(=)关于临床在接触临床的带教工作中，在目前辨证与辨病相结合的要求下，感到临床上单靠中医的辨证，显得十分不够，是毋庸讳言的。然而有些病例，在现代诊断的客观指标提示下，却闪烁着中医理论的光辉。例如，慢性肾炎病人的早期，尿检中有蛋白、管型、红白细胞等等，至晚期血检中非蛋白氮等升高而死于尿毒症。这就充分证明了清代邹澍在《本经疏证》「山药」条下「肾气者，周当留其精而泻其粗也」之说，是天才的发现。在彼时的历史条件下，当然不可能清楚地认识到精与粗的实质，但这一论点，确是对肾脏生理功能认识上的突破。尤其是在目前，有足够的资料使人理解到：慢性肾炎病人，始而留精功能不足，亦肾气之衰颓，继而去粗功能有亏，知邪毒之潴留。从而为指导治疗提供了有益的论据，有力地纠正了过去仅据尿毒症出现的惊厥、昏迷症状，认为是病久延虚、虚风内动，治以三甲复脉汤等方的偏差。不仅于此，现在还能根据肾脏早有器质性病变的认识，及早地适当地佐用活血化瘀、消肿生肌的药物以提高疗效而推迟恶化，乃至完全治愈。当然，也不能因此而忽视中医的整体观点。如在治疗经过现代医学确诊为冠心病范围内的某些心脏疾患时，根据传统的四诊所得，参用补肾阴或温肾阳的方法，往往取得比较满意的疗效，这又说明了中医「心肾相交」、「坎离既济」等理论并没有过时。与此相反，我在运用肤浅的现代医学知识从事临床实践中，又常常感到某些中医理论的不够完善，甚至变更了原来整套的理法方药。如众所周知，现代医学对其所谓炎症，每指出其病所有充血、水肿等病变。我曾遇到一个失音五年、别无所苦、久治不愈的病人，即根据五官科对声带诊断的结论，用通窍活血汤合真人活命饮加减，不过数剂即得音开而逐渐响亮如初。这就免去了是「金实不呜」还是「金破不鸣」不必要的顾虑。还有，我曾用活血消肿、渗湿清热、专理肠间的方法，治愈多例慢性腹泻，以及在治疗迁延性肝炎、慢性肝炎和早期肝硬化的过程中，总是尽先解决血气有亏与邪毒和瘀血留滞这一对虚与实的主要矛盾及其矛盾的主要方面，多能完全治愈或获得缓解。这又使我感到李士材治泻九法和王旭高治肝三十法，都不免限于历史条件而不尽切合实际。也有一些慢性腹痛，其病机正如《临证指南医案》「便血」医案中所说「脏阴有寒，腑阳有热」的相反状况，治疗上自应兼筹并顾。叶氏之说，自是从《金匮》黄土汤方义领会而来。实际上，有很多胃肠和其它方面疾病的病机，同时存在着脏寒腑热，亟需仔细分析，这就是辩证法在病理上的体现，也是辨证论治的精华所在。闲尝忆及《医学入门》有「人皆知百病生于气也，而不知百病生于血也」之说。我则认为，百病未必皆生于血，但百病都或多或少地与血有关。这从活血化瘀法在临床上用途之广，取效之捷，可见一斑。吾生有涯而知无涯。纵皓首穷经，犹未窥堂奥。然涉猎既久，也不免有一知半解。但一念及先贤顾亭林「凡著书立说，必为前人所未言，而为后人所必需」之言，则又不敢率尔操觚。荏苒至今，徒伤老大。
最后，我不辞衰朽，谨向同道们贡一得之愚：就是我们祖先留下来的宝贵医学，是研究和解决医学部门特殊矛盾运动的学问。要学好这一宝贵医学，就要学习辩证法。《辩证唯物主义讲课提纲》中曾指出：「科学历史告诉我们，每一种科学都是研究世界的某一方面的过程的矛盾运动的学问，科学家只要一旦离开了矛盾分析的研究，把它研究的对象看作是没有矛盾的东西，就要使科学的进步遇到障碍。」因此，我愿在有生之年，和同道们一起，一面加强辩证法的学习，一面呼吁多学科的协助，进一步探索祖国医学理论的精髓，为中医学术的发展共同努力。
(郭无玲整理)
涉医征途回眸
北京中医医院到院长、教授关幼波
【作者简介】关幼波(1913～)，北京市人。医承家学，广撷博采。临床四十多年，对于肝病的治疗，积累了丰富的经验。在有关同志协助下，创制「关幼波肝病辨证施治电子计算器程序」，获得成功。着有《关幼波临床经验选》等。现兼任中华全国中医学会常务理事、中华医学会内科分会理事、北京中医分会副理事长、北京市科协理事等职。像
我从事中医工作已四十多年，途中小憩回眸，展望中医现代化的美好前景，欣喜之余，乐于总结一下自己的学习经过和体会。
「严」字开的头
(一)严父即严师我幼承家学，六岁读私塾，在老师与家父的严格管教下，熟读四书五经并嗜书法，九岁时曾在街头当众挥毫书写春联，路人得之以求吉利。十六岁与家兄随父学医侍诊左右。我的父亲关月波是北京地区名医，擅长内、妇、儿科，对于时令病、妇女病更有独到之处。他的学术观点受滋阴派朱丹溪的影响，倾向于「阳有余、阴不足」。他体会：天花、麻疹、猩红热等属于温疫范围，病毒由口鼻而入，在气分不发病，在血分才发病，所以在治疗时一定要加用凉血活血的药物，如丹皮、赤芍、白茅根、元参。麦冬、生地等，自始至终注意养阴为佐，亦即解毒养阴、凉血透表之法。由于当时温疫流行，他曾将自己的经验方做成「温疫灵丹」加引吞服，简便廉验，深受劳苦大众欢迎。对于妇科病，他以四物汤治血为法，因病而异，灵活化裁，每收殊效。内科方面善治脾胃病，侧重于调理气血。总起来看虽然方药平平，但是辨证精当，疗效卓著，名人墨客祝贺称颂者不绝于户。其中胡某重病获愈，感激不尽，进金匾一幅，匾中八个大字两行排列：髂翌罄。横竖可读，回环成诵，意思是：儒乃达儒、医是明医，儒达乃儒、医明是医，儒医乃是达明儒医，儒医达明乃是儒医。此段「回文诗」我一直保留到解放前夕，并以此鼓励自己。
父亲既是严父，又是严师，对我兄弟二人要求十分严格。有一次，吾兄误将「橘红」写成「菊红」，父亲当着病人狠狠地给了他一嘴巴!并辞退了这个「徒弟」。我也曾挨过父亲的戒尺，因好学善问，得以继续留在身边学习。但随诊多年，从不轻易放手独诊。在父亲抱病期问，他曾连续抽查了我的三个脉案，经过认真复核，「考试」合格，最后满意地说：「你可以治病救人了。』不久，他便与世长辞了。
(二)根基立坚实父亲以「品端术正」为座右铭，并一再告诫我「知之为知之，不知为不知」对于同道主要是学，不要评头品足，妄加批评，治病救人重于义气、轻于财气……这些朴实而略带「封建色彩」的哲理，作为医德教育，在当时来说，是无可非议的。
父亲医术高超，并非开口《内》、《难》，闭口《金匮》、《伤寒》，而是重视医理与病理的结合，在基本功上严格要求。诸如《雷公药性赋》、《汤头歌》、《濒湖脉学》等，都要求熟背，对于《内经》、《难经》、《伤寒论》、《金匮要略》，则以实用为准选学精读，要求明其理、知其要、融会贯通。比较重视的是叶天士的《温热论》和吴鞠通的《温病条辨》。另外，也重视朱震亨的《丹溪心法》，李东垣的《脾胃论》，王清任的《医林改错》，唐宗川的《血证论》等。父亲常说：「医者理也，认清医理才能治好病。」所以，在学习经典医籍时绝不要求死记硬背，在临床应用时绝不要求生搬硬套，而是在理解的基础上记忆，在实践中加深记忆。
「博」字铺开路
