「藥」與「毒」——本草學「毒」性觀念的歷史回顧與記述模式的幾點反思

“Medicine” and “Poison” Several Reflections for Historical Review and Narrative Mode of “Toxic” Concept in Herbalism

本草學是受傳統醫學理論指導傳統「藥」學的統稱；中藥的毒性理論是本草學藥性理論的一部分，與四氣、五味、升降浮沉、歸經等性能理論同為學習與臨床用藥的基本原則，在當今舉世關注中藥毒副作用的壓力之下，是一急待處理的課題；而記述模式則是指撰寫本草學著作所應用的指導原則。本文認為欲解決此一傳統與現代交融的問題，首先必須回歸到其形成的歷史背景上作充分的理解與檢討，因此採用歷史回顧的方式的研究方法，對本草學中毒性觀念的形成、涵括的範疇與合理性等作一統合檢討。透過回顧，發現毒性理論的記述模式，是《神農本草經》系的本草著作形成主流的結果，其形成是在漢代特有的「生生之具」長生觀念下的產物，內涵夾雜了藥性、毒副作用、藥材基原、藥材製備及配伍等複雜面相，頗不適合當代以毒副作用作為毒性定義的認知。由此，本文得出幾點結論：其一，傳統「有故無殞」的藥性作用部份，應回歸四氣及氣味厚薄的記述。其二，不當的藥材基原部份，應統屬於藥材來源的管控。其三，透過藥材製備得以減輕或消除毒副作用的部份，應以製備後為基準來作為毒性分級的基準。其四，屬於特殊體質的不良服藥反應，不應歸屬於毒性的記述。其五，因劑量不宜或服用方法不當所產生的不良反應，應回歸到相關建議的項目之下。其六，排除以上條件，凡產生臟性損傷的藥物統歸有毒藥物，仍採毒性分級的概念作分類，分類的標準須有現代毒理的研究為基礎，嚴格限制使用劑量與適用範圍。如此一來，或有助於重建一既兼顧中藥用藥安全，又能最大限度發揮中藥優點的現代本草學。

Herbalism is a general term of traditional “pharmacy” instructed by traditional medicine theory; toxic theory of Chinese medicine is a part of drug theory, which is a basic principle for learning and clinical medication along with performance theories of four natures, five flavors of drugs, Sheng-jiang- fu-chen and Guijing, etc. Under the pressure of Chinese medicine’s toxic and side effect widely concerned worldwide nowadays, this is an issue urgently to be solved; meanwhile, narrative mode is a governing principle used to compose Herbalism works. This article regarded this problem as blend of tradition and modernity. Firstly, full understanding and review must be made by returning to the formation of the historical context. Therefore, this study adopted research method on the basis of historical retrospect for an integrative review about the generating of toxic concept in Herbalism, covering the scope and rationality, etc.
Narrative mode of toxic theory through the review is found to form the mainstream of Herbalism works in a series of “Shennong's Herbal”. This outcome was formed from immortality concept of specific “the cycle of life” in the Han Dynasty, including the contents mixed with complicated aspects of drug property, toxic and side effect, the source of medical materials, medicinal preparation and drug matching, etc. It was not quite suitable for contemporary awareness of toxic and side effect as toxic definition. Consequently, this article concluded as follows: 1. Medicine effect of traditional “You Gu Wu Yun” should be returned to narrative of four natures; 2. Improper source of medical materials should be attributed to control of the source of medical materials; 3. Toxic and side effect lightened and eliminated through medicinal preparation should be used as the basis of toxicity grading after the basis of preparation; 4. Adverse drug reaction for special physique should not be attributed to toxicity; 5. Adverse reaction caused by inappropriate dosage should be returned to proposed project under recommended usage; 6. Excluded the foregoing conditions, any drug causing internal organs damage contributed to toxic drug should be still classified by toxicity grading. The standard of classification should be based on modern toxicology research for strictly restricted for use of dosage and applicable scope. Thus, it may be helpful for reestablishment of modern Herbalism, giving consideration to both drug safety of Chinese medicine and the development of Chinese medicine advantages to maximum extent.