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Effect of Laser Acupuncture on Heart Rate Variability of Nonpatients and Patients with Spinal Cord Injury
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MODEL
J Acupunct Meridian Stud 2016;--(-):--e--
Available online at www.sciencedirect.com
Journal of Acupuncture and Meridian Studies journal homepage: www.jams-kpi.com
BRIEF CASE REPORT
Effect of Laser Acupuncture on Heart Rate Variability of Nonpatients and Patients with Spinal Cord Injury Yiu Ming Wong* Health Science Unit (PEC), Hong Kong Physically Handicapped & Able Bodied Association, Sham Shui Po, Kowloon, Hong Kong Available online - - -
Received: Aug 11, 2016 Revised: Oct 19, 2016 Accepted: Nov 15, 2016 KEYWORDS acupuncture; heart rate variability; laser; spinal cord injury
Abstract Sensory loss in a complete spinal cord injury (SCI) can be described as an injury that removes the ability of the brain to receive electrical afferent signals generated below the site of the injury. The sensory nervous system appears to be the same as the meridians in the concept of Oriental medicine, thus, we assumed that a complete SCI would lead to discontinuation of the meridians in humans. In this case series report with a crosssectional view, we observed quantitative changes in heart rate variability induced by laser acupuncture at bilateral GB34 and ST36 points for 15 minutes in eight patients with complete SCIs between the levels of T8 and T12, and eight healthy individuals as a control group. A comparison between pre- and post-treatment data demonstrated that the physiological effect on the heart rate variability was absent when the laser acupuncture was applied below the level of injury among the patients with complete SCI, while the healthy counterparts showed the opposite pattern. The preliminary data suggest that the purported meridian system may not be different from the known sensory nervous system, as the transected spinal cord leads to interrupted meridians. The findings in the present case series warranted further investigation.
This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http:// creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. * Corresponding author. Health Science Unit (PEC), Hong Kong Physically Handicapped & Able Bodied Association, S102, G/F, Lai Lo House, Lai Kok Estate, Sham Shui Po, Kowloon, Hong Kong. E-mail: [email protected]. pISSN 2005-2901 eISSN 2093-8152 http://dx.doi.org/10.1016/j.jams.2016.11.004 Copyright ª 2016, Medical Association of Pharmacopuncture Institute. Please cite this article in press as: Wong YM, Effect of Laser Acupuncture on Heart Rate Variability of Nonpatients and Patients with Spinal Cord Injury, Journal of Acupuncture and Meridian Studies (2016), http://dx.doi.org/10.1016/j.jams.2016.11.004
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MODEL
2
Y.M. Wong
1. Introduction
3. Discussion
Acupuncture is described as an energy-based model of therapy that an energy named ‘‘qi’’ travels through the body along internal channels called ‘‘meridians,’’ with the ‘‘acupuncture points’’ located along the meridians. Theoretically, qi obstructions in the meridians cause diseases in the body, and acupuncture practitioners, by massaging or needling the acupuncture points, can enhance the flow of qi and restore physical wellbeing [1]. The physical existence of the meridians, however, is highly debatable; Longhurst [2] stated that the sensory nervous system is the same as the meridians in the concept of Oriental medicine. Kim [3] found that anatomical structures named the primo vascular system could be direct and visual evidence of the meridians. The primo vascular system has been traced in the subarachnoid space of the spinal cord in animal models [4], therefore, we assumed that a complete spinal cord injury (SCI) would lead to a discontinuation of the meridians in humans. In the following report, we offer preliminary data regarding the above assumption.
The present report preliminarily demonstrated that the physiological effect on HRV was absent when laser acupuncture was applied below the level of injury among the patients with complete SCI; the healthy counterparts showed the opposite pattern. The findings suggest that the purported meridian system may not be different from the known nervous system, as the transected spinal cord leads to interrupted meridians. However, other cause-and-effect phenomena of acupuncture stimulation for SCI patients remain unknown until future data are available, such as electroencephalography and functional magnetic resonance imaging. This report also reinforces that HRV could be used as a tool in acupuncture research and practice for quantifying physiological responses and treatment effectiveness.
2. Case Presentation In our outpatient clinic, we routinely measured heart rate variability (HRV) of neurologically impaired patients using a physiological measurement system (FlexComp; Thought Technology Ltd., Montreal, QC, Canada), while they performed rehabilitation exercises or received acupuncture. We used a commonly used parameter of HRV named the RR interval (intervals between consecutive R waves in electrocardiography), because the RR interval has been used as a biomarker for outcome measures of acupuncture therapy [5e7]. Basically, a longer RR interval is associated with greater parasympathetic dominance and is more desirable during or after acupuncture [8]. Sixteen male adults were involved in the present report: eight were healthy volunteers and eight were without detectable motor and sensory functions below the levels of SCI between T8 and T12. Both groups had a comparable age range between 24 years and 52 years. Under 660 nme50 mV laser acupuncture (Konftec, New Taipei City, Taiwan) on the bilateral GB34 and ST36 points for 15 minutes, the healthy individuals responded by producing significant changes in RR interval (Pre-treatment Z 842 63 milliseconds, Post-treatment Z 992 85 milliseconds; p < 0.05 in paired t test). The SCI patients, however, produced nonsignificant changes in RR interval (Pre-treatment Z 920 76 milliseconds, Post-treatment Z 939 101 milliseconds; p > 0.05 in paired t test).
