Adaptive Medicine 3(2): 91-98, 2011 DOI: 10.4247/AM.2011.

ABB014

91

Review

Hypertension: A Comparative Review Based on Fractal Wave Theory of Continuum

Shyang Chang
Department of Electrical Engineering, National Tsing Hua University, Hsinchu 30013, Taiwan, Republic of China

Hypertension is defined as the condition that the mean arterial pressure is greater than the upper range of accepted normality. It has a few sub-classifications including for instance, hypertension stage I, hypertension stage II, isolated systolic or diastolic hypertension. The isolated systolic hypertension, for instance, refers to elevated systolic pressure only. In this article, we will first review the current knowledge on the etiology of hypertension. Then, diagnostic methods of hypertension will be reviewed. Finally, the methods of treatment will be discussed. Throughout this paper, we will compare the differences between the approaches of orthodox western medicine and traditional Chinese medicine. In particular, the mechanism of acupuncture and its fractal wave theory of continuum will be invoked to elucidate how and why acupuncture can help improve the overall blood circulation and distribution. It is hoped that this review can improve our understanding of hypertension and help us make accurate judgments on the treatments from two different schools of thought. Key Words: acupuncture, blood flow, blood pressure, circulation, fractal wave theory of continuum, hypertension, inductive and capacitive impedances, traditional Chinese medicine

Introduction
Hypertension is said to affect more than a few hundred million individuals worldwide and is believed to be responsible for seven million deaths each year (2, 14). It is also said that hypertension in most individuals remains untreated or uncontrolled. The effective control of hypertension is usually limited by adverse effects, availability, and cost of antihypertensive medications. In order to reduce the adverse effects and cost of antihypertensive medications in western medicine, modalities of complementary and alternative medicine, including acupuncture, have been used by patients worldwide with increasing frequency. However, due to conflict of interest or misunderstanding, these alternative therapies have sometimes been criticized for lacking demonstrated

efficacy and safety in treating cardiovascular disease and hypertension (16, 21). Nevertheless, acupuncture per se has been used in traditional Chinese medicine (TCM) to treat symptoms related to hypertension for more than 3,000 years. Today, the efficacy of acupuncture is well supported for treating other acute and chronic physiological disorders in addition to hypertension in China, Taiwan, and worldwide (1719, 22). This paper will review the most basic and important concepts and developments in the field of hypertension that can impact on the diagnosis and treatment of it. On hypertension, clinicians tend to reduce the systolic and diastolic blood pressures of their patients through the use of drugs in addition to lifestyle modifications. The logic of using such a simplistic measurement of systolic and diastolic pressures recorded with a sphygmomanometer was put forth by Mackenzie in 1926. It is still repeated in modern physiological textbooks and clinical practices nowadays. However, it is well-known that the sphygmomanometer can lead to possible over-interpretation of systolic and diastolic pressures as representing physiological dynamic behavior rather than simply the top and bottom of the absolute pressure waves in the brachial artery. This is perhaps one of the main reasons that the aforementioned references cannot demonstrate the efficacy of acupuncture for treating hypertension (16, 21). The simple matter of fact is that hypertension is actually a misnomer and it is the blood flow and how the blood is distributed in the human body that is important. This is the key point that I will try to explain in this review. Recall earlier still, Thomas Young conducted experiments on arterial segments and established the relation between elastic modulus and pulse wave velocity. Yet, preoccupation with diastolic pressure appears to be a sphygmomanometric phenomenon and to have gained prominence only after the 1920s. Reevaluation of such a phenomenon will be of prime importance in dealing with hypertension. It turns

Corresponding author: Dr. S. Chang, Department of Electrical Engineering, National Tsing Hua University, Hsinchu 30013, Taiwan, R.O.C. Tel: +886-35731146, Fax: +886-35715971, E-mail: shyang@ee.nthu.edu.tw Received: June 30, 2011; Revised: July 20, 2011; Accepted: July 25, 2011. 2011 by The Society of Adaptive Science in Taiwan and Airiti Press Inc. ISSN : 2076-944X. http://www.sast.org.tw

92

Chang

out that a recently proposed fractal wave theory of continuum can help us elucidate the concepts in cardiology (3, 4, 11, 12). This theory will represent a return to the more physiologically based concepts that prevailed in TCM before the advent of the sphygmomanometer.
-X/R0

