臺灣博碩士論文加值系統

中醫脈診在中醫診斷體系中有其獨特的地位，但因其主觀性與取象比類的描述方式，而使得在講求數據的科學研究上令人有所質疑無法取信於非中醫體系的研究者。因此，本論文提出如何量化中醫脈診的手法。其實驗架構包含兩方面，一為如何重建中醫師把脈的手法與其指下感覺；另一方面為提出依據中醫師指下感覺的量化參數，以利未來整合於臨床應用。

在過去二十年間，很多的研究致力於提出如何辨識中醫的脈象。然而，這些研究成果中關於脈診理論或實驗設計均著重於心臟動力學和單點感測取脈平台。因此其結果與醫生把脈手法無法直接相關連，此舉將會造成量化後的結果無法與醫生臨床經驗做整合。

因此，雙感測脈診儀 (Bi-Sensing Pulse Diagnosis Instrument, BSPDI) 根據此目的被設計出來。它可以根據醫生的下指深度在同樣的位置上取出受測者的脈象訊息，因此醫生的手法與指下感覺將同時被量化。醫生下指深度的量測是藉由應變計(Strain gauge)與壓力感測器(Polyvinylidene fluoride, PVDF)形成的雙感測器組而達成。而醫生的指下感覺是藉由PVDF或電容式陣列壓力感測器來實現。

在定義量化參數前須與中醫師和中醫古籍相互比對而後提出量化參數定義，以確保未來可於臨床應用。根據BSPDI與所定義的脈象參數，另本論文亦進行單按取脈法與總按取脈法在關部的差異性比較並提出健康人脈象與弦脈的量化程序。

由我們實驗量測結果發現把脈手法浮至中與中至沉的比例約為3:1，而不是一般認知的1:1。在單按法與總按法的比較結果，我們發現關部在浮中沉的整體趨勢下，兩者在統計上無顯著差異，且在手部撓動脈搏動最強時，兩者在統計上亦無顯著差異性。因此，本論文建議利用脈診儀取脈時可用總按法取得脈象訊息，然而分析上可採用單按法或總按法的思維。

在健康人脈象分析中，依總按法取脈時，利用雙感測器脈診儀可以得到與醫師手感達94%的吻合率。在浮位取脈時，寸部脈強（224.2±174.6 mV）確實可以在統計上與關部（44.2±83.7 mV）與尺部（0.0±0.0 mV）區分出來且脈強明顯大於關部與尺部。在中位取脈時，關部（519.2±295.4 mV）可以和尺部（97.5±170.7 mV）區分出來，且關部明顯大於尺部，另關部在浮位與中位在統計上亦明顯具有差異性。而在沉位取脈時，尺部（295.0±179.6 mV）確實開始明顯變大，尺部在浮-沉、中-沉的取脈深度時在統計上的確具有明顯差異性。

在弦脈分析中，本論文提出以平面脈搏波(Plain Pulse Wave, PPW)與微分脈搏波(differentiation Pulse Wave, dPW)的方法區分弦脈(高血壓弦脈與春季弦脈)與非弦脈。先以PPW分出弦脈與非弦脈，再以dPW區分出高血壓弦脈與春季弦脈。

總結來說，利用BSPDI可重現中醫師的把脈手法與其脈象判斷思維。相信只要有更多的人員投入中醫脈診量化的研究其神密性將在未來逐漸被打開，而可視化的脈象診斷將不是夢想。

This research aims to propose a novel approach to discuss how to quantify Traditional Chinese Medicine Pulse Diagnosis (TCMPD). The experiment methodology includes two features: one is how to reconstruct the pulse-taking environment; the other is how to integrate both the quantification parameters and clinical experiences.

Over the last two decades, a number of scientific efforts have been made to quantify pulse diagnosis so as to recognise the inherent value of Traditional Chinese Medicine (TCM). However, previously published pulse diagnostic theoretical or experimental researches have not directly related the use of these new techniques to the experiences of TCM physicians.

Hence, the Bi-Sensing Pulse Diagnosis Instrument (BSPDI) is designed for the following purposes: to repeat pulse-taking depth of physicians and to reconstruct fingertips sensations of physicians. The Polyvinylidene fluoride (PVDF) and strain gauge are designed to repeat the pulse taking depth of physicians. The PVDF or capacitive array pressure sensors are used to detect the fingertips sensations.

To integrate smoothly both quantifiable parameters and clinical experiences, these defined parameters of pulse diagnosis have to follow clinical experiences. Definitions of quantifiable parameters are based on ancient medical books, such as Neijing (內經), Nanjing (難經), Pulse Classic (脈經), Binhumaixue (瀕湖脈學) and so on, because they are conclusions of clinical experiences. According to BSPDI and defined parameters, the different pulse-taking methods such as Simultaneous Palpation (SP) and Pressing with One Finger (PWOF), are checked to ensure the pulse taking procedure. In addition, two clinics results are used to verify its feasibility. One is the pulse conditions of a healthy person; the other is the way to quantify string-like pulse.

