通过初步观察，认为小儿生理具有「稚阴稚阳」的特点，基本上是符合实际情况的。同时，小儿在病理上所表现韵易虚易实、易寒易热，也是随着年龄增长而转归的。伤阴与伤阳亦互有转化，多见者如腹泻病例中的中毒性消化不良症，它可先伤胃阴，继伤脾阳，又能在胃朋耗损的同时，既出现口干舌缘、皮肤干燥皱瘪的症状，又有面觥无神，肢厥脉微的脾阳阿惫证，具体反映了「稚阴稚阳」的临床征象。对阴阳两伤的处理问题，往往采取扶其阳而救其阴的方法，但必须审察孰者为主。盖阴与阳虽是不同的属性，但又是互根的。所以阴之滋生，必须赖阳气之濡化，阳可以统阴，而阴则不能统阳。这使我进一步体会到，对待不同的学术观点，只有通过反复实践，才能有较深刻的理解。
又例如小儿的指纹诊，过去有些儿科书籍中，把它讲得神乎其神，而且在群众中影响极为深刻，认为儿科医生就是依靠指纹来诊断疾病的。我们对此也做了一些调查研究，观察了三岁以内的正常儿和不同病证的小儿五百例。看到指纹的三关颜色，在各种疾病中，似未见有明显的特异性诊断依据。有些正常儿的指纹，也有直透三关的。对病情的发生和发展也未发现有一定的规律可循。故初步认为，指纹充盈度的变化，可能与静脉压有关。临床上见到一些心力衰竭的肺炎患儿，其指纹可向命关伸展。指皱的色泽在某些程度上可反映体内缺氧的程度，即缺氧愈甚，指纹的青紫色也就愈见明显，这似有一定的参考价值。当然，由于观察的例数不多，方法上是否符合科学性，还有待进一步研究。
(二)总结规律，使来自实践的经验更加科学化过去，由于历史条件的限制，有些疾病的诊断概念比较模糊，对临床缺乏普遍的指导意义。因此，在实践的基础上，进行整理和总结，对于提高医疗、教学的质量，可能会起到较好的作用。
例如，疳症是儿科四大证之一，其涉及的范围颇为广泛：它不仅是营养不良的一种现象，而且是多种疾病的综合反映。不但病因复杂，且命名繁多。历代以来，仁者见仁，智者见智，概念亦不够清楚，分类方法更无统一标志。有的以脏腑分类，如心、肝、脾、肺，肾的五脏疳；有的以症状分类，如疳渴、疳肿等》有的则以病位分类，如眼疳、鼻疳、牙疳等也有的以病因分类，如蚵疳、哺乳疳等等。从临床实践中，看到的疳症症状是错综复杂的，很少以独立的症状出现。为此，我们做了五百三十三例各类疳症的临床观察，并从病因调查、症候分类，诊断依据、治疗法则以及合并症的产生等几个方面，进行了分析。在五百三十三例中，属于喂养不当的有三百零五例，占57％(其中包括过多的营养)；由于病后失调的有一百七十一例，占32．1％；属于先天不足，后天失调的五十七倒，占10．7％。说明古代医家指出的「诺疳皆脾胃为病」的论点，是符合实际的。我们将各类症候的表现和不同疳症的名称，根据「有诸内必形诸外」的理论，结合患儿的临床特征，把疳症列为三大类证：一为形体比正常儿消瘦，食欲不振，大便欠调者，本组中有一百九十六例，占总数36．89，6，属疳之初期，称为「疳气」症，其病机一为脾胃失调，二为能食不充形骸，肚腹膨大，甚则青筋暴露，形如橄榄，多有合并肠寄生虫者，有二百五十六例，占48％，名为「疳积」症，其病机属脾虚夹积，虚中夹实三为极度消瘦，状如皮包骨头者，有八十一例，占15．2％，乃疳症之晚期，诊为「干疳」，病机为气血津液亏耗。在治疗上，「疳气」以和为主，「疳积」消补并施，「干疳」则以补为主。合并症属本病的兼证，不作病名分类。如口疳为心脾积热，服疳为肝阴不足，疳肿胀为脾虚气弱、水湿滞留等等。虽然还很不成熟，但对临床医疗总结经验，尚有一定指导意义。
又如流行性乙型脑炎的治疗，各地均积累了不少的经验。在病因方面，中医学者认为属于温病学说的「暑温」范畴。按温病的传变规律，一般均由卫及气，由气入营入血。而本病特别是重症病例，发病急骤，往往起病即见昏迷、抽风等营血症状，如沿用卫气营血辨证，则难以合拍。且急性期与恢复期、后造症期的病因机理，亦无统一的认识。因此，对本病的病因机理，形成了阶段之间的割裂，对医疗教学亦带来困难。为进一步探索本病的发病机理及其辨证治疗规律，有意识、有目的地对一百二十一例「乙脑」急性期及一百三十五例恢复期和后遗症期的病例进行了全面观察。根据「乙脑」急性期所出现的高热、昏迷、抽风三太主症，恢复期、后遗症期的不规则发热、意识障碍、吞咽困难，失语阻及强直性瘫痪，震颤样抽动等症状，均具体表现了热(发热)、痰(意识障碍和颅神经症状)、风(抽风)等三大症候。而热、痰、风三者又互有联系、互为因果。如热极可以生风，风动生痰，痰盛生惊，它既是症候，又属病机。虽然三者之间可以同时存在，但必有主要的一个方面。不过，急性期的热、痰、风证，实者为主；恢复期，后遗症期的热、痰、风证，则以虚者为主，或虚中夹实。
