Search JIM Advanced Search

Journal of Integrative Medicine ›› 2016, Vol. 14 ›› Issue (2): 100-113.doi: 10.1016/S2095-4964(16)60233-9

Special Issue: Traditional Chinese Medicine

• Research Article • Previous Articles     Next Articles

Traditional Chinese medicine wrist pulse-taking is associated with pulse waveform analysis and hemodynamics in hypertension

Nathalia GomesRibeiro de Mouraa, IvanCordovilb, Arthurde Sá Ferreiraa,c   

  1. a Postgraduate Program of Rehabilitation Science, Augusto Motta University Center, 21041-010, Rio de Janeiro, RJ, Brazil 
    b Division of Arterial Hypertension, National Institute of Cardiology, 22240-002, Rio de Janeiro, RJ, Brazil
    c Department of Physical Therapy, Salgado de Oliveira University, 24030-060, Niterói, RJ, Brazil
  • Received:2015-06-12 Accepted:2015-07-22 Online:2016-03-15 Published:2016-03-15
  • Contact: Arthur de Sá Ferreira, D.Sc.; E-mail: arthur_sf@ig.com.br, arthurde@unisuamdoc.com.br

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, η2 =0.352), strength (λ=0.608, F5,29 =3.736, P=0.010, η2 =0.392), and speed (λ=0.535, F5,29 =5.302, P=0.002, η2 =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.

Key words: Medicine, Chinese traditional, Hypertension, Syndrome differentiation, Rehabilitation

