停經後骨質疏鬆症中醫證型的實證文獻探討

Evidence Based Clinical Trial Articles Review Study Regarding to Syndrome Patterns Classification of Traditional Chinese Medicine on Postmenopausal Osteoporosis Syndrome

停經後骨質疏鬆症(postmenopausal osteoporosis，PMO)是一種多面向致病因素的全身代謝性骨骼疾病，盛行率和發生率隨全球人口老化趨勢而上升。辨證論治是中醫臨床實踐的重要特色，中醫藥在PMO的治療，也有幾千年的實務經驗，唯其相關證型在中醫界尚無共識。因此，本文藉由實證醫學精神及評分方法，探討2005至2015年內的中醫相關臨床試驗研究，結果顯示「骨質疏鬆症中醫證型」相關文獻搜尋共96篇，排除動物實驗模式與針灸治療、中西結合治療、從臨床實踐中總結出來的自製中藥製劑之72篇相關文獻，以及臨床個案報告14篇後，篩選出PMO中醫證型的實證文獻共10篇。其中屬隨機對照臨床實驗研究文獻1篇，病例對照研究文獻1篇，病例研究文獻8篇。上述PMO實證文獻以腎陽虛證80%最高，肝腎陰虛證70%次之，脾腎陽虛證、及氣滯血瘀證皆60%又次之，研究結論建議腎陽虛證、脾腎陽虛證、肝腎陰虛證、氣滯血瘀證等四型，可作為PMO治療的主要證型。

Female postmenopausal osteoporosis (PMO) is a multiple and complicated pathological change of systemic metabolic bone diseases. The incidence and prevalence of PMO is increasing with the aging population in the world.
Pattern identification as the base for determining treatment has been playing a very important role in the clinical practice of traditional Chinese medicine(TCM). There are thousands of years of clinical experience in the treatment of PMO with TCM. However, there is no consensus related to syndrome patterns of PMO among TCM practitioners to each other. In this present evidence based study, we survey the clinical trial articles during the year 2005-2015 in order to invertigating the syndrome patterns classification of TCM in postmenopausal osteoporosis syndrome. We found 96 articles related to TCM syndrome pattern of PMO from database. After excluding 72 relevant literature with animal model, acupuncture, integrated Chinese and western medicine, homemade herbs, or case report, we finally selected 10 evidenced based papers. There were one randomized clinical trial, one case control study and 8 case series literature. Our results showed that proportion of PMO would be 80% deficiency of Kidney-yang, 70% Yin-deficiency of both the Liver and Kidney, followed by 60% Yang-deficiency of both the Spleen and Kidney and 60% blood stasis due to Stagnancy of Qi. Therefore, we recommend that there are four main patterns, namely deficiency of Kidney-yang, Yin-deficiency of both the Liver and Kidney, Yang-deficiency of both the Spleen and Kidney and blood stasis due to Stagnancy of Qi on PMO.