Past, Present, and Future of the Pulse Examination ( mài zhen).

The pulse examination ( mài zhen) is a unique diagnostic approach of Traditional Chinese Medicine. The description of pulse examination in the history of Traditional Chinese Medicine is full of amazement and mythology. After researching in hemodynamics and investigating in clinical application for three decades, this article describes the development and the merits and demerits of pulse examination. The experiences of the ancients are tried to be illustrated with modern knowledge and language. As the theory of resonant blood circulation is discovered, Traditional Chinese Medicine could be on the shoulder of Newton and then lead the development of modern medicine. Hope the tool of pulse examination constructed according to eigen-vector with specific time domain and position can bring the running water for Traditional Chinese Medicine. Quantitative research could overcome the plight of analog logic qualitative research, and therefore bring new health revolution.

Effects of antihypertensive drugs on specific harmonic indices of the pulse waveform in normotensive Wistar Kyoto rats.

We used a self-comparison method and harmonic analysis to compare the blood pressure wave before and after the injection of antihypertensive drugs (atenolol, captopril, and losartan) in normotensive Wistar Kyoto rats. Systolic and diastolic blood pressures decreased significantly after the intraperitoneal injection of drugs. Atenolol significantly reduced all the harmonic proportions of the pulse wave, while captopril and losartan significantly increased the first and fourth harmonic proportions. These findings are the same as those reported for human subjects and confirm that harmonic analysis of the pressure pulse is a useful method to study the efficacy of antihypertensive drugs.

Similarity between coffee effects and qi-stimulating events.

AIMS: Previously, we found that qi-stimulating events exerted similar frequency-specific effects on the blood pressure pulse spectrum. Because coffee and qi induce similar stimulatory psychological responses, we aimed to determine whether they would induce similar pulse effects. Such a relationship would suggest a close linkage between the physiologic mechanisms underlying the psychostimulatory responses and vascular effects of coffee and qi. Therefore, the profound investigations into the mechanisms underlying the effects of coffee on the central nervous system and the vascular system may help to elucidate the underlying physiology mechanisms of qi. METHODS: Each test subject took three rounds of 150 mL coffee (0.1 g/kg, 0.05 g/kg, 0.05 g/kg) in a 30-minute interval. The subject's pulses were recorded at the end of each round. The changes in the test subject's pulse spectrum between before and after coffee consumption were compared with changes induced by a water placebo. RESULTS: Both coffee and qi caused the intensities of the third, sixth, and ninth harmonics of the pressure pulse spectrum to be relative peaks to their neighboring harmonics. CONCLUSION: Our results suggest that the coffee effect may be considered a qi-stimulating event, and there is a common physiologic factor determining the psychostimulatory responses of qi and coffee as well as their effects on the cardiovascular system, which results in a specific frequency pattern in the blood pulse spectrum. Adenosine, which is the main physiologic compound affected by coffee, might also be the key factor affected by qi.

Connection between RR-interval length and the pulsatile microcirculatory flow.

The present study used laser Doppler flowmetry (LDF) to investigate the connection between skin microcirculatory flow and the length of the RR interval (LRR). Local heating was performed on healthy volunteers to further elucidate its effect on LDF index. ECG and LDF signals were measured in 102 trials on seven volunteers. Each experiment involved a 5 min control and a 5 min heating-effect sequence. Each laser Doppler flux pulse was categorized into four groups according to its LRR compared with the 5 min average LRR. Synchronized averaging analysis was applied to the four groups of pulses to obtain their averaged waveforms, from which four flux parameters were calculated. The ac component of the flux increased significantly with increasing LRR, and the differences therein between the groups with LRR more than 4% smaller and more than 4% larger than the average LRR increased from 15.8% during the control period to 23.9% during the heating period. Understanding of the different flux responses between the control and local-heating experiments may aid the development of a new index, which helps to avoid LDF's main drawback of providing only qualitative measurement.

Spectral analysis on the microcirculatory laser Doppler signal at the acupuncture point.

