老年病治疗如何选：中医整体观与西医还原论的思辨

在医学发展的漫漫长河中，西医与中医宛如两条并行的溪流，各自流淌着独特的智慧与光芒，在人类对抗疾病的征程中发挥着不可替代的作用。然而，当我们聚焦于老年病这一特殊领域时，会发现中医的整体观与西医的还原论呈现出截然不同的治疗思路与效果，而中医的整体观在老年病治疗中似乎展现出更为显著的优势。

西医还原论：精准背后的局限

现代西医，以其精密的仪器、先进的检测技术和对微观世界的深入探索，在诊治单独病理病灶方面堪称卓越。它如同一位技艺精湛的工匠，能够精准地定位疾病的根源，针对特定的靶点设计出相应的药物或治疗方案。例如，对于高血压这一常见疾病，西医可以通过一系列的检查，明确是血管紧张素系统的问题，还是肾素 - 血管紧张素 - 醛固酮系统（RAAS）的异常，然后针对性地使用血管紧张素转换酶抑制剂（ACEI）或血管紧张素Ⅱ受体拮抗剂（ARB）等药物进行治疗，在控制血压方面往往能取得立竿见影的效果。

然而，当面对老年人的疾病时，西医的这种还原论方法却逐渐显露出其局限性。老年人往往患有多种疾病，可谓是“从头到脚”的“全毛病”，病理病灶繁多复杂。在这种情况下，如果仍然不顾整体而只追求“局部最佳”，让患者在各个专家门诊之间徘徊，按照各位专家依据科学依据开出的全部药物治疗，其综合结果和相互作用就如同一个难以解开的谜团。据相关统计数据显示，在老年患者中，同时服用5种以上药物的比例高达40%以上，而这些药物之间的相互作用导致的不良反应发生率也显著增加。例如，一位患有高血压、糖尿病和冠心病的老年患者，可能需要同时服用降压药、降糖药、抗血小板药、调脂药等多种药物。这些药物都是按照一个个的靶点设计的，对于它们在人体内形成的复杂“因果网络”的影响，目前还没有完善的评价方法。而且，随着科学仪器的不断精密，分子水平的“高表达”“低表达”的数量爆发式地增加，需要拮抗、阻断的靶点越来越多，人体“需要”的化学制剂也将会越来越多。这种还原论指导下的方法论，就像是在一个错综复杂的迷宫中不断寻找出口，却忽略了整个迷宫的结构和布局，其缺陷将会越来越明显。

中医整体观：方剂背后的智慧

与西医的还原论不同，中医秉持着整体观的哲学思想，将人体视为一个有机的整体，认为人体的各个脏腑、组织、器官之间相互关联、相互影响，同时人体与外界环境也存在着密切的联系。这种整体观在老年病治疗中体现得淋漓尽致。中医一张方子可以治整体，它不是针对某一个具体的病理病灶进行治疗，而是从整体出发，综合考虑患者的体质、症状、病因等多方面因素，通过调整人体的阴阳平衡、气血运行和脏腑功能，达到治疗疾病的目的。

以一位患有多种慢性疾病的老年患者为例，他可能既有咳嗽、气喘等呼吸系统症状，又有食欲不振、腹胀等消化系统症状，同时还伴有失眠、乏力等全身症状。中医在诊治时，不会仅仅关注某一个系统的症状，而是会通过望、闻、问、切四诊合参，全面了解患者的病情，然后根据中医的理论进行辨证论治，开具一张综合性的方剂。这张方剂中可能包含了多种中药，每一种中药都有其独特的功效，它们相互配合、协同作用，共同调节人体的整体功能。例如，方剂中可能会使用黄芪来补气升阳、益卫固表，增强人体的免疫力；使用茯苓来健脾渗湿、宁心安神，改善消化系统和神经系统的症状；使用桔梗来宣肺利咽、祛痰排脓，缓解呼吸系统的症状。通过这样一张方剂，就可以同时对患者的多个系统的症状进行治疗，达到整体调理的效果。

而且，中医的整体观还强调人与自然的和谐统一。中医认为，人体的疾病与季节、气候、环境等因素密切相关。例如，在春季，风邪易侵，人体容易出现感冒、咳嗽等疾病，此时中医在治疗时会注重疏风解表；在夏季，暑湿之气较重，人体容易出现中暑、腹泻等疾病，治疗时则会注重清热祛湿。这种因时制宜的治疗方法，体现了中医对人体与自然关系的深刻认识，也使得中医在治疗老年病时能够更加贴合患者的实际情况，提高治疗效果。

