仝小林：方药量效如何在《伤寒论》原剂量与《中国药典》间找平衡

7月5日，山城重庆迎来了第二届两江国际医学年会的重头戏——由重庆市中医院主办的传统医学创新发展国际研讨会。这场盛会汇聚了近300名中医药领域的专家学者，他们带着对中医药未来的深切期许，围绕“中医药的创新发展”这一主题展开了深入而热烈的研讨。

在众多精彩纷呈的发言中，中国中医科学院首席科学家仝小林的见解尤为引人注目。他以其深厚的学术功底和敏锐的洞察力，直指中医药用药特点的变迁及其背后的深层问题。

仝小林指出，张仲景作为中医史上的巨匠，其用药风格以“药少而精，药专力宏”著称。然而，时至今日，中医药的用药特点却悄然发生了变化，整方药味增多，单味剂量却逐渐减小。这种变化看似是为了安全起见，实则不然。药味一多，品种就杂，各种药物之间难免互相牵制，反而影响了疗效的发挥。

他进一步分析道：“出于安全考虑，‘广设攻围’或许能取得一定效果，但这种‘分量减而药味渐多’的大处方，绝非提高疗效的最佳途径。”仝小林强调，我们应该回归经方本原剂量，重视临床用足剂量，这才是中医药传承发展的正道。

然而，这一观点的实施却面临着现实的困境。按照传统经验开具药量，虽然往往能出奇制胜，但却可能突破《中国药典》的法定剂量。这无疑增加了医生的法律风险，使他们在治病救人时束手束脚，步履维艰。如何降低医生的医疗风险，避免他们只能以围方、合方取效，成为中医传承中的一大难题。

面对这一难题，我们不禁要问：中医药的创新发展，究竟路在何方？

首先，我们需要明确的是，中医药的传承与发展并非一成不变地照搬古方，而是在继承的基础上不断创新。这就要求我们在尊重传统的同时，也要敢于突破束缚，勇于探索新的用药方法和剂量。

其次，我们应该加强中医药的科研投入，通过科学的方法验证传统药方的有效性和安全性。只有经过科学验证的药方，才能更好地服务于临床，降低医生的法律风险。

再者，我们还应该建立完善的中医药法律体系，为中医药的创新发展提供有力的法律保障。只有这样，医生才能在法律允许的范围内自由发挥，为患者提供更加精准、有效的治疗方案。

值得一提的是，近年来已有不少学者和专家在中医药的创新发展上取得了显著成果。他们通过深入研究古代医籍，挖掘传统药方的潜在价值，并结合现代医学技术，研发出了一系列具有创新性的中药制剂。这些制剂不仅疗效显著，而且安全性高，为中医药的传承与发展注入了新的活力。

例如，某研究团队通过对张仲景《伤寒杂病论》中的经典药方进行深入研究，发现其中某些药方的剂量与现代临床常用剂量存在显著差异。他们通过临床试验验证，发现按照传统剂量使用这些药方，能够取得更好的治疗效果。这一发现不仅为中医药的临床应用提供了新的思路，也为中医药的创新发展开辟了新的道路。

当然，中医药的创新发展并非一蹴而就。它需要我们在传承与创新之间找到平衡点，既要尊重传统、继承精华，又要勇于创新、开拓进取。只有这样，我们才能让中医药这一瑰宝在现代社会中焕发出更加璀璨的光芒。

最后，让我们共同期待中医药的未来。相信在不久的将来，中医药将成为世界医学领域中一颗璀璨的明珠，为人类的健康事业作出更加巨大的贡献。而这场传统医学创新发展国际研讨会，正是我们迈向这一目标的坚实步伐。

作者简介：梁世杰 中医高年资主治医师，本科学历，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。事迹入选《当代科学家》杂志、《中华英才》杂志。

Tong Xiaoping: Effectiveness of prescription drugs - How to find a balance between the original dose of Typhoid Theory and the Chinese Pharmacopoeia

On July 5, the mountain city of Chongqing welcomed the main event of the second Bijiang International Medical Annual Conference - the International Symposium on the Innovation and Development of Traditional Medicine, hosted by the Chongqing Provincial Medical Hospital. The event brought together nearly 300 experts and scholars in the field of traditional Chinese medicine, who, with deep expectations for the future of traditional medicine, engaged in in-depth and lively discussions around the theme of "innovative development of traditional China medicine."

