Research Showing Differences Between Chinese & Germans

[Guest guest]

It has long been my experience that Westerners present different

patterns in different proprotions than do Chinese. However, till now,

this belief has only been based on my personal experience treating

patients in China, India/Nepal, Europe & N. America. On pages 339-341

of issue #4, 2005 of Tian Jin Zhong Yi Yao (Tianjin &

Medicinals), Nei Long-dao (Gunter Neeb?), Ye Bi-xia, and Zhang Bo-li

published an article titled, " A Comparison of TCM Syndromes Between

Chinese & German Patients. " This article and the study on which it was

based statistically confirm that there are indeed differences in

pattern presentation between Chinese living in China and Westerners.

 

In this article, the authors compare 177 Chinese patients seen in

Tianjin with 212 patients seen in two cities in Germany. Among the 177

Chinese, there were 64 males and 113 females with an average age of

57.74 years. Among the 212 Germans, there were 76 males and 136

females with an average age of 52.74. Comparisons were made between

pulse images, tongue bodies and fur, and overall pattern

identifications. The following are some of the most notable discrepancies.

 

Pulse images:

 

44.35% of Chinese presented deep, confined, or deep-lying pulses

compared to only 8.96% of the Germans. (This is also my experience.)

 

3.45% of Germans presented with floating or soggy pulses compared to

only 0.56% of Chinese. (I also agree Western patients are more likely

than Chinese to present floating pulse images.)

 

32.55% of Germans presented vacuous, faint, or weak pulses compared to

only 13.84% of Chinese.

 

22.41% of Germans presented with choppy, short, forceful pulses

compared to only 1.98% of Chinese.

 

21.23% of Germans presented with choppy, short, forceless pulses

compared to only 2.82% of Chinese.

 

27.97% of Chinese presented fine or soft pulses compared to only 7.31%

of Germans.

 

Tongue bodies:

 

20.90% of Chinese presented with teeth-marks on their tongue edges

compared with 62.74% of Germans. (Also my experience.)

 

20.75% of Germans presented with red tongues compared to only 11.86%

of Chinese.

 

47.45% of Germans presented dark red tongues compared to only 10.73%

of Chinese. (Also my experience.)

 

38.98% of Germans presented with a red tongue tip compared to only

3.95% of Chinese. (Also my experience.)

 

Tongue fur:

 

59.32% of Chinese had thin tongue fur compared to 21.23% of Germans.

 

13.21% of Germans had thin, dry tongue fur compared to 1.69% of

Chinese, while 13.21% of Germans had thick, dry tongue fur compared to

1.13% of Chinese.

 

6.13% of Germans had peeled tongue fur compared to 0.56% of Chinese.

 

24.29% of Chinese had yellow tongue fur compared to 3.30% of Germans,

but 19.81% of Germans had white tongue fur in the front and yellow

tongue fur in the rear compared to 0% of Chinese.

 

Overall pattern identification:

 

50.94% of Germans presented a yang (qi) vacuity, while only 25.99% of

Chinese did.

 

28.77% of Germans presented a yang (qi) vacuity mixed with blood

stasis, but only 17.51% of Chinese did.

 

31.64% of Chinese presented a qi and yin dual vacuity compared to

20.75% of Germans.

 

While these cohort sizes are relatively small to conclusively

establish epidemiological incidences of patterns in comparative

populations, they do suggest that such differences do, in fact, exist.

 

According to the authors of this study, these differences suggest that

Chinese medicine taught in the West must have a strong basis in theory

and the generalities of pattern discrimination. In other words, simply

doing what Chinese typically might do in China will not necessarily

work in a Western setting. Western practitioners need to gather their

own experiences and the insights based on those experiences. If one

understands the logic inherent in the TCM methodology, one will not be

confused by these differences in presentation. One will still be able

to figure out the patient's pattern and compose an appropriate

treatment plan.

 

Bob

[Guest guest]

Bob

Good timing on your behalf to send this information. Thanks for translating

this for us. I couldn't agree more. What is interesting for me at the moment is

that I work and teach at a acup college in Auckland that is owned and run by

Chinese and has many Chinese students, either directly come from China to do the

course or have been here a few years and decide to study TCM. These Chinese

students also see mainly Chinese patients.

I have never compared pulses and tongues as the study did but certainly observed

differences in presenting patterns and problems. Many Chinese patients present

with simple pattern discrimination patterns as opposed to the NZ counterparts.

It is not uncommon for Chinese patients(and Korean) to present with just a few

basic symptoms to confirm one patterm. EG, blurred vision, floaters, numbness

and pale tongue and have no other symptoms!

The average NZ patient always has at least 3- 5 patterns knotted together. In

fact when the Chinese students have NZ patients they often comment/complain that

the case is difficult and can't work out the disagnosis!

