Why is Something Wrong With You?

We got talking a bit about this on another thread...rather than de-rail the other perfectly good thread, I thought it deserved its own.

Bob Day said this in that thread:

bob day wrote:
...i got my treatment from the chinese herbalist,....one interesting thing i noticed when the herbalist was working out the formula to give me was that even though i was able to tell her with fair certainty what the cause was, she made a point to enumerate my symptoms one by one and devised her formula from them, not from the name of the disease or any generic protocol.

One of the reasons modern medicine sometimes struggles with healing things rather than merely removing symptoms is that all of their efforts are often driven by the wrong question "What's wrong with you?" . It's not a bad question, I mean they have to know why we came in to see them of course, but it leads naturally to the presumption that making the symptom go away equates with making the problem go away.

Traditional healers ask a different question; "Why is something wrong with you?". It's a very different question and, by its nature, leads to very different answers. The Chinese are the true masters of this approach. They view disease and symptoms of illness not as the problems themselves, but as evidence of the real underlying lack of harmony between the Yin and Yang elements of a person's nature. They spend their efforts balancing the Yin and Yang and the body fixes the symptoms itself.

It's true that Western herbalists often use the same Chinese plants in a more "allopathic" approach (this root for this symptom) so the plants do have symptom-specific pharmacologically active principles, but, the way the Chinese think about things is more likely to get to the root of the problem.

It's not a question of curing disease....it's a question of correcting the dis-ease. We can do the same thing as Western herbalists without having to wrap our poor Western brains around all the metaphorical whimsy of Traditional Chinese Medicine (dampness in the liver, fire in the kidneys...snowballs in the spleen, yin, yang, Qi, etc...) so long as we keep asking the right question. Why is something wrong with you?

I wrote a little blog about this that has an interesting example of a case where this approach worked very well. If you're a glutton for punishment, you can read it here: http://homegrownherbalist.typepad.com/my-blog/2013/10/a-question-of-questions.html

Patrick

Beautiful course of events for that young lady , Doc ! That is a question most physicians never ask . The last time I went to an MD was for a physical . I needed it to complete a college degree . At that time I was overweight{238 lbs}, stressed out , and sedentary . Being a nurse , I glanced at my chart when he finished his exam . He had written "morbid obesity" and "borderline hypertensive" . When conducting his exam he appeared quite concerned while palpating my right upper quadrant below the rib cage . He was focusing on my liver and asked if I drank alcohol . I said no . When he began writing out prescriptions I told him I would not be taking any medications . He looked puzzled , said "Oh" and left the room after signing the needed school form . Not one word was said about losing weight , exercising , or my liver .
I like to utilize the "5 Whys" in conducting root cause analysis . Usually you don't have to ask more than two or three "Whys" to get to the bottom of things .
Why am I overweight ? : Because I eat too much and don't exercise .
Why do I eat too much and not exercise ? : I'll leave that one up to the Freudians .

Thanks Wayne.

I'm a practicing veterinarian as well as a clinical herbalist. The vet training (like medical training) really is designed to create practitioners that "know the answers". Alas, the answers we know tend to be for the wrong questions.

There is a lot of pressure on physicians to push patients through and keep visit numbers high. I have a physician brother that catches a lot of flack from his employers because he spends too much time with his patients and tries to teach them non-pharmaceutical ways to manage their chronic pain (he's a pain specialist). The clinic wants more patient visits/day and more prescriptions. Apparently, deep breathing, meditation and self-hypnosis don't pay the bills. I have another brother (a neurosurgeon) who took grief from his group because he was sending patients to physical therapists, acupuncturists etc.. instead of doing surgery on them. Apparently, not every patient that goes to see a neurosurgeon actually needs back surgery...weird.

There are still some great physicians out there. Shop around a little and find one that doesn't know everything.

