Difference analysis of Doppler ultrasound blood flow of Cunkou(radial artery) pulse,Renying (carotid artery) pulse,and Fuyang(anterior tibial artery) pulse

WANG Chao,WU Qiong,WANG Zhigang,WEI Yun,XU Shijie

WANG Chao,Postdoctoral Mobile Station of Chinese Academy of Traditional Chinese medicine,Beijing 100700,China

WANG Chao,WU Qiong,XU Shijie,Zang-xiang Teaching and Research Department,the Institute of Basic Theory for Chinese Medicine,China Academy of Chinese Medical Sciences,Beijing 100700,China

WANG Zhigang,Finance Office,Shandong College of Traditional Chinese Medicine,Yantai 264199,China

WEI Yun,Department of Doppler Ultrasound,Beijing Anzhen Hospital,Capital Medical University,Beijing 100029,China

Abstract OBJECTIVE: To analyze the Doppler ultrasound blood flow of Renying (carotid artery) pulse,Cunkou (radial artery) pulse,and Fuyang (anterior tibial artery) pulse in the normal group and the functional constipation with gastrointestinal heat (FCGH) group,and to compare and explore the differences of Renying,Cunkou and Fuyang pulses.METHODS: Sixty normal subjects and 60 patients with gastrointestinal heat constipation were collected in the department of ultrasound,Beijing Anzhen Hospital,Capital Medical University.Doppler ultrasound was used to observe the blood flow indexes including maximum systolic velocity (Vp),maximum diastolic velocity (Vd),mean velocity (Vm),pulse index (PI),resistance index(RI),vascular diameter (D),and circulation blood flow cycle (ET) of Renying pulse,Cunkou pulse and Fuyang pulse in the normal group and patients with gastrointestinal heat constipation.The differences of these three pulses were compared between the normal group and the FCGH group.RESULTS: The PI,Vp,Vm,RI,and D of the three pulses in the normal group were statistically significant different(P ＜ 0.01).In the comparison of Doppler flow diagram of three pulses in the FCGH group,there were significant differences in PI,Vd,Vp,Vm,RI,and D (P ＜ 0.01).CONCLUSION: Under normal conditions,the indexes of Renying pulse Doppler flow diagram,Cunkou pulse Doppler flow diagram,and Fuyang pulse Doppler flow diagram are significantly different.In the FCGH group,most of the indexes of Renying pulse Doppler flow diagram,Cunkou pulse Doppler flow diagram,and Fuyang pulse Doppler flow diagram are different.This result verified the necessity of simultaneous examinations of all Renying,Cunkou,and Fuyang pulses in modern Chinese medicine.

Keywords: Cunkou pulse;Renying pulse;Fuyang pulse;Doppler flow diagram;functional constipation;gastrointestinal heat type;pulse index;resistance index

1.INTRODUCTION

Pulse diagnosis is a unique diagnostic method of Traditional Chinese Medicine (TCM),which has played an important role in the development of TCM for more than two thousand years,and is still one of the important TCM diagnostic methods until today.Clinically,the main pulse diagnosis is Cunkou diagnostic method with“heart,liver,and kidney in left hand,and lung,spleen and kidney (Mingmen) in right hand”,which is not the only way of traditional pulse diagnosis.In ancient times,the common method of pulse diagnosis is the “diagnosis of all over the body”,which pays attention to the whole body meridians,not only Cunkou pulse,also,Renying pulse and Fuyang pulse.

Zhang zhongjing stated clearly in the preface ofShang Han Za Bing Lun,1“Look at the doctors of today,they don’t want to think about the teachings of the medical classics to expand and deepen their knowledge of medicine.Just each inherits the family medical skills,always follow the old law.When looking at the disease and inquiring about the condition,he always talks sweetly to the patient.After seeing the patient for a while,the medicine was prescribed.When diagnosing the pulse,only the Cun pulse was taken without touching the Chi pulse.The pulse of the hand only took,but not the pulse of the foot.Renying,Fuyang,and Cunkou pulses did not refer to each other … There was no vague impression of the nine parts of the pulse.The nose,between the eyebrows,and the forehead were completely unexamined.” Zhongjing took this opportunity to criticize the doctors at that time that Renying,Fuyang and Cunkou pulses were not diagnosed by mutual reference.According to the original text ofShang Han Za Bing Lun,1it is clear that Zhang Zhongjing still used the diagnosis method of Renying,Fuyang and Cunkou pulses in the Eastern Han Dynasty.The diagnostic function of Fuyang pulse and Renying pulse to other meridians of the whole body is also emphasized.

