The Veteran TCM Physician Yin Huihe: Disease-Based Treatment Is Higher Than Pattern Differentiation

The veteran TCM physician Yin Huihe came from a medical family. His father Yin Bingzhong was a famous doctor in Jingjiang, Jiangsu, and a third-generation disciple of Fei Boxiong, founder of the Menghe school of the Jiangnan region.

Yin Huihe studied medicine with his father from childhood and memorized a great deal of the TCM classics. He began treating patients alongside his father while still young, with outstanding clinical results, and was hailed as a 'little famous doctor of Jiangnan' before the age of twenty.

In 1955, at the age of 31, Yin Huihe was selected for the faculty-training class of the Nanjing School of Chinese Medicine; after graduating he stayed on to teach, serving as head of teaching affairs and director of the Jinkui (Synopsis of the Golden Chamber) teaching office. While teaching at the Nanjing School of Chinese Medicine (predecessor of Nanjing University of Chinese Medicine), he edited the textbook Zhongyi Xue Gailun (Introduction to Chinese Medicine). Later, recognized for his exceptional talent, he was designated by the Ministry of Health as a TCM backbone; in 1957 he was ordered to lead a group of TCM talents to the Beijing College of Chinese Medicine (now Beijing University of Chinese Medicine), where he founded and headed the internal-medicine teaching office.

He later took on important leadership roles at the Dongzhimen Hospital and the China-Japan Friendship Hospital, and edited the fifth nationally unified textbook, Zhongyi Jichu Lilun (Basic Theory of Chinese Medicine). In 1983 he published Zhongyi Neike Xinlun (New Treatise on TCM Internal Medicine), a distillation of his years of clinical experience. The book was reprinted many times to meet demand, and a revised edition appeared in 2010.

Yin Huihe was an outsider in the TCM world: his family learning was deep and his personal insights profound and original. He refused to be bound by the old rules and habits of predecessors, arguing that TCM should look forward, not backward, and must not treat the words of the ancients as oracles—dare not change a single character even if they were wrong. He proposed: 'TCM must be bold in reform and daring in innovation if it is to make faster progress.'

'Revering the past and disparaging the present' and 'valuing the ancient and slighting the modern' are deep-rooted traditions in Chinese society. When compiling Gujin Zhongyi Linzheng Jinjian, Shan Shujian noted that after the Han dynasties, Chinese scholars and writers gradually developed a fashion for studying the classics, expounding them, and probing the thought and norms of the ancient sages through them. This fashion greatly influenced TCM, and especially after the Song dynasty it severely constrained the development of medicine.

Pattern-differentiation treatment remains the tradition that TCM even now clings to, and many TCM practitioners revere it as the core of Chinese medicine. But Professor Yin Huihe held that both pattern differentiation and disease-based treatment are ideas valued by TCM and Western medicine alike, yet disease-based treatment is a higher stage than pattern differentiation.

In his most famous paper, Brief Remarks on Moving from Pattern-Differentiation and Disease-Based Treatment to Grasping the Main Symptom, Professor Yin wrote: 'Pattern differentiation is the foundation; disease identification is the direction. They are two stages of cognition. The pattern can only address the phenomenal aspects of disease; only when one recognizes the disease itself has one grasped its essence.'

This was a major breakthrough in how contemporary TCM understands disease. But the innovative school represented by Professor Yin also drew fierce attacks from many TCM devotees. Even today many believe the contemporary academic TCM colleges led Chinese medicine into decline, absorbing too much Western medicine and losing the root of pattern differentiation.

I regard Professor Yin as a senior TCM physician who spoke with a clear conscience. Since I began TCM clinical practice, I have also questioned the value of pattern differentiation. I do not question that it has no value; rather, I question that the TCM world has exaggerated its role, going too far down that road, so that TCM has grown ever more detached from reality and its results ever poorer.

