II. Modern medicine provides microscopic evidence

“Syndrome differentiation and treatment” is the hallmark of TCM scholarship and the essence of all Chinese medicine. The foundation of “syndrome differentiation and treatment” lies in observation, auscultation and olfaction, inquiry, and palpation; the method is logical reasoning. During the process of “syndrome differentiation and treatment,” only the full use of the physician’s sensory organs and the analytical capabilities of the cerebral cortex is employed. Looking back at the history of TCM development, we can easily trace the origins of this tendency. Throughout the development of TCM scholarship, from Bian Que in the 4th century BC to modern physicians such as Xiao Longyou and Pu Fuzhou, their practical experience and academic ideas have always been rooted in agriculture and handicrafts. Throughout history, TCM scholars have never had the opportunity to use the precise tools provided by large-scale industry to study traditional Chinese medicine. Consequently, the traditional achievements in the field of TCM can only come from macroscopic observation and judgment of the external manifestations of disease. In this context, tongue color, pulse condition, the patient’s subjective symptoms, and certain external physical signs become the main basis for diagnosing disease. Previous generations summarized four diagnostic methods, eight categories of syndrome differentiation, qi-blood-phlegm-fire, five movements and six energies... thus forming a distinctive TCM syndrome differentiation system. This system has indeed played a tremendous role in humanity’s understanding and treatment of disease and continues to do so today. However, since human senses can only observe the external manifestations of disease, the essence of the principle “treatment must seek the root cause” is actually logical reasoning to identify the cause based on observed symptoms, while direct insight into the internal changes of disease remains elusive. Over the years, physicians have accumulated many vivid reasoning methods through rich clinical practice—such as analogy, similarity of energy, and seeking common ground—to try to form a correct understanding of the essence of disease. Although these understandings lack a solid experimental research foundation, they originate from clinical practice and have practical experience as their core, making them universally applicable and guiding for TCM clinical practice. II. Modern medicine provides microscopic evidence In modern times, the development of large-scale industry and natural science complement each other and promote one another. With the help of new theories provided by natural science and advanced tools produced by large-scale industry, humanity’s understanding of disease has gradually become more microscopic. At the end of the 17th century, following the Industrial Revolution in Britain, Western medicine emerged in this context: experimental research replaced traditional logical preaching, and microscopic understanding supplemented medieval macroscopic reasoning—this was the hallmark of that initial stage. Thus, Western medicine stood out with a brand-new appearance, forming a microscopic system based on physiological and pathological changes in organs, tissues, cells, body fluids, and nerves. Every link in this system, as well as the corresponding clinical treatments and prescriptions, are closely related to the progress of modern natural science. This change in the field of Western medicine made it an important link in the modern scientific network system, where it interpenetrates and mutually benefits with other branches of modern natural science such as physics, chemistry, microbiology, meteorology, and geology, advancing in sync. Examination methods and microscopic data for liver diseases—such as liver function tests, protein electrophoresis, alpha-fetoprotein, and the three-system test—and examination methods for stomach diseases—such as fiberoptic gastroscopy and tissue biopsy—and examination methods for heart diseases—such as electrocardiogram, vectorcardiogram, and echocardiography—are all products of experimental research and results of mutual penetration among various fields of modern natural science. III. Only by combining macroscopic and microscopic perspectives can we gain a comprehensive understanding of disease There is no doubt that macroscopic syndrome differentiation is an important aspect of understanding disease; however, microscopic syndrome differentiation is another equally important aspect. To achieve a comprehensive and precise diagnosis, both must be used together. For example, when dealing with liver disease, in addition to macroscopic conditions such as liver qi stagnation, liver wood overcoming earth, damp-heat in the liver and gallbladder, and yin deficiency of the liver and kidneys, if we also take into account microscopic changes in liver function, plasma proteins, and alpha-fetoprotein from the perspective of TCM syndrome differentiation and treatment, we can certainly strengthen our understanding and improve therapeutic efficacy. Through long-term clinical practice, I have discovered some patterns that may be useful for colleagues to reference. To lower transaminase levels, it is effective to use heat-clearing and