天南星嚴重毒性的評估---發展科學方法測定生製及炮製天南星之藥效、毒性及安全劑量(II)

楊榮森
國立台灣大學
天南星塊莖的味性具有苦、辛、溫、燥烈，藥理作用很強，即能理脾胃濕痰，又善治經絡風痰而解痙，散結消腫。故通治中風痰壅，風痰所致的肢體麻痺、眩暈、驚癇口噤、口眼喎斜等病症，另尚有散血消腫袪痰作用，對腫瘤及外傷瘀腫均有功效。天南星依照其不同炮製方法，常用的有三種，即生南星、制南星（以生薑、白(石凡);、甘草等輔料加以炮製）及(月旦)南星（以牛(月旦)汁炮製而成），這些天南星製劑乃是數千年來傳統中醫藥常使用的藥物之一。 然而天南星，全株有毒，過量中毒，產生口腔黏膜糜爛，運動神經末端麻痺，並逐漸影響身體運動中樞，產生驚厥，呼吸不規則，嚴重時，呼吸麻痺而致死。另有報告，天南星會影響小兒智力發育障礙，延遲語言及行走的學習。天南星的毒性與其麻辣味有關，而麻辣味又與天南星所含的Caoxylate及強心甘有平行關係，經炮製後，毒性成分的破壞與麻味的消除有密切關係，然而目前尚無報告，去除強心甘與消除毒性的關係。 有鑒於天南星辛燥而專走經絡，故散風寒，除經絡間之風痰濕之攻捷，專治中風及癲癇引起之風痰，吐逆，頭暈及目眩之症狀不可或缺的重要藥物，但它又是有毒植物。因此發展科學方法來定量天南星的藥效及毒性之間的劑量反應關係，乃是目前急迫等待解決的問題。我們擬於本研究計畫中，發展有關定性及定量天南星的功效及毒性的方法，並且使用這些方法，比較研究上述三種不同天南星製劑的功效及毒性，以確保經過炮製後的天南星，達到提高藥效及降低毒性的功能。
關鍵字：生南星；制南星；膽南星藥效；毒性；安全劑量

Evaluation of severe toxicities of Tien-Nan Shin---Development of quantitative methods for estimation of pharmacological and toxicological effects (safty margin ) of the crude and processing preparations

Yang Rong-Sen
National Taiwan University
The Chinese traditional drug Tien-Nan Shin(TNS) possesses bitter, warm, dry and toxic properties. Its pharmacological effects are potent including sedation, stomachic, expectorant anticonvulsant, anti-coagulation, anti-inflammation, antitumor and enhanced circulation (Gen-Dou). Therefore, its clinical indications are for management of stroke, paralysis, hemiplegia, vertigo, tetanus etc. However, the specific preparation procedures for removing the toxic components of TNS is especially emphasized. The most frequent used adjuvants for removing toxic components are ginger, aluminum sulfate and bovine bile salts. The whole plant of TNS is toxic, the intoxication symptoms include mucus membrane necrosis, paralysis of motor nerve terminals and center motor area, convulsion and irregular respiration. The cause of death is respiratory paralysis. Moreover, TNS caused mental retardation in children and inhibition of learning in language and movement. It was noted that the degree of numbness produced by TNS was proportional to its toxicity. The numbness property is probably due to the existence of Ca oxalate and cardiac glycosides.
關鍵字：Tien-Nan Shin；pharmacological effects；toxicological effects；safty margin