Today, I would like to take some time to discuss the differentiation methods and clinical applications of the “Essentials of the Golden Cabinet”. This topic, “Differentiation Methods in the Essentials of the Golden Cabinet”, is proposed in conjunction with the research on differentiation and treatment methods by some renowned TCM experts and my personal experiences. Why choose this topic? First, because the emphasis on classical works in teaching at TCM colleges across the country has significantly declined compared to the past. Recently, I wrote a book titled “Differentiation Methods and Clinical Applications of the Golden Cabinet”, published by the People’s Health Publishing House. Mr. Deng provided a preface, stating that many places do not value classical works. In fact, classical works are the foundation of clinical practice and essential reading for clinicians. However, many young practitioners, after reading the classics, do not know how to apply them, leading to a decline in differentiation abilities and treatment levels in clinical practice. Therefore, I believe that there is now more emphasis on developing new approaches in TCM while less on inheritance. As a result, many graduates do not understand how to use TCM principles, methods, and prescriptions for differentiation and treatment. They often think about how to conduct examinations, diagnose diseases according to Western medicine, and then prescribe based on relevant data, which is fundamentally a Western medical mindset. Consequently, they fail to achieve effective results when using TCM. I believe the key issue lies in the inadequate mastery of TCM differentiation and treatment, as they are thinking in terms of Western medical theories, which leads to ineffective clinical practice. Inaccurate and careless differentiation, solely considering Western medical theories, such as using clearing heat and detoxifying methods for inflammation, or using invigorating blood circulation for cardiovascular diseases and angina, I believe that eight out of ten cases will fail using these theories to guide TCM prescriptions.Recently, some have proposed abolishing TCM. Last night, I watched a debate on Phoenix TV regarding pseudoscience. One well-known scientist claimed that TCM theories, especially the theories of Yin-Yang and the Five Elements, are absurd, questioning the relationship between a person and the Five Elements. Many people immediately rebutted him, including a renowned TCM physician, who stated that his question indicates a lack of understanding of TCM or a superficial understanding. Such thinking is the lowest level of cognition. Even if you are a scientist, if you do not understand TCM, how can you claim that TCM theories are unscientific? Recently, some individuals have been clamoring to abolish TCM. I wonder why they want to abolish it? The main issue is their lack of understanding of TCM theories, its current state, history, and how many patients TCM has successfully treated throughout history. More importantly, this elder may have self-studied TCM for a few years, but when treating patients, he may have relied on textbooks, finding that treatments for Zhang San, Li Si, and Wang Liu were ineffective, leading to frustration and criticism of TCM. In fact, he has not even entered the door and does not understand the essence of TCM—the importance of differentiation and treatment. Therefore, when he fails to achieve results, he criticizes TCM. Why not reflect on himself? Is it his inadequacy as a physician or TCM’s failure? Of course, TCM cannot cure all diseases; it has its shortcomings, but does Western medicine not have its limitations? Western medicine also has many diseases it cannot treat. Since Western medicine is deemed scientific, why are there still so many diseases that remain untreated? This indicates that there are also problems and shortcomings within Western medicine. Therefore, one cannot hold TCM to an impossible standard.As a TCM practitioner, especially one who has studied classical works, it is essential to master the methods of differentiation and treatment. Classical works are the foundation of differentiation and treatment, and every clause within them addresses key points of differentiation, making them essential reading for clinical practice. The classics of TCM are the roots and trunk of a tree, while modern internal medicine is the branches and leaves. There is also a misguided trend that believes internal medicine can encompass everything, rendering classical works unnecessary. I believe this is incorrect. Therefore, I chose this topic primarily to discuss how to differentiate in the “Essentials of the Golden Cabinet”. I believe that to achieve therapeutic efficacy in clinical practice, the most important factor is accurate differentiation. To achieve accurate differentiation, one must be meticulous