4. Disclosure statement The author declares that he has no conflicts of interest and no financial interests related to the material of this manuscript.
References [1] Veith I. Acupuncture in traditional Chinese medicinedan historical review. Calif Med. 1973;118:70e79. [2] Longhurst JC. Defining meridians: a modern basis of understanding. J Acupunct Meridian Stud. 2010;3:67e74. [3] Kim HG. Formative research on the primo vascular system and acceptance by the Korean scientific community: the gap between creative basic science and practical convergence technology. J Acupunct Meridian Stud. 2013;6:319e330. [4] Moon SH, Cha R, Lee M, Kim S, Soh KS. Primo vascular system in the subarachnoid space of the spinal cord of a pig. J Acupunct Meridian Stud. 2012;5:226e233. [5] Wang G, Tian Y, Jia S, Zhou W, Zhang W. Acupuncture regulates the heart rate variability. J Acupunct Meridian Stud. 2015;8: 94e98. [6] Nishimoto T, Ishikawa T, Matsumoto K, Fujioka A. Efficacy of acupuncture treatment in autonomic ataxia. Am J Chin Med. 1987;15:133e138. [7] Anderson B, Nielsen A, McKee D, Jeffres A, Kligler B. Acupuncture and heart rate variability: a systems level approach to understanding mechanism. Explore (NY). 2012;8: 99e106. [8] Berntson GG, Bigger Jr JT, Eckberg DL, Grossman P, Kaufmann PG, Malik M, et al. Heart rate variability. origins, methods, and interpretive caveats. Psychophysiology. 1997;34: 623e648.
Please cite this article in press as: Wong YM, Effect of Laser Acupuncture on Heart Rate Variability of Nonpatients and Patients with Spinal Cord Injury, Journal of Acupuncture and Meridian Studies (2016), http://dx.doi.org/10.1016/j.jams.2016.11.004
MODEL
J Acupunct Meridian Stud 2016;--(-):--e--
Available online at www.sciencedirect.com
Journal of Acupuncture and Meridian Studies journal homepage: www.jams-kpi.com
BRIEF CASE REPORT
Effect of Laser Acupuncture on Heart Rate Variability of Nonpatients and Patients with Spinal Cord Injury Yiu Ming Wong* Health Science Unit (PEC), Hong Kong Physically Handicapped & Able Bodied Association, Sham Shui Po, Kowloon, Hong Kong Available online - - -
Received: Aug 11, 2016 Revised: Oct 19, 2016 Accepted: Nov 15, 2016 KEYWORDS acupuncture; heart rate variability; laser; spinal cord injury
Abstract Sensory loss in a complete spinal cord injury (SCI) can be described as an injury that removes the ability of the brain to receive electrical afferent signals generated below the site of the injury. The sensory nervous system appears to be the same as the meridians in the concept of Oriental medicine, thus, we assumed that a complete SCI would lead to discontinuation of the meridians in humans. In this case series report with a crosssectional view, we observed quantitative changes in heart rate variability induced by laser acupuncture at bilateral GB34 and ST36 points for 15 minutes in eight patients with complete SCIs between the levels of T8 and T12, and eight healthy individuals as a control group. A comparison between pre- and post-treatment data demonstrated that the physiological effect on the heart rate variability was absent when the laser acupuncture was applied below the level of injury among the patients with complete SCI, while the healthy counterparts showed the opposite pattern. The preliminary data suggest that the purported meridian system may not be different from the known sensory nervous system, as the transected spinal cord leads to interrupted meridians. The findings in the present case series warranted further investigation.
