(二)辨证严谨抓实质，力挽危难我不仅仅治疗肝病，对于杂病也注意积累经验。在学术观点上，我比较重视气、血、痰的理论，因为「气血为病」，「痰生百病」。所谓气、血、痰(古人称痰者水也)，实际上是气、血、水三者，既是构成人体的物质基础，又是病理变化的实质。所以在临证时，除了遵守传统的辨证法则之外，特别注意抓住气、血、痰，对于疑难重症的治疗更是如此，例如有一次外院会诊，中西医专家也在场，患者(河南人)是流行性出血热，因在外地抢救未愈来京，病情危重。本病北京不多见，我不熟悉，于是以「能者」为师，首先向西医专家请教，了解到本病病原为特殊病毒，由地鼠(啮齿动物)和恙螨传播，而且发病急骤，死亡率很高，且以发热，出血、休克、肾功能障碍为特征。临床可分为发热期、低血压期、尿少期、多尿期。我又向护送的中医师请教，他们认为：发热期相当于毒热入于血分，用犀角地黄汤加减，低血压期以西医药为主积极抢救休克，肾功能障碍多尿期，以补肾为法，用六味地黄丸加减。而本例正处于多尿期，曾服六味诸剂数日效果不显，我聆听了中西医「能者」珍言，进行认真的思考，并详细询问患者现状，发现患者少气懒言，精神萎靡，虽然发热已平，然而尿虽多而口渴、喜冷饮，舌苔白而舌质红，脉细数而略有鼓指。于是透过复杂的表象，深入探求毒热入血，耗伤气阴的病理实质，辨证为里热未清、气崩大伤。使用六味之辈为时尚早，于是改用竹叶石膏汤与人参白虎汤合方加减，三剂后症除溲敛，再用六昧加减而收功。
(三)著书立说，继承发扬传心悟我瞄为我应当是祖国医学历史中的接力赛跑队员，继承了古人的遗产，又传下去。所以，我从十几年前就开始积累病历和数据。在整理和编写的过程中，所采取的态度是：通过「加工制作」使经验带上系统性、条理性，从而提高一步。除了突出肝病治疗经验外，对于杂病也围绕我的学术观点，进行归纳和分析，并采取说理与举例相结合的方法，对于每一观点、每一看法，都用实际病历加以说明，有一说一，有二说二，避免重谈，更忌夸张炫耀之词，同时为了通俗易懂、深入浅出，还把主要论点用歌诀的形式作标题，以利上口，读后能诵能用。例如肝病调护宜忌简介一节，以「情绪舒畅，不能着急」饮食有节，不可偏倚；生活起居，要有规律；劳逸结合，善于调理」四句话为小标题，概括地说明了肝病调护的要点。
《关幼波临床经验选》出版后受到多方面的关注。例如一位主管卫生工作的领导写信给我说：「总结行医经验，交流推广，造福人类，是件大好事，你的著作显示了你的贡献。」这对于我是极大的鼓励和鞭策。日本神户市中医研究会会长森雄材来函说：「我们的中医研究会，计划出版一本西医诊断与中医辨证相结合的临床书籍，并打算将先生的《关选》作为编写的参考。」由于本书源于实践，所以书中的经验可以借鉴。例如山西临汾人民医院某医生说；「我觉得此书章法新颖，重点突出，经验确实，可以重复。」并用实际病例来说明运用我的经验后所获得的效果。如封××，男，38岁，一九七九年十月确诊为急性黄疸型肝炎，服用茵陈蒿汤加减八十余剂，黄疸虽减终未全除，加用白矾、郁金、陈皮、莱菔子等化痰之品，黄疸迅速消除，验证了「治黄要治痰」的看法。再如桂西山区中医治疗站某医生来信说：「有一妇女久患顽固性头痛，邻近医院跑遍，百药皆惘然。后按《关选》中『怪病责之于痰』一章治法，原方加减服十二剂，病症大减。」
「创」字展新图
(一)师古不泥古，学术力争创见在继承祖国医学遗产的过程中，对于古典医籍和近世先贤著述，既要熟悉，但又不能受其束缚，因为实践是检验真理的唯一标准。例如，对于黄疸，除了同意「湿热相搏」乃生黄疸的传统概念外，对于与「疫毒」传染有关的病因学说我也比较重视。在病理上，我体会到：湿热羁留气分不会出现黄疽，而湿热为胶固之邪，入于血分，瘀阻百脉，逼迫胆汁外溢，浸渍肌肤，才能出现黄疸，若湿热蕴毒，则血热沸腾流速，胆液横溢，除黄疸日益加重外，尚可出现衄血、呕血、皮肤出血、斑点、赤缕、掌红、蜘蛛痣等，甚至毒热弥漫三焦，侵犯心包，而见高热、烦躁、神昏谵语等危候，若湿热凝痰，更加胶固粘滞，瘵阻血脉，脉道不通则胆汁更难循其常道而行，黄疸更难消退。所以在治法上除了遵守传统的清利温热之外，尚且提出「治黄必治血，血行黄易却；治黄需解毒，毒解黄易除，治黄要治痰，痰化黄易散」的个人见解。
再如对于血证的看法，我体会：血在气的统帅之下环行于竦中。如果某种固素影响了气血沟运行，使血流缓慢渐渐淤积不散，或使血流急述，壅阻脉道恤滞血淤，最后都可以形成瘀血。瘀血既成阻隔经络，新血源源循经而来，由于瘀血阻挡不能循经而去，以致逆经决络溢出脉道，造成出血。由于影响气血运行的因素是多方面的，所以在治法上也是多种多样的。应当针对并彻底清除引起血瘀的直接或间接因素，才是治疗血证的根本法则。这种瘀血滞留、阻隔脉道而引起出血的理论，对于阐明中医出血病机和治疗血证也是有益的。
(二)坚信中医学术必将继续发展在卫生部一九八0年召开的中医、中西医结合工作会议上，总结了三十年来的经验教训，明确提出了中医、西医、中西医结合三支力量都要大力发展，长期并存的方针。这一方针是适合我国实际情况的，解决了历史遗留下来的根本问题，对整个中医事业和中西结合事业的发展是一件大事，对于我国医学科学现代化有着重要的现实意义和深远的历史意义。作为一个老中医，我坚信中国医药学是一个伟大的宝库，同时也不排斥现代科学和现代医学。在中西医结合的过程中，我真诚地与西医合作，在中医现代化的问题上，也愿积极前进。例如，几年以前，有人向我提出来准备把我治疗肝炎的经验输入电子计算器。当时一无先例可鉴，二无电子计算器，提出这样的问题是一个新的大胆设想，各方面的态度也不一致。但是，在各级领导的大力支持下，我的态度很坚决，对这些年青人说：「我全力支持，有问题我负责。」就这样《关幼波肝病辨证施治电子计算器程序》的研究开始了。我们不知熬过多少不眠之夜。研究人员在理解和掌握我的治疗思想的基础上，根据望、闸、问、切所收集的症状、数据，制定数学模型，编制逻辑图，然后用算法语言编写成计算器程序，使之再现我的辨证施治思想。这套诊疗系统将肝病分为八个主型，三十六个亚型，并根据病情的变化进行加减。对于肝病的诊断、处方、医嘱等工作，不到一分钟的时间就全部完成。到一九七八年底初步研究成功了。经过一年多的实验性门诊，治疗肝炎病人一千多人次，在充分肯定的基础上，于一九八0年六月二十四n下午，再现我的治疗肝病思想的「计算机医生」在北京中医院正式门诊，具有数千年历史的中医治法获得了新的生命力。当人们问及我的想法时，我说：「可以精于古，不可泥于古。中医必须在古人的基础上，有所发展，有所前进，中医现代化，势在必行。」我还想，应该把各地治疗肝病的好经验集中起来输入计算机，这就不单是我一个人，而是全国的名医同时给患者瞧病了。当我真正理解了「知识的最大敌人，就是没有任何新的欲求」的时候，我每时每刻都准备向知识的大海，提出新的欲求，并决心在发展中医学术的征途中，继续向前挺进。