为了进一步明确辨证，又将急性期热证，按其不同的属性，分为温、热、火三个类别，痰证为意识障碍，其狂躁不宁者为痰火，深度昏迷者为痰浊。风证中头痛项强，有表证者灼热无汗为外风，惊厥反复发作，持续不止而有汗者为邪硝心包、肝风内动之内风。恢复期及后遗症发热，有阴虚和阳虚两点(感染性发热例外)，强直性瘫痪为风窜络道，震颤样不自主动作的抽风为虚风。对吞咽用难、失语、痴呆者均列入痰浊症。通过多年的宴践证明，运用热，痰、风理论，指导「乙脑」的辨证施治，似有一定的规律性。对今后进一步探索其机理，也提供了初步的参考数据。
治学三部曲
中医研究院研究员朱仁康
【作者简介】朱仁康(1908～)，江苏无锡人。从事中医事业五十余年，于疮疡皮肤外科有较高的造诣。
治学衷中参西，多所创新，着有《中西医学汇综》、《实用外科中药治疗学》、《朱仁康临床经验集》等。
在名师指点下苦练基本功
我出身于一个小市民家庭，家父是粮店职员。其时军阀割据，战乱频仍，兵匪横行，民不聊生。我家食指浩繁，入不敷出，只能东挪西凑，苦度日月。尽管如此，家父还很注意对下一代的培养，不惜债台高筑，设法资助我弟兄上学。我读完高小后考入中学，仅读了一年，因多病而辍读。
少年时，我家赁居无锡南郊。当时外科名医章治康氏因避兵乱，由郊区乔迁来城区与我家合居，方圆百里，慕名而米求治者络绎不绝。凡贫困患者，章氏非特分文不取，甚至相赠药金，故深得百姓爱戴。章老先生不但专长外科，亦熟谐内科。余家人有病，经其诊治，无不霍然而愈。某年家父因心境不畅，郁火结聚，脑后发疽，肿痛日厉。章氏为其遣方用药，并嘱家人宰三年老母鸡一只，炖熟与服。初疑不敢从命，章谓此乃以毒攻毒，坚议不妨，才放心服用。不久疮头收束，顶透脓泄而愈，全家信服。后朝夕相处，与家父交称莫逆，家父遂有使我两兄弟从师学医之意。我哥长余四岁，先从章氏执弟子礼，三载学成，悬壶锡地郊区行医，余全家亦移居相随。我即从兄长随诊抄方学习，因而亦尽得章氏薪传之秘。
章氏对疮疡外科有独到之处。常惯用虫类药如山甲、全蝎、斑蝥、蜈蚣之类，配成秘方丸散，用以内消疮疡，功效卓著，故能驰名于世。
我学医过程中，一则从小长期与名医相处，耳濡目染，有所熏陶；再则由于长兄提携督促苦练基本功，打下良好基础。以下谈几点经验体会。
(一)我读医书从《汤头歌诀》及《医家四要》启蒙。初学时无门径，亦走了一些弯路，单就《汤头歌诀》来讲，不知背诵了多少遍，还是前记后忘，后来找到了窍门，把各类方剂经过分析、对比异同，便能牢记下来。以后再读《医方集解》，深入了解方义，就更牢固了。在读外科专著方面，由于师承相传，我最推崇高锦庭《疡科心得集》一书。盖明清两代在外科史上虽有明显发展，外科书亦不少，但大多陈陈相因，多所雷同，惟此书一反既往以疮疡部位编次的惯例，而首创两病或三病骈列立论，辨其异同，条分缕析，既便于辨病(现在所谓鉴别诊断)，更有助于辨治。例如「辨附骨疽、附骨痰论」，已能明确地把骨髓炎、骨结核区别开来。又如在脑疽论中，首先提出三陷变局，对全身化脓性感染败血症与脓毒症，已有很好的认识。如是之处皆发前人所未发，确实在中医外科史上有很大的贡献。我对此书曾反复攻读，受益非浅。体会到高氏组方用药，偏重于清热解毒，毕竟疮疡属于火毒，阳证多见，观其所创新方如清营解毒汤、银花解毒汤、羚羊角散皆属此类。据此我认为当时高氏是受到温病学派卫气营血理论的影响所致。
我既以熟读《疡科心得集》先入为主外，亦参阅了外科名著，如《外科正宗》、《医宗金鉴·外科心法》等，作了摘录，博采众长，从中吸取精华，充实了师承经验之不足。
