2020/02Ⅰ 49

于防止進(jìn)一步的神經(jīng)損傷。

在難以治療的情況下，疼痛專家可以使用侵入性

或可植入設(shè)備來(lái)有效管理疼痛。參與神經(jīng)性疼痛的神

經(jīng)的電刺激可顯著控制疼痛癥狀。針灸治療神經(jīng)性疼

痛有非常顯著的療效。

本文重點(diǎn)介紹糖尿病足的針灸治療。糖尿病足

病的主要癥狀是下肢疼痛及皮膚潰瘍。在早期，雙腳

會(huì)感覺皮膚瘙癢，怕冷，發(fā)白或發(fā)紫，肢端刺痛，麻

木，感覺遲鈍或喪失，走路像踩在棉花上一樣，進(jìn)而

在行走時(shí)突然出現(xiàn)下肢疼痛，必須休息一會(huì)兒才能繼

續(xù)行走；后來(lái)，往往會(huì)足部皮膚潰爛、壞死，創(chuàng)口久

久不愈，壞死可深入肌腱、韌帶以及骨頭，最終病人

不得不接受截肢手術(shù)而導(dǎo)致殘廢。

針灸治療糖尿病足，根據(jù)其臨床特征性表現(xiàn)來(lái)進(jìn)

行取經(jīng)絡(luò)和穴位。比如，間歇性跛行通常發(fā)生在病變

早期，具體表現(xiàn)為行走一段距離后，突然出現(xiàn)臀部、

大腿、小腿肌肉麻木、疼痛，以至于痙攣或跛行，嚴(yán)

重者甚至需要蹲下休息，等癥狀完全消失后才可繼續(xù)

行走。中醫(yī)辨證多為氣滯、風(fēng)寒邪阻滯經(jīng)絡(luò)，根據(jù)疼

痛所在或接近的經(jīng)絡(luò)和穴位進(jìn)行局部針刺，根據(jù)患者

的體質(zhì)，用稍重或疏泄的手法行針刺激以疏通經(jīng)絡(luò)，

臀部要取環(huán)跳穴為主穴?；颊咴诮邮茚槾汰h(huán)跳穴時(shí)局

部疼痛的立刻緩解，并有傳至下肢體的傳導(dǎo)感應(yīng)。細(xì)

節(jié)上要考慮到準(zhǔn)確取穴，針刺的深度和角度，刺激的

量和傳導(dǎo)，以及針刺入穴位后，患者的癥狀有明顯的

緩解甚至完全消失。同時(shí)，有大腿癥狀的加刺風(fēng)市

穴，膝陽(yáng)關(guān)穴或承扶穴，殷門穴和委中穴。有小腿癥

狀的加刺陽(yáng)陵泉穴和飛揚(yáng)穴、懸鐘穴等穴位。另外，

效果的差異還體現(xiàn)在手法上的差異。

休息疼痛通常發(fā)生在疾病的中間，表現(xiàn)為腳趾或

腳趾末端處于安靜狀態(tài)時(shí)的疼痛，躺下時(shí)尤其是在晚

上，疼痛更明顯，需要采取一些步驟減輕它。在傳統(tǒng)

中醫(yī)中，表現(xiàn)為血管的血瘀阻滯，經(jīng)絡(luò)的痰濕阻滯，

關(guān)節(jié)發(fā)紅、腫脹、熱痛。這個(gè)時(shí)期的治療需要針灸和

藥物的結(jié)合。在治療疼痛的同時(shí)，有必要改善血管、

經(jīng)絡(luò)和關(guān)節(jié)的循環(huán)以消除瘀滯。根據(jù)相鄰的經(jīng)絡(luò)和穴

位選擇穴位?？傊?，有必要考慮降低血糖，消除血瘀

腫脹，減輕體重和腹部。充分利用針灸和中藥對(duì)病因

進(jìn)行綜合治療，在治療一周內(nèi)，患者的血糖水平、腫

痛、體重和四肢周圍循環(huán)能得到明顯改善，長(zhǎng)期治療

可以控制和治愈糖尿病足。

糖 尿 病 足 案 例 ： 糖 尿 病 患 者 病 程 長(zhǎng) （ > 1 0

年），伴白蛋白尿和/或估算腎小球?yàn)V過(guò)率 (estimated

glomerular filtration, eGFR) 降低，如沒(méi)有其他腎損傷

原發(fā)病因的體征或癥狀，則通常可臨床診斷糖尿病腎

病 (diabetic kidney disease, DKD)。一些癥狀直到疾病

晚期才出現(xiàn)，例如乏力、厭食以及肢體水腫。體征包

括高血壓、水腫和微血管并發(fā)癥（糖尿病視網(wǎng)膜病變

和神經(jīng)病變）。在這種情況下，如何用針灸治療來(lái)改

善腎功能，提高GFR，改善視力，并改善四周肢體循

環(huán)呢？A先生，65歲，因血糖失控，長(zhǎng)期在10以上，

高血壓服用利尿藥導(dǎo)致腎功能損傷，GFR低于60（正

常大于60），同時(shí)有痛風(fēng)、糖尿病足、紅腫疼痛、視

力下降。針灸取穴：調(diào)理脾胃運(yùn)化痰濕，瀉天樞、陰

陵，補(bǔ)商丘、公孫增益脾陽(yáng)，太沖疏通氣機(jī)，并結(jié)合

足部局部穴位，來(lái)診所治療僅一年多，血糖控制非常

好，HA1c指標(biāo)下降，GFR明顯改善到68。痛風(fēng)消失，

糖尿病足疼痛在一個(gè)星期內(nèi)緩解，下肢水腫消失。針

灸治療讓他非常滿意！

結(jié)束語(yǔ)：在美國(guó)約有一千萬(wàn)個(gè)糖尿病患者，而足

部疾病是百分之二十糖尿病患住院治療的主要原因，

且下肢毛病是最常見而需要手術(shù)的疾病。大約三分之

二非創(chuàng)傷性下肢截肢發(fā)生在糖尿病患者身上。據(jù)數(shù)據(jù)

統(tǒng)計(jì)，糖尿病患者下肢的截肢率是非糖尿病患者的40

倍，約15%的糖尿病患者會(huì)在一生中發(fā)生足潰瘍。另

外，糖尿病足潰瘍還可并發(fā)或誘發(fā)其他急性心腦血管

事件，甚至誘發(fā)糖尿病急性并發(fā)癥，如酮癥酸中毒、

高滲性昏迷、全身膿毒癥等，直接威脅到患者的生

命。對(duì)于糖尿病足的問(wèn)題，絕不可忽略。介紹和推廣

針灸治療糖尿病足，極大地降低糖尿病足的發(fā)病率和

減少政府醫(yī)療費(fèi)用，是一件利民利國(guó)的好事，希望能

引起相關(guān)專業(yè)人士和患者的高度重視。

（作者為加拿大醫(yī)學(xué)博士 ）

Clinical practice of acupuncture treatment｜針炙實(shí)戰(zhàn)

50 Ⅰ2020/02

臨床名醫(yī)｜Clinic Specialist

Thoughtson the New Coronavirus Plague.

◎ caodongyi yizhe/zhangfengrong chensirong

After the outbreak of the COVID-19 plague,

General Secretary Xi personally deployed and directed

himself. At the Political Bureau meeting on the first day

of the first month in Chinese Lunar Calendar (January

25), he decided to adopt the mode of cooperation between

Traditional Chinese and western medicine to treat patients.

Traditional Chinese Medicine personnel quickly entered

the main battlefield and overcame many difficulties

including the lack of reserves of herbal medicine, not

being understood by patients and western doctors and etc.

Traditional Chinese Medicine soon played a great role,

achieved obvious good results. Not only in mobile cabin

Hospital, which supposed to be full of panic and grief, the

herbal fragrance is floating in air, the doctors and patients

practice the Ba Duan Jin constantly, even the person who

discredited TCM in the past has also been rescued by

Traditional Chinese Medicine, defeating COVID-19 to

regain his health.

China’s cooperation between Traditional

Chinese and western medicine rescue model got highly

estimates form WHO expert, he sincerely said that if he

unfortunately infected, also hope to come to China for

treatment. I think he definitely does not envy the ventilator

of ICU in China, but likes the atmosphere and medical

effect of mobile cabin hospital.

TCM as “ the first and required choice ” has

become an unprecedented reality

In the past, the treatment methods of Traditional

Chinese Medicine are listed in the last as one of the

alternative treatment measures, only play the role of

supplement or replacement. There never has a “Diagnosis

and Treatment Guide” to put the Traditional Chinese

Medicine to the prominent position as first choice and

required treatment. But this situation changes in COVID19’s treatment. The participation rate and utilization

rate of TCM, the ratio of patent Traditional Chinese

medicine to herbal soup, have been directly brought into

the investigation index. Even these indexes have the

value of “one vote veto”. Where the TCM rescue rate

is low, the work there will be considered as passive and

become the target of public criticism. According to data

released by the Hubei Provincial Health Commission on

February 12, 2020, the participation rate of TCM was only

30%. This result immediately sparked an uproar, even

though the most elite western medicine experts in China

gathered there. The situation of eagerly looking forward

to Traditional Chinese Medicine has never appeared in the

past, but now it has all of a sudden become a life-saving

fashion and the popularity of the Internet. Moreover, in

a concentration of tens of thousands of patients, some

experts who hope to practice scientific experiments of

western medicine and import western medicine, even not

be able to gather the certain number of people observed

in groups. This is something they did not expect. It can be

said that their expectations have been subverted and their

time and space changed.

Facts have taught many western doctors who looked

down on Traditional Chinese Medicine and thought that

Traditional Chinese Medicine cannot solve any problems;

2020/02Ⅰ 51

Experiences of clinical masters｜名家心得

Cao Lirong, deputy chief physician of obstetrics and

gynaecology who performs surgery in Wuhan No. 1

Hospital, treated herself successfully by syndrome

differentiation knowledge of TCM. Doctor Zhan Tao,

who works for the Department of Neurology of Changsha

western medicine hospital, treated nearly 100 patients

with Traditional Chinese Medicine. The appearance of

these phenomena looks like sudden and accidental, but it

does show a certain inevitable trend, and indicates western

medicine doctors the necessity and great future value to

learn Traditional Chinese Medicine.

“ The Sinicization of Western Medicine“

and “ the Globalization of TCM” are coming

In the process of COVID-19, Traditional Chinese

Medicine plays a greater role than the SARS period,

which moved and educated a lot of western medicine

doctors, also changed some people’s understanding who

once discredited the Traditional Chinese Medicine.

Cao Lirong, deputy director of obstetrics and

gynaecology at Wuhan No. 1 Hospital, often performed

surgery and was infected COVID-19 when treating

patients. She applied TCM treatment to herself and cured

very soon. This is different from the method adopted

by western medical experts such as Li Wenliang, and

the results are also different. Zhan Tao, a physician

of Department of Neurology in the First Hospital of

Changsha, after studying Traditional Chinese Medicine,

treated 100 patients in the first line. He relied on

TCM syndrome differentiation rather than a specific

prescription.

The successful experience of these two “Western

Medicine studying TCM” reveals the necessity and

importance of Sinicization of western medicine.

At present, COVID-19 has spread all over the

world. Through this epidemic situation, we can also see

the necessity of Traditional Chinese Medicine going to

the world, that is, not only TCM acupuncture needs to

go globe wide, but also TCM herbs and other treatment

methods, as well as the whole Traditional Chinese

Medicine system, should go to the world for the benefit of

human being. Therefore, after the Sinicization of western

medicine, a process of globalization of Rraditional

Chinese Medicine will also follow.

Traditional Chinese Medicine plays very important

role in COVID-19’S treatment. However, it is definitely

not a top show of the Traditional Chinese Medicine. As

Zhang Xiaotong and other Chinese medicine colleagues

have said, Traditional Chinese Medicine is in a hurry to

respond to the battlefield with shackles after decades of

transformation and is ordered to fight in distress. It is only

a little show of TCM.

There is no doubt that this time, TCM practitioners

who have the opportunity to display their talents on the

front line are basically the personnel within the system. A

large number of folk TCM personnel with unique skills do

not have the chance to play a role on the first line. Some

of them feel frustrated and almost find no way to serve the

country.

However, when the Traditional Chinese Medicine

faced the outbreak of the epidemic, there was indeed

a lot of chaos and there were different opinions at the

same time. As to the causes of chaos, there are historical

reasons, but more importantly, the unsuitable teaching

materials are the main cause.

Under the background of coexistence of Traditional

Chinese and western medicine, COVID-19 can be cold

damage or warm disease, the difference between them

is only the type of syndrome and the treatment choice

of Xin Wen ( pungent warm ) and Xin Liang (pungent

cold). Rather than the difference between three infectious

diseases in western medicine, not the difference between

pneumonia and meningitis, virus and bacteria. Despite of

52 Ⅰ2020/02

臨床名醫(yī)｜Clinic Specialist

various infectious diseases in western medicine, febrile

disease, cold damage, warm disease and plague in TCM

are all studied on the common pathogenesis, transmission

characteristics, diagnosis and treatment.

The purpose of releasing exterior with pungent warm

herbs is to remove heat, not to dissipate the coldness;

the cold damage is a febrile disease, not a deficiency

cold disease; Zhang Zhongjing only indicated applying

sweating method and relieving the exterior, he never said

that hot nature herbs must be used. In Zhang Zhongjing’s

time, there was no rule for pungent cold herbs to release

the exterior, rather than that he opposed and did not adopt

the pungent cold solution.

The name of disease in TCM is rooted in the

theory of Traditional Chinese Medicine itself. Oracle

bone inscriptions can name COVID-19 as plague, that

is to say, it is epidemic; Nei Jing can name it as febrile

disease, because this kind of disease is characterized by

fever; Nan Jing, Zhang Zhongjing said it is cold damage,

and Cao Zhi of the same era said that is plague; Nei Jing

indicates applying sweating method within three days and

purgation method three days later. Hua Tuo added one

method as vomiting for four days later. Zhang Zhongjing

recommended eight methods and 397 methods, which

shows the treatment methods are more and more abundant.

However, Zhang Zhongjing was called the medical

sage by later generations, and his prescription was

respected as the Jing Fang (classical formula), which

became a closed system. Since then, no matter how good

the prescription is, they still cannot be involved in the

six meridians syndrome differentiation system. As a last

resort, the specialists of febrile disease in order to pass on

their own experience, had to find another way to create

another system: warm disease system.

But the textbook compilers lack of the knowledge

of academic history research, and do not take into account

the background of the coexistence of Traditional Chinese

and western medicine. They only follow the wrong views

of the scholars of febrile disease in Qing Dynasty, always

go along with the old without keeping pace with the times,

and even further magnify the defects of warm disease

experts’ theory, insist that cold damage and warm

disease are completely different from all aspects such as

cause, pathogenesis, transmission, diagnosis and treatment.

They consider cold damage and warm disease belong to

two incompatible major disciplines, which separate the

historical ties, resulting in a variety of confusion.

Disease-syndrome combined with hierarchical

diagnosis and treatment is the prominent

characteristic of TCM

No matter the six meridians syndrome differentiation

of Shang Han Lun, or Wei Qi Ying blood and Sanjiao

syndrome differentiation of Wen Bing (warm disease)

theory, they all describe the process of development and

change of exogenous febrile disease from the exterior

to the interior, from mild to severe. Wu Jutong’s three

energizers syndrome differentiation also reflects the

change process of exogenous febrile disease from shallow

to deep, from light to heavy.

As diagnosis and treatment of plague (infectious

diseases) in TCM way, we cannot only name the disease

simply based on the primary level like cold damage, warm

disease and plague. It must be refined gradually to more

layers, at least three or four levels, in order to carry out

effective treatment.

That is to say, when a TCM practitioner faces

COVID-19’s patient, who is diagnosed with cold

damage, the practitioner cannot prescribe herbal formula

directly. Because there are still 6 types of syndrome

as “secondary level of disease name” belong to the

cold damage: Taiyang syndrome, Yangming syndrome,

Shaoyang syndrome, Taiyin syndrome, Shaoyin syndrome

2020/02Ⅰ 53

and Jueyin syndrome.

Still, Taiyang and other 5 syndrome also have

2 types: Jing ( meridian ) syndrome and Fu ( organ )

syndrome, as the third level of disease name .

Again, the Taiyang Jing ( meridian ) syndrome still

can be divided into “exterior excess without sweating”

and “exterior deficiency with sweating”, which is

deemed as the fourth level of disease name.

If COVID-19 patient is diagnosed as warm disease,

all the process of diagnosis and treatment is same as the

cold damage above. It means before prescribing herbal

soup medicine, the“disease name” must be gradually

layered down. After knowing the primary level of disease

name as warm disease, we need to refine it further to find

the “the secondary level of disease name”: Wei level,

Qi level, Ying level, or blood level;

Or refine it into upper jiao level, middle jiao level

or lower jiao level which are also the secondary level of

disease name.

And also like treating the cold damage patient above,

we need to “name” the disease layer by layer, untill the

syndrome and prescription corresponding to each other,

which is finally counted as “reach the bottom”. Only

then, the herbal soup formula can be prescribed.

No matter how many new infectious diseases there

are, traditional Chinese medicine is everlasting. Sitting in

the distant future of history, waiting for western medicine

to find all kinds of mutated or non-mutated viruses one by

one, there is no need to ask whether it is avian flu or swine

flu, Ebola, or AIDS, SARS, COVID-19, and so on, all of

which are simplified once and for all. The greatest truths

are simplest. Because in the absence of Western medicine,

the diagnosis and treatment path of TCM has begun to

take shape, the only thing we need to do is to integrate

them.

“ innovate while inherit ”is the instruction by

General Secretary Xi, it is also the call of the times.

To go to the world, traditional Chinese Medicine

must show its specific charactor and attach equal

importance to Tao ( rule ) and skills. We cannot settle

for less to use the laboratory indicators to limit the TCM

development, even try to westernize of Traditional

Chinese Medicine, which must end up losing ourselves.