(高益民整理)
有益的回忆
江苏省中医院主任医师江育仁
【作者简介】江育仁 (1916～)，江苏常熟人。一九三八年卒业于上海中国医学院，毕生从事儿科，在理论和临床方面都有较深的造诣。现任中华全国中医学会理事、江苏中医分会副理事长、江苏省科委科研成果评定委员会委员等职。主要著作有《中医儿科诊疗学》、《中医儿科纲要》、《中医儿科临床手册》，《中医儿科》等。
我从事临床四十余年，当然治愈了不少病人，但不敢自信全属「得心应手」，且治疗当时，记录不详，时过境迁，记忆不瓶，即能写出梗概，亦恐犯科学之戒律，于己于人，怕无裨益。而对过去在学习治病时所遇到的教训，虽时隔已久，其来龙去脉，前因后果，却能历历在目，记忆犹新，确有深切的体会。经验心得，固属可贵，丽失败教训，或可资他人借鉴。为此，从求宴出发，信笔写柬，仅供后学参考而已。
从求医谈起
我十四岁那年的夏秋之交，患了一场大病。据当时医生的诊断是「伤寒症」。虽一开始就请医服药，但病情却日益增重。家人三次登门请求某名医出诊，但那位名医不是今天没空，就是明天不便，拒不应邀。那时，我昏昏沉沉，几将无望。幸亏我姑父请来了一位专看伤寒的医生。他非但精心诊治，而且把如何煎药，如何服药，连护理方法也交代得清清楚楚。我当晚服药后，顿觉神消气爽，就渐渐地好了。当时阉家欢欣，对那位医生感激得「恩同再造」。
这场大病，使我下定决心学医。父亲说，你学医可以，但一定要当个好医生，光有本事，如果没有「割股之心」，也是不行的。我提出拜那位「伤寒」名家为师。惜我在十七岁真正开始学医的那年，我心日中的老师，不幸已「遽归道山」了。还是经亲友介绍，得以拜李馨山先生为师，遂了我的宿愿。
李馨山是江苏省常熟县著名的儒医，是晚清的末科秀才，擅内、妇，儿科，亦以治「伤寒」名声远播，同属琴东西石桥世医王似山先生的高足(王似山先生即中国科协副主席、学部委员，物理学专家王淦昌博士的尊翁)。李氏训徒，既爱且严。尝谓：「文墨不通，难作医工」；「秀才学郎中，等于抬根葱」。比喻学习中医一定要有古文基础。所以我们在学习过程中，老师既训医经，亦教古文。
李师有一套学律，三条约法。在第一学年内，要背熟《素问灵枢类纂》、《金匮心典》、《伤寒来苏集》、《难经》等四本书；第二学年背熟《汤头歌诀》、《本草从新》，读熟《温病条辨》、《吴医汇讲》、《温热经纬》，第三学年阅读金元四家的学术流派，《四家医案》，同时随师侍诊；第四学年逐步进行独立应诊。这就是四年中的一套课程设置。所谓「三条约法」者，即；书本不熟不得临证；书法不工不准写方；不修礼貌不带出诊。他说：「这是王氏门相传的学风和学规」。由于不能适应老师治学的严谨，在同期的五个同学中四年内有两位退了学。
结业后，荫老师的盛名，就诊者一时不少。那时有一点初生之犊不怕虎，在处理疑难病症时，常常胸中无数，笔下又欠推敲。尤其是诊治变幻多端的小儿科疾病，就更难免不出纰漏了。因此，曾多次发生医疗纠纷，加之旧社会「同行必妒」，声名一时骤降。在自愧见闻浅陋，贻误苍生的心情下，毅然再作深造，负笈于上海中国医学院，并有目的、有重点地跟随上海名医徐小圃老师学习儿科专业。此即我学医由内科转入儿科经历之大略。
把教训奉为经验
古谚云：「宁医十男于，莫治一妇人；宁医十妇人，奠治一小儿。」反应了小儿疾病的变化多端，掌握不易。我之所以弃内科而从儿科者，有一点知难而进的意思。因为我在这方面的教训，可谓多矣。
(一)知其常而不达其变麻疹属小儿常见传染病。麻疹减毒疫苗未使用前，基本上每年都有流行，对小儿健康的危害很大。顺证的麻疹易被一般医生所掌握，而逆证麻疹多有并发症，如不及时抢治，往往病变仓卒。故麻疹预后良好与否，关键在于如何正确地掌握透疹的时机和透疹的方法。「疹不厌透」，历来奉为治疹的要诀。但事物总是有两面性的，如果把它看作绝对的、不变的，那就会违反客观规律。我就在「疹不厌透」的律法下，险些误了大事。每忆及此，不寒而傈。
一两岁小孩，发热咳嗽三天，麻疹见点两天，突然高热气喘，烦躁不宁，睡时惊惕，大使不结，小便色黄，皮肤痧点隐伏不透，面白唇红，舌苔黄、质红。本证属麻毒化热化火，火灼肺金，已有入营之兆，虽已属逆证，证情并不复杂。此时治法，理应清热解毒为主，略佐透法。重在甘寒护阴，严防伤滓耗液、液劫风动，导致燎原莫制。但我当时审证，心中只有一个「透」字。认为疹点隐约，痧毒未得外泄，此必透发者一也，见点两天，正透疹之期，此应透之理二也。故大胆给予重剂宣透。患儿眼药后，烦躁更甚，夜半呼吸更促，口唇焦裂，皮肤灼热，全身无汗，痧点隐没，两目红赤，不时上翻，抽风两次，小便涓滴，腹膨肚胀，神识渐至昏糊，病情重危，家属十分焦急，次晨另请他人医治，两天后，患儿转危为安。
(二) 辨证严谨抓实质，力挽危难
我不仅仅治疗肝病，对于杂病也注意积累经验。在学术观点上，我比较重视气、血、痰的理论，因为「气血为病」，「痰生百病」。所谓气、血、痰（古人称痰者水也），实际上是气、血、水三者，既是构成人体的物质基础，又是病理变化的实质。所以在临证时，除了遵守传统的辨证法则之外，特别注意抓住气、血、痰，对于疑难重症的治疗更是如此。例如有一次外院会诊，中西医专家也在场，患者（河南人）是流行性出血热，因在外地抢救未愈来京，病情危重。本病北京不多见，我不熟悉，于是以「能者」为师，首先向西医专家请教，了解到本病病原为特殊病毒，由地鼠（啮齿动物）和恙螨传播，而且发病急骤，死亡率很高，且以发热、出血、休克、肾功能障碍为特征。临床可分为发热期、低血压期、尿少期、多尿期。我又向护送的中医师请教，他们认为：发热期相当于毒热入于血分，用犀角地黄汤加减；低血压期以西医药为主积极抢救休克；肾功能障碍多尿期，以补肾为法，用六味地黄丸加减。而本例正处于多尿期，曾服六味诸剂数日效果不显，我聆听了中西医「能者」珍言，进行认真的思考，并详细询问患者现状，发现患者少气懒言，精神萎靡，虽然发热已平，然而尿虽多而口渴、喜冷饮，舌苔白而舌质红，脉细数而略有鼓指。于是透过复杂的表象，深入探求毒热入血，耗伤气阴的病理实质，辨证为里热未清、气崩大伤。使用六味之辈为时尚早，于是改用竹叶石膏汤与人参白虎汤合方加减，三剂后症除溲敛，再用六昧加减而收功。
