Academician Tong Xiaolin on Treatment Strategies for Chronic Disease
In Chapter 3, "Treatment Strategy," of his work Weixin Yilun, Academician Tong Xiaolin specifically wrote an essay titled "Chronic-Disease Strategy" to explain his approach to treating chronic diseases. In that essay, Academician Tong states: "Chronic disease is like ice frozen three feet thick—no one day's cold; therefore it should be treated slowly. Better to expect improvement in three months than seek a quick result in a day. Modern chronic and geriatric diseases often require slow regulation. The key points of slow regulation are three: first, use ‘surrounding formulas’ that address multiple systems, multiple diseases, and multiple layers; second, in dosage form choose pills, powders, plasters, and pellets; third, adhere to the method and formula and adopt a silkworm-eating strategy."
Academician Tong's words are truly a subtle exposition on treating chronic disease. Having grappled for years with chronic diseases such as cancer and stroke sequelae, I deeply agree. In the past, in my own clinical practice, I have been precisely a practitioner of this treatment principle. Chronic disease cannot be rushed; haste makes waste. If the medication is too heavy, not only will the disease not be cured, but the patient's original qi will be greatly damaged, plunging them into an untreatable state. Therefore, treating chronic disease requires a slow approach: better to see a little effect in three months than to be overeager and recklessly dose.
In concrete treatment, the three points Academician Tong raises are each very apt.
The first point is using "surrounding formulas." What is a surrounding formula? Academician Tong vividly describes it as a "big encirclement" prescription. A surrounding formula is relative to a "refined formula": a refined formula is concise, with focused effect, simple herbs, and strong targeting, but such formulas mostly can only treat certain acute diseases with prominent clinical symptoms and are hard pressed to treat chronic diseases of complex etiology. Chronic disease requires a big-encirclement strategy—choosing complex, large formulas and encircling layer by layer.
Academician Tong points out that a chronic-disease surrounding formula should "target multiple systems, multiple organs, and multiple layers," with medication that is "low-dose, broad-coverage, multi-target, and long-course." This is very similar to the approach I advocate of using large-compound, multi-target, broad-spectrum Chinese medicine against cancer. But such medication also needs priorities; Academician Tong notes that in treating chronic disease one must especially protect the patient's spleen and stomach, for cultivating the spleen and stomach is sharpening the axe without delaying the woodcutting.
The second point is dosage form: choose pills, powders, plasters, and pellets, and avoid long-term use of decoctions. There is a popular misconception that ordinary people often think "taking Chinese medicine" means drinking decoctions. But historically, in treating disease—especially chronic disease—TCM more often used pills, powders, plasters, and pellets. Wan are pill medicines; San are powdered formulas; Gao are plaster formulas; Dan are also a kind of pill.
Pills, powders, plasters, and pellets are not only convenient to take but have fewer side effects than decoctions. This is not to say chronic patients absolutely never use decoctions; in fact, in the early stage of treatment a decoction may be used to feel out the path, and once it works, the effective decoction may be converted into pills, powders, plasters, or pellets for continued use. If, during chronic-disease treatment, the patient develops some unexpected acute illness—say, a cold—a decoction may temporarily solve it. Pills, powders, plasters, and pellets harm the patient's spleen and stomach less and protect their upright qi. Their dosage is smaller, so side effects are not great, safety is much higher, and they are more economical. Some precious medicinal herbs put into a decoction are pure waste; put into pills, powders, plasters, or pellets they become economical and practical.
The third point is to adhere to the method and formula and slowly nibble away. Academician Tong explains "silkworm eating" as: "Though a silkworm's mouth is small, it goes on day and night, gradually nibbling away. The silkworm-eating method does not seek to cover a thousand li in a day, but seeks daily progress." In treating chronic disease, adhering to the method and formula, moving step by step and acting steadily, indeed produces far better results than a quick battle. The course of most chronic diseases is long, and even after improvement they easily recur. Moreover, once chronic disease has taken hold, fighting it to the death greatly consumes the patient's qi and blood; such treatment's fortune or misfortune is hard to predict, and it is hard to say whether it is a blessing or a curse.
In short, physicians treating chronic disease and patients suffering from it should both recognize reality, plan for long-term treatment, and balance effectiveness and safety in medication.