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中医药研究论丛
 212.6 《伤寒论》手脚发冷病因及病机之探讨
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TJ TCM.21(2) : 59-72, 2018
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《伤寒论》手脚发冷病因及病机之探讨
Inquiries into the Causes and the Mechanisms for the Adverse Drug Reaction of Chilling Limbs in the Accounts of the Treatise of Febrile Disease
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潘佩兰1 蔡邱辚2 赖荣年2,3,4*
1 内坜仁心堂中医诊所，桃园，台湾
2 中国医药大学附设医院中医部，台中，台湾
3 中国医药大学中医学系，台中，台湾
4 台湾中医家庭医学医学会，台北，台湾
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【摘要】
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医圣张仲景在其《伤寒论》书中明确阐述了在特定的病症下，如果处方了某一些中药，会产生服用後的不良反应，堪称为通报中药不良反应的第一位中医师，本文目的在於整理《伤寒论》中，哪些方药在哪些特定的病症下，会引起手脚发冷的中药不良反应，研究结果显示在宋本《伤寒论》398 条的条文中，共有3 个条文记载着服用中药後会导致手脚发冷的不良反应，其中阴阳两虚的病人，不可以使用桂枝汤；表里两虚的病人，不可以使用大青龙汤，这两个条文具体的记载方药所导致的不良反应，本文将进一步探讨其病因、病机，并提出中医师在临床上问诊所需要注意的事项；现代人的体质可能跟古代人有所不同，而且频繁使用的科学中药粉剂型也与古代的汤剂剂型不同，因此希望藉由本文鼓励中医师们在临床上，观察是否有此类因为服用中药所引起的手脚发冷不良反应的发生，如果有，建议通报全国中药不良反应通报系统(TCM-ADR Reporting Center)，以利汇整资料後由专家再一次的评估判断，此宝贵的资料将是更新张仲景於2000 年前所发现中药不良反应的现代版，也将可以提升中医师处方的医疗服务品质。
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【关键词】伤寒论、手脚发冷、中药不良反应、全国中药不良反应通报系统
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Pei-Lan Pan1Chiu-Lin Tsai2Jung-Nien Lai2,3,4*
1Neili Ren Xin Tang Chinese Medicine Clinic, Taoyuan, Taiwan
2Department of Chinese Medicine, China Medical University Hospital, Taichung, Taiwan
3The School of Chinese Medicine, China Medical University, Taichung, Taiwan
4Taiwan Association Traditional Chinese Medicine of Family, Taipei, Taiwan
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【Summary】
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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.
【Keywords】Treatise of Febrile Disease, Chilling limbs, Chinese medicine
adverse drug reactions, TCM-ADR Reporting Centerr
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