previous Disease

causes. This is important. Causes lead to abnormal physiology.

 

Finally, all symptoms are generated as a result of abnormal physiology.

So while there is an interlocking network of causes and patterns,

there is also a mandatory linearity to this scheme as well.

 

Disease Causes >>>> Pathomechanisms >>>> Signs and Symptoms

 

The main focus of the chinese herbal literature has been the treatment

of the pathomechanisms and the signs and symptoms. While the causes of

illness are often discussed, the main thrust of the translated

premodern literature was on formulas to rectify the abnormal

physiology. Extensive advice on nutrition or psychotherapy to address

emotional imbalances was not the norm amongst herbalists. There seems

to be a theme of generalized advice on diet that runs through

mainstream medical texts. The plethora of books on chinese dietetics

written through the centuries may well represent more of a popular than

a medical tradition. Highly individualized dietary advice was clearly

not central to works such as those of Zhu dan xi, though he admonished

all patients to avoid alcohol plus overly greasy, spicy and sweet

foods. Good advice, essential in fact, but not rocket science. My

point is that Chinese medicine does not seem to have developed as

highly evolved consensus on dietetics as on herbology. And that

certain general commonsense advice may be all that is necessary.

 

I would say the same is true of treating the spirit. First of all,

causes of a spiritual nature are not listed amongst disease causes in

the CM literature. Certainly causes of a mental/emotional nature are

the internal causes, but emotions are not spiritual. To me, a

spiritual cause of illness would be due to separation from spirit

(cured by meditation) or bad karma (cured by good acts). Tibetan

medicine talks about such things as well as demons, but the nei jing

does not. In, the whole point of the nei jing is that disease has

nothing to do with such things. My point here is that we must really

stretch beyond the CM literature to find spirit as a central issue in

medicine. Personally, I think the concepts of karma and demons are

useful, but may come down to inherited defects and psychological trauma

with more mundane explanations. The important thing to note is that

some problems may not be curable and others may only be curable with

direct intervention at the level of causation. Mainstream chinese

herbal texts (modern or premodern) do not really address how to handle

such causative factors directly.

 

Let's consider the emotions. I think both disease causes and disease

mechanisms must be treated to effect a cure or stable remission. So if

emotions are the cause of an illness, herbs only treat the

pathomechanism that are disturbed by those emotions. The herbs do not

rectify the cause of those PM's. For example, if excess of any of the

seven emotions disturbs the liver (the cause), then free coursing is

disturbed (the pathomechanisms), leading to (hypothetically) ribside

pain, plumpit qi and loose stool upon invasion of the spleen (the

symptoms). If the emotions are due to an unresolved issue at work or

or at home or due to some long buried trauma or existential angst, the

herbs will not change that. The question is how is this cause

eliminated? Again, the literature of the mainstream herbal tradition

does not suggest this was a typical clinical emphasis. However there

were doctors who specialized in types of psychotherapy, plus buddhist

and daoist teachers who worked on this level. Nevertheless, no

consensus developed. The only thing that seems clear is that typical

mainstream texts were not very insightful about how to rectify this

cause of illness.

 

It is clear that stress and obesity, the two main causes of illness in

the US, are interrelated and also related to addiction, violence and

immune weakness, need to be treated directly to cure the ills the ail

us. However Chinese medicine did not historically deal directly with

either of these issues. In other words, we have no herbal formulas

that make ones emotions go away or change the climate or make bad food

good or give you a different boss or spouse. We only have formulas

that address the PMs that arise when these causes overwhelm the zheng

qi. Since mainstream CM has no history of dealing directly with the

disease causes and modern TCM education does not give extensive

training in psychotherapy or nutrition, what is the basis of one's

clinical decisions in this area? PCOM's DAOM program does advanced

training in psych assessment and tx, so this one solution for

postgrads. But since CM is not highly evolved in these areas, we must

defer to western modalities (psychology and nutrition) to some degree

in deciding treatment.

 

I think any insistence that CM is indeed highly evolved in these

modalities is wishful thinking. While there are many texts on both

topics, the deciding factor for me is what got integrated into

mainstream practice and what did not. Only that which became

mainstream satisfies the criteria that attracted me to CM in the first

place - its long history of regular use was a reasonable alternative to

modern research. But marginal methods do not meet this criteria, which

is why I say the CM literature on diet and psychology is unevolved.

Thus, unless one has made special advanced studies in these areas, I

think referral is best course of action. We should be skilled at

identifying the causes of illness, but recognize that others may be

better at treating them in some cases. To reiterate, we are are the

experts at treating pathomechanisms and s/s. We are also the experts

at identifying the causes. If the cause is not removed the PMs will

return. And in many cases, even if the cause is removed, the PM's may

have become self-perpetuating. We should feel no shame if we focus

ourselves narrowly on being experts at identifying the cause and

rectifying the PMs. We can always refer out for psychology and

nutrition.

