探討溫熱性與寒涼性食物於溫熱性及寒涼性體質之人體內產生的生理訊號差異

Abstract

傳統中醫食療保健的觀念起源很早，其將人體體質和食物屬性皆區分為寒涼及溫熱兩大類，並強調若將食物與人體的性質相呼應，便能調和臟腑並維持生命力，但目前尚未有科學證據將食物屬性及人體體質之關聯進行清楚的定義。因此，尋找一個能夠區分食物屬性的科學方法應是當今中醫食療上的首要課題。 本研究第一階段的目的即為探討不同屬性之食物於不同體質之人體內產生的多項生理訊號相關性，以尋找適合將食物屬性進行定義及區分的科學方法。首先，本階段挑選已被清楚認知為溫熱性的薑母茶和寒涼性的椰子水做為實驗樣品，並利用中醫之新一代非侵入式脈診儀，及西醫之皮膚和腋下溫度計、心率變異性分析儀、雷射都卜勒微循環測速儀、血壓計等來進行生理訊號的測量，而主觀感覺問卷用來評估受試者在飲用樣品後的主觀感受。受試者的體質則由中醫師利用體質分型問卷、問診記錄及舌診影像來進行診斷。 本階段共收集30位受試者，經由溫熱性體質者（n = 19）體內較小的脈波主波幅（h1）和總面積（Area）、較不明顯的重搏波幅（h5）及較快的心率（HR），可推測其動脈管壁應處於較為緊張且不放鬆的狀態。而在試驗之後測初期，溫熱性之薑母茶會增加寒涼性體質者（n = 11）的動脈順應性（心搏量/脈搏壓），進而維持其右關估計橈動脈寬；反之，薑母茶卻讓體內偏“燥熱”的溫熱性體質者之脈波主波幅（h1）變寬、降中峽（h4）增大及估計橈動脈寬顯著收縮，代表著其血管管壁變得更加緊張，而寒涼性之椰子水則能減少其估計橈動脈寬的收縮。此結果證實新一代非侵入式脈診儀應能做為區分不同個體之體質的輔助儀器，並說明了選擇與自身體質相互對立屬性的食物是非常重要的。 此外，本階段中溫熱性之薑母茶會使溫熱性體質者的甲襞微血管紅血球流速明顯增快，由心率變異性頻域分析結果，進一步推測此現象可能是薑母茶促進了全身的迷走神經活性，進而抑制皮膚血管上由交感神經調控的血管收縮，使體表之小動脈舒張，以加快其微血管紅血球流速；而寒涼性之椰子水則能夠使寒涼性體質者之微血管紅血球流速顯著減慢，此現象呼應了其皮膚溫度在飲用椰子水後的顯著下降，推測亦為藉由促進交感神經之血管收縮活性，進而使小動脈收縮所造成的。因此，本階段研究認為甲襞微循環檢測可能可以對溫熱、寒涼食物屬性分別於溫熱、寒涼體質之人體內產生之變化做科學化的區分。 本研究第二階段的目的便進而觀察不同屬性之食物於不同體質之人體內產生的甲襞微循環相關生理訊號，並藉此探討不同或相同食物屬性間的差異及相關性，以期確認甲襞微循環檢測是否適合定義食物屬性。本階段改選西瓜及洋香瓜為寒涼性樣品，而炒花生及去籽龍眼乾為溫熱性樣品，並利用雷射都卜勒測速儀、皮膚溫度計及耳溫槍進行生理訊號的測量，受試者攝食後的主觀感受亦用主觀感覺問卷來評估，另由中醫師利用體質分型問卷及問診記錄來診斷受試者的體質。 在本階段50位受試者體內，溫熱性的炒花生及去籽龍眼乾會使其甲襞微血管密度、管徑及紅血球流速皆顯著增加，寒涼性的西瓜及洋香瓜則會使各項參數皆明顯降低。然而，溫熱性體質受試者（n = 29）之微血管密度及紅血球流速對於不同溫熱性食物的感受程度不同，而在寒涼性食物之間並無差異；反之，寒涼性體質受試者（n = 21）之微血管訊號則是對於不同寒涼性食物的感受程度有所差異，在溫熱性食物之間則較為相似。綜合上述，本研究中甲襞微循環之微血管紅血球流速確實可以用來評估不同食物屬性於不同體質之人體內產生的變化，並可配合微血管管徑及密度的分析，對食物屬性做科學化的區分及定義。 再者，利用甲襞微血管紅血球流速對於相同食物屬性的敏感度，可回推受試者之體質有七成五以上與醫師之體質分型相符；若再進一步加上甲襞微血管密度對於相同食物屬性的敏感度，共同回推受試者體質之準確度則會升高到八成五以上，此結果驗證了傳統中醫之體質診斷應具有相當程度的客觀性及可信度，若再將樣本數放大，應更能幫助我們藉由對食物的反應來了解自身體質。