(三) 著书立说，继承发扬传心悟
我应当是祖国医学历史中的接力赛跑队员，继承了古人的遗产，又传下去。所以，我从十几年前就开始积累病历和数据。在整理和编写的过程中，所采取的态度是：通过「加工制作」使经验带上系统性、条理性，从而提高一步。除了突出肝病治疗经验外，对于杂病也围绕我的学术观点，进行归纳和分析，并采取说理与举例相结合的方法，对于每一观点、每一看法，都用实际病历加以说明，有一说一，有二说二，避免重谈，更忌夸张炫耀之词，同时为了通俗易懂、深入浅出，还把主要论点用歌诀的形式作标题，以利上口，读后能诵能用。例如肝病调护宜忌简介一节，以「情绪舒畅，不能着急」饮食有节，不可偏倚；生活起居，要有规律；劳逸结合，善于调理」四句话为小标题，概括地说明了肝病调护的要点。
《关幼波临床经验选》出版后受到多方面的关注。例如一位主管卫生工作的领导写信给我说：「总结行医经验，交流推广，造福人类，是件大好事，你的著作显示了你的贡献。」这对于我是极大的鼓励和鞭策。日本神户市中医研究会会长森雄材来函说：「我们的中医研究会，计划出版一本西医诊断与中医辨证相结合的临床书籍，并打算将先生的《关选》作为编写的参考。」由于本书源于实践，所以书中的经验可以借鉴。例如山西临汾人民医院某医生说；「我觉得此书章法新颖，重点突出，经验确实，可以重复。」并用实际病例来说明运用我的经验后所获得的效果。如封××，男，38岁，一九七九年十月确诊为急性黄疸型肝炎，服用茵陈蒿汤加减八十余剂，黄疸虽减终未全除，加用白矾、郁金、陈皮、莱菔子等化痰之品，黄疸迅速消除，验证了「治黄要治痰」的看法。再如桂西山区中医治疗站某医生来信说：「有一妇女久患顽固性头痛，邻近医院跑遍，百药皆惘然。后按《关选》中『怪病责之于痰』一章治法，原方加减服十二剂，病症大减。」
「创」字展新图
(一) 师古不泥古，学术力争创见
在继承祖国医学遗产的过程中，对于古典医籍和近世先贤著述，既要熟悉，但又不能受其束缚，因为实践是检验真理的唯一标准。例如，对于黄疸，除了同意「湿热相搏」乃生黄疸的传统概念外，对于与「疫毒」传染有关的病因学说我也比较重视。在病理上，我体会到：湿热羁留气分不会出现黄疽，而湿热为胶固之邪，入于血分，瘀阻百脉，逼迫胆汁外溢，浸渍肌肤，才能出现黄疸，若湿热蕴毒，则血热沸腾流速，胆液横溢，除黄疸日益加重外，尚可出现衄血、呕血、皮肤出血、斑点、赤缕、掌红、蜘蛛痣等，甚至毒热弥漫三焦，侵犯心包，而见高热、烦躁、神昏谵语等危候，若湿热凝痰，更加胶固粘滞，瘵阻血脉，脉道不通则胆汁更难循其常道而行，黄疸更难消退。所以在治法上除了遵守传统的清利温热之外，尚且提出「治黄必治血，血行黄易却；治黄需解毒，毒解黄易除，治黄要治痰，痰化黄易散」的个人见解。
再如对于血证的看法，我体会：血在气的统帅之下环行于竦中。如果某种固素影响了气血沟运行，使血流缓慢渐渐淤积不散，或使血流急述，壅阻脉道恤滞血淤，最后都可以形成瘀血。瘀血既成阻隔经络，新血源源循经而来，由于瘀血阻挡不能循经而去，以致逆经决络溢出脉道，造成出血。由于影响气血运行的因素是多方面的，所以在治法上也是多种多样的。应当针对并彻底清除引起血瘀的直接或间接因素，才是治疗血证的根本法则。这种瘀血滞留、阻隔脉道而引起出血的理论，对于阐明中医出血病机和治疗血证也是有益的。
(二) 坚信中医学术必将继续发展
在卫生部一九八0年召开的中医、中西医结合工作会议上，总结了三十年来的经验教训，明确提出了中医、西医、中西医结合三支力量都要大力发展，长期并存的方针。这一方针是适合我国实际情况的，解决了历史遗留下来的根本问题，对整个中医事业和中西结合事业的发展是一件大事，对于我国医学科学现代化有着重要的现实意义和深远的历史意义。作为一个老中医，我坚信中国医药学是一个伟大的宝库，同时也不排斥现代科学和现代医学。在中西医结合的过程中，我真诚地与西医合作，在中医现代化的问题上，也愿积极前进。例如，几年以前，有人向我提出来准备把我治疗肝炎的经验输入电子计算器。当时一无先例可鉴，二无电子计算器，提出这样的问题是一个新的大胆设想，各方面的态度也不一致。但是，在各级领导的大力支持下，我的态度很坚决，对这些年青人说：「我全力支持，有问题我负责。」就这样《关幼波肝病辨证施治电子计算器程序》的研究开始了。我们不知熬过多少不眠之夜。研究人员在理解和掌握我的治疗思想的基础上，根据望、闸、问、切所收集的症状、数据，制定数学模型，编制逻辑图，然后用算法语言编写成计算器程序，使之再现我的辨证施治思想。这套诊疗系统将肝病分为八个主型，三十六个亚型，并根据病情的变化进行加减。对于肝病的诊断、处方、医嘱等工作，不到一分钟的时间就全部完成。到一九七八年底初步研究成功了。经过一年多的实验性门诊，治疗肝炎病人一千多人次，在充分肯定的基础上，于一九八0年六月二十四n下午，再现我的治疗肝病思想的「计算机医生」在北京中医院正式门诊，具有数千年历史的中医治法获得了新的生命力。当人们问及我的想法时，我说：「可以精于古，不可泥于古。中医必须在古人的基础上，有所发展，有所前进，中医现代化，势在必行。」我还想，应该把各地治疗肝病的好经验集中起来输入计算机，这就不单是我一个人，而是全国的名医同时给患者瞧病了。当我真正理解了「知识的最大敌人，就是没有任何新的欲求」的时候，我每时每刻都准备向知识的大海，提出新的欲求，并决心在发展中医学术的征途中，继续向前挺进。
高益民整理
有益的回忆
江苏省中医院主任医师江育仁
【作者简介】江育仁 (1916～)，江苏常熟人。一九三八年卒业于上海中国医学院，毕生从事儿科，在理论和临床方面都有较深的造诣。现任中华全国中医学会理事、江苏中医分会副理事长、江苏省科委科研成果评定委员会委员等职。主要著作有《中医儿科诊疗学》、《中医儿科纲要》、《中医儿科临床手册》，《中医儿科》等。
