又如患者李××，男，62岁。冠心病、心肌梗死，心房纤颤15天。医以西药治疗后气短稍减，但心房纤颤未见改善。邀余诊治。审其症见头晕目眩，心悸气短，胸满胸痛，心烦喜呕，脉弦数而时兼涩。余云：此证乃少阳柴胡证也，可予小柴胡汤治之。某医云：余在某次学术讲座时，曾听先生介绍过此方，然余用之不效也。患者听后云：不但无效，而且有很多副作用。余问：您用的什么药?答曰：有柴胡、银花、连翘、川芎、丹参、当归、葛根、生石膏、绛香、桃仁、红花、赤芍、郁金等。余听后云：余所用之柴胡汤乃仲景之小柴胡汤也。乃处：柴胡10克，半夏10克，黄芩10克，人参10克，生姜4片，大枣7枚，甘草10克，瓜蒌15克。服药2剂，诸证大减，其后心房纤颤果然消失。某医问：何前用柴胡汤不效，后用柴胡汤取效也?答曰：前医之方非小柴胡汤，后用之方乃柴胡汤也。此时弊之病也。有云某汤者问其何药组成，不知也，或只知其中的一二味药，此前医之所云柴胡汤者即想当然也。因此辨证论治时必须知时弊也。
怎样学习和应用方剂
方剂是辨证论治过程中的重要环节，方剂组成的好坏直接影响辨证论治过程中的治疗效果，所以历代医家都很重视方剂学的研究。
中医古籍浩如烟海，所载方剂很多，再加上近代医家和每个医生所组成的验方就多而更多了。所以记忆难，应用就更难了。怎么办?我开始时一背就背了5000多个，但是仍然感到很多没有背过，一用就更难了，不知用哪个好，久久难于开方。后来，经过分析、归纳、对比，一下子开朗了很多，5000多个方不过400多个方类，结果确实作到了方中有方、方中有药、药中有方。不但在临床上的用方严格了，而且疗效也提高了。那么我是怎么学习和应用方剂的呢?大致说来有以下几点：
一、学习的方法
1．背过多数人认为有效的方剂。这些方剂不但要背过它的组成、功用、主治，而且要背过它们药物组成上的配伍方法、加减方法。只有这样我们才会作到举一反三地应用方剂。这些方剂从哪找?我的回答很简单：讲义、汤头歌诀中记载的即是多数人认为有效的方剂。
2．善于观察众多方剂间的总趋势。例如银翘散、越婢汤、升降散，尽管药物组成根本不同，但它们间的总趋势都是辛凉解表。麻黄汤、荆防败毒散、九味羌活汤尽管药物组成根本不同，但它们间的总趋势都是辛温解表。因此前者都是治疗风热外感的，后者都是治疗风寒外感的。
3．善于发现总趋势相同方剂中的特殊引经药。例如：独活寄生汤和三痹汤，从其总趋势来看，都是益气养血，祛风除湿，治疗风湿痹证的方剂。但是由于三痹汤多了黄芪的补气升阳，少了桑寄生的补腰肾，使其主要功用变成主治上半身，特别是肩臂风湿的方剂，而独活寄生汤则成了主治腰腿疼痛的方剂了。
4．善于发现相似方剂间的不同用药和药物间的用量比例。例如：黄连汤和半夏泻心汤，两个方剂除一味药不同外，其余药味全部相同，但就是这一味药的不同，使这两个总趋势相同，即都用于寒热夹杂证痞满、泄泻的方剂，变成了一个用于寒多热少证，一个用于热多寒少证。又如：桂枝汤和桂枝去芍药汤，两方仅差一味芍药，但却变成了桂枝汤调和营卫，桂枝去芍药汤温通心阳。
5．善于发现组成药物相似中的不同点。例如：不同方剂中采用了不同的化痰止咳药，如一者采用了百部、紫菀、杏仁，二者采用了贝母、前胡，我们分析时，就要善于区别它们间的相异点，并找出这些药物的特点。如紫菀不但降气化痰，并且止咳通络；百部止咳甚佳，而有润肺之功，但无化痰之力；杏仁重在降气止咳，而稍能定喘；贝母除热痰，稍有软坚之力；前胡既解表，又降气化痰。应区别使用。
6．注意发现方剂组成药物间的协同和制约。例如：用于止咳化痰的紫菀、冬花，两药相配，可使它们的定喘止咳作用增强；黄柏、知母相配，可使它们滋阴降火的作用增强；黄柏、砂仁相配，可明显提高砂仁的涩精作用。
二、应用方法
1．选择方剂要严格要求，绝不马虎从事。例如：证见寒热往来，胸胁苦满，心烦喜呕，口苦咽干，脉弦的少阳证，就予小柴胡汤；厥阴头痛，干呕吐涎沫或呕吐者，就予吴茱萸汤，而不加减任何药物。
2．加减药味一定要严格。在这方面张仲景可以说是一个典范。例如：他在《伤寒论》中阐述小柴胡汤的适应证时，又明确指出：“若胸中烦而不呕者，去半夏、人参，加栝楼实一枚；若渴者，去半夏，加人参合前成四两半，栝楼根四两：若腹中痛者，去黄芩，加芍药三两；若胁下痞硬，去大枣，加牡蛎四两；若心下悸，小便不利者，去黄芩，加茯苓四两；若不渴，外有微热者，去人参，加桂枝三两，温覆微汗愈；若咳者，去人参、大枣、生姜，加五味子半升，干姜二两。”假若随心所欲地加减药物，常常失掉原方含义。例如：麻杏石甘汤是由麻黄、杏仁、石膏、甘草组成的方剂，其麻黄、石膏的用药比例为l：2，主用于热壅在肺的汗出而喘无大热者，假若因为考虑是肺部炎症，而加大石膏用量，并增黄芩、黄连、黄柏、栀子、银花、连翘等清热解毒药，就不治肺，而成了清热解毒剂了。
3．选择用方时，一定要注意适其至所，不可太过不及。这里尤其注意的是药物的用量和归经问题，千万不可认为药量大就是好，因为有的药量过大反而过其病所而伤正，正如《素问》所说：“勿使过之伤其正也。”所以喻嘉言说：“不明脏腑经络，开口动手便错。”
4．加减药物时，一定要注意方中有方，药中有方。例如：真武汤由茯苓、芍药、生姜、白术、附子等组成，主用于肾阳衰微，水气内停，症见小便不利，四肢沉重疼痛，恶寒腹痛，下利，或肢体浮肿，与太阳病，发汗，汗出不解，其人仍发热，心下悸，头眩，身（目闰）动，振振欲擗地者。若去生姜，加人参，则名附子汤，用于寒湿内侵，身体骨节疼痛，恶寒肢冷，脉沉细无力者。若不去生姜，但加人参，则非但具有真武汤之功，并且兼有附子汤之效，就是说虽然仅仅加入了一个人参，但却具有了加人附子汤之意，所以也就具有了加入附子汤的功用主治。若在真武汤中加入一味肉桂，则具有了茯苓甘草汤的功用主治，即非但具有真武汤的功用，并且具有茯苓甘草汤治奔豚之功。
