3. Western Medicine Emphasizes the Pathogen-Causation View, While Chinese Medicine Emphasizes the Body's Response View

Before the 18th century, there was no qualitative difference between Chinese and Western medicine in terms of etiology; both used speculative reasoning to argue about causes. Ancient Greek medicine believed that there were four primary pathogenic factors—air, fire, water, and earth—which was broadly similar to the Five Elements theory in Chinese medicine. Western medicine attributed puerperal fever to "changes in the universe—earth—air," a view roughly consistent with the Chinese notion of "human beings corresponding to heaven and earth." However, once the West was fortunate enough to benefit from the advent of large-scale industry, this situation began to change. In 1847, the Austrian physician Ignaz Semmelweis first noticed that postpartum fever was caused by infection with decaying substances. Although his view was suppressed at the time by religious dogma and he himself was even expelled from the hospital, eventually dying of mental illness, around the same time the famous French scientist Louis Pasteur discovered that milk and wine turned sour due to microorganisms. Subsequently, the British surgeon Joseph Lister proposed that wounds became inflamed because bacteria invaded and caused infection. He was the first to use carbolic acid to spray operating rooms and boil surgical instruments for sterilization, thereby laying the groundwork for disinfection, sterilization, and preservation. Particularly noteworthy in the history of pathogen recognition is the German physician Robert Koch (1843–1910), whose contributions to the development of pathogenology were epoch-making. He is regarded as the founder of modern microbiology. He first created solid culture media, developed bacterial staining techniques, and established experimental animal infection models, thus creating the preconditions for the development of modern microbiology. Thanks to Koch's innovative work, in the second half of the 19th century Western medicine established a firm understanding of pathogen-causation, and with the aid of large-scale industrial technology, over the past century, as immunology emerged, Western medicine's understanding of pathogen causation has grown ever deeper, forming a complete academic system that moves from practice to theory and serving as the fundamental standard for understanding disease etiology and pathology.

Chinese medicine, on the other hand, has always approached etiology through the reasoning frameworks set forth in the Huangdi Neijing: "If righteous qi resides within, evil qi cannot invade," and "Where evil qi gathers, righteous qi must be deficient." According to this logic, the root cause of disease lies either in "deficiency of righteous qi" or "excess of evil qi," with the former being crucial and the latter merely serving as a condition for disease onset. Therefore, Chinese medicine consistently advocates the "theory of deficiency leading to disease" and, in treatment, takes "strengthening righteous qi and consolidating the root" as the general principle for addressing many illnesses. The Suwen: Yin Yang Ying Xiang Da Lun states: "Yin and yang are the way of heaven and earth, the guiding principles of all things, the parents of change, the origin of life and death, the abode of the divine, and when treating disease, one must seek the root." Here, "root" refers to regulating yin and yang, which means adjusting the body's response. After the Huangdi Neijing, Zhang Zhongjing, Chao Yuanfang, Chen Wuzhe, and others elaborated extensively on etiology, proposing concepts such as "six exogenous pathogenic factors," "seven internal emotional disorders," "damage from diet," and "excessive labor or rest." Notably, Chen Wuzhe's "three causes" theory of disease causation, though innovative, still remained within the framework of reasoning based on the Huangdi Neijing. Chinese medicine's understanding of etiology has thus remained unchanged, focusing solely on the body's response while neglecting further investigation into the true pathogen. Throughout the history of Chinese medicine, there have indeed been instances of pioneering applications, such as the first use of the smallpox vaccine and Wu Youke's theory of "noxious qi" causing disease. However, lacking the backing of large-scale industry, these highly promising innovations and ideas, unable to be promptly translated into experimental research, ultimately faded away into the vast sea of logical speculation. Records of brewing and drinking alcohol can be traced back to ancient classics such as the Zhou Li and the Huangdi Neijing, spanning more than 2,000 years; yet no one ever imagined using alcohol for surgical disinfection. Instead, people simply reasoned based on alcohol's flammability and fluidity: "Alcohol burns, so its nature is like fire; alcohol flows, so its form is like water." This clearly demonstrates the one-sidedness of reasoning without experimental verification. During the Ming and Qing dynasties, the Warm Disease School developed significant corrections and supplements to the etiological concepts of exogenous febrile diseases in the Shanghan Lun, but since it still relied on the old method of logical reasoning and lacked the conditions for experimental research, the result was merely changing "wind-cold" to "wind-heat" and "magnolia and cinnamon" to "mulberry and silver." Modern medical pioneers such as Wang Qingren, Tang Zonghai, and Zhang Xichun sought to innovate within the framework of traditional Chinese medicine, but because they still did not have sufficient access to experimental research, their contributions to understanding pathogen causation were minimal.

