| This dissertation includes three parts:literature review, theoretical study of the dose-effect relationship of classical formulae and influencing factors of dose-effect relationship of classical formulae.1Literature reviewFirst, we analyze the concept of classical formulae and the group who use them, in order to clarify the trajectory of the concept and the evolution of ancient and modern thinking, and lay the foundation for further study. By analyzing, we found that the meaning of the classical formulae referred to in a broad sense formula works and effective formulae before Tang dynasty, which appeared as titles in some works, but only as a general term rather than a proper noun. Its meaning was gradually shifted from broad sense into narrow one in Song dynasty, however, it has not been established. Until Qing dynasty, the classical formula was defined as Zhongjing’s formulae by Xu Lingtai. Formulae in classical workds after Zhang Zhongjing’s were not named as classical formulae.Second, basic theory of traditional Chinese medicine on dose-effect relationship was analyzed. There were many factors influencing the Chinese medicine dose-effect, but we must follow the principle of the basic theory of traditional Chinese medicine and Chinese pharmacy, which were key factors to guarantee the efficacy of herbs. By analyzing the four qi, five flavors, ascending and descending, movement of qi, meridian entry and characteristics of zang-fu ograns, we can summarize the basic law of Chinese medicine dosage:in the respect of four qi and five flavors, dosage amount of pungent, sweet herbs in the properties of warm and hot are less than that of sour, bitter, salty herbs in the properties of cold and cool. From the aspect of ascending and descending movement of qi, herbs with the ascending action were used in a lower dosage compared with herbs in a tendency to descend. The dosage of the herbs which have a major meridian entry is generally less than that of secondary meridian entry. In the aspect of zang-fu theory, herbs which were used to treat five zang-organ disorders have a lower dosage and longer treatment course compared with those of treating six fu-organ diseases.Finally, modern research with dose-effect relationship of classical formulae and its influencing factors were summarized and analyzed, and single herb of classical formulae, medicine and the compound dose-effect relationship of theory and experimental studies were reviewed and analyzed. At the same time, collectting and analyzing factors of affecting the dose-effect relationship, by the summary of the factors of dose-effect relationship of classical formulae, I hope the theory of the prescription dose of "human oriented" completely will be established.2Theoretical study of the dose-effect relationship of classical formulaeBy analyzing the law of dose-effect on the Zhongjing medication frequency up to the top ten herbs and the main herbs of six channels, we can find the dosage and efficacy of the drug from the classical formulae have a close link. It is mainly reflected in the following two aspects:first of all, with the changes in drug dosage, efficacy will be changed. For example, three or less than three Liang of Ramulus cinnamomi have the role of dispelling pathogenic wind and warming the Yang qi and eliminating the water evil; four Liang of Ramulus cinnamomi have the role of warming the Yang qi of heart and making the gas decline; five Liang of Ramulus cinnamomi have the role of making the gas decline. Three Liang of Zingiberis have the role of warming the stomach and removing the cold, warming the stomach and eliminating the water evil; More than four Liang of Zingiberis have the role of getting rid of cold and relieving pain. Second, the efficacy of the drug is enhanced with the increase of the amount such as ginger, stopping vomiting and cold-dispelling power and eliminating the water evi is enhanced with the increase of the amount; The strength of of Pinellia making the gas decline and stopping vomiting is also enhanced with the increase of the amount; the role of removal of water evil with Poria also enhanced with the increase of the amount. The factors affecting the amount of drugs:first, Prescription structure affect the main aspects of drug dosage. In general case, the amount of monarch medicinal is large, the amount of supplementary drug is small. Such as Pinellia as supplementary drug to make the gas decline and stop vomiting, it was usually used in half a liter, but as a monarch medicinal to make stop severe vomiting, it was used in one liter to two liter frequently. Second, the processing of drugs is an important factor to affect dose-effect of the drugs, such as raw Aconiti Praeparata poisoning, their efficacy to make yang qi back and save the life from dying, the dosage is generally one coin. The toxicity of processing Aconiti Praeparata is weak, backing to yang power shortage, and the role of it is removing cold and stopping pain mainly. For removing cold and wet. it can use two to three coin. Third, the drug compatibility is an important factor to affect the drug dosage. Ephedrae treatment of prima facie evidence of the swelter, with Gypsum Fibrosum to match. The amount of Ephedrinea and Gypsum Fibrosum compatibility proportion varies with the table evil canopy and the severity of the inside heat changes. When the heat is heavy, the amount of Gypsum Fibrosum is usually greater than the amount of Ephedrae.Through the study of the relationship between dose and efficacy of the drug from classical formulae, we found that compatibility is very strict, so clinical application is best not to arbitrarily change. For exampie, if the amount of drug form classical formulae, or the amount of the two herbs was changed you can change the intensity of the entire prescription and the primary role of the entire prescription. This fully reflects classical formulae through the control of drug dosage to achieve the therapeutic effect of clinical treatment strategies. At the same time, compatibility of dose changes also has a certain regularity. According to the different pathogenesis of the disease, urgency and different symptom complex, we can change the dosage of prescription drugs. This fully reflects the principles of dialectical dosage of Chinese medicine.3Theoretical study of influencing factors of dose-effect relationship of classical formulae.This section is to investigate the boiling method, method of medication, physical factors and drug care impacting on the efficacy of the classical formulae. These factors were important to guarantee of the best clinical outcomes of classical formulae on the basis of a certain amount