Study On The Clinical Prescription Of Pinellia And Bitter Almond In 30 Hospitals

Objective:Through the investigation of clinical medication prescriptions in 30 hospitals in all provinces,cities and autonomous regions of the country,the current dosage of Pinellia ternata and Armeniacae Semen Amarum and the related situation of rational medication were analyzed,the existing problems were discussed,and the relevant solutions were put forward,which provided support and guidance for the clinical safe,effective and rational use of traditional Chinese medicine.Methods:Outpatient prescriptions of 30 hospitals in various regions of the country in 2017were collected,and prescriptions containing toxic Chinese medicines?Pinellia ternata and Armeniacae Semen Amarum?for resolving phlegm and relieving cough were extracted as data sets.Excel2010 and SPSS Modeler20.0 software were used to explore the usage characteristics of Pinellia ternata and Armeniacae Semen Amarum in dosage,application to different age groups,treatment of different diseases and other aspects,respectively.At the same time,a comparative study was conducted with the 2015 edition of Chinese Pharmacopoeia,and the dosage and related aspects of Pinellia ternata and Armeniacae Semen Amarum were depicted by drawing graphs.Results:1 Pinellia ternata,Armeniacae Semen Amarum prescription data sourcesPinellia ternata is used in 30 hospitals,and the prescription number of Pinellia ternata is36,482;the average ratio of the prescription number of Pinellia ternata to the total prescription number in 30 hospitals is 21.07%,and the ratio of the prescription number of Pinellia ternata to the total prescription number in 29 hospitals exceeds 15%.Of the 30hospitals,29 have used Armeniacae Semen Amarum.The average ratio of the prescription number of Armeniacae Semen Amarum to the total prescription number in 30 hospitals is8.48%.Among them,the ratio of the prescription number of Armeniacae Semen Amarum to the total prescription number in the hospital is 28.69%at the maximum and 0.99%at the minimum.2 Name and treatment of prescription of Pinellia ternata and Armeniacae Semen Amarum?1?Prescription Name and Transfer:Pinellia ternata and Armeniacae Semen Amarum are currently used and transferred differently in all provinces,cities and autonomous regions of the country.There are mainly two situations:one is the same prescription name but different payable,and the other is the same actual payment but different prescription name.?2?Use of processed products:There are 7 kinds of processed Pinellia ternata,namely,Pinellia ternata,the normal Pinellia ternata,Jiang Banxia,Banxia koij,the raw Pinellia ternate,Yyphonium flagelliforme,Jing Pinellia.The 7 kinds of processed products are used in26,17,27,5,2,3,and 1 hospital respectively.The prescription numbers are 21144,7163,7147,344,26,649,and 9 respectively,accounting for 57.69%,19.63%,19.58%,0.94%,0.07%,1.78%,and 0.02%respectively.There are two kinds of Armeniacae Semen Amarum processed products:fried Armeniacae Semen Amarum and fried Armeniacae Semen Amarum.The two kinds of processed products are used in 23 and 24 hospitals respectively.The prescription numbers are 5849 and 7892 respectively,accounting for 42.57%and 57.43%respectively.3 Dose application of Pinellia ternata and Armeniacae Semen Amarum?1?Dosage application of Pinellia ternata:The commonly used dosages of Pinellia ternata in 30 hospitals are 1 g,3 g,6 g,9 g,10 g,12 g and 15 g;The dose threshold varies from hospital to hospital,but all exceed 3-9 g of the dose specified in the Chinese Pharmacopoeia to varying degrees,and the maximum dose threshold is 1-80 g;The common dosage range(P₂₀-P₈₀)of Pinellia ternata varies from hospital to hospital,but all exceed 3-9 g of the dosage specified in Chinese Pharmacopoeia to varying degrees,and the maximum common dosage range(P₂₀-P₈₀)is 1-15 g.?2?Dosage application of Armeniacae Semen Amarum:The common dosages of Armeniacae Semen Amarum in 11 hospitals are 3 g,6 g,9 g,10 g,12 g and 15 g;The dose threshold is different from hospital to hospital,but all exceed 5-10 g of the dose specified in the Chinese Pharmacopoeia to different degrees,with the maximum dose threshold being2-60 g;The common dosage range(P₂₀-P₈₀)of Armeniacae Semen Amarum varies from hospital to hospital,but all exceed 5-10 g of the dosage specified in Chinese Pharmacopoeia to varying degrees,and the maximum common dosage range(P₂₀-P₈₀)is 5-20 g.4 Application of Pinellia ternata and Armeniacae Semen Amarum in patients of different ages?1?The application of Pinellia ternata in patients of different age groups:The frequency and dosage of Pinellia ternata in patients of different age groups are different.In terms of the frequency of Pinellia ternata used by patients of different age groups,the age distribution of patients shows a highly concentrated trend with the increase of age,which is mainly concentrated in youth,adult and elderly patients,while the frequency of Pinellia ternata used by nursing infant,infant,preschool child and adolescent patients is basically