IEEE JOURNAL OF BIOMEDICAL AND HEALTH INFORMATICS, VOL. 18, NO. 4, JULY 2014
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Hardware and Software Realization of EDSD for Acupuncture Research and Practice T. Fico, F. Duchoˇn, and J. D´ubravsk´y
Abstract—Traditional acupuncture as a diagnostic and therapeutic method has been known in China for more than 3000 years. Electrodermal screening tests (EDSTs) and electrodermal screening devices (EDSDs) that are based on the knowledge derived from traditional Chinese medicine appeared in the 1950s. This article deals with design, development and realization of such a device. The design considers the principles of two widely used EDSTs and modern trends in the field of electronics and data management. A computer program with simple user interface that provides graphic evaluation and intercomparison of measured data are presented. The designed system is suitable not only for acupuncture research but also for ordinary acupuncture diagnostics. Index Terms—Acupuncture, biological active points, data management, measurement.
I. INTRODUCTION CUPUNCTURE is one of numerous Chinese therapeutic methods that has been used in medical treatment for several thousands years. Recent findings indicate that this tradition can be traced back to about 5000 years ago, while it is still an essential part of the Chinese medicine system today [1]. This treatment method was brought to Europe in the 16th century but its popularity did not start growing rapidly until the 19th century [2], [3]. The word “acupuncture” consists of two Latin words, “acus” (needle) and “pungere” (to prick), which illustrate the principle employed by this therapy. The human body according to traditional Chinese medicine contains energy paths known as meridians. These connect body organs, systems, and biological active points (BAPs) also called acupuncture points. These points represent a type of “portal.” BAPs can be influenced by heat, pressure, light, acupuncture needles, and electric current. The pathological state of an organism can be changed by affecting the BAPs. This way we can influence: the energo-iteration level (BAPs, meridians, and microsystems), the psycho-regulating level (emotionalism and awareness), and the bio-morphological level (organ systems, blood circulation) of an organism [4].
A
From the physical and morphological point of view a BAP can be defined as a place on the body or its mucous membranes. Morphologically speaking, BAPs have thinner skin and more nervous plexuses (sensory receptors) than the surrounding skin [5]. In general, a BAP is characterized by higher temperature and higher sensitivity to pressure and other influence factors [6]. With regard to electrical properties, BAPs are considered to have lower electrical resistance, higher electrical capacitance [7]–[10], and higher electric potential [11]–[14]. BAPs are also sources of low electric current. Acupuncture is mainly used for diagnostics and preventive treatment, but it is also used in analgesia and insomnia treatment [15], [16]. It is also effective in the treatment of various chronic pains [17], mental disorders, addiction relief, and other anamneses [18]. In the 1950s, Dr. Reinhold Voll created a device for patient diagnostics based on the electrical properties of BAPs, as mentioned earlier, and named it electroacupuncture according to Voll (EAV) device [19]. The EAV device measures electrical conductance on a specific set of BAPs. At the same time, a similar method was developed by Dr. Yoshio Nakatan in Japan. This method is called ryodoraku, a compound name composed of the words “ryo” (good), “do” (conductivity), and “raku” (path or line) [20]. The main difference between these two methods is in the sets of measuring points however, there is also a difference in the value of the measuring voltage and the way of evaluation. The device described in this paper combines these two methods. Currently, both approaches and devices belong to the electrodermal screening device (EDSD) equipment type. The EAV is considered to be more precisely developed with lower impact on the human body [21]. The contribution of these methods is to objectify the process of diagnostics in acupuncture and the prediction of diseases. Studies show that these methods can be used for early detection of cancer [4], [22] and other pathological conditions [23]. The relation between measured electrodermal properties and physiotherapy effects can be established [24].
II. EDSD Manuscript received February 14, 2013; revised June 16, 2013 and August 26, 2013; accepted October 7, 2013. Date of publication October 17, 2013; date of current version June 30, 2014. This work was supported by MS SR under Contract APVV-0539-11. The authors are with the Faculty of Electrical Engineering and Information Technology, Institute of Control and Industrial Informatics, Slovak University of Technology, Bratislava 81243, Slovakia (e-mail: [email protected]; [email protected]; [email protected]). Color versions of one or more of the figures in this paper are available online at http://ieeexplore.ieee.org. Digital Object Identifier 10.1109/JBHI.2013.2285729
A. EAV Method The EAV method causes direct current (dc) to run through the body using low direct voltage. The value of the voltage used in the measurement is approximately 1.25 volt (V) and creates current up to 12 microamperes (μA). The devices utilized in both the EAV and ryodoraku methods typically consist of two parts. The first part is intended for diagnostics and the second part applies current to stimulate BAPs.
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Fig. 2.
Fig. 1. Basic schematic diagram of the device according to the EAV for measuring electrical conductivity.
As shown in Fig. 1, the first part of the EAV device works based on the ammeter principle. The source of the safe voltage is an accumulator. The role of the resistors is to limit the meter needle deviation. The chance of tissue polarization is reduced using lower voltage. Devices of the ryodoraku method apply higher voltage: 9, 12, and, in some cases, 21 V. These higher voltages increase the rate of polarization. Measurements are performed while a patient holds the hand electrode in the palm of his closed hand and a therapist measures the electrical conductivity of the BAP with the test electrode. Values are presented in nondimensional units and optimal values are between 50 and 56. Values outside this range indicate a possible disease. However, this approach is imperfect, since different skin moisture and even skin color can produce significantly different values [25]. Both methods are considered as effective as traditional needling; however, they require less time. For example, a classic acupuncture treatment lasting an average of 30 min would only take approximately 3–4 min using ryodoraku, including examination [26]. B. Experimental and Commonly Used EDSD Presently, there are several types of diagnostic equipment, which are mostly based on the described principles [27]. Some of them use alternating current (ac). They are mainly experimental prototypes to verify the properties of BAPs. These diagnostic devices are often realized as nonportable measuring devices, which can be limiting. They currently use specialized computer programs and other interfaces for data evaluation. Modern EDSDs also support Universal Serial Bus (USB) connection. Diverse devices were created to realize measurements on BAPs that can measure the impedance, e.g., on areas of skin [28] or on the needles inserted into skin using the multiple-electrode method [29], [30]. Measurements done on the acupuncture needles do not produce very accurate results, as after puncturing, the skin is more congestive, its temperature rises, and swelling can occur. These states lower the electrical resistance and minimize the difference between BAPs and surrounding skin. III. ELECTRICAL PROPERTIES OF THE BAPS As mentioned earlier, several publications declare that BAPs are different from surrounding skin in electrical properties.
Electrical model of a BAP and surrounding skin [7].
