余少年课读五经而识文字，视《诗经》为最古之文学，知古有采诗之官，王者所以观风俗、知得失焉。《尚书》为中国最古之史料，古代帝王之规模事业，无不备义。然昔日国乱民伤，一味专治《尚书》不足医国救民，诚可叹然。又读《易经》而消遣。悟易起于八卦，八卦为文字之始，伏羲初画八卦，设刚柔二画，像阴阳二气，布以三位，像天、地、人三才也。立天之道日阴日阳，。立地之道目柔日刚，立人之道臼仁日义。又尝读《札》。礼经者，《周礼》、《仪礼》、《札记》也。《周礼》为言国家政制之书，其实与《仪札》、《礼记》之所谓「礼」者不同。考其作者，最为纷纭，欲细考之，华年流水，总无成绩。攻读「春秋》之传，以富其学。偏嗜庄老之书，尤偏《道德经》，习诵五千言。税老子之学，以发道之高与德之大，主先道德而后仁义，失道而后德，失德而后仁，失仁而后义，失义而后礼。全书治国主于无为，求胜致当以卑弱。人皆取强，而聃独取弱}人皆取其实，而老子独取其虚，人皆求其福而老子独取曲全。?以濡弱谦下为表，以空虚不毁万物为实。所谓道者，以自然为体，以刚柔为用，主无为而治，无为丽无不为也。庄子之学，出于老子而后以纵横家言。老子提要勾玄，庄子寓言用譬。先秦诸于中善言明理首推老子之学，而亦不足以医国救民。于是弃儒就医，随父兄攻读《灵枢》、《素问》、《难经》凡十载，明天地人纪，而有专泥医论之弊。又读有方之书，私淑仲景《伤寒》、《金匮》明医学之主体，医理方剂之渊薮。继则博览诸家之论，而独偏重妇科。凡《妇人大全良方》、《傅青主女科》、《济阴纲目》、《经效产宝》、《女科经纶》，《医宗金鉴·妇科心法》等五十余种，尽其博览，而力求专精。年二十岁悬壶问世，凡临床五十年，鬟发斑白，回首来踪，学问未穷。应邀而书治学之道，略陈于次。
学贵于勤而殆于情
举国上下五千年历史，文化遗产典籍浩瀚，诸籍皆览，恐不实际。高以下为基。必读之书，实不可不读，须知之事叉不可不知。识文字谓之小学，不读小学焉知文字。刘歆《七略》把小学置于《六艺略》不可不知。然读书识字，是「以下为基」。积土木石玉，以成大厦。欲之成，必须放宽，而立于专，识之以胆。习医以为用者，无不皆然。是博学于文，而专精于医。但自一身以至天下国家，皆学之事，平生难尽，必专精于一艺而有补于斯民。读医书必先抓主体而后枝叶。应诵之书，必加强记忆而后成巧。《伤寒杂病论》以下，又当重点攻读熟诵，此之谓专精。但专精于细，必细审玩味各家之言，归纳其条理，而得其独到。欲得其独到，在于悃幅无华，坚毅不拔之治学，作持久之劳。余习医每勤于笔，提要勾玄而摘抄，积成日久而自得其独善。二日勤访名师，常不避严寒酷暑而长途访问医长者，结识良师，增长见闻，再验于书而试之临床，积其数年，自得其径而识其妙。三日，光阴如逝水东流，去而不返，如无为流失，实不可弥补，留得终生遗憾。欲得其妙，必有三背之功，即枕上背诵，途中背诵，厕里背诵，不使光阴虚度，才能略有所得。四日，广识医友，取其所长，补己不足，积之录得，验于临床。读古人之书，则勤而有所得，惰而有所失。凡欲一事之成，必勤求而无惰也。
学贵于专精放眼须宽阔
医学谓专门之学，有谓不负众望之医家，亦非诸种病症皆可临诊取效，普救斯民于不殆。实亦有负众望，然可少负众望而已。于专门之学科而必有所专。但学科可谓其博，凡内、外、妇、儿、疮疡、正骨等学科各有专术。博通各科之学术，故谓之博，而后方可专精于一科，而善其一病，即谓之专家。故学习者，始不可偏，必须放眼于宽，抓主体之学术。如《内经》、《伤寒》、《金匮》要通读之，不可寻章摘句，以玄其学。须全面领悟，心有灵犀，可避局隘、破碎。守一隅之说教，知杂症而不晓六经，知医理而不知脉法，知古言而不知今说，知一家而不知百家之论，通河间而不晓丹溪，专泥东垣之论而不知从正之学，所谓学识破碎者也。守一世之说，宗一家之言，遵一派之偏，难以贯通整体而窥其全豹，虽攻读数载而有所得者鲜。若专精基于博览，博览必识主体之学，临证有所宗而有所舍，而后必有独识而独得，必由博而返约。是学贵于专精，而放眼于宽，方不致一叶障目，两豆塞耳，泰山不见，雷霆不闻，是为聋瞽，必无所为。
日有所得月有所积
学术积年，而临诊之际，必日有所得，有所得者，必信笔而录之；月有所积者，而纂其条理，是谓笔记，乃心得之类也。如直觉浮现，必立地而书之，否则流失，更准复得，惜之奈何?是有所积而有所现，有所累积而成条理。每临诊之际，凡《仪病式》中言，必遵其式而为之法，详为记述，是以成案，附之以方，是为医之方案，犹刑名家之例案也。观医之为道，自《灵枢》、《素问》，迄仲景以下，唐宋元明诸家，著述甚多，理法可谓灿然，其晦床体验各有其异同一病人，随人而异治，同一病人，随时而异治，从案例而索之矣。历代之论述，后人总结而为律，如刑名家执律以绳人罪，轻重出入，必有案例为凭。后人立医案，萃而聚之，精而释之。吾尝如此数十年，充医事得失之林，辑成《百灵医案》。以氏名而标其书，非谓百灵而无一失矣。前谓医书不可胜记，一病古来必立一门，余师事之，一门自立数法，法有尽而病无尽，病无尽而法无穷，一病之变亦无穷矣。故临证之际，有所得必有所记，有所记必有所思，有所思必有所悟，数十年之积，不问断之．必有超悟。而积之有胆，言之中肯，必青出于蓝而胜于蓝。否则光阴流逝，日虽有所得而无所记，月虽有累而无所忆，诊务繁忙而无案例，过则更不复知。整理学术，凭主观遐思，必有所偏，甚至贻误后学而害人子弟，欲成美而实积罪。斯时方知启后之难也。
古语谓：专泥药性，决不识病，假若识病，未必得法；识病得法，工中之甲。理法方药，不可有偏，是谓有学有术。若只识医理，罔知方药，或识方药，不通医理，是谓有学无术。学术即得，又躬行实践，是有的放矢。余之治医，先学而后术。始学之际，先文而后哲，及诗词歌赋，以文为戏，常吟诗于野，放歌于朝，填辞于夕，学术于午。即攻读医书，亦首读《灵枢》、《素问》及王冰、张马之注，逐句遍读，次得修园、容川书及其《精义》。又致力于《伤寒》，《金匮》，使理法明而方药得。余之学医笔记，常记临床心得而为夹注。学医只知无方之书，不知理法，虽有学而无术，虽知方药，不知其理，不足成为良医。只有遍读理、法、方、药之书，笔记，研讨，躬行实践，验之患者，有得有失，是谓有学有术矣。
习医回忆
常洲市中医院副院长，主任医师屠揆先
【作者简介】屠揆先(1916～)，江苏常州人。从事中医工作四十多年，擅内科，兼儿科，曾先后在《中医杂志》等医学刊物，发表过论文十多篇。现任中华全国中医学会理事、中华医学会江苏分会理事及常州中医院副院长、主任医师。
先伯祖父屠厚之为武进孟河费伯雄先生之门人。叔父屠士初继承家学，行医于苏常地区。余早年从叔父及堂兄屠贡先学医，当年教诲，言犹在耳，回忆所及，略志一、二，或有助于来者。
勤求博采知常知变
先叔父尝教导我说：「为医之道，首先学好四大经典著作，这是根本。各家学说，必须博览，相互参证，方能逐步深入。识见既多，思路既广，临证之际，自能应付裕如。」记得当年侍诊时，见一中年男子，患春温发热十多天，神志不清，有汗，脉细而数，撬口察舌，舌质红而苔黄，但不厚腻。先叔父用大剂独参汤化眼安宫牛黄丸，一日三粒，两日而神志转清，继用益气、养津、清热之剂而愈(先叔父治疗温病晚期，重用补气扶正法配合养津清热或化浊开窍收效者，不止一次)。当时曾以为何不用养阴清热药配合安宫牛黄而用独参汤为问。先叔笑答日；。温邪伤津耗阴，是其常也。但温邪亦能伤气，即《内经》所谓『热伤气』、『壮火之气衰』也。病人神昏而脉甚细，且出汗，为内闭外脱，元气衰竭之象，如不用大量人参扶持元气，而以养津清热，则津未圊而元气已脱，岂能复苏?要知热邪能伤阴，壮火亦能伤气。寒邪能伤阳，寒燥亦能伤津。况寒邪化热，阳证转阴，病情之变幻多矣，非勤求博采』不能知常知变。」先叔父结合实践指点理论，使人印象更深刻，数十年不忘怀。
