4．烧山火与透天凉的补泻法。以针刺时针下有无热感或冷感作为手法成功与否的衡量标志，它由上述提插补羁法的基础上发展繁复起来。其针刺感应强度，在使用补法时，烧山火显比提插法强，施行泻法时则二者基本相同。这样又与轻刺激兴奋法补法，强刺激抑制法泻法之说，适得其反。关于临床应用，亦与其它补泻法一样，阻经络学说为依据，结合症候的寒热辨型，并在手法上掌握针下热补寒泻的原则。
至于适应病症，《金针赋》中有「烧…火，治顽麻冷痹……除寒之有准」，「透天凉，治肌热骨蒸……退热之可凭」的记载。因冷痹是寒气之胜所致，故当片{烧山火手法以「温阳祛寒」，此又以《素问·痹论、)「寒气胜者为痛痹」、《灵枢·寿夭刚柔》「刺寒痹者内热」等为依据。透天凉所治的肌热骨蒸，则由虚火燔灼，骨髓内热所致，多见于一些虚损病人。故循「寒热正冶」的原则，用透天凉泻法以退虚热。现代的兴奋、抑制的针感不仅与烧l火、透天凉无法雷同，且不能达到针下的热感与冷感。
结语
回顾个人四十余年的治学经历，既有教训，也有经验。不经冰霜苦，难得透骨香。祖国医学渊源悠久，历代医籍浩如烟海，若要提高业务水平，非得下苦功不可。在求知的征途上，切不可浅尝辄止，亦不可略有所获，便沾沾自喜而停顿不前。我虽年迈，尚不敢自怠，愿与后学诸秀共勉。
学医在勤奋临证贵辨析
中医研究院第二临床医学研究所副主任医师路志正
[作者简介]路志正(1920～)，河北省藁城县人。从事中医工作四十余年。解放后在卫生部中医司技术指导科工作，为开展中医学术、推广针灸疗法和中西医学术交流等，做了不少努力。曾任中华医学会中西医学术交流委员会委员。现任中医研究院学术委员会委员、广安门医院内科学术研究室副主任。精通中医典籍，对脾入的研究。擅中医内干辛，兼通针灸等，在临床上有较高造诣。曾参加编写《中医临床资料汇编》(1955年)、《中国针灸学概要》、《中华人民共和国药典》等。
我从事中医工作虽已四十余年，自愧才疏学浅，滥竽医林，无何贡献。但回顾过去的学习，鸡声灯影，备具甘苦，寸积铢累，亦有心得。敞特录出，或可用征得失。
幼承家学积于跬步
家伯路益修为吾乡名医，父亦粗通医道。家境的熏陶，使我幼年即酷爱医学。弱龄之时，父亲即日授《千家诗》、《医学三字经》等。六岁入学，业余时间更嘱我诵读《药性赋》、《汤头歌诀》等入门书籍。后考入高小，因经济拮据而辍学，随从家伯学医，兼读四子之书。但古文枯涩难懂，有时不免畏难。偶或偷空玩耍，家伯即以《苟子·劝学篇》和宋濂的《送东阳马生序》教我。
伯父教我诵读中医典籍的方法是：先是低吟，即自念自听，吟读数十遍或百遍之数，有若流水行云，出口成诵，形成自然记忆。他反对高声朗读或强记在心，否则忘却亦快。低吟之后，要逐渐放慢速度，边读边体会文中涵义，所谓「涵昧吟诵」，务求弄懂原文。孔于日：「学而不思则罔，思而不学则殆。」逐渐使我认识到背诵和理解之间相辅相成的关系，所谓「读书百遍，其义自见」。许多名篇大作及中医经典都是这时诵读的，至今不少原文仍能朗然成诵，深感得力于当年窗下功夫。而且，习惯成自然。晨问如不读书，则怅然如有所失。朗朗上口，乐在其中。今虽六秩，其趣不减。
熟读经典医文并重
一九三四年伯父创办医校，我正式学医。时值山西盐城名医孟正已先生游学河北，在无极一带医名甚噪。伯父与之交往极密，命我拜其为师。孟师经验丰富，于医理造诣尤深，治学严谨，教授有方。主张学习要从难入手，首先学好经典，然后旁通诸家，方能取到高屋建瓴之效。指定书目主要是《素问》、《灵枢经》、《图注难经脉诀》、《伤寒论》、《金匮要略》、《本草备要》等。由于伯父深知中医古籍文义深奥，有些字多音多义，古体假借情况甚多，且无断句，学习经典首先要过好文字关。若无坚实的古文基础，则难以登堂入室。特聘清末秀才陈宣泽先生教授c《易经》和《古文观止》等。医文并重，不仅提高了文学素养，而且加深了对经文的理解和记忆。如学习《易经》了解了阴阳变化、消长盈虚的规律，从而更有助于理解和掌握中医的阴阳学说。古人有「易于医通」之说，即是指此。
《内经》乃中医理论之渊薮。王冰称其为「至道之宗，奉生之始」。但其言简意博，理奥趣深，学习时要结合诸家，多方考虑，择善而从。其难解之处，尤要结合临床，不可贸然否定或擅做改动。记得初读《素问·生气通天论》时，对「因于暑、汗，烦则喘渴，静则多言，体若燔炭，汗出而散」一段经文颇为费解。窃思既有「汗」出，何以叉云「汗出而散」，遍查各注，奠衷一是。丹溪翁更将暑改为「寒」，以明其可汗之理。后读东垣及温病各家论述，并验之临床，始感丹溪之改值得商榷。盖暑证汗出，既{壬邪热蒸迫津液外泄之象，又是邪热得以外解之途，；}表虚亡阳之汗可比。故初起需「汗出而散」，绝对不可以止汗。后世以新加香薷饮治暑温初起无汗，白虎汤加减治暑温壮热烦渴、汗出之证，无不取辛散退热之意，所谓「暑当与汗俱出，勿止」之谓也。可见，一个问题需反复思考，多方查证，并结合实践，才能真正理解。再如切脉，《内经》有「三部九候」之论，日于种种原因，后世发展为「独取寸口」，但实践之中常感不够。如大面积烧伤及某些血管病患者，寸口无法切按或无脉，则不仅需「三部九候」进行诊脉，甚至凡体表末被灼伤部位，一切可触到之动脉，皆可切按。如脐间动气，十二经脉等常可弥补独取寸口之不足。对于危难重症欲知其预后吉凶，还须以下部三候(足厥阴、足少阴、足太阴)中诊视，即古人谓之枝叶虽萎，而树根犹荣也。
