Same Illness — So Why Treat Each Person Differently?

"My friend has the same illness but takes a different medicine. Why is that?"

It is a question I get often at the clinic. And if it isn't answered properly, Korean medicine ends up looking like nothing more than "making something a bit different for each person."

Today I want to give the reason exactly.

What a Name Tells You

The name of an illness is a name put on what is showing at present.

"Insomnia" means you can't sleep. It doesn't tell you why.
"Chronic pain" means it has hurt for a long time. It doesn't tell you where it started.

The name is the name of a result. Treatment is done to the cause.

The Axes That Make Up the Body's Environment

This is how I see the body. There are illnesses that arise from a part breaking. But what I meet far more often in the consulting room is the case where the part is sound and the environment that part sits in has changed.

And that environment is made of several axes.

Axis	What it covers
Physical axis	Tension, stress, pressure — the forces bearing on tissue
Time axis	How fast, how long — speed and accumulation
Chemical axis	Enzymes, acid-base, ions and electrolytes
Metabolic axis	The work of making energy
Immune axis	The immunity of the gut lining sets the whole body's baseline
Molecular recognition axis	The sensitivity of the receptors that pass signals
Nervous-system axis	The autonomic nerves and the pain circuits
Circulatory axis	The flow coming in and going out
Endocrine axis	The regulating hormones

There is no above or below among these axes.

Anyone who has read me for a while knows I speak of pressure often. So you might take it that I see the body through pressure alone. I don't. Pressure is one branch of the physical axis, and the physical axis is one axis among many.

Which Is Why the Same Illness Starts Differently

Take the same "chronic fatigue" as an example.

For one person it starts at the immune axis.
The immunity of the gut lining has been roused for a long time. Absorption has broken down, and with no materials coming in, energy doesn't get made. This person also has diarrhea or digestive trouble. The place to work on is the gut.

For another it starts at the nervous-system axis.
The tension hasn't let go for years. Sleep is shallow, small things startle them, they are always on watch. The body has never once rested. The place to work on is the nerves.

For another it starts at the physical axis.
Breathing is shallow. A stiff ribcage and a swollen belly keep the diaphragm from coming down. The balance of oxygen and carbon dioxide is unsettled. The place to work on is the breathing and the belly.

For another the time axis decides it.
The same load differs depending on whether it built up slowly over months or landed all at once. Whether the body had time to prepare divides the outcome.

All four carry the diagnosis "chronic fatigue." Yet the place to treat is entirely different.

When One Gives Way, the Rest Follow

There is another point that matters here.

The axes are attached to one another. When one gives way, the rest are shaken in turn.

Long-standing diarrhea goes like this.

  The immune axis is shaken (the gut lining stays on watch)
        ↓
  Absorption breaks down
        ↓
  The metabolic axis sinks (energy can't be made)
        ↓
  The circulatory axis narrows (no margin to reach the hands and feet)
        ↓
  The endocrine axis is spent (cortisol all used up holding on)

What the patient reports is usually the bottom of that list. "My hands and feet are cold and I can't get up in the morning."

But what happens if all you look for is something to warm the hands and feet? As long as the top stays as it is, the bottom gives way again.

Reading which axis gave way first — that is what the consultation is for.

So These Are the Questions I Ask

These are what I ask in the consulting room instead of the name.

"Since when?" — I am looking at the time axis. How long, how quickly it worsened.

"What makes it better and what makes it worse?" — Worse after eating, better with movement? This is where the axes divide.

"Apart from this, how is everything else?" — Sleep, digestion, stool, sweat. Things that look unrelated come from the same axis.

"What happened before this illness?" — I look for the point where it began to give way.

This is why I don't prescribe from the name alone. Even with the same name as your friend, the axis that gave way first may be different in each of your bodies.

Then Is the Diagnosis Unnecessary?

No. It is essential.

There are illnesses that have to be ruled out first. Tumors, infection, autoimmune disease, diseases of the heart and vessels. These are not for "reading the axes"; they need an accurate diagnosis and the treatment that fits it.

I find my place once those are ruled out. Someone whose tests show nothing much wrong yet who has been struggling a long time — that is the place I take on.

No name doesn't mean no illness. It may mean it hasn't broken down enough to be named yet. The environment has shifted, while the parts are still sound.

I believe that at that place it can be turned back.

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Each of the axes is something physiology deals with. The immunity of the gut lining bears on immunity throughout the body, metabolism is shaken when absorption breaks down, and the autonomic nerves regulate circulation.

The way of gathering these into axes and reading which one tipped first is not a textbook classification but a framework I have put together over long practice. If a better explanation comes along, I intend to change it.

And there are many illnesses this framework doesn't explain. What herbal medicine cannot help, I tell you it cannot help.

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To "but my friend takes a different medicine," this is my answer.

"It is an illness of the same name, but the order in which your two bodies gave way may be different."

So the question to ask is not "what illness is this," but "where did my body begin to give way."

Written by Dr. Heo Ji-young (PhD in Korean Medicine Pathology, Kyung Hee University · former Research Professor of Herbology, Kyung Hee University)