by Bob Flaws

In Chinese medical journals, there is a genre of article that discusses “new” or “off-label” uses of famous old formulas. The titles of this genre of article typically contain the words “new uses” or “lifting the borders” along with the name of this or that famous formula. The intention of this genre of article is to emphasize the prescription of these famous old formulas on the basis of pattern discrimination as opposed to disease diagnosis. Such formulas usually consist of several case histories of different diseases all treated by the formula under discussion.

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In other words, if the patient’s pattern fit a formula’s pattern indications, then the author used that formula regardless of its usual textbook disease indications. For instance, Xiao Yao San and Bu Zhong Yi Qi Tang are two of the most commonly prescribed Chinese medicinal formulas, and “new use” articles on these two formulas appear in issue #8, 2008 of Xin Zhong Yi (New Chinese Medicine). In the Xiao Yao San article, the diseases treated included insomnia, yang wilting or impotence, constipation, and yin blowing or vaginal flatulence. In the Bu Zhong Yi Qi Tang article, the diseases treated included oligospermia and decreased sperm motility, functional uterine bleeding, and prostatitis. These articles promote the professional Chinese medical methodology of treatment based on pattern discrimination (bian zheng lun zhi) as opposed to treatment based on disease diagnosis, and they exemplify the famous saying, “Different diseases, same treatment.” However, it should be noted that the actual formulas prescribed in such articles are typically modifications of the standard formula in question where the additional ingredients are empirically disease and/or symptom specific. Thus treatment is not solely predicated on pattern discrimination. Rather, treatment is predicated on a combination of pattern and disease/symptoms, with the pattern discrimination being considered the more important of the two.

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