目的 观察逍遥散治疗混合性焦虑抑郁障碍肝郁脾虚证的临床疗效.方法 采用随机、对照的方法,将150例混合性焦虑抑郁患者障碍随机分为观察组和对照组,每组各75例.观察组患者服用逍遥散,对照组患者服用氟哌噻吨美利曲辛片治疗4周,随访1个月,并采用汉密顿抑郁(HAMD)量表、汉密顿焦虑(HAMA)量表和中医证候量表进行疗效评定.结果 治疗4周后,观察组患者HAMD评定总有效率为86.3％、HAMA评定总有效率为79.4％,对照组HAMD评定总有效率为77.8％、HAMA评定总有效率为72.2％,差异均无统计学意义(均P?0.05),但观察组HAMD量表的焦虑/躯体化因子得分[(3.5±1.4)分]明显低于对照组[(4.6±1.3)分](P?0.01),睡眠障碍因子得分[(2.6±1.3)分]明显低于对照组[(3.3±1.4)分](P?0.01).观察组治疗2周、4周时,中医证候改善明显,与对照组比较差异有统计学意义(P?0.01).治疗结束后1个月,对照组HAMD、HAMA及其因子分均较治疗4周时升高,差异均有统计学意义(P?0.01);但是观察组HAMD、HAMA及其因子得分与治疗4周时比较,差异无统计学意义(P?0.05).结论 逍遥散和氟哌噻吨美利曲辛片对改善混合性焦虑抑郁的症状均有明显的效果,但逍遥散对患者焦虑、躯体化及睡眠障碍等方面的改善作用和远期效果优于氟哌噻吨美利曲辛片.

中成药治疗急危重症历史悠久,临床疗效明确,具有突出的实用价值.开展急危重症中成药调剂技术规范研究既是保障临床合理用药的要求,也是推动药学服务发展的关键任务.针对目前急危重症中成药调剂研究范围窄、调剂流程不规范、调剂人才缺乏等掣肘问题,文章思考以临床药学服务为导向,提出构建急危重症常用中成药调剂九项关键技术,包括采购验收技术、库存管理技术、处方审核技术、处方调配技术、处方复核技术、发药与用药交代技术、用药监测技术、处方点评技术以及药物警戒技术.通过对急危重症中成药调剂技术体系及其规范进行构建,保证临床调剂合理高效,推动中医临床药学服务发展.

据说,端午节与蟾蜍的缘分颇深,民间有在端午节阳气最旺的时候取蟾蜍之毒的传统.又有传说,蟾蜍头上长有肉芝,有长生不老之效.为什么满身疙瘩的"丑"蟾蜍,在民间有这么多"说法"呢?可能与蟾蜍自身所带的"宝藏"有关.

Objective: This research aims to analyze the application regularity of Chinese patent medicine during the COVID-19 epidemic by collecting the names of the top three Chinese patent medicines used by 24 hospitals in 14 provinces of China in four time periods (January 20–22, February 16–18, March 01–03, April 01–03, 2020), and explore its contribution to combating the disease. Methods: 1) We built a database of the top three Chinese patent medicines used by 24 hospitals. 2) The frequency and efficacy distribution of Chinese patent medicine were analyzed with risk areas, regions, and hospitals of different properties as three factors. 3) Finally, we analyzed the differences in the use of heat-clearing and non-heat-clearing medicines among the three factors (χ2 test) and the correlation between the Chinese patent medicine and COVID-19 epidemic (correlation analysis) with SPSS 23.0 statistical software. Results: 1) The heat-clearing medicine was the main use category nationwide during January 20–22, 2020. Meanwhile, there was a significant difference in the utilization rate of heat-clearing and non-heat-clearing medicine in different risk areas (p < 0.01). 2) The variety of Chinese patent medicine was increased nationwide during February 16–18, 2020, mainly including tonics, blood-activating and resolving-stasis, and heat-clearing medicines. Meanwhile, there was a significant difference in the utilization rate of heat-clearing and non-heat-clearing medicine in the southern and northern regions (p < 0.05). 3) Tonics, and blood-activating and resolving-stasis medicines became the primary use categories nationwide during March 01–03, 2020. 4) The tonics class, and blood-activating and resolving-stasis medicine were still the primary categories nationwide during April 01–03, 2020. Meanwhile, there was a significant difference in the utilization rate of heat-clearing and non-heat-clearing medicine in different risk areas (p < 0.01). Conclusion: Chinese patent medicine has a certain degree of participation in fighting against the COVID-19. The efficacy distribution is related to the risk area, region, and hospital of different properties, among which the risk area is the main influencing factor. It is hoped that future research can further collect the application amount of Chinese patent medicine used in hospitals all over the country, so as to perfectly reflect the relationship between Chinese patent medicine and the epidemic situation.

