臺灣博碩士論文加值系統

傳統醫學研究顯示，藉由使用經絡能量分析儀（MEAD）測量十二經絡中二十四個手和腳穴道的導電度，人體內的能量可能可被檢測。
本研究的目的是要調查癌症病人的經絡導電度及營養狀況之間是否有相關。參與這橫斷面研究的住院癌症患者共147位。經絡導電度是使用MEAD測量，而營養狀況則是使用病患提供主觀性整體營養狀況評量表（scored PG-SGA）評估。經絡導電總分（12個經絡值的平均）的比值是0.98，表明導電度的下降跟嚴重營養不良（Stage C）增加的可能性有關聯（當與人口統計和疾病相關的變量調整）。以無母數克-瓦二氐檢定（Kruskal-Wallis test）檢驗比較於每個PG-SGA階段的12經絡中位數。結果顯示，經絡導電總分具有顯著差異；當單獨檢驗，十二條中有七條經絡具顯著差異，分別為：心，大腸，肝，腎，膀胱，膽和胃（p < 0.05）。經絡導電度也會受人口統計和疾病相關的變量如性別，年齡和BMI的影響而有差別；但跟癌症分期和ECOG PS分數則沒有差別。本研究暗示經絡導電度與營養狀況之間具有遞減關係。然而，仍需要考慮人口統計和疾病相關的因子，因為它們都有可能影響測量的結果。目前來看，在癌症照護方面，若搭配營養狀態評估，MEAD是一個可能可以被使用的輔助工具。

Traditional Chinese medicine (TCM) studies have shown that energy in the human body may be detected using the meridian energy analysis device (MEAD) through the measurement of skin electrical conductance of 24 hand and foot acupuncture points located on the 12 main meridians. This study aims to investigate whether or not an association exists between electrical conductance of acupuncture meridians and nutritional status in cancer patients. A cross-sectional study was conducted with 147 hospitalized cancer patient cases. Meridian electrical conductance was tested using the MEAD, while nutritional status was assessed using the scored Patient-Generated Subjective Global Assessment (PG-SGA) questionnaire. The odds ratio for the total meridian electrical conductance (average of the 12 meridian values) was reported to be at 0.98, which indicated that a decrease in the conductance level was correlated with an increase in the odds of being severely malnourished (Stage C), when adjusted with demographic and disease-related variables. Nonparametric Kruskal-Wallis test was used to compare median values of the 12 meridians for each PG-SGA stage. The total meridian electric conductance was found to have a significant difference. When examined individually, 7 out of the 12 meridians have a significant difference, namely that of the heart, large intestine, liver, kidney, urinary bladder, gallbladder, and stomach (all p < 0.05). Meridian electrical conductance levels also differ with regards to demographic and disease-related variables such as gender, age, and BMI, but not cancer stage and ECOG PS score. The study suggests a decreasing association between meridian electric conductance and nutritional status. However, there are demographic and disease-related factors that need to be taken into account, as they may have an impact on both measurements. For the time being, the MEAD may be a possible complementary tool, along with nutritional status assessment, in cancer care.

Table of Contents

Acknowledgements.......i
Abstract.......ii
中文摘要.......iv
Table of Contents.......vi
List of Figures.......ix
List of Tables.......x
Chapter 1 – Introduction.......1
1.1 History of Cancer.......1
1.2 Cancer Statistics.......2
1.3 Western Medicine.......3
1.4 Complementary and Alternative Medicine.......4
1.5 Traditional Chinese Medicine.......5
1.6 Electrical Conductance of Meridians.......7
1.7 Related Assessments in Cancer Care.......8
1.7.1 Nutritional Status.......8
1.7.2 Performance Status.......10
1.8 Rationale and Aim of the Study.......11
Chapter 2 – Research Methodology.......11
2.1 Study Protocol.......11
2.2 Data Collection (Measurements).......13
2.2.1 Meridian Energy Analysis Device.......13
2.2.2 Eastern Cooperative Oncology Group Performance Status.......17
2.2.3 scored Patient-Generated Subjective Global Assessment.......18
2.3 Data Analyses.......19
Chapter 3 – Results.......22
3.1 Baseline characteristics of participants with cancer .......22
3.2 Comparison of baseline characteristics between healthy volunteers and participants with cancer.......22
3.3 Comparison of meridian electrical conductance levels of healthy volunteers and participants with cancer .......23
3.4 Distribution of nutrition impact symptoms in participants with different levels of PG-SGA groupings .......23
3.5 Potential predictors of nutritional status.......24
3.6 Comparison of the twelve meridian electrical conductance levels in relation to nutritional status .......25
3.7 Comparison of the twelve meridian electrical conductance levels in relation to demographic and disease-related variables.......26
Chapter 4 – Discussion.......28
Chapter 5 – Conclusion.......36
References.......37
Appendices.......64
Appendix 1. Taipei City Hospital Institutional Review Board certificate.......65
Appendix 2. Participant information and consent form .......66
Appendix 3. Components of MEAD.......73
Appendix 4. Usage of MEAD.......74
Appendix 5. Representative acupuncture points of the 12 meridians.......75
Appendix 6. scored PG-SGA Questionnaire.......77
Appendix 7. Poster presentation.......79
Appendix 8. Manuscript publication.......84