我从事临床四十余年，当然治愈了不少病人，但不敢自信全属「得心应手」，且治疗当时，记录不详，时过境迁，记忆不瓶，即能写出梗概，亦恐犯科学之戒律，于己于人，怕无裨益。而对过去在学习治病时所遇到的教训，虽时隔已久，其来龙去脉，前因后果，却能历历在目，记忆犹新，确有深切的体会。经验心得，固属可贵，丽失败教训，或可资他人借鉴。为此，从求宴出发，信笔写柬，仅供后学参考而已。
从求医谈起
我十四岁那年的夏秋之交，患了一场大病。据当时医生的诊断是「伤寒症」。虽一开始就请医服药，但病情却日益增重。家人三次登门请求某名医出诊，但那位名医不是今天没空，就是明天不便，拒不应邀。那时，我昏昏沉沉，几将无望。幸亏我姑父请来了一位专看伤寒的医生。他非但精心诊治，而且把如何煎药，如何服药，连护理方法也交代得清清楚楚。我当晚服药后，顿觉神消气爽，就渐渐地好了。当时阉家欢欣，对那位医生感激得「恩同再造」。
这场大病，使我下定决心学医。父亲说，你学医可以，但一定要当个好医生，光有本事，如果没有「割股之心」，也是不行的。我提出拜那位「伤寒」名家为师。惜我在十七岁真正开始学医的那年，我心日中的老师，不幸已「遽归道山」了。还是经亲友介绍，得以拜李馨山先生为师，遂了我的宿愿。
李馨山是江苏省常熟县著名的儒医，是晚清的末科秀才，擅内、妇，儿科，亦以治「伤寒」名声远播，同属琴东西石桥世医王似山先生的高足(王似山先生即中国科协副主席、学部委员，物理学专家王淦昌博士的尊翁)。李氏训徒，既爱且严。尝谓：「文墨不通，难作医工」；「秀才学郎中，等于抬根葱」。比喻学习中医一定要有古文基础。所以我们在学习过程中，老师既训医经，亦教古文。
李师有一套学律，三条约法。在第一学年内，要背熟《素问灵枢类纂》、《金匮心典》、《伤寒来苏集》、《难经》等四本书；第二学年背熟《汤头歌诀》、《本草从新》，读熟《温病条辨》、《吴医汇讲》、《温热经纬》，第三学年阅读金元四家的学术流派，《四家医案》，同时随师侍诊；第四学年逐步进行独立应诊。这就是四年中的一套课程设置。所谓「三条约法」者，即；书本不熟不得临证；书法不工不准写方；不修礼貌不带出诊。他说：「这是王氏门相传的学风和学规」。由于不能适应老师治学的严谨，在同期的五个同学中四年内有两位退了学。
结业后，荫老师的盛名，就诊者一时不少。那时有一点初生之犊不怕虎，在处理疑难病症时，常常胸中无数，笔下又欠推敲。尤其是诊治变幻多端的小儿科疾病，就更难免不出纰漏了。因此，曾多次发生医疗纠纷，加之旧社会「同行必妒」，声名一时骤降。在自愧见闻浅陋，贻误苍生的心情下，毅然再作深造，负笈于上海中国医学院，并有目的、有重点地跟随上海名医徐小圃老师学习儿科专业。此即我学医由内科转入儿科经历之大略。
把教训奉为经验
古谚云：「宁医十男于，莫治一妇人；宁医十妇人，奠治一小儿。」反应了小儿疾病的变化多端，掌握不易。我之所以弃内科而从儿科者，有一点知难而进的意思。因为我在这方面的教训，可谓多矣。
(一) 知其常而不达其变
麻疹属小儿常见传染病。麻疹减毒疫苗未使用前，基本上每年都有流行，对小儿健康的危害很大。顺证的麻疹易被一般医生所掌握，而逆证麻疹多有并发症，如不及时抢治，往往病变仓卒。故麻疹预后良好与否，关键在于如何正确地掌握透疹的时机和透疹的方法。「疹不厌透」，历来奉为治疹的要诀。但事物总是有两面性的，如果把它看作绝对的、不变的，那就会违反客观规律。我就在「疹不厌透」的律法下，险些误了大事。每忆及此，不寒而傈。
一两岁小孩，发热咳嗽三天，麻疹见点两天，突然高热气喘，烦躁不宁，睡时惊惕，大使不结，小便色黄，皮肤痧点隐伏不透，面白唇红，舌苔黄、质红。本证属麻毒化热化火，火灼肺金，已有入营之兆，虽已属逆证，证情并不复杂。此时治法，理应清热解毒为主，略佐透法。重在甘寒护阴，严防伤滓耗液、液劫风动，导致燎原莫制。但我当时审证，心中只有一个「透」字。认为疹点隐约，痧毒未得外泄，此必透发者一也，见点两天，正透疹之期，此应透之理二也。故大胆给予重剂宣透。患儿眼药后，烦躁更甚，夜半呼吸更促，口唇焦裂，皮肤灼热，全身无汗，痧点隐没，两目红赤，不时上翻，抽风两次，小便涓滴，腹膨肚胀，神识渐至昏糊，病情重危，家属十分焦急，次晨另请他人医治，两天后，患儿转危为安。
(II) Rigorous Syndrome Differentiation to Grasp the Essence, and Strive to Rescue from Critical Danger
I not only treat liver diseases but also pay attention to accumulating experience in treating miscellaneous diseases. In terms of academic viewpoints, I attach great importance to the theories of Qi, Blood, and Phlegm, because "diseases arise from Qi and Blood," and "Phlegm generates a hundred diseases." What is referred to as Qi, Blood, and Phlegm (the ancients called Phlegm "Water") is actually the triad of Qi, Blood, and Water. These three are both the material basis constituting the human body and the essence of pathological changes. Therefore, in clinical practice, besides adhering to traditional syndrome differentiation principles, I specifically focus on Qi, Blood, and Phlegm, especially in the treatment