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Song J, Choi JY, Lee BW, Eom D, Song CH. Visualizing a Cold Stress-Specific Pulse Wave in Traditional Pulse Diagnosis ('Tight Pulse') Correlated with Vascular Changes in the Radial Artery Induced by a Cold Pressor Trial. SENSORS (BASEL, SWITZERLAND) 2024; 24:2086. [PMID: 38610298 PMCID: PMC11014190 DOI: 10.3390/s24072086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/16/2024] [Revised: 03/07/2024] [Accepted: 03/22/2024] [Indexed: 04/14/2024]
Abstract
Radial pulse diagnosis is the most common method to examine the human health state in Traditional East Asian Medicine (TEAM). A cold stress-related suboptimal health state (subhealth) is often undetectable during routine medical examinations, however, it can be detected through the palpation of specific pulse waves, particularly a 'tight pulse', in TEAM. Therefore, this study examined a correlation between 'tight pulse' and vascular changes in the radial artery (RA) induced by a cold pressor trial (CPT). Twenty healthy subjects underwent sequentially control trial and CPT with room-temperature and ice-cold water, respectively, on the right forearm. The radial pulse and vascular changes were then examined on the left arm. The radial pulse scores for frequencies of 'tight pulse' with strong arterial tension increased after the CPT compared with the control trial. The pulse scores were reversely correlated with the RA thickness and volumes in ultrasonography, but not with changes in the systolic/diastolic blood pressure. The RA thickness-based vascular surface and three-dimensional images visualized a 'tight pulse' showing the vasoconstriction and bumpy-/rope-shaped vascular changes in the radial pulse diagnostic region after the CPT. These findings provide valuable insights into the potential integration of clinical radial pulse diagnosis with ultrasonography for cold-related subhealth.
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Affiliation(s)
- Jichung Song
- Department of Medical History, College of Korean Medicine, Daegu Haany University, Gyeongsan 38610, Republic of Korea;
| | - Jae Young Choi
- Department of Urology, College of Medicine, Yeungnam University, Daegu 42415, Republic of Korea;
| | - Byung-Wook Lee
- Department of Medical Classics & History, College of Korean Medicine, Dongguk University, Gyeongju 38066, Republic of Korea;
| | - Dongmyung Eom
- Department of Medical Classics, College of Korean Medicine, Wonkwang University, Iksan 54538, Republic of Korea;
| | - Chang-Hyun Song
- Department of Anatomy and Histology, College of Korean Medicine, Daegu Haany University, Gyeongsan 38610, Republic of Korea
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Distal Acupoints Outperform Proximal Acupoints in Treating Knee Osteoarthritis: A Randomized Controlled Trial. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2021; 2021:4827123. [PMID: 34457022 PMCID: PMC8387169 DOI: 10.1155/2021/4827123] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Revised: 07/29/2021] [Accepted: 08/11/2021] [Indexed: 12/20/2022]
Abstract
Objectives To determine the difference in efficacy between distal and proximal acupoints in treating knee osteoarthritis. Design Ninety-two eligible participants were randomly assigned into three groups: distal acupoint treatment group (DG), proximal acupoint treatment group (PG), and sham acupuncture control group (SG). Primary and secondary outcomes were compared before and after the intervention. Interventions. A single acupuncture treatment was applied at Quchi (LI11), Shaohai (HT3), and Tianjing (TE10) in DG participants; Yanglingquan (GB34), Yinlingquan (SP9), and Heding (EX-LE2) in PG participants; and Zhongwan (CV12) and Liangmen (ST21) in SG participants. Main outcome measures. The visual analog scale (VAS) and active and passive knee range of motion (ROM) were used primarily to evaluate the treatment efficacy. The radial pulse diagnosis was used as a secondary outcome measure to determine the changes in the spectral energy of the radial pulses. Results The three groups had significant pain reduction after acupuncture (p < 0.05). DG had the greatest difference in pre- and post-VAS scores. Compared with the control group, significant improvement was observed in DG active and passive ROM and in PG passive ROM (p < 0.05). The high-frequency spectral energy of the left chi pulse in PG was significantly decreased, while the low-frequency spectral energy of the left cun pulse in PG and the left guan pulse in DG were significantly increased after acupuncture. Conclusions Distal acupoints provide better pain relief and improve ROM than proximal acupoints in treating knee osteoarthritis. Significant changes in spectral energy were observed in the left cun, guan, and chi pulses, indicating pain relief and blood flow improvement after acupuncture.
