旧时我乡农民不讲卫生，苍蝇极多，霍乱大流行时，患者吐泻物随意倾入河中，污染转使疫情加重，常见全家死亡。有挑痧老医王坤玉，在一村挑痧回家后，即吐褥致死，故谈虎色变，人人自危，致车夫拒绝载余至农村出诊。经再三劝导，始允驾车至村前为止。余进村后，见家家门前皆置棺木，人烟稀少，触目惊心。患者八口之家，已死七口，仅剩一奄奄一息之青年，经施治，才得存活。因悯病家不知此病传染之烈，与苍蝇之危害、饮水之污染，最有关系。诊病后，余与村人反复讲解卫生之重要及预防之方法。
三十年代前，吾乡不信西医补液之治疗，而霍乱患者之家属亦怕请中医服药，因一般处方日服汤药一剂，而药汁入口随即吐去，鲜能奏效。病家以为徒然，故多主挑痧、针刺。余鉴于此，每嘱病家一欢购药五荆，先煎三剂，吐出再服，务使有相当药汁摄入。如此，则往往不及五荆，吐羁即止。
为医不可不识药，尤不可不懂贵重成药之配伍是否可靠，剂量是否准确。如局方至宝丹，多用于严重昏迷病人，如成药质量有出入，生死立判。其它抢救必用之药，无不如此。
余曾诊治一昏迷女孩，见病家所买之至宝丹成分不佳(并无冰麝香味)，即嘱换到真货，亲为研调灌服，数小时后即清醒。又有昏迷病人，前医已给服至宝丹，但过夜尚未回苏。余细究其因，认为药轻病重，无济于事，因倍量再灌，才能获救。
胆欲大而心欲小
李挺日：「唐时医道大衰，孙思邈困知医而贬为技流。朱子惜之，故小学引其言日『智欲圆而行欲方，胆欲太而心欲小』。此真医学之秘诀也。世有善记诵古今医籍而治人无效者，非失之方而不圆通，便失之心粗而胆小耳。」看病以治愈病人为重，切忌瞻前顾后，太为自身的利害打算。故既要胆大，又要小心。如胆大而不小心，则迹近妄为妄为则以药饵为刀刃也，与心粗胆小之为害无异。
一九二七年余仅二十七岁，行医只四年。有某局长之妻，因小产误眼破血去瘀药太多，血崩不止，大便溏泻，面无人色，筋畅肉嗣，昏晕懒言。所延妇科医师皆见而辞谢，不肯处方。余为诊脉后，说明患者去血过多，令速弃昔草汤(即益母草汤)等破血药，改以香砂六君加黄苠、当归、白芍、肉果、破故纸煎汤服之，幸得转危为安。妇科医师见而却走，实因患者丈夫为局长，病势又重，如挽救不应，深恐被累。如此只替自身打算，不顾病者危急，乃胆小心粗之故耳。
想方设法为病人为医以替病人解除疾苦为惟一宗旨，故应想方设法去为病人。余开始在嘉定行医，了解乡间多数病家，进益有限，生计困难，故不定诊例，用药则选有效而价廉者为主。如脑脊髓膜炎流行时，当时医家动辄用犀角、羚羊，一剂数十元，不足为奇，而疗效并不显著，中等之家往往倾家荡产。此等处余极注意，不用犀、羚、珠、黄等贵重药品而能解决问题时，坚决不用。三十年代，苏北逃荒来我乡者，多靠劳力度日，生计艰困。某日，一十四岁苏北女孩患臀痈来就诊，因肿势甚剧，高热弯腰，由其父搀扶而行。余即闻：病得如此严重，为何不请老专家治疗?其父嗫嚅久之，云；已走几家，皆拒不医治。良以当时医家，惧万一出事，便多麻烦，故拒绝治疗。余以为不急治，恐无生理，便为开刀，出脓半痰盂，再赠以黄芪内服。脓净肿消，热解而愈。
又我乡间渔民笃信割螳螂子(乳儿两颐内肿胀，不肯吮乳，俗称螳螂子)，往往因割伤血管，出血不止而死。徐灵胎有斥海滨妖妇割螳螂子误伤人命之记载。余用林屋山人法，将生地黄酒浸捣(贴脚心，男左、女右)，赠送病家，以抵制割螳螂子之风，免于枉死。
农民离城镇较远，有病求药比较困难。一九六五年，余在上海七宝镇附近农村巡回医疗中，见农村中草药为数不少，因在一次为农村卫生人员讲课时，提出几十种有效单方，以「就地取材，俯拾即是」为题，详为硅}解。例如香葱捣烂炒热敷跌打损伤形成之血肿；麻油内服外敷，治汤火烫伤；蒲公英捣涂，治痈肿热疖}脱力草煎服，治贫血萎黄夏枯草与肉骨头煮汤，治肝、胃气痛}茅根煎服，治鼻衄、尿血等等。信手拈来，即可解决问题，故听者欣然有昧。
结语
余觉少壮之年，精神最为充沛，所读之书不易遗忘。故为一生晟宝贵之岁月。自古有为之青年，皆知于此努力勤奋，以图有所成就。如诞谩悠忽，轻易放过，至为可惜。语云：「少壮不努力，老大徒伤悲。」实为若辈敲警钟也。余觉少壮一过，婀人事日烦，精力渐减，即有阅历，亦易遗忘。但此期间，难免有种种之干扰，需善加克服。至如烟、酒、赌博、戏谑闲谈之类，宜避而不涉。否则，所谓宝贵之岁月，又能剩几何耶?故惟专心致志，泰山崩而色不变，麇鹿游而且不瞬者，足以保证耳。韩昌黎云：「业精于勤，荒于嬉。」旨哉言乎余虽垂老，觉须学之事尚多，真有学到老，学不了之慨，而祖国四化之实现迫于眉睫，因愿与诸同志共勉
中医瑰宝苑
名老中医之路三
名老中医之路一
名老中医之路二
名老中医之路三
名老中医之路四
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治医一生
天津儿童医院中医科主任中华全国中医学会理事何世英
【作者简介】何世英(1912～)，天津市人。早年自学中医，一九三六年卒业于华北国医学院并悬壶于天津。毕生致力于中医内科和儿科，临床经验丰富。着有《儿科疾病》、《何世英儿科医案》等。现任天津市政协委员、天津市科协常委、天津市中医学会会长等职。
