葛根芩连汤、麻杏石甘汤量效的循证医学评价
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摘要
循证医学的概念最早于1992年由加拿大著名临床流行病学家提出,并定义为：“慎重、准确、明智地应用当前所能获得的最好的研究证据来确定对患者的治疗措施。”是系统地查找、评价和使用证据从而指导临床医疗决策的方法学。方药剂量是影响中医疗效的关键因素之一,从古至今,对于方药剂量的探讨,一直在延续。目前,方药剂量发展变化的历史研究已经取得了一定的进展,以葛根芩连汤及麻杏石甘汤为代表的经方及常用药物用量的历史轨迹已得到大致的描述。其在现代剂量应用中,有哪些规律特点,与《伤寒论》中原方的用量相比又有哪些变化,本文通过借鉴循证医学的研究方法,对与葛根芩连汤及麻杏石甘汤相关的现代临床文献进行全面而细致的梳理,以进一步明确方药的使用、分布情况及用量范围,为中医剂量理论的形成提供有价值的依据。
研究目的：1分别建立以葛根芩连汤或麻杏石甘汤为干预措施的现代临床观察类文献数据库,对研究内容中涉及的几个方面：文献的一般情况、纳入研究的特征、文献的质量分析、方证研究及量效研究的各个结果分别加以分析及总结。2对量效研究部分进行重点分析,经方的使用现状：单味药／经方总量／总药量：平均剂量、剂量分布区间、最常用剂量、常用剂量范围、药物与药物剂量比等。3临床观察类文献质量的全面评价及分析,提出相应的改进及合理化建议,为今后的临床决策及其他研究工作提供一定的参考和依据。4与药典常用剂量范围进行比较,明晰现代临床研究用量情况。5通过以上研究结果,分析探讨借鉴循证医学研究方法的量效关系研究的思路。
研究对象：发表于1949-2012年；使用葛根芩连汤或麻杏石甘汤为干预措施进行临床疗效观察的非个案类中英文文献报道。
研究方法：1文献检索：以“葛根芩连汤”及“麻杏石甘汤”为检索词进行全文检索CNKI、CBM、VIP、万方、PubMed、Embase数据库,同时手工检索由于年份及其他原因所限未被各个数据库收录的文献。2文献整理：经初步阅读文献题目及摘要,对符合要求的文献进行全文下载,进一步阅读全文,剔除不符合纳入标准及各个数据库间重复的文献,将文献按研究内容中划分的两类及不同干预措施(葛根芩连汤、麻杏石甘汤)分别进行归类。3文献录入：采用Excel表格根据研究内容设计量表并手工录入数据,完成后组织课题参与人员对录入的数据进行校对。4数据处理：采用Excel表格及基本统计学方法来处理相关数据,主要为描述性统计分析。针对量效研究中药物剂量的相关数据,通过百分位数、方差、标准差、离散度、相关性、算术平均数等概念来处理药物的平均剂量、常用剂量、剂量分布区间等。
研究结果：质量分析方面两方研究中根据改良版Jadad量表,≥4分的文献仅3篇,其中葛根芩连汤部分1篇,麻杏石甘汤部分2篇,该3篇文献仅占全部文献量的0.53%,其余文献皆为低质量文献。
在两方研究中的量效研究部分,葛根芩连汤部分分别有11%和14%的文献无药物组成明细及具体剂量使用情况,麻杏石甘汤部分分别有5%和20%的文献无药物组成明细及具体剂量使用情况。
从单味药分析,葛根芩连汤方研究中葛根的儿童用量与药典用量范围接近,成人用量明显超出药典的用量范围,成人最大用量为《伤寒杂病论》中葛根最大用量的1／2左右；黄芩的儿童剂量与药典的用量范围基本重合,成人用量超出药典的用量范围,成人最大用量为《伤寒杂病论》中黄芩最大用量的3/4左右；黄连的儿童用量的常用剂量范围在药典的用量范围之内,但最大剂量超出药典范围,成人用量明显超出药典用量范围,成人最大用量为《伤寒杂病论》中黄连最大用量的2/5左右；炙甘草的儿童用量在药典的用量范围之内,成人用量也与药典用量范围接近,只是最大剂量超出药典的用量范围,成人最大用量为《伤寒杂病论》中炙甘草最大用量的2/5左右。麻杏石甘汤方研究中麻黄的儿童与成人用量的常用剂量均在药典用量范围内,但最大剂量均超出药典的用量范围,成人最大用量为《伤寒杂病论》中麻黄最大用量的1/5左右；石膏的儿童与成人剂量均在药典的用量范围内,成人最大用量为《伤寒杂病论》中石膏最大用量的1/8左右；杏仁的儿童用量的常用剂量范围在药典的用量范围之内,但最大剂量超出药典范围,成人用量超出药典用量范围,成人最大用量为《伤寒杂病论》中杏仁最大用量的2/5左右;炙甘草的儿童用量在药典的用量范围之内,成人用量也与药典用量范围接近,只是最大剂量超出药典的用量范围,成人最大用量为《伤寒杂病论》中炙甘草最大用量的2/5左右。
