3. Combining the Holistic View with the Local Perspective

3. Combining the Holistic View with the Local Perspective

The holistic perspective of TCM is a hallmark of the TCM academic system and the essence of TCM’s syndrome differentiation and treatment. However, to truly understand a disease, one must also have a clear grasp of its specific site of onset; only with accurate insight into this aspect can syndrome differentiation and treatment be truly beneficial. Take exogenous exterior syndromes as an example: traditionally, TCM classifies them into wind-cold and wind-heat types, with diagnostic criteria being headache, fever, chills, body pain, sweating or lack thereof, and floating, slow pulse for wind-cold; while wind-heat is characterized by headache, fever, more heat than cold, thirst, and floating, rapid pulse. Although these diagnostic criteria, derived from the 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, or how much sweat is produced. Moreover, individual differences in nerve type, lifestyle, 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 TCM–Western medicine integration, wind-cold is more likely to fall under the category of viral infections, while wind-heat tends to be associated with bacterial infections (such as pharyngitis and tonsillitis).

Under this premise, people began to supplement the traditional four diagnostic methods of TCM with localized observation—that is, using a Western tongue depressor to examine local redness and swelling in the pharynx, enlarged and suppurating tonsils, and follicular hyperplasia on the posterior pharyngeal wall—as additional criteria for diagnosing wind-heat. This made the differential diagnosis between wind-heat and wind-cold more precise than before, even for novice TCM practitioners. Another example is gynecological bleeding disorders: traditionally, TCM syndrome differentiation often conflates functional uterine bleeding with cervical cancer-related bleeding, and treatment approaches tend to be indiscriminate, leading to frequent misdiagnoses and even causing patients with cervical cancer to miss critical treatment windows. If the traditional holistic perspective of TCM is combined with Western medicine’s localized internal examination, the two can be strictly distinguished, allowing TCM to further refine its syndrome differentiation and treatment of functional uterine bleeding, thereby eliminating confusion and improving effectiveness. In summary, the combination of holistic and localized perspectives is an important component of TCM–Western medicine integrated clinical practice, making clinical diagnoses more accurate and significantly enhancing therapeutic efficacy.

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Pei Zhengxue’s TCM Studies—Discussions on TCM Theory and Clinical Cases

Published by Hepei Jin Publishing House

The three aspects—combining the macroscopic and microscopic views, the holistic and localized perspectives, and the pathogen and body response perspectives—should all be fully utilized.

Starting in 1990, with strong support from the Gansu Provincial Health Department, an annual advanced training course for resident physicians in TCM hospitals across the province was held. The course focused on implementing the “Sixteen-Character Method,” providing instruction on common and frequently occurring diseases. Under the unified guidance of this method, the clinical work of the inpatient departments in 73 TCM hospitals throughout the province showed marked improvement compared with before. Participants unanimously agreed that this method had universal guiding significance for clinical applications in TCM hospitals, and thus the “Sixteen-Character Method” came to be known as the “Sixteen-Character Policy.” In July 1987 and August 1990, the author was invited to deliver academic presentations on the “Sixteen-Character Method” at national academic conferences in Beijing, Kunming, Guiyang, Dalian, and other cities, receiving widespread recognition from colleagues. In April 1992, under the author’s leadership, experts in TCM–Western medicine integration from five northwestern provinces initiated the compilation of a book titled “Practical Internal Medicine of TCM–Western Medicine Integration.” At the plenary editorial meeting held in Lanzhou, the editorial committee unanimously approved the outline, format, and detailed rules drafted by the author, and also determined that the guiding principle for writing the book would be the author’s proposed “Western diagnosis, TCM differentiation, TCM as the mainstay, Western medicine as the auxiliary”—a sixteen-character policy that had been proven effective through years of practice.

2. The Connotation and Significance of the Model

The “Sixteen-Character Policy” of “Western diagnosis, TCM differentiation, TCM as the mainstay, Western medicine as the auxiliary” can serve as a temporary clinical model for TCM–Western medicine integration in the field of internal medicine. The “Sixteen Characters” consist of four sentences, forming four consecutive meanings. First is “Western diagnosis,” meaning that after examining a patient, one must first clarify the Western diagnosis. To clarify the Western diagnosis, one must utilize all available Western diagnostic methods.