of difficult and critical cases. For example, during an external hospital consultation where both TCM and Western medicine experts were present, a patient (from Henan province) suffering from Epidemic Hemorrhagic Fever came to Beijing for rescue after failing to recover elsewhere; his condition was critical. This disease was rare in Beijing, and I was unfamiliar with it. Thus, taking those "capable" people as my teachers, I first consulted Western medicine experts. I learned that the pathogen of this disease is a special virus, transmitted by groundhogs (rodents) and chiggers. It has a sudden onset, a high mortality rate, and is characterized by fever, hemorrhage, shock, and renal dysfunction. Clinically, it can be divided into four stages: febrile stage, hypotensive stage, oliguric stage, and polyuric stage. I then consulted the TCM physician who escorted the patient. They believed: the febrile stage corresponds to toxic heat entering the Blood level, treated with modified Xi Jiao Di Huang Tang (Rhinoceros Horn and Rehmannia Decoction); the hypotensive stage requires active rescue of shock primarily using Western medicine; the polyuric stage of renal dysfunction should be treated by tonifying the Kidney, using modified Liu Wei Di Huang Wan (Six-Ingredient Pill with Rehmannia). However, this case was in the polyuric stage. After taking various formulations of Liu Wei Di Huang Wan for several days, there was no obvious effect. Having listened to the valuable advice of these "capable" TCM and Western medicine experts, I thought carefully and inquired in detail about the patient's current status. I found that the patient had shortness of breath and reluctance to speak, listlessness. Although the fever had subsided, he still had polyuria accompanied by thirst and a preference for cold drinks. His tongue coating was white while the tongue substance was red, and his pulse was fine, rapid, and slightly forceful upon pressing. Thus, penetrating the complex superficial manifestations, I probed deeply into the pathological essence of toxic heat entering the blood and consuming Qi and Yin. The syndrome was differentiated as "uncleared interior heat and severe damage to Qi." Using Liu Wei Di Huang Wan at this time was premature. Therefore, I changed to a combined formula of Zhu Ye Shi Gao Tang (Bamboo Leaf and Gypsum Decoction) and Ren Shen Bai Hu Tang (Ginseng and White Tiger Decoction), modified appropriately. After three doses, the symptoms disappeared and urination normalized. Subsequently, using modified Liu Wei Di Huang Wan brought the treatment to a successful conclusion.