There are several models of a BAP representing their essential electrical properties: lower electrical resistance and higher electrical capacitance [7]. In the human body, we can observe only two types of electrical phenomena: resistivity and capacitance. Fig. 2 shows that the electrical model of skin contains several of these elements. Formations that create inductance in the human body have not yet been discovered. Resistance RR and capacitance CR represent the parameters of the human body. Constant phase element (CPE) is a component of the model that causes a phase shift of the signal. Its value depends on numerous factors, for instance, the roughness of skin. Resistance R1 represents resistivity of the epidermis itself. This element has the largest value, because the upper layers of skin contain dead skin cells, which are dry and therefore poorly conductive. Elements R2 and C describe the intracellular compartments of the skin. Components RBAP and CBAP illustrate the difference in electrical resistance and capacitance between a BAP and normal skin. The latter two elements were added after the finding that the BAP has lower resistance and higher capacitance with both dc and ac [7]. The model does not consider miscellaneous biological sources of voltage that affect the measurements dynamically. An explanation of the fact that a BAP differs from normal skin was presented in a morphological research. The research determined a higher concentration of nervous plexuses, microcirculation vessels, and mast cells (which contain histamine and heparin and play an important role in the protection of the organism) under the stratum corneum (the outermost layer of the epidermis) of BAPs than in the surrounding skin [31], [32]. A universal value of resistance that can determine a “good energetic path” is not possible to estimate. As mentioned earlier, the electrical resistance of the skin depends on skin moisture, and thus on the current mental state of an individual, as nervous people are prone to sweat more. Electrical resistance also depends on ethnic origin. Darker skin has higher resistance because the stratum corneum is denser and has more cell layers [33]. The value of the resistance of a BAP can change during measurement when using direct current [34]. This is probably caused by the polarization of the tissue. When considering the EAV method there are normally five types of curves that therapists use to assign the diagnosis (see Fig. 3). The device proposed in this paper implements a measurement methodology from the ryodoraku method. The value is taken two or three seconds after the test electrode was applied to a BAP.
FICO et al.: HARDWARE AND SOFTWARE REALIZATION OF EDSD FOR ACUPUNCTURE RESEARCH AND PRACTICE
Fig. 3. Basic curves equivalent to conductivity in BAP; interpretation according to EAV [34].
Fig. 4.
Electrical model of the electrode–electrolyte boundary [35].
It is recommended to measure several values for calculating the resulting arithmetic mean when using a digital device. IV. PROPERTIES AND DESIGN OF THE ELECTRODES Electrodes are used to carry the signal (energy) from the patient to the device and conversely. The design of the electrodes takes into account the safety of a patient and reduces influence on measurement. The main function of the electrode is to change the type of conductivity from the first class (the charge is carried by electrons) to the second class (the charge is carried by ions) and vice versa. This conversion occurs on the boundary between the electrode and electrolyte by transmission of ions called oxidation (release of n electrons) and reduction (reception of m electrons). These reactions are reversible [35]. Every metal material used for electrodes has a specific redox potential referenced to a hydrogen electrode. The resulting electric potential, also called the half-cell potential, is calculated as the difference of the potential between the electrode and the electrolyte. Fig. 4 shows the half-cell potential EPP used in the electric model. RP represents the resistance and CP the capacitance of the boundary based on the charged bilayer of the ions. RS denotes the electric resistance of the electrolyte itself. Since we use dc we can simplify the electric model because the capacity element can be neglected. While designing the
Fig. 5.
Measuring and hand electrode with connection cables.
Fig. 6.
Design of the test electrode made of brass.
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electrodes, it is important to choose the same material for the contact area of the hand and the test electrode (see Fig. 5). Different metals have different half-cell potential that can create high voltage drift. In case of using electrodes made of stainless steel and gold the drift could reach values of hundreds of millivolts (>500 mV). In comparison, two silver–silver chloride (Ag/AgCl) electrodes, which are the electrically optimal choice, produce a drift of around 100 mV. The electrocardiography (ECG), electroencephalography (EEG), and electromyography (EMG) methods commonly use the mentioned Ag/AgCl electrodes. These electrodes have desirable qualities, such as stable half-cell potential, low noise, and low contact resistance for the duration of the entire measurement [36]. However, these electrodes are normally intended for single use only, which renders them unsuitable for measuring skin conductance using the EAV and ryodoraku methods. For these and a number of other reasons, brass—a metal alloy made of copper and zinc is used as the most suitable material for the electrodes. Brass has various advantages compared to commonly used materials. This alloy has better conductivity than stainless steel, changes carriers from one class to another quite well, is nonallergic, nonexpensive, and does not wear out like gold-plated or silver-plated layers. The electrolyte on the hand electrode is the skin’s natural perspiration, or, if necessary, an additional saline solution (0.9% NaCl) with electrical properties similar to skin tissues. For the design of the test electrode conventions from both EDSDs were used. The EAV devices use the tip of the test electrode (ø3 mm) and the measured area is moistened with saline solution. The ryodoraku devices use a hollow electrode filled with cotton moistened with biological fluid (see Fig. 6). The saline solution is not only used as an electrolyte but it also balances the different level of moistness of parts of the human body and creates an important conductive connection. The use
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Fig. 8.
Principal scheme with the Op-Amps.
potential than the test electrode. This is caused by the difference in contact areas and the placement of the electrodes on the body. Potential ER represents a variable voltage source, which is the sum of alternating voltages with various frequencies and waveforms. It includes electrical potentials produced by active tissues (e.g., ECG signal), motion artifacts (potentially produced by muscles) and other voltages produced by internal processes or by the environment. VI. DESIGN OF MEASURING CIRCUITS
Fig. 7.
Electrical model of the measured object using dc.
of a 3 mm diameter tip is useful mainly for measurements on the ear where BAPs have the highest density [37]. The resistance of the moistened cotton is 4–6 kΩ, depending on moistness and volume of used cotton. The test tip has a slightly higher resistance of 5–7 kΩ. This is caused by the smaller contact area of the electrode, while the electrolyte layer (saline solution) is thinner. One of the factors affecting the measurements is the oxidation of brass. The electrodes need to be regularly cleaned so that the electrical properties of the surface of brass remain unchanged. It is essential to apply the same pressure to the BAPs as well as to keep the moistness of the epidermis approximately at the same concentration [38]. V. MEASURED OBJECT Since dc will be used, we can simplify the model of the measured object to a system of resistances and electrical potentials. The electric model in Fig. 7 represents the object of measurement, which is divided into three parts: input area of skin, the body, and output area of skin. The electrodes do not have identical parameters, because they have different contact areas. The moistness of the skin is also unequal. Voltage sources EP h and EP t represent several electric potentials, such as the potential of the electrode, the electrolyte and the electrolyte–epidermis boundary. In the model, the potentials have opposite polarity and therefore are subtracted from one another, but as they do not have the same value, this results in a nonzero voltage drift that can reach values up to 150 mV. According to the measurements the hand electrode has higher
When measuring on a patient it is required to consider several factors. The safety of the patient is the most important of all. A patient cannot be injured by the electric current even if a failure of a device should occur. The current passing through the human body must be significantly lower than the sensitivity threshold, which varies from microamperes to tens of microamperes. In addition, the measuring voltage should be low enough, so that it does not significantly affect the measurement by excessive polarization. There are also requirements on measurement accuracy and resolution. To eliminate the risk of an electric shock during measurement the whole device is powered by internal accumulators and is disconnected from the electrical grid. The voltage applied is limited to a maximum of 1.25 V. The current is limited by internal circuits to a value lower than 1 μA. The problem that measuring with dc brings is that partial electric potentials affect the measuring voltage. A change in measuring voltage causes change in the resulting resistance values. This can be solved either by measuring these potentials or by using two different measuring voltages consecutively during one measurement. For our device, the second solution was chosen. The resulting value with correction is calculated from several measured values. We use four operational amplifiers (Op-Amp) in the measuring circuits. Two were used to convert resistance to voltage, while one has noninverting wiring, and the remaining two as voltage followers. The measured object is connected to the noninverting Op-Amp as feedback (see Fig. 8). The output of this component is connected to an Op-Amp differential amplifier to adjust the range. Electric potential UX represents an error that is transferred to the resulting measured value. It is convenient to set the gain of the differential Op-Amp to 2. Equation (1) is a conjunction of two formulas: differential amplifier output voltage and output
FICO et al.: HARDWARE AND SOFTWARE REALIZATION OF EDSD FOR ACUPUNCTURE RESEARCH AND PRACTICE
Fig. 9. Filtered value of the measured resistance converted from ADC code to equivalent resistance. Measured BAP was HE 1 on the right side of the body. The measuring voltage changes every half a second.