从经方总量看,葛根芩连汤经方总量的儿童用量在药典各药用量范围之和内,成人用量约为儿童用量的2倍,成人最大用量为《伤寒论》原方量的1/2左右；麻杏石甘汤经方总量的儿童用量在药典各药用量范围之和内,成人用量约为儿童用量的1.6倍,成人最大用量接近《伤寒论》原方量的1/2。
从全部药量看,两方研究中,所用方剂的全部药量为经方总量的2-2.5倍,在经方基础上所添加的药物总量等于或超过经方药物的总量。
从药味数看,两方研究中,无论成人还是儿童,方药的平均药味数基本都在经方药味数的2倍左右。
从药物用量比值看,与《伤寒论》原方用量比值相比较,相同或偏大或偏小的各种情况皆存在。
研究结论：本文通过对两方研究的文献的一般情况、纳入研究的特征、文献的质量分析、方证研究以及量效研究五个方面的结果进行总结分析,得出如下结论：1文献数量近年增多明显,但整体质量尚有待提高。2临床研究需进一步规范化和标准化。3临床试验有待进一步突出中医特色。4经方中各单味药物的儿童用量基本在药典用量范围内,成人用量超出药典用量范围,但明显低于《伤寒杂病论》中的用量。5经方总量的儿童用量基本在药典各味药物用量范围之和内,成人用量明显超过儿童用量。6所加减的药物总量等于或超出经方总量。7方药的平均药味数基本在经方药味数的2倍左右。8方药中各味药物之间的用量比值没有明显规律可循。
The concept of EBM (Evidence-based Medicine) was first introduced in1992by the famous Canadian clinical epidemiologists and was defined as "To determine the treatment with the best research evidence possible aquired in the manner of prudence, precision and advisability", which is a methodology which can be found, evaulate and use evidence to guide clinical decisions. The prescription dose is one of the key factors and has been discussed since ancient times. At present,the historical study of the development and changes of the prescription does has been made some progress and how were TCM (Traditional Chinese Medicine) prescripitons such as Gegen Qinlian decoction and Maxing Shigan decoction used and what prescription does was used in ancient times have become clear. However, how are they used in modern times?Compared to the prescription does in Treatise on Febrile Diseases, how does the prescription does change?This study has learnt methods from EBM and use it to collect modern clinical research about Cegen Qinlian and Maxing Shigan decoction as many as possible and analysis all data to make clear about how these two prescriptions use especially for the does part. Hope the result can help to improve and perfect the theory of TCM does.
1Objective
(1)To estabilsh two different databases by using Gegen Qinlian decoction or Maxing Shigan decoction as interventions in clinical observations and divide contents into five parts to analysis and conclude.
