Recommended Books
规培的意义——荐书《从书本到临床》（陈罡、孙轶飞） Asked about books on clinical thinking in Traditional Chinese Medicine (TCM), came across these today and am sharing them.
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Must-Read TCM Books for Winter Break (Third Edition)
1: Practical Programmed General Theory of Pattern Identification and Treatment
Jiangxi University of Traditional Chinese Medicine’s Qihuang National Medical Academy is a leader in cultivating students’ clinical thinking nationally. This book represents decades of its teaching achievements in training many outstanding clinical talents. Features: It systematizes the complex process of clinical thinking training into a procedural, highly operable format, providing detailed introductions on how to collect medical history, how to think, dividing the process into steps, and the idea behind prescribing legislation; it also includes medical cases and thought processes from the academy’s top instructors, useful as models and guides.
2: Methods and Skills of TCM Clinical Prescription
This book introduces the concept of TCM Prescription Science and offers detailed discussions aimed at developing meticulous clinical differentiation and prescription thinking.
TCM Prescription Science and Formula Science are two distinct disciplines. TCM Prescription Science integrates basic theory and clinical “pattern identification and treatment” methods to study prescription thinking as an interdisciplinary field. Formula Science is an independent discipline focused on classifying the composition and indications of formulas by therapeutic methods. Prescription Science encompasses a broad range of disciplines, including various basic sciences and mostly internal medicine clinical disciplines. While Formula Science has connections with other disciplines, its focus is primarily on formula composition and application. Prescription Science is based on Formula Science, which serves as examples and models for clinical prescriptions. Thus, Prescription Science derives from, includes, yet transcends and broadens Formula Science.
This book is divided into three parts: The first part analyzes prescription principles and thinking procedures, proposing six clinical prescription steps—four diagnostic evidences collection, department disease identification, pattern differentiation for cause, treatment planning, establishing therapeutic method, and formula and dosage formulation—while discussing the principles and methods for each step. The second part discusses the basic formulas and herbs every clinician should master, following the principle of simplifying complexity and organizing by basic syndromes, proposing corresponding formulas and medication methods. The third part presents various common clinical differentiation methods and prescription ideas based on ancient and modern practitioners’ clinical practices, supported by case studies, famous doctors’ experiences, and clinical reports, including many prescription skills.
3: TCM Clinical Modular Prescription Method
The author is a disciple of the National Medical Master Lv Jingshan. Over years of clinical and teaching experience, Teacher Wang observed that most doctors do not strictly follow the four key steps of principle, method, formula, and herb when prescribing. Instead, they continuously conduct matching, screening, and overall planning. When determining the therapeutic method, they arrange the prescription not merely by formula-herb sequence but by iterative permutations and combinations of formula modifications, formula roots, and formula root pairings to arrive at the final prescription. This book represents a revolutionary prescription science work. After reading it, learners can overcome hesitation in prescribing by analyzing, screening, synthesizing, matching, and modifying freely, navigating through single herbs, pairs, corner herbs, clustered herbs, formula roots, and formula elements in a complex web, thus greatly advancing their prescription thinking and skills.
Yao Meiling’s “TCM Symptom Differential Diagnosis” General Study Notes (1) — Differences Between Chinese and Western Medicine
Preface: Teacher Yao Meiling states that observation is the source of all knowledge. Without observation, questions cannot arise. Different professional fields observe the world from various categories and perspectives; science simplistically calls this “the study of categorizing and understanding the world.”
Compared to Western medicine, which has billions of researchers and medical personnel worldwide and countless research funds, why can Traditional Chinese Medicine, relying on such a primitive diagnostic and therapeutic approach, achieve consistently astonishing effects? One key factor is that TCM and Western medicine differ in how they observe the human body and diseases. Proudly, TCM has a natural advantage over Western medicine in symptom observation.
The angles, breadth, depth, and precision of disease observation differ between Chinese and Western medicine. Both observe major disease manifestations first; for example, with abdominal pain:
First, Western medicine identifies disease types focusing on abdominal pain; TCM differentiates disease types but further distinguishes pathogenesis and pathology through syndrome differentiation.
Second, in characterizing symptoms, Western medicine considers appendicitis, adnexitis, ovarian cyst torsion, intestinal obstruction, localized ileal abscess from a surgical standpoint; and considers ascariasis, enteritis from an internal medicine angle. Western medicine primarily conducts disease-type differentiation by mastering features first, then differentiating, while TCM uses features both for diagnosis and as disease names, such as abdominal pain, headache, cough, asthma, which Western medicine also uses, e.g., periodic paralysis, hypertension, etc.
