中醫保健

 李曜暄¹  陳必誠²  李采娟³

中國醫藥大學¹中西醫結合研究所,²學士後中醫學系,³中醫研究所

目前，現代檢測儀器中，針對經絡系統的測量，以中谷義雄發明的良導絡來測皮膚表面電阻，為較多醫師所應用。良導絡經絡分析儀經過多年改良，並與電腦結合應用，檢測的穩定度及精準度改善很大。但臨床應用時，發現同一人於不同時間的量測值變異不小，使得數據判讀不易，並且正常值的界定目前亦無公定標準，所以仍無法廣泛應用。

本研究乃探討可能影響良導絡量測值的幾個因素，以為臨床進一步應用時的參考。以經絡能量分析儀（簡稱M.E.A.D.）ME-Pro第五代為測量工具，取樣分兩個族群，其一、門診族群300人，僅做一次量測，分五個年齡層做統計分析，同時針對性別、左右側經絡、上下肢經絡之良導絡值做統計分析比較。其二、健康正常族群30人，每週做一回測量，每回做兩次測量，間隔30分鍾，第一週兩次量測間隔的30分鍾期間採靜坐休息為對照組，並針對兩次測量值做是否可重覆性的信度分析；第二週間隔期間針刺雙側足三里穴20分鍾，第三週期間冰刺激雙側足三里穴，第四週期間艾灸雙側足三里穴，針對四組的良導絡值及變化量做統計分析比較。另外，將四組0分鍾起始點的量測值各除以該次量測24經穴的總平均值，所得到的衍生變異值，統計分析四週衍生變異值的相關係數。同時，比較健常族群及同年齡層門診族群的良導絡值是否不同。

實驗結果顯示：

1.良導絡值不論是24經穴總計或個別計算，都隨年齡增加而有良導絡值遞減的結果，且達統計學上的顯著水準；平均而言，三焦經代表點良導絡值最高，膽經最低；左側經穴的良導絡值較右側經穴高；上肢經穴的良導絡值較下肢經穴高，以上均達統計學上的顯著水準。

2.間隔30分鍾再測之信度分析，相關係數介於0.79854到0.93207之間，96%有不錯至良好的一致性，且達極顯著的意義水準（p<0.0001）。

3.四組數據下午組平均值均明顯高於上午組，且於對照組（除右心經外）及艾灸組（除左三焦、左膽經外），幾乎均達統計上的顯著；而30分鍾再測之良導絡變化量平均值並無上、下午之差異。

4.對照組靜坐休息良導絡值變化平均大多下降；其間介入針刺，30分鍾再測之良導絡平均值大多是上升；其間介入冰刺激，30分鍾再測之良導絡平均值全部下降，且以胃經經穴降低最多；其間介入艾灸，30分鍾再測之良導絡平均值全部上升，且以膀胱經經穴上升最多。

5.30分鍾再測之良導絡變化量：左肝經、左膽經、左胃經、右肝經、右胃經：針刺組與艾灸組明顯大於冰刺激組；左胃經、右膽經：針刺組明顯大於對照組；右腎經、右膽經：針刺組明顯大於冰刺激組；右膀胱經：艾灸組明顯大於冰刺激組，以上指達到統計上意義的經絡（p<0.05）。

6.四組的衍生變異值（derived variables）統計分析比較。結果顯示：88.2%有中度以上的相關性，且已有82.6%達統計學上的顯著（p<0.05）。

7.健常30名自願者與門診族群中同年齡層（16~30歲）54人良導絡值的統計分析比較，結果顯示：門診族群在手部12條經絡及左腎、右胃經之良導絡值，較健常族群的平均值高，且達統計學上的顯著。

綜合以上結果，建議良導絡於臨床應用時，需注意以下幾個重點：正常值需隨年齡與量測時間而調整，若難以界定，宜嘗試用衍生變異值去呈現各經穴能量的相對高低，評估經絡失衡現象；實驗量測的時間需統一固定，但若間隔30分鍾，僅比較變化量時，較無時間限制；實驗操作者需做再測信度測試，以確認數據取得可重覆操作的一致性；人體是否藉由經絡系統去調節臟腑的溫度，值得深入研究。

所以，良導絡客觀反應量化經絡在皮膚電阻的導電特性，但何以導致變異大的因素，值得臨床繼續深入探討，以更清楚掌握經絡的真相。

關鍵詞：良導絡，時間，年齡，針刺，艾灸，冰刺激，足三里穴

<英文>

Analysis on the change of Ryodoraku values by time, age, or acupuncture, moxibustion, and ice stimulation on the Zusanli acupoints

Yao-Hsuan Li¹, Bih-Cheng Chen², Tsai-Chung Li³

¹Graduate Institute of Integration Chinese and Western Medicine, ²School of Post Baccalaureate Chinese Medicine, ³Graduate Institute of Chinese Medical Science,

China Medical University, Taiching, Taiwan, R.O.C.

