| 摘要: | 脈診是中醫診斷疾病的特有方法之一，然而中醫脈診科學化的研究由於對測量脈波圖的方式及基本理論認知不同，因此其研究成果無法受到中醫學界的公認，更無法推廣到臨床使用。
近來學者發現，晚清醫家周學海對脈診所提出的位、數、形、勢理論，頗能符合現代研究的需要，因此發展出許多對脈象的數理表達方式。而橈動脈的運動形式為徑向張縮、軸向伸縮和軸心位移組合成的一種三維運動，因此若能發展出一種三軸的測量方式，使其具有標準化的程序，將可以更客觀的將脈象以脈波圖的形式表達出來。
因以本論文擬以一個具有三軸測量能力的脈診儀進行中醫脈診寸關尺分候臟腑學說的臨床研究。首先對三軸測量程序的準確性進行理論及實際的驗證，其次再選取缺血性心臟病及B型肝炎這二個具有代表性的疾病進行脈波圖測量，觀察寸關尺分候臟腑學說是否符合臨床診斷上的需要。
在三軸測量程序的準確性方面，我們首先對中醫脈診寸關尺三部的長度進行研究，結果發現︰肘長的百分之六與「遠側腕橫紋到高骨最高點」的距離相近，表示「遠側腕橫紋到高骨最高點」為寸部的長度為合理，而且可以據此定出關及尺部的位置。其次在脈位的橫向移動及垂直加壓方面，經由血管幾何分析及動脈模型的驗證，也都證實可以準確地找到脈波的最佳測量位置。
在缺血性心臟病患者的脈波圖研究中，以觀察組與對照組相比，頻域分析的結果顯示在僅左寸脈波的C4有顯著差異(p=0.0039)，兩組最佳取脈壓力的比較，也顯示僅在左寸有顯著差異(p=0.013)。而在B型肝炎濕熱證患者之脈波圖研究中，若以以皮爾森相關係數分析法對將六部的脈波參數與肝功能(SGOT、SGPT)進行檢定分析，結果顯示︰右關之W/T與SGOT呈顯著正相關(p=0.023、r=0.389)，與SGPT亦呈接近正相關(p=0.118、r=0.274)，左關之APW與SGOT呈接近顯著正相關(p=0.125、r=0.268)，與SGPT呈顯著正相關(p=0.026、r=0.382)，而其他部位的脈波參數與肝功能則沒有顯著相關性。這二個研究的結果均肯定了中醫寸關尺分候臟腑學說的實用性。
Pulse diagnotics is one of the unique diagnostic techniques of Chinese medicine (TCM). However, these are different to measure sphygmogram ways and fundamental theories on TCM pulse diagnosis scientific studies. It is not convinced by the TCM academic circle and developed in clinic.
The scholars found recently, the theory proposed by Chinese medicine expert Sheu-hai Chou of the late Ching Dynasty by analyzing the attributes of pulse conditions in terms of position, count, shape and trend. The theory can fit to the needs of modern pulse diagnostic research. Therefore, they developed many mathematical and physical equations to represent TCM pulse feeling. However, the motions of radial artery are three dimensions including parallel to the radial artery, vertical to the radial artery (i.e., perpendicular to the radial artery), and horizontal (i.e., perpendicular to the forearm. If we develop a three-dimensional measuring radial pulse method, and standardized positioning procedure. The pulse feeling can be represented by an Objective way.
The purpose of this article was to develop a three-axial sphygmography that employs a standard positioning procedure for detecting the pulse waveform of Cun, Guan, Ch which correspond to different organs. Firstly, we certified the accuracy of the three-dimensional measuring method in theory and clinic. Secondly, we selected the patients with ischemia heart disease and hepatitis B to measuring their sphygmograms. The aim was to certify the theory of Cun, Guan, Ch corresponding to different organs.
The accuracy aspect in three-dimensional measuring procedure, we
study the length of Cun, Guan and Chi on TCM pulse diagnosis firstly. The result showed that the the mean value of relative bias of DWP compared with EL×6% was close to 0%. (males = 2.1%±12.2%, females=0.2%±12.6%). Therefore, by using “the highest point of PB” as the lower limit of Cun and palpating down proximally, the position of Guan and Chi can be found. Secondly, we used an analysis of the vascular geometry and arterial model were used to design a standard positioning procedure for the X- and Z-axes. And the results indicate that our measurement apparatus can locate optimal position of the radial artery precisely.
In the study of radial sphygmogram on the patients with ischemia heart disease, Our analysis of the harmonic C4 of left Cun showed significant difference between the two groups (p=0.0039). And the optimal contact pressure of left Cun was smaller than others (p=0.013). The result was approval for the TCM theory ”Left cun correspond to heart”.In the study of radial sphygmogram on Damp-heat Pattern in Patients with Hepatitis B, One-way repeated measures ANOVA shows the ratio of upper-third width of pulse wave and pulse wave period (W/T) on both guan are greater than other pulse positions (p<0.05). The Pearson correlation coefficient between W/T and liver function are as following: The correlation coefficients between right guan W/T and SGOT, SGPT are 0.389, 0.274. The correlation coefficients between left guan APW and SGOT, SGPT are 0.268, 0.382. The other pulse parameters are not significant different. Therefore, the TCM theory that different pulse positions correspond to different body organs is useful in clinic. |
