中医对时病大证和久病慢证的处理，向以吴鞠通所云「治外感如将，治内伤如租」的两句名言为据。确实治时病大证，必须如将军临阵作战，要胆识兼用，知已知彼，善于观察病情变化，随机应对，当机立断，不稍迟疑，方获全功。慢性久病，复杂多端，可能有十种、八种病丛集于一人之身，五脏皆伤，考虑治疗措施时大有顾此失彼之嫌，要善于分析当前以何病症为主，抓住主要矛盾，方有端绪，如果失策，则贻悔莫及。倘能分其标本轻重缓急，循序求进，重视掌握脾胃运纳之机，方可转危为安。同时还须药治与食养兼施，「得谷者昌」良有以也。
学习中医，应当时刻注意把所学理论和知识运用到临证实际。仪就中医学「整体规念」(包括平调观念)和「辨证论治」(包括审证求因)说一点意见。对「辨证论治」的理解，有人比喻象狂洋大海、茫茫无边。我认为船上有舵，有桨，有风帆，特别是有人能掌握舵、桨、风帆这些工具，还有认识风向和航路的知识，可以达到预定之港。至于「证」是病本质的反映，根据「有诸内必形诸外」的原理，运用四诊、八纲、脏腑经络、气血津液等基本理论，审证求因，就可从错综复杂的病情中，掌握病证的主要矛盾，认清病变本质，采用正确的治法和方药。所谓平调观念，就是把平人与病人区别开来，把病与人统一起来。《内经》说：「平人者，不病也。」就是指人体的正常生理平调，无偏无颇，是谓「平人」；一旦平调失职，失去生理之常，即为病理之变，而为病人。这时就必须给予相应的治疗，以恢复其正常生理状态。因此，医生用药治病，实际就是利用药物的偏性，以纠正人体的偏差。如分寸合度，轻重相宜，自可达到「以乎为期」；若孟浪过剂，则反致伤正，影响人体自身的调节本能，甚至产生副作用或新的病变。
此外，还必须把中医学从纵横两方面「融会贯通」起来。纵的一面，应认识到《内经》、《伤寒》、《金匮》、《温病》及各家学说，自古至今，一脉相承，虽有变迁，脉络一贯。如以温病学说为铡，是可以体现其发展过程的。从横的方面，要把这些基本理论渗透各临床学科，作为指导实践的依据，并借助现代有关科学知识，阐述其真义，以资印证。在继承的基础上，得到进一步发展。
路，可以从崎岖坎坷，到达康庄大道。寄语来哲。
学无止境锲而不舍
天津卫生局长天津市中医学院院长，教授哈荔田
【作者筒介】哈荔目(1912～)，回族，河北保定人。幼承庭训，家学渊源。一九三五年毕业于北平华北国医学院，以成绩优异，深得施今墨、周介人、范更生诸名家赏识。
毕生致力于临床和中医教育事业。
三十到四十年代曾铷办北平国医专科学校，并曾任教于天津市国医训练班，一九五五年始担任天津市卫生局戥局长职务后，积极贯彻执行党的中医政策，先后领导筹办了天津中医学校、天津中医学院，并积极组织了西医离职学习中医的工作，为发展中医事业不遗余力。在学术上穷究医经，研有心得，崇尚易水学派。临床重视胃气、长于内科，尤精于妇科。着有《妇科医案医话选编》等。现任天津中医学院院长、天津市中医研究所所长、中华全国中医学会副会长、天津市医学学术鉴定委员会副主任、卫生部医学科学委员会委员等职。
我家世居河北保定，先祖父文林公，由于少时体弱多病，每患疾则缠绵难愈，以此因缘而酷嗜医学，博览群籍，潜心玩索，积之有年而渐有所会，尤其对眼科颇有心得，四方求医者踵踵相接。时有同宗叔祖昆弟公，精于外科，遐迩知名，与先祖并称保定二哈，均集有医案，惜未成册。先祖父生活上自奉甚俭，而医金收入除维持家计外，每常施药于清贫患者，因此乡里人士成敬重之。
先父振冈公，初攻举业，有声庠序，为前清秀丬『。后来弃儒攻医，就读于光绪年问官办之直隶保定医学堂，兼学中、西医学，六年毕业，以品学兼优而甲于全班。毕业后参加官办医院工作，后叉移居天津悬壶，以长于内科、妇科而蜚声医林。先父敦厚耿介，寡于言笑，不尚交游，暇时课子自娱，庭训颇严。
我总角之时，随先父读书，课余每每旁观先父为人诊治疾病，耳濡目染，遂对医学也渐有所好，恒以古人「不为良相，即为良医」之言自励，先父对我的志趣也深为嘉许。后因先父到天津执业，我遂考入当时保定同仁中学念书。一九二八年初先父因病返里疗养，彼时我高中未及毕业，即中途辕学，随父学医，以遂初志。先父认为，古今精于医者，无不文理精通。「文是基础医是楼」，文理不通则医理难明，学好古文当是学好中医的基本功之一。因此，先父对我一简督教医经，一面补习古文，义在临床细心指点，不惮劬劳。我自己也颇能以「寸阴寸金」之喻自警，发奋刻苦，朝夕攻读，所谓「焚膏油以继晷，恒兀兀以穷年」。如是者两年余，进步很大。之后，先父病愈返津，因促我报考华北国医学院，以求深造。
算来我学医业医，迄已五十余年。虽然愧无建树，但教训得失，不可谓元漫忆一下，写将出来，冀能对后学者有所借鉴。
取法务上扎扎实实
我学医伊始，先父每以诸葛武侯「志当存高远」之语谆谆教诲，并告诚我：医者司人性命，既要富有仁人之心，又须医术精良。因此，一旦选择医学这一专业，便要一生笃志力行，奋斗不已，万不可浅尝辄止，学师不卒，庸医杀人。由此我认识到，要学好医学，首先要专于心，一于志，要有一种献身精神，否则见异思迁，二、三其志，就会失诸精专，「妄陈杂术」，终不会有何成就。其次要敢于攀高峰，要有一种「会当凌绝顶，一览众山小」的志气，树立高远目标，以为自己努力之方向，否则也不免流于平庸、浮浅，终不会有所作为。但取法务上并非好高鹜远、好大喜功。俗说「贪多嚼不烂」。贪多务得，急于求成，就会失于扎实，流于浅薄。古人说：「不积跬步，无以致千里}不积小流，无以成江海。」做学问必要脚踏实地，扎扎实实，不畏艰苦，步步攀登，「书山有窒勤为径」，只有日积月累，循序渐进，才能渐有所得。