and detailed. These classical works provide us with excellent clinical differentiation methods. To effectively utilize classical works, one must start with differentiation. Studying classical works is not merely about using their prescriptions; more importantly, it is about learning their differentiation methods and theories. Only with accurate clinical differentiation can we apply classical prescriptions effectively. Those who have studied the “Essentials of the Golden Cabinet” know that it exemplifies the use of a holistic view and the theories of organs and meridians to differentiate and treat various internal diseases, as well as some surgical and gynecological conditions. This point is well understood. Therefore, after learning the “Essentials of the Golden Cabinet”, to apply it clinically, the most important thing is to know how to differentiate and master the methods of differentiation and treatment, which is a crucial condition for improving clinical abilities.When it comes to differentiation, I mainly want to share my experiences in clinical practice. I have also taken many detours in clinical practice. After graduating, I initially sat idle because no patients sought my treatment. The reasons were twofold: first, patients were unaware of me, and second, I knew that I had just graduated and lacked experience, especially in mastering the methods of clinical differentiation. Although I had studied classical works, including internal, external, gynecological, and pediatric medicine, I had not mastered the basics. Therefore, for every case I encountered in clinical practice, I would reflect on it repeatedly after work, especially for more severe and challenging cases. I would not only think about them repeatedly but also continuously refer back to the classical works I had studied, such as “Shang Han Lun”, “Jin Gui Yao Lue”, and “Wen Bing”, constantly reviewing and learning how others differentiated. I would ponder why others achieved results while I did not or had poor outcomes. Consequently, I read many books on differentiation and treatment, particularly the works of Professor Qin Bo Wei from Beijing University of Chinese Medicine and the book “Seven Lectures on Differentiation and Treatment” by Professor Fang Yao Zhong, among others. Based on the insights from these books, I gradually applied their methods in clinical practice, continuously reflecting, verifying, and summarizing. I believe that to learn the differentiation and treatment methods of the “Essentials of the Golden Cabinet”, one must first learn the basic methods of TCM differentiation and treatment. Therefore, before discussing the differentiation and treatment methods of the “Essentials of the Golden Cabinet”, I will first elaborate on the basic methods of differentiation and treatment.Basic Methods of Differentiation and TreatmentThere are many methods of differentiation in TCM, but I have found the following two commonly used and effective methods to be the most profound: the first is the method of identifying the main symptoms and clarifying the accompanying symptoms, and the second is the comprehensive analysis method. These two methods are the most important and are also integrated into the differentiation methods of the “Essentials of the Golden Cabinet”.(1) What is Differentiation and Treatment?Before discussing differentiation methods, I would like to explain what differentiation and treatment are. The character “证” (zhèng) has many interpretations. Some believe it refers to a syndrome group, others to symptoms, and some to evidence. My personal view is that the “证” in differentiation refers to evidence. Just like in a trial, to determine a person’s guilt, sufficient evidence must be found. Similarly, in TCM differentiation, to draw conclusions and determine what disease it is, what syndrome type it is, what the cause of the disease is, and what the pathogenesis is, one must find evidence. This evidence includes various symptoms, signs, and the causes of the disease or the conditions under which it occurred, and it may even include what medications the patient has taken, any changes after taking the medication, and the current situation. All of these are evidence. The so-called differentiation is to gather sufficient evidence, which involves collecting the patient’s various symptoms, signs, pulse conditions, tongue appearance, including the causes of the disease and the process of changes, to analyze, differentiate, and summarize, thereby making a correct diagnosis. The clauses in classical works are very concise in describing symptoms, but in clinical practice, patients’ conditions are often complex and rarely align perfectly with the symptoms described in the original texts. This is relatively rare, of course, but not impossible. However, in most clinical situations, detailed differentiation is