Honorary Editor-in-Chief of Journal of Traditional Chinese Medicine Dong Demao, Executive Director of All China Association of Chinese Medicine
Learn from a mentor
I was born in Caozhang Village, Fangshan County, Beijing. After graduating from a high school in Liangxiang County in 1926, due to his poor family and unable to continue his studies, he was introduced to a shop as an apprentice to make a living. Because of his younger brother's illness, he was too sorrowful to be a quack doctor, so he determined to go to medicine. My initiation teacher for medical studies was my father-in-law Mr. Zhao Tingyuan. He began to teach me to recite books such as "Leigong Yao Xing Fu", "Linghu Mai Xue", "Three Character Classics of Medicine", "Yi Zong Jin Jian" and so on. At that time, young people were so strong, they often studied eagerly, even if they changed their clothes, they didn't let go. Once I went to my aunt's house and never forgot to endorse. My aunt was deeply moved and sponsored me to apply for the North China Medical College to start my real medical career.
North China Medical College was constructed in 1931 by Mr. Shi Jinmo, one of the four famous doctors in Beijing. In addition to traditional Chinese medicine courses, the college also offers basic and clinical courses in western medicine, with a four-year schooling system. Shi Lao serves as the dean, and personally teaches and leads students in clinical practice. Many famous teachers employed by the college, such as Zhao Bingnan, Chen Yicheng, Yao Jiying, Zhao Xiwu, Yang Shucheng, Yu Daoji, and Western medicine expert Jiang Sichang, have all taught at the school. The college has been established for more than ten years and has trained five to six hundred students. After graduation, they are distributed throughout the country, and most of them are in Beijing, Tianjin, Hebei, Shandong, Henan and other places. Many of them have become the backbone of the current Chinese medicine community.
I studied in the school for the third time, and after graduation I studied internal medicine with Shi Lao. At that time, the students who followed the teacher successively included Ha Litian, Zhu Ye, Li Jiewu and so on. Under the influence of such a superior environment, I have made great progress in my studies. Since 1936, I have been assistant business in Shilao Clinic and have been engaged in acupuncture and moxibustion clinic for more than five years.
Under the teachings of Mr. Shi himself, he was impressed and understood. The main method I learned at the time; endorsement in the morning, copying prescriptions with the teacher during the day, sorting pulse records in the evening, reading medical books, I classified the pulse records of the teacher by disease, certificate, and prescription, and checked the corresponding literature , Make notes, add notes, and often try treatments, and write down personal experiences. So reviewing the past, learning the new, repeatedly verifying, and learning from the teacher's academic experience.
Shi Laozhi used the method of clearing and relieving fever. He said, "In my treatment of exogenous diseases, we should first distinguish the external and internal, cold and heat, and the deficiency and the actual, and then the levels are distinct. For the external disease, sweating should not only be known, and attention should be paid to clear the internal." Qingli medicine ratio. In the treatment of infectious febrile diseases, such as influenza, diphtheria, rubella, chickenpox, scarlet fever, erysipelas, mumps, acute tonsillitis, etc., Yinqiao powder is commonly used to add or subtract, disperse wind-heat, clear heat and detoxify, and its addition and subtraction changes Very wonderful, such as; add hemp and apricot to add cold, increase the amount of nepeta; add heat with blood, add rehmannia, paeonol, salvia miltiorrhiza, add heat toxin, add glutinous rice, rhizome, comfrey, sweet yellow} add wetness, add poria, soybean If the limbs are painful, use vines for silver flower and add mulberry branches; if rash occurs, add duckweed and cicada clothes. He also has a unique style of applying Zixuesan. It is often used when there is no delirium. As long as there is high fever, constipation, red tongue, and yellow coating, the organs are used to relieve the fever and prevent the heat from entrapment.
In the treatment of internal injuries and diseases, Shi Lao emphasized the treatment of Qi and blood. It is believed that "qi and blood" should be listed in the eight outlines and become the "ten outlines." And pay attention to regulating the spleen and stomach, using the methods of soothing the spleen, mobilizing the spleen, and rejuvenating the spleen, which is the foundation of nurturing.
The husband used to use drugs "dual", known as "Shi's anti-drug", often used together with cold and heat, bright yang, qi and blood, dryness, and painstaking medicine, except for the compatibility of ancient people (such as frankincense with myrrh, three-row with turmeric) In addition to effective small parties (such as Zuojin, Zhishu, Shixiao, Jinlingzisan), always create more. It is well known that Shilaoshi used yam and astragalus to treat high feces and sugar, and Atractylodes sinensis with Yuanshen to treat high blood sugar, which is the real medicine of modern Chinese medicine and has been repeatedly tested in the clinical treatment of diabetes. His application of drugs is often inspired by the ancients, such as Pu Huang's treatment of stroke and aphasia, and Chanyi's treatment of tinnitus, which is his clinical experience.
