Measurement of Heart Rate Variability as an Interactive Determinate of the Autonomic Nervous System: Correlation With Chinese Medical Constitution.

全文

(1)167. Measurement of Heart Rate Variability as an Interactive Determinant of the Autonomic Nervous System: Correlation With Chinese Medical Constitution 1. 1. Yung-Hsien Chang, Chuang-Chien Chiu , Yan-Hong Chen Department of Acupuncture, China Medical College Hospital; 1. Department of Automatic Control Engineering, Feng Chia University, Taichung, Taiwan, R.O.C.. Background. The autonomic nervous system (ANS) is the major system controlling the visceral activities. ANS contains both sympathetic and parasympathetic function and coordinates the activity of a specific organ. In this study, we measured heart rate variability (HRV) as an interactive determinant of ANS, and correlated ANS functions with Chinese medical constitution. Methods. In this study we measured the patients' pulse rates and electrocardiography signals and then transformed the data into HRV ratios and spectral energy ratios to represent ANS functions. Three groups were studied in order to correlate HRV findings with the Chinese medical constitution. Healthy subjects were used as the control group (Yin-yang balance); patients in a vegetate state were categorized as being Yin-yang vacuity. Persons who were categorized as Yang vacuity in Chinese medical constitution. R e s u l t s . In the control group, the sympathetic HRV (LF) was 44.34 parasympathetic HRV (HF) was 50.36. 25.38. The ratio (LF/HF) was 0.92. 26.64, and the. 0.35. That is, LF was. balanced with HF, and the patient was considered to be in a homeostatic state. On the other hand, patients in a vegetate state had LF readings of 5.35. 1.12, and HF readings of 6.11. who were categorized as being Yang vacuity, had an average LF reading of 14.74. 2.53. Persons 1.01. Although. HF was within the normal range (60.46 40.32), the ratio between LF and HF was only 0.36 0.18. Conclusions. Our results provide useful information for the relationship between Chinese medical constitution and ANS activity. The procedure is non-invasive, and it could help physicians to make a reliable clinical diagnosis in the Chinese medicine constitution. ( Mid Taiwan J Med 2000;5:167-72 ). Key words autonomic nervous system, Chinese medical constitution, heart rate variability. INTRODUCTION. palpation. The patient's condition is then. Traditional Chinese medicine is a unique. categorized as being vacuity or repletion.. system that utilizes five diagnostic procedures:. Among these characters, the theory of Yin-. inspection, listening, smelling, inquiry, and. yang balance is the most important, and that Yin-yang imbalance in a patient would appear. Received : May 30, 2000.. Revised : July 3, 2000.. Accepted : July 18, 2000. Address reprint requests to : Yung-Hsien Chang, Department of. as a particular symptom requiring immediate medical attention. [1-3]. Interestingly, the. Acupuncture, China Medical College Hospital, No 2, Yuh-Der. symptom of Yin-yang imbalance is quite. Road, Taichung 404, Taiwan, R.O.C.. similar to the described effect of autonomic.

