To do a good job of basic skills, you should read ancient and modern medical books extensively, learn from the experience of others, and then practice them in clinical practice, so that you will continue to improve your clinical skills.
So how do you read the books of the ancients and apply them to clinical practice?
Let's combine my personal experience and talk to you.
1. Remember that the author created his own prescription and is good at clinical tailoring
There are a lot of ancient books of Chinese medicine, and it is impossible and unrealistic to read every book. Therefore, it is important to choose books that are suitable for reading, and the history of the development of each professional course mentions the masterpieces of each era, and these masterpieces are what we want to read.
There are two ways to read.
The first is intensive reading
For example, "Treatise on Typhoid Fever", "Jin Kui Yaolu", "Internal Classics and Knowledge", "External Warmth", "Damp Fever", "Epidemic Rash", "Differentiation of Warm Disease", etc., must not only be familiar with it, but also be able to memorize important articles.
I'm talking about internal medicine, and other departments have masterpieces, such as "Orthodox Surgery" of surgery, "Fu Qing's Main Women's Department", and so on.
Of course, it is best for physicians to read the representative works of each subject, which can enrich their knowledge and broaden their thinking. I won't say much about that.
The second is extensive reading, which is to choose a good reader.
Everyone's experience in reading books is different, but my experience is that when reading books extensively, you should pay attention to the author's own annotations.
Generally speaking, in the ancient books of internal medicine, the content of many books can be said to be repetitive, but the method of annotation is different, that is, the author's views on the experience of predecessors are different, when you have the foundation of the above intensive reading, it is not difficult for you to understand.
But for the author's personal experience, we should pay attention to it, often a doctor, in his life to create so many prescriptions, so in his works will often be self-note, these things, you have to look at these things, and record them, to the clinic to confirm, maybe you will learn the hand.
Let's talk about how I read the book "Medical Mind".
Medical Mind is divided into six volumes, and the main content is just read the book. I spent a lot of time reading this book, and the last thing I learned was a few poems created by Cheng's own poems, which ones? Qi diaphragm powder, treatment of dysentery, cough relief, scrofula pills, plus flavor fragrant Su San. Except for the treatment of dysentery, everyone may be familiar with the others, but can you really use it well in clinical practice?
Let me briefly touch on two of them.
This is undoubtedly a well-known prescription in the field of Chinese medicine. Let's dig deeper into the Zhiyu San described in Cheng's original work. Cheng brilliantly pointed out: "If the external evil qi invades the lungs at first, if the coughing in the lungs continues, then the evil qi will be transferred to the five internal organs, and if the coughing of the five internal organs is not relieved, it will further affect the six internal organs." "This underscores the importance of early **. The ancients said: "A slight cold cough, the cause of coughing, belongs to the wind and cold, nine out of ten." "This tells us that most of the coughs** are wind chills. Therefore, in the initial stage, it is necessary to focus on diverging wind and cold, but it is necessary to avoid excessive divergence and weakening of lung qi. It is specifically mentioned in the book that for cough suppression, if it is used for cough at the beginning of wind and cold, the effect is particularly significant. Many patients feel the wind chill at the beginning, and they only need to take Zhiyusan with ginger soup to quickly relieve the symptoms. However, in practice, we will also encounter some patients, although the cough is caused by wind and cold, but the course of the disease is long, and the effect of using Zhiyusan is not ideal. Such conditions are not uncommon in clinical practice, and even in the case of wind and cold and lung violations, the actual effect of Zhiyusan is not always as miraculous as described in the book. At this point, we need to think about why this is the case. The effectiveness of ancient prescriptions varies from person to person, so when using ancient prescriptions, we should make appropriate additions and subtractions according to the specific conditions of modern patients. For those who have a persistent cough, I usually add chebula. It is mentioned in the "Materia Medica" that Hezi can ** "phlegm cough and shortness of breath", which means that Hezi not only