My husband especially praised Sun Yikui's "Chishui Xuanzhu" and Zhang Shiwan's "Zhang Shiyitong", and considered them to be the must-read books for internal medicine in Chinese medicine. "Zhang Shiyitong" is the brainchild of Zhang Shiwan's teachers and students. It collects more than 100 types of pre-sage books, 16 volumes, 700,000 words, and describes internal medicine syndromes and treatments, including women, children, and surgery. I read "Zhang's Medical Master", with the theory of internal difficulty Zhongjing as the classics, and the theory of later generations as the latitude, and the mastery of its syndrome differentiation program and the application of prescriptions are essential. For Zhang’s personal cases and inventions of syndromes and treatments, I also pay attention to them, such as collaterals and lily disease. There are few examples of verification and treatment in the past. They are included in Zhang’s book and are specially recorded for future reference. For each disease, especially focusing on the understanding and development of the diagnosis and treatment of each family in the past dynasties, it has its own benefits. In the future, I will also refer to the "Ancient and Modern Medical Records" and other excellent medical records, refer to each other, and I have found many new ideas.
Re-accumulate step by step
In my clinical practice, I have an important experience, that is, reading, seeing a doctor, there is an accumulation process, from less to more, from simple to complex, from easy to difficult. Bit by bit, it accumulates over time and trickles into a river. Take the spleen and stomach theory as an example
(1) Using ancient prescriptions, the master’s mind turned the spleen and stomach syndromes into clinical common. For internal injuries and fevers of weak spleen and stomach and subsidence of qi, everyone knows to use Buzhong Yiqi Decoction, that is, "warm and warmth to remove heat." At the beginning, I also applied this prescription to treat every effect of this syndrome. Later, it was discovered that many patients recovered from other symptoms during the treatment of fever, which attracted my attention. Then pay attention to this, record it, and put it together in a book. If there is a fellow Wang who suffers from internal hemorrhoids and blood in the stool, self-use Buzhong Yiqi Decoction is invalid. The rest of the diagnosis is that the Qi is sinking, the blood is not controlled, and the medicine is consistent. Why does the Dongyuan prescription fail? There is still a layer of large intestine blood heat in the hemorrhoid blood. Since ancient times, Sophora japonicus has been used to dispel the cold serum heat, so the two prescriptions of participating in Taiwan are effective. It is also effective for other patients with hemorrhoid blood. The prescription is: 15 grams of Astragalus, 12 grams of Codonopsis, 10 grams of Atractylodes and Angelica, 5 grams of Cohosh, 10 grams of Sophora japonica, 12 grams of Sanguire and Platycladus orientalis leaves, and tangerine peel 5 grams, 3 grams of Bupleurum, 5 grams of licorice. Hemostasis after every five doses, followed by ten doses for consolidation. Since then, Yu Xi used Buzhong Yiqi Decoction to participate in other prescriptions to treat various diseases of Zhongqi depression. Such as habitual abortion, use the original formula to add donkey-hide gelatin, mugwort, Dipsacus, eucommia, and mulberry parasite to nourish the kidney and strengthen the fetus. Use the original formula to add windproof and citrus aurantium to combine Sanqi San, which can improve Qi; Recipe plus Chuanxiong (2.4g), Fangfeng treats spleen deficiency and chronic diarrhea, originated from You Yi's "Golden Chamber Ji", but it does not come out of Dongyuan to nourish the middle and nourish qi and raise yang. It can be seen that the key to using ancient prescriptions is to learn from their hearts, use their methods, and be flexible in order to accumulate their own experience.
