我还对佐药的积极因素，进行了推敲和验证。如真武汤仲景用心良苦，方内白芍恰到好处，既可缓和附子辛热之性而不致伤阴，又能引导附子达下元而不得上窜。与附于相配，阴阳互济；同术、苓为伍，利湿外出。倘若去掉白芍则方义太变，稍微不切就有火盛耗津之虞。如果重用自芍则功力又进，敛阴涵阳，可治虚阳欲浮之证。显然，那些恐其恋邪和视其无功，便弃之不用的人，是千虑一失了。无数的经验证明，方剂中佐或反佐的应用具有实际意义，真武汤如此，芍药汤、达原饮等方也是如此。
此外我还结合五行学说分析方剂的内在联系。如甘露消毒丹治疗湿热黄疸就是一个典型。众所周知，木气太过必然克土侮金，母病及子，肯定火为所伤，子病及母不免水受其害。本方茵、芩、薄荷清泻肝木，蔻、菖、藿香芳化脾土，贝母、射干清宣肺金，通、滑、连翘既降心火叉利肾水，一举三焦全理。实较茵陈蒿汤更胜一筹。这样体现祖国医学整体观念的实例，绝非仅此而已，像六味丸、一贯煎等，不胜枚举。
必须指出，强调使药而不能以使代君，重视佐药而不能以佐废臣，提倡五行演绎而不能牵强附会。否则，难于取效。
一九五五年四月，我被派往锦州省中医进修学校任教。在担任古典医籍和临床课的讲授过程中，我钻研了阴阳五行学说，写了《论阴阳学说的哲学思想》一文，以天平的形象比喻，并阐述了阴阳的斗争、互根、消长和平衡。并用《内经》所说的「阴平阳秘，精神乃治」、「阴阳离决，精气乃绝」的理论。在一九七二年三月十日诊一农民，张姓，男，四十九岁。主诉：五天前，突发咽紧喉痒，胸闷脘痛，恶心呕吐，赴我院急诊。心电图测知为后壁心肌梗塞。血压为零，经西医抢救，证见好转，血压尚低(70／50毫米汞柱左右)，胸痛彻背，恶寒路卧，四肢厥冷，神疲无力，面色苍白，唇甲皆青，尿频、大便溏，舌淡苔白，脉迟微弱不起。此为胸阳不振，寒邪太盛，气失宣达，心脉闭阻，治以回阳救逆，用益气复脉；熟附子、干姜、肉桂、白朮、红人参、茯苓、陈皮、半夏、五味子、炙甘草，生姜为引，水煎，二剂。
』三月十四日复诊：胸痛顿轻，恶寒大减，血压渐升(90／60毫米汞柱)，脉来较前有神，此时必予「阴中求阳」，改拟益气养阴，通阳复脉，用生脉散加熟附子、千姜、炙甘草，水煎，六剂。
三月二十三日三诊：胸痛续减，手足转温，唇甲红润，二便改善，血压逐增(104／70毫米汞柱)，舌淡红，苔薄，脉缓。重按略嫌无力，再予平补气血、通阳复脉(党参、麦冬、生地、丹参、桂枝、生姜、大枣，炙甘草)，十剂。
八月七日四诊：基本康复，气力觉充，血压回升(王60／90毫米汞柱)，时有轻微胸痛，再以上方加瓜萎、薤自，续进十剂，症状消失。
按本例乃「厥心痛」，为阳气衰微，阴邪痹阻所致。当务之法，通阳复脉，遵循「无阴则阳无以生，无阳则阴无以化」之义，初用回阳救急汤，使「阴消阳长」，二诊以四逆汤合生脉散，防其「阳极反崩」三诊投炙甘草汤更令「阴平阳秘」，运筹两全，不致偏伤。此即张景岳所谓「善补阳者，必于阴中求阳」是也。我对五行学说的实在意义进行了研究，认识到生、克、乘、侮是人体生命过程中的运动形式，无论已病或未病，皆不例外。这一学习心得，对我理解脏腑的生理，病理以及研究临床的诊断、治疗，帮助极大。
读书贵在存疑。我学完《医学三字经》已历时四十年了，但其中「胀满蛊胀篇」所谓「单腹胀，实难除。山风卦，指南车。易中旨，费居诸」一段，一直未能了了。陈氏云云，后世相因，皆以抑术培土出其方药，结果不治者多，回春者鲜，这激发了我的求知之心。于是，深究了《周易》，联系了中医理论，明确了歌诀台义。简胲说来，「风」属木属肝，「山」属土届脾，=者合成蛊卦，其刚上，高亢而不下接，其柔下，退缩而不上交。．两不相通，胀病遂成，然此证非但有「木乘土」之由，而且存「土侮木」之因，况暂病则实，久病刚虚，疏泄失司，运化无权又属势在必然。缘肝为系血之脏，初为气滞，渐为血瘀，且脾乃仓麇之官，先必湿停，后必纳呆。拟以四消汤，理脾与疏肝同施，补益和消导并用，行气与活血相协，芳化和淡渗共济，常常疗效满意。由此体会，先精后博，博而后精，温故知新，不断修学，是从无知到有知：从知之甚少，到知之较多的惟一道路。
自从走进辽宁的中医最高学府辽宁中医学院，在学习条件上我得到了我想得到的一切。在这里的第一个收获是脉学，我结合教学，阅读了《内经》、《伤寒论》和《金匮要略》的脉学部分，学习了({脉经》、《三指禅》和《濒湖脉学》的全部章节，结合长辈的传授及个人的体会，写成了读书心得《指下权衡》。将二十八种脉象按浮、沉，迟、数、虚、实，归纳深浅、大小、粗细、长短、清楚与模糊，加以鉴别，指出它们所主病症的程度差异。以关前关后、左手右手相互比较，提示上下虚实、气血盈亏、阴阳盛衰的不同情况。肯定了心肾不交、脾肾阳虚、肝气乘脾、脾肾阴虚等十七种并病的复合脉象，阐释了可能出现的细微变化。并在脉象上主张形容筒赅，反对比喻繁杂。说明了取法与指下感觉。
其次，我又对舌诊进行了研究。我在了解基本知识和变化规律的基础上，重阅先人记载，综合临证抬遗，从简列繁，由粗而精，将舌质分为六纲，并与深、浅、老、嫩相参，分析病机，推测趋向，把舌苔分为四十九目，且同厚、薄、润、燥合论，指明病因，谈及胃气。将舌态分为十类，尚和质、苔、脉、症共议，分析病所，细述利害。意在以纲带目，以证言类，使一般之中不漏特殊，灵活之时不失规矩。
我还对「宣可去壅，通可行滞，补可扶弱，泄可去闭，轻可去实，重可镇怯，滑可去着，涩可固脱，燥可胜湿，湿可润燥」的十剂之说，有选择地收集了牛榔散、。二妙散、左金丸、交泰丸、丹参饮、生脉饮、芍药甘草汤、三子养亲汤等二百多个药少力专的小验方，既可调理阴阳、寒热、表里，虚实、气血之变，又能解除肿胀、痛麻、吐捋、秘淋、喘咳之苦，便于调节方剂中补泻并进的比重和标本兼施的缓急，不至于忙中智昏，手足无措。可是，强调选用小方，必须在精通常用代表方剂的基础之上进行。也只有如此，才能信手拈来，运用自如。
