2013 IEEE Point-of-Care Healthcare Technologies (PHT)

Bangalore, India, 16 - 18 January, 2013

Investigations into TIM perspective of Radial Pulse Analysis

Prasad Joshi1, Rohin Daruwala2

Abstract - Radial Pulse Analysis, a non-invasive diagnostic waveform as recorded at the base of aorta changes
tool, is often used by practicing physicians trained in the system significantly with that of the pressure pulse waveform as
of Traditional Indian Medicine (TIM) - Ayurveda. We explore measured at the radial pulse position. Changes in contour
a unique method of sensing the radial pulse using capacitive shape as well as intensity of the pressure pulse waveform are
sensors. Signals thus obtained compare well with those caused due to decreasing arterial/capillary diameters,
expected. Pulse signal have been analyzed for situations decreasing pressure and are also contributed by the total
ranging from apparently trivial in nature to those aimed at distensibility of the arterial tree[18][10].
exploring and estimating blood sugar levels. Further studies
can help establish pointers which address the strict ‘do’s & A. Pulse Sensing Mechanism and Instrumentation
don’t’ rules laid out by TIM practitioners. Conventional means of measuring the radial pressure pulse
wave as reported in [7] [2] [3] [4] [8] use ultra-low pressure
Keywords: radial pulse analysis, pulse rate variability (PRV), sensors, piezo-electric sensors or optical sensors for
Traditional Indian Medicine (TIM).
obtaining radial-pulse pressure variations. Use of
I. INTRODUCTION impedance plethysemography has also been reported [15]
[16]. In the present study we report the use of capacitive
An important tool for patient diagnosis in the system of
sensors for sensing radial pulse perturbations as accurately
Traditional Indian Medicine (TIM) is examining the radial
pulse [1] [17]. The process involves the physician feeling as felt, to the human sense-perception.
the patient’s radial pulse using his three fingers viz. the
index, middle and the ring. Conventionally the physician
also makes pressure variations in the placed fingers to
evaluate the extent of Vata, Pitta and Kapha dosha in the
patient. Although the procedure is subjective and highly
skill based, quite a few practicing physicians make a
reasonably accurate diagnosis, verified and corroborated by
pathological test[1][10].
Radial pulse analysis as a diagnostic tool is not just used
in TIM but has also been reported and explored extensively
in Traditional Chinese Medicine (TCM)[2][3][4][5]. It is
thus noteworthy that radial pulse can be, and needs to be
evaluated and analyzed objectively to establish the co-
relationship between, the nature of pulse and the cause of
ailment, as is performed by a TIM physician using tactile Fig (1): Pulse Sensing Apparatus.
perception.
Fig (1) shows the instrumentation set-up of the pulse sensing
The present paper is divided into the following parts § (2) apparatus. It uses an electret capacitive pick-up (typical
Pulse sensing mechanism and apparatus, § (3) Pulse analysis CMA-4544PF-W available from DigiKey part no 102-1721-
method § (4) Results and conclusions of experiments. ND), having a near flat frequency response up-to 20KHz.
II. PRESSURE PULSE MECHANISMS Signal obtained from the sensor are digitized using a 14-bit
DAQ from National Instruments (NI), USB-6009. A guide
The radial pulse signal is a pressure pulse signal as LED blinks at pulse-rate when the sensor is placed
measured at the root of the aorta, characterized by a rising
accurately thus helping and guiding the sensor placement at
pressure wave having a dome like top terminated by a notch
the desired point on the radial artery. Sample waveform as
called as the incisura, and followed by a decreasing pressure
waveform-trough, corresponding to the systole[18][10]. As sensed by the sensor and reproduced using signal-
explained in [18] and [10] the contour of the pressure pulse processing-tool, with the peaks highlighted in a zoomed-out
region is as shown in fig (2).
1 is Research Scholar, Department of Electrical Engineering, Veermata
Jijabai Technological Institute, Mumbai India, and working at D. J Sanghvi
COE, Mumbai, India. e-mail: psjoshi@djscoe.org.
2 is Professor, Department of Electrical Engineering, Veermata Jijabai
Technological Institute, Mumbai, India.

