臺灣博碩士論文加值系統

在十二條經絡的循行路徑中，心包經及心經是直接出或屬於心的兩條經絡。內關為手厥陰心包經的絡穴，通里為手少陰心經的絡穴，有多項研究指出:針刺內關穴能改善心率變異度(Heart Rate Variability HRV)，影響心臟自律神經活性，理論上兩穴對心系疾病應該也能有相當的調整與治療效果，通里穴在調控心率變異度及心臟自律神經活性上，與內關穴應具有相當潛力，但其實際效應如何，尚不清楚。本研究將針對此點進行探討。
材料方法:取18-28歲無重大疾病之男性25人，過去一周生活起居正常者。將同一受試者分成不同時間前後四次(間隔一星期以上)進行研究。先請受試者填問卷，靜躺5分鐘後，測量HRV 5分鐘，再進行針刺15分鐘，針刺後第7分鐘後測HRV一次，出針後再測量HRV 5分鐘。針其結果顯示:在心率變異分析雖看不出組別之差異(p﹥0.05)，但針刺內關及通里在高頻功率有提高之趨勢，亦即升高了副交感神經之的調控功能之趨勢。兩者在高頻的調控上有類似效應。
針刺內關或通里均能低頻正常化數值下降，亦即使交感神經活性下降。
在統計上，調控交感及副交感神經的功能兩穴位看不出差異，但在RR增加的功能中針刺組及無針組有顯著差異(p﹤0.05)，也就是在降低心率有針刺優於無針刺，其中通里優於內關。刺穴位分別為內關、通里、非穴位點，第四次完全無針刺。
其結果顯示:在心率變異分析雖看不出組別之差異(p﹥0.05)，但針刺內關及通里在高頻功率有提高之趨勢，亦即升高了副交感神經之的調控功能之趨勢。兩者在高頻的調控上有類似效應。
針刺內關或通里均能低頻正常化數值下降，亦即使交感神經活性下降。
在統計上，調控交感及副交感神經的功能兩穴位看不出差異，但在RR增加的功能中針刺組及無針組有顯著差異(p﹤0.05)，也就是在降低心率有針刺優於無針刺，其中通里優於內關。

Among the pathways of the twelve channels, the pericardium channel as well as the heart channel directly originate from the heart, or belong to the two channels of the heart. The Nei-Kuan acupoint is the connecting point of the hand reverting yin channel, and the Tung-Li is the connecting point of the hand lesser yin heart channel. As pointed out by a multitude of research: Doing acupuncture on the Nei-Kuan point can improve the HRV (Heart Rate Variability) and can influence the ANS activities of the heart. In theory, the two points should have suitable adjustment and treatment effects for heart diseases. The potential of the Tung-Li point to adjust and control the HRV and ANS activity of the heart should be analogous to the potential of the Nei-Kuan point, but the real effect is not yet quite clear. This research aims to explore this point.
Material and method: Take 25 male test persons, aged 18 to 28 years without major diseases, who have adhered to a regular life routine during the past week. We conduct four different acupuncture experiments, the minimum time period between each of them has to be one week or more. The four different experiments are acupuncture on 1. Nei-Kuan, then 2. Tung-Li, then 3. Non-acupoint and 4. no acupuncture. First, the test persons are asked to fill out a questionnaire. After the test person is lying still for 5 minutes, we measure the HRV for five minutes; in the next step we do acupuncture for 15 minutes; after 7 minutes into the acupuncture, we measure the HRV for the second time. After removing the needle, we measure the HRV for the third time for five minutes.
The result is as follows: The Heart Rate Variability analysis does not show a difference between the four different experiments (p﹥0.05 ). We do however observe an improving trend in the high-frequency power when doing acupuncture on the Nei-Kuan or the Tung-Li acupuncture point, that is, we have an improving trend in the regulation and control function of the parasympathetic activities. Nei-Kuan and Tung-Li have a similar effect on the regulation and control of HF.
Nei-Kuan and Tung-Li acupuncture can reduce the LF% value, generally speaking, cause a reduction in the activity of the sympathetic nerve.
For the Nei-Kuan or the Tung-Li acupuncture, we cannot see a difference between the two in their ability to regulate and control the sympathetic and parasympathetic nerves. For the function of increasing RR, all acupuncture groups are better than the non-needle group and a considerable difference (p﹤0.05 ) can be found, that is, the heart rate reduction effect for the acupuncture groups is better than for the non-needle group and the effect of Tong-Li acupuncture is better than the effect of Nei-Kuan acupuncture.

目 錄
誌 謝 v
中文摘要 vi
Abstract vii
目 錄 ix
圖目 錄 xi
第一章 前言 1
第二章 文獻回顧 4
2.1關於手厥陰心包經及手少陰心經之觀點 4
2.1.1歷史沿革 4
2.1.2心系與心包絡的觀點 6
2.2內關及通里之穴位、主治 9
2.2.1內關 9
2.2.2通里: 10
2.2.3內關與心臟相關之研究 11
2.3心臟與自律神經 13
2.3.1心臟與自律神經的生理關係 13
2.3.2自律神經的化學作用 15
2.3.3自律神經的失調的病理 16
2.4關於HRV(heart rate ariability) 18
2.4.1研究採用HRV分析之原因 18
2.4.2心率 20
2.4.3心率變異度 21
2.4.4心率變異度生理意義 22
2.4.5心率變異分析的影響因子 25
2.4.6心率變異度病理意義 26
2.4.7心率變異度分析方法 27
第三章 研究動機 29
第四章 研究材料與方法 30
4.1研究設計 30
4.1.1研究對象 30
4.2研究進行方法 31
4.2.1試驗進行方法 31
4.2.2流程圖 32
4.2.3表格說明: 34
4.2.4儀器、器材及測量: 34
4.2.5心率變異性分析儀的九項參數 36
SSB1 37
4.3統計分析 39
第五章 結果 40
5.1心率變異度分析參數中RR平均值 41
5.2心率變異分析參數高頻功率 43
5.3心率變異分析參數低頻功率 45
5.4心率變異分析參數低頻正常化 47
第六章 討論 49
6.1研究設計中對照組的考量 49
6.2針刺後對心率變異度的參數中RR的影響 51
6.3針刺後對自律神經的探討 53
6.4探討研究控制因子的缺失 58
6.5研究設計年齡的考量 59
6.6研究限制: 60
結論 61
參考文獻 62
附 錄 71
附 圖 92

圖目錄
圖 1試驗流程圖 32
圖 2針刺內關及通里的部位圖 33
圖 3本研究使用之心率變異性分析儀(SS1B) 37

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