在临床中我体会到，应态度严谨，稳中求效。如此，我为自己立下了「六宜准则」，即实宜量重，虚宜剂平}缓宜味多，急宜方精；轻宜缓图，危宜速功。此外，还拟定了「十防纲要」，即；脉浮防火郁，脉大防暴厥)面青防风动，面赤防阳越；热证防戕阳，寒证防耗液久病防卫虚，表病防内邪，渴甚防脾呆，湿肿防津竭。这些看似简单，实为重要，若稍有失慎，轻者贻误病机，重者杀人致命，诚不如防患于未然之时。，．
记得一九七一年五月十七日，治一女性患者，三十二岁，感受风温半月有余，初起恶寒发热，鼻塞流涕，咳嗽气急，右胸疼痛，铁锈色痰。经西医检查听诊：两肺散在干鸣音；X线胸透：右肺下有密度一致之浓影】化验。白细胞19，300,分叶80％，杆状3％，淋巴17％，诊断为右下叶大叶性肺炎。曾用青霉素、氯霉素、金霉素、红霉素、雷米封等，并服中药加昧桑菊饮，高热不退(39。c)，午后尤甚，面色晦暗，精神萎靡，虚汗乏力，胸痛气短，舌红苔黄，脉细数。素休阴亏，感受温邪，留连日久，耗津动液，颇有入营之虞。治以清气透营，滋阴退热。方用银柴胡、胡连、麦冬、白薇、生鳖甲、地骨皮、丹皮、知母、贝母、生桑皮，三剂，水煎服。
五月二十二日复诊；热减(37。c)，症状亦轻，复投三剂，诸症消失，脉静身凉。
按：桑菊饮乃辛凉轻剂，主治风温初起，邪袭肺卫之证，但若热邪不解，留连日久，入于阴分者屡见不鲜，吴鞠通曾立有青蒿鳖甲汤，并指出；「邪气深伏血分，混处血络之中，不能纯用养阴，又非壮火，更不得任用苦燥。」要言不繁，阐明治则，案中所用清骨散，即仿其意。
一九七二年七、八月间，我在病房用王肯堂《证治准绳》十昧温胆汤加强心药，抢救十一次心波骤停的张姓男患者，中西医结合效果良好。当时中医认为「寒涎沃胆、胆寒肝热，心虚烦闷，心悸不眠之证」。后来在病房实习的青年大夫，看我用十味温胆汤，心有怀疑，径自改用生脉散加减，用完两剂后，心波骤停又反复发作，于是患者主动要求服用十味温胆汤多剂而愈，后调理月余出院。
一九七五年五月九日应邀会诊一许姓，女，八十一岁，华侨(居菲律宾)，在归国参观途中，至香港偶感风寒，头痛，咳嗽，身冷，乏力，抵沈后洗澡一次，病情加重。某医院诊为支气管肺炎(由葡萄球菌所弓l起)，用红霉素、氨基苄、青霉素配合中医治疗。认为邪入阳明，投以生石膏、知母、竹叶等，病势不减。
会诊时见其人体质较弱，恶寒发热(38。c)，咳喘，咯稠粘痰，胸闷气短，胃脘饱胀，呕逆不欲饮食，大便溏，面色苍白晦暗，精神萎靡不振。左脉弦细略数，右脉弦数，舌质粗糙，苔白腻。按伤寒六经辨证，此太阳表邪未解，传入少阳。发热恶寒，胸阎呕逆不欲饮食，脉弦，皆少阳证也。古云。「有一分恶寒，便有一分表证。」且「伤寒中风，发热无汗，其表不解，不可与白虎汤。」邪在半表半里之问，惟和解经枢，疏表达里，若用大剂寒凉之品，冰伏其邪，易成坏证，宜慎之又慎。治少阳证则小柴胡汤为宜，故取小柴胡汤加味：柴胡、黄芩、半夏、甘草、生姜、桔梗、枳壳、白干参、瓜萎、杏仁、桑叶、桑皮、紫菀、双花，水煎服，日服三次。
五月十二日复诊：服药后精神转佳，面有笑容，胸闷气短减轻，咳喘亦减，舌质暗红，苔黄白，胃脘稍有不适，二便如常。风寒之邪已从表解。痰热交滞，气机不畅，仍以和解为主，去桑叶之轻宣，加槟榔阻舒通气滞。另用羚羊角1克，煎水，随时饮之，以清热化痰。
五月十八日，上方续服，诺症悉失，已下床活动。
按《伤寒论》指出：「伤寒五、六日，中风往来寒热，胸胁苦满，默默不欲食，心烦喜呕……或咳痰，小柴胡汤主之。」本例为年逾八旬之老人，身体素虚，久居热带，不胜风寒，表邪不解，而见苦满、喜呕、不欲食等少阳病主要症候，用小柴胡汤，最为对症。若见其发热、咳喘，便误以为阳明里热，而用白虎汤，则甚不适宜。「有一分恶寒，便有一分表证」，表邪不解不可用清法，此为经验之谈。
通过这几个病例完全可以证实：温病的卫气营血辨证，伤寒的六经辨证，内经的阴阳八纲辨证，杂病的脏腑辨证，如掌握恰当，运用灵活，真能效如桴鼓，药到病除。
(孙继先整理)
我是怎样学习中医的中医研究广安门医院主任医师沈仲圭
【作者简介】沈仲圭(1901～)，浙江杭州人。早年受业于王香岩先生。一九二八年任教于上海南市中医专门学校，一九三。年任教予上海固医学院，一九三二年又任教于上海中国医学院。抗战期间，曾任北碚中医院院长。解放后先任教于重庆中医进修学校，一九五五年受聘到中医研究医教育外，早年起即为多种中医刊物撰文，为普及中医知识做出了贡献。主要著作有《养生琐言》、《伸圭医论汇选》、《肺肾胃病研讨集》，《中医经验处方集》、《中国小儿传染病学》等。
我生于一九0一年，祖籍杭州。父亲是清代两浙盐运使署房吏，家凌小康。到我中学=年级肄业时，家已衰败，只得改弦学医，拜本地名医王香岩先生为师。王师为湖州凌晓五门人，擅长治疗温热病，和善治杂病的莫尚吉同为杭人所称道。我在师门上午随诊，下午摘抄医案，同时看书学习。
满师后，我一面作小学教员，一面钻研医学，并执笔写文，投寄医刊。当时如王一仁主编的《中医杂志》，吴去痰主编的《神州国医学报》，陈存仁主编的《康健报》，张赞臣主编的《医界春秋》，陆渊雷主编的《中医新生命》等刊物，登载拙作颇多。
我于一九二八年在上海南市中医专门学校任教职，该校为盂河丁甘仁先生所创办。我在该校执教时，丁氏巳去世，长孙丁济万继其业，在上海白克路悬壶，同时主持校务。所用教材，有的自编讲义，有的选用古今名著。教员有程门雪、陆渊雷、时逸人、余鸿孙及我等。
一九三0年下半年至一九三一年，我再次副上海国医学院任教职，该院系陆渊雷、章次公、徐衡之三人所创办，聘章太炎为名誉院长。陆渊雷讲授《伤寒论》，章次公讲授药物学，徐衡之讲授儿科，我讲授中医常识及医案。由于师生共同努力，造就了一批优秀人才，如中国医学史专家范行准，浙江中医学院教授潘国贤，均在该院毕业。