Fig. 10.
Internal structure of the designed device.
Fig. 11.
Constructed device with connected electrodes and USB cable.
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voltage from noninverting amplifier with output offset UX [39] RX =
UO − 2UX RREF UREF
[Ω].
(1)
As mentioned earlier, we use two values of measuring voltage. If we establish that the voltage UREF2 will be double the value of UREF1 and we express the two output voltages UO 1 and UO 2 using the conversion code from an analog-to-digital converter (ADC) and its resolution N , then we get the following equation: RX =
RREF (2X2 − X1 ) N
[Ω].
(2)
The value of variable N is 4096, which corresponds to a 12-bit resolution. Variables X1 and X2 are results of an analog to digital conversion of UO 1 and UO 2 . The resulting formula does not contain any unknown electric potential, but it is necessary to ensure the possibility of switching between reference levels. We used a simple voltage divider made from two resistors of equal value. One end was connected through a unipolar transistor to the ground signal. If we switch the transistor, the reference voltage will change. The impedance of the divider is amplified with a unity buffer amplifier of the value UREF . Resistance RREF adjusts the measuring range and in the realized design it was implemented at the value of 10 MΩ. This value represents the theoretical upper limit but the influence of the unknown electric potential lowers the measured resistance (1). The real boundaries of the measured resistance are 25 kΩ and 8 MΩ. To reduce unwanted external noise both a hardware and a software filter is used. By adjusting the appropriate cutoff frequency it is possible to sufficiently suppress the influence of the electric grid frequency. The curve of the measured resistance shown in Fig. 9 is deformed by the capacitance of the BAP. It is necessary to postpone the measurement until the signal/curve has settled. The sample time may appear to be relatively long (half a second) but the voltage of the BAP is relatively stable and we can assume equal environment noise during the entire measurement (approximately 3 s).
VII. HARDWARE REALIZATION OF DESIGNED EDSD The designed device contains not only circuits for measuring but rather a whole range of subsystems necessary for the basic use (see Fig. 10). The device is based on the ATmega16 L microcontroller from Atmel, which collects data on the input and manages other circuits on the outputs. The microcontroller is connected to: a measuring subsystem, liquid crystal display (LCD), keyboard, external nonvolatile memory, USB-to-serial interface, and power management circuits. Two low-dropout (LDO) regulators are used in the device as shown in Fig. 10. One is used for digital and the other for analog circuits. This design minimizes noise transferred from digital to analog circuits. Most of the electrical components are surface mount devices (SMD) and the printed circuit board is inserted into a case that fits easily into a hand, thus adding to the user-friendly qualities of the device (see Fig. 11). The display and keyboard are on the top side of the case. There are three connectors on the bottom: for charging, communication over USB, and for connecting the electrodes via a jack connector. VIII. SOFTWARE FOR DATA ANALYSES A PC program with several functions was developed to process and analyze the data obtained by the device. The application communicates with the device through a virtual serial link realized via USB. After the data are transferred from the device the analysis can be done. Both established routines and new approaches are used for data analysis that should help rationalize the representation of the measured data.
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Fig. 12. Electrodiagnostic (ED) at biorhythm points using measured data with preview of a specific BAP.
Fig. 14. Additional application window displays the analysis of elements. The analysis is based on data from ED at biorhythm points and proposed in a new way [4].
Fig. 13.
Fig. 15. The window of analyses shows more graphs for better comparison of two diagnostic methods (ED yuan and mamma trigram Wen). There are several analyses shown according to new approaches [4].
Electromammography displayed using a bar graph.
Fig. 12 shows the PC application created in Visual Basic. The application consists of several tabs. Each tab contains an analysis according to distinct diagnostics. Electrodiagnostics (ED) at the yuan and biorhythm points use 12 main meridian paths in both sides of the body. Electro-mammography measures points of meridian paths that run through breasts. Mamma trigram Wen uses BAPs located directly on breasts. Electroextrameridiangraphy utilizes cardinal BAPs from eight extraordinary meridians [4]. Graphs and a data table can be displayed using the default unit siemens (S) or alternatively ohms (Ω). The application can display data using several types of graphs: line graph (see Fig. 12), bar graph (see Fig. 13), and weighted graph (see Fig. 14). It also contains an analysis of elements and yin-yang state based on BAP’s associations. Most BAPs are related to one of five elements and the analysis of elements is a weighted comparison of these (see Fig. 14). The graph also indicates the tolerance area for quantitative assessment (green circle) and arrows of the electrical conductance gradient to determine creative and destructive mechanisms in a new way. This visual representation helps to determine an acupuncture diagnosis on the level of electrical skin conductance [4]. Users can adjust tolerance areas for different graphs. The program stores these values for future use.