问诊中存在的问题
在临床中，我们应该提倡严格准确的问诊内容，因为它是达到正确地进行辨证论治的基础。但是，由于以下的很多主、客观原因严重的影响着辨证论治的准确性。例如：
1．由于患者是一个家庭的主要支柱，他的病情直接影响着家庭成员的经济来源和社会地位的高低，所以每个家庭成员都很关心他的病情，因此家属常常以夸大病情的方法陈述病情。
2．由于患者在家庭中被认为是无足轻重或带来累赘的人，所以家属常常以掩盖病情或大事化小的说法陈述病情。
3．由于患者具有较高的地位和权势，某些人鉴于他的权势和地位可能对其前途的影响，唯恐将其病情说得太轻影响病情的发展，所以常常以夸大病情的方法陈述病情。
4．由于患者的权势已经衰落，某些人或者怕其连累自己而倒霉，或者认为正可落井下石，所以常常以掩盖病情或大事化小的方法陈述病情。
5．由于某些患者过度信任前医的诊断，所以他在主诉上尽量围绕着该种诊断进行陈述，有些患者甚至只说病名而不说症状，致使重要的病情被掩盖。
6．由于某些患者过度信任某些非医务工作者的言语，所以在他的主诉中尽量围绕着这些怀疑进行陈述，而对其他重要的情况不予陈述。7．由于患者不懂或缺乏医学上术语概念的准确含义，而却常常以医学上的概念进行阐述，致使病情的真实情况被掩盖。
8．患者治疗过程中应用的治疗方法和药物本应完整地进行说明，而某些医者或患者却因种种原因只对其中的几种进行宣扬，而对其他的药物和治疗方法却加以掩盖或不予陈述。
9．由于患者对我们的崇拜和敬仰，很希望能够得到信任医生的诊治，所以唯恐说出一些医生不愿听的话，所以常常掩盖一些病情加重或无效的陈述。
10．由于某些人士或某些医生对患者的影响，使患者有意或无意地夸大或贬低药物的真实疗效的陈述。
11．由于我们医者过度地以先人为主的主观性代替了客观性，所以对与我们不相一致的任何陈述往往加以忽视。
所有这些都是影响问诊中准确性的大敌，因此必须加以克服。
为要克服影响问诊准确性的诸多因素，我认为可采用以下方法：
1．尽量以主诉代替代诉，对主诉与代诉不相一致的病情陈述要以主诉为主。
2．对于以病名代替症状表现的陈述，不管是主诉或代诉，都应以症状表现的陈述为主，以企通过询问发现问题。
3．对于涉及到的治疗过程与用药的陈述，一定要认真具体，对于所述药物与实际情况无关，而某些医生或患者认为有关的情况，一定要进一步追询其用药的全部情况。
4．对于涉及治疗中的某些方剂的问题，一定要亲自看看其是否用的该方药，以免以错误的事实作根据进行辨证论治。
中西药并用与药物七情
在与一些医者、患者，甚至政策的决定者的交谈中，经常遇见一些这样的意见。说：“中医好，西医好，中西医结合岂不更好!”“中药好，西药好，中西药并用岂不更好!”又说：“为什么一些西医，一些中医，就是那么顽固?为什么一些老中医就是那么保守，坚持什么纯中医中药治病?”我说：“这个问题很复杂，很难用一句话说清楚。”他们立刻就说：“我们知道你是坚持中医治病的。”有的甚至说：“你是新时代大学毕业的，你是学了很多现代科学、现代医学知识的人，你可千万不要象过去的老中医那样不开窍，顽固地坚持过去的中医那一套。”我说：“科学不科学不是靠嘴说其是不是科学，而是靠其符不符合事实，靠其符不符合实践。我认为只有实践是检验真理，检验是否科学的唯一标准，而无其他。”至于中药好，西药好，中药西药并用是否更好；中医好，西医好，中西医一块儿治某个病是否更好的问题，我看还是具体事物具体分析为好。
例如：患者胡××，男，36岁。突然胸脘满痛，呼吸困难，心悸汗出，头晕。医诊冠心病。急以西医西药抢救，两日后，不见明显改善。邀余会诊。察脉弦紧数促并见，舌苔白。综合脉证，诊为寒饮中阻，心阳不振，肝木失达。为拟疏肝理气，温阳化饮。处以：柴胡10克，半夏10克，黄芩10克，人参10克，甘草6克，干姜4克，大枣5枚，苍术10克，厚朴10克，肉桂10克，陈皮10克，茯苓10克。昼夜兼进2剂，效果不著。患者家属问：“每次患者服用西药之后均感症状加剧，是否可暂停西药?”答曰：“过去曾遇一例患者停用西药后症状很快消失，你们不妨试一试。”患者果遵余意服药3剂，症状也果然大部消失。此时主管医生得知患者停用西药立刻勃然大怒。曰：“你们为什么竟然停用治病的药，中药又不治病，出现危险谁负责。”患者及其家属虽然不完全同意他的意见，但又觉得医生是好意，于是采用了既服西药，又服中药的方法治疗。两日后，诸证非但不减，反见加剧。于是患者又偷偷地停用了各种西药，15日后，诸证果然全部消失。若从这一例看，就不能说中药，西药并用就更好。
又如：一郭姓患者，男，56岁。双眼色素膜炎5年。左眼已基本失明，右眼在1米内可看见手动。邀余会诊。察其脉弦大紧数，舌苔薄白。综合脉证，诊为气阴俱虚，治以补气养阴。东垣清暑益气汤加减为方。服药7剂，不见改善。余云“中药应用过程中有一个重要的理论，就是配伍中的七情理论，这一理论要求除单味者外，还应注意配伍中的相须、相使、相恶、相杀、相反、相畏。既然我在开此方时考虑到了种种配伍中的关系，那么再加西药、中成药于其中将会形成什么结果呢?不知道。因此我的意见是暂时停用任何中、西药物。”服药10剂后，失明之左眼在1米内竟然可以睹见手指晃动，右眼较前视物明显清楚。然因患者及他医多次规劝，又加用中、西药饵一周，诸证又剧，不得不再次停用其他中、西诸药。果愈。其后郭姓患者屡屡介绍患者来诊，且每每嘱咐云：“千万不可既用西药，又用中药，以免使疗效降低。”
