摘要：在大都市的喧嚣与繁华中，我身着白袍，已行医二十余载。这二十多年，就像一部波澜壮阔的长卷，每一页都写满了患者的病痛与希望，也镌刻着我对中医传承与发展的深刻感悟。
在大都市的喧嚣与繁华中，我身着白袍，已行医二十余载。这二十多年，就像一部波澜壮阔的长卷，每一页都写满了患者的病痛与希望，也镌刻着我对中医传承与发展的深刻感悟。
老一辈人，辛辛苦苦工作一辈子，或许就为了攒下一套遮风挡雨的房子，那是他们安身立命的根基，是岁月沉淀后的安稳。而干中医的呢，往往干了一辈子，攒下的却是几套方子。这些方子，可不简单，它们是中医智慧的结晶，是无数先辈在临床实践中摸索出来的“治病密码”。
从历史的维度看，无论是经方、时方、验方还是专病专方，能在历史长河中传承下来的，往往都是疗效可重复性比较高的。就像那璀璨星河中的恒星，历经岁月的洗礼，依然闪耀着光芒。据不完全统计，在中医古籍中记载的方子数以万计，但真正被广泛应用且疗效显著的，不过其中一小部分。这些经过时间考验的方子，就像一位位沉默的老师，默默地传授着治病的诀窍。
然而，问题也随之而来。无数的方子，专靠医生的大脑去储备，这可不是一件轻松的事儿。就好比一个人要同时记住好几本厚厚的书籍内容，随着年龄的增长，大脑就像一台用了多年的电脑，开始出现“卡顿”现象。我见过不少老中医，年轻时记忆力超群，处方时信手拈来，各种方剂烂熟于心。可到了年纪大了，写起方子来就开始丢三落四，少一味药，多一味药，就像厨师做饭时放错了调料，原本美味的菜肴，味道就变了。这看似小小的失误，却很有可能会影响疗效的可重复性。要知道，在中医的世界里，每一味药都像是战场上的士兵，各有其职责和作用，少了一个，多了一个，都可能打乱整个治疗的“战术布局”。
我就遇到过这么一位老中医，年轻时医术高明，在当地颇有名气。有一次，一位患者前来就诊，症状比较复杂。老中医凭借着多年的经验，很快就在脑海中构思出了一个方子。可当他提笔书写时，由于年纪大了，记忆力减退，竟然漏写了一味关键的药。患者按照这个方子抓药服用后，病情并没有得到明显的改善。后来经过仔细复盘，才发现是方子出了问题。这件事让老中医懊悔不已，也让我深刻认识到，好记性不如烂笔头。
现在进入了电子时代，科技的发展为我们提供了便利。把有效的方子储存在电脑里、手机里，用起来反而更方便。这就好比给大脑配备了一个“外置硬盘”，随时可以调用所需的信息。不至于上了年纪，写起方子来手忙脚乱，丢三落四。虽然看起来用笔记、用电子设备记录显得拖沓繁琐，但这是对患者负责，对临床疗效负责。就像工匠打造一件精美的器物，每一个细节都要精益求精，容不得半点马虎。
中医，作为大方脉，面对现代分科细致如内科、皮肤科、小儿科、妇科、男科、骨科、肿瘤科等等，各种疾病纷至沓来，就像一场没有硝烟的战争，医生要在不同的“战场”上随意切换思维逻辑，精准处方。这确实需要一个好的大脑，但更不能忽视记录的重要性。老中医随着年龄的增长，记忆力、反应能力都会减退，这是自然规律，谁也无法抗拒。就像一辆汽车，开了多年，性能总会有所下降。
谦虚谨慎在这个时候就显得尤为重要。因为医生面对的是一个个鲜活的生命，每一个决策都可能影响到患者的健康和未来。辨病与辨证相结合，灵活准确地辨证使用每一套方子，这就像在一场复杂的棋局中，每一步都要深思熟虑。而烂笔头做笔记，就像是棋手在棋盘上记录下每一步的走法，以便回顾和总结。
我有一位同行，他非常注重方子的记录和整理。他不仅把常用的方子整理成电子文档，还按照不同的病症、体质进行分类。每次接诊患者时，他都会先参考这些记录，再结合患者的具体情况进行辨证论治。有一次，一位患有疑难杂症的患者前来就诊，症状十分复杂。他通过查阅自己整理的方子库，结合患者的舌象、脉象等信息，经过一番仔细的斟酌，开出了一张精准的处方。患者按照这个方子服用后，病情逐渐好转。这件事让我深刻体会到，记录和整理方子对于提高临床疗效的重要性。
在这个快速发展的时代，中医传承面临着诸多挑战。我们不能仅仅依靠大脑去记忆那些宝贵的方子，而应该借助现代科技的力量，让中医的智慧更好地传承下去。让烂笔头、电子设备成为我们传承中医的有力工具，为更多的患者带来健康和希望。因为，中医的传承与发展，不仅仅是我们这一代医生的责任，更是对无数先辈智慧的尊重和延续，是为了让中医这门古老的医学在新时代焕发出新的生机与活力。让我们携手共进，在中医传承的道路上，书写属于我们的辉煌篇章。
作者简介：梁世杰 中医高年资主治医师，本科学历，从事中医临床工作24年，积累了较丰富的临床经验。师从首都医科大学附属北京中医院肝病科主任医师、著名老中医陈勇，侍诊多载，深得器重，尽得真传！擅用“商汤经方分类疗法”、专病专方结合“焦树德学术思想”“关幼波十纲辨证”学术思想治疗疑难杂症为特色。现任北京树德堂中医研究院研究员，北京中医药薪火传承新3+3工程—焦树德门人（陈勇）传承工作站研究员，国际易联易学与养生专委会常务理事，中国中医药研究促进会焦树德学术传承专业委员会委员，中国药文化研究会中医药慢病防治分会首批癌症领域入库专家。荣获2020年中国中医药研究促进会仲景医学分会举办的第八届医圣仲景南阳论坛“经方名医”荣誉称号。2023年首届京津冀“扁鹊杯”燕赵医学研究主题征文优秀奖获得者。事迹入选《当代科学家》杂志、《中华英才》杂志。
Liang Shijie: After 20 years of practicing medicine in the city, it is better to have a bad memory than a messy notebook.
Amidst the hustle and bustle of the metropolis, I have been wearing a white robe and practicing medicine for over two decades. These twenty years have been like a grand and sweeping scroll, with each page filled with the sufferings and hopes of patients, as well as my profound insights into the inheritance and development of traditional Chinese medicine.
