中药十八反和十九畏的历史沿革与临床应用情况探析
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摘要
目的:探讨中药十八反、十九畏的历史沿革与临床应用情况,为充实中药合理应用内容提供依据。方法:通过文献挖掘的方法,以"十八反""十九畏""反药""临床应用""不良反应""不良事件"等为关键词,组合检索中国知网、万方和维普数据库(检索时限均为各数据库建库起至2018年8月)和河南中医药大学图书馆馆藏图书,摘录和梳理中药十八反、十九畏的相关文献,就其历史沿革与临床应用情况进行汇总、分析。结果与结论:十八反是中药基础理论的主要内容之一,该词首载于《蜀本草》一书,是中药"七情"中"相反"的具体体现,且历代本草医籍中记载的十八反中药数量有所不同。十九畏是中药配伍的禁忌之一,始见于《神农本草经》,历代均存在"相恶""相反""相畏"混用的情况,且医家对十九畏的"七情"归属尚存有争议。无论古代本草医籍、现代医案医话、历版《中国药典》还是临床应用相关文献中,均存在十八反、十九畏药对的配伍应用。其中,2015年版《中国药典》(一部)收载含十八反药对的成方制剂共8个品种,以川乌/草乌-白及/白蔹居多;收载含十九畏药对的成方制剂共9个品种,以丁香-郁金、肉桂-赤石脂居多。虽有医案或文献指出其可用以治疗危重病证和疑难杂病,且亦有研究初步证实了个别反药/畏药配伍的合理性,但相关研究的结论并不完全一致,且研究证据强度不高、研究证据不充分,故仍有待加强基础研究并开展大样本、多中心、高质量的临床研究予以证实,以保证中药临床用药的合理性和安全性。
OBJECTIVE: To investigate the historical evolution and clinical application of "eighteen incompatible medicaments"and"nineteen medicaments of mutual restraint"of TCM,and to provide reference for enriching the contents of rational use of TCM. METHODS:Through the methods of literature mining,using"eighteen incompatible medicaments""nineteen medicaments of mutual restraint""incompatible medicaments""clinical use""ADR""ADE"as keywords,retrieved from CNKI,Wanfang,VIP database (from the date of database establishment to August 2018)and library of Henan University of TCM,related literatures about"eighteen incompatible medicaments"and"nineteen medicaments of mutual restraint"were extracted and combed,and the history and clinical application of them were summarized and analyzed. RESULTS & CONCLUSIONS:"Eighteen incompatible medicaments"is one of the main contents of TCM basic theory. The word is first published in Shubencao,which is the concrete embodiment of the"opposite"in the"seven compatibility regularities"of TCM,and the number of"eighteen incompatible medicaments"of TCM recorded in the medical books of TCM is different from each other in the past dynasties."Nineteen medicaments of mutual restraint"is one of the taboos of TCM compatibility,which is first found in Shennong's Herbal.There are mixed use of"mutual inhibition""incompatible"and"mutual restraint"in all dynasties,and there is still controversy about the attribution of "seven compatibility regularities" of "nineteen medicaments of mutual restraint" among physicians.Regardless of ancient medical books,modern medical books,various editions of Chinese Pharmacopeia,literature reports and clinical applications, there are compatibility usage of drug pairs of "eighteen incompatible medicaments" and "nineteen medicaments of mutual restraint". Among them, 8 kinds of set prescription preparations containing drug pair of "eighteen incompatible medicaments"were involved in 2015 edition of Chinese Pharmacopoeia (part Ⅰ),most of which were Aconitum carmichaelii/Aconitum kusnezoffii-Bletilla striata/Ampelopsis japonica;9 kinds of set prescription preparations containing drug pair of"nineteen medicaments of mutual restraint"were also involved,most of which were Syringa oblate-Curcuma rcenyujin, Cinnamomum cassia-Halloysitum rubrum. Although there are medical records or literature pointing out that it can be used to treat critical and difficult diseases,and some studies have preliminarily confirmed the compatibility rationality of individual incompatibility medicaments/medicaments of mutual restraint, the conclusions of relevant studies are not entirely consistent,and the intensity of research evidence is not high,and the research evidence is insufficient. Basic researches should be strengthened and large-scle,multiple-center and high-quality clinical studies are needed to confirm this conclusion so as to guaratetee the rationality and safety of drug use in clinic.
