Page 94 - 2019年2月第30卷第4期

中药十八反和十九畏的历史沿革与临床应用情况探析 Δ

李 宁 ，李玲玲 ，李春晓 ，陈玉欢 ，李学林（1.河南中医药大学基础医学院，郑州 450046；2.河南中医药
2 #
1＊
2，3
2
3
大学第一附属医院药学部，郑州 450000；3.河南中医药大学药学院，郑州 450046）
中图分类号 R969.3 文献标志码 A 文章编号 1001-0408（2019）04-0513-05
DOI 10.6039/j.issn.1001-0408.2019.04.16

摘 要 目的：探讨中药十八反、十九畏的历史沿革与临床应用情况，为充实中药合理应用内容提供依据。方法：通过文献挖掘的
方法，以“十八反”“十九畏”“反药”“临床应用”“不良反应”“不良事件”等为关键词，组合检索中国知网、万方和维普数据库（检索时
限均为各数据库建库起至2018年8月）和河南中医药大学图书馆馆藏图书，摘录和梳理中药十八反、十九畏的相关文献，就其历史
沿革与临床应用情况进行汇总、分析。结果与结论：十八反是中药基础理论的主要内容之一，该词首载于《蜀本草》一书，是中药
“七情”中“相反”的具体体现，且历代本草医籍中记载的十八反中药数量有所不同。十九畏是中药配伍的禁忌之一，始见于《神农
本草经》，历代均存在“相恶”“相反”“相畏”混用的情况，且医家对十九畏的“七情”归属尚存有争议。无论古代本草医籍、现代医案
医话、历版《中国药典》还是临床应用相关文献中，均存在十八反、十九畏药对的配伍应用。其中，2015年版《中国药典》（一部）收
载含十八反药对的成方制剂共8个品种，以川乌/草乌-白及/白蔹居多；收载含十九畏药对的成方制剂共9个品种，以丁香-郁金、肉
桂-赤石脂居多。虽有医案或文献指出其可用以治疗危重病证和疑难杂病，且亦有研究初步证实了个别反药/畏药配伍的合理性，
但相关研究的结论并不完全一致，且研究证据强度不高、研究证据不充分，故仍有待加强基础研究并开展大样本、多中心、高质量
的临床研究予以证实，以保证中药临床用药的合理性和安全性。
关键词 中药；十八反；十九畏；合理用药；历史沿革；临床应用

Analysis of the Historical Evolution of“Eighteen Incompatible Medicaments”and“Nineteen Medicaments
of Mutual Restraint”of TCM and Its Clinical Application
2
3
LI Ning ，LI Lingling 2，3 ，LI Chunxiao ，CHEN Yuhuan ，LI Xuelin （1. School of Basic Medicine，Henan
1
2
University of TCM，Zhengzhou 450046，China；2. Dept. of Pharmacy，the First Affiliated Hospital of Henan
University of TCM， Zhengzhou 450000， China； 3. School of Pharmacy， Henan University of TCM，
Zhengzhou 450046，China）
ABSTRACT OBJECTIVE： To investigate the historical evolution and clinical application of “eighteen incompatible
medicaments”and“nineteen medicaments of mutual restraint”of TCM，and to provide reference for enriching the contents of
rational use of TCM. METHODS：Through the methods of literature mining，using“eighteen incompatible medicaments”“nineteen
medicaments of mutual restraint”“incompatible medicaments”“clinical use”“ADR”“ADE”as keywords，retrieved from CNKI，
Wanfang，VIP database（from the date of database establishment to August 2018）and library of Henan University of TCM，related
literatures about“eighteen incompatible medicaments”and“nineteen medicaments of mutual restraint”were extracted and combed，
and the history and clinical application of them were summarized and analyzed. RESULTS & CONCLUSIONS：“Eighteen
incompatible medicaments”is one of the main contents of TCM basic theory. The word is first published in Shubencao，which is
the concrete embodiment of the“opposite”in the“seven compatibility regularities”of TCM，and the number of“eighteen
incompatible medicaments”of TCM recorded in the medical books of TCM is different from each other in the past dynasties.
“Nineteen medicaments of mutual restraint”is one of the taboos of TCM compatibility，which is first found in Shennong’s Herbal.
There are mixed use of“mutual inhibition”“incompatible”and“mutual restraint”in all dynasties，and there is still controversy
about the attribution of“seven compatibility regularities”of“nineteen medicaments of mutual restraint”among physicians.
Regardless of ancient medical books，modern medical books，various editions of Chinese Pharmacopeia，literature reports and
clinical applications， there are compatibility usage of drug pairs of “eighteen incompatible medicaments” and “nineteen
medicaments of mutual restraint”. Among them，8 kinds of set prescription preparations containing drug pair of“eighteen
incompatible medicaments”were involved in 2015 edition of Chinese Pharmacopoeia（part Ⅰ），most of which were Aconitum
carmichaelii/Aconitum kusnezoffii-Bletilla striata/Ampelopsis
Δ 基金项目：国家科技重大专项项目（No.2015ZX09501004）；河
japonica；9 kinds of set prescription preparations containing
南省中医药科学研究专项课题（No.2016ZY1006）
drug pair of“nineteen medicaments of mutual restraint”were
＊讲师。研究方向：情志与衰老相关疾病的理论及临床。电话：
also involved，most of which were Syringa oblate-Curcuma
0371-86565538。E-mail：3598525388@qq.com
# 通信作者：副主任药师。研究方向：中药合理用药及临床评 rcenyujin，Cinnamomum cassia-Halloysitum rubrum. Although
价。电话：0371-66233562。E-mail：lichunxiao@126.com there are medical records or literature pointing out that it can

中国药房 2019年第30卷第4期 China Pharmacy 2019 Vol. 30 No. 4 ·513 ·