中医药研究论丛

232.3 桂枝汤合方在台湾地区中医临床处方模式之研究
TJ TCM.23(2) : 35-48, 2020 35
 
桂枝汤合方在台湾地区中医临床处方模式之研究
Coprescription Pattern of Gui-Zhi-Tang and Traditional Chinese Medicine Formulae in
Taiwan: A Nationwide Population-Based Study   
曾心怡1 王明仁2 赖妘薇2 陈安履1 周晖哲1 谢旭东1 林舜谷1,3*
1 台北市立联合医院仁爱区中医科,台北,台湾
2 台北市立联合医院仁爱区药剂科,台北,台湾
3 国立阳明大学公共卫生研究所,台中,台湾
【摘要】
背景:中医师临床遇到的病况总是变化多端,完全符合某个特定方剂的情形实属罕见,因此中医衍生出了另一种开方模式-「合方」。将两种作用不同的方剂合并使用,以扩大疾病的使用范围,让更好的贴近患者需求。桂枝汤在临床上的应用层面很广,从创立初期记载於伤寒论中的外感风寒,到内伤杂病以及妇儿科疾患,也发展出了许多合方的模式,但目前并没有实证研究探讨桂枝汤的合方在临床使用的实际情形,本研究希望以数据探勘的方式,协助进一步了解台湾中医师对桂枝汤的合方方法。
方法:本研究采用横断式的研究方法,蒐集1997-2012 年申报予台湾全民健康保险局的处方,透过分析卫生福利部释出之百万病患归人医疗资讯档,筛选出包含桂枝汤的处方及合并於同一次治疗中的中医复方,并分析常用合方之种类、频率、使用天数、剂量,以及与桂枝汤相对之剂量关系。
结果:本研究共纳入482,564 笔桂枝汤合方的处方,桂枝汤与经方并用以小柴胡汤的频率最高,达到21 万次之多,其次则为麻黄汤(10851 次)、小青龙汤(7592 次)、麻杏甘石汤(6399 次)等太阳病篇之解表方剂为主;与时方合用时,以解表且专走鼻系的辛夷散(10943 次)及苍耳散(10039次)最多,其次为同属解表药之辛夷清肺汤(7699 次)与解表固卫之玉屏风散(9063 次)。经方与桂枝汤和用时,平均处方的剂量与天数均较为分散;相比之下,时方与桂枝汤合用之处方种类多样,并没有出现单一处方占据极大比例之情形,平均处方天数则明显的集中於6-7 天,平均日剂量亦集中於7-10 克。
结论:台湾中医师处方桂枝汤时大量使用合方技巧,除了过去典籍所记载合并使用小柴胡汤、麻黄汤、越婢汤以外,更发展了许多合并时方或内科杂病方剂的模式,方剂之配合比例也有所不同,显示出台湾中医在数十年的发展中,已逐渐开发出本土的用药特色与配伍知识。
【关键词】桂枝汤、合方、方剂配伍、健保资料库、小柴胡汤
 
Shin-Yi Tzeng1Ming-Jen Wang1Yun-Wei Lai2Andy Chen1Hui-Zhe Zhou1
Hsu-Tung Hsieh1Shun-Ku Lin1,3*
1Department of Chinese Medicine, Taipei City Hospital, RenAi Branch. Department of Health, Taipei, Taiwan
2Department of Pharmacy, Taipei City Hospital, RenAi Branch. Department of Health, Taipei, Taiwan
3Institute of Public Health, National Yangming University, Taiwan
【Summary】
Introduction: “Formulae Coprescription” is a prescription mode for physicians that combines two different formulae to expand the range of indications and increase the effectiveness of the treatment. Guizhi Tang has a wide range of indications, including infectious diseases, respiratory system diseases, gastrointestinal system diseases, and obstetrics and gynecology diseases. At
present, there is no research on the formulae coprescription of Guizhi Decoction. We will analyze Taiwan’s traditional Chinese medicine practitioners’ use of the formulae coprescription method of Guizhi Tang by using the National Health Insurance database.
Methods: This study used a cross-sectional research method to collect medical information of one million people from 1997 to 2012. We screened out the prescription of Guizhi Tang and the accompanying herbal formulae. We analyzed the type, frequency, days of use, dosage, and dose ratio of the main formulae coprescription related to Guizhi Tang.
Results: We included a total of 482,564 pen formulae coprescriptions in the study. The traditional prescription has the highest frequency of Xiaochaihu Decoction (more than 210,000 times), followed by Mahuang Decoction (10851 times), Xiaoqinglong Decoction (7592 times), and Maxing Ganshi Decoction (6399 times); the modern prescription is Xinyi San (10943 times) and Canger San (10039
times), followed by Xinyi Qingfei Decoction (7699 times) and Yupingfeng San (9063 times). The main indication of most current prescriptions is respiratory disease. The average of prescription days is concentrated in 6-7 days, and the average daily dose is focused on 7-10 grams.
Conclusion: Taiwanese Chinese medicine practitioners used a formulae coprescription when formulating Guizhi Tang, and developed many new prescription models. Besides, the relative dose ratio of the prescription is also different from before. This study shows that Taiwanese Chinese medicine has developed a unique prescription model.
 
【Keywords】Gui-Zhi-Tang, combined prescription, prescription compatibility, health insurance database, Xiaochaihu Decoction