中西醫免疫療法抗癌對話

The gap between Chinese medicine and immunotherapy in cancer treatment

10.6528/CAMS.201912_7(1).0002

簡鸞瑤(Chien Luan-Yao)；李政育(Lee Chen-Yu)；廖炎智(Liao Yan-Chih)

免疫藥物療法與細胞療法 ； 中醫證病合辨 ； 中醫治癌 ； 針灸治療 ； immunotherapy and cell therapy ； Chinese medicine pattern differentiation ； Chinese medicine cancer treatment ； acumoxatherapy

中國鍼灸學雜誌

7卷1期（2019 / 12 / 29）

33 - 58

繁體中文

免疫檢查點的研究發現開啟癌症治療革命史的新頁，現代中醫師躬逢其盛，應該隨時精進與生理學、病理學以及生技、科學研究領域的相關議題，方可知己知彼，共同為促進人類健康與生活質量盡最大的努力。世界衛生組織（WHO）已將癌症定義為可控制的慢性病，諾貝爾生醫獎也三度肯定科學家對免疫細胞研究的卓越貢獻，種種跡象透露出中西醫學治病思路之交集範圍已逐漸擴大，本文將仔細闡述始末，包括：皆主張以自身免疫力抗病、皆重視細胞生存的微環境、皆認同積極干預方式不如與病和平共存等觀念。若分析科學界數十年來研究成果，可見免疫療法的出現是人類向內觀照、反諸訴求以全人照顧為本的必然產物，但對於中醫學理而言，這些理念卻再也熟悉不過，此部份將以傷寒論六經傳變的角度作深入探討。單一免疫檢查點抑制劑的療效統計目前僅三～四成，而基因改造的細胞療法也因費用與風險雙居高位而短時間內難以普及，可見中西醫需分頭突破重圍的挑戰還很多。而中醫在這舞台上應扮演如何的角色？應如何利用手中籌碼以畢其功？筆者由上段論點再擴充，進一步分析陰平陽秘與細胞微環境、腸胃論與腸道菌叢等，並整理中醫界在免疫檢查點抑制藥物與幹細胞的研究成果，試圖整理中醫治癌理論與免疫療法的異同處。

Research into the immune checkpoints system opens up a new page in revolutionary cancer therapies. Today's Chinese medicine physicians must improve their knowledge of physiology, pathology, biotechnology and scientific research in order to understand and evolve along with these modern developments. Rooted in tradition and progressing into the future is the only way we can make the most beneficial contributions to health and quality of life. The World Health Organization (WHO) has defined cancer as a controllable chronic disease. Three Nobel Prizes being awarded in physiology or medicine have also affirmed the extraordinary contributions of scientists involved in immunotherapy and cell therapy research. Increasingly impelling indications reveal that the scope of integrative Chinese and Western medicine is expanding. This paper will introduce these areas of common ground in detail, including advocating autoimmunity against disease, the focus on cell survival in the neoplastic microenvironment, and agreeing that peaceful coexistence with disease offers greater potential for superior outcomes compared to aggressive intervention. An analysis of the research results of the scientific community over the past few decades clearly shows that the emergence of immunotherapy is an inevitable outcome of human beings introspection and appeals for a holistic approach to treatment. But in Chinese medicine these concepts form the underlying foundations of our theoretical basis and therapeutic approach, with an in-depth discussion of the six channel transmutations introduced in On Cold Damage and Miscellaneous Diseases presented to elucidate this premise. The efficacy of immune checkpoint inhibitors as single agents is currently only 30% to 40%, and genetically modified cell therapy is also difficult to universalize in a short period of time because of the high costs and risks. There are obviously still many challenges for integrative Chinese and Western medicine to overcome. What role should Chinese medicine have on this stage? How can we use the available resources to actualize our goals? The author further expands upon the previous paragraph to analyze the relationships involving concepts such as calm yin and sound yang and intracellular environment and On the Spleen and Stomach and intestinal flora. Moreover, results of research done by the Chinese medicine community on immune checkpoint system inhibitors and stem cells are presented in attempts to organize the similarities and differences of the Chinese medicine cancer treatment approach and immunotherapy.