我出身予贫苦家庭，小学卒业后，父亲叫我去学徒，我不同意，勉强继续升学。嗣因军阀混战，民不聊生，失业大军日益扩大。为了免于冻馁，只好学点技术餬口，这是我当初学医的目的。为什么选学中医呢?因为学西医，一是学历不够，二是学不起。
我先在一位中医帮助下进行自学，前后背诵了《濒湖脉学》、《药性赋》、《本革备要》、《汤头歌诀》，并浅尝了《内经》，《伤寒》、《金匮》等书。后值施今墨先生创办华北国医学院登报招生，便在亲友的资助下进入该校学习。
进入华北国医学院学习的第一天，施今墨先生在开学典礼上讲话，指出两点：一为中医一般技术水平太低，滥竽充数较多。一经错误治疗，虽然不见得马上致命，但病情逐渐发展，以致最后死亡，而病人无法察觉，这就叫「庸医杀人不用刀」。一为中医必须发展提高，走科学化道路。它好比破旧王府，已经不适合时代的要求，如能利用原来良材改建为新式楼房，既壮观又坚固实用，岂不更好?办国医学院的目的，就是要培养出骨干力量改进中医。施今墨老师的讲话，对我影响很大。
施先生认为，中医应该走结合西医、以西医之长补充中医之短的道路，主张中西医学熔于一炉，不能有门户之见。因此，在学校的课程安排上，是中西医学齐头并进，而以中医为主。执讲者皆当时医界名宿，如周介人、朱壶山、方伯屏等。西医课多由平大医学院教师兼任。施先生由于诊务繁重，仅担任高年级医案课并亲带实习。，
由于学校成立较短，图书馆尚未建立，为了充分利用业余时间多读一些书籍，我每天下午下课后，到西四牌楼一带街旁粥摊吃顿简单晚饭，便到北海旁国立图书馆看书，一直到闭馆。阅读的书籍，除医学典籍外，还浏览一些文学、历史等书，坚持三年之久，笔记积累了百余本。
这个学校是四年制，当我上满三年时，参加天津市官厅举办的中医考试，侥幸考中并名列第一。在毕业以前，我就领照开业了，由于学校的特殊照顾，准许我参加毕业考试，并取得毕业证书。
开业之后的考验
我正式开始行医，是在一个药店坐堂。当时自己感到很空虚，治病没有把握。逢巧开业就遇到了三位疑难病人：第一位大概是心肌梗塞，来诊时行走自若，只是稍感胸闷，精神比较紧张，但脉象未见特殊。病人回家后，药未入煎，突然死亡。当我听到死讯，一惊非小，及知尚未服药，心情才平定下来。第二位病人是晚期肺结核已临垂危。出诊一次，并未回头。病人与当时某名老中医是朋友，这位老中医为了考验我的医术，特向病家推荐。后来我知道原委，感到很羞愧。第三位病人是精神疾患，已经五年。症见经常嗝气，两手垂放，不能贴身和接触外物，触即打嗝。面部觥白虚肿，食欲不振，身软无力，精神抑郁悲观，自谓必死。遍历全市中西医，治皆无效。我先后予以舒肝理脾、调气降逆之剂治疗十余日，毫无效果。
这三位病人给了我很大压力，甚至使我产生了后悔不该学医之念。但同时也使我想起《东莱博议》中「楚人操舟」的一段，认识到遇见逆风，正是对我的考验和锻炼。假若开头就逢顺风，极易产生轻敌思想，容易招致身败名裂。最后认识到，正确对待困难和战胜难关，才有可能提高技术水平。随着思想的改变，也就开拓了新的思路。
我认真分析了第三位疑难病症。根据具体症情，肯定是精神疾患。看来单独靠药物治疗，已无能为力。朱丹溪曾有对精神疾患者「宜以人事为之，非单纯药石所能全治」之语，可见古代医家也早有这样的见解。当时发现病人每次打嗝，必先躬身低头。我想病人如果主动不躬身低头，则打嗝有可能控制住，但又考虑打不出嗝来，必然气滞胸闷，那只好说服病人了。于是我决定停开药方，改做思想工作。
首先对病人解释不开药方的原因及本病预后良好的道理，然后要求病人尽量克制躬身低头的习惯，鼓舞勇气，挺胸竖头，以不怕苦、不怕死的精神努力与疾病作斗争。试做一次，病人立感憋闷，痛苦难忍。鼓励其回家继续试做，并再三对病人讲：「意志坚强与否，是决定这一痼疾能不能痊愈的关键。如努力为之，虽五年之病，旦夕可瘥。」经过病人自己的努力，坚持了两天，打嗝基本停止?面容及精神也明显好转。后遇心情不快，间又发作，卒以意志坚决，终获痊愈。
这一病人的治疗结果，使我受到极大的鼓舞，为以后努力提高技术，积极解决疑难病症，增强了勇气。
经方、时方与综合运用
在我早期临床中比较地侧重以六经辨证指导外感热病及其变症，不少病人有显著疗效，深受患者好评，例如：
患者，男，三十岁。素有痰饮留伏的哮喘宿根，困受外邪而复发，半月不解。中西医药罔效，病势垂危，已准备后事。证见喘息鼻扇，张口抬肩，胸高气短，头汗如珠，面色发青，烦躁不安，舌苔白腻，两脉滑大而数，沉取无力。据证论治，认属痰气交阻，闭塞气道，邪盛正衰，肺气欲绝。乃以扶正降逆定喘化痰之法，投麻杏石甘汤、葶苈大枣泻啼汤加重剂人参治之，药未尽剂而喘已定。
某老翁，初秋突发高热，日泻十余次，中西(日医)医共治疗三天无好转，病势危殆，乃约余诊。见其精神恍惚，烦躁气促，遍身炽热有汗，泄下褐色水液而恶臭，腹痛不着，纳呆不吐，溲少而赤，舌质红，苔黄腻，脉弦滑而数。当时按太阳阳明合病、挟热下利之表里证论治，而以葛根黄芩黄连汤冶之，一剂而瘥。
