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Headache (Pain)* Dizziness * Stiff-Neck * Neck (Pain) * Shoulder (Pain) * Chest (Pain) * Wrist Joint (Pain) * Tennis Elbow * Carpal Tunnel Pain * Lower and Upper Back (Pain) * Sciatic-Nerve Pain * Sprain of Ankle Joint * Immune System * Meridians/Channels Massage  * Prenatal Massage * Facial Massage* People who wants to lose weight * People who depress * People who want to sleep well * People who want to get Natural Energy

Chinese Kung-Fu - "Fist Principles" Train both Internal and External. External training includes the hands, the eyes, the body and stances. Internal training includes the heart, the spirit, the mind, breathing and strength.

Benefits & Herbal :


  Master Chien : (US Practicing Massage License MAE#2902, MAT#11676)

 

 Physical Benefits of Therapeutic Massage

Studies funded by the National Institutes of Health (NIH) have found massage beneficial in improving weight gain in HIV-exposed infants and facilitating recovery in patients who underwent abdominal surgery. At the University of Miami School of Medicine's Touch Research Institute, researchers have found that massage is helpful in decreasing blood pressure in people with hypertension, alleviating pain in migraine sufferers and improving alertness and performance in office workers.

An increasing number of research studies show massage reduces heart rate, lowers blood pressure, increases blood circulation and lymph flow, relaxes muscles, improves range of motion, and increases endorphins (enhancing medical treatment). Although therapeutic massage does not increase muscle strength, it can stimulate weak, inactive muscles and, thus, partially compensate for the lack of exercise and inactivity resulting from illness or injury. It also can hasten and lead to a more complete recovery from exercise or injury.

Research has verified that:

bullet Office workers massaged regularly were more alert, performed better and were less stressed than those who weren't massaged.
bullet Massage therapy decreased the effects of anxiety, tension, depression, pain, and itching in burn patients.
bullet Abdominal surgery patients recovered more quickly after massage.
bullet Premature infants who were massaged gained more weight and fared better than those who weren't.
bullet Autistic children showed less erratic behavior after massage therapy.

According AMTA, massage helps both physically and mentally.

 

bullet Alleviates discomfort during pregnancy

bullet Fosters faster healing of strained muscles and sprained ligaments; reduces pain and swelling; reduces formation of excessive scar tissue
bullet Reduces muscle spasms
bullet Provides greater joint flexibility and range of motion
bullet Enhances athletic performance; Treats injuries caused during sport or work
bullet Promotes deeper and easier breathing
bullet Improves circulation of blood and movement of lymph fluids
bullet Reduces blood pressure
bullet Helps relieve tension-related headaches and effects of eye-strain
bullet Enhances the health and nourishment of skin
bullet Improves posture
bullet Strengthens the immune system

bullet Treats musculoskeletal problems
bullet Rehabilitation post operative
bullet Rehabilitation after injury

 

(Source: AMTA)

Mental Benefits of Massage Therapy

 

bullet Fosters peace of mind
bullet Promotes a relaxed state of mental alertness
bullet Helps relieve mental stress
bullet Improves ability to monitor stress signals and respond appropriately
bullet Enhances capacity for calm thinking and creativity
bullet Emotional Benefits
bullet Satisfies needs for caring nurturing touch
bullet Fosters a feeling of well-being
bullet Reduces levels of anxiety
bullet Creates body awareness
bullet Increases awareness of mind-body connection

(Source: AMTA)

 Wang WK et al / Acta Pharmacol Sin 2003 Feb; 24 (2): 145-151

 

Evaluation of herbal formulas by pulse analysis method

 

WANG Wei-Kung1, HSU Tse-Lin1, BAU Jian-Guo2, WANG-LIN Yuh-Yin3,4

 

1Biophysics Laboratory, Institute of Physics, Academia Sinica, Nankang, Taipei, Taiwan 11529; 2Department of Physics,National Taiwan University, Taipei, Taiwan; 3Department of Physics, National Taiwan Normal University, Taipei, Taiwan, China

4 Correspondence to Dr WANG-LIN Yuh-Yang. Biophysics Lab, Institute of Physics, Academia Sinica, Nankang, Taipei, Taiwan 11529, China. Phn 886-2-788-0058, ext 2049. Fax 882-2-2783-4187. E-mail linhsu@phys.sinica.edu.tw

Received 2002-08-08 Accepted 2002-10-29

 

KEY WORDS pulse analysis; Chinese traditional medicine; Liu-Wei-Dihuang; Bai-Wei-Dihuang

 

ABSTRACT

AIM: To distinguish the component difference between two similar herbal formulas by pulse analysis method. Many Chinese herbs were found to have specific effects on the Fourier components of the blood pressure pulse; it might infer a specific blood redistribution process on the body and reflect the health conditions of specific organs or tissues. The pulse effect of an herbal formula was similar to the linear combination of all its herbal compositions. METHODS: Two different versions of the herbal formula Liu-Wei-Dihuang were fed to the Wistar rats as a single blind test. The blood pressure pulses on the rat tail artery were recorded and then transformed to the frequency domain by Fourier analyzer. RESULTS: Formula A, Bai-Wei-Dihuang, with two more herbs Cortex Cinnamomi and Radix Aconiti added to Liu-Wei-Dihuang, increased the harmonic proportion of the 1st harmonic (C1) but decreased C4, C5. Formula B is composed in the same way but without Rhizoma Batatatis and Poria cocos; it increased the DC of the pulse spectrum (C0), but decreased C2, C3, C4, C5, C6. CONCLUSION: The component adjustment of an herbal formula could be distinctly and quantitatively detected by pulse analysis method.

INTRODUCTION

Traditional Chinese herbal medicine has been developed for thousands of years and is still widely used for disease treatment as well as health care among Chinese. Lacking adequate scientific and systematic evaluation, the clinical effects of herbal medicine have largely been neglected or exaggerated.

Investigations on herbs include extraction of active components and tests of the effects of herbs on a number of physiological indices such as blood pressure, heart rate, hormone level, and so on[1-4]. These studies provided some useful aspects of the herbal effect, however, most of them hardly tell how an herb or an herbal formula functions as described in the Chinese medicine books.

We chose another approach to study Chinese medicine years ago. We found that many Chinese herbs including Rhizoma Coptidis, Panax ginseng, Ganoderma lucidum, Radix Paeonia Lactiforae, Radix Astragali, Radix Aconiti, Rehmannia glutinosa, Cortex Eucom-miae, Cornus officinalis, Paeonia suffruticosa, Poria cocos[5-10], Tuber Pinelliae, Radix Codonopsitis,and Pericarpium Aurantii[11], all had specific effects on the Fourier components of the blood pressure pulse. More than ever, these effects could be divided into different frequency groups which were well correlated with the meridian related herbal classifications as described in traditional Chinese medical literature. For the kidney meridian related herbs, Rehmannia glutinosa, Cortex Eucommiae, Cornus officinalis, Paeonia suffruticosa, and Radix Achyranthis, the major C2 and C3 increasing together with C5, C6 and C7 decreasing effects were in common[9,11]. For the spleen meridian related herbs, Poria cocos, Tuber Pinelliae, Radix Codonopsitis, Pericarpium Aurantii, Rhizoma Polygonati, Semen Lablab, Fructus Amomi Globosi, and Rhizoma Atractylodis Macrocephalae, they all had major C3 increasing effects[11]. For the lung meridian related herbs, Panax ginseng and American ginseng will both decrease C2 but increase C4[6]. Herbal formulas such as Xia-Jian-Zhon-Tang[7], Sie-Zie-Tang[8], Lui-Wei-Dihuang[9] were also studied. The collective effect of herbs in a formula was found to be mainly a linear additive effect on each harmonic of the individual effects of the main components.

