Developing an objective traditional Chinese medicine pulse diagnostic model in essential hypertension

Pao Yue-kong Library Electronic Theses Database

Developing an objective traditional Chinese medicine pulse diagnostic model in essential hypertension

 

Author: Tang, Chui-yan
Title: Developing an objective traditional Chinese medicine pulse diagnostic model in essential hypertension
Degree: Ph.D.
Year: 2010
Subject: Hong Kong Polytechnic University -- Dissertations
Pulse -- Measurement
Hypertension -- Diagnosis
Department: School of Nursing
Pages: viii, 247 leaves : ill. ; 30 cm.
InnoPac Record: http://library.polyu.edu.hk/record=b2343011
URI: http://theses.lib.polyu.edu.hk/handle/200/5341
Abstract: Background: Traditional Chinese medicine (TCM) pulse diagnosis is used to assess the health status of patients in TCM consultation. However, the low inter-rater reliability of pulse diagnosis among TCM doctors does not fit well with evidence-based practice. Developing an objective and reliable standard for TCM pulse diagnosis has thus become a pressing issue. Aim: The aim of this doctoral work was to develop an objective and reliable standard for TCM pulse diagnosis in hypertensive patients. Method: A correlational study design was used and a dice model was formulated to integrate the concepts of pulse in TCM and modern medicine. The independent variable was the arterial pulse, and the dependent variable was essential hypertension. Normotensive and hypertensive subjects were recruited. A TCM doctor rated the eight elements (depth, rate, regularity, width, length, smoothness, stiffness, and strength) at the six locations (left and right cun, guan, and chi) on a visual analogue scale. A validated pulse acquisition device was used to acquire the arterial pressure waveforms at the six locations. Sixteen physical parameters (amppeak, h3/h1, h4/h1, h5/h1, h1/t1, W/t, t, t1/t, t4/t, t5/t, AT, AS, AD, pamax, 80%pamax, and SD-PPI) were generated from the waveforms. Univariate analysis, regression analysis, and an artificial neural network (ANN) were used to analyze the data. A p-value of less than 0.05 denoted statistical significance. Results: Group and location had a significant effect on both the eight elements and the physical parameters. Depth, width, length, smoothness, stiffness, and strength differed significantly among the six locations (p < 0.05). The hypertensive subjects had irregular, larger, longer, rougher, and stiffer pulse, and their pulse at left chi was more floating. For the physical parameters, only t1/t, h5/h1, and pamax differed significantly across the six locations (p < 0.01). AT, AS, AD, amppeak, and h1/t1 at left and right guan and 80%pamax at left and right cun were significantly larger in the hypertensive group (p < 0.01). The nonlinear relationship among the eight elements and the physical parameters at the six locations was identified using an ANN. The r-squared of the models ranged from 0.60 to 0.80. The accuracy of the differentiation models for hypertension was around 80%. Discussion: The significant differences in the eight elements and the physical parameters among locations and between groups give new insight into the role of organs other than the heart in hypertension. The nonlinear relationship among the eight elements and the physical parameters at the six locations indicates that this is a fruitful direction for future study. For the differentiation model of hypertension, the results substantiate the recent postulation in TCM on hypertension. It may help to simplify the complicated process of syndrome differentiation in hypertension. Conclusion: This thesis reports the first study to demonstrate the nonlinear relationship of the eight elements and the physical parameters at the six locations, and the first to differentiate hypertension using the eight elements at the six locations. With further verification, the findings could pave the way for the development of an objective, reliable, and TCM-specific pulse diagnosis standard.

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