I too have drawn suspicion and criticism; some think that, being trained in science and engineering and overly admiring modern natural science, I cannot learn TCM well, because they believe the soul of TCM is classical Chinese philosophy. With all due immodesty I say that people with a deep grounding in classical Chinese philosophy, like Professor Yin Huihe and myself, are rare in the TCM world. Many TCM practitioners do not read seriously; we have read seriously, and we have long pursued the highest spirit of Chinese philosophy, 'the unity of knowledge and action.'

It is precisely in clinical practice that we discovered the shortcomings of pattern differentiation and therefore pointed to the importance of disease-based treatment. In treating many complex diseases, pattern differentiation can only address some superficial symptoms, not the root problem. As the disease progresses, the patient will ultimately be let down—and lose their life—to pattern differentiation.

Thus in treating major diseases such as cancer, the TCM physician should spend more energy exploring disease-based treatment than pattern differentiation. I must emphasize: I am not saying pattern differentiation is unimportant. It is very important and can do much to relieve symptoms. The reason to focus on disease-based treatment is that pattern differentiation has great shortcomings and cannot solve the patient's root problem. Yet as a clinical TCM physician, if one's foundation in pattern differentiation is too weak, results will also be limited.

My intuitive understanding of disease-based treatment comes not from my study of natural science but from the folk herbal doctors I saw as a child. My father himself treated certain throat disorders without any knowledge of pattern differentiation, yet achieved cure rates of 100%—far beyond what pattern differentiation can reach—and with astonishing speed. Seemingly severe acute throat conditions such as epiglottitis and tonsillitis he could cure overnight with folk herbs.

This left too deep an impression on me. To my shame, I have treated many kinds of disease myself but never achieved a 100% cure rate. I have also read the monographs and case records of many throat-professors treating throat disease; at least in the area my father excelled at, I think their papers and monographs could be burned, because what they explore are slow-acting regimens that never reach 100% success and cost a great deal.

I have long wished to turn my father's empirical formulas for acute throat emergencies into a modern preparation, like Professor Tu Youyou's artemisinin, and spread it. Though I still do not know which component of his herbs was active, it is certain that he relied on no pattern-differentiation theory and used a very simple, single method and medicines, nothing complex.

Professor Tu Youyou's artemisinin also has a 100% effective rate against malaria. This shows that, if we are willing to explore, many diseases can have definitive disease-based medicines found for them. Diseases we cannot yet solve may one day be solved easily, and the solutions should be definite and certain.

In other words, we must eventually overcome the uncertainty of medicine and find definitive solutions to disease. That we cannot yet do so is only because human medicine is still at a low stage; once it reaches a higher stage, we will be able to.

How to advance medicine? It requires us clinicians to keep exploring new ideas in practice, not lingering only in the 'classics.' Classics must be studied and the experience of predecessors inherited and carried forward, but more important is that we progress. If we do not progress but stay in place, the problems we could not solve in the past we still cannot solve today, nor tomorrow.

Pattern differentiation is a relatively elementary system of healing that arose when medicine was in its early stage, lacking a clear understanding of the whole course of disease. It is still effective to a degree, but insufficient for deeper problems. Clinging to pattern differentiation stems from our lack of imagination, innovation, and the spirit to explore forward.

Going forward, we should focus on disease-based treatment to further improve clinical results. As another veteran TCM physician, Professor Zhang Haifeng, put it: in the past we did not understand the nature of kidney disease and mistook the disappearance of edema and other symptoms for a cure. Now, with modern testing, we know the edema may be gone but the urine protein remains high and the kidney disease is not cured. So the patient later did not merely relapse; rather, guided by pattern differentiation, we never actually cured them—we cured only the appearance, not the root problem.

Disease-based treatment requires the doctor to have a clear, scientific understanding of the cause, current state, and future course of the patient's disease, rather than lingering only on the present 'pattern.' Only with such comprehensive understanding, and by continuously seeking root solutions to prevent deterioration, is there hope of solving major-disease problems.

Treating self-limiting diseases like the common cold well is no great feat; the more serious threats we face are stubborn diseases like cancer and diabetes. Moreover, we should aim not merely to cure a few individual cases but to solve the problem thoroughly. These diseases require us to stride forward on the foundation laid by our predecessors.