On the Graduated Sequencing of Medication
The human body is subtle and unfathomable, the hardest thing in the world to fathom. Thus, although humanity has lived on earth for millions of years and science and technology have grown magnificent, physicians' understanding of the human body is still only partial, and the number of medical puzzles is beyond counting.
To this day, not only have the countless rare diseases with very few patients found no effective treatment, but even common diseases—hypertension, stroke, cancer, AIDS, diabetes—leave physicians helpless. I have always felt this fact should make practitioners blush with shame. But the opposite is true: doctors are often self-important, dismissive of everything, and boastful.
Not only do shallow Western physicians dismiss TCM as dog excrement; there are also TCM sectarians who, through a one-sided prejudice, believe their own school can cure every disease and all other schools are dog excrement—let alone the quacks who are not even half-full barrels, who talk big while killing countless people. The recklessness of their prescribing is truly chilling. I write this essay as a self-admonition and to share with a few colleagues seeking improvement.
The ancients said: if the internal organs could speak, doctors would look ashen. Even today, with Western diagnostic science so advanced, this saying still holds. To this day, whether the various drugs we physicians apply to patients truly help them remains doubtful. Antibiotics, when they first appeared, saved countless lives; their abuse has likewise harmed countless. Antihypertensives do lower blood pressure, but do they prevent the cardiovascular and cerebrovascular diseases that hypertension brings? That is doubtful. Whether radiotherapy and chemotherapy help cancer patients or harm them is also doubtful.
I venture to hold that in treating major chronic diseases, medication should follow the principle of graduated sequencing. The first choice is the body's own great medicine—self-healing ability. Next, small amounts of drugs with few side effects; then drugs with moderate side effects; only in dire necessity, a small amount of harsh, powerful drugs. But great toxins cure disease by removing six-tenths; once the illness is six or seven parts gone, stop the drugs, following the principle of stop when the disease is reached.
The medical sage Zhang Zhongjing's attitude in using Chengqi Tang can serve as a model. When Zhang Zhongjing hesitated between Da Chengqi Tang and Xiao Chengqi Tang, he first used Xiao Chengqi Tang; if after giving it the patient turned qi (intestinal peristalsis, gurgling, even farting) but did not defecate, he followed up with Da Chengqi Tang—precisely because Da Chengqi Tang is fiercer than Xiao. The great Japanese classical-formula physician Yumoto Kyushin, in treating static-blood patterns, advised physicians first to use the lower-side-effect Xia Yu Xue Tang; if ineffective, then Taohe Chengqi Tang or Dahuang Zhechong Wan; only as a last resort consider the fiercest Xia Yu Xue formula, Didang Tang; and after Didang Tang works, do not continue it but switch to Didang Wan. This cautious, graduated medication shows the true saving-the-world devotion of a great physician—never treating the patient's body or life as a game.
In prescribing, physicians should always remember to protect the patient's own righteous qi. Zhao Wenkui, father of Zhao Shaoqin and a former Qing imperial physician, repeatedly told Zhao Shaoqin that treating disease is like unlocking a lock with a key: one must never use brute force; find the right approach, and a thin iron sheet can open the lock of disease.
TCM treatment stresses that treating disease must seek its root. Disease always has a pathogenic root; once the source is found, the disease can be dealt with at low cost. Today's doctors rely entirely on drugs, using as much highly toxic medicine as possible. Disease has its biases, and drugs have their biases; if a blow misses, the patient acquires new illness or worsens, and the doctor cannot escape responsibility for recklessness. When Confucius fell ill, someone brought him medicine; Confucius politely declined: Qiu does not understand it, and dares not taste it. This shows that as early as the Spring and Autumn period, physicians' overmedication and the casualties it caused were already so frightening that a man like Confucius preferred to endure illness rather than take medicine lightly.
A skilled TCM physician, in treating disease, often supplements medication with non-drug aids such as exercise, qigong, drinking hot congee, and warm covering; avoids drugs when possible; uses local treatment when possible, to avoid unnecessary harm to the liver, kidneys, and other vital organs; and prefers external treatment whenever possible, because external treatment has fewer side effects. A well-informed physician who treats disease cautiously and prescribes in graduated order is most necessary; otherwise, one cannot escape the rebuke of a great thief among the sentient, as the medicine-king Sun Simiao put it.