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1) Practitioners who hold the observation of the movements of psyche

as of fundamental importance in their diagnostic and treatment style

are a bunch of self-inflated New Age flakes who arrogantly impose

their own belief systems on their clients.

 

2) Practitioners who don't practice within a self-described

" spiritual " context are ignorant boors who are only treating on a

superficial level and are therefore not able to " really " heal their

clients; they are inferior physicians.

 

 

What if neither of these statements is true? Can we celebrate the

richness of our diverse practice styles? If we are interested, we may

learn a great deal from each others' diverse ways of mapping the

terrain; if we are not interested, at the very least we can respect

the legitimacy of styles unlike our own.

 

I am interested in looking how our modes of discussion may contribute

towards furthering either greater learning among us, or greater

divisiveness and discord. I think that as a community we must be very

careful to note, in ourselves, when we are becoming polemical in our

discourse, and return to a clear intent of explication and

exploration. In such a mode of discourse we seek only greater and

greater intelligibility of both our own and our partners'

understandings-- because the insights which come out of this process

are more likely to further knowledge and discernment, rather than the

increase of entrenchment in our original positions.

 

Polemical discourse holds differences as primary, and insists on

either/or. By contrast we could choose a more heterodox model,

rigorous but capable of sustaining many paths of legitimate practice.

Somewhat like an octopus with many legs, if we begin by focusing on

what is centrally held in common by our styles, we can observe the

ways in which our " style divergences " remain internally consistent

with the core principles of Chinese medical practice, even as they

diverge in expression.

 

For instance, " treating the pattern " is a core principle which we hold

in common--- but as point of divergence from this common principle,

Trevor has written eloquently about the importance of treating not

only the pattern but also the disease. Sharon has written equally

eloquently about treating not only the pattern but also the

constitution.

 

It is not either/or, although some practitioners may find themselves

gravitating far more towards a constitutional approach, while others

become disease specialists. What folly it would be to debate about

which is the right way? We need both in measure, and our differences

of personal temperament make it more profitable for everyone for each

of us to practice according to our strongest abilities. This is a

good thing, not a weakness in the profession.

 

Treat the pattern. Sure. We agree on this. But some practitioners

are more adept at discerning the pattern by means of the pulse, while

others are more adept at palpating the hara. Nobody can be a master

of every method; what folly would it be to insist that one way is

inherently better than another---- when our own capacities (as well

as the happenstance of our access to various teachers) often dictates

our personal methods of expertise? Some people have an affinity for

pulse, and with their training they can do what needs to be done

primarily via pulse to discern the pattern. Others, because their

expertise is greater in the realm of palpation (whether because of

greater affinity or more training), will use palpation to accomplish a

similar level of discernment.

 

There is nothing wrong with these differences. They enrich us.

 

I submit that the same might be said about those who do or do not

observe movements of the psyche as primary indicators for pattern

discernment. If I am highly trained to detect from someone's voice

and coloration and odor and body posture etc a specific kind of grief

that leads me to further question their lung, this is just as much in

the service of pattern diagnosis as abdominal palpation. We all learn

different tools.

 

I deeply regret that arrogance of, for instance, much of the 5 element

community has left many people with an expectation that practitioners

who have been trained to pay close and discerning attention to

movements of psyche as diagnostic indicators means that we ignore the

physical pattern manifestations, or just consider ourselves God's gift

to Chinese medicine. It is not so. If we hold in common that we

treat the pattern, and then we explore from this common ground the

many means by which we may discern the pattern, and the many means by

which we treat and transform it, perhaps we might find that our

differences give us as much cause to appreciate each other as our

points of agreement.

 

Thea Elijah

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1) Practitioners who hold the observation of the movements of psyche

as of fundamental importance in their diagnostic and treatment style

are a bunch of self-inflated New Age flakes who arrogantly impose

their own belief systems on their clients.

 

2) Practitioners who don't practice within a self-described

" spiritual " context are ignorant boors who are only treating on a

superficial level and are therefore not able to " really " heal their

clients; they are inferior physicians.

 

Lonny: Thea, I merely criticized the inappropriateness of the term

" psycho-spiritual " which conflates two unrelated realms. I also suggested that,

in fact, the larger macrocosmic view congruent with a spiritual perspective

contextualizes the medicine which it does seem to as regards the structure of

the language and the texts themselves.

 

The movements of psyche, as fascinating as they may be to some, have little to

nothing to do with the realm of the heart that Mr. Hur Jun points to except to

indicate denial and ignorance of that which he, and the texts state is higher.

As I've said, there is a lot of humility to go around and the level of practice

we are being pointed to may well elude most, or even all of us, but it's still

the center of the target.

 

Please do not put words in my mouth through exaggerating my position. I have

respect for a very wide range of traditions and perspectives. It's the unfounded

assertions that Spirit " S " is not a part of the historic tradition or a part of

" the Main stream professional practice of Medicine " based on culturally biased

and seemingly blind " scholarship " that I take exception to. And additionally, to

the absurd declarations that " no one one will listen to you if you can't read

Classical Chinese.

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Lonny, I was not writing for your eyes only... Please take as

applying to yourself only shoes that actually fit.

 

For instance although I would certainly define your writing style as

polemical, I by no mean conflate your work or your position with that

of the entire 5 Element community-- in which there are many examples

of folks who " treat the spirit " in a completely psychologically

symptomatic manner, utterly devoid of any responsible attention to the

physical pattern of disharmony signs or the Heart as a reflection of

Heaven. Based on some specific examples from the past correspondence

of Eric, Jason, and Sharon, I suspect that many people here have been

exposed to some pretty silly work done in the name of " spirit, " and

that their understandable disgust with such behavior is part of what

fuels their perspective.

