中藥方劑對坐臀神經再生影響之評估 I.補中益氣湯

Seddon將神經傷害依嚴重程度和所需復原的時間分為三大類--神經失控（neurapraxia）、軸突斷傷 ( axonotmesis ) 與神經截斷 (neurotmesis)。而在臨床上，也可以發現許多周邊神經的病變，主要的像是無力（motor weakness）、感覺異常（paresthsia）、肌腱反射降低或消失（tendon reflexes decreased or absent）與自律神經異常automic disorder）。由於而神經的生長恢復是十分緩慢的（3-4 mm/day），而且若是不予以治療，則可能會發生神經退化、肌肉萎縮甚至筋骨變形等嚴重後果。因此，開發如何能促進神經生長的藥物，不但能解決病人的困擾，亦能減少社會成本在這方面疾病照顧的支出。由於藥物之開發與評估，首先要重視有效性、安全性，尤其是藥材之品質更需具一致性，才能確保藥效，本研究第一部分為方劑補中益氣湯之品質管制，其組成藥材為黃耆、人參、甘草、白朮、陳皮、當歸、升麻、柴胡、薑與大棗，先以鑑定正確之藥材，依照原出典之組成，調製標準湯劑，冷凍乾燥，製作出供試驗用之濃縮製劑，進一步再依據藥物食品檢驗局於民國八十五年訂定的中藥濃縮製劑制訂指標成分定量法及規格注意事項草案，選取兩種藥材，以薄層色層分析法（TLC）進行指標成分之鑑定並得到於移動相為n -butanol：H2O：glacial acetic acid = 7 : 2 : 1時，TLC-Scanner 39 mm處，有 glycyrrhizin之吸收波，移動相為 n- hexane — ethyl acetate =7 : 3 時，58.5 mm處則有atractylenolide III之吸收波。於方劑補中益氣湯之一帖劑量中（27g）有glycyrrhizin 0.181g 的含量，而白朮中則應有atractylenolide III 2.43 × 10-3 g的含量。第二部分為評估中藥方劑補中益氣湯對神經再生修復之影響，方法為以大鼠（Rat）進行動物實驗，先利用液態氮氣損害大鼠之坐股神經，並分別設立投藥組與對照組，經45日之恢復期後，以打入神經元追蹤劑結合凝集素(FITC ) 於液態氮氣破壞之坐骨神經離神經元較遠之一端，待再生神經攝取後，於脊髓L3~L4處，取下做冷凍切片，計算方法為每切片十片取一片，計每一脊髓取十片，以正相螢光顯微鏡檢測能攝取逆向運輸染料的再生神經元之多寡，並計算其總和。實驗結果顯示於螢光顯微鏡下，口服投予補中益氣湯之投藥組再生神經元數目為4.1、4.5、4.4與5.1個/每切片，較無投藥組之3.2、3.8、3.6與3.4個/每切片，發現有較多之再生神經元，顯示有較佳之恢復情形（p<0.05）。實驗中並對原來體重為148.8~151.5g之老鼠於實驗體重的變化記錄下來，發現投予補中益氣湯之老鼠（n=8）於25日後體重分別為305.4g、308.3g、311.0g、315.6g、317.8g、 320.1g、322.0g與330.1g，而無投予藥物之老鼠（n=6）於25日後體重290.2g、293.1g、296.0g、296.0g、296.1g與310.0g。顯示有投藥組較無投藥組有較佳的生長情形 ( p<0.05)。本實驗第一部分為對補中益氣湯進行藥材之定量，第二部分暨以運用此方劑評估神經再生動物實驗模式，期望能以此模式找出對神經再生有利之中藥方劑。

關鍵字

補中益氣湯；坐臀神經；神經生長

並列摘要

Injuries arising from sports, the workplace, and traffic mishaps, and others of an accidental nature, are on the increase in today’s busy commercial society. In fact, according to the reports of Legislative Yuan’s Ministry of Health, accidental injury is already ranked as the fourth highest cause of death nationwide. Through medication, surgery, and physical therapy, many patients can achieve a full recovery. However, those suffering from nerve axon damage require an extended period of convalescence and full recovery is commonly unattainable. As such, the research into drugs promoting nerve regeneration and repair has become a major research goal within modern medicine. This project selected a frequently employed Chinese Bu Qi (補氣) medical prescription —Bu Zhong Yi Qi Tang (補中益氣湯, BT)─and conducted a systematic appraisal of it. The development and assessment of medicines stresses efficacy and safety foremost; but even more important is consistency BT was then freeze-dried to create a concentrate convenient for use in the laboratory. Next, the Thin Layer Chromatograph ( TLC ) analytical method was applied to ensure consistent quality of the ingredients. In this experiment, rats were applied with WGA-FITC (Lectin from Triticum Vulgaris) to assess the effects of BT upon nerve regeneration. Rat sciatic nerve were damaged with liquid nitrogen. Then the rats were treated with BT for 45 days. After the recovery period, the rats were injected WGA-FITC, which was uptaken by the regenerating nerve axon and retrograde to the cell body of neurons. We employed microscopes to observe the number of FITC-labeled neurons. The results showed that the number of labeled regenerating neurons of the experimental group were 4.1, 4.5, 4.4 and 5.1 per section of the lumbar spinal cord, and the control group were 3.2, 3.6, 3.4 and 3.8 (P< 0.05) , These results demonstrated that BT may be useful in promoting nerve regeneration and deserve for further study in the future.

並列關鍵字

Bu Zhong Yi Qi Tang ； Sciatic Nerve ； Nerve regeneration

參考文獻

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中藥方劑對坐臀神經再生影響之評估 I.補中益氣湯

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