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A quantitative system for pulse diagnosis in

Traditional Chinese Medicine


Huiyan Wang, Yiyu Cheng
Pharmaceutical Informatics Institute, Zhejiang University, 310027, Hangzhou, China
Abstract-The pulse diagnosis is one of the most important
examinations in Traditional Chinese Medicine (TCM). Due
to the subjectivity and fuzziness of pulse diagnosis in TCM,
quantitative systems or methods are needed to modernize
pulse diagnosis. But up to now, the effective models that can
classify pulse types according to pulse waves automatically
have not been reported, which undoubtedly limits the
practical applications of pulse diagnosis in clinical
medicines. In this article, a novel quantitative system for
pulse diagnosis was constructed based on Bayesian
networks (BNs) to build the mapping relationships between
pulse waves and pulse types. The results show that the
system obtains relative reliable predictions of pulse types,
and its predictive accuracy rate reach 84%, which testifies
that the model used in our system is feasible and effective
and can be expected to facilitate popular applications of
TCM.

I. INTRODUCTION
Traditional Chinese Medicine is one of the most
important complementary and alternative medicines.
Pulse diagnosis is one of the four examinations, namely
inspection, auscultation and olfaction, inquiry and
palpation. The doctors diagnose the patient by feeling his
pulse beating at the measuring point of the radial artery.
Traditional pulse diagnosis requires long experiences and
a high level of skill, and is subjective and deficient in
quantitative criteria of diagnosis. This affects the
reliability and repeatability of pulse diagnosis. So
quantitative methods or models are needed to classify the
pulse types automatically. Recently, many researchers
have made great efforts in pulse analysis. [1-6]. But the
mapping relations between pulse waves and pulse types
is not considered, which undoubtedly limits their
practical applications in clinical medicines.
In TCM, fuzziness and uncertainty are inherent
issues in the procedure of pulse diagnosis. An attraction
tool for managing various forms of uncertainty is
Bayesian networks BNs [7,8], which is able to
represent knowledge with uncertainty and efficiently
performing reasoning tasks. Comparing with other
methods that also can handle uncertainty quite adequately,
such as fuzzy logic [9], belief functions [8] etc., BNs
have several advantages. Firstly, it is based on a rigorous
theory with a vast amount of known results, which
prompted some researchers [9-11] to claim that


