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Yong gang Han
Abstract: According to the section on “Herbalists and Alchemists” in the “Treatise on Literature” in the Han Shu ［Book of Han］, preQin dynasty traditional Chinese medicine was divided into 4 major schools. Among the 11 texts it mentions from the school of classical remedies, only the Tangye Jingfa ［Canonical Methods for Brews and Decoctions］was passed on through Shanghan Zabing Lun ［On Cold Damage and Miscellaneous Diseases］and Fu Xing Jue ［Extraneous Secrets］. The term “classical remedy” or “Jing Fang” has 4 layers of connotation: classic, selected, simplified, and precise. These 4 connotations are the 4 criteria for distinguishing “classical remedies” from “nonclassical remedies”. The 2 guidelines for creating classical remedies are “sovereign, minister, assistant, and envoy ［i.e. the medicinal roles］” and “the harmony of the 7 affects”. Classical remedies strive to be concise and precise. The author recommends 13 ingredients as the upper limit for a prescription.
Keywords: Classical remediesTangye Jingfa ［Canonical Methods for Brews and Decoctions］ Shanghan Zabing Lun ［On Cold Damage and Miscellaneous Diseases］ Fu Xing Jue ［Extraneous Secrets］ medicinal ingredients in a prescription
The origins of classical remedies
The section on the “Domain of Herbalists and Alchemists” in the “Treatise on Literature” in the Han Shu ［Book of Han］states: “［There are］ 18 volumes in Huangdi Neijing ［Yellow Emperor’s Inner Canon］, 39 volumes in Waijing ［Yellow Emperor’s Outer Canon］, 9 volumes in Bianque Neijing ［Bian Que’s Inner Canon］, 12 volumes in Waijing ［Bian Que’s Outer Canon］, 38 volumes in Baishi Neijing ［Bai’s Inner Canon］,and 36 volumes in Waijing ［Bai’s Outer Canon］. ［There are］ 25 volumes in the Pangpian ［Side Treatise］. These 7 medical classic texts ［contain a total of］ 216 volumes. The medical classics examine the blood vessels, channels and network vessels, bones and marrow, yin and yang, and exterior and interior of the human body to reveal the root of the hundred diseases, and distinguish between life and death. They use needles, stones, decoctions, and fire as treatment methods, and adjust the hundred medicinal preparations appropriately. The best preparation is like a magnet attracting iron, bringing about a powerful response. Unskilled practitioners who fail to grasp these theories make ［those who are in］ recovery worse and bring death to the living.
［There are］ 46 volumes in Wuzang Liufu Shan Shiliu Bingfang ［Prescriptions for 16 Mounting Diseases of the 5 Viscera and 6 Bowels］, 40 volumes in Wuzang Liufu Dan Shier Bingfang ［Prescriptions for 12 Jaundice Diseases of the 5 Viscera and 6 Bowels］,23 volumes in Qinshi Huangdi Bianque Yufu Fang ［Remedies of Qin Shi, Yellow Emperor, Bian Que, and Yufu］, 31 volumes in Wuzang Shangzhong Shiyi Bingfang ［Prescriptions for 11 Diseases of Damage to the 5 Viscera］, 17 volumes in Keji Wuzang Kuangdian Bingfang ［Prescriptions for Visiting Diseases of the 5 Viscera, Mania, and Withdrawal］, 30 volumes in Jinchuang Zongchi ［Incised Wounds, Slackening, and Tugging］, 19 volumes in Furen Yinger Fang Prescriptions for Women and Infants］, 32 volumes in Tangye Jingfa ［Canonical Methods for Brews and Decoctions］, and 7 volumes in Shennong Huangdi Shijin ［Dietary Contraindications of the Divine Husbandman and Yellow Emperor］. These 11 classical remedy texts ［contain a total of］ 274 volumes. Classical remedies ［use］ the cold and warm ［properties of］ roots, herbs, and stones. They measure the depth of disease ［and］ use the nourishment of medicinal ingredients in a way that is appropriate for the season and climate. They identify the 5 bitter and 6 acrid properties ［i.e. the medicinal properties required by the viscera and bowels］ to create formulas of fire and water ［i.e. hot and cold] that open what is blocked and resolve what is bound, returning ［the patient］ to normal.”