detoxifying herbs such as honeysuckle, forsythia, dandelion, houttuynia, prunella, indigofera, gentian, and sedum; to turn turbidity tests negative, it is effective to use tonifying and consolidating herbs such as astragalus, codonopsis, polygonum multiflorum, and angelica. By testing with medication, we can conclude that the former indicates excess heat-toxin, while the latter indicates deficiency—specifically, qi deficiency and blood loss. An increase in transaminase levels indicates an increase in enzyme content, which is “excess”; an increase in turbidity indicates a decrease in albumin, which is “deficiency.” As recorded in the “Inner Canon”: “eliminate the excess, replenish the deficiency.” Therefore, the former should be treated with heat-clearing and detoxifying methods, while the latter should be treated with tonifying and consolidating methods. In regulating the three systems of hepatitis B, I often use heat-clearing and detoxifying methods to reduce surface antigen ratios, and tonifying and consolidating methods to turn core antibodies negative. Modern immunological views hold that the relationship between antigens and antibodies is complementary; therefore, the essence of TCM syndrome differentiation for the three systems of hepatitis B should be a combination of deficiency and excess, and treatment should emphasize both heat-clearing and detoxification as well as tonifying and consolidating, so that the medicine truly addresses the illness. For chronic nephritis, 20 macroscopic syndrome differentiation often manifests as yang deficiency with water overflow, spleen-stomach qi deficiency, lung failure to descend, liver-gallbladder real fire, and bladder damp-heat; microscopic syndrome differentiation, on the other hand, should pay attention to urinary routine findings such as casts, red blood cells, white blood cells, protein, non-protein nitrogen, and carbon dioxide binding capacity. When treating this disease, I first determine a basic formula based on macroscopic syndrome differentiation—for example, Zhenwu, Jisheng, Liu Jun, or Longdan Xiegan—and then, depending on whether there is proteinuria, I prescribe tonifying and astringent herbs; if there is hematuria, I prescribe herbs that clear heat and stop bleeding; if there are white blood cells in the urine, I prescribe heat-clearing and detoxifying herbs; if non-protein nitrogen rises or carbon dioxide binding capacity decreases, I recommend ascending-clearing and descending-turbid methods. For gastric pain, macroscopic syndrome differentiation includes spleen-stomach qi deficiency, liver-stomach disharmony, excessive stomach fire, spleen-stomach damp-heat, and lung-stomach yin deficiency; microscopic syndrome differentiation involves changes revealed by fiberoptic gastroscopy, pathological biopsy, and gastric juice analysis. I usually determine a basic formula based on macroscopic syndrome differentiation—for example, Liu Jun, Xiaoyao, Qingwei, Xiexin, or Yiguan Jian—and if microscopic examination reveals superficial gastritis, I add coptis and scutellaria; if atrophic gastritis, I add salvia miltiorrhiza, corydalis, coptis, and scutellaria; if gastric or duodenal ulcers, I add white peony, raw oyster shell, and cuttlefish bone; if gastric prolapse, I add astragalus, citrus aurantium, and atractylodes; if gastric mucosal prolapse, I add sandalwood, cardamom, amomum, and alpinia. IV. Conclusion The combination of macroscopic and microscopic syndrome differentiation is an important trend in the current development of TCM; it is not only related to the effectiveness of treatment, but also represents the urgent task facing TCM today, in the 1980s. Only by boldly extending TCM scholarship to the microscopic level can TCM both preserve its own characteristics and integrate into the intricate, mutually permeating network system of modern science and technology. Only in this way can TCM advance in step with modern science and technology. The era when “the older TCM is, the better” should be a thing of the past. The era when “every word in the “Shanghan Lun” is golden and unchangeable” should also be a thing of the past. We hope that in the near future, TCM monographs that surpass the “Shanghan Lun” and “Wenbing Tiaobian” will appear in the realm of traditional Chinese medicine, featuring the combination of macroscopic and microscopic perspectives. 21 From the perspective of TCM-Western medicine integration, “different diseases treated the same way” Pei Zhengxue A characteristic of traditional Chinese medicine is “syndrome differentiation and treatment.” The term “syndrome differentiation” refers to the overall concept of identifying the cause, mechanism, and pattern of disease. Therefore, “syndrome differentiation and treatment” is different from simple symptomatic treatment. The causes and mechanisms of disease in TCM are derived from logical reasoning and causal investigation based on clinical symptoms; whereas the causes and mechanisms of disease in Western medicine are often the result of experimental research. Consequently, the “syndrome” in TCM and the “disease” in Western medicine are quite different. In clinical practice, it is common to encounter situations such as: ① Different “diseases” present the same “syndrome”; ② The same “disease” presents different “syndromes.” When TCM uses the method of syndrome differentiation and treatment to handle these situations, the former is called “treating different diseases the same way,” while the latter is called “treating the same disease differently.” Treating the same disease differently is an inevitable rule for handling complex and variable clinical conditions; both TCM and Western medicine encounter this situation in clinical practice. Only treating different diseases the same way, however, is a crucial component of the treasure trove of traditional Chinese medicine. Over the years, TCM has accumulated extremely rich experience and materials in this area. I. Theoretical basis of treating different diseases the same way Although the causes of disease are diverse, the diseased organism is still human, which determines that different diseases inevitably share common factors in their pathogenic mechanisms. In the chaotic and complex array of pathogenic factors, TCM has identified a major, decisive factor—the internal cause. This is a unique element in TCM’s basic theory and also the main basis for “treating different diseases the same way.” The “Suwen: Discussion on Acupuncture Techniques in the Lost Chapters” records: “If righteous qi resides within, evil cannot invade.” It also says: “Where evil gathers, qi must be deficient.” The “Suwen: Discussion on the Harmony of Vital Energy and Heavenly Qi” records: “When yin is balanced and yang is concealed, spirit is healthy; when inside and outside are harmonized, evil cannot harm.” This shows that the body’s inherent righteous qi and “yin-yang harmony” are the main factors resisting external evil invasion. According to “materialist dialectics,” “external factors are the conditions for change, while internal factors are the basis for change.” TCM’s emphasis on internal factors is entirely consistent with this principle. Given the pathogenic significance of internal factors such as “righteous qi deficiency” and “yin-yang imbalance,” the history of traditional Chinese medicine has seen the emergence of the Soil-Replenishing School represented by Li Dongyuan, as well as the Life-Gate School represented by Zhao Xianke and Zhang Jingyue. Based on emphasizing the body’s “qi deficiency,” they formulated the “Qi Deficiency Pathogenesis Theory” and developed the “Tonify and Consolidate” method, opening up a broad space for the theory and practice of “treating different diseases the same way” in TCM. The “Suwen: Great Treatise on Regulating the Four Energies” records: “Do not treat the disease after it occurs; treat it before it occurs. Do not treat chaos after it happens; treat it before it happens.” The “Jingui Yaolue: Chapter on Viscera and Meridians” records: “Why does the superior doctor treat disease before it occurs? Because when you see a liver disease, you know it will spread to the spleen, so you should first strengthen the spleen. During the four seasons, when the spleen is strong and not susceptible to evil, there is no need to supplement it.” From this, it is clear that, as a further development of the basic theory of treating different diseases the same way, traditional Chinese medicine has long taken the right step in disease prevention. This shows that the “Tonify and Consolidate” method can both treat many diseases after they occur and prevent many diseases before they arise. As the main principle of “treating different diseases the same way,” this method has played an extremely important role in disease prevention and treatment for many years. The “Qi Deficiency Pathogenesis Theory” upon which it is based has always been regarded as the main theoretical basis for “treating different diseases the same way.” In addition, there are cases where two or several diseases with completely different causes and pathologies present exactly the same clinical manifestations from the perspective of TCM—for example, uterine fibroids and ovarian cysts. For these two diseases, TCM uses syndrome differentiation and treatment primarily based on activating blood circulation and removing stasis, often achieving good therapeutic effects in clinical practice. This is another aspect of “treating different diseases the same way.” Regarding the pathogenesis of symptom clusters, TCM still believes that they are the product of the body’s “qi deficiency.” The “Yizong Bidu” records: “Accumulation occurs because righteous qi is insufficient, and then evil qi takes hold.” From this, it can be seen that in the “symptom-cluster pathogenesis” relationship between “manifestation” and “root,” “blood stasis” only belongs to the “manifestation” aspect, while the “root” remains “qi deficiency.” Therefore, when treating symptom-cluster diseases, in addition to using activating blood circulation and removing stasis as one method of “treating different diseases the same way,” “tonifying and consolidating” remains an indispensable fundamental method—“the former treats the manifestation, while the latter treats the root.” Besides treating different diseases the same way based on “tonifying and consolidating,” there are also widespread applications of “treating different diseases the same way” within the scope of eliminating pathogenic factors. The “Suwen: Discussion on Evaluating Deficiency and Excess” records: “When evil qi is