Research Article Pain-Induced Pulsograph Changes in ...downloads.hindawi.com/journals/ecam/2015/385136.pdf · Research Article Pain-Induced Pulsograph Changes in Patients with Primary

Research ArticlePain-Induced Pulsograph Changes in Patients withPrimary Dysmenorrhea A Pilot Study

Wan-hong Chen1 Yan Zhao1 Chang-chun Zeng2 Dao-ning Zhang1 Yan-ping Wang3

Ling Tang4 Xiao-mei Zhang5 and Tian-fang Wang1

1Department of Diagnostics of Traditional Chinese Medicine School of Preclinical Medicine Beijing University of Chinese MedicineBeijing 100029 China2School of Basic Medicine Sciences Guilin Medical University Guangxi Guilin 541004 China3School of Acupuncture and Moxibustion Beijing University of Chinese Medicine Beijing 100029 China4Department of Gynecology Dongzhimen Hospital Beijing University of Chinese Medicine Beijing 100700 China5School of Humanities Beijing University of Chinese Medicine Beijing 100029 China

Correspondence should be addressed to Tian-fang Wang tianfangwang2000163com

Received 28 March 2015 Revised 7 August 2015 Accepted 10 August 2015

Academic Editor Baiyun Zeng

Copyright copy 2015 Wan-hong Chen et al This is an open access article distributed under the Creative Commons AttributionLicense which permits unrestricted use distribution and reproduction in any medium provided the original work is properlycited

Objectives To investigate changes in pulsograph caused by pain in primary dysmenorrhea (PD) patientsMethods Pulsograph andpain level of PD patients were detected using electropulsograph and Visual-Analogue Scale (VAS) respectively at four time points7ndash10 days before menstruation (T0) maximal pain during menstruation (T1) immediately after acupuncture analgesia (T2) and30mins after acupuncture analgesia (T3) Parameters (t h 119908) and normalized time parameters (t1015840) of pulsograph were analyzedResults VAS pain scores decreased from 640 plusmn 113 at T1 to 070 plusmn 075 at T2 to 011 plusmn 032 at T3 (119875 lt 0001 and 0001) At T1compared with those at T0 1199081 h3 and h4 significantly increased (119875 lt 001) and t2 t21015840 t31015840 and h(d) significantly decreased(119875 lt 001 0001 005 and 0001) At T2 compared with those at T1 t111990811199082 h2 h3 t11015840 and t41015840 significantly decreased (119875 lt 005001 001 0001 001 0001 and 005) and h(d) significantly increased (119875 lt 0001) There was no difference between T2 and T3Conclusions There are almost opposite changing trends in pulsographic parameters when pain occurs and when it is relieved inPD patients

1 Introduction

Pulse assessment is an assessing method used in TraditionalChinese Medicine (TCM) The main site for pulse feeling isthe radial artery located in the inner side of radial styloidprocess at wrist also called cunkou in ChineseThe cunkou ateach hand is divided into the following three portions respec-tively The guan position is in the middle part of cunkoujust near the radial styloid process cun portion between thewrist crease and guan portion and chi portion on the otherside of guan portion By feeling the pulse condition TCMclinicians may know the unique TCM pattern status of thehuman body [1]

Diagnostics of TCM a textbook widely used at TCMcolleges and universities which is about how to examine

illness and recognize syndrome in TCM recorded that painis often accompanied by wiry pulse tight pulse or tremulouspulse [2] Clinical researcher also found that the wiry pulseis the most common pulse (629) in patients with pain likeheadaches and chest pain Moreover tight pulse deep pulseand thready pulse are also seen in those patients [3]

In view of the subjectivity of cliniciansrsquo pulse feelingincreasing interest has been focused on pulse apparatuswhere sensors are developed to acquire pulse signals Pulseapparatuses are exploited to analyze pulse conditions [4]Recently an increasing number of studies on pulsograph havebeen done in clinical research [5ndash7] However only a fewstudies have focused on the pulsograph of patients sufferingpain One of the studiesrsquo results showed that there weresignificant differences in ℎ1 ℎ3 ℎ4 and ℎ5 of pulsograph

Hindawi Publishing CorporationEvidence-Based Complementary and Alternative MedicineVolume 2015 Article ID 385136 7 pageshttpdxdoiorg1011552015385136

2 Evidence-Based Complementary and Alternative Medicine

during menstruation between different TCM patterns of 148PD patients [8 9]

Pain affects pulse conditions giving rise to pulse changesAccordingly we designed the current research to investigatethe pain-induced changes in pulsograph parameters Primarydysmenorrhea (PD) is a commondisease in youngwomen Inview of its regular episode and quick relieving after treatmentwe chose PD representing pain to provide a basis for furtherstudy on pulse condition associated with pain in TCM