The “Treatise on Literature” in the Book of Han is the earliest extant bibliographical treatise; it is a comprehensive list of the Han dynasty national library. The author, Bangu, based it on Bielu ［Separate Records］and Qilüe ［7 Domains］,written by Liu Xiang and his son Liu Xin. Bangu divided the text into 6 domains: Confucians, philosophers, poets, militarists, astrologers and diviners, and herbalists and alchemists. At the time, TCM was considered part of the school of herbalists and alchemists, so related works are listed in the corresponding section. According to the“Domain of Herbalists and Alchemists”, preQin dynasty TCM was divided into 4 major schools, namely the medical classics school (7 texts), the classical remedies school (11 texts), the bedchamber school (8 texts), and the spirit immortal school (10 texts).
Modern scholars have proposed the concept of “broad” and “narrow” definitions of classical remedies. The “broad” definition of classical remedies includes the 11 texts listed in the “Domain of Herbalists and Alchemists”, while the “narrow” definition specifically refers to Zhang Zhongjing’s Shanghan Zabing Lun ［On Cold Damage and Miscellaneous Diseases］. Of the 11 texts on classical remedies, all have been lost to history except for Yi Yin’s Tangye Jingfa, which was preserved in Shanghan Zabing Lun and Fu Xing Jue.
I believe that both Tao Hongjing’s Fu Xing Jue and Zhang Zhongjing’s Shanghan Zabing Lun originate from Yi Yin’s Tangye Jingfa, and they are the existing representatives of the classical remedies school. Metaphorically speaking, Fu Xing Jue is the eldest son and Shanghan Zabing Lun is the second son of Tangye Jingfa. In ancient Chinese society, the primary responsibility of the eldest son was to serve as the successor of the nation or family, while the second son was free to innovate. Therefore, as the eldest son, Fu Xing Jue faithfully preserved Tangye Jingfa, while the second son, Shanghan Zabing Lun, drew from many sources to innovate on the foundation of Tangye Jingfa. For example, Tangye Jing only discusses “exterior and interior”, while Shanghan Lun adds the concept of “halfexterior, halfinterior”.
The connotations of classical remedies
I believe that the term “classical remedy” has 4 layers of connotation: classic, selected, simplified, and precise. These 4 connotations are the 4 criteria for distinguishing “classical remedies” from “nonclassical remedies”.
First, classical remedies are classic prescriptions. Tangye Jingfa is the only remaining classic text of the “11 texts on classical remedies”; Shanghan Zabing Lun and Fu Xing Jue have preserved this authentic classical remedy lineage.
Second, classical remedies are selected prescriptions. The original text of Fu Xing Jue recorded 60 formulas; the 52 that currently remain all originate from Tangye Jingfa and are true “classical remedies”. Because they were carefully chosen by Tao Hongjing from the 365 classical remedies in Tangye Jingfa, they are selected classical remedies.
Third, classical remedies are simplified prescriptions. Compared to the large formulas written by many modern TCM practitioners containing as many as 20 or 30 ingredients, the traditional medicinal formulations in Fu Xing Jue are concise with few ingredients. For instance, among the 24 major and minor formulas for supplementing and draining the viscera and bowels, minor drainage formulas have 3 ingredients, minor supplementation formulas have 4 ingredients, major drainage formulas have 6 ingredients, and major supplementation formulas have 7 ingredients. Xici ［Commentary on Appended Phases］in Zhou Yi ［Classic of Changes］says, “That which is simple is easy to understand; that which is concise is easy to follow. Ease of understanding yields familiarity; ease of following yields results.” The ancient saying that “the great way is the simplest” is not just empty words; simple methods and techniques are easy to master and apply.
