陈可冀先生说：“中医理沦基本上还是用古代的，发展得很不够，发展得比较多的还是中西医结合，用现代科学方法来发展中医理沦。”又说：“我主要的工作，第一是心血管病方面研究出一套中医的活血化瘀理论，第二个是我主持整理清代宫廷秘方。”是的，正如陈可冀先生所说，中西医结合有很大发展，其在活血化瘀理论方面作出了巨大贡献，并对中医的发展产生了巨大影响。但是由于他的对号入座的研究方法和其违背中医理论固有概念之理论的提出，使着很多临床工作者也对并不是以瘀血为主的疾病采用了活血化瘀方法进行治疗，结果造成了临床上的一误再误。例如：在陈可冀先生所举的两个病：高血压病和心肌梗死。由于把高血压病单纯对号为阴虚肝旺，把心肌梗死病单纯对号为瘀血阻滞，使中医的治疗一误再误，结果就造成了“高血压病人头痛，中医治疗以为好了，上班了，西医一量，血压还高，西医就说没完全好，他就有意见了，说你看我治好了，他没病了，没事了，你给我找事，这矛盾就出在这儿”的现象。由此可见对号入座才是影响中医发展的症结。
(二)引进现代科学是不是中医发展的唯一道路
诚如有一著名专家一再强调，西医由于引进了现代科学的理论和方法，使西医得到了长足的发展，因此中医要引进现代科学。如果从这个角度看问题，我认为是十分正确的，但是问题不是这么简单，因为现代科学的理沦和方法也在不断地更新，不断地被新的理论和方法所代替，假若我们不是以实践是检验真理的唯一标准去衡量中医的理论和方法，单纯地追求其符合与不符合现代科学的某个理论和方法，单纯地把符合与不符合现代科学的某个理论作为衡量中医科学不科学的标准，那就成问题了。因为如果现代科学的某个理论被否定了，我们中医怎么办呢?有专家曾讲：现在有一些人，不懂现代科学，抱着他那个东西不放，一方面自卑，一方面自高白大，一天到晚就是中医存亡论，沉思论……现代医学为什么不可以套中医?现在肝炎，你不检查澳抗的阴性、阳性，转氨酶的高低，……治什么肝炎!这些理论纯粹是虚假的、空洞的。为什么中医这些文章不能登大雅之堂，走不出去?从这个例子可以看出套用西医的理论予以说明是多么有理，可就是这个证明恰恰套用的是失败的例子，因为过去某些中医和西学中的专家们之所以称为有效，是由于其改善了多少确定为肝炎的指标，而近几年卫生部一个命令说多少多少确定肝炎的指标均不可靠；几乎把所有肝炎专家所说的光荣依据都一笔勾销了，而那些什么也不懂的人却仍然站得住脚，这是为什么呢?这是由于这些人坚持着一个原则，即坚持着实践是检验真理的唯一标准，坚持着走自己特色的发展之路。
(三)中医发展的路
既然套用西医不行，套用现代科学也不行，那么中医的发展到底应走什么路呢?我认为所以说不行，是说的套不行，不是说不应该吸收它们的合理内核，不是说不吸收其所有有利的东西，而是说不能套，套必出弊，要走只能走建设中国特色的，以实践是检验真理的唯一标准之路，而绝不应是其他。
二、是坚持科学的是非严肃性，还是走糊涂的路，是坚持实事求是，还是走哗众取宠的路
纵观古今中外的科学发展史可以看出，由于某些科学工作者不断地发现和发明着开始不被人理解，不被人所认识的新的理论和技术，而促进着社会的进步。正如陈可冀先生所举的例子，由于爱因斯坦发现了很多人所不理解的相对论，才使人们推崇的所谓经典物理学又向前进了一步。在我国也同样是这样，由于我国的科学工作者发明了当时不被人所理解的印刷术、指南针、造纸术、火药，才使科学步人了一个新的台阶；由于孙武写出了至今还有些不被人所理解，而在实践中却有着巨大的实用价值的孙子兵法，被世人所瞩目。这些科学工作者在当时想没有想他们的观点、方法要登大雅之堂呢?据我所知，他们是没有的。既然从古至今的中外科学工作者没有一个是为登大雅之堂去工作，没有一个不是通过对事实的研究而发现发明，并通过这些不被当时的人所理解的发明发现去推进科学发展的，那么为什么非要要求通过实践发现的中医理论和方法硬套在某些西医和某些科学工作者所尚不理解的模型上呢?非要为登大雅之堂而背弃基本原则，非要为登大雅之堂而丢掉具有中国特色的科学呢?