(一)实践出真知父亲病故后，房东把房卖了，按照当时「典三卖四」的规矩，必须在四个月之内搬出去。那年我二十八岁，参加伪政府卫生局的考试(应试者五百余人，合格者仅有四十多入)，虽然获得了中医师合格证书，但仍不能正式开业，必须到汪逢春会长为首举办的中医师学会讲习所学习一年，考试合格后才能正式挂牌。当时正值丧父就学之际，饱尝了「贫居闹市无人问，富在深山有远亲」的苦酸辛辣。只好搬到前门外大席胡同「广福客店」，三世同居一小陋室，晚上搭铺就寝，白天拆铺攻读、看病、吃饭。所谓「广福客店」实际上是贫民窟的一角，住有五十多户人家，五行八作、三教九流，应有尽有，故与我交往者尽贫苦之辈。由于国腐民穷，瘟疫流行，应接不暇的门诊、出诊，锻炼了我这个初出茅庐的年轻中医。成功与失败、欣慰与焦虑，复杂的心情激励着我的进程。由于广泛实践，把从父辈和医书上获得的知识变成了我的直接经验。例如，我出诊时进门一闻，便能鉴别出是麻疹还是猩红热，这种闻诊的敏感性，可以说是后天获得的「特异功能」。
由于当时的处境，使我有机会经常接触民众，加强了与劳动人民的思想感情。例如有位「洋车夫」请我出诊，事后拿出一元钱酬谢，我一眼就看见月份牌上夹着一张当票，心中凄然，迅速推回「车夫」的双手说；「快拿去给孩子买药吧l」这样的事是很多的，无数贫民难友虽然无钱送礼挂匾，但是「心中」的匾牌，情意更为深重。
(二)博采思路广北京解放了，我同时在几个药铺坐堂，如前门大街的「永安堂」、「体干堂」。，三里河大街的「同和堂」、「保得堂」等。当时我有幸与北京四大名医之一施今墨同一药铺坐堂，施为下午4～6点，我为下午6～8点。每天我都早去站柜台浏览施的脉案，并亲自询问服药后的变化，洞察其中奥妙，正是「行家看门道」，稍有所得便默记脑海，日久天长像孔伯华、肖龙友、汪逢春等名家脉案都成了我的活教材。另外，我还广交同道淡论医道，像前门地区名医康乃安、赵瑞麟等都是我的挚友。由于我勤学好问，康在临死前把祖传秘方「鹅口散」传给我，经我推广使用对于口腔溃疡、白赛氏病等都有良效，现改名「口腔溃疡散」，由药材公司公开出售。一九五三年我参加了北京市第一中医门诊部，与已故妇科名老中医刘奉五对桌应诊。刘是国医学院科班出身，又曾在校任教，理论基础扎实，临床疗效也好，我打破了「文人相轻」的旧习，主动与刘探讨医术，并互相交换病例。我当时把所能接触到的前辈和同行，都当成了老师，履行了仲景「勤求古训、博采众方」的遗训。
(三)勤学不耻下问我自幼曾受过「三人行必有我师」、「择其善者而从之，其不善者而改之」的古训，又经历了做学问的艰辛。所以，我体会到：「学问、学问，边学边问」通过实践，才是自己真正的学问。平时我参加外院疑难重症会诊较多，很多西医都乐意与我合作，我也把会诊作为向「能者」学习的好机会，并经常从抢救疑难病例中，汲取现代的医学知识。
「钻研」持以恒
(一)由「博」返「约」，深钻肝病辨治调入市中医医院后，由于科研需要，我进了肝病组，组内成员虽几经调整，我可以说是「开国元勋」之一，也是耐力持久的主力队员。从制定科研计划到实际临床观察，我都亲身参加，及时总结经验，多次在杂志上发表文章。我很注意某些新的苗头和新的线索。例如在五十年代初期治疗肝炎除清热利涅法则外，还流行清热解毒之说。我曾发现南方某肝病专家善用芳香化浊之品，对于改善症状和肝功能疗效尚好，我迅即扩大使用，于是藿香、佩兰等芳香化湿解毒的方药得以验证。再如肝病后期，正气耗伤，病邪易于散蔓，过用清热解毒、清热祛湿反而容易中伤脾胃。我根据「肝欲散，以辛补之，以酸泻之」的理论，选用一些酸味的药物，像白芍、木瓜、五倍子、乌梅、五味子等，一方面收敛正气，一方面「泻肝」酸敛解毒。特别是对于五味子的研究更是受到多方面的重视，并做了大量的实验研究。其它如肝病辨治过程中的邪正关系，病证结合与中西合参，对于肝病的胁痛、腹胀、低热、痞块、合并痰湿(肝炎后肝脂肪性变)、消渴等症侯，以及近些年来新发现的「乙型肝炎表面抗原(HBgAg)阳性」等问题，我都认真细致地进行观察，并不断总结自己的治疗体会。
(一) 关于临床带教工作
在目前的临床带教工作中，面对辨证与辨病相结合的要求，我深感仅依靠中医的辨证论治显得十分不足，这是无需讳言的事实。然而，在某些病例中，现代诊断的客观指标却闪烁着中医理论的光辉。例如，慢性肾炎患者在早期，尿检中出现蛋白、管型、红白细胞等；至晚期，血检中非蛋白氮升高，最终死于尿毒症。这充分证明了清代邹澍在《本经疏证》“山药”条下提出的“肾气者，周当留其精而泻其粗也”这一观点，是天才的发现。在当时历史条件下，当然不可能清楚地认识“精”与“粗”的实质，但这一论点确实是对肾脏生理功能认识的突破。特别是在目前，有足够的资料使人理解到：慢性肾炎患者起初是“留精”功能不足，即肾气衰颓；随后是“去粗”功能有亏，导致邪毒潴留。从而为指导治疗提供了有益的依据，有力地纠正了过去仅根据尿毒症出现的惊厥、昏迷症状，就认为是病久致虚、虚风内动，而使用三甲复脉汤等方的偏差。不仅如此，现在还能根据肾脏已有器质性病变的认识，及早且适当地佐用活血化瘀、消肿生肌的药物，以提高疗效、推迟恶化，乃至完全治愈。当然，也不能因此忽视中医的整体观念。例如在治疗经过现代医学确诊为冠心病范围内的某些心脏疾病时，根据传统四诊所得，参用补肾阴或温肾阳的方法，往往取得比较满意的疗效，这又说明了中医“心肾相交”、“坎离既济”等理论并没有过时。相反，我在运用肤浅的现代医学知识从事临床实践中，又常常感到某些中医理论的不够完善，甚至变更了原来整套的理法方药。如众所周知，现代医学对其所谓炎症，每指出其病所存在充血、水肿等病变。我曾遇到一个失音五年、别无所苦、久治不愈的病人，即根据五官科对声带诊断的结论，用通窍活血汤合真人活命饮加减，不过数剂即得音开而逐渐响亮如初。这就免去了是“金实不鸣”还是“金破不鸣”不必要的顾虑。还有，我曾用活血消肿、渗湿清热、专理肠间的方法，治愈多例慢性腹泻，以及在治疗迁延性肝炎、慢性肝炎和早期肝硬化的过程中，总是尽先解决气血有亏与邪毒和瘀血留滞这一对虚与实的主要矛盾及其矛盾的主要方面，多能完全治愈或获得缓解。这又使我感到李士材治泻九法和王旭高治肝三十法，都不免限于历史条件而不尽切合实际。也有一些慢性腹痛，其病机正如《临证指南医案》“便血”医案中所说“脏阴有寒，腑阳有热”的相反状况，治疗上自应兼筹并顾。叶氏之说，自是从《金匮》黄土汤方义领会而来。实际上，有很多胃肠和其它方面疾病的病机，同时存在着脏寒腑热，亟需仔细分析，这就是辩证法在病理上的体现，也是辨证论治的精华所在。闲尝忆及《医学入门》有“人皆知百病生于气也，而不知百病生于血也”之说。我则认为，百病未必皆生于血，但百病都或多或少地与血有关。这从活血化瘀法在临床上用途之广，取效之捷，可见一斑。吾生有涯而知无涯。纵皓首穷经，犹未窥堂奥。然涉猎既久，也不免有一知半解。但一念及先贤顾亭林“凡著书立说，必为前人所未言，而为后人所必需”之言，则又不敢率尔操觚。荏苒至今，徒伤老大。
最后，我不辞衰朽，谨向同道们贡一得之愚：就是我们祖先留下来的宝贵医学，是研究和解决医学部门特殊矛盾运动的学问。要学好这一宝贵医学，就要学习辩证法。《辩证唯物主义讲课提纲》中曾指出：“科学历史告诉我们，每一种科学都是研究世界的某一方面的过程的矛盾运动的学问，科学家只要一旦离开了矛盾分析的研究，把它研究的对象看作是没有矛盾的东西，就要使科学的进步遇到障碍。”因此，我愿在有生之年，和同道们一起，一面加强辩证法的学习，一面呼吁多学科的协助，进一步探索祖国医学理论的精髓，为中医学术的发展共同努力。