Fourth, classical remedies are precise prescriptions. Still using the aforementioned 24 formulas from Fu Xing Jue as an example, all of them are precisely targeted at the core pathology. The minor formulas focus on the affected viscera. The major formulas also handle the mother or child viscera with “a formula within a formula” to treat the mother and child at the same time, supplementing vacuity and draining repletion in a precise treatment. The “precision medicine” sensationalized by modern western medicine and TCM is actually the same as what ancient Chinese practitioners promoted thousands of years ago.
The number of ingredients in classical remedies
According to Zhang Dachang Yilun Yian Ji ［Collected Medical Treatises and Cases of Zhang Dachang］, “While there is a big difference between the academic achievements of post antique formulas and classical remedies, at least the latter follow rules and do not lead to excess. Overall, they are much better than the prescriptions of some mainland Chinese practitioners today. A prescription may use dozens of ingredients in large doses, with no distinction between their primary and secondary functions, and most of the preparation techniques are absurd. The notion that one should use many ingredients for severe diseases, specially selected ingredients for unusual diseases, and adjust doses as one sees fit actually does not work in practice. This is like wasting a whole roll of silk just to make a sheath for a pocket knife or filling a giant cauldron of water just to drink a cupful. For beginners, such practices would not be surprising; if experienced practitioners continued to do this, would it not be a joke? The ancients said it best: nothing can be accomplished without following norms and standards. This is an old cliché, but should not be forgotten.”
In my paper “Medicinal Pairs and Trios in Fu Xing Jue”, I discussed 2 major rules for formulating classical remedies, which are also the 2 major principles for combinations in classical remedies: “sovereign, minister, assistant, and envoy ［i.e. the medicinal roles］” and “the harmony of the 7 affects”. This paper primarily explores the number of ingredients in classical remedies.
Yifang Jijie ［Medical Formulas Gathered and Explained］, written by Qing dynasty practitioner Wang Ang, states: “When the ancients created formulas, they used few ingredients in large doses. This is like how a skilled soldier taking a single route is sufficient to breach barricades and capture the king. Later generations lacked the awareness of their predecessors; they decreased the doses and gradually increased the number of ingredients. This is like setting up a wide perimeter in hopes of possibly encountering the enemy. With so many components, attacking and taking control is sure to be complicated. Can one avoid benefiting the opponent if one does not succeed in this?”
In his text Sushen Liangfang［Good Prescriptions of Su and Shen］, Song dynasty scientist Shen Kuo wrote: “It is easy to understand the use of individual medicinal ingredients and hard to understand their use in compounds.” The chemical components of Chinese herbal medicine are very complicated. A single medicinal ingredient contains multiple organic and inorganic components, so even on its own, it has more than a single effect. The addition of more unknown factors and the combination of multiple ingredients create an extremely complex multi component system. Reactions such as acid base neutralization, oxidation, reduction, substitution, hydrolysis, polymerization, and condensation may occur, all of which could change the original nature of the medicinal ingredients.
According to the 5 flavor supplementation and drainage theory in Fu Xing Jue, any of the 5 flavors could be the “functional flavor” for a given viscus and the “substantial flavor” for the viscus that it restrains, so taking a single medicinal ingredient will act on at least 2 viscera at once, namely the affected viscus and the viscus it restrains (the grandchild), which means that supplementing a given viscus necessitates draining another. Specifically, the acrid flavor supplements liver wood while draining spleen earth, the salty flavor supplements heart fire while draining lung metal, the sweet flavor supplements spleen earth while draining kidney water, the sour flavor supplements lung metal while draining liver wood, and the bitter flavor supplements kidney water while draining heart fire. The greater the number of medicinal ingredients, the harder it is to grasp and control the effects they cause. For this reason, Fu Xing Jue, drawing upon Tangye Jingfa, strives for simplicity in its use of medicinal ingredients. If a minor formula can be used to solve a problem, it does not use a major formula, and even the major formulas contain no more than 7 ingredients.