 

And Bob from the study did you work out the typical German. Works hard and gets

Sp qi xu with teethmarks as well as lots of blood stasis and heat :-)

 

Heiko Lade

M.H.Sc.(TCM)

Lecturer and clinic supervisor

Auckland College of Natural Medicine

Website: www.acnm.co.nz

 

 

 

-

Bob Flaws

Tuesday, October 18, 2005 9:29 AM

Research Showing Differences Between Chinese & Germans

 

 

It has long been my experience that Westerners present different

patterns in different proprotions than do Chinese. However, till now,

this belief has only been based on my personal experience treating

patients in China, India/Nepal, Europe & N. America. On pages 339-341

of issue #4, 2005 of Tian Jin Zhong Yi Yao (Tianjin &

Medicinals), Nei Long-dao (Gunter Neeb?), Ye Bi-xia, and Zhang Bo-li

published an article titled, " A Comparison of TCM Syndromes Between

Chinese & German Patients. " This article and the study on which it was

based statistically confirm that there are indeed differences in

pattern presentation between Chinese living in China and Westerners.

 

In this article, the authors compare 177 Chinese patients seen in

Tianjin with 212 patients seen in two cities in Germany. Among the 177

Chinese, there were 64 males and 113 females with an average age of

57.74 years. Among the 212 Germans, there were 76 males and 136

females with an average age of 52.74. Comparisons were made between

pulse images, tongue bodies and fur, and overall pattern

identifications. The following are some of the most notable discrepancies.

 

Pulse images:

 

44.35% of Chinese presented deep, confined, or deep-lying pulses

compared to only 8.96% of the Germans. (This is also my experience.)

 

3.45% of Germans presented with floating or soggy pulses compared to

only 0.56% of Chinese. (I also agree Western patients are more likely

than Chinese to present floating pulse images.)

 

32.55% of Germans presented vacuous, faint, or weak pulses compared to

only 13.84% of Chinese.

 

22.41% of Germans presented with choppy, short, forceful pulses

compared to only 1.98% of Chinese.

 

21.23% of Germans presented with choppy, short, forceless pulses

compared to only 2.82% of Chinese.

 

27.97% of Chinese presented fine or soft pulses compared to only 7.31%

of Germans.

 

Tongue bodies:

 

20.90% of Chinese presented with teeth-marks on their tongue edges

compared with 62.74% of Germans. (Also my experience.)

 

20.75% of Germans presented with red tongues compared to only 11.86%

of Chinese.

 

47.45% of Germans presented dark red tongues compared to only 10.73%

of Chinese. (Also my experience.)

 

38.98% of Germans presented with a red tongue tip compared to only

3.95% of Chinese. (Also my experience.)

 

Tongue fur:

 

59.32% of Chinese had thin tongue fur compared to 21.23% of Germans.

 

13.21% of Germans had thin, dry tongue fur compared to 1.69% of

Chinese, while 13.21% of Germans had thick, dry tongue fur compared to

1.13% of Chinese.

 

6.13% of Germans had peeled tongue fur compared to 0.56% of Chinese.

 

24.29% of Chinese had yellow tongue fur compared to 3.30% of Germans,

but 19.81% of Germans had white tongue fur in the front and yellow

tongue fur in the rear compared to 0% of Chinese.

 

Overall pattern identification:

 

50.94% of Germans presented a yang (qi) vacuity, while only 25.99% of

Chinese did.

 

28.77% of Germans presented a yang (qi) vacuity mixed with blood

stasis, but only 17.51% of Chinese did.

 

31.64% of Chinese presented a qi and yin dual vacuity compared to

20.75% of Germans.

 

While these cohort sizes are relatively small to conclusively

establish epidemiological incidences of patterns in comparative

populations, they do suggest that such differences do, in fact, exist.

 

According to the authors of this study, these differences suggest that

Chinese medicine taught in the West must have a strong basis in theory

and the generalities of pattern discrimination. In other words, simply

doing what Chinese typically might do in China will not necessarily

work in a Western setting. Western practitioners need to gather their

own experiences and the insights based on those experiences. If one

understands the logic inherent in the TCM methodology, one will not be

confused by these differences in presentation. One will still be able

to figure out the patient's pattern and compose an appropriate

treatment plan.

 

Bob

 

 

 

 

 

Chinese Herbal Medicine offers various professional services, including board

approved continuing education classes, an annual conference and a free

discussion forum in Chinese Herbal Medicine.

 

 

 

 

 

[Guest guest]

A very interesting study, and a topic not covered very often.

 

Thanks for doing this, Bob.

 

 

On Oct 17, 2005, at 1:29 PM, Bob Flaws wrote:

 

> It has long been my experience that Westerners present different

> patterns in different proprotions than do Chinese. However, till now,

> this belief has only been based on my personal experience treating

> patients in China, India/Nepal, Europe & N. America. On pages 339-341

> of issue #4, 2005 of Tian Jin Zhong Yi Yao (Tianjin &

> Medicinals), Nei Long-dao (Gunter Neeb?), Ye Bi-xia, and Zhang Bo-li

> published an article titled, " A Comparison of TCM Syndromes Between

> Chinese & German Patients. " This article and the study on which it was

> based statistically confirm that there are indeed differences in

> pattern presentation between Chinese living in China and Westerners.

 

 

 

 

[Guest guest]

And Bob from the study did you work out the typical German. Works hard and gets

Sp qi xu with teethmarks as well as lots of blood stasis and heat :-)

>>>>

And let not forget that our patients cluster in many varying groups which makes

things even more confusing. I do not agree however that we can always work

through it using the basics, but we have little choice but to try.

