《傷寒雜病論》“一方兩法”思想探究

張鑫蕾　曹鵬　郭夢瑩　孫燕

摘要?“一方兩法”是指方劑組成藥味相同，因劑型、劑量、煎煮方法或服用方法不同從而導致方劑功效有所差異的用藥方法;或指方劑的基本組方結構相同，隨兼證的不同而適當加減變換某些藥味，從而導致方劑功用及治療效果發生變化的用藥方法，即柯韻伯所言“方內之方”，包括仲景5個或然證方及方后注中所列加減法者，如理中丸作湯法等等[1]。此處應指出：“一方兩法”之“兩”并非“二”之意，亦可有一方三法、四法等等，為“多”之意，其變換之因在于邪之深淺、正邪之盛衰以及兼證之不同。此文舉《傷寒論》及《金匱要略》中幾個典型方劑以探討“一方兩法”思想的運用方法，以啟迪臨床靈活運用經方的思路并提高療效。

關鍵詞?傷寒論;金匱要略;一方兩法;劑型劑量;煎服法

Exploration on the Thought of “One Prescription with Two Directions” in Treatise on Febrile and Miscellaneous Diseases

Zhang Xinlei，Cao Peng，Guo Mengying，Sun Yan

（School of Traditional Chinese Medicine，Beijing University of Chinese Medicine，Beijing 100029，China）

Abstract?“One Prescription with Two Directions” is a medication method that means prescriptions constituted by the same herbal medicines have diverse efficacy of prescription as the differences of dosage forms，doses，decoction methods or methods of taking medicine. The thought is as the same as the statement of “the formula of the prescription” said by Ke Yunbo，which means the basic group structures of the prescriptions are as usual，as well as adding or subtracting some herbs of the prescriptions appropriately on the basis of accompanying syndromes. Thus，it can lead to several changes of the efficacy and the treatment effects of prescriptions. It contains 5 probabilistic methods founded by Zhang Zhongjing and the addition or subtraction of the formulas noted after the prescriptions，such as taking Lizhong Bolus as decoction method，and so on. It is indispensable to point out that the “two” of “One Prescription with Two Directions” means not only the number of “two”，but also “One Prescription with Three Directions” or “four directions”. Its meaning is “many”. The reasons for changing the directions are dominated by the depth of pathogenic factors，the vicissitude of vital qi and pathogens，and the imparity of accompanying syndromes. The purport of this paper is to illustrate some typical examples in Treatise on Febrile Diseases and Synopsis of Golden Chamber to discuss the application of the thought of “One Prescription with Two Directions”，so as to enlighten the train of thought to use the classical prescriptions neatly and improve the efficacy.

Key Words?Treatise on Febrile Diseases; Synopsis of Golden Chamber; One Prescription with Two Directions; Dosage forms and doses; Methods of decocting and taking medicine

中圖分類號：R222.2文獻標識碼：Adoi：10.3969/j.issn.1673-7202.2019.03.024

《傷寒論》及《金匱要略》中有很多方劑的藥味組成相同，但劑型、劑量、煎煮方法或服用方法不同;或方劑基本組方結構相同，因兼證不同，藥味有所加減變化，由此使方劑功用及治療效果有所差異，此即本文所論述的“一方兩法”思想。“一方兩法”在《傷寒論》原文中僅一處體現，即174條“傷寒八九日，風濕相搏，身體疼煩，不能自轉側，不嘔不渴，脈浮虛而澀者，桂枝附子湯主之。若其人大便硬，小便自利者，去桂加白術湯主之”。原文方后注“此本一方二法，以大便硬，小便自利，去桂也;以大便不硬，小便不利，當加桂”。但《傷寒雜病論》中還有諸多條文方證體現了“一方兩法”思想。……