At present,few clinicians still use the pulse diagnosis mode of Renying pulse,Fuyang pulse,and Cunkou pulse in clinical diagnosis,and some have forgotten the specific diagnostic positioning of Renying pulse and Fuyang pulse.In theShang Han Za Bing Lun,1it records the use of Fuyang pulse to judge the prognosis of the disease and predict the “survival and death” state,which has been completely neglected by our clinicians today.Therefore,it is of great significance to re-examine the clinical diagnostic function of Cunkou pulse,Renying pulse,and Fuyang pulse at present,when the objectification and standardization of TCM are emphasized.

Modern medical physiology believes that pulse is a kind of blood and blood vessel wall oscillation caused by cardiac ejection activity.This is a mechanical oscillation,along the blood vessel wall to cause wave energy transmission,so called pulse wave.If the pulse wave is recorded by instrument,it is called a pulse diagram.The rapid development of medical ultrasonic imaging diagnosis technology,especially the application of color Doppler ultrasound blood flow imaging,can provide two-dimensional display and spatial location of blood flow signal,and provide a new technical means and support for the research of unified objectification of pulse.

In this study,color Doppler ultrasound blood flow imaging technology was used to study the twodimensional display and spatial location of pulse and Doppler blood flow index from the vivisection anatomical point of view of the dynamics of Renying,Cunkou,and Fuyang pulses.

2.METHODS

2.1.Study design

From May 2019 to December 2019,120 subjects were randomly selected for Doppler ultrasonography in the Department of Ultrasound,Beijing Anzhen Hospital,Capital Medical University (Hitachi Erlang Doppler ultrasound instrument,probe frequency: 5.0-9.0 MHz,Hitachi Medical (Guangzhou) Co.,Ltd.,Guangzhou,China).There were 60 patients in the normal group,including 34 males and 26 females,with an average age of (41 ± 11) years.Another 60 patients with gastrointestinal heat constipation was enrolled in the functional constipation with gastrointestinal heat (FCGH)group,including 27 males and 33 females,with an average age of (39 ± 11) years.

2.2.Diagnostic criteria for FCGH

2.2.1.Diagnostic criteria of Western Medicine

According to the Rome iii standard,2functional constipation (FC) refers to persistent defecation difficulties,reduced defecation times or a sense of incomplete defecation,which requires the elimination of intestinal and systemic organic causes and factors,and does not meet the diagnostic criteria of irritable bowel syndrome.

Functional constipation is determined by the Roman standard at least 6 months prior to diagnosis,and symptoms in the last 3 months have the following characteristics:

(a) Meet the following two points or more:

At least 25% of bowel movements are laborious;at least 25% of the defecation is massive or hard defecation;at least 25% of the bowel movement has a sense of inadequacy;at least 25% of bowel movements has a sense of anal rectum obstruction/obstruction;at least 25% of defecation needs to be helped by manipulation (such as finger help for defecation,pelvic floor support);defecation ＜ 3 times per week.

(b) There is almost no soft excretion when no light laxative is used;

There is insufficient evidence to diagnose irritable bowel syndrome.

2.2.2.Diagnostic criteria of TCM

According to the state administration of traditional Chinese medicine of “TCM industry standard of the People’s Republic of China” issued by the “standard of diagnosis of disease and curative effect of TCM”3of the diagnostic criteria for constipation: “constipation is caused by insufficientQiandYin,or interior heat and dryness,andQistagnation of theFu-organs.The main clinical manifestations were prolonged defecation interval and difficult to solve dry stool.It often refers to habitual constipation.”

(a) The time of defecation is prolonged,more than three days each time,and the stool is dry and hard.

(b) In severe cases,stool difficulties,dry as chestnut,can be accompanied by less abdominal distention,reduced intake.

