類風濕性關節炎中醫臨床診斷之研究

THE CLINICAL DIAGNOSIS OF RHEUMATOID ARTHRITIS ACCORDING TO TRADITIONAL CHINESE MEDICINE

類風濕性關節炎是以慢性多發性關節病變為主的全身自體免疫疾病，其發病機轉尚不清楚，在中醫是屬「痹證」之範疇。本病臨床見證常屬虛實相兼，寒熱錯雜，痰瘀互結，表現非常複雜，而其主要證型之分類，各家見解也不盡相同，不易進行客觀而標準化的辨證診斷。本研究以 60 位類風濕性關節炎患者為對象，進行中醫診察，並以語意差別量表方式，製作寒熱虛實之辨證量表，並以多元尺度法分析所得資料，結果顯示：患者整體與關節局部的寒熱虛實經常錯雜互見，如果合併辨證，則不易看出明確的分佈趨勢。若將此兩方面分別觀察，則可發現患者整體的寒熱辨證與關節局部的虛實表現均有清楚的分佈趨勢。本項研究所設計之量表結合多元尺度分析法，可對上述二種辨證進行量化，並能作為療效評估之參考。Rheumatoid arthritis (RA) is a systemic autoimmune disease of unknown etiology with chronic inflammation in multiple joints. According to traditional Chinese medicine (TCM), it is in the category of “Bi” syndromes. Its pattern is usually a combination of vacuity and repletion, cold and heat, or phlegm and blood stasis. The classification of the clinical patterns of RA is varied, thus, it is difficult to make an objective and standardized treatment protocol. We recruited 60 RA patients to undergo pattern identification according to TCM. We designed parameters for cold and heat, and vacuity and repletion using a questionnaire, and analyzed the data using a multi-dimension scale (MDS). The results revealed that it was difficult to show a trend of distribution of heat, cold, vacuity and repletion for the whole body and local joints. Thus, we separated the whole body and local joints into two parts. The results marked trends in the cold-heat pattern of the whole body and the vacuity-repletion pattern of local joints. The newly developed criteria combined with using a multi-dimension scale may enable practitioners to quantify pattern identification mentioned above and may be useful in evaluating the therapeutic effects of RA using TCM.