Sqid Axon Membrane on the Complex Impedance Plane 1 0.8 0.6 0.4 0.2 0 30 Hz -0.2 -0.4 50 Hz 100 Hz 0 0.2 0.4 0.6 0.8 1 1.2 R/R0 1.4 200 Hz 1.6 1.8 2 5 KHz 2 KHz 300 Hz 1000 Hz 500 Hz

Blood Pressure versus Blood Flow and Impedances

Much of the confusion in this field arises from the misunderstanding of some of the basic concepts in cardiology. The misunderstanding basically arises from words and their use. First of all, pressure is defined to be force per unit area. It is not a good or robust parameter when it is used to measure blood pressure because it depends on the cross sectional area of blood vessels even if the pumping force of the heart is kept relatively the same for quite a while. As we all know that the diameters of blood vessels vary continuously from main arteries to small arteries and to capillaries of the human body. Hence, blood pressure is a constantly changing function of space and time. Actually, it is a random field as we will see later. Secondly, even if one still insists on the correctness of blood pressures and tries to measure them, it is the relative pressures or pressure gradients that are important (2, 14). For blood flow, the absolute pressures are meaningless. Hence, using a cuff that can block not only the arteries, veins, muscles but also the tendons in order to get the absolute systolic or diastolic pressure will induce a very large amount of error in the blood pressure readings (14). As a result, the corresponding diagnosis of hypertension in western cardiology has been very unreliable in addition to being questionable. However, in TCM, there is no such term as blood pressure for three thousand years. In TCM, it is the blood flow and its smoothness that are important. In other words, the blood pressure problem in western medicine has always been treated as a blood distribution problem in TCM. For instance, after meals, our blood should be distributed in such a way that it goes to the digestive tract. During exercises, our blood should be distributed more to our peripheral limbs. In TCM, by adjusting the impedances of neurovascular bundles or meridians via acupuncture, one can redistribute the blood flow in the body (3-6). The approach of TCM indeed makes more sense than its western counterpart. On the other hand, the approach of arterial pulses taken by TCM can be very informative if a strain gauge of compression mode is also adopted. The reason is that the pulses taken by the fingers of physicians in TCM or recorded by the strain gauge sensors are the direct manifestations of the local blood flow and its impedances. For

Fig. 1. Longitudinal impedance diagram of the giant squid axon membrane using the data supplied by K.S. Coles Membranes Ions and Impulses.

instance, we have claimed that the portions of 12 primary meridians located below the elbow and knees are actually the neurovascular bundles (3-6). Recall that the neurovascular bundles usually contain an artery and motor nerves that are centrifugal, and two satellite veins and sensory nerves that are centripetal. These four units are actually enclosed in a connective sheath to form the neurovascular bundles. Hence, they are almost electromagnetically neutralized since their directions of flow are in opposite directions. Consequently, their physiological functions cannot be revealed via the anatomy of corpse for there is no more blood flow or nerve conduction. Moreover, the conditions of meridians are also very difficult to detect even in case of minor physiological dysfunction. In (3, 4), the neurovascular bundle can be characterized and modeled by its distributed electromagnetic dynamical variables of resistance (R), inductance (L), and capacitance (C) as functions of space and time. These variables play vital roles in transmitting neurovascular flows that are modeled as fractal waves in continuum (3, 4, 11, 12). In Figs. 1 and 2, we have used the data supplied from (13) to plot the longitudinal impedance diagram of the giant squid axon membrane and that from (20) the input impedance of the ascending aorta of a dog, respectively. Notice that the longitudinal impedance of nerve fiber is inductive at low frequencies and the input impedance of the aorta is capacitive at low frequencies. They are complementary in the sense that one is inductive and the other will be capacitive. By the same token, it is logical to infer from these two impedance diagrams that the neurovascular bundles in humans can also be characterized by the impedance variables of R, L, and C possibly with

Hypertension: A Comparative Review

93

Impedances of Ascending Aorta of a Dog 8 7 6 5 -X/R0 4 3 2 1 0 6 Hz -1 7 Hz 1.6 1.8 8 Hz 9 Hz 2 2.2 R/R0 2.4 2.6 2.8 3 5 Hz 3 Hz 2 Hz 1 Hz

1.4

Fig. 2. Input impedance diagram of the ascending aorta of a dog using the data supplied by D.A. McDonalds Blood Flow in Arteries.

different ranges of frequencies and values. To recapitulate, in the neurovascular bundle, the impedance characteristics of nerve fibers and blood vessels are complementary to each other. From the modern perspective, this situation is very analogous to the classical yin-yang concept in TCM (3, 4, 11).

