Today I was chatting with a friend about the famous Chai family of traditional Chinese medicine (TCM) practitioners in Shanxi Province. That led us to discuss the current chaos in the TCM world — particularly the disorder surrounding classical formula prescriptions, which has truly become something of a disaster.
I’m not sure what’s happened in recent years, but all manner of TCM training programs have sprung up, operating under various famous names and peddling their wares everywhere. Many of the so-called “masters” they promote are people I’ve never even heard of, and many of the so-called therapies are frankly山寨 to the extreme. These are mostly minor tricks that don’t amount to much, but there is one area that has grown into a truly significant force — the so-called classical formula school.
My first encounter with classical formulas was through Hao Wanshan’s lectures on the Shanghan Lun (Treatise on Cold Damage). When I first heard the term “classical formula,” I simply felt that TCM had a very well-developed theoretical system. Later, Huang Huang’s school became quite famous in the Jiangsu-Zhejiang region, and classmates around me all recommended visiting Huang Huang’s classical formula forum. I lurked there too and discovered that classical formulas were indeed something special — simple to learn, with focused efficacy and powerful results. So I began studying the Shanghan Lun year-round. Zhang Zhongjing’s medical skills had a profound influence on me, and in my early practice I treated many conditions directly with classical formulas. Especially during the 2009 H1N1 flu outbreak, which had already begun spreading through our school — a roommate suddenly developed high fever, nasal congestion, runny nose, cough, headache, and body aches. He didn’t want to be quarantined. I was bold and fearless in those days, so I decisively administered a large dose of Gégen Tāng (Kudzu Decoction). Two hours after taking the medicine, he began sweating and his fever spiked briefly; six hours later, the fever broke and all symptoms vanished. I was astonished. From that moment, I made my reputation.
After that, I became an ardent admirer of classical formulas. For a long time, I believed that the fewer herbs in a prescription, the greater the doctor’s skill. But when I went to the hospital for my clinical internship, I found that most of the senior doctors’ prescriptions were quite large — routinely twenty or thirty herbs. I was quite displeased, feeling they weren’t pursuing excellence, and I looked down on the academic establishment for a long time.
After moving to Beijing, I came into contact with many legendary masters and renowned practitioners, and I met many teachers and students from China’s top TCM institutions. By that time, classical formulas already wielded enormous influence. Everyone knew about them; basically no one would say anything bad about classical formulas, and most people believed that any TCM doctor who could treat patients using pure classical formulas was a good doctor. I once thought so too. In particular, the rapid rise of the Huoshen (Fire God) school was closely related to its connection with classical formulas — one could say the Huoshen school represents one particular approach to applying classical formulas.
When I began treating patients, I mostly used classical formulas directly. For a period, I refused to modify them at all. The results were mixed — when they worked, they worked spectacularly; when they didn’t, a single dose would quickly produce all sorts of discomfort. In recent years, two young prominent practitioners emerged from Shandong — Wang Wei and Chen Jian — both habitual users of classical formulas who rose to fame quickly. But recently, I’ve noticed that they too have encountered bottlenecks.
This year marks my thirteenth year of clinical practice, and I have gradually come to realize that the applicable scope of classical formulas does have certain limits. Nowadays, few acute conditions come to TCM practitioners first. In my outpatient clinic, it’s rare to encounter a first visit for a common cold. Most patients come seeking TCM only after their condition has dragged on for a long time and multiple treatments have failed to help. At that stage, it’s rare to see the three-yang pattern diseases, let alone the chronic and difficult cases that are far from easy to treat. I call these “adverse presentations.”
Many colleagues believe that combining formulas is an excellent approach. I’ve used combined formulas myself for many years, even the so-called “large formula complex treatment” method. However, I strongly disagree with classifying such methods under the umbrella of classical formulas. Yet most classical formula practitioners in the field today treat formula combination as an important weapon in their classical formula arsenal. Among the classical formula experts in Beijing whom I’ve encountered — Feng Shilun, Wang Qingguo, Xiao Xiangru, Shi Xinde, Hao Wanshan, and others — many of their clinical prescriptions are quite substantial. Ten or more herbs is commonplace, and twenty or more is very common. Can you really call these classical formulas? Are they the same as the classical formulas we envision?
In fact, the number of true classical formulas that many experts prescribe each day might be only a handful. Those with a strong patient following — teachers whom patients visit for both major and minor ailments — will have a higher proportion of classical formula use. But they never mention this when giving lectures.
Liu Duzhou’s disciples often mentioned during our classes that at least half of the prescriptions Liu used in his outpatient clinic were not Zhang Zhongjing’s formulas. Most students don’t realize that the cases teachers present in lectures are carefully selected — rare encounters that differ vastly from everyday clinical reality. If you mistakenly believe that using classical formulas exclusively in real practice will always be effective, you’re being terribly naive.
