Communication and Integration

1. Communication and Integration

2. Survey of Physicians • 96% of LAc’s And • 100% of MD’s and Hospital Administrators • Report that Communication is the #1 topic of significance in order to advance integration • National Education Dialogue to Advance Integrated Healthcare (see attached document)

3. Why all the Trouble? • Cultural cognition • School’s failure to communicate “coherent vision of Chinese medicine and an infinitely reproducible, step-by-step methodology for its practice.” (Flaws, Problems Making CM work in the West, Blue Poppy Blog) • The Myth of ‘Body, Mind, Spirit’ in TCM

4. Cultural Cognition • TCM bears a bias of subjectivity in the form of reliance upon the patient’s lived experience of illness • This is a wonderfully empowering bias in regard to the treatment of chronic disease – which inevitably involves subjective aspects of illness (i.e. lifestyle) • It is a disaster for Western model of research which treats disease (as opposed to patterns) and maintains a bias of ‘objectivity’

5. Jung on Eastern Thinking • “Even a superficial acquaintance with Eastern thought is sufficient to show that a fundamental difference divides East and West. The East bases itself on psychic reality, that is, upon the psyche as the main unique condition of existence . . . It is a typically introverted point of view, contrasted with the typically extroverted point of view of the West.” (ibid)

6. Jung on Subjectivity • “The prominence of the subjective factor does not imply a personal subjectivism, despite the readiness of the extraverted attitude to dismiss the subjective factor as “nothing but” subjective.”

7. Jung on Subjectivity • “The psyche and its structure are real enough. They even transform material objects into psychic images . . . They do not perceive waves, but sound; not wave-lengths, but colours. Existence is as we see and understand it.”

8. Manfred Porkert • “As a result of their fundamentally different perspectives on reality . . . emphasis on functional and organic factors in the one case, and retrospective analysis of past events (with) emphasis on somatic and material factors on the other – Chinese and Western medicine can make their observations and then present us with two different ‘versions’ of the same phenomenon.” (Porkert, Chinese Medicine)

9. Cultural Cognition • “Ideas must be transmitted by the head, and, of necessity will undergo change. Where could a foreign idea be accepted, assimilated or transmitted without being influenced by the particular situation it meets . . . And by the preconditioned patterns of thought cherished by the final receiver?” (Unschuld, p. 55)

10. The Thinking Which Accompanies • “Modern science and technology require an absorption of the thought processes which accompany them.” (Huntington, p. 73)

11. Journey to the East • “Concern for historical accuracy and theoretical orthodoxy weren’t part of the zeitgeist (of those who first brought TCM to the West).” (Flaws, Body, Mind, Spirit – Also Not, Blue Poppy Blog)

12. History and Perspective • “With us . . . The grace of God is everything; but in the East, man is God and he redeems himself.” (Jung, Eastern and Western Thinking)

13. The Bias of the West • "Measurement!  It is the very foundation of the modern scientific method, the means by which the material world is admitted into existence.  Unless we can measure something, science won't concede it exists, which is why science refuses to deal with such "non-things" as the emotions, the mind, the soul or the spirit.“ (Pert p.21)

14. Going Deeper • What do MD’s despise? • Lack of Methodology! • It is not that most really cannot acknowledge there are other systems of healing • It is lack of rigor that they cannot stomach

15. Methodology of TCM • Gather Facts (clarify facts) = questioning, tongue and pulse - Reframe patient's Western disease into corresponding TCM diseases by focusing on the clinical signs and symptoms • Differentiate (hypothesize) patterns - Pattern discriminate each TCM disease(s), considering patient's sex, age, body-type, and any common disease mechanisms

16. Methodology of TCM • Hypothesize disease cause / disease mechanism - Question and examine to confirm or deny your working hypotheses. • State treatment principle / treatment plan - When you have identified the presenting patterns, state the treatment principles for those patterns in the same order.

17. Where to Put Effort • What are the most common patterns in chronic disease? • In stress, anxiety, depression? • Pain? • Specific Western medical diseases (i.e. named diseases)

18. Example: MS • Multiple Sclerosis • Clinical Signs and Symptoms • Unilateral numbness, weakness of limbs, decreased libido, shao yin body-type, difficulty walking, cold feet and general cold; menses scant and irregular; muzzy head and general lethargy • red, slightly peeled tongue, hammer shaped and swollen and red on the edges; • pulse: fine, forceless and bowstring

19. Example: MS • Patient was diagnosed with lesion in the cervical spine six months prior to visit and is still suffering symptoms

