2010 3rd International Conference on Biomedical Engineering and Informatics (BMEI 2010)
Radial Pulse Analysis at Deep Pressure in
Abnormal Health Conditions
Bhaskar Thakker and Anoop Lal Vyas
Instrument Design Development Centre
Indian Institute of Technology Delhi
New Delhi, India
Abstract— Radial pulse analysis is popular as complementary
approach for health diagnosis in India and China. Three pulse
pressure signals on the two hands carry rich information about
health status. Pressure applied while observing the pulse signal
plays an important role in the analysis of the body conditions
based on dynamic nature of the pulse signal. Deep pressure is the
pressure applied on pulse point prior to complete obstruction of
radial artery. Pulse morphologies for deep pressure in abnormal
health conditions are studied for the group of subjects suffering
from chronic gastritis, arthritis and prostate enlargement. Two
abnormal pulse patterns have been identified relating to the
characteristics of dicrotic notch at deep pressure and the
dynamics of pulse segment in the late diastole phase of the pulse.
These new abnormal pulse patterns are identified with their
correlation to abnormal status. Time domain quantification
parameters namely Dicrotic Notch Suppression Ratio (DNSR)
and BAD Notch Ratio are defined to identify their presence.
Keywords- Ayurveda; BAD notch; Deep pulse pressure signal;
Dicrotic Notch Suppression Ratio; Traditional Chinese Medicine
I. INTRODUCTION
Radial pulse pressure signal has been found to be utilized in
ancient Indian Ayurveda [1, 2] and Traditional Chinese
Medicine (TCM) [3, 4] for health diagnosis. Both the
approaches give prime importance to three distinct pulse points
over radial artery of the two hands for the assessment of health
status. This complementary approach is defined based on the
pressure wave reflection phenomena in human arteries which
terminate into several organs. An average pulse pressure signal
is established in the arterial structure due to forward wave
generated by pumping action of heart and a reflected wave
generated due to reflections from peripheral organs. Each organ
in human body is having certain mass and blood flow
requirements. The blood perfusion for kidney, liver and heart
are 1.2 l/min, 1.4 l/min and 0.25 l/min respectively against their
mass as 0.3 kg, 1.5 kg and 0.3 kg respectively [5]. Changes in
the physiological state of an organ in abnormal health
conditions alter the relative blood flow in each of the organs
[6]. This ultimately alters the peripheral reflections in the
arterial structure. Hence, in abnormal health conditions the
average pulse signal established in the arterial structure
contains significant information about health status. As per
TCM the static pressure, either low or deep, applied on three
978-1-4244-6498-2/10/$26.00 ©2010 IEEE
D M Tripathi
Ayurvedic Dispensary
New Delhi Medical Council (NDMC)
New Delhi, India
radial pulse points indicate the health status of the organs as
listed in Table I. Careful investigation dictates that hollow
organs are located on the superficial level and semi-solid
organs are located at deep level.
TABLE I. ORGAN PULSES ACCORDING TO TCM
Left Hand Right Hand
LV LP LK RV RP RK
Small Gall
Bladder Colon Stomach
Triple
Intestine Bladder Energizer
Heart Liver Kidney Lungs Spleen Pericardium
Young et al. have analyzed the pulse signal according to the
contact pressure giving maximum pulse strength to identify
whether the pulse is floating or sinking one [7]. The importance
of pulse strengths at deep pressure in identifying the deep pulse
has been mentioned by researchers [8], but variations in the
pulse morphology at several stages of applied pressure on pulse
point have not been yet investigated. Deep pressure is
identified as the pressure applied on pulse point prior to
complete obstruction of the radial artery.
According to Ancient Indian Medicine formally known as
‘Ayurveda’, three basic elements namely ‘Vata’ (a gaseous
element), ‘Pitta’ (liquid and acidic in nature) and ‘Kapha’ (an
element composed of watery and earth elements) govern the
health status of an individual. The balanced state of these three
elements maintains healthy status, while their imbalance
degenerate the body resulting in abnormal health conditions.
Certain abnormalities are related to specific element and the
status of each of these elements can be examined from three
pulse points. The distal pulse point at the root of the thumb
according to Ayurveda gives the status of ‘Vata’ element in the
body.
As per Table I, the proximal pulse point gives information
about Urinary Tract Infection (UTI) related problems like
kidney dysfunctioning and prostate enlargement. The distal
‘Vata’ pulse point is related to the identification of
abnormalities like Gastritis and Arthritis. The pulse
morphologies are studied for these two groups of abnormal
subjects at deep pressure. A unique pulse pattern at deep
pressure in terms of ‘V’ shaped notch and dicrotic notch
suppression have been observed for the abnormal subjects.
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 II. PULSE SIGNAL ACQUISITION