Etiology of Hypertension
According to the American Heart Association (AHA), 90 to 95 percent of all cases of hypertension are idiopathic in nature. However, hereditary and genetic factors, age, race, and weight are often considered to be playing major roles in this essential hypertension. For instance, in hereditary and genetic factors, it is believed that hypertension tends to run in families. The hereditary factors will cause the transmission from one generation to the next generation. As to other common causes, reduction in levels of vitamin D, low potassium levels, excessive consumption of cigarettes and alcohol have also been mentioned (2). However, the factors as indicated by AHA tend to be qualitative, long-term, chronic, or innate in nature. In order to have operational meanings for these factors, precise or more quantitative information must be provided. For instance, if the hereditary and genetic factors play important roles in forming hypertension, then the genes and their time to be turned on and off must be provided. On the other hand, if low potassium level is an important factor, then how low is defined to be low must be pointed out. Otherwise, these factors are not scientifically justified. Sometimes, it is mentioned that the renin secreted by an ischemic kidney will lead to the formation of angiotensin II which can cause secondary hypertension (2, 14). However, the renin level is known to be

highest in the morning and actually will vary throughout the day. It is also affected by a persons position, by stress, and by a variety of prescribed medications such as oral contraceptive and postmenopausal estrogen use. Consequently, measures that can increase the reliability in the diagnostics of renin level turn out to be quite difficult. In TCM, as mentioned previously, there is no such a notion as blood pressure, not to mention hypertension. In TCM, it is through its clinical symptoms and signs like headache, vertigo, tinnitus, dizziness, and fainting to differentiate the etiology of hypertension. Basically, these symptoms are due to the improper blood distribution among the brain, visceral organs, and peripheral limbs. In addition, the nerve innervations of the blood vessels, often called the blood chi (qi), have to go hand in hand with the blood. For instance, according to TCM, when one lies down at night, then the blood that flow in the peripheral limbs can return to liver and other visceral organs. After meals, one should avoid studying or performing strenuous physical exercise immediately so that blood will go to spleen, stomach, and liver of the digestive system for digestive purposes. On the same basis, too much stress and anxiety will also disrupt the proper blood distribution in the head and will cause headache, vertigo, tinnitus, dizziness, and fainting. To sum up, the etiology of hypertension according to TCM is mainly due to the improper blood distribution in the human body that has to do with the nerve innervations or chi (qi).

Diagnostic Procedures of Hypertension

Fundamental to the accurate diagnosis of hypertension in western medicine is the method used to measure blood pressures. Although office blood pressure measurements have been the reference standard for many years, there is an increasing use of self measurement of blood pressure at home and 24-h ambulatory blood pressure measurement. The hypertension thresholds have been associated with optimal (120/80 mmHg), normal (130/85 mmHg), and high (140/90 mmHg) office blood pressure measurements (2, 14). Usually it is also important to ask how often the blood pressures should be measured to obtain a standardized average for use in clinical practice. Some studies have suggested that the average of single measurements twice per day (morning and evening) for 7 days should be sufficient. However, the main problems with the blood pressure measurements are not only on how many times per day or how many times per week but also on the methodology adopted. As indicated in the previous section that it is the pressure gradients along blood vessels are to be measured, not the absolute blood pressures if one insists on using the con-