又如患者李××，男性，62岁。患有冠心病、心肌梗死，心房纤颤15天。经西药治疗后气短症状略有减轻，但心房纤颤未见改善。邀请我诊治。诊察其症状见头晕目眩，心悸气短，胸满胸痛，心烦喜呕，脉象弦数且时常兼有涩象。我说：此证属于少阳柴胡证（少阳经受邪所致的病证），可用小柴胡汤治疗。某医生说：我曾在一次学术讲座上听先生介绍过此方，但我使用它无效。患者听后说：不仅无效，而且有很多副作用。我问：您用的是什么药？回答说：有柴胡、金银花、连翘、川芎、丹参、当归、葛根、生石膏、沉香、桃仁、红花、赤芍、郁金等。我听后说：我所用的柴胡汤是张仲景的小柴胡汤。于是处方：柴胡10克，半夏10克，黄芩10克，人参10克，生姜4片，大枣7枚，甘草10克，瓜蒌15克。服用2剂后，各种症状大幅减轻，之后心房纤颤果然消失。某医生问：为什么之前用柴胡汤无效，后来用柴胡汤却见效？回答说：前医的方子不是小柴胡汤，后来用的方子才是柴胡汤。这是时弊之病。有人说某个汤剂，问其药物组成，却不知道，或者只知道其中的一两味药，此前医所说的柴胡汤就是想当然。因此辨证论治时必须了解这种时弊。
怎样学习和应用方剂
方剂是辨证论治过程中的重要环节，方剂组成的优劣直接影响辨证论治过程中的治疗效果，所以历代医家都很重视方剂学的研究。
中医古籍浩如烟海，所载方剂很多，再加上近代医家和每个医生所组成的验方就多而更多了。所以记忆难，应用就更难了。怎么办?我开始时一背就背了5000多个，但是仍然感到很多没有背过，一用就更难了，不知用哪个好，久久难于开方。后来，经过分析、归纳、对比，一下子开朗了很多，5000多个方不过400多个方类，结果确实作到了方中有方、方中有药、药中有方。不但在临床上的用方严格了，而且疗效也提高了。那么我是怎么学习和应用方剂的呢?大致说来有以下几点：
一、学习的方法
1．背过多数人认为有效的方剂。这些方剂不但要背过它的组成、功用、主治，而且要背过它们药物组成上的配伍方法、加减方法。只有这样我们才会作到举一反三地应用方剂。这些方剂从哪找?我的回答很简单：讲义、汤头歌诀中记载的即是多数人认为有效的方剂。
2．善于观察众多方剂间的总趋势。例如银翘散、越婢汤、升降散，尽管药物组成根本不同，但它们间的总趋势都是辛凉解表。麻黄汤、荆防败毒散、九味羌活汤尽管药物组成根本不同，但它们间的总趋势都是辛温解表。因此前者都是治疗风热外感的，后者都是治疗风寒外感的。
3．善于发现总趋势相同方剂中的特殊引经药。例如：独活寄生汤和三痹汤，从其总趋势来看，都是益气养血，祛风除湿，治疗风湿痹证的方剂。但是由于三痹汤多了黄芪的补气升阳，少了桑寄生的补腰肾，使其主要功用变成主治上半身，特别是肩臂风湿的方剂，而独活寄生汤则成了主治腰腿疼痛的方剂了。
4．善于发现相似方剂间的不同用药和药物间的用量比例。例如：黄连汤和半夏泻心汤，两个方剂除一味药不同外，其余药味全部相同，但就是这一味药的不同，使这两个总趋势相同，即都用于寒热夹杂证痞满、泄泻的方剂，变成了一个用于寒多热少证，一个用于热多寒少证。又如：桂枝汤和桂枝去芍药汤，两方仅差一味芍药，但却变成了桂枝汤调和营卫，桂枝去芍药汤温通心阳。
5．善于发现组成药物相似中的不同点。例如：不同方剂中采用了不同的化痰止咳药，如一者采用了百部、紫菀、杏仁，二者采用了贝母、前胡，我们分析时，就要善于区别它们间的相异点，并找出这些药物的特点。如紫菀不但降气化痰，并且止咳通络；百部止咳甚佳，而有润肺之功，但无化痰之力；杏仁重在降气止咳，而稍能定喘；贝母除热痰，稍有软坚之力；前胡既解表，又降气化痰。应区别使用。
6．注意发现方剂组成药物间的协同和制约。例如：用于止咳化痰的紫菀、冬花，两药相配，可使它们的定喘止咳作用增强；黄柏、知母相配，可使它们滋阴降火的作用增强；黄柏、砂仁相配，可明显提高砂仁的涩精作用。
二、应用方法
1．选择方剂要严格要求，绝不马虎从事。例如：证见寒热往来，胸胁苦满，心烦喜呕，口苦咽干，脉弦的少阳证，就予小柴胡汤；厥阴头痛，干呕吐涎沫或呕吐者，就予吴茱萸汤，而不加减任何药物。
2．加减药味一定要严格。在这方面张仲景可以说是一个典范。例如：他在《伤寒论》中阐述小柴胡汤的适应证时，又明确指出：“若胸中烦而不呕者，去半夏、人参，加栝楼实一枚；若渴者，去半夏，加人参合前成四两半，栝楼根四两：若腹中痛者，去黄芩，加芍药三两；若胁下痞硬，去大枣，加牡蛎四两；若心下悸，小便不利者，去黄芩，加茯苓四两；若不渴，外有微热者，去人参，加桂枝三两，温覆微汗愈；若咳者，去人参、大枣、生姜，加五味子半升，干姜二两。”假若随心所欲地加减药物，常常失掉原方含义。例如：麻杏石甘汤是由麻黄、杏仁、石膏、甘草组成的方剂，其麻黄、石膏的用药比例为l：2，主用于热壅在肺的汗出而喘无大热者，假若因为考虑是肺部炎症，而加大石膏用量，并增黄芩、黄连、黄柏、栀子、银花、连翘等清热解毒药，就不治肺，而成了清热解毒剂了。
3．选择用方时，一定要注意适其至所，不可太过不及。这里尤其注意的是药物的用量和归经问题，千万不可认为药量大就是好，因为有的药量过大反而过其病所而伤正，正如《素问》所说：“勿使过之伤其正也。”所以喻嘉言说：“不明脏腑经络，开口动手便错。”
4．加减药物时，一定要注意方中有方，药中有方。例如：真武汤由茯苓、芍药、生姜、白术、附子等组成，主用于肾阳衰微，水气内停，症见小便不利，四肢沉重疼痛，恶寒腹痛，下利，或肢体浮肿，与太阳病，发汗，汗出不解，其人仍发热，心下悸，头眩，身（目闰）动，振振欲擗地者。若去生姜，加人参，则名附子汤，用于寒湿内侵，身体骨节疼痛，恶寒肢冷，脉沉细无力者。若不去生姜，但加人参，则非但具有真武汤之功，并且兼有附子汤之效，就是说虽然仅仅加入了一个人参，但却具有了加人附子汤之意，所以也就具有了加入附子汤的功用主治。若在真武汤中加入一味肉桂，则具有了茯苓甘草汤的功用主治，即非但具有真武汤的功用，并且具有茯苓甘草汤治奔豚之功。
问诊中存在的问题