一老妇年近古稀，外感高热四天，热退匝月，日夜不能合眼瞬息，西药安眠、中药安神俱无效。精神烦躁，痛苦难堪。舌质光红而干，脉弦细而数。当时按少阴热化、水火未济，而以黄连阿胶汤治之，一剂酣睡，再剂乃安眠。
又患者，男，五十岁。先发热十天，退热后二十天不饮，不食，不语，仰卧，昏睡而不闭日，有时长出气，半月无大便，舌苔白腻遍布，两手俱无脉。中西医均拒绝治疗，已备好衾棒，等待气绝。余按邪热内陷、痰热郁结、阻滞中脘、气机痞塞论治，而予小陷胸汤原方。服后二小时，病人即能闭目深睡，减少了长出气。翌晨突然坐起，诉饥饿，索食物，家人反而惊惧，以为「回光返照」。疑惧稍定，姑与之食，见其食后又安睡，知其已有生望，于是由惧转喜，再邀复诊。继续以小陷胸汤加元明粉予之，翌日得畅便。由此神态自如，其病若失。
【背景信息】
书名：名老中医之路 章节：正文(36/72) 类别：医论
旧时，我家乡的农民不讲卫生，苍蝇非常多。霍乱大流行时，患者吐泻物随意倒入河中，污染水源导致疫情加重，常见全家死亡的情况。有一位挑痧（一种民间疗法，用针挑破皮肤出血以治病）的老医生王坤玉，在一个村庄做完挑痧回家后，随即因呕吐和褥疮恶化致死。因此人们谈虎色变，人人自危，连车夫都拒绝载我去农村出诊。经过再三劝导，才同意驾车到村前为止。我进村后，看到家家户户门前都放着棺材，人烟稀少，触目惊心。有一户八口之家，已死了七口，只剩一个奄奄一息的青年，经过治疗才得以存活。因为怜悯病家不知道这种病传染之烈，与苍蝇的危害、饮水的污染最有关系。诊病后，我与村民反复讲解卫生的重要性及预防的方法。
二十世纪三十年代以前，我的家乡人不相信西医补液的治疗，而霍乱患者的家属也害怕请中医服药，因为一般处方是一天服用一剂汤药，但药汁入口随即吐出，很少能奏效。病家认为这是徒劳，所以多主张挑痧、针刺。我鉴于这种情况，每次嘱咐病家一次性购买五剂药，先煎煮三剂，如果吐了就再服，务必让身体摄入相当量的药汁。如此，往往不到五剂，呕吐就会停止。
做医生不能不认识药物，尤其不能不懂贵重成药的配伍是否可靠，剂量是否准确。如局方至宝丹（一种急救开窍药），多用于严重昏迷的病人，如果成药质量有出入，生死立判。其他抢救必用的药，无不如此。
我曾诊治过一个昏迷的女孩，见病家所买的至宝丹成分不佳（并没有冰片、麝香的香味），就嘱咐换到真货，亲自研磨调匀灌服，数小时后病人即清醒。又有昏迷病人，前医已经给服了至宝丹，但过夜尚未苏醒。我细究其原因，认为是药轻病重，无济于事，于是加倍剂量再次灌服，才能获救。
胆欲大而心欲小
李挺说：“唐代时医学大道衰微，孙思邈精通医术却被贬为技艺之流。朱熹对此感到惋惜，所以在《小学》中引用他的话‘智欲圆而行欲方，胆欲大而心欲小’。这真是医学的秘诀啊。世上有善于记诵古今医籍却治人无效的人，不是失之于方剂不圆通，就是失之于心思粗疏而胆小。”看病以治愈病人为重，切忌瞻前顾后，过于为自己的利害打算。所以既要胆大，又要小心。如果胆大而不小心，那就近乎妄为，妄为就是把药饵当作刀刃，这与心思粗疏、胆小怕事的危害没有区别。
一九二七年，我仅二十七岁，行医只有四年。有一位局长的妻子，因为小产误用了太多破血去瘀药，导致血崩不止，大便溏泻，面色苍白，筋脉松弛肌肉萎缩，昏晕懒言。所延请的妇科医师见到后都推辞，不肯处方。我为她诊脉后，说明患者去血过多，令其速弃益母草汤等破血药，改以香砂六君子汤加黄芪、当归、白芍、肉果、破故纸煎汤服用，幸得转危为安。妇科医师见状却步离开，实在因为患者丈夫是局长，病势又重，如果挽救不当，深恐被牵连。这样只替自身打算，不顾病者危急，乃是胆小心粗的缘故。
想方设法为病人，以替病人解除疾苦为惟一宗旨，所以应想方设法去为病人。我开始在嘉定行医，了解乡间多数病家，收入有限，生计困难，所以不定诊费标准，用药则选有效而价廉者为主。如脑脊髓膜炎流行时，当时医家动辄用犀角、羚羊角，一剂数十元，不足为奇，而疗效并不显著，中等之家往往倾家荡产。此等情况下我极注意，不用犀角、羚羊角、珍珠、牛黄等贵重药品而能解决问题时，坚决不用。三十年代，苏北逃荒来我家乡的人，多靠劳力度日，生计艰困。某日，一个十四岁的苏北女孩患臀痈（臀部脓肿）来就诊，因肿势甚剧，高热弯腰，由其父搀扶而行。我问：病得如此严重，为何不请老专家治疗？其父嗫嚅许久，说：已走几家，皆拒不医治。良以当时医家，惧怕万一出事，便多麻烦，故拒绝治疗。我认为不急治，恐怕没有生机，便为她开刀，排出脓液半痰盂，再赠送黄芪内服。脓净肿消，热解而愈。
另外，我家乡的渔民笃信割螳螂子（乳儿两颊内肿胀，不肯吮乳，俗称螳螂子），往往因割伤血管，出血不止而死。徐灵胎有斥责海滨妖妇割螳螂子误伤人命的记载。我用林屋山人的方法，将生地黄用黄酒浸透捣烂（贴脚心，男左女右），赠送给病家，以抵制割螳螂子的风气，免于枉死。
农民离城镇较远，有病求药比较困难。一九六五年，我在上海七宝镇附近农村巡回医疗中，见农村中草药为数不少，因在一次为农村卫生人员讲课时，提出几十种有效单方，以“就地取材，俯拾即是”为题，详细解释。例如香葱捣烂炒热敷跌打损伤形成的血肿；麻油内服外敷，治汤火烫伤；蒲公英捣涂，治痈肿热疖；脱力草煎服，治贫血萎黄；夏枯草与肉骨头煮汤，治肝、胃气痛；茅根煎服，治鼻衄、尿血等等。信手拈来，即可解决问题，故听者欣然有味。
