- 期刊
某病患服用麻黃附子細辛湯出現副作用之探討
Discussion about One Patient's Adverse Drug Reactions Resulted from Ma Huang Fu Zi Xi Xin Tang
摘要
某37歲女性病患，素有過敏體質，主述自4月初感冒之後，仍時發咳嗽；中醫師針對該患者體質、發病過程及臨床表現，診斷為陽虛外感，故處方中以麻黃附子細辛湯5g為主。但在服藥每一小時半左右，即出現心悸手顫抖、呼吸不暢胸悶緊感，且隨時間經過，該不過逐漸緩和消失。病患服用該中藥期間，並沒有併服西藥，可以確認該心悸手抖副作用因麻黃附子細辛湯所致，但到底是何種中藥引起值得我們注意。檢視麻黃附子細辛湯組成：麻黃、附子、細辛，麻黃在較大劑量時會引起大腦皮層和皮層下中樞的興會；附子有毒成分為烏頭鹼，中毒表現以神經系統及心血管系統的症狀；細辛的毒性成分主要揮發油－黃樟醚，剛開始會興奮中樞神經系統，而後陷入麻痹狀態，過量服用會導致死亡。因此麻黃附子細辛湯的三個組成藥物，都可能會造成病患心悸手抖之現象，但在病患服用中藥治療喘咳前，亦曾因ephedrine而導致心悸手抖現象，所以了解患者本身對ephedrine作用類藥物成受性高，容易出現創作用，高度懷疑病患服用中藥後出現的副作用是因麻黃所引起。每個人對於麻黃鹼之感受性有所不同，因此樂師若能在含有麻黃藥物給與時，詢問病患對麻黃之感受性並給予相關藥物資訊，或者提供病患出現藥物不良反應的通報管道，就能把藥物的不良反應產生時造成病患身體或心理之傷害降至最低，同時也提升民眾用藥安全。
並列摘要
The 37-year-old female with allergic history said that she frequently coughed after having a cold on April. Thechinese medicine practitioner diagnosed the patient as syndrome of exogenous attack due to yang deficiency in according to her constitution, disease process, clinic performance. So the doctor prescribed the major chinese traditional medicine (5g of ma huang fu zi xix xin tang) for patient. But after taking the chinese traditional medicine about 90 minutes, she had the symptoms of palpitation, tremble, hard breathing, chest tightness. As time went by, the symptoms had been gradually disappeared. When the patient taked the chinese traditional medicine, she did not combine any medicine. Therefore we could confirm the adverse drug reactions resulted from ma huang fu zi xi xin tang, but we wanted to know what kind of drug caused. Ma huang fu zi xi xin tang was made up of ma huang, fu zi, and xi xin. Ma huang at bigger dose causes excitation of celebral cortex and subcortical center. The toxic compound of fu zi is acontine which leads to problems of nerve system and cardiovascular system at toxic dose. The main toxic component of xi xin is volatile oil: safrole. It will excite the central nerve at the beginning and then caused palsy, finally results in death at overdose. All of the elements of ma huang fu zi xi xin tang probably brought out the patient's unanticipated condition. Before taking the chinese traditional medicine for coughing, she had taken medicine contained ephedrine and then caused the same unconformable performance. The female patient has sensitivity with ephedrine so that we suspect the patient's adverse effect resulted from ma huang. The susceptibility of ephedrine varies from person to person so that before giving patient medicine which contains ephedrine, pharmacist can ask about patient's sensitivity with ephedrine and offers information about ephedrine to patient, either provides reporting system of adverse drug reactions for patient. For this reasonpharmacist can minimize the physical and mental damage when adverse drug reactions happened, and promotes public medicinal safety.