中醫門診痛經患者臨床中藥方劑用藥頻率與形態分析

Frequency and pattern of clinical application of Chinese medicine prescriptions for dysmenorrhea

目的：本研究主要目的為探討中醫門診痛經患者年齡層之分佈、申報醫療費用型態、處方用藥排行、單方及複方排行前10名用藥為主要目的。材料方法：本研究資料來源以2004~2008年中央健康保險局台北分局特約中醫院所申報全資料為資料庫，以門診痛經病患資料擷取條件，依中醫院所申報ICD-9-CM主、主次診斷為6253之所有患者。結果：2004~2008年中醫門診主診斷申報痛經人數為121,410人，件數為388,043件，而平均每人就醫件數為2.3-3.2間；2004~2008年中醫門診主、次診斷為痛經患者總人數為132,411人，總件數為457,924件，而平均每人就醫件數為2.5~2.9間，平均每人就醫件數為3.5件。在不分主及主次診斷為痛經患者各年齡層分佈為16-35歲分布最多，方藥材排名前10名當中的前五名分別為延胡索、香附，益母草，丹參，五靈脂；藥材前10名藥品當中，前五名的複方分別為，加味逍遙散，當歸芍藥散，溫經湯、桂枝茯苓丸，少腹逐瘀湯；其中每張處方的用藥品項數以3~7個佔最多。在主診斷為痛經患者使用中醫前10名藥品當中，前五名的複方分別為當歸芍藥散，加味逍遙散，溫經湯，桂枝茯苓丸，少腹逐瘀湯；在主診斷為痛經患者使用中醫藥材前10名藥品，排名前五名分別為延胡索，香附，益母草，丹參，五靈脂；其中每張處方的用藥品項數以3~7個佔最多。主診斷為痛經患者持續就醫五年者追蹤佔率為21.26%。主次診斷為痛經患者持續五年者追蹤佔率為22.41%。結論：本研究提供中醫師臨床治療痛經的用藥頻率及型態，從研究中我們無法瞭解痛經的證型分類，但可從用藥的頻律及型態得知，痛經的臨床治療原則是以溫經、活血、化瘀、調養肝脾及行氣止痛為主，對於中醫師臨床用藥處方應是很好的參考價值。至於相關的方劑及藥物的作用機轉仍有待日後進一步加以闡明。

Objective: To conduct a large-scale pharmacoepidemiological study and evaluate the age distribution, frequency, pattern, top ten of TCM prescriptions in treating dysmenorrheal. Methods: we obtained the database of traditional Chinese medicine outpatient(including ICD-9-6253) claims from the national health insurance in Taipei for the whole 2004~2008. Patients with dysmenorrhea were identified by the corresponding diagnosis of International Classification of Disease among claimed visiting files. Corresponding prescription files were analyzed and association rule were applied to evaluate the co-prescription of TCM in treating dysmenorrhea. Results: Among the 121,410 subjects, 388043 formulas treated by TCM for dysmenorrhea, the peak age was in the range of 16 -35 yrs. Corydalis yuanhusuo, Cyperus rotundus, Leonurus sibiricus , Salvia miltiorrhiza, and Trogopterus xanthippes were the first five single herbs used for treating ICD-9-6253 disease. The first five ranks of TCM prescriptions for treating ICD-9-6253 disease were Dang-guishao-yao-san(DGSYS), Jia-wei-xia-yao-san(JWXYS), Wen-Jing-Tang(WJT), Gui-Zhi Fu-Ling-Wan(GZFLW)and Shao-Fu-Zhu-Yu-Tang(SFZYT). The number of TCMs and days for taking in a prescription that Traditional physicians wrote out almost contained 3-7 TCMs and 4-7 days, respectively. There were 21.26% patients who were treating for five years. Conclusion: This study showed the utilization pattern of Chinese herbal drugs or prescription in treating dysmenorrhea. The treating principle of dysmenorrhea in TCM clinic is Wen-Jing, blood-activating and stasis-resolving, Xing-qi-stop pain or renourishing liver and spleen. The present results are worthy of being considered as the reference by the Traditional physicans.