 

I am not putting words in your mouth, because, for better or worse, I

am not considering you to be the only spokesperson for these issues.

My exaggeration of both positions was deliberate, and not personal to

you.

 

 

Thea Elijah

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Thea,

 

Thank you very much for requesting that we check ourselves for civility. I

will certainly commit to that, and invite anyone to tell me what they may

find polemical. I also believe that I have both the right and the

responsibility to share what I've learned in studying and practicing Chinese

medicine. While I agree that there has been considerable contentious

expression for the past few weeks, I haven't found that congested yang an

entirely bad thing. It has helped me bring various ideas into stark relief,

and inspired even greater clarity. Perhaps, the problem is that we actually

have less agreement than we realize.

 

I can say quite honestly and calmly that I do not treat patterns in any

sense. Of course, I recognize patterns. How could I not after going through

an entire training program in modern TCM? Yet, for my mind, they aren't a

vital part of the process. I'm often looking for different information in

differentiating symptoms and signs. I'm looking to differentiate what

aspects of clinical expression are due to pathogenic factors and what

aspects are the intrinsic responses of the individual's qi. I do a process

of disentangling the internal nature of the individual's clinical expression

to identify the nature and " location " of blocks. I treat the blocks. Now, we

all know (at the core of CM theory) blocks in the flow of qi cause disease,

yet we're trained to treat the patterns, so we treat patterns. Many astute

practitioners have found various ways to enhance that basic approach, and I

agree their work is valuable and important. However, I don't believe that's

the only legitimate way to enrich the basic theory of symptom-sign

complexes.

 

For me, the five systems of channels and vessels are far more than another

collection of information; it is, as I have tried to say, a different way of

thinking. It suggests a world of movements, which is rather different from

the " naive " world of common sense, especially for people who grew up in the

modern world. We think of ourselves as living in a solid world of things

that obeys the laws of physics and chemistry, rather than as a fluid,

dynamic, and responsive world. I take our challenge in practicing Chinese

medicine is seeing how it can be both, and indeed we can learn to stimulate

changes in how our patients process their vital interactions in life, so

that they heal -- actually reversing or resolving the disease. The great

challenge we all face is: How do we determine such treatments?

 

Of course, this is where it gets sticky. Many hard working and passionate

practitioners of Chinese medicine continue to be students for prolonged

periods, some for their entire lives. Yet, they don't all follow the same

method for engaging their studies of CM. There have been several

participants in our conversation that think the only legitimate way to study

Chinese medicine is to learn to read Chinese and study historical writings.

I have written several times that I appreciate the translations that many

devoted practitioners are doing, and I know our profession is improving

through their efforts. Yet, I also believe there are other abilities that

one can cultivate in deepening one's understanding of Chinese medicine.

 

I apologize if I've offended anyone. In reflecting on the nature of this

online discussion (which is rather new to me), I'm finding the lack of

personal contact challenging. Yet, I also appreciate the strong challenges

many have offered to me. They have forced me to greater clarity. I have not

tried to suggest that my approach to Chinese medicine is better than any

other, only that it's a legitimate option which offers different ways of

analyzing and differentiating an individual's pathological process. Thank

you all for your kind attention,

 

Steve

CCMforHealing.com

 

On Thu, Mar 4, 2010 at 2:37 PM, Thea Elijah <parkinglotwrote:

 

>

>

> Lonny, I was not writing for your eyes only... Please take as

> applying to yourself only shoes that actually fit.

>

> For instance although I would certainly define your writing style as

> polemical, I by no mean conflate your work or your position with that

> of the entire 5 Element community-- in which there are many examples

> of folks who " treat the spirit " in a completely psychologically

> symptomatic manner, utterly devoid of any responsible attention to the

> physical pattern of disharmony signs or the Heart as a reflection of

> Heaven. Based on some specific examples from the past correspondence

> of Eric, Jason, and Sharon, I suspect that many people here have been

> exposed to some pretty silly work done in the name of " spirit, " and

> that their understandable disgust with such behavior is part of what

> fuels their perspective.

>

> I am not putting words in your mouth, because, for better or worse, I

> am not considering you to be the only spokesperson for these issues.

> My exaggeration of both positions was deliberate, and not personal to

> you.

>

> Thea Elijah

>

>

>

 

 

 

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Evolution takes creative friction. As far as I'm concerned the goal of

discourse, in fact of all human endeavor isn't " peace " but " clarity " and

" change " . Of course it's important to be respectful. But, as recognized by

James, there is also an important place for polemics which serve to define the

absolute centers around which a discourse is based. I echo Steve's sentiments

that such a discourse helps to focus what I know and what I don't, what I'm

committed to and what I'm not.

 

I don't see the value in considering that " every perspective has something to

offer " . Evolution is a messy business and the point is to strive toward truth.

Not a truth that is a matter of perspective, not a consensus, but Truth. I think

it's reasonable to define the poles of discourse and let readers understand the

issues and to seek for the Truth in their own experience.

 

I readily concede that translators provide one leg of the stool that may serve

as the foundation for a meaningful and integrated practice of medicine. Of

course, one has to navigate the terrain as different schools of translators

arrive at different conclusions and bring different values to their work.

 

What I reject wholesale is the Catholic notion that a certain school of

translators will mediate between us and " the One True Tradition " that is

" Standard accepted professional TCM " (Blue meme absolutism, artificial dominator

hierarchies). And that every other interpretation is a footnote subject to

" evidence based testing " (orange meme, Cartesian values: helpful, but hardly a

cutting edge perspective).