In the traditional Chinese medicine (TCM), both of personal constitution and food attribute could be divided into hot and cold categories. The dietary therapy claims that people need to select foods with attributes opposite to their constitutions in order to maintain the human vitality. However, there are less scientific evidences about the clear definition of connection between food attributes and personal constitutions. Therefore, establishing a suitable methodology to define the scientific attributes for food ingredients is a very important issue for the Chinese medicine dietary therapy. The first study was to investigate the relationship between the different food attributes and the physiological signals produced in the healthy subjects with different constitutions. Hopefully, a suitably scientific methodology for defining food attributes would be established. This work selected the well-recognized aged ginger tea (AGT) and coconut water (CW) to be warm/hot and cool/cold samples. Physiological signals were then monitored with the modernized Chinese medicine diagnostic instrument: novel noninvasive sphygmography; and the Western medicine diagnostic instruments: the skin and axillary temperature sensors, the heart rate variability, a laser Doppler anemometer (capillaroscope), and a blood pressure monitor. Besides, the questionnaire about subjective feeling would be used to evaluate the feelings of subjects after drinking samples. The personal constitutions of 30 subjects would be diagnosed by Chinese medical doctors using the division of personal constitution questionnaire, asked record, and tongue image. As the baseline faster heart rate, as well as smaller h1 (height of percussion wave), h5 (height of dicrotic wave) and area under the sphygmogram of the hot constitution subjects (n = 19), this work suggest the blood vessel of these subjects may be tighter than that of the cold constitution ones (n = 11). Stroke volume increased and pulse pressure decreased in the cold constitution subjects after taking the warm/hot food, AGT, which may elevate arterial compliance corresponding to maintaining an estimated radial-arterial diameter in our study. However, the percussion wave widened and h4 (height of valley) increased in the hot constitution subjects after taking AGT. This corresponds to the markedly reduced radial-arterial diameter, indicating tighter blood vessels than the baseline status. In contrast, the cool/cold food, CW maintained the radial-arterial diameter of the hot constitution subjects. This result confirms that selecting foods with attributes opposite to personal constitutions is actually important. Moreover, novel noninvasive sphygmography may be a useful instrument to classify scientifically the hot personal constitution and the responses to different food attributes. The capillary red blood cell (RBC) velocity of nail fold microcirculation (NFM) of the hot constitution subjects was accelerated significantly after drinking the warm/hot-attribute AGT, which may be the result of elevated vagal activity (nHF and HF) leading to arteriole dilation in these subjects. In contrast, in the cold constitution subjects, capillary RBC velocity decelerated significantly and skin temperature decreased markedly after drinking the cool/cold-attribute CW, which may have been induced by sympathetic nerve activation causing the arteriole to be constricted. Accordingly, the use of capillary RBC velocity of NFM measured by laser Doppler anemometer may be a promising way to classify the attributes of food ingredients in accordance with different personal constitutions. The second study was to investigate the relationship between the different food attributes and the capillary signals of NFM produced in the healthy subjects with different constitutions. This research expected to confirm that the measurement of NFM is a suitable methodology to scientifically define the food attributes. This work selected watermelon (W) and cantaloupe (C) to be the cool/cold samples, as well as fried peanut (FP) and seedless dried longan (SDL) to be the warm/hot ones. Physiological signals were then monitored with a laser Doppler anemometer and the sensors of skin and auricular temperature. Besides, the questionnaire about subjective feeling would be used to evaluate the feelings of subjects after taking samples. The personal constitutions of 50 subjects would be diagnosed by Chinese medical doctors using the questionnaire pertaining to the division of personal constitution. As the results of the subjects with any of the constitutions, the warm/hot-attribute FP and SDL significantly increased the capillary density, diameter, and RBC velocity, while the cool/cold-attribute W and C markedly decreased these capillary signals. However, the capillary density and RBC velocity of the hot constitution subjects (n = 29) after taking SDL was raised more significantly compared with taking FP, but no differences between taking W and C. In contrast, the capillary density and RBC velocity of the cold constitution subjects (n = 21) after taking C was reduced more significantly compared with taking W. Accordingly, the capillary RBC velocity and other capillary signals of NFM should be a suitable method to scientifically classify the food attributes in accordance with the different constitutions of people. Furthermore, this study calculated the sensitivities of capillary density and RBC velocity of the subjects to the same attribute of samples. The error-count estimate of discriminability on the personal constitution derived from these sensitivities was less than 15%, which was compared with the constitutions diagnosed by Chinese medical doctors. Therefore, this work also suggested that the diagnosis of personal constitutions in the Chinese medicine was quite objective and reliable. Besides, these capillary signals in NFM may help us to figure out personal constitutions in the future based on more database of the responses to different food attributes in the human body.