心血管疾病的形成大部分肇因於不良的生活形態所引起的血管硬化，因此，用簡單、快速、準確的方法初步篩選是否為血管硬化的高危險群是很重要的，而切診符合了以上的需求。在傳統中國醫學中，切診儘管居於四診之末，但卻佔有重要的一席之地，透過切診可以得知脈象，而不同的脈象反應不同的生理訊息。近年來許多研究利用單點式手腕橈動脈之脈波波形分析(Pulse Wave Analysis, PWA)作為病理的解析，並區分中醫脈象，但其解析度與手指之感覺有相當的差異。因此，本論文使用由羅錦興教授團隊所研發之具多點式的雙感測脈診儀(Bi-Sensing Pulse Diagnosis Instrument, BSPDI)取得手腕橈動脈之壓力波波形，並透過數值分析建立多維脈波圖譜以呈現脈象。
本論文對健康受測者(年齡為22.10±3.52、BMI為20.30±1.54、血壓為111.30±4.96 mmHg / 73.57±3.31 mmHg)左手手腕尺部作局部冷刺激以模擬血管硬化，並全程觀察其壓力波形在基態期(Base)、刺激期(Cold Stimulation)以及恢復期(Recovery)的變化。基態期時，會先量測15秒的橈動脈脈波波形並量測手腕尺部溫度，此段時間為Base階段；接著，刺激期時，會將事先準備好的冰袋放在手腕橈動脈上，並且每30秒會量測一次橈動脈壓力波形以及其溫度變化，總共量測三次，這三次分別稱為C1、C2與C3，刺激期時間共為90秒；最後，在恢復期時，將冰袋拿掉，並且每30秒量測一次橈動脈壓力波波形和其溫度變化，共量測三次，這三次分別稱為R1、R2與R3，恢復期的時間共為90秒。整個實驗流程時間共為3分15秒，並且共有7個階段，分別為Base、C1、C2、C3、R1、R2與R3。
在30位受測者之結果顯示，經局部冷刺激使得手腕橈動脈血管變硬之後，PWA分析中的AI(Augmentation Index)與H3/H1會變大(P<0.001)；3DPM等高線分析中，等高線為0.5至0.8的長軸顯著地變長(P<0.001)；Dynamic 2DPM等高線分析中，長軸會顯著地變長(等高線值為0.5至0.8時，P<0.001)、時間軸也會顯著地變長(等高線值為0.5與0.6時，P<0.001；等高線值為0.7時，P<0.01；等高線值為0.8時，P<0.05)。
本論文證明冷刺激會使得血管順應性變差，且符合中醫理論中「弦脈(Taut Pulse)」的現象，其將有助於將血管硬化程度以視覺化的方式呈現，醫師亦能更精確判讀和掌握患者病情，對廣大的民眾是一大福音。

Arterial stiffness, a common disorder affecting nearly 30% of population in Taiwan, is an early marker of cardiovascular diseases. Since prevention is better than cure, a non-invasive approach for early detection has come into its own. One of the familiar ways to investigate arterial stiffness risk factors is PWA, measuring radial pulse waves with single-point sensors and widely used in palpation of TCM. Radial pulse waves consist of multiple waves indicating health status; however, the resolution of single-point PWA is different from human fingers. Accordingly, this study utilized multiple-point BSPDI to record radial pulse waves, and then constructed multiple dimension pulse mapping with numerical analysis. 30 healthy subjects, 22.10±3.52 years old, BMI 20.30±1.54, and blood pressure 111.30±4.96/73.57±3.31mmHg, were studied by given local cold stimulation test at “Chi” on left hand to simulate arterial stiffness and by observing radial pulse waves during Base, Cold Stimulation, and Recovery Stage, respectively. According to results, on PWA, significantly higher (P<0.001) AI and H3/H1 occurred after local cold stimulation test making radial artery stiffer. On 3DPM analysis, major axes were significantly longer as contour values were from 0.5 to 0.8(P<0.001). On Dynamic 2DPM analysis, major axes were significantly longer (P<0.001 as contour values were from 0.5 to 0.8) and so were time axes(P<0.001 as contour values were 0.5 and 0.6; P<0.01 as contour values were 0.7; P<0.05 as contour values were 0.8). This implied that local cold stimulation test induced lower arterial compliance associated with taut pulse and provided physicians with a novel way to take care of patients’ health status.

