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 employed simultaneously. For example, when diagnosing liver disease, in addition to macroscopic patterns such as liver-qi stagnation, liver-wood overcoming 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 references. For instance, to lower SGPT levels, it is effective to use heat-clearing and detoxifying herbs such as Lonicera japonica, Forsythia suspensa, Taraxacum mongolicum, Patrinia scabiosaefolia, Prunella vulgaris, Isatis tinctoria, Gentiana scabra, and Sedum sarmentosum; to turn turbidity tests negative, it is effective to use tonifying and consolidating herbs such as Astragalus membranaceus, Codonopsis pilosula, Polygonum multiflorum, and Angelica sinensis. By correlating medication with diagnosis, we can conclude that the former case involves excess heat-toxin, while the latter involves deficiency—specifically, qi deficiency and blood depletion. An increase in SGPT indicates elevated transaminase levels, which signifies "excess"; an increase in turbidity indicates decreased albumin levels, which signifies "deficiency." As stated in the "Inner Canon of Medicine": "Reduce what is excessive, and replenish 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, while using tonifying and consolidating methods to turn core antibody levels negative. Modern immunological views hold that the relationship between antigens and antibodies is complementary; 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 to ensure targeted therapy. 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

should pay attention to tubular casts, red blood cells, white blood cells, protein, non-protein nitrogen, and carbon dioxide binding capacity in routine urine tests. When treating such conditions, Pei Zhengxue first determines a basic formula based on macroscopic differentiation—for example, Zhenwu Tang, Jisheng San, Liu Jun Tang, or Longdan Xiegan Tang—and then adds tonifying and astringent agents to address proteinuria, anti-inflammatory 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 carbon dioxide binding capacity decreases, it is advisable to use methods that elevate clarity and reduce turbidity. In diagnosing and treating epigastric pain, macroscopic patterns include spleen-kidney qi deficiency, liver-stomach disharmony, stomach fire raging, spleen-stomach damp-heat, and lung-stomach yin deficiency; microscopic patterns involve findings from fiberoptic gastroscopy, pathological biopsies, and gastric juice analysis. Pei Zhengxue usually determines a basic formula based on macroscopic differentiation—for example, Liu Jun Tang, Xiaoyao San, Qingwei San, Xiexin Tang, or Yiguan Jian Tang. If microscopic examination reveals superficial gastritis, he adds Coptis chinensis and Scutellaria baicalensis; if it is atrophic gastritis, he adds Salvia miltiorrhiza, Corydalis yanhusuo, Coptis chinensis, and Scutellaria baicalensis; if it is gastric or duodenal ulcer, he adds Paeonia lactiflora, raw oyster shell, and cuttlefish bone; if it is gastric prolapse, he adds Astragalus membranaceus, Citrus aurantium, and Atractylodes macrocephala; if it is gastric mucosal prolapse, he adds Agarwood, Sandalwood, Amomum villosum, 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 view of Western medicine, the integration of the macroscopic perspective of traditional Chinese medicine with the microscopic perspective of Western medicine, and the fusion of the traditional Chinese view of the body's response with the Western view of 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 should not only meet specific clinical needs but 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.