"Healer, art". The correct prescription can reflect the skill level of the doctor's diagnosis and treatment. For example, the selection of medicines, the weight of the quantity, the compatibility of the fit and the focus on the effectiveness should be carefully considered. Only when there is a prescription and a prescription and a prescription that the evidence is compatible, can it be effective. The doctor commands, you must know. However, it has been observed that this is not the case in some clinical situations, and there are "three failures" in prescription drugs, which should be corrected.
Overcome the "three losses".
In TCM prescriptions, there are three main misunderstandings, which lead to the irrational use of drugs and the decline of the best effect. First of all, there is too much to lose. Some doctors like to pile up drugs when prescribing, and a prescription is often composed of more than a dozen or even dozens of flavored medicines, and it seems that they want to achieve the best purpose through large doses of drugs. This "shotgun technique" style of prescription makes the effect of the drug dispersed, and it is difficult to exert the desired effect. In addition, such large doses of prescriptions are also prone to drug waste and may even cause unnecessary burden on the patient's body. Secondly, it is lost in general. Some doctors prescribe too widely and do not grasp the main symptoms of the disease and **, but blindly use various drugs. This "big platter" type of prescription method not only fails to give full play to the best effect of the drug, but also may lead to adverse reactions due to drug interactions. In the end, it's not a fee. As a result of the above two misconceptions, there is a waste of drug use. This waste not only increases the financial burden on the patient, but also can lead to poor results due to untargeted prescriptions. In the long run, patients' confidence in TCM will gradually decrease, and the position of TCM will also shrink as a result. In order to overcome these misunderstandings, doctors should follow the principle of "simple, accurate, and light" when prescribing. The simple medication is simple and clear, and the accurate and accurate grasp of the disease and symptoms, that is, the appropriate dosage of the drug. Only in this way can we truly give full play to the efficacy of traditional Chinese medicine and benefit more patients. 
Implement three reforms
In the field of medicine, we often face many challenges, the most critical of which is how to transform the complicated means, the wide range of drugs and the high cost into a simple and effective solution. This requires us to take the principle of "less, accurate, and economical", that is, to achieve the best results with the least drugs, the most accurate diagnosis and the most economical way.
"Less" is not only a means, but also a manifestation of academic level. It requires doctors to be able to make accurate judgments in the face of diseases and not blindly use too many drugs. Because the overuse of drugs will not only increase the financial burden of patients, but also may bring unnecessary information, doctors need to have deep medical knowledge and rich clinical experience in order to accurately judge and formulate the most simple plan.
And "quasi" is the guarantee of clinical efficacy. In the process of diagnosis and diagnosis, doctors must accurately grasp the essence of the disease in order to formulate the most effective plan. This requires doctors to clarify the type and degree of the disease in the process of syndrome differentiation and treatment, grasp the essentials of the disease, and rigorously formulate the best plan. Only in this way can the effectiveness of ** be ensured and unnecessary ** and drug abuse can be reduced.
Therefore, doctors should deeply understand the nature of the disease, clarify the differentiation of syndromes, grasp the essentials of the disease, and formulate a rigorous and simple plan with "quasi" as the core. This requires doctors to have profound medical literacy and rich clinical experience, in order to "know the essentials, more and no miscellaneous; Those who don't know what they want are less and not specialized." At the same time, doctors should also participate in the "main and auxiliary envoys, seven emotions and harmony", and comprehensively consider the best plan to ensure the maximization of clinical efficacy.
It is intended to use five tricks
1.Change the dosage of medicine.
The severity of the medicinal dosage is directly related to the layout of the prescription and the efficacy of the formula. It is often said that some people like to use light, and some people like to use heavy, which is not appropriate. Wu Youke said: "There are different degrees of delay and severity, and there are many kinds of medicines. "Light and important according to the disease and the main and auxiliary needs of the group, **, not determined by likes and dislikes, otherwise it will lose its meaning. It has been observed that the dosage of medicine used by doctors in the south of China is lighter, and the dose in the north is heavier. For these doctors who like to use light doses, ask why? He replied: "Light can be realized." There are certain limitations to this statement. For example, "the upper focus is like a feather, not light", generally refers to the sweating table, it cannot be said that all diseases can be solved by "light can be dispelled", so it does not have universal significance.
