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

II. Clinical Models of Integrated Chinese and Western Medicine in Internal Medicine (1) The Proposal of the Model In theoretical discussions, basic research, and clinical studies on integrated Chinese and Western medicine, scholars both domestically and internationally have published numerous reports and papers. Especially over the past decade, TCM and integrated Chinese-Western medicine communities across various regions have held a series of academic conferences, creating a vibrant environment filled with diverse perspectives and lively debates. However, “a journey of a thousand miles begins with a single step.” How should we begin in clinical practice? Can we propose a concrete clinical model for integrated Chinese and Western medicine? This model serves as both a standard procedure for routine ward and outpatient care, as well as a guiding standard for documenting integrated Chinese and Western medicine medical records—and it should also hold forward-looking significance in promoting integrated Chinese and Western medicine and developing modern TCM. With these thoughts in mind, I proposed the “sixteen-character method” for integrated Chinese and Western medicine clinical practice: “Western medical diagnosis, TCM diagnostic reasoning, traditional Chinese medicine as the primary treatment, Western medicine as a supplementary therapy.” In 1984, this method was first applied in the Integrated Chinese and Western Medicine Department of the Gansu Provincial Institute of New Medicine, becoming a standard guideline for inpatient and outpatient treatment in that department. Eight years of clinical practice proved that this method unified the thinking of TCM and integrated Chinese-Western medicine healthcare professionals, enabling full utilization of the three key aspects: the combination of macroscopic and microscopic perspectives, the integration of holistic and local perspectives, and the convergence of pathogen and body response perspectives. Starting in 1990, with strong support from the Gansu Provincial Health Department, a provincial-level resident physician training program was held annually, focusing on the implementation of the “sixteen-character method.” Through lectures on common and frequently occurring diseases, the treatment protocols of inpatient wards in 73 TCM hospitals across the province were guided by this method, enabling the clinical practice of inpatient departments in 73 TCM hospitals nationwide to adhere to the “sixteen-character method.”

Practical Internal Medicine of Integrated Chinese and Western Medicine It is widely acknowledged that this method has proven to be highly effective in clinical practice at TCM hospitals—clearly demonstrating the value of the “sixteen-character method.” On July 1, 1987, Mao Shi Ru, following the guidance of the Beijing Academy of Medical Sciences and Kunming University, delivered a speech that emphasized the importance of this method. As a result, the academic report on the “sixteen-character method” received recognition from fellow scholars. In 1902, at the National Academic Conference, he was invited to deliver a speech titled “Eighteen Characters—A Journey of the Mountains and Fields.” In the Northwest, experts in integrated Chinese and Western medicine from multiple provinces initiated the compilation of this book, which was published in April of the following year. The book was written by the author, who proposed the guiding principles of “Western medical diagnosis, TCM diagnostic reasoning, traditional Chinese medicine as the primary treatment, Western medicine as a supplementary therapy,” which were later refined through years of practical application and proven effective.

(2) The Connotations and Significance of the Model The “sixteen-character method” of “Western medical diagnosis, TCM diagnostic reasoning, traditional Chinese medicine as the primary treatment, Western medicine as a supplementary therapy” can serve as a provisional model for clinical practice in integrated Chinese and Western medicine today. The “sixteen characters” consist of four sentences, each carrying a distinct, consecutive meaning. First comes “Western medical diagnosis,” which means that after seeing a patient, it is essential to first clarify the Western medical diagnosis—and to clarify the Western medical diagnosis, one must make use of all available Western medical diagnostic tools. Once the Western medical diagnosis is established, the second step in the model—“TCM diagnostic reasoning”—begins. This reasoning is based on the established Western medical diagnosis, conducted under specific conditions, thus significantly increasing the accuracy of diagnosis, much like fishing in a fishery versus fishing in the open ocean. “TCM diagnostic reasoning,” like traditional methods, strives to employ traditional diagnostic approaches such as the Six Meridians, Eight Principles, Organs, Wei-Qi, Ying-Vein, Three Jiao, and Disease-Etiology, while also incorporating the diagnostic experiences and viewpoints of medical practitioners throughout history related to similar conditions. After a clear Western medical diagnosis is established, TCM diagnostic reasoning naturally integrates Western medical microscopic, local, and pathogen perspectives with TCM’s macroscopic, holistic, and body response perspectives, elevating the understanding of the entire disease to a level of integrated Chinese and Western medicine. This approach not only overcomes the traditional TCM’s tendency to overlook local aspects but also corrects the Western medical’s bias toward ignoring the whole; more importantly, over time, many points of convergence will emerge between Chinese and Western medicine in terms of understanding. These converging points represent areas where Chinese and Western medicine share common ground in their understanding—these points are expected to be first identified in clinical practice, then confirmed through experimental research. When these points return to clinical practice, they will be widely recognized, embodying both the characteristics of modern TCM and serving as integral components of modern science and technology. As more and more of these converging points emerge, integrated Chinese and Western medicine will expand from isolated instances to broader, deeper levels of understanding. The combination of Western medical diagnosis and TCM diagnostic reasoning creates a comprehensive understanding that lays the groundwork for TCM’s prescription formulation, forming the theoretical basis for the third part of the “sixteen-character method.” The third part of the understanding—“traditional Chinese medicine as the primary treatment”—must be viewed in conjunction with the fourth part—“Western medicine as a supplementary therapy.” Together, these two parts form a unified concept, emphasizing the therapeutic role of TCM formulas. It is clear that the primary purpose of this method is to develop TCM, not Western medicine; furthermore, the goal of this method is to deepen our understanding of integrated Chinese and Western medicine. The “sixteen-character method” serves as a guide for integrated Chinese and Western medicine in internal medicine today.

