Aren’t TCM doctors who prescribe “generous prescriptions” good TCM doctors? This article is based on Mr. Qiu Peiran's experience in studying medicine and treating diseases, talking about the issue of complicated and simplified prescriptions, and his experience in treating some difficult and complicated diseases. Friends are welcome to leave a message for discussion at the end of the article

1

"Prescribing drugs with a lot of flavor" is equivalent to "disposing machine guns indiscriminately"?

Zhu Danxi, a famous doctor in the Yuan Dynasty, wrote a book called "The Use of Prescriptions", which made fierce criticisms of the prescriptions that were popular in the Song Dynasty.

In addition to commenting on the disadvantages of using aromatic, pungent and dry medicines in prescriptions that can damage Yin Jieye, Zhu also pointed out that some of the prescriptions in his book have many medicinal flavors and complicated prescriptions.

He described this kind of prescription to treat diseases, just like a hunter "expanding the wilderness in the hope of catching a rabbit".

Danxi’s theory has its origins.

Xu Yinzong of the Tang Dynasty was also a famous medical expert. He criticized the bad practices of the medical community at that time, and also said that "there are too many medicinal smells, such as hunting, sending many people and horses, covering the open space, or hoping that one person will meet by chance." .

Because the doctor’s prescription must be based on the condition, examine the cause and pathogenesis of the disease, and then prescribe the right medicine. If there is a slight difference, it will be good. If you only rely on the "odor of medicine", it is equivalent to firing a machine gun indiscriminately. Its theory is based on Danxi.

Later, Ye Tiantu in the Qing Dynasty also said "fake things and get lucky", which was used to criticize the current medical school.

2

When I was young, I thought it was not good to prescribe generous prescriptions

In my early years, I studied medicine and devoted myself mostly to Zhang Zhongjing’s "Treatise on Febrile Diseases" and "The Golden Chamber" Most of the prescriptions in "Yaolue" are concise and clear, which can be said to be well-organized prescriptions and medicines.

Therefore, when I read the opinions of the above-mentioned doctors, I was quite convinced and felt that doctors’ diagnosis and treatment prescriptions should be reasonable and legal.

For example, Hua Tuo in the Han Dynasty only used a few kinds of medicines, and acupuncture only used a few places. They could hit the point and solve the problem. Doctors cannot use medicines like Han Xingbing's "the more, the better" approach.

As for some prescriptions in ancient prescription books such as "Qianjin" and "Bureau Prescription", which have complex flavors, with as many as thirty or forty or even fifty or sixty flavors, some are indeed like "Guangluo Yuanye" "It looks like this kind of treatment prescription is not always the road that doctors should take.

However, demonstrating an issue requires specific analysis, especially making judgments in actual tests. Therefore, the ancients also said that "it is better to know Wang Shuhe well than to do clinical diagnosis".

3

With the deepening of practice

I found that some difficult and complicated diseases are suitable for generous treatment

In my long-term clinical practice, Gradually, I came to realize the special effect of "Duo'an Medicinal Flavor", and many people achieved curative effects using this method.

Especially for some difficult and complicated diseases that cannot be cured by ordinary methods, we can consider using it. This is something I did not know and did not think of when I was practicing medicine when I was young.

Let me take my experience in treating migraine as an example. I have encountered some very stubborn diseases that are difficult to cure.

In my early years of prescribing, I advocated legal procedures and was very particular about principles, methods and medicines. I often thought that the prescriptions were perfect, but when I encountered certain stubborn diseases, the curative effect was far from satisfactory.

After reading the prescription books, I finally used a prescription with a very complicated medicinal taste. This kind of prescription is something I have dismissed in the past, but after using it, I often get unexpected results.

This amazes me! It also makes me feel my own ignorance. "My life has a limit, but my knowledge has no limit." This is a truly true saying.

I basically use the following various drugs by adding or subtracting them to get the best results.

Such as aconite, dried ginger, cinnamon twig, asarum, gypsum, gentian, skullcap, rhubarb, dangshen, astragalus, atractylodes, yam, angelica, rehmannia, qianghuo, fang, bupleurum, mountain Cornus, Schisandra, Nanxing, Pinellia ternata, Ligusticum chuanxiong, Angelica dahurica, oyster, magnet, whole scorpion, Clematis, centipede, earth dragon, peach kernel, Poria, date kernel and other medicines.