在诵读原文的同时，要选择一些注本进行阅读，以加深对原文的理解。且许多注家有精辟的论述和极有见地的发挥。为此，家伯和孟师耍我在读书时，除先读序言、凡例以了解其写作动机、过程及大致内容外，还要重视注文的学习。如王冰在注《素问·至真要大论》「诸寒之而热者取之阴，热之而寒者取之阳」时，提出了「壮水之主，以制阳光，益火之源，以消阴翳」的治疗原则，对临证有极大的指导意义。张景岳在「阴阳者，天地之遭也」下注有「道者，阴阳之理也，阴阳者，一分为二也」的精辟论述，若不细读，焉能得知l对于其它典籍的小注眉批，亦应细读，不可草草放过。如汪昂《增补本草备要》，其注文博采各家所长，弓l证广泛，立论公允，文字简练，要言不繁，不仅了解许多医家之用药特点和经验，学到不少有效方剂，且可节省大量时间，真是一举多得。如黄柏治口疮下小注云：「治口疮用凉药不效者，乃中气不足，虚火上炎，宜用反佐之法，参、术、甘草补土之虚，干姜散火之标，甚加附子，或噙官桂，以引火归元。」寥寥数语，而理法方药井然一贯，从中可以得到反治经验。一其次，一些有效的单方验方常以小故事体裁记述下来，既引人入胜，叉易于记忆。如枳壳条下，方士进瘦胎饮；．蛤粉条下，宋徽宗宠姬病痰嗽，面肿不寐，李防御洽之不效，向走方郎中求得黛蛤散。它如肺损用白芨末，产风血运用华佗愈风散(荆芥穗)，阳明头目昏痛甩都梁丸(白芷)，胃气痛甩良附丸等等，至今仍为医家所习用。
上下不通之「关格」证及二便不通之证，病势急追，医者甚感束手。我在翻闵《本草纲目》时，观四十一卷「蜣螂」(又名铁甲将军、推车客)条下，云其「治大小便不通」(大便不通用上截，小便不通用下截，二便不通全用)；「蝼蛄」有「利大小便」之效，用治「十种水病」，「大腹水病」，「小便不通大使闭」之证(用时取下体)。临证用于二便不道之证，果然有效。一妇因针刺后感染，二便不通，腹胀难忍，不可触摸，需支架护其腹部，饮食难进，极度虚弱，因处以铁将军、蝼蛄、人参、附予等攻补兼施之剂。药后二便通利，所下结粪如羊矢状，大量尿液亦浸泡其身，遂得痊愈。可见无论正文、注史，皆是前人经验总结，都应仔细钻研，、验之临床，方能有所收获。
「眉批」亦是评注者在熟读精思、深明个中三昧后，以最简练的语言在原文上方，提出的个人评价或见解，多是最关键、最吃紧处。使读者从疑似之间得到正确的理解，具有提纲挈领、画龙点睛之妙，亦值得认真阅读。
勤于实践善于总结
随师侍诊是临床实践的第一步。我初见病人时，茫然不知所措，但边抄方、边体会老师诊病时的一言一行。侍诊日久，则对老师辨证思路及治疗特点有所认识，并逐渐能够独立思考。许多病症不经过实践是难以认识和掌握的。如亡阴亡阳之重证，若不当机立断，危在顷刻。而只有书本知识，不经过临床体验不敢决断和处理。随伯父侍诊时，曾冶一赵姓患者，证见头身汗出如雨，四条毛巾擦拭不迭，心慌气促，四末厥逆，脉细如丝，伯父诊为大汗亡阳之证，遂投太剂参附，随煎随饮，三小时后汗收厥回而苏。使我对大汗亡阳留下深刻印象。类似病例在我侍诊时见到很多，对以后临证中抢救亡阳亡阴重证教益很大。
一九三九年之后，我独立应诊。凡日间疑似难辨、立法处方无把握者，则于晚问研读有关书籍，即是古人「白天看病，晚上读书」的方法。尤其是阅读一些医案，如喻嘉言《寓意草》、联章楠治案》、《柳选四家医案》、《晦证指南医案》等，以提高辨证分析能力，从前人验案中得到启发。前贤谓读书不若读案，确有一定道理。
在实践中应不断总结，循序渐进，逐步掌握一般疾病发展、转化、预后及诊治的基本规律。如「消渴」一证，有上、中、下三消之说，前人论之甚详。积多年临证观察，我常以脏腑经络辨证，认为本病发于中，起于胃，次及于肺，终归于肾。初因脾胃失和，而致胃热伤津}继则子病累母，胃热上蒸，灼伤肺阴，终则下传于肾，真阴受损，阴损及阳，气化不行，而渐由阴虚阳亢，导致阴阳俱衰。故初则宜白虎、增液清其胃脾燥热。其腑实者亦可以调胃承气釜底抽薪治其标，再用清胃养阴治其本；在肺则以生脉散、白虎剂清胃润肺；入肾则先用生脉散，地黄汤，大补阴丸滋其阴，阳衰者则宜肾气丸益火之源，助其气化。以此辨治，较为简明。但应注意，消渴虽以阴虚燥热为特点，治以养阴清燥为常法。但「火与元气不两立』，「壮火食气」，叉以正气不足为其本，故用药不可过于寒凉，尤应忌用苦寒，而始终要注意益气扶正，助其气化。如黄芪、太子参等，常宜相机选用。