1 World Health Organization.A global brief on hypertension. Silent killer, global public health crisis. Geneva: World Health Organization. 2013.
2 Knuiman MW, Divitini ML, Welborn TA, Bartholomew HC.Familial correlations, cohabitation effects, and heritability for cardiovascular risk factors.Ann Epidemiol. 1996; 6(3): 188-194.
3 World Health Organization. Obesity and overweight. Fact sheet Nº311. (2015-01) [2015-05-03]. . Obesity and overweight. Fact sheet Nº311. (2015-01) [2015-05-03]. http://www.who.int/ mediacentre/factsheets/fs311/en/.
4 Stranges S, Wu T, Dorn JM, Freudenheim JL, Muti P, Farinaro E, Russel M, Nochajski TH, Trevisan M.Relationship of alcohol drinking pattern to risk of hypertension: a population-based study.Hypertension. 2004; 44(6): 813-819.
5 Fagard RH.Physical activity, physical fitness and the incidence of hypertension.J Hypertens. 2005; 23(2): 265-267.
6 Mancia G, Fagard R, Narkiewicz K, Rédon J, Zanchetti A, Bohm M, Christiaens T, Cifkova R, De Backer G, Dominiczak A, Galderisi M, Grobbe D, Jaarsma T, Kirchhof P, Kjeldsen S, Laurent S, Manolis A, Nilsson P, Ruilope L, Schmieder R, Sirnes P, Sleight P, Viigimaa M, Waeber B, Zannad F.The task force for the management of arterial hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC).J Hypertens. 2013; 31(7): 1281-1357.
7 World Health Organization.Global health observatory (GOD) data. Geneva: World Health Organization. 2013.
8 Mourad JJ, Girerd X, Boutourie P, Safar M, Laurent S.Opposite effects of remodeling and hypertrophy on arterial compliance in hypertension.Hypertension. 1998; 31(1 Part 2): 529-533.
9 Ward MR, Pasterkamp G, Yeung AC, Borst C.Arterial remodeling mechanisms and clinical implications.Circulation. 2000; 102(10): 1186-1191.
10 Arribas SM, Hinek A, González MC.Elastic fibres and vascular structure in hypertension.Pharmacol Ther. 2006; 111(3): 771-791.
11 Ferreira Ade S.Integrative medicine for hypertension: the earlier the better for treating who and what are not yet ill.Hypertens Res. 2013; 36(7): 583-585.
12 Bulpitt CJ, Dollery CT, Carne S.Change in symptoms of hypertensive patients after referral to hospital clinic.Br Heart J. 1976; 38(2): 121-128.
13 Zizi F, Jean-Louis G, Magai C, Greenidge KC, Wolintz AH, Heath-Phillip O.Sleep complaints and visual impairment among older Americans: a community-based study.J Gerontol A Biol Sci Med Sci. 2002; 57(10): M691-M694.
14 Suka M, Yoshida K, Sugimori H.Persistent insomnia is a predictor of hypertension in Japanese male workers.J Occup Health. 2003; 45(6): 344-350.
15 Hajjar I, Lackland DT, Cupples LA, Lipsitz LA.Association between concurrent and remote blood pressure and disability in older adults.Hypertension. 2007; 50(6): 1026-1032.
16 Bortel LMV, Duprez D, Starmans-Kool MJ, Safar ME, Giannattasio C, Cockcroft J, Kaiser DR, Thuillez C.Clinical applications of arterial stiffness, Task-force III: Recommendations for the user procedures.Am J Hypertens. 2002; 15(5): 445-452.
17 O’Rourke MF, Pauca A, Jiang XJ. Pulse wave analysis.Br J Clin Pharmacol. 2001; 51(6): 507-522.
18 Ghasemzadeh N, Maziar Zafari A. A brief journey into the history of the arterial pulse. Cardiol Res Practice.2011; 2011: Article ID 164832.
19 Ferreira AS, Lopes AJ.Pulse waveform analysis as a bridge between pulse examination in Chinese medicine and cardiology.Chin J Integr Med. 2013; 19(4): 307-314.
20 Wilkinson IB, Fuchs SA, Jansen IM, Spratt JC, Murray GD, Cockcroft JR, Webb DJ.Reproducibility of pulse wave velocity and augmentation index measured by pulse wave analysis.J Hypertens. 1998; 16(12 Part 2): 2079-2084.
21 Millasseau SC, Patel SJ, Redwood SR, Ritter JM, Chowienczyk PJ.Pressure wave reflection assessed from peripheral pulse: is a transfer function necessary?Hypertension. 2003; 41(5): 1016-1020.
22 Munir S, Guilcher A, Kamalesh T, Clapp B, Redwood S, Marber M, Chowienczyk. Peripheral augmentation index defines the relationship between central and peripheral pulse pressure.Hypertension. 2008; 51(1): 112-118.
23 Shin BC, Kim S, Cho YH.Syndrome pattern and its application in parallel randomized controlled trials.Chin J Integr Med. 2013; 19(3): 163-171.
24 O’Connor J, Bensky D. Acupuncture: a comprehensive text. Seattle: Eastland Press. 1987.
25 Auteroche B, Navailh P. O diagnóstico na medicina chinesa. São Paulo: Editora Andrei.1986. Portuguese.
26 Maciocia G. Os Fundamentos da Medicina Chinesa: Um Texto Abrangente para Acupunturistas e Fitoterapeutas. Sa?o Paulo: Roca. 1996. Portuguese.
27 Yamamoto C. Pulsologia: Arte e Cie?ncia do Diagno?stico na Medicina Oriental. 2nd ed. Sa?o Paulo: Ground.1998. Portuguese.
28 Ross J. Combinac?a?o Dos Pontos de Acupuntura: a Chave para o E?xito Cli?nico. Sa?o Paulo: Roca.2003. Portuguese.
29 Maciocia G. Diagno?stico na Medicina Chinesa: Um Guia Geral. Sa?o Paulo: Roca.2006. Portuguese.
