Same Disease — Why Do I Treat Each Person Differently?

"My friend has the same disease, but was given a different medicine. Why is that?"

This is a question I often get at the clinic. And if I can't answer it properly, Korean medicine comes to look like it's just "prescribing roughly differently from person to person."

Today I want to tell you exactly why.

What does a disease name tell us?

A disease name is a name given to the appearance shown at present.

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

A disease name is the name of a result. Treatment is done to the cause.

The axes that make up the body's environment

I see the body like this. Disease does not arise because a part breaks; it arises because the environment has changed.

And that environment is made up of several axes.

Axis	What it deals with
Physical axis	Tension, stress, pressure — the forces bearing on the tissue
Time axis	How fast, how long — speed and accumulation
Chemical axis	Enzymes, acid-base, ions and electrolytes
Metabolic axis	The work of producing energy
Immune axis	The immunity of the gut mucosa sets the whole body's baseline
Molecular recognition axis	The sensitivity of receptors that exchange signals
Nervous-system axis	The autonomic nervous system and pain circuits
Circulatory axis	The flow of what comes in and goes out
Endocrine axis	The regulating hormones

Among these axes there is no above or below.

Those who have read my writing for a long time will know that I often speak of pressure. So you might mistakenly think I see the body only through pressure. That is not so. Pressure is only one branch of the physical axis, and the physical axis is only one among many axes.

So the same disease begins differently

Let me take the same "chronic fatigue" as an example.

For some, it begins at the immune axis.
The immunity of the gut mucosa has been excited for a long time. Absorption has broken down, and since the materials don't come in, energy isn't made. This person also has diarrhea or digestive trouble. The place to work on is the gut.

For some, it begins at the nervous-system axis.
For years the tension hasn't let up. Sleep is shallow, they are startled by trivial things, always on guard. The body has never rested. The place to work on is the nerves.

For some, it begins at the physical axis.
Their breathing is shallow. Because of a stiff ribcage and a distended belly, the diaphragm can't descend. The balance of oxygen and carbon dioxide is shaken. The place to work on is breathing and the belly.

For some, the time axis decides it.
Even the same stimulus differs whether it accumulated slowly over months or was received greatly all at once. Whether the body had time to prepare divides the result.

All four have the diagnosis of "chronic fatigue." Yet the places to be treated are completely different.

When one breaks down, the rest follow

Here there is another important point.

The axes are attached to one another. When one breaks down, the rest are shaken in a chain.

Take long-standing diarrhea as an example.

  The immune axis is shaken (the gut mucosa stays on guard)
        ↓
  Absorption breaks down
        ↓
  The metabolic axis collapses (energy can't be made)
        ↓
  The circulatory axis narrows (no room to reach the hands and feet)
        ↓
  The endocrine axis is depleted (all the cortisol is spent enduring)

At this point, what the patient complains of is usually the bottom. "My hands and feet are cold and I can't get up in the morning."

But what happens if you warm the hands and feet and take something said to be good for the adrenals? As long as the top stays as it is, the bottom breaks down again.

Reading which axis broke down first — that is the work of the clinic.

So I ask these things

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

"Since when?" — I look at the time axis. How long, how fast it worsened.

"What makes it better and what makes it worse?" — Does it worsen when you eat, get better when you move? Here the axis divides.

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

"What happened before this illness?" — I look for the point where the breakdown began.

This is why I don't prescribe just from hearing a disease name. Even with the same disease name as your friend, the axis that broke down first may differ between the two of you.

Then is the diagnosis unnecessary?

No. It is absolutely necessary.

There are diseases that must be ruled out first. Tumors, infection, autoimmune disease, diseases of the heart and blood vessels. These must not be approached by "reading the axes," but need an accurate diagnosis and the treatment that fits it.

I find my place after ruling those out. A person who is long troubled even though the tests show no great abnormality — that is the place I take on.

The absence of a disease name does not mean there is no disease. It may mean it hasn't broken down enough to be named yet. A state where the environment has changed, but the parts are still fine.

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

Speaking honestly

The framework of "axes" I have described so far is not a classification found in textbooks. It is what I have observed in long clinical practice, organized into the language of modern physiology.

Each of the axes is established physiology. That the immunity of the gut mucosa affects whole-body immunity, that metabolism is shaken when absorption breaks down, that the autonomic nervous system regulates circulation — all are well-known facts.

But the way of bundling these into "axes" and reading which one broke down first is my interpretation. I do not claim it as truth. If a better explanation comes along, I intend to change it.

And there are many diseases this framework does not explain. Saying that what herbal medicine cannot help, it cannot help — I think that is the minimum honesty I can offer a patient.

---

To the words "my friend was given a different medicine," I answer like this.

"It is a disease of the same name, but the order in which your two bodies broke down may be different."

So the thing to ask is not "what disease is it," but "where did my body begin to break down."