勤于学习善于学习
虽然每个人的天分确有差别，但「生而知之」的人则古今未之有，一切知识才干无不源于后天的学习与实践，而学习成绩之优劣，卿与付出劳动量之大小成正比。古云：「聪明可持不可恃也。」即令天资较差，但能勤奋刻苦、穷究不舍，也会有大的成就。清代著名学者闰若璩(公元1636～1704)生来口吃，且很鲁钝。六岁入学，学习成绩很差，剐的聪颖学童看过几遍就能熟记的课文，他往往读至千遍仍不能背诵。但他并不妄自菲薄，而是加倍努力地攻读，数十年如一日，终于成为清代一位享有盛誉的考据学者。他除了助徐干学修《一统志》外，还撰有《古文尚书疏证》，《四书释地》、《孟子生卒年月考》、《潜邱札记》等著述行世。他曾用陶弘景和皇甫谧的话作对联一幅：「一物不知，以为深志；遭人而问，少有宁日。」并书于柱上以明己志。苟子云：「骐骥一跃，不能十步」驽马十驾，功在不舍。」可谓信而有征矣。
然则，学习固须勤奋，亦宜讲求方法。即以背书面言，我初学医时先背药性赋、沥头歌、脉学等，以为启蒙读物，继叉背《内》、《难》、《本经》及《伤寒》、《金匮》等经典著作。我背书时不用默诵法，而是在僻静处朗朗诵读，俾声出之于口，闻之于耳，会之于心，之后则在喧闹环境中默忆背过的内容，所谓「闹中取静」。如此，则不惟能熟记，且能会意。背书颇苦，往往唇敞舌焦，但年轻时背书如石上镌字，记忆牢固，对将来大有好处。古人有「书读百遍，其义可见」之说，我觉得熟读确能使人联想丰富，触类旁通，有利于加强理解，锻炼记忆力。我如今已年过古稀，但青年时期背过的东西，有些现在仍能朗朗上口。
我背诵经典著作时先选白本，熟读后方看注本。
看洼本时不拘于一家之论，如《内经》我选择《太素》及王冰、吴昆、马莳、张隐庵、张景岳等注本，彼此互勘，择善而从，并在领悟各篇全貌后，仿杨上善、张景岳诸家的治学方法，将各篇有关内容分类辑录，每一大类再分细目，此法对于掌握联内经》全部内容，进行整理研究，都有奠大裨益。
《内经》为中医理论之渊薮，为医不读《内经》，则学无根本，基础不固。后世医家虽然在理论上多有创见，各成一家之说，但就其学术思想的继承性而言，无不发轫于《内经」，故读《内》、《难》、《本经》，目的在于掌握中医理论之根本。而仲景之《伤寒》，《金匮》为临床医学之圭臬，辨证论治之大法，不读仲景之书则临床治无法度，依无准绳，故读仲景书要在掌握治疗之常变。仲景之书注家甚多，拢初学时先父命读尤在泾之《伤寒贯珠集》、《金匮心典》，认为尤氏之注对辨证立法阐发精当，剀切详明，不浮不隘，诚如徐大椿所说：「条理通达，指归明显，辞不必烦而意已尽，语不必深而旨已传。」对于「文深奥义，有通之而无可通者」，宁「阅之」而不随文敷衍，强做解人，故对初学者理解仲景之旨，诚多帮助。
我在学习《内》、《难》、《本经》及《伤寒》、《金匮》之后，方开始涉读诸家之书及医案，这样不惟能开阔知识领域，且有了权衡各家学说之基础。先父于金元四家中，独推崇易水学派，临床强调脏腑辨证，尤重视胃气的作用，强调「人以胃气为本」，这一学术思想对我的影响颇为深远；
通过历年的临床实践，我进一步认识到：胃气乃是对脾胃功能之概括，脾胃居处中焦，为气血化生之源泉，人体气机之升降出入，也无不以脾胃为枢纽，脾胃升降失常，则五脏受病，变证丛生。故在治疗中，各脏腑之疾患，凡与脾胃有直接或间接关系者，皆可调治脾胃咀助胃气，使胃气有权则脏损可复，而胃气实关系一身之盛衰，诚足重要。故周学海《读医随笔·升降出入论》说「心肺阳也，随胃气而右降，降则化为阴；肝肾阴也，随胃气而左升，升则化为阳。故戊己二土中气，四气之枢纽，百病之权衡，生死之门户，养生之遭，治病之法，俱不可不谨于此。」至于脾胃之治法，东垣言之虽详，但偏于温补升阳，所谓「详于治脾，而略于治胃」，迨叶桂创清养胃阴之法，适足以补李氏之未逮，而为调理脾胃之两大法门，临床诚能汲取两者之长，兼筹并顾，斯能相得益彰。．
参究各家学说之后，再读请家医案，方能领会其中意趣，而有较大收获。医案乃临床诊病疗疾之纪实，好的医案足以启迪学者之思路，丽为临床之借镜，故古人有读书不如读案之说。读古人与今人之医案，要在参玩其辨证立法及用药旨趣，若以摭拾词句，抄袭方药为务，则是舍本逐末矣。华蛐云在《临证指南医案·凡例》中曾谈及读案方法日：「就一门而论，当察其病情、症状，脉象各异处，知病名虽同而源不同矣，此案用何法，彼案另用何法，此法用何方，彼法另用何方，从其错综变化处，细心参玩，更将方中君臣佐使之药，合病源上细细体贴，其古方加减一、二味处，尤宜理会，其辨证立法处，用朱笔圈出，则了如指掌矣。切勿草草读过，若但得其皮毛，而不得其神髓，终无益也。」此公之论，足可为法。我初读医案时，每将案中辨证立法及方药部分掩住，单就其所述脉证进行分析，辨证、立法、处方，而后弭与原案对照，用以考察自己与彼之辨证用药有何异同，得失原因安在。此种方法对于阅历未深，学验欠丰者，较为适宜。
转益多师博采众长
我十九岁开始临证，彼时白以为读书不少，大有「读方三年，便谓天下无病可治」的劲头，即至遇有复杂症候，则往往感到穷于应付，始知自己的疏陋贫乏，正所谓「治病三年，乃知天下无方可用」。为求深造，遂在先父支持下，于一九三一年报考了北平华北国医学院，是年我二十岁。