Doc

wayne stephen wrote:Beautiful course of events for that young lady , Doc ! That is a question most physicians never ask . The last time I went to an MD was for a physical . I needed it to complete a college degree . At that time I was overweight{238 lbs}, stressed out , and sedentary . Being a nurse , I glanced at my chart when he finished his exam . He had written "morbid obesity" and "borderline hypertensive" . When conducting his exam he appeared quite concerned while palpating my right upper quadrant below the rib cage . He was focusing on my liver and asked if I drank alcohol . I said no . When he began writing out prescriptions I told him I would not be taking any medications . He looked puzzled , said "Oh" and left the room after signing the needed school form . Not one word was said about losing weight , exercising , or my liver .
I like to utilize the "5 Whys" in conducting root cause analysis . Usually you don't have to ask more than two or three "Whys" to get to the bottom of things .
Why am I overweight ? : Because I eat too much and don't exercise .
Why do I eat too much and not exercise ? : I'll leave that one up to the Freudians .

wayne stephen wrote:Beautiful course of events for that young lady , Doc ! That is a question most physicians never ask . The last time I went to an MD was for a physical . I needed it to complete a college degree . At that time I was overweight{238 lbs}, stressed out , and sedentary . Being a nurse , I glanced at my chart when he finished his exam . He had written "morbid obesity" and "borderline hypertensive" . When conducting his exam he appeared quite concerned while palpating my right upper quadrant below the rib cage . He was focusing on my liver and asked if I drank alcohol . I said no . When he began writing out prescriptions I told him I would not be taking any medications . He looked puzzled , said "Oh" and left the room after signing the needed school form . Not one word was said about losing weight , exercising , or my liver .
I like to utilize the "5 Whys" in conducting root cause analysis . Usually you don't have to ask more than two or three "Whys" to get to the bottom of things .
Why am I overweight ? : Because I eat too much and don't exercise .
Why do I eat too much and not exercise ? : I'll leave that one up to the Freudians .

There's a lot of speculation about refined carbohydrates creating a form of malnutrition that manifests as obesity. If the foods contain poor nutrient density, you remain hungry despite having ample calories in the diet.

My sister is also a nurse, and said that among her fellow nurses the opinion on healthy diet ranges from Atkins to vegetarian. Hospital nurse shifts are not conducive to leisurely, fresh/raw food meals. And while there's plenty of walking around, if you aren't eating right it's easy to eat too much to keep your energy up.
She herself is mostly a whole-foods, almost-vegetarian eater, and thinks the idea that a qualified nurse would consider doing the Atkins diet is downright scary. But for that kind of high-stress environment, foods that keep you going a long time have a lot of merit. And foods that help you not be fat, whether they hurt you otherwise or not, are attractive. "Low-fat" foods are common, which means usually a lot of processed carbs as preservatives and texture substitutes.

Most of modern medicine, as a culture, looks pretty unhealthy. It seems to be a very stressful environment; attending others' appointments I've heard mandatory smoking-cessation advice from doctors who smoked, etc. No more unhealthy than the rest of society, and probably way better than the 'regulars' who my friends see in ambulance service or hospital work. But not a glowing example of the secrets to health and happiness, for the most part. Even the ones who claim to be - people on ads who are strong, fit, thin well into their later years - look unhealthy to me.

I like my elders worn, lean and craggy or plump and saggy doesn't matter so much, but I want to see peace and vitality about the eyes, and a lot of laugh lines.
I suppose giving out my criteria for elders is just as crass as discussing one's tastes in women, or men. Hope it doesn't offend anyone.

...

Regarding the article about the young lady who needed holistic help, not symptom treatment, for her eczema:

My family doctor, luckily, had a tendency to ask this type of question. "Are you under stress lately?"

(This might pertain to almost any symptom, from cold sores to weight gain.)
We would discuss what was going on in my life - sometimes an awkward conversation as he'd been my family doctor since childhood, and still treated my mother too. I felt like I had to live up to an almost parental regard. But he didn't offer judgement about lifestyle choices, just made recommendations for specific situations.

One example was a whole-foods diet to reduce cholesterol that worked well for both my mother and myself.
(Breakfast - oatmeal, with whatever trimmings you like. Lunch- a salad of fruits and vegetables, oil-and-vinegar dressing. Dinner - whatever you like, a normal healthy dinner. Snacks- almonds or walnuts between meals.)

I found that as long as I only broke the diet once a day, it still worked. I still eat roughly that diet, with seasonal adjustments for lower availability of salad. I even learned to tolerate 'gorilla food' lunches when working for summer camps. It might not look like any salad you recognize, but if I would not get in trouble for feeding it to the gorilla at the zoo, it went in the lunch sack. Avocado-banana-and-carrot lunches. Sometimes with olives. Not pretty, but it got it done.