Western medicine objectively records all clinical manifestations and disease progression without omission, like all natural sciences. However, recently it has tended to emphasize specific disease classification to focus on the specificity of clinical manifestations tightly linked to diseases. It is unclear if this has caused Western medicine to lose its valuable tradition. Conversely, TCM has retained this comprehensive, systematic, and objective observation and recording of all clinical manifestations and facts related to diseases, notably expanding on Zhang Zhongjing’s work over generations.
In developed Western countries, disease observation still largely preserves the objective observation perspective, recording all clinical manifestations based on inpatient medical records. On this basis, they document what clinical features patients present objectively. This practice remains widespread in the West, but in TCM, the emphasis is on comprehensive observation from TCM’s perspectives of angle, breadth, depth, and precision.
1. Different Angles of Disease Observation Between Chinese and Western Medicine
Let us explore how TCM and Western medicine observe diseases. Although both traditionally conduct comprehensive observation, the four aspects differ in many respects. In clinical history, if a manifestation holds little diagnostic value, Western clinical practitioners and literature gradually minimize its recording.
Example: Pneumonia
For instance, Western medicine emphasizes whether there is cough, dyspnea, sputum, whether the disease was triggered by cold, previous episodes, and treatment and lifestyle history. It also notes comorbidities like hypoxia, orthopnea, heart failure, focusing on pulmonary infections. Detailed physical and chemical examinations such as X-ray or CT scans check for inflammation and shadows, and blood tests assess white blood cell counts to differentiate bacterial from viral infections. Other auxiliary tests target the specific etiology and lesion characteristic of the disease entity. Western medicine does not observe in the way TCM does.
(a) Chills and Sweating
For example, whether the face is yellow, forehead yellow, or red has diagnostic value: yellow and sluggishness often indicates dampness; red face often indicates heat in the lung—diagnostic of pathogenesis. Further questioning about cold aversion reveals that West focuses on fever, whereas TCM pays attention to chills. Cold aversion (chills) signals the presence of cold pathogens—a key to tracing pathogenesis. Western medicine slightly pays attention to chills (aversion to cold) in lobar pneumonia or influenza viral pneumonia but ignores it in other pneumonia types. TCM observes that a portion of chills often relates to exterior cold syndrome, usually treated with exterior-releasing herbs. Importantly, in TCM, whether there is sweating accompanying chills is crucial. If there is fever and chills without sweating, it indicates exterior cold obstruction. Even if the face is red, the sputum is yellow, or temperature exceeds 39–40°C, exterior cold signs persist. Western medicine’s observation of sweating is far less detailed than TCM’s.
Chills without sweating mean exterior cold obstruction. If sweating occurs only on the head or neck, this is recorded only by Zhang Zhongjing, not Western medicine. Sweat confined above the neck or to the upper body and absent on the lower body strongly suggests exterior dampness obstruction. Western medicine does not observe or understand this because it lacks subjective scientific verification.
Exterior dampness obstruction involves phlegm-heat, i.e., wind-damp attacking the lung’s exterior, obstructing the skin and muscle interstices but with internal phlegm-heat, which forces body fluids out causing sweating. Exterior dampness obstructs defensive Qi, impeding its dispersion and closing pores, causing sweat to be limited. The heat forces fluids outward resulting in head-only sweating.
(b) Cough
Western medicine typically ignores this level of observation. For pneumonia coughs, Chinese medicine notes whether the cough is ‘deep and restrained, like coming from a jar’—a heavy, muffled sound. For wind-heat, the cough usually sounds high-pitched and light; for dampness, it is low, thick, and suppressed. Western medicine does not generally observe this.
This includes some subjectivity, as professionally trained doctors observe differently from laypeople. Some young Western-trained doctors may question such symptom relevance if inconsistent with lung shadows or inflammation. Thus, they may stop observing this, not recording cough sounds as muffled in case histories—something TCM doctors routinely do.
(c) Urine
Western medicine mostly disregards detailed urinary habits, only noting total 24-hour output. If the volume is average or above, it is not further considered. In contrast, TCM clinics such as the Yao Hesheng Research Office preliminarily assess urinary habits, focusing not only on total volume but on the volume per urination. Urinary difficulty is characterized by shorter urinations; roughly, adults urinating more than 180 ml per time are considered normal, 120–180 ml subnormal, and less than 120 ml indicates urinary difficulty. Although this absolute cutoff is somewhat simplistic, the general rule applies. The lung, as the upper source of body fluids, when affected by dampness, can cause urinary difficulty. Western medicine does not inquire about cloudy urine either; diagnostic value lies in urinary difficulty with turbidity as a reliable sign of damp-heat syndrome, which Western medicine does not observe.