978-1-4673-2767-1/13/$31.00 ©2013 IEEE 80


Fig (2): Sample sensed signal, along-with signal peaks
identified and highlighted.
III. PULSE ANALYSIS METHODS
ECG signal analysis by using the R-R time interval series has
become a known and established methodology [11] [12].
Heart Rate Variability (HRV) or variations in the heart rate
provide a means of observing or having a glimpse into the
activity of the autonomic nervous system of our body.
Autonomic nervous system encompasses the interplay
between the sympathetic and parasympathetic nervous
system. As reported, HRV time series not only contains and
conveys information about existing physiological disease but
may also provide an indication of an impending disease. We
explore the use of pulse-rate-variability (PRV) on lines
similar to those used in [9]. Using the above mentioned pulse
sensing apparatus we have obtained pulse waveforms from
various subjects at position point proximal to the thumb,
along the radial artery, of the right hand. On lines similar to
[11], which has recommended measures for HRV, we obtain
– time, frequency and non-linear domain measures for PRV
[14].
A. Time Domain Methods
From the obtained pulse peak-to-peak (PP) time series,
we compute simple statistical measures like, pulse peak-to-
peak interval mean(MEAN PP), Standard deviation of PP
interval (STD PP) and root mean square of the differences
between successive PP intervals(RMSSD), apart from
computing the mean pulse rate (MEAN PR)and the standard
deviation of the same(STD PR).
B. Frequency Domain Methods
In order to calculate frequency domain measures we first
interpolate the unevenly sampled PP-interval time series by
using cubic spline interpolation for obtaining the PSD
estimate. We consider the use of AR model, with model
order – 16, for obtaining the PSD estimate and further
compute frequency domain measures [12]. Total absolute
power as well as relative power contents are obtained in
three main frequency bands viz. very low frequency (VLF)
(0-0.04Hz), low frequency (LF) (0.04-0.15Hz) and high
frequency (HF) (0.15-0.4Hz] as per recommendations of
[11].
C. Non-Linear Methods
TIM perspective as discussed and elaborated in [1]
reports the possibility of various types of pulses including
organ pulses, which help in establishing and ascertaining the
well-being of an individual. Considering the physiological
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processes responsible for pulse generation and the complex
interplay of various other inter-dependent physiological
processes, it is reasonable to expect the involvement of non-
linear dynamics in the formation of pulse. Non-linear
properties of PRV are explored using measures like Poincare
Plot, Recurrence Plot (RP) and Detrended Fluctuations
Analysis (DFA). Poincare Plot is a graphical representation
of successive PP-interval. Conventionally an ellipse is fitted
in the plotted points and two measures SD2 and SD1 are
defined along the principal axis and line perpendicular to the
principal axis [11] [14]. SD1 helps us obtain an estimate of
short term variability and SD2 long.
IV. RESULTS
The motivation towards some of our experiments is to
objectively evaluate and test certain strictures and dictates
prescribed and followed by TIM physicians in the process of
pulse examination. The attempt of the exercise is to
examine the change in the nature of the pulse, as regards its
variability, in conditions and situations when such strictures
are not adhered to. In every experiment unless specified, the
subjects have been ensured to be healthy, without any
history of diseases, and belonged to the age group of 18-30,
containing a mix of males and females. Following pulse
sensing, the signal is sampled at 500Hz and digitized using
NI’s USB-6009. Signal peaks are detected and analysis
performed using PRV technique [14].
A. Physical Stress and Exercise
A sample of seven subjects were subjected to rigorous
exercises. Pulse taking and blood pressure measurements
were performed prior-to and post the exercise session. The
post-exercise increased heart rate and blood pressure are
reflected in the time and frequency domain measures of PRV
analysis. Fig (3) depicts the change in LF/HF ratio before
and after exercises for a representative subject.
Fig (3) Typical PSD estimates of a subject - Sub1, before
and after exercise.
As is reflected from Table(1), the circulatory system
changes caused due to increased physical activity, which
have an apparent reflection in the increased blood-pressure
levels, are also reflected in the respiratory system changes,
displayed by the increase in pulse rate and decreased
deviation. Table (2) below displays the Pearson’s
correlation-coefficient for SD1, SD2 and LF/HF ratio, before
and after exercises. SD1 and SD2 display a low level of co-
relationship, however reasonable level of co-relationship is
observed for LF/HF ratio.
B. Valsalva Maneuvers
The Valsalva technique involves doing a forced expiration
of air with the mouth and nostrils closed.
Table 1: Time domain measures before and after exercise. MEAN and STD of PP duration and pulse rate(PR), root-
mean-square of successive differences(RMSSD). Blood Pressure obtained using, Dr Morepen’s® BP-One, Fully
Automatic Blood Pressure Monitor, Model No. BP 3BG1, based on oscillometric technique of BP measurement
(consolidated results displaying mean±standard deviation).
VARIABLE MEAN PP STD PP MEAN PR STD PR RMSSD BP (Sys.) BP (Dia.)
UNITS (ms) (ms) (1/min) (1/min) (ms) mm Hg mm Hg
Before 738.2±59.5 54.4±19.1 82±7 6±2 42.5±16.6 121±16 69±12
After 523.4±54 19.3±6.5 115±11 4±2 15.4±5.6 142±23 78±7