required to make adjustments, and through different adjustments, we can meet the needs of different patients to achieve therapeutic efficacy. Therefore, when differentiating, it is essential to apply TCM theories for analysis, differentiation, and summarization. This process is called “理” (lǐ), which means using TCM theories for analysis and summarization. The so-called “论治” (lùn zhì) refers to the process of formulating treatment methods based on the results of differentiation and diagnosis, including the disease name, cause, pathogenesis, or location and nature of the disease. Therefore, the treatment method must be formulated according to the cause and pathogenesis. Then, based on this method, we select prescriptions and medications, which is called “方药” (fāng yào). I believe that TCM must encompass the four characters “理、法、方、药” (lǐ, fǎ, fāng, yào). Without these four characters, using Western medical theories to guide TCM prescriptions is tantamount to discarding the practice of medicine while retaining the medications, making it difficult to achieve effective results.(2) The Relationship Between Differentiation of Disease and Differentiation of SyndromeThe differentiation and treatment in TCM include both the differentiation of disease and the differentiation of syndrome. Through differentiation, we first identify what disease it is, and then further differentiate what syndrome type it is, meaning what the pathogenesis is. In the “Essentials of the Golden Cabinet”, one disease can have many prescriptions. For example, the main symptoms of chest obstruction disease include “shortness of breath, cough with sputum, chest and back pain, shortness of breath, and a deep and slow pulse at the cun position, with a tight and rapid pulse at the guan position”. This is a typical symptom, and the prescription is “Guo Lou Xie Bai Bai Jiu Tang” (Trichosanthes and Garlic Wine Decoction). However, can all patients with chest obstruction use this prescription? Certainly not. Therefore, Zhang Zhongjing also provided another prescription, “Guo Lou Xie Bai Ban Xia Tang” (Trichosanthes, Garlic, and Pinellia Decoction), for patients with “chest obstruction that prevents lying down, and heart pain radiating to the back”. Some patients may have “chest obstruction with a feeling of fullness in the chest, and a sensation of qi stagnation in the chest”, which is caused by cold. In this case, it would not be suitable to use either “Guo Lou Xie Bai Bai Jiu Tang” or “Guo Lou Xie Bai Ban Xia Tang”, but rather “Zhi Shi Xie Bai Gui Zhi Tang” (Bitter Orange and Garlic Decoction) or “Ren Shen Tang” (Ginseng Decoction). Therefore, each disease has many prescriptions because the same disease presents different pathogenesis in different individuals due to differences in age, diet, constitution, and gender. Thus, the same disease cannot be treated with a single prescription for all patients. This illustrates the relationship between the differentiation of disease and the differentiation of syndrome. Everyone knows that chest obstruction and heart pain can be treated with “Guo Lou Xie Bai Bai Jiu Tang”, “Guo Lou Xie Bai Ban Xia Tang”, or “Zhi Shi Xie Bai Gui Zhi Tang”, or “Ren Shen Tang”, but can all patients in clinical practice use these prescriptions? Not necessarily. For example, a 54-year-old male patient experiences chest tightness and pain after arguing with others, with episodes occurring four to five times a day, each lasting 3-5 minutes. From the perspective of the cause, it occurs only after arguments, accompanied by symptoms such as dizziness, bitter mouth, dry mouth, insomnia, vivid dreams, reduced appetite, shortness of breath, red tongue with yellow coating, and wiry and rapid pulse. For this patient, we cannot use the “Essentials of the Golden Cabinet” prescriptions of “Guo Lou Xie Bai Bai Jiu Tang” or “Guo Lou Xie Bai Ban Xia Tang” for treatment. It is evident that the cause is due to anger damaging the liver, leading to liver qi stagnation. The symptoms clearly indicate liver qi stagnation, liver fire, and disharmony between the liver and spleen. Therefore, for this patient, we can use “Xiao Chai Hu Tang” (Minor Bupleurum Decoction) combined with either “Guo Lou Xie Bai Bai Jiu Tang” or “Guo Lou Xie Bai Ban Xia Tang”, or make adjustments accordingly. Thus, the pathogenesis of the same disease varies significantly among different individuals, and prescriptions must be adjusted based on the specific conditions of the patient.TCM differentiation includes both the differentiation of disease and the differentiation of syndrome. The differentiation of disease must first be conducted, so the “Essentials of the Golden Cabinet” provides the main symptoms for each disease, such as the main symptoms of chest obstruction and the main symptoms of phlegm fluid disease, which states, “The person was previously robust but