中醫治療退化性膝關節炎的實證醫學：文獻回顧

Evidence-Based Medicine of Traditional Chinese Medicine for Treatment of Knee Osteoarthritis: Literature Review

根據全世界研究指出，退化性膝關節炎的盛行率逐年提升，其中和年齡 有高度正相關，面臨人口老化問題，愈來愈多年長者會受到膝關節退化所影 響，治療退化性膝關節炎的議題受到很大的重視。西醫治療從消炎止痛藥 物，到注射玻尿酸，最後利用關節置換術，都有其優缺點；而中醫在輔助治 療上，是否可以提供一定程度的療效是我們想要了解的。針對退化性膝關節 炎的中醫治療相當多元，我們利用文獻回顧的方式，以中醫病因病機的角度 出發，歸納其中醫內科治療、針灸治療、傷科手法，利用實證醫學的概念探 討退化性膝關節炎的中醫治療。 實證醫學以證據等級一的多篇隨機臨床試驗所整合的系統性回顧為標 準，內科治療中，獨活寄生湯的加入，能顯著降低膝關節疼痛及改善膝關節 分數；針灸治療中，除了傳統針刺外，電針、針上灸或火針的效果有更加顯 著的療效。此外，在臨床試驗中，中醫脊柱手法改善膝關節問題是有其理論 架構及正面的成效。最後，本文將以上有效的中醫療法與我們所建構的退化 性膝關節炎的病因病機做整合，以提供給臨床工作者或研究學者作為參考， 期待未來有更多種類型的研究，說明退化性膝關節炎的中醫輔助治療角色能 夠愈來愈明確，強化中西醫結合的信任度及運用度。

According to the worldwide research, the prevalence of degenerative knee joint disease is increasing year by year, which is positively related to age. It is a very important issues that lots of older people will be affected by knee osteoarthritis. The treatments of western medicine (WM) are anti-inflammatory and analgesic drugs, injection of hyaluronic acid, and joint replacement surgery. The methods and effects of traditional Chinese medicine (TCM) as adjuvant treatments is what we want to figure out. Starting from the etiology and pathogenesis of traditional Chinese medicine, we summarize the TCM internal medicine, acupuncture treatment, and TCM spinal manipulation, which use the concept of evidence-based medicine. Evidence-based medicine is based on a systematic review of multiple randomized clinical trials on level 1. First, the addition of Duhuo Jisheng decoction can significantly reduce knee pain and improve knee joint score. Seconds, the effects of electro-acupuncture, acupuncture moxibustion or fireneedle moxibustion have more significant effects than acupuncture manipulation. In addition, TCM spinal manipulation shows positive results in clinical trials, based on its theory. Finally, we integrate the above effective TCM treatments with the etiology and pathogenesis of knee osteoarthritis we have constructed, which can provide the information to clinicians or researchers. We are looking forward to more studies in the future to explain clearly about the role of TCM treatment of knee osteoarthritis and to strengthen the trust and application of TCM with WM.