This presents a stark contrast to modern TCM. According to Fangyao Liangxiaoxue ［Formula and Medicinal Dosimetry］, edited by Tong Xiaolin, an academician of the Chinese Academy of Sciences: “Modern prescriptions contain an average of 19 ingredients; among these, the total dose of all ingredients in the majority of formulas is between 200 and 250 grams. Compared to classical remedies, the number of ingredients used by modern clinical prescriptions has noticeably increased, while there is no major difference in the total dose of all ingredients. Calculations show that the average dose of individual ingredients (total dose of all ingredients / number of ingredients) in modern formulas is less than that of classical remedies. ［…］ In proven cases of classical remedies used by expert TCM practitioners, a single formula contained an average of 10.83±4.09 ingredients, with 11 ingredients being the most common for a total of 134 formulas (13%). The average total dose of all ingredients was 127.43±70.24 grams, with a minimum of 15 grams and a maximum of 678 grams.” Overall, it is clear that the prescriptions written by the majority of modern TCM practitioners tend to contain a relatively large number of ingredients, while the 11 ingredient formulas typically written by expert practitioners fit the requirements of TCM classics.
Clinical application methods of classical remedies from Fu Xing Jue
I recommend the following methods for clinical application of the 24 major and minor formulas for supplementing and draining the viscera and bowels from Fu Xing Jue: (1) Use a single minor or major formula. (2) Supplement a minor or major formula. (3) Combine 2 minor formulas. (4) Combine a minor formula with a major formula.
I do not recommend combining 2 major formulas for a simple reason: the greater the number of ingredients, the more complicated the interactions between ingredients and the more difficult it is to maintain control. Not only does this fail to conform to the ancient concept that “the great way is the simplest”, it also deviates from the modern concept of “precision medicine”.
In terms of the number of ingredients in a prescription, I advocate for an upper limit of 13 ingredients in TCM prescriptions. My teacher, modern TCM master Fang Yaozhong, always emphasized that “words must be based in fact; believe nothing without evidence”; is there evidence for my proposal in the TCM classics?
Chapter 74 of Huangdi Neijing Suwen ［The Yellow Emperor’s Inner Canon, Elementary Questions］, entitled “Comprehensive Discourse on the Essentials of Utmost Truth”, states: “1 sovereign and 2 ministers is a small composition; 1 sovereign, 3 ministers, and 5 assistants is a midsized composition; 1 sovereign, 3 ministers, and 9 assistants is a large composition.” In Neijing, which belongs to the medical classics school, there is a 3level system of medicinal roles consisting of sovereigns, ministers, and assistants. Small formulas have 3 ingredients, midsized formulas have 9 ingredients, and large formulas have 13 ingredients.
The preface to Shennong Bencao Jing ［The Divine Husbandman’s Herbal Foundation Canon］ states: “Medicines consist of sovereigns, ministers, assistants, and envoys, which serve to mutually diffuse, contain, unify, and harmonize each other. It is best to use 1 sovereign, 2 ministers, and 5 assistants, or one can use 1 sovereign, 3 ministers, and 9 assistants and envoys.” In this text, which belongs to the classical remedies school, small formulas have 8 ingredients, while large formulas have 13 ingredients.
Fu Xing Jue, which belongs to the classical remedies school, contains 24 major and minor formulas for supplementing and draining the viscera and bowels. Minor drainage formulas have 3 ingredients and minor supplementation formulas have 4 ingredients; minor formulas focus on the affected viscera. Major drainage formulas have 6 ingredients, focusing on the affected viscera and the mother viscera. Major supplementation formulas have 7 ingredients, focusing on the affected viscera and the child viscera.
In my first few years of systematically using Fu Xing Jue in clinical practice, most of my prescriptions contained 11 ingredients. At present, I generally tend to use 9 ingredients in each prescription. Tian Heming (1883-1980), a famous TCM practitioner from Chengdu, Sichuan province, who lived to the age of 97, carefully followed Zhang Zhongjing’s methods by using a small number of selected medicinal ingredients. He preferred to use formulas containing 8 ingredients, so people called him“Tian 8 Ingredients”.