(一)关于症和病的结合
由于数十年来的追求登大雅之堂，使很多学者不再深求中医理论概念的深刻内涵，致使中医日渐走向难于自拔的怪圈，而其中的证、辨证、辨病等概念的误解给中医带来的危害尤为严重。例如：证，这个字在古代的含义本是一个证据的意思，这个证据在中医理论上不但指所谓的自觉症状，而且指的还有脉象、时间、地域、运气、相似、相似相应等等，等等。辨证，则是指的分辨各种证据，并通过对这些分辨得出恰当的结论，这个结论不但包括病位、病性，而且包括标本、先后、各种比例关系。近些年来所提的证与辨证的概念则完全丢掉了其深刻的内涵，并把误解了的内涵作为标准去进行中、西医套用方法的依据，致使很多医者不知所从，并提出无证可辨之说，从而严重地影响着中国医药学的发展。
(二)关于要不要干涉
在我国的古代，由于战国时代的百家争鸣、百花齐放使科学得到了突飞猛进的发展，而由于秦始皇的焚书坑儒，清代的文字狱使我国科学发展受到了严重的阻碍。在欧洲由于所谓的黑暗，伽里略的被处死，使科学的发展受到了影响。而秦始皇、乾隆、教皇等都是以卫护科学的真理面目出现的。陈可冀先生现在是科学院院士了，自然应以卫道士的资格出现了，可是他忘汜了一个事实，那就是现在的中医、中药人员，不但上过大学，学过丰富的自然科学知识。但他们为什么还说你不要干涉我的语言呢?我认为不在于“中医相当长的时间和自然科学隔绝了，自然地在这个群体中产生了一种惰性”，而在于目前的中国医药学研究中的套语不符合实践是检验真理的唯严标准。
综上所述，我认为套用现在的理论和方法不但不能促进中国医药学的发展，而只能使其倒退，而按照建设有中国特色的中国医药学的道路才是中国医药学发展的唯一途径。
如何提高辨证论治的准确率
一、产生辨证论治过程中的错误原因
1．抛弃中医理论，单纯强调套用西医。例如：高血压病，某些医者鉴于其部分患者是阴虚肝旺引起的，便把这部分经验套用到所有的高血压病患者身上，并称这就是中西医结合，而将所有的患者统统采用滋阴平肝法进行治疗。又如心肌梗死，某些医家鉴于其在研究中发现与瘀血有关，就统统认为是瘀血阻滞所致，并认为这就是中西医结合，而将所有的心肌梗死的患者采用活血化瘀法进行治疗。结果把很多非肝旺的高血压病，非瘀血阻滞所致的心肌梗死的患者采用了滋阴平肝，活血化瘀的治疗方法。
2．过度迷信专家、前人，不做认真调查研究。例如：某些医者在临床时只注意某某专家，某某大医院的诊断，而对患者叙述的与专家诊断相反的任何症状，任何体征不屑一顾，一听此病即立刻开据出某某验方，结果常常不效。
3．不顾客观的实际，单纯追求验方。例如：肝炎，某些医者鉴于很多传染病院报道说传染性肝炎乃湿热所致，并云其采用除湿清热法是如何如何的有效，而也认为所有的肝炎患者都是此种证型，结果多数患者不效。他们忘记自己所处的环境不是传染病院，所治疗的患者都是经传染病院治疗无效的事实，所以当然不会取得好的效果。
4．只注意该种疾病的普遍规律，不去探查该种疾病的特殊证候。例如：肺炎，某些医家只注意其痰热壅肺，而对所谓的凉燥犯肺的各种表现不予重视。又如：流行性乙型脑炎，只注意其多见清瘟败毒饮证，而对早已出现的肢厥脉微，泄泻，苔白，根本不去考虑等。
5．不是按照望闻问切去搜集资料，而是凭据想象处理问题。例如：钩端螺旋体病，当一遇见患者说是患的钩端螺旋体病时，即立刻认为其乃湿热所致，而根本不去考虑其证的恶寒发热，头痛身痛，脉浮紧数，致使本是大青龙汤一剂可愈的病，变为长期缠绵不愈。
6．不去理解中医特定术语的含义，而是自造术语歪曲原有的概念。例如：中医辨证论治术语中的证，本是各种证据的意思，而某些医者却把证仅仅理解为症状的代名词，并提出新的无证可辨说来否定辨证论治。
二、提高辨证论治准确率的方法
1．严格地按照中医理论和方法进行辨证论治。这里所谓严格的，即不是有例外的，例如：西医诊断的某某所谓炎症，只要是我们通过严格的中医诊断方法确定其属于虚，属于寒，我们就认为其属于虚、寒，而不能因为其是炎症就认为其属于热，属于实。又如：大便秘结，只要是我们通过严格的中医诊断方法确定其属于虚、寒，那我们就不能因为其系大便秘结而认为其属于实热等。
2．严格地按照中医的诊断步骤去诊查疾病。这里所谓的严格地按照中医的诊断步骤，即毫无例外地按照中医的望闻问切去检查，并根据其检查的所得材料去确定诊断，而绝不可有任何例外。例如：感冒，当患者说其是感冒一病时，我们不能因其是感冒而不去察脉，不去察舌，不去按腹，否则是很难确定其属于什么证候的。又如：低血压病，当患者说其是低血压病时，我们不能因其是低血压而诊为气虚清阳不升，而冒然采用补中益气等。
3．认真地学习古代名家的医案，通过分析了解其成功的辨证论治方法。怎么巧妙地应用中医理论于临床，这是中医临床工作者最难掌握的问题，所以前人常有“熟读王叔和，不如临证多”，“净信书，不如无书”的警语告诫我们。怎么才能临证多?我认为第一应该多临床，第二是应该多学习前人的临床实践经验。在学习前人的临床实践经验上，我认为也有两点：第一是直接跟着有经验的老师学习他们的成功经验，第二是从前人的有效验案中学习成功的经验。只有这样才能学到巧，才能真正地学会辨证论治的方法。
4．认真地分析所谓的大和小，即所谓的大的问题和独处藏奸的关系。例如：有些过敏性紫癜患者，我们通过检查分柝确定其属于热毒炽盛后，本来采用黄芩、黄连、黄柏、生石膏等应该有效，但一通过实践去检验却根本无效。这是为什么；?这是我们忽略了其独处藏奸的寒。又如：某些癃闭，从其证中的尿急尿痛，口干口苦，身热来看，当属一个热证，但应用知母、黄柏却分毫无效，这是为什么?这是由于我们忽略了其中所谓的独处藏奸中的阳虚的结果。这个独处藏奸的问题看起来事小，但其常常是决定成败的关键，因此临床时一定要特别注意。
5．临证处方时，不但要知药物的性味、功用、主治、归经，而且要知所处方剂是什么方，其主治证是什么?不但要知所处方药中是由那些药味组成的，而且要知所处方药中包括了那些前人的方剂?那些前人的方剂的主治证是什么?如此等。
方中有药，药中有方
