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Although health and healing are the common goals of Traditional Chinese Medicine (TCM) and allopathic medicine, their ideas on the etiology of disease, disease itself and the process used to regain health are decidedly different. The allopathic physician learns that disease must be cured by prescribing medicine, which kills bacteria or renders a virus ineffective; at times surgical intervention is a necessity. There is nothing inherently wrong with this approach. It often works. The question worth exploring is why TCM succeeds where allopathic medicine fails? What is the mechanism of action of acupuncture and herbal medicine, which results in palliation or cure that is not manifest in biomedicine? Though the goal of TCM is to cure a patient, the doctor of TCM attempts to do this not by treating the disease but rather by treating the whole person, taking into account the various attributes of an individual which, when combined, account for an individual being sick or healthy. A person, according to the tenets of TCM is more than their pathology. While treating the pathology may yield impressive results, they are commonly temporary. A person is not, according to TCM, represented solely by his or her illness, but by the accumulation of every human interaction engaged in from the moment of birth, including the values of and the culture from which the individual develops. The emotional experiences, eating habits, work habits, work and living environment, personal habits and the social milieu are factors that contribute to disease and are factors which, when modified appropriately may lead to regained health. Though the Western scientific community has not, to date, arrived at a methodology to use in research of Chinese medicine, the veracity and efficaciousness of this medical modality is nonetheless proved by its long history of continued success. More than a quarter of the world's population regularly uses TCM as part of their health care regimen. Chinese medicine is the only form of classical medicine, which is regularly and continuously used outside of its country of origin. THE FOUR EXAMINATIONS The 'Four Examinations' is a method of diagnosis which dates back over three thousand years. Observing, Listening and Smelling (Listening and Smelling are counted as one of the Four Examinations), Questioning and Palpating make up the 'Four Examinations'. This method of diagnosis is far from simplistic, allowing the practitioner to arrive at a differential diagnosis. Each of the "Four Examinations" can take years to master, and while these diagnostic tools are not replacements for that which Western medicine can provide in analyzing and treating disease, they have the ability to offer information which, when understood in the context of TCM, provides additional opportunities in mapping out patterns of disease and arriving at greater treatment success. The doctor of TCM must approach a patient with a clear and calm mind, without a preconceived diagnosis and etiology. This mind-set will enable the practitioner to yield clinical gems which are clues about the individual who sits before us! This is the stuff of TCM. The subjective, interpretive and objective evidence of an individual obtained via the 'Four Examinations' leads to the discovery of the etiology of disease while concomitantly opening a window to the 'Whole Person", thus revealing where in the individual's life the pathogenesis started and what initiated it. The practitioner of TCM must utilize his own interpretive skills, which takes into consideration what is verbalized by the patient and what is observed, while considering what the patient does not verbalize as well. Often, that which is not said can be as clinically enlightening as the information which is freely provided. The tone of the voice, the complexion, the condition of the eyes (in TCM, the Shen or spirt of an individual is said to be revealed through their eyes. Who can deny the clinical efficacy of this? Is there a different expression revealed through the eyes of a clinically depressed individual than from those of a happy, well adjusted one?), the facial expression, the overall demeanor, how one walks, sits, and stands are all observed and utilized by the doctor of Chinese medicine as part of the information required to arrive at a differential diagnosis. The doctor must be able to note and sense inconsistencies in an individual that are expressed by the patient even without the patient being cognizant of the chasms which exist between what they verbally express and what their spiritual presentation divulges. The sensitivity to and awareness of these human idiosyncrasies enables the TCM doctor to develop an understanding of who the patient is even before the 'main complaint' is discussed. Proper treatment in TCM is more than the elimination of pathological processes. In addition to attacking a pathological factor(s), it is the responsibility of the TCM doctor to support the individual in his or her goal of achieving overall health which includes aspects of physical-psycho-emotional and spiritual health. This paradigmatic approach is an inexorable part of the process of healing. Without it, we are merely chasing the sickness and forgetting about the patient. With this approach, the patient is seen as a whole person, representing the sum of a lifetime of experiences if you will, not just an embodiment of pathology. Pathologies are guests (and we hope temporary ones!) in a home which serves as a gracious host - our physical, emotional and spiritual selves. TCM first is concerned with strengthening the immune function which includes homeostasis of the physical, emotional and spiritual attributes of the patient, so as to be able to assist the patient in his or her endeavor to do battle and destroy the enemy at the gates (or inside them). When people are chronically exhausted from lack of sleep resulting from anxiety or depression, they can become chronically sick as a result of a lowered immune system. In TCM the point of departure from Western medicine is not to view the acute presentation (called "the branch" in TCM) as primary, but to treat the etiology (called "the root" in TCM) which is the anxiety and depression which causes the insomnia then facilitating exhaustion and lowering the immune function which can lead to chronic illness. So, rather than prescribing antibiotics repeatedly, we might address the patient's anxiety/depression syndrome or refer them out to a psychotherapist for appropriate intervention while simultaneously providing treatment. In Part II we'll look at the mechanisms of action in infertility.
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