Reading ancient medical books, heavy medicine also has the effect of heavy medicine, fine prescription heavy medicine, force full-time Hong, often can "go to the evil qi before the defeat of righteousness, so as not to tolerate the disease and recuperate" (Liu Heyi). Every time the clinical certificate is seriously ill and the medicine is light, it is a drop in the bucket and delays the "fighter"; It is not advisable to take light illness and severe medicine, and if the medicine passes through the sick place, it will hurt the true element. There is also a prescription format that is often seen in a puzzling format. That is: 4 herbs 10g 3 rows, 12 herbs, the dose is evenly spread. In this way, it is impossible to know oneself and know the other, the combination of the main and auxiliary, the skill is not specialized, the natural disease is not accurate, and the use of it will not be able to play its due effect!
In short, the dosage of medication should be clever, should abide by the "three factors" of the rule, according to the individual situation of the patient, the severity of the disease, the urgency of the specimen, the beginning and end of the course of the disease, the season and the special properties of the drug, to grasp the dose, when the light is light, when the heavy is heavy and the heavy prescription is heavy, in order to make up for the deviation and remedy the disadvantages, each is appropriate. Only in this way can we conform to the objective law of dialectical argumentation. Medical critic Nippon Du Benxi said: "The secret of Kampo is that it is in the dose." "Definitely.
The dosage technique is very wide, and it is also determined by the inherent properties of the drug itself. Generally, the dose of mosaic and leaf species should be light, and the dose of mesolites should be heavy; The dose of aromatic should be light, and the dose of wood should be heavy. The above is based on experimental tips, clinical observations and experiences, to name a few.
2. Choose multiple drug effects.
Clinical prescription, we must also pay attention to the needs of adapting to a special disease, try to select a drug with multiple uses, and take care of the main syndrome, and take care of the syndrome group with more complex syndromes, that is to say, take one drug and take multiple effects. Such a fateful medicine can get twice the result with half the effort, and it will be effective in one fell swoop. For example:
Cassia seed: clear the liver and eyes, and relieve fire and laxative. It is mainly used for the treatment of constipation in the elderly, if it is accompanied by hyperlipidemia, hypertension, coronary heart disease, early arteriosclerosis and other diseases, it should be the first choice, and it can be used as a single substitute for tea and drunk for many years.
Motherwort: In modern times, it has been discovered that it has the effect of diuresis, lowering blood pressure, and eliminating urine protein. Nephrotic syndrome, nephropathy, hypertension, hypertensive nephropathy edema, proteinuria, etc. are the most appropriate.
Black sesame: nourishes the liver and kidneys, moistens the lungs and brightens the eyes, absorbs qi and calms asthma, and smooths the intestines and laxatives. It is a good medicine for chronic bronchitis (old and slow bronchitis), pulmonary heart disease, diabetes, hyperlipidemia, high blood sugar, constipation and other diseases (rich in linolenic acid, vitamin E).
Polygonum multiflori: Nourishes the kidneys and nourishes the blood, calms the nerves and laxatives. For the above cardiovascular diseases with insomnia and dry stools, pay attention to the selection.
Huangjing, Baiji: greatly tonify the lung yin, build muscle and stop bleeding, calm and neutralize the stomach, anti-tuberculosis and straighten, and are good medicines for taking into account the specimens of pulmonary tuberculosis patients. It is especially suitable for patients with chronic gastritis or drug-induced gastritis caused by long-term use of antituberculosis (anti-tuberculosis) drugs.
Flat wood: strong, anti-tuberculosis, cough and phlegm, cough and asthma. It is also a good medicine for tuberculosis patients. It is more suitable for people with liver damage caused by long-term use of antituberculosis drugs (Zijin Niu is often used as a special health care drug for tuberculosis patients).
Mulberry parasitism: tonifying the kidney, stabilizing the fetus, and lowering blood pressure. It is ideal for edema and prenatal eclampsia of pregnancy.