does not have the disadvantages of staying behind closed doors, but can converge lung qi without leaving evil qi. For patients with external cough, if the cough does not heal for a long time, it is often because the lung qi is dissipated. By constricting the lung qi, the addition of chebula can greatly improve the ** effect. This has been proven in our clinical practice. In summary, we have to be flexible when using ancient remedies for modern diseases. Adjust the prescription according to the specific condition of the patient to achieve the best results. This is exactly the concept advocated by Zhu Danxi of "medicine changes with the certificate" and "the certificate heals with the medicine". The treatment of dysentery, as stated in the original prescription, is dedicated to the treatment of dysentery at the beginning, regardless of whether it is red or white. If Coptis chinensis is added, its effect is even better. The materials used in this recipe are simple and simple, and they are nothing more than ordinary medicinal materials: kudzu, Sophora radix, tangerine peel, Chen Songluo tea, red peony, malt, hawthorn. Compared with bitter cold herbs such as peony soup and pulsatilla soup, this recipe is less fierce and a little more mild. So, how effective is this recipe? Under clinical verification, I found that its efficacy is even better than that of peony medicine soup and pulsatilla soup. Combined with modern pharmacological research, we found that Sophora sophora has a good antibacterial effect. In the medical book "China's 100 Hundred Chinese Medicine Clinicians in a Hundred Years" by Li Jiren and Zhang Shunhua, Li Lao used Sophora radix as the main medicine, composed of 5 prescriptions, and used for the treatment of filariasis and urinary tract infection, which further confirmed the anti-inflammatory effect of Sophora radix. In addition, I also learned from the experience of other doctors and used Sophora sophora on the basis of syndrome differentiation** arrhythmia, which also achieved reliable efficacy. Of course, before using it, you need to make sure that it is consistent with the patient's condition and in line with the principle of syndrome differentiation in traditional Chinese medicine. 2. When encountering clinical problems, go to school purposefully
We once admitted a patient with myasthenia gravis, the first symptom was dyspnea, and after half a year of diagnosis and treatment in the affiliated hospital of a medical school, the condition did not improve significantly, and he has been maintained by a ventilator, and later transferred to our hospital, hoping that Chinese medicine can have a curative effect.
After syndrome differentiation, on the basis of Western medicine, the tonic and qi soup was added with the flavors of fairy grass, epimedium and other flavors, and after a few months, the condition did not improve significantly, and finally the patient passed away disappointed.
Why is Chinese medicine ineffective? Is it a medication error or something else? With this question, we flipped through a lot of information and found that Professor Deng Tietao of Guangzhou University of Traditional Chinese Medicine is very experienced in this area, and in the first episode of "The Stone Collection", Deng Lao has a detailed discussion.
After analysis, it was found that our legislation, medication and Deng Lao are basically the same, and there is a big difference in the dosage of medication, Deng Lao uses a large dose of astragalus, is the problem here?
Later, we came across another case of myasthenia gravis, an 8-year-old child with droopy eyelids, weakness of limbs, slurred arthria, poor spirit, pale tongue, thin white moss, and weak pulse. The patient was unable to walk on his own and was carried by his father.
Western medicine is given pyridostigmine bromide, and traditional Chinese medicine is given to tonify Zhongyi Qi Tang plus Xianmao and Epimedium plus or minus, of which 50g of astragalus is used, 1 dose per day. The patient brought the medicine home, and the family showed the prescription to an old Chinese medicine doctor in the countryside.
The old Chinese medicine doctor said that children are pure yang bodies, and astragalus is a yang tonic medicine, and too much dosage may be unfavorable. The patient's family was not at ease, and found Professor Deng Tietao for diagnosis and treatment through the relationship, and Deng Lao read the prescription and said that the original prescription was very good (it can be seen from here that Deng Lao's love for later scholars is not slandered, and he does not easily deny the prescription).It is just that patients are asked to use astragalus to make water instead of tea every morning and evening. What does it mean? The dose of astragalus is not enough! Later, the patient took the prescription for 8 months, and all kinds of symptoms were relieved.