衷中参西融会古今
「古训必须勤求，新知亦应吸收，古代医籍要多读，近人著述勿忽视；经方极可贵，时方有妙用；现代西方医学知识，亦应有所了解。」此皆先兄之教导。他非常推崇王清任、张锡纯之实践探索精神。主张古今学说，不宜偏废，中西医两方面之理论相互参照，非常有益。尤其是懂得一点西医知识，会更感到祖国医学之伟大。例如，西医近年来才一致认为多吃动物脂肪和糖类饮食能增加血脂，引起动脉粥样硬化，而明朝张三锡氏早就提出，预防中风要「屏除一切膏粱厚昧、鹅肉、曲洒、肥(动物脂肪)、甘(糖类饮食)」等物。又如，我在三十多年前，经常看到农村小儿患走马牙疳，尤其在麻疹之后易得此病。病势重而急，患儿满口秽臭，腮破牙落，甚至死亡。倘此病能在初发时立即用金枣丹吹患部，配合内服药，一般疗效良好。但走马牙疳为阳明经毒火燔盛之症，金枣丹之主药是白砒，白砒是大热剧毒之药，何以能治走马疳?后来看到西医书籍，知道走马牙疳即现代医学上奋森氏口腔炎，其病原体为螺旋体，砒为杀灭螺旋体之有效药物。而中国古代早已用金枣丹治走马牙疳，这不能不说是伟大的创造。还有，有人患咳嗽久不愈，化验痰液发现有白色念珠状霉菌。当时有一民间单方用白药子叶治鹅口疮有效，因而联想到鹅口疮之病原体既是白色念珠状霉菌，则对支气管之念珠状霉菌亦应有效，因于清肺化痰药中加用白药予。不久，咳平，痰液化验已无霉菌。先兄的教导和自己的实践使我深信，学习一些现代医学知识，对于继承发扬祖国医学，必然会大有好处。
临床辨证重在含从
先叔父常讲：「学辨证不难，难在舍从。或舍脉从证，或舍证从脉，或舍脉从舌，或舍舌从脉。设舍从不慎，往往毫厘之差，千里之谬。」诚然，如肢冷、口淡、溺清、便搪、面白、舌淡、脉细为寒证，身热、烦躁、口干、尿赤、便秘、面红、舌绛、脉数为热证，如此寒热分明，辨有何难?但如证、脉、舌三者之间有不符之处，则属寒，属热、属虚、属实，有时则很难定论。先叔父曾治一中年妇女，下痢两个多月，痢止后，食欲极差，全身无力，皮肤干燥，舌红无苔。原来认为是久痢伤脾阴或余热来清，大都用健脾养阴之剂，但几次治疗，食欲未见好转，倦怠益甚。求治于先叔父，先叔父说：「此病虽然舌红无苔，但无烦热、口碎、掌热等症，脉象细而软，垒身无力，是痢后脾胃气虚之证，不属久痢伤阴。至于舌红无苔，皮肤干燥，则是脾胃气虚，运化失职，不能吸收水谷之精微，使『水精四布』所致。应舍舌从脉，甩补脾益气之法。」遂以四君子汤加山药、谷芽、莲肉，党参改为人参，于术易白朮。三剂之后，食欲逐渐好转，继续调养脾胃而愈。另一例中年男子，患烦渴引饮，几乎口不能离水，。一日夜尽数十碗，小便亦极多，食欲嫠，进食少，皮枯肌瘟。原来认为是阴虚火盛之消渴症，屡用养阴生津之方无效。先叔父日：「患者舌相不红不光，无易饥多食之象，而脉象沉细，尺脉尤弱，虽有烦渴引饮之症，但非阴虚消渴之病。是宜舍证从脉，改用温肾法。盖肾气虚不能调摄水分，故溺多，肾阳虚不能蒸腾津夜，故烦渴，肾火衰则脾运弱，故食少肌瘦而肤枯。方用金匮肾气丸改作汤剂，再加人参、鹿角胶、覆盆子。十日之后，症状趋向缓和。通过以上事实，使我当年领悟舍从问题在临证治疗中之重要意义，更认识到正确掌握舍从，必须四诊结合，全面考察，得出重点。否则，孰真孰假，孰台孰从，无从着手。
对症下药须善调配
我少年时期研读五经，识得文字，认为《诗经》是最古老的文学，知道古代有采诗之官，君王借此观察风俗、知晓得失。《尚书》是中国最古老的史料，古代帝王的规模事业，无不具备义理。然而昔日国家动乱、百姓受伤，一味专治《尚书》不足以医治国事、拯救民众，实在令人叹息。又读《易经》以消遣。领悟到易学起于八卦，八卦是文字的开端，伏羲初画八卦，设立刚柔两画，象征阴阳二气，布置为三位，象征天、地、人三才。确立天的道是阴和阳，确立地的道是柔和刚，确立人的道是仁和义。又曾读《礼》。礼经包括《周礼》、《仪礼》、《礼记》。《周礼》是论述国家政治制度的书，其实与《仪礼》、《礼记》中所谓的“礼”不同。考证其作者，最为纷纭，想要详细考证，青春如流水逝去，总无成绩。攻读《春秋》的传注，以丰富学识。偏爱庄子和老子的书籍，尤其偏爱《道德经》，习诵五千言。推崇老子之学，以发挥道的崇高与德的伟大，主张先道德而后仁义，失道而后德，失德而后仁，失仁而后义，失义而后礼。全书治国主张无为，求胜致当以卑弱。人们都取强，而老子独取弱；人们都取其实，而老子独取其虚；人们都求福，而老子独取曲全。以濡弱谦下为外表，以空虚不毁万物为实质。所谓道，以自然为体，以刚柔为用，主张无为而治，无为而无不为。庄子之学，出于老子之后而以纵横家之言为主。老子提要勾玄，庄子寓言用譬。先秦诸子中善于阐明道理首推老子之学，但也不足以医治国事、拯救民众。于是弃儒从医，跟随父兄攻读《灵枢》、《素问》、《难经》共十年，明了天地人纪，而有专泥医论的弊端。又读有方之书，私下仰慕张仲景的《伤寒》、《金匮》，明了医学的主体，医理方剂的渊薮。接着博览诸家之论，而独偏重妇科。凡《妇人大全良方》、《傅青主女科》、《济阴纲目》、《经效产宝》、《女科经纶》、《医宗金鉴·妇科心法》等五十余种，尽其博览，而力求专精。二十岁悬壶问世，凡临床五十年，鬓发斑白，回首来踪，学问未穷。应邀书写治学之道，略陈于次。
学习贵在勤奋，懈怠于懒惰
举国上下五千年历史，文化遗产典籍浩瀚，诸籍皆览，恐怕不切实际。高以下为基。必读之书，实在不可不读，须知之事又不可不知。识字谓之小学，不读小学怎知文字。刘歆《七略》把小学置于《六艺略》中，是不可不知的。然而读书识字，是“以下为基”。积土木石玉，以成大厦。欲其成功，必须放宽眼界，而立于专精，识之以胆量。习医以为用者，无不皆然。这是博学于文，而专精于医。但自一身以至天下国家，皆是学问之事，平生难尽，必专精于一艺而有补于斯民。读医书必先抓主体而后枝叶。应诵之书，必加强记忆而后成巧。《伤寒杂病论》以下，又当重点攻读熟诵，此之谓专精。但专精于细，必细审玩味各家之言，归纳其条理，而得其独到。欲得其独到，在于诚恳朴实、坚毅不拔的治学态度，作持久之劳。我习医每勤于笔，提要勾玄而摘抄，积成日久而自得其独善。第二是勤访名师，常不避严寒酷暑而长途访问医长者，结识良师，增长见闻，再验于书而试之临床，积其数年，自得其径而识其妙。第三，光阴如逝水东流，去而不返，如无为流失，实在不可弥补，留得终生遗憾。欲得其妙，必有三背之功，即枕上背诵，途中背诵，厕里背诵，不使光阴虚度，才能略有所得。第四，广识医友，取其所长，补己不足，积之录得，验于临床。读古人之书，则勤而有所得，惰而有所失。凡欲一事之成，必勤求而无惰也。
学习贵在专精，放眼须宽阔