List of Figures

Figure 1. Flow of recruiting study participants.......44
Figure 2. Mean electrical conductance in healthy volunteers and participants with cancer.......45
Figure 3. Box plots of the total meridian electrical conductance level in participants with different levels of PG-SGA groupings.......46
Figure 4. Clustered box plots of the median meridian electrical conductance levels of the twelve meridians in participants with different levels of PG-SGA groupings .......47
Figure 5. Clustered box plots of the median meridian electrical conductance levels of the three yin and yang meridians of the hands and feet in participants with different levels of PG-SGA groupings.......48

List of Tables

Table 1. Instrument test-retest reliability analysis .......50
Table 2. Baseline characteristics of participants .......51
Table 3. Comparison of baseline characteristics between healthy volunteers and participants with cancer (subgroup).......53
Table 4. Comparison of meridian electrical conductance levels between healthy volunteers and participants with cancer (subgroup).......54
Table 5. Comparison of demographic and disease-related variables in participants with different levels of PG-SGA groupings.......55
Table 6. Ordinal logistic regression analysis for nutritional status (PG-SGA) adjusted for demographic and disease-related factors of the study participants .......57
Table 7. Comparison of meridian electric conductance levels in participants with different levels of PG-SGA groupings.......58
Table 8. Comparison of meridian electric conductance levels in participants of different genders.......59
Table 9. Comparison of meridian electric conductance levels in participants of different age groups.......60
Table 10. Comparison of meridian electric conductance levels in participants of different levels of BMI groupings.......61
Table 11. Comparison of meridian electric conductance levels in participants of different levels of cancer stage groupings.......62
Table 12. Comparison of meridian electric conductance levels in participants of different levels of ECOG PS groupings.......63

