2018年版《国家基本药物目录》中成药部分含毒性中药应用分析
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摘要
目的研究2018年版《国家基本药物目录》中成药处方中含毒性中药的使用情况、功效应用及配伍规律,为中医临床安全合理用药提供参考。方法对268个《国家基本药物目录》中成药处方中含毒性中药的处方及其使用频数、功效分布和配伍情况进行统计分析。结果《国家基本药物目录》中成药部分含有"大毒""有毒"及"小毒"的中药共计34种,占2015年版《中华人民共和国药典》中收载的83种毒性中药的40.96%。含毒性中药的中成药处方有86个,占比为32.09%,其中内科与外科用药含毒性中药处方数排序居前2位,分别占比18.28%、3.36%,功能多为祛瘀、止咳平喘、补益、清热,配伍应用较多的是半夏与苦杏仁,半夏与陈皮、茯苓、甘草配伍应用,苦杏仁与桔梗、麻黄、白芍等组方。结论毒性中药在《国家基本药物目录》中成药部分应用频数较高,临床上使用时尤需谨慎,在联合用药时应避免重复给药。毒性中药的应用分析对于临床上合理使用《国家基本药物目录》中成药及保障患者用药安全具有较重要的意义。
Objective To study the use, efficacy application and compatibility law of toxic traditional Chinese medicine(TCM) in the Chinese patent medicine in 2018 edition of National Essential Medicine List, and to provide references for safe and rational use of drugs in clinical practice of TCM. Methods The frequency of use, distribution of efficacy and compatibility of 268 Chinese patent medicines containing toxic Chinese medicine in the National Essential Medicine List was analyzed statistically.Results There were 34 kinds of traditional Chinese medicines which contain "great toxin", "toxic" and "little toxin" in the part of Chinese patent medicine of National Essential Medicine List. It accounted for 40.96% of the 83 kinds of toxic Chinese herbs contained in 2015 edition of Chinese Pharmacopoeia. There were 86 prescriptions of traditional Chinese patent medicine with toxicity, accounting for 32.09%. Among them, internal medicine and surgery ranked the first two in the order of the number of prescriptions containing toxic Chinese medicine, which accounted for 18.28%, 3.36% respectively. Most of the functions are removing blood stasis, relieving cough and relieving asthma, tonifying benefits, clearing heat. The compatibility is mostly Rhizoma Pinelliae and bitter Semen Armeniacae Amarums, Rhizoma Pinelliae and Pericarpium Citri Reticulatae, Poria, Radix Glycyrrhizae,bitter Semen Armeniacae Amarums and Radix Platycodonis, Herba Ephedrae, Radix Paeoniae Alba, etc. Conclusion The application frequency of toxic traditional Chinese medicine in the part of Chinese patent medicine of National Essential Medicine List is very high. It should be carefully used clinically to avoid repeated administration of drugs in combination. Analysis on the application of toxic traditional Chinese medicine is of great significance for the rational use of traditional Chinese patent drugs in National Essential Medicine List in clinic and for ensuring the safety and effectiveness of drug use in patients.
Objective To study the use, efficacy application and compatibility law of toxic traditional Chinese medicine(TCM) in the Chinese patent medicine in 2018 edition of National Essential Medicine List, and to provide references for safe and rational use of drugs in clinical practice of TCM. Methods The frequency of use, distribution of efficacy and compatibility of 268 Chinese patent medicines containing toxic Chinese medicine in the National Essential Medicine List was analyzed statistically.Results There were 34 kinds of traditional Chinese medicines which contain "great toxin", "toxic" and "little toxin" in the part of Chinese patent medicine of National Essential Medicine List. It accounted for 40.96% of the 83 kinds of toxic Chinese herbs contained in 2015 edition of Chinese Pharmacopoeia. There were 86 prescriptions of traditional Chinese patent medicine with toxicity, accounting for 32.09%. Among them, internal medicine and surgery ranked the first two in the order of the number of prescriptions containing toxic Chinese medicine, which accounted for 18.28%, 3.36% respectively. Most of the functions are removing blood stasis, relieving cough and relieving asthma, tonifying benefits, clearing heat. The compatibility is mostly Rhizoma Pinelliae and bitter Semen Armeniacae Amarums, Rhizoma Pinelliae and Pericarpium Citri Reticulatae, Poria, Radix Glycyrrhizae,bitter Semen Armeniacae Amarums and Radix Platycodonis, Herba Ephedrae, Radix Paeoniae Alba, etc. Conclusion The application frequency of toxic traditional Chinese medicine in the part of Chinese patent medicine of National Essential Medicine List is very high. It should be carefully used clinically to avoid repeated administration of drugs in combination. Analysis on the application of toxic traditional Chinese medicine is of great significance for the rational use of traditional Chinese patent drugs in National Essential Medicine List in clinic and for ensuring the safety and effectiveness of drug use in patients.