April 24th 2020,Revised

（Hebei Academy of Chinese Medical Sciences）

（上接第55頁(yè)）

假如新冠肺炎患者被中醫(yī)診斷為溫病，其診治

過(guò)程也和被診斷為傷寒這樣，必須逐步向下分層，

才能開具湯藥。在知道是溫病這個(gè)“一級(jí)疾病”名

稱之后，無(wú)法憑此開具湯藥，還要進(jìn)一劃分是衛(wèi)分

病、氣分病、營(yíng)分病、血分病的“第二級(jí)疾病”名

稱。

或者，分上焦病、中焦病、下焦病的“第二級(jí)疾

病”名稱。并且還要進(jìn)一步像面對(duì)傷寒病患者那樣，

一層一層分下去，到了證候與方劑（方證）相對(duì)應(yīng)的

時(shí)候，才算“探底”了，這個(gè)時(shí)候才能開湯藥。

不管有多少新發(fā)的傳染病，中醫(yī)都是“萬(wàn)變不離

其宗”，來(lái)自遙遠(yuǎn)的古代，卻坐在未來(lái)深處，當(dāng)西醫(yī)

一個(gè)一個(gè)去發(fā)現(xiàn)各種變異的或者沒(méi)有變異的病毒，中

醫(yī)不用問(wèn)它是禽流感還是豬流感，是埃博拉，還是艾

滋病、非典、新冠肺炎等等，統(tǒng)統(tǒng)“大道化簡(jiǎn)”，一

勞永逸。因?yàn)樵跊](méi)有西醫(yī)的時(shí)候，中醫(yī)的診療路徑，

和理論已自成體系，可在關(guān)鍵時(shí)刻“厚積薄發(fā)”。

“守正創(chuàng)新”是習(xí)總書記給我們的指示，也是時(shí)

代的呼喚。

中醫(yī)藥走向世界，必須彰顯個(gè)性，道術(shù)并重，而

不能用實(shí)驗(yàn)室的指標(biāo)限制發(fā)展，不能舍本逐末，西化

中醫(yī)，丟了自己。

（作者單位：河北省中醫(yī)院科學(xué)院）

Experiences of clinical masters｜名家心得

54 Ⅰ2020/02

臨床名醫(yī)｜Clinic Specialist

曹東義：新冠瘟疫的反思

◎曹東義 譯者/張楓戎 陳思蓉

這一次新冠瘟疫爆發(fā)之后，習(xí)總書記親自部署、

親自指揮，在正月初一（1月25日）的政治局會(huì)議決

定采用“中西醫(yī)協(xié)作”的模式救治患者。中醫(yī)藥人員

很快進(jìn)入主戰(zhàn)場(chǎng)，克服了中醫(yī)藥儲(chǔ)備不足、不被醫(yī)患

人員理解等重重困難，中醫(yī)藥迅速發(fā)揮了巨大作用，

取得了有目共睹的成果。方艙醫(yī)院，這個(gè)本應(yīng)該“風(fēng)

聲鶴唳”“哀聲一片”的地方，空氣中卻飄著中藥

香，不斷上演著醫(yī)患共做八段錦的動(dòng)人畫面，連過(guò)去

的“中醫(yī)黑”也獲得中醫(yī)藥的救助，戰(zhàn)勝新冠肺炎重

獲健康。

中國(guó)的“中西醫(yī)協(xié)作”救助模式，令世衛(wèi)專家

感慨不已，他由衷地說(shuō)假如自己不幸感染了，也希望

來(lái)中國(guó)治療。我想，他絕對(duì)不是羨慕中國(guó)ICU的呼吸

機(jī)，而是喜歡方艙醫(yī)院的氛圍與效果。

中醫(yī)藥“首選必治”，成為前所未有的事實(shí)

在過(guò)去各種疾病的醫(yī)學(xué)救治方案里，中醫(yī)藥的

治療方法都是列在最后，作為“備選的治療措施之

一”，是“補(bǔ)充”和“替補(bǔ)”的角色，從來(lái)沒(méi)有《診

療指南》把中醫(yī)藥的作用提高到“首選、必治”的突

出地位。然而，這一次新冠肺炎的治療不一樣了，中

醫(yī)藥的“參與率”“使用率”，中成藥與湯夜使用比

例，直接成為考察指標(biāo)，甚至有“一票否決”的價(jià)

值，哪里的中醫(yī)藥救治率低，哪里的工作就被動(dòng)，成

為眾矢之的、萬(wàn)夫所指。2020年2月12日湖北省衛(wèi)健

委公布的數(shù)據(jù)，中醫(yī)藥參與治療只有30%，這樣的結(jié)

果立即引發(fā)一片嘩然，盡管那里云集了全國(guó)最精英的

西醫(yī)專家。對(duì)于中醫(yī)藥熱切期盼的形勢(shì)，過(guò)去從未出

現(xiàn)，現(xiàn)在一下子成為救命的時(shí)尚和網(wǎng)絡(luò)流行的顯學(xué)。

而且，有些希望“科學(xué)實(shí)驗(yàn)”西藥、進(jìn)口藥的專家，

在幾萬(wàn)例患者集中出現(xiàn)的時(shí)候，竟然湊不齊“入組觀

察的人數(shù)”，這是他們始料未及的事情，可以說(shuō)顛覆

了他們的預(yù)想，換了一個(gè)時(shí)空。

“西醫(yī)中國(guó)化與中醫(yī)世界化”即將到來(lái)

新冠肺炎過(guò)程之中，中醫(yī)藥比非典時(shí)期發(fā)揮了更

大的作用，感動(dòng)了或教育了很多西醫(yī)，也讓有些“中

醫(yī)黑”改變對(duì)于中醫(yī)的認(rèn)識(shí)。

武漢市第一醫(yī)院的婦產(chǎn)科副主任師曹麗蓉，經(jīng)常

做手術(shù)，并且在救治患者的時(shí)候被感染，她身患新冠

肺炎之后，用中醫(yī)藥的方法很快治好了。這與李文亮

等西醫(yī)專家所采取的方式方法不同，結(jié)果也不一樣。

長(zhǎng)沙市第一院神經(jīng)內(nèi)科的湛濤主治醫(yī)師，他學(xué)習(xí)了中

醫(yī)之后，在一線治療一百例患者，依靠中醫(yī)辨證論治

而不是某個(gè)具體方藥。

這兩位“西學(xué)中”的成功經(jīng)驗(yàn)，揭示了“西醫(yī)中

國(guó)化”的必要性，及其重要性。

目前，新冠肺炎在世界范圍內(nèi)傳播，經(jīng)歷這次

疫情，也可以看出中醫(yī)藥走向世界的必要性，也就是

不僅中醫(yī)針灸需要走向世界，中醫(yī)的藥物和其他治療

方法，以及整個(gè)中醫(yī)體系都應(yīng)該走向世界，造福于人

類。因此，在“西醫(yī)中國(guó)化”之后，一個(gè)“中醫(yī)世界

化”的過(guò)程，也將隨之而來(lái)。

中醫(yī)藥在這次新冠肺炎救治之中的作用，是非

常重要的，但是，這絕對(duì)不是中醫(yī)藥作用的“頂級(jí)展

示”，而是如張曉彤等中醫(yī)藥同道所說(shuō)，中醫(yī)是在被

改造幾十年之后帶著枷鎖上戰(zhàn)場(chǎng)，受命于危難之際，

倉(cāng)促應(yīng)戰(zhàn)，略顯身手而已。

2020/02Ⅰ 55

毫無(wú)疑問(wèn)，這一次有機(jī)會(huì)在一線展示才能的中

醫(yī)，基本上都屬于體制內(nèi)的中醫(yī)，大量身懷絕技的民

間中醫(yī)藥人員，沒(méi)有機(jī)會(huì)到前線去發(fā)揮作用，他們有

些人覺得“馮唐易老，李廣難封”，幾乎是“報(bào)國(guó)無(wú)

門”。

但是，中醫(yī)界面對(duì)疫情爆發(fā)的時(shí)候，的確有很多

混亂，亂說(shuō)紛紜，莫衷一是。這些混亂形成的原因，

有歷史的因素，更重要的是學(xué)校教材“上梁不正”造

成的。

在中西醫(yī)并存的背景下，新冠肺炎既可以是傷

寒，也可以是溫病，它們的區(qū)別只有發(fā)病類型不一

樣，治療選擇上的辛溫與辛涼的主要區(qū)別，而不是西

醫(yī)三類不同傳染病病種之間的區(qū)別，不是肺炎與腦

炎、病毒與細(xì)菌的不同。熱病、傷寒、溫病、瘟疫，

研究的都是各種傳染病的共同發(fā)病規(guī)律、傳變特征與

診治方法。

辛溫解表的目的，是為了除熱，而不是散寒；傷

寒是熱病，而不是虛寒??；張仲景只說(shuō)當(dāng)發(fā)汗、當(dāng)解

表，從來(lái)沒(méi)有說(shuō)必須用熱藥。張仲景的時(shí)代，沒(méi)有辛

涼解表的法則，而不是他反對(duì)辛涼解表、不采用辛涼

解表。

中醫(yī)的疾病名稱，都根源于中醫(yī)自身的理論來(lái)

命名?！凹坠俏摹笨梢哉f(shuō)新冠肺炎是瘟疫，就是說(shuō)它

具有流行性；《內(nèi)經(jīng)》能說(shuō)它是熱病，是因?yàn)檫@類疾

病都以發(fā)熱為主要特征；《傷寒論》張仲景說(shuō)它是傷

寒，同時(shí)代的曹植就說(shuō)它是瘟疫；《內(nèi)經(jīng)》治療，三

日之前用汗法，三日之后用泄法；華佗增加一法，四

日用吐法；張仲景八法、三百九十七法，治療的方法

越來(lái)越豐富。

但是，張仲景被后人稱為醫(yī)圣，他的方子被尊為

“經(jīng)方”，成了封閉的體系。此后，再有多少好的方

子，也進(jìn)不了“六經(jīng)辨證”的體系。不得已，溫病學(xué)

家為了把自己的經(jīng)驗(yàn)傳承下去，就另辟蹊徑，開創(chuàng)了

另個(gè)一個(gè)溫病學(xué)體系。

但是，編教材的人，缺乏學(xué)術(shù)史研究知識(shí)，也

沒(méi)有把中西醫(yī)共存的時(shí)代背景考慮進(jìn)去，只是順著清

代溫病學(xué)者的錯(cuò)誤觀點(diǎn)，“始終順舊”，不能與時(shí)俱

進(jìn)，并且“變本加厲”，進(jìn)一步放大了溫病學(xué)家的不

足，硬說(shuō)傷寒與溫病在病因、病機(jī)、傳變、診治方面

“完全不同”，屬于寒溫、水火不容的兩大學(xué)科，人

為割裂了歷史的聯(lián)系，造成了各種混亂。

病證結(jié)合分級(jí)診療，是中醫(yī)突出的特色優(yōu)勢(shì)

傷寒的六經(jīng)辨證，溫病學(xué)說(shuō)的衛(wèi)氣營(yíng)血、三焦辨

證，都描述了外感熱病由表入里，由輕而重的發(fā)展、

變化過(guò)程。吳鞠通所說(shuō)的“三焦辨證”，也反應(yīng)了外

感熱病由淺入深，從輕到重的變化過(guò)程。

中醫(yī)診療瘟疫（傳染病）的疾病名稱，不能簡(jiǎn)單

停留在傷寒、溫病、瘟疫的“初級(jí)階段”，必須逐漸

分層，到三四級(jí)之下，才能開展有效治療。

也就是說(shuō)，當(dāng)一個(gè)中醫(yī)面對(duì)新冠肺炎患者，他

（她）被診斷為“傷寒病”的時(shí)候，不能憑此診斷開

具湯藥。因?yàn)椋瑐∠逻?，還有太陽(yáng)病、陽(yáng)明病、

少陽(yáng)病、太陰病、少陰病、厥陰病的“第二級(jí)疾病名

稱”。

太陽(yáng)病等“病名”下邊，還有“經(jīng)?。ㄗC）”和

“腑病（證）”的“第三級(jí)疾病名稱”。

太陽(yáng)經(jīng)病（證）下邊，還有“表實(shí)無(wú)汗”病

（證）與“表虛有汗”病（證）的第四級(jí)疾病名稱。

（下轉(zhuǎn)第53頁(yè)）

Experiences of clinical masters｜名家心得

56 Ⅰ2020/02

臨床名醫(yī)｜Clinic Specialist

與腫瘤博弈的策略與智慧

◎王振華

在科學(xué)高度發(fā)達(dá)的今天，腫瘤依然是高懸在人

們頭上的一把利劍，一個(gè)人無(wú)論平時(shí)多么冷靜自信，

多么勇敢堅(jiān)強(qiáng)，一旦患了腫瘤，同樣會(huì)驚慌失措，方

寸大亂。腫瘤不但考驗(yàn)醫(yī)生，更考驗(yàn)患者及其家屬，

因?yàn)橄鄬?duì)其他疾病而言，腫瘤治療方法的選擇、決策

需要患者及其家屬更多地參與其中。然而腫瘤治療是

一個(gè)非常復(fù)雜的問(wèn)題，既有西醫(yī)的手術(shù)、放療、化療

等，又有中醫(yī)中藥，面對(duì)紛亂復(fù)雜的治療方法，如何

選擇和取舍對(duì)預(yù)后和轉(zhuǎn)歸至關(guān)重要，這不僅需要一定

的知識(shí)儲(chǔ)備，更需要超越具體知識(shí)之上的綜合能力、

思辨能力、決策能力，只有這樣，才能在與腫瘤的博

弈中處變不驚，游刃有余，策略而又智慧地選擇最佳

的治療方法、方案，避免陷入誤區(qū)，取得最后的勝

利。

1 什么是腫瘤？

西醫(yī)認(rèn)為，腫瘤是人體自身細(xì)胞的異常增生。所

謂異常增生，一方面是指增生得太快，超出了正常的

生長(zhǎng)節(jié)奏，另一方面則是指腫瘤細(xì)胞與正常細(xì)胞的結(jié)

構(gòu)不同。癌細(xì)胞的無(wú)限制增生足以摧殘機(jī)體，置人于

死地，而這正是癌癥的可怕之處。

從分子生物學(xué)層面看，腫瘤是機(jī)體在各種致瘤因

素作用下，細(xì)胞在基因水平失去了對(duì)其生長(zhǎng)的正常調(diào)

控，導(dǎo)致異常增生而形成的新生物。也就是說(shuō)，腫瘤

的本質(zhì)是基因突變。

腫瘤有良性與惡性之分，良性腫瘤對(duì)機(jī)體的影響

不大，而惡性腫瘤則會(huì)導(dǎo)致嚴(yán)重后果。通常人們習(xí)慣

將惡性腫瘤稱之為“癌癥”，但嚴(yán)格地講，癌癥是指

起源于上皮組織的一類惡性腫瘤，如肝癌、乳腺癌、

皮膚癌等，占惡性腫瘤的80%～90%，而另外約10%

起源于間葉組織（包括纖維結(jié)締組織、脂肪、肌肉、

脈管、骨和軟骨組織等）的惡性腫瘤則稱為肉瘤。

既然腫瘤是基因突變的結(jié)果，那么腫瘤與機(jī)體之

間的關(guān)系就是敵我矛盾，治療目標(biāo)就是殺滅癌細(xì)胞。

以殺滅癌細(xì)胞為目標(biāo)是西醫(yī)治療腫瘤的主要方法，手

術(shù)、放療、化療是其經(jīng)典方法，而新近發(fā)明的靶向治

療、免疫治療、基因治療等，從根本上說(shuō)，依然是殺

滅癌細(xì)胞，只是更為精巧、精準(zhǔn)而已。以殺滅癌細(xì)胞

為目標(biāo)是一種對(duì)抗性治療模式，作為一種系統(tǒng)的治療

腫瘤的方法和模式經(jīng)歷了漫長(zhǎng)的歷程，取得了偉大成

就，在腫瘤治療中的地位和價(jià)值是毋庸置疑的，然而

對(duì)抗性治療是一把雙刃劍，效果雖然很明顯，缺陷和

局限性也很明顯。

2 對(duì)抗性治療模式的缺陷和局限性

西醫(yī)對(duì)抗性治療模式的缺陷和局限性主要表現(xiàn)為

以下幾個(gè)方面：

（1）治療作用有限

以手術(shù)為例，腫瘤早期，由于病灶比較局限，手

術(shù)切除效果較好。然而臨床上多數(shù)患者一經(jīng)發(fā)現(xiàn)往往

已經(jīng)是中晚期了，無(wú)法徹底手術(shù)切除，只能做姑息性

手術(shù)（部分切除腫瘤），此時(shí)，手術(shù)的作用是非常有

限的。其他局部治療方法如介入治療、放射治療、射

頻消融、激光、氬氦刀等也存在類似問(wèn)題。

（2）促進(jìn)腫瘤轉(zhuǎn)移

據(jù)報(bào)道，所有以消滅腫瘤細(xì)胞為目標(biāo)的治療方

法，包括姑息性手術(shù)、介入治療、放療、射頻消融、

化療，甚至靶向治療等，均可導(dǎo)致未被殺滅的殘存癌

2020/02Ⅰ 57

細(xì)胞轉(zhuǎn)移潛能增強(qiáng)，而且發(fā)現(xiàn)，這些腫瘤轉(zhuǎn)移潛能的

提高還伴有不同的基因改變。這就提示，對(duì)抗性治療

模式激發(fā)了腫瘤細(xì)胞的耐受、進(jìn)化和逃逸機(jī)制，而這

已經(jīng)成為腫瘤治療失敗的主要原因。

（3）毒副作用比較嚴(yán)重

以化療為例，首先化療藥物往往敵我不分，在

殺滅腫瘤細(xì)胞的同時(shí)，也會(huì)殺滅正常的組織細(xì)胞，所

謂“殺敵一千，自損八百”，其對(duì)機(jī)體的摧殘是巨大

的；其次，化療藥物通常具有明顯的胃腸道反應(yīng)，骨

髓抑制以及肝腎功能損害等。很多患者往往因無(wú)法耐

受化療藥物的毒副作用而被迫終止治療，甚至有些患

者因化療藥物的毒副作用而加速死亡。

（4）對(duì)腫瘤的復(fù)發(fā)與轉(zhuǎn)移乏術(shù)

