那么究竟用什么办法去研究中医呢?我认为用行政的手段去肯定某一学派正确、某一学派错误，树立某一学派、砍掉某一学派都是不利于科学发展的。中医的发展证明利用二分法为研究方法去发展中医是可以前进的，可以发现很多规律，西医用直观的方法也发现了很多规律，通过两条不同道路进行深入研究的过程中，有的不谋而合发现了同一规律，有的西学中者通过互相渗透的理解也发现了一些规律，三种途径各有优劣，互相补充，互相促进，对人体的奥妙越来越了解，越来越深入。
有的人可能说这是“复古”、“倒退”，是否定西医学习中医的必要性，我认为帽子先不戴为好，实践证明有些患者发现单纯请纯西医治疗一直无效，而改请西学中的同志治疗，很快即治愈了；有些患者反复请西学中同志治疗无效，而请中医治疗很快治愈了；有的请中医、西学中治疗一直不效，而请西医治疗很快治愈了，所以有的患者要求纯中医治疗，有的要求纯西医治疗，有的愿让西学中的治疗。为什么呢?我认为由于学术观点的不同，处理问题的角度不同，得到的效果也不同，也就是说他们在某些问题上的深度、广度不同。为了促进科学的发展，从各个不同的角度和广度去认识、处理问题是有好处的。
研究中医的什么呢?我认为利用中医的固有方法、西医的方法、现代科学的所有办法都是研究中医的方法，都可以促进中医的发展，但这些方法都有他们的条件和认识能力的限制，不可能对所有问题都认识清楚，因此根据一种方法去决定研究什么，去作为衡量研究什么的标准都是不正确的。正确的研究对象应该是实践过程中发现的规律性的东西，凡是符合实践真理的东西都应该研究。科学的发展历史证明，在这个时代被认为是谬误的东西，当科学发展至另一个时代的时候，通过证明又是完全正确的，因此我们不可因为在某些方面与目前的医学水平唱反调，与现代科学的某个方面唱反调而轻易地放弃它，而应该坚持实践第一的观点，在科学发展的长河中去验证它。
直观地利用现代科学的一切最新成就去探索已经发现的科学规律性的实质是非常必要的，它是促进我们认识机体病理、生理、诊断、治疗的重要手段，目前一切边缘学科的研究大大促进了中医已经发现的科学规律性的认识。但是由于目前科学水平的限制，一些复杂的规律，还缺乏必要的手段，因此还不能真正认识各种规律。辩证的、非直观的研究，可以发现很多规律，但是由于科学的实验手段难于设计，困难很大，因此很难进行，为了开展科学研究，还应该采用直观的、非直观相结合的方法进行研究。
有的同志说西医要在病上进行研究，中医要在证上研究，我认为这是研究中西医的一个办法，但它不是所有办法，因为中医不单纯是证，西医也不单纯是病，中医还有很多内容，如气象、地域、心理，以及经络、藏象、阴阳等等，都没有很好解决，都需要研究。
中西医如何结合呢?什么时候结合呢?这个问题单纯依靠行政手段是不能解决的。实际上自从西洋医学传人中国后就开始了结合的工作，有些西医自动地利用中药去治病，有些中医自动地应用西药去治病，有些西医自觉不自觉地利用中医的理论观点去认识问题、解释问题，有些中医也自觉不自觉地利用西医的某些理论去解释问题，这种情况在中华人民共和国成立以后50多年的今天就更加明显。目前经常听一些西医同志说应用西药也得辨证，抗生素的应用也不能单纯靠敏感性试验去决定；中医治病时也往往问一问这是什么病，你量过血压没有，作过胸透、造影、心电图等没有，这都是结合，因此说中西医什么时候结合，我认为现在就正在结合着，而且有的现在就结合得很好。但是中西医什么时候就完全结合了，还是很遥远的事，因为科学的发展还很有限，认识的能力和实际情况的距离还相差很远，所以只能在中西医的发展中，科学的发展中去结合，否则依靠行政命令在某天突然宣布几年以后中西结合，保留一个医、废除一个医，就美其名日中西医已经结合了，我认为这样的结合不如不结合，不如丢掉。
通过各种方法去进行研究，通过各种学派的努力，百家争鸣，百花齐放，通过中医、西医、中西医以及各方面科学，工作者的努力，在科学发展的道路上的不断合分、分合，让它们自然而然地形成统一学派吧。
四、结语
中医的发展史是一个总结经验和利用现实科学成就去认识解释这些经验的历史，是巩固成就，纠正错误的实践——理论——实践上升史。
历史上研究中医的方法，有直观的和辩证的两种，两种方法都各自发现了一定的科学规律。
研究学习《内经》、《伤寒论》、《金匮要略》等著作，对于研究学习整个中医理论和临床经验是非常重要的，但是也应该研究学习后人发展起来的理论和经验。
研究中医应该采用中医的、中西医结合的、西医的、现代科学的其他领域的不同方法进行研究，不应该肯定或否定一种方法。在采用不同方法研究的过程中，逐步探索病理、生理、诊断、治疗的客观科学规律性。
中西医结合创造统一的新医学、新药学是我们的理想，这种结合应该逐步地结合，能结合多少就结合多少，不能结合的就不要强求凑合，什么时候形成一个统一的新医学、新药学，要在中西医和现代科学发展的长河中逐渐形成，不应采用行政命令的形式进行。
相似·联想·纠偏·辨证论治
