I. The Connotation of Integrating Traditional Chinese and Western Medicine in Internal Medicine

I. The Connotation of Integrating Traditional Chinese and Western Medicine in Internal Medicine

1. The Combination of Macro and Micro Perspectives

Introducing the Western medical understanding of disease at the microscopic level into the traditional Chinese diagnostic differentiation system is an urgent task for advancing traditional Chinese diagnostic differentiation and treatment. Implementing this clinical approach will not only combine macro and micro perspectives but also usher traditional Chinese medicine onto the path of experimental research. Historically, traditional Chinese medicine has placed greater emphasis on logical reasoning than on experimental research, inevitably overlooking crucial microscopic indicators that can only be discovered through modern scientific methods and are vital for gaining insight into the inner essence of disease. Traditional Chinese diagnostic differentiation and treatment must be combined with modern microscopic indicators to overcome the limitations of conventional diagnostic methods. Let us take liver disease as an example to illustrate this point. Traditionally, Chinese medicine approaches liver disease from a macro perspective, categorizing it into types such as liver-qi stagnation, liver-wood overpowering earth, liver-gallbladder damp-heat, liver-kidney yin deficiency, spleen-kidney yang deficiency, and qi stagnation with blood stasis. For liver-qi stagnation, the recommended prescription is Chaihu Shugan San with added ingredients; for liver-wood overpowering earth, the recommended prescription is Xiaoyao San with added ingredients; for liver-gallbladder damp-heat, the recommended prescription is Longdan Xiegan Tang with added ingredients; for liver-kidney yin deficiency, the recommended prescription is Yigui Tongyuan Yin with added ingredients; for spleen-kidney yang deficiency, the recommended prescription is Shipi Yin combined with Wuling San with added ingredients; for qi stagnation with blood stasis, the recommended prescription is Gexia Zhuyu Tang combined with Jinlingzi San with added ingredients. If, on top of these macroscopic diagnoses, we incorporate modern medical microscopic data—such as changes in liver function, plasma proteins, and alpha-fetoprotein—and comprehensively consider them through the lens of traditional Chinese diagnostic differentiation and treatment, our overall understanding of liver disease will be greatly refined, thereby improving existing therapeutic outcomes. Pei Zhengxue has preliminarily identified several patterns through long-term clinical practice that can serve as references for colleagues during clinical treatment. To lower SGPT levels, one can select heat-clearing and detoxifying herbs such as Lonicera japonica, Forsythia suspensa, Taraxacum mongolicum, Patrinia scabiosaefolia, Prunella vulgaris, Isatis tinctoria, Gentiana scabra, and Sedum sarmentosum, building on traditional macroscopic diagnoses; to improve turbidity, one can rely heavily on tonifying and consolidating herbs such as Codonopsis pilosula, Astragalus membranaceus, Salvia miltiorrhiza, Polygonum multiflorum, and Angelica sinensis. By correlating medication with diagnosis, we can determine that the former case is a real case of excess heat-toxin, while the latter is a case of deficiency—often involving dual deficiencies of qi and blood. An increase in SGPT indicates a rise in serum transaminase levels, which signifies "excess"; an increase in turbidity indicates a decrease in serum albumin levels, which signifies "deficiency." As stated in the "Inner Canon of Medicine": "Reduce what is excessive, and replenish what is deficient" is the correct treatment approach. Therefore, an increase in SGPT calls for heat-clearing and detoxifying treatment, while changes in turbidity call for tonifying and consolidating treatment. In regulating the three systems of hepatitis B, Pei Zhengxue often uses heat-clearing and detoxifying methods to lower surface antigen titers and tonifying and consolidating methods to turn E antigen negative. Modern immunology holds that the relationship between antigens and antibodies is complementary; therefore, the traditional Chinese diagnostic differentiation for the three systems of hepatitis B should be a combination of deficiency and excess, with treatment emphasizing both tonifying and consolidating and heat-clearing and detoxifying to ensure targeted therapy.

