肿瘤科毒性中药处方临床应用分析

目的 分析毒性中药饮片在我院肿瘤科门诊使用情况,为临床安全合理使用毒性中药饮片提供数据参考。方法 抽取2022年肿瘤科门诊含毒性中药饮片处方838张,对患者性别、年龄、临床诊断、毒性中药品种、毒性中药使用频次、超剂量频次及毒性中药联合使用等问题进行回顾性统计分析。结果 838张含毒性中药饮片处方中,共涉及22味毒性中药饮片,占医院毒性中药81.48%,50~60岁使用毒性中药饮片的处方居多（217 例,占25.89%）,且每张处方药味多集中在11-15味,临床主要用于各类肿瘤疾病、慢性胃炎、结节病等。除了土荆皮、白果、蜈蚣3种以外,其他毒性中药均存在超剂量现象。毒性中药联用≥2味处方231张,以2味联用190张最多（占比22.67%）。配伍禁忌处方78张,以炮附片与半夏配伍居多,临床用于治疗慢性萎缩性胃炎、失眠、郁病等。结论 毒性中药饮片在肿瘤科使用普遍,超剂量现象多,需警惕毒性中药超剂量使用及毒性中药联用配伍导致的潜在风险,加强药物管理,促进合理应用,保证患者用药安全。     

The way for carrying medicine and its containers (V). "Packaging material--paper"

In the Edo era, paper was useful as the most suitable packaging materials for carrying medicines. It was considered that the wrapping paper protected medicines from an imaginary gaseous medium "ki", which meant atmospheric moisture in this case. Also brand name and indications of medicines were printed on the wrapping paper for taking a medicine correctly. In the 18th century, wrapping paper for medicine was produced. It was specially processed for wrapping medicines only, and it was called "yakutaishi" in Japanese.     

Studies of various editions of "Heji Jufang" and objective of compilations of "Heji Jufang" during the Kyoho era of the Edo period

The author conducted a comparative study of the various editions of "Taiping Huimin Heji Jufang" (Pharmacopoeia of the Taiping Welfare Dispensary Bureau; in Chinese) to "Zeng-guang Taiping Huimin Heji Jufang" (Kyoho edition), which was compiled in the year Kyoho 17 (1732), by order of the Bakufu (shogunate) government for the purpose of elucidating its characteristics, and obtained the following results. 1. Heji Jufang is available in three different versions :(i) the Zokohon version, (ii) the Teitentaku version, and (iii) the Zochuhon version. The Genjo Noro edition to represent the original form of the Kyoho edition belongs in the Zokohon version. Furthermore, it closely resembles the book published by "Luling-Gulin-Shutang" (Library of the Imperial Household Agency, No. 558-28). 2. The reason for selecting the Zokohon version among the three versions is thought to be that it is divided into separate pharmacopoeias, including Daguan, Shaoxing and Baoqing, and that the inclusion of Tujing bencao yaoxing zonglun with illustrations of medical materials, Zhinan zonglum, Paozhi zonglum and other relevant information, gave the volume a great importance as a practical medical resource. 3. The purpose of the Kyoho compilation was thought to be the invigoration of the pharmaceutical industry under Shogun Tokugawa Yoshimune, while at the same time enabling regulation and control of drug manufacturing.     

波士顿矩阵理论在医院药品战略管理中的应用研究

目的:通过对比研究H1医院和H2医院的药品销售数据,供H1医院领导决策参考。方法:调查和统计H1医院和H2医院2003~2007年的药品销售总额及化学药品(包括生物制品)、中成药和中草药的销售额,应用波士顿矩阵进行相对市场占有率、市场增长率等的分析评价。结果:H1医院的化学药品、中成药业务为明星类业务;中草药业务为瘦狗类业务。结论:对H1医院的化学药品、中成药业务采取增长战略,促使其转变为金牛类业务;对中草药业务采取收缩战略,积极寻找出路,合理控制库存。     

中药饮片与中药免煎颗粒在临床的应用

目的探讨中药饮片与中药免煎颗粒的特点及临床应用情况。方法对笔者所在医院中药饮片及中药免煎颗粒销售情况进行统计分析,总结中药饮片及中药免煎颗粒在使用过程中的优缺点。结果中药饮片总体销售情况好于中药免煎颗粒,两种不同剂型药物各自具有优缺点。结论中药饮片与中药免煎颗粒具有各自特点及优势,临床使用中需根据患者病情选择合适剂型。     

