中草藥轉骨之近代研究進展

Development of Recent Research on the Tńg-Kut Herbal Medicine

轉骨方劑包含傳統中藥與在地草藥，應用於促進青春期間的生長發育，為台灣特有經驗。本文之目的將探討青春期的骨骼變化與轉骨中草藥之藥理作用、以供臨床上的應用。青春期的骨骼改變包含縱向骨生長與骨礦獲取，其高峰發生時間先後依序為縱向生長高峰與骨礦獲取高峰。生理改變以譚納階段（Tanner stage，T）作評估比年齡時間軸更為恰當。青春期時生長突增期男性約於起始於T2，於T3-4達到生長高峰；女性同樣起始於T2，在T2-3達到生長高峰。據研究顯示杜仲、砂仁、竹茹與方劑Jaoga-Yukmiwon（R）、HT042、Bojungikgitang-gagambang具有促進骨縱向生長效果，這類中草藥適合於T2開始使用。無論是男性或女性，約25％的骨質於骨礦獲取高峰期鄰近2年內累積，男性約於T3-5，女性於T2-4之間。男性骨礦獲取高峰期約接近T4，女性骨礦獲取高峰約於T3-4，接近初經來潮時期。促進骨獲取的中草藥包含杜仲、續斷、紅花、肉蓯蓉、冬蟲夏草、女貞子、補碎骨、補骨脂、巴戟天、地黃、九層塔與蚶殼草。以中醫而言，這些中草藥大部分具有補益肝腎效果。精準用藥時期男性約於T3-5，女性於T2-4之間。

The Tńg-Kut decoctions, applied for adelocence to promote physical growth and development during puberty, were composed of traditional Chinese medicines and native folk herbs, which is regarded as a widespread unique experience used in Taiwan. The objective of this review article is to investigate the clinical indication and pharmacological effects of the Tńg-Kut decoctions. The skeletal development consist of longitudinal change in linear growth and bone mineral gain during puberty. Physiological growth is more accurately evaluated by using Tanner Stages than by chronological age alone. Girls tend to get growth spurt at Tanner stage 2 and achieve peak height velocity during Tanner stage 2-3. The pubertal growth spurt in Boys begins at Tanner stage 2 and the peak height velocity occur during Tanner stage 3-4. Eucommia ulmoides, Amomum villosum, Phyllostachyos Caulis and the 3 dectoctions- Jaoga-Yukmiwon (R), HT042, Bojungikgitang-gagambang were recognized to have pharmacological effect to induce longitudinal bone growth, and the appropriate time for those herbal intervention in both adolescent Boys and Girls is after the onset of Tanner stage 2. It is estimated that one quarter of adult bone mass is accumulated in the two years surrounding peak bone mineral content velocity, which corresponds to Tanner stage 2-4 in girls and Tanner stage 3-5 in Boys.The peak bone mineral content velocity occurred at Tanner stage 4 in Boys, and at Tanner stage 3-4 in Girls coincided closely with the period at menarche. Eucommia ulmoides, Dipsacus asper, Carthamus tinctorius, Cistanche deserticola, Cordyceps sinensis, Drynaria fortune, Ligustrum lucidum, Morinda officinalis,Psoralea corylifolia, Rehmannia glutinosa, Ocimum basilicum, Centella asiatica were confirmed to possess the bone accural activicity. Most of these herbs were regarded as liver- and kidney-tonic herbs, and which were precisely for adolescent Boys between Tanner stage 3-5 and for Girls in Tanner stage 2-4.