Treatment Strategy, Pattern Differentiation, and Case Management
Strategy and differentiation
Treatment strategy asks what to treat first, how much, and for how long. Distinguish root (ben) from branch (biao), and decide whether to treat the branch acutely, support upright qi, or eliminate pathogen. Consider constitution, age, season, and course. Pattern differentiation should be dynamic: a pattern can transform, and the formula should follow the change. Case management includes baseline assessment, clear goals, informed consent, scheduled follow-up, and referral when red flags appear.
Traps
A common error is treating a label rather than the patient-"liver qi stagnation" does not automatically mean a fixed formula. Another is ignoring the acute branch while pursuing a chronic root, or over-treating a weak patient with strong draining herbs. Do not confuse a single symptom with a pattern, and do not continue a formula unchanged when the tongue or pulse has shifted.
Worked example
A patient with chronic fatigue and poor appetite develops sudden sore throat, fever, and chills. The acute exterior pattern is the branch; the underlying deficiency is the root. Treat the acute branch first with a gentle release formula, avoiding heavy tonics that may trap the pathogen. Rule of thumb: in acute-on-chronic presentations, address the urgent branch, protect upright qi, and reassess within days.