Speaking of classic prescriptions, almost no one in the field of Chinese medicine knows this ancient and modern term. Classic prescription is the ancient name for experienced prescription. For example, in the classification of bibliographies in the Han Dynasty, medical books that study medical theories, especially the principles and methods of health preservation, are classified as "medical classics", and the experience handed down from ancient times is classified as "classics". According to the Records of Hanshu Yiwenzhi, there were 1 1 classics, with a total of 274 volumes. But unfortunately, because of the war and other reasons, so many classic books are out of sight today. However, many ancient experiences with high clinical practical value are kept in one book, which is Zhang Zhongjing's Treatise on Febrile Diseases.
Treatise on Febrile Diseases is the ancestor of classic prescriptions.
Zhang Zhongjing is from the Eastern Han Dynasty. It is said that he used to be a magistrate in Changsha. Later, because the disease was prevalent at that time, the mortality rate was very high. In the past ten years, two-thirds of his rich family actually died, and seven out of ten of them died of typhoid fever. Great changes in the family prompted Zhang Zhongjing to study medicine angrily. On the one hand, he studied many medical works left by predecessors and their experiences and lessons in treating diseases, on the other hand, he collected clinically effective experience everywhere. In his words, it is "diligently seeking ancient teachings and learning from others", which is another name for classics.
Therefore, Treatise on Febrile Diseases concentrated the essence of the classic prescriptions before the Han Dynasty, and later people called it "the ancestor of the classic prescriptions", which is not excessive, because after more than 800 years of clinical verification, the clinical guiding value of Treatise on Febrile Diseases is recognized, and the clinical efficacy of the classic prescriptions recorded in the book is also true.
It should be noted that shortly after Zhang Zhongjing wrote Treatise on Febrile Diseases, the book was lost due to frequent wars. Thanks to Wang Shuhe, a great doctor in the Western Jin Dynasty, he spent a lot of energy collecting the contents of Treatise on Febrile Diseases and compiling it into Treatise on Febrile Diseases. Later, in the Northern Song Dynasty, miscellaneous diseases in Treatise on Febrile Diseases were found in ancient books, and it was renamed synopsis of the golden chamber after editing. Treatise on febrile diseases and synopsis of golden chamber have been handed down from generation to generation, which have played a vital role in the spread and application of classical prescriptions. It can be said that without studying Treatise on Febrile Diseases and Synopsis of the Golden Chamber, it is absolutely impossible to learn classic prescriptions.
What's the difference between classic prescriptions and contemporary prescriptions?
Historically, there was the name "Shifang" opposite Fang Jing. The so-called prescription is the prescription after Song and Yuan Dynasties, and also refers to the conventional prescription, popular prescription and general prescription taught and accepted by modern physicians. Fashion, like fashion, refers to some newly created formulas that were popular at that time. Compared with the classical prescriptions, the two are different.
First, the differences in the formation of prescriptions. From the source of prescriptions, most of the classic prescriptions developed from a single drug, from drugs to prescriptions. After many ups and downs, including the practical experience of the ancients, the formation process is quite slow. It is by no means a temporary achievement of one person, but it can be said that it embodies the painstaking efforts of countless wise men. For example, who invented Guizhi decoction cannot be verified; Zhongjing Fang does not refer to Zhongjing's personal experience, but the ancient experience he collected. Although there are more or less traces of classic prescriptions, most of them were created by a physician since the Song and Yuan Dynasties, according to the medical theory or philosophy at that time, combined with local medication habits and their own medication experience, and in accordance with the procedure of "reasoning-law-prescription-medicine" and the principle of assisting the monarch and the minister. The formation process is short, and some need to be tested in practice.
Second, the difference in drug composition. There are few herbs in the classic prescription. According to Treatise on Febrile Diseases and Synopsis of the Golden Chamber, 15 contains 1 herbs, 40 contains 2 herbs, 45 contains 3 herbs, 30 contains 4 herbs and 28 contains 5 herbs, totaling 65,438+. There are also small prescriptions, but most of them are generous. At present, most prescriptions of traditional Chinese medicine are 12, which reflects this characteristic.
