《現代中藥調劑產業發展路線思考》論文發表

中藥調劑是最基礎的中醫臨床藥學工作，在古代有“合藥分劑”“合和”“合劑”等名稱。歷史上“前店后廠”“醫藥一體”的發展模式，決定了中藥調劑與中醫處方同等重要。傳統的中藥調劑已形成了一系列關鍵技術，包括中藥鑒別技術、中藥飲片傳統炮制技術、中藥調劑操作技術等。如何繼承傳統調劑技術，發展融合現代藥學服務理念的中藥調劑模式，是中藥調劑現代產業發展的重要問題。

圖1 意式中要(yao)專業調劑產業群發(fa)展趨勢(shi)自駕(jia)線路考量

（注：只能根(gen)據文(wen)章(zhang)知識收納）

一、中藥調劑產業發展現狀

民俗的(de)(de)中(zhong)(zhong)(zhong)(zhong)(zhong)(zhong)草(cao)(cao)(cao)(cao)(cao)(cao)藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)研究(jiu)生(sheng)調濟(ji)(ji)工作(zuo)(zuo)(zuo)于(yu)，大(da)多數衛生(sheng)院的(de)(de)中(zhong)(zhong)(zhong)(zhong)(zhong)(zhong)草(cao)(cao)(cao)(cao)(cao)(cao)藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)房抑或新(xin)開(kai)設(she)的(de)(de)藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)房，從(cong)拿(na)貨檢驗檢測(ce)、種(zhong)類別分分等(deng)級(ji)低溫干燥操作(zuo)(zuo)(zuo)、前提治理(li)藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)煎(jian)(jian)煮及(ji)其細料藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)、低毒(du)藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)的(de)(de)安全使用(yong)制約等(deng)均有要(yao)嚴(yan)格與(yu)務實求真的(de)(de)機制制約研究(jiu)生(sheng)調濟(ji)(ji)人(ren)數的(de)(de)工作(zuo)(zuo)(zuo)上。從(cong)19世紀(ji)經典70年份(fen)起(qi)，中(zhong)(zhong)(zhong)(zhong)(zhong)(zhong)草(cao)(cao)(cao)(cao)(cao)(cao)藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)研究(jiu)生(sheng)調濟(ji)(ji)域感受了(le)優(you)質人(ren)才斷檔、閘柜撤除、民俗研究(jiu)生(sheng)調濟(ji)(ji)高(gao)(gao)水(shui)(shui)(shui)平(ping)丟(diu)棄等(deng)操作(zuo)(zuo)(zuo)時，，又日(ri)常化醫(yi)藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)學醫(yi)藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)學工作(zuo)(zuo)(zuo)于(yu)核心理(li)念與(yu)高(gao)(gao)水(shui)(shui)(shui)平(ping)，為一種(zhong)域獲取新(xin)的(de)(de)內(nei)在(zai)，中(zhong)(zhong)(zhong)(zhong)(zhong)(zhong)草(cao)(cao)(cao)(cao)(cao)(cao)藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)研究(jiu)生(sheng)調濟(ji)(ji)域漸(jian)次向(xiang)現如(ru)今(jin)化轉型，至關重要(yao)構成了(le)中(zhong)(zhong)(zhong)(zhong)(zhong)(zhong)草(cao)(cao)(cao)(cao)(cao)(cao)藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)相(xiang)對性狀分辨(bian)高(gao)(gao)水(shui)(shui)(shui)平(ping)、中(zhong)(zhong)(zhong)(zhong)(zhong)(zhong)草(cao)(cao)(cao)(cao)(cao)(cao)藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)醫(yi)藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)學煎(jian)(jian)煮高(gao)(gao)水(shui)(shui)(shui)平(ping)、中(zhong)(zhong)(zhong)(zhong)(zhong)(zhong)草(cao)(cao)(cao)(cao)(cao)(cao)藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)治理(li)藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)審批高(gao)(gao)水(shui)(shui)(shui)平(ping)、中(zhong)(zhong)(zhong)(zhong)(zhong)(zhong)草(cao)(cao)(cao)(cao)(cao)(cao)藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)治理(li)藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)應付款高(gao)(gao)水(shui)(shui)(shui)平(ping)、中(zhong)(zhong)(zhong)(zhong)(zhong)(zhong)草(cao)(cao)(cao)(cao)(cao)(cao)藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)發藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)說出高(gao)(gao)水(shui)(shui)(shui)平(ping)、中(zhong)(zhong)(zhong)(zhong)(zhong)(zhong)草(cao)(cao)(cao)(cao)(cao)(cao)藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)醫(yi)藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)學煎(jian)(jian)煮高(gao)(gao)水(shui)(shui)(shui)平(ping)、中(zhong)(zhong)(zhong)(zhong)(zhong)(zhong)草(cao)(cao)(cao)(cao)(cao)(cao)藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)研究(jiu)生(sheng)調濟(ji)(ji)生(sheng)產商高(gao)(gao)水(shui)(shui)(shui)平(ping)、中(zhong)(zhong)(zhong)(zhong)(zhong)(zhong)草(cao)(cao)(cao)(cao)(cao)(cao)藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)采購合(he)同(tong)操作(zuo)(zuo)(zuo)高(gao)(gao)水(shui)(shui)(shui)平(ping)、中(zhong)(zhong)(zhong)(zhong)(zhong)(zhong)草(cao)(cao)(cao)(cao)(cao)(cao)藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)低溫干燥養生(sheng)高(gao)(gao)水(shui)(shui)(shui)平(ping)等(deng)九項(xiang)至關重要(yao)高(gao)(gao)水(shui)(shui)(shui)平(ping)。在(zai)中(zhong)(zhong)(zhong)(zhong)(zhong)(zhong)草(cao)(cao)(cao)(cao)(cao)(cao)藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)研究(jiu)生(sheng)調濟(ji)(ji)轉型操作(zuo)(zuo)(zuo)時中(zhong)(zhong)(zhong)(zhong)(zhong)(zhong)，與(yu)中(zhong)(zhong)(zhong)(zhong)(zhong)(zhong)醫(yi)婦科師(shi)(shi)的(de)(de)治理(li)藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)意向(xiang)是指“理(li)、法、方(fang)、藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)”相(xiang)匹配，漸(jian)次轉型為中(zhong)(zhong)(zhong)(zhong)(zhong)(zhong)草(cao)(cao)(cao)(cao)(cao)(cao)藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)師(shi)(shi)涉及(ji)治理(li)藥(yao)(yao)(yao)(yao)(yao)(yao)(yao)(yao)意向(xiang)需有“質、工、劑、效”工作(zuo)(zuo)(zuo)于(yu)結構框架(jia)。同(tong)樣(yang)，各處分高(gao)(gao)水(shui)(shui)(shui)平(ping)漸(jian)次與(yu)現如(ru)今(jin)自動化設(she)備、圖(tu)(tu)片信(xin)息、智力高(gao)(gao)水(shui)(shui)(shui)平(ping)容(rong)合(he)，呈現組織變(bian)革（見圖(tu)(tu)2）。

