从量效关系谈李可老中医临床常用药物特点

Discussion on Characteristics of Chinese Herbs Commonly Used by Old TCM Doctor LI Ke in Clinic from Perspective of Dose-Effect Relationship

目的:从量效关系角度谈李可老中医临床常用药物的特点,以期为中医临床医师提供经验指导。方法:以半结构式访谈的形式,就仲景本源剂量、量效关系的影响因素、量效之间的关系、大剂量用药安全性控制策略及现版《中华人民共和国药典》的中药饮片剂量观等方面对李老进行了访谈。再者,对李老所编著的《李可老中医急危重症疑难病经验专辑》里的相关处方按照本课题组选定的常用50味药物(TOP50)统计了最小量、最大量、最常用量以及最常用量与2010版《中华人民共和国药典》饮片剂量上限值的相对比。结果:李老某些药物使用剂量极大,如炮附子600 g,生石膏500 g,柴胡250 g等,在选定的药物中有16味药物使用量超过100 g,占30.77%。李老用药的剂量阈比较宽泛,如大黄、生黄芪、炙甘草等13味药,其剂量阈值均过百。而在其常用剂量与新版《中华人民共和国药典》饮片剂量的上限值的比较中,18味药物与《中华人民共和国药典》上限值一致,且有3味药物:生石膏、大黄、黄柏的常用剂量低于《中华人民共和国药典》上限值。结论:李老在急危重症中,尤其在亡阴亡阳时,其剂量大,一日数剂,且急煎频服。对于毒性药物的炮制及煎服法值得当代临床医生在急救时效仿。对于稳定期或者恢复期患者的常用剂量仍多数与《中华人民共和国药典》接近。

Objective ： To discuss the characteristics of commonly-used Chinese herbs in clinic by traditional Chinese medicine （TCM） doctor LIKe from the respective of dose-effect relationship in order to provide the empirical guidance for TCM clinicians. Methods ： Doctor LI was agreed with interview in the contents of original dosage of Zhongjing, influencing factors of dose-effect rela- tionship, relationship between dose and effect, safety control strategy on prescribing large-dose herbs, and opinions about dosage of Chinese herbal pieces stated in Pharmacopoeia of the People＇s Republic of China in 2010 edition, in the form of semi-structured interview. What＇s more, based on the selected 50 frequently-used Chinese herbs by our team, the prescriptions containing these herbs in the book experience album of critical, emergent, and complicated diseases treated by TCM doctor LIKe compiled by him- self, whose minimum dose, maximum dose, and most commonly-used one were calculated as well as the ratio of most commonly- used dose to upper limited value of dose in the same herb set up in latest pharmacopoeia. Results ： Some Chinese herbs used by doctor LI were in extremely large dosages, such as Fuzi （ blast-fried, 600 g）, Shigao （ raw, 500 g）, and Chaihu （ 250 g）, and so forth. Among all these selected herbs,there were 16 herbs whose dosages were over 100g,accounted for 30.77%. The dose range of these herbs applied by doctor LI was wide. To be specific, 13 Chinese herbs like Dahuang, Huangqi （raw）, and Gancao （hon- ey-fried） whose dose ranges were more than 100. In the comparison of ratio between dosage of most commonly-used herbs and up- per limit value of Chinese herbal pieces in the same herb in latest pharmacopoeia, dosages of 18 herbs were in accordance with those in the pharmacopoeia,and 3 herhs,Shigao（raw）, Dahuang, and Huanghai ,whose commonly-prescribed dosages were lower than those in the upper limit of pharmacopoeia. Conclusion：In the critical and emergent conditions, especially Yin exhaustion or Yang exhaustion, the dosage prescribed by doctor LI was larger with several packages per day which was decocted right away and taken constantly. The processing method of toxic herbs and ldecoction method can be adopted by TCM clinicians dealing with e- mergent cases. The commonly-used dosages for patients in the stable or recovery stage are mostly approximate to those formulated in the latest pharmacopoeia.