Jaeuk U. Kim

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 Duncans 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.

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.

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.

Constitution-specific features of perspiration and skin visco-elasticity in SCM

BackgroundHuman skin properties have been used as an important diagnostic component in traditional medicine as they change with health conditions. Sasang constitutional medicine (SCM) puts emphasis on the recognition of the constitution-specific skin features prior to the diagnostic decision of health. In this work, in search of skin-characteristics effectively reflecting SCM features, we compared several skin properties such as perspiration, visco-elasticity, elasticity, and elasticity hysteresis, in several candidate body parts.MethodsWe conducted a clinical study in which a total of 111 healthy females aged 50 – 70 years participated with their Sasang constitution (SC) types determined objectively by the Sasang constitutional analytic tool. Perspiration on the skin surface was estimated by using a capacitance sensor to measure the amount of moisture on the palm, forehead, and philtrum before and after a heating stimulus. We acquired the visco-elasticity, elasticity, and elasticity hysteresis at the forearm by Dermalab’s elasticity sensing device. An analysis of covariance (ANCOVA) was conducted to evaluate the effect of SC on the nine skin features acquired.ResultsThe visco-elasticity of the forearm of the Soeum-in (SE) group was significantly lower than that of the Taeeum-in (TE) group (F = 68.867, p < 0.001), whereas the elasticity hysteresis of the SE group was higher than that of the TE group (F = 10.364, p < 0.01). The TE group had more perspiration on the forehead than the SE group (F = 9.050, p < 0.01). The SE group had a large perspiration difference between the philtrum and the forehead compared with the TE group (F = 7.892, p < 0.01).ConclusionsWe found four significant skin features that reflect the inherent constitutional attributes of the TE and SE groups in accordance with SCM literature; the visco-elasticity, elasticity hysteresis, perspiration on the forehead and philtrum. Our findings are based on a novel interpretation of the SCM literature and will contribute to developing the constitutional health status evaluation system in SCM.

Short-Term Effect of Laser Acupuncture on Lower Back Pain: A Randomized, Placebo-Controlled, Double-Blind Trial

Purpose. This trial was performed to investigate the efficacy of laser acupuncture for the alleviation of lower back pain. Methods. This was a randomized, placebo-controlled, double-blind trial. Fifty-six participants were randomly assigned to either the laser acupuncture group (n = 28) or the sham laser acupuncture group (n = 28). Participants in both groups received three treatment sessions over the course of one week. Thirteen acupuncture points were selected. The visual analogue scale for pain, pressure pain threshold, Patient Global Impression of Change, and Euro-Quality-of-Life Five Dimensions questionnaire (Korean version) were used to evaluate the effect of laser acupuncture treatment on lower back pain. Results. There were no significant differences in any outcome between the two groups, although the participants in both groups showed a significant improvement in each assessed parameter relative to the baseline values. Conclusion. Although there was no significant difference in outcomes between the two groups, the results suggest that laser acupuncture can provide effective pain alleviation and can be considered an option for relief from lower back pain. Further studies using long-term intervention, a larger sample size, and rigorous methodology are required to clarify the effect of laser acupuncture on lower back pain.

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.”

Glucose-independent segmental phase angles from multi-frequency bioimpedance analysis to discriminate diabetes mellitus

We investigated segmental phase angles (PAs) in the four limbs using a multi-frequency bioimpedance analysis (MF-BIA) technique for noninvasively diagnosing diabetes mellitus. We conducted a meal tolerance test (MTT) for 45 diabetic and 45 control subjects stratified by age, sex and body mass index (BMI). HbA1c and the waist-to-hip-circumference ratio (WHR) were measured before meal intake, and we measured the glucose levels and MF-BIA PAs 5 times for 2 hours after meal intake. We employed a t-test to examine the statistical significance and the area under the curve (AUC) of the receiver operating characteristics (ROC) to test the classification accuracy using segmental PAs at 5, 50, and 250 kHz. Segmental PAs were independent of the HbA1c or glucose levels, or their changes caused by the MTT. However, the segmental PAs were good indicators for noninvasively screening diabetes In particular, leg PAs in females and arm PAs in males showed best classification accuracy (AUC = 0.827 for males, AUC = 0.845 for females). Lastly, we introduced the PA at maximum reactance (PAmax), which is independent of measurement frequencies and can be obtained from any MF-BIA device using a Cole-Cole model, thus showing potential as a useful biomarker for diabetes.

