腦中風患者與脈診儀的相關性初探病例報告

A Preliminary Case Report on the Correlation Between Stroke Patients and Pulse Diagnostic Device

10.6516/TJTCM.202109_24(3).0009

吳凱麗(Wu Kari)；何宗融(Tsung-Jung Ho)；王健豪(Chien-Hao Wang)；陳中奎(Jhong-Kuei Chen)

腦中風 ； 脈診儀 ； 幹細胞治療 ； Stroke ； Pulse Diagnostic Device ； Stem Cell Therapy

中醫藥研究論叢

24卷3期（2021 / 09 / 30）

117 - 135

繁體中文

腦中風為急症，依照腦組織受影響部位、影響範圍、是否及時接受適當治療等因素，其預後差異很大。腦中風患者接受中藥與針灸治療已被證實可顯著降低各種併發症的風險並且降低再次中風的機率。本病例為第三次梗塞性中風且合併出血性轉變，病情嚴重且複雜，發病後三個月進入花蓮慈濟醫院接受幹細胞治療與中西醫合療。中醫治療方面，除了科學中藥粉、水煎藥、針灸等常見的治療方式之外，針灸方面另外強調了調整全身氣機的思路，並且結合了芳香療法、耳穴按揉，盡力以最大程度幫助病人。住院治療期間（4/13到5/11），心跳速率有較穩定，GCS從7分（E4VTM2）進步到9分（E4VTM4），肌肉力量上肢從0分進步到2分，下肢從1分進步到3分。症狀表現上，嘔吐咳痰較改善，肢體動作較明顯。腦中風是腦部血液循環出問題因而引起腦部功能損傷的疾病。脈診儀可用於觀察中風病患針灸前後血循環的差異，期待可以提供客觀的療效評估。本病例嘗試用米安科技的「微小壓力換能器」（型號TD01C）脈診儀，觀察針灸前後其諧頻指標的變化。我們觀察到本病例針刺前後，除了C0之外，其他諧頻的振幅平均值皆有增加，且腦相關的Cn值明顯提高，證明針刺治療有增加腦部循環的效果。

Stroke is an emergency, and its prognosis varies greatly according to factors such as the affected part of the brain tissue and whether or not to receive appropriate treatment in time. The treatment of stroke patients with traditional Chinese medicine and acupuncture has been proven to significantly reduce the risk of various complications and reduce the chance of a second stroke. This case is the third infarct stroke with hemorrhagic transformation. Three months after the onset, he was admitted to Hualien Tzu Chi Hospital for stem cell therapy and a combination therapy of Chinese and Western medicine. In terms of traditional Chinese medicine treatment, in addition to common treatment methods in Taiwan such as scientific Chinese medicine powder, water decoction, and acupuncture, acupuncture also emphasizes the idea of adjusting the body's qi, and combines aromatherapy and ear acupoint massage to help patients to the greatest extent. During hospitalization (4/13 to 5/11), the heart rate was relatively stable, GCS improved from 7 points (E4VTM2) to 9 points (E4VTM4), muscle strength improved from 0 points to 2 points for upper limbs, and 1 point to 3 points for lower limbs. In terms of symptoms, vomiting was improved, and physical movements were more obvious. Stroke is a disease in which there are blood circulation problems in the brain. The pulse diagnostic device can be used to observe the difference of blood circulation before and after acupuncture in stroke patients, and it is expected to provide objective evaluation of therapeutic effect. In this case, we tried to observe the changes in the harmonic frequency index before and after acupuncture. We observed that except for C0, the average amplitude of other harmonic frequencies increased, and the brain-related Cn value increased significantly, proving that acupuncture has the effect of increasing cerebral circulation.

