Valuing Formula-Pattern and Herb-Pattern Correspondence Is the Key to Raising TCM Clinical Efficacy
Professor Liu Fangbo believes that the most effective way to raise the clinical efficacy of physicians is to start from "formula-pattern" (fangzheng); I agree with this view. The key to TCM pattern differentiation and treatment is "for this pattern, use this medicine" and "treat according to the pattern"; whichever formula or herb is used, it must correspond to a "pattern."
Using today's medical terminology, TCM pattern differentiation means that there must be an indication for using a certain herb or formula; one decides which formula or herb to use based on the patient's series of clinical manifestations.
The reason TCM especially reveres Zhang Zhongjing's Shanghan Lun (Treatise on Cold Damage) and Jingui Yaolue (Essential Prescriptions from the Golden Cabinet) is that Zhang Zhongjing's works pay special attention to "formula-pattern" and "herb-pattern." The indications for using formulas and herbs are very clear. Once a practitioner has mastered the medication indication for a given formula and encounters such a patient in the clinic, selecting the formula and herb according to the indication often produces immediate results.
Recently a patient came to me for treatment of gastric cancer. Besides the gastric cancer, this patient had several other problems: for years his neck had been stiff, he had intractable urticaria, and he did not sweat much; no doctor had ever been able to resolve these problems for him.
This is recorded in a line in the Shanghan Lun. The "stiff and tight neck and back" described in the Shanghan Lun refers to the patient's rigid neck and back that cannot turn; when this indication appears, one must use the Kudzu root (gegen) series of formulas. This patient did not sweat and belonged to the TCM "excess exterior pattern," requiring ephedra (mahuang). Thus, among the Kudzu-root formulas, he was suited to Kudzu Decoction (Ge Gen Tang), which contains ephedra, rather than Kudzu-plus-Guizhi Decoction; Kudzu-plus-Guizhi Decoction requires the indication of "spontaneous sweating." Once these "formula-pattern" and "herb-pattern" correspondences were grasped, it was clear that this patient was an indication for Kudzu Decoction. I therefore suggested he use Kudzu Decoction to resolve these problems, while also using anti-cancer medicines such as Compound Cantharis Capsules (Fufang Banmao Jiaonang) to prevent recurrence of the gastric cancer.
Although TCM emphasizes "do not use cold and cool medicines in autumn and winter, and do not use acrid-warm medicines in spring and summer," and some doctors insist that ephedra must never be used in summer, TCM has always held that "flexible mechanism and adaptable method reside in the mind." Therefore medication should not be rigidly bound by such old admonitions. The phrase "reside in the mind" is too subjective; I believe one should instead emphasize the objective "formula-pattern" and "herb-pattern." As long as the corresponding formula-pattern and herb-pattern are present, one need not be bound by various rules; when the formula-pattern matches and the right formula is used, the effect is immediate.
When this patient contacted me again after a month of taking the medicine, the neck stiffness and urticaria that had troubled him for years were both resolved. This shows that using Kudzu Decoction was correct for this patient. It should be explained that I did not specifically target his urticaria; because Kudzu Decoction is an exterior-releasing formula, urticaria usually resolves on its own once the exterior pattern is released—something I have seen repeatedly in the clinic. Therefore one only grasps the principal contradiction and is not distracted by secondary contradictions; resolve the principal contradiction, and the secondary contradictions, left alone, resolve themselves. Of course, TCM has a great many exterior-releasing formulas, so urticaria should not all be treated with Kudzu Decoction alone; using only this one formula would certainly yield poor results, and the corresponding formula must be chosen according to the patient's specific indications.
Speaking of Kudzu Decoction, I previously treated a driver with hypertension who also had years of shoulder and neck discomfort, a stiff neck, and little sweating. This patient also matched the formula-pattern of Kudzu Decoction, so I gave it to him. As a result, not only was the neck stiffness resolved, but his hypertension was also completely cured; he has not taken antihypertensive drugs since, and his blood pressure is normal and stable. From the viewpoint of modern pharmacology, the ephedra in Kudzu Decoction raises blood pressure. If, because of this pharmacological effect, we set aside TCM formula-pattern, this patient might not have recovered.
Does TCM have therapeutic effect? TCM certainly does. Although TCM cannot solve every disease problem, it can solve quite a number of them. And the foundation of TCM clinical efficacy lies in formula-pattern and herb-pattern. When I teach my own students, I firmly grasp formula-pattern and herb-pattern, constantly reminding them to memorize a given formula-pattern or herb-pattern, so that they will not fumble when prescribing in the clinic.
