There’s a few reasons.
First, there’s the convenience. It’s much easier to remember every four hours to take two tablets than it is to take one every two, plus it gets it over with. Most people don’t want to set an alarm every two hours to keep the dosage proper, they just wait for the signal to take more pills if after four hours the pain starts coming back.
Then there’s the dosage level. If you take one, and then take another two hours later, you’re only getting 50% of best possible pain relief for the first two hours. When you’re hurting enough for two tablets as the “full dose”, you’re going to want that pain relief NOW, so you take the full dose at the start.
Next, a lot of reasons to take Tylenol are completely solved by the first dose. A lot of headaches or other aches go away completely on a single two-tablet dose, so you don’t have to come back two hours later to dose up again. And you should really only take pain meds when you actually need them, not take them sequentially over a period of hours if the pain has already been taken care of.
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