传承与展望：中医治疗的启示

老年病的治疗是一个复杂而艰巨的任务，中医的整体观为我们提供了一种独特的思路和方法。让我们以科学的态度、开放的胸怀，探索中医的奥秘，传承中医的智慧，让中医这一中华民族的瑰宝在老年病治疗领域绽放出更加耀眼的光芒，为人类的健康事业做出更大的贡献。

作者简介：梁世杰 中医高年资主治医师，本科学历，从事中医临床工作24年，积累了较丰富的临床经验。师从首都医科大学附属北京中医院肝病科主任医师、著名老中医陈勇，侍诊多载，深得器重，尽得真传！擅用“商汤经方分类疗法”、专病专方结合“焦树德学术思想”“关幼波十纲辨证”学术思想治疗疑难杂症为特色。现任北京树德堂中医研究院研究员，北京中医药薪火传承新3+3工程—焦树德门人（陈勇）传承工作站研究员，国际易联易学与养生专委会常务理事，中国中医药研究促进会焦树德学术传承专业委员会委员，中国药文化研究会中医药慢病防治分会首批癌症领域入库专家。荣获2020年中国中医药研究促进会仲景医学分会举办的第八届医圣仲景南阳论坛“经方名医”荣誉称号。2023年首届京津冀“扁鹊杯”燕赵医学研究主题征文优秀奖获得者。事迹入选《当代科学家》杂志、《中华英才》杂志。

How to choose treatments for age-related diseases: A contemplation of traditional Chinese medicine’s holistic view versus Western medicine’s reductionist approach.

In the long and winding journey of medical development, Western medicine and traditional Chinese medicine resemble two parallel streams, each flowing with its own unique wisdom and brilliance, playing irreplaceable roles in humanity’s struggle against disease. However, when we focus on the specific field of geriatric medicine, we find that the holistic view of traditional Chinese medicine differs markedly from the reductionist approach of Western medicine, with the holistic view of traditional Chinese medicine seemingly demonstrating greater advantages in the treatment of geriatric diseases.

Western medicine’s reductionist approach: The limitations behind precision.

Modern Western medicine, with its sophisticated instruments, advanced diagnostic techniques, and in-depth exploration of the microcosmic world, is exceptionally effective in diagnosing and treating individual pathological conditions. It functions like a highly skilled craftsman, capable of pinpointing the root cause of a disease with precision and designing corresponding medications or treatment plans tailored to specific targets. For example, in the case of hypertension, a common condition, Western medicine can conduct a series of examinations to determine whether the issue lies with the angiotensin system or the renin-angiotensin-aldosterone system (RAAS). Based on this diagnosis, targeted treatments such as angiotensin-converting enzyme inhibitors (ACEIs) or angiotensin II receptor blockers (ARBs) can be employed, often resulting in immediate improvements in blood pressure control.

However, when dealing with the illnesses of the elderly, the reductionist approach of Western medicine has gradually revealed its limitations. Elderly individuals often suffer from multiple ailments, which can be described as having “all kinds of problems” from head to toe. The pathological lesions are numerous and complex. In such cases, if one only pursues “local optimality” without considering the overall situation and leaves patients to navigate between various specialist clinics and medications prescribed by each expert based on scientific evidence, the combined outcomes and interactions can be akin to a puzzle that is difficult to unravel. According to relevant statistical data, the proportion of elderly patients taking more than five medications simultaneously is as high as over 40%. The incidence of adverse reactions caused by the interactions between these medications has also significantly increased. For example, an elderly patient with hypertension, diabetes, and coronary heart disease may need to take multiple medications, including antihypertensive drugs, antidiabetic drugs, antiplatelet drugs, and lipid-lowering drugs. These medications are designed to target specific points, but there is currently no comprehensive evaluation method for the complex “causal networks” they form within the human body. Moreover, with the continuous refinement of scientific instruments, the number of “highly expressed” and “lowly expressed” molecules has exploded, leading to an increasing number of targets that need to be antagonized or blocked, and the human body will require an increasing number of chemical agents. This reductionist-guided methodology resembles searching for an exit in a complex maze while ignoring the structure and layout of the entire maze. Its flaws will become increasingly apparent.

