麻黄的化学成分及其药效作用和药代特征

Mahuang(herbaceous stem of Ephedra spp.):chemistry,pharmacodynamics,and pharmacokinetics

中药麻黄为麻黄科植物草麻黄Ephedra sinica、中麻黄E.intermedia或木贼麻黄E.equisetina的干燥草质茎。麻黄是中医上千年抗击瘟疫的一味关键中药,不同时期的疫病虽有不同,但使用含麻黄的方药始终传承,在我国抗击新型冠状病毒肺炎疫情中发挥了积极作用。麻黄是一味非常有特色的中药,一方面麻黄的药效作用突出,不仅是中医发汗解表的要药和宣肺平喘的要药,而且具有明确的利水消肿作用。另一方面麻黄的毒副作用也比较突出,因此安全有效的临床用药取决于能否“用之得当”。该文全面总结了麻黄的化学组成及多方面的成分差异、麻黄成分的药效作用和药代动力学特征、麻黄成分及制品的不良反应。笔者认为在学习传统中医用药理论和实践经验的基础上,对麻黄系统开展现代药物科学研究,有利于进一步发挥传统中医药独特优势、发展新型中药以有效应对新型冠状病毒肺炎等重大突发传染性疾病。为此,可重点在两方面着力,其一是深入研究多物质参与下的麻黄药效作用特点,其二是系统研究麻黄毒副作用的临床表现、物质基础和规避方法。

The Chinese medicinal herb Mahuang is herbaceous stem of Ephedra sinica,E.intermedia,or E.equisetina(Family,Ephedraceae).In China,Mahuang has been used,all the way over a millennium,as a key component herb of many herbal medicines for management of epidemics of acute respiratory illness and is also used in officially recommended herbal medicines for COVID-19.Mahuang is the first-line medicinal herb for cold and wheezing and also an effective diuretic herb for edema.However,Mahuang can also exert significant adverse effects.The key to safety and effectiveness is rational and precise use of the herb.In this review article,we comprehensively summarize chemical composition of Mahuang and associated differences in pharmacognosy,pharmacodynamics and pharmacokinetics of Mahuang compounds,along with the adverse effects of Mahuang compounds and products.Based on full understanding of how Mahuang is used in Chinese traditional medicine,systematic research on Mahuang in line with contemporary standards of pharmaceutical sciences will facilitate promoting Chinese herbal medicines to become more efficient in management of epidemic illnesses,such as COVID-19.To this end,we recommend research on Mahuang of two aspects,i.e.,pharmacological investigation for its multicompound-involved therapeutic effects and toxicological investigation for clinical manifestation of the adverse effects,chemicals responsible for the adverse effects,and conditions for safe use of the herb and the herb-containing medicines.