医学谓专门之学，有谓不负众望之医家，亦非诸种病症皆可临诊取效，普救斯民于不殆。实在也有负众望，然可少负众望而已。于专门之学科而必有所专。但学科可谓其博，凡内、外、妇、儿、疮疡、正骨等学科各有专术。博通各科之学术，故谓之博，而后方可专精于一科，而善其一病，即谓之专家。故学习者，始不可偏，必须放眼于宽，抓主体之学术。如《内经》、《伤寒》、《金匮》要通读之，不可寻章摘句，以玄其学。须全面领悟，心有灵犀，可避局隘、破碎。守一隅之说教，知杂症而不晓六经，知医理而不知脉法，知古言而不知今说，知一家而不知百家之论，通河间而不晓丹溪，专泥东垣之论而不知从正之学，所谓学识破碎者也。守一世之说，宗一家之言，遵一派之偏，难以贯通整体而窥其全豹，虽攻读数载而有所得者鲜。若专精基于博览，博览必识主体之学，临证有所宗而有所舍，而后必有独识而独得，必由博而返约。是学贵于专精，而放眼于宽，方不致一叶障目，两豆塞耳，泰山不见，雷霆不闻，是为聋瞽，必无所为。
日有所得月有所积
学术积年，而临诊之际，必日有所得，有所得者，必信笔而录之；月有所积者，而纂其条理，是谓笔记，乃心得之类也。如直觉浮现，必立地而书之，否则流失，更准复得，惜之奈何？是有所积而有所现，有所累积而成条理。每临诊之际，凡《病历式》中言，必遵其式而为之法，详为记述，是以成案，附之以方，是为医之方案，犹刑名家之例案也。观医之为道，自《灵枢》、《素问》，迄仲景以下，唐宋元明诸家，著述甚多，理法可谓灿然，其晦床体验各有其异同一病人，随人而异治，同一病人，随时而异治，从案例而索之矣。历代之论述，后人总结而为律，如刑名家执律以绳人罪，轻重出入，必有案例为凭。后人立医案，萃而聚之，精而释之。吾尝如此数十年，充医事得失之林，辑成《百灵医案》。以氏名而标其书，非谓百灵而无一失矣。前谓医书不可胜记，一病古来必立一门，余师事之，一门自立数法，法有尽而病无尽，病无尽而法无穷，一病之变亦无穷矣。故临证之际，有所得必有所记，有所记必有所思，有所思必有所悟，数十年之积，不问断之．必有超悟。而积之有胆，言之中肯，必青出于蓝而胜于蓝。否则光阴流逝，日虽有所得而无所记，月虽有累而无所忆，诊务繁忙而无案例，过则更不复知。整理学术，凭主观遐思，必有所偏，甚至贻误后学而害人子弟，欲成美而实积罪。斯时方知启后之难也。
古语谓：专泥药性，决不识病，假若识病，未必得法；识病得法，工中之甲。理法方药，不可有偏，是谓有学有术。若只识医理，罔知方药，或识方药，不通医理，是谓有学无术。学术即得，又躬行实践，是有的放矢。余之治医，先学而后术。始学之际，先文而后哲，及诗词歌赋，以文为戏，常吟诗于野，放歌于朝，填辞于夕，学术于午。即攻读医书，亦首读《灵枢》、《素问》及王冰、张马之注，逐句遍读，次得修园、容川书及其《精义》。又致力于《伤寒》，《金匮》，使理法明而方药得。余之学医笔记，常记临床心得而为夹注。学医只知无方之书，不知理法，虽有学而无术，虽知方药，不知其理，不足成为良医。只有遍读理、法、方、药之书，笔记，研讨，躬行实践，验之患者，有得有失，是谓有学有术矣。
习医回忆
常洲市中医院副院长，主任医师屠揆先
【作者简介】屠揆先(1916～)，江苏常州人。从事中医工作四十多年，擅内科，兼儿科，曾先后在《中医杂志》等医学刊物，发表过论文十多篇。现任中华全国中医学会理事、中华医学会江苏分会理事及常州中医院副院长、主任医师。
先伯祖父屠厚之为武进孟河费伯雄先生之门人。叔父屠士初继承家学，行医于苏常地区。余早年从叔父及堂兄屠贡先学医，当年教诲，言犹在耳，回忆所及，略志一、二，或有助于来者。
勤求博采知常知变
先叔父尝教导我说：“为医之道，首先学好四大经典著作，这是根本。各家学说，必须博览，相互参证，方能逐步深入。识见既多，思路既广，临证之际，自能应付裕如。”记得当年侍诊时，见一中年男子，患春温发热十多天，神志不清，有汗，脉细而数，撬口察舌，舌质红而苔黄，但不厚腻。先叔父用大剂独参汤化眼安宫牛黄丸，一日三粒，两日而神志转清，继用益气、养津、清热之剂而愈（先叔父治疗温病晚期，重用补气扶正法配合养津清热或化浊开窍收效者，不止一次）。当时曾以为何不用养阴清热药配合安宫牛黄而用独参汤为问。先叔笑答曰：“温邪伤津耗阴，是其常也。但温邪亦能伤气，即《内经》所谓‘热伤气’、‘壮火之气衰’也。病人神昏而脉甚细，且出汗，为内闭外脱，元气衰竭之象，如不用大量人参扶持元气，而以养津清热，则津未圊而元气已脱，岂能复苏？要知热邪能伤阴，壮火亦能伤气。寒邪能伤阳，寒燥亦能伤津。况寒邪化热，阳证转阴，病情之变幻多矣，非勤求博采不能知常知变。”先叔父结合实践指点理论，使人印象更深刻，数十年不忘怀。
衷中参西融会古今
“古训必须勤求，新知亦应吸收，古代医籍要多读，近人著述勿忽视；经方极可贵，时方有妙用；现代西方医学知识，亦应有所了解。”此皆先兄之教导。他非常推崇王清任、张锡纯之实践探索精神。主张古今学说，不宜偏废，中西医两方面之理论相互参照，非常有益。尤其是懂得一点西医知识，会更感到祖国医学之伟大。例如，西医近年来才一致认为多吃动物脂肪和糖类饮食能增加血脂，引起动脉粥样硬化，而明朝张三锡氏早就提出，预防中风要“屏除一切膏粱厚昧、鹅肉、曲洒、肥（动物脂肪）、甘（糖类饮食）”等物。又如，我在三十多年前，经常看到农村小儿患走马牙疳，尤其在麻疹之后易得此病。病势重而急，患儿满口秽臭，腮破牙落，甚至死亡。倘此病能在初发时立即用金枣丹吹患部，配合内服药，一般疗效良好。但走马牙疳为阳明经毒火燔盛之症，金枣丹之主药是白砒，白砒是大热剧毒之药，何以能治走马疳？后来看到西医书籍，知道走马牙疳即现代医学上奋森氏口腔炎，其病原体为螺旋体，砒为杀灭螺旋体之有效药物。而中国古代早已用金枣丹治走马牙疳，这不能不说是伟大的创造。还有，有人患咳嗽久不愈，化验痰液发现有白色念珠状霉菌。当时有一民间单方用白药子叶治鹅口疮有效，因而联想到鹅口疮之病原体既是白色念珠状霉菌，则对支气管之念珠状霉菌亦应有效，因于清肺化痰药中加用白药予。不久，咳平，痰液化验已无霉菌。先兄的教导和自己的实践使我深信，学习一些现代医学知识，对于继承发扬祖国医学，必然会大有好处。
临床辨证重在含从
先叔父常讲：“学辨证不难，难在舍从。或舍脉从证，或舍证从脉，或舍脉从舌，或舍舌从脉。设舍从不慎，往往毫厘之差，千里之谬。”诚然，如肢冷、口淡、溺清、便搪、面白、舌淡、脉细为寒证，身热、烦躁、口干、尿赤、便秘、面红、舌绛、脉数为热证，如此寒热分明，辨有何难？但如证、脉、舌三者之间有不符之处，则属寒，属热、属虚、属实，有时则很难定论。先叔父曾治一中年妇女，下痢两个多月，痢止后，食欲极差，全身无力，皮肤干燥，舌红无苔。原来认为是久痢伤脾阴或余热来清，大都用健脾养阴之剂，但几次治疗，食欲未见好转，倦怠益甚。求治于先叔父，先叔父说：“此病虽然舌红无苔，但无烦热、口碎、掌热等症，脉象细而软，垒身无力，是痢后脾胃气虚之证，不属久痢伤阴。至于舌红无苔，皮肤干燥，则是脾胃气虚，运化失职，不能吸收水谷之精微，使‘水精四布’所致。应舍舌从脉，甩补脾益气之法。”遂以四君子汤加山药、谷芽、莲肉，党参改为人参，于术易白朮。三剂之后，食欲逐渐好转，继续调养脾胃而愈。另一例中年男子，患烦渴引饮，几乎口不能离水，。一日夜尽数十碗，小便亦极多，食欲嫠，进食少，皮枯肌瘟。原来认为是阴虚火盛之消渴症，屡用养阴生津之方无效。先叔父日：“患者舌相不红不光，无易饥多食之象，而脉象沉细，尺脉尤弱，虽有烦渴引饮之症，但非阴虚消渴之病。是宜舍证从脉，改用温肾法。盖肾气虚不能调摄水分，故溺多，肾阳虚不能蒸腾津夜，故烦渴，肾火衰则脾运弱，故食少肌瘦而肤枯。方用金匮肾气丸改作汤剂，再加人参、鹿角胶、覆盆子。十日之后，症状趋向缓和。通过以上事实，使我当年领悟舍从问题在临证治疗中之重要意义，更认识到正确掌握舍从，必须四诊结合，全面考察，得出重点。否则，孰真孰假，孰台孰从，无从着手。
