中药“十八反”之反药配伍的可行性思考  

Feasibility of Combination of Antagonism Chinese Medicinals based on the Theory of “Eighteen Antagonisms”

作　　者：葛友涛 肖倩倩 高毅 卞廷松 GE Youtao;XIAO Qianqian;GAO Yi;BIAN Tingsong(Taizhou Hospital of Traditional Chinese Medicine,Jiangsu Province,225300;Postdoctoral Research Station,ShandongUniversity of Traditional Chinese Medicine;School of Sports Medicine and Rehabilitation,Shandong First Medical University;Affiliated Hospital of Nanjing University of Chinese Medicinee/Changzhou Hospital of Traditional Chinese Medicine)

机构地区：[1]泰州市中医院,江苏省泰州市225300 [2]山东中医药大学博士后科研流动站 [3]山东第一医科大学运动医学与康复学院 [4]南京中医药大学附属医院/常州市中医医院

出　　处：《中医杂志》2023年第17期1734-1739,共6页Journal of Traditional Chinese Medicine

基　　金：山东省自然科学基金(ZR2019PH107);江苏省常州市卫生系统拔尖人才项目(2016CZBJ048);江苏省中医药科技发展计划项目(MS2022073)

摘　　要：中药“十八反”一直被中医药界视为中药配伍的禁忌,其内涵在中医药的发展过程中逐渐被绝对化。从历史源流来看,十八反并非配伍的绝对禁忌,且现有反药种类亦值得进一步商榷。从毒理作用来看,十八反的毒副作用多来自配伍中某药毒副作用的加强,而非两药相配产生毒副作用;从药效作用来看,部分反药相配可获常规用药无法获得的疗效,具有临床实践的可行性和合理性。基于此,认为十八反的部分反药配伍应用有其积极意义,认为反药的使用应注意严格的配伍、炮制及煎煮方法,以期为中药十八反配伍的正确认知和使用提供参考,为临床疾病的中医药配伍治疗拓宽思路。The“eighteen antagonisms”of Chinese medicinals have been regarded as taboos in the field of tradi⁃tional Chinese medicine(TCM),and the connotations have gradually been narrowed down in the development of TCM.From the historical perspective,“eighteen antagonisms”are not an absolute taboo in terms of the combination of medicinals,and the existing types of antagonism medicinals are also worth further discussion.From the perspective of toxicological effects,the toxicology of the“eighteen antagonisms”mainly comes from the enhancement of the toxic and side effects of a certain herb,rather than the combination of two herbs.From the perspective of pharmacodynamic actions,the combination of some antagonism medicinals can achieve therapeutic effects that cannot obtained by con⁃ventional medicinals,which is feasible and reasonable in clinical practice.Therefore,it is believed that the applica⁃tion of combining some antagonism medicinals based on“eighteen antagonisms”is of positive significance.Moreover,strict combination,processing and decoction methods should be noted in the use of antagonism medicinals.All men⁃tioned above will provide reference for the correct recognition and use of the combination of“eighteen antagonisms”,and broaden the combination thinking for the treatment of clinical diseases with TCM.

关 键 词：十八反 中药配伍 配伍禁忌 反药 合理用药 

分 类 号：R289.1[医药卫生—方剂学]