Table 2: Correlation between SD1, SD2 and LF/HF before and after exercises.
Sub1 Sub2 Sub3 Sub4 Sub5 Sub6 Sub7
SD1 Before 42.7 20.4 33.1 29.7 14 46.7 24.6
SD1 After 12.2 10.5 10.6 19 7 7.7 9.7 r = 0.116
SD2 Before 80 51.7 90.9 81.5 34.5 104 62.2
SD2 After 14.9 40.5 19.8 31.2 15 27 24.4 r = 0.008
LF/HF Before 1.537 3.433 2.073 2.746 1.599 0.9 1.909
LF/HF After 1.135 0.684 1.214 1.203 2.064 5.853 2.58 r = -0.728
Valsalva techniques effects, on respiratory and circulatory morning pulse as a desired option). The second condition is
mechanism are very well know and evaluated. Effect of a rule mandated by the physicians, prohibiting the patients
Valsalva procedure on the nature of pulse as compared to its from sitting cross-legged, or with fingers clawed during
normal nature have been studied on a group of healthy pulse examination. Although these conditions do not seem
subjects. As depicted in Fig. (4) below, a perceptible shift in to convey any logic, nevertheless discussions with practicing
the frequency spectrum as indicated by the graph and the physicians have motivated us to explore this seemingly
LF/HF ratio is noted. Valsalva maneuver’s effects on blood trivial aspect more objectively.
pressure variations and certain cardiac arrhythmias are well 1) A group of thirteen healthy subjects (9-males and 4-
studied and documented. In light of above results, indirect females) in the age group of 18-35 were examined.
pointers conveying the ability of pulse signal to be explored Subjects were asked to fast for 4-hours and their pulse was
for extracting cardiac-activity related information can be taken before and after normal lunch. In each case
drawn. However rigorous experimentation on numerous subsequent to pulse peak detection, a total of 100 peaks
subjects involving ECG, blood-pressure and pulse, needs to were processed for pulse rate variability analysis. Table (3)
be preformed to explore further. below shows the results in consolidated form. Pulse
rate(PR), LF/HF ratio, PP_SD 1 and PP_SD2 changes as
observed before and after lunch have been listed in the
consolidated results. Pearson’s correlation coefficient(r)
has been computed to estimate the extent of co-
relationship. Pulse rate appears to change perceptibly, -
increasing in most subjects and having a strong co-
relationship level. Changes in PP_SD1 and PP_SD2 are
also quite prominent with an equally high degree of co-
Fig(4) AR spectrum estimates of pulse waveform for relationship. Spectrum changes as reflected in LF/HF
normal breathing and during Valsalva maneuvers. parameter however do not reflect any identifiable change
C. Effect of food ingestion and limb postures on the in pattern and is conveyed in the low value co-relations
nature of the pulse coefficient.
The consolidated results have been arrived at by
Personal interaction of author 1, with practicing experts of
considering the gross dynamics of physiological processes,
pulse analysis, have apparently brought to light certain
without any individual based relative comparison, although
conditions/constraints, required to be adhered to by patients
TIM perspective warrants and desires a relative evaluation,
prior to or in the process of their pulse examination. These
co-relations or comparison. The changes in the pulse as
conditions are in the form of unwritten rules passed on
reflected in the computed parameters do convey, that
orally. We have explored in the present study two of these
physiological changes due to digestive processes post
conditions and attempted to obtain a physiological rationale
lunch, are indeed responsible for causing them.
or basis, if any, for these conditions. First is the requirement
for the patient to preferably have an empty stomach as a pre-
requisite condition for pulse examination (with early

