人體結構與脈診定位──下背痛疾患與寸口脈之關係

Human Anatomy and Pulse Diagnosis-The Correlation Between Low Back Pain and Pulse in Tsun-Kou Area

目的：資深傷科醫師時常利用脈診診斷人體結構病變，然而脈診技巧在傷科文獻上僅見於外傷類疾病之預後診斷預測。本研究設計針對下背痛患者寸口脈診數據之前後測做偵測，期待研究結果能夠發現下背痛疾患與寸口脈之關係。方法：針對台中慈濟醫院中醫部傷科急性、亞急性下背痛患者進行收案，並進行針灸及傷科治療。脈診儀之寸口脈數據及疼痛指數於治療前、後兩小時內進行測量。結果：共收案19人，取得完整資訊13人（男性7人，女性6人，平均年齡50.2歲）。經初步統計，可發現經針灸傷科合併治療後，以視覺類比量表（visual analogue scale, VAS）評估疼痛之分數大幅下降並達到顯著差異（p＜0.001），且治療前後右尺部最佳沉脈圖取脈壓力有顯著差異（p＜0.01），其他部位脈象則無顯著差異。疼痛分數改善程度與左關最佳脈圖取脈圖取脈壓力變化中度正相關（p＜0.05）。故可推論經傷科與針灸治療後，下背部所產生之生理結構變化可反應於右尺部，而疼痛表現可反應於左關部。結論：本研究證實下背痛疾患與寸口脈之關係與脈診於傷科疾病診斷與人體結構異常診斷之價值。 Background: Experienced traumatologists often diagnose human structure abnormality by pulse diagnosis technique. However, pulse diagnosis techniques in traumatology literature only focused on predicting prognosis of traumatic diseases. This study investigated pre-test and post-test data of low back pain patient's wrist pulse in tsun-kou area. And the result was expected to find correlation between low back pain and pulse in tsun-kou area. Method: Patients with acute/subacute low back pain in Traditional Chinese medicine traumatology department in Taichung Tzu Chi Hospital were enrolled. They receive acupuncture and traumatology treatment. The pre-test and post-test data of pulse in tsun-kou area from pulse sensing machine and pain indexes of patients were collected within 2 hours before and after treatment. Results: 19 people were included and 13 full information was obtained (7 males and 6 females, with an average age of 50.2 years). After treatment, pain scores assessed by visual analogue scale (VAS) decreased significantly (p＜0.001). Patient's “optimal pulse spectra? at right Chi position exhibited significant difference in obtained pressure before and after treatment (p＜0.01). Other locations of tsun-kou pulse exhibited no significant difference in obtained pressured. And improvement of VAS score has positively moderate correlation with change of obtained pressure of left Guan “optimal pulse spectra? (p＜0.05). Therefore, it indicates that physiological structure of the lower back corrected by traumatology and acupuncture treatment can be reflected in right Chi position, and the pain can be reflected in left Guan position. Conclusions: This study confirms the correlation between low back pain and pulse in tsun-kou area, and the value of pulse diagnosis technique in diagnosing traumatology diseases and spine abnormality.