References

1. American Cancer Society. The History of Cancer. http://www.cancer.org/cancer/cancerbasics/thehistoryofcancer/index?sitearea. Accessed May 30, 2014.
2. Sudhakar A. History of Cancer, Ancient and Modern Treatment Methods. J. Cancer Sci. Ther. Dec 1 2009;1(2):1-4.
3. Raven R. The Theory and Practice of Oncology: Historical Evolution and Present Principles. Park Ridge, New Jersey: Parthenon 1990.
4. International Agency for Research on Cancer. All Cancers (excluding non-melanoma skin cancer) Estimated Incidence, Mortality and Prevalence Worldwide in 2012. http://globocan.iarc.fr/Pages/fact_sheets_cancer.aspx. Accessed May 1, 2014
5. Ferlay J, Shin HR, Bray F, Forman D, Mathers C, Parkin DM. Estimates of worldwide burden of cancer in 2008: GLOBOCAN 2008. Int. J. Cancer. Dec 15 2010;127(12):2893-2917.
6. Ministry of Health and Welfare. Causes of Death, 2012. http://www.mohw.gov.tw/EN/Ministry/Statistic.aspx?f_list_no=474&fod_list_no=3523. Accessed May 1, 2014.
7. Hanahan D, Weinberg RA. The hallmarks of cancer. Cell. Jan 7 2000;100(1):57-70.
8. Hanahan D, Weinberg Robert A. Hallmarks of Cancer: The Next Generation. Cell.144(5):646-674.
9. National Cancer Institute. Cancer Staging. Accessed June 10, 2014.
10. Stedman T. Stedman's Medical Dictionary. 28th ed: Lippincott Williams & Wilkins; 2006.
11. American Cancer Society. Cancer Treatment Types. Accessed June 10, 2014.
12. Horneber M, Bueschel G, Dennert G, Less D, Ritter E, Zwahlen M. How many cancer patients use complementary and alternative medicine: a systematic review and metaanalysis. Integr. Cancer Ther. Sep 2012;11(3):187-203.
13. Ernst E, Cassileth BR. The prevalence of complementary/alternative medicine in cancer: a systematic review. Cancer. Aug 15 1998;83(4):777-782.
14. Chen FP, Chen TJ, Kung YY, et al. Use frequency of traditional Chinese medicine in Taiwan. BMC Health Serv. Res. 2007;7:26.
15. Lin YH, Chen KK, Chiu JH. Prevalence, patterns, and costs of Chinese medicine use among prostate cancer patients: a population-based study in Taiwan. Integr. Cancer Ther. Mar 2010;9(1):16-23.
16. Chien CR, Su SY, Cohen L, Lin HW, Lee RT, Shih YC. Use of Chinese medicine among survivors of nasopharyngeal carcinoma in Taiwan: a population-based study. Integr. Cancer Ther. Sep 2012;11(3):221-231.
17. Wong R, Sagar SM. Supportive Cancer Care Using Chinese Medicine. In: Cho WCS, ed. Supportive Cancer Care Using Chinese Medicine: Springer; 2010:2-3.
18. Beinfeld H, Korngold E. Chinese Medicine and Cancer Care. Alternative Therapies. 2003;9(5):38-52.
19. Unschuld PU, Tessenow H. Huang Di Nei Jing Su Wen: An Annotated Translation of Huang Di’s Inner Classic – Basic Questions: 2 volumes, Volumes of the Huang Di Nei Jing Su Wen Project.: University of California Press; 2011.
20. Wang GJ, Ayati MH, Zhang WB. Meridian studies in China: a systematic review. Journal of acupuncture and meridian studies. Mar 2010;3(1):1-9.
21. Huang KF, Tang ST, Chuang CY, Han WR, Lin JH, Young ST. Different patterns of dynamic variations on electrical conductances of acupoints between Qi Vacuity and Qi non-Vacuity after glucose ingestion. J. Altern. Complement. Med. Sep 2011;17(9):843-849.
22. Huang SM, Chien LY, Chang CC, Chen PH, Tai CJ. Abnormal gastroscopy findings were related to lower meridian energy. Evid. Based Complement. Alternat. Med. 2011;2011:878391.
23. Lee CT, Chang YH, Lin WY, et al. Applications of meridian electrical conductance for renal colic: a prospective study. J. Altern. Complement. Med. Aug 2010;16(8):861-866.
24. Wiseman N, Ellis A. Fundamentals of Chinese Medicine. Brookline, Massachusetts: Paradigm Publications; 1995.
25. Ahn AC, Colbert AP, Anderson BJ, et al. Electrical properties of acupuncture points and meridians: a systematic review. Bioelectromagnetics. May 2008;29(4):245-256.
26. Chen KG. Electrical properties of meridians. IEEE Eng. Med. Biol. Mag. 1996;15(3):58-63.
27. Lee MS, Jeong SY, Lee YH, Jeong DM, Eo YG, Ko SB. Differences in electrical conduction properties between meridians and non-meridians. Am. J. Chin. Med. 2005;33(5):723-728.
28. Nakatani Y, Yamashita K. A Guide for the Application of Ryodoraku Autonomous Nerve Regulatory Therapy. Alhambra, California: Chan's Books & Products; 1972.