对症下药须善调配
In my youth, I studied the Five Classics and learned characters. I regarded *Shijing* (Classic of Poetry) as the oldest literature, knowing that in ancient times there were officials who collected poems so that rulers could observe customs and understand gains and losses. *Shangshu* (Book of Documents) is China's oldest historical material; the grand enterprises of ancient emperors are fully contained within its principles. However, in times of past national turmoil and civilian suffering, specializing solely in *Shangshu* was insufficient to heal the nation and save the people, which is truly lamentable. I also read *Yijing* (Classic of Changes) for leisure. I realized that Yi studies originated from the Eight Trigrams (Bagua), which marked the beginning of writing. Fuxi initially drew the Eight Trigrams, establishing two lines of firm and yielding to symbolize the Qi of Yin and Yang, arranged in three positions to symbolize Heaven, Earth, and Humanity. The Way of Heaven is defined as Yin and Yang; the Way of Earth as yielding and firm; the Way of Humanity as Ren (Benevolence) and Yi (Righteousness). I also read *Li* (Rites). The Rite classics include *Zhouli* (Rites of Zhou), *Yili* (Etiquette and Ceremonial), and *Liji* (Record of Rites). *Zhouli* discusses state political systems, which differs from the concept of "Rites" in *Yili* and *Liji*. Examining its authors is complex; despite attempts at detailed research, my youth flowed away like water without achieving results. I studied commentaries on *Chunqiu* (Spring and Autumn Annals) to enrich my learning. I had a particular fondness for the works of Zhuangzi and Laozi, especially *Daodejing*, reciting its five thousand words. I admired Laozi's learning to highlight the loftiness of Dao and the greatness of De (Virtue), advocating prioritizing Dao and De over Ren and Yi: losing Dao leads to De, losing De leads to Ren, losing Ren leads to Yi, and losing Yi leads to Li (Rites). The book advocates non-action (Wuwei) for governing the state, seeking victory through humility and weakness. While others seek strength, Laozi alone seeks weakness; while others seek substance, Laozi alone seeks emptiness; while others seek fortune, Laozi alone seeks compromise and preservation. He presents himself with softness, humility, and condescension, while his essence is emptiness that does not destroy all things. The so-called Dao takes Nature as its substance and firmness/yielding as its function, advocating governance through non-action, where non-action achieves nothing but no action is left undone. Zhuangzi's learning emerged after Laozi, adopting the rhetoric of the School of Diplomacy. Laozi extracted key points and profound truths, while Zhuangzi used fables and