[1]J. Y. Kim, K. Y. Jung, Y. S. Hong, J. I. Kim, T. W. Jang, and J. M. Kim, "The relationship between cold exposure and hypertension," Journal of Occupational Health, 45(5):300-306, 2003.
[2]T. M. Ikaheimo, T. Lehtinen, R. Antikainen, J. Jokelainen, S. Nayha, J. Hassi, S. Keinanen-Kiukaanniemi, T. Laatikainen, P. Jousilahti, and J. J. Jaakkola, "Cold-related cardiorespiratory symptoms among subjects with and without hypertension: the National FINRISK Study 2002," European Journal of Public Health, 24(2):237-243, 2014.
[3]行政院衛生署公布之2013年衛生統計指標，available：
http://www.mohw.gov.tw
[4]I. K. Robertson, K. D. Ahuja, M. J. Ball, "Acute effects of food on postprandial blood pressure and measures of arterial stiffness in healthy humans," American Journal of Clinical Nutrition, 90(2):298-303, 2009.
[5]C. S. Hu, Y. F. Chung, C. H. Luo, C. C. Yeh, X. C. Si, D. H. Feng, S. M. Yeh, and C. H. Liang, "Possibility of Quantifying TCM Finger-Reading Sensations: II. An Example of Health Standardization," European Journal of Integrative Medicine, 4(3):e263-e270, 2012.
[6]Y. F. Chung, C. H. Luo, C. S. Hu, C. C. Yeh, X. C. Si, D. H. Feng, Y. C. Lee, S. I. Huang, S. M. Yeh, and C. H. Liang, "Possibility of Quantifying TCM Finger-Reading Sensations: I. Bi-Sensing Pulse Diagnosis Instrument," European Journal of Integrative Medicine, 4(3):e255-e262, 2012.
[7]高美媚、蔡秀純、溫小娟、廖美華、羅瑋瑜、葉濬毅、張林松、張澎 心、張懿欣、陳敏惠、楊佳璋、鄧貞賢、劉詩蓉、蕭明裕、謝幸媚、 顧雅真(以上編譯者)、王錫崗(總校閱)(2002)，人體生理學 (pp. 396-402)，文京出版社。
[8]C. K. Mittal, W. P. Arnold, S. Katsuki, F. Murad, "Nitric oxide activates guanylate cyclase and increases guanosine 3′:5′-cyclic monophosphate levels in various tissue preparations," Proceedings of the National Academy of Sciences of United States of America, 74(8):3203-3207, 1977.
[9]R. F. Furchgott, and J. V. Zawadzki, "The obligatory role of endothelial cells in the relaxation of arterial smooth muscle by acetylcholine," Nature, 288(5789):373-376, 1980.
[10]B. J. Epstein, "Aliskiren and valsartan combination therapy for the management of hypertension," Vascular Health and Risk Management, 6:711-722, 2010.
[11]M. B. Hussain, S. Singhal, H. S. Markus, and D. R. Singer, "Abnormal vasoconstrictor responses to angiotensin II and noradrenaline in isolated small arteries from patients with cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL)," Stroke, 35(4): 853-858, 2004.
[12]費兆馥(2003)，現代中醫脈診學 (pp. 162-351)，人民衛生出版社。
[13]李君，「高血壓動脈彈性功能指標及臨床評價」，華西醫學，21(2)：426，2006。
[14]J. Nurnberger, A. Keflioglu-Scheiber, A. M. O. Saez, R. R. Wenzel, T. Philipp, and R. F. Schafers, "Augmentation index is associated with cardiovascular risk," Journal of Hypertension, 20(12):2407-2414, 2002.
[15]謝晉湘、劉麗芳、蔣雄京、晉庫根、牛愛萍、張培湘、劉力生，「漢族人群中血壓與動脈硬化關係的研究」，中國循環雜誌，18(2)：49-51，2003。
[16]T. Weber, J. Auer, M. F. O'Rourke, E. Kvas, E. Lassnig, R. Berent, and B. Eber, "Arterial stiffness, wave reflections, and the risk of coronary artery disease," Circulation, 109(2):184-189, 2004.