某医云：朱老。你是著名的疑难病学家，请你谈一谈治疗疑难病上的经验。余云：疑难者何?时弊之未明者也。科学上有科学上的疑难，政治上有政治上的疑难，经济上有经济上的疑难，医学上有医学上的疑难，西医上有西医上的疑难，中医上有中医上的疑难，如此等等，不胜枚举。细读科学上的科学发展史，经济上的经济发展史，革命上的革命发展史，医学上的医学发展史，西医上的西医发展史，中医上的中医发展史，不难看出任何科学发展中的疑难问题都有一个相似的规律，即时弊的潮流性。当这种时弊统治的时候，人们的思想就禁锢，所有与此有关的问题就疑难，就不能解决。而一旦这种时弊被认清，。被打破的时候，则与此有关的所有疑难均会变成小问题。例如：在科学的发展史上，当唯心主义的上帝统治人们的思想的时候，所有与此有关的问题都成了疑难，而当哥白尼等打破了这一禁区时，科学立刻取得了发展。在中国的社会主义革命发展史上，当教条主义思想统治革命者时，革命即屡遭失败，而当毛泽东打破这一思想禁锢后，革命即取得了胜利；而当新的形势下的教条主义又统治人们时，社会主义建设又遭到了失败，而当邓小平打破了这一思想禁锢时，社会主义建设又取得了发展。在中国医学的发展史上，由于以《内经》为代表的理论指导的正确，加之特别强调调查研究的“入国问俗，人家问讳，上堂问礼，临病人问所便”的盛行，所以使秦汉以前的医学取得了很大的发展；可是由于东汉以后，长期的思想禁锢，加之多数医家不去认真调查研究，盲目地使用汗、吐、下三法治疗疾病，结果严重地影响了中医的发展，张仲景著《伤寒杂病论》，除大倡研究调查之风外，又以精辟的语言指出了盲目使用汗、吐、下的弊端，从而促进了中医学的发展；但是由于宋以来长期思想的禁锢，又使中医落到新形势下经验主义的泥坑，从而又大大影响了中医的发展，为此刘完素提出了注意火，李东垣提出了注意脾胃，朱震亨提出了注意相火，并特别针对时弊，著成了《局方发挥》一书，除痛斥了时弊外，并提出了正确的应用《局方》的方法，从而促进了中国医学的发展；其后温病学派的出现，大肆针砭了温热病应用辛温药治疗的时弊，从而促进了医学的发展。那么当前中医界的时弊是什么呢?通过数十年来临床正反两方面的不断总结，认为主要的有下列几点：
1．认为辨证论治是辨症状的论治方法和按病论治方法，而忽略脉象等的价值。2．认为发热(即体温高)的病都是热证，都必须用清热解毒，养阴清热，清热泻火的药进行治疗。3．认为西医所说的疑难病就是中医的疑难病，按照西医的思路方法套用在中医的治疗上。4．认为抓一个主要的问题即可解决所有问题，而不注意夹杂着的复杂问题，更不注意一种倾向掩盖着的另一种倾向。5．在治学上不严谨，不认真，常以想象和道听途说为根据去处理问题。6．教条主义泛滥，否认实事求是，不作调查研究，反而自以为是。
辨证论治是一个中医临证过程中的思想体系，它是一个系统工程，而绝不是象某些人所理解的那样简单和粗糙。当前中医界之所谓疑难病者，大多是时弊所成者，因此治疗疑难病时必须注意时弊。
尝治患者魏××，男，34岁。肺炎12天，持续高热不退，常在40℃～40．2℃之间浮动。遍用抗生素及中药无效。邀余诊治。审之发热呈寒热往来状，并见气短胸满，口苦咽干，烦乱不安，时或胸胁疼痛，舌苔白，脉弦滑数。余云：此少阳柴胡证也。治宜小柴胡汤加减为方。某医云：朱老。此病乃肺炎也，肺炎之疾诸医均云宜用麻杏石甘汤，并云此兼热毒也，宜加清热解毒之药治之，何独先生用小柴胡汤也?答曰：麻杏石甘汤者，仲景为汗出而喘无大热者设也，鞠通先生《温病条辨》虽对本方的应用有所发展，但仍没有脱离仲景之规范。今人见其麻黄定喘，石膏清热，列为肺炎之专方，虽在临床上常有取效者，然其不效者甚多，医者见其不效，囿于炎者热毒之禁锢，复加清热解毒之味以治之，岂不知诸种西药清热解毒不效，怎能用杯水之中药清热解毒者可效?此病之不效者正在于此种时弊之论所致也。余之所以用小柴胡者，因其证为少阳柴胡证，然其脉弦中兼有滑数，滑数之脉者痰热脉也，故处以柴胡28克，半夏10克，黄芩10克，瓜蒌30克，甘草10克，生姜3片，大枣7个。次日往诊。云：体温已降至36．8℃，且气短胸满，心烦口苦等症若失，并开始稍进饮食。三日后，诸证消失，出院。某医云：小柴胡汤者，治感冒之方也，先生何用其治肺炎乎?答曰：小柴胡汤者，仲景所创治疗热病之方也，并云：“但见一证便是，不必悉具。”其并未说肺炎不可用也。今之炎证即热毒之说实乃想象与推理之见，不可胶粘于此也。
又如：患者郭××，男，32岁。肥厚性心肌病，完全性束支传导阻滞，右心衰竭。前后在青岛、济南、北京、上海等数家医院治疗8个多月不效。来电求余处方救救其生命，余根据所述证候处方治之，半月后，在数人护理下来并求诊。云：服用15剂，不但寸效不见，反见恶心呕吐，呼吸困难加重。余细审脉证，思之：脉见濡弱，气短纳呆，咽干而有异物阻塞感，头晕而难于站立，且失眠心悸，与所用方剂应称合拍，其何故不效也?再询其服用其他中、西药否?答曰：此病如此之严重，中、西药均进耳。余云：中药处方前人特别强调配伍，其应君者为臣，臣者为佐尚且不效，今加大中、西药饵，何者为君?何者为臣?不知也。且夫俗语云：三个和尚无水吃，其怎能取效呢!余意应仅服此种中药，诸药均予停用耳。陪侍诸医云：不可也。我们西医治之尚且无效，岂可用中药单独治之!某医更声色俱厉地说：此乃重病，中、西医结合尚且无效，你们中医怎敢独治。然因患者及其家属屡屡体会应用前医诸法不效，见余所言甚为中肯，便云：停用其他药，试试可也。连续服药50剂，诸证消失，恢复工作。某医云：朱老，你为什么要求停用其他药物?答曰：当前一个很大的时弊是在中西医会诊过程中认为西药是治病的，中药是可有可无的，所以中药治的实际是西药的副作用，而很多中医不注意这一点。有些中医一听西医说是什么病，也想从中找一个恰当的治疗方药，岂不知不但没有治了病，反而增加了西药的毒副作用，这样下去怎能取得应有的效果呢?余之所以要求停用其他任何中西药物，其目的是通过充分衡量疾病、药物之间的各方面关系，采用恰当的药物配伍方法，以取得应有的效果。事实证明这种想法是正确的。
