My Medical Thoughts 3
Symptoms: The Bridge Connecting Diverse Medical Systems
Abstract: This article proposes that clinical symptoms serve as the fundamental communicative interface among different medical traditions, including traditional Chinese medicine, modern Western medicine, and various indigenous healing systems. By examining the historical evolution of medical knowledge, the shared biological basis of human disease, and the operational logic of pattern differentiation in Chinese medicine, the author argues that symptoms constitute the most objective, cross-culturally identifiable, and practically actionable unit of medical cognition. This perspective facilitates the integration of diverse therapeutic approaches and provides a coherent foundation for the development of comprehensive treatment strategies such as the Large-Formula Multi-Target Specialty Therapy.
1. Introduction: The Diversity of Medical Traditions
For contemporary Chinese society, the two most familiar medical paradigms are traditional Chinese medicine (TCM) and Western medicine. However, these represent only a fraction of the world's historical medical heritage. Many civilizations have developed their own indigenous medical systems:
Ayurveda, the classical medicine of India, is regarded by some medical historians as the "mother of medicine" and continues to exert significant influence, including in contemporary Western psychiatric literature.
Persian medicine has maintained a continuous tradition in Iran.
Ancient Egyptian medicine, originating around 3300 BCE and persisting until the Persian invasion in 525 BCE, encompassed surgery, pharmacotherapy, and gynecology. Its knowledge is preserved in documents such as the Edwin Smith Papyrus and the Ebers Papyrus, which describe treatments for cranial trauma and even tumor-like conditions.
Despite this rich diversity, only two ancient medical systems—Ayurveda and TCM—have survived to the present day in active clinical practice. This survival is attributable not merely to historical contingency but to their continued demonstrable efficacy, particularly in areas where modern medicine has limitations.
2. The Common Biological Ground of Human Disease
Despite differences in skin color, language, and ethnicity, human populations share a fundamental genetic homogeneity. Consequently, the diseases affecting different populations are largely similar, although their relative prevalence may vary. Moreover, the common diseases encountered by ancient and modern populations are essentially comparable, albeit with shifting epidemiological profiles:
In antiquity, infectious diseases predominated. Without antibiotics or vaccines, epidemics caused massive mortality and significantly reduced populations.
In the modern era, advances in medicine have curtailed infectious disease burden, while chronic, non-communicable diseases—closely associated with genetics, lifestyle, and aging—have become predominant.
This epidemiological transition does not alter the fact that, at the level of pathophysiology and clinical presentation, human disease remains fundamentally consistent across time and geography.
3. The Prehistoric and Anthropological Perspective
The human species experienced an extended prehistoric period of approximately 4 million years before the advent of written records some 6,000 years ago. By approximately 10,000 years ago, human cognitive capacity had reached levels essentially comparable to modern standards. Since then, while knowledge accumulation has accelerated, the rate of brain evolution has been comparatively slow.
Throughout this vast time span, human ancestors across the globe faced disease challenges similar to ours and sought various therapeutic solutions. These methods are recorded fragmentarily in various texts, some preserved, others lost.
Anthropological studies of contemporary hunter-gatherer societies, such as the !Kung people of the Kalahari Desert in Africa, offer valuable insights into this prehistoric medical heritage. These groups:
Consume over 500 species of insects and animals, along with diverse plant tubers and fruits;
Have an intimate knowledge of their local flora and fauna, including medicinal properties;
Maintain diets low in salt, saturated fats, and refined carbohydrates but rich in unsaturated fats, fiber, vitamins, and minerals;
Lead physically active lives, resulting in low incidence of hypertension, obesity, varicose veins, ulcers, gastroenteritis, and malignancies—conditions common in industrialized societies;
Experience low rates of anxiety and depression, largely due to non-sedentary lifestyles and limited time spent on subsistence activities (typically 1–2 hours daily).
Remarkably, despite the absence of modern medical infrastructure, the proportion of elderly individuals among the !Kung is comparable to that in developed regions. In times of drought—such as the 1964 African famine—while neighboring agricultural Bantu populations suffered food shortages, the !Kung remained unaffected, and the Bantu eventually learned from the !Kung's subsistence strategies to survive.
