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A Comparative Evaluation of Diagnostic Systems Used in Herbal Medicine |
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By Michael Tierra L.Ac, O.M.D.
1. Western DiagnosisA. Origins and meansDiagnosis in scientific medicine (derived from the word "discern" in Greek) is based on patient's history and physical examination and on laboratory testing. Case history taking is a tradition dating back to the time of Hippocrates and a good physician is skilled at how and when to ask the right questions. I have concurred with Andrew Weil when he states, " More than one skillful physician has said that if one asks the right questions, the patient will make the diagnosis for you in his or her own words." Physical examination is also an ancient art which has changed dramatically since the advent of instruments in the 19th century. Laboratory testing is a radical contemporary innovation that is rapidly becoming the mainstay of contemporary Western medical scientific diagnoses and along with expensive technological diagnostic procedures threatens to replace the traditional art of case taking and direct observation and physical examination. While previous diagnostic methods used by Western physicians were similar to the so-called Four Diagnosis of Traditional Chinese Medicine, the use of diagnostic instruments dates back to 1819, with the introduction of the stethoscope by the French physician, Rene Laennec (1781-1826). An explosion of diagnostic technology occurred in the late 1800s with the mushrooming appearance of four types of procedures and inventions:
In 1954 the Yale-New Haven Hospital performed forty-eight thousand laboratory procedures; in 1959, ninety-eight thousand; and in 1964, two hundred thousand, while the patient census increased only slightly in the same period. In the US as a whole, about 2 billion laboratory diagnostic tests were done in 1971, 3 billion in 1974, and 4.5 billion in 1976 (Stanley Joel Reiser, Medicine and the reign of Technology (Cambridge, Eng.: Cambridge University Press, 1978), 159). The increasing reliance on expensive diagnostic procedures and testing is sometimes called by some critics "defensive medicine,' because its intent seems more to protect the doctor than to help the patient. With the increase of malpractice suits by dissatisfied patients, doctors have been forced to resort to such extensive and expensive high tech diagnostic procedures in attempt to protect themselves. Nevertheless, the best diagnosticians remain highly trained observers who have learned to rely on intuition based on subtle observations. Andrew Weil describes "an old clinician in Boston who could "guess" the blood pressure of patients in the hospital by watching them lying in their beds. His guesses were usually right to within a few points." Urinalysis, X-rays, and standard blood tests may clinch an intuited diagnosis or provide useful clues to prompt one and generally do not cause much discomfort or damage. "Newer tests," according to Andrew Weil, "are directly productive of illness --- iatrogenic illness, that is, doctor-caused (from iatros, the doctor of ancient Greece)." Some of the procedures that may injure or even kill significant percentages of patients include, sampling pieces of liver, lung, and kidney, infecting radiopaque dyes into arteries, exposing patients to great numbers of diagnostic X-rays, injecting powerful drugs for diagnosis. Criticism by the AMA leveled at the few possible mishaps which have occurred in chiropractic and traditional medicine must be compared to the large numbers of mistakes which have been caused by medical doctors not in the course of treatment but simply as part of contemporary diagnostic procedures. These may include such methods as pneumoencephalography (injecting air into the ventricles of the brain for diagnostic X-rays), angiography (putting catheters and dyes into major arteries), and many other techniques counted as standard procedure in every Western allopathic hospital today. B: Level of Reliabilitya. A nationwide, 32 hospital study compared 1800 clinical diagnoses made on living patients to anatomical diagnoses made at autopsy. They found the error rate was nearly 20 percent. About half of those mistakes probably led to death. (Washington University in St. Louis Feature Service, September 1985) With an 800 billion dollar a year U.S. medical bill, much of which is simply involved with the process of diagnosis, we see how such extreme reliance on high tech diagnostic procedures, not treatment contributes the largest percentage of that bill. One is reminded of a statement by the German philosopher, Immanuel Kant, "Physicians think they are doing something for you if they label it as a disease." APPLIED AND BEHAVIORAL KINESIOLOGYGood-Bad Methods1. Applied kinesiology --- Dr. George Goodheart saw a relationship between each large muscle of the body to a body organ. He posited the idea that weakness in a muscle usually meant that there was a problem at the energy level in the associated organ. He found that by treating the muscle in a variety of ways and making it strong, he was able to improve the functioning of the organ. One of the methods used Dr. Goodheart to strengthen a muscle was through nutrition. Thus is a particular nutritional supplement was given to a patient and the muscle tested strong, it was the right supplement; if it tested weak, it was not. Other methods of treatment could be similarly evaluated such as physical manipulations. Basically this was a good bad method based upon the subjectively evaluation by the practitioner as to whether a particular muscle felt stronger or weaker when influenced by a particular substance, event or stimuli. One of Dr. Goodheart's students was Dr. John Diamond, M.D. who was an Australian psychiatrist who relocated himself in the United States. After studying Dr. Goodheart's methods, Dr. Diamond, seeing tremendous psychological value in the concepts of Applied kinesiology and developed his own more psychological approach which he called Behavior Kinesiology (BK). 2. Behavioral psychology, according to Dr. diamond is based on the physiological feedback loop of the Thymus gland. While previously, before the 1950's, little was understood about the thymus since then with the increasing recognition, largely with the dawn of AIDS, of the immune system, the thymus has risen in importance as the special area of the body where bone marrow generated lymphocytes, are transformed by thymus hormones into generations of lymphocytes called T-cells. While B cells are antibodies originating in the bone marrow and secreted by plasma cells to protect the body against external invasions of bacteria and viruses, T-cells are B-cells which have been transformed in the thymus by a secretion called thymosin or thymopoietin, into cytotoxic T-cells. The job of T-cells is to destroy cells which have become cancerous or infected by viruses. Understood in the light of BK, the thymus gland creates T-cells specifically to "distinguish self from non-self, friend from foe, and to destroy foreign cells." These T-cells perform a vital immunological surveillance that is directly concerned with the body's ability to resist infections and cancer. In all mammalian species there is a tendency for thymus activity to diminish with age with a correspond risk of deadly diseases such as cancer. The thymus gland, itself, is very stress sensitive. Within a day after undergoing a severe physical or emotional stress, millions of lymphocytes are destroyed and the thymus shrinks to half its size. It is specifically this internal ability of the body to recognize viruses, bacteria, diseases and cancerous cells as "friend or foe" that is at the heart of Diamond's Behavioral Kinesiology. He hypothesizes that if certain cells created by the thymus, can recognize foreign or non-foreign substances as useful or not, than the mind of the individual must also be capable of such a recognition. In many instances, this recognition is at the subconscious "energetic" level so that the therapist using BK must find a way to access this "inner knowing." This is done by first establishing a normal resistance of a muscle group, usually, because of convenience, the middle part of the deltoid and then comparing this muscular strength or resistance while pointing to, thinking about or otherwise allowing the influence of a specific bodily area, food, supplement, herb or other substance. The basic purpose of BK is to test the positive, "good-bad" effects of a substance or experience first on the thymus gland as the primary center of the immune system. In fact, according to Dr. Diamond, the method can be used to diagnose the condition of specific organs or functions in the body as well as determine the effect of specific substances and experiences on any or all other areas of the body. The value of this diagnostic system, if indeed it can be regarded as such, is that it generates information from the "inner" subconscious knowing of the patient. The therapist only becomes a facilitator of this process. This approach, in itself, has considerable therapeutic benefit whether in fact, the information indeed originates within the patient or from various subjective or objective evaluations of the practitioner. Using such a system, begins by indirectly centering and empowering the patient to an understanding that he or she is responsible for his or her own well being. That there are specific foods, supplements or herbs one can take that will prove to be uniquely relatively beneficial or harmful. The therapist serves as a facilitator to help the patient access this obvious fact. The method is especially beneficial if the therapy one uses is largely dependent on the patient's cooperation in affecting certain psychological and life style change. It metaphorically informs the patient through suggestion that if he or she, thinks, acts or eats differently for instance, he or she can expect first an immediate positive response by demonstrating a stronger muscular response through BK, secondarily a stronger and more positive response in terms of all other physiological muscles and organs as well as all mental process. The negative aspect of this approach is first that it confines itself to an implied "good-bad" methodology. Secondly that results while taking off from pseudo objective scientific theories cased on, for instance, the immediate response of the thymus gland to the mere thought of a "good or bad" substance or experience, has little control over the influence of other experiences that may be simultaneously influencing or might I say, distracting, the patient while being tested. Dr. Diamond cites how one will test negative to white sugar, coffee, loud rock music, a disturbing color, picture, odor or any other experience. How can the therapist be sure that the BK results are confined to the particular stimulus being tested. The only answer, is that while intending to base one's results on the "inner knowing" of the patient, the therapist, in fact is bringing to bear a lifetime's worth of personal experience and prejudices which will have a decisive influence on the ultimate results. First, we must bear in mind that it it not so easy to objectively determine the relative strength or weakness of a muscle. There are, as Dr. Diamond readily admits, many influences that will influence a patient's response. some of these are from the patient such as:
Kinesiology has become a very popular diagnostic modality by many holistic therapists including chiropractors, some osteopaths, occasional maverick holistic medical doctors, herbalists, nutritionists, naturopaths and acupuncturists. For some it serves as an obvious trick to motivate and empower the patient to make those changes that the therapist already has determined will be good for the patient. For others it offers an efficient right brain exercise that is a welcome relief from the labyrinthine theoretical considerations unique to the discipline of each therapeutic modality. The danger, is that the therapist abandons his system of knowledge and skill, which admittedly requires continues practice and study for a non-system approach which may be far more inaccurate and certainly deprives the therapist from gaining deeper understanding of his particular healing discipline. By confining one's self to a good-bad feedback mechanism, the breadth of understanding that is possible from a more balanced understanding based on physiological homeostasis in Western medicine, yin yang balance in Traditional Chinese Medicine or Tridosha theory in Ayurvedic medicine is lacking in kinesiology. The danger then is to prescribe diet and supplements based on an overly simplistic understanding of differences of constitution and disease manifestations between people. Using a good-bad determination, offers little recognition for the possibility that is equally a part of holistic medicine and traditional medicine that particular symptoms or disease patterns is often a manifestation of the best and therefore most healthy response to an unhealthy stimuli or condition. The job of the therapist from this point of view is to attempt first to understand the unique expression of the patient without any preconceived good-bad prejudicial considerations and help the body complete the process it is in the process of manifesting. This is most obvious in the case of a rash or measles, which in traditional herbal systems is best treated by taking herbs that help them ripen and complete their cycle of expression. Given the fact of all the complex variables described above, it is impossible to apply the rigorous double-blind testing that medical modern science requires, one would have to say that kinesiology as a diagnostic tool would fall more under the classification of shamanistic rather than clinical. As with any of these systems, the value of diagnostic evidence from muscle testing is absolutely dependent on the skills and "other" knowledge that the therapist possesses rather than confirmable diagnostic data. Recently, some acupuncturists, inspired by a Japanese therapist, use a system called "O" ring testing. This is done by testing the muscular resistance of the thumb and index finger when firmly locked together to form an O. As with other, holistic diagnostic systems, a good deal of the success of patients treated based on kinesiology is the broader an more general value of the more wholesome foods, supplements, physio-therapies that accompany it. Just as it is impossible to limit the effects of a vitamin such as vitamin C or an herb such as ginseng to a particular part of the body, it is also impossible to isolate the effects of a particular acupuncture point or spinal manipulation. This is not offered so much as a criticism of kinesiology as a diagnostic system but more to place it into perspective. It is my personal opinion, however, that it is very dangerous for a practitioner to abandon the diagnostic discipline of his own particular therapeutic modality solely on the basis of kinesiological diagnosis. IRIDOLOGYAccording to the admittedly questionable legend of the origin of iridology as told by Bernard Jensen, it all began as follows: during the mid 1800's a ten year old boy destined to become Dr. Ignatz von Peczely of Egervar, Hungary, was playing with his pet owl. Accidentally one of the owl's legs was broken. The young boy remembered noticing a curious dark stripe form in the lower region of the iris of the bird which he later realized corresponded to the area of the leg. Eventually the black stripe became a tiny black spot which gradually filled in with white lines and shading. This youthful incident made a lasting impression on the boy so that when he later grew into a successful doctor working in hospital surgical wards at the college hospital he had the opportunity to observe the irises of patients after accidents and operation. From this he was able to develop the first iridology chart outlining corresponding areas of the iris of the eye with all parts of the body. Doctor von Peczely published his first book called "Discovery in the Realm of Nature and Art of Healing" in 1866. The work was first promoted in Germany by August Zoeppritz. Later, Dr. Emil Schlegel of Tuebingen published a book on the results of von Peczely's establishing the Germans ongoing interest and evolution of iridology or the method of diagnosing the body by study of the iris of the eye. A Swedish homeopath, Nils Liljequist, further improved the methods of iris diagnosis and introduced it to America. A two volume set based on a translation of his writings was called "Diagnosis from the Eye." Dr. Henry Edward Lane, a native of Austria, moved to this country and taught iridology to Dr. Henry Lindlahr of Chicago. Dr. Lindlahr practiced iridology and wrote about his experiences in his many books. Dr. Lindlahr was famous for emphasizing the importance of the "law of Cure" based on retracing prior acute symptoms which he believed were the beginning of all chronic conditions. One of the greatest iridologists of recent times is Peter Johannes Thiel of Germany. A detailed and outstanding textbook was by Dr. J. Haskell Kritzer. The late Dr. John Raymond Christopher and Dr. Bernard Jensen both have been popular exponents of this system which in turn has been adopted by thousands of their followers and students. As a student and protégé of the beloved Dr. Christopher, I began my career as an herbalist using iridology as the sole diagnostic method. The reasons why and the fact that after three years I abandoned it in favor of traditional Chinese and Ayurvedic diagnostic systems, is based upon certain deficiencies I personally felt and experienced with iridology. I say this despite the fact that many of my respected herbal colleagues still strongly rely on iridology as their primary system of diagnosis and obviously must be getting, as I did, some positive results in their prescribed herbal and dietary treatments based on iris diagnosis. What ultimately persuaded me to give up the practice and teaching of iris diagnosis was its inaccuracy and the tendency to provide the same kind of limited unholistic good-bad negative information to the majority of patients. In this I was reminded of how I felt when I personally attended Dr. Christopher's readings and heard him say essentially the same thing to every patient and subsequently prescribe the same diet and at least one of his formulas for each major organ in the body. Dr. Christopher also got very good results, but I feel certain that, despite his statement to the contrary, his results had little to do with his iris diagnosis and everything to do with the generally beneficial nature of his dietary regime for the majority of patients he was seeing at the time and the broadly beneficial effects of his herbal formulas. My own misgivings about iridology became especially apparent when giving a seminar at Esalen and I was casually socializing and sitting with several of my students on the living room floor of Pfeiffer house one evening when they all requested that I read their irises. I must have read from twelve to fifteen sets of irises over the course of an hour. It was at that time that I was confronted with questions about the accuracy and ethics of a system that authoritively told somebody based on a single piece of rather inconclusive evidence, that they were essentially sick or nearly sick. I heard myself reciting the standard litany of iridology, "nerve rings here, prolapsed colon there, heart lesions, etc." -- even to the point of suggesting cancerous or precancerous conditions any or all of which may or may not have actually existed! One positive outcome for them was that they became motivated, hopefully, to a better lifestyle and dietary regime. For me and hopefully for them, that they had the experience of purchasing several of Dr. Christopher's excellent formulas which I just happened to be selling and might experience the many health benefits from following a relatively balanced herbal program. As I became more deeply interested in traditional Chinese herbal and Ayurvedic differential diagnosis, I found iridology to be of little or no value compared to the more comprehensive value of these Asian diagnostic systems. My last consideration for the value of iridology was the hope that I could monitor a patient's progress by observing the fabled "fine