(2) Studying theory is worth tracing the source. Starting from the application of Dongyuan Buzhong Yiqi Decoction, I repeatedly read Dongyuan’s "Internal and External Injury Distinguishing Theory", "Spleen and Stomach Theory", and "Lanshi Secret Store". Get a lot of inspiration. In particular, "Spleen and Stomach Theory" quoted a large number of "Suwen" and "Lingshu" scriptures, expounded the spleen and stomach theory, raised difficulties and solved puzzles, advocated the theory of lifting and lowering, and prepared various prescriptions for invigorating the middle and rising Yang. Therefore, I focus on the spleen and stomach physiology, pathology, symptoms, treatment methods, prescriptions, and medicines to trace the origin of the spleen and stomach theory and compare similar and opposite aspects comprehensively. For example, in the "Internal Classics" "Human is based on stomach qi" and Li Zhongzi's "Spleen is the foundation of acquired nature". "Internal Classics" "Yang Dao is solid, vagina is weak" and "Treatise on Febrile Diseases" Yang Ming "stomach family is solid", Taiyin spleen is insufficient Dongyuan promotes spleen Yang, Tianshi nourishes stomach yin, Dongyuan "regulates the spleen and stomach to treat the five internal organs" and Jing Yue "regulates the five internal organs to regulate the spleen and stomach." All these are divided into categories by famous sentences, prescriptions, main methods, and main medicines, accumulated and summarized, and made classification cards. Among them, I especially appreciate Zhang Zhongjing's "Golden Chamber Synopsis" "Four seasons spleen is prosperous without evil" and Zhou Shenzhai's words "Many people find the spleen and stomach to heal after illnesses are not healed". If a patient with aplastic anemia has a history of six years, the use of Western medicine and Chinese medicine for nourishing the kidney and nourishing blood is not effective. Although there is a syndrome of deficiency of the five internal organs, the deficiency is not supplemented; it is seen that the abdomen is full, appetite, loose stools, greasy moss, cold and damp For sleepy spleen, put Huoxiang Zhengqi and Pingwei San, bitter, warm and dry dampness, awaken the spleen and appetite, eliminate cold and dampness and the middle earth will become healthy, and the five internal organs will be nourished by filling the valley with Qi. Following the various methods of invigorating qi and nourishing blood to treat difficult diseases such as chyle ascites, hemopuromyiasis, coronary heart disease, etc., it has also achieved good results (see the second issue of "Journal of Traditional Chinese Medicine" in 1981, Duan Rong text).
(3) Thinking hard and summing up experiences and lessons. I am not only used to accumulating successful experiences, but also paying attention to summing up failures and lessons from frustrated cases. I remember that in Yongxiu County, Jiangxi Province, there was a group of children with summer fever who had fever, polydipsia, frequent urination, dullness, loose stools, red tongue, and false pulse. The initial syndrome is yin deficiency and heat, and nourishing yin and clearing heat are not effective. After thinking about it for a long time, the upper thirst and lower urine are the dialectical focus, but the compress is abnormal. "The spleen is the gastrointestinal fluid." Violation of this: Chisuimu set the chisel and twist the boat. The symptoms of fever, appetite, loose stools, red tongue, and empty pulse are caused by insufficient spleen yin and floating yang. Therefore, Chen Wuze Liusou San, "Jufang" Shenling Baizhu San, etc. were used to moisturize the spleen and yin with a large amount of yam, lentils, Yingshi, and lotus meat, combined with Shenzhulingcao to invigorate the spleen and nourish the qi, and the spleen and soil would be healthy After the liquid is infused, the spleen yin will recover and the heat will disappear, and the whole work will eventually be achieved.
At the same time, I often draw lessons and accumulate experience from the failures of other people's treatments. There was a six-month-old baby surnamed Liu, suffering from pneumonia. The use of blue, chain, red, and gentamicin was not effective. Except for fever, no sweat, cough, phlegm, hold breath and lift shoulders, he had vomiting, anorexia, and diarrhea. Twenty times, the stool is green and mucus-like. Ask his mother, the child usually has poor digestion, often diarrhea and vomiting. I have experienced vomiting and diarrhea after taking western medicine erythromycin. It can be seen that the spleen and stomach have been injured, which is caused by the loss of temper and stomach qi. Therefore, it is recommended to stop using western medicine and limit the amount of breastfeeding to protect the stomach, wheeze up and down and diarrhea and fever. It is commonly known as "flood-bottom typhoid". For example, the spleen and stomach can be easily injured when treating diarrhea. I think that the condition is complicated, the deficiency of the spleen is the root, and the actual lung is the symptom. The symptoms should be treated first, and the root cause should be treated later. Take the second dose of Xiaoqinglong plus Huangqin Decoction (the original recipe is gypsum, because of spleen deficiency gypsum is not suitable, it is easy to take Huangqin), after getting sweat, switch to Jianpai and Stomach Shenqin Baizhu Powder to cultivate the soil.
(4) Selected medicines, repeated scrutiny and consideration of the application of the medicines, I also continue to accumulate experience in clinical syndromes, repeated scrutiny, and compare the differences between similar drugs and the same drugs.