metaphors. Among pre-Qin philosophers, Laozi's learning was foremost in elucidating principles, yet it was still insufficient to heal the nation and save the people. Thus, I abandoned Confucianism for medicine, studying *Lingshu* (Spiritual Pivot), *Suwen* (Basic Questions), and *Nanjing* (Classic of Difficult Issues) with my father and brothers for ten years. I understood the connections between Heaven, Earth, and Humanity but fell into the flaw of being overly rigid in medical theories. I then read books on formulas, privately admiring Zhang Zhongjing's *Shanghan Lun* (Treatise on Cold Damage) and *Jingui Yaolue* (Essential Prescriptions of the Golden Cabinet) to grasp the main body of medicine and the source of medical principles and formulas. Subsequently, I extensively read various schools' discussions, focusing particularly on gynecology. I thoroughly studied over fifty types including *Funü Daquan Liangfang* (Great Good Prescriptions for Women), *Fu Qingzhu Nuke* (Fu Qingzhu's Gynecology), *Jiyin Gangmu* (Outline of Maternal Care), *Jingxiao Chanbao* (Effective Precious Prescriptions for Childbirth), *Nuke Jinglun* (Gynecological Classic Discussions), and *Yizong Jinjian·Fuke Xinfa* (Golden Mirror of Medicine·Gynecological Mind Methods), striving for specialization. At twenty, I began practicing medicine. Over fifty years of clinical practice, my hair has turned gray. Looking back, my learning remains inexhaustible. Invited to write about my approach to study, I briefly present the following.
Learning values diligence and suffers from laziness.
With five thousand years of history and vast cultural heritage, reading all texts is impractical. High foundations rely on low bases. Books that must be read cannot be skipped; matters that must be known cannot be ignored. Learning characters is called "Xiaoxue" (Elementary Studies); without Xiaoxue, how can one know characters? Liu Xin's *Qielüe* places Xiaoxue under *Liuyi Lue* (Classics Section), indicating it is indispensable. Reading and writing characters serve as the "low foundation." Accumulating earth, wood, stone, and jade builds a mansion. To succeed, one must broaden one's vision while standing firm in specialization, guided by courage. This applies to all who study medicine for practical use. It means being broad in culture but specialized in medicine. From oneself to the state, learning is endless; one must specialize in one art to benefit the people. When reading medical books, one must grasp the main body before the branches. Required readings must be memorized to achieve skill. Below *Shanghan Zabing Lun*, one should focus on intensive study and recitation; this is specialization. But specialization requires carefully examining and savoring each school's words, summarizing their logic, and finding unique insights. To gain uniqueness, one needs sincere simplicity and unyielding perseverance in study, engaging in long-term effort. In my medical studies, I diligently took notes, extracting key