中医学教学课件：13 SCIENCE of PRESCRIPTIONS

1、PRESCRIPTIONS 仁济医院中医科仁济医院中医科 WHAT IS THE TCM SCIENCE OF PRESCRIPTIONS?WHAT IS THE TCM SCIENCE OF PRESCRIPTIONS?Science of prescriptions is a subject dealing with treatment and the theories of compatibility of prescription as well as the clinical application. One of the important basic courses （理、法、方

2、、药）and has a close relationship with all other clinical branches,与其他临床分科密切相关linking up the basic theories with clinical practices. 使基本理论与临床实践相连PRESCRIPTIONS 处方Select drugs and suitable doses. 选择药物及合适剂量Based on syndrome differentiation 基于不同症状According to the principle of formulating a prescription.依据

3、组方原则：组方原则：君、臣、佐、使君、臣、佐、使Formula compatibility. 处方兼容性WHAT IS THE TCM SCIENCE OF PRESCRIPTIONS? 辨证 syndrome differentiation 药Drug，medicine，herb方formula配伍配伍Compatibility汉书艺文志：“经方者，本草石之寒温，量疾病之深浅，假药味之滋，因气感之宜，辨五味六辛，致水火之剂，通闭解结，反之于平”。方剂最早的解释。“经方”的由来。方剂是药物治疗疾病的一个飞跃。Wushier Bingfang West Han Dynasty 五十二病方 The

4、 oldest extant medical formulary 最古老 Huangdi Neijing 黄帝内经Spring and autumn periodOnly 13 prescriptions with simple ingredientsDosage forms（剂型）: decoction汤剂、 pill丸、 powder散、 ointment膏、 pellet丹、and medicinal liquor药酒.Shanghan Zabing Lun伤寒杂病论 314/214 （waigan- Shanghan Lun,113/93. neishang Jingui yaolue

5、,238/207）Zhang Zhongjing “YI sheng” 医圣 Eastern Han Dynasty 东汉 张仲景 The forerunner of prescription book “fangshuzhizu” 方书之祖Established TCM theoretical construct “LI FA FANG YAO ” “理法方药”(theories, methods, prescription, and drugs)“classic on prescriptions” 经方Jin Dynasty. Ge hong. Zhouhou Fang 晋 葛洪 肘后备急

6、方 Sun Simiao Tang dynasty 唐 孙思邈 千金方Qianjin fang.(Beiji Qianjin Yaofang, Qianjin Yifang)千金要方千金翼方 Taiping Shenghui FangShengji zonglu Song Yuan Dynasty .太平圣惠方，圣济总录 方剂资料总结Puji Fang Ming Dynasty 明 朱棣 普济方61739 The most voluminous prescription book in ancient China. Zhang Juebin : Jinyue Quanshu. 张介宾 号景岳

7、景岳全书组成与变化组成与变化 PRINCIPLE OF COMPOSITION (JUN CHEN ZUO SHI PRINCIPLE OF COMPOSITION (JUN CHEN ZUO SHI 组方原则：君臣佐使) Accurate differentiation of syndromes Establishment of therapeutic method appropriate choice of drugs and doses 明明 何瑭（柏斋）医学管见：何瑭（柏斋）医学管见：“主治者，君也。辅助者，主治者，君也。辅助者，臣也。与君相反而相助，佐也。引经及引治病之药至于病臣也。

8、与君相反而相助，佐也。引经及引治病之药至于病所者，使也。所者，使也。” 君君 药药 ROLE: an essential(most important and necessary, can not be lacked) ingredient (fundamental part) FUNCTION: play a leading curative role ,aiming at the main cause, main syndromes 君药：针对主病或主证起主要治疗作用的药物。是方中君药：针对主病或主证起主要治疗作用的药物。是方中不可缺少的重要组成部分。不可缺少的重要组成部分。 臣臣 药药

9、an important ingredient help strengthen the curative effect of the monarch drugs. aiming at the accompanied diseases and accompanied syndromes 臣药臣药（1 1）辅助君药加强治疗作用的药物；辅助君药加强治疗作用的药物； （2 2）或针对兼病或兼证起治疗作用的药物。）或针对兼病或兼证起治疗作用的药物。 ZUO DRUG(ADJUVANT DRUG)佐佐 药药佐助药佐助药：加强君、臣药的治疗作用，或直接 治疗次要症状的药物。佐制药：佐制药：减轻或消除君、臣药