文章对临床中药饮片处方应付过程中易出现的主要问题与常见错误进行分析和归纳,初步建立全国统一的中药饮片处方应付技术规范.以“中药饮片”“中药调剂”“处方应付”“标准化研究”等为关键词,在中国知网、万方等数据平台进行检索.参考《中药饮片处方给付规定》《中药处方与调剂技术规范》《北京市中药饮片调剂规程》《广东省中药饮片炮制规范》等行业规范及地方标准文件,比较各地区中药饮片及中药炮制品之间的区别,分析各地区中药处方应付情况.提出建立“饮片名称规范化、基原炮制规范化、处方书写规范化、操作技能规范化、系统集成规范化及药学服务规范化”6种技术规范,来解决目前处方应付存在的不规范现象,为制定《全国中药饮片处方应付技术规范》提供理论依据和参考.

Objective To explore the effect of different treatment methods on the prognosis of primary liver cancer and analyze the risk factors related to the survival of patients with liver cancer after surgery. Methods Seventy-one patients with primary liver cancer in our hospital were treated with surgical treatment, interventional chemotherapy or conservative treatment according to the condition and pa-tients' wishes. The complications and postoperative survival were observed after different treatments. Results The half-year, 1-year and 2-year survival rate of the surgical treatment group was respectively 88% (36/41), 66% (27/41) and 44% (18/41). That of the interventional chemotherapy group was respectively 80% (20/25), 52% (13/25) and 8% (2/25). That of the conservative treatment group was respectively 100% (5/5), 80% (4/5) and 0% (0/5). There was significant difference in the 2-year survival rate between the three groups (P<0.05). The main complications in the three groups included hypoproteinemia and pleural effusion, but no significant differences were found in their incidences between the groups (P>0.05). Age, HBV history and drinking history were observed to have a significant effect on the 2-year survival rate (P<0.05). Conclusion The long-term survival rate of primary liver cancer patients with surgical treatment was higher than that of patients with interventional chemotherapy. Surgery combined with intraoperative chemotherapy could be considered as a more effective treatment. Age and drinking history had significant effect on postoperative survival of primary liver cancer.

As a modern dosage form drug with rapid effect, traditional Chinese medicine (TCM) injection has been more and more used in clinical practice. Meanwhile the safety of TCM injection has attracted more and more attention. The retrospective analysis on 74 cases of adverse reaction of TCM injections collected from 2007 to 2016 in the Third Affiliated Hospital of Beijing University of Chinese Medicine showed that the proportion of men and women with adverse reactions was 0.54:1; the average age was 62.5 years old; 21 kinds of TCM injections were involved. Among them, the most reported were blood-regulating agents. The top four kinds of TCM injections with highest adverse drug reactions (ADRs) were Tanreqing injection, Danhong Injection, Shuxuening Injection and Xuesaitong for injection. The top three clinical manifestations of adverse reactions were lesions of skin and its appendages, damage of circulatory system and damage of nervous system. The potential causes of the adverse reactions of TCM injections were analyzed, and it was believed that individual difference, medicine, pharmaceutical excipients, solvent and TCM syndrome differentiation may be the main five causes for the adverse reactions of TCM injections. In order to reduce the adverse reactions of TCM injections, it is suggested that the clinical pharmacists should participate in the application management of TCM injections in the hospital; the production enterprises shall strengthen the whole life cycle management of the drugs; and at the same time, the drug control and administration authorities should improve the drug management methods constantly and encourage the development of TCM injections to the high quality level.

Objective To assess the clinical effect and safety of Tanreqing injection combined with antibiotics in the treatment of hospital acquired pneumonia (HAP).Methods Randomized controlled trials of Tanreqing injection combined with antibiotics treating HAP were retrieved from Cochrane,PubMed,Embase,China National Knowledge Infrastructure,Wanfang Data and Chinese Sci-tech Periodical Full-text Database.Quality of the literatures was evaluated by the Jadad score.Statistical analysis was performed using the RevMan 5.3 software.Results Eight trials involving 566 patients were included.Results of meta analysis showed that the total effectiveness(odds ratio =3.40,95％ confidence interval:2.09-5.53,P ＜ 0.05) and defervescence time(standardized mean difference =-1.26,95％ confidence interval:-1.48 to-1.05,P ＜ 0.05) in Tanreqing injection + antibiotics group were superior to those in antibiotics-alone group.Funnel plot showed small bias in both total efficiency and defervescence time analysis.Conclusions Tanreqing combined with antibiotic treating HAP can improve the total efficiency and shorten defervescence time.