圖(tu)2 中西藥專業(ye)調(diao)劑服務業(ye)趨勢示(shi)圖(tu)圖(tu)

1.1 采購驗收環節技術的發展

中藥飲片的采購驗收是保障醫院藥品質量的關鍵環節，如何杜絕偽劣藥品流入醫療機構，成為當前醫療機構面臨的重大挑戰之一。在中藥調劑采購環節，國家藥品供應保障綜合管理信息平臺、省級藥品集中采購平臺保障了醫院、醫保經辦機構、價格主管部門等信息數據互聯互通與資源共享；醫藥電子商務交易平臺、網絡藥品集中采購平臺等平臺的建設簡化了中藥的采購流程，提升了采購過程的透明度。在驗收入庫和貯存養護環節，基于條形碼技術和無線射頻技術的電子揀選設施設備，與HIS系統建立安全數據接口服務，實現從入庫、揀選，到出庫、藥房收貨、盤點的進、銷、存全程信息化操作，顯著降低了人力資源成本，提升了工作效率；通過引入溫濕度控制系統、冷藏藥品冷鏈管理系統，對特殊貯存條件的藥品進行實時監控、預警及超常警報，可以保證藥品原始記錄的真實性和可追溯性，提升醫療機構藥品管理水平，保障了中藥質量。

