中藥學堂
總論與興奮劑篇
中藥運動禁藥觀念建立與高風險中藥材（四）
◎文／藥師楊佳蒨
其他一些中藥含有去甲烏藥鹼Higenamine，是目前最常在運動員尿液中被檢出的中藥興奮劑成分，廣泛存在於多種中藥材與食材，包括黃柏/黃蘗(Phellodendri Cortex）、買麻藤（Gnetum montanum Markgr.）、南天竹（Nandina domestica Thunb.）、細辛（Asari Radix）、川烏頭（Aconiti Radix）、漢防己（Stephaniae Tetrandrae Radix）、蓮（Nelumbinis）、釋迦（Annona Squamosa L.）等，去甲烏藥鹼被歸類為S3類β2 受體致效劑（β2 - agonists），而非S6興奮劑，但由於其具有腎上腺素作用（adrenergic effect），因此常被提及並討論其興奮劑活性，代謝產物可在尿液中持續檢出數天，且部分濃縮製劑含量極高，服用後可導致尿液檢測陽性，運動員服用常規劑量即有違規風險。2,5,16,17,18,19
在亞洲（特別是中國、台灣、韓國）運動員中，因中藥材使用頻率高，去甲烏藥鹼、麻黃鹼、番木鼈鹼/士的寧等成分常因增強體能、恢復疲勞、減重等目的被誤用，陽性檢出率明顯高於歐美國家，各國需根據當地用藥習慣與政策調整檢測策略，以降低非故意違規風險。2,10,11,20
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參考資料：
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17.	Discovery of Chemical Markers for Improving the Quality and Safety Control of Sinomenium Acutum Stem by the Simultaneous Determination of Multiple Alkaloids Using UHPLC-QQQ-MS/MS. Huang YF, He F, Wang CJ, et al. Scientific Reports. 2020;10(1):14182.
18.	Identification and Characterization of Higenamine Metabolites in Human Urine by Quadrupole-Orbitrap LC-MS/MS for Doping Control. Zhao X, Yuan Y, Wei H, et al. Journal of Pharmaceutical and Biomedical Analysis. 2022;214:114732.
19.	Undeclared Doping Substances Are Highly Prevalent in Commercial Sports Nutrition Supplements. Duiven E, van Loon LJC, Spruijt L, Koert W, de Hon OM. Journal of Sports Science & Medicine. 2021;20(2):328-338.
20.	How Do Government Regulations Influence the Ability to Practice Chinese Herbal Medicine in Western Countries. Fleischer T, Su YC, Lin SJ. Journal of Ethnopharmacology. 2017;196:104-109.

（本文作者為彰化基督教醫院中醫藥局主任）