OBJECTIVE: To investigate the historical evolution and clinical application of "eighteen incompatible medicaments"and"nineteen medicaments of mutual restraint"of TCM,and to provide reference for enriching the contents of rational use of TCM. METHODS:Through the methods of literature mining,using"eighteen incompatible medicaments""nineteen medicaments of mutual restraint""incompatible medicaments""clinical use""ADR""ADE"as keywords,retrieved from CNKI,Wanfang,VIP database (from the date of database establishment to August 2018)and library of Henan University of TCM,related literatures about"eighteen incompatible medicaments"and"nineteen medicaments of mutual restraint"were extracted and combed,and the history and clinical application of them were summarized and analyzed. RESULTS & CONCLUSIONS:"Eighteen incompatible medicaments"is one of the main contents of TCM basic theory. The word is first published in Shubencao,which is the concrete embodiment of the"opposite"in the"seven compatibility regularities"of TCM,and the number of"eighteen incompatible medicaments"of TCM recorded in the medical books of TCM is different from each other in the past dynasties."Nineteen medicaments of mutual restraint"is one of the taboos of TCM compatibility,which is first found in Shennong's Herbal.There are mixed use of"mutual inhibition""incompatible"and"mutual restraint"in all dynasties,and there is still controversy about the attribution of "seven compatibility regularities" of "nineteen medicaments of mutual restraint" among physicians.Regardless of ancient medical books,modern medical books,various editions of Chinese Pharmacopeia,literature reports and clinical applications, there are compatibility usage of drug pairs of "eighteen incompatible medicaments" and "nineteen medicaments of mutual restraint". Among them, 8 kinds of set prescription preparations containing drug pair of "eighteen incompatible medicaments"were involved in 2015 edition of Chinese Pharmacopoeia (part Ⅰ),most of which were Aconitum carmichaelii/Aconitum kusnezoffii-Bletilla striata/Ampelopsis japonica;9 kinds of set prescription preparations containing drug pair of"nineteen medicaments of mutual restraint"were also involved,most of which were Syringa oblate-Curcuma rcenyujin, Cinnamomum cassia-Halloysitum rubrum. Although there are medical records or literature pointing out that it can be used to treat critical and difficult diseases,and some studies have preliminarily confirmed the compatibility rationality of individual incompatibility medicaments/medicaments of mutual restraint, the conclusions of relevant studies are not entirely consistent,and the intensity of research evidence is not high,and the research evidence is insufficient. Basic researches should be strengthened and large-scle,multiple-center and high-quality clinical studies are needed to confirm this conclusion so as to guaratetee the rationality and safety of drug use in clinic.
引文
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[13]潘艳琼.海藻、甘草同方应用探讨[J].亚太传统医药,2016,12(17):87-88.
[14]张力,杨晓晖,郭朋,等.消核片相关肝损害回顾性研究及风险控制措施探讨[J].中国中药杂志,2010,35(16):2199-2203.
[15]郭效建,刘安述,楮体云.半夏、附子配伍中毒2例报告[J].山东医药,2004,44(25):75.
[16]唐玉仲.党参与藜芦配伍反应2例[J].湖南中医杂志,1993,19(4):47、51.
[17]周敏华,吴晓玲,王志高.附子与半夏同方配伍调查与临床分析[J].中国药业,2018,27(8):91-95.
[18]陈嘉谟.本草蒙筌[M].张印生,韩学杰,赵慧玲,校.北京:中医古籍出版社,2008:240.
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[20]李时珍.本草纲目[M].张守康,校注.北京:中国中医药出版社,1998:875.
[21]严西亭.得配本草[M].姜典华,姜洪涛,姜典勋,等,校注.北京:中国中医药出版社,1997:199.
[22]武秀峰,时银英.丁香、郁金同用出现不良反应1例[J].现代中医药,2008,28(2):71.
[23]梁爱玲,高铭坚,黎莲珺,等.人参五灵脂配伍对人参补气作用影响的初步药效学研究[J].中华中医药学刊,2010,28(4):729-731.
[24]李梦雯,范欣生,张泠杉,等.基于复杂网络等方法的十九畏人参-五灵脂同方配伍探析[J].中国中药杂志,2017,42(18):3623-3627.
[25]欧阳菊.丁香配郁金治疗虚寒性胃痛32例[J].实用中医药杂志,2006,22(2):79.
[26]刘长斌,徐厚谦.丁香与郁金的配伍应用[J].中医临床研究,2014,6(31):19-20.
[27]张德邦.丁郁汤加味治疗胃肠病360例[J].四川中医,2013,31(11):83-84.
[28]刘殿娜,陈丰,于雪,等.含反药组合的海藻玉壶汤中不同品种海藻与甘草配伍应用对甲状腺肿大模型大鼠肝脏的影响[J].中华中医药杂志,2018,33(5):1788-1793.
[29]王茜,韩雪,王亚芬,等.醋甘遂与炙甘草免煎颗粒配伍对CYP2E1、CYP3A4基因和蛋白表达的影响[J].中华中医药学刊,2017,35(7):1679-1683、1925.
[30]许皖.甘遂半夏汤中甘遂与不同品种甘草反药组合加减应用对腹水大鼠“毒效”机制的研究[D].北京:北京中医药大学,2016.