(c) Exclude intestinal organic diseases.

If you have above and other symptoms,tongue coating,pulse can be diagnosed.

The diagnosis criteria of TCM syndromes refer to the consensus opinions on TCM diagnosis and treatment of chronic constipation issued by Spleen and Stomach Diseases Branch of China Association of Chinese Medicine in 2011,4as well as the TCM clinical path and diagnosis and treatment plan of slow transit constipation issued by State Administration of Traditional Chinese Medicine in 2011.5

Syndrome of gastrointestinal heat accumulation can be drawn from a series of symptoms and signs including dry stool like chestnut,anal pain when defecating,short dark urine,abdominal distention or pain,dry mouth with foul smell,upset,red tongue yellow dry coating,slippery rapid pulse.

2.3.Subject selection and clinical data collection

2.3.1.Inclusion criteria

2.3.1.1.In the normal group

Target population: healthy participants aged 20-70 years old from colleges and universities,enterprises,institutions,and communities in Beijing.

Inclusion criteria: no systemic history of organic diseases and infection;no obvious conscious symptoms or occasionally 1-2 mild conscious symptoms;normal physical examination,normal electrocardiogram,chest X-ray examination;normal mind,clear and coherent speech,and cooperation behavior;informed consent signature and volunteer for the study.

2.3.1.2.In the FCGH group

Target population: patients aged from 18 to 70 years old in Guoyitang TCM Outpatient Clinic,Outpatient Department of Gastroenterology,Beijing Anzhen Hospital,Outpatient Department of Gastroenterology,Beijing University of Chinese Medicine (BUCM)Dongzhimen Hospital,Outpatient Department of Gastroenterology,Outpatient Department of Gastroenterology,Dongfang Hospital Affiliated to BUCM,Outpatient Department of Gastroenterology,the Third Affiliated Hospital of BUCM.

Inclusion criteria: patients who met the diagnostic criteria for FCGH (course of disease more than 1 year)and did not meet the exclusion criteria.

2.3.2.Exclusion criteria

Other serious primary diseases (such as heart,brain,kidney,blood,etc.) and mental disorders;pregnancy and women on lactation;allergy to ultrasound or cardiac pacemaker installation;local plaque or dilation of the arteries of the upper and lower limbs,thickening or plaque of the intimacy of the lumen;intestinal stenosis caused by other digestive system organic diseases such as intestinal polyps,intestinal tumors,intestinal tuberculosis;patients who use drugs that may affect gastrointestinal function (calcium channel blockers,antacids,anticholinergic drugs,prostaglandins,stimulants,sedatives,and antidepressants);warning symptoms such as recent changes in stool size,positive occult blood in stool,iron deficiency anemia,obstruction symptoms,rectal bleeding,rectal prolapse,etc.

2.4.Sample size

Given that this study is a theoretical exploratory study,60 subjects were assigned to the normal group and 60 to the FCGH group.

2.5.Detection method

2.5.1.Precautions before testing

After determining the test time: do not drink alcohol within 24 h before test,avoid stimulants,do not take too much exercise,and maintain normal living habits;Do not receive stimulating physiotherapies such as electrotherapy,acupuncture and moxibustion,thermal therapy,cryotherapy,Tuina massage,and cupping within 24 h before testing;Do not take vasoconstriction or dilatation drugs such as anti-hypertensive drugs and hypoglycemic drugs on the day before test;Avoid exercise within 4 h before test,don’t take a shower within 1 h,and stop smoking within 30 min.

After arriving at the waiting room for assessment: ensure that the test is conducted within 1 h after meals;Rest for more than 15 min,during which you can fill in the personal clinical questionnaire;Do not wash hands and feet in cold water 20 min before the examination.Don’t sit near the air conditioner or the heater.

The detection room and the detection process: please keep the examination room quiet,to ensure the absolute quietness of the examination process,to prevent the influence of listening to Doppler audio signal to judge the nature of the blood flow of the lesion;it is best to place only one instrument in an inspection room to avoid mutual interference of audio signals;all the tests were carried out in the Doppler ultrasound room,the room temperature was kept at 20-25 ℃,and the body position was kept comfortable.Multi-frequency gain settings should be appropriate;Take a rest before test and try not to move your body during the test.