在我临床之余，经常求教于山西省中医研究所前所长，已故名老中医李翰卿先生。问：为什么有的患者别人用大方大剂不效，而老师用小方小剂却其效如神?答曰：要想做到处方用药精炼有效，必须做到处方时要方中有药，药中有方。再问：何谓方中有药，药中有方?答曰：所谓方中有药，药中有方，即：①我们每开一个处方，都应该知道这是前人的什么方?它的主治证是什么?②我们每开一个处方，都应该知道后人在这一方剂的主治证上有什么发挥?我们每开一个处方，都应该知道该方的组成药物的主治证、性味特点、升降沉浮、归经是什么?这是方中有药、药中有方原则的第一步。第二步，即所谓加减药物的问题，其中：①加减一个药物时，必须了解加减药．物的性味、归经、升降沉浮、主治功用的特性。②加一个药物时，必须了解加一个药物可以与原方药物组成什么方?这个方的主治证是什么?③减一个药物时，必须了解减去该药组成的方剂及主治证。总之，不管加减什么药都不但知道药，而且应该知道方的复杂变化。
还说：有的人所以用大方大剂不效，其原因有四：①处方时只注意了处方中单个药物的主治功用，没有注意单个药物的性味、归经、升降浮沉。②处方时只注意了单个药物的主治功用，没有注意药物组成方剂后所带来的变化。③加减药物时，只注意了单个药物的主治功用，没有注意单个药物所带来的升降浮沉、归经的变化。④加减药物时，只注意了加减药物的特性，没有注意到加减药物所带来的方剂组成和功能主治的变化。在这四个问题中特别是带来的方剂变化。
要想做到方中有方，方中有药，药中有方，必须在以下两个方面下功夫：①熟读药物学。在读药物学时，要切忌死背，要多在比较中下功夫，找出众多药物间的相同点和相异点。②多读方。要善于把众多医家主治相同、组成相同，主治相同而用药不同，主治不同而用药相同，药味相同而剂型不同的方剂进行纵横比较，并在比较中找出它们共性和特性。如此这般的钻研数年，就可达到心中有数。
病重者应施以微药
陈可冀先生表示：“中医的理论基础基本上仍沿用古代的内容，发展尚不充分；发展较为显著的领域是中西医结合，即运用现代科学方法来推动中医理论的发展。”他又说：“我的主要工作有两项：第一是在心血管疾病方面研究并建立了一套中医活血化瘀理论；第二是我主持整理了清代宫廷的秘方。”诚然，正如陈可冀先生所言，中西医结合取得了巨大进展，尤其在活血化瘀理论方面贡献卓著，并对中医的发展产生了深远影响。然而，由于其采用“对号入座”的研究方法，以及提出违背中医固有理论概念的观点，导致许多临床工作者将活血化瘀法应用于并非以瘀血为主的疾病，从而在临床上造成了一误再误的后果。例如，在陈可冀先生所列举的高血压病和心肌梗死这两个病症中，由于将高血压病单纯对应为阴虚肝旺证，将心肌梗死单纯对应为瘀血阻滞证，致使中医治疗陷入误区。其结果是出现了这样的现象：“高血压患者出现头痛，中医治疗后症状消失，患者恢复工作；西医测量后发现血压依然偏高，西医便认为未完全治愈，患者因此产生异议，说道：‘你看我治好了，没病了，没事了，你却在给我找麻烦。’矛盾就出在这里。”由此可见，“对号入座”才是阻碍中医发展的症结所在。
(二) 引进现代科学是否是中医发展的唯一道路？
诚如某位著名专家反复强调的那样，西医因引进了现代科学的理论和方法而得到了长足发展，因此中医也应引进现代科学。若仅从这一角度审视问题，我认为这是十分正确的。但问题并非如此简单，因为现代科学的理论和方法也在不断更新，不断被新的理论和方法所取代。如果我们不以“实践是检验真理的唯一标准”来衡量中医的理论和方法，而是单纯追求中医是否符合现代科学的某一特定理论或方法，并将这种符合与否作为衡量中医是否具备科学性的标准，那就会出现问题。因为如果现代科学的某一理论被否定，我们中医该怎么办呢？曾有专家指出：现在有一些人不懂现代科学，却固守己见，一方面自卑，一方面自高自大，整天谈论中医存亡论、沉思论……为何现代医学不能套用中医理论？如今治疗肝炎，若不检查澳抗（乙型肝炎表面抗原）的阴性和阳性，不查看转氨酶的高低，……还谈什么治疗肝炎！这些理论纯粹是虚假且空洞的。为什么中医的这些文章不能登大雅之堂，无法走向世界？从这个例子可以看出，套用西医理论进行解释似乎很有道理，但恰恰这个证明是一个失败的套用案例。因为过去某些中医和西学中专家之所以被认为有效，是因为他们改善了那些被确定为肝炎的指标；而近几年卫生部的一项命令指出，此前确定的许多肝炎指标均不可靠，几乎将所有肝炎专家所谓的权威依据一笔勾销，而那些什么都不懂的人却依然站得住脚，这是为什么呢？这是因为这些人坚持一个原则，即坚持“实践是检验真理的唯一标准”，坚持走具有自身特色的发展道路。
(三) 中医发展的道路
既然套用西医不行，套用现代科学也不行，那么中医的发展究竟应该走什么路呢？我认为，所谓“不行”，是指不能“套用”，而不是说不应该吸收它们的合理内核，也不是说不吸收其所有有利的东西，而是说不能生搬硬套，套用必然产生弊端。我们要走的只能是建设有中国特色的、以“实践是检验真理的唯一标准”为准则的道路，而绝不应该是其他道路。
二、是坚持科学的是非严肃性，还是走糊涂的路；是坚持实事求是，还是走哗众取宠的路
纵观古今中外的科学发展史可以看出，由于某些科学工作者不断发现和发明起初不被理解、不被认识的新技术和新理论，从而促进了社会的进步。正如陈可冀先生所举的例子，由于爱因斯坦发现了许多人难以理解的相对论，才使人们推崇的经典物理学又向前迈进了一步。在我国也是如此，由于我国的科学工作者发明了当时不被理解的印刷术、指南针、造纸术和火药，才使科学步入一个新的台阶；由于孙武写出了至今仍有部分人不理解、但在实践中具有巨大实用价值的《孙子兵法》，从而受到世人的瞩目。这些科学工作者在当时想过他们的观点和方法要登大雅之堂吗？据我所知，他们没有想过。既然从古至今的中外科学工作者没有一个是为了登大雅之堂而去工作，没有一个不是通过对事实的研究而发现发明，并通过这些当时不被理解的发明发现去推进科学发展的，那么为什么非要要求通过实践发现的中医理论和方法硬套在某些西医和某些科学工作者尚不理解的模型上呢？为什么要为了登大雅之堂而背弃基本原则，为了登大雅之堂而丢掉具有中国特色的科学呢？
(一) 关于症和病的结合
由于数十年来追求“登大雅之堂”，使许多学者不再深入探究中医理论概念的深刻内涵，致使中医日渐陷入难以自拔的怪圈，其中对证、辨证、辨病等概念的误解给中医带来的危害尤为严重。例如：“证”这个字在古代的含义本是“证据”的意思，在中医理论上，它不但指所谓的自觉症状，还包括脉象、时间、地域、运气、相似性及相应关系等等。辨证，则是指分辨各种证据，并通过对这些分辨得出恰当的结论，这个结论不但包括病位、病性，还包括标本、先后顺序以及各种比例关系。近些年来提出的证与辨证的概念，则完全丢掉了其深刻的内涵，并将误解后的内涵作为标准，作为中西医套用的依据，致使许多医者无所适从，甚至提出“无证可辨”的说法，从而严重影响中国医药学的发展。
