中药“禁忌慎”的沿革及内涵

Evolution and Connotations of"Prohibition","Contraindication",or"Use with Caution"in Chinese Materia Medica

本文基于历代本草及方书,《中华人民共和国药典》,中药学教材和专著,以诠释学、训诂学、考据学及数据挖掘等为技术手段,系统梳理与分析中药“禁忌慎”的使用情况。研究中药禁忌用语“禁忌慎”的历史沿革与概念内涵,为规范“禁忌慎”的认识及中药临床合理用药提供参考。中药“禁忌慎”在先秦至汉时期被提出,“忌”和“禁”分别在隋唐五代时期和宋金元时期得到积累与发展,至明清时期“禁”“忌”开始被广泛应用,“慎”在近现代的使用激增,与“禁”“忌”共同成为主要的中药临床禁忌用语。“禁忌慎”的基本含义分别为严格禁止使用、尽量避免使用与审慎使用。中药“禁忌慎”始终贯穿于中药学从先秦至现代的发展历程,是对药物使用限制程度的划分(“禁”>“忌”>“慎”)。

This study systematically combed and analyzed the use of such terms as"prohibition","contraindication",and"use with caution"in ancient Chinese books on materia medica and prescriptions,Pharmacopoeia of the People's Republic of China(《中华人民共和国药典》),and teaching materials and monographs of Chinese materia medica by means of hermeneutics,commentariology,textology,and data mining,and explored the historical evolution and conceptual connotations of"prohibition","contraindication",and"use with caution"in Chinese materia medica,so as to provide reference for standardizing their understandings and clinical reasonable medication.The"prohibition","contraindication",and"use with caution"of Chinese materia medica were first proposed in the period of pre-Qin and Han dynasties."Prohibition"and"contraindication"were separately developed in the Sui,Tang,and Five dynasties and Song,Jin,and Yuan dynasties and have been widely used since the Ming and Qing dynasties.The"use with caution"becomes popular rapidly in modern times and is often present in clinical medication together with"prohibition"and"contraindication"."Prohibition"basically means strictly prohibited and"contraindication"means to avoid as much as possible.The terms"prohibition","contraindication",and"use with caution"have experienced evolution from the pre-Qin period to modern times,and they are used to describe the degree of restriction on drug use("prohibition">"contraindication">"use with caution").