We aimed to characterize the frequency spectra of skin blood flow signals simultaneously recorded at Hoku, an important acupoint in oriental medicine, and two nearby nonacupoints to understand the underlying physiological mechanism of acupuncture points. ECG and laser Doppler flowmetry signals were measured simultaneously. A four-level Haar wavelet transform was applied to the measured 20-minute LDF signals, and periodic oscillations with five characteristic frequency peaks were obtained within the following frequency bands: 0.0095-0.021, 0.021-0.052, 0.052-0.145, 0.145-0.6, and 0.6-1.6 Hz (defined as FR1-FR5), respectively. The power in FR3 was significantly larger at Hoku than at the two nonacupoints. Spectral analysis of the flux signal revealed that one of the major microcirculatory differences between acupoints and nonacupoints was in the different myogenic responses of their vascular beds. This information may aid the development of a method to noninvasively study the microcirculatory characteristics of the acupoint.

The benefit of stretching along the artery.

Many rehabilitation exercises involve the stretching of bodies. We point out the necessity of the longitudinal stretching in arteries. The efficiency of an arterial system is closely related to the condition of the transverse vibration of the arterial walls or to the magnitudes of the area oscillation in all blood vessels. For a given blood pressure wave, a more elastic arterial wall has larger area oscillation, and therefore a higher efficiency in circulation. Elastic properties of the artery depend on the longitudinal stretching. In vitro experiment on pig aorta confirms that proper longitudinal stretching increases its elasticity and benefits to the circulatory system.

Spectral analysis on the microcirculatory laser Doppler signal of the acupuncture effect.

We aim to analyze the frequency content of skin blood flow signals recorded on Hoku following acupuncture stimulation (AS). Each experiment involved recording a 20-minute control-data sequence and two effects data recorded 0-20 and 50-70 minutes after stopping AS, respectively. 4-level Haar-wavelet transform was performed on the measured LDF signals, and periodic oscillations with five characteristic frequency peaks were obtained within the frequency interval: 0.0095-0.021, 0.021-0.052, 0.052-0.145, 0.145-0.6, and 0.6-1.6 Hz, respectively. Band proportion and DC component of the flux signal were calculated to elucidate the effects following AS. At Hoku, the DCflux was significantly increased, the band proportion of the 1st and the 2nd frequency band were significantly decreased, and that of the 5th band was significantly increased following AS. Our results facilitate a non-invasive method to evaluate sympathetic control of peripheral vascular activity between the acupoint and non-acupoints, which may be important for studying the therapeutic effects of AS.

Effects of angiotensin II on flux rise time in rats (a time index of laser Doppler flowmetry) and its relation with microvascular structures.

Laser Doppler flowmetry (LDF) is a popular method for monitoring the microcirculation, but it does not provide absolute measurements on local area with small size microvessels. Instead, the mean flux response is generally compared between before and after stimulus. In this study, we proposed a new dimension for comparing the LDF signals. The flux rise time (FRT), a time index with absolute physical quantity, was extracted from noisy LDF signals using a pulsatile-based synchronized-averaging method. We investigated the changes of FRT and its relation to the microvascular resistance (MVR) under the selective effects of angiotensin II (Ang II) on the kidney and the plantar palm. Ang II was infused into anesthetized Wistar Kyoto rats via the femoral vein for 1 h. Using the heartbeat as a self-trigger, we calculated the FRT and MVR from the renal cortical flux, plantar palm flux, and abdominal aortic blood pressure recorded before, during, and after Ang II infusion. The control FRT values were similar in the two vascular beds. Ang II decreased the renal cortical flux but significantly increased the FRT and MVR of both beds. The effects on the renal FRT and renal MVR were selectively larger than those on the palm FRT and palm MVR. The results indicate that the changes of FRT and MVR are similarly physiologically linked with microvascular structures. As an MVR-related absolute physical quantity, the FRT could be developed as a monitoring tool in physiological, pathological, and pharmacological investigations.

Study on the microcirculatory blood velocity of acupoint monitored by laser Doppler signal.

Meridian system composed of acupoints is the most fundamental concept to build oriental medicine. In this study, we employ LDF measurement to compare the microcirculatory blood velocity of acupuncture point and its surrounding tissues. Measurements were performed around an important acupoint in oriental medicine, Hoh-Ku (Li4, on the hand), in healthy volunteers. The study presented has shown that the acupoints have significantly slower mean blood velocity than their surrounding tissues (p all < 0.005). This finding facilitates the detection of the position of acupuncture point and helps us to provide a possible connection between microcirculatory physiology and the underlying mechanism of acupoints.

Evaluation of stationarity of laser Doppler signal in the pulse-based synchronized-averaging analysis.