北平(今北京)是学者云集，名医荟苹的地方，我在华北国医学院求学期间，不仅深受施今墨、周介人、范更生等诸前辈之亲自教导，也曾得列一些临床大家的点拨。加之我有搜求名医方案手迹之癖好，每有所得，如获至宝。倘闻某医善治某病，而又无缘识荆者，辄乔装病人往求诊治，一为学习其遣方用药特点，一为得其手迹观摩书法，我在很长一段时间都乐此不疲，也深受其益。当时我所搜隶的医学大家的方案手迹，除北京四大名医如肖龙友、孔伯华、施今墨、汪逢春者外，尚有陆仲安、恽铁樵、张简斋、丁甘仁、夏应堂、丁济万、陆士锷、陆渊雷、何廉臣等等名家的真迹，正所谓琳螂满目，美不胜收。惜乎这些宝贵资料在十年浩劫中，尽被付之一炬。通过这样广学博求，我眼界大开，学识渐增，为此后之临床实践，奠定了良好的基础。
中医对于时行疾病重症和慢性久病的治疗，一向以吴鞠通所说的“治疗外感病要像将军作战一样果断，治疗内伤病要像农夫耕作一样细致”这两句名言为依据。确实，治疗时行重症，必须像将军临阵作战那样，胆识兼备，知己知彼，善于观察病情变化，随机应变，当机立断，毫不迟疑，才能取得圆满疗效。慢性久病复杂多变，可能一个人身上同时聚集了十种、八种病症，五脏都受到损伤，在考虑治疗措施时很容易顾此失彼，要善于分析当前哪种病症为主，抓住主要矛盾，才能理清头绪；如果策略失误，就会后悔莫及。如果能够分清标本、轻重、缓急，循序渐进地求取进步，重视掌握脾胃运化受纳的机能，才可以转危为安。同时还须药物治疗和饮食调养相结合，“能进食者昌”是有道理的。
学习中医，应当时刻注意将所学理论和知识运用到临床实际中。仅就中医学的“整体观念”（包括平衡调节观念）和“辨证论治”（包括审察证候以求病因）说一点意见。对于“辨证论治”的理解，有人比喻它像汪洋大海，茫茫无边。我认为船上要有舵、桨和风帆，特别是有人能掌握舵、桨、风帆这些工具，还有认识风向和航路的知识，就可以达到预定的港口。至于“证”，是疾病本质的反映，根据“有诸内必形诸外”的原理，运用四诊、八纲、脏腑经络、气血津液等基本理论，审察证候以求病因，就可以从错综复杂的病情中，掌握病证的主要矛盾，认清病变本质，采用正确的治法和方药。所谓平衡调节观念，就是把健康人与病人区别开来，把病与人统一起来。《内经》说：“平人，就是不生病的人。”就是指人体正常的生理平衡状态，无偏无颇，称为“平人”；一旦平衡调节失职，失去生理常态，就是病理变化，成为病人。这时就必须给予相应的治疗，以恢复其正常生理状态。因此，医生用药治病，实际上就是利用药物的偏性，来纠正人体的偏差。如果分寸合适，轻重适宜，自然可以达到“以平为期”；如果鲁莽过量，反而会导致损伤正气，影响人体自身的调节本能，甚至产生副作用或新的病变。
此外，还必须把中医学从纵横两个方面“融会贯通”起来。纵的方面，应认识到《内经》、《伤寒》、《金匮》、《温病》及各家学说，自古至今一脉相承，虽有变迁，脉络一贯。例如以温病学说为例，是可以体现其发展过程的。从横的方面，要把这些基本理论渗透到各临床学科中，作为指导实践的依据，并借助现代有关科学知识，阐述其真义，以资印证。在继承的基础上，得到进一步发展。
道路，可以从崎岖坎坷，到达康庄大道。寄语后来者。
学无止境，锲而不舍。
天津卫生局长、天津市中医学院院长、教授 哈荔田
【作者简介】哈荔田（1912～），回族，河北保定人。自幼接受家庭教导，家学渊源深厚。一九三五年毕业于北平华北国医学院，因成绩优异，深得施今墨、周介人、范更生等名家赏识。
毕生致力于临床和中医教育事业。
三十到四十年代曾创办北平国医专科学校，并曾任教于天津市国医训练班，一九五五年开始担任天津市卫生局副局长职务后，积极贯彻执行党的中医政策，先后领导筹办了天津中医学校、天津中医学院，并积极组织了西医离职学习中医的工作，为发展中医事业不遗余力。在学术上穷究医经，研有心得，崇尚易水学派。临床重视胃气，长于内科，尤精于妇科。著有《妇科医案医话选编》等。现任天津中医学院院长、天津市中医研究所所长、中华全国中医学会副会长、天津市医学学术鉴定委员会副主任、卫生部医学科学委员会委员等职。
我家世代居住在河北保定，祖父文林公，因为年少时体弱多病，每次患病则缠绵难愈，因此因缘际会而酷爱医学，博览群书，潜心钻研，积年累月逐渐有所领悟，尤其对眼科颇有心得，四方求医的人络绎不绝。当时同宗叔祖昆弟公，精通外科，远近闻名，与先祖并称“保定二哈”，都收集有医案，可惜未成册。祖父生活上非常节俭，而医金收入除维持家计外，经常施药给清贫患者，因此乡里人士都非常敬重他。
父亲振冈公，起初攻读科举，在地方上有名望，曾是秀才。后来弃儒从医，就读于光绪年间官办的直隶保定医学堂，兼学中、西医学，六年毕业，以品学兼优而名列全班第一。毕业后参加官办医院工作，后来又移居天津行医，以擅长内科、妇科而在医林中闻名。父亲敦厚耿直，少言寡语，不尚交游，闲暇时教子自娱，家教颇严。
我童年时期，跟随父亲读书，课余常常旁观父亲为人诊治疾病，耳濡目染，于是对医学也逐渐有了喜好，常以古人“不为良相，即为良医”的话自勉，父亲对我的志趣也深为赞许。后来父亲到天津执业，我便考入当时的保定同仁中学读书。一九二八年初父亲因病回乡疗养，那时我高中尚未毕业，便中途辍学，随父学医，以实现初衷。父亲认为，古今精于医术的人，无不文理精通。“文是基础，医是楼”，文理不通则医理难明，学好古文是学好中医的基本功之一。因此，父亲对我一边督促研读医经，一面补习古文，又在临床细心指点，不辞辛劳。我自己也颇能以“寸阴寸金”的比喻自警，发奋刻苦，朝夕攻读，所谓“点燃灯油接续日光，常年勤勉不懈”。这样两年多，进步很大。之后，父亲病愈返津，催促我报考华北国医学院，以求深造。