10、峻烈之性或毒性的药物。 反佐药：反佐药：根据病情需要，在方中配伍少量与君药性味相反而又能在治疗中起相成作用的药物。反反 佐佐兰室秘藏：滋肾通关丸 知母、黄柏各一两，肉桂五分为丸，治热在下焦血分，不渴而小便闭者。反佐与反治。反佐与反治。寒热并用，补泻兼施，敛散结合，升降互配。SHI DRUG ( GUIDING DRUG)使药使药引经药：引经药：引导方中药物的药力直达病所。调和药：调和药：能调和方中诸药的性能，协调诸药的 相互作用。Prescriptions for relieving exterior syndromesMahuang Tang Monarch drug Mahuang: re

11、lieving exterior syndrome by means of diaphoresis, activating the flow of the lung-qi to relieve asthma Minister drug Guizhi: Assisting the monarch drug to induce diaphoresis, relieve exterior syndrome and expel cold. Adjuvant drug Xingren : Helping the monarch drug to promote the flow of lung-qi an

12、d stop asthma. Guiding drug Gancao : Mediating the drug properties and preventing the impairment of vital qi due to excessive diaphoresis.Mahuang Tang麻黄汤麻黄汤解表剂解表剂君药君药 麻黄：味辛性温，发汗解表，宣肺平喘。麻黄：味辛性温，发汗解表，宣肺平喘。臣药臣药桂枝：温通卫阳，配伍麻黄，相须相得，助桂枝：温通卫阳，配伍麻黄，相须相得，助麻黄发汗解表散寒。麻黄发汗解表散寒。佐药佐药 杏仁：宣肺利气，止咳平喘，配伍麻黄，降杏仁：宣肺利气，止咳平喘，

13、配伍麻黄，降肺气，平喘止咳。肺气，平喘止咳。使药使药 甘草：调和诸药，并润肺止咳化痰。甘草：调和诸药，并润肺止咳化痰。COMMON FORMS OF PRESCRIPTIONS常用处方剂形常用处方剂形MEDICATED TEA, MEDICINAL DEW, PASTILLE, LOZENGE, MEDICICATED THREAD, LINIMENT,SUPPOSITORY, GRANULE, TABLET,SYRUP, ORAL LIQUID, INJECTION,DECOCTIONPILL 、POWDER汤剂，露剂，锭剂，条剂，线剂，搽剂，栓剂，汤剂，露剂，锭剂，条剂，线剂，搽剂，栓剂，

14、冲剂，片剂，糖浆，口服液，注射剂。冲剂，片剂，糖浆，口服液，注射剂。EXTRACT, OINTMENT PLASTERDAN、MEDICATED LIQUOR汤剂汤剂herbal pieces soaking and decocting，getting the solution. (Concept: It refers to the medicinal solution obtained by removing the dregs(药渣) after soaking and decocting the prepared herbal pieces in water for a period o

15、f time.) 汤剂：是将药物饮片混合，加水浸泡后煎煮一定时间，然后去渣取汁而制成的液体剂型，可内服、外洗、熏蒸或含漱。It is chiefly for oral administration. 主要口服给药Most widely used in clinical practice.临床广泛应用Absorb easily.Produce quick curative effectsBe suitable for serious or unsteady cases.Could be modified according to the changes of disease.It can mee

16、t the need of treatment based on syndrome differentiation.优点：个体化处方，利调整加减，制作简便，易于吸优点：个体化处方，利调整加减，制作简便，易于吸收，作用较快。收，作用较快。缺点缺点A large amount of drugs. Not easily to get.The effective compositions of some drugs are difficult to extract and easy to volatilize. Difficult for carrying and storing.缺点：服用量大，不便

17、服用，某些药有效成分不易煎出缺点：服用量大，不便服用，某些药有效成分不易煎出或易挥发散失。储藏携带困难。或易挥发散失。储藏携带困难。The drugs are ground into fine powder and well mixed for oral use and external use. 散剂：是将药物粉碎后均匀混合而制成的粉末状制剂散剂：是将药物粉碎后均匀混合而制成的粉末状制剂。Less drugs used.Prepared easily and absorbed quickly.Stable in property.Convenient to use and carry. 优点