30 Ferreira AS, Lopes AJ.Chinese medicine pattern differentiation and its implications for clinical practice.Chin J Integr Med. 2011; 17(11): 818-823.
31 Yang SZ.The pulse classic: a translation of the Mai Jing. Boulder: Blue Poppy Enterprise, Inc. 1997.
32 Flaws B.The Lakeside Master’s study of the pulse: a translation of the Bin Hu Mai Xue Bai Shuo Jie. Boulder: Blue Poppy Enterprises, Inc. 1999.
33 World Health Organization.International standard terminologies on traditional medicine in the Western Pacific Region. Geneva: World Health Organization. 2007.
34 Lu WA.Pulse spectrum analysis in primary hypertension patients.Taipei City Med J. 2006; 3(9): 23-32.
35 Liu SH, Tyan CC.Quantitative analysis of sensor for pressure waveform measurement.Biomed Eng Online. 2010; 9: 6.
36 Huang CM, Chang HC, Kao ST, Li TC, Wei CC, Chen CC, Chen FJ, Tsou SS.Radial pressure pulse and heart rate variability in normotensive and hypertensive subjects.J Altern Complement Med. 2011; 17(10): 945-952.
37 Jeon YJ, Kim JU, Lee HJ, Lee J, Ryu HH, Lee YJ, Kim JY.A clinical study of the pulse wave characteristics as the three pulse diagnosis positions of Chon, Gwan and Cheok.Evid-Based Complement Altern Med. 2011; 2011: 904056.
38 Tang ACY, Chung JWY, Wong TKS.Validation of a novel tradicional Chinese medicine pulse diagnostic model using an artificial neural network.Evid-Based Complement Altern Med. 2012; 2012: 685094.
39 Luo CH, Chung YF, Hu CS, Yeh CC, Si XC, Feng DH, Lee YC, Huang SI, Yeh SM, Liang CH.Possibility of quantifying TCM finger-reading sensations: I. Bi-Sensing Pulse Diagnosis Instrument.Eur J Integr Med. 2012; 4: e255-e262.
40 O’Brien KA, Birch S, Abbas E, Movsessian P, Hook M, Komesaroff PA. Traditional East Asian Medical Pulse Diagnosis: A preliminary physiologic investigation.J Altern Complement Med. 2013; 19(10): 793-798.
41 Yim YK, Lee C, Lee HJ, Park KS.Gender and Measuring-position differences in the radial pulse of healthy individuals.J Acupunct Meridian Stud. 2014; 7(6): 324-330.
42 Ferreira AS, Moura NGR.Asserted and neglected issues linking evidence-based and Chinese medicines for cardiac rehabilitation.World J Cardiol. 2014; 6(5): 295-303.
43 Moura NGR, Ferreira AS. Pulse waveform analysis of Chinese pulse images and its association with disability in hypertension. J Acupunct Meridian Stud.2015; Epub ahead of print.
44 Luiz AB, Cordovil I, Barbosa Filho J, Ferreira AS.Zangfu zheng (patterns) are associated with clinical manifestations of zang shang (target-organ damage) in arterial hypertension.Chin Med. 2011; 6: 23.
45 Ferreira AS.Statistical validation of strategies for Zang- Fu single pattern differentiation.J Chin Integr Med. 2008; 6(11): 1109-1116.
46 Ferreira AS.Diagnostic accuracy of pattern differentiation algorithm based on traditional Chinese medicine theory: a stochastic simulation study.Chin Med. 2009; 4: 24.
47 Ferreira AS, Santos MAR, Barbosa Filho J, Cordovil I, Souza MN.Determination of radial artery compliance can increase the diagnostic power of pulse wave velocity measurement.Physiol Measur. 2004; 25(1): 37-50.
48 Ferreira AS, Barbosa Filho J, Cordovil I, Souza MN.Three-section transmission-line arterial model for noninvasive assessment of vascular remodeling in primary hypertension.Biomed Signal Process Control. 2009; 4(1): 2-6.
49 Ferreira AS, Filho JB, Cordovil I, Souza MN.Noninvasive pressure pulse waveform analysis of flow-mediated vasodilatation evoked by post-occlusive reactive hyperemia maneuver.Biomed Signal Process Control. 2012; 7(6): 616-621.
50 World Health Organization Western Pacific Region, International Association for the Study of Obesity, International Obesity Task Force. Redefining obesity and its treatment. Geneva: World Health Organization. 2000.
51 American Diabetes Association.Standards of medical care in diabetes - 2014.Diabetes Care. 2014; 37(Suppl.1): S14-S80.
52 Richardson JTE.Eta squared and partial eta squared as measures of effect size in educational research.Educ Res Rev. 2011; 6(2): 135-147.
53 World Health Organization.Health research methodology: a guide for training in research methods. 2nd ed. Manila, Philippines: World Health Organization Regional Office for the Western Pacific Region. 2001.
54 Cohen J.A coefficient of agreement for nominal scales.Educ Psychol Measurem. 1960; 20(1): 37-46.
55 Xu LS, Wang KQ, Zhang D.Modern researches on traditional Chinese pulse diagnosis.Eur J Oriental Med. 2004; 4(6): 46-54.
56 Sá Ferreira A.Misdiagnosis and undiagnosis due to pattern similarity in Chinese medicine: a stochastic simulation study using pattern differentiation algorithm.Chin Med. 2011; 6: 13.
57 Ferreira AS.Promoting integrative medicine by computerization of traditional Chinese medicine for scientific research and clinical practice: The SuiteTCM project.J Integr Med. 2013; 11(2): 135-139.
