Pattern-Based Medicine?

So what the hell is this 'pattern-based medicine' anyway? It is, like many Chinese ideas, something very difficult to put into words. But I'll try. Perhaps the easiest way is by contrasting it against 'disease-based medicine'.

Disease-based medicine is a medicine that diagnoses a disease and then treats or cures that disease. For instance, a patient might be diagnosed with pneumonia, and the pneumonia is then cured using antibiotics that kill the pneumococcal bacteria. Disease-based medicine can be said to be 'yang' in nature - it is direct, forceful, somewhat violent, and produces a swift result.

Pattern-based medicine is 'yin' in nature - indirect, slippery, gentle, and slow. Definitely not the method of choice if you're drowing from fluid accumulating in your lungs and you've not got long to live! But when you're feeling 'not quite right' and no single cause can be identified, this is when pattern-based medicine shines.

(At this point, I need to point out that sometimes strange things happen - sometimes disease-based medicine is very effective in treating mild, chronic complaints. Pattern-based medicine occasionally produces powerful benefits in acute illnesses. Biology is such a complicated field that few rules exist without exceptions.)

In pattern-based medicine, a patient's signs and symptoms are grouped according to certain themes. For example, fever, red skin, red eyes, insomnia, irritability, dry skin, and dark urine are all among the signs and symptoms that indicate 'heat'. By contrast, a runny nose, large urine output, mental sluggishness and excess body weight are among the signs that indicate 'dampness'. A patient with a mixture of signs from both lists might well be described as having a 'damp heat pattern'.

(Note that physical and mental indicators are mixed together in these lists, and that not all of the items on each list are things one might automatically associate with concepts of 'heat' or 'damp'.)

Having determined the particular pattern of someone's illness (which could be as simple as 'rising heat' or as complex as 'phlegm-heat obstructing the orifices with cold below, heat above and wind attacking the upper organs with failures of the digestive and nervous systems', which is why we go to school to learn the difference), the pattern-based therapist determines a counter-pattern, or 'treatment principle', such as 'cool heat' or 'drain damp'.

For example, let us assume that a patient presents with a mild, congested headache and upset stomach. Both of these symptoms can be described in terms of things (stomach contents and sinus fluids) going up when they are supposed to go down. And acupuncture point LI4 is good for sending things down, which is why you use it for congested headaches and nausea, but not on pregnant women (unless you're trying to induce labour).

In a more complex case, multiple acupuncture points and/or herbs can be combined to provide a tailored combination that address all of a patient's symptoms at once.

Somehow, I'm not satisfied that I've explained the difference between pattern-based and disease-based medicine approaches, let me try another angle.

Disease-based medicine is based on a 'cause and effect' model. To return to pneumonia, a bacterium causes an accumulation of fluid in the lung which inhibits breathing, which eventually results in death if the disease is not treated. Eliminating the cause (the bacterium) eliminates the effect (life-threatening disease).

Pattern-based medicine is based on a 'mutual causation' model. Imagine a stressed-out worker with insomnia, high blood pressure, irritability and a tendency to brood over the problems they're having at work. The brooding over problems causes the insomnia, which causes a lack of sleep, which makes the patient irritable, which means they have outbursts at work, which means they're on edge all the time (driving up their blood pressure), which makes them brood about their problems when they get home - this causes insomnia... (repeat as required). The pattern-based therapy makes a simultaneous assault on all of these symptoms at once.

Now, you could treat the stressed-out worker with a disease model, and you could treat the pneumonia with a pattern model, but neither of these solutions would be ideal. In the case of the pneumonia, a single cause can be found and elminated - and it needs to be done quickly if the patient's life is to be preserved.

Let's now treat our stressed-out worker with some medication to help them sleep, on the assumption that the sleep deficit is the root cause of their problem. Sleepers in a high enough dose to overcome the psychological effects are problematic, since they introduce the possibility of overdose or dependancy. Then there's the possibility of simply oversleeping, which stands a good chance of driving up the anxiety levels and defeating the whole exercise. The power of the disease-based approach works against itself here, threatening to upset the balance more than the original illness. A gentle approach over multiple fronts is preferred over a powerful strike at a key location.

So yeah, pattern-based medicine and disease-based medicine. Like yin and yang, they complement each other very nicely if they can learn to work together.