从《黄帝内经》“有故无殒”谈儿童风湿免疫疾病治疗中的药“毒”及“毒”药的应用

Discussion on drug toxicity and application of toxic durgs in rheumatic immune diseases in children from the perspective of“You Gu Wu Yun”in Huangdi Neijing

儿童风湿免疫疾病缠绵难愈、易于反复,严重影响患儿身心健康,是临床的治疗难点。目前该类疾病的治疗多依赖激素、免疫抑制剂、生物制剂等,然此类药物在发挥治疗作用的同时也具有较大的副作用。中医将药物的副作用归属于药“毒”范畴,具有药“毒”的药物被称为“毒”药。对于“毒”药。《黄帝内经》中“有故无殒”理论提示,临床应因“故”用药,药虽有“毒”,而病先受之,于人体无碍。基于这一理论,本文提出“毒”药峻猛,非“急”不用;病衰大半,止药缓“毒”;权衡“效”与“毒”,以平为期;耐“毒”不同,应因人制宜;因证施药,配伍减“毒”的“毒”药运用原则,并提出精准用药、采取减毒举措、提高效益与风险比的“毒”药施用策略,对儿科临床安全用药具有指导意义。

Rheumatic immune diseases in children are difficult to treat,frequently recur,and can seriously affect children’s physical and mental health.At present,treatment of rheumatic immune diseases mainly depends on hormones,biologicals and immunosuppressants.However,these drugs have nonnegligible side effects.Traditional Chinese medicine deems that the side effects of drugs belong to the category of drug“toxicity”.Drugs that are toxic are called“toxicity”drugs,with regard to“toxicity”drugs,the theory of“You Gu Wu Yun”in Inner canon of Huangdi considers that although drugs are“toxic,”drugs are used for an explicit“reason,”so the disease itself receives the drug first,which are not harmful to the human body.Based on this theory,we propose“toxicity”drugs’use principles that“toxicity”drugs are severe;therefore,drugs should not be used until the plight is urgent.“Toxicity”drugs should be stopped when the disease is mostly cured.The“effectiveness”and“toxicity”must be weighed to find a balance between the body and the drugs.Treatment ought to be adapted according to personal condition,because tolerance to“toxicity”drugs varies.Drugs must be used based on disease differentiation and syndrome differentiation,and toxicity must be reduced by compatibility.We also put forward the“toxicity”drugs’use strategies of precising drugs’use,taking measures to attenuate toxicity,improving the benefit/risk ratio,which are of great guiding significance to the safe use of drug in pediatric clinics.