此外，不仅要总结成功的经验，更要善于总结失败的教训。一九四二年，乡中陈某患温病逾月，屡治不效，延请往视。至时家人正焚香拜佛，祈祷神灵。患者年方十七，观其僵卧于炕，两目直视不眩，面色晦滞，昏睡不醒。观其舌，质暗而紫，苔黄厚而干。切其脉如转索，左右弹指。扪鼻察息，呼吸虽慢而尚匀，吐气虽微而仍温，四肢逆冷。索观前医处方数十张，多宗白虎加减，而方中石膏用量颇重，初用二两，渐增至半斤，且皆锻用。面对此等危症，一时难于决断。沉思良久，悟出此系石膏用之不当。石膏锻用，失却解肌之效，而成寒凝之弊，遂致邪热内伏不得外达，犯了「汗不出者，不可与也」之戒。欲解其凝，必以温通。虽热伏于内，但元气已衰，遂以参附汤化裁，以人参、淡附片、紫油棒各1．5克，煎水频服，观其动静。翌晨，家人喜来相告，药后至夜半时，病者眼启能言，少思饮食，四肢转温而能圃伸。我因忙于诊务，以为既已见效，可守方不变，嘱其继进两剂。孰知三日后家属张惶来告，言服完两剂后，骤然烦躁不安，赤身裸体，言语不休，行动狂妄，如有种凭。我急往诊视，果如所述。见其面色红赤，舌质红绎，苔黄燥而有芒刺。询其大便数日未行，口渴思饮，手足溅然汗出，其脉沉实有力，纯系一派阳明府实之候。遂用增液承气化裁，以滋阴润燥，荡涤腑实。药后当晚下燥屎二十余枚，二日后热退身清。事后，我自责临证草率从事，致生变端。本例初用温通回阳之桂附，原为救急扶正之图，既已奏效，则当更议他法，然未详察，以为得效而觉原方药少量小力薄，可再继进。致使燥烈之性激发伏热，二火交炽，亢盛莫制，遂成阳明府实之证。误治之失，甚为内疚。深感医者责任重大，且医理精深，必须详究。倘稍有疏忽，则祸不旋踵。孙真人谓「胆欲大而心欲细，行欲方而智欲圆」，诚为至理名言，应为医者之座右铭。
博采众长融会贯通
4. 烧山火与透天凉的补泻手法。以针刺时患者针下是否出现热感或冷感作为判断手法成功与否的标志，这是在上述提插补泻法的基础上发展演变而来的复杂技法。其针刺感应强度在使用补法时，烧山火的效果明显强于提插法；施行泻法时，则两者基本相同。这与“轻刺激为兴奋性补法，强刺激为抑制性泻法”的说法恰好相反。关于临床应用，也与其他补泻法一样，以经络学说为依据，结合症状的寒热辨证分型，并在手法上掌握“针下热感用补法，针下冷感用泻法”的原则。
至于适应病症，《金针赋》中有记载：“烧山火，治疗顽固性麻木和冷痹……祛除寒邪有确切疗效”，“透天凉，治疗肌肉发热和骨蒸潮热……退热有可靠依据”。因为冷痹是由寒气偏胜所致，所以应当采用烧山火手法来“温阳祛寒”，这又是依据《素问·痹论》中“寒气偏胜的叫痛痹”、《灵枢·寿夭刚柔》中“刺治寒痹要使其内部产生热感”等理论。透天凉所治疗的肌热骨蒸，是由虚火炽盛灼烧、骨髓内热所致，多见于一些虚损病人。因此遵循“寒者热之，热者寒之”的正治原则，使用透天凉泻法来消退虚热。现代的兴奋、抑制针感不仅无法与烧山火、透天凉相提并论，而且达不到针下的热感与冷感。
结语
回顾个人四十多年的求学经历，既有教训，也有经验。不经受冰霜之苦，难得透骨的清香。祖国医学渊源悠久，历代医籍浩如烟海，若要提高业务水平，非得下苦功不可。在求知的征途上，切不可浅尝辄止，也不可略有所获就沾沾自喜而停顿不前。我虽然年迈，尚不敢自我懈怠，愿与后学诸君共勉。
学医在于勤奋，临证贵在辨析
中医研究院第二临床医学研究所副主任医师路志正
[作者简介] 路志正（1920～），河北省藁城县人。从事中医工作四十余年。解放后在卫生部中医司技术指导科工作，为开展中医学术、推广针灸疗法和中西医学术交流等，做了不少努力。曾任中华医学会中西医学术交流委员会委员。现任中医研究院学术委员会委员、广安门医院内科学术研究室副主任。精通中医典籍，对脾胃的研究颇有造诣，擅长中医内科，兼通针灸等，在临床上有较高造诣。曾参加编写《中医临床资料汇编》（1955年）、《中国针灸学概要》、《中华人民共和国药典》等。
我从事中医工作虽已四十余年，自愧才疏学浅，滥竽医林，并无多大贡献。但回顾过去的学习过程，鸡鸣灯影之下，备尝甘苦，日积月累，亦有心得。特此记录出来，或许可以用来验证得失。
幼承家学，积于跬步
伯父路益修是我乡的名医，父亲也粗通医道。家境的熏陶，使我幼年即酷爱医学。少年时期，父亲每天教我诵读《千家诗》、《医学三字经》等。六岁入学，业余时间更嘱咐我诵读《药性赋》、《汤头歌诀》等入门书籍。后来考入高小，因经济拮据而辍学，随从伯父学医，兼读四书五经。但古文枯涩难懂，有时不免畏难。偶尔偷空玩耍，伯父就以《荀子·劝学篇》和宋濂的《送东阳马生序》来教导我。
伯父教我诵读中医典籍的方法是：先是低吟，即自己念给自己听，吟读几十遍或上百遍，如同流水行云一般，出口成诵，形成自然记忆。他反对高声朗读或强行记在心里，否则遗忘也快。低吟之后，要逐渐放慢速度，边读边体会文中的含义，所谓“涵泳吟诵”，务求弄懂原文。孔子说：“只学习不思考就会迷惑，只思考不学习就会危险。”逐渐使我认识到背诵和理解之间相辅相成的关系，所谓“读书百遍，其义自见”。许多名篇大作及中医经典都是这时诵读的，至今不少原文仍能朗朗成诵，深感得力于当年的窗下功夫。而且，习惯成自然。早晨如果不读书，则怅然若有所失。朗朗上口，乐在其中。如今虽已六十多岁，其趣味不减。
熟读经典，医文并重
一九三四年伯父创办医校，我正式学医。当时正值山西盐池名医孟正已先生游学河北，在无极一带医名很噪。伯父与之交往极密，命我拜其为师。孟师经验丰富，于医理造诣尤深，治学严谨，教授有方。主张学习要从难入手，首先学好经典，然后旁通诸家，方能取得高屋建瓴之效。指定书目主要是《素问》、《灵枢经》、《图注难经脉诀》、《伤寒论》、《金匮要略》、《本草备要》等。由于伯父深知中医古籍文义深奥，有些字多音多义，古体假借情况甚多，且无断句，学习经典首先要过好文字关。若无坚实的古文基础，则难以登堂入室。特聘清末秀才陈宣泽先生教授《易经》和《古文观止》等。医文并重，不仅提高了文学素养，而且加深了对经文的理解和记忆。如学习《易经》了解了阴阳变化、消长盈虚的规律，从而更有助于理解和掌握中医的阴阳学说。古人有“易于医通”之说，即是指此。
