Metrological standardisation of pulse diagnostics methods by means of a new laser-electronic pulse sensor, VAS research and classification of observable

pulse reactions.
Sergue Timoschevski
Nowadays the auricular medicine is being widely applied and it became necessary to multiply the given method and introduce it into medical practice. However, a number of difficulties make its introduction into practice problematic, that is: - it is not easy to master VAS fingering ; - results greatly depend on the physical, emotional and spiritual state of the researcher ; results depend on the interrelations between the researcher and the patient under examination which, in its turn, results in the necessity to use stabilizers which, in our opinion, do not remove the undesirable interrelation. Many researchers made attempts to objectify VAS but the fact, that they did not take into consideration metrological aspects, while registering pulsograms, did not produce stable results. Here we would like to tell you about the results of metrological rescarch in the field of pulse objectification, achieved by our group with the help of a new pulse sensor with elements of lazer and fibre optics. It is a topical task to register and identify pulsograms, recorded simultaneously from six pulse sensors, imitating fingers of a physician. To solve this task, it is necessary to design original devices, in particular - efficient multi-purpose pulse sensors and their holders which shall be designed with regard to all main requirements to this class of research. To provide metrologically adjusted registration of a pulse curve, pulse sensors shall meet the following requirements : 1. They shall have high, sensitivity and register changes of amplitude of oscillations of walls of artery not less then up to 0,2 micrometer ; 2. They shall have a rather dunamic rangc of registration of changes in order not to overstep the limits of linear characteristics of changes in case the elastic elements of the sensor have been deformed ; 3. The sensor shall have the linear amplitude-frequency characteristic within the range of frequencies being measured (from a coustant signal up to 100 hertz) and it shall not have resonance frequencies within this range, that is the entrance electric and physiical parameters of the sensor shall correspond to the parameters of the pulse signal which is being receivec. All those features of the sensor are expressed in its frequency and amplitude characteristics. To get a pulse curve, the form and

amplitude of which will not be distoroted, the sensor shall provide reproduction of all frequency components of the pulsogram without visible distortions. 4. The contact membrane of the sensor shall not have its own resonances within the frequency range of pulse oscillations (as well as their low harmonics of the I st and 2nd order) and register without distortions the tiniest nuances of the vector matrix of the pulse oscillations field. This task is of special importance when a mosaic pulse sensor is being designed which will register pulse simultaneously in 25 and more points (permission shall be not less then 1 element per 1 sq.mm) Besides, the pulse sensor shall be a tiny one, its size shall be equal to fingers of a researcher. * it shall have stable measuring with regard to time ; * it shall be resistant to electric noises and mechanical interferences ; * it shall be highly reliable. The existing systems of pulse sensors - capa citance-type, piezoelectric, ultrasonic, photoelectronic, impedance, and mechanotronic - do not meet the above requirements; On the basis of metrological researches in the area of pulse objectification by our group is developed and tested an, original, pulse sensor with an application of elements of laser and fiber optics having the system of adjustable pressing and "adhesion" of the registering membrane to the zone of pulsing. This pulse sensor fully meets the above requirements. The task to design holders of pulse sensors is also topical. The holders shall * precisely place and fix pulse sensors in the field of measuring ; * pulse sensors shall be fixed safely and at the same time they shall not press upon vasculars, in order not to distort pulse curves ; * pulse sensor holder shall have a precise system of regulation of the pressure force upon the radial artery for all six sensors, for each of them independently. The pressure force shall have the electronic system of dynamic tracking in the actual time. * it is desirable to have a system of control of the pressure depth of the sensor end in order to be able to measure both the pressure force upon the artery and, applying the law of Hooke, its stiffness. * finally, pulse sensor holder shall not hamper to visualize the exploring part of pulse sensors which is very important for thier precise placement in the pulsing area of the vascular. The device, made by us, consists of two systems of manipulators, meant fort inndependent replacement and fixation of six pulse sensors simulltancously on radial arteries of the left and rith hands. Each of them can havre from 1 to 16 (four per four) points of registration (elementary sensors) of pulse on the 36-81 sq.mm dimensions of the snesor allowed us to make a mosaic pulse sensor, consisting of 16 microsensors and having a good spatial and time permission. The application of the mosaic sensor allows : * to differentiate (during the registration) longitudinal and transverse vibrations of the walls and cavity of the artery ; biotissues, connected with hemodynamics and aroused in liquid, viscous and elastic mediums ; tto study interrelations between longitudinal and transverse waves (that is to obtain practical material, connected with the analysis of the theeory of stagnant waves). * to track the appearance and distribution of vibration processes on the given area (that is to define the spatial topography oof the pulse), to conostruct its three - dimension relief, which is much more informative than the two-dimension diagram, registered in one point only. * to differentiate direct and reflected waves during the process of pulse formation, that iis to divide centripetal and centrifugal processes of the pulse wave distribution ;