又如：曾治患者崔××，男，6岁。慢性扁桃体炎急性发作10天。医予抗生素大剂输液治疗7天，发热不减，又邀某医以中药大剂清热解毒养阴药配合治疗3天仍无功。审其体温38．9℃，咽喉疼痛，扁桃体肿大，上罩白色脓栓。舌苔白，脉虚大弦紧而数。余云：仲景谈辨证论治时云应脉证并治耳。此病脉象明明已露气阴两虚，岂可但用清热解毒养阴之剂可取效，治宜补气养阴，予清暑益气汤两剂愈。某医云：朱老，你怎么想到用清暑益气汤治疗扁桃体炎?答曰：辨证论治中的一个重要内容是知时弊，今之时弊者何?但见炎症即予清热解毒而忘记脉证并治耳。
那么究竟应该用什么方法来研究中医呢？我认为，利用行政手段去肯定某一学派正确、否定另一学派错误，或者树立某一学派、打压另一学派，都不利于科学发展。中医的发展历史证明，采用二分法作为研究方法可以促进中医进步，可以发现许多规律；西医通过直观的方法也发现了许多规律。在通过这两条不同道路进行深入研究的過程中，有的规律不谋而合地被发现是相同的，有的“西学中”（学习中医的西医）人士通过相互渗透的理解也发现了一些规律。这三种途径各有优劣，互相补充，互相促进，使我们对人体的奥秘越来越了解，认识越来越深入。
有人可能会说这是“复古”或“倒退”，是否定了向西医学习中医的必要性。我认为最好先不要扣这样的帽子。实践证明，有些患者单纯接受纯西医治疗一直无效，但改由“西学中”医师治疗后很快治愈了；有些患者反复请“西学中”医师治疗无效，但请中医治疗后很快治愈了；还有的患者请中医和“西学中”医师治疗一直无效，但请西医治疗后很快治愈了。因此，有的患者要求纯中医治疗，有的要求纯西医治疗，有的愿意接受“西学中”的治疗。为什么呢？我认为这是由于学术观点不同，处理问题的角度不同，导致效果也不同，也就是说他们在某些问题上的深度和广度不同。为了促进科学发展，从各个不同的角度和广度去认识和解决问题是有好处的。
研究中医的什么呢？我认为，利用中医固有的方法、西医的方法以及现代科学的所有方法都是研究中医的方法，都可以促进中医的发展。但这些方法都有其条件和认知能力的限制，不可能对所有问题都认识清楚。因此，根据某一种方法来决定研究什么，或以此作为衡量研究内容的标准，都是不正确的。正确的研究对象应该是实践过程中发现的具有规律性的东西，凡是符合实践真理的东西都应该研究。科学发展史证明，在这个时代被认为是谬误的东西，当科学发展到另一个时代时，经过验证又可能是完全正确的。因此，我们不能因为某些方面与目前的医学水平或现代科学的某个方面相悖就轻易放弃它，而应该坚持“实践第一”的观点，在科学发展的长河中去验证它。
直观地利用现代科学的一切最新成就去探索已发现的科学规律的实质是非常必要的，它是促进我们认识机体病理、生理、诊断和治疗的重要手段。目前，一切边缘学科的研究大大促进了人们对中医已发现的科学规律的认识。但是由于目前科学水平的限制，对于一些复杂的规律，还缺乏必要的手段，因此还不能真正认识各种规律。辩证的、非直观的研究可以发现很多规律，但由于科学实验手段难以设计，困难很大，因此很难进行。为了开展科学研究，还应该采用直观与非直观相结合的方法进行研究。
有的同志说，西医要在“病”上进行研究，中医要在“证”上进行研究。我认为这是研究中西医的一种办法，但它不是所有办法。因为中医不仅仅是“证”，西医也不仅仅是“病”。中医还有很多内容，如气象、地域、心理，以及经络、藏象、阴阳等，都没有得到很好的解决，都需要研究。
中西医如何结合呢？什么时候结合呢？这个问题单纯依靠行政手段是不能解决的。实际上，自从西洋医学传入中国后，结合的工作就开始了。有些西医自动利用中药治病，有些中医自动应用西药治病，有些西医自觉或不自觉地利用中医的理论观点来认识问题、解释问题，有些中医也自觉或不自觉地利用西医的某些理论来解释问题。这种情况在中华人民共和国成立后的50多年里更加明显。目前经常听到一些西医同志说，应用西药也得辨证，抗生素的应用也不能单纯靠敏感性试验来决定；中医治病时也往往询问这是什么病，量过血压没有，做过胸透、造影、心电图等没有。这都是结合。因此，关于中西医什么时候结合，我认为现在就正在结合，而且有的地方结合得很好。但是，中西医什么时候才能完全结合，还是很遥远的事。因为科学发展还很有限，认识能力和实际情况之间的距离还相差很远，所以只能在中西医的发展和科学发展中去结合。否则，依靠行政命令在某天突然宣布几年以后中西医结合，保留一个医、废除一个医，并美其名曰中西医已经结合了，我认为这样的结合不如不结合，不如丢掉。