算来我学医业医，迄今已五十余年。虽然愧无建树，但教训得失，不可谓没有回忆一下，写出来，希望能对后学者有所借鉴。
取法乎上，扎扎实实。
我学医伊始，父亲常以诸葛武侯“志当存高远”的话语谆谆教诲，并告诫我：医者掌管人的性命，既要富有仁爱之心，又须医术精良。因此，一旦选择医学这一专业，便要一生笃志力行，奋斗不已，万不可浅尝辄止，学业不终，庸医杀人。由此我认识到，要学好医学，首先要专心致志，立志坚定，要有一种献身精神，否则见异思迁，意志不坚，就会失于精专，“妄陈杂术”，最终不会有何成就。其次要敢于攀高峰，要有一种“会当凌绝顶，一览众山小”的志气，树立高远目标，作为自己努力的方向，否则也不免流于平庸、浮浅，最终不会有所作为。但取法乎上并非好高骛远、好大喜功。俗话说“贪多嚼不烂”。贪多务得，急于求成，就会失于扎实，流于浅薄。古人说：“不积累半步一步的行程，就无法到达千里之远；不积累细小的流水，就无法形成江河大海。”做学问必要脚踏实地，扎扎实实，不畏艰苦，步步攀登，“书山有路勤为径”，只有日积月累，循序渐进，才能渐有所得。
勤于学习，善于学习。
虽然每个人的天分确有差别，但“生而知之”的人则古今未有，一切知识才干无不源于后天的学习与实践，而学习成绩之优劣，恰与付出劳动量之大小成正比。古云：“聪明可以凭借，不可以倚仗。”即使天资较差，但能勤奋刻苦、穷究不舍，也会有大的成就。清代著名学者阎若璩（公元1636～1704）生来口吃，且很迟钝。六岁入学，学习成绩很差，别的聪颖学童看过几遍就能熟记的课文，他往往读至千遍仍不能背诵。但他并不妄自菲薄，而是加倍努力地攻读，数十年如一日，终于成为清代一位享有盛誉的考据学者。他除了协助徐干学修《一统志》外，还撰有《古文尚书疏证》、《四书释地》、《孟子生卒年月考》、《潜邱札记》等著述行世。他曾用陶弘景和皇甫谧的话作对联一幅：“一物不知，以为深耻；遭人而问，少有宁日。”并书于柱上以明己志。荀子云：“骐骥一跃，不能十步；驽马十驾，功在不舍。”可谓信而有征矣。
然而，学习固须勤奋，亦宜讲求方法。即以背书而言，我初学医时先背《药性赋》、《汤头歌诀》、《脉学》等，以为启蒙读物，继而又背《内经》、《难经》、《本经》及《伤寒》、《金匮》等经典著作。我背书时不用默诵法，而是在僻静处朗朗诵读，使声音出于口，闻于耳，领会于心，之后则在喧闹环境中默忆背过的内容，所谓“闹中取静”。如此，则不仅能熟记，且能会意。背书颇苦，往往唇裂舌焦，但年轻时背书如石上镌字，记忆牢固，对将来大有好处。古人有“书读百遍，其义自见”之说，我觉得熟读确能使人联想丰富，触类旁通，有利于加强理解，锻炼记忆力。我如今已年过古稀，但青年时期背过的东西，有些现在仍能朗朗上口。
我背诵经典著作时先选白文本，熟读后方看注本。
看注本时不拘泥于一家之论，如《内经》我选择《太素》及王冰、吴昆、马莳、张隐庵、张景岳等注本，彼此互勘，择善而从，并在领悟各篇全貌后，仿杨上善、张景岳诸家的治学方法，将各篇有关内容分类辑录，每一大类再分细目，此法对于掌握《内经》全部内容，进行整理研究，都有莫大裨益。
《内经》为中医理论之渊薮，为医不读《内经》，则学无根本，基础不固。后世医家虽然在理论上多有创见，各成一家之说，但就其学术思想的继承性而言，无不发轫于《内经》，故读《内》、《难》、《本经》，目的在于掌握中医理论之根本。而仲景之《伤寒》、《金匮》为临床医学之圭臬，辨证论治之大法，不读仲景之书则临床治无法度，依无准绳，故读仲景书要在掌握治疗之常变。仲景之书注家甚多，初学时父亲命读尤在泾之《伤寒贯珠集》、《金匮心典》，认为尤氏之注对辨证立法阐发精当，恳切详明，不浮不隘，诚如徐大椿所说：“条理通达，指归明显，辞不必烦而意已尽，语不必深而旨已传。”对于“文深奥义，有通之而无可通者”，宁“阙之”而不随文敷衍，强做解人，故对初学者理解仲景之旨，诚多帮助。
我在学习《内》、《难》、《本经》及《伤寒》、《金匮》之后，方开始涉猎诸家之书及医案，这样不惟能开阔知识领域，且有了权衡各家学说之基础。父亲于金元四家中，独推崇易水学派，临床强调脏腑辨证，尤重视胃气的作用，强调“人以胃气为本”，这一学术思想对我的影响颇为深远；
通过历年的临床实践，我进一步认识到：胃气乃是对脾胃功能之概括，脾胃居处中焦，为气血化生之源泉，人体气机之升降出入，也无不以脾胃为枢纽，脾胃升降失常，则五脏受病，变证丛生。故在治疗中，各脏腑之疾患，凡与脾胃有直接或间接关系者，皆可调治脾胃以助胃气，使胃气有权则脏损可复，而胃气实关系一身之盛衰，诚足重要。故周学海《读医随笔·升降出入论》说：“心肺阳也，随胃气而右降，降则化为阴；肝肾阴也，随胃气而左升，升则化为阳。故戊己二土中气，四气之枢纽，百病之权衡，生死之门户，养生之道，治病之法，俱不可不谨于此。”至于脾胃之治法，东垣言之虽详，但偏于温补升阳，所谓“详于治脾，而略于治胃”，迨叶桂创清养胃阴之法，适足以补李氏之未逮，而为调理脾胃之两大法门，临床诚能汲取两者之长，兼筹并顾，斯能相得益彰。