2. The Combination of Pathogen View and Body Response View

Western medicine places great emphasis on the pathogenicity of pathogens and has achieved remarkable success in this area. Research on pathogenic microorganisms has led to the development of various antibiotics, which are highly effective against most infectious diseases. However, the sequelae caused by infection—such as deficiency of righteous qi, disharmony of qi and blood (including disturbances in the autonomic nervous system, immune system, and metabolic system)—cannot be adequately addressed by a purely pathogen-focused approach. Traditional Chinese medicine, on the other hand, emphasizes the body's response. The "Inner Canon of Medicine" states: "When righteous qi resides within, evil cannot invade" and "Where evil gathers, qi must be deficient," laying the foundation for the traditional Chinese understanding of the body's response. Throughout history, traditional Chinese medicine has used methods such as "tonifying and consolidating" and "activating blood circulation and removing stasis" to regulate the autonomic nervous system, metabolism, and immune system. Given this, antibiotics are most effective during the acute phase of infectious diseases, but once the condition becomes chronic, traditional Chinese medicine is required for regulation. Take osteomyelitis as an example to illustrate this point. During the acute phase of osteomyelitis, the pathogenic bacteria (and their toxins) directly affect the patient, resulting in local symptoms dominated by infection. In such cases, antibiotic treatment combined with traditional Chinese herbal medicines that clear heat and detoxify and activate blood circulation and remove stasis is appropriate. Once osteomyelitis enters the chronic phase, systemic infection symptoms subside, and the main clinical manifestations become local bone destruction, compensatory hyperplasia of the cortical bone, non-healing sinus tracts, and purulent secretions. At this stage, there is no need to administer Western antibiotics; instead, traditional Chinese medicine focusing on tonifying and consolidating, eliminating phlegm and dispersing nodules, and activating blood circulation and removing stasis, with appropriate adjustments, can achieve excellent therapeutic effects. Similarly, for acute pancreatitis, antibiotics combined with traditional Chinese herbal medicines that promote bowel movement and regulate qi are effective; whereas for chronic pancreatitis, traditional Chinese medicines that soothe the liver and strengthen the spleen and promote bowel movement and regulate qi are sufficient. Likewise, antibiotics are highly effective for acute bronchitis, while traditional Chinese medicines for regulating the chronic condition yield satisfactory results. In clinical practice, there are also some diseases whose pathogens have not yet been identified by modern medicine, or although identified, no effective drugs targeting those pathogens have been developed. For such diseases, traditional Chinese medicine and herbal remedies remain the most effective treatments, such as viral hepatitis, nephritis, aplastic anemia with hemolytic crisis, and connective tissue diseases. Through regulating the body's response, traditional Chinese medicine provides feedback on the true pathogens of these diseases, thereby achieving therapeutic effects to a certain extent.

3. The Combination of Holistic and Local Perspectives

The holistic view of traditional Chinese medicine is a hallmark of the entire system and the essence of traditional Chinese diagnostic differentiation and treatment. However, understanding a disease also requires a detailed grasp of its specific site of onset; only with an accurate understanding of this detail can diagnostic differentiation and treatment be truly beneficial. Take exogenous exterior syndromes as an example: traditionally, Chinese medicine divides them into wind-cold and wind-heat types, with diagnostic criteria being headache, fever, chills, body pain, presence or absence of sweat, and floating, slow pulse for wind-cold, and headache, fever, chills (more heat than cold), thirst, and floating, rapid pulse for wind-heat. While these diagnostic criteria, derived from a holistic perspective, do reflect the characteristics of wind-heat and wind-cold, beginners often struggle to accurately weigh factors such as whether the pulse is rapid or slow, whether there is thirst or not, and whether there is much or little sweat. Moreover, differences in individual nerve types, lifestyle habits, current emotional state, and working conditions can significantly affect the stability of these symptoms. Therefore, distinguishing between wind-cold and wind-heat is merely a textual distinction and far from easy to master. From the perspective of integrated traditional Chinese and Western medicine, wind-cold is mostly associated with viral infections, while wind-heat tends to be linked to bacterial infections (such as pharyngitis and tonsillitis). Under this premise, people began to supplement the shortcomings of the traditional four diagnostic methods of Chinese medicine with localized observations—using a Western tongue depressor to examine local redness and swelling in the pharynx, enlargement and suppuration of the tonsils, and proliferation of follicles on the posterior pharyngeal wall—as additional criteria for diagnosing wind-heat, thereby making the differential diagnosis between wind-heat and wind-cold more precise than before, even for beginners in traditional Chinese medicine. Another example is gynecological bleeding disorders: traditionally, Chinese medicine often confuses functional uterine bleeding with cervical cancer-related bleeding, and treatment is handled in a one-size-fits-all manner, leading to frequent misdiagnoses and even causing cervical cancer patients to miss the optimal window for treatment. If the traditional holistic view of Chinese medicine is combined with the Western localized view, the two can be strictly distinguished, allowing traditional Chinese medicine to further eliminate confusion in diagnosing functional uterine bleeding and better fulfill its role. In summary, the combination of holistic and localized perspectives is an important component of the clinical approach of integrated traditional Chinese and Western medicine, making clinical diagnosis more accurate and thereby greatly enhancing therapeutic efficacy.