2.5.2.Positioning

Preheat the machine for 10 min,set the diagram drive speed as 25 mm/s,and mark it as 30 cm/s.After taking a 15-min rest in the examination room,the body of the subject will relax naturally and be fully exposed.During the neck vascular test,remove the pillow and lie on the diagnostic bed in supine position.The ultrasonic probe was glued to the carotid artery of the subject.For the upper limb vascular test,remove the pillow and lie on the diagnostic bed.Then take the seat to extend the arm,palm arm extension about 90 degrees or slightly abduction,external rotation.Place palms flat on the bed(wrists at heart level).The ultrasonic probe was glued with moderate amount of coupling agent,and the location of the guan pulse was measured on the high radial styloid process behind the palms of the subjects respectively.For the lower limb blood vessel test,take the supine,prone position with the body abduction,external rotation,lower limb elongation,and heels together.The examiner felt the most obvious tibial pulse on dorsum of foot with the middle finger,and glued the ultrasonic probe with moderate amount of coupling agent on it.It is required that the probe is closely connected with the skin without causing the compression of the vessels to artificial turbulence.On the display screen,the two-dimensional graph of the measured pulse is first displayed,and then the transverse graph is taken to display the color blood flow image and measure the relevant data.When the best pattern is found on the display screen (flat baseline,highest main wave amplitude,steep rise without trace of the ascending branch),the plotter is started to draw the sampling wave on the four-guide paper.The frequency of the probe was 5.0-9.0 MHz,the wall filter was set at 50-100 Hz to prevent low-speed blood flow from filtering out,the sampling volume was 2-4 mm and placed in the center of the lumen,and the angle between the sound beam and blood flow was ＜ 60 degrees when paralleling with the blood vessel.

2.5.3.Take three parts of pulses

Anatomical characteristics of radial artery Cunkou pulse:radial artery surface covered with brachial radial muscle.The medial side of Cunkou is the flexor carpi radialis muscle,followed by the supinator muscle,flexor superficialis,flexor pollicis longus,and pronator anterior from top to bottom.The radial artery is accompanied on either side by two radial veins medial to the brachioradialis muscle.Press the Cunkou,and skin,subcutaneous tissue,abductor pollicis longus tendon,pronator anterior muscle,and radius can be felt respectively.

Anatomical characteristics of carotid artery Renying pulse: the diameter of carotid artery is 6.33 mm.It locates in the neck,beside the larynx,and on the anterior edge of the sternocleidomastoid,where the common carotid artery beats.Its anatomical structure is skin,subcutaneous tissue,platysma muscle,and carotid artery triangle respectively.In this triangle,there is a carotid sheath formed by the deep cervical fascia,which contains the common carotid artery,the internal jugular vein and the posterior vagus nerve between them.The sublingual nerve is located on the surface or in the carotid sheath.

Anatomical characteristics of anterior tibial artery Fuyang pulse: at the highest point of dorsalis pedis,between extensor pollicis longus tendon and extensor digitorum longus tendon,and the beat of dorsalis pedis artery.The local anatomical structure includes skin,subcutaneous tissue,between the extensor pollicis longus tendon and the extensor digitorum longus tendon,extensor brevis,and the second cuneus.The skin is distributed by the superficial genicular nerve.Subcutaneously,there is a network of dorsal foot veins,laterally leading to the small saphenous vein,and medial to the origin of the great saphenous vein.The superficial layer of deep dorsal fascia is thin and tough.

2.5.4.Inspection

Before ultrasonic detection,physical examinations were carried out on the limbs of the selected subjects.The masses,pigmentation,varicose veins,and ulcers were observed.Limb skin temperature,arterial pulsation,and tremor on touching are also observed;

Carefully examine the vasculature,lumen shape,wall thickness,intima-media membrane thickness,and lumen contents along the long/short-sleeved lumen.

Color Doppler flow imaging was used to observe the flow direction,the color difference of the blood flow,the blood filling degree in the vascular lumen,and whether there was shunt and reflux.D.Pulse Doppler or continuous Doppler was used to measure the blood flow velocity (Vp),and energy Doppler could be used for slow blood flow.