* to track the artery displacement as a whole with regard to the surrounding tissue, that is the artery bed and dependence of the VAS formation on the dynamics of the heart functioning. When our system of sensors is being applied, it is possible to control the pressure force of the sensors - from 0.01 to 30 newton - and place digital information either on autonomous indicators or computer monitor. With the help of the system it is possible to precisely differentiat' the surface, medium and remote pulses as well as to define stiffness and elastic features of the artery walls. Manipulators together wwith pulse sensors can adapt themselves to the relief of the hand because each of the them has six degrees of freedm (three linear and three angular) and according to their mechanical characteristics they have been approximated to the biomechanifcs of the hand of a human being. ith the help of interface (the same as the ACUS system interface) the given system could be connected to a computer. The following will be ou the monitor. * pulse curves graphics ; * information about the sensors pressure force in six points and the elasticity power of arteries ; * snesitivity of each of the six sensors ; * information about artifacts during the pulse and VAS study ; * attendant service information. Using the given program, computer can regulate the sensors pressure force and their sensibility, working in the dialogue mode. The given system has the appropriate program support, allowing to form archives of pulsometric studies with the aim of their further mathematical processing. The given complex has a nomber of sensors. * for registration of light, acoustic, temperature and other irritants during VAS study, for imput of information into computer with the aim or the appropriate marking of pulse graphics. The latter makes it possible to synchronize the imput of information with the irritan effect * in the complex we used original technical methodsand sensors, made by us, for registration of exterior irritantzs with the aim of cutting off mechanical interferences, caused by hand movements and micropulsations of surface vasculars of the patient wich is being tested. We have designed a device for calibration of pulse sensors and electronic system. It allows to make microreplacement of the artificial artery wall within the 0.15.25 micrometer amplitude range and the 0.1-100 herz frequency range. The form of impulse and amplitude of the microreplacement can be programmed. With the help of the device it is possible to define (with high precision) the degree of distortion of pulse curves form in the measuring system as well as the actual sensibility of the system. With the help of our pulsometry complex there was conducted a set of pulse experiments. During the first cycle pulse reactions were investigated, registered by a special system of manipulators, consisting of three independent monopulse sensors. We have recorted pulsograms of fifty seven patients by the four-channel recorder. Tests were conducted in two directions : * first, we studied VAS with the help of one out of three monopulse sensors, fixed in the place, typical of VAS registration process, that is on the slope of radial stilloide. * in the second experiment pulse sensors of the above system were fixed simultaneously in three points of the radial artery, corresponding to three positions of the Chinese classic pulse, that is Chi, Guan and Tsun. Pulse was being recorded under the 0.1-5 newton pulse sensors pelot pressure. Tests were mainly conducted on the left hand of the patients and only a part of the tests were conducted on the right hand . Pulse was being recorded at various time of the day with regard to the biorhyithmic regularities of various bioenergetic systems of organism. The energetic optimum of bioenergetic systems was calculated with the help of the ACUS chronoacupuncture computer program. A number of experiments have been carried out : * first,we studied test VAS, caused by heinelamp effect (the face of the patient is being lighted by a narrow fixed pencill of rays) ;