(二) 关于要不要干涉
在我国古代，战国时代的百家争鸣、百花齐放使科学得到了突飞猛进的发展；而秦始皇的焚书坑儒、清代的文字狱则使我国科学发展受到了严重阻碍。在欧洲，由于所谓的黑暗时期，伽利略被处死，使科学的发展受到了影响。而秦始皇、乾隆皇帝、教皇等人都是以卫护科学真理的面目出现的。陈可冀先生现在是科学院院士，自然应以卫道士的身份出现，但他遗忘了一个事实，那就是现在的中医、中药人员，不仅上过大学，还学过丰富的自然科学知识。但他们为什么还说“你不要干涉我的语言”呢？我认为，不在于“中医在相当长的时间内与自然科学隔绝，自然地在这个群体中产生了一种惰性”，而在于目前的中国医药学研究中的套用方法不符合“实践是检验真理的唯一标准”。
综上所述，我认为套用现有的理论和方法不仅不能促进中国医药学的发展，反而只能使其倒退；而按照建设有中国特色的中国医药学的道路，才是中国医药学发展的唯一途径。
如何提高辨证论治的准确率
一、产生辨证论治过程中错误的原因
1. 抛弃中医理论，单纯强调套用西医。例如：高血压病，某些医者鉴于部分患者是由阴虚肝旺引起的，便将这部分经验套用到所有高血压病患者身上，并称这就是中西医结合，而对所有患者一律采用滋阴平肝法进行治疗。又如心肌梗死，某些医家鉴于其在研究中发现其与瘀血有关，便统统认为是瘀血阻滞所致，并认为这就是中西医结合，对所有心肌梗死患者均采用活血化瘀法进行治疗。结果导致许多非肝旺型的高血压病和非瘀血阻滞所致的心肌梗死患者，被采用了滋阴平肝、活血化瘀的治疗方法。
2. 过度迷信专家、前人，不做认真调查研究。例如：某些医者在临床时只注意某某专家、某某大医院的诊断，而对患者叙述的与专家诊断相反的任何症状、任何体征不屑一顾，一听此病名即立刻开出某某验方，结果常常无效。
3. 不顾客观实际，单纯追求验方。例如：肝炎，某些医者鉴于许多传染病院报道传染性肝炎乃湿热所致，并声称其采用除湿清热法如何有效，便也认为所有肝炎患者都是此种证型，结果多数患者无效。他们忘记了自己所处的环境不是传染病院，所治疗的患者都是经传染病院治疗无效的事实，所以当然不会取得好的效果。
4. 只注意该种疾病的普遍规律，不去探查该种疾病的特殊证候。例如：肺炎，某些医家只注意其痰热壅肺的表现，而对所谓的凉燥犯肺的各种表现不予重视。又如：流行性乙型脑炎，只注意其多见清瘟败毒饮证，而对早已出现的肢厥脉微、泄泻、苔白等症状，根本不去考虑等。
5. 不是按照望闻问切去搜集资料，而是凭想象处理问题。例如：钩端螺旋体病，当一遇见患者说是患的钩端螺旋体病时，即立刻认为其乃湿热所致，而根本不去考虑其证的恶寒发热、头痛身痛、脉浮紧数等症状，致使本是大青龙汤一剂可愈的病，变为长期缠绵不愈。
6. 不去理解中医特定术语的含义，而是自造术语歪曲原有的概念。例如：中医辨证论治术语中的“证”，本是各种证据的意思，而某些医者却把“证”仅仅理解为症状的代名词，并提出新的“无证可辨”说来否定辨证论治。
二、提高辨证论治准确率的方法
1. 严格地按照中医理论和方法进行辨证论治。这里所谓严格的，即没有例外的。例如：西医诊断为某某所谓炎症，只要是我们通过严格的中医诊断方法确定其属于虚、属于寒，我们就认为其属于虚、寒，而不能因为其是炎症就认为其属于热、属于实。又如：大便秘结，只要是我们通过严格的中医诊断方法确定其属于虚、寒，那我们就不能因为其系大便秘结而认为其属于实热等。
2. 严格地按照中医的诊断步骤去诊查疾病。这里所谓的严格地按照中医的诊断步骤，即毫无例外地按照中医的望闻问切去检查，并根据其检查所得材料去确定诊断，而绝不可有任何例外。例如：感冒，当患者说其是感冒一病时，我们不能因其是感冒而不去察脉、不去察舌、不去按腹，否则是很难确定其属于什么证候的。又如：低血压病，当患者说其是低血压病时，我们不能因其是低血压而诊为气虚清阳不升，而冒然采用补中益气等法。
3. 认真地学习古代名家的医案，通过分析了解其成功的辨证论治方法。怎么巧妙地应用中医理论于临床，这是中医临床工作者最难掌握的问题，所以前人常有“熟读王叔和，不如临证多”、“尽信书，不如无书”的警语告诫我们。怎么才能临证多？我认为第一应该多临床，第二是应该多学习前人的临床实践经验。在学习前人的临床实践经验上，我认为也有两点：第一是直接跟着有经验的老师学习他们的成功经验，第二是从前人的有效验案中学习成功的经验。只有这样才能学到巧，才能真正地学会辨证论治的方法。
4. 认真地分析所谓的大和小，即所谓的大的问题和“独处藏奸”的关系。例如：有些过敏性紫癜患者，我们通过检查分析确定其属于热毒炽盛后，本来采用黄芩、黄连、黄柏、生石膏等应该有效，但一通过实践去检验却根本无效。这是为什么？这是我们忽略了其“独处藏奸”的寒证。又如：某些癃闭（小便不通），从其证中的尿急尿痛、口干口苦、身热来看，当属一个热证，但应用知母、黄柏却分毫无效，这是为什么？这是由于我们忽略了其中所谓的“独处藏奸”中的阳虚结果。这个“独处藏奸”的问题看起来事小，但其常常是决定成败的关键，因此临床时一定要特别注意。
5. 临证处方时，不但要知药物的性味、功用、主治、归经，而且要知所处方剂是什么方，其主治证是什么？不但要知所处方药中是由哪些药味组成的，而且要知所处方药中包括了哪些前人的方剂？那些前人的方剂的主治证是什么？如此等。
方中有药，药中有方
在我临床之余，经常求教于山西省中医研究所前所长、已故名老中医李翰卿先生。问：为什么有的患者别人用大方大剂不效，而老师用小方小剂却其效如神？答曰：要想做到处方用药精炼有效，必须做到处方时要“方中有药，药中有方”。再问：何谓方中有药，药中有方？答曰：所谓方中有药，药中有方，即：①我们每开一个处方，都应该知道这是前人的什么方？它的主治证是什么？②我们每开一个处方，都应该知道后人在这一方剂的主治证上有什么发挥？我们每开一个处方，都应该知道该方的组成药物的主治证、性味特点、升降沉浮、归经是什么？这是方中有药、药中有方原则的第一步。第二步，即所谓加减药物的问题，其中：①加减一个药物时，必须了解加减药物的性味、归经、升降沉浮、主治功用的特性。②加一个药物时，必须了解加一个药物可以与原方药物组成什么方？这个方的主治证是什么？③减一个药物时，必须了解减去该药组成的方剂及主治证。总之，不管加减什么药都不但知道药，而且应该知道方的复杂变化。