Older generations worked hard their whole lives, perhaps just to save up enough money to buy a house that could provide shelter from the wind and rain. This house was the foundation upon which they built their lives, a sense of security that came with the passage of time. In contrast, those who practice traditional Chinese medicine often spend their entire careers accumulating just a few sets of prescriptions. These prescriptions are no ordinary things; they are the culmination of the wisdom of traditional Chinese medicine and the "secret formulas" that countless predecessors discovered through years of clinical practice.
From a historical perspective, whether it is an ancient formula, a contemporary formula, a proven formula, or a specialized formula for a specific disease, those that have been passed down through the ages are often those with relatively high reproducibility of efficacy. Just like the stars in the magnificent cosmic expanse, after enduring the test of time, they continue to shine brightly. According to incomplete statistics, there are tens of thousands of formulas recorded in ancient Chinese medical texts, but only a small portion of them are widely used and have been shown to be highly effective. These time-tested formulas are like silent teachers, quietly imparting the secrets of treating various ailments.
However, problems also arise from this. With countless prescriptions, relying solely on a doctor's brain to store them is not an easy task. It is akin to someone trying to remember the contents of several thick books at the same time. As one ages, the brain functions like a computer that has been used for many years and starts to experience "crashes." I have seen many elderly traditional Chinese medicine practitioners who, in their younger years, had exceptional memory and could easily recall prescriptions and various formulas. However, as they grew older, they began to make mistakes when writing prescriptions, such as forgetting or adding an ingredient. This is similar to a chef who accidentally adds the wrong seasoning to a dish, changing its original taste. These seemingly minor mistakes can potentially affect the reproducibility of the treatment's efficacy. In the world of traditional Chinese medicine, each ingredient is like a soldier on the battlefield, each with its own role and function. The absence or presence of even one ingredient can disrupt the overall "tactical layout" of the treatment.
I have encountered such a senior traditional Chinese medicine practitioner. In his youth, he was highly skilled and well-known in his area. One time, a patient came to him with a complex set of symptoms. Based on his many years of experience, he quickly came up with a prescription in his mind. However, when he picked up his pen to write it down, due to age-related memory decline, he accidentally omitted a crucial ingredient. After the patient took the prescribed medicine, there was no significant improvement in their condition. It was only after a thorough review that it was discovered that the prescription was flawed. This incident left the senior practitioner deeply regretful, and it also made me realize that a good memory is not as reliable as a well-maintained notebook.
