台湾戴氏脉法在妇科疾病诊断中的应用

【作者】 黄丽慧；

【导师】 李宇航；

【作者基本信息】 北京中医药大学 ， 中医临床基础， 2010， 博士

【摘要】 台湾脉学源于大陆,亦有自己的特色之处。尤其是民间脉法,在继承古脉、传统脉学的基础上,往往有所发挥。其中戴君强氏的提出的月经周期中尺部生理脉与病理脉,在台湾具有一定的影响。本研究选取戴氏尺部生理、病理脉法,将之运用于妇科肿瘤的研究,以验证其科学性和适用性。研究一戴氏月经生理脉研究。[目的]：通过脉象仪获得相关脉图参数,以验证戴氏月经周期生理脉的客观性。[方法]：采用汪氏脉波仪(Wang’s sphygmometer)对48例健康女性受试者双侧关尺两部脉象之脉图参数进行记录,观察P波振幅(h1,mm)、降中峡与主波高度比(h4／h1)、D波(h5,mm)、主波上1／3宽度与脉波周期之比值(W3／T)、脉图总面积(AT)及两部参数差值在月经周期中的变化。[结果]：月经周期中,月经结束关部h1、AT值明显高于尺部(P<0.01),排卵期次之(P<0.05),月经期稍高于尺部(P>0.05)。三期各项脉图参数比较发现,h1、AT、h5值在月经周期中呈月经期>排卵期>月经结束的过程；W3/T、H4/h1则呈月经结束>排卵期>月经期的过程。对受试者三期关尺两部脉图参数差值的比较表明,脉图参数中,h1、AT差值在月经结束期最大,排卵期次之,月经期最小。三者相比具有统计学意义(排卵期与月经结束相比P<0.01；月经期与月经结束期相比P<0.05)。[结论]：48例健康受试者在月经周期过程中,相关脉图参数存在一个变化的过程。h1以及A在月经周期过程中变化较为显著,呈现出月经期>排卵期>月经结束后的变化过程。而h1以及AT在关尺两部的差值,则呈现月经结束后>排卵期>月经期的过程；脉象则根据排卵期—月经期—月经结束而呈弦滑—滑脉—弦脉而变化的过程。研究二戴氏月经病理脉研究。[目的]：通过对卵巢囊肿患者脉图参数的观察,验证戴氏月经病理脉用于妇科肿瘤诊断的可行性与适用性。[方法]：对65例卵巢囊肿患者中月经周期者47例作为研究对象,用采用汪氏脉波仪观察月经周期中关尺两部脉图参数(h1、h4/h1、w3/T/t、AT)的变化；并将47例患者按中医辨证分为气滞血瘀组、痰湿阻滞组、阳虚寒凝组、阴虚血瘀组,并与正常对照组比较,观察各组患者在月经末期脉图参数差值的变化。[结果]：47例卵巢囊肿患者月经周期正常者,在排卵期、月经期、月经结束三期过程中,关部h1、AT、值均高于尺部,其中排卵期与月经末期表现较为明显(P<0.0 5,P<0.0 1)。三期关部、尺部h 1、AT、h5亦呈月经结束期>排卵期>月经期趋势(h1只有在尺部月经期部高于月经结束。AT、h5在三期相比则有统计学差异)。而关尺部之W3/T、H4/h1则呈月经结束>排卵期>月经期趋势,但其中只有月经期与月经结束相比具有统计学意义(P<0.05)。卵巢囊肿患者在月经周期中关尺两部脉图参数差值比较显示：患者双侧关尺两部h1、AT差值,均呈月经结束期>排卵期>月经期(P<0.05,P<0.01)趋势。月经结束后不同中医证型关尺两部差值的比较显示,气滞血瘀型及痰湿阻滞组患者患侧h1、AT差值显著小于对侧(P<0.01),而阳虚寒凝型及阴虚血瘀型患者患侧之h1、AT差值虽然小于对侧,但是无统计学意义(P>0.05)。与健康组相比,气滞血瘀型、痰湿阻滞型患者患侧h1、AT差值小于健康组,具有显著差异(P<0.01)。阳虚寒凝组与阴虚血瘀组患者患侧、对侧h1、AT差值均则大于正常组(P<0.01)。表明月经结束后尺部充盈度与关部的差异,以气滞血瘀及痰湿阻滞型为主,而阳虚寒凝及阴虚血瘀型患者并不显著。[结论]：通过对47例月经周期正常的卵巢囊肿患者月经周期中脉图参数的研究,我们发现患侧尺部充盈度在月经周期过程中,月经期>排卵期>月经结束的过程仍然存在。但与对侧相比并无统计学差异(P>0.05)。也就是说,要通过患侧与对侧尺部充盈度的对比赖判断囊肿情况,虽然有一定的可行性,但是在统计学上却无意义。通过患者不同中医证候在月经结束后关尺两部脉图参数差值的分析,发现患侧与对侧尺部充盈度的比较,以气滞血瘀型及痰湿阻滞型为主阳虚寒凝型及阴虚血瘀型并不显著。因此,戴氏尺部脉诊应用于妇科肿瘤的诊断具有一定的适应性,应当与中医辨证论治相结合,更能体现出其价值。更多还原