2 Methods

21 Subjects From April 2014 to May 2014 college stu-dents in Beijing University of Chinese Medicine who wereaged 18 to 30 years with dysmenorrhea with pain levelreaching 5 scores on a Visual-Analogue Scale (VAS) withinthe previous 3 regular menstrual cycles were recruited PDpatients who were diagnosed by the follow-up clinical exam-inationswere invited to participate in the studyThe diagnosiswas made according to Primary Dysmenorrhea ClinicalGuidelines made by Society of Obstetricians and Gynecolo-gists of Canada (SOGC) in 2005 Accordingly all patients hadperiodical pain in the lower abdomen before or during men-struation with normal pelvic examination and ultrasound[10]

Since unnatural changes of bodymay impact pulse [2] weexcluded patients who had a history of injury or who caught acold within the previous week or who were complicated withany diseases of the heart liver kidney and peripheral nervesand so forth For convenient detection we excluded patientswith physiologic variations or skin damage in left cunkou

22 Observing Time Points We observed PD patients at 4time points 7ndash10 days before menstruation (1198790) maximalpain during menstruation (1198791) immediately after acupunc-ture analgesia (1198792) and 30mins after acupuncture analgesia(1198793)

23 Pain Measurement Pain intensity was assessed at 11987901198791 1198792 and 1198793 by using a 10 cm VAS a scale presented asa horizontal row of equidistant numbers from 0 to 10 withratings that ranged from ldquono painrdquo at 0 to ldquopain as bad as youcan imaginerdquo at 10 [11]

24 Pulse Apparatus and Gathering of Pulsograph In thisstudy pulsograph was detected by DS01-C electropulsographwhere baroreceptors were developed to acquire pulse signalsproduced by Shanghai DaoshengMedical Limited CompanyThe pulse signals were converted into pulsograph through acomputer system The characteristics extraction and analysisof pulsographwere done by using the time-domain technique[12] As shown inFigure 1 a standard pulsograph is composedof main wave prodicrotic wave and dicrotic wave Themain wave and prodicrotic wave correspond to systole whilethe dicrotic wave corresponds to diastole The analyzedpulsographic parameters in this study were as below timeand amplitude of the peak of themainwave (1199051 ℎ1) and gorgeofmainwave (1199052 ℎ2) andpeak of the prodicroticwave (1199053 ℎ3)

w1w2

10

h1

h3h2

h(d)h4

00

h (m

m)

0 t1 t2t3 t4 t(d)10

t (s)

D1

D2

D3

D4

D5

D6

Main wave

Prodicrotic wave

Dicrotic wave

Figure 1 Pulsograph and pulsographic parameters

and dicrotic notch (1199054 ℎ4) width of the upper 13 (1199081) and 15(1199082) of the main wave the time of dicrotic wave (119905(d)) andamplitude of the peak of dicrotic wave (ℎ(d))

Cunkou is themain position for pulse feeling in TCM andalso is the only partwhich electropulsograph candetect TCMholds that left cunkou can better show the body situationof women because it mainly reflects the situation of heartliver and kidney In addition left cunkou can avoid theinfluence on the pulse by different motion styles in right-handed individuals Electropulsograph only has one probeand guan position is more easily to be accurately detectedSo pulsograph of guan position of left cunkouwas detected inthis study

Pulsograph was detected at 1198790 1198791 1198792 and 1198793 Specificdetection method was as follows patients were requiredin supine position with forearm stretched wrist straightpalm up and wrist at the same level with heart Trainedexperimenter fixed the probe of collector at the guan positionof left cunkouThe computerwould collect pulsographs of dif-ferent pressures when the patients were relaxed and breathednaturally and then select the best pulsograph automaticallyfor analysis

25 Acupuncture Analgesia Previous researches prove thatacupuncture has instant analgesic effect [13] and is of highefficiency in primary dysmenorrhea [14] Besides consider-ing the acceptance of acupuncture for subjects in this studyand side effects of painkillers [15] acupuncture was chosen toalleviate primary dysmenorrhea

Acupuncture was initiated at 1198791 Selected acupointsincluded Sanyinjiao (SP6) Diji (SP8) and Yinlingquan (SP9)on both sides [16] Manipulation is as follows the patient wasin a supine position with local skin exposed After routinedisinfection with 75 alcohol cotton balls on the local skindisposable acupuncture needles (40mm times 030mm) werethen inserted at SP6 SP8 and SP9 perpendicularly in thedepth of about 1 cm Lift thrust and twist gently till thepatients had sensations of soreness and distension All theneedles were retained for 30mins

Evidence-Based Complementary and Alternative Medicine 3

8

6

4

2

0

VAS

pain

scor

es

T0 T1 T2 T3

Time points

(n = 30)

lowastlowastlowast

lowastlowastlowast

lowastlowastlowast

Figure 2 VAS pain scores of 30 PD patients at 1198790 1198791 1198792 and1198793 Notes 1198790 means 7ndash10 days before menstruation 1198791 meansmaximal pain (VAS pain scores ge 5) duringmenstruation1198792meansimmediately after acupuncture analgesia and 1198793 means 30minsafter acupuncture analgesia lowastlowastlowast119875 lt 0001 compared with 1198790

119875 lt 0001 compared with 1198791 119875 lt 0001 compared with

1198792

26 Statistical Analysis Measurement data were presented asmean plusmn standardThe measurement data were analyzed by 119905-test Differences with 119875 lt 005 were considered statisticallysignificant The statistical evaluation was performed by usingthe statistical software package SPSS 170

