Do Not Throw Away the Marrow of Chinese Medicine
Health News reporter Liu Yanling
In recent years, against the broad push to speed the modernization of Chinese medicine, one call has grown ever louder: Chinese herbs must be used in accord with TCM theory. Many TCM specialists hold that countless practice has shown — using Chinese herbs apart from TCM theory, relying only on modern pharmacology, not only undercuts efficacy but, more importantly, causes serious aftermath. Some even say: To use a TCM patent medicine without pattern-discernment is in essence to abolish the medicine and keep the drug — and the end of "abolish medicine, keep drug" is that even the drug cannot be saved. "Without the skin, where will the hair hang?" — that ancient saying fits here.
The most persuasive case is Japan's Xiao Chaihu Decoction affair. In the 1970s, Japan's Tsumura Junten-do made the Shanghan Lun's famous Xiao Chaihu Decoction into granules; at the same time, Japanese Professor Yu Dizi published the report "Tsumura Xiao Chaihu Decoction Granules Are Effective in Treating Chronic Hepatitis." The news caused a great reaction in Japan; lauded as Kampo medicines are very safe, no problem even long-term, Xiao Chaihu Decoction became a bestseller — used not only for hepatitis, but widely for colds, pneumonia, fevers, gastroenteritis, and other common conditions. In a few short years, Tsumura Junten-do became a pharmaceutical company watched throughout Japan and the world, with wealth accumulating to a peak. But after the 1990s, reports of Xiao Chaihu Decoction's adverse reactions broke one after another; the Ministry of Health and Welfare issued notices to physicians and pharmacists warning of interstitial pneumonia from the drug. Statistics show that between 1994 and 1999, 188 cases of interstitial pneumonia arose from its adverse reactions, of whom 22 died. The result: Tsumura Junten-do went bankrupt in 1997; in 2000, its president Tsumura Shō was sentenced to three years. Tsumura Junten-do rose by Xiao Chaihu Decoction and fell by Xiao Chaihu Decoction — and the main cause was knowing only how to use the Chinese drug while ignoring the TCM marrow of pattern-discernment-based prescribing.
Xiao Chaihu Decoction comes from the Shanghan Lun, a classical formula in use for 2,000 years. By TCM theory it is the chief formula for taiyang disease transmitting into shaoyang; the Shanghan Lun expressly notes that whether in cold-damage or miscellaneous disease, all who present with bitter mouth and dry throat, alternating cold-and-heat, fullness in chest and flanks, loss of appetite, restless heart and nausea may use it; conversely, it may not be used. The Japanese scholars who had not truly understood Chinese medicine departed from pattern-discernment treatment and used the herb on the basis of Western disease-name diagnosis; like the blind men touching the elephant, the lucky ones were cured, the unlucky became victims. In China the same is everywhere, and still without adequate attention.
The most representative case is the use of TCM patent medicines without pattern-discernment. National inspections of TCM hospitals have revealed that for patent medicines — already about half of TCM drug volume — non-pattern-based use is rampant; at general hospitals where patent-medicine use even exceeds that of TCM hospitals, many Western and Chinese-Western-integrated physicians prescribe by Western disease-names or symptom descriptions on the package insert, prescribing Chinese drugs entirely by Western thinking — and the resulting adverse reactions are more frequent still. Although the State Administration of TCM long ago included pattern-based use of TCM patent medicines in the national TCM hospital registration-and-evaluation rules, the practice has by no means ceased — not even in TCM hospitals.
In recent years there has been much noise over toxic and adverse reactions of Chinese drugs. In fact, a large share of these are caused by non-pattern-based use. Senior TCM Professor Leng Fangnan says: "The cold-and-fever-clearing granule for the common cold (Ganmao Qingre Chongji) is, by its name, easily taken to be for wind-heat colds, but its actual formula treats wind-cold colds. Use it without pattern-discernment, and so-called 'adverse reactions' appear — in truth the result of erroneous use."
Why must one discern patterns to use Chinese herbs? This comes from the special theory of Chinese medicine. TCM holds that the human being is an organism with self-harmonizing and self-regulating mechanisms, and that this regulating mechanism is the inner basis of recovery. TCM treatment is grounded on the inherent self-healing capacity of the person, using certain therapeutic means to spark and push the organism toward overall coordination, helping the body heal itself. For infectious lesions, for example, TCM chooses formulas in accord with the patient's different reactive state, raising the body's nonspecific immune capacity and relying on its own anti-disease power to clear pathogens and the damage they cause and improve overall symptoms — not, as in Western medicine, killing bacteria directly. Further, TCM holds that every herb has the four qi, five flavors, ascending-descending-floating-sinking, and channel-entering qualities. These are determined by the herbs' action and effect in the human body, the fruit of long experience — precious knowledge not contained in any Pharmacopoeia abroad. Such effect and indication must, through organic compounding with other herbs and use in a person of a specific state, be released and pinned down via the body's self-harmonizing and self-regulating mechanism. The action of a Chinese herb is therefore the result of a synthesis; it cannot be reduced to one chemical component, because the sum of the effects of the components does not equal the integral effect of the herb, and the components stand in no linear correspondence to the herb's effect. Pattern-discernment treatment plays a decisive role throughout — in one phrase, this role is raising effect, reducing toxicity.
Faced with a current all-out Westernization tendency, Deng Tietao, named senior TCM physician and professor at Guangzhou University of Chinese Medicine, has cried out: "Never become foam-TCM!" What is foam-TCM? "Beneath a coat of many colors, the substance of Chinese medicine is already gone." TCM's li-fa-fang-yao (principle, method, formula, drug) is one unbroken chain; its efficacy depends on the level of pattern-discernment treatment. Whether to raise efficacy or to bring out the strengths, the marrow of TCM — pattern-discernment treatment — must not be cast away.
Originally published in Health News, page 1, September 6, 2002