小柴胡湯合方在台灣地區中醫臨床處方模式之研究

Coprescription Pattern of Xiao-Chai-Hu- Tang and Traditional Chinese Medicine Formulae in Taiwan: A Nationwide Population-Based Study

前言：方劑的合併使用一直是臨床上極大的學問，受限於全民健康保險只給付固定處方的濃縮中藥粉，方劑配伍有著只能加味不能減藥的限制，造就台灣中醫獨特的處方模式。在這樣的處方體系中，了解合用方劑的處方比例與使用狀態非常重要。特別是傷寒論中的小柴胡湯，由於使用時間長、病機症狀複雜，因此有許多合併其他方劑的配伍方法。然而，目前仍沒有嚴謹的研究來探討台灣中醫師使用小柴胡湯合方的情形。方法：本研究採用橫斷式分析法，分析臺灣1997-2012共16年的全民健康保險資料庫，由全國的中醫師處方資料中找出小柴胡湯及其合併方，除了找出最常用的合併處方外，也分析常用合方之使用頻率、每次開立的平均天數、劑量，以及與小柴胡湯相對劑量關係。結果：本研究發現小柴胡湯合方在台灣非常常見，在所有小柴胡湯處方中僅有1.2%使用小柴胡湯單方，過去典籍中時常提到的柴胡桂枝湯（13.9%）、大柴胡湯（10.9%）、柴陷湯（7.7%）、柴平煎（1.5%）、柴苓湯（1.1%）仍是主要的合併模式，但也逐漸發展出併用川芎茶調散、香砂六君子湯、麻杏甘石湯、辛夷清肺湯、麥門冬湯等新處方模式；相反的中國大陸常使用的當歸芍藥散、四物散等配伍在台灣卻仍未大量使用。結論：台灣中醫除了廣泛利用過去的典籍知識外，也逐漸發展出獨特的配伍方式。

The combined use of prescription has been a great clinical challenge in Traditional Chinese Medicine clinical practice; practitioners is limited to a given order only prescribe concentrated herb powder by National Health Insurance in Taiwan. Such situation led to a different traditional Chinese medicine prescribing patterns in Taiwan. In the prescription system, realizing the combined proportion and dosage of medications becomes imperative. Xiao-Chai-Hu-Tang was combined use with a lot of formulae. This study used a cross-sectional analysis to explore the total of 16 years prescription data of health care database in Taiwan, and we aim to find the most popular merging parties, an average number of days each time, dose, and dose relationship with the Xiao-Chai-Hu-Tang. The study found that Xiao-Chai-Hu-Tang combined use is very common in Taiwan, only 1.2% prescription using only Xiao-Chai-Hu-Tang, and chai Hu-Gui- Zhi-Tang（13.9%）, Da-Chai-Hu-Tang（10.9%）, Chai-Xian-Tang（7.7%）, chai-ping-tang（1.5%）, Chai-Ling-Tang（1.1%）were the main way of merger applications. However, the new combination pattern including Chuan-Xiong-Cha- Tiao-San, Xiang-Sha-Liu-Jun-Zi-Tang, Ma-Xing-Gan-Shi-Tang, Xin-Yi-Qing-Fei- Tang, and Mai-Men-Dong-Tang also seemed. Our research shows that the Chinese Medicine Doctor in Taiwan not only use the traditional prescriptions methods but also actively develop new recipes.