还说：有的人所以用大方大剂不效，其原因有四：①处方时只注意了处方中单个药物的主治功用，没有注意单个药物的性味、归经、升降浮沉。②处方时只注意了单个药物的主治功用，没有注意药物组成方剂后所带来的变化。③加减药物时，只注意了单个药物的主治功用，没有注意单个药物所带来的升降浮沉、归经的变化。④加减药物时，只注意了加减药物的特性，没有注意到加减药物所带来的方剂组成和功能主治的变化。在这四个问题中特别是带来的方剂变化。
要想做到方中有方，方中有药，药中有方，必须在以下两个方面下功夫：①熟读药物学。在读药物学时，要切忌死背，要多在比较中下功夫，找出众多药物间的相同点和相异点。②多读方。要善于把众多医家主治相同、组成相同，主治相同而用药不同，主治不同而用药相同，药味相同而剂型不同的方剂进行纵横比较，并在比较中找出它们共性和特性。如此这般的钻研数年，就可达到心中有数。
病重者应施以微药
Mr. Chen Keji stated: "The theoretical basis of Traditional Chinese Medicine (TCM) basically still relies on ancient content, and its development is insufficient; the area that has developed more significantly is the integration of Chinese and Western medicine, which involves using modern scientific methods to promote the development of TCM theory." He further said: "My main work consists of two aspects: first, researching and establishing a theory of activating blood circulation and resolving stasis in Traditional Chinese Medicine for cardiovascular diseases; second, presiding over the compilation of secret prescriptions from the Qing Dynasty imperial court." Indeed, as Mr. Chen Keji pointed out, the integration of Chinese and Western medicine has made tremendous progress, especially contributing greatly to the theory of activating blood circulation and resolving stasis, and having a profound impact on the development of TCM. However, due to his research method of "matching symptoms to diseases" (duihao ruzuo) and proposing viewpoints that contradict the inherent conceptual framework of TCM, many clinical practitioners have applied methods of activating blood circulation and resolving stasis to diseases not primarily characterized by blood stasis, thereby causing repeated errors in clinical practice. For example, regarding hypertension and myocardial infarction cited by Mr. Chen Keji, by simply equating hypertension with Yin deficiency and Liver Yang hyperactivity syndrome, and myocardial infarction with blood stasis obstruction syndrome, TCM treatment fell into误区 (misunderstanding). The result was the phenomenon where: "A hypertensive patient presents with headache; after TCM treatment, symptoms disappear, and the patient returns to work; when measured by Western medicine, blood pressure remains high, so Western medicine deems it not fully cured. The patient then objects, saying, 'Look, I am cured, no longer sick, everything is fine, yet you are creating trouble for me.' The contradiction lies here." Thus, it can be seen that "matching symptoms to diseases" is the crux hindering the development of TCM.
