承氣湯系方劑實證醫學與藥理作用探討
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 moder
ate 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。
A systematic review of clinical efficacy and
investigations of pharmacological effects of three
Chen-Chi-Tang decoctions
So far, there are still many traditional Chinese medical theories and practices not su
pported with good enough scientific evidences. We are interested in the mechanism
involved in purgation that traditional Chinese doctors used when their patients suffe
red with internal heat, stagnation, and fullness syndromes. Three Chen-Chi-Tang de
coctions (CCTD), including Ta-Chen-Chi-Tang (TCCT), Xiao-Chen-Chi-Tang (XC
CT), Tiao-Wei-Chen-Chi-Tang (TWCCT) are three famous purgative formulas In t
his study, we first conducted a systemic review for evaluating the clinical efficacy
of these purgative decoctions on gastrointestinal problems and obesity and hyperlip
idemia. 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 revi
ew, 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 sup
port 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 pote
nt anti-oxidantant. Inflammation and oxidative stress are two pathophysiological pr
ocesses involved in many diseases suffered by modern man today. Future clinical a
pplication of CCTDs may based on these findings in order to improve the efficacy
of these traditional Chinese medicine in the present world.
