经方用之得当，效如稃鼓，这是历代医家共同的体验。但我通过临床认识到，同于经方一隅，是不能解决一切外感热病的。在某些情况下，必须用温病辨证及应用时方才能取得效果。例如神昏一症，完全按照《伤寒论》胃家实处理，是不符合实际的。又如外感热病初期之属于温病的，依然坚持「一汗不解，可以再汗」，及「下不厌迟」的原则，也是不合理的。更以流行性乙型脑炎为例，如以六经辨证，则只能受到阳明经证的局限。在把好乙脑三关(高热、惊撇、呼吸衰竭)中，即使对退高热有利，但也不能控制惊厥和呼吸衰竭，何况乙脑在临床上常表现为暑温证和湿温证不同的类型。所有这些，都不是六经辨证所能指导，也不是单用经方所能解决的。由于历史的条件，《伤寒论》决不可能概括万病，它的理法方药，也决不可能完全适用于一切外感热病。温病的学说是在《伤寒论》基础上发展起来的，两者都代表外感热病。从整个发病过程中，由初期、中期到末期，都有其不同的临床特点。可以说，伤寒与温病是外感热病的两大类型，每一类型包括若干病种，同一病种也可能在病程中出现不同的类型。这两个类型既有所区别，又各有特点，而且它们的理论核心，都是落实副脏腑经络之上，《伤寒论》一些方荆，仍为温病所沿用。因此，六经、三焦、卫气营血辨征应该密切地结合在一起。根据具体病情，灵活掌握，经方、时方统一运用，不应继续存在几百年来所谓寒温门户之见。个人早期临床既在经方上有所收获，但以后也常应用时方而收效。因此，我个人既不是经方派，更不是时方派，而是综合派。
继承师学与独立思考
施今墨先生治病，博采古今南北各家之长，遇有疑难之症，必参合医理，穷源溯流，深思巧构，疗效突出。其临床特点很多，外感内伤均所擅长。举如急性传染病、呼吸、消化、循环、泌尿，特别对神经系统疾患，均有独到之处。施师尤擅长妇科，特别注意调理气血，强调「气以帅血，理血必先理气」之旨。对功能性子宫出血、子宫脱垂、闭经、滑胎、妊娠恶阻、盆腔急慢性疾患等，疗效极为显著。
施师处方，喜开「对药」，如厚朴花与玳玳花连用，大生地与大熟地连用，砂仁壳与豆蔻壳连用，苍朮与白朮连用等。用药剂量非常谨慎，麻黄均用蜜炙且份量极微，一般O．9～1．5克，很少用至3克。常谆谆告诫同学慎用葛根，必要时以青蒿代之。
我多年来秉承师法，每获良技，但有时也要跳出老师的框子。施师慎用葛根，而我经常习用，并无副作用发生。施师对某些药使用剂量甚微，而我根据病情需要，往往超量应用始能奏效。例如施师用葶苈子经常不超过1．5克，而我则用至9克。又如麻黄定喘，对急性呼吸道疾患，虽小量亦效，但对慢性者，墨守微量，往往无济于事。施师治疗头风证中的神经性头痛，喜用虫类平肝熄风药，一般地用地龙、殭蚕，稍重用全蝎，特重用蜈蚣。施师用蜈蚣，每剂从未超过一条，我则根据病情需要，每剂最多用至十六条，并未发生中毒反应。举例如下；
宋××，男，三十一岁，某面粉厂工人。1956年2月15日初诊：头痛四周，阵发性，痛时剧烈难忍。
一周前头痛突然昏例，手足厥冷，当时由厂医送往某医院晒系科住院检查。医院考虑脑肿瘤，决定开颅探查。患者不同意手术，于术前一日自动出院来诊。
当时精神紧张，头痛时额汗如珠，常有幻视，夜梦纷纭，不能酣睡。舌质暗红，苔少，脉象弦数。证属肝风上扰，头风重证。宜镇肝熄风。
处方：天麻、猛莶草、菊花、白蒺藜各g克，桑寄生15克，代赭石18克，山慈菇0克，锻磁石30克，川连、胆草各4．5克，蜈蚣3条，全蝎g克，水煎眼。
上方加减服至2月28日，头痛好转，但头部有时有上撞感。睡眠时间略长，但梦多、幻视已轻，脉象弦数转缓。改定处方：紫石英24克，锻磁石30克，生龙齿、代赭石、茺蔚子各15克，生石决明30克，全蝎9克，殭蚕、胆草各4．5克，菊花、地、坨、勾藤、天麻、稀莶草各9克，蜈蚣4条。
从2月28日起，依上方加减服至4月4日一个多月中，蜈蚣用量陆续增至16条，头痛全止。再服五、六剂后逐步减量。一般情况仍好，乃停药观察，后封某医院脑系科复查，已无阳性体征，恢复工作。
当然，在临床方面，每人经历不同，故有不同的经验积累。但是新的经验积累，必然是在前人的基础上建立起来的。如我喜用葛根，系我的启蒙老师天津市已故名医陈泽东亲传。陈老以善用温燥药而闻名，里证动辄姜、附、桂，表证常用苏(苏叶代替麻黄)、葛、柴。我虽然投入施门，但对陈派用药已先入为主，故对施师深恶葛根，反滋疑窦，而我以后在长期临床体验中，葛根用之得法，其妙无穷。因此，兼采各家之长，又要独立思考、推陈出新，才是治学治医的必由之路。
儿科特点与提高方向
在我学医时对儿科比较感兴趣。学校聘请施师胞兄光致先生主讲儿科。光老对儿科很有造诣，临床经验丰富，个人受益匪浅。
自专业儿科后，发现存在许多阀题阻碍着中医儿科的发展，其中最为突出的是剂型问题。小儿服汤药很不方便，煎多了无法吞服，煎少了又容易炭化。其实这一实际问题，早就引起古代一世纪《小儿药证直诀》中所载一百二十四方属于丸、散、膏、服易用的剂型。这种适应小儿疾病服药传统有效方法，是应该继承的.过去虽有一些儿科古方和验方删改，多数盛称百病皆冶，疗效不专。解放后经过审订，淘汰了一些品种，现有仅能治疗小儿部分疾病，大部分疾病缺少专药。
为了解决这一问题，从一九六0年开始，总结个人经验，筛选出疗效比较满意的方剂，由本单位制成便于服用的成药，包括片、丸、糖颗粒、糖浆、水剂、散剂、软膏等二十余种，一般常见病几乎都有专药(参阅《中医杂志})1965，11、12两期)。其中大部分作了系统地临床观察，并反复修正了配方，经过长期临床应用，颇受患儿及家属的欢迎。当然，成药有它的局限性，至于病情复杂等特殊情况，仍需要服用汤药，不能削足适履。
配制成药的目的，固然是解决剂型问题，但更重要的是提高临床疗效。以最常见的急性扁桃腺炎来说，由于对抗菌素敏感的减弱，有些病儿往往服用西药多日不能解热而转看中医。我观察到患本病的小儿，除局部病变及全身的高热外，多数伴有口唇特红、脐腹疼痛、大便秘结等特征，这是西医儿科教材所没有，中医儿科教材有也叙述不全的。从患儿多数舌红、苔薄黄、脉弦数来看，风热相搏，来势甚暴，其病机则里热偏重。据此治以清热解毒、化瘀通便，配制成「清降丸」一药。服后一般翌日或当日必大便，便后热退，局灶随之改善。仅此一药的推广使用，便节省了大量的抗菌素。