 

At this point, it seems what can be said, has been said for the record and this

discussion has been thoroughly explicated. I have met several people through the

discussion who evidence the rare balance of both authentic scholarship and the

possession of an open and inquiring and developing mind, and I am always

thankful for that.

 

Straight Ahead, Lonny

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Steve,

 

 

 

Just for the record, I do not think anyone on the list has ever suggested

that the " only legitimate way to study Chinese medicine is to learn to read

Chinese and study historical writings. "

 

The only point that I have seen being made is that if one is going to try to

weigh in on *interpretations* of classical Chinese texts (especially when

they re are not common) that such a person be able to actually read the

texts. As logical as this may seem, for some odd reason, this seems to be in

debate. In this bizarro world anyone that has an opinion about how to

translate a term as equal say. I just think about what universities who

specialize in sinology think about our methodology. But to each their own,

my point has already been made...

 

 

 

For the record, I spend most my time with modern (usually prior 1960s)

/pre-modern texts (qing dynasty), not classical texts. I find that this is

where the most juice is, because these doctors have devoured the classical

texts on a level that I personally will never be able to achieve and have

run it through the clinical mill. Honestly though, if one had a good teacher

one can learn Chinese medicine without accessing any historical writings or

reading Chinese -- who can deny this?. But it is my experience, that when

researching topics of specific personal interest, accessing such texts can

give a deeper insight. There just is more variety of opinions and quite

simply more literature written in Chinese than English. However, there are

plenty of good modern (even books out within the last five years) Chinese

texts that give great clinical perspectives.

 

 

 

Anyway, I don't think anyone can argue with Steve here that there are " other

abilities that one can cultivate in deepening one's understanding of Chinese

medicine. " And I think we all know that there are many roads. I guess my

challenge with Steve's approach, which sounds great for acupuncture, is how

does this apply to herbal medicine? There are many many acupuncture

theories, and for some reason, they all seem to work. However this is a

whole different ballgame when we start talking about prescribing herbs. I

would love to hear a little bit more explanation, maybe a case study, on how

Steve applies his approach to herbal medicine and how this differs from

basic Chinese medicine theory.

 

 

 

 

 

-Jason

 

 

 

 

On Behalf Of Steven Alpern

Thursday, March 04, 2010 8:48 PM

 

 

 

There have been several

participants in our conversation that think the only legitimate way to study

Chinese medicine is to learn to read Chinese and study historical writings.

I have written several times that I appreciate the translations that many

devoted practitioners are doing, and I know our profession is improving

through their efforts. Yet, I also believe there are other abilities that

one can cultivate in deepening one's understanding of Chinese medicine.

 

I apologize if I've offended anyone. In reflecting on the nature of this

online discussion (which is rather new to me), I'm finding the lack of

personal contact challenging. Yet, I also appreciate the strong challenges

many have offered to me. They have forced me to greater clarity. I have not

tried to suggest that my approach to Chinese medicine is better than any

other, only that it's a legitimate option which offers different ways of

analyzing and differentiating an individual's pathological process. Thank

you all for your kind attention,

 

Steve

CCMforHealing.com

 

 

 

 

 

 

 

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For instance although I would certainly define your writing style as

polemical,

 

Lonny: I'm not sure this is a fair characterization. It's clear that the

position " Only those who fluently read Classical Chinese are in a position to

determine what real Chinese medicine is " is an absolutist position. I've merely

suggested that there are other interpretations than those ascribed by one school

of thought and provided sound evidence that this is so. It strikes me as

unreasonable to characterize this position as " polemic " . Still, as I said in

another post I think there is a valid place for such discourse.

 

And, what are you going to do, concede the earth may not be round because a few

people insist repeatedly that it is not?

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Lonny: It's clear that the position " Only those who fluently read Classical

Chinese are in a position to determine what real Chinese medicine is " is an

absolutist position.

 

 

 

Jason: The question is what is " real " CM? Some people like SHL, some TCM,

some modern, some Qing, some Han, and some wenbing. IMHO it is all " real "

and it all works. I personally have no opinion to what is " real. " But

clearly some people have a more accurate view of what was going on

*classically* then others.

 

If one wants to discuss classical Chinese medicine and what specific

characters mean in a specific time period then yes I believe one should have

access to the source material with commentaries and dictioanries. The only

way to have access to this time period's material is to read Chinese. Quite

simply the commentary that explains these issues just has not yet been

translated.

 

 

 

Without such access, study, and knowledge it is like 5 stock brokers

sitting around and trying to weigh in on an archeological dig. Yes they all

might have theories, and some might have even have read some journal

articles on the topic, but none of them will actually be taken seriously by

the PhD's who actually know how to interpret the bones and artifacts that

they are looking at.

 

 

 

Just because someone feels like they should have a say, does not

automatically make their opinion valid. I find it odd that scholarship is

rejected in this conversation, like it is some evil entity suppressing the

truth. This is completely mind boggling and would be laughed at in most any

other field except some metaphysical one's. Wait maybe that is how some

people view CM??? I feel some parts of this conversation purely about

philosophy and the oneness of heaven but really never talk about anything

tangible.

 

 

 

Actually think back 15-20 years when there was but 1 very poorly translated

SHL book. Do you think with that one book one could actually have a

realistic interpretation of this text? No way. Think about the huge leap we

made when Mitchell & Wiseman's contribution with commentary was released. We

also now have people like Dan Bensky & Mitchell (who have PhD's in the SHL)

and Arnaud and Huang Huang lecturing at a high level bringing us more

clarity. Our understanding is now light years beyond what it was 20 years

ago. This jump took scholarship and language skills that were simply not

present 20 years ago. These people accessed commentaries that are not

available in English.