* second, we studied WHAS which comes into existence after auricular points have been affected. This points were revealed with the help of electrical detector.In some experiments / VAS was caused by mechanical effect, / that is mechanical effect was being produced by a special marking feeler (the pressure of the spring - about 2 g/sq.mm). It produced an electric signal when it was touching a point, and marked a time period of the beginning and the end of the effect of the chosen point of the auricle.* in other experiments ative points were affecdted by lazer and three-volt hammere etc. The analysis of more than 600 pulse graphs allowed us to single out the most frequent main characteristics during VAS registration. The following are the most important typical characteristics : * Amplitude characteristics : 1. Increase of amplitude (from 20-30 % till the two- fourfold increase). 2. Decrease of amplitude (from 20-30 % till the pulse collapse);3. Negative ejection (curve) can be observed practically in 90 % cases ath the end of the testing mechanical effect of the auricule point. 4<; Curve inversion can be observed in several cases of pulse collapse. * Frequency characteristic ; 1. The 1.3-1.5 fold frequency decrease is the most frequent. 2. Frequency increase is rather seldom. * Time of pulse reaction to the test : Start ot the reaction : 1. simultaneously with the start of the reaction. 2. within the effect interval (after 3-6 pulse vibrations, after the start of the effet on the auricule point till the effect removal). 3. at the moment of the effect removal. 4. if a time period, after the effect removal. The end of the reaction : 1. at the start of the effect (solitary VAS impulse). 2. within the interval between the start and the end of the effect. 3. at the end of the effect. 4. beyond the interval of the effect on the auricle point. Reaction interval : 1. solitary impluse. 2. From two till seven VAS pulse vibrations. 3. long VAS (more than 8 pulse vibrations, in some cases up to 30 pulse vibrations). Various VAS ratio in two or three pulse positions : 1. strong VAS is present in one pulse position and VAS is absent in two other pulse positions (the most frequent case). 2. strong VAS in one pulse position (more often - in the Chi pulse position. seldom - in the Guan pulse position) and moderate VAS in one or two other pulse position. 3. strong VAS in one pulse position and moderate or weak VAS in two other poulse positions Form of pulse vibrations : 1. change of correlations of the extreme points of the amplitude within the pulse ; 2. change of steepness of the front and the back half of the impulse 3. worsening or, vice versa, improvement of the pulse vibration. 4. oscillations. 5. modulations by the fibrillation noises and upper harmonics,

6. pulse inversion. Phase characteristics : change of impulse phase in the Tsun, Guan and Chi points with regard to one another. However in the first cycle of our work using the monosensor we have found rather low percent of pulse reactions reproducibility ; some difficultics of pulse registration being stable in time, sometimes we could observe pulse disappaearance (escaping) during the experiment ; large depenndence of pulse reactions ou a hand position, the degree of its pressure (tension). occurrence of pulse reactions, often noncorrelated to a marker (irritant). Therefore in the second cycle of our experiments we moved on to researches of pulse reactions registered by means of mosaic sensors, having of 6 to 12 independant microsensors. Themicrosensors were arranged in the chess order as a retangular 3 on 4 or 2 on 6, or 6 in oneline; A numberof some original technical decisions alloweed to avoid practically complete absence of cross interferences (disturbances). All diagrams simultancously are being displayed on the screen of the computer and easily analyzed. pulse reaction are very eviddent. The technical, electronic, cybernetic and progoram decisions realiized is the given measuring device, have allowed to carry out correctly a large series of researches of pulse characteristigs and pulse reactions to external irritants; An additional special device has allowed to investigate a large ares of pulsation under preservation of the high spatial resolving, and to receive some additional information on dynamic topology of pulse fluctuations. Thee use of a mosaic pulse sensor resulted in the satisfactory reproducibility, there were registered hundreds of various plulse reactions concurring with time of auricular points irritation. In this research cycle the was eceived a number of results, among which it is possible to note the following. 1. The local pulse reaction being observed only in one diagram. That very oase confirms the necessity of the mosaic sensor application, as the monosensor displacement of only 1 mm would fait the reaction registrtion. 2. Pulse reactions could be observed all at once (dimultaneously) in 6 of 12 twelve pulse diagrams, or insome cases - in 2-3 ones. 3. There found out the so-called "pendulum phenomena" in mosaic dynamics (changes) of pulse connected with spatial displacement of a pulse hill. They consist in 1-2 mm pulse displacement at the moment of influence to the next pulse sensor more often across artery, and sometimes at a corner, and after termination influence it came back. Only mosaic sensor makes possible obsservation of such effect. Should we observe this process with the help of monopulse sensor, then only one part of this process could be registered, inncrease of amplitude or, on the contrary, its attenuation, up to collapse, and could treat them as different reactions, though it is one and the same reaction just being observed in various points. 4. There registered pulse reaction in the form of spreading of strong amplitude pulsation over the lare area. 5. Pulse reaction as pulse vector change. Pulse vector is a notion meaning a vector of a spatial direction of pulsation in a particular observation point in respect to the central line or a rest line. Known capacitor, piezoelectric and strain puls sensors fail to register this effect, as due to their rigidity, lack of pumping up and particular features of their work they register only positive components of pulsation. Why we have detailed the definition of a pulse vector ? I is duc to the fact that the processes of interaction and displacement of pulses harving various pulsation vectors are the key

