中医药研究论丛

254.4 浓缩中药(科学中药)处方剂量探讨

 TJ TCM.25(4) : 35-50, 2022

DOI : 10.6516/TJTCM.202212_25(4).0004
 
浓缩中药(科学中药)处方剂量探讨
Discussion on the Dosage of Chinese Medicine Concentrated Preparations
郭博元1 戴承杰2,3*
1 台北医学大学附设医院传统医学科,台北,台湾
2 台北医学大学医学系,台北,台湾
3 戴承杰中医诊所,台北,台湾
【摘要】
在健保制度下中医师的处方由水煎药转变以浓缩中药为主,此一剂型的转变使得中医的处方模式有大幅的改变。而水煎药与浓缩中药间剂量的转换与疗效的差异等问题,至今仍未有详细的研究分析阐明。而浓缩中药常见的叠方(合方)的模式,常形成药味繁多、单一药物剂量低的处方,治疗的剂量是否达到有效剂量/ 治疗阈值则值得探讨。本文旨在了解健保制度下中药使用,并厘清传统水煎剂与现代浓缩中药之间的差异与转换问题,最後分析浓缩中药的处方模式所遇到的问题及可能的解决方法。
结果发现健保给付的中药品项以浓缩散、浓缩粉、浓缩颗粒、浓缩细粒等剂型较常使用,而现在浓缩中药复方的原饮片用量以卫福部公告的「基准方」剂量为准则。「基准方」所使用的饮片用量多数相较於水煎剂小,但在有效成分的萃取与吸收上和水煎剂相比并无明显优劣。此外,叠方的使用已是现今浓缩中药处方的常态,然而在每日药费的限制下,可能产生单一药物的剂量不足而无法达到有效治疗浓度的疑虑。故处方上可在明确的诊断基础上,确立治疗的主次先後、针对核心病机开立处方并简化药物的使用,使处
方能够精简及提高处方中药物的剂量以达到有效的治疗。
【关键词】浓缩中药、科学中药、水煎药、处方、剂量
Po-Yuan Kuo1Chen-Jei Tai2,3*
1Department of Traditional Chinese Medicine, Taipei Medical University Hospital, Taipei, Taiwan
2School of Medicine, Taipei Medical University Hosipital, Taipei, Taiwan
3Dr. Tai’s TCM clinic, Taipei, Taiwan
【Summary】
Under the National Health Insurance system, the prescriptions of traditional
Chinese medicine (TCM) doctors have mainly been changed from decoction forms
to concentrated preparations. This alteration in the prescription pattern of TCM
may also have significant effect on prescription dosage. The common prescription
methods of combined several formula prescriptions (叠方) of concentrated
preparations often results in prescriptions of a variety of contents and possible low
dose of a single herbs, which may not reach the minimum effective concentration.
This article aims to understand the prescribed dosage of current TCM doctors,
to clarify the differences and conversions between decoctions and concentrated
preparations, and finally to discuss the problems enered in the prescription
pattern of concentrated preparations and possible solutions.
Our study found that most commonly used concentrated preparations were
powder like preparations. The concentrated formulas are based on the “Official
Standard Formula”, and the dosage of the ingredients in the concentrated
preparations are mostly lesser than the dosage generally used in decoctions.
However, there is no obvious pro and cons in the extraction efficiency and
human absorption of the active ingredients between decoctions and concentrated
preparations. In addition, the use of combined several formula prescriptions is now
the norm for concentrated prescriptions. However, due to the limitation of daily
TCM prescription cost and insurance payments, there may be doubts that the dose
of a single herbs in a prescription may not be sufficient to achieve an effective
therapeutic concentration. Therefore, we suggest that the principle of prescription
should be based on making a definite diagnosis, establishing priority of treatment,
prescribing a prescription for the core pathogenesis, and simplifying the use of
items of TCM prescription. Thereafter the prescription can be simplified and the
dosage of each single herbs in the prescription can be streamlined to achieve
effective treatment.
 
【Keywords】Traditional Chinese medicine (TCM); concentrated preparations of
TCM; decoction of TCM; dosage; formula