My Medical Philosophy: Symptoms Are the Bridge Between Medical Traditions

For Chinese people today, the two most familiar medical systems are TCM and Western medicine. In fact, many peoples once had their own traditional medicine; India's classical Ayurveda is even called the mother of medicine, and its influence is considerable.

Iran has a Persian medical tradition, and ancient Egypt likewise developed its own system. Ancient Egyptian medicine originated around the 33rd century BCE and lasted until the Persian invasion in 525 BCE. It included branches such as surgery, pharmacotherapy, and gynecology. Its medical literature was recorded in the Edwin Smith Papyrus, the Ebers Papyrus, and other documents. Ancient Egypt dealt with traumatic brain injuries, and Egyptian physicians could even diagnose and attempt to treat tumors.

Yet among the ancient medical systems, only Indian Ayurveda and Chinese TCM have survived to the present. Many factors are involved, but the key is that both still offer real efficacy, and in many diseases their results compensate for gaps in modern medicine. Today's Western psychiatric literature even draws heavily on ancient Indian medicine.

Although humans differ in skin color, language, and race, the peoples living on this planet are genetically much the same, and the diseases we get are broadly similar. Different groups merely have slightly different incidence rates for different diseases. The common diseases of ancient and modern people are also basically the same; only the dominant diseases in the spectrum have shifted across eras.

In ancient times, infectious diseases predominated. Without antibiotics or vaccines, devastating epidemics swept through humanity with terrifying mortality, each sharply reducing population. In modern times, as medicine has advanced, the harm from infectious diseases has shrunk and life expectancy has risen; chronic diseases tied to genetics, lifestyle, and age now dominate the disease spectrum.

Before written records, humanity went through a long prehistory of roughly four million years. Writing emerged only about 6,000 years ago. The ancient medicines of various peoples that we discuss today all refer to the period after written records.

But as early as about 10,000 years ago, our ancestors had intellectually reached essentially the same level as modern humans. Since then, although knowledge has accumulated, the speed of evolution of our brains has not kept pace.

For at least the past ten thousand years, the peoples spread across the globe have faced the same kinds of disease problems we do today and have tried all sorts of cures. These remedies are scattered across many texts; some have been lost, others survive.

Archaeologists find that humans entered agricultural societies gradually between roughly 8000 and 4000 BCE. Before then, most people worldwide lived by hunting and gathering. Until modern times, desert regions of Africa and other areas unsuited to farming still survived by hunting and gathering.

The food sources of these tribal peoples were far more varied than ours. Anthropologists have found, for instance, that the !Kung people of the Kalahari Desert know far more than modern urbanites about the properties and uses of local plants and animals. They eat over 500 species of insects and animals, plus various plant tubers and fruits. These foods are low in salt, saturated fat, and carbohydrates, yet rich in polyunsaturated fats, rough fiber, vitamins, and minerals.

Add to this their nomadic, highly active lifestyle, and they rarely suffer from the diseases common in industrial societies: hypertension, obesity, varicose veins, ulcers, gastroenteritis, and malignancies.

The !Kung spend only one or two hours a day foraging; the rest of the time they are at leisure, and they are spared the anxiety and depression common in modern society.

So despite lacking doctors and drugs and being mocked as backward by modern people, the proportion of long-lived individuals among them is comparable to that in medically advanced modern nations.

Even their survival skills far exceed ours. In 1964, drought caused crop failure in Africa; the Bantu peoples nearby, who relied on farming, faced food shortage, while the !Kung had enough to eat and wear. The Bantu later survived the great famine by adopting the !Kung way of life.

Watching the !Kung, we see our ancestors reflected. The !Kung eat centipedes, scorpions, geckos, and lizards, which instinctively frighten us today. They found that certain plant juices, smeared on arrowheads, could anesthetize prey during the hunt, and they discovered that certain plants, animals, and even minerals could treat disease.

Not only these tribal peoples made such discoveries. Ms. Li Weiyi, who studied wild wolf packs and wrote the book Returning to the Wolf Pack, observed that wolves use puffballs to stop bleeding. The puffball fungus is no stranger to TCM—it is a common Chinese herb with hemostatic properties.

Could our ancestors, over four million years of living practice, have been less perceptive than wolves? The crops they domesticated ten thousand years ago remain the staple foods on our tables today. Why should the natural remedies and methods they discovered be dismissed as pseudoscience by modern people who fancy themselves superior?

According to anthropologists, most peoples on Earth share a basic bias: each believes its own people are the finest, and each believes its own cultural heritage is the best. Modern people instinctively feel themselves superior to the ancients.

This is understandable: we see the strengths of our own traditional culture and the real advances of modern civilization. But it also produces the effect of "a leaf before the eye blocking out Mount Tai," narrowing our cognition and leaving us sitting in a well watching the sky, blind to the strengths of others.

To study science, we must rise above cultural chauvinism and stand at a higher vantage point to appreciate the different cultures of different eras and peoples. Only thus can different ages and peoples communicate and blend effectively, making common progress in the process.

This is especially true in medicine. Our Chinese ancestors were actually quite open-minded in this regard. Two common TCM anti-swelling and pain-relieving herbs, Ruxiang (Olibanum) and Moyao (Myrrh), come from Africa; Xuejie (Sanguis Draconis) comes from Southeast Asia. Many spices originally from the Middle East—roudoukou (Nutmeg), Suhexiang (Styrax), dingxiang (Clove), bibo (Long Pepper), sharen (Amomum)—also entered China along the Silk Road. With these spices, TCM even added the therapeutic principle of "aromatics transforming dampness."