2.6.Observational indexes

The Doppler flow diagrams of Renying,Cunkou and Fuyang pulses were observed.Systolic maximum Vp,mean blood flow velocity (Vm),diastolic maximum blood flow velocity (Vd),pulse index (PI),resistance index (RI),vascular diameter (D) and circulation blood flow cycle (ET) were analyzed.The differences among Renying,Cunkou,and Fuyang pulses are explored.

2.7.Statistical analysis

Access 2010 was used to establish the basic information database of subjects.To ensure the quality of data entry,trained third party personnel input the original data into the Access database.

The measurement data were described by mean ±standard deviation (),median,maximum,minimum and quartile.The counting data were expressed in percentage (%).All hypothesis tests were two-sided,andP＜ 0.05 was considered statistically significant.Baseline data were evaluated for inter-group comparability,and double-tailed statistical test was performed at α=0.05.In the normal group,single factor analysis of variance was conducted in blood flow indexes in different pulse conditions of Renying,Cunkou and Fuyang pulses.If the data were not in normal distribution,non-parametric test was performed;In the FCGH group,the indexes of blood flow were compared at three different pulse conditions using single factor analysis of variance.However,non-parametric test was conducted when the data were not normally distributed.We aimed to explore whether there are differences in the indexes of pulse Doppler flow diagram in Renying,Cunkou,and Fuyang pulses.

3.RESULTS

3.1.Results of Doppler flow diagram of Renying,Cunkou,and Fuyang pulses in the normal group

The values of PI,Vp,Vm,RI,and D of Renying,Cunkou,and Fuyang pulses in the normal group were statistically different (P＜ 0.01) (Table 1).The results showed that PI,Vp,Vm,RI,and D of Renying pulse Doppler flow diagram,Cunkou pulse Doppler flow diagram and Fuyang pulse Doppler flow diagram were significantly different under normal conditions.

Table 1 Parameters variation of the Renying,Cunkou,and Fuyang pulses in the normal group ()

Table 1 Parameters variation of the Renying,Cunkou,and Fuyang pulses in the normal group ()

Notes: PI: pulse index;Vd: maximum diastolic velocity;Vm: mean velocity;Vp: maximum systolic velocity;RI: resistance index;D: vascular diameter;ET: circulation blood flow cycle. aP ＜ 0.001,Renying pulse vs Cunkou pulse;bP ＜ 0.001,Renying pulse vs Fuyang pulse;cP ＜ 0.01,Renying pulse vs Cunkou pulse;dP ＜ 0.001,Cunkou pulse vs Fuyang pulse,eP ＜ 0.01,Cunkou pulse vs Fuyang pulse.

Table 2 Parameters variation of the Renying,Cunkou,and Fuyang pulses in the functional constipation with gastrointestinal heat group ()

Table 2 Parameters variation of the Renying,Cunkou,and Fuyang pulses in the functional constipation with gastrointestinal heat group ()

Notes: PI: pulse index;Vd: maximum diastolic velocity;Vm: mean velocity;Vp: maximum systolic velocity;RI: resistance index;D: vascular diameter;ET: circulation blood flow cycle.aP ＜ 0.001,Renying pulse vs Cunkou pulse;bP ＜ 0.001,Renying pulse vs Fuyang pulse;cP ＜ 0.001,Cunkou pulse vs Fuyang pulse.

3.2.Results of Doppler flow diagram of Renying,Cunkou,and Fuyang pulses in patients with FCGH

In the comparison of Doppler flow diagram of Renying,Cunkou and Fuyang pulses in patients with FCGH,there were significant differences in PI,Vd,Vp,Vm,RI,and D (P＜ 0.01).The results showed that PI,Vd,Vp,Vm,RI and D of Renying pulse Doppler flow diagram,Cunkou pulse Doppler flow diagram,and Fuyang pulse Doppler flow diagram were significantly different under the FCGH condition.