 

 

 

Unfortunately this type of knowledge and scholarship does not exist for

things like the Nei Jing. We currently do not even have a accurate

translation. There are so many commentaries that one must be able to access

if you think to are going to get in the ring with the big boys. Nei Jing

experts in China spend their lives deciphers the issue we speak about. One

can ignore them in favor of more new age interpretations, and that is fine,

but this is not scholarship.

 

 

 

So to be clear no one is saying " Only those who fluently read Classical

Chinese are in a position to determine what real Chinese medicine is " - that

is distorting the point. But if one wants to talk specific Nei Jing

interpretations, you must step up. Otherwise it is like these Westerners 20

years ago trying to tell Liu Du-Zhou (SHL expert) how it really is and the

stock broker yapping his mouth sell sell I bean dinosaur bone buffalo bone.

Ha.

 

 

 

 

 

-Jason

 

 

 

 

 

 

 

 

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Jason,

 

As I've said, there are significant translators and clinicians who

disagree with your conclusions. I have no doubt you could translate Hur Jun's

work in a way that supports your thesis and probably find a historical figure or

two that agrees with you. Best of luck in your studies. I'll be getting back to

creating the future of the medicine.

 

See you the next go round.

 

 

Regards, Lonny

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Well Jason, my " approach, which sounds great for acupuncture " is exactly the

same as I use for herbal medicine. Differential diagnosis is differential

diagnosis, whether one does it for acupuncture or for herbs. Classifying the

manifestations of distress into symptom-sign complexes is the barest of

beginnings in my process of differential diagnosis; I focus my attention on

disentangling the nature of clinical expressions, and discerning the process

of evolution and transformation of pathogenic factors. That entails

understanding how external pathogenic factors penetrate and how the embodied

spirit reacts to them; and for internal pathogenic factors how they are

displaced from conscious awareness and somatized into physical humors to be

stored.

 

External and internal pathogenic factors typically accumulate for some time,

before they generate overt pathology, and I like the theoretical framework I

use to reflect that basic and fundamental fact. It effects how I think about

both diagnosis and devising treatment strategies, regardless of which

modality of Chinese medicine I'm considering at any moment. While Jason

appears to suggest that he now wants to learn something of how I practice by

asking for a case study, his request is actually worded as a challenge:

 

Jason: my challenge with Steve's approach, which sounds great for

acupuncture, is how

does this apply to herbal medicine? There are many many acupuncture

theories, and for some reason, they all seem to work. However this is a

whole different ballgame when we start talking about prescribing herbs. I

would love to hear a little bit more explanation, maybe a case study, on how

Steve applies his approach to herbal medicine and how this differs from

basic Chinese medicine theory.

 

Steve: Well, there's a serious teleological problem here! Theories don't

work, treatments do. And treatments don't CAUSE healing, they stimulate the

" patient's " intrinsic capacity to heal. We've grown far to used to thinking

of acupuncture as " treatments " and herbs as supplements (as they are legally

classified), and at least Jason seems to forget that they are both meant to

simply stimulate changes and transformations in how the patient's embodied

spirit is processing his or her vital interactions of life. And, by they

way, not all theories are equivalent in their ability to discriminate

different situations and stimulate practitioners in coming up with incisive

and effective treatment strategies.

 

If you (or anyone else) wants to see how I think about cases, you might

check out my posting in response to Sean's questions four days ago about a

patient who appeared to catch colds after treatments. I've seen that sort of

thing hundreds of times during the past dozen years, since I've learned to

focus on stimulating wei qi, rather than treating the syndrome/disease to

diminish symptomatic expression. While Jason's request for a case seems

reasonable on the surface, I'm concerned that providing them may be

counter-productive. I can write up lots of cases, because I understand what

happened with those patients, but those same treatments wouldn't work with

another person, even with the " same " pattern and disease. They were designed

for that person at that time.

 

Further, Jason (or someone else) may read my cases and think they

understand, but I can assure you they do not. This is just one of those

things one has to do and see for oneself in order to really understand it.

I'm currently teaching a four weekend series of seminars as a " primer " on

the five systems of channels and vessels to help practitioners trained in

modern TCM expand that theoretical framework, so they can start working with

patients in this manner. I give out lots of handouts, so participants aren't

just scrambling to write down new ideas; instead we spend a fair amount of

time in each seminar focusing on specific clinical skills to help

participants start working with CM as I'm suggesting. While it takes

considerable discrimination to devise truly individual treatments that

stimulate responsiveness, rather than controlling expression, they are also

(in my experience) the most effective.

 

However, Jason does have a point that the historical development of

acupuncture and herbal medicine have been rather different. The history of

herbal medicine has been relatively cumulative, since the first important

herbal texts of Zhang Zhongjing nearly 2000 years ago. Yet, there remain

important commentators, such and Xu Dachun, who have decried the

modernization of Chinese medicine (primarily since the Song Dynasty) for

many centuries. On the other hand, since that period, acupuncture theory has

been severely distorted by Imperial fiat, and modern CM clinical doctrine

continues subject to the limitations they imposed. A little more historical

perspective might be helpful, especially when the way we're taught to

practice has been so substantially impacted by various historical

developments.