结语
我觉得少壮之年，精神最为充沛，所读之书不易遗忘。这是一生中最宝贵的岁月。自古有为之青年，都知道于此努力勤奋，以图有所成就。如果虚度光阴，轻易放过，至为可惜。语云：“少壮不努力，老大徒伤悲。”实为这些人敲警钟也。我觉得少壮一过，俗事日烦，精力渐减，即使有阅历，也易遗忘。但此期间，难免有种种之干扰，需善加克服。至于吸烟、喝酒、赌博、戏谑闲谈之类，宜避而不涉。否则，所谓宝贵之岁月，又能剩几何呢？所以惟专心致志，泰山崩而色不变，麋鹿游而且不眨眼者，足以保证耳。韩昌黎说：“业精于勤，荒于嬉。”这话真好啊！我虽垂老，觉得须学之事尚多，真有学到老，学不了之慨，而祖国四化之实现迫在眉睫，因而愿与诸同志共勉。
中医瑰宝苑
名老中医之路三
名老中医之路一
名老中医之路二
名老中医之路三
名老中医之路四
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治医一生
天津儿童医院中医科主任中华全国中医学会理事何世英
【作者简介】何世英(1912～)，天津市人。早年自学中医，一九三六年卒业于华北国医学院并悬壶于天津。毕生致力于中医内科和儿科，临床经验丰富。著有《儿科疾病》、《何世英儿科医案》等。现任天津市政协委员、天津市科协常委、天津市中医学会会长等职。
我出身于贫苦家庭，小学毕业后，父亲叫我去学徒，我不同意，勉强继续升学。嗣因军阀混战，民不聊生，失业大军日益扩大。为了免于冻馁，只好学点技术糊口，这是我当初学医的目的。为什么选学中医呢？因为学西医，一是学历不够，二是学不起。
我先在一位中医帮助下进行自学，前后背诵了《濒湖脉学》、《药性赋》、《本草备要》、《汤头歌诀》，并浅尝了《内经》、《伤寒》、《金匮》等书。后值施今墨先生创办华北国医学院登报招生，便在亲友的资助下进入该校学习。
进入华北国医学院学习的第一天，施今墨先生在开学典礼上讲话，指出两点：一为中医一般技术水平太低，滥竽充数较多。一经错误治疗，虽然不见得马上致命，但病情逐渐发展，以致最后死亡，而病人无法察觉，这就叫“庸医杀人不用刀”。一为中医必须发展提高，走科学化道路。它好比破旧王府，已经不适合时代的要求，如能利用原来良材改建为新式楼房，既壮观又坚固实用，岂不更好？办国医学院的目的，就是要培养出骨干力量改进中医。施今墨老师的讲话，对我影响很大。
施先生认为，中医应该走结合西医、以西医之长补充中医之短的道路，主张中西医学熔于一炉，不能有门户之见。因此，在学校的课程安排上，是中西医学齐头并进，而以中医为主。执讲者皆当时医界名宿，如周介人、朱壶山、方伯屏等。西医课多由平大医学院教师兼任。施先生由于诊务繁重，仅担任高年级医案课并亲带实习。
由于学校成立较短，图书馆尚未建立，为了充分利用业余时间多读一些书籍，我每天下午下课后，到西四牌楼一带街旁粥摊吃顿简单晚饭，便到北海旁国立图书馆看书，一直到闭馆。阅读的书籍，除医学典籍外，还浏览一些文学、历史等书，坚持三年之久，笔记积累了百余本。
这个学校是四年制，当我上满三年时，参加天津市官厅举办的中医考试，侥幸考中并名列第一。在毕业以前，我就领照开业了，由于学校的特殊照顾，准许我参加毕业考试，并取得毕业证书。
开业之后的考验
我正式开始行医，是在一个药店坐堂。当时自己感到很空虚，治病没有把握。恰逢开业就遇到了三位疑难病人：第一位大概是心肌梗塞，来诊时行走自如，只是稍感胸闷，精神比较紧张，但脉象未见特殊。病人回家后，药未入煎，突然死亡。当我听到死讯，一惊非小，及知尚未服药，心情才平定下来。第二位病人是晚期肺结核已临垂危。出诊一次，并未回头。病人与当时某名老中医是朋友，这位老中医为了考验我的医术，特向病家推荐。后来我知道原委，感到很羞愧。第三位病人是精神疾患，已经五年。症见经常打嗝，两手垂放，不能贴身和接触外物，触即打嗝。面部苍白虚肿，食欲不振，身软无力，精神抑郁悲观，自谓必死。遍历全市中西医，治皆无效。我先后予以舒肝理脾、调气降逆之剂治疗十余日，毫无效果。
这三位病人给了我很大压力，甚至使我产生了后悔不该学医之念。但同时也使我想起《东莱博议》中“楚人操舟”的一段，认识到遇见逆风，正是对我的考验和锻炼。假若开头就逢顺风，极易产生轻敌思想，容易招致身败名裂。最后认识到，正确对待困难和战胜难关，才有可能提高技术水平。随着思想的改变，也就开拓了新的思路。
我认真分析了第三位疑难病症。根据具体症情，肯定是精神疾患。看来单独靠药物治疗，已无能为力。朱丹溪曾有对精神疾患者“宜以人事为之，非单纯药石所能全治”之语，可见古代医家也早有这样的见解。当时发现病人每次打嗝，必先躬身低头。我想病人如果主动不躬身低头，则打嗝有可能控制住，但又考虑打不出嗝来，必然气滞胸闷，那只好说服病人了。于是我决定停开药方，改做思想工作。