oues in determination oof the criteria fot the search of ACR zones. From our point of wiew pulse reactions are most frequently observed on bordere between positive and negative pulsation vectors. 6. Also there registered pulse reactions in the form chaotic and high-frequency pulsations not having aparticular vector of pulsation direction. nThey can be pulsations and noises (not to be confused with noises of the installation !), dealing with hydrodynamic and acoustic interaction of various areas of a pulsing artery andthe around tissues. CONCLUSION. 1. Practical results, we got during the test of the original sensor, prove that thee appliciation of highly sensitive lazer-optic-electronique sensors, basd on high t'echnologies and having a wide dynamic range, linear amplitude-frequency characteristic and contact membrane, sensitive to miroreplacemnts (up to 0,2 micrometer), allows to objectify pulse vibrations, gt high-quality pulsograms and provide good reproductivity of pulsograms when experiments are repeated 2. To provide metrological purity of pulsometric resarches, it is necessary to use calibration devices to define distortions caused by the pulse measuring system. 3. Correct pulso-and VAS-metry requires the obligtory application of the artifacts sensors as well as the seznsors fo testing (provoking VAS stimuli. 4. To achieve good reproductivity of pulsometry, it is necessary to use high-precision system of regulation of the sensors pressure force on the artery. 5. The pulse objectification allows to exclude (during VAS registrtion) dependance on the state of the researcher and removes the application of stabilizers and VAS amplifiers. 6. The results achieved during the test of our sensors ive us the right to say VAS takes place in all three positions of the Chinese pulse at various depth and on both extremities. At the same time its amplitude and characterologie peculiarities depend on the chosen pulse position, on the one hand, and the area of skin surface of the auricle under examination, on the other hand. 7. Experiments revealed that two standard reactions - positive and negative VAS - do not characterize all cases. In a number of experiments we registered several not typical pulse reactions that is curve inversion, strong VAS in oue ar two pulse positions and VAS is absent in two other pulse positions, variousratio of vector of pulse vibration in two or three pulse positions with regard to the medium line. These reactions are not typical because they do not correspond to the well-known typical pulse reactions, observed by auricular physicians. If we ignore the univeersally recognized opinion, these facts shall be considered rather important because the above mentioned not typical reactions could be observed in a bigf number of experiments, thus,they are not occasional and at jeast they shall be taken into consideration. Thus, many unquestionable observations give evident arguments in favour of the following view. In our opinion, VAS is in fact manysided. Both positive and negative pulse reactions are only two out of many VAS reflections. They require further serious and laborious study. 8. The application of the mosaic sensor allows to study the sspatial distribution of the pulse wave in the forme of three-dimension graphics (in one of the next issues of the international journal of auricular medicine we'll inform about practical results achieved with the help of the iven type of sensors). 9. Recorded by the mosaic sensor effects of the pulse pattern displacements (shifts) within the space of the neighbouring points allow to assume that the sigificant part of pulse reactions is esulted

in (is connectedto) displacement (shift= of a dynamic relief of pulsations. A profound research of subtle pulse structures gives the ground to assume that the reproducibility of he rresults will be a convincing one. It is doubtless that the development of the concept of our mosaic pulse sensor will make it possible to obtain some additional data on pulse, and to construct its real temporarily-spatial model, for construction of which we have gainedlready partial experimental data. 10. Appliicdation of the mosaic sensor allows to derive criteria for search of pulse areas, where ACR is most possible (probable). ACR is a border reaction occurring due to local displacement of a dynamic pulse relief, and therefore it is necessary to search ACXR zoznes either in the zones of unstable pulse, or in a zone of steady (stable) pulse but on the borderr of positive and negative pulsation vectors. Creation of the final version of such model will enable on the base of an observable pulse relief pattern to find zones, where pulser reactions are reproductible with maximal persuasiveness, since we are convinced that under the correct choice of the position of the mosaic sensor pulse reactions are well replicated and sharplly differ from artefact by their manifestations. 11. Pule reactions were rather convincingly observed when use of an ion of auiricle points were irritated by currents of small quantity. Quite good results were obtained when acupuncture points were irritated tactilely. In this case the exact hitting the point was essential. Some interesting reactions were observed during irradiation by white light (pendulum phenomenon), and acting by heat and cold. Application of a black and white hammer and a three volt hammer has not yiielded convincing ACR. At the given stage of researches we can make a conclusion, that exactly initiation by real physiological irritants shoows most convincing pulse reactions. 12. If the above tasks have been solved, it allows to get a big amount of additional information about the mechanism of the VAS origin and development : to study nuances of the pulse vibrations dynamics as one of the manifestations of the energy and information interrelation in the organism which will sharply increase the VAS diagnostic value.