As practitioners of Chinese medicine we must be able to understand not only pathological factors but etiologies too. For example, a pathology leading to male factor infertility is low sperm count. Many TCM practitioners will automatically render treatment based upon the TCM diagnosis arrived at through the four examinations. This is all well and good and appropriate according the context of our training. There is, however, an inherent problem with this type of diagnosis.
Let’s use a case history for illustrative purposes: A forty-five year old male presents with the main complaint of low sperm count. His constellation of signs and symptoms include mild erectile dysfunction, dribbling urination status-post voiding, he craves salty foods and has tinnitus and low back pain and has a chronic sore knee secondary to unresolved childhood Osgood-Schlatter disease. We may conclude perhaps that there is a dual vacuity of kidney qi and essence, and treat accordingly.
Many practitioners of Chinese medicine would be happy to diagnose this case as I have illustrated above yet their treatments would not yield the desired outcome. Why? Because the etiology of this pathology is manifest as a result of a varicocele of long standing. As a result of this varicocele, qi has stagnated, blood has become static and heat has become trapped in the liver channel locally at the level of the affected testicle.
It is important to note that there are no signs or symptoms in this patient of blood stasis or heat. Not in the tongue and not in the pulse and not in other presenting signs and/or symptoms. This type of presentation is not uncommon. I refer to it as a ‘hidden pathology’.
It is a standard method of operation that one must arrive at a differential diagnosis not matter how confusing the case may be and treat accordingly and if the treatment is ineffective, dig deeper, look more closely, reanalyze and alter the diagnosis and try another approach. This is a clumsy approach and with greater knowledge our system of diagnosis can become more economic and more accurate.
In China, one hundred or five hundred or three thousand years ago, the doctors did not have the distinct advantage that we, as modern day practitioners have. That is, Western medical science. If for example, the modern day TCM doctor did his or her full intake on the above patient and then simply inquired “have you been evaluated by a urologist?” the answer to the riddle would have been instantly revealed if the patient had and come back to your office with a Western diagnosis of vericocele. Thus, as a result of a urological examination we are able to state with certainty that the TCM diagnosis is stagnation and binding of liver qi and stasis of liver blood transforming heat; not kidney vacuity! If the patient had not been worked-up by a urologist we would be treating uselessly. Greater knowledge affords greater treatment options. As the Spanish saying goes: “Saber es poder” or knowledge is power!
What we have at our finger tips today that Chinese practitioners of even fifty years ago were deprived of is the availability of a knowledge-base that can positively affect our diagnoses and our treatment outcomes.
I am not suggesting that there is a direct clinical analogue from a Western medical diagnosis to a TCM pattern differentiation in every case, but frequently, in internal medicine there is.
Let’s say that we have a patient whose main complain is azoospermia. Once again, we treat according to the probable diagnosis of jing-essence vacuity. But if the patient was diagnosed as having Klinefelter's syndrome one could say with confidence that the diagnosis is pre heaven jing-essence vacuity and detriment which, in my opinion, in this case, is untreatable as the pathomechanism is chromosomally derived. So, now we have treated this patient with herbs and acupuncture for six months to no avail. If you treated him for six years, results would not differ. We have taken his money, raised his hopes and proceeded in a way which could negatively impact the reputation of Chinese medicine.
Here is another all too familiar classic story: A thirty-three year old female patient presents at the clinic with the main complaint of primary infertility. She is afraid of Western doctors and really believes in alternative medicine and has heard wonderful things about your skills. In fact, you helped a good friend of hers to become pregnant. So, you treat the patient; and treat her, and treat her some more.
You use many point protocols and many herbal formulas. You supplement the kidneys and boost the spleen. You sooth the liver and nourish the blood. You fail. Why? Because this patient has severe bilateral adhesions on the salpinges secondary to pelvic inflammatory disease. You cannot help this patient to conceive naturally, and your advice at the first interview should have been to visit a Reproductive Endocrinologist and have a full work-up.
Dan Inosanto who was one of Bruce Lee’s martial arts teachers wrote: “Absorb what is useful and discard the rest” I highly recommend that we, as healthcare providers absorb the useful diagnostic data which is presently available to us from Western medical science. Until we do, we will not truly be practitioners of integrated medicine.
Having an understanding of Western medical science will improve our analytic and diagnostic skills and as a result will improve the results of our treatments and as important, help us determine who is treatable and who isn’t.