Pulse parameters calculated from the LDF waveform based on time-domain synchronized averaging analysis were shown to be able to discriminate the difference in microvascular resistance, however its applicability depends seriously on the assumption of signal stationarity. In this study, our aim is to investigate the effect of pulse number, which may destroy the signal stationarity, on the pulse LDF parameters. The study presented here has established the criteria for pulse number to achieve the signal stationarity so that the microcirculatory discriminability of the pulse-based time-averaging analysis on LDF signal can be improved. The proposed quantitative method to verify the assumption of signal stationarity when utilizing time-averaging can also be applied to analysis of other bio-signals.

Microcirculatory characteristics of acupuncture points obtained by laser Doppler flowmetry.

Acupuncture points (acupoints) form part of the meridian system that constitutes the most fundamental concept in oriental medicine, but their physiological basis has not been clarified. In this study we employed laser Doppler flowmetry (LDF) to extract the microcirculatory characteristics of acupoints and their surrounding tissues, and we interpreted the results from the viewpoint of microcirculatory physiology. Three groups of measurements were performed focusing on the following two important acupoints in oriental medicine in healthy volunteers (n = 13 for group A and n = 9 for groups B and C, respectively): Hoh-Ku (Li4, on the hand) and Ching-Ku (B64, on the foot). The two groups of measurements around Hoh-Ku (Groups A and B) were so designed as to examine the effect of the direction of the nonacupoint away from the acupoint, whereas comparison between the Hoh-Ku and the Ching-Ku measurements was to verify whether the phenomenon was consistent in the upper and the lower extremities. We found that the mean LDF signals were significantly larger at the acupoints than in their surrounding tissues (all p < 0.05), which indicates a larger blood supply into the microvascular beds of acupoints. The results indicate that the physical properties of the vascular structure of acupoints may affect the perfusion resistance, and thereby modulate the microcirculatory perfusion in accordance with tissue needs. This finding facilitates the localization of acupoints, helps in identifying the connection between microcirculatory physiology and responses to acupoint stimulation, and introduces an objective research method for understanding the mechanisms that underlie oriental medicine.

Organ-specific ligation-induced changes in harmonic components of the pulse spectrum and regional vasoconstrictor selectivity in Wistar rats.

It has been shown previously that the amplitudes of the harmonic components of the pulse spectrum vary in specific patterns when the arteries leading to different organs are ligated, with the variations in the harmonics being linearly additive. Since ligation can be regarded as a vast increase in organ resistance, the present study examined the potential of using these ligation-induced variations in the pulse spectrum as reference parameters for an increase in vascular resistance and for regional vasoconstrictor selectivity. A vasoconstrictor, either arginine vasopressin (AVP) or angiotensin II (Ang II), was infused into anaesthetized Wistar rats via the femoral vein for 1 h. The distinct harmonic-specific drug effects on the pulse spectrum were simulated by combining renal artery and superior mesenteric artery ligations in different ratios, the ratio with the lowest mean square difference determining the regional drug selectivity. The ratios indicated that the effect of AVP on the pulse spectrum was attributable to the combined effect of ligating the renal and superior mesenteric arteries, while the effect of Ang II was attributable to ligation of the renal artery. The results are comparable with those of investigations of regional vascular resistance performed using traditional methods. Our findings indicate that the ligation-induced variations in the pulse spectrum can be used to determine regional increases in vascular resistance. This implies that blood pressure can be used as the sole parameter to determine which arterial bed has been affected by the vasoconstrictor, and how seriously.

Three-block electrical model of renal impedance.

In this study, we measured the characteristic renal impedance profiles of Wistar rats and simulated the profiles using an electrical model with three series connected Windkessel blocks containing inductance. It is expected that a complete renal impedance profile ought to provide better physical properties information and have more diagnostic power than the pulsatility (PI) and resistive indices (RI) as a result of frequency dependency. A characteristic peak value at the third harmonic on the renal impedance amplitude curve was observed and the phase curve decreased with increasing harmonic numbers. From least mean square fitted parameters, the three blocks were given distinct physical properties and identified as: (1) the renal artery, (2) the small arteries plus the afferent arteriole and (3) the residual kidney (i.e., the efferent arteriole plus the post glomerular capillary structures). These allocations were made according to respective physical properties reported in previous research. These classifications were further confirmed when we compressed the kidney or infused Ang II. Variations in electrical parameters concurred with the likely affected blood vessels reported. This model describes renal impedance characteristics well; and it provides useful hints on the physical properties of the renal vascular system as well as allows for distinctions in possible physiologically affected locations during functional disturbance. It has potential for development as a clinical non-invasive diagnostic tool.