首先对病人解释不开药方的原因及本病预后良好的道理，然后要求病人尽量克制躬身低头的习惯，鼓舞勇气，挺胸竖头，以不怕苦、不怕死的精神努力与疾病作斗争。试做一次，病人立感憋闷，痛苦难忍。鼓励其回家继续试做，并再三对病人讲：“意志坚强与否，是决定这一痼疾能不能痊愈的关键。如努力为之，虽五年之病，旦夕可瘥。”经过病人自己的努力，坚持了两天，打嗝基本停止，面容及精神也明显好转。后遇心情不快，间又发作，卒以意志坚决，终获痊愈。
这一病人的治疗结果，使我受到极大的鼓舞，为以后努力提高技术，积极解决疑难病症，增强了勇气。
经方、时方与综合运用
在我早期临床中比较地侧重以六经辨证指导外感热病及其变症，不少病人有显著疗效，深受患者好评，例如：
患者，男，三十岁。素有痰饮留伏的哮喘宿根，因受外邪而复发，半月不解。中西医药罔效，病势垂危，已准备后事。证见喘息鼻扇，张口抬肩，胸高气短，头汗如珠，面色发青，烦躁不安，舌苔白腻，两脉滑大而数，沉取无力。据证论治，认属痰气交阻，闭塞气道，邪盛正衰，肺气欲绝。乃以扶正降逆定喘化痰之法，投麻杏石甘汤、葶苈大枣泻肺汤加重剂人参治之，药未尽剂而喘已定。
某老翁，初秋突发高热，日泻十余次，中西（日医）医共治疗三天无好转，病势危殆，乃约余诊。见其精神恍惚，烦躁气促，遍身炽热有汗，泄下褐色水液而恶臭，腹痛不着，纳呆不吐，溲少而赤，舌质红，苔黄腻，脉弦滑而数。当时按太阳阳明合病、挟热下利之表里证论治，而以葛根黄芩黄连汤冶之，一剂而瘥。
一老妇年近古稀，外感高热四天，热退匝月，日夜不能合眼瞬息，西药安眠、中药安神俱无效。精神烦躁，痛苦难堪。舌质光红而干，脉弦细而数。当时按少阴热化、水火未济，而以黄连阿胶汤治之，一剂酣睡，再剂乃安眠。
又患者，男，五十岁。先发热十天，退热后二十天不饮，不食，不语，仰卧，昏睡而不闭目，有时长出气，半月无大便，舌苔白腻遍布，两手俱无脉。中西医均拒绝治疗，已备好衾棒，等待气绝。余按邪热内陷、痰热郁结、阻滞中脘、气机痞塞论治，而予小陷胸汤原方。服后二小时，病人即能闭目深睡，减少了长出气。翌晨突然坐起，诉饥饿，索食物，家人反而惊惧，以为“回光返照”。疑惧稍定，姑与之食，见其食后又安睡，知其已有生望，于是由惧转喜，再邀复诊。继续以小陷胸汤加元明粉予之，翌日得畅便。由此神态自如，其病若失。
[Background Information]
Book: The Path of Renowned TCM Physicians
Chapter: Main Text (36/72)
Category: Medical Discourse
In the past, farmers in my hometown did not pay attention to hygiene, and there were many flies. During the cholera epidemic, patients' vomit and diarrhea were casually poured into rivers, polluting the water and worsening the outbreak; it was common for entire families to die. An old doctor named Wang Kunyu, who practiced "Tiao Sha" (a folk therapy involving pricking the skin to bleed), died immediately after returning home from treating a village, suffering from vomiting and bedsores. Consequently, people lived in fear, refusing even to hire cart drivers to take me to rural areas for consultations. After repeated persuasion, they agreed to drive only as far as the village entrance. Upon entering the village, I saw coffins placed in front of every household, with few people around, which was shocking. In one family of eight, seven had died, leaving only one youth on his deathbed, who survived after treatment. Pitying the family's ignorance of the disease's high contagion, the harm of flies, and water pollution, I repeatedly explained the importance of hygiene and prevention methods to the villagers after diagnosis.