 

For example, a patient will get far more benefit from a personal

trainer and nutritionist than from an acupuncturist for weight loss.

Unless you are a personal trainer, don't waste your patient's money.

Refer. You can see them monthly to address the PMs, but let the

trainer handle the causes (and/or the psychologist if the cause is

emotional). It is holistic to treat the PM's using pattern

differentiation, but it may be unethical to try and treat the causes

without special expertise in those areas that is not part of TCM

training (yes, I know you all have your 2-3 counseling classes and 1

nutrition class - that is not what I mean by expertise - you get little

enough training in herbs and acupuncture in your internship; let's not

delude ourselves and claim anyone develops expertise in nutrition and

psychology during this time as well. It is in the patient's best

interest to get the holistic care they need from experts in the

modalities they are prescribed. TCM training does not and cannot

provide such expertise. Arguably, current training is not adequate at

training in the assessment and treatment of PMs and s/s.

 

Two other topics jump to mind as a result of this discussion. The

first is sort of a chicken and egg conundrum. What causes abnormal

emotions if they are the causes of disease themselves? We have talked

before about the confusion that has occurred between emotions as

disease causes versus symptoms or chief complaints. We noted that,

except for anger, none of the other emotions was a standard confirming

symptom for any pattern in Sionneau. On the other hand, excessive Joy

as a chief complaint is associated with heart patterns and excessive

thinking with spleen pattern and so on. But only when the the aberrant

emotion is the chief complaint. In other words, excess emotions can be

chief complaints, but not confirming symptoms of any pattern.

Overthinking can be caused by Spleen qi xu, but its presence does not

confirm spleen qi xu at all. But how does the zang become imbalanced

in the first place in order to generate the aberrant thinking. Is it

constitutional or dietary or are emotions always first and zang fu

disease second.

 

I would say that one can certainly be born with imbalances that affects

ones psyche. This is the concept of ayurvedic doshas. Such doshas

lead to characteristic temperaments. So one might be predisposed to

overthinking (spleen xu, damp or kapha dosha) by nature which leads to

further worsening of natural tendencies in a vicious cycle. But on the

other other hand, form a buddhist perspective, the emotions just arise.

Sure, your inheritance may determine the nature of those emotions, but

that is irrelevant. It is all just qi flow that the ego fixates on or

not. When one fixates on these emotions, then they become excessive or

stagnant. This leads to disease. Psychotherapy or meditation may help

here. If the latter helps, then one might immediately think that is

confirmation of there being a spiritual cure for emotional or physical

symptoms. However, I would offer another hypothesis. That while the

early stages of meditation do indeed lead to increased physical and

emotional health (though often after crises), that is not the goal in

and of itself and those changes are not permanent or cumulative as one

progresses on the spiritual path.

 

I think perhaps some of the confusion over what the word spiritual

means in relation to medicine can be understood by reference

patanjali's yoga sutras. In the sutras, the stages of spiritual

development are described. At a certain stage, one develops robust

physical health and even minor supernatural abilities. Ken Wilber

considers this a normal development in all persons and the next phase

in human evolution. However Patanjali has warned (and others have

reiterated), that the purpose of this robust health was not for

personal indulgence in egoic or carnal pursuits, but rather to bear the

trials of spiritual cultivation in which the physical form would

ultimately wither and be sacrificed. Now here's the rub, though. One

could always choose to ignore the sutras and pursue what Patanjali

thought was a dangerous path more likely to generate a huge karmic debt

than lead to freedom from samsara (conversely in the aghora tantra

tradition, the final freedom only came to those few who survived the

so-called left hand path of egoism and carnality without being consumed

by it). So while it was typically accepted that yoga and meditation

could be used for solely physical gains, this was not typically

considered a spiritual application of the methods and was in fact

considered a distraction from the path of enlightenment. It was even

thought that dallying on this path would insure many more lifetimes of

rebirth. Now having said that, it was still one's choice and a

perfectly valid one. For those who have experienced increased vigor

through yoga and meditation, I would merely submit that this is

expected and has nothing to do with spiritual cultivation, per se.

 

Secondly, the issue of microbes. Microbes may be an important cause of

many chronic illnesses. They are an exterior and miscellaneous factor

that was at least hinted at in the premodern CM literature. I

certainly find that in many patients the zang fu PMs cannot be

rectified as long as there are microbiological imbalances. This ranges

from candida to abnormal gut bacteria to low grade parasites (protozoa)

to things like mycoplasma, EBV, HIV, h. pylori, etc. This may a cause

that has exploded in modern times. CM has never developed the tools to

detect these lurking pathogens while they lay hidden. And now in the

modern age, CM has to consider whether certain modern tools provide

answers to these questions. BTW, I know there are those who claim

various signs identify lurking pathogens while they lurk (pulse or

tongue, for example). I am merely restating the mainstream CM position

that there is no consensus on this.