在临床中，我们应该提倡严格准确的问诊内容，因为它是达到正确地进行辨证论治的基础。但是，由于以下的很多主、客观原因严重的影响着辨证论治的准确性。例如：
1．由于患者是一个家庭的主要支柱，他的病情直接影响着家庭成员的经济来源和社会地位的高低，所以每个家庭成员都很关心他的病情，因此家属常常以夸大病情的方法陈述病情。
2．由于患者在家庭中被认为是无足轻重或带来累赘的人，所以家属常常以掩盖病情或大事化小的说法陈述病情。
3．由于患者具有较高的地位和权势，某些人鉴于他的权势和地位可能对其前途的影响，唯恐将其病情说得太轻影响病情的发展，所以常常以夸大病情的方法陈述病情。
4．由于患者的权势已经衰落，某些人或者怕其连累自己而倒霉，或者认为正可落井下石，所以常常以掩盖病情或大事化小的方法陈述病情。
5．由于某些患者过度信任前医的诊断，所以他在主诉上尽量围绕着该种诊断进行陈述，有些患者甚至只说病名而不说症状，致使重要的病情被掩盖。
6．由于某些患者过度信任某些非医务工作者的言语，所以在他的主诉中尽量围绕着这些怀疑进行陈述，而对其他重要的情况不予陈述。7．由于患者不懂或缺乏医学上术语概念的准确含义，而却常常以医学上的概念进行阐述，致使病情的真实情况被掩盖。
8．患者治疗过程中应用的治疗方法和药物本应完整地进行说明，而某些医者或患者却因种种原因只对其中的几种进行宣扬，而对其他的药物和治疗方法却加以掩盖或不予陈述。
9．由于患者对我们的崇拜和敬仰，很希望能够得到信任医生的诊治，所以唯恐说出一些医生不愿听的话，所以常常掩盖一些病情加重或无效的陈述。
10．由于某些人士或某些医生对患者的影响，使患者有意或无意地夸大或贬低药物的真实疗效的陈述。
11．由于我们医者过度地以先入为主的主观性代替了客观性，所以对与我们不相一致的任何陈述往往加以忽视。
所有这些都是影响问诊中准确性的大敌，因此必须加以克服。
为要克服影响问诊准确性的诸多因素，我认为可采用以下方法：
1．尽量以主诉代替代诉，对主诉与代诉不相一致的病情陈述要以主诉为主。
2．对于以病名代替症状表现的陈述，不管是主诉或代诉，都应以症状表现的陈述为主，以企通过询问发现问题。
3．对于涉及到的治疗过程与用药的陈述，一定要认真具体，对于所述药物与实际情况无关，而某些医生或患者认为有关的情况，一定要进一步追询其用药的全部情况。
4．对于涉及治疗中的某些方剂的问题，一定要亲自看看其是否用的该方药，以免以错误的事实作根据进行辨证论治。
中西药并用与药物七情
在与一些医者、患者，甚至政策的决定者的交谈中，经常遇见一些这样的意见。说：“中医好，西医好，中西医结合岂不更好!”“中药好，西药好，中西药并用岂不更好!”又说：“为什么一些西医，一些中医，就是那么顽固?为什么一些老中医就是那么保守，坚持什么纯中医中药治病?”我说：“这个问题很复杂，很难用一句话说清楚。”他们立刻就说：“我们知道你是坚持中医治病的。”有的甚至说：“你是新时代大学毕业的，你是学了很多现代科学、现代医学知识的人，你可千万不要象过去的老中医那样不开窍，顽固地坚持过去的中医那一套。”我说：“科学不科学不是靠嘴说其是不是科学，而是靠其符不符合事实，靠其符不符合实践。我认为只有实践是检验真理，检验是否科学的唯一标准，而无其他。”至于中药好，西药好，中药西药并用是否更好；中医好，西医好，中西医一块儿治某个病是否更好的问题，我看还是具体事物具体分析为好。
例如：患者胡××，男，36岁。突然胸脘满痛，呼吸困难，心悸汗出，头晕。医诊冠心病。急以西医西药抢救，两日后，不见明显改善。邀余会诊。察脉弦紧数促并见，舌苔白。综合脉证，诊为寒饮中阻，心阳不振，肝木失达。为拟疏肝理气，温阳化饮。处以：柴胡10克，半夏10克，黄芩10克，人参10克，甘草6克，干姜4克，大枣5枚，苍术10克，厚朴10克，肉桂10克，陈皮10克，茯苓10克。昼夜兼进2剂，效果不著。患者家属问：“每次患者服用西药之后均感症状加剧，是否可暂停西药?”答曰：“过去曾遇一例患者停用西药后症状很快消失，你们不妨试一试。”患者果遵余意服药3剂，症状也果然大部消失。此时主管医生得知患者停用西药立刻勃然大怒。曰：“你们为什么竟然停用治病的药，中药又不治病，出现危险谁负责。”患者及其家属虽然不完全同意他的意见，但又觉得医生是好意，于是采用了既服西药，又服中药的方法治疗。两日后，诸证非但不减，反见加剧。于是患者又偷偷地停用了各种西药，15日后，诸证果然全部消失。若从这一例看，就不能说中药，西药并用就更好。
又如：一郭姓患者，男，56岁。双眼色素膜炎5年。左眼已基本失明，右眼在1米内可看见手动。邀余会诊。察其脉弦大紧数，舌苔薄白。综合脉证，诊为气阴俱虚，治以补气养阴。东垣清暑益气汤加减为方。服药7剂，不见改善。余云“中药应用过程中有一个重要的理论，就是配伍中的七情理论，这一理论要求除单味者外，还应注意配伍中的相须、相使、相恶、相杀、相反、相畏。既然我在开此方时考虑到了种种配伍中的关系，那么再加西药、中成药于其中将会形成什么结果呢?不知道。因此我的意见是暂时停用任何中、西药物。”服药10剂后，失明之左眼在1米内竟然可以睹见手指晃动，右眼较前视物明显清楚。然因患者及他医多次规劝，又加用中、西药饵一周，诸证又剧，不得不再次停用其他中、西诸药。果愈。其后郭姓患者屡屡介绍患者来诊，且每每嘱咐云：“千万不可既用西药，又用中药，以免使疗效降低。”