3 Results

31 Study Population 30 patients with PDwere enrolled witha mean age of 23 years (range 19 to 29) and with an averagesuffering time of 7 years (range 2 to 15) All the patients hadprovided written informed consent before completion of theexperiment between May and August 2014

32 VAS Pain Scores As shown in Figure 2 30 enrolled PDpatients showed no pain at 1198790 At 1198791 patients experiencedthe maximal pain and the reading on the VAS increaseddrastically to 640 plusmn 113 With acupuncture analgesia com-pared with the reading at 1198791 VAS pain scores significantlydecreased to 070plusmn075 at 1198792 (119875 lt 0001) After acupunctureanalgesia the pain scores at 1198793 significantly decreased to011 plusmn 032 (119875 lt 0001) compared with that at 1198792

33 Changes in Pulsograph Parameters during Systole in PDPatients From 1198790 to 1198791 time of peak of the main wave(1199051) increased (119875 gt 005) and amplitude of peak of mainwave (ℎ1) decreased (119875 gt 005) (Figure 3(a)) Time of gorgeof the main wave (1199052) decreased significantly (119875 lt 005)and amplitude of gorge of the main wave (ℎ2) increased(119875 gt 005) (Figure 3(b)) Time of peak of the prodicroticwave (1199053) decreased (119875 gt 005) and amplitude of peak ofprodicrotic wave (ℎ3) increased significantly (119875 lt 001)(Figure 3(c)) Time of dicrotic notch (1199054) increased (119875 gt 005)and amplitude of dicrotic notch (ℎ4) increased significantly

(119875 lt 001) (Figure 3(d))Widths of the upper 13 (1199081) and 15(1199082) of main wave both increased (119875 lt 001 and 119875 gt 005)(Figure 3(e))

From1198791 to1198792 to1198793 1199051decreased gradually and therewasstatistically significant difference between 1198791 and 1198792 (119875 lt005) Meanwhile ℎ1 increased gradually and was signif-icantly higher at 1198793 than at 1198791 (119875 lt 005) (Figure 3(a)) 1199052increased (119875 gt 005) while ℎ2 significantly decreased (119875 lt005) at first and then increased (119875 gt 005) (Figure 3(b)) 1199053increased at first (119875 gt 005) and then decreased (119875 gt 005)while ℎ3 significantly decreased (119875 lt 0001) at first and thendecreased (119875 gt 005) (Figure 3(c)) 1199054 increased (119875 gt 005)while ℎ4 decreased (119875 gt 005) at first and then increased(119875 gt 005) (Figure 3(d)) Both 1199081 and 1199082 demonstratedsignificant reductions at first (119875 lt 001) and then had nosignificant changes (119875 gt 005) (Figure 3(e))

34 Changes in Pulsographic Parameters duringDiastole in PDPatients As shown in Figure 4 from 1198790 to 1198791 time of thepeak of dicrotic wave increased (119875 gt 005) and amplitude ofthe peak of dicrotic wave (ℎ(d)) significantly decreased (119875 lt0001) From 1198791 to 1198793 119905(d) increased (119875 gt 005) while ℎ(d)increased significantly (119875 lt 0001) firstly and then increasedmildly (119875 gt 005)

35 Changes in Heart Rate in PD Patients Heart rate was71930 plusmn 1122 timesmin at 1198790 and decreased to 6963 plusmn 624timesmin at 1198791 (119875 gt 005) After acupuncture treatmentheart rate significantly decreased to 6653plusmn694 timesmin at1198792 (119875 lt 001) and increased to 6763 plusmn 914 timesmin at 1198793(119875 gt 005) (Figure 5)

36 Changes in Normalized-Based Time Parameters In viewof the fact that time parameters will be effected by differentheart rates in this paper time parameters of pulsograph at 4time points were normalized at 75 timesmin heart rate andnamed as t1015840 The comparison of t1015840 results after normalizationis shown in Figure 6 comparedwith those at1198790 there was nodifference in t11015840 t41015840 and t(d)1015840 (119875 gt 005) at 1198791 Meanwhilet21015840 and t31015840 significantly decreased from 1198790 to 1198791 (119875 lt 0001005) From 1198791 to 1198793 t11015840 and t41015840 significantly decreased atfirst (119875 lt 0001) and then remained unchanged (119875 gt 005)And there was no significant change in t21015840 t31015840 and t(d)1015840 from1198791 to 1198793 (119875 gt 005)

4 Discussion

Primary dysmenorrhea (PD) is defined as a cramp-like painin the lower abdomen before or duringmenstruation withoutany identifiable pelvic pathology Pain may be accompa-nied by lower back pain nausea vomiting and diarrheaPD is frequently found in young nullipara [17] Modernmedical science holds that the emergence of PD is relatedwith many factors Among them temporary ischemia ofmyometrium and endometrium of the uterus plays a partThe ischemia may result from pressured intermuscular bloodvessels induced by forceful contraction of uterine arteriesand paroxysmal contraction of uterine smooth muscles [18]