Once the Western diagnosis is established, the second step of the model—the “TCM differentiation”—can begin. This differentiation is conducted under the premise of a confirmed Western diagnosis and within specific conditions, thereby greatly increasing the accuracy of the differentiation, much like fishing in a net rather than in the open sea, which is naturally far more precise. The “TCM differentiation” follows traditional principles as much as possible, including six meridians differentiation, eight categories differentiation, zang-fu organ differentiation, wei-qi-ying-xue differentiation, sanjiao differentiation, and etiology differentiation, while also incorporating the diagnostic experience and viewpoints of past medical masters regarding similar diseases. After the Western diagnosis is clarified, the TCM differentiation naturally integrates the Western medical microscopic, localized, and pathogenic perspectives with the TCM macroscopic, holistic, and body response perspectives in the physician’s mind, elevating the understanding of the overall disease to the level of TCM–Western medicine integration. In doing so, it not only overcomes the traditional TCM’s neglect of the local but also corrects the Western medicine’s tendency to overlook the whole. More importantly, over time, many points of convergence emerge between the two medical systems in terms of understanding—these points of convergence represent the shared ground between the two systems. It is anticipated that these points of convergence will first be proposed clinically and then confirmed through experimental research; when they return to clinical practice, they will already be widely recognized, embodying both the characteristics of modern TCM and the components of modern science and technology.

As these points of convergence increase, TCM–Western medicine integration evolves from isolated instances to broader, deeper developments. The combination of Western diagnosis and TCM differentiation creates a comprehensive understanding that lays a more precise foundation for formulating TCM prescriptions. The third aspect, “TCM as the mainstay,” must be considered together with the fourth aspect, “Western medicine as the auxiliary,” as the two together form a single concept that highlights the therapeutic role of TCM prescriptions. It is thus evident that the primary purpose of this policy is to develop TCM, rather than Western medicine, and that further understanding of the full implications of TCM–Western medicine integration also serves this very purpose. As a clinical model for TCM–Western medicine integration in the field of internal medicine, the “Sixteen-Character Policy” aims to fulfill the grand mission of developing contemporary TCM through the principles of “applying ancient knowledge to contemporary practice” and “applying foreign knowledge to Chinese practice.” Our years of clinical application have shown that prescriptions formulated under this integration not only demonstrate outstanding efficacy but also exhibit high reproducibility.

Part One: Academic Thought

3. Clinical Application of the Model

The clinical model of “Western diagnosis, TCM differentiation, TCM as the mainstay, Western medicine as the auxiliary” can be applied to any systemic internal medicine condition; let us now illustrate this with examples.

(1) Epigastric Pain

This syndrome is a clinical manifestation caused by multiple diseases. If one does not first clarify the Western diagnosis before proceeding with TCM differentiation and treatment, it will inevitably be difficult to pinpoint the root cause of the illness; at best, the medication will be ineffective, and at worst, misdiagnosis and improper treatment will occur. Sometimes, conditions such as pancreatitis and gastric perforation are mistakenly treated as ordinary stomach ailments, leading to delayed treatment and even unforeseen consequences. However, if “Western diagnosis” is performed prior to “TCM differentiation,” not only can the above problems be avoided, but TCM can also be further developed through the integration of disease and diagnosis. For the Western diagnosis of epigastric pain, barium meal radiography, gastroscopy, and pathological tissue biopsies should be used; where necessary, ultrasound can also be employed to rule out diseases of the liver, gallbladder, pancreas, and spleen, utilizing all available Western diagnostic methods to confirm the true cause of the epigastric pain. Common diseases that cause epigastric pain include peptic ulcer disease, chronic atrophic gastritis, chronic superficial gastritis, chronic hypertrophic gastritis, chronic pancreatitis, chronic cholecystitis, and chronic liver diseases. In addition, conditions such as gastric perforation, acute pancreatitis, and liver abscess can also cause severe epigastric pain; if left untreated, they can pose a life-threatening risk.

