The Qilu School of Medical Thought and Research on Classical Prescriptions

Enqin Zhang

This article was originally a speech delivered by Professor Enqin Zhang at the “2024 Darcy Manor International Summit on TCM in the UK”, and now published after editing)

Abstract: The Qilu School of Medical Thought refers to both a school of thought and an academic group that originated in the land of Qilu (present day Shandong province, China ), was rooted in Qilu culture, and retained certain cultural characteristics, originating during the Spring and Autumn/Warring States Period, and passed down to this day. Jing fang (Classical formulas) refers to the prescriptions recorded in Shang Han Za Bing Lun (Treatise on Febrile Diseases and Miscellaneous Diseases) written by Zhang Zhongjing in the Eastern Han Dynasty, which was later divided into two books: Shang Han Lun (Treatise on Febrile Diseases) and Jin Kui Yao Lue (Synopsis of the Golden Chamber). The characteristics of Jing fang can be summarized as: “popular, simple, inexpensive and effective”. The author believes that the method of studying and researching classic prescriptions includes: correctly understanding and mastering the original text, prescriptions and usage; paying attention to the clinical application and modern pharmacological research, and trying to find effective ingredients and mechanism of action of classical prescriptions.

Keywords: Qilu TCM school, classic prescriptions, clinical application, pharmacological research

1.The origin and meaning of the name “Qilu”

Qilu is the name of a region in China, referring to present-day Shandong province. The name originated from the two states of Qi and Lu in the pre-Qin Dynasty era. At the end of the Warring States Period, the cultures of Qi and Lu gradually merged into one. During the time before Qin, today’s Shandong province was divided into the states of Qi and Lu. Qi State had Linzi as its capital, and a large area of land east of Shandong; while Lu State had Jining, Qufu as its capital. It was a small piece of land west of Shandong. In 256 BC the state of Chu conquered Lu, and in 221 BC, Qin conquered Qi. Due to the amalgamation of the two cultures after they were conquered, “Qilu” became a unified culture, and the unified cultural circle formed the regional concept of “Qilu”. This area is roughly equivalent to the territory of the later Shandong Province, so it became an alternative name of Shandong Province.

2.The Concept of Qilu School of Medical Thinking

The Qilu School and academic group originated in the land of Qilu. It was rooted in Qilu culture, beginning in the Spring and Autumn and the Warring States Periods, and has been passed down to this day.

Qilu culture has a long history. During the Spring and Autumn, and the Warring States Periods, the first strand of theory in the history of traditional Chinese medicine, the Bian Que School of thought, was established and represented by Bian Que (who was a native of Changqing District, Jinan, Shandong province today). Formed in the land of Qilu, it soon became a school of medical thought with great social influence, and eventually developed into the Qilu school, representing the regional characteristics of Shandong province. The Qilu school has formed its own unique system in TCM theory, diagnosis and treatment techniques, which has had a significant impact on the development of the broader concepts of TCM.

In the history of the development of traditional Chinese medicine, there have been many famous doctors in Qilu, from the famous doctor Bian Que (AKA Qin Yueren) in the Spring and Autumn Period, Chun Yuyi in the Han Dynasty, and the famous doctor Wang Shuhe during the Jin Dynasty. Qian Yi, a great pediatrician in the Song Dynasty, Cheng Wuji, a famous doctor during the Jin and Yuan Dynasties, and Huang Yuanyu, a master of the Sutra sect in the Qing Dynasty. Among contemporary famous doctors Liu Huimin, Zhou Fengwu, my former tutor from when I was a postgraduate student, Professor Li Keshao, and my former clinical mentor Professor Lu Tongjie. Each had their own strengths, and inherited and improved upon the academic system of the Qilu School.

3. Academic Characteristics of Qilu School of Medical Thought

The Qilu school has a history of more than 2,000 years. Its general characteristics are that each school of thought within it is rich and varied, and as a result, a hundred flowers bloom. Drawing on one anothers strengths, it includes many famous doctors. Its characteristics are as follows:

(1) Pay attention to pulse diagnosis

Pulse diagnosis has a long history. Sima Qian (a historian from the early Han) spoke highly of Bian Que’s pulse diagnosis in Historical Records, saying, “To this day, Bian Que is first in pulse diagnosis”. Following Bian Que, Chun Yuyi during the Han Dynasty also attached great importance to pulse diagnosis. Pulse diagnosis was used in 20 of the 25 medical records in his Clinical Records. In the Jin Dynasty, Wang Shuhe summarized the experience of previous studies on pulse and wrote the first monograph on pulse studies that has come down to us, the Mai Jing (Classics of the Pulse), which made important contributions to the development of pulse studies. Huang Yuanyu of the Qing Dynasty also attached great importance to pulse diagnosis. In his works, he wrote a “Special Chapter on Pulse Interpretation” to discuss the twenty four types of pulse conditions in detail.

（2）Paying equal attention to classics and clinical practice

The Qilu School has always attached great importance to the research and study of classics and using them to guide clinical practice. In the Jin Dynasty, Wang Shuhe spared no effort to compile Shang Han Zabing Lun from the scattered source material; in the Song Dynasty, Cheng Wuji was the first person to annotate the Shang Han Lun; in the Qing Dynasty, Huang Yuanyu was a representative figure of the Sutra School, annotating the Su Wen in his Suwen Xuanjie/Questions and Answers for Plain Questions, Lingsu Xuanjie/ Questions and Answers to Miraculous Pivot and Shang Han Lun Xuan Jie/Questions and Answers to Treatise on Febrile Diseases. Huang Yuanyu annotated 11 classic works in total. My former tutors, the contemporary Professor Li Keshao’s Shang Han Jie Huo Lun/ The Theory of Solving Problems of Treatise on Febrile Diseases, and Professor Xu Guoqian along with Professor Zhang Canjia, the former president of Shandong University of TCM, had made great contributions in correcting ancient TCM classics such as the Huangdi Neijing, and the Zhenjiu Jia Yi Jing. They also required the students, including me, to be proficient in reciting from the Huangdi Neijing and Shang Han Lun and other classic medical books, laying a solid foundation for future clinical diagnosis and further study.