（郭无玲整理）
涉医征途回眸
北京中医医院院长、教授关幼波
【作者简介】关幼波（1913～），北京市人。医承家学，广撷博采。临床四十多年，对于肝病的治疗，积累了丰富的经验。在有关同志协助下，创制“关幼波肝病辨证施治电子计算器程序”，获得成功。著有《关幼波临床经验选》等。现兼任中华全国中医学会常务理事、中华医学会内科分会理事、北京中医分会副理事长、北京市科协理事等职。
我从事中医工作已四十多年，途中小憩回眸，展望中医现代化的美好前景，欣喜之余，乐于总结一下自己的学习经过和体会。
“严”字开的头
（一）严父即严师
我幼承家学，六岁读私塾，在老师与家父的严格管教下，熟读四书五经并嗜书法，九岁时曾在街头当众挥毫书写春联，路人得之以求吉利。十六岁与家兄随父学医侍诊左右。我的父亲关月波是北京地区名医，擅长内、妇、儿科，对于时令病、妇女病更有独到之处。他的学术观点受滋阴派朱丹溪的影响，倾向于“阳有余、阴不足”。他体会：天花、麻疹、猩红热等属于温疫范围，病毒由口鼻而入，在气分不发病，在血分才发病，所以在治疗时一定要加用凉血活血的药物，如丹皮、赤芍、白茅根、元参、麦冬、生地等，自始至终注意养阴为佐，亦即解毒养阴、凉血透表之法。由于当时温疫流行，他曾将自己的经验方做成“温疫灵丹”加引吞服，简便廉验，深受劳苦大众欢迎。对于妇科病，他以四物汤治血为法，因病而异，灵活化裁，每收殊效。内科方面善治脾胃病，侧重于调理气血。总起来看虽然方药平平，但是辨证精当，疗效卓著，名人墨客祝贺称颂者不绝于户。其中胡某重病获愈，感激不尽，进金匾一幅，匾中八个大字两行排列：髂翌罄。横竖可读，回环成诵，意思是：儒乃达儒、医是明医，儒达乃儒、医明是医，儒医乃是达明儒医，儒医达明乃是儒医。此段“回文诗”我一直保留到解放前夕，并以此鼓励自己。
父亲既是严父，又是严师，对我兄弟二人要求十分严格。有一次，吾兄误将“橘红”写成“菊红”，父亲当着病人狠狠地给了他一嘴巴！并辞退了这个“徒弟”。我也曾挨过父亲的戒尺，因好学善问，得以继续留在身边学习。但随诊多年，从不轻易放手独诊。在父亲抱病期间，他曾连续抽查了我的三个脉案，经过认真复核，“考试”合格，最后满意地说：“你可以治病救人了。”不久，他便与世长辞了。
（二）根基立坚实
父亲以“品端术正”为座右铭，并一再告诫我“知之为知之，不知为不知”。对于同道主要是学，不要评头品足，妄加批评，治病救人重于义气、轻于财气……这些朴实而略带“封建色彩”的哲理，作为医德教育，在当时来说，是无可非议的。
父亲医术高超，并非开口《内》、《难》，闭口《金匮》、《伤寒》，而是重视医理与病理的结合，在基本功上严格要求。诸如《雷公药性赋》、《汤头歌》、《濒湖脉学》等，都要求熟背，对于《内经》、《难经》、《伤寒论》、《金匮要略》，则以实用为准选学精读，要求明其理、知其要、融会贯通。比较重视的是叶天士的《温热论》和吴鞠通的《温病条辨》。另外，也重视朱震亨的《丹溪心法》，李东垣的《脾胃论》，王清任的《医林改错》，唐宗川的《血证论》等。父亲常说：“医者理也，认清医理才能治好病。”所以，在学习经典医籍时绝不要求死记硬背，在临床应用时绝不要求生搬硬套，而是在理解的基础上记忆，在实践中加深记忆。
“博”字铺开路
（一）实践出真知
父亲病故后，房东把房卖了，按照当时“典三卖四”的规矩，必须在四个月之内搬出去。那年我二十八岁，参加伪政府卫生局的考试（应试者五百余人，合格者仅有四十多人），虽然获得了中医师合格证书，但仍不能正式开业，必须到汪逢春会长为首举办的中医师学会讲习所学习一年，考试合格后才能正式挂牌。当时正值丧父就学之际，饱尝了“贫居闹市无人问，富在深山有远亲”的苦酸辛辣。只好搬到前门外大席胡同“广福客店”，三世同居一小陋室，晚上搭铺就寝，白天拆铺攻读、看病、吃饭。所谓“广福客店”实际上是贫民窟的一角，住有五十多户人家，五行八作、三教九流，应有尽有，故与我交往者尽贫苦之辈。由于国腐民穷，瘟疫流行，应接不暇的门诊、出诊，锻炼了我这个初出茅庐的年轻中医。成功与失败、欣慰与焦虑，复杂的心情激励着我的进程。由于广泛实践，把从父辈和医书上获得的知识变成了我的直接经验。例如，我出诊时进门一闻，便能鉴别出是麻疹还是猩红热，这种闻诊的敏感性，可以说是后天获得的“特异功能”。
由于当时的处境，使我有机会经常接触民众，加强了与劳动人民的思想感情。例如有位“洋车夫”请我出诊，事后拿出一元钱酬谢，我一眼就看见月份牌上夹着一张当票，心中凄然，迅速推回“车夫”的双手说：“快拿去给孩子买药吧！”这样的事是很多的，无数贫民难友虽然无钱送礼挂匾，但是“心中”的匾牌，情意更为深重。
（二）博采思路广
北京解放了，我同时在几个药铺坐堂，如前门大街的“永安堂”、“体干堂”，三里河大街的“同和堂”、“保得堂”等。当时我有幸与北京四大名医之一施今墨同一药铺坐堂，施为下午4～6点，我为下午6～8点。每天我都早去站柜台浏览施的脉案，并亲自询问服药后的变化，洞察其中奥妙，正是“行家看门道”，稍有所得便默记脑海，日久天长像孔伯华、肖龙友、汪逢春等名家脉案都成了我的活教材。另外，我还广交同道谈论医道，像前门地区名医康乃安、赵瑞麟等都是我的挚友。由于我勤学好问，康在临死前把祖传秘方“鹅口散”传给我，经我推广使用对于口腔溃疡、白赛氏病等都有良效，现改名“口腔溃疡散”，由药材公司公开出售。一九五三年我参加了北京市第一中医门诊部，与已故妇科名老中医刘奉五对桌应诊。刘是国医学院科班出身，又曾在校任教，理论基础扎实，临床疗效也好，我打破了“文人相轻”的旧习，主动与刘探讨医术，并互相交换病例。我当时把所能接触到的前辈和同行，都当成了老师，履行了仲景“勤求古训、博采众方”的遗训。
（三）勤学不耻下问
我自幼曾受过“三人行必有我师”、“择其善者而从之，其不善者而改之”的古训，又经历了做学问的艰辛。所以，我体会到：“学问、学问，边学边问”，通过实践，才是自己真正的学问。平时我参加外院疑难重症会诊较多，很多西医都乐意与我合作，我也把会诊作为向“能者”学习的好机会，并经常从抢救疑难病例中，汲取现代的医学知识。
“钻研”持以恒
（一）由“博”返“约”，深钻肝病辨治调
入市中医医院后，由于科研需要，我进了肝病组，组内成员虽几经调整，我可以说是“开国元勋”之一，也是耐力持久的主力队员。从制定科研计划到实际临床观察，我都亲身参加，及时总结经验，多次在杂志上发表文章。我很注意某些新的苗头和新的线索。例如在五十年代初期治疗肝炎除清热利湿法则外，还流行清热解毒之说。我曾发现南方某肝病专家善用芳香化浊之品，对于改善症状和肝功能疗效尚好，我迅即扩大使用，于是藿香、佩兰等芳香化湿解毒的方药得以验证。再如肝病后期，正气耗伤，病邪易于散蔓，过用清热解毒、清热祛湿反而容易中伤脾胃。我根据“肝欲散，以辛补之，以酸泻之”的理论，选用一些酸味的药物，像白芍、木瓜、五倍子、乌梅、五味子等，一方面收敛正气，一方面“泻肝”酸敛解毒。特别是对于五味子的研究更是受到多方面的重视，并做了大量的实验研究。其它如肝病辨治过程中的邪正关系，病证结合与中西合参，对于肝病的胁痛、腹胀、低热、痞块、合并痰湿（肝炎后肝脂肪性变）、消渴等症侯，以及近些年来新发现的“乙型肝炎表面抗原（HBsAg）阳性”等问题，我都认真细致地进行观察，并不断总结自己的治疗体会。
