There is a Rhyme and a Reason
December 8, 2008 at 12:54 am | In Chinese Medicine, Herbal Medicine, Modern Research, Science | Leave a CommentTags: Chinese Medicine, Herbal Medicine, jargon, Skepticism, Theory
While I don’t like to go on about reductionism and its assumed evils and so forth, there are grains of truth in these criticisms.
There is a difference between a complex, open (interconnected) system and a small, (relatively) closed system – the former is like the weather, and the latter is like a motor vehicle. I believe we are all familiar with the viscissitudes of weather forecasting, and yet, on the other hand, how generally reliable and unperplexing our vehicles are.
In essence, the first system cannot be reduced without losing its essential complexity and interrelatedness, while the second one can (for a deeper discussion on the relative aspects of this idea, click here). This means that in order to understand a complex, open system, it must be met in its arena of effect. Reducing the arena changes the game and damages the data irretrievably.
In a previous post (Herb Comparable to Prednisone), I wrote about how the oversimplification of Chinese Medical principles tended to damage the effectiveness of the intervention, sometimes completely, and how it was important to understand that in Chinese Medicine we do things for a reason.
More careful research can illuminate some of these reasons, and I would like to provide you with a brief glimpse into one of these investigations:
Chinese Medicine almost always uses herbal combinations rather than single herbs, not only because a single herb has a weak effect, but because herbs can act in synergistic or antagonistic ways to each other (amongst other effects). Thus a properly constructed formula with the individual patient in mind provides a superior effect than the administration of a single herb, or of a non-individualised formula.
The following graph from the Biological and Pharmaceutical Bulletin (2003;26(7):911-919) dramatically illustrates this phenomenon:
The blood concentration of wagonoside from HuangQinTang was twice as high as that of HuangQin alone.
HuangQin Tang is a Chinese Herbal Combination, Huang Qin is merely the lead herb.
HuangQin Tang contains: huáng qín, huáng lián, gé gēn, and zhì gān cǎo.
This type of investigation makes two points:
1. There is a reason that herbal combinations are the standard of care in CM.
2. Deconstructing an open, complex system is fraught with dangers if the aim is to illuminate the true mechanisms or energetic dynamics of said system.
In the western world, and even the eastern world, too much effort has been spent on “identifying” the one herb in a formula which provides the effect, and then further “isolating” “active ingredients” in order to provide the end-user with a “real” medicinal in a “more potent” form for, ostensibly, superior clinical effect.
It’s as if a scientist wanted to provide us with a better vehicle, and decided the active ingredient was the piston, made us a big giant piston to use and acted all proud.
It is my hope that our understanding of the ancient and wise medical systems of this world becomes much more mature in the next short little while.
Incidentally, HuangQin Tang is primarily used for something called “Damp-Heat in the Lower Burner”, one manifestation of which is dysentery. Years ago, a chemical called “berberine” was isolated from another herb in this formula, huáng lián, and used in cases of dysentery. And yes, you guessed it, it doesn’t work as well as HuangQin Tang for the indicated condition.
Oh well.
Diagnosis
November 13, 2008 at 4:45 pm | In BioMedicine, Chinese Medicine | Leave a CommentTags: jargon, Terminology
Question: Does anyone know what Trichotillomania is? My daughter was diagnosed with this recently. Any help is appreciated.
Response: Oh gosh. Trichotillomania. How obscenely stupid. I wonder if this syndrome is further differentiated based on whether it is the left or right hand that’s doing the pulling, or if there is a naming convention that takes into account how many strands of hair are in each fistful, and how many, thereof, are dyed, split-ended or glossy?
There is one good thing about this obsessive compulsion to give long, stupid names to diseases, and that is that the name for fear of long names is Hippopotomonstrosesquippedaliophobia.