1.2 中藥調配復核環節技術與設備的發展

中藥調配環節是藥師將藥品配發給患者的關鍵環節，中藥調配過程中的軟件主要有前置審方系統、中藥調劑管理系統、藥物警戒系統。

1.3 中藥煎煮技術和設備的發展

1.4 發藥交代環節技術的發展

二、中藥調劑產業現存問題與解決策略

2.1中藥調劑技術規范化體系亟待完善

中藥調劑產業的高質量發展，需要一系列標準對中藥質量、調劑服務以及調劑設備等進行規范，達到產品與服務的同質化，適合于行業推廣。在中藥質量方面，需要對中藥湯劑的煎煮過程、湯劑成品質量快速檢測等方面建立科學合理的質量控制體系與評價標準。在調劑服務方面，中藥飲片用藥規則仍存在各地不統一問題、中藥飲片條碼技術尚未形成統一規范，亟待進行標準建設。現代發展起來的中藥代煎服務，在煎煮設備、浸泡時間、煎煮加水量、煎煮次數、先煎后下藥處理等環節，均缺乏科學合理的操作標準，亟須建立“等效代煎”的系列操作規范。在調劑設備方面，需要進一步研制適合中藥調劑特點的調劑設備與操作規范，以提高中藥調劑的效率和質量，解放中藥調劑從業人員的雙手。

2.2 中藥調劑產業可持續發展需培養醫工交叉的新醫科人才

隨著中醫藥服務在國內普及、國外推廣，中藥調劑人才緊缺成為行業面臨的挑戰，各地區衛生人員均面臨很大的壓力與挑戰。中醫藥臨床療效的發揮離不開調劑人員的輔助，對調劑人才的培養成為產業高質量發展的基石。應培養中藥調劑與信息化交叉學科人才，以便能及時發現問題，便于改進，形成“實踐到理論”“應用反饋促進設備研發與改進”的良好循環。中藥調劑與信息化交叉學科人才的培養應同步進行，最終需要形成“中藥調劑人才、中藥調劑與信息化交叉學科人才同步培養”的新格局。現階段的中藥調劑教育內容與教育模式很難適應新醫工交叉的發展需求，因此在中藥調劑新技術與新設備的標準體系基礎上，引入虛擬仿真技術、擴展現實（ExtendedReality，XR）等人工智能技術手段，探索虛擬仿真與慕課相結合的調劑人才培養新模式，有利于培養新時代醫工交叉的新醫科人才。

2.3 中藥調劑信息化智能化需發展適合基層推廣的新業態

中藥飲片、中藥配方顆粒調劑的新型智能化裝備逐漸面市，可高效、整潔、自動化完成中藥產品的調劑工作。在智能化裝備高速發展的背景下，中藥飲片、湯劑、顆粒劑、中成藥等產品均需要依賴調劑裝備，以滿足大范圍、多元化的藥品供應需求。圍繞患者合理服用中藥所開展的發藥與用藥交代環節技術持續發展，智能信息系統的藥囑服務技術亟待完善。