white healing lines slowly filling in the dark lesions," which I never saw or the eyes change to a lighter color, which I did observe and was supposed to represent a cleansing or detoxification. The problem was that matching the lighter eye shade that developed after a patient went on a cleansing, vegetarian, mostly fruit and raw food diet for a few months, from the perspective of Chinese differential diagnosis and based on other signs and indications, represented blood deficiency or anemia. Nevertheless, despite the fact that I was no longer using iridology but relying solely on traditional diagnostic systems of Traditional Chinese Medicine (i.e. acupuncture and Chinese herbalism) I was undaunted to try to satisfy at least for myself the value and truth, if any of iridology. A younger colleague fully equipped with the most up to date specialized iridology equipment introduced himself and stated that he wanted to give iridology readings at my clinic and at the same time monitor the course of my patients over a period of six months. Given the fact that for most of us as well my patients six months is quite a long period, there was ample opportunity for many of these to go through a variety of health related changes. Some people became well and got sick again with either the same or perhaps a different set of symptoms, others suffered injuries or operations. They all had their irises repeatedly photographed and studied by my colleague and myself. Where was Peczely's owl or the markings he claimed to observe in patients of the 19th century Hungarian hospital ward? Were were the fine white healing lines that were supposed to knit together the small dark lacunae corresponding to the healing of operations and injuries of different parts of the body? Our conclusion after six months: my colleague, trying to hold on to the fast disappearing shred of belief in the validity of iridology sheepishly and somewhat guiltily sold his camera to another would be iridology enthusiast. I buried my official iridology magnifying head band in a box in a dark, hopefully soon forgotten area of my office closet, where I must confess it still remains after over 15 years, unopened. Since that time and only last year I spoke with another herbalist, colleague, Debra Nuzzi who worked as the editor of many of Dr. Bernard Jensen's books, including his "The Science and Practice of Iridology." She continues to hold Dr. Jensen in high esteem both as a teacher and dedicated healer. Nevertheless in assembling the various photographs for his book, she told me how she confronted Dr. Jensen with the fact that in the many photographs she was editing to include in the book there were never any fine white lines filling in dark areas that would exemplify healing and recovery. It seemed that, like my colleague with the camera and myself, attempts to discover positive signs of healing solely from iridology was for Dr. Jensen more of a longed for hope than a reality. As with kinesiology, I would not question the value of these "good-bad" systems when used by an experienced and skilled practitioner. The problem is when an inexperienced practitioner naively decides that he need not study or practice any other diagnostic system. That he or she can know everything solely from pushing a patients arm up or down or looking with a magnifying glass in this or her eyes. As we shall see, even in Traditional Chinese or Ayurvedic medicine few experienced practitioners would trust themselves to rely solely on such highly respected systems as pulse or tongue diagnosis. Rather these methods are part of a broader, more holistic differential system which evaluates different diagnostic indications, comparing them against each other and arriving at a differential hypothesis for which to begin treatment. RADIONICS AND PSIONIC MEDICINERadionics is a diagnostic method and treatment that is done at the distance from the patient. Psionic medicine is a simpler version of radionics that is primarily based on the use of a device such as the pendulum. Both these methods are based on a similar unified theory concept. This concept was developed and exemplified through the teachings of a distinguished physician, George Laurence, Mac Donagh and Rudolf Steiner and it essentially affirms the interconnection of all life and phenomena as understood in various Asian spiritual philosophies such as Yoga and Buddhism. The concept of radionics and psionic medicine along with more recent techniques such as crystal healing is based on the idea that by clearing one aspect or part of the the self or universe through the force of directed will and intention, another person or part of the universe will also be cleared. Thus absent diagnosis and treatment of disease can be accomplished by simply stilling the mind to a certain rate of vibration (usually called "alpha" which is approximately seven brain cycles per second) and focusing inward one can determine and affect the condition of another individual irregardless of their location in the world or universe. Since many highly skilled and effective herbalists use a psionic methods called "dowsing" with the use of a pendulum it is appropriate to consider this approach as a prototype for a wide variety of so-called psychic or shamanistic diagnostic methods. I must preface my discussion by saying that I have absolute belief and first hand experience of the spiritual unified field concept as well as the potential and power of a absent diagnosis and treatment. I feel that such methods can be abused and misused and readily admit of ingenuine charlatry and should be regarded, especially, it it the only understanding one has of healing and health, with suspicion. Radionic machines, including a wide variety of high priced electro-diagnostic machines are being widely manufactured and sold and used by very competent natural practitioners ranging from herbalists, acupuncturists to radical medical doctors. I believe that such mercenary sale and use of these pseudo-scientific devices are unnecessary since the energy that is supposed to operate them is essentially mental. They may have some definite "shamanistic" value as they constitute a material bridge between the physical and mental worlds. It is unfortunate and confusing at best, to substitute or mistake such methods for appropriate understanding and study of herbal diagnosis and healing. I have seen master herbalists such as the late Norma Myers of Vancouver B.C. adroitly and expertly use a window shade string to determine specific foods, herbs and amounts to include in an herbal formula for her patients. I have confidence in her ability to do this because she had a consummate knowledge of herbs and healing and would often use a pendulum to check between a number of possibilities that she already considered might be effective for a condition. Since there is a big area for the influence of hypnotic suggestion and placebo effect in such methodology, it is not always clear, nor, however, do either the therapist or patient cares why something may be effective so long as it is. The problem is that it may be unduplicatable in the hands of another, unless one considers the implications of the use of Bach Flower Essences as a manifestation of this same psychosomatic phenomena. The general unreliableness of such an approach, plus its highly subjective nature and tendency to be influenced by various external influences should rule such methods of treatment as not inherent to the practice of herbal medicine but useful as an adjunctive tool for diagnosis and treatment. Spiritual medicine as a part of holistic healing has always been a part of traditional herbalism in all cultures. We see this in the tendency to combine shamanistic practices and rituals in Traditional Chinese herbalism as influenced by the Taoists as well as the use of omens and talismans that is a part of Ayurvedic medicine. further, herbs and diseases have been classified in many traditional cultures according to astrological signs and condition. This is seen in the writings of the famous sixteenth century herbal physician, Nicholas Culpepper whose controversial statement as a closing state of his famous Complete Herbal is "To such as study astrology (who are the only men I know that are fit to study physic, physic, without astrology, being like a lamp without oil." The world's most renowned medical astrologist, Ingrid Naiman, achieves phenomenal results in combining astrological-spiritual guidance together with traditional herbal medicine for the treatment of cancer. I am honored and proud of the fact that she has chosen to use my herbal Planetary formulas, River of Life and The Complete Pau 'd Arco Combination along with escharotic salves based on traditional Eclectic formulas to achieve her outstanding results. The HERBAL TAROT developed by artist-herbalist Candice Cantin and myself associates a single herb with each of the 78 cards of the Tarot. The major arcana has a single herb assigned to each card that most represents the energies and qualities while each of the four minor arcana or suites corresponds to the four elements, the pentacles for the earth elements using herbs that are good for digestion and assimilation; the swords for the air element using herbs that are useful for treating the respiratory and nervous systems; the cups for the water element assign herbs that are good for the genito-urinary tract and finally the wands for the fire element that combine herbs that both cool and stimulate circulation. The traditional symbology of the cards are preserved to allow for the subconscious mind to associate images that correspond to various stages and states of one's conscious evolution. A particular spread can serve the same purpose as a Navajo sand painting to help the patient get in touch with different psycho-physiological aspects relating to their healing. The herbs indicated can be used as talismans, essences or as "plant allies" that if not specifically indicated for the patient, can help guide both the patient and healer to an herbal combination that would be useful for their particular condition. Again, unless one were an Edgar Cayce, I would caution against the inexperienced relying solely on such purely