In clinical practice, I suggest that the first choice should be to use a single minor or major formula, which can be supplemented with other ingredients. The second choice is to combine 2 minor formulas for a total of 6 to 8 ingredients, or combine 1 major formula with 1 minor formula for a maximum of 11 ingredients. Whenever possible, one should avoid combining 2 major formulas. The first reason for this is that 2 major formulas contain a total of up to 14 ingredients, which exceeds the limit of 13 ingredients. The second reason is that 2 major formulas would target 4 viscera, resulting in a lack of focus and prioritization. Expert TCM practitioners are like expert martial artists; among the 5 viscera, they choose one to focus on as a priority for supplementation or drainage, just like an expert martial artist’s decisive final move! If the disease symptoms are so complex that it is hard to confirm which one of the 5 viscera is key to the pathology, then focus on the affected viscus, include its mother or child, or include the viscera that restrain or are restrained by it. Following the pattern of engendering, restraining, controlling, and transforming is still an acceptable choice. Using medicines that focus on 3 viscera at a time is likely to yield mediocre results.
In addition, I frequently combine 2 minor formulas in clinical practice by using 1 minor drainage formula and 1 minor supplementation formula. Why does the combination of 1 minor drainage formula and 1 minor supplementation formula yield good results?
According to chapter 66 of Huangdi Neijing Suwen, entitled “Comprehensive Discourse on the Arrangement of the Original ［Qi］ of Heaven”: “The emperor said, ‘Good. What is meant by “qi may be abundant or lacking; the ［physical］ form may be exuberant or debilitated”?’ Gui Yuqu said, ‘［This refers to］ the respective abundance or lack of the qi of yin and yang, so they are called the 3 yin and 3 yang. ‘The form may be exuberant or lacking’ refers to the treatment of the 5 phases, among which each may be excessive or insufficient. Hence, at the start, ［a phase］ may be in excess and insufficiency will follow it, or ［a phase］ may be insufficient and excess will follow it. If one knows that which has come up and that which follows, the qi can be predicted.”
It can be seen that the excess of a given viscus, bowel, channel, or network vessel inevitably accompanies the insufficiency of another viscus, bowel, channel, or network vessel that is associated with it, and the opposite is also true! What practitioners must do is use the 4 examinations to accurately locate the viscera, bowels, channels, and network vessels affected by the pathology. After the viscera, bowels, channels, and network vessels involved in the core pathology have been confirmed, one can supplement or drain them and those to which the pathology has shifted based on motherchild and overwhelmingrebellion relationships. Supplement vacuity and drain repletion; this is the actual application of the concept that “the great way is the simplest” in TCM!
About the Author:
Han Yonggang earned his doctoral degree from the Institute of Basic Research in Clinical Medicine at the China Academy of Chinese Medical Sciences. He studied under Wang Yongyan, a member of the Chinese Academy of Engineering, and Professor Gao Sihua, former president of Beijing University of Chinese Medicine. He has worked in the UK since 2009, where he is currently employed at Chelsea Natural Health Clinic and the London Academy of Chinese Acupuncture. He is a member of the World Classic Chinese Medicine Association Expert Committee, a standing member of the World Federation of Chinese Medical Societies Expert Committee on Prescription Dose Effects, and a council member of the World Federation of Chinese Medicine Yunqi Societies.
Email:[email protected] WeChat: yonggang01
References
1. Zhang Dachang. Zhang Dachang Yilun Yian Ji ［Collected Medical Treatises and Cases of Zhang Dachang］. Beijing: Xueyuan Chubanshe ［Academy Press］, 2008.
2. Han Yonggang. Medicinal pairs and trios in Fu Xing Jue. World Chinese Medicine Journal (Swiss version). 2002, 2(4): 226-236.
3. Han Yonggang. Overall principles for the formulation of supplementation and drainage formulas for the viscera and bowels in Fu Xing Jue. The Journal of Chinese Medicine and Acupuncture. 2022, 29(2): 45-48.