《内经》乃中医理论之渊薮。王冰称其为“至道之宗，奉生之始”。但其言简意博，理奥趣深，学习时要结合诸家，多方考虑，择善而从。其难解之处，尤要结合临床，不可贸然否定或擅做改动。记得初读《素问·生气通天论》时，对“因于暑，汗，烦则喘渴，静则多言，体若燔炭，汗出而散”一段经文颇为费解。窃思既有“汗”出，何以又说“汗出而散”，遍查各注，莫衷一是。丹溪翁更将暑改为“寒”，以明其可汗之理。后读东垣及温病各家论述，并验之临床，始感丹溪之改值得商榷。盖暑证汗出，既是邪热蒸迫津液外泄之象，又是邪热得以外解之途，非表虚亡阳之汗可比。故初起需“汗出而散”，绝对不可以止汗。后世以新加香薷饮治暑温初起无汗，白虎汤加减治暑温壮热烦渴、汗出之证，无不取辛散退热之意，所谓“暑当与汗俱出，勿止”之谓也。可见，一个问题需反复思考，多方查证，并结合实践，才能真正理解。再如切脉，《内经》有“三部九候”之论，由于种种原因，后世发展为“独取寸口”，但实践之中常感不够。如大面积烧伤及某些血管病患者，寸口无法切按或无脉，则不仅需“三部九候”进行诊脉，甚至凡体表未被灼伤部位，一切可触到之动脉，皆可切按。如脐间动气，十二经脉等常可弥补独取寸口之不足。对于危难重症欲知其预后吉凶，还须以下部三候（足厥阴、足少阴、足太阴）中诊视，即古人谓之枝叶虽萎，而树根犹荣也。
在诵读原文的同时，要选择一些注本进行阅读，以加深对原文的理解。且许多注家有精辟的论述和极有见地的发挥。为此，家伯和孟师要求我在读书时，除先读序言、凡例以了解其写作动机、过程及大致内容外，还要重视注文的学习。如王冰在注《素问·至真要大论》“诸寒之而热者取之阴，热之而寒者取之阳”时，提出了“壮水之主，以制阳光，益火之源，以消阴翳”的治疗原则，对临证有极大的指导意义。张景岳在“阴阳者，天地之道也”下注有“道者，阴阳之理也，阴阳者，一分为二也”的精辟论述，若不细读，焉能得知？对于其它典籍的小注眉批，亦应细读，不可草草放过。如汪昂《增补本草备要》，其注文博采各家所长，引证广泛，立论公允，文字简练，要言不繁，不仅了解许多医家之用药特点和经验，学到不少有效方剂，且可节省大量时间，真是一举多得。如黄柏治口疮下小注云：“治口疮用凉药不效者，乃中气不足，虚火上炎，宜用反佐之法，参、术、甘草补土之虚，干姜散火之标，甚加附子，或噙官桂，以引火归元。”寥寥数语，而理法方药井然一贯，从中可以得到反治经验。其次，一些有效的单方验方常以小故事体裁记述下来，既引人入胜，又易于记忆。如枳壳条下，方士进瘦胎饮；蛤粉条下，宋徽宗宠姬病痰嗽，面肿不寐，李防御治之不效，向走方郎中求得黛蛤散。它如肺损用白芨末，产风血运用华佗愈风散（荆芥穗），阳明头目昏痛用都梁丸（白芷），胃气痛用良附丸等等，至今仍为医家所习用。
上下不通之“关格”证及二便不通之证，病势急迫，医者甚感束手。我在翻阅《本草纲目》时，观四十一卷“蜣螂”（又名铁甲将军、推车客）条下，云其“治大小便不通”（大便不通用上截，小便不通用下截，二便不通全用）；“蝼蛄”有“利大小便”之效，用治“十种水病”，“大腹水病”，“小便不通大便闭”之证（用时取下体）。临证用于二便不通之证，果然有效。一妇因针刺后感染，二便不通，腹胀难忍，不可触摸，需支架护其腹部，饮食难进，极度虚弱，因处以铁将军、蝼蛄、人参、附子等攻补兼施之剂。药后二便通利，所下结粪如羊矢状，大量尿液亦浸泡其身，遂得痊愈。可见无论正文、注释，皆是前人经验总结，都应仔细钻研，验之临床，方能有所收获。
“眉批”亦是评注者在熟读精思、深明个中三昧后，以最简练的语言在原文上方，提出的个人评价或见解，多是最关键、最吃紧处。使读者从疑似之间得到正确的理解，具有提纲挈领、画龙点睛之妙，亦值得认真阅读。
勤于实践，善于总结
随师侍诊是临床实践的第一步。我初见病人时，茫然不知所措，但边抄方、边体会老师诊病时的一言一行。侍诊日久，则对老师辨证思路及治疗特点有所认识，并逐渐能够独立思考。许多病症不经过实践是难以认识和掌握的。如亡阴亡阳之重证，若不当机立断，危在顷刻。而只有书本知识，不经过临床体验不敢决断和处理。随伯父侍诊时，曾治一赵姓患者，证见头身汗出如雨，四条毛巾擦拭不迭，心慌气促，四末厥逆，脉细如丝，伯父诊为大汗亡阳之证，遂投大剂参附，随煎随饮，三小时后汗收厥回而苏。使我对大汗亡阳留下深刻印象。类似病例在我侍诊时见到很多，对以后临证中抢救亡阳亡阴重证教益很大。
一九三九年之后，我独立应诊。凡日间疑似难辨、立法处方无把握者，则于晚间研读有关书籍，即是古人“白天看病，晚上读书”的方法。尤其是阅读一些医案，如喻嘉言《寓意草》、章楠治案》、《柳选四家医案》、《辨证指南医案》等，以提高辨证分析能力，从前人验案中得到启发。前贤谓读书不若读案，确有一定道理。