is now thin, with water flowing between the intestines, making a dripping sound”, and the main symptoms of fluid retention disease, which states, “Coughing with a sensation of fullness, shortness of breath, and an inability to lie down, with a swollen appearance”. These all indicate the main symptoms of a disease. In clinical practice, we first differentiate the disease and then the syndrome type. I believe that differentiation of syndrome is more important than differentiation of disease. If you diagnose what disease a person has but do not further differentiate the syndrome and simply use that prescription for treatment, the efficacy will certainly be greatly affected. Therefore, the relationship between differentiation of disease and differentiation of syndrome in TCM is that differentiation of disease identifies the universality of contradictions, while differentiation of syndrome identifies the specificity of contradictions. Universality refers to the commonalities among all patients with the same disease, whether in terms of pathogenesis or symptoms, which can be considered the commonality of contradictions. Specificity refers to the differences in pathogenesis or causes among different individuals who have the same disease. TCM treatment must target the specificity of contradictions; only by addressing the specificity can therapeutic efficacy be achieved. Therefore, some research studies that claim a single prescription treats a certain Western medical disease, reporting efficacy rates of 80-90%, I believe this method is not very advisable. The reason is that the targeting is not strong enough, unless the selected patients all have the same causes and pathogenesis suitable for that prescription; otherwise, it will not be effective. In clinical practice, we often conduct differentiation of disease and differentiation of syndrome simultaneously. First, we clarify what disease it is, narrowing down the patient’s complex symptoms to a specific range. Just as you need to know where a person is to find them, within the range of that disease, we further differentiate to identify the cause and specific pathogenesis. Moreover, during the differentiation process, it is essential to meticulously analyze every symptom, sign, tongue, pulse, and other aspects to achieve a correct diagnosis. This illustrates the relationship between differentiation of syndrome and differentiation of disease.It must be emphasized that the differentiation of disease in TCM differs significantly from that in Western medicine. One cannot use Western medical diagnoses to guide TCM prescriptions, nor can one use Western medical theories to guide TCM prescriptions. Western medicine is reductionist; its research on the human body starts from organs and tissues, then studies cells, and if cellular issues cannot be resolved, it moves to molecular biology and physical chemistry. Therefore, it is reductionist medicine. It requires many examinations to diagnose diseases, in addition to the patient’s symptoms and the disease’s progression, relying on many auxiliary tests, including blood tests, ultrasound, CT, MRI, etc. Some tests can cost over ten thousand yuan. Of course, it is undeniable that Western medicine provides clear and detailed diagnoses. However, I believe that TCM’s understanding of diseases is closer to systems theory. What is systems theory? The most basic principle of systems theory is that all things in the world, primarily material, are composed of systems of varying sizes, and each system consists of two or more elements. For example, water is composed of hydrogen and oxygen atoms. Once these two elements form a system, the properties of that system are not merely the simple sum of its components; its properties undergo significant changes. Systems theory posits that there are many complex interrelationships between these elements that cannot be separated, and once this system is formed, it has intricate connections with the outside world. TCM’s understanding of diseases and physiology is similar. At the very least, TCM believes that the human body is composed of five major systems: liver, heart, spleen, lung, and kidney, which are all interconnected, such as through mutual generation, mutual restraint, mutual promotion, and mutual insult. Therefore, TCM is a science based on systems theory, and its understanding and research methods of human physiology and pathology differ from those of Western medicine. Thus, one cannot use Western medical theories to explain TCM; the methods of the two are different. Therefore, I mainly propose that while both TCM and Western medicine must clarify what disease it is, there are significant differences between the two that should not be conflated.