Psyllium: diuretic and drenching, phlegm and cough, water and gas to attack the heart and lungs (pulmonary heart failure), pericardial effusion, exudative pleurisy, multi-functional drugs used in medicine (according to the prescription of "Penhua Medical Mirror", it is the "general" of the cocoon).
Buddha ear grass: and neutral, cough, phlegm, asthma, blood pressure, this product does not distinguish between cold and heat. It is most suitable for geriatric patients with chronic branches, chronic gastritis, and high blood pressure.
Dai Clam San: Cheap, meritorious, and effective. It is a good product for a variety of respiratory diseases, thick and bloody sputum, and restless cough and asthma.
Drugs with multiple efficacy should be continuously discovered, developed, and popularized in clinical work. If it can be combined with the prescription of a small prescription in the form of "medicine pair", it can achieve "refined prescription and simple medicine".
3. Rationalization and tailoring.
Illness is impermanent, medicine is impermanent, medicine is impermanent, and the ear is good at learning. (Yaojian). Lesions are impermanent, the prescription is difficult to adhere to, and he is good at tailoring ancient prescriptions to suit the time, flexibly add and subtract, and can be expanded into many types of prescriptions. It is not advisable to stick to the established formula and change it indiscriminately, which is undesirable. Mr. Hu Yanchen, the commentator of "Moral Grass", said: "It can be attacked, but it is difficult to live. "I can understand Sun Simiao's way of organizing: anti, radical, reverse, and subordinate, and turn it into a square; Naturally, it is in the chest.
1) One party is multi-purpose.
Clever clinicians, in the process of using prescriptions, often use one method to make the most of the magic of many methods, and use one method to change the ingenuity of many methods. Zhu Danxi's "Gezhiyu Treatise" only uses a four-thing soup to add or subtract strain, ** diseases. Xue Ji's "Summary of Internal Medicine" highlights two recipes in the whole book, namely: Buzhong Yiqi Soup and Liuwei Dihuang Pill. Fang Yu's "Medical Forest Rope and Ink" only revolves around a second Chen soup in and out of the cut. For example:
Erchen soup. Gaza ginseng, wheat winter, treatment of coke and dampness and lung yin deficiency (ginseng wheat two Chen soup).
Add wood incense, sand kernels, treat phlegm and dampness internal resistance, qi stagnation and ruffians (famous fragrant sand two Chen soup).
Add Evodia and Coptis chinensis to treat dampness and stagnation in the middle of the coke, and those with liver and stomach disharmony (named Zuojin Erchen Soup).
Add fried atractylodes and magnolia, treat dampness and spleen yang, and vomit and reverse moss (known as Ping Stomach Er Chen Tang, also known as Chen Ping Tang).
Add gastrodia and atractylodes to treat phlegm turbidity upwelling, tinnitus and dizziness (famous anesthesia Erchen soup).
Add aster, coltsfoot flowers, phlegm drink in the treatment, wheezing and coughing are difficult to calm (the name of the two Chen soup).
Add citrus aurantium and bellflower, treat dampness and stagnation, and eat less chest tightness (famous citrus orange two Chen soup).
Add white mustard seeds and almond puree, treat those who have phlegm inside and feel cold outside (named Lu'an decoction).
Add citrus aurantium and bamboo ru to treat phlegm and heat disturbances, and those who are tired and sleepless (name warm bile soup).
Add citrus aurantium and gall south star, treat phlegm and salivation, and cough against the chest (famous phlegm soup).
Add angelica, cooked land, cure yin and blood deficiency, water into phlegm, cough and shortness of breath (name gold water six jun decoction).
Add atractylodes and schisandra to treat the five internal organs damp and cough up phlegm ("Jisheng Fang").
Cinnamon branch Poria pills.
Add red vine, soybean grass, rice and so on to treat acute and chronic pelvic inflammatory disease.
Add red vine, soybean grass, curcuma, etc., to treat pelvic inflammatory mass.
Add salvia, motherwort, leech capsules, etc., to treat pelvic congestion.