(III) Writing Books and Establishing Theories, Inheriting and Promoting Insights
I should be a relay runner in the history of our motherland's medical science, inheriting the legacy of the ancients and passing it on. Therefore, I began accumulating medical records and data more than ten years ago. During the process of organizing and compiling, my attitude was to enhance the systematicity and logicality of experience through "processing and production," thereby elevating it to a higher level. Besides highlighting experiences in treating liver diseases, I also summarized and analyzed miscellaneous diseases around my academic viewpoints. I adopted a method combining reasoning with examples. For every viewpoint and opinion, I used actual medical records to illustrate them, stating one thing as one and two things as two, avoiding repetition, and strictly forbidding exaggerated or showy language. Meanwhile, to make the content accessible and profound yet simple, I used verse formulas as titles for main arguments, making them easy to recite and apply after reading. For example, in the section "Introduction to Precautions for Liver Disease Care," I used four sentences as subheadings: "Emotions should be smooth, do not worry"; "Diet should be regulated, do not have biases"; "Daily life and rest should be regular"; "Combine work and rest, be good at regulation." These briefly explained the key points of liver disease care.
After the publication of *Selected Clinical Experiences of Guan Youbo*, it attracted attention from various sectors. For instance, a leader in charge of health work wrote to me saying: "Summarizing medical experience, exchanging and promoting it to benefit humanity is a very good thing. Your work demonstrates your contribution." This was a great encouragement and spur for me. Sen Yuzai, President of the Kobe City TCM Research Association in Japan, sent a letter saying: "Our TCM Research Association plans to publish a clinical book combining Western diagnostic methods with TCM syndrome differentiation, and intends to use Mr. Guan's *Selected Works* as a reference for compilation." Since this book stems from practice, the experiences within can be referenced. For example, a doctor at Linfen People's Hospital in Shanxi said: "I feel this book has novel structure, prominent highlights, and reliable experiences that can be replicated." He illustrated the effects obtained by applying my experiences with actual cases. For instance, Feng XX, male, 38 years old, was diagnosed with acute icteric hepatitis in October 1979. After taking over eighty doses of modified Yin Chen Hao Tang (Artemisia Scoparia Decoction), although jaundice decreased, it did not completely disappear. Adding phlegm-resolving herbs such as Bai Fan (Alumen), Yu Jin (Curcuma Root), Chen Pi (Citrus Peel), and Lai Fu Zi (Radish Seed) led to the rapid elimination of jaundice, verifying the view that "treating jaundice requires treating phlegm." Furthermore, a doctor from a TCM treatment station in the Guixi mountainous area wrote: "A woman suffered from stubborn headache for a long time. She visited neighboring hospitals everywhere, and all medicines failed. Later, following the treatment methods in the chapter 'Strange Diseases Blamed on Phlegm' from *Guan Selected Works*, she took twelve doses of the original formula with modifications, and her symptoms greatly reduced."
"Creation" Unfolds a New Picture
(I) Following the Ancients without Being Bound by Them, Striving for Academic Innovations
In the process of inheriting the heritage of our motherland's medical science, we must be familiar with classical medical texts and writings of recent sages, but we cannot be bound by them, because practice is the sole criterion for testing truth. For example, regarding jaundice, besides agreeing with the traditional concept that "damp-heat clashing together" generates jaundice, I also attach importance to etiological theories related to the transmission of "epidemic toxins." Pathologically, I realized: damp-heat lingering in the Qi level will not cause jaundice. Damp-heat is a sticky and solid pathogen; when it enters the Blood level, it causes stasis blocking the hundred vessels, forcing bile to overflow and soak the skin, thus causing jaundice. If damp-heat accumulates into toxin, blood heat boils and flows rapidly, bile spills horizontally. Besides worsening jaundice, it may also present with epistaxis, hematemesis, skin bleeding, spots, red threads, palm erythema, spider nevi, etc. Even worse, if toxic heat diffuses through the San Jiao (Triple Burner) and invades the Pericardium, critical conditions such as high fever, irritability, coma, and delirium may appear. If damp-heat condenses into phlegm, becoming even stickier and more viscous, obstructing blood vessels and blocking vessel channels, bile finds it harder to follow its normal course, making jaundice even harder to resolve. Therefore, in treatment methods, besides adhering to traditional clearing and draining of damp-heat, I proposed personal insights: "To treat jaundice, one must treat the blood; when blood moves, jaundice easily retreats; to treat jaundice, one needs to resolve toxins; when toxins are resolved, jaundice easily disappears; to treat jaundice, one must treat phlegm; when phlegm is transformed, jaundice easily scatters."
