| Panic disorder is an acute anxiety disorder characterized by panic attacks, which is the significant recurring heart palpitations, sweating, tremors and other autonomic symptoms, accompanied by a strong sense of impending doom or a sense of loss of control, and feared of unfortunate consequences. The discussions about panic, fear in in traditional Chinese Medicine and the later books suggest that fear is human beings emotional reaction, and belongs to instinctive, single basic emotions for human beings. Fear is the most harmful and strong effect negative emotion. The mental vibrations produced by intense fear will threaten people’s lives. The intense and prolonged fear of the individual will produce stress reaction. While the stress response on the one hand is related to individual adaptive response, on the other hand is also closely related to many diseases. Emotional disorders often accompanied with autonomic nervous system symptoms, and psychosomatic diseases are considered closely related to emotional factors. Accordingly, this study put forward that acupuncture may improve the plant nerve function disorder caused by the panic, and the mechanism is related to that heart rate and heart rate variability are affected.Recently, clinical observations suggest that acupuncture can relieve and control panic disorder. Xi Wu etc observed that multi-direction needling of Neiguan not only can improve shortness of breath, chest pain and other discomfort, especially quickly relieve sense of impending doom, the non- reality of non- self and other emotional disorders, but also have a good effect of autonomic nerve function related headache, dizziness, nausea, sweating, chills and hot flashes. It has been reported that acupuncture effect is closely related to autonomic functions. It achieve efficacy by regulating autonomic balance, improving HRV and adjusting the heart rate.Heart rate variability (HRV), which refers to the tiny fluctuation during continuous heartbeat, is measured by R-R period of dynamic electrocardiogram to obtain information about the heart rhythm control. It is the index reflect tension and balance between sympathetic and vagus nerve. Indices of HRV are abundant, including the time domain indices, frequency domain indices and nonlinear indices. The time domain indices comprise SDNN, RMSSD, and HRV triangular index. The frequency domain indices include VLF, LF, HF, LF/HF. These indicators are of guiding significance to the autonomic nerve. For instance, HF is mediated by the vagus nerve, and influenced by respiratory activity. LF is considered to be a marker of sympathetic nerve activity. Moreover, LF/HF quantifies the equilibrium state of sympathetic nerve and vagus nerve. Detection of heart rate variability is noninvasive, easy to fit volunteers, its detection index are not only rich, but also the quantitative indicators to facilitate analysis. At present, heart rate variability is the only sensitive indicator, which can quantitative assess cardiac autonomic tension, balance and its impact on cardiovascular events. HRV is widely used in clinical studies, including the cardiovascular system and diabetes, and many other non-cardiovascular diseases. Furthermore, it has been more and more applied to study on the central regulation of autonomic nervous state, and the fundamental link between the psychological process and physiological functions, and cognitive development estimation.In recent years, the preliminary study found that different acupuncture methods could reduce sympathetic activity, and increase vagal tone, as well as regulate the balance of sympathetic nerve and vagus nerve. Acupuncture increased HRV, so that it could reduce the probability of different diseases, especially cardiovascular and cerebrovascular disease and improve the prognosis.Motherland medicine thinks that Neiguan(PC6)and Jianshi(PC5)are the points of the Pericardium Meridian of Hand-Jueyin, which can treat heart and vessel related diseases. In recent years, the public scholars studied the cardiac-related of PC6 and PC5 from the clinical, morphological and other aspects. Acupuncture may improve autonomic dysfunction caused by panic, and its mechanism is related to the heart rate and heart rate variability affected. Heart rate variability is the only sensitive indicator, which can quantitative assess cardiac autonomic tension, balance and its impact on cardiovascular events. Many studies indicated that there was a close link between PC6, PC5 and heart. These could be the theoretical basis for acupuncture on PC6, PC5 treating heart disease.In summary, this study simulated panic state, and the volunteers within panic state received electro-acupuncture stimulation of PC6 and PC5. We use Actiheart ECG recorder to record of the continuous ECG on the entire electro-acupuncture process, and analyze variation of cardiac autonomic nervous. Thus, the examination preliminary investigated the effects of electro-acupuncture PC6-Neiguan and PC5-Jianshi points on heart rate and heart rate variability in fear emotion, moreover, explored the underlying mechanism.