市售臺灣、中國、日本製胃散之配伍分析

Combination analysis for commercially traditional Chinese Gastrointestinal medication from Taiwan, China and Japan

「胃痛」在臺灣是常見疾病，由於生活作息不規律、工作環境壓力、飲食型態不正常，導致胃痛、胃酸上泛、胃食道逆流等多樣化上腹部不適症狀，由於年齡層分布廣泛且盛行率大，在市售成藥的龐大市場中，「中藥胃散」種類與選擇性相對較多。然而藥物配方與成分各不相同，也不確定是否適合臺灣民眾，因此本研究選擇市售中藥胃散進行藥物統計，透過不同分析來了解胃散的適應證與相關療效機轉，並分析不同國別的胃散有無地區差異。本研究搜集實體店面與網路購物平台所販售臺灣、中國、日本地區胃散，進行藥物組成以及佔重比例進行分析與統計，並使用中、英文資料庫輸入關鍵字進行更廣泛之實證文獻搜尋。統計結果發現，一共有34家市售中藥胃散納入分析研究，臺灣製品以理氣和中、化痰健胃為主，結構類似二陳湯、平胃散加減，常用半夏、茯苓、陳皮、甘草、薄荷、砂仁、丁香、廣木香、蒼朮、枳殼、藿香等藥；中國製品以健脾補氣、行氣和中為主，結構類似香砂六君子湯，常用白朮、黨參、茯苓、陳皮、半夏、甘草、廣木香、砂仁、香附、厚朴等藥；日本製品以順氣安中、散寒止痛為主，結構類似安中散，常用桂皮、延胡索、牡蠣、小茴香、砂仁、甘草、高良薑、丁香、生薑、龍膽、薄荷。三地區共同用藥為甘草；臺灣、中國共同用藥為陳皮、廣木香、茯苓；臺灣與日本共同用藥為薄荷、丁香。三個國家的中藥胃散成分各異，也顯然與飲食文化相關。中醫理論中，胃痛證型常見為寒邪犯胃、胃火上炎、飲食所傷、脾胃虛弱、肝胃鬱熱、濕熱中阻等，需要分證論治，然而市售胃散多為行氣化濕、補益脾胃、散寒止痛等。雖然在地域性飲食、文化影響下產生相對應的偏好選擇，但在缺乏辨證論治的原則下，一般民眾較難依照自身需求選擇正確胃散，而市售胃散也需要更嚴謹的臨床試驗來證實療效，確保民眾健康。

Epigastric pain is a common symptom in Taiwan, precipitated by irregular life style, improper dietary habit, and increasing environmental stress in modern society. The typical symptoms include abdominal discomfort, gastric acid regurgitation, and the onset age ranges widely from young to old. Therefore, numerous commercial gastrointestinal medication“Wei san”composed of traditional Chinese medicine (TCM) powder are available easily on the market. However, the regimens and ingredients of these gastrointestinal medication vary from each other, the patients may choose inappropriate products for their individual symptoms. To address this issue, we composed a study to systemically analyze the ingredients of commercially available traditional Chinese gastrointestinal medication to investigate their indication and pharmaceutical mechanism. We collected data from pharmacy and online shopping platform, analyzed the composition and weight proportion in all types of products. Moreover, we also used various key words to query Chinese and western database for extensive and evidenced-based searching guide. A total of 34 products included in our study, and most of them are made from Taiwan, China, and Japan. Taiwan-made products are similar to Er Chen decoction and modified Ping Wei San, and their therapeutic effects are to regulate qi of spleen and stomach, as well as dry dampness to resolve phlegm. The common herbal medicine are Pinellia ternate, Wolfiporia extensa, Citrus reticulata Blanco, Glycyrrhiza uralensis, Mentha haplocaly Brio, Amomum villosum, Eugenia caryophyllata Thunb, Saussurea costus, Atractylodes lancea, Poncirus trifoliata, and Agastache rugosa. Products from China are similar to Xiang Sha Liu Jun Zi Tang which provide therapeutic effects to fortify the spleen and stomach, and their common compositions are Atractylodes macrocephala, Codonopsis pilosula, Wolfiporia extensa, Citrus reticulata Blanco, Pinellia ternate, Glycyrrhiza uralensis, Saussurea costus, Amomum villosum, Cyperus rotundus, and Magnolia officinalis. Japan-made products are similar to Antyusan, which warm the interior to dissipate cold in the stomach and spleen. Their common used herbal medicine are Cinnamomum cassia, Corydalis yanhusuo, Ostrea rivularis, Foeniculum vulgare, Amomum villosum, Glycyrrhiza uralensis, Alpinia officinarum, Eugenia caryophyllata Thunb, Zingiber officinale, Gentiana scabra, and Mentha haplocaly Brio. As a result, Glycyrrhiza uralensis are the most common prescribed herbal medicine among the products made from three countries. On the other hand, the ingredients of these products are obviously different from their original country. In view point of TCM, epigastric pain might be caused by cold, fire, improper diet, dyspepsia, qi stagnation, or phlegm stagnation. However, commercial gastrointestinal medication may not cover the above disease patterns. In conclusion, the patients may choose unsuitable products without proper pattern diagnosis made by qualified TCM physicians. More clinical trials are warranted to prove their efficacy and safety.