(2)Take does effect part as an important part to analysis, including how TCM prescripitions use resently and does part including single herb, the amount of classical prescriptions and TCM prescriptions to analysis the common dosage range, the average dosage, the most frequently used dosage, and the distribution extent from the minimum to the maximum dosage and so on.
(3)Evaluate and analysis the quality of clinical studies and propose how to improve to get high qulity research and provide reference for furture research.
(4)Let the result compare with what dosage herbs use in pharmacopoeia and be clear about the herbs dosage in modern clinical research.
(5)According to the result,try to discuss how to research does effect relationship by using method from EBM.
2Included studies
Clinical observation in Chinese or English use Gegen qinlian or Maxing Shigan decoction as interventions except cases in1949-2012.
3Methods
(1)Use "Maxing Shigan decoction" and "Gegen Qinlian decoction" as the search term to search literature in CNKI, CBM, VIP, WanFang Data, PubMed, Embase and search other literature which is not in the database metioned due to years and other reasons by hand.
(2)Read title and abstract of all the studies and download what this study need. Read full text of all literature downloaded to exclude some of them which is not needed or repeated in different database. Then classify the literature into two groups according to different decoctions.
(3)Use excel to set up scale and enter data by hand. When all data was entered, researchers who involve in this study were going to proofread all data.
(4) Use basic statistical methods to process data including standard deviation, variance, dispersion, arithmetic mean and so on, obtain the common dosage range, the average dosage,the most frequently used dosage,and the distribution extent from the minimum to the maximum dosage. Most of them are descriptive statistical analysis.
3Results
Based on a modified version of the Jadad scale, there are only three studies>4points, one in Gegen Qinlian part and the other two in Maxing Shigan part and these three accounted for only0.53%of all studies. The rest of studies are all low quality.
In does effect research part, there were11%of all studies which didn't have composition of prescriptions and14%of all studies which didn't have dosage of the herbs in prescriptions in Gegen Qinlian part. In Maxing Shigan part, there were5%of all studies which didn't have composition of prescriptions and20%of all studies which didn't have dosage of the herbs in prescriptions.
In single herb research of Gegen Qinlian part, the dosage of children of Gegen is similar to Gegen dosage range in pharmacopoeia. However, the adult dosage exceed the dosage of the pharmacopoeia. Maximum dosage of Gegen for adults is about1/2of Gegen maximum dosage in Treatise on Febrile Diseases. The dosage of children of Huangqin is similar to Huangqin dosage range in pharmacopoeia. However, the adult dosage exceed the dosage of the pharmacopoeia. Maximum dosage of Huangqin for adul ts is about3/4of Huangqin maximum dosage in Treatise on Febrile Diseases. The common dosage range of children of Huanglian is in Huanglian dosage range of pharmacopoeia, but the maximum dosage exceed dosage range of pharmacopoeia. The adult dosage exceed the dosage of the pharmacopoeia. Maximum dosage of Huanglian for adults is about2/5of Huanglian maximum dosage in Treatise on Febrile Diseases. The dosage of both children and adults of Zhigancao is similar to Zhigancao dosage range in pharmacopoeia. However, the maximum dosage for adults exceed the dosage of the pharmacopoeia. Maximum dosage of Zhigancao for adults is about2/5of Zhigancao maximum dosage in Treatise on Febrile Diseases. In single herb research of Maxing Shigan part, the common dosage range of both children and adults of Mahuang is similar to Mahuang dosage range in pharmacopoeia. However, the maximum dosage for both of them exceed the dosage of the pharmacopoeia. Maximum dosage of Mahuang for adults is about2/5of Mahuang maximum dosage in Treatise on Febrile Diseases. The dosage of both children and adults of Shigao is in Shigao dosage range in pharmacopoeia.Maximum dosage of Shigao for adults is about1/8of Shigao maximum dosage in Treatise on Febrile Diseases. The common dosage range of children of Xingren is in Xingren dosage range of pharmacopoeia, but the maximum dosage exceed dosage range of pharmacopoeia. The adult dosage exceed the dosage of the pharmacopoeia. Maximum dosage of Xingren for adults is about2/5of Xingren maximum dosage in Treatise on Febrile Diseases. The dosage of both children and adults of Zhigancao is similar to Zhigancao dosage range in pharmacopoeia. However, the maximum dosage for adults exceed the dosage of the pharmacopoeia. Maximum dosage of Zhigancao for adults is about2/5of Zhigancao maximum dosage in Treatise on Febrile Diseases.