 

 

 

 

Oakland, CA 94609

 

 

 

 

[Guest guest]

This is of course, an extremely important study and it touches on, if

not strikes directly at the writing that should get published and the

type of education that students and practitioners should receive. Lets

try to think this out in a beneficial way. What, since we now can

admit to the " knottiness " of the Western patient, do we need to do

research and create solutions for our patients?

doug

 

, " "

<zrosenbe@s...> wrote:

>

> A very interesting study, and a topic not covered very often.

>

> Thanks for doing this, Bob.

>

>

> On Oct 17, 2005, at 1:29 PM, Bob Flaws wrote:

>

> > It has long been my experience that Westerners present different

> > patterns in different proprotions than do Chinese. However, till now,

> > this belief has only been based on my personal experience treating

> > patients in China, India/Nepal, Europe & N. America. On pages 339-341

> > of issue #4, 2005 of Tian Jin Zhong Yi Yao (Tianjin &

> > Medicinals), Nei Long-dao (Gunter Neeb?), Ye Bi-xia, and Zhang Bo-li

> > published an article titled, " A Comparison of TCM Syndromes Between

> > Chinese & German Patients. " This article and the study on which it was

> > based statistically confirm that there are indeed differences in

> > pattern presentation between Chinese living in China and Westerners.

>

>

>

>

[Guest guest]

, " "

wrote:

What, since we now can

> admit to the " knottiness " of the Western patient, do we need to do

> research and create solutions for our patients?

 

 

I don't think that the Western patient is any more or less " knotty "

than the Asian patient, and I don't think the study demonstrated that

they were. Complex environmental factors may cause more knotty

disease in modern times than historically overall, but I don't think

that Western patients somehow have more complex physiology and

pathology than Eastern patients. The study showed that there is a

difference between which pathologies show up between the races, which

makes perfect sense and is also consistent with parallel observations

in Western medicine.

 

Heiko mentioned that many Chinese patients in her clinic had a more

textbook presentation when compared with the New Zealand locals.

However, Chinese people generally use phrases such as bitter mouth

(kou ku), oppression (men), and fear of cold (pa leng) much more

commonly than Westerners do. Each language has different habitual

phrases that it uses to describe human experience. Our books on TCM

are rooted in the Chinese expression of the human experience, so it is

only natural that their expression style fits the textbook more

closely. But it is not as though they somehow have fewer complex

environmental factors or have more streamlined physiology and less

complex disease.

 

This study is interesting. Bob, have you ever seen similar studies

done comparing Chinese patients of different localities? For example,

in Taiwan there is a much higher prevalence of red-tipped tongues than

was reported in the Chinese cohort of this study. However, we are

just coming out of summer and Taiwan is very hot in the summer. When

doctors come from Sichuan to teach in Taiwan, they constantly remark

on how the prevalence of damp disease is far higher in Sichuan

relative to Taiwan (though Taiwan is already reasonably damp). I have

also heard Taiwanese doctors say that they had never seen a ma huang

tang presentation until they travelled to Northern China.

 

Did this study use the PRC numerical rating scales for diagnosis?

 

Eric

[Guest guest]

On Oct 18, 2005, at 5:10 AM, Eric Brand wrote:

> When

> doctors come from Sichuan to teach in Taiwan, they constantly remark

> on how the prevalence of damp disease is far higher in Sichuan

> relative to Taiwan (though Taiwan is already reasonably damp).  I have

> also heard Taiwanese doctors say that they had never seen a ma huang

> tang presentation until they travelled to Northern China.

--

Eric,

 

I believe many mainland Chinese moved to Taiwan, and many of those

would have been from the Beijing area, after the revolution and the

ascension of Mao. Do you know whether anyone has done a study of

changes in family health patterns of these people in terms of Chinese

medicine?

 

Rory

 

 

[Guest guest]

, Rory Kerr <rorykerr@o...>

wrote:

> Eric,

>

> I believe many mainland Chinese moved to Taiwan, and many of those

> would have been from the Beijing area, after the revolution and the

> ascension of Mao. Do you know whether anyone has done a study of

> changes in family health patterns of these people in terms of Chinese

> medicine?

 

I don't know of any studies like this. There would be a variety of

confounding variables, though. The food is different, the economic

situation is different, the weather is different, and the healthcare

is different. I'd be interested to see such a study, but I don't know

whether or not one exists.

 

Eric

[Guest guest]

Did this research also describe the patient populations showing up at the

TCM clinic?

 

Our clinics are full of people who couldn't be helped by their first choice,

biomedicine. So our patients have complex syndromes that arise after years

of failed attempts at treatment and time for multiple syndromes to interact.

 

Might be nice to see the age breakdown on the two different patient

populations, too. Are they identical in terms of age and sex?

 

-al.

 

On 10/18/05, Eric Brand <smilinglotus wrote:

>

> , " "

> wrote:

> What, since we now can

> > admit to the " knottiness " of the Western patient, do we need to do

> > research and create solutions for our patients?

>

>

> I don't think that the Western patient is any more or less " knotty "

> than the Asian patient, and I don't think the study demonstrated that

> they were. Complex environmental factors may cause more knotty

> disease in modern times than historically overall, but I don't think

> that Western patients somehow have more complex physiology and

> pathology than Eastern patients. The study showed that there is a

> difference between which pathologies show up between the races, which

> makes perfect sense and is also consistent with parallel observations

> in Western medicine.

>

> Heiko mentioned that many Chinese patients in her clinic had a more

> textbook presentation when compared with the New Zealand locals.

