Pulse Wave Variation during the Menstrual Cycle in Women with Menstrual Pain

Objective Analysis of Traditional Chinese Medicine Syndrome Differentiation of Patients With Diabetes and Prediabetes: Protocol for a Nonrandomized, Exploratory, Observational Case-Control Study Using Digitalized Traditional Chinese Medicine Diagnostic Tools

BACKGROUND

Diabetes and prediabetes are diagnosed differentially by Western and Chinese medicine. While Western medicine uses objective laboratory analysis of biochemical parameters to define the severity of diabetes and prediabetes, Chinese medicine uses a comprehensive approach that integrates observation, inquiry, pulse palpation, and tongue diagnosis. The medical information collected is then categorized into different syndromes. However, traditional methods of pulse and tongue diagnoses used to determine syndrome differentiation are highly subjective and skill dependent.

OBJECTIVE

This study aims to identify the gap in conventional traditional Chinese medicine (TCM) diagnostic techniques for syndrome differentiation analysis using contemporary diagnostic devices. We devised a protocol for a nonrandomized, exploratory, observational case-control study with equal allocations in 5 arms to investigate the syndrome differentiation of diabetes and prediabetes. We hypothesize that the TCM syndrome differentiation of diabetes and prediabetes in the tropical climate may differ from that defined based on the Chinese demographic. We also speculate that the high-frequency spectral energy may reflect a difference in pulse wave intensity and density between the healthy and diabetes groups.

METHODS

A total of 250 eligible participants will be equally assigned to 1 of 5 arms (healthy or subhealthy, prediabetes, diabetes, prediabetes with hypertension and dyslipidemia, and diabetes with hypertension and dyslipidemia). Participants aged 21-75 years, of any sex or race, and have been diagnosed with diabetes (fasting plasma glucose [FPG] of 7 mmol/L, or 2-hour plasma glucose [2hPG] of 11.1 mmol/L) or prediabetes (impaired FPG of 6.1-6.9 mmol/L, or impaired glucose tolerance with an 2hPG of 7.8-11 mmol/L) will be included. The Health Evaluation Questionnaire, Physical Activity Questionnaire, sugar intake assessment, Constitution in Chinese Medicine Questionnaire, radial pulse diagnosis, and tongue diagnosis will be performed in a single visit. ANOVA for continuous data and chi-square tests of independence will be used for categorical data assessments, with a level of P<.05 considered significant.

RESULTS

The recruitment is in progress. We anticipate that the study will conclude in June 2025. As of July 15, 2024, we have enrolled 140 individuals.

CONCLUSIONS

To the best of our knowledge, this is the first study to use contemporary TCM diagnostic instruments to map expert and empirical knowledge of TCM to its scientific equivalents for the purpose of evaluating the syndrome differentiation of diabetes. We designed this protocol with the exploratory goal to examine objectively the syndrome differentiation of patients with diabetes and those with prediabetes using TCM diagnostic technologies. The data collected and evaluated under standardized conditions using these contemporary diagnostic devices will exhibit a higher degree of stability, hence yielding dependable and unbiased results for syndrome differentiation. Thus, our findings may potentially increase the accuracy of identification, diagnosis, treatment, and prevention of diabetes and prediabetes through a system of targeted treatment.

TRIAL REGISTRATION

ClinicalTrials.gov NCT05563090; https://clinicaltrials.gov/ct2/show/NCT05563090.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/56024.

A Noncontact Method for Locating Radial Artery above Radial Styloid Process in Thermal Image

