摘要：在古老的中医学说中，流传着一句至理名言：“用药如用兵，治病如打仗。”这句话不仅揭示了医者用药的精妙与策略，更深刻地体现了中药组方中的药味多少与剂量大小之间的微妙平衡。本文旨在深入探讨这一话题，揭示中药组方的智慧与奥秘。

在古老的中医学说中，流传着一句至理名言：“用药如用兵，治病如打仗。”这句话不仅揭示了医者用药的精妙与策略，更深刻地体现了中药组方中的药味多少与剂量大小之间的微妙平衡。本文旨在深入探讨这一话题，揭示中药组方的智慧与奥秘。

首先，让我们回顾历史，走进张景岳的《景岳全书》。在这部医学巨著中，张景岳提出了古方八阵的概念，将中药组方比作排兵布阵，每一种药物都有其特定的位置和作用，共同构成了一个完整的治疗方案。这种方阵用药的思想，不仅是对中药组方艺术的生动描绘，更是对医者智慧的极高赞誉。

然而，在中药组方的实践中，药味的多少与剂量的大小却常常成为争议的焦点。以汉朝组方为例，药味少（不超过13味药居多）而药量重是其显著特点。据科学家考证，汉之一两相当于现代的15.625克或13.7克左右，张仲景等医家在用药时，往往将药量用至一两、二两甚至三两（在纯野生药材居多的汉朝，绝大多数情况均超现代药典限量），取得了显著的疗效。故有后人传颂：“药过十三，百病不沾！”然而，这一观点却被一些好事者用来道德绑架医生，他们只关注药味的多少，却忽视了药量的重的特点以及病情的复杂性。

事实上，中药组方的智慧远不止于此。药味的多少与剂量的大小，往往需要根据患者的具体病情、体质、年龄以及地理环境等多种因素进行综合考虑。例如，南方人皮肤皱里疏松，身体敏感，因此药剂量轻而能奏效；而北方人皮肤紧密厚实，则需药剂重才能显效。这种能大能小、轻重变化，因地制宜、因人而异的用药策略，正是中药组方艺术的精髓所在。

在现实生活中，我们可以看到一些医生擅长使用寥寥几味药物组成精简的方剂，却能取得显著的疗效。这些医生往往对药物的药性、功效以及相互作用有着深刻的理解，能够精准地把握病情，做到药到病除。然而，也有一些医生在治疗重症如癌症时，采用组方药味相对较多、药量较重的方剂，同样取得了显著的疗效。例如，全国有名的王三虎教授在治疗癌症时，就采用了经方抗癌的方法，虽然组方药味较多，但疗效却非常好。近代名医施今墨擅长使用合方、大方治疗疑难重症，药味儿多，但屡起沉疴，效如桴鼓。并且在组方中善于使用对药，并著有《施今墨药对》一书。这再次证明了中药组方艺术的灵活性和多样性。

古语云：夏虫不可言冰。

西医同样存在用药的智慧和逻辑。一个把自己标榜成治疗感冒的专家，或许很擅长一针退烧的技术，和他大讲大病、重病、急病的联合用药。就是对牛弹琴了……

那么，如何评判一个中药方剂的好坏呢？显然，不能仅凭药味的多少或剂量的大小来断定。

梁世杰科研团队认为一个优秀的医生组织处方，应该具备精准、灵活、高效的特点。它需要根据患者的具体情况进行个性化定制，既要考虑病情的轻重缓急，又要兼顾患者的体质差异和地理环境等因素。脱离了病人、病情客观实际谈处方的大、小，药量的多、少，都是不负责任的夸夸其谈。只有客观严谨的结合病人和病情，才能真正做到因病施治、因人而异，达到最佳的治疗效果。

此外，我们还需要警惕那些脱离病人病情和疗效结果，单纯以药味多少来衡量医生技术水品，道德绑架医生的行为。这些行为不仅违背了中药组方的原则和精神，更损害了患者的利益和信任。

相反，一个真正为患者负责任的医生，不肯也不屑冒着患者的病情风险，不加辨证的，主观任性地一味去开轻浅小方，只为浪得一个所谓虚名……

“韩信点兵多多益善”