(2) 168. HRV as a Measurement of ANS. nervous. [3].. response of autonomic function was obtained. Physiologically, the main function of ANS is. system. (ANS). activity. by a resting test method. Before testing,. to coordinate the activities of internal organs,. subjects were examined by two respective. such as adjusting body temperature, blood. physicians for the detailed Chinese medical. pressure, heart rate, and endocrine output. The. Yin-yang constitution. Subjects were then laid. corresponding relationship between the ANS. quietly for 5 minutes while maintaining. activity and Chinese medical constitution. spontaneous breathing before the ECG. The. therefore deserves more attention.. subjects were not under the influence of. In this study, we will determine heart. alcohol, caffein or medicine. The test was. rate variability (HRV) and electrocardiograph. performed in the morning between 9:00 A.M.. (ECG) signals as an interactive determinant of. and 12:00 a.m. with controlled ambient. ANS, and then correlate ANS functions with. temperatures of 24 C.. Chinese medical constitution [4-11]. The. Physiological data were recorded by an. purpose of this study is to provide an. ECG recorder (Model FCP-2201, Fukuda. objective measure for characterizing the state. Denshi), and the signal was digitized by a 12-. of vacuity or repletion by using modern. bits A/D converter (Model Lab-PC-1200,. techniques to analyze ANS activities. Moreover,. National Instrument). The data acquisition and. the practice of traditional Chinese medicine. analysis programs were analyzed under the. could be coupled with modern medical. LabVIEW. Off-line analysis was performed on. diagnoses.. a personal computer [6]. The ECG signals were collected at 300 samples/sec. Each data file METHODS. contained nearly 350 points of R-R interval variability, and the QRS segment (ECG signal. Measurement and Analysis Thirty healthy subjects without evident. between QRS wave) [7] was used to. disease were used as a control group. Patients. characterize the QRS wave, from which the R. with obvious Chinese medical Yin-yang. wave can be located at the time axis by. constitution. into. selecting the suitable threshold. The standard. experimental groups. In addition to the. deviation of the R-R interval variability was. normal control group (Yin-yang balance), two. calculated by time-domain analysis and power. groups were further studied to correlate HRV. spectrum density (PSD) analysis [10]. The. findings. medical. spectrum range was restricted to within 0.04. constitution. Data collected from patients in. to 0.5 Hz in order to measure the autonomic. vegetate states was used as Yin-yang vacuity. function accurately [4-6, 8]. The low frequency. (n = 30). Persons who are frequently cold-. (LF) was determined to be between 0.04 Hz. extremities. and 0.15 Hz, and high frequency (HF) was. were. with. then. the. and. placed. Chinese. lack. of. energy. were. categorized as Yang vacuity in Chinese. determined to be between 0.15 Hz and 0.5 Hz.. medical constitution (n = 30). The other RESULTS. three types of Chinese medical Yin-yang Yang. Through the power spectrum density. repletion and Yin repletion, were categorized. method in frequency domain of heartbeat. according. of. (Fig. 1A), the difference in HRV could be. sympathetic and parasympathetic HRV.. visualized (Figs. 1B and C). The normal range. Nonetheless, because the number of cases in. of LF power in a person at a state of Yin-yang. each category was below five patients, the. balance was 44.34. data for the accurate prediction are under. was 50.36. evaluation. The. 0.35. The result indicated a balance between. electrocardiogram signal was continuously. sympathetic and parasympathetic functions as. captured by a computer, and the stability. depicted. constitution, to. in. Yin-yang the. an. repletion,. measured. ongoing. ratio. study.. 26.64, while the HF power. 25.38. The LF/HF ratio was 0.92. by. PSD. analysis. (Fig.. 2A)..

(3) Yung-Hsien Chang, et al.. 169. C. Time (sec). D. Time (sec). A. B. Time (ms). Fig. 1 Definition of power spectrum density regions, ECG spectrum and HRV profile. A: The regions of sympathetic and parasympathetic activities in PSD. B: Normal ECG spectrum. C: HRV profile of a normal person that represents Yin-yang balance. D: HRV profile of a patient at vegetate state that represents the extreme of Yin-yang vacuity.. Table 1. Comparison between parameters of Yin-yang balance and those of Yin-yang vacuity on mean of LF, HF, HRV and SD of HRV Parameter. Yin-yang balance (n = 30). LF HF SD of HRV (ms). 44.34 50.36 44.01. 26.64 25.38 10.64. p value. Yin-yang vacuity (n = 30) 5.35 6.11 20.52. 1.12 2.53 3.27. < 0.001 < 0.001 < 0.05. LF = low frequency power; HF = high frequency power; SD = standard deviation; HRV = heart rate variability.. Interestingly, LF/HF ratio in patients with Yin-. examples of Yin-yang repletion, Yang. 0.64. Nonetheless, LF. repletion and Yin repletion were respectively. 1.12, and HF was also low, at. shown in Figs. 2D to 2F. However, since the. 2.53 (Fig. 2B). Moreover, the standard. case number in each category was less than. deviation of the R-R interval variability in the. five, the data are being evaluated in an. time domain could demonstrate a significant. ongoing study. In terms of clinical parameters,. difference between Yin-yang balance and Yin-. no significant differences were found among. 10.64. groups that were divided by Chinese medical. yang vacuity was 1.13 was only 5.35 6.11. yang vacuity (Yin-yang balance: 44.01 ms, Yin-yang vacuity: 16.66. 3.36 ms) (Table 1).. The HRV standard deviation of person with Yang vacuity was 43.89 LF reading was 14.74 60.46. 11.03 ms, where the 1.01, and the HF was. 40.32. The ratio of LF/HF was 0.36. Yin-yang constitutions. In the Yin-yang balance group, the age was 24.0 height was 167.0. 3.4 years, the. 7.3 cm, the weight was 62.6. 8.0 kg, blood pressure was 109 mmHg, hear rate 71.5. 12/69. 9.6 beats/min, and 0.4 C. In Yin-. 0.18. Such data correlated well with our. body temperature was 36.6. hypothesis (Fig. 2C).. yang vacuity group, the age was 65.0. Besides these three conditions, other. 9. years, the blood pressure was 112. 21/74. 19.1 14.