Fig. 15 shows the window of analyses with the ED yuan and mamma trigram Wen methods. The upper part of the window contains the main graphs and the yin-yang and elements analyses are at the bottom. The mamma trigram Wen analysis uses a weighted graph that represents the acupuncture microsystem of the breasts according to a new approach. We can import and export data using the Microsoft Excel xls file format. Measured data from different devices can be imported if they are converted into units of conductivity. Moreover, the application supports its own file format for saving measured data and basic information about the patient. The PC program can be enhanced with communication standards like DICOM [40] for standardizing transfer of analyses and patient data. The application provides ample possibilities for analysis, which simplifies work and research in acupuncture practice. IX. CONCLUSION The objective of this paper was to outline the problems related to designing a device of the EDSD category and the solutions to those problems. A related computer program was developed. The paper covers various areas, such as acupuncture,
FICO et al.: HARDWARE AND SOFTWARE REALIZATION OF EDSD FOR ACUPUNCTURE RESEARCH AND PRACTICE
medicine, measuring, electronics, and informatics. The designed solution suppresses unwanted electric potential and makes measurements on BAPs more relevant than the commonly used devices in EAV and ryodoraku methods. The computer program provides means to conduct multiple analyses and is comparable with commercially used applications. Some features, such as individual analysis and data export/import, predestine this software for research. In the future we plan to enhance the measuring resolution of the device and extend the application with other sets of points based on existing analyses. The program can be enhanced with psychological tests of the state of mind to make it a comprehensive tool. ACKNOWLEDGMENT The authors would like to thank Dr. T. Mochn´acˇ for his many helpful insights and discussions. REFERENCES [1] L. Dorfer, M. Moser, F. Bahr, K. Spindler, E. Egarter-Vigl, S. Giull´en, G. Dohr, and T. Kenner, “A medical report from the stone age?” Lancet, vol. 354, pp. 1023–1025, Sep. 1999. [2] N. Vadivelu, R. D. Urman, and R. L. Hines, “Acupuncture,” in Essentials of Pain Management. New York, NY, USA: Springer, 2011, pp. 337– 366. [3] A. White and E. Ernst, “A brief history of acupuncture,” Rheumatology, vol. 43, no. 5, pp. 662–663, May 2004. [4] T. Mochn´acˇ , “The risk factors and the extraordinary acupuncture vessels functions in relation to a mammary glands diseases,” Ph.D. dissertation, Dept. of Public Health, St. Elizabeth University of Health and Social work, Bratislava, Slovakia, 2012. [5] P. Rabischong, J. E. Niboyet, C. Terral, R. S´enelar, and R. Casez, “Bases exp´erimentales de l’analg´esie acupuncturale,” La Nouvelle Presse M´edicale, vol. 4, pp. 2021–2026, Aug./Sep. 1975. [6] D. Zhang, W. Fu, S. Wang, Z. Wei, and F. Wang, “Displaying of infrared thermogram of temperature character on merians,” Chen Tzu Yen Chi., vol. 21, pp. 63–67, 1996. [7] E. F. Prokhorov, J. Gonz´alez-Hern´andez, Y. V. Vorobiev, E. MoralesS´anchez, T. E. Prokhorova, and G. Zaldivar Lelo de Larrea, “In vivo electrical characteristics of human skin, including at biological active points,” Med. Biol. Eng. Comput., vol. 38, no. 5, pp. 507–511, 2000. [8] M. Reichmanis, A. A. Marino, and R. O. Becker, “Laplace plane analysis of impedance between acupuncture points H-3 and H-4,” Comparative Med. East West, vol. 5, no. 3–4, pp. 289–295, 1977. [9] M. Reichmanis, A. A. Marino, and R. O. Becker, “Laplace plane analysis of impedance on the H meridian,” Amer. J. Chin. Med., vol. 7, no. 2, pp. 188–193, 1979. [10] H. M. Johng, J. H. Cho, H. S. Shin, K. S. Soh, T. H. Koo, S. Y. Choi, H. S. Koo, and M. S. Park, “Frequency dependence of impedances at the acupuncture point Quze (PC3),” IEEE Eng. Med. Biol. Mag., vol. 21, no. 2, pp. 33–36, Mar./Apr. 2002. [11] M. L. Brown, G. A. Ulett, and J. A. Stern, “Acupuncture loci: Techniques for location,” Amer. J. Chin. Med., vol. 2, no. 1, pp. 67–74, Jan. 1974. [12] J. Hyvarinen and M. Karlsson, “Low-resistance skin points that may coincide with acupuncture loci,” Med. Biol., vol. 55, no. 2, pp. 88–94, Apr. 1977. [13] Z. Zhu, “Research advances in the electrical specificity of meridians and acupuncture points,” Amer. J. Acupuncture, vol. 9, no. 3, pp. 203–216, 1981. [14] C. Ionescu-Tirgoviste and S. Pruna, “Electroacupunctogram: A new recording technique of the acupoint potentials,” M´edecine Interne, vol. 25, no. 1, pp. 67–76, Jan./Mar. 1987. [15] F. F. Kuo and J. J. Kuo, Recent Advances in Acupuncture Research. Garden City, NY, USA: Institute for Advanced Research in Asian Science and Medicine, 1979, pp. 401–499. [16] Y. Lin, “Acupuncture treatment for insomnia and acupuncture analgesia,” Psychiatry Clin. Neurosci., vol. 49, pp. 119–120, 1995.
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[17] A. J. Vickers, A. M. Cronin, A. C. Maschino, G. Lewith, H. MacPherson, N. E. Foster, K. J. Sherman, C. M. Witt, and K. Linde, “Acupuncture for chronic pain: Individual patient data meta-analysis,” Deutsche Zeitschrift f¨ur Akupunktur, vol. 55, no. 4, pp. 24–25, Nov. 2012. [18] L. Trivieri, Alternative Medicine: The Definitive Guide, 2nd ed. Berkeley: Ten Speed Press, 2002, p. 1280. [19] R. Voll, “Twenty years of electro-acupuncture diagnosis in Germany: A progress report,” Amer. J. Acupuncture, vol. 3, no. 1, pp. 7–17, 1975. [20] Y. Nakatani, “Skin electric resistance and ryodoraku,” J. Autonomic Nervous Syst., vol. 6, p. 52, 1956. [21] J. J. Tsuei, “A modern interpretation of acupuncture and the meridian system,” in Proc. 2nd Int. Conf. Bioelectromagnetism, 1998, pp. 177–182. [22] W. Tiller, “What do electrodermal diagnostic acupuncture Instruments really measure?” Amer. J. Acupuncture, vol. 15, pp. 15–23, 1987. [23] V. I. Filatov and N. F. Poriadin, “The potentials of the Reflexotest computer diagnostic system with patients suffering from kidney failure,” Urol Nefrol (Mosk), vol. 2, pp. 35–37, Mar./Apr. 1996. [24] A. Zytkowski, “Electrodermal method of ryodorak—An attempt at clinical measurement for evaluation of physiotherapy effects in patients with low back pain,” Neurol Neurochir Pol., vol. 32, pp. 207–215, 1999. [25] E. F. Prokhorov, T. E. Prokhorova, J. Gonz´alez-Hern´andez, Y. A. Kovalenko, F. Llamas, S. Moctezuma, and H. Romero, “In vivo dc and ac measurements at acupuncture points in healthy and unhealthy people,” Complementary Therapies Med., vol. 14, no. 1, pp. 31–38, Mar. 2006. [26] A. P. Larsen. (2004, March 5). Ryodoraku Acupuncture Measurement and Treatment [Online]. Available: http://www.logan.edu/mm/files/LRC/ Senior-Research/2004-Apr-61.pdf [27] A. C. Ahn and O. G. Martinsen, “Electrical characterization of acupuncture points: Technical issues and challenges,” J. Alternative Complementary Med., vol. 13, no. 8, pp. 817–824, Oct. 2007. [28] S. Kramer, D. Zaps, B. Wiege, and D. Irnich, “Changes in electrical skin resistance at gallbladder 34 (GB34),” J. Acupuncture Meridian Stud., vol. 1, no. 2, pp. 91–96, Dec. 2008. [29] A. C. Ahn, J. Wu, G. J. Badger, R. Hammerschlag, and H. M. Langevin, “Electrical impedance along connective tissue planes associated with acupuncture meridians,” BMC Complementary Alternative Med., vol. 5, pp. 1–9, May 