此外，我接受前人「治外必本之内，知其内以求其外」及「冶外而不知内，非其治也」的教诲，重视学外科医必须熟诸内科基础，为此我先后读过《素灵类纂》、《时病论》、《伤寒来苏集》、《温病条辨》，《本草从新》等书，为我后来树立整体观，主张疮疡皮肤外科诸症应着重内科，打下基础。
回想起我学廉的方式，基本上是以师带徒的方式。我白天协助长兄(亦说是随师)应诊、抄方、配药，夜晚才有时间攻读书本，因此常夜以继日，不敢偷懒，曾作「十七而学论」以自励。我深深体会到，我这样的学医方式，临床实习与理论知识紧密结合，收获大，进步快，缺点是理论基础差些，不能像在医学院学习的那样系统、扎实。但目前的学习方式，先学理论，后再临床实习，两者似有脱节，而且实际掌握医疗技术就欠缺些。
(二)学外科与其它科不同，必颓配合外用药，炼丹制药乃是一项必须掌握的专门技术。过去师徒之间，保守思想严重，向有传子不传婿之说。灵丹妙药视为囊中之宝，秘而不宣，雌恐外传。外科常用红升、白降二丹，视为不可或缺之品，必须亲自动手炼制。炼制时应掌握好火候(文火、武火、炼取时间)，否则，必遭失败。如炼升丹，火候太过则丹药发黑，弃之无用；火候不足则丹药发黄，功效不着。熬煎膏药亦如此。熬油温度在400。C以上，必须滴水成珠，方是火候到的征候，这时下丹，才能熬成乌黑光亮。这些都要经过亲自实践，反复试验，才能制好。有好多外用配方膏、丹、散、水、酒等，都有一套工艺方法、先后次序，功效好坏，上此大有关系。这些基本功，必须掌握好。
(三)开刀技术，首先要掌握好辨脓法。全靠手指按摸，判断有脓无脓，尤以深部脓疡，辨之又难，尚有似脓非脓、气肿、血肿，易于误诊，均要经过反复实践方可取得经验。中医开刀，向以小切口为主，辨脓疡深浅，定切口部位，浅则浅开，深则深刺，恰如其分。反之，过浅则未到脓腔，脓不外泄，过深则伤筋动络，甚至大出血。开口过小则脓出不畅，造成蓄脓，脓未成熟而切，及脓成而过时不切，均非所宜。此一基本功，亦得打牢，掌握分寸。
由于长兄的谆谆教导及自己的苦学多练，用了不到三年的时间，初步掌握了一般医疗技术。为了减轻长兄挑起全家生计的重担，我开始自立门户，离开长兄，去相隔五十里之遥的苏州郊区开业行医。初出茅庐，对过去学医时常见的病，治好不难，但遇到以前不常见的病，甚至从未见过的疑难之症，就不这样简单了。毕竟实践不够，经验不足，又无师可问，只能从书本上去找办法，自己揣摩，真如所谓「初学三年，天下通行，再学三年，寸步难行」了。我曾碰到这样一个病例，虽事隔五十年，迄今记忆犹新。患者蔡某，男性，农民，二十余岁，遍身起青紫斑块，状如葡萄，两腿青肿，浦口牙龈麋烂，血从外溢，不断吐出青紫黑红夹杂的血块，臭秽之气冲人。其家属惶惶然，来所求治。余自忖行医方始，此病从未见过，如何处理，心中无数，初思牙龈属胃，现今腐烂出血不止，想是胃火上炽，遍身青紫斑块，良由邪热伤络、血溢脉外所致。筹思有顷，蓦然想起方书有消斑青黛饮一方，或许尚能合拍。故拟先用犀角尖(镑末)1．5克，以银花露送服，继拟方用鲜生地、川黄连、黑栀、知母、青黛、生石膏、丹皮、赤芍、元参、鲜芦根与服，另以五倍子末外搽牙龃以收敛止血。两剂后复诊，龊血明显减少，周身青紫斑块亦渐消退，仍宗前方，去犀角，加侧柏叶、大青叶等增损，六剂后痊愈。合家称颂不止，余亦深感满意。事后查察《外科正宗》、《医宗金鉴》诸书，此症均称青腿牙疳及葡萄疫，与现代所称坏血病相似。而消斑青黛饮一方，出自《伤寒六书》，治邪热入胃，里实表虚。阳毒发斑之症，亦见合拍。余开业伊始，不意能旗开得胜，初建奇功，私自庆幸。
通过初步观察，认为小儿生理具有「稚阴稚阳」的特点，基本上是符合实际情况的。同时，小儿在病理上所表现的易虚易实、易寒易热，也是随着年龄增长而转归的。伤阴与伤阳亦互有转化，多见者如腹泻病例中的中毒性消化不良症，它可先伤胃阴（胃之阴液），继伤脾阳（脾之阳气），又能在胃阴耗损的同时，既出现口干舌燥、皮肤干燥皱瘪的症状，又有面色无神，肢冷脉微的脾阳虚惫证，具体反映了「稚阴稚阳」的临床征象。对阴阳两伤的处理问题，往往采取扶其阳而救其阴的方法，但必须审察孰者为主。盖阴与阳虽是不同的属性，但又是互根的。所以阴之滋生，必须赖阳气之濡化，阳可以统阴，而阴则不能统阳。这使我进一步体会到，对待不同的学术观点，只有通过反复实践，才能有较深刻的理解。