通过各种方法进行研究，通过各学派的共同努力，百家争鸣，百花齐放，通过中医、西医、中西医结合以及各方面科学工作者的努力，在科学发展的道路上不断分合、合分，让它们自然而然地形成统一学派吧。
四、结语
中医的发展史是一个总结经验和利用现实科学成就去认识、解释这些经验的历史，是巩固成就、纠正错误的“实践—理论—实践”上升史。
历史上研究中医的方法，有直观的和辩证的两种，这两种方法都各自发现了一定的科学规律。
研究学习《内经》、《伤寒论》、《金匮要略》等著作，对于研究学习整个中医理论和临床经验是非常重要的，但是也应该研究学习后人发展起来的理论和经验。
研究中医应该采用中医的、中西医结合的、西医的、现代科学其他领域的不同方法进行研究，不应该肯定或否定某一种方法。在采用不同方法研究的过程中，逐步探索病理、生理、诊断、治疗的客观科学规律性。
中西医结合创造统一的新医学、新药学是我们的理想，这种结合应该逐步地进行，能结合多少就结合多少，不能结合的不要强求凑合。什么时候形成一个统一的新医学、新药学，要在中西医和现代科学发展的长河中逐渐形成，不应采用行政命令的形式进行。
相似·联想·纠偏·辨证论治
某医生问：朱老，您是著名的疑难病学家，请您谈谈治疗疑难病的经验。
我答：什么是疑难病？就是时弊（时代弊端）尚未明了的问题。科学上有科学上的疑难，政治上有政治上的疑难，经济上有经济上的疑难，医学上有医学上的疑难，西医上有西医上的疑难，中医上有中医上的疑难，如此等等，不胜枚举。细读科学的发展史、经济的发展史、革命的发展史、医学的发展史、西医的发展史、中医的发展史，不难看出任何科学发展中的疑难问题都有一个相似的规律，即时弊的潮流性。当这种时弊统治的时候，人们的思想就受到禁锢，所有与此有关的问题就变得疑难，无法解决。而一旦这种时弊被认清、被打破的时候，则与此有关的所有疑难都会变成小问题。例如：在科学的发展史上，当唯心主义的上帝统治人们思想的时候，所有与此有关的问题都成了疑难，而当哥白尼等人打破了这一禁区时，科学立刻取得了发展。在中国的社会主义革命发展史上，当教条主义思想统治革命者时，革命屡遭失败，而当毛泽东打破这一思想禁锢后，革命取得了胜利；而当新形势下的教条主义又统治人们时，社会主义建设又遭到了失败，而当邓小平打破这一思想禁锢时，社会主义建设又取得了发展。在中国医学的发展史上，由于以《内经》为代表的理论指导正确，加之特别强调调查研究的“入国问俗，人家问讳，上堂问礼，临病人问所便”的风气盛行，所以使秦汉以前的医学取得了很大的发展；可是由于东汉以后长期的思想禁锢，加之多数医家不去认真调查研究，盲目地使用汗、吐、下三法治疗疾病，结果严重影响了中医的发展。张仲景著《伤寒杂病论》，除大倡研究调查之风外，又以精辟的语言指出了盲目使用汗、吐、下的弊端，从而促进了中医学的发展；但是由于宋以来长期思想的禁锢，又使中医落入新形势下经验主义的泥坑，从而又大大影响了中医的发展。为此刘完素提出了注意火邪，李东垣提出了注意脾胃，朱震亨提出了注意相火，并特别针对时弊，著成了《局方发挥》一书，除痛斥了时弊外，并提出了正确应用《局方》的方法，从而促进了中国医学的发展；其后温病学派的出现，大肆针砭了温热病应用辛温药治疗的时弊，从而促进了医学的发展。那么当前中医界的时弊是什么呢？通过数十年来临床正反两方面的不断总结，认为主要有以下几点：
1. 认为辨证论治是辨症状的论治方法和按病论治方法，而忽略脉象等的价值。
2. 认为发热（即体温高）的病都是热证，都必须用清热解毒、养阴清热、清热泻火的药进行治疗。
3. 认为西医所说的疑难病就是中医的疑难病，按照西医的思路方法套用在中医的治疗上。
4. 认为抓一个主要的问题即可解决所有问题，而不注意夹杂着的复杂问题，更不注意一种倾向掩盖着的另一种倾向。
5. 在治学上不严谨、不认真，常以想象和道听途说为根据去处理问题。
6. 教条主义泛滥，否认实事求是，不作调查研究，反而自以为是。
辨证论治是一个中医临证过程中的思想体系，它是一个系统工程，而绝不是像某些人所理解的那样简单和粗糙。当前中医界之所谓疑难病者，大多是时弊所造成的，因此治疗疑难病时必须注意时弊。
曾治疗患者魏某某，男，34岁。肺炎12天，持续高热不退，常在40℃～40.2℃之间浮动。遍用抗生素及中药无效。邀我诊治。审察其发热呈寒热往来状，并见气短胸满，口苦咽干，烦乱不安，时或胸胁疼痛，舌苔白，脉弦滑数。我说：这是少阳柴胡证。治宜小柴胡汤加减为方。
某医生说：朱老，此病乃肺炎也，肺炎之疾诸医均云宜用麻杏石甘汤，并云此兼热毒也，宜加清热解毒之药治之，何独先生用小柴胡汤也？
我答：麻杏石甘汤者，是张仲景为汗出而喘无大热者设立的。鞠通先生的《温病条辨》虽对本方的应用有所发展，但仍没有脱离张仲景的规范。今人见其麻黄定喘，石膏清热，列为肺炎之专方，虽在临床上常有取效者，然其不效者甚多。医者见其不效，囿于“炎者热毒”的禁锢，复加清热解毒之味以治之，岂不知诸种西药清热解毒不效，怎能用杯水车薪般的中药清热解毒者可效？此病之不效者正在于此种时弊之论所致也。我之所以用小柴胡汤，是因为其证为少阳柴胡证，然而其脉弦中兼有滑数，滑数之脉者是痰热脉也，故处以柴胡28克，半夏10克，黄芩10克，瓜蒌30克，甘草10克，生姜3片，大枣7个。次日往诊。他说：体温已降至36.8℃，且气短胸满，心烦口苦等症状消失，并开始稍进饮食。三日后，诸证消失，出院。