(II) Is introducing modern science the only path for the development of TCM?
As repeatedly emphasized by a certain famous expert, Western medicine has achieved substantial development by introducing modern scientific theories and methods; therefore, TCM should also introduce modern science. If we view the issue solely from this perspective, I believe this is quite correct. However, the matter is not that simple, because modern scientific theories and methods are constantly updating and being replaced by new ones. If we do not measure TCM theories and methods against the criterion that "practice is the sole criterion for testing truth," but instead solely pursue whether TCM conforms to specific modern scientific theories or methods, and use such conformity as the standard to judge whether TCM is scientific, problems will arise. Because if a certain modern scientific theory is negated, what shall we do with TCM? An expert once remarked: Currently, some people who do not understand modern science cling stubbornly to their views, feeling inferior on one hand and arrogant on the other, constantly discussing the survival of TCM or contemplative theories... Why cannot modern medicine apply TCM theories? Nowadays, in treating hepatitis, without checking the negative or positive status of HBsAg (Hepatitis B surface antigen) and the levels of transaminases... how can one discuss treating hepatitis! These theories are purely false and empty. Why cannot these TCM articles enter the mainstream academic circles and go global? From this example, it appears reasonable to explain things by applying Western medical theories; however, this very proof is actually a failed case of application. This is because experts in TCM and those learning Western medicine through TCM were previously considered effective because they improved indicators defined as hepatitis; whereas recently, an order from the Ministry of Health stated that many previously determined hepatitis indicators are unreliable, almost nullifying all the authoritative bases cited by hepatitis experts, yet those who know nothing still stand firm. Why is this? It is because these individuals adhere to a principle: adhering to "practice is the sole criterion for testing truth" and persisting in a development path with their own characteristics.
(III) The Path of TCM Development
Since applying Western medicine does not work, and applying modern science does not work either, then what path should the development of TCM take? I believe that when saying it "does not work," it refers to the inability to "apply mechanically," not that we should not absorb their rational cores, nor that we should not absorb all beneficial elements, but rather that we must not force-fit them; mechanical application inevitably leads to drawbacks. We must walk the path of building a TCM with Chinese characteristics, guided by the criterion that "practice is the sole criterion for testing truth," and absolutely not any other path.
II. Whether to uphold the seriousness of scientific right and wrong, or take a muddled path; whether to seek truth from facts, or take a path of grandstanding.
Observing the history of scientific development at home and abroad throughout ancient and modern times, it can be seen that social progress has been promoted by certain scientists continuously discovering and inventing new theories and technologies that were initially not understood or recognized by others. As exemplified by Mr. Chen Keji, it was Einstein's discovery of the Theory of Relativity, which many found difficult to understand, that pushed the so-called classical physics, revered by people, forward another step. The same applies in China; it was the invention of printing, the compass, papermaking, and gunpowder—technologies not understood at the time by our country's scientists—that brought science to a new level; it was Sun Wu writing "The Art of War," which is still partially misunderstood today but holds immense practical value in practice, that attracted worldwide attention. Did these scientists think at the time that their viewpoints and methods would enter the mainstream academic circles? To my knowledge, they did not. Since neither ancient nor modern domestic and foreign scientists worked for the sake of entering mainstream academic circles, and since none did not discover and invent through the study of facts, advancing science through inventions and discoveries not understood by contemporaries, why must we insist on forcing TCM theories and methods discovered through practice into models not yet understood by certain Western physicians and scientists? Why must we abandon basic principles for the sake of entering mainstream academic circles, and discard science with Chinese characteristics for the same reason?
(I) Regarding the combination of symptoms and diseases.
Due to decades of pursuing entry into mainstream academic circles, many scholars have ceased to deeply explore the profound connotations of TCM theoretical concepts, causing TCM to gradually fall into an inextricable vicious circle. Among these, the misunderstanding of concepts such as Zheng (Syndrome), Bian Zheng (Syndrome Differentiation), and Bian Bing (Disease Differentiation) has caused particularly severe harm to TCM. For instance, the character "Zheng" originally meant "evidence" in ancient times. In TCM theory, this evidence not only refers to so-called subjective symptoms but also includes pulse conditions, time, geography, climatic factors (Yunqi), similarities, and corresponding relationships, etc. Bian Zheng refers to distinguishing various evidences and drawing appropriate conclusions through this distinction; these conclusions include not only disease location and nature but also root and branch, sequence, and various proportional relationships. The concepts of Zheng and Bian Zheng proposed in recent years have completely lost their profound connotations, and the misunderstood connotations have been used as standards and bases for Sino-Western mechanical application, leaving many physicians bewildered and even proposing the notion of "no syndrome to differentiate," thereby seriously affecting the development of Chinese pharmacology and medicine.
