中药“十八反”源流考辨及现代阐释

doi:10.19803/j.1672-8629.20260407

摘要/Abstract

摘要： 目的探讨中药临床用药安全核心概念“十八反”内涵,构建现代理论解释框架,为中医药临床安全用药与配伍规律深化研究提供参考。方法通过文献考证与语义辨析探析“反”字源流;结合实证分析与系统评价,整合现代药典规范、临床试验及基础实验研究,剖析“证候微环境”下反药毒–效转化机制。结果拟定涵盖体质辨识、剂量阈值及配伍佐制等多维度临床条件适用决策树模型。研究表明,“十八反”并非绝对配伍禁忌,实为顺应中医辨证思维并带有非常规属性临床用药策略。结论 “十八反”的临床应用须具备明确条件适用性,未来应依托真实世界研究（RWS）与单病例随机交叉试验（N-of-1 Randomized Crossover Trial）提供更高级别循证证据。

关键词: “十八反”, 药物配伍禁忌, 用药禁忌, 中药, 药性

Abstract: Objective To study the connotation of the eighteen incompatible (Shibafan), a core concept of safety of clinical medication in traditional Chinese medicine (TCM), construct a modern framework for theoretical interpretation, and provide data for safe medication and in-depth research on compatibility in TCM. Methods The origin and semantic evolution of the character “fan” (incompatibility) were explored via historical textual research and semantic analysis. By combining empirical analysis and systematic evaluation and integrating modern pharmacopeial standards, clinical trials, and basic experimental research, the toxicity-efficacy transformation mechanism of incompatible medicaments under the syndrome microenvironment was analyzed. Results A multidimensional and clinically-applicable decision tree model was established that involved constitution identification, dosage thresholds, and compatibility with adjuvant herbs. Research indicated that the “eighteen incompatible medicaments” were not absolute compatibility contraindications, but rather an unconventional clinical medication regimen that conformed to the dialectical thinking of TCM. Conclusion Clinical applications of the “eighteen incompatible medicaments” are clearly applicable under specific conditions. In the future, real-world studies (RWS) and N-of-1 randomized crossover trials should be leveraged to provide higher-level evidence-based evidence.

Key words: Eighteen Incompatible (Shibafan), Drug Compatibility Contraindications, Medication Contraindications, Trational Chinese Medicine, Medicinal Properties

中图分类号:

杨玉琴, 郎英琦, 王敏舒, 吴美玲, 柏冬. 中药“十八反”源流考辨及现代阐释[J]. 中国药物警戒, 2026, 23(10): 1139-1143.

Yang Yuqin, Lang Yingqi, Wang Minshu, Wu Meiling, Bai Dong. The origin and modern interpretation of the eighteen incompatibilities in traditional Chinese medicine[J]. Chinese Journal of Pharmacovigilance, 2026, 23(10): 1139-1143.

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