In conclusion,it was found that thePvalues of various indexes of Doppler flow diagram were all less than 0.01 in the comparison of Renying,Cunkou,and Fuyang pulse in all normal groups.The results showed that there were significant differences in the indexes of Renying pulse Doppler flow diagram,Cunkou pulse Doppler flow diagram,and Fuyang pulse Doppler flow diagram under normal conditions.It shows the feasibility of the study.It also verified the necessity of simultaneous examinations of Renying,Cunkou and Fuyang pulses in contemporary TCM clinic.ThePvalues of most indexes were less than 0.01 in the comparison of Renying pulse Doppler flow diagram,Cunkou pulse Doppler flow diagram,and Fuyang pulse Doppler flow diagram in the FCGH group.The results showed that most of the indexes of Renying pulse Doppler flow diagram,Cunkou pulse Doppler flow diagram,and Fuyang pulse Doppler flow diagram were different in gastrointestinal heat constipation.Few individual indicators such as ET did not show the statistical difference.It also verified the necessity of simultaneous examination of Renying,Cunkou and Fuyang pulse in modern TCM clinic.

4.DISCUSSION

Doppler ultrasound technology is a continuous real-time color imaging and quantitative analysis technology.In the late 1980s,Doppler ultrasound was used in the standardization of pulse images in TCM.Although the research was limited to the position of Cunkou pulse,it showed its feasibility for the differential diagnosis of different syndromes,which greatly supported for the objectification of pulse diagnosis in TCM.6In view of this,it is of great significance for us to use Doppler ultrasound to explore the differences of Renying,Cunkou,and Fuyang pulses and their clinical diagnostic functions.

It is found in modern studies that the artery diagram studies potential energy changes,with certain limitations.However,the pulse composition is affected by a variety of information,such as pressure pulsation,lumen volume,blood flow velocity,and three-dimensional movement of the vessel.Therefore,the study of the pulse condition must start from the omni-directional influence factors of the pulse condition,such as the biomechanical characteristics of the heart movement and arterial movement.7

PI and VD can reflect whether the pulse pulsation is strong or not,and show the pulse strength.RI indicates the smoothness of the pulse.However,the pulsating force and fluidity of pulsations are also affected by factors such as blood flow velocity,vessel tenderness and anatomical location.8

Relevant scholars have shown that the data of expansionand contraction of radial artery in autopsy is different from thatin vivo,so radial artery belongs to themiddle artery with greater elasticity.9And the radial artery is closer to the heart,the blood flow is big,the blood vessel expands,the pulse pressure is high.10Therefore,normal people have a lower RI of Cunkou pulse and a higher SV.Anterior tibial pulse is floating and moderate.11According to Mr.Wu Zhongwen,the working hours should be four times for one breath or 60 to 75 times per minute of normal anterior tibial pulse.12

Two-dimensional ultrasound image of the normal artery:without pressure,the systolic pulsation of the radial artery of the normal human inch is subcircular,with a pulsatile wall at the periphery;the wall structure is poorly displayed,and the lumen is a non-echoic area in the middle.The systolic pulsation at the dorsalis pedis artery is sub-circular and superficial to the skin in normal subjects,and at the carotid artery in normal subjects,the systolic pulsation is sub-circular and very superficial to the skin,with a strong systolic pulsation.

The size of the pulse depends on the thickness of the vascular anatomy,the degree of vascular dilatation,the intravascular pressure and the degree of constraint of the surrounding tissue structures.Since the diameter of the blood vessels in the Fuyang pulse is not much different from that of the Cunkou pulse,we can deduce that the pulse shape of the instep artery and the Cunkou pulse are not much different under normal conditions,while the pulse shape of the Renying pulse is much larger than the former two.From the modern medical anatomy point of view,the human Ying pulse is closer to the heart,followed by the inch mouth pulse,and the Enying pulse is farther away from the heart,so the blood flow speed of the Enying pulse is greater than the latter two,and the blood flow speed of the inch mouth pulse is greater than the blood flow speed of the Fuyang pulse (including diastolic blood flow speed and average blood flow speed).Any pulse image carries dynamic information in threedimensional space.However,how to obtain the dynamic information of pulse images is always a difficult issue in the process of objectification of pulse diagnosis.In this paper,two-dimensional ultrasound and color blood flow imaging technique were used to dynamically observe the anatomical positions of Renying,Cunkou,and Fuyang pulses,providing a new idea for the objectification of TCM pulse images.The differences of Renying,Cunkou,and Fuyang pulses were revealed by blood flow diagram and related indexes.From the analysis and summary of the above studies,it can be concluded that whether the normal group or the FCGH group,there are great differences in the indexes of the Doppler ultrasound blood flow of the Renying pulse,Cunkou pulse,and Fuyang pulses.It also proves the objective significance of the diagnosis of Renying,Cunkou,and Fuyang are mutually referred.Therefore,it is far from enough for TCM clinicians to study the Cunkou diagnosis only by“heart,liver,and kidney in left hand,and lung,spleen and kidney (Mingmen) in right hand”.We need to rediscuss and sort out the literature and specific applications of the ancient TCM diagnosis with“diagnosis all over the body” as the main method to facilitate its positive role in our TCM clinic.