To understand the development process of Dioscoreae Rhizoma in origin,processing and clinical application by sorting out the historical origin in the development of Dioscoreae Rhizoma,and preliminarily discuss the construction of the standard system of Chinese yam (Dioscoreae Rhizoma).During the analytic process,with'Dioscoreae Rhizoma (yam)','historical origin'and'standard system'as the key words,the related literature on yam and traditional Chinese medicine (TCM) standardization was searched in CNKI,Wanfang and other databases.In addition,Compendium of Materia Medica,Miscellaneous Records of Famous Physicians,Pharmacopoeia of the People's Republic of China (2015 edition),Flora of China and other books were accessed to summarize the history of the development of yam and trace the origin,processing and clinical application of Chinese yam.According to the actual situation,the evolution of the origin of Chinese yam has experienced a process from dispersing to concentrating in Huaiqing,Henan,and the processing technology has also undergone great evolution.Now the processing and processing technology are also being innovated.In view of the wide application of yam in clinical and daily health care,but there is still no unified planting and production standard system,the construction of the standard system of yam is to be preliminarily explored based on the current needs of the development of TCM,mainly including the planting standard system,production and processing standard system,storage and maintenance standard system,product quality standards and other standards,aimed at promoting the standardization of yam construction,and accelerating the healthy development of Chinese medicine industry.

目的 评估不合理处方情况,促进临床合理用药.方法 收集2017年1～12月门诊西成药房调剂的处方及不合理处方.对处方进行分类统计,采用帕累托图分析主要原因.结果 全年处方共520950例,其中不合理处方1572例,占0.30％,成功干预1421例次,成功率90.39％.经帕累托图分析,不合理处方主要原因为开具处方未填写临床诊断或临床诊断书写不全,用法、用量不适宜,无特殊情况门诊、急诊处方药量超过7d和3d.干预失败的主要类型为对无特殊情况门诊和急诊处方药量超过7 d和3 d,用法、用量不适宜的处方.每月不合理处方百分比与干预月份呈负相关(r=-0.604,P=0.038),成功干预处方百分比与干预月份呈正相关(r=0.588,P=0.044).结论 调剂前处方干预提高了合理用药水平,保障患者的用药安全.

传统中药炮制技艺遵循古代中医药学思想,符合临床辨证论治要求,使中药饮片增效、减毒,以满足临床用药需求,意义重大.从国医大师金世元教授对于传承传统中药“少泡多润”“质坚宜薄,质松宜厚”“逢子必炒”“炒炭存性”和“以药制药”等炮制技艺的实践角度出发,分析传统炮制关于切制、炮制的意义及方法,以总结、探索金老传承传统中药炮制技艺的宝贵经验.

Objective:To understand the clinical application of folk medicine in our hospital from 2013 to 2015, summarize the commonly used folk medicines in our hospital, and analyze the rationality of their use in clinic considering the clinical characteristics of our hospital to guide the scientiifc use of folk medicine in the future.Methods:Taking deifned daily dose (DDD), DDDs (DDDs), and deifned daily cost (DDC) as the evaluation index, the use of the top 20 folk medicines in amount of money in our hospital during 2013-2015 were analyzed.Results:The top 20 folk medicines were mostly drugs for topical bone injury, encephalopathy and gastrointestinal diseases.The amount of money of the drugs remained stable for three years, and the amount of money and the number of patients synchronized well. Conclusion: Folk medicines are widely used in orthopedics,encephalopathy and spleen and stomach diseases, and their clinical application is basically reasonable.