psychic or intuitive methods. Usually it doesn't work if one's ego is involved and at times, it is very difficult to remove one's ego sufficiently to achieve reliable results with such methods. WESTERN MEDICAL HERBALISMWestern medical herbalism, unlike traditional Asian systems such As Traditional Chinese Medicine, Ayurvedic and Unani or Tibb herbal medicine, seems to lack a universally accepted traditional or school of herbal medicine. Since the time of Henry VIII, with the signing of the herbalist charter, herbal medicine has been protected in the UK and throughout the Commonwealth (including Australia and New Zealand) against the type of repression that has occurred in other countries, especially in the US. There are no laws restricting the practice of herbal medicine in the UK by anyone but there is the National Institute of Medical Herbalists who have a four year curriculum with highly trained and qualified graduates who practice professionally. The herbalism expounded by graduates of the NIMH is a combination of humoral theory as represented in the Teachings of Hippocrates and the Roman Galen, the lineage of medical herbalists that have been a part of the rich herbal heritage of Great Britain, the significant influence of North American Thompsonian herbal medicine as transpoted from America to the U.K. by Dr. Coffin and last but not least, orthodox scientific medicine. Two of the leading exponents of British Medical Herbalism in North America are David Hoffman and AManda McQuade. One of the most interesting and important books specifically outlining the system, besides David Hoffman's writings is Herbal Medication by A.W. Priest and L.R. Priest. In terms of diagnosis, according to Stephen Fulder, "Modern Western herbalists use much the same terminology and concepts as current orthodoxy (referring to Western medical science), but they are interested in detecting and restoring normal function rather than acting to stop a pathology. The symptom is seen as a sign, if read correctly, point to the seat of disorder. For example an infection may point in the first place to 'stagnation' of the affected tissues. Healthy tissues, like running water, cannot suffer colonization by bacteria; such an invasion can only occur in the histological equivalent of the brackish pond. Treatment of infections then demands that the tissue be 'cleansed' and brought back into the vital circulation. Antibiotics would only be necessary in this scheme if the colonization was so excessive that there was real doubt as to the host's ability to overcome it from vital resources, and then appropriate only if underlying stagnation were treated as well. Using antibiotics alone is seen as being as productive as pouring disinfectant into a brackish puddle and pronouncing it 'clean'. The same concern with underlying causes marks the herbal practitioner's approach to other conditions. A spasmodic condition like asthma or colitis speaks first of an irritant factor combined with a tendency to over-react. AN inflammatory condition like skin disease or arthritis speaks of a healthy but insufficient attempt to eliminate toxic accumulations. Similarly, in dealing with migraine or the autoimmune conditions a primary aim is to search for the source of toxicity, perhaps in defective digestive or liver function or in inadequate elimination." Medical herbal diagnosis uses the standard methods of Western medical science to determine where the primary and secondary physiological imbalances occur that may be the underlying cause for a particular disease manifestation. There is a special emphasis on case history, taking into account current stresses, dietary habits and lifestyle as well as evaluating the main physiological functions of the body: digestive, respiratory, genito-urinary, cardio-vascular, nervous and emotional. This is done together with relative clinical assessments: general physical examination, blood pressure, pulse, microscopic assessment of urine, blood and stool. There are two predominant influences prevalent within the practice of Western Medical Herbalism as represented in NIMH. These include "physiomedicalism" and other systems based on Western physiology such as "holistic herbalism" of David Hoffman. PHYSIOMEDICALISMPhysiomedicalism originated from the teachings of Samuel Thompson (1769-1843) and who himself was strongly influenced by Native American healing practices, the use of their herbs but more important the use of the vapour bath which was derived from the physio-spiritual teachings of the Native American 'sweat Lodge', that combined the psycho-active principle of prayer with physical therapies. Samuel Thompson's system, at one time in 19th century North America claimed up to three million adherents, later matured in the work of Wooster Beach (the founder of Eclectic Medicine), W.H. Cook, T.J. Lyle and J.M. Thurston. The essential emphasis of Thompson's system was based on the essential Vitality of the organism and its ability to eliminate toxic waste from the organs and tissues or the body. In this, there is considerable similarity with the concept of "chi" in Traditional Chinese Medicine or "prana" in Ayurveda. The major difference with Chinese herbal medicine is in the emphasis on detoxification whereas Chinese herbal medicine has tonification or the principle of to "first tonify the deficiencies," as its founding maxim. Ayurveda emphasizes a balance of both elimination and detoxification. Japanese-Chinese herbal medicine, called "kanpo" again sees even the process of tonification as a way not only of building up the deficiencies but to tonify or strengthen the bodies' eliminative power. According to Herbal Medication, physiomedical diagnosis, while borrowing the terms of Western pathology, aims at a deeper understanding or functional organic states. Symptoms are evaluated in terms of their being manifested as:
Peculiar to the diagnostic system of physiomedicalism as expounded by Priest and Priest and others who representative of the the National Institute of Medical Herbalists, is an assessment of underlying Vitality necessary for effective herbal treatment. The vital state may be:
Disease is seen as a necessary compensation to an imbalanced condition. Before disturbing the particular adaptation the body has made to, for instance, an imbalanced diet, lack of sleep, various physical and emotional stresses, one needs to evaluate the inherent strenght or weaknesses the body has to make the necessary changes. A positive crisis assumes that the body has sufficient vital energy to overcome the disease as in a simple cold or flu for instance. All that is needed is proper management, to get out of the body's way through rest and fasting or simple diet. A negative disease crisis requires stronger support of relative vital functions in order to prevent chronic soquelae from becoming established. In terms of the Eliminative functions which especially include the colon and kidneys, evaluations are made as to the bodies' ability to adequately eliminate waste materials on three levels:
The synthetic metabolic process of anabolism or the eliminative process of catabolism results in some chemical by-product that requires elimination. If for any reason, proper elimination cannot be achieved, the chemical by-product is stored in the tissues of the body and gradually obstructs other vital metabolic processes that lead to chronic degenerative disease. It is for these kinds of conditions that alteratives are indicated to promote elimination of various tissue wastes. These include herbs broadly classed as blood purifiers by Western herbalists or 'heat clearing herbs' in Chinese herbal medicine. also included are diuretics to eliminate fluid wastes, purgatives to eliminate solid wastes and cholagogues to promote the discharge of bile and general blood purification through the liver. Following the principles of Thompsonian theory as the basis for physiomedical practice, the patient is evaluated in terms of the need for thermotaxis and hydration using the so-called vapour bath, to remove toxic encombrances from the tissues of the body. In this, the American Samuel Thompson (1769-1843), strongly influenced by Native American healing practices, may have been imitating the universal practice of the "sweat lodge" that integrated sweating and prayer to purify body, mind and spirit. The underlying cause of disease according to Thompson and subsequent physio-medical practices is chronic sub-thermal conditions that impeded or slowed the eliminative processes of the body. From this, the use of warming stimulants such as cayenne and ginger and the vapour bath became, as it still is today in the legacy of the late Dr. Raymond Christopher, the primary therapy of Thompsonian physiomedical herbalism. The second characteristic is the use of the lobelia emetic for helping to clean mucus from stomach and lungs. This practice has much in common with similar emetic therapies recommended in Ayurvedic medicine that also uses vomiting as a technique for clearing deep seated mucus called "kapha" and in its more degenerative form "ama" from the tissues of the body. Overall, there are many common elements in the practice of physiomedical herbalism and older traditional systems, especially Ayurveda. The biggest difference, as with most Western medical herbal systems, is in the more subtle differential evaluation not only of bodily and emotional symptoms but tongue, pulse, abdominal and palpation diagnosis as is characteristic in Traditional Chinese, Ayurveda as well as the more highly developed art of herbal tonification therapy used in these traditional Asian systems. It seems that in Western medical herbal systems, while there is much regard for what is called "vital force" there is little understanding of the herbs and preparations that can be used directly to supplement these subtle energies as with the Chinese use of herbs like ginseng, codonopsis, dang quai, astragalus to name a few and the various tonics used in Ayurveda such as the purified mercury compound called "Sidh Makaradwaj" or Chyavanprash. HOLISTIC MEDICAL HERBALISMThis system is another branch of British Medical Herbalism as presently expounded in the writings of David Hoffman