在实践中应不断总结，循序渐进，逐步掌握一般疾病发展、转化、预后及诊治的基本规律。如“消渴”一证，有上、中、下三消之说，前人论之甚详。积多年临证观察，我常以脏腑经络辨证，认为本病发于中，起于胃，次及于肺，终归于肾。初因脾胃失和，而致胃热伤津；继则子病累母，胃热上蒸，灼伤肺阴，终则下传于肾，真阴受损，阴损及阳，气化不行，而渐由阴虚阳亢，导致阴阳俱衰。故初则宜白虎、增液清其胃脾燥热。其腑实者亦可以调胃承气釜底抽薪治其标，再用清胃养阴治其本；在肺则以生脉散、白虎剂清胃润肺；入肾则先用生脉散，地黄汤，大补阴丸滋其阴，阳衰者则宜肾气丸益火之源，助其气化。以此辨治，较为简明。但应注意，消渴虽以阴虚燥热为特点，治以养阴清燥为常法。但“火与元气不两立”，“壮火食气”，又以正气不足为其本，故用药不可过于寒凉，尤应忌用苦寒，而始终要注意益气扶正，助其气化。如黄芪、太子参等，常宜相机选用。
此外，不仅要总结成功的经验，更要善于总结失败的教训。一九四二年，乡中陈某患温病逾月，屡治不效，延请往视。至时家人正焚香拜佛，祈祷神灵。患者年方十七，观其僵卧于炕，两目直视不眩，面色晦滞，昏睡不醒。观其舌，质暗而紫，苔黄厚而干。切其脉如转索，左右弹指。扪鼻察息，呼吸虽慢而尚匀，吐气虽微而仍温，四肢逆冷。索观前医处方数十张，多宗白虎加减，而方中石膏用量颇重，初用二两，渐增至半斤，且皆煅用。面对此等危症，一时难于决断。沉思良久，悟出此系石膏用之不当。石膏煅用，失却解肌之效，而成寒凝之弊，遂致邪热内伏不得外达，犯了“汗不出者，不可与也”之戒。欲解其凝，必以温通。虽热伏于内，但元气已衰，遂以参附汤化裁，以人参、淡附片、紫油桂各1.5克，煎水频服，观其动静。翌晨，家人喜来相告，药后至夜半时，病者眼启能言，少思饮食，四肢转温而能屈伸。我因忙于诊务，以为既已见效，可守方不变，嘱其继进两剂。孰知三日后家属张惶来告，言服完两剂后，骤然烦躁不安，赤身裸体，言语不休，行动狂妄，如有鬼凭。我急往诊视，果如所述。见其面色红赤，舌质红绛，苔黄燥而有芒刺。询其大便数日未行，口渴思饮，手足濈然汗出，其脉沉实有力，纯系一派阳明腑实之候。遂用增液承气化裁，以滋阴润燥，荡涤腑实。药后当晚下燥屎二十余枚，二日后热退身清。事后，我自责临证草率从事，致生变端。本例初用温通回阳之桂附，原为救急扶正之图，既已奏效，则当更议他法，然未详察，以为得效而觉原方药少量小力薄，可再继进。致使燥烈之性激发伏热，二火交炽，亢盛莫制，遂成阳明腑实之证。误治之失，甚为内疚。深感医者责任重大，且医理精深，必须详究。倘稍有疏忽，则祸不旋踵。孙真人谓“胆欲大而心欲细，行欲方而智欲圆”，诚为至理名言，应为医者之座右铭。
博采众长，融会贯通
4. The tonification and sedation techniques of "Burning Mountain Fire" (Shāoshānhuǒ) and "Penetrating Heaven Coolness" (Tòutiānliáng). The presence or absence of thermal sensation (heat or cold) under the needle during acupuncture serves as the indicator for the success of these techniques. They evolved from the aforementioned lifting-thrusting tonification and sedation methods into more complex manipulations. Regarding the intensity of needle sensation: when using tonification, the effect of Burning Mountain Fire is significantly stronger than that of the lifting-thrusting method; when applying sedation, the two are basically identical. This contradicts the theory that "light stimulation acts as an excitatory tonification method, while strong stimulation acts as an inhibitory sedation method." In clinical application, like other tonification and sedation techniques, it relies on the meridian theory, combined with the differentiation of cold and heat patterns based on symptoms. The manipulation must adhere to the principle of "tonifying with heat sensation under the needle, and sedating with cold sensation under the needle."