This is a hodgepodge product that combines cold, heat, warmth, qi, blood, yin and yang, and ascending, descending, attacking and tonifying in one area. It violates the current standards of principles, methods, prescriptions, and medicines in the medical field. However, The clinical effect is very good. It is true that the reason is not clear but the effect is visible.

I infer from this that some of the generous and compound prescriptions contained in ancient prescription books are likely to have their basis in practice. We often ignore this aspect, and even ridicule it without putting it into practice. This may not be a scientific and serious attitude.

Regarding the so-called "Guangluo wilderness" theory by Zhu Danxi and others, of course we should agree that he is right, but their discussion is not completely complete.

4

My experience in medication for chronic nephritis

Another example is my treatment of chronic nephritis, the medication is also very complex.

There is no name for nephritis in the medical literature of the motherland. Its content is scattered in records such as edema, water vapor, stone water, Zhengshui, Feng Shui, and skin water.

This disease is divided into two types: acute and chronic. Chronic disease is more difficult to treat. There are many cases and it is often difficult to completely cure it. And most of the patients I treat are cases that are not cured for a long time. During the treatment process, there are successes and failures, but often very complicated prescriptions are used to achieve unexpected successes.

Chronic nephritis is currently generally considered to be an immune disease, caused by antigen-antibody complexes, and can undergo proliferative changes, basement membrane changes, degenerative changes, etc.

Its clinical classification can be roughly divided into latent type, nephrotic type, hypertensive type, renal insufficiency type and mixed type.

I generally treat the latent type, nephrotic type and hypertensive type, but each type is often difficult to separate clearly, so the mixed type is the most common.

In clinical practice, hormones and traditional Chinese medicines for strengthening the spleen and kidneys are generally used. Some are temporarily relieved but still have recurring attacks, and some have no obvious effect. Patients with long-term illness may show varying degrees of decline in kidney function. Condition.

I have an immature opinion on this. I think that in addition to the deficiency of the lungs, spleen and kidneys, the deficiency of qi and yin or yang, and the lingering water and dampness, we should pay attention to the lingering accumulation of evil, heat and poison. Take advantage of this important factor.

The reasons are:

1. In many cases, typical symptoms of nephritis will quickly appear due to pharyngitis or upper respiratory tract infection after remission, and colds and fever are often prone to occur. This is one of the characteristics of this disease, which is consistent with the theory in traditional Chinese medicine that "new feelings induce evil spirits".

2. Analyzing the clinical manifestations of this disease, not all of them are symptoms of Yang Qi deficiency. Common symptoms include sore throat, turbid urine, oliguria, obvious hematuria, rash, high blood pressure, and headache. Epistaxis, etc. are all signs of the fiery inner nature.

3. From the emergence of symptoms such as nausea and vomiting, irritability, coma, delirium and even convulsions in the later stages of the disease, we finally see the hidden evidence of heat and poison, which is completely exposed.

4. For this disease, when the methods of nourishing the kidneys, strengthening the spleen and removing dampness are ineffective, the effect will be improved if combined with methods of clearing away heat, detoxifying, cooling blood and dispelling wind. In the later stage, rhubarb can even be used.

Therefore, I believe that this disease is an extremely complex disease with a mixture of cold and heat, and a mixture of deficiency and excess. This may be the reason why it is so lingering and difficult to heal.

My guiding ideology in treating this disease is to use both tonic and diarrhea, and to take both prevention and treatment into consideration.

The specific content includes the following medicines: heat-clearing and detoxifying, warming the kidneys and promoting yang, nourishing the spleen and replenishing qi, astringent and astringent, pungent and wind-removing, diuretic and urinating, nourishing yin and cooling blood, which belong to the seven categories. The generosity of prescriptions and the scope of compound prescriptions.

The prescription adopts commonly used compatibility methods, such as the combination of pungent and warming drugs with sour and astringent drugs, the combination of heat-clearing and detoxifying drugs with kidney-warming and yang-boosting drugs, the combination of qi-replenishing and essence-boosting and water-tonifying drugs. The combined use of wet medicine, etc.