又例如小儿的指纹诊法，过去有些儿科书籍中，把它讲得神乎其神，而且在群众中影响极为深刻，认为儿科医生就是依靠指纹来诊断疾病的。我们对此也做了一些调查研究，观察了三岁以内的正常儿和不同病证的小儿五百例。看到指纹的三关颜色，在各种疾病中，似未见有明显的特异性诊断依据。有些正常儿的指纹，也有直透三关的。对病情的发生和发展也未发现有一定的规律可循。故初步认为，指纹充盈度的变化，可能与静脉压有关。临床上见到一些心力衰竭的肺炎患儿，其指纹可向命关伸展。指纹的色泽在某些程度上可反映体内缺氧的程度，即缺氧愈甚，指纹的青紫色也就愈见明显，这似有一定的参考价值。当然，由于观察的例数不多，方法上是否符合科学性，还有待进一步研究。
(二)总结规律，使来自实践的经验更加科学化过去，由于历史条件的限制，有些疾病的诊断概念比较模糊，对临床缺乏普遍的指导意义。因此，在实践的基础上，进行整理和总结，对于提高医疗、教学的质量，可能会起到较好的作用。
例如，疳症（小儿脾胃虚弱引起的慢性营养障碍性疾病）是儿科四大证之一，其涉及的范围颇为广泛：它不仅是营养不良的一种现象，而且是多种疾病的综合反映。不但病因复杂，且命名繁多。历代以来，仁者见仁，智者见智，概念亦不够清楚，分类方法更无统一标志。有的以脏腑分类，如心、肝、脾、肺、肾的五脏疳；有的以症状分类，如疳渴（因疳症引起的口渴）、疳肿等；有的则以病位分类，如眼疳、鼻疳、牙疳等；也有的以病因分类，如蛔疳（因蛔虫引起的疳症）、哺乳疳等等。从临床实践中，看到的疳症症状是错综复杂的，很少以独立的症状出现。为此，我们做了五百三十三例各类疳症的临床观察，并从病因调查、症候分类，诊断依据、治疗法则以及合并症的产生等几个方面，进行了分析。在五百三十三例中，属于喂养不当的有三百零五例，占57％(其中包括过多的营养)；由于病后失调的有一百七十一例，占32．1％；属于先天不足，后天失调的五十七例，占10．7％。说明古代医家指出的「诸疳皆脾胃为病」的论点，是符合实际的。我们将各类症候的表现和不同疳症的名称，根据「有诸内必形诸外」（内在病变必然反映于外在体征）的理论，结合患儿的临床特征，把疳症列为三大类证：一为形体比正常儿消瘦，食欲不振，大便欠调者，本组中有一百九十六例，占总数36.89％，属疳之初期，称为「疳气」症，其病机一为脾胃失调，二为能食不充形骸，肚腹膨大，甚则青筋暴露，形如橄榄，多有合并肠寄生虫者，有二百五十六例，占48％，名为「疳积」症，其病机属脾虚夹积，虚中夹实；三为极度消瘦，状如皮包骨头者，有八十一例，占15.2％，乃疳症之晚期，诊为「干疳」，病机为气血津液亏耗。在治疗上，「疳气」以和为主，「疳积」消补并施，「干疳」则以补为主。合并症属本病的兼证，不作病名分类。如口疳为心脾积热，眼疳为肝阴不足，疳肿胀为脾虚气弱、水湿滞留等等。虽然还很不成熟，但对临床医疗总结经验，尚有一定指导意义。
又如流行性乙型脑炎的治疗，各地均积累了不少的经验。在病因方面，中医学者认为属于温病学说的「暑温」范畴。按温病的传变规律，一般均由卫及气，由气入营入血。而本病特别是重症病例，发病急骤，往往起病即见昏迷、抽风等营血症状，如沿用卫气营血辨证，则难以合拍。且急性期与恢复期、后遗症期的病因机理，亦无统一的认识。因此，对本病的病因机理，形成了阶段之间的割裂，对医疗教学亦带来困难。为进一步探索本病的发病机理及其辨证治疗规律，有意识、有目的地对一百二十一例「乙脑」急性期及一百三十五例恢复期和后遗症期的病例进行了全面观察。根据「乙脑」急性期所出现的高热、昏迷、抽风三大主症，恢复期、后遗症期的不规则发热、意识障碍、吞咽困难、失语及强直性瘫痪，震颤样抽动等症状，均具体表现了热(发热)、痰(意识障碍和颅神经症状)、风(抽风)等三大症候。而热、痰、风三者又互有联系、互为因果。如热极可以生风，风动生痰，痰盛生惊，它既是症候，又属病机。虽然三者之间可以同时存在，但必有主要的一个方面。不过，急性期的热、痰、风证，实者为主；恢复期，后遗症期的热、痰、风证，则以虚者为主，或虚中夹实。