For example, drugs commonly used in clinical treatment of qi stagnation of the spleen and stomach, such as Cyperus rotundus, black medicine, woody, Amomum villosum, tangerine peel, Citrus aurantium, Magnolia officinalis, betel nut, big belly peel, komen, etc., its spicy fragrance is warm and dry. It relieves pain, relieves fullness, relieves depression, resolves phlegm, dispels dampness, harmonizes the stomach, and moves the spleen. Some medicines also have the effects of relieving asthma, promoting blood circulation, soothing the liver, and dredging down. However, it is not suitable for long-term use because it is dry and easy to consume energy and burn fluid. Later, it was discovered in the clinic that "Jiyin Gangmu" Jiawei Wuyao Decoction can not only treat women's dysmenorrhea, but also have an effect on spleen and stomach qi stagnation syndrome. Fang Neiwu medicine, Cyperus rotundus, Amomum villosum, and Shuxiang four meditation qi, the medicinal properties are peaceful, and there are differences in the same, and the same in the differences. For example, Xiangfu promotes qi and relieves the liver and relieves depression, which is better than analgesic; black medicine promotes qi to eliminate fullness, which is suitable for fullness of chest and abdomen; Muxiang promotes qi and widens to stop diarrhea, which is more suitable for diarrhea and diarrhea. Appetizing, can aromatize dampness. l Clinically, choose one of them =, a small amount of three flavors (3 to 5 grams) and use it with each good effect.
Another example is the disharmony of the spleen and the stomach, and the stomach qi is reversible, see vomiting, heating, hiccups, and soreness, etc. For the rest of the stomach, the two medicines are inferior and ocher. At first, I used Zhongjingxuan Fudaizhe Decoction, but the time limit was not effective. It is more appropriate to use the original formula for those with deficiency of the spleen and stomach. For those with excessive gastrointestinal heat and constipation, dry mouth, and greasy moss, remove ginseng, grass, jujube, add melon wilt, weathered nitrate, rhubarb, citrus aurantium, combined use with Jiangnitong . It can be seen that the selection of medicine must be based on the correct differentiation of symptoms and signs before it can accumulate reasonable experience.
For Yueju Pills, Wuji Pills, Banxia Xiexin Decoction, Zhizhu Pills and other prescriptions, the compatibility ratio of the remaining medicines also depends on the patient's physique and symptoms of cold and heat deficiency. Such as Zhizhu Wan, the deficiency of Atractylodes macrocephala, and the actual weight of Citrus aurantium. Wu has pills, Hanjun Wuyu, Rejun Coptis. Yueju pills, Cyperus rotundus, Chuanxiong, Cangzhu, Divine Comedy, and Shanzhi treat the "six depressions". They also distinguish between qi, blood, dampness, phlegm, food, and fire depression.
When taking medicine, I always observe it carefully. For example, Xiaoyao powder contains mint to relieve depression and improve vitality. The dosage is small and the compatibility is good. It is also effective after adding it to the spleen and stomach prescriptions. And imitating the meaning of the use of lotus leaf, Huoxiang leaves, also played the same effect. Then add sesame leaves and loquat leaves to the Jiangni prescription to relieve vomiting and relieve the lungs. Both are leaf medicines, lotus leaf and mint promote clearness, loquat leaf and sesame leaf reduce turbidity. This kind of continuous accumulation of experience seems to be commonplace, and many things can be gained from it.
Be good at induction
Learning is not only more important than accumulation, but also the accumulation of things should be summarized into a brief program, to control the complexity, and guide the clinic.
In the treatment of liver disease, I focused on studying "Internal Classics", "Difficult Classics", "Chao's Disease Origin", "Thousands of Gold", "Zang Fu Yao Shi Jian Zheng", "Xixi Book House Night Talk", "Bi Hua Medical Mirror" , And even recent theoretical works on the liver such as Zhao Shuping and Qin Bowei. But I always feel that liver disease is more common in clinical practice, but the theory is complicated. On the basis of the above, I use induction to summarize the following points;
(1) The Physiology of the Liver "The liver is the officer of the general." The master plan to hide the soul, which is related to the modern anatomical nervous system. "The liver stores blood", "the blood of human beings belong to the liver", which stores blood, regulates blood volume, and is related to blood circulation. The liver is yin and yang is used, which is a combination of the two.
(2) The treatment of liver disease, one is to nourish the liver and the other is to make the liver. Nourishing the liver and body is to nourish yin and blood, and it can also start from the aspect of organ intergrowth. The liver can be used for the purpose of restoring and dredging, and it can also start from the aspect of organ phase system. Time or both.