Before the 1930s, people in my hometown did not believe in Western medicine's fluid replacement therapy, and families of cholera patients feared taking Chinese herbal medicine because a typical prescription required one decoction per day, but the liquid was often vomited immediately upon ingestion, rendering it ineffective. Patients considered this futile, preferring Tiao Sha or acupuncture. Given this situation, I instructed families to purchase five doses at once, boil three initially, and if vomiting occurred, administer again, ensuring a sufficient amount of herbal liquid was retained. With this approach, vomiting usually ceased before five doses were exhausted.
A physician must know herbs and, crucially, understand whether the composition and dosage of expensive proprietary medicines are reliable. For instance, Ju Fang Zhi Bao Dan (Official Formulation Precious Pill), used for severe coma, can determine life or death instantly if its quality varies. This applies to all essential emergency medications.
I once treated a comatose girl. Observing that the Zhi Bao Dan purchased by her family lacked the scent of Borneolum Syntheticum (Bingpian, 冰片) and Moschus (Shexiang, 麝香), I advised switching to authentic medication, ground and mixed by myself for administration. She regained consciousness after several hours. Another comatose patient had been given Zhi Bao Dan by a previous doctor but remained unconscious overnight. Investigating the cause, I determined the dosage was too light for the severity of the illness. Doubling the dose and administering it again saved the patient.
Courage should be great, but caution should be small
Li Ting stated: "During the Tang Dynasty, medical practice declined significantly. Sun Simiao, despite his expertise, was disparaged as a mere technician. Zhu Xi lamented this, quoting him in 'Xiaoxue': 'Wisdom should be round and flexible, conduct square and upright; courage should be great, but caution should be small.' This is truly the secret of medicine. There are those who memorize ancient and modern medical texts yet fail to cure patients; their failure lies either in rigid application of formulas or in being careless yet timid." Treating patients prioritizes curing them; one must avoid hesitation or excessive concern for personal gain or loss. Thus, one must be both courageous and cautious. Being courageous without caution leads to reckless action, turning medicine into a weapon, which is no less harmful than being careless and timid.
In 1927, I was twenty-seven years old and had practiced medicine for only four years. The wife of a bureau director suffered from uncontrollable uterine bleeding and loose stools due to an abortion where she had taken too much blood-breaking and stasis-resolving medication. Her face was pale, muscles flaccid, and she was fainting and reluctant to speak. Gynecologists consulted refused to prescribe. After diagnosing her pulse, I explained that excessive blood loss required stopping blood-breaking drugs like Yimucao Decoction (Motherwort Decoction). Instead, I prescribed Xiangsha Liujunzi Decoction (Aucklandia and Amomum Six Gentlemen Decoction) supplemented with Astragali Radix (Huangqi, 黄芪), Angelicae Sinensis Radix (Danggui, 当归), Paeoniae Radix Alba (Baishao, 白芍), Myristicae Semen (Rouguo, 肉果), and Cistanches Herba (Poguzi, 破故纸). Fortunately, she recovered. The gynecologists withdrew because the husband was a director and the condition was critical; fearing liability if they failed, they acted out of timidity and carelessness, prioritizing themselves over the patient's crisis.
My sole purpose is to relieve patients' suffering through every means possible. When I started practicing in Jiading, I realized most rural families had limited income and financial difficulties. Therefore, I did not set fixed consultation fees and prioritized effective yet affordable medications. During an epidemic of cerebrospinal meningitis, doctors often used Rhinoceros Horn (Xijiao, 犀角) and Antelope Horn (Lingyangjiao, 羚羊角), costing dozens of yuan per dose, with little significant efficacy, often bankrupting middle-class families. In such cases, I strictly avoided expensive herbs like Rhinoceros Horn, Antelope Horn, Pearl (Zhenzhu, 珍珠), and Calculus Bovis (Niuhuang, 牛黄) if cheaper alternatives could solve the problem. In the 1930s, refugees from northern Jiangsu relied on manual labor and struggled financially. One day, a fourteen-year-old girl from northern Jiangsu presented with a carbuncle on her buttock, suffering from severe swelling, high fever, and inability to stand straight, supported by her father. I asked why she hadn't seen an expert. Her father hesitated, saying several doctors had refused treatment due to fear of trouble if complications arose. Believing immediate intervention was necessary for survival, I performed surgery, draining half a chamber pot of pus, and prescribed Astragali Radix orally. The swelling subsided, fever resolved, and she healed.
