麻杏石甘汤临床应用近况

Research Progress on Clinical Application of Ephedra and Apricot Kernel and Gypsum and Licorice Decoction

麻杏石甘汤首载于《伤寒论》,具有辛凉疏表、清肺平喘之功,无论有汗、无汗均可使用。现已广泛应用于新型冠状病毒感染、肺炎、慢性阻塞性肺病、哮喘及荨麻疹等疾病,临床疗效较为确切,且安全性好,不良反应少。目前,虽然关于麻杏石甘汤单味药物的化学成分及药理作用研究较多,但对于整方的化学成分作用机制研究鲜有报道,整方化学成分作用的发挥与煎煮工艺、各组分剂量大小、不同产地药材质量等因素等有关。今后,可以将全方的药效物质基础及作用机制、体内代谢过程、起效成分之间配伍作用及质量控制标准等作为研究目标;其次,关于麻杏石甘汤临床试验的样本量较少,缺乏大样本试验数据,下一步应增加样本量,确证疗效的可信度与实效性;除此之外,还需针对不同病证作用机制进行研究,阐明中药通过多靶点参与其关键病理生理进程的机制,再依据异病同治的治法,按照方证相应理论,灵活加减配伍以与病证相适应,为拓展临床应用范围及相关制剂开发提供一定的理论依据。

Ephedra and Apricot Kernel and Gypsum and Licorice Decoction was first recorded in Treatise on Cold Damage Diseases,which has the functions of dispersing the interior with pungent and cold,clearing the lung to relieve asthma.It can be used regardless of whether there is sweat or not.It is now widely used in the treatment of novel coronavirus infection,pneumonia,bronchopneumonia,chronic obstructive pulmonary disease,asthma,and urticaria,etc.,with a relatively certain clinical efficacy and good safety,with few adverse reactions.Currently,although there have been many studies on the chemical components and pharmacological actions of individual components in the formula,there are few reports on the research on the chemical components and action mechanisms of the whole formula.The exertion of the chemical components of the whole formula is related to the cooking process,the dosage of each component,the quality of the herbs from different sources,etc.In the future,research objectives can include the pharmacological substance basis and mechanism of action,in vivo metabolic processes,compatibility between active components,and quality control standards of the entire formula.Secondly,the sample size of the clinical trial of Ephedra and Apricot Kernel and Gypsum and Licorice Decoction is relatively small and lacks large sample trial data.The next step should be to increase the sample size to confirm the credibility and effectiveness of the therapeutic effect.In addition,it is necessary to study the mechanism of action of different diseases and syndromes,clarify the mechanism of Chinese medicinals participating in its key pathological and physiological processes through multiple targets,and then based on the treatment method of treating different diseases together,according to the corresponding theory of formula and syndrome,flexibly adjust the combination to adapt to the disease and syndrome,providing a certain theoretical basis for expanding the scope of clinical application and related formulation development.