全科医生合理使用中成药的三大关键思维

Three key thoughts on rational use of Chinese patent medicine for general practitioners

中成药在基层全科处方中经常出现,全科医生掌握基本的中成药治疗特点和选用思路十分重要。本文从近年来关于中成药处方点评和合理用药的专家共识入手,梳理中成药合理用药的三大关键点。一是中成药作为成方制剂,临床治疗有利有弊,中医药理论的整体观和辨证观、数千年传承的经典名方是其优势;固定配方带来的药不对证风险、药品本身的不确定性风险是其不足。二是中成药品种多样且繁复,宜分类管理分类认识,例如口服-外用-静脉注射的分类法、含毒性饮片中成药-不含毒性饮片中成药分类法、基于功效亚类的分类法等。三是借鉴“抓主症”思维,采用关键提示性症状进行简明辨“症”选药,可以帮助全科医生最大限度地合理选药。此外,全科医生应进一步加强自身学习,掌握基本的中成药合理用药常识。本文为全科医生用好、用对中成药提供了新思路。

It is very important for general practitioners to master the basic characteristics and selection ideas of Chinese patent medicine.This paper sorted out three key points of rational use of Chinese patent medicines based on recent years′ working experience of the community prescription review group of health commission.First,as a prescription preparation,Chinese patent medicines have both advantages and disadvantages in clinical treatment,among which the holistic view and dialectical view of TCM theory,as well as the classic prescriptions inherited for thousands of years,are its advantages.The disadvantages of the fixed formulation are the risk of drug mis-identification and the uncertainty risk of the drug itself.Secondly,there are various and complex varieties of Chinese patent medicines,which should be classified and managed,such as the classification method of oral administration-external application-intravenous injection,the classification method of Chinese patent medicines containing toxic decoction pieces-non-toxic decoction pieces,and the classification method based on efficacy subcategories.The third point is to use the thinking of "grasping the main symptom" for reference and use the key suggestive symptoms to make a concise distinction of the "symptom" and select the medicine,which can help the general practitioners and western doctors to select the medicine as reasonably as possible.In addition,general practitioners should further strengthen their own learning to master the basic knowledge of rational use of Chinese patent medicines.This paper provided a new idea for general practitioners to use Chinese patent medicine well.