Relationship among intermittent pulse, regularly intermittent pulse,and bradyarrhythmia

Bei Jing, Di Zhang, Shi-Quan Chang, Xuan-Zhang Hunag,2,Xin Li, Hui-Mei Shi, Ya-Chun Zheng, Jian-Xin Sun,Bing Yang, Guo-Ping Zhao*

1School of Traditional Chinese Medicine, Jinan University, Guangzhou, China; 2Wuyi Hospital of Traditional Chinese Medicine,Jiangmen City, Jiangmen, China.

Abstract Pulse diagnosis is an important basis for the diagnosis of Chinese medicine.It is the rich experience accumulated by the predecessors in the long and continuous practice, and it is a unique diagnosis method of Chinese medicine.There are many names of pulse conditions in traditional Chinese medicine.The four elements are analyzed and summarized in terms of position, number, shape, and momentum.The four elements are used as 28 kinds of pulses.Among them, the regularly intermittent pulse and the intermittent pulse are characterized by arrhythmia and intermittent stop of the pulse.Intermittent pulse means irregular intervals;when a pulse comes, Regularly Intermittent pulse have regular stops.This kind of phenomenon is similar to the bradyarrhythmia in modern medicine.The knot pulse is an irregular pulse stopping, which can be seen clinically in sinus arrest, second-degree type I sinus block, second-degree type I atrioventricular block, and escape beats and so on .On the other hand,Regularly Intermittent pulse is a regular pulse stopping, which can be clinically found in the second degree type II sinus block, the second degree type II sinus block, and the second degree type I atrioventricular block with a special 2:1 type of atrioventricular block type and so on.

Keywords: intermittent pulse; regularly intermittent pulse; bradyarrhythmia.

Introduction

The knot pulse and the generation pulse are the rest of the pulse, pulse law is not uniform, there are signs of rest.Traditional medical scholars have the same understanding of the knot pulse and the generation pulse, on its characteristics:the knot pulse is slow and the time is a stop, the stop is not fixed, and can return;Generation of pulse slow and a stop, stop a certain number, not since.The so-called "rest" of the pulse is derived from the absence of pulse, the absence or suspension of normal heart beats.The clinical characteristics of bradyarrhythmia in modern medicine also show the slowness of heart beat and the absence of heart beat to varying degrees, which is similar to the pulse condition "rest and stop" in traditional Chinese medicine.So this article by collecting and combing, integrating ancient houses for pulse literature description of the knot pulse and the generation pulse,the analysis of the relationship between the pulse and heart beat in traditional medicine, combined with modern medical disorder rate of slow core in electrocardiogram (ecg) characteristics, to explore the relationship and generation of vein type and slow arrhythmia, in order to reveal the visualization of traditional medicine, improving the objectivity and accuracy of pulse.It can also explore the treatment principles and methods of slow cardiac arrhythmia from the perspective of traditional medicine, providing reference value for later clinical application and scientific research.

1 Knot veins and surrogate veins

1.1 Characteristics of nodal veins

Knot veins and veins are characterized by slow pulse,when you see a stop, stop without number, its main Yin sheng qi knot, cold phlegm and blood stasis, also main qi and blood failure.There are corresponding descriptions of knot veins in the works of ancient Chinese doctors.It means that the pulse feels slow,and sometimes stops, and then resumes.Such pulse is called knot pulse.It pointing out that the pulse characteristics of knot are stopping and stopping,stopping and not fixed.Knot pulse to slow, modern Chinese medicine for slow pulse understanding, that slow pulse is a breath four to, equivalent to a pulse of 60 times per minute, the number of pulses is still in a normal cardiac range.Zhong-Zi Li, a doctor in theMingDynasty, said:" The knot is condensed, and the slow time stops; Xu Xing and idle, quite its purpose.Knot promote the stop, stop impermanence number,a stop that the end is righteousness; the end does not come apart; the delay comes to an end." Shi-Zhen Li,in the study ofBinhu Veins, said "The knot of veins is slow, and when it stops, it comes back." Lu Zhang,a doctor in theQingDynasty, said inDiagnosing the Samadhi: "The finger is slow in the middle, frequently sees the rest and stops, and rarely tilts back".Zhongjing Zhang "treatise on February diseases" in the cloud:"The shinning is like a hood and it is called sun knot."Wu-Ji Cheng said:" countless like round the long pole,repeatedly and straight also.Yang qi stasis in the inside,not with Yang qi miscellaneous also."Shinning is as big and dull as a carhood.Yang qi yu outside, not with Yang qi and miscellaneous also." Shu-He Wang said inMaijing:" such as pockmarks shake, lead and close,gather and scatter not often, yue knot, the lord died."The three are all knots, but their meanings are different,floating part is Yang knot.Heavy division of the Yin knot.It is an incurable disease, but the same thing is the rest of its pulse.In this paper, it is concluded that there are irregular intervals in the veins, which are characterized by irregular stop of pulse, that is, there are irregular pauses in the normal pulse process, or an early pulsation, but the time is short, and then there are complete or incomplete compensatory intervals, after which the pulse frequency may be slightly faster.