The Holistic View of Traditional Chinese Medicine: The Wisdom Behind Formulas

Unlike the reductionist approach of Western medicine, traditional Chinese medicine upholds a philosophical perspective of holism, viewing the human body as an organic whole. It believes that the various viscera, tissues, and organs of the body are interconnected and influence one another, and that the body also has a close connection with the external environment. This holistic view is vividly demonstrated in the treatment of age-related diseases. A traditional Chinese medicine prescription can address the whole person, rather than targeting a specific pathological lesion. It takes a holistic approach, considering various factors such as the patient’s constitution, symptoms, causes, and other aspects, and aims to achieve the goal of treating the disease by adjusting the balance of yin and yang, the flow of qi and blood, and the functions of the viscera.

Take an elderly patient with multiple chronic conditions as an example. He may experience respiratory symptoms such as coughing and shortness of breath, as well as digestive symptoms like loss of appetite and abdominal bloating. He may also experience general symptoms like insomnia and fatigue. When diagnosing and treating this patient, traditional Chinese medicine (TCM) does not focus solely on the symptoms of one particular system. Instead, it employs the four diagnostic methods of observation, smelling, asking questions, and palpation to comprehensively understand the patient’s condition. Based on TCM theory, a comprehensive treatment plan is then formulated, which may include a combination of various herbs. Each of these herbs has its unique properties, and when used together, they work synergistically to regulate the overall functions of the body. For instance, the formula might include astragalus to invigorate the qi and enhance immunity; rehmannia to tonify the spleen, remove dampness, and calm the mind, thereby alleviating symptoms related to the digestive and nervous systems; and rhizoma gromeri to clear the lungs, relieve phlegm, and eliminate pus, thus addressing respiratory symptoms. By using such a formula, multiple symptoms of the patient’s different systems can be treated simultaneously, leading to a holistic healing effect.

Furthermore, the holistic view of traditional Chinese medicine emphasizes the harmonious unity between humans and nature. Traditional Chinese medicine believes that diseases in the human body are closely linked to factors such as seasons, climate, and environment. For example, during spring, wind-borne pathogens are more likely to invade, and people are more prone to illnesses like colds and coughs. In this case, traditional Chinese medicine focuses on clearing wind and relieving exterior symptoms. During summer, when heat and dampness are more prevalent, people are more likely to suffer from heatstroke and diarrhea. In treatment, traditional Chinese medicine emphasizes clearing heat and removing dampness. This time-sensitive approach reflects the profound understanding of traditional Chinese medicine regarding the relationship between humans and nature, allowing it to tailor treatments more closely to the actual conditions of elderly patients and thereby improving treatment outcomes.

Legacy and Prospects: Insights from Traditional Chinese Medicine Therapy

The treatment of age-related diseases is a complex and arduous task, and the holistic view of traditional Chinese medicine offers a unique approach and method. Let us approach this with a scientific mindset and an open-minded attitude, explore the mysteries of traditional Chinese medicine, and pass on its wisdom. By doing so, we can allow this treasure of the Chinese nation to shine even brighter in the field of treating age-related diseases and make greater contributions to the cause of human health.

Author Bio: Liang Shijie is a senior medical practitioner in traditional Chinese medicine with an undergraduate degree. He has been engaged in traditional medicine clinical work for 24 years and has accumulated a wealth of clinical experience. Following Chen Yong, chief physician of liver disease at Beijing Traditional Medicine Hospital, affiliated with Capital Medical University, and renowned old Chinese medicine, he has been treated for many years and received great attention. He specializes in the treatment of difficult diseases using "conversational traditional therapy" and special treatments combined with the academic ideas of Jiao Shude and Guan Yubo's ten-level diagnosis.He is currently a researcher at the Shude Tang TCM Research Institute in Beijing, a fellow at the new 3 + 3 project of traditional Chinese medicine flame inheritance in Beijing - a scholar at the inheritance workstation of Jiao Shude's protégés (Chen Yong),He is a standing committee member of the International Expert Committee on E-learning and Health Care, a member of the Jiao Shude Academic Heritage Special Committee of the Chinese Association for the Advancement of Chinese Medicine Research, and the first cancer specialist to be included in the chapter of the Chinese Pharmaceutical Culture Research Association. Won the 2020 China Association for the Promotion of Traditional Chinese Medicine Zhongjing Medical Branch held the eighth session of the Medical Saint Zhongjing Nanyang Forum "Classic Prescription Famous Doctor" honorary title. The winner of the first Beijing-Tianjin-Hebei "Pingui Cup" Yanzhao Medical Research Essay Award in 2023. His work was featured in the journal Current Scientist and the journal Chinese Talent.