某医生说：小柴胡汤者，治感冒之方也，先生何用其治肺炎乎？
我答：小柴胡汤者，是张仲景所创治疗热病之方也，并云：“但见一证便是，不必悉具。”其并未说肺炎不可用也。今之炎症即热毒之说实乃想象与推理之见，不可胶粘于此也。
又如：患者郭某某，男，32岁。肥厚性心肌病，完全性束支传导阻滞，右心衰竭。前后在青岛、济南、北京、上海等数家医院治疗8个多月不效。来电求我处方救救其生命。我根据所述证候处方治之，半月后，在数人护理下来并求诊。他说：服用15剂，不但寸效不见，反见恶心呕吐，呼吸困难加重。我细审脉证，思之：脉见濡弱，气短纳呆，咽干而有异物阻塞感，头晕而难于站立，且失眠心悸，与所用方剂应称合拍，其何故不效也？再询其服用其他中、西药否？答曰：此病如此之严重，中、西药均进耳。我说：中药处方前人特别强调配伍，其应君者为臣，臣者为佐尚且不效，今加大中、西药饵，何者为君？何者为臣？不知也。且夫俗语云：三个和尚无水吃，其怎能取效呢！我的意思是应仅服此种中药，诸药均予停用耳。陪侍诸医云：不可也。我们西医治之尚且无效，岂可用中药单独治之！某医更声色俱厉地说：此乃重病，中、西医结合尚且无效，你们中医怎敢独治。然因患者及其家属屡屡体会应用前医诸法不效，见我言甚为中肯，便云：停用其他药，试试可也。连续服药50剂，诸证消失，恢复工作。
某医生说：朱老，你为什么要求停用其他药物？
我答：当前一个很大的时弊是在中西医会诊过程中认为西药是治病的，中药是可有可无的，所以中药治的实际是西药的副作用，而很多中医不注意这一点。有些中医一听西医说是什么病，也想从中找一个恰当的治疗方药，岂不知不但没有治了病，反而增加了西药的毒副作用，这样下去怎能取得应有的效果呢？我之所以要求停用其他任何中西药物，其目的是通过充分衡量疾病、药物之间的各方面关系，采用恰当的药物配伍方法，以取得应有的效果。事实证明这种想法是正确的。
又如：曾治患者崔某某，男，6岁。慢性扁桃体炎急性发作10天。医予抗生素大剂输液治疗7天，发热不减，又邀某医以中药大剂清热解毒养阴药配合治疗3天仍无功。审其体温38.9℃，咽喉疼痛，扁桃体肿大，上罩白色脓栓。舌苔白，脉虚大弦紧而数。我说：张仲景谈辨证论治时云应脉证并治耳。此病脉象明明已露气阴两虚，岂可但用清热解毒养阴之剂可取效，治宜补气养阴，予清暑益气汤两剂愈。
某医生说：朱老，你怎么想到用清暑益气汤治疗扁桃体炎？
我答：辨证论治中的一个重要内容是知时弊，今之时弊者何？但见炎症即予清热解毒而忘记脉证并治耳。
So, what methods should be used to study Traditional Chinese Medicine (TCM)? I believe that using administrative means to affirm the correctness of one school and the error of another, or to promote one school while suppressing another, is detrimental to scientific development. The history of TCM development proves that utilizing dichotomy as a research method can advance TCM, allowing for the discovery of many laws; Western medicine has also discovered many laws through intuitive methods. In the process of in-depth research via these two different paths, some laws were coincidentally found to be identical, and some "Western doctors learning TCM" (physicians trained in Western medicine who also study TCM) discovered certain laws through mutual understanding and integration. These three approaches each have their advantages and disadvantages, complementing and promoting each other, leading to an increasingly deep understanding of the mysteries of the human body.
