Yesterday, a woman called my office and asked me to tell her about “my program” for a particular problem. This is a common and understandable question in a time when “evidence based medicine” is prevalent, and people expect there to be a proven, standardized approach for their symptoms or illness. While this approach has value and even has a place within Chinese medicine, it can be limiting and may lead to ineffective treatment.
Chinese medicine is characterized by individualized diagnosis and treatment. Programs and protocols are not the standard of care in Chinese medicine. While there may be some component of treatment that is stable for all people – for example, a particular herbal formula – there will be additions, subtractions and modifications that are specific to the individual.
Chinese medicine outlines ten forms of pattern discrimination, or differential diagnosis (differentiating between conditions that share signs and symptoms and appear similar, but have different causes and outcomes). These are diagnoses according to:
- 8 Principles
- Qi, blood and fluids
- Zang fu (organs and bowels)
- Channels and collaterals
- Causation and pathogenic factors
- 5 elements
- 4 levels
- 6 stages
- 3 Burners
- Diseases
The last category above of disease diagnosis, or bian bing (辨病), is equivalent to the disease diagnosis category in Western medicine. According to this category, there are standardized treatment guidelines according to common manifestation of disease symptoms. This presentation is always varied though, and in Chinese medicine the variation leads to personalized treatment.
The Nei Jing states: “one disease many formulas, one formula many diseases.” In Chinese medicine, one disease can be treated with many different formulas, as the individual disease presentation and differential diagnosis may vary. Similarly, many different diseases may present with the same underlying differential diagnosis, and thus be treated with the same formula (the base formula remains the same, but there are personalized modifications).
As examples of this: in the first case of “one disease many formulas,” there may be dozens of formulas that can be further adjusted for individual variation to treat diabetes. In the second case of “one formula many diseases,” diabetes, high blood pressure, high cholesterol, headaches and reflux may all be treated using one formula.
There are no set protocols or programs in Chinese medicine. The notion of generalized, protocol-oriented treatment is antithetical to the premise of Chinese medicine that treatment needs to be specific and individualized to be effective. While there are situations where this is acceptable – such as minor and self-limiting symptoms, for which over-the-counter patent medicines can be used – more difficult or complex situations require more precise treatment.
Chinese medicine excels at precise, effective treatment.