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Kung YY, Kuo TBJ, Lai CT, Shen YC, Su YC, Yang CCH. Disclosure of suboptimal health status through traditional Chinese medicine-based body constitution and pulse patterns. Complement Ther Med 2020; 56:102607. [PMID: 33220452 DOI: 10.1016/j.ctim.2020.102607] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Revised: 07/29/2020] [Accepted: 10/31/2020] [Indexed: 01/25/2023] Open
Abstract
OBJECTIVES Suboptimal health status (SHS) is a dynamic state wherein people have not been diagnosed with a disease but tend to develop diseases. People with SHS often experience fatigue and other nonspecific symptoms, which are related to a deviated body constitution in traditional Chinese medicine (TCM). However, the correlation between TCM constitution and SHS has not been adequately investigated. Furthermore, no study has explored the radial pulse analysis-an assistive objective indicator of TCM constitution-in healthy people and people with SHS. DESIGN A cross-sectional study. SETTINGS/LOCATION Center for Traditional Medicine, Taipei Veterans General Hospital, Taiwan. SUBJECTS Sixty-six adults (27 healthy participants and 39 participants with SHS) who were aged 20-39 years. OUTCOME MEASURES The body constitution questionnaire (BCQ) scores, suboptimal health status questionnaire-25 (SHSQ-25) scores, and radial pulse waves detected using sphygmography were recorded. Pulse wave analyses are presented as the ratio of frequency below 10 Hz to that above 10 Hz (SER10), which represent energy changes in organ blood flow. RESULTS Participants with SHS had significantly higher Yang-Xu, Yin-Xu, and stasis scores of BCQ compared with healthy participants. The SHSQ-25 scores of the participants with SHS were moderately correlated with their Yang-Xu, Yin-Xu, and stasis scores (r = 0.65, 0.66, and 0.72, respectively; all p < 0.001), but weak correlations were discovered for healthy participants. The participants with SHS had significantly higher SER10 at the left guan (the "liver" system in TCM) than did the healthy participants. CONCLUSIONS SHS is moderately correlated with TCM-based constitution and those with SHS had increased SER10 at the leftguan of the radial pulse.
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Affiliation(s)
- Yen-Ying Kung
- Center for Traditional Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC; Institute of Traditional Medicine, National Yang-Ming University, Taipei, Taiwan, ROC; Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC.
| | - Terry B J Kuo
- Institute of Brain Science, National Yang-Ming University, Taipei, Taiwan, ROC; Sleep Research Center, National Yang-Ming University, Taipei, Taiwan, ROC; Brain Research Center, National Yang-Ming University, Taipei, Taiwan, ROC.
| | - Chun-Ting Lai
- Institute of Brain Science, National Yang-Ming University, Taipei, Taiwan, ROC; Sleep Research Center, National Yang-Ming University, Taipei, Taiwan, ROC.
| | - Yuh-Chiang Shen
- National Research Institute of Chinese Medicine, Ministry of Health and Welfare, Taipei, Taiwan, ROC.
| | - Yi-Chang Su
- National Research Institute of Chinese Medicine, Ministry of Health and Welfare, Taipei, Taiwan, ROC.
| | - Cheryl C H Yang
- Institute of Brain Science, National Yang-Ming University, Taipei, Taiwan, ROC; Sleep Research Center, National Yang-Ming University, Taipei, Taiwan, ROC; Brain Research Center, National Yang-Ming University, Taipei, Taiwan, ROC.
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Colectomy influences the radial pulse parameters of traditional Chinese medicine pulse diagnosis in patients with colorectal cancer. Eur J Integr Med 2020. [DOI: 10.1016/j.eujim.2020.101067] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Ng HP, Huang CM, Ho WC, Lee YC. Acupuncture Differentially Affects the High-Frequency Spectral Energy in Radial Pulse Positions Depending on Type of Lower Back Pain. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE : ECAM 2019; 2019:4024501. [PMID: 31871481 PMCID: PMC6907064 DOI: 10.1155/2019/4024501] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/22/2019] [Revised: 09/17/2019] [Accepted: 10/14/2019] [Indexed: 12/13/2022]
Abstract
Acupuncture is a core discipline in traditional Chinese medicine (TCM) and has been practised in China for centuries. In traditional acupuncture, pulse palpation is an important clinical diagnostic technique that guides practitioners in their treatment strategies as they evaluate the effectiveness of the treatment. This paper provides the findings of our investigation of acupuncture's effect on specific radial pulse spectral energies in 41 individuals with lower back pain (LBP), in response to a single acupuncture treatment delivered bilaterally at acupoints BL23, BL25, and BL40. Baseline assessments (vital signs and radial pulse diagnoses), primary outcome measures (radial pulse diagnoses), and secondary outcome measures (the Faces Pain Scale-Revised (FPS-R) and fingertip-to-floor (FTF) tests) were performed at specified intervals before and after the intervention. Our study provides novel information about the effects of acupuncture on the radial pulse spectral energy in individuals with different types of LBP. Our findings suggest that the right Chi pulse is an effective indicator to assess the effects of acupuncture in individuals with fixed, distended, or sharp pain, whereas the left Guan pulse is a potentially useful diagnostic technique to determine acupuncture's effects in individuals with dull, aching pain. The acupoints BL23, BL25, and BL40 provide effective treatment for LBP. Study participants with dull, aching pain had a significant improvement in their lumbar ranges of motion, and their pain rating scores were markedly decreased after acupuncture treatment.