When my mother went back with better cholesterol readings, but low energy in the afternoons, they added back in some lean meats like tuna or chicken along with the lunch salad.

That kind of workable, sensible, adaptive lifestyle advice is something that many physicians don't have time for any more.
The ones that do, often have a full and successful private practice, and aren't taking new patients.

I think there is also bias where the doctors who treat patients as a speed-reading exercise see a lot more patients. So for ever 8 happy patients who are made better after my family doctor finishes a good day's work, there are 60 patients who are totally ticked off about their useless, 10-minute visit with Dr. Quickie.
These 60 patients may go see 4 more doctors before they find either a lucky guess by another Dr. Quickie, or a Dr. Care who takes the time to understand the situation fully. Lots of office visits are charged, and perhaps even treatments prescribed, but the process of accurate diagnosis, and effective healing, often doesn't happen in that context.

You don't have to be an MD to be a Dr. Quickie, nor is every MD a Dr. Quickie. There are acupuncture clinics that aim for the same kind of speed, and sometimes sacrifice patient care. There's value to treating routine conditions quickly and keeping care affordable, but I think that overall it is a better use of time to make sure that the person seeking treatment gets what they need, and doesn't need to keep coming back or searching for better care.

-EKW

I would even say the more important question is not What or Why is wrong with you, but

"What's going on with you?"

An annual check-up, where we don't assume something is wrong but we make sure everything is going right, can catch a lot of issues before they even progress to dis-ease.
Then we are dealing with 'Dr. Healthy.'

All this process of paying per-service makes over-prescribing, over-testing, and mis-diagnosis lucrative.

Does anyone know whether it's true that traditional Chinese medicine somehow the doctors only get paid when the patient is healthy? Do they bill only at the end of successful treatment, or do patients who die just not pay their bills?

-Erica W

Erica Wisner wrote:

There's a lot of speculation about refined carbohydrates creating a form of malnutrition that manifests as obesity. If the foods contain poor nutrient density, you remain hungry despite having ample calories in the diet.

It's not merely speculation. There's good solid science that's been around for a long time and vigorously ignored by the food industry.

In a nut shell, insulin and glucagon are two hormones produced by the pancreas to manage blood sugar. When blood sugars are low, glucagon levels rise. Glucagon stimulates the liver to break up glycogen (long strands of glucose molecules stored in the liver) and release the glucose into the blood. If glycogen levels are low, the glucagon stimulates the process of converting body fat into glucose to be used for energy.

When blood sugars are high, insulin is released. Insulin drives glucose into the cells (including fat cells leading to obesity).

When we eat a a healthy, well-balanced diet of unrefined foods, glucagon and insulin levels work as they should in their regular feedback loop.
When we eat excessive or highly processed carbohydrates, insulin levels soar and glucagon levels plummet. In addition to obesity, high insulin levels cause myriad other serious health problems from inflammation to atherosclerosis.

Barry Sears has done some great work and writing on how to eat like we were designed to eat. Some Barry Sears' Books

The other critical thing to understand is fats. In short, we need to eat fats found in nature (tasty dead animals, natural dairy products, nuts, olive oil etc...) rather than the industrially-created fats so beloved by food scientists. Anyone wanting to learn more about fats would do well to study Mary Enig's Work and Sally Fallon's books..

I'd also highly recommend studying the works of Weston Price and Francis Pottinger. Here's a little Video that gives an introduction to their research. I'd recommend both of Their books.

Patrick

Hi team,
Bona fide normal regular "allopathic" doctor here, albeit a geneticist - I am not great with sore toes, but I've got your genes covered . I'm going to straight-out say that there is a lot of hooey talked about traditional medicine and a lot of over-emphasis on "natural" treatments that are anything but (for example, a lot of "alternative" products are laced with pharmacologically active ingredients, sometimes at enormous doses that would kill a moose). And there are a lot of quacks (such as Burzynski) making vast amounts of money from desperate people, promising the earth, and only delivering a top load of six feet of it.