参究各家学说之后，再读诸家医案，方能领会其中意趣，而有较大收获。医案乃临床诊病疗疾之纪实，好的医案足以启迪学者之思路，而为临床之借镜，故古人有读书不如读案之说。读古人与今人之医案，要在参玩其辨证立法及用药旨趣，若以摭拾词句，抄袭方药为务，则是舍本逐末矣。华岫云在《临证指南医案·凡例》中曾谈及读案方法曰：“就一门而论，当察其病情、症状，脉象各异处，知病名虽同而源不同矣，此案用何法，彼案另用何法，此法用何方，彼法另用何方，从其错综变化处，细心参玩，更将方中君臣佐使之药，合病源上细细体贴，其古方加减一、二味处，尤宜理会，其辨证立法处，用朱笔圈出，则了如指掌矣。切勿草草读过，若但得其皮毛，而不得其神髓，终无益也。”此公之论，足可为法。我初读医案时，每将案中辨证立法及方药部分掩住，单就其所述脉证进行分析，辨证、立法、处方，而后与原案对照，用以考察自己与彼之辨证用药有何异同，得失原因何在。此种方法对于阅历未深，学验欠丰者，较为适宜。
转益多师，博采众长。
我十九岁开始临证，那时自以为读书不少，大有“读方三年，便谓天下无病可治”的劲头，即至遇有复杂症候，则往往感到穷于应付，始知自己的疏陋贫乏，正所谓“治病三年，乃知天下无方可用”。为求深造，遂在先父支持下，于一九三一年报考了北平华北国医学院，是年我二十岁。
北平（今北京）是学者云集，名医荟萃的地方，我在华北国医学院求学期间，不仅深受施今墨、周介人、范更生等诸前辈之亲自教导，也曾得列一些临床大家的点拨。加之我有搜求名医方案手迹之癖好，每有所得，如获至宝。倘闻某医善治某病，而又无缘识荆者，辄乔装病人往求诊治，一为学习其遣方用药特点，一为得其手迹观摩书法，我在很长一段时间都乐此不疲，也深受其益。当时我所搜罗的医学大家的方案手迹，除北京四大名医如肖龙友、孔伯华、施今墨、汪逢春者外，尚有陆仲安、恽铁樵、张简斋、丁甘仁、夏应堂、丁济万、陆士锷、陆渊雷、何廉臣等等名家的真迹，正所谓琳琅满目，美不胜收。惜乎这些宝贵资料在十年浩劫中，尽被付之一炬。通过这样广学博求，我眼界大开，学识渐增，为此后之临床实践，奠定了良好的基础。
Traditional Chinese Medicine (TCM) has always relied on two famous sayings by Wu Jutong regarding the management of acute epidemic diseases and chronic conditions: "Treating external contractions is like a general going to battle; treating internal injuries is like a farmer tilling the land." Indeed, treating acute epidemic diseases requires one to be like a general in battle, combining courage with wisdom, knowing oneself and the enemy, being adept at observing changes in the condition, responding flexibly, making prompt decisions without hesitation, so as to achieve complete success. Chronic and long-standing diseases are complex and varied; a person may suffer from ten or eight different ailments simultaneously, with all five Zang organs damaged. When considering treatment measures, there is a risk of attending to one thing while neglecting another. One must be good at analyzing which symptom is predominant at present, grasping the principal contradiction, so that order can be established. If strategies fail, regret will come too late. If one can distinguish between root and branch, severity and mildness, urgency and non-urgency, and advance step by step, while valuing the mechanism of Spleen-Stomach transportation and transformation, then danger can be turned into safety. Furthermore, drug therapy must be combined with dietary nourishment; "those who obtain grain prosper" is indeed well-founded.
