以實證研究及相關文獻探析痤瘡之中醫「辨體」「辨病」「辨證」治療觀

Identification of Constitution, Disease, and Syndrome of Traditional Chinese Medicine with Evidence Based Articles and Related literature Review

藉由實證文獻的探討，希望能統合「辨體」、「辨病」、和「辨證」三個面向，取其系脈相承之益，以利於一窺中醫對痤瘡治療的全貌，並提供臨床實務遣方用藥的參考。本研究檢索近10年來（2007至2016年），有關痤瘡的中醫「辨體」、「辨病」、「辨證」文獻共1,043篇，篩選納入其中具備實證之臨床研究文獻6篇，及敘述性綜論文獻6篇，進行探討分析。文獻分析結果，患者體質以「濕熱質」最常見；病位在肺，肺腸合病可能是主要病因，病機與「肺與大腸相表裡」有關；證型與體質並非總是一致，痤瘡的主要四個基本證型為肺經風熱、脾胃濕熱、衝任失調、痰瘀凝結，處方常選用清熱解毒、涼血祛濕類方藥，其中衝任失調證型，運用中藥人工週期法，可調節血清的性激素濃度，使復發率降低，並緩解兼症。本實證文獻探討，可提供臨床實務有關痤瘡未病防治，以及既病防變的調養依據。

In this evidence based review study, the authors hope to integrate the identification of constitution, disease, and syndrome patterns in order to achieve a holistic view of TCM in the treatment of acne in our clinical practice. There are 1,043 relevant articles retrieved regarding to the identification of constitution, disease, and syndrome of Traditional Chinese Medicine(TCM) in the treatment of acne in recent 10 years (2007-2016). Among them, 6 evidence based clinical research articles and 6 narrative review articles were enrolled in this study for analysis. Our results showed that dampness-heat constitution is the most common constitution, and lung is the main disease location. Lung and the large intestine are closely related in the mechanism of disease. The syndrome pattern is not always correlative with the constitution. There are four main (common) syndrome types of acne: (1) wind-heat in lung meridian, (2) spleen and stomach damp heat, (3) disharmony of the thoroughfare and conception vessels and (4) blood stasis- phlegm congealing coagulated. The common prescriptions are mainly for heatclearing, detoxification, blood-cooling and dampness-dispelling medicine. The use of TCM artificial cycle treatment can regulate the level of sex hormone, reduce the recurrence rate, and alleviate symptoms for women with acne due to disharmony of the thoroughfare and conception vessels. The results of this evidence based review study may provide guidance for prevention of disease and control of ongoing disease in the treatment of acne in our clinical practice.