Later, we saw the book "Deng Tietao's Medical Case and Research", which recorded in detail the prescription for successfully rescuing many cases of myasthenic gravis crisis, through analysis, we can safely say that the first idea is very correct, and the reason for the poor efficacy is that the dosage is not well mastered.
Japanese Kampo physician Tanba Motojian said: "The secret of traditional Chinese medicine lies in the dosage. Yashu Michiaki and Fujimoto Kenya said: "The secret of Kampo is unspeakable, that is, in the dose." "Believe it or not! Reading with questions is an important way to learn TCM and improve clinical skills in TCM.
3. Memorize some unique TCM theories and apply them to clinical practice
There are theories that are rarely used in clinical practice, such as ".Lack of qi is cold", everyone is probably most familiar with ".Yang deficiency gives birth to external coldTherefore, when encountering patients with chills in clinical practice, yang deficiency is considered first, don't you know".Lack of qi is coldIf the person who is afraid of cold has evidence of qi deficiency, he can benefit qi and obtain results.
The following is a teacher's ** case, and the theory used is".Evil fire does not kill the valleyWhere did this phrase come from?
From the "Treatise on Typhoid Fever", you may say that there is no such sentence in "Treatise on Typhoid Fever". Hehe, you're not wrong, we really don't have this sentence in the "Treatise on Typhoid Fever" we learned in school, but if you go to the "Treatise on Typhoid Fever" article included in "A Thousand Golden Prescriptions", you will find this sentence.
A patient had diarrhea for 2 years, and he had seen traditional Chinese and Western medicine in many places across the country, but it was ineffective, and he was later treated. Symptoms include warmth in the limbs, chills in the body, abdominal pain and diarrhea, post-diarrheal pain reduction, loose stools, several times a day, dry mouth and hot drinks, light tongue, thin white moss, and heavy pulse. A symptom of spleen and kidney yang deficiency.
Looking ahead, the four god pills, real people raise dirty soup, Shenling Baizhu powder, etc.
From the dialectical point of view, it is basically correct, why is it invalid?
If you think about it for a long time, you will have the disease of hiding adultery alone. So I asked carefully, and found that the patient's stool was loose but extremely foul. I understand, there is heat inside, yin and yang are not connected, and yang is depressed inside, so there is a cold outside. There is evil heat within,"Evil fire does not kill the valleyThe evil heat is not less fire (physiological fire), and it cannot digest the water valley, so there is an accumulation that stops inside, dispels its accumulation, regulates the stomach and Chengqi decoction, and cures the disease after a few doses.
There are many patients with heart failure in clinical practice, limb swelling, ascites, pleural effusion, wheezing, this situation is very common, but patients often have a dry tongue without lichen, or a red tongue without lichen. The general syndrome differentiation is yin deficiency and water stoppage, and it is commonly used to add Siling San, Sijiqing, Yaoli Zi, etc., to nourish yin and water and diarrhea lungs, but it is often difficult to achieve good curative effects, why?
Looking at the patients with edema, they are generally warm, cold, drinking little water or having a harmonious mouth, etc., which is a symptom of yang deficiency, and doctors who have worked for a long time in the cardiology department may have experienced.
There is a similar case in "The Case of Dr. Wang Mengying", Wang thinks that when the tongue is abandoned, why? Wang believes that the dry tongue without moss or the tongue is red without moss, not because of yin deficiency, but because the water blocks the qi and cannot be spread on the tongue.
On further reflection, I think Wang's theory has unique insights and is in line with clinical practice. However, the formation of edema is due to the subtlety of Mizutani not being normalized, and the lack of fluid still exists objectively, so I often choose itThe whole truth in "The Secret Record of Feng's Tips".The party consists of:It is composed of appendages, ginseng, rehmannia rehmannia, wheat winter, atractylodes, hyssop, and schisandra, which have the functions of nourishing qi and returning to yang, strengthening and nourishing yin, and absorbing vitality.