Several lines of experimental evidence[12-17] strongly support the theory that the physical conditions of an organ or tissue (which might be the physical entity of the meridian) are related to specific Fourier components of the blood pressure pulse via their influence to the blood pressure wave propagation and thus the blood distribution to the body[18-22]. The variation of the physical conditions of an organ [such as clamping the artery to an organ) will be shown on the specific Fourier components of the blood pressure pulse spectrum[12-14,20]. The harmonic proportions will have a maximum decreasing effect at the 2nd harmonics if the renal artery were clamped, but the maximum decreasing effects will be at the 3rd harmonics if the splenic artery were clamped[12-14,20]. The pulse spectrums of the clinical patients with possible liver problems and chemical factory worker with abnormal blood test[16,17] indicated the liver-C1 relations; but the patients with acute uncomplicated myocardial infection indicated the heart-C0 [DC term of the pulse) relations[15]. Therefore, the pulse shape may reveal the status of the entire circulatory system in relation to the health condition. Any treatment that affects the condition of an organ or tissue will change the haemodynamic forces and therefore redistribute the blood supply[5,22]. This will show up as a variation of the corresponding harmonic, and could be detected by pulse analysis. The frequency-specific effect of herbal medicine is therefore indicated as a specific blood redistribution process on the body and may reflect the health conditions of specific organs or tissues as well. All the clues indicated that the C0 (DC term of the pulse) is related with the heart; the 1st harmonic is related with the liver (and the liver meridian); the 2nd harmonic is related with the kidney (and the kidney meridian); the 3rd for spleen, the 4th for lung, the 5th for stomach, the 6th for gall bladder, the 7th for bladder and so on.

As we know, Chinese doctors will usually change one or two herbal compositions of an origin herbal formula for different complex symptoms. These various compound prescriptions may keep part of the therapeutic effect of the origin formula but with some additional effects. For instance, Liu-Wei-Dihuang, a very popular six component construction herbal formula, is usually used to relieve the symptoms of some of the urinary and the sexual dysfunction as well as problems from the lower limbs. Nonetheless, Chinese doctors sometimes will prescribe "Gwei-Fu Bai-Wei-Dihuang" or "Zi-Bou Bai-Wei-Dihunag" for patients with different health status to improve the therapeutic effect of Liu-Wei-Dihuang. Each of the formula is composed by adding two more herbs in Liu-Wei-Dihuang. It is important to have an objective and quantifiable method to evaluate the effect of these formulas and to understand how exactly the effect varied with the change of the constituents in the prescribed herbs or drugs.

From our previous report[9], we have seen that Liu-Wei-Dihuang would increase the amplitude of the 2nd (C2) and the 3rd (C3) Fourier components of the blood pressure pulse spectrum but decrease the C4, C5 and C6. It can be asked whether pulse analysis is sufficiently sensitive to differentiate prescriptions in which one or two components are omitted.

In this report, two versions of Liu-Wei-Dihuang were studied in a single blind test. The sensitivity of the pulse analysis method was tested.

DISCUSSION

As we reported previously, Liu-Wei-Dihuang would significantly increase C2 and C3, but decrease C4, C5, C6, and C7[9]. It is inferred that Liu-Wei-Dihuang may increase the blood flow to the kidney (C2) and the spleen (C3) but decrease the blood flow to the higher resonance frequency organs and meridians, the lung (C4), the stomach (C5), the gall bladder (C6), and the bladder (C7). This inference is consistent with its therapeutic effects as described in the Chinese medicine books. The kidney and its related meridian are highly concerned with the healthy status of lower limb as well as the "Yin Qi". However, the stomach, the gall bladder, the bladder, and their related meridians are connected with the healthy status of the head as well as the "Yung Qi" [5,21]. Liu-Wei-Dihuang increased the blood flow to the kidney (C2) and the spleen (C3). This effect is emphasized on its tonic function. It may replenish the "Qi" in the "Yin" organs and revitalized the blood and is usually used to relieve the symptoms of the lower limbs[5,21].

The composition differences between formulas A and Liu-Wei-Dihuang are shown in Fig 1 and Fig 3. Formula A increased C0, but lowered the increasing effect on C2 and C3 of Liu-Wei-Dihuang. It may be less potent to push blood flow to the kidney (C2) and spleen (C3) with higher heart load (C0) than Liu-Wei-Dihuang. The two more herbs Cortex Cinnamomi and Radix Aconiti in formula A are fully responsible for the difference. Cortex Cinnamomi may increase C1 but decrease C2, C3 (Data was not reported). Radix Aconiti as a heart strengthens helps the heart work properly under the larger heart load[8]. The C1 increasing effect of Liu-Wei-Dihuang may reach the maximum in normal physiological range; there was no further increasing for formula A or formula B. Formula A, as the well-known Ba-Wei-Dihuang, it was prescribed for patients with weak fire (lower C1 together with weak heart). Compared with Liu-Wei-Dihuang, it helps push more "Qi" to the "Yung" organs instead of replenishing all of the "Qi" into the "Yin" organs (lower C2, C3, higher C5, C6, C7). Since the liver meridian and the bladder meridian are intercrossed around the prostate, formula A, with its increasing effect on the blood flow to the liver meridian (C1) together with the higher bladder meridian flow (C7), may contribute to the therapeutic effect on prostate function as well as the sex function on some extend.

Looking into Fig 2 and Fig 4, formula B was similar to formula A but decreased even more C2 and C3 and increased more C0. Formula B is composed in the same way as formula A but without Rhizoma Batatatis and Poria cocos. Without these two C2, C3 increasing herb[9], the amplitudes of the 2nd and 3rd harmonics were further reduced.

Formula B is a new product with much higher producing ratio and pushes even more "Qi" to the "Yung" organs (higher harmonics) than formula A does. Nonetheless, it pays with much lower potency of replenishing the "Qi" in the "Yin" organs and the tonic function to "Yin" is further reduced. Formula B may be more potent in helping sex function and prostate problems, however, it causes higher heart load (C0) and lower lung (C4) blood supply therefore has to be used only for patients with very healthy heart and lung functions. The detailed physiological changes of the rat body beyond the blood distributions may be very complicate, the inferences here are only the herbal effects on the blood redistribution.

All three herbal formulas decrease C4, C5, C6, however formula A and formula B have higher value of C5, C6 than Liu-Wei-Dihuang from roughly estimation. This tendency should be considered together with the different dose usage and the different producing ratios of these formulas. The producing ratio of formula A was 25 %, however without Rhizoma Batatatis and Poria cocos, the producing ratio of formula B was increased to 62.5%. There could be some other herbal components conjugated together with the polysaccharides of Rhizoma Batatatis and Poria cocos had been removed in the producing procedure of formula A. This could decline our inference to a certain extent; the pulse spectrum effect of formula B on C0 and C1 may be modified.

