《金匮要略》汤剂特殊煎服法  

Special Methods of Making a Decoction in Synopsis of the Golden Chamber

作　　者：郑相敏 赵海滨[2] ZHENG Xiang-min;ZHAO Hai-bin(Beijing Sixth Hospital,Beijing,China,100007;DongfangHospital of Beijing University of Chinese Medicine,Beijing,China,100078)

机构地区：[1]北京市第六医院,北京100007 [2]北京中医药大学东方医院,北京100078

出　　处：《河南中医》2021年第6期811-814,共4页Henan Traditional Chinese Medicine

基　　金：2020年度北京市自然科学基金资助项目(7202126)。

摘　　要：《金匮要略》中汤剂的服用次数,是由药性、用药目的、病证性质、病势缓急、疗程长短等决定的。常规服用方法为日3次,若攻邪救危,可集中药力,日服2次;长期服药或病轻者,可减少服药次数。邪重病急者,欲取高效、速效者应顿服,并注意药后之病证变化及患者反应,决定是否停用或再服。服用较小剂量的方药大致有3类:一是治疗痰饮病、水气病的方药;二是含有有毒中药的方剂;三是治疗慢性病证,病程长、疗程长的方剂。小剂量服用法,其方所治病证在病性、病势、病位有其特殊性。就病性而言,治疗痰饮病的方剂,不仅服药次数不宜多,剂量也应小,以免多服汤液而助饮邪。就病势而言,治疗呕吐(小半夏汤)、肺痈吐脓血(桔梗汤)、吐血(柏叶汤)等病势向上的方剂,大量服用则药性偏于下行。就病位而言,治疗胸、肺病证的方剂,如栀子豉汤、泽漆汤,量大恐药过病所,抵于中下焦。此外,含有毒药物的方剂,如通脉四逆汤,也应小剂量服药。《金匮要略》中,只有治疗虚寒便血的黄土汤服用剂量是大剂量,其目的是使药物直趋大肠,发挥止血作用。The frequency of taking decoction in Synopsis of the Golden Chamber is determined by the nature of medicine,the purpose of medication,the nature of disease syndrome,the urgency of disease,the length of treatment,etc.The routine method is three times a day.If for attacking pathogen and rescuing emergency,the medicine can be concentrated and taken twice a day.For patients with long-term medication or mild disease,the frequency of medication can be reduced twice a day.If the pathogen is serious and the disease is urgent,decoction can be taken immediately.Pay attention to the changes of disease and syndrome and the patient′s reaction after taking the medicine,and then decide whether to stop or take it again.There are three types of formulas for taking a small dose:The first type is for the treatment of phlegm retention disease and edema;the second is formula containing toxic Chinese medicinals;the third is formula for the treatment of chronic diseases with long course of disease.Taking medicine in small dose has its own particularity in the nature,situation and location of the disease.As far as the nature of the disease is concerned,the formula for the treatment of phlegm retention should not only be taken with few frequency,but also with a small amount,so as to avoid taking more decoction to help retention pathogen.As far as the disease situation is concerned,the formulas for vomiting(Minor Pinellia Decoction),for lung carbuncle vomiting pus blood(Radix Platycodonis Decoction),for vomiting blood(Cacumen Platycladi Decoction)and others for diseases with upward situation,but if they are taken in large quantities,the drug natures tend to be downward.Such formulas aim at the pathogenesis,and the dosage should not violate the disease situation.As far as the disease location is concerned,the formulas for treating chest and lung diseases,such as Gardenia and Semen Sojae Praeparatum Decoction,Herba Euphorbiae Thymifoliae Decoction,if the quantity is large,the drug will cross the disease location and reach the middle and l

关 键 词：《金匮要略》 汤剂 煎服方法 服药次数 服药剂量 张仲景 

分 类 号：R222.2[医药卫生—中医基础理论]