The most important reason why the Qilu School survives and continues to be passed on and evolve is clinical efficacy. One of the characteristics of Qilu School is that it emphasizes practical results and regards clinical efficacy as the highest criterion for evaluating doctors.

Bian Que was a highly skilled general practitioner. During his travels around the states of ancient China, he engaged in different medical work such as internal medicine, surgery, gynecology, and pediatrics, according to needs. The famous doctor Chun Yuyi was proficient in medical skills, and his clinical records passed down to later generations reflect his superb medical skills. From a clinical perspective, Wang Shuhe’s Mai Jing systematically summarized the twenty-four conditions of the pulse, and specifically explained the morphological standards of each pulse condition, providing a basis for pulse syndrome differentiation. Qian Yi first created the five-organ syndrome differentiation based on the physiological characteristics of children. Clinical diagnosis started from the five organ syndrome differentiation to treat various pediatric diseases.

（3）Embracing Inheritance and Innovation Simultaneously

Since Bian Que, the Qilu School has focused on innovation in patterns of thinking. Bian Que boldly innovated, pioneering pulse theory, and the use of iron needles to replace stone needles for treating diseases. This was a major change in the history of traditional Chinese medicine and acupuncture techniques. Chun Yuyi created the first medical records; Wang Shuhe compiled the first monograph on pulse theory, the Mai Jing. Qian Yi pioneered pediatrics, and was particularly good at adapting ancient prescriptions and daring to innovate new prescriptions. He removed aconite and cinnamon from the classic herbal prescription Jingui Shenqi Wan, creating Liuwei Dihuang Wan. Cheng Wuji was to create a precedent for the theory of prescription.

The descendants of the Qilu School also pay attention to learning from the ancients’ideas rather than following fixed prescriptions. They are good at absorbing modern medical theories, emphasizing the combination of syndrome and treatment rules of contemporary diseases, focusing on the combined use of traditional Chinese medicine properties, and making full use of Zhang Zhongjing’s prescriptions to treat various modern diseases. Professor Li Keshao, the founder of the Qilu Shanghan Lun School, broke down the theory of transmission of the six-channel diseases and established a theory of “pattern transmission of febrile diseases” and “transfer of attributes”. He believed that exterior syndrome (symptoms of aversion to cold and fever) is different from Taiyang disease, and the six-channel diseases are not transmitted sequentially. All six-channel diseases have exterior symptoms, not only Taiyang disease. He also broke with the theory that Wuling San’s pathology was caused by water stagnation in the urinary bladder and pointed out that the symptoms of Wuling San are not due to the accumulation of water in the urinary bladder, but a failure of the qi transformation of the San Jiao. His representative work Shang Han Jie Huo Lun (The Theory of Solving Problems of Treatise on Febrile Diseases) is unique in the study of the Shang Han Lun. It has become the representative work of the Qilu Shanghan Lun School.

Professor Wang Xinlu, the former president of Shandong University of TCM, represents the Qilu Internal Medicine School, and he continues to innovate, proposing five classic prescriptions for treating seasonal diseases. He created the “blood turbidity” theory, and the “brain-blood” syndrome differentiation system based on the changes in the types of diseases dealt with in a contemporary clinical setting. At the same time, this theory integrates the pharmacological results of modern TCM research, and pioneers the “aiding medicine theory”: That is, when a Chinese medicine doctor treats modern diseases, they should comprehensively analyze the patient’s information collected from both the traditional diagnostic methods and modern medical examinations, and combines this with the current pharmacological and other research. Therefore the treatment is on the basis of traditional Chinese medicine syndrome differentiation plus modern “Micro-Targeted Therapy”.

（4）The integration of traditional Chinese medicine, Qilu culture, and the Qilu School is an important part of the treasure house of traditional Chinese medicine. The school not only has outstanding academic achievements and far-reaching academic thoughts, but also has rich academic resources and obvious academic value. The Qilu School is deeply rooted in the soil of Qilu culture, so it is not only an important part of traditional Chinese medicine, but also an important part of Qilu culture.

Qilu culture has a certain influence on the construction of the medical theory of Qilu School, the medical thinking mode of Qilu School, the treatment methods of Qilu School, and the medical inheritance and education concept of Qilu School. The development of Qilu School has enriched Qilu culture. The connotation of the two blends with each other and has far-reaching influence.

4. The transmission method of Qilu School

Qilu School is based on the nourishment of Qilu culture and was inherited by famous doctors such as Bian Que, Chun Yuyi, Cheng Wuji, Huang Yuanyu, etc. It still has influence throughout the country. The Qilu School experienced a glorious history with the prosperity of the Qilu culture. However, after the Song Dynasty, due to the southward shift of the cultural center, it went into decline. Therefore, it is necessary to further organize and excavate the Qilu School to promote its prosperity and development.

