Thoughts on the Integration of Chinese Medicine & Western Psychi

by Bob Flaws, Dipl. Ac. & C.H., FNAAOM

In the Dec. 1998 issue of Psychiatry & Clinical Neuroscience, Kanba, Yamada, Mizushima, and Asai. describe their use of 120 Chinese herbal formulas for the treatment of various psychiatric disorders. They say that improvement brought about by these formulas is usually mild and slow but may be quite drastic. In addition, they say that side effects due to the use of these formulas are rare. Because of this and the fact that Chinese medicine makes no distinction between psychological and somatic complaints, they think that Chinese herbal medicine is especially useful for the treatment the elderly and/or psychiatric patients with physical complications. Kanba et al. go on to say that, traditionally, these formulas are prescribed on the basis of a Chinese medical pattern discrimination. However, they also say that these formulas may be prescribed on the basis of a modern Western psychiatric diagnosis and that, "Western physicians can select the appropriate preparation without having a special knowledge of Oriental medicine."[1]

Due to the relatively high rate of unwanted side effects and adverse reactions of Western psychiatric drugs, more and more Western psychiatrists are becoming interested in Chinese medical psychiatry. The fact that I was asked to compile Chinese Medical Psychiatry (published by Blue Poppy Press, Jan. 2001) by a board-certified psychiatrist underscores this point. However, I strongly disagree that Chinese herbal formulas can be accurately and effectively prescribed on the basis of a Western psychiatric disease diagnosis alone and "without having a special knowledge of Oriental medicine." As Kanba et al. correctly point out, traditionally, these formulas are prescribed not on the basis of a disease diagnosis (even a traditional Chinese disease diagnosis) but on the basis of each patient’s individual pattern discrimination. It is this prescriptive methodology which makes Chinese medicine the safe, effective, and holistic medicine it is. In order to explain this, let me explain the difference between a Chinese medical pattern and a disease.

Patterns & diseases

A Chinese medical pattern is the sum total of all signs and symptoms gathered by the traditional four examinations - looking, smelling/listening, questioning, and palpation. This stream of information takes into account the patient’s sex, age, bodily constitution, facial complexion, sleep, energy, appetite, defecation, urination, perspiration, menstruation and reproductive history if female, body warmth, thirst, and any other sign observed by the practitioner with their unaided senses and any symptoms reported by the patient. In addition, the practitioner pays special attention to the tongue, its color, shape, moisture, movement, and fur, and their pulse as felt at the styloid process on the radial artery of both wrists. In other words, in discriminating a patient’s personal pattern of disharmony, the Chinese doctor gathers a wide variety of information about the patient’s entire bodymind and their physiological processes.

A disease, whether a traditional Chinese disease category or a modern Western disease diagnosis, is comprised of a much smaller, more narrowly defined group of signs and symptoms. For each disease, there are certain key or core pathognomonic signs and symptoms which define that disease. For instance, one cannot have a headache without having some kind of pain in the head. However, the signs and symptoms which make up a disease are always less in number than the total signs and symptoms of a patient’s Chinese medical pattern. A person with a headache may be old or young, mae or female, thin or obese, strong or weak, hot or cold, have diarrhea or constipation, have a large or no appetite, have a pale or a red tongue, have a vacuous or replete pulse, etc., etc. Thus the relationship between patterns and diseases is the same as that between a forest and its trees. Disease are like trees living within the larger forest of the sum total of gatherable signs and symptoms of the patient. In other words, diseases are the figures that exist within the ground of larger, more inclusive patterns. Therefore, in Chinese medicine, two patients could have exactly the same disease diagnosis and present radically different patterns. While both patients would share a certain core group of signs and symptoms in common, such as pain in the head, they might also have many other different and even diametrically opposite signs and symptoms.

Treatment based on pattern discrimination

One of the fundamental and important statements of methodology in Chinese medicine is, "Same disease, different treatments; different diseases, same treatment." In Chinese medicine, two patients with the same disease presenting different overall patterns receive different treatments. This is because, in professional Chinese medicine, treatment is predicated on the patient’s pattern first and foremost and only secondarily on their disease diagnosis. Conversely, two patients with different disease diagnoses may get essentially the same treatment if their patterns are the same. In the first case, where the patients have the same disease but different patterns, treatment for one pattern might actually make the other patient worse. This is because the modus operandi of Chinese medicine is to bring a person back to balance. If a treatment is strong enough to push a person back to balance if they need it, it also stands to reason that treatment must also be strong enough to push a person out of balance if they don’t need it. In medicine, there is no such thing as a panacea.