The eccentric position of the heart in the mammalian body and optimal energy transfer in single tube models.

Many phenomena cannot be explained by traditional haemodynamics models. For example, the hearts of all mammals are neither at one end of the circulatory system nor at the geometric centre. Based on a new circulation model, we report that if the heart is located at either of these two positions, the energy saving rule will be violated. We assume that the main arterial system is under a steady, distributed transverse vibration with the heart as the input power source. The equation of motion of the artery is governed by a new pressure wave equation with total energy. We analyse the effects of the heart position on the pressure pulse shape and the spectrum. By a simplifying T-tube model, we find that there are many harmonic oscillating modes for the overall arterial system. The position of the heart affects the weights of different modes. If the heart is at the midpoint or at one end of the body, none of the even harmonic modes can be excited. If the heart is at a third along the whole system, the third oscillation mode in the system is missing. Thus, from an efficiency point of view, this model gives a strong reason for all mammals' hearts being at an eccentric position. Tube simulations were carried out to confirm the theoretical prediction. A new standing wave model to analyse the variation of the pressure pulse shape along the artery is discussed. The interesting result indicates that our new pressure wave equation possesses a high problem solving potential. It provides a new tool for studying arterial dynamics.

Losing harmonic stability of arterial pulse in terminally ill patients.

OBJECTIVE: To measure the coefficient of variation of the harmonic magnitude (HCV) of the radial arterial pulse before death of cancer patients. METHODS: We non-invasively recorded the radical arterial pulse of 21 end-stage cancer patients, 31 healthy subjects, and 47 outpatient department (OPD) patients. During the 2-week study, eight cancer patients expired. RESULTS: There were no considerable differences in diastolic or systolic blood pressure between cancer patients and other subjects; however, all six HCVs were significantly higher in the cancer patients (P<0.05). Within the cancer patient group, the first and second HCV were notably higher in the patients that expired (P<0.05), and the first to fourth HCVs were significantly increased on their last day (P<0.05). In the control healthy subjects and the OPD group, the HCVs were below 5 and 8%, respectively. In the cancer patients, the third to sixth HCVs were higher than 15%. On the last day of the cancer patients that expired, even the first and second HCVs were higher than 15%. CONCLUSIONS: During the dying process, the traditional diastolic and systolic blood pressure did not show significant changes; however, all the harmonic components gradually lost their stability. The HCVs, which increased first for the high-frequency components and then the low-frequency components, could quantitatively reflect the severity of different stages of illness.

One important area gradient force has been omitted in the Moens and Korteweg's Equation.

Pulse wave velocity is mostly related to the young's modulus by the Moens and Korteweg's formula. In deriving this formula, the wall's effect on the blood was ignored at the first step and the pressure gradient was considered as the only driving force in the axial flow of the blood. The local area gradient was assumed to be zero. However, for a real arterial system with compliance, the area gradient is automatically accompanied with the pressure gradient and it will contribute an area gradient force. This force has been omitted so far without any justification because it will contribute a nonlinear term and also leads an obstacle for the analogy with the transmission line theory. We give a quantitative evaluation of the ratio of the area gradient force to the pressure gradient force and find that it is more than 50% in the main artery. This shows the inadequacy and the inaccuracy of the pulse wave velocity derived based on this axial flow equation. We propose that starting from the radial equation of motion might provide an alternate, feasible method to study hemodynamics by energy concern.

Pressure pulse velocity is related to the longitudinal elastic properties of the artery.

It is known that arteries in their natural position are always subject to a longitudinal stress. However, the effect of this strong longitudinal tension has seldom been addressed. In this paper, we point out that the traditional pulse wave velocity formulae considering only the circumferential elasticity fail to include all the important energies. We present a vigorous derivation of a pressure wave equation, the pressure wave equation with total energy, which considers all the important energies of the whole arterial system by treating the arterial wall and the blood as one system. Our model proposes that the energy transport in the main arterial system is primarily via the transverse vibration motion of the elastic wall. The final equation indicates that the longitudinal stress is essential and the high frequency phase velocity is related to the longitudinal tension along the arterial wall and its Young's shearing modulus. By applying this equation, we suggest that longitudinal elastic property is an important factor in hemodynamics and in the treatment of cardiovascular diseases.