科学阐明中药的起效方式是中医药界迫切需要解决的问题，目前学术界对于中药起效方式的看法百家争鸣，其中认为“叠加作用”是中药起效核心方式的科学假说，引发了中药药理学领域学者和专家的思考和争鸣。“叠加作用”为中药作用方式和作用特点提供了新解读，对中药药理学发展有积极推动作用。本文根据当前中药研究中的研究成果及临床案例对中药起效的核心方式作了进一步思考，提出以下观点：①中药成分结构的多样性及作用靶点的复杂性决定了中药药效发挥作用的方式也是复杂多样的；②中药作用方式复杂而多变是为了适应环境变化进化而来，进化所致机体受体的多样性和中药的多样性以及生物的复杂网络调控系统，决定了单个中药成分更有可能是通过作用于不同的靶点发挥协同增效作用；③从中药“君臣佐使”的配伍规律来看“叠加作用”具有局限性。综上所述，笔者认为，仅仅依赖“叠加作用”可能无法全面解释中药“君臣佐使”的配伍规律；“叠加作用”只是中药众多起效方式之一，是否还有其他更为重要的起效方式，值得我们去思考。

cientifically elucidating the mode of action of Chinese medicine has become an urgent challenge to Chinesemedicine researchers. Opinions on the mode of Chinese medicine effect are active. The scientific hypothesis that additiveeffect is the key mode of action for Chinese medicine, trigger the scholars and experts in pharmacology field of Chinesemedicine to think and contend. The opinion of additive effect provides a new interpretation for mode of action and actioncharacteristics of Chinese medicine. It plays a positive role in the development of pharmacology of Chinese medicine.According to current research results of traditional Chinese medicine (TCM) and clinical cases, this paper made furtherthinking and summary on the key mode of action for Chinese medicine. The summary is as follows. The diversity ofChinese medicine structure and complexity of Chinese medicine targets determine the complicated mode of action ofChinese medicine. Mode of action for Chinese medicine is complex and variable, which is to adapt to changes in theenvironment. The genetic diversity of the body receptors due to evolution and the diversity of Chinese medicine andbiological complex network control system have determined that a single component of Chinese medicine is more likely toact synergistically by targeting on different targets. From the point of view of Monarch, Minister, Assistant and Guide theory of Chinese medicine, additive effect has limitation. Therefore, just using additive effect is unable to fully explainthe Chinese medicine compatible regularity of Monarch, Minister, Assistant and Guide theory. Additive effect is one ofaction types for Chinese medicine. It is worth to consider if there has any other more important action type for Chinesemedicine.

国家自然国家自然科学基金面上项目（81573859）：丹参酚酸/丹参酮类对血小板介导肿瘤血行转移的整合效应研究，负责人：王爱云；国家自 然科学基金面上项目（81673725）：利用“遗传协同致死”模式研究丹参微量弱效多成分的效应倍增机制，负责人：陆茵；国家自然科学基金面上 项目（81673648）：基于Warburg效应探究破血药化瘀散结抑制肿瘤转移的分子基础，负责人：陈文星；2013年江苏高校优秀科技创新团队计划 [苏教科（2013）10号文]，负责人：陆茵。