(I) Regarding Clinical Teaching
In current clinical teaching work, under the requirement of combining syndrome differentiation (Bian Zheng, 辨证) with disease differentiation (Bian Bing, 辨病), I feel that relying solely on Traditional Chinese Medicine (TCM) syndrome differentiation is quite insufficient, which is a fact that needs no concealment. However, in some cases, objective indicators from modern diagnosis shine with the brilliance of TCM theory. For example, in the early stage of chronic nephritis (Chronic Nephritis), urine tests show protein, casts, red and white blood cells, etc.; in the late stage, non-protein nitrogen levels rise in blood tests, leading to death from uremia (Uremia). This fully proves that Zou Shu's statement in Qing Dynasty's *Ben Jing Shu Zheng* (Annotation of the Materia Medica) under the entry for "Shan Yao" (Dioscoreae Rhizoma), "The Qi of the Kidney should retain its essence and excrete its coarse parts," was a genius discovery. Under the historical conditions of that time, it was naturally impossible to clearly understand the substance of "essence" and "coarse parts," but this viewpoint was indeed a breakthrough in the understanding of renal physiological functions. Especially nowadays, there is sufficient data to make us understand: patients with chronic nephritis initially suffer from insufficient "retention of essence" function, which is the decline of Kidney Qi; subsequently, they suffer from impaired "excretion of coarse parts" function, knowing that pathogenic toxins are retained. Thus, providing beneficial evidence for guiding treatment, and strongly correcting the deviation of previously considering convulsions and coma appearing in uremia as resulting from prolonged illness causing deficiency and internal movement of deficient wind, treating with formulas such as San Jia Fu Mai Tang (Three-Shelled Pulse-Nourishing Decoction). Not only that, now we can also, based on the understanding that kidneys have already undergone organic lesions, timely and appropriately adjuvantly use drugs that invigorate blood and resolve stasis (Huo Xue Hua Yu, 活血化瘀), reduce swelling and generate flesh (Xiao Zhong Sheng Ji, 消肿生肌) to improve curative effects, delay deterioration, and even achieve complete cure. Of course, we cannot ignore the holistic view of TCM because of this. For instance, when treating certain heart diseases within the scope diagnosed by modern medicine as coronary heart disease (Coronary Heart Disease), according to the findings of the traditional four diagnostic methods (Four Diagnostic Methods, 四诊), adopting methods of tonifying Kidney Yin or warming Kidney Yang often yields relatively satisfactory results. This further illustrates that TCM theories such as "Heart-Kidney Interaction" (Xin