臺灣博碩士論文加值系統

頸部及肩部疼痛是典型的肌肉關節疼痛，是常見的全球性健康問題，好發於中老年。目前常見中醫治療包括針灸、中藥、穴位按摩、熱敷、以及拔罐等。有關拔罐對肩頸疼痛強度緩解之效果目前相關研究文獻仍然稀少；因此本研究目的為探討拔罐對肩頸疼痛強度緩解之成效。
研究分二階段進行；研究一目的在探討拔罐(火罐)對慢性肩頸疼痛緩解之程度與對皮膚表面溫度及血壓改變之差異。採類實驗研究設計，研究對象為60位東部地區之民眾，年齡介於20~65歲。個案以隨機方式分派為兩組，拔罐組(n=30)於肩井、肩中俞、肩髃等穴施以拔罐各10分鐘，兩側共20分鐘；控制組(n=30)不執行拔罐，只予以休息20分鐘。實驗介入前後評估肩頸疼痛強度、皮膚表面溫度、以及血壓之變化。測量工具包括：疼痛視覺類比量表、遠紅外線熱像儀、以及血壓計，p＜0.05為顯著水準。結果顯示在肩頸疼痛強度方面，拔罐組之肩頸部疼痛強度下降程度顯著於控制組。在皮膚表面溫度方面，拔罐組在肩井、肩中俞、肩髃等穴施之溫度上升均顯著高於控制組。結果顯示拔罐對肩頸疼痛俱有緩解之成效。
研究二目的在探討拔罐(火罐)與熱敷對慢性肩頸疼痛緩解之程度差異並觀察其5日之延遲反應效果。採類實驗研究設計，研究對象為自願參與之48位個案，實驗組於肩頸部施以拔罐，控制組於肩頸部施以熱敷20分鐘。測量工具包括疼痛視覺類比量表、心率變異測量儀及經絡電阻儀。結果顯示，在頸部疼痛強度方面，拔罐組能持續下降至第五日，與熱敷組比較呈現顯著差異。在指溫方面，兩組之指溫均呈現上升情形；在心律變異方面，拔罐組於高頻功率(High Frequency, HF)顯著下降，而熱敷組則在低頻功率(Lower Frequency, LF)、HF皆有顯著改變；在經絡活性方面，兩組部份經絡電阻均呈現下降。結果顯示熱敷對肩頸疼痛亦有某種程度之緩解成效，然而拔罐療法之效果可延續至五日。有關拔罐對慢性肩頸部疼痛緩解之長期功效和相關機制還需進一步探討。

Chronic neck and shoulder pain (NSP) is musculoskeletal　pain typically occurring in middle- and older- aged　people. Traditional Chinese medical, treatments include acupuncture, traditional Chinese medicine, acupressure, heat therapy, and cupping therapy. Current literature remains sparse for studies on NSP intensity, skin temperature changes due to cupping therapy. This investigation was divided into two phases.
Part one aimed to investigate the effectiveness of fire cupping therapy (CT) for NSP and changes in skin surface temperature (SST), and blood pressure (BP). A quasi-experimental design consisting of 60 subjects between the ages of 20 - 65 years old with self-perceived NSP was conducted. Pain was measured using the visual analog scale (VAS), SST and BP with p＜0.05 significance.
The neck pain intensity (NPI) and shoulder pain intensity (SPI) in the cupping groups decreased significantly compared to the control group. The SST differences between the groups were statistically significant. BP showed a statistically significant difference in the cupping group, which presented as a decrease in systemic blood pressure (SBP).
Part two of the study aimed to investigate the changes in finger temperature, heart rate variability (HRV), meridian resistance and length of time post intervention for the relief of chronic NSP using fire CT. Participants comprised 48 volunteers with self-perceived NSP. The experimental group underwent CT at the three acupoints on both sides of the body for a total of 20 min. The control group was given hot compression therapy for the neck and shoulder regions for 20 min. Post intervention, the changes in finger temperature, HRV, and meridian resistance were collected. Participants were evaluated over a 5 day period to evaluate efficacy of fire CT.
The results show statistically significant difference in NPI before and after intervention when compared between the two groups. The fire CT group demonstrated greater significant differences than the heating group. The HRV in the cupping group showed decreases in high frequency (HF), some meridians resistance, and increases in finger skin temperature at different time intervals. The heating group demonstrated decreases in lower frequency (LF), HF, some meridians resistance, and increases in finger temperature at different time points. However, there were no significance differences between groups in HRV, meridian resistance and finger temperature.
One treatment of CT is shown to increase both finger temperature and SST. In conjunction with physiological responses, the subjective experience of NSP is reduced pain intensity, which extends up to five days. Further studies are required to improve the understanding and potential long-term effects of CT. Findings from this study suggest that CT is beneficial for relieving pain with no known adverse effects.

