中医治病方法多,何必只认一汤方

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September 09

中医治病方法多,何必只认一汤方

近来又逢医院管理年检查,今年一改往年以病人为中心的主题，变成了内涵建设!可见，如果不修练真功夫，对病人再好，解决不了问题！可是，什么事情，一旦被提到检查监督的高度，就难免扭曲变形，所谓矫枉过正！

我的病史每每被查，每次都有问题，也促使我每次进步，每次都有反思！

最近一次的检查，说我使用中成药缺乏指征，（就是开了药，没在病史里反映为什么用这个药），再加上我常常用小柴胡处理一些八竿子打不着的问题，因为没法在条条框框中予以合理解释，也就懒得交待！结果，检查的老师们看得有点火了，就差发作了。好在我一向勇于承认错误，毫不吝啬承担责任，所以和老师们关系还处得比较好，每每给我开小灶，予以“辅导”。

这天讲的内容大致如下：既然已经开了汤药了，为什么还要用中成药？而且你一开就是好几种，你看小柴胡、三黄片、桂枝茯苓胶囊，这辨的是什么证？病人一下吃这么多药，胃口马上就倒了！中医的灵魂就在汤方上，十分灵活，经方一味加减变化，主治功效即会有非常大的变化，你完全可以把中成药融汇到汤方中解决问题嘛！这样你的药占比也就降下来了！不好么？

当时我觉得是应该这样，颇感羞愧！后来自己在审查病史，虽然没有冤枉我，但是这也是事出有因。我们的汤药，头一天开，第二天吃到，一开7帖，每每有新的变化，根本来不及靠调整汤药。而且，又有不能重复开汤药的规定，就是在前一张方子没吃完的情况下，不能开第二张方子。（初衷是好的，不许浪费），好在我们还有成药以备不虞。于是就出现了这种颇令人尴尬的医嘱，不知道的人以为我在卖药，其实那是个大柴胡汤合桂枝茯苓丸证，成药用了三天也解决了问题！

最近在病房里，一直强调医生的操作治疗，就是像针灸、推拿这种不依靠药物和检查的治疗，上级的出发点也很好，以最少的钱，解决问题！然后药物自然受到打压，谁要在此时不知回避，难免要被正以典型，我就没有注意风向！

不过，我还是觉得我们的检查者和监督者是有问题的！《内经》黄帝有五方之问，歧伯举四治之能！放在今天，大概就是：针、灸、推、药这四大疗法。就药这一门来讲，还有膏丹丸散之不同，把中医内涵集中在区区一个汤方上，怕是反而丢了中医的内涵了吧！各种剂型用途各别，贵在临床者善驭之耳！有了汤方，就一定要排斥中成药，似乎也没有必要！

偶有所感，聊以志之！希望有司坚持科学发展观指导中医的可持续发展！

10:41 PM | Blog it | 乱弹

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