and the teachings of Amanda McQuade. This approach is very similar to the preceding except there is not such a strong influence of Thompsonian herbalism with the use of strong stimulants such as cayenne, the vapour bath and the lobelia emetic. Holistic medical herbalism represents an attempt to prescribe relative simple herbs according to the condition of the barious biological organs and physiological functions of the body. As with all the more evolved systems of herbal medicine, the actual Western named disease, especially in more chronic conditions is treated indirectly using herbs appropriate for various systems, especially the digestive-eliminative systems, the circulatory system and the nervous systems. The method of evaluating the state of health is through standard case history evaluation of symptoms, clinical evaluations and Western microscopic tests. The term "holistic" refers not only to the relationship of the body and mind but the inner relationship of the various organs and physiological processes. Herbs, diet and various physical exercises are recommended to remove any stagnations of toxins in any of these systems. By so doing, the body is best able to strengthen and heal itself. In America, herbalist, Michael Moore, has evolved his own unique medical herbal system based on a profound and intimate understanding of Western physiology and the actions of specific herbs. Michael's diagnostic approach is generally based on observation of the the patient and his or her symptoms. WESTERN SCIENTIFIC MEDICINEWe need to mention Western scientific medicine, because some of the diagnostic procedures of this approach are used by medical herbalists. The most significant difference in the approach of orthodox Western medicine is its emphasis on symptom suppression primarily through the use of surgery and drugs. With the rapid rise of medical technology, there are increasingly refined and expensive diagnostic tests which can supply a seemingly inexhaustible series of criteria to support one's thesis concerning a patient's condition. There is, so far, little regard for holistic interrelationships between the various internal organs. Thus the underlying cause of disease is of little consequence and too often the most shallow understanding of a particular condition, however couched it may be in scientific medical jargon, is the result. Treatments are prescribed according to the specific disease, often with little regard for the nature and condition of the patient. The result is a plethora of adverse reactions to treatment, rampant patient dissatisfaction and skyrocketing medical costs. Back in 1874, one of the great eclectic physicians, John M Scudder stated in his book "Specific Diagnosis", "It is yet the opinion, that "diagnosis" has reference to the classification of disease according to the received nosology; that it means naming the affection "bilious fever," "typhoid fever," "pneumonia," "nephritis," etc. And so it does with the genius doctor, at large, and their souls travail in diagnosis until a suitable name is delivered. And then they consult their memories and books for recipes to throw at this name, which to them seems almost an entity." Later Scudder is even more vitriolic as he states,"Do you mean to say," asks the reader, "that the present system of nosology is useless?" Yes, so far as curing the sick is concerned, that is just what I mean to say. Not only useless, but worthless--a curse to physician and patient--- preventing the one from learning the healing art, and the other from getting well.---- The first lesson in pathology we want to learn is, that disease is wrong life. The first lesson in diagnosis is, that this wrong finds a distinct and uniform expression in the outward manifestations of life, cognizable by our senses. The first lesson in therapeutics is, that all remedies are uniform in their action; the conditions being the same, the action is always the same." In his two volumes "Specific Diagnosis" and Specific Medication" Scudder outlines a system of differential diagnosis, including pulse, tongue and other signs and symptoms that is amazingly like that of Traditional Chinese and Ayurvedic medicine. Also like these traditional systems of remedy classification, Scudder is opposed to isolating and separating the classification from the specifically named disease. Like the indications of traditional herbal systems, Scudder states that the "new diagnosis means medicine, and must point out the cure for the particular case in hand." Whereas Western medicine has tended to advance towards increasing diagnostic technology, traditional medicine aims at sharpening the sensory direct powers of observation, listening, feeling and interrogation of the healer. Specific Western diagnosis can be very misleading. The reason for this is always in the subsequent treatment which usually aims at the most superficial suppresion of symptoms. Usually what is best for suppressing symptoms is usually harmful to the overall lifeforce of the individual. For instance, an antidepressent sedative such as Haldol (haloperidol) is the current drug of choice for dementia and Alzheimer patients. Its action is aimed totally at suppressing aberrant behavior. Unfortunately it is well known to cause irreversible damage to the brain and thus hastens the metal degeneration. Similarly, various forms of corticosteroids are used for treating a variety of chronic inflammatory diseases including diseases of the respiratory tract, skin as well as various rheumatic and arthritic conditions. The patient who takes corticosteroids today is generally quite aware of the inevitable side effects from long term use. Nevertheless, this particular class of drugs is remarkably effective in suppressing painful inflammatory conditions. Whereas the intention of the Western medical doctor is to fully supplant the body's natural capacity to produce antiinflammatory hormones through the adrenals and endocrine system, the traditional herbalist uses herbs that contain saponins which are used as organic building blocks or hormone precursers by the body. The use of antibiotics is well known to cause an indiscriminate destruction not only of unfavorable bacteria but favorable ones as well. Since the favorable flora and fauna seem to play an important immunological function, the abuse of antibiotics has been attributed as the underlying cause of many chronic immune dysfunctions that we se today. Just as destroying a certain insect or animal in nature can upset the delicate balance that exists there, so also the destruction of certain microorganisms in the body can cause an imbalanced proliferation of others such as candida albicans. One of the questions that I have not seen addressed, however, is what other substances besides antibiotics can imbalance favorable microorganisms in the body. Taking the perspective that antibiotics have a cold energy, and that these are known to exert marked antibiotic properties, we might see some broad relationship whereby other cold natured substances such as a lack of calories, protein, excess of vegetables, vitamins, expecially vitamin c might cause a similar imbalance. The use of sulfisoksazole, a sulfonmide drug for urinary tract infections while having the ability to overcome the infection, also has well documented injurious effects on the kidneys. Since many who have problems with urinary tract infections would be understood in TCM to have chronic kidney-adrenal deficiency, to cure an infection in the urinary tract with a drug that further injures the kidneys seems in the long run counterproductive. The problem is compounded by the fact that medical doctors are not usualy aware of underlying lifestyle causes that may be the root of the problem. Some of these are the abuse of what is classified in traditional medicine as "heating" substances such as sugar and other stresses. To remove the acute pattern of disease without addressing the underlying cause seems to be very short sighted to say the least. It is interesting to note that such conditions as high cholesterol and blood lipids may correspond to traditional imbalances described in the ancient literature of Ayurveda. There is a definite correlation between what is classified as "ama" in Ayurveda with high blood lipids. Ama is described as a sticky substances that impairs circulation and is accompanied with a wide variety of circulatory disorders. It is particularly associated with aging and there certain herbal preparations that are traditionally used in Ayurveda to help reduce Ama in the body. The primary preparation is called "guggula" which is a preparation made from the resin of commiphora guggul. Usually for excess ama it is combined with triphala which combines three myrobolic fruits that together are revered as the most precious of all herbal formulas in ayurveda because of their balanced detoxifying effects. In Chinese medicine a similar diagnosis, however at a more extreme stage of imbalance is called "invisible phlegm masking the opening of the heart". This condition is usually associated with insane or impaired mental function since the heart, in TCM governs the mind. It would seem that the biggest problem in Western medicine is that there is little, if any, correspondence between diagnosis and cure as Scudder so aptly noted. Western medicine generally takes a symptomatic mechanical perspective to treatment while traditional herbal medicine takes a nutritional approach based on attempting to discover what the body needs to maintain better homeostasis. Drugs are used to mechanically inhibit certain adverse so-called disease reactions, whereas herbs in the hands of a traditional practitioner are used to empower vital organic processes so the body heals itself. There is a problem, with Traditional Western herbalism being corrupted with the Western medical model. There is a danger in using herbs such as mahuang in highly concentrated extracts to boost energy. There is also a problem in over inflating through advertising specific herbs for a specifically named pathological disease. Because of their mild nature, herb work best when used holistically, in harmony with all physiological functions and processes. With the exagerrated