以直接殺死腫瘤細(xì)胞為目的的對(duì)抗性治療方法，

并沒(méi)有從根本上觸及腫瘤得以產(chǎn)生的原因和土壤，治

標(biāo)不治本，因此，對(duì)于腫瘤的復(fù)發(fā)與轉(zhuǎn)移基本上束手

無(wú)策，而復(fù)發(fā)與轉(zhuǎn)移恰恰是決定腫瘤預(yù)后的關(guān)鍵。

3 中醫(yī)對(duì)腫瘤的認(rèn)識(shí)

中醫(yī)對(duì)腫瘤的命名包括“瘤”“積聚”“癌”

等?！傲觥闭?，留也，有停留、阻塞、聚集之意，故

中醫(yī)又稱腫瘤為“積聚”。大家熟悉的“癌癥”之

“癌”字其實(shí)就來(lái)自中醫(yī)，宋代醫(yī)家楊士瀛在《仁齋

直指附遺方論》中記載：“癌者上高下深，巖穴之

狀……毒根深藏，穿孔透里”?？梢?，“癌”是古人

對(duì)腫瘤形狀的描述。

在中醫(yī)看來(lái)，腫瘤的發(fā)生是由于氣滯、血瘀、

痰阻等導(dǎo)致經(jīng)絡(luò)不通，氣血運(yùn)行不暢而形成的一類疾

病。具體內(nèi)容包括：（1）氣滯、血瘀、痰阻等導(dǎo)致

經(jīng)絡(luò)不通。（2）經(jīng)絡(luò)不通，則局部組織得不到正常

氣血陰陽(yáng)的溫潤(rùn)和滋養(yǎng)而發(fā)生變異，形成對(duì)機(jī)體有害

的惡肉、毒瘤，其狀峻險(xiǎn)，如癌如巖。（3）從經(jīng)絡(luò)

阻滯不通到形成腫瘤經(jīng)歷了漫長(zhǎng)的過(guò)程，腫瘤相對(duì)

獨(dú)立，在機(jī)體局部“安營(yíng)扎寨”，形成“巢穴”。

（4）腫瘤對(duì)機(jī)體的危害性在于對(duì)機(jī)體組織結(jié)構(gòu)的浸

潤(rùn)破壞，并以其特有的方式盜取機(jī)體的營(yíng)養(yǎng)，最終導(dǎo)

致機(jī)體衰竭而死亡。（5）腫瘤并非外來(lái)物，并不完

全是異己分子（比如細(xì)菌、寄生蟲、膿腫等），雖然

不完全受機(jī)體節(jié)制，但畢竟與正常組織同源、相似，

與機(jī)體共生共存，息息相關(guān)。

不難發(fā)現(xiàn)，腫瘤與機(jī)體的關(guān)系非常像匪寇與政

府的關(guān)系。由良民落草為寇的原因無(wú)非有二，一是物

質(zhì)匱乏，二是精神扭曲，兩者都可以理解為個(gè)體因得

不到政府的陽(yáng)光雨露，誤入歧途，落草為寇，危害一

方，成為社會(huì)的毒瘤。對(duì)于匪寇該如何處置呢？方法

無(wú)非有兩種，一是剿滅，二是招安。也就是說(shuō)，除了

剿滅，如果曉之以理，動(dòng)之以情，并給其以出路，匪

寇是可以棄惡從善，改邪歸正的。腫瘤也是如此，除

了剿滅，也可以安撫，即讓癌細(xì)胞改邪歸正。

明代醫(yī)家李中梓在《醫(yī)宗必讀·積聚》中指出：

“初者，病邪初起，正氣尚強(qiáng)，邪氣尚淺，則任受

攻；中者，受病漸久，邪氣較深，正氣較弱，任受且

攻且補(bǔ)；末者，病魔經(jīng)久，邪氣侵凌，正氣消殘，則

任受補(bǔ)。”這里的“攻”就相當(dāng)于剿滅，而“補(bǔ)”則

相當(dāng)于安撫。

扶正祛邪是中醫(yī)治療腫瘤的基本方針，具體地

說(shuō)，祛邪的方法有：以毒攻毒法，軟堅(jiān)散結(jié)法，行氣

解郁法，活血化瘀法，化痰散結(jié)法，清熱解毒法等；

而扶正的方法有：補(bǔ)氣養(yǎng)血法，滋補(bǔ)肝腎法，健脾益

腎法等。

可見，在中醫(yī)眼里，腫瘤與機(jī)體之間并非簡(jiǎn)單的

敵我矛盾，而是息息相通，休戚與共，是一個(gè)無(wú)法截

然分割的有機(jī)整體。在治療上并非簡(jiǎn)單地剿滅，而是

立足整體，審時(shí)度勢(shì)，攻補(bǔ)結(jié)合，恩威并施，與冷冰

冰的手術(shù)、放療、化療等相比，多了一些溫度、多了

一些智慧，也多了一些希望和出路。

古人云：“善弈者謀勢(shì)，不善弈者謀子，善謀

勢(shì)者必成大事?！蔽麽t(yī)擅長(zhǎng)“謀子”，而中醫(yī)則擅長(zhǎng)

“謀勢(shì)”，雖然從殺滅癌細(xì)胞的角度看，西醫(yī)的優(yōu)勢(shì)

非常明顯，但從長(zhǎng)遠(yuǎn)看，中醫(yī)審時(shí)度勢(shì)，攻補(bǔ)結(jié)合，

進(jìn)退有方的治療模式更為深邃、睿智。中藥取之于自

然，沒(méi)有明顯的毒副作用，只要假以時(shí)日，便可水滴

石穿，峰回路轉(zhuǎn)，收到意想不到的神奇效果。

Experiences of clinical masters｜名家心得

58 Ⅰ2020/02

臨床名醫(yī)｜Clinic Specialist

基于對(duì)剿滅模式缺陷和局限性的反思，西醫(yī)對(duì)腫

瘤的認(rèn)識(shí)也在改變。動(dòng)物實(shí)驗(yàn)證明，將腫瘤細(xì)胞移植

到正常成年動(dòng)物體內(nèi)并不產(chǎn)生腫瘤，而且還參與正常

器官的構(gòu)成；對(duì)腫瘤細(xì)胞的細(xì)胞外基質(zhì)加以干預(yù)，可

誘導(dǎo)癌細(xì)胞轉(zhuǎn)化為正常細(xì)胞。臨床報(bào)道，三氧化二砷

對(duì)某一類型的白血病有效，而其作用并非直接殺死白

血病細(xì)胞，而是使其“改邪歸正”。反式維A酸也有

類似作用，這種治療叫作“分化誘導(dǎo)治療”。

西醫(yī)這一新的發(fā)現(xiàn)與中醫(yī)對(duì)腫瘤的認(rèn)識(shí)不謀而

合。也就是說(shuō)，西醫(yī)也逐漸認(rèn)識(shí)到腫瘤是一種全身性

疾病，同時(shí)也是一種慢性病，無(wú)法速戰(zhàn)速?zèng)Q，必須

打持久戰(zhàn)，否則欲速則不達(dá)，反而加速患者的死亡。

“帶瘤生存”“打持久戰(zhàn)”等策略的提出，目的就在

于為剿滅模式降溫，防止過(guò)度治療帶來(lái)的危害，強(qiáng)調(diào)

綜合效果，強(qiáng)調(diào)患者的生存時(shí)間和生活質(zhì)量。西醫(yī)中

有遠(yuǎn)見卓識(shí)者再次將目光投向中醫(yī)中藥。

4 中西醫(yī)結(jié)合治療腫瘤的策略

對(duì)于腫瘤，西醫(yī)長(zhǎng)于剿滅，速戰(zhàn)速?zèng)Q；中醫(yī)長(zhǎng)于

調(diào)理，打持久戰(zhàn)。因此，臨床上一般西醫(yī)打頭陣，先

有效地清除、剿滅腫瘤，然后由中醫(yī)來(lái)收拾殘局。中

醫(yī)與西醫(yī)相互結(jié)合，取長(zhǎng)補(bǔ)短，可以收到更為理想的

效果。

（1）中醫(yī)中藥配合手術(shù)

手術(shù)切除是治療大多數(shù)實(shí)體惡性腫瘤行之的有效

方法，尤其是對(duì)于早期腫瘤，手術(shù)切除可以獲得較好

的效果，部分患者可長(zhǎng)期緩解甚至治愈，故又稱“根

治性手術(shù)”。為了防止復(fù)發(fā)，追求“根治”效果，曾

經(jīng)有片面擴(kuò)大手術(shù)范圍的傾向，然而真正達(dá)到“根

治”效果的畢竟是少數(shù)，多數(shù)患者會(huì)復(fù)發(fā)，過(guò)度的手

術(shù)創(chuàng)傷反而加速患者的死亡。相反，適當(dāng)縮小手術(shù)范

圍，患者的生存時(shí)間反而更長(zhǎng)。惡性腫瘤的手術(shù)治療

經(jīng)歷了“由小到大、由大到小、保全功能”的再認(rèn)識(shí)

過(guò)程。對(duì)于中晚期腫瘤，手術(shù)的意義只是減輕腫瘤負(fù)

荷，稱之為姑息性手術(shù)。因此，無(wú)論是早期、中期還

是晚期，手術(shù)之后并非萬(wàn)事大吉，而是要治病求本，

防止腫瘤的復(fù)發(fā)與轉(zhuǎn)移。

手術(shù)具有明顯的創(chuàng)傷性，術(shù)后患者往往身體虛

弱，體質(zhì)下降，對(duì)此，中醫(yī)的調(diào)理脾胃，補(bǔ)氣養(yǎng)血等

治療方法，可以改善體質(zhì)，促進(jìn)術(shù)后康復(fù)。手術(shù)康復(fù)

之后，采取中醫(yī)辨證施治，可以從根本上糾正腫瘤得

以產(chǎn)生的土壤，防止腫瘤的復(fù)發(fā)和轉(zhuǎn)移。

（2）中醫(yī)中藥配合化療

與手術(shù)類似，也有“根治性化療”之說(shuō)，所謂根

治性化療，是指某些腫瘤對(duì)于化療藥物敏感，通過(guò)系

統(tǒng)、充分的化療可以收到長(zhǎng)期緩解甚至治愈的效果。

這些腫瘤細(xì)胞增殖快，與正常細(xì)胞的分裂周期有一個(gè)

明顯的時(shí)間差，因而對(duì)化療藥物比較敏感，容易被化

療徹底摧毀。主要包括：惡性淋巴瘤、急性白血病、

睪丸精原細(xì)胞瘤、絨癌等。

除了根治性化療，尚有輔助化療和姑息性化療。

所謂輔助化療是指配合手術(shù)、放療而進(jìn)行的化療，旨

在提高手術(shù)、放療的治愈率。對(duì)于手術(shù)后復(fù)發(fā)、轉(zhuǎn)移

或無(wú)法手術(shù)切除者，化療的目的在于使腫瘤縮小，減

輕癥狀，延長(zhǎng)生存時(shí)間，稱之為“姑息性化療”。

無(wú)論是根治性化療、輔助化療，還是姑息性化

療，共同的問(wèn)題是毒副反應(yīng)比較嚴(yán)重，因此，化療必

須審慎、適度，過(guò)度化療會(huì)適得其反，加速患者的

死亡。尤其是對(duì)于姑息性化療，治療作用有限，卻要

承受化療藥物嚴(yán)重的毒副作用，如果患者體質(zhì)可以耐

2020/02Ⅰ 59

受，則給予適度化療，否則，應(yīng)選擇中醫(yī)中藥治療。

化療藥物常見的毒副作用包括胃腸道反應(yīng)、骨髓

抑制、肝毒性、腎毒性、心臟毒性等，在化療期間配

合中藥，可以明顯減輕化療藥物的毒副反應(yīng)，增強(qiáng)人

體對(duì)化療藥物的耐受性以及敏感性（減毒增敏），順

利地渡過(guò)化療難關(guān)。

（3）中醫(yī)中藥配合靶向治療

所謂靶向治療是指在方子水平找出精確的致癌

靶點(diǎn)（該靶點(diǎn)可以是腫瘤細(xì)胞內(nèi)部的一個(gè)蛋白分子或

者基因片段），進(jìn)而設(shè)計(jì)相應(yīng)的藥物阻斷這些靶點(diǎn)，

達(dá)到殺死腫瘤細(xì)胞的目的。由于這些致癌的靶點(diǎn)往往

為腫瘤細(xì)胞特有或者在腫瘤細(xì)胞中含量更為豐富，因

此，靶向治療對(duì)腫瘤細(xì)胞的特異性較傳統(tǒng)化療更強(qiáng)，

而副作用相對(duì)較小。目前，靶向治療較為成功的腫瘤

主要有乳腺癌、胃癌、小細(xì)胞肺癌、B細(xì)胞淋巴瘤、

胃腸道間質(zhì)瘤、黑色素瘤、結(jié)直腸癌、卵巢癌等。

靶向治療將西醫(yī)對(duì)腫瘤的治療推向了一個(gè)新的高

度，為腫瘤患者帶來(lái)了更多希望。然而，依然有其局

限性，表現(xiàn)為：其一，靶點(diǎn)尋找困難，目前只有為數(shù)

不多的腫瘤找到了靶點(diǎn)；其二，找到了靶點(diǎn)，未必找

到了藥物；其三，即使找到了藥物，也不是所有人都

有效，對(duì)于同一種腫瘤，有的人有靶點(diǎn)的表達(dá)，有的

人沒(méi)有表達(dá)。例如，曲妥珠單抗只對(duì)約25%～30%的

乳腺癌患者有效。其四，靶向治療也有副作用，有的

靶點(diǎn)并非完全為腫瘤細(xì)胞所特有，正常細(xì)胞也有不同

程度的表達(dá)，從而引起各種各樣的不良反應(yīng)。多靶點(diǎn)

藥物則可引起廣泛而嚴(yán)重的副作用。另外靶向藥物也

具有通常意義上的胃腸道反應(yīng)、骨髓抑制以及肝腎功

能損害等不良反應(yīng)。更為重要的是，從根本上說(shuō)，靶

向治療的性質(zhì)依然屬于剿滅模式，只是更為精巧、精

準(zhǔn)而已，所以靶向治療也需要與中醫(yī)中藥相結(jié)合，方

可收到更為理想的效果。

（4）中醫(yī)中藥配合放射治療

放射治療對(duì)早期霍奇金淋巴瘤、睪丸精原細(xì)胞

瘤、腎母細(xì)胞瘤、神經(jīng)母細(xì)胞瘤、視網(wǎng)膜母細(xì)胞瘤等

比較敏感，其次對(duì)鼻咽癌、口腔癌、皮膚癌、宮頸

癌、食管癌等效果也可以。放射治療的副作用有皮膚

黏膜損傷、厭食、惡心、嘔吐、發(fā)熱、血細(xì)胞降低

等，配合中藥常常可以使其減輕。

此外，西醫(yī)尚有介入治療、免疫治療、內(nèi)分泌治

療等，均有其相應(yīng)的適應(yīng)證，在臨床上常常與手術(shù)、

放療、化療等相結(jié)合，在此不再一一贅述。

臨床上經(jīng)常遇到一些腫瘤晚期的患者，腫瘤已

經(jīng)擴(kuò)散轉(zhuǎn)移，既失去了手術(shù)機(jī)會(huì)，又對(duì)放、化療不敏

感，或者因年高體弱無(wú)法耐受放療、化療，此時(shí)，中

醫(yī)中藥成了他們唯一的救命稻草。通過(guò)服用中藥，大

部分患者癥狀減輕，生活質(zhì)量改善，生存時(shí)間延長(zhǎng)，

腫瘤生長(zhǎng)減緩、縮小甚至消失。

5 結(jié)語(yǔ)

如果問(wèn)，什么疾病最可怕？腫瘤一定排會(huì)在第

一?？梢哉f(shuō)，沒(méi)有哪一種疾病像腫瘤一樣讓人突然變

得惶恐和脆弱；也沒(méi)有哪一種疾病像腫瘤一樣能夠

讓人放下一切，像投入戰(zhàn)斗一樣嚴(yán)陣以待；更沒(méi)有哪

一種疾病像腫瘤一樣讓人重新審視自我，重新規(guī)劃人

生。與腫瘤博弈不僅僅需要知識(shí)，更需要策略與智

慧，這種策略和智慧不僅可以幫助人們走出腫瘤的陰

影，同時(shí)也會(huì)讓人們重拾自信，以全新的姿態(tài)面對(duì)人

生。

（作者單位：中國(guó)人民解放軍總醫(yī)院第八醫(yī)學(xué)

中心）

作者簡(jiǎn)介：王振華，醫(yī)學(xué)博士、博士后，畢業(yè)

于中國(guó)中醫(yī)科學(xué)院研究生院，先后在西苑醫(yī)院攻讀

心血管專業(yè)博士學(xué)位，在廣安門醫(yī)院作腫瘤專業(yè)博

士后研究。原就職于解放軍總醫(yī)院第八醫(yī)學(xué)中心。

從事中醫(yī)臨床30余年，以“弘揚(yáng)中醫(yī)，濟(jì)世惠民”

為己任，勤求古訓(xùn)，融匯新知，躬身實(shí)踐，勇于創(chuàng)

新，對(duì)多種慢性疑難病癥的診治得心應(yīng)手，療效顯

著。行醫(yī)感言：心系蒼生方開慧，藝經(jīng)百煉可通

神。

Experiences of clinical masters｜名家心得

60 Ⅰ2020/02

臨床名醫(yī)｜Clinic Specialist

Unknown cause treatment equals neither

prevent nor reduce the deterioration of the

health of an individual

◎Li Shan Ju

1.Teacher You Xiyin is one of a few pure Chinese

medicine doctors in this era. He pays no attention to

fame and fortune. He has a noble medical ethics, superb

medical skills, and is humble in the public.He is a

traditional Chinese medicine doctor, but he doesn't stick to

stereotypes.He integrates the benevolence of doctors into

clinical practice, and he combines modern technology with

traditional Chinese medicine.Without the support of any

capital, he clinically overcome the difficulties of leukemia

treatment and obtained the corresponding national patent.

But teacher You XiYin is little known.The reason why our

cover character introduced him is because he is a powerful

faction who speaks with "efficacy", and he is also an

advocate and practitioner of clinical symptoms and cause

treatment.