引文
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[21]谷瑞红,马营营,郭莎,等.含毒性中药的成药应用情况分析[J].临床药物治疗杂志,2018,16(2):48-51.
[2]张须学,程晓卫.《伤寒杂病论》中附子的功用及减毒方法探析[J].中医学报,2011,26(12):1535-1536.
[3]邓家刚.论张仲景对有毒中药临床应用的贡献[J].山东中医杂志,2001,20(8):454-456.
[4]中华人民共和国国家卫生健康委员会.国家基本药物目录(2018年版)(国卫药政发31号)[S].2018.
[5]国家药典委员会编.中华人民共和国药典·临床用药须知(中药卷)[S].北京:人民卫生出版社,2015.
[6]徐培红,干荣富.深度解读2012版国家基本药物目录[J].世界临床药物,2013,34(11):34-38.
[7]林琳,刘智强.中药不良反应与“毒性”的关系及热点事件解析[J].新疆中医药,2018,36(5):34-36.
[8]王志琪,张序晴,王尚尧,等.基于化学、体内过程和代谢组学的甘草解毒作用研究概况[J].湖南中医药大学学报,2019,39(1):132-137.
[9]姚军强.半夏的药理作用及其临床配伍运用[J].中医研究,2013,26(2):3-5.
[10]张义敏,张玉修,王均宁.基于方剂组成统计分析的半夏减毒增效配伍规律探讨[J].中华中医药学刊,2016,34(12):2838-2841.
[11]高洁,李浩.《金匮要略》中生姜、干姜与半夏的配伍运用[J].中医杂志,2015,56(7):628-630.
[12]李博文,高长玉,王聪,等.半夏在《金匮要略》中的配伍运用规律[J].中国中医基础医学杂志,2017,23(10):1459-1460.
[13]鲍永娟.半夏炮制沿革及临床配伍应用[J].亚太传统医药,2015,11(16):68-69.
[14]王均秀,吴鹏,张学兰,等.苦杏仁炮制的现代研究进展[J].山东中医杂志,2016,35(9):840-842.
[15]罗玉君,温晓莹,倪晓良,等.基于数据挖掘的小儿慢性咳嗽用药规律研究[J].新中医,2018,50(7):39-41.
[16]范海洲.浅谈杏仁的药性及功效[J].湖北中医杂志,2016,38(5):67-68.
[17]呼敏,马珊珊,王荣.杏仁药对配伍规律及临床应用研究[J].辽宁中医药大学学报,2016,18(2):116-118.
[18]张雪,杨雨婷,董艳红,等.中药配伍减毒增效的研究概况[J].中国民族民间医药,2015,24(21):19-20.
[19]高建联,苗明三.“十八反”药理毒理研究现状、存在问题及研究思路[J].中医学报,2010,25(3):483-486.
[20] GULER S, AYTAR H, SOYUDURU M, et al. Disulfiram-like Reaction with Ornidazole[J]. American Journal of Emergency Medicine,2015, 33(9):1330.
[21]谷瑞红,马营营,郭莎,等.含毒性中药的成药应用情况分析[J].临床药物治疗杂志,2018,16(2):48-51.