《傷寒論》手腳發冷病因及病機之探討

Inquiries into the Causes and the Mechanisms for the Adverse Drug Reaction of Chilling Limbs in the Accounts of the Treatise of Febrile Disease

醫聖張仲景在其《傷寒論》書中明確闡述了在特定的病症下，如果處方了某一些中藥，會產生服用後的不良反應，堪稱為通報中藥不良反應的第一位中醫師，本文目的在於整理《傷寒論》中，哪些方藥在哪些特定的病症下，會引起手腳發冷的中藥不良反應，研究結果顯示在宋本《傷寒論》398條的條文中，共有3個條文記載著服用中藥後會導致手腳發冷的不良反應，其中陰陽兩虛的病人，不可以使用桂枝湯；表裡兩虛的病人，不可以使用大青龍湯，這兩個條文具體的記載方藥所導致的不良反應，本文將進一步探討其病因、病機，並提出中醫師在臨床上問診所需要注意的事項；現代人的體質可能跟古代人有所不同，而且頻繁使用的科學中藥粉劑型也與古代的湯劑劑型不同，因此希望藉由本文鼓勵中醫師們在臨床上，觀察是否有此類因為服用中藥所引起的手腳發冷不良反應的發生，如果有，建議通報全國中藥不良反應通報系統（TCM-ADR Reporting Center），以利彙整資料後由專家再一次的評估判斷，此寶貴的資料將是更新張仲景於2000年前所發現中藥不良反應的現代版，也將可以提升中醫師處方的醫療服務品質。 Zhang Zhong-jing explicitly elaborated that certain Chinese medicines induce the adverse drug reaction of chilling limbs for specific diseases. He has been widely recognized as the first Chinese medical practitioner to report the adverse drug reactions of Chinese medicine in the medical history of China. This paper aims at identifying which Chinese medicine results in chilling limbs for which diseases by revisiting the accounts in the version of the Treatise on Febrile Disease during the Song Dynasty. The findings show that only three out of three hundred ninety-eight accounts report the adverse drug reaction. Among the three accounts, only two of them specify and match the Chinese medicines with the adverse drug reaction. One is Gui-zhi-tang for patients with deficiency in yin and yang. The other is Da-qing-long-tang for patients with external and internal fatigue. We further investigate the causes and mechanisms for the two accounts as physical constitutions may differ over time. Additionally, we take into account the forms of Chinese medicines varying from soup in ancient times to scientifically processed powder in modern times. The paper makes a useful reference to the Chinese medical practitioners, who were encouraged to report the cases of chilling limbs induced by Chinese medicines to the TCM-ADR Reporting Center, Taipei, Taiwan. By updating Zhang Zhongjing’s 2000-year-old accounts of adverse drug reactions, we advocate promoting the on-job educational training for the Chinese medicine practitioners in the interest of improving the quality of their prescriptions of Chinese medicine.

Zhang Zhong-jing explicitly elaborated that certain Chinese medicines induce the adverse drug reaction of chilling limbs for specific diseases. He has been widely recognized as the first Chinese medical practitioner to report the adverse drug reactions of Chinese medicine in the medical history of China. This paper aims at identifying which Chinese medicine results in chilling limbs for which diseases by revisiting the accounts in the version of the Treatise on Febrile Disease during the Song Dynasty. The findings show that only three out of three hundred ninety-eight accounts report the adverse drug reaction. Among the three accounts, only two of them specify and match the Chinese medicines with the adverse drug reaction. One is Gui-zhi-tang for patients with deficiency in yin and yang. The other is Da-qing-long-tang for patients with external and internal fatigue. We further investigate the causes and mechanisms for the two accounts as physical constitutions may differ over time. Additionally, we take into account the forms of Chinese medicines varying from soup in ancient times to scientifically processed powder in modern times. The paper makes a useful reference to the Chinese medical practitioners, who were encouraged to report the cases of chilling limbs induced by Chinese medicines to the TCM-ADR Reporting Center, Taipei, Taiwan. By updating Zhang Zhongjing’s 2000-year-old accounts of adverse drug reactions, we advocate promoting the on-job educational training for the Chinese medicine practitioners in the interest of improving the quality of their prescriptions of Chinese medicine.