同方汤散临床疗效差异的低极性分子组合缺失机制.pdf

同方汤散临床疗效差异的低极性分子组合缺失机制 王建农，张广德，余仁欢，周彩云，顾士萍，卜璟 中国中医科学院西苑医院 本文得到国家自然科学基金“同方汤散低极性分子组合缺失与临床疗效相关性机制”（课题 编号经费资助。 关键词：玉屏风散；五苓散；逍遥散；同方汤散；低极性分子组合缺失 摘要：大量临床实践表明，经典宜散方剂以超乎寻常的小剂量应用，不仅具有同 方汤剂无法替代且无可质疑的确切临床疗效，而且毒副作用显著减小。在前期对 宜散不宜汤方同方汤散成分比较预实验研究基础上，我们提出了“宜散方同方汤 剂比相应散剂缺失一组非挥发低极性化学成分，这一分子组合缺失是同方散剂临 床疗效优于汤剂的根本机制”这一假说。进而选择传统代表性的宜散方玉屏风散、 五苓散和逍遥散为研究对象，进行一系列的药学、药效学和临床疗效观察比较研 究。药学研究结果表明，由于以水作为溶媒的汤剂对小极性分子溶出有限，致使 同方汤剂比散剂最高缺失约450倍的低极性分子组合，而中、高极性段的分子组 合，同方汤散两者之间几乎不存在任何定性和定量差异。而且宜散方同方汤剂所 缺失的这些低极性组合分子大多为原存于处方中的天然成分，很少有新产生成 分。即宜散方的同方汤剂较散剂缺失低极性分子组合，但并不缺失中、高极性段 分子组合。药效学实验研究和临床观察试验表明，同方汤剂较其散剂缺失部分药 效和/或疗效。药学研究结论完全支持药效学和临床试验中同方汤散一部分药效 重叠，而另一部分缺失的研究结论，即宜散方同方汤剂化学缺失与其药效缺失具 有非常明确的相关和一致性。本文证明了宜散方不宜汤的分子组合缺失与临床疗 效相关性机制，进而为阐明其它宜散不宜汤方的深刻科学内涵奠定基础，为中医 临床依据辨证和药性特点确定中药剂型提供明确的科学依据。 Key Words: Yu Ping Feng Powder; Wu Ling Powder; Xiao Yao Powder; Powder and doction from a same prescription; missing of low polarity components Abstract: A large number of clinical practis has shown that the classical powder suitable prescriptions have much better effect and significantly reduced side effects when they are used as powder comparing with their correspording doctions. We put forward to a hypothesis that missing of a set of non-essential low polarity components of the correspording doction is a fundamental mechanism. In this paper, three clasical powder suitable prescriptions, Yu Ping Feng, Wu Ling, and Xiao Yao powder prescription were selected as an object for study. Chemical research results indicated that due to the solubility limitttion of water for small polar molecular, the highest missing of low polar combination molecule of the selected decoctions were more than 450 times comparing with their correspording powder, but the midium and highly polar molecules in combination were not missing at all. Most of the miss