Third, the difference in drug choice. Most of the classic prescriptions use drugs with strong medicinal properties. The so-called "medicine does not dazzle, but faints" is as light as ephedra and cassia twig, as heavy as rhubarb and aconite root, as toxic as aconite croton, and as dramatic as Daphne genkwa and Euphorbia. On the other hand, when the prescription is not available, tonics and foods, such as Radix Rehmanniae Preparata, Ginseng, Dendrobium, such as Chrysanthemum, Plum Blossom, magnolia officinalis flower, and substitute flowers, such as Luffa sponge, lotus leaf stalk, lentils, soybeans, beef, deer tendon, sheep kidney, and pork belly, should be used.
Fourth, the difference of indications. The indications of classical prescriptions are clear and specific, and each drug has its indications; At that time, the prescriptions were mainly concerned with the pathological concepts such as yin deficiency, yang deficiency, water shortage, excessive fire, excess in the upper body and deficiency in the lower body, total wind, five strains and seven injuries. For example, Jiuwei Qianghuo Decoction, Zhang said, "This can cure cold in winter, hot in summer, warm in spring and wet in autumn, which is the response of all roads."
Fifth, the difference between the tightness of prescription structure. The classic prescription is quite strict. When one medicine changes, even one medicine changes, the indications and efficacy also change, which reflects the strict structure-activity relationship and shows the classical and simple structural beauty. But the prescription is looser, with many additions and subtractions. Many prescriptions only list some basic drugs to treat this kind of disease. For example, Jiuwei Qianghuo Decoction stipulates: "Depending on the difference of the front, back, left and right meridians, the size is different, so it can be used to increase damage."
Sixth, the differences between evidence and machines in research methods. Classic prescriptions can be used to study their indications by testing prescriptions and drugs, and the curative effect can withstand repeated tests. Prescription science must study the pathogenesis in order to understand its general idea. The meaning of the so-called prescription is often the same in the end, and it is foggy; The repeatability of its curative effect is not ideal.
Compared with the prescriptions in Treatise on Febrile Diseases and Synopsis of the Golden Chamber, many prescriptions of later generations belong to contemporary ones, especially the new prescriptions created by doctors after Jin and Yuan Dynasties, the prescriptions for fever in Qing Dynasty and the empirical prescriptions of some contemporary doctors. Although some of these new formulations have been tested for a long time and have yet to accumulate experience in indications and dosage, they are also in the category of experience in essence, but they are not mature enough.
However, in history, some doctors have their own preferences for classics or prescriptions because of their different academic views, different knowledge structures and different clinical experiences. Some classical prescriptions that praised Treatise on Febrile Diseases and Synopsis of the Golden Chamber rejected all prescriptions of later generations. Others don't study ancient classics, don't absorb the formula experience handed down from generation to generation, or just inherit the family tradition or the theory taught by the teacher, or create new prescriptions at will with the teacher's heart. These two ideological tendencies are not conducive to the academic development of traditional Chinese medicine. The correct attitude is to absorb and use the experience of later generations on the basis of mastering the classic prescriptions, so as to achieve better clinical results.
Why do you advocate classical prescriptions?
First, the classic prescription is the essence of Chinese medicine. Traditional Chinese medicine (TCM) has been gradually developed through countless people's own experiments and experience accumulation. The experience of predecessors is the basis of future generations' practice, and history is the best tool to test and deal with medical experience. Therefore, many classical prescriptions in Treatise on Febrile Diseases and Synopsis of the Golden Chamber have been taken by many people because of their long history, and their application rules and toxic and side effects have been clearly studied, so their curative effects are reliable, so they must be mastered. In other words, the classic prescription is an experienced prescription that has been proved by thousands of years of practice.