emphasis on quality and potency, the public is misinformed to believe that if an herb doesn't work in its whole form, it must be taken in an concentrated extract before it will prove effective. While the question on herb quality is of paramount importance to the producer of herb products, the problem of selecting the correct herbal remedy is the primary problem of the practitioner. I would like to take a few examples from the current popular books and literature on herbs to point out some of the misleading information that does not corroborate traditional diagnostic systems with the herbal remedy. St Johnswort (Hypericum Perforatum)A recent book Christopher Hobbs is quoted as stating "In Europe, St. Johnswort has a long history of use, particularly as a folk remedy in the treatment of wounds, kidney and lung ailments, and depression." Next the author goes on to describe a clinical study of 15 women suffering with depression who were given a standardized extract (promoting his companies' product line), which "led to significant improvement in symptoms of Anxiety, depression, and feelings of worthlessness" according to a German study. In addition, the extract greatly improved sleep quality because it was effective in relieving both insomnia and hypersomnia (excessive sleep). The problem with this from a clinical perspective is that there are many causes of depression and related insomnia. It most certainly has an emotional cause which is different for each individual. There are many who tend to fall depressive slump for which, I suppose St Johnswort might be effective. The question is how long must it be taken before such favorable results are noticed and assuming that the depression comes in cycles, how can we distinguish the difference between a self limiting cycle and the effect of St Johnswort. Further, supposing that the cause of one individual's chronic depression is traumatic memories of child abuse or lack of self esteem perhaps aggravated by a recent separation, what is St. Johnswort going to do about these causes for depression which usually take time to resolve. It seems that in these circumstances we need to determine whether published scientific research plays a significant "placebo" like role in the popular use of St. Johnswort for depression on the European continent. Looking up Hypericum in Boericke's Materia Medica, a homeopathic materia medica that tends to use a majority of low potency or mother tincture herbal remedies, we find that St Johnswort is specific for nerve injuries and symptoms associated with an injured nervous system. Certainly an emotional shock with resultant depression would qualify as a possible injury to the central nervous system. For that matter an injury to the spine or the coccyx also qualifies as affecting the automatic nervous system. There is a big distinction between depression caused by recent shock or injury as opposed to chronic depression caused by more deep seated psychological problems. I personally know how complex and difficult it is to treat chronic depressive individuals and it is extremely misleading to not specify the specific type and causes of depression for which St Johnswort might be effective. Taking one more example of the misrepresentation that results from trying to validate a traditional herbal remedy solely from a superficial Western alopathic medical perspective, the use of a standardized 24% extract of flavonoid glycosides of Ginkgo biloba is described allopathically indicated for:
The same author describes the leaves as being traditionally used to "benefit the brain". The overwhelming description of use for Ginkgo, especially the nuts, is for the treament of asthma and coughs. There is also a less frequent reference for the leaves as being used to treat coughs and asthma. Other uses are as a digestive stimulant and antiparasite remedy. The fruit is classified in Traditional Chinese Materia Medicas as an astringent herb with sweet, bitter, slightly toxic and neutral properties. It is used to expel phlegm from the lungs, luekorrhea, spermatorrhea, frequent urination and urinary incontinence. No mention in traditional medicine for the use of the leaves especially in a concentrated 24 to one extract form to improve vascular circulation to the brain. We can read voluminous information about the chemistry of 24% ginkgo leaves as well as its effects of cells, neuronal cells, tissues, blood. We read of studies that seem to point to the usefulness of gingko in the treatment of Alzheimer's disease. The pressing question for the therapist is how can he or she determine whether the whole flesh and blood person who sits before him or her in a clinical setting is the one for whom 25% Ginkgo extract is indicated? For an herbalist to give allopathically for any conditions of the indicated key use is hardly worthy of the high art and science of herbal medicine. The indications are simply not specific enough to inform the practitioner of the effectiveness of the remedy. To make our diagnosis and prescribing more accurate and precise all we need to do is inquire about the cause of the above stated indications or in a word fill in the important question of who with the well known indications for 24% ginkgo extract should get the remedy. This requires a lot more thought and consideration on the part of the practitioner. Decreased blood supply to the brain could be caused by simple lack of blood or anemia for which ginkgo has little benefit. Its primary benefit, if we are convinced by the scientific studies, is to improve circulation of blood and nerve force not to directly tonify or nourish it. Ginkgo is a circulatory stimulant so that it may be good for circulatory problems related to all the above indications, making it a useful yang-moving tonic but it is not good for patterns of deficiency chi, blood or yin-essence. In fact, taken alone, it could further exhaust the body's reserves and deplete blood and yin, which is a broad term that describes bodily fluids and substance. From these few examples, we see that there are some very real problems in applying an alopathic diagnostic model to the use of herbs. I personally hope, that herbalists will take a more active role in condemning such dangerous and misleading herbal indications by scientists and those who have made themselves spokespersons for the simplistic allopathic style of herbal prescribing whose primary aim is to cell herbal products rather than make them therapeutically useful agents. Western Medical herbalists, however, have found good use for combining Western diagnostic precedures with herbal medicine. They use such indexes as blood pressure, microscopic lab tests, pulse, symptom evaluation and so forth to arrive at a differential diagnosis of what organs and functions to treat that is appropriate to the individual rather than the disease name. TRADITIONAL CHINESE MEDICAL DIAGNOSTIC MODELSTCM diagnosis is based on a differential system where several paramaters are examined based on the four diagnosis, questioning, observation, palpation and listening and the predominant concurring findings are taken as the basis for the diagnosis. This is called 'differential' diagnosis and strongly contrasts with the earlier simplistic iridology and kinesiological "good-bad" systems and other overly simplistic diagnostic systems that are based on one finding only. Western medical diagnosis is also based on a differential system of evaluating several parameters before making a fully authoritive diagnosis. The problem is that Western medicine aims only at diagnosing the named pathology while Traditional diagnostic systems such as Ayurveda and TCM aim at diagnosing dynamic functional organic systems encompassed by the concepts of the ZangFu organ syndromes. Chinese physiology takes quite a different perspective from Western scientific physiology. First, the Chinese describe only twelve functional organ systems of which the six transformative solid yin organs are the most important. The remaining six yang hollow organs are merely considered as vessels of transport and their function is usually directly related to the function of the deeper Zang or yin organs. The six Zang are heart, pericardium, spleen, lungs, kidney and liver. There are corresponding diagnostic indications for each of these some of which are obvious from a Western perspective such as palpitations and blood vessels are indicative of heart, urinary problems are indicative of kidney-bladder imbalances and cough, nasal conditions are indicative of lung imbalances. Other indications are not so obvious from a Western perspective such as the relationship of the ears or head hair to the kidneys, insane or aberrant mental behavior and the tip of the tongue to the heart, feelings of spaced out, ungroundedness to the spleen. There are even assignments of physical postures and movements that are used to direct the TCM physician to the troubled organ system such as problems with stretching or walking being heart related, problems associated with sitting being related to the spleen, problems with standing being associated with the kidneys and so forth. In fact, it might be said that the only limits to interpreting any given symptom or sign is the knowledge and understanding of the physician. Despite the sometimes colorfully obtuse language of Tcm it is my belief that the major difference between Western and classical Chinese medical physiology are semantic based upon two very different perspectives of the body. To begin, traditional medicine is truly holistic in that it unites all physical and mental symptoms in a common diagnostic system. The mind and body are simply not separate according to Traditional medicine. In TCM, various emotional states are aligned with each of the five elements and their corresponding organs so that their is a corresponding emotion and mental state for each element-organ. Similarly, Ayurveda outlines gunas or states of consciousness with each of the three humours or tridosha, which is the basis of Ayurvedic diagnosis. They are influenced by food, herbs and various lifestyle factors and are sattva, a state of peaceful equilibrium, rajas, a state of outgoing, aggressive action and tamas, a state of