（1） Looking deeply at and sorting the academic thoughts of famous doctors

Taking in and studying the clinical experience and academic ideas of famous traditional Chinese medicine practitioners is urgently needed to promote the academic development of traditional Chinese medicine, accelerate training, and improve clinical capabilities. Physicians from the Qilu School have had a profound influence on the development of traditional Chinese medicine since the Spring and Autumn and the Warring States Period. Famous doctors have emerged in large numbers throughout the ages, and their academic thoughts and clinical experiences are worthy of further study and summarization. According to the “Chinese Provincial Medical Records Examination”, there were more than 300 Qilu school physicians registered in the Qing Dynasty, and they collectively wrote more than 450 books, far exceeding the total of all physicians before the Ming Dynasty. Therefore, it is necessary to sort out the academic thoughts of famous doctors of the Qilu School, salvage and preserve the diagnosis and treatment materials of famous doctors, refine the academic thoughts and clinical experience of famous doctors, and promote their legacy.

（2）Strengthening training and improving the quality of those inheriting the lineage

The continuity of talent is the lifeblood of a medical tradition. The cultivation of talent should equally emphasize both the traditional master-apprentice transmission and more formal education in institutions. It should combine basic education with clinical teaching, allowing students to learn medical fundamentals while simultaneously following their mentors in clinical practice. The duration of this mentorship should be extended to enhance clinical practice. Additionally, young and middle-aged scholars of traditional Chinese medicine should be encouraged to apprentice under the distinguished and experienced masters who are still active today, ensuring that the unique medical skills of these seasoned practitioners are passed down to future generations.

Flexibility and diversity in training methods should be emphasized, including the implementation of various forms of continuing education after formal schooling ends. Furthermore, in the process of talent development, there should be a focus on cultivating thinking skills and improving clinical capabilities, following the principle of “respecting tradition without being confined by it,” and fostering the ability to adapt creatively.

For example, my senior classmate, Professor Jiang Jianguo, a representative of the Qilu School scholarship of the Shang Han Lun, has advocated exploring difficult and controversial issues from Shang Han Lun for their perspectives on academic thinking in order to cultivate outstanding doctors.

Please allow me to take this opportunity to talk about my experience. Dr. Zhang Enqin, one of the heirs of the Qilu School. I was a postgraduate student majoring in Shang Han Lun at Shandong University of Traditional Chinese Medicine from 1979 to 1982. My tutor was the famous Shang Han Lun expert Professor Li Keshao. After graduation, I continued to study as an apprentice following Professor Lu Tongjie, a famous clinical expert and director of the Affiliated Hospital of Shandong University of Traditional Chinese Medicine. I persisted in clinical practice with Professor Lu , two days a week for 9 years. Professor Lu unreservedly taught me his valuable experience in using classic prescriptions to treat difficult diseases. With the encouragement of my former mentors, Professors Li Keshao and Lu Tongjie, I compiled and published the book “Research on Classic Prescriptions” published by Yellow River Press in 1987, which summarized clinical reports on classic prescriptions at home and abroad for treating various diseases in the last century. At the same time, I cooperated with Professor Liu Weixin, a Western medicinal pharmacologist, and his team, to conduct pharmacological experiments on 100 classical prescriptions, and promoted the research method of combining the clinical application of classic prescriptions with pharmacological approaches.

In 1990, I edited the world’s first bilingual TCM textbooks “A Practical English-Chinese Library of TCM“ published by Shanghai University of Traditional Chinese Medicine Press, composed of 14 books, comprehensively and systematically introducing traditional Chinese medicine to the West, from basic theory to clinical application, English-Chinese comparison, and integration of traditional Chinese medicine and Western medicine.

In 1992, I compiled“ Shang Han Lun Study Guide” published by People’s Medical Publishing House , which added the theoretical and clinical research results on Shang Han Lun in the past 20 years. It has become a textbook for traditional Chinese medicine schools in many countries, and has contributed to the promotion of classical education in traditional Chinese medicine in Western countries.

I founded a TCM school, the UK Academy of Chinese Medicine in London in 2012. Thanks to everyone’s efforts, we have trained a large number of Chinese medicine, acupuncture practitioners, and massage therapists in the UK. We have also successively cooperated with Hunan University of Traditional Chinese Medicine, Zhejiang University of Traditional Chinese Medicine, and Shanghai University of Traditional Chinese Medicine to organize and teach the master and doctoral level courses in traditional Chinese medicine and acupuncture, providing the UK with a number of senior Chinese medicine and acupuncture talents.

（3）Emphasize Academic Innovation and Promote the Application of Clinical Diagnosis and Treatment Experience

For a medical school of thought to survive and develop, it must continuously deepen and innovate its existing theories and methods. Otherwise, the school will gradually wither and fade from the historical stage. The development of the Shanghan school is sufficient to prove this point. To better inherit and develop a school of thought, it is essential to focus on academic innovation. The ultimate goal of passing on and developing a medical tradition is to highlight its unique academic strengths, continuously improve the clinical efficacy of traditional Chinese medicine, and better serve the public. Therefore, it is necessary to promptly translate research results into clinical applications and to widely promote and apply specialized diagnostic and treatment techniques, fully demonstrating their effectiveness.

In short, the Qilu School has many talents and has numerous representative books. These books cover almost all fields of TCM theory and clinical practice, enriching the treasure house of Chinese medicine. The academic thoughts, inheritance methods and culture of Qilu TCM School have a profound impact on the development of traditional Chinese medicine. Continuing research, delving into, and organization of Qilu School will have a positive effect on promoting the development of traditional Chinese medicine world-wide.