I also carefully examined and verified the positive factors of assistant herbs (Zuoyao). For instance, in Zhenwu Tang (True Warrior Decoction), Zhang Zhongjing's design was meticulous. The inclusion of Baishao (White Peony Root) is perfectly proportioned: it can moderate the acrid-hot nature of Fuzi (Prepared Aconite Root) without damaging Yin, and simultaneously guide Fuzi to reach the lower origin (Kidney/Adrenal area) preventing it from flaring upward. Paired with Fuzi, they mutually support Yin and Yang; combined with Baizhu (Atractylodes Rhizome) and Fuling (Poria), they promote the elimination of dampness. If Baishao were removed, the therapeutic intent of the formula would change drastically, risking excessive fire consuming body fluids. If used in heavy doses, its efficacy increases, astringing Yin and containing Yang, making it suitable for treating conditions where deficient Yang is about to float outward. Clearly, those who discard it due to fear that it might retain pathogens or view it as ineffective have made a grave oversight. Countless experiences prove that the application of assistant (Zuo) or counter-assistant (Fan Zuo) herbs in formulas has practical significance. This is true for Zhenwu Tang, Shaoyao Tang (Peony Decoction), Dayuan Yin (Reach the Origin Decoction), and others.
Furthermore, I analyzed the internal connections of formulas by combining them with the Five Elements Theory. Ganlu Xiaodu Dan (Sweet Dew Detoxifying and Draining Decoction) for treating damp-heat jaundice is a typical example. It is well known that excessive Wood energy inevitably overacts on Earth and insults Metal. When the mother organ is sick, it affects the child, so Fire is certainly injured; when the child is sick, it affects the mother, so Water suffers harm. In this formula, Ychen (Artemisiae Scopariae Herba), Huangqin (Scutellariae Radix), and Bohe (Menthae Haplocalycis Herba) clear and drain Liver Wood; Kouren (Amomi Fructus), Shichangpu (Acori Tatarinowii Rhizoma), and Huoxiang (Agastaches Herba) transform Spleen Earth via aromatic properties; Beimu (Fritillariae Bulbus) and Shegan (Belamcandae Rhizoma) clear and diffuse Lung Metal; Tongcao (Tetrapanacis Medulla), Huashi (Hirudinis), and Lianqiao (Forsythiae Fructus) both descend Heart Fire and benefit Kidney Water, thereby regulating the Triple Burner comprehensively. It is indeed superior to Yinchen Hao Tang (Artemisiae Scopariae and Hordeum Decoction). Such examples reflecting the holistic concept of Traditional Chinese Medicine are not limited to this; Liuwei Wan (Six-Ingredient Pill with Rehmannia) and Yiguan Jian (One Glance Infusion) are just a few among many.
