Reporter survey: Chinese medicine

change "noble medicine" why?

Jinghua times

Recently, many people complain that the "traditional Chinese medicine master," one period of treatment frequently hundreds of even one thousand, Chinese traditional medicine into the aristocratic medicine. What caused the eat Chinese traditional medicine to be more and more expensive? Reporter discovery after investigation, the recent price rise is one reason for Chinese herbal medicine, but the more the main reason is the Chinese traditional medicine "DaChuFang". Many Chinese medicine clinic and pharmacy sitting on the judgment seat was driven, medical benefits the more open, the greater the prescription is a preference for the valuable Chinese herbal medicine.

Survey report

7 for prescription price exceeds 500 yuan

June 14, morning, the journalists located in the south of horses at home near the road of a level of first-class hospital. In a 3 piece of fifty cents to the booking form, the reporter entered the hospital after general a clinic, the reporter said recently, hope the doctor can sleep recuperated. A man surnamed hou reporters for the doctor, the arteries and veins, says the reporter two empty cases, overwork, then open to reporters, and charged prescription reporter, must hold to eat seven dose (7 days), don't eat dose of cold drink, don't eat turnip, vinegar, and soy products. The reporter ask the doctor, this prescription need how many money, the doctor said he is not too clear.

11 o 'clock noon, the reporter also entered is located in metro line 4, the corner near the west a doctor. On the second floor of the pharmacy, a name is handsome doctor received a reporter, the reporter also said they sleep, handsome doctor pulse, the reporter is said after the spleen deficiency, pericardiac phlegmy wet. He used a printed with a 3 armour hospital to tear open the name of the reporters for prescription, and seven days, and no tear in doses of reporters on what did disease. Then ask for 20 yuan to reporters sit to diagnose a fee, but did not provide any receipt.

Then, reporters at the pharmacy in their two prescription for the price. The pharmacy open the medicine FangChan agents need to 39.8 yuan, 7 total need medication 278.6 yuan. The medicine FangChan agent at the hospital to 78.5 yuan, as directed by a physician, 7 total need medication 549.5 yuan. Price member told reporters, in general, show the than hospital cheap, so many patients choose their way out of the hospital. 549.5 yuan prescription contains American ginseng, sand benevolence, leeches, and therefore more expensive medicine.

In addition, the reporter also statistical once, hospital open the prescription in a total contains 16 kinds of medicinal herbs, the pharmacy open the prescription in a total with 20 medicine. Find two prescription only skin and salvia miltiorrhiza in meadow two kinds of medicinal herbs is also use of medicinal materials.

Save precious medical abuse phenomenon

Beijing university of Chinese medicine DuJinHang, said professor in the industry are now often the number of prescription, from large to dose was terrible taste, he had seen a hebei patients in the local doctor, be doctors prescribe medicine DuoYuan prescription 7 5000. Among them, contains the natural ginseng, bezoar has a lot of expensive medicinal herbs, "only with the ginseng 50 g".

DuJinHang professor analysis, the journalist had the $549.5 price for the prescription, said after the most expensive prescription medicine American ginseng not necessary to use, not only expensive and not suitable for the illness and season. Is now at the heat season, it is hot, the reporter recently rest bad and climate has the very big relations, if want to clear the drug should be the wet primarily, but American ginseng there really is no need to take.

In addition, the journalist had two prescription there is more complex, more taste your problem. Price partial A prescription contains 16 kinds of medicinal herbs, the other with 20 a prescription medicine. DuJinHang said he give patients a prescription when, in addition to special complex patients condition, the general every medication are only twelve sanwei medicinal herbs, each drug price in 10 yuan to 20 yuan between, 15 yuan of the following prescription in the majority.

In addition to the flavour easily open medicine, there are excessive use of the famous medicinal phenomenon. These medicinal materials including: cordyceps sinensis, ginseng, American ginseng, velvet antler, natural bezoar, tiger whips, bear PAWS, saffron, musk deer, whip, red ginseng, wild ganoderma lucidum, rhino horns, etc.

DuJinHang said, precious traditional not completely can not be used, but generally speaking, there is really no need to patients. The efficacy of a drug, and is suitable for the strong critical and emergency patients. These big improper use of the materials for not only can't cure, still can cause body unwell and even poisoning occurred. Clinical go up common is not used properly, and kind of hemorrhage, elevated blood pressure.