This work was sponsored by a key grant from the State
Administration of Traditional Chinese Medicines of Peoples
Republic of China (No. 2000-J-Z-03)
probability is the only sensible description of uncertainty
and is adequate for all purposes. Secondly, BNs describe
causal relationships in graphics mode, which is prone to
comprehend and can be used to predict the consequences
of intervention. Thirdly, it is often insensitive to
imprecision in the numerical probabilities. In view of the
advantages, we utilize BNs to construct a system for
quantitative pulse diagnosis in TCM.
In this article, we develop a new quantitative system
for pulse diagnosis based on Bayesian networks (BNs) to
build the mapping from pulse parameters to pulse types.
This system constructs the mapping relationships
between pulse wave parameters and pulse types. The
performance of the system was evaluated. The results
show that the system performs well in the differentiation
of pulse types.
II. DATABASES OF PULSE WAVE
In our system, the pulse transducer is
pressure-adjusting and we can regulate the pressure from
25~150 g . We record the pulse wave when the amplitude
reaches the maximum.
The pulse sample database (PS-DB) consists of two
parts: (1) a total of 407 pulse waves, collecting from 298
patients and 109 healthy volunteers, and (2) diagnostic
results of pulse type. The patients were from several
hospitals of TCM and healthy volunteers were chosen
from the campus students of universities and children
from certain kindergartens. The diagnostic results were
all given by one group of clinical physicians with three
members. In addition, the cases in database did not
contain missing values, or in other words, the missing
values were regarded as absence, so we did not consider
handling missing values in the experiments.
Fig.1. Pulse recognition contents
Proceedings of the 2005 IEEE
Engineering in Medicine and Biology 27th Annual Conference
Shanghai, China, September 1-4, 2005
0-7803-8740-6/05/$20.00 2005 IEEE.
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The pulse parameters are continuous variables. For
convenience, we use the equal-width-intervals
discretization method [13], and the interval is set to 5.
III. FEATURE EXTRACTION OF PULSE WAVE
Generally, the pulse types that often appear in clinic
can be classified into eleven types see Fig. 1 according
to seven factors, viz. depth, width, length, frequency,
rhythm and strength. Fig.2 is an example of pulse wave
obtained through the pulse transducer. As the contact
pressure increases, the amplitude of the pulse signal first
increases, reaching a maximum and then decreases. The
pulse wave is composed of three sub-waves, namely the
wave SP , the wave EF and the wave FG see Fig.
5. The parameters of pulse wave that utilized in our
system are as follows [14]: (a) the contact pressure P
1
, at
which the maximum amplitude of pulse wave is attained,
(b) the height of the maximum amplitude of SP (
sp
h ,
shown as ' PP in Fig.5), (c) the height of the maximum
amplitude of EF (
ef
h , shown as
'
KK in Fig.5), (d)
the height of the maximum amplitude of FG (
fg
h ,
shown as ' LL in Fig.5), (e) the height of the start point
of FG (
ff
h , shown as ' FF in Fig.5), (f) the height of
the start point of EF (
ee
h , shown as ' EE in Fig.5), (g)
sp ee ep
h h r = , (h)
sp ff fp
h h r = , (i)
sp ef es
h h r = , (j)
sp fg fs
h h r = , (k) the cycle of pulse wave
1
C , (l) the
ascending time of pulse wave (
1
t ), (m) the area of the
pulse wave ( A ). Thereof
'
P ,
'
E ,
'
F , and
'
L are the
projections of P , E , F , K and L onto X axis,
respectively. These parameters are meaningful in TCM
[16] and testified to be effective in the analysis of pulse
[14,15].
According to the pulse definition in TCM, a floating
pulse is palpable on light touch and grows faint on hard
pressure, while sinking pulse can only be felt on pressing
hard, so we conclude that Floating or Sinking (FS) can be
distinguished reliably by
1
P . In like manner, the pulse
frequency can be reflected by
1
C , which can be used to
differentiate Moderate or Rapid (MR). Besides, it were
known that the knotted pulse pausing at irregular
intervals and intermittent pulse pausing at regular
intervals, according to which we define several new
parameters as following, which can be representative of
the pulse rhythm. (n)
2 1 m m ma
N N r = , thereof
1 m
N and
2 m
N denoting the number of cycles of pulse wave in
two adjacent minutes, (o)
1 m c mb
N N r = , thereof
1
60 C N
c
= . For slippery or hesitant or wiry (SHW) and
feeble or replete (FR), there are not corresponding
parameters yet. So we assume that SHW and FR are
influenced by all the parameters defined above. The
effective of these parameters will be validated in the
experiments as below.
IV. QUANTITATIVE DIAGNOSIS MODEL BASED ON BNs
The architecture of the system for pulse diagnosis is
given (see Fig. 3). The probabilistic reasoning module
consists of discovering dependency relationship module,
parameter learning and reasoning module (see Fig.4). A
new hybrid leaning algorithm [12] for dependency
relationship discovery and parameter learning was used,
which was developed by our research group and named
as
*
GBPS algorithm. Given the parameterized model,
the reasoning module is implemented via Clique Tree
Propagation algorithm (CTP) [16], which allows
computation sharing among multiple queries and can
satisfy the requirement of pulse diagnosis.
In addition, we use Markov blanket [8] to perform
causal inference. A Markov blanket is the minimum set
of nodes that renders node X conditionally
independent of all other nodes in the directed graph. The
Markov blanket of a node X consists of the parents of
X , the children of X , and the parents of the children of
X . We can get rid of all other nodes outside Markov
blanket of X to obtain simplified BNs without
influencing the predictive PAR
Fig.3. The architecture of the system for pulse diagnosis
Fig.2. An example of pulse wave
133
1
= P
E
F
'
F
'
E
P
S
G
'
P
K
L
'
L
'
K
1
C
1
t
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V. EXPERIMENT RESULTS
The sample size of some items is relative small,
such as knotted, intermittent, hesitant in Table 2. This
situation is popular in medical statistics due to the
difficulty in obtaining both sufficient cases and reliable
data for each case. To solve this problem, we used a
stratified fold cross validation technique [17]
( equals to 5 in all of the experiments, named as CV-5)
to estimate the predictive accuracy rate (PAR) of the
system. Besides, the PAR for each item is defined as
follows:
samples Total
correctly recognized being samples of Number
rate Accuracy =
The performance of the quantitative system is evaluated
through experiments. In the experiments, we trained 5
BNs from PS-DB, which are used for recognize the five
pulse types, respectively, based on corresponding
parameters of pulse wave. The graphical structures of
Markov blanket of SHW and FR are illustrated in Fig.5.
From SHW-BNC, we can see that only 5 parameters,
namely
fp
r ,
es
r ,
sp
h ,
ef
h and
1
t , are selected and
contribute to the discrimination of SHW. From FR-BNC,
it can be noted that 6 parameters, namely
es
r ,
ff
h , P
1
,
fp
r ,
fs
r and
sp
h , survive and are most relevant to the
diagnosis of FR. The predictive results are tabulated as
below (see Table 1). The average PAR is 84%, which
demonstrates that the system performs well, especially for
the identification of MR with 97% PAR, and FS with
95% PAR. For SHW, FR and KI, the PAR is relative low.
The error might come from three parts. Firstly, the
information contained in pulse wave was not adequate,
which can be conquered by amelioration of pulse
transducer. Secondly, the pulse parameters that utilized in
our system were not very discriminating for diagnosing
these pulse types. Thirdly, the corresponding pulse
samples were insufficient. Further improvement of
diagnostic performance of the system could be expected
in the near future.
Pulse types SF MR KI FR SHW Average
PAR 0.95 0.97 0.76 0.84 0.69 0.84
TABLE 2
LISTS OF VALUES OF PULSE TYPES AND
CORRESPONDING NUMBER OF SAMPLES
Pulse type Value
ID
Number of
samples
Depth Regular depth
Sinking
Floating
0
1
2
FS
184
204
19
Frequency Regular
frequency
Moderate
Rapid
0
1
2
MR
288
82
37
Rhythm Non-knotted
and
Non-intermittent
Knotted
Intermittent
0
1
2 KI
370
14
23
Strength Feeble
Replete
0
1
FR
132
275
Quality Slippery
Hesitant
Wiry
0
1
2
SHW
185
32
190
VI. CONCLUSION
Pulse diagnosis is the most important components in
TCM. But the complexity and elusiveness of diagnosis
method confine its development and generalization. In
order to classify pulse types automatically, we propose a
quantitative system based on BNs to build the mapping
relationships between pulse waves and pulse types. The
experiment results validate that the system for pulse
diagnosis is effective. Note that, the feature of our system
is that it can keep enhancing the predictive accuracy of
pulse types by learning the experiences of experts of
TCM.
REFERENCES
Fig.4. The architecture of probabilistic reasoning model
TABLE 1
PREDICTIVE RESULTS OF THE SYSTEMFOR PULSE
Fig.5 .The Markov blanket of SHW and FR
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