1.2 Generation of pulse

The characteristics of the pulse is to stop when the pulse comes, stop there is a fixed number, long time to.Its main organ decline, also main wind syndrome, pain,seven emotions panic, fall injury.Inner Canon of the Yellow Emperorsaid:" generation of qi decline." The description of Daimai inMai Jingis as follows:" Dai mai, stop counting, can not tell by oneself, so it moves again." Because the pulse stopped, it could not be recovered quickly, and after some time, it began to beat again."Veins knot the main, the generation of death."Treatise on Febrile Diseasessays:" The pulse moves and stops, and cannot be returned to itself, so the person who moves again is called Dai, Yin also.Those who get this vein will be hard to cure." Shi-Zhen Li said inBinhu Veinssaid that "the generation of maiyuan is due to internal organ failure".Said the Daimai master virtual defeat.Zhong-Zi Li holds that the generation of veins for Yin veins, said "generation of veins stop,stop there is a constant, long prescription." Therefore,it describes the characteristics of the rest and stop of the generation of pulse, and its clinical symptoms are heavier.Shu-he Wang said: "the generation of death." The spleen and soil decline when the veins are substituted, and the kidney water is eliminated when the veins are scattered.The prognosis is poor when the veins cross.On this basis, this paper holds that the characteristic of the substitute pulse is that its rest and stop are regular, that is, the stop has a fixed number,and the substitute pulse only resumes after stopping for a long period of time, and the frequency does not accelerate after the recovery.

2 Pulse formation

According toSu Wen"The heart ……it is filled in the blood ", indicating that the basic power of pulse condition is the heart beating, the heart is the power source of pulse, and the specific expression of heart function outside the human body is pulse condition.Nan Jingsaid, "The pulse will be Taiyuan." Taiyuan for the lung shu point, the lung toward 100 arteries,Taiyuan point in the mouth, for the general assembly of the pulse.Through the whole body, the qi and blood of the viscera must travel around the body through blood,when the body is stimulated by internal and external factors, it will inevitably affect the flow of qi and blood,and then the pulse changes, the doctor can understand the depth of the pulse position, The speed, strength,rhythm, size of pulse shape and fluency of blood flow and other different manifestations of the measurement of viscera, qi and blood, the positive and negative rise and fall of evil, as well as the disease of cold and heat.

3 Normal heart conduction

The conduction system of the heart includes the sinoatrial node, atrioventricular node, Hitchcock bundle, left and right bundle branches, and Purkinje fibers.The sinoatrial node is the normal pacemaker of the heart, located in the wall of the right atrium.The excitement of the pacemaker cells in the sinoatrial node is transmitted to the atrial muscle through the transit cells, so that the atrial muscle contracts.At the same time, excitation can be transmitted down to atrioventricular node via the internodal bundle.The av node is located in the lower part of the septum and the av bundle from the atrioventricular node enters the ventricles.The atrioventricular node transmits impulses from the sinus node to the ventricles and causes them to contract.The atv-bundle enters the interventricular septum and divides into left and right fascicles, which descend along the intima of the ventricle respectively.Finally, the tiny branches, purkinje fibers, distribute in the ventricular muscles.See Figure 1.