94

Chang

cept of pressure. The absolute pressures are not very informative. In addition, the use of a cuff that blocks the arteries and veins in order to get the absolute systolic and diastolic pressures will also induce a large amount of error in the blood pressure measurements (2). In cardiology, other tests like blood and urine tests are also included. However, the biochemical data from both tests are not conclusive in determining hypertensive patients. X ray, ultrasound, electrocardiogram (ECG), and other more sophisticated tools can also be adopted to help the doctors in diagnosing hypertensive patients. However, one must be careful here that more data do not necessarily mean they can provide more information and better diagnosis. These data may give contradictory results and cannot be correctly interpreted even by experts. Above all, an abuse of the use of sophisticated equipments is perhaps one of the main reasons that the medical cost is getting out of control nowadays. In contrast, the corresponding diagnostic methods of blood flow and local impedance in TCM are more informative and economical, yet less expensive and invasive. To make it more precise, let us use Fig. 3a to explain what we mean by a recording from the strain gauge under compression mode over the radial artery. The working principle of the strain gauge under compression mode over an artery is that it will only respond to a time-varying compression force from the artery itself. Under a relaxed condition of the test subject, say in supine position, the force of the pumping heart is kept in a rather constant value. The compression force to the strain gauge, under this condition, will be proportional to the local blood flow or the amount of blood volume in the artery. By the same token, the recoil of the artery will be inversely proportional to the local peripheral arterial impedance. If the local peripheral impedance is low, then the arterial recoil will be high. As a result, the readings from strain gauges will have larger fluctuations, and vice versa. Hence, the magnitude of percussion wave, denoted by P, of radial artery in the Fig. 3a is proportional to the blood flow or volume and the base point A is proportional to the local impedance at the radial artery. The dicrotic notch or valley V in the pulse wave is roughly the mean blood pressure in the standard physiology textbook (2, 14). Notice that the dicrotic wave D is very sensitive to perturbation of local finger or joint movements. As a result, its magnitude will not be used as a credible indicator in our study. It is also important to realize that the purpose of pulse-taking by the fingers of physicians in TCM can be interpreted as performing the same functions of the strain gauge sensors. The physicians are interested precisely in the local blood flow and its impedances. However, mastering this kind of

(a)

P wave

D wave

V wave

(b)

Fig. 3. Radial arterial pulse wave and ECG wave: (a) the typical pulse wave marked with A, P, V, D where A stands for a base point, P the percussion wave, V the valley, and D the dicrotic wave; (b) the ECG and its R peak.

skill will take a long time of practical training and clinical practice. Since the activity of the autonomic nervous system (ANS) plays an important role in the nerve control of arteries, the ECG data will also be recorded to analyze heart rate variability (HRV) that is related to the ANS. For instance, the sympathetic nervous system can alter the degree of vasoconstriction in the blood vessels of many visceral organs and limbs in our body (7, 10). In the HRV, there are in general three ranges. One is called the very low frequency range (VLF: 0.00-0.04 Hz), the second called low frequency range (LF: 0.04-0.15 Hz), and the third called high frequency range (HF: 0.15-0.40 Hz) (1). They are believed to reflect the activities of sympathetic and/or that of parasympathetic nervous systems (1). A typical ECG diagram is illustrated in Fig. 3b.

Treatment of Hypertension
The treatment of essential hypertension has mainly two types. The first type is the so-called lifestyle modifications. The modifications include avoidance of tobacco, weight reduction, relaxation techniques, and physical exercise that may include weight training. As to this type of treatment, the East and West are basically the same except that the TCM will encourage a combination of relaxation techniques with physical exercise, such as Tai chi chuan or shadow boxing instead of the strenuous physical exercise that will require much more physical efforts. The second type of treatment is through drugs. In the western medicine, the individualized choices of drug therapy include the following five major classes: diuretic, beta blocker, alpha blocker, calcium blocker, and angiotensin-converting enzyme inhibitors (ACEI). In the first class of diuretics, side effects

Hypertension: A Comparative Review

95

(a)
200

(b)
200

(c)
200

150

150

150

100
Magnitude

100

100

50

50

50

-50

-50

-50

-100 0 200 400 600

-100 0 200 400 600

-100 0 200 400 600

Time (sec)

Time (sec)

Time (sec)

Fig. 4. The increase of magnitude P in the radial arterial pulse: amplitudes of base point A coded in green, dicrotic notch V in red, percussion wave P in blue (a) before (b) during, and (c) after manual acupuncture at PC 6.