points and summaries, accumulating them over time to find personal benefits. Secondly, diligently visiting famous teachers, often traveling long distances regardless of extreme weather to learn from senior physicians, making good friends, expanding knowledge, verifying theories in books, and testing them clinically. After years of accumulation, one finds the path and understands the subtleties. Thirdly, time flows east like water, never returning. Losing time is irreparable and leaves lifelong regrets. To master subtleties, one must have the ability to recite: reciting in bed, on the way, and in the toilet, ensuring no time is wasted to gain something. Fourthly, make wide acquaintance with medical peers, learn from their strengths, compensate for one's weaknesses, record them, and verify clinically. Reading ancient books yields gains through diligence and losses through laziness. To accomplish anything, one must seek diligently without laziness.
Learning values specialization, but vision must be broad.
Medicine is a specialized field. A physician who lives up to expectations cannot necessarily treat all diseases effectively to save everyone. One may fall short of expectations, but less so. In a specialized discipline, one must have specific expertise. Disciplines are broad; internal medicine, surgery, gynecology, pediatrics, dermatology, and orthopedics each have specialized techniques. Being proficient in various fields is called "broad," which allows one to later specialize in one field and excel in treating specific diseases, becoming an expert. Therefore, learners must not be biased initially; they must broaden their vision and grasp the core academics. For example, *Neijing* (Inner Canon), *Shanghan Lun*, and *Jingui Yaolue* must be read comprehensively, not just picking sentences to obscure the learning. One must comprehend fully, having intuitive understanding, avoiding narrow and fragmented views. Adhering to partial doctrines, knowing miscellaneous diseases but not Six Channels (Liu Jing), knowing medical theory but not pulse diagnosis, knowing ancient terms but not modern explanations, knowing one school but not百家 (Hundred Schools), understanding He Jian but not Danxi, sticking rigidly to Dong Yuan's theories while ignoring orthodox learning—this is fragmented knowledge. Adhering to one era's sayings, worshipping one school's words, following one faction's bias makes it difficult to integrate the whole picture. Few gain much after years of study. If specialization is based on extensive reading, and extensive reading recognizes the core learning, then in clinical practice, one knows what to follow and what to discard, leading to unique insights. One must return to simplicity through breadth. Thus, learning values specialization while keeping a broad vision, preventing being blinded by a leaf or deafened by beans, seeing Mount Tai or hearing thunder. Otherwise, one becomes blind and deaf, achieving nothing.
Daily gains and monthly accumulations.