The efficacy and safety of application of traditional Chinese medicines (TCMs) during the pregnancy is a hotspot among scholars. However, the traditional pregnancy contraindication content has certain historical limitations, and cannot meet the needs of the current pregnant women for rational drug use. We need to refine and interpret it with modern medical science. In this paper, we summarized the ancient and modern knowledge about pregnancy contradiction and tried to establish a grading safety system, based on the actual clinical practices and thte medication grading concept of western medicines. Specifically speaking, in this paper, we compared the connotations of forbidden/contradiction and cautious use, and focused on the safe herbs that included in the prescriptions for dietary therapy. Meanwhile, in this paper, we summarized the core content of the famous theories of ″You Gu Wu Yun (pregnancy disease)″ and ″Shuai Qi Da Ban Er Zhi (therapy during pregnancy)″, and studied the dangerous and unknown risk of TCMs during pregnancy. At last, a five-grade safety system of TCMs applied on the pregnant women was established, including forbidden, contraindicated, cautious, uncertain and available medicines. We classified medicines with the embryotoxicity (e.g. teratogenic, mutagenic, ageneisa), the traditional toxicity (e.g. abortion), the fierce herbal property (e.g. removing blood stasis, promoting Qi circulation) and reliable edible medicinal herbs. We also place an ″uncertain″ category based on objective reality. Meanwhile, 33 sample TCMs were preliminarily determined. This paper proposed the preference and ideas for the rational herbal use in pregnancy.

Objective:In this study, we retrospectively analyzed the hospital records of in-patients with cerebral infarction in our hospital in 2013 in order to identify the point for the clinical pharmacists to provide pharmaceutical care for patients with cerebral infarction, and initially establish the model of individual pharmaceutical care for patients with cerebral infarction in our hospital.Methods:202 patients with cerebral infarction were selected from all medical records in 2013, and the information such as admission diagnosis and drug use were collected, and the usage amounts of drugs, DDDs and DUI were calculated by EXCEL to analyze the rationality of drug use.Results: The drug use for treating cerebral infarction in our hospital mainly included anticoagulant agents, anti-platelet agents and neuro-protective agents for the purpose of the treatment of cerebral infarction, and anti-hypertensive agents, hypoglycemic agents, and lipid regulating agents for the purpose of treating complications. Observed adverse reactions were few and patients had good compliance. Conclusion: The results showed that drug use for treating cerebral infarction in our hospital was normative. Through this study, clinical pharmacists understand the current situation of the treatment of cerebral infarction in our hospital and the existing problems, and targeted pharmaceutical service model has been initially established according to the clinical and the needs of patients. The ability of pharmacists to participate clinical drug treatment work has been improved in our hospital, thus laying a foundation for the high-quality pharmaceutical care.

Chinese patent medicines for orthopedics are among the hotspot and difficulty in the rational medication of traditional Chinese medicine (TCM), because they mostly contain toxic medicinal herbs and oriented to special patients. According to the hospital pharmacy practices and the therapeutic theories of TCM, this paper focused on a novel model of rational drug use of Chinese patent medicine for orthopedics based on the principles of ″syndrome-dosage-toxicity differentiation″. We also proposed relevant specifications for guiding their clinical use. Firstly, we proposed a list of the primary clinical application characteristics for rational drug use of orthopedic TCMs, including the syndromes of patient, the dosage of medicine and the toxic ingredients in medicine. Secondly, a database was established for recording the package inserts of all of the 81 orthopedic patent medicines in our hospital, and 2 000 retrospective recipes were analyzed for looking for the high-frequency medicines and common irrational factors. Then clinical case reports involving the adverse reactions and side effects of related drugs were searched from CNKI, VIP and WanFang databases. Then the key information for rational application of each medicine was extracted from these resources and some survey questionnaires. Finally, we established a guide named instructions for clinical use of orthopedic Chinese patient medicines (ICUOCPM) after the discusstion with experts. According to the effect after the practice in hospital for 2 months, the proposed principles of ″syndrome-dosage-toxicity differentiation″ in this paper were believed to be the core elements and the most important clinical monitoring points in TCM for orthopedic patents. It would provide innovative ideas, theoretical guarantee and data support for the development of TCM clinical pharmacy.

目的 提出中医中药在发展临床药学过程中面临的特殊内容,并剖析其原因,为学科发展提供参考.方法 简述临床药学发展史,对比分析临床药学与中医中药的关系与特点,并阐述了在保证中药临床合理应用时所面临的特殊内容.结果 个体化精准用药是现代临床药学的发展方向,现代医药学科分化促使临床药师成为团队药学专家,但这种模式和路径可能并不适合本就具备辩证观和整体观的传统中医中药.与此同时,中药临床药学在药品质量的评价与管控方面、在临床用药合理性评价方面、在药品处方及非处方使用主体方面、在临床药学科研的思路方法方面,均存在不同于现代临床药学的特殊内容.结论 中医药独特的治疗特点决定了中药临床药学不同于现代临床药学的诸多特殊性,创新而非照搬是必经的发展之路.