2005. [30] S. Liu, J. Pan, and M. Zhou, “A semi-quantitative method to study electrical properties of acupuncture points,” Int. J. Intell. Control Syst., vol. 13, no. 4, pp. 237–241, Dec. 2008. [31] E. G. Portnov, Electroacupuncture and Reflex Therapy. Riga, Latvia: Zinatne, 1987, p. 22. [32] E. L. Macheret and A. O. Korkushko, Foundation of Electro and Acupuncture. Kiev, Ukraine: Zdorov’e, 1993. [33] A. M. Klingman, “Skin permeability: Dermatologic aspects of transdermal drug delivery,” Amer. Heart J., vol. 108, pp. 200–206, Jul. 1984. [34] J. J. Tsuei, “The past, present and future of the electrodermal screening system (EDSS),” J. Advancement Med., vol. 8, no. 4, pp. 217–232, 1995. [35] J. G. Webster, Medical Instrumentation: Application and Design, 4th ed. Hoboken, NJ, USA: Wiley, 2009, p. 713. [36] P. Tallgren, S. Vanhatalo, K. Kaila, and J. Voipio, “Evaluation of commercially available electrodes and gels for recording of slow EEG potentials,” Clinical Neurophysiol., vol. 116, pp. 799–806, Apr. 2005. [37] Ch. Shang. (2012, Dec. 7). Mechanism of Acupuncture—Beyond Neurohumoral Theory [Online]. Available: http://med-vetacupuncture.org/english/ articles/mechan.html [38] Q. Fang, R. Bedi, B. Ahmed, and I. Cosic, “Comparison of skin resistance between biological active points of left and right hands with various contact pressures,” in Proc. 26th Annu. Int. Conf. IEEE EMBS, San Francisco, CA, USA, 2004, pp. 2995–2998. [39] R. Mancini. (2002, Aug. 22). Op Amps For Everyone, [Online], pp. 3-3–3-7 Available: http://www.ti.com/general/docs/litabsmultiplefilelist. tsp?literatureNumber=slod006b ˇ anik, “Application of communication [40] L. Hargaˇs, M. Hrianka, and P. Sp´ ˇ systems in biomedical engineering,” Commun. Sci. Lett. Univ. Zilina, vol. 7, no. 1, ISSN 1335-4205, pp. 43–47, 2006.
Authors’ photographs and biographies not available at the time of publication.
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Hardware and Software Realization of EDSD for Acupuncture Research and Practice T. Fico, F. Duchoˇn, and J. D´ubravsk´y
Abstract—Traditional acupuncture as a diagnostic and therapeutic method has been known in China for more than 3000 years. Electrodermal screening tests (EDSTs) and electrodermal screening devices (EDSDs) that are based on the knowledge derived from traditional Chinese medicine appeared in the 1950s. This article deals with design, development and realization of such a device. The design considers the principles of two widely used EDSTs and modern trends in the field of electronics and data management. A computer program with simple user interface that provides graphic evaluation and intercomparison of measured data are presented. The designed system is suitable not only for acupuncture research but also for ordinary acupuncture diagnostics. Index Terms—Acupuncture, biological active points, data management, measurement.
I. INTRODUCTION CUPUNCTURE is one of numerous Chinese therapeutic methods that has been used in medical treatment for several thousands years. Recent findings indicate that this tradition can be traced back to about 5000 years ago, while it is still an essential part of the Chinese medicine system today [1]. This treatment method was brought to Europe in the 16th century but its popularity did not start growing rapidly until the 19th century [2], [3]. The word “acupuncture” consists of two Latin words, “acus” (needle) and “pungere” (to prick), which illustrate the principle employed by this therapy. The human body according to traditional Chinese medicine contains energy paths known as meridians. These connect body organs, systems, and biological active points (BAPs) also called acupuncture points. These points represent a type of “portal.” BAPs can be influenced by heat, pressure, light, acupuncture needles, and electric current. The pathological state of an organism can be changed by affecting the BAPs. This way we can influence: the energo-iteration level (BAPs, meridians, and microsystems), the psycho-regulating level (emotionalism and awareness), and the bio-morphological level (organ systems, blood circulation) of an organism [4].
A
From the physical and morphological point of view a BAP can be defined as a place on the body or its mucous membranes. Morphologically speaking, BAPs have thinner skin and more nervous plexuses (sensory receptors) than the surrounding skin [5]. In general, a BAP is characterized by higher temperature and higher sensitivity to pressure and other influence factors [6]. With regard to electrical properties, BAPs are considered to have lower electrical resistance, higher electrical capacitance [7]–[10], and higher electric potential [11]–[14]. BAPs are also sources of low electric current. Acupuncture is mainly used for diagnostics and preventive treatment, but it is also used in analgesia and insomnia treatment [15], [16]. It is also effective in the treatment of various chronic pains [17], mental disorders, addiction relief, and other anamneses [18]. In the 1950s, Dr. Reinhold Voll created a device for patient diagnostics based on the electrical properties of BAPs, as mentioned earlier, and named it electroacupuncture according to Voll (EAV) device [19]. The EAV device measures electrical conductance on a specific set of BAPs. At the same time, a similar method was developed by Dr. Yoshio Nakatan in Japan. This method is called ryodoraku, a compound name composed of the words “ryo” (good), “do” (conductivity), and “raku” (path or line) [20]. The main difference between these two methods is in the sets of measuring points however, there is also a difference in the value of the measuring voltage and the way of evaluation. The device described in this paper combines these two methods. Currently, both approaches and devices belong to the electrodermal screening device (EDSD) equipment type. The EAV is considered to be more precisely developed with lower impact on the human body [21]. The contribution of these methods is to objectify the process of diagnostics in acupuncture and the prediction of diseases. Studies show that these methods can be used for early detection of cancer [4], [22] and other pathological conditions [23]. The relation between measured electrodermal properties and physiotherapy effects can be established [24].
II. EDSD Manuscript received February 14, 2013; revised June 16, 2013 and August 26, 2013; accepted October 7, 2013. Date of publication October 17, 2013; date of current version June 30, 2014. This work was supported by MS SR under Contract APVV-0539-11. The authors are with the Faculty of Electrical Engineering and Information Technology, Institute of Control and Industrial Informatics, Slovak University of Technology, Bratislava 81243, Slovakia (e-mail: [email protected]; [email protected]; [email protected]). Color versions of one or more of the figures in this paper are available online at http://ieeexplore.ieee.org. Digital Object Identifier 10.1109/JBHI.2013.2285729
A. EAV Method The EAV method causes direct current (dc) to run through the body using low direct voltage. The value of the voltage used in the measurement is approximately 1.25 volt (V) and creates current up to 12 microamperes (μA). The devices utilized in both the EAV and ryodoraku methods typically consist of two parts. The first part is intended for diagnostics and the second part applies current to stimulate BAPs.