For example, Guizhi Decoction is said to have been invented by Yi Yin in Shang Dynasty, and doctors are still using it now. I use Guizhi decoction to treat valvular heart disease, and the effect is very good. Another example is Xiaochaihu decoction, which is the prescription in Treatise on Febrile Diseases. It is not only a common prescription in ancient times, but also a common prescription today. Xiaochaihu decoction is used to treat various diseases of immune system, respiratory system, hepatobiliary system and fever. And not only in China, but also in Japan and South Korea. Wouldn't it be a pity if these famous names handed down from generation to generation were not used?
There are also many good prescriptions, such as Yupingfeng Powder, Buzhong Yiqi Decoction and Huoxiang Zhengqi Powder. Although the indications of many prescriptions are not clear enough, and the relationship between dosage and decoction and curative effect is not very clear, they have been formulated after all. As long as it is carefully explored in clinic and tested for a period of time, these prescriptions will also become new prescriptions.
The problem is that a large number of clinicians prescribe drugs at will, completely ignoring the principle of Chinese medicine prescription. Often a prescription contains 15, 16 drugs, or even dozens of drugs. They don't have a prescription structure at all, and they don't know how the drugs react to each other after compatibility, and they don't know the effect of patients after taking drugs. This clinical attitude is not desirable. We not only do not advocate this "status quo", but also resolutely oppose it. Therefore, advocating classic prescriptions is determined by the characteristics of traditional Chinese medicine.
Second, the classic prescription is the basis of prescription. Prescription is the compatible structure of drugs. The ancients understood diseases from one symptom to another, such as fever, headache, diarrhea, vomiting and so on. Medication, but also from the beginning of blindly using drugs. Later, it was found that diseases often have multiple symptoms, either before or after, or at the same time, so the concept of disease name was established, such as typhoid fever, sudden lump, dysentery, abdominal distension and so on. Then, the use of drugs has also changed, not only one drug, but also several drugs have been developed for use together. After many people and years of practice, the structure of this compatibility has gradually stabilized, so there are prescriptions, such as Guizhi Decoction, Mahuang Decoction, Xiaoqinglong Decoction, Dachaihu Decoction and Wenjing Decoction.
Just as a chess player must be familiar with the chess manual and a painter must be familiar with the painting manual, classic prescriptions have become the basis and principle for doctors to prescribe drugs. Even the prescriptions commonly used today are mostly evolved on the basis of classical prescriptions. For example, the well-known Wendan decoction is made of small Pinellia tuber and Poria cocos soup. Xuefu Zhuyu Decoction is a famous prescription of Wang Qingren, a famous doctor in Qing Dynasty, and it is an addition and subtraction prescription of Sinisan. Both Jiaomei Decoction and Lianmei Decoction in Qing Dynasty have the shadow of Wu Mei Pill, while Huoxiang Zhengqi Powder is a variant of Banxia Houpu Decoction. Therefore, many famous doctors in later generations emphasized their familiarity with Treatise on Febrile Diseases and Synopsis of the Golden Chamber. That's the reason.
Third, there are many other advantages of classic prescriptions.
The first is the refining of drugs. The prescriptions in Treatise on Febrile Diseases and Synopsis of the Golden Chamber contain less drugs, mostly 2 ~ 7 flavors, which is convenient for understanding the structure of the prescriptions, observing the clinical efficacy, modern pharmacological research and new drug development. In particular, many small squares of 2 ~ 4 herbs are the foundation of future generations, which can be called square roots.
Second, the price is low. Most of the drugs used in the classic prescriptions are commonly used drugs, most of which are plant drugs, and the prescription drugs have a small taste, so the price is relatively low. I often treat pancreatitis with the original prescription of Dachaihu Decoction. Bupleurum, Scutellaria baicalensis, Pinellia ternata, rhubarb, immature bitter orange and peony, plus ginger and jujube, cost 3 yuan more every day! Guizhi soup is cheaper, and 1 yuan per day is enough.