It must be pointed out that while emphasizing minister herbs (Shiyao), one should not let them replace sovereign herbs (Junyao); while valuing assistant herbs, one should not discard deputy herbs (Chenyao) based on them; while advocating Five Elements deduction, one must avoid forced interpretations. Otherwise, therapeutic effects will be difficult to achieve.
In April 1955, I was sent to teach at the Jinzhou Provincial School of Traditional Chinese Medicine Advanced Studies. During my lectures on classical medical texts and clinical courses, I studied the Yin-Yang and Five Elements theories, wrote an article titled "On the Philosophical Thoughts of Yin-Yang Theory," using the image of a balance scale to explain the struggle, mutual rooting, waxing and waning, and balance of Yin and Yang. I also utilized the theory from the *Neijing* (Inner Canon): "When Yin is peaceful and secret, spirit governs; when Yin and Yang separate, essence perishes." On March 10, 1972, I treated a farmer surnamed Zhang, male, 49 years old. Chief complaint: Sudden onset of throat tightness and itching, chest fullness and epigastric pain, nausea and vomiting five days prior, leading to an emergency visit. Electrocardiogram indicated posterior wall myocardial infarction. Blood pressure was zero. After Western medical rescue, symptoms improved, but blood pressure remained low (around 70/50 mmHg). Symptoms included chest pain radiating to the back, aversion to cold with curled-up posture, cold limbs, mental fatigue and weakness, pale complexion, cyanotic lips and nails, frequent urination, loose stools, pale tongue with white coating, and slow, weak, barely palpable pulse. This indicates failure of Chest Yang, excessive Cold pathogen, loss of Qi circulation, and blockage of Heart vessels. Treatment: Restore Yang and rescue from collapse, boost Qi and restore pulse. Formula: Prepared Fuzi, Ganjiang (Dried Ginger), Rougui (Cinnamon Bark), Baizhu, Hong Renshen (Red Ginseng), Fuling, Chenpi (Aged Tangerine Peel), Banxia (Pinellia Rhizome), Wuweizi (Schisandra Fruit), Zhigancao (Honey-fried Licorice Root), with Shengjiang (Fresh Ginger) as a guide. Decoct in water, two doses.
