本研究實驗組和對照組在針刺四神針之前的年齡、FIM、性別、偏癱 側、使用柺杖情形以及 Brunstrom’s stage 兩者之間相似，如此說明針刺 在實驗組和對照組之效用，兩組之間是可以互相比較的。我們的結果 腦中星狀細胞所分泌的血管內皮生長因子(vascular endothelial growth factor)增加，促進腦梗塞大鼠的功能恢復 [30]，另外，腦缺血的沙鼠在針 刺足三里之後，齒狀腦回細胞增生[31]。有研究發現6位中大腦梗塞的患者 針刺治療後，單質子發射電腦斷層掃描(single-photon emission computed tomography)影像檢查，顯示梗塞局域周圍的低灌流區和同側、對側或兩 側的感覺運動區的局部腦血流增加[32]；功能性腦部核磁共振掃瞄顯示，
針刺合谷和足三里兩穴位可以激發丘腦下部及對位核，抑制前扣帶回向 頭側皮質，扁桃構造及海馬複合物的活動[45]；針灸至陰穴可刺激枕葉，
其反應與光直接刺激眼睛時枕葉之反應相類似，因此推測穴位與大腦皮
質特定部位存在相關性[46]。以上之研究報告，可以支持本研究的結果針 刺四神針能改善腦中風患者的平衡功能。
有臨床研究顯示針刺能促進急性和亞急性期腦中風患者的腦部功能
恢復[33-35]，如Johansson等人隨機將78位亞急性腦中風的患者分為實驗組
（針刺治療組）38位，對照組40位，經10週，除了復健外每星期二次的
雙盲對照臨床試驗是研究的最高準則(Double blind randomized control trial)，針刺臨床療效之研究尤其難以達成，因施測者容易發現
種特殊之安慰針灸針，而研究之安慰劑組若以表淺性針灸(扎針於皮下) 當安慰劑[50]，將無法排除安慰劑組個案腦部受刺激之可能，因此安慰 劑亦可能有部份療效，而導致針灸組與安慰劑組比較時，針灸組真正 之療效被低估；故本研究對照組在 6 公尺行走與由坐姿至站立之時間 縮短，針灸前後有進步的情形，且兩組間的分析仍未達統計意義，故 推論其有存在之潛在刺激，另一方面，『靈樞、官針』篇提到：毛刺 者，刺浮痺皮膚也[39]。淺刺之頭皮針與中醫針刺手法中之毛刺有相同 之道理，針刺於皮下即可產生治療效果。
本研究的缺點為樣本數少，尚無法代表全部的母群體，進針皮下並 留針可能產生潛在刺激，患者可能因有無針感得氣得知自己為實驗組或 對照組，失去雙盲實驗設計，建議未來對頭皮針長期客觀之評估，可將 上述幾點修正，更可改善其缺陷。
第六章結論
結論是針刺四神針得氣可以減少腦中風患者的平衡板位移的面 積、增強膝伸肌的肌力，推測能改善腦中風患者的平衡功能。針刺四 神針的作用與穴位的解剖位置有密切的關連，而針刺需得氣才有療 效。
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附錄
治療的人，但此暈針現象並不常見，症狀為針刺後感到頭暈冒冷汗等不適
八、 簽章
(一) 經由說明後，本人已完全瞭解以上所有內容，並同意參加本研 究，且將持有同意書副本。
受試者或代理人簽名： 日期： / / （年/月 /日）
(二) □計劃主持人
□協同主持人 （請簽名）日期： / / （年/月 /日）
□研究代理人
(三) 如您不是受試者，請用正楷書寫您的姓名：並指出您是受試者 之：
□父母 □監護人 □法定代理人 □受任人（需附委任書）
□其他，請說明
簽名： 日期： / / （年/月/日）
（醫療法第五十七條規定：受試者為無行為能力或限制行為能力人，
應得其法定代理人之同意）
(四) 如您是受試者，但無法親自簽名，請見證人簽名：
日期： / / （年/月/日）
附錄二
33
附錄三
財團法人彰化基督教醫院
針刺治療對腦中風患者平衡能力影響之研究
編號：
年齡：
FIM：
性別：□男 □女 Br. Stage：UE / LE 中風後日數：
偏癱側 □左 □右
行動能力：□須柺杖 □不須柺杖 針灸治療日期： 年 月 日
檢查項目 前 中 後
6 Meter walk time(s) Sit to stand time(s) 平衡力板(張眼)mm2 平衡力板(閉眼)mm2
Right 肌力測試(pound)
Knee
extensor Left Right 肌力測試(pound)
hip flexor
Left
英文摘要
Balance ability is the basic foundation of forming daily life independently.