These observations suggest that our prehistoric ancestors possessed considerable practical medical knowledge. The !Kung, for example, consume centipedes, scorpions, geckos, and lizards—creatures that evoke instinctive fear in modern humans—and have discovered plant juices with anaesthetic properties for hunting, as well as various medicinal substances derived from plants, animals, and minerals.
Similarly, studies of wild wolves have documented their use of puffball fungus for hemostasis—a substance well known in TCM for its blood-stopping properties. If wolves can develop such practical knowledge through experience, it is unreasonable to assume that human ancestors, over 4 million years of evolutionary practice, failed to accumulate comparable therapeutic wisdom. The crops domesticated by our ancestors 10,000 years ago remain staple foods on our tables today. Why, then, should the medicinal substances they discovered be dismissed as "pseudoscience" by some modern observers?
4. Cultural Relativism and the Need for Epistemic Openness
According to anthropological observations, a near-universal human tendency exists: each ethnic group tends to regard its own people as the most superior, its own cultural heritage as the best, and modern populations tend to view themselves as inherently superior to their ancestors. This inclination is understandable, as we directly experience the strengths of our own traditions and witness the tangible progress of modern civilization.
However, this cognitive bias also produces a "leaf-before-the-eye" effect, rendering us blind to the strengths of others and confining us to a narrow, provincial worldview. To advance scientific inquiry, we must transcend cultural chauvinism and adopt a broader perspective, appreciating the distinct contributions of different periods and cultures. Only through such mutual appreciation can effective communication and integration occur, ultimately fostering collective progress.
5. Historical Integration in Chinese Medicine: A Precedent
In this regard, our Chinese ancestors demonstrated remarkable openness. Several commonly used TCM medicinals originated outside China:
Frankincense and myrrh (used for swelling and pain relief) came from Africa;
Dragon's blood (Resina Draconis) came from Southeast Asia;
Various spices of Middle Eastern origin—including nutmeg, storax, clove, long pepper, and cardamom—were introduced to China via the Silk Road.
With the introduction of these aromatics, TCM's therapeutic principles expanded to include the treatment principle of "aromatics transforming dampness." Thus, what we now call "Chinese medicine" was never a purely autochthonous system; it has absorbed influences from ancient Egyptian, Persian, and Indian medicine throughout history. Today, its primary interlocutor is Western medicine—often perceived by some TCM enthusiasts as its greatest antagonist, yet in reality, its most important contemporary partner.
6. Symptoms: The Universal Clinical Bridge
Amidst this diversity of medical systems, there exists a common bridge: clinical symptoms. From its inception, medicine has aimed to alleviate the discomfort and dysfunction manifested by human beings (and, in veterinary contexts, animals). Without these symptoms, medicine would have no raison d'être. Throughout history, humans have exhaustively sought methods to relieve various symptoms, accumulating rich experiential knowledge that constitutes the global medical heritage.
Returning to TCM: the essence of TCM is often summarized as "holism" and "pattern differentiation and treatment" (bian zheng lun zhi). Holism provides a systemic perspective, while pattern differentiation is a concrete diagnostic method built upon symptoms.
The four diagnostic methods (inspection, auscultation/olfaction, inquiry, and palpation) collect the patient's clinical manifestations.
The physician's prescription is based on comprehensive judgment derived from these symptom-related data.
The term zheng (pattern) in pattern differentiation has been rendered ambiguous in much literature; for the purposes of this work, it is explicitly defined as symptoms or symptom clusters.
Symptoms or symptom clusters of a given disease are generally fixed and not arbitrary. Not only do different patients with the same disease present with consistent symptoms, but different animal species also exhibit comparable symptom patterns when afflicted with the same disease. This consistency reflects underlying pathophysiological regularities that are largely invariant.
Of course, individual variation exists, but this variation is generally insufficient to produce fundamental differences in the clinical presentation of the same disease. When multiple diseases coexist (comorbidity), the resulting symptom complex becomes more intricate. Managing such patients requires applying the systems theory advocated by Qian Xuesen—comprehensively evaluating the disease state and formulating integrated therapeutic regimens, which by their nature tend to be large, comprehensive, and multi-targeted.
7. The Diagnostic Utility and Limitation of Symptoms
The key to learning medicine lies in recognizing disease-specific symptoms, and the key to bridging TCM and Western medicine likewise lies in symptoms. While complex, symptoms are fundamentally objective:
Jaundice, vomiting, fever, pain—these are directly observable and do not depend on subjective interpretation.