Regarding my views on blood disorders, I realize: Blood circulates in the chest under the command of Qi. If certain factors affect the circulation of Qi and Blood, causing blood flow to slow down and gradually accumulate without dispersing, or causing blood flow to become rapid and obstruct vessel channels leading to stasis, ultimately blood stasis forms. Once formed, blood stasis blocks meridians and collaterals. New blood continuously arrives along the meridians, but due to the blockage by blood stasis, it cannot depart along the meridians, thus flowing backward against the meridians and bursting out of the vessel channels, causing bleeding. Since factors affecting Qi and Blood circulation are diverse, treatment methods are also varied. One should target and thoroughly eliminate direct or indirect factors causing blood stasis; this is the fundamental rule for treating blood disorders. This theory that blood stasis stagnation and vessel obstruction cause bleeding is beneficial for elucidating the pathogenesis of TCM bleeding disorders and treating blood disorders.
(II) Firmly Believing that TCM Academic Discipline Will Continue to Develop
At the TCM and Integrated Chinese and Western Medicine Work Conference convened by the Ministry of Health in 1980, lessons learned from thirty years of experience were summarized. It clearly proposed the policy that TCM, Western medicine, and integrated Chinese and Western medicine—the three forces—must all be vigorously developed and coexist for a long term. This policy suits China's actual situation, solves fundamental problems left over from history, and is a major event for the development of the entire TCM cause and integrated medicine. It has important practical significance and far-reaching historical meaning for the modernization of China's medical science. As an old TCM practitioner, I firmly believe that Chinese medicine and pharmacology is a great treasure house, while also not excluding modern science and modern medicine. In the process of integration, I sincerely cooperate with Western medicine, and on the issue of TCM modernization, I am willing to advance actively. For example, a few years ago, someone proposed inputting my experience in treating hepatitis into an electronic calculator. At that time, there were no precedents to follow, nor electronic calculators available. Proposing such a question was a new and bold idea, and attitudes from various sides were inconsistent. However, with strong support from leaders at all levels, my attitude was firm. I told these young people: "I fully support this; I take responsibility for any problems." Thus, the research on the *Electronic Calculator Program for Syndrome Differentiation and Treatment of Liver Diseases by Guan Youbo* began. We endured countless sleepless nights. Based on understanding and mastering my treatment philosophy, researchers formulated mathematical models and compiled logic diagrams according to symptoms and data collected through Inspection, Auscultation/Olfaction, Inquiry, and Palpation. Then, using algorithmic languages, they programmed the calculator to reproduce my thoughts on syndrome differentiation and treatment. This diagnostic and treatment system classified liver diseases into eight main types and thirty-six subtypes, with modifications based on changes in the condition. Diagnosis, prescription, and medical advice for liver diseases could be completed in less than a minute. By the end of 1978, preliminary research was successful. After more than a year of experimental outpatient clinics, treating over a thousand patients with hepatitis, and based on full affirmation, on the afternoon of June 24, 1980, the "Computer Doctor," reproducing my thoughts on treating liver diseases, officially held outpatient sessions at Beijing Hospital of Traditional Chinese Medicine. TCM treatment methods with thousands of years of history gained new vitality. When asked about my thoughts, I said: "One can excel in ancient knowledge but must not be bound by it. TCM must develop and advance upon the foundation of the ancients. TCM modernization is imperative." I also thought that good experiences in treating liver diseases from various places should be centralized and input into computers. This would mean not just me alone, but famous doctors nationwide consulting for patients simultaneously. When I truly understood that "the greatest enemy of knowledge is having no desire for anything new," I prepared at every moment to propose new desires toward the ocean of knowledge, determined to continue advancing on the journey of developing TCM academics.
(Organized by Gao Yimin)
Beneficial Memories
Jiang Yuren, Chief Physician, Jiangsu Province Hospital of Traditional Chinese Medicine
[Author Profile] Jiang Yuren (1916–), from Changshu, Jiangsu. Graduated from Shanghai China Medical College in 1938. Dedicated his life to pediatrics, achieving deep attainments in both theory and clinical practice. Currently serves as a Director of the All-China Association of Traditional Chinese Medicine, Vice Chairman of the Jiangsu TCM Branch, and a member of the Scientific and Technological Commission of Jiangsu Province for assessing scientific research achievements. Major works include *TCM Pediatric Diagnosis and Treatment*, *Outline of TCM Pediatrics*, *Manual of TCM Pediatric Clinical Practice*, and *TCM Pediatrics*.
I have engaged in clinical practice for over forty years. Naturally, I have cured many patients, but I dare not claim that everything was done with "ease and skill." Moreover, records at the time of treatment were often incomplete. As time passes, memories fade. Even if I could write a summary, I fear violating the laws of science, bringing no benefit to myself or others. However, the lessons encountered during past learning and treatment, though long past, remain vivid in my mind, with their origins and consequences clear. I have indeed had profound realizations. While experiential insights are precious, failures and lessons might serve as references for others. Therefore, proceeding from a sincere attitude, I write freely, solely for the reference of future learners.
Starting from Seeking Medical Help
Between summer and autumn when I was fourteen, I suffered a serious illness. According to the diagnosis of the doctor at that time, it was "Shanghan Syndrome" (Cold Damage Syndrome). Although I sought medical help and took medicine from the beginning, the condition worsened day by day. My family requested a famous doctor to visit home three times, but that famous doctor either had no time today or was inconvenient tomorrow, refusing the invitation. At that time, I was dazed and nearly hopeless. Fortunately, my uncle invited a doctor specializing in Shanghan. He not only treated meticulously but also explained clearly how to decoct the medicine, how to take it, and even nursing methods. After taking the medicine that night, I immediately felt refreshed and energetic, and gradually recovered. The family was overjoyed, grateful to that doctor "as if he had given me a second life."