为了进一步明确辨证，又将急性期热证，按其不同的属性，分为温、热、火三个类别，痰证为意识障碍，其狂躁不宁者为痰火，深度昏迷者为痰浊。风证中头痛项强，有表证者灼热无汗为外风，惊厥反复发作，持续不止而有汗者为邪陷心包、肝风内动之内风。恢复期及后遗症发热，有阴虚和阳虚两点(感染性发热例外)，强直性瘫痪为风窜络道，震颤样不自主动作的抽风为虚风。对吞咽困难、失语、痴呆者均列入痰浊症。通过多年的实践证明，运用热、痰、风理论，指导「乙脑」的辨证施治，似有一定的规律性。对今后进一步探索其机理，也提供了初步的参考数据。
Through preliminary observation, it is considered that the physiological characteristics of children possess the feature of "Zhi Yin Zhi Yang" (Delicate Yin and Delicate Yang), which basically conforms to actual conditions. Meanwhile, the pathological manifestations in children of being prone to deficiency or excess, cold or heat, also transform with age. Injury to Yin and injury to Yang can mutually transform; a common example is toxic indigestion in cases of diarrhea. It may first injure Wei Yin (Stomach Yin fluid), then injure Pi Yang (Spleen Yang Qi). Simultaneously, while Wei Yin is depleted, symptoms such as dry mouth, dry tongue, dry and wrinkled skin appear, alongside signs of Spleen Yang exhaustion like listless complexion, cold limbs, and faint pulse. This specifically reflects the clinical manifestation of "Zhi Yin Zhi Yang". In handling cases of dual injury to Yin and Yang, the method often involves supporting Yang to rescue Yin, but one must examine which aspect is primary. Although Yin and Yang are different attributes, they are mutually rooted. Therefore, the generation of Yin relies on the moistening and transformation by Yang Qi; Yang can command Yin, but Yin cannot command Yang. This has further enabled me to realize that only through repeated practice can one achieve a profound understanding of different academic viewpoints.
