The Cautions and Contraindications of Chinese Herbal Medicine during Pregnancy

懷孕時期的中藥使用注意事項與禁忌

賴永昌(Yung-Chang Lai) ； 陳玉蘭(Yu-Lan Chen) ； 鄭人豪(Ren-Hao Zheng)

《中山醫學雜誌》 17卷1期 (2006/06) Pp. 137-150

https://doi.org/10.30096/CSMJ.200606.0015

摘要

隨著中醫在世界各國的接受度逐漸增加，專業醫療人員對於中藥的使用、藥理作用及毒性的認識也相對提高。根據文獻記載，中藥的使用注意事項主要可分為毒性、交互作用及禁忌等三方面。其中因為懷孕時期的中藥使用安全涵蓋範圍廣泛且涉及胎兒及孕婦的健康，因此常特別獲得重視。
古代中醫典籍將懷孕時期的中藥禁忌分兩大類解釋：[1]具有毒性的中藥或浚下類藥品。例如桃仁(Semen Persicae)、巴豆(Croton tiglium)及大戢(Radix Euphorbiae seu Knoxiae)。此類藥品因容易導致流產或傷及胎兒，屬於絕對禁忌的範疇。[2]活血、破氣或大辛、大熱類的藥品。例如附子(Lateralis Aconiti)及乾薑(Rhizoma Zingiberis Officinalis)，此類藥品因容易改變孕婦體內的氣血循環及影響子宮的血液供應，因此必須謹慎使用。
鑑於全世界中藥的使用需求與日俱增，在此我們嘗試以中醫藥理學的角度，探討下列幾類懷孕時期禁用與慎用藥物：(1)潤腸通便藥，(2)活血化瘀藥，(3)破氣、行氣藥，(4)溫裏藥(大辛大熱類)，以及(5)其他類藥。冀望能讓讀者進一步認識中藥藥性、藥理作用與懷孕用藥安全之間的關係。

關鍵字

中藥 ； 注意事項 ； 禁忌 ； 懷孕

並列摘要

There is an increasing awareness and worldwide acceptance of Chinese herbal medicine, and it is therefore important for medical professionals to understand the pharmacology involved. According to the literature of ancient Chinese medicine, cautions and contraindications are the major reasons why certain Chinese herbs should either not be used at all or should only be used with great caution during pregnancy. The first of these two categories involves medicinal substances such as toxic or extremely harsh substances that can cause problems for the fetus or even lead to miscarriage are absolutely forbidden, for instance, Croton tiglium (巴豆, Ba Dou), Radix Euphorbiae seu Knoxiae (大戢, Da Ji), Semen Persicae (桃仁, Tao Ren) and Flos Carthami Tinctorii (紅花, Hong Hua). The second category includes herbs that may be used during pregnancy, but should be prescribed with the greatest of caution due to their extremely hot properties that may strongly interfere with the components of body fluids or the circulation of Qi and blood within the mother's body, such as Radix Lateralis Aconiti (附子, Fu Zi) and Rhizoma Zingiberis Officinalis (乾薑, Gan Jiang).
The latter group can be divided into the following sub-categories: (1) laxative herbs that stimulate or lubricate the large intestine; (2) herbs that invigorate the blood circulation, ease the menstruation and expel blood stasis; (3) herbs that strongly circulate Qi and break up Qi stagnation; (4) herbs that warm the interior body with pungent-hot properties and (5) others. This means that clinical practitioners need to take the possible adverse effects of medication into account when prescribing it to pregnant women, thereby preventing injury to the fetus, avoiding miscarriage, and thus ensuring the safe of both the mother and the fetus. These effects are discussed in this paper.

並列關鍵字

Chinese herbal medicine ； cautions ； contraindication ； pregnancy