Similar pulse spectrum effects may come from various physiological origins. From the blood pressure wave propagation equation we derived[18,19], any changes such as the ways of the heart output, the property of blood vessels or even the viscosity of the blood, which influence the organ-main artery coupling conditions may all change the frequency characteristics of the vascular system. We found that the meridian related herbs were classified according to their effects on the frequency characteristics. The tonic kidney meridian related herbs are all having the similar pulse spectrum effect, the large C2 increasing effects with minor differences on other harmonics; they push more blood to nourish and therefore to enhance the healthy condition of the kidney and the kidney meridian. The spleen meridian related herb are all having large C3 increasing effects and push more blood to the spleen and the spleen meridian. Therefore, the pulse spectrum effect is not unique; two different herbs may both improve the health condition of the same organ and have very similar pulse spectrum effect but may be via completely different physiology mechanism. We may replace one component in an herbal formula by another herb (or by several herbs together) and having similar spectrum effect as well as similar therapeutic effect too. How to improve the "qi"(the pressure pulse) and the "blood" (the nourishment in the blood) is the central principle for Chinese medicine. A quantitative and scientific measurement of this principle is our goal. This study indicates that the herbal formula prescription is a delicate blood redistribution work, which may study from the pulse spectrum variation curves. If the heart output is the same, different herbal formulas simply redistribute blood to different places of the body. We adjusted the ratio of herbal components to make the linear combination of their effects on pulse to be the wanted way. We may first study one's pulse spectrum knowing his healthy status and then prescribe the right herbal formula to overcome the unhealthy inclination by redistributing more blood to the insufficient places. The pulse analysis method makes the quantitatively fine adjustment of herbal formula be possible.

The herbal effects on the pressure pulse were frequency specific and linear additively; the pulse effect of an herbal formula was an adding up of all its compositions accordingly.

As we have mentioned above, the herbal effects could be divided into different frequency groups, which were well correlated with the meridian related herbal classifications as described in traditional Chinese medical literature. Since the variation of the physical conditions of an organ or a group of tissue will be shown on the specific Fourier components of the blood pressure pulse spectrum[12-14,20-21], the pulse spectrum may reveal the health status of the entire circulatory system. It interlocks the frequency classified herbal effects with the health condition of the body. Therefore, We may further infer how the pulse effect will be influenced if a formula is changed somewhat and evaluate its health benefit accordingly.

This pulse analysis method can quantify the herbal effect and is closely related to fundamental Chinese medical theory; it helps herbal formulation be much reasonable and easier and makes the evaluation of clinical Chinese medicine therapy be possible. The therapeutic effect could be quantified and the obscure syndrome descriptions in Chinese medicine could be turn into clear modern scientific words.

 

REFERENCES

  • 1 Kubo M, Asano T, Matsuda H, Yutani S, Honda S. Studies on Rehmanniae Radix. 3. The relation between changes of constituents and improvable effects on hemorrheology with the processing of roots of Rehmannia-Glutinosa. Yakugaku Zassshi 1996; 116: 158-68.
  • 2 Lin HC, Ding HY, Wu TS, Wu PL. Monoterpene glycosides from Peonia-Suffruticosa. Phytochemistry 1996; 41: 237-42.
  • 3 Tseng J, Tsui LL. Si-Jun-Zi-Tang regulate granulocyte macrophage colony-stimulating factor secretion by human peripheral blood mononuclear cells. Am J Chin Med 1996; 24: 45-52.
  • 4 Yoshikawa M, Yamaguchi S, Matsuda SH, Tanaka N, Yamahara J, Murakami N. Crude drugs from aquatic plants. V. On the constituents of alismatisrhizoma. (3). Stereostructures of water-soluble bioactive sesquiterpenes, sulfoorientalols-a, b, c, and d from Chinese alismatis rhizoma. Chem Pharm Bull 1994; 42: 2430-5.
  • 5 Wang WK, Hsu TL, Chen HL, Wang YY. Blood pressure and velocity relation in tissue. In: Liepsch HD, editor. Biofluid mechanics. Proceedings of the 3rd International Symposium. Munich (Germany) 1994 July 16-19. p 119-32.
  • 6 Wang WK, Chen HL, Hsu TL, Wang YY. Alterations of pulse in human subjects by three Chinese herbs. Am J Chin Med 1994; 22: 197-203.
  • 7 Wang WK, Hsu TL, Huang ZY, Wang YY. Collective effect of a Chinese formula-a study of Xiao-Jian-Zhong-Tang. Am J Chin Med 1995; 23: 299-304.
  • 8 Wang WK, Hsu TL, Chiang Y, Wang YY. Pulse spectrum study on the effect of Sie-Zie-Tang and Radix Aconiti. Am J Chin Med 1997; 25: 357-66.
  • 9 Wang WK, Hsu TL, Wang YY. Liu-Wei-Dihuang: a study by pulse analysis. Am J Chin Med 1998; 26: 73-82.
  • 10 Wang-Lin YY, Sheu JI, Wang WK. Alterations of pulse by Chinese herb medicine. Am J Chin Med 1992; 20: 181-90.
  • 11 Wang WK, Bau JG, Hsu TL, Wang YY. Pulse study on spleen meridian related herbs. Am J Chin Med 2000; 28: 279- 89.
  • 12 Young ST, Wang WK, Chang LS, Kao TS. Specific frequency properties of the renal and the supermesenteric arterial beds in rats. Cardiovasc Res 1989; 23: 465-7.
  • 13 Young ST, Wang WK, Chang LS, Kao TS. The filter properties of the arterial beds of organs in rats. Acta Physiol Scan 1992; 145: 401-6.
  • 14 Yu GL, Wang YL, Wang WK. Resonance in the kidney system of rats. Am J Physiol 1994; 267 (4 Pt 2): H1544-8.
  • 15 Chen CY, Wang WK, Kao T, Chen BC, Chiang C. Spectral analysis of radial pulse in patients with acute uncomplicated myocardial infection. Jpn Heart J 1993; 34: 37-49.
  • 16 Wang WK, Tsuei J, Chang HC, Hsu TL, Lin YY. Pulse spectrum analysis of chemical factory workers with abnormal blood test. Am J Chin Med 1996; 26: 199-203.
  • 17 Lu WA, Cheng CH, Wang-Lin YY, Wang WK. Pulse spectrum analysis of hospital patients with possible liver problems. Am J Chin Med 1996; 24: 315-20.
  • 18 Wang YY, Chang SL, Wu YE, Hsu TL, Wang WK. Resonance-the missing phenomena in hemodynamics. Circ Res 1991; 69: 246-9.
  • 19 Wang YY, Chang CC, Cheng JC, Hsiu H, Wang WK. Pressure wave propagation in arteries. A model with radial dilatation for simulating the behavior of a real artery. IEEE Eng Med Biol Mag 1997: 16: 51-6.
  • 20 Wang WK, Lo YY, Chiang Y, Hsu TL, Wang YY. Resonance of organs with the heart. In: Young WJ, editor. Biomedical engineering-an International Symposium. Washington: Hemisphere; 1989. p 259-68.
  • 21 Jan MY, Chen KJ, Hsu TL, Wang WK. Effects of acupuncture on the blood pressure pulse spectrum and microvascular flow. In: Litscher G, Cho ZH, editors. Computer-controlled acupuncture. Lengerich; Berlin: Pabst Science publication; 2000. p179-92.