20. Logic • Decreased libido, cold feet and general cold, as well as lack of strength indicate spleen qi and kidney yang vacuity • Numbness and shao yin body indicate vacuity of blood and yin • Hammer tongue, peeled and red along with muzzy head indicate evil heat consuming yin fluids as well as phlegm obstruction in the upper jiao

21. Logic • Fine, forceless confirms vacuity of qi and yin • Bowstring indicates lack of free-flow

22. Disease Mechanisms • Former heaven insufficiency, over-exercise (taxation), habitual bodily vacuity • Spleen qi vacuity with marked liver depression, depressive heat has consumed yin and damaged blood • Qi vacuity has now given rise to yang vacuity and aging and heat have all contributed to yin and blood vacuity

23. Pattern Discrimination • Spleen qi, kidney yin and yang dual vacuity with liver blood vacuity and phlegm heat obstructing and harassing above

24. Treatment Principles • Supplement the spleen and boost qi and yang, nourish yin and supplement the blood, clear heat and transform phlegm

25. Treatment Plan • Acupuncture and moxabustion: • He gu, tai chong, feng long, yang ling quan, zhao hai, tian shu, zhang men, liang men • Moxa at: qi hai, guan yuan ming men, shen shu • Pick 4-6 (do not over treat with needles!!) • Shi Quan Da Bu Tang with Xiao Chai Hu Tang he Si Wu Tang

26. Translating the Untranslatable • Qi – is not electricity (bioelectricity) • Energy? Don’t even go there! • See Robert Becker’s explanation of the ‘current of injury’ in Body Electric

27. How to Talk About Qi • Every question is an opportunity to teach • Knowing holistic metaphors and TCM methodology are pre-requisites for speaking to MD’s • Qi is function – i.e. when speaking of qi, refer to aspects of function

28. Functional Medicine • Functional medicine is personalized medicine that deals with primary prevention and underlying causes instead of symptoms for serious chronic disease. It is a science-based field of health care that is grounded in the following principles:

29. Functional Medicine • Biochemical individuality • Patient-centeredDynamic balance of internal and external factors • Web-like interconnections of physiological factors – an abundance of research now supports the view that the human body functions as an orchestrated network of interconnected systems

30. Functional Medicine • Health as a positive vitality – not merely the absence of disease. • Promotion of organ reserve as the means to enhance health span • Functional medicine emphasizes . . . functionality at many levels . . . rather than a single treatment for a single diagnosis. Functional medicine uses the patient’s story as a key tool for integrating diagnosis, signs and symptoms

31. Examples Good and Bad • Liver/gallbladder = sympathetic nervous system • This approach is fraught with opportunities for trapping oneself into a pissing contest

32. Objections from the West • No Placebo – no dice • General mistrust of studies from outside the U.S.

33. Placebo • “Dismissing the effect of faith on one’s physical well-being as merely a placebo effect misses the existential truth central to our being – that Mind is preeminent.” (Flaws, Blue Poppy Essays 1988, p. 307)

34. Research • Seek research done via pattern discrimination for use in presentation or circulation among MD’s • It may (will) require explanation, but if you are competent, you will find opportunities to teach conventional folks about TCM methodology and metaphors

35. Conclusions • Take control of the game by learning to teach • If you do not know TCM pattern discrimination and the metaphors of holism COLD, you are not ready to speak to MD’s • Be (extremely) clear about methodology • Treat questions as non-questions and use them as opportunities to teach

36. Sources for Further Study • Blue Poppy Blog • Teaching Chinese Medicine to Lay People • Body Electric. Robert Becker and Gary Selden • Eastern and Western Thinking. Carl Jung • Medicine in China, A History of Ideas. Paul Unschuld • Chinese Medicine. Manfred Porkert

37. Sources • A Master’s Class in Chinese Medical Diagnosis – Blue Poppy Distance Learning • The Treatment of Disease in Chinese Medicine (7 volumes). Philippe Sionneau • TCMLARS – for research • Blue Poppy Research Reports (online and CD)

38. Sources • The Power of Context: reconceptualizing the placebo effect. Franklin G. Miller, Ted J. Kaptchuck • The Structure of Scientific Revolutions. Thomas Kuhn • Statements of Fact in Chinese Medicine. Blue Poppy

39. Websites • Barefoot Medicine Training • www.BarefootMedicineTraining.com • Functional Medicine University (http://www.functionalmedicineuniversity.com/)

40. Online Courses • Fundamentals of Holistic Chinese Medicine: Statements of Fact • http://www.barefootmedicinetraining.com/massage.html • Presentation Communication and Teacher Training Skills • http://www.barefootmedicinetraining.com/tcm.html • These are the first and only courses which teach TCM folks how to present to and communicate with Western MD’s