Side effects as a result of disease-based prescription

From the Chinese medical point of view, when Western drugs cause unwanted side effects and adverse reactions, it is not because there is anything intrinsically wrong with or bad about the drug itself. It is only that the wrong medicine has been prescribed in the wrong dose to the wrong patient with the wrong pattern. Pattern discrimination is the missing piece which helps explain, and even predict, why some patients with a disease are benefitted by a particular Western drug and other patients with that same disease have an adverse reaction to that same drug. While the drug may have been appropriate to a patient with one pattern of that disease, it was inappropriate for a patient with another pattern of that disease.

As an example of this, most antidepressants, such as Prozac, Elavil, and Zoloft are categorized in Chinese medicine as windy-natured, yang-upbearing medicinals similar to powerful exterior-resolving and qi-rectifying medicinals. While such medicinals upbear clear yang and, therefore, increase a sense of energy and mental alertness and elevate the mood, they also tend to consume or plunder yin. If one looks at many of the side effects of the above-mentioned drugs, one will see that, from the Chinese medical point of view, they typically group themselves around yin vacuity-fire effuglence/yin vacuity-yang hyperactivity symptoms. When one knows this, then these kinds of medicinals should either A) not be administered to patients presenting a yin vacuity pattern; B) be administered in small doses, with care, and for relatively short periods of time in patients with yin, blood, and/or fluid vacuities; or C) be combined with blood-nourishing, yin-enriching medicinals so as to "buffer" or harmonize their action and thus prevent side effects the same way yin-enriching medicinals are commonly combined with exterior-resolving medicinals in Chinese medicinal formulas for the same reason. In other words, the same prescriptive indications and contraindications for potent exterior-resolving, qi-rectifying Chinese medicinals can be applied to these kinds of Western antidepressants. If Western pharmaceuticals were prescribed based on a combination of disease diagnosis and Chinese medical pattern discrimination, I believe that many of Western drugs unwanted side effects and adverse reactions could be avoided. In other words, using this pattern-based prescriptive methodology, I believe that physicians could harness of the power and precision of Western medicines in a safer, more selective, more holistic way.

True vs. false holism & a new model of medicine

It is my experience that, when Western physicians are attracted to so-called holistic medicine, they often first try to prescribe "natural" remedies based on their usual disease-based prescriptive methodology, and this is itself only natural. We all tend to do what we are used to. It is the path of least resistance, the known, the comfortable, the standard operating procedure. However, prescribing Chinese medicinals on the basis of a Western disease diagnosis is not holistic medicine since disease-based prescription only takes into account a small slice of the sum total of the patient’s signs and symptoms. While some people have a naïve assumption that "natural" remedies are better than synthetic drugs, it is the prescriptive methodology which makes a treatment holistic, not its source.

Therefore, I very much disagree with Kanba et al. that Chinese herbal formulas may be prescribed to psychiatric patients on the basis of a Western psychiatric diagnosis and with little, if any, knowledge of Chinese medicine. To me, this is like exchanging a bowl of porridge for a king’s crown. It is not the herbs or even the formulas of Chinese medicine which are its most precious and potent possessions. It is our prescriptive methodology. It is the basing of treatment on each individual’s pattern discrimination which is what makes professional Chinese medical treatment holistic. It is this methodology which insures that the right person gets just the right treatment in the right dose. This is what makes our treatments safe and effective, because they take into account the patient’s whole situation, not just their disease diagnosis. I believe that prescribing Elavil, Paxil, Zoloft, or Prozac based on this methodology is just as holistic as prescribing Ginseng or Dang Gui. In fact, I believe that it is this system of pattern discrimination which is the single most precious gift Chinese medicine has to offer the world. If Western MDs were to adopt this pattern-based prescriptive methodology, it would truly revolutionize the practice of medicine. This would be a radical systemic transformation and not just the adoption of so-called natural remedies.

However, one cannot practice this kind of personalized pattern-based treatment without learning Chinese medicine at a relatively high degree of proficiency. It takes years of study and practice to really master this prescriptive methodology - at least as many years as to learn modern Western medicine. As the famous, now retired Chinese doctor, John Shen, once said, "Western medicine is hard to study but easy to practice; Chinese medicine is easy to study but hard to practice." Therefore, I believe that Kanba et al. are not only wrong that the prescription of Chinese herbal formulas for the treatment of Western psychiatric diseases does not require any special knowledge of Oriental medicine but also obscure what I believe is the single greatest gift of Chinese medicine to humanity - treatment based pattern discrimination, i.e., safe and effective, truly holistic treatment - what could be the foundation of a New World Medicine.

Copyright © Blue Poppy Press, 2000. All rights reserved. 

For more thoughts on the integration of Chinese medicine and Western psychiatry, see Book 1, Chapter 8 of Bob Flaws & James Lake’s Chinese Medical Psychiatry available from Blue Poppy Press in Jan. 2001. Bob Flaws is a world-renowned practitioner of Chinese medicine with over 20 years clinical experience. James Lake, MD, is a board-certified psychiatrist.