影响中药煎剂质量的因素分析

目的:分析影响中药煎剂质量的因素。方法:从饮片质量、煎煮器具、煎煮技术、处方调剂等几个方面来阐述如何保证中药煎剂的质量。结果:饮片的道地性和炮制方法,煎煮器具的类型,煎煮、浸泡时间,煎煮次数,特殊药物的煎煮方法,处方调剂是否合理都会影响中药煎剂的质量。结论:有质量保证的中药饮片应是将道地中药材根据自身的性质合理净制、切制、干燥,并且用一定的方法加工炮制而成的。中药复方必须经过适当加水浸泡,用合适的煎煮工艺才能将复方中的有效成分充分煎出,且中药饮片要经过准确及时的处方调配,才能保证中药煎剂的质量。     

Causes and prevention of herb-induced aconite poisonings in Asia

The recent reports from Hong Kong, Taiwan, China and Korea were reviewed to determine the causes and prospects for prevention of herb-induced aconite poisonings. The contributory factors included overdose (use of greater than the recommended doses), faulty processing (after harvest and during decoction), use of tincture (herbal medicinal wine), use of crude aconite roots (for preparing decoction, proprietary medicines and tincture), lack of standardisation in processing of aconite roots and preparation of tincture and proprietary medicines, unsupervised use of aconite roots and contamination or mix-up with aconite roots. As tincture (herbal medicinal wine) made from aconite roots contains a much larger amount of Aconitum alkaloids, the public should be strongly discouraged from making their own and taking it by mouth. Aconite roots should only be used after post-harvest processing and proper decoction. The public should be educated on the hazards from unsupervised use and improper decoction of processed aconite roots. There should be regular publicity measures to promote awareness among the herbalists and to publicise the risk of serious cardiotoxicity if the recommended doses of processed aconite roots are exceeded. The processing of aconite roots and their proprietary preparations should be standardised. Quality control of processed aconite roots and their proprietary preparations should be strengthened. National reporting or monitoring systems can be used to identify the causes of aconite poisonings and assess the impact of preventive measures.     

2010年版《中国药典》中中药饮片不同炮制方法归类与分析

目的:为掌握中药炮制方法、规范饮片质量标准、促进临床合理用药提供依据。方法:对2010年版《中国药典》中所收载的中药饮片炮制内容进行归类与分析。结果:2010年版《中国药典》中共收载中药材591种,其中未列饮片项的中药有148种,23味中药的25个炮制品单列质量标准、附有2种及以上炮制品的中药159种;中药不同炮制方法与炮制品质量标准各有特点。结论:2010年版《中国药典》为规范全国中药饮片炮制方法与饮片质量标准提供了依据与指导,应认真参照执行。同时,中药炮制方法及饮片质量标准研究还有待进一步深入。     

Significance of the term "huku-yaku" (taking medicines)

The term "Huku or Fu" in "Huku-yaku or Fu-yao", which means taking medicines, does not mean " to wear" , but means "to obey certain rituals or duties." Therefore "Huku-yaku (Fu-yao)" means " to obey the nature of a drug." From the viewpoint of "ShenXian" thought, the term used when referring to taking medicine depends on whether the purpose is to cure diseases or strengthen pneuma. The term "Huku (Fu)" is adopted for the latter. When the purpose is to strengthen pneuma, the drug does not only effect the inner body, but also works on the external world. Hence the "ShenXian" thought aims to conform to the rules of nature and obtain youth and longevity through taking medicines.     

超声波提取在中药汤剂煎煮中的应用研究

目的考察超声波提取在中药汤剂煎煮中的应用。方法对比超声波提取、煎煮法同时使用与单独煎煮对汤剂各项指标的影响。结果超声波提取、煎煮法同时使用可以使汤剂一些指标得到提高。结论超声波提取有可能在中药汤剂中进行推广应用。     

对EMA草药质量标准指南（第3修订版草案）的思考

草药及其产品的质量标准具有区别于化学药品或生物制品的特殊性，因此欧洲药品管理局（EMA）于2018年发布了“质量标准指南：草药物质、草药制剂和草药产品或传统草药产品的检验程序和可接受标准（第3修订版草案）”。EMA的草药及其产品的情况与我国中药有相似之处，从起始物料到成品多为活性成分未知的复杂混合物。目前我国尚未制定关于中药或中药材（饮片）质量标准相关指导原则。介绍该指南文件的主要内容，并结合中药质量监管情况进行分析，以期EMA相关质量标准制定的指导思路为制定中药质量标准提供参考。     