Some might argue this is "retrogression" or "backwardness," denying the necessity of Western doctors learning TCM. I suggest we refrain from attaching such labels for now. Practical experience shows that some patients treated solely by pure Western medicine remained ineffective, but were quickly cured when treated by physicians trained in both systems ("Western doctors learning TCM"); some patients repeatedly treated by "Western doctors learning TCM" were ineffective, but were quickly cured by TCM practitioners; others treated continuously by TCM and "Western doctors learning TCM" were ineffective, but were quickly cured by Western medicine. Therefore, some patients request pure TCM treatment, some request pure Western medicine treatment, and some are willing to accept treatment from "Western doctors learning TCM." Why? I believe this is due to differences in academic viewpoints and angles of problem-solving, resulting in different effects, meaning their depth and breadth of understanding on certain issues differ. To promote scientific development, it is beneficial to recognize and address problems from various angles and breadth.
What aspects of TCM should be studied? I believe that utilizing inherent TCM methods, Western medical methods, and all methods of modern science are all valid ways to study TCM and can promote its development. However, these methods have limitations regarding conditions and cognitive capacity, making it impossible to clearly understand all issues. Therefore, deciding what to study based on a single method, or using it as the standard for measuring research content, is incorrect. The correct object of study should be the regularities discovered in practice; anything that conforms to practical truth should be studied. The history of scientific development proves that what is considered erroneous in one era may be proven completely correct in another era after verification. Thus, we should not easily discard something just because it contradicts current medical levels or certain aspects of modern science. Instead, we should adhere to the principle of "practice first" and verify it in the long river of scientific development.
It is very necessary to intuitively utilize all the latest achievements of modern science to explore the essence of already discovered scientific regularities. This is an important means to promote our understanding of the pathology, physiology, diagnosis, and treatment of the organism. Currently, research in all interdisciplinary fields has greatly enhanced the understanding of scientific regularities already discovered in TCM. However, due to limitations in current scientific levels, necessary means are lacking for some complex laws, so we cannot truly understand all laws yet. Dialectical and non-intuitive research can discover many laws, but due to the difficulty in designing scientific experimental methods, it is hard to conduct. To carry out scientific research, we should adopt a combination of intuitive and non-intuitive methods.
Some colleagues say that Western medicine should study "diseases" (Bing), while TCM should study "syndromes" (Zheng). I believe this is one method for studying both, but not the only one. Because TCM is not merely about syndromes, nor is Western medicine merely about diseases. TCM contains much more content, such as meteorology, geography, psychology, as well as meridians (Jingluo), Zang-Fu organ manifestations (Zangxiang), Yin-Yang, etc., which have not been well resolved and require further study.
How should TCM and Western medicine combine? When should they combine? This issue cannot be solved solely by administrative means. Actually, since Western medicine was introduced to China, the work of combination has begun. Some Western doctors automatically use Chinese herbs to treat diseases, some TCM practitioners automatically apply Western medicines, some Western doctors consciously or unconsciously use TCM theoretical viewpoints to recognize and explain problems, and some TCM practitioners also consciously or unconsciously use certain Western theories to explain problems. This situation has become even more obvious in the more than 50 years since the founding of the People's Republic of China. Currently, it is often heard that some Western doctor colleagues say that applying Western medicines also requires syndrome differentiation (Bian Zheng Lun Zhi), and the application of antibiotics cannot be decided solely by sensitivity tests; TCM practitioners also often ask what disease this is, whether blood pressure has been measured, or if chest fluoroscopy, angiography, electrocardiograms, etc., have been performed. These are all forms of combination. Therefore, regarding when TCM and Western medicine will combine, I believe they are combining right now, and in some places, the combination is quite good. However, when they will be fully combined is still a distant matter. Because scientific development is still limited, and the gap between cognitive ability and actual conditions is large, combination can only occur within the development of TCM, Western medicine, and science. Otherwise, relying on administrative orders to suddenly announce a few years later that TCM and Western medicine will combine, retaining one and abolishing the other, and calling it "combination," I believe such combination is worse than no combination, better discarded.
Through various methods of research, the joint efforts of various schools, letting a hundred schools of thought contend and a hundred flowers bloom, and the efforts of TCM, Western medicine, integrated TCM and Western medicine, and scientists from all fields, let them naturally form a unified school through continuous division and integration on the path of scientific development.
IV. Conclusion
The history of TCM development is a history of summarizing experiences and utilizing real-world scientific achievements to recognize and explain these experiences, a history of consolidating achievements and correcting errors in the ascent of "Practice-Theory-Practice."
Historically, there were two methods for studying TCM: intuitive and dialectical. Both methods discovered certain scientific regularities.
Studying and learning works such as *Neijing* (Classic of Internal Medicine), *Shanghan Lun* (Treatise on Cold Pathogenic Diseases), and *Jingui Yaolue* (Essential Prescriptions of the Golden Cabinet) is very important for studying and learning the entire TCM theory and clinical experience, but one should also study and learn the theories and experiences developed by later generations.
Researching TCM should employ different methods from TCM, integrated TCM and Western medicine, Western medicine, and other fields of modern science, without affirming or negating any single method. In the process of researching with different methods, gradually explore the objective scientific regularities of pathology, physiology, diagnosis, and treatment.
Creating a unified new medicine and new pharmacology through the integration of TCM and Western medicine is our ideal. This combination should proceed gradually; combine as much as possible, do not force combinations where none exist. When a unified new medicine and new pharmacology will form must be gradually realized in the long river of the development of TCM, Western medicine, and modern science, and should not be conducted through administrative orders.