*Having said that*, a couple of good points are made in this thread, and certainly in UK these issues are seen as being really important. The "War on Fat" is seen by many now (and this is being widely written about in medical journals such as BMJ by people like Des Spence, Ben Goldacre and Asseem Malhotra - Asseem in particular is worth a twitter follow) as having been hopelessly driven by commercial agendas and pet theories. Fat has become the bad guy when in fact refined carbohydrates, especially sugar, turn out to carry *much* higher risks of cardiovascular disease and diabetes. It seems to me that most of the folks on Permies are aware of this and have known it for a long time. Personally if I see a product advertised as "LOW FAT!!!" or "HEALTHY OPTION!!!" my scepticism detectors go into overdrive - typically you find it's been filled with nutritionally empty sugars or gels or sweeteners to bulk it out and simply go straight for the sweet sensation. That is the road to being buried in a wide coffin.

What modern medicine sometimes doesn't project is a holistic approach to the patient. But the best modern doctors *do* provide this, and we have it drummed into us from day 1 at med school that we should try. The patient has to be the priority. However there is now a "patient paradox" (as Margaret McCartney puts it) where people who are well are pulled in to have "check-ups" (whatever the feck that's supposed to do for ya) for X, Y and Z, while sick people have a hard time accessing medical services, and when they do, the process is so fraught that they don't have someone who will take the time to go over everything, make a proper diagnosis, and decide *with the patient* how they're going to manage it. And one of the most important things that we as doctors do *badly* is taking people OFF a lot of their drugs. We're loading people up with statins and crap that they very often don't need. Drugs are often prescribed on the basis of "number needed to treat" (NNT) - for statins to prevent ONE heart attack over 10 years, you may have to treat TWENTY people in some risk categories - and risk side effects etc. Is that sane? Sometimes yes, sometimes no, but patients deserve to have that information and make an informed choice.

On the alternative side, some treatments are simply ineffective, or placebo at best, eg homeopathy. Ben Goldacre's "Bad Science" (which should be read with "Bad Pharma" and Margaret McCartney's "The Patient Paradox") is utterly excellent in outlining some of these points. There are "non-holistic" simplistic quick fixes all over the place on the alternative scene, such as plant extracts that are suggested to cure everything from cancer to baldness - and it's all a pile of shite (pardon my Gaelige).

Sorry this is a long post, but this is where I think "permies" and medics need to come together. We've spent millions of years evolving a biology (as humans) that works pretty well. For *most* of our daily bodily functions we don't need pharmacological products to continue to exist - just what we graze. We have a natural homeostasis as long as we have proper varied nutrition, sanitation, emotional and social support etc. More and more, medics are trying to find ways to rebalance things, eg weight loss isn't just about consuming less calories - it's about choice of food, lifestyle, other activities, exercise, social situations etc etc. My impression is that many people on these fora understand that very well, so I guess I'd like to reassure folks that "mainstream medicine" takes natural stuff extremely seriously, and that we're not all in the pockets of Big Pharma (who incidentally make shedloads from "natural" supplements too - you knew that of course).

But imagine how many antidepressants and sleeping pills would be rendered unnecessary if people got outside in their gardens a bit more, or started working with their neighbours, or even started keeping an eye out for each other. Your doctors are here to help you - not make you miserable

-S

Oh, and what Doc Jones said above - Amen to that

Great points Shane.

It's unfortunate that there is a turf war between some physicians and some "alternative" medicine folks. I understand the reasons both economic and emotional on both sides but it's too bad. In my experience, patients are best served by a successful combination of the two.

As an example, people occasionally come to my herbal practice wanting an herbal solution to a skin cancer. I tell them to go get the danged thing cut off (stainless steel scalpel blades are all-natural and have no side effects ). After the removal, I'm delighted to visit about herbal and nutritional things that might help to improve their health in the future.

I recently had a fellow come in that was referred to me by a local physician. He'd been bitten on the hand by a dog and had a serious infection. His hand was about twice the normal thickness and he had nasty dark streaks running up his arm. His physician gave him an IV antibiotic (as well he should have!) and then told him "If you don't find a good herbalist, you're going to lose that hand." Using poultices and internal herbs he was able to bring the swelling down overnight and quickly get headed back to good health.

Contrast that with another case of a lady that had a post-surgical head wound. Her surgeons wanted to take a skin graft from her bottom and put it on her head. This would quickly have solved her problem but at the price of looking like Friar Tuck for the rest of her life. She called me because she'd seen a case of a dog I'd worked on. I told her about second intention healing and taught her about some herbs that could accelerate/promote the process. The wound filled in and contracted beautifully leaving only a small scar which she can easily cover with her hair. Her surgeons treated her very unkindly when they found out what she was doing.

