中草药肾损害的现状及对策-1.ppt

;Medicinal herbal extracts – renal friend or foe?;Herbal extracts with potential renal benefits; Among the herbs, polyherbal formulae and fungi with potential renal benefits are Cordyceps sinensis（冬虫夏草） Sairei-to（柴苓汤） Rheum spp（大黄） Salvia miltiorrhiza（丹参）and its component magnesium lithospermate B （丹参酚酸B镁 ） others. ;;“Herbs for health，but how safe are they？” Int Public Health 2001.342：1686-1692 中草药一向被人们认为毒副作用少、使用安全。近年来，随着中草药不断走向世界，某些中草药的毒副作用，特别是中草药肾损害的问题，引起了国内外医学界的广泛关注。;;马兜铃酸肾病Aristolochic Acid Nephropathy; Paucicellular Interstitial Fibrosis and Tubular Atrophy;2001年美国FDA宣布禁止销售和使用含AA中药，欧美及东南亚国家相继采取类似行动;A、确认含有马兜铃酸的植物;B、可能混杂有（或误用）马蔸铃酸的药物;Case Report;All clinical findings were normal, except for an increase in blood pressure (BP) of 180/100 mmHg. Urinalysis revealed trace proteinuria and glycosuria without pyuria and hematuria. white blood cells 7500/μL; hemoglobulin 10.9 g/dL; hematocrit 31.1%; and platelet 217,000/μL. Then, losartan 50 mg per day was prescribed, followed by a gradual improvement in renal function. ; ???????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????? ;According to a recent analysis of aristolochic acid in nine sources of Xi Xin collected from China, the concentrations of AA-I were found to range from 3.3 ng/mg (Asarum sieboldii) to 3376.9 ng/mg (Asarum crispulatum). Applying HPLC to determine the amounts of AA-I and AA-II in the Duhuo Tisheng Tang sample ingested by the patient, It was found AA-I and AA-II concentrations of 239.687 and 606.15 ng/mg, respectively. Since the patient took in total 400g of Chinese powder, up tong AA-I were ingested. Yang HY，et al：J Nephrol. 2006;19(1):111;C、含有木通、防己和??兜铃酸的成药;文献报道产生肾毒性的中药(1);文献报道产生肾毒性的中药(2);文献报道产生肾毒性的中药(3);中草药肾毒性产生的原因;国内学者看法;（一）中医药应用没有遵循辨证施治和中病即止的原则;讲究组方配伍：中药组方严格按“君、臣、佐、使”的原则，为减少中药的毒副作用提供了一条有效途径，