Pei Zhengxue

Chinese and Western medicine each followed their own paths to modern times. Although Western medicine’s experimental research was highly advanced, when Weiliao’s cell pathology began to sweep away the remnants of medieval Western medicine with new methods, ushering in a new era in history, while we rejoiced at uncovering the microscopic mysteries of disease, another side of the story—yet another aspect of development—was already nurturing a seed of impending danger. People’s thinking shifted from the microscopic to the ultra-microscopic, from cells to cell nuclei, mitochondria, ribonucleic acid… Yet to some extent, they overlooked the fact that all of this could not exist without the objective reality of the body’s overall regulatory functions. This tendency continued until the 1930s, when Western medicine inevitably fell into the fatal trap of treating “headaches with head remedies and foot pain with foot remedies.” Thus, within the ranks of Western medicine, Pavlov’s theory of neural reflexes and Selye’s theory of stress response emerged one after another, and in 1937, Harris discovered the systemic regulatory functions of the thalamus and hypothalamus. Their research and theories aimed to bring Western medicine back from localized treatments to systemic approaches, from the microscopic to the macroscopic. This perspective was further strengthened by the remarkable advances in immunology over the past three decades. Looking at the modern history of Traditional Chinese Medicine, although it was not as obvious as Western medicine, we could still faintly see efforts by insightful scholars to shift their understanding from the macroscopic to the microscopic. Wu Youke’s “Li Qi Theory,” Wang Qingren’s “Anatomical Approach,” and Tang Zonghai and Zhang Xichun’s “Integration of Chinese and Western Medicine” were all concrete manifestations of this endeavor. Looking back at the dynamic history of Chinese and Western medicine over the past century, both sides have begun to address their own shortcomings. All things, in their development, are premised on gradual correction and continuous improvement—a natural law governing the evolution of all phenomena. As part of modern science and technology, Western medicine, in its rapid pace of advancement, has sought to obtain nourishment from every possible source in order to strengthen itself. In recent years, a wave of interest in TCM has swept across the Western world. While clinical treatment needs also played a role, the deeper reason behind this trend was that Western medicine had begun to draw inspiration from TCM, seeking to adopt its best practices and apply them to its own work. It is safe to say that the holistic perspectives and the concept of harmony between heaven and man found in the treasure trove of TCM were first explored by Western medicine, then subjected to experimental research, and soon put to use in our own interests, striving for a new leap forward in Western medical scholarship. Descendants of Yan and Huang—the inheritors of contemporary TCM—have clearly recognized that, today, advancing Chinese medical theory from the macroscopic to the microscopic is an urgent task, the only way forward for developing TCM. There is no other path. Modern science and technology have formed interconnected and interdependent networks; yet TCM remains excluded from these networks, continuing to follow ancient traditions and slowly progressing through the old ways of logical reasoning. As we’ve already discussed, long periods of feudal society, characterized by individual agriculture and scattered handicrafts, did not provide opportunities for TCM to advance toward the microscopic realm—though we cannot place too much expectation on our ancestors. However, with the advent of the 1990s, China’s modern industry has risen to the ranks of the world’s leading nations, and the conditions for TCM to move toward the microscopic have now been fully met. Contemporary TCM practitioners must align with the laws of development, boldly pushing their thinking toward the microscopic, adopting Western medical experimental techniques for their own use, developing themselves, and achieving the goal of “using the past to serve the present,” “taking the best from both East and West,” in order to preserve TCM’s unique characteristics while opening up new prospects for modern TCM. TCM should combine its holistic approach with Western medicine’s focus on the local; it should integrate its macroscopic perspective with Western medicine’s microscopic perspective; and it should harmonize TCM’s view of bodily responses with Western medicine’s view of pathogenic mechanisms—this is precisely the need for both medical systems to learn from each other and complement one another. Whoever takes the initiative first, harnessing the strengths of the other to serve their own purposes, will achieve significant progress in the short term. Contemporary TCM practitioners should clearly recognize this reality: under current conditions, the most effective way to develop TCM is to first draw upon Western medicine, for it is precisely in Western medicine’s strengths that TCM’s weaknesses lie. The integration of Chinese and Western medicine is primarily a model for drawing on Western medicine (though it also involves mutual exchange between the two), but within this model, TCM practitioners must always uphold the principle of “using the past to serve the present” and “taking the best from both East and West.” Only in this way can we truly achieve the goal of developing TCM. With the growth of China’s large-scale industry, unprecedented opportunities have arrived, and the glorious yet arduous task of developing modern TCM falls squarely upon the shoulders of us TCM practitioners.

