The Importance of “Zheng” – diagnostic pattern differentiation – in clinical trials of Chinese medicine

Efficacy and side effects of Chinese Herbal Medicine for menopausal symptoms: a critical review.  Lian-wei XUJia ManRoland SalchowMichael KentschXue-jun CuiHong-yong DengZhuo-jun Sun, and Lan Kluwe

“Chinese herbal medicine may be effective for at least some menopausal symptoms while side effects are less likely than with hormone therapy. However, all these findings need to be confirmed in further well designed comprehensive studies which meet the standard of evidence-based medicine and include Zheng-differentiation of TCM.”

Best practice of Chinese Medicine (CM) depends on accurate diagnosis and treatment procedures known as Bian Zheng Lun Zhi (“syndrome differentiation followed by treatment procedures”).  Syndrome differentiation is a key concept in the practice of CM, and  consists of a series of diagnostic procedures of observation, listening, questioning, pulse and body palpation, and visual tongue inspection, and the analysis of information thereby obtained.  It is used to guide the choice of CM treatment using acupuncture, Chinese herbal formulae, dietary modifications, and other lifestyle recommendations.

Syndrome differentiation clearly differs from the conventional diagnosis methodology used in conventional biomedical practice – 10 folks with the diagnosis of “Migraine” can walk into my clinic, and then each receive a different CM diagnosis. CM diagnosis is MUCH less homogenous, is not “one size fits all,” is entirely individualized to the unique ONE who sits before us.

To date, nearly all “scientific” clinical trials on acupuncture and/or Chinese herbal medicine developed and completed in the Western hemisphere have IGNORED this key concept, and instead have relied upon standardized biomedical diagnoses and standardized “point prescriptions” to treat all participants… In other words, used a “one size fits all” approach.

All 50 patients with chronic low back pain will receive the same points, needled with the same technique, for the same length of time, etc. etc.

With such an oversight of such a KEY aspect of the practice of Chinese medicine, is it any wonder that evidencing our efficacy has been so SLOOOW, so fraught with difficulties?  Zheng pattern differentiation inclusion in scientific studies moving forward is a must!

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