The Three Main Steps of Pattern Differentiation and Treatment in Chinese Medicine
Pattern differentiation and treatment (bianzheng lunzhi) is the foundational clinical skill of Chinese medicine. It comprises three parts: first, eight-principle pattern differentiation; second, six-channel, triple-burner, defense-qi-nutrient-blood, and zang-fu pattern differentiation; third, formula-pattern and herb-pattern differentiation. The level of one’s pattern differentiation determines the level of a Chinese medicine practitioner’s clinical efficacy. Only by mastering, and applying with ease, the knowledge and skills of each link in Chinese medicine’s “principle, method, formula, and herb” can one have outstanding pattern-differentiation ability.
Chinese medicine differentiation first differentiates the eight principles: exterior, interior, cold, heat, deficiency, excess, yin, and yang. Mr. Shi Jinmo once proposed “ten-principle differentiation,” adding two more principles: qi and blood; this proposal is also quite reasonable. Eight-principle differentiation is the first step; it is when the doctor takes the objective data obtained from the four examinations (inspection, auscultation-olfaction, inquiry, and palpation), analyzes and summarizes them according to basic Chinese medical theory, and thereby recognizes the location and nature of the lesion, its trend of development, and the strength of the patient’s constitution.
According to traditional Chinese medicine, eight-principle differentiation is the foundation for six-channel, triple-burner, defense-qi-nutrient-blood, and zang-fu differentiation; among the eight principles, yin and yang are the governing principles. Exterior, heat, and excess patterns belong to yang; interior, deficiency, and cold patterns belong to yin. Chinese medicine says that in treating disease one must seek its root, and the root lies in yin and yang; so the doctor must first determine which nature the patient’s disease belongs to within eight-principle differentiation.
After completing eight-principle differentiation, the doctor then applies other modes of differentiation to the patient according to detailed circumstances. Six-channel, triple-burner, defense-qi-nutrient-blood, and zang-fu differentiation are the second step. After these two steps, the doctor identifies, according to the patient’s specific symptoms, which formula and herbs the patient is suited to; thus identifying formula-pattern and herb-pattern is the third and most crucial step. Whether a doctor treats disease effectively hinges on using the right formula and herbs.
For example, a patient has a floating pulse, fever, aversion to cold, spasmodic pain of the neck and back, spontaneous sweating, clear long urine, and no thirst. First, from the floating pulse, fever, and aversion to cold we identify an exterior pattern; from clear long urine and absence of thirst we identify a cold pattern. Then, from the symptom of spasmodic pain of the neck and back, we identify it as Taiyang disease among the six-channel diseases. Next, from the combined symptoms we judge it to be the Guizhi Plus Gegen Decoction pattern within Taiyang disease. Having completed such a full process of pattern differentiation and treatment, we can prescribe Guizhi Plus Gegen Decoction for the patient.
Of course, with the progress of the times, Chinese medicine has also developed increasingly sophisticated disease-differentiation-and-treatment capability; today we advocate combining pattern differentiation with disease differentiation. This requires clinicians to master both skills.
For example, a patient has breast cancer and at the same time the above Guizhi Plus Gegen Decoction pattern. In treating this patient, we must take into account the fact of her breast cancer; while prescribing Guizhi Plus Gegen Decoction, we also prescribe formulas and herbs that soften hardness, dissipate nodules, and anticancer and reduce swelling. We must not simply judge from the clinical symptoms that she is the Guizhi Plus Gegen Decoction pattern and use only that formula.
Combining disease differentiation with pattern differentiation can solve the various problems of many patients with complex conditions. Although the patient’s condition is complex, the doctor must have his own judgment, be able to turn complexity into simplicity, and must not complicate the differentiation-and-treatment process by applying all kinds of clinically unproven ideas to the patient. Although Chinese medicine advocates “upholding orthodoxy while using the extraordinary,” upholding orthodoxy is the key. The core issue of medicine is safety and efficacy; what upholding orthodoxy upholds is precisely the safety and efficacy of treating disease in Chinese medicine.