Additionally, fishermen in my hometown believed in cutting "Tanglangzi" (swelling in infants' cheeks preventing suckling). This often led to fatal hemorrhage from severed blood vessels. Xu Lingtai recorded criticism of such practices causing deaths. Using a method from Linwu Shanshanren, I prepared fresh Rehmanniae Radix (Shengdihuang, 生地黄) soaked in yellow wine, mashed, and applied to the soles of the feet (left for males, right for females), distributing it to families to discourage the dangerous practice and prevent unnecessary deaths.
Farmers living far from towns faced difficulties obtaining medicine. In 1965, during mobile clinics near Qibao Town, Shanghai, I observed abundant local medicinal plants. In lectures for rural health workers, I introduced dozens of effective simple prescriptions under the theme "Local Resources, Readily Available." For example, crushed scallions fried and applied hot for hematomas from trauma; sesame oil taken internally and applied externally for burns; dandelion applied topically for boils and furuncles; Tuolicao Decoction for anemia and sallow complexion; Prunella Vulgaris (Xiakucao, 夏枯草) boiled with pork bones for liver and stomach pain; Imperata Rhizome (Maogen, 茅根) decoction for epistaxis and hematuria. These solutions were easy to implement, and the audience appreciated them.
Conclusion
I believe youth is the period of peak vitality and memory retention, making it the most precious time in life. Ambitious youths throughout history have worked hard during this period to achieve success. Wasting this time is regrettable. As the saying goes, "If you do not work hard when young, you will regret it when old." This serves as a warning. After youth, worldly affairs increase, energy declines, and even with experience, forgetting becomes easier. However, this period is prone to distractions that must be overcome. One should avoid smoking, drinking, gambling, and idle chatter. Otherwise, how much precious time remains? Only those who focus intently, remaining calm amidst chaos and undistracted by trivialities, can ensure success. Han Yu said, "Excellence comes from diligence, while neglect stems from play." How true! Though elderly, I feel there is still much to learn, experiencing the sentiment of learning until death. With the realization of the nation's Four Modernizations imminent, I wish to encourage my colleagues to strive together.
TCM Treasure Pavilion
The Path of Renowned TCM Physicians Vol. 3
The Path of Renowned TCM Physicians Vol. 1
The Path of Renowned TCM Physicians Vol. 2
The Path of Renowned TCM Physicians Vol. 3
The Path of Renowned TCM Physicians Vol. 4
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A Lifetime of Healing Medicine
He Shiying, Director of TCM Department, Tianjin Children's Hospital; Councilor, China Association of Chinese Medicine
[Author Profile] He Shiying (1912–), from Tianjin. Self-taught in TCM early on, graduated from North China College of Traditional Chinese Medicine in 1936 and began practice in Tianjin. Dedicated his life to internal medicine and pediatrics, with rich clinical experience. Author of *Pediatric Diseases* and *He Shiying's Pediatric Case Records*. Currently serves as a member of the Tianjin Municipal Committee of the Chinese People's Political Consultative Conference, Standing Committee Member of the Tianjin Association for Science and Technology, and President of the Tianjin Association of Traditional Chinese Medicine.
I came from a poor family. After primary school, my father wanted me to apprentice, but I disagreed and reluctantly continued my education. Later, due to warlord conflicts and livelihood hardships, unemployment grew. To avoid starvation and cold, I learned a skill for survival, which was my initial motivation for studying medicine. Why TCM? Because studying Western medicine required qualifications I didn't have and tuition I couldn't afford.
With the help of a TCM practitioner, I self-studied, memorizing *Ben Cao Bei Yao* (Compendium of Materia Medica Essentials), *Yao Xing Fu* (Ode to Herb Properties), *Tang Tou Ge Jue* (Song of Prescriptions), and *Bin Hu Mai Xue* (Lake Shore Pulse Studies), and briefly studied *Neijing* (Inner Canon), *Shanghan Lun* (Treatise on Cold Damage), and *Jingui Yaolue* (Essential Prescriptions of the Golden Cabinet). Later, when Mr. Shi Jinmo founded the North China College of Traditional Chinese Medicine and advertised for students, I entered the school with financial support from relatives and friends.
On the first day of college, Mr. Shi Jinmo spoke at the opening ceremony, pointing out two issues: First, the general technical level of TCM was too low, with many unqualified practitioners. Incorrect treatment might not kill immediately, but conditions would worsen leading to death unnoticed by patients—this is "quackery killing without a knife." Second, TCM must develop and improve via scientific integration. It is like an old mansion unfit for modern times; using its good materials to build a new, sturdy, and practical building would be better. The college aimed to train backbone personnel to improve TCM. Mr. Shi's speech greatly influenced me.
Mr. Shi believed TCM should integrate Western medicine, using its strengths to supplement TCM's weaknesses, advocating for a fusion without sectarianism. Thus, the curriculum combined Western and TCM studies, focusing on TCM. Lecturers were renowned figures like Zhou Jieren, Zhu Hushan, and Fang Bobing. Western courses were taught by teachers from Pingda Medical College. Due to heavy clinical duties, Mr. Shi only taught senior case studies and supervised internships personally.
Since the library was not yet established, I utilized spare time to read. After afternoon classes, I ate a simple dinner at a porridge stall near Xisi Pagoda, then went to the National Library near Beihai Park until closing. Besides medical classics, I read literature and history, maintaining this for three years, accumulating over a hundred notebooks.