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Fig. 2.
Fig. 1. Basic schematic diagram of the device according to the EAV for measuring electrical conductivity.
As shown in Fig. 1, the first part of the EAV device works based on the ammeter principle. The source of the safe voltage is an accumulator. The role of the resistors is to limit the meter needle deviation. The chance of tissue polarization is reduced using lower voltage. Devices of the ryodoraku method apply higher voltage: 9, 12, and, in some cases, 21 V. These higher voltages increase the rate of polarization. Measurements are performed while a patient holds the hand electrode in the palm of his closed hand and a therapist measures the electrical conductivity of the BAP with the test electrode. Values are presented in nondimensional units and optimal values are between 50 and 56. Values outside this range indicate a possible disease. However, this approach is imperfect, since different skin moisture and even skin color can produce significantly different values [25]. Both methods are considered as effective as traditional needling; however, they require less time. For example, a classic acupuncture treatment lasting an average of 30 min would only take approximately 3–4 min using ryodoraku, including examination [26]. B. Experimental and Commonly Used EDSD Presently, there are several types of diagnostic equipment, which are mostly based on the described principles [27]. Some of them use alternating current (ac). They are mainly experimental prototypes to verify the properties of BAPs. These diagnostic devices are often realized as nonportable measuring devices, which can be limiting. They currently use specialized computer programs and other interfaces for data evaluation. Modern EDSDs also support Universal Serial Bus (USB) connection. Diverse devices were created to realize measurements on BAPs that can measure the impedance, e.g., on areas of skin [28] or on the needles inserted into skin using the multiple-electrode method [29], [30]. Measurements done on the acupuncture needles do not produce very accurate results, as after puncturing, the skin is more congestive, its temperature rises, and swelling can occur. These states lower the electrical resistance and minimize the difference between BAPs and surrounding skin. III. ELECTRICAL PROPERTIES OF THE BAPS As mentioned earlier, several publications declare that BAPs are different from surrounding skin in electrical properties.
Electrical model of a BAP and surrounding skin [7].
There are several models of a BAP representing their essential electrical properties: lower electrical resistance and higher electrical capacitance [7]. In the human body, we can observe only two types of electrical phenomena: resistivity and capacitance. Fig. 2 shows that the electrical model of skin contains several of these elements. Formations that create inductance in the human body have not yet been discovered. Resistance RR and capacitance CR represent the parameters of the human body. Constant phase element (CPE) is a component of the model that causes a phase shift of the signal. Its value depends on numerous factors, for instance, the roughness of skin. Resistance R1 represents resistivity of the epidermis itself. This element has the largest value, because the upper layers of skin contain dead skin cells, which are dry and therefore poorly conductive. Elements R2 and C describe the intracellular compartments of the skin. Components RBAP and CBAP illustrate the difference in electrical resistance and capacitance between a BAP and normal skin. The latter two elements were added after the finding that the BAP has lower resistance and higher capacitance with both dc and ac [7]. The model does not consider miscellaneous biological sources of voltage that affect the measurements dynamically. An explanation of the fact that a BAP differs from normal skin was presented in a morphological research. The research determined a higher concentration of nervous plexuses, microcirculation vessels, and mast cells (which contain histamine and heparin and play an important role in the protection of the organism) under the stratum corneum (the outermost layer of the epidermis) of BAPs than in the surrounding skin [31], [32]. A universal value of resistance that can determine a “good energetic path” is not possible to estimate. As mentioned earlier, the electrical resistance of the skin depends on skin moisture, and thus on the current mental state of an individual, as nervous people are prone to sweat more. Electrical resistance also depends on ethnic origin. Darker skin has higher resistance because the stratum corneum is denser and has more cell layers [33]. The value of the resistance of a BAP can change during measurement when using direct current [34]. This is probably caused by the polarization of the tissue. When considering the EAV method there are normally five types of curves that therapists use to assign the diagnosis (see Fig. 3). The device proposed in this paper implements a measurement methodology from the ryodoraku method. The value is taken two or three seconds after the test electrode was applied to a BAP.
FICO et al.: HARDWARE AND SOFTWARE REALIZATION OF EDSD FOR ACUPUNCTURE RESEARCH AND PRACTICE
Fig. 3. Basic curves equivalent to conductivity in BAP; interpretation according to EAV [34].
Fig. 4.
Electrical model of the electrode–electrolyte boundary [35].
It is recommended to measure several values for calculating the resulting arithmetic mean when using a digital device. IV. PROPERTIES AND DESIGN OF THE ELECTRODES Electrodes are used to carry the signal (energy) from the patient to the device and conversely. The design of the electrodes takes into account the safety of a patient and reduces influence on measurement. The main function of the electrode is to change the type of conductivity from the first class (the charge is carried by electrons) to the second class (the charge is carried by ions) and vice versa. This conversion occurs on the boundary between the electrode and electrolyte by transmission of ions called oxidation (release of n electrons) and reduction (reception of m electrons). These reactions are reversible [35]. Every metal material used for electrodes has a specific redox potential referenced to a hydrogen electrode. The resulting electric potential, also called the half-cell potential, is calculated as the difference of the potential between the electrode and the electrolyte. Fig. 4 shows the half-cell potential EPP used in the electric model. RP represents the resistance and CP the capacitance of the boundary based on the charged bilayer of the ions. RS denotes the electric resistance of the electrolyte itself. Since we use dc we can simplify the electric model because the capacity element can be neglected. While designing the
Fig. 5.
Measuring and hand electrode with connection cables.
Fig. 6.
Design of the test electrode made of brass.
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electrodes, it is important to choose the same material for the contact area of the hand and the test electrode (see Fig. 5). Different metals have different half-cell potential that can create high voltage drift. In case of using electrodes made of stainless steel and gold the drift could reach values of hundreds of millivolts (>500 mV). In comparison, two silver–silver chloride (Ag/AgCl) electrodes, which are the electrically optimal choice, produce a drift of around 100 mV. The electrocardiography (ECG), electroencephalography (EEG), and electromyography (EMG) methods commonly use the mentioned Ag/AgCl electrodes. These electrodes have desirable qualities, such as stable half-cell potential, low noise, and low contact resistance for the duration of the entire measurement [36]. However, these electrodes are normally intended for single use only, which renders them unsuitable for measuring skin conductance using the EAV and ryodoraku methods. For these and a number of other reasons, brass—a metal alloy made of copper and zinc is used as the most suitable material for the electrodes. Brass has various advantages compared to commonly used materials. This alloy has better conductivity than stainless steel, changes carriers from one class to another quite well, is nonallergic, nonexpensive, and does not wear out like gold-plated or silver-plated layers. The electrolyte on the hand electrode is the skin’s natural perspiration, or, if necessary, an additional saline solution (0.9% NaCl) with electrical properties similar to skin tissues. For the design of the test electrode conventions from both EDSDs were used. The EAV devices use the tip of the test electrode (ø3 mm) and the measured area is moistened with saline solution. The ryodoraku devices use a hollow electrode filled with cotton moistened with biological fluid (see Fig. 6). The saline solution is not only used as an electrolyte but it also balances the different level of moistness of parts of the human body and creates an important conductive connection. The use
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Fig. 8.
