中医药研究论丛

232.6 中医治疗退化性膝关节炎的实证医学:文献回顾
TJ TCM.23(2) : 81-92, 2020
 
中医治疗退化性膝关节炎的实证医学:文献回顾
Evidence-Based Medicine of Traditional Chinese Medicine
for Treatment of Knee Osteoarthritis: Literature Review   
黄靖钧1 林正哲1*
1 高雄医学大学附设医院中医部,高雄,台湾
【摘要】
根据全世界研究指出,退化性膝关节炎的盛行率逐年提升,其中和年龄有高度正相关,面临人口老化问题,愈来愈多年长者会受到膝关节退化所影响,治疗退化性膝关节炎的议题受到很大的重视。西医治疗从消炎止痛药物,到注射玻尿酸,最後利用关节置换术,都有其优缺点;而中医在辅助治疗上,是否可以提供一定程度的疗效是我们想要了解的。针对退化性膝关节炎的中医治疗相当多元,我们利用文献回顾的方式,以中医病因病机的角度出发,归纳其中医内科治疗、针灸治疗、伤科手法,利用实证医学的概念探讨退化性膝关节炎的中医治疗。
实证医学以证据等级一的多篇随机临床试验所整合的系统性回顾为标准,内科治疗中,独活寄生汤的加入,能显着降低膝关节疼痛及改善膝关节分数;针灸治疗中,除了传统针刺外,电针、针上灸或火针的效果有更加显着的疗效。此外,在临床试验中,中医脊柱手法改善膝关节问题是有其理论架构及正面的成效。最後,本文将以上有效的中医疗法与我们所建构的退化性膝关节炎的病因病机做整合,以提供给临床工作者或研究学者作为叁考,期待未来有更多种类型的研究,说明退化性膝关节炎的中医辅助治疗角色能够愈来愈明确,强化中西医结合的信任度及运用度。
【关键词】退化性膝关节炎、中医治疗、实证医学、文献回顾
 
Ching-Chun Huang1Cheng-Che Lin1*  
1Department of Traditional Chinese Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
【Summary】
According to the worldwide research, the prevalence of degenerative knee joint disease is increasing year by year, which is positively related to age. It is a very important issues that lots of older people will be affected by knee osteoarthritis. The treatments of western medicine (WM) are anti-inflammatory and analgesic drugs, injection of hyaluronic acid, and joint replacement surgery. The methods and effects of traditional Chinese medicine (TCM) as adjuvant treatments is what we want to figure out. Starting from the etiology and pathogenesis of traditional Chinese medicine, we summarize the TCM internal medicine, acupuncture treatment, and TCM spinal manipulation, which use the concept of evidence-based medicine.
Evidence-based medicine is based on a systematic review of multiple randomized clinical trials on level 1. First, the addition of Duhuo Jisheng decoction can significantly reduce knee pain and improve knee joint score. Seconds, the effects of electro-acupuncture, acupuncture moxibustion or fireneedle moxibustion have more significant effects than acupuncture manipulation. In addition, TCM spinal manipulation shows positive results in clinical trials, based on its theory. Finally, we integrate the above effective TCM treatments with the etiology and pathogenesis of knee osteoarthritis we have constructed, which can provide the information to clinicians or researchers. We are looking forward to more studies in the future to explain clearly about the role of TCM treatment of knee osteoarthritis and to strengthen the trust and application of TCM with WM.
 
【Keywords】knee osteoarthritis, TCM treatment, evidence-based medicine, literature review