In learning TCM, one should always pay attention to applying learned theories and knowledge to clinical practice. I would like to offer some opinions on the TCM concepts of "holistic view" (including the concept of balance regulation) and "syndrome differentiation and treatment" (including examining syndromes to seek causes). Regarding the understanding of "syndrome differentiation and treatment," some compare it to an endless ocean. I believe that a ship needs a rudder, oars, and sails, and especially someone who can master these tools, along with knowledge of wind direction and navigation routes, can reach the predetermined port. The "syndrome" (Zheng) is a reflection of the disease's essence. Based on the principle that "what exists internally must manifest externally," by applying basic theories such as the Four Diagnostic Methods, Eight Principles, Zang-Fu organs, meridians and collaterals, Qi-Blood, and Body Fluids, and by examining syndromes to seek causes, one can grasp the principal contradictions in complex clinical situations, recognize the nature of the lesions, and adopt correct treatment methods and prescriptions. The concept of balance regulation involves distinguishing between healthy individuals and patients, and unifying the disease with the person. The *Neijing* states: "A Pingren (balanced person) is one who is not ill." This refers to the normal physiological balance of the human body, without bias or deviation, called a "Pingren"; once this balance fails and physiological norms are lost, it becomes a pathological change, resulting in illness. At this point, corresponding treatment must be given to restore the normal physiological state. Therefore, when doctors use drugs to treat diseases, they are actually using the biased properties of drugs to correct deviations in the human body. If the dosage is appropriate and the weight is suitable, one can naturally achieve "balance as the goal"; if one acts rashly and overdoses, it will instead damage healthy Qi, affect the body's self-regulatory instincts, and even produce side effects or new lesions.
Furthermore, one must integrate TCM comprehensively from both longitudinal and horizontal perspectives. Longitudinally, one should recognize that the *Neijing*, *Shanghan Lun*, *Jingui Yaolue*, *Wenbing Tiao Bian*, and various schools of thought have been passed down continuously since ancient times. Although there have been changes, the lineage remains consistent. For example, the development process can be reflected through the theory of Warm Diseases. Horizontally, these basic theories should be permeated into various clinical disciplines as a basis for guiding practice, and modern scientific knowledge should be utilized to elucidate their true meaning for verification. On the basis of inheritance, further development is achieved.
The path may start rugged and bumpy but leads to a broad highway. Words of advice for future generations.
Learning has no limits; perseverance is key.
Ha Litian, Director of Tianjin Health Bureau, Dean of Tianjin University of Traditional Chinese Medicine, Professor
[Author Introduction] Ha Litian (1912–), Hui ethnicity, from Baoding, Hebei. He received family training in his youth and had deep academic roots. He graduated from Beiping Huabei College of Traditional Chinese Medicine in 1935. Due to his excellent grades, he was highly appreciated by famous experts such as Shi Jinmo, Zhou Jieren, and Fan Gengsheng.
He dedicated his life to clinical practice and TCM education.
In the 1930s and 1940s, he founded the Beiping National Medical Professional School and taught at the Tianjin National Medical Training Class. After assuming the position of Deputy Director of the Tianjin Health Bureau in 1955, he actively implemented the Party's TCM policies, led the establishment of the Tianjin TCM School and Tianjin University of TCM, and organized programs for Western medicine practitioners to leave their posts to study TCM, sparing no effort for the development of TCM. Academically, he studied medical classics deeply and had his own insights, advocating the Yishui School. Clinically, he valued Stomach Qi, specialized in Internal Medicine, and was particularly skilled in Gynecology. He authored works such as *Selected Cases and Discussions in Gynecology*. He currently serves as Dean of Tianjin University of TCM, Director of Tianjin Institute of TCM Research, Vice President of China Association of Chinese Medicine, Deputy Director of Tianjin Medical Academic Appraisal Committee, and Member of the Medical Science Committee of the Ministry of Health.
My family has lived for generations in Baoding, Hebei. My grandfather, Mr. Wenlin, suffered from weak health and frequent illnesses in his youth, which were lingering and difficult to cure. Through this experience, he developed a passion for medicine, reading extensively and studying intently. Over the years, he gradually gained insight, especially in Ophthalmology. Patients came from all directions in continuous streams. At that time, my clan uncle, Mr. Kundibing, was proficient in Surgery and well-known far and wide. Together with my grandfather, they were known as the "Two Has of Baoding." Both collected medical cases, unfortunately, none were compiled into books. My grandfather lived very frugally. Apart from maintaining his household, he often distributed medicine to poor patients, so he was highly respected by the locals.
My father, Mr. Zhengang, initially studied for the imperial examinations and had a reputation in the local school system, becoming a Xiucai (scholar). Later, he abandoned Confucian studies for medicine and attended the Zhili Baoding Medical Hall, an official institution established during the Guangxu reign, where he studied both TCM and Western medicine. He graduated after six years, ranking first in his class for both character and scholarship. After graduation, he worked in an official hospital and later moved to Tianjin to practice medicine, gaining fame in the medical community for his expertise in Internal Medicine and Gynecology. My father was honest and upright, spoke little, did not engage much in socializing, and enjoyed teaching his children in his spare time. His family discipline was strict.
In my childhood, I studied with my father. During breaks, I often watched him diagnose and treat patients. Influenced by what I saw and heard, I gradually developed an interest in medicine. I constantly encouraged myself with the saying of the ancients: "If not a good prime minister, then be a good doctor." My father greatly approved of my aspirations. Later, when my father went to Tianjin to practice, I enrolled in Tongren Middle School in Baoding. In early 1928, my father returned home for medical treatment due to illness. At that time, I had not yet graduated from high school, so I dropped out midway to study medicine with my father to fulfill my original wish. My father believed that those who excel in medicine throughout history must be proficient in both literature and logic. "Literature is the foundation; medicine is the building." Without understanding literature and logic, it is difficult to comprehend medical principles. Learning classical Chinese is one of the basic skills for mastering TCM. Therefore, my father supervised me to study medical classics while also helping me catch up on classical Chinese, providing careful guidance in clinical practice without sparing himself labor. I also warned myself with the metaphor "an inch of time is worth an inch of gold," working hard day and night. As the ancients said, "burning oil to extend the daylight, working tirelessly year after year." For over two years, I made great progress. Afterwards, my father recovered and returned to Tianjin, urging me to apply to Huabei College of Traditional Chinese Medicine for further study.