Shen Xiang Jiao, 心肾相交) and "Kan and Li Both Satisfied" (Kan Li Ji Ji, 坎离既济) have not become outdated. Conversely, in my clinical practice using superficial modern medical knowledge, I often feel the imperfection of certain TCM theories, even changing the original complete set of principles, methods, formulas, and drugs. As is well known, modern medicine points out congestion, edema, and other pathological changes at the site of inflammation for what it calls inflammation. I once encountered a patient who had lost their voice for five years, suffered from no other discomfort, and had been treated unsuccessfully for a long time. Based on the diagnosis of the otorhinolaryngology department regarding the vocal cords, I used Tong Qiao Huo Xue Tang (Orifice-Opening Blood-Invigorating Decoction) combined with Zhen Ren Huo Ming Yin (True Person's Life-Preserving Decoction) with modifications. After just a few doses, the voice opened up and gradually became loud as before. This avoided unnecessary concerns about whether it was "Metal Solid Not Ringing" (Jin Shi Bu Ming, 金实不鸣) or "Metal Broken Not Ringing" (Jin Po Bu Ming, 金破不鸣). Furthermore, I used methods of invigorating blood and reducing swelling, leaching out dampness and clearing heat, and specifically regulating the intestines to cure multiple cases of chronic diarrhea (Chronic Diarrhea). In the process of treating persistent hepatitis (Persistent Hepatitis), chronic hepatitis (Chronic Hepatitis), and early-stage liver cirrhosis (Liver Cirrhosis), I always prioritized resolving the main contradiction between deficiency of Qi and Blood (Qi Xue Xu Kui, 气血亏虚) and the retention of pathogenic toxins and blood stasis (Yu Xue Liu Zhi, 瘀血留滞), and the principal aspect of this contradiction between deficiency and excess. Most could be completely cured or achieved remission. This made me feel that Li Shicai's Nine Methods for Treating Diarrhea and Wang Xugao's Thirty Methods for Treating the Liver were inevitably limited by historical conditions and not entirely practical. There are also some cases of chronic abdominal pain where the pathogenesis is exactly the opposite situation described in the "Blood in Stool" case record in *Lin Zheng Zhi Nan Yi An* (Guidelines for Clinical Practice Medical Cases) as "Visceral Yin has cold, Fu Yang has heat." Treatment should naturally consider both aspects. Ye Tianshi's saying naturally comes from understanding the prescription meaning of Huang Tu Tang (Yellow Earth Decoction) in *Jin Gui Yao Lue*. In reality, the pathogenesis of many gastrointestinal and other diseases simultaneously involves visceral cold and Fu heat, requiring careful analysis. This is the embodiment of dialectics in pathology and also the essence of syndrome differentiation and treatment (Bian Zheng Lun Zhi, 辨证论治). I occasionally recall the saying in *Yi Xue Ru Men* (Introduction to Medicine): "Everyone knows that hundreds of diseases