Anyway, on to something useful, I hope:
Apart from being all technically technicacious about our patients, we shouldn’t forget to be human. While we must be very careful to mind our manners, ethics, scope of practice and personal limitations, be not afraid to be human. If someone is pulling their hair out, ask yourself, what in god’s dreaming heaven would cause ME to pull out my mane. Start from there, and you may find a way to delicately tease out (part, just enough) of a painful story to inform your pattern diagnosis, and perhaps give the girl and her family a better result than something who blindly, meaninglessly tries to treat for liver qi, or phlegm misting the heart.
In a case like this, it might be most important to find out what started it. I just had a patient in the other week with bad chest pain who responded not at all to western medicine, a very competent naturopath or a very heartfelt osteopath, and yet responded in my clinic (with a 100% reduction in pain after 20 minutes), in my humble opinion, because I asked her what was going on when this started (thirty years ago when she was 17). And when she said “nothing”, I gently said, “something”. And eventually she “mentioned”, by the by, that her boyfriend, when she was 16, had tried to kill her. I gently, over the course of our conversation, explained about some possible connections, placed some needles in her, and she seemed to relax, cry, and begin a new stage in her life. Not my credit, I credit it to being human, and trying to keep the old sages in mind.
(excerpted from an online forum conversation)
CPR – Cardio Pulmonary Resuscitation
November 13, 2008 at 2:29 am | In Chinese Medicine, History Lesson, Modern Health-Care | Leave a CommentTags: CPR, History
I have something to say:
CPR saves lives. It is an excellent resuscitation technique:
Millions of people receive CPR training each year, and its use has been shown to increase the survival rate of people who are suffering from otherwise fatal conditions.
CPR is used in a variety of situations, including drug overdose, near drowning and electrical shock. It is also used when a person has entered cardiac arrest, or the heart has stopped beating (most often due to an abnormal heart rhythm called ventricular fibrillation). Patients may avoid sudden cardiac death if they receive CPR until emergency medical help arrives (who may use a defibrillator to restore a natural heart rhythm).
A Brief History of CPR
1891: The first external cardiac massage in the Western world was reported to be done successfully by Friedrich Maass.
1960: Kowenhoven and Knickerbocker reported their method in JAMA that chest compression was accepted as a method of resuscitation for cardiac arrest.
1966: The first guideline for CPR was published.
1970: Teaching the lay public to do CPR was started.
1974: American Heart Association (AHA) formally promoted the practice involving the combination of rescue breathing and external cardiac massage for cardiac arrest in a ratio of 2:15.
2005: Ewy in Arizona showed that hands-only CPR, at a rate of 100 per minute until the emergency crew armed with automated cardiac defibrillators arrive, was superior to the traditional method of CPR.
The AHA was hesitant to accept Ewy’s idea in their new guidelines for CPR in 2005, but as a compromise, recommended a ratio of 2 breaths to 30 chest compressions instead.
2007: In March The Lancet reported a Japanese study on a series of over 4000 cases in Tokyo, comparing traditional CPR to hands-only CPR by bystanders. The results showed that the latter was more successful in the resuscitation of cardiac arrest with preservation of neurological function.
2008: In April, the AHA finally gave its approval on hands-only CPR from bystanders.
Oh wait, I forgot something – Chinese Medicine has been practicing CPR since at least 403 BC:
A more complete History of CPR
403-221 BC: (Warring Kingdoms period) External cardiac massage was practised as a method of resuscitation for victims of suicide by hanging. Some credited this to Bian Que.
6 BC – 221 AD: (Eastern Han Dynasty) The first description of CPR for resuscitation of victims of hanging came from Zhang Zhongjing.
In his Essence of the Golden Chest, miscellaneous therapy #23, he described the method as follows: “Lower the victim gently, don’t just cut the rope, and lie him on the blankets. One person should put his feet against the shoulders of the victim and pull on his hair, rendering it taut (to open the airway). One person should put his hands on the victim’s chest and compress rhythmically (external cardiac massage). One person should flex and extend the victim’s limbs (to promote venous return). One person should press on the victim’s abdomen (to enhance intrathoracic pressure during external cardiac massage). ….This method is the best and usually successful.”