015

014

013

012

011

010

009

t1(s

)

T0 T1 T3T2

t1h1

Time points

(n = 30)

h1

(mm

)

28

26

24

22

20

18

16

lowast

(a)

026

024

022

020

018

016

014

t2(s

)

t2h2

Time points

(n = 30)

h2

(mm

)

lowastlowast

22

20

18

16

14

12

lowast

T0 T1 T3T2

(b)

028

026

024

022

020

018

t3(s

)

t3h3

Time points

(n = 30)h3

(mm

)22

20

18

16

14

12

10

lowastlowast lowast

T0 T1 T3T2

(c)

040

038

036

034

032

030

t4(s

)

t4h4

Time points

(n = 30)

h4

(mm

)

14

12

10

8

6

lowastlowastlowast

lowastlowastlowastlowastlowast

T0 T1 T3T2

(d)

w1w2

Time points

(n = 30)

lowastlowast

Wid

th o

f mai

n w

ave (

mm

)

030

025

020

015

010

005

T0 T1 T3T2

(e)

Figure 3 Pulsograph parameters during systole in 30 PD patients at 1198790 1198791 1198792 and 1198793 Notes (a) (b) (c) and (d) were the changes in thetime and amplitude of D1 D2 D3 and D4 (e) was the changes in the width of the upper 13 (1199081) and 15 (1199082) of the main wave lowastlowast119875 lt 001and lowast119875 lt 005 compared with 1198790 119875 lt 0001 119875 lt 001 and 119875 lt 005 compared with 1198791


t(d)h(d)

Time points

066

060

054

048

042

036

t(d)

(s)

h(d

) (m

m)

24

18

12

06

00

minus06(n = 30)

lowast

lowastlowastlowast

T0 T1 T3T2

Figure 4 Pulsographic parameters during diastole in 30PDpatientsat119879011987911198792 and1198793 Notes lowastlowastlowast119875 lt 0001 and lowast119875 lt 005 comparedwith 1198790 119875 lt 0001 compared with 1198791

Time points

(n = 30)

lowastlowastlowastlowast

84

78

72

66

60

Hea

rt ra

te (p

er m

in)

T0 T1 T3T2

Figure 5 Changes in heart rate in 30 PD patients at 1198790 1198791 1198792 and1198793 Notes lowastlowast119875 lt 001 compared with 1198790 119875 lt 001 comparedwith 1198791

Traditional Chinese Medicine holds that PD is often causedby blood stasis blocking the uterus That is to say duringmenstruation qi and blood fail to flow freely Pain arises as aresult Apart from pain changes in movement of qi and bloodwould also affect cunkou pulse [19]

In this study pulsographic parameters of cunkou pulsebefore dysmenorrhea and in obvious dysmenorrhea and afterdysmenorrheal relieving in PD patients were investigatedConsidering effect of different heart rates on the time param-eters of pulsograph in this experiment the time parameterswere normalized at the heart rate of 75 timesmin In sodoing we were more inclined to think that normalized timeparameters could better reflect the effect of pain on timeparameters in PD patients

Changes in pulsographic parameters revealed almostopposite changing trends from before dysmenorrhea tobefore dysmenorrhea (from 1198790 to 1198791) and finally to after

dysmenorrheal relieving (from 1198791 to 1198792) Although theeffect of menstruation on pulsographic parameters cannotbe excluded from 1198790 to 1198791 combining with the changesfrom 1198791 to 1198792 we can come to a preliminary conclusion thatpain could cause increases in width of the upper 13 of mainwave (1199081) in amplitude of gorge of main wave (ℎ2) andin amplitude of dicrotic notch (ℎ4) and decreases in time ofgorge of main wave (1199052) and in amplitude of peak of dicroticwave (ℎ(d))

Interestingly we also noticed different changing trendsfrom the commencement of acupuncture to 30mins afteracupuncture (from 1198791 to 1198792 and from 1198792 to 1198793) Part ofparameters showed continuous similar changes For example1199051 kept decreasing and ℎ1 1199054 119905(d) and ℎ(d) kept increasingSome changes from 1198791 to 1198792 and from 1198792 to 1198793 were inopposite directions For instance ℎ3 and ℎ4 increased atfirst and then decreased and 1199053 decreased at first and thenincreased Still others changed significantly from 1198791 to 1198792but no obvious changes from 1198792 to 1198793 were observed suchas 1199081 and 1199082 which decreased at first and then almost didnot change The possible reason for this phenomenon maybe related to the negative feedback regulation which causedcorresponding changes in the radial artery