arise from Qi, but do not know that hundreds of diseases arise from Blood." I believe that not all diseases necessarily arise from blood, but all diseases are more or less related to blood. This can be seen from the wide application and rapid efficacy of blood-invigorating and stasis-resolving methods in clinical practice. My life is finite, but knowledge is infinite. Even if I study classics until my hair turns white, I may still not penetrate the innermost secrets. However, having studied for a long time, I inevitably have partial understanding. But whenever I think of the words of the sage Gu Tinglin: "Whenever writing books and establishing theories, one must say what predecessors have never said, and what successors need," I dare not write hastily. Time flies, and now I am merely lamenting my old age.
Finally, disregarding my decay, I respectfully offer my humble insight to colleagues: Our ancestors' precious medicine is the study of researching and solving the special contradictory movements within the medical field. To learn this precious medicine well, one must learn dialectics. The *Outline of Dialectical Materialism Lectures* once pointed out: "Scientific history tells us that every science is the study of the contradictory movement of processes in a certain aspect of the world. Once scientists leave behind the research of contradictory analysis and regard their objects of study as things without contradictions, scientific progress will encounter obstacles." Therefore, I wish, during my remaining years, together with colleagues, to strengthen the study of dialectics while calling for multi-disciplinary assistance, further exploring the essence of our motherland's medical theories, and working together for the development of TCM academics.
(Organized by Guo Wuling)
Looking Back on the Medical Journey
Guan Youbo, Dean and Professor, Beijing Hospital of Traditional Chinese Medicine
[Author Profile] Guan Youbo (1913–), from Beijing. He inherited family medical traditions and absorbed extensively from various sources. With over forty years of clinical experience, he accumulated rich experience in treating liver diseases. With the assistance of relevant comrades, he successfully created the "Guan Youbo Liver Disease Syndrome Differentiation and Treatment Electronic Calculator Program." He authored works such as *Selected Clinical Experiences of Guan Youbo*. He currently serves concurrently as Executive Director of the All-China Association of Traditional Chinese Medicine, Director of the Internal Medicine Branch of the Chinese Medical Association, Vice Chairman of the Beijing TCM Branch, and Director of the Beijing Association for Science and Technology.
I have been engaged in TCM work for over forty years. Pausing briefly on the journey to look back, and looking forward to the bright prospect of TCM modernization, amidst joy, I am happy to summarize my learning process and experiences.