Zhang Zhongjing’s writings were handed down and read by Chinese physicians through the centuries.
1186-1249 AD: (Sung Dynasty) The above passage in Essence of the Golden Chest was cited by Sung Ci in his book on forensic medicine “Washing Away of Wrongs (Xi Yuan Ji Lu)”, which is recognized as the first book of forensic medicine in the world and has been translated into many languages both in Asia and Europe.
If you read the description of CM CPR carefully, you will see that there is no mention of rescue breathing.
CM has been teaching the better form of CPR for over 2400 years.
The above two histories are very slightly abridged and are courtesy of Am An Zhang, Child Psychiatrist and Author of “The Cockroach Catcher”, which is a very interesting book and available at online bookstores, including lulu.com.
Tongue Diagnosis
October 22, 2008 at 10:40 pm | In Chinese Medicine | Leave a CommentTags: Tongue Diagnosis
I am commonly asked why I look at a tongue and what it is I look for. The tongue, for some reason, shows a tremendous amount of variation which is consistently associated with the presenting signs and symptoms of a patient.
A tongue’s shape, coating, colour, salivary volume, inherent tissue moisture and movement will change according to the progression or remission of a state of illness.
Images from the Atlas of Lingual Coatings in Chinese Medicine
The above atlas features 300 different tongue presentations and states that “[i]t is axiomatic in Chinese Medicine that any part of the body may carry in it the traces of events occurring throughout the whole body”.
I Love Chinese Medicine
September 25, 2008 at 3:04 pm | In BioMedicine, Chinese Medicine | Leave a CommentTags: Diagnosis, Narcissism, Theory
A topic that I expect to touch upon often in this blog is the problem of loving systems more than people. I recall that while I was in school my teacher would often say, “but just remember, this is theory!”. He meant many things by this, but the fundamental meaning always had to do with mental constructs and their limitations. It is a wisdom that runs throughout Chinese culture (and, I wager, traditional cultures in general) that a system is no more than a bridge, and that, when it has been crossed, that bridge will lose its usefulness as the journey continues on the other side.
I have witnessed, so many times, medical Doctors loving their diagnosis more than the patient. Because of technical reasons which I will explore in another post on CM diagnosis, this is more difficult to do in CM, but yet I have still seen it happen. I too have found myself loving my system more than my patient at times.
This is dangerous because when we do this our patient loses their voice, and we, as therapists, lose our life-line to the truth of their condition.
Therapists must always stand on the side of the patient, not the theory, and yet both people must simultaneously retain a healthy respect for the guidance and context which the theory brings. Only in this way can we be sure to remain therapists and not cross the line into mental narcissism.
The Middle Way
September 22, 2008 at 4:47 pm | In Chinese Medicine | Leave a CommentZhong-Yi. “Middle-Medicine”. This is the doctrine of Balance: Moderation in all things – even moderation.
Zhong-Yi, “Middle-Medicine”, also known as Chinese Medicine, is based on this founding principle of balance. How to maintain it, and how to regain it.
It was decided, as a profession, ages ago, that extreme conditions were inherently unstable and unsafe, and that, for these reasons, these situations were to be avoided whenever possible. This meant a focus on preventative care – the maintenance and potentiation of health.
It was understood that, for balance to be maintained, there was a price to be paid, on a daily basis. A price, fee, or tax, that – over the years – amounted to a healthy balanced body. Or a weakened and diseased one.
The old Tai Chi (and Chinese Medical) axiom “four ounces to move a thousand pounds” captures the essence of this process. A small force, applied consistently at the correct point, can shift huge masses in our favour – or against us.
Like anything else in life, all of this is a skill that must be learned, practiced and perfected.
* The most recent Blog posts will always begin below this first introduction *
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