Academic accumulation over years means daily gains during clinical practice. Gains must be recorded freely. Monthly accumulations involve organizing logic, called notes, which are reflections. If intuition arises, write it down immediately, otherwise it is lost and hard to regain. Accumulation leads to manifestation and logical structure. During every consultation, following the format of the "Medical Record Form," one must describe details to form cases, attaching formulas, creating medical plans similar to legal precedents. Observing medicine as a way, from *Lingshu* and *Suwen* to Zhang Zhongjing and subsequent Song, Yuan, Ming, and Qing families, many writings exist with clear principles and methods. Clinical experiences vary; the same patient is treated differently by different doctors or at different times, derived from cases.历代 (Past dynasties)' discussions were summarized into laws by later generations, like legal codes requiring case evidence for sentencing. Later generations established medical cases, collecting and explaining them precisely. I did this for decades, compiling *Bailing Yian* (Bailing Medical Cases). Naming the book after my name doesn't mean Bailing made no mistakes. Previously stated that medical books are countless; since ancient times, each disease established a school. My teacher established several methods within one school. Methods are finite, but diseases are infinite, and variations are endless. Thus, in clinical practice, gains must be recorded, records lead to thought, thoughts lead to enlightenment. Decades of accumulation, if uninterrupted, lead to transcendental insight. With bold accumulation and pertinent speech, one surpasses the master. Otherwise, time passes, daily gains are unrecorded, monthly accumulations unremembered, busy consultations lack cases, and past errors are forgotten. Organizing academics based on subjective speculation leads to bias, potentially misleading future students and harming disciples, intending beauty but accumulating sin. Only then does one realize the difficulty of guiding successors.
Ancient saying: Sticking only to drug properties means definitely not recognizing the disease; even if recognizing the disease, one may not get the method; recognizing the disease and getting the method makes one the best among craftsmen. Principles, methods, formulas, and drugs must not be biased; this is having both learning and technique. If one only knows medical theory but ignores formulas and drugs, or knows formulas and drugs but not theory, it is having learning but no technique. Having academic knowledge and practicing it is shooting with a target. My approach to medicine is learning first, then technique. Initially, I focused on literature, philosophy, poetry, and songs, playing with words, chanting in the wild, singing in the morning, filling lyrics in the evening, and studying academics at noon. Even when studying medical books, I first read *Lingshu*, *Suwen*, and commentaries by Wang Bing and Zhang Ma, reading sentence by sentence, then obtained books by Xiuyuan and Rongchuan and their *Jingyi* (Essences). I then devoted myself to *Shanghan* and *Jingui*, clarifying principles and methods to obtain formulas and drugs. My medical notes often recorded clinical insights as annotations. Knowing only books without formulas, without understanding principles and methods, is having learning but no technique; knowing formulas and drugs without their principles is insufficient to become a good doctor. Only by reading books on principles, methods, formulas, and drugs, taking notes, discussing, practicing, and verifying on patients, gaining and losing, is one said to have both learning and technique.
Memories of Studying Medicine
Tu Kuixian, Vice President and Chief Physician of Changzhou Traditional Chinese Medicine Hospital.
[Author Introduction] Tu Kuixian (1916–), from Changzhou, Jiangsu. Engaged in TCM work for over forty years, skilled in internal medicine and pediatrics. Published over ten papers in journals like *Zhongyi Zazhi*. Currently serves as Director of the Chinese Association of Traditional Chinese Medicine, Director of the Jiangsu Branch of the Chinese Medical Association, Vice President and Chief Physician of Changzhou TCM Hospital.
My late great-uncle Tu Hou was a disciple of Mr. Fei Boxiong from Menghe, Wujin. My uncle Tu Shichu inherited the family learning and practiced in the Suzhou-Changzhou area. In my early years, I studied medicine with my uncle and cousin Tu Gongxian. Their teachings from those days are still ringing in my ears. Recalling them, I briefly record one or two points, hoping they might help future practitioners.
Diligent Seeking and Broad Collection to Know Constants and Variations.
My late uncle once taught me: "The way of medicine begins with mastering the Four Great Classical Works, which is the root. One must extensively read various schools' theories, cross-reference them, and gradually deepen understanding. With more insights and broader thinking, one can handle clinical situations with ease." I remember accompanying him on consultations, seeing a middle-aged man suffering from Spring-Warmth fever for over ten days, unconscious, sweating, with a fine and rapid pulse. Inspecting his mouth and tongue, his tongue body was red with yellow coating, but not thick or greasy. My uncle used a large dose of Dushen Tang (Single Ginseng Decoction) combined with Angong Niuhuang Wan (Calming the Heart Pill with Bezoar), three pills a day. After two days, his consciousness cleared. He then recovered using qi-tonifying, fluid-nourishing, and heat-clearing agents (My uncle's treatment of late-stage Warm Diseases, heavily using qi-tonifying and supporting righteous Qi methods combined with fluid-nourishing, heat-clearing, or turbidity-resolving and orifice-opening methods, succeeded more than once). I once asked why he didn't use yin-nourishing and heat-clearing herbs combined with Angong Niuhuang, but instead used Dushen Tang. My uncle smiled and replied: "Warm pathogens damaging fluids and consuming Yin is the norm. But warm pathogens can also damage Qi, as mentioned in *Neijing*: 'Heat damages Qi' and 'Blazing fire causes Qi decline.' The patient's coma, very fine pulse, and sweating indicate internal closure and external collapse, a sign of Yuan Qi (Original Qi) exhaustion. Without large doses of Ginseng to support Yuan Qi, using only fluid-nourishing and heat-clearing methods would result in depleted fluids and collapsed Qi before recovery, making revival impossible. Know that heat pathogens damage Yin, and blazing fire damages Qi. Cold pathogens damage Yang, and cold-dryness damages fluids. Moreover, cold transforming into heat, Yang conditions turning Yin, the changes in condition are manifold. Only diligent seeking and broad collection allow one to know constants and variations." My uncle's combination of practice and theory left a deep impression, unforgettable for decades.
