3. The Superiority of Integrating Chinese and Western Medicine

TCM views disease from a macroscopic perspective, while Western medicine adopts a microscopic approach; this inevitably leads to the following tendencies: TCM tends to emphasize the whole while overlooking the part, whereas Western medicine focuses on the part while neglecting the whole. Over the past century, both medical traditions have recognized these tendencies as impediments to their own development, prompting a wave of “systematization of modern medicine” within Western medicine. This movement was spearheaded by Pavlov’s theory of reflexes and followed by Selye’s stress response theory. In the past two decades, the rapid advancement of immunology, cybernetics, and information theory has further deepened this trend. The goal of modern medical systematization is to shift Western medicine’s disease perception from the local to the global, from cells and organs to the overall system, ecology, climate, and society. In contrast, the developmental tendency of modern TCM runs counter to that of Western medicine: it moves from a systemic, holistic view of the seven emotions, six exogenous evils, qi, blood, phlegm, dampness, meridians, and zang-fu organs toward a gradual exploration of the local and concrete. The Warm Disease School’s emphasis on clearing heat and detoxifying, Wang Qingren’s anatomical practices and blood-activating, as well as contemporary research on the spleen and kidneys, are all integral parts of this process. In summary, the shift of Western medicine toward systematization and holism, coupled with TCM’s move toward localization and concreteness, is an inevitable outcome of medical development—a natural law of historical progression. If TCM’s systemic, holistic perspective can serve as a reference for Western medicine’s systematization, and Western medicine’s localized, concrete understanding of disease can inform TCM’s deepening focus on the local, then the pace of medical advancement will undoubtedly accelerate. This mutual exchange of insights is, in essence, what is commonly referred to as the integration of Chinese and Western medicine.

Since the initiation of the integration of Chinese and Western medicine, abundant evidence has demonstrated that adopting an integrated approach to studying Traditional Chinese Medicine can elevate traditional TCM theory to new heights. Chest oppression is a traditional ailment in TCM, analogous to coronary heart disease in modern medicine. The Golden Cabinet’s chapter on chest oppression, palpitations, and shortness of breath states that this condition arises when yin occupies the position of yang and chest yang fails to disperse, requiring treatments that invigorate chest yang. The nine prescriptions listed, including the Gualou-Xiebai-Baijiu decoction, all focus on the qi level; while these formulas do offer some therapeutic effect for chest oppression, they never achieve complete cure. Since the integration of Chinese and Western medicine began, given that this condition is caused by narrowing of the coronary arteries due to atherosclerosis, leading to insufficient blood supply, it is broadly classified as “blood stasis” in TCM. Consequently, integrators of Chinese and Western medicine have experimented with blood-activating and stasis-resolving therapies for this condition, significantly enhancing therapeutic efficacy and opening up new avenues for understanding and treating chest oppression. The Beijing regional collaborative group, based on this new understanding, formulated the Coronary Heart No. 2 prescription, which is used in conjunction with Gualou-Xiebai-type formulas in clinical practice, achieving an overall effectiveness rate of over 90%. This addition of “blood stasis” to the pathogenesis of chest oppression has greatly deepened TCM’s understanding of this condition. Regarding edema, TCM has traditionally relied on warming yang to transform water, strengthening the spleen to drain dampness, and dispersing lung qi to facilitate water elimination—again, all focusing on the qi level. Since the integration of Chinese and Western medicine began, given that kidney inflammation is the most common cause of edema, and that the pathological changes in kidney inflammation are rooted in the proliferation of the glomerular basement membrane, this “proliferation” can still be categorized as “blood stasis” in TCM. The Shanxi Institute of Traditional Chinese Medicine, guided by this perspective, formulated the Yi Shen Tang formula, primarily aimed at activating blood circulation and resolving stasis, for treating various types of kidney inflammation, achieving an effectiveness rate of over 70%. This fact demonstrates that the integration of Chinese and Western medicine has deepened TCM’s understanding of edema and revolutionized its treatment approach, breaking away from the traditional focus on warming yang to transform water, strengthening the spleen to drain dampness, and dispersing lung qi to facilitate water elimination. In recent years, integrators of Chinese and Western medicine have conducted extensive experimental research on the spleen, discovering that the spleen is closely linked to the autonomic nervous system, metabolic system, immune system, and endocrine system. Using spleen-strengthening and qi-boosting methods, TCM can now provide differentiated treatment for ailments affecting these systems, providing a material basis for the concept of “treating different diseases with the same approach.” This has significant implications for strengthening traditional TCM theory. After the founding of the People’s Republic of China, Chinese and Western medicine integrators have also conducted a series of experiments on the kidney, discovering that, beyond its role in the urinary system, the kidney primarily represents the functions of the hypothalamus-pituitary-adrenal cortex system and the hypothalamus-pituitary-gonadal system. This provides empirical support for the traditional TCM view that the kidney is the “root of life” and the “foundation of existence.” Elevating a thesis formed through logical reasoning in clinical practice to a theory backed by scientific experimentation is undoubtedly a major boost for the development of Traditional Chinese Medicine. In summary, employing an integrated approach to studying Traditional Chinese Medicine can enrich and enhance its content, thereby powerfully advancing its development.

