Neumothorax - Day 4

I can walk briskly and go up stairs at my normal 2-step rate. I started noticing this yesterday evening.

Sitting at my reading desk I still have discomfort in my left chest. I've also noticed a feeling of distention in my lower left head back/upper left neck back, but I don't think it is necessarily related as I've had it before.

Neck Pain

A Proposal For Relieving Neck Pain Due To Fixed Staring At Computer Screen

Take a tennis ball and toss it lightly from hand to hand, hundreds of times. Allow one's gaze to follow the ball.

(do jugglers have wonderfully healthy necks? How about Wimbledon fans?)

Pneumothorax - day 3

The various discomforts have subsided considerably (though still remain), and I feel less restricted in my movement options. Walking up stairs quickly still makes me uncomfortable.

Pneumothorax - day 2

When I walk quickly or walk up stairs at my usual pace the pain in my left chest and back intensifies, and when I slow down it fades.

The pain is in my upper left chest (near the needle insertion point), mid-left chest, and mid-left back. Occasionally I feel light-headed, and my hands are often very cold (not just my left hand, as it was yesterday before needling).

There is also a dull pain in the low-middle of my chest, and when I bend my thorax there is a feeling of something bubbling up my lower left back.

hidden goal?

I've got a funny feeling that the (false?) distinction Prof Wei Jia has set up between static and dynamic points is a clever way of sneaking up on the 'static treatment' style that is so prevalent in Chinese TCM acumoxa today. Other voices such as Chen Ri-Xin (陈日新) are much more blunt - "What is an acupoint? Acupoints are the surface reaction areas of disease; they are individualized, dynamic areas in a sensitized state."

What Wei has done is carefully tease the two apart - leaving all of the traditional information on acupoints in its original state (like a well trained archeologist).

So what about all those people who perform their point location the traditional way, but search for reactive areas to actually insert the needle? Or insert the needle at a standard point, but dynamically determine the depth and angle based on needle response? (ie 'de qi'/obtaining qi)

Action －－<---static －－dynamic--->
diagnosis －－ask patient what disease they have －－望闻问切
choose points－－ X disease = X point prescription －－ inspect body for reactive areas
needle－－insert needle to standard depth at standard angle －－determine angle and depth on response
manipulation －－even supplementation/draining －－base type and strength of stimulation on response
length－－retain for twenty minutes －－base length of treatment on response

Currents

In the future will WM and CM be considered different currents or schools of thought?

In the past were 温补派、温热派 etc considered as different as WM and CM are today?

Oral tradition

Due to the fact that the oral tradition in CM (the bridge between CM theory and clinical practice) was washed out in the last century, theory is currently unable to effectively guide clinical practice.

It will take many years of clinical experience to rebuild the bridge.

unconvincing explanations

The explanations for why CM works (at least the ones in my Chinese TCM textbooks) are terribly unconvincing...another reason that in CM education clinical observation should take place as early as possible - not in the last year as it does in the Chinese higher education system.

Seeing something produce an obvious effect more than makes up for the unconvincing explanations!

I'm wondering if these unconvincing explanations (which I don't recall when I learned about CM in the US) are part of the official goal of ridding TCM of superstition and mystical belief.

music analogy

I've just thought of an analogy between printed music and 'the authoritative listings of acupoint indications in textbooks'. (I think this is the first time I've actually made use of being a musician for half of my life...)

A page of printed music records information that can be used by well-trained individuals to produce a musical experience.

A page of acupoint indications record information that can be used by well-trained individuals to produce a healing experience.

hmm...

I have a book called "American Ballads and Folk Songs" (John A. Lomax & Alan Lomax). I borrowed it from my father. When I found it I was so excited to be able to play traditional American folk songs! Unfortunately I found this not to be true...scanning through the book, I was only able to make music out of a limited number of tunes - all of which I was already familiar with. Was that because of my instrument? My stylistic background? Because I started with the recorded information and not with the musical experience? Or because I simply didn't give myself time to bring the information to life?

One of my former colleagues recounted to me one of the most moving experiences of her career - performing S. Barber's 'Adagio for Strings' soon after 9/11.

dynamic points vs dynamic treatment

I need to acknowledge that to a certain extent I'm using Prof Wei's distinction between dynamic and static points towards my own ends - namely fighting against a certain style of acupuncture practice that I would describe as "fallout-from-TCM-education-system style" or "static treatment"; ie diagnosing a disease (usually WM), basing the choice of static points on that diagnosis, then repeating the same acupuncture treatment until the disease is cured or the patient gets fed up.

More on that later, but I need to be careful not to muddy the waters by mixing up 'dynamic points' with 'dynamic treatment'; the latter being a style that makes dynamic use of static points - changing the 'point prescription' based on the feedback (from palpation, needle/moxa response, symptoms, signs) gained about the current state of the disease.

dynamic static points?

So what is it called when you base the insertion point of the needle on philological records, but choose the depth and direction of insertion and manipulation stimulation on the response of the patient?

According to Wei Jia's clear definition, which only applies to locating the point on the surface of the body, the above would still be classified as a method using static points.

It is interesting though, that in his essay he gives as an example of dynamic point usage Wang Zhi-Zhong's method of choosing effective static points based on their response to digital pressure!

I'm pleased to report that the results from my masters degree research project - acupuncture treatment of frozen shoulder - are quite positive so far.

I'm not talking about the research results, but rather the clinical results. I'm treating the third patient right now. He is an old gentleman who developed shoulder pain 2 years ago after taking up bowling. When the symptoms first appeared he received acupuncture and massage treatment, but as the results were not significant he stopped and resigned himself to living with the symptoms.

