中醫門診肝病患者中藥製劑用藥頻率與形態分析

FREQUENCY AND PATTERN OF CHINESE MEDICINE PRESCRIPTIONS FOR CHRONIC LIVER DISEASES

本研究以2004-2007年中央健康保險局台北分局特約中醫院所申報資料分析不同國際病名[病毒性肝炎（ICD-9-070）、慢性肝病及肝硬化（ICD-9-571）、肝膿瘍及慢性肝病之後遺症（ICD-9-572）、肝之其他疾病（ICD-9-573）] 之肝病患者就診人數與次數、年齡層之分佈、處方用藥頻率與型態及開立單一處方之單味藥及複方數，以了解中醫治療肝病現況為主要目的。結果發現2004-2007年中央健康保險局台北分局特約中醫院所申報資料，總共收集54,418人，242,193件。肝病患者就診人數與就診次數均以慢性肝病及肝硬化為最多，年齡層分佈男性或女性均分布於20歲至59歲之間，男性就醫人數較女性為多，約為女性的1.8倍。依不同國際病名分別統計其用藥排行發現，用於治療病毒性肝炎前五名方劑分別為加味逍遙散、小柴胡湯、柴胡疏肝湯、茵陳五苓散、龍膽瀉肝湯；用於治療慢性肝病及肝硬化前五名方劑分別為加味逍遙散、龍膽瀉肝湯、小柴胡湯、柴胡疏肝散、茵陳五苓散；用於治療肝膿瘍及慢性肝病之後遺症前五名方劑分別為加味逍遙散、小柴胡湯、濟生腎氣丸、葛根湯、杞菊地黃丸；用於治療肝之其他疾病前五名方劑分別為加味逍遙散、柴胡疏肝湯、小柴胡湯、龍膽瀉肝湯、柴胡疏肝湯。用於治療ICD-9-070、ICD-9-571、ICD-9-573單味藥前一、二名分別為丹參及茵陳蒿，用於治療ICD-9-572前一、二名單味藥分別為大黃及夜交藤，其原因主要是針對其後遺症的治療為主，而對肝病的治療為次。中醫治療肝病所用單方品項數以三至七個品項佔最多，複方品項數以一至三方佔最多，而在不分單、複方時，其處方之總藥味品項數以三至七個品項數最為普遍，其平均約為五個藥味品項數。本研究結果顯示中醫治療不同國際病名肝病之臨床用藥型態，臨床中醫治則及方劑使用頻率不盡相同，本研究結果值得臨床中醫用藥參考。這些方劑及單味藥治療慢性肝病的效果仍有待進一步研究及臨床試驗。Traditional Chinese medicine (TCM) has been commonly used in treating liver diseases in Asian countries. To conduct a large-scale pharmacoepidemiological study and evaluate the frequency and pattern of TCM prescriptions in treating chronic liver diseases, we obtained the database of traditional Chinese medicine outpatient (including ICD-9-070, ICD-9-571, ICD-9-572, ICD-9-573) claims from the national health insurance in Taipei for the whole 2004-2007. Patients with chronic liver diseases 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 chronic liver diseases. Among the 54,418 subjects treated by TCM for chronic liver diseases, the peak age was in the range of 20 -59 yrs. Male/female ratio was 1.8:1. The first five ranks of TCM prescriptions for treating ICD-9-070 disease were Jia-Wei- Xia-Yao-San (JWXYS), Xiao-Chai-Hu-Tang (XCHT), Chai-Hu-Su-Gan-San (CHSGS), Yin-Chen-Wu- Ling-San (YCWLS), Long-Dan-Xie-Gan-Tang (LDXGT). The first five ranks of TCM prescriptions for treating ICD-9-571 disease are JWXYS, LDXGT, XCHT, CHSGS, YCWLS. The first five ranks of TCM prescriptions for treating ICD-9-572 were JWXYS, XCHT, Ji-sheng-shen-qi-wan, Ge-gentang, Qi-ju-di-huang-wan. The first five ranks of TCM prescriptions for treating ICD-9-573 disease were JWXYS, CHSGS, XCHT, LDXGT, CHSGS. JWXYS was commonly used in the ICD-9-070, ICD-9-571, ICD-9-573, ICD-9-572 diseases. Salvia miltiorrhiza and Artemisia capillaries were the first two single herbs used for treating ICD-9-070, ICD-9-571, ICD-9-573 diseases. Rheum officinale and Polygonum multiflorum were the first two single herbs used for treating ICD-9-572 disease, because they were used to treat the sequela. The number of TCMs and formule in a prescription that Traditional physicians wrote out almost contained 3-7 TCMs and 1-3 formule, respectively. This study showed the utilization pattern of Chinese herbal drugs or prescription in treating chronic liver diseases. Further researches and clinical trials are needed to evaluate the efficacy of these Chinese herbs or its ingredients in treating chronic liver diseases.