2.Leukemia is commonly known as blood cancer,

especially in children and adolescents with a high mortality

rate.Traditional Chinese medicine, as a traditional treasure

of China, has a long history and profound knowledge. It

has good effect, fast recovery, low cost, and low toxicity

and side effects in the treatment of blood diseases. It

has been widely concerned by scholars at home and

abroad. On the patent website of the State Intellectual

Property Office of the People's Republic of China, the

patent number ZL2007101193834 "A traditional Chinese

medicine composition for the treatment of leukemia and

its preparation method" is impressive, the patent inventor

is You XiYin.Who is You Xiyin? What kind of academic

attainments made his research achievements in the

treatment of hematological diseases of Chinese medicines

win national patents?

3.You Xiyin was born in 1951 in a village in the

hometown of Qihuang in Qingyang, Gansu Province.

Qingyang is the beginning of the "QihuangzhiShu” of

the Chinese people and the source of the Chinese farming

culture.Traditional Chinese medicine has always occupied

a dominant position in the field of this area, and it is very

popular among local people. Famous Chinese medicine

doctors were from various local families.You Xiyin is

the third generation of TCM descendants of the You

family in Changle Prefecture, Longyuan, Gansu Province.

Since his childhood, XiYin has been reading classics of

traditional Chinese medicine under the guidance of his

grandfather, and has learned to recognize herb medicine,

process the herb medicine and use the herb medicine.

The You family has a high reputation and prestige in

Qingyang, and it is deeply supported and respected by

the local villagers.You Xiyin, who has been in the past

few years, can still remember the classics of traditional

Chinese medicine when he was young. We often hear

people say that someone has TCM merit, which refers to

people like XiYin.In his youth, You Xiyin worked as a

barefoot doctor for a few years, but after the outbreak of

the Cultural Revolution, he stopped practicing medicine

and decided to go to an engineering design school and

become an engineering designer.During the Cultural

2020/02Ⅰ 61

Revolution, Chinese medicine was considered to be one

of the four legacy left by feudal society. A large family

of Chinese medicine such as You Xi Yin has suffered a

violent impact. All the medical books in his family were

piled up in the yard for incineration. Due to the large

number of ancient medical books, the smoke from the

burning books did not disappear for days and nights.His

father was also taken away to fight in the street wearing

a sign. During the parade, a villager secretly replaced

the brand worn by his father with a fake paper sticker,

which looked large but light in weight. The simple folks,

in this way, return this folk good doctor. Shortly after Xi

Yin’s father was forced to list and travel the street, the

red guards demolished the door of his home as a feudal

superstition, and the family cultural heritage of several

generations was immediately destroyed, and his father

was lying in chaos. Throwing on the ground at the gate

beam of the gate, weeping helplessly like a child. Due to

excessive sadness, he died of anger in a few days. The

death of his father was greatly affected by Xi Yin, and

he decided not to practice medicine. Go far away and

study engineering design. In the field of engineering

design, Xi Yin quickly grew into a senior engineer with a

good income and a very comfortable life. But he always

felt that his life was missing something. After the end

of the Cultural Revolution, all people in the society are

getting better every day, and new social diseases are also

getting more and more every day. Depression has become

a new stubborn disease that destroys healthy lives. A

prestigious distant relative of the You family, best at doing

communication work for others, for some reason, suffering

from severe depression, after a period of self-torture,

he eventually ended his life by suicide.When the news

reached Yu Yin's ears, he was shocked. The laughter of

the distant relatives in the past and the scene of solving the

problems for the folks are still vivid.Moreover, depression

is not a terminal illness! The death of this relative is like

Cover clinical specialists｜ 封面名醫(yī)

opening the door to bad news, one after another, and some

news of serious illness or death.The medical consciousness

rooted in the heart and immersed in the bone marrow from

a young age makes You XiYin think that these people

can obviously save lives! At this time, another bad news

came that a child of a family member of the family had

leukemia and was lying on the bed.From the last period

of the child's life in the hospital bed, You XiYin clearly

found that the child's leukemia symptoms were very

similar to the anemia that was treated by the grandfather.

Recalling the process of the grandfather's treatment

and the memorized medical books, and the father had

enlightened him to treat the medical treatment of anemia,

he suddenly realized the treatment. He deplored the death

of the child.The Qi Huang spirit that flows through the

blood of the clan's family and rescues the crisis, reminds

of Yu Xiyin all the time: Is it going to be a doctor again

in the future life?When he was working in Xi'an, a

seriously ill young girl with leukemia found Yu Xiyin on

the recommendation of a friend. The patient knew that

the Chinese medicine of his family from generation to

generation had a high reputation, and the patient begged

Yuxi to treat her leukemia. You Xi Yin described a

prescription for her and asked her to grab three pieces

of herbal medicine. Try it. If it works, then take it. If it

doesn’t work, go to another doctor.Later, there was no

news of young women. A few years later, when a middleaged woman kneeled and thanked him with two children,

he learned that this person was a leukemia patient who he

had inadvertently cured a few years ago.The news that Xi

Yin could treat leukemia spread like wildfire. The sense

of responsibility and mission of treating and saving people

made him decisively give up his professional design and

start to take the road of medical treatment again.You Xiyin

said: "While modern medicine has given a high name to

many modern diseases, it is daunting, but as long as you

know the cause, find the root cause, apply the right herbal

62 Ⅰ2020/02

臨床名醫(yī)｜Clinic Specialist

medicine, and the treatment will have wonders. When I

was a child, I often heard my grandfather say to his father:

Treatment without knowing the cause is murder!" This

sentence was also regarded as the highest criterion for

practicing Chinese herbal medicine.Xi Yin began research

on blood diseases in 1981, and made breakthrough

progress in the research of traditional Chinese medicine

treatment of blood system diseases. He obtained a national

patent for the treatment of leukemia in 2007. He settled in

Tongzhou, Beijing in 2008 and concentrated on Chinese

medicine for blood diseases. According to You XiYin, the

effect is the objective standard of Chinese medicine. The

real effect of traditional Chinese medicine is both to treat

the symptoms and treat the root or cause of diseases.

4.The old Yuxi has the spirit of a middle-aged

man in his forties. His eyes were bright and sharp, his

words were powerful, and he was full of integrity.He

said: Acute leukemia belongs to the categories of "warm

poison", "heat labor" and "blood syndrome" of Chinese

medicine. Chronic leukemia belongs to the categories of

"deficiency", "disease", "disease", and "sputum nucleus"

of traditional Chinese medicine based on its manifestations

of weak anemia, enlarged liver and spleen, and lymph

nodes.At present, some scholars have summarized the

etiology and pathogenesis of leukemia into three points:

one is due to evil excess cause the diseases, and chronic

illness causes deficiency; the second is due to deficiency

and illness, and then becomes a futile labor;The third is

the combination of deficiency and evil excess. Through

research and analysis of leukemia, it is believed that in

addition to internal and external factors in traditional

Chinese medicine theory, junk food, environmental

pollution, the abuse of hormones and antibiotics, ionizing

radiation and other chemical and physical factors can

cause spleen qi deficiency and bone marrow. In the early

1960s, some scholars divided leukemia into 6 syndrome

types: Yin deficiency type, Yang deficiency type, Yin

and Yang deficiency type, fatigue type, phlegm-heat

type and warm type.From Xiyin, leukemia is divided into

three categories: one is poisoned into the bone marrow,

the patient has high fever, sweating and heat, hemorrhage,

anemia, hepatosplenomegaly, lymphadenopathy,

dizziness, bone pain, joint pain, pulse like flood Big.This

type is more common in adolescent patients, manifested

as various acute leukemias or various chronic leukemias

during the acute attack period, the onset is rapid and fierce.

The second is liver and kidney disease and stasis and

poisoning, patients with hot flashes and night sweats, five

upset fevers, frequent irritations, general weakness, weight

loss, hepatosplenomegaly, especially spleen, sternal

tenderness or pain in the ribs, pulses wiry tread rapid

or thread rapid. This type is more common in chronic

myelogenous leukemia.The third is spleen and kidney

deficiency and stasis and toxin. The onset is slower than

the first two, pale, dizziness, palpitations, waist and knee

soreness, fatigue, poor appetite, enlarged liver and spleen

or lymph nodes, pale tongue and less fur, pulse pulse

fine. This type is more common in patients with chronic

lymphocytic leukemia.What is the cause of leukemia,

it is necessary to use the corresponding symptomatic

Chinese medicine, so that the effect is significant.Chinese

medicine is not slow, symptomatic Chinese medicine can

take effect after taking 3 to 5 package of Chinese herbal

formula. If the effect of the herbal medicine is slow to

one or two months, the patient will not be alive.According

to Xi Yin, the treatment of leukemia with traditional

Chinese medicine cannot be measured by the relevant

indicators of Western medicine. The patient's morbidity in

the morbidity of the cells has been constantly changing in

uncertain factors. Pursuing the ever-changing indicators

inevitably will delay the current emergency condition.

The key is to See if the patient's Jingqi has improved in

time after taking the medicine. If you are full of spirit and

energy, all related physiological indicators will naturally

2020/02Ⅰ 63

improve, that is, righteousness and evil are not necessary.

According to Xi Yin, the human body has the integrity

and systemic nature of the unity of nature and man. For

any disease, the blindness of local confrontation without

the integrity and system conception will definitely lose the

true intention of medicine.Traditional Chinese medicine

pays attention to balance and harmony. The disease of the

human body stems from the original balance of the system

being broken. Therefore, the Yellow Emperor's Internal

Classic believes that the disease is "born in yin or yang."

In the study of leukemia, analyze the mechanism of the

disease, diagnose and explore the pathology in various

ways, that is, "differentiation".The diagnosis of TCM is to

"look, smell, ask, and touch” to understand the condition

of the disease, identify the attributes of surface, cold, heat,

virtual, yin and yang, and then determine the treatment

according to the pathological changes such as etiology,

viscera disease position, qi, blood and fluid. Methods,

using the corresponding Chinese medicine herbs.

5.Clinical practice works like a god, meditation

is the secret.You Xiyin has decades of peace-keeping

practice, he believes that all diseases are born from

emotional stress (heart).Although the etiology of the

patient is very complicated, the heart is the master.To

date, none of the leukemia patients he has treated have

been caused by the same etiology. In order to find out

the exact cause, the doctor must practice meditation to

improve his understanding and correctly judge the related

pain mechanism.Chinese medicine professionals with

meditation skills have the wisdom to find out the cause.

If a Chinese medicine practitioner does not meditate

internally, even if he is very smart, it is nothing but clever.

Modern Chinese medicine practitioners have a lot of

stress in life and have a lot of daily chores. There are few

people who have a pure and calm heart. This pure heart

cannot fall from the sky, it can only be obtained through

meditation. Meditation can make people concentrate,

not distracted. The specific method of meditation is to

meditate, adjust your breathing, and carefully observe your

own mental state, from static to fixed, from which you can

get physical and mental purity, and open wisdom. Wisdom

(Hui) comes from Zen.During the process of meditation,

self-adjustment of body, self-adjustment of breath and

mind. The interest-adjustment can purify one's physiology

and psychology, and one's life will be relaxed and

vigorous. The wisdom gained through meditation can help

people eliminate greed, aversion, infatuation, slowness,

doubt and other troubles. The wisdom brought by deep

meditation can eliminate these troubles, bring life into

truth and tranquility, reconnect the body and the soul, and

in the softness and lightness, make one's life a pure and

beautiful magic power. As a Chinese medicine practitioner

who has been meditating, his heart and wisdom is like

a mirror, and he has insight into the patient's condition.

In the process of deep exploration of leukemia by You

Xi Yin, it is precisely meditation that allows him to be

loyal to objective facts in clinical practice. As a result, his

prescribination of herbal medicine has the help of divine

aid and has a significant effect. Regarding meditation,

You Xiyin once published a monograph entitled "Dao

Dao Health Preservation", which is regarded as a rare

traditional authentic health practice by the society.

6.Meeting new healthcare challenge needs, Chinese

medicine is a miracle.Chinese medicine is a general

practice, and leukemia is just one of the modern diseases

that You XiYin is good at treating. There are too many

patients looking for him to treat leukemia, and most of

these patients are ruined and penniless.Faced with many

troubled leukemia patients, Yu Yin often feels unable to

help. He hopes that the patents for his leukemia Chinese

medicine composition and its preparation method can

be transformed as soon as possible to benefit more

patients. This is the crystallization of the practice of

medicine by several generations of the family, and it is

Cover clinical specialists｜ 封面名醫(yī)

64 Ⅰ2020/02

臨床名醫(yī)｜Clinic Specialist

also the crystallization of traditional Chinese medicine

and modern technology.He said: "The emphasis is on

syndrome differentiation. Traditional Chinese medicine

should be innovative in order to show its vitality in the

new era. The principle of innovation is to meet the health

needs of the people in the new era." Xi Yin pointed

out In order to meet the health needs of the people,

traditional Chinese medicine needs to innovate on the

basis of the original without breaking away from the

traditional medical track.Traditional Chinese medicines

are usually prepared by roughing and extracting essences,

such as quenching, braising, calcining, frying, and so on

processing . Innovative invention is to study its theory

and pharmaceutical technology in a broad sense, and

to innovate the traditional Chinese medicine service

method, usage, manufacturing technology, processing

accessories, and process flow to adapt and meet the needs

of modern people to the greatest extent.Safety and high

quality are the two aspects most valued by Xiyin. He

said that the key to controlling the quality of herbs lies

in the quality of medicinal materials and the technical

standards of the extraction process. Traditional Chinese

medicine prescriptions are based on standard decoctions,

and they attach great importance to the compound effect

of prescriptions and single-flavor Chinese medicines.

They often control the internal quality of raw materials

in many aspects.The invention by Xiyin not only focuses

on the process of selecting, extracting, concentrating, and

drying medicinal materials, but also avoids the loss and

destruction of the index components of the main herbs.

He strictly controls the stability of the product to ensure

the high quality of the product after molding. Because

the invention inherits the comprehensive curative effect

of decoction, it is easy to absorb, has obvious effects,

and has the advantages of ready-made medicine, easy

storage, easy to carry, and easy to take. The declaration

is very smooth.According to Xi Yin, there are serious

problems in the production, study, and research of Chinese

medicine in my country. Few companies are willing

to invest in this aspect, making innovation in Chinese

medicine "important in speaking and secondary in doing

it." He believes that the examination of the innovation

effect of traditional Chinese medicine takes a lot of

manpower and material resources. If Western medicine

indicators are used to verify and explain the theory of

traditional Chinese medicine, this is inappropriate. The

affirmation and utilization of traditional Chinese medicine

should be shifted from "emphasis on experiment and

light on clinical" to "emphasis on clinical and light on

experiment", that is, avoiding short-selling theory and

speaking with actual effect is the essence of medicine.

The so-called innovation of traditional Chinese medicine

must be fully understood Chinese medicine innovates on

the basis of its own enlightenment. Otherwise, using only

a little level of limited knowledge to innovate traditional

Chinese medicine with profound cultural heritage will

become a perpetual sinner who destroys the image of

traditional Chinese medicine.Xiyin hopes that relevant

national functional departments can use Chinese medicine

patents to promote the progress of Chinese medicine

technology, enhance the competitiveness of Chinese

medicine in domestic and foreign markets, combine

Chinese medicine technology research and patents, study

international patent regulations and declarations, and

organize professional technical personnel and experts

To jointly discuss and formulate protective measures to

promote the development of traditional Chinese medicine

to the mainstream international pharmaceutical market.

The author sincerely hopes that the patent of "Chinese

medicinal composition for the treatment of leukemia and

its preparation method" invented by Xi Yin will be able to

give healthy help to leukemia patients in the society with

the support of investors.

2020/02Ⅰ 65

由璽?。翰恢∫虻闹委煹扔跉⑷?/p>

◎李善舉

白血病俗稱血癌，特別是兒童、青少年發(fā)病率較

高。中醫(yī)藥作為中華民族的傳統(tǒng)瑰寶，歷史悠久，博

大精深，在血液病的治療方面具有療效好、速度快、

費(fèi)用低、毒副作用小的優(yōu)勢(shì)，受到國(guó)內(nèi)外學(xué)者的廣泛

關(guān)注。中華人民共和國(guó)國(guó)家知識(shí)產(chǎn)權(quán)局的專利網(wǎng)站

上，“一種用于治療白血病的中藥組合物及其制備方

法”（專利號(hào)ZL2007101193834）赫然在目，專利發(fā)

明人是由璽印。

由璽印是誰(shuí)？是什么樣的學(xué)術(shù)造詣，讓他的中藥

治療血液病研究成果榮獲國(guó)家專利？

濟(jì)危救困日月鑒，難舍中醫(yī)動(dòng)乾坤

由璽印，1951年出生于甘肅省慶陽(yáng)地區(qū)歧黃故

里的一個(gè)村莊里，慶陽(yáng)是華夏民族“岐黃之術(shù)”的開

端，華夏農(nóng)耕文化的源頭。中醫(yī)在這個(gè)地區(qū)的醫(yī)療領(lǐng)

域里一直占據(jù)著主導(dǎo)地位，深受當(dāng)?shù)匕傩盏臍g迎。當(dāng)

地各個(gè)家族的名中醫(yī)也人才輩出。由璽印是甘肅省隴

源地區(qū)長(zhǎng)樂(lè)府由氏家族第三代中醫(yī)傳人。由璽印自幼

年開始，就在祖父指導(dǎo)下熟讀中醫(yī)經(jīng)典，并學(xué)習(xí)識(shí)

由璽印老師是當(dāng)今這個(gè)時(shí)代為數(shù)不多的純正中醫(yī)人之一。他不計(jì)名利，醫(yī)德高尚，醫(yī)術(shù)精湛，

深藏民間。他是傳統(tǒng)中醫(yī)人，卻不墨守陳規(guī)。他把醫(yī)者仁心融入臨床實(shí)踐，他讓現(xiàn)代科技與傳統(tǒng)中醫(yī)

完美結(jié)合。他在沒(méi)有任何資本的支持下，在臨床上攻克白血病治療難關(guān)，取得了相應(yīng)的國(guó)家專利。但

是由璽印老師卻鮮為人知。我們的封面人物之所以推出他，是因?yàn)椋核怯谩隘熜А闭f(shuō)話的實(shí)力派，

他還是臨床標(biāo)本兼治的倡導(dǎo)者和踐行者。

編者按

Cover clinical specialists｜ 封面名醫(yī)