For example, patient Li XX, male, 62 years old. He suffered from coronary heart disease (Coronary Heart Disease), myocardial infarction, and atrial fibrillation for 15 days. After treatment with Western medicine, his shortness of breath slightly decreased, but the atrial fibrillation showed no improvement. I was invited to consult. Upon examining his symptoms, he presented with dizziness and vertigo, palpitations and shortness of breath, chest fullness and pain, irritability and a desire to vomit, and a wiry, rapid pulse that occasionally had a choppy quality. I said: This syndrome belongs to the Shaoyang Chaihu Syndrome (a syndrome caused by pathogenic factors affecting the Shaoyang meridian), which can be treated with Xiao Chai Hu Tang (Minor Bupleurum Decoction). A certain doctor said: I once heard Mr. introduce this formula at an academic lecture, but when I used it, it was ineffective. The patient then said: Not only was it ineffective, but it also had many side effects. I asked: What medicine did you use? He answered: It included Chai Hu (Bupleuri Radix), Yin Hua (Flos Lonicerae Japonicae), Lian Qiao (Fructus Forsythiae), Chuan Xiong (Chuanxiong Rhizoma), Dan Shen (Salviae Miltiorrhizae Radix et Rhizoma), Dang Gui (Angelicae Sinensis Radix), Ge Gen (Puerariae Lobatae Radix), Sheng Shi Gao (Gypsum Fibrosum), Jiang Xiang (Aucklandiae Radix), Tao Ren (Persicae Semen), Hong Hua (Carthami Flos), Chi Shao (Paeoniae Radix Rubra), and Yu Jin (Curcumae Longae Radix). Upon hearing this, I said: The Chai Hu Tang I use is Zhang Zhongjing's Xiao Chai Hu Tang. Therefore, I prescribed: Chai Hu 10g, Ban Xia (Pinelliae Rhizoma) 10g, Huang Qin (Scutellariae Radix) 10g, Ren Shen (Ginseng Radix et Rhizoma) 10g, Sheng Jiang (Zingiberis Rhizoma Recens) 4 slices, Da Zao (Jujubae Fructus) 7 pieces, Gan Cao (Glycyrrhizae Radix et Rhizoma) 10g, Gua Lou (Trichosanthis Fructus) 15g. After taking two doses, all symptoms significantly decreased, and subsequently, the atrial fibrillation indeed disappeared. The doctor asked: Why was the previous use of Chai Hu Tang ineffective, while the later use was effective? I answered: The previous doctor's prescription was not Xiao Chai Hu Tang; the one used later was indeed Chai Hu Tang. This is a pathological trend of the times. Some people mention a certain decoction but do not know its composition, or only know one or two ingredients. The "Chai Hu Tang" mentioned by the previous doctor was merely assumed. Therefore, in pattern differentiation and treatment, one must be aware of this contemporary malpractice.