中医儿科也存在诊查方法问题。儿科又称哑科，既不能自诉病情，家属反映情况也不见得完全可靠；小儿精神容易激动，脉象也不稳定}儿科特殊诊法的指纹观察，又难以掌握标准。因此，中医儿科诊查方法必须扩大，诊查指标要求尽量客观化，应适当结合西医诊查方法。几十年前中医儿科很少使用体温表，现在不是普遍应用了吗?为了便于了解呼吸道疾患病情轻重以及心功情况，没有理由拒绝采用听诊器。为了有利于鉴别诊断，根据需要，还应作必要的化验室检查及其它检查。如肾炎，当临床症状已经消失，而尿化验仍不正常，如果只凭临床现象，主观认为痊愈，岂不误事?从病人实际出发，我认为中医儿科工作者必须打破保守，虚心采用西医之长，补中医之短，才能有助于提高疗效。
中医儿科当前存在的最严重问题，是没有接触急症及急性传染病的机会。像我单位门诊急症中医不能插手不说，由于未建立传染病科，平日既不收也不看急性传染病(只夏秋季开病房收治乙脑)。中医儿科本来长于治疗麻疹，现在也看不到了，经验成为书本上的空谈。长此以往，确实要像有人指责的那样：中医不会治急病。
上举三点，前两者可以通过中医本身努力来改进，但最后一点，涉及某些问题，则无能为力。从长远看，这一点能否改进，是关系到中医儿科能不能长期存在的重大问题。
扬长避短与发挥优势
诊断明确，应急措施多，是西医之长；辨证施治，灵活性强，是中医特点。两者结合起来，扬长避短，发挥优势，就能提高临床疗效。以收治乙脑为例，从一九七三至一九七八年间统计我单位共收治乙脑三百六十二例，通过中西医结合以中药治疗为主，平均病死率仅2．89，6(参阅《天津医药》1980．7，「流行性乙型脑炎的中医治疗体会」)。
中医中药单独治疗急性传染病，疗效还是比较满意的。一九五九年津市白喉流行，我单位接受临时收治任务。因白喉类毒素供应不足，除开两个西医病房外，又开了一个中医病房，专以中药治疗。当时合并症很多(主要是心肌炎)，症势险恶。我在临床观察中，发现这年白喉病儿有如下特征：发热不高，日暮较甚，既不恶寒，也不恶热，身软无力，口干不喜饮水，咳嗽无痰，咽痛不重，舌质光红微干，脉弦细而数等，无一不切合阴虚证。前人认为阴虚肺燥是白喉发病的病理基础，是完全符合实际的。于是在治疗上便确定以「养阴救燥」为治则，并以吹喉药配合汤剂治疗。对于合并心肌炎，则按病情轻重，辨证论治处理。这个病房共收治白喉病儿一百零七例，仅一例死于合并心肌炎，临床呈现阴分已竭，阳气虚脱的严重败象。另外，有两例病儿合并皮肤白喉(疮面培葬证实)而以吹喉药外用，迅速取得脓消疮愈的意外敛果(参阅「天津医药杂志》1960．7，「中药治疗白喉107例初步总结」)。这里附带说明，在治疗白喉的西医病房中，不少患儿对白喉类毒素过敏，而改用中药治疗，无一例失败。
中医儿科在临床上有很多经验可以补充现代西医儿科之不及。例如肠麻痹症，西医常需肛管排气，而效果有时不理想。中医辨证有属肺气不宣，大肠雍滞的实证，也有脾阳虚衰，运化失调的虚证。我对前者常用「小儿一捻金」或「牛黄夺病散」收效，后者则以温脾消胀之剂取胜。
清热利湿治疗新生儿高胆脂血症，凉血散瘀加镇摄治疗过敏性紫癜}清热解毒，逐瘀化浊之治疗肺脓疡；淡渗去湿，驱风止痒治顽固性皮肤过敏性疾患等，疗效均比较突出。
又如脑症昏迷病人的尿闭，不论程度轻重，只要指压利尿点(病儿仰卧取平，从脐眼至耻骨联合上缘，连一直线，在二分之一交点处)，立即排尿，而且通畅彻底。自从我在《天津医药杂志》1965年7期发表「指压利尿法治疗昏迷病儿伴发屎潴留八十例临球观察」一文后，我单位迅速推广，医护均能掌握，一直到现在，重复可靠，效果显著。
医学生涯六十年
重庆市中医研究所顾问陈源生
【作者简介】陈源生(1897～)，四川铜梁县人。中医世家，致力于中医临床工作六十余年。对《伤寒论》、《金匮要略》的临床意义多有阐发,善于汲取各家学说的长处，对中草药的研究尤其心得。治病不拘成法，主张轻灵巧取，在内、妇、儿科临床上，有较深的造诣。着有《临床常用中草药选编》、《简便验方歌括》
在畸岖的医学道路上，我虽已经历了六十多个寒暑，但仍不敢妄言医道精微。只能把一些点滴的经验教训披陈如下，以与同道共勉。
由诵习方药入手，从流溯源
我家世代以医为业。叔祖父陈济普，以内、妇、喉科见长，在铜梁一带行医数十年，名噪一方，家父及兄长皆从其学。我九岁发蒙读私塾，二、三年后，父亲就叫我在课余背诵《药性赋》。所赖年少，记忆力强，不多久，寒、热、温、平几百味药性背得滚瓜烂熟。紧接着又背诵了《药性四百昧歌括》。一切都很顺利，对医道兴趣倍增。．继而征得塾师之允，遂与儒书、医书合炉共冶。按照叔祖父安排，进一步就读《时方歌括》、《时方妙用》。因先背熟了药性，虽初读方书亦不感到陌生。叔祖父对我讲：「虽说『医不执方』，而『医必有方』。前人立方，皆遵法度，故学方易知法。法与方，犹藤与瓜之关系，欲临证者，当先从方与法入门。」之后，又读了《成方便读》、《成方切用》等方书。在熟悉了基本治法与方剂后，开始读《医学三字经》。背得了(《医学三字经》，叔祖父嘱我再读《医学心悟》。并说：「《心悟》一书，其精粹又在『医门八法』篇中，务必要熟读、精恩，最好背得。」确如其言，「八法」篇颇切实用，我临证以来，立法处方得程锺龄先生益处不小。除陈、程这两本书外，还陆续读了一些入门书籍，由此而具备了浅显的理论及一般的临证知识，为学习经典医著作了一些铺垫。
攻读经典的方法：相互参证，
经方如果使用得当，疗效迅速显著，这是历代医家共同的体验。但我通过临床认识到，仅凭《伤寒论》中的经方，是不能解决所有外感热病的。在某些情况下，必须运用温病辨证方法并应用时方（后世医家创制的方剂）才能取得效果。例如神昏这一症状，如果完全按照《伤寒论》中“胃家实”（阳明腑实证）的原则处理，是不符合实际情况的。又如外感热病初期属于温病类型的，如果依然坚持“一汗不解，可以再汗”以及“下法（泻下法）不嫌迟”的原则，也是不合理的。再以流行性乙型脑炎为例，如果只用六经辨证，则只能局限于阳明经证的范围。在应对乙脑的三关（高热、惊厥、呼吸衰竭）中，即使对退去高热有利，也不能控制惊厥和呼吸衰竭，何况乙脑在临床上常表现为暑温证和湿温证等不同类型。所有这些情况，都不是六经辨证所能指导的，也不是单用经方所能解决的。由于历史条件的限制，《伤寒论》决不可能概括所有的疾病，它的理法方药，也决不可能完全适用于一切外感热病。温病学说是在《伤寒论》基础上发展起来的，两者都代表了外感热病的范畴。从整个发病过程来看，由初期、中期到末期，都有其不同的临床特点。可以说，伤寒与温病是外感热病的两大类型，每一类型包括若干病种，同一病种也可能在病程中出现不同的类型。这两个类型既有所区别，又各有特点，而且它们的理论核心，都是落实在脏腑经络之上，《伤寒论》的一些方剂，至今仍被温病学派所沿用。因此，六经辨证、三焦辨证、卫气营血辨证应该密切地结合在一起。根据具体病情，灵活掌握，将经方与时方统一运用，不应继续存在几百年来所谓寒温门户之见。我个人早期临床在经方上有所收获，但以后也常应用时方而收到疗效。因此，我个人既不是经方派，更不是时方派，而是综合派。
