利用健保資料庫探討常見複雜疾病之中草藥處方研究

傳統中醫學在中國累積長久以來的治療經驗，這歷史悠久的醫療方式現仍普及於分佈全球的華人社會。然而中醫的傳統診斷學上以「辯證」呈現結果，這樣的證候診斷術語對於非中醫專業人士則難以瞭解且無標準化締訂。為了幫助中醫學與西醫學兩者間之溝通，我們應用中央健康保險局數據資料，分析當中一整年中所有的中醫健保給付項目，每一項目包括：(1)病人被診斷疾病之國際疾病分類代碼、(2)該診斷疾病所對應之政府批准的中藥處方，包括305複方和435單方。本研究著重於中醫門診資料庫中之四種診斷疾病：腫瘤、第二型糖尿病、失智症及帕金森氏症。利用非教導型階層分群法分析結果發現，中醫處方將疾病分為三種不同的集群。此外，在腫瘤疾病之中，良性腫瘤的中醫處方則有別於惡性腫瘤。我們並對個別疾病依照中藥複方21大類和中草藥單方之四性及五味加以鑑別並分類集群，發現：除了補養之劑外，中醫對惡性腫瘤的處方也施予清熱瀉火之劑；糖尿病(神經退化疾病)以補養與潤燥(安神)的中藥複方為主。我們發現中醫處方中，單方四性及五味則會輔助補充複方的功能。中藥配方對於疾病有特異性，且複方與單方之間有互補性，從規律的發現可做為中醫學研究的第一步，亦希望能促進中醫藥學處方更加邁向全球化。

關鍵字

健保資料庫；中草藥； ICD-9 ；失智症；糖尿病；腫瘤

並列摘要

Traditional Chinese medicine (TCM), as a modality of therapy, has a long history of practice in ancient China and now still receives popularity in some Chinese communities worldwide. The result of TCM diagnostics has traditionally been expressed in “pattern” or syndrome in TCM. The terminology of TCM syndromes is not understandable to non-TCM personnel, nor is it well standardized. In an attempt to bridge the gap between TCM and modern western medicine, we analyzed a public medical insurance database in which a reimbursement item records 1) the disease in the International Classification of Diseases code, and 2) the prescription in government approved TCM formulas including 305 formulas and 435 herbs. We focused on the TCM outpatients with one of the four diseases in the database: neoplasms, diabetes, dementias, and Parkinson’s. By the method of unsupervised hierarchical clustering, we found that the TCM prescriptions to the three diseases separate into distinct groups. Moreover, among the neoplastic diseases, TCM prescriptions for benign neoplasms are different from those for malignant neoplasms. We identified and clustered the classes of TCM formulas and natures/flavors of TCM medicinals for individual diseases. For example, in addition to tonic, fire-quenching TCM formulas were prescribed to malignant neoplasms. The diabetic (neurodegenerative) were mainly treated with tonic and moisturizing (tranquilizing) TCM formulas. We found that medicinal natures/flavors complement formula’s classes, from prescription to prescription, suggesting a synergy in TCM prescription. The disease-specificity and herbal complementarity of TCM prescription may serve as a first step toward promotion and globalization of TCM prescriptions.

並列關鍵字

neoplasms ； diabetes ； dementia ； ICD-9 ； herbs ； NHI database

參考文獻

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國際替代計量

利用健保資料庫探討常見複雜疾病之中草藥處方研究

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