 

Steve

CCMforHealing.com

 

 

 

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Steve,

 

 

 

Please do not take my request as some strange challenge of sorts. When I

stated " my challenge " it was simply referring to " my " issue (/challenge)

with trying to understand your thinking not a *challenge* to you. Quite

simply, as stated, the way you describe your methodology makes sense to me

from acupuncture perspective but I am having a hard time understanding it

from an herbal perspective. In my practice, I actually use completely

different theoretical system when I practice acupuncture then when I

practice herbs -- so differential diagnosis can be drastically different

depending on the system.

 

 

 

It is my experience, the West has a extremely wide range of acupuncture

theories and applications. Somehow, everyone is getting " results " . This has

been a topic of past discussions on the CHA. My take is acupuncture just

works. Because people see results and have vivid imaginations we come up

with all sorts of explanations. This is fine, but when it comes to herbs

there is much less room for BS.

 

 

 

That being said, I still would like to see a case study. Case studies

essentially are one of the most important aspects in studying Chinese

medicine. They are not meant to show a specific treatment for a specific

disease, but more importantly or to demonstrate the thinking of a specific

practitioner. I do not think anyone on this list would expect to use your

treatment for their patients.

 

 

 

I am sure your seminar is chock-full of examples, but unfortunately myself,

and probably most people on the list, cannot make it. Therefore, it is only

reasonable if one wants to demonstrate their methodology, to present a case

study.

 

 

 

Because of my belief in the importance of case studies, I pretty much have

dedicated my website to presenting case studies from famous doctors

throughout history. These case studies are not about learning how to treat a

specific disease but more importantly learning how a specific doctor thinks

and to broaden one's perspective essentially thinking in a different way.

This is precisely why I asked for case studies for someone like Hur Jun. How

exciting would it be to see this guy actually practice, unfortunately we

only now have what writings he has left behind. People say all sorts of

things in introductions to books, but how they take that information and

actually apply it in the clinic is most interesting to me. Without this

step, it is all just lip service. Case studies takes the theoretical and

demonstrate how it is applied clinically.

 

 

 

I looked for the clinical example Steve mentioned from four days ago in

relation to herbs but cannot find it. Did I miss it? Can someone repost it?

 

 

 

However I do find it odd that you state that people who read your case

studies might think they understand, but you can assure us that they do not.

Well, this makes me even more interested. I have read thousands of case

studies from doctors from all time periods, from both the West and East.

Granted, there are always small intricacies and idiosyncratic ideas that may

be difficult to understand, but since they are all using Chinese herbs and

we are talking about Chinese medicine one can usually, with some thought,

figure out quite a bit of how this doctor was thinking. Sometimes this

requires commentary which is often provided. There is no reason why, any of

us, including Steve, cannot present a case study that we can all learn

something from. This is where one's commentary can be helpful and may be

essential in Steve's cases. Therefore I must completely disagree that

providing case studies is " counter-productive. " It is essential to growing

and learning about new ideas in Chinese medicine. Without it we just have a

bunch of theoretical talk.

 

 

 

For some idea in how I provide commentary so others could understand my

thinking (in a case study) check out

 

Case Study: Malaria Like Syndrome due to a Lurking Pathogen or

 

Lurking Pathogens - Three Modern Case Studies at

 

Chinese Medicine/practitioners/articles/

 

 

 

 

 

Maybe some of us just feel a little shy in presenting such material. However

I want to encourage everyone out there to type up their case studies and

present them. I am offering Steve an open invitation to submit his personal

case studies to the CHA and if he so desires I will add it to my website

under modern Western case studies.

 

 

 

-

 

 

 

 

 

 

On Behalf Of Steven Alpern

Saturday, March 06, 2010 9:36 AM

 

Re: Re: polemics

 

 

 

 

 

Well Jason, my " approach, which sounds great for acupuncture " is exactly the

same as I use for herbal medicine. Differential diagnosis is differential

diagnosis, whether one does it for acupuncture or for herbs. Classifying the

manifestations of distress into symptom-sign complexes is the barest of

beginnings in my process of differential diagnosis; I focus my attention on

disentangling the nature of clinical expressions, and discerning the process

of evolution and transformation of pathogenic factors. That entails

understanding how external pathogenic factors penetrate and how the embodied

spirit reacts to them; and for internal pathogenic factors how they are

displaced from conscious awareness and somatized into physical humors to be

stored.

 

External and internal pathogenic factors typically accumulate for some time,

before they generate overt pathology, and I like the theoretical framework I

use to reflect that basic and fundamental fact. It effects how I think about

both diagnosis and devising treatment strategies, regardless of which

modality of Chinese medicine I'm considering at any moment. While Jason

appears to suggest that he now wants to learn something of how I practice by

asking for a case study, his request is actually worded as a challenge:

 

Jason: my challenge with Steve's approach, which sounds great for

acupuncture, is how

does this apply to herbal medicine? There are many many acupuncture

theories, and for some reason, they all seem to work. However this is a

whole different ballgame when we start talking about prescribing herbs. I

would love to hear a little bit more explanation, maybe a case study, on how

Steve applies his approach to herbal medicine and how this differs from

basic Chinese medicine theory.

 

Steve: Well, there's a serious teleological problem here! Theories don't

work, treatments do. And treatments don't CAUSE healing, they stimulate the

" patient's " intrinsic capacity to heal. We've grown far to used to thinking

of acupuncture as " treatments " and herbs as supplements (as they are legally

classified), and at least Jason seems to forget that they are both meant to

simply stimulate changes and transformations in how the patient's embodied

spirit is processing his or her vital interactions of life. And, by they

way, not all theories are equivalent in their ability to discriminate

different situations and stimulate practitioners in coming up with incisive

and effective treatment strategies.