 

 

 

Disturbance of macro- and microcirculation: relations with pulse pressure and cardiac organ damage

Michel E. Safar1 and P. Lacolley2

1Paris-Descartes University, Faculty of Medicine; Hôtel-Dieu Hospital, Diagnosis Center Assistance Publique-Hôpitaux de Paris, Paris, France; and 2Faculté de Médecine de Nancy, Nancy University, Nancy, France

    ABSTRACT
 TOP
 ABSTRACT
 REFERENCES

 
Whereas large arteries dampen oscillations resulting from intermittent ventricular ejection, small arteries steadily deliver optimal blood flow to various organs as the heart. The transition from pulsatile to steady pressure is influenced by several factors as wave travel, damping, and reflections, which are mainly determined by the impedance mismatch between large vessels and arteriolar bifurcations. The mechanism(s) behind the dampening of pressure wave in the periphery and the links between central and peripheral pulsatile pressure (PP) may determine cardiac damage. Active pathways participate to pulse widening and changes in pulse amplitude in microvessels. Steady and cyclic stresses operate through different transduction mechanisms, the former being focal adhesion kinase and the latter being free radicals and oxidative stress. Independently of mechanics, calcifications and attachment molecules contribute to enhance vessel wall stiffness through changes in collagen cross-links, proteoglycans, integrins, and fibronectin. Enhanced PP transmission may thus occur and precipitate organ damage at each time that autoregulatory mechanisms, normally protecting the heart from vascular injury, are blunted. Such circumstances, observed in old subjects with systolic hypertension and/or Type 2 diabetes mellitus, particularly under high-sodium diet, cause cardiac damage and explain why increased PP and arterial stiffness are significant predictors of morbidity and mortality in the elderly.

 

 

microvessels; end-organ damage

 


CARDIAC COMPLICATIONS, a major cause of mortality, are traditionally attributed to alterations of the cardiac pump and/or to intrinsic modifications of myocardial cells. The damage due to changes in arterial and arteriolar alterations is less frequently taken into consideration to explain cardiac events. The goal of this report is to summarize the principal consequences of a disturbed macro- and microcirculation on cardiac mortality. A necessary prerequisite for this purpose is to define in humans the principal characteristics of arterial and arteriolar functions.

The major goal of large arteries is to deliver an adequate blood supply from the heart to peripheral tissues, as dictated by metabolic activity. Conduit-function efficiency, which is the consequence of the width of the arteries and their very low resistance to flow, is primarily dependent on the diameter of the arterial lumen, which reacts to endothelial function and shear stress (30, 31). Atherosclerosis, which is the most common vascular disease disturbing conduit function, is considered to dominate cardiovascular (CV) risk in each individual (30, 31).

In addition to conduit function, large arteries have a cushioning function that consists to dampen the pressure oscillations resulting from intermittent ventricular ejection and to transform the pulsatile flow of arterial vessels into the steady flow required for oxygen supply. The efficiency of cushioning function depends on the viscoelastic properties of arterial walls and the vascular geometry, including diameter and length. Stiffening of arterial walls results in an increase of systolic (SBP) and a decrease of diastolic (DBP) blood pressure (BP) and therefore a high pulse pressure (PP). PP, arterial stiffness, and central wave reflections are independent predictors of CV risk, particularly for CV diseases and mainly for myocardial infarction (30). Increased PP is associated with higher SBP, which promotes cardiac hypertrophy, and with decreased DBP, which favors myocardial ischemia. The pathophysiological consequences of defective cushioning function, which differ consistently from those observed in subjects with atherosclerosis, affect mainly the heart and coronary vessels and thus are mainly located upstream. In contrast, the downstream consequences of defective cushioning function have been poorly explored in the literature (23, 26, 27, 30, 31). In many situations, such as those observed in diabetes mellitus and systolic hypertension, a microvascular disease is observed in the elderly, in association with end-organ damage affecting the kidney (proteinuria and chronic renal failure), the brain (retinopathy and/or dementia), and/or the heart (coronary ischemia without evidence of atherosclerosis) (23). In most of these situations, the contribution of PP, arterial stiffness, and wave reflections in the mechanism(s) of end-organ damage has not been extensively explored.

The purpose of this review is to determine, in the mechanism of CV risk, the possible consequences of heightened PP, arterial stiffness, and wave reflections on macro- and microvessels and to evaluate in which conditions such alterations may affect CV risk of vital organs, including the heart. Our working hypothesis is that, particularly in the elderly, PP may be transmitted to microvessels in each circumstance where the blood flow autoregulatory mechanisms normally protecting vital organs are offset. After the principal basic concepts on macro- and microvessels have been defined in this review, the two main questions will be: first, how may an exacerbation of PP widening be observed in the elderly? Second, why and how could the autoregulatory mechanisms normally protecting the brain, the kidney, and mainly the heart be offset?

Basic Concepts on Macro- and Microvessels

Because this report requires an analysis of the principal factors modulating the transition between pulsatile and steady pressure along the arterial tree, it is necessary to summarize (Fig. 1) the most traditional structural and functional aspects of the macro- and microcirculation in humans. It is worth noting that arterial diameter in the microvascular network is considered to be below the value of 150 µm (23, 27).

Figure 1
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Fig. 1. Summary of the structure and function of the different compartments of the arterial tree (see Refs. 30 and 31).

 

 
Pulsatile pressure and large arteries. Following ventricular ejection, BP propagates along the arterial tree as a wave (Fig. 2). At each discontinuity of the arterial wall, this wave may be "reflected" and then becomes retrograde (30, 31). Arteriolar branching is considered to be the main sites of wave reflections (Fig. 2). As a consequence of the summation of incident and reflected waves at each discontinuity of the arterial wall, SBP and PP are physiologically higher in peripheral than in central arteries, whereas mean arterial pressure (MAP) and DBP remain practically unchanged along the arterial trajectory. For each given artery, the summation of the forward and the reflected wave is influenced by several factors (Fig. 2): the velocity of the wave [i.e., pulse wave velocity (PWV); the higher the PWV, the higher the arterial stiffness], the degree of arterial lumen diameter mismatch with amplitude reflection (small diameter results in higher amplitude), and the aortic length (wave reflection is closely correlated with arterial length and hence body height). In young, healthy, tall subjects, the wave summation takes place low in the abdominal aorta, in early diastole, thus boosting the diastolic coronary perfusion without disturbing cardiac afterload (30, 31). A stiffer aorta with greater PWV, aortic branches with smaller lumen diameters, and shorter stature cause the reflections to occur in late systole (rather than in diastole as in healthy individuals). Under this condition, i.e., with the pressure wave occurring earlier and closer to the aortic valve and coronary sinuses during systole, coronary perfusion is impaired, leading to myocardial ischemia. SBP is augmented through an additional increase due to wave reflections. These are classical situations, particularly observed in diabetic and elderly subjects, where systolic hypertension is frequently present (23, 26, 27, 30, 31). Finally, it appears that the particular site of each vessel branching and the geometrical characteristics of each resistance vessel are critical points for the understanding of increased SBP, PP, end-organ damage, and their relationships.

Figure 2
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Fig. 2. Propagation of the pressure wave along the arterial tree. Propagation needs a given velocity [pulse-wave velocity (PWV) as in 1]. Reflections mainly occur at the sites of arteriolar branching points (2). The blood pressure (BP) curve represents the summation between the forward and the reflected waves (3) (see Refs. 30 and 31).

 

 
Steady pressure and microvascular network. At the end of the arterial system (diameter < 150–158 µm), the complex network of small arteries and arterioles represents the resistance vasculature in which a nearly steady flow is achieved. Accordingly, a small but consistent loss in pressure gradient is noted from larger to smaller arteries, including capillaries (31). Finally, a very low intraluminal pressure is obtained, which is necessary for capillary exchanges. This requires, according to age, adaptive changes of the microvascular network, as well as in normotensive, hypertensive, or diabetic populations. According to the Poiseuille's law, these changes may affect the viscosity of blood, the diameter of individual microvessels, but also their length and their number (density), with wide variations according to each organ, particularly the heart.

