Pulse Waveform Analysis as A Bridge between Pulse Examination in Chinese Medicine and Cardiology

Pulse examination was probably the earliest attempt to distinguish between health and illnesses. Starting at the pre-Hippocratic era, Chinese medicine practitioners developed techniques for pulse examination and defined pulse images based on their perceptions of pulse waveforms at the radial artery. Pulse images were described using basic variables （frequency, rhythm, wideness, length, deepness, and qualities） developed under philosophical trends such as Taoism and Confucianism. Recent advances in biomedical instrumentation applied to cardiology opened possibilities to research on pulse examination based on ancient Chinese medical theories： the pulse wave analysis. Although strongly influenced by philosophy, some characteristics used to describe a pulse image are interpretable as parameters obtained by pulse waveform analysis such as pulse wave velocity and augmentation index. Those clinical parameters reflect concepts unique to Chinese medicine - such as yin- yang - while are based on wave reflection and resonance theories of fluids mechanics. Major limitations for integration of Chinese and Western pulse examination are related to quantitative description of pulse images and pattern differentiation based on pulse examination. Recent evidence suggests that wave reflection and resonance phenomena may bridge Chinese medicine and cardiologyto provide a more evidence-based medical practice.

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

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） mm Hg, diastolic blood pressure（93± 17） mm Hg） 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（l=0.648, F_（5,29）=3.149, P=0.022, h^2 =0.352）, strength（l=0.608, F_（5,29） =3.736, P=0.010, h^2 =0.392）, and speed（l=0.535, F_（5,29） =5.302, P=0.002, h^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 mm Hg and systolic blood pressure ≥ 149.5 mm Hg, 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 La Place＇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.