Regarding indications, *The Golden Needle Ode* (*Jīnzhēn Fù*) records: "Burning Mountain Fire treats stubborn numbness and cold bi-syndrome... effectively dispelling cold," and "Penetrating Heaven Coolness treats muscle fever and bone-steaming consumption... reliably reducing heat." Since cold bi-syndrome is caused by an excess of cold pathogenic factors, the Burning Mountain Fire technique should be employed to "warm yang and dispel cold." This is based on theories such as those in *Suwen: Bi Syndrome Chapter* stating "excess cold is called pain-bi syndrome," and *Lingshu: Shouyao Gangrou* stating "acupuncture for cold bi-syndrome should induce internal heat." The muscle fever and bone-steaming treated by Penetrating Heaven Coolness are caused by deficiency fire blazing and internal marrow heat, commonly seen in patients with consumptive diseases. Therefore, following the principle of "treating cold with heat and heat with cold" (direct treatment), the sedation technique of Penetrating Heaven Coolness is used to reduce deficiency heat. Modern concepts of excitatory and inhibitory needle sensations cannot equate to Burning Mountain Fire and Penetrating Heaven Coolness, nor can they achieve the specific thermal sensations under the needle.
Conclusion
Looking back on my forty-plus years of academic pursuit, I have encountered both lessons and experiences. Without enduring the bitterness of frost and ice, one rarely achieves the penetrating fragrance. Traditional Chinese Medicine has a profound heritage, and medical texts through the ages are as vast as the sea. To improve professional competence, one must exert great effort. On the journey of seeking knowledge, one must not stop after a superficial taste, nor should one become complacent and stagnate after achieving minor gains. Although advanced in age, I dare not slacken off, and I wish to encourage myself along with the younger scholars.
(Compiled by Lou Xinghuang and Shi Mingxian)
Studying Medicine Requires Diligence; Clinical Practice Values Differentiation
Deputy Chief Physician, Second Clinical Medical Research Institute, Academy of Traditional Chinese Medicine: Lu Zhizheng
[Author Profile] Lu Zhizheng (1920–), from Gaocheng County, Hebei Province. Engaged in Traditional Chinese Medicine work for over forty years. After liberation, he worked in the Technical Guidance Section of the TCM Department of the Ministry of Health, making numerous efforts to develop TCM academics, promote acupuncture therapy, and facilitate Sino-Western medical exchanges. He served as a committee member of the Sino-Western Medical Exchange Committee of the Chinese Medical Association. Currently, he is a committee member of the Academic Committee of the Academy of Traditional Chinese Medicine and Deputy Director of the Internal Medicine Academic Research Office at Guang'anmen Hospital. Proficient in TCM classics, with particular expertise in the spleen and stomach, skilled in TCM internal medicine and acupuncture, possessing high clinical attainments. He participated in compiling *Compilation of TCM Clinical Data* (1955), *Overview of Chinese Acupuncture*, and the *Pharmacopoeia of the People's Republic of China*.
Although I have been engaged in TCM work for over forty years, I feel ashamed of my shallow learning and lack significant contribution. However, reviewing my past studies, amidst the chicken crow and lamplight, I experienced both sweetness and bitterness. Day by day and grain by grain, I gained some insights. I record them here, perhaps to verify gains and losses.
Inheriting Family Learning, Accumulating Step by Step
My uncle, Lu Yixiu, was a famous doctor in our hometown, and my father had basic knowledge of medicine. The family atmosphere made me love medicine since childhood. In my youth, my father taught me daily recitations of *Thousand Character Poems* and *Medical Three Character Classic*. At six, I entered school, and in my spare time, he urged me to read introductory books like *Ode to Drug Properties* and *Song of Prescriptions*. Later, I entered primary school but dropped out due to financial difficulties, studying medicine with my uncle while also reading the Four Books. Classical Chinese was dry and difficult, often causing fear of difficulty. Occasionally, when I stole time to play, my uncle would teach me using *Xunzi: Encouraging Learning* and Song Lian's *Preface to Sending Dongyang Ma Sheng to Study*.
My uncle's method for teaching me to recite TCM classics was: first, low chanting—reading aloud softly to oneself, repeating dozens or hundreds of times, flowing like water and clouds, memorizing naturally upon speaking. He opposed loud reading or forced memorization, as forgetting would be rapid. After low chanting, one should gradually slow down, feeling the meaning of the text while reading, known as "immersive chanting," striving to understand the original text. Confucius said: "Learning without thinking leads to confusion; thinking without learning leads to danger." This gradually helped me recognize the complementary relationship between recitation and understanding, as the saying goes, "Read a hundred times, and the meaning reveals itself." Many masterpieces and TCM classics were recited then, and I can still recite many passages clearly today, deeply benefiting from those years of study. Habit becomes nature. If I do not read in the morning, I feel lost. Reciting fluently brings joy. Now in my sixties, this interest remains undiminished.
Familiarity with Classics, Equal Emphasis on Medicine and Literature
In 1934, my uncle founded a medical school, and I formally began studying medicine. At that time, Meng Zhengyi, a famous doctor from Yanchi, Shanxi, was traveling in Hebei, becoming well-known in the Wuji area. My uncle interacted closely with him and ordered me to take him as my teacher. Master Meng had rich experience and deep theoretical attainment, rigorous scholarship, and effective teaching. He advocated starting with difficult material, mastering classics first, then exploring various schools, to achieve a commanding perspective. Designated books mainly included *Suwen*, *Lingshu Jing*, *Illustrated Nanjing Pulse Rhymes*, *Shanghan Lun*, *Jingui Yaolue*, and *Essentials of Materia Medica*. Knowing that TCM classics are profound, with characters having multiple pronunciations and meanings, frequent ancient borrowings, and no punctuation, mastering the classics requires overcoming the language barrier first. Without a solid foundation in classical Chinese, one cannot enter the hall. He specially invited Chen Xuanze, a late Qing scholar, to teach *I Ching* and *Guwen Guanzhi*. Emphasizing both medicine and literature improved literary literacy and deepened understanding and memory of scriptures. For example, studying *I Ching* revealed laws of yin-yang changes, growth, decline, fullness, and emptiness, aiding the understanding of TCM yin-yang theory. The ancients said "I Ching and medicine are connected," referring to this.
