(cont'd)

Syndrome differentiation: treatment based on this is the distinguishing feature of TCM, and represents the application of the theory into clinical practice. It is also the manifestation of the philosophy of dialectic materialism. Syndrome differentiation refers to analyzing and summarizing the relevant information gathered from the four primary diagnostic methods: inspection, auscultation (listening to bodily sounds), olfaction (smelling), interrogation (what the client tells us), feeling pulses, and palpation (touching). All of these are non-invasive and do not require lab testing to have effectiveness. Another distinguishing method in diagnosis in TCM is tongue inspection. The reason is that your body's physical state, whether it is too hot, too cold, too dry, too damp, malnourished, retaining too much water, is suffering from poor circulation, etc., is all reflected in the tongue. There are approximately 700 types of tongue appearances that can be looked at in TCM in order serve as one effective method of knowing what is happening in the body. Each tongue can also be explained using western science for why it looks the way it does. Some western medicine diseases look at the tongue, such as in rheumatic fever where the tongue appears bright red, but it is not used as a primary diagnostic technique.

Other sub-sets of the syndrome differentiation philosophy are:

(I) The body as an organic whole: the body has many different parts but they are all related, connected, and integrated with each other in physiology and pathology. It is therefore not possible in TCM to isolate one part of the body for diagnosis and treatment while ignoring the activities and functions of the others.

(II) Each organ has a partner (traditionally called the husband-wife pair, or an internal-external pair) and the functions of one directly affect the functions of the others. The pairs are: liver and gallbladder, kidney and bladder, heart and small intestine, stomach and spleen*, lung and large intestine. So for example, the early signs of an oncoming pneumonia will be diarrhea because the lungs and large intestine are connected; digestive problems in the small intestine can branch out to the heart causing bodily pain, etc. The relationships are complex and I won't have time to talk about them all here.

* PLEASE NOTE: There was a translation problem many years ago and the Chinese word 脾 got translated as spleen, but it is actually the pancreas. So in TCM when we say "spleen" it actually means "pancreas", the organ responsible for insulin and digestive enzyme production.

(III) The principle basis of TCM diagnosis is that internal change must exhibit external manifestations, and in seeing these external manifestations we will know how to identify the syndromes and in turn the disease.

(IV) The human world and the natural world are united. Not only is a body itself organic and whole, but one's body and the natural world demonstrate the integral relationship of unity of opposites. This means that things like the seasons, the climate zone you live in, your pace of life, the foods you eat, the people you associate with, the activities you engage in, and all other external factors are related to what happens inside of your body.

You may be wondering how TCM arrived at these conclusions about the body, such as the organ relationships. The answer is time and astute observation. In ancient times, traditional knowledge was mostly gathered and accumulated in family lineages. Each family knew a piece of the puzzle about the human body as well as remedies and techniques for treating it, but these were closely guarded. There wasn't a unified body of work until the first century BCE when the Yellow Emperor's Classic (黄帝内经） was created under the Yellow Emperor. It contained the most accurate model to date of the human body, the energy pathways within it, and a base of a few hundred herbs and acupoints for treating the body. Most now believe that this was not the work of one man but a large group of doctors over the course of many decades, but nonetheless it constituted the first major work in TCM history. Over the next 1500 years, people began to test the theories found in the Yellow Emperor's Classic through clinical trials and observations.

Many people make the error of comparing TCM to folk herbal medicine and ethnobotany. It is true that TCM holds its roots in those areas because without the knowledge of local, traditional practitioners and family lineages, it would have taken far, far longer to evaluate the use of herbs for different illnesses; however, the distinguishing factor between folk medicine and TCM is a complete diagnostic system of examining the body, including anatomy, physiology, pathology, treatment, and complex, standardized procedures. All of these pre-date the rise of the school of rationality in Europe and clinical empiricism.

Like most traditional based medicines, results and benefits are based on inductive reasoning. This means that if 1,000 people use herb X to treat disease Y, and 9,500 people recover, then the herb must work. Over time, clinicians would observe closely any other effects that the herbs have other than the known ones, including the most subtle variations. The microbiological interactions of the herb on a chemical level are not important. Despite this fact, TCM developed its own methods of describing the actions of herbs based on their observations, and now many of them reside in trusted materia medica that describe both the use of single herbs, and formulas that combine herbs. (I will describe this more later.)

Western medicine uses deductive reasoning and empiricism to arrive at the validity of medicines. So for example, even if herb X cures 9,500 people and western medicine acknowledges, inductively, that it may hold curative value, it will not achieve widespread clinical use until the fine details of the nature of the herb are known down to the molecular level, including interactions with the body. It is for this reason that western medicine and herbalism in general are at odds right now, because one demands deductive reasoning as its gold standard while the other has relied on time, traditional knowledge, trial and error, and keen observation to accept the benefits. Also, there are discrepancies in the described dangers. In the herbs that western medicine has already tested, it has done so by extracting what it considers to be the active ingredient, concentrating it, and then using that concentrate on lab animals to look for side effects. If there are any adverse reactions, the herb is labeled as dangerous and may be taken off the shelf. The problem with this approach is that no herb in nature exists as a concentrate, but rather the whole plant which contains far smaller amounts of the 'key ingredient' among other substances in the plant that moderate and balance its activation that we don't know about. Our environment was designed to provide us with the perfect levels of medicine in dosages that are generally not dangerous. Not to mention, humans are not rats. :)