(4) 170. HRV as a Measurement of ANS. A. Frequency (Hz). B. Frequency (Hz). C. Frequency (Hz). D. Frequency (Hz). E. Frequency (Hz). F. Frequency (Hz). Fig. 2 Power spectrum density analysis shows the significant difference among persons at various conditions of Chinese medical constitution. A: Normal control that represents Yin-yang balance. B: patient at vegetate state that represents the extreme of Yin-yang vacuity. C: PSD profile of a person with Yang vacuity. D: PSD profile of a person with Yin-yang repletion. E: PSD profile of a person with Yang repletion. F: PSD profile of a person with Yin repletion.. mmHg, hear rate 63.6. 6.9 beats/min, and. body temperature was 36.3 vacuity group, the age was 23.5 height was 161.0. 0.7 C. In Yang 2.6 years, the. 5.5 cm, the weight was 50.5. 4.3 kg, blood pressure was 112 mmHg, hear rate 66.0. 8/71. 6. 9.7 beats/min, and. body temperature was 36.1. 0.3 C. In Yang. repletion group (n = 5), blood pressure was.

(5) Yung-Hsien Chang, et al.. 102. 12/64. 171. 9 mmHg, hear rate 73.9. 3.8. AKNOWLEDGEMENT. beats/min, and body temperature was 36.5 0.2 C. In Yin repletion group (n = 4), blood pressure was 101 61.25. 9/65. This study was supported by the China Medical College Hospital (DMR-87-030).. 5 mmHg, hear rate. 9.8 beats/min, and body temperature. was 36.3. REFERENCES. 0.2 C. In Yin-yang repletion group 6.0. 1.. 11.0 beats/min, and. 2.. (n = 4), blood pressure was 112 mmHg, hear rate 65.4. body temperature was 36.5. 7/75. 0.8 C.. 1989 1990. 3. 1996. DISCUSSION. 4. Chiu, CC, Yeh SJ. The comparative study of ECG and finapres signals for the examination of autonomic. We used a non-invasive method to. nervous system, Proc Biomed Eng Soc 1997 Ann. evaluate the correlation of the autonomic nervous function with Chinese medicine Yin-. Symp, 1997:46-7. 5.. yang constitution. Our results showed that by. Med Biomed Eng 1995;15:47-58.. measuring R-R interval variability from ECG, the PSD analysis could differentiate Yin-. 6.. thesis. Institute of Automatic Control Engineering,. difference is quite significant (p < 0.05). Such analytic method to monitor the Yin-yang modulation or to follow the regulation of physiological activity is feasible. Our findings provide useful information confirming the. Lin RC. The study on data acquisition and analysis system for noninvasive physiological signals. Master. symptom from Yang-symptom easily. The results also suggest that utilizing a PSD. Chiu CC, Yeh SJ, Lin RC. Data acquisition and validation analysis for finapress signals. Chinese J. Feng Chia Univ, 1996. 7.. Tompkins WJ, Pan J. A real-time QRS detection algorithm. IEEE Trans Biomed Eng 1985;32:230-6.. 8. Tepperman J. Heart rate variability physician's guide, 2nd edition, Marquette Electronics, 1995:1-35. 9. Yeh SJ. The autonomic nervous disease and clinical examinations. China Med Ass 1996;39:45-9.. relationship between autonomic nervous. 10. Pomeranz B, Macaulay RJ, Caudill MA, et al.. activity and Chinese medicine constitution.. Assessment of autonomic function in humans by. The principle could be applied clinically not. heart rate spectral analysis. Am J Physiol 1985;248(1. only to make a reliable diagnosis in Chinese medicine constitution, but also to replenish the adequate remedy for patients in need.. Pt 2):H151-3. 11. DeBoer RW. Comparing spectra of a series of points events particularly for heart rate variability data. IEEE Trans Biomed Eng 1984;31:384-7..

(6) 172. 1. 1 1. 44.34 50.36 1.12. HF. 25.38. 6.11. 0.92. 0.35. 2.53 60.46. 40.32. 2000;5:167-72. 5/30/2000 7/18/2000. LF LF. HF. 404. 26.64. 2 7/3/2000. 14.74 0.36. 1.01. 0.18. 5.35.

(7)