Classically, the changes in vascular resistance observed from the conduit arteries to the microcirculation occur very abruptly over the short distance of the path between arteries and veins (Fig. 3). The very high resistance over a short pathway is mainly located in prearteriolar vessels and causes MAP to fall precipitously over this distance (15, 30). Thus high resistance is associated with a reduction of both pulsatile phenomena and steady flow (Fig. 3), resulting in quasi-total steady flow through resistance vessels. Arterial pulsations that cannot enter high-resistance vessels are reflected and combined with pressure waves approaching the area of high resistance, thereby contributing to the occurrence of backward pressure wave (30, 31). Finally, through the control of pressure-induced arteriolar myogenic tone, the circulations of the main organs, such as the brain, the heart, and the kidney, are normally highly protected from the systemic BP changes, which initially involve both a steady and a pulsatile component (Figs. 2 and 3). In this review, the complete description of myogenic tone as well as of organ autoregulation (23, 27, 30) will be considered as out of the scope of the study.

Figure 3
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Fig. 3. Description of the transition from the pulsatile to the steady pressure (see Refs. 30 and 31). Left: physiological BP changes. Right: modelization of the system. Curves 1 and 3 represent the normotensive and hypertensive curves, both leading to the same low capillary pressure. To avoid an increased capillary pressure (as in curve 2) in hypertension, an adaptation of the mechanosensitive vasomotor function of endothelium is required (arrow; see Ref. 15).

 

 
Age, PP, and autoregulatory mechanisms protecting the brain, heart, and kidneys from organ damage. The hemodynamic model described in this report is well adapted to the understanding of normal capillary exchanges and to the pathophysiological mechanisms resulting from increased cardiac load. This model cannot adequately describe in which conditions a defective cushioning function may have downstream deleterious consequences on microvessels and finally affect vital organs, such as the brain, the heart, and the kidney.

An increase in arterial stiffness with age, which was in the past considered as uncommon in acculturated societies (30, 31), is nowadays constantly observed in industrialized countries and even studied as a "physiological" phenomenon. With age, the increased stiffness, which initially predominates on central large arteries, affects the pressure wave of all systemic arteries (23, 27, 30, 31). Since the incident and reflected waves summate and are additive, a general rise of SBP and PP throughout arterial system is observed (30). Pressure wave contour and amplitude become similar in all arteries and then reach peripheral organs. Recent data have shown that, in healthy cohorts with a minimal burden of CV risk factors, a "physiological" age-related increase in aortic stiffness, compared with peripheral arterial stiffness, is associated with an increasing forward wave amplitude and PP, with even reversal of the arterial stiffness gradient (26). Thus, with aging, together with the presence of endothelial dysfunction and oxidative stress, there is a facilitation of the forward transmission of pressure pulsations into the peripheral organs, with potential deleterious consequences. This hemodynamic profile may be particularly relevant to consider for the kidney (30).

The diffusion of pulsatility, which nowadays has been observed much deeper than it was thought in the past (23, 27), may occur very close to the heart, the brain, and the kidneys, depending not only on age but also on the site and the characteristics of each organ. For instance, whereas the perfusion of coronary arteries occurs exclusively during the diastolic time, the brain and the kidney receive relatively high flow at rest during both systole and diastole. For these simple reasons, the key arterial segments in which blood flow is changed from pulsatile to steady flow may differ according to the geometry and structure of each vascular territory. As far as the mechanism(s) of myogenic tone is (are) concerned, it is worth noting that myogenic tone differs from flow dilation, particularly regarding the role of endothelial function and control of diameter changes (5). In fact, the two processes may be difficult to differentiate in each organ because several aspects of the physiology of arterial vessels, including flow-dependent responses, are not restricted (as myogenic tone) to vessels of particular size. Thus it cannot be excluded that, in some examples, myogenic tone and flow-dilation affect the lumen diameter differently and even in opposite directions (5, 23, 26, 31).

Finally, two different mechanisms are required for an effective but pathological transmission of PP toward vital organs: an excessive widening of PP and a defective pressure-induced myogenic tone (15). Both are commonly observed in aged people, particularly in subjects undergoing a high-sodium diet and/or with systolic hypertension and/or diabetes mellitus (25, 28, 32).

Mechanisms of PP Extent and Diffusion

In recent years, it has been shown that PP interacts with the arterial wall through transduction mechanisms independent of MAP. Indeed, at any given value of MAP, the arterial wall becomes stiffer in the presence, than in the absence, of pulsatile stimulus (30, 31). Furthermore, calcifications and attachment molecules are able to increase arterial stiffness independently of both systemic MAP and the amounts of elastin and collagen within the vessel wall (30).

Cyclic mechanical factors and the arterial wall. Since the pioneering studies of Glagov (10), many investigations (12, 21, 30, 31, 35) have studied the effect of cyclic forces on the arterial wall, particularly on endothelial cells exposed to pulsatile shear stretch in vitro (12, 21, 30, 31, 35). The role of cyclic shear stress (as opposed to steady stress) and the importance of stimulus duration and graded responses to mechanical forces have been investigated, particularly regarding nitrite oxide and super oxide anions (12). Cyclic mechanical strain has also been examined, mostly in cultured vascular smooth muscle (VSM) cells. Long-term cyclic distention enhances the mechanical properties of collagen-based medial components and even heightens collagen and fibronectin (FN) accumulations in animal or human VSM models (12, 21, 35). The vessel/wall materials become stronger and stiffer than those obtained under static conditions.

A distinct feature of VSM cells is their phenotypic plasticity, particularly during the transition from the contractile to the synthetic phenotype of VSM cell cultures in the absence of mechanical forces (21). Exposing cultured VSM cells to cyclic stretch can restore the expression of high-molecular weight caldesmon and other markers of differentiated VSM cells. A certain degree of stretch is necessary for the preservation of the VSM contractile state (21). Hence, the failure to maintain a threshold level stretch is likely to contribute to VSM cell transformation.

Stretch initiates complex signal transduction cascades leading to gene transcription and functional responses via interaction of integrins with extracellular matrix proteins or by stimulation of G protein receptors, tyrosine kinase receptors, or ion channels (reviewed in Ref. 3). The intracellular pathways reported to be activated by cyclic stretch in VSM cells include mainly the mitogen-activated protein kinase cascades and nuclear factor-{kappa}B (21, 30), which have been studied at both VSM and endothelial levels. More recently, steady and cyclic modes of stretch have been shown to transduce differently in the aorta, the former implicating focal adhesion kinase and the latter free radicals as derived from oxidative stress and the presence of inflammatory factors (19, 20) (Fig. 4).

Figure 4
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Fig. 4. Schematic representation of the different pathways of mechanotransduction for steady and pulsatile stretch (19, 20). The representation is oversimplified but obviously shows that the two mechanisms of stretch differ consistently. FAK, focal adhesion kinase; ROS, reactive oxygen species; MAP, mean arterial pressure (see Refs. 19 and 20).

 

 
Finally, the transcriptional profile of mechanically induced genes in VSM cells subjected to a uniform biaxial cyclic strain has been studied (18). Cyclic stretch was found to stimulate the expression of a number of genes, including vascular endothelial growth factor and plasminogen activator inhibitor-1, but to negatively regulate others, such as extracellular matrix metalloproteinase-1 and thrombomodulin.

Nowadays, the differential effects of steady and pulsatile forces should be considered as obvious, even if several of them have been investigated only in vitro (12, 21). The corresponding in vivo findings remain scarce. Most of them are simply deduced from human epidemiological investigations, indicating that pulsatile stress, as represented by PP, wave reflections, and/or arterial stiffness, is a more adequate predictor of CV risk than steady stress. In humans, steady stress is traditionally represented by the height of brachial SBP or DBP (30).

Stiffness of wall material, calcifications, and attachment molecules. In recent years, studies on rodents have shown that, particularly in old age, with diabetes mellitus, and/or in subjects on a high-sodium diet, arterial calcifications (not described in this review) and attachment molecules (between VSM cells, or VSM cells and extracellular matrix proteins, or between collagen fibers) contribute per se to stiffen the vascular wall (2, 30).