(Pei Zhengxue)

Chapter Two: The Connotations and Models of Integrated Chinese and Western Medicine in Internal Medicine The connotations of integrated Chinese and Western medicine in internal medicine should reflect the characteristic of mutual learning and complementarity between the two systems. Here, we should emphasize the combination of TCM’s holistic perspective with Western medicine’s local perspective, the integration of TCM’s macroscopic views with Western medicine’s microscopic ones, and the convergence of TCM’s view of bodily responses with Western medicine’s view of pathogenic mechanisms. To achieve these goals, it is essential to design specific working procedures in clinical practice within internal medicine—these procedures for integrating Chinese and Western medicine for each particular disease can also be referred to as clinical models of integrated Chinese and Western medicine. While taking into account the specific clinical needs, these models should also support the further deepening of the theoretical framework and clinical practice of integrated Chinese and Western medicine, thereby contributing to the development of contemporary TCM.

I. The Connotations of Integrated Chinese and Western Medicine in Internal Medicine (1) The Combination of Macroscopic and Microscopic Perspectives Introducing Western medical insights into the microscopic understanding of disease into TCM’s diagnostic system is an urgent task for developing TCM’s diagnostic and therapeutic approaches. By implementing this clinical method, while fostering the integration of macroscopic and microscopic perspectives, TCM will naturally embark on the path of experimental research. Throughout its development, TCM has focused primarily on logical reasoning rather than experimental research, completely overlooking the microscopic indicators—critical for gaining insight into the true nature of disease—that can only be identified through modern scientific methods. Only by combining TCM’s traditional diagnostic and therapeutic approaches with modern microscopic indicators can we overcome the limitations of traditional diagnostic and therapeutic methods. Take liver disease as an example: traditional TCM begins with a macroscopic analysis, categorizing liver disease into pathological types such as liver qi stagnation, liver wood overcoming earth, liver gallbladder damp-heat, liver-kidney yin deficiency, spleen-kidney yang deficiency, and qi stagnation with blood stasis. For liver qi stagnation, the Shaihu Shugan Powder with modifications is used to soothe the liver and resolve depression; for liver wood overcoming earth, the Xiaoyao San with modifications is employed to soothe the liver and the stomach; for liver gallbladder damp-heat, the Longdan Xiegan Decoction with modifications is used to clear damp-heat; for liver-kidney yin deficiency, the Yige Tongyuan Drink with modifications is used to nourish the liver and kidneys; for spleen-kidney yang deficiency, the Shishi Yin Decoction combined with Wuling San with modifications is used to warm the kidneys and strengthen the spleen; for qi stagnation with blood stasis, the Gexia Zhu Yuyu Decoction combined with Jinlingzi Powder with modifications is used to promote qi circulation, activate blood flow, and relieve pain. If, based on these macroscopic diagnoses, we incorporate modern medical microscopic data—such as changes in liver function, plasma proteins, alpha-fetoprotein, and other indicators—and comprehensively consider them through the lens of TCM diagnostic principles, we will undoubtedly enhance TCM’s comprehensive understanding of liver disease and improve the effectiveness of liver disease treatment. Through long-term clinical practice, I have initially discovered certain patterns that can serve as references for colleagues in this area. To lower ALT and AST levels, we can choose herbs like honeysuckle, Forsythia, Astragalus, Bidens pilosa, Prunella vulgaris, Indigofera tinctoria, Gentiana lutea, and Lysimachia christinae for their heat-clearing and detoxifying properties; to improve turbidity, we can heavily utilize Codonopsis pilosula, Astragalus membranaceus, Salvia miltiorrhiza, Polygonum cuspidatum, and Angelica sinensis for their tonifying and reinforcing effects. When evaluating herbal efficacy, the former often indicate real symptoms, where heat toxicity is the primary issue; the latter often suggest deficiency, with a general lack of both qi and blood. An increase in ALT and AST signifies an elevation in serum transaminase levels, indicating “excess”; an increase in turbidity indicates a decrease in serum albumin, signifying “deficiency.” As the "Nei Jing" states, “reduce what is excessive, replenish what is deficient”—this is the principle of correct treatment. Therefore, when ALT and AST rise, we should employ heat-clearing and detoxifying therapies; when turbidity increases, we should focus on tonifying and reinforcing the body. In the regulation of the three-systems in hepatitis B, I have often used heat-clearing and detoxifying therapies to reduce surface antigen titers, while employing tonifying and reinforcing therapies to help core antibody titers turn negative. Modern immunology posits that the relationship between antigens and antibodies is mutually reinforcing; therefore, the essence of TCM diagnosis for hepatitis B should be a balance between deficiency and excess, with treatment emphasizing both tonifying and reinforcing the body and clearing heat and detoxifying the body simultaneously to achieve optimal results.