The program was four years long. After three years, I took the Tianjin municipal TCM exam, passing with the highest score. Before graduation, I obtained a license to practice. Due to special arrangements, I was allowed to take the final exams and receive my diploma.
Tests After Starting Practice
I began practicing officially at a pharmacy counter. Feeling insecure about my diagnostic abilities, I encountered three difficult cases shortly after opening: The first likely suffered myocardial infarction. He walked normally, complained of slight chest tightness and nervousness, with normal pulses. He died suddenly at home before taking any medicine. Hearing the news shocked me, but relief came knowing he hadn't taken the drug. The second was a terminal tuberculosis patient. I visited once and didn't return. The patient was friends with a famous old doctor who recommended me to test my skills. Learning this made me ashamed. The third was a psychiatric patient ill for five years, exhibiting frequent hiccups, arms hanging limp unable to touch body or objects, touching caused hiccups. His face was pale and puffy, appetite poor, body weak, spirit depressed and pessimistic, believing he would die. All treatments in the city failed. I treated him for over ten days with liver-soothing, spleen-regulating, and qi-descending formulas with no effect.
These cases pressured me, even making me regret studying medicine. However, recalling the story of "Chu Man Steering a Boat" from *Donglai Boyi*, I realized headwinds were tests and training. Favorable winds early on could lead to arrogance and failure. I realized overcoming difficulties was key to improving skills. Changing my mindset opened new approaches.
I analyzed the third case carefully. Based on symptoms, it was clearly psychiatric. Medication alone seemed powerless. Zhu Danxi noted that mental illnesses require human intervention, not just herbs. I noticed the patient bowed his head before hiccupping. If he stopped bowing, hiccups might cease, though holding back breath could cause chest tightness. So, I decided to stop prescribing and use psychological counseling.
First, I explained why I wasn't prescribing and assured him of a good prognosis. Then, I urged him to control the habit of bowing, encouraging him to stand tall and fight the disease with courage. Trying once, he felt suffocated and painful. Encouraging him to continue at home, I told him: "Willpower determines recovery. With effort, even a five-year illness can heal quickly." Through his own efforts, persisting for two days, hiccups largely stopped, and his appearance and spirit improved. Occasional relapses occurred due to bad moods, but firm willpower led to full recovery.
This success encouraged me greatly, boosting my confidence to tackle difficult cases and improve my skills.
Integration of Classic and Contemporary Formulas
In my early clinical practice, I focused on using Six Meridian differentiation for exogenous febrile diseases and their variations, achieving significant results praised by patients. Examples include:
Case 1: Male, 30 years old. History of asthma due to phlegm-fluid retention, exacerbated by external pathogens for half a month. Western and Chinese medicines failed; condition critical. Symptoms: panting with nasal flaring, mouth open shoulders raised, chest distension, shortness of breath, bead-like sweat on head, cyanotic face, restlessness, white greasy tongue coating, slippery-large-rapid pulses, weak on deep pressure. Diagnosis: Phlegm-qi obstruction blocking airways, pathogen excess, righteous qi deficiency, lung qi failing. Treatment: Support righteous qi, descend rebellious qi, calm asthma, resolve phlegm. Prescribed Maxing Shigan Decoction (Ephedra, Apricot Seed, Gypsum, Licorice Decoction) and Tingli Dazao Xiefei Decoction (Descurainia Seed and Jujube Lung-Draining Decoction) with heavy dose of Ginseng Radix et Rhizoma (Renshen, 人参). Asthma stabilized before finishing the dose.
Case 2: Elderly man. Sudden high fever in early autumn, diarrhea over ten times daily. Western/Japanese medicine treatment for three days showed no improvement; condition critical. Symptoms: Trance, irritability, rapid breathing, whole body hot with sweat, brown foul-smelling watery stool, abdominal pain absent, anorexia without vomiting, scanty red urine, red tongue body, yellow greasy coating, wiry-slippery-rapid pulse. Diagnosis: Taiyang-Yangming combined syndrome with heat-induced diarrhea. Treatment: Gegen Qinlian Decoction (Kudzu, Scutellaria, Coptis, Licorice Decoction). Recovered after one dose.
Case 3: Elderly woman, nearly seventy. High fever from external contraction for four days, followed by insomnia for a month. Western sedatives and TCM calming herbs ineffective. Irritable, painful. Bare red dry tongue, wiry-thin-rapid pulse. Diagnosis: Shaoyin heat transformation, failure of water-fire interaction. Treatment: Huanglian Ejiao Decoction (Coptis and Donkey-Hide Gelatin Decoction). Slept soundly after one dose, slept well after second.
Case 4: Male, 50 years old. Fever for ten days, then twenty days of no drinking, eating, speaking, lying supine, sleeping with eyes open, occasional deep sighs, no bowel movement for half a month, white greasy tongue coating, no pulse in both hands. Doctors refused treatment; family prepared shroud. Diagnosis: Internal penetration of pathogenic heat, phlegm-heat stagnation, obstruction of middle jiao, qi mechanism blocked. Treatment: Xiaoxianxiong Decoction (Pinellia, Citrus Peel, Trichosanthes Root Decoction) original formula. Two hours later, patient slept deeply, sighs reduced. Next morning, sat up suddenly, hungry, asking for food. Family frightened, thinking it was "terminal lucidity." Doubts eased, gave food. Patient slept peacefully after eating, indicating hope. Joy replaced fear, invited for follow-up. Continued Xiaoxianxiong Decoction with Natrii Sulfas (Yuanmingfen, 元明粉). Next day, smooth bowel movement. Patient returned to normal, illness seemingly gone.