(3) Classification of liver disease syndromes and treatments
1. Liver depression. It is caused by emotional suppression, and often sees fullness or pain in the flanks. Method to aromatic Xin San, soothing liver and relieving depression. , Fang with Sini San, Chaihu Soothing Liver, Xiaoyao, Yueju. Medicinal Bupleurum, Cyperus rotundus, Chinese neem, bergamot, orange leaves, green peel, etc. Combine fire plus qin and Zhi.
2. Anger. More than qi is fire, which comes from stagnation of the liver. Symptoms include red face, red sun, bitter mouth, ringing ears, headache, irritability, red tongue, yellow coating, and facial symptoms are the main symptoms. For those who are really hot and strong, use the method of clearing and purging, such as Angelica Aloe Pills and Longdan Xiegan Decoction. If the symptoms are mild, or if the heat is strong and the body is weak, then take a light dose to vent the fire, such as Danzhi Xiaoyao San, Qinghao Biejia Decoction, use mulberry leaves, chrysanthemums, Danpi, Danshen, Gardenia, Yinchen, Xia Withered grass, artemisia annua, etc.
3. Liver yang. The rising of liver yang can be caused by insufficient liver blood, deficiency of liver and kidney yin, or rising liver fire. Headache, dizziness, irritability, tinnitus, vertigo, insomnia, pain in the mouth, and red tongue are more common. If liver blood is insufficient, use the liver to suppress Yang, and Siwu Decoction plus drugs for suppressing Yang. For those caused by rising liver fire, use Pinggan Qianyang, add flavored Cizhu Pills and Longgu Oyster Soup. If the liver yin is insufficient, the yin and yang can be nourished, and the Qiju Dihuang Decoction should be added with anti-yang medicine. Qianyang medicine includes keel, oyster, magnet, stone cassia, mother-of-pearl, ochre, etc. Choose 2 to 3 flavors, and the amount should be large and fry first.
4. Liver wind. Either from fire, or from stagnation of qi, or from yin deficiency and less blood, it belongs to internal wind. Wind vacillation, number of good deeds change, symptoms such as dizziness, tremor, convulsions, and skin consciously like insects. It is appropriate to extinguish the wind inside, and not to hurt the liquid. Fang such as Tianma Gouteng Decoction, heat spasm with antelope horned Uncaria Lek, blood dryness and wind movement with Huanglian Ejiao Jizi Huang Tang, yin deficiency and wind movement with Sanjia Fumai soup.
5. Liver deficiency. Insufficient blood. And because of the same origin, the deficiency of liver yin can be combined with kidney yin deficiency. Deficiency of liver yin cannot conceal yang, so it means Yin deficiency and Yang hyperactivity. Siwu and Danggui Buxue Decoction are used to invigorate the liver and blood; Yiguan Decoction and Qiju Dihuang Decoction are used to invigorate the liver yin. If the Yin and blood are insufficient, the main symptoms of pain can be softening the liver, using Shaoyao Gancao Decoction, Danggui Shaoyao San. If liver deficiency and blood are not concealed, use Jiao Ai four substances plus hemostatic medicine, which is often used for women's metrorrhagia. If liver deficiency is not solid, blood does not nourish the fetus, or infertility, Jiao Ai Si Wu and Buzhong Yiqi Decoction are often used.
6. Liver cold. Most liver diseases are hot, but there are also cold syndromes. For the syndrome of excessive cold of the liver, such as accumulation syndrome, it is suitable for warming, take the "Shen's Zunshengshu" blood pills, and for the deficiency and cold of the liver, take Jingyue Nuangan Decoction.
In this way, the intricate liver diseases are divided into six categories. The syndrome differentiation of deficiency, feast, cold, heat, yin and yang is convenient for clinical use and also suitable for teaching. Of course, this still needs to be based on the correct grasp of the thought of syndrome differentiation and treatment in order to be flexible in and out, otherwise it will become a sourceless water and a tree without roots. In addition, I have summarized the spleen management methods into the ten methods of replenishing qi, lifting, warming the middle, clearing away heat, regulating qi, consolidating astringent, removing dampness, nourishing yin, and eliminating dampness. The method of attack is to pass down, regulate qi, clear away heat, dispel dampness, and dispel dampness, and the method of tonic is to replenish qi, lift, warm middle, solidify astringent, and nourish yin. All these show the importance of induction in the learning process.
In short, to do academics and careers, you must learn from good teachers and make good friends to lay a solid foundation for your career. Good induction, emphasis on accumulation, familiarity, careful thinking, and magical use are also the so-called "accumulate thick and thin hair", especially in the learning process. This is my shallow experience, and I put it forward for your reference.
(Compiled by Lu Shoukang)