This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http:// creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. * Corresponding author. Health Science Unit (PEC), Hong Kong Physically Handicapped & Able Bodied Association, S102, G/F, Lai Lo House, Lai Kok Estate, Sham Shui Po, Kowloon, Hong Kong. E-mail: [email protected]. pISSN 2005-2901 eISSN 2093-8152 http://dx.doi.org/10.1016/j.jams.2016.11.004 Copyright ª 2016, Medical Association of Pharmacopuncture Institute. Please cite this article in press as: Wong YM, Effect of Laser Acupuncture on Heart Rate Variability of Nonpatients and Patients with Spinal Cord Injury, Journal of Acupuncture and Meridian Studies (2016), http://dx.doi.org/10.1016/j.jams.2016.11.004
+
MODEL
2
Y.M. Wong
1. Introduction
3. Discussion
Acupuncture is described as an energy-based model of therapy that an energy named ‘‘qi’’ travels through the body along internal channels called ‘‘meridians,’’ with the ‘‘acupuncture points’’ located along the meridians. Theoretically, qi obstructions in the meridians cause diseases in the body, and acupuncture practitioners, by massaging or needling the acupuncture points, can enhance the flow of qi and restore physical wellbeing [1]. The physical existence of the meridians, however, is highly debatable; Longhurst [2] stated that the sensory nervous system is the same as the meridians in the concept of Oriental medicine. Kim [3] found that anatomical structures named the primo vascular system could be direct and visual evidence of the meridians. The primo vascular system has been traced in the subarachnoid space of the spinal cord in animal models [4], therefore, we assumed that a complete spinal cord injury (SCI) would lead to a discontinuation of the meridians in humans. In the following report, we offer preliminary data regarding the above assumption.
The present report preliminarily demonstrated that the physiological effect on HRV was absent when laser acupuncture was applied below the level of injury among the patients with complete SCI; the healthy counterparts showed the opposite pattern. The findings suggest that the purported meridian system may not be different from the known nervous system, as the transected spinal cord leads to interrupted meridians. However, other cause-and-effect phenomena of acupuncture stimulation for SCI patients remain unknown until future data are available, such as electroencephalography and functional magnetic resonance imaging. This report also reinforces that HRV could be used as a tool in acupuncture research and practice for quantifying physiological responses and treatment effectiveness.
2. Case Presentation In our outpatient clinic, we routinely measured heart rate variability (HRV) of neurologically impaired patients using a physiological measurement system (FlexComp; Thought Technology Ltd., Montreal, QC, Canada), while they performed rehabilitation exercises or received acupuncture. We used a commonly used parameter of HRV named the RR interval (intervals between consecutive R waves in electrocardiography), because the RR interval has been used as a biomarker for outcome measures of acupuncture therapy [5e7]. Basically, a longer RR interval is associated with greater parasympathetic dominance and is more desirable during or after acupuncture [8]. Sixteen male adults were involved in the present report: eight were healthy volunteers and eight were without detectable motor and sensory functions below the levels of SCI between T8 and T12. Both groups had a comparable age range between 24 years and 52 years. Under 660 nme50 mV laser acupuncture (Konftec, New Taipei City, Taiwan) on the bilateral GB34 and ST36 points for 15 minutes, the healthy individuals responded by producing significant changes in RR interval (Pre-treatment Z 842 63 milliseconds, Post-treatment Z 992 85 milliseconds; p < 0.05 in paired t test). The SCI patients, however, produced nonsignificant changes in RR interval (Pre-treatment Z 920 76 milliseconds, Post-treatment Z 939 101 milliseconds; p > 0.05 in paired t test).
4. Disclosure statement The author declares that he has no conflicts of interest and no financial interests related to the material of this manuscript.
References [1] Veith I. Acupuncture in traditional Chinese medicinedan historical review. Calif Med. 1973;118:70e79. [2] Longhurst JC. Defining meridians: a modern basis of understanding. J Acupunct Meridian Stud. 2010;3:67e74. [3] Kim HG. Formative research on the primo vascular system and acceptance by the Korean scientific community: the gap between creative basic science and practical convergence technology. J Acupunct Meridian Stud. 2013;6:319e330. [4] Moon SH, Cha R, Lee M, Kim S, Soh KS. Primo vascular system in the subarachnoid space of the spinal cord of a pig. J Acupunct Meridian Stud. 2012;5:226e233. [5] Wang G, Tian Y, Jia S, Zhou W, Zhang W. Acupuncture regulates the heart rate variability. J Acupunct Meridian Stud. 2015;8: 94e98. [6] Nishimoto T, Ishikawa T, Matsumoto K, Fujioka A. Efficacy of acupuncture treatment in autonomic ataxia. Am J Chin Med. 1987;15:133e138. [7] Anderson B, Nielsen A, McKee D, Jeffres A, Kligler B. Acupuncture and heart rate variability: a systems level approach to understanding mechanism. Explore (NY). 2012;8: 99e106. [8] Berntson GG, Bigger Jr JT, Eckberg DL, Grossman P, Kaufmann PG, Malik M, et al. Heart rate variability. origins, methods, and interpretive caveats. Psychophysiology. 1997;34: 623e648.
Please cite this article in press as: Wong YM, Effect of Laser Acupuncture on Heart Rate Variability of Nonpatients and Patients with Spinal Cord Injury, Journal of Acupuncture and Meridian Studies (2016), http://dx.doi.org/10.1016/j.jams.2016.11.004