II. Clinical Models of Integrated Traditional Chinese and Western Medicine in Internal Medicine

II. Clinical Models of Integrated Traditional Chinese and Western Medicine in Internal Medicine

1. Proposal of the Model

Both domestic and international scholars have published numerous reports and papers on the theoretical foundations and clinical research of integrated traditional Chinese and Western medicine. Especially over the past decade, various regions have held a series of academic conferences on this topic, creating a vibrant atmosphere of diverse opinions and vigorous debate. However, when it comes to practical implementation in clinical settings, the question remains: can a concrete clinical model for integrated traditional Chinese and Western medicine be proposed? Such a model would serve as both the standard procedure for daily ward and outpatient care and the guiding principle for writing integrated traditional Chinese and Western medical records. Addressing this issue is of forward-looking significance for advancing the cause of integrated traditional Chinese and Western medicine and promoting the modernization of traditional Chinese medicine. It was precisely under this philosophy that Pei Zhengxue meticulously conceived the "Sixteen-Character Method" for clinical work in integrated traditional Chinese and Western medicine: Western diagnosis, Chinese differentiation, herbal medicine as the mainstay, Western medicine as the auxiliary. In 1984, this method was first implemented in the Department of Integrated Traditional Chinese and Western Medicine at the Gansu Provincial Institute of New Medicine, becoming the established guideline for inpatient and outpatient clinical practice in that department. Eight years of clinical practice proved that this method could unify the thinking of all traditional Chinese and integrated traditional Chinese and Western medical staff and effectively address three key aspects: the combination of macro and micro perspectives, the integration of holistic and localized perspectives, and the fusion of pathogen view and body response view. Starting in 1990, with strong support from the Gansu Provincial Health Department, an annual provincial training course for resident physicians in traditional Chinese hospitals was organized, with the "Sixteen-Character Method" as the main content. Through lectures on common and frequently occurring diseases, the clinical practices of inpatient departments in 73 traditional Chinese hospitals across the province improved markedly under the guidance of the "Sixteen-Character Method." Physicians generally believed that this method provided universal guidance for clinical practice in traditional Chinese hospitals, hence the nickname "Sixteen-Character Policy." In July 1987 and August 1990, Pei Zhengxue was invited to deliver academic presentations on the "Sixteen-Character Method" at national academic conferences in Beijing, Kunming, Guiyang, and Dalian, receiving widespread recognition from his peers. In April 1992, Pei Zhengxue led a group of experts in integrated traditional Chinese and Western medicine from the five northwestern provinces to jointly compile a book titled "Practical Internal Medicine of Integrated Traditional Chinese and Western Medicine." At the plenary meeting of the editorial committee held in Lanzhou, the committee unanimously approved the outline, format, and detailed rules drafted by him, while also determining that the guiding principle for compiling the book would be the "Sixteen-Character Policy" of "Western diagnosis, Chinese differentiation, herbal medicine as the mainstay, Western medicine as the auxiliary," which had been proven effective through years of practice.

2. Content and Significance of the Model

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The "Sixteen-Character Guideline" — "Western medical diagnosis, TCM syndrome differentiation, TCM as the mainstay, Western medicine as the adjunct" — can serve as a temporary clinical model for integrated Chinese and Western medicine within the field of internal medicine. This "sixteen-character" guideline consists of four sentences, forming four consecutive meanings. First is Western medical diagnosis: upon receiving a patient, one must first conduct a Western medical diagnosis, utilizing all appropriate Western diagnostic methods to clarify the condition. Once the Western diagnosis is established, the second step in the model — TCM syndrome differentiation — can begin. This differentiation is conducted under the premise of a confirmed Western diagnosis, making it more precise due to the specific conditions involved; it’s akin to fishing in a net rather than in the open sea, thus achieving far greater accuracy. TCM syndrome differentiation, in accordance with traditional principles, primarily employs conventional methods such as Six Meridians Differentiation, Eight Principles Differentiation, Zang-Fu Organ Differentiation, Wei-Qi-Ying-Xue Differentiation, San Jiao Differentiation, and Etiology Differentiation, while also incorporating the diagnostic experiences and viewpoints of past medical scholars regarding similar diseases. With a clear Western diagnosis, TCM syndrome differentiation naturally integrates the Western medical perspectives of microcosmic, localized, and pathogenic views with the TCM macrocosmic, holistic, and organismic response views in the physician's mind, elevating the understanding of the overall disease to a level that combines both Chinese and Western medicine. In doing so, it overcomes the traditional TCM deficiency of neglecting local aspects while correcting the Western tendency to overlook the whole. More importantly, over time, numerous points of convergence emerge between the two systems in terms of understanding. These points of convergence represent areas where the two medical systems share common ground, and it is anticipated that they will first be proposed clinically, then validated through experimental research, and finally, when reintroduced into clinical practice, will have gained widespread recognition. Such approaches not only embody the characteristics of modern TCM but also constitute an integral part of modern science and technology. As these points of convergence increase, the integration of Chinese and Western medicine will expand from isolated instances to broader applications, advancing to deeper levels. The combined understanding resulting from the integration of Western diagnosis and TCM syndrome differentiation provides a more precise foundation for formulating TCM prescriptions. The third component of the model, emphasizing TCM as the mainstay, must be viewed together with the fourth component, which prioritizes Western medicine as the adjunct; together, these two parts form a concept that highlights the therapeutic efficacy of TCM formulas and herbs. It is thus evident that the primary purpose of this guideline is to develop TCM, rather than to promote Western medicine, and further understanding of the full implications of integrating Chinese and Western medicine also serves this very purpose. As a clinical methodology for integrated Chinese and Western medicine within the scope of internal medicine, the "Sixteen-Character Guideline" aims to fulfill the important mission of advancing contemporary TCM by applying the principle of "drawing on the past to serve the present" and "borrowing from the West to benefit China." Our years of clinical practice have shown that the formulations selected through this integrated approach not only demonstrate outstanding efficacy but also exhibit strong reproducibility.

3. Clinical Application of the Model

The clinical model of "Western medical diagnosis, TCM syndrome differentiation, TCM as the mainstay, Western medicine as the adjunct" can be applied to any systemic internal medicine condition; examples are provided below.