(d) Warmth of Hands and Feet
West also rarely observes hand and foot warmth. Increasing cases of Taiyin wind-damp exterior syndrome relate to milk consumption and air conditioning use. Children consuming cold drinks accumulate internal dampness, leading to lung infections manifesting as this syndrome, causing warmth in hands and feet. TCM notes this warmth beyond the wrist and ankles as typical, with the body otherwise not febrile—a fact not recorded by Western medicine. It is a common clinical reality often overlooked by Western medicine because their focus is on lung-specific infection-related symptoms and pathogens.
Thus, Western medicine fails to observe many such features because its professional focus centers on specific pathological changes and pathogens related to lung inflammation. This professional training leads to omission of such signs in Western medical schools and literature, whereas TCM training encourages attention to these observations.
The facts remain: examples like yellow face, muffled deep cough (“from a jar”), sticky phlegm, slight increase in sputum, sweating without downward flow, urinary difficulty and turbidity, and warmth in hands and feet all relate to lung exterior and interior dampness. These observations arise from experienced TCM training and clinical practice.
(e) Mechanism of Exterior Dampness Formation
TCM observes the disease state by noting what problems the body has under disease, including pathological and main disease nature. Exterior dampness forms at the body surface, not from external humid air penetrating skin, but from damp formed internally due to cold, heat, bacterial or viral infection, or constitution (body state). A skilled TCM doctor treats disease to eradicate its root and improve the body beyond the pre-disease state by observing and diagnosing body status, pathological changes, and disease tendency from a different perspective than Western medicine. This difference in perspective yields significantly different results in disease understanding and treatment.
(f) Differences in Treatment Between Chinese and Western Medicine
A diagnosis of Taiyin wind-damp exterior syndrome leads to appropriate treatment addressing exterior dampness with formulas like Maxing Yigan Tang, sometimes adding herbs like Huo Xiang, Yu Jin, or Sangju Drink with them. In contrast, using antibiotics, antipyretics, intravenous infusions, physical cooling, sedation, or nasal and throat corticosteroids often aggravates the condition. This results in worsening cough, increased frequency of exacerbations, and lowered immunity due to increasing dampness, eventually progressing to obstructive bronchitis or emphysema. Except for very strong individuals or short-term treatment, generally prolonged hospital stay and medication intensify symptoms.
Many do not know that, per TCM, “cold and raw drinks damage the lungs”; historically, asthma was mostly due to inadequate living conditions, constant cold exposure, and poor clothing. Today, with improved living conditions, asthma prevalence—especially in urban children—has increased dramatically, mainly because of medical treatment practices combined with milk consumption and air conditioning.
Different observation angles lead to significantly different disease understanding and treatment outcomes. Many patients worldwide are trapped by nasal and throat corticosteroids, difficult to resolve with TCM. However, nasal sprays alone are better than injections. This difference in observation angles requires professional training. Without thorough and proper TCM symptom differential diagnosis training, one cannot understand these observations and would be led astray by Western limited observation in respiratory clinics. Ignoring subtle changes like intensifying cough, worsening sputum after nasal spraying, or shortening and turbidity of urination results in losing clinical insight and impairs treatment timing. This leads to treatment delay or deterioration. Notably, exterior dampness patients tend to worsen and relapse more frequently with treatment. This condition has become a primary challenge for colds, bronchitis, pneumonia, and allergic rhinitis.
Western medicine often dismisses observations like warmth of hands and feet or urinary difficulties in pneumonia statistics as lacking value; it views diseases as uniquely distinct entities for specific statistical analysis, ignoring complex multi-factorial pathogenesis. Dissecting diseases purely by specificity excludes recognizing complex overlapping etiologies highlighted in TCM, which acknowledges multiple contributing factors such as wind-cold, wind-damp, their combinations, and phlegm, thus presenting a broader perspective.
2. Differences in Breadth of Disease Observation Between Chinese and Western Medicine
Secondly, TCM and Western medicine differ in the breadth of disease observation, particularly regarding the thoroughness of current illness history. Western medicine mainly classifies diseases by etiology, pathology, and lesion specificity, resulting in exclusive categories. For example, hepatitis B virus excludes other hepatitis viruses, bacteria, alcohol, or schistosomiasis; common cold viral causes exclude bacterial infections and traditional concepts like cold and damp. This exclusivity denies other etiologies’ combined effects alongside specific causes in disease progression. Conversely, TCM often recognizes composite pathogenesis more than single causes, considering multiple overlapping factors, thereby offering a broader observational perspective.