Starting with the Character "Strict"
(I) A Strict Father is a Strict Teacher
I inherited family learning from childhood. At six years old, I attended a private school. Under the strict discipline of teachers and my father, I became familiar with the Four Books and Five Classics and developed a passion for calligraphy. At nine years old, I once publicly wrote Spring Festival couplets on the street, and passersby took them for good luck. At sixteen, I followed my father and elder brother to study medicine and attend consultations. My father, Guan Yuebo, was a famous doctor in the Beijing area, skilled in internal medicine, gynecology, and pediatrics, with unique insights into seasonal diseases and women's diseases. His academic views were influenced by the Nourishing Yin School's Zhu Danxi, tending towards "Yang is excessive, Yin is insufficient." He realized: Diseases such as smallpox, measles, and scarlet fever belong to the category of warm epidemics. Viruses enter through the mouth and nose; they do not cause disease in the Qi level but manifest in the Blood level. Therefore, in treatment, it is essential to add blood-cooling and blood-invigorating drugs, such as Mu Dan Pi (Moutan Cortex), Chi Shao (Paeoniae Rubra Radix), Bai Mao Gen (Imperatae Rhizoma), Yuan Shen (Scrophulariae Radix), Mai Dong (Ophiopogonis Radix), and Sheng Di Huang (Rehmanniae Radix). Throughout the entire process, attention must be paid to nourishing Yin as an assistant, which is the method of detoxification, nourishing Yin, cooling blood, and venting the exterior. Due to the epidemic of warm diseases at that time, he made his experienced formula into "Wen Yi Ling Dan" (Warm Epidemic Spirit Pill) with guides for swallowing. It was simple, convenient, inexpensive, and effective, deeply welcomed by the laboring masses. For gynecological diseases, he used Si Wu Tang (Four Substances Decoction) as the method for treating blood, varying flexibly according to the disease, often achieving remarkable effects. In internal medicine, he was good at treating spleen and stomach diseases, focusing on regulating Qi and Blood. Overall, although the prescriptions were ordinary, the syndrome differentiation was precise, and the curative effect was outstanding. Celebrations and praises from celebrities and literati were incessant. Among them, a certain Mr. Hu recovered from a severe illness. Overwhelmed with gratitude, he presented a gold plaque with eight large characters arranged in two lines: "Qia Yi Qing" (髂翌罄). Readable horizontally and vertically, forming a palindrome, the meaning is: Confucianism reaches Confucianism, Medicine is clear medicine; Reaching Confucianism is Confucianism, Clear Medicine is Medicine; Confucian Medicine is thus Clear Confucian Medicine, Clear Confucian Medicine is Confucian Medicine. I kept this "palindrome poem" until the eve of liberation and used it to encourage myself.
My father was both a strict father and a strict teacher, demanding very strictly of my brother and me. Once, my elder brother mistakenly wrote "Ju Hong" (Pericarpium Citri Reticulatae Viride) as "Ju Hong" (Chrysanthemi Flos). My father slapped him severely in front of the patient! And dismissed this "apprentice." I also received blows from my father's ruler. Because I loved learning and asked questions, I was allowed to continue studying by his side. But after years of attending consultations, he never easily let me diagnose independently. During my father's illness, he continuously checked three of my pulse records. After serious verification, passing the "exam," he finally said satisfactorily, "You can treat people and save lives." Shortly after, he passed away.
(II) Establishing a Solid Foundation
My father took "Upright Character and Correct Technique" as his motto and repeatedly admonished me: "Know what you know, know what you don't know." Regarding colleagues, mainly learn, do not criticize blindly or add arbitrary criticism; saving lives is more important than righteousness, and money is secondary... These simple philosophical truths, slightly tinged with "feudal colors," served as medical ethics education, which was impeccable at that time.
My father's medical skills were superb. He did not open with *Nei Jing* (Inner Canon) and *Nan Jing* (Classic of Difficult Issues), nor close with *Jin Gui* (Essential Prescriptions of the Golden Cabinet) and *Shang Han* (Treatise on Cold Damage). Instead, he emphasized the combination of medical principles and pathology, demanding strict requirements for basic skills. Such works as *Lei Gong Yao Xing Fu* (Lei Gong's Ode to Medicinal Properties), *Tang Tou Ge* (Song of Formulas), and *Bin Hu Mai Xue* (Bin Hu's Study of Pulse Diagnosis) were required to be memorized thoroughly. For *Nei Jing*, *Nan Jing*, *Shang Han Lun* (Treatise on Cold Pathogenic Diseases), and *Jin Gui Yao Lue* (Essential Prescriptions from the Golden Cabinet), he selected them for intensive reading based on practicality, requiring understanding of principles, grasping essentials, and thorough comprehension. He paid particular attention to Ye Tianshi's *Wen Re Lun* (Treatise on Warm Heat) and Wu Juztong's *Wen Bing Tiao Bian* (Systematic Differentiation of Warm Diseases). Additionally, he valued Zhu Zhenheng's *Dan Xi Xin Fa* (Core Concepts of Danxi), Li Dongyuan's *Pi Wei Lun* (Treatise on the Spleen and Stomach), Wang Qingren's *Yi Lin Gai Cuo* (Correction of Errors in Medical Works), and Tang Zonghai's *Xue Zheng Lun* (Treatise on Blood Disorders). My father often said: "Medicine is principle; only by recognizing medical principles can diseases be cured." Therefore, when studying classic medical texts, rote memorization was absolutely not required; when applying clinically, rigid copying was absolutely not required. Instead, memory was based on understanding, deepened through practice.
Paving the Way with the Character "Broad"
(I) Practice Yields True Knowledge
After my father passed away, the landlord sold the house. According to the rule of "mortgage for three years, sell for four," we had to move out within four months. That year I was twenty-eight years old. I participated in the examination held by the pseudo-government Health Bureau (over five hundred candidates, only forty-plus qualified). Although I obtained the qualified certificate for TCM practitioners, I still could not officially open a clinic. I had to study for one year at the TCM Practitioners Association Training Institute headed by President Wang Fengchun. Only after passing the exam could I officially hang up my sign. At that time, grieving the loss of my father while studying, I tasted the bitterness of "Poor in the busy market, no one asks; Rich in the deep mountains, distant relatives come." I had to move to "Guangfu Guesthouse" in Daxi Hutong outside the Front Gate. Three generations lived together in a small dilapidated room. At night, beds were set up for sleeping; during the day, beds were dismantled for studying, seeing patients, and eating. The so-called "Guangfu Guesthouse" was actually a corner of a slum, housing over fifty families. Various trades and social classes were all present, so those I interacted with were all poor people. Due to national corruption and people's poverty, and the prevalence of epidemics, the endless outpatient visits and home consultations tempered me, a young TCM practitioner just starting out. Success and failure, relief and anxiety, complex emotions motivated my progress. Through extensive practice, knowledge obtained from my father and medical books became my direct experience. For example, when visiting patients, upon entering, I could distinguish by smell alone whether it was measles or scarlet fever. This sensitivity to olfactory diagnosis can be said to be a "special ability" acquired postnatally.