Chinese patent orthopedic medicines feature complex components, mainly including desperate and toxic herbal pieces, narrow safety window, more clinical contraindications and frequent adverse drug reaction/events (ADR/ADE). To study the general safe medication regularity of Chinese patent orthopedic medicines, define key points in the medication education and ensure rational clinical medication, the authors took 80 types of commonly used Chinese patent orthopedic medicines as the study objects, collect 237 cases from 164 ADR/ADE documents through a system retrieval strategy, make a multidimensional literature analysis to determine the common risk factors for safe and rational medication of Chinese patent orthopedic medicines and establish an ADR/ADE prevention regularity. First, in the aspect of clinical symptoms, skin allergy is the most common ADR/ADE and closely related to the toxic ingredients, particularly accumulated liver or kidney damage caused by some drugs. Second, there are three time nodes in the ADR/ADE occurrence; The ADR/ADE occurred in 30 minutes is closely related to the idiosyncrasy; the ADR/ADE occurred between several months and half a year is related to the drug-induced liver and kidney damages; The most common ADR/ADE was observed within 7 days and predictable according to the pharmacological actions; Third, toxicity is an important factor in the occurrence of ADR/ADE of Chinese patent orthopedic medicines. Fourth, emphasis shall be given to the special medication factors, such as the combination with western medicines and Chinese herbal decoctions, overdose and long-course medication and self-medical therapy. In conclusion, the general ADR/ADE prevention regularity for Chinese patent orthopedic medicines was summarized to provide supports for clinicians in safe and rational medication and give the guidance for pharmacist in medication education.

目的:借鉴临床药学服务质量评价标准,结合中医药临床治疗特点,初步探索中药临床药学服务质量评价体系.方法:梳理国内外临床药学服务质量评价标准现状,分析中药临床药学工作的现状及特殊内容,以临床药师工作经典模板为底本,设计中药临床药学服务质量评价的框架及细则.结果:国外临床药学服务质量评价及相关标准已较为成熟,对于明确药师职责、规范药学服务具有重要推动作用.中药临床药学在诊疗方案评价、用法用量界定、中药质量管控、科研成果转化等方面存在自身特殊性,并衍生出在核实治疗方案、评估治疗效果、提供药学信息、开展用药教育等药学服务质量评价多个方面的新内容.结论:本研究初步构建中药临床药学服务质量评价体系,“以评促建”,规范中药临床药师工作职责,推动中药临床药学深入发展.

目的:探讨中成药临床合理使用的关键要素.方法:参考《处方点评管理办法》,回顾性随机抽取某院2013年1-6月门诊中成药处方870张,开展处方点评,并分析合理用药关键要素.结果:不合格处方共171张,超剂量或超疗程用药、疹断与用药不符、药品不合理配伍、重复给药为不合理用药的四大主要因素,恰当剂量和理论指导是合理用药的关键要素.结论:以门诊一线处方为基础开展处方点评,分析中成药合理用药要素,可为深入研究中成药临床合理使用提供参考.

OBJECTIVE:To probe into to the utilization characteristics of Chinese herbal pieces so as to provide references for reasonable use and scientific supervision of Chinese herbal pieces.METHODS:A total of 71 273 prescriptions of Chinese herbal medicine from July 2007 to June 2010 collected from the outpatient pharmacy of our hospital were collected and analyzed statistically using computer.RESULTS:Chinese herbal pieces have been widely used for treating various diseases.The number of patients that are treated by traditional Chinese medicine(TCM),the amount of prescriptions,the consumption amount and the consumption sum of Chinese herbal medicines has been increasing year by year.The prescriptions of traditional Chinese medicine in Neurology Department etc represented a higher proportion.CONCLUSION:Middle aged and elderly patients whose bodies are wasted by chronic diseases are still the major group that are adopting TCM treatments,however,the number of patients aged below 40 increased year by year.In the third year,the prescribed dose of Chinese herbal pieces showed a significant increase,which might be attributed to some physicians' preference of prescribing large dose for chronic and refractory diseases.The results indicate that the relevant standards of clinical use of Chinese herbal pieces should be modified in accordance with the development of medicine,characteristics of diseases and dosage of Chinese herbal pieces prescriptions in an attempt to improve the level of rational administration of this kind of medicine.The percentage ranking of the number of Chinese herbal pieces prescriptions provides basis for monitoring the rationality of the use of Chinese herbal pieces and evolving of clinical pharmacy of traditional Chinese medicine.