These drugs originally have opposite effects, but in complex illnesses, by applying various drugs with opposite effects, you can expect to achieve opposite but complementary purposes.

In short, the prescription is very complex, which involves syndrome differentiation and treatment, but is not limited by syndrome differentiation and treatment.

For example, Qianghuo and Rehmannia glutinosa in the prescription can be used together, Cuscuta and raspberry can be used together with General, duckweed and Schisandra chinensis can be used together, etc.

This combination seems to be a bit out of the norm, but in my personal experience in treating chronic nephritis, I feel that the effect is better.

5

Chinese medicine should be used flexibly

Use generous methods when necessary, and use small prescriptions when necessary

Let’s talk a little about me here My experience:

(1) Regarding the issue of complicated and simplified prescriptions

If we can cure diseases in the simplest way, this is what everyone hopes for and is the most ideal. thing.

However, it seems that there are not too many problems that can be solved by one medicine for one disease or one prescription for one disease. However, some complicated prescriptions are fairer and can be explained in a more orderly manner than those prescriptions. The effects of traditional Chinese medicine prescriptions are better. Ancient prescriptions such as Biejiajian Pills, Suhexiang Pills, and Angong Niuhuang Pills are an obvious example.

Especially for some difficult diseases, the pathogenesis is often complex, often with cold and heat mixed in, both deficiency and excess, and evil love and decline. Therefore, seemingly complicated prescriptions may produce many compound effects to achieve effective results. .

Therefore, for some intractable diseases or difficult and critical illnesses, the thinking can be broader and the medication can be more complicated. It is not necessarily restricted by the classification and typing of a certain disease in some clinical medical books. If If it is too rigid, it will be difficult to inherit the rich content of the motherland’s medicine.

The principles of prescriptions in traditional Chinese medicine include major, minor, urgent, odd, even, complex and other methods. The prescription should not be judged by the complexity or simplicity of the condition, but by the simplicity or complexity of the condition. to consider prescriptions.

There are various types of prescriptions in books such as "Qianjin Prescription" and "Waitai Secrets". We should first master them completely, which will be conducive to discovery and improvement.

(2) Regarding the selective issue of medication

There are many types of traditional Chinese medicine. For example, there are at least more than a hundred types of traditional Chinese medicine, such as clearing away heat and detoxifying. The medicine needs to be carefully selected and precise. The selection means to find out the specific effect among the same effects.

For example, to treat chronic nephritis, it is necessary to clear away heat and detoxify. What medicines should be used?

Personally, I think the five medicines of Lu, Bletilla, Hedyotis diffusa, Scutellaria baicalensis, and Cortex Phellodendron are the first-choice medicines.

Because these medicines not only have the effect of clearing away heat and detoxifying, Baitian also has the effect of treating "loss of sperm"; Luolu also has the effect of treating "loss of sperm and hematuria"; Hedyotis diffusa also has the effect of diuresis. It can reduce swelling and activate blood circulation; Scutellaria baicalensis can also treat colds, high blood pressure and edema; Cortex Phellodendri can also treat spermatorrhea.

Due to the limited historical conditions at that time, there is no record of proteinuria in Chinese medicine. However, based on modern scientific knowledge, proteinuria seems to belong to the category of kidney essence.

In addition to their heat-clearing and detoxifying effects, the above medicines are also effective in treating proteinuria, hematuria, hypertension, edema and colds due to nephritis.

For another example, patients with chronic nephritis are prone to colds. I started to treat them with Yupingfeng Powder. After it failed, I reviewed the medical book.

The meridian distribution of the antifungal medicine is the three meridians of bladder, liver and spleen, while the meridian distribution of Qianghuo is the two meridians of kidney and bladder. After switching from Fanghuo to Qianghuo, the patient's susceptibility to infection was gradually eliminated.

There was a flu epidemic and the whole family got sick, but this patient was the only one who didn't catch a cold.

It shows that Qianghuo can not only cure colds caused by nephritis, but also prevent colds. It shows that the theory of drug meridian distribution still has certain clinical value.

The above examples illustrate that in addition to mastering the common effects of each drug, we must also master the specific effects of each drug.