中药十八反配伍禁忌的历史沿革与用药分析

Evolution and Medicine-using Analysis of Eighteen Incompatible Medicaments in TCM

古今临床医家把十八反的药物视作配伍禁忌,认为合用后会致毒增毒,然而成功运用反药的例证也代有所传。本文通过对中药十八反的历史演变过程以及在方剂中的应用状况进行分析,发现藜芦组方剂应用在宋元时期达到最高,而甘草和乌头组方剂则是在明清时期最多,3组方剂在民国时期和现代应用均较快下降;并且外用方的比例偏高,方剂药味数有增多的趋势,主要集中在8～9味。本文认为十八反配伍与毒性药材密切相关,是有条件的中药配伍禁忌,如不同的生理病理条件,配比剂量的变化,不同的给药途径,与其它药物配伍使用;其配伍致毒/增毒机理的阐明将为保障中医临床安全合理用药提供科学依据,并有助于推动中药药性理论和中医方剂配伍理论的研究与发展,也将为其他禁忌理论研究提供参考和借鉴。

Clinical Chinese medical practitioners at all times considered eighteen incompatible medicaments as incompatibility, which would lead to toxicity. However, the tradition to utilize eighteen incompatible medicaments for remedying human disease has been passed down from one generation to another. In this paper, based on the histori- cal development of eighteen incompatible medicaments and analysis of its application in formulae, we found that the formulae in Veratrum group reached the heap in Song and Yuan Dynasties, while, the formulae in Glycyrrhiza and Aconitum group were at most in Ming and Qing Dynasties, but they all gradually disappeared since the 20th century. It is also informed that the formulae containing eighteen incompatible medicaments for external use are more than others, and the number of medicines used in these formulae was higher, usually 8 to 9. Therefore, the eighteen incompatible medicaments which are closely related to toxic medicines is a conditional incompatibility such as different pathophysiologic conditions, variation in ratio and dose, different administration routes and application with other medicines. The clarification of the toxicity mechanism for the eighteen incompatible medicaments would offer scientific support for safe medicine utilization in clinical practice, help to promote the development of TCM property theories and TCM formulae compatibility rules, and provide reference for the research about other incompatibility theory.