獨活寄生湯運用在退化性關節炎之抗發炎活性探討

關節炎泛指發生在關節及其周圍組織的發炎性疾病，其主要症狀為疼痛及行動不便，而發炎反應即為引起關節疼痛的主要原因。發炎反應的產生與一氧化氮（NO）與前列腺素E2 ( PGE2 )等發炎介質過量表現有關，而這些發炎介質繼而刺激軟骨細胞中的基質金屬蛋白酶表現，導致軟骨組織降解、軟骨受損而引起行動不便；然而目前治療除使用止痛藥外即是置換人工關節，尚無根治的方法。因此本研究將探討臨床常用治療關節炎的中藥方劑，期望開發出具有療效之創新複方。本研究利用台灣健保資料庫搜尋臨床常用於治療關節炎的方劑，其中獨活寄生湯使用於退化性關節炎的頻率最高，繼而利用體內、體外抗發炎試驗，確認獨活寄生湯具有抗發炎以及鎮痛的作用；再從傳統中醫藥的理論角度將方劑拆解，探討其組成配伍關係。結果得知最佳抗發炎之組成為補益藥，再利用體內、體外抗發炎試驗檢測，發現補益組的抗發炎及鎮痛效果比獨活寄生湯更佳，並以HPLC 指紋圖譜探討其活性指標成分，得到其活性指標成分為cinnamic acid 以及 glycyrrhizic acid，確定獨活寄生湯抗發炎之功效來自於補益組，故推測未來可使用補益組做為抗關節炎之創新複方。

關鍵字

關節炎；發炎反應；獨活寄生湯；退化性關節炎；高效液相層析法

並列摘要

Arthritis is a condition in which joints and tissues are inflamed, and cause pain and physical challenges. The most common cause of joint pain is inflammation. Nitric oxide and prostaglandin E2 (PGE2) are two pleiotropic inflammatory mediators overproduced in arthritis-affected joints. Inflammation also induce the expression of matrix metalloproteinases such as MMP-13, which are responsible for cartilage matrix degradation. However, at present, there is no definite cure of arthritis except taking NSAIDs for pain and inflammation control or joint replacement surgery. The purpose of this study was to investigate the frequently used Traditional Chinese Medicine (TCM) in TCM clinics in order to develop innovative prescription which has potential to treat arthritis effectively. The Du-Huo-Ji-Sheng-Tang (DHJST), a clinical formula for treating osteoarthritis was obtained from our study based on the National Health Insurance Research Database (NHIRD) in Taiwan. We delineated its anti-arthritic mechanisms with in vitro and in vivo anti-arthritic models. Then we explored the efficacy of the principle constituent of DHJST on anti-inflammation according to the medical philosophy of TCM. We found the tonifying and replenishing medicinal group had better anti-arthritis activity than DHJST. Phytochemical chromatographic technique including high performance liquid chromatography (HPLC) was used to identify the active marker substances from the tonifying and replenishing medicinal group. The cinnamic acid and glycyrrhizic acid were the major active compounds of DHJST. In conclusion, we suggested the tonifying and replenishing medicinal group could be the new innovative prescription for treating the osteoarthritis in the future.