 

Now the question in many minds is whether microbes cause zang fu

imbalances or zang fu imbalances lead to microbial breeding grounds. I

would say both. To choose either is just biased. CM already allows

for exterior excess to be the starting point of chronic illness. I

would suggest that this may be the case far more than we normally

believe. Thus elevating the wen bing to new level of importance in

modern American practice. My teacher Li Wei felt the wen bing xue was

the most important TCM " classic " . A linkage of lurking pathogen and

yin fire theory provides a powerful model for understanding the

progression of chronic illness that may begin with microbial factors.

Finally, at what point does one still treat the microbe/pathogenic

factor with attacking therapies? Most lurking pathogens in the ying

and blood phase are treated with supplementing, not attacking

therapies. However, as noted in a previous post, many supplementing

herbs have antimicrobial properties, so attacking (CM) and

antimicrobial (WM) are not synonymous. OTOH, Liu does warn about

supplementing in yin damage at the blood phase further trapping the

pathogen, yet offers no strategy around this.

 

When reading Warm Diseases, despite the amazing insights developed in

this school, one cannot help but get this sense that the ideas of this

school are not yet fully formed. That because they deal largely with

infectious disease, a point Liu makes, and because it is a relatively

new school of thought, that perhaps it could not have been until the

modern era that it was fully developed. If someone came up with Warm

disease theory today, purists would scream that they had copied WM.

But wen bing precedes the WM germ theory. So why should we reject

western methods of dx that may aid us in further understanding of wen

bing just because those methods are not premodern. It is the

application of modern methods that really developed the school of blood

stasis. Just because western medicine went over the top on microbes,

let's not go over the top on terrain. Another important avenue of

integration may be to rescue the germ theory into a holistic immunity

model before WM leads us into a nightmare of superbugs with thier

rampant misuse of antibiotics.

 

 

 

Chinese Herbs

 

 

FAX:

 

 

 

[Guest guest]

, " Marian Blum " <marianb@r...> wrote:

I

> may be misunderstanding this part of your post, but I don't

> think we're necessarily 'the experts' at identifying the

> causes of the pathomechanisms. If I have a patient who is SP

> Qi xu and LV Qi Depression and she overindulges in sweets as

> well as in the 7 emotions, how am I to ascribe the relative

> contribution of those causes?

 

 

 

You can quantify it like 3 parts liver and 1 part spleen. but you can identify

general areas

of concerns for further examination or referral like emotions or diet. I think

CM does

allow us a certain expertise in pinning down likely factors. For example, if a

condition

came on suddenly, no matter how long it has lasted, it probably started as some

excess,

possibly exterior or lurking. It may be a waste of time to look for the dietary

or emotional

factors that may have caused this illness, when some pathogenic factor is more

likely.

OTOH, an illness that came on slowly after immense ongoing stress and taxation

is

probably not due to an infection (at least as the primary cause). As to

specific nature and

cure for these causes, that is what the referral is for.

 

I have rarely seen a multidisciplinary clinic work. I have worked briefly in 4

failed ones

over the past 12 years (hoping again and again that it was a good model). In my

experience, there is very little referral and considerable guarding of patients.

There is

much more referral between people who do not compete directly for patient load

with you.

I have found an outside referal network to be far more conducive to good care

than in

house models. An in house model might work if all the parties were established.

But

usually such practices attract really hungry folks who prefer competition to

cooperation.

Established folks rarely leave their established practices for something " new "

and those I

have known who have joined such group clinics have almost always been sorry. A

sad

comment on human nature.

 

[Guest guest]

I have rarely seen a multidisciplinary clinic work.

>>>For them to work you need a good medical director that understands all that

is offered.

Alon

 

 

[Guest guest]

I think Dr. Issac Eliaz , who is also an L. Ac., does a nice job with

his Bay Area clinic.

 

 

On Sep 28, 2004, at 10:32 AM, Alon Marcus wrote:

 

> I have rarely seen a multidisciplinary clinic work.

>>>> For them to work you need a good medical director that understands

>>>> all that is offered.

> Alon

[Guest guest]

, " " wrote:

 

>

> You can quantify it like 3 parts liver and 1 part spleen.

 

that should have said CAN'T

 

 

[Guest guest]

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

wrote:

> I have rarely seen a multidisciplinary clinic work.

> >>>For them to work you need a good medical director that understands all that

is

offered.

 

 

and one with the leadership skills to carry it out. folks with such skills are

rarely spending

their prime earning years in our field.

 

[Guest guest]

I think Dr. Issac Eliaz , who is also an L. Ac., does a nice job with

his Bay Area clinic.

 

 

>>>>So does Len Saputo

Alon

 

 

[Guest guest]

I think part of the problem is that in these 'rainbow clinics', no one

is really aware of what modalities other practitioners are using, so

they are prejudiced towards what they already know. Also, there are

limited insurance bucks, that depend on the chief honcho M.D. or D.C.'s

referral. There is also the issue of 'clashing paradigms', i.e.

different healing philosophies thrown under one umbrella. Mixing them

can create chaos without an 'orchestra leader'. While I've always

worked in private practice, in my Boulder/Denver days I took part in

the activities of two 'rainbow clinics' with some great doctors,

therapists and L. Ac.'s, but they didn't work out according to the

ideals presented.