Example: Psoriasis
Recent decades have seen vibrant development of autoimmune theories. Western medicine divides immunity into non-specific, specific, humoral, and cellular immune types, not stratified by layers. TCM divides immune layers.
Taking psoriasis as an example—an autoimmune disease—Western treatment mainly blocks immune mechanisms to prevent progression. TCM differentiates and treats based on Wei Qi (defensive Qi), Ying (nutritive Qi), and Xue (blood) layers, emphasizing their organic connections, requiring observation of disease phenomena at each layer.
A male psoriasis patient we treated exhibited rough skin, scaling, thickening; purplish-red skin; itching; burning sensation; needle-like pricking sensation; and a wiry pulse, indicating that he had nutrient stagnation and heat in the nutrient aspect, but he hardly sweated, with defensive qi failing to disperse and transform, and damp evil stagnating in the defensive aspect. It is evident that he had diseases in both the defensive and nutrient aspects, whose layers differ in depth: the defensive aspect is more superficial, the nutrient aspect deeper. “Qi is the commander of the blood; where qi flows, blood flows”—to some extent, one can say “the defensive is the commander of the nutrient,” because the defensive qi circulates outside the vessels, while the nutrient qi circulates within; the movement of defensive qi promotes nutrient qi movement, and if defensive qi is obstructed, nutrient stagnation results. We diagnosed a Taiyang (Greater Yang) exterior syndrome, with defensive qi blocked by damp evil and wind-heat stagnation in the nutrient aspect. At this point, treatment must address both nutrient and defensive aspects, but the first step is to disperse and unblock defensive qi. We used Ephedra (mahuang), Agastache (huoxiang), Siler (fangfeng) to disperse the defensive and penetrate dampness, adding honeysuckle (yinhua), forsythia (liangqiao), and red peony (chishao) to clear heat and resolve stagnation in the nutrient aspect. Gradually, his skin improved, and the condition ameliorated. However, one day he suddenly developed tinnitus, hearing loss, slight ear pain, and ear discharge. We added Artemisia annua (qinghao), Kuding tea, and Scutellaria baicalensis (huangqin), but these did not stop the rapid progression. Ear pus and bloody discharge occurred, chills and fever alternated, sore throat appeared, followed by deafness and perforation, reflecting the disease entering the qi level, involving the Shaoyang. Looking back to when the diagnosis was Taiyang exterior syndrome, he already had turbid urine. “The bladder and triple burner correspond to the couli and the hair follicles,” where the hair follicles and skin are the bladder’s external manifestations and the couli are the triple burner’s membranes; dampness must have at least affected the membranes and the qi level inside, causing turbid urine, indicating that at that time damp evil was already in the qi level, and now damp turbidity has penetrated to the blood level. The stratification of pathology shows that this autoimmune skin disease involves defensive qi, nutrient qi, and blood; the layered differentiation in TCM is far broader in scope than the single-layer immune-level observation used in Western medicine.
Moreover, TCM does not stop at just stratifying the layers; it also clarifies the organic relationships among them. Whether it is defensive qi invading nutrient qi, qi invading blood, nutrient and defensive qi invading qi and blood, or qi and blood permeating the nutrient and defensive layers—the treatment for pathogenic factors originating internally versus externally differs. It is critical to identify the source of the disease, which depends on keen observation. This observation is far more complex than Western medicine’s single-factor focus on immune-level disorders.
3. Different Depths of Disease Observation between TCM and Western Medicine
The observation depths of TCM and Western medicine differ. From nearly two centuries of Western medical history, its depth of disease observation is generally greater, mainly because of its use of modern scientific tools. Western medicine uses X-rays and CT scans to see the location, size, and nature of lesions inside the body, microscopes to study cellular ultrastructure, and investigates anatomy, pathology, and molecular levels—undoubtedly a huge scientific advancement. TCM sees the essence through the phenomena, which is less deep compared to Western medicine. Therefore, TCM should earnestly learn from Western medicine, especially its diagnostic techniques supported by modern science. Clinically, all laboratory tests and chemical analyses are documented in medical records, as they greatly assist in understanding diseases.
The purpose of observation is to recognize the nature of disease and its patterns of onset and progression. Western medicine reveals deep reasons and critical changes at a fundamental level. However, because it stops at disease classification by type, its observation, though deeper than TCM’s on the surface, remains limited. It does not delve into integrated deep systemic changes in the body but stays on superficial classification, pursuing unilateral, specific depth without multidimensional breadth.