III. Applying Advanced Theories from Modern Disciplines to Study Traditional Chinese Medicine, Gradually Achieving Its Modernization

Due to the high degree of specialization in modern science, natural sciences are composed of various disciplines that are closely interconnected,

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A multi-layered, interwoven network system formed by mutual penetration. Traditional Chinese Medicine, as an applied science that studies human life phenomena and seeks effective means to combat disease, should, like Western medicine, also be regarded as one link in this network system. We must study TCM from this perspective; otherwise, TCM will not be able to advance with the times. The theory of traditional Chinese medicine is built on a macroscopic foundation. It understands the laws of human life and disease from a holistic perspective, but relatively lacks detailed descriptions of specific details, which reflects the insufficient differentiation within the TCM theoretical system. Practice in the development of natural sciences shows that breakthrough research on the fundamental theories of the TCM system cannot be achieved by medical professionals alone; it requires extensive collaboration across multiple disciplines such as biophysics, molecular biology, quantum chemistry, and quantum biology to make progress. The "Inner Canon" is the classic work of TCM theory. In terms of its content, it covers not only physiology, pathology, treatment methods, and prescriptions, but also astronomy, geography, mathematics, biology, psychology, and other fields. It is not unreasonable to say that the "Inner Canon" is an encyclopedia that synthesizes the achievements of various disciplines of its time. Research on such an "encyclopedia" must rely on the methodologies of modern scientific disciplines—including cybernetics, information theory, and systems theory—to achieve meaningful results. The same applies to the study of works such as "Shanghan Lun" and "Jingui Yaolue."

IV. Conclusion

Currently, the development of traditional Chinese medicine must proceed simultaneously in the aforementioned three aspects, none of which can be neglected. However, among these three aspects, inheriting, organizing, and improving traditional TCM theory is the foundation of this work. On this basis, strengthening research on the integration of TCM and Western medicine will enable traditional Chinese medicine to absorb nourishment from Western medicine, continuously enrich itself, and develop further. At the same time, advanced theories and technologies from various disciplines must also be mobilized to join this effort, gradually modernizing traditional Chinese medicine so that it can keep pace with the times and shine forever. To achieve this glorious goal, in addition to the three forces of TCM, Western medicine, and the integration of TCM and Western medicine, we must also mobilize the most advanced multidisciplinary scientific and technological forces of our time, working together with one heart and one mind. We believe that under the correct guidelines and policies of the Party Central Committee and the government, the vast majority of medical and scientific workers will surely overcome numerous difficulties and gradually fulfill this great historical mission over a considerable period of time.

("Gansu Medical Journal," 1983.2)

Pushing macroscopic syndrome differentiation toward microscopic syndrome differentiation is the current top priority for the development of TCM scholarship.