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Clinical Methodology: The approach aims to fulfill the crucial task of developing contemporary traditional Chinese medicine by adopting the perspectives of "using ancient knowledge for modern applications" and "adapting foreign practices to Chinese needs." Over many years, our clinical practice has revealed that combining selected formulas with this approach not only yields remarkable therapeutic effects but also exhibits high levels of reproducibility.

(3) Clinical Application of the Model

The clinical model of "Western medical diagnosis, TCM syndrome differentiation, traditional Chinese medicine as the primary treatment, and Western medicine as a supplementary therapy" can be applied to internal medicine conditions across any system. This is illustrated through several case examples.

1. Stomach Pain
   This condition arises from various underlying diseases. If one does not first clarify the Western medical diagnosis before engaging in TCM syndrome differentiation and treatment, it becomes difficult to grasp the root cause of the disease—leading to ineffective medication in mild cases or even misdiagnosis and mistreatment in severe cases. Sometimes, conditions such as pancreatitis or gastric perforation are treated as common gastrointestinal disorders, which can delay the proper diagnosis and even pose life-threatening risks. However, if Western medical diagnosis is performed prior to TCM syndrome differentiation, not only can these drawbacks be overcome, but TCM can also be developed through a comprehensive integration of disease and syndrome analysis. For Western medical diagnoses of stomach pain, methods such as barium imaging, gastroscopy, and pathological biopsy should be employed; when necessary, ultrasound examinations may be used to rule out diseases affecting the liver, gallbladder, pancreas, spleen, and other organs. All available Western medical techniques should be utilized to accurately diagnose the true cause of stomach pain. Common causes of stomach pain include peptic ulcer, chronic atrophic gastritis, chronic superficial gastritis, chronic hypertrophic gastritis, chronic pancreatitis, chronic cholecystitis, and chronic liver diseases. Additionally, gastric perforation, acute pancreatitis, and hepatic abscesses often result in severe abdominal pain in the epigastric region; if left untreated, these conditions can be life-threatening. Once the diagnosis of stomach pain is confirmed, TCM syndrome differentiation becomes much more accurate. Peptic ulcers are often accompanied by acid reflux, belching, abdominal distension, loss of appetite, fatigue, and pallor, typically indicating spleen-stomach qi deficiency; commonly prescribed formulas include Xiangsha Liu Junzi Tang, Huangqi Jianzhong Tang, and Liangfu Wan. Chronic atrophic gastritis frequently presents with burning pain in the epigastric region, dry mouth, and a thick, greasy tongue coating, often reflecting damp-heat accumulation beneath the heart; commonly prescribed formulas include Banxia Xie Xin Tang, Huanglian Tang, and Huanglian Jiedu Tang. Biliary disorders are often associated with bitter taste in the mouth, dry throat, and right flank pain radiating to the back; these conditions are often due to pathogenic factors invading the Shaoyang meridian; commonly prescribed formulas include Da Chai Hu Tang, Xiao Chai Hu Tang, Chai Hu Shu Gan San, Qianjin Cao, Ban Zhi Lian, and Hu Zhang. Pancreatic disorders often present with pain radiating to the upper left abdomen, accompanied by low back pain, loose or constipated stools, and intense pain during acute episodes—sometimes even leading to cold extremities and a weak, rapid pulse indicative of yang deficiency. In such cases, Chai Hu Shu Gan San, Danshen Yin, Jinling Zi San, Da Jianzhong Tang, San Huang Xie Xin Tang, and Wu Wei Xiaodu Yin are commonly used formulas. If gastric perforation is chronic, TCM may employ Huoluo Xiao Ling Dan or Tao Hong Si Wu Tang, with modifications; in cases of acute perforation, if conservative treatment fails, immediate surgical intervention is required.