Formula-pattern and herb-pattern are even more important than pulse diagnosis. Pulse diagnosis is highly subjective, whereas formula-pattern and herb-pattern are very objective. Once you have grasped formula-pattern and herb-pattern, you do not necessarily have to feel the pulse to treat the patient. The gastric-cancer patient mentioned above, because of the pandemic, simply could not come to me for pulse-taking and face-to-face consultation; I conducted a video consultation over the internet, detailedly learned the patient's various symptoms and signs, then judged him to be an indication for Kudzu Decoction. Using Kudzu Decoction resolved his problem.
This year, many patients have been unable to have face-to-face consultations because of the pandemic. But as long as the inquiry work is done very patiently and carefully, satisfactory clinical results can still be achieved without pulse diagnosis.
Recently another ovarian-cancer patient, referred by an ovarian-cancer patient I have treated for years, insisted on seeing me in person. But because of the pandemic we could not meet; in the end we also adjusted the medication approach through video consultation. After several adjustments, the patient did very well on the medication. In less than a month, the tumor markers began to fall, and the patient was delighted, convinced that TCM anti-cancer treatment does have a certain effect.
This patient had originally planned to use targeted therapy, but because of the special situation this year, she could not get the targeted drug in June and had to wait until July. She therefore decided in June to try the TCM regimen I had given her. It turned out to be effective, so she temporarily abandoned the plan to use targeted therapy.
When this patient first came to me, I also told her frankly that although the patient who had referred her had indeed responded to Chinese medicine, I was not certain that TCM would necessarily work for her—indeed, most of the time TCM anti-cancer treatment is ineffective, but there are also quite a few successes. My ability is humble, and I never dare exaggerate the efficacy of my TCM anti-cancer treatment. But I cannot agree with completely denying the efficacy of TCM anti-cancer treatment, because every month some of my patients achieve marked results.
The principle I uphold is to firmly grasp formula-pattern and herb-pattern. The theory of yin-yang and the five phases is too mysterious to quantify well, but formula-pattern and herb-pattern have objective standards; following these objective standards is more reliable than relying on a doctor's subjective guesswork. Treating according to formula-pattern and herb-pattern, TCM efficacy is reproducible. It is just as with scientific experiments: if they are true, other colleagues can repeat the same results. As long as one grasps TCM formula-pattern and herb-pattern, TCM efficacy is also reproducible. For medicine, the most precious thing is a treatment with reproducible efficacy.
Nowadays many people are full of prejudice against TCM, which has been marginalized. I think this has something to do with TCM's own lack of persuasive evidence. Formula-pattern and herb-pattern are a path by which TCM can become evidence-based; TCM research should put effort into this area.
By the way, personally I am fairly calm about TCM being marginalized. I believe that as time goes by, TCM will become more and more scientific and more and more recognized by patients. The marginalization of TCM is not without benefit: the lower patients' expectations of TCM, the less pressure we have to bear.
Personally, for patients who have the option of Western treatment, I first advise them to try Western treatment. When Western treatment fails, they mostly go to see some famous big-name TCM masters; only after these doctors fail to help do they come to me. Most patients who come to me have rich experience in seeking treatment and can view cancer treatment rationally. If I can solve a problem, I help them solve it; if I cannot, I tell them honestly, and then there is not much resentment.
I think this is quite good; this way I personally bear no great medical-ethical pressure. I do my best to treat these patients who have run out of options; although there are many failures, there are also no few successes. When I occasionally succeed in treating someone, that is not without merit. Why must I compete with others to prove who is better?
Laozi says that the soft overcomes the hard; when a person is born he is soft and supple, and when he dies he is rigid. There is nothing terrible about showing weakness to others. Act without contending, teach without contending, and following nature better accords with the spirit of TCM.
Having studied medicine for a long time, I have come to believe that all things should follow their karmic conditions; this is also why my body and mind have become lighter in recent years. Anything forced is mentally exhausting. Having studied TCM to the end, one must learn to face the world calmly and remain unmoved by storms.
Let us keep our feet on the ground, memorize more formula-patterns and herb-patterns, solve some patients' problems in practice, grasp the fundamental thing of clinical efficacy, and strive to raise our own clinical cure rate with TCM. As time goes by, through word-of-mouth from patients with good results, more and more patients will naturally recognize us and recognize TCM. Why rely on words to defeat anyone?