A radial artery above the radial styloid process is called GUAN and is a critical position for collecting pulse wave in traditional Chinese medicine theory. Locating GUAN is a precondition for collecting radial pulse wave. However, existing methods for locating GUAN lead to large deviations. This paper proposes a novel nontouch method for locating GUAN based on thermal imaging and image processing. This method consists of three parts: the infrared thermal imaging location imaging platform, the wrist edge contour extraction algorithm based on arbitrary angle edge recognition, and radial protrusion recognition algorithm (x coordinate identification algorithm of GUAN) and radial artery fitting algorithm (y coordinate identification algorithm of GUAN). The infrared thermal imaging positioning imaging platform is used to ensure that the wrist of the subject enters the fixed imaging area in a fixed position during each measurement and transmits the thermal imaging images carrying the image information of radial processes and radial arteries to the upper computer. Arbitrary angle edge recognition algorithm is used to extract wrist contour and radial artery edge information. The x-axis coordinates of the radial artery were provided by the identification algorithm, and the y-axis coordinates of the radial artery were provided by the fitting algorithm. Finally, the x and y coordinates determine the GUAN position. The algorithm for locating GUAN could provide repeatable and reliable x and y coordinates. The proposed method shows that relative standard deviation (RSD) of x distance of GUAN is less than 9.0% and RSD of y distance of GUAN is less than 5.0%. The proposed method could provide valid GUAN coordinates and reduce deviations of locating GUAN.

Acupuncture Differentially Affects the High-Frequency Spectral Energy in Radial Pulse Positions Depending on Type of Lower Back Pain

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.

Association of the second derivative of photoplethysmogram with age, hemodynamic, autonomic, adiposity, and emotional factors

The second derivative of photoplethysmogram (SDPTG) is used as an arterial stiffness marker. This study aimed to examine the associations between SDPTG indices and age, in addition to hemodynamic, autonomic, adiposity, and emotional factors.This study had a cross-sectional chart review design, and electronic medical records of 262 women outpatients (mean ± SD,|38.57| ± |11.64 years) were reviewed. Among SDPTG measurements, b/a, c/a, d/a, and (b-c-d)/a were considered. Hemodynamic measurements included systolic and diastolic blood pressure (SBP and DBP) and cardiac output. Autonomic measurements included low and high frequency (LF and HF) values of the heart rate variability. Adiposity measurements included body mass index (BMI) and waist-hip ratio (WHR). Tension, anger, depression, fatigue, confusion, and vigor scores using the Profile of the Mood States were included as emotional markers. All data were normalized through the Box-Cox transformation, and 4 hierarchical regression models were constructed.Age was independently predictive of SDPTG, hemodynamic, autonomic, and adiposity factors (β; 0.143-0.648).After the adjustment for age, SBP and DBP showed negative correlations with d/a (r = -0.201, -0.262), whereas BMI, WHR, LF, and HF showed positive correlations with c/a (r = 0.126, 0.131, 0.151, 0.234). In the hierarchical regression modeling, age and hemodynamic factors were directly predictive of SDPTG indices (β; 0.103-0.626). Age had moderating effects between diastolic blood pressure, heart rate, depression scores, and SDPTG indices (β; 0.104-0.176).In conclusion, age, hemodynamic, adiposity, and autonomic factors may be independently associated with SDPTG indices for women. As age has moderating effects between hemodynamic, emotional factors, and SDPTG indices, its moderating effects should be considered when assessing arterial stiffness using SDPTG indices.

A comparative study of the radial pulse between primary dysmenorrhea patients and healthy subjects during the menstrual phase

The aim of this study was to compare radial pulse characteristics between primary dysmenorrhea (PD) patients and healthy subjects throughout the menstrual cycle. A total of 48 females aged 20 to 29 years participated, and all subjects were assigned to two groups according to their visual analogue scale scores. The radial pulse of each subject was obtained using a pulse tonometric device during menstrual, follicular, and luteal phases. In addition, various pulse analysis indices were used to estimate the pulse characteristics. The pulse tension index (PTI) and pulse depth index (PDI) in the patient group were significantly lower than those in the healthy group during the menstrual phase (P < 0.01 and <0.001, respectively). According to univariate logistic regression results, the PTI, PDI and optimal applied pressure (OAP) were significantly correlated with PD, and the model based on the PTI and OAP performed best (AUC = 0.828). This study is the first to analyze pulse tension inferred from the PTI and to apply this parameter to clinical practice. The results of this study confirmed the possibility of quantitatively measuring pulse tension and suggest that the PTI and OAP can serve as potential clinical indicators for pain disorders.