With the ginseng, for example, has fill gas role, but eat when the requirements of the dosage of ginseng is very strict.

More than 30 taste or for traditional Chinese medicine DaChuFang

In fact, Chinese medicine DaChuFang contain two kinds of circumstances, is a pill, capsule of traditional Chinese medicine DaChuFang, additionally one kind is DaChuFang liquid form. In liquid form, for example, see a prescription, the size of a number of milliseconds and taste of the two aspects. DaChuFang should be said too much too miscellaneous, number of taste and conventional medicine who are far apart. Some DaChuFang a dose of medicine penchant for gout drug, regardless of duan fujin made.

Someone once on how much taste made a census count. One is the "treatise on febrile diseases" to ZhangZhongJing and synopsis of golden chamber of the two books formula statistics, an average of 3 ~ 7 each party to taste the Chinese traditional medicine in the majority, each party 10 or more gout drug and a small, 20 or more taste only one party. 2 it is to the latest version of traditional Chinese medicine colleges for teaching of the pharmacology, each party to statistics composing 4 to 8 taste the majority, the 15 or 20 taste, smell less or more only two party, and each party more than 20 taste were for pills.

This shows, historically, clinicians from the drugs in less than 10 each party most, each party shall taste the 10 to 20 flavour of some, each party 20 or more rare taste.

DuJinHang says, in the 70 s to the problem of traditional Chinese medicine DaChuFang was discussed. Later, the hospital to taste of prescription also had the related regulations. Set at that time, the old Chinese medicine shackled at no more than 20 kinds of medicinal prescription of Chinese medicine, and usually a prescription no more than 15 taste. 2000 years relevant regulations to be abolished. At present, including management department, hospitals and other aspects of Chinese medicine taste prescription volume was coercive; In medical school in the teaching material and not for strict regulation, composing principle only some standard.

One does not wish to disclose the name of a 3 armour hospital director general told reporters, physicians for a patient's prescription, with how many gout drug and with how many doses to decide, have always been without rules. Therefore, Chinese medicine not too good distinguish DaChuFang and small prescription, in addition, at present Chinese herbal medicine price soaring, leading to the doctors prescribe medicine also on the rise.

The sino-japanese friendship hospital, director of traditional Chinese medicine, said that while JiaLiQun oncology at present to the traditional Chinese medicine DaChuFang not a regulation, to taste the number is not provided, but in general, small prescription has about six gout drug, more prescription has 17 flavour of about 20 kinds of medicinal herbs, is larger, more than 30 flavour prescription can be DaChuFang. JiaLiQun had seen a friend's mother, for getting skin cancer, by local doctors prescribe medicine 156 flavour.

Performance income hook is basic reasons

Why many people are now open taste even in their 40 DaChuFang taste?

DuJinHang analysis, causing the reasons of this phenomenon is a driven economic interests. Now many of the hospital, especially small hospitals and private hospital management mode is the doctor have created economic performance and wage bonus hook, the doctor for hospital creation of the greater the economic performance of its individual income is higher. He revealed, DaChuFang appear the frequency have a rule that private clinics and private hospital there is little more than a hospital, and a small hospital than the big hospital; and Outside the hospital and clinic present more than Beijing and.

2 it is the doctor didn't really understand and treatment based on syndrome differentiation. Some people only to the knowledge of TCM is a little superficial understanding is popular, never mind what no duan fujin made prescription medicine, when not some "i-want-it-all" dozens of medicine, carelessly taste prescription opened out. Individual bad "providers", were not certified physician, only seen some books on with traditional Chinese medicine, and jump to HuChui blind plait, piling up a lot of drugs to deceive the people in the world, to display their work miracles.

JiaLiQun also remind patients, must beware use medicine doctor, and the tactics of the sea is the nature of the profit some units, had better choose regular hospital of traditional Chinese medicine and the department examination.