Pei Zhengxue

TCM scholarship was founded in the pre-Qin period, underwent practical refinement through Zhang Zhongjing's contributions, was strengthened by the debates among scholars of the Jin and Yuan dynasties, and was boldly innovated by the Warm Disease School, ultimately becoming an invaluable treasure for the survival, prosperity, and national strength of the Chinese nation. Even today in the 20th century, TCM continues to stand tall in the world of medicine, shining brightly and attracting widespread attention. However, over the past century, modern science and technology have been advancing at an astonishing rate, and humanity's understanding of disease has shifted from the macroscopic to the microscopic, from broad generalizations to minute details. As a natural science dedicated to combating disease, TCM should naturally become a link in the modern scientific network system and advance in step with modern science and technology. Yet due to historical constraints, previous generations were unable—and could not possibly—take larger steps in this regard, leaving this glorious yet arduous historical mission squarely on the shoulders of us, the current generation of TCM practitioners. Faced with this issue, I propose the question of "pushing macroscopic syndrome differentiation toward microscopic syndrome differentiation" for discussion with my colleagues in the TCM community. If there are any shortcomings, I hope comrades will offer criticism and suggestions.

I. Traditional TCM syndrome differentiation is macroscopic

"Syndrome differentiation and treatment" is the hallmark of the TCM academic system and the very essence of all Chinese medicine. The foundation of "syndrome differentiation and treatment" lies in observation, auscultation and olfaction, inquiry, and palpation, while the method is logical reasoning. Throughout the process of "syndrome differentiation and treatment," doctors primarily rely on their sensory organs and the analytical capabilities of the cerebral cortex. Looking back at the history of TCM development, it is easy to see the origins of this tendency.

The development of TCM scholarship can be traced back to Bian Que in the 4th century BC and extends to modern physicians such as Xiao Longyou and Pu Fuzhou. Their practical experience and academic ideas have always been rooted in agriculture and handicrafts as the social foundation. Throughout history, TCM scholars never had the opportunity to use the precise instruments provided by large-scale industry to study traditional Chinese medicine. Consequently, the traditional achievements in the field of TCM could only emerge from macroscopic observation and judgment of the external manifestations of disease. In this context, tongue color, pulse condition, patients' subjective symptoms, and certain external physical signs became the main bases for diagnosing diseases. Previous generations summarized four diagnostic methods, eight principles, qi-blood-phlegm-fire, five movements and six energies, and so on, thereby forming a distinctive TCM syndrome differentiation system. This system has indeed played a tremendous role in humanity's understanding and treatment of disease and continues to do so today. However, since human senses can only observe the external manifestations of disease, the essence of the principle of "treating disease by seeking its root" is actually logical reasoning based on syndrome identification and etiology analysis, while direct insight into the internal qualitative changes of disease remains elusive. Over the centuries, physicians have accumulated many vivid reasoning methods, such as analogy and similarity, and the principle of "like attracts like," striving to form a correct mental image of the nature of disease. Although these imaginations lack a foundation in experimental research, they originate from clinical practice and are supported by practical experience, giving them universal guiding significance for TCM clinical practice.

II. Modern medicine provides microscopic evidence

In modern times, the development of large-scale industry and natural science have complemented and promoted each other. With the help of new theories provided by natural science and advanced tools produced by large-scale industry, humanity's understanding of disease has gradually become more microscopic. At the end of the 17th century, following the Industrial Revolution in Britain, Western medicine emerged in this context. Experimental research replaced traditional logical preaching, and microscopic understanding supplemented medieval macroscopic reasoning—these were the hallmarks of this initial stage. As a result, Western medicine stood out with a brand-new appearance, forming a microscopic system based on physiological and pathological changes in organs, tissues, cells, body fluids, and nerves. Every link in this system, as well as the corresponding therapeutic measures and prescriptions used in clinical practice, are closely related to advances in modern natural science. This shift in Western medicine has made it an important component of the modern scientific network system, where it permeates and mutually benefits from other branches of modern natural science, such as physics, chemistry, microbiology, meteorology, and geology, advancing in tandem. Examination methods and microscopic data used in diagnosing liver diseases—such as liver function tests, protein electrophoresis, alpha-fetoprotein, and the three-system test—as well as those used in diagnosing stomach diseases—such as fiberoptic gastroscopy and tissue biopsy—and those used in diagnosing heart diseases—such as electrocardiogram, vectorcardiogram, and echocardiography—are all products of experimental research and results of mutual penetration among various fields of modern natural science.