继承师学与独立思考
施今墨先生治病，广泛采纳古今南北各家之长，遇到疑难病症，必定参合医理，追根溯源，深思熟虑，巧妙构思，疗效突出。他的临床特点很多，对外感和内伤疾病均擅长。举例如急性传染病、呼吸、消化、循环、泌尿系统疾病，特别对神经系统疾患，均有独到之处。施老师尤其擅长妇科，特别注意调理气血，强调“气为血帅，治理血液必须先治理气机”的宗旨。对功能性子宫出血、子宫脱垂、闭经、滑胎（习惯性流产）、妊娠恶阻、盆腔急慢性疾患等，疗效极为显著。
施老师处方，喜欢开“对药”（两味药配合使用），如厚朴花与玳玳花连用，大生地与大熟地连用，砂仁壳与豆蔻壳连用，苍术与白术连用等。用药剂量非常谨慎，麻黄均用蜜炙且份量极微，一般0.9～1.5克，很少用至3克。常谆谆告诫学生慎用葛根，必要时以青蒿代替。
我多年来秉承老师的教法，每获良效，但有时也要跳出老师的框子。施老师慎用葛根，而我经常习用，并无副作用发生。施老师对某些药使用剂量甚微，而我根据病情需要，往往超量应用始能奏效。例如施老师用葶苈子经常不超过1.5克，而我则用至9克。又如麻黄定喘，对于急性呼吸道疾患，虽小量亦有效，但对于慢性者，墨守微量，往往无济于事。施老师治疗头风证中的神经性头痛，喜欢用虫类平肝熄风药，一般用地龙、僵蚕，稍重用全蝎，特重用蜈蚣。施老师用蜈蚣，每剂从未超过一条，我则根据病情需要，每剂最多用至十六条，并未发生中毒反应。举例如下：
宋某某，男，三十一岁，某面粉厂工人。1956年2月15日初诊：头痛四周，阵发性，痛时剧烈难忍。
一周前头痛突然昏倒，手足厥冷，当时由厂医送往某医院脑系科住院检查。医院考虑脑肿瘤，决定开颅探查。患者不同意手术，于术前一日自动出院来诊。
当时精神紧张，头痛时额部出汗如珠，常有幻视，夜梦纷纭，不能酣睡。舌质暗红，苔少，脉象弦数。证属肝风上扰，头风重证。宜镇肝熄风。
处方：天麻、豨莶草、菊花、白蒺藜各9克，桑寄生15克，代赭石18克，山慈菇9克，煅磁石30克，川黄连、龙胆草各4.5克，蜈蚣3条，全蝎9克，水煎服。
上方加减服至2月28日，头痛好转，但头部有时有上撞感。睡眠时间略长，但梦多、幻视已减轻，脉象弦数转缓。改定处方：紫石英24克，煅磁石30克，生龙齿、代赭石、茺蔚子各15克，生石决明30克，全蝎9克，僵蚕、龙胆草各4.5克，菊花、地黄、钩藤、天麻、豨莶草各9克，蜈蚣4条。
从2月28日起，依上方加减服至4月4日一个多月中，蜈蚣用量陆续增至16条，头痛全止。再服五、六剂后逐步减量。一般情况仍好，乃停药观察，后赴某医院脑系科复查，已无阳性体征，恢复工作。
当然，在临床方面，每人经历不同，故有不同的经验积累。但是新的经验积累，必然是在前人的基础上建立起来的。如我喜欢用葛根，是我的启蒙老师天津市已故名医陈泽东亲传。陈老以善用温燥药而闻名，里证动辄姜、附、桂，表证常用苏叶（苏叶代替麻黄）、葛根、柴胡。我虽然投入施门，但对陈派用药已先入为主，故对施老师深恶痛绝葛根，反滋疑窦，而我以后在长期临床体验中，葛根用之得法，其妙无穷。因此，兼采各家之长，又要独立思考、推陈出新，才是治学治医的必由之路。
儿科特点与提高方向
在我学医时对儿科比较感兴趣。学校聘请施老师胞兄光致先生主讲儿科。光老对儿科很有造诣，临床经验丰富，个人受益匪浅。
自专业儿科后，发现存在许多问题阻碍着中医儿科的发展，其中最为突出的是剂型问题。小儿服汤药很不方便，煎多了无法吞服，煎少了又容易炭化。其实这一实际问题，早就引起古代一世纪《小儿药证直诀》中所载一百二十四方属于丸、散、膏、服易用的剂型。这种适应小儿疾病服药传统有效方法，是应该继承的。过去虽有一些儿科古方和验方删改，多数盛称百病皆治，疗效不专。解放后经过审订，淘汰了一些品种，现有仅能治疗小儿部分疾病，大部分疾病缺少专药。
为了解决这一问题，从一九六零年开始，总结个人经验，筛选出疗效比较满意的方剂，由本单位制成便于服用的成药，包括片、丸、糖颗粒、糖浆、水剂、散剂、软膏等二十余种，一般常见病几乎都有专药（参阅《中医杂志》1965，11、12两期）。其中大部分作了系统地临床观察，并反复修正了配方，经过长期临床应用，颇受患儿及家属的欢迎。当然，成药有它的局限性，至于病情复杂等特殊情况，仍需要服用汤药，不能削足适履。
配制成药的目的，固然是解决剂型问题，但更重要的是提高临床疗效。以最常见的急性扁桃腺炎来说，由于对抗菌素敏感的减弱，有些病儿往往服用西药多日不能解热而转看中医。我观察到患本病的小儿，除局部病变及全身的高热外，多数伴有口唇特红、脐腹疼痛、大便秘结等特征，这是西医儿科教材所没有，中医儿科教材也有叙述不全的。从患儿多数舌红、苔薄黄、脉弦数来看，风热相搏，来势甚暴，其病机则里热偏重。据此治以清热解毒、化瘀通便，配制成「清降丸」一药。服后一般翌日或当日必大便，便后热退，局灶随之改善。仅此一药的推广使用，便节省了大量的抗菌素。
中医儿科也存在诊查方法问题。儿科又称哑科，既不能自诉病情，家属反映情况也不见得完全可靠；小儿精神容易激动，脉象也不稳定；儿科特殊诊法的指纹观察，又难以掌握标准。因此，中医儿科诊查方法必须扩大，诊查指标要求尽量客观化，应适当结合西医诊查方法。几十年前中医儿科很少使用体温表，现在不是普遍应用了吗？为了便于了解呼吸道疾患病情轻重以及心功能情况，没有理由拒绝采用听诊器。为了有利于鉴别诊断，根据需要，还应作必要的化验室检查及其它检查。如肾炎，当临床症状已经消失，而尿化验仍不正常，如果只凭临床现象，主观认为痊愈，岂不误事？从病人实际出发，我认为中医儿科工作者必须打破保守，虚心采用西医之长，补中医之短，才能有助于提高疗效。