abundant, it is excess; when righteous qi is depleted, it is deficiency.” The “Suwen: Discussion on Evaluating Deficiency and Excess” also records: “Treat excess by draining it; treat deficiency by replenishing it.” It can be seen that among the various factors contributing to disease occurrence, besides “qi deficiency” as the fundamental factor, the abundance of evil qi is also very important. For diseases dominated by “abundant evil qi” (usually belonging to the category of excess), treatment should focus on “eliminating evil qi.” The “Leijing” records: “If there is no deficiency, the urgent priority is to eliminate evil qi; if it is not eliminated quickly, problems will arise.” The “Lingzhu: Root-and-Branch Chapter” records: “When pathogenic qi is in excess, it means evil prevails; urgently drain it.” TCM’s methods for eliminating evil qi are diverse; among the so-called “eight methods,” except for the “replenishing” method, all the others contain the meaning of “eliminating evil qi.” TCM’s six meridian differentiation, Wei-Qi-Ying-Xue syndrome differentiation, and visceral syndrome differentiation—all these are theoretical systems formed through horizontal classification of syndromes and logical reasoning. They also lay the foundation for “treating different diseases the same way,” enabling TCM theory to simplify complexity and, with limited principles and prescriptions, successfully solve infinitely variable clinical problems. Take the Shanghan Six Meridians as an example: although it only represents six types of illnesses in the course of fever development, the clinical practices guided by it extend far beyond these six. Baihu Tang, as the main formula for Yangming meridian syndrome, can be used for patients with high fever, thirst, profuse sweating, and a large, powerful pulse—therefore, people not only use this formula in adjusting treatment for febrile diseases such as influenza, typhoid fever, pneumonia, meningitis, encephalitis, epidemic typhus, relapsing fever, rheumatic fever, tuberculosis, etc., but also use it in adjusting treatment for diabetes, diabetes insipidus, heatstroke, autonomic nervous system dysfunction, and other diseases. Xiaochaihu Tang, as the main formula for Shaoyang syndrome, can be used for patients with bitter taste in the mouth, dry throat, dizziness, fullness of chest and flank, restlessness and desire to vomit, alternating chills and fever—therefore, people often use this formula in adjusting treatment for cholecystitis, hepatitis, pelvic inflammatory disease, urinary tract infections, influenza, autonomic nervous system dysfunction, pleurisy, pancreatitis, etc. From this, it can be seen that the number of diseases suitable for adjusting treatment with these two formulas is roughly estimated to be dozens for each. This fully demonstrates the importance of “treating different diseases the same way” in TCM scholarship. 24 II. Clinical application of treating different diseases the same way Through analyzing and classifying the external manifestations of disease, TCM identifies the common characteristics shared by a group of diseases and establishes the principle of treating different diseases the same way. Take the Buzhong Yiqi Tang, a tonic for strengthening the spleen and replenishing qi, as an example: when used for qi deficiency leading to inability to control bleeding, it can achieve the effect of tonifying qi and stopping bleeding—this includes aplastic anemia, purpura, leukemia, gynecological bleeding, etc.; when used for qi deficiency causing downward collapse, it can lift yang and raise the fallen—this includes hypotension, uterine prolapse, gastric prolapse, myasthenia gravis, etc.; when used for qi deficiency causing fever, it can warm the yang and dispel the heat—this includes chronic nephritis, heart failure, malnutrition-related edema, etc. Taking the Shenqi Wan, a warming and tonifying formula for kidney yang, as another example: when used for yang deficiency with water overflowing, it can warm yang and transform water—this includes chronic nephritis, heart failure, malnutrition-related edema, etc.; when used for kidney not accepting qi, it can warm the kidney and accept qi—this includes chronic bronchitis, emphysema, bronchial asthma, etc. In addition, this formula can also treat prostatitis, gynecological leukorrhea, diabetes, systemic lupus erythematosus, etc. The Guizhi Fuling Wan from the “Jingui Yaolue” was originally designed specifically for women’s ailments, but after being put into clinical practice by physicians, it can now treat uterine fibroids, ovarian cysts, acute and chronic pelvic inflammatory disease, dysmenorrhea, menopausal hypertension, incomplete abortion, placental remnants, old ectopic pregnancy, functional uterine bleeding, retinal inflammation, prostatitis, etc. The Xiaoyao San was originally designed for spleen deficiency and liver depression, but after clinical practice, it can now treat retinal inflammation, optic neuritis, optic nerve atrophy, infectious hepatitis, chronic cholecystitis, chronic pancreatitis, menstrual irregularities and autonomic nervous system dysfunction in women, gastric and duodenal ulcers, chronic gastritis. The famous Qing Dynasty physician Wang Qingren formulated the Xuefu Zhuyu Tang, Gexia Zhuyu Tang, and Shaofu Zhuyu Tang.