29. Colbert AP, Spaulding K, Larsen A, Ahn AC, Cutro JA. Electrodermal activity at acupoints: literature review and recommendations for reporting clinical trials. Journal of acupuncture and meridian studies. Mar 2011;4(1):5-13.
30. Correia MI, Waitzberg DL. The impact of malnutrition on morbidity, mortality, length of hospital stay and costs evaluated through a multivariate model analysis. Clin. Nutr. Jun 2003;22(3):235-239.
31. Jeejeebhoy KN. Nutritional assessment. Nutrition. Jul-Aug 2000;16(7-8):585-590.
32. Kern KA, Norton JA. Cancer cachexia. JPEN J. Parenter. Enteral Nutr. May-Jun 1988;12(3):286-298.
33. Ollenschlager G, Viell B, Thomas W, Konkol K, Burger B. Tumor anorexia: causes, assessment, treatment. Recent Results Cancer Res. 1991;121:249-259.
34. Argiles JM. Cancer-associated malnutrition. Eur. J. Oncol. Nurs. 2005;9 Suppl 2:S39-50.
35. Barber MD, Ross JA, Fearon KC. Cancer cachexia. Surg. Oncol. Nov 1999;8(3):133-141.
36. Carson JA, Gormican A. Taste acuity and food attitudes of selected patients with cancer. J. Am. Diet. Assoc. Apr 1977;70(4):361-365.
37. Trant AS, Serin J, Douglass HO. Is taste related to anorexia in cancer patients? Am. J. Clin. Nutr. Jul 1982;36(1):45-58.
38. von Meyenfeldt M, Chance WT, Fischer JE. Correlation of changes in brain indoleamine metabolism with onset of anorexia in rats. Am. J. Surg. Jan 1982;143(1):133-138.
39. Moldawer LL, Rogy MA, Lowry SF. The role of cytokines in cancer cachexia. JPEN J. Parenter. Enteral Nutr. Nov-Dec 1992;16(6 Suppl):43S-49S.
40. Strassmann G, Kambayashi T. Inhibition of experimental cancer cachexia by anti-cytokine and anti-cytokine-receptor therapy. Cytokines Mol. Ther. Jun 1995;1(2):107-113.
41. Tisdale MJ. Cancer anorexia and cachexia. Nutrition. May 2001;17(5):438-442.
42. Davis MP, Dreicer R, Walsh D, Lagman R, LeGrand SB. Appetite and cancer-associated anorexia: a review. J. Clin. Oncol. Apr 15 2004;22(8):1510-1517.
43. Van Cutsem E, Arends J. The causes and consequences of cancer-associated malnutrition. Eur. J. Oncol. Nurs. 2005;9 Suppl 2:S51-63.
44. Pattison RM, Richardson, R.A., Dougan, H., Davidson, H.I.M.,. Impact of altered taste sensitivity on dietary intake of patients with advanced cancer. . Proceedings of the Nutrition Society 56, 314A. 1997.
45. Grant M, Kravits K. Symptoms and their impact on nutrition. Semin. Oncol. Nurs. May 2000;16(2):113-121.
46. Ottery FD. Supportive nutrition to prevent cachexia and improve quality of life. Semin. Oncol. Apr 1995;22(2 Suppl 3):98-111.
47. Davies M. Nutritional screening and assessment in cancer-associated malnutrition. Eur. J. Oncol. Nurs. 2005;9 Suppl 2:S64-73.
48. Holder H. Nursing management of nutrition in cancer and palliative care. Br. J. Nurs. Jun 12-25 2003;12(11):667-668, 670, 672-664.
49. Sorensen JB, Klee M, Palshof T, Hansen HH. Performance status assessment in cancer patients. An inter-observer variability study. Br. J. Cancer. Apr 1993;67(4):773-775.
50. Weeks J. Quality-of-life assessment: performance status upstaged? J. Clin. Oncol. Dec 1992;10(12):1827-1829.
51. Oken MM, Creech RH, Tormey DC, et al. Toxicity and response criteria of the Eastern Cooperative Oncology Group. Am. J. Clin. Oncol. Dec 1982;5(6):649-655.
52. Meridian Energy Analysis Device 6 System Operation Manual In: MedPex Enterprises, ed2009.
53. WHO Regional Office for the Western Pacific Region. WHO Standard Acupuncture Point Locations in the Western Pacific Region. Manila: World Health Organization; 2009.
54. Lee Y. Analysis on the change of Ryodoraku values by time, age, or acupuncture, moxibustion, and ice stimulation on the Zusanli acupoints. Taichung, Taiwan: Graduate Institute of Integrated Medicine, China Medical University; 2006.
55. Conill C, Verger E, Salamero M. Performance status assessment in cancer patients. Cancer. Apr 15 1990;65(8):1864-1866.
56. Bauer J, Capra S, Ferguson M. Use of the scored Patient-Generated Subjective Global Assessment (PG-SGA) as a nutrition assessment tool in patients with cancer. Eur. J. Clin. Nutr. Aug 2002;56(8):779-785.
57. McCallum PD. Nutrition screening and assessment in oncology. In: Elliot L, Molseed L, McCallum PD, eds. The Clinical Guide to Oncology Nutrition. United States of America: American Dietetic Association; 2006:46-47.