Figure 1 Heart structure

4 Pulse and electrocardiogram

When the electrical activity of the sinoatrial node is initiated in the heart and transmitted to the atrium, the atrium senses the electrical activity of the sinoatrial node and causes atrial contraction, which will pump the blood of the atrium to the ventricle, and then ventricular contraction occurs.When the ventricle contracts, the blood of the ventricle will be pumped out of the heart, thus completing a complete heartbeat.The artery is a pipeline formed by elastic connective tissue and muscle.When a large amount of blood enters the artery, the pressure of the artery increases and the diameter of the artery dilates.The artery can feel the dilation at the shallow part of the body surface,and the pulsing from this is the so-called pulse.Qian Wu , a doctor in theQingDynasty, wrote "The pulse is the blood house, through all the body.Cunkou artery is related to the whole blood line." Blood vessel is the channel of blood movement, throughout the body, nowhere, and the location of the radial artery pulse, is to reflect the viscera and blood situation, is also the place where all blood vessels will gather.P wave, namely atrial contraction, has a weak sense of force in the process of heart beating and is not strong in the pulse, so it is rarely palpable in the process of pulse diagnosis.However, QRS wave group is more intense in the process of blood pumping from atrium to ventricle, so it is reflected in the pulse.

5 Relationship between knot and intermittent pulse and bradyarrhythmia

The origin that the heart excites, frequency, rhythm,the order that excites conduction, speed, among them any produces abnormal, call rhythm of the heart wrong.Pulse is a blood vessel wall oscillation caused by cardiac ejection activity.It is produced by the aortic root and spreads rapidly to the peripheral blood vessels along the arterial tree, thus forming the pulse of all parts of the human body.There is a close relationship between pulse and heart.Su Wensaid, "The heart dominates the blood of the whole body".The heart governs the blood.The circulation of blood in the veins is also driven by the heart, which is equivalent to the function of the heart pumping blood.So if the heart is strong, the pulse is gentle and powerful.And the heart is weak, promote the weak, the pulse can be thin and weak.Pulse arrest is caused by the absence of a pulse and is the absence or suspension of normal heart beats.When the strength of the heart is insufficient or uneven, the pulse condition of knot or intermittent may occur.In traditional medicine, the intermittent pulse and the knot pulse are common resting and stopping pulse conditions.Both of them belong to abnormal rhythm and have resting and stopping pulse conditions.However, the intermittent pulse is irregular intermittent,short resting and stopping time, slow and stopping; the knot pulse stops regularly and the rest time is longer.

6.Bradyarrhythmias associated with knot pulse

6.1 Sinus arrest

The sinoatrial node does not produce excitation.Suddenly a long interval, long interval without the appearance of P wave, intermittent length, PP distance before and after the normal PP distance is not a multiple of the relationship.See Figure 2.

Figure 2 Sinus arrest

6.2 Sinus block

Second degree type I sinus block, characterized by progressive shortening of the PP interval until the appearance of a long PP interval, which is twice as short as the basic PP interval, with irregular occurrence.The ecg showed that the intermittent sinus QRS wave group disappeared.

6.3 Atrioventricular block

Second degree TYPE I ATrioventricular block is characterized by gradual prolongation of THE PR interval until a QRS wave group is released after several P waves.Atrioventricular block is improved to some extent after leaky beats, and the PR interval is shortened and then gradually prolonged again, and so on.See Figure 3.

Figure 3 Second degree TYPE I ATrioventricular block

6.4 Escape beats

Delayed passive ectopic pacemaker beats in bradycardia after a long interval are called escape beats.One or two protective pacemakers are known as escape beats, while three or more consecutive pacemakers are known as escape rhythms.See Figure 4.

Figure 4 escape beats

6.5 Premature beats

Premature beats, also known as prephase contractions,are heart beats caused by premature impulses from ectopic pacemakers.The clinical symptoms of premature beats may be palpitations or pauses, and the electrocardiogram may be characterized by one or more P-QRS waves earlier than the basic rhythm.When palpation of the pulse can be touched the pulse of the knot.

6.6 Complex arrhythmia symptoms in clinical

Such as sinus slow and premature beat, conduction block and premature beat or atrial fibrillation ventricular rate less than 60 times, its can show slow heart beat and the absence of heart beat, which can lead to the intermittent pulse, the formation of knot pulse.