For another example, regarding pediatric fingerprint diagnosis, some past pediatric books described it as miraculous, exerting a profound influence on the public, who believed that pediatricians relied solely on fingerprints to diagnose diseases. We conducted some investigative research, observing 500 cases of normal children under three years old and children with various pathological conditions. Regarding the color of the three sections of the fingerprint, no obvious specific diagnostic basis was seen across various diseases. Some normal children's fingerprints also penetrated all three sections directly. No certain regularity could be found in the occurrence and development of the condition. Thus, it is preliminarily believed that changes in fingerprint fullness may be related to venous pressure. Clinically, in some pneumonia patients with heart failure, their fingerprints may extend to the Ming Guan (Life Gate section). The color of the fingerprint can reflect the degree of hypoxia in the body to some extent; that is, the more severe the hypoxia, the more obvious the bluish-purple color of the fingerprint, which seems to have certain reference value. Of course, due to the small number of observed cases and whether the methods conform to scientific standards, further research is needed.
(II) Summarizing laws to make experience from practice more scientific. In the past, due to historical limitations, the diagnostic concepts for some diseases were relatively vague, lacking universal guiding significance for clinical practice. Therefore, organizing and summarizing based on practice may play a good role in improving the quality of medical treatment and teaching.
For example, Gan Syndrome (Chronic nutritional disorder caused by spleen and stomach weakness in children) is one of the four major syndromes in pediatrics, involving a wide range: it is not only a phenomenon of malnutrition but also a comprehensive reflection of various diseases. Not only are the etiologies complex, but there are also numerous names. Throughout history, views have varied, concepts have been unclear, and classification methods have lacked uniform standards. Some classify by Zang-Fu organs, such as Heart, Liver, Spleen, Lung, Kidney Five-Zang Gan; some by symptoms, such as Gan Ke (Thirst due to Gan) and Gan Zhong (Swelling due to Gan); some by lesion site, such as Eye Gan, Nose Gan, Tooth Gan; and some by etiology, such as Ascaris Gan (Gan caused by roundworms) and Nursing Gan. From clinical practice, the symptoms of Gan syndrome are intricate and rarely appear independently. Therefore, we conducted clinical observations on 533 cases of various Gan syndromes and analyzed them from aspects including etiological investigation, symptom classification, diagnostic basis, therapeutic principles, and the occurrence of complications. Among the 533 cases, 305 cases (57%) were due to improper feeding (including excessive nutrition); 171 cases (32.1%) were due to post-illness imbalance; and 57 cases (10.7%) were due to congenital insufficiency and postnatal imbalance. This illustrates that the ancient physicians' viewpoint that "all Gan syndromes are diseases of the Spleen and Stomach" conforms to reality. Based on the theory that "internal pathology must manifest externally," combining the clinical features of patients, we classified Gan syndrome into three major categories: First, those thinner than normal children, with poor appetite and irregular bowel movements. There were 196 cases in this group, accounting for 36.89% of the total. This belongs to the early stage of Gan, called "Gan Qi" (Gan Qi Syndrome). Its pathogenesis is either Spleen-Stomach imbalance or sufficient intake failing to nourish the body frame, leading to abdominal distension, exposed veins, and an olive-shaped abdomen. Second, those with intestinal parasites, numbering 256 cases (48%), named "Gan Ji" (Gan Accumulation Syndrome). Its pathogenesis belongs to Spleen deficiency with accumulation, deficiency mixed with excess. Third, those extremely emaciated, resembling skin-wrapped bones, numbered 81 cases (15.2%). This is the late stage of Gan syndrome, diagnosed as "Gan Gan" (Dry Gan Syndrome), with a pathogenesis of depletion of Qi, Blood, and Body Fluids. In treatment, "Gan Qi" focuses on harmonization; "Gan Ji" employs both purging and tonifying; "Gan Gan" focuses primarily on tonification. Complications belong to concurrent syndromes of the main disease and are not classified as separate disease names. For instance, Mouth Gan is Heat-Toxin accumulation in Heart and Spleen; Eye Gan is Liver Yin deficiency; Gan Edema is Spleen deficiency with weak Qi and water-dampness retention. Although still immature, this has certain guiding significance for summarizing clinical medical experience.