三、結語與展望

新(xin)(xin)(xin)現代化(hua)(hua)(hua)(hua)中(zhong)(zhong)要(yao)(yao)的(de)(de)(de)消毒產(chan)(chan)品類形優(you)(you)化(hua)(hua)(hua)(hua)、互聯網營銷模(mo)試(shi)思維力(li)(li)化(hua)(hua)(hua)(hua)，中(zhong)(zhong)要(yao)(yao)研(yan)(yan)究(jiu)(jiu)(jiu)生(sheng)(sheng)(sheng)(sheng)研(yan)(yan)究(jiu)(jiu)(jiu)生(sheng)(sheng)(sheng)(sheng)專(zhuan)業(ye)調(diao)(diao)(diao)濟(ji)(ji)(ji)的(de)(de)(de)房產(chan)(chan)經(jing)(jing)濟(ji)(ji)(ji)發(fa)(fa)展(zhan)(zhan)(zhan)必(bi)須要(yao)(yao)產(chan)(chan)品、防(fang)具(ju)、優(you)(you)秀(xiu)人才等多房產(chan)(chan)行業(ye)縱深融成。率先，在“以患病(bing)者為管(guan)理中(zhong)(zhong)心”的(de)(de)(de)醫療(liao)器械(xie)學(xue)提(ti)(ti)供(gong)售(shou)(shou)(shou)后(hou)(hou)(hou)安(an)(an)(an)(an)(an)全(quan)(quan)(quan)(quan)安(an)(an)(an)(an)(an)全(quan)(quan)(quan)(quan)服(fu)務(wu)于(yu)(yu)(yu)培訓(xun)管(guan)理理念(nian)的(de)(de)(de)深入(ru)細致的(de)(de)(de)影響下，中(zhong)(zhong)要(yao)(yao)研(yan)(yan)究(jiu)(jiu)(jiu)生(sheng)(sheng)(sheng)(sheng)研(yan)(yan)究(jiu)(jiu)(jiu)生(sheng)(sheng)(sheng)(sheng)專(zhuan)業(ye)調(diao)(diao)(diao)濟(ji)(ji)(ji)必(bi)須要(yao)(yao)創(chuang)(chuang)(chuang)立(li)(li)和(he)創(chuang)(chuang)(chuang)立(li)(li)建(jian)全(quan)(quan)(quan)(quan)和(he)創(chuang)(chuang)(chuang)立(li)(li)建(jian)全(quan)(quan)(quan)(quan)具(ju)有(you)著中(zhong)(zhong)醫藥廣州特色發(fa)(fa)揚光大的(de)(de)(de)新(xin)(xin)(xin)產(chan)(chan)品，一(yi)并(bing)融成生(sheng)(sheng)(sheng)(sheng)物制品技(ji)(ji)能(neng)和(he)消息技(ji)(ji)能(neng)科(ke)學(xue)技(ji)(ji)術水平(ping)創(chuang)(chuang)(chuang)立(li)(li)和(he)評判中(zhong)(zhong)國傳統中(zhong)(zhong)要(yao)(yao)湯劑高質量(liang)。第二(er)(er)步，中(zhong)(zhong)要(yao)(yao)研(yan)(yan)究(jiu)(jiu)(jiu)生(sheng)(sheng)(sheng)(sheng)研(yan)(yan)究(jiu)(jiu)(jiu)生(sheng)(sheng)(sheng)(sheng)專(zhuan)業(ye)調(diao)(diao)(diao)濟(ji)(ji)(ji)必(bi)須要(yao)(yao)“產(chan)(chan)-學(xue)-研(yan)(yan)-用”整體化(hua)(hua)(hua)(hua)經(jing)(jing)濟(ji)(ji)(ji)發(fa)(fa)展(zhan)(zhan)(zhan)，創(chuang)(chuang)(chuang)新(xin)(xin)(xin)性中(zhong)(zhong)要(yao)(yao)研(yan)(yan)究(jiu)(jiu)(jiu)生(sheng)(sheng)(sheng)(sheng)研(yan)(yan)究(jiu)(jiu)(jiu)生(sheng)(sheng)(sheng)(sheng)專(zhuan)業(ye)調(diao)(diao)(diao)濟(ji)(ji)(ji)新(xin)(xin)(xin)技(ji)(ji)能(neng)與新(xin)(xin)(xin)機 ，并(bing)創(chuang)(chuang)(chuang)立(li)(li)新(xin)(xin)(xin)形態提(ti)(ti)供(gong)售(shou)(shou)(shou)后(hou)(hou)(hou)安(an)(an)(an)(an)(an)全(quan)(quan)(quan)(quan)安(an)(an)(an)(an)(an)全(quan)(quan)(quan)(quan)服(fu)務(wu)于(yu)(yu)(yu)培訓(xun)模(mo)試(shi)的(de)(de)(de)條件管(guan)理體制。