【作者】 许希迎；

【导师】 齐向华；

【作者基本信息】 山东中医药大学 ， 中医内科学， 2012， 博士

【摘要】 目的：传统脉诊教学方法的不足制约了脉诊的学习、传承及客观化研究,建立一套有效的脉诊教学方法势在必行。通过现况调查,发现传统脉诊教学的不足；通过脑电试验进行脉象信息认知过程的研究,为“诊脉需启动情景记忆”假说提供客观依据,为脉诊教学方法规范化研究提供思路。方法：1.脉诊理论及应用的现况调查研究：设计针对临床医师、中医大学四年级学生中医临床实习医师三个群体的调查表,问卷回收后,将问卷问题及答案进行编码并登记,将调查原始结果录入数据库,对调查问卷的封闭式问题进行统计学分析。2.“脉象要素训练”脉诊教学方法的认知心理过程试验研究：设立对照组与试验组,分别对其进行“传统脉诊教学方法”强化训练和“脉象要素训练”教学方法的干预,比较两组的脉象评定成绩,并通过脑电试验研究,采集每组受训者诊脉前后、组间16个导联上4个频段功率谱平均值,采用t检验及卡方检验进行数据分析。结果：1.现况调查通过三个群体的脉诊理论及应用的现况调查研究,发现传统脉诊教学方法存在不足,并影响了三个群体的脉诊学习、脉诊水平的提高。2.脉象评定测试及脑电试验研究(1)两组对标准化病人脉象评定成绩的试验研究两组受训者在接受两种教学方法培训后脉诊评定成绩有非常显著性差异(P=0.00)。试验组在接受“脉象要素训练”教学方法后脉诊成绩(7.00±1.31分)显著高于对照组(2.40±0.74分)。(2)两组静息状态与诊脉状态下,16导联脑电α1、α2、β1、β2四个频段功率谱平均值脑电试验研究对照组静息状态与诊脉状态下,不同脑区的α1、β1、α2、β2频段功率谱平均值变化不大；试验组静息状态与诊脉状态下,不同脑区的α1、β1、α2、β2频段功率谱平均值有显著变化,其中α1、α2频段功率谱平均值降低,而β1、β2频段功率谱平均值增加,这些变化集中在额叶、颞叶及枕叶。结论：1.脉诊理论及应用的现况调查研究通过三个群体脉诊理论及应用的现况调查研究,发现传统脉诊教学方法存在不足,需要改革传统脉诊教学方法,增加脉诊实践。2.“脉象要素训练”脉诊教学方法的认知心理过程试验研究“脉象要素训练”脉诊教学方法能取得较好的脉诊教学效果,可以尝试作为一种规范化脉诊教学方法在中医诊断学教学中推广更多还原

【Abstract】 Objective: The shortcomings of traditional pulse-taking teaching methods impededthe study,inheritance and objective research on pulse-taking. It is imperative to establish aset of effective pulse-taking learning methods. This paper investigated the shortcomings oftraditional teaching. EEG experiment was applied to study the cognitive process of pulseinformation which supplied evidence for hypothesis "episodic memory started in pulseexamination" and idea for the standardization research on pulse-taking teaching method.Methods1. The status of research: Questionnaire designed for three groups: clinicians, collegesenior, interns of TCM. After questionnaires were collected, the questions and answerswere coded and registered. The original investigation results were recorded into thedatabase and the closed questions of the questionnaire were analyzed statistically.2. Experiment on cognitive psychology of pulse-taking teaching method——"Pulsemanifestation elements training":A control group and an experimental group wereestablished to be trained by traditional pulse teaching methods and "pulse manifestationelements training". Pulse assessment scores were compared. EEG experiment was used tostudy the cognitive process of pulse information. Before and after training, mean powerspectrum of4frequency band in16lead was analyzed by t tests and chi-square teststatistically.Results1. Current Status:Through studying current status of the three groups, we found the shortcomings oftraditional teaching methods of pulse examination which influenced the study and improvement of pulse examination.2. Pulse assessment test and EEG experiment(1) Two sets of experiments of pulse assessment scores on the standardized patientThe pulse assessment scores of two groups have a significant difference (P=0.00).The score of the experimental group (7.00±1.31points) was significantly higher than thatof the control group (2.40±0.74points).(2) The experiment of16-channel EEG on the mean power spectrum of1,2,1,2in two conditionsThere is little change of the mean power spectrum of4frequency band in16lead intwo conditions of the control group. There are significant differences of the mean powerspectrum of4frequency band in16lead in two conditions of experimental group, in whichmean power spectrum of1and2bands decreased while that of1,2bandsincreased which concentrated in the frontal, temporal and occipital lobes.Conclusion1. Current Status:Through studying current status of the three groups, we found the shortcomings oftraditional teaching methods of pulse examination which need to be reformed and morepractice.2. Experiment on cognitive psychology of pulse-taking teaching method——"Pulsemanifestation elements training"Good effects could be achieved in pulse-taking teaching method——"Pulsemanifestation elements training" which could be applied as a standardized teaching methodin traditional Chinese diagnostics teaching.更多还原