桂枝湯合方在台灣地區中醫臨床處方模式之研究

背景：中醫師臨床遇到的病況總是變化多端，完全符合某個特定方劑的情形實屬罕見，因此中醫衍生出了另一種開方模式－「合方」。將兩種作用不同的方劑合併使用，以擴大疾病的使用範圍，讓更好的貼近患者需求。桂枝湯在臨床上的應用層面很廣，從創立初期記載於傷寒論中的外感風寒，到內傷雜病以及婦兒科疾患，也發展出了許多合方的模式，但目前並沒有實證研究探討桂枝湯的合方在臨床使用的實際情形，本研究希望以數據探勘的方式，協助進一步了解台灣中醫師對桂枝湯的合方方法。方法：本研究採用橫斷式的研究方法，蒐集1997-2012年申報予台灣全民健康保險局的處方，透過分析衛生福利部釋出之百萬病患歸人醫療資訊檔，篩選出包含桂枝湯的處方及合併於同一次治療中的中醫複方，並分析常用合方之種類、頻率、使用天數、劑量，以及與桂枝湯相對之劑量關係。結果：本研究共納入482,564筆桂枝湯合方的處方，桂枝湯與經方併用以小柴胡湯的頻率最高，達到21萬次之多，其次則為麻黃湯（10851次）、小青龍湯（7592次）、麻杏甘石湯（6399次）等太陽病篇之解表方劑為主；與時方合用時，以解表且專走鼻系的辛夷散（10943次）及蒼耳散（10039次）最多，其次為同屬解表藥之辛夷清肺湯（7699次）與解表固衛之玉屏風散（9063次）。經方與桂枝湯和用時，平均處方的劑量與天數均較為分散；相比之下，時方與桂枝湯合用之處方種類多樣，並沒有出現單一處方占據極大比例之情形，平均處方天數則明顯的集中於6-7天，平均日劑量亦集中於7-10克。結論：台灣中醫師處方桂枝湯時大量使用合方技巧，除了過去典籍所記載合併使用小柴胡湯、麻黃湯、越婢湯以外，更發展了許多合併時方或內科雜病方劑的模式，方劑之配合比例也有所不同，顯示出台灣中醫在數十年的發展中，已逐漸開發出本土的用藥特色與配伍知識。

關鍵字

桂枝湯；合方；方劑配伍；健保資料庫；小柴胡湯

並列摘要

Introduction: ＂Formulae Coprescription＂ is a prescription mode for physicians that combines two different formulae to expand the range of indications and increase the effectiveness of the treatment. Guizhi Tang has a wide range of indications, including infectious diseases, respiratory system diseases, gastrointestinal system diseases, and obstetrics and gynecology diseases. At present, there is no research on the formulae coprescription of Guizhi Decoction. We will analyze Taiwan's traditional Chinese medicine practitioners' use of the formulae coprescription method of Guizhi Tang by using the National Health Insurance database. Methods: This study used a cross-sectional research method to collect medical information of one million people from 1997 to 2012. We screened out the prescription of Guizhi Tang and the accompanying herbal formulae. We analyzed the type, frequency, days of use, dosage, and dose ratio of the main formulae coprescription related to Guizhi Tang. Results: We included a total of 482,564 pen formulae coprescriptions in the study. The traditional prescription has the highest frequency of Xiaochaihu Decoction (more than 210,000 times), followed by Mahuang Decoction (10851 times), Xiaoqinglong Decoction (7592 times), and Maxing Ganshi Decoction (6399 times); the modern prescription is Xinyi San (10943 times) and Canger San (10039 times), followed by Xinyi Qingfei Decoction (7699 times) and Yupingfeng San (9063 times). The main indication of most current prescriptions is respiratory disease. The average of prescription days is concentrated in 6-7 days, and the average daily dose is focused on 7-10 grams. Conclusion: Taiwanese Chinese medicine practitioners used a formulae coprescription when formulating Guizhi Tang, and developed many new prescription models. Besides, the relative dose ratio of the prescription is also different from before. This study shows that Taiwanese Chinese medicine has developed a unique prescription model.