III. The Complementarity of Chinese and Western Medicine Is Both a Need for Their Respective Development and an Inevitable Trend in Historical Development

Chinese and Western medicine have each followed their own trajectory of development until modern times. Although Western medicine's experimental research boasts tremendous advantages, when Virchow's cell pathology swept away the vestiges of medieval Western medicine and ushered in a new era, the joy of uncovering the microscopic secrets of disease also harbored a sinister seed on the other side of the coin. People's thinking shifted from the microscopic to the ultra-microscopic—from cells to cell nuclei, mitochondria, ribonucleic acid, and so on—yet to some extent, they overlooked the objective fact that none of this could be separated from the body's overall regulatory function. This tendency persisted until the 1930s, when Western medicine inevitably fell into the fatal trap of treating symptoms rather than causes. Consequently, within the ranks of Western medicine, Pavlov's theory of neural reflexes and Selye's theory of stress emerged one after another, and in 1937 Harris discovered the systemic regulatory effects of the hypothalamus-pituitary gland. Their research and viewpoints aimed to shift Western medicine from a localized focus back to a holistic one, from the microscopic back to the macroscopic. Over the past thirty years, this approach has been further strengthened by the remarkable advances in immunology. Looking at the modern development of Chinese medicine, although it is not as obvious as that of Western medicine, we can still faintly discern attempts by insightful individuals to shift their understanding from the macroscopic to the microscopic. Wu Youke's "noxious qi" theory, Wang Qingren's "anatomical" approach, and Tang Zonghai and Zhang Xichun's efforts to integrate Chinese and Western medicine are all concrete manifestations of this endeavor. Overall, over the past century, both Chinese and Western medicine have begun to correct their respective shortcomings. All things, once they begin to develop, do so through gradual correction and refinement—this is the inevitable law of development. As part of modern science and technology, Western medicine, in the rapid pace of modern scientific advancement, strives to draw nourishment from every possible source in order to strengthen itself. In recent years, the Western world has seen a surge of interest in Chinese medicine—not only because of the need for clinical treatment, but also because, at a deeper level, the West has begun to learn from Chinese medicine, seeking to extract its essence and apply it. It can be confidently asserted that the holistic perspectives and the human-heaven correspondence views embedded in the treasure trove of Chinese medicine will be the first things Western medicine seeks to tap into, then subject to experimental research, and soon put to use, in an effort to spark a new renaissance in Western medical scholarship. The descendants of Yan and Huang—the inheritors of contemporary Chinese medical heritage—have clearly recognized that today, pushing the Chinese medical system from the macroscopic to the microscopic is an urgent priority; this is the only path forward for developing Chinese medicine. There is no other way. Modern science and technology have formed an interconnected and interdependent network, yet Chinese medicine remains excluded from this network, still adhering to ancient teachings and proceeding slowly along the traditional path of reasoning and speculation. As previously mentioned, this situation arose because of the long feudal era, during which individual agriculture and scattered handicrafts did not provide opportunities for Chinese medicine to advance toward the microscopic. We cannot hold the ancients accountable for this. However, by the 1990s, China's contemporary industry had already joined the ranks of the world, and the conditions for advancing Chinese medicine toward the microscopic were fully in place. Contemporary Chinese medical practitioners must follow the laws of development, boldly push their thinking toward the microscopic, adopt Western medicine's experimental methods, put them to use, develop themselves, and achieve the goal of adapting the ancient to the modern and the foreign to the Chinese, so as to preserve the unique characteristics of Chinese medicine while opening up a new chapter for modern Chinese medicine. The combination of Chinese medicine's emphasis on the holistic aspect and Western medicine's emphasis on the localized aspect; the combination of Chinese medicine's emphasis on the macroscopic aspect and Western medicine's emphasis on the microscopic aspect; and the combination of Chinese medicine's view of the body's response and Western medicine's view of pathogen causation—are precisely the mutual needs of the two systems to complement each other's strengths. Whoever can take the initiative and draw on the other's strengths will make rapid progress in the short term. Contemporary Chinese medical practitioners should be keenly aware of this reality: under current conditions, the most effective way to develop Chinese medicine is to first draw on Western medicine, because what Western medicine excels at is precisely what Chinese medicine lacks. The integration of Chinese and Western medicine is the main model for drawing on Western medicine (and, of course, for mutual exchange between the two), but within this model, Chinese medical practitioners must always keep in mind the principle of adapting the ancient to the modern and the foreign to the Chinese; only in this way can the goal of developing Chinese medicine be achieved. With the development of China's large-scale industry, unprecedented opportunities have now arisen, and the glorious yet arduous task of developing modern Chinese medicine has fallen squarely on the shoulders of our generation of Chinese medical practitioners.

Note: ① Engels: "Dialectics of Nature," People's Publishing House, 1971, p. 30 ② Virchow: "Cell Pathology," People's Medical Publishing House, 1963, p. 11 ③ Lindholt: "History of Scientific Thought," Social Sciences Press, 1961, p. 298 ("Research on the Integration of Chinese and Western Medicine," March 1996)

The Connotation and Model of Integrating Chinese and Western Medicine in Internal Medicine

Pei Zhengxue

In the field of internal medicine, the connotation of integrating Chinese and Western medicine should reflect the characteristic of each system complementing the other's strengths. Specifically, it should highlight the combination of Chinese medicine's holistic perspective with Western medicine's localized perspective, the combination of Chinese medicine's macroscopic view with Western medicine's microscopic view, and the combination of Chinese medicine's view of the body's response with Western medicine's view of pathogen causation. To achieve these goals, it is necessary to design specific procedures for clinical practice in internal medicine—procedures that integrate Chinese and Western medicine for each particular disease. Such procedures can also be called clinical models of integration. While taking into account specific clinical needs, these models must also facilitate the further deepening of the overall theory and clinical practice of integrated Chinese and Western medicine, thereby contributing to the development of modern Chinese medicine.

I. The Connotation of Integrating Chinese and Western Medicine in Internal Medicine