(3) Two Basic Methods of DifferentiationNext, I will discuss the most common methods of differentiation in clinical practice. I believe the two most important methods that must be mastered are: the first is the method of identifying the main symptoms and clarifying the accompanying symptoms, and the second is the comprehensive analysis method. If these two methods are well mastered and familiarized in clinical practice, then all of the patient’s symptoms can be naturally and meticulously differentiated.1. Method of Identifying the Main Symptoms and Clarifying the Accompanying SymptomsWhat does it mean to identify the main symptoms and clarify the accompanying symptoms? It involves differentiating from both the main symptoms and accompanying symptoms. The first step is to differentiate based on the main symptoms. For example, if a patient has fever as their main symptom, we must conduct preliminary differentiation based on the fever. First, we look at how long the fever has lasted. If the fever has lasted for a week or ten days, it is generally considered an externally contracted fever. Next, we need to understand the characteristics of the fever. If the fever starts in the afternoon and is relatively high, we can think about which diseases in TCM classics are characterized by high fever in the afternoon. The “Essentials of the Golden Cabinet” states, “If the patient has pain all over the body, fever, and the fever is more severe in the afternoon, it is called wind-dampness.” This indicates that wind-dampness can cause high fever in the afternoon. Another example is the Yangming disease in the “Shang Han Lun”, where the excess pattern also presents with high fever in the afternoon. But which one is it? Is it wind-dampness or Yangming excess? At this point, we cannot be completely certain. Next, we look at the patient’s symptoms of sweating without relief from the fever. This situation is mostly due to wind evil combined with damp evil, as dampness is inherently heavy and turbid. Therefore, although there is sweating and the wind has been expelled, the dampness remains, as stated in the “Jing Shi Wen”: “Only the wind has been expelled, but the dampness remains, hence it does not recover.” Thus, from the main symptom of fever lasting a week, with more severe afternoon fever, we suspect wind-dampness. The symptom of sweating without relief from the fever also indicates damp evil. Through the characteristics of the main symptoms, we can preliminarily reflect that it may be wind-dampness on the surface. The second step is to clarify the accompanying symptoms. The patient has symptoms of aversion to wind, so we combine the aversion to wind with the fever. The fever has lasted a week, is more severe in the afternoon, and now there are symptoms of aversion to wind. This connection indicates that the patient is likely not suffering from Yangming excess, as they have aversion to wind, suggesting that it is likely wind evil on the surface. At the same time, the patient is fatigued, has poor appetite, abdominal distension and pain after eating, dull abdominal pain, loose stools, and short, red urine, with a red tongue and yellow coating, and a slippery and thin pulse. Analyzing these symptoms sequentially, fatigue is often caused by damp evil obstructing the internal organs, hindering the flow of qi and blood. Poor appetite is due to the spleen being obstructed by damp evil, leading to impaired transformation and transportation. Abdominal distension after eating is due to qi stagnation, and dull abdominal pain is also due to qi stagnation. Although the stools are loose, they are not satisfactory, indicating damp evil transforming into heat. Short, red urine also indicates damp evil transforming into heat. A red tongue indicates internal heat, and a yellow greasy or intermingled yellow and white coating indicates dampness transforming into heat.Thus, from the accompanying symptoms, we differentiate each symptom, and the final comprehensive result indicates internal dampness transforming into heat and qi stagnation. The third step is diagnosis. The diagnosis is that the “Essentials of the Golden Cabinet” describes it as damp disease, with wind-dampness on the surface, internal dampness transforming into heat, and qi stagnation as the pathogenesis. The fourth step is to formulate a treatment plan, which must be based on the pathogenesis. We need to disperse the lung, expel wind, eliminate dampness, and clear heat. Therefore, if we use the “Essentials of the Golden Cabinet” prescription of “Ma Xing Yi Gan Tang” (Apricot Kernel and Perilla Leaf Decoction) or the later “Huo Xiang Zheng Qi Wan” (Agastache Correct Qi Pill), the effect would be unsatisfactory, as the pathogenesis is wind-dampness on the surface with internal dampness transforming into heat. The “Huo Xiang Zheng Qi Wan” is based on exterior cold and internal dampness, with dampness being heavier and heat being lighter. Therefore, we need to not only eliminate dampness