For the time being, Ryodoraku instrument discovered by Dr. Yoshio Nakatani which measures the skin electric resistance to reflect the bioenergy of the meridians is the most useful noninvasive technique used by doctors. Many years passed, the Meridian Energy Analysis Device, shortened to M.E.A.D., was improved and connected with computer, so the stability and accuracy are better. Because the variation of the Ryodoraku values of one person in different time is large, and the normal range is not yet standardized in Taiman, so it’s not easy to read the data of Ryodoraku values.

This study was designed to investigate the influences of the change of Ryodoraku values by time, age, or acupuncture, moxibustion, and ice stimulation. We used M.E.A.D. ME-PRO type as measured tool. There were two sample populations were recruited. One is 300 patients from clinic, we measured only one time of each person, and to analyse the mean values and distribution in five age layers. At the same time, to compare the difference of sex, left from right meridians, and upper from lower meridians. Another is 30 volunteers of healthy students from university, we measured one time every week ,and twice of each time in the interval of 30 minutes. First week, we measured twice and the 30 subjects sat and rested during the 30 minutes interval, which served as their own control(comparison) group. We compared these two measurements for the reliability analysis. Second week, we stimulated the both Zusanli acupoints for 20 minutes by using acupuncture during the interval, which acted as acupuncture group. Third week, we stimulated the same acupoints by ice as ice group. Fourth week, we stimulated them by moxibustion as moxibustion group. We analysed and compared the change of Ryodoraku values between four groups. Furthermore, the value divided by the mean value of that time called derived variable, and we analysed the relationship of the derived variables between these four groups. We also compared the mean values between the healthy volunteers and the clinical patients with the same age layer.

The following is a summary of our conclusions：

(1). The Ryodoraku values significantly decreased when the age increased in total or individual measured acupoints. The mean value of TE meridian is the highest, and the Gall bladder meridian is the lowest. The left side is significantly more than the right side, and the upper is significantly more than the lower.

(2). The correlation coefficients are between 0.79854 to 0.93207 in the reliability analysis. There are 96% have good to excellent consistency significantly in the test-retest reliability in the interval of 30 minutes (p<0.0001).

(3). The mean values measured in the afternoon are higher than in the morning. In the comparison group (except right heart meridian) and moxibustion group (except left TE and left gall bladder meridians) reach significant level statiscally. But the average changes of Ryodoraku values measured in the afternoon or morning have no difference significantly.

(4). The average changes of the comparison group significantly dropped mostly. The average changes of the acupuncture group both raised and dropped. The average changes of the ice group dropped in all meridians, especially stomach meridians. The changes of the moxibustion group raised in all meridians, especially urinary bladder meridians.

(5). The change values retested after 30 minutes showed that: left liver, left gall bladder, left stomach, right liver, and right stomach meridians: acupuncture and moxibustion group are higher than ice group significantly. Left stomach, right gall bladder meridians: acupuncture group is higher than comparison group significantly. Right kidney, and right gall bladder meridians: acupuncture group is higher than ice group significantly. Right urinary bladder meridian: moxibustion group is higher than ice group significantly.

(6). There are 88.2% of the derived variables have more than moderate relationship, and 82.6% reach significant level statiscally.

(7). We compared the mean values of the healthy volunteers with the clinical patients with the same age layer. The result revealed the mean values of the clinical patients are significantly more than the values of the healthy volunteers in the 12 meridians of the hands, left kidney and right stomach meridians.

  Finally, from all of the above, we suggest that the normal range must be adjusted to age layer, if it cannot be defined, we can try to use derived variable to evaluate the relative values of meridians. The time to measure must be fixed, but it may not be fixed to see the change of Ryodoraku values at the interval of 30 minutes. The operater must pass the test-retest reliability, to confirm the consistency of data. It needs further study to see the meridian system from the view of body temperature regulation.

Keywords: Ryodoraku, time, age, acupuncture, moxibustion, ice stimulation, Zusanli acupoint(ST-36)