5. Studying methods and clinical application of classic prescriptions

（1）The Concept of Jing Fang/Classical Prescriptions

Regarding Jing fang/ classical prescriptions, there are two main sayings: First refers to empirical formulas that doctors have found to be truly curative during the treatment process; Second refers to the classic prescriptions in Zhang Zhongjings Shang Han Lun and Jingui Yao Lue.

Before the Ming and Qing Dynasties, the term“Jing fang” mainly referred to empirical formulas, those that were regarded as particularly effective. The Jing fang school that existed during the Han Dynasty also referred to this idea. In the early Qing Dynasty, another branch emerged, the ancient Jing Fang School. They called the prescriptions used in Zhang Zhongjing’s works Jing Fang; while the formulas created by later generations of doctors and the formulas for treating epidemiological and other disease were termed Shi Fang (Popular formulas).

At present, the majority view in the field of traditional Chinese medicine refers to the prescriptions recorded in Shang Han Za Bing Lun by Zhang Zhongjing in the Eastern Han Dynasty. This text comes down to us as two books, the Shang Han Lun and Jin Kui Yao Lue as edited by Wang Shu He during the Western Jin Dynasty. It is relative to the time when it appeared after the Song and Yuan Dynasties. The Shang Han Lun contains 113 prescriptions, and Jin Kui Yao Lue contains 205 prescriptions, so, excluding 38 duplicate prescriptions, there are 280 prescriptions in total. Shang Han Lun utilizes 90 medicinal herbs, and Jin Kui Yao Lue 192, excluding 76 duplicates, a total of 206 medicinal herbs are represented in these texts. Jing fang are the “ancestors of medical prescriptions”. Later generations of practitioners called Shang Han Za Bing Lun the “book of living people” and the “ancestor of prescriptions”, and praised Zhang Zhongjing as the “sage of medicine”. Traditional Chinese medicine experts within China and abroad often use classical prescriptions as their basis and develop a series of new prescriptions based on the principles of syndrome differentiation and treatment. The characteristics of Jingfang can be summarized as “popular, simple, inexpensive, and effective”. Therefore, the “classical prescriptions” recognized by later generations refer to the prescriptions recorded in Zhang Zhongjing’s Shang Han Zabing Lun.

（2）Classification of Jingfang / Classical Prescriptions

Gui Zhi Tang / Cinnamon Twigs Decoction types

Ma Huang Tang / Ephedra Decoction types

Ge Gen Tang/Pueraria Decoction types

Chai Hu Tang/Bupleurum Decoction types

Xie Xin Tang/Heart Draining Decoction types

Bai Hu Tang/White Tiger Decoction types

Cheng Qi Tang / Qi Ordering Decoction types

Xian Xiong Tang / Chest Purging Decoction types

Wu Ling San / Five Ingredients including Poria Powder types

Ling Gui Ji/Poria and Cinnamon Twig Preparation types

Si Ni Tang/ Cold Extremities Decoction types

Li Zhong Tang / Middle Regulating Decoction types

Fu Zi Tang / Aconite Decoction types

3）Methods for studying and researching classic prescriptions

1) Correctly understand and master the original prescription and text, including the usage and notes of the prescription. For example, Shang Han Lun clause 177 states:“during febrile disease, knotted pulse, palpitations, Zhi Gan Cao Tang/Prepared Licorice Decoction is the governing prescription”. The original text briefly explains that the main indications of Zhi Gan Cao Tang are severe palpitations and irregular pulse. I use this formula to treat arrhythmia patients whose electrocardiogram shows premature contractions or atrial fibrillation, which is effective.

Another example is the note at the end of the recipe for Da Cheng Qi Tang/Major Order the Qi Decoction: “For the four ingredients, use a bowl of water. Boil two substances first, take five liters, remove the dregs, add Da Huang, and boil down to two liters, remove the dregs, add Mang Xiao. Bring it to a boil over low heat, then take it if it is warm enough, but do not take the rest of the herbal decoction if constipation resolves” Zhang Zhongjing introduced the method of decoction in detail in the usage and note after this prescription, and especially emphasized that “if the patients symptoms resolve dont take the rest” to avoid harm to the human body caused by overdose of Da Cheng Qi Tang.

2) Extensively collect experience and literature on the application of modern classical prescriptions. For example, Dang Gui Bei Mu Ku Shen Wan (Chinese Angelica Fritillaria and Sophora pill), in Jin Kui Yao Lue Chapter 20 on Treatment of Women’s diseases during the Pregnancy, it says that this prescription was used to treat “difficulty urinating during pregnancy”. Today I use this formula for treating chronic prostatitis in men which is effective. Another example is the Ban Xia Xie Xin Tang, in clause 149 of the Shang Han Lun and Chapter 17 Jin Kui Yao Lue the formula was originally used to treat “fullness below the heart” caused by improper purging during febrile diseases. Right now I apply this formula widely for treating superficial gastritis, and gastric and duodenal ulcers caused by Helicobacter pylori infection with reliable results.

It is generally believed that Zhang Zhongjing’s Wen Jing Tang is a prescription to aid pregnancy and regulate menstruation, and it is also one of the prescriptions for treating women’s menopause today. The formula is rarely used with men. For example, Chapter 22 of Jin Kui Yao Lue on “Diagnosis and Treatment of Women’s Miscellaneous Diseases and Pulse Patterns” says:“The woman was fifty years old and had been ill for ten days with fever. At night, she felt irritable in her lower abdomen and her palms were hot. It was very annoying, and her lips and mouth were dry… use Wen Jing Tang to treat it”. However, Professor Huang Huang, a famous modern master of classical prescriptions, believes that men and women are both human beings, and if women can be treated with Wen Jing Tang why not men as well? Professor Huang introduced the idea of using Wen Jing Tang to treat low sperm motility, low sperm count, insomnia in elderly men, and “male menopausal syndrome”. Professor Huang’s experience in classic prescriptions has broadened our horizons.