Previous researches show that each pulse is of specificpulsograph featuresThe changes in pulsographic parametersin our research could be interpreted with reference to wirypulse slippery pulse and forceful pulse The pulsograph ofwiry pulse is characterized by higher prodicrotic wave closeto or fused to the main wave manifesting as a broad singlepeak main wave and higher dicrotic notch and flat dicroticwave The pulsograph of slippery pulse is characterized by ahigher double-humped main wave with big-slope ascendingand descending branches and a delayed prodicrotic waveand a higher dicrotic wave In addition pulsograph offorceful pulse is characterized by a higher main wave [20]In this paper the pulsographs of patients with obvious painmanifested as wider upper 13 of main wave and earliergorge of main wave and higher prodicrotic wave and higherdicrotic notch and lower dicrotic wave compared withpulsographs of those without pain All these changes showedthat pulsographs of patients with obvious pain resembledthat of wiry pulse However when the pain is relieved theabove parameters change to the other way around As thegorge of main wave gets higher and earlier the dicrotic notchcomes earlier while the time of dicrotic wave does not changeobviously which indicated that the slope of ascending anddescending branches is elevated and there is a trend towardmoving to a slippery pulse with aweakened pulse-powerThisfinding was consistent with the records in TCM that pain isoften associated with wiry pulse

As a pilot study we have to admit that there are somelimitations in this study Firstly a limitation was the smallnumber of enrolled patients and lack of control groupWithout control group of healthy females influence of men-struation on pulsograph could not be excluded Secondlythe pain of PD cannot represent all kinds of pain owing toits localization and patient population particularity Furtherstudies on different types of pain influencing pulsograph are


Time points

(n = 30)

lowastlowast

lowastlowast lowastlowast

lowastlowast lowastlowastlowastlowastlowast

lowastlowast

t1998400t2998400

t3998400

022

020

018

016

014

012

010

Nor

mal

ized

t (s

)

T0 T1 T3T2

(a)

Time points

(n = 30)

lowast

t4998400

t(d)998400

Nor

mal

ized

t (s

)

052

048

044

040

036

032

T0 T1 T3T2

(b)

Figure 6 Changes in normalized-based time parameters at 1198790 1198791 1198792 and 1198793 Notes (a) was changes in t11015840 t21015840 and t31015840 (b) was changes int41015840 and t(d)1015840 lowastlowastlowast119875 lt 0001 lowastlowast119875 lt 001 and lowast119875 lt 005 compared with 1198790 119875 lt 0001 119875 lt 001 and 119875 lt 005 compared with 1198791

needed before we can know for sure how pain affects pulso-graphic parameters

5 Conclusions

There are changes in pulsographic parameters basically inopposite trends in patients with PD when their pain occursand when it is relieved Further studies with control groupsare needed to determine whether pulsographic parameterscan be used as an objective indicator for pain changes inpatients with primary dysmenorrhea

Conflict of Interests

The authors declare that there is no conflict of interestsregarding the publication of this paper

Acknowledgments

This work was sponsored by the National Natural ScienceFoundation of China (no 81473598) Self-Research of BeijingUniversity of Chinese Medicine (no 2014-JYBZZ-XS-011)Project of Teaching Masters of Beijing Educational Commit-tee ldquoResearch and Implementation of Bilingual EducationrdquoReform and Research in Teaching of Outstanding InnovationTeam of Beijing High Schoolsrsquo Continuing Education (Diag-nostics of Traditional ChineseMedicine) InnovationTeamofBeijing University of Chinese Medicine (no 2011-CXTD-08)and 111 Project of ChinaMinistry of Education (no B07007)

References

[1] S Walsh and E King Pulse Diagnosis A Clinical GuideChurchill Livingstone Edinburgh Scotland 2008

[2] S L Ji and Z Z ChengDiagnostics of Traditional ChineseMedi-cine Peoplersquos Medical Publishing House Beijing China 2006

[3] L JWang ldquoPreliminarily study of the relationship between painandwiry pulsemdashanalysis of 280 casesrdquoXinjiang Journal of Tradi-tional Chinese Medicine vol 1 pp 17ndash19 1987

[4] X Q Xiao Y Q Wang H X Yan et al ldquoObjectification ofChinese pulse diagnosisrdquo Chinese Archives of Traditional Chi-nese Medicine pp 2042ndash2204 2011

[5] H J Wu Z F Zhang J T Xu et al ldquoRelationship between bodysurfacearea BMI and taking pulse pressure pulsograph param-eters in 677 healthy personsrdquoChina of Traditional ChineseMedi-cine and Pharmacy vol 5 pp 1361ndash1365 2013

[6] R Li L Yong C Y Liu et al ldquoPulse feature and change rule ofpulsograph parameters in deficiency and cold patternsrdquo ActaUniversitatis Traditionis Medicalis Sinensis PharmacologiaequeShanghai vol 1 pp 37ndash39 2007

[7] J B Tai D Z Zhu and C Q Ling ldquoComparative research onpulsographs of qi deficiency and blood stasis in primary livercancer patientsrdquo Chinese Archives of Traditional Chinese Medi-cine vol 1 pp 118ndash122 2011

[8] Y Zhao L M Ou-Yang and F Zeng ldquoCorrelational analyses ofthe syndrome differentiation and pulsographic parameters inprimary dysmenorrhealrdquo Shangdong Journal of Traditional Chi-nese Medicine vol 11 pp 743ndash744 2007

[9] Y Zhao and X J Sun ldquoPulsograph analysis of deficiency andexcess patterns in primary dysmenorrhealrdquo Hebei TraditionalChinese Medicine vol 3 pp 350ndash351 2009