*Neijing* is the source of TCM theory. Wang Bing called it "the ancestor of the supreme way, the beginning of nurturing life." Its words are concise yet profound, principles obscure yet interesting. Study must combine various commentaries, consider multiple aspects, and adopt what is good. Difficult parts especially require combination with clinical practice; one must not rashly deny or arbitrarily modify them. Remembering my first reading of *Suwen: Shengqi Tongtian Lun*, I struggled with the passage: "Affected by summer-heat, sweating; if restless, panting and thirst; if quiet, excessive talking; body like burning charcoal, disperses with sweating." I pondered: if there is already "sweating," why say "disperses with sweating"? Consulting various annotations yielded no consensus. Danxi changed "summer-heat" to "cold" to clarify the rationale for sweating. Later, reading Dongyuan and warm disease theorists, and verifying clinically, I felt Danxi's change was debatable. Summer-heat sweating is both an image of evil heat steaming and forcing fluids outward, and a pathway for evil heat to resolve externally, unlike the sweating of exterior deficiency and yang collapse. Thus, initially, it needs "to disperse with sweating"; absolutely do not stop sweating. Later generations used Xinjia Xiangru Yin for early-stage summer-warmth without sweat, and Baihu Tang modifications for summer-warmth with high fever, irritability, thirst, and sweating, all taking the intent of pungent dispersion to reduce heat, meaning "summer-heat should exit with sweat, do not stop it." Thus, a problem requires repeated thought, verification, and practice to truly understand. Regarding pulse diagnosis, *Neijing* discusses "Three Regions and Nine Locations," but later developed "Only Taking the Cunkou" due to various reasons. In practice, this often feels insufficient. For extensive burns or certain vascular patients, the Cunkou may be unpalpable or pulseless, requiring "Three Regions and Nine Locations" for diagnosis, even palpating any accessible artery on unaffected skin, such as abdominal pulsations or twelve meridians, to supplement Cunkou limitations. For critical conditions to predict prognosis, one must examine the lower three locations (Foot Jueyin, Foot Shaoyin, Foot Taiyin), as the ancients said: "Though branches and leaves wither, the tree roots remain prosperous."
While reciting originals, select commentary editions to deepen understanding. Many commentators offer profound discussions and insightful expansions. Therefore, my uncle and Master Meng required that besides reading prefaces and examples to understand motives, processes, and content, one must value studying annotations. For instance, when Wang Bing annotated *Suwen: Zhi Zhen Yao Da Lun* "Those treated with cold remain hot, treat the yin; those treated with heat remain cold, treat the yang," he proposed the treatment principle "Strengthen the root of water to control solar brilliance, benefit the source of fire to dissipate yin shadows," which has great guiding significance for clinical practice. Zhang Jingye annotated "Yin and yang are the dao of heaven and earth" with "Dao is the principle of yin and yang; yin and yang are divided into two." Without careful reading, how could one know? Small notes and marginal comments in other classics should also be read carefully. For example, Wang Ang's *Supplemented Essentials of Materia Medica* collects strengths from various schools, cites extensively, argues fairly, uses concise language, and avoids verbosity. It reveals medication characteristics and experiences of many doctors, teaches effective formulas, and saves time, achieving much with little effort. Under Huangbai treating mouth ulcers, a small note says: "When cooling medicines fail to treat mouth ulcers, it is due to middle qi deficiency and deficiency fire flaming upward. Use counter-assistance method: Ginseng, Atractylodes, Licorice to tonify earth deficiency; Dried Ginger to scatter fire's branch; add Aconite or hold Cinnamon Bark to guide fire back to its origin." In few words, principles, methods, formulas, and drugs are consistent, providing experience in reverse treatment. Secondly, effective single prescriptions are often recorded as short stories, engaging and easy to remember. Under Zhiqiao, a Daoist offered Shoutai Yin; under Ge Fen, Emperor Huizong's concubine suffered phlegm-cough, facial swelling, and insomnia; Li Fangyu failed to cure her, so she sought Daihe San from a wandering physician. Others include Biejia powder for lung damage, Huatuo Yufeng San (Schizonepeta) for postpartum wind-blood, Duliang Wan (Angelica dahurica) for Yangming head/eye pain, Liangfu Wan for stomach qi pain, etc., still widely used by doctors today.
"Guan Ge" syndrome of upper and lower blockage, and syndromes of inability to pass urine and stool, are urgent, leaving doctors helpless. While consulting *Compendium of Materia Medica*, observing the entry for "Scarab Beetle" (also Iron General, Cart Pusher) in Volume 41, it states it "treats inability to pass large and small stools" (upper part for large stool, lower part for small stool, whole for both); "Mole Cricket" has the effect of "promoting urination and defecation," used for "ten types of edema," "large abdomen water disease," and "inability to pass urine with constipation" (use lower body). Clinically applied to these cases, it was indeed effective. A woman, infected after acupuncture, could not pass urine or stool, abdomen distended and unbearable, untouchable, needing support, unable to eat, extremely weak. She was prescribed a formula combining attack and tonification with Scarab Beetles, Mole Crickets, Ginseng, and Aconite. After medication, bowels and bladder opened, passing hard feces like sheep dung, soaking in large amounts of urine, and recovered. Thus, whether main text or annotations, they are summaries of predecessors' experience, requiring careful study and clinical verification to gain results.
"Marginal comments" are personal evaluations or insights proposed by annotators in concise language above the original text after deep reading and comprehension, usually at the most critical points. They help readers obtain correct understanding from doubt, serving as a summary and highlight, worthy of serious reading.