> However, Chinese people generally use phrases such as bitter mouth

> (kou ku), oppression (men), and fear of cold (pa leng) much more

> commonly than Westerners do. Each language has different habitual

> phrases that it uses to describe human experience. Our books on TCM

> are rooted in the Chinese expression of the human experience, so it is

> only natural that their expression style fits the textbook more

> closely. But it is not as though they somehow have fewer complex

> environmental factors or have more streamlined physiology and less

> complex disease.

>

> This study is interesting. Bob, have you ever seen similar studies

> done comparing Chinese patients of different localities? For example,

> in Taiwan there is a much higher prevalence of red-tipped tongues than

> was reported in the Chinese cohort of this study. However, we are

> just coming out of summer and Taiwan is very hot in the summer. When

> doctors come from Sichuan to teach in Taiwan, they constantly remark

> on how the prevalence of damp disease is far higher in Sichuan

> relative to Taiwan (though Taiwan is already reasonably damp). I have

> also heard Taiwanese doctors say that they had never seen a ma huang

> tang presentation until they travelled to Northern China.

>

> Did this study use the PRC numerical rating scales for diagnosis?

>

> Eric

>

>

>

>

>

> Chinese Herbal Medicine offers various professional services, including

> board approved continuing education classes, an annual conference and a free

> discussion forum in Chinese Herbal Medicine.

>

>

>

>

>

>

>

[Guest guest]

OK, well perhaps you disagree with " knotty " and I won't argue that

point. But still you say there are " complex enviromental factors " in

modern times. And obviously this is not just a East/West issue now. Of

course the human body is the same between countries and eras and I

don't think anyone is saying that. But there are lifestyle issues and

pressures which I can see differing even between Germany and say...

Italy. I see this study as an opening in how to better apply CM to our

own patients.

But what I would like to discuss is how to put this into our

educational literature and education. My urgency is in asking what

form should the discussion of complex diseases take? How can we begin

to take our diagnostic tools, transform and apply them to a modern world?

doug

 

, " Eric Brand "

<smilinglotus> wrote:

>

> , " "

> wrote:

> What, since we now can

> > admit to the " knottiness " of the Western patient, do we need to do

> > research and create solutions for our patients?

>

>

> I don't think that the Western patient is any more or less " knotty "

> than the Asian patient, and I don't think the study demonstrated that

> they were. Complex environmental factors may cause more knotty

> disease in modern times than historically overall, but I don't think

> that Western patients somehow have more complex physiology and

> pathology than Eastern patients. The study showed that there is a

> difference between which pathologies show up between the races, which

> makes perfect sense and is also consistent with parallel observations

> in Western medicine.

>

> Heiko mentioned that many Chinese patients in her clinic had a more

> textbook presentation when compared with the New Zealand locals.

> However, Chinese people generally use phrases such as bitter mouth

> (kou ku), oppression (men), and fear of cold (pa leng) much more

> commonly than Westerners do. Each language has different habitual

> phrases that it uses to describe human experience. Our books on TCM

> are rooted in the Chinese expression of the human experience, so it is

> only natural that their expression style fits the textbook more

> closely. But it is not as though they somehow have fewer complex

> environmental factors or have more streamlined physiology and less

> complex disease.

>

> This study is interesting. Bob, have you ever seen similar studies

> done comparing Chinese patients of different localities? For example,

> in Taiwan there is a much higher prevalence of red-tipped tongues than

> was reported in the Chinese cohort of this study. However, we are

> just coming out of summer and Taiwan is very hot in the summer. When

> doctors come from Sichuan to teach in Taiwan, they constantly remark

> on how the prevalence of damp disease is far higher in Sichuan

> relative to Taiwan (though Taiwan is already reasonably damp). I have

> also heard Taiwanese doctors say that they had never seen a ma huang

> tang presentation until they travelled to Northern China.

>

> Did this study use the PRC numerical rating scales for diagnosis?

>

> Eric

>

[Guest guest]

Eric,

 

" I don't think that the Western patient is any more or less " knotty "

than the Asian patient, and I don't think the study demonstrated that

they were. Complex environmental factors may cause more knotty

disease in modern times than historically overall, but I don't think

that Western patients somehow have more complex physiology and

pathology than Eastern patients. The study showed that there is a

difference between which pathologies show up between the races, which

makes perfect sense and is also consistent with parallel observations

in Western medicine. "

 

I agree. The study had nothing to do with " knottiness. "

 

" Heiko mentioned that many Chinese patients in her clinic had a more

textbook presentation when compared with the New Zealand locals.

However, Chinese people generally use phrases such as bitter mouth

kou ku), oppression (men), and fear of cold (pa leng) much more

commonly than Westerners do. Each language has different habitual

phrases that it uses to describe human experience. Our books on TCM

are rooted in the Chinese expression of the human experience, so it is

only natural that their expression style fits the textbook more

closely. But it is not as though they somehow have fewer complex

environmental factors or have more streamlined physiology and less

complex disease. "

 

Your point about language is right on. This is why I have developed a

list of questions of my own for confirming certain common patterns,

i.e., signs and symptoms that my patients more readily relate to or

commonly mention.

 

" This study is interesting. Bob, have you ever seen similar studies

done comparing Chinese patients of different localities? "

 

No. That would also be interesting.