A. Radial Pulse Acquisition and pre processing

A pressure sensor capable of measuring 350 mm Hg of
pressure is used for acquiring radial pulse signals. The pulse
signal is amplified and filtered to obtain a clean pressure signal.
The signal is then sampled at 500 Hz with the help of USB-
6009 Data Acquisition system from National Instruments.
Since the radial pulse contains most of the signal in the lower
frequency band, the signal is filtered with the help of a low
pass filter having cut off frequency of 40Hz. The signal also
contains baseline fluctuations due to motion artifacts and
respirations of the person. This baseline is removed by
subtracting eighth level approximation of the pulse signal using
Daubichies wavelet transform ‘DB8’.
B. Variations in Pulse Characteristics with respect to Static
Pressure
The pressure sensor is placed over the pulse point by
identifying the highest pulsation. The pulse signal is acquired
with pressure varying from light to deep contact pressure until
the artery is fully obstructed. On light pressure the signal shows
weak strength as well as dicrotic notch is visible below the
onset of the pulse. When the static pressure is increased on
pulse point, peak to peak amplitude of signal increases along Fig. 1 (a) Radial pulse signal acquired for increasing static pressure. Pulse
with the elevation of dicrotic notch. Further increase of the signal at light (b), moderate (c) and deep (d) static pressure
static pressure reduces the peak to peak pulse amplitude. When
the artery is completely obstructed the pulse signal amplitude A. Deep pulse for Urinary Tract Infection related problems
becomes zero. Fig. 1 (a) shows a pulse pressure signal acquired
from light static pressure to deep static pressure for a normal Traditional Chinese Medicine suggests the use of proximal
subject. The ancient literatures use qualitative terminology as pulse point namely ‘Chi’ for the assessment of Urinary Tract
light and deep pressure for analyzing the pulse characteristics. related problems involving bladder and kidney dysfunctioning.
The pulse at deep pressure is the one prior to the complete From the prepared pulse data base eight patients suffering from
obstruction of the artery. Based on the peak to peak pulse Prostate Enlargement have shown a unique pulse feature at
strength at various stages in Fig. 1(a), three stages of pulse deep pressure. The dicrotic notch is having a tendency of
acquisition is defined qualitatively as dynamic pulse at light, elevating upwards against applied static pressure in normal
moderate and deep static pressure as shown in Fig. 1(b), (c) and subjects. But in abnormal subjects of this subgroup as one of
(d). the abnormal pulse parameters the dicrotic notch is found to be
suppressed in increasing static pressure conditions as shown in
All the pulse signals for normal as well as abnormal Fig. 2, where notch remains below the onset of the pulse
subjects are recorded with this methodology. The abnormal segment.
group contains subjects suffering from various disorders like
Gastritis, Arthritis, Hypertension, Ulcerative colitis, Liver
enlargement, Liver Cirrhosis, Prostatitis and Kidney
dysfunctioning. The morphological variations in these pulses at
three stages for all the subjects have been studied.
III. ANALYSIS OF DEEP PULSE IN ABNORMAL HEALTH
CONDITIONS
The abnormal subjects are categorized in two subgroups
based on their abnormality. First group pertains to the subjects
suffering from UTI related problems, while second group has
subjects suffering from chronic gastritis and arthritis related Fig. 2 (a) Abnormal pulse recording for Prostate Enlargement
problems. The pulse signal at deep pressure is studied for all
the subjects of these two groups.

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Fig. 2(b) Pulse recording of Fig. 2 (a) for Moderate pressure
Fig. 2(c) Pulse recording of Fig. 2 (a) for Deep pressure
An interesting observation is made that out of eight
subjects, six subjects show elevation of dicrotic notch for distal
and middle pulse points of the left hand. Hence the proximal
‘Chi’ pulse point carries an abnormal pulse character in the
form of Dicrotic notch suppression with increasing static
pressure. To quantify such abnormal pulse pattern a
quantifying parameter namely Dicrotic Notch Suppression
Ratio (DNSR) is defined as follows.
practitioner following the Ayurveda methodology. The
examination of the practitioner and the symptoms of the
disorder are in agreement in almost all the cases. The deep
pulse of these patients shows a unique pulse character at the
end of diastole phase of the pulse as shown in Fig. 3. The pulse
shows elevation of dicrotic notch with increasing static
pressure. But prior to the onset of the next pulse segment,
diastole phase of current pulse segment is getting elevated,
giving rise to ‘V’ shaped notch. This notch is termed as ‘BAD’
notch (Bhaskar, Anoop, Diwakar) who first observed this
notch. Only the ‘Vata’ pulse point for all the subjects of these
two groups show the ‘BAD’ notch presence at deep pressure on
either left or right hand. The reasons behind the formation of
such notch are yet to be ascertained. The diastole phase of the
pulse contains the reflections of pressure wave from peripheral
organs. This tailing end of the pulse segment is still too
complex to understand and rich in information about the health
status.
To quantify this ‘BAD’ notch, first derivative of the pulse
series is calculated. Fig. 4(a) and (b) indicates the pulse series
at deep pressure and its first derivative respectively. The
highest value for each pulse segment in the first derivative
shows the maximum slope attained during forward rise of the
pulse. Pulse segment containing the ‘BAD’ notch shows a
negative slope prior to this maximum positive slope. The ratio
of minimum negative slope and maximum positive slope can
help in identifying the presence of ‘BAD’ notch.
Minimum Negative Slope
BAD Notch Ratio = (2)
Maximum Positive Slope