Strictly speaking, the TCM we talk about was never purely Chinese; in ancient times it already blended with ancient Egyptian, Persian, and Indian medicine. Today, TCM's main counterpart—and the great rival in many TCM fans' eyes—is Western medicine.

All the world's medicines—traditional and modern, Chinese and Western—share a common bridge: the clinical symptoms caused by disease. Medicine was born to relieve the discomfort felt by humans and animals. Without those uncomfortable symptoms, medicine would have no reason to exist. Humanity has exhausted every possibility to find ways to relieve symptoms, accumulating rich experience that has grown into the forest of world medicine.

Returning to TCM: we often say its essence lies in "holism" and "pattern differentiation and treatment" (bianzheng lunzhi). Holism is a systemic way of seeing, while pattern differentiation is a concrete diagnostic and therapeutic method built on symptoms.

TCM's four examinations gather the patient's clinical manifestations; the physician prescribes based on the information gathered through inspection, listening/smelling, inquiry, and palpation to judge how to use herbs. Over the years, the concept of zheng (syndrome/pattern) in "pattern differentiation" has become muddled. In this book I define it clearly as symptoms or symptom clusters.

The symptoms or symptom clusters of a given disease are generally fixed, not arbitrary. Not only do different people with the same disease show basically the same symptoms; even different animals with the same disease show basically the same symptoms. This is because diseases have internal regularities and produce similar pathological reactions.

Of course, there is individual variation between people, but this variation is not enough to produce fundamentally different clinical symptoms for the same disease. When one disease overlaps another, various accompanying symptoms may appear. Many patients have multiple diseases mixed together, making their symptoms even more complex.

Diagnosing and treating such patients requires the systems-thinking approach advocated by Mr. Qian Xuesen—comprehensively assessing the patient's condition and designing a combined medication plan. Such a plan is necessarily large, comprehensive, and complex; by its nature it should be large-formula and multi-target.

I stress again: the key to studying medicine is recognizing the symptoms of various diseases. The key to bridging Chinese and Western medicine also lies in the word "symptoms." Symptoms are complex but objective. When a patient develops jaundice, what we observe is unmistakable; when a patient vomits, what we observe is equally unmistakable. These do not change with subjective opinion, are not easily mistaken, and allow shared understanding across people.

But the same symptom can be the shared presentation of many diseases. Jaundice may signal acute hepatitis, gallstones, or even gallbladder or pancreatic cancer. A single symptom therefore gives only a preliminary judgment; to diagnose what disease a patient actually has, we must combine other symptoms and often rely on various examinations.

Symptoms also divide into overt and covert. Overt symptoms are gathered through inquiry, examination, and the patient's complaint; covert symptoms are those a disease should manifest when severe, but which have not yet appeared because the patient is early and mild. The physician must keep this in mind.

Drugs effective against overt symptoms are usually equally effective against covert ones. Early gallbladder cancer shows almost no observable symptoms, yet a drug that treats gallbladder cancer works just as well for early as for advanced disease.

Modern medicine's greatest advance is the ability to make accurate diagnoses with instruments at the early stages of disease, buying time for treatment. That is why many early- or mid-stage patients we screen show few clinical symptoms.

For such patients, the physician must use medical knowledge to predict what symptoms will appear as the disease progresses. When we treat them with traditional medicine, we can use modern diagnostic tools to intervene early.

Of course, the above is not absolute. I once studied a little Western clinical medicine under a retired physician. She told me that during Japanese encephalitis outbreaks, when they saw patients showing symptoms, they started treatment immediately rather than waiting for bloodwork to confirm. Because many JE patients show symptoms before blood tests can detect anything; by the time the lab confirms it, treatment is too late.

That is why medicine is hard and why clinicians have so much to learn.

Clarifying these relationships matters because they directly affect how we compose prescriptions. TCM originated in antiquity, before advanced diagnostics, and absorbed the ideas and methods of many peoples. We often say TCM is broad and profound; its flip side is that it is heterogeneous and tangled, hard to untangle. That makes it hard to learn and hard to master clinically.

My own experience is to treat symptoms as the core of learning TCM: focus on learning and memorizing what clinical symptoms each disease produces, which formulas and herbs relieve which symptoms. Treating disease is seeking this one-to-one correspondence between formulas, herbs, and symptoms. Find that correspondence and you solve the patient's problem. Studying this way brings clarity rather than the confusion of losing one's way.

For example, in ancient times our ancestors did not know that jaundice was caused by gallstones, gallbladder cancer, or hepatitis, but they discovered that herbs like Jinqiancao (Lysimachia), Yinchen (Artemisia capillaris), Huzhang (Polygonum cuspidatum), and Zhizi (Gardenia) treated jaundice, and that Yinchenhao Tang (Artemisia Annua Decoction) worked well. Today, when we study these herbs with modern pharmacology, we can work out the mechanism of some but not others. But whether or not the mechanism is understood does not prevent us from using them to relieve symptoms and suffering. Is not the purpose of medicine to relieve suffering?

If, in the process, we also ensure safety, efficacy, and economy, that is even better. That is the main motivation behind advocating the TCM large-formula multi-target special therapy.

When I took the Western-medicine physiology course, I listened to Professor Luo Ziqiang's online lectures. He said that before long, the students would have forgotten most of what they learned in class. But the main purpose of the course is to cultivate a way of thinking—a way of thinking that speaks with evidence. That is what matters most.

I think Professor Luo's words are excellent. The main purpose of this book is not to teach readers the action of one or a few specific formulas. What I most hope is that readers will learn from my writing a way of thinking that probes the essence of medicine. Only then can we extrapolate, exploring treatments for other diseases in broader domains.