贵州中医药大学学报

“大毒治病，十去其六”源自《素问·五常政大论》，是中医学“以毒攻毒”治则的理论源头，其强调峻猛药物攻邪需“衰其大半而止”，以防伤正。本文基于中医学治疗恶性肿瘤临床实践，提出大毒药物是临床攻坚疑难重症的重要利器，不可因惧其不良作用而弃用，但需严守三大核心原则，即精研药性，知毒善用;精准辨证，方证相应;精确应用，中病即止。同时，本文通过构建“识药-辨证-施治”的三“精”一体路径，实现大毒药物临床应用安全与有效的统一，有助于提升中医学对疑难重症的攻坚能力与临床疗效。

" Severe toxic medicinals treat severe diseases,eliminating six-tenths of pathogenic factors" is originated from Suwen·Wuchang Zheng Da Lun( Plain Questions·Comprehensive Treatise on the Normal Governance of the Five Constants),which is also the origin of the traditional Chinese medicine( TCM) therapeutic principle of " combating toxins with toxins". It emphasizes that drastic potent medicinals for attacking pathogenic evils must be withdrawn once most pathogens are eliminated to prevent impairment of healthy Qi. Based on the clinical diagnosis and treatment practice of TCM for maligment tumors,this paper holds that severely toxic medicinals are an indispensable powerful theriputic weapons for the clinical treatment of difficult and severe diseases. Such medicinals should not be discarded merely because of the fear of their adverse effect. However,their application must strictly abide by three core principles: thorough study of medicinal properties to understand toxicity and apply herbs appropriately; precise syndrome differentiation for formula construction and medication administration; accurate clinical administration with timely discontinuaion uopn subsidence of symptom. Meanwhile,this paper constructs an integrated triple-precision framework of " medicinal recognition-syndrome differentiation-therapeutic intervention",which reconciles safety and efficacy in the clinical administration of highly toxic medicinals. This framework helps strengthen TCM's capacity to treat refractory severe diseases and improve corresponding clinical therapeutic effects.