After confirming the above diagnosis of epigastric pain, proceeding with “TCM differentiation” will naturally be much more accurate. Peptic ulcer disease is often accompanied by heartburn, belching, abdominal distension, loss of appetite, fatigue, and pallor, typically indicating spleen-stomach qi deficiency; commonly used prescriptions include Xiangsha Liujunzi Tang, Huangqi Jianzhong Tang, and Liangfu Wan. Chronic atrophic gastritis, on the other hand, often presents with burning pain in the epigastric region and thick, greasy tongue coating, usually indicating damp-heat accumulation in the lower abdomen; commonly used prescriptions include Banxia Xiexin Tang, Huanglian Tang, and Huanglian Jiedu Tang. Biliary tract diseases are often accompanied by bitter taste in the mouth, dry throat, right flank pain radiating to the right back, typically indicating pathogenic invasion of the Shaoyang channel; commonly used prescriptions include Da and Xiao Chaihu Tang, Chaihu Shugan San, Biliary Stone Expelling Tang, Jinqiancao, Ban Zhi Lian, and Huzhang. Pancreatic diseases, meanwhile, often cause pain radiating to the upper left abdomen, accompanied by low back pain, loose or hard stools, and during acute attacks, the pain can be extremely severe, even leading to cold extremities and weak, almost dying pulse—symptoms indicative of yang deficiency; commonly used prescriptions include Chaihu Shugan San, Danshen Yin, Jinlingzi San, Da Jianzhong Tang, Sanhuang Xiexin Tang, and Wuwei Xiaodu Yin. For chronic gastric perforation, TCM still recommends Huoluo Xiaoling Dan and Taohong Siwu Tang with appropriate modifications; for acute perforation, if conservative treatment fails, surgical intervention should be sought immediately.

(2) Chest Pain

Coronary heart disease, pleurisy, pulmonary inflammation, lung cancer, pleural mesothelioma, intercostal neuralgia, chronic pancreatitis, liver diseases, heart valve disease, arrhythmia, and other conditions can all produce chest pain. First, the cause of the chest pain must be clarified through Western diagnosis, followed by TCM differentiation. Coronary heart disease falls under the TCM category of “chest obstruction,” and the treatment should focus on broadening the chest, regulating qi, and dispersing stagnation; commonly used prescriptions include Gualou Xiebai Banxia Tang, combined with recent TCM–Western medicine integration studies on coronary heart disease, which recommend blood-activating and stasis-removing medications such as Guanxin II and Guanxin Suhé Wan. Pleurisy, on the other hand, falls under the TCM categories of “suspended fluid” and “chest constriction,” and clinicians can choose among prescriptions such as Shizao Tang, Da Xianxiong Tang (pill), and Xiao Xianxiong Tang; some patients present with pathogenic invasion of the Shaoyang channel, in which case Chaihu Shugan San and Da Chaihu Tang with appropriate modifications can be used. Pulmonary infections often manifest as lobar pneumonia, bronchial pneumonia, viral pneumonia, chronic bronchitis, emphysema, cor pulmonale, bronchial asthma, and bronchiectasis, among others.