Zhang Zhongjing, by observing many diseases especially after traumatic diseases, realized that disease is a process of change with constantly shifting spatial location and fundamental nature. At this point, TCM’s observation and understanding of disease deepens to the level of zheng (syndrome differentiation). Zheng represents “the specific properties of the disease in the current time segment,” which is more profound and systematic than Western medicine, derived from observation.
Example: Ankylosing Spondylitis
Take ankylosing spondylitis as an example; TCM has very good efficacy for it, yet Western medicine currently regards it as incurable. Western medicine recognizes it as a joint disease, understanding changes at the molecular level and histological changes in joint tissues including synovium and cartilage calcification and fusion—already deeply examined anatomically and etiologically. Is this understanding deep? Yes, but is it deeper than TCM? No. Western medicine is limited by disease classification and assumes all such changes are due to autoimmunity—the effect of immune substances and immunoglobulins on joints causing degeneration. How to block these changes? By suppressing autoimmunity with hormones, most cases improve, but later progressively worsen with increased joint damage, and hormone efficacy declines. Joints become fixed, deformed, motionless, and internal organs are damaged because the disease is seen only at this layer, so all observation and treatment focus there—for example, joint redness, swelling, heat, pain, limited movement, and fever. Is the understanding complete? No; detecting specific antibodies completes the diagnosis at a superficial classification level—a deep but limited understanding along a single line.
(1) Joint Color
How does TCM understand this? TCM asks, “Is your joint hot?” If yes, they also ask, “Is your joint cold?” Such patients often have burning joint pain with aversion to cold, even wrapping themselves in blankets on hot days; the joints are red but feel cold to the touch. Aversion to cold corresponds to cold or damp causation—pursuing the cause of disease. Our ankylosing spondylitis patient from Hong Kong had jet-black or bright red joints, with swelling and severe pain in the right middle finger metacarpophalangeal joint. TCM observes red or black joint color to differentiate whether heat stagnation or blood stasis predominates; whether the condition is heat with blood congealment or cold-damp with blood congealment, completely opposite natures.
(2) Pain Quality
We must ask about pain quality: stabbing, distending, knife-like, or aching. Aching pain often relates to wind and dampness; distending pain to heat and fire; knife-like pain to fire and heat, especially fire; stabbing pain to blood stasis; pain worsened by cold relates to cold; relieved by cold relates to heat. “Do you hurt more during the day or at night?” Some patients have midnight pain. The bone is the external manifestation of the kidney; the process from the kidney exterior to deep inside the kidney relates to midnight pain possibly indicating liver and kidney essence deficiency and cold evil deeply affecting the kidney. This involves probing deeply into pathogenesis. Such patients may be asked about birth history, whether full-term, with congenital insufficiency, or five delayed developmental milestones, deeply exploring congenital liver and kidney insufficiency as the pathological basis of ankylosing spondylitis. If the patient has congenital kidney yin or essence deficiency, or kidney yang deficiency, treatment differs greatly from conventional therapy—this is exploring deeper causes and mechanisms. In other words, TCM holds that ankylosing spondylitis is not caused by a single factor or mechanism but multiple factors and layered mechanisms, including deep reasons. The treatment approach, prognosis, and chance of curing root causes differ accordingly. It cannot be seen as a single-natured disease type. By tracing these deeper reasons and mechanisms, TCM’s observation and understanding of disease is somewhat deeper.
Understanding disease depends on the perspective of observation depth, not merely technical means. Is reaching the molecular level really deep? Western medicine has begun to recognize its problems, subdividing types and grades, finding flaws in its classifications. Zhang Zhongjing earlier recognized that the same disease can have multiple causes—is it the same disease? Medical revolution holds that disease cannot end at classification or subtyping. We must deepen our understanding of disease, using Western medicine’s modern technological tools as aid, but first deepen clinical observation of disease occurrence and progression to collect complete facts, resulting in fuller understanding. Both Chinese and Western medicine have their own depths of observation; however, TCM’s approach is the foundation, and technology is the aid. A clear understanding of disease preconditions is essential, recognizing that disease has simple and complex layers, with proximal and distal causes.
4. Differences in Observation Accuracy between TCM and Western Medicine
Differences exist between TCM and Western medicine in the accuracy—commonly called precision—of disease observation. Accuracy includes correctness and reliability; precision refers to qualitative and quantitative exactness and rigor. The hallmark of accuracy aligns with evidence-based medicine’s gold standard: objectivity reflecting key disease issues. Western medicine, aided by modern science and technology, has made leaps in depth and precision. By contrast, TCM’s technological means lag far behind; the pace, depth, and height of Western medicine’s progress are incomparable to TCM’s. TCM faces large issues in qualitative and quantitative assessment. How does TCM qualitatively define deficiency, excess, cold, and heat? At what temperature is cold evil? Mixed deficiency and excess, or seventy percent deficiency with thirty percent excess? Although some quantifications exist, they are impressionistic and experiential, not fully reliable.