[10] G Lefebvre O Pinsonneault and V Antao ldquoPrimary dysmen-orrheal consensus guidelinerdquo SOGC Clinical Practice Guide-lines vol 27 no 12 pp 1117ndash1130 2005

[11] G X Shi Q Q Li C Z Liu et al ldquoEffect of acupuncture on deqitraits and pain intensity in primary dysmenorrheal analysis ofdata from a larger randomized controlled trialrdquo BMC Comple-mentary and Alternative Medicine vol 14 article 69 2014

[12] D Di M Zhou P F Qin et al ldquoDevelopments acquisition ofChinese medicine pulse researchrdquo Shanghai Journal of Tradi-tional Chinese Medicine vol 7 pp 104ndash108 2014


[13] DY ZhuThe immediate analgesia effect observation of acupunc-turing Diji and acupuncturing Diji and Guanyuan to curepatients with primary dysmenorrheal [PhD thesis] ShandongUniversity of Traditional Chinese Medicine Jinan China 2014

[14] J Y Hou ldquoClinical on acupuncture treatment in patients withprimary dysmenorrhealrdquo Guangming Journal of Chinese Medi-cine vol 2 pp 330ndash332 2010

[15] M L Proctor and P A Murphy ldquoHerbal and dietary therapiesfor primary and secondary dysmenorrhealrdquoCochrane Databaseof Systematic Reviews no 3 Article ID CD002124 2001

[16] D Z Ye ldquoDescribing of the rules of selecting points in treatmentof primary dysmenorrheal with acupuncturerdquo Chinese andForeign Medical Research vol 10 pp 147ndash149 2015

[17] X Xie and W L Gou Obstetrics and Gynecology 8 VersionsPeoplersquos Medical Publishing House Beijing China 2013

[18] D Chung and R L Caruso ldquoPotential role for oxidative stressin 221015840-dichlorobiphenyl-induced inhibition of uterine contrac-tions but not myometrial gap junctionsrdquo Toxicological Sciencesvol 93 no 1 pp 172ndash179 2006

[19] Y Z Zhang Gynecology of Traditional Chinese Medicine ChinaTraditional Medicine Press Beijing China 2007

[20] Z F Fei Modern Pulse Diagnosis in Traditional Chinese Medi-cine Peoplersquos Medical Publishing House Beijing China 2003

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Volume 2014Hindawi Publishing Corporationhttpwwwhindawicom


during menstruation between different TCM patterns of 148PD patients [8 9]

Pain affects pulse conditions giving rise to pulse changesAccordingly we designed the current research to investigatethe pain-induced changes in pulsograph parameters Primarydysmenorrhea (PD) is a commondisease in youngwomen Inview of its regular episode and quick relieving after treatmentwe chose PD representing pain to provide a basis for furtherstudy on pulse condition associated with pain in TCM

2 Methods

21 Subjects From April 2014 to May 2014 college stu-dents in Beijing University of Chinese Medicine who wereaged 18 to 30 years with dysmenorrhea with pain levelreaching 5 scores on a Visual-Analogue Scale (VAS) withinthe previous 3 regular menstrual cycles were recruited PDpatients who were diagnosed by the follow-up clinical exam-inationswere invited to participate in the studyThe diagnosiswas made according to Primary Dysmenorrhea ClinicalGuidelines made by Society of Obstetricians and Gynecolo-gists of Canada (SOGC) in 2005 Accordingly all patients hadperiodical pain in the lower abdomen before or during men-struation with normal pelvic examination and ultrasound[10]

Since unnatural changes of bodymay impact pulse [2] weexcluded patients who had a history of injury or who caught acold within the previous week or who were complicated withany diseases of the heart liver kidney and peripheral nervesand so forth For convenient detection we excluded patientswith physiologic variations or skin damage in left cunkou

22 Observing Time Points We observed PD patients at 4time points 7ndash10 days before menstruation (1198790) maximalpain during menstruation (1198791) immediately after acupunc-ture analgesia (1198792) and 30mins after acupuncture analgesia(1198793)

23 Pain Measurement Pain intensity was assessed at 11987901198791 1198792 and 1198793 by using a 10 cm VAS a scale presented asa horizontal row of equidistant numbers from 0 to 10 withratings that ranged from ldquono painrdquo at 0 to ldquopain as bad as youcan imaginerdquo at 10 [11]

24 Pulse Apparatus and Gathering of Pulsograph In thisstudy pulsograph was detected by DS01-C electropulsographwhere baroreceptors were developed to acquire pulse signalsproduced by Shanghai DaoshengMedical Limited CompanyThe pulse signals were converted into pulsograph through acomputer system The characteristics extraction and analysisof pulsographwere done by using the time-domain technique[12] As shown inFigure 1 a standard pulsograph is composedof main wave prodicrotic wave and dicrotic wave Themain wave and prodicrotic wave correspond to systole whilethe dicrotic wave corresponds to diastole The analyzedpulsographic parameters in this study were as below timeand amplitude of the peak of themainwave (1199051 ℎ1) and gorgeofmainwave (1199052 ℎ2) andpeak of the prodicroticwave (1199053 ℎ3)

w1w2

10

h1

h3h2

h(d)h4

00

h (m

m)