从某种意义上讲，擅用大方、合方治疗慢性病、疑难病、危重病，更能考验医生的辨证用药技术水品和把握治病救人全局思维逻辑的能力。

作为一个合格的医生，我们应该以更加客观、严谨的态度来看待中药组方技术，尊重医者的智慧和经验，共同推动中医学的健康发展。

总之，中药组方是一门深奥而复杂的学问。它要求医者不仅要精通药物的药性和功效，还要具备高超的用药策略和灵活的思维方式。只有这样，才能在临床实践中做到精准用药、因病施治，为患者带来最佳的治疗效果。同时，我们也应该摒弃那些片面的、不切实际的用药观念，以更加开放、包容的心态来接受和理解中药组方的智慧与奥秘。

作者简介：梁世杰 中医高年资主治医师，从事中医临床工作24年，积累了较丰富的临床经验。师从首都医科大学附属北京中医院肝病科主任医师、著名老中医陈勇，侍诊多载，深得器重，尽得真传！擅用“商汤经方分类疗法”、专病专方结合“焦树德学术思想”“关幼波十纲辨证”学术思想治疗疑难杂症为特色。现任北京厚德为怀医生集团渐冻症研究中心主任，北京树德堂中医研究院研究员，北京中医药薪火传承新3+3工程—焦树德门人（陈勇）传承工作站研究员，国际易联易学与养生专委会常务理事，中国中医药研究促进会焦树德学术传承专业委员会委员，中国药文化研究会中医药慢病防治分会首批癌症领域入库专家。荣获2020年中国中医药研究促进会仲景医学分会举办的第八届医圣仲景南阳论坛“经方名医”荣誉称号。2023年首届京津冀“扁鹊杯”燕赵医学研究主题征文优秀奖获得者。

Traditional Chinese Medicine Composition: The Wisdom Game of How Much the medicine Tastes and How Large the Doses

In ancient Chinese medicine, there is a wise saying that "medicine is like soldiers, and healing is like fighting." This sentence not only reveals the sophistication and strategy of medical practitioners' medication, but also more profoundly reflects the delicate balance between the amount of flavor and the size of the dosage in traditional Chinese medicine prescriptions. This article aims to explore this topic in depth and reveal the wisdom and mysteries of traditional Chinese medicine recipes.

First, let's look back at history and walk into Zhang Jingyue's Complete Book. In this medical monumental work, Zhang Jingyue proposes the concept of ancient eight regimens, likening traditional Chinese medicine prescriptions to a military preparation. Each drug has its specific location and role, which together constitute a complete treatment plan. This idea of a combination of medicine is not only a vivid depiction of the art of traditional Chinese medicine formulation, but also a high praise for the wisdom of the practitioner.

However, in the practice of traditional Chinese medicine prescriptions, the amount of flavor and the size of the dosage are often the focus of controversy. Take the Han Dynasty prescription, for example, which has few flavors (no more than 13 flavors) and heavy amounts are its distinctive characteristics. According to scientists, one and two grams of a man is equivalent to the modern day 15.625 grams or 13.7 grams. When using medicine, doctors such as Zhang Zhongjing often used the amount of medicine to one, two, two or even three (2) (in the Han Dynasty, where pure wild medicine was prevalent, the vast majority of cases exceeded the limits of modern pharmacopoeia), and achieved remarkable therapeutic results. Therefore, some descendants have said, "After thirteen medicines, they will never get sick." However, this view has been used by some good causes to morally kidnap doctors by focusing only on the amount of flavor, while ignoring the heavy nature of the drug and the complexity of the condition.

In fact, the wisdom of Chinese medicine prescriptions goes far beyond that. The amount of flavor and the size of the dose often need to be considered according to a variety of factors such as the patient's specific condition, physical condition, age and geographical environment. For example, Southerners have loose skin and sensitive bodies, so the drug can be given in a light dose. The skin of northerners is tightly thick and requires a heavy dose to be effective. This strategy of medication that can be large or small, change lightly, adapt to local conditions and vary from person to person is the essence of the art of traditional Chinese medicine prescription.