[31]鲁耀邦,唐惕凡,丁果元,等.人参五灵脂配伍对急性血瘀和气虚血瘀大鼠血液流变学的影响[J].中国中西医结合杂志,1995(S1):88-91.
[31]李春晓,张业,李学林.从合理用药角度探析中药“十八反”[J].中华中医药杂志,2012,27(9):2284-2286.
[2]凌一揆,林森荣.对中药十八反、十九畏的文献考察[J].上海中医药杂志,1982(1):24-27.
[3]刘源,高晓山.明清以降129家医案中十八反的临床应用[J].北京中医杂志,1989(4):14-17.
[4]蒲志孝.蒲辅周轶事[J].山东中医杂志,1985(2):29-31.
[5]林通国.中药“十八反”之研究[J].成都中医学院学报,1981(1):48-52、83.
[6]林通国.中药“十八反”之研究:第3部分[J].成都中医学院学报,1981(2):65-68.
[7]林通国.中药“相反”“相畏”合用的临床研究:100例追风下毒丸应用分析[J].吉林中医药,1981(2):49-51.
[8]林通国.中药“十八反”之研究:250例拮抗丸的应用分析[J].成都中医学院学报,1981(3):58-61.
[9]林通国.拮抗丸治疗恶性肿瘤273例的临床观察[J].辽宁中医杂志,1988(6):15-16.
[10]高洁,范璐,柳海艳,等.含“十八反”反药组合的中成药再评价方法初探[J].中华中医药杂志,2018,33(2):416-422.
[11]荀培军,黄嬿.对“十八反”“十九畏”破禁运用的研究和探讨[J].世界最新医学信息文摘,2018,18(48):158-159、161.
[12]张文昌.基于数据挖掘的“十八反”在头痛治疗中应用研究[D].济南:山东中医药大学,2016.
[13]潘艳琼.海藻、甘草同方应用探讨[J].亚太传统医药,2016,12(17):87-88.
[14]张力,杨晓晖,郭朋,等.消核片相关肝损害回顾性研究及风险控制措施探讨[J].中国中药杂志,2010,35(16):2199-2203.
[15]郭效建,刘安述,楮体云.半夏、附子配伍中毒2例报告[J].山东医药,2004,44(25):75.
[16]唐玉仲.党参与藜芦配伍反应2例[J].湖南中医杂志,1993,19(4):47、51.
[17]周敏华,吴晓玲,王志高.附子与半夏同方配伍调查与临床分析[J].中国药业,2018,27(8):91-95.
[18]陈嘉谟.本草蒙筌[M].张印生,韩学杰,赵慧玲,校.北京:中医古籍出版社,2008:240.
[19]王晋三.珍珠囊补遗药性赋、雷公炮制药性解[M].上海:上海科学技术出版社,1958:97.
[20]李时珍.本草纲目[M].张守康,校注.北京:中国中医药出版社,1998:875.
[21]严西亭.得配本草[M].姜典华,姜洪涛,姜典勋,等,校注.北京:中国中医药出版社,1997:199.
[22]武秀峰,时银英.丁香、郁金同用出现不良反应1例[J].现代中医药,2008,28(2):71.
[23]梁爱玲,高铭坚,黎莲珺,等.人参五灵脂配伍对人参补气作用影响的初步药效学研究[J].中华中医药学刊,2010,28(4):729-731.
[24]李梦雯,范欣生,张泠杉,等.基于复杂网络等方法的十九畏人参-五灵脂同方配伍探析[J].中国中药杂志,2017,42(18):3623-3627.
[25]欧阳菊.丁香配郁金治疗虚寒性胃痛32例[J].实用中医药杂志,2006,22(2):79.
[26]刘长斌,徐厚谦.丁香与郁金的配伍应用[J].中医临床研究,2014,6(31):19-20.
[27]张德邦.丁郁汤加味治疗胃肠病360例[J].四川中医,2013,31(11):83-84.
[28]刘殿娜,陈丰,于雪,等.含反药组合的海藻玉壶汤中不同品种海藻与甘草配伍应用对甲状腺肿大模型大鼠肝脏的影响[J].中华中医药杂志,2018,33(5):1788-1793.
[29]王茜,韩雪,王亚芬,等.醋甘遂与炙甘草免煎颗粒配伍对CYP2E1、CYP3A4基因和蛋白表达的影响[J].中华中医药学刊,2017,35(7):1679-1683、1925.
[30]许皖.甘遂半夏汤中甘遂与不同品种甘草反药组合加减应用对腹水大鼠“毒效”机制的研究[D].北京:北京中医药大学,2016.
[31]鲁耀邦,唐惕凡,丁果元,等.人参五灵脂配伍对急性血瘀和气虚血瘀大鼠血液流变学的影响[J].中国中西医结合杂志,1995(S1):88-91.
[31]李春晓,张业,李学林.从合理用药角度探析中药“十八反”[J].中华中医药杂志,2012,27(9):2284-2286.