 

If you (or anyone else) wants to see how I think about cases, you might

check out my posting in response to Sean's questions four days ago about a

patient who appeared to catch colds after treatments. I've seen that sort of

thing hundreds of times during the past dozen years, since I've learned to

focus on stimulating wei qi, rather than treating the syndrome/disease to

diminish symptomatic expression. While Jason's request for a case seems

reasonable on the surface, I'm concerned that providing them may be

counter-productive. I can write up lots of cases, because I understand what

happened with those patients, but those same treatments wouldn't work with

another person, even with the " same " pattern and disease. They were designed

for that person at that time.

 

Further, Jason (or someone else) may read my cases and think they

understand, but I can assure you they do not. This is just one of those

things one has to do and see for oneself in order to really understand it.

I'm currently teaching a four weekend series of seminars as a " primer " on

the five systems of channels and vessels to help practitioners trained in

modern TCM expand that theoretical framework, so they can start working with

patients in this manner. I give out lots of handouts, so participants aren't

just scrambling to write down new ideas; instead we spend a fair amount of

time in each seminar focusing on specific clinical skills to help

participants start working with CM as I'm suggesting. While it takes

considerable discrimination to devise truly individual treatments that

stimulate responsiveness, rather than controlling expression, they are also

(in my experience) the most effective.

 

However, Jason does have a point that the historical development of

acupuncture and herbal medicine have been rather different. The history of

herbal medicine has been relatively cumulative, since the first important

herbal texts of Zhang Zhongjing nearly 2000 years ago. Yet, there remain

important commentators, such and Xu Dachun, who have decried the

modernization of Chinese medicine (primarily since the Song Dynasty) for

many centuries. On the other hand, since that period, acupuncture theory has

been severely distorted by Imperial fiat, and modern CM clinical doctrine

continues subject to the limitations they imposed. A little more historical

perspective might be helpful, especially when the way we're taught to

practice has been so substantially impacted by various historical

developments.

 

Steve

 

 

 

 

 

 

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>Steve: Well, there's a serious teleological problem here! Theories don'twork,

treatments do. And treatments don't CAUSE healing, they stimulate the " patient's "

intrinsic capacity to heal. We've grown far to used to thinkingof acupuncture as

" treatments " and herbs as supplements (as they are legally classified), and at

least Jason seems to forget that they are both meant to simply stimulate changes

and transformations in how the patient's embodied spirit is processing his or

her vital interactions of life. And, by they way, not all theories are

equivalent in their ability to discriminate different situations and stimulate

practitioners in coming up >with incisive and effective treatment strategies.

Yea right! this has always been a wonderful way to dance with the unknown.Why do

spiritual answers always want to separate the thought from the finger that

pulled the trigger?It works together in this world, spirit and flesh are not

separate here, your never going to get real till you deal with it on this level.

>Further, Jason (or someone else) may read my cases and think theyunderstand,

but I can assure you they do not. This is just one of thosethings one has to do

and see for oneself in order to really understand it.I'm currently teaching a

four weekend series of seminars as a " primer " onthe five systems of channels and

vessels to help practitioners trained inmodern TCM expand that theoretical

framework, so they can start working >with patients in this manner.

So why bother coming to the seminar?

Patrick

--- On Sat, 3/6/10, Steven Alpern <stevenalpern wrote:

 

Steven Alpern <stevenalpern

Re: Re: polemics

 

Saturday, March 6, 2010, 8:36 AM

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Well Jason, my " approach, which sounds great for acupuncture " is exactly

the

 

same as I use for herbal medicine. Differential diagnosis is differential

 

diagnosis, whether one does it for acupuncture or for herbs. Classifying the

 

manifestations of distress into symptom-sign complexes is the barest of

 

beginnings in my process of differential diagnosis; I focus my attention on

 

disentangling the nature of clinical expressions, and discerning the process

 

of evolution and transformation of pathogenic factors. That entails

 

understanding how external pathogenic factors penetrate and how the embodied

 

spirit reacts to them; and for internal pathogenic factors how they are

 

displaced from conscious awareness and somatized into physical humors to be

 

stored.

 

 

 

External and internal pathogenic factors typically accumulate for some time,

 

before they generate overt pathology, and I like the theoretical framework I

 

use to reflect that basic and fundamental fact. It effects how I think about

 

both diagnosis and devising treatment strategies, regardless of which

 

modality of Chinese medicine I'm considering at any moment. While Jason

 

appears to suggest that he now wants to learn something of how I practice by

 

asking for a case study, his request is actually worded as a challenge:

 

 

 

Jason: my challenge with Steve's approach, which sounds great for

 

acupuncture, is how

 

does this apply to herbal medicine? There are many many acupuncture

 

theories, and for some reason, they all seem to work. However this is a

 

whole different ballgame when we start talking about prescribing herbs. I

 

would love to hear a little bit more explanation, maybe a case study, on how

 

Steve applies his approach to herbal medicine and how this differs from

 

basic Chinese medicine theory.

 

 

 

Steve: Well, there's a serious teleological problem here! Theories don't

 

work, treatments do. And treatments don't CAUSE healing, they stimulate the

 

" patient's " intrinsic capacity to heal. We've grown far to used to thinking

 

of acupuncture as " treatments " and herbs as supplements (as they are legally

 

classified), and at least Jason seems to forget that they are both meant to

 

simply stimulate changes and transformations in how the patient's embodied

 

spirit is processing his or her vital interactions of life. And, by they

 

way, not all theories are equivalent in their ability to discriminate

 

different situations and stimulate practitioners in coming up with incisive

 

and effective treatment strategies.