Unfortunately, after more than a decade of hype and indoctrination, the latest batch of TCM students and enthusiasts have been thoroughly brainwashed by the classical formula dogma. They believe that any doctor who doesn’t use classical formulas is not a good TCM practitioner. They even look down upon contemporary formulas and the academic establishment, dismissing any prescription they don’t understand as reckless prescribing. This is deeply unfortunate, and I hope this phenomenon will change soon.
中文原文 / Chinese Original
今天与好友聊天，谈到了山西著名的柴姓中医世家，而后就说起当今中医之乱象，特别是经方之乱，真可谓是一场灾难。
这些年不知是怎么了，各种中医培训班倾巢出动，打着各家的名号，四处忽悠，许多高人闻所未闻，许多所谓的疗法真是山寨之极。这些都算是雕虫小技，一般成不了大气候，但是其中有一个领域已经成了大气候，那就是所谓的经方派。
我最早接触经方是听郝万山讲伤寒论，初闻经方一词，只是觉得中医是很有理论体系的。后来黄煌一派在江浙一带非常出名，我周围的同学都推荐去看黄煌经方论坛，那时候我也潜水其中，发现经方确实是个好东西，简单易学，效专力宏，于是就常年看起了伤寒论。仲景的医术对我影响很大，早期很多病都是直接用经方治疗的，尤其是2009年H1N1流感爆发，我们学校里已经开始流行，当时宿舍一位同学突然高热，鼻塞流涕，咳嗽，头痛，浑身酸痛，他并不想被隔离，当时我真是初生牛犊不怕虎，果断用了大剂量葛根汤，药后两小时汗出热升，六小时后热退诸症皆消，心中大呼不可思议，从此一战成名。
自此之后，我对经方也是崇拜有加，曾有很长一段时间我也是认为药开的越少医术越高，但待我去医院实习时，发现大部分老师的方子都很大，动辄二三十味药，心中甚是不悦，觉得他们不精益求精，从此便鄙夷学院派很久。
来到北京后，接触到了许多传说中的大家、名家，结识了中国最顶尖中医学府的很多老师和学生，那个时候经方的影响力已经很大了，所有人都知道经方，基本上所有人都不会说经方不好，大多数人都认为能用纯经方看病的中医都是好中医，我也曾经是那么认为的。特别是后来火神派之所以能迅速崛起，与火神派跟经方直接相关有很大关系，可以说火神派是经方运用的一个思路的体现。
我开始治病大多数也是直接用经方的，有段时间也是绝不加减的，疗效可以说是时好时坏，好的时候特别好，不好的时候一副药下肚很快就有各种不舒服。前几年山东冒出了王伟和陈健两位青年名家，都是惯用经方，成名很快，但是，最近我发现他们也遇到了瓶颈。
今年是我临证第十三年，我逐渐发现，经方的适用范围确实是有一定界限的。现在很少有急病来找中医，我在门诊很难遇到初诊看感冒的，大多是拖了很久，治了多次都没有好转的情况下，才来找中医解决，这个阶段很少能见到三阳病了，更别提那些慢性病疑难病，治起来不会那么得心应手，我称之为逆证。
有许多同道认为合方是一个很好的办法，我也用了很多年的合方，甚至所谓的大方复治法。我非常不认同把这类方法纳入经方的范畴。但是，目前业内大部分经方家都把合方作为经方运用的一个重要武器。我接触到北京的一些经方家，比如冯世纶、王庆国、肖相如、史欣德、郝万山等等，这些大家在临床中许多方子都不小，十几味算稀疏平常，二十多味很常见，你能说这叫经方么，这跟我们心中的经方一样么？
事实上，许多经方家每天能开出去的真正的经方可能也就几张，有些群众基础好的，喜欢大病小病都来看的老师使用经方占比会高很多，但是他们在讲课的时候全然不提此事。刘渡舟先生的弟子在给我们上课的时候时常提到，刘老门诊时至少一半不是用的张仲景的方子。
大多数学生并不明白，老师在给他们上课时举得例子都是精挑细选，难得遇到一次的，与临床实际大相径庭。如果你误以为真正看病的时候全部用经方都能起效的话，那真是太年轻了。
可惜的是，经过近十多年的渲染和熏陶，这一批刚刚出炉的中医学生和中医爱好者已经被经方洗脑，他们认为不用经方的医生不是好中医，甚至鄙视时方和学院派，遇到看不懂的方子就认为是乱开药，这是十分不应该的，希望这种现象能尽快改变。
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