Now that we are in the electronic age, the development of technology has brought us many conveniences. Storing effective formulas in computers and mobile phones makes it even easier to access them. This is akin to equipping the brain with an "external hard drive" that can be called upon at any time to retrieve the necessary information. This way, one is not left flustered and disorganized when it comes to writing down formulas as one ages. Although it may seem tedious and cumbersome to use notes and electronic devices for recording, it is a responsible approach towards the patients and the clinical efficacy. It is akin to a craftsman meticulously crafting a beautiful piece of art; every detail must be perfected, with no room for error.
As a broad practitioner of traditional Chinese medicine, one must contend with the highly specialized fields of modern medicine, such as internal medicine, dermatology, pediatrics, obstetrics and gynecology, andrology, orthopedics, and oncology, among others. With so many different types of illnesses presenting themselves, it is akin to a war without any visible conflict. Doctors must be able to switch between different mental frameworks and apply precise prescriptions on various "battlefields." This indeed requires a sharp mind, but it is equally important not to overlook the significance of record-keeping. As one ages, both memory and reflexes tend to decline, which is a natural process that no one can escape. Just like a car that has been driven for many years, its performance will inevitably deteriorate.
In this situation, modesty and prudence are particularly important. This is because doctors are dealing with living individuals, and every decision made could have an impact on the patient's health and future. Combining disease diagnosis with syndrome differentiation, and using each set of prescriptions in a flexible and accurate manner, is akin to making every move in a complex chess game with careful consideration of each step. Jotting down notes in a tattered notebook is similar to a chess player recording each move made on the board for review and reflection.
I have a colleague who places great emphasis on documenting and organizing prescriptions. Not only has he compiled a list of commonly used prescriptions into an electronic document, but he has also categorized them based on different conditions and patient characteristics. Whenever he sees a patient, he first reviews these records before making a diagnosis and formulating a treatment plan tailored to the patient's specific situation. One time, a patient with a complex and difficult-to-diagnose condition came to see him. After reviewing his own collection of prescriptions and analyzing the patient's tongue and pulse patterns, he carefully considered the situation and created a precise prescription. After taking the prescribed medicine, the patient's condition gradually improved. This experience made me realize the significance of documenting and organizing prescriptions in improving clinical outcomes.
In this era of rapid development, the inheritance of traditional Chinese medicine is facing numerous challenges. We cannot rely solely on memory to recall those invaluable prescriptions; instead, we should harness the power of modern technology to ensure the better inheritance of the wisdom of traditional Chinese medicine. Letting notebooks and electronic devices become our powerful tools for the inheritance of traditional Chinese medicine can bring health and hope to more patients. Because the inheritance and development of traditional Chinese medicine is not only the responsibility of our generation of doctors, but also a respect and continuation of the wisdom of countless predecessors. It is meant to allow this ancient form of medicine to flourish with new vitality in the new era. Let us work together and write our own glorious chapter in the journey of the inheritance of traditional Chinese medicine.
Author Bio: Liang Shijie is a senior medical practitioner in traditional Chinese medicine with an undergraduate degree. He has been engaged in traditional medicine clinical work for 24 years and has accumulated a wealth of clinical experience. Following Chen Yong, chief physician of liver disease at Beijing Traditional Medicine Hospital, affiliated with Capital Medical University, and renowned old Chinese medicine, he has been treated for many years and received great attention. He specializes in the treatment of difficult diseases using "conversational traditional therapy" and special treatments combined with the academic ideas of Jiao Shude and Guan Yubo's ten-level diagnosis.He is currently a researcher at the Shude Tang TCM Research Institute in Beijing, a fellow at the new 3 + 3 project of traditional Chinese medicine flame inheritance in Beijing - a scholar at the inheritance workstation of Jiao Shude's protégés (Chen Yong),He is a standing committee member of the International Expert Committee on E-learning and Health Care, a member of the Jiao Shude Academic Heritage Special Committee of the Chinese Association for the Advancement of Chinese Medicine Research, and the first cancer specialist to be included in the chapter of the Chinese Pharmaceutical Culture Research Association. Won the 2020 China Association for the Promotion of Traditional Chinese Medicine Zhongjing Medical Branch held the eighth session of the Medical Saint Zhongjing Nanyang Forum "Classic Prescription Famous Doctor" honorary title. The winner of the first Beijing-Tianjin-Hebei "Pingui Cup" Yanzhao Medical Research Essay Award in 2023. His work was featured in the journal Current Scientist and the journal Chinese Talent.
来源：首都专家梁世杰一点号
