僵直性脊椎炎之中醫藥文獻回顧

A Literature Review of Traditional Chinese Medicine for Ankylosing Spondylitis

僵直性脊椎炎在中醫歸屬於痹證，主要為自體免疫系統失常引起，好發於脊椎及下背部，患者普遍認為現行常規療法存在療效不佳及藥物副作用等問題，因此近年來許多患者紛紛尋求中醫藥、針灸、替代醫療以改善病情。本文利用中華醫典、中國期刊全文數據庫、PubMed及臺灣期刊論文索引等資料庫，搜尋1980年至2016年間國內外相關中醫藥治療僵直性脊椎炎之文獻，希望藉由文獻回顧傳統中醫理論、辨證論治及現代生物醫學等中西醫整合觀點，重新梳理與探究僵直性脊椎炎之中醫藥理論與辨證治療，以期能提供現行中醫藥治療之參考。文獻分析結果顯示研究使用之方劑與中藥大部分具有抗發炎、免疫調控及降低氧化壓力之作用，因此相關中藥及針刺方式可透過上述作用達到改善臨床症狀及相關指標之療效。但由於文獻提到多數中醫藥臨床研究缺乏嚴謹之研究設計方法、對中醫療效評估及生物醫學指標尚無共識、中醫證型尚未統一。因此，未來也需要有規範嚴謹之臨床試驗來證實中醫藥之療效，並研究治療方劑及中藥之機轉，將可提供僵直性脊椎炎中醫診療之實證醫學證據。

Ankylosing spondylitis (AS) is classified to ＂Bi pattern＂ in traditional Chinese medicine (TCM), which the pathogenesis focus in the dysregulation of immune system, the lesions usually involved in vertebra and low back. Many AS patients received conventional medicine with poor efficacy, drug relatedside effect and higher cost of healthcare, so the patients seek Chinese herbal medicine, acupuncture and complementary and alternative medicine for reliving these conditions. In this article, we used the database of ＂Zhonghua-Yidian＂, ＂China Academic Journals Full-text Database＂, ＂PubMed＂, and ＂Index to Taiwan Periodical Literature System＂ to search the literatures from year 1980 to 2016 for AS treatment of TCM. And we wanted to review and organize the TCM theory, pattern identification as the basis for determining treatment, and modern biomedical studies for the TCM integrative therapies in AS. The results showed many TCM formula and single herbs had potential function of antiinflammation, immune modulation and anti-oxidation, which the herbal medicine and acupuncture could improve the clinical manifestation and related biomarker with these function. However, these TCM formula and single herbs lacked of well- defined clinical trial design, the consensus of therapeutic endpoint and biomarker, and variance TCM pattern. Hence, we need well-defined clinical trials and the studies of mechanism for these drugs; it could provide some evidence in TCM for AS.