Add loss of laughter, white mustard seeds, seaweed, leech capsules, etc., to treat pelvic adhesions.
Add turtle insects, shoot dry, and saluted seeds, etc., to treat uterine fibroids (bleeding stoppage, as pills).
Gaze epsom, Qu wheat, leech capsules, etc., to treat hydrosalpinx and pelvic cystic mass.
Add cannon beetle, hollyhock seeds, cherry seeds, etc., to treat prostatic hypertrophy (pills).
Gashiwei, knotweed, black medicine, etc., to treat prostatitis.
Curcuma, seaweed, etc., to treat old ectopic pregnancy.
2) Multi-party co-use.
Whenever there is a serious and complex disease or too many complications, several prescriptions are often combined and used around the main prescription to form a "big array" with synergistic effects and a wide range of effects, so as to drive away the disease or greatly replenish qi and blood. Yu Shiyu's clear temperature and poisonous drink, and Wu Jutong's Zhuan Xi Dasheng ointment can be described as typical representatives. For example, Guben Pill is a mixture of Four Gentlemen's Soup, Six Gentlemen's Soup, Jade Screen Powder plus placenta, and boralen. I often use the combination of four recipes, such as lily Zhimu soup, sweet wheat jujube soup, peony licorice soup, and magnetic zhu pills, to ** hysterical convulsions, plus calamus, tulip can also solve symptoms such as visual and auditory hallucinations. The combination of Jinlingzisan, Lost Xiaosan, Peony Licorice Soup, and Liver Qi Disan (formerly known as Qingbao Pill) is used in combination with the name Bawei Pain Soup to treat all kinds of pain syndromes, such as: intestinal adhesions, dysmenorrhea, gastrointestinal cramp pain, tumor pain, etc., in a few cases, this medicine can also be used to stop the use of pertidine (Demerol).
This is not only the case with prescriptions, but also with medications. The author often uses mother-of-pearl, pig iron, and ochre together, and its calming effect has been significantly improved; The combined use of calcined dragon oyster, deer antler cream and cuttlefish bone can collect the lower yuan and have a stronger effect on the collapse of menstruation; The combined use of golden buckwheat, houttuynia cordata and goat's milk ginseng can achieve faster and ...... results in refractory lung infections or lung abscesses, empyema, etc. It must be pointed out: "Repeated medication, medicine is powerful." This is the unique pattern of "Qianjin Yao Fang" to deal with special diseases and combine repeated medication prescriptions, which is different from the blind "overlapping medicine" prescription.
3) Simplification into squares.
Some ancient prescriptions, test prescriptions for too much use, should be analyzed and optimized, simplified and sublimated, simplified does not affect the efficacy, some can also improve the efficacy, there are many examples in ancient and modern China and foreign countries, for saving medicinal materials (economy) is of great significance. In the past, there was an old lady in England who had a prescription at home, which was composed of more than 30 herbs, ** cardiac edema had a special effect, and a doctor spent 10 years (1865 1875) to screen out 1 flavor of digitalis, and the research on digitalis has not yet ended. Suhexiang Pill is composed of 15 flavor medicines, which are later screened into 6 flavor medicines to make coronary heart Suhe pills, and then screened into 2 flavor medicines, named Su Bing Dripping Pill; Wumei pill is composed of 10 flavors, which can be preferably compressed into 2 flavors of black plum and Sichuan pepper, and the famous pepper plum soup (), which is effective for biliary ascariasis; The Mugwort Warm Palace Pill is composed of 10 flavored medicines, and Mr. Jinxian Pufu Zhou uses 2 flavors of Xiangfu and Mugwort Leaves as a pill, and the effect is not reduced; According to the principle of "want to rise and descend first", some people have improved the effect of stomach prolapse in the tangerine peel for citrus aurantium shell in the tonifying and Yiqi soup, and then simply use astragalus and citrus aurantium husk, composed of 2 flavors. "Medical Supplement" cloud: "The law cares about life, and the party cares about purity", it is true.