Jing-yue Zhang wrote "Knot pulse, pulse to suddenly stop, stop and resume, in short, for the knot"."There is a pause in the slow knot of fingers, and a few moments of repetition.All late, slow, intermittent, astringent, all belong to the knot class.Not like the intermittent pulse of the movement can not be returned.Qian Wu said,"Slow stop call knot……where this diagnosis, all to the number".When the pulse comes slowly and has a rest,it is the knot pulse, which depends on the number and should refer to the situation.It emphasizes the change of pulse rhythm on the basis of slow, and there is no constant when the pulse stops.Sinus cardiac arrest, a second type I sinus conduction block, a second type I atrioventricular block, escape, premature beat, etc on the ecg characteristics can be characterized by the appearance of a short-lived cardiac arrest, irregular heartbeat, the lack of QRS complex, can touch in the process of the corresponding pulse and pulse in the rest, its characteristics and traditional medicine knot affectionately to rest when a check, check on winning the concept of phase approximation.Therefore, the author believes that bradyarrhythmias mentioned above may be related to the characteristics of knots pulse in pulse diagnosis.

7 Arrhythmias associated with the intermittent pulse

7.1 Sinoatrial block

PP interphase rule in second degree type II sinus block;Long PP interval is the integral multiple of basic PP interval, and escape beat may occur after sinoatrial block.See Figure 5.

Figure 5 Second degree type II sinoatrial block

7.2 Atrioventricular block

In second-degree TYPE II ATrioventricular block,atrioventricular conduction is interrupted in proportion,and the PR interval is constant, which may be normal or prolonged, and there is no QRS wave group behind some P waves.See Figure 6.

Figure 6 Second degree type II ATrioventricular block

7.3 2:1 type second degree atrioventricular block

In the second degree atrioventricular block, is a relatively special type 2:1 atrioventricular block type, it is every 2 P wave only one can be the next to ventricular QRS complex, so it is difficult to judge its belong to the type I or type II, but because of its fixed 2:1 conduction characteristic, therefore can belong to the category of corresponding to the intermittent pulse characteristics of cardiac arrest.

7.4 Double rhythm and triple rhythm

Long intervals can be heard after every two or three beats when the regular double or triple rhythm is observed at sight.Its electrocardiogram also regularly shows a long PP or RR interval, can touch the regular interval at the pulse, for the characteristics of the intermittent pulse.

7.5 Regular atrial flutter

Rapid and regular heart rate is the most common in clinical cardiac auscultation.About 150 times/min, the ratio of room to room is 2:1.When the atrioventricular ratio is 3:1 or 4:1 down, the heart rate is slow, at this time careful auscultation can hear fast and low atrial contraction sound.Showing the absence of regular heart beats and may show intervals in the pulse.

Shi-zhen Li said "The intermittent pulse, moving and stopped, unable to return, so moving again.Pulse to also into the cubit, a long time to square.Qian Wu said, "move and suspension, unable to return, to the number of not good, the intermittent pulse is difficult to cure", here "good" take departure, no definite meaning,patients pulse to rest and stop, for a long time, unable to return, at the same time there is a certain number,for the intermittent pulse, and the general prognosis is poor.Second degree TYPE II sinoatrial block, second degree TYPE II sinoatrial block, second degree TYPE I atrioventricular block, special 2:1 atrioventricular block, double rhythm, triple rhythm and regular atrial flutter, etc., can show regular loss of heart beat in clinical, and can show regular loss of QRS wave group in electrocardiogram.And in its recovery after an absence of heart throb for a long time, and in the process of pulse, can reach the patients with special characteristics and the pulse of the corresponding check break rules, and that with the traditional medicine for the intermittent pulse "check is constant, for a long time to" is similar to the description, so the author thinks that the slow rate of core disorder and the characteristics of the intermittent pulse have corresponding relations of rest.

Conclusion

According to the description of the knot pulse and the intermittent pulse, we can get the characteristics of the knot pulse and the intermittent pulse.The knot pulse come a stop, the stop is not fixed.When the intermittent pulse comes, stop a certain number.Pulse is a subjective strong diagnostic technique, influenced by metabolism of viscera function, as well as other various factors.The knot pulse and the intermittent pulse have strong specificity in their diagnosis.Combining its characteristics with the characteristics of slow cardiac arrhythmia in clinic, pulse diagnosis can be objectively visualized, making pulse diagnosis more normative and accurate, and greatly improving its scientific credibility.For clinical purposes, we should try multi-center, large sample collection and recording of patients' pulse condition in the later stage, and make corresponding comparison with their ELECTRO cardiogram, so as to provide clearer identification diagnosis, treatment and research for TCM pulse diagnosis, and further confirm the correlation between electrophysiological changes of the heart and pulse condition.