3. Combining Macro and Micro Perspectives for Comprehensive and Accurate Disease Understanding

3. Combining Macro and Micro Perspectives for Comprehensive and Accurate Disease Understanding

There is no doubt that macroscopic diagnostic differentiation is an important aspect of understanding disease, while microscopic diagnostic differentiation is equally crucial. To achieve comprehensive and precise diagnostic differentiation, both perspectives must be integrated. For example, when diagnosing liver disease, in addition to considering macroscopic patterns such as liver-qi stagnation, liver-wood overacting on earth, liver-gallbladder damp-heat, and liver-kidney yin deficiency, one should also take into account microscopic changes in liver function, plasma proteins, and alpha-fetoprotein, all viewed through the lens of traditional Chinese diagnostic differentiation and treatment. Only in this way can our understanding be deepened and therapeutic efficacy improved. Certain patterns discovered by Pei Zhengxue through long-term clinical practice can serve as useful references. For instance, to lower SGPT 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 test results negative, it is more effective to use tonifying and consolidating herbs such as astragalus, codonopsis, polygonum multiflorum, and angelica. By correlating medication with syndrome differentiation, we can conclude that the former indicates excess heat-toxin, while the latter indicates deficiency—specifically, qi deficiency and blood depletion. An increase in SGPT signifies elevated transaminase levels, which corresponds to "excess"; an increase in turbidity indicates decreased albumin levels, which corresponds to "deficiency." As stated in the "Inner Canon of Medicine": "Reduce what is excessive, and supplement what is deficient." Therefore, the former requires heat-clearing and detoxifying treatment, while the latter requires tonifying and consolidating treatment. In regulating the three systems of hepatitis B, Pei Zhengxue often uses heat-clearing and detoxifying methods to reduce surface antigen levels, and tonifying and consolidating methods to turn core antibody results negative. According to modern immunological views, the relationship between antigens and antibodies is mutually reinforcing; thus, the essence of traditional Chinese diagnostic differentiation for the three systems of hepatitis B should be a combination of deficiency and excess, with treatment emphasizing both heat-clearing and detoxification and tonifying and consolidating, so that the medication truly addresses the underlying problem. In chronic nephritis, macroscopic diagnostic differentiation often manifests as yang deficiency with water overflow, spleen-stomach qi deficiency, lung failure to descend, liver-gallbladder excess fire, and bladder damp-heat; microscopic diagnostic differentiation, on the other hand,

should pay attention to findings in routine urinalysis, such as casts, red blood cells, white blood cells, protein, non-protein nitrogen, and carbon dioxide binding capacity. When treating such conditions, Pei Zhengxue first determines a basic formula based on macroscopic differentiation—for example, Zhenwu, Jisheng, Liu Jun, or Longdan Xiegan—and then adds tonifying and astringent agents to address proteinuria, heat-clearing and hemostatic agents to address hematuria, and heat-clearing and detoxifying agents to address white blood cells in the urine. If non-protein nitrogen rises, or if carbon dioxide binding capacity decreases concurrently, it is advisable to use methods that elevate clarity and reduce turbidity. In diagnosing and treating epigastric pain, macroscopic differentiation may reveal spleen-kidney qi deficiency, liver-stomach disharmony, excessive stomach fire, spleen-stomach damp-heat, and lung-stomach yin deficiency, while microscopic differentiation involves fiberoptic gastroscopy, pathological biopsy results, and gastric juice analysis. Pei Zhengxue typically determines a basic formula based on macroscopic differentiation—for example, Liu Jun, Xiaoyao, Qingwei, Xiexin, or Yiguan Jian. If microscopic examination reveals superficial gastritis, he adds coptis and scutellaria; for atrophic gastritis, he adds salvia miltiorrhiza, corydalis, coptis, and scutellaria; for gastric and duodenal ulcers, he adds white peony, raw oyster shell, and cuttlefish bone; for gastric ptosis, he adds astragalus, citrus aurantium, and atractylodes; and for gastric mucosal prolapse, he adds sandalwood, agarwood, amomum, and cardamom.

Section 3: The Connotation and Model of Integrated Traditional Chinese and Western Medicine in Internal Medicine

Pei Zhengxue believes that, within the scope of internal medicine, the connotation of integrating traditional Chinese and Western medicine should reflect the complementary strengths of the two systems. Specifically, it should emphasize the combination of the holistic view of traditional Chinese medicine with the localized perspective of Western medicine, the integration of the macroscopic approach of traditional Chinese medicine with the microscopic approach of Western medicine, and the fusion of the traditional Chinese concept of bodily response with the Western medical focus on pathogenic factors. To achieve these goals, it is necessary to design specific procedures for clinical work in internal medicine—procedures tailored to each individual disease—that can also be referred to as clinical models of integrated traditional Chinese and Western medicine. These models, while taking into account specific clinical needs, must also facilitate the further development of the overall theory and clinical practice of integrated traditional Chinese and Western medicine, thereby contributing to the advancement of contemporary traditional Chinese medicine.