4. Tong Xiaolin. Fangyao Liangxiao Guanxi Mingyi Huijiang ［Collected Speeches by Famous Practitioners on Formula and Medicinal Dosing Relationships］. Beijing: Renmin Weisheng Chubanshe ［People’s Medical Publishing House］, 2014.
5. Tong Xiaolin. Fangyao Liangxiaoxue ［Formula and Medicinal Dosimetry］. Beijing: Kexue Chubanshe ［China Science Publishing & Media］, 2015.
論經方的來源、內涵和藥味數量
韓永剛
摘要：根據《漢書·藝文志·方技略》，先秦中醫分為四大流派，經方派十一家，僅其中的《湯液經法》通過《傷寒雜病論》和《輔行訣》得以傳承。“經方”有四層內涵：經典、精選、精簡、精準。這四層內涵是區分“經方”和“非經方”的四大標準。經方組方的兩大規矩是“君臣佐使”與“七情和合”。經方的組方力求精簡、精準，筆者建議以13味藥物作為組方上限。
關鍵詞：經方 湯液經法 傷寒雜病論 輔行訣 藥味
經方的來源
《漢書·藝文志·方技略》曰：“黃帝內經十八卷，外經三十九卷，扁鵲內經九卷，外經十二卷，白氏內經三十八卷，外經三十六卷。旁篇二十五卷。右醫經七家，二百一十六卷。醫經者，原人血脈、經絡、骨髓、陰陽、表裡，以起百病之本，死生之分，而用度箴石湯火所施，調百藥齊和之所宜，至齊之得，猶慈石取鐵，以物相使。拙者失理，以愈為劇，以死為生。
五藏六府疝十六病方四十卷，五藏六府癉十二病方四十卷，風寒熱十六病方二十六卷，泰始黃帝扁鵲俞拊方二十三卷，五藏傷中十一病方三十一卷，客疾五藏狂顛病方十七卷，金創瘲瘛方三十卷，婦人嬰兒方十九卷，湯液經法三十二卷，神農黃帝食禁七卷。右經方十一家，二百七十四卷。經方者，本草石之寒溫，量疾病之淺深，假藥味之滋，因氣感之宜，辨五苦六辛，致水火之齊，以通閉解結，反之於平。”
《漢書·藝文志》是現存最早的一部文獻目錄專著，是漢代國家藏書的總目。班固以劉向、劉歆父子的《別錄》和《七略》為依據編寫而成，分六藝、諸子、詩賦、兵書、數術、方技等六略。中醫在當時類編於方技家，因此相關著作見於《方技略》。根據《方技略》，先秦中醫分為四大流派，即醫經派（七家）、經方派（十一家）、房中派（八家）、神仙派（十家）。
有現代學者提出了“廣義經方”和“狹義經方”的概念，所謂“廣義經方”，包括《方技略》所列舉的經方十一家，而“狹義經方”則特指張仲景《傷寒雜病論》。經方十一家，除了伊尹《湯液經法》通過《傷寒雜病論》和《輔行訣》得以傳承之外，其它均已經亡軼。
筆者認為，陶弘景《輔行訣》與張仲景《傷寒雜病論》同源於伊尹《湯液經法》，是現存經方的代表。我做個比喻，《湯液經法》是父母，《輔行訣》是長子，《傷寒雜病論》是次子。在中國古代社會，國家和家族中的長子的首要責任是繼承，次子則可以不拘一格地創新。因此，《輔行訣》作為長子，忠實地繼承了《湯液經法》；而《傷寒雜病論》作為次子，“博採眾方”，在《湯液經法》的基礎上做了創新。例如，《湯液經》只有“表裡”，《傷寒論》則增加了“半表半裡”。
經方的內涵
筆者認為，“經方”有四層內涵：經典、精選、精簡、精準。這四層內涵是區分“經方”和“非經方”的四大標準。