 

" Did this study use the PRC numerical rating scales for diagnosis? "

 

No. Nor did they cite their diagnostic criteria. For instance, they

did not define their pulse images.

 

Bob

[Guest guest]

Al,

 

" Might be nice to see the age breakdown on the two different patient

populations, too. Are they identical in terms of age and sex? "

 

You might read my posting again. There were cohort descriptions, and,

yes, I would say the two groups were statistically comparable in terms

of sex and age.

 

Bob

[Guest guest]

" But what I would like to discuss is how to put this into our

educational literature and education. My urgency is in asking what

form should the discussion of complex diseases take? How can we begin

to take our diagnostic tools, transform and apply them to a modern

world? "

 

doug,

 

You might want to check out my DL program on diagnosis. This is

exactly what I attempt to do for Western practitioners.

 

Bob

[Guest guest]

Al Stone wrote:

 

>Did this research also describe the patient populations showing up at the

>TCM clinic?

>

>Our clinics are full of people who couldn't be helped by their first choice,

>biomedicine. So our patients have complex syndromes that arise after years

>of failed attempts at treatment and time for multiple syndromes to interact.

>

>

>

This is a great point. I was wondering myself about the two groups'

relative degrees of pharmaceutical medicalization...for example, if

62.74% of Germans have tooth-marked tongue edges and a total of 68.2% of

them have either red or dark red tongues, there must be some overlap

there; but I think the only times I've seen a red or dark red tongue

that was also swollen and scalloped the patient was on prednisone or

some such. My experience is limited, though.

 

I also appreciate Eric's point about language and questioning. I'd be

interested in seeing Bob's Westerner-oriented questions, and a

discussion about them (wishful thinking?). Since all we have to go on

in diagnosing a patient is the combination of, on the one hand,

objective findings, which are often very subtle and, are, after all,

pretty damn subjective; and, on the other hand, the patient's subjective

reporting, and we know what unreliable witnesses they can be (I bet

we've all seen patients who say " no " to hypochondriac discomfort but you

can practically SEE it from their posture and their breathing...but a

bitter taste isn't something you can see).

 

(I do take issue, Eric, with your reference to " the races, " as race is,

as I understand, a pretty defunct category and, judging by the rest of

your comments, not what you really mean to say... " populations " maybe? or

perhaps " ethnic groups, " when one is emphasizing cultural differences

such as eating habits?... Just an aside, not an attack.)

 

Finally, Bob, I'm assuming that the patients were examined by the same

people? And thank you very much for sharing this information.

 

Nora

[Guest guest]

It's my suspicion that as China industrializes and imports more junk food

from abroad, that they will begin to see similar complexity of patterns in

Chinese people.

People in the U.S. who have a combination of junk food diets, environmental

toxic exposure, and heavy-metal toxicity always have the most complex

patterns. One way I make it easier on myself is to have such a client clean

up his or her diet before I even give herbs. Often, over 50% of the

symptoms and patterns resolve with this step alone, then the remaining 50%

can be more readily analyzed (pattern assessment).

 

If one examines the history of western herbalism in the U.S. one sees the

same trend toward more complex illnesses with industrialization, and former

simple remedies do not work as well for these conditions.

 

As industrialization on a massive scale began in countries like Germany and

England, it is not suprising that the extremes will be most dramatic there.

The science of epigenetics is revealing that environmental chemical

exposures, even if they do not necessarily cause genetic mutations, may

nevertheless cause transmission of health problems to at least several

generations, even if these latter generations are never exposed to the

original offending chemical toxins. (One mechanism is by DNA methylation.)

This observation suggests that environmental toxins leave a cumulative

burden on successive generations and is a much more serious problem that

even most environmentalists acknowledge.

 

I also agree with Bob conclusion that we cannot simply mimic what the

Chinese herbalists do. The patterns are more complex here and require

students be trained much more thoroughly in complex pattern recognition

skills. That's why we insist that all of our students, including ones who

have already completed a TCM college program, complete our TCM assessment

skills review, including use of special software that tests certain skills

in complex pattern recognition. Simplistic multiple-choice-type exam or

review questions ***DO NOT*** test these skills.

 

Several years ago I wrote an article on this problem, as it was frustrating

to deal with colleagues and students who did not take this complexity issue

seriously and blithely pretended that we could simple mimic the Chinese

model and everything would work out OK:

 

http://www.rmhiherbal.org/review/2002-2.html

Computer-aided instruction in TCM clinical analysis and

decision-making skills

 

 

Bob, is it possible that the translated article (Research Showing

Differences Between Chinese & Germans) could be permanently posted on some

webpage? I would like to be able to refer students and others to it. I

believe it is an important article that all TCM students should be aware

of.

 

 

---Roger Wicke, PhD, TCM Clinical Herbalist

contact: www.rmhiherbal.org/contact/

Rocky Mountain Herbal Institute, Hot Springs, Montana USA

Clinical herbology training programs - www.rmhiherbal.org

 

 

> " Heiko Lade " <heikolade.acnm

>Re: Research Showing Differences Between Chinese & Germans

>

>Bob

>Good timing on your behalf to send this information. Thanks for

>translating this for us. I couldn't agree more. What is interesting for

>me at the moment is that I work and teach at a acup college in Auckland

>that is owned and run by Chinese and has many Chinese students, either

>directly come from China to do the course or have been here a few years

>and decide to study TCM. These Chinese students also see mainly Chinese

>patients.