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Affiliation(s)
- Hui-Ping Ng
- International Master Program in Acupuncture, China Medical University, Taichung City 40402, Taiwan
- Singapore Chung Hwa Medical Institution, Singapore
| | - Chin-Ming Huang
- School of Post-Baccalaureate Chinese Medicine, China Medical University, Taichung City 40402, Taiwan
| | - Wen-Chao Ho
- Department of Public Health, China Medical University, Taichung City 40402, Taiwan
- Department of Nursing, Asia University, Taichung City 41354, Taiwan
| | - Yu-Chen Lee
- Department of Acupuncture, China Medical University Hospital, Taichung City 40402, Taiwan
- Graduate Institute of Acupuncture Science, China Medical University, Taichung City 40402, Taiwan
- Chinese Medicine Research Center, China Medical University, Taichung City 40402, Taiwan
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Ng HP, Huang CM, Ho WC, Lee YC. An investigation into the effects of acupuncture on radial pressure pulse waves in patients with low back pain: A protocol for a quasi-experimental study. Contemp Clin Trials Commun 2019; 15:100384. [PMID: 31198880 PMCID: PMC6556812 DOI: 10.1016/j.conctc.2019.100384] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Revised: 05/05/2019] [Accepted: 05/22/2019] [Indexed: 11/21/2022] Open
Abstract
Introduction The characteristics of radial pressure pulse waves (RPPW) provide an essential diagnostic technique in Traditional Chinese Medicine (TCM). The purpose of this research is to develop a study protocol that integrates the concept of TCM and traditional acupuncture treatment with modern scientific tools utilizing a quasi-experimental design. We will investigate the effects of acupuncture on the RPPW in study participants with low back pain (LBP) using modern tools, including the pulse sphygmograph, the fingertip-to-floor test, the Faces Pain Scale-Revised, the Oswestry Disability Index, the Health Status Questionnaire, and the Constitution in Chinese Medicine Questionnaire. Methods We will attempt to recruit 80 eligible subjects with LBP based on our predefined inclusion and exclusion criteria. Acupuncture intervention will be performed bilaterally on Shenshu (BL23), Dachangshu (BL25) and Weizhong (BL40) for 20 min. Objective and subjective baseline assessments and outcome evaluations will be performed at a specific time before and after the intervention. This paper describes the methods of our original research approved by the China Medical University Hospital's Research Ethics Committee. Recruitment is in progress and data collection will continue until March 2019. Conclusions To our knowledge, this preliminary study is the first attempt to investigate the effects of acupuncture on the RPPW in LBP subjects using a pulse sphygmograph and other modern tools. The findings will also investigate the effectiveness of the selected acupuncture point combinations for LBP. We hope this preliminary study will provide a basic foundation for a large-scale research study that involves randomisation in the future.
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Affiliation(s)
- Hui-Ping Ng
- International Master Program in Acupuncture, China Medical University, Taichung City, 40402, Taiwan
| | - Chin-Ming Huang
- School of Post-Baccalaureate Chinese Medicine, China Medical University, Taichung City, 40402, Taiwan
| | - Wen-Chao Ho
- Department of Public Health, China Medical University, Taichung City, 40402, Taiwan
- Department of Nursing, Asia University, Taichung City, 41354, Taiwan
| | - Yu-Chen Lee
- Department of Acupuncture, China Medical University Hospital, Taichung City, 40402, Taiwan
- Graduate Institute of Acupuncture Science, China Medical University, Taichung City, 40402, Taiwan
- Chinese Medicine Research Centre, China Medical University, Taichung City, 40402, Taiwan
- Corresponding author. Graduate Institute of Acupuncture Science, China Medical University, 91 Hsueh-Shih Road, Taichung City, 40402, Taiwan.