III. Only by combining macroscopic and microscopic perspectives can we gain a comprehensive understanding of disease

There is no doubt that macroscopic syndrome differentiation is an important aspect of understanding disease. However, microscopic syndrome differentiation is another crucial aspect. To achieve a comprehensive and accurate diagnosis, both approaches must be employed. For example, in cases of liver disease, based on macroscopic patterns such as liver-qi stagnation, liver-wood overcoming earth, damp-heat in the liver and gallbladder, and yin deficiency of the liver and kidneys, if we also take into account microscopic changes in liver function, plasma proteins, and alpha-fetoprotein from the perspective of TCM syndrome differentiation and treatment, we can undoubtedly deepen our understanding and improve therapeutic efficacy. Through long-term clinical practice, I have discovered several patterns that may serve as references for colleagues. To lower SGPT levels, it is often effective to use herbs such as honeysuckle, forsythia, dandelion, houttuynia, prunella, indigofera, gentian, and sedum, which clear heat and detoxify; to turn turbidity tests negative, it is often effective to use tonifying herbs such as astragalus, codonopsis, polygonum multiflorum, and angelica, which strengthen the body and consolidate the root. By testing the effects of medication, we can determine that the former case is due to excess heat and toxin, while the latter is due to deficiency and qi-blood insufficiency. An increase in SGPT indicates elevated transaminase levels, which represents "excess"; an increase in turbidity indicates decreased albumin levels, which represents "deficiency." As stated in the "Inner Canon," "eliminate excess" and "replenish deficiency," so the former should be treated with heat-clearing and detoxifying methods, while the latter should be treated with tonifying and consolidating methods. In regulating the three hepatitis markers, I often use heat-clearing and detoxifying methods to reduce surface antigen levels, and tonifying and consolidating methods to turn core antibody levels negative. Modern immunological views hold that the relationship between antigens and antibodies is complementary; therefore, the essence of TCM syndrome differentiation for the three hepatitis markers should be a combination of deficiency and excess, and treatment should emphasize both heat-clearing and detoxification as well as tonifying and consolidating, so that the medication truly addresses the underlying problem. In chronic nephritis, macroscopic syndrome differentiation often manifests as yang deficiency with water overflow, spleen-stomach qi deficiency, lung failure to descend, liver-gallbladder excess fire, and bladder damp-heat; microscopic syndrome differentiation, on the other hand, should pay attention to urinary sediment, red blood cells, white blood cells, protein, non-protein nitrogen, and carbon dioxide binding capacity. When treating this disease, I first determine a basic formula based on macroscopic syndrome differentiation—for example, Zhenwu, Jisheng, Liu Jun, or Longdan Xiegan—and then, depending on whether there is proteinuria, I add herbs that tonify and consolidate; if there is hematuria, I add herbs that clear heat and stop bleeding; if there are white blood cells in the urine, I add herbs that clear heat and detoxify; if non-protein nitrogen rises or carbon dioxide binding capacity decreases, I use methods that elevate the clear and descend the turbid. For gastric pain, macroscopic syndrome differentiation includes spleen-stomach qi deficiency, liver-stomach disharmony, excessive stomach fire, spleen-stomach damp-heat, and lung-stomach yin deficiency; microscopic syndrome differentiation involves fiberoptic gastroscopy, pathological biopsy findings, and gastric juice analysis. I usually determine a basic formula based on macroscopic syndrome differentiation—for example, Liu Jun, Xiaoyao, Qingwei, Xiexin, or Yiguan Jian—and if microscopic examination reveals superficial gastritis, I add coptis and scutellaria; if it is atrophic gastritis, I add salvia miltiorrhiza, corydalis, coptis, and scutellaria; if it is gastric or duodenal ulcer, I add white peony, raw oyster shell, and cuttlefish bone; if it is gastric prolapse, I add astragalus, citrus aurantium, and atractylodes; if it is gastric mucosal prolapse, I add sandalwood, agarwood, amomum, and cardamom.

IV. Conclusion

The combination of macroscopic and microscopic syndrome differentiation is an important trend in the current development of TCM. It is not only related to the effectiveness of treatment, but also represents the urgent task facing TCM today in the 1980s. Only by boldly extending TCM scholarship to the microscopic level can TCM both preserve its unique characteristics and integrate into the modern scientific network system characterized by mutual interconnection and penetration. Only in this way can TCM advance in step with modern science and technology. The era when "the older TCM is, the better" should be a thing of the past. Likewise, the era when "every word in 'Shanghan Lun' is golden and unchangeable" should also be a thing of the past. We hope that in the near future, specialized TCM works that surpass "Shanghan Lun" and "Wenbing Tiaobian" will appear in the realm of traditional Chinese medicine, featuring the combination of macroscopic and microscopic perspectives.