中医儿科当前存在的最严重问题，是没有接触急症及急性传染病的机会。像我单位门诊急症中医不能插手不说，由于未建立传染病科，平日既不收也不看急性传染病（只在夏秋季开病房收治乙脑）。中医儿科本来长于治疗麻疹，现在也看不到了，经验成为书本上的空谈。长此以往，确实要像有人指责的那样：中医不会治急病。
上举三点，前两者可以通过中医本身努力来改进，但最后一点，涉及某些问题，则无能为力。从长远看，这一点能否改进，是关系到中医儿科能不能长期存在的重大问题。
扬长避短与发挥优势
诊断明确，应急措施多，是西医之长；辨证施治，灵活性强，是中医特点。两者结合起来，扬长避短，发挥优势，就能提高临床疗效。以收治乙脑为例，从一九七三至一九七八年间统计我单位共收治乙脑三百六十二例，通过中西医结合以中药治疗为主，平均病死率仅2.89%（参阅《天津医药》1980.7，“流行性乙型脑炎的中医治疗体会”）。
中医中药单独治疗急性传染病，疗效还是比较满意的。一九五九年津市白喉流行，我单位接受临时收治任务。因白喉类毒素供应不足，除开两个西医病房外，又开了一个中医病房，专以中药治疗。当时合并症很多（主要是心肌炎），症势险恶。我在临床观察中，发现这年白喉病儿有如下特征：发热不高，日暮较甚，既不恶寒，也不恶热，身软无力，口干不喜饮水，咳嗽无痰，咽痛不重，舌质光红微干，脉弦细而数等，无一不切合阴虚证。前人认为阴虚肺燥是白喉发病的病理基础，是完全符合实际的。于是在治疗上便确定以“养阴救燥”为治则，并以吹喉药配合汤剂治疗。对于合并心肌炎，则按病情轻重，辨证论治处理。这个病房共收治白喉病儿一百零七例，仅一例死于合并心肌炎，临床呈现阴分已竭，阳气虚脱的严重败象。另外，有两例病儿合并皮肤白喉（疮面培养证实）而以吹喉药外用，迅速取得脓消疮愈的意外结果（参阅“天津医药杂志”1960.7，“中药治疗白喉107例初步总结”）。这里附带说明，在治疗白喉的西医病房中，不少患儿对白喉类毒素过敏，而改用中药治疗，无一例失败。
中医儿科在临床上有很多经验可以补充现代西医儿科之不及。例如肠麻痹症，西医常需肛管排气，而效果有时不理想。中医辨证有属肺气不宣，大肠雍滞的实证，也有脾阳虚衰，运化失调的虚证。我对前者常用「小儿一捻金」或「牛黄夺命散」收效，后者则以温脾消胀之剂取胜。
清热利湿治疗新生儿高胆红素血症，凉血散瘀加镇摄治疗过敏性紫癜；清热解毒，逐瘀化浊之治疗肺脓肿；淡渗去湿，驱风止痒治顽固性皮肤过敏性疾患等，疗效均比较突出。
又如脑症昏迷病人的尿闭，不论程度轻重，只要指压利尿点（病儿仰卧取平，从脐眼至耻骨联合上缘，连一直线，在二分之一交点处），立即排尿，而且通畅彻底。自从我在《天津医药杂志》1965年7期发表“指压利尿法治疗昏迷病儿伴发尿潴留八十例临床观察”一文后，我单位迅速推广，医护均能掌握，一直到现在，重复可靠，效果显著。
医学生涯六十年
重庆市中医研究所顾问陈源生
【作者简介】陈源生(1897～)，四川铜梁县人。中医世家，致力于中医临床工作六十余年。对《伤寒论》、《金匮要略》的临床意义多有阐发，善于汲取各家学说的长处，对中草药的研究尤其心得。治病不拘成法，主张轻灵巧取，在内、妇、儿科临床上，有较深的造诣。著有《临床常用中草药选编》、《简便验方歌括》
在崎岖的医学道路上，我虽已经历了六十多个寒暑，但仍不敢妄言医道精微。只能把一些点滴的经验教训披陈如下，以与同道共勉。
由诵习方药入手，从流溯源
我家世代以医为业。叔祖父陈济普，以内、妇、喉科见长，在铜梁一带行医数十年，名噪一方，家父及兄长皆从其学。我九岁发蒙读私塾，二、三年后，父亲就叫我在课余背诵《药性赋》。所赖年少，记忆力强，不多久，寒、热、温、平几百味药性背得滚瓜烂熟。紧接着又背诵了《药性四百味歌括》。一切都很顺利，对医道兴趣倍增。继而征得塾师之允，遂与儒书、医书合炉共冶。按照叔祖父安排，进一步就读《时方歌括》、《时方妙用》。因先背熟了药性，虽初读方书亦不感到陌生。叔祖父对我讲：“虽说‘医不执方’，而‘医必有方’。前人立方，皆遵法度，故学方易知法。法与方，犹藤与瓜之关系，欲临证者，当先从方与法入门。”之后，又读了《成方便读》、《成方切用》等方书。在熟悉了基本治法与方剂后，开始读《医学三字经》。背得了《医学三字经》，叔祖父嘱我再读《医学心悟》。并说：“《心悟》一书，其精粹又在‘医门八法’篇中，务必要熟读、精思，最好背得。”确如其言，“八法”篇颇切实用，我临证以来，立法处方得程钟龄先生益处不小。除陈、程这两本书外，还陆续读了一些入门书籍，由此而具备了浅显的理论及一般的临证知识，为学习经典医著作了一些铺垫。
攻读经典的方法：相互参证，
When classical formulas (Jingfang) are used appropriately, their efficacy is as immediate as the echo of a drum; this is a shared experience of medical practitioners throughout history. However, through clinical practice, I have realized that relying solely on the cornerstones of classical formulas cannot resolve all exogenous febrile diseases (Wai Gan Re Bing). In certain situations, it is necessary to employ differentiation of warm diseases (Wen Bing) and apply contemporary formulas (Shifang, i.e., formulas created by later physicians) to achieve therapeutic effects. For instance, regarding the symptom of coma (Shen Hun), handling it entirely according to the "Stomach House Excess" (Wei Jia Shi, referring to