SEP-PNAP在朝医体质辨象中的应用

Korean Medicine goes along with the method of "Therapy after Discrimination " because everyone has an own-special constitution. Discrimonation is a key step in therapy, but several subjective factors have effects on it so that the phenomena of side effect or inefficacy frequently appears during treatment because of the mistake of discrimination and irrelevant drugs. This item plans to examine 1000 healthy people. First, by several methods such as filling in discrimination designed-question form, expert's deliberation, test drug, Taiji acupuncture therapy and so on, type of constitution of every volunteer is diagnosed by Korean Medicine; and then, by Portabook electromyographic evoked instrument and with several techniques of electrophysiology, Peripheral Nerve Action Potential(PNAP）and Somatosensory Evoked Potential(SEP）of upper and lower limb are measured; afterwards, with the data measured above, relevant aspects of body are comprehensively analyzed: ① central nerve conduction time of Sasang's people; ② limbs' peripheral nerve conduction characteristics of Sasang's people; ③ relevant regularity of central and peripheral nerve conduction time; ④ conduction difference between right and left side, rate of latent injury. These actions above will be helpful to all-sidedly grasp the constitutional characteristics of Sasang people's central-peripheral nervous system and improve the accuracy of discrimination and effective rate of diagnosis and treatment in therapy.

朝医学是针对不同体质而"辨象论治"的医学。辨象是治疗的关键，但因其辨象依据中包含有许多主观因素性选项内容，所以频繁出现辨象错误而误用异象药物产生副作用或治疗无效的现象。本课题组拟计划以健康人1000名为对象，首先通过填写辨象设问表和专家研讨以及试药、太极针法等多种方式，对每一位志愿者进行朝医辨象；然后利用Portabook肌电图诱发仪，采用多方面的电生理学技术，测量上肢和下肢的末梢神经动作电位（PNAP）和体感诱发电位(SEP)。根据辨象结果，分析电生理学数据，如：①四象人的中枢神经传导时间；②四象人的四肢末梢神经传导特点；③中枢与末梢神经传导时间的相关规律；④左右侧间的传导差异、潜在性损伤率。进而全面地掌握四象人的中枢-末梢神经系体质特征，以期提高朝医辨象的准确率和诊疗的有效率。

辨象是朝医治疗的关键步骤，但因判断四象过程中包含有许多主观性因素，所以频繁出现辨象误差而误用异象药物产生副作用或治疗无效的现象。研究方法：首先通过填写辨象设问表和专家研讨以及试药、太极针法等多种方式，对1000名健康人进行朝医辨象；然后利用肌电图诱发仪，测量其上下肢SEP、PNAP；最后根据辨象和测量结果，分析四象人CCT、PNAP特点，SEP各成分与PNAP的相关规律，左右间传导差异以及潜在性损伤率。结果与数据：第一、朝医辨象 ABO血型与冷热饮喜好、性格倾向，易感病之间有密切相关；根据《朝医四象鉴别表》进行自辨象，其正确率为35.5%。选项选择中，误差率较高的是“容貌表情、汗液、步态、目、二便、鼻、性情、性质、嗜好”等。第二、SEP、PNAP与针感 电刺激正中神经诱发的SEP、SNAP、CMAP和F波中，1.太阴人N20a、N20b、N20c较少阳人延长，N20b、N20c较少阴人延长；左体N20c、N13b-N20b较少阴人同侧延长，右体N13a-N20a、N13b-N20b较少阳/少阴人同侧延长。2.太阴人左体N13a-N20a、N13b-N20b较右体缩短，DD/DA/SCV存在着左右差异；针刺右侧阳陵泉穴，传导感太阴人低于少阳人。3.太阴人N13a较少阴人延长，少阳人N20c较少阴人缩短。太阴人的F-Lat较少阳/少阴人延长、右侧MCV较左侧慢、右侧P/D Amp比值≤0.5神经数较少阳人同侧增多。4.胫神经F波特点 太阴人F-Lat长于太阳/少阳/少阴人；F-Lat大于50ms神经数中，太阴人多于少阴/少阳人；出现A波率，太阴人最高，并且存在着潜在性末梢神经损伤几率最大。第三、NCS与针感 腓肠神经波幅太阴＜少阳人；太阴/少阳人SCV右侧＞左侧。与DSCV＞X-S神经相比，DSCV≤X-S神经DLat延长和DSCV减慢；小腿部腧穴针感传导率32.6%，上巨虚针感传导计数最多，阳陵泉、解溪最低。针感传导率高的体质中，Onset N13左右差异较小、Onset N20左右侧差异较大，太阴人足三里针刺传导感低于少阳人，少阴人合谷穴无针感多于少阳人。科学意义：全面地掌握四象人的中枢-末梢神经系与经络腧穴系统的体质特征，以期提高朝医辨象的准确率和诊疗的有效率，奠定朝医神经经络学基础。