DuJinHang said, and treatment based on syndrome differentiation as the criterion of unconventional DaChuFang, the harm is multifaceted. DaChuFang adverse to the illness. In clinical practice problem, don't really like books so simple, clear, often than books is much more complicated. But more complicated problem also hold on to the main contradiction, solve the main problem. It is hard to imagine a taste of Chinese traditional medicine prescription forty or fifty how points duan fujin made.

JiaLiQun think, DaChuFang oerdoses caused by waste is self-evident. This will cause the human and the waste of money, also can cause the waste of natural resources. Although Chinese medicine prescription may not like the western medicine that precise, but still have a degree, the greater the prescription drug, is by no means the more the better. By common Chinese wolfberry, for example, the drug blindly contains dozens of monomer composition, if a dose of medicine contains kinds of medicinal word, that which contain of monomer component will be very large number. If some of these medicinal materials do not get the main disease patients, it is easy to have side effects, light person cause stomach upset, the person that weigh delay's condition.

mountain

Hangzhou focus on management DaChuFang Chinese traditional medicine

Face DaChuFang, recently hangzhou health bureau issued a notice: TCM doctor opens treatment of common disease, frequently-occurring disease, each drug prescriptions for general control in the 18 flavour, price control within 40 yuan within; At the same time should be controlled strictly rare medicinal materials use the indications, of all kinds of malignant tumor, systemic lupus erythematosus (sle), hemophilia, aplastic anemia, schizophrenia, kidney failure and medical insurance formulary disease treatment prescription can relax appropriately, in principle for each shall not exceed 50 yuan. Prescription

According to hangzhou health bureau in hangzhou to 23 public and private home of traditional Chinese medical treatment institutions nearly 3500 copies in Chinese medicine yinpian prescription investigation: each prescription medicine for less than 10 flavour accounted for 1% of drug use 20 to 30 taste flavour accounted for 47%, drug use 10 to 20 taste flavour 46%, more than 30 taste of 6%, some even as many as 40 taste.

In the prescription price, public medical institution of square value control overall reasonable, average party value is less than 50 yuan/post, most medical institutions and for the price control prescription in within 200 yuan. And some private medical institutions "DaChuFang", price is on the high side phenomenon is obvious.

In this notice, hangzhou health bureau also requires the district or county public health administrative department, regular medical institution within areas under their jurisdiction of traditional Chinese medicine yinpian prescription management situation, prescribing the supervision of profited of the medical institutions and doctors to perform criticized, and if the circumstances are flagrant to delay for calibration, pause.

Countermeasures article

Experts to deal with Chinese traditional medicine "DaChuFang" support

Curator of 1

Promote the clinical pathway

Want to conquer the DaChuFang and is currently in the western medicine common problem of the pilot clinical pathway is also being used in the medical profession. Recently, the state administration of traditional Chinese medicine in zhuhai of guangdong province traditional Chinese medicine clinical pathway management at work related diseases, the pilot of the traditional Chinese medicine clinical pathway and diagnosis and treatment of pilot scheme hospitals in the training.

The so-called "clinical pathway is by doctors, nurses and other professionals on a specific group of diagnosis and surgery of the most appropriate, a sequence and timing of health care plan, it for examination and treatment project, order and made specific time are limited, and set up a set of standardized treatment mode.

Participate in the clinical pathway and diagnosis and treatment of the regulations of sino-japanese friendship hospital, director of traditional Chinese medicine, said JiaLiQun oncology at the clinical pathway can not only control DaChuFang, control, and the improvement and the rational use of drugs not stable treatment effect; Can also the most advanced treatment quickly spread to the hospital at the county level and the remote areas.

With diabetes, for example, due to various hospitals and doctor to the interpretation of the test results have their own standard, result in a patient in the hospital inspection results are not comparable with each other, I can't judge patient condition and control condition, go against the development of determine treatment. If according to the uniform clinical diagnosis and treatment, the path medical institutions and the doctor to the patient condition and treatment is the unity of the evaluation of the basis for patients, doctors determine next treatment options can be targeted.

According to reporter understanding, according to the state administration of traditional Chinese medicine "Chinese clinical pathway management plan" pilot, the state administration of traditional Chinese medicine in the "eleventh five-year plan" key specialty cooperative construction unit and the member unit of 329 hospitals 765 clinical departments have been included in Chinese medicine clinical pathway pilot limits; The first pilot encephalopathy, 22, 95 kinds of diseases in traditional Chinese medicine clinical pathway, each department will take at least a disease of experiments. Pilot work will spend about one year, and explore the clinical pathway set up for hospital management system and the working pattern, operation mechanism and quality evaluation and continuous improvement system, for in the nationwide scale by experience.

