摘要：慢病作为一类病程长、难治愈的疾病，其治疗策略历来为医学界所重视。本文基于仝小林院士的学术观点，探讨了慢病治疗的核心理念与实践方法。仝院士强调，慢病治疗需采用“围方”策略，注重多系统、多疾病、多层面的综合调理；剂型选择上宜先用汤剂开路，后用丸散膏丹巩固，便于长期
摘要
慢病作为一类病程长、难治愈的疾病，其治疗策略历来为医学界所重视。本文基于仝小林院士的学术观点，探讨了慢病治疗的核心理念与实践方法。仝院士强调，慢病治疗需采用“围方”策略，注重多系统、多疾病、多层面的综合调理；剂型选择上宜先用汤剂开路，后用丸散膏丹巩固，便于长期调理；治疗过程应守法守方，采取蚕食策略，不求速战速决，但求日日进步。文章进一步分析了慢病治疗的多个关键环节，包括建立患者信心、绕路解决难点、调理脾胃、预热渗透、找到治疗支点等，旨在为慢病治疗提供科学、系统的指导思路。
关键词：慢病治疗；围方；蚕食策略；丸散膏丹；多系统调理
引言
慢病，因其病程漫长、病因复杂、病情多变，给医疗实践带来了巨大挑战。传统医学认为，慢病治疗需“慢调”，强调“宁期三月好，不求一日速”。仝小林院士作为中医领域的杰出学者，对慢病治疗有着独到的见解和丰富的临床经验。本文旨在梳理并阐述仝院士关于慢病治疗的核心策略，以期为临床医生和患者提供有益的参考。
正文
一、慢病治疗的核心理念
（一）围方策略：大包围，多层面
慢病往往涉及多个系统、多种疾病，病情错综复杂。仝小林院士提出，针对慢病的治疗，应采用“围方”策略，即在治疗方剂上采取大包围的方式，全面覆盖患者的多种病理变化。这种策略体现了中医整体观的思维，旨在通过调和全身气血、阴阳平衡，达到治疗疾病的目的。围方策略不仅关注单一病症，更注重整体调理，从而实现多病同治、异病同治的效果。
（二）丸散膏丹：剂型选择，便于长期
在剂型选择上，仝院士主张慢病治疗宜先用汤剂治疗，解决病症的首要矛盾和基础症状，后选用丸散膏丹等慢性调理剂型。这些剂型具有服用方便、药效持久、副作用小等特点，适合长期调理。丸剂、散剂便于携带和服用，膏剂、丹剂则能深入滋养，调理脏腑。通过选用这些剂型，可以更好地满足慢病患者的长期治疗需求。
（三）守法守方：蚕食策略，步步为营
慢病治疗切忌急功近利，而应采取蚕食策略，步步为营，逐步削噬病邪。仝院士强调，治疗慢病需守法守方，即在治疗过程中保持治疗方案的稳定性和连续性。蚕食策略要求医生在治疗初期就透彻分析病情，制定长期治疗计划，并在治疗过程中不断调整优化，确保治疗效果的稳步提高。这种策略不仅有助于建立患者信心，还能有效避免病情反复和药物副作用。
二、慢病治疗的关键环节
（一）建立信心：出手迅捷，乘胜追击
慢病治疗初期，迅速缓解病情、建立患者信心至关重要。仝院士指出，医生应针对患者的主要症状，采取迅速有效的治疗措施，使患者病情有所起色。这不仅能增强患者对治疗的信心，还能为后续治疗打下良好基础。在病情有所好转后，医生应乘胜追击，继续巩固治疗效果，确保病情稳定。
（二）绕路解决难点：毁城抽筋，促其坍塌
慢病治疗过程中，难免会遇到一时难以逾越的难点。仝院士建议，此时可采取绕路策略，即先解决相对容易的问题，逐步削弱病邪势力，待时机成熟时再集中力量攻克难点。这种策略体现了中医“避实击虚”的思想，通过迂回战术达到治疗目的。在绕路解决难点的过程中，医生应密切关注病情变化，及时调整治疗方案，确保治疗方向正确。
（三）调理脾胃：培育胃气，磨刀不误砍柴工
脾胃为后天之本，气血生化之源。仝院士强调，慢病治疗应注重调理脾胃，培育胃气。脾胃功能强健，才能确保药物的有效吸收和利用，从而提高治疗效果。因此，在治疗过程中，医生应关注患者的脾胃状况，及时采取调理措施，如健脾和胃、消食导滞等。通过调理脾胃，可以为后续治疗打下坚实基础。
（四）预热渗透：逐步渗透，润物细无声
慢病治疗不宜急于求成，而应采取预热渗透的策略。仝院士指出，治疗初期应先通过温和的药物或方法，逐步渗透病邪所在部位，为后续治疗创造条件。这种策略有助于减少患者的痛苦和不适，提高治疗的舒适度和接受度。在预热渗透的过程中，医生应密切关注患者的反应和病情变化，及时调整治疗方案。
（五）找到支点：牵一发而动全身
慢病治疗的关键在于找到治疗的支点，即能够带动全局的关键环节。仝院士认为，通过精准辨识患者的体质、病性、病位等信息，可以找到治疗的关键所在。一旦找到支点，即可采取针对性的治疗措施，实现“牵一发而动全身”的效果。这种策略要求医生具备深厚的中医理论和临床经验，能够准确判断病情并制定相应的治疗方案。
三、慢病蚕食法的实践应用
蚕食法作为慢病治疗的一种有效策略，其核心在于不求一日千里，但求日日进步。仝小林院士指出，蚕食法适用于多系统、多脏器、多层面的复杂慢病治疗。通过小剂量、广覆盖、多靶点、长疗程的手法，逐步削噬病邪，实现病情的逐步稳定和好转。
在具体实践中，蚕食法要求医生在治疗初期就制定详细的治疗计划，并根据患者的病情变化不断调整优化。同时，医生还应关注患者的心理状态和生活习惯，通过心理疏导和健康宣教等方式，提高患者的治疗依从性和生活质量。
结论
慢病治疗是一项长期而复杂的任务，需要医生和患者的共同努力。仝小林院士提出的围方策略、丸散膏丹剂型选择、守法守方与蚕食策略等核心理念和实践方法，为慢病治疗提供了科学、系统的指导思路。通过综合运用这些方法，可以更有效地缓解患者病情、提高治疗效果、改善患者生活质量。未来，随着中医理论的不断发展和临床实践的深入探索，慢病治疗策略将更加完善和优化，为更多患者带来福音。
作者简介：梁世杰 中医高年资主治医师，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。现任北京厚德为怀医生集团渐冻症研究中心主任，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。
Academician Tong Xiaoping on the treatment of chronic diseases: a prescription for a slow-motion plan, and a contribution made by eating.
abstract
As a type of long-term and intractable disease, the treatment strategy has always been of great importance to the medical community. This paper explores the core concepts and practical methods of chronic disease treatment based on the academic views of academician Tong Xiaoping. Professor Tong emphasized that the treatment of chronic diseases needs to adopt a "prescription" strategy, focusing on comprehensive management of multiple systems, multiple diseases and multiple levels. In the choice of dosage form, it is advisable to open the way with a tonic first, and consolidate it with a dispersed ointment afterwards, so as to facilitate long-term treatment; The treatment process should adhere to the law and the prescription, adopt a strategy of encroachment, not seek speedy resolution, but seek daily progress. The article further analyzes several key aspects of chronic disease treatment, including Building patient confidence, bypassing difficult points, conditioning the spleen, preheating infiltration, and finding treatment support points, aiming to provide scientific and systematic guidance for chronic disease care.
