从《伤寒论》《金匮要略》方药剂量考辨谈临床用药剂量

Discussion on the clinical dose from the prescription of Treatise on Cold Pathogenic Diseases and Synopsis of Golden Chamber

《伤寒论》《金匮要略》皆从《伤寒杂病论》分化而来,故二书所用之剂量具有一致性。从宋代林亿等校订之后,原书记载之方药剂量一直流传至今。医家们在临床运用时应如何考量原书所定方药之剂量,则一直有广泛争议。但是,近年来却兴起一种趋势,主张运用仲景方应该依据原书所定之剂量。若如此,在当今临床上就会出现运用大剂量,甚至超大剂量的现象。本文从历代有关剂量折算的不同认识,及方药剂量与临床疗效关系等方面,对有关方药剂量展开一些讨论。提出了中医临床疗效之关键并非只在方药剂量上,运用仲景方用量宜多宜少之关键在于"善测病情"。须知"毒药治病",用之得宜则为治病之药,用之失宜则为害人之毒。若不在识病断证上下功夫以明方药治病之理,而独以剂量之大者为要,病者可能反受其害。

Both Treatise on Cold Pathogenic Diseases and Synopsis of Golden Chamber are from Shanghan Zabinglun, therefore, the dose used in both books is consistent. After the revision of Lin Yi, et al in the Song Dynasty, the dose of prescription recorded in the original book has been passed down to today. It is widely controversial that doctors should consider the dose of the prescription in the original book when they are used in clinical practice. However, in recent years, there has been a trend in which the use of Zhongjing’s prescriptions should be based on the doses specified in the original book. If so, the phenomenon of using large doses or even super large doses will occur in clinical practice today. From the different understandings of dose conversion in the past generations, and the relationship between prescription dose and clinical efficacy, some discussions were held on the doses of related parties. The key to the clinical efficacy of TCM is not only in the amount of dose, but the key to using the Zhongjing’s prescriptions is that it is more appropriate to "measure the disease". It is necessary to know that "poison medicine cures disease", and if it is used properly, it is a medicine for treating diseases. If it is used improperly, it is harmful to humans. If you don’t work hard on disease and syndcome to understand clearly about the truth of using the prescriptions, to get rid of the disease and cure the disease with the prescriptions, the person with the largesr dose is the one who may suffer insteadly.