| 摘要: | 中醫骨傷科對筋骨受傷的治療早已發展出許多理論與治療方式，對受傷後的分期、治則、治療方式等都有詳細的記載。用問卷的方式去了解民眾對意外傷害的健康素養程度與受傷時是否仍會尋求中醫的治療，以及後續利用健保資料庫，探討現代中醫在治療挫傷時使用中藥濃縮製劑的處方用藥模式。
針對挫傷等意外傷害進行問卷調查，結果顯示年紀大、教育程度低、女性、個人月收入的意外傷害防護知識偏低。在就醫行為方面，大多選擇西醫與中醫治療。
在中醫治療挫傷的醫古文回顧中，處方用藥有引經藥的概念，上肢常用續斷、桂枝，下肢常用牛膝、木瓜等。常用的藥物有活血、補血的當歸、白芍、川芎、桃仁、紅花，瀉下的大黃，行氣的木香、陳皮，補養的人參，溫裡的附子、肉桂等。骨傷科常用藥的現代藥理作用大多有消炎、止痛、抑菌、活血、補血等作用。
自健保資料庫篩選出中醫門診診斷為挫傷且有X光處置的處方進行分析，結果顯示最常用的複方是疏經活血湯、單味藥是延胡索、單味藥配對是乳香與沒藥。處方類型以藥效分類來看依序為「理血」、「理血」與「補養」、「理血」與「和解」、「理血」與「清熱」。而處方使用比例為「理血」劑量占四分之三以上，搭配其他藥效。在急性期時處方以「理血」為主，非急性期時「補養」的使用略有提升。
藉由本研究結果希望能提供中醫臨床治療挫傷時處方用藥的參考依據，建立屬於中藥濃縮製劑的使用綱領。
Traditional Chinese medicine (TCM) has developed many theories and drugs for the treatment of bone and muscle injuries, and it has detailed records on the stages, treatment principles, and treatment methods after the injury. Use questionnaires to find out where people will seek treatment for accidental injuries, and what is the health literacy level of accidental injuries? Follow up using the National Health Insurance Research Database (NHIRD) in Taiwan to explore the mode of TCM prescription drug use in the treatment of contusion.
A questionnaire survey was conducted on accidental injuries such as contusion. As a result, women and people with higher age, lower education level, or lower income have a lower degree of health literacy in accidental injuries. From the aspect of health seeking behavior, they mostly chose Western medicine and TCM treatment.
In the review of treatment of contusion in TCM, the prescription medicines have the concept of channel ushering drug. Commonly used drugs were blood-regulating, qi- regulating, dampness draining, tonifying, and cold-dispelling herbs. Most of the common medicines of Chinese osteo-traumatology has the pharmacological effect of anti-inflammatory, pain relief, blood-activating, and blood-tonifying, etc.
Screening from the NHIRD to find out the prescriptions diagnosed as contusion in TCM clinics and analyzed by X-ray treatment, the first commonly used formula was Shu Jing Huo Xue Tang, and the first commonly used single herb was Yan Hu Suo. The single herb and single herb pairing was Ru Xiang and Mo Yao. The efficacy of the prescriptions was usually blood-regulating, blood-regulating with tonifying and replenishing, blood-regulating with harmonizing, blood-regulating with fire purging. The dosage of blood-regulating took up a big portion of the prescription use, pairing with another efficacy. During acute phase, the prescription mainly based on blood-regulating, and during non-acute phase, the use of tonifying and replenishing slightly increased.
With the results of this study, we hope to provide a clinical guideline of contusion for TCM physicians. |