66 Ⅰ2020/02

臨床名醫(yī)｜Clinic Specialist

藥、制藥和用藥。由氏家族在慶陽(yáng)當(dāng)?shù)氐拿暫屯?/p>

很高，深受當(dāng)?shù)卮迕竦膿泶骱妥鸪纭，F(xiàn)今已經(jīng)近古稀

之年的由璽印對(duì)年輕時(shí)讀過(guò)中醫(yī)經(jīng)典還能倒背如流。

我們常常聽人說(shuō)某某人有中醫(yī)童子功，指的就是由璽

印這樣的人。青年時(shí)期的由璽印曾做過(guò)幾年赤腳醫(yī)

生，但是在文化大革命暴發(fā)后，他不再行醫(yī)，毅然就

讀了工程設(shè)計(jì)學(xué)校，成為一名工程設(shè)計(jì)師。

文化大革命期間，中醫(yī)被認(rèn)為是封建社會(huì)遺留下

的四舊之一。像由璽印這樣的中醫(yī)大家族遭受到了猛

烈的沖擊，他家中珍藏的醫(yī)書全部被堆在院子里進(jìn)行

焚燒，由于古籍醫(yī)書太多，燒書發(fā)出的濃煙幾天幾夜

才散盡。他的父親也被拉走戴著牌子游街批斗。游行

時(shí)有村民偷偷把他父親戴的牌子換成了一個(gè)紙糊的假

牌子，看著很大，份量卻很輕。樸實(shí)的鄉(xiāng)親，用這樣

的方式回報(bào)這位民間的良醫(yī)，讓人想哭又想笑，悲中

又有喜。由璽印的父親被強(qiáng)制掛牌游街后不久，破四

舊立四新的紅衛(wèi)兵把他家中的大門當(dāng)做封建迷信強(qiáng)行

拆除，幾代人的家族文化遺產(chǎn)即刻間毀于一旦，父親

趴在亂扔在地上的大門木板橫梁上，像一個(gè)孩子樣無(wú)

助地嚎啕大哭。由于傷心過(guò)度，幾天之后氣絕身亡。

父親的死對(duì)由璽印打擊很大，他決定不再行醫(yī)。遠(yuǎn)走

他鄉(xiāng)，學(xué)習(xí)工程設(shè)計(jì)。在工程設(shè)計(jì)領(lǐng)域，由璽印很快

就成長(zhǎng)為一名高級(jí)工程師，收入頗豐，日子過(guò)得十分

滋潤(rùn)。但是他總覺得自己的生活少點(diǎn)兒什么。

文化大革命結(jié)束后，社會(huì)各界人民群眾的日子

一天比一天好起來(lái)，新的社會(huì)疾病也一天比一天多。

憂郁癥成為危及健康的新頑疾。由氏家族一位有威望

的遠(yuǎn)親，最擅長(zhǎng)的是給他人做思想工作，不知什么原

因，卻患上了重度憂郁癥，一段時(shí)間的自我折磨后，

最終選擇以自殺的方式結(jié)束了自己的生命。消息傳到

由璽印的耳里時(shí)，他十分震驚。昔日遠(yuǎn)親爽朗的笑聲

和給鄉(xiāng)親排憂解難的場(chǎng)景還歷歷在目，怎么人說(shuō)沒(méi)有

就沒(méi)有了呢？況且，憂郁病也不是什么絕癥！這位親

戚的離世就像打開了一個(gè)壞消息的大門，接二連三，

又傳來(lái)一些親朋好友病重或病故的消息。從小扎根在

心里和浸入骨髓的醫(yī)者意識(shí)，使由璽印認(rèn)為：這些人

明明是可以救活的！就在這時(shí)，又一噩耗傳來(lái)，家中

某位親人的孩子得了白血病已躺在病床上奄奄一息，

全家人眼睜睜地看著這個(gè)孩子病逝，心如刀割，卻無(wú)

能為力。從孩子在病床上最后的一段生命時(shí)光中，由

璽印清晰發(fā)現(xiàn)孩子的白血病癥狀和祖上醫(yī)治的貧血病

十分相似，回想祖輩治病的過(guò)程和熟背的醫(yī)書，及父

親曾點(diǎn)悟他治療貧血癥的醫(yī)理，他突然頓悟出治病藥

方。他為孩子的病逝感到痛惜。由氏家族血脈中流淌

的濟(jì)危救困的岐黃精神，無(wú)時(shí)無(wú)刻不提醒著由璽?。?/p>

今后的人生路，是不是要再次做醫(yī)生？他在西安工作

時(shí)，一位重病的白血病女青年在朋友的推薦下找到由

璽印?；颊咧浪募易迨朗来闹嗅t(yī)都有很高的

名望，患者懇請(qǐng)由璽印把她死馬當(dāng)活馬醫(yī)?；颊甙延?/p>

璽印當(dāng)成生命中最后一根救命稻草。由璽印給她開了

藥方，讓她去抓三付藥，試一下，如果有效就接著

吃，如果沒(méi)有效就趕緊去找別的醫(yī)生治。后來(lái)便沒(méi)有

了女青年的消息。事隔幾年后，一位中年婦女帶著兩

個(gè)孩子給他下跪感恩時(shí)，他才得知這個(gè)人就是幾年前

自己無(wú)意間治愈的白血病患者！

由璽印能治療白血病的消息不脛而走。治病救人

的責(zé)任感和使命感，使他果斷放棄自己的設(shè)計(jì)專業(yè)，

再次開始踏上行醫(yī)之路。由璽印說(shuō)：“很多現(xiàn)代病雖

2020/02Ⅰ 67

然西醫(yī)給取了一個(gè)高大上的名字，讓人心存畏懼，但

是只要知道病因，找到病根，對(duì)癥下藥，治療就會(huì)有

奇效。小時(shí)候常聽爺爺對(duì)父親說(shuō)，不知病因的治療等

于殺人！”爺爺?shù)脑捯脖凰?dāng)成行醫(yī)的最高準(zhǔn)則。

由璽印1981年開始進(jìn)行血液病的研究，在中醫(yī)

藥治療血液系統(tǒng)疾病研究方面取得了突破性進(jìn)展，于

2007年獲得中藥治療白血病的國(guó)家專利，并于2008年

定居北京通州，專心從事血液病的中藥研究。由璽印

認(rèn)為，療效是檢驗(yàn)醫(yī)學(xué)真理的唯一標(biāo)準(zhǔn)。真正的中醫(yī)

療效是標(biāo)本兼治。

病因復(fù)雜蹤難尋，找準(zhǔn)病因須辨證

近古稀之年的由璽印，有著四十多歲中年男性的

精氣神。他雙目炯炯有神，話語(yǔ)鏗鏘有力，正氣浩然

于胸。他說(shuō)，急性白血病屬于祖國(guó)醫(yī)學(xué)“溫毒”“熱

勞”“血證”等范疇。慢性白血病根據(jù)其貧血虛

弱、肝脾及淋巴結(jié)腫大等表現(xiàn)，屬于祖國(guó)醫(yī)學(xué)“虛

損”“癥浪”“底病”“痰核”等范疇。目前有學(xué)者

將白血病的病因病機(jī)歸納為三點(diǎn)：一是因?qū)嵓安?，?/p>

病致虛；二是因虛致病，遂成虛勞；三是虛實(shí)交錯(cuò)，

虛證多見。通過(guò)對(duì)白血病進(jìn)行研究分析后認(rèn)為，除中

醫(yī)理論中的內(nèi)因和外在因素外，垃圾食品，環(huán)境污染

以及激素和抗生素的濫用，電離輻射等化學(xué)物理因素

均可致精氣內(nèi)虛傷及骨髓。上世紀(jì)60年代初期有學(xué)者

將白血病分為6個(gè)證型：陰虛型、陽(yáng)虛型、陰陽(yáng)兩虛

型、瘀血型、痰熱型和溫?zé)嵝汀?/p>

由璽印則將白血病分為三類：一是毒入骨髓，

患者高熱，大汗而熱不解，出血，貧血，肝脾、淋巴

結(jié)腫大，頭昏痛，一身骨痛關(guān)節(jié)痛，脈象洪大。該類

多見于青少年患者，表現(xiàn)為各種急性白血病或各種慢

性白血病急性發(fā)作期，起病迅速兇猛。二是肝腎同病

瘀毒，患者潮熱盜汗，五心煩熱，動(dòng)輒激怒，全身乏

力，形體消瘦，肝脾腫大，以脾為甚，胸骨壓痛或肋

處痛，脈象多弦數(shù)或細(xì)數(shù)。該類多見于慢性粒細(xì)胞性

白血病。三是脾腎兩虛瘀毒類，發(fā)病較前兩類緩慢，

面色蒼白，頭昏心悸，腰膝酸軟，神疲乏力，胃口不

佳 ，肝脾或淋巴結(jié)腫大，舌淡少苔，脈象虛細(xì)。該類

多見于慢性淋巴細(xì)胞性白血病患者。

是什么樣的病因引起白血病，就要用相應(yīng)的對(duì)

癥中藥，這樣才會(huì)療效顯著。有些人認(rèn)為中醫(yī)是“慢

郎中”，由璽印認(rèn)為持有這種觀點(diǎn)的人如果是中醫(yī)從

業(yè)者，應(yīng)該對(duì)中醫(yī)再進(jìn)行深入的學(xué)習(xí)。如果是業(yè)外人

士，那是對(duì)中醫(yī)存在著誤解?！爸兴幉宦?，對(duì)癥的中

藥3～5付藥就能見效，如果藥效慢到一兩個(gè)月才能見

效，患者早不在人世了?！庇森t印認(rèn)為，中醫(yī)藥治療

白血病的過(guò)程中不能用西醫(yī)的相關(guān)指標(biāo)衡量，患者在

病態(tài)中細(xì)胞指標(biāo)一直在千變?nèi)f化的不確定因素中，窮

追萬(wàn)變指標(biāo)必然會(huì)耽誤當(dāng)下的緊急病情，關(guān)鍵要看患

者用藥后精氣神是否得到了及時(shí)改善。精氣神俱足，

一切相關(guān)的生理指標(biāo)自然會(huì)隨之改善，即“正氣內(nèi)

存，邪不可干”。

由璽印認(rèn)為，人體具有天人合一的整體性和系

統(tǒng)性，對(duì)于任何一個(gè)疾病而言，失去整體性和系統(tǒng)觀

念盲目局部對(duì)抗，必定會(huì)失去醫(yī)學(xué)的真實(shí)本意。中

醫(yī)講究平衡和諧，人體的疾病源于系統(tǒng)原有的平衡被

打破，所以《黃帝內(nèi)經(jīng)》認(rèn)為疾病“或生于陰，或生

于陽(yáng)”。在白血病的研究中，分析疾病產(chǎn)生的機(jī)制，

多種方式診斷探求病理，即“辨證”。中醫(yī)診病首先

是“望、聞、問(wèn)、切”了解病情，辨表里、寒熱、虛

實(shí)、陰陽(yáng)的屬性，然后根據(jù)病因、臟腑病位、氣血津

液等病理變化，按證候?qū)傩?，決定治療方法，采用相

應(yīng)的藥物。唯有進(jìn)行辨證找準(zhǔn)病因，才能知己知彼，

百戰(zhàn)百勝。

臨床實(shí)踐效如神，禪修功夫是秘密

由璽印有數(shù)十年的平心靜修歷程，他認(rèn)為萬(wàn)病

皆由心生。雖說(shuō)患者的病因十分復(fù)雜，但萬(wàn)變不離其

宗，心為其主。迄今為止，他所治療的白血病患者

中，還沒(méi)有是同一種病因?qū)е碌?。而想找?zhǔn)病因，醫(yī)

者必須進(jìn)行禪修來(lái)提高自己的悟性，來(lái)正確判斷相關(guān)

的疼痛機(jī)理。有禪修功夫的中醫(yī)人更容易擁有找準(zhǔn)病

因的智慧，如果一個(gè)中醫(yī)人不禪修內(nèi)養(yǎng)，即使聰明過(guò)

Cover clinical specialists｜ 封面名醫(yī)

68 Ⅰ2020/02

臨床名醫(yī)｜Clinic Specialist

人也不過(guò)是“小聰明”而已。

現(xiàn)代中醫(yī)人，生活壓力大，日常的瑣事繁多，

有一顆清凈心的人少。這顆清凈的心不可能憑空從天

而降，只有通過(guò)禪修才可以獲得。禪修可以讓人聚精

會(huì)神，心神不散亂。由璽印禪修的具體方法是：通過(guò)

打坐，調(diào)整呼吸，細(xì)心觀察自身的心理狀態(tài)，由靜到

定，由定獲得身心清凈，并開啟智慧?；蹚亩U中來(lái)。

禪修過(guò)程中的調(diào)身、調(diào)心、調(diào)息，可以使人的生

理和心理得到凈化，人的生命會(huì)因此輕松愉快，生機(jī)

勃勃。通過(guò)禪修得到的智慧，能夠幫助人們清除貪、

嗔、癡、慢、疑等煩惱。深層次的禪修所帶來(lái)的智

慧，可以把這些煩惱消除，使生命進(jìn)入真實(shí)與寧?kù)o，

使身體與心靈重新聯(lián)結(jié)，在柔軟和輕安中，使一個(gè)人

的生命擁有一股清凈美好的神奇力量。

經(jīng)歷禪修的中醫(yī)人，其心靈好似一面明鏡，對(duì)病

人的病情可以洞察秋毫。由璽印在對(duì)白血病深入探索

的過(guò)程中，正是禪修讓他在臨床實(shí)踐中，忠于客觀事

實(shí)，他的立方用藥也因此如有神助，療效顯著。關(guān)于

禪修，由璽印曾出版過(guò)一本專著《丹道養(yǎng)生大成》，

被社會(huì)各界公認(rèn)是罕見傳統(tǒng)正宗養(yǎng)生術(shù)。

滿足健康新需求，中醫(yī)中藥有神威

中醫(yī)是全科，白血病只是由璽印擅長(zhǎng)治療的現(xiàn)代

疾病的其中一種。找他治療白血病的患者太多，并且

這些患者絕大部分是被西醫(yī)治療的傾家蕩產(chǎn)、身無(wú)分

文，走投無(wú)路之后，才找到中醫(yī)。很多白血病患者在

西醫(yī)治療時(shí)，還受到藥源性二次傷害。面對(duì)眾多困苦

的白血病患者，由璽印常常感到幫不過(guò)來(lái)。他希望他

的白血病中藥組合物及其制備方法的專利，能盡早的

轉(zhuǎn)化出來(lái)，讓更多的患者受益。這是由氏家族幾代人

行醫(yī)的臨床結(jié)晶，也是傳統(tǒng)中醫(yī)與現(xiàn)代科技的結(jié)晶。

他說(shuō)：“治病重在辨證，中藥在新時(shí)期要想展

現(xiàn)出生命活力則應(yīng)該創(chuàng)新，創(chuàng)新的原則是滿足新時(shí)期

民眾健康需求?！庇森t印指出，歷代中醫(yī)藥大家豐富

的醫(yī)療實(shí)踐證明，中藥要想滿足民眾健康的需求，需

要在原本的基礎(chǔ)上不脫離傳統(tǒng)醫(yī)學(xué)軌道再進(jìn)行創(chuàng)新。

傳統(tǒng)中藥通常是去粗取精，在淬、燴、煅、炒、炮等

外形上制作。而創(chuàng)新發(fā)明則是從廣義上研究其理論及

制藥技術(shù)，對(duì)中藥的服法、用法、制作技術(shù)、炮制輔

料、工藝流程進(jìn)行革新，以適應(yīng)和最大限度的滿足現(xiàn)

代民眾的需求。

安全和高品質(zhì)，是由璽印最看重的兩個(gè)方面。他

說(shuō)，控制藥品質(zhì)量的關(guān)鍵在于藥材質(zhì)量及提取工藝的

技術(shù)標(biāo)準(zhǔn)。傳統(tǒng)中藥方劑基于標(biāo)準(zhǔn)煎劑，十分重視方

劑及單味中藥的復(fù)方作用，常常是多方位嚴(yán)格控制原

料的內(nèi)在質(zhì)量。由璽印的發(fā)明不僅注重藥材的選用、

提取、濃縮、干燥、成型等過(guò)程，還盡量避免主藥指

標(biāo)性成分的損失和破壞。他對(duì)產(chǎn)品穩(wěn)定性進(jìn)行嚴(yán)格控

制，以確保產(chǎn)品成型后的高品質(zhì)。由于該發(fā)明繼承了

煎劑的綜合療效，易吸收、顯效快，又具備成藥易貯

存、易攜帶、易服用的優(yōu)點(diǎn)，同時(shí)克服了服用量大、

工藝不合理、成分破壞嚴(yán)重等缺點(diǎn)，所以專利申報(bào)十

分順利。

由璽印認(rèn)為，我國(guó)中藥存在嚴(yán)重的產(chǎn)、學(xué)、研

脫節(jié)問(wèn)題，很少有企業(yè)愿意在這方面投入，使中藥創(chuàng)

新“說(shuō)起來(lái)重要，做起來(lái)次要”。他認(rèn)為，中醫(yī)藥創(chuàng)

新效果檢驗(yàn)要花費(fèi)巨大的人力、物力，用西醫(yī)指標(biāo)對(duì)

中醫(yī)藥理論進(jìn)行驗(yàn)證與說(shuō)明是不妥當(dāng)?shù)?。?duì)中醫(yī)藥的

肯定和利用，應(yīng)該由“重實(shí)驗(yàn)、輕臨床”轉(zhuǎn)向“重臨

床、輕實(shí)驗(yàn)”，即回避空頭理論，用實(shí)效說(shuō)話才是醫(yī)

學(xué)本質(zhì)所在，對(duì)中醫(yī)藥的所謂創(chuàng)新，必須在了解中醫(yī)

藥后，在自身開悟的基礎(chǔ)上進(jìn)行創(chuàng)新。否則，只利用

一點(diǎn)局限性的自我水平來(lái)對(duì)文化底蘊(yùn)深厚的中醫(yī)藥進(jìn)

行創(chuàng)新，反而破壞了中醫(yī)的形象。

由璽印希望國(guó)家相關(guān)職能部門能利用中藥專利促

進(jìn)中藥技術(shù)進(jìn)步，增強(qiáng)中藥在國(guó)內(nèi)外市場(chǎng)的競(jìng)爭(zhēng)力，

并將中藥技術(shù)研究與專利相結(jié)合，研究國(guó)際專利法規(guī)

及申報(bào)技巧，組織專業(yè)技術(shù)人員與專家共同探討并制

定保護(hù)措施，促進(jìn)中藥走向國(guó)際醫(yī)藥主流市場(chǎng)。

筆者衷心希望由璽印發(fā)明的“治療白血病的中藥

組合物及其制備方法”的專利，能夠在有識(shí)之士的資

助下，盡早化成甘霖，給社會(huì)上的白血病患者們及時(shí)

送去健康的福音。

2020/02Ⅰ 69

Chen Yuanwei, doctors must have a benevolent heart

◎Li Shanju

Excellent folk practitioners of traditional Chinese

medicine are pearls scattered in the world. Chen Yuanwei

is undoubtedly the most dazzling one in Zunyi, Guizhou.