In real life, we can see some doctors who are adept at using a few flavors of drugs to make a streamlined formulation that delivers significant results. These doctors often have a deep understanding of the medicinal properties, efficacy and interaction of drugs, and can accurately grasp the condition, so as to cure the disease to eliminate it. However, some doctors have also achieved significant results when treating serious diseases such as cancer, using relatively more flavored and heavier doses of prescription medicines. For example, Professor Wang Sanhu, a nationally renowned professor, used prescription anti-cancer methods when treating cancer, and although the prescription drugs were more flavored, the efficacy was very good. Shi Jinmu, a renowned medical doctor in recent times, is adept at using combinations and prescriptions to treat difficult and serious illnesses. There are many flavors of medicine, but they repeatedly become serious ailments, and the effect is like a drum. He was also adept at using prescription remedies in combinations and authored the book "The Applying Ink Solution." This is yet another proof of the flexibility and diversity of the art of traditional Chinese medicine prescription.

The ancient saying goes that summer insects cannot speak of ice.

Western medicine also has the wisdom and logic of medicine. A person who promotes himself as a cold specialist may be adept at a fever-reducing injection and talk to him about combinations of medicine for major, serious, and acute illnesses. It was just playing the piano against a cow...

How to judge the goodness of a Chinese herbal remedy? Obviously, it cannot be determined solely by the amount of flavor or the size of the dose.

A good doctor's organization of prescriptions should be precise, flexible and efficient. It needs to be tailored to the specific situation of the patient, taking into account the priority of the condition, as well as factors such as the physical differences and geographical environment of the patient. Speaking objectively about the size and size of prescriptions and the amount of drugs without regard to the patient and the condition is irresponsible bluster. Only an objective and rigorous combination of the patient and the condition can truly treat the disease and achieve the best treatment effect.

In addition, we need to be vigilant against ethical abduction of physicians by measuring their expertise simply by the flavor of their medicines, despite the patient's condition and efficacy. These actions not only violate the principles and spirit of traditional Chinese medicine prescriptions, but also harm the interests and trust of patients.

On the contrary, a doctor who is truly responsible for his patients will not and will not take the risk of his patients' conditions, and willfully and subjectively prescribe lightly in order to waste a so-called false name.

"Hon Shin is better off having more soldiers."

In a sense, using generosity and combinations to treat chronic diseases, difficult diseases, and critical illnesses can more than test the doctor's ability to identify medicinal techniques and medicines and grasp the global thinking logic of seeking to cure diseases and save people.

As qualified doctors, we should view traditional Chinese medicine prescription techniques in a more objective and rigorous manner, respect the wisdom and experience of the practitioner, and jointly promote the healthy development of Chinese medicine.

In short, Chinese medicine prescription is an esoteric and complex science. It requires that doctors not only be proficient in the medicinal and efficacy of drugs, but also have a high medication strategy and a flexible mindset. Only in this way can we achieve precision medicine usage and treatment for the disease in clinical practice, bringing the best treatment effect to the patient. At the same time, we should also abandon those one-sided and unrealistic notions of medication and accept and understand the wisdom and mysteries of traditional Chinese medicine prescriptions with a more open and inclusive mindset.

Author Bio: Liang Shijie is a senior medical practitioner in traditional Chinese medicine. He has been engaged in traditional medicine clinical work for 24 years and has accumulated a wealth of clinical experience. Following Chen Yong, chief physician of liver disease at Beijing Traditional Medicine Hospital, affiliated with Capital Medical University, and renowned old Chinese medicine, he has been treated for many years and received great attention. He specializes in the treatment of difficult diseases using "conversational traditional therapy" and special treatments combined with the academic ideas of Jiao Shude and Guan Yubo's ten-level diagnosis.He is currently the director of the Center for Diffusion Research of Dr. Houde Wei Group in Beijing, a researcher at the Shude Tang Institute of Chinese Medicine, and a fellow at the new 3 + 3 project of traditional Chinese medicine flame inheritance in Beijing - a scholar at the inheritance work station of Jiao Shude's protégés (Chen Yong),He is a standing committee member of the International Expert Committee on E-learning and Health Care, a member of the Jiao Shude Academic Heritage Special Committee of the Chinese Association for the Advancement of Chinese Medicine Research, and the first cancer specialist to be included in the chapter of the Chinese Pharmaceutical Culture Research Association. Won the 2020 China Association for the Promotion of Traditional Chinese Medicine Zhongjing Medical Branch held the eighth session of the Medical Saint Zhongjing Nanyang Forum "Classic Prescription Famous Doctor" honorary title. The winner of the first Beijing-Tianjin-Hebei "Pingui Cup" Yanzhao Medical Research Essay Award in 2023.

来源：首都专家梁世杰