58 Feldstein CA.Nocturia in arterial hypertension: a prevalent, underreported, and sometimes underestimated association.J Am Soc Hypertens. 2013; 7(1): 75-84.
59 Letíc M.Feeling wall tension in an interactive demonstration of Laplace’s law.Adv Physiol Educ. 2012; 36(2): 176.
60 Rutherford RB.Vascular surgery. 4th ed. Philadelphia: W.B. Saunders Company. 1995.
61 Silbernagl S, Despopoulos A. Fisiologia: texto e atlas. 5ª edição. Porto Alegre: Artmed.2003. Portuguese.
62 Lantelme P, Mestre C, Lievre M, Gressard A, Milon H.Heart rate: an important confounder of pulse wave velocity assessment.Hypertension. 2002; 39(6): 1083-1087.
63 Ferreira AS.Resonance phenomenon during wrist pulse-taking: a stochastic simulation, model-based study of the ‘pressing with one finger’ technique.Biomed Signal Process Control. 2013; 8(3): 229-236.
64 O’Brien KA, Birch S. A review of the reliability of traditional East Asian medicine diagnosis.J Altern Complement Med. 2009; 15(4): 353-366.
[1] Xue-qing Yu, Shu-guang Yang, Yang Xie, Jian-sheng Li. Traditional Chinese medicine in the treatment of idiopathic pulmonary fibrosis based on syndrome differentiation: Study protocol of exploratory trial. Journal of Integrative Medicine, 2020, 18(2): 163-168.
[2] Pranay Soni, Rajesh Choudhary, Surendra H. Bodakhe. Effects of a novel isoflavonoid from the stem bark of Alstonia scholaris against fructose-induced experimental cataract. Journal of Integrative Medicine, 2019, 17(5): 374-382.
[3] Sonia Chew Wen Phang, Uma Devi Palanisamy, Khalid Abdul Kadir. Effects of geraniin (rambutan rind extract) on blood pressure and metabolic parameters in rats fed high-fat diet. Journal of Integrative Medicine, 2019, 17(2): 100-106.
[4] Nevin Lianwen Zhang, Chen Fu, Teng Fei Liu, Bao-xin Chen, Kin Man Poon, Pei Xian Chen, Yunling Zhang. A data-driven method for syndrome type identification and classification in traditional Chinese medicine. Journal of Integrative Medicine, 2017, 15(2): 110-123.
[5] Qing Ji, Yun-quan Luo, Wen-hai Wang, Xuan Liu, Qi Li, Shi-bing Su. Research advances in traditional Chinese medicine syndromes in cancer patients. Journal of Integrative Medicine, 2016, 14(1): 12-21.
[6] Nouran A. Aleyeidi, Khaled S. Aseri, Shadia M. Matbouli, Albaraa A. Sulaiamani, Sumayyah A. Kobeisy. Effects of wet-cupping on blood pressure in hypertensive patients: A randomized controlled trial. Journal of Integrative Medicine, 2015, 13(6): 391-399.
[7] Kylie Connolly, Douglas Jackson, Candice Pullen, Andrew Fenning. Alpha-adrenoceptor antagonism by Crassostrea gigas oyster extract inhibits noradrenaline-induced vascular contraction in Wistar rats. Journal of Integrative Medicine, 2015, 13(3): 194-200.
[8] Ya Yuwen, Yu-qi Liu, Yan-ping Wang, Jin-gang Dai, Da-sheng Liu, Yue-xi Wang, Xue-jie Han. The add-on effect of a Chinese herbal formula for patients with resistant hypertension: Study protocol for a pilot cohort study. Journal of Integrative Medicine, 2015, 13(2): 122-128.
[9] Vamsi Reddy, Arvind Sridhar, Roberto F. Machado, Jiwang Chen. High sodium causes hypertension: Evidence from clinical trials and animal experiments. Journal of Integrative Medicine, 2015, 13(1): 1-8.
[10] Arthur de Sá Ferreira, Antonio Guilherme Pacheco. SimTCM: A human patient simulator with application to diagnostic accuracy studies of Chinese medicine. Journal of Integrative Medicine, 2015, 13(1): 9-19.
[11] Yong-hong Lian, Mei-xia Fang, Li-guo Chen. Constructing protein-protein interaction network of hypertension with blood stasis syndrome via digital gene expression sequencing and database mining. Journal of Integrative Medicine, 2014, 12(6): 476-482.
[12] Yi Chen, De-yu Fu, Yu Chen, Yan-ming He, Xiao-dong Fu, Yan-qiu Xu, Yi Liu, Xiao-tao Feng, Teng Zhang, Wen-jian Wang. Effects of Chinese herbal medicine Yiqi Huaju Formula on hypertensive patients with metabolic syndrome: A randomized, placebo-controlled trial. Journal of Integrative Medicine, 2013, 11(3): 184-194.
[13] Chan Chen, Chang-xun Chen, Xi-min Wu, Rui Wang, Yi-ming Li. Effects of extracts of Radix Scrophulariae on blood pressure in spontaneously hypertensive rats and the underlying mechanisms. Journal of Chinese Integrative Medicine, 2012, 10(9): 1009-1017.
[14] David Sibbritt, Pamela van der Riet, Saowapa Dedkhard, Kannapatch Srithong. Rehabilitation of stroke patients using traditional Thai massage, herbal treatments and physical therapies. Journal of Chinese Integrative Medicine, 2012, 10(7): 743-750.
[15] Li Zhao-guo. Comparative study on WHO Western Pacific Region and World Federation of Chinese Medicine Societies international standard terminologies on traditional medicine: Triple Energizer Pattern Identification/Syndromes Differentiation. Journal of Chinese Integrative Medicine, 2012, 10(3): 353-356.
Viewed
Full text