Cross-links may stabilize collagen fibrils, preventing slippage of adjacent molecules under applied tensile stress (30) and contributing to increased arterial stiffness through formation of end-glycation products (34). In elderly subjects with systolic hypertension, drugs involving collagen cross-link breakers acutely reduce arterial stiffness and PP without any change in MAP (34). Glycosaminoglycans exhibit viscoelastic properties, which make them good candidates as flow-sensing molecules, binding sodium and calcium ions in their helicoidal chains (1). Removal of 65% of chondroitin-dermatan sulfate-containing glycosaminoglycans from mesenteric resistance arteries increases their stiffness (8). In carotid arteries of spontaneously hypertensive rats (SHR), a chronic high-sodium diet results in a reduction in arterial hyaluron and enhanced aortic stiffness (6).

Because integrins transmit inside-out and outside-in signals capable of modulating vascular responses, Lacolley and colleagues (2) suggested that adhesion molecules, such as FN and its integrin receptor(s), might contribute per se to change arterial wall stiffness (2). FN-matrix polymerization increases tensile strength of model tissue (9). In young and old SHR, measurements of aortic FN indicate that an increased number of attachment sites between VSM cells and extracellular matrix proteins may contribute to enhance arterial rigidity (2). On a normal sodium diet, angiotensin-converting enzyme inhibition (ACEI) reduces MAP and PP, together with a reduction in aortic FN and {alpha}5beta1 integrin and an increase in isobaric arterial distensibility (16). With ACEI plus a high-sodium diet, MAP is significantly reduced, but PP and arterial stiffness, as well as aortic FN, remain enhanced. Similar results have been obtained when chronic administration of aldosterone is combined with a high-sodium diet in Sprague-Dawley rats (17). In this latter experiment, the enhancement in FN and stiffness are reversed by an administration of the selective aldosterone antagonist eplerenone (17).

In conclusion, local changes in the attachments between VSM cells and extracellular matrix, as well as arterial calcification, may independently modulate the stiffness of each artery taken individually. All these pathophysiological mechanisms also contribute to the development of new sites of wave reflections. Finally, the extent of disturbed arterial stiffness and wave reflections in each individual subject is largely influenced by the vascular territories involved and by the patient's age. In some cases, as in subjects with obesity and/or insulin resistance, arterial stiffness is increased with minor changes in wave reflections (30, 31). In most cases, both parameters are increased in parallel. For all patients, bidirectional interactions develop between increased PP and enhanced wall stiffness, thus creating a vicious circle and increasing the risk of CV complications (30, 31).

PP, Arterial Stiffness, and Cardiac Damage

In the coronary circulation, autoregulation is a quite powerful process protecting the heart, exactly as in the renal and cerebral circulations (28). However, there are two main particularities. First, in old people and in subjects with hypertension and/or atherosclerosis, the coronary reserve is markedly reduced very early. This situation, which affects primarily the arteriolar and prearteriolar resistance of the coronary circulation, may also alter consistently the capillary network. Second, because of the constantly contracting effect of cardiac muscle, the coronary perfusion pressure is represented exclusively by DBP, and not by MAP, as in the totality of the other organs as the brain and the kidney.

Within the heart, capillary pressure is, in general, very difficult to determine, so cautious interpretations are necessary. However, it is generally admitted that capillary hydrostatic pressure should be considered to be held constant at all times (23). The coronary arterioles (ranging in size from 150 to 300 µm) act as the main resistance vessels (4, 14). The capillaries are very small but, at least in some models, offer an additive role of high resistance to flow. Because they are arranged in parallel, the total capillary resistance may decrease markedly with the increasing number of capillaries (14).

When hyperaemia is induced in the normal coronary circulation, smooth muscle relaxation results in dilatation of the arterioles and venules with little change in the capillaries (14). The total myocardial vascular resistance decreases and, because of the similar decreases of arterial and venular resistances, the capillary hydrostatic pressure remains largely unchanged (14). However, under such circumstances, the specific contribution of capillary resistances in the total myocardial vascular resistance may become very high. Thus capillaries may generate the most resistance to coronary blood flow during hyperemia and even define an upper limit to the effects of this hyperemia (14). Because they lie in parallel, the more numerous the capillaries, the higher the hyperemia, and, vice versa, the fewer the numbers of capillaries, the lower the hyperaemia (14, 23). Because, in several circumstances, cardiac hypertrophy is present, the intercapillary distance is widely augmented and contributes to myocardial hypoperfusion and to a reduction of oxygen delivery (11, 23). Finally, conditions associated with fewer capillaries (either anatomically or functionally, as for instance, under high-sodium diet), such as observed in myocardial infarction, hypertension, or diabetes, are also associated with reduced coronary reserve even in the absence of coronary stenosis (23, 33). In recent years, therapeutic programs in rats models have confirmed the respective contribution of arterioles and capillaries in the mechanism of neovascularization of coronary and leg arteries (24, 33). In cardiac models, ACEI by perindopril alone increases only arteriolar density, whereas the diuretic indapamide increases only capillary density. Exclusively, the combination of both ACEI and diuretic improves the density of the total microvascular network (arterioles and capillaries). Such results fit well with the opposite effects that are widely observed on cardiac microvessels under high-sodium intake, administration of angiotensin II, or their combination (7, 11).

From a clinical viewpoint, when coronary reserve is markedly reduced, the almost unique hemodynamic factor determining coronary perfusion remains aortic DBP, particularly in subjects with coronary atherosclerosis (13). A low DBP favors myocardial ischemia as a consequence of either low systemic vascular resistance or increased arterial stiffness or a combination of both factors (30, 31). In subjects with hypertension, drug treatment markedly reduces systemic vascular resistance and hence MAP and DBP. In contrast, drug treatment has little effect on arterial stiffness, which increases "physiologically" with age, independently of changing MAP and vascular resistance. Thus, as a consequence of an age-induced increase of arterial stiffness, aortic DBP and coronary blood flow tend to fall (22), whereas SBP and PP rise in parallel, thus favoring the development of cardiac hypertrophy (30, 31). Finally, the deleterious effects of increased PP on the heart completely differ from that of PP on the brain and the kidney (28). Because of the exclusive diastolic perfusion of the heart, increased SBP is not transmitted to microvessels but only contributes to enhance the size of myocardial cells. The low DBP, on the other hand, markedly affects myocardial perfusion. Finally, cardiac hypertrophy is associated with an increased intercapillary distance, which is associated with reduced oxygen delivery, particularly in the subendocardial territory (13, 23). Probably for all these reasons, the drug treatment of hypertension prevents myocardial infarction, but less successfully than stroke (30, 31).

Prospective Views

The transition of pulsatile pressure and flow from larger to smaller arteries is traditionally conceived as a pure adaptive phenomenon, mainly due to the progressive and passive narrowing of the vessels and contrasting with powerfully active autoregulatory mechanisms protecting vital organs as the brain, kidney, and heart. With age and under several pathophysiological situations as those observed in diabetes mellitus, systolic hypertension, and high-sodium diet, active mechanisms develop and contribute to associate increased arterial stiffness, widened PP, and defective protection of organ blood flow autoregulatory mechanisms. Even in the presence of normal steady pressure, enhanced BP transmission results from increased PP and finally determines cardiac damage. For the heart, this situation is particularly complex since the cardiac intermittent contraction is responsible per se for both increased PP and coronary perfusion exclusively in diastole. However, for the heart as for all varieties of end-organ damage, the same consequence occurs: a hypoperfusion of the corresponding organ. This alteration is in turn exacerbated by the presence of capillary rarefaction, which predominates in hypertrophied (the heart) much more than in atrophied (the kidney and brain) organs.