Follow-up on March 14: Chest pain significantly reduced, aversion to cold greatly decreased, blood pressure gradually rose (90/60 mmHg), pulse became more vigorous compared to before. At this stage, "seeking Yang within Yin" is necessary. Revised prescription: Boost Qi and nourish Yin, unblock Yang and restore pulse. Formula: Shengmai San (Generate Pulse Powder) plus Prepared Fuzi, Ganjiang, Zhigancao. Decoct in water, six doses.
Third visit on March 23: Chest pain continued to decrease, hands and feet turned warm, lips and nails became ruddy, urination and defecation improved, blood pressure increased further (104/70 mmHg), pale red tongue with thin coating, slow pulse. Deep pressure felt slightly weak. Further treatment: Balance tonify Qi and Blood, unblock Yang and restore pulse. Formula: Dangshen (Codonopsis Root), Maidong (Ophiopogon Tuber), Shengdi (Rehmannia Root prepared fresh), Danshen (Salvia Miltiorrhiza Root), Guizhi (Cinnamon Twig), Shengjiang, Dazao (Jujube Fruit), Zhigancao. Ten doses.
Fourth visit on August 7: Basically recovered, strength felt sufficient, blood pressure returned to normal (106/90 mmHg), occasional mild chest pain. Continue previous formula adding Gualou (Trichosanthes Fruit) and Xiebai (Allium Macrostemon Bulb), ten more doses. Symptoms disappeared.
Note: This case is "Jue Xin Tong" (Cold Pain of the Heart), caused by declining Yang and obstruction by Yin pathogens. The urgent method is to unblock Yang and restore pulse, following the principle "Without Yin, Yang cannot generate; without Yang, Yin cannot transform." Initially used Huyang Jiuji Tang (Restore Yang Rescue Crisis Decoction) to make "Yin decline and Yang grow." Second visit used Sini Tang (Four Counterflow Decoction) combined with Shengmai San to prevent "extreme Yang causing collapse." Third visit used Zhigancao Tang (Licorice Decoction) to further achieve "Yin peace and Yang secrecy," ensuring comprehensive strategy without bias. This aligns with Zhang Jingyue's saying: "Those skilled in tonifying Yang must seek Yang within Yin." I researched the practical significance of the Five Elements Theory, recognizing that generation, restriction, overacting, and insulting are movement forms in human life processes, applicable whether diseased or healthy. This learning insight greatly helped me understand the physiology and pathology of Zang-Fu organs and aided in clinical diagnosis and treatment research.
Reading values maintaining doubt. I had finished studying *Medical Three Character Classic* forty years ago, but the passage in the "Distension and Ascites Chapter" stating "Single abdominal distension is truly hard to cure. Mountain-Wind Hexagram, the compass car. The profound meaning in I Ching, Fei Ju Zhu..." remained unclear. Mr. Chen's views were followed by later generations, all prescribing methods to suppress Wood and strengthen Earth, resulting in many untreatable cases and few recoveries. This stimulated my desire for knowledge. Thus, I deeply studied the *I Ching* (Book of Changes), connected it with TCM theory, and clarified the meaning of the rhyme. Simply put, "Wind" belongs to Wood and Liver, "Mountain" belongs to Earth and Spleen. Together they form the Gu (Infestation) Hexagram. Its rigid part is above, high and aloof, not connecting downward; its soft part is below, retreating, not connecting upward. The two do not communicate, leading to distension disease. However, this condition not only involves "Wood overacting on Earth" but also "Earth insulting Wood." Moreover, acute illness implies excess, chronic illness implies deficiency. Loss of free flow regulation and failure of transformation are inevitable. Since Liver stores Blood, initially there is Qi stagnation, gradually progressing to Blood stasis. Since Spleen is the official of granaries, initially Dampness stops, later leading to poor appetite. I proposed Six Elimination Decoction (Six Xiao Tang), applying Spleen regulation and Liver soothing together, tonification and digestion promotion concurrently, Qi movement and Blood activation harmoniously, aromatic transformation and mild diuresis cooperatively, often achieving satisfactory results. From this experience, I realized that becoming specialized first then broad, then specialized again, reviewing the old to learn the new, and continuous study is the only path from ignorance to knowledge, from knowing little to knowing much.