In the amount of classical prescriptions part for Gegen Qinl ian decoct ion, the amount of dosage of classical prescription for children is in the dosage range of pharmacopoeia and the adult dosage is about2times of children amount. The maximum dosage of adult is about1/2of dosage in Treatise on Febrile Diseases. In the amount of classical prescriptions part for Maxing Shigan decoction, the amount of dosage of classical prescription for children is in the dosage range of pharmacopoeia and the adult dosage is about1.6times of children amount. The maximum dosage of adult is about1/2of dosage in Treatise on Febrile Diseases.
In the amount of all herbs in prescriptions,according to the result, the amount dosage of all herbs is2-2.5times of the amount dosage of herbs in classical prescriptions which means the amount of adding herbs for classical prescriptions is equal to or more than the amount of all herbs in classical prescriptions.
In the number of herbs part,no matter adults or children, the average of the number of herbs is2times of the number of herbs in classical prescriptions.
In dosage ratio part, compare to the ration in Treatise on Febrile Diseases, there are variety of conditions existing.
4Conclusion
According to the results in this study, there are8conclusions.(1)The number of literature has increased significantly recently but the overall quality still needs to be improved.(2)Clinical studies need to be standardized.(3)Clinical studies need to have more characteristics of TCM.(4) The dosage of children in classical prescriptions is in dosage range in pharmacopoeia. The adult dosage exceed the dosage of the pharmacopoeia but significantly lower than the dosage in Treatise on Febrile Diseases.(5)The amount of dosage of classical prescriptions for children is in the dosage range of pharmacopoeia which is much lower than adults dosage.(6) The amount of adding herbs for classical prescriptions is equal to or more than the amount of all herbs in classical prescriptions.(7) The average of the number of herbs is2times of the number of herbs in classical prescriptions.(8)There's no obvious pattern about dosage ratio in this study.
研究目的：1分别建立以葛根芩连汤或麻杏石甘汤为干预措施的现代临床观察类文献数据库,对研究内容中涉及的几个方面：文献的一般情况、纳入研究的特征、文献的质量分析、方证研究及量效研究的各个结果分别加以分析及总结。2对量效研究部分进行重点分析,经方的使用现状：单味药／经方总量／总药量：平均剂量、剂量分布区间、最常用剂量、常用剂量范围、药物与药物剂量比等。3临床观察类文献质量的全面评价及分析,提出相应的改进及合理化建议,为今后的临床决策及其他研究工作提供一定的参考和依据。4与药典常用剂量范围进行比较,明晰现代临床研究用量情况。5通过以上研究结果,分析探讨借鉴循证医学研究方法的量效关系研究的思路。
研究对象：发表于1949-2012年；使用葛根芩连汤或麻杏石甘汤为干预措施进行临床疗效观察的非个案类中英文文献报道。
研究方法：1文献检索：以“葛根芩连汤”及“麻杏石甘汤”为检索词进行全文检索CNKI、CBM、VIP、万方、PubMed、Embase数据库,同时手工检索由于年份及其他原因所限未被各个数据库收录的文献。2文献整理：经初步阅读文献题目及摘要,对符合要求的文献进行全文下载,进一步阅读全文,剔除不符合纳入标准及各个数据库间重复的文献,将文献按研究内容中划分的两类及不同干预措施(葛根芩连汤、麻杏石甘汤)分别进行归类。3文献录入：采用Excel表格根据研究内容设计量表并手工录入数据,完成后组织课题参与人员对录入的数据进行校对。4数据处理：采用Excel表格及基本统计学方法来处理相关数据,主要为描述性统计分析。针对量效研究中药物剂量的相关数据,通过百分位数、方差、标准差、离散度、相关性、算术平均数等概念来处理药物的平均剂量、常用剂量、剂量分布区间等。