Renying pulse,Cunkou pulse,and Fuyang pulses have great differences in ancient TCM literature.In theHuang Di Nei Jing,13it records the “diagnosis all over the body”:Renying,Cunkou,and Fuyang pulses were divided into three parts: heaven,earth,and human.Because of faraway anatomical locations and different meridian entries,they can have a very comprehensive reflection of the state ofQiand blood of the whole body,indicating different clinical diagnostic significance.

After literature review on TCM classical works,we summarized the anatomical positions and diagnostic functions of Renying,Cunkou and Fuyang pulses.Renying pulse locates in the Stomach Meridian of Foot-Yangmingand distributes on both sides of neck,that’s carotid artery.It plays an important diagnostic role in gastric diseases and can judge the disease conditions and predict prognosis,especially for critical diseases.Cunkou pulse relates to the radial artery and locates on the beat of radial artery on the medial side of the radial styloid process.Cunkou pulse can judge the conditions of the twelve meridians andZangfuorgans,so it can be used to diagnose and predict many disease conditions.Fuyang pulse refers to the location of Chongyang (ST 42)acupoints in the Stomach Meridian of Foot-Yangming,and is in the depression of fivecunascending between the big toe and second toe,probably to the anterior tibial artery.So we can judge the gastrointestinal function by feeling the Fuyang pulse,which plays a guiding role in the prognosis of disease.

After analyzing the above data,we found that the values of Vd,Vm,Vp,and D in the Renying pulse were greater than those of Cunkou and Fuyang pulses.It shows that the blood flow of the Renying pulse can more obviously reflect the internal blood circulation of the human body.There’s a saying that Renying pulse governs/controls the exterior.For example,when the human body is invaded by externally-contracted pathogens,the Renying pulse will quickly reflect the internal conditions of the whole body.The values of PI and RI in the Fuyang pulse were higher than those in the Renying and Cunkou pulses.It shows that the beat of Fuyang pulse can be more easily felt compared with that of Renying and Cunkou pulses.Therefore,when people are in critical conditions indicating extreme deficiency ofQiand blood,Fuyang pulse is easier to be felt than Renying and Cunkou pulses.According to the literature,the doppler flow charts of Renying,Cunkou artery and anterior tibial artery are of great significance for the study of related diseases.13

In the normal state of the circulatory blood flow cycle index,the value of the Cunkou pulse is greater than that of the Fuyang Yang pulse and the Renying pulse,indicating that the Cunkou pulse can more obviously reflect the internal blood circulation of the body in terms of blood flow conditions,so the ancient people proposed the diagnostic method of "taking the Cunkou pulse alone.To sum up,analysis of the hemodynamic data of Renying,Cunkou,and Fuyang pulses has important guiding significance for judging the beat of TCM pulse.Therefore,based on the relevant data of Doppler flow diagrams,comparisons of the differences among Renying,Cunkou,and Fuyang pulses not only provide objective quantitative indexes for studying the pulse intensity,pulse fluency,and the changes of vascular tension.Moreover,after literature reviewing,the clinical diagnostic significance of related diseases is different on feeling Renying,Cunkou,and Fuyang pulses.Therefore,to strengthen the study of blood flow indexes of Renying,Cunkou,and Fuyang pulses not only plays important guiding significance for the objectification of TCM pulse diagnosis,but also has an indispensable role in restoring the classical TCM pulse-taking method on the modern clinical diagnosis.