Yangming Fu syndrome) principle in *Treatise on Cold Damage* (*Shanghan Lun*) does not align with reality. Similarly, for exogenous febrile diseases in their early stages that belong to the category of warm diseases, adhering strictly to the principles of "if one sweating fails, another may be attempted" and "purging is never too late" is unreasonable. Taking epidemic encephalitis B (Yi Nao) as an example, if differentiated only by the Six Channels (Liu Jing), one would be limited to the Yangming Channel syndrome. In managing the three critical phases of encephalitis B (high fever, convulsions, respiratory failure), even if beneficial for reducing high fever, it cannot control convulsions or respiratory failure. Moreover, clinically, encephalitis B often presents as different types such as Summerheat-Warmth syndrome (Shu Wen Zheng) and Dampness-Warmth syndrome (Shi Wen Zheng). All these aspects cannot be guided by Six Channel differentiation, nor can they be resolved by using classical formulas alone. Due to historical conditions, *Treatise on Cold Damage* could never encompass all diseases, and its theory, methods, formulas, and drugs could never fully apply to all exogenous febrile diseases. The theory of warm diseases developed on the basis of *Treatise on Cold Damage*; both represent categories of exogenous febrile diseases. Throughout the entire course of disease onset, from initial, middle, to terminal stages, there are distinct clinical characteristics. It can be said that Cold Damage (Shang Han) and Warm Diseases (Wen Bing) are the two major types of exogenous febrile diseases. Each type includes several disease species, and the same disease species may present different types during its course. These two types are distinct yet possess unique features, and their theoretical cores are both grounded in Zang-Fu organs and meridians. Some formulas from *Treatise on Cold Damage* are still used by the warm disease school. Therefore, Six Channel differentiation, San Jiao (Triple Burner) differentiation, and Wei-Qi-Ying-Blood differentiation should be closely integrated. Based on specific conditions, flexible mastery is required, unifying the application of classical and contemporary formulas, without maintaining the so-called sectarian views between Cold Damage and Warm Diseases that have existed for centuries. Although I gained early clinical experience with classical formulas, I frequently applied contemporary formulas later with good results. Thus, I am neither a Classical Formula School adherent nor a Contemporary Formula School adherent, but rather a Comprehensive School practitioner.
