有毒中药吴茱萸及减毒配伍研究探讨

Euodiae Fructus(Wuzhuyu):Exploring traditional Chinese medicine compatibility for reducing toxicity

有毒中药是中医临床用药的重要组成部分。传统中医药在使用有毒中药的过程中逐渐加深对毒性的认识,并通过炮制减毒、配伍减毒、对证用药、剂量与疗程控制等方式保障其安全使用。吴茱萸是临床常用“小毒”中药,一方面,吴茱萸的药效作用明确,既是治疗肝寒气滞诸痛的主药,又是治疗脾胃阳虚、五更泄泻的常用药,现代药理研究表明吴茱萸具有抗炎、抗肿瘤和心脏保护等作用;另一方面,吴茱萸具有潜在的毒性,古代多部经典医书中对其有“小毒”的描述,现代研究也证实其具有肝毒性。为保障吴茱萸的临床安全使用,需要对吴茱萸的毒性相关研究和减毒措施进行全面了解。以吴茱萸的现代药物科学研究为中心,对吴茱萸所含的化学成分、药理作用、不良反应和毒理研究、药代特征进行系统阐述,结合已有配伍研究对吴茱萸的后续减毒配伍研究进行探讨,以期达到毒性作用明确、毒性物质明确、减毒配伍物质和机制明确的目标,明确临床安全用药的技术条件,使其能够安全有效地应用于临床治疗,由此扩大中医的用药范围和选择。

Toxic traditional Chinese medicines(TCMs)are important components of clinical medications.The understanding of the toxicity associated with toxic TCMs has steadily improved.To ensure their safe use,various methods have been developed,including processing to reduce toxicity,compatibility adjustments to reduce toxicity,medication based on syndrome differentiation,as well as control of dosage size and duration.Wuzhuyu(Euodiae Fructus)is a commonly used TCM with“low toxicity”.It is frequently employed to alleviate pain associated with liver cold and qi stagnation,as well as to relieve diarrhea caused by spleen-stomach weakness.Modern pharmacological studies have demonstrated the anti-inflammatory,antitumor,and cardioprotective effects of Euodiae Fructus.However,Euodiae Fructus has been acknowledged as a toxic TCM in numerous classical medical texts from ancient time and has been substantiated as hepatotoxic by contemporary studies.To ensure the continued safe use of Euodiae Fructus,it is crucial to have a comprehensive understanding of the TCM toxicity and its associated detoxification measures.This review article provides an overview of the chemical composition,pharmacodynamics,adverse reactions and toxicity,and pharmacokinetics of Euodiae Fructus.Additionally,the potential reduction of the TCM toxicity through TCM compatibility is also discussed.For those toxic TCMs that exhibit prominent therapeutic effects,have well-defined toxic effects,and whose toxicity can be mitigated or alleviated through certain methods,thorough research should be conducted to establish the technical conditions for their safe clinical use and enable their continued application in clinical treatment.This could potentially expand the range of therapeutic options available in TCM.