基于药性功能认知的何首乌安全用药对策研究

Safety Administration Strategy for Heshouwu(Polygoni Multiflori Radix) Based on Properties and Actions of Chinese Medicine

何首乌为中医滋补肝肾的良药,但近年来屡有肝损伤案例报道。何首乌自古就有毒性记载,近年来何首乌肝毒性报道多为偶发性的免疫特异质型肝损伤。临床不合理用药是导致何首乌肝损伤的主要原因之一,而药性功能定位不当、药不对症(证)可能是造成何首乌不合理用药的源头性风险。何首乌性温,不寒不燥,有"阴中阳药"的特征,而何首乌肝损伤多见于免疫异常活化类疾患,属中医辨证阴虚火旺、热毒内蕴者。提出何首乌可用于精血亏虚的血虚证,而兼有阴虚火旺、热毒内蕴的患者使用时则需配伍补阴药而慎用单味何首乌,可从辨证用药、合理用药角度减少何首乌肝损伤的发生。

Heshouwu（Polygoni Multiflori Radix） has always been considered as beneficial in enriching and nourishing the liver and kidney,but it received much concern due to its increasing liver injury reports in recent years.Heshouwu has toxicity records since ancient times. In recent years,the toxicity reports of Heshouwu were accidental immunospecific liver injury,and clinical irrational drug use is one of the main causes of hepatic injury. Heshouwu is warm in Qi,and not cold nor dry in property,with characteristics of＂Yang herbs in Yin＂. The liver injury caused by Heshouwu was mainly seen in immune abnormal activation diseases,which belongs to hyperactivity of fire due to Yin deficiency,internal accumulation of heat toxin syndrome by Chinese medicine syndrome differentiation. It was proposed that Heshouwu could be used in blood deficiency syndrome with essence and blood depletion. Patients with hyperactivity of fire due to Yin deficiency,internal accumulation of heat toxin should be cautious with Heshouwu alone,instead supplementing Yin herbs should be used. The liver injury by Heshouwu can be reduced from medication with syndrome differentiation,and reasonable medication.