How to Learn and Apply Formulas
Formulas are an important link in the process of pattern differentiation and treatment. The quality of formula composition directly affects the therapeutic effect in this process, so physicians of past dynasties have attached great importance to the study of formulaology.
Traditional Chinese Medicine (TCM) ancient books are as vast as the sea, containing many formulas, and adding to them are the verified formulas composed by modern physicians and individual doctors, making them even more numerous. Thus, memorization is difficult, and application is even harder. What should be done? At first, I memorized over 5,000 formulas, but still felt that many were unmemorized, making application even more difficult. I did not know which one to choose and struggled to prescribe for a long time. Later, through analysis, induction, and comparison, my understanding suddenly became much clearer. The over 5,000 formulas amounted to only over 400 formula categories. As a result, I truly achieved the state where there are formulas within formulas, medicines within formulas, and formulas within medicines. Not only was the use of formulas in clinical practice stricter, but the efficacy also improved. So how did I learn and apply formulas? Generally speaking, there are the following points:
I. Methods of Learning
1. Memorize formulas considered effective by most people. These formulas must not only be memorized for their composition, functions, and indications, but also for their compatibility methods and modification techniques in drug composition. Only in this way can we apply formulas flexibly. Where to find these formulas? My answer is simple: those recorded in textbooks and *Tang Tou Ge Jue* (Song Verses on Decoctions) are considered effective by most people.
2. Be good at observing the general trends among numerous formulas. For example, although Yin Qiao San (Honeysuckle and Forsythia Powder), Yue Bi Tang (Yue Bi Decoction), and Sheng Jiang San (Ascending and Descending Powder) have fundamentally different drug compositions, their general trend is all Acrid-Cool Release of the Exterior. Similarly, although Ma Huang Tang (Ephedra Decoction), Jing Fang Bai Du San (Schizonepeta and Notopterygium Powder to Overcome Toxins), and Jiu Wei Qiang Huo Tang (Nine-Ingredient Notopterygium Decoction) have fundamentally different drug compositions, their general trend is all Acrid-Warm Release of the Exterior. Therefore, the former are all used to treat external wind-heat, and the latter are all used to treat external wind-cold.
3. Be good at discovering special guiding drugs in formulas with the same general trend. For example: Du Huo Ji Sheng Tang (Decoction for Expelling Rheumatism and Nourishing the Liver and Kidneys) and San Bi Tang (Three Obstructions Decoction), from their general trend, are both formulas for tonifying Qi and nourishing Blood, dispelling wind and removing dampness, and treating wind-damp bi-syndrome. However, because San Bi Tang has added Huang Qi (Astragali Radix) for tonifying Qi and raising Yang, and lacks Sang Ji Sheng (Taxilli Herba) for tonifying the lower back and kidneys, its main function becomes treating rheumatism of the upper body, especially the shoulders and arms, while Du Huo Ji Sheng Tang becomes a formula for treating lower back and leg pain.
4. Be good at discovering differences in medication and dosage ratios between similar formulas. For example: Huang Lian Tang (Coptis Decoction) and Ban Xia Xie Xin Tang (Pinellia Decoction to Drain the Epigastrium), except for one different herb, have identical remaining ingredients. Yet, this single difference makes these two formulas, which share the same general trend of treating epigastric fullness and diarrhea in mixed cold-heat syndromes, become one for treating syndromes with more cold than heat, and the other for treating syndromes with more heat than cold. Again: Gui Zhi Tang (Cinnamon Twig Decoction) and Gui Zhi Qu Shao Yao Tang (Cinnamon Twig Decoction without Paeonia), differing by only one herb, Shao Yao (Paeoniae Radix), yet transform Gui Zhi Tang into harmonizing Ying and Wei, and Gui Zhi Qu Shao Yao Tang into warming and unblocking Heart Yang.
5. Be good at discovering differences in similar compositional drugs. For example: Different formulas adopt different phlegm-resolving and cough-stopping herbs. One uses Bai Bu (Stemonae Radix), Zi Wan (Asteris Radix), and Xing Ren (Armeniacae Semen Amarum); another uses Bei Mu (Fritillariae Bulbus) and Qian Hu (Peucedani Radix). In our analysis, we must be good at distinguishing their differences and finding the characteristics of these drugs. For instance, Zi Wan not only directs Qi downward and resolves phlegm but also stops cough and unblocks collaterals; Bai Bu is excellent for stopping cough and moistens the Lung but lacks phlegm-resolving power; Xing Ren focuses on directing Qi downward and stopping cough, and slightly calms wheezing; Bei Mu clears hot phlegm and has slight softening hardness capability; Qian Hu both releases the exterior and directs Qi downward to resolve phlegm. They should be used differently.
6. Pay attention to discovering synergy and constraint among drugs in formula composition. For example: Zi Wan and Dong Hua (Daphne Genkwa Flower) used for stopping cough and resolving phlegm, when combined, enhance each other's anti-wheezing and anti-cough effects; Huang Bo (Phellodendri Cortex) and Zhi Mu (Anemarrhenae Rhizoma), when combined, enhance each other's yin-nourishing and fire-descending effects; Huang Bo and Sha Ren (Amomi Fructus), when combined, significantly improve Sha Ren's essence-astringing effect.
II. Application Methods
1. Selection of formulas must be strictly required, never careless. For example: If the syndrome presents with alternating chills and fever, bitter fullness in the chest and hypochondrium, irritability and a desire to vomit, bitter taste in the mouth and dry throat, and a wiry pulse—Shaoyang Syndrome—then give Xiao Chai Hu Tang; if there is Jueyin headache, dry vomiting of saliva and froth, or vomiting, then give Wu Zhu Yu Tang (Evodia Decoction), without adding or subtracting any drugs.