3) Strengthen pharmacological research and experiments, and try to find the effective ingredients and mechanism of action of the prescriptions. For example, the mechanism of action of Wu Mei Wan (Black Plum Pill) in treating Hui Jue (biliary ascariasis). In the past, traditional Chinese medicine theory believed that the characteristics of roundworms are: “ When exposed to sour, they become still; when exposed to bitter, they become calm; and when they encounter spicy, they lower their heads and retreat.” Among the ingredients of the prescription, Wu Mei tastes sour, Coptis tastes bitter, and Asarum is pungent. Wu Mei Wan treats biliary roundworms through three flavors: sour, bitter, and pungent. Modern pharmacological research has found that after taking Wu Mei Wan, the roundworm body becomes anesthetized and loses the inherent ability to adhere to the bile duct wall; increased bile secretion has Increased impact against roundworms causing these inactive roundworms to return to the intestine through relaxed the sphincter of Oddi; after taking Wumei Pills, the pH of the bile has been changed, making the bile more acidic. The roundworm itself has the characteristic of disliking acid and preferring

Alkali environments. This change is not conducive to the survival of roundworms in the biliary tract, and the roundworms have to return to the intestines through relaxation of the sphincter of Oddi. This is the mechanism of action of Black Plum Pill in treating biliary ascariasis.

In short, I believe that promoting the clinical application of classical prescriptions and strengthening pharmacological research on classic prescriptions will help broaden the thinking of traditional Chinese medicine, promote the development of traditional Chinese medicine academics, serve society, and benefit mankind.

參考文獻

References

1. History of Chinese Medicine], edited by Li Jian, Science Press 2022-05.

2.［Historical Records］, by Western Han Dynasty historian Sima Qian

3. ［Shang Han Jie Huo Lun/ The Theory of Solving Problems of Treatise on Febrile Diseases］ by Li Keshao, Shandong Science and Technology Press, 1978

4. “School inheritance/A brief analysis of the academic characteristics and inheritance methods of Qilu Medical School ” by Sun Huiming et al., “Journal of Traditional Chinese Medicine” 2020/03/16

5. ［Research on Classical Prescriptions］ chief editor Zhang Enqin, Yellow River Publishing House, 1987

6. ［A Practical English-Chinese Practical Library of Traditional Chinese Medicine Library］ 14 volumes, chief editor Zhang Enqin, Shanghai University of Traditional Chinese Medicine Press, 1997.

7.［Shang Han Lun Study Guide］ by Engin Can, People’s Medical Publishing House 2022



Author information:

Professor Enqin Zhang, president of UK Academy of Chinese Medicine, a fellow member of ATCM, and a senior member of the Royal Society of Medicine. He practices at Kings Cross TCM & Herbal Center UACM, London, and also as a distinguished Professor at Shaanxi University of Chinese Medicine, a visiting professor at Shanghai University of Chinese Medicine and Zhejiang University of Chinese Medicine, and teaches masters and doctoral courses on Chinese medicine and acupuncture at London. Telephone number: 004478 461 93488. WeChat: drzhang1953; Website: www.uacm.co.uk

齊魯中醫學派與經方研究

張恩勤

此文原為張恩勤教授在“2024英國達西莊園中醫藥國際高峰會”講稿,編輯後發表

摘要：齊魯中醫學派是指產生在齊魯大地（今中國山東省）上，植根於齊魯文化，始於春秋戰國，流傳至今的具有地域性特色的醫學流派與學術群體。它在戰國、秦漢時 期產生過重大社會影響的中醫學派, 並最終衍生發展為具有山東地方特色的齊魯醫派。經方則是指東漢時期朝張仲景所著【傷寒雜病論】（後世分為【傷寒論】和【金匱要略】兩書）所記載之方劑。經方的特徵可概括為「普、簡、廉、效」。作者認為，經方的研 習方法包括正確理解及掌握原方、原文及方後注，重視近代經方的臨床應用及藥理研 究，盡可能找到經方的有效成分和作用機轉。

關鍵詞: 齊魯 中醫學派，經方 臨床應用，藥理研究

一、“齊魯”名稱的來源與意義

齊魯，是中國區域範圍名稱，指今山東省。該名始於先秦齊、魯兩國。戰國末年，因齊、魯兩國文化逐漸融合為一體，而先秦時期今山東大體分屬於齊魯兩國，齊國是以山東臨淄為國都，山東以東的大片土地；魯國是以東濟寧曲阜為國都，山東西方的小塊土地，故有此稱。西元前256年楚國滅魯國，西元前221年秦國滅齊國。因為文化的一體，“齊魯”形成一個統一的文化圈，由統一的文化圈形成了“齊魯”的地域概念。這一地域與後來的山東省區範圍大致相當，故成為山東省的代稱。

二、“齊魯醫派”的概念

齊魯醫派是指產生在齊魯大地（今中國山東省）上，植根於齊魯文化，始於春秋戰國，流傳至今的具有地域性特色的醫學流派與學術群體。

齊魯文化歷史悠久，源遠流長。早在春秋戰國時期齊魯大地上就形成了以扁鵲(今山東濟南長清區人）為代表的中醫史上的第一個醫學學派——扁鵲學派，它在戰國、秦漢時期產生過重大社會影響的醫學學派, 並最終衍生發展為具有山東地方特色的齊魯醫派。齊魯醫派在醫學理論和診療技術方面均形成了自己獨特的體系，對中醫學的發展 產生了重大影響。