Natural and social sciences require rigorous mathematical calculation. Mathematics underpins theories and conclusions. Ancient Chinese astronomy and geography included mathematics. Mathematical logic links quantitative change to qualitative change. Without numerical data, precise determination is impossible, thus introducing constants, variables, and parameters with error ranges. Although variables exist, quantity measurement is essential. Early reformers described TCM as a form of fuzzy mathematics, which also involves quantification and a range of membership, with strict logical relationships, even if TCM lacks clear orders of magnitude. Introducing mathematics into TCM is difficult but must be done; TCM must adopt mathematics or lose precision. TCM must reinforce qualitative analysis and parallel quantitative study mathematically to achieve breakthrough development.
(1) Example: Headache
TCM surpasses Western medicine in some aspects of accuracy—much more tightly. From shallow to deep, consider headaches as a diagnostic element. To be useful, this element requires precision. Western medicine treats headache as a single symptom. Clinically, experienced doctors know patients often mistake dizziness, lightheadedness, or mild head fullness for headache, though the head isn’t painful. Thus, for symptom observation, one must first differentiate the exact phenomenon precisely: is it dizziness or headache? TCM’s inquiry is more precise than Western medicine’s.
1. Pain Location
Additionally, TCM details pain location more precisely; Western medicine generally lacks such records. Pain in the back of the head mostly relates to Taiyang (greater yang) meridian pain, occasionally Yangming meridian; pain atop the head often reflects Jueyin meridian pain; pain in front or behind the ears tends to be Shaoyang meridian pain; pain over the brow ridges is often Yangming exterior syndrome pain but may also be caused by internal Yangming wind-fire. Numbness and pain in the back of the head is more common in Shaoyang meridian disease, since Shaoyang meridian branches innervate the back of the head. Clinically, Shaoyang wind-damp exterior syndrome is common; its pain is dull and heavy. If dampness is severe, numbness may occur in the back of the head. One must ask during consultation, “When resting your head on the pillow, do you feel as if there’s a layer of cloth between your head and pillow? Is sensation diminished?” The pain is attributed to the Shaoyang meridian because it may extend to the nape, shoulders, and even the forearm, following the Sanjiao meridian of Hand Shaoyang. It may cause unilateral nape stiffness and shoulder pain. The Huangdi Neijing says, “All spasm and stiffness belong to dampness,” and the Sanjiao meridian governs waterways and body fluids; if wind-damp blocks Shaoyang meridian, it causes numbness and pain and unilateral nape stiffness. Notably, unilateral stiffness is more common than bilateral. In terms of location, Taiyang wind-cold causes midline stiffness; Zhang Zhongjing sometimes describes Shaoyang nape stiffness as lateral neck stiffness, as seen in Shang Han Lun No. 99: “After four or five days of cold damage, body heat with aversion to wind, neck stiffness, fullness below ribs, warm hands and feet with thirst, Xiao Chai Hu Tang (Minor Bupleurum Decoction) is indicated.” The addition of “neck” emphasizes stiffness not fully in the back but somewhat lateral and usually unilateral. Heavier damp is more often on the right side, heavier wind and blood stasis on the left.
2. Pain Nature
Recognition of headache includes another fine aspect: the nature of the pain. Dull pain often corresponds to wind; distending pain to heat and fire. If fire is strong, wind-fire surges upward causing severe distending pain; splitting headaches often indicate wind-fire; tight pain relates to cold; heavy pain to dampness; numb pain in the back of the head also often relates to dampness. If dampness causes muscle blockage, tightness and wrapping sensation may also accompany it. Internal injury causes are characterized by pain types such as cramping pain associated with wind, particularly wind established on nutrient stagnation or blood stasis, treated by promoting blood circulation and dispelling wind stagnation. Meridian, skin, muscle, and tendon nutrient qi stagnation can cause cramping pain. Blood stasis involves deficiency and stagnation, a dual concept. Stabbing pain is often due to blood stasis or nutrient stagnation. Empty, hollow pain in the head resembling lack of brain fluid is often due to essence or yin deficiency, which relates to pathogenesis. From the meridian perspective, though Shaoyin meridian does not ascend to the head, the kidney generates marrow, marrow generates bone, and bone generates brain; kidney deficiency resulting in insufficient marrow leads to empty pain in the head. Western medicine lacks such detailed pain nature distinctions; TCM’s precise observations aid diagnosis and differential diagnosis.