Similarity · Association · Correction · Syndrome Differentiation and Treatment
A certain doctor asked: Elder Zhu, you are a famous expert in difficult and complicated diseases. Please talk about your experience in treating them.
I replied: What are difficult and complicated diseases? They are issues where the prevailing trends (contemporary biases/errors) are not yet clear. There are difficulties in science, politics, economy, and medicine; there are difficulties specific to Western medicine and specific to TCM, and so on, too numerous to mention. Reading carefully the histories of scientific, economic, revolutionary, medical, Western medical, and TCM development, it is not difficult to see that any difficult issues in scientific development share a similar law: the trendiness of contemporary biases. When such biases dominate, people's thoughts are imprisoned, and all related issues become difficult and unsolvable. Once these biases are recognized and broken, all related difficulties become minor issues. For example: in the history of science, when the God of idealism dominated people's thoughts, all related issues became difficult; when Copernicus and others broke this taboo, science immediately progressed. In the history of China's socialist revolution, when dogmatism dominated revolutionaries, the revolution suffered repeated failures; when Mao Zedong broke this ideological imprisonment, the revolution achieved victory; when dogmatism under new circumstances again dominated people, socialist construction suffered setbacks; when Deng Xiaoping broke this ideological imprisonment, socialist construction progressed again. In the history of Chinese medicine, due to the correct guidance of theories represented by *Neijing*, and the prevalence of emphasizing investigation and research—"asking customs when entering a country, asking taboos when visiting a home, asking etiquette when ascending a hall, asking patient preferences when seeing a patient"—medicine before the Qin and Han dynasties achieved great development. However, due to long-term ideological imprisonment after the Eastern Han Dynasty, plus most physicians failing to seriously investigate and research, blindly using sweating (Han), vomiting (Tu), and purging (Xia) methods to treat diseases, the development of TCM was severely affected. Zhang Zhongjing, in writing *Shanghan Zabing Lun* (Treatise on Cold Damage and Miscellaneous Diseases), besides advocating research and investigation, also pointed out the drawbacks of blindly using sweating, vomiting, and purging with incisive language, thereby promoting the development of TCM. However, due to long-term ideological imprisonment since the Song Dynasty, TCM fell into the quagmire of empiricism under new circumstances, greatly affecting its development. Therefore, Liu Wansu proposed paying attention to Fire, Li Dongyuan proposed paying attention to Spleen and Stomach, and Zhu Zhenheng proposed paying attention to Ministerial Fire. Specifically targeting contemporary biases, Zhu wrote *Ju Fang Fa Hui* (Exposition on the Formulary), which not only condemned the biases but also proposed correct methods for applying *Ju Fang*, thereby promoting the development of Chinese medicine. Later, the emergence of the Warm Disease School heavily criticized the bias of using acrid-warm medicines for warm diseases, thereby promoting medical development. So, what are the contemporary biases in the current TCM field? Through continuous summary of positive and negative aspects over decades of clinical practice, the main points are considered to be:
1. Believing that syndrome differentiation and treatment is merely a method of treating symptoms and diseases according to illness, ignoring the value of pulse diagnosis, etc.
2. Believing that all diseases with fever (high body temperature) are Heat Syndromes and must be treated with drugs that clear heat and detoxify, nourish Yin and clear heat, or purge fire and clear heat.
3. Believing that diseases called difficult and complicated by Western medicine are the same as those in TCM, and applying Western medical思路 (thought processes/methods) to TCM treatment.
4. Believing that grasping one main problem can solve all problems, ignoring complex mixed issues, and further ignoring other tendencies masked by one tendency.
5. Being rigorous and serious in scholarship is lacking; often handling problems based on imagination and hearsay.
6. Dogmatism is rampant, denying seeking truth from facts, refusing to conduct investigations and research, and instead being self-righteous.
Syndrome differentiation and treatment is a system of thought in the TCM clinical process. It is a systematic project, not simple and rough as some understand it. The so-called difficult and complicated diseases in the current TCM field are mostly caused by contemporary biases; therefore, when treating difficult and complicated diseases, one must pay attention to these biases.
Case 1: Patient Wei XX, Male, 34 years old. Pneumonia for 12 days, persistent high fever not subsiding, fluctuating between 40°C and 40.2°C. Extensive use of antibiotics and Chinese herbs was ineffective. Invited me for consultation. Upon examination, the fever presented as alternating chills and heat, accompanied by shortness of breath and chest fullness, bitter taste in the mouth and dry throat, restlessness and unease, occasional chest and hypochondriac pain, white tongue coating, and wiry, slippery, rapid pulse. I said: This is a Shaoyang Chaihu Syndrome. The treatment should be modified Xiao Chai Hu Tang (Minor Bupleurum Decoction).
The doctor said: Elder Zhu, this disease is pneumonia. All physicians state that Ma Xing Shi Gan Tang (Ephedra, Apricot Kernel, Gypsum, and Licorice Decoction) should be used for pneumonia, and that this case involves heat toxicity, requiring the addition of heat-clearing and detoxifying drugs. Why do you alone use Xiao Chai Hu Tang?