Because stroke patients have damage in sensory and motor systems, it results in balance disability when doing actions in various degrees and even causes tumbles. The rehabilitative balance training has played an important role for stroke patients. There has been a long history for using acupuncture in treating brain stroke in China. But there are only few reports on its effectiveness of balance in stroke patients. Therefore, this study aimed a randomized, double-blind, controlled trial for a general appraisal in the effectiveness of balance ability in stroke patients using Shishencong acupuncture point. The subjects include patients diagnosed with brain stroke who were able to walk for at least 6 meters. Thirty subjects were randomized into experimental and control groups of equal size. The primary outcome measures were the degree of displacement from the patient's center of gravity as measured by a balance platfrom when the patient was standing alone, and the length of time for the patient to move from a sitting to standing position and to walk over 6 meters, and the muscle strength of the patient's lower extremities.
The result showed that when obtaining “Qi” from manipulating on Shishencong acupuncture point, it could reduce the gravity variation while taking the balance examination with eyes opened or closed. In contrast it did not have the result when it did not obtain the “Qi＂. Manipulating on Shishencong acupuncture point to obtaining “Qi” has less gravity variation than without “Qi”. It could reduce the time from sitting to standing posture and walking time for 6 meters both with and without “Qi”. It had similar changes in both with and without “Qi” in manipulating on Shishencong acupuncture point; Manipulating Shishencong acupuncture point and obtaining “Qi” could increase the knee extensor strength in the paralyzed
side, but without “Qi” it didn’t have similar result. Moreover, manipulating Shishencong point with “Qi” has greater knee extensor strength in the paralyzed side muscle than without “Qi”; Manipulating Shishencong acupuncture point and obtaining “Qi” could increase the knee extensor strength in the non-paralyzed side, but without “Qi” it didn’t have similar result. In addition, manipulating Shishencong point with “Qi” had greater knee extensor strength in the non-paralyzed side than without “Qi”;
Manipulating Shishencong acupuncture point and obtaining “Qi” could increase the hip flexor strength in the paralyzed side, but without “Qi” it didn’t have similar result. Furthermore, manipulating Shishencong point with “Qi” had greater hip flexor strength in the paralyzed side than without
“Qi”;
The conclusion is that manipulating on Shishencong acupuncture point with
“Qi” can reduce the gravity variation in balance examination and improve the knee extensor strength in stroke patients. The effectiveness of the stimulation also closely associates with the anatomical location of the Shishencong point, and the curative effect can only be achieved when “Qi”
is obtained from the point.
謝辭
感謝中國醫藥學院中西結合研究所謝慶良教授、彰化基督教醫院
復健科魏大森主任的悉心指導，及步態平衡研究室醫學工程師劉鵬達
先生、復健科同仁們與流病分析室張玉君小姐的支持與協助，使得本
研究報告能順利付書並有如此之成果。最後，感謝賢內助、乖巧的女
兒及家人的體諒，讓我可以投入大量的空閒來完成此研究論文，在此
謹致最誠摯的謝意與感激。
本研究計劃獲得彰化基督教醫院研究經費補助，在此一併致謝。