基于情绪诱发实验探讨喜、怒、悲、恐四种情志状态的脉象、脉图特点及其生理特化模式

Pulse diagnosis means a physician figuring out the body's physiological and pathological changes by feeling the pulsation. According to TCM, a normal pulse may undergo corresponding physiological changes with influences of the internal and external factors (e.g. climate, sex, age and emotion). And knowing these changes is significant in the diagnosis of the disease. However, there is still no objective evidence in real sense to support the theory that different physiological emotions would lead to corresponding physiological changes of pulse condition. This study uses experimental methods of emotion inducing derived from psychology ,adopting four emotion (joy, fury, grief and fear), taking neutral emotion as control, choosing healthy young female as the subjects. To observe the changes of emotions, pulse condition ,pulseogram parameter, physiologic parameter related to the autonomic nervous system( which is tested by Hemodynamic Recording System) and Hormone levels tested in the saliva simultaneously at the different time points( The time before watching video, the right time when finished watching video, the time of 15minutes, 30minutes, 45minutes after watchingvideo).With comparing and analyzing the differrent changes of pulse condition and explaning their specific phsiological mode,his study provides objective evidence for both the development of pulse and emotions study of TCM and directions of clinical practice.

脉诊是指通过切脉，获取脉象，推断人体内部的生理、病理变化。根据中医理论，健康状态下的脉象可受人体内外因素（气候、性别、年龄、情志等）的影响而发生生理范围内的变化。了解这种变化，对于切脉诊病具有重要的参考意义。那么不同情志变化所致健康人的脉象变化是否存在差异，尚缺乏现代意义上的客观证据。本课题拟借助心理学的情绪诱发实验方法，从心理学目前研究比较成熟、且能与中医五志中的喜、怒、悲、恐相对应的喜悦、愤怒、悲伤、恐惧四种情绪入手，以中性情绪为对照，健康年轻女性为被试，通过同步观测其在观看情绪诱发视频前的静息态，观看结束即刻，观看结束后15分、30分、45分等多个时点的情绪状态及左手寸口关部的脉图与基于生理多导仪和唾液检测的相关自主神经系统与激素指标，比较、分析不同情志状态下脉象、脉图变化的差异，探讨不同情志所致脉象、脉图变化的生理特化模式，为促进中医脉学和情志理论的发展及指导临床实践提供客观依据。

根据中医理论，健康状态下的脉象可受情志的影响而发生生理范围内的变化。那么基于现代意义上的客观证据，这种变化是否可被观测？不同情志所致脉象的变化是否存在差异？本课题从文献和实验两个方面进行了研究。(1)文献研究：通过梳理归纳古文献中相关记载，发现古人多是基于《内经》中情志对气机的影响，探讨喜、悲、怒、恐所致脉象变化，这些变化存在一定差异，但未将生理和病理分开。(2)实验研究：以年轻健康女性为被试，基于情绪诱发实验，通过两组共计88例、264人次的多时点观测，以中性情绪为对照，分别观测、比较了喜、悲和怒、恐情志状态下脉图参数的变化特点及其差异，基于自主神经系统、唾液皮质醇和唾液淀粉酶变化及中医体质理论，初步验证了生理范围内的情志变化可引起脉象一定变化的中医理论；分析了不同情志状态下脉图参数的变化特点；初步阐释了不同情志状态下脉图参数的变化规律及其机制。为促进中医脉学和情志理论的发展及指导临床实践提供了一定客观依据。具体来说，①实验所用喜悦、悲伤、愤怒及恐惧视频均可诱发被试者的相应情绪；②观看喜悦视后t1显著升高，t5显著降低，t显著降低；观看悲伤视频之后，t5显著升高，t呈上升趋势。喜悦与悲伤对t5的影响呈相反趋势，分别通过缩短左心室舒张期、心动周期及延长左心室舒张期而表现为脉率的加快与减慢，但均在正常范围内; 喜悦、悲伤视频未能引起被试者唾液淀粉酶和唾液皮质醇的变化。③观看愤怒视频后t显著缩短，通过缩短心动周期而使脉率增加；观看恐惧视频之后，t3显著延长，t5显著缩短，t呈缩短趋势，通过缩短舒张期使脉率呈增加趋势。愤怒与恐惧视频均可导致唾液皮质醇水平的变化，但呈前者降低、后者升高的相反趋势；恐惧视频可使唾液淀粉酶水平升高。