Calculating from now, I have been studying and practicing medicine for over fifty years. Although I feel ashamed of having no significant achievements, the lessons and gains cannot go unremembered. Writing them down, I hope they can serve as a reference for future learners.
Aim high, be solid and practical.
When I started learning medicine, my father frequently instructed me with Zhuge Liang's words: "One's ambition should be lofty." He also warned me: "Doctors hold people's lives in their hands. They must possess a benevolent heart and excellent medical skills." Therefore, once choosing medicine as a profession, one must be devoted and strive continuously throughout life. One must never stop after a superficial attempt or fail to complete one's studies, lest a quack doctor kill people. From this, I realized that to learn medicine well, one must first focus the mind and fix the will, possessing a spirit of dedication. Otherwise, changing views upon seeing something new and wavering in willpower will lead to a lack of specialization and "recklessly presenting miscellaneous arts," ultimately achieving nothing. Secondly, one must dare to climb peaks, having the ambition of "reaching the summit and viewing all other mountains as small," setting lofty goals as the direction of effort. Otherwise, one will inevitably fall into mediocrity and superficiality, ultimately accomplishing nothing. However, aiming high does not mean being unrealistic or seeking grandiose results. As the proverb goes, "Greedily eating too much makes it hard to digest." Seeking too much and being eager for quick success leads to a lack of solidity and superficiality. The ancients said: "Without accumulating small steps, one cannot reach a thousand miles; without accumulating small streams, one cannot form rivers and seas." Scholarship requires being down-to-earth, solid, fearless of hardship, and climbing step by step. "Diligence is the path up the mountain of books." Only through daily accumulation and gradual progress can one gain something.
Study diligently and study wisely.
Although everyone's natural aptitude differs, there have been no "born-knowers" in history. All knowledge and talent stem from postnatal learning and practice. The quality of learning outcomes is directly proportional to the amount of labor invested. The ancients said: "Intelligence can be relied upon but not depended upon." Even with poor natural gifts, if one is diligent, hardworking, and relentless in pursuit, one can achieve great things. Yan Ruqu (1636–1704), a famous scholar of the Qing Dynasty, was born stuttering and rather dull. He entered school at age six and performed poorly. While clever students could memorize texts after reading them a few times, he often had to read them a thousand times before he could recite them. But he did not belittle himself. Instead, he doubled his efforts in studying, day and night for decades, eventually becoming a renowned textual research scholar in the Qing Dynasty. Besides assisting Xu Ganxue in compiling the *Yitong Zhi*, he authored works such as *Guwen Shangshu Shuzheng*, *Sishu Shidi*, *Mengzi Shengci Nianyue Kao*, and *Qianqiu Zhaji*. He created a couplet using words from Tao Hongjing and Huangfu Mi: "Not knowing one thing is a deep shame; asking others leaves little peace." He wrote it on a pillar to show his resolve. Xunzi said: "A fine horse may leap ten paces, but a nag driving ten days achieves the same result through persistence." This is indeed credible evidence.
However, learning requires diligence but also method. Taking memorization as an example, when I first started learning medicine, I memorized *Yaoxing Fu* (Ode to Drug Properties), *Tangtou Gejue* (Song of Decoction Heads), and *Maixue* (Pulse Studies) as introductory readings. Then I memorized classics such as *Neijing*, *Nanjing*, *Shennong Bencao Jing*, *Shanghan Lun*, and *Jingui Yaolue*. I did not use silent recitation. Instead, I read aloud in quiet places, letting the sound come from my mouth, enter my ears, and be understood by my heart. Later, I recalled the memorized content silently in noisy environments, a method called "finding quiet amidst noise." Thus, I could not only memorize well but also understand the meaning. Memorization was bitter, often cracking lips and drying tongues, but memorizing in youth is like carving on stone, leaving firm memories that benefit the future greatly. The ancients said, "Read a book a hundred times, and its meaning will appear." I feel that familiar reading indeed enriches associations, allows drawing inferences, strengthens understanding, and exercises memory. Now past seventy, some things I memorized in my youth are still clear in my mind.
When memorizing classics, I first chose unannotated texts. Only after reading them thoroughly did I look at annotated versions.
When reading annotations, I did not stick to one school. For *Neijing*, I selected annotations by *Taisu*, Wang Bing, Wu Kun, Ma Shi, Zhang Yin'an, and Zhang Jingyue, comparing them mutually and adopting the best parts. After comprehending the overall picture of each chapter, I imitated the scholarly methods of Yang Shangshan and Zhang Jingyue, categorizing and compiling relevant contents from each chapter. Each major category was further divided into sub-items. This method greatly benefited the mastery and organization of the entire *Neijing*.
*Neijing* is the source of TCM theory. A physician who does not read *Neijing* has no root and unstable foundation. Although later physicians had many theoretical innovations and formed their own schools, their academic thoughts all originated from *Neijing*. Thus, reading *Neijing*, *Nanjing*, and *Bencao Jing* aims to grasp the root of TCM theory. Zhang Zhongjing's *Shanghan Lun* and *Jingui Yaolue* are the standards of clinical medicine and the great laws of syndrome differentiation and treatment. Not reading Zhang's books means lacking rules and criteria in clinical practice. Therefore, reading Zhang's books focuses on mastering the constancy and variation of treatments. There are many annotators for Zhang's books. In my initial study, my father instructed me to read You Zaijing's *Shanghan Guanzhu Ji* and *Jingui Xin Dian*. He believed that You's annotations elaborated precisely on syndrome differentiation and legislation, earnestly and clearly, neither floating nor narrow. As Xu Dachun said: "Logic is clear, purpose is obvious; words need not be verbose for meaning to be complete, nor profound for intent to be conveyed." For passages where "the text is profound and obscure, and cannot be explained," it is better to "leave them blank" than to perfunctorily explain them or force interpretations. This truly helped beginners understand Zhang's intent.