研究结果：质量分析方面两方研究中根据改良版Jadad量表,≥4分的文献仅3篇,其中葛根芩连汤部分1篇,麻杏石甘汤部分2篇,该3篇文献仅占全部文献量的0.53%,其余文献皆为低质量文献。
在两方研究中的量效研究部分,葛根芩连汤部分分别有11%和14%的文献无药物组成明细及具体剂量使用情况,麻杏石甘汤部分分别有5%和20%的文献无药物组成明细及具体剂量使用情况。
从单味药分析,葛根芩连汤方研究中葛根的儿童用量与药典用量范围接近,成人用量明显超出药典的用量范围,成人最大用量为《伤寒杂病论》中葛根最大用量的1／2左右；黄芩的儿童剂量与药典的用量范围基本重合,成人用量超出药典的用量范围,成人最大用量为《伤寒杂病论》中黄芩最大用量的3/4左右；黄连的儿童用量的常用剂量范围在药典的用量范围之内,但最大剂量超出药典范围,成人用量明显超出药典用量范围,成人最大用量为《伤寒杂病论》中黄连最大用量的2/5左右；炙甘草的儿童用量在药典的用量范围之内,成人用量也与药典用量范围接近,只是最大剂量超出药典的用量范围,成人最大用量为《伤寒杂病论》中炙甘草最大用量的2/5左右。麻杏石甘汤方研究中麻黄的儿童与成人用量的常用剂量均在药典用量范围内,但最大剂量均超出药典的用量范围,成人最大用量为《伤寒杂病论》中麻黄最大用量的1/5左右；石膏的儿童与成人剂量均在药典的用量范围内,成人最大用量为《伤寒杂病论》中石膏最大用量的1/8左右；杏仁的儿童用量的常用剂量范围在药典的用量范围之内,但最大剂量超出药典范围,成人用量超出药典用量范围,成人最大用量为《伤寒杂病论》中杏仁最大用量的2/5左右;炙甘草的儿童用量在药典的用量范围之内,成人用量也与药典用量范围接近,只是最大剂量超出药典的用量范围,成人最大用量为《伤寒杂病论》中炙甘草最大用量的2/5左右。
从经方总量看,葛根芩连汤经方总量的儿童用量在药典各药用量范围之和内,成人用量约为儿童用量的2倍,成人最大用量为《伤寒论》原方量的1/2左右；麻杏石甘汤经方总量的儿童用量在药典各药用量范围之和内,成人用量约为儿童用量的1.6倍,成人最大用量接近《伤寒论》原方量的1/2。
从全部药量看,两方研究中,所用方剂的全部药量为经方总量的2-2.5倍,在经方基础上所添加的药物总量等于或超过经方药物的总量。
从药味数看,两方研究中,无论成人还是儿童,方药的平均药味数基本都在经方药味数的2倍左右。
从药物用量比值看,与《伤寒论》原方用量比值相比较,相同或偏大或偏小的各种情况皆存在。
研究结论：本文通过对两方研究的文献的一般情况、纳入研究的特征、文献的质量分析、方证研究以及量效研究五个方面的结果进行总结分析,得出如下结论：1文献数量近年增多明显,但整体质量尚有待提高。2临床研究需进一步规范化和标准化。3临床试验有待进一步突出中医特色。4经方中各单味药物的儿童用量基本在药典用量范围内,成人用量超出药典用量范围,但明显低于《伤寒杂病论》中的用量。5经方总量的儿童用量基本在药典各味药物用量范围之和内,成人用量明显超过儿童用量。6所加减的药物总量等于或超出经方总量。7方药的平均药味数基本在经方药味数的2倍左右。8方药中各味药物之间的用量比值没有明显规律可循。
The concept of EBM (Evidence-based Medicine) was first introduced in1992by the famous Canadian clinical epidemiologists and was defined as "To determine the treatment with the best research evidence possible aquired in the manner of prudence, precision and advisability", which is a methodology which can be found, evaulate and use evidence to guide clinical decisions. The prescription dose is one of the key factors and has been discussed since ancient times. At present,the historical study of the development and changes of the prescription does has been made some progress and how were TCM (Traditional Chinese Medicine) prescripitons such as Gegen Qinlian decoction and Maxing Shigan decoction used and what prescription does was used in ancient times have become clear. However, how are they used in modern times?Compared to the prescription does in Treatise on Febrile Diseases, how does the prescription does change?This study has learnt methods from EBM and use it to collect modern clinical research about Cegen Qinlian and Maxing Shigan decoction as many as possible and analysis all data to make clear about how these two prescriptions use especially for the does part. Hope the result can help to improve and perfect the theory of TCM does.
1Objective
