中藥相互作用的理論與現代臨床應用上之關係

Modern Clinical Applications Related to Traditional Theories of Drug Interactions

傳統中醫學假設有七種中藥（ 天然物 ）產生藥理作用的模式，而稱為「七情」，其中只用一種中藥者稱為「單行」，而其他則二種以上之中藥併用。處方中併用的藥物，可以相互影響，如加強或抑制藥效強度（或最大藥效），而達到利於病人或減少毒性的結果。這些古代醫師沒有聽診器、溫度計、血壓計協助下的直覺洞察力，是從精敏的臨床觀察得來的。張仲景及陶弘景在二千年以前利用「望、聞、問、切」診斷病人之後，所擬就的處方中，六種藥物間的相互作用，可用現代定量的實驗測定方法所述的化學物質間的致活、或拮抗作用加以解釋。而相須、相使、相畏、相惡、相殺及相反，也與現代西方醫學中相加、協同、酶誘導、部份致活、競爭或非競爭性拮抗，及藥物禁忌所造成的藥效及毒性加強相當。

Chinese traditional medicine postulates seven modes by which drugs (natural products) can elicit pharmacologic effects, one when an agent is used alone and six when several are used in combination. In the latter instance, the combined products in a prescription can interact with each other to augment or reduce potency or intrinsic activity with respect to beneficial or harmful effects. Such intuitive insight was derived from skillful clinical observations made by the ancient attending physician without the aid of instrumentation such as the stethoscope, thermometer and sphygmom-anometer. The prescribing followed external methods of diagnosis involving inspection, ausculation, olfaction, and interrogation coupled with palation and pulse feeling. It is most illuminating, therefore, that the six types of drug interactions conceived from clinical applications by Zhang Zhong-Jing and Tao Hong-jing almost two millennia ago can be utilized to explain contemporary proposed modes of agonistic and antagonistic actions between chemical substances derived from quantitative experimental measurements. Examples will be given with respect to how xiang xu 相須， xiang shi 相使，xiang wei 相畏， xiang wu 相惡， xiang sha 相殺 and xiang fan 相反 can be incorporated into mechanistic Western terminology for producing beneficial or harmful effects associated with additive, synergistic, enzyme inductive, partial agonistic, competitive or non-competitive antagonism and pharmaceutic incompatibility properties.