18、优点：吸收快，制作简便，便于携带：吸收快，制作简便，便于携带。分内服和外用两类。分内服和外用两类。It refers to the round solid preparation of drugs obtained by grinding drugs into fine powder or extracting medicinal materials and then mixing with excipient.指将药物研磨成细末或药物提取物，加适宜的粘合赋指将药物研磨成细末或药物提取物，加适宜的粘合赋形剂制成的圆形固体剂型。形剂制成的圆形固体剂型。Honeyed pills or bolus

19、es, water-paste pills, paste-pills, condensed pills. 蜜丸蜜丸 、水丸、水丸 、糊丸、糊丸 、浓缩丸、浓缩丸Slow absorption, lasting potency, Small dosage, small volumes .Convenient to carry and take.吸收缓慢，药力持久，便于携带，储存、服用吸收缓慢，药力持久，便于携带，储存、服用Commonly adopted to treat chronic diseases or deficiency syndromes.Also used for chronic

20、 treatment with drugs drastic in properties. (acute)用于慢性、虚弱性疾病；急救。用于慢性、虚弱性疾病；急救。 蜜丸蜜丸 Mixing powder with honey 赋形剂：蜜。赋形剂：蜜。Soft and moist in property 性柔润性柔润. Moderate and lasting in action. 作用缓和持久作用缓和持久Rectifying taste, replenishing and nourishing. 补益、矫味补益、矫味作用作用Been applied in the treatment of chro

21、nic diseases or patients of weak constitution. 用于慢性、虚弱性疾病用于慢性、虚弱性疾病 水丸水丸 Excipient : water, wine, vinegar, or drug juice. 赋形剂：水、酒、醋、药汁。赋形剂：水、酒、醋、药汁。easy 简便简便糊糊 丸丸 The excipient : rice ,flour, yeast paste. 赋形剂：米糊、面糊。赋形剂：米糊、面糊。Prolong the therapeutic effect , and reduce harmful reaction ( gastrointest

22、inal side effects) 延长药物吸收时间延长药物吸收时间,减轻药物的胃肠副作用。减轻药物的胃肠副作用。 浓缩丸浓缩丸 Decocting liquid ,then decoction is concentrated to extract, then mixing with other powder.药物煎汁浓缩后，与药物细粉混合干燥、粉碎，加药物煎汁浓缩后，与药物细粉混合干燥、粉碎，加赋形剂制成丸剂赋形剂制成丸剂Higher content of active constituents, Convenient. 用药量小，含有效成分高，体积小，便于服用。用药量小，含有效成分高，体

23、积小，便于服用。 膏剂膏剂Decocting drugs in water or vegetable oil and discarding Decocting drugs in water or vegetable oil and discarding the the dregs.是将药物用水或植物油煎熬浓缩而成的剂型是将药物用水或植物油煎熬浓缩而成的剂型Oral: liquid extract, extract and decocted extract . Oral: liquid extract, extract and decocted extract . 内服膏剂：流浸膏、浸膏、煎膏内

24、服膏剂：流浸膏、浸膏、煎膏External application: ointment, plaster. External application: ointment, plaster. 外用膏：分软膏剂、硬膏剂外用膏：分软膏剂、硬膏剂浸膏浸膏 用溶媒浸出有效成分后，采用低温蒸发除去全部用溶媒浸出有效成分后，采用低温蒸发除去全部溶媒，调整药物浓度至标准。溶媒，调整药物浓度至标准。1ml = 25g。可以制成片剂、丸剂、或装入胶囊。可以制成片剂、丸剂、或装入胶囊。有效浓度高有效浓度高软浸膏，干浸膏。软浸膏，干浸膏。煎膏煎膏 （膏滋）（膏滋）煎药、取汁、浓缩、加入蜂蜜或冰糖或砂煎药、取汁、浓缩、