2. Modification of drug flavors must be strict. In this regard, Zhang Zhongjing can be said to be a model. For example: When expounding the indications for Xiao Chai Hu Tang in *Shang Han Lun* (Treatise on Cold Damage Disorders), he explicitly stated: "If there is vexation in the chest but no vomiting, remove Ban Xia and Ren Shen, add one fruit of Gua Lou (Trichosanthes Fruit); if there is thirst, remove Ban Xia, add Ren Shen to make a total of four taels and half, and Gua Lou Gen (Trichosanthes Root) four taels; if there is abdominal pain, remove Huang Qin, add three taels of Shao Yao; if there is hardness and fullness under the costal margin, remove Da Zao, add four taels of Mu Li (Ostrea Concha); if there is palpitation in the heart region and difficulty urinating, remove Huang Qin, add four taels of Fu Ling (Poria); if there is no thirst and slight external heat, remove Ren Shen, add three taels of Gui Zhi (Cinnamomi Ramulus), cover with warmth to induce slight sweating for cure; if there is cough, remove Ren Shen, Da Zao, and Sheng Jiang, add half sheng of Wu Wei Zi (Schisandrae Fructus) and two taels of Gan Jiang (Zingiberis Rhizoma)." If one arbitrarily adds or subtracts drugs, one often loses the original meaning of the formula. For example: Ma Xing Shi Gan Tang (Ephedra, Apricot Kernel, Gypsum, and Licorice Decoction) is composed of Ma Huang (Ephedrae Herba), Xing Ren, Shi Gao (Gypsum Fibrosum), and Gan Cao. The ratio of Ma Huang to Shi Gao is 1:2, mainly used for sweating and wheezing due to heat congestion in the Lung without high fever. If, considering lung inflammation, one increases the dosage of Shi Gao and adds Huang Qin, Huang Lian (Coptidis Rhizoma), Huang Bo, Zhi Zi (Gardeniae Fructus), Yin Hua, and Lian Qiao for clearing heat and detoxifying, it ceases to treat the Lung and becomes a heat-clearing and detoxifying agent.
3. When selecting formulas, one must pay attention to reaching the target precisely, avoiding excess and deficiency. Here, particular attention should be paid to drug dosage and meridian tropism. One must never think that a large dosage is good, because some drugs in excessive dosages may go beyond the disease site and damage Zheng Qi (Upright Qi), just as *Su Wen* (Basic Questions) states: "Do not let it exceed and damage Zheng Qi." Therefore, Yu Jiayan said: "Without understanding Zang-Fu organs and meridians, opening the mouth and moving the hand will lead to errors."
4. When modifying drugs, one must pay attention to formulas within formulas and medicines within formulas. For example: Zhen Wu Tang (True Warrior Decoction) is composed of Fu Ling (Poria), Shao Yao, Sheng Jiang, Bai Zhu (Atractylodis Macrocephalae Rhizoma), and Fu Zi (Aconiti Lateralis Radix Praeparata). It is mainly used for Kidney Yang decline with internal retention of water qi, presenting with difficulty urinating, heaviness and pain in the four limbs, aversion to cold and abdominal pain, diarrhea, or limb edema, and in Taiyang Syndrome after sweating, where sweating does not resolve the condition, the person still has fever, palpitation in the heart region, dizziness, twitching of muscles, and trembling desire to fall to the ground. If Sheng Jiang is removed and Ren Shen is added, it is named Fu Zi Tang (Aconite Decoction), used for internal invasion of cold-dampness, body and joint pain, aversion to cold and cold limbs, and deep, thin, and weak pulse. If Sheng Jiang is not removed but Ren Shen is added, it not only has the efficacy of Zhen Wu Tang but also the effect of Fu Zi Tang. That is, although only one Ren Shen is added, it embodies the intent of adding Fu Zi Tang, thus possessing the functional indications of Fu Zi Tang. If Yi Gu Rou Gui (Cortex Cinnamomi) is added to Zhen Wu Tang, it possesses the functional indications of Fu Ling Gan Cao Tang (Poria and Licorice Decoction), i.e., not only having the function of Zhen Wu Tang but also the function of Fu Ling Gan Cao Tang in treating Ben Tun (Rushing Pig) syndrome.
Problems Existing in Inquiry
In clinical practice, we should advocate strict and accurate inquiry content because it is the foundation for achieving correct pattern differentiation and treatment. However, due to many subjective and objective reasons below, the accuracy of pattern differentiation and treatment is seriously affected. For example:
1. Since the patient is the main pillar of the family, his illness directly affects the economic source and social status of family members, so every family member cares about his illness. Therefore, family members often describe the illness by exaggerating it.
2. Since the patient is considered insignificant or a burden in the family, family members often describe the illness by covering it up or downplaying it.
3. Since the patient has high status and power, some people, fearing the impact of his status on their future, dread saying his illness is too light and affecting development, so they often describe the illness by exaggerating it.
4. Since the patient's power has declined, some people either fear being implicated and suffering misfortune or believe it is right to kick him when he is down, so they often describe the illness by covering it up or downplaying it.
5. Since some patients overly trust the previous doctor's diagnosis, they try to center their chief complaint around that diagnosis. Some patients even only mention the disease name without symptoms, causing important conditions to be covered up.
6. Since some patients overly trust the words of non-medical workers, they try to center their chief complaint around these suspicions and do not state other important situations.
7. Since patients do not understand or lack accurate knowledge of medical terminology concepts, they often elaborate using medical concepts, causing the true situation of the illness to be covered up.
8. Treatment methods and drugs applied during the patient's treatment process should be explained completely, but some physicians or patients, for various reasons, only promote a few of them and cover up or do not state other drugs and treatment methods.
9. Due to patients' worship and admiration for us, hoping to receive treatment from trusted doctors, they fear saying things doctors do not want to hear, so they often cover up statements of worsening or ineffective conditions.
10. Due to the influence of certain individuals or doctors on patients, patients intentionally or unintentionally exaggerate or belittle the true efficacy of drugs.