(II) Regarding whether interference is necessary.
In ancient China, the Hundred Schools of Thought and the flourishing of diverse ideas during the Warring States period led to rapid scientific development, whereas the burning of books and burying of scholars by Qin Shi Huang, and the literary inquisitions of the Qing Dynasty, severely hindered scientific development in our country. In Europe, the so-called Dark Ages and the execution of Galileo impacted scientific development. Yet figures like Qin Shi Huang, Emperor Qianlong, and the Pope appeared under the guise of defending scientific truth. Mr. Chen Keji is now an academician of the Chinese Academy of Sciences and naturally appears in the capacity of a defender of orthodoxy, but he has forgotten a fact: current TCM and Chinese materia medica personnel have attended university and studied abundant natural science knowledge. So why do they say, "Do not interfere with my language"? I believe it is not because "TCM was isolated from natural sciences for a long time, naturally generating inertia within this group," but rather because the mechanistic application methods currently prevalent in Chinese pharmacological research do not conform to the criterion that "practice is the sole criterion for testing truth."
In summary, I believe that mechanically applying existing theories and methods will not promote the development of Chinese pharmacology and medicine but will only cause regression; only by following the path of building a Chinese pharmacology and medicine with Chinese characteristics can this be the sole pathway for its development.
How to Improve the Accuracy of Syndrome Differentiation and Treatment
I. Causes of Errors in the Process of Syndrome Differentiation and Treatment
1. Abandoning TCM theory and emphasizing mechanical application of Western medicine. For example: Hypertension. Some physicians, noting that some patients suffer from Yin deficiency and Liver Yang hyperactivity, apply this experience to all hypertensive patients, claiming this is the integration of Chinese and Western medicine, and treat all patients uniformly with methods to nourish Yin and calm Liver Yang. Similarly, for myocardial infarction, some experts, finding associations with blood stasis in their research, uniformly attribute it to blood stasis obstruction, claiming this is the integration of Chinese and Western medicine, and treat all myocardial infarction patients uniformly with methods to activate blood circulation and resolve stasis. Consequently, many hypertensive patients not caused by Liver Yang hyperactivity, and many myocardial infarctions not caused by blood stasis obstruction, were treated with methods to nourish Yin, calm Liver Yang, activate blood circulation, and resolve stasis.
2. Over-reliance on experts and predecessors without serious investigation and research. For example: Some physicians focus only on the diagnoses of certain experts or major hospitals during clinical practice, disregarding any symptoms or signs reported by patients that contradict the expert's diagnosis. Upon hearing the disease name, they immediately prescribe a certain proven prescription, often resulting in ineffectiveness.
3. Ignoring objective realities and solely pursuing proven prescriptions. For example: Hepatitis. Some physicians, citing reports from many infectious disease hospitals stating that infectious hepatitis is caused by Damp-Heat, and claiming their use of methods to drain Dampness and clear Heat are highly effective, assume all hepatitis patients present with this syndrome pattern. Consequently, most patients show no improvement. They forget that their environment is not an infectious disease hospital, and the patients they treat are those who have already failed treatment in infectious disease hospitals; thus, good results are naturally unattainable.
4. Focusing only on the general patterns of a disease while neglecting special syndrome manifestations. For example: Pneumonia. Some experts focus only on Phlegm-Heat obstructing the Lungs, ignoring various manifestations of so-called Cool-Dryness invading the Lungs. Similarly, for Epidemic Encephalitis B, focusing only on the frequent presentation of Qingwen Baidu Yin syndrome, while completely ignoring early出现的 limb coldness with faint pulse, diarrhea, and white coating, etc.
5. Collecting data based on imagination rather than Observation, Auscultation and Olfaction, Inquiry, and Palpation (Wang Wen Wen Qie). For example: Leptospirosis. Upon encountering a patient diagnosed with leptospirosis, one immediately assumes it is caused by Damp-Heat, completely ignoring syndrome manifestations such as aversion to cold and fever, headache and body ache, and floating, tight, and rapid pulse. This turns a condition curable with a single dose of Da Qing Long Tang into a chronic, lingering illness.
6. Failing to understand the meaning of specific TCM terminology, instead creating new terms to distort original concepts. For example: In TCM syndrome differentiation terminology, "Zheng" originally meant various evidences, but some physicians reduce "Zheng" merely to a synonym for symptoms and propose the new theory of "no syndrome to differentiate" to negate syndrome differentiation and treatment.
II. Methods to Improve the Accuracy of Syndrome Differentiation and Treatment
1. Strictly conduct syndrome differentiation and treatment according to TCM theories and methods. By "strictly," I mean without exceptions. For example: Even if Western medicine diagnoses a certain inflammation, if our strict TCM diagnostic methods determine it belongs to Deficiency and Cold, we must regard it as Deficiency and Cold, and cannot consider it Heat and Excess simply because it is an inflammation. Similarly, for constipation, if strict TCM diagnostic methods determine it belongs to Deficiency and Cold, we cannot consider it Excess-Heat simply because it is constipation.
