附子与半夏同方配伍调查与临床分析

Investigation and Clinical Analysis of Compatibility of Aconiti Lateralis Radix Preparata and Pinelliae Rhizoma

目的寻找附子、半夏安全、有效的配伍方法。方法以某院146首附子、半夏同时配伍的方剂为调查样本,对其治疗的疾病、附子和半夏使用的剂量配比、用药疗程、特殊煎煮方法、不良反应发生情况,以及常见处方配伍品种等进行统计与分析。结果调查方剂中,附子、半夏同方配伍应用证型排前3位的分别是脾虚证、痰浊证和脾肾亏虚证;两药多采用1∶1配伍,其中以附子10 g-半夏10 g居多;平均使用疗程为4 d;附子先煎的例数占58.22%;出现可能相关的不良反应有4例(2.74%);方剂中常用配伍中药排前3位的品种、使用剂量及占比分别是干姜10 g(38.36%)、炙甘草15 g(17.81%)、干姜15 g(8.22%)。结论附子、半夏同方配伍并非绝对禁忌,在辨证与"阳虚兼寒湿、痰阻"相关时,两药同方配伍有效性较好;并且两药通过使用炮制品、附子给予先煎、使用剂量配比1∶1,以及随证加用炙甘草或干姜等可增加同方配伍的安全性;此外,临床药师加强对附子、半夏同方应用的人群及个体化使用剂量的审核,以及督促临床对确有循证依据的方剂做好超药典用药备案,做好不良反应的识别和宣教工作,均可提高附子、半夏同方使用的安全性和有效性。

Objective To investigate the safe and effective compatibility of Aconiti Lateralis Radix Preparata and Pinelliae Rhizoma. Methods Totally 146 recipes of compatibility of Aconiti Lateralis Radix Preparata and Pinelliae Rhizoma in a hospital were taken as the samples. The diseases,dosage ratio of Aconiti Lateralis Radix Preparata and Pinelliae Rhizoma,medication course,special decoction method, adverse reactions, compatible varieties of common recipes were analyzed. Results In the recipes, the former 3 positions of the treatment of disease were spleen deficiency syndrome,phlegm syndrome and spleen and kidney deficiency. 1：1 formula of Aconiti Later- alis Radix Preparata and Pinelliae Rhizoma was widely used, and the majority of the application was 10 g Aconiti Lateralis Radix Preparata and 10 g Pinelliae Rhizoma. The average usage period of treatment was 4 d. The casess of the preside decoction of Aconiti Lateralis Radix Preparata accounted for 58.22% , and there was 4 cases of relative adverse reactions（2. 74% ）. The commonly used compatibility of traditional Chinese medicine in the recipes which accounted for the top three were Zingiberis Rhizoma 10 g（38.36% ）, Radix Glycyrrhizae Preparata 15 g（17.81% ）, Zingiberis Rhizoma 15 g（8.22% ）. Conclusion The compatibility of Aconiti Lateralis Radix Preparata and Pinelliae Rhizoma is not absolute contraindication. In the syndrome differentiation associated with ＂Yang deficiency, cold dampness and phlegm obstruction＂ , the compatibility effectiveness of two drugs is good. And through the use of processed products, the first decoction of Aconiti Lateralis Radix Preparata,the dosage ratio is 1 ：1 ,and the addition of Radix Glycyrrhizae Preparata or Zingiberis Rhizoma,the security can be increased. In addition,the clinical pharmacists should strengthen the review of application crowd and individualized dosage of the compatibility of Aconiti Lateralis Radix Preparata and Pinelliae Rhizoma,and make record for the evi- dence- based and super pharmacopoeia medication. The identification of adverse reactions and missionary work should be well done,in order to improve the safety and effectiveness of compatibility of Aconiti Lateralis Radix Preparata and Pinelliae Rhizoma.