Inheriting Mentorship and Independent Thinking
Mr. Shi Jinmo, in treating patients, extensively absorbed the strengths of various schools from ancient and modern times, north and south. When encountering difficult cases, he would necessarily integrate medical theories, trace the origins, think deeply, and construct ingenious treatments, yielding outstanding efficacy. His clinical characteristics were numerous, excelling in both exogenous and endogenous diseases. For example, in acute infectious diseases, and diseases of the respiratory, digestive, circulatory, and urinary systems, particularly neurological disorders, he had unique insights. Master Shi was especially skilled in gynecology, paying particular attention to regulating Qi and Blood, emphasizing the principle that "Qi commands Blood, so treating Blood requires first treating Qi." He achieved remarkable efficacy in functional uterine bleeding, uterine prolapse, amenorrhea, habitual abortion (Hua Tai), hyperemesis gravidarum (Ren E E Zu), and acute/chronic pelvic diseases.
Master Shi preferred prescribing "paired herbs" (Dui Yao, combinations of two herbs), such as using Hou Po Hua (Magnolia Flower) together with Dai Dai Hua (Aurantii Fructus), Da Sheng Di (Rehmanniae Radix Preparata) with Da Shu Di (Rehmanniae Radix Preparata), Sha Ren Ke (Amomi Pericarpium) with Dou Kou Ke (Cardamomi Pericarpium), Cang Zhu (Atractylodis Rhizoma) with Bai Zhu (Atractylodis Macrocephalae Rhizoma), etc. He was very cautious with dosages; Ma Huang (Ephedrae Herba) was always honey-fried and used in very small amounts, generally 0.9–1.5 grams, rarely reaching 3 grams. He often earnestly advised students to use Ge Gen (Puerariae Lobatae Radix) with caution, substituting Qing Hao (Artemisiae Annuae Herba) when necessary.
For many years, I followed my mentor's teachings and achieved good results, but sometimes I had to step out of his framework. While Master Shi used Ge Gen cautiously, I frequently used it without side effects. Where Master Shi used minute doses of certain herbs, I often needed to exceed those doses based on clinical needs to achieve efficacy. For instance, Master Shi rarely used Ting Li Zi (Lepidii Semen) exceeding 1.5 grams, whereas I used up to 9 grams. Regarding Ma Huang for calming asthma, while small doses are effective for acute respiratory diseases, sticking to minute doses for chronic cases is often futile. For neuralgia within Head Wind syndrome (Tou Feng Zheng), Master Shi liked using insect-based herbs to calm Liver Wind and extinguish wind, generally using Di Long (Pheretima) and Jiang Can (Bombyx Batryticatus), with slightly heavier doses of Quan Xie (Scorpio), and specially heavy doses of Wu Gong (Scolopendra). Master Shi never used more than one Wu Gong per prescription, whereas I used up to sixteen per prescription based on clinical needs, without any toxic reactions. An example is as follows:
Patient Song XX, Male, 31 years old, worker at a flour mill. First visit on February 15, 1956: Headache for four weeks, paroxysmal, severe and unbearable during attacks.
One week prior, the headache suddenly caused fainting, with cold extremities. The factory doctor sent him to the Neurology Department of a certain hospital for examination. The hospital suspected a brain tumor and decided on craniotomy exploration. The patient disagreed with surgery and discharged himself automatically the day before the operation to seek treatment.
At that time, he was mentally tense, sweating profusely on the forehead during headaches, experiencing visual hallucinations, frequent dreams, and unable to sleep soundly. The tongue body was dark red with little coating, and the pulse was wiry and rapid. The pattern was Liver Wind disturbing upwards, a severe case of Head Wind. Treatment should focus on calming the Liver and extinguishing Wind.
Prescription: Tian Ma (Gastrodiae Rhizoma), Xi Xian Cao (Siegesbeckiae Herba), Ju Hua (Chrysanthemi Flos), Bai Ji Li (Tribuli Fructus) each 9g; Sang Ji Sheng (Taxilli Ramulus) 15g; Dai Zhe Shi (Magnetitum) 18g; Shan Ci Gu (Fritillariae Cirrhosae Bulbus) 9g; Duan Ci Shi (Magnetitum Prepared) 30g; Chuan Lian (Coptidis Rhizoma), Dan Cao (Gentianae Scabrae Radix et Rhizoma) each 4.5g; Wu Gong (Scolopendra) 3 pieces; Quan Xie (Scorpio) 9g. Decoct in water and take orally.
After modifying and taking the above prescription until February 28, the headache improved, but there was occasionally a sensation of upward pressure in the head. Sleep duration increased slightly, but dreams and visual hallucinations lightened; the wiry-rapid pulse became slower. Revised prescription: Zi Shi Ying (Fluoritum) 24g; Duan Ci Shi (Magnetitum Prepared) 30g; Sheng Long Chi (Draconis Os Preparatum), Dai Zhe Shi (Magnetitum), Chong Wei Zi (Leonuri Fructus) each 15g; Sheng Shi Jue Ming (Haliotidis Concha) 30g; Quan Xie (Scorpio) 9g; Jiang Can (Bombyx Batryticatus), Dan Cao (Gentianae Scabrae Radix et Rhizoma) each 4.5g; Ju Hua (Chrysanthemi Flos), Di Huang (Rehmanniae Radix), Gou Teng (Uncariae Ramulus cum Uncis), Tian Ma (Gastrodiae Rhizoma), Xi Xian Cao (Siegesbeckiae Herba) each 9g; Wu Gong (Scolopendra) 4 pieces.
From February 28 onwards, taking the modified prescription until April 4, over a month, the dosage of Wu Gong (Scolopendra) gradually increased to 16 pieces, and the headache completely ceased. After taking five or six more doses, the dosage was gradually reduced. General condition remained good, so medication was stopped for observation. Later, re-examination at the Neurology Department of a certain hospital showed no positive signs, and he resumed work.
