某院《中华人民共和国药典》未收载中药饮片的处方点评要点及实践

Key points and practice of prescription evaluation on Chinese herbal pieces not included in Chinese pharmacopoeia

目的探讨中国中医科学院望京医院《中华人民共和国药典》未收载中药饮片品种的处方点评要点,并进行实践。方法收集中国中医科学院望京医院中药饮片检验报告书,删选检验依据不是《中华人民共和国药典》的品种,结合2020版《中华人民共和国药典》一部,制订《中华人民共和国药典》未收载中药饮片目录。根据2008年版、2023版《北京市中药饮片炮制规范》、《中华人民共和国药典临床用药须知中药饮片卷2020版》、《北京市中药饮片调剂规程2011年版》,整理《中华人民共和国药典》未收载中药饮片品种的用法用量、是否有毒性、特殊煎煮方法、用药禁忌、注意事项等,制订《中华人民共和国药典》未收载中药饮片的处方点评要点,为处方点评提供依据。每月抽取一周的中药饮片处方,抽取并点评中国中医科学院望京医院2023年的中药饮片处方。结果中国中医科学院望京医院共有42种是《中华人民共和国药典》未收载中药品种,占总品种数的8.3%。制订了42种《中华人民共和国药典》未收载中药品种饮片的处方点评要点。共点评2023年中药饮片32853张处方,铁线透骨草、海桐皮、白花蛇舌草、茯神、煅龙骨、焦神曲、龙骨、浮小麦使用频次较高,主要存在问题为部分品种超量较多,可达常用剂量上限的3~12倍,特殊煎服方法如先煎、冲服、包煎等不合理。结论制订《中华人民共和国药典》未收载中药饮片品种的中药处方点评要点,对于规范医师处方、药师审方、调剂具有一定的指导作用,对于保障临床用药的安全、合理、有效具有重要意义。

Objective To explore and practice the key points of prescription evaluation on the varieties of Chinese herbal pieces not included in the Chinese Pharmacopoeia.Methods The inspection report of Chinese herbal pieces of Wangjing Hospital of China Academy of Chinese Medical Sciences was collected,and deleted the variety is not based on Chinese Pharmacopoeia.Combined with the 2020 edition of Chinese Pharmacopoeia,a catalogue of Chinese herbal pieces not included in Chinese Pharmacopoeia was formulated.According to the 2008 and 2023 edition’Beijing Chinese Herbal Pieces Processing Specification,2020 Edition’Chinese Pharmacopoeia Clinical Medication Instructions Chinese Herbal Medicine Volume,and Beijing Chinese Medicine Decoction Pieces Dispensing Regulations 2011 Edition,the usage and dosage,whether or not toxicity,special decoction methods,contraindications and precautions of Chinese herbal pieces not included in the Chinese pharmacopoeia were sorted out,and to formulate the key points for prescription comments of Chinese herbal pieces not included in Chinese pharmacopoeia,so as to provide a basis for prescription comments.The prescription of Chinese herbal pieces was extracted for one week every month,and the prescription of Chinese herbal pieces from Wangjing Hospital of China Academy of Chinese Medical Sciences in 2023 was extracted and reviewed.Results There were 42 kinds of Chinese herbal pieces not included in Chinese pharmacopoeia in a hospital,accounting for 8.3%of the total varieties.Formulation of 42 kinds of prescription evaluation points of Chinese herbal pieces not included in Chinese pharmacopoeia.A total of 32853 pres-criptions of Chinese herbal pieces in 2023 were reviewed.The use frequency of Herba Clematidis Intricatae,Cortex Zanthoxyli,Herba Hedyottds Difflsae,Poria Cum Radix Pini,Os Draconis Ustum,Massa Medicata Fermentata,Os Draconis,and Fructus Tritici Levis were higher.The main problems were that some varieties were overdosed,which could reach 3-12 times of the upper limit of the commonly used dose,and special decoction methods such as first decoction,chongfu,baojian were unreasonable.Conclusion It is significance to formulate the key points of prescription review for the varieties of Chinese herbal pieces not included in Chinese pharmacopoeia,which has a certain guiding function for standardizing doctors’prescriptions,pharmacists’prescription audit,and dispensing.It has great significance to ensure the safety,rationality,and effectiveness of clinical medication.