1. Chen, S.-T.(2019)。NLRP12 Regulates Antiviral RIG-I Activation via Interaction with TRIM25。Cell Host Microbe，25(4)，602-616。
2. Gatenby, R. A.(2009).A change of strategy in the war on cancer.NATURE,508-509.
3. Hoshino(2015)。Tumour exosome integrins determine organotropic metastasis。Nature，527(7578)，329-335。
4. 方德琳,燕珍宜(2019)。細胞療法全解析。今週刊，58-79。
5. 方麗華, “嵌合抗原受體T細胞(Chimeric Antigen Receptor T Cells, CAR-T)的傳奇與創新,”25 01 2018. [線上]. Available: http://www.tpms.org.tw/2018/01/25/car-t/
6. 伍焜玉(2019).免疫的威力：免疫力,就是最好的醫生！.遠流出版社.
7. 吳渙淦,翁志軍(2016)。基于免疫相關性疾病的艾灸鎮痛與抗炎免疫研究。世界中醫藥，11(12)，2505。
8. 吳濱,周榮興(1999)。針灸對免疫功能調節的研究現狀與展望。上海針灸雜誌，18(1)，46-48。
9. 李岳倫,“中藥免疫療法在癌症治療的前瞻性研究,” 25 11 2018. [線上]. Available: https://www.facebook.com/Dr.alanylee/posts/2054965944561192/
10. 李岳倫(2018)。顛覆癌症治療的革命。科學月刊，587
11. 李政育,鄭淑鎂(2016).中西醫結合治癌新法.新北市:元氣齋.
12. 李雙艷(2012)。近幾年針灸對免疫功能影響的研究進展。CJCM，4(5)，118-120。
13. 林欣榮,“林欣榮：花蓮慈院希望成為細胞治療的「台積電」,”6 8 2019. [線上]. Available: https://udn.com/news/story/7266/3973771.
14. 林建予,寇華勝(1993).中醫免疫醫學─針灸氣功的免疫作用.臺北市:旺文社.
15. 邱紹智,周德陽(2018)。樹突細胞免疫治療技術中國附醫臨床試驗成果亮眼。中國醫訊，185，7-8。
16. 施茵,周珊玲(2003)。足三里穴對神經─內分泌─免疫網絡的調節作用。江西中醫學院學報，15(2)，37-39。
17. 洪維謙,“治療型癌症疫苗提升CAR-T 細胞對實體瘤的治療效果,”13 8 2019. [線上]. Available: https://investigator.tw/8999/治療型癌症疫苗提升-car-t-細胞對實體瘤的治療效果/
18. 徐世達, “保衛人體健康的免疫大軍,”2011. [線上]. Available: http://sa.ylib.com/MagArticle.aspx?Unit=easylearn&id=1885
19. 徐玉真,李宣書(2019)。「精準又量身訂做」新抗原癌症疫苗抗癌新突破。好健康，48
20. 高承源, 腸道菌可預測癌患對免疫療法成效, 聯合報, 2019.
21. 張文震, 免疫細胞療法--多一個選擇並非萬靈丹, 聯合報, 2019.
22. 陳旺全(2018)。中藥免疫療法在癌症治療的前瞻性研究。第19屆國際東洋醫學會學術大會
23. 陳榮洲(2003)。李東垣脾胃論元氣陰火學說的研究。J Chin Med.，14(1)，1-15。
24. 黃靜宜,柯博升(2019)。免疫療法擬納健保！關鍵問答了解抗癌新療法。好健康，47
25. 楊泮池, “文茜世界週報,” 15 12 2018. [線上]. Available: https://www.youtube.com/watch?v=RLmZeDuQQ_w
26. 楊惠,張何驕子(2017)。針灸調節皮膚局部免疫功能及其機理的研究進展。遼寧中醫雜誌，4(2)，433-435。
27. 維基百科, “維基百科,”8 2019. [線上]. Available: https://zh.wikipedia.org/wiki/%E7%99%8C%E7%97%87%E5%85%8D%E7%96%AB%E7%96%97%E6%B3%95
28. 趙坤山,“文茜世界週報,”15 12 2018. [線上]. Available: https://www.youtube.com/watch?v=RLmZeDuQQ_w
29. 趙榮傑(2019)。免疫細胞療法治癌新進展。台灣醫界，62(4)，32-38。
30. 衛福部,“衛生福利部,”8 2019. [線上]. Available: https://dep.mohw.gov.tw/DOMA/cp-4127-48287-106.html
31. 鄭吉元,蔡慈貞,張文震(2018)。破解癌細胞逃脫免疫擊殺七步曲。藥學雜誌，34(4)，8-13。
32. 鄭隆賓(2018)。細胞治療嘉惠病人中國附醫升火待發。中國醫訊，185，3-4。
33. 鄧鐵濤(2006).中醫診斷學.上海:上海科學技術出版社.
34. 賴基銘,“癌症免疫細胞療法的新進展喚醒沉睡的免疫系統軍隊,”26 12 2018. [線上]. Available: https://www.canceraway.org.tw/page.asp?IDno=3458
35. 閻雲(2019)。癌症治療國際趨勢關鍵報告—從最新諾貝爾醫學獎談免疫療法新進展。康健雜誌
36. 戴念梓, 細胞療法為何這麼夯？, 聯合報, 2019.
37. 謝世良,“CLEC5A是嗜中性白血球對抗細菌的關鍵,”23 8 2017. [線上]. Available: http://www.genomics.sinica.edu.tw/index.php/tw/news/lastest-news/521-clec5a

1. 簡鸞瑤,鄭淑鎂,廖炎智,李政育(2020)。中醫協同癌症免疫療法之探討。中國鍼灸學雜誌，8(1)，7-27。