從腸內菌菌落分布情形建立過敏性鼻炎中醫辨證之客觀依據

張宏州
中國醫藥大
特異過敏性疾病(Atopic disease)，包括過敏性氣喘、過敏性鼻炎及異位性皮膚炎，是全球性的重大公共衛生問題。其中過敏性鼻炎在台灣的盛行率超過20%，塵?是最常見的過敏原。而建立過敏性疾病中醫辨證的客觀標準，提供給中醫藥臨床試驗運用，是目前中醫藥研究的當務之急。傳統中醫對於過敏性鼻炎患者的治療著重於辨證論治，多數研究都認為過敏性鼻炎乃本虛標實之證，肺、脾、腎三臟之虛為本，加上內有鬱熱或外感風寒等標證，但各家辨證分型不盡相同，且缺乏現代醫學客觀依據。近年來腸內菌(intestinal microflora)被廣泛研究並且運用於過敏性疾病，認為腸內菌可以在腸道扮演免疫調節的作用，降低第二型輔助T細胞的活化及表現，因而有治療或有助於過敏性疾病的控制。此外，日本學者發現甘草、大黃、蘆薈等有效成分，實際上受到腸內菌的代謝而吸收，而腸內菌種的多少與種類的多寡都會影響到中藥中有效成分的吸收與藥效，是中藥藥效發揮的重要因素。因此，我們可以預期，中藥使用於不同個體、在不同環境、不同飲食習慣、不同氣候、不同的年齡、不同的疾病狀況，可能得到不同程度的藥效或副作用，這也是中醫辨證論治的精神所在，而其中患者體內腸內菌的菌叢分布，極可能扮演著極為重要的角色。因此，我們希望從過敏性鼻炎患者的糞便中，進行菌種的培養與分析，預期熱證的表現與腸內菌菌種的分布呈現有意義的關係。期盼能夠找出更多中醫辨證的客觀判斷基礎，提供日後中醫證型判斷的參考。
關鍵字：過敏性鼻炎、中醫辨證、腸內菌

To establish the objective evidence of the syndrome differentiation and typing of Traditional Chinese Medicine in allergic rhinitis by the distribution of the intestinal microflora

Hung-Chou Chang
China medical university hospital
Atopic disease, including allergic asthma, allergic rhinitis and atopic dermatitis, is the important public healthy burden in the world. In Taiwan, the prevalence of allergic rhinitis is more than 20%, and mite is the most common allergen. To establish the objective evidence of the syndrome differentiation and typing of Traditional Chinese Medicine in allergic rhinitis is preoccupation.The treatment of allergic rhinitis by Traditional Chinese Medicine obeys the principle of “syndrome differentiation and typing” according to the patient’s symptoms and signs. Numerous Chinese Medicine physicians and studies suggest that almost the patients of allergic rhinitis presentations could be summarized to the phenomenon of “asthenia of lung, spleen and kidney”, and associate with presentations of “heat Zheng” or “cold Zheng”. However, there are no enough objective evidences to differentiate the characteristics of “heat Zheng” or “cold Zheng”. And so on, subjective biases always perse
關鍵字：allergic rhinitis, Traditional Chinese Medicine, intestinal microflora