濃縮中藥（科學中藥）處方劑量探討

在健保制度下中醫師的處方由水煎藥轉變以濃縮中藥為主，此一劑型的轉變使得中醫的處方模式有大幅的改變。而水煎藥與濃縮中藥間劑量的轉換與療效的差異等問題，至今仍未有詳細的研究分析闡明。而濃縮中藥常見的疊方（合方）的模式，常形成藥味繁多、單一藥物劑量低的處方，治療的劑量是否達到有效劑量／治療閾值則值得探討。本文旨在了解健保制度下中藥使用，並釐清傳統水煎劑與現代濃縮中藥之間的差異與轉換問題，最後分析濃縮中藥的處方模式所遇到的問題及可能的解決方法。結果發現健保給付的中藥品項以濃縮散、濃縮粉、濃縮顆粒、濃縮細粒等劑型較常使用，而現在濃縮中藥複方的原飲片用量以衛福部公告的「基準方」劑量為準則。「基準方」所使用的飲片用量多數相較於水煎劑小，但在有效成分的萃取與吸收上和水煎劑相比並無明顯優劣。此外，疊方的使用已是現今濃縮中藥處方的常態，然而在每日藥費的限制下，可能產生單一藥物的劑量不足而無法達到有效治療濃度的疑慮。故處方上可在明確的診斷基礎上，確立治療的主次先後、針對核心病機開立處方並簡化藥物的使用，使處方能夠精簡及提高處方中藥物的劑量以達到有效的治療。

關鍵字

濃縮中藥；科學中藥；水煎藥；處方；劑量

並列摘要

Under the National Health Insurance system, the prescriptions of traditional Chinese medicine (TCM) doctors have mainly been changed from decoction forms to concentrated preparations. This alteration in the prescription pattern of TCM may also have significant effect on prescription dosage. The common prescription methods of combined several formula prescriptions (疊方) of concentrated preparations often results in prescriptions of a variety of contents and possible low dose of a single herbs, which may not reach the minimum effective concentration. This article aims to understand the prescribed dosage of current TCM doctors, to clarify the differences and conversions between decoctions and concentrated preparations, and finally to discuss the problems encountered in the prescription pattern of concentrated preparations and possible solutions. Our study found that most commonly used concentrated preparations were powder like preparations. The concentrated formulas are based on the "Official Standard Formula", and the dosage of the ingredients in the concentrated preparations are mostly lesser than the dosage generally used in decoctions. However, there is no obvious pro and cons in the extraction efficiency and human absorption of the active ingredients between decoctions and concentrated preparations. In addition, the use of combined several formula prescriptions is now the norm for concentrated prescriptions. However, due to the limitation of daily TCM prescription cost and insurance payments, there may be doubts that the dose of a single herbs in a prescription may not be sufficient to achieve an effective therapeutic concentration. Therefore, we suggest that the principle of prescription should be based on making a definite diagnosis, establishing priority of treatment, prescribing a prescription for the core pathogenesis, and simplifying the use of items of TCM prescription. Thereafter the prescription can be simplified and the dosage of each single herbs in the prescription can be streamlined to achieve effective treatment.