inertia or dullness. Obviously, such conscious states and their correspondences have a lot to do with one's health. Both traditional systems see health as a state of balance or homeostasis. TCM seeks to achieve a balance of yin-passive and yang-active physiological function which equates to the concept of shiva-shakti in Ayurveda. Ayurveda, nevertheless, emphasizes a balance in terms of three using the tridosha or three humour system. Both systems really accomplish Scudder's dictum that "diagnosis means cure" since the specific diagnosis of each system is integrally linked with a classification of foods, herbs, lifestyle, exercise that is intended to counterbalance any perceived diagnostic imbalance. The greatest difference with Western scientific diagnosis is again that the objective of Western scientific diagnosis is to arrive at a specifically named pathology for which a drug or surgery is usually prescribed whose intent is to somehow inhibit the expression of the pathological condition. Traditional herbal medicine, aims at providing herbs and special foods whose purpose is to stimulate innate biological functions that help the body heal itself. the difference between these two systems is not really so black and white but represents a more general tendency. With alopathic herbalism, the intention is to use herbs to stop an itch, kill a virus, bacteria or yeast; with traditional herbalism herbs may also be used 'allopathically' but there is always a dominance of treating the underlying causes of imbalance. In TCM this is expressed in the concept of supporting the Righteous chi while eliminating the evil chi. Bob flaws in his article published in American Herbalism, described the difference in TCM when he says, " Bian bing means to differentiate various named diseases and recognized pathological signs and symptoms. Bian zheng, on the other hand, means to discriminate varius professionally recognized patterns of disharmony." Since traditional diagnosis always leads to cure, there is the concept of "Tong bing yi zhi, Yi bing tong zhi -- One disease, different treatments; Different diseases, same treatment". The fundamental difference therefore between Western and traditional diagnostic systems is the difference between "form and function." Western medicine, being more material is based on form whereas traditional medicine is more energetic and is based on function. PULSE DIAGNOSISThere are several similar diagnostic criteria used in traditional diagnostic systems but one of the most characteristic and enigmatic to Western practitioners is that of the pulse. Pulse diagnosis is of paramount importance in is the hallmark of a classical physician. The pulse is a direct manifestation of the circulatory energy of the body and in the hands of an expert physician, is best for describing the internal function of the body mind complex. In Tibetan culture, they use a system of pulse diagnosis that is strongly influenced by the Chinese, it is so ingrained amongst the people that upon first contact with a physician, the patient automatically holds out his arms for a pulse reading. It is expected that a qualified physician, without any further questioning, will be able to tell the patient something that is relevant to their condition. Failing to do this, patients would have no faith in the doctor's qualifications. Nevertheless, despite its high regard in traditional cultures, in dialectical materialistic TCM, the pulse is taken as being of secondary importance with interrogation being primary. The reason, obviously, is the illusive nature and the profound experience required to accurately and effectively read the traditional pulses. While a traditional student would have confined himself to following the model of his experienced teacher, today, with the advent of publishing and communication, the study of pulses is further complicated by the different styles and ways that it is taken. This is true not only between cultural lines but even within each tradition between different schools of practitioners. One of the most interesting statements of a highly respected Taiwan trained practitioner in the San Francisco Bay area, Michael Broffman is that the classical five phase pulse correspondences on the wrist are only the norm but that, in clinical practice, the pulse must be assessed on an individual basis with the actual organ locations on the wrist being idiosyncratic for each individual. The idea that the meaning of the pulses in terms of their location may be different for each individual makes such a rational understanding of pulse diagnostics by a linear thought oriented Western student an almost insurmountable leap of faith. Despite the fact that pulse diagnosis is such a distinctive aspect of TCM diagnosis, it is generally considered to be only about 40% reliable as a sole diagnostic method by most TCM practitioners. It is the experienced masters who are able to accurate physiological and lifestyle analysis based on pulse reading. Then, of course, considering that observation of the patient's complexion, voice, manner is also able to provide a great deal of information about the patient that may be either consciously or not noted by the practitioner. Unlike other diagnostic criteria, the pulse is very reactive and reflects the most current state of the individual. The practice of taking the pulse on the radial artery of the wrist was first expounded in the "Nan Jing" or "Classic of Difficulties". Before that the pulse was taken at nine different arteries, three on the head, three on the hands and three on the legs, each reflecting the condition of the upper, middle and lower burners, respectively. The triple burner refers to the organs that are located within the upper, middle and lower parts of the body. An old common saying concerning the difficulty of learning pulse diagnosis is: "In the mind quite certain, under the finger unsure". The idea is to unite the knowledge of pulse taking with the actual process of feeling. Three fingers are placed on three different positions beginning at the base of the wrist with the index finger representing the upper warmer including the heart and lungs, the middle fingers over the thenar prominence indicating the liver-gall bladder on the left and the spleen-stomach on the right, the ring finger higher just proximal to the thenar prominence with the kidney-bladder on the left and the triple warmer-pericardium on the right. Ideally the pulses are studied in the early morning taking about 15 minutes to study each wrist. The patients are should be horizontal at the level of the heart. The breath of the practitioner should be equalized and the mind stilled. This later indication has two functions. Traditionally, without a second hand on a watch, the speed of the pulse could only be measured by counting the number of beats per normal respiration of the physician. Less than four beats per complete respiration indicates a slow pulse while more than five indicates a fast pulse. Another reason for stilling the mind is that pulse diagnosis is a subtle intuitive art requiring an empty, open and receptive mental state. The fact is that the best pulse diagnosticians combine a balance of rational observation with intuitive thought processes. One great ancient clinician states that "The essential when watching a patient is to preserve the mind and turn the thoughts within, to quiet the breath and turn inward one's gaze, to keep the heart attentive - showing a line of fine inquiry: then one can reachthe spiritual light, search through all obscurities, and decide upon the question of life and death, without one single mistake in a thousand cases." Most individuals are able to discern six relatively easily verifiable qualities which form the basis for pulse study. These form the basis of the eight principles which allows one to evaluate overall yin-yang homeostasis and metabolic function. Following are the six basic pulse qualities:
If the pulse feels weak and deficient, one would not use eliminative or strong heat clearing but rather emphasize the use of tonics. If it feels strong and full, one would prescribe some type of clearing or eliminative strategy. If it feels slow which signifies cold, one would prescribe warming and stimulating herbs; if fast, cooling and sedating remedies. If it is floating one would use some type of surface relieving diaphoretic herbs. If it is floating at the superficial level but empty at the deep level, it indicates yin deficiency and would require yin-nutritive tonics. If the pulse feel deep one would treat internal organ conditions. If deep and weak, it is a deficiency of chi and yang and would require tonics. If it is deep and full, it indicates stagnation of chi and blood and one would use emmenagogue herbs and foods that would promote blood circulation or carminative herbs that promote circulation of chi. Ayurvedic Pulse DiagnosisAyurvedic medicine attempts to correlate the pulse to the tridosha or three humours. The pulse closest to the wrist which is taken by the index finger of the physician corresponds to the vata-air or nerve oriented humour, the middle position taken with the middle finger corresponds to the pitta-fire or digestive and circulatory humour; the third position taken with by the ring finger corresponds to the kapha-fluid or bodily substance humour. The individual qualities of the pulse are described in terms of several animals. A vata or air predominant pulse is compared with the movement of a snake or leech. Usually this pulse feels faster and indicates indigestion, nervous problems, fever, etc. In Chinese medicine it might be classified as yin deficient. A pitta or fire predominant pulse is described as resembling the jerky movement of a frog, a sparrow or a crow. Since these are generally a jerky or jumpy movement, it can indicate insomnia, diarrhea, vertigo, hypertension, heat of the skin, palms, soles and burning eyes. A kapha or water predominant pulse is described as the movement of a swan, cock or peacock. This is generally a slow pulse and indicates the presence of phlegm coughs, a melancholic disposition, etc. Western Pulse DiagnosisWestern medical diagnosis also recognizes various pulse indications that