2. Strictly follow TCM diagnostic steps to examine diseases. By "strictly following TCM diagnostic steps," I mean examining flawlessly according to Observation, Auscultation and Olfaction, Inquiry, and Palpation, and determining the diagnosis based on the obtained materials, allowing for absolutely no exceptions. For example: When a patient says they have a common cold, we cannot skip pulse taking, tongue inspection, or abdominal palpation just because it is a cold; otherwise, it is difficult to determine the syndrome pattern. Similarly, when a patient says they have hypotension, we cannot diagnose Qi deficiency with failure of Clear Yang to ascend and rashly employ Bu Zhong Yi Qi Tang simply because it is hypotension.
3. Seriously study medical cases of ancient masters, analyzing and understanding their successful methods of syndrome differentiation and treatment. Skillfully applying TCM theory to clinical practice is the most difficult problem for TCM clinicians. Hence, predecessors often warned us with phrases like "Being familiar with Wang Shuhe's writings is inferior to gaining more clinical experience" and "Believing books entirely is worse than having no books." How can one gain more clinical experience? I believe first, one must engage in more clinical practice; second, one must learn more from the clinical practical experiences of predecessors. Regarding learning from predecessors' experiences, I believe there are two points: First, directly learning successful experiences from experienced teachers; second, learning successful experiences from effective verified cases of predecessors. Only in this way can one learn skillfully and truly master the methods of syndrome differentiation and treatment.
4. Seriously analyze the relationship between the so-called "big" and "small," i.e., major issues and the concept of "hidden treachery in solitude" (duchu cang jian). For example: In some patients with allergic purpura, after examination and analysis determining the syndrome as Blazing Heat-Toxin, one would expect methods using Huang Qin (Scutellariae Radix), Huang Lian (Coptidis Rhizoma), Huang Bai (Phellodendri Cortex), and Sheng Shi Gao (Gypsum Fibrosum) to be effective, yet practical verification shows complete ineffectiveness. Why? Because we ignored the Cold hidden within ("treachery in solitude"). Similarly, in certain cases of strangury (difficulty in urination), judging from symptoms like urgent and painful urination, dry mouth and bitter taste, and body heat, it seems to be a Heat syndrome, yet applying Zhi Mu (Anemarrhenae Rhizoma) and Huang Bai proves completely ineffective. Why? Because we ignored the Yang Deficiency hidden within ("treachery in solitude"). Although this issue of "hidden treachery in solitude" seems minor, it is often the key to determining success or failure, so special attention must be paid during clinical practice.
5. When prescribing during clinical practice, one must not only know the properties, flavors, functions, indications, and meridian tropisms of the herbs, but also know what formula the prescribed mixture constitutes and what its indicated syndromes are. One must not only know which herb combinations make up the prescription, but also know which predecessor formulas are included in the prescribed herbs, and what the indicated syndromes of those predecessor formulas are, and so forth.
Formula Contains Herbs, Herbs Contain Formulas
During my spare time from clinical practice, I frequently sought advice from Mr. Li Hanqing, former director of the Shanxi Institute of Traditional Chinese Medicine and a renowned late old TCM physician. Question: Why do some patients fail to respond to large formulas with heavy doses administered by others, while responding miraculously to small formulas with light doses administered by the teacher? Answer: To achieve refined and effective prescription and medication, one must ensure that "the formula contains herbs, and the herbs contain formulas." Further Question: What is meant by "the formula contains herbs, and the herbs contain formulas"? Answer: By "the formula contains herbs, and the herbs contain formulas," I mean: ① Every time we write a prescription, we should know which predecessor's formula this is and what its indicated syndromes are. ② Every time we write a prescription, we should know what developments later generations have made upon the indicated syndromes of this formula. Every time we write a prescription, we should know the indicated syndromes, property-flavor characteristics, ascending-descending-floating-sinking movements, and meridian tropisms of the constituent herbs of this formula. This is the first step of the principle "formula contains herbs, herbs contain formulas." The second step concerns the addition and subtraction of herbs, wherein: ① When adding or subtracting a herb, one must understand the property-flavor, meridian tropism, ascending-descending-floating-sinking movements, and functional characteristics of the added or subtracted herb. ② When adding a herb, one must understand what formula this herb forms with the original formula's herbs, and what the indicated syndrome of this new formula is. ③ When subtracting a herb, one must understand the formula formed by removing that herb and its indicated syndrome. In short, regardless of what herbs are added or subtracted, one must know not only the herbs but also the complex variations of the formulas.
He also said: The reasons why some people fail with large formulas and heavy doses are fourfold: ① When prescribing, attention was focused only on the individual therapeutic functions of single herbs, neglecting their properties, flavors, meridian tropisms, and ascending-descending-floating-sinking movements. ② When prescribing, attention was focused only on the individual therapeutic functions of single herbs, neglecting the changes brought about when herbs form a formula. ③ When adding or subtracting herbs, attention was focused only on the individual therapeutic functions of single herbs, neglecting the changes in ascending-descending-floating-sinking movements and meridian tropisms brought by single herbs. ④ When adding or subtracting herbs, attention was focused only on the characteristics of the added/subtracted herbs, neglecting the changes in formula composition and functional indications brought by the additions/subtractions. Among these four issues, the changes in formula composition are particularly significant.
To achieve "formula contains formula, formula contains herbs, herbs contain formula," effort must be exerted in two aspects: ① Become familiar with Pharmacology. When studying pharmacology, avoid rote memorization; instead, focus on comparison, identifying similarities and differences among numerous herbs. ② Read extensively on formulas. Be adept at conducting vertical and horizontal comparisons of formulas with identical indications and compositions, identical indications but different herbs, different indications but identical herbs, and identical herbs but different dosage forms, finding their commonalities and specificities through comparison. Through such diligent study over several years, one can achieve clarity of mind.
Patients with Severe Illness Should Be Treated with Mild Medication