How TCM Treatment Plans Are Built and How Progress Is Judged

The traditional logic: pattern, principle, treatment

In traditional Chinese medicine (TCM), the plan follows from the practitioner's pattern assessment. In the words of one Ontario regulator, the practitioner explains the diagnosis, including "how to remove what is excessive and/or replenish what is deficient," and may combine herbal medicine with acupuncture, moxibustion, cupping, gua sha and tui na. [1]

Put simply, the steps are:

1. Assessment. History, tongue, pulse and other findings lead to a pattern. See Zang-Fu Pattern Differentiation.
2. Treatment principle. The aim in the tradition's own terms, such as replenishing what is described as deficient or removing what is described as excessive. [1]
3. Choice of methods. Herbs, acupuncture points, manual therapy or other techniques matched to that aim.
4. Review and adjustment. In general practice the plan is reassessed and changed; the sources we read do not describe how often.

One overview says that in TCM the differentiation of syndromes rather than diseases is essential for choosing treatment, and that therapeutic success depends closely on the accuracy of the diagnosis. [2] That is the tradition's view, and it raises a fair question: how accurate and consistent is that diagnosis?

Does tailoring to the pattern matter?

Two kinds of research bear on this. They do not settle it, and they concern specific treatments, not TCM as a whole.

Reading this honestly: acupuncture in that trial helped more than usual care, but the individualized version was no better than the standard one, and the authors raised questions about the proposed mechanisms. [4] We found no comparable trial for herbal formulas in our search, so for herbs: Proper evidence not found on whether pattern-based prescriptions outperform fixed formulas. (We searched PubMed for individualized versus standardized Chinese herbal medicine trials.)

Herbal plans

A herbal plan is a prescription from a practitioner, often a combination of herbs. We do not give doses or recipes. Quality and safety issues apply: some Chinese herbal products have been contaminated with heavy metals or undeclared drugs, and herbs can interact with medicines. [6] The NHS (UK) lists statins, antidepressants, diabetes and blood pressure medicines, warfarin and hormonal contraception among medicines that do not mix well with herbal medicines. [7] See Chinese Herbal Products: Quality, Contamination and Medicine Interactions.

How progress can be judged

The sources we read do not set one standard way to measure progress in TCM. A reasonable approach, which is practical advice and not a sourced standard, is to agree at the start on what you want to change (pain level, sleep, a daily activity), how it will be noted, and when you and the practitioner will decide to continue, change or stop.

One real-world example of progress-based planning: US Medicare covers acupuncture only for chronic low back pain, up to 12 visits, with 8 more if the first 12 result in improvement. [8] Coverage rules differ elsewhere.

Signs that a plan should be reviewed: no change you can identify after the agreed period, new symptoms, or any reaction to a herb. In those cases contact the practitioner and your doctor. Do not stop prescribed medicines on a TCM plan; use TCM to complement, not replace or delay, conventional care. [6]

Related reading

Your First TCM Visit, Questions to Ask Your TCM Practitioner, Telling Your Doctor About TCM Use.