Pei Zhengxue’s TCM Studies—Discussions on TCM Theory and Clinical Cases

Published by Hepei Hui Zi Publishing House

All types of pneumonia are collectively referred to in TCM as “real fire accumulating in the lungs” and “phlegm-heat cough,” and should be treated with prescriptions such as Maxing Shigan Tang, Da Qinglong Tang, Xie Bai San, and Tingli Dazao Xie Fei Tang; where necessary, Wuwei Xiaodu Yin can be added to enhance the heat-clearing and detoxifying effects. Inflammation of the trachea is generally classified as either wind-heat or wind-cold, and can be treated with Sangju Yin, Jingfang Baidu San, Su Xing San, Ma Huang Tang, Gui Zhi Tang with Houpu Xingzi Tang, among others. Bronchial asthma falls under the TCM categories of “lung distension” and “phlegm wheezing,” and should be treated with Maxing Shigan Tang, Xiao Qinglong Tang, Suzi Jiangqi Tang, and Houpu Ma Huang Tang. Emphysema is considered “kidney failing to contain qi,” and if accompanied by infection, it is also regarded as “upper excess, lower deficiency,” so prescriptions such as Suzi Jiangqi Tang and Du Qi Wan should be chosen. Bronchiectasis can be either wind-heat or wind-cold, and also falls under the category of lung distension; if there is hemoptysis, it should be treated according to the principles of “blood heat running wild” or “qi deficiency unable to control the blood.” Cor pulmonale, meanwhile, falls under the TCM category of “fluid accumulation in the lungs,” and treatment should focus on draining phlegm, promoting water metabolism, and calming the spirit; commonly used prescriptions include Linggui Zhugan Tang, Zhenwu Tang, and Baizi Yangxin Tang. Intercostal neuralgia is caused by qi stagnation and blood stasis in the Shaoyang region, so Chaihu Shugan San can be supplemented with qi-moving and blood-activating herbs, or one can use Fuyuan Huoxue Tang, Taohong Siwu Tang, or Huoluo Xiaoling Dan with pangolin scales, soapberry spines, frankincense, and myrrh. Chronic pancreatitis is associated with liver qi stagnation and liver wood overcoming earth, so prescriptions such as Chaihu Shugan San, Xiaoyao San, and Da and Xiao Jianzhong Tang are recommended; for severe pain, add Yuanhusuo and Chuanlianzǐ.

Liver diseases, on the other hand, should be treated primarily by addressing the liver, with particular emphasis on regulating liver function. In TCM differentiation, the main syndromes are still liver qi stagnation and liver wood overcoming earth, so prescriptions such as Chaihu Shugan San, Danzhi Xiaoyao San, and Qianggan Tang are preferred. Additionally, as mentioned earlier, for those with significant increases in turbidity in liver function, heavily use Huangqi, Danshen, and Shouwu; for those with markedly elevated transaminases, heavily use Gongying, Baijiang, Bailuanshe She Shi Cao, and Ban Zhi Lian. The former is due to decreased albumin, indicating “deficiency,” so tonifying methods are used; the latter is due to increased transaminases, indicating “excess,” so heat-clearing and detoxifying methods are employed. Heart valve and arrhythmia issues are usually attributed to “water qi overwhelming the heart,” “dampness stifling the heart’s yang,” “blood failing to nourish the heart,” or “dual qi and blood deficiency,” and should be treated with Linggui Zhugan Tang, Zhenwu Tang, Baizi Yangxin Tang, Zhigan Cao Tang, and Shengmai San. Lung cancer and pleural mesothelioma require early consultation with Western specialists; if the opportunity for surgery is missed, chemotherapy and radiation therapy will be necessary, at which point TCM can be used in conjunction with tonifying and consolidating methods to reduce the side effects of chemotherapy and radiation.

(3) Lower Abdominal Pain

Gynecological pelvic inflammatory disease, uterine fibroids, dysmenorrhea, cystitis, bladder and urinary tract stones, bladder cancer, colonic inflammation (both non-specific and specific), appendicitis, and other conditions can all cause lower abdominal pain of varying degrees and natures. First, modern medical physical examinations and laboratory tests should be conducted to confirm the specific disease causing the lower abdominal pain, followed by TCM differentiation.

Whether it’s adnexal inflammation or more extensive pelvic inflammation, gynecological pelvic inflammatory disease is generally classified as “damp-heat descending” in TCM. If the pain is severe, it may indicate “lower-jiao blood stasis,” and prescriptions such as Simiao San, Wanda Tang, Qingdai Tang, Gui Zhi Fu Ling Wan, Dang Gui Shao Yao Tang, and Taohong Siwu Tang should be selected, with additional heat-clearing and detoxifying ingredients like Bailuanshe She Shi Cao, Ban Zhi Lian, Pu Gong Ying, and Baijiang added as needed. Uterine fibroids, meanwhile, depend on the size revealed by ultrasound—

Pei Zhengxue’s TCM Studies—Discussions on TCM Theory and Clinical Cases Published by Gansu Science and Technology Press