Another example is the treatment of Epidemic Encephalitis B, where considerable experience has been accumulated everywhere. In terms of etiology, TCM scholars consider it within the scope of "Shu Wen" (Summerheat-Warmth) in Warm Disease theory. According to the transmission rules of Warm Diseases, it generally proceeds from Wei (Defensive) to Qi (Nutritive), and from Qi to Ying (Nutrient) and Xue (Blood). However, this disease, especially severe cases, has an abrupt onset, often presenting Ying-Xue symptoms such as coma and convulsions at the very beginning. If one continues to use Wei-Qi-Ying-Blood differentiation, it does not fit well. Moreover, there is no unified understanding of the etiological mechanisms in the acute phase, recovery phase, and sequelae phase. Consequently, the etiological mechanism of this disease became fragmented between stages, causing difficulties in medical teaching. To further explore the pathogenesis and patterns of syndrome differentiation and treatment of this disease, we consciously and purposefully conducted comprehensive observations on 121 cases of the acute phase of "Encephalitis B" and 135 cases of the recovery and sequelae phases. Based on the three major symptoms in the acute phase of "Encephalitis B"—high fever, coma, and convulsions—and symptoms in the recovery and sequelae phases such as irregular fever, consciousness disorders, dysphagia, aphasia, spastic paralysis, and tremor-like twitching, these specifically manifested three major syndromes: Re (Heat/Fever), Tan (Phlegm/consciousness disorders and cranial nerve symptoms), and Feng (Wind/convulsions). These three—Heat, Phlegm, and Wind—are interconnected and causally related. For example, extreme Heat can generate Wind; Wind movement generates Phlegm; abundant Phlegm generates Fright. They are both syndromes and pathogeneses. Although all three can exist simultaneously, there must be a primary aspect. However, in the acute phase, the Heat, Phlegm, and Wind syndromes are primarily Excess; in the recovery and sequelae phases, they are primarily Deficiency, or Deficiency mixed with Excess.
To further clarify syndrome differentiation, the Heat syndrome in the acute phase was divided into three categories according to its different attributes: Warm, Heat, and Fire. The Phlegm syndrome refers to consciousness disorders; restlessness and agitation indicate Phlegm-Fire, while deep coma indicates Phlegm-Turbidity. In Wind syndrome, headache and neck stiffness with exterior syndrome, burning heat, and no sweat indicate Exterior Wind; recurrent seizures, continuous and unceasing with sweat, indicate Interior Wind caused by Evil invading the Pericardium and stirring up Internal Liver Wind. Fever in the recovery and sequelae phases involves two points: Yin deficiency and Yang deficiency (except for infectious fever). Spastic paralysis is Wind wandering through the collaterals; tremor-like involuntary convulsions are Deficient Wind. Dysphagia, aphasia, and dementia are all categorized under Phlegm-Turbidity. Years of practice have proven that applying the theory of Heat, Phlegm, and Wind to guide the syndrome differentiation and treatment of "Encephalitis B" seems to have certain regularity. It also provides preliminary reference data for further exploration of its mechanism in the future.