常用中药及复方制剂的肝毒性

Hepatotoxicity Caused by Commonly-used Chinese Medicinal Herbs and Compound Preparation

中药所致肝毒性的临床表现与常见肝病相似,可出现急性肝细胞损害、肝功能异常、血清转氨酶升高、肝肿大、黄疸、胆汁淤积、慢性肝炎伴纤维化、肝硬化、暴发性肝衰竭或肝脏肿瘤等各种病理变化。停药后,多数肝脏损害是可逆的。常见的具有肝毒性单味药有黄药子、苍耳子、雷公藤、麻黄、苦楝子、番泻叶等;常见的肝毒性复方制剂有壮骨关节丸、疳积散、复方青黛丸、克银丸、小柴胡汤等。中药配伍及中西药联合用药均可导致肝毒性的发生;中药的药性与肝毒性也有关;引起肝毒性的原因除与中药本身的毒性有关外,与医者用药剂量和用药时间及与患者本身体质也有关,季节、地域等因素也是引起肝毒性的重要原因。只有在中医药理论指导下,辨证施治,提高医术,合理用药,才是防止中药及复方制剂引起肝毒性的有效措施。

The manifestations of hepatotoxicity caused by Chinese medicinal herbs are similar with ordinary liver disease. Many pathological alterations of hepatotoxicity can be seen, such as hepatocellular damage, liver disfunction, increased serum transaminase, hepatomegalia, jaundice, cholestasis, chronic hepatitis complicated with fibrosis, hepatic cirrhosis, fulminating hepatic failure, liver tumor, and etc. In most cases, the liver damage is reversible after discontinuation. The commonly-seen herbs which may cause hepatotoxicity are Huang Yao Zi （ Tuber Dioscoreae Bulbiferae ） 、 Cang Er Zi （ Fructus Xanthii Sibirici ）、 Lei Gong Teng （ Radix Tripterygum）、Ku Lian Zi（ Fructus Meliae Azedarach）, etc. , and the compound preparations are Zhuang Gu Guan JIe Wan（ The Pill for Asthritis） , Ke Yin Wan（The Pill for Psoriasis）, Xiao Chai Hu Tang （Xiao Bupleuri Decoction）, and so on. In addition, the improper combination of Western medication and Chinese medicinal herbs may also bring about hepatotoxicity. Except the toxicity of herbs themselves, the other factors include the dosage, time, the body constitution of patients, sensitivity, seasons, and geographic regions, etc. Therefore, the medicinal herbs and their preparations should be used rationally under the guidance of the theory of traditional Chinese medicine and differentiation of symptoms, and the medical skill should be improved, which are the effective measures for avoiding hepatotoxicity.