Such manifestations are consistent across individuals and enable consensual recognition.
However, identical symptoms may arise from multiple distinct diseases. Jaundice, for example, can result from acute hepatitis, cholelithiasis, gallbladder cancer, or pancreatic cancer. Thus, a single symptom can only provide preliminary diagnostic direction; definitive diagnosis requires integration with other symptoms and, where necessary, laboratory and imaging investigations.
8. Explicit and Implicit Symptoms
Symptoms can be categorized as:
Explicit symptoms: Those obtainable through inquiry, physical examination, and patient history.
Implicit symptoms: Those that would be expected in severe disease but remain latent in early-stage, mild cases due to insufficient pathological progression. Physicians should maintain cognitive awareness of these potential manifestations.
Notably, pharmaceuticals effective against explicit symptoms tend to be equally effective against implicit symptoms. For example, early-stage gallbladder cancer may present no observable symptoms, but medications effective against advanced gallbladder cancer are equally effective in early-stage patients.
9. Modern Diagnostics and Early Intervention
The most significant advance of modern medicine lies in its ability, through various instruments, to make accurate diagnoses at early disease stages, thereby gaining therapeutic time. Many patients identified through screening have minimal clinical symptoms.
For such patients, physicians should apply their medical knowledge to anticipate the symptoms that would emerge as the disease progresses. When treating these patients with traditional medicine, we can leverage modern diagnostic tools for early intervention—without waiting for the full clinical picture to unfold.
However, this principle is not absolute. A retired Western-medicine physician with whom I studied recounted that during Japanese encephalitis epidemics, they would initiate treatment immediately upon observing clinical symptoms, rather than waiting for laboratory confirmation—because in many cases, blood tests remained negative for several days after symptoms appeared, and delaying treatment until confirmation proved fatal.
This illustrates the complexity of clinical medicine and the extensive knowledge required of practitioners.
10. Symptoms as the Organizing Principle for Clinical Learning
Clarifying these relationships is essential because it directly affects how we formulate treatment regimens. TCM originated in an era of limited diagnostic technology and later integrated concepts and practices from multiple other traditions. We often praise TCM as "profound and extensive," but its other face is eclecticism and complexity—making it difficult to learn and master.
My personal approach is to regard symptoms as the core and key to learning TCM, focusing on:
The characteristic symptom profile of each disease;
The specific formulas and medicinals that can relieve those symptoms.
Treatment consists of establishing the correspondence between disease, symptoms, and therapeutic interventions. Once this mapping is established, the patient's problem can be addressed. This framework provides clear, structured learning without leading to the confusion of "losing one's way at the crossroads."
1. Traditional Wisdom and Modern Pharmacology: A Pragmatic Reconciliation
For example, ancient practitioners did not know that jaundice arises from cholelithiasis, hepatitis, or malignancy. Yet they discovered that Lysimachia christinae (moneywort), Artemisia capillaris(yinchen), Polygonum cuspidatum (huzhang), and Gardenia jasminoides (zhizi) can treat jaundice, and that Yinchenhao Decoction exerts significant antijaundice effects. Modern pharmacological research has elucidated the mechanisms of some of these agents, while others remain incompletely understood.
Regardless of whether the mechanisms are fully understood, the clinical utility of these agents in relieving symptoms and alleviating suffering is undeniable. The fundamental purpose of medicine is the relief of suffering. If we can achieve this while ensuring safety, efficacy, and economic accessibility—the primary goal of the Large-Formula Multi-Target Specialty Therapy—then we have fulfilled our clinical obligation.
12. The Educational Objective: Cultivating a Mode of Thinking
I recall a lecture by Professor Luo Ziqiang during my study of physiology, in which he remarked: "In a few years, most of what you learn today will be forgotten. But the primary purpose of studying this course is to cultivate a way of thinking—a mode of reasoning grounded in evidence. That is what truly matters."
I find this observation profoundly insightful. The primary objective of this book is not to impart specific formulas or therapeutic protocols, but to inspire readers to adopt a mode of inquiry that probes the essence of medical practice. Only by mastering this approach can we generalize from particular cases and explore therapeutic strategies across a broader range of diseases.