He is radiant, like an uncontested great virtue hermit,

silently protecting the health of the grassroots people.

Good Chinese herbal medicine, good

prescription, good therapeutic effect

Chen Yuanwei gave himself the WeChat name

"Qianbei Grassroots Doctor", which means a private doctor

who specializes in treating ordinary people. However, his

patients are not only ordinary people, but also many highranking officials living in provincial and capital cities, as

well as many foreign patients from Germany, Italy, Japan,

the United States, and South Korea.

Chen Yuanwei is in the folk countryside, but his

medical skills and herbal medicine are advancing with the

times, and it is his responsibility to meet the health needs

of the people. For example, traditional Chinese medicine

is troublesome and the decoction is difficult to swallow.

Chen Yuanwei purchased modern western medicine

pharmaceutical equipment and made Chinese medicine

raw materials into capsules and tablets.

When you approached his Chinese herbal medicine

room and took a sharp look, there were small bottles and

boxes similar to western medicines in your eyes. You

thought it was western medicine. A closer look reveals

that they are all Chinese herbal medicines made from

raw materials of Chinese medicine in accordance with

modern western medicine. According to the different

conditions of the patients, he combined different Chinese

patent medicines and gave them to the patients. Don't

underestimate the Chinese patent medicines processed

by these individuals. They are all made with the addition

and reduction of medicinal flavors on the basis of classic

prescriptions. Taking the treatment of colds as an example,

colds can be divided into wind-cold cold and windheat cold. However, whether it is to treat wind-cold cold

or wind-heat cold, Chen Yuanwei here only uses a pill

composed of several Chinese medicine raw materials. As

long as you take a few tablets at the beginning of a cold,

you can get relief at a time. There is no such thing as a

saying that it takes a week to treat a cold.

When the new crown epidemic broke out in the

spring of 2020, Chen Yuanwei asked the villagers

to use this tablet to prevent colds, and the effect was

excellent. This approach of Chen Yuanwei not only

fully retains the advantages of personalized and tailormade prescriptions of traditional Chinese medicine, but

also adds the advantages of modern western medicine

quantitative concepts. While the advantages of traditional

Chinese medicine are not discounted, the bright spots of

western medicine are added. It not only overcomes the

shortcomings of the popularization of western medicine

without individual specificity, but also overcomes the

shortcomings of traditional Chinese medicine. For those

patients who know how to decoction and are willing to

decoction, they still prescribe authentic herbal decoctions.

Different from traditional Chinese medicines in other

Outstanding medical experts ｜杏林英才

70 Ⅰ2020/02

臨床名醫(yī)｜Clinic Specialist

places, most of the traditional Chinese medicines used

by Chen Yuanwei here are collected by his family and

disciples in the mountains, or purchased from villagers

near the primeval forest. The Chinese herbal medicines

he stocked filled the warehouse of nearly 1,000 square

meters. Chinese herbal medicine is good, the prescription

is good, and the effect is good. Together, it is really good

to be Doctor Chen Yuanwei.

Hello, hello, hello everyone

Traditional Chinese medicine is a general

practitioner, and Chen Yuanwei is a typical representative

of general practitioners. You can’t say that he is good at

seeing that kind of disease. It seems that modern people’s

diseases range from common children’s gynecological

trauma to many difficult diseases such as heart disease,

hypertension and tumors. , He can be treated. The effect

is amazing. In order to facilitate medical treatment for

patients from afar, Chen Yuanwei converted some idle

houses on the outskirts of Suiyang into hotel-like rooms,

and equipped them with kitchen utensils. Patients can cook

their own meals and have meals with Chen Yuanwei's

family. Chen Yuanwei called this place "Tianyuan Health

Care Center". The health centers in many places were born

under the planning of the person involved, but his health

center was born naturally to meet the needs of patients. It

is really hello, hello, everyone.

Since mankind entered the 1990s, the aging of the

population has become increasingly serious. Relevant

data show that in 2016, China's population aged 60 and

above accounted for 13.26% of the total population,

2.93% higher than that in 2000. The number of elderly

people with chronic diseases and empty-nest elderly both

exceeded the 100 million mark in 2013. Related agencies

predict that by 2025, China's population of people over 60

years old will reach 300 million, making it a super-aged

country. However, the Chinese pension market has not yet

formed a standardized system and model. Chen Yuanwei's

health care center provides useful lessons for latecomers.

In China, people often equate health care and elderly

care industries. There are basically three types of elderly

care industry: family care, community care and institution

care. The main models are "combination of medical

care", "combination of health care" and "combination

of medical care". "Combination of medical care and

elderly care" realizes the docking of medical and elderly

care services, but the post-rehabilitation treatment for

some semi-disabled and disabled elderly people is not

perfect; "Combined medical care" is usually located in

medical institutions and rehabilitation institutions. It is

not integrated into the daily life of the elderly at home,

and lacks the services, facilities and environment for the

elderly life, so it cannot meet the needs of "nourishment";

the "combined health and nurture" lacks the doctor team

and medical facilities of professional medical institutions,

and suffers from illness The elderly are often unable to

receive timely diagnosis and treatment. In view of the

above, Chen Yuanwei integrated the three modes of

"medicine and health care", "healthcare and health care"

and "medicine and health care" to form an integrated

model of "medicine, health care and health care". This

model solves the problems that hospitals cannot provide

for the elderly, nursing homes cannot treat diseases, and

families cannot take care of them.

The magic weapon for a lifelong career

Chen Yuanwei's relationship with Chinese medicine

is inevitable by accident. Chen Yuanwei has his magic

weapon to build a career based on traditional Chinese

medicine. This magic weapon is what his mother taught

him when he first studied medicine.

Chen Yuanwei also had an older brother ten years

2020/02Ⅰ 71

older than him. In 1952 or 1953, he had just graduated

from the Political Department of Southwest Revolutionary

People’s University and suffered from bronchial lung

cancer. The government sent his brother to the best

hospital in Beijing at that time, but he died in the end.

Chen Yuanwei's grandfather was Weng Guqiu, a

famous Chinese medicine doctor in Chengdu before and

during the early liberation period. After learning about

this, he and Chen Yuanwei's mother suggested that Chen

Yuanwei should learn Chinese medicine from him.

Before Chen Yuanwei went to Chengdu to study

medicine, his mother called him to the bed and asked

him if he knew: "Doctors must have a loving heart?"

Chen Yuanwei said I didn’t know, and his mother told

him the source of the allusion: ancient times , There is an

old Chinese doctor, a patient is sick, and he asks him for

treatment. There is a herbal introduction "human flesh" in

the prescription prescribed by the doctor. The doctor was

afraid that the patient could not find human flesh, so he cut

a piece of flesh from his leg and used it for the patient's

family. The saying "Doctors must have a loving heart" has

been around since then. My mother said to Chen Yuanwei:

"To tell you this allusion today, I don’t want you to cut

off your own flesh to make medicinal primers for patients

in the future. I want you to remember one thing. People

who study medicine should learn ethics first. To study

medicine, you must have an empathy with the patient and

sit in the position of the patient to think about the problem.

Then what questions will the patient think about? Three

questions: one, hope that the disease can be cured. Two,

hope that it will be faster. , I hope to save a little money.

If you say that the purpose of your medical study is to get

the money in the patient’s pockets into your own pockets

after you have mastered the techniques, you will never be

a good doctor. "My mother’s teaching of Chen Yuanwei,

Affected his life. Today, all the patients seeing Chen

Yuanwei are like seeing relatives who have reunited after

a long absence.

Enlightenment when life is dark

During his youth, Chen Yuanwei was detained for

two years. It was the period of the Cultural Revolution,

and there were big-character posters everywhere. When

Chen Yuanwei wrote "Long live Mao Zedong Thought",

he made a clerical error and missed the word "East". It

was pronounced as "Long live Mao Zedong Thought".

Because of the similar pronunciation of "Mao Ze" and

"Mao Lao" in Guizhou dialect, Chen Yuanwei was

detained for two years. In the past two years, apart from

reading philosophy books and medical books, all were

isolated from the world. In the past two years, Chen

Yuanwei once again studied classics of traditional Chinese

medicine such as Treatise on Febrile Diseases, and studied

philosophical works such as Marx and Mao Zedong

Thought. He found that using philosophical concepts

to learn, research and apply Chinese medicine is very

beneficial.

Someone asked Chen Yuanwei: Is he full of hatred in

his heart because he was detained for two years because

he missed a word? He said sincerely from the heart: No.

He said that if it were not for the past two years, he would

not have such ample time to "deep research on Chinese

medicine" and "deep research on philosophy." For others,

the past two years have been a disaster of imprisonment.

For him, the past two years have been the prime time for

"cultivating the Tao", especially the successful "getting

the Tao".

Chen Yuanwei now has his own "Tianyuan Health

Care Center" as well as a Tianyuan winery. In the 1990s,

his Jiujiu Tianyuan wine was as famous as Kweichow

Moutai, which is now well-known overseas. It is not

only designated for use by some local government

agencies, but also popular in Hong Kong. The reason why

Outstanding medical experts ｜杏林英才

72 Ⅰ2020/02

臨床名醫(yī)｜Clinic Specialist

Tianyuan Wine was so popular at that time was that it

helped the Chinese National Weightlifting Team achieve

unprecedented results in many important events. In 1995,

the national weightlifting team was in a low period, and

its performance was stagnant. According to a person from

the National Sports Commission, Mr. Chen Yuanwei, the

producer of Tianyuan Wine, sponsored this wine for the

National Weightlifting Team. The national weightlifting

team first sent the wine to the National Doping Testing

Center for doping testing. As a result, Tianyuan wine does

not contain any stimulants, hormones and antibiotics,

which meets the strict requirements for athletes to drink.

Subsequently, the national weightlifting team conducted

a one-month trial. At that time, dozens of male athletes

participated in the trial, and individual athletes generally

improved by 5-10 kg! Subsequently, at the Guangzhou

World Weightlifting Championships held at the end of

1995, he won five gold, five silver, six bronze and the first

in the team total score, making a historic breakthrough!

The previous national weightlifting team's performance

was ninth in the group. The national weightlifting team

fully affirmed the three major effects of drinking Tianyuan

wine: one is that the team members fall asleep quickly

and sleep normally; the other is to recover from training

fatigue and play a good role in persisting in large-volume

training the next day; third is to increase Athlete muscle

strength training plays a very good role. With the help of

Tianyuan Wine, the national weightlifting team achieved

brilliant results in Atlanta in 1996 and Sydney in 2000.

Mr. Chen Yuanwei has never regarded himself as a

winemaker, let alone a businessman, because he felt that

his true identity was a doctor, and Tianyuan wine was just

one of his weapons for healing and saving people. Related

research found that Tianyuan wine contains 8 kinds of

essential amino acids and 11 kinds of non-essential amino

acids. Among them, arginine can improve the vitality of

lymphocytes and phagocytes, activate the cellular immune

system and regulate immune function.

Tianyuan Feed Additives and Tianyuan Feed are byproducts when Mr. Chen Yuanwei developed Tianyuan

Wine. The breeding experiment was carried out on

chickens and pigs in the experimental breeding farm of

the institute. The test results show that the weight gain of

the monomer is similar or higher than that of the existing

compound feed and the conventional farm feed; the meat

quality of livestock and poultry has obvious advantages,

and the ability to resist disease is strong; More lean meat,

less fat, and thin eggshells. The test results show that

the developed TY-I TY-II functional compound feed has

reached the expected five goals.

Not many people know about Tianyuan Feed

Additives and Tianyuan Feed. These two treasures born

from the research and development of Tianyuan wine have

been in the boudoir for 20 years. Chen Yuanwei looks

forward to the people who are destined to come together

and form an alliance between the Qin and the Jin Dynasty

for the benefit of To the people, create greater social value.

Conclusion

Chen Yuanwei is ordinary, but Chen Yuanwei is not

ordinary. He never said that he would inherit and innovate

Chinese medicine, but he naturally inherited and innovated

Chinese medicine. There is no relevant organization to

commend him, but he is deeply loved by patients all over

the country. In addition to the role of a doctor, he has his

own winery, pig farm, and chicken farm. The words of the

"heart of love" that his mother said when he was a child

helped him settle down, establish a career, and establish a

virtue. He has accomplished himself and blessed others.

2020/02Ⅰ 73

陳遠(yuǎn)維：醫(yī)家要有“割股之心”

◎李善舉

優(yōu)秀的民間中醫(yī)，是散落在人世間的珍珠。陳遠(yuǎn)

維無(wú)疑是貴州遵義地區(qū)最耀眼的那顆，他光芒四射，

像一位與世無(wú)爭(zhēng)的大德隱者，默默護(hù)佑一方基層百姓

的健康。

藥好、方好、療效好

陳遠(yuǎn)維給自己取的微信名是“黔北丐醫(yī)”，意為

專給普通老百姓看病的民間醫(yī)生。但是他的患者不僅

僅普通老百姓多，身居省城、京城的“達(dá)官貴人”也

很多，還有眾多慕名而來(lái)的德、意、日、美、韓等外

國(guó)患者。

陳遠(yuǎn)維雖身處民間鄉(xiāng)野，但他以滿足老百姓健

康需求為己任，在醫(yī)療和藥物方面保持與時(shí)俱進(jìn)。傳

統(tǒng)的中藥煎熬麻煩，湯藥難以下咽，陳遠(yuǎn)維就購(gòu)買引

進(jìn)現(xiàn)代化的西藥制藥設(shè)備，把中藥原料制成膠囊和藥

片等中成藥。走近他的藥房，猛一看，滿眼是類似西

藥的小瓶、盒子，讓人以為是西藥，仔細(xì)一看，竟全

是由中藥原料制成的西藥狀中藥片。他根據(jù)病人病情

的不同，把不同的中成藥進(jìn)行組合后，給患者使用。

不要小看了這些手工制作的中成藥，其實(shí)都是在經(jīng)方

的基礎(chǔ)上增減藥味制成，別看模樣普通，但都在延續(xù)

中國(guó)傳統(tǒng)醫(yī)學(xué)的血脈。以治療感冒為例，中醫(yī)分風(fēng)寒

感冒和風(fēng)熱感冒，但是不論是治療風(fēng)寒感冒還是風(fēng)熱

感冒，陳遠(yuǎn)維只用數(shù)種中藥原料合成的藥片，讓患者

在感冒初期吃幾片，就能很快見效，他這里沒(méi)有“治

療感冒需要一周時(shí)間”的說(shuō)法。2020年春季，新冠疫

情暴發(fā)時(shí)，陳遠(yuǎn)維讓鄉(xiāng)親們用這種藥片預(yù)防感冒，效

果極佳。陳遠(yuǎn)維的這種做法，既完整保留了中醫(yī)個(gè)性

化量身定做的開藥優(yōu)勢(shì)，還加進(jìn)了西藥“清清爽爽”

的優(yōu)勢(shì)。在中醫(yī)藥優(yōu)勢(shì)不打折的同時(shí)，加進(jìn)了西藥的

亮點(diǎn)。既克服了西藥普適大眾化沒(méi)有針對(duì)性的缺點(diǎn)，

還克服了中醫(yī)難熬難吃的缺點(diǎn)。而對(duì)于那些會(huì)煎藥、

愿意煎藥的患者，則還是會(huì)開出傳統(tǒng)的草藥湯劑。與

別的地方的中藥材不同的是，陳遠(yuǎn)維這里的中藥材大

多數(shù)是家人和弟子們?cè)谏嚼锩娌赏诙鴣?lái)，或是從原始

森林附近村民的手中收購(gòu)而來(lái)。他囤積的中草藥，裝

滿了近千平米的庫(kù)房。藥好，方好，療效好，加在一

起，成為陳遠(yuǎn)維醫(yī)生的“法寶”。

你好、他好、大家好

中醫(yī)是全科醫(yī)生，陳遠(yuǎn)維是全科醫(yī)生的典型代

Outstanding medical experts ｜杏林英才

74 Ⅰ2020/02

臨床名醫(yī)｜Clinic Specialist

表，并不能說(shuō)他不擅長(zhǎng)看哪種具體疾病，然而，從常

見中醫(yī)的內(nèi)、外、婦、兒，到諸如心臟病、高血壓、

腫瘤等疾病，他都可以治療。效果還讓人贊嘆。為了

方便遠(yuǎn)道而來(lái)的患者就醫(yī)，陳遠(yuǎn)維把綏陽(yáng)郊區(qū)的一些

閑置的房子改裝成類似旅店的風(fēng)格，并配套了廚房用

具，患者可以自己動(dòng)手做飯菜，還可以和陳遠(yuǎn)維一家

人一起進(jìn)餐。陳遠(yuǎn)維把這個(gè)地方稱之為“天源康養(yǎng)中

心”。很多地方的康養(yǎng)中心，是當(dāng)事者策劃誕生，而

他的這個(gè)康養(yǎng)中心，是為了滿足患者需要，自然而然

地生成，真是你好，他好，大家好。

進(jìn)入20世紀(jì)90年代以來(lái)，全球人口老齡化日趨嚴(yán)

重。相關(guān)數(shù)據(jù)顯示：2016 年，我國(guó) 60 歲及以上人口占

總?cè)丝诘?13.26%，比 2000 年高出 2.93%，慢性病患

病老年人和空巢老年人人口數(shù)量在 2013 年均突破 1 億

人大關(guān)。相關(guān)機(jī)構(gòu)預(yù)測(cè)，2025 年我國(guó) 60 歲以上老年

人口將達(dá)到 3億，成為超老年型國(guó)家。然而，我國(guó)養(yǎng)