Master the prescription and the medicine
Xu Lingti said: "There must be a main prescription for a disease, and there must be a main medicine for one party." "Clinical physicians must not only be familiar with syndrome differentiation and treatment, but also master special prescriptions and special drugs (i.e., special prescriptions for special diseases, special drugs for special diseases), and the two should not be neglected, so as not to lose the training of learning from others. Although the collection of "Heyao Bureau" is very miscellaneous, it has played a great role in retaining and recommending special prescriptions for special diseases, such as Zhibaodan, Suhe Pill, Xiaoyaosan, etc., all from "Heyao Bureau". The use of special prescriptions for special diseases has learned from the prescriptions of the ancients and self-established prescriptions. For example, if I often encounter some people who have no evidence to distinguish or the indications for syndrome differentiation are not obvious, I immediately plan to use a special prescription for the disease. Red Vine Liumiao Drink**Adnexitis, Huajian Zhubi Wine**Lumbar Intervertebral Disc Herniation, Compound Pheasant Powder**Pediatric Anorexia, Pingmai Xiaoyaosan is used as a conditioner for liver disease and liver function recovery**, and Aifu Warm Uterine Pill plus Placenta**Uterine infertility is smaller than normal, etc., all belong to special prescriptions. As for special drugs and diseases, the application range is wider, such as: thunder pill hookworm, betel nut tapeworm, sheep's hoof to treat ringworm, leakage of reed milk, shoot dry and open throat, calamus Xuanqi and garlic solution **whooping cough ......, all of which belong to the category of special drugs and diseases. The application of special drugs for special diseases should not be too indiscriminate, and some people say: "What kind of medicine do I like to use the most?" "I don't think this statement is objective and should be decided on the basis of the needs of the disease. Otherwise, it will become: Zhang Shudi, Chen Chaihu, Wang Honghua, Luo Poria. It can be seen that the doctor's nickname has a history.
Clever medication for the group
According to the principle of adjudication, reverse, formation and preparation of drugs, a small formula group with two flavors and a pair of strong targets is formed, which has a certain ease of use and can make people familiar with the main symptoms; The need for the main disease to be added to the prescription at any time is aimed at synergistically increasing the efficacy, restricting it to prevent it from winning, which can accelerate the prescription speed and improve the clinical efficacy, which is a common means for clinicians. This form of prescription is called "medicine pair" or "medicine pair". The medicine pair was first published in the "Yellow Emperor's Neijing", squid bone and madder root (four squid bones and one squid pill), Banxia with rice (compound cup soup), etc., which are still in use today. Zhang Ji is a master of using medicine. In his "Treatise on Typhoid Fever", he often said: Cinnamon and ephedra, ephedra and almonds, almonds and magnolia, magnolia and banxia, banxia and poria cocos, and poria cocos and cinnamon branches ......Pairing apps, evolved into many famous parties. As for the monographs on the medicine pair, such as "Lei Gong Medicine Pair" and "Xu Zhicai Medicine Pair", it is a pity that they have died. Mr. Qin Bowei, a famous doctor in modern times, attaches great importance to the application of "medicine pair", and he has 81 prescriptions in the "Qianzhai Medical Lectures". Mr. Shi Jinmo is known for his generosity, but he attaches great importance to refining the combination of "medicine pairs". The advent of "Shi Jinmo Medicine Pair" has benefited future generations, enlightened the end of learning, and expanded the application scope of "medicine pair".
Doctors do not have many medicines, but fine. Whether it is to learn from the predecessors or to combine the medicine pairs by yourself, you must follow the traditional law and modern understanding of the prescription. Carefully analyze whether the research is in line with logical reasoning, evaluate the expected efficacy, and use it well, natural practice makes perfect, skillful adaptation, and easy to come, the head is the way. This is the ingenuity of applying the "medicine pair".
Learning other people's "medicine pairs" can be selected from medical books, and must be repeatedly verified in clinical practice, experience its subtleties, and then fixed. The self-created drug pair should be repeatedly tempered in practice to verify the reproducibility of its efficacy in clinical practice. The discovery of drug pairs can be inexhaustible with the progress of clinical work, but it is required to rather concentrate than abuse.
February** Dynamic Incentive Program