臺灣博碩士論文加值系統

針灸是傳統中醫採用針刺人體穴位治療多種疾病的方式，然而目前許多驗證中醫療效的科學研究工具與方法常不能完全符合中醫的邏輯思維。近年來動態複雜度理論的多尺度熵運算法廣被應用於醫學的領域中，該理論認為一個處於動態平衡的健康人會有較高的自由度與生理信號複雜度用以適應外在環境的變化。這與中醫的邏輯思維有許多相似之處，本論文研究期望能結合該理論為中醫的科學研究方法樹立新的里程碑。
本論文研究共分兩大實驗部分，分別使用非侵入性心電圖(ECG)與光容積波描述圖(PPG)，來評估針刺右腳足三里穴對人體自主神經活性、末梢血液灌流量與生理複雜度的影響。實驗一部分共收集28位健康年輕受試者年齡為18至31歲(男性22位，女性6位)，將BMI>25體重過重的受試者分類為Group 1(n=10)，BMI<25正常體重的受試者分類為Group 2 (n=18)。8個PPG夾具接在受試者左右手的拇指、食指末端與左右腳的第二腳趾與第五腳趾末端，3個ECG夾具則接在右手手腕與左右腳腳踝上方。每位受試者先後接受兩個階段信號量測，每位受試者全部實驗量測時間為一小時。此外使用多尺度熵(Multiscale entropy, MSE)與短時間多尺度熵 (short time MSE, sMSE)的資料分析方法來評估刺足三里穴前後生理信號複雜度的變化。結果顯示28位受試者經過針刺足三里穴後末梢血液灌流量有上升。另外，Group 2 (BMI<25)的受試者交感神經活性明顯下降而sMSE明顯上升(兩者p<0.05)，顯示刺足三里穴會使人體末梢血液灌流量上升，且使正常體重人副交感神經活性與生理信號複雜度都有上升。
考量遠紅外線照射能與人體內分子產生共振，並產生熱效應(Thermal effects)與非熱效應(Non-thermal effects)。過去雖有許多單一遠紅外線或針灸的研究，但少有將兩者合併的治療效果進行研究評估。本論文研究實驗二部分收集有20位受試者(男性17位，女性3位)，平均年齡25.5 ± 4.6 歲(19~37歲)，4個PPG夾具接在受試者兩手食指與兩腳第二腳趾末端，3個ECG夾具則接在右手手腕與左右腳腳踝上方。每位受試者皆會接受針刺治療、偽針治療、遠紅外照射治療、遠紅外線與針刺合併治療等四種不同治療方式的實驗，每次實驗量測時間皆為30分鐘，其中ECG與PPG同步信號擷取共分成三段；前5分鐘為基線信號，施針後擷取15分鐘，拔針後再量10分鐘。結果顯示20位受試者在四種不同治療方式施針後之PI皆較其基線信號有上升的趨勢，並達統計上的差異(P<0.05)。而偽針治療組拔針後PI雖有上升的趨勢，但無統計上的差異(P=0.069)，其他三組不但PI上升且具統計上的差異(P<0.05)。在自主神經功能LHR指標方面，僅有偽針治療組施針後LHR平均值較基線信號有上升的趨勢(P=0.206)，其他三組皆是平均值有下降的趨勢，又以遠紅外線與合併治療組呈現統計意義下降(2.42±1.58 vs 1.74±0.93, P=0.041)。證實遠紅外線與針刺合併治療足三里穴會比單一的治療方式更能提升人體末梢血液灌流量與副交感神經活性。