58. Chen MF, Yu HM, Li SF, You TJ. A complementary method for detecting qi vacuity. BMC Complement Altern Med. 2009;9:12.
59. Haemmerich D, Staelin ST, Tsai JZ, Tungjitkusolmun S, Mahvi DM, Webster JG. In vivo electrical conductivity of hepatic tumours. Physiol. Meas. May 2003;24(2):251-260.
60. Laufer S, Ivorra A, Reuter VE, Rubinsky B, Solomon SB. Electrical impedance characterization of normal and cancerous human hepatic tissue. Physiol. Meas. Jul 2010;31(7):995-1009.
61. Joines WT, Zhang Y, Li C, Jirtle RL. The measured electrical properties of normal and malignant human tissues from 50 to 900 MHz. Med. Phys. Apr 1994;21(4):547-550.
62. Smith SR, Foster KR, Wolf GL. Dielectric properties of VX-2 carcinoma versus normal liver tissue. IEEE Trans. Biomed. Eng. May 1986;33(5):522-524.
63. Stauffer PR, Rossetto F, Prakash M, Neuman DG, Lee T. Phantom and animal tissues for modelling the electrical properties of human liver. Int. J. Hyperthermia. Jan-Feb 2003;19(1):89-101.
64. O'Rourke AP, Lazebnik M, Bertram JM, et al. Dielectric properties of human normal, malignant and cirrhotic liver tissue: in vivo and ex vivo measurements from 0.5 to 20 GHz using a precision open-ended coaxial probe. Phys. Med. Biol. Aug 7 2007;52(15):4707-4719.
65. Haemmerich D, Schutt DJ, Wright AW, Webster JG, Mahvi DM. Electrical conductivity measurement of excised human metastatic liver tumours before and after thermal ablation. Physiol. Meas. May 2009;30(5):459-466.
66. Jossinet J, Schmitt M. A review of parameters for the bioelectrical characterization of breast tissue. Ann. N. Y. Acad. Sci. Apr 20 1999;873:30-41.
67. Halter RJ, Schned A, Heaney J, Hartov A, Paulsen KD. Electrical properties of prostatic tissues: I. Single frequency admittivity properties. J. Urol. Oct 2009;182(4):1600-1607.
68. Calle EE, Kaaks R. Overweight, obesity and cancer: epidemiological evidence and proposed mechanisms. Nat. Rev. Cancer. Aug 2004;4(8):579-591.
69. Zhang L, Lu Y, Fang Y. Nutritional status and related factors of patients with advanced gastrointestinal cancer. Br. J. Nutr. Apr 14 2014;111(7):1239-1244.
70. Segura A, Pardo J, Jara C, et al. An epidemiological evaluation of the prevalence of malnutrition in Spanish patients with locally advanced or metastatic cancer. Clin. Nutr. Oct 2005;24(5):801-814.
71. Teunissen SC, Wesker W, Kruitwagen C, de Haes HC, Voest EE, de Graeff A. Symptom prevalence in patients with incurable cancer: a systematic review. J. Pain Symptom Manage. Jul 2007;34(1):94-104.
72. Gharib MI, Burnett AK. Chemotherapy-induced cardiotoxicity: current practice and prospects of prophylaxis. Eur. J. Heart Fail. Jun 2002;4(3):235-242.
73. Mitchell EP. Gastrointestinal toxicity of chemotherapeutic agents. Semin. Oncol. Feb 2006;33(1):106-120.
74. Xue H, Sawyer MB, Wischmeyer PE, Baracos VE. Nutrition modulation of gastrointestinal toxicity related to cancer chemotherapy: from preclinical findings to clinical strategy. JPEN J. Parenter. Enteral Nutr. Jan 2011;35(1):74-90.
75. King PD, Perry MC. Hepatotoxicity of chemotherapy. Oncologist. 2001;6(2):162-176.
76. de Jonge MJ, Verweij J. Renal toxicities of chemotherapy. Semin. Oncol. Feb 2006;33(1):68-73.
77. Makhnev VP. [Dynamics of electrodermal activity during changes in the hydration of the epidermis: theoretical model]. Biofizika. Jan-Feb 1997;42(1):201-208.
78. Rathkolb O, Gallei L. [Biosignals of dermal activity]. Wiener klinische Wochenschrift. 1993;105(8):228-231.
79. Freedman LW, Scerbo AS, Dawson ME, Raine A, McClure WO, Venables PH. The relationship of sweat gland count to electrodermal activity. Psychophysiology. Mar 1994;31(2):196-200.
80. Weng CS, Hung YL, Shyu LY, Chang YH. A study of electrical conductance of meridian in the obese during weight reduction. Am. J. Chin. Med. 2004;32(3):417-425.
81. Lukaski HC, Johnson PE, Bolonchuk WW, Lykken GI. Assessment of fat-free mass using bioelectrical impedance measurements of the human body. Am. J. Clin. Nutr. Apr 1985;41(4):810-817.
82. Marchello MJ, Berg PT, Swantek PM, Tilton JE. Predicting live and carcass lean using bioelectrical impedance technology in pigs. Livestock Production Science. 4/1/ 1999;58(2):151-157.