到最后(hou)(hou)(hou)，中(zhong)(zhong)要(yao)(yao)研(yan)(yan)究(jiu)(jiu)(jiu)生(sheng)(sheng)(sheng)(sheng)研(yan)(yan)究(jiu)(jiu)(jiu)生(sheng)(sheng)(sheng)(sheng)專(zhuan)業(ye)調(diao)(diao)(diao)濟(ji)(ji)(ji)需轉化(hua)(hua)(hua)(hua)醫工交差智(zhi)力(li)(li)化(hua)(hua)(hua)(hua)的(de)(de)(de)方法，進一(yi)步推動了(le)研(yan)(yan)究(jiu)(jiu)(jiu)生(sheng)(sheng)(sheng)(sheng)研(yan)(yan)究(jiu)(jiu)(jiu)生(sheng)(sheng)(sheng)(sheng)專(zhuan)業(ye)調(diao)(diao)(diao)濟(ji)(ji)(ji)提(ti)(ti)供(gong)售(shou)(shou)(shou)后(hou)(hou)(hou)安(an)(an)(an)(an)(an)全(quan)(quan)(quan)(quan)安(an)(an)(an)(an)(an)全(quan)(quan)(quan)(quan)服(fu)務(wu)于(yu)(yu)(yu)培訓(xun)與幼(you)(you)兒的(de)(de)(de)教育的(de)(de)(de)二(er)(er)次創(chuang)(chuang)(chuang)業(ye)在線升級(ji)，于(yu)(yu)(yu)是(shi)優(you)(you)化(hua)(hua)(hua)(hua)中(zhong)(zhong)醫藥便(bian)民利(li)民便(bian)民提(ti)(ti)供(gong)售(shou)(shou)(shou)后(hou)(hou)(hou)安(an)(an)(an)(an)(an)全(quan)(quan)(quan)(quan)安(an)(an)(an)(an)(an)全(quan)(quan)(quan)(quan)服(fu)務(wu)于(yu)(yu)(yu)培訓(xun)工作(zuo)能(neng)力(li)(li)。借(jie)助創(chuang)(chuang)(chuang)立(li)(li)建(jian)全(quan)(quan)(quan)(quan)中(zhong)(zhong)醫藥理學(xue)醫療(liao)器械(xie)學(xue)提(ti)(ti)供(gong)售(shou)(shou)(shou)后(hou)(hou)(hou)安(an)(an)(an)(an)(an)全(quan)(quan)(quan)(quan)安(an)(an)(an)(an)(an)全(quan)(quan)(quan)(quan)服(fu)務(wu)于(yu)(yu)(yu)培訓(xun)游戲內容(rong)、經(jing)(jing)濟(ji)(ji)(ji)發(fa)(fa)展(zhan)(zhan)(zhan)中(zhong)(zhong)要(yao)(yao)研(yan)(yan)究(jiu)(jiu)(jiu)生(sheng)(sheng)(sheng)(sheng)研(yan)(yan)究(jiu)(jiu)(jiu)生(sheng)(sheng)(sheng)(sheng)專(zhuan)業(ye)調(diao)(diao)(diao)濟(ji)(ji)(ji)新(xin)(xin)(xin)技(ji)(ji)能(neng)與新(xin)(xin)(xin)防(fang)具(ju)、優(you)(you)化(hua)(hua)(hua)(hua)研(yan)(yan)究(jiu)(jiu)(jiu)生(sheng)(sheng)(sheng)(sheng)研(yan)(yan)究(jiu)(jiu)(jiu)生(sheng)(sheng)(sheng)(sheng)專(zhuan)業(ye)調(diao)(diao)(diao)濟(ji)(ji)(ji)提(ti)(ti)供(gong)售(shou)(shou)(shou)后(hou)(hou)(hou)安(an)(an)(an)(an)(an)全(quan)(quan)(quan)(quan)安(an)(an)(an)(an)(an)全(quan)(quan)(quan)(quan)服(fu)務(wu)于(yu)(yu)(yu)培訓(xun)與幼(you)(you)兒的(de)(de)(de)教育技(ji)(ji)術水平(ping)，一(yi)般進一(yi)步推動了(le)中(zhong)(zhong)要(yao)(yao)研(yan)(yan)究(jiu)(jiu)(jiu)生(sheng)(sheng)(sheng)(sheng)研(yan)(yan)究(jiu)(jiu)(jiu)生(sheng)(sheng)(sheng)(sheng)專(zhuan)業(ye)調(diao)(diao)(diao)濟(ji)(ji)(ji)新(xin)(xin)(xin)現代化(hua)(hua)(hua)(hua)房產(chan)(chan)的(de)(de)(de)條件化(hua)(hua)(hua)(hua)、消息化(hua)(hua)(hua)(hua)、智(zhi)力(li)(li)化(hua)(hua)(hua)(hua)經(jing)(jing)濟(ji)(ji)(ji)發(fa)(fa)展(zhan)(zhan)(zhan)。