Also, headache timing relates to nature: persistent pain often indicates excess pathogenic factors, corporeal pathogenic factors more than formless. “When evil remains, disease is not cured,” a governing principle for pattern differentiation and a key sign of excess syndrome. Deficiency syndrome often presents with intermittent pain, triggered by exertion. Accompanying symptoms include whether headache improves with pressure, attack timing relative to circadian rhythms, which has diagnostic value. For example, a chronic rhinitis patient treated with Xiao Chai Hu Tang presented with pain in the Yangming meridian area, especially in the forehead at around 3–5 p.m. He habitually had nasal congestion, yellow nasal discharge, good appetite, no heavy sweating or thirst, no fever, no stomach pain, or diarrhea. The diagnosis was Yangming exterior syndrome treated with Ge Gen Qin Lian Tang emphasizing kudzu root. After five to six packages of herbs, he recovered. Timing-related pain and rhythm considerations are natural laws. Western medicine lacks this level of detailed observation—TCM is unquestionably more precise.
(2) Example: Autism Spectrum Disorder
Western medicine has finer observational tests than TCM in some respects, such as calf muscle compression tests and McBurney’s point tenderness, which TCM lacks. Western medicine is very meticulous, even palpating liver and spleen more precisely than TCM. However, TCM also has very detailed points. For example, we treated two cases of Burkitt syndrome—a form of autism—which is roughly a developmental abnormality in the brain’s frontal lobe blood supply. Now, Western medicine classifies Burkitt syndrome under autism spectrum disorder according to the American Psychiatric Association’s DSM-5 diagnostic criteria.
How should TCM observe and record psychiatric symptoms? How should we analyze the pathogenesis of their mental abnormalities? TCM is seriously lacking in this regard; I say seriously because undergraduate education is deficient. Existing scattered classical texts on Zang Xiang theory (organ manifestations) are numerous but miscellaneous and unsystematic. This is why I urge everyone to study藏象学说 (Zang Xiang theory) of 精气神 (essence, qi, and spirit), especially “spirit” with its five emotions: shen (mind), hun (ethereal soul), yi (intellect), zhi (will), po (corporeal soul), and the functional interplay of zang organs and emotions. My father’s compilation on Zang Xiang theory discusses these systematically with some conceptual layers. This broadens horizons, but here I can only touch briefly.
Regarding psychological illness, now very fashionable, our upcoming national difficult diseases workshop and our website will upload large amounts of related materials to classrooms and websites. The aims are simple: first, help these children; second, help psychologists understand the intimate interaction of psychology and physiology. Psychology is often studied inversely; we hope all modern medicine shifts to a biopsychosocial model, focusing on psychological effects on the body. However, the body’s effects on psychology are decisive to a great extent but poorly understood. Western medicine stresses psychology’s impact on physiology: anxiety can cause hypertension and coronary artery disease. But how does physiology affect psychology? This is poorly known. Treatments for mental illness mostly involve sedation, which is problematic. Our approach is to follow the body’s momentum. Such mental symptoms represent the body’s self-defense and regulation, like sneezing or coughing—necessary bodily responses. The patient needs to express agitation and release. Administering sedatives opposes the body’s natural direction.
This autistic six-year-old girl was rated a genius in Shenzhen; she had exceptional calculation, fast writing, excellent puzzle skills, and fluency in foreign languages; frequently appeared on TV, always winning first. Her traits: first, ignoring others; second, oppositional behavior; third, agitation and hitting others; fourth, sleepless nights; fifth, tirelessness; sixth, severe suicidal tendencies. Her tongue was dark red with prickles on the tip; thick, greasy yellowish coating. She had red, oozing rashes on the forehead. She did not watch TV or read, spent all day covered in a blanket, lying and sulking in bed, holding a knife threatening parents, jumping while shouting from the 12th-floor balcony: “I want to become an immortal, fly to the Southern Heavenly Gate, jump down,” terrifying her parents. She often sweated profusely, had voracious appetite, and thready, wiry, rapid pulse. She stayed awake for three straight days, with blood-heat attacking the heart, waking her from dreams. After taking Western medicine, the twelve-year-old started developing small enlarged breasts and galactorrhea. Why? Because she had dampness; the breasts are in the path of the Jueyin liver meridian, where stagnation converts to yellow milk. Her condition was mainly liver and pericardium constraint fire and blood-heat, causing severe autism and social withdrawal. When oppositional, “all agitation belongs to fire,” she became homicidal and hostile, blaming her parents for bringing her into the world, and rejected all else due to blood stasis dulling many sensations; praise or scolding elicited uniform opposition. Her preferences and aversions were shaped by her physical state. We treated with Cimicifuga (shengma), Aurantii Fructus (zhike), Coptis (huanglian), scutellaria (huangqin), plus honeysuckle, forsythia, Smilax (tufuling), and Dictamnus (baixianpi), to regulate liver qi upward and downward and invert spleen and stomach function—normally the spleen ascends, the stomach descends, but here yang is reversed, so we lift the stomach and lower the spleen. Now, she is much improved emotionally and calmer. All this owes to TCM’s fine-grained observation and detailed characterization of symptoms and preferences.