在中醫學發展史上，齊魯大地名醫輩出，自春秋時期名醫扁鵲/秦越人（今山東濟南長清區人）到漢代淳於意（今山東淄博市人），以及晉代醫家王叔和（今山東菏澤市鉅野縣人），宋代兒科大家錢乙（今山東東平縣人），金元名家成無己（今山東茬平縣人)，到清代尊經派大家黃元禦（今山東昌邑縣人），再到當代名醫劉惠民（山東沂水縣人），週鳳悟（山東臨邑縣人），我讀研究生時的導師李克紹教授（山東牟平縣人）和我的臨床師傅呂同傑教授（山東臨邑縣人）等，他們各有所長，不斷傳承並完善著齊魯醫派的學術體系。

三、“齊魯醫派”的學術特色

齊魯醫派綿延兩千多年，總的特點是各家異彩紛呈，百花齊放，博採眾長，名醫覆蓋各科。其學術特徵具體如下：

（一）注重脈診

脈診歷史悠久，司馬遷在《史記》中對扁鵲的脈診給予極高的評價，曰：“至今天下言脈者，由扁鵲也”。繼扁鵲之後，漢代淳於意亦相當重視脈診，“診籍”所記載的25 個病案中20個病案均運用了脈診。晉代王叔和總結前人脈學經驗著第一部脈學專著《脈經》，為脈學的發展做出重要貢獻。清代黃元禦也非常重視脈診，在其論著中特設“脈解專篇”，對二十四種脈象進行了詳細論述。

（二）經典與臨床並重

齊魯醫派歷來重視經典的研究與學習，並以此指導臨床實務。晉代王叔與不遺餘力整理《傷寒雜病論》；宋代成無己則是註解《傷寒論》的第一人；清代黃元禦為尊經派的代表人物，註解《素問懸解》、《靈樞懸解》、《傷寒懸解》等醫經11種。當代李克紹（我研究生時期的指導教授）之《傷寒解惑論》，徐國仟教授、張燦玾院長等校正的《黃帝內經》、《針灸甲乙經》等經典醫籍，貢獻卓著。他們要求弟子們皆能熟練誦 讀《黃帝內經》、《傷寒論》等經典醫籍，為以後的臨床診療及進一步學習打下堅實 的基礎。

齊魯醫學學派之所以能夠生存並持續傳承發展，最重要的是臨床療效好，而齊魯醫派的特色之一就是重實效，並將臨床療效作為評價醫者的最高準則。

扁鵲是一位技術高超的全科醫生，在其周遊列國的過程中，根據當地的需求從事內 科、外科、婦科、兒科、五官科等不同的醫療工作。名醫淳淳於意精通醫術，後世流傳的“診籍”反映了他精湛的醫療技術。

王叔和《脈經》從臨床角度出發，系統總結出 數、弦、緊、細、遲等二十四種脈象，並具體闡釋每種脈象的形態標準，為論脈辨證 提供了依據。錢乙據小兒生理特徵首創五臟辨證綱領，臨證從五臟分證入手，治療兒科各類疾病。

（三）繼承與創新並舉

自扁鵲開始，齊魯醫派就注重思維模式的創新。扁鵲大膽創新，首創脈學理論，並用 鐵針代替砭石治療疾病，可以說是醫學史上的重大變革。淳於意首創醫案“診籍”；王叔和編纂第一部脈學專著《脈經》；錢乙開創兒科，尤其善於“化裁古方，勇創新方”，將經典醫方金匱腎氣丸去掉附子、肉桂化裁成六味地黃丸，而成無己則開創方論之先河。

齊魯醫派後繼傳人亦注重師古人意而不泥古人方，善於吸收現代醫學理論，臨證強調結合當代疾病的證治規律，注重中藥藥性的組合運用，活用張仲景之方，治療各種現代疾病。

齊魯傷寒流派創始人、本人研究生時導師李克紹教授破六經傳變說，立“傷傳”與“轉屬”論，認為表證不同於太陽病，六經並非依次傳變，六經皆有表證；破“水停膀胱”說，指出五苓散證並非膀胱蓄水，而是三焦氣化失職，水邪瀰漫三焦；其代表作《傷寒解惑論》在傷寒學研究中獨樹一幟，成為齊魯傷寒學派的代表著作。

齊魯內科時病學派代表人、本人研究生時的師兄王新陸教授（原山東藥大學校長）不斷創新，提出治療時病經方化裁五法，並根據當代疾病譜系的改變創立“血濁”理論和“腦血”辨證體系，同時充分整合現代中藥理成果，首創“援藥理論”: 即中醫在治療現代疾病時，將傳統四診及現代醫學檢查收集來的患者信息，利用傳統中醫理論及現代臨床醫學方法進行綜合分析，並結合中藥藥理學等研究結果，在傳統中醫辨證論治基礎之上加上微觀標靶用藥。

（四）中醫學科與齊魯文化相互交融

齊魯醫學是中醫學寶庫的重要組成部分，不僅學術成就突出，學術思想深遠，而且學術資源豐富，學術價值明顯。深植於齊魯文化土壤的齊魯醫派，不僅是中醫藥學的重要組成部分，也是齊魯文化的重要組成部分。