>I have never compared pulses and tongues as the study did but certainly

>observed differences in presenting patterns and problems. Many Chinese

>patients present with simple pattern discrimination patterns as opposed

>to the NZ counterparts. It is not uncommon for Chinese patients(and

>Korean) to present with just a few basic symptoms to confirm one patterm.

>EG, blurred vision, floaters, numbness and pale tongue and have no other

>symptoms!

>The average NZ patient always has at least 3- 5 patterns knotted together.

>In fact when the Chinese students have NZ patients they often

>comment/complain that the case is difficult and can't work out the

>disagnosis!

>

>And Bob from the study did you work out the typical German. Works hard and

>gets Sp qi xu with teethmarks as well as lots of blood stasis and heat

>:-)

>

>Heiko Lade

>M.H.Sc.(TCM)

>Lecturer and clinic supervisor

>Auckland College of Natural Medicine

>Website: www.acnm.co.nz

>

>

>

> -

> Bob Flaws

>

> Tuesday, October 18, 2005 9:29 AM

> Research Showing Differences Between Chinese & Germans

>

>

> It has long been my experience that Westerners present different

> patterns in different proprotions than do Chinese. However, till now,

> this belief has only been based on my personal experience treating

> patients in China, India/Nepal, Europe & N. America. On pages 339-341

> of issue #4, 2005 of Tian Jin Zhong Yi Yao (Tianjin &

> Medicinals), Nei Long-dao (Gunter Neeb?), Ye Bi-xia, and Zhang Bo-li

> published an article titled, " A Comparison of TCM Syndromes Between

> Chinese & German Patients. " This article and the study on which it was

> based statistically confirm that there are indeed differences in

> pattern presentation between Chinese living in China and Westerners.

>

> In this article, the authors compare 177 Chinese patients seen in

> Tianjin with 212 patients seen in two cities in Germany. Among the 177

> Chinese, there were 64 males and 113 females with an average age of

> 57.74 years. Among the 212 Germans, there were 76 males and 136

> females with an average age of 52.74. Comparisons were made between

> pulse images, tongue bodies and fur, and overall pattern

> identifications. The following are some of the most notable discrepancies.

>

....

 

> According to the authors of this study, these differences suggest that

> Chinese medicine taught in the West must have a strong basis in theory

> and the generalities of pattern discrimination. In other words, simply

> doing what Chinese typically might do in China will not necessarily

> work in a Western setting. Western practitioners need to gather their

> own experiences and the insights based on those experiences. If one

> understands the logic inherent in the TCM methodology, one will not be

> confused by these differences in presentation. One will still be able

> to figure out the patient's pattern and compose an appropriate

> treatment plan.

 

 

 

---Roger Wicke, PhD, TCM Clinical Herbalist

contact: www.rmhiherbal.org/contact/

Rocky Mountain Herbal Institute, Hot Springs, Montana USA

Clinical herbology training programs - www.rmhiherbal.org

[Guest guest]

" Finally, Bob, I'm assuming that the patients were examined by the same

people? "

 

Nora,

 

Yes.

 

Bob

[Guest guest]

" Bob, is it possible that the translated article (Research Showing

Differences Between Chinese & Germans) could be permanently posted on

some webpage? I would like to be able to refer students and others to

it. I believe it is an important article that all TCM students should

be aware of. "

 

Roger,

 

I have not translated the entire article, nor am I intending to -- at

least not at the present time. If I were to translate the entire

article, then it would probably become an article in the Blue Poppy

On-line CM Journal. However, if you or anyone wants to copy my

original post and republish it elsewhere, you have my permission.

 

Bob

[Guest guest]

, Nora <nora@h...> wrote:

 

> (I do take issue, Eric, with your reference to " the races, " as race is,

> as I understand, a pretty defunct category and, judging by the rest of

> your comments, not what you really mean to say... " populations "

maybe? or

> perhaps " ethnic groups, " when one is emphasizing cultural differences

> such as eating habits?... Just an aside, not an attack.)

 

All I said was: " The study showed that there is a

difference between which pathologies show up between the races, which

makes perfect sense and is also consistent with parallel observations

in Western medicine. "

 

I was simply referring to races because the article was constrasting

ethnically Chinese people in China vs. Germans. While Germany and

China both have substantial ethnic diversity, it seems that this

article was comparing Han Chinese with Germans (who, unlike the

Chinese cohort, did not appear to be specified as to their ethnicity).

In Tianjin province were the study was taking place, the population

is nearly exclusively Han. Racial differences in drug metabolism and

such are widely researched in Western medicine, so I assumed (possibly

incorrectly?) that the research concerned ethnicity.

 

At any rate, I'm sorry if I was inadvertantly un-PC. If I was, it was

entirely unintentional. To the contrary, I was taking issue with the

fact that others were suggesting that certain ethnic groups or

cultures were somehow more prone to " knotty " diseases than others.

Knotty diseases have been recognized for a long time, and all people

are equally subject to them.

 

I like all people from every place and every ethnic group, and would

love to see all of their knotty diseases resolved, so I assure you

that I have no ill-intentions with my wording! Please enlighten me as

to the current rules, I like to be PC.