Of course, in clinical practice, individual experiences differ, leading to different accumulations of experience. However, new experience accumulation must be built upon the foundation of predecessors. My preference for using Ge Gen (Puerariae Lobatae Radix) was personally taught by my启蒙 teacher, the late famous physician Chen Zedong from Tianjin. Old Master Chen was famous for skillfully using warm-drying herbs; for interior syndromes, he frequently used Jiang (Zingiberis Rhizoma), Fu Zi (Aconiti Lateralis Radix Preparata), Gui Zhi (Cinnamomi Ramulus); for exterior syndromes, he commonly used Su Ye (Perillae Folium, replacing Ma Huang), Ge Gen (Puerariae Lobatae Radix), and Chai Hu (Bupleuri Radix). Although I entered Master Shi's school, I was already influenced by Chen's school of medication, so I harbored doubts about Master Shi's strong aversion to Ge Gen. However, through long-term clinical experience, I found that when Ge Gen is used correctly, its efficacy is boundless. Therefore, absorbing the strengths of various schools while thinking independently and innovating is the only path for studying medicine and practicing healing.
Pediatric Characteristics and Directions for Improvement
I was interested in pediatrics when I started learning medicine. The school invited Mr. Guang Zhi, Master Shi's elder brother, to lecture on pediatrics. Old Master Guang had profound attainments in pediatrics and rich clinical experience, benefiting me greatly.
After specializing in pediatrics, I discovered many problems hindering the development of TCM pediatrics, the most prominent being the dosage form issue. It is inconvenient for children to take decoctions; too much cannot be swallowed, and too little may carbonize. This practical issue was addressed early on in the first century AD in *Xiao Er Yao Zheng Zhi Jue* (*Key to Therapeutics of Pediatric Diseases*), where 124 prescriptions listed were pills, powders, pastes, or other easy-to-administer forms. This traditional effective method adapted for pediatric medication should be inherited. Although some ancient pediatric formulas and verified prescriptions were modified in the past, many claimed to cure all diseases without specific efficacy. After review post-liberation, some varieties were eliminated, leaving only those treating partial pediatric diseases, lacking specific medicines for most diseases.
To solve this problem, starting from 1960, summarizing personal experience, I screened satisfactory formulas and had them manufactured into convenient solid preparations by our unit, including tablets, pills, sugar granules, syrups, aqueous solutions, powders, ointments, etc., totaling over twenty types. Almost all common diseases have specific medicines (refer to *Chinese Journal of Traditional Medical Science and Technology*, 1965, Issues 11 & 12). Most underwent systematic clinical observation and repeated formula revisions. After long-term clinical application, they were well-received by patients and families. Of course, solid preparations have limitations; for complex conditions, decoctions are still necessary, avoiding forcing the foot to fit the shoe.
The purpose of preparing solid preparations is certainly to solve dosage form issues, but more importantly, to improve clinical efficacy. Taking the most common acute tonsillitis as an example, due to decreased sensitivity to antibiotics, some children often take Western medicine for days without reducing fever and then turn to TCM. I observed that children suffering from this disease, besides local lesions and systemic high fever, mostly exhibited characteristics such as specially red lips, umbilical and abdominal pain, and constipation. These features are absent in Western pediatric textbooks and incompletely described in TCM pediatric textbooks. From the majority of patients presenting with red tongues, thin yellow coatings, and wiry-rapid pulses, it indicates Wind-Heat combusting, with a violent onset and predominant interior Heat pathology. Based on this, the treatment principle was clearing Heat and detoxifying, resolving stasis and promoting bowel movement, formulated into "Qing Jiang Wan" (Clearing and Descending Pill). Generally, patients defecated on the following day or the same day after ingestion; after defecation, fever subsided, and local inflammation improved. The widespread use of just this one drug saved a large amount of antibiotics.
TCM pediatrics also faces diagnostic method issues. Pediatrics is known as the "Mute Department"; patients cannot describe their symptoms, and family reports may not be entirely reliable; children's spirits are easily agitated, making pulses unstable; and the standard for observing fingerprints, a special pediatric diagnostic method, is hard to master. Therefore, TCM pediatric diagnostic methods must be expanded, diagnostic indicators should be as objective as possible, and appropriate integration with Western diagnostic methods is needed. Decades ago, thermometers were rarely used in TCM pediatrics; aren't they universally applied now? To better understand the severity of respiratory diseases and cardiac function, there is no reason to refuse using a stethoscope. For differential diagnosis, necessary laboratory tests and other examinations should be conducted as needed. For nephritis, if clinical symptoms disappear but urine tests remain abnormal, relying solely on clinical phenomena and subjectively assuming recovery would be detrimental. Starting from the patient's reality, I believe TCM pediatric workers must break conservatism, humbly adopt Western strengths to supplement TCM weaknesses, to help improve efficacy.
The most serious current problem in TCM pediatrics is the lack of opportunities to contact emergency cases and acute infectious diseases. Not only can TCM doctors not intervene in emergency outpatient cases at my unit, but since there is no infectious disease department, acute infectious diseases are neither admitted nor treated routinely (only Encephalitis B is admitted in summer/autumn wards). TCM pediatrics was originally good at treating measles, but now we don't see them either; experience becomes empty talk in books. If this continues, it will indeed be like what some criticize: TCM cannot treat acute diseases.
Regarding the three points mentioned above, the first two can be improved through TCM's own efforts, but the last point involves certain issues beyond our control. From a long-term perspective, whether this point can be improved is a major issue concerning the long-term existence of TCM pediatrics.
Maximizing Strengths and Avoiding Weaknesses to Leverage Advantages
Clear diagnosis and abundant emergency measures are Western medicine's strengths; syndrome differentiation and treatment with high flexibility are TCM characteristics. Combining the two, maximizing strengths and avoiding weaknesses, leveraging advantages, can improve clinical efficacy. Taking the treatment of Encephalitis B as an example, statistics from 1973 to 1978 show our unit treated 362 cases. Through integrating Chinese and Western medicine, primarily treating with Chinese medicine, the average mortality rate was only 2.89% (refer to *Tianjin Medicine*, 1980.7, "Experiences in Treating Epidemic Encephalitis B with TCM").