Dicrotic Notch Depth from peak of pulse

DNSR =
Peak of the pulse
Pulse Peak-Dicrotic Notch Height
= (1)
Peak of the pulse
Dicrotic notch height as well as pulse peak are measured
from the onset of the pulse segment. When the dicrotic notch is
suppressed, its height remains below the onset of the pulse; Fig. 3 (a) Radial pulse from moderate to deep static pressure
hence the dicrotic notch depth will come out to be greater than
the peak of pulse. For suppressed notch, this ratio turns out to
be more than 100%. For healthy subjects, DNSR ratio remains
always less than 100% due to elevation of dicrotic notch
beyond onset of the pulse segment.
B. Deep pulse for ‘Vata’ element related problems
Ancient Indian Medicine believes that a gaseous element is
flowing along with the blood throughout the body. Certain
disorders in human body are generated due to predominance or
vitiation of this element. Gastritis and Arthritis are the two
disorders for which ‘Vata’ element plays an important role.
This element can be examined with the help of distal pulse
point of the two hands. The second abnormal subgroup Fig. 3 (b) Radial Pulse at deep pressure showing ‘BAD’ notch
contains total 35 subjects suffering from Chronic Gastritis and
Arthritis. The pulse of these subjects was examined by a

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Fig. 4 (a) Abnormal pulse recording for Gastritis subject
Fig. 4 (b) First derivative of the pulse series in Fig. 4(a)
Table II shows the mean and standard deviation along with
maximum and minimum value of BAD Notch Ratio in the
pulse recording at deep pressure for 18 normal and 35
abnormal subjects suffering from Gastritis and Arthritis.
TABLE II. STATISTICAL PARAMETERS FOR % BAD NOTCH RATIO
Standard
Group Mean Maximum
Deviation
Normal 23.94 6.88 35.67
Abnormal 66.70 26.89 149.05
IV. DISCUSSION AND CONCLUSION
The pressure applied on the pulse point plays a key role in
the assessment of health conditions according to this
complementary approach. The pulse pressure signal shows
significant differences in their morphologies at three stages of
pressure defined qualitatively as light, moderate and deep
pressure. These differences are visible among different pulse
points in severe abnormal health conditions. Investigation of
deep pulse pressure signal for proximal and distal pulse points
show two distinct abnormal pulse patterns. These pulse patterns
show suppressed dicrotic notch and formation of ‘BAD’ notch
as an abnormal pulse pattern. According to TCM proximal
pulse point and according to Ayurveda distal pulse point shows
strong correlation in terms of their importance for UTI related
problems and ‘Vata’ element related problems respectively.
The parameters quantified as DNSR and BAD notch ratio
help in identifying the presence of abnormal pulse pattern at
deep pressure. For healthy subjects the elevation of dicrotic
notch gives rise to moderate, taut, unsmooth or wiry kind of
pulse patterns. Here the DNSR ratio shows less than 100%
value due to elevation of dicrotic notch. On the other hand in
case of UTI related problems, for the pulse segments showing
suppressed dicrotic notch, the DNSR ratio remains to be more
than 100%. Another abnormal pulse pattern showing ‘BAD’
notch is quantified with the help of % BAD Notch ratio. For
normal and abnormal group containing 18 and 35 subjects
respectively, mean and standard deviations are achieved as
23.94 6.88 and 66.70 26.89 respectively.
These two abnormal pulse parameters are observed by the
author first time at deep pressure which relate to the abnormal
health status of human body. As far as dicrotic notch
suppression is concerned, this abnormal pulse pattern is
observed for other pulse points as well in different abnormal
health status. The BAD notch has not been found in the
abnormal database for the patients other than Chronic Gastritis
and Arthritis. The level static pressure at which BAD notch
starts appearing in pulse recording may help in identifying the
severity of the disorder. As far as identification of disorder is
concerned, presence of BAD notch prior to complete
obstruction of ‘Vata’ pulse point gives information about
Gastritis or Arthritis related problems.
ACKNOWLEDGMENT
This research is partially supported by a collaborative project
under UK India Education Research Initiative (UKIERI)
program. We are thankful to New Delhi Municipal Council
(NDMC), India for providing facilities to acquire radial pulse
signals. Their kind support in this research work is sincerely
acknowledged.
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