 

There has to be a unifying vision and approach, and I think this is

what someone like Dr. Eliaz has developed with his Amitabha medical

clinic.

 

 

On Sep 28, 2004, at 9:33 AM, wrote:

 

> I have rarely seen a multidisciplinary clinic work. I have worked

> briefly in 4 failed ones

> over the past 12 years (hoping again and again that it was a good

> model). In my

> experience, there is very little referral and considerable guarding of

> patients. There is

> much more referral between people who do not compete directly for

> patient load with you.

> I have found an outside referal network to be far more conducive to

> good care than in

> house models. An in house model might work if all the parties were

> established. But

> usually such practices attract really hungry folks who prefer

> competition to cooperation.

> Established folks rarely leave their established practices for

> something " new " and those I

> have known who have joined such group clinics have almost always been

> sorry. A sad

> comment on human nature.

>

[Guest guest]

Hi Todd

 

Great post. A couple of questions and comments:

 

,

wrote:

> > I would say the same is true of treating the spirit. First of

all,

> causes of a spiritual nature are not listed amongst disease causes

in

> the CM literature. Certainly causes of a mental/emotional nature

are

> the internal causes, but emotions are not spiritual. To me, a

> spiritual cause of illness would be due to separation from spirit

> (cured by meditation) or bad karma (cured by good acts).

 

1. What is " separation from spirit " ? What about the meditation

traditions of Daoism (specifically medical qi gong/nei

gong)/Buddhism which address specifically the emotions such as

Transforming the Negative Emotions of Each Organ into Useful Energy

(Chia: Fusion of the Five Elements), Balancing the Organ Energy to

Experience Inner Peace and Harmony (ibid) or Tong Lin (Buddhist

tradition) which is entirely to do with emotions using the Heart's

emotions (joy, compassion, love) as antidote to all negative

emotions?

 

2. How can we separate mental, emotional and spiritual (let's just

stick with insubstantial for now and leave out the body itself)?

 

I see these as a continum. Mental states creating emotions which set

up spiritual orientation. By disciplining the mind, I think we can

redirect emotions and settle the spirit.

 

Emotions may not be " spiritual " in the strictest sense, but do they

not precede and direct our spiritual manifestation? It is my

understanding (and my experience) from my studies/practice that

emotions are quite effectively moderated using certain meditations

which use the mind to elicit emotions. Moreso than any psychotherapy

I ever tried.

 

Personally, I would only refer for psychotherapy a patient who

seemed completely out of touch with his reality: past and/or

present. Someone who had done no " work on himself " to date or is in

imminent danger of self-harm. In these cases, one must track back to

the perceptions, past truamas and the mental with the assistance of

a trained therapist who can help a person realize what they are

feeling and why. But the vast majority of my patients seem to have

some sense of what's going on and why but still can't seem to master

their emotions, behavior and consequent physical symptoms. They've

seen the shrink and gone around and around but still have the same

feelings haunting them. For this population, certain meditative

techniques have proven quite useful. IMO, knowledge cannot cure

emotions, only emotions can address emotions and the above mentioned

meditations use internally generated emotional states for just this

purpose.

 

3. Has anyone heard of any comparative clinical trails/research

comparing effectiveness/patient satisfaction of populations treated

with psychotherapy vs. Nei Gong or Buddhist meditations? This would

be interesting indeed.

 

> Let's consider the emotions. I think both disease causes and

disease

> mechanisms must be treated to effect a cure or stable remission.

So if

> emotions are the cause of an illness, herbs only treat the

> pathomechanism that are disturbed by those emotions. The herbs do

not

> rectify the cause of those PM's. For example, if excess of any of

the

> seven emotions disturbs the liver (the cause), then free coursing

is

> disturbed (the pathomechanisms), leading to (hypothetically)

ribside

> pain, plumpit qi and loose stool upon invasion of the spleen (the

> symptoms). If the emotions are due to an unresolved issue at work

or

> or at home or due to some long buried trauma or existential angst,

the

> herbs will not change that. The question is how is this cause

> eliminated? Again, the literature of the mainstream herbal

tradition

> does not suggest this was a typical clinical emphasis. However

there

> were doctors who specialized in types of psychotherapy, plus

buddhist

> and daoist teachers who worked on this level. Nevertheless, no

> consensus developed. The only thing that seems clear is that

typical

> mainstream texts were not very insightful about how to rectify

this

> cause of illness.

While there are many texts on both

> topics, the deciding factor for me is what got integrated into

> mainstream practice and what did not. Only that which became

> mainstream satisfies the criteria that attracted me to CM in the

first

> place - its long history of regular use was a reasonable

alternative to

> modern research.