Since entering Liaoning College of Traditional Chinese Medicine, the highest institution of TCM in Liaoning, I obtained all the learning conditions I desired. The first gain here was Pulse Diagnosis. Combining teaching, I read the pulse sections of *Neijing*, *Shanghan Lun* (Treatise on Cold Damage), and *Jingui Yaolue* (Essential Prescriptions from the Golden Cabinet), studied all chapters of *Mai Jing* (Pulse Classic), *San Zhi Chan* (Three Finger Zen), and *Binhu Maixue* (Pulse Studies of Binhu). Combining teachings from elders and personal experience, I wrote reading notes titled *Zhi Xia Quan Heng* (The Scale Under the Fingers). I categorized the twenty-eight pulse types by Floating/Sinking, Slow/Rapid, Deficient/Excess, summarizing depth, size, thickness, length, clarity, and ambiguity for differentiation, indicating degree differences in diseases they signify. By comparing Guan position front/back and Left/Right hands, it highlights differences in upper/lower deficiency/excess, Qi/Blood abundance/deficiency, and Yin/Yang prosperity/decline. It confirmed seventeen composite pulse types for concurrent diseases such as Heart-Kidney Non-Interaction, Spleen-Kidney Yang Deficiency, Liver Qi Overacting on Spleen, and Spleen-Kidney Yin Deficiency, explaining possible subtle changes. Regarding pulse description, I advocated concise terms rather than complex metaphors, clarifying techniques and tactile sensations.
Secondly, I researched Tongue Diagnosis. Based on basic knowledge and variation laws, re-reading ancestors' records, and synthesizing clinical observations, simplifying complexity and refining roughness, I divided tongue body into six main categories, cross-referencing deep/shallow, old/tender to analyze pathogenesis and predict trends. I divided tongue coating into forty-nine sub-categories, discussing thickness, moisture, dryness, etiology, and Stomach Qi. I classified tongue posture into ten types, discussing body, coating, pulse, and symptoms together to analyze disease location and detail pros/cons. The aim was to lead sub-categories with main categories, classify by symptoms, ensuring no special cases missed in generalities and rules maintained in flexibility.
I also selectively collected over two hundred small, effective prescriptions with few ingredients and focused power based on the "Ten Agents" theory: "Dispersing removes obstruction, Unblocking moves stagnation, Tonifying supports weakness, Draining removes closure, Light dispels excess, Heavy calms fear, Slippery removes adherence, Astringent secures leakage, Dryness overcomes dampness, Moisture moistens dryness." These include Niubangzi San, Er Miao San, Zuo Jin Wan, Jiao Tai Wan, Danshen Yin, Shengmai Yin, Shaoyao-Gancao Tang, Sanzi Yangqin Tang, etc. They regulate Yin/Yang, Cold/Heat, Exterior/Interior, Deficiency/Excess, Qi/Blood variations, and relieve swelling, pain/numbness, vomiting/diarrhea, constipation/dysuria, asthma/cough. They facilitate adjusting the ratio of tonifying/draining and addressing root/symptom urgency, preventing confusion in haste. However, emphasizing small prescriptions requires mastery of common representative formulas. Only then can they be used effortlessly.
In clinical practice, I realized the need for rigorous attitude and steady effectiveness. Thus, I established "Six Suitability Principles": Excess suits heavy dosage, Deficiency suits balanced dosage; Slow suits many flavors, Urgent suits precise formulas; Mild suits gradual approach, Critical suits rapid action. Additionally, I drafted "Ten Prevention Guidelines": Floating pulse prevents Fire depression, Large pulse prevents sudden syncope; Blue face prevents Wind stirring, Red face prevents Yang floating; Heat syndrome prevents Yang damage, Cold syndrome prevents fluid consumption; Chronic disease prevents deficiency, Exterior disease prevents interior invasion; Severe thirst prevents Spleen stagnation, Damp edema prevents fluid exhaustion. These seem simple but are crucial. Negligence can delay treatment or cause death; prevention is better than cure.