low.In terms of dosage of Pinellia ternata for patients of different ages,the dosage threshold of Pinellia ternata for patients of different ages basically shows the rule of elderly patients?adults?youths?adolescents?preschool children?infants?nursing infants.In old age,adult and young patients,the maximum dosage of Pinellia ternata can reach 60 g,80 g and 60 g respectively,respectively,which exceed 6.67 times,8.89 times and 6.67 times of the maximum dosage stipulated in the Chinese Pharmacopoeia.?2?Application of Armeniacae Semen Amarum in patients of different age groups:There are differences in application frequency and dosage of Armeniacae Semen Amarum in patients of different age groups.In terms of the frequency of using Armeniacae Semen Amarum by patients of different age groups,the patients using Armeniacae Semen Amarum showed a high concentration trend in preschool child,adult and old age,while the frequency of using Armeniacae Semen Amarum was relatively low in nursing infants,infants,adolescents and youths.In terms of dosage of Armeniacae Semen Amarum for patients of different age groups,the dosage threshold of Armeniacae Semen Amarum for patients of different age groups basically shows the rule of elderly patients?adults?youths?adolescents?preschool children?infants?nursing infants.In old age,adult and young patients,the maximum dosage of Armeniacae Semen Amarum can reach 50 g,50 g and 36 g respectively,respectively,exceeding 5 times,5 times and 3.6 times of the maximum dosage stipulated in the Chinese Pharmacopoeia.5 Application of Pinellia ternata and Armeniacae Semen Amarum in treating different diseases?1?that application of Pinellia ternata in treat different diseases:The therapeutic window for treating high-frequency diseases by using Pinellia ternata in southwest China is:1-20 g for cough,1-15 g for menstrual disease,1-15 g for gastric fullness,1-30 g for epigastric pain,5-30 g for cancer,1-20 g for cold due to wind chill,5-20 g for insomnia,and 9-15 g for hyperplasia of mammary glands/cysts.The common dosage range for treating high-frequency diseases with Pinellia ternata in southwest China is 10-15 g for cough,menstrual disease,gastric fullness and epigastric pain,15 g for cancer and cold,10-15 g for insomnia and 10-12g for hyperplasia of mammary glands/cyst.The therapeutic window for treating high-frequency diseases with Jiang Banxia in northwest China is 6-10 g for gastric fullness,10-15 g for vomiting,9-15 g for epigastric pain,6-15 g for menstrual disease and 8-15 g for dermatosis.The common dosage range of Jiang Banxia for treating high frequency diseases in northwest China is 10-12 g for treating gastric fullness,epigastric pain and menstrual diseases,and 10 g for treating vomiting and skin diseases.?2?application of Armeniacae Semen Amarum in treating different disease:The therapeutic window for treating high frequency diseases with Armeniacae Semen Amarum in southwest China is:cough 5-15 g,common cold 5-15 g,asthma 10-15 g,wet sore 10-15 g,and cancer 10-50g.Common dosage range of Armeniacae Semen Amarum for treating high frequency diseases in southwest China is 10-15 g for cough,common cold,asthma,wet sore and cancer.6 Application of the raw Pinellia ternataOf the 30 hospitals,only 2 have 26 prescriptions for the raw Pinellia ternata,which are clinically applied to gastric pain caused by deficient cold of spleen and stomach,depression,vertigo and stroke caused by qi deficiency and blood stasis,insomnia caused by deficiency of both heart and spleen,hyperthyroidism,brain malignant tumor,lung malignant tumor,chest distress and phlegm dampness and other diseases,and mainly treat the syndromes,tumors and cysts of deficiency and cold,and all the raw Pinellia ternata are decocted first when being decocted.Conclusion:At present,Pinellia ternata is commonly used in out-patient clinics of hospitals in various regions,while Armeniacae Semen Amarum is widely used in out-patient clinics of different hospitals,and both prescription names and coping situations are complicated.It is necessary to further strengthen the research on prescription name and prescription regulation of Pinellia ternata and Armeniacae Semen Amarum.It is common to use Pinellia ternate and Armeniacae Semen Amarumhave overdosage in hospitals in various regions.When dispensing prescriptions,small doses should be used and patients'medication situation should be closely monitored.Pinellia ternata and Armeniacae Semen Amarumhave different treatment ranges when treating different diseases respectively,but they all exceed the dosage prescribed in the Chinese Pharmacopoeia,which to some extent reflects the characteristics of a single traditional Chinese medicine with multiple treatment windows.However,the use of Pinellia ternate and Armeniacae Semen Amarum beyond the dosage prescribed in the Chinese Pharmacopoeia should also pay close attention to the situation of patients after medication.The clinical use of raw Pinellia ternata is mainly to treat various syndromes of deficiency and cold,tumors and cysts,but the usage is less.