("Chinese Journal of Traditional Chinese Medicine," 1986.7)

The necessity and inevitability of integrating TCM and Western medicine

Pei Zhengxue

"Integration of TCM and Western medicine"—this major issue that determines the success or failure of traditional Chinese medicine—has increasingly attracted the attention of medical professionals and all sectors of society both domestically and internationally. Because TCM and Western medicine originated and developed on completely different social foundations, the two systems are entirely distinct academically, from form to content. These two systems exhibit obvious complementary characteristics, and contemporary medical professionals deeply feel the necessity of their integration. Today, this aspiration has transcended national borders, becoming a shared desire among medical scholars in both the East and the West, and also representing an inevitable trend in advancing global medicine to new heights.

I. TCM and Western medicine originated on different social foundations

TCM and Western medicine arose and developed on different social foundations. Engels stated in "Dialectics of Nature": "When the economic base changes, the entire massive superstructure undergoes transformation, sooner or later"^①^. The differences between TCM and Western medicine are precisely the result of such transformations in the superstructure. TCM emerged as a discipline around the 4th century BC, during a period of transition in China from slave society to feudal society. In line with the change in the ownership of the means of production, TCM broke free from the constraints of divine authority and the doctrine of heavenly mandate, finally separating itself from shamanism. The renowned TCM physician Bian Que was a representative figure of this transformative period, and the "Yellow Emperor's Inner Canon" (hereinafter referred to as the "Inner Canon") was the representative work of this era. Over the subsequent 2,000-plus years, China remained in a long feudal society (after the Opium War in 1840, it became a semi-feudal, semi-colonial society), with an economic base dominated by individual agriculture and scattered handicrafts. Such an economic foundation could not provide modern, relatively precise experimental tools and equipment for the development of medicine, let alone the microscopic data essential for modern medicine. The only resources available to TCM clinicians and theorists were the external manifestations of disease; beyond that, if anything else could be relied upon, it would be the thinking and analytical abilities of TCM practitioners themselves. Before the 16th century, Western medicine, like TCM, also lacked the modern industrial economic base on which it depended for development. From the 4th to the 3rd century BC, the works of Hippocrates, the great father of ancient Greek medicine—"Hippocratic Corpus"—were published, comprising more than 70 treatises that synthesized the pinnacle of ancient Greek medicine at the time. Like China's "Yellow Emperor's Inner Canon" of the same era, it became a beacon guiding and influencing the development and direction of medicine worldwide. Around the 2nd century AD, the focus of Western medicine shifted from ancient Greece to the Mediterranean coast, and the scholarly ideas in the "Hippocratic Corpus" blossomed in ancient Rome, where a brilliant star of medicine rose—the most famous Roman physician known as the "King of Physicians," Galen. Galen was born in 130 AD and died in 200 AD. During the same period, another figure hailed as the "Sage of Medicine," Zhang Zhongjing (150–219 AD), emerged in China. The former inherited the ideas in the "Hippocratic Corpus" and further integrated them with clinical practice, thereby establishing a milestone in the development of Western medicine; the latter inherited the scholarly ideas in the "Yellow Emperor's Inner Canon" and combined them with clinical practice, thus creating a unique model for the development of Eastern medicine. From the "Hippocratic Corpus" to Galen and from the "Inner Canon" to Zhang Zhongjing, the social foundations on which Western medicine and Chinese medicine relied for their emergence and development were clearly similar: neither possessed the modern industrial economic base. However, because the ancient Greeks and Romans lived for generations along the Aegean and Mediterranean waters, their turbulent maritime lifestyle fostered a spirit of innovation and enterprise, whereas the Chinese people lived for generations in the inland Yellow River basin, where a relatively stable agricultural production system cultivated a mindset of stability, conservatism, and lack of initiative. Moreover, after the Western Han Dynasty, the teaching of "suppressing all schools of thought and exclusively honoring Confucianism" greatly restricted the Chinese people's courage to innovate. In the field of medicine, this was reflected in the fact that, apart from the abundant "logical reasoning" teachings common to both the "Inner Canon" and the "Shanghan Lun," the works of Hippocrates and Galen also contained some innovative experimental research on anatomy, physiology, pathology, and other areas, which laid the groundwork for the rapid emergence of modern medicine within the original framework