correlate with disease factors. For instance: There are literally dozens of other pulse indications that once were part of the medical doctors training and are seldom used today in modern clinical practice except for the speed. AYURVEDIC MEDICINELike Traditional Chinese Medicine, Ayurvedic Medicine, the ancient, traditional medical system of India dating from around 2000 to 1500 BC, is based on an energetic model where the native constitution of the patient, diseases, herbs, foods, remedies and treatments are all classified as hot-cold, moist-dry, light-heavy, coarse-smooth, weak-strong, etc. The entire system is based on what is called Tridosha or the Three Humours. In the sense of Ayurveda, a 'dosha' means 'fault', a quality or substance that is controlled neutralized by the elusive balance of each other. Tridosha could be considered the distinctive and founding principle of Ayurveda and is comparable in importance to Yin and Yang in TCM. It is interesting that as Ayurveda has a dual system called "shiva-shakti" as part of its philosophy it is not strongly emphasized as the Three Humours. In TCM, there is also a Three Humour diagnostic classification, probably originating from India, while it is important to the system, it is remains as only one approach to the classification of diseases and herbal treatments. The early Greco-Roman humoural system expounded by Hippocrates to Galen, is probably more closely based on the Ayurvedic model. Ayurveda also has a Five Element model as a cornerstone of its theory. It is similar to the TCM Five Elements and to the Greco-European Four Elements although there are differences probably based on social, cultural and geographical characteristics unique to each area and society. The Chinese Five Elements are Fire, Earth, Metal, Water and Wood; the Ayurvedic Five Elements are Fire, Earth, Water, Air and Ether and the Greco-Roman is Fire, Air, Water and Earth. The differences are even less if we consider that in both the Chinese and Ayurvedic systems, Earth may not have been a distinctive element but was the center for the outer four. We may also consider that the Chinese having Metal and Wood for two of its elements is more an expression of its earth centered agrarian philosophy while Air and Ether of Ayurveda perhaps is an expression of the more spiritually centered philosophy so characteristic of ancient and modern India. In any case, the similarities of the Humoral and Elemental systems of these three great cultures, strongly suggests that there was a dynamic exchange of knowledge between all the great civilizations of the ancient world and that the knowledge of India was probably a root for all of them. In Ayurveda, diagnosis and treatment is centered around the understanding of Tridosha or Three Humours which are: Vata or Air, Pitta or Fire and Kapha or Earth. TRIDOSHA
(Chart derived from Ayurveda: The Ancient indian Healing Art by Scott Gerson MD, Publ Element Press) Like TCM, the Ayurvedic doctor diagnosis by evaluation of symptoms and direct sensory experience of touch (pulse and body palpation), listening (sound of voice and body sounds), observation (the body and facial appearance and tongue) and smell (body odors). A major difference between TCM and Ayurveda is that the latter places a greater emphasis on constitution while TCM at least as it is currently practiced in China and the West is more disease oriented. This difference offers the possibility of combining the two systems effectively since at least in my opinion, Ayurveda is better at constitutional analysis while TCM is better at disease diagnosis. In all cases the qualitative difference between the two lies in their ability to produce the most reliable and effective treatment result. Ayurveda also expresses an important concept where "agni" or "life fire" eventually vitiates tridosha leading to impaired digestion. This eventually creates "Ama" which is an accumulation that begins in the GI tract and eventually congests and blocks the "srotas" or channels (roughly equivalent to the TCM meridians) involving the blood vessels, capillaries and lymphatic system. In contemporary Western thought the is roughly equivalent to hypercholesterol and/or hyperlipidemia which is considered an important predisposing condition leading to heart failure and stroke, the leading causes of death. Ama generally burdens the system and can impair various other systems that eventually manifest as chronic diseases including gallstones, bronchitis, cancer, depression, arthritis and so forth. Like TCM, Ayurveda posits two general types of disease: exogenous, or diseases that originate outside the body, and endogenous or diseases that are more chronic and originate inside the body. While external climatic factors are the cause of exogenous diseases such as fevers, colds and flus, Ama is the root of more endogenous diseases such as arthritis, heart disease and cancer. When Ama accumulates in the digestive tract it can be observed as a thicker than normal whitish coat on the tongue. In TCM, this is viewed as cold stagnation which being an obstruction can eventually change to heat and a variety of chronic inflammatory conditions. When it changes to heat, the coating will appear yellowish. Ama is viewed as the very death or "harbinger of misery, the cause of disease" as described by Scott Gerson. In contrast to TCM, which views various and particular imbalances with no great overriding emphasis on one, Ama, in Ayurveda, becomes a general cause for all chronic disease. The measures used to balance the doshas and eliminate Ama in Ayurveda include lifestyle changes, dietary, herbal, physiotherapeutic and a system of profound detoxification called "Panchkarmas". "Panch", meaning "five" and "karmas" meaning "tasks" or "jobs" relates to five methods that are systematically performed over a concentrated period of time of say a month or more alternating 1. sweating, 2. oiling, 3. bleeding, 4. vomiting and 5. enema. This is mostly unique to Ayurvedic Medicine as most of these methods are not emphasized in contemporary TCM practice although they do have some historical tradition of their use in Chinese medicine. In any case, Panchkarma is another powerful adjunct therapy that can easily be added to the practice of TCM or any other alternative healing practice with great result. Some important Ayurvedic herbal therapies is the use of Triphala which consists of three myrobalans or fruits each having the property to regulate each of the respective Tridoshas. Thus Amla (Emblic myrobalan) regulates fire or Pitta humour, Bibhitaki (Beleric myrobalan) regulates water-earth or Kapha humous, Haritaki (Chebulic myrobalan) regulates air or Vata humour. The overall effect is to clear the entire GI tract, regulate the bowels and improve digestion and generally eliminate Ama from the GI tract. It is taken for constipation or diarrhea and as a foundation for gently detoxifying the entire body without causing and weakness or deficiencies. Guggul is another important Ayurvedic preparation made from the purified resin of the guggul plant which is closely related to myrrh. Guggul is specific for eliminating hypercholesterol and hyperlipidemia. It is indicated for all circulatory and arthritic conditions. CONCLUSIONAs the West and various countries of the world adopt various traditional systems of healing such as TCM and Ayurveda, as well as forming some diagnostic methods of their own, we will see a tendency for these various traditions to be either corrupted or enriched, depending upon one's point of view. In any case, the mutual influence between Western scientific medicine and traditional medical systems such as TCM and Ayurveda is inevitable and are being taught side by side in colleges in each of their respective countries. Just as the more holistic influence of traditional healing systems are a welcome perspective to the practice of conventional Western medicine, so also should the influence of Western scientific understanding be harmonious with the tenets of traditional medical systems. Diagnosis will always be a challenge in every healing system. Because of this, intuition will always be a vital part of practice of any good physician. Some Western approaches such as kinesiology, radionics and in my opinion, iridology, focus more on the intuitive side of diagnosis. As with any diagnostic method, the approach used is as good as the practitioner. However, the concept of differential diagnosis, meaning to evaluate an individual from different criteria should remain important as a check and balance to lessen the possibility of error. My approach is to evaluate all that is possible of the known and continue to extend gradually to the stages of the more intuitive level of knowing. I think it is dangerous for most practitioners to start from the intuitive or unknown to the known because at the very least, a sound intuitive judgment must be dependent on a level of inner clarity that may not always be present. In traditional systems such as pulse and tongue diagnosis there are the verifiable pulses and tongue signs and there are the less verifiable indications based on assigning individual organs or humors to areas within a half inch of each other on the radial artery of the wrist or interpreting individual areas of the tongue as belonging to specific organs of the body. Intuition is less obvious in modern today's technological Western medicine, however, the qualitative difference between one doctor and the next may be the one with the best hunch. Dr. Michael Tierra is a California state licensed acupuncturist with a 30 year clinical practice in Santa Cruz, California. He is the author of several books including The Way of Herbs (publ by Pocket Books, a division of simon and Schuster), Planetary Herbology (publ by Lotus Press), coauthor with his wife, Lesley of a text on Chinese Herbal Medicine (publ. by Lotus Press), Magnet Healing (publ by Lotus Press). He is also the author of the East West Herb Course which is based both in the US and in the UK. Michael has an extensive line of Planetary Herb Products that are available both in the US and in the UK. Please visit Planetherbs.com. |
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