include a number of biochemical changes such as a decrease in plasma potassium, and increase in glucose, insulin, and cholesterol. The side effects of beta blockers during pregnancy include fetal growth retardation and various other problems. The calcium blocker will induce flushing and ankle edema. As to the ACEI, side effects are also abundant, such as rash, loss of taste, and leucopenia. It is my belief that the designs of these drugs are based on the fundamental misunderstanding of the etiology of hypertension and how the ANS works. According to our preliminary studies of micturition and storage of urine in rats, and acupuncture effects in humans, the sympathetic and parasympathetic systems of ANS are cooperative not antagonistic (3, 4, 7-10). Consequently, the drug designs using the concept of inhibition completely miss the point. On the other hand, the herbal medicine and acupuncture in TCM are based on a completely different philosophy as mentioned previously. It is the blood distribution among different parts of the body that is the utmost important thing, not the blood pressure at the outset. Moreover, it is believed that the visceral organs should work together cooperatively rather than antagonistically. For instance, the liver, spleen, kidney, heart and limbs all need blood flow while the total amount of blood volume is a constant. It is essential to distribute the right amount of blood to the right place at the right time. Due to the limited space of this paper, I will be concentrating on the

approach of acupuncture instead of the more involved herbal treatment in TCM. The philosophy of herbal treatment in TCM is basically the same as that of acupuncture. Let us look at the temporal changes of radial arterial blood flow, local impedance, and heart rate variability via the acupuncture at Neiguan (3-6, 11). The ECG data is also recorded so that we can correlate the HRV with ANS. From Figs. 4 and 5, it is clear that the amplitudes of mean radial arterial pressures denoted in red do not change very much after manual acupuncture at Neiguan. Yet, the blood flow or blood volume in blue can either increase in Fig. 4 or decrease in Fig. 5. Furthermore, we find out that the rise and fall of the blood flow in blue after acupuncture are negatively correlated with the impedances denoted in green. Notice here the interesting result that the increase of blood volume is actually achieved by a reduction of impedance in Fig. 4. Similarly, the decrease of blood flow is achieved by an elevation of impedance value in Fig. 5. By looking at the recordings of Figs. 4 and 5, it is clear that the blood flow and local impedances are random functions of space and time. They are the results of fractal wave theory of continuum as indicated in (3, 4, 11, 12). These results have confirmed again that the blood flows can be adjusted via acupuncture at Neiguan by changing their local impedances. In order to probe further, we can look at the HRV as shown in Fig. 6. In Fig. 6, the spectra of HRV before, during and

96

Chang

(a)
350 300 250 200

(b)
350 300 250 200 150 100 50 0 -50 -100 -150 0 200 400 0 200 400

(c)
350 300 250 200 150 100 50 0 -50 -100 -150 0 200 400

Magnitude

150 100 50 0 -50 -100 -150

Time (sec)

Time (sec)

Time (sec)

Fig. 5. The decrease of magnitude P in the radial arterial pulse: amplitudes of base point A coded in green, dicrotic notch V in red, percussion wave P in blue (a) before (b) during, and (c) after manual acupuncture at PC 6.

after acupuncture corresponding to Fig. 4 are exhibited. Significant changes are observed during and after acupuncture experiments. Recall the established fact that the LF range of HRV spectrum is governed by both sympathetic and parasympathetic nervous systems (1). The disappearance of the range of LF part after acupuncture indicates that the adjustment of blood pressures have invoked the mediation of the autonomic innervations of the heart through the sensory nerves. In the VLF range, the intensities are now more concentrated during and after acupuncture even though the power intensities are about the same. Hence, we are sure that the peripheral ANS is involved in the changes of HRV. However, the ratio of power in high frequency to that in low frequency is not able to distinguish sympathetic from parasympathetic activities (3-5). Hence, the claims in (1) cannot be reliably used in distinguishing the contributions from sympathetic or parasympathetic systems. Notice that there is an intrinsic paradox on the role played by HRV. As taught in the standard textbook of physiology that the function of parasympathetic nerves on heart is to inhibit the heartbeat, hence it has no rhythm by itself at all. If that is the case, then how one can say that the high (or low) frequency component of HRV is actually due to parasympathetic nerves. Obviously, the HRV analysis is not compatible with the orthodox teaching of the ANS functions in our standard physiology textbooks. The mechanism of acupuncture has been proposed in (3, 4, 11) recently. To explain how it can im-

(a)
400 350 300 250 200 150 100 50 0 0.05 0.1 0.15 0.2 0.25 0.3 0.35 0.4 0.45 0.5 40 35 30 25 20 15 10 5 0

Time (sec)

Frequency (Hz)