Third, the prescription is clear. The basic principle of treating diseases by classical prescriptions is that prescriptions should correspond to syndromes, that is, in Treatise on Febrile Diseases, it is said that "observing the pulse, knowing its faults and treating it with syndromes", and "patients with corresponding prescriptions should be served". In other words, the indications must be strictly followed when applying classic prescriptions to treat diseases. These indications are objective and concrete, and can be determined by listening, listening and asking. Prescription syndrome is the indication or indication of classic prescription, and it is the goal of guiding doctors to apply classic prescription. No matter how good the prescription is, it is not easy to get results. So Chinese medicine attaches great importance to the right medicine. The descriptions of indications in Treatise on Febrile Diseases and Synopsis of the Golden Chamber are simple and clear, but they are objective. After the enrichment and perfection of many doctors in later generations, many prescriptions and syndromes have been basically clear, such as "pressing under the heart is full of pain" in Dachaihu decoction syndrome and "palpitation and pulse depression" in Zhigancao decoction syndrome.
Can the ancients cure this disease?
This is an old question. My views are as follows: First, the classic prescription is the crystallization of ancient people's clinical experience, and the diseases treated by the classic prescription are also some common and frequently-occurring diseases of that year. Due to the change of disease spectrum, today, many ancient diseases have disappeared, and new diseases that the ancients have never seen have appeared. However, it cannot be said that the diseases we are suffering from now are completely different from those in ancient times. For example, malaria and dysentery, which are still visible today, are very old diseases. Therefore, it can't be said in general that the ancient prescription can't cure today's disease.
Second, many indications of classic prescriptions are mostly aimed at the reaction state of human body in diseases, such as the advantages and disadvantages of aversion to cold, sweating, thirst, defecation and urination. These focuses are related to the basic state of human physiology and pathology.
It has been hundreds of thousands of years since human beings appeared, and the age distance of Zhang Zhongjing is only about 1800 years now. During this period, our human body changes are not obvious, and our responses to various external stimuli, whether ancient or modern, are generally not much different. For example, if we go to the sauna with the ancients, everyone will sweat; If everyone eats rhubarb, the frequency of defecation will increase.
Because the classic prescription attaches importance to the reaction state of the body, the ancient prescription may not be used for modern diseases, even for modern AIDS, as long as there are symptoms and signs, there is a chance to use the classic prescription. It is reported that Japanese doctors have proved that Xiaochaihu decoction is effective in treating AIDS. This is because although Chinese medicine does not know about AIDS, the manifestations of AIDS, such as emaciation, low fever, loss of appetite and swollen lymph nodes, are similar to those of Xiaochaihu decoction, such as "cold and heat, pain in the chest and hypochondrium, upset and vomiting, and silence for food". The object of classical prescription treatment is not pathogens, but sick people. This is the theoretical basis for the ancient prescription to treat today's diseases.
Does the classic prescription have toxic side effects?
Every medicine has three kinds of toxicity. The drugs used in the classic prescriptions are all classic and commonly used drugs, which are inevitably toxic. However, it is not so simple to answer the question "Is there any toxic side effect in the classic prescription?". As for the factors causing side effects, we should not only consider the drug itself in isolation, but also consider the patient's physique and disease, as well as the compatibility, dosage, decocting method and nursing measures of classical Chinese medicines. In the use of classic prescriptions, if all factors are considered comprehensively and the compatibility and usage are appropriate, the side effects can be alleviated or avoided.
For example, using Daqinglong decoction, because the dosage of ephedra in this prescription is quite large, it has a strong sweating effect, and there may be side effects such as sweating, palpitation, muscle beating, cold limbs, irritability and insomnia. How to avoid it? Zhang Zhongjing pointed out: First, we should recognize the indications, that is, "heatstroke, tight pulse, fever, aversion to cold, body pain, irritability and no sweat"; Second, we must recognize the contraindications, that is, "people with weak pulse, sweating and bad wind should not take it"; The third is to master the dosage, "once you sweat, take it after stopping taking it"; Fourth, pay attention to the reaction after taking the medicine and take rescue measures, such as "sweating too much and warming the powder."
