中药配伍禁忌理论探索研究

中药配伍禁忌,涉及临床用药安全性问题,受到社会广泛关注.随着“十八反”为代表的配伍禁忌研究逐渐深入,对中药配伍禁忌理论的内涵认识达到一个新的水平.从中药配伍禁忌理论概念渊源、药物关系、禁忌的危害形式、规避原则方法,以及近年来对具体相反药物毒效机制的揭示,探讨了中约配伍禁忌理论创新发展.中药配伍禁忌在结构上表述为以七情为基础、两药相对的、具有经验特点的禁忌形式;合药配伍犯禁可能导致人体伤害,尤其是表现出“潜害”和干扰药物功效发挥而“不能治病”的特点;规避反药合用以及以病证-药物功效两相经权是趋利避害的基本方法.近年研究揭示了反药禁忌的5个特点:增毒、致毒、降效、减效是相反禁忌关系的4种主要表现形式,物质变化可以反映相反增毒致毒的本质,蓄积中毒及机体代谢改变是“潜害”产生的基础,主要功效的相反拮抗以及正性与负性同时并存的功效关系是配伍禁忌有别于一般药物禁忌的关键.相反配伍的内涵揭示为中药配伍禁忌理论创新发挥了重要作用.

Study on incompatibility of traditional Chinese medicines

The incompatibility of traditional Chinese medicines is related to the clinical medication safety, so has attracted wide attentions from the public. With the deepening of studies on the incompatibility of traditional Chinese medicines represented by 18 incompatible herbs, the incompatibility of theory traditional Chinese medicines has raised to new heights. From the origin of incompatibility theory of traditional Chinese medicines, relationship of herbs, harms of incompatible herbs and principle of prevention to toxic effects of specific incompatible medicines, the innovation and development of the traditional Chinese medicine incompatibility theory was explored. Structurally, the incompatibility of traditional Chinese medicines refers to the opposition of two herbs based on seven emotions and clinical experience. The combination of incompatible herbs may lead to human harms, especially latent harm and inefficacy of intervention medicines. The avoidance of the combination of incompatible herbs and the consideration of both symptoms and drug efficacy are the basic method to prevent adverse reactions. The recent studies have revealed five characteristics of incompatible herbs. Toxicity potentiation, toxication, efficacy reduction and inefficacy are the four manifestations of the incompatible relations. The material changes can reflect the effects of toxicity potentiation and toxication of opposite herbs. The accumulation of toxicity and metabolic changes are the basis for latent harms. The antagonistic effect of main efficacies and the coexistence of positive and negative effects are the distinctive part of the incompatibility. The connotation of incompatible herbs plays an important role in the innovation of the traditional Chinese medicine incompatibility theory.