(2) The Combination of Pathogen Perspective and Body Response Perspective Western medicine focuses on the pathogenicity of pathogens and has achieved tremendous success in this regard. Research on pathogenic microorganisms has led to the development of various antibiotics, which have proven highly effective against most infectious diseases. However, the sequelae caused by infection—such as qi deficiency, imbalance of qi and blood, and other disorders affecting the autonomic nervous system, immune system, and metabolic system—cannot be fully addressed by a purely pathogen-centric approach. TCM emphasizes the body’s responsiveness. The "Nei Jing's" statements—"righteous qi resides within, and evil cannot invade"—and "where evil gathers, qi must be deficient"—lay the foundation for TCM’s understanding of bodily responses. Historically, TCM has employed methods such as "tonifying and reinforcing the body," "activating blood circulation and resolving stasis" to regulate the autonomic nervous system, metabolism, immunity, and other systems. Given this, antibiotics are particularly effective in the acute phase of infectious diseases; however, once the disease transitions to the chronic stage, TCM’s role becomes crucial in regulating the body. Take the treatment of osteomyelitis as an example. During the acute phase of osteomyelitis, the pathogenic bacteria (including their toxins) directly affect the patient’s local and systemic condition, so treatment should primarily rely on antibiotics, supplemented by traditional Chinese medicine to clear heat and detoxify, and activate blood circulation and resolve stasis. Once osteomyelitis progresses to the chronic stage, systemic infection symptoms subside, and the main clinical manifestations include local bone destruction, compensatory bone cortical hyperplasia, sinus tract non-healing, and purulent discharge. At this point, there is no need to administer Western medical antibiotics; instead, TCM can focus on tonifying and reinforcing the body, eliminating phlegm and dispersing masses, activating blood circulation and resolving stasis, and other adjustments to achieve good therapeutic results. Similarly, in the treatment of acute pancreatitis, antibiotics can be used in conjunction with traditional Chinese medicine to clear the intestines and regulate qi; while for chronic pancreatitis, TCM alone—such as soothing the liver and strengthening the spleen, clearing the intestines and regulating qi—can yield satisfactory results. Acute bronchitis is also well treated with antibiotics, whereas chronic bronchitis benefits from TCM-based regulation. In clinical practice, there are also diseases whose pathogenic causes have not yet been identified by modern medicine, or even if identified, effective drugs targeting those pathogens have not yet been developed. For these conditions, TCM’s therapeutic efficacy remains superior, such as viral hepatitis, nephritis, aplastic anemia, hemolytic anemia, connective tissue diseases, and others. By regulating the body’s response, TCM provides feedback to the true pathogenic origins of these diseases, thereby achieving therapeutic goals to a certain extent.

(3) The Combination of Holistic and Local Perspectives TCM’s holistic viewpoint is a hallmark of Chinese medical theory and the essence of TCM’s diagnostic and therapeutic approaches. However, when understanding disease, it is essential to gain a precise understanding of the specific location of the disease’s onset—accurate insights into these locations can greatly benefit diagnostic and therapeutic approaches. Take exogenous surface syndromes as an example: traditional TCM categorizes them into wind-cold and wind-heat, based on symptoms such as headache, fever, chills, body aches, sweating or not, and a floating, tight pulse in the wind-cold case; and headache, fever, chills (with more heat than cold), thirst, and a floating, rapid pulse in the wind-heat case. While these diagnostic criteria rooted in holistic thinking do reflect the characteristics of wind-heat and wind-cold, beginners often struggle to accurately distinguish between the number of pulses and the absence of pulses, the presence or absence of thirst, and the amount of sweat—plus, individual neurological types, lifestyle habits, emotional states at the time, and working conditions can all significantly influence the stability of these symptoms. Therefore, distinguishing between wind-cold and wind-heat is often merely a matter of textual distinction, and mastering this skill is far from easy. From a Chinese-Western medical perspective, wind-cold is more likely to be associated with viral colds, while wind-heat tends to be linked to bacterial infections (such as pharyngitis and tonsillitis). Based on this premise, people began to supplement traditional TCM’s four diagnostic methods with local observations—using Western medical tongue depressors to examine redness and swelling in the throat, redness and pus in the tonsils, and hyperplasia of the pharyngeal wall follicles as additional criteria for diagnosing wind-heat, making the differential diagnosis between wind-heat and wind-cold more accurate than before, even for beginners in TCM. Taking gynecological amenorrhea as another example, traditional TCM often confused functional uterine bleeding with cervical cancer-related bleeding, resulting in indiscriminate treatment approaches. This frequently led to misdiagnoses and even caused cervical cancer patients to miss critical treatment windows. If we combine TCM’s traditional holistic perspective with Western medicine’s local internal examinations, we can clearly distinguish between the two, allowing TCM’s diagnostic and therapeutic approaches for functional uterine bleeding to further eliminate confusion and play a more effective role. In summary, the combination of holistic and local perspectives is an important component of clinical methods in integrated Chinese and Western medicine. It enables more accurate clinical diagnoses, thereby significantly improving therapeutic outcomes.