I answered: Ma Xing Shi Gan Tang was established by Zhang Zhongjing for cases of sweating, wheezing, and no significant heat. Although Mr. Ju Tong's *Wen Bing Tiao Bian* (Systematic Differentiation of Warm Diseases) developed the application of this formula, it did not depart from Zhang Zhongjing's norms. Modern physicians, seeing Ephedra stop wheezing and Gypsum clear heat, list it as a specialized formula for pneumonia. Although it often takes effect clinically, many cases fail. Physicians, seeing failure, confined by the禁锢 (imprisonment) of the idea that "inflammation equals heat toxicity," add heat-clearing and detoxifying agents. Do they not know that if various Western drugs fail to clear heat and detoxify, how can a mere cup of Chinese herbal medicine succeed? The ineffectiveness of this case is precisely due to this contemporary bias. I used Xiao Chai Hu Tang because the syndrome is Shaoyang Chaihu Syndrome. However, the pulse is wiry with slippery and rapid qualities; a slippery and rapid pulse indicates Phlegm-Heat. Therefore, I prescribed Chai Hu (Bupleuri Radix) 28g, Ban Xia (Pinelliae Rhizoma) 10g, Huang Qin (Scutellariae Radix) 10g, Gua Lou (Trichosanthis Fructus) 30g, Gan Cao (Glycyrrhizae Radix et Rhizoma) 10g, Sheng Jiang (Zingiberis Rhizoma Recens) 3 slices, Da Zao (Jujubae Fructus) 7 pieces. Visiting the next day, he reported: Body temperature dropped to 36.8°C, and symptoms like shortness of breath, chest fullness, vexation, and bitter taste disappeared, and he began to eat slightly. Three days later, all symptoms vanished, and he was discharged.
The doctor said: Xiao Chai Hu Tang is a formula for treating colds. Why did you use it for pneumonia?
I answered: Xiao Chai Hu Tang was created by Zhang Zhongjing to treat febrile diseases, and he stated: "If even one symptom appears, it suffices; it is not necessary for all to be present." He did not say pneumonia could not use it. The current notion that inflammation equals heat toxicity is actually a view based on imagination and reasoning, which should not be rigidly adhered to.
Case 2: Patient Guo XX, Male, 32 years old. Hypertrophic cardiomyopathy, complete bundle branch block, right heart failure. Treated for over 8 months in several hospitals in Qingdao, Jinan, Beijing, Shanghai, etc., without effect. Called me requesting a prescription to save his life. Based on the described symptoms, I prescribed treatment. Half a month later, he came for consultation accompanied by several caregivers. He said: After taking 15 doses, there was no effect at all; instead, nausea, vomiting, and worsened breathing difficulties occurred. I carefully examined the pulse and symptoms, pondering: The pulse is soggy and weak, with shortness of breath, poor appetite, dry throat with a sensation of foreign body obstruction, dizziness making standing difficult, insomnia, and palpitations. This matches the prescribed formula well. Why was it ineffective? I inquired further if he took other Chinese or Western medicines. He answered: Given the severity of this disease, both Chinese and Western medicines were taken. I said: Predecessors particularly emphasized compatibility in Chinese herbal prescriptions. If the Sovereign drug acts as Minister, and Minister as Assistant, and still fails, how can adding large amounts of Chinese and Western medicines help? Who is the Sovereign? Who is the Minister? Unknown. As the saying goes: "Three monks have no water to drink"; how can it take effect! My intention was that only this Chinese herbal medicine should be taken, and all other medicines stopped. The accompanying doctors said: Impossible. Even our Western medicine treatment failed; how can Chinese herbal medicine alone treat it? Another doctor said sternly: This is a severe disease. Even combined TCM and Western medicine treatment failed; how dare you TCM practitioners treat it alone. However, since the patient and family repeatedly experienced the ineffectiveness of previous treatments and found my words pertinent, they agreed: Stop other medicines, try this. After continuously taking 50 doses, all symptoms disappeared, and he returned to work.
The doctor asked: Elder Zhu, why did you require stopping other medications?
I answered: A major contemporary bias is the belief during TCM-Western medicine consultations that Western medicines cure the disease, while Chinese herbs are optional. Thus, Chinese herbs often treat the side effects of Western medicines, a point many TCM practitioners ignore. Some TCM practitioners, upon hearing the Western diagnosis, try to find an appropriate Chinese prescription, unaware that this not only fails to cure the disease but increases the toxic side effects of Western medicines. How can the desired effect be achieved this way? My purpose in requiring the cessation of all other Chinese and Western medicines was to fully evaluate the relationships between the disease and drugs, adopt appropriate drug compatibility methods, and achieve the desired effect. Facts prove this thinking is correct.
Case 3: Patient Cui XX, Male, 6 years old. Acute exacerbation of chronic tonsillitis for 10 days. Doctors administered large-dose intravenous antibiotic therapy for 7 days, with fever persisting. Another doctor was invited to cooperate with large-dose Chinese herbs for clearing heat, detoxifying, and nourishing Yin for 3 days, still without effect. Examination showed body temperature 38.9°C, sore throat, swollen tonsils covered with white pus plugs. White tongue coating, deficient, large, wiry, tight, and rapid pulse. I said: When Zhang Zhongjing discussed syndrome differentiation and treatment, he stated that pulse and symptoms should be treated together. The pulse clearly reveals Qi and Yin deficiency. How can one expect success using only heat-clearing, detoxifying, and Yin-nourishing agents? The treatment should tonify Qi and nourish Yin. Two doses of Qing Shu Yi Qi Tang (Clear Summerheat and Boost Qi Decoction) resulted in recovery.
The doctor asked: Elder Zhu, how did you think to use Qing Shu Yi Qi Tang to treat tonsillitis?
I answered: An important aspect of syndrome differentiation and treatment is recognizing contemporary biases. What is the current bias? Seeing inflammation and immediately administering heat-clearing and detoxifying agents while forgetting to treat based on pulse and symptoms.