A study on characteristics of radial arteries through ultrasonic waves

Differences in the Properties of the Radial Artery between Cun, Guan, Chi, and Nearby Segments Using Ultrasonographic Imaging: A Pilot Study on Arterial Depth, Diameter, and Blood Flow

Aim of the Study. The three conventional pulse-diagnostic palpation locations (PLs) on both wrists are Cun, Guan, and Chi, and each location reveals different clinical information. To identify anatomical or hemodynamic specificity, we used ultrasonographic imaging to determine the arterial diameter, radial artery depth, and arterial blood flow velocity at the three PLs and at nearby non-PL segments. Methods. We applied an ultrasound scanner to 44 subjects and studied the changes in the arterial diameter and depth as well as in the average/maximum blood flow velocities along the radial artery at three PLs and three non-PLs located more proximally than Chi. Results. All of the measurements at all of the PLs were significantly different (P < 0.01). Artery depth was significantly different among the non-PLs; however, this difference became insignificant after normalization to the arm circumference. Conclusions. Substantial changes in the hemodynamic and anatomical properties of the radial artery around the three PLs were insignificant at the nearby non-PLs segments. This finding may provide a partial explanation for the diagnostic use of “Cun, Guan, and Chi.”

New assessment model of pulse depth based on sensor displacement in pulse diagnostic devices

An accurate assessment of the pulse depth in pulse diagnosis is vital to determine the floating and sunken pulse qualities (PQs), which are two of the four most basic PQs. In this work, we proposed a novel model of assessing the pulse depth based on sensor displacement (SD) normal to the skin surface and compared this model with two previous models which assessed the pulse depth using contact pressure (CP). In contrast to conventional stepwise CP variation tonometry, we applied a continuously evolving tonometric mechanism at a constant velocity and defined the pulse depth index as the optimal SD where the largest pulse amplitude was observed. By calculating the pulse depth index for 18 volunteers, we showed that the pulse was deepest at Cheok (significance level: P < 0.01), while no significant difference was found between Chon and Gwan. In contrast, the two CP-based models estimated that the pulse was shallowest at Gwan (P < 0.05). For the repeated measures, the new SD-based model showed a smaller coefficient of variation (CV ≈ 7.6%) than the two CP-based models (CV ≈ 13.5% and 12.3%, resp.). The SD-based pulse depth assessment is not sensitive to the complex geometry around the palpation locations and temperature variation of contact sensors, which allows cost-effective sensor technology.

New pulse wave measurement method using different hold-down wrist pressures according to individual patient characteristics

In traditional Chinese and Korean medicine, doctors first observe a patient’s pulse by gently and strongly pressing their fingers onto the wrist, and then make a diagnosis based on the observed pulse waves. The most common method to implement this diagnostic technique is to mechanically extract the pulse waves by applying a fixed range of pressures for all patients. However, this method does not consider the patients individual characteristics such as age, sex, and skin thickness. In the present study, we propose a new method of pulse wave extraction that incorporates the personal characteristics of the patients. This method measures the pulse wave signal at varying hold-down pressures, rather than applying a fixed hold-down pressure for all patients. To compare this new technique with existing methods, we extracted pulse waves from 20 subjects, and then determined the actual applied pressure at each step, the coefficient of floating and sinking pulse (CFS), and the distinction of floating/sinking pulse for each group. Consequently, each subject had a different pressure range in our proposed method, whereas all subjects had a similar pressure range in the existing method. Four of 20 subjects exhibited different floating/sinking pulse patterns due to the value of the first pressure step and the range of hold-down pressures. These four subjects were categorized as overweight based on BMI. In addition, the moving distance of the proposed method was longer than the existing method (p = 0.003, paired t-test), and the correlation coefficient between CFS values of two different methods was 0.321, indicating that there was no correlation.

A clinical study of the pulse wave characteristics at the three pulse diagnosis positions of chon, gwan and cheok

In this work, we analyze the baseline, signal strength, aortic augmentation index (AIx), radial AIx, time to reflection and P_T2 at Chon, Gwan, and Cheok, which are the three pulse diagnosis positions in Oriental medicine. For the pulse measurement, we used the SphygmoCor apparatus, which has been widely used for the evaluation of the arterial stiffness at the aorta. By two-way repeated measures analysis of variance, we tested two independent measurements for repeatability and investigated their mean differences among Chon, Gwan and Cheok. To characterize further the parameters that were shown to be different between each palpation position, we carried out Duncan's test for the multiple comparisons. The baseline and signal strength were statistically different (P < .05) among Chon, Gwan and Cheok, respectively, which supports the major hypothesis of Oriental medicine that all of the three palpation positions contain different clinical information. On the other hand, aortic AIx and time to reflection were found to be statistically different between Chon and the others, and radial AIx and P_T2 did not show any difference between pulse positions. In the clinical sense, however, the aortic AIx at each palpation position was found to fall within the 90% confidence interval of normal arterial compliance. The results of the multiple comparisons indicate that the parameters of arterial stiffness were independent of the palpation positions. This work is the first attempt to characterize quantitatively the pulse signals at Chon, Gwan and Cheok with some relevant parameters extracted from the SphygmoCor apparatus.

Novel diagnostic algorithm for the floating and sunken pulse qualities and its clinical test

We propose a novel classification algorithm for the floating pulse and the sunken pulse using a newly defined coefficient (C_fs). To examine the validity of the proposed algorithm, we carried out a clinical test in which 12 oriental medical doctors made pairwise diagnoses on the pulses of volunteering subjects. 169 subjects were simultaneously diagnosed by paired doctors, and the diagnoses in 121 subjects were concordant, yielding an accuracy of 72% and a Matthews correlation coefficient of 0.42, which indicates reasonable agreement between doctors. Two sample T-tests showed that subjects in the sunken pulse group had significantly higher BMI and C_fs (P < .05) than those in the floating pulse group. The pulse classification by the algorithm converged with the diagnoses of paired doctors with an accuracy up to 69%. With these results, we confirm the validity of the novel classification algorithm for the floating and sunken pulses.