The press of physician’s finger causes the variation of strain gauge that is used to represent the pulse taking depth, such as Fu, Zhong, and Chen. The proportion of the displacement span from Fu to Zhong (FZ) to that from Zhong to Chen (ZC) is originally assumed to be 1:1. However, our measurements indicate this displacement to be 3:1. The results of a Pearson product moment reveal that the correlation coefficients of PWOF and SP from Fu to Chen are highly correlated, and the results of a paired samples t test reveal that the SP and PWOF are not different at a special pulse taking depth (i.e. at the maximum pulse strength). By using the pulse-taking platform with tactile sensor, it is concluded that the pulse taking method could adopt SP and the analysis method includes SP or PWOF.

The sequent appearances of wrist pulse among Fu, Zhong, and Chen are consistent with clinic experiences. At the pulse taking depth, Fu, the wrist pulse appear only at Cun (224.2±174.6 mV); at Zhong pulse taking depth, the wrist pulse at Guan will be appeared (519.2±295.4 mV); at Chen pulse taking depth, the wrist pulse at Chi will be appeared 295.0±179.6 mV).
The quantifiable approaches of string-like pulse, dPW (differentiation Pulse Wave), and PPW (Plain Pulse Wave) are found to classify string-like pulse and non-string-like pulse. Firstly, PPW is used to distinguish string-like pulse and non-string-like pulse. And then, dPW is used to distinguish hypertensive string-like pulse and spring string-like pulse.

In summary, the quantification of TCMPD is feasible by using BSPDI and defined parameters. The mystery of TCMPD will be opened and quantifiable parameters make it possible for the researchers to discuss with other. The more discussion we discuss, the more we understand. The TCMPD will not disappear; on the other hand, TCMPD will be a good method to cure patients.

摘要 I
Abstract III
致謝 VI
Table of Contents VII
List of Tables X
List of Figures XII
Nomenclatures XVI
Chapter 1 Introduction 1
1.1 The Brief of Traditional Chinese Medicine 1
1.2 The Procedure of Traditional Chinese Medicine Diagnosis 2
1.3 The Importance of Traditional Chinese Medicine Pulse Diagnosis 2
1.4 The Necessity of Quantification of Pulse Diagnosis 3
1.5 The Problem of Quantification of Pulse Diagnosis 5
1.6 The Aim of this Research 7
Chapter 2 Materials and methods 9
2.1 Subjects 9
2.2 Bi-Sensing Pulse Diagnosis Instrument – Type I 10
2.2.1 PDBSS 12
2.2.2 Robot Fingertips 16
2.3. Bi- Sensing Pulse Diagnosis Instrument – Type II 16
2.4 Definition of Core Parameters 17
2.5 Pulse-taking Methods 20
2.5.1 Pre-processing Signal Block 23
2.5.2 Waveform Test Block and Analytical Procedure 24
2.5.3 Discrete Mode 25
2.5.4 Surface Fitting Mode 27
2.6 Definition of the TPNI Finger-reading Skill 30
2.7 Definition of TPNI-HRT (Health Rule of Thumb) 31
2.8 Experimental Protocol 32
2.8.1 Bi-Sensing Pulse Diagnosis Instrument – Type I 32
2.8.2 Bi-Sensing Pulse Diagnosis Instrument – Type II 34
2.8.3 SP and PWOF 37
2.9 Definition of Hypertensive String-like Pulse by dPW 38
2.10 Definition of the String-like Pulse by PPW 40
2.11 Statistical Methods 41
Chapter 3 Results 42
3.1. Type I Bi-Sensing Pulse Diagnosis Instrument 42
3.1.1 Calibration of the PDBSS 42
3.1.2 Clinical Test 43
3.2 Type II Bi-Sensing Pulse Taking Instrument 47
3.3 Pulse-taking Methods 49
3.3.1 Correlation at Different Pulse-taking Depths between SPG and PWOFG 49
3.3.2 The Paired t Test at a Special Pulse-taking Depth between SPG and PWOFG 50
3.4 TPNI-HRT 52
3.5 String-like Pulse 57
Chapter 4 Discussions 62
4.1 Bi-Sensing Pulse Diagnosis Instrument 62
4.2 Pulse-taking Methods 64
4.3 TPNI-HRT 66
4.4 String-like Pulse 69
Chapter 5 Conclusions 72
References 74
Appendix A 79
Appendix B 83
Publications List 92
Biography 93

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