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Huang CJ, Lin HJ, Liao WL, Ceurvels W, Su SY. Diagnosis of traditional Chinese medicine constitution by integrating indices of tongue, acoustic sound, and pulse. Eur J Integr Med 2019. [DOI: 10.1016/j.eujim.2019.04.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
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Lee BJ, Jeon YJ, Bae JH, Yim MH, Kim JY. Gender differences in arterial pulse wave and anatomical properties in healthy Korean adults. Eur J Integr Med 2019. [DOI: 10.1016/j.eujim.2018.11.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Lee BJ, Jeon YJ, Kim JY. Association of obesity with anatomical and physical indices related to the radial artery in Korean adults. Eur J Integr Med 2017. [DOI: 10.1016/j.eujim.2017.08.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Moura NGR, Cordovil I, Ferreira ADS. Traditional Chinese medicine wrist pulse-taking is associated with pulse waveform analysis and hemodynamics in hypertension. JOURNAL OF INTEGRATIVE MEDICINE-JIM 2016; 14:100-13. [PMID: 26988431 DOI: 10.1016/s2095-4964(16)60233-9] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
BACKGROUND Pulse wave analysis (PWA) quantifies the phenomenon of pulse waveform propagation in patients with cardiovascular diseases, whereas pulse image analysis (PIA) is a subjective examination in traditional Chinese medicine. OBJECTIVE This study evaluated the association of PIA with PWA and hemodynamics in patients with hypertension. DESIGN, SETTING, PARTICIPANTS AND INTERVENTIONS This observational, cross-sectional study enrolled 45 patients (26 men, (55.2 ± 10.3) years, systolic blood pressure (155 ± 28) mmHg, diastolic blood pressure (93 ± 17) mmHg) for assessment of clinical and laboratorial data. MAIN OUTCOME MEASURES Primary outcomes comprised: pattern differentiation based on an automated method; PIA at the radial artery using the 'simultaneous pressing' method for identification of factors such as strength (strong/weak), depth (superficial/deep), and speed (fast/moderate/slow); and PWA at the same artery using a noninvasive system. RESULTS Significant multivariate main effects were observed for depth (λ=0.648, F5,29 =3.149, P=0.022, η(2) =0.352), strength (λ=0.608, F5,29 =3.736, P=0.010, η(2) =0.392), and speed (λ=0.535, F5,29 =5.302, P=0.002, η(2) =0.465). General effects comprised high values of PWA and blood pressure for superficial, strong, and fast pulse images. A strong pulse was found for pulse pressure ≥ 62.5 mmHg and systolic blood pressure ≥ 149.5 mmHg, whereas a superficial pulse was found for heart rate ≥ 58.25 beats/min; a fast pulse was found for heart rate ≥ 69.6 beats/min and pulse wave velocity ≥ 9.185 m/s. CONCLUSION Associations were explained by LaPlace's law, arterial remodeling in hypertension, alongside the traditional criterion for classifying speed in pulse images. PIA is associated with PWA and hemodynamics in patients with hypertension. Systolic and pulse pressures, heart rate, and pulse wave velocity are quantitative variables that have information to describe the qualitative pulse images such as strength, depth and speed.
