从《伤寒论》“以知为度”谈仲景对用药药量的宏观把握

Discussion on Zhongjing's Macro-grasp of Dosage Based on “Efficacy Determines Degree” in Treatise on Febrile Diseases

"以知为度"一词出自《伤寒论》,是以用药见效为尺度来控制总体给药量的一种方法。临证所见,病情有轻重、药物有厚薄、人体耐受度也有差异,所以用药剂量不能一概而论,而应该以患者服药后确切反应为基础,从宏观把握用药剂量,达到个体化治疗的目的。仲景十分重视对患者服药后出现不同反应的观察,笔者全面梳理《伤寒论》《金匮要略》中的相关论述,以作为不同经方疗效评价及临床药量把握的依据,意在举一反三,启迪临床用药思路,从而更好地继承和发扬仲景学术。

＂Efficacy determines degree＂is derived from Treatise on Febrile Diseases. It is a method of controlling the overall dosage based on the pharmaceutical effect. In clinical practice,the severity of the disease,the nature and flavor of Chinese medicine and the degree of tolerance of the human body are different,so the dosage cannot be generalized. The dosage should be grasped macroscopically according to the exact reaction of the patient after taking the medicine to achieve the purpose of individualized treatment. Zhongjing attached great importance to observing the patient＇s different reactions after taking prescription. The authors have combed the relevant discussion in Treatise on Febrile Diseases and Synopsis of Golden Chamber comprehensively and the relevant discussion can be a basis for the efficacy evaluation and controlling dosage of classical formula in clinical practice. It is intended to draw inferences from other cases and enlighten the thinking of medication in clinical practice,so as to inherit and carry forward Zhongjing academic better.