This report has also shown that all these mechanisms have a common denominator: the presence of a defect in the elasticity of the CV tissues. This finding reflects modern aspects of CV epidemiology in which not only atherosclerosis and the heights of SBP and DBP are predictors of CV risk but also other CV mechanical factors involving the macro- (arterial stiffness, wave reflections, and PP) (30) and microcirculation (structural changes of the arterioles) (29).

    ACKNOWLEDGMENTS

 
This study was performed in relation with Institut National de la Santé et de la Recherche Médicale and Groupe de Pharmacologie et d'Hémodynamique Cardiovasculaire (Paris, France). We thank Dr. Anne Safar for pertinent discussions.

 

    FOOTNOTES

 


Address for reprint requests and other correspondence: Michel Safar, Centre de Diagnostic, Hôtel-Dieu, 1, place du Parvis Notre-Dame, 75181 Paris Cedex 04 (e-mail: michel.safar@htd.aphp.fr )

 

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IEEE Trans Biomed Eng. 2004 Jan;51(1):193-5. Related Articles, Links


Comment in:
IEEE Trans Biomed Eng. 2004 Jan;51(1):196-7.

The natural frequencies of the arterial system and their relation to the heart rate.

Lin Wang YY, Jan MY, Shyu CS, Chiang CA, Wang WK.

Department of Physics, National Taiwan Normal University, no. 88, Sec. 4, Ting-Chou Rd., Taipei 116, Taiwan. yuhying@phy03.phy.ntnu.edu.tw

We assume the major function of the arterial system is transporting energy via its transverse vibration to facilitate the blood flowing all the way down to the microcirculation. A highly efficient system is related to maintaining a large pressure pulse along the artery for a given ventricular power. The arterial system is described as a composition of many infinitesimal Windkessels. The strong tethering in the longitudinal direction connects all the Windkessels together and makes them vibrate in coupled modes. It was assumed that at rest condition, the arterial system is in a steady distributed oscillatory state, which is the superposition of many harmonic modes of the transverse vibration in the arterial wall and the adherent blood. Every vibration mode has its own characteristic frequency, which depends on the geometry, the mass density, the elasticity, and the tethering of the arterial system. If the heart rate is near the fundamental natural frequency, the system is in a good resonance condition, we call this "frequency matching." In this condition, the pulsatile pressure wave is maximized. A pressure wave equation derived previously was used to predict this fundamental frequency. The theoretical result gave that heart rate is proportional to the average high-frequency phase velocity of the pressure wave and the inverse of the animal body length dimension. The area compliance related to the efficiency of the circulatory system is also mentioned.

------

Pacing Clin Electrophysiol. 2003 Jan;26(1 Pt 1):36-43. Related Articles, Links


Influencing the heart rate of rats with weak external mechanical stimulation.

Hsiu H, Jan MY, Wang YY, Wang WK.

Department of Electric Engineering, National Taiwan University, Taipei, Taiwan.

The ventricular-arterial coupling is assumed to minimize the expenditure of cardiac energy. From the conjecture of the resonance theory, the arterial system transmits pressure waves and resonates with the heartbeat, therefore, the arterial system is similar to a mechanical resonator. Theoretically, the heart rate can be paced with weak external mechanical stimulation and corresponding blood pressure changes can be observed. A waterbed was activated to generate 0.5-mmHg pressure vibrations as a stimulus and the rate was set to deviate 5% from the control heart rate. Among 13 studies on seven rats, the linear regression between X (stimulation frequency--control heart rate) and Y (actual changes of the heart rate) is Y = 0.992X = 0.062 (Hz) with a correlation coefficient of 0.97 (Y = X implies complete steering). The intercorrelation coefficient between the change in mean blood pressure and the heart rate was 0.79. The study showed that this weak mechanical stimulation influences the heart rate, and the blood pressure changes according to the heart rate. Cardiovascular optimization and the resonance theory may explain the way one may regulate the heart rate and the blood pressure of humans noninvasively in the future.

----

Acta Pharmacol Sin. 2003 Feb;24(2):145-51. Related Articles, Links


Evaluation of herbal formulas by pulse analysis method.

Wang WK, Hsu TL, Bau JG, Wang-Lin YY.

Biophysics Laboratory, Institute of Physics, Academia Sinica, Nankang, Taipei, Taiwan 11529, China.

AIM: To distinguish the component difference between two similar herbal formulas by pulse analysis method. Many Chinese herbs were found to have specific effects on the Fourier components of the blood pressure pulse; it might infer a specific blood redistribution process on the body and reflect the health conditions of specific organs or tissues. The pulse effect of an herbal formula was similar to the linear combination of all its herbal compositions. METHODS: Two different versions of the herbal formula Liu-Wei-Dihuang were fed to the Wistar rats as a single blind test. The blood pressure pulses on the rat tail artery were recorded and then transformed to the frequency domain by Fourier analyzer. RESULTS: Formula A, Bai-Wei-Dihuang, with two more herbs Cortex Cinnamomi and Radix Aconiti added to Liu-Wei-Dihuang, increased the harmonic proportion of the 1st harmonic (C1) but decreased C4, C5. Formula B is composed in the same way but without Rhizoma Batatatis and Poria cocos; it increased the DC of the pulse spectrum (C0), but decreased C2, C3, C4, C5, C6. CONCLUSION: The component adjustment of an herbal formula could be distinctly and quantitatively detected by pulse analysis method.

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Am J Chin Med. 2000;28(2):279-89. Related Articles, Links


Influence of spleen meridian herbs on the harmonic spectrum of the arterial pulse.

Wang WK, Bau JG, Hsu TL, Wang YY.

Biophysics Lab, Institute of Physics, Academia Sinica, Nankang, Taipei, Taiwan.

Pulse analysis is a powerful method in Chinese medicine. We suggest that the effect of herbal medicine is to redistribute the blood to organs and meridians. In this report, by injecting extracts into rats and then analyzing the blood pressure wave measured at the caudate arteries, we studied eight important spleen meridian related herbs: They were Semen Lablab, Fructus Amomi Globosi, Rhizoma Atractylodis Macrocephalae, Rhizoma Atractylodis, Tuber Pinelliae, Radix Codonopsitis, Pericarpium Aurantii and Rhizoma Polygonati. All eight herbs increased the intensity of the 3rd harmonic (C3) of the pressure pulse which is correlated to the spleen and spleen meridian, as described in traditional Chinese medical literature. All of them also increased the 2nd harmonic (which is correlated to the kidney and the kidney meridian) as well as decreased the heart load (DC term of pressure wave, C0). Tuber Pinelliae, Radix Codonopsitis, Pericarpium Aurantii and Rhizoma Polygonati decreased the 1st harmonic (correlated to the liver meridian) significantly, while Rhizoma Atractylodis Macrocephalae only decreased C1 slightly. Except for Semen Lablab, all the others decreased the intensity of the 5th (stomach meridian) and the 7th harmonics. The effects of kidney herbs: Cortex Eucommiae and Radix Achyranthis were also shown for comparison.

--------

IEEE Eng Med Biol Mag. 2000 May-Jun;19(3):106-11. Related Articles, Links


The importance of pulsatile microcirculation in relation to hypertension.

Jan MY, Hsiu H, Hsu TL, Wang YY, Wang WK.

Department of Electrical Engineering, National Taiwan University.