老市場(chǎng)還沒(méi)有形成一個(gè)規(guī)范性的體系和模式。陳遠(yuǎn)維

的康養(yǎng)中心，給后來(lái)者提供了有益的借鑒經(jīng)驗(yàn)。

在我國(guó)，人們常把康養(yǎng)和養(yǎng)老產(chǎn)業(yè)劃等號(hào)，養(yǎng)老

產(chǎn)業(yè)基本是存在三大類型：家庭養(yǎng)老、社區(qū)養(yǎng)老和機(jī)

構(gòu)養(yǎng)老。主要模式為“醫(yī)養(yǎng)結(jié)合”“康養(yǎng)結(jié)合”“醫(yī)

康結(jié)合”三種?！搬t(yī)養(yǎng)結(jié)合”實(shí)現(xiàn)了醫(yī)療和養(yǎng)老服務(wù)

的對(duì)接，但是對(duì)于一些半失能、失能老年人的后期康

復(fù)治療卻不完善；“醫(yī)康結(jié)合”，由于其服務(wù)地點(diǎn)通

常在醫(yī)療機(jī)構(gòu)和康復(fù)機(jī)構(gòu)，沒(méi)有融入老人的日常居家

養(yǎng)老生活中，并缺乏養(yǎng)老生活的服務(wù)、設(shè)施和環(huán)境，

所以也無(wú)法滿足“養(yǎng)”的需求；“康養(yǎng)結(jié)合”，由于

缺乏專業(yè)醫(yī)療機(jī)構(gòu)的醫(yī)生團(tuán)隊(duì)和醫(yī)療設(shè)施，患病老人

往往無(wú)法得到及時(shí)的診治。鑒于上述，陳遠(yuǎn)維把“醫(yī)

養(yǎng)結(jié)合”“康養(yǎng)結(jié)合”“醫(yī)康結(jié)合”三種模式整合在

一起，構(gòu)成了“醫(yī)康養(yǎng)”一體化模式。這一模式解決

了醫(yī)院不能養(yǎng)、養(yǎng)老院不能醫(yī)、家庭無(wú)法護(hù)的難題。

安命立業(yè)一生的法寶

陳遠(yuǎn)維跟中醫(yī)結(jié)緣，是偶然當(dāng)中的必然。陳遠(yuǎn)維

憑借中醫(yī)藥安命立業(yè)，有他的法寶。這法寶就是他學(xué)

醫(yī)之初母親教導(dǎo)他的一席話。

陳遠(yuǎn)維的上面還有個(gè)哥哥，比他大十歲，上世紀(jì)

50年代初，從西南革命人民大學(xué)政治系剛剛畢業(yè)，就

患了支氣管肺癌。當(dāng)?shù)卣退母绺缛ケ本┊?dāng)時(shí)最

好最好的醫(yī)院治療，但最終還是不治身亡。

陳遠(yuǎn)維的外祖父叫翁古秋，是解放前和解放初期

時(shí)成都的名中醫(yī)，知道這件事后，和陳遠(yuǎn)維的母親建

議，讓陳遠(yuǎn)維去跟他學(xué)中醫(yī)。

陳遠(yuǎn)維去成都學(xué)醫(yī)之前，母親把他叫到床面前，

問(wèn)他是否知道,醫(yī)家要有“割股之心”。陳遠(yuǎn)維搖搖

頭。母親就給他講這個(gè)典故的出處：古時(shí)候，有位老

中醫(yī)，病人請(qǐng)他診治。醫(yī)生開出的藥方中有一味藥引

子——“人肉”。醫(yī)生怕病人找不到人肉，就把自己

腿上的肉割了一塊下來(lái)，給這個(gè)患者家屬用。醫(yī)家要

有“割股之心”的說(shuō)法，就是從這時(shí)開始有的。母親

對(duì)陳遠(yuǎn)維說(shuō)：“今天給你講這個(gè)典故，并不是希望以

后你把自己的肉也割了給病人做藥引子，是要你記住

一點(diǎn)，學(xué)醫(yī)先學(xué)德，醫(yī)生要和病人有一個(gè)換位思考，

坐在病人的位置上思考問(wèn)題。那么，病人會(huì)想些什么

問(wèn)題呢？三個(gè)問(wèn)題：一，希望把病治好。二，希望好

快一點(diǎn)。三，希望錢省一點(diǎn)。如果說(shuō)你學(xué)醫(yī)的目的，

是想把技術(shù)學(xué)到手后，把病人兜里的錢搞到自己兜里

來(lái)，你永遠(yuǎn)不會(huì)是個(gè)好醫(yī)生?！蹦赣H對(duì)陳遠(yuǎn)維的教

導(dǎo)，影響了他的一生。今天，所有的病人見到陳遠(yuǎn)

維，就像是見到久別重逢的親人。

人生至暗時(shí)悟道

青年時(shí)期的陳遠(yuǎn)維被關(guān)過(guò)兩年禁閉。那是文化

大革命時(shí)期，到處是大字報(bào)，大放大鳴。陳遠(yuǎn)維在寫

“毛澤東思想萬(wàn)歲”時(shí)，出現(xiàn)了筆誤，少寫了一個(gè)

“東”字，被人念成“毛澤思想萬(wàn)歲”，由于貴州方

言中“毛澤”和“茅廁”的發(fā)音相似，陳遠(yuǎn)維被關(guān)押

了起來(lái)，一關(guān)就是兩年。這兩年中，除了能看哲學(xué)書

和醫(yī)書外，精神世界幾乎與世隔絕。在這兩年中，陳

遠(yuǎn)維再次深研了《傷寒論》之類的中醫(yī)經(jīng)典著作，并

且深入學(xué)習(xí)了馬克思主義、毛澤東思想等相關(guān)理論著

2020/02Ⅰ 75

作。他發(fā)現(xiàn)用哲學(xué)觀念來(lái)學(xué)習(xí)、研究和運(yùn)用中醫(yī)，受

益頗深。

有人問(wèn)陳遠(yuǎn)維：因?yàn)樯賹懸粋€(gè)字被關(guān)了兩年，內(nèi)

心是不是充滿了仇恨？他發(fā)自內(nèi)心真誠(chéng)地說(shuō)：沒(méi)有。

他表示，如果不是這兩年，他不會(huì)有這么充裕的時(shí)間

“深研中醫(yī)”，并“深研哲學(xué)”。在別人看來(lái)，這兩

年是牢獄之災(zāi)，對(duì)他而言，這兩年是“修道”的黃金

時(shí)間，尤其是成功地“得了道”。

現(xiàn)在的陳遠(yuǎn)維，除了有自己的“天源康養(yǎng)中

心”，還有一個(gè)天源酒廠。他的九九天源酒在上世紀(jì)

90年代，曾與當(dāng)今蜚聲海外的貴州茅臺(tái)酒齊名，不僅

是一些地方政府機(jī)構(gòu)指定用酒，還在香港地區(qū)熱銷。

天源酒之所以在那時(shí)受到如此熱捧，是因?yàn)檫@款酒助

力中國(guó)國(guó)家舉重隊(duì)在諸多重要賽事中取得了前所未有

的好成績(jī)。1995年，國(guó)家舉重隊(duì)處于低谷期，成績(jī)徘

徊不前。經(jīng)國(guó)家體委相關(guān)人士介紹，天源酒的釀造者

陳遠(yuǎn)維先生贊助了國(guó)家舉重隊(duì)這款酒。國(guó)家舉重隊(duì)首

先將酒送到國(guó)家興奮劑檢測(cè)中心進(jìn)行興奮劑檢測(cè)，其

結(jié)果是天源酒不含任何興奮劑、激素和抗生素等，符

合運(yùn)動(dòng)員飲用的嚴(yán)格要求。隨后，國(guó)家舉重隊(duì)進(jìn)行了

一個(gè)月的試驗(yàn)，當(dāng)時(shí)數(shù)十名男運(yùn)動(dòng)員全部參加了試

驗(yàn)，單項(xiàng)成績(jī)運(yùn)動(dòng)員普遍提高了5～10公斤！隨后在

1995年底舉行的廣州世界舉重錦標(biāo)賽上，獲得了五

金、五銀、六銅及團(tuán)體總分第一的好成績(jī)，取得了歷

史性突破！之前國(guó)家舉重隊(duì)的成績(jī)是團(tuán)體第九名。國(guó)

家舉重隊(duì)充分肯定了飲用天源酒的三大作用：一是隊(duì)

員入睡快，睡眠正常了；二是對(duì)恢復(fù)訓(xùn)練疲勞，對(duì)第

二天堅(jiān)持大運(yùn)動(dòng)量訓(xùn)練起到很好作用；三是對(duì)增加運(yùn)

動(dòng)員肌肉力量訓(xùn)練起到很好作用。在天源酒的助力

下，國(guó)家舉重隊(duì)在1996年亞特蘭大和2000年悉尼奧運(yùn)

會(huì)上取得了輝煌的成績(jī)。

陳遠(yuǎn)維先生從沒(méi)有把自己當(dāng)成造酒人，更沒(méi)有把

自己當(dāng)成一個(gè)商人，因?yàn)樗X得自己的真正身份是醫(yī)

生，理應(yīng)懸壺濟(jì)世，天源酒只是他治病救人的利器之

一。相關(guān)研究發(fā)現(xiàn)，天源酒中含有8種人體必須的氨

基酸和11種非必需氨基酸，其中精氨酸具有提高淋巴

細(xì)胞、吞噬細(xì)胞活力的作用，能激活細(xì)胞細(xì)胞免疫系

統(tǒng)，調(diào)節(jié)免疫功能。

天源飼料添加劑和天源飼料是陳遠(yuǎn)維先生研發(fā)

天源酒時(shí)的副產(chǎn)品。飼養(yǎng)試驗(yàn)在研究所實(shí)驗(yàn)養(yǎng)殖場(chǎng)以

雞、豬為對(duì)象進(jìn)行。試驗(yàn)結(jié)果表明，單體增重相似或

高于現(xiàn)有配合飼料和農(nóng)家常規(guī)飼料；畜禽肉質(zhì)具有明

顯優(yōu)勢(shì)，抗病變能力強(qiáng)；肉、蛋口感鮮、香，肉質(zhì)緊

密細(xì)嫩，豬肉皮薄、瘦肉多、肥肉少、蛋殼薄。 試驗(yàn)

結(jié)果表明，所研制的TY-I型TY-II型功能型復(fù)合飼料

達(dá)到了預(yù)期的五項(xiàng)目標(biāo)。

天源飼料添加劑和天源飼料知道的人并不多，這

個(gè)因研發(fā)天源酒而誕生的兩個(gè)“寶貝”待字閨中已經(jīng)

有二十年，陳遠(yuǎn)維期待有緣人來(lái)珠聯(lián)璧合，結(jié)秦晉之

盟，從而造福于民，創(chuàng)造更大的社會(huì)價(jià)值。

結(jié)語(yǔ)

陳遠(yuǎn)維很普通，但是陳遠(yuǎn)維又不普通。他從沒(méi)有

說(shuō)過(guò)要對(duì)中醫(yī)進(jìn)行繼承和創(chuàng)新，但是他自然而然、潤(rùn)

物無(wú)聲地對(duì)中藥進(jìn)行了繼承和創(chuàng)新。沒(méi)有相關(guān)機(jī)構(gòu)對(duì)

他進(jìn)行表彰，但是他深得全國(guó)患者的厚愛。在醫(yī)生這

個(gè)角色之外，他有屬于自己的酒廠、豬場(chǎng)、雞場(chǎng)。母

親在他小時(shí)候說(shuō)的“割股之心”的典故，讓他安身、

立業(yè)、立德。既成就了自己，也福澤了他人。

Outstanding medical experts ｜杏林英才

76 Ⅰ2020/02

臨床名醫(yī)｜Clinic Specialist

Zhang Jinbo, Chinese medicine has the effect of "covering the

cup" in treating insomnia

◎Li Shanju

Insomnia refers to sleep disorders, which is a

common physical and mental illness of modern people

in modern society. Traditional Chinese medicine in the

motherland calls insomnia "not looking at sight" or

"insomnia". Insomnia is not only high in the elderly,

but also common in middle-aged men and middle-aged

women in cities, which seriously interferes with people's

normal work and life. Zhang Jinbo is the director of the

"Preventive Treatment" Center of Yantai Hospital of

Traditional Chinese Medicine and a special clinical expert

of Chinese medicine at Beijing University of Chinese

Medicine. He has won praise and trust from many patients

in treating insomnia. Zhang Jinbo has proved with a lot of

clinical practice: TCM has the effect of "covering the cup"

in treating insomnia.

Don't use jujube seed as a "sedative" medicine

When Zhang Jinbo came to the Traditional Chinese

Medicine Clinic of Beijing University of Traditional

Chinese Medicine from Yantai, there were very few

patients in the clinic. However, since the treatment of a

long-term insomnia Tianjin aunt, the number of patients

has begun to surge, and one third of the outpatients are

insomnia patients.

This 70-year-old woman in Tianjin has had insomnia

for more than 30 years. She has been using sleeping pills

for a long time to fall asleep at night. As she gets older,

her insomnia becomes more and more serious. As long

as there are new sedatives on the market, this aunt will

become the first group of drug users. Before receiving

Zhang Jinbo's treatment, Tianjin aunt will not only take

the latest sedatives but also antidepressant drugs. In the

words of Tianjin Auntie, sleeping pills have a certain

effect of helping sleep, but they can only be regarded as

maintenance, not as being cured. When Tianjin Auntie's

mood fluctuates, these sleeping pills will be ineffective.

Over the years, Tianjin Auntie has a pale complexion,

her mind is dizzy during the day, she has no energy, she

is forgetful about doing things, she loses her appetite and

loses her appetite when eating, and she is very painful.

Under normal circumstances, it is difficult for her to fall

asleep. After falling asleep, she usually wakes up an hour

later. After waking up, she can't sleep again.

Zhang Jinbo prescribed seven pairs of Chinese herbal

medicines to Tianjin Auntie. The old lady asked before

leaving, "Do my sleeping pills stop?" Zhang Jinbo said,

"Don't stop. You have been dependent on sedatives for so

many years. You can't stop them all at once. After eating

Chinese herbal medicines, slowly reduce the amount."

Aunt Tianjin would like to follow the doctor’s advice.

When the second Chinese herbal medicine worked, she

began to slowly reduce the amount of sedatives. On the

night of the last Chinese herbal medicine, she wanted

to see what would happen if she did not take western

sedatives. Still slept well. The old lady has poker friends,

drinking friends, and patient friends. She shared her joy of

getting a good doctor in a group of patients, who all like

to pass on word of mouth. When Tianjin Aunty returned

to the clinic, she brought seven patients with insomnia to

Zhang Jinbo.

Zhang Jinbo told Qihuang Chuanren's column that

with the popularization of Chinese medicine knowledge,

whether it is Chinese medicine or Western medicine,

2020/02Ⅰ 77

many doctors like to use wild jujube seed to make Chinese

herbal medicine when they encounter insomnia. Some

patients have an effect, but most patients have no effect. .

Why is there no effect in some patients with jujube seed?

Because people are different, the causes of insomnia are

different, and the treatment methods and Chinese herbal

medicine should also be different.

Many Chinese medicine practitioners think that it

is a sedative. Some people even use up to 100 grams of

fried jujube seed to treat insomnia, but it still cannot cure

insomnia. Because wild jujube seed is not a sedative, it

cannot cure all kinds of insomnia. Jujube seed nourishes

liver blood, which can nourish liver yin. The liver

belongs to wood among the five elements. If wood does

not make fire, it will not disturb the mind. If your mind

is not disturbed, people will be at peace, as long as they

are at peace, they will sleep. The ancients used wild

jujube seed to nourish blood, nourish yin and soften the

liver, and prevent the lack of liver yin and blood from

starting a fire. After the fire becomes strong, it disturbs

the mind. This is the principle used by the ancients to

treat insomnia with fried jujube seeds, and it has a certain

range of applications. If jujube seed is used as a sedative,

500 grams of jujube seed is not as sedative as a bottle of

diazepam. One diazepam only costs a penny. How much is

100 g of jujube seed? This is from the economic point of

view. From the point of view of curative effect, it cannot

be considered as a sedative. TCM treatment of insomnia

is not based on sedation. In the treatment of insomnia

with traditional Chinese medicine, only by identifying the

cause of the disease and seeking the root cause can it be

effective.

Mechanism of TCM Differentiation and

Treatment of Insomnia

Chinese medicine believes that insomnia is caused

by the imbalance of yin and yang in the body. But yin and

yang are a big concept in Chinese medicine, and almost

all diseases are caused by the imbalance of yin and yang.

Insomnia is essentially that the yin and yang of the body's

meridians cannot embrace each other. Ancient Chinese

medicine believed that when yang qi enters yin qi, one

will sleep soundly, and when yang qi flows out of yin qi,

one will wake up. When we treat insomnia, we must think

of nourishing yin and restraining yang so that yang can

enter yin.

In the treatment of insomnia in traditional Chinese

medicine, it is necessary to grasp the time period of

insomnia of the patient, and the reasons for insomnia

are different at what time period. Traditional Chinese

medicine has a very fine division of the viscera, such as

heart yin, heart yang, kidney yin and kidney yang, liver

yin and liver yang. Is the patient’s insomnia caused by

the loss of balance between heart yin and heart yang, or

liver yin and liver yang. Whether the loss of balance is

caused by the imbalance of spleen yang and spleen yin, or

the loss of balance between kidney yin and kidney yang,

depends on the patient's pulse image.

Depending on the situation, the prescription

and medicine prescribed by the doctor are different.

Traditional Chinese medicine pays attention to syndrome

differentiation and treatment. Different Chinese herbal

medicines have different prescriptions. There is no

fixed prescription for the disease, and the doctor always

formulates the prescription according to the disease.

Suppose there is a patient with insomnia who wakes

up at 12 o’clock at night and can’t sleep anymore. At

this time, the hour belongs to the Zishi, Zidan, the gall

bladder meridian is in Shaoyang, Shaoyang moves,

causing fire, disturbing the mind and confusion. disturbed.