齊魯文化對齊魯醫派醫學理論的建構、齊魯醫派醫學思維方式、齊魯醫派的治療方法以及齊魯醫派醫學傳承教育理念方式都具有一定的影響，而齊魯醫派的發展又豐富了齊魯文化的內涵，二者相互交融，影響深遠。

四、齊魯醫派的傳承方法

齊魯醫派基於齊魯文化的滋養，秉持於扁鵲、淳於意、成無己、黃元禦等名醫大家，迄今在全國仍具有影響力。

齊魯醫派伴隨著齊魯文化的興旺發達而經歷過輝煌的歷史，但宋代以後由於文化中心的南移，趨於沒落。因此，有必要對齊魯醫派進一步整理挖掘，促進其繁榮與發展。

（一）深入挖掘，整理名醫學術思想

傳承研究名老中醫的臨床經驗和學術思想是推動中醫學術發展、加快人才培養、提高臨床服務能力的迫切需求。

齊魯醫家自春秋戰國時期開始對中醫發展就有深遠影響，歷代名醫輩出，其學術思想與臨床經驗值得我們進一步研究總結。

根據《中國分省醫籍考》記載，清代可考的齊魯醫家就有300餘位之多，著作450餘部，遠超過明代以前所有醫家的總和。

因此，有必要對齊魯醫派名醫的學術思想進行整理，搶救保存名老中醫診療資料，提練名老中醫學術思想與臨證經驗，促進其傳承與發展。

（二）加強人才培養，完善傳承隊伍

人才傳承建設是流派的生命力。人才的培育應堅持師徒傳承與院校教育並重，基礎與 臨床教學並舉，學生邊學醫學基礎課邊跟隨老師臨床實踐，並且加長跟師時間，加強臨床實踐。同時鼓勵廣大中青年中醫學者拜健在的名老中醫為師，使老中醫的特色醫術後繼有人。著重培養方式的彈性多樣性，在學校教育結束後貫徹多種形式的繼續教育。同時在人才培育方面，注重思維的培養和臨證能力的提升，“遵古不泥古”，善於培養學生懷疑精神，不完全迷信古人。只有批判地繼承，才能有不斷地創新。

例如齊魯傷寒流派代表人、本人研究生時的師兄姜建國教授力主站在治學思維的角度 探討《傷寒論》的疑難爭論問題，培養優秀的中醫人才。藉此機會請容許我談談本人的經驗/張恩勤醫師，也是齊魯傷寒派的成員之一。

1979-1982年我是山東中醫藥大學傷寒專業研究生，導師是著名的傷寒學家李克紹教授；畢業後又拜師著名中醫臨床專家、山東中醫藥大學附屬醫院院長呂同傑教授，每週兩天隨師臨床，連續9年。呂老毫不保留地傳授其運用經方治療疑難病症的寶貴經驗。在恩師李克紹和呂同傑教授的鼓勵指導下，我於1987年主編出版了《經方研究》（黃河出版社出版），總結了近百年來國內外有關經方治療各種疾病的臨床報道; 同時與西藥藥理專家劉唯新教授團隊合作，對100多個經方進行動物藥理實驗，推進了以經方臨床應用和藥理研究相結合的研究方法。

1990年我主編的世界第一部《英漢對照實用中醫文庫14冊》（上海中醫藥大學出版社），從基礎理論到臨床應用，英漢對照，中西醫結合，全面系統地向西方介紹了中醫學。1992年我編譯出版《傷寒論研習指導》（人民衛生出版社），又增加了近二十年來關於傷寒論理論和臨床研究的成果，成為許多國家中醫藥院校的教材，為促進西方中醫經典著作教育提供了新的途徑。

自2012年我在倫敦創辦英國中醫學院，由於大家的共同努力，為英國培養了大量中醫針灸推拿師；並先後與湖南中醫藥大學、浙江中醫藥大學和上海中醫藥大學聯合辦學，舉辦中醫碩士和博士研究生班，為英國培養了一批高級中醫針灸人才。

(三）注重學術創新，推廣應用臨床診療經驗

一個醫學學派為了求得生存和發展，就必須使本學派原有的理論或方法不斷深化、不斷創新，否則這個學派就要逐漸枯萎而退出歷史舞台。傷寒學派的發展就足以證明這一點。為了更好地傳承與發展，必須重視學術思想的創新。

學術流派的傳承發展最終歸結點是突出自身學術特色優勢，不斷提高中醫臨床療效，以更好地服務於廣大人民群眾。因此，需要及時地將研究成果轉化為臨床應用，並將特色診療技術廣泛推廣應用，充分彰顯其療效。

總之，齊魯醫派人才濟濟，醫學著作眾多，幾乎涉及中醫理論與臨床的各個領域，豐富了中國醫藥寶庫。

齊魯醫派的學術思想、傳承方式及其文化對中國傳統醫學發展影響深遠。對齊魯醫派的研究、挖掘和整理，將對推動世界中醫藥事業的發展產生積極作用。

五、經方的研習方法與臨床應用

（一）經方的概念

關於經方，主要有兩種說法：一是指經驗之方，即醫家在治療過程中發現確有療效的「經驗之方」；二是指經典之方：即在張仲景著作傷寒論、金匱要略中所使用的“醫經之方”。

在明清之前，經方一詞主要是指“經驗之方”；在漢朝時曾經存在的經方派，所指的也是前者。在清朝初葉，出現另一支尊古的經方派，他們稱張仲景著作使用過的方劑是“經方”，而後世醫家及溫病學派設計的方劑則稱之為“時方”。