This serious illness made me determined to study medicine. My father said, "You can study medicine, but you must be a good doctor. Having skills alone is not enough; without a 'heart to cut one's own flesh' [to save others], it won't work." I proposed to apprentice under that "Shanghan" master. Unfortunately, in the year I truly started studying medicine at seventeen, my ideal teacher unfortunately passed away. Still, through introductions by relatives and friends, I was able to apprentice under Mr. Li Xinshan, fulfilling my long-held wish.
Li Xinshan was a renowned Confucian physician in Changshu County, Jiangsu Province, a last-generation Xiucai (scholar) of the late Qing Dynasty. He specialized in Internal Medicine, Gynecology, and Pediatrics, and was also famous for treating "Shanghan." He was a distinguished student of Master Wang Sishan, a hereditary physician from Shiqiao, Qindongxi (Mr. Wang Sishan was the father of Dr. Wang Ganchang, Vice Chairman of the China Association for Science and Technology, Member of the Academy of Sciences, and physics expert). Master Li disciplined his disciples with both love and strictness. He once said: "If one cannot read and write well, it is difficult to become a medical worker"; "A scholar studying to be a physician is like carrying a green onion [useless]." This metaphor implies that learning TCM requires a foundation in classical Chinese literature. Therefore, during our learning process, the teacher instructed us in both medical classics and classical prose.
Master Li had a set of study rules and three contractual agreements. In the first academic year, we had to memorize four books: *Suwen Linglei Leizuan* (Compilation of Questions and Answers from Suwen and Linghu), *Jingui Xin Dian* (Heart Classic of Jingui Yaolue), *Shanghan Laisu Ji* (Collection of Shanghan Commentary), and *Nanjing* (Classic of Difficult Issues). In the second year, we memorized *Tangtou Gejue* (Rhymes of Formulas) and *Bencao Congxin* (New Compendium of Materia Medica), and read fluently *Wenbing Tiaobian* (Systematic Differentiation of Warm Diseases), *Wu Yi Huijiang* (Collected Discussions of Wu Physicians), and *Wenre Jingwei* (Coordinates of Warm and Heat Diseases). In the third year, we studied the academic schools of the Four Masters of Jin and Yuan, *Si Jia Yi An* (Medical Cases of Four Masters), while accompanying the master for clinical consultations. In the fourth year, we gradually conducted independent consultations. This was the curriculum for the four years. The so-called "Three Contractual Agreements" were: "Do not allow clinical practice until books are memorized"; "Do not allow writing prescriptions until calligraphy is proficient"; "Do not allow going out for consultations unless manners are cultivated." He said: "These are the academic style and rules passed down in the Wang family school." Due to inability to adapt to the master's rigorous scholarship, two out of five classmates dropped out within the four years.
After graduation, benefiting from the master's fame, there were initially many patients. At that time, possessing a bit of "newborn calves are not afraid of tigers," when handling difficult cases, I often had no clear ideas in mind and lacked careful consideration in writing prescriptions. Especially in diagnosing and treating the ever-changing pediatric diseases, it was hard to avoid errors. Therefore, medical disputes occurred multiple times. Coupled with the old society's "peers inevitably envy each other," my reputation dropped sharply overnight. Feeling ashamed of my shallow knowledge and fearing I was harming the people, I resolutely pursued further studies, traveling to Shanghai China Medical College, and purposefully and focusedly followed the famous Shanghai physician Master Xu Xiaopu to study pediatrics professionally. This is the general outline of my transition from internal medicine to pediatrics.
Treating Lessons as Experience
An ancient proverb says: "Better to cure ten men than treat one woman; better to treat ten women than treat one child." This reflects the complexity and difficulty in mastering pediatric diseases. The reason I abandoned internal medicine for pediatrics was partly due to a sense of advancing despite difficulties. Because my lessons in this aspect can be counted as numerous.
(I) Knowing the Norm but Not Reaching the Variations
Measles is a common infectious disease in children. Before the use of live attenuated measles vaccines, it basically circulated annually, posing a great threat to children's health. Typical measles is easily mastered by general doctors, while atypical measles often has complications. If not rescued promptly, lesions often develop suddenly. Therefore, whether the prognosis of measles is good or bad depends on correctly grasping the timing and method of venting the rash. "Venting the rash without weariness" has always been regarded as the essential secret for treating rashes. But things always have two sides. If viewed as absolute and unchanging, it violates objective laws. I almost caused a major mistake under this rule of "venting the rash without weariness." Every time I recall this, I shudder with fear.
A one-to-two-year-old child had fever and cough for three days, and measles spots appeared for two days. Suddenly, high fever and wheezing occurred, accompanied by irritability and restlessness, startle during sleep, loose stools, and yellow urine. Skin rash spots were hidden and not vented. The face was pale, lips red, tongue coating yellow, and tongue substance red. This syndrome belonged to measles toxin transforming into heat and fire, burning Lung Metal, showing signs of entering the Ying (Nutritive) level. Although it was already an atypical syndrome, the condition was not complex. At this time, the treatment method should prioritize clearing heat and detoxifying, slightly assisting with venting methods. The emphasis should be on sweet-cold protection of Yin, strictly preventing injury to fluids and depletion of liquids, which could lead to fluid exhaustion triggering wind movement, resulting in uncontrollable devastation. But at that time, in examining the syndrome, my mind only contained the character "vent." I believed: since rash spots were faint and measles toxin had not been externally discharged, this was reason one to vent; since spots had appeared for two days, it was the right period for venting, this was reason two to vent. Therefore, I boldly administered a heavy dose of venting agents. After the child took the medicine, irritability worsened. By midnight, breathing became faster, lips cracked, skin burned hot, the whole body had no sweat, rash spots disappeared, eyes turned red and rolled up frequently, convulsions occurred twice, urine was scanty, abdomen bloated, and consciousness gradually became confused. The condition was critically dangerous, and the family was extremely anxious. The next morning, another doctor was invited. Two days later, the child turned from danger to safety.