 

Maybe it is a semantics issue? You are saying that I should be saying

populations or ethnic groups instead because race is a defunct

category. Is the word " race " substantially different than " ethnic

group " ? Merriam-Websters describes race as:

 

2 a : a family, tribe, people, or nation belonging to the same stock b

: a class or kind of people unified by community of interests, habits,

or characteristics <the English race>

 

Best,

Eric

[Guest guest]

An afterthought after I sent my previous reply:

 

I've heard a lot of American TCM students express dismay at their lack of

results in applying what they have been taught is standard TCM pattern

analysis to cases. When this fails, they desert the TCM model and flail

about, finally reverting to the simplistic paradigm of choosing herbs and

formulas for western biomedical diseases. (This is not likely to work that

well either in my experience.) Instead what they should be doing is

learning their TCM theory and **complex** pattern assessment skills, which

very few ever bother attempting to learn. A major part of successfully

applying complex pattern assessment skills includes understanding how

modern dietary and environmental factors interact with the TCM pattern

manifestions. This is also missing from most TCM training programs. We

heavily emphasize the latter in our own curriculum.

 

 

 

 

It's my suspicion that as China industrializes and imports more junk food

from abroad, that they will begin to see similar complexity of patterns in

Chinese people.

People in the U.S. who have a combination of junk food diets, environmental

toxic exposure, and heavy-metal toxicity always have the most complex

patterns of all. One way I make it easier on myself is to have such a

client clean up his or her diet before I even give herbs. Often, over 50%

of the symptoms and patterns resolve with this step alone, then the

remaining 50% can be more readily analyzed (pattern assessment).

 

If one examines the history of western herbalism in the U.S. one sees the

same trend toward more complex illnesses with industrialization, and former

simple remedies do not work as well for these conditions.

 

As industrialization on a massive scale began in countries like Germany and

England, it is not suprising that the extremes will be most dramatic there.

The science of epigenetics is revealing that environmental chemical

exposures, even if they do not necessarily cause genetic mutations, may

nevertheless cause transmission of health problems to at least several

generations, ***even if these latter generations are never exposed to the

original offending chemical toxins***. (One mechanism is by DNA

methylation.) This observation suggests that environmental toxins leave a

cumulative burden on successive generations and is a much more serious

problem that even most environmentalists acknowledge.

 

I also agree with Bob conclusion that we cannot simply mimic what the

Chinese herbalists do. The patterns are more complex here and require

students be trained much more thoroughly in complex pattern recognition

skills. That's why we insist that all of our students, including ones who

have already completed a TCM college program, complete our TCM assessment

skills review, including use of special software that tests certain skills

in complex pattern recognition. Simplistic multiple-choice-type exam or

review questions ***DO NOT*** test these skills.

 

Several years ago I wrote an article on this problem, as it was frustrating

to deal with colleagues and students who did not take this complexity issue

seriously and blithely pretended that we could simple mimic the Chinese

model and everything would work out OK:

 

http://www.rmhiherbal.org/review/2002-2.html

Computer-aided instruction in TCM clinical analysis and

decision-making skills

 

 

Bob, is it possible that the translated article (Research Showing

Differences Between Chinese & Germans) could be permanently posted on some

webpage? I would like to be able to refer students and others to it. I

believe it is an important article that all TCM students should be aware

of.

 

 

 

---Roger Wicke, PhD, TCM Clinical Herbalist

contact: www.rmhiherbal.org/contact/

Rocky Mountain Herbal Institute, Hot Springs, Montana USA

Clinical herbology training programs - www.rmhiherbal.org

[Guest guest]

, " Bob Flaws " <pemachophel2001>

wrote:

 

>

> According to the authors of this study, these differences suggest that

> Chinese medicine taught in the West must have a strong basis in theory

> and the generalities of pattern discrimination. In other words, simply

> doing what Chinese typically might do in China will not necessarily

> work in a Western setting. Western practitioners need to gather their

> own experiences and the insights based on those experiences. If one

> understands the logic inherent in the TCM methodology, one will not be

> confused by these differences in presentation. One will still be able

> to figure out the patient's pattern and compose an appropriate

> treatment plan.

 

 

 

It also raises the issue of genetic differences being a prominent factor in

presentation.

Some of the attributes you describe also do not change very much during

treatment. And I

am not just talking about my patients, but also my frequent observation of

hundreds of

other patients who were treated by other supposedly expert px in school clinics

in 3

different schools over a 19 year period. Patients who have toothmarked tongues

typically

will always have toothmarked tongues. Same with wiry pulses. These parameters

may

lessen a bit during treatment and exacerbate with certain behaviors, but they

never

disappear. This observation is one more piece of evidence that chinese

herbology has

most of its effects on symptoms, not underlying pathology. The value of pattern

differentiation is not that it leads to cure of organic illnesses, but that if

done properly,

allows the treatment of a wide range of presentations without causing

iatrogenesis. The

primary longterm benefits of TCM are not the rectification of mysterious

patterns of

imbalance, but rather something much more mundane. Many chinese formulas used

for

longterm use contain herbs that promote digestion and relaxation (such as

ginger, jujube

and licorice). Arguably most of the benefit of chinese herbs beyond symptoms

relief is

due to improved nutrition and sleep as a result.

