中风病相反配伍临床应用规律  

Study on Law of Contrary Drugs Compatibility in Treatment of Apoplexy

作　　者：丁瑞丛 周生花[2] 周德生[3] 刘利娟[3] DING Ruicong;ZHOU Shenghua;ZHOU Desheng;LIU Lijuan(The Second Clinical Medical College of Henan University of Traditional Chinese Medicine,Zhengzhou 450002,Henan,China;Encephalopathy Department of Henan Hospital of Traditional Chinese Medicine,Zhengzhou 450002,Henan,China;Neurology Department of The First Affiliated Hospital of Hunan University of Traditional Chinese Medicine,Changsha 410007,Hunan,China)

机构地区：[1]河南中医药大学第二临床医学院,河南郑州450002 [2]河南省中医院脑病科,河南郑州450002 [3]湖南中医药大学第一附属医院神经内科,湖南长沙410007

出　　处：《实用中医内科杂志》2020年第8期12-15,共4页Journal of Practical Traditional Chinese Internal Medicine

基　　金：国家自然科学基金(81874463);河南省中医院院级科研项目(2018YJKT12);湖南省科技厅科技创新平台与人才计划(2017SK4005)。

摘　　要：中风病是以口眼歪斜,言语謇涩,半身不遂,甚至突然昏仆,不省人事为主症的一类疾病,具有高发病率、高致残率、高病死率的特点,被列为中医四大难症之首,因此挖掘治疗中风病的有效方药具有重要意义。反药被认为是合用可产生毒性反应或不良反应的药物,关于反药是否能在临床中应用,古今均存在较大争议,有反对者,亦有赞同者,对于其在中风病中的运用尤其如此。事实上,反药在中风病中应用历史悠久且较为普遍,据统计《中医方剂大辞典》中古今中风病方中,含有"十八反"相反药物者共173首,其中古代方剂111首,近现代方剂62首,其应用主要集中于3组药物,即乌头(包括川乌、草乌、附子、天雄)组,与半夏、瓜蒌、天花粉组合;藜芦组,与人参、细辛组合;甘草组,与海藻组合,作用主要表现在温经化痰、润通经脉、涌吐风痰等方面。临床应用经验表明,相反药物若辨证准确,运用得当,确能对中风病产生良好的防治作用,因此认为反药在中风病中的运用并非绝对禁忌。由于药物基源、品种、炮制方法、配伍等众多影响反药作用的因素存在,对于古文献中记载的相反药物应当客观地看待,需进一步行理论和实践的挖掘,不能墨守成规的认为反药均不可应用,以使确切有效的药物配伍湮没,影响患者的诊疗。Apoplexy is a kind of disease characterized by facial paralysis,slurred speech,hemiplegia,even sudden fainting and unconsciousness. It has high morbidity,high disability rate and high mortality,and is listed in the first place of the four major difficulties in traditional Chinese medicine. Therefore,it is of great significance to explore effective prescriptions for treating apoplexy. Contrary drugs compatibility is considered to produce toxic reactions or side effects when used together.Whether contrary drugs compatibility can be applied in clinical practice is controversial in ancient and modern times. There are opponents and supporters,especially for its application in stroke. Used in stroke,in fact,it has a long history and is more common. According to the statistics of the prescriptions of traditional Chinese medicine dictionary of ancient and modern stroke,a total of 173 prescriptions contained eighteen incompatible medicaments,and there were 111 ancient prescriptions and62 modern prescriptions. Its application mainly focuses on three groups of drugs: Fuzi( Aconitum) [including Chuanwu( radix aconiti),Caowu( kusnezoff monkshood root),Fuzi( Aconite),Tianxiong( Aconite) ] group,Banxia( Pinellia),Gualou( Trichosanthes) and Tianhuafen( Trichosanthes root) group,Lilu( Veratrum) group,combined with Renshen( ginseng) and Xixin( asarum);Gancao( Liquorice) group,combined with Haizao( seaweed). These drugs groups have the functions of warming meridians and resolving phlegm,moistening meridians and expelling wind phlegm. Clinical application experience shows on the contrary,if drugs are accurate for syndrome differentiation and properly used,they can have a good prevention and treatment effect on stroke. Therefore,we believe that the use of contrary drugs compatibility in stroke is not absolutely taboo. Due to many factors affecting the effect of contrary drugs compatibility,such as source,variety,processing method,compatibility and so on,the contrary drugs recorded in the ancient literature should be treated objective

关 键 词：中风病 脑血管疾病 相反药物 十八反 毒性反应 配伍禁忌 附子 藜芦 

分 类 号：R285.1[医药卫生—中药学]