2020年版《中国药典》收载“大毒”中药的安全性综述  

Review on the Safety of“Highly Toxic”Traditional Chinese Medicinal Materials in the 2020 Edition of Chinese Pharmacopoeia

作　　者：刘青[1] 康琪[1] 郑红梅[1] 梁雪兰[1] 蒋永忠[1] 李奕松 LIU Qing;KANG Qi;ZHENG Hongmei;LIANG Xuelan;JIANG Yongzhong;LI Yisong(Sichuan College of Traditional Chinese Medicine,Sichuan Mianyang 621000,China)

机构地区：[1]四川中医药高等专科学校,四川绵阳621000

出　　处：《中国医药导刊》2024年第12期1227-1231,共5页Chinese Journal of Medicinal Guide

基　　金：中央引导地方项目(XZ202102YD0027C);校级科研项目(TD-2022-8)。

摘　　要：对2020年版《中国药典》收载的10味“大毒”中药的单味药急性毒性、配伍禁忌、炮制减毒、配伍减毒4个方面进行文献调研,结果发现红粉、天仙子2味“大毒”中药尚缺乏急性毒性相关研究,其余“大毒”中药的毒性程度和安全性风险存在差异。毒性由大到小依次为斑蝥、生马钱子、砂烫马钱子(马钱子粉)、巴豆、草乌、巴豆霜、闹羊花、川乌。可内服的“大毒”中药用药安全风险由大到小依次为砂烫马钱子(马钱子粉)、闹羊花、斑蝥、巴豆霜,其中砂烫马钱子(马钱子粉)的安全性风险最大。部分“大毒”中药配伍禁忌研究显示,“十八反”中的某些配伍并非绝对禁忌,但临床应用时需注意剂量和配比。炮制是降低“大毒”中药毒性的常用方法。马钱子炮制前后始终存在较大临床用药安全风险,其余“大毒”中药通过炮制,在较大程度上降低了用药安全风险。部分文献数据显示,“大毒”中药通过与证型结合的合理配伍后,毒性显著降低。本研究通过对10味“大毒”中药的安全性进行综述,以期为毒性中药的临床安全用药提供参考。The literature on 10“highly toxic”traditional Chinese medicinal materials included in the 2020 edition of Chinese Pharmacopoeia was investigated from four aspects:acute toxicity of single medicine,contraindications to compatibility,attenuating toxicity by processing,and attenuating toxicity by compatibility.It was found that there was a lack of studies on acute toxicity of Hydrargyri Oxydum Rubrum and Hyoscyami Semen,while the toxicity levels and safety risks of the other“highly toxic”traditional Chinese medicinal materials vary.Toxicity in descending order is Mylabris,Strychni Semen,Strychni Semen Pulveratum,Crotonis Fructus,Aconiti Kusnezoffii Radix,Crotonis Semen Pulveratum,Rhododendri Mollis Flos,Aconiti Radix.The safety risks of"highly toxic"traditional Chinese medicinal materials that can be taken internally,from large to small,are as follows:Strychni Semen Pulveratum,Rhododendri Mollis Flos,Mylabris,Crotonis Semen Pulveratum.Among them,the safety risk of Strychni Semen Pulveratum is the greatest.Some studies on the contraindications to compatibility of“highly toxic”traditional Chinese medicinal materials suggest that certain incompatibilities in the“eighteen incompatible medicaments”are not absolutely contraindicated,but it is necessary to pay attention to dosage and proportion in clinical use.Processing is a common method to reduce the toxicity of“highly toxic”traditional Chinese medicinal materials.There remains a significant safety risk for clinical use of Strychni Semen after processing.The other“highly toxic”traditional Chinese medicinal materials have reduced the safety risks to a large extent through processing.Some literature data show that the toxicity of"highly toxic"traditional Chinese medicinal materials is significantly reduced after rational compatibility based on syndrome differentiation.This study reviews the safety of 10"highly toxic"traditional Chinese medicinal materials in order to provide reference for the clinical safe use of toxic traditional Chinese medicinal

关 键 词：“大毒”中药 急性毒性 安全性 

分 类 号：R285[医药卫生—中药学]