In preparation for opening practice, I've started re-reading some of my favourite old "medical" books. One such book is The Web That Has No Weaver by Ted Kaptchuk, an essential read for any practitioner or patient of Traditional Chinese Medicine. A few pages into the book, Kaptchuk highlights an example of differing medical perspectives and how these perspectives can affect diagnostic patterns. The example is based on a Chinese study comparing a Western physician's diagnosis of peptic ulcer disease in (three) patients, and the subsequent diagnoses of the same patients by a TCM practitioner. This is an excellent concise example of the value in keeping an open mind to different methods of medical diagnosis and how to consider the whole picture when assessing a patient. The text reads as follows:
A Western physician, using...x-ray and endoscopy...diagnoses (three) patients with stomach pain as having petic ulcer disease. From the Western doctor's perspective, based on the analytic tendency to narrow diagnosis to an underlying entity, all these patients suffer from the same disorder. The physician then sends the patients to a Chinese doctor for examination. The following results are found.
Upon questioning...the first patient, the Chinese physician finds pain that increases at touch (by palpation) but diminishes with the application of cold compresses. The patient has a robust constitution, broad shoulders, a reddish complexion, and a full, deep voice. He seems assertive and even aggressive. He is constipated and has dark yellow urine. His tongue has a greasy yellow coating; his pulse is "full" and "wiry". The...physician characterizes this patient as having the pattern of disharmony called "Damp Heat Affecting the Spleen".
When the Chinese physician examines the second patient, he finds a different set of signs, which indicate another overall pattern. The patient is thin. Her complexion is ashen, though her cheeks are ruddy. She is constantly thirsy, her palms are sweaty, and she has a tendency toward constipation and insomnia. She seems nervous, fidgety, and unable to relax. Her tongue is dry and slightly red, with no "moss"; her pulse is "thin" and also a bit "fast". This patient is said to have the pattern of "Deficient Yin Affecting the Stomach".
The third patient reports that massage and heat somewhat alleviate his pain, which is experienced as a minor but persistent discomfort. He is temporarily relieved by eating. The patient dislikes cold weather, has a pale face, and wants to sleep a lot. His urine is clear and his urination is frequent. He appears timid, shy, and almost afraid. His tongue is moist and pale; his pulse is "empty". The patient's condition is diagnosed as the pattern of "Exhausted Fire of the Middle Burner" (or) "Deficient Cold Affecting the Spleen".
This is a good example of three typical (but concise) TCM intakes.
If you've never consulted with a TCM practitioner, you can expect these types of questions. As you can see from this example, in the three TCM diagnoses, all the patients are viewed completely differently and diagnosed with unique patterns of disharmony (illness). The TCM practitioner would then have prescribed a unique treatment protocol for each patient, likely involving diet, exercise, acupuncture or Eastern herbs.
In Naturopathic medicine, one of the tenets by which we practice is Tolle Totum, a Latin phrase loosely translated as "Treat the Whole". The Kaptchuk example is an example of treating the patient as a whole, and TCM has certainly mastered this approach. A (w)holistic practitioner views a patient as a whole, thereby analyzing not only the part of the patient involving the primary concern (eg. the stomach in stomach pain), but the entire picture in order to discern the underlying pattern contributing to the illness.
Luckily, treating the whole is not limited to naturopathic medicine or more traditional systems of medicine (on which naturopathic medicine is based). More and more practitioners in all medical fields are realizing that human health is a complex web, intertwining the physical with the mental, social and spiritual aspects of a person. This is evidenced by the increasing number of "integrative" clinics that incorporate practitioners of both Western and Eastern alignment, and the deepening body of research that accompanies this view.
As a patient, when seeking medical care, keep this perspective in mind and don't settle for a practitioner that doesn't examine your whole picture. Demand the belief of Tolle Totum from all your practitioners and you will receive better care. As a practitioner, we have the duty of considering every aspect of your health in determining what the most appropriate treatment and/or health maintenance prescription should be: what may work for one person may not for another.
Kaptchuk, Ted J. (2000). The web that has no weaver. McGraw-Hill Publishing: New York, NY. P. 4-5