(1)To estabilsh two different databases by using Gegen Qinlian decoction or Maxing Shigan decoction as interventions in clinical observations and divide contents into five parts to analysis and conclude.
(2)Take does effect part as an important part to analysis, including how TCM prescripitions use resently and does part including single herb, the amount of classical prescriptions and TCM prescriptions to analysis the common dosage range, the average dosage, the most frequently used dosage, and the distribution extent from the minimum to the maximum dosage and so on.
(3)Evaluate and analysis the quality of clinical studies and propose how to improve to get high qulity research and provide reference for furture research.
(4)Let the result compare with what dosage herbs use in pharmacopoeia and be clear about the herbs dosage in modern clinical research.
(5)According to the result,try to discuss how to research does effect relationship by using method from EBM.
2Included studies
Clinical observation in Chinese or English use Gegen qinlian or Maxing Shigan decoction as interventions except cases in1949-2012.
3Methods
(1)Use "Maxing Shigan decoction" and "Gegen Qinlian decoction" as the search term to search literature in CNKI, CBM, VIP, WanFang Data, PubMed, Embase and search other literature which is not in the database metioned due to years and other reasons by hand.
(2)Read title and abstract of all the studies and download what this study need. Read full text of all literature downloaded to exclude some of them which is not needed or repeated in different database. Then classify the literature into two groups according to different decoctions.
(3)Use excel to set up scale and enter data by hand. When all data was entered, researchers who involve in this study were going to proofread all data.
(4) Use basic statistical methods to process data including standard deviation, variance, dispersion, arithmetic mean and so on, obtain the common dosage range, the average dosage,the most frequently used dosage,and the distribution extent from the minimum to the maximum dosage. Most of them are descriptive statistical analysis.
3Results
Based on a modified version of the Jadad scale, there are only three studies>4points, one in Gegen Qinlian part and the other two in Maxing Shigan part and these three accounted for only0.53%of all studies. The rest of studies are all low quality.
In does effect research part, there were11%of all studies which didn't have composition of prescriptions and14%of all studies which didn't have dosage of the herbs in prescriptions in Gegen Qinlian part. In Maxing Shigan part, there were5%of all studies which didn't have composition of prescriptions and20%of all studies which didn't have dosage of the herbs in prescriptions.