but also clear heat and promote qi. Thus, based on this method, we select prescriptions. For wind-dampness on the surface, we choose “Ma Xing Yi Gan Tang”, and for internal heat, we can select “San Ren Tang” (Three Nut Decoction) and “Huang Qin Hua Shi Tang” (Scutellaria and Talcum Decoction), combining them for treatment. This is a practical case where we used “Ma Xing Yi Gan Tang”, “Huang Qin Hua Shi Tang”, and “San Ren Tang” with adjustments to achieve good results. This is the first method: the method of identifying the main symptoms and clarifying the accompanying symptoms.2. Comprehensive Analysis MethodThe comprehensive analysis method is suitable for cases where the main symptoms of the patient are unclear, such as in a comatose patient or when the clinical symptoms are very complex, making it difficult to differentiate based on any single main symptom. In such cases, the comprehensive analysis method must be employed. The comprehensive analysis method involves analyzing each of the patient’s symptoms one by one and then combining them to identify the cause and pathogenesis. For example, a patient presents with intermittent abdominal pain, loose stools that are unsatisfactory, abdominal distension, poor appetite, belching, yellow urine, poor sleep, a slippery and rapid pulse, and a red tongue with a yellow greasy coating. Upon examination, the abdomen is soft with no masses. We analyze each symptom. The patient experiences intermittent abdominal pain, which can be caused by cold, heat, deficiency, or excess. Even postpartum women with excessive bleeding can experience abdominal pain, so this symptom is difficult to differentiate; it can be deficiency, excess, cold, or heat. The issue is that the patient has loose stools that are unsatisfactory. In clinical practice, we cannot simply take the patient’s word that the stools are loose; we must clarify whether they feel unsatisfied after defecation. If they feel unsatisfied, even though the stools are loose, it indicates a tendency for dampness to transform into heat, which is very important. Abdominal distension indicates obstruction of qi by dampness, and poor appetite is due to the spleen being weak and unable to perform its functions. Belching, where the patient feels full after eating, is primarily due to the spleen’s upward movement and the stomach’s downward movement being obstructed by dampness. When dampness obstructs the qi, the qi that should descend cannot descend, leading to counterflow. Therefore, the patient often feels the need to belch. Yellow, short urine indicates damp-heat in the lower jiao. Poor sleep must also be clarified in clinical practice. If the patient has always had poor sleep, that is different from having poor sleep after developing this illness. If the latter is the case, then poor sleep is certainly influenced by damp-heat, as damp-heat can disturb the heart spirit. Therefore, we should not hastily conclude that poor sleep is due to deficiency of heart yin or blood deficiency; in many cases, damp-heat obstruction can also lead to poor sleep. A slippery and rapid pulse also indicates damp-heat, and a red tongue with a yellow greasy coating indicates damp-heat as well. Therefore, based on all the symptoms, we conclude that the patient has damp-heat in the gastrointestinal tract, with damp-heat accumulation and qi stagnation. Based on this differentiation, the diagnosis is damp disease, with the syndrome type being damp-heat accumulation in the gastrointestinal tract and qi stagnation. Therefore, the treatment principles must be based on this pathogenesis: tonifying the spleen, eliminating dampness, clearing heat, and promoting qi, using prescriptions such as “Huo Po Xia Ling Tang” (Magnolia Bark and Poria Decoction), “Huang Qin Tang” (Scutellaria Decoction), or “Huang Qin Hua Shi Tang” (Scutellaria and Talcum Decoction), with adjustments. Personally, I like to use “Jiu Bi Ying”, “Huo Tan Mu”, and “Mian Yin Chen”, as these herbs are very effective in clearing heat and eliminating dampness.For instance, there was a patient from Hunan who sought treatment for rheumatoid arthritis. After admission, it was discovered that she also had hyperthyroidism. The Western medical diagnosis was rheumatoid arthritis and hyperthyroidism. After two to three weeks of treatment, there was no significant improvement. When I visited her, she reported many symptoms, including shortness of breath, fatigue, lack of appetite, loose stools that were unsatisfactory, a feeling of urgency and heaviness in the lower abdomen, lower limb edema, joint swelling and pain, sore throat, dry mouth, palpitations, insomnia, and joint swelling in the limbs. I asked her, “Among all these symptoms, which one bothers you the most?” She replied, “Doctor, I feel uncomfortable everywhere. I can’t sleep, my heart races, my limbs ache, and I feel