| 摘要: | 目的：在傳統中醫診斷中，橈動脈脈搏波的特徵可提供重要的診斷訊息。這項研究的目的是採用準實驗設計(quasi-experimental design)將中醫傳統針灸治療的概念與現代科學工具結合起來。 針刺影響橈動脈的研究有限，目前只有對健康受試者，消化不良和頸椎病病患的研究報導。 迄今為止，尚無關於針刺下背痛患者對橈動脈參數影響的研究。
方法：我們提供42位符合納入條件的受試者一次性的針灸治療。我們使用現代工具探討了針刺腎俞(BL23)，大腸俞(BL25)和委中(BL40)對下背痛患者橈動脈的影響。 此研究的基線評估為生命體征(vital signs)，主要評估指標是在針刺前後特定間隔利用脈診儀評估寸口橈動脈寸、關、尺六部的高頻頻譜能量 (high-frequency spectral energy)。次要評估指標是採用指尖地板距離量測和面部疼痛量表評估針刺的有效性。
結果：共有30名女性和12名男性受試者，年齡分別為20?87歲。 年輕成人（20?44歲）佔47.6％，中年成人（45?65歲）佔38％，老年人（65歲及以上）佔14.4％。 固定疼痛、脹痛或刺痛患者佔42.9%，而痠痛(以痠為主)患者佔57.1%。 橈動脈高頻頻譜能量探測的結果顯示，針刺腎俞、大腸俞和委中後，右尺的高頻頻譜能量有顯著的降低（p = 0.0444）。相對於痠痛患者(p = 0.6903)，固定疼痛、脹痛或刺痛患者右尺的高頻頻譜能量有更顯著的降低 (p = 0.0380)。然而，痠痛患者的左關高頻頻譜能量在針刺後有明顯增加趨勢（p = 0.0582），腰部運動範圍的靈活性有顯著改善，疼痛指數也顯著下降。
結論：本研究提供針刺對下背痛不同類型的患者之橈動脈脈搏波高頻頻譜能量影響的新信息。 研究結果顯示，右尺脈是可評估針刺對固定疼痛、脹痛或刺痛患者療效的有效指標，而左關脈可能是評估針刺對痠痛患者療效的有效指標。 另外，結果明顯的指出針刺腎俞、大腸俞和委中對下背痛患者的治療是有效。 痠痛患者腰部活動範圍的靈活性在針刺後有較顯著的改善，疼痛指數也有較顯著的下降。
Introduction: The unique characteristics of radial pressure pulse waves (RPPW) provide an essential diagnostic technique in Traditional Chinese Medicine (TCM). The aim of this research is to use a quasi-experimental study design that integrates the concept of TCM and traditional acupuncture treatment with modern scientific tools. Limited studies have reported the effects of acupuncture intervention on the RPPW in healthy subjects, dyspepsia, and cervical spondylosis. To date, no study has investigated the effect of acupuncture on the radial pulse patterns of patients with Low Back Pain (LBP).
Methods:
We administered a single acupuncture treatment to 42 eligible participants with the same bilateral intervention at the BL23, BL25 and BL40 acupoints. Baseline assessments (vital signs), primary outcome measures (radial pulse diagnoses), and secondary outcome measures (fingertip-to-floor and the Faces Pain Scale-Revised tests) were performed at specified intervals before and after intervention.
Results: There were 30 female and 12 male participants between 20 and 87 years of age in the study. The study comprised 47.6% young adults (20?44 years), 38% middle-aged adults (45?64 years), and 14.4% elderly adults (65 years and above). Of our study participants, 42.9% experienced fixed, distended or sharp pain while 57.1% experienced dull aching pain (the intensity of dull aches is more than that of sharp pain). The results of the radial pulse diagnoses showed that in general, acupuncture at the Shenshu (BL23), Dachangshu (BL25) and Weizhong (BL40) acupoints significantly reduced the high-frequency Spectral Energy (SE13-50Hz) at the right Chi pulse after the treatment (p = 0.0444). However, the reduction was more significant in group 1 with the fixed, distended or sharp pain (p = 0.0380) compared to those with dull aching pain (p = 0.6903). In contrast, group 2 with the dull aching pain had a marked trend of increase in high-frequency SE at the left Guan pulse after the treatment (p = 0.0582). In addition, group 2 with the dull aching pain had significantly better lumbar range of motion than group 1 with the fixed, distended or sharp pain (p < 0.001). The FPS-R test results showed that both groups experienced a significant reduction in pain after the acupuncture procedure (p < 0.001), although participants in group 2 had a significantly better pain rating than participants in group 1.
Conclusions: Our study provides novel information about the effect of acupuncture on the radial pulse SE in participants with different types of LBP. Our finding suggests that the right Chi pulse is an effective indicator to assess the effect of the acupuncture intervention in participants with fixed, distended or sharp pain, whereas the left Guan pulse is a potentially effective indicator to assess the acupuncture effect in participants with dull aching pain. The BL23, BL25 and BL40 acupoints provide effective treatment for LBP. Participants with dull, aching pain had a more significant improvement of lumbar range of motion and showed a significant decrease on the pain rating after acupuncture. |
