中藥（疏經活血湯）治療類風濕關節炎之有效性及其可能機轉

THE EFFICACY AND POSSIBLE MECHANISMS OF SUCHING-- HUO- HSUEI- TANG IN RHEUMATOID ARTHRITIS

為了瞭解傳統中藥對類風濕關節炎之有效性及其可能作用之機轉，本科從早先 使用一種治療關節炎之中藥一疏經活血湯去進行臨床及實驗室檢查之評估。其研究結果顯示，疏經活血湯使用于臨床10例較嚴重類風濕關節炎之患者，發現用藥後，不論對晨間僵硬、疼痛、手握力試驗、50呎步行時間、疼痛關節總數及關節壓痛指數等皆有明顯地助益，且無明顯之副作用。另外，將疏經活血湯以Butanol抽取後所分出之水層及Butanol層，發現二者不論給患者服用，或在體外進行試驗，皆有明顯地抑制中性白血球趨化功能(p<0.05)。對血小板聚集功能測試，病人服用中藥前後，並無明顯差別(p<0.05)，而在體外試驗，則疏經活血湯可抑制血小板聚集作用，且與中藥濃度相關－－即濃度愈高，抑制作用最強。除上述外，疏經活血湯（水層）如與正常人淋巴球作體外培養，發現可減少PHA或ConA刺激淋巴球所產生第二介白質(IL-2)之數量。上述的結果顯示疏經活血湯確對臨床類風濕關節炎有效，而其有效之機轉，可能為多層面，包括不同發炎細胞之抑制作用等。

Concerning the high incidence of rheumatoid arthritis (RA) in Taiwan, one Chinese herbal formula- suching- huo- hsuei- tang (SCHHT) was prepared under stepwise quality control and then subjected to the clinical and laboratory studies, in a view to evaluate the treatment efficacy and the possible mechanism of herb on RA. The results showed SCHHT was observed with a significant clinical response for RA. In comparison with Western medicine, SCHHT have less toxicities to GI, skin or CNS systems but take a slow onset of action. For laboratory studies, after herb (butanol and H20 layer) administration, neutrophil chemotaxis was significantly inhibited, resembling the result of colchicine (P< 0.05). The platelet aggregation test before and after herb taking in RA patients did not show the difference. However, in vitro study, herb could significantly decrease platelet aggregation and the response was dose-related. Besides, the PH A-stimulated lymphocyte IL-2 production was reduced after coculture of herb with lymphocyte. Those findings suggest that SCHHT are very promising to be used in RA and the possible mechanisms of herb are multifactorial.