Novel diagnostic algorithm for the floating and sunken pulse qualities and its clinical test

Abstract

We propose a novel classification algorithm for the floating pulse and the sunken pulse using a newly defined coefficient (C(fs)). To examine the validity of the proposed algorithm, we carried out a clinical test in which 12 oriental medical doctors made pairwise diagnoses on the pulses of volunteering subjects. 169 subjects were simultaneously diagnosed by paired doctors, and the diagnoses in 121 subjects were concordant, yielding an accuracy of 72% and a Matthews correlation coefficient of 0.42, which indicates reasonable agreement between doctors. Two sample T-tests showed that subjects in the sunken pulse group had significantly higher BMI and C(fs) (P < .05) than those in the floating pulse group. The pulse classification by the algorithm converged with the diagnoses of paired doctors with an accuracy up to 69%. With these results, we confirm the validity of the novel classification algorithm for the floating and sunken pulses.

Figure 1

Floating versus sunken versus hidden pulses distinguished in the P-H curve [6].

Figure 2

P-H curve with interpolation (solid curve) for a few discrete data points (circles) for the calculation of C _fs [19]. Examples for (a) a floating pulse, (b) an erroneous decision as a sunken pulse. Compare (b) with Figure 3(b).

Figure 3

New algorithm for C _fs [20]. It compares explicitly the pulse strengths at low hold-down pressure and high hold-down pressure. Example for (a) a floating pulse, (b) a middle-depth pulse (neither floating nor sunken). Compare (b) with Figure 2(b).

Figure 4

Study design and the outcomes of OMDs' pulse diagnoses.

Figure 5

(a) palpation positions of Chon, Gwan, and Cheok, and (b) a demonstration of pulse-taking operation by the 3-D MAC.

Figure 6

Data acquisition process from raw data (top panel) to the pulse strength for each pressure-step (bottom panel).

Figure 7

The number of decisions by (3) that are concordant with the diagnoses by paired OMDs, for the floating (asterisked curve) and sunken pulses (squared curve), as a function of the discriminant C _fs*. Result by using C _fs ^new(1) is shown in (a) and C _fs ^new(2) in (b), where the plain curve corresponds to the total concordant decisions as the floating or sunken pulses, between the algorithm and OMDs. The boxed area in (a) is the regime showing both the maximal accuracy and MCC, while in (b) the accuracy is shown maximal in the solid box and the MCC is shown maximal in the dotted box.

Figure 8

Decision by (4) with C _fs ^new(2) for (a) the floating pulse and (b) sunken pulse as a function of the discriminant (a) C _f* and (b) C _s*. The asterisked curve corresponds to the total number of decisions, and the squared curve the concordant decisions with the OMDs (scale on the left vertical axis), while the plain curve is the accuracy (scale on the right vertical axis).

Figure 9

Decision by (4) with C _fs ^new(1) (asterisked curve) and (b) C _fs ^new(2) (squared curve). The graph shows the accuracy for the maximum number of coincidences with OMDs' decisions as a function of the decision rate, that is, the number of decisions made into the floating or sunken pulses.