承氣湯系方劑實證醫學與藥理作用探討
A systematic review of clinical efficacy and investigations of pharmacological effects of three Chen-Chi-Tang decoctions
中文摘要
中醫認為當邪在裡宜下，重必攻而下之，也就是運用通腑攻下之法去邪、恢復機 體的平衡。本研究利用傷寒論中的大承氣湯、小承氣湯、及調胃承氣湯為研究對 象，以現代醫藥研究法，探討此重要的中醫治療理論。以實證醫學的方法搜尋三 承氣湯相關之文獻，了解三個方劑之臨床療效與差異。結果顯示此三種承氣湯
（尤其是大承氣湯）具有促進腸胃功能之改善作用（證據等級為moderate 級），
但大黃或大黃複方應用於減重則是無效、應用於降血脂之臨床證據仍有爭議。再 者，以現代瀉下、抗肥胖、降血脂、抗發炎與抗氧化研究方法，評估「瀉下清熱」
之藥理作用。結果顯示大承氣湯確實具有較強的瀉下作用，且還具有抑制血中油 脂急性增加的作用。小承氣湯瀉下作用確實較大承氣湯弱，但可降低因較長期服 用高脂飼料所導致的高膽固醇症。但是三種承氣湯皆無降低體重的效果。「清熱」
機制的藥理研究部分顯示大承氣湯具有最強的抗發炎效用，可抑制發炎介質的 表現，如nitric oxide （NO）、prostaglandin E2（PGE2）、 iNOS 等的表現，因此 大承氣湯在非腸胃型之發炎模式中也有很好的抗發炎反應。小承氣湯之抗氧化能 力與保肝能力最顯著，推測是小承氣湯中總多酚含量、總類黃酮含量、 (+)- catechin 的含量最多有關。傳統中醫利用三承氣瀉下的作用，清除?媦騿 A 恢復 身體機能的平衡。本研究結果提供了三種承氣湯瀉下清熱的作用可能與具有抗發 炎與抗氧化之機制有關。未來之臨床應用可朝發炎反應與氧化反應機能失衡的疾 病去思考三種承氣湯的現代應用。
英文摘要
So far, there are still many traditional Chinese medical theories and practices not supported with good enough scientific evidences. We are interested in the mechanism involved in purgation that traditional Chinese doctors used when their patients
suffered with internal heat, stagnation, and fullness syndromes. Three Chen-Chi-Tang decoctions (CCTD), including Ta-Chen-Chi-Tang (TCCT), Xiao-Chen-Chi-Tang (XCCT), Tiao-Wei-Chen-Chi-Tang (TWCCT) are three famous purgative formulas In this study, we first conducted a systemic review for evaluating the clinical efficacy of these purgative decoctions on gastrointestinal problems and obesity and
hyperlipidemia. We also designed many in vitro and in vivo studies in order to delineate the efficacy and underlying mechanisms involved in purgation. From the systemic review, there is moderate evidence to support the efficacy of CCTD (especially TCCT) in the management of gastro-intestinal problems, but most of the studies do not support anti-obesity effect of purgative decoctions, and clinical
evidence of purgatives on hyperlipidemia is still controversial. Through in vitro and in vivo experiments, we have shown that TCCT is a potent anti-inflammatory agent, and XCCT is a potent anti-oxidantant. Inflammation and oxidative stress are two
pathophysiological processes involved in many diseases suffered by modern man today. Future clinical application of CCTDs may based on these findings in order to improve the efficacy of these traditional Chinese medicine in the present world.