(b)
400 350 300 250 200 150 100 50 0 0.05 0.1 0.15 0.2 0.25 0.3 0.35 0.4 0.45 0.5 70 60 50 40 30 20 10

Time (sec)

Frequency (Hz)

(c)
400 350 300 250 200 150 100 50 0 0.05 0.1 0.15 0.2 0.25 0.3 0.35 0.4 0.45 0.5 90 80 70 60 50 40 30 20 10

Time (sec)

Frequency (Hz)

Fig. 6. The time-frequency analysis of HRV for the experiment in Fig. 4: (a) before (b) during, and (c) after manual acupuncture at Neiguan.

prove the blood distribution problem, it is believed that the injury current derived from the insertion of the needle will first change the impedances of neurovascular bundles. Then, based on a reticular meridian model of TCM, neurovascular standing

Hypertension: A Comparative Review

97

waves and traveling waves as in the theory of communication networks will propagate very fast in the body. Through the matching or mismatching of the impedances in the meridians with their associated visceral organs, proper blood flow can be adjusted and balanced. In the proposed mechanism, neurovascular bundles are designated as meridians and are treated as continua of fractal structures, the blood flow and nerve signals are treated as fractal wave motions. In other words, the essence of meridians and mechanism of acupuncture are interpreted via a socalled fractal wave theory of continuum.

Discussion and Conclusions

It is also found out that in our experiment that the central nervous system (CNS) has been activated at the same time from the synchronization result of brain alpha rhythms (3-5, 11). We have claimed that the lower frequency band (~0.2 Hz) of the brain waves may have to do with the parasympathetic system and the higher alpha band (8~12 Hz) with the sympathetic system. Another important point provided by the acupuncture experiment is that the synchronization of central brain waves, peripheral blood pressure changes, and associated HRV are exhibited almost instantly after De Qi which takes only about 15 to 30 sec. Figs. 4-6 have indicated such a dramatic rhythmic change over the whole human body within seconds. In other words, the afferent somatosensory input near the wrist can initiate neural response of the whole brain as indicated in (5) not just restricted to the somatosensory cortex. One has to believe that the brain is more likely to be hologramic rather than modularly organized. As we all know the brain contains more than 100 billion neurons and associated synapses, it is almost impossible to derive a feasible model based on synaptic connections that can explain the instantaneous effects of acupuncture. For if one wants to use a parallel model to describe the synchronization of neurons via synaptic transmission, the spatial integration of neurotransmitter release from these synapses will make the surface EEG look like random noise. On the other hand, if a serial model is applied, then it will take days or months instead of seconds to achieve synchronization of rhythms. As a result, models based on the neuron doctrine are either infeasible or impossible. As to the nerve fiber model of Hodgkin and Huxley in the generation of action potentials, the nerve is only capacitive and resistive in nature; it can never be inductive (15). According to our theory, the nerve fiber can never be impedance matched under such circumstances. As a result, the propagation of nerve signals in nerve fibers will always encounter reflection waves that will interfere with the incoming

nerve signals due to impedance mismatching. This is a very serious drawback and can only be resolved through our approach as in (3-5, 11). Moreover, the sodium and other membrane pumps in the ionic theory of action potentials will suffer from the insufficient energy to operate as mentioned in (3, 4). In this paper, we have reviewed the basic concepts, etiology, diagnosis and treatment of hypertension. We have also compared the differences between the approaches of mainstream medicine and traditional Chinese medicine. In particular, I have tried to emphasize that the blood distribution problem is more essential in dealing with hypertensive patients. It is hoped that this review will improve our understanding on the nature of hypertension and reduce the cost of our medical health systems.

Acknowledgments
This work was supported in part under the grant number NSC 99-2221-E-007-004 of the National Science Council in Taiwan.

