中藥學堂
同化製劑與利尿劑篇
中藥運動禁藥補益與代謝的陷阱（三）
◎文／藥師楊佳蒨
芫花（Genkwa Flos）：透過下調腎臟第二型水通道蛋白（AQP2）發揮利尿作用，且不會引起大多數利尿劑常見的電解質失衡。19
五苓散（Oryeongsan / Wulingsan）：是一經典方劑，透過抑制腎素-血管收縮素-醛固酮系統(RAAS)來誘導鈉排泄和利尿，作用機轉也與利尿劑類似。18,20
當歸芍藥散（Danggui Shaoyao San）：含有pentagalloylglucose等生物活性成分，能促進排鈉並抑制鈉滯留，其作用機轉與臨床利尿劑類似。21
甘草（Glycyrrhizae Radix et Rhizoma）：含甘草酸可影響類固醇代謝，引起偽醛固酮症，類似利尿劑與礦物皮質激素(mineralocorticoid)作用，亦可影響腎臟過濾與電解質調節。3,22
這些中藥材及方劑的利尿機制與臨床利尿劑（如噻嗪類（Thiazides）、環形利尿劑（Loop diuretics）、保鉀利尿劑）相似，均可增加尿量、排鈉、調節腎臟水分與電解質平衡，並在動物及部分臨床研究中證實其效用。18,20,22
在運動禁藥檢測上，雖然這些中藥材並未被WADA明確列為禁用，但其利尿作用可能導致尿液稀釋，進而影響禁藥檢測結果，或被判定為掩蔽劑使用，存在違規風險。部分文獻指出，運動員若大量服用這類中藥，可能被視為有意掩蔽其他禁藥，需高度警惕。1,23,24
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（本文作者為彰化基督教醫院中醫藥局主任）