A feasibility study on age-related factors of wrist pulse using principal component analysis

Various analysis methods for examining wrist pulse characteristics are needed for accurate pulse diagnosis. In this feasibility study, principal component analysis (PCA) was performed to observe age-related factors of wrist pulse from various analysis parameters. Forty subjects in the age group of 20s and 40s were participated, and their wrist pulse signal and respiration signal were acquired with the pulse tonometric device. After pre-processing of the signals, twenty analysis parameters which have been regarded as values reflecting pulse characteristics were calculated and PCA was performed. As a results, we could reduce complex parameters to lower dimension and age-related factors of wrist pulse were observed by combining-new analysis parameter derived from PCA. These results demonstrate that PCA can be useful tool for analyzing wrist pulse signal.Various analysis methods for examining wrist pulse characteristics are needed for accurate pulse diagnosis. In this feasibility study, principal component analysis (PCA) was performed to observe age-related factors of wrist pulse from various analysis parameters. Forty subjects in the age group of 20s and 40s were participated, and their wrist pulse signal and respiration signal were acquired with the pulse tonometric device. After pre-processing of the signals, twenty analysis parameters which have been regarded as values reflecting pulse characteristics were calculated and PCA was performed. As a results, we could reduce complex parameters to lower dimension and age-related factors of wrist pulse were observed by combining-new analysis parameter derived from PCA. These results demonstrate that PCA can be useful tool for analyzing wrist pulse signal.

Development and Evaluation of Repeatability of the Integrated Constitutional Diagnosis System

Abstract Development and Evaluation of Repeatability of the Integrated Constitutional Diagnosis System Young-Ju Jeon, Jang-Woong Kim, Jae-Uk Kim, Jang-Han Bae, Jong-Yeol Kim, and Keun-Ho KimKorean Institute of Oriental MedicineObjectivesIn this study, we developed a mock-up of the system for Sasang Constitutional (SC) diagnosis. This system consistsof 5 devices which are the face analyzer, the voice analyzer, the skin analyzer, the pulse analyzer, and the computer-basedquestionnaire. Our goal is to evaluate the repeatability of the system.MethodsEach device is capable of classifying SC types. The classification probability of the integrated system for the SC types was obtained by summing the probability from each device. For evaluating the repeatability of the system,we collected data for 5 subjects, and repeated the measurement three times for each individual. The average and standard deviation were used for calculating the Coefficient of Variation.ResultsThe results showed that the repeatability of the classification probability of the integrated system is about 8%, which implies the system is repeatable. ConclusionsTo increase usability of this system, it is desirable for the system to offer information on health condition of the user. The integrated constitutional diagnosis system will be upgraded to complement the convenience and to develop the diagnostic algorithm for the user’s health condition.Key Words: Sasang Constitutional Medicine, Integrated Constitutional Diagnosis System, Diagnosis Instrument

Radial pulse and electrocardiography modulation by mild thermal stresses applied to feet: An exploratory study with randomized, crossover design

Objective To investigate the changes in radial pulse induced by thermal stresses (TSs). Methods Sixty subjects were enrolled. Using an open-label, 2×2 crossover randomization design, both feet of each subject were immersed in 15 °C water for cold stress (CS) and in 40 °C water for heat stress (HS) for 5 min each. Radial pulse, respiration and electrocardiogram (ECG) signals were recorded before, during and immediately after the TSs. Results The analysis of heart rate variability revealed that CS increased the low-frequency (LF) and high-frequency (HF) components ( P <0.05) and that HS reduced the LF and HF components ( P <0.01). Both TSs reduced the normalized LF, increased the normalized HF, and reduced the LF/HF ratio. The differences in the ECG signals were more dominant during the TS sessions, but those in the radial pulse signals became more dominant immediately after the TS sessions. CS decreased the pulse depth ( P <0.01) and increased the radial augmentation index ( P <0.1), and HS increased the pulse pressure ( P <0.1) and subendocardial viability ratio ( P <0.01). There were no significant differences in pulse rate during the three time sequences of each TS. The respiration rate was increased ( P <0.1), and the pulse rate per respiration (P/R ratio) was significantly decreased ( P <0.05) with CS. The HF region (10–30 Hz) of the pulse spectral density was suppressed during both TSs. Conclusions CS induced vasoconstriction and sympathetic reactions, and HS induced vasodilation and parasympathetic reactions. Based on definitions used in pulse diagnosis, we made the novel discoveries that the pulse became slower (decreased P/R ratio), more floating and tenser under CS and that the HF region of the spectral power decreased significantly under both TSs.