------

IEEE Trans Biomed Eng. 2000 Mar;47(3):313-8. Related Articles, Links


Effect of length on the fundamental resonance frequency of arterial models having radial dilatation.

Wang YY, Lia WC, Hsiu H, Jan MY, Wang WK.

Department of Physics, National Taiwan Normal University, Taipei, R.O.C. wkwang@phys.sinica.edu.tw

The pressure wave moving along an elastic artery filled with blood was examined as a moving Windkessel having a natural oscillation angular frequency nu 0 and a damping coefficient b. The radial directional motion for an element of the wall segment and the adherent fluid was considered. This equation was solved with conditions at both ends of an artery of length L. An external impulse force was applied at one end and a static pressure Po at the other. Analytic solution allowed only certain oscillation modes of resonance frequencies fn, where fn2 = a + cnL-2 with [formula: see text] and V infinity is the high frequency phase velocity. The relationship between f0 and L was examined experimentally for tubes constructed of latex, rubber, or dissected aorta. The effect of raising the static pressure P0 or increasing the tension in the tube was consistent with the prediction. The hypertension that accompanies an augmentation in arterial wall and the association between the heart rate and the mean blood pressure were discussed.

--------

IEEE Eng Med Biol Mag. 1999 Jan-Feb;18(1):73-5. Related Articles, Links


Pulse analysis of patients with severe liver problems. Studying pulse spectrums to determine the effects on other organs.

Lu WA, Wang YY, Wang WK.

Department of Electrical Engineering, National Taiwan University.

Publication Types:
Clinical Trial

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Am J Chin Med. 1998;26(1):73-82. Related Articles, Links


Liu-wei-dihuang: a study by pulse analysis.

Wang WK, Hsu TL, Wang YY.

Biophysics Laboratory, Academia Sinica, Taipei, Taiwan.

Pulse analysis method was used in studying the traditional Chinese formula Liu-Wei-Dihuang as well as five of its main components (Rehmannia glutinosa, Cornus officinalis, Paeonia Suffruticosa, Poria cocos and Alisma plantogo-aquatica var oriental). Based on our recently developed resonance theory, we tried to elucidate the mechanism and mutual reactions of these meridian related herbs. Hot water herbal extracts were injected intraperitoneally into rats and the pressure pulse spectrum at the caudate artery was measured. The results of this study indicated that Liu-Wei-Dihuang mildly increased blood flow to meridians with lower resonance frequency: namely the liver C1, the kidney C2 and the spleen C3; but decreased blood flow to the higher resonance frequency organs and meridians: the lung C4, the stomach C5, the gall bladder C6, and the bladder C7. It also decreased the heart load C0. All of the five herb components increased blood flow to the kidney C2 and the spleen C3; but their effects on the high frequency organs varied. Alisma plantogo-aquatica var. oriental decreased the C0, C5, C6, C7; Poria cocos decreased C1, C4, C5, C6; Rehmannia glutinosa, Paeonia Suffruticosa decreased C0, C4, C5, C6, C7; Cornus officinalis increased C4 but decreased C0, C5, C6, C7.

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Am J Chin Med. 1997;25(3-4):357-66. Related Articles, Links


Pulse spectrum study on the effect of sie-zie-tang and Radix aconiti.

Wang WK, Hsu TL, Chiang Y, Wang YY.

Biophysics Laboratory, Academia Sinica, Taipei, Taiwan.

Extracts of the traditional Chinese formula Sie-Zie-Tang as well as one of its main components, Radix Aconiti were injected into rats intraperitoneally to observe pressure wave spectrum changes at the caudate artery. We found that Radix Aconiti decreased the C0 (DC term of the pulse), C5 and C6 (the harmonic proportions of the 5th and the 6th harmonic), but increased C2 and C3 (the harmonic proportions of the second and the third harmonic) significantly. For Sie-Zie-Tang, the increases of C2, C3, and C4 were accompanied by the decreasing of C0. The decreases of C5, C6 were small and not significant. The additional ingredients in the formula reduce toxic side effects (arrhythmia or heart failure caused by faster and stronger heart beat) due to Radix Aconiti. For human subjects, low dose Sie-Zie-Tang tends to normalize the Fourier components of the pressure wave. Orally taking the formula elevates the harmonic proportion of the harmonic that is lower than normal, but suppresses the higher one. Our results provides a possible mechanism for heart meridian related herbs. It strengthens heart beats, and normalizes energy distribution to different meridians. The study on Sie-Zie-Tang reveals another formula construction to reduce toxic side effects.

Publication Types:
Clinical Trial

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IEEE Eng Med Biol Mag. 1997 Jan-Feb;16(1):51-6. Related Articles, Links


Pressure wave propagation in arteries. A model with radial dilatation for simulating the behavior of a real artery.

Wang YY, Chang CC, Chen JC, Hsiu H, Wang WK.

Dept. of Physics, National Taiwan Normal University, Taipei.

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The importance of pulsatile microcirculation in relation to hypertension
Ming-Yie Jan Hsin Hsiu Tse-Lin Hsu Yuh-Ying Lin Wang Wei-Kung Wang
Dept. of Electr. Eng., Nat. Taiwan Univ., Taipei ;
This paper appears in: Engineering in Medicine and Biology Magazine, IEEE

Publication Date: May/Jun 2000
On page(s): 106-111
Volume: 19, Issue: 3
ISSN: 0739-5175
References Cited: 26
CODEN: IEMBDE

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Abstract:
The aim of the study presented was to prove that increased pulsatile blood pressure (PBP) increases perfusion in peripheral vascular beds (PVBs). We used a laser Doppler flowmeter (LDF) to measure surface renal cortical flux (RCF) and a pressure-tip transducer catheter to measure abdominal aortic blood pressure (AABP). Besides demonstrating the relationship between RCF and AABP by linear regressive analysis with an averaged periodogram (AP), we also used time-domain pulse averaging to clarify the pulsatile AABP and RCF. Furthermore, we define a flux-to-pressure-area ratio (FPAR) to evaluate the efficiency by which the pulsatile AABP drives RCF

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The natural frequencies of the arterial system and their relation to the heart rate
Yuh-Ying Lin Wang Ming-Yie Jan Ching-Show Shyu Chi-Ang Chiang Wei-Kung Wang
Dept. of Phys., Nat. Taiwan Normal Univ., Taipei, Taiwan;
This paper appears in: Biomedical Engineering, IEEE Transactions on

Publication Date: Jan. 2004
On page(s): 193- 195
Volume: 51, Issue: 1
ISSN: 0018-9294

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Abstract:
We assume the major function of the arterial system is transporting energy via its transverse vibration to facilitate the blood flowing all the way down to the microcirculation. A highly efficient system is related to maintaining a large pressure pulse along the artery for a given ventricular power. The arterial system is described as a composition of many infinitesimal Windkessels. The strong tethering in the longitudinal direction connects all the Windkessels together and makes them vibrate in coupled modes. It was assumed that at rest condition, the arterial system is in a steady distributed oscillatory state, which is the superposition of many harmonic modes of the transverse vibration in the arterial wall and the adherent blood. Every vibration mode has its own characteristic frequency, which depends on the geometry, the mass density, the elasticity, and the tethering of the arterial system. If the heart rate is near the fundamental natural frequency, the system is in a good resonance condition, we call this "frequency matching". In this condition, the pulsatile pressure wave is maximized. A pressure wave equation derived previously was used to predict this fundamental frequency. The theoretical result gave that heart rate is proportional to the average high-frequency phase velocity of the pressure wave and the inverse of the animal body length dimension. The area compliance related to the efficiency of the circulatory system is also mentioned.