Remembering May 17, 1971, I treated a 32-year-old female patient suffering from Wind-Warmth for over half a month. Initial symptoms: aversion to cold, fever, nasal congestion, runny nose, cough, shortness of breath, right chest pain, rust-colored sputum. Western medical examination: scattered dry rales in both lungs; X-ray fluoroscopy: consistent dense shadow in lower right lung; Lab: WBC 19,300, segmented neutrophils 80%, band cells 3%, lymphocytes 17%. Diagnosed with right lower lobe lobar pneumonia. Previously treated with Penicillin, Chloramphenicol, Aureomycin, Erythromycin, Rifampicin, and modified Sangju Yin (Mulberry Leaf and Chrysanthemum Decoction). High fever persisted (39°C), worse in afternoon, dark complexion, listlessness, spontaneous sweating, weakness, chest pain, shortness of breath, red tongue with yellow coating, fine rapid pulse. Constitutionally Yin deficient, exposed to Warm pathogen, lingering long, consuming fluids, risk of entering Ying (Nutrient) level. Treatment: Clear Qi level, penetrate Ying level, nourish Yin, reduce heat. Formula: Yin Chaihu (Stellariae Radix), Hulan (Coptidis Rhizoma - likely typo for Huanglian), Maidong, Baiwei (Dictamni Cortex), Sheng Biejia (Tartar Testudinis), Digupi (Lycii Cortex), Danpi (Moutan Cortex), Zhimu (Anemarrhenae Rhizoma), Beimu, Sheng Sangpi (Morus Bark). Three doses, decoct in water, take orally.
Follow-up May 22: Temperature reduced (37°C), symptoms lighter. Re-administered three doses. All symptoms disappeared, pulse calm, body cool.
Note: Sangju Yin is a light Acrid-Cool agent, treating early Wind-Warmth invading Lung-Wei. But if Heat pathogen persists, lingers long, and enters Yin level, it is common. Wu Jutong established Qinghao Biejia Tang (Artemisia Annua and Turtle Shell Decoction), stating: "Pathogen deeply hidden in Blood level, mixed in blood collaterals, cannot purely use Yin-nourishing, nor is it Strong Fire, must not arbitrarily use bitter-dry." Concise words clarify treatment principles. The Qinggu San (Clear Bone Powder) used in this case imitates this idea.
Between July and August 1972, in the ward, I used Wang Kentang's *Zhengzhi Zhunsheng* Shiwei Wendan Tang (Ten-Ingredient Warm Gallbladder Decoction) combined with heart-strengthening herbs to rescue a male patient surnamed Zhang who suffered cardiac arrest eleven times. Integrated Chinese-Western medicine effect was good. TCM at the time considered this "Cold phlegm flooding Gallbladder, Gallbladder Cold Liver Heat, Heart Deficiency irritability, palpitations insomnia." Later, young doctors interning in the ward doubted my use of Shiwei Wendan Tang and switched to modified Shengmai San. After two doses, cardiac arrest recurred. The patient actively requested more Shiwei Wendan Tang and recovered, discharged after a month of conditioning.
May 9, 1975, invited to consult on an 81-year-old female overseas Chinese (living in Philippines). Caught Wind-Cold in Hong Kong during return trip: headache, cough, chills, fatigue. Condition worsened after bathing in Shenyang. Hospital diagnosed bronchopneumonia (Staphylococcus aureus), treated with Erythromycin, Ampicillin, Penicillin combined with TCM. Believed pathogen entered Yangming, prescribed Shigypsum, Zhimu, Zhuye (Bamboo Leaf), but disease progressed.
Consultation showed weak constitution, aversion to cold and fever (38°C), cough/wheeze, thick sticky sputum, chest fullness/shortness of breath, epigastric fullness, vomiting, anorexia, loose stools, pale dark complexion, listlessness. Left pulse wiry/fine/slightly rapid, Right pulse wiry/rapid, rough tongue body, white greasy coating. According to Shanghan Six Meridian differentiation, this is Taiyang exterior pathogen unresolved, transmitting to Shaoyang. Fever/aversion to cold, chest oppression/vomiting/anorexia, wiry pulse are all Shaoyang signs. Ancient saying: "For every bit of aversion to cold, there is a bit of exterior syndrome." And "Shanghan/Windstroke, fever/no sweat, exterior unresolved, cannot give Baihu Tang." Pathogen between Exterior and Interior, only Harmonize pivot, release Exterior, resolve Interior. Using large doses of Cold/Cool drugs freezes pathogen, easily causing bad outcomes, very cautious. For Shaoyang syndrome, Xiaochaihu Tang (Minor Bupleurum Decoction) is suitable. Modified Xiaochaihu Tang: Chaihu, Huangqin, Banxia, Gancao, Shengjiang, Jiegeng, Zhike, Baisharen (Ginseng), Gualou, Xingren, Sangye, Sangpi, Ziwan, Jinyinhua (Honeysuckle). Decoct in water, three times daily.