Principal scheme with the Op-Amps.
potential than the test electrode. This is caused by the difference in contact areas and the placement of the electrodes on the body. Potential ER represents a variable voltage source, which is the sum of alternating voltages with various frequencies and waveforms. It includes electrical potentials produced by active tissues (e.g., ECG signal), motion artifacts (potentially produced by muscles) and other voltages produced by internal processes or by the environment. VI. DESIGN OF MEASURING CIRCUITS
Fig. 7.
Electrical model of the measured object using dc.
of a 3 mm diameter tip is useful mainly for measurements on the ear where BAPs have the highest density [37]. The resistance of the moistened cotton is 4–6 kΩ, depending on moistness and volume of used cotton. The test tip has a slightly higher resistance of 5–7 kΩ. This is caused by the smaller contact area of the electrode, while the electrolyte layer (saline solution) is thinner. One of the factors affecting the measurements is the oxidation of brass. The electrodes need to be regularly cleaned so that the electrical properties of the surface of brass remain unchanged. It is essential to apply the same pressure to the BAPs as well as to keep the moistness of the epidermis approximately at the same concentration [38]. V. MEASURED OBJECT Since dc will be used, we can simplify the model of the measured object to a system of resistances and electrical potentials. The electric model in Fig. 7 represents the object of measurement, which is divided into three parts: input area of skin, the body, and output area of skin. The electrodes do not have identical parameters, because they have different contact areas. The moistness of the skin is also unequal. Voltage sources EP h and EP t represent several electric potentials, such as the potential of the electrode, the electrolyte and the electrolyte–epidermis boundary. In the model, the potentials have opposite polarity and therefore are subtracted from one another, but as they do not have the same value, this results in a nonzero voltage drift that can reach values up to 150 mV. According to the measurements the hand electrode has higher
When measuring on a patient it is required to consider several factors. The safety of the patient is the most important of all. A patient cannot be injured by the electric current even if a failure of a device should occur. The current passing through the human body must be significantly lower than the sensitivity threshold, which varies from microamperes to tens of microamperes. In addition, the measuring voltage should be low enough, so that it does not significantly affect the measurement by excessive polarization. There are also requirements on measurement accuracy and resolution. To eliminate the risk of an electric shock during measurement the whole device is powered by internal accumulators and is disconnected from the electrical grid. The voltage applied is limited to a maximum of 1.25 V. The current is limited by internal circuits to a value lower than 1 μA. The problem that measuring with dc brings is that partial electric potentials affect the measuring voltage. A change in measuring voltage causes change in the resulting resistance values. This can be solved either by measuring these potentials or by using two different measuring voltages consecutively during one measurement. For our device, the second solution was chosen. The resulting value with correction is calculated from several measured values. We use four operational amplifiers (Op-Amp) in the measuring circuits. Two were used to convert resistance to voltage, while one has noninverting wiring, and the remaining two as voltage followers. The measured object is connected to the noninverting Op-Amp as feedback (see Fig. 8). The output of this component is connected to an Op-Amp differential amplifier to adjust the range. Electric potential UX represents an error that is transferred to the resulting measured value. It is convenient to set the gain of the differential Op-Amp to 2. Equation (1) is a conjunction of two formulas: differential amplifier output voltage and output
FICO et al.: HARDWARE AND SOFTWARE REALIZATION OF EDSD FOR ACUPUNCTURE RESEARCH AND PRACTICE
Fig. 9. Filtered value of the measured resistance converted from ADC code to equivalent resistance. Measured BAP was HE 1 on the right side of the body. The measuring voltage changes every half a second.
Fig. 10.
Internal structure of the designed device.
Fig. 11.
Constructed device with connected electrodes and USB cable.
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voltage from noninverting amplifier with output offset UX [39] RX =
UO − 2UX RREF UREF
[Ω].
(1)
As mentioned earlier, we use two values of measuring voltage. If we establish that the voltage UREF2 will be double the value of UREF1 and we express the two output voltages UO 1 and UO 2 using the conversion code from an analog-to-digital converter (ADC) and its resolution N , then we get the following equation: RX =
RREF (2X2 − X1 ) N
[Ω].
(2)
The value of variable N is 4096, which corresponds to a 12-bit resolution. Variables X1 and X2 are results of an analog to digital conversion of UO 1 and UO 2 . The resulting formula does not contain any unknown electric potential, but it is necessary to ensure the possibility of switching between reference levels. We used a simple voltage divider made from two resistors of equal value. One end was connected through a unipolar transistor to the ground signal. If we switch the transistor, the reference voltage will change. The impedance of the divider is amplified with a unity buffer amplifier of the value UREF . Resistance RREF adjusts the measuring range and in the realized design it was implemented at the value of 10 MΩ. This value represents the theoretical upper limit but the influence of the unknown electric potential lowers the measured resistance (1). The real boundaries of the measured resistance are 25 kΩ and 8 MΩ. To reduce unwanted external noise both a hardware and a software filter is used. By adjusting the appropriate cutoff frequency it is possible to sufficiently suppress the influence of the electric grid frequency. The curve of the measured resistance shown in Fig. 9 is deformed by the capacitance of the BAP. It is necessary to postpone the measurement until the signal/curve has settled. The sample time may appear to be relatively long (half a second) but the voltage of the BAP is relatively stable and we can assume equal environment noise during the entire measurement (approximately 3 s).
VII. HARDWARE REALIZATION OF DESIGNED EDSD The designed device contains not only circuits for measuring but rather a whole range of subsystems necessary for the basic use (see Fig. 10). The device is based on the ATmega16 L microcontroller from Atmel, which collects data on the input and manages other circuits on the outputs. The microcontroller is connected to: a measuring subsystem, liquid crystal display (LCD), keyboard, external nonvolatile memory, USB-to-serial interface, and power management circuits. Two low-dropout (LDO) regulators are used in the device as shown in Fig. 10. One is used for digital and the other for analog circuits. This design minimizes noise transferred from digital to analog circuits. Most of the electrical components are surface mount devices (SMD) and the printed circuit board is inserted into a case that fits easily into a hand, thus adding to the user-friendly qualities of the device (see Fig. 11). The display and keyboard are on the top side of the case. There are three connectors on the bottom: for charging, communication over USB, and for connecting the electrodes via a jack connector. VIII. SOFTWARE FOR DATA ANALYSES A PC program with several functions was developed to process and analyze the data obtained by the device. The application communicates with the device through a virtual serial link realized via USB. After the data are transferred from the device the analysis can be done. Both established routines and new approaches are used for data analysis that should help rationalize the representation of the measured data.
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Fig. 12. Electrodiagnostic (ED) at biorhythm points using measured data with preview of a specific BAP.
