by Bob Flaws

Yesterday I taught a webinar on how to treat asymptomatic Western medical diseases with Chinese medicine. One of the pieces of feedback we received was from an MD who said that contemporary Chinese medicine should not follow Western medicine's mistaken lead in treating diseases. Chinese medicine is supposed to treat the whole person. I've heard this objection before, not only from MDs who are recent enthusiasts of Chinese medicine but also from our own students and practitioners. So I'd like to address this issue directly. There is an important misconception or missing piece of Chinese medicine at work here.

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Professional Chinese medicine has always treated professionally recognized, named diseases. As I mentioned in my webinar yesterday, Chinese medicine recognizes approximately 1,000 traditional Chinese medical disease categories. For two thousand years, Chinese doctors have begun their clinical process by diagnosing their patient's named disease. These named diseases are not some new or recent addition to Chinese medicine. We know that many of these disease names predate the Nei Jing (Inner Classic), while others show up for the first time in surviving literature in the Nei Jing and the Shang Han Lun/Jin Gui Yao Lue. So the idea of disease diagnosis per se is nothing foreign to professional Chinese medicine. Rather it has been an intrinsic part of professional Chinese medicine from our earliest records. Therefore, in the 20th century, Chinese doctors saw absolutely nothing wrong with or contrary to adopting modern Western medical disease diagnosis as well. They were already using disease diagnosis as an integral part of their therapeutic process, and, frankly, modern Western medical disease diagnosis is more precise and more informative than traditional Chinese medical disease diagnosis. Thus beginning in the mid-20th century, most Chinese medical treatment manuals began to be organized by Western medical disease categories as opposed to the less precise traditional Chinese disease categories.

In the West, the interest in Chinese medicine largely grows out of the holistic health movement. Many practitioners and patients of modern Western medicine have become dissatisfied with contemporary Western medical treatment. The critique is that, basing treatment on disease diagnosis fails to take into account the entire patient, thus missing the forest for the trees. And this is a valid criticism if the medical system only uses disease diagnosis as its prescriptive methodology.

However, that is simply not the case in professional Chinese medicine. In professional Chinese medicine, each disease is further broken down into its clinically presenting patterns, and, in standard professional Chinese medicine, treatment is primarily based on these patterns and only secondarily on the patient's named disease. We refer to this as bian zheng lun zhi, treatment based on pattern identification or discrimination. It is basing treatment primarily on the patient's presenting patterns that is the hallmark of professional Chinese medicine. Further, treatment based primarily on pattern discrimination always sees and treats the whole person.

As I was mentioning yesterday in my webinar, each disease, whether traditional Chinese or modern Western medical disease, has its pathognomonic signs and symptoms. These are the sine qua non of that disease. If a patient doesn't exhibit those signs and symptoms, they categorically do not have that disease. By their nature, such pathognomonic signs and symptoms are limited and tend to be narrowly focused (unless the disease itself is widely dissemintated throughout multiple systems within the patient). However, the pathognomonic signs and symptoms of Chinese medical patterns are much broader, potentially encompassing the whole patient on every level, physical as well as mental-emotional. In fact, the signs and symptoms of Chinese medical patterns are so all-encompassing that often Western patients will try to tell us not to worry about this or that symptom because it has nothing to do with their disease. Nevertheless, because we primarily base our treatment on the patient's presenting patterns, we absolutely need uncover and to be aware of any and all symptoms which deviate from Chinese medicine's normative values. Thus we typically review all physical and mental-emotional functions in our patients regardless of how limited and circumscribed their disease diagnosis.

Put simply, it is pattern discrimination which makes professional Chinese medicine the holistic medicine it is. It is pattern discrimination which allows us to see and, therefore, treat the whole person and not just one particular symptom or disease. However, that being said, we always have and we continue to also use disease diagnosis. As stated above, disease diagnosis has always been an integral part of the therapeutic process or methodology of Chinese medicine. In addition, it makes perfect sense that contemporary Chinese medical practitioners have adopted modern Western medical disease diagnosis. Modern Western medical disease diagnosis tells us much more about the natural history of the patient's disease than does traditional Chinese medical disease diagnosis. As a clinician, I need to know such things as whether a disease is self-limiting, progressive, relapsing-remittent, degenerative, life-threatening, contagious, malignant, etc., all fundamental parts of a disease's natural history. I also need to be aware of and incorporate in my overall treatment plan any treatments that are proven to be empirically effective for that specific disease. To fail to take such things into account would be, as a doctor of Chinese medicine, negligent and unprofessional.

So next time you hear some partially informed recent convert say that Chinese medicine treats or should treat the whole person and not disease, you can set them straight or not, but at least you know that we do and always have made and taken disease diagnoses into account. The issue is whether one only treats the disease or whether one primarily treats the pattern with the disease being of secondary importance. Bottom line: Because Chinese medical patterns intrinsically describe the whole person, treatment based on pattern discrimination is always treatment of the whole person.

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