Follow-up May 12: Spirit improved, smiling, chest fullness/shortness of breath reduced, cough/wheeze decreased, dark red tongue, yellow-white coating, slight epigastric discomfort, normal urination/defecation. Wind-Cold pathogen resolved from Exterior. Phlegm-Heat stuck, Qi mechanism不畅, still focus on Harmonizing. Remove Sangye (light dispersing), add Binglang (Areca Seed) to soothe Qi stagnation. Also use Lingyangjiao (Antelope Horn) 1g, decoct in water, drink as needed to clear Heat and transform Phlegm.
May 18: Continued previous formula, all symptoms disappeared, able to get out of bed and move.
Note: *Shanghan Lun* states: "Shanghan 5-6 days, Windstroke alternating chills/fever, chest/hypochondriac fullness, silent anorexia, heart vexation/likes vomiting... or cough/phlegm, Xiaochaihu Tang governs." This case is an elderly patient over 80, constitutionally weak, long-term resident of tropics, unable to withstand Wind-Cold, exterior unresolved, showing Shaoyang main symptoms like fullness, likes vomiting, anorexia. Xiaochaihu Tang is most appropriate. Seeing fever/cough, mistaking for Yangming interior Heat and using Baihu Tang is inappropriate. "For every bit of aversion to cold, there is a bit of exterior syndrome," unresolved exterior cannot use Clearing method, this is experiential wisdom.
Through these cases, it is fully proven: Wei-Qi-Ying-Blood differentiation for Warm Diseases, Six Meridian differentiation for Shanghan, Yin-Yang Eight Principles differentiation for Neijing, Zang-Fu differentiation for miscellaneous diseases, if mastered appropriately and applied flexibly, truly achieve efficiency like drumbeat response, medicine cures disease instantly.
(Compiled by Sun Jixian)
How I Learned Traditional Chinese Medicine Shen Zhonggui, Chief Physician, Guang'anmen Hospital, Institute of Chinese Medical Sciences
[Author Profile] Shen Zhonggui (1901~), from Hangzhou, Zhejiang. Studied under Mr. Wang Xiangyan early on. Taught at Shanghai Nanshi School of TCM in 1928, taught at Shanghai Guo Medical College in 1930, and taught at Shanghai China Medical College in 1932. During the Anti-Japanese War, served as Director of Beibei TCM Hospital. After liberation, taught at Chongqing TCM Advanced Studies School, hired by Institute of Chinese Medical Sciences in 1955. Besides education, wrote for various TCM journals since early years, contributing to popularizing TCM knowledge. Main works include *Yangsheng Suoyan*, *Shengui Yilun Huixuan*, *Fei Shen Wei Bing Yantao Ji*, *Zhongyi Jingyan Chufang Ji*, *Zhongguo Xiao'er Chuanranbingxue*, etc.
I was born in 1901, ancestral home Hangzhou. Father was a clerk in the Liangzhu Salt Transport Commissioner's Office in Qing Dynasty, family moderately wealthy. By my second year of middle school, family declined, forced to switch to medicine, apprenticed to local famous doctor Mr. Wang Xiangyan. Master Wang was a disciple of Ling Xiaowu from Huzhou, skilled in treating Warm-Thermal diseases, praised alongside Mo Shangji who treated miscellaneous diseases. In master's clinic, I accompanied consultations in morning, copied medical cases in afternoon, while reading and studying.
After completing apprenticeship, I worked as a primary school teacher while studying medicine, writing articles submitted to medical journals. Publications like *Zhongyi Zazhi* edited by Wang Yiren, *Shenzhou Guoyi Xuebao* edited by Wu Qutan, *Kangjian Bao* edited by Chen Curen, *Yijie Chunqiu* edited by Zhang Zanchen, *Zhongyi Xin Shengming* edited by Lu Yuanlei, etc., published many of my works.
In 1928, I took a teaching post at Shanghai Nanshi School of TCM, founded by Mr. Ding Ganren from Menghe. When I taught there, Mr. Ding had passed away, eldest grandson Ding Jiwan inherited his practice, practiced on Baieke Road in Shanghai, and managed school affairs. Teaching materials included self-compiled handouts and selected ancient/modern classics. Teachers included Cheng Menxue, Lu Yuanlei, Shi Yiren, Yu Hongsun, and myself.
From second half of 1930 to 1931, I again took a teaching post at Shanghai Guo Medical College, founded by Lu Yuanlei, Zhang Cigong, Xu Hengzhi, with Zhang Taiyan as Honorary Dean. Lu Yuanlei taught *Shanghan Lun*, Zhang Cigong taught Pharmacology, Xu Hengzhi taught Pediatrics, I taught TCM Basics and Medical Cases. Through joint efforts, cultivated outstanding talents like Fan Xingzhun (expert in Chinese Medical History) and Pan Guoxian (Professor at Zhejiang College of TCM), both graduated from this college.