1. 108 年度死因統計，衛生福利部，台灣。2020， 取自：https://dep.mohw.gov.tw/DOS/lp-4927-113.html
2. Chang, CC,Chen, TL,Lin, CS,Chung, CL,Yeh, CC,Hu, CJ,Lane, HL,Liao, CC,Shih, CC(2018).Decreased risk of pneumonia in stroke patients receiving acupuncture: A nationwide matched-pair retrospective cohort study.PLoS One,13(5),e0196094.
3. Chang, CW,Liao, KM,Chang, YT,Wang, SH,Chen, YC,Wang, GC(2019).Fourth harmonic of radial pulse wave predicts adverse cardiac events in asymptomatic patients with type 2 diabetes.J Diabetes Complications,33(6),413-416.
4. Chang, CW,Liao, KM,Chang, YT,Wang, SH,Chen, YC,Wang, GC(2019).The effect of radial pulse spectrum on the risk of major adverse cardiovascular events in patients with type 2 diabetes.J Diabetes Complications,33(2),160-164.
5. Chang, CW,Liao, KM,Chang, YT,Wang, SH,Chen, YC,Wang, GC(2018).The First Harmonic of Radial Pulse as an Early Predictor of Silent Coronary Artery Disease and Adverse Cardiac Events in Type 2 Diabetic Patients.Cardiol Res Pract,23,5128626.
6. Chang, CW,Liao, KM,Chen, YC,Wang, SH,Jan, MY,Wang, GC(2018).Radial Pulse Spectrum Analysis as Risk Markers to Improve the Risk Stratification of Silent Myocardial Ischemia in Type 2 Diabetic Patients.IEEE J Transl Eng Health Med,6,1900509.
7. Chavez, LM,Huang, SS,MacDonald, I,Lin, JG,Lee, YC,Chen, YH(2017).Mechanisms of Acupuncture Therapy in Ischemic Stroke Rehabilitation: A Literature Review of Basic Studies.Int J Mol Sci.,18(11),2270.
8. Chen, YC,Wang, SH,Wang, GC,Chang, CW,Liao, KM(2018).Glycated haemoglobin, Ankle-Brachial Index, Radial pulse spectrum and risk of coronary artery diseases with and without the angina symptoms in type 2 diabetic patients.International Diabetes Federation Congress,Hyderabad, India:
9. Chuang, SF,Shih, CC,Yeh, CC,Lane, HL,Tsai, CC,Chen, TL,Lin, JG,Chen, T,Liao, CC(2015).Decreased risk of acute myocardial infarction in stroke patients receiving acupuncture treatment: a nationwide matched retrospective cohort study.BMC Complement Altern Med,15,318.
10. Covic, A,Haydar, AA,Bhamra-Ariza, P,Gusbeth-Tatomir, P,Goldsmith, DJ(2005).Aortic pulse wave velocity and arterial wave reflections predict the extent and severity of coronary artery disease in chronic kidney disease patients.J Nephrol,18,388-396.
11. Hsu, PF,Yu, WC,Lin, IF,Lin, YP,Chuang, SY,Cheng, HM,Chen, CH(2008).Chen CH: Differential effects of age on carotid augmentation index and aortic pulse wave velocity in end-stage renal disease patients.J Chin Med Assoc.,71,166-173.
12. Kis, E,Cseprekál, O,Horváth, Z,Katona, G,Fekete, BC,Hrapka, E,Szabó, A,Szabó, AJ,Fekete, A,Reusz, GS(2008).Pulse wave velocity in end-stage renal disease: influence of age and body dimensions.Pediatr Res,63,95-98.
13. Koyoshi, R,Miura, S,Kumagai, N,Shiga, Y,Mitsutake, R,Saku, K(2012).Clinical significance of flow mediated dilation, brachial intimamedia thickness and pulse wave velocity in patients with and without coronary artery disease.Circ J.,76,1469-1475.
14. Liao, KM,Chang, YT,Wang, SH,Jan, MY,Chang, CW(2017).Radial pulse spectrum may be a risk marker of peripheral artery disease in patients with type 2 diabetes.International Diabetes Federation Congress,Abu Dhabi, UAE:
15. Liao, KM,Chang, YT,Wang, SH,Jan, MY,Chang, CW(2017).Radial pulse spectrum may be a predictor on ischemic heart disease in patients with type 2 diabetes.International Diabetes Federation Congress,Abu Dhabi, UAE:
16. Liao, KM,Chen, YC,Wang, SH,Wang, GC,Chang, CW(2018).Harmonics of the radial pulse could be risk factors for myocardial ischemia and decrease of heart function in patients with type 2 diabetes.Journal of diabetes investigation,9(Suppl. 1)
17. Matsui, Y,Ishikawa, J,Shibasaki, S,Shimada, K,Kario, K(2011).Association between home arterial stiffness index and target organ damage in hypertension: Comparison with pulse wave velocity and augmentation index.Atherosclerosis,219,637-642.
18. McCall, DO,McGartland, CP,Woodside, JV,Sharpe, P,McCance, DR,Young, IS(2010).The relationship between microvascular endothelial function and carotid-radial pulse wave velocity in patients with mild hypertension.Clin Exp Hypertens,32,474-479.
19. McEniery, CM,Yasmin,Hall, IR,Qasem, A,Wilkinson, IB,Cockcroft, JR(2005).Normal vascular aging: differential effects on wave reflection and aortic pulse wave velocity: the Anglo-Cardiff Collaborative Trial (ACCT).J Am Coll Cardiol,46(Nov 9),1753-1760.
20. Milnor, WR(1982).Hemodynamics.Baltimore:Williams & Wilkins.
21. Schillaci, G,Mannarino, MR,Pucci, G,Pirro, M,Helou, J,Savarese, G,Vaudo, G,Mannarino, E(2007).Age-specific relationship of aortic pulse wave velocity with left ventricular geometry and function in hypertension.Hypertension,49,317-321.
22. Shih, CC,Liao, CC,Sun, MF,Su, YC,Wen, CP,Morisky, DE,Sung, FC,Hsu, CY,Lin, JG(2015).A Retrospective Cohort Study Comparing Stroke Recurrence Rate in Ischemic Stroke Patients With and Without Acupuncture Treatment.Medicine (Baltimore),94(39),e1572.
23. Shih, CC,Yeh, CC,Hu, CJ,Lane, HL,Tsai, CC,Chen, TL,Liao, CC(2017).Risk of dementia in patients with non-hemorrhagic stroke receiving acupuncture treatment: a nationwide matched cohort study from Taiwan’s National Health Insurance Research Database.BMJ Open,7(6),e013638.
24. Tseng, SP,Hsu, YC,Chiu, CJ,Wu, ST(2017).A Population-Based Cohort Study on the Ability of Acupuncture to Reduce Post Stroke Depression.Medicines,4(1),16.
25. Weng, SW,Liao, CC,Yeh, CC,Chen, TL,Lane, HL,Lin, JG,Shih, CC(2016).Risk of epilepsy in stroke patients receiving acupuncture treatment: a nationwide retrospective matched-cohort study.BMJ Open,6(7),e010539.
26. Yang, JL,Chen, TL,Yeh, CC,Hu, CJ,Liao, CC,Lane, HL,Shih, CC(2019).Acupuncture treatment and the risk of urinary tract infection in stroke patients: a nationwide matched cohort study.Acupunct Med.,37(3),175-183.