从搬木头谈中医处方药味的多寡问题（转载）
本帖最后由 moni 于 2013/8/2 12:07 编辑临床上经常遇到这样的人，他们判断一个医生水平的高低，常常依据处方药味的多少，认为一张处方药物越少，则医生处方越自信，医术越高，疗效肯定越好。事实上并非如此，判断一个处方的好坏，并非单纯以药物的数量来定，而当看处方思路是否符合病机。有些大夫看不透病机，不敢开药，随便弄个三五味药，不求用功但求无过，这能解决问题吗？
疾病的治疗目的是折其病势，扭转病机，这是目的，用药不是为了将病治疗到什么程度，而关键是看病势是否调头，病势扭转了，身体自身就会得到了修复，如果病势得不到扭转，用药只是对症处理，疾病永远没有治愈的一天，用药也就是追着疾病跑。
扭转病机就好似一艘船调头，也好似将一根木头调头一样，调头需要外力的帮助，如果我们从木头的一端用力，力量强大，很轻松就将木头调头了（如图一）。
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但这是有前提的，木头能够承受强大的外力，如果木头本身已经不结实了，只从一个角度用力，就很容易出现从中折断（如图二）。
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这时需要从两端着力，相对用力，这样才能将木头调头，而保证不折断。临床上寒热搭配，升降同施，攻补兼顾，就是如此（如图三）。
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但如果木头久经风雨，已经腐烂，碰一碰都会掉下一块来，你只从一端用力，绝对不行。从两端用力，也会非常勉强，这是就需要从多个地方用力，才能保证木头调头的同时，不会被折断（如图四）。
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临床上很多慢性病，病史追溯一下，常常是七八上十年，有的是二三十年，病机不再是单纯肾阳虚，也不再单纯是心血虚……常常五脏受累，如果单从一个角度入手，只用两三味药，大剂量使用，身体稍强的人可能受得住，但更多的时候，容易出现身体不适，很多医家认为是排病反应，其实是身体受到损害的表现（当然也有一些是排病反应）。用药时如果五脏兼顾，虚实各有照应，则这些慢性病就会稳步好转，慢慢扭转病机，而不会出现病没治好，命却没了的状况。
那么，是不是用药越多越好呢，这是绝对错误的，用药太多，相互之间牵涉、制约，窝工不干活，效果也不好。
所以遣方用药，不要刻意追求处方药味的多寡，切中病机，照顾五脏，就可以了。
本帖最后由 竹根 于 2013/8/2 12:15 编辑
不要为自己的大处方辩解什么。像黄元御《四圣》的处方都是非常精简的。再者，经方的组方是最能说明问题的。请巡查不要发这些内容来误导人了。没有什么意义。 本帖最后由 灶心土 于 2013/8/2 12:55 编辑
孰是孰非，没有自己实践一下是无法体会的。 大处方好象就施今墨吧
施今墨遣方用药自成一格，其处方配伍精当，药品繁多，前后搭配无不相合，博得了“雍容华贵”的美誉。他擅用大方，药品的搭配极有法度，与一般医生之随意堆砌药物，断不可同日而语。中医遣方用药，每药的使用，都必须与其他药物相互为用，七情和合。因此，药味越多，就越容易出现不和、不当的搭配，影响全方的整体性和治疗效果。
然而施老用药，常见二、三十味之多，但即使药味再多，也配合得体，法度严谨，毫无繁琐冗赘之感，反倒彰显其华贵大方，非常人能及之气度，其处方之华美常令中医药界的行家矢口赞叹。
后人看不懂他的路数，也学不来。
在学术上，他也有独到的见解，他认为气血为人身的物质基础，实属重要，因此，提出了“以阴阳为总纲，表、里、虚、实、寒、热、气、血为八纲”的理论
愚猜测：其处方大的原因在于，兼顾了病人气血在各脏腑的偏衰。而病人变了，处方也变了，硬套是套不了的。没弄明白是什么回事，所以才有：
“然而施老用药，常见二、三十味之多，但即使药味再多，也配合得体，法度严谨”的说法。 有道理，可以借鉴。 嗯，好像有些道理。 中医学好了，身体健康了，
不管是搬砖还是搬木头，你都觉得很轻松嘛 说来说去主要还是要根据病者的脉象证候下药处方 说的好 药多者通常医术一般，辩证不清就只好撒拦河网。
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