第一，經方是經典處方。《湯液經法》是“經方十一家”中碩果僅存的經典著作，《傷寒雜病論》、《輔行訣》傳承着正宗的經方血脈。
第二，經方是精選處方。《輔行訣》原書載方60首，現存處方52首，均來源於《湯液經法》，都是真正的“經方”，是陶弘景從《湯液經法》365首經方中精心选择的處方，即精选的經方。
第三，經方是精簡處方。相對於很多現代中醫所開的動輒20味、30味以上的龐大處方，《輔行訣》的遣藥組方，味少而精。以臟腑大小補瀉方24首為例，小瀉方3味藥，小補方4味藥，大瀉方6味藥，大補方7味藥。《周易·系辞》“易則易知，簡則易從。易知則有親，易從則有功。”古人所謂的“大道至简”並不是一句空話，简單的方法、技術才容易掌握和運用。
第四，經方是精準處方。仍以《輔行訣》臟腑大小補瀉方24首為例，所有處方精確定位於病變的核心，小方以本臟為核心；大方兼顧母臟或者子臟，方中有方，母子同治，補虛瀉實，精準治療。現代西醫和現代中醫炒作的“精準醫療”，實際上就是幾千年前的中國古代先賢們所倡導的。
經方的藥味數量
《張大昌醫論醫案集》：“盡管時方的學術造詣比經方差距很大，但尚有規矩，不致泛濫難收。總比今天國內某些醫家之處方好得多。一方用藥多至數十味，藥量輒重八九兩，性能主次不分，炮製多屬離奇。病重藥多，病奇藥精，量所當然，而考所施，實又非是。製寸錐之囊而殘匹帛，為杯水之飲而舉鼎釜，若初學之士，尚不足怪，赫赫耆宿亦復如是，豈非笑柄耶?古語說得好，不依規矩不能成方圓，不依六律不能定五音，老生常談，何竟忘之。”
在“《輔行訣》的藥對和角藥”一文中，筆者論述了經方組方的兩大規矩，也就是經方的兩大基本配伍原則：“君臣佐使”與“七情和合”。本文主要探討一下經方的藥味數量。
（清）汪昂《醫方集解》曰：“古人立方，分量多而藥味寡。譬如勁兵，專走一路，則足以破壘擒王矣。後世無前人之朗識，分量減而藥味漸多，譬猶廣設攻圍，以庶幾於一遇也。然品類太繁，攻治必雜，能無宜於此，而不宜於彼呼?”
宋代科學家沈括《蘇沈良方》曰：“藥之單用為易知，藥之復用為難知。”中藥的化學成分是很複雜的，一味中藥含有多種有機成分和無機成分，其本身的作用已不是單一的，再加上更多的未知因素，多味中藥配伍在一起，就組成了一個非常複雜的多成份系統。酸鹼中和反應、氧化反應、還原反應、取代反應、水解反應、聚合反應、縮合反應等都有可能發生，這些反應可以改變中藥原來的性質。
根據《輔行訣》的五味補瀉理論，五味中的任意一味都同時是一臟的用味和我克臟的體味，服用一味藥至少會同時作用於兩臟，本臟和我克臟（孫臟），也就是在補一臟的同時必然會瀉另一臟。具體而言，辛味補肝木而瀉脾土，鹹味補心火而瀉肺金，甘味補脾土而瀉腎水，酸味補肺金而瀉肝木，苦味補腎水而瀉心火。藥味越多，其產生的作用越難以掌握和控制。因此，傳承《湯液經法》的《輔行訣》，用藥力求簡潔，能用小方解決問題就不用大方，大方的藥味也不超過7味藥。
反觀現代中醫，根據中國科學院院士仝小林主編的《方藥量效學》：“現代處方的平均藥味數為19味，其中大部分方劑的整方用量為200～250克。與經方比較，現代臨床處方的藥味數明顯增多，整方用量與經方差別不大，經計算可知現代處方單味藥的平均劑量（整方用量/藥味數）小於經方中單味藥的平均用量……國醫大師經方驗案，單劑平均（10.83±4.09）味藥物，11味藥物組成的處方最常見，共134方（13.3%）。平均整方劑量為（127.43±70.24）克，最小15克，最大678克。”可見，從整體上看，大部分現代中醫師的中藥處方藥味數明顯偏多；而國醫大師們做常見的11味藥物是符合中醫經典的要求的。