目前中醫學界最為普遍的說法，是指東漢時期張仲景所著《傷寒雜病論》（後世分為 《傷寒論》及《金匱要略》二書）所記載之方劑。乃是相對於宋、元以後出現的時方而言的。

其中《傷寒論》載方113首，《金匱要略》載方205首，除去重複的38方，共計280方。《傷寒論》載藥90味，《金匱要略》載藥192味，除去重複的76味，共 206味。

經方是“醫方之祖”，後世中醫學家稱《傷寒雜病論》為“活人之書”、“方書之祖”，讚譽張仲景為“醫聖”。

古今中外的中醫學家常以經方作為母方，依辨證論治的原則而化裁出一系列的方劑。

經方的特徵可概括為“普、簡、廉、效”。所以後世公認的“經方”是指張仲景之《傷寒雜病論》中所記載的方劑。

（二）經方的分類

桂枝湯類、麻黃湯類、葛根湯類、柴胡湯類、瀉心湯類、白虎湯類、承氣湯類、陷胸湯類、抵當湯類、五苓散類、苓桂劑類、四逆湯類、理中湯類、附子湯類。

（三）經方的研習方法

1.正確理解並掌握原方、原文，包括方後注。如《傷寒論》第177條“傷寒，脈結代， 心動悸，炙甘草湯主之”。原文以簡短文字闡述了炙甘草湯的主症，即劇烈的心悸和脈律紊亂。

我以此方加減用來治療心電圖檢查顯示期前收縮或心房纖顫的心律不整病人, 效果良好。再如大承氣湯的方後注上四味，以水一斗，先煮兩物，取五公升，去渣，納大黃，更煮取兩升，去渣，納芒硝，更上微火一兩沸，分溫再服。張仲景在此方後注具體地介紹了炸藥方法，並特別強調“得下，餘勿服”，以避免過服大承氣湯造成對人體的傷害。

2.認真總結近代經方應用的經驗和文獻資料。如當歸貝母苦蔘丸, 《金匱要略/婦人瑪利亞 慰病脈證並治第二十》原文記載是用此方來治療“妊娠小便難，飲食如故”。現在我用來治療男人的慢性前列腺炎有效。再如半夏瀉心湯，《傷寒論》149條和《金匱要略/ 嘔吐噦下利病脈證治第十七篇》原是用來治療傷寒下後引起的“ 心下痞”，我目前廣泛應用於幽門螺旋菌感染引起的表淺性胃炎、胃及十二指腸潰瘍等，效果可靠。一般認為，溫經湯是張仲景的助孕方、調經方，更是治療女人更年期的處方之一，很少用於用於男性，如《金匱要略/婦人雜病脈證並治第二十二》說：“婦人年五十所，病下利十日不止，暮即發熱，少腹裡急，手掌煩熱，唇口乾燥”。

然而近代經方大師黃煌教授認為：男女都是人，女人可以，為何男性不可以用溫經湯呢。

黃教授曾介紹同仁和自己運用溫經湯治療男子精子活力下降和數量不足、老年男性失眠以及男性更年期綜合徵等。黃教授為運用經方開闊了視野。

3.加強藥理研究和實驗，盡可能找到經方的有效成分和作用機轉。近代藥理實驗可以幫助我們揭示經方的作用原理，擴大應用範圍。如關於烏梅丸治療膽道蛔蟲的原理，傳統的中醫理論認為是，蛔蟲的特點是：得酸則靜，得苦則定，見辣則頭伏而下。

具體地說，方中烏梅味酸，黃連味苦，細辛味辛。烏梅丸治療膽道蛔蟲是透過酸、 苦、辣這三種藥味來實現的。

透過現代藥理研究發現，服烏梅丸後使蛔蟲蟲體呈麻醉狀態，失去了蛔蟲固有的附著膽道壁的能力；烏梅丸使膽汁分泌增多，增加了對這些沒有活動性的蛔蟲的衝擊力，迫使蛔蟲退回腸道；服烏梅丸後能鬆弛奧狄氏括約肌； 服烏梅丸後，改變了膽汁的酸鹼度，使膽汁趨於酸性，蛔蟲本身有惡酸好鹼的特性， 此種改變不利於蛔蟲在膽道生存，蛔蟲即透過弛緩擴大的奧狄氏括約肌退回腸道，從而使膽道蛔蟲病得到治癒。

總之，我認為推廣經方的臨床應用和加強經方的藥理研究，有助於開闊中醫的思路， 促進中醫學術的發展，服務社會，造福人類。

作者簡介:

張恩勤,教授，英國中醫學院院長，英國中醫藥學會資深會員，英國皇家醫學會資深會員。目前在英國中醫學院倫敦國王十字街中醫藥中心教學行醫，兼世界中醫藥學會臨床療效評估委員會委員，陝西中醫藥大學特聘教授，上海中醫藥大學和浙江中醫藥大學客座教授，教英國和歐洲的中醫和針灸碩士和博士課程。電話號碼：004478 461 93488。微信号：drzhang1953。网站：www.uacm.co.uk

參考文獻

References

1. 《中国医学史》李剑 主编，科学出版社2022-05。

2. ［史记］，西汉史学家司马迁

3. 《伤寒解惑论》李克绍，山东科技出版社，1978年

4. 《流派承传/ 齐鲁医派的学术特色及传承方法探析》，孙辉明等，中医杂志 2020/03/16 4.

5. 《经方研究》张恩勤主编，黄河出版社，1987

6. 《英汉对照实用中医文库》14册，张恩勤主编，上海中医药大学出版社，1990

7. 《伤寒论研习指》张恩勤，人民卫生出版社2022