《伤寒杂病论》同药异量方探析  

Exploration of Same Drug with Different Dosage in Treatise on Febrile and Miscellaneous Diseases

作　　者：李薇薇[1] 姬卫国[1] 邵雷[2] 梁鹤[2] 

机构地区：[1]河南中医药大学第三附属医院,河南郑州450008 [2]河南中医药大学,河南郑州450046

出　　处：《河南中医》2017年第5期754-758,共5页Henan Traditional Chinese Medicine

基　　金：河南中医药大学2011年博士基金(编号:BSJJ2011-23)

摘　　要：药物相同而剂量不同,会影响处方的功效。张仲景用方多妙在用量,很多重复出现的药物剂量往往不同,有的差异还很大。急危重症多使用大剂量以切中病机,中病即当减少用量,当病情稳定之后,针对病机,可用小剂量徐徐图之。一方面,仲景对于同药的处方在用量上反复斟酌,命名各异,根据不同的病因病机而具有不同的功效主治;另一方面,煎服方法正确,可以使方剂发挥最大疗效,从而减轻毒副反应,张仲景对汤剂煎服方法有深入研究,奠定了中医煎服法的基础。《伤寒杂病论》中药物组成相同但剂量不同的异名方有以下组合:四逆汤、通脉四逆汤;半夏泻心汤、甘草泻心汤;桂枝附子汤、桂枝去芍药加附子汤;桂枝汤、桂枝加桂汤、桂枝加芍药汤;桂枝麻黄各半汤、桂枝二麻黄一汤;抵当汤、抵当丸;半夏散和半夏汤;小承气汤、厚朴三物汤、厚朴大黄汤。总之,在经方量效关系研究、汤剂煎服法与药效发挥等方面,确有太多值得深入挖掘之处,临证时当反复推敲,细细揣摩。Same drug of different dosage may iwffluence the effects of the prescription. The best part of Zhang Zhongjing＇s prescrip- tions lies in the dosage of the drug. Many drugs with repeated occmwence in the book differ in dosages. Acute and critical diseases are often treated with drug of high dosage corresponding to the pathogenesis, and then the dosage of medication would be reduced once the effects arc achieved. Afteng,ards, the disease condition becomes stable and dosage of drug can be reduced corresponding to the pathogenesis. For one thing, Zhang Zhongjing considered carefully the dosage of same drug in different prescriptions; drugs ap- plied to diseases with different etiology and pathogenesis may achieve diftbrent therapeutic effects. for another thing, correct decoe- ring method promotes the prescription to exert maximal effects and reduce the toxic and side effects. Zhmlg deeply studied the de- coeting and administr;ltion methods of decoctions, which laid a foundation for the decoeting and administration methods in Chinese medicine. In Treatise on Febrile and Miscellmwou. Diseases, the combinalions of prescriptions containing same drug but of different dosages include： Frigid Extremities Decoction and Channel - Unblncking for Frigid Extrenfities Decoction; Pinellia Heart - Draining Decoction and Licorice Heart - Draining Deeoclion; Cinnamon Twig and Aconite Decoctionand Cinnamon Twig Subtracting Peony and Adding Aconite decoction; Half Cinnamon Twig and Half Ephedra Decoction, Two Cinnamon Twig and One Ephedra Decoc- tion ; Resistance Decoction and Resistance Pills ; Pinellia Powder and Pinellia Decoction ; Minor Purgative Decoction, Offieinal Magnolia Bark Three Substances Decoction, and Officinal Magnolia Bark and Rhubarb Decoction. The relations between classic prescriptions, dosages and effects as well as the deeoeting anti administration methods and the exertion of the drug effects still have much to explore. Practitioners should consider anti analyze carefully in clinical practice.

关 键 词：《伤寒杂病论》 同药异量 张仲景 

分 类 号：R222.2[医药卫生—中医基础理论]