Daqinglong decoction is a powerful agent for sweating, so Zhang Zhongjing made it clear. Just because Zhang Zhongjing didn't make clear the points for attention of some classic prescriptions doesn't mean they are non-toxic and safe. Especially the long-term use of traditional Chinese medicine in modern clinic is quite different from that in ancient China. Therefore, the probability of side effects will naturally increase, which should attract our attention. Because the indications and contraindications of classic prescriptions are not very clear in ancient literature, clinical research needs to be carried out cautiously.
How to judge the curative effect of classic prescriptions
The curative effect of classic prescriptions should be judged from the following three aspects:
The first is the change of objective indications, such as sweating, edema fading, unobstructed stool, asthma relief, slow and strong pulse, and thick and thin tongue coating. For example, after eating Guizhi decoction, it seems to be sweating all over. After eating Daxianzhong decoction, it takes effect quickly, and after eating Tongmai Sini decoction, the pulse comes out. In addition to these traditional treatment standards, modern clinical physical and chemical indicators should also be paid attention to, such as the blood lipid level after taking Dachaihu decoction, the platelet count after taking Xiexin decoction, and the detection results of Helicobacter pylori after taking Banxia Xiexin decoction. The second is the improvement of self-feeling, such as the increase of appetite, the disappearance of chest tightness, the disappearance of foreign body sensation in throat and the improvement of mood. This is an important traditional standard of the effectiveness of classical prescriptions. Because the diagnosis of many classic prescriptions is based on self-feeling, such as "burning throat" in Banxia Houpu decoction syndrome, "cold and heat come and go, chest and hypochondrium are full" in Xiaochaihu decoction and so on. The third is the improvement of the quality of life and the extension of life. The first two are commonly used at present, and the latter is also very important, but because the indications are not very clear, further research and discussion are needed.
The curative effect index of the classic prescription needs to be agreed by both doctors and patients. Doctors should listen carefully to the patient's chief complaint, understand the patient's motivation and purpose of seeking medical treatment, and understand the patient's most painful symptoms, the most urgent wishes and the problems that need to be solved by doctors. Then according to the judgment of disease and constitution, according to the clinical experience and reports of the application of the classic prescription, following the evidence of the clinical application of the classic prescription, the expected effect on the classic prescription (that is, whether it is effective or not, what kind), how long the course of treatment is, and whether there are any side effects. ), and then communicate with patients, after reaching a * * * understanding, cooperate with each other, and make an effective, effective and invalid judgment on the curative effect of the classic prescription in the follow-up visit.
Reasons for the unfashionability of classical prescriptions
At present, classics are not very popular, and not many doctors are used. What is the reason why the eternal prescription is not widely used? We think there are three possibilities:
I dare not use it. Classic prescription is a double-edged sword, which has the effect of drum testimony. Misuse is not only ineffective but also harmful. It's best not to take risks.
Second, I don't want to use it. The classic prescription has little taste and cheap medicine. For doctors, not only do they get less kickbacks, but patients often doubt and despise them because drugs are cheap. Therefore, it is better to be generous, which can please patients and increase economic benefits. Why not?
It can't be used for three days. To be familiar with the prescriptions of drugs and prescriptions, it is best to teach them specifically and carefully. They are very empirical and practical. If you only know some so-called efficacy prescriptions, it is of course difficult to have an effect.
In my opinion, there are not many people in the field of Chinese medicine at present, and there are more people in the third category. It is urgent to let everyone know and use classical prescriptions and revitalize Chinese medicine!
Problems needing attention in learning classics
To learn classical prescriptions well, we should also clarify some vague understandings and correct some improper practices.
Some people think that Chinese medicine should have a theory before a prescription, and there must be a theory for treating diseases. In fact, the clinical thinking of traditional Chinese medicine is medicine-prescription-method-principle. Without medicine, there is no way; Without justice, there can be no reason and law!