In clinical practice, on the basis of this formula, Guizhi is often added to Tongyang Qi, and a dose of Cornus officinalis is added to collect vitality, and Astragalus membranaceus is combined with Poria cocos to strengthen the spleen and benefit water, and practice has proved that the clinical effect is very satisfactory.
Traditional Chinese medicine ** internal wind mostly follows the "Neijing".All winds and dizziness belong to the liverIt is said that the wind is mostly started from the liver, or to clear the liver heat to relieve the wind, or to calm the liver and yang to relieve the wind, or to nourish the liver and yin to relieve the wind, or to nourish the liver and blood to relieve the wind.
But for ADHD, it is often difficult to take effect, why? Pediatrics".The spleen is often insufficientFor this case, if you only nourish the liver yin to breathe the wind, it is difficult to have curative effect, and its treatment should be "sought from the root".In the spleen prescription, it is slightly supplemented with the product of relieving the wind, which can often be effective and accidental, which is called "in the ancient medical books".Dirt and wood shake"Clinical application of theory.
Another example is that canker sores cannot be cured for a long time, and we propose according to the "Moral Grass".Thick earth and fire"Method, using Lizhong pills**, often obtain satisfactory results.
When I read the book, I saw some unique theories that cannot be ignored, and these theories often have important guiding significance in clinical practice.
Fourth, students should be good at comprehensively applying the knowledge they have learned
Reading should be learned and put into practice, not dead books, and what you have learned should be connected and applied, otherwise, you can only become a bookcase at most, and it is difficult to improve clinical skills.
How to get through? That is to say, whether you are studying or seeing a doctor, you have to integrate what you have learned and analyze the problem.
Now let's take a look at a medical case of Wu Jutong, please analyze why it is called the lung opening method?
Dow, 68 years old. The left limb is spasmal, the tongue is thick and unable to speak, there is white moss on it, dripping water cannot be swallowed, and drinking water is choking. This empirical evidence of stroke and phlegm is that the previous doctor made a mistake and was tired of medicine to replenish yin, so the tunnel was blocked, and the lungs were opened first. Four taels of raw gypsum, four coins of almonds, five coins of fresh mulberry branches, five coins of Yunling blocks, five coins of self-defense, five cents of Baitongcao, five coins of ginger Banxia, and three coins of Guangpi. ("Wu Jutong Medical Case: Stroke").
We will now analyze this case, which has pointed out that "the empirical evidence of this stroke containing phlegm is the mistake of the previous doctor and the greasy medicine to replenish the yin, so the tunnel is blocked." "From the tongue image, medication history and Wu's prescription, we can see that the main pathogenesis of the disease is damp heat and phlegm obstruction, where does damp heat and phlegm come from? The former doctor gave "greasy medicine to replenish yin" and caused the middle anxiety to be obstructed, damp and hot endogenous, damp depression and phlegm. **The key is to dispel dampness and clear heat.
For damp heat**, it is clinically tricky, why? What did the ancients say about dampness and heat that are difficult to treat? Treating dampness and heat is like peeling off the cocoon, removing layer after layer. Dryness and dampness will hurt yin and help heat, clearing heat will easily hurt yang, dampness is yin and evil, and yang injury is not conducive to dispelling dampness. What to do?
**First of all, it is necessary to separate the heat from the dampness, and first remove the dampness. The method of separation and elimination is mostly used to treat dampness, that is, Xuan, dry, and seepage. Wu's prescription has a total of eight flavor medicines, of which there are five flavors that directly treat dampnessPoria cocos, self-defense, and Baitong grass are damp in the bottom, tangerine peel and banxia are dry and damp in the middle (both dry phlegm at the same time), only a gypsum clears heat, and only a mulberry branch is used to pass the channel.