【Abstract】 Pulse diagnosis of Tiwan stemed from the mainland, while it has formed its own characteristics. Tiwan civil pulse method developes the ancient and traditional sphygmology in particular. The thesis studied the physiological and pathological pulse of D.D.P.D (David Dai’s Pulse Diagnotics) which used for gynecologic cancer research in order to verify its scientific validity and applicability.The study of Physiological pulse of D.D.P.D.Objective:To verify the objectivity of Physiological pulse of D.D.P.D through the detection by pulse apparatus.Method: Observe the parameters’ change of P-wave amplitude(h1,mm), D-wave amplitude(h5,mm), dicrotic notchand/P-wave amplitude(h4/h1), one third width of P-wave/pulse cycle time(W3/T) and area of pulse graph (AT) in guan and chi’ departments’ pulses to 48 healthy women menstrual cycle by Wang’s sphygmometer.Result:The value of h1, AT of after-menstruation period was significantly higher than the foot department (P<0.01). The value of h1, AT of ovulatory phase and menstrual period was than the foot department (P＜0.05). The value of h1、AT、h5 show up the rend of menstrual period>ovulatory phase> after-menstruation period. The value of W3/T、H4/h1 show up the rend of after-menstruation period>ovulatory phase> menstrual period. The value difference of h1、AT show up the rend of after-menstruation period>ovulatory phase> menstrual period through the comparison of three periods(P<0.01, P<0.05).Conclusion:Pulse parameters is a change process in menstrual cycle. The value of h1. AT、h5 show up the rend of menstrual period>ovulatory phase> after-menstruation period. The value difference of h1、AT show up the rend of after-menstruation period>ovulatory phase> menstrual period through the comparison of three periods. The pulse show up the rend of wiry pulse to pulse string slide to slide in three periods of menstrual cycle.The study of pathological pulse of D.D.P.D.Objective:TO verify the feasibility pathological pulse of D.D.P.D through the using to gynecological tumors detection by pulse apparatus.Method:Observe the parameters’ change of P-wave amplitude(h1,mm), D-wave amplitude(h5,mm), dicrotic notchand/P-wave amplitude(h4/h1), one third width of P-wave/pulse cycle time(W3/T) and area of pulse graph (AT) in guan and chi’departments’pulses to 47 cases for normal menstrual cycle in 65 cases of ovarian cysts by Wang’s sphygmometer. The 47 patients were divided into Qi stagnation group according to TCM, phlegm block group, Yang cold coagulation group, Yin deficiency and blood stasis group. We observed the difference of value pulse parameters of the after-menstruation period in theGroups.Result:h1 and AT’vaule of Guan were higher than the Chi In three process of menstrual cycle particularly the after-menstruation period and ovulatory phase(P<0.05, P<0.01). The value of h1、AT、h5 show up the rend of menstrual period>ovulatory phase> after-menstruation period. The value of W3/T、H4/h1 show up the rend of after-menstruation period>ovulatory phase> menstrual period. The value difference of h1、AT show up the rend of after-menstruation period>ovulatory phase> menstrual period through the comparison of three periods (P<0.05, P<0.01). The value difference of different groups in after-menstruation period show that h1, AT of Qi stagnation and phlegm type block group was significantly smaller than the contralateral (P＜0.01、while Yang deficiency blood stasis type and cold coagulation in patients with the affected side of the h1, AT difference was smaller than, but not significant (P>0.05). Compared with the healthy group, The value difference of h1, AT to Qi stagnation type and phlegm block type ipsilateral is less than the healthy group with significant difference (P<0.01),and that Yin Yang cold coagulation group and blood stasis group ipsilateral, contralateral were larger than normal group (P<0.01).Conclusion: The fullness degree of trouble sidel Chi show up the rend of menstrual period>ovulatory phase> after-menstruation during the menstrual cycle. However, there has no significant difference compared with the contralateral side (P> 0.05). It is said that there’s some possibility to cyst the contrast of fullness degree depends on judgments by ipsilateral and contralateral Chi while there is no statistically meaningless. The fullness difference of Guan and Chi was notable to Qi stagnation and Phlegm-type block-type. There wad a certain degree of flexibility to D.D.P.D applied to the department of gynecological tumors and it’s better to be combined with tcm differential treatment.更多还原