 

As you say, Buddhist/daost teachers worked on this level. But can

you say no consensus was developed? The Buddhist traditions are more

united than Acupuncture probably. The Daoists mainly passed along

information from master to student so consensus cannot be proven.

Perhaps this is more an example of different fields of study not

taking interest in each other--i.e. herbal masters weren't so

concerned with qi gong (nor was it being shared with them as a rule

until Mao's era) and qi gong masters weren't out there writing

herbal treatises. Qi Gong practices haven't been shared publically

on any sort of wide scale until very recently. The information

simply wasn't disseminated. Perhaps this could be why it never made

it into the " mainstream " as you say.

>

. It is all just qi flow that the ego fixates on or

> not. When one fixates on these emotions, then they become

excessive or

> stagnant. This leads to disease. Psychotherapy or meditation may

help

> here. If the latter helps, then one might immediately think that

is

> confirmation of there being a spiritual cure for emotional or

physical

> symptoms. However, I would offer another hypothesis. That while

the

> early stages of meditation do indeed lead to increased physical

and

> emotional health (though often after crises), that is not the goal

in

> and of itself and those changes are not permanent or cumulative as

one

> progresses on the spiritual path.

 

Nothing is permanent according to CM theory. But tools exist to be

used when imbalance rears it's ugly head. And these tools, IMO, can

contribute to the cumulative outcome of wellbeing.

 

 

>

> I think perhaps some of the confusion over what the word spiritual

> means in relation to medicine can be understood by reference

> patanjali's yoga sutras. In the sutras, the stages of spiritual

> development are described. At a certain stage, one develops

robust

> physical health and even minor supernatural abilities. Ken Wilber

> considers this a normal development in all persons and the next

phase

> in human evolution. However Patanjali has warned (and others have

> reiterated), that the purpose of this robust health was not for

> personal indulgence in egoic or carnal pursuits, but rather to

bear the

> trials of spiritual cultivation in which the physical form would

> ultimately wither and be sacrificed. Now here's the rub, though.

One

> could always choose to ignore the sutras and pursue what Patanjali

> thought was a dangerous path more likely to generate a huge karmic

debt

> than lead to freedom from samsara (conversely in the aghora tantra

> tradition, the final freedom only came to those few who survived

the

> so-called left hand path of egoism and carnality without being

consumed

> by it). So while it was typically accepted that yoga and

meditation

> could be used for solely physical gains, this was not typically

> considered a spiritual application of the methods and was in fact

> considered a distraction from the path of enlightenment. It was

even

> thought that dallying on this path would insure many more

lifetimes of

> rebirth. Now having said that, it was still one's choice and a

> perfectly valid one. For those who have experienced increased

vigor

> through yoga and meditation, I would merely submit that this is

> expected and has nothing to do with spiritual cultivation, per se.

 

What about the meditations using emotions for aleviating

mental/emtional/physical suffering in the moment? Does this also

lead to a distraction from the path of enlightenment? I can see how

pursuing strictly the physical benefits could distract one, but when

integrating the emotions does this not complete the path puzzle?

Getting beyond the fixation on negative emotions, one sees the

bigger picture and can rest in acceptance and compassion--wellbeing.

 

 

Thanks for reopening this can of worms as removing causes

(especially emotional) is one of my primary interests. Hope I

haven't missed your point.

 

Regards, Shanna

 

>

>

[Guest guest]

, " " <zrosenbe@s...>

wrote:

 

>

> There has to be a unifying vision and approach, and I think this is

> what someone like Dr. Eliaz has developed with his Amitabha medical

> clinic.

>

 

 

you are no doubt right. but that requires a leader and followers. everyone in

our field

fancies themselves a leader. Its the same problem at PCOM. I like Jack and

Stacy's vision,

but not everyone does and so the vision is never fulfilled. Everyone has their

own ideas

about what is right and that leads nowhere. That is why I harp over and over

again about

developing a consensus in the field and bemoan the fact that irreconcilable

differences

between key factions make this an unlikely conclusion. We can't move ahead

without

consensus and no consensus that does not involve outrageous compromises is

possible

within the current community. Stalemate.

 

[Guest guest]

I agree that this is the exception rather than the rule.

 

What do you think about this upcoming AAOM conference in Las Vegas, in

terms of unity of the profession? I am curious, it looks like a very

big event. Comments welcomed.

 

 

On Sep 29, 2004, at 9:39 AM, wrote:

 

> you are no doubt right. but that requires a leader and followers.

> everyone in our field

> fancies themselves a leader. Its the same problem at PCOM. I like

> Jack and Stacy's vision,

> but not everyone does and so the vision is never fulfilled. Everyone

> has their own ideas

> about what is right and that leads nowhere. That is why I harp over

> and over again about

> developing a consensus in the field and bemoan the fact that

> irreconcilable differences

> between key factions make this an unlikely conclusion. We can't move

> ahead without

> consensus and no consensus that does not involve outrageous

> compromises is possible

> within the current community. Stalemate.