Due to the circumstances at that time, I had the opportunity to frequently contact the public, strengthening my ideological and emotional connection with the working people. For instance, a "rickshaw puller" invited me for a home consultation. Afterwards, he offered one yuan as remuneration. I immediately saw a pawn ticket clipped in the calendar on the wall. Feeling sorrowful, I quickly pushed back the "puller's" hands and said, "Take it quickly to buy medicine for your child!" There were many such incidents. Countless poor friends, though unable to afford gifts or plaques, held plaques in their "hearts," with deeper affection.
(II) Broad Absorption Widens Thinking
Beijing was liberated. I simultaneously worked at several pharmacies, such as "Yong'an Tang" and "Ti Gan Tang" on Qianmen Street, and "Tong He Tang" and "Bao De Tang" on Sanlihe Street. At that time, I was fortunate to share a pharmacy with Shi Jinmo, one of the Four Famous Doctors of Beijing. Shi worked from 4 PM to 6 PM, and I worked from 6 PM to 8 PM. Every day, I went early to stand at the counter to browse Shi's pulse records and personally asked about changes after taking medicine, penetrating the mysteries within. As the saying goes, "Experts see the craft." With slight gains, I memorized them in my mind. Over time, pulse records from famous doctors like Kong Bohua, Xiao Longyou, and Wang Fengchun became my living textbooks. Additionally, I made broad contacts with colleagues discussing medical ways. Famous doctors in the Qianmen area, such as Kang Nai'an and Zhao Ruilin, were my close friends. Because I was diligent in learning and asking, Kang passed down the ancestral secret recipe "E Kou San" (Goat Mouth Powder) to me before his death. Promoted and used by me, it had good effects on oral ulcers, Behçet's disease, etc. Now renamed "Oral Ulcer Powder," it is sold openly by the pharmaceutical company. In 1953, I joined the Beijing First TCM Outpatient Department, consulting side-by-side with the deceased famous TCM gynecologist Liu Fengwu. Liu graduated from the National College of Chinese Medicine, taught at the school, had a solid theoretical foundation, and good clinical efficacy. I broke the old habit of "scholars despising each other," actively discussed medical skills with Liu, and exchanged cases. At that time, I regarded all seniors and peers I could contact as teachers, fulfilling Zhongjing's [Zhang Zhongjing] testament: "Diligently seek ancient teachings, broadly collect numerous formulas."
(III) Diligent Learning, Ashamed Not to Ask Inferiors
Since childhood, I was educated by the ancient maxims: "When walking with two others, there must be my teacher"; "Select their good qualities and follow them, select their bad qualities and correct them." I also experienced the hardships of scholarship. So, I realized: "Learning, learning, learn while asking." Through practice, it becomes one's own true knowledge. Usually, I participated in many consultations for difficult and critical cases in other hospitals. Many Western doctors were willing to cooperate with me. I also took consultations as a good opportunity to learn from "the capable" and often absorbed modern medical knowledge from rescuing difficult cases.
Persisting in "Research"
(I) Returning from "Broad" to "Concentrated," Deeply Researching Liver Disease Differentiation and Treatment
After entering the Municipal TCM Hospital, due to scientific research needs, I joined the liver disease group. Although group members adjusted several times, I can be considered one of the "founding fathers" and a main member with enduring stamina. From formulating research plans to actual clinical observation, I participated personally, summarized experiences in time, and published articles in magazines multiple times. I paid close attention to certain new trends and clues. For example, in the early 1950s, besides the method of clearing heat and promoting diuresis for treating hepatitis, the theory of clearing heat and detoxifying was also popular. I once discovered that a certain liver disease expert in the south skillfully used aromatic turbidity-transforming products, which had good effects on improving symptoms and liver function. I rapidly expanded their use, thereby verifying formulas and drugs like Huo Xiang (Patchouli Herba) and Pei Lan (Eupatorii Herba) for aromatic damp-resolving and detoxifying. Furthermore, in the late stage of liver disease, healthy Qi is consumed, and pathogenic evils easily spread. Overuse of clearing heat and detoxifying, or clearing heat and removing dampness, easily damages the spleen and stomach. Based on the theory "The Liver desires dispersion, tonify with pungent, drain with sour," I selected some sour-flavored drugs, such as Bai Shao (Paeoniae Radix Alba), Mu Gua (Chaenomelis Fructus), Wu Bei Zi (Galla Chinensis), Wu Mei (Mume Fructus), and Wu Wei Zi (Schisandrae Chinensis Fructus). On one hand, they converge healthy Qi; on the other hand, they "drain the Liver" through sour astringency and detoxification. Particularly, research on Wu Wei Zi received attention from various aspects, and extensive experimental studies were conducted. Others include the relationship between pathogenic factors and healthy Qi in the differentiation and treatment of liver diseases, combining disease and syndrome, and integrating Chinese and Western medicine. Regarding symptoms of liver disease such as hypochondriac pain, abdominal distension, low-grade fever, abdominal masses, complications with phlegm-dampness (post-hepatitis hepatic steatosis), and diabetes (Xiao Ke, 消渴), as well as newly discovered issues in recent years such as "Hepatitis B Surface Antigen (HBsAg) Positive," I observed carefully and continuously summarized my treatment experiences.