Page 114 - 《中国药房》2021年第1期

Investigation and Analysis of the Dose Status of TCM Decoction Piece Prescription in 13 TCM Hospitals
CHEN Yuhuan ，LING Xiao ，LIU Shuyu ，WANG Panpan ，MA Zhihuan ，LI Xuelin（1. College of Pharmacy，
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Henan University of TCM，Zhengzhou 450046，China；2. Dept. of Pharmacy，the First Affiliated Hospital of
Henan University of TCM/Henan Province Engineering Laboratory for Clinical Evaluation Technology of
Chinese Medicine，Zhengzhou 450000，China）
ABSTRACT OBJECTIVE：To provide reference for rational use of TCM decoction piece. METHODS：Electronic questionnaire
survey was conducted on the use（dose，ingredient number）of TCM decoction piece prescriptions in 12 TCM hospitals from 10
provinces（regions，cities）. Through the hospital information system，416 100 outpatient prescriptions of TCM decoction piece
were collected from the First Affiliated Hospital of Henan University of TCM（our hospital）during May 2016 to Apr. 2019，and
were analyzed in terms of prescription dose，the number of ingredients and use of TCM decoction pieces. At the same time，the use
of TCM decoction piece prescription were analyzed in different departments，and the clinical application status of TCM decoction
pieces prescription were investigated and relevant suggestions were put forward. RESULTS：The average dose of TCM decoction
piece prescriptions in 12 hospitals were 129.60-245.00 g，and the average number of ingredients were 11.90-18.25；the average
dose of TCM decoction piece prescriptions in pediatric department was lower than other departments. The average dose of TCM
decoction piece prescriptions in our hospital was 242.21 g；55.75％ of the prescription dose were distributed in 201-300 g，and
15.22％ were over 300 g. The average number of ingredients in prescriptions was about 15，and the prescriptions with 11-20
ingredients accounted for 87.75％，those with more than 20 ingredients accounted for 6.64％. Top 20 TCM decoction pieces in
TCM prescriptions of our hospital had different degrees of overdose. Three decoction pieces with the highest frequency of overdose
were Radix Curcumae processed by vinegar （85.51％），Atractylodes macrocephala stir-fried with bran （82.10％） and A.
macrocephala（79.13％）. The number of TCM decoction piece prescriptions in internal medicine department accounted for 40.84％
in our hospital；there were a lot of TCM prescriptions with dose exceeding 300 g（11.98％ and 18.69％）and the number of
ingredients exceeding 18（14.60％ and 9.53％）in internal medicine department and surgery department. The proportion of pediatric
TCM decoction piece prescriptions with more than 18 ingredients accounted for 24.09％. CONCLUSIONS：The overall dosage of
TCM decoction piece prescriptions is relatively high，the number of ingredients is too much，and the overdose of single-flavored
TCM decoction piece is common. Internal medicine department and surgery department should focus on controlling the number of
and the dosage of single-flavored decoction pieces of TCM prescriptions to standardize the prescribed dosage. Gynecology
department needs to focus on controlling the dosage of single-flavored TCM pieces and pediatrics department should pay special
attention to the use of prescription ingredients，so as to ensure a more scientific and reasonable standard for the clinical application
of TCM decoction piece.
KEYWORDS TCM decoction piece prescriptions；Dosage；Ingredient number；Standard

对于中药的临床使用而言，药物剂量选择非常重 算），药味数范围分布在 2～16 味，平均药味数为 6.88
[6]
要，既要发挥药效，又要避免发生不良反应，同时还要控 味 。近年来，随着中药饮片处方中药味数增多或饮片
[1]
制药费 。临床对中药剂量的认识多在于单味中药饮片 用量加大，处方总量也不断增大，持续出现药味数多、单
[7]
剂量的特点和规律，而由中药饮片组成的复方才是中医 剂处方剂量过大的临床“大处方”现象 。各专家共识、
临床应用的主要形式。《中药饮片临床应用专家共识（第 指导原则针对临床实际情况，对中药饮片处方的剂量和
一版）》明确指出中药剂量包括单味中药饮片剂量和中 药味数的最高极限值给予限定，提出单剂处方剂量一般
药饮片处方剂量，且表明中药饮片处方剂量对于中医临 应控制在 240 g 以内，原则上不能超过 300 g，每张中药
[2]
床更具有指导意义 。相对剂量是指处方的中药饮片之 饮片处方的药味数原则上应控制在18味以内 [2，8] 。但在
[3]
间的比例，重点讲究配伍关系，归属于方剂学范畴 。古 中药饮片处方审核及点评实际工作时，仍发现处方临床
今医药学家在长期实践中，累积了许多对方药剂量的认 应用剂量过大的问题较突出 [9-10] 。医院信息系统（HIS）
识，但这些观点散在于诸家论著之中，尚未形成完整的 存储了患者真实的临床诊疗数据，为发现临床用药规律
[11]
理论体系 。有研究通过汇总分析，发现古籍中汤剂处 及其问题提供了有利的平台 。本研究对全国多家中
[4]
方剂量常用范围为 0～200 g，药味数的常用范围为 6～ 医院中药饮片处方剂量临床实际应用情况进行调研分
10味 。《方剂学》共收编经典汤剂处方132张，处方剂量 析，并重点梳理我院中药饮片处方使用情况，整理目前
[5]
范围分布在18～270 g，平均处方剂量为64.54 g（其中十 中药饮片处方临床应用存在的问题，为中药饮片临床使
枣汤、清瘟败毒饮、瓜蒌薤白白酒汤3张处方剂量无法计 用提供科学、合理的参考依据。

·104 · China Pharmacy 2021 Vol. 32 No. 1 中国药房 2021年第32卷第1期