2. Chest Pain
   Conditions such as coronary heart disease, pleurisy, lung inflammation, lung cancer, mesothelioma, intercostal neuralgia, chronic pancreatitis, liver diseases, cardiac valve disease, and arrhythmias can all cause chest pain. First, it is essential to determine the cause of chest pain through Western medical diagnosis, followed by TCM syndrome differentiation. Coronary heart disease falls under the category of “Xiong Bi” in TCM, and treatment should focus on opening the chest, regulating qi, and promoting yang circulation; formulas like Gua Lou Xie Bai Ban Xia Tang are used in conjunction with recent research on the integration of TCM and Western medicine for coronary heart disease, incorporating herbs that promote blood circulation and resolve stasis, such as Guan Xin No. 2 and Guan Xin Su He Wan. Pleurisy, on the other hand, falls under the categories of “Xuan Yin” and “Jie Tong,” and clinical options include Shijiao Tang, Da Lie Xin Tang (or pills), and Xiao Lie Xin Tang. Some patients exhibit symptoms of pathogenic factors invading the Shaoyang meridian, and can be treated with modified Xiao Chai Hu or Da Chai Hu Tang. Lung infections encompass various conditions, including lobar pneumonia, bronchopneumonia, viral pneumonia, chronic bronchitis, emphysema, cor pulmonale, bronchial asthma, and bronchiectasis. TCM generally refers to these types of pneumonia as “Shi Hu Yun Fei,” characterized by phlegm-heat cough; formulas like Mashi Shi Gan Tang, Da Qing Long Tang, Xie Bai San, and Dianli Dazhong Tang are suitable for treatment, with additional use of Wu Wei Xiaodu Yin to enhance heat-clearing and detoxification effects. Inflammation of the trachea may be caused by wind-heat or wind-cold; options include Sangju Yin, Jing Fang Baidu San, Su Xing San, Mahuang Tang, and Gui Zhi Tang, with additions of Houpu Xingzi Tang. Bronchial asthma falls under the category of “Fei Zhang” and “Tan Xiang,” and treatments should focus on Ma Xing Gan Tang, Danshen Yin, Su Zi Jiang Qi Tang, and Houpu Mahuang Tang. Emphysema is often associated with “Kidney’s inability to receive qi”; if combined with infection, it may also indicate “upper excess, lower deficiency,” and formulas like Su Zi Jiang Qi Wan and Du Qi Wan are recommended. Bronchiectasis may be caused by wind-heat or wind-cold, and may also involve “feeling of lung expansion”; if there is hemoptysis, treatment should focus on “blood heat wandering” or “qi deficiency unable to contain blood.” Cor pulmonale, however, falls under the category of “Shui Qi Ling Xin,” and treatment should aim to eliminate phlegm and promote water metabolism while calming the spirit; formulas like Ling Gui Shu Gan Tang, Zhen Wu Tang, and Bai Zi Yang Xin Tang are commonly used. Intercostal neuralgia is caused by qi stagnation and blood stasis in the Shaoyang meridian; adding qi-regulating and blood-moving herbs to Chai Hu Shu Gan San, or using Fuyuan Huo Xue Tang, Tao Hong Si Wu Tang, or Huoluo Xiao Ling Dan with additions of Chuan Huai, Shao Jiao, Roushi, and Momo can help alleviate symptoms. Chronic pancreatitis is often associated with liver qi stagnation and liver wood overcoming earth; formulas like Chai Hu Shu Gan San, Xiao Yao San, Da Jianzhong Tang, and others are used, with added Yuan Hu Suo and Chuan Lian Zi for severe pain. Liver diseases should focus on treating the liver itself, emphasizing liver function regulation; TCM syndrome differentiation primarily focuses on liver qi stagnation and liver wood overcoming earth, with formulas like Chai Hu Shu Gan San, Dan Zhi Yao Xiang Tang, and Qiang Gan Tang being commonly chosen. Furthermore, if liver function tests show significant increases in albumin levels, Huangqi, Danshen, and Shouwu are used; if transaminases are elevated, Gongying, Baishang, Bai Hua She She Cao, and Ban Zhi Lian are employed. The former indicates a decrease in albumin, suggesting “deficiency,” and thus requires tonifying treatment; the latter indicates elevated transaminases, suggesting “excess,” and therefore requires heat-clearing and detoxification treatment. Cardiac valve disease and arrhythmias often fall under the categories of “Shui Qi Ling Xin,” “Wetness Confusing Heart Yang,” “Blood Not Nourishing Heart,” or “Both Qi and Blood Deficiency,” and treatments should be selected from Ling Gui Shu Gan Tang, Zhen Wu Tang, Bai Zi Yang Xin Tang, Zhi Gan Tang, and Sheng Mai San. Lung cancer and mesothelioma should be evaluated early by specialists in Western medicine; if surgery is missed, chemotherapy and radiation therapy may be administered. At this stage, TCM can complement Western medicine by supporting the body’s natural defenses and strengthening the foundation, often helping to reduce the side effects of chemotherapy and radiation therapy.