我們的結論是 2 Hz 或 100 Hz 的經皮電刺激合谷穴可以促進 soleus H反射，而 100 Hz 比 2 Hz 有更強的作用，這些說明不同節段 的經皮電刺激對脊髓前角細胞的運動神經元有興奮的作用，又不同的 頻率的電刺激可導致不同的效應，但它的作用機轉有待進一步的研 究。另外，傳統徒手針刺則沒有產生顯著的影響，支持先前的研究認 為經皮電刺激和電針或針刺是透過不同的機轉。
2 Hz 電針或 2 Hz 經皮電刺激合谷穴能延長對側表皮反射的 I1 潛 期，推測它們的作用部位在 supraspinal，可能在 subcortical 或 cortical level， 而較高頻率的電刺激如 100Hz 可能較容易導致表皮反射的 habituation 發生。
51
附錄
附 錄 一 、 受 試 者 須 知
實驗名稱：
本研究的目的在探討針刺、電針或經皮電刺激(TENS)正常人的合 谷穴時，是否對 H 反射或表皮反射的反應波成分產生不同的影響。
為了獲得正確的研究結果，請詳細閱讀並遵守下列事項：
一、實驗前四十八小時內不得參與任何激烈運動，禁止喝酒、抽 煙，喝咖啡、茶及其它含咖啡因的飲料。並請日常飲食、睡眠，定時 定量。
二、在實驗期間不得另外接受針灸或 TENS 治療。
三、請在本實驗計畫完成前勿與其它受試者相互交流實驗的過程 及感受。
四、請於實驗開始前三十分鐘，穿著輕便服裝到實驗室。實驗開 始前一小時內請勿進食，並保持情緒平和。
五、實驗前，如果受試者不符合實驗之規定，則另訂實驗時間。
六、實驗內容：受試者須平躺在實驗床上接受誘發電位儀的測 試，以及針刺、電針或 TENS 的處理。
七、受試期間請儘量保持穩定的情緒、呼吸狀態與體姿，若您有 不適情況發生，如胸悶、胸痛、頭暈目眩、欲嘔、極度倦怠、呼吸困 難等，應立即告知並停止測驗。
※本研究須要您的協助與合作！
謝謝！
52
附 錄 二 、 受 試 者 同 意 書
實驗名稱：
一、實驗時間自民國 年 月 日至 月 日止。
二、受試者應於指定時間著輕便服裝到針灸生理研究室接受體穴 刺激及肌電圖儀的分析。每次實驗間隔至少三天以上，每個人須作四 次測驗。
本研究須要您的參與及合作才能順利進行。依實驗研究之規定，
研究者應將研究過程可能發生的危險向受試者說明清楚，盡其所能保 護受試者的安全及權益，並回答受試者的疑問。如您同意自願遵守受 試者須知及同意書所列有關規定，請在下欄內簽名
自願者： (簽名) 說明者： (簽名)
日期：民國 年 月 日
指 導 教 授 ：謝慶良教授
研究生：張光遠醫師 聯絡電話：
53
附 錄 三 、 健 康 調 查 表
過去一年間，醫師是否告訴您有下列狀況，或是您曾患有之疾病：
□高血壓 □心臟病
□糖尿病 □中風
□腎臟病 □痛風
□貧血 □心律不整
□很快站起時會頭暈痛□暈厥
□肺炎 □慢性支氣管炎
□肺結核 □氣喘
□過敏 □甲狀腺疾患
□胃、十二指腸潰瘍 □肝硬化或其它肝病
□癌症 □風濕症
□心理異常 □精神分裂□狂躁□憂鬱 □癲癇□頭痛□失眠
□酗酒□藥物過敏□長期服用藥物_________________
□其它重要疾病________________________
□過去一年曾否住院或開刀，原因______________________
□過去一年內曾否作健康檢查
□是否曾用針灸治病而暈針
姓名：____________
填表日期：___________
54
附 錄 四 、 個 人 基 本 資 料
姓名：__________ 年齡：____ 出生日期：____年____月____日 身份證字號：
聯絡地址：
聯絡電話：
身高_______公分 體重_______公斤 T:_____℃ P:_____beat/min R:______
BP:_______mmHg NCV
LENGTH OF UPPER LIMB
實驗日期：______年______月______日______時______分
55
英文摘要
THE STUDY IN EFFECT OF ACUPUNCTURE AND TRANSCUTANEOUS ELECTRICAL NERVE STIMULATION AT
HEGU ACUPOINT ON THE CENTRAL NERVOUS SYSTEM:
SOLEUS H-REFLEX AND CUTANEOUS REFLEX
Qwang-Yuen Chang, Jaung-Geng Lin, Ching-Liang Hsieh
Several studies find that manual acupuncture and transcutaneous electrical nerve stimulation (TENS) are via different mechanisms and generate different effect on the central nervous system, therefore, the aim of the present study was to compare the effect of manual acupuncture (MA) and TENS on the spinal cord using H-reflex recordings. A total of 13 healthy adult volunteers were studied. The electrical stimuli were delivered to the posterior tibial nerve transcutaneously at the left popliteal fossa to evoke the soleus H-reflex. MA, 2Hz TENS, 100Hz TENS, respectively, was applied to the surface of the right first dorsal interosseous muscle exactly at the Hegu acupoint (LI.4). Four assessments were performed randomly, separated by an interval of at least three days in all the subjects as follows: 1) Control assessment: a pair of electrodes placed on the surface of the right Hegu acupoint (LI.4), but no electrical stimulation was delivered throughout the test; 2) MA assessment: MA was done at the right Hegu acupoint (LI.4) for 15 minutes; 3) TENS assessment at 2Hz: electrical stimulation (40 mA in intensity) at 2Hz was applied to the surface of the right Hegu acupoint (LI.4) for 15 minutes; 4) TENS assessment at 100Hz: electrical stimulation (20 mA in intensity) at 100 Hz was applied to the surface of the right Hegu acupoint (LI.4) for 15 minutes.
