中国临床药学杂志

目的 通过对处方点评文献数据的提取与分析，探讨中药饮片合理用药的问题及对策，以期优化中药饮片处方点评细则和提高中药合理用药水平。方法 以篇名中包含“中药饮片处方点评”字段，检索2017年7月至2023年7月在中国知网、万方、维普数据库中公开发表的文献。经过2次筛选后获得相关文献。提取文献中点评处方数量、不合理处方数量、不合理问题数量和具体问题陈述后进行分析与总结。结果 共纳入文献20篇，总计181 649张中药饮片处方，其中不合理处方14 306张，不合理率为0.09%～44.31%，平均为13.91%，文献间差异较大。不合理问题数占比排名前4位的是“缺少中医诊断和辨证”“未按要求标注药物调剂、煎煮等特殊要求（包括脚注遗漏和标注错误）”“用法用量不适宜”“处方正文缺项（处方用法用量缺项）”，占比分别为31.62%、25.90%、10.46%和8.65%，累计构成比超过70%，是造成中药饮片处方不合理的主要因素。对上述4类问题进行细分，其中有毒中药饮片超量使用，有中医诊断但诊断内容不完整，缺少证型和仅有西医诊断而无中医诊断在文献中出现频次较多。结论 学习和总结文献中不合理处方问题的具体陈述，有助于临床药师拓宽点评思路，完善处方点评细则和解决对策，促进中药饮片合理使用。

AIM To explore the problems of traditional Chinese medicine(TCM) decoction pieces and propose countermeasures based on the literature of prescription comment, to provide references for optimizing prescription review and promoting rational application of TCM. METHODS CNKI, Wangfang database and VIP database were retrieved for "Review prescriptions of traditional Chinese medicine" from July 2017 up to July 2023. After two times of screening,the basis for the number of reviewed prescriptions, number of irrational prescriptions, number of irrational problems and corresponding content of the involved literature were extracted, then the descriptive analysis and summary were conducted RESULTS A total of 20 articles were included. A total of 181 649 prescriptions were reviewed, of which 14 306 were irrational prescriptions. The irrational rate ranged from 0.09% to 44.31% and the average irrational rate was 13.91%, with significant differences among literature. The top 4 irrational problems in terms of proportion were "lack of TCM diagnosis and syndrome differentiation" "did not indicate special requirements for drug dispensing instructions and decoction as required(including missing footnotes and incorrect labeling)" "improper usage and dosage" and "miss items in the text of prescription(miss usage and dosage in prescription)". They were accounting for 31.62%, 25.90%, 10.46%and 8.65%, respectively. The cumulative percentage was more than 70%, which was the main factor causing the irrational prescription of TCM decoction pieces. The above 4 types of problems were further subdivided. Among them, the excessive use of toxic TCM decoction pieces, incomplete TCM diagnostic content, a lack of syndrome types, and the presence of only Western medicine diagnoses without TCM diagnoses were more frequently observed in the literature. CONCLUSION Learning and summarizing the specific statements of irrational prescription problems in the literature is helpful for clinical pharmacists to broaden their thinking, and improve the rules of prescription review and the solutions, to promote the rational use of TCM decoction pieces.