由免疫學觀點探討中醫治療子宮內膜異位

Immunological Views of Endometriosis with the Traditional Chinese Medicine Treatment

目前子宮內膜異位的形成雖有六種理論，但真正機制不詳。本文旨在從免疫學的角度探討常用於治療子宮內膜異位症方藥之細胞激素免疫機轉，歸納子宮內膜異位症免疫學觀點及台灣已被研究方藥的免疫機制。
免疫細胞藉由調控發炎途徑以誘發黏附及侵襲、血管新生、增殖等作用幫助子宮內膜異位病灶植入和存活。中醫辨證論治的治法，多以活血化瘀為主，阻斷局部血管新生，使異位病灶萎縮。常用方劑為桂枝茯苓丸、血府逐瘀湯、少腹逐瘀湯；另一主軸為補腎健脾，促進細胞免疫功能，可使用歸腎丸、左歸丸、六君子湯；隨症加減則以小柴胡湯、龍膽瀉肝湯、溫經湯。本研究建議免疫功能失調導致的子宮內膜異位症，可藉由補益法恢復正常免疫機能和緩解病情。

Six theories of endometriosis have been proposed until now, but the real mechanism is unknown. This study aimed to explore cytokine-related immune responses of traditional herb prescription in endometriosis. We would summarize immunological aspects of endometriosis and immune-related mechanisms of prescription for endometriosis in Taiwan.
By way of regulating inflammatory pathway to induce adhesion and invasion, angiogenesis, and proliferation, immune cells could help endometriosis lesions implantation and survival.
Based on differential diagnosis and treatment of Chinese medicines, activation of blood circulation and elimination of blood stasis were as the main method of treatment. It could block local angiogenesis and lead ectopic lesion to atrophy. Gui-Zhi-Fu-Ling-Wan, Xue-Fu-Zhu-Yu-Tang and Shao-Fu-Zhu-Yu-Tang were commonly used prescriptions. In addition, reinforcement of kidney and spleen to promote cellular immunity may be as an alternative treatment strategy. For example, Gui-Shen-Wan, Zuo-Gui-Wan and Liu-Jun-Zi-Tang were the common prescriptions. According to the other symptoms and signs, Xiao-Chai-Hu-Tang, Long-Dan-Xie-Gan-Tang and Wen-Jing-Tang would be used to treat endometrisis. The present study would suggest that endometriosis caused by immune dysfunction could be restored and improved by replenishing method.