of herbs.The majority of Zhongjing’s formulae were decocted, but also use other special cooking method according to the needs of the characteristics of drugs and disease, to improve clinical outcomes. We find that:first, the certain drugs of classical formulae use the fry method in advance in order to reduce the side effects of drugs to ensure that the active ingredients of the main drug to fully precipitation and adapt to the needs and conditions. Second, post-cooking method is mainly determined by the needs of the characteristics of the drug itself and disease treatment. Three, the law of sediment and fry applicable to the mixed cold and heat, attack and supplementation and reconciliation prescription. This method first makes various drugs of the prescription mixed with cold and heat, and makes attack and supplementation to achieve reconciliation function. Second, enrichment of drug action can make a more gentle and long-lasting, more in line with the meaning of reconciliation; Third, long fried again conducts the benefit of drug efficacy cook, and enhances the righting and tonic effect of the settlement agent; Finally, concentrated concoction can reduce stomach irritation, and can conduct to the qi of stomach upping treatment. Four, rice and drug cook in order to benefit to the spleen and stomach, and to protect the stomach qi. Five, impregnated juice method includes two cases: First, a simple dipping juice, such as Rhei and Coptidis Decoction for purging stomach-fire. It focuses on the nature of the bitter cold not on the thick of flavor, in order to clear the stomach of the invisible evil heat, without the shortcomings of diarrhea injury righteousness. The second is impregnated with boiling or steaming and long blended to make the drug, raw and cooked heterosexual but perform their duties. Six, cook bulk method. Zhongjing changes decoction to cook scattered taking, to take on more of the effect of scattered wind and dampness; cook scattered taking is more probable to enhance the power of evil wash away within. Seven, cook the pill method is mainly used for evil is real heavy, but can not be steep attack Syndrome, in order to take the cook pill, slowly swing the evil. The choice of the boiling solvent, according to the characteristics of the disease and drugs, Zhongjing selects the appropriate solvent to accommodate the clinical needs and improve clinical outcomes. Wine, honey, Whey, bitter and Framatome juice have their own tastes and efficacies of both solvents and drugs in their prescription drugs, and they have played a hard to replace the effectiveness of other drugs. Spring, east water, Gan Lan water, wells flower water, and flooded water are the areas of water. The main advantage of their respective properties to facilitate the treatment of the corresponding syndromes. The above several more boiling methods are one of the important measures of the drug of classical formulae having clinical efficacy and to ensure drug safety.Medication method is also an important factor in the effects of drug treatment. First, drinking three times a day is the most commonly used for classical formulae. It is used for the treatment of chronic illness, the righteousness wasting disease and evil hyperactivity disease. This medication method conducts to maintain a certain concentration of drug in the body to continue to play a drug effect. Second, drinking two times a day is the also commonly used for classical formulae. It is used for the treatment of excess heat, disease, the demise of yang qi, pathogenic cold strongly and water stopping diseases, in order to focus on the drug, and enhance the therapeutic efficacy of the drug; For water stopping diseases, reducing the dose can reduce the side effects to help water evil; For the treatment of focal disease or mild disease, generally a small amount can take to achieve therapeutic effects. Third, day and night taking method can make the drugs in the body day and night to maintain a certain concentration and the persistence of efficacy, in order to therapy night aggravated syndrome, or in the development trend of the disease, or episodes of frequent syndromes. Fourth, once finished decoction is used for physically strong, prosperity of evil and serious disease. The focus of the drug, violent, quickly relieve the advantages of the disease, mainly used for the treatment of evil strongly and critical disease. Fifth, frequent medication method is used according to the needs of illness and disease, and the main purpose is to maintain the persistence of drug efficacy, or to prevent damage of the righteousness. Sixth, some formulae need drinking one times a day,such as Ten Ziziphi Jujubae Decoction and large Aconitum fried. They are evil attacking and toxic, drinking one times a day in order to attack evil without injury a positive purpose. Seventh, according to the severity of illness, the site of disease, the law of disease attacking, as well as drug role characteristics, take a different medication to ensure the unity of the drug’s efficacy and safety. Eighth, the diagnosis of medication method allows doctors to medication condition after the change, consider medication measures to ensure the validity and accuracy of the treatment.Based on the severity of illness, the patient’s reaction after taking the drug and the patient’s physical conditions and ages, Zhongjing often changes the prescription dose at any time to achieve the best therapeutic effect. Zhongjing adjusts method of taking the drug can be summarized as the following aspects:The law of the disease is cured and the drug immediately stopped, and gradually increase the dose, and gradually reduce the dosage, accumulate efftiveness according to the constitution to take the drug. This fully demonstrates the dialectical thinking with the disease of usage and people-oriented of classical formulae.Nursing care after taking decoction is an important part which directly links to efficacy and time of treatment course. The significance of care in Zhongjing’s works was as follows: First, in order to enhance the clinical efficacy of the classical formulae; Second to prevent drugs with severe properties to damage the right qi, or prevent the evils invasing the body again; Third, different syndromes with different nursing methods fully embodies the principle of nursing according to syndrome differentiation. Dietary taboo of classical formulae is mainly to protect the qi of the spleen and stomach, which is the root of postnatal. Only spleen and stomach being strong, the pathogenic factors will be dispelled fast and the disease will be cured soon. |
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