0 t1 t2t3 t4 t(d)10

t (s)

D1

D2

D3

D4

D5

D6

Main wave

Prodicrotic wave

Dicrotic wave

Figure 1 Pulsograph and pulsographic parameters

and dicrotic notch (1199054 ℎ4) width of the upper 13 (1199081) and 15(1199082) of the main wave the time of dicrotic wave (119905(d)) andamplitude of the peak of dicrotic wave (ℎ(d))

Cunkou is themain position for pulse feeling in TCM andalso is the only partwhich electropulsograph candetect TCMholds that left cunkou can better show the body situationof women because it mainly reflects the situation of heartliver and kidney In addition left cunkou can avoid theinfluence on the pulse by different motion styles in right-handed individuals Electropulsograph only has one probeand guan position is more easily to be accurately detectedSo pulsograph of guan position of left cunkouwas detected inthis study

Pulsograph was detected at 1198790 1198791 1198792 and 1198793 Specificdetection method was as follows patients were requiredin supine position with forearm stretched wrist straightpalm up and wrist at the same level with heart Trainedexperimenter fixed the probe of collector at the guan positionof left cunkouThe computerwould collect pulsographs of dif-ferent pressures when the patients were relaxed and breathednaturally and then select the best pulsograph automaticallyfor analysis

25 Acupuncture Analgesia Previous researches prove thatacupuncture has instant analgesic effect [13] and is of highefficiency in primary dysmenorrhea [14] Besides consider-ing the acceptance of acupuncture for subjects in this studyand side effects of painkillers [15] acupuncture was chosen toalleviate primary dysmenorrhea

Acupuncture was initiated at 1198791 Selected acupointsincluded Sanyinjiao (SP6) Diji (SP8) and Yinlingquan (SP9)on both sides [16] Manipulation is as follows the patient wasin a supine position with local skin exposed After routinedisinfection with 75 alcohol cotton balls on the local skindisposable acupuncture needles (40mm times 030mm) werethen inserted at SP6 SP8 and SP9 perpendicularly in thedepth of about 1 cm Lift thrust and twist gently till thepatients had sensations of soreness and distension All theneedles were retained for 30mins


8

6

4

2

0

VAS

pain

scor

es

T0 T1 T2 T3

Time points

(n = 30)

lowastlowastlowast

lowastlowastlowast

lowastlowastlowast



1198792


3 Results









4 Discussion



015

014

013

012

011

010

009

t1(s

)

T0 T1 T3T2

t1h1

Time points

(n = 30)

h1

(mm

)

28

26

24

22

20

18

16

lowast

(a)

026

024

022

020

018

016

014

t2(s

)

t2h2

Time points

(n = 30)

h2

(mm

)

lowastlowast

22

20

18

16

14

12

lowast

T0 T1 T3T2

(b)

028

026

024

022

020

018

t3(s

)

t3h3

Time points

(n = 30)h3

(mm

)22

20

18

16

14

12

10

lowastlowast lowast

T0 T1 T3T2

(c)

040

038

036

034

032

030

t4(s

)

t4h4

Time points

(n = 30)

h4

(mm

)

14

12

10

8

6

lowastlowastlowast


T0 T1 T3T2

(d)

w1w2

Time points

(n = 30)

lowastlowast

Wid

th o

f mai

n w

ave (

mm

)

030

025

020

015

010

005

T0 T1 T3T2

(e)



t(d)h(d)

Time points

066

060

054

048

042

036

t(d)

(s)

h(d

) (m

m)

24

18

12

06

00

minus06(n = 30)

lowast

lowastlowastlowast

T0 T1 T3T2


Time points

(n = 30)


84

78

72

66

60

Hea

rt ra

te (p

er m

in)

T0 T1 T3T2










Time points

(n = 30)

lowastlowast



lowastlowast

t1998400t2998400

t3998400

022

020

018

016

014

012

010

Nor

mal

ized

t (s

)

T0 T1 T3T2

(a)

Time points

(n = 30)

lowast

t4998400

t(d)998400

Nor

mal

ized

t (s

)

052

048

044

040

036

032

T0 T1 T3T2

(b)



5 Conclusions




Acknowledgments


References



























of






Disease Markers



OncologyJournal of





PPAR Research



Journal of

ObesityJournal of

















8

6

4

2

0

VAS

pain

scor

es

T0 T1 T2 T3

Time points

(n = 30)

lowastlowastlowast

lowastlowastlowast

lowastlowastlowast



1198792


3 Results









4 Discussion



015

014

013

012

011

010

009

t1(s

)

T0 T1 T3T2

t1h1

Time points

(n = 30)

h1

(mm

)

28

26

24

22

20

18

16

lowast

(a)

026

024

022

020

018

016

014

t2(s

)

t2h2

Time points

(n = 30)

h2

(mm

)

lowastlowast

22

20

18

16

14

12

lowast

T0 T1 T3T2

(b)