25、加入蜂蜜或冰糖或砂糖煎熬成膏。可以制成片剂、丸剂、或装糖煎熬成膏。可以制成片剂、丸剂、或装入胶囊。入胶囊。味甜，有滋补作用。味甜，有滋补作用。适合久病体虚者。适合久病体虚者。软膏软膏 （药膏）（药膏）采用基质与药物均匀混合，制成一种半固体的外用采用基质与药物均匀混合，制成一种半固体的外用制剂。制剂。常温下半固体；外用于皮肤黏膜后渐渐软化或融化。常温下半固体；外用于皮肤黏膜后渐渐软化或融化。有效成分缓慢吸收，作用持久。有效成分缓慢吸收，作用持久。局部用，适用于局部用，适用于外科疮疡肿疖。外科疮疡肿疖。硬膏硬膏 （膏药）（膏药）用油类将药物煎熬后，去渣，再加黄丹、白蜡等收膏，用油类将药物煎熬后，去

26、渣，再加黄丹、白蜡等收膏，用时加热涂于布或纸等裱褙材料，供敷贴用。用时加热涂于布或纸等裱褙材料，供敷贴用。常温下固体；外用于皮肤后软化。常温下固体；外用于皮肤后软化。MEDICATED LIQUOR 酒剂酒剂Put the drugs in liquor, soaking weeks or months. Put the drugs in liquor, soaking weeks or months. 是将药物置于酒中浸泡或加温隔水炖煮，去渣取将药物置于酒中浸泡或加温隔水炖煮，去渣取液而制成的澄清液体制剂。液而制成的澄清液体制剂。Stewing. Stewing. 适用于祛风散寒通络及补益强

27、身。适用于祛风散寒通络及补益强身。DAN 丹剂丹剂Produced under high temperature and long time. Produced under high temperature and long time. 是以某些矿物类药物经高温烧炼制成的不同结晶形状是以某些矿物类药物经高温烧炼制成的不同结晶形状的制品（外用：红升丹）的制品（外用：红升丹）Rare drugs or remarkable effect. Rare drugs or remarkable effect. 另有一些方剂由于药品贵重或药效显著而名之曰另有一些方剂由于药品贵重或药效显著而名之曰“丹丹”（

28、内服：至宝丹）（内服：至宝丹）MODIFICATION OF PRESCRIPTION方方药变化药变化It is necessary to modify it flexibly under the guidance of It is necessary to modify it flexibly under the guidance of the compatible principle. the compatible principle. “师其法而不泥其方师其法而不泥其方”NOT CHANGE: NOT CHANGE: JUN drug, main syndromes君药，主症君药，主症C

29、HANGE: CHANGE: accompanied diseases, accompanied syndromes and some symptoms. 伴随疾病、症状伴随疾病、症状illness, constitution, age, sex. 疾病、体质、年龄、性别疾病、体质、年龄、性别season, climate, region. 季节、气候、地域季节、气候、地域 Modification of Drugs Modification of Dosage Modification of Forms 药味药味的增减的增减药量的增减药量的增减剂型的更换剂型的更换药味增减药味增减四君子汤四君

30、子汤 人参、白术、茯苓、炙甘草。人参、白术、茯苓、炙甘草。异功散异功散 人参、白术、茯苓、炙甘草、陈皮。人参、白术、茯苓、炙甘草、陈皮。六君子汤六君子汤 人参、白术、茯苓、炙甘草、半夏、陈皮。人参、白术、茯苓、炙甘草、半夏、陈皮。香砂六君子汤香砂六君子汤 人参、白术、茯苓、炙甘草、半夏、陈人参、白术、茯苓、炙甘草、半夏、陈皮、木香、砂仁。皮、木香、砂仁。归芍六君子丸归芍六君子丸 人参、白术、茯苓、炙甘草、半夏、陈人参、白术、茯苓、炙甘草、半夏、陈皮、当归、白芍。皮、当归、白芍。剂型变化剂型变化NOT CHANGE: Drugs。CHANGE: Function，treatment method and syndrome.药物组成相同，剂型不同，功用不同。药物组成相同，剂型不同，功用不同。 枳实、白术枳实、白术枳术汤：消食导滞枳术汤：消食导滞-心下痞，有水饮。心下痞，有水饮。枳术丸：枳术丸： 健脾和中健脾和中- 助消化。助消化。 药量的增减药量的增减大黄、枳实、厚朴大黄、枳实、厚朴小乘气汤：小乘气汤： 荡热攻实荡热攻实-阳明腑实证。心下痞，有水阳明腑实证。心下痞，有水饮。饮。 大黄大黄四两、枳实三枚、厚朴三两。四两、枳实三枚、