[Objective] To investigate the effects of electro-acupuncture PC6-Neiguan and PC5-Jianshi points on heart rate and heart rate variability in fear emotion.[Methods] In order to try to get the actual impact of the fear emotion on heart rate and heart rate variability, we chose a single channel auditory stimulation; so that the volunteer’s attention focused on stimulating material as possible, so as to better induce a state of fear. Terrorist audio validation had been carried out in the early experiment. One hundred and twenty volunteers were randomly allocate to acupuncture and control groups with 60 in each. After 20 min frightening audio stimulation, volunteers in acupuncture group received electro-acupuncture PC6 and PC5 for 20 min and continued to repose for 20min after withdrew the needles. Volunteers in control group reposed 40min in the waking state. The heart rate and heart rate variability of each subject was recorded during the whole process through Actiheart. We directed the subjects fill out emotional self evaluation table after unloading machines.[Results] 1. According to statistics, basic information including sex ratio, age, height, body weight, BMI, heart rate before test and horror self-assessment, were not obvious differences, which have become comparable between the two groups.2. The trial included the volunteers who produced changes of emotional state of fear during the listening period (fear self-assessment> 0). The data was divided into two parts, rate rise and decreased or unchanged parts, after listening to audio and analyzed respectively. (1) Under the heart rate rising part:compared to that of listening period, the average heart rate, HF, LF/HF of the post listening period were statistically significant (P<0.05) between different intervention groups, while SDNN, SDANN, RMSSD, VLF, LF, HRVindex were not statistically significant (P >0.05). Compared to that of listening period, the average heart rate, SDNN, SDANN, RMSSD, VLF, LF, HF, LF/HF, HRV index in intervention were not statistically significant (P>0.05). (2) Under the condition of heart rate decreasing or unchanging parts:compared to that of listening period, the average heart rate, SDNN, SDANN, RMSSD, VLF, LF, HF, LF/HF, HRV index of the post listening period were not statistically significant (P>0.05) between different intervention groups. Compared to that of listening period, the average heart rate, RMSSD, HF in intervention were statistically significant (P<0.05) between two groups, while SDNN, SDANN, VLF, LF, LF/HF, HRV index were not statistically significant (P> 0.05).[Conclusions] (1) Electro-acupuncture PC6 and PC5 have the immediate regulating on heart rate and heart rate variability, which can regulate the heart rate rises caused by panic, as a result of heart rate decreases. Accordingly, the vagus nerve is activated so that it becomes the dominant of sympathetic-vagal balance.(2) Electro-acupuncture PC6 and PC5 has the post effects on heart rate and heart rate variability, which can regulate the heart rate decreases caused by panic, and bring about decreasing the heart rate decline consequently. Correspondingly, the vagus nerve is repressed, and its tension is reduced.(3) Electro-acupuncture PC6 and PC5 has bidirectional regulations of the plant nerve function disorder caused by fear, which can treat diseases through excitatory or inhibitory vagus nerve function.(4) The vagus nerve of the post listening period is suppressed under the condition of heart rate decreasing or unchanging, instead of the heart rate drop. This reason is related to heart rate affected by many factors.(5) In this study, SDNN, SDANN, VLF, LF did not change significantly, which may be related to shortages, including large individual differences in heart rate variability, and that many factors affect heart rate reflex, along with the impact of environmental factors difficult to avoid, as well as the sample size is still small.However, the sample size of the experiment is still small, and the VLF, ULF band, which accounted for most of the energy of the power spectrum of HRV, failed to carry out a full analysis. Thus, the results represent the data of this experiment and instrument measured alone. In addition, heart rate variability in the present study is not sufficient, and the physiological significance indexes have not been fully revealed. The analysis of HRV in this experiment only base on current research findings. Secondly, most recent detection techniques of HRV are linear analysis, which do not really react the body’s nonlinear physiological changes. The next step is to learn and improve the analytical methods of engineering technique, and increase the sampling frequency, as well as to extract the effective information, in order to dissect the VLF, ULF band clearly. If conditions permit, we will further increase the sample size and repeat interrelated experiments in different populations to verify the conclusions. Or, we make use of other HRV instruments to combine linear and nonlinear analysis methods, with the aim of going deep into the HRV variation of autonomic nervous system activity. |
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