>

 

>

[Guest guest]

 

 

In regard to you comments on emotions as the causative factor:

 

I too have pondered the dilemma you state below, how do we treat the person

without addressing the root cause (source of emotion), and are we qualified.

I do not think we are qualified, but it seems that due to the circular

nature of CM's emotional understanding (i.e. anger damages liver, liver

creates anger), one can treat such a condition through the physiological

matrix of CM. Meaning, one can allow the body to let these stressors or

emotions more smoothly flow through, unblocking the qi mechanism and the

patient then seemingly feels less stress or emotions, even though no

external change has occurred. The argument would be why get wrapped up in

psychobabble (although sometimes needed) when we can change the body's core

ability to process these emotions. Most people's outside environment is not

going to change, so they need to learn to deal with it as is, I think CM has

as good a chance at doing this as WM - psychology. I have plenty of people

that come in for emotional related problems and say that their normal stress

just doesn't seem as strong... The question for me is how to make this stick

without the herbs and acupuncture? One must retrain the patient through

these means, and this takes time, but so does WM's approach.

 

-

 

>

>

> Sunday, September 26, 2004 3:53 PM

> cha

> disease causes and disease mechanisms

>

> There is some confusion that lingers in some student's minds between

> disease causes and disease mechanisms. In light of several recent

> threads, I thought a more in depth look was warranted.

>

> Disease causes are the internal, external and miscellaneous causes of

> illness. They include emotions, external factors (including ideas

> similar to parasites, viruses and bacteria), diet, iatrogenesis,

> trauma, exercise, taxation.

>

> Disease mechanisms are the disruptions of physiology as understood in

> TCM terms that are CAUSED by one or more of the previous Disease

> causes. This is important. Causes lead to abnormal physiology.

>

> Finally, all symptoms are generated as a result of abnormal physiology.

> So while there is an interlocking network of causes and patterns,

> there is also a mandatory linearity to this scheme as well.

>

> Disease Causes >>>> Pathomechanisms >>>> Signs and Symptoms

>

> The main focus of the chinese herbal literature has been the treatment

> of the pathomechanisms and the signs and symptoms. While the causes of

> illness are often discussed, the main thrust of the translated

> premodern literature was on formulas to rectify the abnormal

> physiology. Extensive advice on nutrition or psychotherapy to address

> emotional imbalances was not the norm amongst herbalists. There seems

> to be a theme of generalized advice on diet that runs through

> mainstream medical texts. The plethora of books on chinese dietetics

> written through the centuries may well represent more of a popular than

> a medical tradition. Highly individualized dietary advice was clearly

> not central to works such as those of Zhu dan xi, though he admonished

> all patients to avoid alcohol plus overly greasy, spicy and sweet

> foods. Good advice, essential in fact, but not rocket science. My

> point is that Chinese medicine does not seem to have developed as

> highly evolved consensus on dietetics as on herbology. And that

> certain general commonsense advice may be all that is necessary.

>

> I would say the same is true of treating the spirit. First of all,

> causes of a spiritual nature are not listed amongst disease causes in

> the CM literature. Certainly causes of a mental/emotional nature are

> the internal causes, but emotions are not spiritual. To me, a

> spiritual cause of illness would be due to separation from spirit

> (cured by meditation) or bad karma (cured by good acts). Tibetan

> medicine talks about such things as well as demons, but the nei jing

> does not. In, the whole point of the nei jing is that disease has

> nothing to do with such things. My point here is that we must really

> stretch beyond the CM literature to find spirit as a central issue in

> medicine. Personally, I think the concepts of karma and demons are

> useful, but may come down to inherited defects and psychological trauma

> with more mundane explanations. The important thing to note is that

> some problems may not be curable and others may only be curable with

> direct intervention at the level of causation. Mainstream chinese

> herbal texts (modern or premodern) do not really address how to handle

> such causative factors directly.

>

> Let's consider the emotions. I think both disease causes and disease

> mechanisms must be treated to effect a cure or stable remission. So if

> emotions are the cause of an illness, herbs only treat the

> pathomechanism that are disturbed by those emotions. The herbs do not

> rectify the cause of those PM's. For example, if excess of any of the

> seven emotions disturbs the liver (the cause), then free coursing is

> disturbed (the pathomechanisms), leading to (hypothetically) ribside

> pain, plumpit qi and loose stool upon invasion of the spleen (the

> symptoms). If the emotions are due to an unresolved issue at work or

> or at home or due to some long buried trauma or existential angst, the

> herbs will not change that. The question is how is this cause

> eliminated? Again, the literature of the mainstream herbal tradition

> does not suggest this was a typical clinical emphasis. However there

> were doctors who specialized in types of psychotherapy, plus buddhist

> and daoist teachers who worked on this level. Nevertheless, no

> consensus developed. The only thing that seems clear is that typical

> mainstream texts were not very insightful about how to rectify this

> cause of illness.