Zusanli (ST-36) is one of the four most important acupoints in traditional Chinese medicine because it is believed to co-ordinate the functions of the immunological and gastrointestinal systems. Far-infrared radiation (FIR) is a noninvasive treatment, it can stimulate living organisms generating many biological effects. Although acupuncture and far infrared radiation (FIR) have been reported to improve peripheral circulation, their combined use has not been evaluated. My research includes two parts: the first part is “Assessing the impact of acupuncture on peripheral blood perfusion, autonomic activities and physiological signal complexity.”，the second part is “Assessing the impact of combined far-infrared radiation (FIR) and acupuncture at ST36 on peripheral blood perfusion and autonomic activities.”
The first part is“Assessing the impact of acupuncture on peripheral blood flow，autonomic activities and physiological signal complexity.”We used non-invasive eight channel photoplethysmography (PPG) and electrocardiography (ECG) for acquisition of peripheral arterial waveforms and heart rate variability (HRV) and then investigated peripheral blood flow index and autonomic activities. Twenty-eight healthy young adults (22 males, 6 females) were enrolled for a 60-minute measurement. Additionally, complexity of physiological signals was compared with multiscale entropy (MSE) and short-time MSE (sMSE) before and after acupuncture. Bland Altman analysis of the blood perfusion index (PI) showed that the majority of values were located within 1.96 SD. This suggested that our data has high consistency and our measuring device has high accuracy. The results showed significant elevation of peripheral blood perfusion index in all subjects during and immediately after acupuncture. On the other hand, significantly reduced sympathetic activities in subjects with body mass index (BMI) <25 (n=18) (p<0.05) was noted. Additionally, MSE analysis of R-R interval (RRI) from 5-minute recording of ECG from subjects with BMI<25 before and immediately after acupuncture showed significantly elevated sMSE immediately after acupuncture. However, no significant difference was noted in MSE between the two time points. In conclusion, the study demonstrated that acupuncture at Zusanli improves peripheral blood perfusion and parasympathetic activities. Furthermore, sMSE revealed increased physiological signal complexity after acupuncture for individuals of normal weight.
The second part is “Assessing the impact of combined far-infrared radiation (FIR) and acupuncture at ST36 on peripheral blood perfusion and autonomic activities.” Twenty healthy young adults (17 males, 3 females) were enrolled. Each subject received four different interventions during the experimental sessions: Session 1 (acupuncture at ST36), Session2 (pseudo-acupuncture), Session 3 (FIR) and Session 4 (MIX: FIR combine with acupuncture at ST36). During each session, initial 5 minutes is defined as baseline stage (Stage 1), the following 15 minutes as intervention stage (Stage 2), and the last 10 minutes as post-intervention stage (Stage 3). Data were acquired from non-invasive approaches on four-channel PPG and ECG.
The results demonstrated increase in peripheral blood perfusion for each therapeutic strategy from stage 1 to stage 2 for all subjects (all p<0.05). Besides, elevation in peripheral blood perfusion was noted for all treatment strategies at stage 3 compared to stage 1 except pseudo-acupuncture. Increase in LHR was noted only in subjects undergoing pseudo-acupuncture at stage 3 compared to stage 1 (p<0.05). Notable drop in LHR at stage 2 compared to stage 1 was found only in subjects receiving combined treatment (p<0.05). In conclusion, combined treatment of acupuncture and FIR could produce much effects in than mono-therapy on peripheral blood perfusion and parasympathetic activity.

致謝 I
中文摘要 II
英文摘要 Ⅴ
目 錄 VII
圖 目 錄 X
表 目 錄 XII
第一章 緒論 1
1.1 前言 2
1.2 自主神經系統 3
1.3 微循環系統 5
1.4 足三里穴在中醫臨床運用與研究 6
1.5 遠紅外線的研究與應用 10
1.6 研究目的 13
第二章 量測系統與資料分析方法 14
2.1 量測系統介紹 14
2.2 資料分析方法說明 15
2.2.1 光容積波描述圖與血液灌流量指標運算 15
2.2.2 心率變異度分析 17
2.2.3 多尺度熵運算 20
2.2.3.1 粗粒化(Coase-grained)處理 21
2.2.3.2 樣本熵(sample entropy)運算 22
2.2.3.3 短時間多尺度熵(short time MSE, sMSE)運算 23
2.2.3.4 MEI and sMEI之大小尺度指標 26
第三章 評估針刺足三里穴對人體末梢血液灌流量、自主神經活性及生理信號複雜度的影響 27
3.1 實驗目的 27
3.2. 受試者納入、排除條件與分組 27
3.3 實驗一流程 27
3.4 統計方法 30
3.5 實驗結果 31
3.5.1受試者基本生理資料 31
3.5.2量測儀器一致性驗證 32
3.5.3針刺足三里穴對末梢血液灌流量的影響 33
3.5.4針刺足三里穴對自主神經活性的影響 35
3.5.5以多尺度熵評估針刺足三里穴效果 36
3.5.5.1 以MSE評估針刺足三里穴對生理信號複雜度的影響 36
3.5.5.2 以sMSE分析針刺足三里穴對生理信號複雜度的影響 39
3.6 討論 41
3.7 結論 45
第四章 評估遠紅外線與針刺足三里穴位對人體末梢血液灌流量、自主神經活性的影
響 47
4.1 實驗目的 47
4.2 受試者納入與排除條件 47
4.3 實驗儀器:遠紅外線治療儀 47
4.4 實驗二流程 48
4.5 統計方法 52
4.6實驗結果 53
4.6.1受試者基本生理資料 53
4.6.2各種治療實驗對人體末梢血液灌流量的影響 54
4.6.3各種治療實驗對人體自主神經活性的影響 56
4.7討論 59
4.8 結論 62
第五章 結論與未來展望 63
5.1論文研究結論 63
5.2未來展望 66
參考文獻 67

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