Diligent in Practice, Good at Summarizing
Attending consultations with a teacher is the first step of clinical practice. When I first saw patients, I was bewildered, copying prescriptions while observing the teacher's every word and deed. After long attendance, I understood the teacher's differentiation思路 and treatment characteristics, gradually gaining independent thinking ability. Many syndromes are hard to recognize and master without practice. For severe syndromes of collapsing yin or yang, hesitation means imminent danger. Book knowledge alone, without clinical experience, makes one afraid to decide and handle. Attending with my uncle, I once treated a Mr. Zhao, presenting with profuse sweating like rain, requiring four towels constantly, palpitations, shortness of breath, cold extremities, and thread-like pulse. My uncle diagnosed massive sweating leading to yang collapse, administered a large dose of Shen Fu Decoction, brewed and drunk immediately. Three hours later, sweating stopped, coldness reversed, and he revived. This left a deep impression on me regarding massive sweating and yang collapse. Similar cases were common during my attendance, greatly educating me in rescuing severe collapsing yin/yang cases later.
After 1939, I practiced independently. For ambiguous diagnoses or uncertain prescriptions during the day, I studied relevant books at night, following the ancients' method of "seeing patients by day, reading by night." Especially reading medical cases like Yu Jiayan's *Yuyi Cao*, Zhang Nan's cases, *Liu's Selection of Four Families' Cases*, and *Bianzheng Zhinan Yi An*, to improve differentiation analysis skills and gain inspiration from predecessors' verified cases. Predecessors said reading cases is better than reading books, which has truth.
One should constantly summarize in practice, advance step by step, and gradually master basic laws of disease development, transformation, prognosis, and treatment. For "Xiao Ke" (Wasting-Thirst), there are upper, middle, and lower divisions, discussed in detail by predecessors. Based on years of observation, I often use zang-fu and meridian differentiation, believing this disease originates in the middle, starts in the Stomach, spreads to the Lung, and finally settles in the Kidney. Initially, spleen-stomach disharmony causes stomach heat injuring fluids; subsequently, the child disease affects the mother, stomach heat steams upward, scorching lung yin; finally, it transmits downward to the kidney, damaging true yin, yin damage affecting yang, qi transformation failing, gradually shifting from yin deficiency with yang hyperactivity to dual deficiency of yin and yang. Thus, initially, use Baihu Tang and Zengye Tang to clear stomach-spleen dryness-heat. For fu-organ excess, use Tiaowei Chengqi Tang to remove the bottom wood to draw away fire (treat branch), then clear stomach and nourish yin (treat root); for Lung, use Shengmai San and Baihu agents to clear stomach and moisten lung; for Kidney, first use Shengmai San, Dihuang Tang, and Dadu Yin Wan to nourish yin; for yang deficiency, use Shenqi Wan to benefit fire source and assist qi transformation. This differentiation is relatively simple. But note: although Xiao Ke features yin deficiency and dryness-heat, treated normally by nourishing yin and clearing dryness, "fire and primordial qi do not coexist," "vigorous fire consumes qi," so deficiency of righteous qi is the root. Medicines should not be too cold, especially avoid bitter-cold, always focusing on boosting qi and supporting righteousness to assist qi transformation. Astragalus and Pseudostellaria Root are often selected opportunistically.
Furthermore, one must summarize not only successful experiences but also learn from failures. In 1942, a villager named Chen suffered from warm disease for over a month, unresponsive to treatments. I was invited. Upon arrival, his family was burning incense and praying. The patient was seventeen, lying stiffly, eyes staring fixedly, complexion dull, unconscious. Tongue was dark purple with thick, dry yellow coating. Pulse was like a turning rope, bouncing fingers. Nose breathing was slow but regular, exhaled air warm, extremities cold. Reviewing dozens of previous prescriptions, mostly Baihu Tang variations, with heavy doses of Gypsum, starting at two taels, increasing to half a catty, all calcined. Facing such critical illness, I hesitated. After deep thought, I realized improper use of Gypsum. Calcined Gypsum loses its muscle-releasing effect and causes cold coagulation, trapping evil heat internally, violating the warning "if no sweat, do not give [Gypsum]." To resolve coagulation, warmth and unblocking are needed. Although heat is trapped inside, primordial qi is depleted. I modified Shen Fu Tang, using Ginseng, mild Aconite slices, and Purple Oil Cinnamon Bark, each 1.5g, decocted and taken frequently, observing reactions. Next morning, family happily reported that after midnight, the patient opened eyes, spoke, desired food, extremities warmed, and could bend/stretch. Busy with consultations, assuming efficacy, I advised sticking to the formula for two more doses. Three days later, family anxiously reported that after finishing two doses, the patient suddenly became irritable, naked, talkative, and wild, possessed by spirits. I rushed to examine, confirming their description. Face red, tongue red with prickles, coating yellow and dry. Bowels hadn't moved for days, thirsty, hands and feet sweaty, pulse deep, firm, and forceful—a pure Yangming fu-excess pattern. I modified Zengye Chengqi Tang to nourish yin, moisten dryness, and purge fu-excess. That night, passed over twenty hard feces; two days later, fever subsided, body cleared. Afterwards, I blamed myself for hasty clinical judgment causing complications. Initially using warming/unblocking Gui-Fu was for emergency rescue and supporting righteousness. Once effective, methods should change. However, failing to observe carefully, thinking small dose was weak, I continued it. This stimulated latent heat with dry-hot nature, fire and heat intertwining uncontrollably, resulting in Yangming fu-excess. The error in treatment caused deep guilt. Realizing the heavy responsibility of doctors and the profundity of medical principles, one must study thoroughly. Any negligence brings immediate disaster. Sun Simiao said, "Courageous but cautious, upright but flexible," truly a golden rule for doctors.
Absorb Strengths from All Sources, Integrate and Comprehend