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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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| 篇名： | 中药十八反和十九畏的历史沿革与临床应用情况探析 |
| TITLE： | |
| 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。 |
| ABSTRACT： | 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. |
| 期刊： | 2019年第30卷第4期 |
| 作者： | 李宁，李玲玲，李春晓，陈玉欢，李学林 |
| AUTHORS： | LI Ning，LI Lingling，LI Chunxiao，CHEN Yuhuan，LI Xuelin |
| 关键字： | 中药；十八反；十九畏；合理用药；历史沿革；临床应用 |
| KEYWORDS： | TCM； Eighteen incompatible medicaments； Nineteen medicaments of mutual restraint； Rational drug use； Historical evolution； Clinical use |
| 阅读数： | 400 次 |
| 本月下载数： | 16 次 |
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