中成药是治疗慢性肾衰竭(CRF)的常用方法之一,但在临床工作中存在诸多不合理使用的情况。 笔者探讨了CRF 患者不合理使用中成药的原因和类型:辨证依据不足、药不对证,不符合中医辨证用药的原则;重复用药;违反中医“十八反”、“十九畏”的配伍禁忌;不熟悉特殊人群的用药禁忌等。 提出了CRF 患者合理使用中成药的建议:以中医基本理论为指导辨证使用中成药;对于没有中医基础的西医医生,可根据CRF 患者脾肾阳(气)虚、湿瘀互阻、浊毒内蕴的中医核心病机,选择具有健脾益肾、活血化瘀、利湿降浊中成药如尿毒清颗粒、肾衰宁胶囊等作为基本用药,其他则根据病人在某一阶段的中医证型特点或某些特定中医证型选择相关中成药如肺肾阳(气)虚者,加百令胶囊、金水宝胶囊等;尽量避免中成药与中药汤剂或中成药与同类中成药之间联合使用;提高医生及CRF 患者合理使用中成药的自觉性等。

Traditional Chinese patent medicine is commonly used in China for patients with chronic renal failure (CRF), but there are many irrational uses of it to be improved in clinical practice, including inadequate syndrome differentiation, not symtomatic use of drugs, repeated use of decoction and patent medicine, violation of Chinese medicine principles, such as the “eighteen incompatible medicaments” and the “nineteen medicaments of mutual restraint”, and unfamiliarity with the contraindications of specific patients. Therefore, the writer proposes some suggestions for rational use of patent Chinese medicine in patients with CRF. First, use of patent Chinese medicine should abide by the principles of traditional Chinese medical sciences. Second, the major pathogenesis of CRF includes Yang (Qi) deficiency in both Pi and Shen, mutual resistance of Shi and Yu, and Zhuo Du Nei Yun, so patent Chinese medicaments that can reinforce the Pi and Shen, stimulate blood circulation, or Li Shi Jiang Zhuo can be selected with priority,such as Niaoduqing granules, and Shenshuaining capsule, etc. Bailing and Jinshuibao capsules are used when there is Yang Qi deficiency of the Li Shi Jiang Zhuo. Third, joint use of patent Chinese medicines or joint use of patent medicine and decoction should be avoided. Forth, Both doctors and patients should raise consciousness in rational use of patent chinese medicine.