Fig. 14. Additional application window displays the analysis of elements. The analysis is based on data from ED at biorhythm points and proposed in a new way [4].
Fig. 13.
Fig. 15. The window of analyses shows more graphs for better comparison of two diagnostic methods (ED yuan and mamma trigram Wen). There are several analyses shown according to new approaches [4].
Electromammography displayed using a bar graph.
Fig. 12 shows the PC application created in Visual Basic. The application consists of several tabs. Each tab contains an analysis according to distinct diagnostics. Electrodiagnostics (ED) at the yuan and biorhythm points use 12 main meridian paths in both sides of the body. Electro-mammography measures points of meridian paths that run through breasts. Mamma trigram Wen uses BAPs located directly on breasts. Electroextrameridiangraphy utilizes cardinal BAPs from eight extraordinary meridians [4]. Graphs and a data table can be displayed using the default unit siemens (S) or alternatively ohms (Ω). The application can display data using several types of graphs: line graph (see Fig. 12), bar graph (see Fig. 13), and weighted graph (see Fig. 14). It also contains an analysis of elements and yin-yang state based on BAP’s associations. Most BAPs are related to one of five elements and the analysis of elements is a weighted comparison of these (see Fig. 14). The graph also indicates the tolerance area for quantitative assessment (green circle) and arrows of the electrical conductance gradient to determine creative and destructive mechanisms in a new way. This visual representation helps to determine an acupuncture diagnosis on the level of electrical skin conductance [4]. Users can adjust tolerance areas for different graphs. The program stores these values for future use.
Fig. 15 shows the window of analyses with the ED yuan and mamma trigram Wen methods. The upper part of the window contains the main graphs and the yin-yang and elements analyses are at the bottom. The mamma trigram Wen analysis uses a weighted graph that represents the acupuncture microsystem of the breasts according to a new approach. We can import and export data using the Microsoft Excel xls file format. Measured data from different devices can be imported if they are converted into units of conductivity. Moreover, the application supports its own file format for saving measured data and basic information about the patient. The PC program can be enhanced with communication standards like DICOM [40] for standardizing transfer of analyses and patient data. The application provides ample possibilities for analysis, which simplifies work and research in acupuncture practice. IX. CONCLUSION The objective of this paper was to outline the problems related to designing a device of the EDSD category and the solutions to those problems. A related computer program was developed. The paper covers various areas, such as acupuncture,
FICO et al.: HARDWARE AND SOFTWARE REALIZATION OF EDSD FOR ACUPUNCTURE RESEARCH AND PRACTICE
medicine, measuring, electronics, and informatics. The designed solution suppresses unwanted electric potential and makes measurements on BAPs more relevant than the commonly used devices in EAV and ryodoraku methods. The computer program provides means to conduct multiple analyses and is comparable with commercially used applications. Some features, such as individual analysis and data export/import, predestine this software for research. In the future we plan to enhance the measuring resolution of the device and extend the application with other sets of points based on existing analyses. The program can be enhanced with psychological tests of the state of mind to make it a comprehensive tool. ACKNOWLEDGMENT The authors would like to thank Dr. T. Mochn´acˇ for his many helpful insights and discussions. REFERENCES [1] L. Dorfer, M. Moser, F. Bahr, K. Spindler, E. Egarter-Vigl, S. Giull´en, G. Dohr, and T. Kenner, “A medical report from the stone age?” Lancet, vol. 354, pp. 1023–1025, Sep. 1999. [2] N. Vadivelu, R. D. Urman, and R. L. Hines, “Acupuncture,” in Essentials of Pain Management. New York, NY, USA: Springer, 2011, pp. 337– 366. [3] A. White and E. Ernst, “A brief history of acupuncture,” Rheumatology, vol. 43, no. 5, pp. 662–663, May 2004. [4] T. Mochn´acˇ , “The risk factors and the extraordinary acupuncture vessels functions in relation to a mammary glands diseases,” Ph.D. dissertation, Dept. of Public Health, St. Elizabeth University of Health and Social work, Bratislava, Slovakia, 2012. [5] P. Rabischong, J. E. Niboyet, C. Terral, R. S´enelar, and R. Casez, “Bases exp´erimentales de l’analg´esie acupuncturale,” La Nouvelle Presse M´edicale, vol. 4, pp. 2021–2026, Aug./Sep. 1975. [6] D. Zhang, W. Fu, S. Wang, Z. Wei, and F. Wang, “Displaying of infrared thermogram of temperature character on merians,” Chen Tzu Yen Chi., vol. 21, pp. 63–67, 1996. [7] E. F. Prokhorov, J. Gonz´alez-Hern´andez, Y. V. Vorobiev, E. MoralesS´anchez, T. E. Prokhorova, and G. Zaldivar Lelo de Larrea, “In vivo electrical characteristics of human skin, including at biological active points,” Med. Biol. Eng. Comput., vol. 38, no. 5, pp. 507–511, 2000. [8] M. Reichmanis, A. A. Marino, and R. O. Becker, “Laplace plane analysis of impedance between acupuncture points H-3 and H-4,” Comparative Med. East West, vol. 5, no. 3–4, pp. 289–295, 1977. [9] M. Reichmanis, A. A. Marino, and R. O. Becker, “Laplace plane analysis of impedance on the H meridian,” Amer. J. Chin. Med., vol. 7, no. 2, pp. 188–193, 1979. [10] H. M. Johng, J. H. Cho, H. S. Shin, K. S. Soh, T. H. Koo, S. Y. Choi, H. S. Koo, and M. S. Park, “Frequency dependence of impedances at the acupuncture point Quze (PC3),” IEEE Eng. Med. Biol. Mag., vol. 21, no. 2, pp. 33–36, Mar./Apr. 2002. [11] M. L. Brown, G. A. Ulett, and J. A. Stern, “Acupuncture loci: Techniques for location,” Amer. J. Chin. Med., vol. 2, no. 1, pp. 67–74, Jan. 1974. [12] J. Hyvarinen and M. Karlsson, “Low-resistance skin points that may coincide with acupuncture loci,” Med. Biol., vol. 55, no. 2, pp. 88–94, Apr. 1977. [13] Z. Zhu, “Research advances in the electrical specificity of meridians and acupuncture points,” Amer. J. Acupuncture, vol. 9, no. 3, pp. 203–216, 1981. [14] C. Ionescu-Tirgoviste and S. Pruna, “Electroacupunctogram: A new recording technique of the acupoint potentials,” M´edecine Interne, vol. 25, no. 1, pp. 67–76, Jan./Mar. 1987. [15] F. F. Kuo and J. J. Kuo, Recent Advances in Acupuncture Research. Garden City, NY, USA: Institute for Advanced Research in Asian Science and Medicine, 1979, pp. 401–499. [16] Y. Lin, “Acupuncture treatment for insomnia and acupuncture analgesia,” Psychiatry Clin. Neurosci., vol. 49, pp. 119–120, 1995.
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Authors’ photographs and biographies not available at the time of publication.
