十八反十九畏理论的分层分类认识及其用于临床安全风险评估的药学专家共识  

Pharmacy Expert Consensus on Classification of the Eighteen Incompatible Medicamentsand Nineteen Counteraction Theory and Application in Clinical Safety Risk Assessment

作　　者：中药临床使用合理性评价与合理化改进专家组 金锐 李云 Expert Group on Rational Evaluation and Improvement of Clinical Use of Traditional Chinese Medicine

机构地区：[1]不详 [2]中国中医科学院西苑医院 [3]西安市中医医院

出　　处：《医药导报》2024年第6期841-849,共9页Herald of Medicine

基　　金：首都卫生发展科研专项(首发2020-2-2081);中国中医科学院科技创新工程重大攻关项目(CI2021A03805);全国中药特色技术传承人才培训项目(国中医药人教函[2023]96号)。

摘　　要：十八反、十九畏理论属于中药配伍禁忌范畴,长期作为合理性评价依据用于中药处方的审核点评工作。但是,从该理论的历史源流、内容范畴、现代研究、临床应用和古今学术观点来看,争议不断。基于此,在文献梳理、专家访谈和问卷调研基础上,笔者汇集全国各级各类医疗机构的医学和药学专家,采用改良的Delphi法和证据综述评价体系,对十八反、十九畏理论进行分层分类认识,以“毒-毒”联用、“毒-非毒”联用和“非毒-非毒”联用的分类模式解析十八反、十九畏理论的核心要义,并综合各类证据形成临床安全风险评估的推荐意见。最终形成的共识包括三部分共19条陈述,旨在为中药科学合理用药和行业高质量发展提供参考。The eighteen incompatible medicaments and nineteen counteraction theory belongs to the category of compatibility contraindications in Traditional Chinese Medicine(TCM),and has been used as a basis for rational evaluation in the review and evaluation of TCM prescriptions for a long time.However,there is constant controversy on the theory from perspectives of the historical origins,content categories,modern research,clinical applications,and ancient and modern academic.Thus the author gathered opinions medical and pharmaceutical experts from various types of medical institutions across the country based on literature review,expert interviews,and questionnaire surveys.The improved Delphi method and evidence review evaluation system were used to classify and understand,the eighteen incompatible medicaments and nineteen counteraction theory in a hierarchical manner.The core principles of this theory were analyzed using a classification model of"toxic-toxic"combination,"toxic-non toxic"combination and"non toxic-non toxic"combination.The recommendations for clinical safety risk assessment were formed on various types of evidence.The final consensus consists of three parts and a total of 19 statements,aiming to provide reference for the scientific and rational use of herbal medicines and the high-quality development of the industry.

关 键 词：中药 十八反 十九畏 配伍禁忌 风险评估 专家共识 

分 类 号：R289.1[医药卫生—方剂学]