基于多时点动态观测比较原发性痛经患者不同证型的脉象、脉图参数变化特征及其血流动力学机制

Pain is a common clinical symptom. According to Chinese medicine theory, the occurrence of pain disease (syndrome)/symptom is the result of zang-fu and qi-blood disorders; at the same time, pain can further lead to changes in the qi and blood in zang-fu organs. Pulse manifestation is the impression of how the pulse feels underneath the fingers, which can reflect the body's internal zang-fu and qi-blood changes. Thus, the ancient medical classics have recorded that a variety of pulses, such as the wiry, tight, bouncing and intermittent pulses, will be presented when pain occurs. But does the same type of pulse, such as the wiry pulse, vary in different diseases? For chronic paroxysmal pain, is the pulse only seen during the onset of pain, or can it also be seen when pain is absent? What is the correlation between syndromes and the characteristics of pulse changes? To answer the above-mentioned questions, this study is designed to compare the pulse changes in patients with primary dysmenorrhea (syndrome of blood stasis due to cold coagulation (60 cases) and syndrome of qi stagnation and blood stasis (60 cases)) and those in healthy people as the controlled group. With the pulse diagnosis instrument, the pulse manifestation and pulsograph parameters are dynamically observed at the following four time points: 7-10 days before menstruation, the typical pain episode during menstruation, the end of 30-minute acupuncture analgesic treatment, and 30 minutes after the treatment. Besides, at these four time points, the pulse diagnosis based on the eight elements by TCM practitioners will also be acquired. With these statistics obtained, we will be able to compare and analyze the differences between changes in pulse manifestations and pulsograph parameters, explore the correlation between these changes and diseases/syndromes/symptoms, and probe into the mechanisms from the perspective of hemodynamics. Through this research, we intend to provide objective experimental evidences for the explanation of potential correlation between pulse manifestations and diseases/syndromes/symptoms, and promote development of TCM pulse theory.

疼痛是临床常见症状，根据中医理论，痛病（证）/症的产生是脏腑气血等功能紊乱的结果，同时疼痛发作又可进一步影响脏腑气血变化。脉象是脉动应指的形象，可反映机体内脏腑气血变化，因此古籍有弦、紧、动、代等脉象主痛的记载。但上述脉象有无病的特异性？对于慢性发作性痛病，上述脉象仅见于疼痛发作时，还是疼痛未作时也可出现？其变化特征与证型的相关性如何？基于上述问题，本研究以原发性痛经为疾病载体，分别选寒凝血瘀证和气滞血瘀证各60例，以健康者为对照，以脉诊仪为脉象信息采集技术手段，动态观测患者经前7-10天、经期痛经典型发作时、针刺镇痛治疗30min结束即刻及针刺镇痛治疗结束后30min四个时点的脉图参数变化，同时参照医师在上述时点基于脉象八要素的诊脉结果，分析、比较脉象、脉图参数变化与病、证、症的相关性，并从血管血流动力学角度探讨其变化机制，为阐释脉象与病、证、症间的关系及丰富、发展脉学理论提供客观依据。

古籍记载弦、紧、动、代等脉象主痛。但上述脉象有无病的特异性？仅见于疼痛发作时，还是疼痛未作时也可见？其变化特征与证型是否相关？本研究选择寒凝血瘀、气滞血瘀原发性痛经患者为研究对象，以健康者为对照，在痛经典型发作时电针治疗，分别观测原发性痛经患者在疼痛未作（T0）、疼痛发作（T1）、缓解期（T2、T3）脉象、脉图参数的变化，发现①原发性痛经4个时点分别以虚、弦、缓、弦脉为主。与对照组比，脉图参数在4个时点的变化分别为h1、ad显著降低、w1/t显著升高、t显著升高、t1、t1/t显著升高，表明疼痛发作时可能伴有主动脉压力升高的持续时间延长。②寒凝血瘀4个时点分别以虚、弦、浮、弦脉为主，气滞血瘀以虚、弦、缓、缓脉为主。与对照组比，寒凝血瘀在4个时点的脉图参数变化分别为h1显著降低、w1/t、t1显著升高、t显著升高、t1、t1/t显著升高，与气滞血瘀比，T0时点w2显著升高，T1时点t1显著升高，表明疼痛发作时两证型可能都伴有主动脉压力升高的持续时间延长，而寒凝血瘀还伴有左心室快速射血期延长。③原发性痛经4个时点的脉图参数变化为：T1与T0比，h2、h3、h4、h3/h1、w、as均显著升高，HR、h5/h1均显著降低；T2与T1比，h5/h1、t5、t均显著升高，HR、h3/h1、w、t1、t1/t均显著降低。原发性痛经的VAS评分，T1比T0显著升高，T2、T3比T1均显著降低。与VAS评分呈显著正相关的脉图参数是h2、h3、h4、h3/h1、h4/h1、w、t1、t4、as，呈显著负相关的是h5、h5/h1，表明疼痛程度的变化可能与大动脉弹性降低、主动脉压力升高的持续时间延长、血管外周阻力增大等有一定相关性。以上可见原发性痛经患者脉象、脉图参数变化在其与健康者间、两证型间、痛经发作前后均有所不同，初步说明原发性痛经患者脉象、脉图参数变化与病、证、症有一定的相关性，为丰富、发展脉学理论提供了一定客观依据。