基于古今文献与临床实践的“附子反半夏”再思考  

Reconsideration of“Aconiti Lateralis Radix Praeparata(Fuzi)Antagonizing Pinelliae Rhizoma(Banxia)”Based on Ancient and Modern Literature and Clinical Practice

作　　者：陈昭橦 覃献锋 刘敏[2] CHEN Zhaotong;QIN Xianfeng;LIU Min(The First Clinical College,Guangzhou University of Chinese Medicine,Guangzhou 510405,China;The First Affiliated Hospital,Guangzhou University of Chinese Medicine,Guangzhou 510405,China)

机构地区：[1]广州中医药大学第一临床医学院,广东广州510405 [2]广州中医药大学第一附属医院,广东广州510405

出　　处：《中医药学报》2024年第12期1-5,共5页Acta Chinese Medicine and Pharmacology

基　　金：国家自然科学基金项目(81373767);广州中医药大学“双一流”与高水平建设项目(2021xk44)。

摘　　要：附子与半夏是否可以配伍使用一直存在争议,开展相关古今文献整理与临床实践分析,多维度探讨“附子反半夏”的合理性,具有重要意义。从历史发展来看,将“附子反半夏”纳入反药的常规范畴不到40年;从“相反”的内涵分析,将反药视为绝对配伍禁忌值得商榷;从附子与乌头毒性、药效的对比分析,附子因与乌头的亲缘性而被纳入反药范畴不合理;从毒理作用看,两药合用在药物的炮制、复方配伍及用药对象生理病理状态不同条件下,产生的毒性不同;从药效作用看,两药合用对辨证为脾肾阳虚,痰湿内蕴者疗效显著。综上,可认为附子与半夏配伍使用具有重要临床价值。在准确辨证的前提下,经过药物的炮制、复方配伍、药物比例选择及正确的煎服方法,附子与半夏配伍应用具有可行性。The compatibility of Aconiti Lateralis Radix Praeparata(Fuzi)and Pinelliae Rhizoma(Banxia)has long been a subject of controversy.Therefore,conducting a comprehensive analysis of relevant ancient and modern literature along with clinical practice to explore the rationality of the combination of“Aconiti Lateralis Radix Praeparata and Pinelliae Rhizoma”is of great significance.From a historical perspective,it has been less than 40 years since“Aconiti Lateralis Radix Praeparata and Pinelliae Rhizoma”were believed to be antagonist contraindicated each other.Analyzing the connotation of“antagonism”,it is worth questioning whether contraindicated combinations should be viewed as absolute here.Comparing the toxicity and efficacy of Aconiti Lateralis Radix Praeparata and Aconite Main Root,we found that it is unreasonable to classify Aconiti Lateralis Radix Praeparata into the range of contraindication herbs just because of it is related to Aconite Main Root.Assessing the toxic effects of the combined use of Aconiti Lateralis Radix Praeparata and Pinelliae Rhizoma,it is evident that the toxicity varies under different conditions of drug processing,compound compatibility,and the physiological and pathological states of the patients.From the perspective of efficacy,the combination of Aconiti Lateralis Radix Praeparata and Pinelliae Rhizoma has significant therapeutic effects on patients with spleen-kidney yang deficiency and phlegm-dampness retention syndrome.In conclusion,the combination of Aconiti Lateralis Radix Praeparata and Pinelliae Rhizoma has important clinical value.With accurate differentiation and proper drug processing,compound compatibility,selection of drug proportions,and correct administration methods,the combination of Aconiti Lateralis Radix Praeparata and Pinelliae Rhizoma is feasible.

关 键 词：附子 半夏 十八反 相反 中药配伍 配伍禁忌 

分 类 号：R289.1[医药卫生—方剂学]