of ancient Roman medicine when large-scale industry later arose. Although ancient Roman medicine, thanks to the creations of Galen and others, initially bore the mark of "experimental research," this was still only a manual, artisanal practice. Without the support of the economic base provided by large-scale industry, such practices ultimately could not escape the patchwork and concatenation of "logical reasoning" methods. After all, at that time, medicine was at most a superstructure dependent on the economic base. Facts proved that over the subsequent 1,500-plus years after Galen, since the Western world did not experience any major social transformation that broke through old relations of production and created new productive forces, Western medicine continued to remain and develop on the basis of a society without large-scale industry. The experimental research portions in the works of Hippocrates and Galen were never vigorously developed and made the main theme of Western medicine; instead, some of their maxims and teachings outside the experimental research were elevated to the status of golden rules, becoming the dogmatic confines of the "Scholastic" school of ancient Roman medicine that stifled innovative thinking. This situation could only begin to change after the 16th century. At that time, capitalism began to sprout in the West, and the development of mining and machine industries, especially the invention of telescopes and microscopes, opened the door to the mysteries of nature, providing unprecedented conditions. Thus, natural science began to break free from the cage of "Scholastic philosophy" and stride forward on the path of modern experimental research. In the field of medicine, the application of microscopes enabled people to venture into the microscopic world, leading to the discovery of cells and a renewed understanding of blood circulation. In the mid-16th century, modern large-scale industry powered by steam engines emerged, having a groundbreaking impact on the development of medicine. The precision machinery produced by large-scale industry accelerated the rapid development of basic medical research, and a series of breakthrough theoretical achievements enabled Western medicine to quickly emerge with a brand-new look. Modern Western medicine consists of disciplines closely related to clinical practice, such as physiology, anatomy, pathology, and biochemistry, forming a scientific system based on experimental research. Every link in this system is closely related to the progress of modern natural science, making it naturally part of the modern natural science system. Modern natural science is a complex, interwoven network composed of various disciplines, where each link promotes and constrains the others, and the advancement of any one link can drive the advancement of related links. Take, for example, how every invention in modern science inevitably leads to breakthroughs in corresponding technologies within the medical system. The development of the glass and metallurgical industries facilitated the creation of microscopes; the invention of electricity and electric lights enabled the application of various endoscopes; advances in atomic physics gave rise to the clinical application of X-rays; radar technology provided B-ultrasound for medicine; integrated circuits provided CT scans; and isotope technology produced gamma cameras and ECT. In short, almost every major invention in contemporary science can be directly absorbed and utilized by modern medicine. However, traditional TCM has always been excluded from the ranks of modern science and technology, and none of the achievements of modern science and technology can be absorbed and utilized by TCM. The main reason for this is that, from Bian Que in the 4th century BC to contemporary medical masters such as Xiao Longyou and Pu Fuzhou, throughout the long 2,000-plus-year history of TCM development, it has always been based on individual agriculture and scattered handicrafts.

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On this basis, the entire theoretical system was formed entirely as a product of "logical reasoning," rather than experimental research.

The conclusions of such studies are that optical instruments cannot reveal "phantom movement of the phase fire," and CT and B-ultrasound cannot reveal "wood overcoming earth." Since the founding of the People's Republic of China, especially over the past decade, China has established a vast modern industrial system, fundamentally transforming the socio-economic foundation. Traditional Chinese medicine must therefore undergo reforms to adapt to these changes; otherwise, it will forever remain disconnected from modern science and technology and unable to advance in step with them.

II. Chinese and Western Medicine Are Completely Different Academic Systems

Because Chinese and Western medicine employ completely different research methods—Western medicine relies on experimental research while Chinese medicine uses logical reasoning—the two systems differ fundamentally in both form and content. However, both study the human body and its diseases. In light of this, a clear comparison reveals three distinct tendencies in how the two approaches treat the human body and disease.