 

 

 

If you (or anyone else) wants to see how I think about cases, you might

 

check out my posting in response to Sean's questions four days ago about a

 

patient who appeared to catch colds after treatments. I've seen that sort of

 

thing hundreds of times during the past dozen years, since I've learned to

 

focus on stimulating wei qi, rather than treating the syndrome/disease to

 

diminish symptomatic expression. While Jason's request for a case seems

 

reasonable on the surface, I'm concerned that providing them may be

 

counter-productive. I can write up lots of cases, because I understand what

 

happened with those patients, but those same treatments wouldn't work with

 

another person, even with the " same " pattern and disease. They were designed

 

for that person at that time.

 

 

 

Further, Jason (or someone else) may read my cases and think they

 

understand, but I can assure you they do not. This is just one of those

 

things one has to do and see for oneself in order to really understand it.

 

I'm currently teaching a four weekend series of seminars as a " primer " on

 

the five systems of channels and vessels to help practitioners trained in

 

modern TCM expand that theoretical framework, so they can start working with

 

patients in this manner. I give out lots of handouts, so participants aren't

 

just scrambling to write down new ideas; instead we spend a fair amount of

 

time in each seminar focusing on specific clinical skills to help

 

participants start working with CM as I'm suggesting. While it takes

 

considerable discrimination to devise truly individual treatments that

 

stimulate responsiveness, rather than controlling expression, they are also

 

(in my experience) the most effective.

 

 

 

However, Jason does have a point that the historical development of

 

acupuncture and herbal medicine have been rather different. The history of

 

herbal medicine has been relatively cumulative, since the first important

 

herbal texts of Zhang Zhongjing nearly 2000 years ago. Yet, there remain

 

important commentators, such and Xu Dachun, who have decried the

 

modernization of Chinese medicine (primarily since the Song Dynasty) for

 

many centuries. On the other hand, since that period, acupuncture theory has

 

been severely distorted by Imperial fiat, and modern CM clinical doctrine

 

continues subject to the limitations they imposed. A little more historical

 

perspective might be helpful, especially when the way we're taught to

 

practice has been so substantially impacted by various historical

 

developments.

 

 

 

Steve

 

CCMforHealing. com

 

 

 

 

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As I see it, two things typically get in the way of productive discussion:

 

1. Whatever a person focuses their energy on is of importance to them

and the more energy and time they invest, the more committed they

become. In addition, there is an ever growing tendency to wonder why

others cannot understand the value of investing their energy and

awareness in the same direction. Hence, positions tend to harden and

antennas become very sensitive to perceived heresy.

 

2. It is becoming extremely rare for even two people separated in time

and space to have agreed upon touchstones for establishing the truth

of a perspective, procedure, or fact when there is disagreement. It

is even rarer for a widely dispersed group.

 

The western science community has tried to establish their touchstones

on double blind random controlled clinical trials and peer review but

even there money, prestige and lack of a solid understanding of these

principles is continually leading to real communication problems.

 

I have no easy solutions to overcoming these obstacles except to

recognize them and try to hold to the time honored traditions of open

mindedness, forbearance and civility.

 

Ideally as practitioners, our touchstones would be clinical efficacy

and patient improvement. Unfortunately, usually all we have are

self-reports of each other's effectiveness. Anyone who has spent

anytime thinking and studying such matters knows that self-reporting

is notoriously biased and unreliable.

 

This is particularly a problem in TCM as most of us are in private

practice and only gather for symposiums and courses.

 

Since effectiveness with patients is the true ground of our practice,

and objective reporting is the only real way to progress, we have a

real challenge as a community.

 

 

 

--

Duncan E

 

" We are here to help each other get though this thing, whatever it is. "

-Mark Vonnegut

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Jason,

 

Thank you for your well reasoned appeal for me to share case studies, and

your gracious invitation to post my cases on your site. While I'm willing to

dialogue about the logic I use in making conclusions regarding those cases,

I'd rather provide my own commentary where it may be needed.

 

I agree that acupuncture thinking and herbal thinking are somewhat

different, yet is there not still a unifying search to understand what is

happening with the patient? Thank you for not taking offense to my comment

that while I can explain my cases, I don't believe that reading them alone

will allow others to understand them. This is a very challenging concept for

me to clearly articulate. In the past I've mentioned a thinking process that

I consider vital, and that just stirred a lot of heat on this list. Yet,

there really is something that I'm trying to say, so I'll try again.

 

At root, I believe that pathogenic factors accumulate -- that they are

typically tolerated to some extent, before they lead to overt pathological

expression. Certainly, with respect to internal pathogenic factors that is

easy to recognize. People have emotional stagnations, and just tolerate

them. Well, I think the same happens with external pathogenic factors in

many people -- they accumulate in a slow gradual way, until the individual

can no longer continue to tolerate them. Anyway, when unresolved pathogenic

factors accumulate, they don't just sit there, they transform and progress.

They change -- that is the nature of life, as clearly discussed in texts

such as Shanghanlun.

 

So, when diagnosing a patient, I seek to dig back down through the strata of

reactions, adaptations and accommodations to find the nature of the

" original " pathogenic factor(s). Whether I'm trying to devise an acupuncture

strategy or an herbal one, that process of what I've called in the past

" sorting out " symptoms and signs is the same. I'm trying to figure out the

dynamics of what's happening in any individual patient. When I can do that,

I can focus my treatment on facilitating what the patient's intrinsic

responsiveness is trying to do, but has been unable to do because of some

block, without suppressing it's efforts.