After studying *Neijing*, *Nanjing*, *Bencao Jing*, *Shanghan Lun*, and *Jingui Yaolue*, I began exploring works by various schools and medical cases. This not only broadened my knowledge field but also provided a basis for weighing different schools' theories. Among the Four Great Masters of Jin-Yuan, my father uniquely advocated the Yishui School. Clinically, he emphasized Zang-Fu syndrome differentiation, particularly valuing the role of Stomach Qi, stressing that "humans rely on Stomach Qi as their root." This academic thought influenced me profoundly.
Through years of clinical practice, I further realized that Stomach Qi is a summary of Spleen-Stomach functions. Located in the Middle Jiao, they are the source of Qi and Blood generation. The ascending and descending, entering and exiting of the body's Qi mechanism all take the Spleen-Stomach as the hub. If Spleen-Stomach ascending and descending become abnormal, the Five Zang organs suffer, and complicated symptoms arise. Therefore, in treatment, any disease of the Zang-Fu organs related directly or indirectly to the Spleen-Stomach can be treated by regulating the Spleen-Stomach to assist Stomach Qi. If Stomach Qi has authority, organ damage can be restored. Stomach Qi relates to the prosperity or decline of the whole body, making it crucial. Zhou Xuehai in *Du Yi Suibi · Shengjiang Chu Ru Lun* said: "Heart and Lungs are Yang, descending right with Stomach Qi, turning into Yin; Liver and Kidneys are Yin, ascending left with Stomach Qi, turning into Yang. Thus, the central Qi of Wujii (Earth) is the hub of the four Qi, the scale of hundred diseases, the gate of life and death, the way of health preservation, and the method of treatment. One must be cautious here." Regarding Spleen-Stomach treatment methods, Dong Yuan spoke in detail but leaned towards warming tonification and raising Yang, described as "detailed in treating Spleen, brief in treating Stomach." Later, Ye Gui created the method of clearing and nourishing Stomach Yin, sufficiently supplementing Li Dongyuan's shortcomings. These became the two major gates for regulating Spleen-Stomach. Clinically, absorbing the strengths of both and considering them together yields complementary effects.
After researching various schools' theories, reading various medical cases allows one to appreciate their charm and gain significant harvest. Medical cases are records of clinical diagnosis and treatment. Good cases can inspire scholars' thinking and serve as mirrors for clinical practice. Hence, the ancients said reading cases is better than reading books. Reading ancient and modern medical cases requires studying their syndrome differentiation, legislation, and medication interests. If one merely collects phrases and copies prescriptions, it is neglecting the root for the branches. Hua Xiuyun discussed case-reading methods in the *Preface* of *Linzheng Zhinan Yian*: "Discussing one specialty, observe where the condition, symptoms, and pulse differ. Knowing that although disease names are the same, sources differ. What method does this case use? What method does that case use? What prescription does this method use? What prescription does that method use? Carefully study their intricate variations. Also, carefully consider the Sovereign, Minister, Assistant, and Envoy herbs in the prescriptions relative to the disease source. Pay special attention to adding or subtracting one or two herbs from ancient formulas. Circle the syndrome differentiation and legislation parts with red ink, and everything will be clear. Do not skim through. If you only get the skin but not the marrow, it is ultimately useless." This gentleman's argument is worthy of emulation. When I first read cases, I would cover the syndrome differentiation/legislation and prescription parts, analyzing only the described pulse and symptoms to differentiate syndrome, legislate treatment, and prescribe. Then I compared it with the original case to examine differences and similarities in my vs. their syndrome differentiation and medication, and reasons for gains and losses. This method is suitable for those with shallow experience and insufficient learning/practice.
Learn from many teachers, absorb strengths widely.
I started clinical practice at nineteen. At that time, I thought I had read enough, feeling confident like "having read prescriptions for three years, believing no disease in the world is untreatable." But when facing complex symptoms, I often felt overwhelmed, realizing my ignorance and poverty of knowledge. As the saying goes, "Having treated diseases for three years, one realizes no prescription in the world is applicable." To seek further study, supported by my father, I took the entrance exam for Beiping Huabei College of Traditional Chinese Medicine in 1931, at age twenty.
Beiping (now Beijing) was a place where scholars gathered and famous doctors assembled. During my studies at Huabei College, I was not only personally taught by seniors like Shi Jinmo, Zhou Jieren, and Fan Gengsheng, but also guided by some clinical masters. Additionally, I had a hobby of collecting handwritten prescriptions from famous doctors. Every acquisition was like finding a treasure. If I heard of a doctor good at treating a certain disease but couldn't meet them, I would disguise myself as a patient to seek treatment. One reason was to learn their prescription and medication characteristics; another was to obtain their handwriting to observe their calligraphy. I enjoyed this for a long time and benefited greatly. The handwritten prescriptions I collected included those from Beijing's Four Famous Doctors: Xiao Longyou, Kong Bohua, Shi Jinmo, and Wang Fengchun, as well as Lu Zhongan, Yun Tieqiao, Zhang Jianzhai, Ding Garen, Xia Yingtang, Ding Jiwan, Lu Shie, Lu Yuanlei, He Lianchen, and others. It was truly a feast for the eyes. Unfortunately, these precious materials were burned to ashes during the Ten Years of Turmoil. Through such extensive learning and seeking, my horizons widened, and my knowledge increased, laying a good foundation for subsequent clinical practice.