致謝
中文摘要…………………………………………………………………………………… Ⅰ
英文摘要…………………………………………………………………………………… Ⅲ
目錄……………………………………………………………………………………………… Ⅴ
圖表目錄…………………………………………………………………………………… Ⅶ
附錄……………………………………………………………………………………………… Ⅹ

第一章　緒論…………………………………………………………………………… 01
第一節　研究背景與動機…………………………………………………… 01
第二節　研究目的………………………………………………………………… 04
第三節　研究假設………………………………………………………………… 05
第四節　名詞界定………………………………………………………………… 06

第二章　文獻查證………………………………………………………………… 07
第一節　肩頸疼痛之生理病理、作用機轉及影響…… 07
第二節　肩頸疼痛的西醫治療………………………………………… 16
第三節　肩頸疼痛的中醫治療………………………………………… 20
第四節　拔罐在肩頸疼痛之應用…………………………………… 24

第三章　研究一……………………………………………………………………… 33
第一節　研究目的………………………………………………………………… 33
第二節　研究架構與流程…………………………………………………… 33
第三節　材料與方法…………………………………………………………… 35
第四節　統計與分析…………………………………………………………… 40
第五節 研究倫理………………………………………………………………… 41
　　第六節 結果………………………………………………………………… 43
第七節　討論…………………………………………………………………………… 50

第四章　研究二……………………………………………………………………… 52
第一節　研究目的………………………………………………………………… 52
第二節　研究架構與流程…………………………………………………… 52
第三節　材料與方法…………………………………………………………… 54
第四節　統計與分析…………………………………………………………… 61
　　第五節 結果………………………………………………………………… 63
第六節　討論…………………………………………………………………………… 76

第五章 結論與建議…………………………………………………………… 82

參考文獻…………………………………………………………………………………… 86

圖表目錄
圖2-1 肩頸疼痛之解剖生理……………………………… 08
圖2-2　肩頸疼痛相關之經脈……………………………… 12
圖2-3　肩頸疼痛相關穴位………………………………… 15
圖2-4　體外震波治療機…………………………………… 19
圖2-5　治體外震波治療…………………………………… 19
圖2-6　電針………………………………………………… 20
圖2-7　針上灸……………………………………………… 20
圖2-8 拔罐相關器具……………………………………… 30
圖2-9 拔罐使用方式……………………………………… 31
圖3-1　概念架構圖………………………………………… 33
圖3-2 研究流程圖………………………………………… 34
圖3-3 視覺類比量表……………………………………… 38
圖3-4　肩、頸疼痛評估項目……………………………… 38
圖3-5　FLIR 遠紅外線熱影像器………………………… 39
圖3-6　熱影像在肩中俞、肩井、以及肩顒等穴，拔罐前、後皮膚表面溫度之變化…………………………… 44
圖3-7　皮膚表面溫度變化於拔罐期間在肩中俞五分鐘之間隔………………………………………………… 45
圖3-8　皮膚表面溫度變化於拔罐期間在肩井五分鐘之間隔…………………………………………………… 46
圖3-9　皮膚表面溫度變化於拔罐期間在肩髃五分鐘之間隔…………………………………………………… 46
圖3-10 肩痛強度於拔罐介入前後之改變………………… 48
圖3-11 頸痛強度於拔罐介入前後之改變………………… 48
圖4-1　研究架構圖………………………………………… 52
圖4-2 研究流程圖………………………………………… 53
圖4-3　熱敷墊……………………………………………… 56
圖4-4　心律變異擴大器…………………………………… 56
圖4-5　經絡電阻儀………………………………………… 59
圖4-6　十二條經絡人體體表電阻點……………………… 60
圖4-7　在拔罐及熱敷期間，指溫10分鐘間隔之變化…… 64
圖4-8　低功頻於介入拔罐及熱敷前後10鐘間隔之變化… 66
圖4-9　高功頻於介入拔罐及熱敷前後10鐘間隔之變化… 66
圖4-10 低／高功頻比於介入拔罐及熱敷前後10鐘間隔之變化………………………………………………… 67
圖4-11 在拔罐及熱敷期間，頸部疼痛強度5天間隔之變化 75
圖4-12 在拔罐及熱敷期間，肩部疼痛強度5天間隔之變化 75
圖4-13 十二經絡循行圖…………………………………… 79

表3-1 受試者人口學特性………………………………… 43
表3-2 皮膚表面溫度在三個穴位組別間五分鐘區隔之變化…………………………………………………… 44
表3-3　視覺類比量表在肩、頸疼痛強度之變化………… 49
表4-1　受試者之人口學特性……………………………… 63
表4-2　皮膚溫度在拔罐組及熱敷組組別間之變化……… 64
表4-3 心率變異在拔罐組及熱敷組於低功頻、高功頻、以及低/高功頻比組別間之變化……………………… 65
表4-4 經絡活性(左側)於拔罐組及熱敷組介入前後之變化…………………………………………………… 69
表4-5 經絡活性(右側)於拔罐組及熱敷組介入前後之變化…………………………………………………… 71
表4-6 視覺類比量表在肩頸疼痛強度於拔罐組及熱敷組組別間之變化……………………………………… 74


附錄
附錄一　縮寫指引…………………………………………… 101
附錄二　人體試驗同意書…………………………………… 103
附錄三　佛教慈濟綜合醫院臨床試驗受試者同意書……… 104
附錄四　論文受稿期刊……………………………………… 107

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