028

026

024

022

020

018

t3(s

)

t3h3

Time points

(n = 30)h3

(mm

)22

20

18

16

14

12

10

lowastlowast lowast

T0 T1 T3T2

(c)

040

038

036

034

032

030

t4(s

)

t4h4

Time points

(n = 30)

h4

(mm

)

14

12

10

8

6

lowastlowastlowast


T0 T1 T3T2

(d)

w1w2

Time points

(n = 30)

lowastlowast

Wid

th o

f mai

n w

ave (

mm

)

030

025

020

015

010

005

T0 T1 T3T2

(e)



t(d)h(d)

Time points

066

060

054

048

042

036

t(d)

(s)

h(d

) (m

m)

24

18

12

06

00

minus06(n = 30)

lowast

lowastlowastlowast

T0 T1 T3T2


Time points

(n = 30)


84

78

72

66

60

Hea

rt ra

te (p

er m

in)

T0 T1 T3T2










Time points

(n = 30)

lowastlowast



lowastlowast

t1998400t2998400

t3998400

022

020

018

016

014

012

010

Nor

mal

ized

t (s

)

T0 T1 T3T2

(a)

Time points

(n = 30)

lowast

t4998400

t(d)998400

Nor

mal

ized

t (s

)

052

048

044

040

036

032

T0 T1 T3T2

(b)



5 Conclusions




Acknowledgments


References



























of






Disease Markers



OncologyJournal of





PPAR Research



Journal of

ObesityJournal of

















015

014

013

012

011

010

009

t1(s

)

T0 T1 T3T2

t1h1

Time points

(n = 30)

h1

(mm

)

28

26

24

22

20

18

16

lowast

(a)

026

024

022

020

018

016

014

t2(s

)

t2h2

Time points

(n = 30)

h2

(mm

)

lowastlowast

22

20

18

16

14

12

lowast

T0 T1 T3T2

(b)

028

026

024

022

020

018

t3(s

)

t3h3

Time points

(n = 30)h3

(mm

)22

20

18

16

14

12

10

lowastlowast lowast

T0 T1 T3T2

(c)

040

038

036

034

032

030

t4(s

)

t4h4

Time points

(n = 30)

h4

(mm

)

14

12

10

8

6

lowastlowastlowast


T0 T1 T3T2

(d)

w1w2

Time points

(n = 30)

lowastlowast

Wid

th o

f mai

n w

ave (

mm

)

030

025

020

015

010

005

T0 T1 T3T2

(e)



t(d)h(d)

Time points

066

060

054

048

042

036

t(d)

(s)

h(d

) (m

m)

24

18

12

06

00

minus06(n = 30)

lowast

lowastlowastlowast

T0 T1 T3T2


Time points

(n = 30)


84

78

72

66

60

Hea

rt ra

te (p

er m

in)

T0 T1 T3T2










Time points

(n = 30)

lowastlowast



lowastlowast

t1998400t2998400

t3998400

022

020

018

016

014

012

010

Nor

mal

ized

t (s

)

T0 T1 T3T2

(a)

Time points

(n = 30)

lowast

t4998400

t(d)998400

Nor

mal

ized

t (s

)

052

048

044

040

036

032

T0 T1 T3T2

(b)



5 Conclusions




Acknowledgments


References



























of






Disease Markers



OncologyJournal of





PPAR Research



Journal of

ObesityJournal of

















t(d)h(d)

Time points

066

060

054

048

042

036

t(d)

(s)

h(d

) (m

m)

24

18

12

06

00

minus06(n = 30)

lowast

lowastlowastlowast

T0 T1 T3T2


Time points

(n = 30)


84

78

72

66

60

Hea

rt ra

te (p

er m

in)

T0 T1 T3T2










Time points

(n = 30)

lowastlowast



lowastlowast

t1998400t2998400

t3998400

022

020

018

016

014

012

010

Nor

mal

ized

t (s

)

T0 T1 T3T2

(a)

Time points

(n = 30)

lowast

t4998400

t(d)998400

Nor

mal

ized

t (s

)

052

048

044

040

036

032

T0 T1 T3T2

(b)



5 Conclusions




Acknowledgments


References



























of






Disease Markers



OncologyJournal of





PPAR Research



Journal of

ObesityJournal of

















Time points

(n = 30)

lowastlowast



lowastlowast

t1998400t2998400

t3998400

022

020

018

016

014

012

010

Nor

mal

ized

t (s

)

T0 T1 T3T2

(a)

Time points

(n = 30)

lowast

t4998400

t(d)998400

Nor

mal

ized

t (s

)

052

048

044

040

036

032

T0 T1 T3T2

(b)



5 Conclusions




Acknowledgments


References



























of






Disease Markers



OncologyJournal of





PPAR Research



Journal of

ObesityJournal of






























of






Disease Markers



OncologyJournal of





PPAR Research



Journal of

ObesityJournal of





















of






Disease Markers



OncologyJournal of





PPAR Research



Journal of

ObesityJournal of
















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Research Article Pain-Induced Pulsograph Changes in ...downloads.hindawi.com/journals/ecam/2015/385136.pdf · Research Article Pain-Induced Pulsograph Changes in Patients with Primary