>

> It is clear that stress and obesity, the two main causes of illness in

> the US, are interrelated and also related to addiction, violence and

> immune weakness, need to be treated directly to cure the ills the ail

> us. However Chinese medicine did not historically deal directly with

> either of these issues. In other words, we have no herbal formulas

> that make ones emotions go away or change the climate or make bad food

> good or give you a different boss or spouse. We only have formulas

> that address the PMs that arise when these causes overwhelm the zheng

> qi. Since mainstream CM has no history of dealing directly with the

> disease causes and modern TCM education does not give extensive

> training in psychotherapy or nutrition, what is the basis of one's

> clinical decisions in this area? PCOM's DAOM program does advanced

> training in psych assessment and tx, so this one solution for

> postgrads. But since CM is not highly evolved in these areas, we must

> defer to western modalities (psychology and nutrition) to some degree

> in deciding treatment.

>

> I think any insistence that CM is indeed highly evolved in these

> modalities is wishful thinking. While there are many texts on both

> topics, the deciding factor for me is what got integrated into

> mainstream practice and what did not. Only that which became

> mainstream satisfies the criteria that attracted me to CM in the first

> place - its long history of regular use was a reasonable alternative to

> modern research. But marginal methods do not meet this criteria, which

> is why I say the CM literature on diet and psychology is unevolved.

> Thus, unless one has made special advanced studies in these areas, I

> think referral is best course of action. We should be skilled at

> identifying the causes of illness, but recognize that others may be

> better at treating them in some cases. To reiterate, we are are the

> experts at treating pathomechanisms and s/s. We are also the experts

> at identifying the causes. If the cause is not removed the PMs will

> return. And in many cases, even if the cause is removed, the PM's may

> have become self-perpetuating. We should feel no shame if we focus

> ourselves narrowly on being experts at identifying the cause and

> rectifying the PMs. We can always refer out for psychology and

> nutrition.

>

> For example, a patient will get far more benefit from a personal

> trainer and nutritionist than from an acupuncturist for weight loss.

> Unless you are a personal trainer, don't waste your patient's money.

> Refer. You can see them monthly to address the PMs, but let the

> trainer handle the causes (and/or the psychologist if the cause is

> emotional). It is holistic to treat the PM's using pattern

> differentiation, but it may be unethical to try and treat the causes

> without special expertise in those areas that is not part of TCM

> training (yes, I know you all have your 2-3 counseling classes and 1

> nutrition class - that is not what I mean by expertise - you get little

> enough training in herbs and acupuncture in your internship; let's not

> delude ourselves and claim anyone develops expertise in nutrition and

> psychology during this time as well. It is in the patient's best

> interest to get the holistic care they need from experts in the

> modalities they are prescribed. TCM training does not and cannot

> provide such expertise. Arguably, current training is not adequate at

> training in the assessment and treatment of PMs and s/s.

>

> Two other topics jump to mind as a result of this discussion. The

> first is sort of a chicken and egg conundrum. What causes abnormal

> emotions if they are the causes of disease themselves? We have talked

> before about the confusion that has occurred between emotions as

> disease causes versus symptoms or chief complaints. We noted that,

> except for anger, none of the other emotions was a standard confirming

> symptom for any pattern in Sionneau. On the other hand, excessive Joy

> as a chief complaint is associated with heart patterns and excessive

> thinking with spleen pattern and so on. But only when the the aberrant

> emotion is the chief complaint. In other words, excess emotions can be

> chief complaints, but not confirming symptoms of any pattern.

> Overthinking can be caused by Spleen qi xu, but its presence does not

> confirm spleen qi xu at all. But how does the zang become imbalanced

> in the first place in order to generate the aberrant thinking. Is it

> constitutional or dietary or are emotions always first and zang fu

> disease second.

>

> I would say that one can certainly be born with imbalances that affects

> ones psyche. This is the concept of ayurvedic doshas. Such doshas

> lead to characteristic temperaments. So one might be predisposed to

> overthinking (spleen xu, damp or kapha dosha) by nature which leads to

> further worsening of natural tendencies in a vicious cycle. But on the

> other other hand, form a buddhist perspective, the emotions just arise.

> Sure, your inheritance may determine the nature of those emotions, but

> that is irrelevant. It is all just qi flow that the ego fixates on or

> not. When one fixates on these emotions, then they become excessive or

> stagnant. This leads to disease. Psychotherapy or meditation may help

> here. If the latter helps, then one might immediately think that is

> confirmation of there being a spiritual cure for emotional or physical

> symptoms. However, I would offer another hypothesis. That while the

> early stages of meditation do indeed lead to increased physical and

> emotional health (though often after crises), that is not the goal in

> and of itself and those changes are not permanent or cumulative as one

> progresses on the spiritual path.