Treating acute infectious diseases solely with TCM yields satisfactory results. During the diphtheria epidemic in Tianjin in 1959, our unit accepted temporary admission tasks. Due to insufficient supply of diphtheria toxoid, besides two Western medicine wards, a TCM ward was opened, exclusively treating with Chinese medicine. There were many complications at the time (mainly myocarditis), and the condition was perilous. In clinical observation, I found the following characteristics in diphtheria children that year: low-grade fever, worse in the evening, neither aversion to cold nor heat, soft body and weakness, dry mouth but no desire to drink, cough without sputum, mild sore throat, smooth red tongue slightly dry, wiry-thin-rapid pulse, etc., all fitting Yin Deficiency syndrome. Predecessors believed that Yin Deficiency and Lung Dryness were the pathological basis of diphtheria, which was completely consistent with reality. Thus, the treatment principle was determined as "Nourishing Yin and Saving Dryness," combined with throat-powdering medicines and decoctions. For complicated myocarditis, treatment was handled according to syndrome differentiation based on severity. This ward admitted 107 diphtheria children; only one died from complicated myocarditis, presenting severe collapse with exhaustion of Yin aspect and deficiency-collapse of Yang Qi. Additionally, two children with cutaneous diphtheria (confirmed by culture) were treated externally with throat powder, rapidly achieving pus reduction and wound healing unexpected results (refer to *Tianjin Medical Journal*, 1960.7, "Preliminary Summary of Treating 107 Cases of Diphtheria with Chinese Medicine"). Incidentally, in the Western medicine ward treating diphtheria, many children were allergic to diphtheria toxoid and switched to Chinese medicine treatment, with no failures.
TCM pediatrics has many clinical experiences that can supplement modern Western pediatric inadequacies. For example, in intestinal paralysis, Western medicine often requires anal tube decompression, with sometimes unsatisfactory results. TCM differentiation identifies excess patterns belonging to Lung Qi non-dispersion and Large Intestine stagnation, as well as deficiency patterns belonging to Spleen Yang deficiency and impaired transformation. For the former, I often use "Xiao Er Yi Nian Jin" or "Niu Huang Duo Ming San" with good effect; for the latter, warming Spleen and reducing distension agents prevail.
Clearing Heat and draining Dampness treats neonatal hyperbilirubinemia; cooling Blood and dispersing stasis plus sedation treats allergic purpura; clearing Heat, detoxifying, removing stasis, and transforming turbidity treats lung abscess; leaching out Dampness, dispelling Wind, and stopping itching treats stubborn skin allergic diseases, etc., all showing relatively outstanding efficacy.
Furthermore, for urinary retention in comatose patients with cerebral symptoms, regardless of severity, pressing the diuresis point (patient supine, draw a straight line from the umbilicus to the upper edge of the pubic symphysis, at the midpoint) induces immediate urination, which is smooth and thorough. Since I published "Clinical Observation of 80 Cases of Comatose Children with Urinary Retention Treated by Finger Pressure Diuresis" in *Tianjin Medical Journal*, July 1965, our unit rapidly promoted it, and medical staff mastered it. Up to now, it is repeatable, reliable, and significantly effective.
Sixty Years of Medical Career
Chen Yuansheng, Advisor, Chongqing Institute of Traditional Chinese Medicine
[Author Profile] Chen Yuansheng (1897–), from Tongliang County, Sichuan Province. From a family of TCM practitioners, dedicated to TCM clinical work for over sixty years. Has elaborated on the clinical significance of *Treatise on Cold Damage* (*Shanghan Lun*) and *Essential Prescriptions from the Golden Cabinet* (*Jingui Yaolue*), skilled at absorbing the strengths of various schools, with particular insights into the study of Chinese herbal medicines. Does not adhere rigidly to established methods in treatment, advocates light, clever, and quick approaches, with deep attainments in internal medicine, gynecology, and pediatrics. Author of *Selected Common Clinical Chinese Herbal Medicines* and *Simple Effective Prescription Songs*.
On the rugged path of medicine, although I have experienced over sixty winters and summers, I still dare not rashly claim profundity in the medical Dao. I can only present some bit-by-bit experiences and lessons below, to encourage mutual improvement with colleagues.
Starting from Reciting Formulas and Herbs, Tracing the Source from the Stream
My family has practiced medicine for generations. My great-uncle Chen Jipu specialized in internal medicine, gynecology, and laryngology, practicing for decades in the Tongliang area, becoming famous locally. My father and elder brother both studied under him. I started schooling at age nine. Two or three years later, my father asked me to memorize *Yao Xing Fu* (Ode to Properties of Medicinals) during spare time. Relying on my young age and strong memory, soon I memorized hundreds of herb properties—cold, hot, warm, neutral—flawlessly. Immediately following, I memorized *Yao Xing Si Bai Wei Ge Kuo* (Song of Four Hundred Herb Properties). Everything went smoothly, greatly increasing my interest in medicine. Then, with the tutor's permission, I merged Confucian and medical studies. Following my great-uncle's arrangement, I further studied *Shi Fang Ge Kuo* (Songs of Contemporary Formulas) and *Shi Fang Miao Yong* (Wonderful Uses of Contemporary Formulas). Having memorized herb properties first, reading formula books initially did not feel unfamiliar. My great-uncle told me: "Although 'a doctor does not stick to formulas,' 'a doctor must have formulas.' Ancients creating formulas followed rules, so learning formulas makes understanding methods easy. Method and formula are like vine and melon; those wishing to practice clinically should enter through formulas and methods first." Afterwards, I read formula books like *Cheng Fang Bian Du* (Easy Reading of Established Formulas) and *Cheng Fang Qie Yong* (Practical Use of Established Formulas). After familiarizing myself with basic treatment methods and formulas, I began reading *Yi Xue San Zi Jing* (Three Character Classic of Medicine). After memorizing *Yi Xue San Zi Jing*, my great-uncle instructed me to read *Yi Xue Xin Wu* (New Insights into Medicine). He said: "The essence of *Xin Wu* lies in the 'Eight Methods of Medicine' chapter; you must read it thoroughly, think carefully, and preferably memorize it." Indeed, the 'Eight Methods' chapter was quite practical. Since starting clinical practice, I benefited greatly from Mr. Cheng Zhongling's teachings in establishing methods and prescribing. Besides these two books by Chen and Cheng, I successively read some introductory books, thereby acquiring elementary theory and general clinical knowledge, laying some groundwork for studying classic medical works.
Method for Studying Classics: Mutual Cross-Reference,