Keywords: chronic disease treatment; The Siege; Cultivating strategies; Take a lump of ointment and apply it. Multisystem conditioning
Introduction
Chronic diseases, because of their long duration, complex causes and variable conditions, have brought great challenges to medical practice. Traditional medicine believes that the treatment of chronic diseases needs a "slow tone," emphasizing that "the rest period is good in March, and does not require a daily speed." As an outstanding scholar in the field of traditional Chinese medicine, academician Tong Xiaoping has unique insights and extensive clinical experience on the treatment of chronic diseases. This paper aims to tease out and explain Tong's core strategies for the treatment of chronic diseases with a view to providing useful references to clinicians and patients.
text
I. The core concept of chronic disease treatment
(1) Siege strategy: large siege, multidimensional
Chronic diseases often involve multiple systems, multiple diseases and complex conditions. Academician Tong Xiaoping proposed that for the treatment of chronic diseases, a "prescription" strategy should be used, i.e., a large envelope approach should be taken in the treatment formulation to fully cover multiple pathological changes of the patient. This strategy reflects the holistic thinking of traditional Chinese medicine and aims to achieve the goal of treating diseases by reconciling the body's qi and blood and yin and yang balance. The prescription strategy not only focuses on a single disease, but also focuses on holistic management, so as to achieve the effect of treating multiple diseases and different diseases together.
(2) Powdered ointment: the dosage type is chosen to facilitate long-term use
In the choice of dosage, Academician Tong advocates that chronic disease treatment should first be treated with a tonic to resolve the main contradiction and basic symptoms of the disease, and then choose a chronic conditioning regimen such as pills and ointments. These preparations have the characteristics of easy to take, lasting efficacy and little side effect, and are suitable for long-term conditioning. Pills and drops are easy to carry and take, while creams and tablets can deepen nourishment and regulate the internal organs. By selecting these dosage forms, the long-term treatment needs of patients with chronic diseases can be better met.
(3) Obeying the law and following the rules: eating strategies, step by step
In the treatment of chronic diseases, it is absolutely against taking immediate steps for immediate gain, but instead, we should adopt a strategy of encroaching, gradually attacking the disease. Academician Tong emphasized that the treatment of chronic diseases requires adherence to the law and the prescription, i.e. maintaining the stability and continuity of the treatment program during the treatment process. The encroachment strategy requires doctors to thoroughly analyze the condition at the beginning of treatment, formulate a long-term treatment plan, and continuously adjust and optimize during treatment to ensure the steady improvement of treatment effectiveness. Not only does this help build confidence, but it is also effective in avoiding relapses and side effects.