Why use almonds? Sanren soup is very clearAlmonds are bitter and warmGood at opening the upper coke, Xuantong lung qi, the lungs are the main body of the qi, and the vaporization is also wet. Xuan Lung is also to open Xuan Lung Qi, so Wu called this method "Open Lung Method".
Damp and hot, the tunnel is self-open, not through the meridians, and the meridians are self-smooth. In fact, Wu's prescription was cut from Sanren Tang and incorporated into the recipe of Poria Cocos Drink from Waitai.
The person who is the most proficient in the history of Chinese medicine may be Wu Jutong, who simply reads a three-focal syndrome differentiation from the "Clinical Guide to Medical Cases", if you don't believe it, look at the "Clinical Guide Medical Cases", and then look at the "Warm Disease Strips", you will find that most of the prescriptions created by Wu are taken from the former.
Hehe, so Wang Mengying looked down on Wu Jutong the most, saying that his things were copied, and he did not quote a clause in "Warm Illness Article" when he wrote "Warm Jingwei". Wu's copy, is the result of the good mind, he is up and down for 5,000 years, the last of the top ten doctors of Chinese medicine, his medical status is comparable to Wang Meng Ying!
I chose this case just to see if we can think about the relationship between phlegm, dampness, and heat, the ** law of dampness, and the commonly used dampness treatment formulas.
Reading and clinical practice must learn to integrate the knowledge learned together to analyze problems, and if you can do this, your clinical level will definitely improve quickly.
Another point is to tell everyone not to forget to open their lungs to cure dampness!
Here's a case study to see if you've made progress in this area.
A woman, teacher, in her 50s. On the spring day of the illness, the onset of wind and cold is felt, and the symptoms are fever (body temperature 395) Chills, headache, aching limbs, dry mouth, slightly bitter, pale red tongue, pale moss, floating pulse. The syndrome is characterized by the external feeling of wind, cold and dampness, and the internal heat is contained, so the nine-flavor Qiang living soup is used. After taking 1 dose of medicine, the fever subsided, the chills were removed, and the pain in the limbs was relieved. However, the patient has unbearable pain in both eyesWith the head against the wall, the mouth is dry and the mouth is bitter, and the pulse is stringy. Then he took gentian laxative liver soup and antelope horn, and 1 dose of symptoms was flattened.
Let's think for ourselves first, think about why there is eye pain after using Jiuwei Qianghuo soup?
Why does a symptomatic patient change hands so quickly from the solution to the prescription to clear the heat of the laxative?
Don't rush to see my analysis. This case was diagnosed and treated by Mr. Xiong Jibai, a well-known Chinese medicine expert in China.
Now let's analyze why using Jiuwei Qianghuo soup will cause eye pain.
Women take the liver as the innate foundation, and there are clouds in ancient times, "people are over forty, and yin qi is half".Women are more than half a hundred years old, yin blood is particularly insufficient, liver meridian yin blood deficiency, then liver yang is easy to hyperactive, coinciding with spring, it is the time when the liver qi rises, the pungent and warm divergent products are more likely to rise, and it is most likely to drive the liver yang upwardTherefore, after using the Jiuwei Qianghuo soup with the divergence of pungent and warm, although the wind and cold can be solved, the liver yang also rushes up with the divergence of pungent and warm, and the liver opens up to the eyes, so the eye pain is unbearable.
The evidence has been solved, and the evidence is all the evidenceThe key to the disease lies in the upward flushing of liver yang, so the gentian laxative liver decoction and antelope horn are effective in clearing the liver yang. These methods are not possible for those who have not learned enough!
We've learned all of these theories, can you also integrate them?
People who do Chinese medicine should be good at thinking, and in clinical practice, they should be good at synthesizing the knowledge they have learned from reading books and analyzing their conditions, only in this way will you become a good doctor!
**10,000 Fans Incentive Plan