《金匮》同病异治的实证研究- - 以“夫短气，有微饮，当从小便去之，苓桂术甘汤主之，肾气丸亦主之”为例

"Treating the same disease with different methods" is exactly "The same disease with different syndromes and different prescriptions for different syndromes", or "The same disease with the same syndrome, but the same syndrome having different treatments"? Different people have different views. The explanation, "the same disease with different syndromes has different prescriptions", seemed to be a conclusion in the latest hundred odd years. However, from a cognitive perspective, there is a new interpretation for this theory that neither the explanation based on "The same disease with different syndromes", nor the interpretation based on "The same disease with the same syndrome" is completely right. The explanation, "the same disease with the same syndrome has different treatments", is possible and more in line with people's intuition. That, "different prescriptions be effective against the same disease and syndrome", lies on the hypothesis that "different prescriptions" have the material basis of the same role, or different substances in different prescriptions are effective on different pathology links of the same disease. This program is based on the cognitive interpretation of "Treating the same disease with different methods", takes the sentence that "Patients with diseases that have shortness of breath and micro retained fluid, should be treated with diuretics such as Linggui Zhugan decoction and Shenqi Wan" for example, selects rat models with representative diseases which have shortness of breath and micro retained fluid, treats different groups of rats with Linggui Zhugan decoction、Shenqi Wan、Linggui Zhugan decoction without Poria cocos and cassia twig、Shenqi Wan without Poria cocos and cassia twig、Poria cocos and cassia twig etc. then analyze different prescriptions' functions and mechanism at two time points to provide empirical basis for the two explanations of the theory"treating the same disease with different methods" in Synopsis of Golden Chamber.

"同病异治"究竟是"病同而证异，证异而方异"，抑或"病同且证同，证同而方亦异"？见仁见智。"病同-证异-方异"解说，百余年来约定俗成，似成定论，丝毫未有见疑者。然而，有学者从认知学角度对《金匮要略》同病异治进行了新的诠释，提出：基于"病同证异"假定的"同病异治"解说与基于"病同证同"假定的"同病异治"诠释，任何一种都是不完全的。"病同-证同-方异"是可能的，且更符合人们的直觉。同病同证用异方能够取效乃在于"异方"中存在着作用相同的物质基础，或"异方"中不同的有效物质作用于"同病"中不同病理环节等。本项目基于同病异治的认知学新诠释，以"夫短气，有微饮，当从小便去之，苓桂术甘汤主之，肾气丸亦主之"为例。选取"短气，有微饮"的代表性疾病大鼠模型，以苓桂术甘汤、肾气丸、苓桂术甘汤去苓桂、肾气丸去苓桂、苓桂等干预，分析比较不同方剂的作用、作用环节，为《金匮要略》同病异治的认知学新诠释提供实证依据。

“同病异治”究竟是“病同而证异，证异而方异”，抑或“病同且证同，证同而方亦异”？见仁见智。“病同-证异-方异”解说，百余年来约定俗成，似成定论，丝毫未有见疑者。然而，有学者从认知学角度对《金匮要略》同病异治进行了新的诠释，提出：基于“病同证异”假定的“同病异治”解说与基于“病同证同”定的“同病异治”诠释，任何一种都是不完全的。“病同-证同-方异”是可能的，且更符合人们的直觉。同病同证用异方能够取效乃在于“异方”中存在着作用相同的物质基础，或“异方”中不同的有效物质作用于“同病”中不同病理环节等。本项目基于同病异治的认知学新诠释，以“夫短气，有微饮， 当从小便去之，苓桂术甘汤主之，肾气丸亦主之”为例。选取“短气，有微饮”的代表性疾病大鼠模型，以苓桂术甘汤、肾气丸、苓桂术甘汤去苓桂、肾气丸去苓桂、苓桂等干预，分析比较不同方剂的作用、作用环节，为《金匮要略》同病异治的认知学新诠释提供实证依据。 .本项目研究严格按照计划顺利完成。研究结果显示：通过药效学观察（为防止孤证不立，构建了2个体现“短气有微饮”的动物模型---气道黏液高分泌大鼠模型、慢性心衰大鼠模型），证实了基于“病同---证同---方异”的“同病异治”是可能存在的，即苓桂术甘汤与肾气丸均能有效改善“短气”，两者作用差异不显著。其次，在证实了基于“病同---证同---方异”的“同病异治”是可能存在的基础上，从作用环节、功效两个角度诠释了“同病异治”的内涵，即苓桂术甘汤与肾气丸肾气丸和苓桂术甘汤均能“同病异治”改善“短气有微饮”，其“病同-证同-方异”之内涵可能在于异方作用于疾病的不同环节或具有相同功效---利小便。此外，开展了《金匮要略》“同病异治”原理探讨。