II. Key aspects of chronic disease treatment
(1) Build confidence: move quickly and take advantage of victory.
In the early stage of chronic disease treatment, it is essential to rapidly relieve the condition and build the patient's confidence. Academician Tong pointed out that doctors should take rapid and effective treatment measures to address the main symptoms of the patient so that the patient's condition can improve. This not only enhances the patient's confidence in the treatment, but also lays a good foundation for subsequent treatment. After the condition has improved somewhat, doctors should take advantage of the victory and continue to consolidate the treatment effect to ensure that the condition is stable.
(ii) Around the corner to solve the difficult problem: destroying the city and causing its collapse
In the course of chronic disease treatment, we will inevitably encounter difficulties that are difficult to overcome for a while. Tang advised that at this time, a bypass strategy can be adopted, namely, to solve the relatively easy problem first, gradually weaken the evil forces, and concentrate on the difficult points when the time is ripe. This strategy reflects the idea of traditional Chinese medicine to "hide from reality and fight against reality" and achieve therapeutic purposes through circuitous tactics. In the process of dealing with difficult points, doctors should pay close attention to the changes in the condition, adjust the treatment plan in a timely manner, and ensure the correct direction of treatment.
(3) Correct the spleen: cultivate stomach qi, grind the knife and never miss the woodcutter
The spleen and stomach are the natural ingredients and the biochemical sources of qi and blood. Academician Tong stressed that the treatment of chronic diseases should focus on the management of the spleen and the cultivation of stomach qi. The strong function of the spleen and stomach can ensure the effective absorption and utilization of drugs, thereby improving the treatment effect. Therefore, during treatment, doctors should pay attention to the patient's spleen and stomach condition and promptly take conditioning measures, such as strengthening the spleen and the stomach, and eliminating food restriction. By conditioning the spleen, you can lay a solid foundation for subsequent treatment.
(4) Preheated permeation: gradually permeates, the lubrication is thin and silent
Chronic disease treatment should not be rushed, but should adopt a strategy of preheating penetration. Academician Tong pointed out that the early stage of treatment should first penetrate the site of the disease through mild drugs or methods, creating conditions for subsequent treatment. This strategy helps reduce pain and discomfort for patients and improves comfort and acceptance of treatment. During the preheated penetration process, doctors should closely watch the patient's reaction and changes in condition and promptly adjust the treatment plan.
(v) Finding a focal point: Bring one hair and move the whole body
The key to chronic disease treatment is to find the focal point of treatment, which is the key link that can drive the overall picture. Tong believes that by accurately identifying the patient's physical condition, illness, and location information, the key to treatment can be found. Once the thrust point is found, targeted therapeutic measures can be taken to achieve the effect of "bringing one hair to the whole body." This strategy requires doctors to have deep theoretical and clinical experience in traditional Chinese medicine, and can accurately diagnose the condition and formulate a corresponding treatment plan.
III. Practical application of chronic disease encroaching methods
As an effective strategy for the treatment of chronic diseases, the core of the diet is not to strive for a thousand miles a day, but to strive to make progress every day. Academician Tong Xiaoping pointed out that the encroachment method is suitable for the treatment of complex chronic diseases with multiple systems, multiple organs and multiple levels. Through the technique of small doses, wide coverage, multiple targets and long therapy, the disease is gradually destroyed and the condition stabilized and improved.
In specific practice, the nitrification method requires doctors to formulate a detailed treatment plan at the beginning of treatment and continuously adjust and optimize according to the changes in the patient's condition. At the same time, doctors should also pay attention to the patient's psychological state and lifestyle habits, and improve patient adherence to treatment and quality of life through psychological guidance and health promotion.
conclusion
The treatment of chronic diseases is a long-term and complex task that requires the joint efforts of doctors and patients. The core concepts and practice methods proposed by academician Tong Xiaoping, such as the prescription strategy, the choice of pills and tablets, and the adherence to the law and the strategy of encroachment, provide scientific and systematic guidance for the treatment of chronic diseases. By combining these methods, it is possible to relieve patients' conditions more effectively, improve the treatment effectiveness, and improve the quality of life of patients. In the future, with the continuous development of traditional Chinese medicine theory and the in-depth exploration of clinical practice, chronic disease treatment strategies will be more perfected and optimized, bringing benefits to more patients.
Author Bio: Liang Shijie is a senior medical practitioner in traditional Chinese medicine. 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 the director of the Center for Diffusion Research of Dr. Houde Wei Group in Beijing, a researcher at the Shude Tang Institute of Chinese Medicine, and a fellow at the new 3 + 3 project of traditional Chinese medicine flame inheritance in Beijing - a scholar at the inheritance work station 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.
来源：首都专家梁世杰