 

[Guest guest]

When

doctors come from Sichuan to teach in Taiwan, they constantly remark

on how the prevalence of damp disease is far higher in Sichuan

>>>>

Also when they come to canton

 

 

 

 

Oakland, CA 94609

 

 

 

 

[Guest guest]

Eric

I think we see alot more diversity in cultures, diets, genetic makeups, etc.,

than in PRC. I do agree with you that Chinese do use the same langue we see in

text books. That struck me more than anything when i worked there.

 

 

 

 

Oakland, CA 94609

 

 

 

 

[Guest guest]

People in the U.S. who have a combination of junk food diets, environmental

toxic exposure, and heavy-metal toxicity always have the most complex

patterns.

>>>>>

Roger the environment in Chinese cities is much more toxic than US.

 

 

 

 

Oakland, CA 94609

 

 

 

 

[Guest guest]

I've heard a lot of American TCM students express dismay at their lack of

results in applying what they have been taught is standard TCM pattern

analysis to cases.

>>>>

Roger

The problem however is also true for PRC if one understand disease processes and

critically evaluates what one sees in PRC.Lets not shift to romantic posturing

 

 

 

 

Oakland, CA 94609

 

 

 

 

[Guest guest]

Again I apologize for unfortunately using knotty in my previous post,

collapsing Heiko's response into the mix. I appreciate both Roger and

Bob's efforts into the righting the situation. I've been taking the

Blue Poppy courses the last few days and they are really good. But it

is interesting that both Roger and Bob offer their own curriculum

through (on-line) classes. My concern is that for the most part the

books we are offered the same solutions for zang-fu issues that may or

may not be relevant for the Western clinician. And I agree with Roger

that often this drives the new practitioner into less than standard

herbal solutions (if not into less than standard acupuncture

techniques). I'm hoping for some considered opinions of how to

" mainstream " more difficult material into the student and practitioner

population (i.e. books).

doug

 

, rw2@r... wrote:

>

> An afterthought after I sent my previous reply:

>

> I've heard a lot of American TCM students express dismay at their

lack of

> results in applying what they have been taught is standard TCM pattern

> analysis to cases. When this fails, they desert the TCM model and flail

> about, finally reverting to the simplistic paradigm of choosing

herbs and

> formulas for western biomedical diseases. (This is not likely to

work that

> well either in my experience.) Instead what they should be doing is

> learning their TCM theory and **complex** pattern assessment skills,

which

> very few ever bother attempting to learn. A major part of successfully

> applying complex pattern assessment skills includes understanding how

> modern dietary and environmental factors interact with the TCM pattern

> manifestions. This is also missing from most TCM training programs. We

> heavily emphasize the latter in our own curriculum.

>

>

>

>

> It's my suspicion that as China industrializes and imports more junk

food

> from abroad, that they will begin to see similar complexity of

patterns in

> Chinese people.

> People in the U.S. who have a combination of junk food diets,

environmental

> toxic exposure, and heavy-metal toxicity always have the most complex

> patterns of all. One way I make it easier on myself is to have such a

> client clean up his or her diet before I even give herbs. Often,

over 50%

> of the symptoms and patterns resolve with this step alone, then the

> remaining 50% can be more readily analyzed (pattern assessment).

>

> If one examines the history of western herbalism in the U.S. one

sees the

> same trend toward more complex illnesses with industrialization, and

former

> simple remedies do not work as well for these conditions.

>

> As industrialization on a massive scale began in countries like

Germany and

> England, it is not suprising that the extremes will be most dramatic

there.

> The science of epigenetics is revealing that environmental chemical

> exposures, even if they do not necessarily cause genetic mutations, may

> nevertheless cause transmission of health problems to at least several

> generations, ***even if these latter generations are never exposed

to the

> original offending chemical toxins***. (One mechanism is by DNA

> methylation.) This observation suggests that environmental toxins

leave a

> cumulative burden on successive generations and is a much more serious

> problem that even most environmentalists acknowledge.

>

> I also agree with Bob conclusion that we cannot simply mimic what the

> Chinese herbalists do. The patterns are more complex here and require

> students be trained much more thoroughly in complex pattern recognition

> skills. That's why we insist that all of our students, including

ones who

> have already completed a TCM college program, complete our TCM

assessment

> skills review, including use of special software that tests certain

skills

> in complex pattern recognition. Simplistic multiple-choice-type exam or

> review questions ***DO NOT*** test these skills.

>

> Several years ago I wrote an article on this problem, as it was

frustrating

> to deal with colleagues and students who did not take this

complexity issue

> seriously and blithely pretended that we could simple mimic the Chinese

> model and everything would work out OK:

>

> http://www.rmhiherbal.org/review/2002-2.html

> Computer-aided instruction in TCM clinical analysis and

> decision-making skills

>

>

> Bob, is it possible that the translated article (Research Showing

> Differences Between Chinese & Germans) could be permanently posted

on some

> webpage? I would like to be able to refer students and others to it. I

> believe it is an important article that all TCM students should be aware

> of.

>

>

>

> ---Roger Wicke, PhD, TCM Clinical Herbalist

> contact: www.rmhiherbal.org/contact/

> Rocky Mountain Herbal Institute, Hot Springs, Montana USA

> Clinical herbology training programs - www.rmhiherbal.org

>