Each assessment was divided into three periods as follows: 1) Baseline period:
H-reflexes recorded prior to MA or TENS; 2) TENS period: six H-reflex recordings after MA or TENS for a duration of 4-5 min, 9-10 min and 14-15 min, respectively; 3) Post TENS period: H-reflex recordings of 6 after TENS period 4-5 min and 9-10 min, respectively. Our results indicate that both 2Hz TENS and 100Hz TENS increased the amplitude of the H-reflex, and that these increases may be retained longer with 100 Hz TENS than with 2 Hz TENS, whereas MA could not increase the amplitude of the H-reflex. MA, TENS at 2 Hz or 100 Hz didn’t change the latencies of the H-reflexes.
We conclude that both 2Hz and 100Hz TENS increased the amplitude of the H-reflex,
56
suggesting that TENS enhances the excitability of the motoneuron pool in the spinal cord, and 100Hz TENS has a greater effect than 2Hz TENS, whereas MA was not similar effect to TENS on spinal cord.
Our previous studies have known that the cerebral cortex plays a modulator role in the physiological mechanisms of acupuncture and 2Hz electroacupuncture (EA), but either acupuncture or 2Hz EA has no effect on spinal cord. In addition, 2Hz or 100Hz transcutaneous electrical nerve stimulation (TENS) applied to Hegu acupoint can increase the amplitude of the H-reflex, whereas manual acupuncture has no similar effect. Therefore, the aim of the following study was to further investigated the effect of 2Hz EA, 2Hz or 100Hz TENS on cutaneous reflex (CR). A total of 13 healthy adult volunteers were studied. CR recordings were obtained on the right first dorsal interosseous muscle by electrical stimulation of the ipsilateral index finger. 2Hz EA, 2Hz or 100Hz TENS was applied to the surface of the left Hegu acupoint (LI.4), and then the changes of CR were observed. The results indicated that CR was characterized by an initial short latency excitatory wave (E1), followed by an inhibitory wave (I1), then a long latency exc itatory wave (E2). Both 2Hz EA and 2Hz TENS applied to the surface of the left Hegu acupoint (LI.4) could prolong the latencies of I1 component of CR, whereas 100Hz TENS has no similar effect. In addition, either EA or TENS could not change the latencies of E1, E2 component and the amplitudes of I1, E2 component of CR. In conclusion, 2Hz EA or 2Hz TENS applied to the Hegu acupoint (LI.4) prolonged the latencies of I1 component of CR, suggesting that the action site of 2Hz EA or 2Hz TENS located in the supraspinal, possibly in the subcortical or cortical level. In addition, the electrical stimulation of higher frequency such as 100Hz TENS is easier causing the habituating development of CR.
Keywords: manual acupuncture, electroacupuncture, transcutaneous electrical stimulation, Hegu acupoint, H- reflex, cutaneous reflex
57
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