In single herb research of Gegen Qinlian part, the dosage of children of Gegen is similar to Gegen dosage range in pharmacopoeia. However, the adult dosage exceed the dosage of the pharmacopoeia. Maximum dosage of Gegen for adults is about1/2of Gegen maximum dosage in Treatise on Febrile Diseases. The dosage of children of Huangqin is similar to Huangqin dosage range in pharmacopoeia. However, the adult dosage exceed the dosage of the pharmacopoeia. Maximum dosage of Huangqin for adul ts is about3/4of Huangqin maximum dosage in Treatise on Febrile Diseases. The common dosage range of children of Huanglian is in Huanglian dosage range of pharmacopoeia, but the maximum dosage exceed dosage range of pharmacopoeia. The adult dosage exceed the dosage of the pharmacopoeia. Maximum dosage of Huanglian for adults is about2/5of Huanglian maximum dosage in Treatise on Febrile Diseases. The dosage of both children and adults of Zhigancao is similar to Zhigancao dosage range in pharmacopoeia. However, the maximum dosage for adults exceed the dosage of the pharmacopoeia. Maximum dosage of Zhigancao for adults is about2/5of Zhigancao maximum dosage in Treatise on Febrile Diseases. In single herb research of Maxing Shigan part, the common dosage range of both children and adults of Mahuang is similar to Mahuang dosage range in pharmacopoeia. However, the maximum dosage for both of them exceed the dosage of the pharmacopoeia. Maximum dosage of Mahuang for adults is about2/5of Mahuang maximum dosage in Treatise on Febrile Diseases. The dosage of both children and adults of Shigao is in Shigao dosage range in pharmacopoeia.Maximum dosage of Shigao for adults is about1/8of Shigao maximum dosage in Treatise on Febrile Diseases. The common dosage range of children of Xingren is in Xingren dosage range of pharmacopoeia, but the maximum dosage exceed dosage range of pharmacopoeia. The adult dosage exceed the dosage of the pharmacopoeia. Maximum dosage of Xingren for adults is about2/5of Xingren maximum dosage in Treatise on Febrile Diseases. The dosage of both children and adults of Zhigancao is similar to Zhigancao dosage range in pharmacopoeia. However, the maximum dosage for adults exceed the dosage of the pharmacopoeia. Maximum dosage of Zhigancao for adults is about2/5of Zhigancao maximum dosage in Treatise on Febrile Diseases.
In the amount of classical prescriptions part for Gegen Qinl ian decoct ion, the amount of dosage of classical prescription for children is in the dosage range of pharmacopoeia and the adult dosage is about2times of children amount. The maximum dosage of adult is about1/2of dosage in Treatise on Febrile Diseases. In the amount of classical prescriptions part for Maxing Shigan decoction, the amount of dosage of classical prescription for children is in the dosage range of pharmacopoeia and the adult dosage is about1.6times of children amount. The maximum dosage of adult is about1/2of dosage in Treatise on Febrile Diseases.
In the amount of all herbs in prescriptions,according to the result, the amount dosage of all herbs is2-2.5times of the amount dosage of herbs in classical prescriptions which means the amount of adding herbs for classical prescriptions is equal to or more than the amount of all herbs in classical prescriptions.
In the number of herbs part,no matter adults or children, the average of the number of herbs is2times of the number of herbs in classical prescriptions.
In dosage ratio part, compare to the ration in Treatise on Febrile Diseases, there are variety of conditions existing.
4Conclusion
According to the results in this study, there are8conclusions.(1)The number of literature has increased significantly recently but the overall quality still needs to be improved.(2)Clinical studies need to be standardized.(3)Clinical studies need to have more characteristics of TCM.(4) The dosage of children in classical prescriptions is in dosage range in pharmacopoeia. The adult dosage exceed the dosage of the pharmacopoeia but significantly lower than the dosage in Treatise on Febrile Diseases.(5)The amount of dosage of classical prescriptions for children is in the dosage range of pharmacopoeia which is much lower than adults dosage.(6) The amount of adding herbs for classical prescriptions is equal to or more than the amount of all herbs in classical prescriptions.(7) The average of the number of herbs is2times of the number of herbs in classical prescriptions.(8)There's no obvious pattern about dosage ratio in this study.
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