[17]神戶中醫學研究會(1996)，舌診與脈診 (pp. 76-134)，旺文社。
[18]周松華、朱德增，「弦脈的血流動力學機理探討」，遼寧中醫雜誌, 21(2)：49-50，1994.
[19]張葉青、董耀榮、王憶勤、燕海霞、許文杰、許朝霞、郭睿、劉國萍、郝一鳴、錢鵬，「高血壓病弦脈和非高血壓病弦脈脈圖參數的比較」，世界科學技術：中醫藥現代化，1：1302-1305，2012。
[20]鍾裕峯(2012)，「以雙感測脈診儀為基礎的脈診健康準則和弦脈之研究」，國立成功大學電機工程學系博士論文。
[21]J. Y. Kim, K. Y. Jung, Y. S. Hong, J. I. Kim, T. W. Jang, and J. M. Kim, "The Relationship between Cold Exposure and Hypertension," Journal of Occupational Health, 45(5):300-306, 2003.
[22]Z. Sun, R. Cade, Z. Zhang, J. Alouidor, and H. Van, "Angiotensinogen Gene Knockout Delays and Attenuates Cold-Induced Hypertension," Hypertension, 41(2):322-327, 2003.
[23]P. Abraham, M. Bourgeau, M. Camo, A. Humeau-Heurtier, S. Durand , P. Rousseau, G. Mahe, "Effect of skin temperature on skin endothelial function assessment," Microvascular Research, 88:56-60, 2013.
[24]L. Aubiniere-Robb, P. Jeemon, C. E. Hastie, R. K. Patel, L. McCallum, D. Morrison, M. Walters, J. Dawson, W. Sloan, S. Muir, A. F. Dominiczak, G. T. McInnes, and S. Padmanabhan, "Blood Pressure Response to Patterns of Weather Fluctuations and Effect on Mortality," Hypertension, 62(1):190-196, 2013.
[25]D. L. Wood, S. G. Sheps, L. R. Elveback, and A. Schirqer, "Cold Pressor Test as Predictor of Hypertension," Hypertension, 6(3):301-306, 1984.
[26]S. Garg, A. Kumar, and K. D. Singh, "Blood pressure response to cold pressor test in children of hypertensives," Online Jounral of Health and Allied Sciences, 9(1):7, 2010.
[27]Q. Zhzo, L. A. Bazzano, J. Cao, J. Li, J. Chen, J. Huang, J. Chen, T. N. Kelly, C. S. Chen, D. Hu, J. Ma, T. K. Rice, J. He, and D. Gu, "Reproducibility of Blood Pressure Response to the cold pressor Test: the GenSalt Study," American Journal of Epidemiology, 176(7):S91-8, 2012.
[28]J. Mayet, and A. Huqhes, "Cardiac and vascular pathophysiology in hypertension," Heart, 89(9):1104-1109, 2003.
[29]C. M. McEniery, Yasmin, S. Wallace, K. Maki-Petaja, B. McDonnell, J. E. Sharman, C. Retallick, S. S. Franklin, M. J. Brown, R. C. Lloyd, J. R. Cockcroft, I. B. Wilknson, and ENOGMA Study Investigators, "Increased Stroke Volume and Aortic Stiffness Contribute to Isolated Systolic Hypertension in Young Adults," Hypertension, 46(1):221-226, 2005.
[30]郭裕誠(2013)，上池之水—漢醫的秘密 (pp. 42-140)，當代漢醫苑中醫診所。
[31]D. T. Sandwell, "Biharmonic Spline Interpolation of Geos-3 and Seasat Altimeter," Geophysical Research Letters, 14(2):139-142, 1987.
[32]Y. Y. Wang, M. Y. Jan, G. C. Wang, J.G. Bau, and W. K. Wang, "Pressure pulse wave velocity is related to the longitudinal elastic properties of the artery," Physiological Measurement, 25(6): 1397-403, 2004.