5. Exploring the Depth of Disease Understanding through TCM’s Treatment Perspective—‘Following the Momentum’
What deeper understanding does TCM hold? Disease is the process of a struggle between harmful factors and the body. Hundreds of millions of years of biological evolution have endowed all organisms, especially higher species, with mechanisms of disease resistance, immunity, regulation, and repair. When harmful factors invade and damage body organs and tissues causing disease, pay close attention to two things: First, how strong is the body’s fighting power? Second, in what direction does the body expel foreign substances, repair damaged tissues, and regulate function to maintain normal physiology, metabolism, and life? Observe carefully the trend and direction of battle between body and disease. “Momentum” mainly refers to where the body’s effort to overcome disease is focused, its strength, direction, and how vigorous it is. To some extent—and this requires demonstration—TCM pattern diagnosis emphasizes judging the body’s efforts, focus, strength, and trend in fighting or reversing disease. Pattern differentiation asks: what is the body’s contribution, focus, strength, trend? In other words, if harmful factors are seen as the enemy, we must observe how the body expels or eliminates it. Planning treatment must align with the body’s direction.
TCM treatment philosophy centers on “following the momentum.” This momentum is the body’s momentum in fighting disease. When pathogens attack superficially, induce sweating to expel; when pathogens are high, induce vomiting to expel; when pathogens are low, induce diarrhea to exhaust. The body is wise; when the pathogen is above, vomiting is a rejection process; sneezing and coughing also reject pathogens, so treatment follows this trend, using medicines to promote upward dissemination. When lower burner dysfunction causes urinary retention with urgency and frequency as in urinary infection, the body is expelling harmful bacteria; treatment should aid urination aligned with this momentum. When constipation is agitated but stool cannot be passed, such as in dysentery with tenesmus and mucoid or bloody stools, the body seeks to expel pathogens but fails; treatment uses medicines like areca and bitter orange to guide downward elimination, following the body’s direction.
Western medicine differs greatly. Sneezing is suppressed, coughing sedated, vomiting inhibited—this is wrong. In skin diseases, exudation, itching, and scaling represent rejection. TCM follows this external dispersing direction and uses herbs like floating duckweed, honeysuckle, forsythia to dispel wind-damp-heat. Although these may exacerbate eczema or urticaria temporarily, it follows the body’s momentum to discharge foreign pathogenic factors, akin to dispersing measles to clear the body, resulting in healing while herbs disperse the condition. Western treatment of such diseases uses anti-allergy and corticosteroids to suppress autoimmunity, but most patients see chronicity and worsening, with stubborn, recurrent illness, because these block the body’s natural direction. Steroids not only block pathogens but also block the body’s self-healing—this explains widespread dependence on Western medicine, continuous usage with withdrawal symptoms, eventual loss of efficacy, since one cannot oppose natural laws and the body. Meanwhile, health deteriorates and treatment costs impoverish patients, trapping them.
For skin diseases treated here, all must be fully dispersed. Western medicine suppresses allergy and autoimmunity, antiviral, antihypertensive—all often against the body’s momentum—aggravating disease severity and spread. Disease may progress to muscles causing soreness, joint swelling and pain, then cardiac arrhythmias, myocarditis, and kidney damage. Western medicine labels this systemic rheumatic disease; what started as psoriasis may evolve to suspected systemic lupus erythematosus. Thus, following the momentum is crucial: what is the defensive qi’s momentum? Nutrient qi? Qi level? Blood level? What about yin and yang in these layers? Deep layered observation and analysis of the body’s momentum lie within the TCM perspective, which Western medicine almost never performs or recognizes. TCM’s depth of understanding, especially regarding the body’s momentum to reverse disease, far exceeds Western medicine’s. Therefore, studying TCM requires systematic, solid foundation; our observations must be systematic and deep.