1. The Combination of Macroscopic and Microscopic Perspectives

1. The Combination of Macroscopic and Microscopic Perspectives

Introducing Western medicine's microscopic understanding of disease into the Chinese medicine diagnostic system is an urgent priority for advancing the theory and practice of syndrome differentiation and treatment in Chinese medicine. Implementing this clinical approach, while achieving the combination of macroscopic and microscopic perspectives, will also enable Chinese medicine to embark on the path of experimental research. Because throughout its entire development, Chinese medicine has placed greater emphasis on logical reasoning than on experimental research, it has completely overlooked the microscopic indicators that are essential for gaining insight into the intrinsic nature of disease—indicators that can only be discovered through modern scientific methods. Thus,

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The traditional Chinese medicine approach of syndrome differentiation and treatment must be combined with modern microscopic indicators in order to overcome the limitations of traditional syndrome differentiation. Let us take liver diseases as an example to illustrate this issue. Traditional Chinese medicine, starting from a macroscopic perspective, classifies liver diseases into pathological types such as liver qi stagnation, liver wood overacting on earth, liver-gallbladder damp-heat, liver-kidney yin deficiency, spleen-kidney yang deficiency, and qi stagnation with blood stasis. For liver qi stagnation, the treatment is to soothe the liver and resolve depression, using Chaihu Shugan San with additional herbs; for liver wood overacting on earth, the treatment is to soothe the liver and harmonize the stomach, using Xiaoyao San with additional herbs; for liver-gallbladder damp-heat, the treatment is to drain and clear damp-heat, using Longdan Xiegan Tang with additional herbs; for liver-kidney yin deficiency, the treatment is to nourish the liver and kidneys, using Yigui Tongyuan Yin with additional herbs; for spleen-kidney yang deficiency, the treatment is to warm the kidneys and strengthen the spleen, using Shipi Yin combined with Wuling San with additional herbs; and for qi stagnation with blood stasis, the treatment is to regulate qi, activate blood circulation, and relieve pain, using Gexia Zhuyu Tang combined with Jinlingzi San with additional herbs. If, on the basis of the above macroscopic syndrome differentiation, we also incorporate modern medical microscopic data—such as changes in liver function, plasma proteins, and alpha-fetoprotein—and comprehensively consider these factors from the perspective of TCM syndrome differentiation, it will undoubtedly greatly enhance TCM's comprehensive understanding of liver diseases, thereby improving existing therapeutic outcomes. In my long-term clinical practice, I have preliminarily identified several patterns that can serve as references for colleagues when practicing in this area. To reduce GPT levels, one can select Yinhua and Lianqiao based on traditional macroscopic syndrome differentiation, along with Qingre Jiedu herbs such as Gongying, Baijiang, Xiakucao, Banlangen, Longdan Cao, and Chuipeng Cao; to improve turbidity changes, one can re-use Fuzheng Guben herbs such as Dangshen, Huangqi, Danshen, Shouwu, and Danggui. Based on pharmacological evidence, the former corresponds to real syndrome, caused by heat-toxin; the latter corresponds to虚证, often due to dual deficiency of qi and blood. An increase in GPT indicates a rise in serum transaminase levels, which represents "excess"; an increase in turbidity indicates a decrease in serum albumin, which represents "deficiency." As stated in the "Inner Canon," "eliminate excess" and "supplement deficiency" are the correct methods of treatment. Therefore, for elevated GPT, use Qingre Jiedu therapy; for turbidity changes, use Fuzheng Guben therapy. In regulating the three systems of hepatitis B, I often use Qingre Jiedu therapy to lower surface antigen titers and Fuzheng Guben therapy to induce seroconversion of HBe antibody. Modern immunology holds that the relationship between antigens and antibodies is mutually reinforcing; therefore, TCM syndrome differentiation for the three systems of hepatitis B should combine deficiency and excess, and treatment should emphasize both Fuzheng Guben and Qingre Jiedu in order to achieve targeted therapeutic effects.