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Table 3: Consolidated results for thirteen subjects. Results display PR changes, LF/HF ratio changes, PP_SD1 and
PP_SD2 changes (MEAN±STD with Pearson coefficient(r) reflecting the changes prior-to and post, the lunch session.
PR (1/min) changes LF/HF changes PP_SD1 (ms) changes PP_SD2 (ms) changes
Pre-lunch 72±11 1.35±1.36 39.1±15.7 70.4±24.1
Post-lunch 79±8 1.25±0.9 31.8±14.6 61.8±21.4
Pearson's coeff (r) r = 0.86 r = 0.11 r = 0.85 r = 0.88
Table 4: Results for limb postures and positions. Measured locations are right and left hand with normal position,
and limbs, left-over-right & right-over-left position. Measure values are MEAN and STD of PP_SD1, PP_SD2 for
Poincare plots and LF/HF ratio for frequency domain analysis.
MEAN STD MEAN STD
PP_SD1 PP_SD1 PP_SD2 PP_SD2 MEAN STD
(ms) (ms) (ms) (ms) LF/HF LF/HF
Normal R 21.38 8.54 43.15 20.35 1.24 0.85
Normal L 21.86 10.40 44.79 15.51 1.30 0.80
L on R 22.36 10.86 39.11 18.73 1.04 0.89
R on L 21.44 10.58 36.31 14.73 1.12 1.01
However we need to have a larger sample data and representative male subject. It is worth observing that
preferably of the same set of individuals collected over an although the change in posture are not causing a noteworthy
extended period for refining the results. change in pulse rate, however the shift of the spectrum
2) A sample group of 14 subjects, males and females, in towards higher side is reflected by a small decrease in the
the age group of 20-60 years were considered. Pulse LF/HF ratio. Poincare parameters SD1 and SD2 have
waveforms were recorded, with subject postures in normal decreased substantially requiring the need for further
recommended positions – sitting with limbs in normal explorations vis-à-vis a physiological co-relation. Table 6
position and with limbs in prohibited conditions – right over similarly lists the parameters for a representative female
left limb or left over right limb. After detecting peaks of subject. A shift in frequencies towards the higher side is
pulses, pulse-to-pulse time series were obtained. Time, Table 6 Representative Female
frequency and non-linear domain parameters were MEAN
computed. Table 4 above lists the composite variation of the PR LF/HF PP_SD1 PP_SD2
parameters across all the subjects. Whereas there is not (1/min) Power (ms) (ms)
much apparent change in the short term variability, SD1, for F1 normal R 70.49 0.744 32.8 62.8
all four conditions, SD2 the long term variability shows a
marked decrease for prohibited conditions. The LF/HF ratio F1 normal L 67.52 0.498 39.9 64.7
can be interpreted to convey a shift in the spectrum towards F1 L on R 70.01 0.337 40.9 56.4
the high frequency side as the subject shifts position from
F1 R on L 68.46 0.417 37.8 57.1
normal to left-over-right limb position, although the shift in
spectrum for the right-over-left position is not that visible on changeover from normal posture to right-over-left
prominent. Although Table 4 above lists the results by or left-over-right.
considering the gross analysis across all the subjects,
however in light of TIM, perceptible changes in the pulse V. CONCLUSIONS
waveform for the right and left hand pulse are expected. A novel method for sensing the radial pulse perturbations
Moreover with strong emphasis given on the ‘particular has been developed. Signal waveforms thus obtained
nature’ and uniqueness of an individual’s constitution compare well with those of pressure pulse waveforms. Pulse
(technically termed as ‘prakruti’) [1] [10], we were rate variability as a tool has been used to observe the pulse
motivated to observe and report the relative changes of time, period inconsistencies and quantified using time, frequency
frequency and non-linear domain parameters for individual and non-linear domain analysis methods. Various
subjects. Table 5 below lists the parameters for a tasks/exercises have been carried out to observe the change
Table 5 Representative Male in nature of pulse due to these physiological activities.
MEAN Strong correlation between physiological activities and
PR LF/HF PP_SD1 PP_SD2 nature of pulse has been observed. These are reflected by
(1/min) Power (ms) (ms) way of changes in time domain parameters – rate, period and
M1 normal standard deviation; frequency domain parameters – LF/HF
R 101.22 3.76 11.6 36 ratio; and non-linear domain parameters PP_SD1, PP_SD2.
M1 normal Co-relationship level computed using Pearson’s
L 102.9 2 10.2 25.5 coefficient(r) has helped us evaluate the extent of
interdependence between the physiological processes and
M1 L on R 102.9 2 10.2 25.5
the computed parameter. However rigorous experimentation
M1 R on L 101.52 2.11 9.2 17.9 on a larger sample size needs to be carried out to have

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conclusive results which will help identify the reason for the
change in quantifying parameters and the investigated
physiological process.
ACKNOWLEDGMENT
We are highly grateful and thankful to the support and
guidance that we have received from Dr Kiran Ambekar
(MD physician) and Dr. Prasanna Kelkar (MD physician)
both leading and practicing TIM experts based in Mumbai.
Author(1) acknowledges support and encouragement
received form management and principal of the parent
institute, D. J. Sanghvi COE, VileParle, Mumbai, where
most of the experimental work was carried out.
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