Integrating Chinese and Western, Merging Ancient and Modern.
"Ancient teachings must be sought diligently, new knowledge should be absorbed; read ancient medical texts more, do not ignore recent writings; classical formulas are precious, contemporary formulas have wonderful uses; modern Western medical knowledge should also be understood." These were my late brother's teachings. He highly admired the practical exploration spirit of Wang Qingren and Zhang Xichun. He advocated not neglecting either ancient or modern theories; referencing both Chinese and Western medical theories is very beneficial. Especially understanding some Western medicine makes one feel the greatness of our motherland's medicine more. For example, Western medicine recently agreed that eating too much animal fat and sugar increases blood lipids and causes atherosclerosis. But Zhang Sanxi of the Ming Dynasty proposed preventing stroke by "avoiding all rich foods, goose meat, fermented drinks, fat (animal fat), and sweet (sugar) items." Again, thirty-plus years ago, I often saw rural children suffering from Gan Gangrene (Zouma Yagan), especially after measles. The disease was severe and acute, with foul breath, broken gums, fallen teeth, and even death. If treated immediately upon onset with Jinzao Dan (Gold Date Powder) blown onto the affected area, combined with internal medicine, the efficacy was generally good. But Gan Gangrene is a syndrome of blazing toxic fire in the Yangming Meridian. The main ingredient of Jinzao Dan is White Arsenic (Bai Pi), a highly hot and toxic drug. How could it treat Gan Gangrene? Later, reading Western medical books, I learned that Gan Gangrene is Vincent's Angina in modern medicine, caused by spirochetes. Arsenic is an effective drug for killing spirochetes. That ancient China used Jinzao Dan to treat Gan Gangrene is undoubtedly a great creation. Also, someone suffered from chronic cough. Sputum tests revealed white candida-like fungi. There was a folk single prescription using Baoyaozi leaves to treat Thrush (E Kou Chuang) effectively. Since the pathogen of Thrush is white candida-like fungi, it should also be effective for candida-like fungi in the bronchi. Thus, I added Baoyaozi to lung-clearing and phlegm-resolving medicines. Soon, the cough stopped, and sputum tests showed no fungi. My brother's teachings and my own practice convinced me that learning some modern medical knowledge will greatly benefit the inheritance and development of our motherland's medicine.
Clinical Differentiation Values Flexibility in Following or Discarding.
My late uncle often said: "Learning differentiation is not difficult; the difficulty lies in deciding whether to follow or discard symptoms/pulses. One may discard pulse to follow symptoms, or discard symptoms to follow pulse, or discard pulse to follow tongue signs, or discard tongue signs to follow pulse. If this decision is careless, a slight error leads to a huge mistake." Indeed, if cold limbs, bland taste, clear urine, loose stools, pale face, pale tongue, and fine pulse indicate Cold Syndrome, while fever, irritability, dry mouth, dark urine, constipation, red face, crimson tongue, and rapid pulse indicate Heat Syndrome, differentiation is easy when Cold and Heat are distinct. But if symptoms, pulse, and tongue signs contradict, determining Cold, Heat, Deficiency, or Excess is sometimes very difficult. My uncle once treated a middle-aged woman who had dysentery for over two months. After the dysentery stopped, her appetite was poor, she had no strength, dry skin, and a red tongue with no coating. Originally thought to be Spleen Yin damage from chronic dysentery or lingering residual heat, most treatments used Spleen-tonifying and Yin-nourishing agents. But after several treatments, appetite did not improve, and fatigue worsened. She sought my uncle's help. He said: "Although the tongue is red with no coating, there are no symptoms of vexation, heat, mouth ulcers, or palm heat. The pulse is fine and soft, and the whole body lacks strength. This is Spleen-Stomach Qi deficiency after dysentery, not Yin damage from chronic dysentery. As for the red tongue with no coating and dry skin, it is due to Spleen-Stomach Qi deficiency failing to transport and transform, unable to absorb the essence of food and drink, causing 'water essence to distribute everywhere.' One should discard tongue signs and follow the pulse, using Spleen-tonifying and Qi-supplementing methods." He prescribed Sizijunzi Tang (Four Gentlemen Decoction) adding Dioscorea (Shanyao), Sprouted Grain (Guaya), and Lotus Seed (Lianrou), changing Dangshen to Renshen, and Baizhu to Baizhu. After three doses, appetite gradually improved. Continuing to regulate Spleen and Stomach led to recovery. Another case: a middle-aged man suffered from excessive thirst and drinking, almost unable to leave water, drinking dozens of bowls a day, with frequent urination, poor appetite, little food intake, dry skin, and emaciated muscles. Originally diagnosed as Xiao Ke (Wasting-Thirst) due to Yin deficiency and Fire hyperactivity, multiple treatments with Yin-nourishing and fluid-generating formulas failed. My uncle said: "The patient's tongue is not red or peeled, no signs of easy hunger or excessive eating. The pulse is deep and fine, especially weak at the Chi position. Although there is excessive thirst, it is not Yin-deficiency Xiao Ke. One should discard symptoms and follow the pulse, switching to Kidney-warming methods. Kidney Qi deficiency fails to regulate water, causing frequent urination; Kidney Yang deficiency fails to vaporize fluids, causing thirst; Kidney Fire decline weakens Spleen transport, causing poor appetite, emaciation, and dry skin." He prescribed Jingui Shenqi Wan modified as a decoction, adding Renshen, Deer Antler Glue (Lujiaojiao), and Rubus fruit (Fupenzi). After ten days, symptoms eased. Through these facts, I understood the importance of flexibility in following or discarding in clinical treatment, realizing that correct mastery requires combining Four Diagnostics, comprehensive examination, and identifying key points. Otherwise, distinguishing true from false, following from discarding is impossible.
Prescribing Drugs Requires Skillful Coordination.