He told me today that when he agreed to take part in the study (at the insistance of his wife, who saw me treating another patient at the hospital), he had no hope of seeing any improvement in his symptoms after two years of no change. With this background, he was doubly surprised at the improvement in the range of movement of his shoulder. This in spite of the sudden dip in temperature that we experienced recently (he is usually worse in the winter).

I'm hoping he will have a painless winter!

fwiw, he feels that the most effective point was 'zhong ping' (中平).

Erase those lines!

Erase those lines, baby!

It's coming...it's coming...wait for it...it's gonna be big! Huge! A tsunami!

Perhaps even big enough to wash away the 'Bronze Man'!

I feel that I have, for the first time in a years worth of hospital internship, observed an entire course of treatment being carried out on a patient.

I don't mean the 10-day 'course of treatment'(s), but rather I observed the entire successful course of treatment, from first diagnosis to "the disease is cured".

Never before have I seen a patient come in with a disease (one with no tendency towards self-recovery) and receive treatment until both the doctor and patient are satisfied the disease is cured.

A doctor, with all the information that is available to her, knows more about the internal functioning of the human body than she does about the influences and interactions between the body and its environment. Or the mind and the body, or the mind and other minds. In the past this was not true. More was known (relatively speaking) about the influence of society on an individual, and the influence of natural environment on an individual, than was known about the ... Ah-Ha! ...the internal chemistry (ah!) of the human body, and the influence of man-made chemicals on the human chemistry. (so that is why people talk about the 'internal pharmacy'!)

Is that what micro and macro means? Knowledge of the interaction between units of the internal environment as opposed to knowledge of the interaction between the body (the smallest unit) and the external environment? But...in CM (at least in TCM as it is taught today) there is a considerable amount of information about the internal units...and not very much information about the external environment's influence on the body-unit (this is according to my understanding, of course).

So if one is aware of both the interactions between inter-body units and between various external units and the body (as a unit), is this 'holism'? Dunno...

To continue the interrupted post, this particular patient is an English-speaker whom I have a closer relationship with than other patients. Is this why I consider this patient treatment to be complete? I think this is an important factor - over the last 2 months I've gotten to know this patient quite well, and their recovery had quite an impact on my thoughts.

There are other factors as well. The doctor in charge of this patient has a fair bit of experience with this particular disease, and the doctor in question is dedicated to his patients. Quite an exceptional doctor.

It also quite impressed me that this particular disease is considered untreatable by conventional Western medicine.

To round this post up, it heartens me to no end to have seen this recovery. Also, having observed the entire process, I know that my skills are up to repeating the same treatment on patients with the same condition. I've never felt that I could cure anything before...

I am in a state of eager anticipation!

diagnosis, treatment, and assessment are continuously being carried ou

There is a patient in the acumoxa/tuina dept who has been coming in for lower back and shoulder pain. Her back pain (related to a fall that fractured a lumbar spinous process) has been resolved, but her right shoulder pain (related to a radical mastectomy that involved removing her entire pectoral major muscle) is still giving her trouble.

I often give patients massages while they are waiting for Dr Ye. This particular patient will always ask me if I'm free to give her a 'warm up'. Today she was especially communicative about her shoulder - showing me which positions were painful, asking me to stretch her arm to the back and so on. At one point she pointed out 'the exact' painful point in her shoulder joint (at the area where the long head of the bicep crosses the joint). She asked me to press there. More! There! Then she asked me to provide traction on her arm - pulling it above her head. She knew what direction and how much force to use.

Reflecting on this later, I realized I want to be a tool for the patient to use. Not so much for the 'patient', but rather for their awareness of what is needed. Getting to a postion where the patient can express this awareness (and I can respond accurately to it) is going to be a great challenge.

This style of practicing contrasts highly with the "diagnose the problem, perform the treatment, assess the response" style. In the aforementioned style, diagnosis, treatment, and assessment are continuously being carried out, with great emphasis on eliciting feedback from the patient (whether verbal or through subtle physical indications).

brain vs heart

When did it become public knowledge that the brain was the center of consciousness? Was there a corresponding huge change in society?

I don't think of the heart as being my center, or even as being in the center of my chest...it feels quite different to imagine it being in the center of my chest.

Influences

I think what I have to remember is: no matter what my influences, what I am developing is my own personal sense of what health is and how it can be reached.

If I say I'm practicing Chinese medicine, what I mean is that my personal approach is influenced to the largest extent by the body of knowledge that goes by the name 'Chinese medicine'.

(Funny how much of what I'm learning is not Chinese medicine!)

So what if one used a very formulaic method of treatment? One that completely concealed the the healer? I remember using a computer program that allowed you to enter your symptoms, asked some questions, then produced a result consisting of a pattern and herbal formula.

I guess I can't figure out what kind of medicine I'm practicing. Or learning, for that matter.

current state

The current state of Chinese medicine is a reflection of the current state of Chinese society.

literary/oral traditions

What I would really appreciate seeing is some serious work about what CM information was left out of books. What was only passed on orally? Does the lack of tuina literature mean there were no tuina physicians? Does the relative plethora of static point information mean dynamic points were not used?

What kind of person wrote books? What kind of person did not write books? Where did authors get their information from? Which authors were authors first and physicians second? Which authors were not physicians at all? What content in X book is first-hand? Second-hand?

This information will be helpful in resolving some social problems, but in most cases will not directly affect my ability to work with patients. However, as I have this strange obsession with determining what is and what isn't Chinese medicine, and I (to a certain extent) restrict my study to those which are CM, answering the above questions will have a big indirect impact on how I treat patients.

ps I have the impression that there might be some answers in the book "Currents of Tradition in Chinese Medicine" by Dr. Volker Scheid