不同骨折部位的中藥應用──臺灣長庚醫院世代研究

Utilization of traditional Chinese medicine in different fracture sites–A cohort study of Chang Gung Memorial Hospital

研究背景與動機：不同骨折部位需要不同固定和治療。中醫學中，“引經學說＂是中藥處方的重要理論。特定藥物稱為引經藥，可作為藥引或嚮導，具有引導其他藥物功效到達病灶或經脈的效果。材料與方法：透過長庚醫院研究數據庫（CGRD），我們收集了2001年至2020年間所有骨折患者的數據。骨折患者由ICD-9-CM和ICD-10-CM診斷碼定義。結果：頭顱和頸部骨折中，前三個最常見的方劑是血府逐瘀湯、芍藥甘草湯和龜鹿二仙膠，單味藥是三七、丹參和石菖蒲。在軀幹骨折組中，前三名方劑是龜鹿二仙膠、血府逐瘀湯和正骨紫金丹，單味藥是骨碎補、延胡索和續斷。在上肢和下肢骨折組中，前三名方劑是正骨紫金丹、龜鹿二仙膠和疏經活血湯，單味藥是骨碎補、續斷和延胡索。軀幹骨折的引經藥是鬱金，上肢骨折的引經藥是桑枝，下肢骨折的引經藥是川牛膝和懷牛膝。結論：引經藥主要用於軀幹、上肢和下肢骨折。不同骨折中出現了主要方劑的作用，也使用了引經藥作為其他藥物的藥引。本研究觀察了長庚紀念醫院中醫師在治療骨折的中藥處方趨勢，可為未來的藥理學研究和臨床試驗奠定基礎。

Background: Different fracture sites need different ways to stabilize and cure. In traditional Chinese medicine (TCM), the“channel conductor theory”is an important part of prescriptions that particular drug can act as guide or conductor to lead the efficacy of other drugs to reach lesion or a certain meridian. Methods: By using Chang Gung Research Database (CGRD), we collected data from all patients who suffered from fracture between 2001 and 2020. Fracture patients were defined by ICD-9-CM and ICD-10-CM codes. Results: The top three most common prescriptions in the skull and neck fracture group were xue-fu-zhu-yu-tang, shao-yao-gan-cao-tang and gui-lu-er-xianjiao, and the single herbs were san-qi, dan-shen and shi-chang-pu. In the trunk fracture group, the top three TCM formulas were gui-lu-er-xian-jiao, xue-fu-zhu-yu-tang and zheng-gu-zi-jin-dang, and the single herbs were gu-sui-bu, yan-hu-suo and xu-duan. In the upper limb and lower limb fracture groups, the top three prescriptions were zhenggu- zi-jin-dang, gui-lu-er-xian-jiao and shu-jing-huo-xue-tang, and the single herbs were gu-sui-bu, xu-duan and yan-hu-suo. The meridian-conducting drug for trunk fractures was yu-jin (Radix Curcumae), for upper limb fractures is sang-zhi, and those for lower limb fractures were chuan-niu-xi (Radix Cyathula) and huai-niu-xi (Radix Achyranthes bidentata). Conclusion: The channel conductor drug is used mainly for trunk, upper limb and lower limb fractures. Despite the major effect of formulas appearing in the four groups, channel conductor drugs can act as a guide for other formulas or single herbs. A prescription trend of CGMH TCM doctors for clinical fracture outpatients was observed in this study, which could be the base for future pharmacological investigations and clinical trials.