Why Regular Follow-Up and Prescription Adjustment Are Necessary in TCM

Patients seeing Western doctors assume that one disease has one drug, and that taking it faithfully to the end will cure them; they assume TCM works the same way. If treating disease were this simple in TCM, it would be ideal. Unfortunately, it is not: not every disease has a "specific drug." Nor is taking one drug for one disease guaranteed in Western medicine—some drugs relieve symptoms for the first few days but, continued, lose effect and cause serious side effects. Long-term antibiotics cause drug-induced illness, gut flora disruption, and even stubborn fungal vaginitis in women. Long-term targeted therapy or chemotherapy brings drug resistance and serious bodily harm.

In TCM it is even harder for one formula to cover one disease; there is no prescription that works for everyone and lasts to the end. The fundamental aim of TCM medication is to use herbs with a certain bias to correct an imbalanced constitution, and constitution varies from person to person. Thus even patients diagnosed with the same Western disease cannot be treated by the same TCM method.

Chinese herbs are distinguished as cold, hot, warm and cool, and each has its own nature. The body's cold-heat is dynamic: after taking warming herbs for a while, a cold pattern is no longer cold; continuing them goes too far—producing what people call "upper fire." After taking cooling herbs for a while, a hot pattern is no longer hot; continuing them makes the constitution cold, curing one disease and adding another. Seasonal changes in temperature and humidity also naturally regulate the body; when the environment shifts and the prescription does not, side effects outweigh benefit.

Prof. Liu Duzhong once told of a patient who, after two doses of Baihu Tang prescribed by a doctor, felt such good results that he decided follow-up was unnecessary; he went on dispensing twelve more doses of the same formula on his own. When finished, the original illness was gone, but he had developed a new condition from overuse of cold herbs, and had to spend half a year regulating before he recovered.

In TCM this is called "the medicine passing beyond the disease"—i.e., overcorrection. The same thing happens with Western medicine: beyond a certain dose and duration, antibiotics cause irreversible harm; reports of death, disability or birth defects from overuse are common.

Hence in ancient times TCM advocated the principle of "stop when the disease is reached": use herbs just right, never too long. The most important overuse is clinging to one formula for too long. After the main symptoms ease, the doctor should gradually adjust the prescription to the patient's changing condition. Otherwise, although there is momentary effect, treatment easily fails later. A patient who insists on one prescription indefinitely, on his own authority, may likewise cause serious harm.

Some chronic illnesses take a very long time and require years of medication; without regular follow-up and adjustment, cure is difficult. I often meet patients who, once given a prescription, think they can take it forever until cured—only to be disappointed. Others complain to me that, after seeing a certain TCM doctor, the first few doses worked, then stopped, and they blame the doctor for treating wrongly.

This lazy approach and habitual thinking are a gross misunderstanding of TCM. Some patients, to avoid trouble and expense, keep taking one formula on their own; some even recommend it to other patients with the same disease, usually with unhappy results. A few develop severe liver or kidney damage—failing to cure the illness and instead creating tragedy through over-medication, which is deeply regrettable.

Thus, when seeing a TCM doctor, knowing a little of how TCM treats disease is no bad thing.