Perspective of chemical fingerprinting of Chinese herbs

The holistic system of traditional Chinese medicine (TCM) is an integrity of the ingredients contained in the Chinese herbal medicines, which creates a challenge in establishing quality control standards for raw materials and the standardization of finished herbal drugs because no single component is contributing to the total efficacy. Chromatographic fingerprinting analysis represents a rational approach for the quality assessment of TCM. It utilizes chromatographic techniques, which include CE, GC, HPLC, HPTLC, etc., to construct specific patterns for recognition of multiple compounds in TCMs. Thus, chromatographic fingerprinting analysis of herbal medicines represents a comprehensive qualitative approach for the purpose of species authentication, evaluation of quality, and ensuring the consistency and stability of herbal drugs and their related products. The pragmatic comprehensive chromatographic fingerprinting analysis can disclose the detectable ingredients composition and concentration distribution under quantifiable operational conditions and therefore provide real-time quality information. It may leave a "gray" entity at the primary stage. However, consecutive study will deepen the knowledge and reduce its "gray scale", increase the transparency gradually, thereby strengthening its quality assessment potency.     

Use of herbal medicines by patients receiving warfarin.

BACKGROUND: Patients receiving warfarin therapy are discouraged from taking herbal medicines. Whether patients adhere to this advice and, if they do not, the types of products they use, are not known. OBJECTIVE: The objective of this observational study was to estimate the magnitude of use of herbal medicines among Chinese patients attending the Warfarin Clinic of the Prince of Wales Hospital in Hong Kong. METHODS: A medical officer interviewed all patients who attended the Warfarin Clinic during May 2001. Patients were asked about the use of herbal medicines in the preceding week. Demographic data, indication and duration of warfarin therapy, and International Normalised Ratio (INR) value at the time of the visit were also noted. RESULTS: Of 107 patients interviewed, 28 (26%) claimed to have taken herbal medicines during the week prior to the clinic visit. The users of herbal medicines had lower INR values than non-users (mean INR value 2.41 +/- 0.65 vs 2.75 +/- 0.65, p = 0.019), possibly because of a lower warfarin dosage (mean dosage 2.93 mg/day +/- 1.23 vs 3.34 mg/day +/- 1.45; p = 0.185) and because a smaller proportion of such patients had heart valve replacement (21% vs 39%, p = 0.141). 'Herbal soup' (soup made at home from vegetables, meat and certain herbs for consumption with the main meals) and 'cool tea' (herbal decoction for the treatment of 'endogenous heat') were the most popular and were taken by 12 (11%) and 11 (10%) patients, respectively. Four patients took proprietary medicines each containing between one and three different herbs that could potentially enhance or antagonise the effects of warfarin. None of the patients in this study showed any evidence of thromboembolism or bleeding on the day of clinic visit. CONCLUSION: Among Chinese patients treated with warfarin at a Hong Kong clinic, the use of herbal medicines was relatively common. Healthcare professionals play an important role in educating the patients and updating the list of herbal medicines that should be avoided by patients taking warfarin.     

儿科毒性中药饮片门诊处方临床应用回顾性分析

目的 分析毒性中药饮片在儿童专科医院的使用情况及分布特点,为临床安全合理使用毒性中药饮片提供数据参考。方法 根据相关法定文件,收集整理2019—2021年首都医科大学附属北京儿童医院门诊患儿含毒性中药饮片处方数据,对患儿性别、年龄、临床诊断和毒性中药使用频率、使用剂量、超药典剂量使用频率等进行回顾性统计分析。结果 66 294张门诊中药饮片处方中,涉及11味毒性中药饮片,处方18 680张,占比28.18%。据年龄组统计,学龄前期和学龄期患儿使用毒性中药饮片情况最多,男性患儿多于女性患儿。口服含毒性中药饮片处方数多于外用。使用频数前5位的毒性中药饮片分别为炒苦杏仁、盐蒺藜、炒苍耳子、川楝子和全蝎。9味毒性中药饮片存在不同程度的超剂量使用情况,制吴茱萸处方超剂量问题最突出。毒性中药饮片条目数22 309条,单张处方大多使用1味毒性中药饮片,毒性中药饮片联用≥2味的共3 913条。结论 儿科临床应用毒性饮片比较广泛,使用毒性中药饮片基本合理。但需警惕毒性中药连续使用、超药典剂量使用以及毒性中药联用的潜在风险。