 

My point about having a lot of clinical practica in my seminars was to

address the experiential aspect of this process of interaction with the

patient through the five systems of channels, and the subtle thinking

process that evolves from it. Others can read what I write, and they still

have to learn for themselves to look beneath what appears to present in a

patient to what's at the origin of the patient's distress. While I certainly

acknowledge this idea is not unique to me, I believe it's at the core of

virtually every patient with chronic, recurrent, progressive, or

degenerative disease manifestations, so I consider it central to

differential diagnosis.

 

Thanks for your kind attention, and Jason especially for the invitation. I'm

currently away from home, so don't have access to charts from which I can

write up cases. When I return home late this week, I'll pull out some cases

to write up, though I may also be particularly busy with patients for a few

days. However, I must caution you that I combine acupuncture and herbs in my

practice, and am not always clear how the therapies interact in individuals

to stimulate healing. In the meantime, you may wish to read my first essay

for AT, which was called " In Defense of Case

Studies<http://www.ccmforhealing.com/wp-content/uploads/2009/08/In-Defense-of-Ca\

se-Studies.pdf>. "

In that essay I made the point that having " prospective " cases, where the

patient has been evaluated by medical doctors, is particularly valuable.

Indeed, I'm mostly interested in cases where medical experts claim that

nothing can be done.

 

Steve

 

On Sat, Mar 6, 2010 at 5:41 PM, <

> wrote:

 

>

>

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Ultimately, we must recognize that case studies are much more about the

willingness of “patients†to transform their lives than they are about the

power or

effectiveness of particular practitioners or treatment methods.

This is in my opinion the root of almost all healing.

This paper is very good, thank you Steven

Patrick

--- On Sun, 3/7/10, Steven Alpern <stevenalpern wrote:

 

Steven Alpern <stevenalpern

Re: Re: polemics

 

Sunday, March 7, 2010, 8:03 AM

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Jason,

 

 

 

Thank you for your well reasoned appeal for me to share case studies, and

 

your gracious invitation to post my cases on your site. While I'm willing to

 

dialogue about the logic I use in making conclusions regarding those cases,

 

I'd rather provide my own commentary where it may be needed.

 

 

 

I agree that acupuncture thinking and herbal thinking are somewhat

 

different, yet is there not still a unifying search to understand what is

 

happening with the patient? Thank you for not taking offense to my comment

 

that while I can explain my cases, I don't believe that reading them alone

 

will allow others to understand them. This is a very challenging concept for

 

me to clearly articulate. In the past I've mentioned a thinking process that

 

I consider vital, and that just stirred a lot of heat on this list. Yet,

 

there really is something that I'm trying to say, so I'll try again.

 

 

 

At root, I believe that pathogenic factors accumulate -- that they are

 

typically tolerated to some extent, before they lead to overt pathological

 

expression. Certainly, with respect to internal pathogenic factors that is

 

easy to recognize. People have emotional stagnations, and just tolerate

 

them. Well, I think the same happens with external pathogenic factors in

 

many people -- they accumulate in a slow gradual way, until the individual

 

can no longer continue to tolerate them. Anyway, when unresolved pathogenic

 

factors accumulate, they don't just sit there, they transform and progress.

 

They change -- that is the nature of life, as clearly discussed in texts

 

such as Shanghanlun.

 

 

 

So, when diagnosing a patient, I seek to dig back down through the strata of

 

reactions, adaptations and accommodations to find the nature of the

 

" original " pathogenic factor(s). Whether I'm trying to devise an acupuncture

 

strategy or an herbal one, that process of what I've called in the past

 

" sorting out " symptoms and signs is the same. I'm trying to figure out the

 

dynamics of what's happening in any individual patient. When I can do that,

 

I can focus my treatment on facilitating what the patient's intrinsic

 

responsiveness is trying to do, but has been unable to do because of some

 

block, without suppressing it's efforts.

 

 

 

My point about having a lot of clinical practica in my seminars was to

 

address the experiential aspect of this process of interaction with the

 

patient through the five systems of channels, and the subtle thinking

 

process that evolves from it. Others can read what I write, and they still

 

have to learn for themselves to look beneath what appears to present in a

 

patient to what's at the origin of the patient's distress. While I certainly

 

acknowledge this idea is not unique to me, I believe it's at the core of

 

virtually every patient with chronic, recurrent, progressive, or

 

degenerative disease manifestations, so I consider it central to

 

differential diagnosis.

 

 

 

Thanks for your kind attention, and Jason especially for the invitation. I'm

 

currently away from home, so don't have access to charts from which I can

 

write up cases. When I return home late this week, I'll pull out some cases

 

to write up, though I may also be particularly busy with patients for a few

 

days. However, I must caution you that I combine acupuncture and herbs in my

 

practice, and am not always clear how the therapies interact in individuals

 

to stimulate healing. In the meantime, you may wish to read my first essay

 

for AT, which was called " In Defense of Case

 

Studies<http://www.ccmforhe aling.com/ wp-content/ uploads/2009/ 08/In-Defense-

of-Case-Studies. pdf>. "

 

In that essay I made the point that having " prospective " cases, where the

 

patient has been evaluated by medical doctors, is particularly valuable.

 

Indeed, I'm mostly interested in cases where medical experts claim that

 

nothing can be done.

 

 

 

Steve

 

 

 

On Sat, Mar 6, 2010 at 5:41 PM, <

 

@chinesemed icinedoc. com> wrote:

 

 

 

>

 

>

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

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