>

> I think perhaps some of the confusion over what the word spiritual

> means in relation to medicine can be understood by reference

> patanjali's yoga sutras. In the sutras, the stages of spiritual

> development are described. At a certain stage, one develops robust

> physical health and even minor supernatural abilities. Ken Wilber

> considers this a normal development in all persons and the next phase

> in human evolution. However Patanjali has warned (and others have

> reiterated), that the purpose of this robust health was not for

> personal indulgence in egoic or carnal pursuits, but rather to bear the

> trials of spiritual cultivation in which the physical form would

> ultimately wither and be sacrificed. Now here's the rub, though. One

> could always choose to ignore the sutras and pursue what Patanjali

> thought was a dangerous path more likely to generate a huge karmic debt

> than lead to freedom from samsara (conversely in the aghora tantra

> tradition, the final freedom only came to those few who survived the

> so-called left hand path of egoism and carnality without being consumed

> by it). So while it was typically accepted that yoga and meditation

> could be used for solely physical gains, this was not typically

> considered a spiritual application of the methods and was in fact

> considered a distraction from the path of enlightenment. It was even

> thought that dallying on this path would insure many more lifetimes of

> rebirth. Now having said that, it was still one's choice and a

> perfectly valid one. For those who have experienced increased vigor

> through yoga and meditation, I would merely submit that this is

> expected and has nothing to do with spiritual cultivation, per se.

>

> Secondly, the issue of microbes. Microbes may be an important cause of

> many chronic illnesses. They are an exterior and miscellaneous factor

> that was at least hinted at in the premodern CM literature. I

> certainly find that in many patients the zang fu PMs cannot be

> rectified as long as there are microbiological imbalances. This ranges

> from candida to abnormal gut bacteria to low grade parasites (protozoa)

> to things like mycoplasma, EBV, HIV, h. pylori, etc. This may a cause

> that has exploded in modern times. CM has never developed the tools to

> detect these lurking pathogens while they lay hidden. And now in the

> modern age, CM has to consider whether certain modern tools provide

> answers to these questions. BTW, I know there are those who claim

> various signs identify lurking pathogens while they lurk (pulse or

> tongue, for example). I am merely restating the mainstream CM position

> that there is no consensus on this.

>

> Now the question in many minds is whether microbes cause zang fu

> imbalances or zang fu imbalances lead to microbial breeding grounds. I

> would say both. To choose either is just biased. CM already allows

> for exterior excess to be the starting point of chronic illness. I

> would suggest that this may be the case far more than we normally

> believe. Thus elevating the wen bing to new level of importance in

> modern American practice. My teacher Li Wei felt the wen bing xue was

> the most important TCM " classic " . A linkage of lurking pathogen and

> yin fire theory provides a powerful model for understanding the

> progression of chronic illness that may begin with microbial factors.

> Finally, at what point does one still treat the microbe/pathogenic

> factor with attacking therapies? Most lurking pathogens in the ying

> and blood phase are treated with supplementing, not attacking

> therapies. However, as noted in a previous post, many supplementing

> herbs have antimicrobial properties, so attacking (CM) and

> antimicrobial (WM) are not synonymous. OTOH, Liu does warn about

> supplementing in yin damage at the blood phase further trapping the

> pathogen, yet offers no strategy around this.

>

> When reading Warm Diseases, despite the amazing insights developed in

> this school, one cannot help but get this sense that the ideas of this

> school are not yet fully formed. That because they deal largely with

> infectious disease, a point Liu makes, and because it is a relatively

> new school of thought, that perhaps it could not have been until the

> modern era that it was fully developed. If someone came up with Warm

> disease theory today, purists would scream that they had copied WM.

> But wen bing precedes the WM germ theory. So why should we reject

> western methods of dx that may aid us in further understanding of wen

> bing just because those methods are not premodern. It is the

> application of modern methods that really developed the school of blood

> stasis. Just because western medicine went over the top on microbes,

> let's not go over the top on terrain. Another important avenue of

> integration may be to rescue the germ theory into a holistic immunity

> model before WM leads us into a nightmare of superbugs with thier

> rampant misuse of antibiotics.

>

>

>

> Chinese Herbs

>

>

> FAX:

>

>

>

[Guest guest]

>

>

>

> I have rarely seen a multidisciplinary clinic work. I have worked briefly

> in 4 failed ones

> over the past 12 years (hoping again and again that it was a good model).

> In my

> experience, there is very little referral and considerable guarding of

> patients. There is

> much more referral between people who do not compete directly for patient

> load with you.

> I have found an outside referal network to be far more conducive to good

> care than in

> house models. An in house model might work if all the parties were

> established. But

> usually such practices attract really hungry folks who prefer competition

> to cooperation.

> Established folks rarely leave their established practices for something

> " new " and those I

> have known who have joined such group clinics have almost always been

> sorry. A sad

> comment on human nature.

[Jason]

Before we give up hope, I would just like to mention I am in a very friendly

successful multidisciplinary practice (total 8 practitioners)... We often

refer to each other and things work out very well. IT is a mix between 20+

year practitioners and fairly new ones.

 

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