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Affiliation(s)
- Nathalia Gomes Ribeiro Moura
- Postgraduate Program of Rehabilitation Science, Augusto Motta University Center, 21041-010, Rio de Janeiro, RJ, Brazil
| | - Ivan Cordovil
- Division of Arterial Hypertension, National Institute of Cardiology, 22240-002, Rio de Janeiro, RJ, Brazil
| | - Arthur de Sá Ferreira
- Postgraduate Program of Rehabilitation Science, Augusto Motta University Center, 21041-010, Rio de Janeiro, RJ, Brazil
- Department of Physical Therapy, Salgado de Oliveira University, 24030-060, Niterói, RJ, Brazil
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Gomes Ribeiro Moura N, Sá Ferreira A. Pulse Waveform Analysis of Chinese Pulse Images and Its Association with Disability in Hypertension. J Acupunct Meridian Stud 2016; 9:93-8. [DOI: 10.1016/j.jams.2015.06.012] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2015] [Revised: 06/23/2015] [Accepted: 06/23/2015] [Indexed: 10/23/2022] Open
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Garafova A, Penesova A, Cizmarova E, Marko A, Vlcek M, Jezova D. Cardiovascular and sympathetic responses to a mental stress task in young patients with hypertension and/or obesity. Physiol Res 2015; 63:S459-67. [PMID: 25669677 DOI: 10.33549/physiolres.932931] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Present study was aimed to investigate sympathetic responses to mental stress with hypothesis that the presence of obesity in patients with hypertension has a modifying effect. Young male subjects, 8 with hypertension grade I, with BMI 25 kg/m(2) (HT), 10 with hypertension grade I, and BMI 30 kg/m(2) (HT OB), 14 healthy controls with BMI 30 kg/m(2) (OB), and 13 healthy controls with BMI 25 kg/m(2) (C) underwent the Stroop test. ECG was recorded continuously to evaluate heart rate variability (HRV). Blood pressure (BP) and catecholamine concentrations were measured at baseline, at the end of mental stress test and 15 min thereafter. Patients with HT demonstrated increased adrenaline concentrations and enhanced stress-induced noradrenaline release compared to that in healthy controls. In obese subjects, stress-induced increase of systolicBP was lower compared to lean individuals. Stress exposure induced a significant rise in the low frequency power component of HRV, however the increase was lower in the HT OB group compared to C. Obesity in patients with hypertension did not lead to a different reaction in comparison with lean hypertensive subjects. The present data demonstrate higher sympathoadrenal activity in early-stage of hypertension. Obesity is connected with higher resting systolicBP and modifies the HRV response to mental stress.
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Affiliation(s)
- A Garafova
- Laboratory of Human Endocrinology, Institute of Experimental Endocrinology, Slovak Academy of Sciences, Bratislava, Slovak Republic.
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Meeuse JJ, Löwik MSP, Löwik SAM, Aarden E, van Roon AM, Gans ROB, van Wijhe M, Lefrandt JD, Reyners AKL. Heart Rate Variability Parameters Do Not Correlate with Pain Intensity in Healthy Volunteers. PAIN MEDICINE 2013; 14:1192-201. [DOI: 10.1111/pme.12133] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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Huang CM, Chang HC, Li TC, Chen CC, Liao YT, Kao ST. Acupuncture Effects on the Pulse Spectrum of Radial Pressure Pulse in Dyspepsia. THE AMERICAN JOURNAL OF CHINESE MEDICINE 2012; 40:443-54. [DOI: 10.1142/s0192415x12500346] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
This study is to investigate the influences of acupuncture for dyspepsia on the Radial Pressure Pulse (RPP) between the Chun, Guan and Chy positions of the right/left wrist. Two series of experiments were designed; for the first series, 30 patients with dyspepsia (Group P) and 30 normal subjects (Group N) were seated to undergo the measurements of pulse pressure waveforms from radial artery by sphygmograph. The parameters of RPP included the spectral energy of 0–10 Hz (SE0–10Hz), 10–50 Hz (SE10–50Hz) and 13–50 Hz (SE13–50Hz). For the second series, acupuncture was administered at the right and left Tsu San Li (St-36) points for the same 30 dyspepsia patients, and then their pulse pressure waveforms were re-examined. The results showed that the SE0–10Hz at Right Guan (RB) (p < 0.05), the SE10–50Hz at RB (p < 0.01), and the SE13–50Hz at RB (p < 0.01) and Left Guan (LB) (p < 0.05) of Group P were significantly greater than that of Group N. After the acupuncture, there were significant decreases in the SE0–10Hz only at RB (p < 0.01), in the SE10–50Hz at RB (p < 0.01), Right Chy (RC) (p < 0.05) and LB (p < 0.05), and in the SE13–50Hz RB (p < 0.01), RC (p < 0.05) and LB (p < 0.01). We concluded that the pulse-frequency spectrum at RB was a more effective characteristic for dyspepsia patients, and the acupuncture had an effect on SE10–50Hz and SE13–50Hz more obviously than that on SE0–10Hz.
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Affiliation(s)
- Chin-Ming Huang
- School of Post-Baccalaureate Chinese Medicine, China Medical University, Taichung, Taiwan
| | - Hsien-Cheh Chang
- School of Chinese Medicine, China Medical University, Taichung, Taiwan
| | - Tsai-Chung Li
- Graduate Institute of Biostatistics, China Medical University, Taichung, Taiwan
| | - Chia Chung Chen
- Department of Bio-industrial Mechatronics Engineering, National ChungHsing University, Taichung, Taiwan
| | - Yin-Tzu Liao
- School of Chinese Medicine, China Medical University, Taichung, Taiwan
| | - Shung-Te Kao
- School of Chinese Medicine, China Medical University, Taichung, Taiwan
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