Abstract

Cited

  Shared   
  Discussed   
[1] Wei-xiong Liang. Problems-solving strategies in clinical treatment guideline for traditional Chinese medicine and integrative medicine. Journal of Chinese Integrative Medicine, 2008, 6(1): 1-4
[2] Zhao-guo Li. Discussion on English translation of commonly used sentences in traditional Chinese medicine: part one. Journal of Chinese Integrative Medicine, 2008, 6(1): 107-110
[3] Hao Li, Ming-jiang Yao, Wen-ming Zhao, Jie Guan, Lin-lin Cai, Ling Cui. A randomized, controlled, double-blind trial of Huannao Yicong capsule in senile patients with mild cognitive impairment. Journal of Chinese Integrative Medicine, 2008, 6(1): 25-31
[4] Jun Cai, Hua Wang, Sheng Zhou, Bin Wu, Hua-rong Song, Zheng-rong Xuan. Effect of Sijunzi Decoction and enteral nutrition on T-cell subsets and nutritional status in patients with gastric cancer after operation: A randomized controlled trial. Journal of Chinese Integrative Medicine, 2008, 6(1): 37-40
[5] Dong Yang, Yong-ping Du, Qing Shen, Wei Chen, Yan Yu, Guang-lei Chen. Expression of alpha-smooth muscle actin in renal tubulointerstitium in patients with kidney collateral stasis. Journal of Chinese Integrative Medicine, 2008, 6(1): 41-44
[6] SUN Ming-yu, ZUO Jian, DUAN Ji-feng, HAN Jun, FAN Shi-ming, ZHANG Wei, ZHU Li-fang, YAO Ming-hui. Antitumor activities of kushen flavonoids in vivo and in vitro. Journal of Chinese Integrative Medicine, 2008, 6(1): 51-59
[7] Wei Zhang, Xiang-feng Lu, Xiao-mei Zhang, Jian-jun Wu, Liang-duo Jiang. A rat model of pulmonary fibrosis induced by infusing bleomycin quickly through tracheal intubation. Journal of Chinese Integrative Medicine, 2008, 6(1): 60-67
[8] Hai-feng Wei, Bai-liu Ya, Ling Zhao, Cui-fei Ye, Li Zhang, Lin Li. Evaluation of tongue manifestation of blood stasis syndrome and its relationship with blood rheological disorder in a rat model of transient brain ischemia. Journal of Chinese Integrative Medicine, 2008, 6(1): 73-76
[9] Guo-hong Yuan, Xiao-jing Pang, He-chao Ma. Synergic effects of Danggui Buxue Decoction in reducing toxicity of cytoxan in tumor-bearing mice. Journal of Chinese Integrative Medicine, 2008, 6(1): 83-88
[10] Li Zhou, Hong-xing Zhang, Ling-guang Liu, Wen-jun Wan. Effect of electro-acupuncture at Fenglong (GV 16) on nitric oxide and endothelin in rats with hyperlipidemia. Journal of Chinese Integrative Medicine, 2008, 6(1): 89-92