exhausted. Everything is difficult for me.” This case is challenging to differentiate based on any single symptom, so I employed the comprehensive analysis method. She had joint swelling and pain, loose stools that were unsatisfactory, poor appetite, shortness of breath, and fatigue. Analyzing these symptoms one by one, I concluded that she had spleen and stomach deficiency, insufficient qi, dampness obstructing the internal organs, and dampness transforming into heat. Additionally, she had palpitations, heart racing, and insomnia, with a red tongue and dry white coating, indicating heart yin deficiency, which cannot nourish and calm the heart spirit. However, she also exhibited irritability and anger, as her mother mentioned that she had a bad temper and was easily angered, with symptoms of bitter mouth and dry mouth, along with palpitations and insomnia. These symptoms collectively indicate a deficiency of both liver and heart yin. Furthermore, she had lower limb edema due to spleen deficiency and dampness obstructing the internal organs, leading to fluid retention in the limbs.Thus, she presented with joint swelling and pain, as well as lower limb edema. In summary, this patient exhibited a combination of liver and heart yin deficiency, along with deficiency of both heart and spleen, and internal heat due to yin deficiency. Additionally, she had a sore throat and dry mouth, indicating internal heat combined with damp-heat obstruction. Therefore, the comprehensive analysis of her condition revealed a combination of yin deficiency with dampness and heat, as well as deficiency of both heart and spleen. Based on this differentiation, I selected nourishing heart herbs, such as “Sheng Mai San” (Generate the Pulse Powder) with Bai Zi Ren (Semen Ziziphi Spinosae), and for nourishing the liver, I used “Suan Zao Ren Tang” (Sour Jujube Decoction) with Chuan Xiong (Rhizoma Chuanxiong). For strengthening the spleen, I selected “Shen Ling Bai Zhu San” (Ginseng, Poria, and Atractylodes Powder), and since she had dampness transforming into heat and a bitter mouth, I included herbs for strengthening the spleen and eliminating dampness, such as Yi Yi Ren (Coix Seed), Bian Dou (Lentil), and Lian Zi (Lotus Seed). Additionally, I added Han Fang Ji (Stephania Tetrandra) and Fu Ling (Poria) for her edema, along with Dandelion (20g) due to dampness transforming into heat. After taking the prescribed herbs, by the second week of follow-up, her sleep and appetite had significantly improved, and her sore throat had resolved. By the third week, her insomnia and palpitations had markedly improved, allowing her to sleep for three to four hours. This patient was treated in the hospital for a month and a half, during which various adjustments were made to her prescriptions, leading to significant improvement in her rheumatoid arthritis symptoms. This case exemplifies a complex condition that required the use of the comprehensive analysis method.In the process of applying classical prescriptions, the comprehensive analysis method is often necessary. Each disease in classical texts, whether it be from the “Tai Yang Disease”, “Yang Ming Disease”, or the “Essentials of the Golden Cabinet” regarding jaundice, chest obstruction, or lung abscess, has many symptoms. One cannot simply diagnose based on a single symptom. In cases with multiple symptoms, comprehensive analysis must be employed. For example, in the case of “Xiao Chai Hu Tang” (Minor Bupleurum Decoction), although the original text states, “If you see one symptom, it is sufficient”, I have found that in clinical practice, one cannot diagnose it solely based on one symptom. Can you diagnose it based on just a bitter mouth or dizziness? Certainly not; doing so will lead to poor treatment outcomes. I believe that at least two or three symptoms must be combined to confidently diagnose that the patient has a lesser yang syndrome suitable for “Xiao Chai Hu Tang”. Therefore, in such cases, the comprehensive analysis method must be employed.Many diseases in clinical practice, such as chest obstruction disease, present with symptoms like shortness of breath, cough with sputum, and chest and back pain. In such cases, the comprehensive analysis method must be used to clarify the diagnosis. In summary, for each patient, it is best if all symptoms can be explained by a single pathogenesis. If a single pathogenesis cannot explain all symptoms, then two or more pathogenesis must be used to explain them. For instance, in the case of the young girl mentioned earlier, a single pathogenesis cannot explain all her symptoms. In such cases, using a single prescription for treatment will certainly lead to problems. This is the second method: the comprehensive analysis method of differentiation.This article is from: Liao Shihuang
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