When some doctors see patients, the first thing they consider is what is wrong. Doctors must clear away evil, qi must be deficient, deficiency must be affected by evil, and illness must be real!
Traditional Chinese medicine does not require that every syndrome must have a pulse condition and a corresponding tongue condition. In clinical diagnosis, astragalus syndrome can be diagnosed without looking at the pulse condition; The master's card can be read without looking at the tongue, but it must look at the pulse; The key of asarum syndrome is aversion to cold and not thirst.
Don't be blinded by the so-called "theory". When you see blood in the stool, you think that the spleen does not control blood; Seeing that urination is unfavorable, it is considered to be insufficient gas; When you see gastroptosis, you think it's depression of middle qi; Seeing a long illness is called deficiency; Seeing hypertension is called hyperactivity of liver yang; Seeing coronary heart disease is called blood stasis. Clinical practice is by no means so simple.
Don't discuss medicine first, then discuss disease. When you see rhubarb and coptis root, you are afraid of its bitter cold injury; If you use yellow donkey-hide gelatin, you will be afraid of obstructing the stomach; Look at peach blossoms and red flowers, afraid of breaking blood; Seeing Bupleurum and Pueraria lobata, I am afraid that they will rob the liver and hurt the gastric juice; Seeing ginseng and astragalus membranaceus, I am afraid of consolidating the exterior and blocking evil; See ephedra cassia twig, afraid of its pungent warm blood. What can you do if you are so afraid of your hands and feet? It can only be flat products such as bamboo shavings, loofah, lily, substitute flowers and white lentils.
Some people think that the ancient prescription can't cure new diseases. This statement seems to be innovative, but there is actually a gap. The spectrum of diseases is constantly changing, but the way people deal with diseases is unchanged, and all kinds of symptoms are unchanged. Many prescriptions in the classics are based on "sick people", which can be said to be unchanged for thousands of years. In Mr. Cao's words, it is "the method of middle school, that is, modern Xian Yi".
Some people say that classics are difficult to learn. In fact, it is not difficult to use classical prescriptions. Ke Yunbo, a medical scientist in the Qing Dynasty, said: "The way of Zhongjing is flat and easy; The gate of Zhongjing is open to everyone. " The prescriptions in Treatise on Febrile Diseases and Synopsis of the Golden Chamber are concise and practical, and there is no vague talk. As long as you study it carefully, compare it repeatedly, learn from old Chinese medicine practitioners, communicate with your peers and use it repeatedly in clinic, you will naturally reach the point where you are at both ends.
Mr. Cao is a self-taught Chinese medicine practitioner, and his admiration for classic prescriptions comes from his bold clinical practice. He used Dachengqi decoction to treat constipation and abdominal distension in the neighborhood, but refused to press it. He used Fuzi Lizhong decoction to treat primipara diarrhea, Dahuang Mudan decoction to treat Pan Shi intestinal carbuncle, and personally took Baihu Guizhi decoction to treat his own cold and heat. He repeatedly verified the efficacy of the classic prescription in clinic, and gradually became very skilled in the use of the classic prescription and became addicted repeatedly. During his stay in Shanghai, "Nine times out of ten, those who use classic prescriptions will get results" (Introduction to Classic Prescription Experiments), which makes him unique in Shanghai where famous doctors gather.
Many people are afraid that classic prescriptions will have side effects. You should know that "medicine should not be dizzy, but it should not be dizzy." All drugs have certain side effects. As long as the prescription is proper, the dosage is appropriate and the adjustment is scientific, there will be no or few side effects. For a long time, traditional Chinese medicine has been discussing drugs before epidemics, and it is necessary to criticize the advantages and disadvantages of drugs without targeting specific patients and conditions.
In a word, advocating classic prescriptions is not only a simple clinical technical problem, but also involves scientific thinking, medical ethics, personnel training, scientific research methods and many other aspects related to the development of traditional Chinese medicine. Only by correctly and comprehensively understanding the classic prescriptions can we fully understand the historical achievements of the classic prescriptions and the practical significance of advocating them.