11. Because we physicians excessively replace objectivity with subjectivity based on preconceived notions, we often ignore any statements inconsistent with us.
All these are major enemies affecting the accuracy of inquiry, and therefore must be overcome.
To overcome the many factors affecting the accuracy of inquiry, I believe the following methods can be adopted:
1. Try to use the chief complaint instead of the proxy complaint. For descriptions of illness where the chief complaint and proxy complaint are inconsistent, the chief complaint should prevail.
2. For descriptions substituting disease names for symptom manifestations, whether chief or proxy complaint, the description of symptom manifestations should prevail, aiming to discover problems through inquiry.
3. For descriptions involving the treatment process and medication, one must be serious and specific. For described drugs irrelevant to the actual situation but considered relevant by some doctors or patients, one must further inquire about the entire situation of their medication.
4. For questions involving certain formulas in treatment, one must personally check whether the prescribed formula was actually used, to avoid basing pattern differentiation and treatment on erroneous facts.
Concurrent Use of Chinese and Western Medicines and the Seven Emotions of Drugs
In conversations with some physicians, patients, and even policy makers, one often encounters such opinions. Saying: "Chinese medicine is good, Western medicine is good, would not integrating Chinese and Western medicine be better!" "Chinese herbs are good, Western drugs are good, would not using Chinese and Western drugs together be better!" Also saying: "Why are some Western doctors and some TCM doctors so stubborn? Why are some old TCM doctors so conservative, insisting on pure Chinese medicine and herbs for treatment?" I said: "This issue is very complex and hard to clarify in one sentence." They immediately said: "We know you insist on treating diseases with Chinese medicine." Some even said: "You graduated from university in the new era; you are someone who has learned much modern science and modern medical knowledge. You must not be like the old TCM doctors of the past, obtuse and stubbornly adhering to the old set of Chinese medicine." I said: "Whether something is scientific or not does not depend on mouth saying it is scientific, but on whether it conforms to facts and practice. I believe only practice is the sole standard for testing truth and whether something is scientific, with no other." As for whether Chinese herbs are good, Western drugs are good, and using them together is better; whether Chinese medicine is good, Western medicine is good, and treating a certain disease with both is better, I think it is best to analyze specific matters specifically.
For example: Patient Hu XX, male, 36 years old. Suddenly experienced fullness and pain in the chest and epigastrium, dyspnea, palpitations and sweating, and dizziness. Diagnosed with coronary heart disease by the doctor. Urgently rescued with Western medicine and drugs. After two days, no obvious improvement was seen. I was invited to consult. Observing the pulse, it was wiry, tight, rapid, and hurried simultaneously; tongue coating was white. Synthesizing pulse and symptoms, diagnosed as obstruction of cold-fluid in the middle, declining Heart Yang, and stagnation of Liver Wood. Planned to soothe the Liver and regulate Qi, warm Yang and transform fluid. Prescribed: Chai Hu 10g, Ban Xia 10g, Huang Qin 10g, Ren Shen 10g, Gan Cao 6g, Gan Jiang (Zingiberis Rhizoma) 4g, Da Zao 5 pieces, Cang Zhu (Atractylodis Rhizoma) 10g, Hou Po (Magnoliae Officinalis Cortex) 10g, Rou Gui (Cortex Cinnamomi) 10g, Chen Pi (Citri Reticulatae Pericarpium) 10g, Fu Ling 10g. Taken day and night, two doses, effect was not remarkable. The patient's family asked: "Every time the patient takes Western medicine, he feels symptoms worsen. Can we pause Western medicine?" I answered: "I once encountered a patient whose symptoms disappeared quickly after stopping Western medicine. You might as well try." The patient indeed followed my advice, took medicine for 3 doses, and symptoms indeed largely disappeared. At this time, the attending doctor learned that the patient stopped Western medicine and immediately flew into a rage. Saying: "Why did you stop the medicine for treating the disease? Chinese medicine does not treat diseases. Who is responsible if danger occurs?" Although the patient and his family did not fully agree with his opinion, they felt the doctor meant well, so they adopted a method of taking both Western and Chinese medicine. Two days later, all symptoms not only did not decrease but worsened. Thus, the patient secretly stopped all Western medicines again. After 15 days, all symptoms indeed disappeared completely. From this case, one cannot say that using Chinese and Western medicines together is better.
Again: A patient surnamed Guo, male, 56 years old. Uveitis of both eyes for 5 years. The left eye was basically blind; the right eye could see hand movement within 1 meter. Invited me to consult. Observing his pulse, it was wiry, large, tight, and rapid; tongue coating was thin and white. Synthesizing pulse and symptoms, diagnosed as deficiency of both Qi and Yin, treated by tonifying Qi and nourishing Yin. Modified Dong Yuan Qing Shu Yi Qi Tang (Li Dongyuan's Clear Summerheat and Tonify Qi Decoction) as the formula. After taking 7 doses, no improvement was seen. I said: "There is an important theory in the application of Chinese medicine, which is the Theory of Seven Emotions in compatibility. This theory requires that besides single herbs, one should pay attention to mutual enhancement (Xiang Xu), mutual promotion (Xiang Shi), mutual antagonism (Xiang E), mutual destruction (Xiang Sha), mutual incompatibility (Xiang Fan), and mutual inhibition (Xiang Wei) in compatibility. Since I considered various compatibility relationships when prescribing this formula, what result will forming by adding Western medicine and Chinese patent medicines into it? I do not know. Therefore, my opinion is to temporarily stop any Chinese and Western medicines." After taking 10 doses, the blind left eye could actually see finger waving within 1 meter, and the right eye saw objects significantly clearer than before. However, due to repeated persuasion by the patient and other doctors, Chinese and Western medicines were added again for a week, and all symptoms worsened again, forcing another cessation of other Chinese and Western medicines. Indeed cured. Afterwards, patient Guo frequently introduced patients to consult, and always instructed: "Absolutely do not use both Western and Chinese medicines, to avoid reducing efficacy."