異位性皮膚炎的中西醫觀點與相關實證研究進展

Atopic Dermatitis from the TCM Perspective and the Related Evidence-based Research Progress

異位性皮膚炎是一常見且具有遺傳傾向的過敏性皮膚病，在台灣的盛行率約為8~10%。此並和古代文獻描述「奶癬」、「濕瘡」、「浸淫瘡」、「四彎風」、「血風瘡」等相類似。臨床皮膚表現依年齡層分成三個階段，中醫認為本病先天稟賦不足，加上後天失調，與脾、心、肝關係密切，濕、風、熱、瘀為其主要表現，而脾虛濕盛貫穿病史。基礎醫學研究發現此病與皮膚屏受損，免疫系統功能異常和超抗原的免疫有關。在中醫的辨證分型治療上可以分成風熱夾濕、濕熱蘊積、脾虛濕蘊、血虛風燥四個主要證型，常用方劑包括消風散、消風導赤湯、龍膽瀉肝湯、萆薢滲濕湯、除濕胃苓湯、當歸飲子、養血定風湯等。目前的西醫治療以局部保濕與藥膏，配合口服抗組織胺、抗生素或類固醇治療為主。同時我們介紹了目前幾個較為嚴謹的實證醫學研究相關文獻和臨床試驗。整體而言，中藥在治療異位性皮膚炎有其療效存在，未來可設計更完整的雙盲臨床對照研究，探討中藥治療異位性皮膚炎臨床療效與作用機轉。

Atopic dermatitis is a common allergic skin disorder with inheritance. The prevalence rate of atopic dermatitis in Taiwan is around 8-10%. It is similar to the syndrome such as 'milk ringworm', 'eczema', 'nappy rash', 'wind of four fossae', 'itching eruption due to blood-heat or wind-heat' that described in the traditional Chinese medicine books. The clinical manifestations include three phases by age group. It often happens to those who are congenital deficient or lack of proper postnatal care. According to the viewpoint of TCM, the occurrence of atopic dermatitis is supposed to be closely related to the liver, heart and spleen. The main performance includes wind, heat, dampness and stagnation. The medical history is usually focused on the dampness-retention due to spleen deficiency. Basic medical research showed that the occurrence of atopic dermatitis is related to the destruction of skin barrier function, the disorders of the immune system, and the immune response to the super-antigen. Based on TCM syndrome differentiation treatment, there are four syndrome types of 'wind-heat accompanied with dampness', 'dampness-heat accumulation', 'spleen deficiency damp retention' and 'blood deficiency and wind-dry'. The usually used TCM prescriptions include 'Xiaofeng San', 'Xiaofeng Daochi Tang', 'Longdan Xiegan Tang', 'Beixiao Shenshi Tang', 'Chushi Weiling Tang', 'Danggui Yinzi' and 'Yangxue Dingfeng Tang'. The main method of western medical treatment on atopic dermatitis is local hydration and ointment application accompanied with oral antibiotics, antihistamines or steroid. In this study, we also introduced several more stringent related literatures and clinical trials which were based on evidence-based medical research. Taken as a whole, some more complete double-blind researches on the clinical treatment efficiency of TCM treatment on atopic dermatitis should be developed since TCM treatment on atopic dermatitis is effective.