We treat according to the syndrome differentiation of

Chinese medicine. At this time, Shaoyang fires strong

and Shaoyang is easy to move. We use Chaihu Shugan

Decoction to reconcile Shaoyang. It is to soothe the

liver and relieve Shaoyang, plus some Chinese herbal

Outstanding medical experts ｜杏林英才

78 Ⅰ2020/02

臨床名醫(yī)｜Clinic Specialist

medicines that help sleep, basically a few Chinese herbal

medicines can solve the patient's problem.

The causes of insomnia are different for men and

women, and for old and middle-aged people. Generally

speaking, women who suffer from insomnia should start

with the liver, because most women suffer from spleen

deficiency and liver depression, which will turn into fire

for a long time. Women generally need to relieve the

liver, relieve depression, invigorate the spleen and soothe

the nerves. Men should start with the kidneys, and men

generally suffer from kidney deficiency. The elderly need

to replenish qi and blood.

Zhang Jinbo pointed out that sometimes a word of

the patient is the valuable diagnostic information of the

doctor. For example, patients often dream of fighting or

dueling, which is generally arousing anger. Dreaming

of always flying up, generally considered to be full of

energy, dreaming of always falling from high altitude,

Chinese medicine thinks it is kidney deficiency. Always

dream of some trivial things in life, that is, the spleen is

weak. When thinking too much hurts the spleen, it’s easy

to dream of lingering dreams, and sometimes there will

be dreaming dramas. The dreams I had last night can be

continued tonight from yesterday. This is thinking too

much hurts the spleen. Our Chinese medicine doctors

think it is concerning. Because of the spleen idea, he is

very concerned about some problems. Caring is about

thinking. Traditional Chinese medicine generally uses

the spleen to nourish the heart. At this time, we need to

use Guipi Decoction, which is sad and fearful. We use

different prescriptions. Men always dream about water,

which is usually caused by kidney problems. According to

Chinese medicine, it may be caused by prostate problems

or bladder meridian problems.

However, in the treatment of insomnia, Chinese

medicine is not a panacea. Medication is not as good

as diet therapy, and diet therapy is not as good as

psychotherapy. The so-called psychotherapy is the use of

health rules, such as exercise. In the daytime, try to get

yourself excited and sweat. When you exercise and sweat,

the meridians of your body will open and close. When you

sweat, you will be relieved. When all the meridians are

running smoothly, the energy of the meridians will flow

in and out on time. Yin and Yang can hug each other in

time. Therefore, sweating during exercise during the day

is also a good way to solve sleep problems. This is not a

medicine therapy, this is a traditional Chinese medicine

method, also called natural therapy. As long as you know

how insomnia is caused and find the cause of insomnia,

any method can be used to cure it. There is no fixed

method. Does traditional Chinese medicine have to use

medicine to treat diseases?

Introduction to Zhang Jinbo:

Male, born in 1964, master tutor of Shandong

University of Traditional Chinese Medicine, special clinical

expert of Beijing University of Traditional Chinese Medicine.

He brought into play the theory of "all qi and depression,

all belong to the lung" in the "Internal Classics'', and refined

the dialectical and therapeutic thinking of "declaration

and transparency"; he proposed ten methods of declaring,

transparent, rectifying, opening and closing, and opening and

closing to cure diseases It is believed that the meridians of the

whole body are dependent on the three energizers, attached to

the fur, the lungs are depressed, and the occlusion of the Xuan

Mansion is the main pathogenesis. He authored "Xuanming

Medicine Heart Method''. He put forward the academic view

that the numbness is outside, the dysfunction is inside, the

swelling is inside, and the disease is outside. He invented

the method of picking through the meridian, enriching the

scope of the external treatment method; he declared the

transparent Xuanfu, and used Jinpingmu to treat liver disease

; He proposed that the viscera, blood vessels, meridians, and

limbs also have appearances, and they all have a new view

of the lung owner, and innovated a new theory of "resolving

the appearance and expanding the collaterals". He sits in

expert outpatient clinics in the Traditional Chinese Medicine

Hall of the hospital. There are an average of more than 70

outpatients per day, with a maximum of more than 100

visits. Many medical seekers come from Beijing, Shanghai,

Nanjing, Jinan, Guangzhou, Shaanxi, Chongqing, Northeast

China, Xinjiang and Inner Mongolia. , Overseas Chinese, and

overseas and international friends from the United States,

Canada, Japan, South Korea, etc., have created a huge social

impact on the outpatient service at twelve o'clock in the

morning and even the first afternoon in the first afternoon,

registration, and appointment registration two months ago.

2020/02Ⅰ 79

張金波：中醫(yī)治失眠有“覆杯”之效

◎李善舉

失眠是指睡眠障礙，是現(xiàn)代社會(huì)的一種常見身

心疾病，祖國(guó)傳統(tǒng)中醫(yī)將失眠稱之為“目不瞑”“不

寐”。失眠不僅在老年人群中高發(fā)，在都市里的中年

男性和中年女性群體中，也很常見，嚴(yán)重干擾了人們

的正常工作和生活。張金波是煙臺(tái)市中醫(yī)醫(yī)院“治未

病”中心主任，也是北京中醫(yī)藥大學(xué)中醫(yī)臨床特聘專

家，在治療失眠上，贏得了眾多患者的稱贊和信賴。

張金波用大量的臨床實(shí)踐證明了：中醫(yī)治失眠有“覆

杯”之效。

莫把酸棗仁當(dāng)“鎮(zhèn)靜”藥

張金波初到北京中醫(yī)藥大學(xué)國(guó)醫(yī)堂出診時(shí)，門診

室里的患者十分稀少。然而，自從醫(yī)治了一位從分診臺(tái)

引導(dǎo) 過(guò)來(lái)的長(zhǎng)期失眠的天津大媽之后，患者應(yīng)診量開始

暴增，門診量三分之一的患者都是失眠病人。

一位七十多歲的天津大媽，失眠已經(jīng)有三十多

年了，夜晚入睡長(zhǎng)期以來(lái)用安眠藥維持，隨著年齡的

增長(zhǎng)，失眠越來(lái)越嚴(yán)重。市場(chǎng)上只要有新的鎮(zhèn)靜藥

出現(xiàn)，這位大媽就會(huì)成為第一批用藥人，天津大媽

在接受張金波治療前，不僅吃最新的鎮(zhèn)靜藥，還吃

抗抑郁的藥。用天津大媽的話說(shuō)，安眠藥有一定的助

眠效果，但是只能算是維持，不能算是被治愈。天津

大媽情緒出現(xiàn)波動(dòng)的時(shí)候，這些安眠藥就會(huì)處在失效

狀態(tài)。這么多年來(lái)，天津大媽面色萎黃，白天頭腦昏

沉，渾身沒(méi)有力氣，做事情健忘，丟三拉四，吃飯?jiān)?/p>

來(lái)越?jīng)]有胃口，十分痛苦。她一般情況下很難入睡，

入睡以后，通常是一個(gè)小時(shí)后就醒，醒了之后就再也

睡不著覺。

張金波給天津大媽開了七劑藥，老太太臨走時(shí)

問(wèn)，“我的安眠藥停嗎？”張金波說(shuō)：“你先別停，你

吃這么多年的鎮(zhèn)靜藥，已經(jīng)有依賴，一下子停掉不行，

吃中藥見了效以后，慢慢的減量?！碧旖虼髬屩?jǐn)遵醫(yī)

囑，第二劑藥見效時(shí)，她就開始把鎮(zhèn)靜藥慢慢地減量，

到吃最后一劑中藥的那個(gè)晚上，她想試試不吃西醫(yī)鎮(zhèn)靜

藥會(huì)怎么樣。結(jié)果，她照樣兒睡得挺好。老太太有牌

友、酒友，還有病友。她在一個(gè)病友群中分享了自己得

遇良醫(yī)的喜悅，病友們?nèi)绔@福音。天津大媽復(fù)診時(shí)，一

下就給張金波帶來(lái)了七位失眠病友。

張金波告訴歧黃傳人專欄采訪者，隨著中醫(yī)知識(shí)

的普及，不論是中醫(yī)還是西醫(yī)，遇見失眠患者，很多醫(yī)

生都喜歡用酸棗仁。有的患者用后有效果，但是絕大多

數(shù)患者沒(méi)有效果。為什么不同患者用酸棗仁后的效果不

一樣？答案是致病原因不一樣！那么，遣方用藥也應(yīng)

不一樣！很多醫(yī)生用酸棗仁，覺得它是個(gè)鎮(zhèn)靜藥，甚

至有人治失眠時(shí)炒酸棗仁的用量達(dá)到100克，但是照樣

不能治失眠。因?yàn)樗釛椚什皇擎?zhèn)靜藥，更不能包治各

種失眠。酸棗仁養(yǎng)肝血，肝血能夠滋潤(rùn)肝陰。肝在五

行中屬于木，木不生火，就不擾心神。心神不亂，人

就安。只要安，人就眠。古人用酸棗仁是養(yǎng)血滋陰柔

肝，防止肝不足而生火的，火旺以后呢，擾動(dòng)心神。

這是古人用炒酸棗仁治失眠的道理，它是有一定的應(yīng)

用范圍的。假如把酸棗仁作為鎮(zhèn)靜藥來(lái)用，500克棗

仁它也不如一瓶安定片鎮(zhèn)靜作用強(qiáng)，一片安定片才一

分錢，100克酸棗仁多少錢？這是從經(jīng)濟(jì)上算，從療

效上看，不能認(rèn)為酸棗仁它是個(gè)鎮(zhèn)靜藥。中醫(yī)治失眠

不是以鎮(zhèn)靜為主。中醫(yī)治失眠，只有找準(zhǔn)病因，求根

治本，才會(huì)有“覆杯”之效。

中醫(yī)辨證治失眠的原理

中醫(yī)認(rèn)為，失眠是人體陰陽(yáng)失衡所導(dǎo)致。但是陰

Outstanding medical experts ｜杏林英才

80 Ⅰ2020/02

臨床名醫(yī)｜Clinic Specialist

陽(yáng)在中醫(yī)里面是一個(gè)大概念，幾乎所有的病都是因?yàn)?/p>

陰陽(yáng)失衡所導(dǎo)致。失眠，本質(zhì)上是人體經(jīng)脈之氣的陰

陽(yáng)不能相抱。古人認(rèn)為，陽(yáng)氣入陰氣則寐，陽(yáng)氣出于

陰氣則悟。我們?cè)谥问邥r(shí)，就要想法滋陰斂陽(yáng)，讓

陽(yáng)氣進(jìn)入陰。

中醫(yī)治失眠要抓住患者失眠的時(shí)間段，在什么時(shí)

間段失眠，其病因往往是不同的。中醫(yī)對(duì)臟腑有很細(xì)

的劃分，如有心陰，也有心陽(yáng)，有腎陰也有腎陽(yáng)，有

肝陰也有肝陽(yáng)，患者的失眠癥到底是心陰心陽(yáng)失去平

衡造成，還是肝陰肝陽(yáng)失去平衡造成，還是脾陽(yáng)脾陰

失去平衡造成，還是腎陰腎陽(yáng)失去平衡造成，要從患

者的脈象來(lái)確定。

根據(jù)不同的情況，醫(yī)生開出的方和藥不一樣。中

醫(yī)是講究辨證論治，一方一藥，一癥一藥，病無(wú)定病，

方無(wú)定方，醫(yī)生永遠(yuǎn)是根據(jù)具體病癥來(lái)遣方用藥。比

如說(shuō)有一位失眠患者，夜里12點(diǎn)醒后，就再也就睡不

著了，這個(gè)時(shí)候，時(shí)辰屬于子時(shí)，子膽，膽經(jīng)是在少

陽(yáng)，少陽(yáng)一動(dòng)，生火，擾亂心神，神亂不安。我們根

據(jù)中醫(yī)的辨證，這個(gè)時(shí)候是少陽(yáng)火旺，少陽(yáng)易動(dòng)，我

們用柴胡舒肝湯，和解少陽(yáng)，或者是用小柴胡湯加

減，或者是用四逆散，只要是舒肝和解少陽(yáng)，再稍加

一些有助睡眠的藥，基本上幾付藥就能解決患者問(wèn)

題。

失眠的病因，男女不一樣，老年、中年也不一

樣。一般的女性失眠，多從肝上著手，因?yàn)榕源蠖?/p>

數(shù)脾虛肝郁，虛久化火，女性一般要舒肝解郁、健脾

安神。男人要從腎上著手，男性一般多是腎虛。而老

人則要益氣補(bǔ)血。

張金波指出，有時(shí)患者的一句話，就是醫(yī)生寶貴

的診斷信息。比如說(shuō)，患者常夢(mèng)見打仗或是決斗，一

般是肝火旺盛。夢(mèng)見老是飛騰，一般認(rèn)為是氣盛，夢(mèng)

見總是從高空處墜落，中醫(yī)認(rèn)為是腎虛?？偸菈?mèng)見一

些生活的瑣碎小事，就是脾虛了。多思傷脾，就容易

做夢(mèng)纏綿，并且有時(shí)候會(huì)出現(xiàn)做夢(mèng)連續(xù)劇，昨天晚上

做的夢(mèng)，今天晚上還可以接著昨天的繼續(xù)往下做，這

是思多傷脾，中醫(yī)認(rèn)為病因源于“意”，因?yàn)椤捌⒅?/p>

意”，患者經(jīng)常思考一些問(wèn)題，過(guò)度思慮?！耙狻?，

就是思考，中醫(yī)一般用健脾養(yǎng)心，這個(gè)時(shí)候要用歸脾

湯。悲思憂恐驚，不同情志用方是不一樣的。男性總

是夢(mèng)見水，一般是腎出了問(wèn)題，按照中醫(yī)斷病，可能

是前列腺出了問(wèn)題，或是膀胱經(jīng)出了問(wèn)題。

但是，在治療失眠方面，藥物也不是萬(wàn)能的。藥

療不如食療，食療不如心療。白天想辦法讓自己精神

飽滿，適當(dāng)運(yùn)動(dòng)出汗。一運(yùn)動(dòng)一出汗，全身的經(jīng)脈就

會(huì)處于開合的狀態(tài)，一出汗經(jīng)脈就運(yùn)行通暢了，經(jīng)脈

就會(huì)按時(shí)出入，陰陽(yáng)就能按時(shí)“相生相抱”。因此，

白天運(yùn)動(dòng)出出汗，也是解決睡眠問(wèn)題的好辦法。這不

是藥的療法，這是中醫(yī)療法，也叫自然療法。只要知

道失眠是怎么導(dǎo)致的，找到病根，用什么法都可以

治，法無(wú)定法。難道中醫(yī)治病就一定要用藥嗎？

張金波簡(jiǎn)介

男，1964年生，山東中醫(yī)藥大學(xué)碩士研究生導(dǎo)師，

北京中醫(yī)藥大學(xué)臨床特聘專家。他發(fā)揮《內(nèi)經(jīng)》“諸氣膹

郁，皆屬于肺”學(xué)說(shuō)，提煉了“宣解通透”的辨證論治思

想；他提出宣解、通透、中正、開闔、啟閉治病十法，認(rèn)

為全身經(jīng)脈都依仗于三焦，依附于皮毛，肺氣怫郁，使玄

府閉塞為主要病機(jī)，著有《玄冥用藥心法》。他提出“痹

于外，而痿于內(nèi)，瘕于內(nèi)，而癥于外”的學(xué)術(shù)觀點(diǎn)，發(fā)明

了循經(jīng)挑刺法，豐富外治法的范圍；他宣解通透玄府，佐

金平木治療肝??；他提出臟腑血管經(jīng)絡(luò)及四肢百骸亦有

表，皆有肺所主的新觀點(diǎn)，創(chuàng)新了“解表寬中擴(kuò)絡(luò)”的新

理論。他在醫(yī)院國(guó)醫(yī)堂專家門診坐診，日門診平均達(dá)70多

人，最多可達(dá)100人次以上，慕名求醫(yī)者來(lái)自全國(guó)各地，以

及美國(guó)、加拿大、日本、韓國(guó)等國(guó)家的海外華人和國(guó)際友

人。在中醫(yī)院工作的他，門診掛號(hào)、預(yù)約的人往往排到凌

晨十二點(diǎn)，甚至有的人在前一天的下午來(lái)等號(hào)，臨床療效

讓他擁有巨大的社會(huì)影響力。

2020/02Ⅰ 81

Zhang Jinbo is the director of the "Preventive Treatment" Center of Yantai Hospital of Traditional Chinese

Medicine and a distinguished clinical expert of TCM at Beijing University of Traditional Chinese Medicine. In

addition to patients from all over the country, there are also international friends from the United States, Canada,

Japan, South Korea, etc. This is the huge social impact of the Chinese Medicine Hospital at 12 o'clock in the

morning, even the first afternoon in the outpatient department, equal number, registration, and appointment

registration two months ago. See page for details.

張金波是煙臺(tái)市中醫(yī)醫(yī)院“治未病”中心主任，也是北京中醫(yī)藥大學(xué)中醫(yī)臨床特聘專家，慕名求醫(yī)者來(lái)

自全國(guó)各地，以及美國(guó)、加拿大、日本、韓國(guó)等國(guó)家的海外華人和國(guó)際友人。在中醫(yī)院工作的他，門診

掛號(hào)、預(yù)約的人往往排到凌晨十二點(diǎn)，甚至有的人在前一天的下午來(lái)等號(hào)，臨床療效讓他擁有巨大的社

會(huì)影響力。詳見79頁(yè)。

Cao Dongyi believes that when Chinese medicine goes to the world, it must show its individuality and pay equal

attention to Taoism and art, and cannot use laboratory indicators to restrict its development. "Respect orthodoxy and

strive to innovate" is the instruction given to us by General Secretary Xi, and it is also the call of the times. See page

for details .

曹東義認(rèn)為，中醫(yī)藥走向世界，必須彰顯個(gè)性，道術(shù)并重，而不能用實(shí)驗(yàn)室的指標(biāo)限制自身發(fā)展，不能舍本

逐末，西化中醫(yī)，丟了自己?！笆卣齽?chuàng)新”是習(xí)總書記給我們的指示，也是時(shí)代的呼喚。詳見54頁(yè)。