My veterinary patients almost always get a multi-pronged approach with modern as well as traditional remedies. In my experience, the combination of the two is generally more effective than using one discipline or the other exclusively (though there are medical exceptions favoring each side).

The two quotes that guide my approach to healing (modern or herbal) are these:

"Prove all things. Hold fast that which is good."
and
"It's good to have an open mind, but not so open that your brain falls out."

The judicious application of these two quotes has served me well.

Doc

Shane McKee wrote:Hi team,
Bona fide normal regular "allopathic" doctor here, albeit a geneticist - I am not great with sore toes, but I've got your genes covered . I'm going to straight-out say that there is a lot of hooey talked about traditional medicine and a lot of over-emphasis on "natural" treatments that are anything but (for example, a lot of "alternative" products are laced with pharmacologically active ingredients, sometimes at enormous doses that would kill a moose). And there are a lot of quacks (such as Burzynski) making vast amounts of money from desperate people, promising the earth, and only delivering a top load of six feet of it.

*Having said that*, a couple of good points are made in this thread, and certainly in UK these issues are seen as being really important. The "War on Fat" is seen by many now (and this is being widely written about in medical journals such as BMJ by people like Des Spence, Ben Goldacre and Asseem Malhotra - Asseem in particular is worth a twitter follow) as having been hopelessly driven by commercial agendas and pet theories. Fat has become the bad guy when in fact refined carbohydrates, especially sugar, turn out to carry *much* higher risks of cardiovascular disease and diabetes. It seems to me that most of the folks on Permies are aware of this and have known it for a long time. Personally if I see a product advertised as "LOW FAT!!!" or "HEALTHY OPTION!!!" my scepticism detectors go into overdrive - typically you find it's been filled with nutritionally empty sugars or gels or sweeteners to bulk it out and simply go straight for the sweet sensation. That is the road to being buried in a wide coffin.

What modern medicine sometimes doesn't project is a holistic approach to the patient. But the best modern doctors *do* provide this, and we have it drummed into us from day 1 at med school that we should try. The patient has to be the priority. However there is now a "patient paradox" (as Margaret McCartney puts it) where people who are well are pulled in to have "check-ups" (whatever the feck that's supposed to do for ya) for X, Y and Z, while sick people have a hard time accessing medical services, and when they do, the process is so fraught that they don't have someone who will take the time to go over everything, make a proper diagnosis, and decide *with the patient* how they're going to manage it. And one of the most important things that we as doctors do *badly* is taking people OFF a lot of their drugs. We're loading people up with statins and crap that they very often don't need. Drugs are often prescribed on the basis of "number needed to treat" (NNT) - for statins to prevent ONE heart attack over 10 years, you may have to treat TWENTY people in some risk categories - and risk side effects etc. Is that sane? Sometimes yes, sometimes no, but patients deserve to have that information and make an informed choice.

On the alternative side, some treatments are simply ineffective, or placebo at best, eg homeopathy. Ben Goldacre's "Bad Science" (which should be read with "Bad Pharma" and Margaret McCartney's "The Patient Paradox") is utterly excellent in outlining some of these points. There are "non-holistic" simplistic quick fixes all over the place on the alternative scene, such as plant extracts that are suggested to cure everything from cancer to baldness - and it's all a pile of shite (pardon my Gaelige).

Sorry this is a long post, but this is where I think "permies" and medics need to come together. We've spent millions of years evolving a biology (as humans) that works pretty well. For *most* of our daily bodily functions we don't need pharmacological products to continue to exist - just what we graze. We have a natural homeostasis as long as we have proper varied nutrition, sanitation, emotional and social support etc. More and more, medics are trying to find ways to rebalance things, eg weight loss isn't just about consuming less calories - it's about choice of food, lifestyle, other activities, exercise, social situations etc etc. My impression is that many people on these fora understand that very well, so I guess I'd like to reassure folks that "mainstream medicine" takes natural stuff extremely seriously, and that we're not all in the pockets of Big Pharma (who incidentally make shedloads from "natural" supplements too - you knew that of course).

But imagine how many antidepressants and sleeping pills would be rendered unnecessary if people got outside in their gardens a bit more, or started working with their neighbours, or even started keeping an eye out for each other. Your doctors are here to help you - not make you miserable

-S