Among the many brilliant speeches, Tong Xiaolin, Chief Scientist of China Academy of Traditional Chinese Medicine Department, was particularly eye-catching. With his deep academic foundation and keen insight, he points to the changing characteristics of Chinese medicine and the deep problems behind it.

Tong Xiaoping pointed out that Zhang Zhongjing, as a giant in the history of Chinese medicine, is known for his medicinal style of "less pills, more refined pills, and specialized in medicine." However, to this day, the characteristics of traditional Chinese medicine have quietly changed, the whole prescription has increased in flavor, and the single-flavor dose has gradually decreased. This change might seem to be for safety reasons, but it is not. The more flavors of medicines, the more diverse the variety, and the various drugs inevitably contain each other, which instead affects the effectiveness of the treatment.

"Widespread siege may be effective for security reasons, but such large-scale prescriptions of diminishing amounts and increasing flavors are by no means the best way to improve efficacy," he added. Tong Xiaoping stressed that we should return to the original dose of traditional Chinese medicine and attach importance to the full dose in clinical use, which is the right way to inherit and develop Chinese medicine.

However, the implementation of this view faces real dilemmas. Although prescribing a dose according to traditional experience is often surprisingly successful, it may break the legal dose in the Chinese Pharmacopoeia. This undoubtedly increases the legal exposure of doctors, leaving them struggling to navigate while treating patients and saving lives. How to reduce the medical risks of doctors and avoid them using only prescriptions and combinations for effective results has become a major difficulty in the traditional Chinese medicine.

In the face of this difficult situation, we cannot help but ask: where is the path to the innovative development of Chinese medicine?

First, we need to be clear that the inheritance and development of Chinese medicine is not an immutable copy of ancient recipes, but is based on continuous innovation. This requires that while respecting traditions, we also have the courage to break through boundaries and explore new ways and doses of medicine.

Secondly, we should strengthen the research investment in traditional Chinese medicine and verify the effectiveness and safety of traditional prescriptions through scientific methods. Only prescriptions that are scientifically validated can better serve the clinic and reduce the legal risks for doctors.

Furthermore, we should also establish a sound legal system for traditional Chinese medicine to provide strong legal safeguards for the innovative development of traditional Chinese Medicine. Only in this way can doctors freely exercise their freedom to provide patients with more accurate and effective treatments within the bounds of the law.

It is worth mentioning that in recent years, many scholars and experts have achieved remarkable results in the innovative development of traditional Chinese medicine. They have developed a series of innovative preparation of Chinese materia medica through in-depth study of ancient medical literature, tapping into the potential of traditional prescriptions and combining modern medical techniques. These preparations not only have significant efficacy, but also have high safety, injecting new vitality into the inheritance and development of Chinese medicine.

For example, a team of researchers conducted an in-depth study of classical prescriptions in Zhang Zhongjing's Annals of Typhoid and found that the dosages of some of these prescriptions differed significantly from those commonly used in modern clinical settings. They tested it in clinical trials and found that using traditional doses of these medicines produced better results. This discovery not only provides new ideas for the clinical application of traditional Chinese medicine, but also opens up new paths for the innovative development of traditional medicine.

Of course, the innovative development of traditional Chinese medicine did not happen overnight. It requires us to find a balance between inheritance and innovation, to respect tradition and inherit the best, but also to be brave and innovative. Only in this way can we make this treasure of Chinese medicine shine even brighter in modern society.

Finally, let us look forward to the future of traditional Chinese medicine together. It is believed that in the near future, traditional Chinese medicine will become a shining pearl in the world medical field and make a greater contribution to human health. This International Symposium on the Innovation Development of Traditional Medicine is a solid step towards this goal.

Author Bio: Liang Shijie is a senior medical practitioner in traditional Chinese medicine with an undergraduate degree. 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 a researcher at the Shude Tang TCM Research Institute in Beijing, a fellow at the new 3 + 3 project of traditional Chinese medicine flame inheritance in Beijing - a scholar at the inheritance workstation 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. His work was featured in the journal Current Scientist and the journal Chinese Talent.