The state administration of traditional Chinese medicine officials say, the Chinese medicine effective method through the clinical pathway is extended, can reduce medical process of arbitrary in medical expenses, controlled, curative effect can expect, but also can prevent the omissions and misdiagnosed, delay the phenomenon such as disease happening.

However, guangdong hospital in as early as 2002 began to introduce a clinical pathway management ideas. In 2007, the hospital will bear the state administration of traditional Chinese medicine research special-seven disease to develop traditional Chinese medicine diagnosis and treatment scheme based on the best clinical pathway of common technology research. Guangdong hospital of YangZhiMin, vice President of the once in accept media interviews that, our country of clinical pathway of traditional Chinese medicine and traditional Chinese medicine is in groping stage clinical pathway in the formulation and implementation process in some difficulties and problems to further researching.

YangZhiMin said, TCM syndrome differentiation and curative effect evaluation of the process of the objective there exist certain obstacles. At present, Chinese medicine diagnosis standard although there are certain norms enacted, but in specific clinical still lack of objectivity, and artificial, subjective factors in the present TCM syndrome differentiation ShiZhiZhong to completely standardization, so, how to try to make the standardization of clinical diagnosis and treatment of traditional Chinese medicine, hospital clinical pathway is the biggest obstacle. In the therapeutic effect evaluation is also an issue. He thinks that, in order to overcome this problem, must be explicitly into the common diseases, the most common USES to the traditional Chinese medicine clinical pathway into USES as the standard, and for more rare, with variations USES for records and solve. Use of clinical pathway of TCM and western medicine is also a very good combining site, in clear disease differentiation on syndrome differentiation and treatment on the basis of, the targeted, save medical resources, but also be on the effect of TCM treatment preliminary evaluation.

In addition, at present on the introduction of the traditional Chinese medicine clinical pathway to the strengthening of doctor-patient communication's preparations is not enough also. YangZhiMin pointed out that at present, only to provide medical personnel, and no single clinical pathway for reading and access to patients with clinical pathway single Chinese clinical path after implementing the more convenient to the advantages of doctor-patient communication can't reflected.

There are parts of the traditional Chinese medicine doctors say, the implementation of clinical pathways for the doctor to narrow the independent of diagnosis and treatment, appear "very mechanical space". To this, JiaLiQun think, a clinical pathway is a tricky thing, use this mode, and must take account of the patient's individual needs, should not see it as a fixed template, attention should be paid to the clinical variations. At the same time, the clinical pathway will be professional young doctor accepted, but also cannot rule out individual factions and a doctor's treatment and characteristics. Only in this way can we ensure that curative effect of traditional Chinese medicine, play simple easy to cream characteristics.

Strategy 2 to

Traditional Chinese medicine diagnosis and treatment standardized

JiaLiQun lead the group, was responsible for the traditional Chinese medicine clinical pathway set of esophageal cancer. JiaLiQun revealed, June 15,, the state administration of traditional Chinese medicine to organize an expert of the esophagus cancer, including he is responsible for the 17 kinds of diseases diagnosis and treatment on the path review. In the review process, experts will be listed in the path of each prescription and every kinds of medicinal inquire the audit, every kinds of medicinal use to say why, if not suitable reason, this flavour medicine will be removed.

At present, the JiaLiQun responsible esophageal cancer clinical pathway plan has been basically established, the next step will be in the home to 20, in the process of popularization group promotion will continuously improve after modification, to be finalised.

He said, the traditional medical model by a doctor according to the individual's experience, knowledge to make a diagnosis and treatment plan, does not have uniform standard, although pay attention to "individual", but also not cause chaos in the medical behavior and difficult to assess the quality of medical care. And the clinical pathway is a comprehensive industry in the expert opinion, work out a recognized standard diagnosis and treatment process, asked people in accordance with this standard path as far as possible to carry out the medical work to the disease, optimal treatment.

Our correspondent YeZhou