《輔行訣》經方的臨床應用模式
筆者推荐《輔行訣》臟腑大小補瀉方24首的臨床應用模式如下：1，小方或大方單獨應用。2，小方或大方加味。3，小方合小方。4，小方合大方。
筆者不推薦大方合大方的模式。理由很簡單，藥味越多，藥物之間的相互作用越複雜，越難以掌控。不但不符合古人“大道至簡”的理念，也不符合現代“精準醫療”的理念。
就處方藥味數量而言，筆者提倡中藥處方的藥味上限為13味藥。我的師爺，現代中醫大家方藥中先生始終強調“言必有據，無證不信”！我的倡議有沒有中醫經典的依據？
《黃帝內經·素問·至真要大論》曰：“君一臣二，制之小也；君一臣三佐五，制之中也；君一臣三佐九，制之大也。”醫經派的《內經》，君臣佐三級用藥體系，其小方3味藥，中方9味藥，大方13味藥。
《神農本草經·序》曰：“藥有君臣佐使，以相宣攝合和者，宜用一君二臣五佐，又可一君三臣九佐使也。”經方派的《本經》，小方8味藥，大方13味藥。
經方派的《輔行訣》臟腑大小補瀉方24首，小瀉方3味藥，小補方4味藥，小方重點在本臟；大瀉方6味藥，重點在本臟和母臟；大補方7味藥，重點在本臟和子臟。
筆者在臨床系統使用《輔行訣》最初幾年，處方基本是11味藥，目前基本保持在每個處方9味藥。四川成都著名老中醫田鶴鳴（18831980），享年97歲，生前謹遵仲景之法，用藥精而少，多喜用8味組方，人称“田八味”。
在實際臨床中，筆者建議首選是單獨應用小方或者大方，可以加味。其次，可以聯合使用兩個小方，這樣藥味是6味至8味，或者聯合使用一個大方和一個小方，這樣最多是11味藥。盡可能不聯合使用兩個大方，理由一，兩個大方最多14味藥，超過了13味藥的上限；理由二，两個大方就針對四臟，從而失去了重點和主次。中醫的高手猶如武林高手，在五臟之中立足於一臟，做重點補瀉，相當於武林高手的一劍封喉！如果病症複雜，難以在五臟中確定核心病臟，則以本臟為核心，或配合母臟、子臟，或配合克我之臟、我克之臟，行生克制化之術，仍不失為中上之选。若用藥立足於三臟，恐已落於中工。
另外，筆者在臨床上用藥多聯合使用兩個小方，一個小瀉方合一個小補方。為什麼一補一瀉兩個小方的合方效果好？
《黃帝內經·素問·天元紀大論》：“帝曰：善。何謂氣有多少，形有盛衰？鬼臾區曰：陰陽之氣各有多少，故曰三陰三陽也。形有盛衰，謂五行之治，各有太過不及也。故其始也，有餘而往不足隨之，不足而往有餘從之，知迎知隨，氣可與期。”
可見，某個臟腑或者經絡的太過，必然伴隨着與其相關的某個臟腑或者經絡的不及！反之亦然！醫生需要做的就是通過四診，精準定位病變所涉及到的臟腑經絡！核心病變的臟腑經絡確定之後，再根據臟腑之間的母子關係、乘侮關係，對核心病變及其傳變的臟腑經絡進行補瀉，虛者補之，實者瀉之，這就是中醫“大道至簡”的實際應用！
作者簡介
韓永剛，中國中醫科學院臨床醫學基礎研究所博士研究生，師從中國工程院王永炎院士和原北京中醫藥大學校長高思華教授。2009年赴英國工作至今，現就職於Chelsea Natural Health Clinic和倫敦中醫針灸學院。擔任世界經典中醫學會專家委員會委員，世界中聯方藥量效專業委員會常務委員，世界中醫五運六氣學會聯合會理事，歐洲中醫五運六氣學會副會長，英國中醫聯盟學會學術理事。
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