References
1. Akselrod, S., Gordon, D., Ubel, F.A., Shannon, D.C., Berger, A.C. and Cohen, R.J. Power spectrum analysis of heart rate fluctuation: a quantitative probe of beat-to-beat cardiovascular control. Science 213: 220-222, 1981. 2. Braunwald, E. Heart disease. 6th edition W. B. Saunders Company, 2001. 3. Chang, S. Physiological rhythms, dynamical disease, and acupuncture. Chinese J. Physiol. 53: 72-90, 2010. 4. Chang, S. The rationale behind a reticular meridian model for Chinese acupuncture. Proceeding of the 4th International Conference on Bioinformatics and Biomedical Engineering (ICBBE), Chengdu, PRC, June 1-4, 2010. 5. Chang, S., Chang, Z.G., Li, S.J., Chiang, M.J., Ma, C.M., Cheng, H.Y. and Hsieh, S.H. Effects of acupuncture at Neiguan (PC 6) on electroencephalogram. Chinese J. Physiol. 52: 1-7, 2009. 6. Chang, S., Chao, W.L., Chiang, M.J., Li, S.J., Lu, Y.T., Ma, C.M., Cheng, H.Y. and Hsieh, S.H. Effects of acupuncture at Neiguan (PC 6) of the pericardial meridian on blood pressure and heart rate variability. Chinese J. Physiol. 51: 167-177, 2008. 7. Chang, S., Chiang, M.J., Li, S.J., Hu, S.J., Cheng, H.Y., Hsieh, S.H. and Cheng, C.L. The cooperative phenomenon of autonomic nervous system in urine storage. Chinese J. Physiol. 52: 72-80, 2009. 8. Chang, S., Hsyu, M.C., Cheng, H.Y. and Hsieh, S.H. Synergic coactivation of muscles in elbow flexion via fractional Brownian motion. Chinese J. Physiol. 51: 376-386, 2008. 9. Chang, S., Li, S.J., Chiang, M.J., Hu, S.J. and Hsyu, M.C. Fractal dimension estimation via spectral distribution function and its application to physiological signals. IEEE Trans. Biomed. Eng. 53: 1895-1898, 2007. 10. Chang, S., Li, S.J., Hu, S.J., Cheng, H.Y., Hsieh, S.H. and Cheng, C.L. Dynamic performance evaluation on the synergy of micturition in spinal cord-injured female rats under pharmacological effects. Chinese J. Physiol. 52: 81-92, 2009. 11. Chang, S. Dynamical system perspectives on the theoretical foundation of traditional Chinese medicine. Proceeding of the 5th International Conference on Bioinformatics and Biomedical Engineering (ICBBE), Wuhan, PRC, May 10-12, 2011.

98

Chang

12. Chang, S. Fractional Brownian motion and its increments as undulatory models. Proceeding of the 5th International Conference on Bioinformatics and Biomedical Engineering (ICBBE), Wuhan, PRC, May 10-12, 2011. 13. Cole, K.S. Membranes, Ions and Impulses. Berkeley: University of California Press, USA, 1968. 14. Guyton, A.C. and Hall, J.E. Textbook of Medical Physiology, 11th ed. Philadelphia: Elsevier Saunders, USA, 2006. 15. Hodgkin, A.L. and Huxley, A.F. A quantitative description of membrane current and its application to conduction and excitation in nerve. J. Physiol. 117: 500-544, 1952. 16. Kaplan, N.M. Acupuncture for hypertension: can 2500 years come to an end? Hypertension 48: 815, 2006. 17. Lee, H., Park, H.J., Park, J., Im, D.M., Blinder, R.A., Park, H.W. and Kaptchuk, T.J. Acupuncture application for neurological disorders. Neurol. Res. 29 (Suppl. 1): S49-S54, 2007.

18. Li, Z.Y., Wang, C.T., Mak, A.F.T. and Chow, D.H.K. Effects of acupuncture on heart rate variability in normal subjects under fatigue and non-fatigue state. Eur. J. Appl. Physiol. 94: 633-640, 2005. 19. Longhurst, J.C. Acupunctures beneficial effects on the cardiovascular system. Prev. Cardiol. 1: 21-33, 1998. 20. McDonald, D.A. Blood Flow in Arteries. Edward Arnold: London, UK, 1974. 21. Macklin, E.A., Wayne, P.M., Kalish, L.A., Valaskatgis, P., Thompson, J., Pian-Smith, M.C.M., Zhang, Q., Stevens, S., Goertz, C., Prineas, R.J., Buczynski, B. and Zusman, R.M. Stop hypertension with the acupuncture research program (SHARP): results of a randomized, controlled clinical trial. Hypertension 48: 838-845, 2006. 22. Pomeranz, B. and Stux, G. Scientific Basis of Acupuncture. Berlin, Germany: Springer-Verlag, 1989.