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Contemporary TCM practitioners should follow the laws of development, boldly extend their thinking to the microscopic level, adopt Western medical experimental methods for their own use, and thereby develop TCM; they should apply ancient knowledge to modern practice and foreign knowledge to Chinese practice, with the aim of preserving the unique characteristics of TCM while opening up new horizons for modern TCM. The integration of TCM's holistic perspective with Western medicine's focus on the local is essential; the combination of TCM's macroscopic view with Western medicine's microscopic approach; and the fusion of TCM's concept of bodily response with Western medicine's pathogenic theory—these are all intrinsic needs for the two medical systems to learn from each other's strengths and compensate for their weaknesses. Whoever takes the initiative to leverage the strengths of the other 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 emulate Western medicine, because what Western medicine excels at is precisely what TCM lacks. The integration of TCM and Western medicine is the primary model for emulating Western medicine (and, of course, for mutual emulation between the two), but within this model, TCM practitioners must always adhere to the principles of "applying ancient knowledge to modern practice" and "using foreign knowledge for Chinese purposes." Only in this way can the goal of developing TCM be achieved. With the development of modern industry in China, unprecedented opportunities have now arisen, placing the glorious yet arduous task of developing modern TCM squarely on the shoulders of our generation of TCM practitioners.

(Research on the Integration of TCM and Western Medicine, March 1996)

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Pei Zhengxue’s TCM Studies—Discussions on TCM Theory and Clinical Cases

Published by Heji Book Publishing House

① Engels: Dialectics of Nature, People’s Edition, p. 30, 1971

② Virchow: Cellular Pathology, People’s Health Edition, p. 11, 1963

③ Lindemann: History of Scientific Thought, Social Sciences Edition, p. 298, 1961

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The Connotation and Models of TCM-Western Medicine Integration in Internal Medicine

Pei Zhengxue

Within the field of internal medicine, the connotation of TCM-Western medicine integration should reflect the characteristic of mutually learning from each other’s strengths. Specifically, it should emphasize the combination of TCM’s holistic view with Western medicine’s localized perspective, TCM’s macroscopic approach with Western medicine’s microscopic analysis, and TCM’s concept of bodily response with Western medicine’s pathogenic theory. To achieve these goals, certain working models must be designed for clinical practice in internal medicine; such disease-specific TCM-Western medicine integration models can also be referred to as clinical integration models. While taking into account specific clinical needs, these models must also facilitate further in-depth theoretical and clinical research on the overall integration of TCM and Western medicine, thereby contributing to the development of contemporary TCM.

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Pei Zhengxue’s TCM Studies—Discussions on TCM Theory and Clinical Cases

Published by Heji Book Publishing House

If, on the basis of the aforementioned macroscopic differentiation, we incorporate modern medical microscopic data—such as changes in liver function, plasma proteins, and fetal proteins—and comprehensively consider them through the lens of TCM differentiation, then TCM’s comprehensive understanding of liver diseases will undoubtedly be greatly enhanced, leading to improved therapeutic outcomes. Through long-term clinical application, the author has initially identified several patterns that readers may find useful as references. For example, to reduce elevated GPT levels, one can, based on traditional macroscopic differentiation, select herbs such as honeysuckle, forsythia, dandelion, houttuynia, prunella, indigofera, gentian, and sedum, which clear heat and detoxify; whereas to improve turbidity, one can reapply tonifying and consolidating herbs like codonopsis, astragalus, salvia, polygonum multiflorum, and angelica. By using medication to confirm the diagnosis, the former case corresponds to a real syndrome caused by heat-toxin, while the latter corresponds to a deficiency syndrome often due to dual qi and blood deficiency. An increase in GPT indicates a rise in serum transaminase levels, which represents “excess”; an increase in turbidity, on the other hand, reflects a decrease in serum albumin, which signifies “deficiency.” As stated in the Inner Canon, “reducing excess” and “tonifying deficiency” constitute proper treatment. Therefore, for elevated GPT, one should employ heat-clearing and detoxifying methods, while for turbidity, tonifying and consolidating methods are appropriate. In regulating the three systems of hepatitis B, the author tends to use heat-clearing and detoxifying methods to lower the surface antigen index, and tonifying and consolidating methods to induce seroconversion of the e antigen. Modern immunology holds that the relationship between antigens and antibodies is mutually complementary; thus, TCM differentiation for the three systems of hepatitis B should take both deficiency and excess into account, and treatment should balance tonifying and consolidating with heat-clearing and detoxifying in order to achieve complete recovery.